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PubMed2006

Brittle bones: ageing or threat of disease exploring women's cultural models of osteoporosis.

AIMS: To explore elderly Danish women's ideas about osteoporosis and the possible threat to health. The authors discuss the issue of risk interpretations in itself, using osteoporosis as a case. METHODS: A qualitative study based on material from focus-group discussions. Twenty-two 60- to 61-year-old healthy women were selected on the basis of questionnaire answers. Analysis was based on a meaning-centred approach. RESULTS: Comprehension of osteoporosis was mainly based on images representing various dimensions of osteoporosis. The women drew on experiences with relatives, friends, and health information. Physical appearance seemed to be the most common way of assessing those who had osteoporosis or who might have it in the future. Women's ideas about osteoporosis were influenced by two main, parallel stereotypes of knowledge based on models of ageing with bodily decay and the threat of a preventable disease. They seemed to vacillate, often integrating elements from both models in their comprehension. The scenarios for women with or liable to develop osteoporosis as a disease appeared to be founded on worst-case scenarios. CONCLUSION: It is suggested that health professionals pay greater attention to people's models and images of risk conditions and carefully decide which images they wish to promote. Health education regarding osteoporosis comprises an ethical obligation to avert the construction of the more extreme and anxiety-producing prototypes. This is especially important when informing individuals about risk and prevention and when decisions on screenings and other medical examinations are made.

Aging↗
PubMed1999

Use of competencies in training fertility nurses in clinical practice.

In this article, the value of clinical competencies in the role development of fertility nurses is discussed using the example of the Oxford Fertility Programme. Clinical competencies are incorporated into the training programme within the Oxford Fertility Unit to enable new staff to demonstrate their clinical ability and undergo assessment while learning new and expanded skills. New staff are required to explore both the theoretical and practical foundations that underpin clinical practice. Competencies are used in a structured programme in which staff have to provide evidence of the appropriate knowledge to perform new and expanded procedures. New staff work with a senior nurse, who is their lecturer and who assesses both their clinical and theoretical development. The new staff are also assigned a preceptor with whom they work on a daily basis to consolidate the practice explored with the lecturer. The Scope of Professional Practice produced by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC, 1992) places the emphasis on professional development for individual practitioners. Within the Oxford Fertility Unit, the nurses work collectively and as autonomous practitioners, which enables them to provide a specialized and personal service to their patients. Professional profiles are an integral element of an individual's professional development and are used in the training programme. They provide an accurate record of a nurse's abilities and knowledge and how he or she relates them to practice.

Journal Article↗
PubMed1979

Developing and implementing an industrial hygiene and safety program in industry.

The development and implementation of a comprehensive industrial hygiene and safety program is a complex activity for which there does not exist a uniform code or set of guidelines. Although the ultimate goal of such a program is to provide for the welfare of the employee through the use of engineering control and other preventive measures, there is great variation among business establishments on methods necessary to attain this result. Factors which contribute to this variation usually are: type of industry, management philosophy and size of the business establishment. This paper addresses many key elements integral to this activity such as justification and philosophy, organizational reporting relationships, interfunctional communication, technical and personnel requirements and program performance indicators.

Accidents, Occupational↗
PubMed1977

Localization of creatine kinase isoenzymes in myofibrils. I. Chicken skeletal muscle.

Purified, repeatedly washed, skeletal muscle myofibrils contain approx. 0.2 U of creatine kinase (CK) activity (equivalent to 2.5 micrograms CK) per milligram dry weight; this firmly bound CK activity is estimated to represent 3-5% of the total cellular CK. It had been shown previously that the myofibrillar CK, which can be quantitatively extracted at low ionic strength and purified to homogeneity, is very similar, if not identical, to the bulk MM-CK. It is shown that the two protein preparations also have the same peptide pattern after cyanogen bromide fractionation and very similar specific activities, confirming their identity. The earlier demonstration that the bound CK is specifically located at the M-lines of isolated myofibrils has been confirmed by immunofluorescence. Antibodies directed against purified MM- and BB-CK were used in the indirect fluorescent antibody technique to study the specificity of myofibril binding sites for different forms of CK. With myofibrils from adult muscle, which has only MM-CK, as well as from early developmental stages in which BB-CK is the predominant isoenzyme, M-type CK was localized exclusively at the M-line, while greater or lesser amounts of B-type CK were found at the Z-line. The data provide strong evidence that the MM-CK at the M-lines in skeletal myofibrils is not adventitiously bound but is rather an integral element in the M-line structure. The amount of CK bound is reasonably consistent with the earlier proposal that the CK molecules might be the transverse M-bridges and appears to be sufficient to regenerate all of the ATP hydrolyzed during muscle contraction.

