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PubMed2005

[Development of a checklist for evaluation of mental health activities at the workplace].

"The Checklist for Evaluation of Mental Health Activities at the Workplace" was developed for workplace staff evaluating mental health activities in their own workplace. The validity and reliability of the checklist were examined and criteria for evaluation were developed for workplace/organization/companies with 50 or more employees in Japan. The checklist initially included 33 items covering seven major domains of occupational mental health, with a four-point response option, based on the Japanese Guideline for Worker Mental Health in the Workplace and a relevant literature review. A questionnaire was send to 60 members of the Occupational Mental Health Committee (OMHC) of the Japan Society for Occupational Health to ask their opinions on the checklist and on the minimum requirement for each item on the checklist; 30 (50%) responded. A random sample of 1,335 workplaces from a contractor list of workplaces for worker compensation insurance and a questionnaire was send to the personnel department to fill in the checklist; 412 (31.5%) responded and data from 335 of them with 50 or more employees were analyzed. Some OMHC members felt that one of the items (concerning the Total Health Promotion program) should be dropped; thus the checklist was revised to include 32 items, still covering the seven domains. Based on the workplace survey data, most domain scales showed internal consistency reliability at an acceptable level; explanatory factor analysis yielded a four-factor structure that was well concordant with the hypnotized seven-domain structure. Three levels of adequacy of mental health activities were set for each domain scale: "red" (inadequate), "yellow" (minimal), and "green" (adequate). One third of occupational health professionals from 49 workplaces rated the evaluation result based on the checklist as concordant with their view; 95% of them said the checklist would be useful in promoting occupational mental health activities. The study indicated that the checklist had reliability (based on internal consistency reliability) and content- and construct-validity (based on expert opinions, a factor-structure concordant with empirical data, and evaluation by workplace staff). The checklist seems useful in promoting occupational mental health activities.

Counseling↗

PubMed1993

Spontaneous variability of regional haemodynamics in unanaesthetized rats.

AIM: To study the spontaneous variability in regional haemodynamics. METHODS: Twenty normotensive Wistar-Kyoto rats were chronically instrumented with an arterial catheter and with pulsed Doppler flowmeters on the distal aorta, and the superior mesenteric and left renal arteries. After surgical recovery, the rats were monitored in unrestrained conditions. The recorded signals were analysed beat-to-beat to obtain means and coefficients of variation for mean arterial pressure, heart rate, regional blood flow velocity (consecutive 0.8-s periods) and indices of regional vascular resistance (0.8-s ratio of mean arterial pressure to mean blood flow velocity). RESULTS: Muscle and splanchnic blood flow velocities were markedly variable, with coefficients of variation of 12.8 +/- 0.8 and 12.2 +/- 1.7% (means +/- SEM), respectively, about twice as large as the coefficient of variation for mean arterial pressure (6.2 +/- 0.3%). The renal blood flow velocity was slightly less variable than the muscle and splanchnic blood flow velocities, with a coefficient of variation of 10.4 +/- 0.8%, but still markedly and significantly more variable than systemic arterial pressure. A contingency analysis of paired variations in any two given parameters (arterial blood pressure, heart rate, blood flow velocities and indices of vascular resistance) showed a concordant pattern, the only exception being a distinctly discordant trend for the covariations in muscle and splanchnic blood flow velocities. CONCLUSIONS: Regional blood flow velocity and vascular resistance have a larger degree of spontaneous variability than systemic arterial pressure. Renal blood flow velocity is also highly variable, suggesting that short-term stimuli that affect the renal blood vessels are not countered by autoregulation to any great degree. We conclude that while central factors may drive concordant regional haemodynamic variations, some opposing changes in regional blood flow velocity may cancel each other out, thereby reducing the variability in systemic blood pressure.

Animals↗

PubMed1997

History of genital warts in 10,838 women 20 to 29 years of age from the general population. Risk factors and association with Papanicolaou smear history.

