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PubMed2000

[The Menopause Rating Scale (MRS II): methodological standardization in the German population].

The Menopause-Rating-Scale (MRS I) was used in clinical practice since 1992. The physician had to document the severity of 10 important estrogen-related climacteric symptoms. Practical experience and a critical methodological evaluation justified a revision: The MRS I should be converted into a self-administrative rating scale, the wording somewhat optimized, the layout adjusted and one item added. The standardization of the new scale (MRS II) was performed in a representative sample of the German population aged 45-60 years. Three dimensions were extracted from the menopausal symptoms using multivariate statistical techniques: somato-vegetative, psychological, and urogenital complexes of symptoms. A simple evaluation scheme was developed for the MRS II by summing up scoring points. Reference values for the frequency of 4 levels of intensity of complaints in the population were defined and provided for purposes of comparison. The MRS II meets a high methodological standard as an instrument standardized in the population. Moreover, it is convenient to apply this instrument in daily practice in order to quantitate variation of menopausal complaints.

Climacteric↗
PubMed2001

Epidemiological survey of mental disorders and knowledge attitude practice upon mental health among people in Bangkok Metropolis.

To find the prevalence of 8 mental disorders and study knowledge, attitude, practice (KAP) upon mental health among people in Bangkok Metropolis a cross sectional, descriptive community survey was conducted. Two thousand, nine hundred and forty eight samples aged 15-60 years were selected by a multistage simple random sampling technique. Data collection was made by qualified interviewers who had experience in mental health care and had been trained to use the questionaires. The questionaires had been modified from DSM-IV and CIDI that had been tested for good validity and reliability. The survey methodology was divided into 2 stages, screening and diagnosis. The results showed that the life time prevalence of mental disorders were; schizophrenia (1.3%), mood disorders; manic episode (9.3%), major depressive episode (19.9%), dysthymia (1%), anxiety disorders (10.2%), mental retardation (1.8%), epilepsy (1.3%), suicidal idea (7.1%), drug and substances use disorders (11.2%), and alcohol use disorders (18.4%). Knowledge score was good, attitude was fairly good, practice was still weak in promotion and prevention aspects. As such, this study was used as a pattern to conduct a national survey in 14 provinces all over Thailand and the results are being summarized. The information is similar to the Global Burden of Diseases. We produced a national training program on "Detection and Management of Depression" for Primary Care Physicians that was, a 2 days' workshop. Other national programs promoting prevention and control have also been set up.

Adolescent↗
PubMed2002

Legal, ethical and human-rights issues related to the storage of oral history interviews in archives.

This paper provides some personal reflections that explore the legal, ethical and human rights issues of conducting oral history interviews with elderly retired nurses. The interviews are part of a research study into the history of nursing in the West Yorkshire towns of Halifax and Huddersfield, UK, between 1870-1960. The merit of this research is that it provides a unique account of the development of nursing and can enrich our understanding of the implications for present-day practice within the fast changing world of the 21st century. A literature review identified a 'gap in knowledge' of how and why local nursing developed. This study proposes to bridge this gap and provide an investigative account of the important issues for local nursing. The two methodological approaches are analysis of the primary and secondary documentary archival sources, and oral history interviewing of retired nurses. 'Word of mouth' or snowball sampling identified over 300 potential interviewees ranging from 65-97 years old. A final sample of 21 representative of location, age and career experience was selected to ensure a strategic purposive sample. The resultant audiotapes and transcripts will be stored in the university's archives. The main focus of the paper will be the legal, ethical and human rights issues of storing interviewees tapes/transcripts in archives. Reflections on these problems and attempts to overcome them have been provided. These are centred on the issue of whether to edit the tapes and/or transcripts. Arguments are provided for and against editing and potential practical solutions to some of the practical issues are identified. The main aim is to identify methods that will enable the protection of those who may be harmed in anyway by the tapes or transcripts been open to public access.

England↗
PubMed1996

Strategies for crystallizing membrane proteins.

