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At least 865 records · Page 48Linked to original sources
PubMed2000

Avoiding gender and minority barriers to NIH funding.

PURPOSE: To inform investigators of the National Institutes of Health (NIH) guidelines for the inclusion of women and minorities as subjects in clinical research and provide tips on avoiding barriers to federal funding. METHODS: Information about gender and minority barriers to funding was obtained by reviewing NIH policies, information submitted by applicants, and comments provided by NIH reviewers. ORGANIZING FRAMEWORK: A brief history of the goals of U.S. federal legislation to increase opportunities for obtaining information to help enhance health and disease treatment for all Americans and to detect and account for ethnic and gender differences is described. Examples were derived from NIH Summary Statement comments of initial review groups. CONCLUSIONS: Applications submitted to NIH are being barred from initial funding, even with excellent priority scores, if the plan for inclusion of women and minorities is judged to be scientifically unacceptable by the initial review group. This situation is correctable and avoidable.

Clinical Trials as Topic↗
PubMed1991

The acceptability of behavioral treatments for marital problems. A comparison of behavioral exchange and communication skills training procedures.

Married female undergraduates were asked to provide ratings of the acceptability of two treatment components commonly used within the framework of behavioral marital therapy. The study compared subjects' evaluations of detailed taped descriptions of behavioral exchange/contracting procedures and communication/problem-solving skills training as they were applied to two hypothetical clinical marital cases. The study also evaluated the extent to which the severity of the marital problems influenced treatment acceptability evaluation. Communication/problem-solving skills training was judged as more acceptable than behavioral exchange/contracting procedures and received a higher score on the Evaluative and Potency dimensions of the Semantic Differential. Judgments of treatment Potency were also found to be influenced by idiosyncratic features of the cases described in association with problem severity. Implications and directions for future research are briefly discussed.

Adult↗
PubMedDate not supplied

Neural network analysis of follow-up data in primary breast cancer.

This paper reports on the performance of a recently developed neural network environment incorporating likelihood-based optimization and complexity reduction techniques in the analysis of breast cancer follow-up data with the goal of building up a clinical decision support system. The inputs to the neural network include classical factors such as grading, age, tumor size, estrogen and progesterone receptor measurements, as well as tumor biological markers such as PAI-1 and uPA. The network learns the structural relationship between these factors and the follow-up data. Examples of neural models for relapse-free survival are presented, which are based on data from 784 breast cancer patients who received their primary therapy at the Department of Obstetrics and Gynecology, Technische Universität München, Germany. The performance of the neural analysis as quantified by various indicators (likelihood, Kaplan-Meier curves, log-rank tests) was very high. For example, dividing the patients into two equally sized groups based on the neural score (i.e., cutoff = median score) leads to an estimated difference in relapse-free survival of 40% or better (80% vs. 40%) after 10 years in Kaplan-Meier analysis. Evidence for factor interactions as well as for time-varying impacts is presented. The neural network weights included in the models are significant at the 5% level. The use of neural network analysis and scoring in combination with strong tumor biological factors such as uPA and PAI-1 appears to result in a very effective risk group discrimination. Considerable additional comparison of data from different patient series will be required to establish the generalization capability more firmly. Nonetheless, the improvement of risk group discrimination represents an important step toward the use of neural networks for decision support in a clinical framework and in making the most of biological markers.

Adult↗
PubMed2006

Evaluating an Interpersonal Model of Depression among adults with Down syndrome.

The Interpersonal Model of Depression (IMD) based on the Theory of Human Relatedness (Hagerty, Lynch-Sauer, Patusky, & Bouwsema, 1993) is evaluated among adults with Down syndrome. One hundred subjects participated, with 32% having elevated depression scores and 40% stating they felt lonely. The relationship between depression, perceived social support, loneliness, and life satisfaction is statistically significant, F(6, 172) = 4.36, p < .001. Loneliness, social isolation, loss of sense of well-being, self-hate, and social withdrawal are important interpersonal manifestations and represent increasing levels of depression. Social and emotional loneliness are two dimensions of loneliness. The IMD provides a framework to assess depression in this population. Research on the efficacy of depression treatment based on the IMD is needed.

