[Infections caused by "anonymous" (atypical) mycobacteria].
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Adolescent↗
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Ethical guideposts for allelic variation databases.
Basically, a mutation database (MDB) is a repository where allelic variations are described and assigned within a specific gene locus. The purposes of an MDB may vary greatly and have different content and structure. The curator of an electronic and computer-based MDB will provide expert feedback (clinical and research). This requires ethical guideposts. Going to direct on-line public access for the content of an MDB or to interactive communication also raises other considerations. Currently, HUGO's MDI (Mutation Database Initiative) is the only integrated effort supporting and guiding the coordinated deployment of MDBs devoted to genetic diversity. Thus, HUGO's ethical "Statements" are applicable. Among the ethical principles, the obligation of preserving the confidentiality of information transferred by a collaborator to the curator is particularly important. Thus, anonymization of such data prior to transmission is essential. The 1997 Universal Declaration on the Human Genome and Human Rights of UNESCO addresses the participation of vulnerable persons. Researchers in charge of MDBs should ensure that information received on the testing of children or incompetent adults is subject to ethical review and approval in the country of origin. Caution should be taken against the involuntary consequences of public disclosure of results without complete explanation. Clear and enforceable regulations must be developed to protect the public against misuse of genetic databanks. Interaction with a databank could be seen as creating a "virtual" physician-patient relationship. However, interactive public MDBs should not give medical advice. We have identified new social ethical principles to govern different levels of complexity of genetic information. They are: reciprocity, mutuality, solidarity, and universality. Finally, precaution and prudence at this early stage of the MDI may not only avoid ethically inextricable conundrums but also provide for the respect for the rights and interests of all those involved.
Adult↗
Impact of resident duty-hour reform on faculty clinical productivity.
OBJECTIVE: Prior data have shown that resident duty-hour reform has not affected faculty work hours; yet the preservation of faculty hours may have been at the expense of productivity. We sought to examine change in clinical productivity. DESIGN: Anonymous survey and analysis of faculty relative value units (RVU) database. SETTING: A single, large academic medical center. PARTICIPANTS: All clinical faculty in the Department of Surgery. METHODS: An anonymous survey was distributed to surgical faculty 18 months after reform and compared with surveys taken before and after reform. Opinions regarding productivity and working hours were solicited. P values were determined by chi-square or Student t-tests. Relative value unit data, reflecting clinical productivity, were compared before and after reform. Regression was performed with dependent variable "lnRVU" and independent variables "calendar month," "pre/post" July 2003, and "surgeon." The coefficient on "pre/post" reflected average change in RVUs. RESULTS: A total of 49 of 73 surveys were returned (67% response). Faculty reported an average of 68.0+/-7.0 weekly work hours (p=NS compared with previous survey). In the current survey, 35% felt their overall productivity had fallen due to reform. Among these, 83% felt academic productivity had suffered, 11% were unsure, and 1 person (6%) believed academic productivity was preserved. The majority (82%) reported preserved clinical productivity, 6% reported a decrease, and 12% were unsure. Overall, 60% reported doing work previously done by residents. When RVU data were examined, the coefficient on change pre- and post-reform indicated a 5.7% increase in productivity (p=0.005). However, this effect was driven by 5 surgeons with a greater than 75% increase in productivity, all young faculty, early in practice. Excluding these, there was no significant change (0.6% increase, p=0.77). CONCLUSIONS: Faculty have preserved work hours and clinical productivity, despite a tendency to take on work previously done by residents. This suggests that academic activities may have suffered.
Academic Medical Centers↗
Tampon use in young women.
