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At least 1,063 records · Page 59Linked to original sources
PubMed2006

Socioeconomic deprivation, coronary heart disease prevalence and quality of care: a practice-level analysis in Rotherham using data from the new UK general practitioner Quality and Outcomes Framework.

BACKGROUND: The provision of coronary heart disease (CHD) health care has been shown to be inequitous, with those most in need having the least access to high-quality care. The new UK general practitioner (GP) Quality and Outcomes Framework (QOF) contract offers substantial financial rewards to general practices that combine maximal CHD case finding with high-quality CHD care. OBJECTIVE: To examine whether GP practice-level CHD prevalence and the measures of quality of care derived from the new QOF data are associated with area-level socioeconomic deprivation. METHODS: An ecological study of 38 GP practices contracting with Rotherham Primary Care Trust, United Kingdom, was carried out. We calculated Spearman rank correlation coefficients for practice-level age-sex-standardized QOF CHD prevalence against area deprivation score and for 11 QOF CHD indicator achievements against area deprivation score. RESULTS: Practice-level CHD prevalence showed a positive correlation with deprivation (r=0.64, p<0.001), as did one of the 11 quality-of-care indicators (recording of smoking status, r=0.34, p=0.04). The remaining 10 quality-of-care indicators showed no significant correlation with deprivation. CONCLUSION: Practice-level CHD prevalence is associated with deprivation, but we found no evidence of socioeconomic inequality in CHD care. This finding is in contrast to that from previous studies and the widely reported inverse care law.

Contract Services↗
PubMed2026

MyGeneRisk Colon: A Web-Based Tool for Personalized Colorectal Cancer Risk Prediction Based on Genetics and Lifestyle.

Colorectal cancer (CRC) is a leading cause of cancer-related death, with incidence rising substantially among individuals under 50 years of age. Polygenic risk scores (PRS) hold promise for identifying high-risk individuals; when combined with lifestyle factors, they substantially improve prediction accuracy compared with models based on lifestyle factors alone. However, few clinical tools currently exist that facilitate this integrated, PRS-enhanced risk assessment. To bridge this gap, we developed MyGeneRisk Colo n, a publicly accessible web portal that delivers individualized CRC risk prediction by incorporating genetic, demographic, family history, and lifestyle factors. This paper details the development of the underlying risk prediction model, the portal's architecture and data security, our reporting framework, and engagement with a community advisory panel. Designed as a user-friendly platform, MyGeneRisk Colon aims to effectively communicate personalized CRC risk profiles and educate users and healthcare providers about prevention strategies.

Journal Article↗
PubMed2002

[Evaluation of intractable diseases].

OBJECTIVE: The aim of this study was to determine priorities for specific intractable disease from the viewpoint of countermeasures. METHODS: A significance evaluation to provide a priority framework for intractable disease was performed with a questionnaire distributed to the staff of preventive medicine and public health departments of medical schools in Japan. To determine the actual conditions of these intractable diseases question were directed at the chairmen of individual clinical study groups. The priority to be assigned countermeasures for such diseases was obtained from the two questionnaires. RESULTS: When the 4 factors "rare nature of diseases," "level of clarity of causes and pathology," "unestablished curative treatment", and "influence on daily life" were evaluated using 100 point as a full score, the mean scores were 14.5, 27.1, 28.5 and 29.9 points, respectively. In attaching importance to the various items, regarding the "rare nature of disease" the elements of "few patients nationwide" and "few specialist doctors nationwide" proved important; for the "level of clarity of causes and pathology," this was the case for the elements of "unclear triggering mechanism" and "diagnostic criteria not established." With the "unestablished curative treatment," the "no efficacious treatment available" and "low 5-year survival rate elements were important; and with the factor of "influence on daily life," the two most significant were "high proportion of patients needing assistance in daily life" and "high percentage of patients impeded from attending school or obtaining a job (playing a role in society)". CONCLUSION: When the priority among the 118 intractable diseases was evaluated by combining the overall results of the questionnaire survey with preventive medicine and public health staffs, and actual condition data from survey investigation of the intractable diseases among chairmen of clinical study groups, it was suggested that some intractable diseases whose medical expenses are covered by the medical aid program have a low ranking.

Activities of Daily Living↗
PubMedDate not supplied

The Leiden Early Arthritis Clinic.

