Comparison of sensitivity and reading time for the use of computer-aided detection (CAD) of pulmonary nodules at MDCT as concurrent or second reader.

The purpose of this study was to compare sensitivity for detection of pulmonary nodules in MDCT scans and reading time of radiologists when using CAD as the second reader (SR) respectively concurrent reader (CR). Four radiologists analyzed 50 chest MDCT scans chosen from clinical routine two times and marked all detected pulmonary nodules: first with CAD as CR (display of CAD results immediately in the reading session) and later (median 14 weeks) with CAD as SR (display of CAD markers after completion of first reading without CAD). A Siemens LungCAD prototype was used. Sensitivities for detection of nodules and reading times were recorded. Sensitivity of reading with CAD as SR was significantly higher than reading without CAD (p < 0.001) and CAD as CR (p < 0.001). For nodule size of 1.75 mm or above no significant sensitivity difference between CAD as CR and reading without CAD was observed; e.g., for nodules above 4 mm sensitivity was 68% without CAD, 68% with CAD as CR (p = 0.45) and 75% with CAD as SR (p < 0.001). Reading time was significantly shorter for CR (274 s) compared to reading without CAD (294 s; p = 0.04) and SR (337 s; p < 0.001). In our study CAD could either speed up reading of chest CT cases for pulmonary nodules without relevant loss of sensitivity when used as CR, or it increased sensitivity at the cost of longer reading times when used as SR.

Kinetics of chromium(V) formation and reduction in fronds of the duckweed Spirodela polyrhiza--a low frequency EPR study.

The uptake of chromate by the duckweed Spirodela polyrhiza was investigated with atomic absorption spectroscopy and the reduction of Cr(VI) to Cr(V) was measured using low frequency EPR spectroscopy. The biphasic kinetics of the uptake was fitted to parameters of a proposed kinetic model. Another model was developed to simulate chromate reduction. The first step of chromate reduction was found to be much faster than the uptake of Cr(VI) from the free space. Most probably, this step occurs already in the cell wall or on the cell membrane surface. Further reduction of Cr(V) to Cr(III) was estimated to be slower. The disappearance of the Cr(V) signal, following transfer of the plants into a Cr-free solution, lasted several tens of hours; the kinetics was mono- or biexponential depending on the length of Cr loading. The rate constants for Cr reduction in living plants were determined for the first time.

Reliability, criterion-related validity and qualitative comments of the Fourth Edition of the Stanford-Binet Intelligence Scale with a young adult population with intellectual disability.

The test-retest reliability and concurrent, criterion-related validity of the Fourth Edition of the Stanford-Binet Intelligence Scale (SB-IV) were examined in a young adult population with intellectual disability. Forty adults with mild to moderate intellectual disability (mean age = 20.8 years; SD = 1.8 years) were administered the SB-IV and retested approximately 5 weeks later (mean = 33.4 days, SD = 1.2). The Vineland Adaptive Behavior Scale: Interview Edition (VABS) was completed by a reliable informant within one week of the SB-IV testing. The test-retest reliability coefficients for the four SB-IV area and composite scores were all significant (P < 0.00). Individual subtest correlations tended to be lower but consistent across the two administrations. Moderate correlations were observed between the VABS composite and SB-IV composite scores. The present results provide support for the temporal reliability of the SB-IV and its concurrent, criterion-related validity in an exceptional sample.

Pregnancy termination and contraceptive failure in Viet Nam.

