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PubMedDate not supplied

Healthcare professional education: a unique role for hospices.

We sought to describe the educational experiences that hospices currently provide for students in health professions by using a national cross-sectional, Web-based survey of the National Hospice and Palliative Care Organization (NHPCO) and the Population-based Palliative Care Research Network (PoPCRN) hospice sites. Of the 75 responding sites, 71 (95 percent) participated in the education of health profession students, most commonly providing education for bachelor of science in nursing students (73 percent), associate's degree nursing students (61 percent), master's-level social work or counseling students (61 percent), registered nursing students (59 percent), medical students (58 percent), and medical residents (57 percent). Significant staff time was devoted to educating these students (averaging 11 to 30 hours/week), but less than 3 percent received any financial compensation. Therefore, we conclude that hospices provide a significant amount of uncompensated education. This conclusion provides a unique opportunity for hospices to collaborate with healthcare educational institutions and to influence the work force of the future.

Cross-Sectional Studies↗
PubMed2000

Problems with quality monitoring for Medicaid managed care: perceptions of institutional and private providers in New York City.

The study objective was to examine quality oversight efforts by Medicaid managed care organizations (MCOs) for children in a sample of ambulatory care institutions and private practices in New York City. This was a cross-sectional study of quality assurance priorities and strategies of MCOs and their impact date in institutions in New York City. Data were from structured interviews administered in 1997 to medical directors in the eight largest MCOs; and medical directors, heads of ambulatory pediatrics, and institutional pediatricians in a random sample of 15 institutions and 20 private office-based providers. Medical directors in MCOs reported that their main priority areas were the preventive care measures (e.g., immunization and lead screening) that they must report to the state. Knowledge of these MCO priority areas and monitoring activities was high for medical directors in the random sample, but decreased from these medical directors to heads of ambulatory pediatrics to institutional pediatricians, with the differences between the medical directors and institutional pediatricians significant (P < .05). However, 96% of the institutional pediatricians reported knowing their own institution's priorities and monitoring activities. In contrast, most private pediatricians reported they knew MCO priorities and monitoring activities (80%). Less than 33% of any group reported activities as "very effective" or felt any incentive to improve performance. There was a high level of overlap in provider networks, with institutions and private providers having children in many MCOs, and MCOs having children in many sites. Conclusions. The current model of quality oversight is producing reports for the state, but is not translating into effective strategies at the provider level. The need to work through the leadership in institutions to influence quality is highlighted. The level of overlap in provider networks suggests the need for collaboration among MCOs in quality monitoring.

Attitude of Health Personnel↗
PubMed1996

Rating authors' contributions to collaborative research: the PICNIC survey of university departments of pediatrics. Pediatric Investigators' Collaborative Network on Infections in Canada.

OBJECTIVES: To determine how department chairs in pediatrics rate involvement in medical research and to determine whether faculty deans' offices have written criteria for evaluating research activity when assessing candidates for promotion or tenure. DESIGN: Cross-sectional mailed survey and telephone survey. SETTING: Canadian faculties of medicine. PARTICIPANTS: Chairs of the 16 Canadian university departments of pediatrics and deans' offices of the 16 university medical faculties. MAIN OUTCOME MEASURE: Weight assigned by department chairs to contributions to published research according to author's research role and position in list of authors and the method of listing authors. RESULTS: Fifteen of 16 chairs responded. Twelve submitted a completed survey, two described their institutions' policies and one responded that the institution had no policy. Eleven reported that faculty members were permitted or requested to indicate research roles on curricula vitae. There was a consensus that all or principal investigators should be listed as authors and that citing the research group as collective author was insufficient. The contribution of first authors was rated highest for articles in which all or principal investigators were listed. The contribution of joint-principal investigators listed as first author was also given a high rating. In the case of collective authorship, the greatest contribution was credited to the principal investigator of the group. Participation of primary investigators in multicentre research was rated as having higher value than participation in single-centre research by seven respondents and as having equal value by four. Only one dean's office had explicit written criteria for evaluating authorship. CONCLUSIONS: Most departments of pediatrics and medical faculty dean's offices in Canadian universities have no criteria for assessing the type of contribution made to published research. In view of the trend to use multicentre settings for clinical trials, guidelines for weighting investigators' contributions are needed.

Authorship↗
PubMed1992

Children's mental health service needs and utilization patterns in an urban community: an epidemiological assessment.

To assess children's mental health service needs and utilization patterns for a state planning effort, a cross-sectional survey that sampled 822 children aged 6 to 11 of a metropolitan center was conducted. When reports of parents and teachers were combined, 38.5% of children were screened to be at risk of psychiatric disturbance. Only 11% of children at risk received treatment in mental health settings, fewer than in schools (37%) or medical settings (13%). The findings illustrate the importance of interagency collaboration and the need to consider reports of parents and teachers and different dimensions of psychopathology in future planning and research.

