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PubMed2005

A shared response model for clustered binary data in developmental toxicity studies.

Existing distributions for modeling fetal response data in developmental toxicology such as the beta-binomial distribution have a tendency of inflating the probability of no malformed fetuses, and hence understating the risk of having at least one malformed fetus within a litter. As opposed to a shared probability extra-binomial model, we advocate a shared response model that allows a random number of fetuses within the same litter to share a common response. An explicit formula is given for the probability function and graphical plots suggest that it does not suffer from the problem of assigning too much probability to the event of no malformed fetuses. The EM algorithm can be used to estimate the model parameters. Results of a simulation study show that the EM estimates are nearly unbiased and the associated confidence intervals based on the usual standard error estimates have coverage close to the nominal level. Simulation results also suggest that the shared response model estimates of the marginal malformation probabilities are robust to misspecification of the distributional form, but not so for the estimates of intralitter correlation and the litter-level probability of having at least one malformed fetus. The proposed model is fitted to a set of data from the U.S. National Toxicology Program. For the same dose-response relationship, the fit based on the shared response distribution is superior to that based on the beta-binomial, and comparable to that based on the recently proposed q-power distribution (Kuk, 2004, Applied Statistics53, 369-386). An advantage of the shared response model over the q-power distribution is that it is more interpretable and can be extended more easily to the multivariate case. To illustrate this, a bivariate shared response model is fitted to fetal response data involving visceral and skeletal malformation.

2,4,5-Trichlorophenoxyacetic Acid↗

PubMed2004

The prevalence and characteristics associated with parent-infant bed-sharing in England.

AIMS: To investigate the characteristics of parent-infant bed-sharing prevalence in England. METHODS: Data on night-time sleeping practices from a two year, local, longitudinal study and a three-year, national, cross-sectional study were obtained. A total of 261 infants in North Tees were followed up at 1 and 3 months of age, as were 1095 infants aged 1 week to 1 year from five English health regions. RESULTS: Data from both studies found that almost half of all neonates bed-shared at some time with their parents (local = 47%, 95% CI 41 to 54; national = 46%, 95% CI 34 to 58), and on any one night in the first month over a quarter of parents slept with their baby (local = 27%, 95% CI 22 to 33; national = 30%, 95% CI 20 to 42). Bed-sharing was not related to younger mothers, single mothers, or larger families, and was not more common in the colder months, at weekends, or among the more socially deprived families; in fact bed-sharing was more common among the least deprived in the first months of life. Breast feeding was strongly associated with bed-sharing, both at birth and at 3 months. Bed-sharing prevalence was uniform with infant age from 3 to 12 months; on any one night over a fifth of parents (national = 21%, 95% CI 18 to 24) slept with their infants. CONCLUSION: Bed-sharing is a relatively common practice in England, not specific to class, but strongly related to breast feeding.

Adult↗

PubMed2006

Rheumatoid arthritis and genetic markers in Syrian and French populations: different effect of the shared epitope.

OBJECTIVE: To investigate whether ethnic differences exist in the effect of the shared epitope and selected cytokine gene polymorphisms on the susceptibility and severity of rheumatoid arthritis in Syria (Damascus) and France (Rhône-Alpes area). METHODS: 156 patients with rheumatoid arthritis and 120 healthy controls from Syria were compared with 512 patients with rheumatoid arthritis and 471 healthy controls from France. Shared epitope status, cytokine gene polymorphisms interleukin (IL)-1B +3954, IL-1RN +2018 and tumour necrosis factor alpha promoter (-238 and -308) were analysed by enzyme-linked oligosorbent assay. Joint destruction was defined by a right wrist Larsen score > or =2. Odds ratios (ORs) were calculated. RESULTS: In both countries, a dose effect was observed between the shared epitope copy number and rheumatoid arthritis (Syria: OR 1 v 0 copies = 1.6, p = NS; OR 2 v 0 = 15.3, p<0.01; and France: OR 1 v 0 = 2.3, p<0.001; OR 2 v 0 = 7.2, p<0.001). A dose effect was also observed between the shared epitope copy number and joint destruction in Syria (OR 1 v 0 = 2.2, p = NS; OR 2 v 0 = 9.9, p<0.01) and France (OR 1 v 0 = 1.8, p<0.01; OR 2 v 0 = 4.8, p = 0.001). The dose effect of the shared epitope was greater in Syria than in France. Only the -238 tumour necrosis factor alpha polymorphism was associated with joint destruction in the Syrian population (p<0.05). However, after adjustment for age, sex, disease duration and rheumatoid factor for severity, this association disappeared. CONCLUSION: The frequency of the shared epitope was increased in the French population with rheumatoid arthritis and in controls, but the association between the shared epitope and joint destruction was more pronounced in the Syrian population, with an OR of almost 10 for the homozygotes.