OBJECTIVE: To study the prevalence of tampon use among young females, the factors and persons influencing this choice, the role of primary care physicians, and the potential association of tampon use with sexually transmitted diseases and urinary tract infections. METHODS: An anonymous questionnaire regarding the use of feminine hygiene products was completed by 250 female college students between 17 and 21 years of age and 90 primary care physicians. Percentages were calculated for most outcome measurements and Fisher's Probability Exact Test was used to compare groups. RESULTS: Of the participants, 19% use pads, 29% use tampons, and 52% use both, with a total of 81% using tampons alone or in combination. The choice was influenced mostly by the woman herself or her mother. Only 22% reported that their physician discussed tampon usage with them. Incidence of sexually transmitted diseases was not significantly different between those using pads and tampons. In the pad group, 12% reported urinary tract infections versus 32% in the other group (P = 0.007). Among physicians, only 30% said they discussed hygiene products, although 52% of them thought it was medically important. Of the female physicians, 71% use tampons alone or in combination; 29% exclusively use pads, with 92% citing fear of toxic shock syndrome as a reason for their choice. CONCLUSIONS: The majority of young women use tampons based on own decision or maternal influence for comfort, convenience, and appearance. Physician input in this regard is not routinely provided, probably because of lack of agreement about the importance of the subject among physicians. Based on participants' report in this survey, the incidence of urinary tract infections seems to be significantly higher among tampon users than among pad users. Physicians should assume a more active role in explaining the appropriate use, benefits, and potential risks of feminine hygiene products.
Adolescent↗
Attitudes toward blood donation incentives in the United States: implications for donor recruitment.
BACKGROUND: The potential effectiveness of various donation incentive programs may vary by demographics, first-time or repeat status, and collection site. STUDY DESIGN AND METHODS: Attitudes toward future incentives were obtained from a 1998 anonymous survey sent to 92,581 US blood donors. Responses (encouraged, discouraged, no difference) to incentives were compared within demographic groups, donations sites, and between first-time and repeat community whole-blood (WB) donors using chi-square tests and logistic regressions adjusted for sample design. RESULTS: Incentives most likely to encourage donation return among all 45,588 WB respondents were blood credits (61%), cholesterol screening (61%), and prostate-specific antigen (PSA) screening (73% of men). Younger donors (< or = 25 years old) were 4 to 5 times more likely to be encouraged to donate if offered compensatory incentives (tickets to events, discounts or lottery and/or raffle tickets), gifts, or a token of appreciation than were those donors older than 55. This age effect influenced positive attitudes toward incentives in first-time donors and in donors giving at schools, universities, or military sites. Among all donors, up to 7 to 9 percent reported they would be discouraged to return if offered compensatory incentives. CONCLUSIONS: Blood credits and cholesterol and PSA screening would be well received at all donation sites. Gifts, compensatory incentives, and tokens of appreciation appeal more to younger donors. These data may allow blood centers to optimize recruitment by tailoring limited incentive resources more effectively.
Adult↗
Screening the public for depression through the Internet.
OBJECTIVE: Despite increased public screening, many individuals with depression remain undetected or untreated. This study explored the performance of an Internet-based program in screening for depression. METHODS: The Centers for Epidemiological Studies Depression (CES-D) scale was adapted as an online screening test. The program advised persons whose score indicated a high probability of depression to seek treatment and asked them to complete a survey of attitudes and preferences that could be printed and taken to a health professional. Responses were collected anonymously for epidemiologic research. Demographic characteristics of participants were compared with those of the U.S. population and participants in previous community screenings. The costs of the program were calculated. RESULTS: The CES-D scale was completed 24,479 times during the eight-month study period. The respondents' median age category was 30 to 45 years, and almost 30 percent were male; 58 percent (N=14,185) screened positive for depression, and fewer than half of those had never been treated for depression. The proportion of younger individuals was larger than in previous public screenings, but was still lower than that in the U.S. population. Our sample contained a lower proportion of minorities than the U.S. population (16.6 percent versus 28.3 percent). Sunk costs totaled $9,000, and additional marginal costs to maintain the system totaled $3,750. CONCLUSIONS: The Internet provides a continuously available, inexpensive, easily maintained platform to anonymously screen a large number of individuals from a broad geographic area. However, older adults and minorities may visit screening sites less frequently than other populations.
Adolescent↗
[Early diagnosis of genital Chlamydia trachomatis infection among adolescent girls].