Animals↗
PubMed2000

Correlates of alcohol and/or drug use among HIV-infected individuals.

The purpose of this article is to describe the psychosocial factors associated with alcohol and/or drug (AOD) use among HIV-infected individuals. Their attitudes toward AOD use are also examined. Three hundred and three HIV-infected adults completed a survey on AOD use while waiting for their appointment at the largest, HIV-outpatient clinic in the Gulf South. Logistic regression showed that associating with others who use drugs and hospitalization for a mental illness were associated with current AOD use. Variables derived from the AIDS Risk Reduction Model that integrates elements of the Health Belief Model, efficacy theory, and social network theory, indicated that 14% of the sample admitted to having an AOD problem. Twenty-six percent of the AOD users reported that they have little social support to help them stop their AOD use. A disturbing finding was that 24% of the AOD users have actively sought help or treatment for their AOD problem and have not been able to find help. These patients differ significantly from the AOD users who could find help in that they are primarily African-American and 46% have been hospitalized for a mental illness. Motivational strategies and mental health interventions are necessary, which provide peer counseling and social support, factors that have been found to greatly influence behavior change. The intervention may also need to include spiritual and humor components because the vast majority of AOD users are interested in treatment approaches that include these two elements.

Adult↗
PubMed2000

Theoretical neuroanatomy: relating anatomical and functional connectivity in graphs and cortical connection matrices.

Neuroanatomy places critical constraints on the functional connectivity of the cerebral cortex. To analyze these constraints we have examined the relationship between structural features of networks (expressed as graphs) and the patterns of functional connectivity to which they give rise when implemented as dynamical systems. We selected among structurally varying graphs using as selective criteria a number of global information-theoretical measures that characterize functional connectivity. We selected graphs separately for increases in measures of entropy (capturing statistical independence of graph elements), integration (capturing their statistical dependence) and complexity (capturing the interplay between their functional segregation and integration). We found that dynamics with high complexity were supported by graphs whose units were organized into densely linked groups that were sparsely and reciprocally interconnected. Connection matrices based on actual neuroanatomical data describing areas and pathways of the macaque visual cortex and the cat cortex showed structural characteristics that coincided best with those of such complex graphs, revealing the presence of distinct but interconnected anatomical groupings of areas. Moreover, when implemented as dynamical systems, these cortical connection matrices generated functional connectivity with high complexity, characterized by the presence of highly coherent functional clusters. We also found that selection of graphs as they responded to input or produced output led to increases in the complexity of their dynamics. We hypothesize that adaptation to rich sensory environments and motor demands requires complex dynamics and that these dynamics are supported by neuroanatomical motifs that are characteristic of the cerebral cortex.

Animals↗
PubMed1997

Collecting data on potentially harmful events: a method for monitoring incidents in general practice.

OBJECTIVE: The prediction and subsequent prevention of errors, which are an integral element of human behaviour, require an understanding of their cause. The incident monitoring technique was developed in the study of aviation errors in the Second World War and has been applied more recently in the field of anaesthetics. This pilot study represents one of the first attempts to apply the incident monitoring technique in the general practice environment. METHOD: A total of 297 GPs across Australia anonymously reported details of unintended events which harmed or could have harmed the patient. Reports were contemporaneously recorded on prepared forms which allowed a free text description of the incident, and structured responses for contributing and mitigating factors, immediate and long-term out-comes, additional costs etc. RESULTS AND DISCUSSION: The first 500 reports were analysed using both of qualitative and quantitative methods and a brief overview of results is presented. The methodological issues arising in the application of this technique to such a large, widely spread profession, in which episodes of care are not necessarily confined to a single consultation, are discussed. This study demonstrated that the incident monitoring technique can be successfully applied in general practice and that the resulting information can facilitate the identification of common factors contributing to such events and allow the development of preventive interventions.

Australia↗
PubMed2002

Translating HIV/AIDS research findings into policy: lessons from a case study of 'the Mwanza trial'.

