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PubMed1974

Human parathyroid hormone. Immunological characterization of antibodies against a glandular extract and the synthetic amino-terminal fragments 1-12 and 1-34 and their use in the determination of immunoreactive hormone in human sera.

Antibodies to a urea-trichloroacetic acid extract [hPTH-(TCA)] of human parathyroid tumors and to the synthetic NH(2)-terminal fragments of human parathyroid hormone hPTH-(1-12) and -(1-34) were developed in goats to characterize immunochemically various PTH preparations and to estimate immunoreactive PTH (iPTH) in human sera. They were quantitated on the basis of their capacity to bind [(131)I]-hPTH-(1-12), [(131)I]hPTH-(1-34) or [(131)I]bovine PTH (bPTH-(1-84)). The quality of the antibodies was assessed by reference to inhibition of their interaction with labeled peptides by synthetic hPTH comprising 34 NH(2)-terminal amino acid residues or fragments thereof [hPTH-(1-12), -(13-34), -(18-34), -(25-34), -(18-24)] or by the Sephadex G-100-purified full-length peptide hPTH-(1-84) [hPTH-(1-84)G-100]. The synthetic peptides used in this work correspond in their structure to the NH(2)-terminal amino acid sequence 1-34, as elucidated by Brewer and collaborators (1972. Proc. Natl. Acad. Sci. U. S. A.69: 3583-3588). Inhibition studies were also carried out with bPTH-(1-34) and bPTH-(1-84). Anti-hPTH-(TCA) exhibited specificities directed to determinants in the COOH-terminal and NH(2)-terminal part of hPTH-(1-84) and exhibited cross-reactivity with bPTH-(1-84). Anti-hPTH-(1-34), on the other hand, showed immunological specificities mainly directed to antigenic determinants located in the COOH-terminal half of hPTH-(1-34). In addition, some reactivity with the NH(2)-terminal hPTH-(1-12) and with the extractive full-length peptides of human and bovine origin was observed. Antibodies to hPTH-(1-12) cross-reacted with hPTH-(1-34) and -(1-84)G-100.IPTH WAS RADIOIMMUNOLOGICALLY DETERMINED IN HUMAN SERA BY THE FOLLOWING SYSTEMS: (a) [(131)I]bPTH-(1-84), anti-hPTH-(TCA) and hPTH-(1-84)G-100 as standard; (b) [(131)I]hPTH-(1-34), anti-hPTH-(1-34) and hPTH-(1-34) as standard. With system (a), COOH-terminal fragments of hPTH-(1-84) having a molecular weight of approximately 7,000 were detected, and there was an almost total discrimination of serum iPTH levels in normal and in hyperparathyroid subjects. With system (b), on the other hand, several molecular species of iPTH were detected, including a component larger than hPTH-(1-84) and others similar to hPTH-(1-84) and to a fragment co-eluting with the NH(2)-terminal fragment hPTH-(1-34). When serum iPTH was assayed in system (b), there was a large overlap of iPTH levels in control subjects and in patients with primary hyperparathyroidism.

Animals↗
PubMed1997

Mental health treatment in Ontario: selected comparisons between the primary care and specialty sectors.

OBJECTIVE: Epidemiologic research has demonstrated that the majority of mental illness in the community is not treated. Primary care physicians and the specialty mental health sector each have an important role in the provision of mental health services. Our goal is to clarify the extent of undertreatment of selected mental illnesses in Ontario and to examine how treatment is divided between the primary care and specialty sectors. In particular, we are interested in both the relative numbers and the types--based on sociodemographic and severity indicators--of patients found in each sector, as well as in confirming the key role of primary care in the provision of mental health services. METHODS: Data were taken from the Mental Health Supplement to the Ontario Health Survey, a community survey of 9953 individuals. All subjects who met DSM-III-R criteria for a past year diagnosis of mood, anxiety, substance abuse, bulimic, or antisocial personality disorders were categorized by their use of mental health services in the preceding year--into nonusers, primary care only patients, specialty only patients, and both sector patients. The 3 groups utilizing services were then compared by demographic, clinical, and disability characteristics. RESULTS: Only 20.8% of subjects with a psychiatric diagnosis reported use of mental health services, but 82.9% of these same individuals used primary care physicians for general health problems. Among those who used mental health services, 38.2% used family physicians only for psychiatric treatment, compared with 35.8% who used only specialty mental health providers, and 26.0% who used both sectors. The 3 groups of users showed only modest differences on sociodemographic characteristics. Patients in the specialty only sector reported significantly higher rates of sexual and physical abuse. On specific disability measures, all 3 groups were similar. CONCLUSION: The vast majority of individuals with an untreated psychiatric disorder are using the primary care sector for general health treatment, allowing an opportunity for identification and intervention. Primary care physicians also treat the majority of those seeking mental health services, and individuals seen only by these primary care physicians are probably as ill as those seen exclusively in the specialty mental health sector. From a public health perspective, future policy interventions should aim to improve collaboration between the 2 sectors and enhance the ability of primary care physicians to deliver psychiatric services.

