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PubMed2005

Low-level methylmercury exposure as a risk factor for neurologic abnormalities in adults.

UNLABELLED: Methylmercury is a neurotoxicant that bio-accumulates in the aquatic food chain and is present in all fish. Little is known about the effects of long-term low-dose exposure to methylmercury in adults. The aim of this study was to determine whether a dose-response relationship exists between long-term methylmercury exposure and neurological abnormalities in aboriginal Quebec Cree adults for whom fish is a dietary staple. We re-analysed data from a 1977 cross-sectional study conducted by Kofman and collaborators on a group of Quebec Cree individuals claiming ill health from local fish consumption. In the original 1977 study, 306 adult participants aged 18-82 years were assessed for methylmercury exposure. Tremor and other neurologic outcomes were assessed with a clinical examination. The investigators did not find clinical evidence of methylmercury intoxication based on an analysis of covariance. We used ordinal regression to obtain odds ratios for the relationship between total hair mercury levels and neurologic abnormalities. Hair mercury concentrations ranged from 0.5 to 46 ppm (parts per million). A 6 ppm increase in hair mercury was associated with increasing levels of tremor (OR, 2.22; 95% CI, 1.15-4.26) in adults under 40 years of age. There was no association with nine other outcomes considered, nor with tremor among older persons. Odds ratios were not influenced by gender, smoking, alcohol use, or co-morbidity. CONCLUSION: : Dose-dependent effects of methylmercury on tremor may occur below the commonly accepted 50 ppm threshold, particularly in young adults. These effects may be detectable by clinical examination. However, the results should be interpreted with caution given that alcohol use was probably under-reported and that multiple outcomes were studied.

Adolescent↗
PubMed1986

Detection of trace levels of trichothecenes in human blood using capillary gas chromatography-electron-capture negative ion chemical ionisation mass spectrometry.

A sensitive and selective method has been developed for the simultaneous detection in blood of eleven trichothecenes of widely varying polarity. The procedure involved precipitation of blood proteins with acetone followed by a clean-up using reversed-phase Sep-Pak C18 cartridges. The extracted trichothecenes were derivatised as their pentafluoropropionyl esters, separated using capillary gas chromatography and detected using electron-capture negative ion chemical ionisation with methane reagent gas and selected-ion monitoring. Optimum sensitivity and selectivity were obtained using low source temperatures (60 degrees C indicated) and high source pressures (1 Torr indicated). Detection limits on 1-ml blood samples were in the range 0.1-5 ppb. The method was readily adaptable to the detection of other trichothecenes. A protocol was used which minimised the risk of cross-contamination. The method was validated in collaborative studies by the successful analysis of 42 blood samples spiked and submitted blind by two independent laboratories for analysis.

Chemical Phenomena↗
PubMed1999

Industrial hygiene recommendations as interventions: a collaborative model within occupational medicine.

The authors conducted a cross-sectional telephone survey of patients and employers to evaluate the effectiveness of conducting industrial hygiene work site visits as part of the medical management of clinic patients with suspected occupational disease. Industrial hygiene interventions were intended to keep the index patient from ongoing exposure while simultaneously protecting co-workers from future disease. The demographics of the 76 work sites and patients are summarized. According to the employers, 78 percent had implemented at least one recommended intervention, and 52 percent of the employers had implemented the priority intervention. The factors associated with the employers' implementation of the recommended industrial hygiene controls are presented. Employers were 3.7 times more likely to implement the priority intervention (p = .04) if they believed a worker's illness was work-related. Employers with joint labor-management health and safety committees were 3.8 times as likely to implement the priority intervention (p = 0.04). The factors associated with changes in the patients' self-reported disease status are explored and the social and economic implications of this model, are discussed. Patients who reported an improvement in disease status were 5.5 times more likely to have maintained or increased their salary (p = 0.03). Patients were 10.4 times more likely to be working if the employer had implemented any intervention (p = 0.02) and 13.3 times more likely if the priority intervention (p = 0.01) had been adopted. Those patients who left their original employer suffered a median decrease in salary of 35 percent if they found work with a different employer and a 90 percent decrease when they failed to find a new job.

Connecticut↗
PubMedDate not supplied

Strategic partnerships: bridging the collaboration gap.

