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Orofacial manifestations and seroprevalence of HIV infection in Namibian dental patients.

SUBJECTS AND METHODS: In an anonymous study of HIV-I sero-reactivity in dental patients in a Government clinic in Namibia, 29 (7%) out of 405 patients (10 female and 19 male) were confirmed as HIV-infected. HIV-antibody testing was done cheaply and conveniently by collecting and storing finger-prick blood on absorbent paper, and eluting the samples 7 weeks later. Testing was done by GACPAT, a simple, inexpensive temperature independent assay which requires no specialised equipment. RESULTS AND CONCLUSIONS: Six patients had orofacial lesions, including Kaposi's sarcoma, leukoplakia (bilateral on buccal mucosa), cervical lymphadenopathy, hairy leukoplakia, circum-oral herpes simplex, HIV-gingivitis and necrotising ulcerative gingivitis. This sampling and testing system is well suited for use in epidemiological surveys in developing countries.

AIDS Serodiagnosis↗

Changes in alcohol involvement, cognitions and drinking and driving behavior for youth after they obtain a driver's license.

OBJECTIVE: This study tested whether obtaining a driver's license was associated with increases in alcohol and other drug involvement and changes in alcohol-related cognitions for youth, and whether drinking and driving behavior increased with driving experience. METHOD: Confidential, anonymous surveys were conducted at two time points (fall, spring) with students at four high schools in San Diego county (N = 2,865, 51% female). Data were collected on alcohol, cigarette and marijuana use, license status, alcohol use by peers, attitudes towards drinking and driving and drinking and driving behaviors. RESULTS: Nondrivers (60%), new drivers (obtained a license between Time 1 and Time 2) and experienced drivers (26%) were compared on study variables at both time points and over time. Initially obtaining a driver's license was associated with increased frequency of substance use. Results were not significant for quantity of alcohol use, frequency of heavy drinking or perceived alcohol use norms. Attitudes towards drinking and driving reflected an increase in the perceived dangerousness of this behavior for new drivers. Drinking and driving behavior during the last 30 days increased with increased driving experience. CONCLUSIONS: The results indicate a number of changes in substance involvement after obtaining a driver's license. However, initially this transition may also indicate a period of protection against drinking and driving. These results may have implications for the target and content of drinking and driving interventions.

Adolescent↗

Ego-integrity versus ego-despair: the effect of "accepting the past" on depression in older women.

The relative strength of the later-life personality process of ego-integrity, as operationalized by "accepting the past," was tested as a predictor of depression in a multivariate model containing other well established predictors-age, social support, physical dependency, and positive and negative affectivity. Seventy-three older Australian women living in supported accommodation completed an anonymous, self-report questionnaire. The results showed that "accepting the past" was a significant predictor in the multivariate model, along with social support, physical dependency, and positive affectivity. The results are discussed in terms of the utility of investigating later-life personality processes as potential interventions for alleviating depression in older people.

Adaptation, Psychological↗

[Dental care frequency of female patients in the Netherlands].

OBJECTIVE: Investigate whether there are differences between men and women in dental attendance and in the consumption of dental care. DESIGN: Descriptive analysis, using SPSS (ANOVA, NPAR TEST), based on information on the treatments that are performed for dentate patients. SETTING: Department of Research (afd. O&I) of the Dutch Dental Association (NMT), Nieuwegein, The Netherlands. METHODS: From the practice-administration of 202 dentists, anonymous information was gathered on the treatments these dentists performed for 7698 dentate patients in the years 1993 to 1996. RESULTS: The results indicate that for young people there is only a difference in relation to fillings: girls receive fewer fillings than boys. For adults, however, more differences are apparent. First of all, women visit the dentist for a routine check-up somewhat more often than men. In addition, more X-rays are taken, more instruction is given on oral hygiene and more crowns are made for women, while they receive fewer fillings. CONCLUSION: Adult women and adult men show differences in dental attendance and consumption. These differences are, albeit partially, explained by the fact that adult women are proportionally more often insured for dental costs via the national health service.