UNLABELLED: Genital Chlamydia trachomatis infection is the most frequently found sexually transmitted disease among sexually active adolescent 15-19-year-old girls. In general, infection caused by C. trachomatis tends to be less abrupt in onset, clinical course is usually characterized as asymptomatic or with mild symptoms. If is although the cause of moderate to severe complications (infertility, pelvic inflammatory diseases) at a later age. OBJECTIVE: To study the prevalence of chlamydia infection and the possibilities and of early detection among adolescent girls. METHODS: Four hundred eighty seven 15-19-year-old girls were questioned by anonymous questionnaire. All 240 sexually active girls were advised to come for the investigation to the Clinic of Pediatrics of Kaunas University of Medicine Hospital. Fifty nine girls underwent inspection of the genitalia, had a speculum and bimanual pelvic examination, test of CT/NG DNA hybridisation for C. trachomatis from vagina. Smears from urethra vagina and cervix were taken. RESULTS: Test for C. trachomatis infection was positive in 11 (18%) by CT/NG DNA hibridisation from vagina. Detection of bad smelling discharge from vagina together with nonspecific changes in vaginal and cervical mucosa, mount and methylene blue prepared smears could reliably predict the diagnosis of C. trachomatis infection. CONCLUSION: We found high prevalence of C. trachomatis infection among adolescent girls. Only clinical symptoms together with nospecifical test were reliable predictors of the final diagnosis, enabling to start the early treatment.
Adolescent↗
[Suicidal behaviors and correlated psychological factors in secondary school students].
OBJECTIVE: To investigate the prevalence of suicide ideation, suicide plan and suicide attempts in middle school students in Hefei, Anhui province, and to determine correlated factors. METHODS: The investigation was administered to 3127 middle school students from 7 schools in Hefei, Anhui province. All participants completed an anonymous questionnaire concerning their experiences with specific suicide behaviors during the 12 months preceding the survey. School life satisfaction, coping style were evaluated by School Life Satisfaction Rating Questionnaire for Adolescent and Trait Coping Style Questionnaire, respectively. Chi-squared test was used to assess gender difference of suicide ideation, suicide plan and suicide attempt. Logistic regression analyses were applied to identify factors associated with adolescent suicide behaviors. RESULTS: Of the subjects investigated, 28.0 percent had thought seriously about attempting suicide, 11.9 percent had made a specific plan to attempt suicide, and 4.0 percent actually had attempted suicide. It was found that main risk factors among three specific suicide behaviors were related to negative coping style. School life satisfaction was protecting factor of suicide ideation and suicide attempt. CONCLUSION: It was suggested that focusing on these psychosocial factors would help enhance suicide assessment and prevention efforts with adolescents.
Adaptation, Psychological↗
Prevalence of maternal drug use near time of delivery.
Prenatal substance abuse is a problem of growing concern because of the negative effects it has on the health of the woman and developing fetus. To evaluate the prevalence of this problem in our community, anonymous toxicology studies were performed on 1,003 maternal urines. Samples were connected at time of delivery and selection bias was addressed. Results indicated that cocaine or marijuana metabolites were present in 4% of all urines. Among clinic patients, 12.4% tested positive (7.3% cocaine; 5.1% marijuana) and 1.3% tested positive among private patients (0.7% cocaine; 0.7% marijuana). Poor prenatal care was positively associated with substance use regardless of clinic or private care: 50% of those with fewer than three prenatal visits tested positive for cocaine or marijuana compared with 2% of those with more than three prenatal visits. Maternal age < 18 years did not predict substance use. Program planning in Connecticut should progress with these data in mind.
Adolescent↗
The psychosocial benefits of alcoholics anonymous.