In 1993 a special Early Arthritis Clinic (EAC) was established at the Department of Rheumatology of the Leiden University Medical Center in order to detect and treat inflammatory disorders early in the disease state, especially early rheumatoid arthritis. Patients with confirmed arthritis of recent onset (less than 2 years) were included by rheumatologists and trained research nurses. Parameters of first and follow-up visits (3, 6 and 9 months and yearly) that were entered in the EAC-database include the medical history, physical-diagnostic examination, laboratory tests, questionnaires, radiographic joint scores and diagnosis. This database enables us to conduct research on arthritis, with an emphasis on rheumatoid arthritis, in many ways. Physicians and basic scientists have studied cellular immunology and genetic, environmental and clinical risk factors in order to determine the pathophysiologic mechanisms of inflammatory arthritis. The present article is a review on reports published from the EAC. Over the past ten years, these reports have been highly relevant for both daily clinical practice and research. Present and planned future studies, as described in this article, reconfirm the importance of an EAC framework to ensure that research continues on this disease in the Leiden EAC area.

Ambulatory Care Facilities↗
PubMed1996

The relationship between parenting types and older adolescents' personality, academic achievement, adjustment, and substance use.

The purpose of the present study was to examine Baumrind's T3 conceptual framework using a multiple informant design and an older adolescent population. With 178 college students and their families as participants, the present study found many of the predicted relations between parents' child-rearing style (Authoritative, Democratic, Nondirective, Nonauthoritarian-Directive, Authoritarian-Directive, and Unengaged) and their adolescent children's behavior in the 4 domains assessed: personality, adjustment, academic achievement, and substance use. The differences between parenting types on the criterion measures were not as large as reported in Baumrind's study, and significant effects were predominantly due to the poor scores from children with Unengaged and Authoritarian-Directive parents. The results are discussed in terms of their implications for the Authoritative parenting type, the utility of using a typology, and areas for future research.

Achievement↗
PubMed2026

Failure modes and effects analysis for clinical implementation of online adaptive radiotherapy: A systematic review.

BACKGROUND: The accuracy of radiotherapy is limited by anatomical variations occurring over time scales ranging from sub-seconds to days. Online Adaptive Radiotherapy (OART) addresses this by enabling daily plan adaptation based on real-time imaging. While OART offers improved dose conformity, its dynamic, time-constrained workflow introduces novel failure modes that challenge traditional quality assurance protocols. PURPOSE: This study aims to synthesize the existing literature on Failure Modes and Effects Analysis (FMEA) for OART to systematically catalog risks and identify mitigation strategies. METHODS: A systematic literature search was conducted to identify studies applying FMEA to OART workflows. Eleven studies were included, covering MR-guided (ViewRay MRIdian, Elekta Unity), CBCT-guided (Varian Ethos), and MR-enhanced C-arm linac systems. To address heterogeneity in risk scoring methodologies (e.g., TG-100 10-point scales vs. 5-point rankings), extracted failure modes were harmonized into a standardized three-tier risk classification system (Class I: Low, Class II: Intermediate, Class III: High). RESULTS: A total of 300 unique failure modes were identified, with 49.6 percent classified as high-risk (Class III). Analysis revealed that the majority of high-risk failures were concentrated in the online treatment delivery phase, specifically within human-computer interactions and anatomical contouring steps. CONCLUSIONS: This study supports the development of tailored, robust QA frameworks that prioritize human factors and process consistency to guide safe implementation in diverse clinical settings.

Humans↗
PubMed1982

Metrological study of psychological questionnaires with reference to social variables: the Belgian Heart Disease Prevention Project (BHDPP).

In the framework of a controlled trial on the multifactorial prevention of coronary heart disease, two measures of type A behavior--determined by the Bortner scale and the Jenkins Activity Survey (JAS)--and one personality questionnaire--the Sandler Hazary Questionnaire and Eysenck Personality Inventory (SHEPI)--were used. Their interrelations and relations with social variables are analyzed. It appears that the Bortner scale and the JAS do not measure the overall syndrome of the coronary-prone behavior pattern (CPBP), but similar and different specific aspects of it. There exists a direct relation of the Bortner score, JAS-AB, JAS'-S, and JAS-J with the study level and the socioprofessional class. Neuroticism or emotional hyperreactivity determined by the SHEPI is highly correlated with these scores. No or small relations of social variables with personality traits are found.

Adult↗
PubMed2005

[Home postural evaluation in the elderly: comparison between fallers and non fallers].

