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Apnea and periodic breathing in bed-sharing and solitary sleeping infants.

Mother-infant bed sharing, compared with the solitary sleeping condition, has recently been associated with several physiological and behavioral effects. Because the physiological effects of bed sharing may also include respiratory changes, we compared the incidence of central and obstructive apneas and periodic breathing in bed-sharing and solitary sleeping infants. Twenty routinely bed-sharing mother-infant pairs and fifteen routinely solitary sleeping pairs slept for 3 nights in a sleep laboratory. After an initial adaptation night, each pair spent 1 night bed sharing and 1 night in solitary sleep in random order. Apnea and periodic breathing were scored from polysomnographic recordings. The frequency of central apnea was significantly increased on the bed-sharing night, compared with the solitary night, regardless of routine sleeping arrangement. There were significantly fewer obstructive apneas on the bed-sharing night than on the solitary night, but only in routinely solitary sleeping infants. In both groups, there was a significantly higher frequency of periodic breathing events on the bed-sharing night than on the solitary night. These findings demonstrate that the bed-sharing environment can have a significant impact on respiratory control in the infant. Evidence is also presented to suggest that routine bed sharing may result in subtle neurophysiological and/or developmental differences in infants.

Female↗

Report on the earnings sharing implementation study.

This article summarizes the report on the earnings sharing implementation study mandated by the Social Security Amendments of 1983. In general, earnings sharing means that a married couple would share equally any earnings credited for social security purposes during years of their marriage. The principles of earnings sharing can be meshed with present law in a variety of ways. A range of earnings sharing plans are analyzed. Transitional provisions are included and distributional and cost effects for each plan are provided. In addition, implementation concerns are analyzed and feasible time periods for implementing an earnings sharing plan are discussed. However, no recommendations about the feasibility or desirability of an earnings sharing plan are made. The analysis of the earnings sharing plans in the report shows that implementation of any of these plans would cause a number of persons to get higher benefits than would be available under present law, and, except for one plan that has a permanent guarantee of present law benefit levels, each plan would cause a number of persons to get lower benefits. Women, in general, would get higher benefits under an earnings sharing system, but many individual women and most men would get lower benefits. A variety of proposals other than earnings sharing that have been suggested over the years as ways to improve social security protection for women are also analyzed.

Aged↗

Shared HLA antigens and reproductive performance among Hutterites.

Shared histocompatibility antigens between spouses may affect reproductive outcome adversely as a result of prenatal selection against compatible fetuses. Evidence from both animal and human studies suggest that histocompatible fetuses may not initiate a maternal immunologic response that prevents rejection of the embryo. Therefore, parents sharing HLA antigens may produce compatible fetuses and consequently experience a greater frequency of early fetal losses and show poorer reproductive outcome than couples not sharing antigens. In the Hutterites, an inbred human isolate that proscribes contraception, we tested the hypothesis that couples sharing HLA antigens have poorer reproductive outcomes than couples who do not. The Hutterites are characterized by high fertility and large family sizes. Couples that share zero (no. = 21), one (no. = 15), and more than one (no. = 10) HLA-A or HLA-B antigens were compared for reproductive performance. Median intervals between births were larger among couples that share more than one antigen in eight of 11 intervals examined. In addition, the median intervals from marriage to first, fifth, and tenth birth were consistently larger among couples that share more than one antigen. Differences among the groups appear to become larger with increasing parity, suggesting that the effect of histocompatibility on reproductive performance becomes more evident in later pregnancies. These differences in reproductive performance between couples that share zero, one, or more than one HLA-A or HLA-B antigens may have significant evolutionary consequences. However, our results demonstrate that sharing HLA antigens does not preclude normal pregnancy and caution should be exercised before concluding that shared HLA antigens are solely responsible for repeated fetal losses.

Birth Intervals↗

Needle-sharing among young IV drug users and their social network members: The influence of the injection partner's characteristics on HIV risk behavior.

