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PubMed1988

Human immunodeficiency virus infection in hemodialysis patients. Baltimore-Boston Collaborative Study Group.

Patients undergoing chronic hemodialysis receive multiple blood transfusions and, thus, are susceptible to infections transmitted through blood and blood products, including infection with human immunodeficiency virus (HIV). To determine the prevalence of antibody to HIV among patients undergoing chronic hemodialysis in Baltimore and Boston in 1985, we conducted a cross-sectional seroprevalence study. Repeatedly enzyme-linked immunosorbent assay (ELISA)-positive serum samples were tested by Western blot analysis. Among 435 patients in Baltimore, 12 (2.8%) were seropositive by both ELISA and Western blot techniques. Among 90 patients in Boston, three (3.3%) were seropositive. Among 100 frozen serum samples obtained from another Boston hemodialysis population in 1980, only one was seropositive. Many repeatedly ELISA-positive specimens were observed in each of the three groups studied, especially the serum samples that had been stored at -30 degrees C to -70 degrees C for four years. Most were nonspecifically reactive as demonstrated by reactivity with an H9-control ELISA plate. Patients undergoing hemodialysis, many of whom have received frequent transfusions in the past, are at increased risk for prior infection with HIV. Serologic testing for either screening or case-finding purposes must be conducted with great attention to specificity; serum samples frozen for prolonged periods are especially likely to be nonspecifically ELISA positive. These findings have implications concerning case-finding purposes, dialysis procedures, renal transplantation, and seroepidemiologic research.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Oral health status in relation to ethnicity of children in the Municipality of Copenhagen, Denmark.

UNLABELLED: Approximately 25% of children under the age of 18 in the Municipality of Copenhagen have a non-Danish ethnic background, and it is suspected that there may be major inequalities in oral health as a result. OBJECTIVES: The objectives of this study were to describe the occurrence of dental caries in different ethnic minorities, and to analyse whether the dental caries experience of the children may be affected by cultural and behavioural differences. MATERIALS AND METHODS: The study was conducted in Copenhagen as a cross-sectional investigation of 794 children, aged 3 and 5 years old (preschool), 7 years old (Grade 1) and 15 years old (Grade 9). Children of Danish, Turkish, Pakistani, Albanian, Somali and Arabian backgrounds were selected by convenience sampling. Epidemiological data were retrieved from the Danish Recording System for the Public Dental Health Services (SCOR) and sociological data were collected by postal questionnaires. RESULTS: Marked differences in dental caries prevalence were observed when different ethnic minorities were compared to Danish children. These were most prominent for the primary dentition. At age 7, 53% of the Danish and 84% of the Albanian children were affected by dental caries, the mean caries experience was 3.5 dmfs (decayed, missed and filled surfaces) and 13.8 dmfs, respectively. Caries in incisors and/or smooth surfaces was observed in 10% of the Danish children and 48% of the Albanian children. There were cultural differences in dental attendance and self-care practices of children and parents. These socio-behavioural factors may help to explain the differences in dental caries prevalence and severity. CONCLUSIONS: Development of appropriate oral health promotion strategies is urgently needed to improve oral health behaviour and attitudes of parents and children of ethnic minorities. Preventive programs should be organized at local community level in close collaboration with key persons of ethnic minority societies.

Adolescent↗
PubMed2002

Evaluation of mandated memoranda of understanding between local health departments and Medicaid managed care plans.

The success of mandating memoranda of understanding (MOU) in promoting collaboration between Medicaid managed care (MCMC) plans and local health departments (LHDs) was examined in this research project. The mandate resulted in MOUs that contributed to increases in collaborative activities, increased perceived quality of health care, and successful management of reimbursement to LHDs. Factors associated with success included a local initiative type of health plan, longer length of time that the MOUs were in place, and higher interorganizational collaborativeness. Concerns related to the MOU approval process and lack of contribution of the MOUs to quality of public health services were identified. MOUs promote collaborative relationships between MCMC plans and LHDs on health care issues important to both sectors.

Chi-Square Distribution↗
PubMed1990

The contribution of the basic sciences to nursing practice research.

The scientific knowledge on which nurses may base their clinical practice is often lacking. Not withstanding this, scientific knowledge in isolation is sterile unless it is invoked to address nursing hypotheses. This paper explores how such nursing questions can be both identified and answered within a scientific framework. Using the example of infection control, the complexity of the problem is examined and the contribution that various research approaches, including in vitro investigations, can offer is evaluated. Nursing practice research has a vital role to play in determining the effective prevention of nosocomial infection. The necessity for a collaborative and flexible approach to such research and the value of multidisciplinary teams of nurses and other scientists is emphasized.

