Collaboration in clinical research: binational projects shed new light on old issues.
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Cross-Cultural Comparison↗
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Reducing social isolation in people with mental illness: the role of the psychiatrist.
OBJECTIVES: To determine the level of social isolation and the nature of close relationships among people with mental illness in contact with SANE Australia, and to assess the role of the psychiatrist in assisting in the reduction of social isolation. METHODS: A cross-sectional survey was conducted with 76 carers and 182 consumers via SANE Australia's helpline service, website or face-to-face during February and March 2005. RESULTS: Loneliness and social exclusion are major issues for Australians with mental illness who are in contact with SANE Australia. Almost three out of four respondents said that they, or the person they care for, experienced loneliness often, if not all the time. Consumers who attended psychosocial rehabilitation services regularly were more content with their close relationships than those who did not. Psychiatrists were identified as one of the preferred points of referral for psychosocial rehabilitation services. CONCLUSIONS: The separation between clinical treatment services and psychosocial rehabilitation programmes for people with mental illness has created a system that is fragmented and makes it easy for consumers to 'fall through the net'. For these reasons, there should be greater collaboration between psychosocial and clinical services. This will encourage psychiatrists to refer people to community programmes.
Adult↗
Maxillonasal dysplasia (Binder's syndrome). A study of craniofacial morphology, associated malformations and familial relations.
The aims of the present thesis were to study the craniofacial morphology and growth pattern in individuals with maxillonasal dysplasia, to check the presence of associated malformations and to elucidate the etiological factors. The thesis was based on five investigations. A cross-sectional cephalometric study of the craniofacial morphology of 97 Binder-subjects was performed. Comparison of 36 variables measured was made between these subjects and a control material, consisting of children with orthognathic profile and normal occlusion, matched for sex and age. Highly significant differences were found in a number of variables, correlated to the maxillary retrognathia and associated with the very characteristic appearance of individuals with maxillonasal dysplasia. The growth and development was studied in two longitudinal groups: one consisting of 13 orthodontically untreated children and one consisting of 15 orthodontically treated patients at corresponding ages. The untreated children were compared with the same reference material as in the crossectional study. It was then shown that all linear dimensions changed with age, parallel with normal growth and to about the same extent, although on another level for some variables. Comparison between the two longitudinal groups was made in order to study the possible positive effect of orthodontic treatment on craniofacial growth in Binder-subjects. No such influence could be stated. However, the graphical description of the groups, by means of facial polygons, revealed marked divergences even at early ages, remaining throughout the growth period. In the more severe cases, the maxillary retrognathia was aggravated by the craniofacial morphology of the lower face, similar to that of Class III-anomalies. In these cases, the orthodontic treatment has to be combined with surgical correction after completed growth. Associated malformations of the cervical spine were radiographically examined in 43 Binder-subjects. Defects of varying severity were observed in 44.2% of the patients. No clinical symptoms were found at early ages. An etiological study of 50 patients with maxillonasal dysplasia was performed to elucidate possible genetic factors. The results indicated two possible hypotheses: either the syndrome is caused by an autosomal recessive allele or it is of a quantitative multifactorial character with a threshold. The results did not disprove the possibility of a genetic etiology, although it might not be the full explanation for the syndrome. In conclusion, individuals with maxillonasal dysplasia shall be subjected to a thorough treatment planning in collaboration between orthodontists and surgeons.(ABSTRACT TRUNCATED AT 400 WORDS)
Adolescent↗
Recent research on multiple personality disorder.
