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Subsequent Use (subsequent + use)
Selected AbstractsThe Impact of HIV on Oral Health and Subsequent Use of Dental ServicesJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 2 2003Aram Dobalian PhD Abstract Objective: This study examined differences in health and access to dental services among a nationally representative sample of patients with HIV using Andersen's Behavioral Model of Health Services Use. Methods: This investigation is a longitudinal study that used structural equation modeling to analyze data from the HIV Cost and Services Utilization Study, a probability sample of 2,864 adults under treatment for HIV infection. Key predisposing variables included sex, drug use, race/ethnicity, education, and age. Enabling factors included income, insurance, and regular source of care. Need factors included mental, physical, and oral health. Dependent variables included whether a respondent utilized dental services and number of visits. Results: More education, dental insurance, usual source of dental care, and poor oral health predicted a higher probability of having a dental visit. African Americans, Hispanics, those exposed to HIV through drug use or heterosexual contact, and those in poor physical health were less likely to have a dental visit. Of those who visited dental professionals, older persons, those with dental insurance, and those in worse oral health had more visits. African Americans and persons in poor mental health had fewer visits. Conclusions: Persons with more HIV-related symptoms and a diagnosis of AIDS have a greater need for dental care than those with fewer symptoms and without AIDS, but more pressing needs for physical and mental health services limit their access to dental services. Providers should better attend to the oral health needs of persons with HIV who are in poor physical and mental health. [source] Budesonide delivered by dosimetric jet nebulization to preterm very low birthweight infants at high risk for development of chronic lung diseaseACTA PAEDIATRICA, Issue 12 2000B Jónsson We investigated the effect of an aerosolized corticosteroid (budesonide) on the oxygen requirement of infants at high risk for developing chronic lung disease (CLD) in a randomized, double-blind study. The study objective was to attain a 30% decrease in FiO2 levels in the budesonide treatment group after 14 d of therapy. Thirty very low birthweight (VLBW) infants (median (range)) gestational age 26 wk (23,29) and birthweight 805 g (525,1227) were randomized. Inclusion criteria were mechanical ventilation on day 6 of life, or if extubated on nasal continuous positive airway pressure with FiO2± 0.3. The budesonide (PulmicortÔ dose was 500 ,g bid, or placebo. The aerosol was delivered with a dosimetric jet nebulizer, with variable inspiratory time and breath sensitivity. Inhalations were started on day 7 of life. Twenty-seven patients completed the study. A significant lowering of the FiO2 levels at 21 d of life was not detected. Infants who received budesonide were more often extubated during the study period (7/8 vs 2/9) and had a greater relative change from baseline in their oxygenation index (budesonide decreased 26% vs placebo increased 60%). Subsequent use of intravenous dexamethasone or inhaled budesonide in the treatment group was significantly less. All patients required O2 supplementation on day 28 of life. At 36 wk postconceptual age, 61% of infants in the budesonide group needed supplemental O2 as opposed to 79% in the placebo group. No side effects on growth or adrenal function were observed Conclusion: We conclude that inhaled budesonide aerosol via dosimetric jet nebulizer started on day 7 of life for infants at high risk for developing CLD decreases the need for mechanical ventilation similar to intravenous dexamethasone, but without significant side effects. [source] Persistence of road runoff generation in a logged catchment in Peninsular MalaysiaEARTH SURFACE PROCESSES AND LANDFORMS, Issue 13 2007Alan D. Ziegler Abstract Measurements of saturated hydraulic conductivity (Ks) and diagnostic model simulations show that all types of logging road/trail in the 14·4 ha Bukit Tarek Experimental Catchment 3 (BTEC3) generate substantial Horton overland flow (HOF) during most storms, regardless of design and level of trafficking. Near-surface Ks(0,0·05 m) on the main logging road, skid trails and newly constructed logging terraces was less than 1, 2 and 34 mm h,1, respectively. Near-surface Ks on an abandoned skid trail in an adjacent basin was higher (62 mm h,1), owing to the development of a thin organic-rich layer on the running surface over the past 40 years. Saturated hydraulic conductivity measured at 0·25 m below