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PubMed2001

A new target for shigellosis: rational design and crystallographic studies of inhibitors of tRNA-guanine transglycosylase.

Eubacterial tRNA-guanine transglycosylase (TGT) is involved in the hyper-modification of cognate tRNAs leading to the exchange of G34 at the wobble position in the anticodon loop by preQ1 (2-amino-5-(aminomethyl)pyrrolo[2,3-d]pyrimidin-4(3H)-one) as part of the biosynthesis of queuine (Q). Mutation of the tgt gene in Shigella flexneri results in a significant loss of pathogenicity of the bacterium, revealing TGT as a new target for the design of potent drugs against Shigellosis. The X-ray structure of Zymomonas mobilis TGT in complex with preQ1 was used to search for new putative inhibitors with the computer program LUDI. An initial screen of the Available Chemical Directory, a database compiled from commercially available compounds, suggested several hits. Of these, 4-aminophthalhydrazide (APH) showed an inhibition constant in the low micromolar range. The 1.95 A crystal structure of APH in complex with Z. mobilis TGT served as a starting point for further modification of this initial lead.

Binding Sites↗
PubMed1994

Comparisons of the smoking cessation counseling activities of six types of health professionals.

BACKGROUND: This study was designed to assess and compare the smoking cessation counseling activities of primary care physicians, dentists, dental hygienists, family planning counselors, WIC counselors, and community mental health counselors in four counties in the northeastern United States for planning appropriate education programs. METHODS: Lists of the health professionals in each of these groups in the four study counties were obtained from state licensing boards, clinic directors, and telephone directories. Surveys were conducted by mail, using a 19-item instrument which could be completed in 2-4 min. RESULTS: Comparisons among these professional groups showed that physicians, family planning counselors, and WIC counselors felt better prepared to provide cessation advice than did mental health counselors, dentists, and dental hygienists. Physicians, family planning counselors, and WIC counselors also were more active in providing smoking cessation advice to women smokers than were the other three groups. Levels of use of specific counseling activities were generally low. Setting a quit date, arranging for follow-up visits, and referral for further assistance were used for only a minority of women smokers. CONCLUSIONS: Opportunities for educational interventions that could increase these health professionals' effectiveness were apparent for each of the groups.

Adolescent↗
PubMed1994

The Portable Dictionary of the Mouse Genome: a personal database for gene mapping and molecular biology.

The Portable Dictionary of the Mouse Genome is a database for personal computers that contains information on approximately 10,000 loci in the mouse, along with data on homologs in several other mammalian species, including human, rat, cat, cow, and pig. Key features of the dictionary are its compact size, its network independence, and the ability to convert the entire dictionary to a wide variety of common application programs. Another significant feature is the integration of DNA sequence accession data. Loci in the dictionary can be rapidly resorted by chromosomal position, by type, by human homology, or by gene effect. The dictionary provides an accessible, easily manipulated set of data that has many uses--from a quick review of loci and gene nomenclature to the design of experiments and analysis of results. The Portable Dictionary is available in several formats suitable for conversion to different programs and computer systems. It can be obtained on disk or from Internet Gopher servers (mickey.utmen.edu or anat4.utmen.edu), an anonymous FTP site (nb.utmem.edu in the directory pub/genedict), and a World Wide Web server (http://mickey.utmem.edu/front.html).

Animals↗
PubMed1984

Telephone surveys of mental health need and the unlisted subscriber.

Community surveys for needs assessment purposes have gained considerable popularity in recent years, yet the prevalence estimates of psychiatric impairment or mental health need vary widely across studies. It is hypothesized that part of this variability may reflect methodological concerns, in particular the directory listing status of respondents when telephone survey methods are employed. Using data from two independent community surveys, the mental health needs of listed versus unlisted subscribers were compared on a series of mental health scales. The implications of the differences observed are discussed both for further telephone needs assessment projects, as well as for service providers.

Data Collection↗
PubMed1978

A comparison of three survey methods to obtain data for community mental health program planning.

