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PubMed2001

Different associations of blood pressure with 24-hour urinary sodium excretion among pre- and post-menopausal women. WHO Cardiovascular Diseases and Alimentary Comparison (WHO-CARDIAC) Study.

OBJECTIVE: Having found no definite relationship between blood pressure (BP) and 24h sodium excretion in women aged 48-56 years (in contrast to the results in men of the same age) in the WHO Cardiovascular Diseases and Alimentary Comparison (WHO-CARDIAC) Study, we analyzed the data to investigate whether the sodium-BP association differed between pre- and post-menopausal women. DESIGN AND METHODS: The WHO-CARDIAC is a multicenter cross-sectional study, involving, as of July 2000, 60 collaborating centers in 25 countries. In each center, 100 men and 100 women aged 48-56 years were selected randomly from the general population of the area. In this report, 2,212 women in 21 centers located in 17 countries worldwide, who had data on menopausal status, were studied. RESULTS: After adjustment for age, body mass index (BMI) and 24h urinary potassium excretion, 24h sodium excretion was positively and significantly associated with systolic blood pressure (SBP) [pooled regression coefficient: 0.037 (SE 0.01), P < 0.01] and with diastolic blood pressure (DBP) [0.023 (0.006), P< 0.01] in post-menopausal women. Pooled regression coefficients of sodium-BP association were not significant in pre-menopausal women (P< 0.05). Cross-center correlation analyses of the 21 centers showed that 24h sodium excretion was positively associated with SBP and DBP in both pre- and post-menopausal women, and this positive association between sodium excretion and SBP was significant in post-menopausal women (R2 = 0.23, P = 0.029). CONCLUSION: Different associations between sodium and BP were observed in women with pre- and post-menopausal status. There may be a tendency for salt sensitivity to increase at the menopause.

Blood Pressure↗
PubMed2005

Differences in education, knowledge, self-management activities, and health outcomes for patients with heart failure cared for under the chronic disease model: the improving chronic illness care evaluation.

BACKGROUND: The objective of this study was to determine whether participation in a quality improvement (QI) collaborative for heart failure (HF) was associated with better interpersonal aspects of care and health outcomes. METHODS AND RESULTS: We conducted a cross-sectional telephone survey of patients in 6 organizations who participated in a QI collaborative for HF (participants, n = 387) and 6 comparable control organizations (controls, n = 414) and measured provider-patient communication, education received, knowledge of HF, self-management behaviors, satisfaction, and quality of life. The participant group patients were more likely to report their doctor and nurse discussed treatment options and reviewed self-management (P < .01 for both). A total of 88% of participants were told to weigh themselves daily and record their weight compared with 34% of controls (P < .01). Participants were more likely to know how often to check their weight (P < .01), recognize symptoms of worsening HF (P < or = .01 for all), have a scale (P = .002), and monitor their weight daily (P < .001). Participants had similar quality of life but fewer emergency department visits and hospitalizations. CONCLUSION: Participation in a QI collaborative for HF was associated with better communication, education, and knowledge, and lower health care use. Collaboratives may be a useful method for disseminating quality improvement strategies.

Adolescent↗
PubMed1999

Parasitology crossing borders.

In veterinary parasitology it is important to further strengthen international collaboration and interactions. On the one hand, there is a strong and promising trend towards growth in large international programmes. However, we, as researchers, should make more serious attempts to influence the targets and structures of these programmes. On the other hand, let us not forget to fully exploit the possibilities for support to even small projects and visiting researchers' arrangements, preferably in a flexible way. The paper emphasizes the obvious need for research capacity building in the least developed countries, and advocates a partnership approach in research for development. The presentation suggests more operative initiatives in international veterinary parasitology. Finally, how language barriers can hamper international contacts and exchange of information is discussed. Ways to possibly avert this are indicated.

Africa↗
PubMed1985

Murine helper T lymphocyte response to influenza virus: recognition of haemagglutinin by subtype-specific and cross-reactive T cell clones.