Adult↗

PubMed2005

Smoking is a risk factor for anti-CCP antibodies only in rheumatoid arthritis patients who carry HLA-DRB1 shared epitope alleles.

OBJECTIVES: To study the gene-environment interaction of tobacco exposure and shared epitope on autoantibodies in patients with rheumatoid arthritis and undifferentiated arthritis. METHODS: From incident cases of arthritis (n = 1305), patients who did not fulfil any classification criteria (undifferentiated arthritis (n = 486)) and those who fulfilled the American College of Rheumatology criteria for rheumatoid arthritis (n = 407) were identified. IgM rheumatoid factor (RF), anti-cyclic-citrullinated peptide (CCP) antibodies, and HLA-DRB1 alleles were determined. RESULTS: In rheumatoid arthritis, an interaction was found between tobacco exposure and shared epitope for the presence of anti-CCP antibodies, as the odds ratio for anti-CCP antibodies in patients having both tobacco exposure (TE) and shared epitope (SE) was higher than the summed odds ratios of patients having only tobacco exposure or shared epitope (odds ratios: TE+/SE-, 1.07; TE-/SE+, 2.49; and TE+/SE+, 5.27-all relative to TE-/SE-). A similar effect was found for RF, but stratification showed that the interaction primarily associated with the anti-CCP antibody response. In patients with undifferentiated arthritis at two weeks, or with persistent undifferentiated arthritis after one year, no interaction between tobacco exposure and shared epitope was observed for the presence of autoantibodies. CONCLUSIONS: Tobacco exposure increases the risk factor for anti-CCP antibodies only in shared epitope positive patients with rheumatoid arthritis. The gene-environment interaction between smoking and shared epitope leading to autoantibodies is specific for rheumatoid arthritis and is not observed in undifferentiated arthritis.

Aged↗

PubMed1996

Job sharing at a children's hospital: evaluation by medical staff.

OBJECTIVE: To evaluate job sharing for registrars at Princess Margaret Hospital for Children, Perth, by seeking responses from members of the relevant medical teams. DESIGN: A questionnaire was sent to all 126 medical staff within the hospital (and three managers in medical administration) asking their views on job sharing for registrars. OUTCOME MEASURES: Whether job sharing should continue, who should do it, at what stage of training, and the effects on patient care. RESULTS: Among the 77 respondents (60%) there was broad support for the continuation of job sharing at the hospital: only 5 of 37 consultants and 2 of 19 non-job sharing registrars rejected the idea (with a further 4 consultants uncertain). 43% Of the consultants who had worked with job sharing registrars thought continuity of care was adversely affected. CONCLUSION: The committee for physician training of the Royal Australasian College of Physicians emphasises that advanced training should be flexible, with a wide range of opportunities for individuals to plan an appropriate training programme in line with their personal goals. This study has shown that job sharing for registrars at Princess Margaret Hospital for Children allows this choice. Action on concerns over any adverse effects on patient care should resolve any persisting disquiet.

Attitude of Health Personnel↗

PubMed2001

Allele-sharing among affected relatives: non-parametric methods for identifying genes.