The last decade has seen the emergence of solid research on MPD and the dissociative disorders, particularly in the area of diagnosis and clinical phenomenology. A number of other areas have been opened up or advanced considerably. The most notable of these include child and adolescent dissociative disorders; investigation of dissociative memory disturbances; studies of differential alter personality psychophysiology and switching; cross-cultural comparisons of MPD, possession, and dissociative states; and the contribution of pathologic dissociation to the symptomatology of other psychiatric disorders. Yet to be attempted, however, are prospective clinical trials and treatment outcome studies. In addition to clinical and theoretical insights, recent research provides strong evidence for the validity of the diagnosis of MPD. The repeated replication of a core clinical phenomenology demonstrates a construct validity equal to or superior to that demonstrated for most DSM-III/IIIR disorders. The ability of several independently developed instruments to blindly discriminate MPD patients from nondissociative disorder patients with high rates of accuracy supports both the construct and discriminant validity of the diagnosis; and as the astute clinical observations of the last century continue to be confirmed, MPD manifests an historical validity absent in most modern era diagnoses. In the future, arguments about the "reality" of MPD cannot confine themselves merely to attacking one aspect of the disorder but rather must confront the broad range of evidence supporting the validity and reliability of the diagnosis. The future belongs to multicenter studies, although intensive single-case and personal-case series will continue to make important contributions in some areas. The essential elements necessary to begin prospective multicenter studies are rapidly coming together. Already one multicenter structured interview study of clinical phenomenology has been completed and other studies are underway or near publication. As these collaborative research networks mature, even more ambitious studies will be attempted. Adequate funding remains the principal obstacle and must be creatively addressed in this era of budgetary shortfalls, particularly as several research networks cross international boundaries. Exceptionally gratifying is the burgeoning interest of large numbers of psychiatric residents and psychology graduate students in the dissociative disorders. Thanks to a decade of hard work, the next generation of clinicians and researchers will know a great deal more about these patients than the last.
Dissociative Disorders↗
Health care and patient-reported outcomes: results of the cross-national Diabetes Attitudes, Wishes and Needs (DAWN) study.
OBJECTIVE: The purpose of this study was to assess the relationship of patients' self-reported well-being, self-management, and diabetes control with factors related to the patient's health care. RESEARCH DESIGN AND METHODS: This was a cross-sectional survey of national samples of patients with diabetes (n = 5,104) from the multinational study of Diabetes Attitudes, Wishes and Needs (DAWN). Patients from 13 countries in Asia, Australia, Europe, and North America reported their level of well-being, self-management, and diabetes control. Hierarchical multiple regression analysis (blocks are countries, respondent characteristics, and health care features) was used to examine predictors of diabetes-related distress and general well-being, adherence to lifestyle and medical treatment recommendations, and perceived diabetes control and hyperglycemic symptoms. RESULTS: Country, respondent demographic and disease characteristics, and health care features were all associated with patient-reported outcomes. Better patient-provider collaboration was associated with more favorable ratings on all outcomes, and better access to the provider and availability of team care were associated with some positive outcomes. Country differences were only partly accounted for by patient and health care factors. Relationships between health care factors and outcomes varied across countries. CONCLUSIONS: Patients' reports of well-being, self-management, and diabetes control were related to the countries in which they live, their demographic and disease characteristics, and features of their health care. Opportunities to enhance patient-provider collaboration, access to care, and availability of team care should be pursued.
Adult↗
The augmentation of tumor-specific immunity using haptenic muramyl dipeptide (MDP) derivatives. III. Eradication of disseminated murine chronic leukemia cells by utilizing MDP hapten-reactive helper T-cell activity.
