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Context: Fluoroquinolones are commonly prescribed classes of antibiotics. Despite numerous case reports of ocular toxicity, a pharmacoepidemiological study of their ocular safety, particularly retinal detachment, has not been performed.Objective: To examine the association between use of oral fluoroquinolones and the risk of developing a retinal detachment.Design, Setting, and Patients: Nested case-control study of a cohort of patients in British Columbia, Canada, who had visited an ophthalmologist between January 2000 and December 2007. Retinal detachment cases were defined as a procedure code for retinal repair surgery within 14 days of a physician service code. Ten controls were selected for each case using risk-set sampling, matching on age and the month and year of cohort entry.Main Outcome Measure: The association between retinal detachment and current, recent, or past use of an oral fluoroquinolone.Results: From a cohort of 989,591 patients, 4384 cases of retinal detachment and 43,840 controls were identified. Current use of fluoroquinolones was associated with a higher risk of developing a retinal detachment (3.3% of cases vs 0.6% of controls; adjusted rate ratio [ARR], 4.50 [95% CI, 3.56-5.70]). Neither recent use (0.3% of cases vs 0.2% of controls; ARR, 0.92 [95% CI, 0.45-1.87]) nor past use (6.6% of cases vs 6.1% of controls; ARR, 1.03 [95% CI, 0.89-1.19]) was associated with a retinal detachment. The absolute increase in the risk of a retinal detachment was 4 per 10,000 person-years (number needed to harm = 2500 computed for any use of fluoroquinolones). There was no evidence of an association between development of a retinal detachment and β-lactam antibiotics (ARR, 0.74 [95% CI, 0.35-1.57]) or short-acting β-agonists (ARR, 0.95 [95% CI, 0.68-1.33]).Conclusion: Patients taking oral fluoroquinolones were at a higher risk of developing a retinal detachment compared with nonusers, although the absolute risk for this condition was small. [ABSTRACT FROM AUTHOR]

Because of the importance of relationship power and cultural norms on women's ability to protect themselves from HIV/STDs, effective interventions must address power differentials among men and women. These programs need to be informed by and adapted to the cultural values of the target population. Accordingly, we conducted exploratory interviews with 22 young African American women at risk of HIV/ STDs and unintended pregnancy and their male partners regarding the meaning of power in heterosexual relationships, what makes a woman feel powerful in a relationship with a man, and who makes sexual and reproductive decisions in their relationships. Content analyses suggested that relationship power was linked to control and decision-making for most participants; yet, others appeared to associate power with positive relationship qualities such as respect and security. In addition, most participants reported that they shared decision-making about sexual and reproductive matters with their partners. Subsequently, interviews were conducted with another 40 women to explore and identify cultural beliefs regarding what makes women feel powerful in their relationships with their husbands or partners. Cultural consensus analysis was performed and results indicated that the participants comprise a cultural group with shared beliefs about what makes women feel powerful in their relationships. Participants believed that women's sense of power in their relationships came from (1) knowing what they want and having autonomy and control; (2) the quality of their relationships; (3) having resources to provide for their families; and (4) physical attractiveness and sexual factors. [ABSTRACT FROM AUTHOR]

Background: Most studies of sexual behavior and risk are based on self-reports of individuals.Goal: The goal of this study was to assess interpartner concordance on self-reported sexual behavior, condom use, and relationship characteristics; and agreement between individuals' perceptions of their partners' sexual risks and the partners' actual reports.Study Design: Interviews were conducted separately but concurrently with 112 heterosexual couples at increased risk for HIV/sexually transmitted infections recruited through women at clinics and community locations.Results: Couples were concordant on reports of relationship characteristics (kappa > or = 0.84), sexual behavior, and condom use (r > or = 0.62), but disagreed on who has more power and sexual decision-making dominance (kappa < or = 0.26). We found substantial agreement between men's perceptions and their partners' reported risky behavior (kappa = 0.62), but only fair agreement between women's perceptions and their partners' reports (kappa = 0.30).Conclusion: Individual self-reports could be reliable measures of sexual behavior. Additionally, prevention interventions need to address women's misperceptions about their partners' risky behaviors. [ABSTRACT FROM AUTHOR]