The scale and severity of the impact of the global HIV/AIDS pandemic on low-income countries, mainly those in sub-Saharan Africa, is almost unimaginable to people in high-income countries. There is a particularly pressing need to understand better how to ensure the translation into policy and practice of important research findings in HIV/AIDS prevention and care in countries threatened by fast spreading HIV epidemics. The purpose of this paper is to review the findings and implications of a policy analysis case study of an HIV/AIDS clinical trial that has been successful in influencing HIV prevention policy relevant to low-income countries, in order to identify illustrative lessons for HIV/AIDS researchers in the future. The case study sought to detail the interaction between researchers and policy-makers for this particular case study to ascertain detailed analysis by these two groups on the interaction between research and policy. The major findings of the policy analysis case study were that policy shift was a cumulative but non-linear process, with the Mwanza trial placing a crucial role in both boosting and confirming existing policy movements. Researchers and policy-makers held similar longitudinal views of the process and political environment. Key moments of communication tended to involve personal contact. The important role played by people and organizations who could work in both the research and policy communities was often mentioned as crucial in enabling research relevant policy shifts. Researchers may absorb themselves in the technicalities of their study without considering their role in pursuing the wider policy implications. The impact of research on policy must be an integral element of every stage of the research process. The case study illustrates the need to take a contextual view of the interaction between research and policy, and understand how changing political contexts affect receptivity to research outcomes. This will increase the likelihood of research findings having an impact on policy. The review reflects the authors' experiences of working for organizations in non-governmental organization, bilateral development agency and academic settings.

Acquired Immunodeficiency Syndrome↗
PubMed1994

A multi-component stage model for matching drug prevention strategies and messages to youth stage of use.

The purpose of this paper was to describe the development of a comprehensive, stage-based model for the prevention of drug use titled the multi-component motivational stages (McMOS) model. The McMOS model is proposed as a multi-element, integrative theoretical framework for the development of prevention strategies and content which are matched to the developmental stages of drug use among youth, based on previous work by Prochaska and DiClemente. The major components of the McMOS drug prevention model include: (1) a stage-based framework which permits the matching of prevention strategies and messages to youths' stage of development in the change process; (2) the delineation of a continuum of stages ranging from the acquisition of drug use through the successful modification of drug use; (3) a two-level prevention schema for targeting a broader range of youth for intervention, including those regularly using drugs as well as those not yet regularly using drugs; (4) a drug specific emphasis for proposing prevention strategies targeting the most prevalently used drugs, based on epidemiologic research; (5) the delineation of major theoretical constructs influencing the movement of youth through the stages, based on three prominent behavioral theories; and (6) a framework for selecting a range of prevention delivery modes for youth at all stages and levels of behavioral change.

Adolescent↗
PubMed2000

Between evidence-based practice and total quality management: the implementation of cost-effective care.

There is an increasing number of studies showing that patients often do not receive necessary care or receive care that is not needed, inefficient or even damaging. There is no lack of ideas and approaches on how to improve practice. In the last decades we have seen the rise of fascinating models for quality improvement, for instance Evidence Based Medicine, Total Quality Management and Patient Partnership. These models are interesting and potentially very valuable in improving patient care. However, the evidence for their (cost-) effectiveness is very limited. The challenge for the years to come is to design strategies for quality improvement that integrate elements from the different models and to set the step from anecdotal evidence for these strategies to systematic evaluation in order to distinguish between faith and fact in the field of improving care.

Cost-Benefit Analysis↗
PubMed2004

The Saccharomyces cerevisiae TRT2 tRNAThr gene upstream of STE6 is a barrier to repression in MATalpha cells and exerts a potential tRNA position effect in MATa cells.

A growing body of evidence suggests that genes transcribed by RNA polymerase III exhibit multiple functions within a chromosome. While the predominant function of these genes is the synthesis of RNA molecules, certain RNA polymerase III genes also function as genomic landmarks. Transfer RNA genes are known to exhibit extra-transcriptional activities such as directing Ty element integration, pausing of replication forks, overriding nucleosome positioning sequences, repressing neighboring genes (tRNA position effect), and acting as a barrier to the spread of repressive chromatin. This study was designed to identify other tRNA loci that may act as barriers to chromatin-mediated repression, and focused on TRT2, a tRNA(Thr) adjacent to the STE6 alpha2 operator. We show that TRT2 acts as a barrier to repression, protecting the upstream CBT1 gene from the influence of the STE6 alpha2 operator in MATalpha cells. Interestingly, deletion of TRT2 results in an increase in CBT1 mRNA levels in MATa cells, indicating a potential tRNA position effect. The transcription of TRT2 itself is unaffected by the presence of the alpha2 operator, suggesting a hierarchy that favors assembly of the RNA polymerase III complex versus assembly of adjacent alpha2 operator-mediated repressed chromatin structures. This proposed hierarchy could explain how tRNA genes function as barriers to the propagation of repressive chromatin.

ATP-Binding Cassette Transporters↗
PubMed2003

Testing combined pharmacotherapies and behavioral interventions in alcohol dependence: rationale and methods.

