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Assessment of the integration of the ecological approach in health promotion programs.

PURPOSE: This article proposes a model of the ecological approach in health promotion programs. Based on system theory, the model identifies intervention settings and targets as two independent dimensions for assessing the integration of this approach in programs. Additional objectives are to present and pretest an analytical procedure that allows the assessment of integration of the ecological approach in programs. DESIGN: This was a descriptive study of the integration of the ecological approach in a sample of health promotion programs. SUBJECTS: Subjects were 44 health promotion programs drawn from the population of Canadian federally funded programs. MEASURES: Descriptions of programs were obtained by telephone interviews. A coding scheme was applied to the data to identify intervention settings and targets for each program. Using this information, a summative score of the integration of the ecological approach was estimated for each program. RESULTS: Single-setting programs were the dominant pattern in the sample. Individuals whose health was of concern were very frequently the direct targets of the programs. However, organizational and interpersonal environments were also often directly targeted. Single-setting or single-intervention strategy programs outnumbered ecological programs. CONCLUSION: The proposed model and analytical procedure is a useful framework for the assessment of integration of the ecological approach in health promotion programs. The pilot test having been conducted on a convenience sample, future work should replicate the study in a representative sample of programs.

Canada↗

PubMed2005

Health sector reform and equity: a study at a family health center affiliated to health insurance organization in Alexandria.

The 1990's witnessed a wave of reform in health systems of many countries. Health sector reform (HSR) initiatives aimed at improving health status, utilizers' satisfaction, as well as equity and accessibility of care. This study aims at exploring the question of whether there is a socioeconomically- based differential access to services provided by a family health center applying HSR. A total of 248 utilizers were randomly selected and interviewed. An access index comprised of eight elements was developed to measure access and its corollary equity. Results demonstrated that the majority belonged to the low middle socio-economic class and one- quarter belonged to the low class. Approximately 9/10 of utilizers had high access to the services offered. Mean access index score for all utilizers was above the 90% mark. ANOVA analysis of mean access index according to socio-economic class revealed that there is no statistically significant disparity among various socio-economic classes regarding their access to care. However, it was demonstrated that higher classes had a higher opinion concerning the completeness of physical examination during the initial visit than lower classes. It was recommended to establish an appropriate policy framework to assure optimal standards of equity, preferably a 100% of high access as measured through the access index devised in this study.

Adolescent↗

PubMed1983

Infant crying and stability in the mother-infant relationship: a systems analysis.

Mother-infant interaction was studied using a general systems theory framework. 20 mother-infant pairs were observed in their home for a 7-hour period when the infants were 2, 3, 4, and 5 weeks of age. A measurement procedure was devised to assess, for each pair, the consistency over weeks in their allocation of time to 4 interactional contexts that make up the day: feeding, changing or bathing, social attention, and baby alone. The measure was called an Interactional Stability Score. Construct validity for this measure was investigated based on our hypothesis that high interactional stability would be strongly linked to low levels of crying during social attention. This hypothesis was confirmed. The results are interpreted within a general systems theory perspective--namely, that this measure of interactional stability is an empirical indicator of the degree of equilibrium within the relationship, at the level of patterning of interactional contexts. High stability scores represent consistency in allocation of time to the 4 contexts over weeks and not a rigidity in sequencing of these contexts, and thus appeared to reflect a dynamic process of mutual constraints on the behaviors of both partners.

Child Development↗

PubMed1989

Empathy, diversity, and telepathy in mother-daughter dyads: an empirical investigation utilizing Rogers' conceptual framework.

