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PubMed1997

The influence of posttreatment mutual help group participation on the friendship networks of substance abuse patients.

The effect of 12-step mutual help groups (e.g., Narcotics Anonymous) on members' friendship networks has received little attention. This 1-year longitudinal study examined such effects in a sample of 2,337 male substance abuse inpatients, 57.7% of whom became significantly involved in 12-step activities (e.g., reading program literature, attending meetings) after treatment. An a priori model of the interplay of 12-step involvement) and friendship networks was tested using structural equation modeling, and found to have excellent fit to the data. Twelve-step group involvement after treatment predicted better general friendship characteristics (e.g., number of close friends) and substance abuse-specific friendship characteristics (e.g., proportion of friends who abstain from drugs and alcohol) at follow-up. Results are discussed in terms of how mutual help group involvement benefits patients and how the self-help group evaluation paradigm should be broadened.

Adult↗
PubMed1999

CRITICA: coding region identification tool invoking comparative analysis.

Gene recognition is essential to understanding existing and future DNA sequence data. CRITICA (Coding Region Identification Tool Invoking Comparative Analysis) is a suite of programs for identifying likely protein-coding sequences in DNA by combining comparative analysis of DNA sequences with more common noncomparative methods. In the comparative component of the analysis, regions of DNA are aligned with related sequences from the DNA databases; if the translation of the aligned sequences has greater amino acid identity than expected for the observed percentage nucleotide identity, this is interpreted as evidence for coding. CRITICA also incorporates noncomparative information derived from the relative frequencies of hexanucleotides in coding frames versus other contexts (i.e., dicodon bias). The dicodon usage information is derived by iterative analysis of the data, such that CRITICA is not dependent on the existence or accuracy of coding sequence annotations in the databases. This independence makes the method particularly well suited for the analysis of novel genomes. CRITICA was tested by analyzing the available Salmonella typhimurium DNA sequences. Its predictions were compared with the DNA sequence annotations and with the predictions of GenMark. CRITICA proved to be more accurate than GenMark, and moreover, many of its predictions that would seem to be errors instead reflect problems in the sequence databases. The source code of CRITICA is freely available by anonymous FTP (rdp.life.uiuc.edu in/pub/critica) and on the World Wide Web (http:/(/)rdpwww.life.uiuc.edu).

Algorithms↗
PubMed2005

The impact of male-to-male sexual experience on risk profiles of blood donors.

BACKGROUND: Men who have had sex with men (MSM) since 1977 are permanently deferred from donating blood. Excluding only men who engaged in male-to-male sex within either the prior 12 months or 5 years has been proposed. Little is known about infectious disease risks of MSM who donate blood. STUDY DESIGN AND METHODS: Weighted analyses of data from an anonymous mail survey of blood donors were conducted to examine the characteristics of men reporting male-to-male sex during specified time periods. RESULTS: Of the 25,168 male respondents, 569 (2.4%) reported male-to-male sex, 280 (1.2%) since 1977. Compared to donors who did not report male-to-male sex, the prevalence of reactive screening test results was higher among donors who reported the practice within the past 5 years (< or =12 months odds ratio [OR] 5.3, 95% confidence interval [CI] 2.6-10.4; >12 months to 5 years, OR 7.1, 95% CI 1.2-41.7); however, no significant difference was found for donors who last practiced male-to-male sex more than 5 years ago (>5 years-after 1977, OR 1.4, 95% CI 0.7-2.6; 1977 or earlier, OR 1.6, 95% CI 0.7-3.7). The prevalence of unreported deferrable risks (UDRs) other than male-to-male sex was significantly higher for all donors who reported male-to-male sex with ORs ranging from 3.1 to 18.9 (p < or = 0.01). CONCLUSIONS: No evidence was found to support changing current policy to permit donations from men who practiced male-to-male sex within the past 5 years. For donors with a more remote history of male-to-male sex, the findings were equivocal. A better understanding of the association between male-to-male sex and other UDRs appears needed.

Blood Banks↗
PubMed2005

Comparative study of drug use among undergraduate students at the University of São Paulo--São Paulo campus in 1996 and 2001.