Injection drug use is a risk factor for HIV among adolescents and young adults, yet the interpersonal dynamics of needle-sharing among young injectors remain poorly understood. Research has focused on identifying the characteristics of individual IV drug users (IVDUs) that increase their risk of needle-sharing. Most studies have not taken into consideration IVDUs' decisions to share needles with certain partners but not with other partners. This study examined partner characteristics associated with needle-sharing among 96 male and 77 female young adult IV drug users who had shared needles previously. Men were most likely to share needles with partners who gave them emotional support, partners who they injected or who injected them, and partners with whom they had had sex. Women were most likely to share needles with partners who they injected or who injected them, partners with whom they had discussed HIV risk, and partners with whom they had had sex. Results indicate that needle-sharing occurs within the context of mutual injection rituals and close emotional and sexual relationships. Public health interventions are needed to help young IVDUs to avoid needle-sharing with intimate partners.

Adolescent↗

The effects of patient cost sharing on ambulatory utilization in South Korea.

This study focused mainly on the effects of patient cost sharing on the demand for physician service, especially in the low-income people. Patient cost sharing is one of the policies used extensively in the health care financing in Korea, which has been adopted to control the health care cost. It has raised the argument that cost sharing inhibits low-income patients' access to affordable medical care. Data from the National Health and Nutrition Survey conducted 1998 by the Korean Ministry of Health and Welfare was used for this analysis. Multiple regression was done with the dependent variable of the amount of ambulatory utilization and price elasticities are estimated. We obtained significant out-of-pocket price elasticities depending on patient income levels and types of care facilities in the range of -0.21 to -0.07, -0.20 to -0.10, respectively. We found out that low-income patients are more sensitive to cost sharing than high-income patients. Furthermore, we found out that the users of general hospitals are less sensitive to cost sharing than the users of clinics. These results shows that the cost sharing policy in Korea does not efficiently work. Patient cost sharing in Korea induces inequitable medical service utilization and also it does not decrease moral hazard in the sense that the higher cost-sharing sector is less sensitive to cost sharing.

Adult↗

Social support and zero sharing risk among hazardously drinking injection drug users.

We compared the sociodemographic, drug use, and social support characteristics of injection drug users (IDUs) who reported at least 6 months having not "shared needles or works" (zero sharing risk) with those who reported recent equipment sharing. 187 AUDIT-positive (>8), active IDUs were recruited between February 1998 and October 1999 from a needle exchange program in Providence, RI. The sample was 64% male and 87% white, with a mean age of 36 years, and 32% of subjects reported zero sharing risk in the prior 6 months. Variables having significant (P<.05) associations with zero sharing risk included: older age, lower heroin use frequency, lower cocaine use, and increased frequency of needle exchange visits. As social support from friends increased, the likelihood of sharing decreased. Subjects with substance-using friends or partners were significantly more likely to share than those without such associations (OR = 9.4; P<.05). Social support and social network composition influenced sharing behaviors in active, out-of-treatment drug injectors. Interventions that mobilize social support may increase the possibility of zero sharing, an important public health goal.

Adult↗

The preparedness to share injecting equipment: an analysis using vignettes.

This paper reports on the use of vignettes to study drug injectors' preparedness to share injecting equipment. Separate vignettes referring to borrowing and passing on injecting equipment have been submitted to 505 injecting drug users in Glasgow. Injectors were asked to identify their own likely response in each of the situations described within the vignettes. It was shown that even among those injectors not reporting any actual sharing in the last 6 months a significant proportion would still be prepared to share injecting equipment within certain situations. The preparedness to share injecting equipment was seen to be influenced by such factors as social distance, sex and length of time injecting. It is suggested that even in situations where drug injectors may have modified their behaviour in the direction of lower levels of reported sharing, a propensity to share may remain. This suggests the continuing need to provide injectors with easy access to sterile injecting equipment; in addition, services working with injecting drug users may need to focus not only upon actual sharing behaviour but also upon what we have described here as the preparedness to share. Indeed, the latter dimension should stand as a warning to services of the potential for sharing injecting equipment to increase in the future.