BACKGROUND AND OBJECTIVES: The most important risk factor for cervical neoplasia is genital infection with certain types of human papillomavirus (HPV). Genital warts (GW) are an easily recognizable condition caused by HPV. Although only a fraction of HPV infections are clinical, a history of ever having had GW could serve as a marker for exposure to HPV. GOALS: To study the risk factors for ever having had GW. The association of GW with abnormal Papanicolaou (Pap) smear and relation to cervical neoplasia is also discussed. STUDY DESIGN: A case-control study among 10,838 women aged 20 to 29 years and reporting at least one lifetime sexual partner. The women were participants in a prospective cohort study on the relationship between HPV and cervical neoplasia in Copenhagen, Denmark. Data were obtained by means of personal interviews using structured questionnaires. RESULTS: In all, 1,820 women (17%) reported ever having had GW. The most important risk factor was the number of lifetime of sexual partners (adjusted odds ratio 5.2; 95% confidence interval: 3.4-8.0) for at least 40 partners vs. 1 to 2 partners). The number of regular partners, sexually active years, a history of chlamydial infection, and smoking were also associated with the risk of ever having had GW. Women who had had GW were 1.9 times more likely than other women to report an abnormal Pap smear. CONCLUSIONS: The study confirms the sexual transmission of the infection. There is also good concordance between risk factors for ever having had GW and cervical neoplasia. A close relationship between having had GW and an abnormal Pap smear was observed.

Adolescent↗

PubMed2001

The contrasting influence of depressive and hyperthymic temperaments on psychometrically derived manic subtypes.

The present investigation focused on symptomatological subtypes of mania and their relationships with affective temperaments and other clinical features of bipolar disorder. In 153 inpatients with mania diagnosed according to DSM-III-R, symptomatological subtypes have been investigated by means of principal component factor analysis of 18 selected items of the Comprehensive Psychopathological Rating Scale (CPRS). We compared other clinical features, depressive and hyperthymic temperamental attributes, and first degree-family history for mood disorders among the various manic subtypes on the basis of the highest z-scores obtained on each CPRS factor (dominant CPRS factor groups). Five factors--Depressive, Irritable-Agitated, Euphoric-Grandiose, Accelerated-Sleepless, Paranoid-Anxious--emerged, accounting for 59.8% of the total variance. When the factor-based groups were compared, significant differences emerged in terms of the duration of the current episodes, rates of chronicity and incongruent psychotic features--being highest in the 'Depressive' and 'Paranoid-Anxious' dominant groups. The patients with highest z-scores for the 'Euphoric-Grandiose', 'Paranoid-Anxious' and 'Accelerated-Sleepless' factors were those most likely to belong to the hyperthymic temperament, while the 'Depressive' dominant group had the highest rate of depressive temperament. Finally, it is noteworthy that the 'Irritable-Agitated' group was high for both temperaments. The foregoing multidimensional structure of mania--revealing five factors--is generally concordant with the emerging literature. Consistently with our original hypothesis, a hyperthymic temperament seems to underlie the most extreme manic excitement with euphoric-accelerated-paranoid phenomenology. By contrast, the depressive temperament seemed to mute the expression of mania into a depressive-manic phenomenology.

Adolescent↗

PubMed2006

Risk factors for cocaine-induced paranoia in cocaine-dependent sibling pairs.

OBJECTIVE: Cocaine-induced paranoia (CIP), an irrational intense suspicion of others, is a common manifestation of cocaine dependence. Both environmental and genetic factors are thought to play a role, but the specific nature of such contributions is poorly understood. METHODS: Demographic, diagnostic, and cocaine-use data were obtained from 420 cocaine-dependent, genetically confirmed, full-sibling pairs (N=840 subjects) interviewed with the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA). Probands with and without CIP were compared; then, factors associated with sibling CIP status were analyzed by logistic regression. Alcohol dependence, a known heritable phenotype, was analyzed as a positive control. RESULTS: Of 420 probands, 273 (65%) experienced CIP. Probands with CIP were more severely dependent upon cocaine, had an earlier age of onset, were more likely to smoke cocaine, and used cocaine less frequently during the preceding year. Independent analyses of siblings replicated two of the former (i.e., dependence severity and age of onset). Probands with CIP also had a non-significantly higher proportion of siblings with the trait (66% versus 59%). Probands with concurrent alcohol dependence were confirmed to have significantly higher rates of alcoholism among their siblings. CONCLUSIONS: Severity of cocaine dependence and age of onset appear to be important risk factors for CIP. Concordance for CIP between siblings did not emerge as significant in our analyses.