A quasi-experimental design was implemented to evaluate the attitudes of alcoholics toward themselves and others after they had worked all twelve steps of an AA program compared to those who had not yet completed all twelve steps. One hundred individuals who were attending AA meetings were selected so that one half had completed all of the steps and the other half had not. Participants were tested in individual sessions during which they completed a series of questionnaires. Measures were taken of global self-esteem, social self-esteem, social confidence, network trust, fear of negative evaluation, need for approval, preoccupation with relationships, discomfort with closeness, relationships as secondary, and optimism. A principal components analysis of participants' responses to these measures revealed that the factors being assessed could be divided into one regarding interpersonal insecurity and another regarding social potency. The data showed that alcoholics who had been able to stay in the program and work through all twelve steps had lower levels of interpersonal insecurity than those who were just beginning to work the steps. No significant differences were found in social potency between those who had completed the steps and those who had not completed the steps. Further research is needed to clarify the specific nature of changes that occur in personality as alcoholics work through the twelve steps within community-based AA programs.
Adult↗
Computer-based tutorial in MR imaging.
PURPOSE: To test the effectiveness of customized software as a teaching tool to help the novice understand basic physics concepts underlying the creation of MR images via various pulse sequences. METHODS: The authors have developed animating graphic and highly interactive electronic MR audiovisual software for the Macintosh computer in the C programming language, and have integrated it into the classroom setting for teaching MR imaging physics concepts such as T1, T2, T2*, proton density, RF excitation, TR, TE, TI, flip angle, static magnetic field strength, gradient magnetic fields, section thickness, number of phase-encoding gradients, number of excitations, field of view, intersection gap, receiver bandwidth, contrast agent(s), etc. The program interactively demonstrates the effects of these variables upon such imaging objectives as voxel dimensions, section quantity, total scanned volume, signal-to-noise ratio, contrast, contrast-to-noise ratios, resolving power, and scan acquisition time. Partial saturation, gradient echo, inversion recovery, and fat-saturation imaging techniques are included. Written posttests on the syllabus covered in our basic MR course were administered to three groups: 43 student professionals (technologist/physicist/radiologist) (control professional group) before, 149 student professionals (exposed professional group) after the addition of the tutorial software into the MR course as an integral part of the teaching process, and a group of 200 pharmaceutical sales staff with little to no prior MR or scientific background (exposed pharmaceutical group). The scores were then evaluated and compared among the groups. One hundred ten students exposed to this software also anonymously rated the software on a 1 to 5 scale (harmful to very helpful, respectively) as to their feeling regarding its role in their MR educational experience and the ease with which they were able to understand the material covered in the basic MR course curriculum. RESULTS: Mean test scores were statistically significantly lower in the Control Professional Group (60%, +/- 2.59 standard error of the mean (SEM)) than in either the Exposed Pharmaceutical (73% +/- 0.75 SEM) or Exposed Professional Groups (77% +/- 0.99 SEM). The mean subjective assessment score regarding the software was 4.8 (scale 1 to 5). CONCLUSION: This custom-developed interactive MR tutorial software is demonstrated to be effective in assisting even those new to MR imaging in understanding the concepts underlying MR imaging physics in a manner that is felt to be significantly more palatable than lectures, articles, and/or textbooks alone.
Computer-Assisted Instruction↗
The two-week pediatric surgery rotation: is it time wasted?
BACKGROUND: With increasing medical school emphasis on generalist training and decreasing enrollment in surgical residency, the authors assessed the adequacy of a 2-week pediatric surgery rotation on meeting the learning and competency objectives outlined in The Canadian Association of Pediatric Surgeons' Self-Directed Evaluation Tool. METHODS: A prospective survey was conducted of 39 clinical clerks. An anonymous self-assessment scale measuring competency objectives (medical and psychosocial) was administered pre-and postrotation. Also, exposure to pediatric surgical conditions from a list of "essential" and "nonessential" learning objectives was measured. Statistical analysis was performed using paired t test with significance at.05 level. RESULTS: Response rate was 77% and 54% for the competency and learning objectives, respectively. Students reported improvement in medical (P <.00001; 95% CI, 1.30, 1.90) and psychosocial (P =.00036; 95% CI 0.64, 1.28) competency objectives after the rotation. Almost all "essential" learning objectives were met. Overall, students reported an increased awareness of the breadth of pediatric surgical practice (P <.0001; 95% CI 2.06, 3.18). CONCLUSIONS: A 2-week rotation in pediatric surgery appears adequate in fulfilling most competency and learning objectives, but discussion is needed about how to best assess student competency, which topics are considered essential, and the long-term effect on recruitment to the profession.