Adult↗
PubMedDate not supplied

[Effectiveness of treatment in day hospital versus inpatient ward evaluated by patients' psychopathological symptoms and subjective quality of life (QoL) analysis].

AIM: The authors analyzed patients' psychopathological symptoms and subjective quality of life (QoL) for evaluating the effectiveness of treatment in day hospital versus inpatient wards. Analyses concerned patients from Wrocław and recruited within the framework of an EU funded multi-centre study EDEN. METHOD: 238 patients admitted to the Psychiatric Hospital in Wrocław were randomly assigned to treatment in either day hospital (n=l15) or inpatient ward (n=123). Patients were interviewed at 4 time-points comprising their stay in hospital. Differences between settings in terms of dynamics of psychopathological symptoms and subjective QoL were expressed in mean scores of BPRS subscales and MANSA. Two parameters of effectiveness were considered: the static--the score on the scale at a given time-point and average score level, and the dynamic--describing dynamics of changes (gradients). Statistical methods included ANOVA and ANCOVA with co-variables. RESULTS: In terms of manic and excitement symptoms inpatient wards proved to be more effective as measured at discharge, no differences in dynamics between settings were found. Day hospital was superior in alleviating negative symptoms during treatment but improvement in that respect was quicker in the inpatient ward. In terms of alleviating positive symptoms, the inpatient ward was more effective only at the beginning of the treatment. Day hospital was more effective in handling symptoms of depression and anxiety but only at the beginning of treatment. Dynamics of subsiding of the symptoms at the beginning of hospitalization was better for the inpatient ward. No differences in QoL in both settings were found. CONCLUSIONS: Taking into consideration the static and the dynamic parameters of effectiveness of treatment, the superiority of inpatient treatment over day hospital has not been, therefore, definitely proven.

Adolescent↗
PubMed1988

Adolescent stress factors: implications for the nurse practitioner.

This article present results of a descriptive study designed to assess gender differences in stress factors of adolescents attending rural, urban and suburban public schools. The Roy Adaptation Model of Nursing was selected as the theoretical framework for the study. Subjects were 323 freshmen in high schools in eastern Tennessee; mean age was 15.5 years. Most frequently reported stressors were hassling with parents, hassling with siblings, and making new friends. There was little difference between boys and girls in prevalence of these stress factors. However, gender differences in amount and types of other stressors were identified. Regardless of geographic location, mean stress scores of females were higher; urban females reported the highest stress levels. Females were more concerned with self-concept issues and interdependence issues, whereas males were more concerned with role function issues. Nurse practitioners and school nurses have unique opportunities to promote improved adaptation in adolescents experiencing stress. Intervention strategies are proposed for each of the four adaptation modes delineated by Roy.

Adaptation, Psychological↗
PubMed1990

Marginal microleakage of resin-retained bridges in association with existing resin composite and amalgam restorations.

The aim of this study was to determine the microleakage associated with resin-retained bridge retainers cemented over amalgam and resin composite restorations. Cavities prepared on the labial surfaces of bovine incisors were restored with either amalgam or a posterior resin composite. Non-precious nickel-chromium alloy frameworks were then attached to the teeth by use of one of four cements: Conclude, ABC, Panavia Ex, and Superbond. The specimens were then stored for two weeks or six months, thermocycled, and tested for microleakage by use of a radioactive tracer and an autoradiographic technique. The results showed that more leakage was associated with the amalgam restorations than with the teeth filled with resin composite. Leakage scores increased with time with both the amalgam and composite restorations, except for the Panavia Ex and ABC materials, respectively.