Adult↗

PubMed2003

In vivo measurement of receptor density and affinity: comparison of the routine sequential method with a nonsequential method in studies of dopamine D2 receptors with [11C]raclopride.

Positron emission tomography with the dopamine D(2/3) receptor ligand raclopride was used to compare sequential (studies on 1 day) and nonsequential (different days) approaches to in vivo measurement of the density and affinity of receptors. The choice of temporal sequence of radiotracer injection over a range of specific activities might result in bias because of diverse factors. A strong concordance is reported between the outcomes of the sequential and nonsequential methods. This suggests that the characteristics of the dopamine D(2/3) receptors are relatively stable within physiologic boundaries and can be reproducibly and reliably measured in stable conditions.

Animals↗

PubMed1991

Twin studies of psychopathology: why do the concordance rates vary?

Many current discussions of hereditary factors in psychopathology focus on twin studies as the primary source of evidence supporting the importance of genetic determinants. In summarizing the results of these studies, authors often derive estimates of concordance rates by collapsing across studies and presenting mean or median rates. This practice implicitly assumes that the concordance rates yielded by different studies represent equally reliable estimates of the population mean. The present study evaluates the validity of this assumption. Reports of twin studies of schizophrenia and affective disorder were reviewed. A meta-analysis was conducted to examine the influence of methodological factors on concordance rates. Analyses indicated that both sample-selection and zygosity-determination procedure are systematically associated with concordance rates. For schizophrenia, MZ concordance rates are significantly lower when samples are selected from a twin register as opposed to a psychiatric facility. Lower MZ concordance rates are also yielded by studies that employ laboratory procedures to determine zygosity. Implications of the findings for future research are discussed.

Affective Disorders, Psychotic↗

PubMed2003

Progression of mouse mammary tumors: MCP-1-TNFalpha cross-regulatory pathway and clonal expression of promalignancy and antimalignancy factors.

The progression of breast cancer is affected by multiple cellular and microenvironmental components. The monocyte chemoattractant MCP-1, IL-6 and matrix metalloproteinases (MMP) were suggested to promote, each on its own, breast cancer progression. We recently demonstrated that the high-tumorigenicity phenotype of the DA3 and CSML murine mammary adenocarcinoma cells is correlated with a high expression of MCP-1, IL-6 and MMP. This raised the possibility that common intrinsic tumor-derived factors regulate the concordant expression of these 3 components. The aim of the present study was to gain insight into the mode by which the secretion of MCP-1, IL-6 and MMP from murine mammary adenocarcinoma cells is regulated. This was investigated in cellular clones established from a highly malignant variant of the DA3 tumor (DA3-high). We also determined the secretion of the antimalignancy chemokine IP-10 from these cells. The results indicate that the secretion levels of IL-6, MMP and IP-10 varied between the clones. In contrast, all the clones secreted uniformly high levels of MCP-1, suggesting that MCP-1 constitutes an important feature of the malignancy phenotype of mammary carcinoma. In most of the clones, elevated levels of 1 of the 3 promalignancy factors did not correlate with a high expression of the other 2 factors and vice versa. These findings indicate that the 3 promalignancy factors are not coregulated by a common intrinsic tumor-derived factor. Rather, these results suggest that the individual capacities of the different clones to secrete these factors are summed up in the high-malignancy DA3 parental tumor population, which secretes relatively high levels of MCP-1, IL-6 and MMP as compared to DA3 cells expressing a low-malignancy phenotype. In contrast to the lack of coordinated intrinsic regulation of MCP-1, IL-6 and MMP, it was found that recombinant TNFalpha, a product of tumor-associated macrophages contributing to breast cancer progression, upregulated the secretion of MCP-1, IL-6 and MMP from all the clones. These results suggest a key role for this microenvironmental, monocyte-derived cytokine in the coordinated regulation of these 3 molecules. Furthermore, additional results demonstrated that monocytic cell-derived TNFalpha upregulated MCP-1 secretion from the tumor cells and that MCP-1 in turn promoted the secretion of TNFalpha from monocytic cells. This may result in a positive feedback loop, whereby the tumor cells and the monocytic cells at tumor site promote each other's ability to express and secrete promalignancy factors. We next attempted to assess the contribution of the promalignancy factors MCP-1, IL-6 and MMP and of the antimalignancy factor IP-10 to mammary adenocarcinoma progression. To this end, a preliminary formula was developed in which the net balance between secretion levels of the promalignancy factors and that of the antimalignancy IP-10 chemokine from different clones was related to their in vivo tumorigenicity profile. This formula suggests that a balance between the secretion levels of these factors plays an important role in determining the malignancy phenotype of mammary carcinomas. In all, our findings demonstrate that the mammary tumor cell population is composed of a heterogeneous assortment of clones whose individual characteristics are averaged in the whole population. The malignancy potential of such tumors is thus determined, inter alia, by a combinatorial effect of several promalignancy and antimalignancy factors secreted from each of the clones comprising these tumors. Our results also suggest that the expression of such factors is determined by several nonmutually exclusive regulatory mechanisms.

