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PubMed1994

Linking the university with the community and its health system.

Over many years Latin American universities have operated 'extension projects' in their surrounding communities. These projects, in health professions schools, frequently involved the establishment of community-based health centres operated by the university. Since the early 1970s, a large number of health professions schools entered into agreements with local or regional health systems for the operation of projects of 'articulation of teaching and services' in well-defined geographic areas. The primary health care strategy emphasized by WHO and actively promoted by national governments since the Alma Ata Declaration of 1978 led to a worldwide movement toward effective 'community participation' in each own local health system. An assessment of these initiatives, involving three types of paired relationships (university-community; university-local health system; local health system-community) provided the idea and the experiential basis for an innovative programme bringing the three partners together in a joint effort. Program UNT was set up and now includes 23 projects which are partially supported by the Kellogg Foundation. They all share a common set of ideas and ideals, emanating from the Alma Ata and Edinburgh Declarations, and are currently being implemented in 11 countries of Latin America.

Brazil↗
PubMed2006

Novel subgingival bacterial phylotypes detected using multiple universal polymerase chain reaction primer sets.

INTRODUCTION: Molecular ecological analysis based on 16S rRNA gene sequence analysis is well established for the characterisation of complex bacterial communities. However, 'universal' PCR primers can introduce biases into the analysis of the species composition of clone libraries because of mismatches between the primer and target organism sequences. In this study, three universal primer sets were compared for the analysis of the microflora in subgingival plaque. METHODS: Three subgingival plaque samples were collected from two subjects with localised severe chronic periodontitis. Half of each sample was cultured while DNA was extracted from the remaining half and 16S rDNA amplified with universal primer pairs 27F, 1525R (A); 27F, 1492R (B) and 530F, 1525R (C). Amplified genes were cloned, sequenced and identified by comparison with 16S rRNA databases. RESULTS: 137 taxa were identified among 177 isolates and 417 clones sequenced. Of these, 86 were detected only by the molecular technique whereas 26 were found only by culture. Sequences from 81 taxa did not correspond to those of named species and of these, 38 were not represented in the nucleotide databases. 16S RNA genes for these 38 taxa were sequenced and deposited with GenBank. CONCLUSION: The use of three sets of universal primers allowed the identification of 38 novel bacterial phylotypes. There were marked differences in the composition of the libraries generated by the different primer sets. A combination of molecular and cultural techniques is recommended to maximise the coverage of detection of bacterial taxa in oral samples.

Bacteria↗
PubMed1997

Multicultural health care: reconciling universalism and particularism.

One of the issues of concern in multicultural health care is the degree to which one universal (or mainstream) service can meet the needs of all groups and the extent to which specialist (or ethno-specific) services are required to meet the needs of particular groups. In order to advance debate on this issue, multiculturalism is examined against concepts of identity, equality, bureaucracy and participation. While the appeal of universal healthcare services is that they appear to deliver equal health care to all, they in fact systematically advantage those whose values most closely fit with the dominant social norms. Although ethnic-specific services may overcome this problem, in that they enable 'tailor-made' care, it is unlikely that they would be able to meet all of the health needs of all people from ethnic minorities, especially in locations where numbers are low. Ethnic minority participation in the processes of the health system is proposed as a way for the universal health system to reconcile the need to treat people equally (universalism), but in accordance with their unique and different needs (particularism).

Australia↗
PubMed2005

The 'Manchester scheme': a study of the Diploma in Community Nursing, the first pre-registration nursing programme in a British university.

The Diploma in Community Nursing at the University of Manchester began in 1959, after a long period of planning and negotiation. It was the earliest pre-registration nursing education programme in a British university. The paper reports on a historical study which examined its foundation and development. The history of the 'Manchester Scheme', as it came to be known, is placed into the context of wider reforms and modifications in British nursing education. The methods used for the study were a broad-based literature review, examination of material from the 1950s to the present day, five oral history interviews with some of those who were influential in developing the diploma, and the interpretation of relevant documentary source materials. The Diploma in Community Nursing at the University of Manchester was important and innovative in its time, combining as it did nurse and health visitor training with a university-based education. The paper traces the struggle to establish the course, which was largely due to the efforts of one charismatic individual, Fraser Brockington, Professor of Social and Preventive Medicine. It then goes on to examine the reforms and modifications the programme underwent from 1959 to 1969, as it was developed into the prototype for the 'Bachelor of Nursing Degree'.

Community Health Nursing↗
PubMed2001

An economic evaluation of universal infant vaccination against hepatitis B virus using a combination vaccine (Hib-HepB): a decision analytic approach to cost effectiveness.