Clinical Clerkship↗
Isolation and characterization of two Saccharomyces cerevisiae genes that encode proteins that bind to (TG1-3)n single strand telomeric DNA in vitro.
By screening lambda gt11 libraries with a radiolabeled (TG1-3)n oligonucleotide, two Saccharomyces cerevisiae genes were identified that encode polypeptides that recognize the single-stranded telomeric repeat sequence (TG1-3)n. The first gene, NSR1, a previously identified gene, encodes a protein involved in ribosomal RNA maturation and possibly in transport of proteins into the nucleus. The second gene, GBP2 (G-strand Binding Protein), is an anonymous open reading frame from chromosome III. These two genes contain RNA recognition motifs (RRMs) that are found in proteins that interact with RNA. Both Nsr1p and Gbp2p bind specifically to yeast single strand (TG1-3)n DNA in vitro. To test whether these two proteins associate with telomeres in vivo, strains were constructed in which one or both of these genes were either disrupted or overexpressed. None of these alterations affected telomere length or telomere position effect. The potential role of these two (TG1-3)n binding proteins is discussed.
Base Sequence↗
[Selected ethical problems in neonatology -- opinions of physicians and nurses based on questionnaire study].
UNLABELLED: AIM OF THIS PAPER: To present the opinions of doctors and nurses on the limitations of resuscitation and treatment of extremely premature newborns. MATERIAL AND METHODS: Anonymous questionnaire studies were carried out in 342 doctors and 1194 nurses from 6 provinces of Poland. The authors compared the answers of doctors and nurses as well as the answers form different provinces. The results were processed using the Chi2 test, with the significance level p<0.05. RESULTS: The will to resuscitate the neonate, regardless of its birth weight was declared by 29% of the physicians and 49% of the nurses, regardless of the gestational age - by 21% of the physicians and 47% of the nurses. Resuscitation of an extremely immature, asphyctic newborn was declared by 71% of the physicians and 59% of the nurses. Limitation of therapy after diagnosing severe intracranial hemorrhage is declared by 67% of the physicians and 45% of the nurses. 37% of the doctors and 30% of the nurses would comply with parents' will when deciding about resuscitation. 44% of the physicians and 31% of the nurses declare taking parents' decision into account in the matter of abandoning resuscitation. CONCLUSIONS: 1. There is a higher percentage of persons convinced about the necessity of resuscitation of every newborn, regardless of its maturity, among the nurses than among the doctors. 2. Among the nurses there are more persons, who are sceptical about saving the extremely premature newborns born with asphyxia, whereas among the doctors there are more persons inclined to stop therapy in case of a severe intracranial hemorrhage. 3. The most controversial are problems concerning the consideration of parents' will in decision about whether to continue or abandon resuscitation, but physicians are more apt to regard parents' will in resuscitation in some situations. 4. The analysis of the questionnaire points to the need for deeper knowledge of the present mortality rates of the extremely immature newborns and further development of the surviving ones among the physicians and nurses.
Adult↗
A view through the gateway: expectancies as a possible pathway from alcohol to cannabis.
AIM: The aim of this study was to test the hypothesis that cannabis outcome expectancies would be more positive in adolescents who drink alcohol than in non-drinkers. PARTICIPANTS AND SETTING: The participants in the study were 4544 11-16-year-olds attending eight secondary schools located in the north-west midlands of England. PROCEDURE: Participants completed an anonymous self-report questionnaire that incorporated sections designed to tap adolescents' expectancies of positive and negative outcomes of alcohol and cannabis use, together with other questions relating to substance use and associated issues. RESULTS: Four reliable six-item scales were derived, and used to measure positive and negative alcohol and cannabis outcome expectancies. Negative expectancies were relatively stable across age and frequency of substance use, particularly for alcohol. However, positive expectancies for both substances increased markedly with age and, independently, with frequency of use. Positive alcohol and cannabis outcome expectancies were meaningfully related to expectancies of future substance use, and to measures of problem drug use and resistance to peer influence, supporting the validity of these expectancy measures, and their possible value as diagnostic screening instruments. The main hypothesis of the study was supported: among respondents who reported never using cannabis, positive cannabis outcome expectancies increased and negative cannabis outcome expectancies decreased with increasing frequency of alcohol use. CONCLUSIONS: The results are consistent with a version of the 'gateway hypothesis' for the relationship between alcohol and cannabis use (alcohol use leads to changes in cannabis expectancies and thereby to cannabis use), but a proper test of the hypothesis requires a longitudinal study.
