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PubMed2026

Ancient DNA and Human Physiology.

Ancient DNA (aDNA) enables the reconstruction of chronologically sampled genomes from ancient humans, animals, plants, pathogens, and microorganisms, as well as environmental DNA, providing a record of biological changes through time. Improvements in short and degraded DNA extraction methods and low-cost sequencing now enable the generation of broad, cross-regional datasets that expand evolutionary analyses from past population demography to biological mechanisms. By tracking temporal shifts of allele frequencies, integrating functional genomics resources (e.g., gene expression, chromatin structure variation), modeling population demography to separate selection from genetic drift, and aligning genetic changes with archaeological, cultural, and climatic data, aDNA has the potential to link sequence variation to physiological function within their temporal and environmental contexts. In this review, we summarize illustrative case studies from aDNA research spanning complex traits, dietary adaptations, and responses to pathogens and other environmental changes, showing how human biology has evolved under multiple selective pressures through time. These dated signals help triage experimental work and expose mechanisms that are rare or absent in living cohorts. Although some challenges remain, such as geographic and temporal sampling disparities, limitations in data resolution and variant detection, and genotype-phenotype uncertainties, rapid methodological progress and stronger ethical frameworks are expanding what can be inferred, making aDNA a promising tool for refining physiological pathways, their timing, and their drivers.

Humans↗
PubMed1981

Results of the 1976 APA Self-Assessment Program.

The authors describe the development and implementation of the third edition of the Psychiatric Knowledge and Skills Self-Assessment Program (PKSAP-III). An assessment of the performance of 4,137 participants in PKSAP-III according to their primary professional activity, time spent in continuing medical education (CME), Board certification, and geographical area reveal that participation in CME had a positive effect on test performance. The authors conclude that the PKSAP is most valuable as a diagnostic tool for the individual practitioner and as a resources tool to assist in structuring a curriculum for small group discussions.

Clinical Competence↗
PubMed2003

[Evaluation of a wheelchair recycling program].

BACKGROUND: In 1998, 11.8% of the Quebec population over 15 years showed mobility problems and 2.3% of that group revealed that their needs were not met. The same year, the Régie de l'assurance-maladie du Québec distributed more than 4,500 wheelchairs and repaired some 30,000 others, at a cost of over $20 million. The recycling of wheelchairs is seen as a solution for improving this situation. This paper presents an evaluation of a wheelchair recycling program. METHODS: Three groups of participants involved in the recycling of wheelchairs contributed to the gathering of information. These were: personnel (n = 9), occupational therapists in the community (n = 5) and users of refurbished wheelchairs (n = 20). RESULTS: A participative and qualitative research approach was conducted with the 1st group. The results outline the inefficacy of the process on the structural level (e.g. not enough resources to collect unused wheelchairs), operational level (e.g. absence of norms to recycle), strategic level (e.g. absence of policy to encourage people to give back their unused wheelchair) and systemic level (e.g. the state is not imputable). A quantitative approach with the 2nd and 3rd groups revealed high satisfaction with regard to the efficacy, appearance, safety, durability and comfort as well as the delivery and follow-up services rendered. PRACTICE IMPLICATIONS: The evaluation procedure herein proposed can be customized to fit other contexts and provides policy-makers with quick access to field data to help them choose the appropriate course of action.

Canada↗
PubMed1992

Community and culture: a Chinese model of community care for the mentally ill.

Although psychiatric hospitals are thought to be the main focus of care for the mentally ill, China has not inherited the large asylums that were, and are, such a feature in the West. China has developed her own model of community care for the mentally ill, which is coherent with what are seen to be the available resources and fits into existing structures of social organisation. The elements in this model include small neighbourhood workstations, factory clinic liaison work, 'home beds' and neighbourhood care units. So far alternative accommodation schemes appear to have no part to play in the model. The reasons for this are discussed. However, while the Chinese model of community care for the mentally ill is quite well articulated, there appear to be major problems in ensuring its implementation.

Adult↗
PubMed2003

Correlates of hospital provision of prevention and health promotion services.