Helper T cel lines specific for influenza virus were established by continuous culture of Mem 71-Bel (H3) virus-immune spleen cells in the presence of virus and antigen-presenting cells and their specificity assessed in proliferation experiments. A line stimulated in vitro with Mem 71-Bel virus was able to proliferate in response to viruses of the same, and also of different, type A haemagglutinin (HA) subtypes as the immunizing virus but not to a type B influenza virus. A component of this cross-reactivity was due to recognition of the HA molecule. Lines stimulated in vitro with purified disrupted H3 or H2 viruses showed a higher degree of cross-reactivity. Of nine clones isolated from these lines, seven were directed against the HA molecule and recognized the HA1 chain. The HA-specific T cell clones were either subtype-specific T cell clones were either subtype-specific, recognizing only viruses of the H3 subtype, or cross-reactive, also recognizing viruses of the H2 subtype of type A (but not type B). Subtype-specific and cross-reactive T cell clones were shown to function as helper T cells in vitro. In addition to collaborating with H3 virus-primed B cells responding to H3 virus in culture, the cross-reactive T cell clone could also provide help for H2 virus-primed B cells making anti-HA antibody in response to H2 virus.

Animals↗
PubMedDate not supplied

Progress of pharmacist collaborative practice: status of state laws and regulations and perceived impact of collaborative practice.

OBJECTIVES: To determine the current status and features of states' laws on pharmacist collaborative practice, barriers and facilitators to the passage of such laws, pharmacists' satisfaction with present regulations, and pharmacy leaders' perceptions regarding the impact of collaborative practice on pharmacist-physician relationships and on patients' perceptions of pharmacists. DESIGN: Cross-sectional survey. SETTING: United States. PARTICIPANTS: Executives of state pharmacy organizations and officers of state pharmacy boards. MAIN OUTCOME MEASURES: Presence and features of collaborative practice law, perceptions regarding effects of collaborative practice on pharmacist-physician relationships, and patients' perceptions of pharmacists. RESULTS: Of 48 states responding to the survey, 32 (66%) had existing pharmacist collaborative practice laws; 23 states (48%) allowed pharmacists to initiate and modify therapy, whereas 9 (19%) allowed only modification of therapy. Dependent collaborative practice was permitted in 31 states (65%). Most state laws applied to hospital, long-term care, and community settings. Five of the 32 states with pharmacist collaborative practice laws had made changes to broaden the provisions since the original laws were enacted. Nine states out of 16 that did not have collaborative practice laws indicated plans to pursue passage of such laws. Overall, collaborative practice was viewed as having a positive effect on pharmacist-physician relationships and a slightly positive effect on patients' perceptions of pharmacists. Respondents believed that pharmacists currently involved in collaborative practice were mostly satisfied with present laws, although some respondents mentioned the need for further revisions to the laws. CONCLUSION: Significant progress has been made in passing and implementing laws on pharmacist collaborative practice. As positive experience is gained, good opportunities exist to broaden current laws and increase pharmacists' involvement in collaborative practice.

Attitude of Health Personnel↗
PubMed2006

Cardiovascular and metabolic risk in outpatients with schizophrenia treated with antipsychotics: results of the CLAMORS Study.

AIM: To assess the prevalence of Coronary Heart Disease (CHD) and Metabolic Syndrome (MS) in patients treated with antipsychotics. METHODS: Retrospective, cross-sectional, multicenter study in which 117 Spanish psychiatrists (the CLAMORS Study Collaborative Group) recruited consecutive outpatients meeting DSM-IV criteria for Schizophrenia, Schizophreniform or Schizoaffective Disorder, receiving antipsychotic treatment for at least 12 weeks. CHD risk was assessed by SCORE (10-year CV death) and Framingham (10-year all CHD events) function. MS was defined by at least 3 of the following components: waist circumference >102 (men)/>88 (women) cm; triglycerides > or =150 mg/dl; HDL-cholesterol <40 mg/dl (men)/<50 mg/dl (women); blood pressure > or =130/85; fasting glucose > or =110 mg/dl. RESULTS: 1452 evaluable patients (863 men, 60.9%), aged 40.7+/-12.2 years (mean+/-SD) were included. MS was present in 24.6% [23.6% (men), 27.2% (women); p=0.130)]. The overall 10-year risks were 0.9+/-1.9 (SCORE) and 7.2+/-7.6 (Framingham). 8% (95%CI: 6.5-9.5) and 22.1% (95%CI: 20.0-24.3) of patients showed a high/very high risk according to SCORE (> or =3%) and Framingham (> or =10%) function. Abdominal obesity and low HDL-cholesterol were more prevalent in women: 54.5% (95%CI: 50.2-58.9) versus 34.3% (95%CI: 31.0-37.7), and 46.1% (95%CI: 41.4) versus 28.5 (95%CI: 50.8), p<0.001 in both cases. Hypertension and hypertriglyceridemia were more prevalent in men: 59.0% (95%CI: 55.7-62.3) versus 46.0% (95%CI: 41.8-50.2), and 40.7% (95%CI: 37.2-44.2) versus 32.4 (95%CI: 28.3-36.5), p<0.01 in both cases. CONCLUSIONS: CHD risk and MS prevalences among patients with schizophrenia treated with antipsychotics were in the same range as the Spanish general population 10 to 15 years older.

