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PubMed2004

RNA interference and its current application in mammals.

OBJECTIVE: The aim of this review was to assess RNA interference (RNAi) and its possibility as a potential and powerful tool to develop highly specific double-stranded RNA (dsRNA) or small interfering RNA (siRNA) based gene-silencing therapeutics. DATA SOURCES: The data used in this review were obtained from the current RNAi-related research reports. STUDY SELECTION: dsRNA-mediated RNAi has recently emerged as a powerful reverse genetic tool to silence gene expression in multiple organisms. The discovery that synthetic duplexes of 21 nucleotides siRNAs trigger gene-specific silencing in mammalian cells has further expanded the utility of RNAi in to the mammalian system. DATA EXTRACTION: The currently published papers reporting the discovery and mechanism of RNAi phenomena and application of RNAi on gene function in mammalian cells were included. DATA SYNTHESIS: Since the recent development of RNAi technology in the mammalian system, investigators have used RNAi to elucidate gene function, and to develop gene-based therapeutics by delivery exogenous siRNA or siRNA expressing vector. The general and sequence-specific inhibitory effects of RNAi that will be selective, long-term, and systemic to modulate gene targets mentioned in similar reports have caused much concern about its effectiveness in mammals and its eventual use as a therapeutic mordality. CONCLUSIONS: It is certain that the ability of RNAi in mammals to silence specific genes, either when transfected directly as siRNAs or when generated from DNA vectors, will undoubtedly accelerate the study of gene function and might also be used as a potentially useful method to develop highly gene-specific therapeutic methods. It is also expected that RNAi might one day be used to treat human diseases.

Animals↗
PubMed2004

Second-hand smoke exposure--who's at risk?

OBJECTIVES: This article examines exposure to second-hand smoke (SHS) in 2003 in various settings by age and sex, and compares exposure indicators by province and health region. DATA SOURCE: The data are from the 2000/01 and 2003 Canadian Community Health Survey, conducted by Statistics Canada. ANALYTICAL TECHNIQUES: Rates of exposure to SHS among non-smokers are calculated by sex, age and location for the household population aged 12 or older. Rates of exposure at work are examined for employed non-smokers aged 15 or older. Smoking prevalence is expressed as a percentage of the household population aged 12 or older. MAIN RESULTS: In 2003, 33% of non-smokers reported that they were regularly exposed to SHS. The risk of exposure was greatest in public spaces, but regardless of setting, rates of exposure were higher for men than women. Exposure rates varied by age and peaked in young adulthood. However, at home and at work, the younger the non-smokers, the more likely they were to be exposed to SHS. Disparities in SHS exposure by province/territory and by health region were substantial.

Adolescent↗
PubMed2004

Alcohol and illicit drug dependence.

OBJECTIVES: This article estimates the prevalence of alcohol and illicit drug dependence among Canadians aged 15 or older Comorbidity with depression is examined. DATA SOURCES: The data are from the 2002 Canadian Community Health Survey: Mental Health and Well-being and the National Population Health Survey. ANALYTICAL TECHNIQUES: Cross-tabulations were used to estimate the prevalence of alcohol and illicit drug dependence by selected characteristics. Multiple logistic regression models were used to determine if associations persisted after controlling for potentially confounding factors, and to test temporal relationships between frequent heavy drinking and depression. MAIN RESULTS: In 2002, an estimated 641,000 people (2.6% of the household population aged 15 or older) were dependent on alcohol, and 194,000 (0.8%), on illicit drugs. These people had elevated levels of depression compared with the general population. Heavy drinking more than once a week was a risk factor for a new episode of depression, and depression was a risk factor for new cases of frequent heavy drinking.

Adolescent↗
PubMed2005

Studies of coltivirus in China.

OBJECTIVE: The purpose of this article is to review the developments of studies of Coltivirus in China. DATA SOURCES: The data used in this review was obtained mainly from the studies of Coltivirus reported from 1990 to 2003 in China. STUDY SELECTION: Relevant articles on studies of Coltivirus in domestic and foreign literature were selected. DATA EXTRACTION: Data were maily extracted from the articles which are listed in the reference section of this review. RESULTS: Many Coltiviruses have been isolated not only from blood samples of patients with unknown fever or from cerebrospinal fluid of patients with encephalitis in Xishuangbanna area in Yunnan province, but also from mosquitoes collected in many areas in China. In some patients diagnosed as Japanese encephalitis or unknown fever, an increase of Coltivirus IgG antibody of fourfold, or more, has been detected using ELISA. Similarly, Coltivirus IgM antibody was positive in some patients with Japanese encephalitis or viral encephalitis. From most Chinese patients, except the northeastern, the isolates of Coltiviruses belong to subgroup B2, according to RT-PCR amplification of the ninth and twelfth segments of the isolates and sequence analysis of their amplicons. Some biological properties of Chinese Coltiviruses isolates are different from that of North American Coltiviruses. CONCLUSIONS: The isolates of Coltiviruses from Chinese patients are one of the common agents causing viral encephalitis and unknown fever in summer-autumn season. It might be an important public health problem due to its high isolation rate and wide distribution in China. Mosquito is the main transmission vector of the virus.

