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PubMed2007

Contact allergy to topical drugs: prevalence in a clinical setting and estimation of frequency at the population level.

OBJECTIVES: To estimate the prevalence of contact allergy (CA) to a set of topical drugs patch tested in the research network IVDK (Information Network of Departments of Dermatology; www.ivdk.org) between 1995 and 2004, and to extrapolate these clinical data to the German population. METHODS: Clinical data comprised results of allergy patch tests with topical drugs in patients with suspected CA. Clinical epidemiology and drug utilization research (CE-DUR) methods were employed to grossly estimate the incidence of CA to these topical drugs during two 5-year periods (1995-1999 and 2000-2005) in the German general population. To estimate the number of persons eligible for patch testing (with the topical drugs) on a general population level, sales data of patch test material were obtained. By relating this denominator to the CA frequency observed in the IVDK, the incidence of CA to selected topical drugs in the German general population was crudely estimated. RESULTS: In general, topical aminoglycosides showed the highest CA frequencies and, except for gentamicin sulfate, frequencies of CA to all other allergens tested were lower in the 2nd period of analysis. According to the medium model, 1-year incidence rates ranged from 1 (hydrocortisone-17-butyrate) to 29 persons/100,000 (neomycin sulfate) in the general population (1995-1999). CONCLUSION: The CE-DUR approach yielded incidence estimates of CA to relevant topical drugs in the German general population, which, despite their limited precision in absolute terms, illustrate the relative frequency of this particular adverse effect. However, comparative risk assessment should preferably take exposure information into account.

Administration, Topical↗
PubMedDate not supplied

Resource use in women completing treatment for breast cancer.

OBJECTIVE: To explore resources used by women completing treatment for breast cancer, how they learned about them, and the psychological factors that predicted their use. DESIGN: A questionnaire on resource use was administered as part of a randomized clinical trial which assessed subjects' psychosocial characteristics and tested the outcomes of a psychosocial intervention. SETTING: Women completing treatment for breast cancer were recruited from the oncology departments of three university-teaching hospitals in Montreal. A questionnaire gathered data on the resources used by the subjects, how they learned about them, and the role of the health care team in their decision-making. Emotional distress, dimensions of coping effort, a sense of control and optimism were also measured. RESULTS: Five categories of resources were explored; professional services, informal support networks, informational resources, support organizations and complementary therapies. Most women found out about the last two resources by themselves. Women who used cancer support organizations or complementary therapies scored high on the use of problem-solving coping and low on the use of escape/avoidance coping. In addition they were moderately optimistic, had a slightly lower sense of personal control and were somewhat more distressed than the non-users. The use of support organizations and complementary therapies appears to represent a thoughtful approach to dealing with the distress of cancer. The opinion of the oncologist regarding resource use was valued by nearly half of the sample.

Adaptation, Psychological↗
PubMed1998

The art of recruitment: the foundation of family and linkage studies of psychiatric illness.

Family and linkage studies of psychiatric illness involve special benefits and challenges in the field of scientific investigation. The success of a family or linkage study is dependent on the recruitment process. The most informative and reliable method of data collection in this field of investigation is through direct interviews with as many family members as possible. Although there are circumstances when direct interviewing is not possible, there are other circumstances, such as refusal of relatives to participate, that deserve closer scrutiny. The complexities involved in the recruitment process while conducting medical investigations have been explored in the literature. However, special issues relevant to the recruitment process merit further exploration for working with families in the context of family and linkage studies of psychiatric illness. Careful understanding of this psychiatric illness. Careful understanding of this critical topic may minimize the incidence of family nonparticipation in such research endeavors. This article addresses these issues as they relate to recruiting individuals and their families in this field of investigation. These issues include the role of attitudes, values and beliefs, family interaction and the identification of influential members, informal communication networking, informed consent while promoting the research, and ethical concerns.

Adult↗
PubMed1993

[Functional level, care needs and family-based care for home-care recipients with extended care needs].

