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PubMed2005

Predicting externalizing problems in Moroccan immigrant adolescents in the Netherlands.

BACKGROUND: Although an increasing proportion of the population in Western countries originates from non-Western parts of the world, little research has been conducted on predictors of externalizing problems in immigrant adolescent samples. This study on the predictors of externalizing problems in Moroccan immigrant adolescents in the Netherlands was aimed to contribute to the knowledge in this field. METHODS: We obtained 415 parent-reports, 376 self-reports and 238 teacher-reports on problem behavior in a general population sample of randomly selected 11- to 18-year-old Moroccan immigrant adolescents, using the Child Behavior Checklist, Youth Self-Report and Teacher's Report Form. RESULTS: The data revealed a clear relation between externalizing problems and several child (gender, internalizing problems), proximal family (parental monitoring and affection, support from father and mother, and parent-child conflict), contextual family (conflicts between parents about parenting, destructive communication between parents, and total number of life-events), school/peer (problems at school, involvement with deviant peers, hanging out), and migration variables (adolescent's perceived discrimination). Hardly any association was observed between externalizing problems and parental psychopathology, and between externalizing problems and global family variables (e.g., family employment level). Most findings matched results found in earlier studies on non-immigrant youth. CONCLUSIONS: Our results suggest that the child, school/peer, and proximal family factors are essential in models predicting the development of externalizing behavior. The impact of the migration factor on externalizing problems turned out to be relatively small.

Acculturation↗
PubMed1988

Left ventricular size and function in double inlet left ventricle.

Using quantitative cineangiography we studied left ventricular size and function in 15 patients (aged 1 day to 15 years) with double inlet left ventricle. Our purpose was to assess how ventricular volume and performance change with age and palliative surgery in patients with and without restriction to pulmonary flow. Ventricular volumes were calculated using Simpson's rule method; end-diastolic volume was also stated as a percentage of predicted total (combined right and left) ventricular volume. Ejection fraction and systolic pressure to end-systolic volume ratio were calculated as indexes of ventricular function. Our results suggest that ventricular size is inadequate for a septation procedure in patients with restriction to pulmonary flow but increases after shunting operation. In patients without restriction to pulmonary flow, ventricular volume is adequate for a septation procedure during the first months of life, but it tends towards reduction, along with obstruction of the interventricular communication, after pulmonary artery banding. Ejection fraction is slightly lower than in left ventricle of heart with biventricular atrioventricular connexion, but it does not decrease with age, at least during the first 15 years of life. Systolic pressure to end-systolic volume ratio also does not decrease with age, but it is lower in patients with excessive pulmonary flow or atrioventricular valvar regurgitation.

Adolescent↗
PubMed2004

Rheumatology outcomes: the patient's perspective. A multicentre focus group interview study of Swedish rheumatoid arthritis patients.

OBJECTIVES: Patients with rheumatoid arthritis (RA) and clinicians have different views about benefits from treatments. More knowledge is needed about how patients assess outcomes in order to update current measurements. METHODS: Focus group interviews were performed at four Swedish rheumatology clinics. A total of 25 patients with RA were included, representing a wide range of ages and disease duration. Predetermined topics relating to important outcomes from and satisfaction/dissatisfaction with RA treatments were discussed. RESULTS: The participants' initial outcome assessments included physical and psychosocial items, which comprised overall treatment goals such as impairment in social roles, fatigue, daily activities and self-confidence. The identified themes were 'Normal life', 'Physical capacity', 'Independence' and 'Well-being'. Satisfaction with treatment was associated with the quality of communication between staff and the patient. The participants assumed this as a prerequisite for a treatment to work. Patients wanted to be accepted as experts on their own bodies, and expected all clinicians to be experts on RA. This made it possible for patients to 'take charge' of their life situation. Good resources for and access to rheumatology care were desired. CONCLUSIONS: Suggesting a holistic approach to rheumatology care, the study results indicate that the illness and outcomes have to be evaluated within an individual RA patient's total life situation, described in the identified themes: 'Normal life', 'Physical capacity', 'Independence' and 'Well-being'. Development and validation of measurements covering these issues is suggested. More research is needed about communication and how patients experience their roles in the rheumatology clinic.