Adolescent↗
PubMed2003

Discontinuities, side steps, and finding a proper place: an autobiographical account.

In this invited autobiography, I present an account of some influential events and experiences in my life that led me eventually, after some false starts, to a career in personality assessment psychology. The psychological research and applied areas (self-report personality assessment and cross-cultural research) with which I have been identified for over 40 years can, however, be seen in early interests, although their impact and their direction were not always apparent at the time of occurrence. Several people who were influential in my career development are noted and a number of important collaborators who helped sustain my efforts in personality assessment research and practice over the years are highlighted.

Career Mobility↗
PubMed2004

Influential characteristics of physician/pharmacist collaborative relationships.

BACKGROUND: A theoretical model of physician/pharmacist collaborative relationships, driven by 3 groups of relationship characteristics termed participant, context, and exchange, has been developed. There are no studies that have examined the types of characteristics which most influence development of collaborative relationships between physicians and pharmacists. OBJECTIVE: To test the model and determine which drivers most influence physician/pharmacist collaboration. METHODS: Data on the relationship drivers and collaborative practice were collected via a mailed survey of a random sample of 1000 primary care physicians in Iowa. Participant variables include demographics; context drivers refer to the practice environment and professional interactions between physicians and pharmacists. Exchange characteristics describe the nature of social exchange and were elicited using scores from 3 domains (relationship initiation, trustworthiness, role specification) of the Physician/Pharmacist Collaboration Instrument (PPCI). Five additional questions asked about the physician's collaborative practice with a pharmacist. Hierarchical linear regression analysis was performed with collaborative practice as the dependent variable and measures of participant, context, and exchange drivers as independent variables. RESULTS: Three hundred forty usable surveys (34%) were returned. Almost 70% of the respondents were male and aged 45.8 +/- 9.9 years (mean +/- SD). The majority were family practice physicians (72.1%) in private practice (67.3%). Regression analyses produced an R2 = 0.804 (p < 0.001). Significant predictors in the model were internal medicine physicians, professional interaction with a pharmacist, and the 3 domains of exchange drivers from the PPCI (p < 0.05). CONCLUSIONS: Although participant and context factors influenced physician/pharmacist collaborative relationships, exchange characteristics were the most influential relationship drivers. Role specification, trustworthiness, and relationship initiation were positively associated with physician/pharmacist collaborative practice. Recognition of these drivers may help pharmacists who are developing collaborative working relationships with physicians. But, studies are needed to delineate other factors that may influence physician/pharmacist relationships.

Adult↗
PubMed1998

Implications of oral infections on systemic diseases in the institutionalized elderly with a special focus on pneumonia.

Systemic infection in the elderly patient living in a chronic care setting presents a significant burden to the health care system. The extent to which oral organisms cause systemic infections through hematogenous dissemination in the institutionalized elderly is still unknown. A more likely and common route of systemic infection by oral microorganisms is through aspiration of oropharyngeal fluids containing oral pathogenic microorganisms, which colonize the lower respiratory tract and cause pneumonia. Respiratory pathogens emerge in the dental plaque of elderly patients with very poor oral hygiene and severe periodontal disease. In the chronic care setting, aspiration of oropharyngeal fluids contaminated with these bacteria occurs in patients with diminished host defenses, resulting in bacterial pneumonia. This is also a problem in intensive care units in the hospital setting. In one study, pre-rinsing with a 0.12% chlorhexidine gluconate mouthwash significantly lowered the mortality rate from postsurgical pneumonia in patients undergoing open heart surgery. Selective digestive decontamination, a technique involving the topical application of antimicrobials to reduce the risk of colonization of the respiratory tract, has been used to reduce the incidence of nosocomial pneumonia in the acute care setting of hospitals. This technique has not been employed in the nursing home setting. Whether improving oral hygiene would also lower the risk in either of these settings has not been studied. A number of obstacles must be overcome in designing studies to investigate the relationship between oral infections and lung infections in the institutionalized elderly. Ethical issues must be addressed, and full collaboration of the medical team is required. Future studies should establish whether reducing the risk for pneumonia in the institutionalized elderly is possible through improved oral health.

