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State policies and programs that address the needs of mentally ill mothers in the public sector.

OBJECTIVE: The authors sought to determine whether state departments of mental health have specific policies and programs addressing the needs of mentally ill women served in the public sector who have preschool-age children. METHODS: A questionnaire was sent to the commissioner of mental health for each state and the District of Columbia. Questions addressed whether information was routinely collected on the parenting status of women who receive public-sector psychiatric services, whether services targeting mentally ill women with young children were available, and whether the state had policies concerning hospitalized women who are pregnant or who have young children. RESULTS: Sixteen states routinely collect data on whether women who receive public-sector services have young children. Four states have residential programs for mentally ill women and their children. About half of the states have programs for assessing parenting skills and outpatient services focused on improving those skills. No state has a policy about visitation between a hospitalized mentally ill mother and her children. Twenty states have policies for the care of hospitalized pregnant patients, primarily for their medical management. CONCLUSIONS: Further efforts are needed to identify mentally ill women in the public sector who have young children, to enhance the parenting skills of mentally ill patients, and to promote positive outcomes for their children.

Child↗

Addressing social determinants of health through community-based participatory research: the East Side Village Health Worker Partnership.

The authors describe the use of a stress process model by the East Side Village Health Worker Partnership (ESVHWP), a project of the Detroit Community-Academic Urban Research Center, as a framework for understanding social determinants of health. Specifically, the authors describe the development by the ESVHWP Steering Committee of a context-specific stress process model for east side Detroit residents. The authors examine data from in-depth interviews to illuminate actions taken by community members to reduce stressors or minimize their impact on health. Finally, the authors describe the use of this context-specific stress process model and data gathered regarding actions to address community stressors to inform the development of interventions by the ESVHWP to reduce stressors or strengthen the conditioning factors that reduce the impact of stress on health. On the basis of these results, the authors discuss opportunities and challenges for partnership approaches to addressing social determinants of health in urban communities.

Adult↗

Coalition-based approaches for addressing environmental issues in childhood asthma.

Outdoor air pollution and the indoor environment have been shown to cause or exacerbate childhood asthma. Allies Against Asthma coalitions implemented a broad range of activities to reduce or remediate indoor exposure to asthma environmental triggers for children with asthma including education and trigger remediation, physician and other health care provider education, and policy efforts to improve air quality in homes and schools. Outdoor environmental triggers were addressed through programs to increase education and awareness and efforts to change policies related to environmental conditions. Implementation of such efforts was complicated by the lack of safe and affordable housing and the amount of time and resources necessary to address policy change. Keys to success included promoting coordination and partnerships among coalition members, implementation of consistent messages, and building a broad and unified voice for policy change.

Adolescent↗

Personally addressed hand-signed letters increase questionnaire response: a meta-analysis of randomised controlled trials.

BACKGROUND: Postal questionnaires are commonly used to collect data for health studies, but non-response reduces study sample sizes and can introduce bias. Finding ways to increase the proportion of questionnaires returned would improve research quality. We sought to quantify the effect on response when researchers address participants personally by name on letters that accompany questionnaires. METHODS: All randomised controlled trials in a published systematic review that evaluated the effect on response of including participants' names on letters that accompany questionnaires were included. Odds ratios for response were pooled in a random effects meta-analysis and evidence for changes in effects over time was assessed using random effects meta-regression. RESULTS: Fourteen randomised controlled trials were included covering a wide range of topics. Most topics were unrelated to health or social care. The odds of response when including participants' names on letters were increased by one-fifth (pooled OR 1.18, 95% CI 1.03 to 1.34; p = 0.015). When participants' names and hand-written signatures were used in combination, the effect was a more substantial increase in response (OR 1.45, 95% CI 1.27 to 1.66; p < 0.001), corresponding to an absolute increase in the proportion of questionnaires returned of between 4% and 10%, depending on the baseline response rate. There was no evidence that the magnitude of these effects had declined over time. CONCLUSION: This meta-analysis of the best available evidence indicates that researchers using postal questionnaires can increase response by addressing participants by name on cover letters. The effect appears to be enhanced by including hand-written signatures.