A previous paper has demonstrated that enhanced tumor-specific immunity could be induced by priming mice with Bacillus Calmette Guerin (BCG) and subsequently immunizing them with syngeneic tumor cells modified with BCG-cross-reactive muramyl dipeptide (MDP) hapten. The present study establishes a tumor-specific immunotherapy protocol for a murine chronic leukemia based on the above T-T cell collaboration between antitumor effector T cells and anti-MDP hapten helper T cells induced by BCG priming. BALB/c mice which had been primed to BCG were injected intravenously (i.v.) with viable, syngeneic BCL1 leukemia cells. One week later, these mice were immunized intraperitoneally (i.p.) with unmodified or MDP hapten-modified, 10,000 R X-irradiated BCL1 cells, followed by 4 booster immunizations at 5-day intervals. The administration of unmodified BCL1 tumor cells into BCG-primed mice failed to prevent them from tumor death due to the persistent growth of preinjected BCL1 cells. In contrast, the immunization of BCG-primed, BCL1 leukemia-cell-bearing mice with MDP-modified BCL1 cells resulted in a high growth inhibition of leukemia cells and protection of these mice from death by leukemia. It was also revealed that potent tumor-specific, T-cell-mediated immunity was generated in mice which survived in this immunotherapy model. Thus, these results indicate that administration of MDP hapten-modified, syngeneic leukemia cells into leukemia-bearing mice which have been primed with BCG results in potent tumor-specific, T-cell-mediated immunity attributable to preventing the growth of disseminated leukemic cells.
Acetylmuramyl-Alanyl-Isoglutamine↗
The advisory subgroup in toxicology of the european medical research councils.
The European Medical Research Councils set up an Advisory Group in Toxicology which met from 1975 to 1988. Since encouragement of cross discipline research is still difficult, a resumé is presented of the procedures developed to encourage interdisciplinary research in toxicology in Europe. A programme of grants in toxicology for collaborative research between European countries was begun in 1981 under the auspices of the European Science Foundation. Resulting from the final meeting of AST in Milan, the need for the development of links between epidemiology and molecular aspects of toxicology and for new approaches in eco-toxicology are briefly discussed.
Environmental Monitoring↗
Pathways to care and psychological problems of general practice patients in a "gate keeper" and an "open access" health care system: a comparison of Germany and the Netherlands.
BACKGROUND: The comparison of different health care systems is one way to give empirical evidence to health care reform and policy. The differences between health care systems in which general practitioners serve as gate keepers in comparison to systems in which patients are free to contact every physician and specialist they like are a question of high interest. METHOD: This study compares the Netherlands and Germany, two countries with very similar political, social, and health system structures, but different types of access to the health care system. While Germany offers unconstrained access to specialist ambulatory care, the Netherlands restricts health care utilization by giving primary care a 'gate keeper' function not allowing patients direct access to specialist care. Data from the WHO international collaborative study on psychological problems in general health care (Ustün and Sartorius 1995) were analysed with respect to pathways to care, treatment, and health status. In an initial cross-sectional assessment, in 3-month and 12-month follow-ups, contacts to physicians or hospital admission have also been monitored. RESULTS: There were only marginal differences between the Dutch and the German sample in the sociodemographic characteristics as well as in the diagnostic status with respect to mental disorders. In the Netherlands, 95.5%, and in Germany, 68.8% of the patients presented their 'reason for visit' for the first time to any physician at this index contact with a general practitioner. During the following 3 months, 24% of the Dutch patients, but 60.2% of the German patients, additionally contacted other physicians ( P < 0.001). At 12 months, this rate was 62.9% vs. 78.6% ( P < 0.001). During the 12-month follow-up period, there were 15.7 0/00 hospital admissions in Germany vs. 25.4 0/00 in the Netherlands ( P < 0.005) [corrected]. CONCLUSIONS: Family physicians in a gate keeper system reduce the number of contacts to other physicians and the intensity of treatment, while at the same time the rate of hospital admissions is increased.
Adolescent↗
The pharmacologic treatment of depression: drug selection criteria.