PIP: In Viet Nam, health workers conducted focus groups with women seeking pregnancy termination at 2 rural district hospitals in Thai Binh Province and at 2 urban district hospitals in Hanoi to learn why contraceptives failed and why some of these women did not use contraceptive. Researchers used information from the focus groups to design questions for a July-September 1991 survey of 2088 women seeking an abortion at all 9 rural district hospitals in Thai Binh Province and at 5 district hospitals in Hanoi. 85.3% of the women were married and lived with their husbands. Most women were eligible for menstrual regulation (53.7% in Hanoi and 64.9% in Thai Binh). 50% of all women (52.8% in Hanoi and 47.4% in Thai Binh) had had at last 1 prior pregnancy termination (1.6 pregnancy terminations/woman), suggesting that induced abortion is being used as a substitute for family planning methods. Effective modern contraceptive use by 50% of these women would have reduced the number of abortions during the 3 months by 25%. 36.8% (54.7% in Hanoi and 19.9% in Thai Binh) used traditional family planning methods. 38.3% (25.7% in Hanoi and 49.9% in Thai Binh) did not use any method. The leading reason for not using oral contraceptives (OCs) were personal health problems, unavailability, and the perception that contraceptives were bad for one's health. For IUDs, they were bleeding, lumbago, headache, loss of energy, and dizziness. For condoms, reasons for nonuse were disliked by one spouse and unavailability. Women's fear and husband's disapproval were key reasons for not choosing sexual sterilization. Reasons for failure of condoms, IUDs, and OCs were irregular use (62.6%) and poor quality (27.9), retained but still missed menstruation (74.3%), and used irregularly (23/28), respectively. The researchers recommended using these findings to develop an IEC campaign and training curricula for health workers.^ieng

[Talking to an "unconscious" patient?]. / Parler à un "inconscient"?

In our every day practice in intensive care unit, we have the constant worry to join words to our care, is it towards conscious our unconscious patients. This paper is the issue of a work of listening and thinking over from the nursing team, to the testimony of a patient who was in our unit for three months. This person was in the coma for long weeks, and he tells us afterwards about how he experienced this trial.

Immunization: full coverage the aim.

PIP: In November 1988, nursing students at Khon Kaen University in northeast Thailand conducted a baseline survey in 16 villages before a retraining program for village health workers began. It consisted of a 1-week intensive training program and meetings between officers and village health workers. The goal was to achieve full immunization coverage for children under 5. After retraining, the workers implemented their health education and immunization recruitment programs with a refresher course 4 months later. The nursing students conducted a follow-up survey in June 1989 so researchers could compare the effects of the 8 intervention villages with data collected in the 8 control villages. The intervention indeed brought about improvement in immunization coverage, mother's and health worker's knowledge, and health worker participation in program planning and coordination in the case villages. For example, full immunization coverage among children under 1 increased from 65% to 89% while in the control villages it remained at 56%. It also increased among children over 5 (30-81%) but in the control villages it only rose slightly (23-31%). The percentage of mothers who were very knowledgeable about infectious diseases increased from 1% to 8% yet in the control villages it decreased from 2% to 0. Mothers with high level of knowledge about immunization was higher in the 2nd survey in both groups, but the increase was greater in the intervention villages (12-33% vs. 14-21%). High level of knowledge about infectious diseases among health workers grew considerably (3-72%) in the case villages but in the control villages it decreased from 10% to 2%. In addition, health workers in the case villages improved their contact with health officers but not those in the control villages (47-64% vs. 70-36%). Program participation increased in the intervention villages (11-36%) but fell in the control villages (22-13%).^ieng

The impact of a community based health education program on the incidence of diarrheal disease in southern Thailand.

This study has demonstrated that additional training of service providers [village health volunteers (VHVs), village health communicators (VHCs)] in combination with the mobilization of village leaders and influentials to promote selective preventive health behavior, can have a marked impact upon the effective practice of these behaviors and diarrheal incidence. Further, this impact can be achieved through the existing staff structure, ie, VHV/VHCs of the national health program. For example, increased contact between these service providers and mothers of children under 5 years through home visits and attendance at meetings held by the service providers, contributed positively to the practice of selected preventive behaviors. If the national program provided similar training inputs on the promotion of selected preventive behaviors and increased service provider contacts, the program's impact upon diarrheal disease would be enhanced.

The KAP-gap in Nepal: reasons for non-use of contraception among couples with an unmet need for family planning.

