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PubMed1998

An evaluation of practice nurses working with general practitioners to treat people with depression.

BACKGROUND: The diagnosis and treatment of depression constitutes a significant component of a general practitioner's workload. A pilot study has suggested that the practice nurse may have an important contribution to make in the care of patients with depression. AIM: To evaluate an extended role for practice nurses in improving the outcome of depression through two specially-designed interviews running in parallel. METHOD: Two naturalistic, random allocation studies took place concurrently over four months. Study 1 evaluated the effectiveness of standardized psychiatric assessment by a practice nurse and feedback of information to the general practitioner (GP). Study 2 evaluated the above assessment and feedback combined with nurse-assisted follow-up care. Twenty general practices participating in the Medical Research Council General Practice Research Framework took part in the study. Subjects included general practice attenders identified as depressed by their GP. The main outcome measures were a change in Beck Depression Inventory (BDI) scores and in the proportion of patients fulfilling DSM-III criteria for major depression. RESULTS: A total of 577 patients were recruited; 516 [89% (95% CI = 86-92%)] were rated as depressed on the BDI and 474 [82% (95% CI = 79-85%)] met criteria for DSM-III major depression. Altogether, 524 (91%) patients completed follow-up at four months. All groups of patients showed improvement, but no difference in the rate of improvement was shown for the nurse intervention groups. BDI mean scores fell from 18.54 (95% CI = 17.53-20.06) to 11.53 (95% CI = 10.02-13.04) in Study 1, and from 21.01 (95% = CI 20.26-21.86) to 10.62 (95% CI = 9.73-11.51) in Study 2. The proportion of patients fulfilling criteria for DSM-III major depression in Study 1 fell from 80% (95% CI = 73-87%) to 30% (95% CI = 22-38%), and in Study 2 from 80% (95% CI = 76-84%) to 27% (95% CI = 23-31%). Prescription rates of antidepressant medication were higher than expected, ranging between 63% and 76% in the two studies. CONCLUSION: There was an increase in the rate of antidepressant prescription, but no additional benefit could be adduced for patients who received a nurse intervention.

Adolescent↗
PubMed2026

Multi-trait polygenic scores for COPD and COPD exacerbations implicate druggable proteins.

BACKGROUNDWe constructed multi-trait polygenic risk scores (PRSs) predicting chronic obstructive pulmonary disease (COPD) and exacerbations, validated their performance in diverse cohorts, and identified PRS-related proteins for potential therapeutic targeting.METHODSPRSmix+, a multi-trait PRS framework, is used to train a composite PRS (PRSmulti) in COPDGene non-Hispanic White participants (n = 6,647). Associations of PRSmulti with COPD status (GOLD 2-4 vs. GOLD 0 or ICD) and exacerbation frequency were tested in COPDGene African American (n = 2,466), ECLIPSE (n = 1,858), Mass General Brigham Biobank (n = 15,152), and All of Us (n = 118,566). Protein prediction models were applied to GWAS summary statistics from traits contributing to PRSmulti and were validated with proteomic data in COPDGene (n = 5,173) and UK Biobank (n = 5,012).RESULTSPRSmix+ selected 7 traits for PRSmulti. In multivariable models, PRSmulti was associated with COPD status (meta-analysis random effects [RE] OR 1.58 [95% CI: 1.28-1.94]) and exacerbation frequency (meta-analysis RE β 0.21 [95% CI: 0.11-0.31]), with higher effect sizes observed in smoking-enriched cohorts. PRSmulti outperformed traditional single-trait PRS in all tested cohorts. Using protein prediction models, we identified 73 proteins associated with the PRSs that were also validated with measured protein levels in COPDGene and UK Biobank. Of these proteins, 25 were linked to approved or investigational drugs. Notable targets include RAGE/sRAGE, IL1RL1, and SCARF2, all implicated in COPD pathogenesis and exacerbations.CONCLUSIONSMulti-trait PRS improves prediction of COPD and exacerbation risk. Integration with proteomic data identifies druggable protein targets, offering a promising avenue for precision medicine in COPD management.TRIAL REGISTRATIONCOPDGene: ClinicalTrials.gov NCT00608764; ECLIPSE: ClinicalTrials.gov NCT00292552.

