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PubMed2005

Repair of avulsed ventral nerve roots by direct ventral intraspinal implantation after brachial plexus injury.

Currently, the authors' research confirms that,in humans, communication between the cord and effector muscles can be re-established after multi-ple nerve root avulsion by the implantation of peripheral nerve grafts. Outcomes are still modest,but the possibility of improvement exists. The technique of reimplantation makes it possible to envisage global repair with the possibility of repair of all avulsed regions. The most important factor that could maximize the extent of functional recovery is reducing the time between the injury and corrective surgery: the diagnosis of avulsion within 10 days and reparative surgery within 3 weeks is the objective. This goal will involve a global re-evaluation of how these patients are managed. The problem of the recovery of sensory function (tactile and fine perception and proprioception) warrants further work. It seems likely that methods combining medullary reimplantation with neurotization will be the best way of correcting these lesions of the brachial plexus. In this context, cross-disciplinary collaboration is probably more important than ever. The place that methods based on reimplantation will have in the final picture remains to be seen. The key question is in which patients should medullary reimplantation be attempted and which method should be used. Moreover, medullary reimplantation should be considered as an adjunct to all other surgical options and should not compromise the chance of the latter modalities to be effective.An important point remains: are physicians going to be able to map out all the boundaries of this question in the future?

Brachial Plexus↗
PubMed2003

Dietary guidelines: the development process in Australia and New Zealand.

There is increasing pressure on those developing public health guidelines such as the US Dietary Guidelines to take an evidence-based approach to review of the literature that is increasingly used for clinical practice guidelines. While the public health arena poses a number of problems in terms of the types of evidence available in many instances, one of the consequences of a move to an evidence-based approach will be an increased demand on time and resources. Different countries have varying approaches to the development of dietary guidelines. This paper outlines the approaches used in Australia and New Zealand. It highlights the dependence on the goodwill of academics and other health professionals with limited capacity to undertake major, structured, evidence-based review of the extensive literature relevant to dietary guideline development. It further highlights the potential value of cross-country collaboration in establishing and maintaining a centralized, accessible evidence base for development or review of dietary guidelines.

Adolescent↗
PubMed2026

Watershed-scale risk assessment of cadmium contamination in Chinese cropland soils: Dual pathways of irrigation input and flood-driven transport.

Irrigation and flood events serve as critical pathways for the transport of cadmium (Cd) from industrial sources into cropland soils at the watershed scale, constituting a major driver of widespread Cd contamination in China's cropland soil. This study evaluated the risk of Cd contamination in cropland soils across China's nine major river basins at the watershed scale, focusing on the contributions of irrigation and flood events, and conducted a sensitivity analysis of key risk factors. The assessment was conducted within a framework that considered factors including hazard, exposure, and vulnerability. The results revealed that numerous watersheds in southeastern China are exposed to dual pressures of Cd contamination risks in cropland soils, driven by both irrigation practices and flood events. Watersheds categorized as High-High, High-Moderate, or Moderate-High risk, reflecting combined Cd contamination risks from irrigation and flood, are vital to China's grain production, contributing 67.1 % of the national cropland area and 66.4 % of the grain yield. The study suggests localized strategies for managing cropland soils Cd contamination risks from irrigation and flood at the watershed scale in China, alongside strengthened cross-regional collaboration in southeastern China.

Cadmium↗
PubMed2026

An introductory practical guide to secondary data analysis in pediatric urology.