PIP: This report summarizes the findings of a study designed to identify the reasons for non-use of family planning among Nepalese women who want to space or limit childbirth. The study's initial phase involved focus group sessions of women with unmet need for family planning who were asked their reasons for non-use. Researchers used this information to develop an in-depth questionnaire. Researchers then randomly selected a total sample of 5,152 women. After interviewing the women, researchers concluded that 31.6% the sample had unmet need for family planning. Consequently, researchers administered the questionnaire to the unmet demand population, which was almost equally divided among women who want to either spacing or limit childbirth. The study analyzes both reasons for the general non-use of contraception and reasons for the non-use of specific contraceptive methods (oral contraceptives, laparoscopy, and vasectomy). Although varying among the different contraceptive methods, the most commonly cited reasons were: 1) causes headache, weakness, nausea; 2) causes weight loss; 3) causes heavy bleeding; 4) insufficient money for nutritious foods; 5) causes weakness and cannot work; 6) currently in poor health; 7) husband disapproves; and 8) affects breastfeeding and dries breast-milk. Explaining the benefits of the study, the report indicates that the information can be incorporated into the training curriculum of health workers, and can be used to target information, education, and communication campaigns. Furthermore, evident in the responses that cite lack of nutritious foods and weakness, the study reveals that nutrition and food supplement programs could help increase contraceptive use.^ieng

Socioeconomic and health programme effects upon the behavioral management of diarrhoeal disease in northeast Thailand.

This study investigates the effects of socioeconomic and health programme factors on preventive and curative health behaviors and assesses the impact of preventive health behaviors on the incidence of diarrhoea among children under five years of age. Methodological approaches included focus groups to uncover local definitions of diarrhoeal disease, a baseline survey which collected data on maternal preventive health behaviors for 1,364 children, and a monitoring system which collected data on the incidence of diarrhoea and on maternal curative behaviors among the same group of children. Results indicate that socioeconomic status and exposure to health programmes showed significant relationships with selected maternal preventive behaviors. Children whose mothers washed their hands before breastfeeding, gave their child food immediately after cooking and warmed foods each time before meals had significantly lower proportions with diarrhoea than children of mothers who did not practice these behaviors, and 70 percent of the children with diarrhoea were exposed to high risk of severe dehydration and related health complications. Implications of these findings for health programmes are discussed.

Nutritional status and the incidence and duration of diarrhoeal disease among children in northeast Thailand.

In Thailand, diarrhoeal diseases are among major community health problems. The relationship between nutrition status and the incidence and duration of diarrhoea was studied in a sample of 1,117 mothers and 1,364 children under the age of 5 years. The findings are reported and analysed.

Health programme effects upon acceptance of immunisation in northeast Thailand.

PIP: As every year 5 million children die in developing countries because of infectious diseases, the government of Thailand in 1976 initiated an expanded program for immunization. Although vaccine coverage of the under 1 year of age population with BCG, diphtheria, pertussis, and tetanus is over 80%, the dropout rates are high and over 40% are without complete immunization. The availability and accessibility of immunization and the efficacy of health care delivery is analyzed. Group sessions were carried out with mothers of children under 4, with village health communications (VHCs) and village health volunteers (VHVs). 2 provinces with the highest immunization coverage and 2 with the lowest were selected. 608 women from 16 villages provided the sample as well as a total of 128 VHVs and VHCs. Distance to health center showed a significant relationship with completion of immunization (in contrast to travel time). The rate of complete immunization was higher for those who received regular information from VHVs and VHCs and who themselves contacted this personal than for those who never contacted the VHVs and VHCs. The most important factor of completion of immunization was the VHV/VHC contact. High immunization areas were highly correlated with high level of VHV/VHC knowledge about infectious diseases. The frequency of VHV/VHC reporting to subdistrict health officers also increased immunization coverage. Household visits were utilized by 54.6% of VHVs and VHCs in high immunization areas and by 15/7% only in low average areas. In high coverage areas, 13% of them were not instructed about dissemination of information as compared with 27.4% of them in low immunization areas. The 2nd phase of the study will consist of the measurement of intervention impact on immunization acceptance.^ieng

Gender-specific socioeconomic impacts of development programs in Sri Lanka.

