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PubMed2004

Health-related quality of life in cardiac patients with dyslipidemia and hypertension.

BACKGROUND: Hypertension is associated with lower health-related quality of life (HRQOL). Similar association may be found for dyslipidemia. However, controversies exist regarding the HRQOL with dyslipidemia. We evaluated the HRQOL of cardiac patients with and without dyslipidemia and hypertension. METHODS: In a cross-sectional study, 284 cardiac patients rated their HRQOL using SF-36 Health Survey (SF-36), and three preference-based measures (Rating Scale, Time Trade-off and Standard Gamble). RESULTS: Compared to those without dyslipidemia, those with dyslipidemia reported better HRQOL on all preference-based measures and most SF-36 scales particularly on the physical health scales. Adjusted mean differences and 95% confidence interval (95% CI) were equal to 4.5 (0.5, 8.5), 10.8 (2.8, 18.8), and 2.2 (0.2, 4.2) on the Physical Functioning, the Role-Physical and the Physical Component Summary scales, respectively. Exactly the opposite trends were observed among patients with hypertension. The adjusted mean differences (95% CI) were equal to -2.7 (-6.7, 1.4), -10.9 (-19.1, -2.8), and -2.9 (-4.9, -0.9) on the Physical Functioning, the Role-Physical and the Physical Component Summary scales, respectively. CONCLUSION: Cardiac patients with hypertension reported lower physical health than those without hypertension while cardiac patients with dyslipidemia reported better physical health than those without dyslipidemia. The reason for these different trends is not known. Possible explanations are discussed.

Adult↗
PubMedDate not supplied

Adhesions and pain in women with first diagnosis of endometriosis: results from a cross-sectional study.

OBJECTIVE: To analyze the relationship between pain and presence, site, and type of adhesions in women with endometriosis. METHODS: This was a multicenter, observational cross-sectional study. Eligible for the study were women with endometriosis and pelvic pain, consecutively observed during the study period at the collaborating centers. A total of 574 women entered the study. RESULTS: Adhesions were observed in 81.9% of cases (470 women). The frequency was lower in women with endometriosis at stage I-II (65%) and higher in women with stage III-IV (88%); this difference was statistically significant (p < .01). The frequency of adhesions was lower in women with ovarian endometriosis (74%) and higher in those with ovarian and peritoneal endometriosis (87%) or other sites (96%) (p < .01). The presence of adhesions was associated with higher mean visual analog scale (VAS) scores and median multidimensional scale ratings in women with ovarian disease and with stage I-II disease. Women with ovarian adhesions reported higher VAS and multidimensional scale scores (p < .05) than women with peritoneal adhesions or adhesions in other sites. CONCLUSIONS: The results of this study suggest that there is no overall association between the presence of adhesions and the degree of pain in women with endometriosis. The data suggests that there may be an association between adhesions and pain in women with ovarian and Type I-II endometriosis. However, these associations were no longer significant after correction for multiple comparisons. Further research is indicated to test these associations.

Adolescent↗
PubMed2003

A cross-cultural study of the structure of comorbidity among common psychopathological syndromes in the general health care setting.

This study presents analyses of 7 common psychopathological syndromes in the World Health Organization (WHO) Collaborative Study of Psychological Problems in General Health Care (T. B. Ustun & N. Sartorius, 1995). Data on depression, somatization, hypochondriasis, neurasthenia, anxious worry, anxious arousal, and hazardous use of alcohol were analyzed for 14 countries (Ns for each country ranged from 196 to 800). Four models were evaluated: a 1-factor model; a 2-factor model in which all syndromes except hazardous use of alcohol represented internalizing problems; and two 3-factor models. The 2-factor model fit best. These results extend previous research on the 2-factor model to the current complaints of attendees of general health care clinics, to a new set of syndromes, and to a variety of both Western and non-Western countries.

Cross-Cultural Comparison↗
PubMed2006

Treatment of snakebite in Australia: the current evidence base and questions requiring collaborative multicentre prospective studies.