Clinical Nursing Research↗
PubMed1983

Lomest psychiatric case register: the statistical context required for planning.

Descriptive statistics derived from a psychiatric case register are presented. They may be useful for a more rational planning of new services, and provide a preliminary evaluation of the effects of the recent Act (1978) which has abolished large mental hospitals in Italy. Each component of the 1-year prevalence rates has been examined closely, and the results have indicated three main considerations: abolishing the large mental hospital does not abolish the long-stay patients still living in it, and these people will remain a heavy load on the mental health care system for a long time; the new Act has halved admission rates, but the decline may be a positive result if in-care and out-care are sufficiently integrated; treated out-patients tend to increase year by year, and they seem more and more to be "young men and middle-aged women" suffering from minor psychiatric disorders. Finally, a closer collaboration between planners and evaluators is suggested.

Adolescent↗
PubMed1995

[Analysis of research in primary health care in the Murcia region (1988-1992)].

OBJECTIVE: To analyse Primary Health Care (PHC) research in Murcia between 1988 and 1992, looking at the possible influence of regional PHC conferences (RC) on the production of scientific work, which might be presented to RC, national conferences (NC) or national reviews (NR), as well as the impact of personal factors. DESIGN: A crossover, retrospective and descriptive study. PARTICIPANTS: Publications in NR and presentations at Murcia PHC RC and at NC between 1988 and 1992. 176 works were analysed. There were two sources of information: a) documents on PHC done in the region, articles, editorials or letters to the editor in NR collected in the IME (Spanish Medical Index), or as oral contributions, papers or posters in PHC RC or NC; b) personal and professional data of the authors. MEASUREMENTS AND MAIN RESULTS: Documents: title, authors, sources, date, theme, type, work centre and describer. Authors: sex, age, work activity, work situation, place of work and number of jobs. Statistical treatment: Chi squared and variance analysis. Between 1988 and 1992 works presented to RC duplicated (16 to 39) and increased by six to NC (1 to 6) and NR (2 to 13). Health Centres (62% of studies) made the greatest scientific contribution. CONCLUSIONS: The celebration of RC has a positive impact on the number of articles sent to NR, but not on the presentation of work in NC. Increase in the number of PHC research works (18 in 1988 and 52 in 1992) does not imply higher proportional collaboration of nonmedical health staff.

Cross-Over Studies↗
PubMed1996

Synergistic growth stimulation of mouse fibroblasts by tumor-derived adhesion factor with insulin-like growth factors and insulin.

Tumor-derived adhesion factor (TAF) has been purified as a major secretory protein with cell-adhesion activity from culture medium conditioned by human bladder carcinoma cells (K. Akaogi et al., Biochem. Biophys. Res. Commun., 198: 1046-1053, 1994). TAF is closely related or identical to a putative protein encoded by the mac25 gene (M. Murphy et al., Cell Growth & Differ., 4: 715-722, 1993) and prostacyclin-stimulating factor (T. Yamauchi et al., Biochem. J., 303: 591-598, 1994). TAF has a characteristic cysteine cluster in its NH2-terminal sequence, which is conserved in the NH2 termini of insulin-like growth factor-binding proteins. In the present study, we examined the interaction of TAF with insulin-like growth factors (IGFs) and insulin. Although in a ligand blotting assay TAF bound neither IGFs nor insulin, immunoprecipitation assay showed weak interaction of TAF with IGF-I, IGF-II, and insulin. TAF by itself stimulated the growth of BALB/c3T3 cells on the usual plastic substrates and significantly enhanced IGF- or insulin-mediated cell growth. Moreover, marked potentiation of the mitogenic activities of IGFs and insulin by TAF was found in the culture on type IV collagen substrates. The synergistic growth stimulation was completely blocked by heparin. These results suggest that TAF may regulate the growth of fibroblastic cells in collaboration with IGFs and insulin.

3T3 Cells↗
PubMed2003

Primary care patients with depression are less accepting of treatment than those seen by mental health specialists.

