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Additional Impact (additional + impact)
Selected AbstractsEvidence for the effectiveness of sterile injecting equipment provision in preventing hepatitis C and human immunodeficiency virus transmission among injecting drug users: a review of reviewsADDICTION, Issue 5 2010Norah Palmateer ABSTRACT Aims To review the evidence on the effectiveness of harm reduction interventions involving the provision of sterile injecting equipment in the prevention of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) transmission among injecting drug users (IDUs). The interventions assessed were needle and syringe programmes (NSP), alternative modes of needle/syringe provision (pharmacies, vending machines and outreach) and the provision of injecting equipment other than needles/syringes. Methods Systematic searches of the English language literature to March 2007 were undertaken to identify systematic, narrative or meta-analytical reviews (also known as a review of reviews) of the impact of interventions on HCV transmission, HIV transmission or injecting risk behaviour (IRB). Critical appraisal criteria classified the reviews as either high quality (,core') or supplementary: a framework based on the quality of reviews, the reviewers' conclusions and the designs/findings of the primary studies was used to derive evidence statements. Results Three core and two supplementary reviews of injecting equipment interventions were identified. According to the proposed framework, this study found (a) insufficient evidence to conclude that any of the interventions are effective in preventing HCV transmission; (b) tentative evidence to support the effectiveness of NSP in preventing HIV transmission; (c) sufficient evidence to support the effectiveness of NSP (and tentative evidence of an additional impact of pharmacy NSP) in reducing self-reported IRB; and (d) little to no evidence on vending machines, outreach or providing other injecting equipment in relation to any of the outcomes. Conclusions The evidence is weaker than given credit for in the literature. The lack of evidence for effectiveness of NSP vis-à-vis biological outcomes (HCV and HIV incidence/prevalence) reflects the limitations of studies that have been undertaken to investigate these associations. Particularly for HCV, low levels of IRB may be insufficient to reduce high levels of transmission. New studies are required to identify the intervention coverage necessary to achieve sustained changes in blood-borne virus transmission. [source] Comparative quantification of alcohol exposure as risk factor for global burden of diseaseINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 2 2007Jürgen Rehm Abstract Alcohol has been identified as one of the most important risk factors in the burden experienced as a result of disease. The objective of the present contribution is to establish a framework to comparatively quantify alcohol exposure as it is relevant for burden of disease. Different key indicators are combined to derive this quantification. First, adult per capita consumption, composed of recorded and unrecorded consumption, yields the best overall estimate of alcohol exposure for a country or region. Second, survey information is used to allocate the per capita consumption into sex and age groups. Third, an index for detrimental patterns of drinking is used to determine the additional impact on injury and cardiovascular burden. The methodology is applied to estimate global alcohol exposure for the year 2002. Finally, assumptions and potential problems of the approach are discussed. Copyright © 2007 John Wiley & Sons, Ltd. [source] Disruption of an exotic mutualism can improve management of an invasive plant: varroa mite, honeybees and biological control of Scotch broom Cytisus scoparius in New ZealandJOURNAL OF APPLIED ECOLOGY, Issue 2 2010Quentin Paynter Summary 1.,A seed-feeding biocontrol agent Bruchidius villosus was released in New Zealand (NZ) to control the invasive European shrub, broom Cytisus scoparius, in 1988 but it was subsequently considered unable to destroy sufficient seed to suppress broom populations. We hypothesized that an invasive mite Varroa destructor, which has caused honeybee decline in NZ, may cause pollinator limitation, so that the additional impact of B. villosus might now reach thresholds for population suppression. 2.,We performed manipulative pollination treatments and broad-scale surveys of pollination, seed rain and seed destruction by B. villosus to investigate how pollinator limitation and biocontrol interact throughout the NZ range of broom. 3.,The effect of reduced pollination in combination with seed-destruction was explored using a population model parameterized for NZ populations. 4.,Broom seed rain ranged from 59 to 21 416 seeds m,2 from 2004 to 2008, and was closely correlated with visitation frequency of honeybees and bumblebees. Infestation of broom seeds by B. villosus is expected to eventually reach 73% (the average rate observed at the localities adjacent to early release sites). 5.,The model demonstrated that 73% seed destruction, combined with an absence of honeybee pollination, could cause broom extinction at many sites and, where broom persists, reduce the intensity of treatment required to control broom by conventional means. 6.,Nevertheless, seed rain was predicted to be sufficient to maintain broom invasions over many sites in NZ, even in the presence of the varroa mite and B. villosus, largely due to the continued presence of commercial beehives that are treated for varroa mite infestation. 7.,Synthesis and applications. Reduced pollination through absence of honeybees can reduce broom seed set to levels at which biocontrol can be more effective. To capitalize on the impact of the varroa mite on feral honeybees, improved management of commercial beehives (for example, withdrawal of licences for beekeepers to locate hives on Department of Conservation land) could be used as part of a successful integrated broom management programme at many sites in NZ. [source] Spousal Concordance for Alcohol Dependence: Evidence for Assortative Mating or Spousal Interaction Effects?ALCOHOLISM, Issue 5 2007Julia D. Grant Background: Alcohol dependence (AD) is among the most common psychiatric disorders, and impacts the health and well-being of problem drinkers, their family members, and society as a whole. Although previous research has consistently indicated that genetic factors contribute to variance in risk for AD, little attention has been paid to nonrandom mating for AD. When assortative mating occurs for a heritable trait, spouses are genetically correlated and offspring are