Humans↗
PubMed1995

Refining the localization of the PKD2 locus on chromosome 4q by linkage analysis in Spanish families with autosomal dominant polycystic kidney disease type 2.

Autosomal dominant polycystic kidney disease (ADPKD) is a genetically heterogeneous disorder. At least two distinct forms of ADPKD are now well defined. In approximately 86% of affected European families, a gene defect localized to 16p13.3 was responsible for ADPKD, while a second locus has been recently localized to 4q13-q23 as candidate for the disease in the remaining families. We present confirmation of linkage to microsatellite markers on chromosome 4q in eight Spanish families with ADPKD, in which the disease was not linked to 16p13.3. By linkage analysis with marker D4S423, a maximum lod score of 9.03 at a recombination fraction of .00 was obtained. Multipoint linkage analysis, as well as a study of recombinant haplotypes, placed the PKD2 locus between D4S1542 and D4S1563, thereby defining a genetic interval of approximately 1 cM. The refined map will serve as a genetic framework for additional genetic and physical mapping of the region and will improve the accuracy of presymptomatic diagnosis of PKD2.

Adult↗
PubMedDate not supplied

Using a self-care framework for continuing education in gerontological nursing.

Orem's (1985) Self-Care Deficit Nursing Theory (S-CDNT) was used as a framework for an 8-day continuing education course in gerontological nursing provided nine times throughout Missouri. Through the use of case studies, major elements of the theory were not only introduced, but also were related to practice by speakers who focused on self-care abilities and limitations, as well as self-care demands and agency. Evaluation data from each of the locations demonstrated a significant increase in participants' knowledge scores from pre- to posttest (p less than .0001) using the Sign Rank Test. Participants perceived a substantial increase in both knowledge of theory-based gerontological nursing and theory-based practice. Follow-up evaluations after 6 months suggested that the use of S-CDNT as a framework for gerontological nursing content had a lasting impact on the development of a strong nursing perspective and on more positive attitudes toward gerontological nursing.

Education, Nursing, Continuing↗
PubMed2005

Spatial-scale effects on relative importance of physical habitat predictors of stream health.

A common theme in recent landscape studies is the comparison of riparian and watershed land use as predictors of stream health. The objective of this study was to compare the performance of reach-scale habitat and remotely assessed watershed-scale habitat as predictors of stream health over varying spatial extents. Stream health was measured with scores on a fish index of biotic integrity (IBI) using data from 95 stream reaches in the Eastern Corn Belt Plain (ECBP) ecoregion of Indiana. Watersheds hierarchically nested within the ecoregion were used to regroup sampling locations to represent varying spatial extents. Reach habitat was represented by metrics of a qualitative habitat evaluation index, whereas watershed variables were represented by riparian forest, geomorphology, and hydrologic indices. The importance of reach- versus watershed-scale variables was measured by multiple regression model adjusted-R2 and best subset comparisons in the general linear statistical framework. Watershed models had adjusted-R2 ranging from 0.25 to 0.93 and reach models had adjusted-R2 ranging from 0.09 to 0.86. Better-fitting models were associated with smaller spatial extents. Watershed models explained about 15% more variation in IBI scores than reach models on average. Variety of surficial geology contributed to decline in model predictive power. Results should be interpreted bearing in mind that reach habitat was qualitatively measured and only fish assemblages were used to measure stream health. Riparian forest and length-slope (LS) factor were the most important watershed-scale variables and mostly positively correlated with IBI scores, whereas substrate and riffle-pool quality were the important reach-scale variables in the ECBP.

Agriculture↗
PubMed2000

Validity of annoyance scores for estimation of long term air pollution exposure in epidemiologic studies: the Swiss Study on Air Pollution and Lung Diseases in Adults (SAPALDIA).