"Teambuilding," "partnering," "outreach," and "collaboration" all are terms of the new millennium. Such terms suggest a continuing trend in healthcare. Partnering and collaboration are the hallmark of many successful models implemented by practice and academic healthcare settings worldwide. Strategic partnering, within and beyond institutions, provides opportunities for personal and professional growth, outreach, and collaboration. Within the global nursing community, cross-national partnerships represent a vehicle for extending knowledge sharing, and for using on-site visits, tele- and videoconferencing, electronic mail, and other resources. The World Wide Web has opened doors to distance learning programs that were once a dream, and that now represent reality. The author addresses the partnering concept and applications within the local healthcare community, within the country, and worldwide.

Attitude of Health Personnel↗
PubMed2003

Creating a family-centered approach to early intervention services: perceptions of parents and professionals.

PURPOSE: This study compares the attitudes of parents and early intervention (EI) providers concerning the effectiveness of family-centered services, identifies factors associated with parental satisfaction, and describes providers' perceptions of obstacles in forming collaborative relationships with families. METHODS: A cross-sectional study was used to assess providers' (N = 11) and parents' (N = 18) perceptions of EI services. Participants completed a questionnaire including basic demographics, services received, and perceived effectiveness in the delivery of services. Participants also completed a modified version of the Project Dakota assessment of program effectiveness in meeting the needs of families. RESULTS: Eighty-seven percent of parents were satisfied with their EI programs, with lesser parental satisfaction noted in learning how to develop strategies and set goals, strategies to discipline and set limits, and available community resources. Providers' overall satisfaction was 99%. Providers felt they needed more development in building parent networks and helping parents value the time their child spends with children without delays. CONCLUSIONS: The results of this study are consistent with previous literature and suggest that the attitudes of parents and professionals regarding program effectiveness are similar.

Journal Article↗
PubMed1999

Objectives, methods and content of patient education programmes for adults with asthma: systematic review of studies published between 1979 and 1998.

BACKGROUND: Education programmes for adults with asthma vary widely. Such variability suggests a lack of consensus on what works and what does not. The objectives of this paper are to describe asthma education programmes and assess their variability. METHODS: A systematic review of reports published between 1979 and 1998 was conducted. Medline, the CINAHL database, the PsycINFO database, the Cochrane collaboration database, the Dissertation Index database, and cross referencing were used to identify educational interventions; 77 projects including 94 interventions that involved 7953 patients were analysed. A standard form was used to record characteristics of studies (design, setting, size, year, and country of publication), projects (theoretical framework, objectives), and education (methods, duration, intensity, educator, and content). RESULTS: Most reports did not specify the general (56%) and educational objectives (60%) of the intervention. Important training characteristics were often not available: duration of education (45%) and number of sessions (22%), who delivered education (15%), whether training was conducted in groups or was individualised (28%). When this information was available there were wide variations in training methods and content: training duration ranged from 0 (self-education) to 58 hours and the number of sessions from 0 to 36; training tools such as peak flow meters, diary cards or books were used in various proportions of interventions (19%, 27%, and 23%, respectively). The content of education also differed widely between programmes. CONCLUSIONS: Insufficient documentation of asthma education programmes for adults precludes their replication. This, together with excessive variability, reduces the possibility of identifying their most effective components. A more systematic description of asthma training programmes should be promoted.

Adult↗
PubMed1994

Hospice: a comprehensive program.

Having begun operations in 1991 with six employees, four volunteers, and three patients, the St. Louis-based Incarnate Word Family and Alzheimer's Hospice today boasts 44 professional employees, 6 clerical staff, and more than 100 volunteers. The hospice offers a medically supervised home care program in which staff work closely with patients and families throughout the illness and bereavement period. Using a palliative rather than curative approach, the Incarnate Word Family and Alzheimer's Hospice focuses on enhancing the remaining life of the patient. Patients are enrolled based on their need for care, not on their ability to pay for services. To meet the unique needs of certain patients, the hospice offers a variety of specialized services, including pediatric, Alzheimer's, and AIDS care. Collaborative efforts with local agencies include cross-training, continuing education, client referrals, and support services. In 1993 Incarnate Word introduced hospice services to area residential care facilities (RCFs). The program enables RCF residents who develop life-limiting illnesses to remain in the place that they have come to know as home. In March 1994 Incarnate Word Family and Alzheimer's Hospice opened a branch office in north St. Louis. The new location enables the hospice to serve more people and creates an additional resource for physicians treating terminally ill patients. Volunteers provide rest breaks for care givers, help with meal preparation and simple housekeeping, run errands, comfort patients and family, and listen when others may find their story too overwhelming.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Skills for adolescence: experience with the International Lions-Quest program.