Communication↗

Chemically synthesized zinc finger molecules as nano-addressable probes for double-stranded DNAs.

Our experiments describe an alternative method of dsDNA recognition using zinc finger (ZF) molecules which bind DNA specifically and with high affinity. Our aim was to develop zinc finger probes which are able to bind to dsDNA molecules at predetermined sites. In our basic approach we used pairs of complementary oligonucleotides to form dsDNAs, containing one of the three SP1-transcription factor motifs as a zinc finger recognition site. Two zinc finger probes of the SP1 motif were chemically synthesized and modified with a Dy-633 fluorophore. The SP1 peptides were folded into functional zinc fingers using zinc chloride. The addressable dsDNAs were immobilized on optical fibres, and the kinetics and binding rates of the artificial zinc finger probes were measured by a fluorescence detecting device (photomultiplying tube). The two zinc fingers and their corresponding DNA recognition sites served as specific probes and controls for the matching site and vice versa. Our experiments showed that a variety of dsDNA-binding probes may be created by modification of the amino acid sequence of natural zinc finger proteins. Our findings offer an alternative approach of addressing dsDNA molecules, for example for use in a nanoarray device.

Journal Article↗

Systematic reviews in rehabilitation for stroke: issues and approaches to addressing them.

OBJECTIVES: To describe the problems encountered when undertaking systematic reviews of rehabilitation and to give advice to reviewers about ways of addressing these issues. BACKGROUND: Evidence-based practice has become established as a way of linking clinical practice with research evidence. The most robust evidence is usually considered to be that from randomized controlled trials, and from systematic reviews of these trials. However, most reviews have focused on drug and surgical interventions, and few reviews have been produced in the field of rehabilitation. This may be due to the unique difficulties that are posed by reviews in this area. EXPERIENCE OF SYSTEMATIC REVIEWS IN APHASIA: We describe the challenges that occurred when carrying out systematic reviews of speech and language therapy for aphasia following stroke, and of ways to deliver rehabilitation services to people who have suffered a stroke. Issues arose at all stages of the reviews and included: using expertise; planning the review; defining the health care problem, patients, outcomes and interventions of interest; searching for, interpreting and synthesizing the results of the studies identified; and deriving implications from the review. Suggestions made to address these challenges include: developing a suitable team of reviewers; using inclusive and broad criteria for inclusion of trials to a review; developing appropriate search strategies; and using caution in arriving at conclusions. It is important to be explicit about decisions made during the review process concerning how to handle the challenges. Practical advice about carrying out reviews in the field of stroke rehabilitation is likely to be helpful to reviewers of other rehabilitative interventions. There are likely to be relatively few studies available for such reviews, and limitations in drawing specific practical conclusions. Such undertakings are, however, useful in setting the agenda for further research.

Humans↗

Lung cancer practice guidelines: lessons learned and issues addressed by the Ontario Lung Cancer Disease Site Group.

PURPOSE: The primary objective was to identify the lessons learned and issues addressed by the Disease Site Group (DSG) developing guidelines on lung cancer for practitioners in the province of Ontario. METHODS: The minutes of the Ontario Lung Cancer Disease Site Group (LCDSG) and the meeting notes of a medical sociologist who attended all LCDSG meetings were reviewed to identify the disease-specific and generic issues addressed by the LCDSG during guideline development. RESULTS AND CONCLUSION: The Ontario LCDSG has completed three practice guidelines and has five evidence-based recommendations (EBRs) in production. Topics for guideline development were selected on the basis of known practice variability (eg, advanced-stage non-small-cell lung cancer [NSCLC]); the size of the patient population that could potentially be affected by the guideline; results of phase II trials of new and potentially expensive agents (vinorelbine, paclitaxel, and docetaxel); and randomized controlled clinical trials that support new practice standards (combined modality therapy for unresectable stage III NSCLC). The wording of each EBR reflects the strength and quality of the evidence in support of the treatment option, the primary outcome(s), and the individual physician and discipline values concerning treatment outcomes in the absence of known patient values.

