Variations in genetic assessment and recurrence risks quoted for childhood deafness: a survey of clinical geneticists. (33/50730)

We report here the results of a questionnaire survey of consultant clinical geneticists in the United Kingdom to which we had an 81% response rate. In this questionnaire we asked about: (1) the nature of services currently offered to families with hearing impaired children, (2) what recurrence risks they quoted in isolated non-syndromic cases, and (3) what they might suggest for improving the range of genetic services available at present. We noted great variation both in these services and in the recurrence risks quoted in isolated cases. Based on the results of the questionnaire, we have proposed a protocol for the investigation of permanent childhood hearing impairment, which we believe to be both comprehensive and practical in an outpatient clinic setting. It is only by improving existing clinical and social understanding and knowledge of childhood hearing impairment that it will become possible to use recent molecular advances to develop comprehensive and consistent services for these families.  (+info)

Placebo medication use in patient care: a survey of medical interns. (34/50730)

The use of placebo medication, long recognized by clinicians, often has serious practical implications, such as patient deception. Past evidence has suggested that resident physicians tend to misuse placebo medication. Interns from two consecutive years of a residency program were surveyed anonymously to assess their knowledge and use of placebos. Of the 74 interns surveyed, 44 (59%) were familiar with placebo use in patient care. Fifty percent of these interns familiar with placebo use had learned about placebos from another physician. All interns who had learned about placebos during their internships had learned from another physician, whereas interns who had gained their knowledge of placebos as medical students were as likely to have learned from the medical literature as they were to have learned from a physician (P = 0.027). Interns aware of placebo use were more likely to consider placebo administration for suspected, factitious pain (P = 0.022). The present study uncovered no relationship between interns' estimations of placebo efficacy and the utility they attributed to placebos in assessing a complaint of pain. This suggests that conceptual inconsistencies underlie their use of placebos. Interns often learn of placebos as medical students and are influenced by physician-mentors. Placebo use in patient care is an area of attention for medical educators.  (+info)

Perceived health in a randomised trial of treatment for chronic venous ulceration. (35/50730)

STUDY OBJECTIVE: To observe changes in perceived health in patients during a clinical trial of treatments for venous leg ulceration. DESIGN: Randomised prospective factorial trial in patients with venous ulceration. Each patient randomised to a bandage, dressing and a drug. Perceived health assessed at entry and after 24 weeks. SETTING: Outpatient departments and patient's home. PATIENTS: Two hundred patients presenting to two vascular services in Falkirk and Edinburgh with chronic (duration > 2 months) non-healing venous ulceration. STATISTICAL ANALYSIS AND MAIN RESULTS: Analysis using the Nottingham Health Profile revealed that after 24 weeks there were significant improvements in all subscores (p < 0.01) with the exception of social isolation (p = 0.081). Patients with healed ulceration had improved in energy, pain, emotion, sleep and mobility compared with those whose ulceration failed to heal (p < 0.05). Patients randomised to four layer bandaging had significantly better energy (diff = 7.9, 95% CI 0.2, 15.6, p = 0.04) and mobility (diff = 4.5, 95% CI 0.0, 9.0, p = 0.046). This difference could be explained largely by the improved healing of patients randomised to this bandage system (67/97 vs. 50/103, OR = 2.37, 95% CI 1.31, 4.27). CONCLUSIONS: Improvements in perceived health were significantly greater in patients whose ulcers had completely healed. Methods of treatment which offer improved healing for patients with venous leg ulceration are likely to improve patients' perceived health status.  (+info)

Use of SoloShot autodestruct syringes compared with disposable syringes, in a national immunization campaign in Indonesia. (36/50730)

Autodestruct syringes can reduce the improper reuse of syringes, which present a significant risk in the transmission of bloodborne pathogens in developing countries, especially during immunization campaigns owing to the high number of injections given per session. SoloShot is an autodestruct syringe, distributed by UNICEF, which has been shown to be safer and easier to use than standard syringes. This study analyses the accuracy and dose-efficiency of SoloShot, compared with disposable syringes, during a national tetanus toxoid immunization campaign on the Indonesian island of Lombok. Observation and dose measurements revealed that SoloShot syringes delivered more precise and consistent doses and 15% more doses per vial than disposable syringes. Vaccine savings may partially be offset by the higher price of SoloShot. Vaccinators preferred SoloShot, describing it as easier to use, faster, and more accurate than the disposable syringe. The study indicates that SoloShot is highly appropriate for use in immunization campaigns by reducing vaccine wastage and improving injection safety.  (+info)

Validation of measures of food insecurity and hunger. (37/50730)