The purpose of this study was to examine empathy, diversity, and telepathy in natural mother-daughter dyads. The investigation was conceptualized and conducted according to the concepts and principles of the Rogerian Science of Unitary Human Beings. The sample for this descriptive study consisted of 180 volunteer mother-daughter dyads; the mother served as the receiver and the child as sender of telepathic messages. Empathy and diversity were expected to be related to telepathy levels. Results indicated that one form of empathy (personal distress) and diversity were significantly (p less than .05) related to telepathy. When the components of the diversity score were further examined, only those subjects who were moderately differentiated and mobile demonstrated significant telepathy scores. Multiple regression analysis showed that 6% of the variance in telepathy was accounted for by diversity and empathy. Findings added to what is known about living systems that manifest negentrophy and evolve toward increasing diversity.

Adult↗

PubMed2006

A genetic linkage map of Pacific white shrimp (Litopenaeus vannamei): sex-linked microsatellite markers and high recombination rates.

Pacific white shrimp (Litopenaeus vannamei) is the leading species farmed in the Western Hemisphere and an economically important aquaculture species in China. In this project, a genetic linkage map was constructed using amplified fragment length polymorphism (AFLP) and microsatellite markers. One hundred and eight select AFLP primer combinations and 30 polymorphic microsatellite markers produced 2071 markers that were polymorphic in either of the parents and segregated in the progeny. Of these segregating markers, 319 were mapped to 45 linkage groups of the female framework map, covering a total of 4134.4 cM; and 267 markers were assigned to 45 linkage groups of the male map, covering a total of 3220.9 cM. High recombination rates were found in both parental maps. A sex-linked microsatellite marker was mapped on the female map with 6.6 cM to sex and a LOD of 17.8, two other microsatellite markers were also linked with both 8.6 cM to sex and LOD score of 14.3 and 16.4. The genetic maps presented here will serve as a basis for the construction of a high-resolution genetic map, quantitative trait loci (QTLs) detection, marker-assisted selection (MAS) and comparative genome mapping.

Animals↗

PubMed2026

Deep learning and statistical methods identify novel asthma risk variants in Europeans.

BACKGROUND: Asthma is a common heritable respiratory disorder with a complex genetic basis. Although large-scale genome-wide association studies have identified many risk loci, the full spectrum of its polygenic architecture remains to be defined. OBJECTIVE: We refined the genetic landscape of asthma in individuals of European ancestry and improve polygenic risk prediction through statistical and deep learning-based methods. METHODS: We conducted the largest genome-wide association study meta-analysis of asthma in individuals of European ancestry, combining data from the Global Biobank Meta-analysis Initiative (121,940 cases, 1,254,131 controls) and the Million Veteran Program (36,823 cases, 398,278 controls). To enhance discovery, we applied pleiotropy-informed multitrait analysis and conditional false discovery rate approaches, each incorporating eosinophil counts as a secondary trait. In parallel, we used a Transformer-based deep learning framework to further prioritize variants and improve polygenic risk prediction. RESULTS: The meta-analysis identified 69 independent genome-wide significant loci (P < 5 × 10-8) not previously reported in asthma. Multitrait analysis of genome-wide association studies, conditional false discovery rate, and deep learning approaches uncovered additional candidate loci. Functional annotation and expression quantitative trait locus mapping implicated novel genes in immune regulation, airway remodeling, and metabolic processes. Polygenic risk score models derived from deep learning-prioritized variants outperformed those based on conventional genome-wide association study and standard statistical approaches. CONCLUSIONS: Our study yields a comprehensive map of asthma-associated loci in European ancestry populations, improves genetic risk prediction, and informs future mechanistic studies.

Humans↗

PubMed2000

Beyond the Spearman-Brown: a structural approach to maximal reliability.

The requirement of parallel parts has long been the cornerstone of classic reliability theory. By recasting reliability in a structural equation framework, items, raters, or judges no longer need to be treated as equivalent entities. Instead, unique reliability estimates can be determined for each and collectively used to assess the maximal reliability of a weighted composite, with the composite reliability submitted to inferential test. Procedures are shown to generalize from single to multifactor applications. Ramifications of a structural approach to reliability determination are probed, and the dilemma posed by possible falsification of the true score hypothesis presented for individual researcher consideration.