Activities of Daily Living↗
PubMed2002

The anatomy of the professional lapse: bridging the gap between traditional frameworks and students' perceptions.

PURPOSE: To support students' developing professionalism, it is necessary to understand the professional challenges and dilemmas they perceive in the clinical setting. This study systematically documented and catalogued students' reports of professional lapses. METHOD: Six focus groups were conducted with senior medical students (n = 29) at three universities. Using a grounded-theory approach, three researchers analyzed the students' reports of specific lapses in professionalism for recurrent themes. The resulting coding structure was applied using NVivo qualitative data analysis software. RESULTS: A total of 120 pages of text yielded 48 specific incidents of professional lapses, which were analyzed by three researchers using grounded theory. Most incidents were witnessed (n = 34) or known about (n = 4), as opposed to self-reported (n = 10). Six critical "issues" emerged: communicative violations (to or about patients or other health care professionals); role resistance (individuals chafing against constraints or expectations of their perceived roles); objectification of patients (ignoring patients or treating patients as vehicles for learning); accountability (to colleagues or patients, including avoiding patients, failing to disclose information, or failing to treat appropriately); physical harm (to patients or others); and crossfire (being put in the middle of a struggle between superiors). CONCLUSIONS: This study explored how students experienced and operationalized professionalism in clinical settings at a variety of universities. Interestingly, the critical issues they reported as salient did not map easily onto standard, abstract definitions of professionalism. This incongruence suggested that the development of effective curricula in this domain must bridge the gap between traditional taxonomies and students' perceptions of professionalism.

Canada↗
PubMed2026

A pan-cancer single-cell atlas uncovers the role of sex hormones and chromosomes in sex-divergent reprogramming of the tumor microenvironment.

BACKGROUND: Sex bias is pervasive in tumors; however, how sex chromosomes and hormone-responsive signaling shape the tumor microenvironment (TME) remains insufficiently characterized. Considering the critical impact of the TME on tumor progression and response to immunotherapy, a pan-cancer investigation of sex-specific and cancer-context-dependent TME features is warranted. METHOD: Based on stringent inclusion criteria, we constructed a high-resolution pan-cancer single-cell sequencing atlas by integrating 31 publicly available single-cell RNA-seq datasets, comprising a total of 1,831,436 cells by integrating 468 samples from eight types of non-sex-specific solid tumors (282 males and 186 females). After correcting for batch effects, we identified major and minor cellular subsets. Multiple computational approaches were applied to investigate sex-associated differences in cellular composition, gene expression, pathway activity, malignant cell states and intercellular communication. RESULTS: We systematically compared sex-specific TME features across eight common solid malignancies. Male-biased CD8+ T cell exhaustion emerged as a recurrent but non-uniform feature, with its magnitude varying across cancer types and being modified by tissue-specific contexts. This pattern was associated with androgen-response signature scores and expression-based loss of the Y chromosome (LOY) scores. M2-like macrophage polarization showed a more cancer-type-dependent pattern; although female-biased enrichment was observed in selected malignancies, it did not represent a uniform pan-cancer feature. Expression-based X chromosome inactivation (XCI)/XCI escape-related programs, estrogen-response signature scores and stromal components, including fibroblasts and endothelial cells, were associated with macrophage and immune-regulatory states in specific tumor contexts. Tumor cells of male origin displayed higher genomic instability and more aggressive phenotypes, with androgen-response signatures and LOY contributing to the development of a male biased malignant state. Furthermore, expression-based LOY scores in malignant cells were associated with CD8+ T cell exhaustion based on transcriptomic proxies. CONCLUSION: Our study uncovers extensive but heterogeneous sex-specific differences in the TME across multiple cancer types. We propose a regulatory framework linking sex chromosomes, hormone-responsive signaling and TME interactions, which is consistent with recurrent male-biased CD8⁺ T cell exhaustion and context-dependent M2-like macrophage polarization. Importantly, the magnitude and, in some cancers, the direction of these sex-biased features are modified by tissue-specific contexts. These findings underscore the need to include sex chromosome and hormone status as essential biological variables in studies of the tumor microenvironment and the design of immunotherapies.