Aged↗
PubMedDate not supplied

Can managed health care help manage health care-associated infections?

Managed-care organizations have a unique opportunity, still largely unrealized, to collaborate with health-care providers and epidemiologists to prevent health care-associated infections. Several attributes make these organizations logical collaborators for infection control programs: they have responsibility for defined populations of enrollees and for their overall health, including preventive care; they possess unique data resources about their members and their care; and they are able to make systemwide changes in care. Health care-associated infections merit the attention and effort of managed-care organizations because these infections are common, incur substantial illness and costs, and can be effectively prevented by using methods that are unevenly applied in different health-care settings. Both national and local discussions will be required to enable the most effective and efficient collaborations between managed care organizations and health-care epidemiologists. It will be important to articulate clear goals and standards that can be readily understood and widely adopted.

Cooperative Behavior↗
PubMed1980

Infection control committee reviews policies, cuts costs.

Working in cooperation with other hospital departments, especially nursing, the members of an infection control program were able to review and change hospital policies and procedures without compromising patient care. This collaboration resulted in hospital policies that are more uniform, rational, and workable and a savings of $63,000.

Cost-Benefit Analysis↗
PubMed1989

WHO MONICA Project: assessing CHD mortality and morbidity.

In the WHO MONICA Project mortality and morbidity from acute myocardial infarction is being monitored in 39 Collaborating Centres in 26 countries for a period of 10 years. The myocardial infarction registration procedures have been standardized and suspect coronary events are classified into diagnostic categories according to common criteria. This paper presents ischaemic heart disease mortality figures, based on routine statistics for the study populations and discusses cross-sectional comparability of morbidity data from event registration. Because of differences in availability of data used for diagnostic classification of events (such as autopsy data) the proportions of different diagnostic categories vary from centre to centre. There are, therefore, problems in cross-sectional comparison of morbidity data between the centres. The primary target of event registration in the project is to monitor morbidity changes within centres during the ten-year period. This goal should not be affected by the problems described in this paper.

Adult↗
PubMed1994

Strategies for the management and control of antibiotic resistant organisms on a spinal cord injury unit.

Individuals with a spinal cord injury (SCI) are at an increased risk of infection and colonization. Frequent lengthy hospitalizations, invasive procedures, and skin breakdown contribute to this risk. Intermittent antibiotic use influences the emergence of antibiotic resistance in these organisms. As a result, there is risk of transmission of these antibiotic resistant organisms (ARO). This article describes the application of a continuous quality improvement model to evaluate ARO management strategies in a SCI unit. A conservative, labor intensive, crisis management approach to the control of ARO was replaced with a more cost effective prospective plan. The new strategies were aimed at control rather than eradication and included collaborative, multidisciplinary planning and improved resource utilization. Efforts have been successful and have resulted in the control of ARO.

Cross Infection↗
PubMed1981

Collaborative study of bronchial tumour-associated antigens.

Eleven groups of workers submitted a total of 21 bronchial tumour-associated antigen preparations and 19 antisera for comparative studies. Many of the antisera proved to be polyspecific despite absorption procedures. Most of the antigen preparations contained some material reactive towards a reference antiserum to normal human serum proteins. While it appeared that no participants were studying identical antigen-antibody reactions, several cross-reactivities were identified in the antisera. When immune reactions to CEA, AFP, NCA, ferritin, lactoferrin, human pepsin and gastricsin, and the pregnancy proteins, SP1 and SP3 were excluded by use of reference antisera and electroimmunoprecipitation methods, there remained 5 antigen-antibody reactions defining unique antigens. The clinical usefulness of any of these 5 antigens has yet to be determined.

Adenocarcinoma↗
PubMed1994

Body weight, fat distribution and the menopausal status in women. The VMH Collaborative Group.

