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PubMedDate not supplied

[Acceptability of food supplements in pregnant or lactating women and children under 5 years of age].

OBJECTIVE: The present study explores the acceptance and consumption of nutritional supplements that form part of a governmental program to support nutritionally vulnerable groups. MATERIAL AND METHODS: Pregnant and lactating women, and mothers of malnourished toddlers, infants and children were interviewed. Data were collected, after introduction with an interview guide with an open-ended format, through face-to-face interviews conducted at home. Interviews were taped with previous informed consent. Analysis included topics and subtopics approached by the interviewed women. RESULTS: The studied population showed good acceptance to the supplement when offered as a drink. When considering benefits, pregnant women thought first of their baby's health than of their own and associated the possible advantages of the supplement to its "vitamin" contents. Acceptance of the flavors was largely influenced by previous contact to specific flavors. Children under 1 year of age preferred the liquid consistency and elderly children favored the puree. Most mothers considered that the offered amount was enough and there was the general impression that, as the time of the intervention elapsed, children showed greater appetite. The diet was not substituted by the supplement. CONCLUSIONS: Acceptance of the supplement may be improved by messages focusing on the well-being and health of the child and insisting on the benefits for the pregnant mother. Community health providers should be involved in supporting the program, recommending consumption and acceptance of the supplement. The identification by mothers of "vitamins" as part of the supplement may be used to reinforce the concept of beneficial effects associated to micronutrient supplementation. Qualitative evaluations should be performed as part of the assessment of community-based programs.

Child, Preschool↗

PubMedDate not supplied

The experiences of international nursing students in a baccalaureate nursing program.

International students, especially those with English as a second language (ESL), can have difficulty adjusting to university life in the United States and successfully completing the demands of a nursing program. The purpose of this qualitative study was to explore the perceptions and experiences of international nursing students in a baccalaureate nursing program. Eight female Nigerian nursing students aged 25 to 48 who had been in the United States from 5 to 20 years were interviewed. Most (75 per cent) had some prior college experience, but only two had a baccalaureate degree. The data was analyzed by using a multifunctional computer software program and three themes emerged: social isolation, resolved attitudes, and persistence despite perceived obstacles. Factors contributing to each theme explained how these students progressed from their social isolation to their resolved attitudes. Their progression was marked by an acceptance of antagonistic attitudes found in the program and their development of persistence despite perceived obstacles. Their persistence was the impetus to achieve their overall goal of graduating from the program. Implications for nursing faculty include assisting these students through social and academic transitions and nursing administrators' provision of fiscal and support resources to facilitate effective integration of international students into the nursing program and the community.

Adult↗

PubMed2001

An information-based sequence distance and its application to whole mitochondrial genome phylogeny.

MOTIVATION: Traditional sequence distances require an alignment and therefore are not directly applicable to the problem of whole genome phylogeny where events such as rearrangements make full length alignments impossible. We present a sequence distance that works on unaligned sequences using the information theoretical concept of Kolmogorov complexity and a program to estimate this distance. RESULTS: We establish the mathematical foundations of our distance and illustrate its use by constructing a phylogeny of the Eutherian orders using complete unaligned mitochondrial genomes. This phylogeny is consistent with the commonly accepted one for the Eutherians. A second, larger mammalian dataset is also analyzed, yielding a phylogeny generally consistent with the commonly accepted one for the mammals. AVAILABILITY: The program to estimate our sequence distance, is available at http://www.cs.cityu.edu.hk/~cssamk/gencomp/GenCompress1.htm. The distance matrices used to generate our phylogenies are available at http://www.math.uwaterloo.ca/~mli/distance.html.

Animals↗

PubMedDate not supplied

The application of laparoscopic bariatric surgery for treatment of severe obesity in adolescents using a multidisciplinary adolescent bariatric program.