Tumor Microenvironment↗
PubMed2002

Distribution of risk factors, plasma lipids, lipoproteins and dyslipidemias in a small Mediterranean island: the Ustica Project.

BACKGROUND AND AIM: The populations of the Mediterranean area have a low incidence of cardiovascular disease (CHD). The aims of this paper are: 1) to present demographic data of the population of Ustica, a small island in the southern part of the Tyrrhenian sea that has reduced communications with the mainland and a diet presumably rich in fish; and 2) to evaluate the distribution of risk factors, plasma lipids, lipoproteins and dyslipidemias in this population. METHODS AND RESULTS: We invited all of the free-living resident population aged more than 14 years (about 800 individuals) to participate in the study; 576 responded, for a participation rate of about 73%. The distribution of cardiovascular risk factors, plasma lipids, lipoproteins and dyslipidemias were evaluated in all of the subjects. More than 60% of the population was out of the normal weight range. Total and low-density lipoprotein cholesterol levels were respectively 207.4 +/- 46.7 and 141.7 +/- 42.4 mg/dL, and similar in males and females. Lipoprotein (a) (Lp[a]) levels presented the classical "skewed" distribution and, among the apolipoprotein(a) isoforms, there was a clear predominance of intermediate-sized kringle IV repeats. Overall, 43% of the subjects had a lipid disorder: the prevalence of hypercholesterolemia was 22.8% (3.2% with severe hypercholesterolemia terolemia > or = 300 mg/dL); low high-density lipoprotein cholesterol levels were found in 22.5%; the so-called lipid triad in 2.1%; and high Lp(a) levels in 6.2%. Large familial clusters were found for some lipid disorders. CONCLUSIONS: A large prevalence of body weight disturbances and high frequency of dyslipidemias are the main characteristics of this population. Ongoing data and future longitudinal studies will better clarify the relative influence of each parameter on CHD risk and total mortality.

Adolescent↗
PubMed1994

Network analytic methods for epidemiological risk assessment.

The authors measure the efficacy of three methods for predicting the time to infection for susceptible individuals in a population undergoing an HIV epidemic. The methods differ in whether they require detailed information of the contact network and whether they require knowledge of the initial source of infection. Efficacy is evaluated using simulations for 20 different contact patterns. Only the risk score that uses both kinds of information accounts for more than 15 per cent of individual variability. The efficacy of this score ranges from 10 per cent in very unstructured populations to 60 per cent for spatially localized contact networks. This improved performance may be explained by the larger fraction of the total variability not due to the disease dynamics. When all variables are dichotomized, the two poorer methods produce odds ratios between 1.4 and 2.3. The odds ratio for the risk score with full information ranges from 2.5 to 17. Risk assessment protocols and intervention programmes are encouraged to assess contact patterns and detect sources of infection.

Analysis of Variance↗
PubMed1976

[Applies phoniatry. III. Stuttering and Cluttering (author's transl)].

Stuttering is caused by many factors, and consequential verbal communication may be abolished partially or even totally. Medical management should not concern itself solely with the speech problem, and the individual problem and behaviour of each patient should be considered. Unlike stuttering, cluttering does not mean poor communication, but again in its treatment, individuality must be considered. Treatment is based on frequent tuition of a slower speech and of control of the impulsive personality traits.

Adolescent↗
PubMed2006

[Retinopathy of prematurity--functional and structural outcome in children treated with diode laser photocoagulation].

