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PubMed2003

Survey of the opinions, knowledge and practices of surgeons and internists regarding Helicobacter pylori test-and-treat policy.

BACKGROUND: Helicobacter pylori infection is highly prevalent and may cause disease in 10% to 15% of infected individuals: duodenal and gastric ulcer, gastric cancer and gastric lymphoma. Guidelines for a test-and-treat policy have been published by the European H. pylori working group in Maastricht. GOALS: To assess the current approach to H. pylori-related diseases, indications for testing and eradication therapy, among internists and surgeons of a University affiliated medical center. STUDY: A 15-items questionnaire was formulated according to the Maastricht II test-and-treat recommendation and distributed among the physicians of 6 internal medicine departments and the department of surgery. The questionnaires were completed anonymously at the department's staff meeting, under the supervision of the head of the department. All questions required a yes/no answer; the maximum possible score was 15. The relative ratio (RR) of correct answers was calculated for every question and by subgroups as follows: all participants, internists, surgeons, experts and residents in internal medicine and surgery. RESULTS: The response rate was 68% (55 out of 80 physicians). Total score for all participants was 10.9 (RR = 0.73), significantly lower than the maximum score of 15 (RR = 1.00). The internists had significantly higher average score than the surgeons for 2 questions: causative agent in gastric cancer (p = 0.003) or gastric lymphoma (p = 0.003), 1 question about triple therapy, PPI, penicillin and azythromycin being not recommended (p = 0.022), and for 1 question of test-and-treat policy: should this strategy apply to family members of gastric cancer patients (p = 0.045). Only 56% of the internists and 21% of surgeons knew what MALToma is, and the correlation with H. pylori infection. CONCLUSION: Knowledge of Surgeons and Internists regarding infection and correlation with diseases or test and treat policy should be improved.

Academic Medical Centers↗
PubMed1999

A novel type of hereditary motor and sensory neuropathy characterized by a mild phenotype.

BACKGROUND: Three loci for autosomal dominant hereditary motor and sensory neuropathy type I (HMSN I) or Charcot-Marie-Tooth disease type 1 (CMT1) have been identified on chromosomes 17p11.2 (CMT1A), 1q21-q23 (CMT1B), and 10q21.1-q22.1 (designated here as CMT1D). The genes involved are peripheral myelin protein 22 (PMP22), myelin protein zero (MPZ), and the early growth response element 2 (EGR2), respectively. Probably a fourth locus (CMT1C) exists since some autosomal dominant HMSN I families have been excluded for linkage with the CMT1A and CMT1B loci. Four loci for autosomal dominant hereditary motor and sensory neuropathy type II (HMSN II) or Charcot-Marie-Tooth disease type 2 (CMT2) have been localized on chromosomes 1p35-p36 (CMT2A), 3q13-q22 (CMT2B), 7p14 (CMT2D), and 3p (HMSN-P). OBJECTIVE: To describe the clinical, electrophysiologic, and neuropathological features of a novel type of Charcot-Marie-Tooth disease. PATIENTS AND METHODS: We performed linkage studies with anonymous DNA markers flanking the known CMT1 and CMT2 loci. Patients and their relatives underwent clinical neurologic examination and electrophysiologic testing. In the proband, a sural nerve biopsy specimen was examined. RESULTS: Linkage studies excluded all known CMT1 and CMT2 loci. The clinical phenotype is mild and almost all affected individuals remain asymptomatic. Electrophysiologic and histopathological studies showed signs of a demyelinating neuropathy, but the phenotype is unusual for either autosomal dominant HMSN I or HMSN II. CONCLUSION: Our findings indicate that the HMSN in this family represents a novel clinical and genetic entity.

Biopsy↗
PubMed1996

[The determination of patient satisfaction as a part of quality management in the hospital].

BASIC PROBLEM AND OBJECTIVE OF STUDY: Patient-satisfaction is an important part of the quality of results of medical treatment in hospital. Such satisfaction can be measured with a standardised multi-dimensional questionnaire which takes into account all relevant parts of a hospital. An enquiry was undertaken on patients in a university department of urology to find out whether a scientifically based measurement of patient-satisfaction is possible and whether organisational improvement can result from it. PATIENTS AND METHODS: Dimensions of patients-satisfaction included "care by doctors", "care by nursing staff", "food and accommodation", and "administration and daily activity". A questionnaire with a scale for answers (total of 65 items with closed answers) was developed for each of the dimensions. A one-month pretest served to ascertain acceptance and understanding of the questionnaire. In the three-month main test period questionnaires were given to all in-patients over 16 years old on admission. Participation was voluntary and anonymous. RESULTS: 232 patients took part (172 men, 60 women; median age 57 years), a response rate of 61%. The scales were shown to have a high internal consistency. The answers provided, for example, the means for simple and directly applicable improvement in patient information and the organisation of daily routine. Making the results known had a positive effect on the motivation of the staff. CONCLUSION: The work and cost involved in such a study are reasonable. This is the more so since in future investigation on patient-satisfaction will be undertaken every year or two as part of the demanded quality management in hospitals. However, scientific principles in the methodology must be taken into account when evaluating the results.