Adult↗

[Patient confidence in health care].

The aim of the study was to evaluate patient confidence in organization of health care and health care policy. The study material was gathered using self-administrated anonymous questionnaire in November-December, 2001. The patients were recruited from therapeutic departments of Kaunas 2nd hospital and Alytus S. Kudirka hospital. The data was analyzed using Microsoft Excel and SPSS program data package. Chi-square test was used to compare observed results with expected results. The hypothesis was statistically significant at the p<0.05. More patients in Alytus hospital (31%) than in Kaunas hospital (22%) predicated as being non-confident in health care policy. Statistical significant difference between patients of two hospitals was obtained comparing opinion about health care reform. Alytus S. Kudirka hospital patients were more optimistic about health care reform than patients in Kaunas hospital. Thirty percent of patients in Alytus hospital and 19% in Kaunas hospital were confident that reform has improved their treatment (p<0.05). More patients in Kaunas hospital (22%) than in Alytus hospital (9%) confirmed that health care reform aggravated their treatment. The majority of Alytus hospital patients (62%) and 40% of Kaunas hospital patients were satisfied with health care services. More than half respondents were not confident in health care system but they trusted physicians. Gender and education level had impact on patient confidence in health care. The most part of the respondents were satisfied with health care in hospital. More patients in Alytus hospital compared with Kaunas hospital patients confirmed that they did not trust health care policy, however were more satisfied with health care reform and services in hospital.

Adult↗

Study shows 12-hour shifts increase errors.

--Anonymity was key in ensuring candid reportinc of errors and near-errors. --The likelihood of making an error increases as the total number of hours worked increases. --The data are to be used for pilot study to test a fatigue countermeasures program.

Fatigue↗

[Prevalence and a drug use development model for the study of adolescent drug use in Japan].

The purposes of this study were to estimate the prevalence of drug use, to examine the correlation between drug use and drinking/smoking in Japan, and to test a developmental model of adolescents' drug use based on three basic theories of deviance: Strain, Social control, and Differential association. The survey was conducted from April to May, 1996, in 14 public high schools in Tokyo, using anonymous self-reporting. A total of 4,171 (99.45%) students responded to our questionnaire. It included central concept items in the three deviant theories, beliefs about the ill effects of drugs, sex, grades, etc. The following findings were obtained: 1) Among the subjects, 255 students (6.1%) reported drug use within the past year. Of these drug users, 73.3% used drugs soon after being "tempted" by friends. Responding to "When was it.", as a first year junior high school was the most common first experience, and the next most common was during the sixth year of elementary school. 2) Drinking and smoking appeared to be gateway drugs for adolescents in Japan as has been shown in the United States. 3) Multiple regression and logistic multiple regression analyses suggested that differential association variables were far more powerful predictors of adolescent drinking, smoking and drug use than either the control or strain variables. Results provided modest support for the Differential Association Theory as an explanation of drug use. 4) LISREL's goodness-of-fit statistic indicated a much better fit between the model and the data. (CN: 282, GFI: 0.967, AGFI: 0.941). These findings show two processes by which adolescents become involved in drug use. Strain and Social Control do not directly affect drug use. However, Social Control is important because it works indirectly, through Differential Association resulting in drug use. Second, though weaker, Differential Association appears to lead to dangerous beliefs in drug use followed by actual drug use.

Adolescent↗

Reduced substance-abuse-related health care costs among voluntary participants in Alcoholics Anonymous.

