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[Analysis of German language consumer information brochures on screening for colorectal cancer].

A total of 17 consumer brochures that deal with the screening for colorectal cancer were analysed by two independently working researchers. The aim was to assess the quality of the information as a basis for evidence-based informed decision making using pre-defined evaluation criteria. No brochures fulfilled the necessary criteria. In most brochures there was a lack of transparency of the information process. No data was provided for estimating individual risks of colorectal cancer morbidity or mortality. With respect to the efficacy of screening no data was provided about relative or absolute risk reductions, number needed to screen, number needed to harm, predictive rates and false positive rates. In conclusion, presently available information brochures in Germany do not allow informed decision-making by consumers.

Colonic Neoplasms↗

Smoking behavior and views of Jordanian dentists: A pilot survey.

OBJECTIVE: The purpose of this study was to examine tobacco use among Jordanian dentists and their views on smoking. STUDY DESIGN: In July 1999, a self-reported questionnaire survey was mailed to a representative sample of 849 of 1693 licensed general dentists. The data were analyzed by using the Statistical Package for the Social Sciences (Chicago, Ill), and the statistical significance was determined by means of the chi(2) test. RESULTS: A response rate of 72.2% (613) was obtained. Overall, two thirds of the respondents were men younger than 40 years of age who worked in the private sector. Current tobacco users made up 35% (215/613), the majority of whom smoked cigarettes, with 83% being daily smokers. One fifth of daily smokers said that they smoke 20 or more cigarettes per day. Of respondents, 86.8% agreed that dentists should be a nonsmoking role model, and 77% believed that they should be involved in tobacco cessation counseling. Only 38.3% thought that they could convince patients who smoke to quit. Nonsmokers were significantly more likely to respond positively to these questions. Most respondents (92.2%) reported that the harmful effect of tobacco on health is a good reason to motivate smokers to quit. Unfortunately, almost half of the respondents (46.7%) thought that dental treatment is more important than providing tobacco counseling, and those were significantly more likely to be from private practices. CONCLUSIONS: Despite the high proportion of general dentists who were current smokers, many hold positive views on the tobacco issue. An education program targeted at dentists in Jordan is needed to discourage them from using tobacco and to teach them tobacco-cessation techniques and behaviors to reduce use among their patients.

Adult↗

Geneticists and the biology of race crossing.

Geneticists in England and the United States clearly reversed their published remarks on the effects of race crossing between 1930 and 1950. The reversal occurred in two steps. First came the change in the 1930's from a condemnation of wide race crosses to an agnostic view. The second change, from the agnostic view to the belief that wide race crosses were at worst biologically harmless, took place during and shortly after World War II. The entire reversal occurred in the light of little new compelling data from studies of actual human race crosses. The lack of new data is unsurprising. Few geneticists wished to initiate experiments that took three human generations to complete. And controlled race crosses are hard to arrange, even with government grants. What might be more surprising was the willingness of geneticists to make such positive statements about race crossing when they had so little reliable genetic evidence. I interviewed or wrote to ten prominent geneticists who worked on human genetics between 1930 and 1950. Not one believed that new evidence on race crossing was the primary reason why geneticists changed their minds about the effects of race crossing. One plausible explanation, that the rise of "population thinking" (44) caused geneticists to change their minds, does not fit the evidence. Castle was no more of a "population" thinker than East, yet they differed radically in their conclusions about race crossing. What, then, did cause geneticists to change their minds? Most important was the revulsion of educated people in the United States and England to Nazi race doctrines and their use in justifying extermination of Jews. Few geneticists wanted to argue, as had the Nazis, that biology showed race crossing was harmful. Instead, having witnessed the horrible toll, geneticists naturally wanted to argue that biology showed race crossing was at worst harmless. No racist nation could misuse that conclusion. And geneticists did revise their biology to fit their feelings of revulsion. Geneticists' ideas about the related question of hereditary mental differences between races is perhaps undergoing a similar development to that seen earlier in their ideas about race crossing. In 1951, judging from the response to the Unesco second statement on race and comments in genetics literature, most geneticists agreed with Muller that races probably differed in significant average mental traits. By 1969, when Arthur Jensen advocated this view in his controversial article (45), most geneticists who spoke publicly on the issue had adopted an agnostic position. Knowledge of hereditary racial differences in IQ had scarcely changed since 1951, but society had changed considerably in racial attitudes. It will be interesting to see if during the next several decades geneticists will argue, on the basis of little additional evidence, that hereditary mental differences between races do not exist. I am not condemning geneticists because social and political factors have influenced their scientific conclusions about race crossing and race differences. It is necessary and natural that changing social attitudes will influence areas of biology where little is known and the conclusions are possibly socially explosive. The real danger is not that biology changes with society, but that the public expects biology to provide the objective truth apart from social influences. Geneticists and the public should realize that the science of genetics is often closely intertwined with social attitudes and political considerations.