Crystallizing membrane proteins remains a challenging endeavor despite the increasing number of membrane protein structures solved by X-ray crystallography. The critical factors in determining the success of the crystallization experiments are the purification and preparation of membrane protein samples. Moreover, there is the added complication that the crystallization conditions must be optimized for use in the presence of detergents although the methods used to crystallize most membrane proteins are, in essence, straightforward applications of standard methodologies for soluble protein crystallization. The roles that detergents play in stability and aggregation of membrane proteins as well as the colloidal properties of the protein-detergent complexes need to be appreciated and controlled before and during the crystallization trials. All X-ray quality crystals of membrane proteins were grown from preparations of detergent-solubilized protein, where the heterogeneous natural lipids from the membrane have been replaced by a homogeneous detergent environment. It is the preparation of such monodisperse, isotropic solutions of membrane proteins that has allowed the successful application of the standard crystallization methods routinely used on soluble proteins. In this review, the issues of protein purification and sample preparation are addressed as well as the new refinements in crystallization methodologies for membrane proteins. How the physical behavior of the detergent, in the form of micelles or protein-detergent aggregates, affects crystallization and the adaptation of published protocols to new membrane protein systems are also addressed. The general conclusion is that many integral membrane proteins could be crystallized if pure and monodisperse preparations in a suitable detergent system can be prepared.

Animals↗
PubMed1998

Contextualizing critical care family needs through triangulation: an Australian study.

Family needs and concerns within the critical care context have been thoroughly explored from the quantitative perspective utilizing the Critical Care Family Needs Inventory (CCFNI). Nursing interventions have been designed on the basis of the findings from these studies. However, while the CCFNI would seem to encompass all the possible needs of families with a critically ill loved one, at no time were the family members themselves consulted at length in regard to the development of the instrument, or in any subsequent validation studies. Individual reality generates the variables that are measured in a needs analysis, and the family member experiences encompass dimensions that are not easily assessed by quantification. In fact the unique experiences of family members underpin their perception of need. Methodological triangulation formed the basis for this study to determine the degree of confirmation (or otherwise) between family member respondents to the CCFNI (n = 105) and those participating in an interview (n = 26) designed to explore needs and experiences. The qualitative data served the purpose of completeness by providing a more contextual representation of needs and therefore greater depth of understanding of the whole construct. The results indicate that, while there were many areas of convergence between the two samples, there were also areas of diveregence. Two major needs emerged from the interviews that are not represented on the CCFNI: the need of family members to provide reassurance and support to the patient; and their need to protect (others as well as the patient). A more complete understanding of family needs was obtained through the contextualization of their experiences.

Adolescent↗
PubMed2001

Do high-threat life events really provoke the onset of psychiatric disorder in children?

Studies on adults have suggested important effects of stressful life events in provoking onset of psychiatric disorder. Only a few comparable studies on children exist, and their results are inconsistent in relation to definite timing effects. Meeting some important methodological challenges overlooked in the past research, this study set out to examine whether the onset of psychiatric disorder in children was more likely to occur shortly after a severe event, as compared with other times. The sample consisted of 99 consecutive, newly referred patients, aged 8-16 years, from a child psychiatry service in London. PACE (Psychosocial Assessment of Childhood Experiences), an investigator-based, standardized interview was used to assess the timing and impact of life events over the preceding 18 months. CAPA (Child and Adolescent Psychiatric Assessment), a standardized diagnostic assessment, was used to establish the presence, timing, and consequential impairment of child and adolescent psychiatric symptoms. In a within-subject, over-time design, conditional logistic regression techniques were employed to examine whether risk of onset was greater in the 9 weeks following a high-threat life event than at other times. There was a small but statistically significant association between child-reported events and child-reported onset; the associations with parent-reported onset were inconsistent. Parent-reported events failed to relate to onset by either source. The study offers only quite limited support to the notion of negative life events provoking onset of psychiatric disorder in children and young people. The possible reasons for this are discussed, together with important conceptual and methodological issues to problems of defining onset, and the choice of appropriate designs for data analysis.

Adolescent↗
PubMed2005

The utility of geographic information systems (GIS) in rapid epidemiological assessments following weather-related disasters: methodological issues based on the Tropical Storm Allison Experience.