Animals↗
PubMed2000

The use of molecular markers to investigate the genetic structure of an oil palm breeding programme.

RFLP markers (40 probes covering 60% of the oil palm genome) have been used to assess genetic diversity within 54 palms of a specific oil palm breeding programme. A further 10 palms encompassing a broader range of origins were also included to provide a wider framework for comparative analysis. These palms represent a majority of the parents in a crossing programme which aims to combine the best features of African tenera germplasm with South-east Asian Deli dura material. Progeny from these crosses are planted in up to six sites on three continents, where the palms are being assessed in detail for yield components. A total of 157 RFLP bands were scored and the data analysed by calculating genetic distances according to Nei & Li, and by correspondence and cluster analysis. The relationships that emerge through this molecular analysis correspond well with known pedigree and provenance. For example, south-east Asian Deli dura material forms a cluster clearly distinct from AVROS pisifera gene pools, and a selection of African breeding material forms a further and broader grouping. The potential ability of markers to assist in oil palm breeding through examination of the genetic structure of crossing programmes is discussed, as is their value in parental selection to maintain residual diversity within specific breeding pools and use in evaluating the fidelity of breeding lineages.

Chromosome Mapping↗
PubMed2000

The CNS's impact on process and outcome of patients with total knee replacement.

This study was designed to determine whether differences exist between patients with total knee replacement on hospital units with or without clinical nurse specialists (CNSs) in terms of selected process and outcome variables. The charts of 128 randomly chosen patients who had undergone total knee replacement were reviewed. Sixty-four patients were from orthopedic units with CNSs and 64 were from orthopedic units without CNSs. This study was based on Donabedian's framework for assessment of quality of care using structure, process, and outcome variables. Structural variables were collected on institutional and unit demographics. Data were gathered on nursing care interventions (process variables) using process instruments designed by the investigator. Length of stay, total length of stay, which included rehabilitation length of stay, and complications were the outcome variables used. Patients on units with CNSs had significantly higher process scores, shorter total length of stay, and fewer complications than patients on units without CNSs. In addition, significant negative correlations were found between process instrument scores and total length of stay. Higher scores on the process instruments (with CNS units) were correlated with shorter total length of stay. The number of complications was also negatively correlated to the process instrument scores.

Aged↗
PubMed2005

Quality of life and the concept of "living well" with HIV/AIDS in sub-Saharan Africa.

PURPOSE: To increase understanding of the meaning of quality of life for people living with HIV/AIDS in four countries in sub-Saharan Africa: Botswana, Lesotho, South Africa, and Swaziland. METHODS: Using a cross-sectional design and convenience sample, we administered a survey and collected data on demographic characteristics, measures of severity of illness, and perceptions of quality of life. The purposefully selected sample (N=743) consisted of community-based people living with HIV/AIDS in 2002. Based on the Wilson and Cleary framework for organizing variables related to quality of life, a hierarchical multiple regression was conducted with quality of life as the dependent variable. RESULTS: The sample of 743 persons was 61.2% female with a mean age of 34 years. Approximately 62 % of the sample reported having received an AIDS diagnosis. Ten predictor variables explained 53.2 % of the variance in life satisfaction. Those participants with higher life satisfaction scores were less educated, had worries about disclosure and finances, did not have an AIDS diagnosis or other comorbid conditions, had lower symptom intensity, had greater functioning, and had fewer health worries. None of these participants was taking antiretroviral medications at the time of this study. CONCLUSIONS: Several dimensions of the Wilson and Cleary model of quality of life were significantly related to life satisfaction for people living with HIV/AIDS in sub-Saharan Africa. Quality of life for this sample was primarily defined as overall functional ability and control over symptom intensity. These findings are similar to studies in developed countries that have shown the significant relationships among functional abilities, symptom control, and perceived quality of life. As antiretroviral medications become more available in these areas, community members and care providers can help clients realize the possibility of living well with HIV/AIDS, and can work with clients to improve functional ability and control symptom intensity to make living well a reality.