Attitude↗

Fundamentals and possibilities of classification of occupational substances as developmental toxicants.

It is now widely accepted that describing and labeling of chemicals as developmental toxicants on a purely qualitative basis does not make sense. Agents possessing the potential to induce reproductive or developmental toxicity present a risk of human harm only under certain conditions. This critical fact cannot be properly communicated with a simple designation as "positive" or "negative". Rather, a number of parameters that deal with dose or concentration, frequency, duration and route of exposure must also be conveyed. Unsubstantiated blacklisting is equally counterproductive for preventive medicine as downplaying of the toxicity of chemicals. Gender-based restrictions on exposure at workplaces of women of child-bearing age are neither socially acceptable nor scientifically justifiable. Therefore, the German Commission for the Investigation of Health Hazards of Chemical Compounds in the Work Area published in 1983 a quantitatively based classification concept, which became effective in 1985 and was modified in the following years. The present contribution summarizes what is required for an integrated judgment on the relevance of laboratory and epidemiological data for predicting the potential risk associated with exposure at workplaces to occupational chemicals. Methyl mercury, carbon disulfide, dimethylformamide, ethanol, toluene, N,N-dimethyl acetamide, nitrous oxide, methanol, ethyl benzene, and phosphorus pentoxide will be described as examples of classified substances.

Abnormalities, Drug-Induced↗

Health researchers' views of ethics committee functioning in New Zealand.

AIMS: To find out, from the perspective of researchers, how ethics committees are dealing with matters of ethical concern in research on humans and to seek the views of researchers on their role in thinking through the ethical issues in research. METHODS: A sample of researchers was selected from the Health Research Council database of grant recipients. Information was sought, using a mailed questionnaire, in relation to essential elements of concern to ethics committees according to the 1996 National Standard, types of study undertaken, codes of practice, national application forms, multicentre review, aspects of committee function and the role of researchers. RESULTS: The response rate was 35/40 (87.5%). Approximately half the respondents commented favourably on most aspects of ethics committee functioning. Major criticisms were directed at the assessment of risks and benefits, scientific validity and handling of consent procedures. Consistent weaknesses in multicentre review, quality of advice and the composition of committees were noted. Positive aspects were: availability of chairpersons for discussion, the protection of vulnerable participants, the handling of the Health Information Privacy Code and the introduction of a national application form. Most researchers expected to take a major role in thinking through the ethical issues in their work. Half reported occasions where ethics committees had unnecessarily impeded research. CONCLUSIONS: The high level of commitment of researchers to ethics should be acknowledged by involving them more in guideline development and education. Perceived deficiencies in the range of expertise on ethics committees, particularly expertise to judge potential harms in experimental research, should be further investigated and addressed. Recommendations to improve the quality of ethical review include reducing the overload on committees by identifying categories of research which might not require full ethics committee review.

Ethics Committees↗

Conflicting messages: how criminal HIV disclosure laws undermine public health efforts to control the spread of HIV.