A study of home care and home health services was undertaken in three Swedish municipalities. Persons who received extended home care and home health care were interviewed. The interviews covered different themes such as impairments, care needs, functions and activities in the horizontal social network (the informal network), and opinions concerning how care is and should be provided. A modified ADL-index was used to assess the functional level of daily living. Care needs were measured by the judgement of the care recipient, and by the interviewer's judgement. The correspondence between these measures was high, with some exceptions. Lower correspondence between the measures was obtained for three categories of care recipients: individuals with communicative dysfunctions, younger individuals with reduced ability to move and, thirdly, individuals with psychosocial problems. Problems concerning measurement of care given by family members were also identified and discussed.

Activities of Daily Living↗
PubMed2000

Services and information utilised by female sex workers for sexual and physical safety.

AIMS: To examine services utilised by female sex workers in Christchurch for sexual and physical safety. METHOD: Estimates were made of the sex worker population in Christchurch before conducting a cross-sectional survey. RESULTS: 303 women responded. Almost all went for sexual health check-ups. Most (251) had a general practitioner, but only about half disclosed they were sex workers. Of the 135 women who used their own general practitioner for sexual health checks, 62% disclosed they were sex workers. In general, the women relied upon informal networks for information and advice, but the peer organisation of New Zealand Prostitutes Collective was also important. CONCLUSION: While general practitioners were used by the majority of sex workers, high levels of nondisclosure need to be understood and redressed. The preference of sex workers for informal, peer relationships should be considered in future health promotion efforts.

Adolescent↗
PubMed2005

Social and geographical boundaries around senior nurse and physician leaders: an application of social network analysis.

The purpose of this study was to describe the social and geographical boundaries around the networks of senior nurse executives and physician leaders and managers in acute-care hospitals in the United Kingdom. A telephone survey was conducted using standard social network methods. A random sample was drawn from a national list and repeatedly sampled until 100 respondents were interviewed. The response rate was 49.5%. Both groups tended to discuss "important professional matters" with others who were similar to themselves in terms of profession, gender, age, and seniority, with physicians being more extreme in this regard. The implication is that gaps in the network of informal ties will impede the dissemination of information and the spread of social influence between these 2 important groups. Managers (non-clinically qualified) appear to occupy a powerful "brokerage" role. Informal networks are mainly composed of local ties. The authors argue that dissemination and influence strategies that take features of the social structure into account are more likely to be successful.

Geography↗
PubMed1983

Towards more effective intervention in natural helping networks.

Fiscal constraints which are promoting a retreat from social welfare programming place increasing responsibility for care on natural helping networks of family and friends. Research has identified several characteristics of informal networks which are associated with support such as density, reciprocity, homogeneity, and multiplexity. Professional interventions have also responded to the potential supports available in networks. Professional practice concentrates primarily on self-help groups and the use of key persons in networks. There is, however, little correspondence between research findings and professional approaches to intervention. Little has been done to determine the possible impact of formal service provision on the dynamics of informal networks. More effective intervention in informal networks must consider the limitations of current practice, the development of assessment instruments, and the changes in network structures and processes over time.

Aged↗
PubMed1998

Bonding and cracking: the role of informal, interpersonal networks in health care decision making.

This study examined the role and impact of informal, interpersonal networks in health care decision making. Questioning the traditional approach to studying health communication as it is situated within institutions (e.g., Burgoon, 1992; Nussbaum, 1989; Pettegrew & Logan, 1987), this ethnographic study ventured into the lived experiences of women in a mothers' and toddlers' playgroup as they discussed their own, their family members', and their friends' health experiences. Their conversations revolved around such health-related issues as pregnancy and delivery, physicians and hospitals, breastfeeding, illnesses and accidents, and diet and nutrition. The conversations were found to serve not necessarily opposing but distinctive functions including a rather practical purpose of "cracking the code" of institutional practices, as well as a "bonding" function evidenced through stories or narratives. The conversations are not only exchanges of information but also narratives through which shared experiences are created and maintained. In addition to these narrative functions, examination of these conversations reveals how diagnoses and remedies from the institutions are discussed and decisions are made. The conclusion offers ideas for how agencies and institutions can utilize the findings of this particular research venture.