Child↗
PubMed2002

Calcium channel blockers for inhibiting preterm labour.

BACKGROUND: Preterm birth is a major contributor to perinatal mortality and morbidity and affects approximately six to seven per cent of births in developed countries. Tocolytics are drugs used to suppress uterine contractions. The most widely tested tocolytics are betamimetics. Although they have been shown to delay delivery, betamimetics have not been shown to improve perinatal outcome, and they have a high frequency of unpleasant and even fatal maternal side effects. There is growing interest in calcium channel blockers as a potentially effective and well tolerated form of tocolysis. OBJECTIVES: To assess the effects on maternal, fetal and neonatal outcomes of calcium channel blockers, administered as a tocolytic agent, to women in preterm labour. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's specialised register of controlled trials, the Cochrane Controlled Trials Register (February 2002), MEDLINE, EMBASE, and Current Contents. We also contacted recognised experts and cross referenced relevant material. SELECTION CRITERIA: All published and unpublished randomised trials in which calcium channel blockers were used for tocolysis for women in labour between 20 and 36 weeks gestation. DATA COLLECTION AND ANALYSIS: Standard methods of the Cochrane Collaboration and the Cochrane Pregnancy and Childbirth Group were used. Evaluation of methodological quality and trial data extraction were undertaken independently by three authors. Additional information was sought to enable assessment of methodology and conduct of intention-to-treat analyses. Meta-analysis was conducted assessing the effects of calcium channel blockers compared with any other tocolytic agent. Results are presented using relative risk for categorical data and weighted mean difference for continuous data. MAIN RESULTS: Eleven randomised controlled trials involving 870 women were included. When compared with any other tocolytic agent (mainly betamimetics), calcium channel blockers reduced the number of women giving birth within 48 hours (relative risk (RR) 0.73; 95% confidence interval (CI) 0.54, 0.98) and within seven days (RR 0.76; 95% CI 0.59, 0.99). Calcium channel blockers also reduced the requirement for women to have treatment ceased for adverse drug reaction (RR 0.15; 95% CI 0.06, 0.43), the frequency of neonatal respiratory distress syndrome (RR 0.64; 95% CI 0.45, 0.91) and neonatal jaundice (RR 0.73; 95% CI 0.57, 0.93). REVIEWER'S CONCLUSIONS: When tocolysis is indicated for women in preterm labour, calcium channel blockers are preferable to betamimetic agents. Further research should address the effects of different dosage regimens and formulations of nifedipine on maternal and neonatal outcomes.

Calcium Channel Blockers↗
PubMed2000

Reproductive factors and incidence of breast cancer: an international ecological study.

Ecological studies can help in understanding the relation of reproductive history of breast cancer. We analyzed data from 9416 women, comprising the control groups of seven countries (Australia, People's Republic of China, Colombia, (former) German Democratic Republic, Israel, Philippines, and Thailand) from the WHO international, multi-center case-control study of female cancers. Positive correlations with country-specific breast cancer incidence were observed for (median) duration of reproductive life (r > or = 0.95, p < 0.005), age at menopause (r > or = 0.84, p < 0.025) and delay to first birth (r > or = 0.59, p < 0.22) (when People's Republic of China was omitted, r > or = 0.85, p < 0.07). The association of age at first birth with breast cancer incidence was weakly positive in the whole sample (age-adjusted r = 0.18, p = 0.73), but weakly negative in the age groups 15-29 and 30-39 years and weakly positive in the age groups 40-49 and 50-64 years. A strong inverse correlation was observed between age at menarche and breast cancer incidence (r < or = -0.84, p < 0.03). These international ecological correlations agree with the associations previously reported for single populations, between higher incidence of breast cancer and younger age at menarche, older age at menopause, longer duration of reproductive life, and (possibly) longer delay to first birth. In contrast, age at first birth is only weakly related to breast cancer incidence across populations, indicating that this variable represents different constructs when measured ecologically versus individually.

Adolescent↗
PubMed2006

Depression and suicidality in HIV/AIDS in China.