OBJECTIVE: To compare the rate of drug use prevalence and to investigate opinions regarding such use among undergraduate students at the University of São Paulo--São Paulo campus in 1996 and again in 2001. METHODS: Both studies followed the same procedures of sampling and data collection. A random sample of undergraduate students, divided into the areas Humanities, Exact Sciences and Biologic Sciences, responded to an anonymous and self-report survey regarding the use of licit and illicit drugs within the last 30 days, within the last 12 months and over the lifetime of the subject. The two surveys were compared through the construction of (95%) confidence intervals for the prevalence differences for each substance by area and by total number of students. The Wald test for homogeneity was applied in order to compare the prevalences. RESULTS: High approval of regularly trying and using cocaine, crack, amphetamines and inhalants was observed. The drugs that showed statistic significant increasing were:lifetime use: alcohol, tobacco, marijuana, inhalants, hallucinogens, amphetamines, anti cholines, barbiturics and any illicit drug;last-12-month use: marijuana, inhalants, amphetamines, hallucinogens and any illicit drug;last-30-day use: marijuana, inhalants, amphetamines and any illicit drug. DISCUSSION: The observed difference in the use of some drugs between the two surveys appears to be a consequence of the higher rates of favorable opinions regarding trying and regularly using some psychoactive substances, a finding that mirrors global trends in drug use.

Adult↗
PubMed1991

[Anonymous and free-of-charge detection of human immunodeficiency virus infection. 20-months' experience at a center].

The results of 20 months' activity of the anonymous and free-of-charge detection centre of the Pitié-Salpêtrière hospital group, Paris, concerning human immunodeficiency virus infection (HIV) are presented. During that period, 3,480 persons consulted and 3,332 anonymous questionnaires were filled and returned: 20.5 percent of the subjects were homosexuals, 6.5 percent were drug-addicts and 73 percent were non drug-addict heterosexuals; 31 percent used condoms. A total of 3,398 blood samples were collected; 232 sera were positive or undetermined for HIV-1 and/or HIV-2 by the ELISA method; 132 Western Blot tests confirmed the positivity for HIV-1 but not for HIV-2. The overall serum positivity was 4 percent; 18.3 percent of drug-addicts, 9.5 percent of homosexuals and 0.9 percent of heterosexuals were HIV positive. Among seropositive subjects, 51 percent were homosexuals, 27 percent were drug-addicts, 4 percent were homosexual drug-addicts and 18 percent were heterosexuals (43 percent of these had had multiple partners); condoms were used by 59 percent of HIV positive subjects. The percentage of HIV positive subjects in our series was lower than that estimated in populations at risk (drug-addicts 50 percent, homosexuals 32 percent); it was similar to the percentages found in other detection centres (5 to 6 percent). Most seropositive patients belong to the category of persons who are the first to be struck by HIV. The heterosexual population is relatively spared, but most of the recent seroconversions have occurred in this group.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Seroprevalence of HIV infection in childbearing women in Nova Scotia.

OBJECTIVE: To determine the prevalence of HIV-1 infection in childbearing women in Nova Scotia. DESIGN: An anonymous, unlinked seroprevalence study using "leftover" cord bloods. The study was done in 2 stages: I-Halifax Co. women delivering between February 1, 1992 and December 31, 1993; II-non-Halifax Co. women delivering between November 15, 1993 and December 15, 1994. RESULTS: Of 9,115 deliveries during stage I and 5,515 during stage II, specimens were tested from 8,864 (97.2%) and 5,219 (95%) respectively. Halifax Co. women were older, more often married and more often reported a STD than the non-Halifax Co. participants with 20% under age 20 reporting a history of STD. There was one EIA and WB positive result among Halifax Co. women (seroprevalence 1/10,000; 95% CI 0.03-6.29) and one EIA positive, WB indeterminant result among non-Halifax Co. women (seroprevalence 0/10,000; 95% CI 0-5.7). CONCLUSION: There is a low prevalence of HIV infection among Nova Scotia childbearing women. However, a substantial number, especially those < age 20, reported a history of STD.

Acquired Immunodeficiency Syndrome↗
PubMed1998

The effect of microgravity on testicular androgen secretion.

