Interdisciplinary health research--a symposium.
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Delivery of Health Care↗
Biomedical subjects
L Sachs
Publications and source records attributed to L Sachs.
Practice-knowledge-attitudes-practice: an explorative study of information in primary care.
Contemporary information programmes for health staff fail to give thorough consideration to the influence of situational factors on information transfer within health institutions. To study information transfer in Swedish primary care health centres, we have therefore used the participant observation method, to explore the influences of practice on knowledge and attitude formation, in turn giving rise to new practice. Management of hyperlipidaemia was used as an example. Our study suggests that the practice generates new information, which is added to or counteracts the acquisition and use of already existing information and is subsequently used in practice. Ongoing discussions between staff members give an opportunity to share practice experiences. Profession, professional hierarchy and gender are some of the factors influencing the use of information in this context. To improve the effectiveness of information programmes these factors and the professional roles of the health staff should be taken into consideration.
Clinical Competence↗
Safe motherhood in refugee settings.
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Delivery of Health Care↗
Therapists' anxiety and attitudes toward computerized documentation in the clinical setting.
Many hospitals are converting to electronic records and allied health professionals are required to modify their traditional documentation practices to accommodate this new technology. This paper discusses a study conducted to determine the computer anxiety and attitudes of physical, occupational, and speech therapists in a large urban teaching hospital before and after the implementation of a computerized documentation system. Fifty-three therapists surveyed with a preinstallation questionnaire reported mild computer anxiety and generally good attitudes about the planned computer system. A greater amount of previous computer use and better self-related computer skills were consistent with less computer anxiety. Seven of the original sample became the first to use the computer system. After their six month trial period, surveys revealed a reduction in computer anxieties. Manual time logs completed before and after the system implementation revealed a significant decrease in total documentation time when using computers.
Adult↗
Differential suppression by protease inhibitors and cytokines of apoptosis induced by wild-type p53 and cytotoxic agents.
Apoptosis induced in myeloid leukemic cells by wild-type p53 was suppressed by different cleavage-site directed protease inhibitors, which inhibit interleukin-1 beta-converting enzyme-like, granzyme B and cathepsins B and L proteases. Apoptosis was also suppressed by the serine and cysteine protease inhibitor N-tosyl-L-phenylalanine chloromethylketone (TPCK) [corrected], but not by other serine or cysteine protease inhibitors including N alpha-p-tosyl-L-lysine chloromethylketone (TLCK), E64, pepstatin A, or chymostatin. Protease inhibitors suppressed induction of apoptosis by gamma-irradiation and cycloheximide but not by doxorubicin, vincristine, or withdrawal of interleukin 3 from interleukin 3-dependent 32D non-malignant myeloid cells. Induction of apoptosis in normal thymocytes by gamma-irradiation or dexamethasone was also suppressed by the cleavage-site directed protease inhibitors, but in contrast to the myeloid leukemic cells apoptosis in thymocytes was suppressed by TLCK but not by TPCK. The results indicate that (i) inhibitors of interleukin-1 beta-converting enzyme-like proteases and some other protease inhibitors suppressed induction of apoptosis by wild-type p53 and certain p53-independent pathways of apoptosis; (ii) the protease inhibitors together with the cytokines interleukin 6 and interferon-gamma or the antioxidant butylated hydroxyanisole gave a cooperative protection against apoptosis; (iii) these protease inhibitors did not suppress induction of apoptosis by some cytotoxic agents or by viability-factor withdrawal from 32D cells, whereas these pathways of apoptosis were suppressed by cytokines; (iv) there are cell type differences in the proteases involved in apoptosis; and (v) there are multiple pathways leading to apoptosis that can be selectively induced and suppressed by different agents.
Amino Acid Chloromethyl Ketones↗
Cellular oxidative stress and the control of apoptosis by wild-type p53, cytotoxic compounds, and cytokines.
Apoptosis induced by wild-type p53 or cytotoxic compounds in myeloid leukemic cells can be inhibited by the cytokines interleukin 6, interleukin 3, granulocyte-macrophage colony-stimulating factor, and interferon gamma and by antioxidants. The antioxidants and cytokines showed a cooperative protective effect against induction of apoptosis. Cells with a higher intrinsic level of peroxide production showed a higher sensitivity to induction of apoptosis and required a higher cytokine concentration to inhibit apoptosis. Decreasing the intrinsic oxidative stress in cells by antioxidants thus inhibited apoptosis, whereas increasing this intrinsic stress by adding H2O2 enhanced apoptosis. Induction of apoptosis by wild-type p53 was not preceded by increased peroxide production or lipid peroxidation and the protective effect of cytokines was not associated with a decrease in these properties. The results indicate that the intrinsic degree of oxidative stress can regulate cell susceptibility to wild-type p53-dependent and p53-independent induction of apoptosis and the ability of cytokines to protect cells against apoptosis.
Antioxidants↗
The control of hematopoiesis and leukemia: from basic biology to the clinic.