In air pollution epidemiology, estimates of long term exposure are often based on measurements made at one fixed site monitor per area. This may lead to exposure misclassification. The present paper validates a questionnaire-based indicator of ambient air pollution levels and its applicability to assess their within-area variability. Within the framework of the SAPALDIA (Swiss Study on Air Pollution and Lung Diseases in Adults) cross-sectional study (1991), 9,651 participants reported their level of annoyance caused by air pollution on an 11-point scale. This subjective measure was compared with annual mean concentrations of particulate matter less than 10 microm in diameter (PM10) and nitrogen dioxide. The impact of individual factors on reported scores was evaluated. Nitrogen dioxide concentrations at home outdoors (measured in 1993), smoking, workplace dust exposure, and respiratory symptoms were found to be predictors of individual annoyance scores. Regression of population mean annoyance scores against annual mean PM10 and nitrogen dioxide concentrations (measured in 1993 and 1991, respectively) across areas showed a linear relation and strong correlations (r>0.85). Analysis within areas yielded consistent results. The observed associations between subjective and objective air pollution exposure estimates suggest that population mean scores, but not individual scores, may serve as a simple tool for grading air quality within areas. Reported annoyance due to air pollution should be considered an indicator for a complex environmental condition and thus might be used for evaluating the implementation of environmental policies.

Adolescent↗
PubMed2005

Enhancing clinician communication skills in a large healthcare organization: a longitudinal case study.

OBJECTIVE: This article describes the approach taken over the past 16 years by one large healthcare organization, Kaiser Permanente (KP), to enhance the clinical communication and relationship skills of their clinicians. METHODS: The centerpiece of KP's approach has been the creation and dissemination of a unifying clinician-patient communication (CPC) framework for teaching and research called the Four Habits Model. RESULTS: The Model has served as the foundation for a diverse array of KP programs. Sustained improvement in patient satisfaction scores has been demonstrated. Clinician-patient communication training has become a well-established component of professional development in KP. DISCUSSION: Enhancing clinicians' communication with patients is a complex task requiring planning and organizational commitment. Factors that have contributed to the success and lessons learned from incorporating clinician communication skills across the organization are described. CONCLUSION: The KP experience attests to the feasibility of bringing the vital skills of effective communication to large numbers of busy clinicians. PRACTICE IMPLICATIONS: Healthcare practices wishing to enhance clinician-patient communication skills should consider using a consistent teaching model, ensuring strong sponsorship from leaders, and emphasizing clinician satisfaction in the design of programs.

California↗
PubMed1997

Self-efficacy of senior baccalaureate nursing students and preceptors.

The purpose of this descriptive study was to investigate the effects of a senior clinical preceptorship experience on the self-efficacy levels of senior baccalaureate nursing students and their preceptors. Bandura's (1977, 1986) theoretical model of self-efficacy provided the conceptual framework. A non-probability convenience sample of 74 students and preceptors completed the self-efficacy pre-questionnaire; 47 the post-questionnaire. Students' overall self-efficacy scores increased significantly (M = 3.46/4.00; P < or = 0.01) following the 12-week preceptorship. Preceptors' post-scores, although not significantly increased, remained high, suggesting confidence in their role. Continuation of preceptorship programs is recommended.

Adult↗
PubMed1981

Does the right hemisphere age more rapidly than the left?

It has been hypothesized that the right hemisphere ages more rapidly than the left, but there have been no direct empirical studies aimed at confirmation of that hypothesis. Within the framework of a cross-sectional design, 1,247 subjects, divided into six age groups (20's-70's), were tested with a modified Halstead-Reitan battery. The test scores were analyzed with the Russell, Neuringer, and Goldstein localization key, with each case being evaluated for number of right- and left-hemisphere points. It was found that there was a significant increase in right-hemisphere points with age, with a significant, but less pronounced, effect for left-hemisphere points. The same effect was found in a subsample of nonbrain-damaged medical and psychiatric patients. It was also established on the basis of neurological diagnostic evidence that there was not a coincidental increase in structural lateralized brain damage with age in the present sample. The results were discussed in terms of possible differences in functional organization of the two hemispheres, the general conclusion being that the right hemisphere ages in a different manner than does the left.

Adult↗
PubMed2005

Using a Bayesian latent growth curve model to identify trajectories of positive affect and negative events following myocardial infarction.

Positive and negative affect data are often collected over time in psychiatric care settings, yet no generally accepted means are available to relate these data to useful diagnoses or treatments. Latent class analysis attempts data reduction by classifying subjects into one of K unobserved classes based on observed data. Latent class models have recently been extended to accommodate longitudinally observed data. We extend these approaches in a Bayesian framework to accommodate trajectories of both continuous and discrete data. We consider whether latent class models might be used to distinguish patients on the basis of trajectories of observed affect scores, reported events, and presence or absence of clinical depression.

