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PubMed2005

Evaluating health-care: the perspectives of sufferers with upper limb pain.

BACKGROUND AND AIMS: There is considerable uncertainty over the diagnosis, treatment and management of upper limb pain, which has implications for patient care. Research into patient experiences and evaluation of health-care has been neglected and the study presented here aims to fill this gap. METHODS: A two-staged, mixed methodology was adopted. Phase 1 involved a postal survey of a random sample (n = 2781) of the working age population (25-64) of an area in south-west England. Phase 2 consisted of follow-up, informal face-to-face interviews with a purposive sample of 47 informants identified, according to pre-defined criteria, from the survey sample. RESULTS: Our data showed that concerns about the effectiveness of treatments for alleviating pain were fundamental to users' evaluations of both orthodox and non-orthodox health-care. This took priority over the need for a diagnosis and other information. There was a general recognition that the treatments available were, at least, only partially effective and the pragmatic approach led some to eventually withdraw from both orthodox care and complementary and alternative medicines (CAM). CONCLUSION: Patients' priorities for health-care, in this context, were perceived to involve the provision of treatments which alleviated pain and were safe and painless. Orthodox and non-orthodox care needed to be more closely integrated into primary care services.

Adult↗
PubMedDate not supplied

Gallbladder cancer in a high risk area: morphological features and spread patterns.

BACKGROUND/AIMS: Gallbladder carcinoma is one of the most frequent malignant tumors in Chile. The aim of this paper is to show our experiences in gallbladder carcinoma. METHODOLOGY: Six-hundred-sixty-nine cases of gallbladder carcinoma were included in this prospective study; 557 females (83.5%) and 112 males (16.5%). In 466 cases (70%), diagnosis was carried out in the cholecystectomy sample, 45 cases were partial cholecystectomies and 158 cases were metastases of gallbladder carcinoma. RESULTS: Ninety-eight per cent of the cases were adenocarcinomas, and in 85% of the cases gallstones were observed. Thirty-seven per cent of the primary tumors were macroscopically inapparent. One-hundred-thirty-one cases (29%) were early carcinomas and 323 cases (71%) were advanced carcinomas. A relationship between differentiation grade and infiltration level (p=0.0001) was observed. Lymph-node metastasis was found in 18.5%, 4.5% and 3.3% in the first, second and third lymph-node barriers respectively. Muscular tumors presented no lymph-node metastasis, while in serosal tumors lymph node metastasis reached 62% (p=0.04). Hepatic tumor infiltration was observed in 11%, 19% and 38% of muscular, subserosal and serosal tumors. CONCLUSIONS: The high frequency of inapparent carcinomas, gallstones and inflammatory changes of the vesicular wall are elements that make the pre-operative diagnosis of gallbladder carcinoma difficult. Differentiation grade and infiltration level are the most reliable prognostic factors in gallbladder carcinoma. Lymph-node metastasis or liver tumor infiltration are infrequent in early gallbladder carcinoma.

Adenocarcinoma↗
PubMed2004

Toxicological considerations in the application and interpretation of DNA adducts in epidemiological studies.

This chapter will review a variety of issues related to the use of biomarkers in molecular epidemiological studies. It will draw upon experience gained from related mechanistic research in toxicological studies. This includes important methodological issues that impact on the type of assays that can be used and how these issues affect the selection of the method and the biological sample. It will also address issues affecting the use of biomarkers as measures of exposure and effect, and discuss inferences for causality and the selection of target organ versus surrogate tissues. Combining information from toxicological studies can also aid in the interpretation of epidemiological studies, such as tissues with and without strong biological plausibility and relationships between observed DNA adducts and those that arise from endogenous processes. Finally, it will discuss issues related to important pathways of metabolism and implications of genetic polymorphisms. These critical issues affect both the design and interpretation of molecular epidemiological studies.

Animals↗
PubMedDate not supplied

[Preliminary reports from a psychometric fixation-regression study using the McGill Object Relations Scale].