Despite the wealth of anecdotes and case reports there are fundamental questions of management of snakebite in Australia that remain unresolved or for which the current evidence is limited. The efficacy in the field, potential limitations and possibility of improvements in pressure immobilisation first aid need objective studies in humans. Optimal bandage sizes, stretch and pressure for different sized limbs need further evaluation, as does the use of pressure pads. Better definitions of specific clinical envenoming syndromes attributable to individual snake species are required, including elucidation of within-genus variations, similarities and differences. Venom studies suggest this is especially important for species within the brown snake (Pseudonaja) and death adder (Acanthophis) genera. Appropriate antivenom types, doses and dosing intervals for individual snake species should be more formally studied in patients. Especially important are confirmation of the need for higher doses of brown snake antivenom, while possibly limiting unnecessarily high doses, confirmation of the critical importance of early antivenom use to prevent pre-synaptic neurotoxicity in Taipan and tiger snake bites and ascertainment of whether larger doses of antivenom are unhelpful in Taipan bites after specified time delays. Confirmation of clinical efficacy and dosing recommendations for use of tiger snake (Notechis) antivenom in envenoming from Australian copperhead (Austrelaps spp.), broad headed (Hoplocephalus spp.) and rough-scaled snakes (Tropidechis carinatus) also require formal study in patients. Other examples of clinical relevance of cross-specificity of current and future monospecific antivenoms and whether there are geographical variations in antivenom responses within species will require elucidation. Prospective multicentre collaborative studies with predefined data collection and serial venom level assays are proposed as the way forward in Australia to help resolve therapeutic uncertainties and to establish a firmer evidence base for best-practice treatment guidelines for Australasian elapid snakebite.

Adult↗
PubMed2006

The state of international collaboration for health systems research: what do publications tell?

AIM: International collaboration for health system development has been identified as a critical input to meet pressing global health needs. North-South collaboration has the potential to benefit both parties, while South-South collaboration offers promise to strengthen capacity rapidly and efficiently across developing countries. There is an emerging trend to analyze the fruits of such collaboration. This paper builds on this trend by applying an innovative concept-based bibliometric method to identify the international scope of collaboration within the field of health policy and systems research. Two key questions are addressed: to what extent are papers comparing developing countries as against reporting on single country studies? To what extent are papers in either case being produced by researchers within their respective countries or through North-South or South-South collaboration? METHODS: A total of 8,751 papers published in Medline between 1999 and 2003 with data on health systems and policies in developing countries were identified and content-analyzed using an innovative concept-based search technology. A sample of 13% of papers was used to identify the corresponding institution and countries covered. The sampled data was then analyzed by income group. RESULTS: Papers with an international, cross-country focus account for only 10% of the total. Just over a third of all papers are led by upper middle income country authors, closely followed by authors from high income countries. Just under half of all papers target low income countries. Cross-country papers are led mostly by institutions in high income countries, with 74% of the total. Only seven countries concentrate 60% of the papers led by developing country institutions. Institutions in the United States and the United Kingdom concentrate between them as many as 68% of the papers led by high income countries. Only 11% of all single-country papers and 21% of multi-country studies are the product of South-South collaboration. Health Financing is the topic with the greatest international scope, with 26% of all papers in the topic. Topics such as Costing and Cost Effectiveness, Finance, Sector Analysis and Insurance, regardless of their national or international scope, are led in 38% to 54% of cases by high income authors. CONCLUSION: While there is modest health systems research capacity in many developing countries for single country studies, capacity is severely limited for multi-country studies. While North-South collaboration is important, the number of international studies is still very limited to produce the kind of knowledge required to learn from experiences across countries. The fact that lead institutions as well as study countries are concentrated in a handful of mostly middle income countries attests to great disparities in research capacity. However, disparities in research capacity and interest are also evident in the North. It is urgent to build cross-country research capacity including appropriate forms of South-South and North-South collaboration.

Journal Article↗
PubMed1986

The preparation and testing of the proposed International Reference (IRP) Bermuda grass (Cynodon dactylon)-pollen extract.

A lyophilized candidate extract of Bermuda-grass (Cynodon dactylon) pollen, intended for use as an International Reference Standard, was prepared by pooling four individual candidate extracts. In preliminary investigations, the four candidate extracts encompassed a variety of extraction methods. The collaborative testing program simultaneously analyzed the proposed reference and the individual extracts and included 11 laboratories performing RAST inhibition, histamine release, crossed immunoelectrophoresis, crossed radioimmunoelectrophoresis, isoelectric focusing, sodium dodecyl sulfate gel electrophoresis, and protein determinations with a variety of reagents and methods. The four candidate extracts and the pooled reference were found to be equivalent. The stability of this extract has also been studied. This International Reference Preparation of Bermuda grass-pollen extract should be useful for research and industry.

