Structuring the pre-search reference interview: a useful technique for handling clinical questions.

OBJECTIVES: To explore whether structuring a literature search request form according to an evidence-based medicine (EBM) anatomy elicits more information, improves precision of search results, and is acceptable to participating librarians. METHODS: Multicenter before-and-after study involved six different libraries. Data from 195 minimally structured forms collected over four months (Phase 1) were compared with data from 185 EBM-structured forms collected over a further four-month period following a brief training intervention (Phase 2). Survey of librarians' attitudes toward using the EBM-structured forms was conducted early during Phase 2. RESULTS: 380 request forms, EBM-structured and minimally structured, were analyzed using SPSS. A statistically significant Pearson correlation was found between use of the EBM-structured form and complexity of the search strategy (P = 0.002). The correlation between clinical requests handled by the EBM-structured form and fewer items retrieved was also statistically significant (P = 0.028). However, librarians rated minimally structured forms more highly than EBM-structured forms against all dimensions except informativeness. CONCLUSIONS: Although use of the EBM-structured forms is associated with more precise searches and more detailed search strategies, considerable work remains on making these forms acceptable to both librarians and users. Nevertheless, with increased familiarity and improved training, information retrieval benefits could be translated into more effective search practice.

Changes in the sexual lifestyles of young people in Somerset, 1990-1996.

OBJECTIVES: The immediate objective was to up-date knowledge of the socio-sexual lifestyles and AIDS awareness of young people (16-24 years of age) in Somerset, and to compare these 1996 survey findings to the Somerset Survey findings from 1990. The ultimate objective was to provide information to assist the continuing development of HIV risk-reduction and sexual health promotion strategies for young people. DESIGN: An identical schedule-structured survey strategy to that employed in 1990 was undertaken in May to July 1996 among 498 young people throughout Somerset. A quota sampling strategy was undertaken in 50 electoral wards, randomly selected in proportion to population size. The interviews, undertaken in respondents' homes, involved a combined personal interview and self-completion booklet. RESULTS: Between 1990 and 1996 broad shifts in sexual lifestyles were identified, involving earlier ages of first intercourse, slight increases in numbers of sexual partners and more 'casual-recreational' sexual attitudes. These changes were accompanied by a substantial increase in condom use. CONCLUSIONS: The trend among youth in Somerset is towards more open sexual lifestyles, but with the positive public health implications of higher levels of 'safer sex' practice.

PIP: A 1996 survey of the knowledge of sociosexual lifestyles and AIDS awareness of young people (16-24 years of age) in Somerset is presented and compared with the Somerset survey findings from 1990. This information will be utilized in the development of current HIV risk reduction and sexual health promotion strategies for young people. A survey employing a design identical to the one used in 1990 was conducted from May to July 1996 among 498 young people throughout Somerset. A combination personal interview and self-completion booklet was completed in the respondents' homes. The findings between 1990 and 1996 showed broad shifts in sexual lifestyle, involving an earlier age of first intercourse, slight increases in numbers of sexual partners, and more "casual-recreational" sexual attitudes. A substantial increase in condom use was noted along with these changes. The 1996 survey also revealed a heightened HIV/AIDS awareness in the youth. Thus, the more open sexual lifestyles that have developed among the youth in Somerset have been accompanied by safer sex practice.

Narrative explorations and self-esteem: research, intervention and policy for HIV prevention in the sex industry in Thailand.

PIP: This paper reports on a project that integrates basic behavioral and need assessment research with program design, implementation and evaluation to promote consistent condom use in the sex industry of Thailand. The project structure consisted of Phase I, which provided a detailed psychosocial investigation into the factors influencing condom use by female sex workers in Thailand. Phase II translated the research findings of Phase I into an operational intervention. This involved an integrated series of stages including pre-program needs assessment, intervention design, implementation, evaluation, and finally dissemination and policy integration. As a basis for open discussion and personal exploration the use of dramatic narrative scenarios on video were used to depict the problems experienced by sex workers. This program was implemented in high and low-income establishments in central Thailand; evaluation was performed through pre/post-test, intervention and control, and quasi-experimental design. Findings demonstrated an increase in the consistency of condom use over a period of 1 month among the low-income intervention group, from 66% (pre-test) to 86% (post-test), while there was no significant change observed among the sex workers in the control group.^ieng

Operationalizing the new concept of sexual and reproductive health in Indonesia.