PIP: Data from a Sri Lanka national sample survey -- 3597 households stratified on the basis of development program areas -- were analyzed to compare impacts of 3 national development programs and their combinations upon the occupational and income status of females and males in Sri Lanka. These programs, implemented over the last 30 years, are guaranteed price schemes that develop markets for agricultural produce, land settlement schemes that include irrigation, and rural electrification. To date, no attempt has been made to assess the gender-specific socioeconomic impacts of these individual programs and their combinations. It was hypothesized that the utilization of development program outputs will exert a gender-differential impact upon occupational and income status, but the magnitude and direction of the impacts remain to be determined. Path analysis was applied to estimate the model for each development program and their mixes for males and females separated. A multistage stratified sampling design was utilized. All of the development programs and their mixes exhibited significant effect of educational attainment upon participation in nonagricultural occupations. Rural electrification (RE) was the only program whose effect was positive; in combinations with education it accounted for 15% of the variation in occupation. Among the programs that were negatively related to male participation in nonagricultural occupations, the most important predictors were the land settlement (LS) and guarantee price scheme (GPS) programs. Each program contributed to over 1/5 of the variation in occupation net of educational attainment. RE was the only program that was not significantly related to female participation in nonhousehold occupations. All of the remaining programs exerted a positive effect upon occupation. 3 of these programs -- RE + LS, GPS, and LS + GPS -- were of almost equally high importance in predicting participation of females in nonhousehold occupations, and in combination with female education accounted for a little over 20% of the variation. All of the development programs with the exception of GPS exhibited a significant positive relationship with female income. Among males, all programs with the exception of GPS and LS exhibited significant indirect effects upon income. The magnitude of total development program effects upon income was gender specific in Sri Lanka.^ieng

Maintaining family planning acceptance levels through development incentives in Northeastern Thailand.

The results of a two-year longitudinal study of the effect that development program incentives have upon family planning in Northeastern Thailand are presented. These incentives, implemented by the Population and Community Development Association, Thailand, included animal raising and agricultural, home industry, and environmental activities. An experimental design including baseline and follow-up surveys supplemented by a continuous monitoring system was utilized to test hypotheses on the family planning impacts of the incentives. Findings indicate that the incentives contributed significantly to the maintenance of high levels of family planning practice through the program period 1982-1984.

PIP: The results of a 2-year longitudinal study of the effect that development program incentives have upon family planning in Northeastern Thailand are presented. These incentives, implemented by the Population and Community Development Association, Thailand, included animal raising and agricultural, home industry, and environmental activities. An experimental design including baseline and follow-up surveys supplemented by a continuous monitoring system was utilized to test hypotheses on the family planning impacts of the incentives. It was hypothesized that: 1) couples in experimental areas with a greater number and availability of development incentives will have a greater increase in contraceptive practice than couples in experimental areas with a lower number and availability of incentives; 2) in the experimental areas, couples who accept development incentives will have a greater increase in contraceptive practice than other couples; and 3) continuation of family planning practice in the experimental areas will be more prevalent among users who accept a development incentive than among others. Data collection focused on currently married couples in which the females were aged 15-44 years. In the baseline survey, data was collected on social, economic, and demographic factors and family planning. Over 1000 households were interviewed for each experimental model. The 1st hypothesis was not supported by the findings. The 2nd was supported by results from 1 model. The 3rd was supported by the data. Findings indicate that the incentives contributed significantly to the maintenance of high levels of family planning practice through the program period 1982-1984. The findings from this study suggest several avenues for further research and evaluation. Additional data need to be collected from the control area to assess the extent and impact of development incentives introduced by the government. Additionally, the process of program implementation in the experimental areas needs to be given greater attention. As the program continues, its impact on income, employment, migration, and fertility and mortality need to be measured carefully.

Guidelines for overcoming design problems in family planning operations research.