BACKGROUND: This pilot study examined rates of major depression and suicidality and their associations with daily functioning in HIV infected (HIV+) and uninfected (HIV-) persons in China. METHOD: HIV+ participants (N=28) and demographically matched HIV- controls (N=23) completed the Chinese Composite International Diagnostic Interview to determine lifetime rates of major depressive disorder (MDD) and suicidality. Current mood and suicidal ideation were assessed with the Beck Depression Inventory-I. The impact of depression and HIV infection on daily functioning was measured by an Activity of Daily Living questionnaire. RESULTS: Mean duration of known HIV+ status was 2 years. Almost 79% (n=22) of HIV+ but just 4% (n=1) of HIV- groups reported lifetime major depression. Of the 22 HIV+ individuals with lifetime MDD, only one had onset before learning of HIV status. The remainder developed MDD within 6 months after testing HIV positive. In those HIV+ subjects who met MDD criteria after HIV diagnosis, only two (9%) had received depression treatment, yet four (18%) had persisting active suicidal thoughts. Depression and HIV+ status independently predicted worse daily functioning. LIMITATIONS: Representativeness is limited in this small sample of convenience. CONCLUSION: This preliminary study presents evidence of high rates of major depression and suicidality in HIV-infected persons in China. Despite this, few had sought mental health assistance, suggesting a need to increase awareness of psychiatric comorbidity and access to mental health services.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Professionals' awareness of operational antibiotic prescribing controls in UK NHS hospitals.

In recent years, there have been increasing recommendations for multidisciplinary collaboration between clinical pharmacists and medical microbiologists in an attempt to control the quality (and quantity) of antibiotic prescribing. A questionnaire addressing the utilization of antibiotic prescribing controls was sent to the chief pharmacist and medical microbiologist in UK NHS hospitals. Responses were received from both the chief pharmacist and the medical microbiologist employed in the same hospital from 83 hospitals (a 30% response rate from two independent studies). A high level of disagreement and poor awareness was identified between the interprofessional staff groups regarding the existence of antibiotic formulary (with disagreement between the two groups, or not known by one or both respondents, in 46% of the paired hospitals, N = 38) and guideline documents (13%, N = 11), performance of antibiotic prescribing audits (40%, N = 33), and whether pharmacists (52%, N = 43) and medical microbiologists (77%, N = 64) monitored physician compliance with antibiotic prescribing control documents. This study has identified poor knowledge of the existence of basic antibiotic prescribing control mechanisms and the role of professional colleagues. It is suggested that there is some way to go before 'Agenda for Change' principles of flexible and collaborative roles are met.

Anti-Infective Agents↗
PubMed2002

Obesity-depression associations in the population.

This article summarizes data on the relationship between obesity and depression in the population. Both obesity and depression are increasingly prevalent and associated with numerous health complications including hypertension, coronary heart disease, and increased mortality. There does not appear to be a simple or single association between these disorders. Meta-analytic studies suggest no statistically significant relationship, although pooling all subjects may mask important variables that moderate or mediate potential covariations. Sociodemographic, psychosocial, and genetic factors may render certain obese individuals more prone to depression or vice versa. Physiological and behavioral variables that link obesity and depression have received limited study. There are likely multiple obesity-depression covariations in the population, rather than a single pattern of association. There is a need for longitudinal and mechanistic studies to understand casual pathways and greater collaboration between depression and obesity specialists.

Body Mass Index↗
PubMedDate not supplied

Designing hospital infection studies.

The design of investigations of hospital infections often will make a difference between results that are useful and results that only appear to be. The importance of study design and dimensions cannot be overemphasized. Much has been written about methods of research. Most universities and many large hospitals have persons trained in research design and analysis. The more that investigators of nosocomial infections talk with and collaborate with persons who have such training, the more accurate and more productive their research is likely to be.

Cross Infection↗
PubMed2000

Epidemiological research in mental disorders: lessons for the next decade of research--the NAPE Lecture 1999. Nordic Association for Psychiatric Epidemiology.

OBJECTIVE: To provide an overview of the progress in the field of epidemiology of mental disorders during the last decade, and to discuss challenges for the future. METHOD: Following a review of the achievements of psychiatric epidemiology, current shortcomings in the research and publications in the field are discussed. Suggestions for changes in research and solutions to current deficits are proposed. RESULTS: Future research needs to cover a broader spectrum of psychopathology, including inquiries into sub-threshold characterizations; explore etiopathogenic processes and pathways including genetic, neuroscientific and psychological factors for the onset and persistence of psychopathology; and provide a better assessment of help-seeking behaviors and service utilization. CONCLUSION: Future epidemiological research should strengthen the emerging collaborative links with the neurosciences, clinical research and public health by acknowledging the full range of available epidemiological designs and methods, beyond the current emphasis on large-scale, cross-sectional general population studies.

Epidemiologic Factors↗
PubMed2005

Content validation of instruments: are the perspectives of Anglo reviewers different from those of Hispanic/Latino and American Indian reviewers?