Acute Disease↗

PubMed1999

[Adenocarcinoma of the exocrine pancreas: management and therapeutic hopes].

INTRODUCTION: Pancreatic carcinoma is a major public health concern, as it kills more than 6,000 people each year in France. CURRENT KNOWLEDGE AND KEY POINTS: The main risk factor demonstrated by concordant case-control studies is cigarette smoking. Pancreatic carcinoma is generally diagnosed at an advanced stage. Results of radical surgery are still poor. In most of the reported series, less than 25% of the patients survive at five years. FUTURE PROSPECTS AND PROJECTS: Postoperative radiochemotherapy slightly increases the hope of cure. In locally advanced tumors, radiochemotherapy, sometimes preoperative, allows some patients to survive more than two years. Though results of palliative chemotherapy remain very poor, some clinical benefit has been observed in randomized trials comparing this treatment with the currently best supportive treatment.

Adenocarcinoma↗

PubMed2002

Comparison of ADA and WHO criteria for the diagnosis of diabetes in elderly Koreans.

AIMS: This study was conducted to compare the prevalence and cardiovascular risk factors of different categories of glucose tolerance in the elderly Korean population using World Health Organization (WHO) and American Diabetes Association (ADA) criteria. METHODS: This study included 1456 non-diabetic subjects over the age of 60 years, selected from a cross-sectional study, which was conducted in 1999 in Seoul, Korea. Fasting and post-challenge 2-h plasma glucose, insulin levels, body mass index (BMI), waist-hip ratio (WHR), blood pressure, and lipid profiles were examined. Prevalence of glucose tolerance categories and the level of agreement (kappa statistics) were obtained using WHO 2-h criteria and ADA fasting criteria. Comparison of cardiovascular risk factors among several concordant and discordant glucose intolerance groups was done. RESULTS: The prevalence rates of newly diagnosed diabetes of elderly men defined by WHO 2-h criteria and ADA fasting criteria were 11.8% and 4.8%, respectively. That of elderly women was 8.1% by WHO 2-h criteria and 3.1% by ADA fasting criteria. The prevalence of impaired glucose tolerance (IGT) by WHO criteria was also higher than that of impaired fasting glucose (IFG) by ADA criteria (23.5% vs. 10.0% men, 23.7% vs. 7.5% women). The level of agreement between ADA fasting criteria and WHO 2-h criteria was low (weighted kappa = 0.228 men, weighted kappa = 0.301 women). The concordant diabetic women by both ADA fasting criteria and WHO 2-h criteria showed higher BMI, WHR, diastolic blood pressure, total cholesterol and triglyceride levels than concordant normal subjects. However, the isolated post-challenge hyperglycaemia (IPH) women group was not different significantly from the concordant normal women group except in BMI. CONCLUSIONS: Our results clearly show that the 1997 ADA fasting criteria are less sensitive for diagnosing diabetes than oral glucose tolerance test (OGTT)-based WHO criteria in elderly Koreans. Also, there is a poor agreement of different categories of glucose tolerance between ADA and WHO criteria; therefore, the OGTT remains a valuable test in diagnosing diabetes and classifying various categories of glucose intolerance, especially in elderly Koreans.

Aged↗

PubMed2002

Identification of a zinc finger homoeodomain enhancer protein after AT(2) receptor stimulation by differential mRNA display.

