Impact of digital labeling on outcome measures

OBJECTIVE: The purpose of this study was to determine whether the label attached to the hearing aid being presented would bias outcome measures towards newer technological designs. DESIGN: Two groups of subjects participated in this investigation. The groups were matched for age, gender, previous hearing aid experience, degree and configuration of hearing loss. Group A wore each of two digital hearing aids for 1 mo; Group B wore the same digital hearing aid for 2 mo, but the subjects were given the impression they were changing hearing aids after 1 mo. In each group the subjects were told that one of the months they were wearing a "digital" hearing aid and one of the months they were wearing a "conventional" hearing aid. Outcome measures consisted of a number of behavioral speech perception tasks and self-report measures, each completed at the onset and after 1 mo use with the hearing aids. RESULTS: Labeling effects were observed for many of the outcome measures. Using a mixed-model factorial analysis of variance to control for irrelevant variables and to explore interaction terms, prejudice (digital versus conventional labeling) was treated as a within-subject factor while the subject group (A or B) and clinician were treated as between-subject factors. Although only the APHAB RV and BN scales showed significant labeling effects on their own, the group of tests used in this study showed a significant labeling effect as a whole (p < 0.01). The total influence of labeling and related interaction terms indicated labeling-related effects accounted for 2 to 32% of the variance in individual outcome measures. DISCUSSION: The results of this investigation indicate a need for double-blinding in hearing aid research aimed at assessing the effectiveness of newer technologies, as well as a need for clinicians to critically evaluate the research describing the potential advantages of certain circuit options.     

Systemic co-treatment with alpha-melanocyte stimulating hormone delays hearing loss caused by local cisplatin administration in guinea pigs

It has previously been demonstrated that ototoxicity induced by systemic administration of cisplatin is reduced by concomitant administration of melanocortins, like alpha-melanocyte stimulating hormone (alpha-MSH). However, these experiments were hampered by large interanimal variability. Therefore, we re-investigated the effects of systemically administered alpha-MSH during local (intracochlear) administration of cisplatin. Guinea pigs, implanted with a round-window electrode, allowing daily monitoring of the compound action potentials (CAPs), and a mini-osmotic pump, pumping either 0.5 microl/h physiological saline or cisplatin solution (15 microg/ml), were co-treated daily with a subcutaneous bolus injection of either alpha-MSH (75 microg/kg) or physiological saline for 1 week or until the electrocochleogram showed a persistent decrease in CAP amplitude (40 dB threshold shift at 8 kHz). Next, the animals were sacrificed and the cochleas were processed for histology. After 2-3 days, cisplatin alone caused a threshold shift at all frequencies (2-16 kHz). Co-administration with alpha-MSH consistently delayed the criterion threshold shift by 1 day. When the 40 dB criterion had been reached, similar outer hair cell losses in both the cisplatin/alpha-MSH- and cisplatin/saline-treated groups were observed. This experiment confirms that direct administration of cisplatin into the cochlea results in considerably less interanimal variability than systemic administration and that co-treatment with alpha-MSH delays cisplatin ototoxicity. Since cisplatin was delivered directly to the cochlea, the ameliorating effect of alpha-MSH probably involves a cochlear target.     

Recommendations for appeal to another resource in a health case brought by nurses in the Info-Health Service CLSC: convergence between utilization declarations and informants' data

OBJECTIVES: To examine the perception of telephone advice-line users as to whether or not a formal recommendation had been made to seek another consultation and to compare users' perception to what the nurse documented. To analyze the effects of different users' and call characteristics on the incorrectness of the self-report. DATA SOURCES/STUDY SETTING: This study is a secondary analysis of data obtained from 4,696 randomly selected participants in a survey conducted among users of Info-Santé CLSC, a free-of-charge telenursing health-line service (THLS) available throughout the province of Quebec. STUDY DESIGN/DATA COLLECTION: Self-reported advice from follow-up survey phone interviews, conducted within 48-120 hours after the participant's call, were compared to the data consigned by the nurse in the computerized call-record. Covariables concerned characteristics of callers, context of the call, and satisfaction with the nurses' intervention. Association between these variables and inaccurate reports was identified using multinomial logistic regression analyses. PRINCIPAL FINDINGS: Advice to consult another health resource was recorded by the nurse in 42% of cases, whereas 39% of callers stated they had received such a recommendation. Overall disagreement between the two sources is 27% (12% by false positive and 15% by false negative) and kappa is 0.45. Characteristics such as living alone (adjusted OR = 2.5), calls relating to psychological problems (OR = 2.8), perceived seriousness (OR = -2.6) as well as others, were associated with inaccurate reports. CONCLUSIONS: Telephone health-line providers should be aware that many callers appear to interpret advice to seek additional health care differently than intended. Our findings suggest the need for continuing quality control interventions to reduce miscommunication, ensure better understanding of advice by callers, and contribute to more effective service.     