This study investigates the factors associated with hospital provision of prevention and health promotion services. The authors conceptualize the provision of these services as a hospital response to the community health concerns of environmental stakeholders. The response depends on hospital recognition and interpretation of institutional and resource dependence pressures and is related to interorganizational linkages, resource dependencies, and information processing structure. Data for the study came from 3,453 U.S. hospitals. The authors found that hospital provision of prevention and health promotion services is positively related to alliance and network membership, the diffusion of such services among other area hospitals, the use of community health status information, and hospital size. Also, for-profit hospitals provide fewer prevention and health promotion services than not-for-profit hospitals. These findings have policy and management implications.

Catchment Area, Health↗
PubMed2026

A Systematic Review of Lived Experiences of Receiving a Diagnosis of ADHD in Adulthood.

OBJECTIVE: With rising numbers of adults seeking and receiving ADHD diagnoses, understanding their first-hand experiences of the diagnostic process is key for sensitive support and service design. This systematic review collates, evaluates and synthesises the existing evidence-base on lived experiences of adult ADHD diagnosis. METHOD: Keyword searches of six databases generated 10,357 citations, which were subjected to a systematic screening process that identified 21 relevant studies. Findings were analysed using thematic synthesis. RESULTS: Analysis generated three overarching themes, elaborating how diagnostic experiences are shaped by adults' Relationship with Self, Relationship with Others, and Relationship with Systems. Personally, diagnosis was widely experienced as a pivotal identity event, triggering biographical reflection that could foster greater self-compassion, but also grief, anger and identity confusion. Socially, diagnosis facilitated interpersonal understanding and communication, but also exposed adults to stigma and introduced dilemmas about diagnostic disclosure. Systemically, adults experienced the diagnostic process as beset by barriers and delays, and reported highly variable access to post-diagnosis supports or treatment. CONCLUSION: Results suggest receiving an ADHD diagnosis in adulthood is a complex relational process that can be both validating and destabilising, with variation in experiences resulting from individual biographies, interpersonal resources, stigma climates, and service structures.

Humans↗
PubMed2006

Studying delays in breast cancer diagnosis and treatment: critical realism as a new foundation for inquiry.

PURPOSE/OBJECTIVES: To examine how delays in breast cancer care currently are conceptualized and to introduce philosophical and theoretical tenets of critical realism as an alternative approach. DATA SOURCES: Health and social sciences literature. DATA SYNTHESIS: Diagnostic and treatment delays in breast cancer most frequently are conceptualized as patient, provider, or system related. The approach has limited utility in guiding explanatory analysis because it does not acknowledge the social context in which the delays occur. The philosophical tenets of critical realism and two related theoretical approaches are an alternative. They illustrate how an individual's biologic, social, and material resources may undermine or support structural inequities in access to breast cancer care. CONCLUSIONS: Critical realism provides a useful framework for analysis of links between social inequalities and delays in breast cancer diagnosis and treatment. IMPLICATIONS FOR NURSING: Access to breast cancer care could be better understood and conceptualized by basing future research and theoretical endeavors on a critical realist perspective.

Breast Neoplasms↗
PubMed2005

Regional impact of Hurricane Isabel on emergency departments in coastal southeastern Virginia.