Adaptation, Psychological↗
PubMed2006

Clinical phenotype of Parkinson disease dementia.

OBJECTIVE: To determine which clinical features best characterize Parkinson disease dementia (PDD), compared with Alzheimer disease (AD) and dementia with Lewy bodies (DLB), and to determine the pathologic basis for PDD. METHODS: We examined 103 participants enrolled in a longitudinal study (nondemented control = 10, PD = 42, DLB = 20, AD = 31) who were followed to autopsy using standardized protocols. We characterized the features of PDD using published criteria for AD and DLB as a framework. Statistical analysis was performed using chi(2) and Fisher exact tests, Kaplan-Meier curves, and logistic regression models. RESULTS: The sample's mean age was 74.0 years (range 53 to 91 years), and individuals were followed for a mean of 3.4 visits (range 1 to 12 visits). During longitudinal follow-up, 83% of subjects with PD developed dementia, defined as a Clinical Dementia Rating score of >or=0.5. Features that distinguished PDD from AD included cognitive fluctuations (p = 0.001), visual (p < 0.001) and auditory (p = 0.006) hallucinations, depression (p = 0.003), and sleep disturbance (p = 0.003). These PDD features were identical to those observed for DLB. The pathologic substrates for PDD included DLB (38%), AD (32%), and nigral LB alone (24%). Clinical predictors of PDD were visual hallucinations (odds ratio [OR] 21.3; 95% CI: 1.5 to 309.6) and male gender (OR 9.6; 95% CI: 1.3 to 71.4). CONCLUSIONS: Parkinson disease dementia (PDD) shares identical clinical features with dementia with Lewy bodies (DLB); both entities can be distinguished from Alzheimer disease. The presence of PDD/DLB features at any time during the course of PD is highly predictive of dementia and the presence of LB at autopsy; in particular, male gender and visual hallucinations in PD predict dementia.

Aged↗
PubMed2026

Multi-omic signatures of genetic mechanisms inform on type 2 diabetes biology and patient heterogeneity.

Type 2 diabetes (T2D) is a heterogeneous disease shaped by genetic pathways related to insulin resistance and &#x3b2;-cell dysfunction, but how this heterogeneity is reflected molecularly remains unclear. We integrated partitioned polygenic scores (pPS) with proteomic and metabolomic profiling to define molecular signatures of T2D and their clinical relevance. We analyzed UK Biobank participants with genomic, proteomic, and metabolomic data. In a disease-free training subset, we used LASSO regression to identify multi-omic signatures associated with each pPS by jointly modeling proteins and metabolites. In an independent testing set, we constructed multi-omic scores and examined their associations with clinical traits and diabetes-related outcomes. Mediation analyses were used to investigate putative causal pathways. Key findings were evaluated in the Multi-Ethnic Study of Atherosclerosis (MESA). We identified distinct multi-omic signatures that capture the molecular architecture of T2D genetic risk across physiological subtypes. Compared with genetic scores alone, multi-omic pPS showed larger effect sizes and better disease discrimination. These scores recapitulated subtype-specific physiology and were associated with T2D risk. The Beta-Cell 2 multi-omic score showed marked stratification for insulin use, which was replicated in MESA, where it also predicted future insulin use. Mediation analyses implicated lipoprotein remodeling and fatty acid metabolism in the Lipodystrophy 1 cluster, accounting for 30-45% of the total effect of pPS on T2D risk. Integrating process-specific genetic risk with circulating multi-omic profiles reveals biologically distinct endotypes of T2D and supports a framework for improved patient stratification and risk assessment.

Journal Article↗
PubMed1999

The responsiveness of health status measures in patients with rheumatoid arthritis: comparison of disease-specific and generic instruments.