Using differential mRNA display, we isolated differentially expressed genes after stimulation of angiotensin II (Ang II) type 2 (AT(2)) receptors in PC12w cells. Among the polymerase chain reaction products isolated, we identified Zfhep, a zinc finger homoeodomain enhancer-binding protein and the angiotensin AT(2) receptor itself, both implicated in developmental processes. In the presence of epidermal growth factor (EGF) a concordant expression pattern of Zfhep and AT(2) mRNA was observed with marked downregulation 6 hours after stimulation with EGF+Ang II. In quiescent PC12w cells, Zfhep mRNA was time-dependently induced by Ang II (10(-7) mol/L) up to 3 hours, an effect that was blocked by the selective AT(2) antagonist PD123177 (10(-6) mol/L). We extended our studies on Zfhep mRNA expression to cells of vascular origin (coronary endothelial cells [CECs]), that express AT(1) and AT(2) receptors, and that respond differently to Ang II dependent on which receptor subtype is stimulated. In CECs, Zfhep mRNA expression was induced up to 3 hours after AT(2) stimulation. Interestingly, this Zfhep induction was observed only when the AT(1) receptor was blocked by using the selective AT(1) receptor antagonist, losartan (10(-5) mol/L), suggesting a negative-regulatory influence of AT(1) receptors on AT(2)-induced Zfhep mRNA induction. In conclusion, Zfhep not only represents a suitable marker for AT(2) receptor activation, but it may also link AT(2) signaling and downstream events involved in the proposed function of the AT(2) receptor in development and regeneration.

Angiotensin Receptor Antagonists↗

PubMed2002

Providers underestimate symptom severity among urban children with asthma.

BACKGROUND: Guidelines recommend that children with mild persistent to severe persistent asthma receive maintenance anti-inflammatory medications. However, providers may not be aware of the severity of their patients' symptoms. The underestimation of severity may contribute to poor adherence to asthma care guidelines. OBJECTIVES: To describe the use of preventive medications among a group of urban children with mild persistent to severe persistent asthma and to evaluate the degree to which their health care providers are aware of their asthma severity. DESIGN: Children (ages 4-6 years) from urban schools in Rochester, NY, were eligible if their parents reported mild persistent to severe persistent asthma symptoms. Each child's health care provider was asked to assess the child's asthma severity and use of medications based both on their knowledge of the child and review of the medical record. Parent and provider assessments were compared. Bivariate and regression analyses were used to identify factors associated with concordant classifications of asthma severity. RESULTS: Ninety children with parent-defined mild persistent to severe persistent asthma participated (64% boys, 67% black, 73% receiving Medicaid). Only 40% of the children were described accurately by their providers as having mild persistent to severe persistent asthma, and only 50% of the total had been prescribed maintenance medications. Thirty-six percent of families reported that their child used maintenance medications daily. In contrast, most of the children who were classified by their provider as having mild persistent to severe persistent asthma were prescribed a maintenance medication (83%), and 58% used them daily. Sociodemographic characteristics and asthma severity were not associated with provider accuracy. CONCLUSIONS: Most children in this study were not accurately classified by their providers as having mild persistent to severe persistent asthma and had not been prescribed maintenance medications. When providers were aware of their patient's asthma symptoms, most of the children were prescribed maintenance medications. Attempts to improve adherence to asthma guidelines should take into consideration provider underestimations of asthma severity.

Anti-Asthmatic Agents↗

PubMedDate not supplied

Recurrence after coronary angioplasty.