Adolescent↗
Screening for hepatitis C virus in a health maintenance organization.
BACKGROUND: Chronic infection with hepatitis C virus (HCV) is a major public health problem and is associated with over 10,000 deaths a year in the United States. In its early stages, HCV tends to be asymptomatic and can be detected only through screening. OBJECTIVES: To develop and validate a database risk algorithm for HCV infection using electronic data at HealthPartners, a health maintenance organization (HMO) in Minnesota. A secondary objective was to evaluate the benefit of screening health care workers for HCV. METHODS: A database risk algorithm was developed using diagnostic and procedure codes in the administrative database to identify at-risk enrollees. One thousand three hundred eighty enrollees (an at-risk sample and a control sample) and 502 health care workers participated in anonymous screening. Both descriptive statistics and logistic regression were used to examine the frequency of HCV infection, associations with risk factors, self-selection factors in participation, and concordance between the database risk algorithm and the risk profile questionnaire. RESULTS: Eleven enrollees tested positive for HCV, 9 from the at-risk sample and 2 from the control sample. All health care workers tested negative for HCV. Both lifestyle and medical risk factors were associated with positive test results for HCV. Enrollees with alcohol-drug diagnoses were less likely to participate in screening. A substantial proportion of enrollees with risk factors was identified either by the database risk algorithm or the risk profile questionnaire, but not by both. CONCLUSION: While the frequency of HCV infection was lower than previous estimates for the US population, the strong correlation with risk factors suggests that using the database risk algorithm for screening is a useful approach. Managed care plans with suitable data on their enrollee populations are in a key position to serve an important public health role in detecting asymptomatic patients who are infected with HCV.
Algorithms↗
Role of peer support and emotional expression on posttraumatic stress disorder in student paramedics.
This exploratory study contrasted and tested the predictive value of the reverse buffering hypothesis of social support and the information processing model of posttraumatic stress disorder (PTSD) in an investigation of trauma-related symptomatology (TRS) in a single sample of 42 student paramedics. Participants completed several anonymous self-report measures of PTSD symptomatology, peer social support, and attitude toward emotional expression. Regression-based path analyses did not support either theory of PTSD in this population. A path model of PTSD in student paramedics was subsequently developed, indicating that a direct relationship exists between duty-related trauma exposure, dysfunctional peer social support, and students' negative attitudes toward emotional expression. This new model accounted for 30% of the variance in student paramedics' TRS.
Adult↗
Modeling condom-use stage of change in low-income, single, urban women.
This study was undertaken to identify and test a model of the cognitive antecedents to condom use stage of change in low-income, single, urban women. A convenience sample of 537 women (M=30 years old) attending two urban primary health care settings in western New York State anonymously completed questionnaires based primarily on two leading social-cognitive models, the transtheoretical model and the information-motivation-behavioral skills model. We used structural equation modeling to examine the direct and indirect effects of HIV-related knowledge, social norms of discussing HIV risk and prevention, familiarity with HIV-infected persons, general readiness to change sexual behaviors, perceived vulnerability to HIV, and pros and cons of condom use on condom-use stage of change. The results indicated two models that differ by partner type. Condom-use stage of change in women with steady main partners was influenced most by social norms and the pros of condom use. Condom-use stage of change in women with "other" types (multiple, casual, or new) of sexual partners was influenced by HIV-related knowledge, general readiness to change sexual behaviors, and the pros of condom use. These findings suggest implications for developing gender-relevant HIV-prevention interventions.
Adolescent↗