OBJECTIVE: To compare the responsiveness of 2 disease-specific questionnaires, the Modified Health Assessment Questionnaire (MHAQ) and the Arthritis Impact Measurement Scale (AIMS2) with corresponding dimensions (physical function, mental health, pain, and fatigue) in a generic health status measure [the MOS Short Form-36)] in patients with rheumatoid arthritis (RA). METHODS: Within the framework of an observational study, a prospective cohort of 595 patients with RA from a community based patient register responded to a questionnaire at baseline and after 2 years' followup. Changes in patient global disease activity assessed on a categorical verbal rating scale (range 1-5) were used as external indicator of improvement or deterioration. Responsiveness was evaluated with standardized response means (SRM), calculated as mean change score divided by the standard deviation of the mean change score. RESULTS: Changes in patient global disease activity were classified as much better (n = 33), slightly better (n = 108), no change (n = 291), slightly worse (n = 108), and much worse (n = 20). There were no significant differences in responsiveness between SF-36 and the disease-specific measures within the same dimensions of health. The SRM of the tools within the dimension of pain (AIMS2 and SF-36) were moderate (0.5-0.8) to large (> 0.8) consistently in both directions (improvement and deterioration). The physical function subscales detected the same pattern, but the magnitude of the gradients was smaller. The fatigue and mental health subscales did not show any clear and consistent pattern of change. CONCLUSION: In patients with RA, there was no difference in responsiveness of subscales from SF-36 and disease-specific instruments when using changes in patient assessed global disease activity as an external indicator of change in health status. The dimension of pain was most sensitive to changes in patient assessed global disease activity followed by physical function, fatigue, and mental health.

Aged↗
PubMedDate not supplied

Cognitive adaptation to stressful events during pregnancy and postpartum: development and testing of the CASE instrument.

The purpose of this article is to describe the development and testing during pregnancy and postpartum of a new instrument, the Cognitive Adaptation to Stressful Events Scale (CASE). The conceptual framework for the CASE is based on Taylor's theory of cognitive adaptation to threatening events using the dimensions of meaning, mastery, and self-esteem. A convenience sample of 202 primigravida women completed the CASE at six assessment points: 10 to 12, 20 to 22, and 30 to 32 weeks of pregnancy and 1 to 2, 8, and 14 weeks postpartum. Regression analysis conducted with CASE scores at each of the assessment points in relation to psychological symptom distress as measured with the SCL-90R Global Severity Index (GSI) indicated a strong relationship during each time period. Although replication with multiethnic, high-risk pregnancy and clinically depressed groups is needed, the CASE is a promising tool for examining the cognitive adaptation process occurring during pregnancy and postpartum.

Adaptation, Psychological↗
PubMed1993

Self-care agency in persons with rheumatoid arthritis.

Using a framework based on Orem's self-care deficit theory, five hypotheses related to conditioning factors in self-care agency were tested. The study sample consisted of 60 outpatients with a diagnosis of rheumatoid arthritis in a large research hospital. Patients completed the Exercise of Self-Care Agency instrument and the Health Assessment Questionnaire; a physician rated their arthritis severity. Twenty percent of subjects had high scores on self-care agency, 63% had average scores, and 16% had low scores. The conditioning factor of age was not related to self-care agency. However, education and the duration of illness were related to self-care agency in this group of persons with rheumatoid arthritis.

Adult↗
PubMed2003

General multilevel linear modeling for group analysis in FMRI.

This article discusses general modeling of multisubject and/or multisession FMRI data. In particular, we show that a two-level mixed-effects model (where parameters of interest at the group level are estimated from parameter and variance estimates from the single-session level) can be made equivalent to a single complete mixed-effects model (where parameters of interest at the group level are estimated directly from all of the original single sessions' time series data) if the (co-)variance at the second level is set equal to the sum of the (co-)variances in the single-level form, using the BLUE with known covariances. This result has significant implications for group studies in FMRI, since it shows that the group analysis requires only values of the parameter estimates and their (co-)variance from the first level, generalizing the well-established "summary statistics" approach in FMRI. The simple and generalized framework allows different prewhitening and different first-level regressors to be used for each subject. The framework incorporates multiple levels and cases such as repeated measures, paired or unpaired t tests and F tests at the group level; explicit examples of such models are given in the article. Using numerical simulations based on typical first-level covariance structures from real FMRI data we demonstrate that by taking into account lower-level covariances and heterogeneity a substantial increase in higher-level Z score is possible.