Recurrence (restenosis) after coronary angioplasty has undermined the initial success of the procedure and has compromised, to some extent, the attractiveness of the technique in the treatment of ischemic heart disease. Assessment of recurrence predictors has been problematic due to lack of coordination of angioplasty recurrence research and includes: incomplete angiographic documentation, variations in definitions of restenosis anatomically and the results of restenosis physiologically (ie, myocardial ischemia), the dirth of morphologic specifications of subsets under investigation and late outcome pathology, limitations in statistical analyses used, and minimal efforts to classify the available data on recurrence. A review of the literature suggests that all findings regarding recurrence after angioplasty can be organized in four categories: clinical, morphologic, technical (or procedural), and pharmacologic. The reported findings with high concordance as risk factors for recurrence after angioplasty include the clinical factors of diabetes mellitus, hyperlipidemia, and angina of short duration or unstable presentation. Morphologic factors which have been corroborated vis-à-vis recurrence include stenoses with diameter reduction of greater than 90% before and greater than 30% after angioplasty, residual trans-stenotic pressure gradients of greater than 20 mmHg after angioplasty, and lesions that are diffuse, long, eccentric, or calcified. Technical factors associated with recurrence include lower balloon/vessel (or graft) ratios and the absence of (uncomplicated) "intimal dissection." The category most deficient in research regarding recurrence after angioplasty is pharmacologic. Since there are statistically documented and reproducible factors predictive of restenosis, to ignore or minimize these findings or resist further evaluation (because of the ease and safety of performing repeat angioplasty) is to deny the opportunity to understand the mechanisms and favorably affect the incidence of recurrence. This review concludes with two major implications of the restenosis research: certain clinical, technical, and pharmacologic factors, if addressed, may predictably decrease the rate of restenosis and certain clinical and morphologic factors may increase the risk of restenosis; these factors may be less readily modified (eg, diabetes, lesion calcification) and thus must be considered in the decision for angioplasty.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗

PubMed1988

Role of calcium ions in reperfusion arrhythmias: relevance to pharmacologic intervention.

Calcium ions may play a role in reperfusion arrhythmias, as suggested by 1) evidence favoring excess internal recycling of calcium during the reperfusion period; 2) electrophysiologic studies in Purkinje fibers and guinea pig papillary muscle in which calcium-dependent delayed after-depolarizations (DADs) have been found; 3) identification of the transient inward current as the basic mechanism underlying DADs; 4) the influence of cyclic adenosine monophosphate (cAMP) in the ischemic period on reperfusion electrophysiologic abnormalities; and 5) calcium oscillations in reoxygenated myocytes. More direct evidence for the role of calcium lies in the concordance between the factors influencing DADs and those associated with reperfusion arrhythmias, as well as the role of an elevated extracellular Ca2+ in causing reperfusion ventricular fibrillation. However, a role for Ca2+ does not necessarily imply that calcium antagonist drugs will be antiarrhythmic in this situation; rather there is no good evidence that these agents are antiarrhythmic unless they have a protective effect in the ischemic period. The antiarrhythmic role of alpha 1-adrenergic blocking drugs remains controversial; in isolated hearts they work in high concentrations, not through specific receptor antagonism. Beta-blocking drugs have no established place in the therapy of reperfusion arrhythmias. The role of lidocaine and other sodium channel blockers is also controversial. In isolated preparations, lidocaine can be antiarrhythmic and can inhibit DADs. Mexiletine, another sodium channel blocker, can inhibit reoxygenation and reperfusion arrhythmias as well as DADs, all in therapeutic concentrations (10 microM). Such drugs may indirectly inhibit sodium-calcium exchange, which is one of the mechanisms underlying the formation of DADs and, hence, a potential site of pharmacologic inhibition of reperfusion arrhythmias.

Animals↗

PubMed2007

Mechanisms of recognition of the outlines of "vanishing" optotypes.

The aim of the present work was to study the interaction between the optical properties of images of " disappearing" optotypes and their recognition thresholds. The "disappearing" optotypes were figures with complex outlines and had a unique property - they were close to the threshold of recognition and observation, which increases the accuracy of measurement of visual acuity and the subjects' attention to them. The recognition distances of "disappearing" optotypes were measured. A relationship was found between the recognition distance of "disappearing" optotypes and different optical density profiles on the one hand and the spatial and spatial frequency characteristics of the stimuli on the other. The decisive factor determining the threshold of recognition of optotypes in spatial frequency terms is its spatial frequency spectrum; that in spatial terms is the width of the black/white pair or black-white triad in the complex outline. Regardless of the shape of the optotype, one of the most important limiting factors was the concordance of this test with the scattering function of the subject's eye optics.

Adolescent↗

PubMed2002

A randomized controlled trial of nurse follow-up clinics: do they help patients and do they free up consultants' time?