A perennial problem for mental health planners is assessing community needs and existing services. The three most common methods used to obtain this data are the telephone survey, the mail-out questionnaire, and the face-to-face interview. However, there are advantages and disadvantages associated with each approach in terms of sampling, response rates, and economic costs. The present study utilized all three methods to survey the same community population in order to determine the comparability of obtained data and relative efficacy of the methods. A standard 21-item questionnaire was developed to obtain demographic and epidemiological data. This included nine Likert-type items to obtain opionions on a typical question such as "To what extent would you have confidence in recommending the Mental Health Center to members of your immediate family?" In the first method, survey teams made door-to-door interviews to complete 449 questionnaires on a random sample. In the second method, 1,000 questionnaires were mailed to a random sample with returns requested. In the third method, 224 people were randomly selected from the telephone directory and asked to respond to the questionnaire over the phone. Precautions were taken in all methods to ensure confidentiality of responses. All respondents were classified according to a two-factor index based on occupation and education. The data were analyed to determine whether comparable data were obtained through divergent methods. Results are discussed and implications are given for community mental health planners.

Community Mental Health Services↗
PubMed1999

Prospecting and evaluation of the anatomy sites on the Internet.

The Internet undoubtedly has an important part to play in medical teaching, generally speaking, and particularly in anatomy. We therefore undertook to survey, list, explore and study the various sites written in French or English devoted to anatomy on the Internet in order to evaluate them. Sites were identified from their URL address, by search engine or by hypertext links found in already listed sites. Useless and non-relevant sites were excluded. Fifty-two sites were selected and evaluated as to their navigability, illustrations, text and general presentation. Addresses of theses sites are available on a web page (http:/(/)www.rockefeller.univ-lyon1.fr/Anato mie-Lyon-Nord; section liens, section Galerie Virtuelle). This directory could be a very useful working tool for the use of teachers and students. It will be regularly updated.

Anatomy↗
PubMedDate not supplied

The influence of patient smoking status on therapeutic decisions.

STUDY OBJECTIVE: To assess the effect of patient smoking status on internists' inclinations to recommend certain types of therapy for conditions that are and conditions that are not related to smoking. DESIGN, SETTING, AND PARTICIPANTS: Five hundred ninety-eight internists identified systematically from the Directory of Medical Specialists (first entry on each page of text) were asked to complete a questionnaire about how their treatment decisions for five therapies differed as a function of patient smoking status. RESULTS: The responses of the 320 internists who completed and returned the questionnaire showed that smoking status had little effect on physicians' inclinations to recommend herniorrhaphy, hemodialysis, or bronchodilator therapy. However, physicians were considerably less inclined to recommend coronary artery bypass grafting or peripheral arterial surgery to patients who smoked. Reduced efficacy and greater risk of therapy were the most frequent reasons given for the observed decrease. Reduced entitlement by smokers to complex therapies for smoking-related diseases and the withholding of therapy as a bargaining tool to induce smokers to quit were also cited as reasons. CONCLUSIONS: Some internists believe they are less likely to recommend complex therapies for smoking-related diseases to patients who continue to smoke. Some of this decrease may be attributable to the notion that smokers are less entitled to complex therapies or that withholding therapies is a permissible way to influence patients to adopt more healthful lifestyles. Whether these physician attitudes reflect actual practice is yet to be shown.

Angina Pectoris↗
PubMedDate not supplied

The impact of the night float system on internal medicine residency programs.

OBJECTIVE: To study the design, method of implementation, perceived benefits, and problems associated with a night float system. DESIGN: Self-administered questionnaire completed by program directors, which included both structured and open-ended questions. The answers reflect resident and student opinions as well as those of the program directors, since program directors regularly obtain feedback from these groups. SETTING/PARTICIPANTS: The 442 accredited internal medicine residency programs listed in the 1988-89 Directory of Graduate Medical Education Programs. RESULTS: Of the 442 programs, 79% responded, and 30% had experience with a night float system. The most frequent methods for initiating a night float system included: decreasing elective time (42.3%), hiring more residents (26.9%), creating a non-teaching service (12.5%), and reallocating housestaff time (9.6%). Positive effects cited include decreased fatigue, improved housestaff morale, improved recruiting, and better attitude toward internal medicine training. The quality of medical care was considered the same or better by most programs using it. The most commonly cited problems were decreased continuity of care, inadequate teaching of the night float team, and miscommunication. CONCLUSION: Residency programs using a night float system usually observe a positive effect on housestaff morale, recruitment, and working hours and no detrimental effect on the quality of patient care. Miscommunication and inadequate learning experience for the night float team are important potential problems. This survey suggests that the night float represents one solution to reducing resident working hours.