Twenty-three U.S. states currently have laws that make it a crime for persons who have HIV to engage in various sexual behaviors without, in most cases, disclosing their HIV-positive status to prospective sex partners. As structural interventions aimed at reducing new HIV infections, the laws ideally should complement the HIV prevention efforts of public health professionals. Unfortunately, they do not. This article demonstrates how HIV disclosure laws disregard or discount the effectiveness of universal precautions and safer sex, criminalize activities that are central to harm reduction efforts, and offer, as an implicit alternative to risk reduction and safer sex, a disclosure-based HIV transmission prevention strategy that undermines public health efforts. The article also describes how criminal HIV disclosure laws may work against the efforts of public health leaders to reduce stigmatizing attitudes toward persons living with HIV.

Criminal Law↗

The physician as fortune teller: a commentary on "The ethical justification for minimal paternalism.

...I shall summarize my argument to this point. 1) A new technology -- medicalizing life choices -- introduces additional sources of uncertainty into the physician-patient relationship. The implications for the authority-autonomy tension of that relationship are not fully worked out, as is evidenced by differing views on professional obligations. 2) The warrants for paternalism are complex, ranging from a pragmatic response in the face of uncertainty to a proactive, highly directive determination of the patient's best interests. 3) Although some proponents of autonomy argue that it entails positive rights to intervention and information, the "strong sense" of autonomy is not the prevailing view. 4) The as yet unclear benefits of knowledge about one's genetic makeup are even less clear in the case of HD. Strong circumstantial evidence of risks of harm from disclosure of unfavorable test results have not been dispelled by early experience with use of the HD test. 5) A cautious approach in the use of HD test seems warranted, even at the cost of restricting autonomy. Legitimating that approach by reference to traditional ethical theory is a necessary element in the transfer of the new technology to the wider clinical setting. 6) While PMP [the principle of minimal paternalism] attempts to offer such an approach, some questions do not appear to have been resolved or fully addressed by this formulation.

Altruism↗

Interleukin 1 inhibits T cell receptor-mediated apoptosis in immature thymocytes.

T cell receptor signaling has been implicated in an intrathymic process of cell selection in which potentially harmful autoreactive precursors are deleted before they emigrate to the periphery. Recent work has shown that immature thymocytes undergo apoptosis, or programmed cell death, upon stimulation via the T cell antigen receptor, and it has been suggested that this mechanism may mediate deletion of the self-reactive clones during T cell development. Here we report that the accessory cell-derived T cell growth hormone interleukin-1 prevents T cell receptor-mediated thymocyte apoptosis by a mechanism that appears to involve protein kinase C activation. This effect may be relevant to the positive signaling that spares the appropriate precursors during the generation of functional T lymphocytes.

Antibodies, Monoclonal↗

On assessment of shoulder exercise and load-elicited pain in the cervical spine. Biomechanical analysis of load--EMG--methodological studies of pain provoked by extreme position.

Biomechanical analyses of load on locomotor structures are essential parts of physical therapy. Load moments of force, compressive and shear joint forces are associated with the risk of eliciting pain or causing excessive load during work and leisure activities as well as during rehabilitative training exercises. Two common therapeutic exercise movements were analysed with special emphasis on the effects of patient positioning on the load relations. Resistance was provided by an ordinary pulley apparatus. A computerized static model was developed, where positioning angle, pulley cord force and pulley distance could be varied. The best adaptation between the curves for induced load moment about the shoulder joint and maximum isometric muscle moment through joint angles was obtained when the subject during internal rotation exercises sat with the pulley located 40 degrees anterior to, and during external rotation exercises 20 degrees posterior to, a frontal plane through the shoulders at a distance of 1.3 m from the joint. EMG was recorded from the pectoralis major, latissimus dorsi and anterior deltoid muscles during internal rotation exercises, and from infraspinatus, deltoid and trapezius during external rotation. Pectoralis major and infraspinatus were the most active muscles during internal and external rotation respectively. Two methodological studies were made concerning pain provoked by loading joints in maintained extreme positions (i.e. positions at the limit of the motion sector). Sensations of discomfort/pain from healthy elbow and knee joints maintained in an extreme position increased with duration of provocation and decreased slowly after removal of loading weight. Using such joint loadings, a comparison of the Visual Analogue Scale with Borg's category-ratio scale showed that both be can be used for reliable assessments of load-elicited pain intensity. In one study cervical spine extreme position was found to be associated with sitting work postures where the thoraco-lumbar spine was slightly inclined backwards or where the whole spine was flexed. Healthy subjects participated in an experimental study in which a position involving extreme flexion of the lower-cervical-upper-thoracic spine (similar to a common work posture) was maintained. Pain was experienced by all ten subjects within 15 minutes, disappeared 15 minutes after the end of provocation, but was again experienced by nine subjects the same evening or the next morning and lasted up to four days. Neck extensor muscle activity was low.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

