Colorectal subspecialization in a DGH. The way forward!
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Journal Article↗
Biomedical subjects
S Mellor
Publications and source records attributed to S Mellor.
Antiunion and prounion attitudes as predictors of college students' willingness to join a union.
The authors proposed a model of antiunion attitudes and prounion attitudes as predictors of American college students' willingness to join a union (N = 1,245). Structural equation modeling results indicated that antiunion and prounion attitudes are moderately related and both show similar strength in predicting willingness to join. In addition, a general antiunion factor is shown to underlie specific antiunion attitudes, whereas items related to prounion attitudes are shown to reflect a general prounion factor. The utility of the model was supported based on initial and cross-validation samples (ns = 623 and 622, respectively). Implications for measuring union attitudes and recruiting union members among college-educated workers are discussed.
Adolescent↗
Pharmacological profile of ZD1611, a novel, orally active endothelin ETA receptor antagonist.
The endothelins (ETs), potent vasoconstrictor peptides, have been implicated in the pathogenesis of various cardiovascular disorders. In the present study, we describe the novel, potent, orally active, selective ET(A) receptor antagonist ZD1611 [3-(4-[3-(3-methoxy-5-methylpyrazin-2-ylsulfamoyl)-2-pyridyl ]phenyl)- 2,2-dimethylpropanoic acid]. ZD1611 competitively inhibited (125)I-labeled ET-1 binding at human cloned ET(A) and ET(B) receptors with pIC(50) values of 8.6 +/- 0.1 and 5.6 +/- 0.1, respectively, showing 1000-fold selectivity for the ET(A) receptor. ZD1611 caused a parallel rightward shift of the concentration response curve to ET-1 in the rat isolated aorta yielding a concentration of antagonist that caused a 2-fold rightward shift in the ET-1-response curve (pA(2)) of 7.5 +/- 0.3. When administered i. v. to anesthetized rats and dogs, ZD1611 caused dose-related rightward shifts of partial dose-response curves to the precursor of ET-1, big ET-1. Threshold doses for significant antagonist activity were determined as 0.1 mg/kg and 0.3 mg/kg in the rat and dog, respectively. Importantly, ZD1611 was able to reverse an established big ET-1-induced pressor response in pithed rats in the presence of continuous big ET-1 infusion. Failure of ZD1611 to inhibit the BQ3020 (ET(B)-selective)-induced depressor response in pithed rats indicated a lack of activity at the endothelial ET(B) receptor. ZD1611 was orally active in the rat at 0.3 mg/kg and had a duration of action of more than 7 h, and, in the dog, a dose of 0.6 mg/kg p.o. was active for at least 6 h. In conclusion, these data demonstrate that ZD1611 is a potent and orally active, selective ET(A) receptor antagonist with a long duration of action which may be of therapeutic use.
Administration, Oral↗
The effect of distance from home on attendance at a small rural health centre in Papua New Guinea.
BACKGROUND: The willingness of patients in the rural tropics to seek medical care at primary health care facilities is influenced by the distance they have to travel, but few studies have tried to estimate these distance effects. METHODS: Distance decay effects in attendance rates were estimated from a database of 4348 attendances at a rural health centre in Papua New Guinea, linked to demographic and house position data for the catchment population. Small-scale spatial patterns and differences between diagnoses, age groups and gender are described. RESULTS: Attendance decreased markedly with distance both overall (50% decrease at 3.5 km) and for patients with malaria or acute respiratory infections. This decrease was non-linear (on log scale) with distance. Although constant over time, there were big differences in this distance effect among age and gender groups: Female patients showed less distance decay in adolescents and adults, but higher in the infant group. Spatial patterns accounted for 32% of the variation in age- and gender-specific attendance rates. Of the spatial effects more than 50% were due to distance effects. CONCLUSIONS: Distance effects were similar in magnitude to those reported elsewhere, suggesting that distance effects may be generalizable to many parts of the rural tropics. The non-linearity of distance decay implies that a bell-shaped demand function should be used in health planning.
Adolescent↗
Readiness of critical care physicians and nurses to handle requests for organ donation.
BACKGROUND: Critical care nurses and physicians usually care for those patients whose condition progresses to brain death and are also often responsible for requesting organ donation from the family of a brain-dead patient. We hypothesized that staff support, knowledge, and training levels would be significantly associated with organ donation rates. OBJECTIVE: To assess the readiness of critical care staff to successfully handle requests for organ donation. METHODS: A total of 1061 critical care staff from 28 hospitals in four separate regions of the United States completed a questionnaire that assessed (1) factual knowledge about organ donation, (2) understanding of brain death, (3) previous training in procedures for requesting donations, and (4) comfort levels with the donation process. RESULTS: Staff training in effective procedures for requesting organ donations was significantly correlated with hospitals' donation rates. Less than a third of respondents, however, had received training in explaining brain death to and requesting organ donation from a grieving family. In hospitals with high rates of organ donation, 52.9% of staff had received training; in hospitals with low rates of organ donation, 23.5% of staff had received training. Levels of factual knowledge about organ donation and brain death were unexpectedly low but were not significantly related to hospitals' rates of organ donation. CONCLUSIONS: Training of critical care nurses and physicians in effective procedures for requesting organ donation is significantly associated with higher rates of organ donation, yet two thirds of critical care staff report no relevant training. Consequently, critical care staff cannot be considered ready to effectively handle requests for organ donation.