Hematopoiesis gives rise to blood cells of different lineages throughout normal life. Abnormalities in this developmental program lead to blood cell diseases including leukemia. The establishment of a cell culture system for the clonal development of hematopoietic cells made it possible to discover proteins that regulate cell viability, multiplication and differentiation of different hematopoietic cell lineages, and the molecular basis of normal and abnormal blood cell development. These regulators include cytokines now called colony-stimulating factors (CSFs) and interleukins (ILs). There is a network of cytokine interactions, which has positive regulators such as CSFs and ILs and negative regulators such as transforming growth factor beta and tumor necrosis factor (TNF). This multigene cytokine network provides flexibility depending on which part of the network is activated and allows amplification of response to a particular stimulus. Malignancy can be suppressed in certain types of leukemic cells by inducing differentiation with cytokines that regulate normal hematopoiesis or with other compounds that use alternative differentiation pathways. This created the basis for the clinical use of differentiation therapy. The suppression of malignancy by inducing differentiation can bypass genetic abnormalities that give rise to malignancy. Different CSFs and ILs suppress programmed cell death (apoptosis) and induce cell multiplication and differentiation, and these processes of development are separately regulated. The same cytokines suppress apoptosis in normal and leukemic cells, including apoptosis induced by irradiation and cytotoxic cancer chemotherapeutic compounds. An excess of cytokines can increase leukemic cell resistance to cytotoxic therapy. The tumor suppressor gene wild-type p53 induces apoptosis that can also be suppressed by cytokines. The oncogene mutant p53 suppresses apoptosis. Hematopoietic cytokines such as granulocyte CSF are now used clinically to correct defects in hematopoiesis, including repair of chemotherapy-associated suppression of normal hematopoiesis in cancer patients, stimulation of normal granulocyte development in patients with infantile congenital agranulocytosis, and increase of hematopoietic precursors for blood cell transplantation. Treatments that decrease the level of apoptosis-suppressing cytokines and downregulate expression of mutant p53 and other apoptosis suppressing genes in cancer cells could improve cytotoxic cancer therapy. The basic studies on hematopoiesis and leukemia have thus provided new approaches to therapy.
Animals↗
Molecular control of development in normal and leukemic myeloid cells by cytokines, tumor suppressor and oncogenes.
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Animals↗
The meaning of 6.8: numeracy and normality in health information talks.
The ambiguities of risk which stem from its translation from epidemiological findings into clinical knowledge and practice and thus to lay experiences of health and illness is a clear dilemma. How are risks expressed statistically, or otherwise mathematically, to be interpreted and communicated within the discourse of medico-science, and how within the discourse of an individual's everyday life? An important tool in all risk discourses and in preventive practices such as health information is testing and test results. Test results--presented in mathematical terms as points on a scale, or as a number--are in fact fundamental to preventive practice. But what do we know about how people involved in these tests understand them and how the results are used in the construction of ideas about risk and normalcy? This article attempts to answer part of that question by drawing on an empirical study of the use of numbers as metaphors in talks between a nurse and her potential patients in a directed health survey.
Adult↗
A nurse in preventive work--dilemmas of health information talks.
The possibility of making scientifically objective statements about health risks is part of a new complex of ideas pervading our Western social institutions. The concept of prevention includes an assessment of risk and dangers which lay persons have difficulties in comprehending. Advances in medical technology have made it possible to detect a growing number of anomalies in the human body and thereby to define more and more people as being at risk of various diseases. Even if it seems desirable for society to be able to detect the risks menacing its members, it calls for delicate management of the test procedures and of the preventive intervention. This article presents some perspectives on preventive work in connection with a directed health survey. The primary aim of the survey in question was to diagnose particular risk factors, for instance a high level of blood cholesterol, and inform the patient about how to prevent or reduce the risk of cardiovascular disease. The preventive measures are commonly undertaken by a nurse; her encounters with the patients--to obtain test samples, communicate the results and provide information about health risks--raise complex issues. These and other dilemmas in preventive work are discussed and analyzed.
Communication↗
Use of heterologous DNA-based gene transfer to follow physiological, T3-dependent regulation of myosin heavy chain genes in Xenopus tadpoles.
In vivo gene transfer and RNase protection assay were used to follow thyroid hormone (T3)-dependent regulation of myosin heavy chain (myHC) genes in Xenopus tadpole dorsal muscle. One embryonic and one adult myHC form were measured by each approach. RNase protection assay showed that T3 decreased expression of endogenous embryonic mRNA (E3), but increased adult (A7) transcripts. Gene transfer showed that T3 exerted transcriptional effects on mammalian embryonic and adult myHc promoters injected into the same muscle. The kinetics and profiles of the transcriptional responses were superimposable on endogenous responses. The results strengthen the use of in vivo approaches for determining the roles of transcription factors and cis-regulatory sequences in integrated contexts.
Animals↗
The interaction of wearing multifocal lenses with head posture and pain.