The most recent survey effort to determine the extent of food insecurity and hunger in the United States, the Food Security Supplement, included a series of questions to assess this complex phenomenon. The primary measure developed from this Food Security Supplement was based on measurement concepts, methods and items from two previously developed measures. This paper presents the evidence available that questionnaire-based measures, in particular the national food security measure, provide valid measurement of food insecurity and hunger for population and individual uses. The paper discusses basic ideas about measurement and criteria for establishing validity of measures and then uses these criteria to structure an examination of the research results available to establish the validity of food security measures. The results show that the construction of the national food security measure is well grounded in our understanding of food insecurity and hunger, its performance is consistent with that understanding, it is precise within usual performance standards, dependable, accurate at both group and individual levels within reasonable performance standards, and its accuracy is attributable to the well-grounded understanding. These results provide strong evidence that the Food Security Supplement provides valid measurement of food insecurity and hunger for population and individual uses. Further validation research is required for subgroups of the population, not yet studied for validation purposes, to establish validity for monitoring population changes in prevalence and to develop and validate robust and contextually sensitive measures in a variety of countries that reflect how people experience and think about food insecurity and hunger.  (+info)

Food insecurity: consequences for the household and broader social implications. (38/50730)

A conceptual framework showing the household and social implications of food insecurity was elicited from a qualitative and quantitative study of 98 households from a heterogeneous low income population of Quebec city and rural surroundings; the study was designed to increase understanding of the experience of food insecurity in order to contribute to its prevention. According to the respondents' description, the experience of food insecurity is characterized by two categories of manifestations, i.e., the core characteristics of the phenomenon and a related set of actions and reactions by the household. This second category of manifestations is considered here as a first level of consequences of food insecurity. These consequences at the household level often interact with the larger environment to which the household belongs. On a chronic basis, the resulting interactions have certain implications that are tentatively labeled "social implications" in this paper. Their examination suggests that important aspects of human development depend on food security. It also raises questions concerning the nature of socially acceptable practices of food acquisition and food management, and how such acceptability can be assessed. Guidelines to that effect are proposed. Findings underline the relevance and urgency of working toward the realization of the right to food.  (+info)

Moderate physical activity in relation to mammographic patterns. (39/50730)

High-risk mammographic patterns may be used as a surrogate end point for breast cancer in etiologic research as well as in prevention studies. Physical activity may be one of the few modifiable risk factors for breast cancer. We examined the relationship between physical activity and mammographic patterns among 2720 Norwegian women, ages 40-56 years, who participated in both the Second and Third Tromso studies. Epidemiologic data were obtained through questionnaires. Two questions from the Second Tromso study and five questions from the Third elicited information on physical activity. The mammograms were categorized into five groups based on anatomical-mammographic correlations. For analysis, patterns I through III were combined into a low-risk group and patterns IV and V into a high-risk group. Odds ratios that were adjusted for age, education, menopausal status, body mass index, parity, age at menarche, oral contraceptive use, and alcohol intake, with 95% confidence intervals, were estimated using logistic regression. Women who reported moderate physical activity, i.e., more than 2 h/week, were 20% less likely (odds ratio, 0.8; 95% confidence interval, 0.6-1.1) to have high-risk mammographic patterns compared with those who reported being inactive. This relationship remains consistent when stratified by menopausal status, parity, and tertiles of body mass index. However, all of the associations between various measures of physical activity and high-risk patterns found in this study are weak with confidence intervals that include 1.0. Thus, chance is a reasonable explanation for the weak associations found. The relationship between physical activity and high-risk patterns should be examined further as a means to explore the biologic mechanisms relating physical activity to breast cancer risk.  (+info)

Familial aggregation of blood pressure in a rural Chinese community. (40/50730)

This study investigated blood pressure in 1,183 Chinese nuclear families (mother, father, and first two children) via a cross-sectional 1994-1997 survey. The mother's, the father's, and the first sibling's blood pressures were each significantly and independently related to the second sibling's blood pressure after adjustment for sex, age, height, weight, education, smoking, and alcohol consumption. The association was consistent across the four age strata (6-10, 11-14, 15-19, and > or = 20 years). The rate of high systolic blood pressure in the second sibling was lowest (2.3%) when both parents and the first sibling were in the low blood pressure tertile (low-low group) and highest (26.0%) when these family members were in the high blood pressure tertile (high-high group). The rate was intermediate if only the parents (10.7%, high-low group) or the first sibling (8.4%, low-high group) was in the high blood pressure tertile. As compared with the low-low group, the odds ratios for the high-high, high-low, and low-high groups were 14.3 (95% confidence interval 4.3-48.2), 4.3 (95% confidence interval 1.2-15.6), and 3.9 (95% confidence interval 1.1-14.4), respectively. A similar pattern was found for diastolic blood pressure. The data indicate a strong familial aggregation of blood pressure in this population and show that such a familial influence on blood pressure can be detected from early childhood onward.  (+info)