the surface of all roads was not different (all <6 mm h,1) and corresponded to the Ks of the adjacent hillslope subsoil, as most roads were excavated into the regolith more than 0·5,1 m. After 40 years, only limited recovery in near-surface Ks occurred on the abandoned skid trail. This road generated HOF after the storage capacity of the upper near-surface layer was exceeded during events larger than about 20 mm. Thus, excavation into low- Ks substrate had a greater influence on the persistence of surface runoff production than did surface compaction by machinery during construction and subsequent use during logging operations. Overland flow on BTEC3 roads was also augmented by the interception of shallow subsurface flow traveling along the soil,saprolite/bedrock interface and return flow emerging from the cutbank through shallow biogenic pipes. The most feasible strategy for reducing long-term road-related impacts in BTEC3 is limiting the depth of excavation and designing a more efficient road network, including minimizing the length and connectivity of roads and skid trails. Copyright © 2007 John Wiley & Sons, Ltd. [source] The alcohol,tobacco relationship: a prospective study among adolescents in six European countriesADDICTION, Issue 12 2003J. J. L. Wetzels ABSTRACT Aim This study examined the earliest stages in drug involvement, in terms of the relationship between alcohol and tobacco use, among adolescents from six European countries (Denmark, Finland, the Netherlands, Portugal, Spain and the United Kingdom). International, gender and age differences were studied. Design, setting and participants A large international sample of European adolescents (n = 10170, mean age = 13.3 years) was followed longitudinally. Data were gathered in the autumn terms of 1998 and 1999 by means of self-administered questionnaires. Measures Adolescents' self-reports on smoking and alcohol behaviour were used. Both behaviours were classified into two categories, that of adolescents who had never used the substance and that of those who had used the substance at least once in their lives. Logistic regression was used to determine which substance was the best predictor of the subsequent use of the other substance. Findings Alcohol use and tobacco use were found to be associated with each other reciprocally. Results revealed that in Europe as a whole, tobacco use predicted subsequent alcohol use better than the converse. However, for Dutch girls, alcohol use predicted subsequent smoking behaviour better than the converse. Conclusion The findings suggest that the development of alcohol and tobacco use patterns are closely related, but the order of progression is not universal and may reflect cultural factors. [source] Inflammation reduces HDL protection against primary cardiac riskEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 6 2010James P. Corsetti Eur J Clin Invest 2010; 40 (6): 483,489 Abstract Background, We recently reported high high-density lipoprotein (HDL) cholesterol as a predictor of recurrent risk in a subgroup of postinfarction patients defined by hypercholesterolemia and high C-reactive protein (CRP) levels. We investigated whether a similar high-risk subgroup might exist for incident cardiovascular disease. Material and Methods, A graphical exploratory data analysis tool was used to identify high-risk subgroups in a male population-based cohort (n = 3405) from the prevention of renal and vascular end-stage disease study by generating 3-dimensional mappings of risk over the HDL-cholesterol/CRP domain with subsequent use of Kaplan,Meier analysis to verify high-risk. Within-subgroup risk was assessed using Cox proportional hazards regression and Kaplan,Meier analysis. Results, Mappings revealed two high-risk subgroups: a low HDL-cholesterol/high CRP subgroup and a high HDL-cholesterol/high CRP subgroup. The low HDL-cholesterol subgroup demonstrated a pattern of metabolic syndrome dyslipidemia contrasted with a predominantly unremarkable biomarker pattern for the high HDL-cholesterol subgroup. However, in the high HDL-cholesterol subgroup, CRP levels were higher than the low HDL-cholesterol subgroup; and within the high HDL-cholesterol subgroup, CRP predicted risk. Moreover, in the high HDL-cholesterol subgroup, risk was associated with lower triglyceride levels in conjunction with presumptively larger HDL particles. Conclusions, High HDL-cholesterol and high CRP levels define a subgroup of men at high-risk for incident cardiovascular disease. High HDL cholesterol-associated risk likely relates to impaired HDL particle remodelling in the setting of inflammation. This approach may facilitate identification of additional inflammation-related mechanisms underlying high HDL cholesterol-associated