This study examines the associations among relationship power, sexual decision-making dominance, and condom use within a sample of women at risk of HIV/STDs. Data from face-to-face interviews with 112 women were analyzed to (a) describe who women perceive as more powerful and who makes sexual decisions within their heterosexual relationships, (b) explore the association between relationship power and sexual decision-making dominance, and (c) examine the relationship of power and decision making regarding condom use to condom use behavior. Women were recruited from clinics and community locations in Atlanta, Los Angeles, Oklahoma City and Portland, OR. Participants were 18-25 years of age and were primarily Hispanic and African American. Over half (58.2%) reported that they share power with their partner, 25.5% said they have more power, and 16.4% reported that their partner has more power in their relationship. For the five domains of sexual decision-making examined, over half (50.5%-75.7%) of the women reported that they and their partners make decisions together. A higher percentage of women who perceived that they have more power or share power, as compared to those who perceived that their partners have more power, reported that 'I/We' make decisions about birth control use, condom use, whether to have sex, and type of sexual activity. Relationship power was not associated with condom use. Condom use was, however, significantly higher among women who reported that they make decisions about using condoms alone or with their partner as compared to those who reported that their partner makes those decisions. [ABSTRACT FROM AUTHOR]

As part of a needs and assets assessment for teen pregnancy prevention, university researchers and practitioners from community-based organizations collaborated to conduct focus groups with 102 young teens of diverse racial/ethnic backgrounds. Understanding ethnic and gender similarities and differences in teen views of adolescent pregnancy helped neighborhood-based planning groups tailor their interventions to specific populations. There were many more similarities in themes than differences across both gender and racial/ethnic groups. Common themes included wanting a baby because of loneliness or a desire to be loved, wanting a baby to maintain a relationship, and viewing teen pregnancy as an unintended consequence of having sex. Differences tended to be gender based, with males viewing teen pregnancy as less of a problem than females. Implications for teen pregnancy prevention are discussed, with examples of how the information was used in a teen pregnancy prevention project in Oklahoma City. [ABSTRACT FROM AUTHOR]

Abstract Background Physical activity has been shown to reduce depression in people with coronary heart disease (CHD), however many people with CHD do not engage in sufficient levels of physical activity to reap its positive effects. People with depression and CHD are at particular risk of non-adherence to physical activity. Little is known about the barriers to and facilitators of physical activity for people with CHD and depressive symptoms. Using qualitative interviews, the aim of this study was to explore the barriers to and facilitators of physical activity for cardiac patients with depressive symptoms. Methods Fifteen participants with CHD and depressive symptoms (assessed using the Cardiac Depression Scale) participated in in-depth semi-structured interviews. The interviews were focussed on investigating participants’ experiences of physical activity since their cardiac event. Interviews were content analysed to determine major themes. Results Participants identified a number of barriers to and facilitators of physical activity. Barriers included having negative perceptions towards health and life changes as a result of the cardiac event, having low mood and low motivation to exercise, feeling physically restricted towards or fearful of exercise, lacking knowledge regarding exercise and perceiving external barriers. Facilitators included having a reason for exercising, being able to identify the psychological benefits of exercise, having positive social support and using psychological strategies. ‘Inactive’ participants reported more barriers and fewer facilitators than did ‘active’ participants. Conclusions The barriers reported in this study were highly salient for a number of participants. Health professionals and researchers can use this information to assist people with CHD and depressive symptoms to identify and possibly overcome barriers to physical activity. Relevant barriers and facilitators could be taken into account to increase their effectiveness when designing interventions to encourage physical activity maintenance in this population.

Abstract Background Cancer cachexia is a syndrome of progressive weight loss. Non-small cell lung cancer patients experience a high incidence of cachexia of 61%. Research into methods to combat cancer cachexia in various tumour sites has recently progressed to the combination of agents. The combination of the anti-cachectic agent Eicosapentaenoic acid (EPA) and the cyclo-oxygenase-2 (COX-2) inhibitor celecoxib has been tested in a small study with some benefit. The use of progressive resistance training (PRT) followed by the oral ingestion of essential amino acids (EAA), have shown to be anabolic on skeletal muscle and acceptable in older adults and other cancer groups. The aim of this feasibility study is to evaluate whether a multi-targeted approach encompassing a resistance training and nutritional supplementation element is acceptable for lung cancer patients experiencing cancer cachexia. Methods/Design Auckland's Cancer Cachexia evaluating Resistance Training (ACCeRT) is an open label, prospective, randomised controlled feasibility study with two parallel arms. All patients will be treated with EPA and the COX-2 inhibitor celecoxib on an outpatient basis at the study site. In the experimental group patients will participate in PRT twice a week, followed by the ingestion of essential amino acids high in leucine. A total of 21 patients are planned to be enrolled. Patients will be randomised using 1:2 ratio with 7 patients enrolled into the control arm, and 14 patients into the treatment arm. The primary endpoint is the acceptability of the above multi-targeted approach, determined by an acceptability questionnaire. Discussion To our knowledge ACCeRT offers for the first time the opportunity to investigate the effect of stimulating the anabolic skeletal muscle pathway with the use of PRT along with EAA alongside the combination of EPA and celecoxib in this population. Trial registration Netherlands Trial Register (NTR): ACTRN12611000870954