INTRODUCTION: Secondary data analysis (SDA) has become an increasingly important approach in pediatric urology, enabling the study of long-term outcomes, care variation, and disparities in populations with chronic or congenital urologic conditions. With the growing availability of large datasets, a structured approach to designing and conducting SDA studies is increasingly relevant. OBJECTIVES: To provide an introductory, practical guide to SDA in pediatric urology by (1) summarizing commonly used data sources with representative studies, (2) outlining a stepwise approach to designing and executing SDA studies, and (3) highlighting key methodological considerations, limitations, and opportunities for future work. STUDY DESIGN: Narrative review of existing literature and commonly used datasets relevant to pediatric urology, including administrative claims, hospital encounter databases, clinical registries, electronic health record networks, and population-based surveys. RESULTS: Data sources differ in scope, clinical granularity, longitudinal follow-up, and representativeness, and each is suited to specific research questions. We present a practical workflow for SDA, including dataset selection, cohort definition, and analytic planning. Linkage across datasets can provide a more comprehensive view of care patterns and outcomes, although feasibility is influenced by legal, technical, and data-quality constraints. DISCUSSION: SDA enables population-level analyses and the study of rare conditions that are challenging to evaluate through single-center or prospective designs. However, careful cohort definition, feasibility assessment, and awareness of data limitations are essential to ensure validity and interpretability. CONCLUSION: SDA provides a scalable, cost-efficient framework for generating meaningful evidence in pediatric urology. Continued efforts to harmonize data elements, improve linkage infrastructure, and support cross-institution collaboration will enhance the quality and impact of future research. This article provides a practical framework and examples to support the design and execution of SDA studies.

Humans↗
PubMed2005

What we know and what they do: nursing students' experiences of improvement knowledge in clinical practice.

Nations around the world face mounting problems in health care, including rising costs, challenges to accessing services, and wide variations in safety and quality. Several reports and surveys have clearly demonstrated that adverse events and errors pose serious threats to patient safety. It has become obvious that future health professionals will need to address such problems in the quality of patient care. This article discuss a research study examining improvement knowledge in clinical practice as experienced by nursing students with respect to a patient-centred perspective, knowledge of health-care processes, the handling of adverse events, cross-professional collaboration, and the development of new knowledge. Six focus groups were conducted, comprising a total of 27 second-year students. The resulting discourses were recorded, coded and analysed. The findings indicate a deficiency in improvement knowledge in clinical practice, and a gap between what students learn about patient care and what they observe. In addition the findings suggest that there is a need to change the culture in health care and health professional education, and to develop learning models that encourage reflection, openness, and scrutiny of underlying individual and organizational values and assumptions in health care.

Education, Nursing↗
PubMed2002

Biological and remote sensing perspectives of pigmentation in coral reef organisms.

Coral reef communities face unprecedented pressures on local, regional and global scales as a consequence of climate change and anthropogenic disturbance. Optical remote sensing, from satellites or aircraft, is possibly the only means of measuring the effects of such stresses at appropriately large spatial scales (many thousands of square kilometres). To map key variables such as coral community structure, percentages of living coral or percentages of dead coral, a remote sensing instrument must be able to distinguish the reflectance spectra (i.e. "spectral signature", reflected light as a function of wavelength) of each category. For biotic classes, reflectance is a complex function of pigmentation, structure and morphology. Studies of coral "colour" fall into two disparate but potentially complementary types. Firstly, biological studies tend to investigate the structure and significance of pigmentation in reef organisms. These studies often lack details that would be useful from a remote sensing perspective such as intraspecific variation in pigment concentration or the contribution of fluorescence to reflectance. Secondly, remote sensing studies take empirical measurements of spectra and seek wavelengths that discriminate benthic categories. Benthic categories used in remote sensing sometimes consist of species groupings that are biologically or spectrally inappropriate (e.g. merging of algal phyla with distinct pigments). Here, we attempt to bridge the gap between biological and remote sensing perspectives of pigmentation in reef taxa. The aim is to assess the extent to which spectral discrimination can be given a biological foundation, to reduce the ad hoc nature of discriminatory criteria, and to understand the fundamental (biological) limitations in the spectral separability of biotic classes. Sources of pigmentation in reef biota are reviewed together with remote sensing studies where spectral discrimination has been effectively demonstrated between benthic categories. The basis of reflectance is considered as the sum of pigmented components, such as zooxanthellae, host tissues and skeletons of corals. Problems in the empirical in situ measurement of reflectance are identified, such as the differing types of reflectance which can be measured, the interaction of the light field with morphology, and depth-dependent variability of measured reflectance due to fluorescence. The latter is estimated in some cases to introduce an error of up to 20% when depth differs by 8 m. Spectral features useful in discriminating reef benthos are identified and related to pigmentation. The slope in the reflectance spectra between 650 and 690 nm is dependent on chlorophyll-a concentration and can be used to discriminate bare sand with no algal component from chlorophyll-a containing benthos (algae, corals). The slope in reflectance at various locations between 500 and 560 nm can be useful in discriminating bleached and unbleached corals, possibly due to reduced peridinin concentration. Rhodophyta may be discernible by the presence of a dip in reflectance at 570 nm, due to a phycoerythrin absorption peak. However, the utility of some discriminatory criteria in deeper waters is mitigated by the relatively poor transmission of light through water at longer wavelengths (especially > 600 nm). Contrary to suggested categorizations of fluorescent pigments in coral host tissues, it is shown that these pigments form an almost continuous distribution with respect to their excitation and emission peaks. Remote sensing by induced fluorescence is a promising approach, but further details about the variation and distribution of these pigments are required. It is hoped that this review will promote cross-disciplinary collaboration between pigment biologists and the reef remote sensing community. Where possible, the discriminative criteria adopted in remote sensing should be related to biological phenomena, thus lending an intuitive, process-orientated basis for interpreting spectral data. Similarly, remote sensing may provide a novel scaling perspective to biological studies of pigmentation in reef organisms.