Chronic placement of the head anterior to the body's center of gravity can be a component in the development of neurovascular and musculoskeletal dysfunction. In order to evaluate and treat dysfunction and pain, physical therapists need to be aware of variables that can affect head position. The objectives of this study were to investigate the interaction between wearing multifocal lenses and head posture; to determine the interaction of forward head posture and upper quarter pain; and to determine the intratester reliability of a head posture gauge. Head posture and self-reported pain were collected on 25 randomly chosen multifocal lens wearers between the ages of 40 and 50 and compared with a similar group of nonmultifocal lens wearers. The mean forward head posture in the two groups were significantly different (t = 2.06, one-tailed, p = 0.023). Subjects wearing multifocal lenses had a greater degree of forward head posture when compared with nonmultifocal lens wearers. A one-way analysis of variance was used to compare forward head posture with pain. In this sample, mean forward head posture levels did not differ significantly according to level of pain (p = 0.15). Intratester reliability of the head posture gauge was demonstrated to be high through the use of the intraclass correlation coefficient (ICC = 0.99). Wearing multifocal lenses may influence a person to hold his/her head in a position more forward than the ideal postural alignment.
Adult↗
Empirical evaluation of the transfusion medicine tutor.
Previous research during the development of Antibody IDentification Assistant (AIDA) revealed that many medical technology students and other laboratory personnel have serious difficulties in determining the specificity of blood group alloantibodies, especially weak or multiple antibodies. Based on these previous results, AIDA was modified to provide a teaching environment for medical technology students. We report the results of a rigorous, objective evaluation of the resultant system, the Transfusion Medicine Tutor (TMT). The results show that the students who were taught by an instructor using TMT to provide the instructional environment went from 0 percent correct on a pretest case to 87 percent correct on posttests (n = 15). This increase compares with an improvement rate of 20 percent by a control group (n = 15) who used a passive version of the system with the tutoring functions turned off.
Journal Article↗
Protection of human myeloid leukemic cells against doxorubicin-induced apoptosis by granulocyte-macrophage colony-stimulating factor and interleukin 3.
Hematopoietic cells require certain cytokines to maintain viability by preventing apoptotic cell death. These cytokines can also protect leukemic cell lines against induction of apoptosis by cytotoxic anticancer compounds. We now show that the cytokines granulocyte-macrophage colony-stimulating factor and interleukin 3 can protect primary human myeloid leukemic cells against doxorubicin-induced apoptosis. Protection was detected in cells from 72% of the myeloid leukemic patients tested. The results indicate that these, and perhaps other, hematopoietic cytokines can decrease the effectiveness of cytotoxic anticancer therapy in some human myeloid leukemias. Leukemic cell sensitization to cytotoxic therapy may, therefore, require decreasing the availability of certain cytokines.
Adolescent↗
Control of apoptosis in hematopoiesis and leukemia by cytokines, tumor suppressor and oncogenes.
Hematopoietic cells require certain cytokines including colony-stimulating factors and interleukins to maintain viability. Without these cytokines the program of apoptotic cell death is activated. Cells from many myeloid leukemias require cytokines for viability, and apoptosis is also activated in these leukemic cells after cytokine withdrawal resulting in reduced leukemogenicity. The same cytokines protect normal and leukemic cells from induction of apoptosis by irradiation and cytotoxic chemotherapeutic compounds. This suggests that decreasing the levels of viability inducing cytokines may increase the effectiveness of cytotoxic anti-cancer therapy. The susceptibility of normal and cancer cells to induction of apoptosis is also regulated by the balance between apoptosis-inducing genes such as the tumor suppressor wild-type p53, and c-myc and bax, and apoptosis-suppressing genes such as the oncogene mutant p53, and bcl-2 and bcl-XL. Cell susceptibility to induction of apoptosis in leukemic cells could be enhanced by increased expression of apoptosis-inducing genes and/or decreased expression of apoptosis-suppressing genes. Modulation of expression of apoptosis-regulating genes should thus also be useful for improvement of anti-cancer therapy.
Apoptosis↗
Thyroid hormone regulation of germ cell-specific EF-1 alpha expression during metamorphosis of Xenopus laevis.
In situ hybridization was used to follow the distribution of the mRNAs encoding the somatic form of elongation factor 1 alpha (EF-1 alpha S) and the germinal counterparts of this factor, thesaurin a and EF-1 alpha O, throughout metamorphosis in the gonads of Xenopus laevis tadpoles. EF-1 alpha S mRNA is detected before metamorphosis in both the somatic and germ cells of the gonads. In contrast, thesaurin a and EF-1 alpha O mRNAs are first detected in spermatogonia and oogonia at stages 60-62, corresponding to the climax of metamorphosis and to the peak of circulating thyroid hormone. To determine whether thyroid hormone, the instigator of metamorphosis, is involved in regulating the expression of the germinal gene EF-1 alpha O, Xenopus XTC cells were transfected with an EF-1 alpha O promoter sequence inserted in front of the luciferase reporter gene. Addition of T3 to the cell culture medium induced a dose-dependent increase in transcription from the EF-1 alpha O promoter. This effect was enhanced when the construct was cotransfected with an expression vector for a Xenopus thyroid hormone receptor. Our data show that germ cells switch from a somatic to a germ-cell specific mode of expression during metamorphosis. Furthermore, this switch appears to be induced by thyroid hormone.
Animals↗
The molecular control of development in normal and leukemic blood cells.
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Antineoplastic Agents↗
[Apoptosis--programmed cell death--molecular aspect].
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Animals↗