The recovery of semen from bathwater using the Evidence Recovery System (ERS)

Sexual offences are under-reported and ascertaining accurate offence numbers is difficult. Any methods which could increase the ability to obtain biological evidence or reduce the additional distress associated with reporting a sexual offence may result in an increase in reporting this crime type. The Evidence Recovery System (ERS) is designed to collect trace evidence, including hairs, fibres and biological evidence, from bath or shower water in a non-invasive manner. Initially, samples of semen were placed in baths filled with water, and washing was simulated using a range of body wash products. The water was then drained through the ERS before its filters were subjected to acid phosphatase testing and haematoxylin and eosin staining of spermatozoa. Recovered spermatozoa were then graded accordingly. Following this, the experiment was repeated with the addition of dirt/dust particulates during the washing stage, to simulate recovery of biological evidence in a more realistic environment. The results showed that spermatozoa considered 'easy to find' could regularly be obtained from bathwater using the ERS. It appeared that this recovery was not affected by the presence of different body wash products. When dust/dirt particles were added, the number of spermatozoa recovered increased at two of the evidence collection stages. The difference in recovery was considered to be statistically significant. This study provides evidence to suggest the feasibility of use of the ERS as a method to collect semen evidence from individuals subjected to sexual offences. The recovery of spermatozoa does not appear to be affected by the presence of a body wash, but does appear to be improved when skin cells, hair and other debris are transferred into the water, as would be likely during a bath/shower. Further to this, the possibility of obtaining spermatozoa from the home bath or shower of a victim following a post-offence bathing experience is implied.

Predicting long-term recovery from depression in community settings in Western Europe: evidence from ODIN

OBJECTIVE

To test the impact of socio-economic and psychological adversity and healthcare on long-term recovery from depression.

METHOD

A community sample of 347 people with depressive disorders was followed up after 9 years. Baseline socio-economic adversity, social support, healthcare use, and psychiatric history were identified. Respondents completed self-report instruments on current depressive status (Beck depression inventory) and longstanding psychosocial adversity (sexual, physical or emotional abuse). Univariate analyses tested for association between recovery and respondent characteristics.

RESULTS

Follow-up was achieved for 182 (52%) of the sample, of whom 75 (41%) indicated recovery from depression. Psychological adversity definitely and socio-economic adversity probably were associated with lack of recovery. Baseline healthcare had no apparent impact on outcome. Rurality and support after life events were associated with recovery. History of depression was associated with non-recovery.

CONCLUSION

Psychological adversity is, and socio-economic adversity may be, associated with long-term non-recovery from depression in community settings.

Estimating psychological treatment effects from a randomised controlled trial with both non-compliance and loss to follow-up

BACKGROUND

The Outcomes of Depression International Network (ODIN) trial evaluated the effect of two psychological interventions for the treatment of depression in primary care. Only about half of the patients in the treatment arm complied with the offer of treatment, prompting the question:'what was the effect of treatment in those patients who actually received it?'

AIMS

To illustrate the estimation of the effect of receipt of treatment in a randomised controlled trial subject to non-compliance and loss to follow-up.

METHOD

We estimated the complier average causal effect (CACE) of treatment.

RESULTS

In the ODIN trial the effect of receipt of psychological intervention (an average of about 4 points on the Beck Depression Inventory) is about twice that of offering it.

CONCLUSIONS

The statistical analysis of the results of a clinical trial subject to non-compliance to allocated treatment is now reasonably straightforward through estimation of a CACE and investigators should be encouraged to present the results of analyses of this type as a routine component of a trial report.

Determinants of cervical cancer screening in a poor area: results of a population-based survey in Rivas, Nicaragua

OBJECTIVE

To obtain baseline information for designing a community-based intervention programme aimed at increasing the cervical cancer screening coverage of women most at risk.

METHODS

A population-based survey, using proportional stratified two-stage cluster sampling in Rivas, one of the 16 Departments of Nicaragua. The individuals selected were interviewed at home by one of 26 interviewers, using a structured questionnaire. The questionnaire was designed to elicit (1) knowledge, attitudes and practices concerning sexual and reproductive health and behaviour, (2) risk factors for cervical cancer and (3) the use of health and cervical cancer screening services.

RESULTS

A total of 612 men and 634 women participated in the survey. Of the women who had been sexually active at least 3 years, only 41.1% had undergone screening within that period and were considered adequately screened. Correlates of inadequate screening status included low educational level, exclusive use of public health facilities and lack of knowledge about prevention and symptoms of cervical cancer. Negligence, absence of medical problems, fear, lack of knowledge and economic reasons were the main reasons given for not being screened. Reluctance to be screened in the future was related to lack of knowledge of the disease, inadequate screening status, older age and low educational level.