Allergens↗
PubMed1995

Hepatitis C virus infection among chronic dialysis patients in the south of France: a collaborative study.

During the last quarter of 1992, 984 patients from 13 dialysis centers in the Provence-Alpes-Côte-d'Azur region in France participated in a multicenter cross-sectional study to determine the prevalence, the risk factors, and the clinical consequences of infection by the hepatitis C virus (HCV). Serum samples were tested for anti-HCV antibodies using second-generation enzyme-linked immunosorbent assay (ELISA). In the case of a positive result, a combination test was performed using second-generation recombinant immunoblot (RIBA) or direct detection of HCV-RNA by nested polymerase chain reaction (PCR). Collected data included the patient's age, gender, cause of the kidney disease, type of dialysis treatment, number of years on dialysis, weekly dialysis time, drug addiction, co-infection with hepatitis B virus and human immunodeficiency virus (HIV), number of kidney transplants, number of blood transfusions, and history of acute or chronic hepatitis. Chronic HCV infection was detected in 232 (23.6%) patients, whereas only 71 (7.2%) were infected by HBV. Logistic-regression analysis showed that HCV infection was associated with dialysis over a long period, numerous blood transfusions, female gender, kidney grafts, HBV infection, hemodialysis, and acute as well as chronic hepatitis. Multiple-correspondence analysis confirmed that the contamination was both transfusional and nosocomial. These results underscore the need for a strict compliance with "universal precautions" (Centers for Disease Control [CDC], Atlanta) in dialysis units and raise the question as to whether anti-HCV-positive patients should be isolated.

Cross-Sectional Studies↗
PubMed2003

Exploring dental patients' preferred roles in treatment decision-making - a novel approach.

AIMS: To assess the transferability of the Control Preferences Scale to dental settings and to explore patients' preferred and perceived roles in dental treatment decision-making. SETTING AND PARTICIPANTS: A convenience sample of 40 patients, 20 recruited from the University Dental Hospital of Manchester and 20 from a general dental practice in Cheshire. METHODS: A cross-sectional survey, using the Control Preferences Scale, a set of sort cards outlining five decisional roles (active, semi-active, collaborative, semi-passive, passive), slightly modified for use in dental settings. A second set of cards was used to identify perceived decisional role. Rationale for choice of preferred role was recorded verbatim. RESULTS: The Control Preferences Scale was found to be transferable to dental settings. All patients in the sample had identifiable preferences regarding their role in treatment decision-making. A collaborative decisional role, with patient and dentist equally sharing responsibility for decision-making, was most popular at both sites. However, patients at both sites typically perceived themselves as attaining a passive role in treatment decisions. Lack of knowledge about dentistry and trust in the dentist were reported contributors to a passive decisional role preference, whilst those with more active role preferences gave rationales consistent with a consumerist stance. CONCLUSIONS: This exploratory study's findings suggest that dental patients have distinct preferences in relation to treatment decision-making role and that these may not always be met during consultations with their dentist. The Control Preferences Scale appears to be appropriate for use in dental settings.

Adult↗
PubMed1997

Incidence, case fatality, risk factors of acute coronary heart disease and occupational categories in men aged 30-59 in France.

OBJECTIVES: To assess the incidence and case fatality rate (CFR) from acute coronary insufficiency in men among occupational categories and to analyse the relationship between these disparities and the distribution of cardiovascular risk factors in the French population. SETTING: Three registers of the WHO-MONICA project in France: the urban area of Lille and two French districts: Bas-Rhin and Haute-Garonne. METHODS: Two sets of data were used: 1) the incident cases collected by the three MONICA Collaborating Centres (MCC) of the French WHO-MONICA Project (Lille, Strasbourg and Toulouse), between 1985 and 1989; 2) a cross-sectional study on cardiovascular risk factor prevalence performed in 1985-1989 in the three areas corresponding to the MCC. SUBJECTS: The data concern 5133 new coronary events in men aged 30-59 and a sample of 1863 men aged 30-59. RESULTS: A strong relationship was observed between occupational categories and the incidence of acute myocardial infarction and coronary events as well as CFR. Both incidence and CFR were lower among senior executives. Incidence was higher among employees and workers. However, employees, as opposed to unskilled workers, did not have higher CFR. Using occupational category as a statistical unit, the incidence of first acute myocardial infarction and coronary events was associated with the prevalence of smokers in the population (r = 0.50, P = 0.06 and r = 0.61, P = 0.02). The CFR was associated with systolic blood pressure (r = 0.82, P = 0.002), and the prevalence of smokers (r = 0.65, P = 0.02). None of the measures of incidence or case fatality among categories was related to cholesterol, HDL-cholesterol or body mass index. CONCLUSIONS: Strong differences were observed between occupational categories and the incidence of acute myocardial infarction, coronary events and CFR. These differences were found to be closely related to the social distribution of two major cardiovascular risk factors: tobacco smoking and blood pressure.