Attitude of Health Personnel↗
PubMed1994

Policy statement for general internal medicine fellowships. Society of General Internal Medicine.

Fellowship programs in general internal medicine should be designed to train outstanding academic internists to serve as future faculty and leaders in the field. Although programs may vary widely in their specific components, all should share a number of characteristics and goals. In this document, the Society of General Internal Medicine outlines basic principles and guidelines for fellowship training, states that its own PCIM Directory will explicitly require that programs indicate how they conform to them, and indicates its interest in considering a formal fellowship accreditation process in the future.

Fellowships and Scholarships↗
PubMed1993

Variation in physicians' decision-making thresholds in management of a sexually transmitted disease.

OBJECTIVE: To gain insight into the variation in physicians' clinical decisions and further understand the factors that influence physicians' thresholds for testing and treating. DESIGN: Written clinical scenarios were mailed to two groups of physicians who were asked to provide probability estimates of syphilis, how these estimates might change with new information, and when a diagnostic test would be ordered or treatment begun. A model was then used to calculate the probabilities at which physicians ordered tests or initiated treatment. PARTICIPANTS: Group 1 comprised 126 board-certified internists from metropolitan Philadelphia responding from a sample of 360 such physicians randomly selected from a directory. Group 2 consisted of 31 experts in sexually transmitted disease responding from a sample of 50 experts selected by the authors. MEASUREMENTS AND MAIN RESULTS: Experts were willing to obtain a serologic screening test at a lower likelihood of syphilis (0.013%) than were internists (0.034%), and they were willing to obtain a lumbar puncture at a lower likelihood of neurosyphilis (0.165%) than were internists (0.393%). The difference in the groups' thresholds to begin neurosyphilis treatment was not significant. A multivariate model showed that group differences were created by individual characteristics (years in practice, subspecialty board certification, and full-time nonacademic practice) that were associated with higher thresholds for serologic screening. CONCLUSIONS: There are differences in the diagnostic testing practices for syphilis between national experts and internists. Although status in one of these groups alone did not predict the threshold for obtaining syphilis tests, certain individual characteristics were predictive. Examination of physician characteristics helps to explain the variation observed in their practice patterns, and determination of physicians' thresholds aids in analyzing these variations.

Clinical Laboratory Techniques↗
PubMedDate not supplied

Management of Barrett's oesophagus in 2001 in Ireland.

BACKGROUND: Endoscopic surveillance of patients with Barrett's oesophagus is recommended to detect early carcinoma. The practice patterns of endoscopists since the publication of more recent management guidelines remain unknown. METHODS: All endoscopists (n=68) in the Irish Medical Directory and their trainees were sent a postal questionnaire on Barrett's surveillance. RESULTS: Fifty-five per cent (30/54) perform surveillance on all patients with Barrett's oesophagus and 38% on selected patients. In patients with no dysplasia, repeat endoscopy was more commonly practiced annually (28/54) than every two to three years (23/54). Surgeons were more likely to perform surveillance annually than gastroenterologists (75% vs 40%). Only 26% of endoscopists took four-quadrant biopsies every 2 cm. Intervention was recommended by a majority (28/54) of endoscopists in a patient with high grade dysplasia. A majority of respondents (47/54) would have surveillance if they were found to have Barrett's oesophagus. CONCLUSION: Most endoscopists in Ireland do not adhere to recent guidelines in their management of Barrett's oesophagus. Surgical endoscopists perform surveillance more frequently than their medical colleagues.

Barrett Esophagus↗
PubMedDate not supplied

Attitudes to peer review as a competence assurance structure--results of a survey of Irish physicians.