risk; and potentially influence management of such patients. [source] Central venous lines in haemophiliaHAEMOPHILIA, Issue 2003R. Ljung Summary., Infections and technical problems are the most frequent complications when using implantable central venous access devices in patients with haemophilia. There are two major experiences reported concerning infections in noninhibitor patients: one is approximately 0.2 infections per 1000 days and the other approximately 1.0 (0.7,1.6) per 1000 days. Infections are more frequent in inhibitor patients and approximately one infection per 6,12 months of use can be expected. The figures are low for clinically apparent thrombosis in the larger series on record, but routine venograms were not carried out in most of these series. In studies where this has been done, a high frequency of abnormalities on venograms has been seen in some but not in others. The final decision to use a central line has to take into account the medical goal, the patient's bleeding tendency, the social situation and the expected risk of complications at the particular haemophilia centre. Some of the complications may be reduced by adequate aseptic measures both during implantation and in subsequent use, and by clear basic routines for surveillance of the systems and repeated education of the users. [source] Cluster Attacks Responsive to Recreational Cannabis and DronabinolHEADACHE, Issue 6 2009Matthew S. Robbins MD Pharmacological preparations of cannabinoid compounds have a variety of therapeutic uses in medicine, including different pain syndromes, but have not been previously reported as beneficial for cluster headache. We present a patient with cluster headache who was refractory to multiple acute and preventive medications but successfully aborted his attacks with recreational marijuana use; subsequent use of dronabinol provided equally effective pain relief. The beneficial effect may be related to the high concentration of cannabinoid receptors in the hypothalamus, which has been implicated as a site of dysfunction in neuroimaging studies of patients with cluster headache. [source] Implementing quality control on a random number stream to improve a stochastic weather generator,,HYDROLOGICAL PROCESSES, Issue 8 2008Charles R. Meyer Abstract For decades, stochastic modellers have used computerized random number generators to produce random numeric sequences fitting a specified statistical distribution. Unfortunately, none of the random number generators we tested satisfactorily produced the target distribution. The result is generated distributions whose mean even diverges from the mean used to generate them, regardless of the length of run. Non-uniform distributions from short sequences of random numbers are a major problem in stochastic climate generation, because truly uniform distributions are required to produce the intended climate parameter distributions. In order to ensure generation of a representative climate with the stochastic weather generator CLIGEN within a 30-year run, we tested the climate output resulting from various random number generators. The resulting distributions of climate parameters showed significant departures from the target distributions in all cases. We traced this failure back to the uniform random number generators themselves. This paper proposes a quality control approach to select only those numbers that conform to the expected distribution being retained for subsequent use. The approach is based on goodness-of-fit analysis applied to the random numbers generated. Normally distributed deviates are further tested with confidence interval tests on their means and standard deviations. The positive effect of the new approach on the climate characteristics generated and the subsequent deterministic process-based hydrology and soil erosion modelling are illustrated for four climatologically diverse sites. Copyright © 2007 John Wiley & Sons, Ltd. [source] Isolation and identification of Alicyclobacillus acidocaldarius by 16S rDNA from mango juice and concentrateINTERNATIONAL JOURNAL OF FOOD SCIENCE & TECHNOLOGY, Issue 7 2005Pieter A. Gouws Summary In this study we investigate the spoilage of ultra high temperature UHT mango juice as well as a carbonated fruit juice blend to identify organisms contributing to the spoilage. The mango concentrate, the final product, as well as the other ingredients used during manufacturing, were tested for the presence of Alicyclobacillus by polymerase chain reaction (PCR) and sequencing analyses. Microbiological examination of the mango pureé and spoiled fruit juices, using YSG agar [yeast extract 2 g, glucose 1 g, soluble starch 2 g, pH 3.7 (adjust with 2N H2SO4), H2O 1000 mL, bacto agar 15 g] incubated at 55 °C, detected