Adult↗
PubMed1990

Confirmatory and disconfirmatory feedback in families of schizophrenics, pathological controls and normals.

Two studies are reported measuring feedback mechanism in 10,771 communication acts in families of schizophrenics, nonschizophrenics within the range of schizophrenia spectrum disorders, and healthy offspring, using the Confirmation-Disconfirmation Coding System (CONDIS). Couples were observed in interaction with their offspring in situations provoking disagreement using the Colour Conflict Method (CCM) (n = 21), and alone during collaboration (n = 21) using the Consensus Spouse-Rorschach Method, respectively. The main categories of confirmatory and disconfirmatory feedback showed cross-situational stability, whereas subcategories such as egocentric utterances and active disqualification of others varied across situations and gave predicted differential deficits in S-parents. In 8 of 14 analyses, parents of pathological controls came out similar to normals or between normals and schizophrenics. The results supported the construct validity of CONDIS. Feedback mechanisms in parental communication were associated with schizophrenic traits in the offspring, incomprehensible egocentric utterances and active disqualification of others with schizophrenia.

Adult↗
PubMed2001

Epidemiologic tools for today and tomorrow.

As the premier population sciences, epidemiology and demography face common challenges as the U.S. population ages, as the genomic revolution unfolds, and as computing power changes the scale of analysis by several orders of magnitude. Each discipline does need to develop new tools to address the changing research questions, and the best strategy for success includes increased collaboration between the disciplines. The paradigms of each discipline still offer important insights into the problems of both disciplines, so cross-training would be a simple step to begin enlarging the tool box for population science.

Adult↗
PubMed2005

Chance favours only the prepared mind: Incubation and the delayed effects of peer collaboration.

Research has shown that the beneficial effects of peer collaboration are not always apparent until some time has elapsed. Such delayed effects are not readily incorporated in current models of collaborative learning, but because they constitute incubation effects in the psychological sense of the term, they should in principle be consistent with cognitive accounts of how incubation occurs. Accordingly, the paper reports three studies which test whether, in accordance with cognitive models of incubation, the delayed effects of peer collaboration could result from: (a) the breaking over time of unhelpful mental sets, (b) the engagement in post-collaborative reflective appraisal, and (c) the experience of subsequent events that, thanks to collaboration, can be used productively. The studies involved 9- to 12-year-old children working on the factors relevant to floating and sinking. The results provide no evidence for the relevance of set breaking or reflective appraisal, but suggest strongly that peer collaboration can 'prime' children to make good use of subsequent input. It is argued that in addition to clarifying how the delayed effects occur and applying incubation models in a novel context, the results flag up issues that are common to collaborative and cognitive theory, and that neither address adequately.

Child↗
PubMed1998

Models and strategies of collaboration across countries in doctoral education.

This paper addresses the globalization of nursing, especially as it pertains to doctoral nursing education. Its purpose is to consider the issues surrounding cross-country doctoral education as identified by doctoral students and to suggest models and strategies that could be used to facilitate cross-country doctoral education. This paper is based on published sources, conversations with doctoral students and personal observations. Nursing, in order to become globally relevant, should develop an independent body committed to cross-country doctoral education. This body should be committed to facilitating and organizing programs that provide opportunities for students and faculty to attain experiences abroad. Several models incorporated under a comprehensive strategy are suggested in this paper.

Cooperative Behavior↗
PubMed1990

Design and conduct of collaborative international epidemiologic studies of rheumatic diseases.