BACKGROUND: Spaceflight causes a number of physiological changes in the human body. Most would consider space travel to be a stressful event even for well-trained astronauts. Should this be true, pituitary gonadotrophins (mainly LH) and testicular androgens, like testosterone (T), should decrease inflight in male astronauts. We therefore hypothesized that lowered testicular androgen levels might occur in men during spaceflight, due to stress-dependent lowered LH concentrations. METHODS: In order to test this hypothesis, on different day pre-, in- and postflight we assayed wake-time salivary and urinary T in four astronauts, as well as wake-time plasma levels of adrenocorticotropin (ACTH), cortisol (CS), LH, T and its peripherally active metabolite 3-alpha-diol glucuronide (3ADG). In order to compare clinical to subjective data, all 7 male crewmembers anonymously answered a daily questionnaire from pre- to postflight asking them to self-rate sexual drive and potency, muscle strength and mood. RESULTS: Salivary, urinary and plasma T, as well as 3ADG, decreased during flight, while LH unexpectedly increased inflight (p < 0.05). A parallel decrease in sexual drive was observed (p < 0.05). A dramatic recovery of salivary T was found on R + 1. CONCLUSIONS: This was the first time that spaceflight was demonstrated to cause temporary, still dramatic hypoandrogenism which was not due to blunted pituitary gonadotrophin secretion. The cause for hypoandrogenism is unknown but it may depend on fluid shift affecting testicular function or androgen distribution in various body compartments.

Adult↗
PubMed1999

Blood testing in biathlon: observation of hematocrit values during competitive periods 1994-1997.

The International Biathlon Union, through its own Medical Commission, has undertaken a three-year program aimed at identifying the hematocrit levels of athletes who participate in biathlons. The purpose was to check for hematocrit levels exceeding normal physiological values as well as for any significant modifications within individuals during the course of the competitive season. All of the athletes registered in international biathlon races were, therefore, subjected to venous blood sampling (1 cc) three times a year prior to competition, in the days preceding two World Cup races (December and January) and the World Championships (February). The blood was centrifuged, the micro-hematocrit determined, and the value (rendered anonymous) recorded. This procedure was repeated for three consecutive competitive seasons (Dec. 1994-Feb. 1995, Dec. 1995-Feb. 1996, Dec. 1996-Feb. 1997). During this three-year period, the collected data showed a significant lowering of the average hematocrit level. In fact, from the first February sampling to the third February sampling, the average hematocrit value for the male population dropped from 48.04 +/- 2.36 to 46.33 +/- 1.91, and for the female population from 44.05 +/- 2.44 to 42.52 +/- 1.92. Even the distribution of the absolute hematocrit values was modified from the first to the third competitive season, especially for the February sampling, with a > or = 50% reduction for males and a > or = 48% reduction for females.

Adolescent↗
PubMed2004

[Effect of the Training Program at Occupational Health Training Center (OHTC) on the attitude of occupational health residents].

University of Occupational and Environmental Health (UOEH) conducts three courses in postgraduate education of occupational health (OH). Graduates of UOEH who have already received a basic education in OH can participate in any course and are trained to play an appropriate role as an occupational physician (OP). We operate the training program to provide practical knowledge and skills as well as to encourage interest in occupational health and to promote a further understanding of the role of the OP. In this study we evaluated changes in attitude of participants and the effectiveness of our program by an anonymous questionnaire. The subjects were all 19 participants of the 3-month program conducted between September 2003 and February 2004 as a part of the postgraduate education following several years of clinical experience. They were expected to be occupational physicians with a clinical specialty. The data were collected from questionnaires handed out at the beginning and the end of the program. The questionnaire included 8 items on the attitude toward occupational health. The subjects answered the questions according to a scale of 1 to 7. Data analysis was performed using the unpaired t-test by SPSS. The results suggested that our training program had a positive effect on trainees. Interest in occupational practice (P < 0.05) and willingness to act as a full-time occupational physician in a large company (P < 0.05) increased significantly. When considering the positive correlation between willingness to act as an OP and interest in a field that has some overlap between the speciality and occupational health, it was thought that developing a vision as an OP with respect to their career was important for training. However, in some clinical fields it may be difficult to define a relationship between the clinical speciality and occupational health. Understanding the role of an OP (P < 0.05) and self-confidence in playing an appropriate role as an OP (P < 0.05) also showed significant improvement. On the other hand, fourteen of the trainees (74%) did not have enough confidence to play a role as an OP even after completion of the program. In this study, the questionnaire we used was anonymous and did not include items concerning various attributes of the subjects. Therefore it was not possible to analyze changes of attitude at the individual level. We recognize the need to improve the program and are preparing a new version of the educational program with emphasis on understanding company organization activities and practical skills for problem solving. Opportunities to consider association between clinical speciality and occupational health are also included in this new version. We hope that the new program will further encourage trainees.

