Potential Study Participants Research Articles

People, places, and questions: An investigation of the everyday life information-seeking behaviors of urban young adults

This article presents preliminary findings from a research grant on the everyday life information-seeking (ELIS) behaviors of urban young adults. Twenty-seven teens aged 14 through 17 participated in the study. Qualitative data were gathered using written activity logs and semi-structured group interviews. A typology of urban teens' preferred ELIS sources, media types, and query topics is presented. The typology shows friends and family as preferred ELIS sources, cell phones as the preferred method of mediated communication, and schoolwork, time-related queries, and social life as the most common and most significant areas of ELIS. The results indicate a heavy preference for people as information sources and that urban teens hold generally unfavorable views of libraries and librarians. The conclusion lists questions that information practitioners should consider when designing programs and services for urban teens and calls for researchers to consider this often-ignored segment of the population as potential study participants.

Partner communication and HIV risk behaviors among ?at risk? women

This research focused on communication with one's sexual and dating partners, and addressed two main research questions: First, what is the relationship between partner communication and involvement in HIV risk behaviors? Second, which factors predict women's level of partner communication about key issues salient in their lives? Cross-sectional interviews were conducted with 250 adult women living in the Atlanta, Georgia metropolitan area between August 1997 and August 2000. Street outreach was used to identify potential study participants, with further expansion of the sample done via targeted sampling and ethnographic mapping procedures. Path analysis was used to examine the relationships between partner communication and HIV risk taking, and to identify predictors for the extent of women's partner communication. The data revealed an inverse relationship between partner communication and involvement in HIV risk taking. Eight statistically significant predictors of partner communication were identified: age, marital status, length of longest marital-type relationship, level of happiness in longest relationship, knowing anyone who had died from AIDS, number of financial problems experienced, having a sexually transmitted disease during the previous year, and self-esteem level. Partner communication is an important variable to consider when understanding "at risk" women's HIV risk behavior practices. Finding ways to enhance women's communication with their sexual and dating partners appears to be one promising way of reducing their level of HIV risk.

Recruitment and retention of an online sample for an HIV prevention intervention targeting men who have sex with men: the smart sex quest project

There is an increasing interest in developing interventions for HIV and STD prevention that can be delivered on the Internet. However, we know little about what it takes to identify, recruit and retain participants in interventions so that we can test their efficacy and effectiveness. Objectives for this investigation were to evaluate rates of recruitment and retention in an Internet-based randomized controlled trial (RCT) to increase sexually transmitted disease (STD) prevention among men who have sex with men (MSM). The Smart Sex Quest study was a RCT conducted online. Eligible participants were MSM, at least 18 years old and US residents. After completing a baseline risk assessment, participants were exposed to tailored or control messages and asked to return to the site at three months for a follow-up interview. From January 2002 through June 2003, 3,625 persons logged on as potential study participants; of these, 563 were not eligible, while 1,286 left the site without filling out a baseline survey. Complete baseline data were available for 1,776 participants, all of whom were eligible to complete a follow-up. Complete follow-up data were available for 270 (15.2%) participants. While the Internet is a valuable tool for conducting research, conducting this longitudinal research online was severely affected by a loss to follow-up, and analyzing outcome data was hampered by significant differences between those who did and did not complete the study. Alternate ways to recruit for and evaluate online trials must be considered.

Predictors of condom-related attitudes among at-risk women.

Negative attitudes toward using male condoms tend to be associated with higher rates of sexual risk. Little has been written about the factors that influence women's attitudes toward condom use, and this has implications for HIV intervention efforts. Two hundred fifty adult women considered to be at risk based on demographic and family characteristics and residing in the Atlanta, Georgia, metropolitan area were interviewed between August 1997 and August 2000. Street outreach efforts were used to identify potential study participants, with further expansion of the sample done via targeted sampling and ethnographic mapping procedures. Women held ambivalent to weakly positive attitudes toward condoms. Multivariate analysis revealed that five factors were associated with a greater frequency of engaging in seven specific types of sexual activities known to be associated with HIV transmission: condom-related attitudes (negative condom attitudes), marital status (being married vs. other marital status classification), religiosity (lesser), childhood physical abuse (greater), and the amount of illegal drug use (greater). Four significant predictors of condom attitudes were also identified: age (better condom attitudes among younger women), childhood neglect (more conductive condom attitudes among nonneglected women), self-esteem (more self-esteem = more favorable condom attitudes), and the number of drug problems experienced (more drug problems = more negative condom attitudes). The more negative at-risk women's attitudes were regarding condom use, the more often they tended to engage in risky sex. Specific backgrounds and characteristics of the women were associated with greater/lesser condom use. To increase condom use, programs should consider targeting specific types of women as well as their specific attitudes toward condom use.