INTRODUCTION: Psychosexual development is generally assessed clinically, that is to say, in a qualitative manner (Piper and Duncan, 1999). Dymetryszyn, Bouchard, Bienvenu, De Carufel, and Gaston (1997) recently proposed a more quantitative approach based on the overall maturity of the subject's object relations. BACKGROUND: Object-relation maturity is quantified using a profile that defines a score for each stage of an individual's psychosexual development: oral-narcissistic, oral-objectal, anal, phallic pre-oedipal, oedipal, and genital. The McGill Object Relations Scale (MORS) (Dymetryszyn et al., 1997) was adapted (Combalbert, Vautier, Bourdet-Loubère, Favard, & Bouchard, 2002) and then used to obtain the quantitative scores. The relationship between overall object-relation maturity and psychosexual development is complex. Psychosexual development is considered here to be a constant latent dimension. Accordingly, the higher the level of development, the greater the individual's possibility of establishing the object relations that correspond to more evolved stages. Inversely, the lower the level of development, the more the individual is forced to rely on object relations corresponding to earlier stages of development. However, the connection between the object-relation maturity profile and psychosexual development is made even more complex by the existence of the well-known phenomenon of fixation-regression. OBJECTIVES: This article attempts to determine how fixation-regression is reflected in the structure of the profiles of a sample of individuals whose clinical diagnosis suggests probable regression to the anal stage. METHODS: The subjects chosen had borderline personality disorder coupled with either perversion or psychopathy. The data were modelled using an unfolding model. MORS was used on 60 criminal subjects who had been charged with, or convicted of, crimes against persons. The nosographic diagnosis was based on the psychiatric assessment of the prisoners. DSM IV diagnostic criteria were used as a reference to confirm or refute the pronounced diagnosis. Only subjects who met at least five criteria for borderline personality disorder were included in the sample. To assess the reliability of the individual scores, two expert judges blindly scored the 60 protocols. RESULTS: The results obtained with an unfolding model support the hypothesis that the observed ordinates for the oral-narcissistic, oral-objectal, phallic pre-oedipal, oedipal, and genital stages obey a law of synchrony that complies with the postulate of a continuum in psychosexual development. The second main result was the fact that the observed ordinates for the level corresponding to the anal stage could not be described by the model. Furthermore, this finding did not come from a possible scoring error, since inter-judge reliability was 0.93 for that level. DISCUSSION: These results are encouraging for the utilization of MORS as a technique for quantifying object relations. This study on a sample of individuals with a high probability of anal stage fixation-regression suggests that this type of phenomenon can be objectified by means of MORS profiles. However, the present study has some limitations of its own. The main methodological drawback pertains to the subjective aspect of the protocol scoring. The two judges had a great deal of joint experience in scoring other protocols on the MORS grid. This could explain the particularly high inter-judge correlations, compared to the within-class correlations published by Dymetryszyn et al. (1997). CONCLUSION: One cannot rule out the possibility that our analyses would have had different outcomes had other independent judges scored the 60 protocols. Moreover, our results cannot be generalized without replication. A critical test would be to replicate our analyses on similar data, and to examine the unfolding model's behavior on data from a sample of ordinary adults diagnosed as not having strong fixation-regression tendencies. If the synchrony laws defined by the unfolding model are correct, the anal stage should be included in the arc formed by projecting the six stages on the factorial plane of the principal component analysis. Fundamental research based on the psychosexual theory of the libido and supported by statistical data can objectify the vicissitudes of psychosexual development (such as fixation-regression) or developmental differences across groups of individuals. This makes a strong case for pursuing MORS-based investigations.

Adult↗
PubMed2004

[The challenge of applying capture-recapture methodology to diabetes mellitus surveillance in the elderly: lessons from a Brazilian experience].

The purpose of this study was to evaluate the feasibility of establishing a surveillance system for diabetes mellitus in the elderly using data sources on morbidity (hospital and outpatient data) and mortality and the capture-recapture methodology. Log-linear models were adjusted for the entire sample and for gender and age strata. Seven hundred and forty patients were identified in the three combined sources. The model selected for the whole sample when the first linkage strategy was deployed estimated a total of 22,925 cases (90%CI: 11,354-57,269), an implausibly high figure that suggested a strong final negative dependency between sources. Age and gender stratification led to more plausible point values, which nevertheless still lacked precision. The only subset that displayed precise values was the 60-to-69-year-old female stratum (1,290 cases; 90%CI: 779-2,476). The factors that possibly explain these results are: (a) the low number of cases originated in the specialized and more complex facilities in the outpatient data source and (b) overall underreporting of diabetes mellitus cases.