OBJECTIVE: This study examined whether depressed patients treated exclusively in primary care report less need for care and less acceptability of treatment options than those depressed patients treated in the specialty mental health setting after up to 6 months of treatment. DESIGN: Cross-sectional study. SETTING: Forty-five community primary care practices. PARTICIPANTS: A total of 881 persons with major depression who had received mental health services in the previous 6 months and who enrolled in 3 of the 4 Quality Improvement for Depression Collaboration Studies. MEASUREMENTS AND RESULTS: Patients were categorized into 1 of 2 groups: 1) having received mental health services exclusively from a primary care provider (45%), or 2) having received any services from a mental health specialist (55%) in the previous 6 months. Compared with patients who received care from mental health specialists, patients who received mental health services exclusively from primary care providers had 2.7-fold the odds (95% confidence interval [CI], 1.6 to 4.4) of reporting that no treatment was definitely acceptable and had 2.4-fold the odds (95% CI, 1.5 to 3.9) of reporting that evidence-based treatment options (antidepressant medication) were definitely not acceptable. These results were adjusted for demographic, social/behavioral, depression severity, and economic factors using multiple logistic regression analysis. CONCLUSIONS: Patients with depression treated exclusively by primary care providers have attitudes and beliefs more averse to care than those seen by mental health specialists. These differences in attitudes and beliefs may contribute to lower quality depression care observed in comparisons of primary care and specialty mental health providers.

Chi-Square Distribution↗
PubMed2005

Involvement in treatment decisions: what do adults with asthma want and what do they get? Results of a cross sectional survey.

BACKGROUND: Current healthcare policy advocates patient participation in treatment decision making. However, in asthma there is little evidence regarding patients' views on such involvement. This study explored the preferred and perceived level of involvement in treatment decisions, rationales for role preference, perceived facilitators of/barriers to involvement, and the interrelationship of role preference and demographic variables in a sample of patients with asthma. METHODS: A cross sectional survey was performed of 230 adults with clinician diagnosed asthma from 10 primary care sites and one specialist respiratory centre in north-west England. Preferred role in treatment decisions was assessed using the Control Preferences Scale. RESULTS: Fifty five (23.9%) preferred an active role, 82 (35.7%) a collaborative role, and 93 (40.4%) a passive role; 19 (8.2%) perceived their role as active compared with 45 (19.6%) collaborative and 166 (72.2%) passive. Only 33.5% (n = 77) of respondents attained their most preferred role; 55.2% (n = 127) were less involved than they preferred. Patient related, professional related, and organisational factors, especially quality and duration of consultations, facilitated or hampered involvement. Role preferences were not strongly associated with demographic variables or asthma severity. CONCLUSIONS: This study in patients with asthma highlights the fact that there is a need for professional and patient education regarding partnership working, skilful communication, and innovative approaches to service delivery.

Adult↗
PubMed2002

Delay in diagnosis among hospitalized patients with active tuberculosis--predictors and outcomes.

Delayed diagnosis of active pulmonary tuberculosis (TB) among hospitalized patients is common and believed to contribute significantly to nosocomial transmission. This study was conducted to define the occurrence, associated patient risk factors, and outcomes among patients and exposed workers of delayed diagnosis of active pulmonary TB. Among 429 patients newly diagnosed to have active pulmonary TB between June 1992 and June 1995 in 17 acute-care hospitals in four Canadian cities, initiation of appropriate treatment was delayed 1 week or more in 127 (30%). This was associated with atypical clinical and demographic patient characteristics, and after adjustment for these characteristics, with admission to hospitals with low TB admission rate of 0.2-3.3 per 10,000 admissions (odds ratio [OR]: 7.4; 95% confidence interval [CI]: 3.2,17.5) or intermediate TB admissions of 3.4-9.9/10,000 (OR: 2.3; CI: 1.6,3.2) as well as potentially preventable (late) intensive care unit admission (OR: 16.8; CI: 2.0,144) and death (OR: 3.3; CI: 1.7,6.5]). In hospitals with low TB admission rates, initially missed diagnosis, smear-positive patients undergoing bronchoscopy, late intensive care unit admission (OR: 2.3; CI: 0.1,56), and death (OR: 3.8; CI: 1.2,12.1) were more common than in hospitals with high TB admissions (> 10/ 10,000); a similar trend was seen in hospitals with intermediate TB admissions. Even after adjustment for workers' characteristics and ventilation in patients' rooms tuberculin conversions were disproportionately high in hospitals with low and intermediate TB admission rates and significantly higher in hospitals with overall TB mortality rate above 10% (OR: 2.5; CI: 1.6,3.7). In the hospitals studied, as the rate of TB admissions decreased, the likelihood of poor outcomes and risk of transmission of TB infection per hospitalized patient with TB increased. Institutional risk of TB transmission was poorly correlated with number of patients with TB and better correlated with indicators of patient care such as delayed diagnosis and treatment and overall TB-related patient mortality.

AIDS-Related Opportunistic Infections↗
PubMed2002

Onchocerciasis: the clinical and epidemiological burden of skin disease in Africa.