Humans↗

PubMed2005

A novel framework for sib pair linkage analysis.

Sib pair linkage analysis of a dichotomous trait is a popular method for narrowing the search for genes that influence complex diseases. Although the pedigree structures are uncomplicated and the underlying genetic principles straightforward, a surprising degree of complexity is involved in implementing a sib pair study and interpreting the results. Ascertainment may be based on affected, discordant, or unaffected sib pairs, as well as on pairs defined by threshold values for quantitative traits, such as extreme discordant sib pairs. To optimize power, various domain restrictions and null hypotheses have been proposed for each of these designs, yielding a wide array of choices for the analyst. To begin, we systematically classify the major sources of discretion in sib pair linkage analysis. Then, we extend the work of Kruglyak and Lander (1995), to bring the various forms into a unified framework and to facilitate a more general approach to the analysis. Finally, we describe a new, freely available computer program, Splat (Sib Pair Linkage Analysis Testing), that can perform any sib pair statistical test currently in use, as well as any user-defined test yet to be proposed. Splat uses the expectation maximization algorithm to calculate maximum-likelihood estimates of sharing (subject to user-specified conditions) and then plots LOD scores versus chromosomal position. It includes a novel grid-scanning capability that enables simultaneous visualization of multiple test statistics. This can lead to further insight into the genetic basis of the disease process under consideration. In addition, phenotype definitions can be modified without the recalculation of inheritance vectors, thereby providing considerable flexibility for exploratory analysis. The application of Splat will be illustrated with data from studies on the genetics of diabetic nephropathy.

Algorithms↗

PubMed2005

Behavioral and emotional problems among Turkish children at ages 2 to 3 years.

OBJECTIVE: Within the framework of the Mental Health Surveys of Turkey, the authors investigated the distribution and prevalence of parent-reported behavioral and emotional problems in a nationally representative sample of 2- to 3-year-old children. METHOD: A cross-sectional population-based survey from October 1996 through March 1997 using a self-weighted and equal probability sample of Turkish toddlers (N = 638) was conducted. The Child Behavior Checklist Total Problem scores and Household Questionnaire reports by parent informant source (response rate 94.3%) were examined for the effects of child gender, age, urban/suburban/rural residence, and geographic region using multiple regression analyses. RESULTS: Overall, the total problem scores placed 11.9% of the children in the clinically significant range and 18.6% of the children in the borderline range. Urban residence was significantly correlated with the Total Problem scores, Internalization and Externalization scores, and six Child Behavior Checklist syndrome scale scores. The child's age, gender, or parental employment status did not affect Total Problem scores. With respect to the Child Behavior Checklist syndrome scale, girls had higher Anxious/Depressed scores than boys, and 2-year-olds had higher Somatic Complaints scores than the 3-year-old children. None of the children with reported emotional and behavioral problems were referred to any mental health services. CONCLUSION: As part of a national mental health policy in Turkey, there is an urgent need to develop early childhood intervention services that emphasize home visits, center-based child care in the community, and caregiver and provider education and training.

Child Behavior Disorders↗

PubMed2007

Development and initial psychometric evaluation of the participation measure for post-acute care (PM-PAC).

OBJECTIVE: To evaluate a patient-reported participation measure constructed within the framework of the International Classification of Functioning, Disability, and Health. DESIGN: The Participation Measure for Post-Acute Care (PM-PAC) contains 51 items that assess participation in nine domains: mobility; role functioning; community, social, and civic life; domestic life/self-care; economic life; interpersonal relationships; communication; work; and education. Self-reported data were collected by interview with 395 noninstitutionalized rehabilitation patients. Psychometric analyses were conducted to test assumptions underlying the scaling and scoring of PM-PAC scales and to evaluate reliability and validity. RESULTS: In general, analyses supported assignment of items to hypothesized scales. However, the community, social, and civic life, interpersonal relationships, and communication domains were highly correlated. Item response theory models indicated that items were directed primarily at people with worse than average limitations in participation than the average patient in this rehabilitation sample. Test and retest scale scores did not differ significantly (intraclass correlation coefficient range, 0.61-0.86). Groups with more severe conditions scored worse on PM-PAC scales, as hypothesized. CONCLUSIONS: PM-PAC is a promising new measure of patient-reported participation as defined by the International Classification of Functioning, Disability, and Health. Information about PM-PAC items from this study will be useful in developing a computerized, adaptive measure of participation.