sporeforming, acid dependent and thermotolerant bacteria. The hyper variable region of the 16S rDNA was amplified. The nucleotide sequence of the PCR fragments was determined using the ABI Prism 310 automated DNA sequencer and the collected sequencing data were analysed and compared with the non-redundant database using NCBI-BLAST. Alicyclobacillus acidocaldarius were isolated and identified by 16S rDNA gene sequences analyses. The results indicated that the mango purèe, as well as the final product of mango juice and the fruit juice blend, were positive for Alicyclobacillus. The preventative measures of low pH, pasteurization of mango juice and the subsequent use of aseptic packaging were not regarded as sufficient to prevent the outgrowth of Alicyclobacillus spoilage organisms. [source] Heterogeneously Catalyzed Oxidative Cyanation of Tertiary Amines with Sodium Cyanide/Hydrogen Peroxide using Polymer-Supported Iron(II) Phthalocyanines as CatalystADVANCED SYNTHESIS & CATALYSIS (PREVIOUSLY: JOURNAL FUER PRAKTISCHE CHEMIE), Issue 8 2010Sweety Singhal Abstract The first report on heterogeneously catalyzed oxidative cyanation of various tertiary amines to the corresponding ,-amino nitriles with high yields and selectivity by using hydrogen peroxide oxidant in presence of sodium cyanide and Fe(II) phthalocyanine supported on a polymer as catalyst is described. The present method has the added benefits of facile recovery of the catalyst from the reaction mixture and its subsequent use without further activation. Consistent catalytic activity with no metal leaching was observed during this course. [source] Familial Factors Associated With the Use of Multiple Child-Care ArrangementsJOURNAL OF MARRIAGE AND FAMILY, Issue 2 2008Taryn W. Morrissey This study examined the use of multiple, concurrent, nonparental child-care arrangements among children under 5 with employed mothers in the NICHD Study of Early Child Care and Youth Development (N= 759). Older children, those primarily cared for in informal child care, those living in cohabitating or single-parent households, and those whose mothers were employed for 40 or fewer hours per week were likely to be in multiple arrangements. Higher quality primary child-care and lower maternal satisfaction with primary care predicted the subsequent use of multiple arrangements. Little support for income differences in selection into multiple arrangements was found. Findings highlight the importance of child-care characteristics and structure in child-care choice. Policy implications are discussed. [source] Characterization of differential ebulliometers for measuring activity coefficientsAICHE JOURNAL, Issue 1 2000J. David Raal Differential ebulliometry is a powerful and rapid procedure for obtaining infinitely dilute activity coefficients with potentially very good accuracy. Tedious degassing procedures are not necessary, as in a static method, and from only a few measurements full system phase behavior can be evaluated. The principal problem, precise evaluation of the equilibrium liquid composition from the known composition of a prepared solution charged to the apparatus, is well known but has so far defied adequate resolution. A system of exact self-consistent equations was developed for the characterization of an ebulliometer through a dimensionless ebulliometer constant. Evaluation of this constant from typical data and its subsequent use are illustrated for a system of known phase equilibrium behavior. Remarkably, the equations permit evaluation of the effective "static" holdups in various parts of the equipment without any volume measurements. Since one equation is redundant to the main purpose, it can be used for a consistency check of measured and calculated data. The equations also furnish a guide for the operation of ebulliometers. [source] Isolation and characterization of Cupriavidus basilensis HMF14 for biological removal of inhibitors from lignocellulosic hydrolysateMICROBIAL BIOTECHNOLOGY, Issue 3 2010Nick Wierckx Summary The formation of toxic fermentation inhibitors such as furfural and 5-hydroxy-2-methylfurfural (HMF) during acid (pre-)treatment of lignocellulose, calls for the efficient removal of these compounds. Lignocellulosic hydrolysates can be efficiently detoxified biologically with microorganisms that specifically metabolize the fermentation inhibitors while preserving the sugars for subsequent use by the fermentation host. The bacterium Cupriavidus basilensis HMF14 was isolated from enrichment cultures with HMF as the sole carbon source and was found to metabolize many of the toxic constituents of lignocellulosic hydrolysate including furfural, HMF, acetate, formate and a host of aromatic compounds. Remarkably, this microorganism does