This article describes the development of the Lions-Quest Skills for Adolescence program. The primary purpose of this program is to respond to the needs of young people by helping them become more self aware, more skilled, more able to make positive and healthy choices, and better able to make informed, aware, and considered decisions about their own behavior. Skills for Adolescence is one school/community/parent-based curricular program that attempts to address health, life skills, and prevention issues in ways that have clearly struck a common chord in numerous countries. The program's emphasis on effective communication, on self-efficacy and social skills, and on strengthening the family appear to have a strong appear in many different contexts and cultures. Careful attention to local needs during adaptation while employing collaborative strategies is an essential ingredient to crossing cultural and national boundaries.

Adolescent↗
PubMed1994

Clinical research in allied health.

Allied health professionals in nutrition and medical dietetics, occupational therapy, physical therapy, and speech-language pathology and audiology play both unique and key cross-cutting roles in the furtherance of clinical research. Clinical research in nutrition and medical dietetics uniquely focuses on food nutrient intake and the metabolic utilization of nutrients. Clinical research in occupational therapy has a special focus on the relationship of impairment to disability, the adaptation to disability and the maximization of function. Physical therapy clinical research uniquely targets movement dysfunction and its evaluation and treatment within the context of quality and effective care. Clinical research in speech-language pathology and audiology is singular in its focus on deafness and hearing disorders, voice, speech, language and related disorders, and intersections among these and other neurological and physical conditions. Thus, all of these disciplines are making unique contributions to clinical research. Clinical research in these allied health professions is much more than the above specific foci. Inasmuch as these disciplines are rooted in practice, their contributions to research are inherently clinical. Many, if not most, of these contributions represent further validations of clinical practice or its underlying knowledge base. This means that, at a macro level, clinical research in allied health is very much "applied" research. Within allied health clinical research, this emphasis is redoubled at the "person," or individual level, where considerable attention is given to concepts of function and effectiveness. Clinical research in allied health has played a key cross-cutting role through its emphasis on collaboration. Possibly due to their professional maturation within multidisciplinary academic units, allied health professionals have demonstrated a level of comfort with multidisciplinary and interdisciplinary collaborations unique within many academic health science centers. While the above contributions are considerable, much more could be accomplished if identified barriers to career progression could be addressed. Principal barriers to the development of clinical research careers in allied health lie in the areas of training, mentoring, and funding. The lack of financial support for clinical research training is the major impediment. Progress in these areas, although valuable in itself, could also lead to more dedicated release time in clinical and academic settings, improved predoctoral and postdoctoral research training mechanisms, and better alignment of institutional and system reward structures with the clinical research mission. Within the existing constraints, allied health professionals have performed remarkably well in tapping into funding streams created for other disciplines and in establishing research traditions within relatively young health professions.(ABSTRACT TRUNCATED AT 400 WORDS)

Allied Health Occupations↗
PubMed2000

Observation and experiment on the cusp of collaboration: a parallel examination of clinical pharmacology and pharmacoepidemiology.

Despite a common interest in the effect of drugs in humans, clinical pharmacologists and pharmacoepidemiologists often operate in isolation since the knowledge base underlying the respective parent disciplines of pharmacology and epidemiology is quite distinct. This lack of communication may lead to a potential for lost opportunities that would otherwise be mutually beneficial. Accordingly, this article juxtaposes the two disciplines to emphasize common areas of interest despite differences in methodology. In addition, weaknesses and strengths are contrasted in an effort to document the mirror image nature of both clinical pharmacology and pharmacoepidemiology in this regard. Specific examples underlying the complementary nature of the two disciplines are also offered that may help to stimulate collaboration. The possibility of greater formal cooperation between societies representing the two disciplines is also suggested to cross-educate both clinical pharmacologists and pharmacoepidemiologists as a means to foster collaboration.

Causality↗
PubMedDate not supplied

A comparison of verbal evaluation of clients with limited English proficiency and English-speaking clients in physical rehabilitation settings.