The evolution of laparoscopic surgery has made bariatric surgery acceptable for weight loss; however, much controversy exists about its appropriateness for adolescents. Despite the controversial issues, the growing epidemic in adolescent obesity has resulted in rising numbers of applications for bariatric surgery. There are few bariatric surgical programs designed for adolescents. Pediatric settings face high start-up costs and poor reimbursement and lack established bariatric surgeons. Even so, bariatric surgery is increasingly being performed on adolescents in alarming numbers. To avoid adverse physical and psychosocial outcomes, the application of the principles of growth and development is essential. The program should be established as a multidisciplinary approach to management of adolescents and should be in institutions capable of meeting the guidelines for surgical treatment outlined by the American Society of Bariatric Surgery. To prevent postoperative complication, a multidisciplinary team of experienced medical and surgical specialists is needed for optimal preoperative decision making and postoperative management and long-term follow-up. Laparoscopic Roux-en-Y gastric bypass is a safe procedure and an effective means to treat obesity-related morbidity in the adolescent. Results have been excellent and justify a clinical trial to confirm the safety and efficacy of bariatric surgery in the adolescent population.

Adolescent↗

PubMed1982

The physician as a manager.

The practice of occupational medicine has undergone considerable change over the last decade. Increased awareness of potential health hazards associated with the workplace and its products and wastes, the interest of society and workers in these subjects, and related governmental regulation have resulted in expanded occupational health programs within industry. The occupational physician has become a key company resource in the optimal management of the business impacts of health-related issues. Health-related matters often have noteworthy business implications, and the occupational physician needs to spend considerable time as a manager in the planning, resourcing, implementation, evaluation, and stewardship of programs. Thus he is experiencing greater demands and often is inadequately prepared for this nonclinical, nonscientific role. Therefore, the preparation of occupational physicians to assume such managerial responsibilities needs to receive high priority. The physician must be willing to accept this challenge both to ensure the program's success and to retain a leadership position in occupational health programs.

Occupational Health Services↗

PubMed1985

Analysis of radioligand binding experiments. A collection of computer programs for the IBM PC.

It is now well accepted that graphic methods are a poor choice of analytical technique for analyzing radioligand binding data given the complexity of some radioligand-binding sites interactions; this is true not only for studies performed at equilibrium but also for those examining kinetic properties of the radioligand. As a consequence the computer plays an important role in all forms of radioligand binding experiments because it reduces the labor-intensive calculations associated with such experiments and it allows the use of more appropriate weighted nonlinear curve-fitting techniques that more accurately describe the radioligand-binding site interaction. This paper describes a collection of four programs (KINETIC, EBDA, LIGAND, and LOWRY) that can be used to analyze most forms of radioligand binding experiments. The programs have been adapted for use on an IBM PC, which is a popular, inexpensive microcomputer and which is well suited to the analysis of radioligand binding data.

Animals↗

PubMedDate not supplied

Potential factors that may affect acceptance of routine prenatal HIV testing.

BACKGROUND: Despite increasing advocacy for an "opt-out" strategy in routine prenatal HIV screening programs in Canada, no published studies have examined factors that may affect acceptance of prenatal HIV testing. METHODS: We included all pregnant women in Alberta who received prenatal care (N = 38,712) and their caregivers (N = 2,007) between January 1 and November 30, 2000. Factors associated with non-acceptance of HIV testing in both pregnant women and their caregivers were assessed using multivariate logistic regression. RESULTS: Overall, 1.5% of women declined HIV testing. First Nations women were about twice as likely to decline the test (adjusted odds ratio [OR(adj)] 1.91, 95% CI [1.42-2.58]) compared to non-First Nations women (p < 0.001). The proportion also increased with age (chi2 trend p < 0.001) in the general population. In First Nations women, however, most (3.2%) declined in the 20-24 year age group. No significant effect was seen for a socio-economic status marker or for the place of residence. The caregivers of women who declined HIV testing were more likely to be female (OR(adj) 1.56 [1.28-1.89]), midwives (OR(adj) 140.65 [58.61-337.49]), other non-obstetrical medical specialties (OR(adj) 4.92 [1.94-12.47]), and general practitioners (OR(adj) 3.44 [1.87-6.33]). CONCLUSION: In an "opt-out" routine prenatal HIV screening program, the characteristics of both the pregnant women and their caregivers may contribute to the non-acceptance of HIV testing. A higher likelihood of declining HIV testing among First Nations pregnant women and other pregnant women under the care of midwives and female physicians warrants further study.