Animals↗
PubMed2005

Early sexual intercourse.

OBJECTIVES: This analysis estimates the percentage of adolescents who have had sexual intercourse by age 14 or 15 and examines characteristics at age 12 or 13 that are associated with early sexual activity. DATA SOURCE: The data are from the 1996/97, 1998/99 and 2000/01 National Longitudinal Survey of Children and Youth, conducted by Statistics Canada. ANALYTICAL TECHNIQUES: Descriptive statistics were used to determine the proportion of 14- or 15-year-olds who have had sexual intercourse. Logistic regression was used to model sexual activity at age 14 or 15 in relation to the adolescent's characteristics at age 12 or 13. MAIN RESULTS: The percentages of boys and girls who had had intercourse by age 14 or 15 were almost the same--12% and 13%--but the characteristics associated with such behaviour differed. Among girls, region of residence, the onset of puberty, weak self-concept, having tried smoking or drinking, and not being overweight were significantly associated with early sexual activity. For boys, older age, a poor relationship with parents, low household income, and having tried smoking were significant.

Adolescent↗
PubMed2005

Individualized immunosuppression: new strategies from pharmacokinetics, pharmacodynamics and pharmacogenomics.

BACKGROUND: The ultimate goal of transplantation is the donor-specific immune tolerance, but at least in the first 15 to 20 years of this century, immunosuppressive agents are still the determinant of clinical outcome of transplant recipients. Individualizing patient's immunosuppression to optimize the balance between therapeutic efficacy and the occurrence of adverse events poses a great challenge to physicians. DATA SOURCES: The data in this article were taken mostly from MEDLINE (2000-2004), part of which were from the research of the authors. RESULTS: Individualized immunosuppression remains a problem because of the narrow therapeutic index and wide inter- and intra-patient variation of commonly used immunosuppressants. Recent progress in study of pharmacokinetics and pharmacodynamics improved the clinical outcome of transplant recipients. More importantly, the emergence of pharmacogenomics might provide a promising and complementary tool for traditional therapeutic drug monitoring (TDM). CONCLUSIONS: Individualizing organ recipient's immunosuppression to balance the therapeutic efficacy and the adverse events represents a great challenge to transplant clinicians. Pharmacogenomics shows great promise for an interesting and hopefully better future.

Humans↗
PubMed2005

Insomnia.

OBJECTIVES: This article estimates the prevalence of insomnia among Canadians aged 15 or older, and factors related to it. Associations between insomnia and coping ability, work status, two-week disability days and life dissatisfaction are analyzed. DATA SOURCES: The data are from the 2002 Canadian Community Health Survey: Mental Health and Well-being. ANALYTICAL TECHNIQUES: Cross-tabulations were used to estimate the prevalence of insomnia by selected characteristics. Associations between these characteristics and insomnia, and between insomnia and selected negative situations, were examined in multivariate logistic regression models. MAIN RESULTS: In 2002, an estimated 3.3 million Canadians (13.4% of the household population aged 15 or older) had insomnia. Factors independently associated with insomnia included painful chronic conditions, activity limitations, mood and anxiety disorders, life stress, frequent use of alcohol or cannabis, obesity, and low education. Compared with those who did not have insomnia, people with insomnia were more likely to report negataive situations such as difficulty coping and not having a job.

Adaptation, Psychological↗
PubMed2006

The effect of universal influenza immunization on vaccination rates in Ontario.