Adolescent↗

PubMed2003

Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project.

BACKGROUND: International interest in clinical practice guidelines has never been greater but many published guidelines do not meet the basic quality requirements. There have been renewed calls for validated criteria to assess the quality of guidelines. OBJECTIVE: To develop and validate an international instrument for assessing the quality of the process and reporting of clinical practice guideline development. METHODS: The instrument was developed through a multi-staged process of item generation, selection and scaling, field testing, and refinement procedures. 100 guidelines selected from 11 participating countries were evaluated independently by 194 appraisers with the instrument. Following refinement the instrument was further field tested on three guidelines per country by a new set of 70 appraisers. RESULTS: The final version of the instrument contained 23 items grouped into six quality domains with a 4 point Likert scale to score each item (scope and purpose, stakeholder involvement, rigour of development, clarity and presentation, applicability, editorial independence). 95% of appraisers found the instrument useful for assessing guidelines. Reliability was acceptable for most domains (Cronbach's alpha 0.64-0.88). Guidelines produced as part of an established guideline programme had significantly higher scores on editorial independence and, after the publication of a national policy, had significantly higher quality scores on rigour of development (p<0.005). Guidelines with technical documentation had higher scores on that domain (p<0.0001). CONCLUSIONS: This is the first time an appraisal instrument for clinical practice guidelines has been developed and tested internationally. The instrument is sensitive to differences in important aspects of guidelines and can be used consistently and easily by a wide range of professionals from different backgrounds. The adoption of common standards should improve the consistency and quality of the reporting of guideline development worldwide and provide a framework to encourage international comparison of clinical practice guidelines.

Europe↗

PubMed1975

[Variance and discriminatory analyses for the classification of wakefulness-dependent EEG patterns].

1. To describe 8 alertness-dependent EEG activity patterns to be observed during wakefulness with eyes closed, mean values and standard deviations of the frequencies 4, ..., 13, 14 to 17, 18 to 22 and 23 to 40 c/sec, of the percentage activity in the theta, alpha and beta bands as well as of the theta and alpha amplitudes were calculated. 2. On the basis of 18 variables significant differences between 7 activity patterns were ascertained by means of univariate and multivariate analyses of variance. 3. In the course of stepwise reduction of variables within the framework of a linear discriminatory analysis, an optimal set of variables was determined for the separation of the patterns comprising the following variables: mean value and standard deviation of the alpha amplitudes and mean value of the theta amplitudes as well as the percent quantity of the frequencies 3, ..., 7, 10, 14 to 17 and 23 to 40 c/sec. 4. By means of a linear regression analysis it was shown that the EEG scoring system can be reflected on an interval scale. In connection with results on the reliability of the methods used the results were discussed.

Analysis of Variance↗

PubMed2005

Managing risk in an unstable world.