An attempt was made to assess the true public-health importance of onchocercal skin disease throughout the African region and hence provide an objective basis for the rational planning of onchocerciasis control in the area. The seven collaborative centres that participated in the study (three in Nigeria and one each in Ghana, Cameroon, Tanzania and Uganda) were all in areas of rainforest or savannah-forest mosaic where onchocercal blindness is not common. A cross-sectional dermatological survey was undertaken at each site following a standard protocol. At each site, the aim was to examine at least 750 individuals aged 5 years and living in highly endemic communities and 220-250 individuals aged 5 years and living in a hypo-endemic (control) community. Overall, there were 5459 and 1451 subjects from hyper-and hypo-endemic communities, respectively. In the highly endemic communities, the prevalence of itching increased with age until 20 years and then plateaued, affecting 42% of the population aged 20 years. There was a strong correlation between the prevalence of itching and the level of endemicity (as measured by the prevalence of nodules; r=0.75; P<0.001). The results of a multivariate logistic regression analysis showed that, at the individual level, the presence of onchocercal reactive skin lesions (acute papular onchodermatitis, chronic papular onchodermatitis and/or lichenified onchodermatitis) was the most important risk factor for pruritus, with an odds ratio (OR) of 18.3 and 95% confidence interval (CI) of 15.19-22.04, followed by the presence of palpable onchocercal nodules (OR=4.63; CI=4.05-5.29). In contrast, non-onchocercal skin disease contributed very little to pruritus in the study communities (OR=1.29; CI=1.1-1.51). Onchocercal skin lesions affected 28% of the population in the endemic villages. The commonest type was chronic papular onchodermatitis (13%), followed by depigmentation (10%) and acute papular onchodermatitis (7%). The highest correlation with endemicity was seen for the prevalence of any onchocercal skin lesion and/or pruritus combined (r=0.8; P<0.001). Cutaneous onchocerciasis was found to be a common problem in many endemic areas in Africa which do not have high levels of onchocercal blindness. These findings, together with recent observations that onchocercal skin disease can have major, adverse, psycho-social and socio-economic effects, justify the inclusion of regions with onchocercal skin disease in control programmes based on ivermectin distribution. On the basis of these findings, the World Health Organization launched a control programme for onchocerciasis, the African Programme for Onchocerciasis Control (APOC), that covers 17 endemic countries in Africa.

Adolescent↗
PubMedDate not supplied

Community-based tobacco control program: the Mamre study, a demonstration project.

OBJECTIVES: To assess the feasibility of a 5-year community-based tobacco control program in the community of Mamre in South Africa, while measuring the smoking and quitting rates at the beginning and end of this demonstration project. METHODS: A tobacco intervention program was developed at low cost in collaboration with the community, and involved a wide range of activities targeting people of all ages, especially those at risk for cardiovascular disease. Community members were trained to deliver smoking cessation programs and specific advice to smokers. Cross-sectional surveys were conducted in 1989 in a random sample of 1238 people, aged 15 years and older, prior to the 5-year demonstration project, and again in 1996 among 974 people at the end of the project. Demographic data and smoking and quitting patterns were collected by interviewer-administered questionnaires. Trained field workers used standardized procedures for recording blood pressure, height, and weight. RESULTS: The community participated with enthusiasm in the activities surrounding smoking cessation and the annual World No Smoking Day. The smoking rate decreased significantly between the two surveys (OR 1996/1989 = 0.82; 95% CI of 0.69-0.99), and the quitting rate increased significantly during the 5-year intervention period compared to the 5 years prior to the baseline survey (OR 1996/1989 = 0.74; 95% CI of 0.57-0.98). Men who participated in the program but continued to use tobacco in 1996 smoked more cigarettes than those who smoked in 1989. People who quit during the intervention period tended to be older, hypertensive, and obese; they consumed no alcohol, and noticed the health warnings posted in the community if they were older and had 10 or more years of education. CONCLUSIONS: A low-cost community-based tobacco control program was successfully implemented in the Mamre community. The program was received enthusiastically, built tobacco cessation skills, and significantly reduced the community's smoking rate compared to that before the demonstration project.

Adolescent↗
PubMed2001

Emotional disorders in young offenders.