OBJECTIVE: To evaluate the health impact and cost effectiveness of two infant vaccination strategies for protection against hepatitis B virus (HBV) infection in the Australian population. Vaccinating only high-risk infants, assuming 65% compliance, was compared with universal vaccination of infants using a combination Hib-HepB vaccine, with 87.4% compliance. METHOD: A Markov model simulated the natural history of HBV infection and disease in an Australian birth cohort. The cohort was divided into those at high risk of infection (infants born into high-risk families) and low-risk infants. Clinical and epidemiological data used were obtained from published reports and a survey of clinical experts. The model included the health costs associated with acute and chronic HBV infection, and the sequelae of chronic HBV infection. RESULTS: The model predicted that universal hepatitis B vaccination of an Australian birth cohort (260,000 births) would result in a 77% reduction in cases of HBV infection. The incremental cost per life year gained was $11,862, which is low compared with many other health care interventions. With no discounting of costs or consequences, universal vaccination with the combination vaccine was predicted to save lives and reduce costs. CONCLUSION: There is no socially accepted threshold value for cost per life year gained to guide decisions about funding Australian health care interventions. Nevertheless, based on these results, universal hepatitis B vaccination of Australian infants using a combination Hib-HepB vaccine would almost certainly be regarded as a worthwhile investment of public funds.

Australia↗
PubMed1985

Application of the Psychiatric Reform Act in the city of Naples. A survey of requests for compulsory admission to the special unit at the University Psychiatric Department I.

One of the most patent inconsistencies in the application of the 1978 Psychiatric Reform Act in many areas of Southern Italy has resulted from the irrational choice, by regional governments, of the general hospitals in which Psychiatric Special Units had to be implemented, and from the inappropriate determination of territorial boundaries defining the competence of such Units. Thus, in the city of Naples, it was decided, in June 1978, to set up Psychiatric Special Units only in the two University Psychiatric Departments and in the Psychiatric Emergency Ward at S. Gennaro Hospital. These Units, equipped with an overall number of 39 beds, were put in charge with the whole province of Naples (about three millions inhabitants). Quite arbitrarily, it was established that University Departments had to admit patients coming from the city of Naples and S. Gennaro Hospital those residing in the rest of the province. By an equally arbitrary choice, female patients from the city of Naples were entrusted to the University Department I and male patients to the Psychiatric Department II. In the following years, from 1979 to 1983, some additional Units were set up in general hospitals of the Naples province. Nonetheless, available beds have not exceeded the overall number of 69, and the catchment areas of the three pre-existing Special Units have not been modified. The chaotic situation engendered by this incongruous application of the Reform Act is outlined, by means of an analysis of the requests for compulsory admission addressed to the Special Unit at the Psychiatric Department I of Naples University during the periods June 16, 1978-December 31, 1979 and June 16, 1982-December 31, 1983.

Commitment of Persons with Psychiatric Disorders↗
PubMed1998

The association of physical activity level characteristics and other lifestyles with obesity in Nagoya University alumni, Japan.

Improving daily-life habits is considered to be effective in treating obesity. We have examined obesity in regular physical examinations in university students since 1974. In this study, the subjects were 199 students regarded as obese (Broca's index: more than 120%) and 326 non-obese students randomly selected (525 subjects in total) among students who underwent regular physical examinations at Nagoya University, Japan, between 1974 and 1978. Here we report our follow-up survey of obese university students and non-obese individuals who were students of the same university during the same period. This study was carried out for the purpose of clarifying the relationship between changes in lifestyle and body weight 20 years after graduation. Concerning eating behavior, a higher proportion of subjects cared about diet intake in the current non-obese group than in the current obese group (P<0.05). The meal-time in the obese was shorter than that in the non-obese group (P<0.01). Ten percent of subjects in the obese group and 24.4% of subjects in the non-obese group selected class II (moderate) or higher as indicative of the intensity of their daily physical activity. There was a significant difference in distribution between the groups (P<0.05). In the group showing improvement in obesity over time, a higher proportion of subjects cared about diet intake than in the group with continued obesity (P<0.05). Concerning intensity of physical activity, 11.8% of subjects in the group with continued obesity selected class II (moderate) or higher, while 45.5% of subjects in the group showing improvement in obesity chose class II (moderate) or higher. A significant difference in distribution existed between the groups (P<0.01). These findings suggest that the eating behavior of ending meals before feeling satiety and a lifestyle change to enhance the intensity of daily physical activity including walking, even if not having any special sports habits, are effective in decreasing body weight.