Adolescent↗
PubMed2002

Data management and quality assurance for an International project: the Indo-US Cross-National Dementia Epidemiology Study.

BACKGROUND: Data management and quality assurance play a vital but often neglected role in ensuring high quality research, particularly in collaborative and international studies. OBJECTIVE: A data management and quality assurance program was set up for a cross-national epidemiological study of Alzheimer's disease, with centers in India and the United States. METHODS: The study involved (a) the development of instruments for the assessment of elderly illiterate Hindi-speaking individuals; and (b) the use of those instruments to carry out an epidemiological study in a population-based cohort of over 5000 persons. Responsibility for data management and quality assurance was shared between the two sites. A cooperative system was instituted for forms and edit development, data entry, checking, transmission, and further checking to ensure that quality data were available for timely analysis. A quality control software program (CHECKS) was written expressly for this project to ensure the highest possible level of data integrity. CONCLUSIONS: This report addresses issues particularly relevant to data management and quality assurance at developing country sites, and to collaborations between sites in developed and developing countries.

Alzheimer Disease↗
PubMed2003

Identifying older Chinese immigrants at high risk for osteoporosis.

BACKGROUND: Data about whether Asian Americans are a high-risk or a low-risk group for osteoporosis are limited and inconsistent. Few previous studies have recognized that the heterogeneity of the Asian American population, with respect to both nativity (foreign- vs U.S.-born) and ethnicity, may be related to osteoporosis risk. OBJECTIVE: To assess whether older foreign-born Chinese Americans living in an urban ethnic enclave are at high risk of osteoporosis and to refer participants at high risk for follow-up care. DESIGN: Cross-sectional survey and osteoporosis screening, undertaken as a collaborative project by the Chinese American Service League and researchers at the University of Chicago. SETTING: Chicago's Chinatown. PARTICIPANTS: Four hundred sixty-nine immigrant Chinese American men and women aged 50 and older. MEASUREMENTS AND MAIN RESULTS: Chinese Americans in this urban setting are generally recent immigrants from south China with limited education and resources: mean age at immigration was 54, 56% had primary only or no education, and 57% reported "fair" or "poor" self-rated health. Eighteen percent are uninsured and 55% receive Medicaid. Bone mineral density (BMD) of the calcaneus was estimated using quantitative ultrasound. Immigrant Chinese women in the study had lower average BMD than reference data for white women or U.S.-born Asian Americans. BMD for immigrant Chinese men in the study was similar to white men at ages 50 to 69, and lower at older ages. Low body mass index, low educational attainment and older age at immigration were all associated with lower BMD. CONCLUSIONS: Foreign-born Chinese Americans may be a high-risk group for osteoporosis.

Aged↗
PubMed1992

Cross-cultural medicine at home.

The cross-cultural approach allows the white physician to see the Ojibwe patient as a person with goals both similar and different from her own. Both the physician and the patient understand that the purpose of the visit is to retain or acquire good health. However, the expectations, communication, and the style of interaction may mask that concordance. Even the definitions of health differ between physician and patient. The Western medical model emphasizes normal physiologic health. The Ojibwe view incorporates spiritual health to a greater degree and emphasizes a wholistic approach encompassing a harmonious balance among the individual, community, and nature, as well as among body, mind, and spirit. The methods and attitudes so apparent in cross-cultural medical interactions are really no different from those needed for the delivery of good medical care generally. The more disparate a patient's and doctor's world views and lifestyles, the greater the effort required on both sides to communicate and collaborate. Nearly every patient encounter will be improved by a cross-cultural perspective. Acknowledgment and tolerance of health practices different from our own can lead to greater flexibility and understanding within the medical care system, thereby allowing for care with less confrontation and conflict. Physicians who incorporate such methods will likely gain better understanding of their own values and practices, which will enhance their care of all patients.