Adult↗
PubMed1985

Symptomatology in alcoholics at various stages of abstinence.

Evaluation of 312 abstinent alcoholics (163 men and 149 women) with the Symptom Check-List 90 revealed high levels of symptomatology for subjects in the early months of abstinence. Symptomatology decreased progressively with prolonged abstinence, approximating normal levels for subjects abstinent 10 years or more. The levels were similar for men and women. At all stages, for both men and women, symptomatology was highest on the depression, interpersonal sensitivity, and obsessive-compulsive symptom dimensions, with guilt a particularly persistent symptom. It is suggested that the findings depict a long-term process of recovery from active alcoholism and are consistent with the concept of a protracted withdrawal syndrome, an intermediate (partially reversible) brain syndrome, and general psychosocial dysfunction and demoralization consequent to active alcoholism.

Adult↗
PubMed2004

Seroprevalence of hepatitis C and associated risk factors among an urban population in Haiti.

BACKGROUND: The seroprevalence of hepatitis C varies substantially between countries and geographic regions. A better understanding of the seroprevalence of this disease, and the risk factors associated with seropositive status, supply data for the development of screening programs and provide insight into the transmission of the disease. The purpose of this investigation was to determine the seroprevalence of hepatitis C and associated risk factors in an urban population in Haiti. METHODS: A prospective survey for hepatitis C antibodies was conducted among an urban outpatient population in Cap-Haitien, Haiti, with a sample size of 500 subjects. An anonymous 12 question survey, with inquiries related to demographic characteristics and risk factors for HCV acquisition, was concomitantly administered with testing. These demographic and behavioral risk factors were correlated with HCV antibody status using univariate and multivariate tests. RESULTS: The prevalence of positive HCV antibody was 22/500 (4.4%). Subjects that were anti-HCV positive had an average of 7 +/- 8.6 lifetime sexual partners, compared to average of 2.5 +/- 3.5 lifetime sexual partners among HCV-negative subjects (p = 0.02). In a multiple logistic regression model, intravenous drug use (OR 3.7, 1.52-9.03 95% CI) and number of sexual partners (OR 1.1, 1.04-1.20 95% CI) were independently associated with a positive HCV antibody result. CONCLUSIONS: A substantial number of subjects with HCV antibodies were detected in this population in Haiti. Further investigation into the correlation between the number of sexual partners and testing positive for hepatitis C antibodies is indicated.

Adult↗
PubMed2000

The role of disabled physicians in the diversion of controlled drugs.

To test the assertion that disabled physicians are loose prescribers and clinically meaningful contributors to the diversion of controlled prescriptions, an anonymous survey of physicians in a confidential treatment program in Ohio was conducted to compare pre- and post-recovery: (1) self-reported number of controlled drug prescriptions written, and (2) self-rated appropriateness of prescribing practices. Forty (50%) of the surveyed physicians responded. Opioids alone showed a post recovery reduction in the number of prescriptions (-4.5; 95% CI: -9.5 to -0.5). The volume of prescribing in all controlled drug categories was small from both a law enforcement and clinical perspective. Respondent's self-assessment of prescribing practices indicated conservative pre-, and more conservative post-recovery prescribing, increasing from 2.0 in stimulants (CI: 1.0-4.0), to 3.5 in sedatives (CI: 1.0-6.0). Despite limitations, this initial data provides evidence to refute the assertion that disabled physicians are loose prescribers and meaningful contributors to the diversion of controlled prescriptions.

Adult↗
PubMed1990

Human Xq24-Xq28: approaches to mapping with yeast artificial chromosomes.