Attitude of Health Personnel↗
Self-efficacy as a mediator of the relationship between perceived union barriers and women's participation in union activities.
This study investigated the influence of union self-efficacy (expectations of success in pursuit of union activities) as a mediator of the relationship between perceptions of barriers to union participation and women's participation in union activities (N = 89). Perceived barriers were defined in 4 domains (community, family, union, work), and self-efficacy was operationalized based on C. Lee and P. Bobko's (1994) analysis of self-efficacy measures (self-efficacy magnitude, self-efficacy strength). Union self-efficacy was found to mediate the relationship between the magnitude of perceived union barriers and the magnitude of union participation, although mediation was limited to women with weak union self-efficacy. Implications for designing training and intervention programs to enhance women's participation in the face of perceived barriers are discussed.
Adult↗
Spatial and temporal variation in abundance of Anopheles (Diptera:Culicidae) in a malaria endemic area in Papua New Guinea.
Abundance of anophelines in 10 villages in the Wosera area of Papua New Guinea was monitored during 1990-1993. Of 85,197 anophelines collected in 1,276 paired indoor and outdoor landing catches, 40.4% were Anopheles koliensis Owen, 36.7% An. punctulatus Donitz, 14.3% An. karwari (James), 4.9% An. farauti s.l. Laveran, 3.1%, An, longirostris Brug, and 0.7% An. bancroftii Giles. Maps of average indoor biting rates were produced using a Bayesian conditional autoregressive model which allowed for heterogeneities in sampling effort over time and space. Differences in spatial distributions among species were observed among and within villages and were related to the distribution of larval habitats and vegetation. Abundance of An. punctulatus and An. koliensis decreased with distance from the main waterway and probably from a sago swamp forest at 6 villages in North Wosera. Abundance of An. punctulatus was associated negatively with those of An. farauti s.l., An. longirostris, and An. bancroftii. The latter 3 species also had relatively low ratios of indoor-to-outdoor biting rates, and earlier biting times than An. punctulatus. Human blood indices of at least 0.79 were observed for all species except An. bancroftii. Abundance of all 6 species was correlated temporally with recent rainfall, but An. koliensis, An. karwari, and An. longirostris showed greater temporal variability than the other species. An punctulatus and An. koliensis tended to occur together in time and space (index of association, I = 0.85). Weaker associations were seen between An. farauti s.l. and An. longirostris (I = 0.44) and An. koliensis and An. karwari (I = 0.34). The most frequently collected species occurred together and were concentrated near the Amugu river; the remaining species tended to occur together but in different parts of the Wosera area. The importance of understanding ecological requirements of the different Anopheles vectors and their association with key household and landscape features are discussed in relation to malaria transmission and control.
Animals↗
The epidemiology of malaria in the Wosera area, East Sepik Province, Papua New Guinea, in preparation for vaccine trials. I. Malariometric indices and immunity.
The epidemiological features of malaria were studied through seven community-based surveys in a population of 4000 in the Wosera area, East Sepik Province, Papua New Guinea. Prevalence of parasitaemia (all species, all ages) was 60%. Plasmodium falciparum was the predominant species in all surveys (55%), followed by P. vivax (25%) and P. malariae (20%). The highest prevalence for asexual forms of P. falciparum occurred in the 5-9-year age group, whereas P. falciparum gametocytaemia and P. vivax parasitaemia were observed most frequently in the 1-4-year age group and P. malariae in the 10-15-year age group. Mean densities of all species decreased with age except for that of P. malariae, which was lower in children aged < 1 year than in those aged 1-4 years. The prevalence of enlarged spleen was 57% in children and 10% in adults and closely matched the corresponding age-related parasite rate. Seroprevalence of antibody to the major merozoite surface antigen 2 rapidly increased with age, with > 90% of individuals older than 5 years being positive. Malariological indices showed irregular changes over time but there was no clear-cut seasonal pattern. The geographical distribution of these indices and immune responses was not uniform within the study area. Bednet use and drug consumption were negatively correlated with malariometric indices. Identification of significant temporal and local variations in malaria endemicity is important for the design and evaluation of intervention studies, including field trials of an antimalarial vaccine.
Adolescent↗
The epidemiology of malaria in the Wosera area, East Sepik Province, Papua New Guinea, in preparation for vaccine trials. II. Mortality and morbidity.