PIP: The new politics of family planning in the 1990s has involved the articulation of a comprehensive concept of sexual and reproductive health (SRH). Following the ratification of the SRH concept and goals at recent international conferences, one major issue is how governments translate the broad statements into operational policies and programs. The authors consider the ways in which the process is occurring in Indonesia, defining SRH, and reviewing the levels of its attainment in 8 of its components in Indonesia. The policy process in Indonesia is explored with regard to pre-existing reassessments, setting important priorities and moralistic and pragmatic policy orientations. The following SRH components are discussed: family planning, infertility, maternal and child health, HIV/AIDS, sexually transmitted diseases, adolescents' needs, sexual health, and gender issues. In terms of SRH, Indonesia has achieved considerable success in addressing family planning and infant and child mortality, limited success in addressing maternal mortality and HIV/AIDS, and very little progress in addressing STDs, adolescent needs, and positive sexuality. There are few data on gender issues.^ieng

An extensive literature review of the evaluation of HIV prevention programmes.

This paper draws out and distils three key themes that have emerged from a substantial bibliographical review of a range of HIV intervention programmes, implemented throughout the world between years 1987 and 1995. Specifically, the paper assesses (1) to what extent intervention programmes have been tailored to meet the requirements and needs of specific target groups; (2) to what extent intervention programmes are supported by social and psychological theory of attitudinal and behavioural change, and also to what extent the results and findings from the interventions have amended existing theory; and, finally, (3) the range of methodologies employed in evaluating intervention programmes and also to what extent behavioural measures have been used in examining a programme's effectiveness. In light of these themes, the paper presents and discusses the principal factors thought to contribute towards the effectiveness of HIV intervention programmes.

PIP: An extensive review of the evaluation literature on global human immunodeficiency virus (HIV) prevention programs implemented during 1987-95 identified three key areas of focus: 1) the extent to which interventions have been tailored to meet the needs of target populations; 2) the extent to which programs are supported by social and psychological theories of attitudinal and behavioral change; and 3) assessment of the methodologies used in program evaluation, especially behavioral measures. The literature reveals a shift over time from interventions aimed at the general public to those tailored to the needs of four risk groups: young people, homosexual/bisexual men, commercial sex workers, and intravenous drug users. Only a minority of programs were based on a specific theoretical approach to behavioral change, and there has been little refinement of existing psychosocial theory; however, awareness of the inadequacy of purely cognitive, information-giving approaches has increased. A trend toward inclusion of an evaluation component has enhanced program design. The ideal evaluation strategy would include explicit theoretical grounding, both process and outcome evaluation methodologies, baseline testing of attitudes and behaviors, use of equivalent control groups, evaluation of both cognitive and behavioral impacts, post-test measures of behavioral change, and longitudinal evaluation of sustained change over time. The literature indicates that prevention programs should involve a significant pre-planning component to assess the nature and extent of salient behaviors. Most effective have been multifaceted efforts that encompass not only knowledge acquisition, but also social skills, role-plays, communication techniques, assertiveness training, and improvements in self-efficacy. Finally, community participation (especially with hard-to-reach or stigmatized groups) and establishment of referral linkages to local health care agencies have been critical to program success.

The provision of female sterilization in São Paulo, Brazil: a study among low income women.

This paper examines some problems involved in the provision of female sterilization procedures in Brazil, mainly those concerned with the ways in which this operation is offered. Female sterilization provision is analysed by reference to the broader institutional context and from the client's perspectives. These themes are discussed in the light of some recent survey findings. A survey was carried out between March and July, 1992 in two selected poor areas of São Paulo Metropolitan Region. 3149 women were asked about contraceptive use including 407 sterilized women under 40 years old who were also interviewed about their adaptation to sterilization. Further information was also obtained through in-depth interviews with 15 sterilized women who regretted the operation. The findings highlight a complex network of interests and misunderstandings which shape the nature of choice of female sterilization by Brazilian low income women.

Responding to the AIDS epidemic in Asia and the Pacific: report on the Third International Conference on AIDS in Asia and the Pacific, Chiang Mai, Thailand, 17-21 September, 1995.

PIP: The Third International Conference on AIDS in Asia and the Pacific was held in Chiang Mai, Thailand, in conjunction with the Fifth National AIDS Seminar in Thailand. These geographical areas accounted for less than 7% of global cumulative AIDS cases, but nearly 20% (over 3.5 million) of global cumulative HIV infections as of mid-1995. The Thai national AIDS program comprises information, education, and communication and the development of sexually transmitted disease (STD) health care with counseling to reduce risk behavior. Safer sex practices among commercial sex workers and injecting drug users (IDUs) have led to a dramatic decline of HIV infection. The impact of the HIV/AIDS epidemic so far has had a small negative effect economically, but the social implications are more serious. There were 160,000 HIV-infected people in 1995 in these areas; the number is expected to rise to 700,000 by the year 2000. The major source of HIV infection in Asia is unprotected sexual intercourse and injecting drug use. HIV-1 subtype E is the most dominant strain in Asia, yet little research has been done on it. In several countries the major focus of prevention research has been on prostitutes, STD clinic attenders, long-distance truck drivers, and IDUs. In Bombay, India, HIV prevalence among prostitutes was found to be 51% vs. 0.8% among women attending a prenatal clinic. Despite an active prevention program in Chiang Mai, 33% of brothel inmates were infected with STDs. Effective programs should include the development of self-esteem and self-protective behavior. Although condom use has soared in recent years, men refusing its use continue to infect their wives and girlfriends. HIV seroprevalence among women attending prenatal clinics in Bangkok increased from 1% to 2% from 1991 to 1994. One Burmese study indicated that 1.1% of the soldiers were HIV-infected; in northern Thailand ethnic minorities have substantial HIV rates; and unsafe behavior among homosexual males in Australia is continuing.^ieng

Sexual hazards for migrant workers.