OBJECTIVES: To determine the main clinical and posturographic factors correlated with falls in elderly individuals and to specify the role of static posturography in this appraisal. MATERIALS AND METHODS: The study involved 38 people living in an residential center who were autonomously ambulatory and had a Mini Mental Test score> or =24. Fallers (N = 15) had fallen within 1 month, and nonfallers (N = 23) had not fallen for at least a year. Assessment consisted of a series of questions, a complete clinical appraisal, specific independently validated tests, and static posturographic analysis different parameters of the stabilogram with the eyes first open and then closed, all carried out in the center. RESULTS: From the clinical standpoint, spinal pathologic features and the scores on the Functional Reach Test were significantly different between the fallers and nonfallers. In static posturography, fallers' equilibrium was more precarious than that of nonfallers with eyes are closed: significant differences were observed in surface, X length and overall fast Fourier transform score. The comparison between results with open and closed eyes showed that the fallers had a pronounced tendency to retropulsion in the absence of visual participation: a significant difference as regards overall length, Y length, minimum Y and FFT Y (0.5-2 Hz). CONCLUSIONS: To complement a satisfactorily conducted clinical examination, static posturography allows for rapid assessment of equilibrium and posture in elderly patients who fall? Performed at the place where an individual resides, this appraisal constitutes an original and pragmatic element. As an evaluation strategy, it can reveal nonnegligible information within the framework of an appraisal of such, and thereby allows for adjustment of the rehabilitation or compensatory strategy.

Accidental Falls↗
PubMedDate not supplied

Problem-solving cancer care education for patients and caregivers.

PURPOSE: A program evaluation was conducted to explore the potential effects of a 90-minute problem-solving education session for persons with advanced cancer and their families. DESCRIPTION OF PROGRAM: Patients with advanced cancer and their families, who were visiting a tertiary-care outpatient setting, were invited to attend a 90-minute individualized educational session that taught basic problem-solving principles using a cognitive-behavioral framework. Pre-education and posteducation data were collected about the confidence of participants in providing care, their feelings about being informed about resources, and their perceptions of their problem-solving ability. RESULTS: At baseline, most participants reported low confidence about their ability to provide cancer care and felt uninformed about community resources, but they viewed themselves as moderate-to-good problem solvers. Forty-two educational sessions were delivered to 49 caregivers and 40 patients. Two months later, participants reported feeling more informed about community resources and achieved higher posteducation scores for problem-solving ability. More caregivers than patients reported that reading The Home Care Guide for Cancer made a great deal of difference in their approach to home care. CLINICAL IMPLICATIONS: Most educational sessions for families affected by cancer focus on delivering information, not on building skills. These findings suggest that a one-on-one educational session that teaches problem-solving skills can be successfully delivered in a busy clinic setting. Family caregivers are especially likely to benefit from this program.

Caregivers↗
PubMed2003

Morphologic classification of filtering blebs after glaucoma filtration surgery: the Indiana Bleb Appearance Grading Scale.

PURPOSE: To establish a new classification system for filtering blebs according to clinical morphologic parameters. The purpose of this classification system is to provide a uniform and objective assessment of bleb appearance and establish a framework system through which outcomes of filtration surgery may be better correlated to clinical morphology. MATERIALS AND METHODS: The Indiana Bleb Appearance Grading Scale contains a set of photographic standards illustrating a range of filtering bleb morphology selected from the slide library of the Glaucoma Service at the Indiana University Department of Ophthalmology. These standards consist of slit lamp images for grading bleb height, extent, vascularity, and leakage with the Seidel test. For grading, the morphologic appearance of the filtration bleb is assessed relative to the standard images for the 4 parameters and scored accordingly. Fifty-one clinical bleb photographs were evaluated and scored by 3 glaucoma subspecialists in a masked fashion according to the scale. RESULTS: For all of the grading scales, high interobserver agreement was found using the scale to classify the appearance of filtering blebs (height +0.76; extent +0.78; vascularity +0.90, interclass correlation coefficient for consistency using a 2-way mixed effect model). CONCLUSION: The Indiana Bleb Appearance Grading Scale is a simple, reproducible, yet comprehensive system for classifying the morphologic slit lamp appearance of filtration blebs.

Filtering Surgery↗
PubMed2003

Groundwater abstraction pollution risk assessment.

A generic groundwater pollution risk assessment methodology has been developed to enable the evaluation and ranking of the potential risk of pollution to groundwater abstractions. The ranking can then be used to prioritise risk management or mitigation procedures in a robust and quantifiable framework and thus inform business investment decisions. The risk assessment consider the three components of the pollution transport model: source-pathway-receptor. For groundwater abstractions these correspond to land use (with associated pollutants and shallow subsurface characteristics), aquifer and the abstraction borehole. An hierarchical approach was chosen to allow the risk assessment to be successfully carried out with different quality data for different parts of the model. The 400-day groundwater protection zone defines the catchment boundary that form the spatial limit of the land use audit for each receptor. A risk score is obtained for each land use (potential pollution source) within the catchment. These scores are derived by considering the characteristics (such as load, persistence and toxicity) of all pollutants pertaining to each land use, their on-site management and the potential for the unsaturated subsurface to attenuate their effects in the event of a release. Risk scores are also applied to the aquifer characteristics (as pollutant pathway) and to the abstraction borehole (as pollutant receptor). Each risk score is accompanied by an uncertainty score which provides a guide to the confidence in the data used to compile the risk assessment. The application of the methodology has highlighted a number of problems in this type of work and results of initial case studies are being used to trial alternative scoring methods and a more simplified approach to accelerate the process of pollution risk assessment.