Increasing knowledge about effective therapies for alcohol dependence calls for new research designs to examine treatment interactions between pharmacotherapies and behavioral interventions. In 1997, the National Institute on Alcohol Abuse and Alcoholism recruited 11 sites and a coordinating center for a large-scale (1,375 subjects), randomized placebo controlled trial to test 16 weeks of active treatment using naltrexone and acamprosate alone and in combination. Most participants receive 9 brief sessions delivered by medically trained providers to promote sobriety and enhance medication adherence (Medical Management, MM). Half the participants are also randomized to individualized psychotherapy (up to 20 sessions of Combined Behavioral Intervention, CBI), integrating elements of the successful behavioral interventions from Project MATCH. COMBINE seeks to evaluate the efficacy of the two most promising medications (naltrexone and acamprosate) both singly and together, when combined with different intensities of behavioral therapies. COMBINE incorporates a number of innovative design aspects, including a no-pill psychotherapy-alone condition, behavioral interventions that are both manual-guided and individualized, and pharmacotherapy dosing that is greater than in some previous trials. Two COMBINE pilot studies demonstrate the safety and acceptability of the combination pharmacotherapy dosing, and the feasibility of implementing the manualized behavioral interventions. This paper introduces COMBINE's goals, methods and analytic strategies, and their potential to improve multimodal treatment selection.

Acamprosate↗
PubMed2003

The Medical Humanities Program at the University of Manitoba, Winnipeg, Manitoba, Canada.

The current Medical Humanities Program at the University of Manitoba has evolved from a series of voluntary sessions into an integral element of the curriculum since its inception as the Human Values Program in 1986. With strong academic and financial support, the Medical Humanities Program has greatly benefited from dedicated leadership and a commitment to ongoing curricular review and redevelopment. The current Medical Humanities Program comprises six distinct components: Clinical Ethics; History of Medicine; Law; Complementary and Alternative Medicine; Palliative Care; and Human Values. Each of these components is compulsory and the first five are tested through examinations and assignments. Human Values sessions are designed to be experiential and to explore the human side of medicine as well as the intersections between medicine and the arts, literature, social psychology, and spirituality. The authors outline the origins and evolution of this successful program and describe its current components, student and faculty opinions, funding, advantages, disadvantages, and anticipated growth.

Curriculum↗
PubMed1996

The quality of life improvement model: a means to guide practice.

Guiding primary health care with quality of life (QOL) in mind is essential to the survival of a practice as well as the health care system. The present system's aggressive methods to increase quantity of life must be abandoned in order to focus on QOL. With the advent of managed care systems, with or without national health care reform, the health care focus will be less on high-technology and more on high-quality assessment, prevention, and health promotion. Promoting and following a practice model that advocates QOL and choices for care should be an integral element for guiding primary health care in the present and future. Utilization of the QOL improvement model will allow the clinician to assist varying clients to achieve enhanced QOL.

Health Promotion↗
PubMed2001

Achieving consistency in the lateral nasal osteotomy during rhinoplasty: an external perforated technique.

The lateral nasal osteotomy is an integral element in rhinoplasty. A reproducible and predictable technique for the lateral nasal osteotomy (when indicated) is a significant contributor to operative success. A variety of methods and instrumentation are used to produce lateral osteotomies; currently, the two different modes used most frequently are the internal continuous and external perforated techniques. A previously published study by the senior author detailed the benefits of the external perforated osteotomy after comparing the two different methods. This article describes the role of the external perforated osteotomy technique in reproducing consistent results in rhinoplasty with minimal postoperative complications.

Adult↗
PubMed2002

The treatment of unstable thoracic spine fractures with transpedicular screw instrumentation: a 3-year consecutive series.