Bayes Theorem↗
PubMed2002

Reliability and validity of the Satisfaction with Hospital Care Questionnaire.

OBJECTIVE: To establish the psychometric properties of the Satisfaction with Hospital Care Questionnaire (SHCQ) for measuring patient satisfaction and evaluations of hospital care quality. DESIGN AND PARTICIPANTS: Patients (n = 275) and staff members (n = 83) of four hospital wards completed the 57-item SHCQ addressing 13 aspects of care. Staff members completed the SHCQ from the patient's perspective. The data were analyzed within the framework of generalizability theory. MAIN OUTCOME MEASURES: Generalizability coefficients (GCs) and standard errors of measurement (SEs). RESULTS: GCs indicating differentiation among patients with different overall levels of satisfaction (SHCQ mean scores) were high (> 0.90). GCs indicating differentiation among patients as to satisfaction with aspects of care (SHCQ scale scores) were generally satisfactory (> 0.75) to high. Patients agreed well on overall level of hospital care quality (GCs > 0.90) and differentiated reliably (GCs > 0.80) among aspects of care. No differentiation among wards was found with respect to quality of care. Patients and staff agreed to a considerable extent (0.78) on ranking the SHCQ items on care quality, but staff ratings were lower. Reliability and validity of patients' evaluations of quality of hospital care varied according to aspect of care. CONCLUSIONS: The SHCQ reliably establishes both patient satisfaction and overall quality of hospital care. Whereas patients' ratings may be too lenient, their ranking of the items on care quality appears to be valid, and is therefore suitable for monitoring and improving hospital care. Within scales, however, results should be interpreted more cautiously: for some items, patients cannot really tell the difference in quality of care.

Academic Medical Centers↗
PubMed1992

Description of learned response to chronic illness: depressed versus nondepressed self-help class participants.

The purpose of this study was to describe the effectiveness of a community-based health-promotion program that was collaboratively designed and that is currently being implemented by lay persons who have the diagnosis of systemic lupus erythematosus (SLE) and by health professionals. Two groups of SLE self-help course participants contributed data for this theory-guided preexperimental program impact study. Braden's self-help model provided the theoretical framework. The variables addressed were severity of illness, limitations, uncertainty, enabling skill self-efficacy, self-worth, and life quality. The groups consisted of 35 subjects having low depression scores (less than or equal to 77) and 37 with high depression scores (greater than or equal to 272) on a measure having a possible range of scores from 0 to 400. Data were collected at three points: at the beginning of class 1, after class 7 (7 wks later), and two months after completion of the course. A group (2) by time (3) by measures (10) MANOVA analysis procedure was used with a follow up univariate F test and Newman-Keuls multiple comparison procedure. Significant change was evident for the level of depression group and for three interaction effects of group X time, group X measure, and group X time X measure.

Adult↗
PubMed2002

Application of a rating system to state clean indoor air laws (USA).

OBJECTIVE: To develop and implement a system for rating state clean indoor air laws. DESIGN: The public health interest of state clean indoor air laws is to limit non-smoker exposure to environmental tobacco smoke (ETS). Current estimates of health risks and methods available for controlling ETS provided a framework for devising a ratings scale. An advisory committee applied this scale to each of seven site specific smoking restrictions and two enforcement related items. For each item, a target score of +4 was identified. The nine items were then combined to produce a summary score for each state. A state that achieved the target across all nine items would receive a summary score of 36 points and be eligible to receive an additional 6 points for exceeding the target on six of the nine items, resulting in a maximum summary score of 42 points. Individual scores were also adjusted to reflect state level preemption measures. Each state's law was evaluated annually from 1993 through 1999. SETTING: USA. MAIN OUTCOME MEASURE: A summary score measuring the extensiveness of the state's clean indoor air law. RESULTS: State laws restricting smoking in the seven individual locations of interest were relatively weak. The overall mean score across the location restrictions ranged from 0.72 in 1993 to 0.98 in 1999. Mean scores were higher for the enforcement items than for the location restrictions. Summary scores ranged from 0 to 20 in 1993 and 0 to 31 in 1994 through 1999. Average summary scores ranged from 8.71 in 1993 to 10.98 in 1999. By the end of 1999, scores increased for 22 states; however, between 1995 and 1997 there were no changes in the summary scores. Three states scored zero points across all years. From 1993 through 1999, there was a 41% increase in the number of states that had in place state level preemption measures. CONCLUSION: The number of newly enacted state clean indoor air laws has remained relatively stagnant since 1995. With a few exceptions, as of the end of 1999, progress in enacting state laws to meet specified public health targets for reducing exposure to ETS was relatively low. Thus, state laws in the USA provide, on average, only minimal protection in specified areas and, given the increase in preemption, are increasingly undermining those passed in localities.