not grow on the most abundant sugars in lignocellulosic hydrolysates: glucose, xylose and arabinose. In addition, C. basilensis HMF14 can produce polyhydroxyalkanoates. Cultivation of C. basilensis HMF14 on wheat straw hydrolysate resulted in the complete removal of furfural, HMF, acetate and formate, leaving the sugar fraction intact. This unique substrate profile makes C. basilensis HMF14 extremely well suited for biological removal of inhibitors from lignocellulosic hydrolysates prior to their use as fermentation feedstock. [source] msatcommander: detection of microsatellite repeat arrays and automated, locus-specific primer designMOLECULAR ECOLOGY RESOURCES, Issue 1 2008BRANT C. FAIRCLOTH Abstract msatcommander is a platform-independent program designed to search for microsatellite arrays, design primers, and tag primers using an automated routine. msatcommander accepts as input DNA sequence data in single-sequence or concatenated, fasta -formatted files. Search data and locus-specific primers are written to comma-separated value files for subsequent use in spreadsheet or database programs. Binary versions of the graphical interface for msatcommander are available for Apple OS X and Windows XP. Users of other operating systems may run the graphical interface version using the available source code, provided their environment supports at least Python 2.4, Biopython 1.43, and wxPython 2.8. msatcommander is available from http://code.google.com/p/msatcommander/. [source] Delaunay Tessellation Field Estimator analysis of the PSCz local Universe: density field and cosmic flowMONTHLY NOTICES OF THE ROYAL ASTRONOMICAL SOCIETY, Issue 1 2007Emilio Romano-Díaz ABSTRACT We apply the Delaunay Tessellation Field Estimator (DTFE) to reconstruct and analyse the matter distribution and cosmic velocity flows in the local Universe on the basis of the PSCz galaxy survey. The prime objective of this study is the production of optimal resolution 3D maps of the volume-weighted velocity and density fields throughout the nearby universe, the basis for a detailed study of the structure and dynamics of the cosmic web at each level probed by underlying galaxy sample. Fully volume-covering 3D maps of the density and (volume-weighted) velocity fields in the cosmic vicinity, out to a distance of 150 h,1 Mpc, are presented. Based on the Voronoi and Delaunay tessellation defined by the spatial galaxy sample, DTFE involves the estimate of density values on the basis of the volume of the related Delaunay tetrahedra and the subsequent use of the Delaunay tessellation as natural multidimensional (linear) interpolation grid for the corresponding density and velocity fields throughout the sample volume. The linearized model of the spatial galaxy distribution and the corresponding peculiar velocities of the PSCz galaxy sample, produced by Branchini et al., forms the input sample for the DTFE study. The DTFE maps reproduce the high-density supercluster regions in optimal detail, both their internal structure as well as their elongated or flattened shape. The corresponding velocity flows trace the bulk and shear flows marking the region extending from the Pisces,Perseus supercluster, via the Local Superclusters, towards the Hydra,Centaurus and the Shapley concentration. The most outstanding and unique feature of the DTFE maps is the sharply defined radial outflow regions in and around underdense voids, marking the dynamical importance of voids in the local Universe. The maximum expansion rate of voids defines a sharp cut-off in the DTFE velocity divergence probability distribution function. We found that on the basis of this cut-off DTFE manages to consistently reproduce the value of ,m, 0.35 underlying the linearized velocity data set. [source] Immunomodulation confers herbicide resistance in plantsPLANT BIOTECHNOLOGY JOURNAL, Issue 3 2004Kurt C. Almquist Summary In order to create a novel mechanism for herbicide resistance in plants, we expressed a single-chain antibody fragment (scFv) in tobacco with specific affinity to the auxinic herbicide picloram. Transgenic tobacco plants and seedlings expressing this scFv against picloram were protected from its effect in a dose-dependent manner. This is the first successful use of an antibody to confer in vivo resistance to a low molecular weight xenobiotic (i.e. < 1000 Da). Our results suggest the possibility for a generic antibody-based approach to create crops resistant to low molecular weight xenobiotics for subsequent use in the bioremediation of contaminated soils, crop protection and as novel selectable markers. [source] Morphological and morphometric attributes of epididymal and testicular spermatozoa following surgical sperm retrieval for obstructive and nonobstructive