This report is concerned with designs for field intervention studies utilized in operations research. Beginning with an overview of the objectives of operations research, the authors go on to review the difficulties associated with using "true experimental" designs. Proposed guidelines for designing quasi-experimental studies are then discussed. The guidelines focus on using multiple sources of data, multiple measurements over time, and multiple replications of the study intervention. Finally, an example is presented of one ongoing operations research study in Sri Lanka.

PIP: This report is concerned with designs for field intervention studies utilized in operations research. Beginning with an overview of the objectives of operations research, the authors go on to review the difficulties associated with using true experimental designs. Proposed guidelines for designing quasi-experimental studies are then discussed. The guidelines focus on using multiple sources of data, multiple measurements over time, and multiple replications of the study intervention. Finally, an example is presented of one ongoing operations research study in Sri Lanka. Since 1981, 14 research studies have been implemented in Thailand, the Philippines, Sri Lanka, and Nepal as part of an ongoing family operations research (OR) program in Asia. 2 features of true experimental designs often prove problematic for health and family planning field studies: random selection of study units (individuals, households, villages, districts) from some larger grouping of these units, and then subsequent random assignment of these units to experimental and control groups; and maintaining full control over timing, intensity and duration of the experimental variables. Random assignment of study units to experimental and control groups relates to internal validity and is important if the objective of a study is to make causal inferences about the impact of a program intervention. Managers are concerned with such questions as: what type and length of training should fieldworkers receive? What is the most cost-effective means of providing accurate information to large numbers of rural people about the availability of services? Do incentives increase contraceptive prevalence, and if so, what type of incentives? A guideline for selecting field research design is the principle of the 3 multiples: seeking multiple data sources to obtain information on the same variables; seeking multiple measurements over time of the same variables; and seeking multiple replications of the study intervention in different field settings. Experience suggests that a good quasi-experimental design includes: background information from 2ndry sources; selecting multiple sites for replication of the study intervention; collecting preliminary qualitative data; conducting a baseline survey; implementing a study monitoring system; conducting a follow-up survey; collecting postintervention qualitative data; and collecting longterm followup data. The Sri Lankan IUD study which followed this basic design presented many difficulties, but at least allowed the investigators to isolate statistically the data from areas known to have been affected by nonstudy intervention variables.

Spouse age difference and fertility in rural Bangladesh: implications for raising the age at marriage of females.

PIP: This study analyzed all births registered in 1968-71 in a population of 117,000 in 132 villages of Matlab Thana, Bangladesh, to test the hypothesis that there is an inverse relationship between spouse age difference and fertility. Marital age-specific and marital total fertility rates were calculated for spouse age difference categories. 73% of the women in the sample had husbands who were at least 10 years their senior, and in 21% of cases the husbands were 15 or more years older. However, the proportions of women whose husbands were more than 14 years older was higher among women in the older age groups. Throughout the age structure, fertility rates declined as the age difference from the husband increased. The total marital fertility rate was 7.3 among women 5-9 years younger than their husbands, 6.9 when there was a 10-14 year difference, 6.4 when the age difference was 15-19 years, and 5.5 when the age difference was 20 years or more. Also analyzed was the magnitude of the effect of the widespread difference in age between spouses in Bangladesh on the crude birth rate. If all women whose husbands are 15 or more years older were shifted to the group in which husbands are 10-14 years older, the crude birth rate would be 2.6% higher. If all women whose husbands are 10 or more years older were shifted to the group in which husbands are 5-9 years older, the birth rate would increase by 5.4%. Overall, reduction of the age difference between spouses to 5-9 years would imply an additional 170,000 births that would have to be prevented to maintain the current crude birth rate in Bangladesh of 46. These findings have implications for population policies aimed at increasing the age at marriage of females. Such a policy is likely to produce a narrowing or reduction in the differences in ages between spouses as well as a reduction in the length of exposure for reproduction.^ieng

The relative impacts of vertical and integrated FP/MCH programs in rural Nepal.