CONCLUSIONS

The current screening programme is not effective in reaching the majority of the population. Complementary activities such as education and information, as well as a more pro-active approach to invite women for screening are necessary.

Mortality following conjugal bereavement, Belgium 1991-96: the unexpected effect of education

This paper examines excess mortality following spousal bereavement by time since bereavement, sex, age, and education. The main hypothesis challenged is that higher education buffers the harmful effects of spousal loss. Using a log-rate model, death-rate ratios (widowed/married) are estimated for 49,849 and 126,746 Belgian widowers and widows and an equal number of non-bereaved controls matched to the bereaved on their socio-demographic characteristics. The hypothesis that the more educated suffer less excess mortality is not supported. Although higher educational levels are associated with lower mortality in general, they do not alleviate the effects of bereavement. On the contrary, in the period immediately following spousal loss, the more highly educated seem to have more, rather than less, excess mortality. Three possible arguments are suggested to account for this: education-related differences in the partner-relationship, structural differences in the availability of appropriate social support, and cultural differences in potential support networks.

Depressive disorders in Europe: prevalence figures from the ODIN study

BACKGROUND

This is the first report on the epidemiology of depressive disorders from the European Outcome of Depression International Network (ODIN) study.

AIMS

To assess the prevalence of depressive disorders in randomly selected samples of the general population in five European countries.

METHOD

The study was designed as a cross-sectional two-phase community study using the Beck Depression inventory during Phase 1, and the Schedule for Clinical Assessment in Neuropsychiatry during Phase 2.

RESULTS

An analysis of the combined sample (n=8.764) gave an overall prevalence of depressive disorders of 8.56% (95% CI 7.05-10.37). The figures were 10.05% (95% CI 7.80-12.85) for women and 6.61% (95% CI 4.92-8.83) for men. The centres fall into three categories: high prevalence (urban Ireland and urban UK), low prevalence (urban Spain) and medium prevalence (the remaining sites).

CONCLUSIONS

Depressive disorder is a highly prevalent condition in Europe. The major finding is the wide difference in the prevalence of depressive disorders found across the study sites.

Problem solving treatment and group psychoeducation for depression: multicentre randomised controlled trial. Outcomes of Depression International Network (ODIN) Group

OBJECTIVES

To determine the acceptability of two psychological interventions for depressed adults in the community and their effect on caseness, symptoms, and subjective function.

DESIGN

A pragmatic multicentre randomised controlled trial, stratified by centre.

SETTING

Nine urban and rural communities in Finland, Republic of Ireland, Norway, Spain, and the United Kingdom.

PARTICIPANTS

452 participants aged 18 to 65, identified through a community survey with depressive or adjustment disorders according to the international classification of diseases, 10th revision or Diagnostic and Statistical Manual of Mental Disorders, fourth edition.

INTERVENTIONS

Six individual sessions of problem solving treatment (n=128), eight group sessions of the course on prevention of depression (n=108), and controls (n=189).

MAIN OUTCOME MEASURES

Completion rates for each intervention, diagnosis of depression, and depressive symptoms and subjective function.

RESULTS

63% of participants assigned to problem solving and 44% assigned to prevention of depression completed their intervention. The proportion of problem solving participants depressed at six months was 17% less than that for controls, giving a number needed to treat of 6; the mean difference in Beck depression inventory score was -2. 63 (95% confidence interval -4.95 to -0.32), and there were significant improvements in SF-36 scores. For depression prevention, the difference in proportions of depressed participants was 14% (number needed to treat of 7); the mean difference in Beck depression inventory score was -1.50 (-4.16 to 1.17), and there were significant improvements in SF-36 scores. Such differences were not observed at 12 months. Neither specific diagnosis nor treatment with antidepressants affected outcome.

CONCLUSIONS

When offered to adults with depressive disorders in the community, problem solving treatment was more acceptable than the course on prevention of depression. Both interventions reduced caseness and improved subjective function.