AIDS Serodiagnosis↗

PubMed1992

How satisfaction with hospital field work affects social work students' willingness to accept employment in hospital settings.

This study of 238 social work students in 27 hospital field work programs examined how student satisfaction with field work affects their willingness to accept employment in host hospitals. Job willingness was positively correlated with five measures of student satisfaction. Factors predictive of each measure were identified. Findings suggest strategies that can be used by hospital social work managers and field work supervisors to enhance student satisfaction with the field work experience, in order to maximize the benefit of providing field work education as a way of recruiting graduating students for employment in hospital settings.

Adult↗

PubMed2001

Constructing a consensus-based prevention outcome measurement instrument.

This article describes Ohio's Prevention Evaluation Project (PEP). The purpose of the project was to develop a process and instrument to assess behavioral and attitudinal outcomes in primary drug abuse prevention programs targeting young people aged twelve to seventeen. One of PEP's principal achievements was the inclusion of community prevention program providers from throughout the state in the evaluation instrument development. The effort produced a self-administered questionnaire to capture data on young peoples' drug use practices, attitudes toward drugs, and problematic behaviors. Most significantly, the product produced was the acceptance and endorsement of community-based programs. The forty-one-item questionnaire has good to excellent reliability for virtually all measures, as assessed by the test-retest method. The instrument is a product of a process that brought together a university-based research team, state alcohol and drug abuse prevention administrators, and representatives of public programs. PEP demonstrates how to productively link service providers, administrators, and evaluators to develop a process for assessing the effectiveness of prevention programs. The process and tools described serve as a model for other communities wanting to evaluate their prevention programming.

Adolescent↗

PubMed2003

Self-assessment of tuberculosis infection risk by urban adolescents.

OBJECTIVE: To examine self-reported risks for tuberculosis (TB) infection relative to recalled receipt of TB risk assessments and skin testing in a cohort of urban adolescents. DESIGN, SETTING, AND PARTICIPANTS: Survey of ninth graders and their parents from 3 inner-city public high schools. Students and parents were asked about TB infection risk factors, frequency of routine health maintenance visits, TB risk assessments, and TB skin testing. Students were surveyed in schools and asked to take home surveys for their parents to complete. RESULTS: Of 578 students (95.4% response rate), 436 (75.4%) claimed at least 1 TB infection risk factor. Although 468 (81.0%) of the students reported having a regular checkup within the past year, only 128 (22.1%) recalled being asked TB risk assessment questions and only 231 (40.0%) recalled undergoing skin testing during the previous year. Parent response rates were low (n = 207; 34.2% response rate), and parents of students attending bilingual classes were overrepresented among responders. There were no significant relationships between self-indicating a risk for TB infection and self-recollection of having undergone TB screening, having had a tuberculin skin test placed, or having had a regular checkup, with the exception that students who responded that they lived with a tuberculin skin test-positive person were 38% less likely to recall having had a tuberculin skin test themselves (n = 21; 95% confidence interval, 24%-50%). The level of agreement between student and parent responses in the 207 survey pairs available for analysis ranged from poor to good (kappa = 0.07-0.61) on individual questions. CONCLUSIONS: These observations suggest that most at-risk adolescents in this city are not being adequately screened for TB infection. Programs to improve health care provider acceptance of targeted testing principles or to reengage in school-based screening of students with certain risk factors seem necessary.

Adolescent↗

PubMed2000

Physicians and the pharmaceutical industry: is a gift ever just a gift?