Models, Theoretical↗
PubMed1991

Adaptation in families with a member requiring mechanical ventilation at home.

Current health care trends indicate that ventilator-dependent patients increasingly will be discharged to home after shorter hospitalizations. The purpose of this study was to determine how care givers adapt to having ventilator-dependent adults at home. Twenty families were interviewed in their homes by using an eight-question semistructured interview guide. The Roy model was used as a framework to analyze these data. Two instruments, the Family Coping Scale (F-COPES) and the Family APGAR, were administered to measure family coping and function. Patients, aged 18 to 74 years, required 24-hour (n = 9), 12- to 15-hour (n = 5), or 8- to 12-hour (n = 6) home ventilatory support and had neuromuscular or trauma-related diagnoses. Months receiving ventilation ranged from 2 to 312. Care givers, aged 20 to 74 years, were all relatives. Six care givers reported using support services outside their extended family. F-COPES scores fell within national norms whether the patient required 24-hour or less ventilation. Family APGAR results revealed satisfaction with overall family function although scores decreased over time. Interview data indicated that essential knowledge and skills are taught but additional information is desired. Both positive and negative responses to care giving were identified, with the majority of responses being concerned with role mastery, self-concept, and dependency issues. Positive themes in the interviews reflected confidence in ventilator care, satisfaction with the decision to care for their family member at home, and improved quality of life. Negative themes in the interviews reflected the burden of care giving, the dependence of the patient on the care giver, resentment, and hopelessness.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed2006

Cortical responses to pain in healthy individuals depends on pain catastrophizing.

The personal experience of pain is complex and depends on physiological and psychological factors. From this latter category, pain catastrophizing plays an important role in pain behavior and response. We aimed to determine the effect of pain catastrophizing on central nociceptive processing in healthy individuals. Functional MRI was performed during two pain intensity levels evoked by electrical median nerve stimulation in 22 healthy individuals. Pain catastrophizing scores were determined for all subjects. Pain catastrophizing was not related to activity in regions associated with sensory-discriminative aspects of pain, such as the primary or secondary somatosensory cortex. Instead, during mild pain, there was a relationship between catastrophizing and activity in cortical regions associated with affective, attention, and motor aspects of pain, including dorsolateral prefrontal, insula, rostral anterior cingulate, premotor, and parietal cortices. During more intense pain, prefrontal cortical regions implicated in the top-down modulation of pain were negatively correlated with catastrophizing. These findings can be viewed from the framework of an attention model of pain catastrophizing, whereby a cortical vigilance network is engaged during mild pain, but diminished prefrontal cortical modulation impedes disengaging from and suppressing pain during more intense pain. These findings may also implicate catastrophizing in the progression to or persistence of chronic pain.

Adult↗
PubMed1995

Security of attachment in 8-12-year-olds: a revised version of the Separation Anxiety Test, its psychometric properties and clinical interpretation.

This study examined the reliability and validity of an adapted version of the Separation Anxiety Test (SAT) for 8-12-year-old children. Clinical (N = 21) and nonclinical (N = 21) participants were compared on responses to the SAT coded using the Seattle scoring indices. Inter-rater reliability was established at an acceptable level, however, test-retest reliability and internal test construction were less satisfactory. Sample comparisons found the clinical participants described themselves as less securely attached and more avoidant of emotional expression than the control participants. The indices of attachment security were also related to various socioemotional aspects of functioning. In addition, the results indicated that describing "self" as different from a similar "other" child was significantly related to parental reports of poor social competence. Results are discussed in relation to an Attachment Theory framework as well as from a clinical perspective.

Anxiety, Separation↗
PubMed1989

Predicting suicide behaviours in incarcerated settings.