OBJECTIVES: This article examines the association between introduction of Ontario's Universal Influenza Immunization Program and changes in vaccination rates over time in Ontario, compared with the other provinces combined. DATA SOURCES: The data are from the 1996/97 National Population Health Survey and the 2000/01 and 2003 Canadian Community Health Survey, both conducted by Statistics Canada. ANALYTICAL TECHNIQUES: Cross-tabulations were used to estimate vaccination rates for the total population aged 12 or older, for groups especially vulnerable to the effects of influenza, and by selected socio-demographic variables. Z tests and multiple logistic regression were used to examine differences between estimates. MAIN RESULTS: Between 1996/97 and 2000/01, the increase in the overall vaccination rate in Ontario was 10 percentage points greater than the increase in the other provinces combined. Increases in Ontario were particularly pronounced among people who were: younger than 65, more educated, and had a higher household income. Between 2000/01 and 2003, vaccination rates were stable in Ontario, while rates continued to rise in the other provinces. Even so, Ontario's 2003 rates exceeded those in the other provinces.

Adolescent↗
PubMed2006

Therapeutic DNA vaccines against tuberculosis: a promising but arduous task.

OBJECTIVE: To review recent developments in therapeutic DNA vaccines against tuberculosis. DATA SOURCES: The data used in this review were obtained mainly from the studies of therapeutic DNA vaccines against tuberculosis reported from 2000 to 2006. STUDY SELECTION: Relevant articles about studies of therapeutic DNA vaccines against tuberculosis were selected. DATA EXTRACTION: Data were mainly extracted from the 32 articles listed in the reference section of this review. RESULTS: Some DNA vaccines which previously showed to induce protective immunity against infection by Mycobacterium tuberculosis in a prophylactic manner are also surprisingly effective when used therapeutically, including persistent Mycobacterium tuberculosis and multidrug-resistant tuberculosis which are refractory to immune system and antibacterial chemotherapy alone. When used in combination with antibacterial drugs, therapeutic DNA vaccines could effectively eliminate residual bacteria in infected animals and shorten the therapy course of conventional chemotherapy. Detailed studies demonstrated that therapeutic effects of DNA vaccines may at least partly be due to the restoration of the Th(1)/Th(2) balance. Some problems have also emerged along with these exciting results. CONCLUSIONS: Therapeutic DNA vaccine is a promising strategy against tuberculosis, however developing an ideal DNA vaccine for therapy of tuberculosis will require further development.

Humans↗
PubMed2006

Obesity--a growing issue.

OBJECTIVES: This article, based on longitudinal data, follows a sample of people who were aged 20 to 56 in 1994/95 to determine the percentage who made the transition from normal to overweight, or from overweight to obese by 2002/03. Characteristics that increased the chances of overweight people becoming obese are examined. DATA SOURCES: The data are from five cycles of the National Population Health Survey, 1994/95 through 2002/03. ANALYTICAL TECHNIQUES: Cox proportional hazards modelling was used to identify variables associated with an increased or decreased risk of becoming obese; 1,937 men and 1,184 women who were overweight in 1994/95 were selected. MAIN RESULTS: Close to a third (32%) of people who were aged 20 to 56 and of normal weight in 1994/95 had become overweight by 2002/03. During the same period, almost a quarter of those who had been overweight in 1994/95 had become obese. Among people who were overweight, the risk of obesity was relatively high for younger men and members of low-income households. Overweight men who smoked or who had activity restrictions had a high risk of obesity. Physical activity helped women avoid obesity.

Adult↗
PubMed2006

Management of data quality--development of a computer-mediated guideline.

Appropriate data quality is a crucial issue in the use of electronically available health data. As source data verification (SDV) and feedback are two standard procedures for measuring and improving data quality it would be worthwhile to adapt these procedures to a current level of quality in order to reduce costs in data management. This project aims to develop a guideline for the management of data quality with special emphasis on this adaptation against the backdrop of research networks in Germany, which operate registers and conduct epidemiological studies. The first step in guideline development was a thorough literature review. The literature offers many measurements as candidates for quality indicators, however, systematic assessments and concepts of SDV and feedback are missing. We assigned possible quality indicators to the levels plausibility, organization, and trueness. Each indicator must be operationally defined to allow automatical calculation. The SDV sample size calculation leads to lower numbers for sites providing data of good quality and larger numbers for sites with poor data quality. The guideline's implementation in a software tool combines two cycles, one for the adaptation of recommendations to a given study/register, the other for the improvement of data quality in a PDCA-like approach. The recommendations will address needs common to medical documentation in daily health care, clinical, epidemiological, and observational studies as well as in surveillance data bases and registers. Further work will have to supplement other aspects of data management.

Feedback↗
PubMed1991

Nurses' perspectives on problems of hospitalized PCP patients: implications for the development of a nursing taxonomy.