CONTEXT: Controversy exists over the fact that physicians have regular contact with the pharmaceutical industry and its sales representatives, who spend a large sum of money each year promoting to them by way of gifts, free meals, travel subsidies, sponsored teachings, and symposia. OBJECTIVE: To identify the extent of and attitudes toward the relationship between physicians and the pharmaceutical industry and its representatives and its impact on the knowledge, attitudes, and behavior of physicians. DATA SOURCES: A MEDLINE search was conducted for English-language articles published from 1994 to present, with review of reference lists from retrieved articles; in addition, an Internet database was searched and 5 key informants were interviewed. STUDY SELECTION: A total of 538 studies that provided data on any of the study questions were targeted for retrieval, 29 of which were included in the analysis. DATA EXTRACTION: Data were extracted by 1 author. Articles using an analytic design were considered to be of higher methodological quality. DATA SYNTHESIS: Physician interactions with pharmaceutical representatives were generally endorsed, began in medical school, and continued at a rate of about 4 times per month. Meetings with pharmaceutical representatives were associated with requests by physicians for adding the drugs to the hospital formulary and changes in prescribing practice. Drug company-sponsored continuing medical education (CME) preferentially highlighted the sponsor's drug(s) compared with other CME programs. Attending sponsored CME events and accepting funding for travel or lodging for educational symposia were associated with increased prescription rates of the sponsor's medication. Attending presentations given by pharmaceutical representative speakers was also associated with nonrational prescribing. CONCLUSION: The present extent of physician-industry interactions appears to affect prescribing and professional behavior and should be further addressed at the level of policy and education.

Attitude↗

PubMed2001

Racial disparity in influenza vaccination: does managed care narrow the gap between African Americans and whites?

CONTEXT: Substantial racial disparities exist in use of some health services. Whether managed care could reduce racial disparities in the use of preventive services is not known. OBJECTIVE: To determine whether the magnitude of racial disparity in influenza vaccination is smaller among managed care enrollees than among those with fee-for-service insurance. DESIGN, SETTING, AND PARTICIPANTS: The 1996 Medicare Current Beneficiary Survey of a US cohort of 13 674 African American and white Medicare beneficiaries with managed care and fee-for-service insurance. MAIN OUTCOME MEASURES: Percentage of respondents (adjusted for sociodemographic characteristics, clinical comorbid conditions, and care-seeking attitudes) who received influenza vaccination and magnitude of racial disparity in influenza vaccination, compared among those with managed care and fee-for-service insurance. RESULTS: Eight percent of the beneficiaries were African American and 11% were enrolled in managed care. Overall, 65.8% received influenza vaccination. Whites were substantially more likely to be vaccinated than African Americans (67.7% vs 46.1%; absolute disparity, 21.6%; 95% confidence interval [CI], 18.2%-25.0%). Managed care enrollees were more likely than those with fee-for-service insurance to receive influenza vaccination (71.2% vs 65.4%; difference, 5.8%; 95% CI, 3.6%-8.3%). The adjusted racial disparity in fee-for-service was 24.9% (95% CI, 19.6%-30.1%) and in managed care was 18.6% (95% CI, 9.8%-27.4%). These adjusted racial disparities were both statistically significant, but the absolute percentage point difference in racial disparity between the 2 insurance groups (6.3%; 95% CI, -4.6% to 17.2%) was not. CONCLUSION: Managed care is associated with higher rates of influenza vaccination for both whites and African Americans, but racial disparity in vaccination is not reduced in managed care. Our results suggest that additional efforts are needed to adequately address this disparity.

Black or African American↗

PubMed2003

Effect of expanded newborn screening for biochemical genetic disorders on child outcomes and parental stress.