Canada↗

The ethical and clinical practice of disclosing raw test data: addressing the ongoing debate.

Neuropsychologists are prone to having raw test data requested by colleagues, clients, and attorneys. Although questions of when and to whom neuropsychologists should release raw test data have been debated for years, uncertainty about how to address requests for raw test data persists. Although contradictions within and between ethical and legal guidelines exist, general bioethical principles, most ethical and professional guidelines, and federal copyright law support the responsibility of practitioners to maintain the security of neuropsychological tests, including raw test data. Neuropsychologists are best served by taking a proactive approach regarding the manner in which requests for raw test data are addressed. The purpose of this article is to provide the information necessary to make informed decisions regarding the release of raw test data; however, each neuropsychologist must ultimately choose to pursue a course of action that is simply ethically acceptable or one that is ethically preferable.

Bioethical Issues↗

Understanding and addressing the epidemic of obesity: an energy balance perspective.

The intent of this paper is to address the obesity epidemic, which is a term used to describe the sudden and rapid increase in obesity rates that began in the 1980s and continues unabated today. Since 1980, the entire population, regardless of starting weight, is gradually gaining weight. This has led to escalating obesity rates and to obesity being considered one of the most serious public health challenges facing the world. At one level, the obesity epidemic is a classic gene-environment interaction where the human genotype is susceptible to environmental influences that affect energy intake and energy expenditure. It is also a problem of energy balance. Understanding the etiology of obesity requires the study of how behavioral and environmental factors have interacted to produce positive energy balance and weight gain. Reversing the epidemic of obesity will require modifying some combination of these factors to help the population achieve energy balance at a healthy body weight. While body weight is strongly influenced by biological and behavioral factors, changes in the environment promoting positive energy balance have been most responsible for the obesity epidemic. Our best strategy for reversing the obesity epidemic is to focus on preventing positive energy balance in the population through small changes in diet and physical activity that take advantage of our biological systems for regulating energy balance. Simultaneously, we must address the environment to make it easier to make better food and physical activity choices. This is a very long-term strategy for first stopping and then reversing the escalating obesity rates, but one that can, over time, return obesity rates to pre-1980s levels.

Disease Outbreaks↗

Differential addressing of 5-HT1A and 5-HT1B receptors in epithelial cells and neurons.

The 5-HT1A and 5-HT1B serotonin receptors are expressed in a variety of neurons in the central nervous system. While the 5-HT1A receptor is found on somas and dendrites, the 5-HT1B receptor has been suggested to be localized predominantly on axon terminals. To study the intracellular addressing of these receptors, we have used in vitro systems including Madin-Darby canine kidney (MDCK II) epithelial cells and primary neuronal cultures. Furthermore, we have extended these studies to examine addressing in vivo in transgenic mice. In epithelial cells, 5-HT1A receptors are found on both apical and basolateral membranes while 5-HT1B receptors are found exclusively in intracellular vesicles. In hippocampal neuronal cultures, 5-HT1A receptors are expressed on somatodendritic membranes but are absent from axons. In contrast, 5-HT1B receptors are found on both dendritic and axonal membranes, including growth cones where they accumulate. Using 5-HT1A and 5-HT1B knockout mice and the binary tTA/tetO system, we generated mice expressing these receptors in striatal neurons. These in vivo experiments demonstrate that, in striatal medium spiny neurons, the 5-HT1A receptor is restricted to the somatodendritic level, while 5-HT1B receptors are shipped exclusively toward axon terminals. Therefore, in all systems we have examined, there is a differential sorting of the 5-HT1A and 5-HT1B receptors. Furthermore, we conclude that our in vivo transgenic system is the only model that reconstitutes proper sorting of these receptors.