Since sex hormones are involved in the regulation of body composition and adipose tissue metabolism, in this study we investigated whether menopause may alter body weight and fat distribution in women. Data were obtained from the Virgilio-Menopause-Health Study, which is a longitudinal epidemiological project aimed at investigating the relationship between menopause and related plasma hormonal concentrations, body weight, fat distribution and health. Only data from the first cross-sectional examination are presented. Out of the 952 women living in the town of Virgilio, Mantua (Italy) and born between January 1st, 1932 and December 31st, 1946, 596 (62.6%) participated in the study. Since incomplete data were present in 19 women, 577 was the final sample size available for statistical analysis. The protocol included a collection of blood for hormones and biochemistry, a full clinical history with socioeconomic and personal information, drug use, smoking, dietary and physical activity habits, and several anthropometric measurements. According to the clinical and hormonal status, 160 women were classified as pre-menopausal, 124 as peri-menopausal and 293 as post-menopausal. After adjusting for age, we found that body mass index (BMI) was significantly higher in peri-menopausal than in pre-menopausal women and remained slightly, but again significantly, higher in post-menopausal women. Although waist-to-hip and waist-to-thigh ratios increased significantly and progressively from pre- to post-menopause, any difference was not significant after adjusting for age. Diet, physical activity and smoking habits did not explain the difference in BMI values. No difference was found in the use of estro-progestagen compounds between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗
PubMed2006

Religiosity, religious coping styles, and health service use: racial differences among elderly women.

This study explored racial differences in the effects of religiosity and religious coping styles on health service use. The sample (N = 274) consisted of a cross-section of women ages 55 and older living in publicly subsidized high-rise dwellings in Nashville, Tennessee (1999 to 2000) and included 159 White and 115 African American women. The results suggested the effects of religiosity on health service use are generally negative for both groups. However, the effects of religious coping styles on health service use differed by race. The self-directing coping style was associated with higher levels of use for White women, but with lower levels of use for African American women. The deferring coping style was associated with greater physician visits and inpatient days among White women, but with fewer inpatient days among African American women. The collaborative coping style was associated with higher inpatient days among African American women, but had no significant effect on use patterns for White women. Conducting assessments of religiosity and religious coping styles would enhance holistic nursing practice.

Adaptation, Psychological↗
PubMed2006

Colorectal cancer screening coverage in Greece. PACMeR 02.01 study collaboration.

BACKGROUND AND AIMS: Colorectal cancer is a major cause of cancer death in European countries and differences in screening implementation may in part explain USA vs European survival differences. Despite the evidence, no study has evaluated the population colorectal cancer screening (CCS) coverage in any European country. We aimed to index the current CCS practices among a large sample of Greek healthy adults. MATERIALS AND METHODS: The study was designed as a cross-sectional survey. Screening practice habits of 5,259 healthy adults, aged 50-80, were surveyed. Both overall and screening practices of stool occult blood test (SOBT), digital rectal examination (DRE), and colonoscopy or sigmoidoscopy (COL/SIG) were analyzed. RESULTS: Of the population analyzed, 90.1% declared that they were interested in cancer prevention activities. Overall SOBT practice rate within the last 2 years was 4.77%. When only screening procedures were analyzed, this percentage shrank to 1.73%. Overall and screening COL/SIG rates within the last 10 years were 8.76 and 1.74%, respectively. The respective proportions of individuals who underwent DRE were 14.54 and 5.2%. Evidence-based screening practices were influenced by age, family history of colorectal cancer, profession, and educational level; however, SOBT and colonoscopy/sigmoidoscopy did not overcome 4.1 and 4.6% in any subpopulation analyzed. CONCLUSION: The level of CCS coverage among the examined sample of Greek adults was discouraging. Surveys among other European countries are encouraged.

Age Factors↗
PubMed2006

Diabetes management in patients receiving palliative care.

A literature review revealed no evidence-based guidelines specific to managing diabetes in the context of palliative care. The purpose of the current project was to describe the management practices of doctors and nurses caring for people with diabetes and advanced disease. Palliative care doctors, palliative care nurses, endocrinologists, and diabetes nurse educators participated in this study. A two-phase project was undertaken: 1) two focus groups, and 2) a cross-sectional survey using a self-completed questionnaire. The focus group and questionnaire data identified that doctors and nurses used a range of practices and blood glucose testing frequencies to control blood glucose based on experience and not according to a robust evidence base. Implications for practice include the importance of collaboration between diabetes and palliative care specialists, and the need to develop clinical management guidelines.

Adult↗
PubMedDate not supplied

Monoclonal antibodies as investigative tools in onchocerciasis.

The development of monoclonal antibodies against parasites can facilitate analysis of host-parasite interactions and can lead to the identification and characterization of antigens that induce protective responses in the immunized host. As diagnostic reagents for human and bovine onchocerciasis, monoclonal antibodies have been used to detect circulating antigens. So far only complex antigens have been used to generate monoclonal antibodies against filarial parasites. The use of such heterogeneous immunogens may result in interference or even in inhibition of the response to the desired parasite antigen(s). Epitopes that are similar or identical to determinants on host molecules or that are components of other infectious agents serve to complicate the generation and selection of monoclonal antibodies against Onchocerca volvulus antigens, and cross-reactivity can be due to monoclonal antibodies reacting with phosphorylcholine, which is present in many preparations of helminth antigens. Because of the host-dependent immunogenicity of filarial agents, reagents should be screened carefully for species specificity by use of a set of different helminth antigens. It is hoped that active collaboration among all investigators engaged in filariasis research will facilitate resolution of such difficulties.