Non-parametric linkage analysis examines similarities among affected relatives in alleles of one or more genetic markers (pieces of DNA at known locations on a chromosome). The objective is to evaluate departures from the null hypothesis that the markers are not near a disease gene. Under the null hypothesis, Mendel's laws give the probabilities that a set of relatives exhibits a particular allele-sharing pattern, and the null hypothesis is rejected if the extent of allele sharing among affected relatives exceeds Mendelian expectation. Because the rationale for allele-sharing methods is intuitively plausible and easily grasped, geneticists have used these methods for more than 30 years, well before the advent of the large sets of polymorphic markers that have made linkage analysis so fruitful today. Here we describe methods for assessing whether the extent of marker allele sharing among affected relatives exceeds Mendelian expectation. We first quantify the notion of allele sharing and the probabilities of allele sharing in various sets of relatives. Then we describe allele sharing methods for affected sibs and more general sets of relatives. We also discuss related issues of test size and power. We conclude with a brief discussion of areas in need of further research.

Alleles↗

PubMed2006

Social sharing of emotion in anticipation of cardiac surgery: effects on preoperative distress.

This study examined associations between social sharing of emotions, social support and preoperative psychological distress. Social sharing was operationalized in terms of quantity and quality. Quantity of social sharing was measured daily using a diary method. Quality of social sharing was measured with the Quality of Sharing Inventory. Participants were 157 hospitalized Greek patients. Hierarchical regression analysis showed that controlling for distress on admission, quality of social sharing was negatively related to distress one day before surgery (p < .01). No effects were found for quantity of social sharing. Results emphasize the importance of studying qualitative aspects of emotional disclosure.

Adaptation, Psychological↗

PubMed2006

Whose data set is it anyway? Sharing raw data from randomized trials.

BACKGROUND: Sharing of raw research data is common in many areas of medical research, genomics being perhaps the most well-known example. In the clinical trial community investigators routinely refuse to share raw data from a randomized trial without giving a reason. DISCUSSION: Data sharing benefits numerous research-related activities: reproducing analyses; testing secondary hypotheses; developing and evaluating novel statistical methods; teaching; aiding design of future trials; meta-analysis; and, possibly, preventing error, fraud and selective reporting. Clinical trialists, however, sometimes appear overly concerned with being scooped and with misrepresentation of their work. Both possibilities can be avoided with simple measures such as inclusion of the original trialists as co-authors on any publication resulting from data sharing. Moreover, if we treat any data set as belonging to the patients who comprise it, rather than the investigators, such concerns fall away. CONCLUSION: Technological developments, particularly the Internet, have made data sharing generally a trivial logistical problem. Data sharing should come to be seen as an inherent part of conducting a randomized trial, similar to the way in which we consider ethical review and publication of study results. Journals and funding bodies should insist that trialists make raw data available, for example, by publishing data on the Web. If the clinical trial community continues to fail with respect to data sharing, we will only strengthen the public perception that we do clinical trials to benefit ourselves, not our patients.

Editorial↗

PubMed2006

Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals' perceptions.

BACKGROUND: Shared decision-making is advocated because of its potential to improve the quality of the decision-making process for patients and ultimately, patient outcomes. However, current evidence suggests that shared decision-making has not yet been widely adopted by health professionals. Therefore, a systematic review was performed on the barriers and facilitators to implementing shared decision-making in clinical practice as perceived by health professionals. METHODS: Covering the period from 1990 to March 2006, PubMed, Embase, CINHAL, PsycINFO, and Dissertation Abstracts were searched for studies in English or French. The references from included studies also were consulted. Studies were included if they reported on health professionals' perceived barriers and facilitators to implementing shared decision-making in their practices. Shared decision-making was defined as a joint process of decision making between health professionals and patients, or as decision support interventions including decision aids, or as the active participation of patients in decision making. No study design was excluded. Quality of the studies included was assessed independently by two of the authors. Using a pre-established taxonomy of barriers and facilitators to implementing clinical practice guidelines in practice, content analysis was performed. RESULTS: Thirty-one publications covering 28 unique studies were included. Eleven studies were from the UK, eight from the USA, four from Canada, two from The Netherlands, and one from each of the following countries: France, Mexico, and Australia. Most of the studies used qualitative methods exclusively (18/28). Overall, the vast majority of participants (n = 2784) were physicians (89%). The three most often reported barriers were: time constraints (18/28), lack of applicability due to patient characteristics (12/28), and lack of applicability due to the clinical situation (12/28). The three most often reported facilitators were: provider motivation (15/28), positive impact on the clinical process (11/28), and positive impact on patient outcomes (10/28). CONCLUSION: This systematic review reveals that interventions to foster implementation of shared decision-making in clinical practice will need to address a broad range of factors. It also reveals that on this subject there is very little known about any health professionals others than physicians. Future studies about implementation of shared decision-making should target a more diverse group of health professionals.