CONTEXT: Tandem mass spectrometry now allows newborn screening for more than 20 biochemical genetic disorders. Questions about the effectiveness and risks of expanded newborn screening for biochemical genetic disorders need to be answered prior to its widespread acceptance as a state-mandated program. OBJECTIVES: To compare newborn identification by expanded screening with clinical identification of biochemical genetic disorders and to assess the impact on families of a false-positive screening result compared with a normal result in the expanded newborn screening program. DESIGN: Prospective study involving an inception cohort of newly diagnosed children. SETTING: Massachusetts, Maine, and a private laboratory in Pennsylvania with expanded newborn screening; other New England states with limited screening. PARTICIPANTS: Families of 50 affected children identified through expanded newborn screening (82% of eligible cases); 33 affected children identified clinically (97% of eligible cases); 94 screened children with false-positive results (75% of eligible cases); and 81 screened children with normal results (63% of eligible cases). MAIN OUTCOME MEASURES: Child's health and development and the Parental Stress Index. RESULTS: Within the first 6 months of life, 28% of children identified by newborn screening compared with 55% of clinically identified children required hospitalization (P =.02). One child identified by newborn screening compared with 8 (42%) identified clinically performed in the range of mental retardation (P<.001). Mothers in the screened group reported lower overall stress on the Parental Stress Index than mothers in the clinically identified group (z = 3.38, P<.001). Children with false-positive results compared with children with normal results were twice as likely to experience hospitalization (21% [n = 20] vs 10% [n = 8], respectively; P =.06). Mothers of children in the false-positive group compared with mothers of children with normal screening results attained higher scores on the Parental Stress Index (z = 4.25, P<.001) and the Parent-Child Dysfunction subscale (z = 5.30, P<.001). CONCLUSIONS: Expanded newborn screening may lead to improved health outcomes for affected children and lower stress for their parents. However, false-positive screening results may place families at risk for increased stress and parent-child dysfunction.

Adult↗

PubMedDate not supplied

Subsidized dental care for young men: its impact on utilization and dental health.

An important part of Norwegian welfare policy is provision of free dental care for children up to the age of 18. After that age some counties have introduced a public subsidy scheme for young people aged 19-20 years, where 75% of their dental care expenses are covered. After the age of 21, all patients have to pay the costs for dental care themselves. The focus of the present work was to examine the effect that the public subsidy scheme for young adults had on demand for dental care, and its effect on dental health. The analyses were performed on 2 extensive sets of survey data. The major finding was that the public subsidy scheme had no effect on demand for dental care. In addition, there was no relationship between whether these young adults were covered by the subsidy scheme and dental health.

Adolescent↗

PubMed1989

Experience with vincristine, doxorubicin, and dexamethasone (VAD) chemotherapy in adults with refractory acute lymphocytic leukemia.

Sixty-four adult patients with refractory acute lymphocytic leukemia (ALL) received salvage therapy with the vincristine, doxorubicin (Adriamycin, Adria Laboratories, Columbus, OH), and dexamethasone (VAD) regimen consisting of induction chemotherapy with the three agents followed by multiple-agent maintenance therapy for 2 years. Overall, 25 patients (39%) achieved complete remission. The median remission duration was 28 weeks with 20% of these patients remaining disease-free at 2 years. The median overall survival was 23 weeks. Prognostic factors associated with differences in remission rates included patient performance status, hemoglobin and platelet levels, and degree of peripheral and marrow blastosis. Factors related to differences in survival were patient age and performance status, hemoglobin and platelet levels, percentage of peripheral blasts, and albumin and bilirubin levels. The toxicity of the regimen was minimal, with 33% of patients requiring hospitalization because of febrile episodes of unknown origin (17%) or documented infections (16%). Therapy-related mortality occurred in four patients (6%). We conclude that the VAD program has significant antileukemic efficacy and acceptable toxicity in adult salvage ALL.

Adolescent↗

PubMed1988

Understanding the accuracy of tests with cutting scores: the sensitivity, specificity, and predictive value model.