Cancer gene discovery using digital differential display

The Cancer Gene Anatomy Project database of the National Cancer Institute has thousands of expressed sequences, both known and novel, in the form of expressed sequence tags (ESTs). These ESTs, derived from diverse normal and tumor cDNA libraries, offer an attractive starting point for cancer gene discovery. Using a data-mining tool called Digital Differential Display (DDD) from the Cancer Gene Anatomy Project database, ESTs from six different solid tumor types (breast, colon, lung, ovary, pancreas, and prostate) were analyzed for differential expression. An electronic expression profile and chromosomal map position of these hits were generated from the Unigene database. The hits were categorized into major classes of genes including ribosomal proteins, enzymes, cell surface molecules, secretory proteins, adhesion molecules, and immunoglobulins and were found to be differentially expressed in these tumorderived libraries. Genes known to be up-regulated in prostate, breast, and pancreatic carcinomas were discovered by DDD, demonstrating the utility of this technique. Two hundred known genes and 500 novel sequences were discovered to be differentially expressed in these select tumor-derived libraries. Test genes were validated for expression specificity by reverse transcription-PCR, providing a proof of concept for gene discovery by DDD. A comprehensive database of hits can be accessed at http:// www.fau.edu/cmbb/publications/cancergenes. htm. This solid tumor DDD database should facilitate target identification for cancer diagnostics and therapeutics.

The Tripler LE3AN Program: a two-year follow-up report

This paper provides a review of 2-year follow-up data on the Tripler Army Medical Center LE3AN Program. The LE3AN Program (emphasizing healthy Lifestyles, reasonable Exercise, realistic Expectations, Emotions, and Attitudes, and Nutrition) provides active duty service members a treatment strategy that involves a reasonable low-intensity exercise regimen, behavior modification, intensive nutritional counseling healthy meal planing, relapse prevention strategies, cognitive coping strategies, and healthy lifestyle principals to lose weight and maintain weight loss. Based on the 2-year data and additional clinical findings, we expand upon earlier preliminary reports. The 2-year follow-up data suggest that the program is a safe and efficacious treatment program.

Palliative care in chronic obstructive airways disease: a needs assessment

The view that palliative care should move beyond cancer is widely endorsed, however, there remains a lack of clarity about the level at which this should occur. In order to target the palliative approach effectively, the value of more detailed and localized needs assessment becomes apparent. This paper provides evidence from a study commissioned by a department of public health, where the focus was the palliative care needs of an individual with chronic obstructive airways disease (COAD). Over a six-month period, 63 individuals in the district were interviewed about their experiences of living with COAD and the services utilized, using a combination of qualitative and quantitative research methods. The findings revealed a poor quality of life, relating to a high degree of social isolation and emotional distress, associated with low physical functioning and disability, and physical symptoms. Current service provision focused on acute exacerbations. Consequently, there is a need to manage the health and social care interface more effectively, with a shift in emphasis from reactive ad hoc provision, which is where the palliative approach to care could be best suited to meet the needs identified.

Social class variation in place of cancer death

The aim of this research was to describe the distribution of place of death for cancer. An analysis of place of death for all 831 cancer deaths in 1995 among Doncaster Health Authority's residents was carried out. The data were extracted using the Public Health Mortality File. It was found that there is statistically significant evidence that place of death is associated with social class. Social class I and II with 15% of all cancer deaths contributed 24% of hospice deaths, 14% of hospital deaths and 12% of home deaths. Social class III with 24% of all cancer deaths contributed 58% of hospice deaths, only 9% of hospital deaths and 35% of home deaths. Social classes IV and V with 61% of cancer deaths contributed only 18% of hospice deaths, 77% of hospital deaths and 53% of home deaths. The reasons for these differences may be to do with access to services, perceptions of different services by patients and general practitioners and the availability of social support within different sections of the community.

Changes in family formation among Turkish and Moroccan women in Belgium

"This paper addresses the extent to which the behaviour of migrants...diverges from the pattern observed in the country of origin and converges on that of the country of destination.... In the first part of the analysis we compare the family formation patterns of Turks and Moroccans living in Flanders and Brussels with the patterns of Belgians living in the same regions on the one hand and with the populations of Turkey and Morocco on the other hand. In the second part we look in more detail at the behaviour of Turks and Moroccans in Belgium, distinguishing between the first and the second generation. To what extent, if any, do the immigrant communities diverge from the countries of origin on various aspects of family formation behaviour, and to what extent is there convergence with the patterns observed for Belgians?" (SUMMARY IN ITA AND FRE)

Screening for coronary heart disease risk factors in retail pharmacies in Sheffield, 1992

OBJECTIVE

To investigate the current and likely future provision of screening services for risk factors for coronary heart disease in retail pharmacies in Sheffield.

