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PubMed2000

Treatment received by depressed patients in Japan and its determinants: naturalistic observation from a multi-center collaborative follow-up study.

BACKGROUND: Undertreatment of depression appears widespread but the available literature is limited to North American and European countries. We aimed to examine the treatment received by patients with major depression in Japan and to elucidate any predictor of their treatment level. METHODS: A naturalistic, prospective follow-up study of an inception cohort of subjects with mood disorders was undertaken in psychiatric departments of 13 university hospitals, those of six general hospitals, three mental hospitals and one community mental health center from all over Japan. A total of 95 patients without any prior antidepressant treatment were diagnosed with major depression according to DSM-IV and were followed up every month until treatment termination and every 6 months thereafter. RESULTS: The follow-up information was available in 98 to 97% of the cohort. The proportion of patients receiving less than 125 mg/day of imipramine or equivalent reached 69% (95% CI: 58-78%) at 1 month and 67% (95% CI: 54-77%) at 6 months. A few clinical variables were significantly associated with inadequate antidepressant prescription but altogether they explained only 5 to 14% of the variance observed. CONCLUSIONS: Japan was no exception to the other industrialized countries in its less than optimal provision of treatment to major depression and its lack of explanatory predictors for this common practice.

Adult↗
PubMed1987

Response of human B cells to different anti-immunoglobulin isotypes: absence of a correlation between early activation events and cell proliferation.

Cross-linking of surface immunoglobulin (sIg) by antibodies against IgM, IgG and IgD activates B cells and in some circumstances can induce cell proliferation. We studied the potential link between anti-Ig-induced changes in the cytosolic free Ca2+ concentration ([Ca2+]i), inositol phosphate production and the ability to induce cell proliferation in the presence or absence of the phorbol ester 12-O-tetradecanoylphorbol 13-acetate (TPA). Anti-IgM, but not anti-IgD or anti-IgG, induced cell proliferation in the presence but not the absence of TPA. Each of the antibodies induced a rapid increase in [Ca2+]i which appeared to be due to release of Ca2+ from internal stores. This was followed by a sustained increase in [Ca2+]i, apparently due to Ca2+ uptake from the extracellular medium. Anti-IgD induced the greatest increase in [Ca2+]i, anti-IgM induced intermediate changes and anti-IgG the lowest change. Since inositol 1,3,5-trisphosphate (IP3) can release Ca2+ from internal stores, we tested the ability of each anti-Ig isotype to increase concentrations of IP3. In contrast to the change in [Ca2+]i and proliferation, anti-IgG induced the most significant increase in IP3 concentrations. Taken together these data indicate that changes in [Ca2+]i, inositol phosphate production and anti-Ig-induced human B cell proliferation are not directly linked. They also demonstrate that changes in [Ca2+]i, inositol phosphate production and activation of protein kinase C are not sufficient to induce proliferation of human B cells. It appears that anti-IgM induces an additional Ca2+-independent, inositol phosphate-independent and protein kinase C-independent activation signal which can collaborate with TPA to induce B cell proliferation. The molecular events involved in this signal remain to be identified.

Antibodies, Anti-Idiotypic↗
PubMed1998

Oral manifestations of HIV infection in 600 South African patients.

Oral lesions associated with HIV infection, as classified by the EC-Clearinghouse on Oral Problems related to HIV infection and the WHO Collaborating Centre on Oral manifestations of the immunodeficiency virus, were studied in 600 consecutive HIV-infected patients in Cape Town, South Africa. One or more lesions were seen in 60.4% of cases. Combined candidal lesions were evident in 37.8%, hairy leukoplakia in 19.7% and combined gingival/periodontal lesions in 8.5% of patients seen. Lesions less commonly recorded include oral ulceration (2.9%) and Kaposi's sarcoma (1.5%). The clinical range of lesions seen is similar to those reported elsewhere, but socio-cultural differences allowed no reliable comparison. More than a quarter of our patients had oral soft tissue discomfort necessitating treatment; in 3.3% these were the presenting symptom. This indicates a potential major public health concern requiring education in recognition and appropriate referral and management.