Aged↗
PubMed1988

An epidemiological study of rotavirus diarrhoea in a cohort of Nigerian infants: I. Methodology and experiences in the recruitment and follow-up of patients.

A community-based prospective study was carried out in the city of Ibadan, Nigeria, to determine the epidemiology of rotavirus infection and diarrhoea among children in the first two years of life. Implementation of the proposed study methods was hindered by a number of factors common to large urban areas in developing Africa. These factors included difficulties in recruiting the study sample because of maternal fears, cultural beliefs, and lack of paternal consent. Following recruitment, longitudinal surveillance was made difficult by inefficient telecommunications, a haphazard house numbering system, transportation difficulties, mobility of the population, and lack of incentive for continued participation. Despite these difficulties, 73% of the recruited newborns remained in the study until they reached the age of 12 months. The drop-out rate in the second year of study was higher, largely because fewer incentives could be provided during the second year. This paper reviews the operational considerations of implementing a longitudinal study protocol under these conditions, and discusses the potential impact of these problems and the measures taken to overcome them on the results of this study.

Cohort Studies↗
PubMed1993

Reaching hidden populations of drug users by privileged access interviewers: methodological and practical issues.

The methodological issues surrounding the use of a privileged access interviewer team to generate a network sample of drug users are examined. Traditionally network samples have tended to be used by qualitative researchers. Privileged access interviewing provides a mechanism for the application of a structured instrument to a network sampling model. In doing so some problematic issues in this area for structured methodology are overcome, reduced or standardized. The use of this method is appraised in terms of meeting the methodological requirements of the Drug Transitions study. The practical experiences of our group in using a privileged access interviewer team to interview more than 400 heroin users, many of whom were not in contact with treatment services, are discussed. This method is most appropriate for the quick collection of data, from diverse networks of drug users, by use of a structured instrument. Success is likely to be dependent on careful implementation. The ongoing monitoring of data quality is of particular importance, as is good management practice and the establishment of supportive and non exploitative relationships with the interviewer team.

Adult↗
PubMed1997

Quality of life in breast cancer survivors as identified by focus groups.

Currently, over 1,700,000 women are living with breast cancer in the United States. These long-term survivors of breast cancer are challenged to redirect their energy from issues of cancer treatment and early side effects toward quality of life issues related to long-term survivorship, such as menopause, infertility, fear of recurrence, family distress, and uncertainty. In an attempt to obtain patient perspectives on quality of life and health care issues faced by breast cancer survivors, focus group methodology was utilized in the first year of a 2 year study. The sample was stratified to represent three age groups: < 40 years, 40-60 years, and > 60, and was intended to represent different developmental levels believed to have varying experiences with quality of life and potentially divergent needs following breast cancer diagnosis. Results of these focus groups revealed unique quality of life concerns of breast cancer survivors across four domains of physical, psychological, social, and spiritual well being. Each of these domains yields important implications for future research and clinical practice.

Adaptation, Psychological↗
PubMed1977

Short term variation of human immunoglobulin levels with an estimation of the day to day physiological variability.

In this work serum Ig levels were determined daily for 14 days in 12 subjects, every two days for 14 days in 19 subjects, every week for 1 month in 11 subjects and fortnightly in 11 subjects for 6 months. The serum IgG, IgM and IgA levels were quantitated by the linear plate method. The day-to-day reproducibility of the technique was checked for a period of one months on seven different samples. The mean coefficient of variation in the reproducibility experiments was found to be 4.8% for IgG, 8.2% for IgM and 5.2% for IgA. Since the observed variation in all groups of subjects was found to be higher than the methodological variation, it appears that physiological variability occurs in the serum Ig levels of an individual. No difference was found between the physiological variances of IgG, IgM and IgA observed in the group with daily analysis and those with determinations every two days. The physiological variations increase when longer periods are considered between consecutive determinations, but the variability of IgG and IgA in the group with fortnightly determinations is less important than that observed in the group with weekly analyses. Some evidence is presented indicating a periodic fluctuation of serum IgG and IgA levels with an amplitude of nearly 20% and with a recurrence rate of two weeks.