Drug problems and "at risk" women's involvement in HIV risk behaviors.

This paper focuses on two research questions: is there a relationship between women's number of drug problems and the extent to which they engage in HIV risk behaviors? What factors influence the extent to which women experience drug-related problems? This study is based on 250 adult "at risk" women (predominantly African American) in the Atlanta, Georgia metropolitan area. Street outreach efforts, targeted sampling, and ethnographic mapping procedures were used to identify potential study participants. The more drug problems women experienced, the greater their involvement in HIV risk behaviors was. The number of drug problems experienced was a significant contributor to the model predicting women's HIV risk involvement, along with religiosity, living with substance abusers, and age of first drug use. Depression, optimism, coping with stress, and number of different drugs used predicted the extent to which women experienced drug problems. Drug problems are an important predictor of women's involvement in HIV risk behaviors. Programs wishing to reduce their risk for contracting HIV should target drug-involved women and help them to stop using drugs.

Collection of Clinical and Epidemiological Data for Linkage Studies

Accurate assessment of the genetic basis for a disorder is necessary to determine if linkage studies will be meaningful. This unit provides an overview of key concepts and presents guidelines for collecting diagnostic, epidemiological, and genealogical data from potential study participants. The commentary discusses methods for evaluating evidence of genetic versus environmental influences in a disease and for assessing individual pedigrees.

Willingness of emergency department patients with musculoskeletal complaints to participate in complementary and alternative medicine research

The emergency department (ED) is a unique potential location for recruitment into studies of complementary and alternative medicine (CAM) therapies. We sought to determine the stated willingness of ED patients with musculoskeletal complaints to participate in CAM research for their presenting problem, and to determine the characteristics of this population. The study was carried out in the ED of Vancouver General Hospital weekdays between 10 am and 6 pm from Oct. 16, 2000, to Nov. 21, 2000. All adults who presented with musculoskeletal complaints involving the spine, upper extremity or lower extremity, unless they had pain severe enough to impair their ability to answer questions or unless there was a language or other communication barrier, were approached by a research nurse. If it was learned that they had already been assessed by an emergency physician, they were eliminated as potential study participants. After being presented background information by the research nurse, consenting patients were asked a series of standardized questions during a 15-minute private interview prior to their assessment by an emergency physician. Of 107 eligible patients, 93 participated (87%). Most symptoms began on the day of presentation (44%) or in the previous week (41%). The mean age of those studied was 38 years, and 56% were male. Most presenting problems involved the ankle/foot (29%), multiple sites (19%), the lumbosacral region (14%) or the wrist/hand (14%). Seventy-six percent of patients had utilized CAM previously during their lives, and 13% were currently using CAM for their presenting problem. The majority of patients stated an informed hypothetical willingness to enroll in a CAM study of the following therapies: traditional Chinese medicine 74% (69/93: 95% confidence interval [CI] 64.1%-82.7%); chiropractic 70% (65/93: 95%CI 59.5%-79.0%); and other CAM therapies 92% (86/93: 95%CI 85.1%-96.9%). Of patients asked, 99% stated they would comply with 4 to 6 weeks of outpatient follow-up, and 70% stated they would participate in a placebo-controlled study. Logistic regression modeling, performed for secondary purposes, indicated that willingness to participate in traditional Chinese medicine or chiropractic research was independent of age, sex, educational status, pain severity or prior exposure to the modality of interest. ED patients with musculoskeletal complaints have a high stated willingness to participate in CAM research, even if this involves outpatient follow-up or a placebo-controlled design. ED-based CAM research appears feasible and should be pursued.