With emerging markets like China and politically unstable countries like Saudi Arabia figuring more than ever into companies' investment calculations, business leaders are turning to political risk analysis to measure the impact of politics on potential markets, minimize risks, and make the most of global opportunities. But political risk is more subjective than its economic counterpart. It is influenced by the passage of laws, the foibles of government leaders, and the rise of popular movements. So corporate leaders must grapple not just with broad, easily observable trends but also with nuances of society and even quirks of personality. And those hard-to-quantify factors must constantly be pieced together into an ongoing narrative within historical and regional contexts. As goods, services, information, ideas, and people cross borders today with unprecedented velocity, corporations debating operational or infrastructural investments abroad increasingly need objective, rigorous assessments. One tool for measuring and presenting stability data, for example, incorporates 20 composite indicators of risk in emerging markets and scores risk variables according to both their structural and their temporal components. The indicators are then organized into four equally weighted subcategories whose ratings are aggregated into a single stability score. Countries are ranked on a scale of zero (a failed state) to100 (a fully institutionalized, stable democracy). Companies can buy political risk analyses from consultants or, as some large energy and financial services organizations have done, develop them in-house. Either way, a complete and accurate picture of any country's risk requires analysts with strong reportorial skills; timely, accurate data on a variety of social and political trends; and a framework for evaluating the impact of individual risks on stability.

Commerce↗

PubMed2005

Some links between classical and modern test theory via the two-level hierarchical generalized linear model.

This article considers some links between classical test theory (CTT) and modern test theory (MTT) such as item response theory (IRT) and the Rasch model in the context of the two-level hierarchical generalized linear model (HGLM). Conceptualizing items as nested within subjects, both the CTT model and the MTT model can be reformulated as an HGLM where item difficulty parameters are represented by fixed effects and subjects' abilities are represented by random effects. In this HGLM framework, the CTT and MTT models differ only in the level 1 sampling model and the associated link function. This article also contrasts the Rasch and two-parameter IRT models by considering the property of specific objectivity in the context of CTT. It is found that the essentially tau-equivalent model exhibits specific objectivity if the data fit the model, but the congeneric measures model does not. Data from English composition scores on essay writing used by Jöreskog (1971) are reanalyzed for illustration.

Educational Measurement↗

PubMed1997

Sensitive immunofluorescence detection of the expression of P-glycoprotein in malignant cells.

Because reversal of multidrug resistance increases chemotoxicity, early detection of low P-glycoprotein expression is clinically relevant for justifying early treatment of those patients that might benefit most from reversal therapy. We elected to score P-glycoprotein in single tumor cells, because the gene is rarely amplified, mRNA levels do not necessarily correlate with protein levels, and many normal hematopoietic or stroma cells within tumors and leukemic marrows also express P-glycoprotein. We enhanced the "signal-to-noise" ratio for detecting low P-glycoprotein levels by a novel complex made by pre-incubating mouse peroxidase-antiperoxidase, used solely to provide a stable framework for attaching multiple DTAF-labeled F(ab')2 fragments of rabbit antimouse IgG. We improved specificity by using both C219 and C494, which are directed against separate internal P-glycoprotein epitopes. We standardized staining with two series of negative and positive controls, in which P-glycoprotein was quantified by immunoblot, and confirmed sensitivity by staining a low-expression cell line and "mixed" samples containing small numbers of positive cells. We measured P-glycoprotein by flow cytometry, examining aliquots by differential interference contrast microscopy to identify malignant cells, in which we confirmed P-glycoprotein staining by fluorescence microscopy. We detected low P-glycoprotein expression in clinical samples of leukemic blasts, distinguishing them from normal P-glycoprotein-expressing hematopoietic cells. This assay may be valuable for early diagnosis of low, but potentially important expression of P-glycoprotein, thereby allowing early application of reversal therapy.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

PubMed2004

Adolescent friendship as a dynamic system: entropy and deviance in the etiology and course of male antisocial behavior.