Cross-Cultural Comparison↗
PubMed2002

A comparison of research general practices and their patients with other practices--a cross-sectional survey in Trent.

BACKGROUND: When interpreting results of studies undertaken by research networks we need to know how representative volunteer practices and their registered patients are of the total population of practices and patients in their locality. AIM: To compare the following in research and non-research general practices in one region: practice and population demography, morbidity and mortality, selected performance indicators, and health outcomes. DESIGN OF STUDY: Cross-sectional survey. SETTING: Sixty-six Trent Focus Collaborative Research Network general practices and 749 other general practices in Trent, United Kingdom. METHOD: Practice characteristics and GP contract data were obtained from the NHS Executive, Quarry House, Leeds. The Trent Regional NHS Hospital Admission Database was searched to identify all relevant admissions to hospital from all practices between 1 April 1993 and 31 March 1997. Ward-linked data on cancer were obtained from the Trent Cancer Registry. RESULTS: Of the 815 general practices in Trent Region in the study period, 66 (8%) were in the Trent Focus network. They were more likely to be involved in training GPs and to have a female partner. They tended to be larger, with fewer single-handed doctors and younger GPs. Network practices prescribed a higher proportion of generics (median % prescribed/practice = 70%, versus 51%, Mann-Whitney U = 1615, P<0.0001). There were no clinically important differences between hospital admission rates between the two groups or waiting times for surgical procedures. There was no difference in the incidence of cancer and standardised mortality ratios related to the electoral wards of the GP surgery. CONCLUSION: Although there were differences in practice structure and some aspects of performance, we found no important differences in the demography of registered patients, nor in morbidity, mortality, or access to or use of secondary care.

Cross-Sectional Studies↗
PubMed2005

Development of emergency medicine administration in the People's Republic of China.

A collaborative partnership between the Johns Hopkins Hospital, Chaoyang Red Cross Hospital and Chinese Ministry of Health has been established to initiate Emergency Medicine (EM) administrative training in Beijing, China. The Emergency Medical Education and Training Center (EMETC) at Chaoyang Red Cross Hospital was opened as a training facility to foster EM administrative curriculum development and training nationwide. A six-step approach with problem identification, needs assessment, goals and objectives, educational strategies, implementation and evaluation was used to form a locally adapted curriculum. With a train-the-trainers model, the EMETC sponsored several EM administration courses, the first of their kind in China. Since its inception, the EMETC has trained 95 persons from throughout China in EM administration. An EM administration curriculum has been developed and refined. In conclusion, an international partnership between academic hospitals, supported by the local Ministry of Health, to develop a national training facility using this six-step approach may be an attractive strategy for dissemination of EM administration principles.

China↗
PubMed2003

Behavioral and psychologic symptoms of dementia.

Although tremendous strides with regard to identification and treatment of BPSD have been made over the last several decades, much work remains. Presently, BPSD research opportunities are at their greatest. The increasing worldwide social and economic impact of BPSD, however, requires that researchers, clinicians, and scientists develop a global network focused on collaboration and innovation. In particular, research must address cross-culturally applicable methods for assessment, exploration of the environmental relationships of BPSD and the underlying biologic and psychologic substrates, longitudinal evaluation, determination of the frequency and underlying pathogenic mechanisms, and development of a clearly defined treatment method profile with specific reference to different types of BPSD [134].

Aged↗
PubMed2002

"Domestic violence".

Domestic violence is no respector of persons but may involve spouses or cohabiting adults across all socioeconomic, ethnic, and religious groups. It is no respect or of community. The abuse can be physical, sexual, or emotional/psychological. It can be economic and be demonstrated by neglect. Nursing care for the problem of domestic abuse needs to be directed at primary, secondary, and tertiary prevention. Care for victims and victimizers of domestic violence involves a collaborative relationship with other professionals as well as interagency cross referrals that involve health, welfare, refuge, and judicial protective services.