Adolescent↗
PubMed2004

Development of a robust procedure for assessing powder flow using a commercial avalanche testing instrument.

The objectives of this work were to develop a robust procedure for assessing powder flow using a commercial avalanche testing instrument and to define the limits of its performance. To achieve this a series of powdered pharmaceutical excipients with a wide range of flow properties was characterized using such an instrument (Aeroflow, TSI Inc., St. Paul, MN, USA). The experimental conditions (e.g., sample size, rotation speed) were rationally selected and systematically evaluated so that an optimal standard-operating-procedure could be identified. To evaluate the inherent variability of the proposed methodology samples were tested at multiple sites, using different instruments and operators. The ranking of the flow properties of the powders obtained was also compared with that obtained using a conventional shear-cell test. As a result of these experiments a quick, simple, and rugged procedure for determining the flow properties of pharmaceutical powders in their dilated state was developed. This procedure gave comparable results when performed at four different testing sites and was able to reproducibly rank the flow properties of a series of common pharmaceutical excipient powders. The limits of the test method to discriminate between different powder samples were determined, and a positive correlation with the results of a benchmark method (the simplified shear cell) was obtained.

Chemistry, Pharmaceutical↗
PubMed2002

Characterization of heat-induced lactosylation products in caseins by immunoenzymatic and mass spectrometric methodologies.

Nonenzymatic glycosylation of proteins occur during milk thermal treatment through the Maillard reaction. Immunoenzymatic and spectrometric methodologies were used to investigate caseins modification in samples submitted to different processing. As expected, protein-bound carbonyl content in raw and thermal-treated milks was positively correlated with the severity of the treatment. When immunoblotting and ELISA experiments were carried out either on isolated or whole milk proteins, carbonyl accumulation on caseins and macromolecular aggregates produced by thermal processing was evidenced. A comparative electrospray-mass spectrometry (ES-MS) analysis of different milks allowed verifying the extent of Amadori adducts on the more abundant protein components (alphas1- and beta-casein (alphas1- and beta-CN)). A combined matrix-assisted laser desorption ionization (MALDI)-MS/Edman degradation approach on enzymatic digests identified caseins modification sites. In moderately heat-treated milks, we observed that lactosylation occurred specifically at Lys-34 (alphas1-CN) and Lys-107 (beta-CN); whereas, samples subjected to more severe conditions presented modification at Lys-7, Lys-34, Lys-83, Lys-103, Lys-105, Lys-132 and Lys-193 (alphas1-CN) and at Lys-32, Lys-48, Lys-107, Lys-113 and Lys-176 (beta-CN). Differences in secondary structure of these components was assayed by circular dichroism (CD) spectroscopy.

Animals↗
PubMed1993

Investing in the comeback: parent's experience following traumatic brain injury.

The increasing incidence of survival following traumatic brain injury necessitates a closer examination of long-term care and caregiver issues. A sample of parents and brain-injured offspring from 20 families was explored to identify a qualitatively-generated theory describing the parent's experience following a brain-injured child's return to the home setting. The grounded theory methodology was used during data collection and analysis. All the brain-injured offspring had survived moderate to severe traumatic brain injury, were living with at least one parent, and were aged 17-34 years. Investing in the Comeback is the generated three-phase theory. These three phases--centering on, fostering independence and seeking stability describe the work of parents living with brain-injured offspring.

Adolescent↗
PubMedDate not supplied

Computer-assisted rapid surveys in developing countries.

Health surveys are an important source of population-based data in much of the developing world. Unfortunately, sample surveys often take more time to plan, process, and analyze than is practical, given the information needs of the local decision-makers. Rapid survey methodology (RSM) has been developed to permit health professionals to answer quickly questions about the health status and activities of people at the community level. These answers may be necessary for determining program priorities or for monitoring program activities. Rapid surveys are meant to supplement, rather than replace, information derived from existing sources of vital and health statistics data. RSM combines sample survey methods with contemporary software used in portable, battery-powered microcomputers. The ability to do rapid surveys in developing countries also requires knowledge of how to use appropriate computer hardware and software and how to apply cluster sampling theory in the local environment. RSM was used for the first time in Hlegu Township, Burma, to conduct a health survey of young children. The survey team started the field work on May 4, 1987. Four days later, while still in the field, the data were processed and rapidly analyzed by portable microcomputers for presentation to the local township medical officer and his staff. Within 10 days of starting the field work, we issued a detailed 50-page report of the study findings. This paper provides (a) a description of the components of rapid survey methodology, including the sample survey method, computer hardware, and computer software; (b) the general requirements for portable computer hardware in less developed regions of the world; (c) the procedures for doing a rapid survey; and (d) a summary of our experiences with RSM in Burma.