Informal caring in late life: a qualitative study of the experiences of older carers

Informal caring in late life: a qualitative study of the experiences of older carers Aim of the study. This study examined the experiences of informal carers who were aged 75 years and over. Background. It has been estimated that 13% of those aged over 65 years are providing some form of informal care. Although there is a substantial body of work reporting the experiences of informal carers, little attention has been paid to the specific situation faced by older carers. Design and methods. Potential study participants were identified during one round of annual over‐75 health checks carried out in one large general practice. Data were collected through personal interviews, which were transcribed and analysed using a thematic approach. Results. Fifty‐eight carers were identified and 14 were approached to take part in the study. Of the 14 interviewees, 13 were caring for a spouse and one was caring for a sibling. There were 10 female and four male carers in the study (age range 76–92 years). Themes to emerge from the interviews were categorized under four headings: (1) the organizational demands and structure of the caring relationship, (2) informal support networks, (3) formal services and (4) the constancy of caring and the need for the role of carer to be recognized. Conclusions. The over‐75 health check may provide a valuable tool to identify older carers who are not known to care providers. This paper concludes that nurses can take a lead role in working with this group in three ways. Firstly, in identifying older carers; secondly, in developing strategies to assist older carers in their caring role and finally, in responding swiftly to crises that can develop among this vulnerable group.

Informal caring in late life: a qualitative study of the experiences of older carers.

This study examined the experiences of informal carers who were aged 75 years and over. It has been estimated that 13% of those aged over 65 years are providing some form of informal care. Although there is a substantial body of work reporting the experiences of informal carers, little attention has been paid to the specific situation faced by older carers. Potential study participants were identified during one round of annual over-75 health checks carried out in one large general practice. Data were collected through personal interviews, which were transcribed and analysed using a thematic approach. Fifty-eight carers were identified and 14 were approached to take part in the study. Of the 14 interviewees, 13 were caring for a spouse and one was caring for a sibling. There were 10 female and four male carers in the study (age range 76-92 years). Themes to emerge from the interviews were categorized under four headings: (1) the organizational demands and structure of the caring relationship, (2) informal support networks, (3) formal services and (4) the constancy of caring and the need for the role of carer to be recognized. The over-75 health check may provide a valuable tool to identify older carers who are not known to care providers. This paper concludes that nurses can take a lead role in working with this group in three ways. Firstly, in identifying older carers; secondly, in developing strategies to assist older carers in their caring role and finally, in responding swiftly to crises that can develop among this vulnerable group.

Effect of Systemic Glucocorticoids on Exacerbations of Chronic Obstructive Pulmonary Disease

Although their clinical efficacy is unclear and they may cause serious adverse effects, systemic glucocorticoids are a standard treatment for patients hospitalized with exacerbations of chronic obstructive pulmonary disease (COPD). We conducted a double-blind, randomized trial of systemic glucocorticoids (given for two or eight weeks) or placebo in addition to other therapies, for exacerbations of COPD. Most other care was standardized over the six-month period of follow-up. The primary end point was treatment failure, defined as death from any cause or the need for intubation and mechanical ventilation, readmission to the hospital for COPD, or intensification of drug therapy. Of 1840 potential study participants at 25 Veterans Affairs medical centers, 271 were eligible for participation and were enrolled; 80 received an eight-week course of glucocorticoid therapy, 80 received a two-week course, and 111 received placebo. About half the potential participants were ineligible because they had received systemic glucocorticoids in the previous 30 days. Rates of treatment failure were significantly higher in the placebo group than in the two glucocorticoid groups combined at 30 days (33 percent vs. 23 percent, P=0.04) and at 90 days (48 percent vs. 37 percent, P=0.04). Systemic glucocorticoids (in both groups combined) were associated with a shorter initial hospital stay (8.5 days, vs. 9.7 days for placebo, P=0.03) and with a forced expiratory volume in one second that was about 0.10 liter higher than that in the placebo group by the first day after enrollment. Significant treatment benefits were no longer evident at six months. The eight-week regimen of therapy was not superior to the two-week regimen. The patients who received glucocorticoid therapy were more likely to have hyperglycemia requiring therapy than those who received placebo (15 percent vs. 4 percent, P=0.002). Treatment with systemic glucocorticoids results in moderate improvement in clinical outcomes among patients hospitalized for exacerbations of COPD. The maximal benefit is obtained during the first two weeks of therapy. Hyperglycemia of sufficient severity to warrant treatment is the most frequent complication.