Algorithms↗
PubMed2002

Assessment of adequacy of ICU admission.

BACKGROUND: Direct costs of critical care are increasing more than in other health care sectors. Tools are needed to evaluate adequacy of ICU admission in order to have a proper allocation of ICU resources. OBJECTIVE: evaluation of different ways used to assess adequacy of ICU admission. METHODS STUDY TYPE: 12 months prospective descriptive study. SETTING: 24 Intensive Care beds of a 1000 beds tertiary hospital in Italy. PATIENTS: 2314 patients admitted to Cardiac Surgery, General and Postoperative Intensive Care Units. INTERVENTIONS: all patients admitted to the ICUs were studied. Information was collected for the patients' age, source of admission, diagnoses, surgical status, reason for admission, SAPS II score, NEMS daily score, LOS, ICU outcome. The number of available beds (ventilated or not) and nurse working hours were obtained. RESULTS: 2373 patients were admitted to the ICs, with an overall readmission rate of 2.5%, and a total amount of 8084 NEMS record. The mean Work Utilization Ratio was significantly different between the three IC and between working and weekend days in PACU and CSU. The 49.7% of the NEMS points is scored by the SAPS II 43-78 patients, corresponding to the 29.2% of >24 h admissions. The level of care provided and the trend of each admission was derived from NEMS score according to Iapichino. The proportion of HT records in each IC was 88.3% in ICU, 73.1% in PACU and 91.2% in CSU; the outcome (dead/discharged) was significantly different between LT and HT. CONCLUSIONS: Despite the difficulties imposed by he rigid nurses' work organization in Italy, a daily data collection about level of care, severity of illness, workload utilization could provide, together with standard administrative indexes, the necessary framework to assess and to improve adequacy of ICU admission.

Humans↗
PubMed1993

A genetic map of chromosome 20q12-q13.1: multiple highly polymorphic microsatellite and RFLP markers linked to the maturity-onset diabetes of the young (MODY) locus.

Multiple highly polymorphic markers have been used to construct a genetic map of the q12-q13.1 region of chromosome 20 and to map the location of the maturity-onset diabetes of the young (MODY) locus. The genetic map encompasses 23 cM and includes 11 loci with PIC values > .50, seven of which have PICs > .70. New dinucleotide repeat polymorphisms associated with the D20S17, PPGB, and ADA loci have been identified and mapped. The dinucleotide repeat polymorphisms have increased the PIC of the ADA locus to .89 and, with an additional RFLP at the D20S17 locus, the PIC of the D20S17 locus to .88. The order of the D20S17 and ADA loci determined genetically (cen-ADA-D20S17-qter) was confirmed by multicolor fluorescence in situ hybridization. The previously unmapped PPGB marker is closely linked to D20S17, with a two-point lod score of 50.53 at theta = .005. These markers and dinucleotide repeat markers associated with the D20S43, D20S46, D20S55, D20S75, and PLC1 loci and RFLPs at the D20S16, D20S17, D20S22, and D20S33 have been used to map the MODY locus on chromosome 20 to a 13-cM (sex averaged) interval encompassing ADA, D20S17, PPGB, D20S16, and D20S75 on the long arm of chromosome 20 and to create a genetic framework for additional genetic and physical mapping studies of the region. With these multiple highly polymorphic loci, any MODY family of appropriate size can be tested for the chromosome 20 linkage.

Base Sequence↗