azoospermiaANDROLOGIA, Issue 6 2003Dr. S. Wood Summary. Whilst the morphological (shape) and morphometric (sperm head size) attributes of ejaculated spermatozoa have been well studied, the morphological and morphometric qualities of testicular and epididymal spermatozoa retrieved from males with obstructive and nonobstructive azoospermia is much less documented. We wished to examine the effect of aetiology of azoospermia and site of retrieval on the attributes of retrieved spermatozoa. This was a prospective observational study of 30 consecutive successful sperm retrievals, six for nonobstructive azoospermia and 24 for obstructive, of which five were retrieved from the epididymis and the remainder from the testis. The proportion of morphologically normal testicular spermatozoa in patients with obstructive and nonobstructive azoospermia was not significantly different (7% versus 7.6%, P = 0.97). Testicular spermatozoa from males with obstructive azoospermia showed an increase in frequency of sperm with small heads [47/180 (26%) versus 97/909 (11%), P = 0.036] as well as small acrosome and increasing vacuole formation over nonobstructive spermatozoa. Similarly, there was a significant increase in tail deformities and decreases in tail lengths in sperm from males with nonobstructive azoospermia. Epididymal spermatozoa showed significantly greater proportion of morphologically normal spermatozoa than testicular (20% versus 13%, P = 0.001) as well as a significant increase in acrosome vacuoles. Furthermore, morphometrically epididymal spermatozoa displayed with smaller head length, width and area than testicular spermatozoa. Testicular spermatozoa from obstructive azoospermia displayed significantly less tail defects (35% versus 57%, P = 0.003) as well as significantly longer tail lengths (30.6 ,m versus 10.7 ,m). These morphological and morphometric differences between epididymal and testicular and obstructive and nonobstructive spermatozoa may represent part of the natural maturation process. There were no associations between any morphological or morphometric abnormality with any significant parameter in subsequent use in ICSI. [source] Satisfaction and Use of Prenatal Care: Their Relationship Among African-American Women in a Large Managed Care OrganizationBIRTH, Issue 1 2003Arden Handler DrPH ABSTRACT:Background: Although many more mothers of almost all ethnic groups began prenatal care in the first trimester during the last decade, a significant number of low-income and minority women still fail to obtain adequate care in the United States,a failure that may be related to their dissatisfaction with the prenatal care experience. This study sought to examine the relationship between satisfaction with care and subsequent prenatal care utilization among African-American women using prospective methods. Methods: A sample of 125 Medicaid and 275 non-Medicaid African-American adult women seeking care through a large Midwest managed care organization were interviewed before or at 28 weeks' gestation at one of two prenatal care sites. Women were interviewed about personal characteristics, prenatal care experience, and ratings of care (satisfaction). Information about subsequent use of prenatal care was obtained through retrospective medical record review after delivery. Univariate and multivariable analyses examining the relationship between women's satisfaction and prenatal care use were conducted using a dichotomous measure of satisfaction and a continuous measure of utilization. Results: Women were highly satisfied with prenatal care, with an overall mean satisfaction score of 80.3. Non-Medicaid women were significantly (p < 0.05) less satisfied with their prenatal care (mean score, 79.1) than Medicaid women (mean score, 82.8), and the latter had significantly fewer visits on average than the former subsequent to the interview. Analyses showed no significant difference in subsequent utilization according to whether a woman had a high versus low level of satisfaction at the prenatal care interview. Conclusions: This study challenges the assumption that improving a woman's satisfaction with care will lead to an increase in the adequacy of her prenatal care utilization. Since this study was limited to African-American women and is the first prospective study of women's satisfaction with care and prenatal care utilization, the negative findings do not yet settle this area of inquiry. Monitoring women's satisfaction with prenatal care in both managed care and fee-for-service settings and working to improve those aspects of care associated with decreased satisfaction is warranted. (BIRTH 30:1 March 2003) [source] Effective coding in birth defects surveillance,BIRTH DEFECTS RESEARCH, Issue S1 2001Sonja A. Rasmussen