Adult↗
PubMedDate not supplied

The effects of a universal wedge and beam obliquity upon the central axis dose buildup for 6-MV x rays.

In a number of clinical situations, the dose to the skin and the superficial tissues is of concern. Both beam obliquity and a beam modifier will modify the dose delivered to these regions due to changes in the scattering geometry, scattered photon and secondary electron production, and changes in the energy spectrum of a polyenergetic beam. Some linear accelerators use a single universal wedge mounted within the treatment head. Because such a wedge is at an extended distance from the patient, its contribution to the beam contaminants incident to the skin will be limited. Measurements of the ionization in the buildup region have been performed in a polystyrene phantom irradiated with a 6-MV x-ray beam from a linear accelerator equipped with a universal wedge. The variation of the buildup dose with obliquity, universal wedging, and distance from the source has been measured for angles of incidence between 0 degrees and 60 degrees and for effective wedge angles between 0 degrees and 45 degrees. The results indicate that the percentage buildup has a much stronger dependence upon the angle of incidence than upon the effective wedge angle. For distances approaching the treatment head, it is shown that the universal wedge generates secondary electrons that elevate the surface dose, but that this contribution decreases with distance.

Humans↗
PubMed1999

A younger age for the universe

The age of the universe in the Big Bang model can be calculated from three parameters: Hubble's constant, h; the mass density of the universe, Omegam; and the cosmological constant, OmegaLambda. Recent observations of the cosmic microwave background and six other cosmological measurements reduce the uncertainty in these three parameters, yielding an age for the universe of 13.4 +/- 1.6 billion years, which is a billion years younger than other recent age estimates. A different standard Big Bang model, which includes cold dark matter with a cosmological constant, provides a consistent and absolutely time-calibrated evolutionary sequence for the universe.

Journal Article↗
PubMed1996

Characterization of universal small-subunit rRNA hybridization probes for quantitative molecular microbial ecology studies.

Universal oligonucleotide hybridization probes targeting the small-subunit rRNA are commonly used to quantify total microbial representation in environmental samples. Universal probes also serve to normalize results obtained with probes targeting specific phylogenetic groups of microorganisms. In this study, six universal probes were evaluated for stability of probe-target duplexes by using rRNA from nine organisms representing the three domains of Bacteria, Archaea, and Eucarya. Domain-specific variations in dissociation temperatures were observed for all probes. This could lead to a significant bias when these probes are used to quantify microbial populations in environmental samples. We suggest lowering the posthybridization wash stringency for two of the universal probes (S-*-Univ-1390-a-A-18 and S-*-Univ-1392-a-A-15) examined. These two probes were evaluated with traditional and modified hybridization conditions to characterize defined mixtures of rRNAs extracted from pure cultures and rRNA samples obtained from anaerobic digester samples. Probe S-*-Univ-1390-a-A-18 provided excellent estimations of domain-level community composition of these samples and is recommended for future use in microbial ecology studies.

Archaea↗
PubMed1997

Determination of Active Marine Bacterioplankton: a Comparison of Universal 16S rRNA Probes, Autoradiography, and Nucleoid Staining.

We compared several currently discussed methods for the assessment of bacterial numbers and activity in marine waters, using samples from a variety of marine environments, from aged offshore seawater to rich harbor water. Samples were simultaneously tested for binding to a fluorescently labeled universal 16S rRNA probe; (sup3)H-labeled amino acid uptake via autoradiography; nucleoid-containing bacterial numbers by modified DAPI (4(prm1),6-diamidino-2-phenylindole) staining; staining with 5-cyano-2,3-ditolyl tetrazolium chloride (CTC), a compound supposed to indicate oxidative cell metabolism; and total bacterial counts (classical DAPI staining), taken as a reference. For the universal-probe counts, we used an image intensifying and processing system coupled to the epifluorescence microscope. All of the above-mentioned methods yielded lower cell counts than DAPI total counts. Universal-probe counts averaged about half of the corresponding DAPI count and were highly correlated to autoradiography counts (r(sup2) = 0.943; n = 7). Nucleoid-containing cell counts could be lower than DAPI counts by as much as 1 order of magnitude but sometimes matched autoradiography or probe counts. CTC counts were 2 orders of magnitude below DAPI counts. Universal 16S rRNA probe counts correlated well with autoradiography results, indicating a population with at least minimal metabolic activity. The greater variability of the nucleoid-containing cell counts calls for further investigation of the processes involved, and CTC counts were well below the range of the other methods tested.