Role of Id proteins in B lymphocyte activation: new insights from knockout mouse studies.

Id (inhibitor of differentiation) proteins play important roles in cell differentiation, cell cycle control, and apoptosis. They act as negative regulators of basic helix-loop-helix-type transcription factors, which positively regulate differentiation of various cell types. Id proteins work to block B lymphocyte (B cell) maturation at an early differentiation step, as demonstrated by gain-of-function studies. In recent years a series of gene-targeted mice lacking different Ids have been generated. Analyses of these gene-targeted mice provide information useful for understanding the physiological roles of Ids in B cell biology. Id3 is required for proper B cell functions and acts by controlling the cell cycle. Upon B cell activation, Id2 acts as a negative regulator to prevent potentially harmful effects brought about by excessive immunological reactions; one of its special roles is to maintain low serum concentrations of immunoglobulin E (IgE). The Id2 protein does this by antagonizing E2A and Pax5 activities, both of which are required for proper B cell activation. This review presents several new insights into B cell differentiation and activation programs and the physiological role of Id proteins in B cell activation.

Animals↗

Vaginal douching and associated factors among married women attending a family planning clinic or a gynecology clinic.

OBJECTIVE: The aim of this study was to determine the vaginal douching habits and associated factors of women attending two different healthcare clinics. STUDY DESIGN: This cross-sectional study was conducted between 1 and 31 May 2004. All participants were women (n=635) who attended either a university hospital gynecology clinic or a primary health care center family planning unit. One-way ANOVA, chi-squared test, and binary and multiple logistic regression analyses were used for the statistical evaluation of data. RESULTS: The mean age of the participants was 36.90+/-10.72 years (range: 18-75). Half of the participants believed vaginal douching had a positive effect on health. They believed vaginal douching demonstrates cleanliness, prevents infections and pregnancy, removes sperm following intercourse, a necessity of Islamic doctrine, and reduces symptoms like discharge, unpleasant odor, etc. Of the women, 50.2% performed vaginal douching. Vaginal douching was associated with age, education level, type of dwelling, working outside of the home, age at marriage, age at birth of first child, parity, spontaneous abortion, history of pelvic inflammatory disease, use of contraceptives, and attending a healthcare clinic. CONCLUSION: Douching is a common habit among Turkish women. Many women are not aware of the harmful effects of douching. Public health and health professionals should monitor more closely this traditional habit in Turkey.

Abortion, Spontaneous↗

[Drug addiction prevention in the workplace--feasibility study in a company from the chemical industry].

INTRODUCTION: In recent years drug prevention at the place of work has became increasingly important for programmes focussing on health promotion at the place of work. Drug prevention programmes aim at reducing cost and protecting the employees from physical harm. There are virtually no reliable figures from surveys in companies. To date intervention programme in companies have hardly been verified. In this feasibility study we intended to examine the practicability of an evaluation of an intervention programme in a large chemical company by means of questionnaires and we present preliminary intervention effects. METHODS: In the context of a pilot study we conducted and evaluated a drug prevention programme at the place of work. Focus was on illegal designer drugs. The programme was conducted as a one-day workshop for trainers in superior management positions. We used a feedback form and a detailed questionnaire on drug prevention in the working place. 41 trainers who participated in the seminar were compared with a control group of 12 trainers who did not participate. RESULTS: The intervention programme was well accepted by the participants. Follow-up data demonstrated, that participants in the seminar had far better knowledge of the employment agreement on addiction and drugs and of the possible ways to get help and they were far more active in realising the employment agreement. CONCLUSION: To achieve a long-term improvement of drug abuse in companies it is not enough to include and implement a passage on drug abuse and addiction in the employment agreement. Well-instructed trainers talk far often with colleagues displaying abnormal or addictive behaviour, resulting in more rapid therapeutic interventions.