AIDS-Related Opportunistic Infections↗
PubMed2004

Sample designs and sampling methods for the Collaborative Psychiatric Epidemiology Studies (CPES).

This paper provides an overview of the probability sample designs and sampling methods for the Collaborative Psychiatric Epidemiology Studies (CPES): the National Comorbidity Survey Replication (NCS-R), the National Study of American Life (NSAL) and the National Latino and Asian American Study of Mental Health (NLAAS). The multi-stage sample design and respondent selection procedures used in these three studies are based on the University of Michigan Survey Research Center's National Sample designs and operations. The paper begins with a general overview of these designs and procedures and then turns to a more detailed discussion of the adaptation of these general methods to the three specific study designs. The detailed discussions of the individual study samples focus on design characteristics and outcomes that are important to analysts of the CPES data sets and to researchers and statisticians who are planning future studies. The paper describes how the expected survey cost and error structure for each of these surveys influenced the original design of the samples and how actual field experience led to changes and adaptations to arrive at the final samples of each survey population.

Adult↗
PubMed2003

First Measurement of the Gerasimov-Drell-Hearn Sum Rule for 1H from 0.7 to 1.8 GeV at ELSA.

To verify the fundamental Gerasimov-Drell-Hearn (GDH) sum rule for the first time experimentally, we measured the helicity dependent total photoabsorption cross section with circularly polarized real photons and longitudinally polarized nucleons in the photon energy range 0.68-1.82 GeV with the tagged photon facility at ELSA. The experiment was carried out with a 4pi detection system, a circularly polarized tagged photon beam, and a frozen spin polarized proton target. The contribution to the GDH sum rule in this photon energy range is [49.9+/-2.4(stat)+/-2.2(syst)] microb.

Journal Article↗
PubMed2002

An enhanced molecular marker based genetic map of perennial ryegrass (Lolium perenne) reveals comparative relationships with other Poaceae genomes.

A molecular-marker linkage map has been constructed for perennial ryegrass (Lolium perenne L.) using a one-way pseudo-testcross population based on the mating of a multiple heterozygous individual with a doubled haploid genotype. RFLP, AFLP, isoenzyme, and EST data from four collaborating laboratories within the International Lolium Genome Initiative were combined to produce an integrated genetic map containing 240 loci covering 811 cM on seven linkage groups. The map contained 124 codominant markers, of which 109 were heterologous anchor RFLP probes from wheat, barley, oat, and rice, allowing comparative relationships between perennial ryegrass and other Poaceae species to be inferred. The genetic maps of perennial ryegrass and the Triticeae cereals are highly conserved in terms of synteny and colinearity. This observation was supported by the general agreement of the syntenic relationships between perennial ryegrass, oat, and rice and those between the Triticeae and these species. A lower level of synteny and colinearity was observed between perennial ryegrass and oat compared with the Triticeae, despite the closer taxonomic affinity between these species. It is proposed that the linkage groups of perennial ryegrass be numbered in accordance with these syntenic relationships, to correspond to the homoeologous groups of the Triticeae cereals.

Chromosome Mapping↗
PubMed2004

Cytogenetic biomarkers and genetic polymorphisms.