Journal Article↗

PubMed2026

Shared genetic architecture between ADHD and intelligence varies across ADHD subtypes.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a heterogeneous neurodevelopmental condition frequently accompanied by cognitive difficulties. Although previous genetic studies have demonstrated substantial overlap between ADHD and intelligence, most have treated ADHD as a single phenotype. However, whether this shared genetic architecture differs across ADHD subtypes remains unclear. METHODS: We conducted a genome-wide cross-trait analysis integrating large-scale genome-wide association study (GWAS) datasets of overall ADHD, its subtypes-childhood ADHD, persistent ADHD, and late-diagnosed ADHD-and intelligence (total N > 300,000). Genome-wide genetic correlations, polygenic overlap, local genetic correlations, and variant-level associations between ADHD phenotypes and intelligence were evaluated to characterize their shared genetic architecture. Shared variants were identified through cross-trait enrichment analyses and subsequently mapped to genes for functional annotation and gene-set enrichment. Bidirectional associations were evaluated using two-sample Mendelian randomization with sensitivity analyses. Additional GWAS datasets were used to validate the robustness of shared loci by assessing the consistency of effect directions. RESULTS: All ADHD phenotypes showed significant negative genetic correlations with intelligence (rg ranging from -0.3442 to -0.4205). Despite these modest genome-wide correlations, cross-trait analyses revealed substantial genetic overlap, including polygenic overlap, local genetic correlations, and variant-level associations. We identified 184 loci jointly associated with ADHD traits and intelligence, including 64 novel loci, whereas no shared loci were detected for persistent ADHD under the current analysis. Functional annotation revealed biologically distinct enrichment patterns across subtypes: childhood ADHD loci were linked to early neurodevelopmental processes, while late-diagnosed ADHD loci were enriched in synapse-related and neuronal signaling pathways. Mendelian randomization analyses suggested bidirectional associations, with stronger evidence supporting a directional association from intelligence to ADHD risk. Furthermore, these shared loci showed largely consistent effect directions across additional GWAS datasets, providing support for the robustness of the findings. CONCLUSIONS: The shared genetic architecture between ADHD and intelligence varies across ADHD subtypes, highlighting distinct biological pathways underlying cognitive heterogeneity in ADHD. These findings suggest that the relationship between ADHD liability and general cognitive ability is not uniform across ADHD subtypes and may inform future research on risk stratification and early identification in child and adolescent psychiatry.

Humans↗

PubMed2003

Twins and non-twin siblings: different estimates of shared environmental influence in early childhood.

Twin studies typically indicate shared environmental influence for cognitive abilities, especially in early childhood. However, across studies, DZ twin correlations tend to be greater than non-twin sibling correlations, suggesting that twin estimates of shared environment are to some extent specific to twins. We tested this hypothesis in a sample of more than 1800 MZ and 1800 same-sex DZ pairs from the Twins Early Development Study (TEDS), a study of twins born in England and Wales in 1994 and 1995. For this analysis, we obtained comparable data from more than 130 same-sex younger siblings of the twins. Twins and their younger siblings were assessed for language, cognitive abilities and behavior problems by their parents at 2 and 3 years of age. For language and cognitive measures at both 2 and 3 years, but not for behavior problems, estimates of shared environment were more than twice as large for twins as compared to non-twin siblings. We conclude that about half of twin study estimates of shared environment for cognitive abilities in early childhood are specific to twins. Although many possibilities exist for explaining the special shared environment effect for twins, we suggest that cognitive-relevant experiences that are not shared by siblings are shared by twins because they are exactly the same age.