While researchers usually are concerned about psychometric properties of psychological tests estimated using large samples, most clinical decision-makers must evaluate the accuracy of test results for individuals. This is particularly true as regards tests that have cutting scores to determine, for example, whether to assign a particular diagnosis or accept an applicant into a training program. This paper reviews a conceptual model that may foster improved understanding of test outcomes for individuals. The terms "sensitivity," "specificity," and "predictive value" are defined, and the relations of positive and negative predictive values to population base rates are emphasized. Examples from the psychological literature are presented to illustrate the utility of these concepts in clinical decision-making with psychological tests. Implications for test users, test developers, and instructors are discussed.

Depressive Disorder↗

PubMed2006

Aerobic exercise for women during pregnancy.

BACKGROUND: Physiological responses of the fetus (especially increase in heart rate) to single, brief bouts of maternal exercise have been documented frequently. Many pregnant women wish to engage in aerobic exercise during pregnancy but are concerned about possible adverse effects on the outcome of pregnancy. OBJECTIVES: The objective of this review was to assess the effects of advising healthy pregnant women to engage in regular aerobic exercise (at least two to three times per week), or to increase or reduce the intensity, duration, or frequency of such exercise, on physical fitness, the course of labour and delivery, and the outcome of pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2005), MEDLINE (1966 to 2005 January Week 1), EMBASE (1980 to 2005 January Week 1), Conference Papers Index (earliest to 2005 January Week 1), contacted researchers in the field and searched reference lists of retrieved articles. SELECTION CRITERIA: Acceptably controlled trials of prescribed exercise programs in healthy pregnant women. DATA COLLECTION AND ANALYSIS: Both review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: Eleven trials involving 472 women were included. The trials were small and not of high methodologic quality. Five trials reported significant improvement in physical fitness in the exercise group, although inconsistencies in summary statistics and measures used to assess fitness prevented quantitative pooling of results. Seven trials reported on pregnancy outcomes. A pooled increased risk of preterm birth (relative risk 1.82, 95% confidence interval (CI) 0.35 to 9.57) with exercise, albeit statistically nonsignificant, does not cohere with the absence of effect on mean gestational age (weighted mean difference +0.3, 95% CI -0.2 to +0.9 weeks), while the results bearing on growth of the fetus are inconsistent. One small trial reported that physically fit women who increased the duration of exercise bouts in early pregnancy and then reduced that duration in later pregnancy gave birth to larger infants with larger placentas. AUTHORS' CONCLUSIONS: Regular aerobic exercise during pregnancy appears to improve (or maintain) physical fitness. Available data are insufficient to infer important risks or benefits for the mother or infant. Larger and better trials are needed before confident recommendations can be made about the benefits and risk of aerobic exercise in pregnancy.

Exercise↗

PubMed2002

Electrical stimulation as an adjunct to spinal fusion: a meta-analysis of controlled clinical trials.

This study was a meta-analysis to examine whether electrical stimulation has a specific effect on spinal fusion. Little evidence exists on the efficacy of electrical stimulation for improving fusion rate of spinal fusion surgery. Using MEDLINE (1966-2000) and EMBASE (1985-1999), a search for articles was carried out using the Medical Subject Headings: (1) electric stimulation or electromagnetic fields, (2) spinal fusion, (3) controlled or clinical trial, and (4) human. Data were extracted from all the hit articles and additionally collected from appropriate journal lists. A total of five randomized controlled trials (RCT) on bones assessing healing of spinal fusion were identified and scored on methodological quality. All the identified studies reported positive findings, but the quality score of each trial showed wide flaws. Because of relatively homogenous subjects who had spine fusion and radiographic assessment from these studies, pooling of the data was able to be performed. Excluding one trial with the lowest score, the combined results of four trials, whose major endpoints were the success rate of the fusion, revealed a statistically significant effect of electrical stimulation with various techniques, but the selected trials still showed wide variation in view of stimulation modalities and treatment protocol. The pooled result of the studies in this review revealed the efficacy of electrical stimulation based on proved methodological quality. As problems on therapeutic modality and protocol remain, there is a further need for improvement in design to constitute acceptable proof and to establish treatment programs that better demonstrate electrical stimulation effects on spinal fusion.

Combined Modality Therapy↗