Developing Countries↗
PubMed1977

Eating in the laboratory: behavioural aspects of the positive energy balance.

A survey is made of a number of experiments conducted in our laboratory over the last six years. Our working hypothesis assumes that positive energy balance, which should not be prematurely defined as the cause of obesity, is itself caused by disturbances in appetite and satiation control which, given certain environmental conditions, can favour the occurrence of obesity. Three points are considered: (1) The hyperphagic reaction as a response to stress. The experimental findings suggest that the hyperphagic reaction is not primarily a biologically determined phenomenon but rather a learned response. The hyperphagic reaction is found more frequently in female and overweight persons. Most children react to stress with a decrease in food consumption. (2) Disturbances of satiation control. The food intake of obese Ss has a linear time function, whilst children and normal weight adults reveal a biological, negatively accelerated satiation curve. (3) Increased responsiveness to external cues. The concept of externality is extended to include the aspect of an internal-external stimulus discrepancy. The findings show that not only manifest obese Ss but also latent obese Ss are characterized by an increased responsiveness to external cues. In three different experiments with the same Ss it could be demonstrated that externality is to a greater or lesser extent independent of the experimental procedure. Finally, methodological aspects are discussed, because in studies on human appetite the possibility exists that experimental procedure, sample composition and laboratory conditions can exert a direct influence on the results.

Adult↗
PubMedDate not supplied

The assessment of physical independence handicap: experience in a community disablement survey.

Two approaches to the ascertainment of physical independence handicap have been explored using data from a survey of disablement in the population. The survey used a two-stage methodology with an initial postal shift to ascertain those with selected disabilities, a stratified random sample of whom were followed-up with an in-depth interview. The first approach to handicap was direct ascertainment of the scale categories by means of a question in the interview schedule. The second approach was to synthesize the scale categories from the answers to interview questions about disabilities in activities of daily living and other relevant factors. The final synthesized algorithm gave a 75% match within one scale point with the direct question and 85% agreement with receipt of attendance allowance, a state benefit paid to those meeting certain criteria for dependence on others. The lessons learned from the work have been incorporated in a revised and expanded scale, which is suggested as a starting point for revision of physical independence dimension of handicap.

Activities of Daily Living↗
PubMed1990

[Measurement of the oncotic pressure of blood (methodology and analysis of errors)].

The authors give their practical recommendations on improving the accuracy of the blood plasma colloid osmometry by standardizing the methods for the collection, treatment, and storage of the samples and the oncometry procedure per se. The recommendations are based on literature data and the authors' experience.

Blood Physiological Phenomena↗
PubMed2004

A double concern: Danish grandfathers' experiences when a small grandchild is critically ill.

This paper addresses grandfathers' lived experiences when a new-born or small grandchild is critically ill. Grandfathers are marginal in nursing research in spite of the fact that intensive care nursing has broadened its perspective from being patient-centred to include family-oriented care. A convenience sample of seven grandfathers was interviewed once. Using Van Manen's phenomenological methodology, the essence of the phenomenon was found to be "a double concern". Main themes in this essential theme were: "Being a father and a grandfather" and "being in the midst of life and death". Six sub-themes expanded and clarified the meaning of these themes. Overall the grandfathers experienced worry and loving concern for parents and grandchildren. In life-threatening situations grandfathers were scared and felt helpless; they were prepared to console and comfort; they always hoped for the best; and they felt like being in the inner circle if the health personnel included them when informing about the infant. Information and presence generally were of importance for the wellbeing of grandfathers. The findings constitute a systematic and thematic description of Danish grandfathers' experiences and therefore add to a family-oriented body of knowledge for intensive care nursing.

Adaptation, Psychological↗