OBJECTIVES: On September 18, 2003, Hurricane Isabel made landfall as a category 2 hurricane over the mid-Atlantic region, generating record conditions for the region's 27 years of monitoring. The purpose of this study was to investigate the impact of the hurricane on the number and type of emergency department (ED) patient visits and its impact on hospital admission rate from the day of landfall to day 5 postlandfall. Comparisons were made with a control group, which comprised average daily ED census during the six-month period preceding landfall and the average daily admission rates for the preceding six months. METHODS: Designed as an observational cohort study, daily ED patient visits and admissions through the ED were tracked from the day of landfall to day 5 postlandfall. The study population included all ED patient visits at a six-hospital urban health care system, including a Level 1 trauma center in the coastal southeastern region of Virginia, with an aggregate annual ED volume of 261,000. Daily patient volumes, complaint categories, and admission rates were measured during the study period and compared with a control population that included average daily patient volumes, complaint categories, and admission rates at the same facilities for six months before landfall. During a 30-day postlandfall period, 63 emergency physicians on staff at the study hospitals were sent an ad hoc survey and asked to report their experiences if they worked during the study period. The survey included requests for future preparedness recommendations based on their experiences and are reported. RESULTS: During the six-month period preceding Hurricane Isabel, the average number of aggregate ED visits per day was 670. The average daily number of patient visits by complaint category included six major traumas, 483 medical complaints, 169 minor traumas, and 13 psychiatric complaints. On the day of landfall, the total aggregate ED volume was 359 (-46%), which included two (-66%) major traumas, 263 (-46%) medical complaints, 88 (-48%) minor traumas, and six (-54%) psychiatric complaints. During the subsequent four days postlandfall, there was a significant increase in average daily aggregate ED census of 840 (+25%) patient visits, which included three (-50%) major traumas, 564 (+17%) medical complaints, 263 (+57%) minor traumas, and ten (-23%) psychiatric complaints. The largest single-day increase in ED visits was day 1 postlandfall, with a 35% increase in daily volume (905 patient visits). The percentage of admissions from the ED to an inpatient unit on the day of landfall also demonstrated a significant increase (19%) compared with the control group (13%). Admission rates through the ED had appeared to normalize on day 1 postlandfall (12%). Response rate to the ad hoc physician survey by those who worked during the study period was 31.2% (10 of 32). The most common problem areas reported included communication failures, access to on-call personnel, and provider and nursing understaffing during the immediate postlandfall period. CONCLUSIONS: A significant overall reduction in ED visits by almost half the typical average volume was noted on the day of landfall (-46%). During the four days immediately following landfall, however, there was a marked increase in the overall ED census, with a particularly high increase on day 1 postlandfall. The largest complaint category increase was minor trauma (+57%). Hospital admission rates were highest on the day of landfall and seemed to return to baseline on day 1 postlandfall. These data may be useful for structuring ED personnel and hospital resource allocation to better serve its community during hurricane preparedness planning.

Case-Control Studies↗
PubMed2000

Effects of early onset brain injury on the development of cognition and behavior: introduction to the special issue.

The effects of brain injury acquired early in life on the development of cognition and behavior are not well understood. Deciphering these effects and modeling their neurodevelopmental trajectories are major concerns for clinicians and scientists. Historically, a prevailing notion has been that early-onset brain damage has a more favorable prognosis than does brain damage acquired in adulthood. However, there is growing evidence suggesting that early-onset damage to prefrontal brain structures may have devastating consequences on the emergence of adaptive behavior throughout development. Particularly prominent are disorders of personality, social behavior, and executive functions such as planning and decision making. This special issue presents a series of new empirical studies that address these issues in depth, from several different perspectives, and in both human and animal participants. The findings promise to shed further light on both the neurobiology of development, and diverse neurodevelopmental disorders. Such advances may also enhance clinical diagnosis and facilitate the design of more effective interventions to help reduce the tremendous burden that neurodevelopmental disorders place on personal well-being, family structure, educational systems, and social resources.

Adolescent↗
PubMed1994

[Population interactions between Triatoma infestans and Triatoma sordida].

Populations of T. infestans and T. sordida were studied between September 1988 and April 1989 with a view to discovering if any kind of interaction took place between them while they lives together in the same experimental unit and exploited the same food resource (chicken). The initial age structure for each species was: 27 N1, 7 N2, 11 N3, 3 N4, 8 N5, 4 males and 10 females. The population dynamics nutritional status, predation and gregarious behavior were estimated by means of a monthly census. The colonizing success of T. infestans was greater than that of T. sordida in view of the values obtained: fecundity (146 eggs/female), longevity (157.8 days) and mortality (39.4) compared with the values recorded for T. sordida: 118 eggs/female, 81.1 days and 54.0% respectively. The population growth of T. insfestans followed an exponential model, with a high nymphal recruitment rate, while the T. sordida population was early extinguished. In general, the average weight of T. infestans remained close to the initial values while that of T. sordida declined. Gregarious groups were formed principally in the inferior sector of wall 1 (near the host) with a higher aggregation in T. infestans. These results make it possible to propose the hypothesis of the competitive superiority of T. infestans.