OBJECTIVES: Recent literature has emphasized collaborative goal setting between therapists and clients and has sought to increase therapists' awareness of treating in cross-cultural settings. How occupational therapists verbally evaluate clients with limited English proficiency (LEP) is important to these topics and underdeveloped in the literature. METHOD: Seventy-four occupational therapists working with adult clients with LEP in physical rehabilitation settings in large U.S. metropolitan areas were surveyed to discover the time taken, methods used, and themes surrounding verbal evaluation, including use of translators and respondents' linguistic abilities. A follow-up telephone interview of 12 survey respondents clarified these discoveries. RESULTS: Respondents reported taking 11.5 min more to verbally evaluate clients with LEP than for English-speaking clients and reported understanding the treatment needs of clients with LEP after verbal evaluation less well. Respondents with higher abilities in second languages reported better understanding of clients" needs than monolingual respondents. CONCLUSION: Methods for cross-lingual verbal evaluation need to be identified so that therapists can collaborate with clients with LEP in planning culturally sensitive treatment.

Adult↗
PubMed1981

Handling the emotional response to disaster: the case for American Red Cross/community mental health collaboration.

This paper presents the theory, rationale, and a working model for integrating professional resources at the time of a disaster. Red Cross and community mental health agencies have worked for too long in parallel. A collaborative approach to meeting the emotional needs of disaster victims makes optimal use of indigenous resources; provides skill and knowledge normally lacking in each agency alone; and helps provide, through early intervention, a preventive factor to thwart long term community distress. Options for maintenance of readiness, local or regional adaptation and piloting are also discussed.

Adjustment Disorders↗
PubMed1993

The structure and correlates of alcohol dependence: WHO collaborative project on the early detection of persons with harmful alcohol consumption--III.

The cross-cultural validity of the Alcohol Dependence Syndrome was tested on 13 symptoms of alcohol dependence which were assessed as part of a WHO collaborative study of the early detection of harmful drinking. The subjects were drinking patients in health care settings in Australia, Bulgaria, Kenya, Mexico, Norway, and the US. Principal Components Analyses were performed on the symptoms in each centre, and the degree of agreement between the results was assessed by calculating coefficients of congruence between the item loadings on the first principal component. In all six centres the first Principal Component accounted for at least half of the total variance and all symptoms had positive loadings greater than 0.40 on the first Principal Component. The coefficients of congruence were all 0.98 or more, and the 13 symptoms had internal consistency coefficients of 0.94 or more. An alcohol dependence score defined by the sum of positive responses to the 13 alcohol dependence symptoms was positively correlated with self-reported alcohol consumption, alcohol-related problems, serum gamma glutamyltransferase and a clinical examination assessment of alcoholism in all six samples.

Adolescent↗
PubMed1997

The mouse homolog of FRG1, a candidate gene for FSHD, maps proximal to the myodystrophy mutation on chromosome 8.

The human autosomal dominant neuromuscular disorder facioscapulohumeral muscular dystrophy (FSHD) is associated with deletions within a complex tandem DNA repeat (D4Z4) on Chromosome (Chr) 4q35. The molecular mechanism underlying this association of FSHD with DNA rearrangements is unknown, and, thus far, no gene has been identified within the repeat. We isolated a gene mapping 100 kb proximal to D4Z4 (FSHD Region Gene 1:FRG1), but were unable to detect any alterations in total or allele-specific mRNA levels of FRG1 in FSHD patients. Human Chr 4q35 exhibits synteny homology with the region of mouse Chr 8 containing the gene for the myodystrophy mutation (myd), a possible mouse homolog of FSHD. We report the cloning of the mouse gene (Frg1) and show that it maps to mouse Chr 8. Using a cross segregating the myd mutation and the European Collaborative Interspecific Backcross, we showed that Frg1 maps proximal to the myd locus and to the Clc3 and Ant1 genes.

Amino Acid Sequence↗
PubMed1989

Interorganizational collaboration and dissemination of health promotion for older Americans.

This article describes how a successful health promotion program for older adults was adapted and disseminated through collaboration of the American Association of Retired Persons, the American Red Cross, and the Dartmouth Institute for Better Health. The details of this effort are presented in three sections: the conceptual framework used to build the collaborative relationship, the outcomes, and an analysis of these experiences as they relate to the diffusion of innovations in organizations. The problems encountered are discussed as well as the need for more time to elapse before judging the ultimate success of the diffusion of the program.