STUDY DESIGN: The treatment of unstable thoracic spine fractures remains controversial. Theoretical biomechanical advantages of transpedicular screw fixation include three-column control of vertebral segments and fixation of a vertebral segment in the absence of intact posterior elements. Additionally, pedicle screw constructs may obviate the need for neural canal dissection and potential neural element impingement by intracanal instrumentation. A 3-year consecutive series was performed to evaluate the use of transpedicular screw fixation in the treatment of unstable thoracic spine injuries. OBJECTIVE: This study was performed to evaluate the efficacy of transpedicular screw fixation in the upper, middle, and lower thoracic spine. SUMMARY OF BACKGROUND DATA: The use of rod/hook and rod/wiring techniques has been evaluated in the treatment of thoracic spine injuries. To date, a study evaluating the safety and efficacy of pedicle screw instrumentation in the upper, middle, and lower thoracic spine has not been reported. METHODS: Thirty-two patients with 79 individual vertebral injury levels (T2-L1) treated with transpedicular spinal stabilization and bone fusion were evaluated during a 3-year consecutive series from 1998 to 2001. Patient charts, operative reports, preoperative and postoperative radiographs, computed tomography scans, and postoperative follow-up examinations and radiographs were reviewed from the time of surgery to final follow-up assessment. Radiographic measurements included: sagittal index, Gardner segmental kyphotic deformity, and compression percentage. RESULTS: A total of 252 pedicle screws were placed, of which 222 were placed in segments T2-L1. Clinical examination and plain radiographs were used to determine the presence of a solid fusion. Fracture healing and radiographic stabilization occurred at an average of 4.8 months after the initial operation. There were no reported cases of hardware failure, loss of reduction, or painful hardware removal. Two hundred fifty-two transpedicular screws were successfully placed without intraoperative complications. The mean preoperative sagittal index was 13.9 degrees, whereas the mean follow-up was 5.25 degrees (P < 0.001). The mean final correction of sagittal index achieved was 8.65 degrees, or a 62.2% improvement. The mean Gardner segmental kyphotic angle was 15.9 degrees, whereas the mean follow-up angle was 10.6 degrees (P < 0.0005). The mean compression percentage was 35.4, and at follow-up was 27.4 (P < 0.07). CONCLUSIONS: In carefully selected instances, pedicle screw fixation of upper, middle, and lower thoracic and upper thoracolumbar spinal injuries is a reliable and safe method of posterior spinal stabilization. Transpedicular screw fixation may offer superior three-column control in the absence of posterior element integrity and obviates the need for intracanal placement of hardware. Transpedicular instrumentation provides rigid fixation for upper, middle, and lower unstable thoracic spine injuries and produces early pain-free fusion results. These results provide evidence that with appropriate preoperative radiographic evaluation of pedicular size and orientation using computed tomography as well as radiograph assessment, transpedicular instrumentation is a safe and effective alternative in the treatment of unstable thoracic (T2-L1) spinal injuries.

Adult↗
PubMed2006

Is there a role for preparatory cycle in ovum donation recipients?

PURPOSE OF REVIEW: In ovum donation cycles, the role of preparatory cycles to ensure proper endometrial development in the recipient remains controversial. As evidenced in the literature, endometrial receptivity is critical in conception. Therefore, endometrial preparation with exogenous hormones in addition to synchronization of the recipient and donor are essential in achieving a successful outcome. RECENT FINDINGS: There are very limited data specifically examining the benefit of recipients undergoing preparatory cycles prior to their actual egg donation cycle. One study concluded that trial hormone replacement treatment cycles with endometrial biopsies may be useful in older reproductive-age women but not in younger women. Another study showed no difference in pregnancy rates between those who did and did not undergo preparatory cycles. SUMMARY: Since one of the integral elements of preparatory cycles is determining endometrial dating, with relatively conflicting data, these mock cycles may not be as beneficial as expected. Therefore, for those who routinely use preparatory cycles, the potential risks, benefits, and costs of these cycles, increased hormonal exposure, the relatively invasive nature of the procedure, and time prior to performing them must be considered.

Endometrium↗
PubMed2004

Familial multiple sclerosis and other inherited disorders of the white matter.

BACKGROUND: An objective demonstration of lesions disseminated in time and space remains the core of the last revision of diagnostic criteria for multiple sclerosis (MS), but this update is now empowered by a weighted use of magnetic resonance imaging (MRI), which results in an earlier and more unambiguous diagnosis ("MS," "not MS," or "possible MS"). Nevertheless, the exclusion of other entities still remains an integral element of the diagnostic process. REVIEW SUMMARY: Exclusion of genetic disorders can be challenging in some cases with familial recurrence of MS, particularly when the transmission is mimicking a mendelian or a maternal pattern of inheritance. Vice versa, many forms of mendelian leukodystrophies and leukoencephalopathies present with juvenile or adult onset, progressive or relapsing-remitting courses, intrafamilial phenotypic heterogeneity and MRI signs of multifocal white matter (WM) pathology, features potentially leading to a temporary confusion with MS. With the recent availability of disease modifying medications in MS, the development of specific molecular therapies in inherited WM disorders, and the general recognition of the effectiveness of early treatments, the accuracy of initial diagnostic assessment has become critical. CONCLUSION: Considering the importance of disease specific treatments, here we review the major characteristics of familial MS and some of the inheritable diseases of the WM. Although no direct genetic link between MS and these WM abnormalities is known, molecular data from the field of rare genetic disorders may also provide some experimental paradigms to a further exploration of MS.

Brain↗