Flooding is the most common natural disaster worldwide, and is the leading cause of weather-related deaths in the United States. Tropical storm Allison hit landfall near Galveston, Texas on June 5, 2001, causing the most severe flood-related damage ever recorded in the Houston metropolitan area. This devastating storm dumped 37 in of rain in 24h on parts of the city, killing 22 people and causing more than $5 billion in damage. The main goal of the public health response to tropical storm Allison was to rapidly evaluate the immediate health needs of the community. Geographical information system (GIS) technology was instrumental to the timeliness of this effort. We conducted a rapid needs assessment in the areas most affected by flooding using modified cluster sampling facilitated by GIS methodology. Of the 420 households participating in the survey, we found a significant increase in illness (OR, 5.1; 95% CI, 2.7-9.4), injuries (OR, 4.8; 95% CI, 1.9-12.8), and immediate health needs (OR, 3.3; 95% CI, 1.7-6.1) among persons living in flooded homes compared to non-flooded homes. There were 60 households reporting serious damage, 24 of which were outside the 500-year flood plain. We also obtained reliable estimates of the extent of damage and household needs to help guide relief efforts. These findings underscore the usefulness of rapid needs assessment as a tool to identify actual health threats and to facilitate delivery of resources to those with the greatest and most immediate need. Our ability to swiftly plan and implement a rapid needs assessment over a large geographical region within 1 week following the damage would not have been possible without the utilization of GIS methodology and the availability of skilled personnel and timely data resources.

Disaster Planning↗
PubMed2000

Thin-layer technology: tempered enthusiasm.

With the introduction of new technologies we often see a pattern of development. As a useful technology moves into the public sector there is often an episode of wild enthusiasm and uncritical acceptance, followed by a time of progressive disillusionment. However, with time and experience, a proper place for the method becomes established. Thin-layer technology is certainly an improvement and solves many of our preanalytical problems; however, it introduces some difficulties of its own. The rounding up of cells in liquid fixation makes cells of high-grade lesions smaller than they would be on a conventional preparation. The abnormal cells are often separated. For both of these reasons they may be overlooked. Furthermore, benign glandular cells can take on an ominous appearance. These differences in conventional and thin-layer morphology are proving to be a fruitful area for publication. Thin-layer technology cannot be all things to all situations, and this is especially true in body fluid and fine-needle cytomorphology. In our experience, while occasionally helpful, the thin-layer technique should not be the primary method for diagnosis in nongynecologic specimens. Time and effort would be better spent on trying to educate select clinicians on how to obtain better samples than to totally convert to thin-layer methodologies. Regarding FNA, the patient is best served when the pathologist is directly involved with the initial sample acquisition. Reimbursement is available for immediate sample interpretation, so funding should be available for staffing if an institution has the interest. For the record, we believe that liquid fixation and thin-layer methodology should not be the primary method for FNA, unless circumstances are absolutely prohibitive. An important problem with thin-layer technology lies with its added cost. Thin-layer interposes another series of steps into cytologic sample preparation. There is additional labor, additional time, another machine in the laboratory, and the significant cost of the reagents. In a situation where the price of a cytologic test is already close to margin, costs of the vial, filter, and preservative throw the test into unprofitability. Price structures have to be changed. Some institutions are waiting until there is more competition in the market and costs decrease. Alternatively, a lot of effort has been expended in trying to get government and other groups to accept the additional costs of the new test for gynecologic examinations, and many payers seem to be falling in line to accept the methodology, secondary to clinician and patient demand. Basic questions about ancillary technologies and gynecologic samples remain to be answered. Cytology is big business. Every year a significant segment of the population has a Pap smear performed. Hardly any other laboratory test can claim the volume of activity of the cervical smear. Any business that can hook into that market stands to prosper. Since the Pap smear has some well-publicized problems, the door is open for technology to nibble away at a few percentage points of false negativity. We are far from the first to ask if we can afford the incremental improvements of thin-layer and other ancillary technologies. There is a conundrum. Government, insurance companies, and our administrators are calling for us to hold back cost increases in medical care. Alternatively, these new technologies, patient demand for the perfect test, increased regulatory oversight, and legal challenges are increasing the cost of doing business. We do not know how to respond to the often-voiced fear that these ancillary technologies increase the cost of cytology services beyond some patients' ability to pay. In this confusion, we do know that we should use the best test to get the most accurate answer for our patients. In selected scenarios this may mean that we will have to accept the cost and follow thin-layer technology.

Breast Neoplasms↗
PubMed1991

Bringing social structure back into clinical decision making.