Attempts to predict suicide behaviours have produced a number of useful clinical tools. Unfortunately, these have been largely designed with a specific psychiatric population or institutional setting in mind and are not easily transferred to an incarcerated setting. In 1983 the authors developed a suicide checklist which could be used to aid screening of new admissions to Remand Centres in the Province of Alberta. Studies completed to date have revealed this checklist to be a practical and reliable method of standardizing the suicide screening process. This paper presents findings from a study designed to evaluate the predictive power (discriminant validity) of the checklist. A stepwise multivariate framework is used to assess the overall ability of checklist items to discriminate a high risk group. As well, the relative importance of specific socio-demographic, clinical and historical variables is assessed. Data were collected on a cohort of consecutive admissions to the Edmonton Remand Centre during 1986. Findings reveal that marital status is the only direct statistical predictor of suicide risk. Inmates who had divorced or separated from a spouse were more likely to be active suicide risks at some time during their remand than those who were married or single. Symptom score was found to be generally predictive, however, closer assessment revealed this relationship to be heterogeneous across subgroups defined on the basis of certain criminological variables. The model which allowed for the interaction of clinical with criminological variables correctly discriminated 100% of the active suicide risks and 63% of inmates who had a prior history of suicide behaviours. The practical implications of these findings for suicide screening are discussed.

Adult↗
PubMed1988

The cognitive orientation of obesity.

The paper focuses on studying the cognitive determinants of obesity within the framework of the cognitive orientation (CO) theory. This theory assumes that cognitive contents and processes guide behavior, and specifies procedures for predicting and changing behaviors. The subjects were 64 obese and 64 nonobese women matched in age, height and other demographic variables. They were administered the MMPI and a CO questionnaire of obesity which assessed beliefs of four types (about goals, rules and norms, self and general beliefs) concerning 20 themes found to represent the meanings of food, eating and obesity. The results showed that the groups did not differ and had no elevated scores on any of the MMPI scales. The obese had higher scores than the controls on each of the belief types, an overall belief index, 19 themes and a conflict propensity measure. A discriminant analysis showed 88.3 percent correct identifications on the basis of the beliefs. Discussion focused on the role of conflicts and the different themes in obesity and on outlining the elements of a CO model of obesity with therapeutic implications.

Adult↗
PubMed1987

Modes of perceiving and processing information in birdsong (Agelaius phoeniceus, Molothrus ater, and Homo sapiens).

In a previous study I examined the abilities of red-winged blackbirds and brown-headed cowbirds trained with a go-right/go-left procedure to identify conspecific and alien song themes (Sinnott, 1980). Results showed that each bird species exhibited superior identification of conspecific final "trill" or "whistle" elements, relative to the alien species. The present study extends these results by examining human perception of these same song stimuli, by examining the effects of tutoring birds with alien final song elements, and by using latency analyses to investigate processing modes that are not apparent from analyses of percent-correct scores. Results suggest three different processing modes: First, humans attend primarily to the final song elements. Second, birds identifying alien songs attend primarily to the introductory elements and disregard information in the final elements. Third, birds identifying conspecific songs process both the initial and final elements, but their response latencies indicate that they direct their attention primarily to the initial elements and process the final elements without investing more time than do the alien birds that fixate on the initial elements. Conspecific special processing is discussed in relation to various psychophysical, ethological, and psycholinguistic frameworks. Human perception of birdsong is discussed in relation to backward recognition masking.

Adult↗
PubMed2026

Multimodal intervention benefits: Responder analysis of J-MINT PRIME Kanagawa trial.

INTRODUCTION: The J-MINT PRIME Kanagawa trial was an 18-month multimodal intervention (incorporating exercise, nutrition, and metabolic management) for dementia prevention. Because the primary analysis showed no significant benefits, we performed an exploratory responder analysis to identify responsive subpopulations. METHODS: We analyzed the Full Analysis Set comprising 188 participants. Classification and regression tree (CART) analysis, applied to the intervention arm, identified baseline predictors of cognitive improvement. These rules were then applied to the entire cohort to evaluate treatment effects on the Mini-Mental State Examination (MMSE) using fully adjusted mixed-effects models for repeated measures (MMRM). RESULTS: CART identified a "Target Group" (N = 108) characterized by baseline profiles such as an MMSE score < 28 or specific metabolic ranges (e.g., LDL-C < 135 mg/dL). Within this target group, the intervention significantly preserved MMSE trajectories compared with the control group (group &#xd7; time interaction, P = 0.022). In contrast, the Non-Target Group (N = 80), consisting of high-functioning individuals (MMSE &#x2265; 28), exhibited no significant group &#xd7; time interaction. DISCUSSION: Multimodal interventions may effectively preserve global cognition in older adults with sub-threshold cognitive decline. Careful targeting of appropriate populations, while considering potential longitudinal measurement artifacts (e.g., practice effects), is essential. These findings provide a hypothesis-generating framework that warrants external validation in future prevention trials.

Humans↗