Animals↗
PubMed1999

Association between cigarette and alcohol consumption and Raynaud's phenomenon.

The association between alcohol and cigarette consumption and Raynaud's Phenomenon (RP) was examined by using data from an American-French collaborative, cross-sectional, epidemiological study in five geographically varied regions (Charleston, South Carolina, USA; and Grenoble, Tarentaise, Nyons, and Toulon, France). Using logistic regression models that take into account the sampling weights, the association was examined stratified by gender and adjusted for age, body mass index, self-perceived health, and education. Overall, neither cigarette nor alcohol consumption showed a significant association with RP. In men, however, a V-shaped relationship between drinking and RP was observed, with mild consumption (1 to 7 drinks per week) exhibiting a protective effect over abstinence, whereas occasional (less than 1 drink per week), moderate (8 to 18 drinks per week) and heavy consumption (more than 18 drinks per week) did not. Among the participants with RP, no significant association was observed between RP attack frequencies and the amount of either alcohol or cigarette consumption. These negative findings suggest that having RP is not strongly affected by alcohol or cigarette consumption.

Alcohol Drinking↗
PubMed2000

Prevention research in eating disorders: theory and new directions.

BACKGROUND: Over the past two decades, scores of articles and several books have been published calling for more attention to the prevention of eating disorders, but less than two dozen prevention intervention studies have been conducted to date. METHODS: This paper reports the results of a systematic review of 20 empirical intervention studies on eating disorders prevention, discussing the data accumulated on what has and has not been effective. Beyond a description of study design and findings, this paper devotes special attention to the theoretical orientations of the studies and their implied assumptions about preventive strategies. RESULTS: Though there has been a compelling interest in social, political and economic factors influencing the incidence of disordered eating, little of this interest has been carried over into the prevention end of eating disorders research. Most studies reported thus far have been designed to target and measure change principally on the individual level, to the exclusion of considering leverage points for intervention in the larger social environment. CONCLUSIONS: This paper concludes with a recommendation for new attention to a model of proactive primary prevention targeted at environmental change and cross-disciplinary collaboration to achieve a reduction in the incidence of eating disorders.

Confounding Factors, Epidemiologic↗
PubMed2006

Lessons in ethnonephrology.