Currently, the pharmacologic treatment of depression is undergoing significant changes that are aimed not only at resolving the acute episode but also at preventing relapse and enhancing the quality of life once full remission is achieved. In addition, the clinical observation of soft residual symptomatology after "full-blown" episodes and of the features of post-depressive personality with severe long-lasting maladjustment has expanded the concept of chronicity and duration in mood disorders. Developing a treatment strategy entails diagnosing the specific subtype of depression, establishing a threshold for initiating pharmacotherapy, and selecting an effective and safe antidepressant. Both the clinical features of the presenting episode and the longitudinal aspects of the mood disorder are relevant when one is defining subtypes of major depression. In 1989, the Pisa-Memphis Collaborative Study, which focused on patients presenting with a major depressive episode, clarified the role of soft indicators of bipolarity in defining subtypes of major depression. Combining a cross-sectional with a longitudinal evaluation can provide guidelines for choosing the most appropriate drug for a depressive episode that is often part of a comorbid condition. When selecting a pharmacologic treatment for the depressed patient, the physician must consider a number of factors, including, but not limited to, efficacy and safety. Although research has demonstrated that tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), atypical antidepressants, and selective serotonin reuptake inhibitors (SSRIs) are of comparable efficacy in patients with severe depression, SSRIs should be considered the agents of first choice for patients with comorbidity and chronicity, adolescents and young adults, and the elderly.(ABSTRACT TRUNCATED AT 250 WORDS)
Antidepressive Agents↗
Anisotropy functions for 169Yb brachytherapy seed models 5, 8 and X1267. An EGS4 Monte Carlo study.
Anisotropy functions for 169Yb sources used in interstitial brachytherapy are investigated. A comprehensive study of several factors affecting the angular dose distribution around four 169Yb seed models (Amersham International) has been undertaken. Absolute dose rates around 169Yb seed models 5, 8a, 8b and X1267 have been estimated by means of the EGS4 Monte Carlo Simulation System. An updated cross section library (DLC-136/PHOTX), binding corrections for Compton scattering and water molecular form factors were included in the calculations. Following the formalism developed by the Interstitial Brachytherapy Collaborative Working Group, anisotropy functions, F(r, theta), have been calculated and compared with other Monte Carlo results and whenever possible with experimental data. Excellent agreement is found with other Monte Carlo calculations. Considering the large experimental errors reported, a fairly good coincidence has been achieved between experimental and Monte Carlo data for models 8a and 8b. For model X1267 large discrepancies with experiment are obtained. Monte Carlo calculations for all seed models showed model 5 to be the least anisotropic and models 8b and X1267 to be almost identical. Statistical fluctuations can be drastically reduced computationally, offering an efficient alternative to measured data. Our results have estimated uncertainties of 0.5%-1.0% within one standard deviation everywhere excluding the longitudinal source axis, where uncertainties are below 3% up to 5 cm, this accuracy being excellent for clinical calculations.
Anisotropy↗
Emerging role of aromatase inhibitors in the adjuvant setting.
Aromatase inhibitors (AIs) have been approved as second-line treatment for estrogen receptor-positive (ER+) metastatic breast cancer after first-line treatment with the selective estrogen receptor modulator (SERM) tamoxifen. Anastrozole and letrozole have also recently been widely approved as first-line endocrine therapy for postmenopausal women with hormone receptor-positive metastatic breast cancer. The three third-generation selective oral AIs approved for use in the United States include two nonsteroidal agents, anastrozole (Arimidex) and letrozole (Femara), and the irreversible steroidal inhibitor exemestane (Aromasin). Several major ongoing clinical trials with a variety of treatment regimens are comparing the relative efficacy of tamoxifen with the steroidal and nonsteroidal AIs in the adjuvant setting. The first strategy compares an AI against tamoxifen directly. Among these are the ATAC (Arimidex, Tamoxifen Alone or in Combination) trial (anastrozole), the BIG FEMTA (Femara-Tamoxifen Breast International Group) trial (letrozole), and the EXEM and TEAM (exemestane) trials. A second strategy is examining the use of an AI as an extension after the initial 5 years of tamoxifen. Examples of this trial design are the MA-17 (letrozole) and the National Surgical Adjuvant Breast and Bowel Project (NSABP B-33, exemestane) trials. A third approach is the use of these agents in sequence with tamoxifen as therapy within the initial 5 postoperative years. Examples of this approach are the International Collaboration Cancer Group trial (tamoxifen for 2-3 years followed by either tamoxifen or exemestane for the remainder of the 5-year period), the BIG FEMTA trial (patients are crossed over from tamoxifen to Ietrozole or letrozole to tamoxifen), and the Arimidex-Nolvadex (ARNO) trial (patients receiving tamoxifen are randomized either to continue with tamoxifen or to switch to anastrozole). A single trial is comparing tamoxifen and anastrozole as initial 5-year therapy, or a combination of the two. The study addressing this design is the ATAC trial. Finally, a small trial in Norway is comparing 2 years of an AI versus a placebo in very low-risk patients with receptor-positive breast tumors. Most adjuvant trials have companion studies associated with the main protocol. These are to determine the end-organ effects of the inhibitors and include measurements of quality of life, bone and lipid metabolism, and endometrial effects. This review addresses the clinical implications of these studies of AIs.