Domestic Violence↗
PubMed2002

Water policy differences between a western democracy and a country in economic transition.

Where environmental policy is concerned Western democracies and transition economies share more similarities than differences. Sound environmental policies require substantial investment. Public-private cooperation can play a major role in the search for solutions, but politicians, environmentalists and academics must act vigorously to ensure that big business does not acquire a final say in the implementation of environmental policy. Lithuania as a transition economy faces major environmental challenges, but international collaboration, including working with the European Union and cross-border cooperation with neighbouring states, is bringing good results. A major unifying factor for the Baltic Sea states is the continuing struggle to purify and protect the Baltic Sea.

Baltic States↗
PubMedDate not supplied

Bridging refugee youth and children's services: a case study of cross-service training.

Bridging Refugee Youth and Children's Services(BRYCS), a public-private partnership between the federal Office of Refugee Resettlement, Lutheran Immigration and Refugee Service, and the United States Conference of Catholic Bishops, provides national technical assistance to public child welfare. After a series of "community conversations," BRYCS identified a lack of knowledge among child welfare staff about newcomer refugees, negative stereotypes, and a fear of child protective services among refugees. BRYCS initiated a number of technical assistance initiatives, including a pilot cross-service training project in St. Louis to strengthen collaboration between child welfare and refugee-serving agencies. This article details the lessons learned from this training and recommends changes in policy and practice.

Adolescent↗
PubMed2001

Quality of life in children and adolescents: a European public health perspective.

OBJECTIVES: The measurement of health-related quality of life (HRQOL) is increasingly important as a means of monitoring population health status over time, of detecting sub-groups within the general population with poor HRQOL, and of assessing the impact of public health interventions within a given population. At present, no standardised instrument exists which can be applied with equal relevance in pediatric populations in different European populations. The collaborative European KIDSCREEN project aims to develop a standardised screening instrument for children's quality of life which will be used in representative national and European health surveys. Participants of the project are centres from Austria, France, Germany, Netherlands, Spain, Switzerland, and United Kingdom. By including the instrument in health services research and health reporting, it also aims at identifying children at risk in terms of their subjective health, thereby allowing the possibility of early intervention. METHODS: Instrument development will be based on constructing a psychometrically sound HRQOL instrument taking into account the existing state of the art. Development will centre on literature searches, expert consultation (Delphi Methods) and focus groups with children and adolescents (8-17 years). According to international guidelines, items will be translated into the languages of the seven participating countries for a pilot test with 2,100 children and their parents in Europe. The final instrument will be used in representative mail and telephone surveys of HRQOL in 1,800 children and their parents per country (total n = 25,200) and normative data will be produced. The potential for implementing the measurement tool in health services and health reporting will also be evaluated in several different research and public health settings. The final analysis will involve national and cross cultural-analysis of the instrument. RESULTS: The international, collaborative nature of the KIDSCREEN project means it is likely to provide many challenges in terms of producing an instrument which is conceptually and linguistically appropriate for use in many different countries, but it will also provide the opportunity to develop, test and implement the first truly cross-national HRQOL instrument developed for use in children and adolescents. This will help to contribute to a better understanding of perceived health in children and adolescents and to identify populations at risk.

Adolescent↗
PubMed1977

Multidisciplinary collaboration in fieldwork: Australian studies.

The Australian situation offers special insights for cross-cultural psychiatric research. The two cultures that "crossed" in Australia were diametrically opposed in their characteristics. Suffering, which is considered to be the raison d'être of cross-cultural psychiatry, became pandemic among Aborigines, not only because the invading society was ruthlessly aggressive, but also because the invaded society did not have the social institutions and modal personality patterns enabling it to adapt to the introduced culture. It is suggested that no applied science makes more demands of more scientific disciplines than does cross-cultural psychiatry. Psychiatry itself is a multidisciplinary science. The amount of information needed by the cross-cultural extension of psychiatry is further expanded. Only a multidisciplinary approach can furnish the necessary level of information. An outline is given of multidisciplinary field work in Australia, indicating advantages and difficulties inherent in it. Attention is drawn to literature in which details of the results may be found. The Australian work leads to the conclusion that if the relief of suffering is the aim then greater involvement is needed in cross-cultural psychiatry from the culture that has been "crossed".

Australia↗