OBJECTIVE: This study examined differences in outcomes, alcoholism treatment utilization, and costs between alcoholic individuals with no previous treatment history who chose to attend Alcoholics Anonymous (AA) or to seek help from a professional outpatient alcoholism treatment provider. METHODS: Participants in this three-year prospective study were recruited at alcoholism information and referral services and at detoxification units in the San Francisco Bay Area. Chi square and t tests and repeated-measures analyses of variance were used to examine data gathered from interviews with 201 participants at baseline and at one and three years. RESULTS: At baseline, participants who chose to attend AA meetings (N = 135) were not significantly different from those who chose professional outpatient treatment (N = 66) in sex, marital status, employment, race, and symptoms of alcohol dependence and depression. However, AA attendees had lower incomes and less education and experienced more adverse consequences of drinking at baseline than did those who sought outpatient care, suggesting somewhat worse prognoses for the AA group. Over the three-year study, per-person treatment costs for the AA group were 45 percent (or $1,826) lower than costs for the outpatient treatment group. Despite the lower costs, outcomes for the AA group at both one and three years were similar to those of the outpatient treatment group. CONCLUSIONS: Voluntary AA participation may significantly reduce professional treatment costs. Clinicians, researchers, and policymakers should recognize the potential health care cost offsets offered by AA and other self-help organizations.

Adult↗

A screen of candidates from peaks of linkage: evidence for the involvement of myeloperoxidase in multiple sclerosis.

We tested 11 microsatellite markers for evidence of transmission distortion in 744 trio families with multiple sclerosis. Ten of the markers lie within or near to candidate genes selected on the basis that they map within the regions of potential linkage identified in our previously reported linkage genome screen, while the eleventh is an anonymous marker which had previously shown modest evidence for transmission distortion in our sibling pair families. Only the marker related to the myeloperoxidase (MPO) gene revealed tentative evidence for linkage disequilibrium and further work on this gene is clearly needed in order to resolve the status of this region in conferring susceptibility to multiple sclerosis.

Adult↗

Diagnosis of urogenital Chlamydia trachomatis infections by home-obtained, mailed samples: do we need a telephone hotline for information and advice?

This study evaluates the use of dedicated telephone hotlines to provide advice to young individuals who were offered the chance to be tested for Chlamydia trachomatis by means of home-obtained samples that were mailed directly to a testing laboratory. In a school-based screening study, a population-based screening study and a partner-tracing study we established hotlines and registered the calls. The target groups for the 3 studies comprised 8,909, 9,000 and 4,622 individuals and 0.1% (8/8,909), 0.7% (66/9,000) and 2.7% (124/4,622) of the populations, respectively took the opportunity to call anonymously to receive advice. The number of calls per opening hour of the hotlines varied between 0.2 (8 calls/40 opening hours) and 0.4 (124 calls/300 opening hours). Major reasons for calling the hotlines included requests for more information about chlamydial infections, questions relating to the study and emotional concerns (e.g. problems relating to partner tracing, adultery or anxiety concerning infertility). Although only a small fraction of the target populations used the hotlines we conclude that there is a need for advice and counseling in connection with strategies involving home-obtained samples for C. trachomatis testing. The optimal setting for this, however, remains to be determined.

Adult↗

Codependency: predictors and psychometric issues.

This study examined the relationships between codependency and age, gender, self-confidence, autonomy, and succorance, which is the quality of soliciting emotional support from others. The study also tested the validity of the Spann-Fischer Codependency Scale (Fischer, Spann, & Crawford, 1991). Ninety-five undergraduates completed a demographic sheet, the Adjective Check List (Gough & Heilbrun, 1983), the Spann-Fischer Codependency Scale, the Co-Dependents Anonymous Checklist (Whitfield, 1991), and a questionnaire developed for this study based on the work of Hemfelt, Minirth, and Meier (1989). As predicted, codependency was negatively related to self-confidence and positively related to succorance. However, contrary to expectation, a negative relationship between codependency and autonomy was not found. In addition, low self-confidence was the strongest predictor of codependency. Finally, all three measures of codependency were strongly related, attesting to the convergent validity of the Spann-Fischer Codependency Scale. Future studies should further investigate the role of emotional autonomy and codependency and should begin to utilize an experimental approach, making predictions regarding the behavior of codependent and noncodependent persons in experimental situations.