Chi-Square Distribution↗

PubMed2001

Sharing of drug preparation equipment as a risk factor for hepatitis C.

OBJECTIVES: This study investigated the sharing of drug preparation equipment as a possible route of hepatitis C virus (HCV) transmission. METHODS: HCV seroconversion was measured in a cohort of 317 injection drug users who tested negative for HCV antibody at recruitment. RESULTS: Cumulative HCV incidence was 16.7% per year. Among those who did not share syringes, HCV seroconversion was associated with sharing drug cookers and filtration cotton (adjusted risk ratio = 5.9; 95% confidence interval = 1.1, 31.7); 54% of HCV infections in injection drug users who did not share syringes were attributable to cooker/cotton sharing. CONCLUSIONS: Among injection drug users who do not share syringes, an important proportion of HCV infections may be attributed to cooker/cotton sharing.

Adolescent↗

PubMed1992

[The effect of motivation on preschool children's sharing judgment and behavior].

The purpose of this study was to examine the effect of motivation on preschool children's sharing judgment and behavior. In Experiment 1, 45 4-year-olds and 41 5-year-olds were asked whether they wanted to share seals in a fictional situation, and were observed whether they shared their seals in an actual situation. The main results indicated that the number of children who shared seals in the latter situation was smaller than those who judged to share seals in the former one. Especially there was a great difference regarding this point in 4-year-olds children. "Empathic orientation" motivated preschool children's sharing behavior, while "self-focused orientation" did not. In Experiment 2, 52 4-year-olds and 60 5-year-olds were divided into two empathic levels (middle, high) and two motivational cost levels (low, high) to examine the effects of "empathic orientation" and "self-focused orientation." The main results indicated that high motivational cost restrained children from sharing in an actual situation.

Child Behavior↗

PubMed2001

Data sharing and dissemination strategies for fostering competition in health care.

OBJECTIVES: To introduce the concept of common models for data sharing and dissemination, highlight the current operational, technical, and political issues surrounding existing data sharing and dissemination initiatives in a health care market, and suggest an ideal model for future data initiatives. DATA SOURCES/STUDY SETTING: A literature review and case studies of existing data sharing and dissemination initiatives that promote the collection and use of comparative information on provider cost and quality. PRINCIPAL FINDINGS: Three broad types of common models for data sharing and dissemination have evolved over the past decade or so: (1) provider-initiated initiatives developed through collaboration among providers of health care; (2) purchaser-initiated activities driven by a coalition of purchasers; and (3) indirect collaboration-data-sharing initiatives between providers and purchasers with a significant facilitating or regulating role by a third group of stakeholders. The success of a data-sharing and dissemination strategy is determined by how the complex operational, technical, and political issues are addressed. General principles by which a health data initiative might abide include the following: standardized databases as the physical foundation, indicators that reflect the changing market; linkages between and across data sets for comprehensive and complete data; economic value; policy relevance; use of evolving technologies to collect, integrate, and disseminate data; and stakeholder support. CONCLUSIONS: Regulatory solutions alone will not overcome the complex political and technical challenges to data sharing and dissemination. The "ideal" model or process nurturing a market for health care information will incorporate compromise and negotiation to address the issues of data ownership and proprietary concerns, therefore securing the necessary political and financial support of the private sector.

Cooperative Behavior↗

PubMed2002

[Shared care--integrated cooperation across the sector boundaries about patient's course. Modern health care system cooperates].