A dynamic systems framework was applied to understand the influence of friendship on antisocial behavior from childhood (age 9-10) through adulthood (age 24-25) for Oregon Youth Study males (N = 206). Boys were videotaped interacting with a friend at ages 14, 16, and 18, and deviant content and interpersonal processes were independently coded. Conditional dyadic interpersonal processes were studied as a communication system and summarized by an index of information entropy (F. Attneave, 1959). High entropy scores represent disorganized, unpredictable patterns of interaction, whereas low entropy scores reflect an organized dialogue. Conversations of early-onset antisocial boys and their best friends were less organized and included more deviant content than those of well-adjusted controls. Prediction analyses, however, revealed an interaction between entropy and deviant talk. Consistent with expectation, males with well-organized interactions (i.e., low entropy) but elevated levels of deviant content were most likely to continue antisocial behavior into adulthood. Findings suggest that individual risk for maladaptation may be amplified by early adolescent friendship dynamics organized around deviance.

Adolescent↗

PubMed2001

A holistic approach to promoting success on NCLEX-RN.

The nursing faculty at the State University of West Georgia views individuals as an integration of body-mind-spirit. Our program's commitment complements efforts to teach students to honor the body, mind, and spirit of patients. Within this framework, faculty recognize that factors other than nursing knowledge impact students' ability to pass NCLEX-RN. An intervention program was designed that incorporated these factors. "Preparation for Licensure" was implemented as a holistic nursing course to intervene with students' learning and testing needs. The purpose was to increase self-awareness, promote a positive attitude toward passing the NCLEX-RN, and provide specific strategies for test taking and stress reduction. Posttest raw scores and percent correct on the Mosby Assess Test were significantly higher (p < .05) than pretest scores. Qualitative analysis of journal data exploring the students' experience of participating in the course revealed three themes: Perfectionism, Self-Worth, and Consequences and Meaning of Failure.

Adaptation, Psychological↗

PubMed2026

Methylation-Associated Differentiation Features Define Biological and Prognostic Heterogeneity in CMS4 Colorectal Cancer.

Consensus molecular subtype 4 (CMS4) colorectal cancer (CRC) is associated with an aggressive clinical course and poor survival, yet the biological basis of heterogeneity within this subtype remains incompletely understood. DNA methylation is an epigenetic mechanism involved in transcriptional regulation, cellular differentiation, and colorectal tumorigenesis. Here, we integrated single-cell RNA sequencing (scRNA-seq), bulk data, and promoter DNA methylation data to characterize CMS4-associated cancer cell states and methylation-related features. Using the scAB algorithm, we integrated scRNA-seq with bulk CMS4 data and identified CMS4-related cells distributed across multiple patients. Single-cell analyses of cell-cell communication and transcriptional regulation revealed a CMS4-related cancer cell population characterized by macrophage migration inhibitory factor (MIF)-centered intercellular communication, enhanced caudal type homeobox 1 (CDX1) and Kruppel-like factor 5 (KLF5) regulon activity, and gene modules enriched in differentiation-related pathways. CytoTRACE analysis further stratified CMS4 cancer cells into poorly and well-differentiated states, yielding 802 differentially expressed genes (DEGs). Linking these differentiation-associated DEGs with bulk expression and promoter methylation data identified 218 methylation-associated DEGs showing significant inverse methylation expression correlations, suggesting a link between differentiation-related heterogeneity and promoter methylation. Univariable Cox regression followed by LASSO regression further prioritized eight genes for construction of the methylation and differentiation-related prognostic model (MeDiff-PM). MeDiff-PM consistently stratified overall survival in the TCGA CMS4 cohort and two independent validation cohorts, with cutoff-independent continuous Cox analyses further supporting its prognostic association across cohorts. And MeDiff-PM remained prognostically significant after adjustment for available clinical variables. High MeDiff-PM risk scores were associated with activation of P53, WNT, and ubiquitin-mediated proteolysis pathways and with consistent predicted drug response differences for compounds across three CMS4 cohorts. While individual in silico knockout analysis suggested links between MeDiff-PM genes and metallothionein-related and immune-associated transcriptional responses. Collectively, these findings indicate that methylation-associated differentiation features represent a molecular dimension of intra-CMS4 heterogeneity and provide a biologically informed framework for prognostic stratification within CMS4 CRC.

Humans↗