Adolescent↗

Identifying DNA and protein patterns with statistically significant alignments of multiple sequences.

MOTIVATION: Molecular biologists frequently can obtain interesting insight by aligning a set of related DNA, RNA or protein sequences. Such alignments can be used to determine either evolutionary or functional relationships. Our interest is in identifying functional relationships. Unless the sequences are very similar, it is necessary to have a specific strategy for measuring-or scoring-the relatedness of the aligned sequences. If the alignment is not known, one can be determined by finding an alignment that optimizes the scoring scheme. RESULTS: We describe four components to our approach for determining alignments of multiple sequences. First, we review a log-likelihood scoring scheme we call information content. Second, we describe two methods for estimating the P value of an individual information content score: (i) a method that combines a technique from large-deviation statistics with numerical calculations; (ii) a method that is exclusively numerical. Third, we describe how we count the number of possible alignments given the overall amount of sequence data. This count is multiplied by the P value to determine the expected frequency of an information content score and, thus, the statistical significance of the corresponding alignment. Statistical significance can be used to compare alignments having differing widths and containing differing numbers of sequences. Fourth, we describe a greedy algorithm for determining alignments of functionally related sequences. Finally, we test the accuracy of our P value calculations, and give an example of using our algorithm to identify binding sites for the Escherichia coli CRP protein. AVAILABILITY: Programs were developed under the UNIX operating system and are available by anonymous ftp from ftp://beagle.colorado.edu/pub/consensus.

Algorithms↗

Anonymous HIV surveillance with risk factor elicitation at Scotland's largest prison, Barlinnie.

OBJECTIVE: To determine prevalence of HIV infection and risk behaviours among male inmates of Her Majesty's Prison (HMP) Barlinnie, Glasgow, Scotland on 8-9 September 1994. DESIGN: Cross-sectional study: voluntary, anonymous HIV surveillance (using saliva samples) of all inmates and linked self-completion risk-factor questionnaire. SUBJECTS: Of 1073 prisoners available to participate, 985 (92%) completed a risk-factor questionnaire and 982 salivettes were received for testing, of which 978 were tested for HIV antibodies (four were dry samples); 928 questionnaires passed logical checks for consistency. MAIN OUTCOME MEASURES: HIV prevalence on saliva testing, related risk behaviours and ratio of overall-to-disclosed HIV prevalence. Proportion of all inmates who have ever injected drugs, ever injected inside prison, started injecting inside, ever had acute hepatitis, had a recent personal HIV test (since January 1993). RESULTS: Nine saliva samples [eight injecting drug users (IDU), one recognized other risk] out of 978 were HIV-antibody-positive (three presumptively from known HIV-infected inmates). Overall HIV prevalence was estimated at 1% compared with a known prevalence of 0.4%, giving an overall-to-disclosed HIV prevalence ratio of 2.6 in HMP Barlinnie in September 1994. A higher proportion of prisoners from Glasgow (48%) than elsewhere (19%) were IDU. Year of first injection was also different by residence with 23% of Glasgow IDU having first injected after 1988 compared with 45% of IDU from elsewhere, mainly West and South Scotland. Half the IDU inmates reported having injected while incarcerated and 6% had started to inject while incarcerated. Ten per cent of all prisoners and 20% of IDU inmates had had a personal HIV test since January 1993. Logistic regression showed that there was a significant deficit of recent HIV test uptake by Glasgow residents (odds ratio, 0.5; 95% confidence interval, 0.27-0.89), that IDU were more likely to have had treatment for a sexually transmitted disease, and that IDU who had injected inside and those whose injecting career began prior to 1989 were more likely to have had acute hepatitis. CONCLUSION: A consistent harm-reduction policy is needed across prisons in the United Kingdom to avoid transmission of blood-borne viral infections. Drug injecting inside prison is common, a proportion of IDU inmates having first injected drugs while in prison, and much higher rates of hepatitis have been reported in association with injecting while incarcerated compared with that for IDU who only injected outside prison.