Shared care programmes have been introduced in Denmark for areas, such as diabetes, asthma, and dementia. Over a three-year period, the communication and co-operation between the health sectors have improved. Specific demands on hospital referral and discharge letters have resulted in improved quality of contents and structure. This review shows that there is limited ongoing research on shared care and that the end points including formulations like "improved co-operation" have been too broad. Almost no research is available on specific improvements obtained by shared care. The study shows that implementation of shared care research programmes with specific end points is very extensive. Only 10 per cent of the present studies have specific end points, and 75 per cent of these show positive effects of shared care programmes. The GP Consulting System in Denmark has proved most useful in the progress of shared care. Future research in shared care should focus on specific end points, in which analyses of patient's course are fundamental in an effort to obtain improvements.

Community Health Services↗

PubMed2006

Visualisation and interaction design solutions to address specific demands in shared home care.

UNLABELLED: When care professionals from different organisations are involved in patient care, their different views on the care process may not be meaningfully integrated. OBJECTIVE: To use visualisation and interaction design solutions addressing the specific demands of shared care in order to support a collaborative work process. METHODS: Participatory design, comprising interdisciplinary seminar series with real users and iterative prototyping, was applied. RESULTS: A set of interaction and visualisation design solutions to address care professionals' requirements in shared home care is presented, introducing support for identifying origin of information, holistic presentation of information, user group specific visualisation, avoiding cognitive overload, coordination of work and planning, and quick overviews. The design solutions are implemented in an integrated virtual health record system supporting cooperation and coordination in shared home care for the elderly. The described requirements are, however, generalized to comprise all shared care work. CONCLUSION: The presented design considerations allow healthcare professionals in different organizations to share patient data on mobile devices. Visualization and interaction design facilitates specific work situations and assists in handling specific demands in shared care. The user interface is adapted to different user groups with similar yet distinct needs. Consequently different views supporting cooperative work and presenting shared information in holistic overviews are developed.

Delivery of Health Care, Integrated↗

PubMed1995

The facilitating effect of one-DR antigen sharing in renal allograft tolerance induced by donor bone marrow in rhesus monkeys.

Infusion of donor bone marrow cells (DBMC), a long-standing, successful strategy for inducing tolerance in experimental rodent transplantation models, can promote long-term acceptance of life-sustaining renal allografts in rhesus monkeys with no maintenance immunosuppression. To investigate the immunological basis for heterogeneity in duration of long-term graft acceptance following infusion of the DR-/dim fraction of DBMC into RATG-treated rhesus monkeys, we examined the relationship of recipient-donor major histo-compatibility class I and II DR matching to the development of antidonor antibody-dependent cellular cytotoxicity (ADCC) and renal allograft survival. The findings indicate a requirement for sharing one DR allele to achieve long-term graft acceptance. The observed immunological consequence of DR sharing that correlated with functional graft tolerance in this model was the suppression of early antidonor ADCC+ IgG antibody responses. Significant associations were observed between graft survival and suppression of ADCC antibody (P < 0.0005), graft survival and DR sharing (P < 0.005), and DR sharing and suppression of ADCC (P < 0.02). Early antidonor ADCC antibody responses associated with failure to maintain graft tolerance and were most consistently directed to donor class I. The required one DR antigen sharing in DBMC-induced suppression of antidonor class I antibody suggests a restriction for recipient DR, implying critical regulation of a response to donor antigen presented on recipient cells. We hypothesize a DBMC tolerogenic mechanism in which presentation of donor class I peptide by a shared DR allele configuration allows a veto effect by DBMC. Thus DR sharing would allow DBMC veto cells to reduce clonal expansion elicited by both the direct and indirect antigen presentation pathways.

Animals↗

PubMed1998

Personal reflections on early learning in shared leadership.

Shared leadership involves a process as well as a structure. Two key principles apply to all forms of shared leadership: a commitment to true partnership and a decision-making structure that allows for balance of power. In this article, the author shares her personal experience of facilitating a shared leadership model for staff on a unit level and also an executive model of shared leadership. The executive model was implemented during a transition after a traditional nursing leadership position was vacated. Lessons learned in facilitating a staff shared leadership model and participating in an executive model are discussed and contrasted. Relationships, dialogue, partnership, and an understanding of boundaries are essential elements for successful implementation of shared leadership at any level.

Decision Making, Organizational↗