Cytogenetic biomarkers have long been applied in surveillance of human genotoxic exposure and early effects of genotoxic carcinogens. Due to their wide use, it has been possible to evaluate, in international collaborative studies, if a high level of these biomarkers in peripheral lymphocytes is predictive of cancer risk. Thus far, such an association has been observed for chromosomal aberrations (CAs), but not for sister chromatid exchanges (SCEs) or micronuclei (MN). The cancer risk predictivity of CAs was not dependent on the time between CA analysis and cancer detection and did not appear to be explained by tobacco smoking or occupational exposure to carcinogens but was seen in unexposed non-smokers as well. This suggests a role for individual susceptibility factors. Genetic polymorphisms of various xenobiotic-metabolising enzymes, influencing the metabolic activation and detoxification of carcinogens, have been associated with cancer risk, and some of them also appear to affect cytogenetic biomarkers. The lack of glutathione S-transferase M1 (GSTM1 null genotype) is associated with increased sensitivity to genotoxicity of tobacco smoke, and GSTM1 null smokers also show an increased frequency of CAs and SCEs. N-Acetyltransferase (NAT2) slow acetylation genotype and glutathione S-transferase T1 (GSTT1) null genotype seem to elevate the baseline level of CAs and SCEs and CAs, respectively--possibly because of reduced capacity to detoxify some wide-spread or endogenous genotoxins. For some chemicals, in vitro cytogenetic studies with lymphocyte donors representing different genotypes have been able to predict a differential in vivo response. For instance, in vitro SCE induction by styrene and by epoxide metabolites of 1,3-butadiene is modified by GSTM1 and GSTT1 genotypes--which also influence the excretion of specific mercapturic acids in humans exposed to butadiene and styrene. Polymorphisms of DNA repair and folate metabolism are expected to be of special importance in modulating genotoxic effects. Some evidence exists for the effects of X-ray cross complementation group 1 (XRCC1) codon 280 and (in smokers) Xeroderma pigmentosum group D (XPD) codon 23 polymorphisms on baseline CAs, for XRCC1 codon 399 polymorphism on SCEs in smokers, and for methylene tetrahydrofolate reductase (MTHFR) codon 677 and methionine synthase reductase (MTRR) polymorphisms on spontaneous MN.

Animals↗
PubMed1989

WHO Collaborative Study on Alcohol Education and Young People: outcomes of a four-country pilot study.

In 1985 the Division of Mental Health, World Health Organization, Geneva, convened a group of investigators from centers in four countries--Australia, Chile, Norway, Swaziland--to participate in a pilot study on the efficacy of school-based alcohol education. The goal of the educational program was to delay onset and minimize involvement of alcohol use among 13- to 14-year-old adolescents. Twenty-five schools in the four countries, representing middle- and lower-class populations, were randomly assigned to peer-led education, teacher-led education, or a control condition. The educational program was derived from social-psychological theory and etiological research on adolescent alcohol use. The program focused on the social and environmental influences to drink alcohol and skills to resist those influences. It consisted of five lessons over 2 months. Baseline and posttest data measured alcohol use knowledge, attitudes, skills, and friends' drinking patterns. Data were collected immediately prior to and 2 months following the educational program. The data converge on the finding that peer-led education appears to be efficacious in reducing alcohol use across a variety of settings and cultures.

Adolescent↗
PubMed1997

Using research for practice: a UK experience of the BARRIERS Scale.

It is generally recognized that the majority of health care has been largely based upon opinion rather than research evidence of clinical effectiveness. Attempts to rectify this have been initiated by increasing emphasis on the dissemination of findings. For example, in the UK this had been supported via the Cochran Collaboration and the Centre for Dissemination and Reviews. Dissemination does not, however, guarantee implementation. The complex nature of research utilization has been studied and obstacles identified that can influence the uptake of research by practising nurses. Sandra Funk and colleagues developed the BARRIERS Scale using this research and literature on research utilization. The scale may be helpful for identifying and measuring the barriers to research utilization perceived by nurses working within the UK and has formed the basis of the present study. A convenience sample of 316 comprising a broad spectrum of nurses working in the UK provided the data. Comparison is made with North American nurses from the studies used in the scale's development. The results suggest there ware items which are consistently perceived as either strong or negligible barriers by both groups of nurses. Differences, however, did emerge between nurses from the UK and North America on several items. These included the confidence in evaluating research and the perception of the nurse's authority to change patient procedures. Psychometric evaluation was also done. These findings are presented and discussed.