DESIGN

This was a questionnaire survey asking about screening tests currently offered, price charged per test, likely future provision of screening tests, the action respondents would take upon finding an abnormal test result, whether the pharmacy was owner-run, franchised, or part of a commercial chain, and inviting open comments from respondents.

SETTING

All retail pharmacy premises on the Sheffield Family Health Services Authority list.

RESULTS

Seventy seven responses were obtained to 102 questionnaires distributed. Only nine of these currently offered any screening test other than pregnancy testing, although 37 indicated that they might offer tests in the future. Thirty nine were not offering screening and had no plans to do so. Pharmacies offering or likely to offer screening tests were mainly owner-run. All pharmacists who replied to the question asking about their action upon finding abnormal result (33) reported that they would advise the patient to see a doctor. The most frequent comments made by pharmacists were about the commercial viability of screening in pharmacies and the lack of space available to ensure patient privacy and confidentiality during screening.

CONCLUSIONS

Screening in retail pharmacies would probably be a commercial failure unless doctors were able to contract for screening services from pharmacies. Evidence from this study and others, however, leads us to question the desirability of this option.

The use of the FHSA (family health services authority) registration index for a health needs survey

The FHSA patient registration index was used as a sampling frame for a population questionnaire survey. The main survey of 3,359 was preceded by a pilot study of 250. Ethical issues such as anonymity and release of data were addressed in order to obtain the approval of the ethical committee and LMC. The acceptability to GPs and the public of using FHSA Registration data was tested. The validity of the survey was indicated by the proportion of wrong addresses, the response rate and the representativeness of the sample and responders. Appropriate software is needed for selecting a random sample and producing address labels.

Estimation of the prevalence and incidence of infertility in a population: a pilot study

A pilot study was undertaken to investigate the use of a mailed questionnaire to estimate the prevalence and incidence of infertility in a population, and the demand for medical advice about infertility. The objectives were to investigate the response rate, the acceptability and comprehensibility of the questionnaire, and to provide initial results. After elimination of undelivered questionnaires, a response rate of 82% was obtained. One question was found to be misleading in its wording: this question can be clarified before the questionnaire is used more widely. The results from analysis of the pilot study indicate that 20% to 35% of couples take more than 1 year to conceive, at some stage in their reproductive history. A much larger study, with a sample of approximately 3,500, is required to provide more accurate information.

The increasing demand for infertility treatment

At present NHS services for infertile couples are under-developed compared with those available in the private sector. Health care planners should be aware that the demand for infertility treatment is likely to increase. The average age at first child birth has increased and presumably also the average age at the first attempt to conceive. The rise in divorce rates and second marriages has resulted in increasing numbers of couples wishing to start a second family at a comparatively advanced age. If, as it appears, the time taken to conceive increases with age, the higher average age of women attempting to conceive could cause an increase in the prevalence of infertility, and the demand for treatment. Divorce and remarriage of sterilised people has resulted in a demand for reversal of sterilisation and for in vitro fertilisation (IVF). The age of onset of sexual activity has fallen. This, combined with later marriage, has led to an increase in the number of sexually active single people, with an increase in the incidence of sexually transmitted disease of which infertility is a possible sequel. The opportunity to adopt is now available for very few couples because of the decreasing proportion of illegitimate babies available for adoption. Recent publicity given to developments such as gamete intra fallopian transfer (GIFT) and IVF may have increased the demand for treatment.

Effectiveness of neonatal transport in New York City in neonates less than 2500 grams--a population study

In the past two decades, there has been a gradual trend to regionalization of perinatal care, categorization of hospitals and transport services for neonatal health care. The literature alludes to both beneficial and deleterious effects of neonatal transport (T) but no controls such as a matched nontransport (NT) population have been utilized to date. The major goal of this study was to evaluate the effect of neonatal transport from Level I and II high risk less than or equal to 2500 gm. neonates (born in NYC in one calendar year, 1979) compared to a cohort nontransported population matched for hospital of birth, weight, race, sex and risk. All transported less than or equal to 2500 gm. from Level I and II (n = 328) were studied and a stratified random sample of the nontransported (NT) infants less than or equal to 2500 gm. from these same hospitals (n = 2042) was used for comparison. The principle outcome variable was survival. The major conclusion of this study is that in Level I and II hospitals the transport group had a significantly increased survival in infants who were sick (Apgar less than 6) compared to cohorted nontransported controls. Interhospital differences in survival were noted among Level I and II but not seen in the subdivisions of (A) and (B) hospitals.

Post-Mortem Artificially Contracted Indian Heads

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