Clinical Competence↗
PubMed2002

Development and psychometric properties of the Verona Service Satisfaction Scale for methadone-treated opioid-dependent patients (VSSS-MT).

We adapted the 32-item Verona Service Satisfaction Scale (VSSS-32) to assess opioid-dependent patient satisfaction with services received from methadone treatment centres. The preliminary version of the VSSS for methadone treatment (VSSS-MT) was filled out anonymously and completed by 516 randomly recruited patients. After exploratory factor analysis and item refinement, the definitive 27-item VSSS-MT accounted for 58.8% of the total variance, comprising four factors: Basic Interventions, Specific Interventions, Social Worker Skills, and Psychologist Skills. These factors showed good to excellent internal reliabilities (Chronbach's alpha: 0.91, 0.85, 0.87, and 0.92, respectively). At test-retest, intraclass correlation coefficients of VSSS-MT overall and factor scores were fair to good. The results of this study suggest that the VSSS-MT measures, briefly but also multidimensionally, opioid-dependent patient satisfaction with methadone treatment centres.

Adult↗
PubMed2001

HIV seroconverters: using surveillance to characterise people with incident HIV infection in Victoria, Australia.

This paper describes a cohort of people living in Victoria, Australia, diagnosed with incident HIV infection and identified through routine HIV surveillance. All HIV diagnoses notified to the Victorian HIV Registry between January 1997 and September 1998 were included. Infections were classified as incident if there was a prior negative test and/or seroconversion illness within 12 months of the first positive HIV test. During the study period there were 277 notifications received of which 70 (25%) were incident infections (seroconversions). People with incident infection were aged 36 years (+/- 10), from an Anglo background (76%) and living in Melbourne (91%). Seroconverters were more likely to have acquired their infection in Victoria (76%), through male-to-male sexual contact (86%), and from casual or anonymous partners (67%). Cohorts of individuals with incident HIV infection provide a valuable resource for understanding the dynamics of HIV acquisition and natural history of the infection.

Adult↗
PubMed2005

Chimpanzees are indifferent to the welfare of unrelated group members.

Humans are an unusually prosocial species-we vote, give blood, recycle, give tithes and punish violators of social norms. Experimental evidence indicates that people willingly incur costs to help strangers in anonymous one-shot interactions, and that altruistic behaviour is motivated, at least in part, by empathy and concern for the welfare of others (hereafter referred to as other-regarding preferences). In contrast, cooperative behaviour in non-human primates is mainly limited to kin and reciprocating partners, and is virtually never extended to unfamiliar individuals. Here we present experimental tests of the existence of other-regarding preferences in non-human primates, and show that chimpanzees (Pan troglodytes) do not take advantage of opportunities to deliver benefits to familiar individuals at no material cost to themselves, suggesting that chimpanzee behaviour is not motivated by other-regarding preferences. Chimpanzees are among the primates most likely to demonstrate prosocial behaviours. They participate in a variety of collective activities, including territorial patrols, coalitionary aggression, cooperative hunting, food sharing and joint mate guarding. Consolation of victims of aggression and anecdotal accounts of solicitous treatment of injured individuals suggest that chimpanzees may feel empathy. Chimpanzees sometimes reject exchanges in which they receive less valuable rewards than others, which may be one element of a 'sense of fairness', but there is no evidence that they are averse to interactions in which they benefit more than others.