The phenomena of interest in nursing informatics research are the data, information and knowledge related to nursing. This study presents nurses' perspectives on the problems of patients hospitalized for Pneumocystis carinii pneumonia from four data sources: nurse interview, intershift report, care plan, and nurses' notes. Even within this narrowly specified sample, patient problems showed variation across sources of data. The results of this study demonstrate the difficulties inherent in developing a nursing taxonomy when there is not consensus about the relevant data for nursing within a specific patient sample. Although existing information technology is capable of processing large volumes of nursing data, the lack of a common taxonomy limits the usefulness of the technology for documentation of care and decision support applications.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The potential for using a trauma registry for injury surveillance and prevention.

Trauma registries are a potential source of data for local injury surveillance. Data from a trauma registry in a Level 1 trauma unit were collected for 1,412 admissions during a one-year period, and the characteristics of these severely injured patients and their injuries were examined. Three-quarters of the injuries were unintentional, and half were vehicle-related injuries. The availability of variables regarding medical cost, patient outcome, and insurance status permits a determination of the impact of these injuries on society in terms of both cost and quality of life. Since the trauma registry contains an account of the patient's hospital experience from admission to discharge and is available in electronic format, it can be a useful data source for establishing priorities and evaluating the effectiveness of injury prevention programs.

Adolescent↗
PubMed1987

Efficacy of different surveillance systems in detecting hospital-acquired infections.

Microbiology laboratory reports are the principal data source for nosocomial infection surveillance in most European countries. Such laboratory based surveillance inherently lacks sensitivity so that additional sources of data are necessary to increase the detection of infections. Long term compliance of voluntary reporting by clinical or ward nursing staff has rarely been achieved but continuous and selective clinical surveillance has been implemented successfully in the USA. Selective clinical surveillance, supplemented by laboratory data, may be a practical proposition in Europe, even with existing staffing levels and validation studies of the various methods are needed urgently.

Cross Infection↗
PubMed1995

Mental health care utilization in prepaid and fee-for-service plans among depressed patients in the Medical Outcomes Study.

OBJECTIVE: We compare mental health utilization in prepaid and fee-for-service plans and analyze selection biases. DATA SOURCE: Primary data were collected every six months over a two-year interval for a panel of depressed patients participating in the Medical Outcomes Study, an observational study of adults in competing systems of care in three urban areas (Boston, Chicago, and Los Angeles). STUDY DESIGN: Patients visiting a participating clinician at baseline were screened for depression, followed by a telephone interview, which included the depression section of the NIMH Diagnostic Interview Schedule. Patients with current or past lifetime depressive disorder and those with depressed mood and three other lifetime symptoms were eligible for this analysis. We analyze mental health utilization based on periodic patient self-report. ANALYTIC METHODS: We use two-part models because of the presence of both nonuse and skewness of use. Standard errors are corrected nonparametrically for correlations across observations due to clustered sampling within participating physicians and repeated observations on the same individual. PRINCIPAL FINDINGS: The average number of mental health visits was 35-40 percent lower in the prepaid system, adjusted and unadjusted for observed differences in patient characteristics, including health status. Utilization differences were concentrated among patients of psychiatrists, with only minor differences among patients of general medical providers. Analyzing the effect of switches that patients make between payment systems over time, we found some evidence of adverse selection into fee-for-service plans based on baseline utilization, but not based on utilization at the end of the study. In particular, after adjusting for observed patient characteristics and health status, patients switching out of prepaid plans had higher baseline use than predicted, whereas patients switching out of fee-for-service had lower use than predicted. Switching itself appears to be related to an immediate decline in utilization and was not followed by an increase or "catch-up" effect. CONCLUSIONS: The absence of the commonly found "catch-up" effect following switching and the significant decrease in utilization during the switching period suggests an interruption in care that does not occur for patients staying within a payment system. This finding emphasizes the need for integrating new patients quickly into a system, an issue that should not be neglected in the current policy discussion.

Boston↗
PubMed1994

Predicting the risk of "permanent" nursing home residence: the role of community help as indicated by family helpers and prior living arrangements.