Advisory Committees↗
PubMed2006

Market and plan characteristics related to HMO quality and improvement.

Existing research on health plan performance examines whether variation in plans' scores is related to enrollee and health plan traits, primarily using cross-sectional research designs. This study extends that literature by incorporating data on market characteristics using a longitudinal framework. We estimate multivariate growth models that relate plan performance on standard measures to market and HMO characteristics using an unbalanced panel of data for 1998 to 2002. We find that HMO competition is not associated with better performance or greater rates of improvement in performance on the HEDIS chronic care measures. HMO penetration, on the other hand, is positively associated with HEDIS performance in several of the chronic care process-and-outcomes measures but not with a greater rate of improvement through time. Our analysis indicates that a significant percentage of the unexplained variation in quality improvement is because of permanent, unobserved plan-level characteristics that future research should strive to identify.

Health Maintenance Organizations↗
PubMed2001

Student outcomes of the healing web: evaluation of a transformative model for nursing education.

The Healing Web is a transformative nursing model, bridging gaps between nursing education and practice, baccalaureate and associate degree education, and public and private educational institutions. It is an educational prototype in which nursing students experience collaborative clinical practice in a differentiated practice model. Based on the Healing Web framework, it was hypothesized that the educational partnership model would influence specific student competencies (i.e., caring abilities, leadership skills, assertiveness, and professional nursing behaviors). Students in the Healing Web program scored higher in caring knowing, caring courage, leadership, and assertiveness than their counterparts who participated in traditional clinical experiences. Students identified collaboration, partnership with students and staff, and learning to value different nursing roles as primary benefits of the experience. Findings support the contribution of Healing Web experiences to selected student outcomes, but the research is limited by instrumentation, small numbers, and the question of adequate "dosage." Future research will emphasize qualitative methods to explicate significant concepts more completely.

Analysis of Variance↗
PubMed2006

Sex inequalities in access to care for patients with diabetes in primary care: questionnaire survey.

BACKGROUND: Health experiences differ between men and women. The health services have focused their attention on gynaecological health problems in women, however women with non-gynaecological health problems could be unintentionally neglected. Given the increased prevalence of diabetes, the healthcare needs and experiences of women with diabetes are increasing. AIM: To determine the extent of sex inequalities in access to care for diabetes in primary care. DESIGN OF STUDY: Cross-sectional population-based questionnaire study. SETTING: Twenty-three general practices spread through 23 different primary care trusts in the former Trent Region, UK. METHOD: The study consisted of a random sample of 1,673 patients with diabetes. Outcomes measured were odds ratios adjusted for age for measures of physical access to the GP's surgery; ease of obtaining appointments; access to primary care professionals; levels of routine diabetes care received; barriers to physical activity, problems eating and psychological distress as measured by the 18 score Diabetes Health Profile. RESULTS: Women were less likely than men to report that they had talked to their GP or practice nurse about their diabetes in the previous 12 months and were less likely to report that they were able to book routine appointments at convenient times. Almost 40% of all patients with diabetes reported difficulty in visiting the GP's surgery for their diabetes care, and women were more likely to report difficulties in visiting the surgery than men. Women were more likely than men to be afraid to go out alone (7.9% versus 3.6%) and more likely to be housebound (6.8% versus 2.4%). Women had significantly higher scores for eating problems and barriers to physical activity than men. CONCLUSIONS: Women report more problems with access to diabetes care than men. If the ambitions of the National Service Framework are to be met, then positive action needs to be taken to improve access to care for women with diabetes.

Aged↗
PubMed1991

[Alcohol in pregnancy].