Aging↗
PubMed2001

Formative self-assessment using multiple true-false questions on the Internet: feedback according to confidence about correct knowledge.

In undergraduate clinical courses, students are often dispersed over several teaching sites. Traditional curricula do not have mechanisms that allow monitoring of an individual student's educational progress or that of a small group of students at a teaching site relative to that of the whole group. To address these issues, we have developed a web-based formative assessment system that consists of knowledge tests based on multiple true-false questions. During the test, in addition to marking true or false against each question, students indicate their level of confidence (doubt or certainty) about each answer. The feedback consists of whether the answer is correct or incorrect and the confidence with which the student had responded. Feedback to students assesses their own performance in relation to that of their peers. Feedback to tutors provides anonymized information about the level of achievement of students at their teaching site relative to that of students at other sites. This systems has the tools that students can use to direct their learning and tutors can use to tailor their teaching in the light of the instantaneously available comparative feedback.

Journal Article↗
PubMed1995

External quality assessment programs in Lombardy, Italy.

In Italy, although a national decree (DPCM of 10/2/84) established that quality control programs involving clinical laboratories should be carried out on a regional basis, external quality assessment schemes (EQAS) are actually run only in some regions. Among these is Lombardy, where an EQAS in clinical chemistry concerning 20 analytes was set up in 1986, and where at present EQA programs (for clinical chemistry, haematology and coagulation) compulsory for both private and public laboratories, are under way. This was made possible by both regional laws and the constant care shown by the regional Committee on pathology department system (Comitato Regionale per l'Ordinamento dei Servizi di Patologia, CROSP). The participation in the schemes (including control material supply) is free of charge. The identity of participants is known only to officers in charge of quality control and analytical results are therefore managed anonymously. Consequently EQAS carried out in Lombardy are not exacting or punitive. In the EQAS for clinical chemistry the following analytes are considered: glucose, urea, proteins, albumin, chloride, sodium, potassium, total calcium, inorganic phosphate, iron, urate, creatinine, cholesterol, triglycerides, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, creatine phosphokinase, gamma glutamyl transferase and alkaline phosphatase. In the EQAS for haematology and coagulation the tests are: a) leukocytes, erythrocytes, haemoglobin, haematocrit, mean cell (erythrocyte) volume, platelets; b) prothrombin time, activated partial thromboplastin time, fibrinogen and antithrombin III. The general organization of the schemes, the statistical procedures adopted for the analysis of data, and some of the results obtained in the three EQA programs are reported in detail in the present article.

Chemistry, Clinical↗
PubMedDate not supplied

Women's use of resources in decision-making for early-stage breast cancer: results of a community-based survey.

BACKGROUND: The majority of women with stage I/II breast cancer may choose between mastectomy and breast-conserving therapy (BCT). A survey was designed to examine the resources women used in making this decision. METHODS: From 1990 to 1994, 261 patients were diagnosed with or treated for stage I/II breast cancer at Washington Hospital (Fremont, CA). One-hundred seventy-six surviving patients received a questionnaire asking them to anonymously rank various medical and nonmedical persons, audio and visual materials, and decision criteria on a 5-point scale with regard to their influence on that individual's choice to undergo BCT or mastectomy. The BCT and mastectomy groups were similar demographically; approximately 50% were college-educated. Statistical significance of the difference in means between groups was assessed with the t test. The response rate to the survey was 65%. RESULTS: The average survey ranking was > 1.0 for the following: surgeon (4.5), primary care physician (2.8), spouse (2.4), radiation oncologist (1.7), medical oncologist (1.5), American Cancer Society brochure (1.4), and children (1.2). The ranking of children (p = 0.08), friends (p = 0.08), parents (p = 0.09), and spouse (p = 0.13) was higher in the mastectomy group; the ranking of the radiation oncologist (p = 0.001) and ACS brochure (p = 0.03) was higher in the BCT group. The majority of patients consulted only with the surgeon (96%), primary care physician (64%), and spouse (55% overall, 75% among married patients) before making a treatment choice. Decision criteria were ranked as follows: chance for cure (4.5), physician recommendation (3.7), potential side effects (1.7), cosmetic appearance (1.3), sexual attractiveness (1.1), treatment convenience (1.0), and desire to avoid mastectomy (1.5). Desire to avoid mastectomy was higher in the BCT group (p < 0.0001); ranking of chance for cure was higher in the mastectomy group (p = 0.12). Overall satisfaction was higher in the BCT group; 87% of these patients were "very satisfied" with their decision versus 68% for the mastectomy group (p = 0.005). Review of the admitting records for 125 patients treated with mastectomy indicated that 46% had clear medical or personal contra-indications to BCT, but that the remainder might have benefitted from specialty consultation. CONCLUSIONS: The surgeon's recommendation and the patient's perception of chance for cure were the most influential factors affecting treatment decision. There was a limited use of specialty consultation or written and audiovisual materials in this educated patient population. The survey results suggest potential areas of intervention to improve rates of BCT, namely use of up-front multidisciplinary evaluation, further education of primary care physicians, and greater attention to concerns of family members.