Cross-Cultural Comparison↗
PubMed2006

Multicentre study of acute alcohol use and non-fatal injuries: data from the WHO collaborative study on alcohol and injuries.

OBJECTIVES: To study the risk of non-fatal injury at low levels and moderate levels of alcohol consumption as well as the differences in risk across modes of injury and differences among alcoholics. METHODS: Data are from patients aged 18 years and older collected in 2001-02 by the WHO collaborative study on alcohol and injuries from 10 emergency departments around the world (n = 4320). We used a case-crossover method to compare the use of alcohol during the 6 hours prior to the injury with the use of alcohol during same day of the week in the previous week. FINDINGS: The risk of injury increased with consumption of a single drink (odds ratio (OR) = 3.3; 95% confidence interval = 1.9-5.7), and there was a 10-fold increase for participants who had consumed six or more drinks during the previous 6 hours. Participants who had sustained intentional injuries were at a higher risk than participants who had sustained unintentional injuries. Patients who had no symptoms of alcohol dependence had a higher OR. CONCLUSION: Since low levels of drinking were associated with an increased risk of sustaining a non-fatal injury, and patients who are not dependent on alcohol may be at higher risk of becoming injured, comprehensive strategies for reducing harm should be implemented for all drinkers seen in emergency departments.

Adult↗
PubMed2001

[ECLAMC: 30-year study of epidemiological surveillance of neural tube defects in Chile and Latin America].

BACKGROUND: There is an urgent need to assess the impact, on the incidence of neural tube defects, of the recently implanted flour fortification with folic acid in Chile. The Collaborative Study of Congenital Malformations in Latin America (ECLAMC) has carried out an uninterrupted register of congenital malformations in the last thirty years. AIM: To assess the epidemiology of neural tube defects in Chile and determine the most adequate base period to evaluate the effects of Folic acid fortification. MATERIAL AND METHODS: Analysis of ECLAMC database that has registered all births over 500 g from 1967. RESULTS: From 1967 to 1999, there were 434.624 births in 18 hospitals in Chile and 3.586.569 births in 155 hospitals in the rest of Latin America. The rate of neural tube defects in Chile was 17.03 per 10.000, significantly higher than the rest of ECLAMC (14.88 per 10.000). The prevalence of neural tube defects has a statistically significant secular tendency to increase in the study period and is higher among stillbirths, newborns with a birth weight of less than 1500 g, women and offspring of mothers aged less than 19 years old. CONCLUSIONS: The period 1982-1999 is considered the best period for reference comparisons of the effects folic acid supplementation.

Adult↗
PubMed2005

Use of and adherence to antiretroviral therapy is associated with decreased sexual risk behavior in HIV clinic patients.

Previous research suggested that the availability of highly active antiretroviral therapy (ART) was associated with increased risky sexual behavior. This study examined the relationship between unprotected anal or vaginal sex (UAV) and ART use and adherence in a cross-sectional survey conducted in 874 randomly selected, sexually active patients at 6 public HIV clinics in California. Patients completed a standardized interview in 1998-1999 regarding HIV history, sexual behavior, illicit drug use, and ART use and adherence. Thirty-four percent reported UAV, defined as anal or vaginal sex without a condom within the past 3 months. Of 79% on ART, 26% reported <95% adherence. Decreased odds for UAV were found for both ART use, odds ratio (OR) 0.5 (95% CI 0.4-0.7, P < 0.001) and adherence to ART of > or = 95%, OR 0.6 (95% CI 0.4-0.8, P < 0.001). These relationships persisted in most stratified analysis for both ART use and adherence but in multivariate analysis only for ART use. An undetectable HIV RNA was associated with decreased odds of UAV, OR 0.6 (95% CI 0.5-0.8, P < 0.001). Contrary to expectations, use of and adherence to ART and their consequent suppression of HIV were associated with a decreased prevalence of self-reported risky sexual behavior.

Adult↗
PubMed1991

Year 2000 objectives for preventing nosocomial infections: how do we get there?