Journal Article↗
PubMed1992

Determination of eukaryotic protein coding regions using neural networks and information theory.

Our previous work applied neural network techniques to the problem of discriminating open reading frame (ORF) sequences taken from introns versus exons. The method counted the codon frequencies in an ORF of a specified length, and then used this codon frequency representation of DNA fragments to train a neural net (essentially a Perceptron with a sigmoidal, or "soft step function", output) to perform this discrimination. After training, the network was then applied to a disjoint "predict" set of data to assess accuracy. The resulting accuracy in our previous work was 98.4%, exceeding accuracies reported in the literature at that time for other algorithms. Here, we report even higher accuracies stemming from calculations of mutual information (a correlation measure) of spatially separated codons in exons, and in introns. Significant mutual information exists in exons, but not in introns, between adjacent codons. This suggests that dicodon frequencies of adjacent codons are important for intron/exon discrimination. We report that accuracies obtained using a neural net trained on the frequency of dicodons is significantly higher at smaller fragment lengths than even our original results using codon frequencies, which were already higher than simple statistical methods that also used codon frequencies. We also report accuracies obtained from including codon and dicodon statistics in all six reading frames, i.e. the three frames on the original and complement strand. Inclusion of six-frame statistics increases the accuracy still further. We also compare these neural net results to a Bayesian statistical prediction method that assumes independent codon frequencies in each position. The performance of the Bayesian scheme is poorer than any of the neural based schemes, however many methods reported in the literature either explicitly, or implicitly, use this method. Specifically, Bayesian prediction schemes based on codon frequencies achieve 90.9% accuracy on 90 codon ORFs, while our best neural net scheme reaches 99.4% accuracy on 60 codon ORFs. "Accuracy" is defined as the average of the exon and intron sensitivities. Achievement of sufficiently high accuracies on short fragment lengths can be useful in providing a computational means of finding coding regions in unannotated DNA sequences such as those arising from the mega-base sequencing efforts of the Human Genome Project. We caution that the high accuracies reported here do not represent a complete solution to the problem of identifying exons in "raw" base sequences. The accuracies are considerably lower from exons of small length, although still higher than accuracies reported in the literature for other methods. Short exon lengths are not uncommon.(ABSTRACT TRUNCATED AT 400 WORDS)

Base Sequence↗
PubMed1987

Enlarging the caring capacity of the community: informal support networks and the welfare state.

In common with most modern industrial societies, Great Britain is facing the unique late 20th century phenomenon of rapidly increasing numbers of people, especially very elderly people, requiring health and social care. The response in Britain has been to search for ways to enlarge the caring capacity of the "community" and, thereby, reduce the demands on public health and social services. Similar policy responses have been developed in other capitalist societies such as Canada, France, and the United States. Although a policy of "community care"--the provision of state services in people's own homes--was followed by governments of both major British political parties over the postwar period, under the right wing neo-monetarist regime of the present Thatcher administration the locus of policy has shifted toward encouraging greater reliance on the informal support networks of kin, friends, and neighbors. The reasons for this sea-change are explored and the assumptions that these networks are "natural" and necessarily the proper matrix of care are examined critically. This analysis draws on the results of recent research which indicates that informal support networks have significant limitations and that a policy based on withdrawing public services in the hope that these networks will fill the growing care gap is likely to be counterproductive. In conclusion, the author indicates the areas where further research is required to provide a sound basis for policy.

Aged↗
PubMed2025

Gene regulatory network structure informs the distribution of perturbation effects.