Antineoplastic Agents↗
Multijet cross sections in deep inelastic scattering at next-to-leading order.
We present the perturbative prediction for three-jet production cross section in deep inelastic scattering at the next-to-leading order accuracy. We study the dependence on the renormalization and factorization scales of exclusive three-jet cross section. The perturbative prediction for the three-jet differential distribution as a function of the momentum transfer is compared to the corresponding data obtained by the H1 Collaboration at HERA.
Journal Article↗
Genomic Medicine Sweden: Advancing precision medicine at the national level.
High-throughput sequencing has transformed clinical diagnostics of rare diseases (RD), cancer and infectious diseases by enabling the identification of disease-causing genetic alterations and facilitating individualised treatment and care. In response to these advances, Genomic Medicine Sweden (GMS) was established in 2017 as a national collaborative effort to accelerate implementation of genomics-based precision medicine within Sweden's regionally organized, publicly funded healthcare system. GMS brings together the seven university healthcare regions and their associated medical faculties, in collaboration with healthcare regions across Sweden, Science for Life Laboratory, patient organizations, industry and governmental agencies. Activities are coordinated through national disease-specific expert groups, supported by cross-cutting functions in bioinformatics, health economics, ethics, education and patient engagement. At the operational level, seven Genomic Medicine Centres, embedded at university hospitals, develop and deliver harmonised genomic diagnostics nationwide. The National Genomics Platform provides secure infrastructure for large-scale data storage, analysis, and national and international data sharing. Following initial project-based funding, GMS now receives long-term governmental support. This review describes the national implementation of genomic-based precision diagnostics, discusses challenges and lessons learnt, and highlights key milestones across disease areas, including whole-genome sequencing in RD and paediatric cancer, comprehensive genomic profiling of haematological malignancies and solid tumours, pathogen genomics in microbiology, pharmacogenomic testing and emerging applications of polygenic risk scores in complex diseases. Collectively, these efforts have contributed to more than 500,000 genomic tests being performed within Swedish healthcare between 2017 and 2025. Finally, we outline future diagnostic needs and priority areas to ensure sustainable, scalable and equitable access to precision medicine.
Precision Medicine↗
Nanoscience and literature: bridging the two cultures.
The growth of nanoscience and nanotechnology as academic pursuits raises important questions about the nature of disciplinarity both within and beyond the sciences. These burgeoning fields also offer many opportunities for interdisciplinary and multidisciplinary collaboration among the sciences and various humanities fields. Literature-nanoscience collaborations, specifically, offer one way for workers in the humanities and sciences--the "two cultures" described by English scientist-writer C. P. Snow in the late 1950s--to cross the great divide that typically isolates them in order more fully to understand and address the potential social and moral consequences of developments in nanotechnology.
Journal Article↗
[National Health Survey 2003-2004 on physical and mental health].