One hundred twenty-seven yeast strains with artificial chromosomes containing Xq24-Xqter human DNA were obtained starting from a human/hamster somatic cell hybrid. The clones were characterized with respect to their insert size, stability, and representation of a set of Xq24-Xqter DNA probes. The inserts of the clones add up to 19.3 megabase (Mb) content, or about 0.4 genomic equivalents of that portion of the X chromosome, with a range of 40-650 kb in individual YACs. Eleven clones contained more than one YAC, the additional ones usually having hamster DNA inserts; the individual YACs could be separated by extracting the total DNA from such strains and using it to retransform yeast cells. One of the YACs, containing the probe for the DXS49 locus, was grossly unstable, throwing off smaller versions of an initial 300-kb YAC during subculture; the other YACs appeared to breed true on subculture. Of 52 probes tested, 12 found cognate YACs; the YACs included one with the glucose-6-phosphate dehydrogense gene and another containing four anonymous probe sequences (DX13, St14, cpx67, and cpx6). Xq location of YACs is being verified by in situ hybridization to metaphase chromosomes, and fingerprinting and hybridization methods are being used to detect YACs that overlap.

Animals↗
PubMed1997

[The attitudes to and needs for education on HIV infection among primary care health professionals].

OBJECTIVE: To evaluate the attitudes, knowledge and training needs for primary care health professionals (PCP) dealing with HIV/AIDS infection. DESIGN: An observational, crossover study. SETTING: primary care: health districts in the Ciutat Vella health area of the city of Barcelona. PARTICIPANTS: 34 nursing professionals and 32 general practitioners. INTERVENTIONS: A validated questionnaire, which was self-administered, anonymous and filled in under supervision during October 1994. MEASUREMENTS AND MAIN RESULTS: Everyone answered a 20-question multiple choice test of knowledge and a 5-point Likert-type attitudes scale with 10 items. The PCP overall displayed: insufficient scores on the test of knowledge, on positive attitudes, on the difficulty of asking about risk practices if the reason for consultation is unrelated, on safety in handling, and need for training. CONCLUSIONS: Half the PCP displayed a level of theoretical preparation in need of improvement. Their positive attitudes and the clear need for more training on the question make it very likely that our PCPs would take advantage of training programmes. The situation in areas with less prevalence of the infection might well be different.

Adult↗
PubMed1992

Familial screening for genetic haemochromatosis by means of DNA markers.

Genetic haemochromatosis (HFE) is a frequent and potentially fatal disease. Early phlebotomies may prevent complications. The recessive gene for HFE is unknown but closely linked to the HLA-A locus. No direct test for homozygosity for HFE is currently available, apart from HLA typing within the family of a patient with confirmed HFE. During a reverse genetic approach to identify the gene, we found three anonymous genomic probes (P3, P5, and I.82) derived from previously cloned YACs and physically mapped in the HLA class I region. P3 and P5 probes recognise 3 loci (P3A, P3B, P5) and I.82 one locus about 100 kb from HLA-A. Using five biallelic polymorphisms (I.82/BglII, P3B/EcoRV, P3B/PstI, P5/HindIII, P3A/PstI), we tested 198 HLA typed subjects from the families of 22 haemochromatosis patients. The information from the five polymorphisms was sufficient to identify unequivocally extended restriction haplotypes in all families. The restriction haplotypes cosegregate with the HFE allele and enable identification of genotypically identical sibs in all families studied. The linked DNA markers described in this article avoid the disadvantages of HLA serological typing and can be used in genetic counselling of HFE families.

DNA↗
PubMed2001

Prevalence of hepatitis C virus infection among clients of HIV counseling and testing sites--Connecticut, 1999.

Hepatitis C virus (HCV) is a common chronic bloodborne virus infection that affects an estimated 2.7 million persons in the United States. HCV infection causes an estimated 8,000-10,000 deaths each year from cirrhosis and hepatocellular carcinoma and is the leading reason for liver transplantation. Because injection drug use is a major risk factor for both human immunodeficiency virus (HIV) and HCV transmission, publicly funded HIV counseling and testing sites (HIV CTS) may have a role in HCV prevention. To evaluate the need for HCV services at these sites, the Connecticut Department of Public Health (CDPH) conducted an anonymous HCV seroprevalence study among clients of HIV CTS. This report summarizes the results of this analysis, which indicate that, among clients of these HIV CTS, the prevalence of antibody to HCV (anti-HCV) was 9.8%, compared with 1.3% for HIV, with significantly higher prevalence among clients of substance abuse treatment sites (40.2%), compared with other sites (6.9%). HCV counseling and testing should be integrated into all HIV CTS, especially those associated with substance abuse treatment.