BACKGROUND: Nurse follow-up clinics have become increasingly popular in recent years. Their impact on service delivery within dermatology may be useful in relation to chronic diseases, where education and treatment concordance are important factors in disease management. OBJECTIVE: To assess the impact of providing a nurse follow-up clinic in addition to the normal service provided by the dermatology outpatient department at Queen's Medical Centre, Nottingham, and to obtain pilot data with which to inform future study design. METHODS: Newly referred patients aged >/= 14 years and with a diagnosis of either eczema or psoriasis were identified. In a randomized, parallel-group study with a follow-up period of 6 weeks, participants were randomized either to normal care, or to receive an additional session with a dermatology nurse specialist immediately after their consultation with the dermatologist. The primary outcome measure was change in quality of life at 6 weeks, as assessed by the Dermatology Life Quality Index (DLQI). Secondary outcomes comprised a comparison of patient knowledge at 6 weeks and the number of consultations (in secondary and primary care) that occurred during the 6-week follow-up period. RESULTS: Both groups improved by approximately 3 points on the DLQI scale after 6 weeks. The between-group difference was 0.27 (95% confidence interval - 2.3 to 2.8, P = 0.83). Patients who had seen the nurse were more likely to know how long they should apply treatment (P = 0.05). There was also a marked difference in patients' understanding of how to obtain a repeat prescription (P = 0.01) and from whom they could receive further support (P < 0.001). Following the addition of this service, 33% of follow-up appointments with a doctor were cancelled in the nurse intervention group. CONCLUSIONS: Dermatology nurses can add to a dermatology consultation and provide effective patient education and support in managing a skin condition. With this added service nurses could help to free up dermatologists' time, thus allowing them to see more new patients. Cost-effectiveness studies are now needed.

Adult↗

PubMed1991

Anaphylaxis to muscle-relaxant drugs: study of cross-reactivity by skin tests.

Intradermal skin tests (two dilutions) carried out systematically with 5 muscle-relaxant drugs were used to study the cross-reactivity between these drugs in 131 patients who had suffered from anaphylaxis. The skin tests were positive for at least 2 drugs in 65.6% of the cases. We observed a significant concordance (positive-positive or negative-negative skin tests) between pancuronium and vecuronium (p less than 0.01) and a significant correlation between the skin test diameters obtained with these 2 drugs (p less than 0.02 for wheals and p less than 0.01 for flares). Conversely, the lack of concordance between pancuronium and suxamethonium was significant (p less than 0.05). When comparing all the concordances obtained with each pair of drugs, it appeared that the concordance between pancuronium and vecuronium was significantly higher than all others. For other concordances, 2 main factors seemed to play a role: the N+ of the ammonium ions included in a ring as in pancuronium and the presence of a 'choline-like' side chain as in suxamethonium. But there was no significant correlation between skin test diameters. Altogether, these results suggest that in vivo there is no 'true' cross-reactivity between the drugs except frequently between pancuronium and vecuronium. In all other cases, the patients have probably specific IgE antibodies for each drug, all these antibodies being able to recognize the ammonium determinant; this common property may be insufficient to induce a clinical allergy.

Adolescent↗

PubMed2002

A comparison of the illness beliefs of people with angina and their peers: a questionnaire study.

BACKGROUND: What people believe about their illness may affect how they cope with it. It has been suggested that such beliefs stem from those commonly held within society. This study compared the beliefs held by people with angina, regarding causation and coping in angina, with the beliefs of their friends who do not suffer from angina. METHODS: Postal survey using the York Angina Beliefs Questionnaire (version 1), which elicits stress attributions and misconceived beliefs about causation and coping. This was administered to 164 people with angina and their non-cohabiting friends matched for age and sex. 132 people with angina and 94 friends completed the questionnaire. RESULTS: Peers are more likely than people with angina to believe that angina is caused by a worn out heart (p < 0.01), angina is a small heart attack (p = 0.02), and that it causes permanent damage to the heart (p < 0.001). Peers were also more likely to believe that people with angina should take life easy (p < 0.01) and avoid exercise (p = 0.04) and excitement (p < 0.01). CONCLUSIONS: The beliefs of the peer group about causation and coping in angina run counter to professional advice. Over time this may contribute to a reduction in patient concordance with risk factor reduction, and may help to create cardiac invalids.

Adaptation, Psychological↗