BACKGROUND: The Medical Council in Ireland is currently implementing Competence Assurance Structures (CAS). Peer review has been proposed as a tool to measure physician competence. AIMS: To assess the attitudes of physicians working in the Irish healthcare system to a peer review programme of competence assurance prior to its implementation. METHODS: A postal survey was sent to all physicians in the Irish Medical Directory in November 2003. Nine questions were asked to gauge attitudes to peer review as a CA tool. The returned questionnaires were collated and data extracted based on responses. RESULTS: The response rate was 67%. The majority of respondents (92%) felt peer review would inform competence assurance in Ireland. Most physicians who were surveyed felt an on-site assessment (88%) every 5 years (87%) was the preferred method. Over 30% responded that there should be a financial incentive for completing a review, and 70% would pay to be assessed. The UK model of competence assurance was the model most physicians preferred for the Irish setting (42%). CONCLUSION: The majority of physicians practising in Ireland would favour a peer review system of competence assurance. The financial implications, and structure, of such a system would need to be explored prior to implementation.

Attitude of Health Personnel↗
PubMed2000

Bridging the gap between molecular genetics and metabolic medicine: access to genetic information.

UNLABELLED: Thanks to the World Wide Web, most results of research in genetics are made available in public databases. At the present time there are resources on genetic diseases, genes and their location, mutations of already cloned genes and on laboratories performing the mutation analysis. The main resources on phenotypes are On-line Mendelian Inheritance in Man (OMIM), Pedbase, GeneClinics, London Dysmorphology Database (LDDB) and Orphanet. The main resources on human genes are, in addition to OMIM, the Genome Database, Genatlas and Genecard. There are also two major sequence databases. All of them can be queried using the OMIM number of the disease. Central databases of mutations, as well as locus specific databases have been created. Their list is maintained at the Human Genome Organisation mutation database initiative website. Several initiative have been taken to integrate all these data and help the clinician to find out quickly what he/she needs. The website of the National Center for Biotechnology Information is the best example of such an effort with sections on diseases, a genome guide, and locus links. Several databases of genetic testing resources have been established. GeneTests is an on-line genetics resource that contains a directory of North American laboratories providing testing for heritable disorders. Orphanet is a similar database on French services which is in the process of becoming a European database. CONCLUSION: Even if clinicians do not have as many services at their disposal as the molecular geneticists, various useful databases already exist and should no longer be ignored in practice.

Databases, Factual↗
PubMed1997

[50 years Zwickau Dermatologic Clinic in the Heinrich-Braum Hospital].

The dermatological clinic in Zwickau celebrated 50 years of existence in 1996. We review the clinics history, starting with its founding in 1946 because of the upsurge in venerological diseases during the post-world war II years. The most important clinic directory and their scientific activities are described.

Dermatology↗
PubMed2000

[Alternative medicine: really an alternative to academic medicine?].

Numerous courses on alternative medicine are regularly advertised in Deutsches Arzteblatt, the organ of the German Medical Association. The present German legislation likewise supports this form of medicine, and this explains why Iscador, an extract of the mistletoe, is found in the Rote Liste, a directory of commercially available medical drugs, under the heading "cytostatic and antimetastatic drugs" although such beneficial effect is unproven. To give another example, a German health insurance fund was sentenced to pay for acupuncture as a treatment for hepatic failure. This judgement is characteristic of the present German judicial system and represents a victory of "oracling irrationalism" (Popper). The astonishing popularity of alternative medicine can be explained by a revival of romanticism. An intellectually fair opposite position has been delineated by Karl Popper in the form of critical rationalism. It is important to realize, however, that our decision to adhere to rational thinking is made in the innermost depth of our heart but not on the basis of rational arguing. Rather, the decision in favor of reason has a moral dimension.

Complementary Therapies↗
PubMed2003

Assessing elder victimization--demonstration of a methodology.