AIM: To present the long-term structural and functional outcome of children treated with diode laser for retinopathy of prematurity. PATIENTS AND METHODS: A total of six premature babies (12 eyes) in whom diode laser treatment was performed for acute retinopathy were followed up. The mean birth weight was 1185.0 +/- 309.6 g and mean gestational age was 28.5 +/- 1.87 weeks. Long term follow-up (18 to 41 months) included retinal examination, refractive status of the eye, and orthoptic evaluation: strabismus, amblyopia and nystagmus assessment. RESULTS: Unfavorable structural outcome was detected in five eyes of six children (5/12 eyes, 41.7%). If only the eyes in no higher than threshold stage (3+) according to surgery records were taken in consideration (6/12 eyes), therapy resulted in favorable structural outcome in all six (100%) eyes. The mean spherical equivalent refractive error was -2.27 +/- 2.03 D (range -6.0 to +0.50 D). Profound amblyopia of one eye was found in five of six study children, and was invariably accompanied by heterotropia of the amblyopic eye: deviation in eso direction in three cases, and exodeviation and hypertropia in one case each. Nystagmus was present in four of six (66.6%) patients. All six children used vision as a dominant sense in space orientation and communication. CONCLUSION: Diode laser therapy is a successful method in stopping and reversing the clinical course of severe retinopathy of prematurity, however only if timely implemented. The availability of this treatment modality in Croatia would significantly improve the structural and functional outcome of children with retinopathy.

Female↗
PubMed2003

Short communication: use of a recombinant antigen-based ELISA to determine prevalence of brugian filariasis among Malaysian schoolchildren near Pasir Mas, Kelantan-Thailand border.

Brugian filariasis infects 13 million people in Asia. The routine prevalence survey method using night thick blood smear is not sensitive enough to reflect the actual infection prevalence. In 1997-2001, only three microfilaraemic cases (of 5601 individuals screened; 0.05%) were reported in Pasir Mas, a district in Kelantan (Malaysia), which shares a border with Thailand. We therefore investigated the infection prevalence in this district by employing a sensitive and specific serological assay (Brugia-Elisa). This test is based on detection of specific IgG4 antibody against a Brugia malayi recombinant antigen. A total of 5138 children, aged 7-12 years, from 16 primary schools, were tested. Eighteen pupils in eight schools, located in five subdistricts, tested positive, giving an overall prevalence rate of 0.35%. Infection in these children is significant as they represent more recent cases. These subdistricts should be included in the national filariasis elimination programme.

Animals↗
PubMed2026

A Sentiment-Based Comparison of AI- and Physician-Generated Empathic Statements in Palliative Care.

CONTEXT: Empathic communication promotes trust in patient-provider relationships. As healthcare integrates artificial intelligence (AI) into patient communication, we have yet to understand how these models' communication compares to that of physicians. OBJECTIVES: Our primary objectives were to examine patient preferences for AI-generated vs. palliative care physician-generated empathic statements addressing fear and anxiety around cancer treatment, and to analyze associations between linguistic features and patient preferences. METHODS: We conducted a secondary analysis of the PALL-AI trial, a randomized controlled survey comparing cancer patients' preferences of AI- to physician-generated empathic statements. Physicians and AI were provided the same prompt with a maximum sentence length. Patient preferences for each statement were measured in blinded surveys. We analyzed sentiment of the statements using the Valence Aware Dictionary and Sentiment Reasoner (VADER) and the National Research Council Canada (NRC) Emotion Lexicon. We evaluated associations between sentiment scores and patient preferences using Spearman's correlation coefficients. RESULTS: A total of 105 patients completed blinded surveys, preferring the AI-generated statement 72.4% of the time. VADER sentiment analysis showed all three AI statements displayed positive sentiment, while all three physician statements displayed negative sentiment. Controlling for statement length, AI statements used twice as many positive words as human statements. However, they contained a similar number of negative words. Of the eight NRC emotions, "trust" and "joy" demonstrated the strongest correlations with patient preference. CONCLUSION: Patients preferred AI-generated statements around cancer care over those from palliative care physicians when standardized for prompt and statement length. Analysis shows AI-generated statements contain more positive language which may be the factor driving patient preference toward AI.

Humans↗
PubMed2002

Family satisfaction with care in the intensive care unit: results of a multiple center study.