Although research in the past twenty years has resulted in an increasingly sophisticated understanding of clinical decision making processes, the dominant approach in this area of inquiry remains limited. Most studies emphasize normative models of how decisions ought to be made, others attempt to describe physicians' thinking, but few take the social context of decision making systematically into account. Research models typically assume that physicians are autonomous professionals practicing in socially insular clinical settings--an approach that is consistent with classic formulations of the social structure of medical practice, but they ignore 30 years of sociological research on research on patient-physician relationships and major historical changes in the structure of medical practice. Eisenberg's still timely advice to students of clinical decision making--that they need to describe decision making in the context of 'sociologic influences' (including patient, physician and practice setting characteristics)--is expanded in the present discussion. Recent studies are reviewed, highlighting important dimensions of social structure impinging on physicians' decision making. Findings indicate that the process of clinical decision making is likely influenced by patients' age, gender, socioeconomic status, and race, physicians' professional training and experience, as well as by larger structural features of organized clinical settings. Our review of these studies on the social context of clinical decision making, however, reveals major methodological limitations including those inherently imposed by secondary data analysis, normative approaches, written case vignettes, small, non-random samples and the inadequate control of confounding influences. We present a feasible, alternative research strategy, built on a factorial experimental design. Illustrative findings indicate how complex social structural influence on clinical decision making may be disentangled in an unconfounded manner.

Age Factors↗
PubMed1984

Pethidine binding in plasma: effects of methodological variables.

Several methodological variables potentially influencing the plasma protein binding of [14C]-pethidine in vitro were investigated using equilibrium dialysis and rigorous pH control. Ionic strength of buffer, pethidine concentration and 21 days of plasma samples frozen to -8 degrees C did not affect the outcome of the binding experiments. Unbound fraction decreased with increasing temperatures between 25 degrees C and 37 degrees C. Unbound fraction decreased with increased pH between pH 7.0 and 8.0; the mean unbound fraction at an equilibrium pH of 7.4 and at 37 degrees C was 0.58 (s.d. 0.03, n = 58). It is likely that previous reports of pethidine unbound fraction as being between 0.2 and 0.4 represent artefacts caused by inadequate pH control during dialysis.

Blood Proteins↗
PubMed2006

Professional competence: factors described by nurses as influencing their development.

AIM: To discuss the results of a study that explored factors that may influence competence development. BACKGROUND: Competence, a controversial issue in health care settings, affects many aspects of the nursing profession, including education, practice and management. Although a number of research and discussion papers have explored the issue, in particular the meaning and assessment of nursing competence, to date little research has explored factors identified by nurses themselves as influencing their development of professional competence. METHODS: A purposive sample of 27 registered nurses was recruited from two university-affiliated hospitals. Data collection was by tape-recorded semi-structured interviews. Interviews were transcribed verbatim and analysed according to the qualitative methodology of content analysis. FINDINGS: Six descriptive categories were identified from the data: experience, opportunities, environment, personal characteristics, motivation and theoretical knowledge. CONCLUSIONS: The findings suggest that the factors influencing the process of developing professional competence in nursing extend across personal and extra-personal domains. An understanding of these factors may enhance the ability of nursing managers and educators to enable student and qualified nurses to pursue effective competency development pathways to prepare them to provide a high standard of care. These findings, which may have important implications for nursing practice, management and education, are being further tested in a larger study.

Attitude of Health Personnel↗
PubMed2003

IDEG6: a web tool for detection of differentially expressed genes in multiple tag sampling experiments.

Here we present a novel web tool for the statistical analysis of gene expression data in multiple tag sampling experiments. Differentially expressed genes are detected by using six different test statistics. Result tables, linked to the GenBank, UniGene, or LocusLink database, can be browsed or searched in different ways. Software is freely available at the site: http://telethon.bio.unipd.it/bioinfo/IDEG6_form/, together with additional information on statistical methodologies.

Database Management Systems↗
PubMed2005

Genetic variability in the group of patients with congenital hip dislocation.

Our study of genetic homozygosity degree includes an analysis of the presence, distribution and individual combination of 20 selected genetically controlled morpho-physiological traits in the group of patients (N = 93) with congenital hip dislocation (CDH) and in control sample consisting of school children from Belgrade (N = 200). Assuming that CDH is genetically controlled disease, we made a hypothesis that an increased homozygosity level, as well as the changed variability among the patients, could be population-genetic parameter for the prediction of the illness. Taking into consideration our experience, as well as the experience of numerous scientists who studied the nature of the inheritance of mono- and oligo-genically controlled qualitative traits, we applied a methodology to estimate the proportion of such homozygously recessive characters (HRC-TEST). This population-genetic study did not only show statistically significant difference of the middle values of genetic homozygosity (CDH-7.1+/-0.2; control - 5.2+/-0.1), but of the differences in the type of distribution too, as well as the differences in the presence of certain individual combinations of such traits. The described methodology can be used in further analyses, with hope that it can be applied as an early prognosis for decreased resistance to different diseases. The frequencies of ABO blood types in the sample of CDH patients were similar to the average value of Serbian population, while the percentage of blood group A is slightly increased. Comparing frequencies of Rh blood groups, there is no difference between tested samples.