BACKGROUND: Research on epidemiological assessment of interpersonal violence in younger adults indicates that there are essential components of interview-based queries necessary to maximize the likelihood that episodes of physical and sexual assault will be identified. These include phrasing to prime comprehensive disclosure, combined with extremely behaviorally specific descriptive questions about assault events. Such methodology permits simultaneous assessment of violence perpetrated by intimates or caregivers (i. e., abuse) as well as that perpetrated by strangers (i. e., assault), and is easily conducted via telephone. However, these strategies have not been used to simultaneously measure both abuse and assault in older adults, and some question exists as to the applicability of telephone interview techniques to geriatric populations. METHODS: A total of 106 elder respondents were surveyed, approximately half in person and half via the telephone, to evaluate the feasibility of using a telephone-based structured interview to measure both assault and abuse, as well as to screen for psychopathology in a geriatric population. In order to assure that a sufficient number of crime victims were available to assess the ability of dependent measures to detect a variety of abuse and assault types, approximately half of the group in each interview context was comprised of a victim oversample referred by local police departments, whereas the remainder of each group were randomly selected from local telephone directories. RESULTS: Data indicated that the methodology was successfully adapted to the geriatric population. Rates of lifetime and recent abuse and assault detected by in-person and telephone methods were comparable, and medical problems associated with aging posed no significant problem. CONCLUSIONS: The methodology was acceptable to older adults and very effective in identifying both abuse and assault events, perpetrator status, and psychopathology. Telephone-based interviewing appeared to be a valid alternative to in-person interviews in identifying victimization and psychopathology.

Aged↗
PubMed2006

Depressive episodes in Sardinian emigrants to Argentina: why are females at risk?

BACKGROUND/OBJECTIVE: To compare the frequency of ICD-10 depressive episodes in a community sample of Sardinian immigrants in Argentina and a community sample of Sardinian residents in Sardinia, Italy. METHOD: A search of telephone directories provided all subscribers with Sardinian surnames in the Argentinean area involved. A 75.8% of all subjects thus identified took part in the study (n = 210). The characteristics of randomisation methods used to identify the community sample in Sardinia (n = 1040) have already been published elsewhere. All subjects were interviewed using the Composite International Diagnostic Interview Simplified. RESULTS: A higher frequency of depressive disorders was observed among the Sardinian immigrants in Argentina (26.7 vs. 13.5%, P < 0.0001). Females in particular showed a higher risk with respect to the Sardinian sample resident in Sardinia. DISCUSSION: On comparison of the present findings with the lifetime rate of depressive episodes in Sardinian immigrants in Paris (France), reported in a previous research study, a lower prevalence was observed among the latter group than in Sardinian immigrants in Argentina but the young male immigrants in Paris were at risk. CONCLUSION: The results obtained seem to suggest that emigration to a country where economic conditions have since dramatically changed may predispose subjects to depressive disorders, particularly when compared to the percentage of affected subjects in their native population and among subjects who had emigrated to more economically stable countries. Further epidemiological studies are warranted in order to confirm the present results and to clarify the determinants of the major risk for females in such a condition.

Adolescent↗
PubMed2000

Access to physician treatment for a mental disorder: a regional analysis.

BACKGROUND: This study examined (1) disparities in the proportion of persons who accessed a physician for treatment of a diagnosed mental disorder across 17 health regions in Alberta, Canada, and (2) the extent to which regional disparities in physician access could be explained by differences in regional demographies, population needs, or physician supply. METHODS: The study illustrates the use of ecological comparisons for regional health system performance evaluations. Regional characteristics were aggregated from four sources of data: the health insurance registry file (population denominators and regional demographies), physician claims data (treatment access), census data (social indicators of population need), and the medical directory of the College of Physicians of Surgeons (physician supply). RESULTS: Regional variability in needs-adjusted measures of access to physician-based treatment services were comparatively small (varying by a factor of 1.6). Models containing adjustments for demography, need, and physician supply explained 41% of regional variation in access. Of the total variation explained, physician supply explained a smaller proportion (39%) in comparison to social demography and needs (61%). Few large regional imbalances were noted when needs-adjusted and supply-adjusted estimates were compared. Only two areas appeared to be underserviced in comparison to their local needs, reflecting approximately 6% of the provincial population. CONCLUSIONS: While all three study factors proved important, findings support the broad conclusion that social demography and social risk (a proxy for need) will remain the key determinants predicting access to physician services for treatment of mental disorders in publicly funded health systems.

Adult↗

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