This article reports on the content validation of eight quantitative instruments developed to evaluate the interventions and outcomes for a Nursing Workforce Diversity Grant. During the expert review phase of the content validation process, response patterns to certain instrument items differed, effectively separating the reviewers into two groups. The response patterns of the Hispanic/Latino and American Indian experts were aligned with one another. The responses of the Anglo reviewers were also aligned with one another but not with the responses of the other group, which evaluated as highly relevant instrument items that were organized around five themes: the Importance of a Personal Relationship with Students of Color; the Effect of Isolation from Home and Family; the Importance of Culture and Ethnicity in Personal Identity; the Need for Collaborative, Interactive Learning and a Curriculum of Inclusion; and the Presence of Prejudice, Discrimination, and Racism.

Cross-Cultural Comparison↗
PubMed2001

Croatian Medical Journal introduces culture, control, and the study of research integrity.

Culture, control, and the study of research integrity represents the future goals of the Croatian Medical Journal. This article will highlight research integrity as experienced in the USA by the Office of Research Integrity (ORI) and discuss the framework being developed in Croatia. First, the Croatian Medical Journal seeks to promote a research culture that is aware of research integrity. This will be accomplished through the education and training of Croatian researchers interested in publishing their results in international scientific journals. To facilitate this goal, the Croatian Medical Journal introduces, what it believes to be, the first Research Integrity Editor. Second, the Croatian Medical Journal intends to facilitate the development of an Office of Research Integrity based on ORI model. The Croatian office of research integrity would be authorized to develop regulations to define scientific misconduct, investigate, and develop administrative actions against those found to have committed scientific misconduct. Furthermore, the office would be responsible for developing national education standards for promoting research integrity and the responsible conduct of research. Third, the Croatian Medical Journal is developing a science-based research agenda. This new research agenda will examine topics similar to those presented recently at the first Research Conference on Research Integrity held in Bethesda, Maryland, USA (November, 2000). The initial research topics would include studying those variables and mechanisms that help to promote research integrity and honorable research practices. This Editorial represents the first step towards achieving this goals, by establishing a collaborative relationship between ORI and the Croatian Medical Journal.

Clinical Trials as Topic↗
PubMedDate not supplied

Primary dentition unilateral crossbite in relation to functional lateralities.

PURPOSE: The aim of this study was to explore primary dentition unilateral crossbite malocclusion prevalences in functionally true right-sided and nonright-sided children, with the latter having 1 or more left-sided or indeterminate functions (eye, hand, foot). METHODS: The transversal relationship of the primary teeth was determined from dental casts of 1,835 young African American (60%) and Caucasian (40%) children in a cross-sectional sample at a mean age of 8.5 years. Hand, foot, and eye preferences (right, left, or indeterminate) were recorded at the age of 4 years during the same collaborative perinatal study. The prevalences of left and right crossbites were compared between true right-sided and mixed or completely nonright-sided children using chi-square analysis. RESULTS: Unilateral crossbite occurred in 140 cases with a complete set of laterality tests: 65 were right-sided and 75 left-sided. True right-sided children had more bilaterally symmetric occlusions and less crossbite on the right side than those having nonright-sidedness in their functions, with the differences being statistically significant (P<.01). CONCLUSIONS: These results point to anatomical relationships between the structures supporting the occlusion, the asymmetric neurocranium, and the cranial base. This suggests variable unilateral compensatory growth after unbalanced fetal asymmetry, modified by sidedness and the growth-stimulating effects of early lateralized functions and oral habits.

Adolescent↗
PubMed1999

Sexual behaviour of commercial sex workers and their clients in Cambodia. Japan-Cambodia Collaborating Research Group.

OBJECTIVE: This study surveyed the sexual behaviour of commercial sex workers and their clients in an attempt to identify factors of transmission of STDs (including HIV/AIDS) and to control their epidemics in Cambodia and South-East Asia. DESIGN: Cross-sectional study. SETTING: Trained questioners asked items of the questionnaires to each objective subject in December 1996. Data were analysed to show the descriptive status by risk group of each person. PARTICIPANTS: 200 direct commercial sex workers, 220 indirect commercial sex workers, and 211 clients in Phnom Penh. RESULTS: Prostitution was widely accepted by both young males and females, and this was an easy way for young girls to obtain money. Although commercial sex workers and clients were knowledgeable about prevention methods against STDs, they seldom used condoms. Some commercial sex workers had been infected with STDs many times, and many of them incompletely treated the diseases by themselves. Social support from governmental and non-governmental organisation was poor. CONCLUSIONS: It is very important to support both commercial sex workers in practicing preventive methods against STDs and also visiting physicians when they notice symptoms of STDs. It is strongly recommended that not only governmental but also non-governmental organisations should be more active in this area.

Acquired Immunodeficiency Syndrome↗