Academies and Institutes↗
PubMed2006

Vestibular schwannoma management: current practice amongst UK otolaryngologists--time for a national prospective audit.

INTRODUCTION: It is generally agreed that the successful management of a vestibular schwannoma (VS) usually involves close collaboration between a neuro-otologist and neurosurgeon. In addition, it is accepted that the experience of the team managing such tumours is one of the key determinants of outcome after surgical intervention. The aim of this study was to identify current practice in the management of such tumours amongst otolaryngologists in the UK and to observe whether such collaborative working practices exist. MATERIALS AND METHODS: A cross sectional postal questionnaire survey of consultant members of the British Association of Otorhinolaryngologists-Head and Neck Surgeons (n = 542). RESULTS: A total of 336 replies were received (62%). Of respondents, 299 consultants referred their patients to another surgeon for further management; 242 referred to another ENT surgeon (80.9%), 29 to a neurosurgeon (9.7%) and 28 to a combined team (9.4%). Twenty-eight of the responding otolaryngologists (8.6%) managed the tumours themselves, of whom 22 worked with a neurosurgeon. Of these 28 neuro-otologists, nearly two-thirds (64%) had been undertaking VS surgery for more than 10 years. The total number of patients with a VS referred to these 28 consultants during 2001 was 775, with a mean caseload of 29.8, median 23 and a range of 4 to 102 per surgeon. Seven of the 28 otolaryngologists chose their surgical approach entirely based on the size of the tumour. Eight consultants preferred the sub-occipital (SO) approach, 10 the translabyrinthine (TL) approach, three chose between SO and TL approaches. The majority of surgeons had a prospective, computer-based data collection and were willing to give further information about their outcomes and complications. CONCLUSIONS: Amongst the otolaryngologists surveyed in the UK, we have identified 28 neuro-otologists who undertake VS surgery. The majority work with neurosurgical colleagues, confirming collaborative practice. The wide range in caseload raises the issue of training and maintaining standards and in the first instance we recommend a prospective national audit of VS management and outcomes with our neurosurgical colleagues. This would also be of value in manpower planning particularly if a minimum caseload could be identified below which results were seen to be less good.

Attitude of Health Personnel↗
PubMed2001

Cross-talk between alpha(4)beta(1)/alpha(5)beta(1) and c-Kit results in opposing effect on growth and survival of hematopoietic cells via the activation of focal adhesion kinase, mitogen-activated protein kinase, and Akt signaling pathways.

Erythroid progenitor cells (EPCs) are deficient in mice lacking either the ligand stem cell factor (SCF), its receptor c-Kit, or beta(1)-integrins. In nonhematopoietic cells, integrins and receptor tyrosine kinases can collaborate to modulate cellular functions, providing evidence for cross-talk between signals emerging from these cell surface molecules. Using specific recombinant fibronectin peptides that contain the binding site for the integrin alpha(4)beta(1) (FN-H296) or alpha(5)beta(1) (FN-CH271) or both alpha(4)beta(1) and alpha(5)beta(1) (FN-CH296), this study investigated the effect of adhesion alone, or in combination with activation of c-Kit, on functional and biochemical outcomes in an EPC line, G1E-ER2, and primary EPCs. G1E-ER2 cells and primary EPCs cultured on FN-CH271 in the presence of c-Kit activation led to a significant increase in proliferation in comparison with cells grown on FN-H296 or FN-CH296. G1E-ER2 cells cultured on FN-H296 or FN-CH296 resulted in significant cell death in comparison to cells grown on FN-CH271. Activation of c-Kit enhanced the survival of G1E-ER2 cells grown on FN-H296 or FN-CH296; however, the rescue was only partial. The reduced survival of G1E-ER2 cells on FN-H296 correlated with reduced activation of Akt and expression of Bcl-2 and Bcl-x(L), whereas increase in proliferation on FN-CH271 correlated with significantly enhanced and sustained activation of focal adhesion kinase (FAK) and extracellular-regulated kinase (ERK) pathways. These data demonstrate that adhesion-induced signals emanating from ligation of alpha(4)beta(1) and alpha(5)beta(1) result in distinct biologic outcomes, including death via alpha(4)beta(1) and survival/proliferation via alpha(5)beta(1). (Blood. 2001;97:1975-1981)

Animals↗