Animals↗
PubMed1981

Program characteristics and residents' length of stay in alcoholism halfway houses.

Data from 23 alcoholism halfway houses are analyzed to assess the relationship of organizational and programmatic variables to clients' average length of stay. Results indicate that programs which have more resources, a more complex administrative structure, better staffing, and stronger community ties report a shorter average length of stay than do those which lack these characteristics. The discussion focuses on differences in interpretation of a longer stay by an individual alcoholic versus a longer average stay by clients of a residential facility. Conclusions are that longitudinal research of a comparative nature is needed to identify the consequences of a longer versus shorter average stay for both long- and short-term residents of a given of facility.

Alcoholism↗
PubMed1994

Hospice for aged persons without cancer: the experience of the Hampshire County (MA) hospice.

Hospice is an option for patients with terminal illness of all types. The advent of the Medicare hospice benefit has led to a rise in numbers of hospice programs as well as hospice expenditure. Terminal care provided through hospice has a demonstrable cost advantage over conventional terminal care. This difference may dissipate as Medicare hospice expenditure continues to rise. An individual hospice program can define its mission within broad guidelines. A program electing to serve all terminally ill patients regardless of diagnosis can occasionally expect to be cast in the role of long term care-provider when six-month survival is exceeded. Precision in prediction of six-month survival would benefit patients and remove one major obstacle to participation by many primary care physicians. Prognostic techniques are being developed that, thus far, have proven no better than physician judgement in assigning risk or predicting survival. Hospice may provide a setting for clinical research of prognostication. The interdisciplinary team can facilitate hospice care and provide support to individual team members. Care of terminally ill non-cancer patients may require added human resources and alteration of team structure to cope with increased service needs and lengths of stay which may be likely to exceed those of cancer patients.

Aged↗
PubMedDate not supplied

Mission committees' role evolves from operations to oversight.

Originally established in the 1970s to ensure that sisters serving in the health care ministry had input into governing board decisions, mission committees in the Holy Cross Health System, South Bend, IN, have evolved through three stages of development. In their early years, mission committees searched for an identity, struggling to define their roles and purpose. In the committees' second stage, activities were the dominant focus as organizations created an array of audiovisual presentations and educational programs. In the early 1980s lay employees began to assume their distinctive role in promoting the religious institute's mission, and the committees moved from an emphasis on operations to one on oversight and policy direction. Today the mission committees' membership includes not only governing board and congregational members but also the chief executive officer, the chief human resource office, and physicians. The system has strengthened the committees' role by charging them with responsibility for the human resources function. Although no single structure can ensure that an organization's identity is an integral part of the religious institute's mission, the mission committees' work in directing how the organization selects, orients, evaluates, and manages its employees gives clear evidence of the vitality of its mission objectives.

Catholicism↗
PubMed1984

How to organize and manage a hospital's information system.

Healthcare organizations are currently faced with a variety of decisions regarding computer systems and information. Of these, the ability of healthcare organizations to make correct decisions regarding developing information systems professionals, managing distributed resources, and enhancing the corporate structure will affect not only the worth of the information systems, but also the ongoing success of the organization.

Centralized Hospital Services↗
PubMed1975

[First national seminar on the teaching of preventive medicine in the medical academic programs in Peru. Summary of the seminar report].

A summary report is presented of the Seminar held in Lima, in November-December 1974, attended by 44 delegates, including university professors, Peruvian Health Ministry officials, representatives of the Peruvian Association of Academic Prpgrams in Human Medicine, students, insturctors and PAHO/WHO advisers. The main topics were: concepts of preventive medicine in medical education, cirriculum structure, teaching methods, and educational resources. A comprehensive review of the course content in preventive medicine and how it is taught was made with the aim of instiuting uniform and criteria in this area of instruction. The recommendations reflect a thoroughgoing analysis of the subjects discussed and are a valuable contribution to improvement of the teaching of preventive medicine.