Chemical Industry↗

Performance of screening instruments for alcohol problems in the ER: a comparison of Mexican-Americans and Mexicans in Mexico.

The performance of standard screening instruments and alternate measures against ICD-10 (International Classification of Diseases, 10th revision) and DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th revision) criteria for alcohol dependence and separately for harmful drinking/abuse were compared between probability samples of 1511 emergency room (ER) patients from three hospitals in Pachuca, Mexico, and 586 Mexican-American ER patients in Santa Clara County, California. Sensitivity was highest for the Alcohol Use Disorders Identification Test (AUDIT), TWEAK, and Rapid Alcohol Problems Screen (RAPS) for alcohol dependence; sensitivity was highest for holding five or more drinks for harmful drinking/abuse in both samples. All instruments performed better for alcohol dependence than for abuse/harmful drinking. Arrests for drinking and driving performed better in Santa Clara than in Pachuca, while a positive Breathalyzer reading and reporting drinking prior to the event performed better in Pachuca; both were significantly more sensitive among the injured compared to the noninjured in Pachuca. The data suggest that instrument performance may be similar between those in Pachuca and those in the low acculturation group in Santa Clara, relative to those scoring higher on acculturation. While standard screening instruments appear to work reasonably well in both samples for alcohol dependence, variation across gender, injury, and acculturation subgroups suggests attention should be given to choosing the "best" instrument.

Acculturation↗

Messing with bacterial quorum sensing.

Quorum sensing is widely recognized as an efficient mechanism to regulate expression of specific genes responsible for communal behavior in bacteria. Several bacterial phenotypes essential for the successful establishment of symbiotic, pathogenic, or commensal relationships with eukaryotic hosts, including motility, exopolysaccharide production, biofilm formation, and toxin production, are often regulated by quorum sensing. Interestingly, eukaryotes produce quorum-sensing-interfering (QSI) compounds that have a positive or negative influence on the bacterial signaling network. This eukaryotic interference could result in further fine-tuning of bacterial quorum sensing. Furthermore, recent work involving the synthesis of structural homologs to the various quorum-sensing signal molecules has resulted in the development of additional QSI compounds that could be used to control pathogenic bacteria. The creation of transgenic plants that express bacterial quorum-sensing genes is yet another strategy to interfere with bacterial behavior. Further investigation on the manipulation of quorum-sensing systems could provide us with powerful tools against harmful bacteria.

Bacteria↗

[European action plan on alcohol in the Czech Republic--no substantial progress].

Czech Republic joined European action plan on alcohol for years 2000 to 2004 and signed its accomplishment. However, since 2000 situation has worsened. Alcohol consumption raised in 2001 (the last known data) to 10.0 litters of 100% alcohol (that is 159.9 litters of beer, 8.2 litters of distillates and 16.2 litters of wine per person per year). The only positive aspect was the small rise of consumption tax in distillates and that some thesis of the European action plan on alcohol were included into the governmental document "Long-term improvement of the health status of the population in Czech republic--Health for everybody in the 21st century". The proclamation has had no practical effect. Highly adverse is the situation with alcohol consumption in children and adolescents, which was described in the last study. Risks related to the high alcohol consumption in Czech republic include: High incidence of alcohol related death, including children, adolescents and young people (injuries, traffic accidents, poisonings, suicides, liver and tumor diseases); higher morbidity; lower productivity at work and worse position of Czech workers in concurrent environment; worse reproduction health, higher incidence of inborn defects caused by alcohol taken during pregnancy (including its beginning, when women do not know it); frequent social and family problems caused by alcohol abuses; increased risk of consumption of non-alcoholic drugs in children and adolescents. Alcohol belong to throughway drugs and its consumption in early age represents for children and adolescents a risk factor for other addictive drugs; alcohol is related namely to violent and negligent delicts; flagrant alcohol excesses together with alcohol related criminality harm the prestige of Czech Republic to foreign visitors and can drive them back.