Adult↗
PubMed1993

Substance use among adolescents with diabetes mellitus: preliminary findings.

Alcohol and drug use frequency was assessed by means of an anonymous, self-administered questionnaire in 79 diabetic adolescents who attended a diabetic sleep away camp. More than half of the participants reported using tobacco or alcohol at least once and 12%-25% reported greater that five times use in their lifetime. The overall frequency of drug and alcohol use was less than the general adolescent population. A modified Michigan Alcohol Screening Test (MAST) was used to evaluate abnormal drinking patterns, and 40%-50% of 12- and 16-year-old campers had an abnormal score, indicating that almost one-quarter of diabetic teens drink dangerously. There was a high correlation between campers who use drugs or alcohol and a positive family history of alcohol or substance abuse. Few campers perceived alcohol or drug use to affect their diabetic control, and the majority believed their control to be good to excellent, thus demonstrating the impact of denial in diabetic adolescent substance use. Adolescent diabetic assessments should include a psychosocial history, with emphasis on patterns of substance use, family substance abuse, and use of the MAST to identify high-risk individuals.

Adolescent↗
PubMed2002

Coital status and perceptions about sexual abstinence refusal skills.

PURPOSE: To compare perceptions and use of sexual refusal skills. METHODS: A voluntary, anonymous sample of ninth and tenth grade students (N = 2256) reported their perceptions about and use of sexual refusal skills that had been taught in school. Forty-four percent of the students classified themselves as virgins, 18% reported one sexual partner, and 38% reported multiple sex partners. Coital status groups were compared on measures addressing refusal skills using Chi-square tests. RESULTS: Approximately one-third of the students reported using refusal skills either a lot or a little, with virgins more likely to indicate that they used refusal skills a lot. Virgins also were least likely to say that they should have used the refusal skills or that they didn't feel like using refusal skills. Furthermore, virgins were most likely to state that they didn't need to use refusal skills. One partner and multiple partner groups were more likely to indicate that they had not been taught refusal skills. CONCLUSIONS: The majority of students did not use the refusal skills taught to them in school; however, all coital status groups used the refusal skills in some capacity. Differences between the virgin and sexually experienced groups present challenges for instructors and curriculum developers. Some of the commonly held assumptions about refusal skill curricula may not be true.

Adaptation, Psychological↗
PubMed2000

Families from assisted conception: ethical and psychological issues.

This article gives the findings of an in-depth study of the outcome for parents and children after assisted conception, namely in vitro fertilization and donor insemination. The study is of 54 families bringing up 110 children, 74 of whom were the result of these two medical interventions. The findings presented in this article deal specifically with the psychological issues and ethical dilemmas experienced by the parents of these two groups. Specific areas regarding in vitro fertilization are use of the term 'test-tube baby'; religious and community attitudes to the use of assisted reproductive technology; and the effects of these attitudes on the families. The major issue of multiple births and their social outcomes is dealt with in the following article. The specific areas for donor insemination families are secrecy and reticence about the whole procedure; infertility as a continuing taboo subject; donor anonymity; and the resulting effect of donor anonymity on parenting children who do not have access to their full health and genetic family history. Reference is made to the findings of other relevant research. Practice and legal implications from the findings are presented.

Journal Article↗