Adult↗

Ethical issues in occupational health research.

This is an overview of ethical issues in occupational health research involving human subjects. Research that requires human subjects review must be distinguished from surveillance or public health practice. Confidentiality and privacy concerns are particularly important in an occupational setting because individual participants may be identifiable through job title or other characteristics, and because there may be concerns about employment discrimination associated with participation status or results. Additional issues include notification of individual test results to the study participants, including whether the results have clinical significance and/or provide other potentially relevant information to the study subjects; consent for banking of biological specimens for future research (e.g., uses of the specimens, plans for anonymization, notification of future results); and the higher level of sensitivity of workplace studies involving genetic modifiers of risk. Many occupational studies involve no more than minimal risk. Studies that involve greater than minimal risk require the investigator to document the potential risks and attempt to minimize them.

Confidentiality↗

[Consumption of medicines among adolescent students: a concern].

OBJECTIVE: To study the prevalence of medicine consumption among adolescent students and to correlate it with school type (public or private), grades and school shift, age and gender of the students, education level of the parents and family habit of medicine consumption. METHODS: This is a cross-sectional study with a representative sample of the school population attending high school in Porto Alegre: 1,281 students from 58 groups, distributed in proportional strata of public and private schools. The questionnaire was answered individually and anonymously by the students inside of the classroom. The students provided information about their consumption of medicines during the seven previous days, specifying the kind of medicine used. Descriptive analysis of the variables, linear association and multiple logistic regression tests were used. RESULTS: The use of medicines occurred in 49.5% of the sample. The most consumed pharmacological groups were analgesics/anti-inflammatories and anti-gout agents (32.5% of the consumption), and hormones and similar (12.1%). Analgesics/antipyretics/anti-inflammatories and estrogens/progestogens were, respectively, the most consumed medicines of the pharmacological groups above mentioned. Aspirin was the most consumed analgesic substance. Female students (RC = 2.24), 17 years old or over (RC = 1.41), with low maternal education (RC = 1.40), and whose relatives have the habit of consuming medicines (RC = 1.39), presented increased risk for medicine consumption. CONCLUSIONS: It was found that the consumption of medicines is high among school adolescents, especially among girls and older students. Family habit of consumption and low maternal education also favor the use of medicines.

Adolescent↗

HIV/AIDS-related discrimination in Shanxi rural areas of China.

OBJECTIVE: In order to explore the features of discrimination against people with HIV/AIDS in rural areas, a community-based intervention was carried out in two pilot communities of X County of Shanxi Province from September 2002 to October 2003. METHODS: Data were collected using qualitative methods (in-depth interview and focus group discussion) and anonymously structured questionnaires. RESULTS: (1) Severe discrimination against people infected with HIV/AIDS was revealed in the target communities. However, the response to HIV/AIDS was different in each community. (2) People were reluctant to disclose their HIV status or get tested for HIV, which endangered their sexual partners to contract HIV through unprotected sexual intercourses. (3) Attitudes towards people infected with HIV/AIDS varied. (4) Public education promoted a better understanding of HIV/AIDS which in turn improved community attitudes and behaviors towards people with HIV/AIDS. CONCLUSION: HIV/AIDS-related discrimination undermines both individuals' and communities' responses to HIV/AIDS and may be a serious obstacle towards effective HIV/AIDS prevention and control.

Acquired Immunodeficiency Syndrome↗

Scandinavian recommendations: sperm donation.

The Danish Council of Ethics is continuing its tradition of publishing in English both its annual report and the report of one substantial investigation each year. With its report for 2002 is the second part of its report on ethical problems concerning assisted reproduction, which examines anonymity and selection in sperm donation. There follow the Council's summary of its recommendations, with an introductory note.

Advisory Committees↗