PROBLEM: To estimate rates of emotional disorder in the Maryland Juvenile Justice system as a guide for planning and policy efforts. METHODS: In this cross-sectional study, psychopathology and level of functioning in a random sample of 312 committed and detained youth (60 females, 252 males) were assessed. Youth diagnostically classified met criteria for mental disorder using the Diagnostic Interview Schedule for Children (DISC) combined with a cut-off score (60 or below) on the Child Global Assessment Scale (CGAS), as established by the National Institute of Mental Health (NIMH). FINDINGS: Fifty-three percent were classified with diagnosable mental disorders on the DISC, but were above the cut-off scores on the CGAS. Forty-six percent met criteria for diagnosis and low functioning. Twenty-six percent of youth indicated need for immediate mental health services. Fourteen percent with serious mental disorders and substantial functional impairment were in need of a highly restrictive environment as determined by the severity of their offenses. CONCLUSIONS: The number of youth in the Maryland Juvenile Justice System in need of mental health services indicates a need to examine treatment options that meet the requirements for security and treatment. The complexity of problems found in this sample indicates the need for collaborative efforts between mental health and juvenile justice personnel in planning for the immediate and future needs of these youth.

Activities of Daily Living↗
PubMed1993

Early child health in Lahore, Pakistan: I. Study design.

In this paper, details are given of a community based follow up study of four areas: a village, a periurban slum, an urban slum and an upper middle class control group living in and around Lahore, Pakistan. The aim was to characterize the determinants of child health in a rapidly urbanizing community. The study was undertaken in two steps. An initial cross-sectional survey collecting socio-economic and demographic background information was carried out between March to August 1984. This was followed by a longitudinal study of 1476 infants representing the outcome of the pregnancies registered continuously between September 1984 to March 1987 among the 3242 families in the study. These infants were followed monthly from birth to 3 years of age and thereafter less frequently. In this communication we describe the study design, the study population, the organization and the research methodology used, including the reasons for drop outs from birth to 24 months of age. The internal consistency of the data is also presented. After the initial examination of the newborns within between 0-7 days of birth, the infants were visited monthly for 24 months making a total of 20911 examinations. At 24 months of age 70% of the infants were still in the study, 11% had died before reaching this age, 13% had moved from the area and 6% had refused to participate in the study. The economic, conditions, social structure, and the quality of life were found, not surprisingly, to vary significantly among the four areas. This community-based project provides new, critical and reliable information for local health planners. The study highlights the importance of the development of a useful model for research collaboration between institutions in developed and developing countries.

Child Welfare↗
PubMed1999

Psychosocial adjustment in twin pairs with and without hemifacial microsomia.

OBJECTIVE: To compare the psychosocial adjustment of children with and without hemifacial microsomia (HFM). DESIGN: This cross-sectional pilot study investigated psychosocial adjustment of twin pairs in which one twin was affected with HFM and the other was unimpaired. Data were analyzed using paired t tests. SETTING: The dental medicine clinic of a large urban children's hospital, serving a multistate area. PARTICIPANTS: Participants were six twin pairs aged 9 to 15 years and their parents. Data were also collected from classroom teachers. MAIN OUTCOME MEASURES: Outcome measures included: the Child Behavior Checklist (CBCL), the Teacher Report Form (TRF), the Coopersmith Self-Esteem Inventory (SEI), and a structured self-concept interview (the Self-Interview). RESULTS: Children with HFM had significantly higher CBCL and TRF total behavior problem scores and lower SEI general self-esteem scores than their unimpaired twins. No differences were found in CBCL competence scores. Interview data revealed concerns among the HFM group related to appearance, negative social responses, and fear of hospital procedures. Children also reported positive aspects of coping with HFM. CONCLUSIONS: The results of this study suggest that, similar to other craniofacial conditions, HFM is associated with an elevated risk for childhood psychosocial difficulties. Replication of specific findings with a larger sample is needed. Multicenter, collaborative studies are a crucial next step for this field.

Adaptation, Psychological↗
PubMed1999

Evaluation of HLA matching for CREG antigens in Europe.

BACKGROUND: In North America, cross-reactive antigen group (CREG) matching was introduced recently for cadaver kidney allocation. This is expected to result in improved graft outcome and an increased number of transplants for patients with rare HLA antigens. METHODS: We analyzed the impact of CREG matching using the data of the Collaborative Transplant Study for 59,516 first cadaver transplants performed in Western Europe. The 10 HLA class I CREGs described by Takemoto et al. were used for a comparison with the conventional HLA-A+B mismatching scheme. RESULTS: Transplant outcome depends primarily on the number of HLA-A+B mismatches and not on the CREG match grades. In a retrospective analysis, CREG mismatches correlated with the number of HLA-A+B mismatches. However, in computer simulations, we found that prospective CREG matching is not associated with beneficial HLA-A+B matching. CONCLUSION: The positive CREG matching effect observed in retrospective analyses is caused by the underlying effects of conventional HLA-A+B matching. CREG-oriented cadaver kidney allocation in Europe would, therefore, be inferior to the current conventional HLA-A+B+DR allocation.

Cadaver↗