Adult↗
PubMed1998

Network support for drinking, Alcoholics Anonymous and long-term matching effects.

AIMS: (1) To examine the matching hypothesis that Twelve Step Facilitation Therapy (TSF) is more effective than Motivational Enhancement Therapy (MET) for alcohol-dependent clients with networks highly supportive of drinking 3 years following treatment; (2) to test a causal chain providing the rationale for this effect. DESIGN: Outpatients were re-interviewed 3 years following treatment. ANCOVAs tested the matching hypothesis. SETTING: Outpatients from five clinical research units distributed across the United States. PARTICIPANTS: Eight hundred and six alcohol-dependent clients. INTERVENTION: Clients were randomly assigned to one of three 12-week, manually-guided, individual treatments: TSF, MET or Cognitive Behavioral Coping Skills Therapy (CBT). MEASUREMENTS: Network support for drinking prior to treatment, Alcoholics Anonymous (AA) involvement during and following treatment, percentage of days abstinent and drinks per drinking day during months 37-39. FINDINGS: (1) The a priori matching hypothesis that TSF is more effective than MET for clients with networks supportive of drinking was supported at the 3 year follow-up; (2) AA involvement was a partial mediator of this effect; clients with networks supportive of drinking assigned to TSF were more likely to be involved in AA; AA involvement was associated with better 3-year drinking outcomes for such clients. CONCLUSIONS: (1) In the long-term TSF may be the treatment of choice for alcohol-dependent clients with networks supportive of drinking; (2) involvement in AA should be given special consideration for clients with networks supportive of drinking, irrespective of the therapy they will receive.

Adult↗
PubMed2001

Maternity care providers' attitudes and practices concerning HIV testing during pregnancy; results of a survey of the Canterbury and upper South Island region.

AIMS: To assess current attitudes and practice toward antenatal human immunodeficiency virus (HIV) risk assessment, HIV testing and barriers towards implementation of these among midwives, general practitioners (GPs) and obstetricians in the upper South Island METHODS: A survey was conducted among maternity care providers by anonymous self-administered questionnaire. Most questions were dichotomous, forced choice or Likert scale format but there were four open- ended questions asking for a written response. RESULTS: The response rate was 57% overall. The main finding was that 275 (66%) of respondents assessed risk of HIV in less than 10% of patients, and 328 (midwives 93, 85%; GP's 226,77%; obstetricians 9,64%) respondents had performed less than three HIV tests in the past twelve months. Most respondents strongly agreed that detection of HIV during pregnancy is beneficial to mother 318 (83%) and to baby 367 (96%) and to mother prior to pregnancy 353 (92%). 202 (52%) supported and 44 (11%) were opposed to an antenatal screening programme in New Zealand. Most knew how to assess risk for HIV saw themselves as having an important role in antenatal HIV testing, and were comfortable performing risk assessment. Multiple reasons for current practices were offered, including perceived reluctance by women to be tested, lack of time, skills, knowledge and support services, and low rates of HIV in the community. CONCLUSIONS: The current policy of routine HIV risk assessment is not working among respondents. A systematic reassessment and implementation of a workable strategy needs to be undertaken in New Zealand.

AIDS Serodiagnosis↗
PubMed2000

[Need of better knowledge of genetic tests among Norwegian physicians].

BACKGROUND: New predictive genetic tests are introduced in clinical work, and this means new tasks for the physician. MATERIAL AND METHODS: Every sixth member of the Norwegian Medical Association practising as a general practitioner, neurologist or psychiatrist (N = 732), were asked to answer a mailed, anonymous questionnaire about their attitudes to the new tasks. RESULTS: We obtained 451 (62%) answers. There were no significant differences between the various groups in the profession. So far, 54% had no patient in their practice who had taken a predictive genetic test. About two-thirds answered that the geneticist should inform about what is known about the consequences after a test result has been given. The general practitioner wants to do the follow-up. 97% of physicians think that the test result could lead to increased distress in various ways for the tested person or his/her family. Half of the physicians would advise taking a prenatal test if one of the parents had a known risk of an inherited disease and the foetus was at risk. Only 22% are in favour of abortion if the foetus has the gene in question. INTERPRETATION: The physicians (93%) do not think they have sufficient knowledge about predictive genetic tests to handle the information procedure on their own. They want courses in medical genetics, concise and relevant information from geneticists, and the possibility of consulting with specialists.

Clinical Competence↗
PubMed2002

Atheists, agnostics and Alcoholics Anonymous.