Journal Article↗
PubMed2000

Use of PCR with universal primers and restriction endonuclease digestions for detection and identification of common bacterial pathogens in cerebrospinal fluid.

We have designed a universal PCR capable of amplifying a portion of the 16S rRNA gene of eubacteria, including Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus pneumoniae, Enterococcus faecium, Enterococcus faecalis, Mycobacterium tuberculosis, Legionella pneumophila, Escherichia coli, Klebsiella pneumoniae, Serratia marcescens, Enterobacter cloacae, Pseudomonas aeruginosa, Acinetobacter baumannii, Proteus mirabilis, Haemophilus influenzae, and Neisseria meningitidis. The sizes of the amplified products from various bacteria were the same (996 bp), but the restriction patterns of most PCR products generated by HaeIII digestion were different. PCR products from S. aureus and S. epidermidis could not be digested by HaeIII but yielded different patterns when they were digested with MnlI. PCR products from S. pneumoniae, E. faecium, and E. faecalis yielded the same HaeIII digestion pattern but could be differentiated by AluI digestion. PCR products from E. coli, K. pneumoniae, S. marcescens, and E. cloacae also had the same HaeIII digestion pattern but had different patterns when digested with DdeI or BstBI. This universal PCR could detect as few as 10 E. coli or 250 S. aureus organisms. Compared with culture, the sensitivity of this universal PCR for detection and identification of bacteria directly from 150 cerebrospinal fluids was 92.3%. These results suggest that this universal PCR coupled with restriction enzyme analysis can be used to detect and identify bacterial pathogens in clinical specimens.

Aged↗
PubMed1993

A trypanosomal CCHC-type zinc finger protein which binds the conserved universal sequence of kinetoplast DNA minicircles: isolation and analysis of the complete cDNA from Crithidia fasciculata.

Replication of the kinetoplast DNA minicircle light strand initiates at a highly conserved 12-nucleotide sequence, termed the universal minicircle sequence. A Crithidia fasciculata single-stranded DNA-binding protein interacts specifically with the guanine-rich heavy strand of this origin-associated sequence (Y. Tzfati, H. Abeliovich, I. Kapeller, and J. Shlomai, Proc. Natl. Acad. Sci. USA 89:6891-6895, 1992). Using the universal minicircle sequence heavy-strand probe to screen a C. fasciculata cDNA expression library, we have isolated two overlapping cDNA clones encoding the trypanosomatid universal minicircle sequence-binding protein. The complete cDNA sequence defines an open reading frame encoding a 116-amino-acid polypeptide chain consisting of five repetitions of a CCHC zinc finger motif. A significant similarity is found between this universal minicircle sequence-binding protein and two other single-stranded DNA-binding proteins identified in humans and in Leishmania major. All three proteins bind specifically to single-stranded guanine-rich DNA ligands. Partial amino acid sequence of the endogenous protein, purified to homogeneity from C. fasciculata, was identical to that deduced from the cDNA nucleotide sequence. DNA-binding characteristics of the cDNA-encoded fusion protein expressed in bacteria were identical to those of the endogenous C. fasciculata protein. Hybridization analyses reveal that the gene encoding the minicircle origin-binding protein is nuclear and may occur in the C. fasciculata chromosome as a cluster of several structural genes.

Amino Acid Sequence↗
PubMed2006

Prevention of mental health problems: rationale for a universal approach.

BACKGROUND AND OBJECTIVE: Mental health problems are a public health issue affecting as many as 20% of children in modern communities. Risk factors for externalising and internalising problems can occur in infancy. Infants at high risk live in stressed families with parent mental health problems, substance misuse, relationship conflict, social isolation, financial problems or infant temperamental difficulty. Although current prevention programmes target services to high-risk groups, targeting can stigmatise families and miss many children in need. The addition of universal prevention programmes for all families could address these concerns. This survey assessed the prevalence of infants at risk attending a primary care service as a delivery point for universal prevention. DESIGN: Survey of mothers of 6-month-old infants attending well-child clinics across six government areas of Melbourne, Victoria, Australia, between August and September 2004. A brief survey measured sociodemographic characteristics and the following family risks: maternal depression, anxiety, stress, substance misuse, violence at home, social isolation and infant temperamental difficulty. RESULTS: The survey was completed by 733 mothers, representing 69% of infant births presented to the primary care service. Of these, 39% of infants were classified as at risk for developing mental health problems. The percentage of infants classified as at risk was not markedly dissimilar across socioeconomic levels (low, 42%; middle, 40%; high, 35%). CONCLUSIONS: A substantial number of infants attending routine universal primary care are at risk of developing mental health problems. This primary care setting could provide an ideal platform for preventing early externalising and internalising problems via a universally offered, evidence-based parenting programme.