Collaborative international epidemiologic studies are important endeavors for improving our understanding of health and disease. They can help answer questions relating to genetic and environmental factors that may plan a role in the etiology and pathogenesis of the disease under study. These studies are challenging but can be very rewarding. There are many opportunities for collaborative international epidemiologic studies in rheumatology which can be explored.

Cross-Sectional Studies↗
PubMed1993

Quantum leap into continuous quality improvement.

Prior to a JCAHO accreditation visit, Southeast Georgia Regional Medical Center implemented a program for improved prevention and treatment of nosocomial pressure ulcers. Forms were developed for monitoring skin integrity and therapy beds were tried from a vendor, which also provided a computerized assessment tool. Results included 15 percent pressure ulcer prevention in addition to enhanced collaborative nursing practice.

Cross Infection↗
PubMed1997

Association of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index with measures of disease activity and health status in patients with systemic lupus erythematosus.

OBJECTIVE: To examine the internal consistency and validity of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) with respect to disease activity, health status, and medication score. METHODS: A prospective cross sectional study of patients with systemic lupus erythematosus (SLE) attending a specialist lupus outpatient clinic between July 1994 and February 1995. The internal consistency of the SDI components was examined using Cronbach's coefficient alpha. The associations of the SDI components with disease activity measured by the British Isles Lupus Assessment Group (BILAG) index, health status measured by the Medical Outcomes Study (MOS) Short Form 20, and with a medication score were analyzed using Spearman's rank correlation coefficient (p). RESULTS: 133 women and 8 men ranging in age from 20.1 to 88.7 years (mean 41.1, SD 12.5) were studied. With few exceptions, the components of the SDI that reflect damage in different organ systems were not associated with each other. We found a significant although weak relationship between some related SDI and BILAG components (p 0.25 to 0.28; p < 0.01). While damage to the musculoskeletal system was associated with limitations in physical functioning measured with the MOS Short Form 20 (p-0.30; p < 0.01) and renal damage inversely with fatigue (p-0.23; p < 0.01) there was no significant relationship of other SDI components with the MOS Short Form 20. Renal and neuropsychiatric damage were associated significantly with the medication score (p 0.27 and 0.23; p < 0.01). CONCLUSION: The components of the SDI are valid in that they are associated with disease activity in the respective organ systems and some of them with a medication score. However, damage in different organ systems in SLE does not follow a common pattern. It is thus suggested that the SDI profile be used in addition to the SDI total score as an endpoint in clinical and epidemiological studies.

Adult↗
PubMed1997

Neonatal integrated home care: nursing without walls.

A Neonatal Integrated Home Care Program was developed to cross-train NICU staff nurses to provide follow-up care for high-risk neonates in the home. Implementation required collaboration of the NICU and the Center for Home Care and Hospice. Initial target populations were premature infants in transition to oral feeds and oxygen-dependent neonates. Staff, parent, and insurer enthusiasm for this innovative program resulted in expansion to serve infants and families with many other care needs. Continuity of care provides an invaluable resource for families at home with their high-risk infants. Outcomes include reduction in NICU length of stay and readmission for this population. The NICU home care team shares experiences with staff, increasing awareness of and sensitivity to family strengths and discharge realities. The program has fostered revisions in practice regarding preparation for discharge and education of families, facilitating the transition to home following NICU hospitalization.

Continuity of Patient Care↗
PubMedDate not supplied

Public health nursing practice change and recommendations for improvement.

OBJECTIVES: This paper reports the characteristics of recent public health nursing (PHN) practice change experienced by staff-level public health nurses. Recommendations for improving PHN practice offered by study participants are reported and discussed. DESIGN: A cross-sectional written survey was used to collect data from 424 public health nurses in 76 local health departments (LHDs) in Wisconsin (68% response rate) in 2003. Characteristics of practice change were identified using a 15-item-scaled response set. Recommendations on improving practice were made through responses to an open-ended survey question. Content analysis was conducted to identify major themes among the responses. RESULTS: PHN practice has become more population focused. Major themes emerging from the recommendations for practice improvement included increasing system and organizational resources, expanding visibility of public health, and strengthening collaboration. CONCLUSIONS: Implications for practice include the need for continuing education in concepts and skills required for population-focused PHN practice, advocacy for more public health resources, and collaboration with academic partners for education and research.

Adult↗