Abstract Background Some patients administered cholesterol-lowering therapies may experience an increase in the proportion of small LDL particles, which may be misinterpreted as a worsening of atherosclerotic coronary heart disease risk. This study assessed the lipid effects of adding ezetimibe to atorvastatin or doubling the atorvastatin dose on low-density lipoprotein cholesterol (LDL-C) levels (and the cholesterol content of LDL subclasses), LDL particle number (approximated by apolipoprotein B), and LDL particle size. This was a multicenter, double-blind, randomized, parallel-group study of hypercholesterolemic, high atherosclerotic coronary heart disease risk patients. After stabilization of atorvastatin 40 mg, 579 patients with LDL-C >70 mg/dL were randomized to 6 weeks of ezetimibe + atorvastatin 40 mg or atorvastatin 80 mg. Efficacy parameters included changes from baseline in LDL-C, apolipoprotein B, non-high-density lipoprotein cholesterol (non-HDL-C), and lipoprotein subclasses (Vertical Auto Profile II) and pattern for the overall population, as well as patient subgroups with baseline triglyceride levels Results Both treatments significantly reduced LDL-C (and the cholesterol content of most LDL subfractions [LDL1-4]) apolipoprotein B, non-HDL-C levels, but did not reduce the proportion of smaller, more dense LDL particles; in fact, the proportion of Pattern B was numerically increased. Results were generally similar in patients with triglyceride levels Conclusions When assessing the effects of escalating cholesterol-lowering therapy, effects upon Pattern B alone to assess coronary heart disease risk may be misleading when interpreted without considerations of other lipid effects, such as reductions in LDL-C, atherogenic lipoprotein particle concentration, and non-HDL-C levels. Trial Registration (Registered at clinicaltrials.gov: Clinical trial # NCT00276484)

Abstract Background Personal Digital Assistants (PDAs) have been integrated into daily practice for many emergency physicians and house officers. Few objective data exist that quantify the effect of PDAs on documentation. The objective of this study was to determine whether use of a PDA would improve emergency medicine house officer documentation of procedures and patient resuscitations. Methods Twelve first-year Emergency Medicine (EM) residents were provided a Palm V (Palm, Inc., Santa Clara, California, USA) PDA. A customizable patient procedure and encounter program was constructed and loaded into each PDA. Residents were instructed to enter information on patients who had any of 20 procedures performed, were deemed clinically unstable, or on whom follow-up was obtained. These data were downloaded to the residency coordinator's desktop computer on a weekly basis for 36 months. The mean number of procedures and encounters performed per resident over a three year period were then compared with those of 12 historical controls from a previous residency class that had recorded the same information using a handwritten card system for 36 months. Means of both groups were compared a two-tailed Student's t test with a Bonferroni correction for multiple comparisons. One hundred randomly selected entries from both the PDA and handwritten groups were reviewed for completeness. Another group of 11 residents who had used both handwritten and PDA procedure logs for one year each were asked to complete a questionnaire regarding their satisfaction with the PDA system. Results Mean documentation of three procedures significantly increased in the PDA vs handwritten groups: conscious sedation 24.0 vs 0.03 (p = 0.001); thoracentesis 3.0 vs 0.0 (p = 0.001); and ED ultrasound 24.5 vs. 0.0 (p = 0.001). In the handwritten cohort, only the number of cardioversions/defibrillations (26.5 vs 11.5) was statistically increased (p = 0.001). Of the PDA entries, 100% were entered completely, compared to only 91% of the handwritten group, including 4% that were illegible. 10 of 11 questioned residents preferred the PDA procedure log to a handwritten log (mean ± SD Likert-scale score of 1.6 ± 0.9). Conclusion Overall use of a PDA did not significantly change EM resident procedure or patient resuscitation documentation when used over a three-year period. Statistically significant differences between the handwritten and PDA groups likely represent alterations in the standard of ED care over time. Residents overwhelmingly preferred the PDA procedure log to a handwritten log and more entries are complete using the PDA. These favorable comparisons and the numerous other uses of PDAs may make them an attractive alternative for resident documentation.