Evaluating minority recruitment into clinical studies: How good are the data?

PURPOSE: There has been much publicized concern about difficulty with minority recruitment into research studies, particularly since minority inclusion in randomized clinical trials was mandated by the 1993 National Institutes of Health Revitalization Act. We reviewed recruitment data in published reports from clinical studies to assess the actual degree of success in recruiting minorities versus whites and to identify barriers to recruitment. METHODS: We abstracted articles published between September 1993 and February 1995 that reported detailed results of participant recruitment for studies conducted in the United States. RESULTS: Of 65 articles meeting our eligibility criteria (median sample size, 1323), only one (1.5%) reported the racial/ethnic composition of potential study participants. Only two articles (3.1%) provided information about the racial/ethnic composition of eligible subjects, and only one (1.5%) provided information about the racial/ethnic composition of refusing subjects. For enrolled subjects, race/ethnicity was less likely to be reported (58.5%) than were age (90.8%) or gender (80.0%). CONCLUSIONS: The published literature currently contains insubstantial data to either refute or prove that there are differential recruitment rates among minorities as compared with whites. Changes in reporting will be needed in order to track progress in this area.

Antibacterial therapy for lower respiratory tract infections in adults: a review.

Because of difficulties in accurately determining an etiologic diagnosis, the ideal treatment for acute community-acquired lower respiratory tract infections remains to be established. Suggested regimens, in the absence of persuasive findings from gram-stained preparations of sputum, are best guesses made on the basis of clinical and epidemiological data. Results from randomized controlled trials are only partially helpful since most trials require the isolation of a potential pathogen, a condition that excludes as many as half of all potential study participants. Nonetheless, initial therapy for patients producing phlegm with abundant polymorphonuclear leukocytes should be chosen on the basis of the predominant organisms seen on a stained sputum smear. Patients who are admitted to the hospital from home, greater than 50 years of age, and not producing phlegm can be safely treated with amoxicillin or a second-generation cephalosporin. Atypical pneumonia in younger patients is best treated with erythromycin or tetracycline. Patients admitted from nursing homes, who frequently fail to respond to an initial treatment course in the absence of a diagnostic sputum sample, should receive empirical therapy with an agent that is also active against aerobic gram-negative rods.

The Breast Cancer Prevention Trial

The incidence of breast cancer continues to rise and now affects one in eight women, despite major early-detection efforts. The Breast Cancer Prevention Trial (BCPT), under the auspices of the National Surgical Adjuvant Breast and Bowel Project (NSABBP), will evaluate the effect of tamoxifen in reducing the incidence of invasive breast cancer, breast cancer mortality, cardiovascular mortality, and bone fractures. A total of 16,000 healthy women 35 years of age or older will be randomized to receive tamoxifen or a placebo over a five-year period. As of March 1993, 42% of the needed study participants had been enrolled in the trial. The University of Maryland is participating in the BCPT, and Maryland physicians can refer potential study participants to 12 locations throughout Maryland.

Learning, Literacy, and Participation: Sorting Out Priorities

The purpose of this qualitative study was to explore the motivations of adults with low literacy skills toward literacy and learning. Sixteen community members were interviewed in order to determine community views on literacy among adult poor readers and to identify potential low-literate study participants. Twenty-seven low-literate adults were interviewed about their learning. The resulting model of forces affecting participation in literacy education and learning illustrated the following findings: (a) the dominant community view perpetuated messages about participation in literacy programs, but did not provide low literates with the opportunity to publicly talk about their own literacy, (b) adults with low literacy skills viewed learning as separate from literacy, (c) practical application, understanding, and challenge motivated low literate adults to learn; (d) most deterrents related to participation in literacy education rather than learning; and (e) women who rarely left the home environment had difficulties in perceiving themselves as learners.

The distribution of physician extenders.

As part of the Medicare Physician Extender Reimbursement Study, a mail survey was conducted of 5,572 physician extenders (PEs) to identify potential study participants. Analysis of survey results indicates that PEs are distributed disproportionately more often than physicians to primary care practices and to rural low income areas. However, there are substantial differences among types of PEs with regard to practice location and practice arrangement. The relationship between these findings and the distribution of other medical manpower and innovations is then discussed.