Only recently has the nephrology community moved beyond a fairly singular focus on terminal kidney failure to embrace population-based studies of earlier stages of disease, its markers and risk factors, and of interventions. Observations in developing countries, and in minority, migrant, and disadvantaged groups in westernized countries, have promoted these developments. We are only beginning to interpret renal disease in the context of public health history, social and health transitions, changing population demography, and competing mortality. Its intimate relationships to other health issues are being progressively exposed. Perspectives on the multideterminant etiology of most disease and the pedestrian nature of most risk factors are maturing. We are challenged to reconcile epidemiologic patterns with morphology in diseased renal tissue, and to consider structural markers, such as nephron number and glomerular size, as determinants of disease susceptibility. New work force models are mandated for population-based studies and intervention programs. Intervention programs need to be integrated with other chronic disease initiatives and nested in a matrix of systematic primary care, and although flexible to changing needs, must be sustained over the long term. Cross-disciplinary collaboration is essential in designing those programs, and in promoting them to health-care funders. Substantial expansion and restructuring of the discipline is needed for the nephrology community to participate effectively in those processes.

Developing Countries↗
PubMed1999

The placement of a social service care manager in a GP surgery as a way to improve carer access to services and improve liaison between statutory agencies.

This paper reports on a pilot project funded jointly by South and West Devon Health Authority and Devon Social Service department which sought to overcome some of the problems encountered with liaison between services, and to improve carer experience and access to social services. This involved the placement in a Plymouth general practitioner (GP) surgery of a social service care manager who worked from the surgery and was allocated extra hours for carer support work. The project was evaluated and compared with the current experience of carers in the more 'traditional' setting. The experience and attitude of GPs in two other surgeries were also explored. The traditional model of work seen in Surgery B and C, the comparison surgeries, was a crisis intervention model which was regarded as adequate by the GPs involved, who had no experience of any other way of working. They directed the carers to telephone or write to social services themselves, or in a few cases the GP contacted social services on their behalf. However, the data showed that carers were less satisfied with this traditional model and preferred the more 'instant' access to support, made possible through the pilot worker in Surgery A. In the pilot project a short and informal visit to the pilot worker on request was seen as a relief by the carers. They had avoided the gate-keeping and bureaucracy involved in the 'normal' process. The drawing together of the various strands of the research showed conclusively that the pilot project in Surgery A was successful in meeting the majority of objectives set out for it. It has been a success in the perception of the carers and all of the professionals and staff involved. Staff involved all agreed that cross service collaboration between social services and the GP surgery had been improved, and that this had improved the service available to patients and carers.

Journal Article↗
PubMed1993

Human T-lymphotropic virus (HTLV) types I and II infection in sexual contacts and family members of blood donors who are seropositive for HTLV type I or II. American Red Cross HTLV-I/II Collaborative Study Group.

Interviews and laboratory testing were conducted for 168 contacts referred by former blood donors identified as seropositive for antibody to human T-lymphotropic virus type I (HTLV-I) or type II (HTLV-II). Thirty-two (28%) of 114 heterosexual contacts of seropositive donors, including 12 women and 20 men, were found to be antibody positive. None of 40 offspring (except one adult man who reported sexual contact in Puerto Rico) or 14 other (nonspousal) family members were seropositive. Thirty-one of the seropositive contacts were typeable as having either HTLV-I (52%) or HTLV-II (48%). Assessment of couples found that the median duration of the sexual relationship was significantly longer (p = 0.03) for those in which both partners were infected than in discordant pairs. Analysis of risk history data for 22 infected couples revealed that, in three cases, risk factors (Japanese ancestry or sexual contact with an injecting drug user) could be identified in the women, but not in their male partners. Among couples in which the male had the greater risk history, the risk factor was either a history of transfusion, birth or sexual exposure in an endemic area, or injected drug use. Counseling strategies for individuals with HTLV-I or HTLV-II infection should take into account the relatively high seroprevalence in their partners and should address the potential for sexual transmission in both directions.

Adolescent↗
PubMed1999

Explanations of ethnic and gender differences in youth smoking: a multi-site, qualitative investigation. The Tobacco Control Network Writing Group.