at increased risk of receiving high-risk genes from both parents. The primary goal of the present analyses is to test hypotheses about the source(s) and magnitude of spousal associations for AD using a twin-spouse design. Methods: DSM-IV AD (without the clustering criterion) was assessed via telephone interview for 5,974 twin members of an older cohort of the Australian Twin Register (born 1902,1964) and 3,814 spouses of the twins. Quantitative genetic modeling was used to determine the extent to which variability in risk for AD was influenced by genetic factors, the extent of spousal association for AD, and whether the association was attributable to assortative mating, reciprocal spousal interaction, or both processes. Results: Genetic factors explained 49% of the variance in risk for AD. There was no evidence of gender differences in the spousal interaction effect, the degree of rater bias, or the association between the twin's report of spouse AD and the spouse's AD phenotype. Either the assortative mating parameter or the spousal interaction parameter could be removed from the model without a significant decrement in fit, but both could not be dropped simultaneously, suggesting a lack of power to differentiate between these 2 causes of spousal correlation. When both effects were included in the model, the spousal correlation was 0.29, the assortative mating coefficient was 0.45 (i.e., "like marries like"), and the reciprocal spousal interaction coefficient was ,0.10 (i.e., after controlling for assortative mating, the additional impact of spousal interactions is slightly protective). Conclusions: These analyses provide evidence of significant spousal associations for AD, with assortative mating increasing spouse similarity and spousal interaction effects decreasing it after controlling for assortative mating. Although the genetic impact is modest, assortative mating results in an increased proportion of offspring exposed to 2 alcoholic parents and the associated detrimental environmental sequelae, and increases the likelihood of offspring inheriting high-risk genes from both parents. [source] The Impact of Hepatitis C and Biliary Complications on Patient and Graft Survival Following Liver TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2009E. C. Verna Recurrent hepatitis C (HCV) and biliary complications (BC) are major causes of post liver transplant morbidity and mortality. The impact of these complications may be additive or synergistic. We performed a retrospective cohort study to analyze the effects of HCV and BC on all patients transplanted at two institutions over 6 years. BC was defined by imaging findings in the setting of abnormal liver function tests that required intervention. The primary outcomes were graft and patient survival over a mean 3.4 years. 709 patients (619 deceased, 90 living donor) were included, 337 with HCV and 372 without. BC was diagnosed more frequently in patients with HCV, 26% versus 18% (p = 0.008). One-year and overall patient and graft survival were significantly lower in patients with HCV, but BC impacted only 1-year graft survival. The combination of BC and HCV had no additional impact on survival or fibrosis rates on 1-year protocol biopsies. Multivariate analysis revealed HCV (HR 2.1) and HCC (HR 1.9) to be independent predictors of mortality. Since BC are diagnosed more frequently in HCV patients and only affect early graft loss, it is likely that recurrent HCV rather than BC accounts for the majority of adverse graft outcomes. [source] No association between maternal psychological symptoms and infant outcome after pregnancy complicated by early-onset hypertensive disordersACTA PAEDIATRICA, Issue 2 2009Ageeth G Kaspers Abstract Aim: The aim of this work was to study the effect of maternal psychological symptoms on infant development 1 year after early-onset hypertensive disorders of pregnancy. Methods: All mothers were enrolled in the Pre-eclampsia, Eclampsia TRial Amsterdam. Mothers were asked to complete the 90-item Symptom Check List (SCL-90) at the corrected ages of their infants of 0, 3 and 12 months. The total sum score of these three checklists was calculated. Infants were examined at the corrected age of 12 months using the Bayley Scales of Infant Development (Mental Developmental Index [MDI] and Psychomotor Developmental Index [PDI] subscales). The Bayley scores were compared between infants of mothers with SCL-90 sum scores in the highest 25% and lowest 75%. Results: For 141 mother,infant pairs (80%) all three SCL-90 checklists and Bayley scores were available. Mean gestational age was 32 weeks and 90% of the infants were growth restricted. The mean MDI was 87 in the highest 25% and 89 in the lowest 75% group. This was 79 versus 80 for the PDI. Conclusion: In this population of high-risk growth-restricted infants born after a pregnancy complicated by early-onset hypertensive disorders, there is no additional impact of negative maternal psychological symptoms on infant development after 1 year. [source] Evaluating medical students' non-verbal communication during the objective structured clinical examinationMEDICAL EDUCATION, Issue 12 2006Hirono Ishikawa Objectives, Non-verbal communication (NVC) in medical encounters is an important method of exchanging information on emotional status and contextualising the meaning of verbal communication. This study aimed to assess the impact of medical students' NVC on interview evaluations by standardised patients (SPs). Methods, A total of 89 medical interviews in an objective structured clinical examination (OSCE) for post-clerkship medical students were analysed. All interviews were videotaped and evaluated on 10 non-verbal behaviour items. In addition, the quality of the interview content was rated by medical faculty on 5 items and the interview was rated by SPs on 5 items. The relationships between student NVC and SP evaluation were examined by multivariate regression analyses controlling for the quality of the interview content. Results, Standardised patients were likely to give higher ratings when students faced them directly, used facilitative nodding when listening to their talk, looked at them equally when talking and listening, and spoke at a similar speed and voice volume to them. These effects of NVC remained significant after controlling for the quality of the interview content. Conclusions, This study provided evidence of specific non-verbal behaviours of doctors that may have additional impacts on the patient's perception of his or her visit, independently of the interview content. Education in basic NVC should be incorporated into medical education alongside verbal communication. [source] | ||||||||||