Gene regulatory networks (GRNs) govern many core developmental and biological processes underlying human complex traits. Even with broad-scale efforts to characterize the effects of molecular perturbations and interpret gene coexpression, it remains challenging to infer the architecture of gene regulation in a precise and efficient manner. Key properties of GRNs, like hierarchical structure, modular organization, and sparsity, provide both challenges and opportunities for this objective. Here, we seek to better understand properties of GRNs using a new approach to simulate their structure and model their function. We produce realistic network structures with a novel generating algorithm based on insights from small-world network theory, and we model gene expression regulation using stochastic differential equations formulated to accommodate modeling molecular perturbations. With these tools, we systematically describe the effects of gene knockouts within and across GRNs, finding a subset of networks that recapitulate features of a recent genome-scale perturbation study. With deeper analysis of these exemplar networks, we consider future avenues to map the architecture of gene expression regulation using data from cells in perturbed and unperturbed states, finding that while perturbation data are critical to discover specific regulatory interactions, data from unperturbed cells may be sufficient to reveal regulatory programs.

Gene Regulatory Networks↗
PubMed1999

Developing a health care information system for Scotland.

The rapid development and uptake of Internet technology has created opportunities for large-scale information networks to replace paper-based information sources. In order to obtain the maximum benefits for patients and medical practitioners it is important that health care providers work together to produce an integrated information service. However, the task of bringing together a large number of different information providers to create a huge structured pool of information covering a wide range of topics with appropriate quality assurance is non-trivial. This paper describes an approach being used to create healthcare information systems in a set of co-operative healthcare information networks in Europe, and specifically in Scotland.

Humans↗
PubMed1996

The anatomy of online information for physicians.

Online medical networked information (OMNI) is one of the newest and fastest growing types of information sources for physicians. The authors present an organizational framework for understanding the range of available OMNI sources and discuss the practical applications, strengths and limitations of online resources. Physicians can now gain access on line to a wealth of information relating to many aspects of clinical medicine and can consult interactively with colleagues on clinical and research questions. The limitations of networked online resources include lack of access, difficulty in navigating online systems and the potential for fraudulent use. Net-worked online systems are growing in popularity and may become integral to medical practice as barriers to efficient use are overcome.

Computer Communication Networks↗
PubMed1993

Building strong networks eight ways.

It is becoming common in healthcare institutions that the charter of Information Services goes beyond providing data. IS often needs to empower the user community with the right information and the right tools, which enable them to perform their jobs more efficiently and effectively. Creating such an infrastructure requires an information network, one that allows information to flow at all levels within and outside the facility. This fortifies and enhances the business process and enables institutions to function efficiently and profitably. But developing such an information network requires analysis and planning. The following eight steps detail considerations you should make to ensure the creation of an infrastructure robust enough to address the needs of today, and capable of incorporating technologies that might be required in the future.

Computer Communication Networks↗
PubMed1993

Outreach programs and their effects within the Cancer Information Service network.

Outreach programs have been part of the Cancer Information Service (CIS) program since its outset. The scope of work of the first two CIS contracts gave broad responsibilities to the local offices for public and professional education, responsibilities that were carried out in a diverse fashion with little national direction. As the National Cancer Institute (NCI) Office of Cancer Communications matured and became more directed, the CIS local offices began successfully to implement programs with the Office of Cancer Communications and through intermediary groups. The Partners in Prevention (PIP) effort, launched by NCI in 1984, was the first major national community education program in which all the CIS offices participated. Shortly after the inception of PIP, however, the outreach personnel were deleted from the CIS contracts, due to budget restrictions. When the outreach component was reinstituted in 1990, the structure of the program changed to a catalytic role, working with local media and intermediary organizations to bring the NCI program messages and materials to targeted audiences and memberships. Under the reconfigured CIS network, the outreach program will serve as a resource to both those community institutions that are funded by NCI and those that are not and will be proactive in intermediary development. This paper details the chronology of the program and presents some of the research issues that need to be addressed in the future.

Humans↗
PubMed1994

Integrating health care with information technology: knitting patient information through networking.

This article discusses the importance of integrating health care with information technology to improve the efficiency, effectiveness, and innovation of health care institutions. It is argued that in addition to networking and the selection of a distributed client/server architecture that conforms to open systems protocols, the adoption of standards and the establishment of a management technology infrastructure would provide the necessary steps and mechanisms to allow for a smoother transition to greater sophistication in the development of total systems integration.

Computer Communication Networks↗