In the late 1970s, the United States Public Health Service (PHS), in collaboration with public and private sector individuals and organizations, for the first time formulated national objectives for the prevention and control of disease. The PHS Year 1990 Objectives and Year 2000 Objectives both contain plans for preventing and controlling nosocomial infections. The Year 2000 Objectives contain goals for reducing infections that have been judged achievable, using existing prevention and control strategies. The specific Year 2000 Objectives targeting nosocomial infections can be divided into two categories: a) protecting the health care worker and b) protecting the patient. The Occupational Safety and Health Administration will play a major role in the upcoming decade in attaining the health care worker objectives. Reductions in patient nosocomial infections focus on surgical wound infections and infections in intensive care patients. Considerable work needs to be done in developing suitable nosocomial infection rate measures that adjust for patient case mix in order to assess progress toward achieving the objectives. Educational efforts targeted at entry-level health care providers and hospital epidemiologists must be strengthened. Government agencies, academic centers, industry, and professional organizations each have unique strengths and talents that can be collectively brought to bear on the problem.

Cross Infection↗
PubMed2006

"Supposed to make you better but it doesn't really": HIV-positive youths' perceptions of HIV treatment.

PURPOSE: Half of new HIV infections worldwide occur among young people. Youth, particularly young women aged 15-29 years, represent a growing population to experience HIV. This study investigated HIV-positive youths' perceptions of, and experiences with, antiretroviral treatment. METHODS: A community-based, participatory approach was used to conduct a mixed methods research study. Thirty-four qualitative, in-depth, semi-structured interviews were conducted with HIV-positive youth (ages 12-24 years) in Ontario, Canada. Brief structured demographic surveys were also administered. A research team of HIV-positive youth, professionals, and researchers collaboratively analyzed the data for emerging themes. RESULTS: Four major themes emerged: Treatment knowledge: confusion and skepticism. Many participants did not understand, or believe in, antiretroviral treatment. Some youth on treatment did not understand why they were taking medications. Treatment decision-making: lack of choice and feeling emotionally unprepared. Some youth did not feel that they had choices about treatment, and others did not feel ready to make treatment decisions. Difficulties taking medications. Youth had problems with social routine disruption, feeling "different" and side effects. Many viewed costs of medications as a barrier to treatment. Inconsistent treatment adherence and treatment interruptions, which were common amongst participants. CONCLUSIONS: Youth may need support for managing difficulties with treatments, such as side effects, social impacts, and adherence. Developmentally appropriate, empowerment-based treatment education may be helpful for HIV-positive youth. The availability of social programs to provide treatment access does not guarantee that youth will be aware of them. This may indicate a need for youth-specific outreach.

Adolescent↗
PubMed2006

Asian/Pacific Islander youth violence prevention center: interpersonal violence and deviant behaviors among youth in Hawai'i.

PURPOSE: This study investigates the prevalence rates of violent and deviant behaviors among a sample of Filipino, Hawaiian, Japanese, and Samoan public high school students residing in Hawai'i, and is the first relatively large-scale study of its kind regarding a disaggregated sample of Asian American and Pacific Islander (AAPI) youth. Filipino, Hawaiian, and Samoan adolescents were the chosen ethnic groups for this study's focus due to their over-representation in Hawai'i's juvenile justice system. METHODS: Data for this study were gathered collaboratively by researchers, community groups, and school officials who agreed that youth violence was a community concern worthy of deeper understanding and community response. The study's process included three phases: a focus group consultation phase, field-testing, and the final risk and protective factor study. For the final study, 326 randomly selected students representing three Hawai'i public high schools were surveyed on a one-on-one basis.A smaller sample of Japanese students was also included in the study, serving as a control group. RESULTS: Findings illustrate the importance of disaggregating specific ethnic and gender groups within the AAPI ethnic category when examining adolescent issues. As examples, Samoan youth reported significantly higher rates of violence than other ethnic groups surveyed, and Hawaiian girls reported higher rates of substance use than Hawaiian boys, which was not commensurate with other ethnic groups. Filipino, Hawaiian, and Samoan youth all reported significantly higher rates than Japanese on overall deviant behavior. CONCLUSIONS: Implications for further research and community development include enhancing minority youths' bicultural self-efficacy.