Malaria mortality and morbidity were studied in a rural population of 4000 in the Wosera area, East Sepik Province, Papua New Guinea. Malaria accounted for 4.9% of the 162 deaths investigated by verbal autopsy and for 12.2% of the 49 deaths assessed through medical records. Malaria was the first cause of death in children aged 0.5-4 years. Of the 7795 subjects interviewed and bled during six cross-sectional community-based surveys, children of 1-4 years had the highest malaria-related morbidity. In this age group, point prevalences of fever, fever associated with parasitaemia, and fever plus Plasmodium falciparum (Pf) parasitaemia > or = 10,000 parasites/microliters blood were 5%, 4.1% and 1.5%, respectively. The corresponding figures for adults were 2%, 0.9% and 0.1%, respectively. The calculation of attributable fraction (AF) using a multiple logistic regression model showed that malaria accounted for 0.44 of all fevers in children of 1-4 years and 0.08 of the fevers in adults. Prevalence data derived from the AF estimate were compared with those calculated using different accepted density thresholds. The prevalences which best approximated the results from the logistic regression model were obtained using parasitaemia cut-offs of > or = 1000 Pf parasites/microliter in children aged 1-4 years and adults older than 19 years and of > or = 10,000 parasites/microliter in those aged 5-19 years. Prevalence of fever associated with parasitaemia was highly seasonal, with a peak at the beginning of the wet season. The geographical distribution of malaria morbidity was not uniform. The measurement of malaria-related morbidity, the identification of significant seasonal and local variation as well as the assessment of different methods of defining a clinical episode of Pf malaria are crucial for the design and evaluation of intervention studies, including field trials of antimalarial vaccines.
Adolescent↗
Assessment of the role of the humoral response to Plasmodium falciparum MSP2 compared to RESA and SPf66 in protecting Papua New Guinean children from clinical malaria.
The prevalence and concentration of naturally acquired humoral response (IgG) to merozoite surface protein 2 (MSP2), RESA, SPf66 and crude schizont extract were measured in a population living in a malaria highly endemic area of Papua New Guinea. A prospective longitudinal study in 0.5-15 year old children was conducted for one year in order to examine the relationship between the humoral response to these antigens and subsequent susceptibility to clinical malaria using a series of clinical definitions. The prevalence and concentration of antibodies to all antigens increased with age. Such correlation with age was most marked for MSP2 recombinant proteins. When age and previous exposure were controlled for, only antibody levels to MSP2 recombinant proteins (3D7 and d3D7) and to RESA predicted a reduction in incidence rate of episodes of clinical malaria. Our results support the inclusion of the recombinant proteins of the 3D7 allelic family of merozoite surface antigen 2 and RESA into a subunit vaccine against malaria.
Adolescent↗
Cross-level analysis of the influence of local union structure on women's and men's union commitment.
The authors tested the influence of structural features of local unions (N = 43) on members' union commitment (N = 539) as moderated by members' gender. By using a cross-level analysis, they identified local structure with officers' ratings of innovation, formalization, and centralization. An anticipated interaction between gender and innovation was not found. However, as predicted, women's commitment was positively related to formalization and negatively related to centralization. In contrast, men's commitment was only slightly influenced by local formalization but was positively related to centralization. The need for structural redesign to enhance member's commitment, particularly among women, was discussed.
Female↗
How do only children differ from other children?
Developmental outcomes of only and non-only children, categorized by birth order and by family size, were investigated. Multiple hypotheses based on meta-analyses of the only-child literature (Falbo & Polit, 1986) were tested with independent comparison techniques. Results indicated that developmental outcomes of only children were similar to outcomes for firstborns and children from two-child families but dissimilar to outcomes for later borns and children from larger families. Furthermore, outcomes were more positive for only children, firstborns, and children from two-child families than for all other comparison groups. In agreement with Falbo and Polit, only-child deprivation and only-child uniqueness explanations for outcome differences were not supported in favor of an explanation that emphasizes qualities of the parent-child relationship. Results suggest that future comparisons to only-child outcomes should preserve the independence of contrast results and expand the only-child category to include data from firstborns and others from two-child families.
Adolescent↗
Psychological health and squash play.
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Adaptation, Psychological↗
Comparative trait analysis of long-term recovering alcoholics.
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Adult↗
Pregnancy in patients with spina bifida cystica.
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Adult↗
Pregnancy following bilateral uterine artery ligation.
A successful pregnancy following bilateral uterine artery ligation performed in an attempt to relieve dysfunctional menorrhagia is reported. Serial biparietal diameters showed a normal growth curve and the newborn infant weighed 2640 g. The patient was normotensive throughtout the pregnancy. Prior to uterine artery ligation, she had had four pregnancies but there were no surviving children. It is suggested that uterine artery ligation may have a limited place in the management of patients with dysfunctional menorrhagia.
Adult↗
Adolescent pregnancy.
The results of a retrospective study of adolescent pregnancy indicated that obstetric and perinatal complications were fewer than expected. The case histories of 178 pregnancies, all occurring in patients aged 15 years or less at the time of delivery, were reviewed. During the ten-year period 1963 to 1972 there were no maternal deaths, no stillbirths and no neonatal deaths. As expected, the majority of patients were primigravidae, but 35 patients (approximately 20 per cent) subsequently became pregnant for a second time before their sixteenth birthday. This emphasizes the need for improvement in contraceptive advice and follow-up for this age-group so that further illegitimate pregnancy or abortion can be avoided.
Abortion, Spontaneous↗