Adolescent↗
PubMed2006

How do bioethics teachers in Japan cope with ethical disagreement among healthcare university students in the classroom? A survey on educators in charge.

OBJECTIVE: The purpose of this study was to demonstrate how educators involved in the teaching of bioethics to healthcare university students in Japan would cope with ethical disagreement in the classroom, and to identify factors influencing them. METHODS: A cross sectional survey was conducted using self administered questionnaires mailed to a sample of university faculty in charge of bioethics curriculum for university healthcare students. RESULTS: A total of 107 usable questionnaires were returned: a response rate of 61.5%. When facing ethical disagreement in the classroom, coping behaviour differed depending on the topic of discussion, was influenced by educators' individual clear ethical attitudes regarding the topic of discussion, and was independent of many respondents' individual and social backgrounds. Among educators, it was commonly recognised that the purpose of bioethics education was to raise the level of awareness of ethical problems, to provide information about and knowledge of those issues, to raise students' sensitivity to ethical problems, and to teach students methods of reasoning and logical argument. Yet, despite this, several respondents considered the purpose of bioethics education to be to influence students about normative ethical judgments. There was no clear relationship, however, between ways of coping with ethical disagreement and educators' sense of the purpose of bioethics education. CONCLUSIONS: This descriptive study suggests that educators involved in bioethics education for healthcare university students in Japan coped in various ways with ethical disagreement. Further research concerning ethical disagreement in educational settings is needed to provide better bioethics education for healthcare students.

Adaptation, Psychological↗
PubMed2007

The possibility of a universal declaration of biomedical ethics.

Statements on issues in biomedical ethics, purporting to represent international interests, have been put forth by numerous groups. Most of these groups are composed of thinkers in the tradition of European secularism, and do not take into account the values of other ethical systems. One fifth of the world's population is accounted for by Islam, which is a universal religion, with more than 1400 years of scholarship. Although many values are held in common by secular ethical systems and Islam, their inferences are different. The question, "Is it possible to derive a truly universal declaration of biomedical ethics?" is discussed here by examining the value and extent of personal autonomy in Western and Islamic biomedical ethical constructs. These constructs are then tested vis-à-vis the issue of abortion. It is concluded that having a universal declaration of biomedical ethics in practice is not possible, although there are many conceptual similarities and agreements between secular and Islamic value systems, unless a radical paradigm shift occurs in segments of the world's deliberative bodies. The appellation "universal" should not be used on deliberative statements unless the ethical values of all major schools of thought are satisfied.

Abortion, Therapeutic↗
PubMedDate not supplied

The concept of anger: universal or culture specific?

I will suggest that the English word 'anger' and its counterparts in diverse languages of the world are based on concepts of anger that have a great deal of complexity. This conceptual complexity derives from several sources: (1) the metaphors and metonymies that apply to the concepts in various languages; (2) the prototypes of anger that people share in these cultures, and (3) the many different senses that the word anger and its counterparts have in different languages. We can ask: Are there any universal aspects of the concept(s) of anger? On the basis of linguistic evidence from English, Chinese, Japanese, Hungarian, Zulu and Wolof, I will suggest that there are, but I will also claim that some of the aspects are culture specific. This raises the further important question of why there is both universality and culture specificity in the conceptualization of this emotion. At stake is the issue of which of the following two contradictory claims is valid: (1) that anger is conceptualized in the same way universally, or (2) that anger is a social construction and thus varies considerably from culture to culture. I will propose a compromise view, which can be called 'body-based social constructionism', that enables us to see anger and its counterparts as both universal and culture specific.

Anger↗
PubMed1986

Recruitment of public psychiatrists: the impact of university and state collaboration on FMGs in Maryland.

The current emphasis on university and state collaboration to recruit competent psychiatrists to the public sector may adversely affect foreign medical graduates (FMGs) working in state hospitals, many of whom received inadequate training in autonomous state hospital residency programs. In Maryland a joint initiative of the state university and the mental hygiene administration called the Maryland Plan has been successful in attracting university-trained psychiatrists, mostly U.S. medical graduates, to public hospitals, leaving fewer training and employment opportunities for FMGs. Most FMGs have retained their positions in the state hospitals, and 15 percent of the university-trained recruits have been FMGs. However, the authors predict that few FMGs will be able to compete with U.S. medical graduates for residency slots, and they call for continued recruitment of the most qualified FMGs into the public system.

Foreign Medical Graduates↗