In Thailand the incidence of HIV/AIDS, other sexually transmitted diseases, and unwanted pregnancies highlights the vulnerability of young people who have moved from rural to urban areas as migrant workers. Possible ways of diminishing the risks are discussed below.

PIP: In-depth interviews, focus group discussions, and surveys conducted among young, single male and female factory workers in Thailand revealed an urgent need for education aimed at promoting safe sex within steady relationships. 85% of survey respondents and 95% of focus group discussants were migrants from rural areas. 63% of men and 9% of women (considered an underestimate) acknowledged sexual activity; 44% of the men reported sexual encounters with a prostitute. Condom use was reported for 83% of encounters with prostitutes, but only 4% of women and 21% of men used this protection in steady sexual relationships. 29% of the sexually experienced women reported coercion to engage in their first intercourse and 13% had been pregnant. Although 35% of females and 30% of males considered they had at least a 50% chance of becoming infected with human immunodeficiency virus (HIV) during the next two years, their main concern was unwanted pregnancy. HIV was not viewed as a threat in steady relationships, and workers believed HIV infection could be detected visually. Recommended are measures to counter coercion in sexual encounters, address the misperception that condom use is not necessary in steady relationships, develop safe sex negotiation skills, and reduce young women's inhibitions about acknowledging their sexuality. Collaboration of factory management with the Ministry of Public Health and nongovernmental organizations and the mass media could help achieve these objectives.

Destinations unknown: the gender construction and changing nature of the sexual expressions of Thai youth.

This paper discusses qualitative findings from a study of the sexual awareness, lifestyles and related health service needs of young, single factory workers in Thailand. The context of this study is Thailand's growing industrialization, the deepening intensity of the threats to sexual health (especially regarding HIV/AIDS transmission) and the vulnerability of young migrant women. Findings from 18 focus group discussions held with groups of young (15-24) male and female factory workers are outlined with principal reference to the gender construction of sexuality. Key themes explored include attitudes towards courtship, marriage, sexual feelings and arousal, expressions of involvement in pre-marital sexual activities and the consequences of such activity. In conclusion there is some discussion of the implication for young women's sexual health, of the interplay of a measure of pre-marital intercourse and the continuing emotional barriers to effective use of contraception.

PIP: Focus group discussions conducted with Thai factory workers 15-24 years of age revealed a conflict between traditionalist gender constructions of sexuality and the sexual culture of urban areas. The 18 group discussions (11 groups of women and 7 groups of men) were held at light industrial factories in Bangkok and surrounding urban centers. 90% of discussants were migrants from rural areas. A sexual double-standard was evident. Virtually all the young men reported that their first sexual contact was with a prostitute. Frequenting brothels remains an important peer group activity, yet most men indicated they would not marry a non-virgin. Despite this, there is a culturally constructed expectation that men will pressure women to engage in premarital intercourse and women will resist. Tension between traditional premarital abstinence and an urban pattern of the possibility of intercourse within committed relationships is widespread. Female discussants found it difficult to acknowledge sexual feelings or experiences, and most indicated they would not insist on contraceptive use for fear of being stigmatized as sexually experienced. In general, men were fearful of sexually transmitted diseases while women were more concerned with the impact of a premarital pregnancy on their reputation and marriageability.

Production and characterization of bovine monoclonal antibodies to respiratory syncytial virus.

Six interspecific hybridomas (heterohybridomas) secreting bovine monoclonal antibodies (MAbs) against respiratory syncytial (RS) virus were produced. Four of the heterohybridomas were formed using the mouse myeloma cell line NS1 as the fusion partner, one using NS0, and the remaining heterohybridoma was formed using a bovine X murine hybridoma as the fusion partner. Five heterohybridomas secreted bovine IgG1 and one secreted IgG2. All six MAbs recognized human subtype A and B viruses as well as bovine RS virus. They were specific for the fusion glycoprotein and reacted with a 140K dimer and a 70K monomer in a Western blot of native antigen; three also bound to the 46K F1 component and its 22K cleavage product in a blot of reduced antigen. Two of these MAbs neutralized RS virus infectivity, inhibited virus-induced fusion, lysed RS virus-infected cells in the presence of complement and protected mice against RS virus challenge.