Curriculum↗
PubMed2001

Clinical pathways or case management.

Clinical pathways are increasingly being used internationally as a mechanism for managing patient care to achieve improved outcomes with more efficient resource use. They are a structured templates guiding multi-professional treatment and care for specific patient groups or procedures, through a sequence of essential treatment and care steps based on the best available evidence. This paper defines clinical pathways, describes their historical context and application, and discusses benefits and concerns about their use.

Case Management↗
PubMed2002

Applying research to practice. Practical guidelines for occupational health nurses.

Much has been written about the research practice gap--and there is no doubt this gap exists in occupational health nursing. It is an irony that the professionals who would benefit most from occupational health and safety research may be the ones who do not participate in or contribute to research. Closing the gap requires a commitment on the part of both practitioners and researchers. It behooves occupational health nurses to constantly seek ways to make the connection--to forge relationships that can continue to advance the specialty. Researchers must increase their efforts to conduct research in "real world" conditions, because this research is most likely to improve practice. Practitioners must be willing to familiarize themselves with research so they can become active participants in the ongoing effort to find answers to troubling occupational health and safety problems. Rosenheck (2001) presents an interesting perspective on the barriers to eliminating the research practice gap. He purports that, although professionals often are highly respectful of scientific endeavors, in reality, "daily decision making is shaped more by power structures, ingrained routines, and established resource configuration than by current scientific findings." In most organizations, standard operating procedures and behavioral norms are the major influences on workplace practices; scientific evidence plays a minor role (Rosenheck, 2001). Several reasons can be found for this lack of reliance on research as a basis for practice. Studies may demonstrate effectiveness among large groups. However, practitioners may not see the relevance or applicability of such studies to individuals or small groups of clients. Also, practitioners may fear that the implementation of new strategies will require more oversight than they are able to provide. Another logistical barrier is the application of the research may require the collaboration of multiple individuals--dynamic environments with extensive turnover may result in constant personnel changes and diminished commitments on the part of the team. Applying research to practice requires thoughtful and careful strategizing. Success depends on the commitment of key people within the organization to see the activities through from planning to implementation to evaluation. The involvement and support of management is crucial to a successful outcome. In many cases, the benefits of the research many not be readily apparent. However, if management perceives the potential value and the eventual "pay offs," they are more likely to allocate funds and other resources needed to assure the research is supported to its completion. Finding the time and resources to read and apply research in the occupational setting is a formidable task. However, the importance of a scientific base to occupational nursing practice is becoming increasingly evident. Occupational health nurses must become effective observers who recognize the value of research findings contributing to more effective practice. They must develop strategies for sharing information and for learning from others' experiences, and through this process, demystify the research process and become better research consumers. If occupational health nurses are to maximize their abilities to achieve their most important health and safety goals and to provide cost effective, quality services, they must develop strategies to enable them to use findings from relevant, well designed, practice oriented research studies.

Diffusion of Innovation↗
PubMed2002

[Unique ecosystem characters and ecological principles for development in the ecotones between agriculture and pasture in north China].

Based on the fact that its ecological deterioration, a rethinking on the former definition of 'transitional zone between agriculture and grassland' was proposed. It was recognized that this zone has been gradually and dynamically formed under the specific circumstances of history and anthroponomy in China. It should thus be re-defined as 'ecotone between agriculture and pasture', instead of just focusing on its features of geography, ecology, and vegetation separately, as well as its character of transition. More attention should be put on its nature of complex system of ecology, society and economy, and then, derive relevant abating measures. Boreal ecotone has the functions of life support for a relatively dense population, as well as ecosystem services. Under the premise of unable copying the models for arid and semiarid areas in abroad, in particular developed countries, an unique strategy of capable of compromising both above-mentioned functions, as well as ecological reconstruction, which is embodied in readjusting agro-structure, rationally utilizing and conserving resources, and establishing 'polar' industries, such as grasses and livestock, should be the center of an interdisciplinary study approach.

Agriculture↗