OBJECTIVE: In spite of the strong emphasis in AA on spiritual beliefs and practices, findings are mixed about the importance of such beliefs in predicting AA affiliation. This study of the Project MATCH outpatient (N = 952) and aftercare (N = 774) samples tested three hypotheses about the role of client God belief and subsequent AA attendance and benefit, taking into account that some individuals may, in fact, deny the existence of a God. METHOD: Longitudinal analyses were conducted (N = 1,526) investigating client God beliefs, AA attendance, patterns of AA attendance and alcohol use. Assessments were conducted at intake and in 3-month intervals using the Form 90, Religious Behaviors and Background, and the Alcoholics Anonymous Inventory. RESULTS: 12-Step treatment was significantly more likely to promote pre-post shifts in client God beliefs, and atheist and agnostic clients attended AA significantly less often throughout follow-up relative to clients self-labeled as spiritual and religious. AA attendance, however, was significantly associated with increased abstinence and reductions in drinking intensity regardless of God belief. Finally, no differences in percent days abstinence and drinking intensity were found between atheist and agnostic versus spiritual and religious clients, but clients unsure about their God belief reported significantly higher drinking frequency relative to the other groups. CONCLUSIONS: God belief appears to be relatively unimportant in deriving AA-related benefit, but atheist and agnostic clients are less likely to initiate and sustain AA attendance relative to spiritual and religious clients. This apparent reticence to affiliate with AA ought to be clinically recognized when encouraging AA participation.

Adult↗
PubMed2000

Why do we still find anonymous ESTs?

During recent years, there has been an exponential rise in the number of sequences accessible in the public databases. Despite this, a high percentage of partial sequences of cDNA (ESTs) submitted to the databases remain unrecognized (anonymous ESTs). This lack of similarities could be explained by several hypotheses: i) a different part of the transcript is present in the GenBank; ii) the transcript represents a novel gene not yet isolated in other species; iii) alternative splicing of the same gene in different species; iv) inaccurate sequence data; and/or v) the sequence of the transcript has diverged to the extent that it is not recognized as an ortholog. In the present study we selected a sample of 20 ESTs from a pool of 656 anonymous pig small intestine ESTs in order to investigate the possible cause for the lack of similarities with database entries. To test the significant hypotheses we carried out total sequencing of each insert along with zoo-blot and Northern-blot analysis. Extended analyses of the 20 ESTs showed significant matches to seven existing database entries, whereas 13 still did not show significant hits. The results are discussed in the context of the hypothesis listed above.

Animals↗
PubMed2004

Cannabis use, sport practice and other leisure activities at the end of adolescence.

PURPOSE: To study the relationship between cannabis use, sports practice and other leisure activities during adolescence, as a test for the sociological theory of deviant opportunities. METHODS: A sample of 12,512 French adolescents aged 18 responded to an anonymous self-reported questionnaire in March 2001. Three logistic models (for occasional, recent and regular cannabis use) were estimated for girls and boys separately. RESULTS: Outings and other peer-oriented activities were strongly correlated with cannabis use but this relationship depended on which levels of use were considered. Occasional use was more common among respondents who participated in many different outdoor activities. Regular use was associated with a more selective lifestyle, focusing on music-oriented outings and time spent at a friend's home in the evening. CONCLUSIONS: Our results provided empirical support for the theory of deviant opportunities. Changing patterns of lifestyle associated with transition from initiation to higher levels of use may reveal a shift from opportunities of cannabis use provided by a wide range of activities to specific activities chosen for their convenience to cannabis use. Further research will need to investigate how drug use is shaped by lifestyle, and conversely, how drug use reshapes lifestyle.

Adolescent↗
PubMed1998

New epidemiological problem in Poland: vertical transmission of human immunodeficiency virus.

New diagnostic, prophylactic and treatment perspectives in HIV infection of the fetus and newborn is a challenge for health services in Poland. In view of these advances, the ascertainment of HIV status of all pregnant women is important both for individuals and for the health services. By law, laboratory HIV testing in Poland can be performed only on a voluntary basis. All newly diagnosed cases of AIDS and HIV infections are anonymously reported to the National Institute of Hygiene in Warsaw. There are no clear data about vertical transmission of HIV infection in Poland mostly because of the unknown number of women who are positive at delivery. Almost all our data were collected from Polish Regional AIDS/HIV Diagnostic and Therapeutic Centres. During the period 1986-95, 88 children were delivered by HIV-positive women and vertical transmission occurred in 15 cases.

Female↗