Two of the most powerful predictors of adolescent smoking are ethnicity and gender, but little research has focused on understanding how these factors play a role in adolescent smoking. This paper reports results from a qualitative, multi-site investigation of explanations for ethnic and gender differences in cigarette smoking with five ethnic groups: whites, African-Americans, Hispanics, Native Americans, and Asian-American/Pacific Islanders. Across 11 states, we conducted 178 focus groups with a total of 1175 adolescents. The groups explored such major research themes as reasons for smoking and not smoking; images of smoking and smokers; messages youth receive about smoking and not smoking; and the social context of smoking. We synthesized data from the focus groups through multiple cross-site collaborations and discussions, with an emphasis on identifying consistent themes across a majority of groups and sites. Striking differences emerged across ethnic and gender sub-groups in reasons for not smoking. African-American females in particular viewed not smoking as a positive identity marker. Asian-American/Pacific Islander females similarly reported strong mandates not to smoke. Youth's perceptions of family messages about smoking also varied by ethnicity and gender, with African-American, Hispanic, and Asian-American/Pacific Islander youth consistently reporting strong, clear anti-smoking messages from family. These findings, notable in their consistency across geographic regions, may shed light on the discrepant prevalence of smoking across ethnic and gender groups.

Adolescent↗
PubMed1997

Urinary biochemical markers of dietary intake in the INTERSALT study.

The INTERSALT Study, an international, collaborative, cross-sectional investigation of the relation between blood pressure and dietary and other factors, used quality-controlled, standardized procedures and assessment of multiple possible confounding factors to study 10,079 men and women in 52 population-based samples in 32 countries. In this study 24-h urinary excretion data were used as biochemical markers of intakes of sodium, potassium, and protein, with repeat examinations done in a randomly selected 8% of participants to asses reliability and correct for regression-dilution bias. INTERSALT showed that high salt intake, low potassium intake, excess alcohol consumption, and energy imbalance resulting in overweight are critically involved in the origins of the high blood pressure prevalent among a majority of adult populations. The findings also show that obtaining accurate estimates of associations between dietary intake and blood pressure requires large population-based samples, high-quality dietary information, control for multiple confounding variables, and modern multivariate methods of data analyses, including correction of observed associations for within-person variation in intake.

Adult↗
PubMed2005

The relative influence of individual and contextual socio-economic status on consumption of fruit and soft drinks among adolescents in Europe.

BACKGROUND: The number of studies among children and adolescents that focus on socio-economic differences in food habits is limited. Moreover, most are done in only one country and often include a non-representative sample. The present study examines whether socio-economic differences in the consumption of fruit and soft drinks can be found among young adolescents in a wide range of European countries. METHODS: Multilevel statistical analysis of 114 558 school-pupils aged 11, 13 and 15 from 28 countries participating in the WHO collaborative cross-national study of Health Behaviours among School-aged Children 2001-2002. The individual outcomes were daily fruit and soft drink consumption and the socio-economic predictors at the individual level were occupation of the head of household and family material wealth. Family material wealth was aggregated at the country level to operationalize country-level socio-economic status. RESULTS: In general, girls and younger pupils consumed fruit more often and soft drinks less often. Significant between-school, between-country and between-region differences were found. Fruit consumption increased with family material wealth and higher parental occupational status. Soft drink consumption was lower among pupils of higher parental occupational status in Northern, Southern and Western European countries, but not in Central and Eastern European countries. Only in Central and Eastern European countries was a significant increase in soft drink consumption with increasing family affluence found. The country level of family affluence did not seem to have an effect on either outcome variable. CONCLUSION: The findings underscore the importance of socio-economic factors in relation to the food habits of young adolescents.

Adolescent↗
PubMed2026

CYClones: a highly powered, fully genotyped, eight-parent yeast mapping population.