Animals↗
PubMed2001

Memoranda of understanding between Medicaid MCOs and public health departments.

PURPOSE: This evaluation research project was conducted to describe local perspectives on creating and implementing mandated memoranda of understanding (MOU) between Medicaid managed care organizations and local health departments (LHD), to provide insights into the strengths and limitations of MOU, and to share information on their use as tools for interorganizational service coordination. DESIGN AND METHODOLOGY: A cross-sectional, qualitative and quantitative, self-administered, mailback survey was conducted with employees of MCOs and LHDs in California having experience in creating and/or implementing state-mandated MOU in nine service areas. Descriptive and qualitative results are reported. PRINCIPAL FINDINGS: The creation of MOU was facilitated by supportive leadership, previous collaborative experience, and the state mandate. The majority of respondents believed the MOU worked well to achieve coordination of services. MOU strengths and limitations were identified. The MOU were reported to have contributed to an increase in participation in four of six types of collaborative activities. Perceived quality of health care services for Medicaid participants improved with the MOU, but no impact on quality of public health services was reported. A majority (78 percent) supported a continuation of the mandated policy. Some organizations reported expanding the use of MOU beyond mandated areas. CONCLUSIONS: Study respondents held generally positive perceptions of the strengths of MOU and supported continuation of the mandated MOU policy in California. Their experience demonstrates a capacity for MCOs and LHDs to work together on health care coordination issues despite the difficulties inherent in interorganizational collaboration.

Cooperative Behavior↗
PubMedDate not supplied

Implementation of nursing conceptual models: observations of a multi-site research team.

The general acceptance by nursing of the nursing process as the methodology of practice enabled nurses to have a common grounding for practice, research and theory development in the 1970s. It has become clear, however, that the nursing process is just that--a process. What is sorely needed is the nursing content for that process and consequently in the past 10 years nursing theorists have further developed their particular conceptual models (CM). Three major teaching hospitals in Toronto have instituted a conceptual model (CM) of nursing as a basis of nursing practice. Mount Sinai Hospital has adopted Roy's adaptation model; Sunnybrook Medical Centre, Kings's goal attainment model; and Toronto General Hospital, Orem's self-care deficit theory model. All of these hospitals are affiliated through a series of cross appointments with the Faculty of Nursing at the University of Toronto. Two community hospitals, Mississauga and Scarborough General, have also adopted Orem's model and are related to the University through educational, community and interest groups. A group of researchers from these hospitals and the University of Toronto have proposed a collaborative project to determine what impact using a conceptual model will make on nursing practice. Discussions among the participants of this research group indicate that there are observations associated with instituting conceptual models that can be identified early in the process of implementation. These observations may be of assistance to others contemplating the implementation of conceptually based practice in their institution.

Attitude of Health Personnel↗
PubMed1995

The epidemiology of prosthetic heart valves in the United States.

The Center for Devices and Radiological Health of the Food and Drug Administration, in collaboration with the National Center for Health Statistics, conducted the Medical Device Implant Supplement to the 1988 National Health Interview Survey, generating the 1st available population-based estimates of the use of prosthetic heart valves in the United States. The 1988 National Health Interview Survey was a massive, nationally representative cross-sectional survey that encompassed 47,485 households and 122,310 individuals. Data from the Medical Device Implant Supplement indicate that an estimated 253,283 persons with 279,175 heart valves were present in the civilian, non-institutionalized US population (population prevalence of 1.1/1,000, 95% CI 0.8-1.3). Prevalence of valve prostheses ranged from 0.2 per 1,000 in those age 44 and under to 5.3 per 1,000 in those 75 years of age and older. Age-adjusted prevalence of valve prostheses did not differ significantly according to sex, race, region of residence, education, or income of recipients. Two thirds of aortic valve recipients identified by the survey were male, compared with only one third of mitral valve recipients. Approximately two thirds of both aortic and mitral valve implants were reported as mechanical. Reported use of anticoagulative agents was significantly more common in recipients of mechanical than of bioprosthetic valves. The single most common reported reason for prosthetic valve implantation was rheumatic heart disease. These data provide useful epidemiologic and public health planning information on prosthetic heart valve use.

Adult↗