Effective coding is critical to data collected by birth defects surveillance programs because subsequent use of the data depends on storage and retrieval of cases using codes. Hence, careful consideration needs to be given to the coding process. The primary goal of coding is to accurately, completely, and concisely represent infants with birth defects. Coding procedures need to accommodate the objectives of the surveillance program; for example, programs that focus on research may require different coding procedures from those that focus on linking infants to services. Several challenges exist in coding birth defects, including the need to distinguish infants with multiple defects and syndromes from those with isolated defects, and the need for strategies to code suspected defects for which confirmation is not available. Selection of a coding system by a birth defects surveillance program is central to the utility of the data collected. Most programs use a modification of the International Statistical Classification of Diseases and Related Health Problems-based (ICD) systems. This paper addresses ICD-based systems and the modifications used by many birth defects surveillance programs and presents examples of the problems in interpreting birth defects data because of inappropriate coding. Teratology 64:S3,S7, 2001. Published 2001 Wiley-Liss, Inc. [source] Parents' use and views of the national standard Personal Child Health Record: a survey in two primary care trustsCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 6 2007S. Walton Abstract Background The Personal Child Health Record (PCHR) is a booklet given to parents in the UK, following the birth of a child, to be used as the main record of their growth, development and uptake of preventative health services. The national standard PCHR has been available since April 2004. The aim of this survey was to explore parental views of the ,new' PCHR, their experiences in receiving it, and its subsequent use, focusing on specific issues of current debate among health professionals. Methods A parental questionnaire (n = 89) was administered in July 2004, in 10 child health clinics located in two primary care trusts; one in central London and the other in Buckinghamshire. Results Nearly all parents (98%) reported that they used the PCHR as a record of their child's health and development and 92% reported that they ,always' took it with them when seeing healthcare staff about their child. Some parents (22%) indicated that they had not been given a satisfactory explanation as to how to use the PCHR, at the time it was issued to them. Parents reported that health visitors were more likely than other health professionals to use the PCHR both to obtain information about their child and to record information. The majority of respondents (78%) were happy for the level of maternal education to be documented in their child's PCHR. Conclusions Parents used, appreciated and liked the design of the national standard PCHR. Health visitors and primary care staff used the PCHR more than secondary care staff. The potential benefits of the PCHR will only be maximized if other healthcare professionals respond by using it. [source] Do Off-Label Drug Practices Argue Against FDA Efficacy Requirements?AMERICAN JOURNAL OF ECONOMICS AND SOCIOLOGY, Issue 5 2008A Critical Analysis of Physicians' Argumentation for Initial Efficacy Requirements The amended Food, Drug and Cosmetics Act requires efficacy certification for a drug's initial uses ("on-label"), but does not require certification before physicians may prescribe the drug for subsequent uses ("off-label"). Does it make sense to require FDA efficacy certification for new drugs but not for new uses of old drugs? Using a sequential online survey, we carried on a "virtual conversation" with some 500 physicians. The survey asked whether efficacy requirements should be imposed on off-label uses; almost all physicians said no. It asked whether the efficacy requirements for initial uses should be dropped, and most physicians said no. We then asked respondents whether opposing efficacy requirements in one case but not the other involved an inconsistency. In response, we received hundreds of written commentaries. We organize and discuss these commentaries with an eye to understanding how the medical market certifies off-label drug uses and how this compares to FDA certification. Does off-label medicine use suggest that efficacy requirements should be placed on new uses of old drugs? Does it suggest that efficacy requirements on new drugs should be lifted? We explore these questions, and ask whether the response of many of the doctors exhibits the familiar behavior bias toward the status quo. [source] | ||||||||||||||||||||||