8-Hydroxy-2-(di-n-propylamino)tetralin↗

BIR presidential address: exploring the niches.

In his 1990 Presidential Address Professor C R Hill posed the question of whether, given the ethos of the late 20th century, there was a future for radiological science. To answer his question he reviewed the scientific basis of current major branches of radiology, demonstrating progress resulting from initial physical discovery, combined with engineering and medical inventiveness. In the process of the development of radiological science, small-scale speculative research, outside mainstream areas, has proved to be an important element. This address complements Professor Hill's by examining the role of a small-scale speculative research (the niches of the field). Examples are taken from the early pioneers of radiological science and the first British Institute of Radiology Congress. Finally some lesser known research activity in this category, being presented at the Golden Jubilee Congress, is reviewed.

Body Composition↗

Addressing smoking cessation in methadone programs.

Little is known about how well methadone programs address smoking cessation. We describe the frequency of smoking cessation counseling, and factors affecting its provision in methadone programs. We conducted a cross-sectional survey of methadone patients and their counselors. Of 575 patients, 76% were eligible smokers. Although only 48% of patients reported receiving smoking cessation counseling within the previous six months, 97% of counselors reported providing it (p < 0.0001). Time with one counselor was significantly associated with patient report of receiving smoking cessation counseling (OR 1.19 [95% CI 1.04-1.36]). Although addiction counseling is required in methadone programs, nicotine addiction is addressed less than half the time. Methadone programs should prioritize the provision of effective smoking cessation and facilitate continuity of patient-counselor relationships.

Adult↗

A question of finding harmony: a grounded theory study of clinical psychologists' experience of addressing spiritual beliefs in therapy.

In spite of the increasing emphasis upon spirituality in the psychological literature, research continues to highlight concerns that issues relating to spirituality are regularly overlooked within a therapeutic setting. The aim of the current study was to develop an account of the way in which clinical psychologists understand and address spirituality within therapy. Semi-structured interviews were conducted with eight clinical psychologists. The transcripts were analysed using the qualitative methodology of grounded theory, which also informed the data collection process. Two core categories were developed and termed spirituality as an elusive concept and finding harmony with spiritual beliefs. The diversity of meaning surrounding spirituality and the relative lack of engagement was found to create difficulty for constructing spirituality coherently as a concept. When specifically considering methods for identifying and addressing spiritual beliefs, contrasting approaches were identified. This diversity in understanding and approach has implications for the process and outcome of therapy, which are discussed in detail. Recommendations are suggested for developing spirituality as a more coherent and accessible concept, both within professional dialogue and the therapeutic context.

Humans↗

Addressing variations: is there hope for the future?

The papers by Robert Berenson and by Steven Lieberman and colleagues show that variations remain a true challenge for those trying to improve the delivery of health care. Recent clarifications in the understanding of unwarranted variations allow us to address variations in a more logical and manageable fashion. In this Perspective we describe key challenges in addressing variations in the context of these recent clarifications. The Centers for Medicare and Medicaid Services (CMS) needs to move forward on information-sharing interventions and use demonstrations to pursue innovative strategies to improve the delivery of care through its purchasing power.

Centers for Medicare and Medicaid Services, U.S.↗

Beyond Bariatric Surgery.Complications We Fail to Address.