ABO Blood-Group System↗
PubMed2004

SAS programs for real-time RT-PCR having multiple independent samples.

Relative real-time reverse transcription PCR (RT-PCR) has become an important tool for quantifying changes in messenger RNA (mRNA) populations following differential development or stimulation of tissues or cells. However, the best methods for conducting such experiments and analyzing the resultant data remain an issue of discussion. In this report we describe an appropriate experimental methodology and the computer programs necessary to generate a meaningful statistical analysis of the combined biological and experimental variability in such experiments. Specifically, logarithmic transformations of raw fluorescence data from the log-linear portion of real-time PCR growth curves for both target and reference genes are analyzed using a SAS/STAT Mixed Procedure program specifically designed to give a point estimate of the relative expression ratio of the target gene with associated 95% confidence interval. The program code is open-source and is printed in the text.

Algorithms↗
PubMed1988

How large should my study be so that I can detect an altered sex ratio?

The world literature on manipulations purported to alter the gender of offspring is a quagmire full of reports presenting inadequate data and contradictory conclusions. Many are due to inappropriate statistical design or analysis. The authors present simple, nontechnical reference tables for determination of the minimum sample size necessary to detect a change in sex ratio (1) from a theoretical value, and (2) between two experimental populations. Simple methods for analyzing the results of gender manipulation experiments are described. Technical details are included in a separate section.

Female↗
PubMedDate not supplied

Qualitative analysis of high-risk drug and alcohol use situations among severely mentally ill substance abusers.

Situational factors have been found to influence relapse to alcohol and drug use in general samples of substance abusers. However, little research exists examining the influence of interpersonal and intrapersonal determinants in samples of individuals dually diagnosed with a severe mental illness (SMI) and a substance use disorder (SUD). This study assessed high-risk alcohol and drug use situations in dually diagnosed individuals using focus group methodology. Qualitative data analysis yielded 10 themes that encompassed 33 high-risk situations: Psychological symptoms, positive and negative affect, reminders of substance use, being around people who use drugs and alcohol, interpersonal conflict, offers of drugs or alcohol, experiencing loss, receiving money, loss of appetite, and being abstinent. These results suggest that individuals with an SMI and SUD experience a number of unique high-risk situations that differ from those reported by non-SMI substance abusers. This study provides the basis for future quantitative studies assessing the prevalence of these situations in representative samples of SMI alcohol and drug abusers. This information allows for the development of relapse assessment instruments and treatment strategies appropriate for this population.

Adult↗
PubMed2002

Improved narrowband dipolar recoupling for homonuclear distance measurements in rotating solids.

Recovery of the magnetic dipolar interaction between nuclei bearing the same gyromagnetic ratio in rotating solids can be promoted by synchronous rf irradiation. Determination of the dipolar interaction strength can serve as a tool for structural elucidation in polycrystalline powders. Spinning frequency dependent narrow-band (nb) RFDR and SEDRA experiments are utilized as simple techniques for the determination of dipolar interactions between the nuclei in coupled homonuclear spin pairs. The magnetization exchange and coherence dephasing due to a fixed number of rotor-synchronously applied pi-pulses is monitored at spinning frequencies in the vicinity of the rotational resonance (R(2)) conditions. The powder nbRFDR and nbSEDRA decay curves of spin magnetizations and coherences, respectively, as a function of the spinning frequency can be measured and analyzed using simple rate equations providing a quantitative measure of the dipolar coupling. The effects of the phenomenological relaxation parameters in these rate equations are discussed and an improved methodology is suggested for analyzing nbRFDR data for small dipolar couplings. The distance between the labeled nuclei in the 1,3-(13)C(2)-hydroxybutyric acid molecule is rederived using existing nbRFDR results and the new simulation procedure. A nbSEDRA experiment has been performed successfully on a powder sample of singly labeled 1-(13)C-L-leucine measuring the dipolar interaction between the labeled carboxyl carbon and the natural abundant beta-carbon. Both narrowband techniques are employed for the determination of the nuclear distances between the side-chain carbons of leucine and its carbonyl carbon in a tripeptide Leu-Gly-Phe that is singly (13)C-labeled at the leucine carbonyl carbon position.

Journal Article↗