Food stamp program participation is positively related to obesity in low income women

This study examined the relationship between Food Stamp Program (FSP) participation and the obesity of low income individuals using data from the National Longitudinal Survey of Youth 1979. Obesity was defined as body mass index >or= 30 kg/m(2). The data were arranged as a panel with multiple observations per individual, and the models of obesity included current and long-term FSP participation, additional demographic, socioeconomic and environment characteristics and individual fixed effects. Individual fixed effects were used to take into account unobserved differences across individuals that did not vary over time. In ordinary least squares models, current and long-term FSP participation were significantly related to the obesity of low income women (P < 0.05), but not of low income men. For low income women, current participation in the FSP was associated with a 9.1% increase in the predicted probability of current obesity. Participation in the FSP in each of the previous five years compared to no participation over that time period was associated with approximately a 20.5% increase in the predicted probability of current obesity. These models did not control for food insecurity, and this omission potentially complicates the interpretation of the FSP participation variables.     

Total subdiaphragmatic vagotomy does not suppress high protein diet-induced food intake depression in rats

This study was undertaken to determine whether the subdiaphragmatic vagus nerve is involved in the depression of food intake induced by the ingestion of a high protein diet (P50) in rats. After total subdiaphragmatic vagotomy (Vago group) or sham surgery (Sham group), rats consumed the control diet for a 2-wk recovery period and then both groups consumed the high protein diet for 16 d. Daily food intake, meal pattern analysis and behavioral satiety sequence were measured. Total subdiaphragmatic vagotomy did not modify the daily intake of the control diet or suppress the dramatic depression in food intake produced by acute transition to a high protein diet. However, the daily intake of a high protein diet was slightly reduced under acute conditions or even after adaptation (P < 0.005). Analysis of meal parameters and the behavioral satiety sequence after adaptation indicated no major metabolic distress. In conclusion, these results suggest that the subdiaphragmatic vagus nerve does not constitute an obligatory pathway for the transfer of information to the brain, resulting in a depression of high protein diet intake. In contrast, a defect in this visceral regulating system could reinforce the metabolic-associated food intake depression signal.     

Qualitative Methodologies and Community Participation in Examining Reproductive Experiences: The Harlem Birth Right Project

Objectives: Racial disparities in health present a challenge to public health because of the complexity of interacting social forces. The Harlem Birth Right Project sought to improve understanding of these forces by using qualitative and community participatory methods. In this paper we 1) describe the process of qualitative inquiry and community involvement, 2) evaluate the impact of community participation, and 3) present a brief summary of the findings on social context as it relates to pregnancy outcomes of women in Harlem. Methods: We operationalized the qualitative method by combining participant observation, longitudinal case studies, and focus groups. An ethnographic survey was used to verify and triangulate findings across methods of data collection. We involved the community in the design, implementation, and analysis by collaborating with community-based organizations, setting up a community advisory board, and the use of dialogue groups and community meetings. Results: The use of qualitative methods and community partnership uncovered important aspects of the social context of women's lives that may not have emerged through traditional epidemiologic research. We found that pregnancy may serve as a catalyst to increase perception of the magnitude of preexisting social stressors. Several stressors and chronic strains associated with structural forces were identified. For example, the high percentage of households headed by women is seen as one consequence of larger structural forces. While social support networks serve as an important coping mechanism to buffer against the stress caused by these structural forces, the types of support women seek differs by social strata, and some strategies were identified as being substantially more effective than others. Conclusions: Qualitative and community participatory research can be successfully conducted to support public health goals and can derive important new information on the social context of women's lives.     

Co-located Substance Use Treatment and HIV Prevention and Primary Care Services,New York State, 1990–2002: A Model for Effective Service Delivery to a High-Risk Population

The New York State Department of Health (NYSDOH) AIDS Institute (AI) began an initiative in 1990 in collaboration with the Office of Alcoholism and Substance Abuse Services (OASAS) to colocate HIV prevention and clinical services at drug treatment clinics. In 1990, the initiative began funding drug treatment programs to provide HIV counseling, testing, and prevention services. HIV primary care was added the following year. Program implementation and development are described. An analysis is included of HIV counseling and testing data for the period 1990–2002 and quality of care data for five standardized quality measures with comparisons to data from other clinical settings. In the first 13 years of the initiative 168,340 HIV-antibody tests were conducted including 52,562 tests of injection drug users (IDUs) identifying 14,612 HIV-infected persons; the seroprevalence was 8.68%. By the end of 2000, the HIV primary care caseload peaked at 3,815 patients. Quality of primary medical care services among participating drug treatment programs has consistently matched or exceeded that provided in more conventional health care settings such as the hospitals and community health centers that were used as a basis for comparison. Colocating HIV primary care within substance use treatment is an effective strategy for providing accessible high-quality HIV prevention and primary care services. Rothman is with the Bureau of HIV Ambulatory Care, AIDS Institute, New York State Department of Health, Albany, New York, USA; Rudnick and Slifer are with the Substance Abuse Unit, AIDS Institute, New York, NY, USA; Agins is with the Office of the Medical Director, AIDS Institute, New York, NY, USA; Heiner is with the Karl Heiner Statistical Consulting, Ltd., Schenectady, New York, USA; Birkhead is with the AIDS Institute, Albany, New York, USA.