The objectives of this analysis were to assess the probable impacts of vertical and integrated FP/MCH programs on family planning (knowledge, use, and intentions to use), family size preferences, fertility, and mortality (child and infant). The following discussion summarizes and draws conclusions regarding the results of this investigation. The vertical program showed a greater impact on knowledge of family planning than the integrated program. Increases in knowledge between 1975 and 1978 while controlling for social and demographic variables were greater in the vertical than the integrated areas. Multiple classification analysis at both household and village levels showed that the vertical program was a better predictor of knowledge and changes in knowledge than the integrated program. In addition, the vertical program showed consistently higher proportions of women with awareness of family planning among those segments of the population that could have the greatest impact on fertility reduction in the future--namely, the younger women who are either childless or just beginning their childbearing and those with husbands who have little or no education. Neither the vertical nor the integrated FP/MCH program showed an impact on current use or ever use of family planning. The very low levels and changes in levels of these factors between the programs showed almost no difference throughout the selected demographic and socioeconomic groups. In both program areas the proportions of ever use and current use increased substantially with the number of living sons, exceeding 14 percent and 10 percent, respectively, among women with three or more sons. There were virtually no family planning users or ever users among women with no sons. This appears to indicate that "son preference" (documented in the Nepal Fertility Survey) is an important factor affecting the incidence of family planning practice and may be a formidable obstacle to a substantial reduction in fertility. Family limitation generally may not be taken seriously until a couple has produced the desired number of sons. Hence, until the value of sons (perhaps as sources of labor, financial support and security in old age, and as performers of funeral rites for fathers) can be altered it is unlikely that a reduction in fertility beyond certain levels could occur. The vertical program showed a slightly greater impact on future intentions to use family planning than the integrated program.(ABSTRACT TRUNCATED AT 400 WORDS)

PIP: An analysis of the impacts of vertical and integrated family planning/maternal child health programs on family planning, family size preferences, fertility, and infant and child mortality was conducted utilizing the 1st longitudinal sample survey data collected in Nepal. Findings indicate that neither program demonstrated an impact on contraceptive use. However, the vertical program (organized from a central office, with 4 regional offices, 40 district offices, and 492 clinic and village based service centers) was shown to have a greater impact on family planning knowledge, future intentions to use family planning, fertility, and infant mortality.

Migrant-nonmigrant differentials in socioeconomic status, fertility and family planning in Nepal.

PIP: This study identifies the socioeconomic characterisitics of immigrants in Nepal, their fertility, and the incidence of family planning. These characterisitics are contrasted with the receiving or nonmigrant population and inferences drawn regarding the probable social and demographic impact immigrants may have on the "receiving" population. Demographic surveys were conducted annually from 1975 through 1978 in the Hills and Terai by the research and evaluation unit of the Family Planning/Maternal Child Health (FR/MCH) Project. In each of these geographic areas, all districts were matched on a set of social and demographic characteristics. 2 districts were then selected from each area on the basis of their similarity to each other. The sample design for all districts involved selection of panchayats (a political unit roughly equivalent to a country) and their wards (villages) on the basis of a procedure which refers to a selection of units based upon probabilities proportional to size of the population of the units. Currently married women aged 15-44 in all households of the secondary sampling units, i.e., wards, were interviewed. Both migrant women and their husbands had a higher level of educational attainment than nonmigrant women and their husbands. Indian migrants had higher proportions in the largest landholding groups than nonmigrant and lower proportions who are landless. The differential was maintained among Indians who had lived in the Terai for 10 years or less as well as 11 years or more. This finding was particularly striking since Indian migrants make up 25% of the sample. Current marital fertility (as measured by age specific and total fertility rates) was highest among Indian migrants, but cumulative fertility or past reproductive performance (as measured by the mean number of children ever-born) was highest among migrants from "other districts." With the exception of the youngest age group, migrants from "other districts" have higher proportion of "ever users" and "current users" of family planning than nonmigrants or migrants from India throughout the age structure. The highest proportion for both "ever users" and "current users" was reached at ages 35-39 years. Indian migrants in contrast had the lowest proportions of "ever users" and "current users" throughout the age structure (with the exception of the age group 35-39).^ieng