Acquired Immunodeficiency Syndrome↗

Needle sharing among southern Thai drug injectors.

AIM: To examine factors associated with needle sharing among injecting drug users (IDU) in southern Thailand. DESIGN: Using a cross-sectional survey, 272 active IDU were interviewed about their socio-economic background, needle sharing and drug use patterns at six drug-treatment clinics in southern Thailand. FINDINGS: Ninety-one per cent of IDU gave a past history of ever sharing injecting equipment: of these, 23% currently injected but did not share and 68% still shared. Only 5% of participants knew that bleaching needles could reduce HIV transmission risks. Recent needle sharing was correlated with number of IDU friends (OR 12.23; CI, 5.24-28.51), engaging in illegal jobs (OR 2.74; CI, 1.13-6.67), being unable to use new needles at all times (OR 2.89; CI, 1.17-7.14) and believing that cleaning contaminated shared needles with at least plain water could reduce HIV transmission (OR 3.32; CI, 1.16-6.68). CONCLUSIONS: Our data suggest that AIDS prevention efforts should focus on approaches to reduce needle sharing. Needle exchange programs, HIV counseling and testing and bleach distribution may reduce levels of needle-sharing risks.

Adult↗

Depressive symptoms, drug network, and their synergistic effect on needle-sharing behavior among street injection drug users.

In this study, we examined the relationship between depressive symptoms and needle-sharing behavior in a community sample of intravenous drug users (N = 499) in Baltimore, Maryland. Based on the polytomous logistic regression, higher depressive symptoms were positively associated both with needle sharing after cleaning with bleach and with needle sharing without first cleaning with bleach at the bivariate analyses. This relationship remained significant (OR = 1.66) even after adjusting for demographic characteristics, life events, drug use patterns, and social and drug networks. A significant synergistic effect of depressive symptoms and drug network on needle sharing after cleaning with bleach and needle sharing without cleaning was observed. More depressed intravenous drug users who also had a larger drug network were found to be at higher risk of needle sharing after cleaning with bleach, as well as needle sharing without cleaning (OR = 2.59). Depression status is discussed as a predisposing factor and drug network size as a precipitating factor for needle-sharing behavior. Implications for preventing needle-sharing behavior by reducing depressive symptoms are discussed.

Adult↗

Changes in the sharing of drug injection equipment among street-recruited injection drug users in Chicago, Illinois, 1994--1996.

This study examines changes in the multi-person use of drug injection paraphernalia during the mid-1990s, a time of increasing awareness of HIV transmission modes and availability of prevention programs. Beginning in 1994, 794 street-recruited injection drug users in Chicago were interviewed and followed at 6 and 12 months postbaseline. Random-effects, pattern-mixture logistic regression models were used to determine correlates of five injection-equipment sharing practices, while accounting for repeated measurement and study attrition. At baseline, 45.7% of participants reported receptive syringe sharing in the previous 6 months. Syringe-mediated sharing was reported by 28.7% of participants and the sharing of cookers (65.1%), cotton filters (55.7%), and rinse water (46.9%) was common. During follow-up, the proportion of all sharing behaviors decreased significantly, especially receptive syringe sharing. Participation in a syringe exchange program was associated with reductions in receptive syringe sharing and syringe-mediated sharing, but not the sharing of cookers.

Adolescent↗

Risk of hepatitis C virus infection among young adult injection drug users who share injection equipment.