Alcohol Drinking↗

Constraints and blocks to change and improvement on acute psychiatric wards--lessons from the City Nurses project.

Recent years have seen sustained criticism and inspection of acute inpatient psychiatric wards, with the publication of reports and research leading to policy developments and a variety of efforts to improve perceived deficits. The City Nurses project seeks to reduce levels of conflict and containment on acute wards through the placement of expert nurses on wards to assist with the implementation of changes according to a working model of conflict and containment generation, based on previous research. Evaluation has shown significant decreases in aggression, absconding and self-harm by patients. However, in the course of working with the wards, various constraints and blocks to change have been identified and we describe these in detail in this paper. Analysis of the fieldwork diaries of the two City Nurses identified that change was hindered by limited staffing resources, problems with the physical environment and other resources, insufficient beds and the process of bed management, hierarchical ambiguity and multidisciplinary issues, the overdemanding role of the ward manager, and pervasive anxiety about the potential for serious untoward incidents and their implications for staff. We argue that sustained positive change in acute inpatient psychiatry requires these underlying structural issues to be both acknowledged and, if possible, resolved.

Acute Disease↗

[The experiences of resuming smoking among medical college students].

The aim of this qualitative study was to explore the experiences of medical college students who resume smoking and their needs and suggestions for assistance. Low-structured, in-depth, audiotaped interviews and were conducted of sixteen medical college students. The content analysis method was used to analyze the collected data. The major findings were: temptation from friends and social environment, uncontrollable addiction, negative consequences of, alongside positive expectations for smoking, and uncomfortable feelings of failure, etc. In order to prevent resumption of smoking, it's very important to teach quitters how to deal effectively with situations of high temptation, coping with stress, defensive restructuring of cognitions, and how to increasing their confidence and motivation. The government should raise cigarette prices, extend school and work place prohibitions on smoking, and strictly enforce its regulations. The government should also reduce the age for tobacco control education, and bring all ethnic groups within the scope of its smoking prevention policies in order to reduce the harm done to healthy people by smoking.

Adolescent↗

Impacts of computerized physician documentation in a teaching hospital: perceptions of faculty and resident physicians.

OBJECTIVE: Computerized physician documentation (CPD) has been implemented throughout the nation's Veterans Affairs Medical Centers (VAMCs) and is likely to increasingly replace handwritten documentation in other institutions. The use of this technology may affect educational and clinical activities, yet little has been reported in this regard. The authors conducted a qualitative study to determine the perceived impacts of CPD among faculty and housestaff in a VAMC. DESIGN: A cross-sectional study was conducted using semistructured interviews with faculty (n = 10) and a group interview with residents (n = 10) at a VAMC teaching hospital. MEASUREMENTS: Content analysis of field notes and taped transcripts were done by two independent reviewers using a grounded theory approach. Findings were validated using member checking and peer debriefing. RESULTS: Four major themes were identified: (1) improved availability of documentation; (2) changes in work processes and communication; (3) alterations in document structure and content; and (4) mistakes, concerns, and decreased confidence in the data. With a few exceptions, subjects felt documentation was more available, with benefits for education and patient care. Other impacts of CPD were largely seen as detrimental to aspects of clinical practice and education, including documentation quality, workflow, professional communication, and patient care. CONCLUSION: CPD is perceived to have substantial positive and negative impacts on clinical and educational activities and environments. Care should be taken when designing, implementing, and using such systems to avoid or minimize any harmful impacts. More research is needed to assess the extent of the impacts identified and to determine the best strategies to effectively deal with them.

Attitude of Health Personnel↗