Adolescent↗
PubMed2006

Differential cross section and photon-beam asymmetry for the gamma n --> K+ Sigma- reaction at E gamma = 1.5-2.4 GeV.

Differential cross sections and photon-beam asymmetries have been measured for the gamma n --> K+ Sigma- and gamma p --> K+Sigma0 reactions separately using liquid deuterium and hydrogen targets with incident linearly polarized photon beams of E gamma = 1.5-2.4 GeV at 0.6 < cos ThetacmK< 1. The cross section ratio of sigma K+ Sigma-/sigma K+ Sigma0, expected to be 2 on the basis of the isospin 1/2 exchange, is found to be close to 1. For the K+ Sigma- reaction, large positive asymmetries are observed, indicating the dominance of K* exchange. The large difference between the asymmetries for the K+ Sigma- and K+ Sigma0 reactions cannot be explained by simple theoretical considerations based on Regge model calculations.

Journal Article↗
PubMed1998

Progress of ICD-10 (F) family in Japan: research, field trials and publications.

The Nagasaki Center, designated as a World Health Organization (WHO) Collaborating Center in 1979, has taken the lead in generalizing ICD-10 (F) in Japan. The progress of ICD-10 (F)-related research, trials and publications has been as follows. The field trials of ICD-10 Clinical Descriptions and Diagnostic Guidelines (CDDG) 1986 draft were carried out with 129 patients by 61 clinicians in five institutions coordinated by Tokyo Medical and Dental University and Nagasaki University in 1988. The Japanese version of ICD-10 CDDG was published by Tooru et al. in February 1993. The field trials of ICD-10 Diagnostic Criteria for Research (DCR) 1990 version were conducted with 847 patients by 169 clinicians at 28 institutions and 2299 assessments were obtained. The Japanese version of ICD-10 DCR final version was published by Nakane et al. in May 1994. The Japanese version of the Glossaries and Conversion Tables between ICD-9 and ICD-10 was published by Nakane et al. in October 1994. The field trials of ICD-10 Multiaxial Presentation were conducted with 34 psychiatrists at six institutions in 1993 and the total of 676 assessments was obtained, and the adequacy and usefulness of the text were examined.

Cross-Cultural Comparison↗
PubMed1997

Patients' perceptions of primary health care in an inner-city practice.

BACKGROUND: The 1978 Alma Ata declaration by the World Health Organization emphasized the importance of primary health care, which includes social services and participation, as well as primary medical care. In the UK, primary medical care is based on general practice, increasingly working from purpose-built premises with primary care teams. However, this does not usually include social services or involve patient participation. Both general practice and social services are undergoing reorganization as separate entities, with little emphasis on intersectoral collaboration. OBJECTIVES: We aimed to assess patients' perceptions of primary health care in an inner-city practice in terms of primary medical care, social services and participation. METHODS: Perceptions of medical and social services, together with levels of satisfaction and patient participation, were assessed by self-completed questionnaires for 248 patients attending an inner-city health centre and by 74 home interviews for those who had requested house calls. RESULTS: Patients were more satisfied with primary medical care than with other aspects of primary health care, such as housing. Older patients at home were less satisfied with primary medical care and more satisfied with social services than younger patients attending the health centre. Physiotherapy, chiropody and pharmacy were the services most requested at the health centre. A domiciliary pharmacy, help with hearing aids and a social worker at the health centre were the main requests by older patients at home. CONCLUSIONS: Medical and social services at primary care level should have coterminous boundaries based on general practice populations, ideally with access through multipurpose health centres.

Adult↗

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