Designing studies to examine hepatitis C virus (HCV) transmission via the shared use of drug injection paraphernalia other than syringes is difficult because of saturation levels of HCV infection in most samples of injection drug users (IDUs). The authors measured the incidence of HCV infection in a large cohort of young IDUs from Chicago, Illinois, and determined the risk of HCV seroconversion associated with specific forms of sharing injection paraphernalia. From 1997 to 1999, serum samples obtained from 702 IDUs aged 18-30 years were screened for HCV antibodies; prevalence was 27%. Seronegative participants were tested for HCV antibodies at baseline, at 6 months, and at 12 months. During 290 person-years of follow-up, 29 participants seroconverted (incidence: 10.0/100 person-years). The adjusted relative hazard of seroconversion, controlling for demographic and drug-use covariates, was highest for sharing "cookers" (relative hazard = 4.1, 95% confidence interval: 1.4, 11.8), followed by sharing cotton filters (relative hazard = 2.4, 95% confidence interval: 1.1, 5.0). Risks associated with syringe-sharing and sharing of rinse water were elevated but not significant. After adjustment for syringe-sharing, sharing cookers remained the strongest predictor of seroconversion (relative hazard = 3.5, 95% confidence interval: 1.3, 9.9). The authors conclude that sharing of injection equipment other than syringes may be an important cause of HCV transmission between IDUs.

Adult↗

[The effect of sharing medical costs for the aged 70 or more on the financial balance of the health insurance society].

The rapid increase of the proportion of older persons in society has made the problem of medical costs more important. Although medical cost-sharing for those aged 70 or more is decided by their medical costs and by the current proportion of such persons in the Society, it is not constant throughout the Society. The study evaluated the contribution ratio of medical cost-sharing for those aged 70 or more to the financial balance of the Society. In addition, characteristics of the Society associated with medical cost-sharing for those aged 70 or more were analyzed. The results are as follows. 1) Medical cost-sharing for those aged 70 or more was the greatest factor in the financial balance of the Society with a contribution ratio of as much as 55.2%. 2) Multiple regression analysis disclosed that dependent ratio, the average monthly salary, the area, the rate of those aged 70 or more and the average age of the Society members are significant in medical cost-sharing for those aged 70 or more. 3) Dependent ratio and the average monthly salary are the most important characteristics among those associated with medical cost-sharing for those aged 70 or more. A higher dependent ratio and a lower average monthly salary are related to higher cost-sharing. This is also related to geographic factors as cost-sharing in western Japan is higher than in eastern Japan. The lower rate of those aged 70 or more and the higher average age of the Society members are related to the higher cost-sharing.

Aged↗

The genotypic distribution of shared-epitope DRB1 alleles suggests a recessive mode of inheritance of the rheumatoid arthritis disease-susceptibility gene.

OBJECTIVE: To test whether the genotypic distribution of rheumatoid arthritis (RA)-associated DRB1 alleles suggests that the DRB1-associated disease-susceptibility gene has a recessive or additive (dominant) mode of inheritance. METHODS: Caucasian patients with RA and control subjects were recruited from a faculty outpatient practice. DRB1 typing was done by several DNA-based techniques: polymerase chain reaction (PCR), followed by dot-blot hybridization with sequence-specific oligonucleotides, conventional and PCR-based restriction fragment length polymorphisms (RFLPs), and a multiplex amplification-refractory mutation RFLP system. The genotypic distribution of shared-epitope DRB1 alleles was analyzed by antigen genotype frequency among patients. The analytical method postulates a linkage-disequilibrium model with a disease locus close to a marker locus and a marker allele in linkage disequilibrium with the disease-susceptibility allele. In this instance, the marker allele was defined alternatively by any DR4-group allele, by any DR4-group or DR1-group allele, by any DR4-group shared-epitope allele, by any DR4-group shared-epitope allele plus DRB1*0101, or by any shared-epitope DRB1 allele. Observed numbers were compared with those predicted for recessive mode or additive (dominant) mode of inheritance of the DRB1-associated RA disease-susceptibility gene. RESULTS: The genotypic distribution of shared-epitope DRB1 alleles (DRB1*0401, *0404, *0405, *0408, *0101, *0102, or *1001) fit that predicted for a recessive mode of inheritance and was significantly different from that predicted for an additive (dominant) mode. When the analysis was restricted to shared-epitope DR4 alleles alone (DRB1*0401, *0404, *0405, or *0408), the observed genotype numbers fit the recessive mode best. When DR1-group alleles were added to DR4-group alleles, or alternatively, when the major shared-epitope DR1 allele (*0101) was added to DR4-group shared-epitope alleles, there was a less significant deviation from the additive mode of inheritance. The reason for this was derived by comparison of observed genotype frequencies to those expected under Hardy-Weinberg equilibrium; there was a deficit of persons with DRB1*0401, *0101 and an excess of *0101,X. CONCLUSION: The genotypic distribution of shared-epitope DRB1 marker alleles suggests that the mode of inheritance of the DRB1-associated disease susceptibility gene must be recessive and not additive (dominant).