The budding yeast Saccharomyces cerevisiae is a remarkably adaptable organism that thrives in diverse environments. Global sequencing of natural isolates has revealed extensive genetic diversity within the species. Here, we describe the construction and characterization of CYClones (Collaborative Yeast Cross clones), a library of 11,392 segregants generated from a multiparent funnel cross of eight genetically diverse parental strains. To enable the genetic dissection of complex traits, we imputed whole-genome sequences for all segregants and show that CYClones captures a substantial fraction of the global genetic diversity of S. cerevisiae. Haplotype representation is well maintained, with each parental haplotype present at >5% frequency across >95% of the genome. Simulations demonstrate that CYClones has ≥95% power to detect variants with heritability as low as 0.36%, with mapping resolution often finer than the length of a single gene. In summary, CYClones is a powerful community resource for dissecting the genetic architecture of complex and quantitative traits, uncovering context-dependent mutational effects, and identifying causal variants underlying phenotypic diversity.

Saccharomyces cerevisiae↗
PubMed2001

Side effects, quality-of-life issues, and trade-offs: the patient perspective.

Increasingly effective adjuvant treatments of invasive breast cancer and their widespread use have improved survival rates. Given the timing required by its use, adjuvant therapy requires the patient to absorb complex medical data and make challenging trade-offs shortly after initial diagnosis. However, many women are unprepared or unable to optimize adjuvant treatment decisions while experiencing the shock and dismay that often follow the confirmation of an invasive breast cancer diagnosis. Each woman needs to know the facts and circumstances of her own case and to fully understand the benefits and risks of adjuvant therapy. Only then can she, with her medical team, choose those therapies that will maximize her benefit as a patient and as a survivor in all aspects of her life, over both the short and longer term. To help the patient accomplish these goals, individualized practical knowledge that complements population-based advances in survival is critically needed. Considerable focus, study, and cross-disciplinary collaboration will be required to compile successful, integrated approaches to adjuvant therapy that reflect varying patient contexts and concerns. Other crucial ingredients are the investment of resources in recently established research fields (such as the tracking of psychosocial outcomes and delayed morbidity) and informed guidance from patient advocates. To accelerate patient-centered progress in adjuvant therapy for breast cancer, areas that need attention include targeted public education programs; patient information and informatics; treatment selection and decision-making tools; and interventions and therapies to improve quality of life for patients, survivors, and their families. Underlying all of these efforts should be culturally competent, multigenerational approaches to communicating effectively with diverse patients and family members in multiple clinical and community settings.

Antineoplastic Agents↗
PubMedDate not supplied

Turning point sets the stage for emergency preparedness planning.

Nearly a billion dollars were made available to state health departments through federal grants in the spring of 2002 for public health emergency preparedness plans. Twenty-one states had already been participating for some years in The Robert Wood Johnson Foundation's Turning Point Initiative. This article illustrates how earlier practice and experience in developing cross-sector collaborations and institutionalizing a model of broad-based partnerships for public health decision making can increase effectiveness and efficiency in responding to a call for action around an emergency.

Bioterrorism↗
PubMed1994

Three years follow-up of panic disorder patients: a naturalistic study.

Forty Danish panic disorder patients participating in a placebo controlled study of alprazolam and imipramine (The Cross National Collaborative Panic Study, Phase II) were followed up by a telephone interview three years later, with essentially the same battery of evaluation procedures applied at baseline, end of study, and follow-up. The main finding was that panic disorder is a chronic disorder, but fluctuating in form and severity in the course of time. Twenty-five percent of the patients no longer fulfilled the DSM-III criteria for panic disorder, but had substantial disability due to a variety of symptoms, including panic attacks at infrequent rate, generalized anxiety symptoms, affective symptoms, and phobic avoidance behavior. Nearly three fourths of the patients were under treatment at follow-up. Benzodiazepines were the drugs most often prescribed, usually in combination with supportive psychotherapy. It was concluded that the different types of treatment offered were insufficient. Variables predicting panic disorder or substantial disability at 3-years follow-up were few.

Adult↗