The National Health Survey is a cross-sectional study initiated by the Ministry of Health as part of the World Mental Health 2000 Survey of the World Health Organization. The survey is being conducted in collaboration with the Central Bureau of Statistics, which is responsible for the field work and is supported by the National Insurance Institute of Israel and the Israel National Institute for Health Policy and Health Services Research. For the first time in Israel, national data will be collected on: (a) prevalence of mental disorders; (b) prevalence of impairments and disabilities; (c) associations between chronic conditions and mental disorders; (d) associations between socioeconomic and demographic characteristics, mental health, physical health, disability, use of health services and out-of-pocket medical expenditure. The survey will provide the much-needed database for the proposed national reform of mental health services. This article describes the main innovations in the national health survey.
Health Status↗
Contributions from anthropology to the study of alcoholism. Overview.
Beginning in the 1950s, we have witnessed a continual acceleration of research activities by anthropologists in the alcohol field. Currently, a substantial number of anthropologists are conducting creative, productive, and eclectic field studies having to do with alcohol use, abuse, and treatment. This overview of this section provides evidence for the proliferation of interest in alcohol research by anthropologists through reports on recent publications, organizational activities, symposia on alcohol topics, and collaborative efforts between anthropologists and colleagues in other fields. Certain themes characterizing the increase in research activities are proposed: the interdisciplinary nature of many anthropology projects and the cross-fertilization of research methods. Each chapter in the section is introduced and placed within the overall context of contemporary alcohol research in anthropology. The overview concludes with a recommendation to expand the role of anthropology in international cross-cultural studies of alcohol.
Alcoholism↗
[The Maastricht aging study (MAAS). The longitudinal perspective of cognitive aging].
The Maastricht Aging Study (MAAS) was designed to specify the usual and pathological aging of cognitive function. In short, the main questions of MAAS are: who deteriorates when in which aspects of cognitive function, and what biomedical or psychosocial factors can be identified that may act as mediators in this process? The study comprises four independent panel studies in which a group of 1,900 initially healthy individuals are followed for a period of 12 years with respect to health characteristics and neurocognitive status. For this purpose a sample was drawn from a patient register of collaborating general practitioners, stratified by age (range 24 to 81 years), sex and general ability level. Rationale and design of MAAS are discussed and some findings from the cross-sectional baseline measurement are summarized: general aspects of memory and attention in aging, cognitive functioning after brain trauma and general anesthesia, physical condition (fitness, morbidity and vascular risk factors, such as blood pressure) as predictors of cognitive function, and finally cognitive complaints and metamemory.
Adult↗
Climacteric symptoms among indigenous Australian women and a model for the use of culturally relevant art in health promotion.
OBJECTIVE: To evaluate climacteric symptoms among rural and remote, indigenous Australian women and to develop culturally relevant women's health midlife educational material. DESIGN: A cross-sectional pilot survey based on structured interviews of women older than 18 years of age who were available for interview and willing to participate. The study was conducted in the Kimberley region of Western Australia and southwestern Victoria between February and June 1999. Health issues central to the local community were identified by the structured survey. Development of culturally relevant information involved collaboration between indigenous women and indigenous artists, health workers, educators, and ourselves. Traditional health themes in art form were then linked with specific health issues to be addressed. Health messages were translated by Aboriginal women and health workers into both traditional language and vernacular, to target all women. RESULTS: Fifty-five women completed the survey. Thirty-eight were premenopausal, 4 were perimenopausal, and 13 were postmenopausal. The 4 perimenopausal women and 9 of the 13 postmenopausal women had climacteric symptoms, but none had been prescribed systemic or local hormonal therapy. Rates of obesity, diabetes mellitus, and hypertension were high. Midlife women's health booklets were produced in collaboration with Aboriginal elders and artists to communicate preventive health information in a visual context familiar to Aboriginal people of the Kimberley and surrounding communities. CONCLUSIONS: In contrast to the case in other non-Caucasian populations, climacteric symptoms seem to be common among Australian indigenous women and are apparently untreated. Aboriginal art and language has been employed in the development of culturally appropriate health promotion literature for Aboriginal communities in the Kimberley region of Western Australia. This process of collaboration provides a useful model for addressing women's health issues in other culturally diverse populations.
Adult↗