Adult↗

Economic implications of shared care arrangements. A primary care based study of patients in an inner city sample.

BACKGROUND: Providing care for people with serious and enduring mental health problems has been prioritised in a number of countries. It has been recognised that good liaison between primary and secondary care services is required for care to be effective. However, little is known about the resource implications of different levels of 'shared care'. The aim of this study is to compare service use and costs of different levels of shared care between primary and secondary care services. METHOD: Service use data were collected at baseline and one year later for participants with severe mental illness and costs were calculated. Levels of shared care were categorised into low, medium and high tertiles. Comparisons were made between the groups using multivariate analysis to control for participant characteristics. RESULTS: Participants receiving a low level of shared care used residential care less and were less likely to have contacts with a psychiatrist or social worker than those receiving medium or high levels of shared care. Mean costs for a low level of shared care were significantly lower than for a medium level (a difference of pound 2606, 90% CI pound 452 to pound 4923), but not significantly lower than for a high level of shared care (difference of pound 1867, 90% CI- pound 287 to pound 3903). CONCLUSION: Different levels of shared care are associated with different patterns of service use, with greater resource consumption associated with a medium level of shared care. Further work is required to investigate the causal links between integrated care and service use and costs.

Follow-Up Studies↗

Force-sharing between cat soleus and gastrocnemius muscles during walking: explanations based on electrical activity, properties, and kinematics.

Studying force sharing between synergistic muscles can be useful for understanding the functional significance of musculoskeletal redundancy and the mechanisms underlying the control of synergistic muscles. The purpose of this study was to quantify and explain force sharing between cat soleus (SO) and gastrocnemius (GA) muscles, and changes in force sharing, as a function of integrated electrical activity (IEMG), contractile and mechanical properties, and kinematics of the muscles for a variety of locomotor conditions. Forces in SO and GA were measured using standard tendon force transducers of the 'buckle' type, and EMGs were recorded using bipolar, indwelling fine wire electrodes. Muscle tendon and fiber lengths, as well as the corresponding velocities, were derived from the hindlimb kinematics, anthropometric measurements, and a muscle model. In order to describe force- and IEMG-sharing between SO and GA, SO force vs GA force and SO IEMG vs GA IEMG plots were constructed. Force- and IEMG-sharing curves had a loop-like shape. Direction of formation of the loop was typically counterclockwise for forces and clockwise for IEMG; that is, forces of GA reached the maximum and then decreased faster relative to forces of SO, and IEMG of SO reached the maximum and then decreased faster relative to IEMG of GA. With increasing speeds of locomotion, the width of the force-sharing loops tended to decrease, and the width of the IEMG-sharing loops increased. Peak forces in GA muscle and peak IEMGs in SO and GA muscles tended to increase with increasing speeds of locomotion, whereas peak SO forces remained nearly constant for all activities. Because of these changes in the peak forces and IEMGs of SO and GA, the slope of the force-sharing loop decreased, and the slope of the IEMG-sharing loop did not change significantly with increasing speeds of locomotion. Length changes and velocities of SO and GA increased with the speed of locomotion and were similar in absolute magnitude for both muscles at a given speed. However, SO tended to work consistently closer than GA to the optimal length for all activities. The normalized velocities of elongation and shortening of SO fibers were consistently larger than those of GA, and the differences in these velocities increased as the speed of locomotion increased.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

Enabling the sharing of neuroimaging data through well-defined intermediate levels of visibility.