OBJECTIVE: This study examines the difference between permanent and transitory residence in a nursing home with special emphasis on the extent to which the risk of a long nursing home stay is reduced by the availability of informal help in the community. DATA SOURCE: Secondary data were used, taken from the National Long-Term Care Surveys of 1982 and 1984. The 1982 NLTCS samples disabled elderly living in the community. For these community dwellers, the 1984 NLTCS provides information on continued residence in the community and on their nursing home episodes between 1982 and 1984. METHOD OF ANALYSIS: The analysis is based on estimates from a multinomial logit regression with three explicit categories: persons with at least one long nursing home stay (n = 292), persons with only short stays (n = 227), and persons who died without ever having had a nursing home stay (n = 945). The implicit category: persons living in the community in 1984 without having had any nursing home stay (n = 3,368). PRINCIPAL FINDINGS: This study demonstrates the systematic differences in the personal characteristics that predict the risk of long stays from those that predict short stays in a nursing home. Controlling for limitations in physical and cognitive functioning, the regression analysis shows that indicators of informal help in the community have a statistically significant and relatively large effect on the risk of long stays; but the effects of these indicators on the risk of short stays is numerically smaller and not statistically significant. Specifically, when the burden of caregiving is shared by a spouse and children, the risk of a long stay in a nursing home is reduced by 9.3 percentage points; in contrast, the risk is increased by 18 percentage points for childless elders who are living alone and by 45.8 percentage points for elders living with adults other than a spouse or children. CONCLUSION: The relatively strong effects of family helpers and living arrangements on the risk of long nursing home stays confirm the hypothesis that, after controlling for the effects of physical and cognitive functioning, adequate help in the community reduces the risk of permanent nursing home residence. But help in the community has no effect on the risk of short nursing home episodes because these episodes are likely to be extensions of acute hospital care. The findings provide essential information for designing a long-term care program because they suggest the magnitudes of the effects that such a program can have on reducing the risk of permanent nursing home residence.

Activities of Daily Living↗
PubMed1994

Determinants of the use of specialist mental health services by nursing home residents.

OBJECTIVE: This study examines the effects of resident and facility characteristics on the probability of nursing home residents receiving treatment by mental health professionals. DATA SOURCES/STUDY SETTING: The study uses data from the Institutional Population Component of the 1987 National Medical Expenditure Survey, a secondary data source containing data on 3,350 nursing home residents living in 810 nursing homes as of January 1, 1987. STUDY DESIGN: Andersen's health services use model (1968) is used to estimate a multivariate logistic equation for the effects of independent variables on the probability that a resident has received services from mental health professionals. Important variables include resident race, sex, and age; presence of several behaviors and reported mental illnesses; and facility ownership, facility size, and facility certification. DATA COLLECTION/EXTRACTION METHODS: Data on 188 residents were excluded from the sample because information was missing on several important variables. For some additional variables residents who had missing information were coded as negative responses. This left 3,162 observations for analysis in the logistic regressions. PRINCIPAL FINDINGS: Older residents and residents with more ADL limitations are much less likely than other residents to have received treatment from a mental health professional. Residents with reported depression, schizophrenia, or psychoses, and residents who are agitated or hallucinating are more likely to have received treatment. Residents in government nursing homes, homes run by chains, and homes with low levels of certification are less likely to have received treatment. CONCLUSIONS: Few residents receive treatment from mental health professionals despite need. Older, physically disabled residents need special attention. Care in certain types of facilities requires further study. New regulations mandating treatment for mentally ill residents will demand increased attention from nursing home administrators and mental health professionals.

Activities of Daily Living↗
PubMed1994

[The public-private mix in hospital care in the Lombardy region].

OBJECTIVES: 1) to compare complexity and severity of the case-mix in the public and private sector, overall and across individual hospitals, and to examine their relative efficiency, by contrasting DRG and/or stage specific average length of stay (ALOS); 2) to assess the impact of a new contractual scheme based on a preassigned number of beddays for a restricted list of specific conditions. DATA SOURCES: Discharge data on 940.670 admissions to 101 public hospitals and 185.161 admissions to 55 private hospitals in the Regione Lombardia in 1990, assigned to HCFA-DRGs, 8th version and to stages and substages of principal and unrelated diagnostic categories, based on Disease Staging. RESULT: The spread of the case-mix is higher in the private sector, which also shows a higher concentration of admissions across hospital for specific medical and surgical conditions. The proportion of more advanced stages of disease is higher in the public sector, for most of the most frequent diagnostic categories. Obstetric care, including abortion, is the largest single public sector activity, while it is virtually not existent in the private sector. Elective surgical procedures, including ENT, cataract and varicose veins surgery make up a substantial proportion of the private hospitals' case load. DRGs-specific ALOS is longer in public hospitals for the most frequent surgical DRGs, mainly due to their preoperative LOS. The net impact of the proposed contractual scheme will save substantial proportion of beddays for most of the conditions considered, except cataract and varicose veins surgery.

Adult↗