As we now progress in the field of bariatric surgery, improving methods and fine tuning operative procedures, we witness many benefits. Fewer complications, shorter hospital stays, and more evidence of successful weight loss consistently appear in the statistics that have been accumulated through years of research. The information accumulated through years of research. The information provided, continues to verify that surgery is the most viable treatment for morbid obesity. There is minimal literature, however, that addresses the emotional issues faced by the patients who have undergone bariatric procedures. Postoperatively we may find at intervals of 3 months, 6 months, and even 1 or more years, a patient struggling to deal with their identity. The resolution or improvements of various medical anomalies, may seem insignificant as the patient now begins to focus on emotional and physical changes. Their bodies' new shape may create distressing personal concerns. Family members may also struggle with these psychological and physical changes. The surgery has forced the patient to deal with the loss of a love that is not easily replaced, the love of food. These, all too frequently, are the actual postoperative complications, co-morbidity changes, and weight loss, most importantly, we must also understand our responsibility to address the patients' emotional well-being. While indicating our concerns for the psychological as well as physiological recovery, the patient may then realize a healthier transition into life beyond bariatric surgery.

Journal Article↗

Sleep problems seldom addressed at two general pediatric clinics.

OBJECTIVE: Sleep disorders can cause substantial morbidity but often remain undiagnosed among adults. We identified a series of children with sleep-related symptoms and reviewed medical chart notes for the previous 2 years to determine how often sleep problems had been addressed. DESIGN: Observational. Setting. Two university-affiliated but community-based general pediatrics clinics. PATIENTS: Children, ages 2.0 to 13.9 years, with clinic appointments. MEASURES: Parental and child responses to a validated Pediatric Sleep Questionnaire (PSQ) were used to identify patients at risk for chronic sleep-disordered breathing, periodic leg movements during sleep, insomnia, or excessive daytime sleepiness. Chart notes written within the previous 2 years were searched for sleep-related symptoms, diagnoses, or treatments. RESULTS: A total of 830 questionnaires were completed; 1395 chart notes of 86 symptomatic participants (mean age: 6.6 +/- 3.1 years; 51% male) with 103 identified sleep problems were reviewed. Fewer than 15% of patients had current chart notes that mentioned any of the PSQ-defined sleep problems; diagnoses were mentioned for 2 of 86 patients and no treatments were discussed. Among the 103 sleep problems, only 16 received mention in any past or current note; 10 had led to a diagnosis; 4 had led to intervention; and 3 were treated in a manner likely to be effective. Seventy-four of the sleep problems (72%) occurred in children whose charts did mention something about sleep, but such notations rarely related to concerns uncovered by the PSQ. CONCLUSIONS: Children with PSQ-identified sleep problems at 2 general pediatrics clinics seldom had these problems addressed, diagnosed, or treated, despite discussions about some aspect of their sleep in the large majority of cases. These findings support expansion of clinician and parent education about sleep disorders in children.

Adolescent↗

The effects of a public address system on the off-task behavior of elementary physical education students.

The purpose of this study was to determine the effects of teacher feedback delivered via a public address system on the off-task behavior of elementary-school physical education students. A multiple baseline design across three classes was used in this investigation. Results indicated a consistent decline in off-task behavior when the public address feedback system was used.

Child↗

Addressing the epidemiologic transition in the former Soviet Union: strategies for health system and public health reform in Russia.

OBJECTIVES: This paper reviews Russia's health crisis, financing, and organization and public health reform needs. METHODS: The structure, policy, supply of services, and health status indicators of Russia's health system are examined. RESULTS: Longevity is declining; mortality rates from cardiovascular diseases and trauma are high and rising; maternal and infant mortality are high. Vaccine-preventable diseases have reappeared in epidemic form. Nutrition status is problematic. CONCLUSIONS: The crisis relates to Russia's economic transition, but it also goes deep into the former Soviet health system. The epidemiologic transition from a predominance of infectious to noninfectious diseases was addressed by increasing the quantity of services. The health system lacked mechanisms for epidemiologic or economic analysis and accountability to the public. Policy and funding favored hospitals over ambulatory care and individual routine checkups over community-oriented preventive approaches. Reform since 1991 has centered on national health insurance and decentralized management of services. A national health strategy to address fundamental public health problems is recommended.

Health Care Reform↗