The sharing of neuroimagery data offers great benefits to science, however, data owners sharing their data face substantial custodial responsibilities, such as ensuring data sets are correctly interpreted in their new shared context, protecting the identity and privacy of human research participants, and safeguarding the understood order of use. Given choices of sharing widely or not at all, the result will often be no sharing, due to the inability of data owners to control their exposure to the risks associated with data sharing. In this context, data sharing is enabled by providing data owners with well-defined intermediate levels of data visibility, progressing incrementally toward public visibility. In this paper, we define a novel and general data sharing model, Structured Sharing Communities (SSC), meeting this requirement. Arbitrary visibility levels representing collaborative agreements, consortium memberships, research organizations, and other affiliations are structured into a policy space through explicit paths of permissible information flow. Operations enable users and applications to manage the visibility of data and enforce access permissions and restrictions. We show how a policy space can be implemented in realistic neuroinformatic architectures with acceptable assurance of correctness, and briefly describe an open source implementation effort.

Academies and Institutes↗

Interaction between bed sharing and other sleep environments during the first six months of life.

This investigation was carried out to determine the relationship between bed sharing and other places of infant sleep in the first six months of life, and to identify patterns of change in the place of infant sleep for infants who do and do not routinely bed share in the first six months of life. The sleep--wake behaviour and place of infant sleep were recorded, at weekly intervals, for bed sharing (n=25) and non-bed sharing (n=68) infants between 2 and 24 weeks after birth. Bed sharing infants spent a significantly increased proportion of their total sleep time per 24 h in other sleep environments which favoured close parental proximity and significantly less time in solitary sleep. Non-bed sharing infants spent a substantial proportion of their time sleeping alone from 2 weeks of age whereas the transition to sleeping alone occurred after 16 weeks for bed sharing infants. We have found that bed sharing acts as a proxy for increased close parental proximity during the first six months of life. This may be of significance in studies which examine the relationship between bed sharing and sudden infant death syndrome.

Adolescent↗

Egg sharing and egg donation: attitudes of British egg donors and recipients.

The question of payment to egg donors has recently focused the attention of both the Human Fertilisation and Embryology Authority (HFEA) and licensed clinics. An acute shortage of egg donors and the rising costs of assisted conception treatment are matters of grave concern to many patients. To understand the emotional and social effects of egg sharing and egg donation, we conducted a survey of attitudes in a group of women who had some knowledge or experience of egg donation. A total of 750 questionnaires were sent out of which 217 were returned within the specified time limit. From these, 107 respondents had experience of egg donation and 110 had made enquiries about donation. The data from these questionnaires were collated and tabulated by the National Opinion Polls (NOP) Research Group. An analysis of the data produced the following key findings: (i) donating or sharing eggs is a social issue, 94% discuss it with partners/family/friends; (ii) altruistic motives are not the prerogative of non-patient volunteers-egg share donors felt that helping the childless was as important as having a chance of in-vitro fertilization (IVF) for themselves; (iii) the treatment procedure causes the most anxiety for egg donors. The recipients were most concerned about delays, donor characteristics and how the eggs were allocated; (iv) most respondents (65%) with prior experience of egg sharing would do it again - 63% of egg share donors, 72% of egg share recipients; (v) cash rewards to egg donors and outright advertising for donors were rejected by 64 and 62% of the sample respectively; and (vi) counselling was highly valued and there were no instances of 'shattered lives' after treatment. The findings do not support the recently announced intentions of the HFEA to disallow payment to gamete donors on the grounds of devalued consent. There is no precedent in modern medicine for egg sharing. The patients surveyed drew a clear distinction between egg sharing and financial rewards. As long as egg donation is not covered by the National Health Service, it is fairer to offer egg sharing than to refuse treatment to those unable to pay.

Adult↗