In 1978, an investigation on alcohol consumption by women, before and during pregnancy, was carried out at Clinic for Gynecology and Obstetrics of the Medical Faculty in Novi Sad. This investigation studied 350 women during their stay in the hospital, after delivery and their newborns regarding birth weight, prematurity, stillbirths, operative interventions for delivery (vacuum extraction, Caesarean section, vaginal breech) and hormonal therapy during pregnancy. Ten years later, in 1988, at the same clinic, a similar investigation took place within the framework of the "Drugs and Pregnancy" project of the WHO Regional Bureau for Europe which included the study of 297 women and their newborns (average birth weight and Apgar-score study). Newborns whose mothers had been drinking before and during pregnancy had lower birth weight and length compared to the newborns whose mothers had never consumed alcohol, but these differences are not of statistical significance (X2 = 2.504; X2 = 0.922). There is no statistical significance either in the incidence of prematurity (X2 = 0.461) or in the incidence of operative interventions during delivery (X2 = 0.632). The stillbirth rate was significantly higher with a 4.3% incidence (p less than 0.05) in women consuming alcohol in contrast to the non-alcohol consumption group (0.5%). More women who had been drinking before and during pregnancy had been receiving hormonal therapy during pregnancy (X2 = 8.195 p less than 0.01). Nowadays, more women drink alcohol (60.6%) than ten years ago (48%) (X2 = 13.874 p less than 0.01). Also, nowadays more women drink during pregnancy (47.5%), than in 1978 - 27.7% (X2 = 26.979 p less than 0.01).

Alcohol Drinking↗
PubMedDate not supplied

[The fragmentation of representational space in schizophrenia].

Existent neurocognitive models of schizophrenia converge towards a core of impairments involving working memory, context processing, action planning, controlled and intentional processing. However, the emergence of this core remains itself difficult to explain and more specific hypotheses do not explain the heterogeneity of schizophrenia. To overcome these limits, we propose a new paradigm based on representational theory from cognitive science. Some recent developments of this theory enable us to describe a subjective universe as a representational space which is displayed from memory. We outline a conceptual framework to construct such a representational space from analogical -representations that can be activated in working memory and are connected to a network of symbolic structures. These connections are notably made through an analytic process of the analogical fragments, which involves the attentional focus. This framework allows us to define rigorously some defense processes in response to traumatic tensions that are expressed on the representational space. The fragmentation of representational space is a consequence of a defensive denial based on an impairment of the analytic process. The fragmentation forms some parasitic areas in memory which are excluded from the main part of the representational space and disturb information processing. The key clinical concepts of paranoid syndromes can be defined in this conceptual framework: mental automatism, delusional intuition, acute destructuration, psychotic dissociation, and autistic withdrawal. We show that these syndromes imply each other, which in return increases the fragmentation of the representational space. Some new concepts emerge naturally in this framework, such as the concept of "suture" which is defined as a link between a parasitic area and the main representational space. Schizophrenia appears as a borderline case of fragmentation of the representational space. This conceptual framework is compatible with numerous etiological factors. Multiple clinical forms can be differentiated in accordance with the persistence of parasitic areas, the degree of fragmentation, and the formation of sutures. We use this approach to account for an empirical study concerning the analysis of analogical representations in schizophrenia. We used the Parallel Visual Information Processing Test (PVIPT) which assesses the analysis of interfering visual information. Subjects were asked to connect several small geometric figures printed on a transparency. The transparency was displayed above four photographs which were the interfering material. Then, subjects completed three tasks concerning the photographs: a recognition task, a recall task, and an affective qualification task. Using a case-by-case study, this test allows us to access the defense processes of the subjects, which is not possible with the usual methods in cognitive psychopathology. Twelve clinically-stable schizophrenic subjects participated in the study which also included a self-assessment of alexithymia by the Toronto Alexithymia Scale. We obtained 2 main results: (a) creation of items in recall or false recognition by 8 subjects, and (b) lack of the usual -negative correlations between the alexithymia score and the recall, recognition and affective qualification scores in the PVIPT. These 2 results contrast with what has been previously observed for alexithymia using the same methodology. The result (a) confirms an interfering activation in schizophrenic memory, which can be interpreted in our framework as indicative of parasitic areas. The creation of items suggests the formation of sutures between the semantic content of photographs and some delusional fragments. The result (b) suggests that the apparent alexithymia in schizophrenia is a defense against interfering activation in parasitic areas. We underline the interest of individual protocols to exhibit the dynamic interplay between an interfering activity in memory and a defensive flattening of affects.

Affective Symptoms↗