OBJECTIVE: To determine the level of satisfaction of family members with the care that they and their critically ill relative received. DESIGN: Prospective cohort study. SETTING: Six university-affiliated intensive care units across Canada. METHODS: We administered a validated questionnaire to family members who made at least one visit to intensive care unit patients who received mechanical ventilation for >48 hrs. We obtained self-rated levels of satisfaction with 25 key aspects of care related to the overall intensive care unit experience, communication, and decision making. For family members of survivors, the questionnaire was administered while the patient was still in the hospital. For family members of nonsurvivors, the questionnaire was mailed out to the family member 3-4 wks after the patient's death. MAIN RESULTS: A total of 891 family members received questionnaires; 624 were returned (70% response rate). The majority of respondents were satisfied with overall care and with overall decision making (mean +/- sd item score, 84.3 +/- 15.7 and 75.9 +/- 26.4, respectively). Families reported the greatest satisfaction with nursing skill and competence (92.4 +/- 14.0), the compassion and respect given to the patient (91.8 +/- 15.4), and pain management (89.1 +/- 16.7). They were least satisfied with the waiting room atmosphere (65.0 +/- 30.6) and frequency of physician communication (70.7 +/- 29.0). The variables significantly associated with overall satisfaction in a regression analysis were completeness of information received, respect and compassion shown to the patient and family member, and the amount of health care received. Satisfaction varied significantly across sites. CONCLUSIONS: Most family members were highly satisfied with the care provided to them and their critically ill relative in the intensive care unit. Efforts to improve the nature of interactions and communication with families are likely to lead to improvements in satisfaction.

Consumer Behavior↗
PubMed1989

[Six channels telemetry system for recording masticatory forces of complete denture wearers].

A six channels telemetry system for recording masticatory force of complete denture wearers has been developed. This system is consisted of three blocks, the transmission block, the receiver block and the data storage and correction block. The transmission block is embedded in a lower complete denture. System has six load sensors and a standard resistor to correct sensor data. Data from six load sensors and standard resistor as well as standard zero are multiplexed using a division multiplex communication method. The sampling frequency is 666 Hz. And the signal is transmitted by FM modulation. The carrier wave frequency is 64 MHz. Receive data are decoded using start-stop system. The wave form noise is reduced using a signal averaging technique at an integrator. The data are input into the computer with an A/D converter. In this system, the sensor data is corrected at the computer with the standard resistor data. This method could reduce the influence of battery power changes and thermal drift significantly. For the load of 10 kg or less, the total linearity of the system remained at +/- 4% of the calibrated value. The noise level is 300 g.

Denture, Complete↗
PubMed2001

The psychology of team interaction.

This paper aims to review psychological research results and methods which might be relevant to the issue of team interaction in the medical domain. The complex research on team performance is coherently organized into a proposed framework focussing in detail on task and social orientations of interacting team members.

Communication↗
PubMed2006

Conceptualizing and measuring pharmacist-patient communication: a review of published studies.

BACKGROUND: Pharmacist-patient communication in community pharmacies has been studied for over 25 years with little effort to evaluate this research comprehensively. OBJECTIVE: The main objective of this review is to examine and summarize how researchers have conceptualized, defined, and measured pharmacist-patient communication across studies and identify gaps in the literature. METHODS: Articles were compiled from a search of (1) Medline, IPA, CINAHL, and PubMed databases using the keywords, "counseling", "patient communication", "patient counseling", "patient education", "patient consult( *)", and/or "pharmacists", (2) bibliographies of selected articles. The search generated 56 studies on community pharmacy, of which 39 studies met the inclusion criteria. RESULTS: Most studies (72%) have used the term patient counseling, although pharmacist-patient communication and patient education were also used. The definition of patient counseling varies across studies. Almost half of the studies (49%) conceptualized pharmacist-patient communication solely as a pharmacist information provision activity. A total of 16 studies (41%) also focused on pharmacists' interpersonal behavior in addition to the information provision activity of the pharmacist. In contrast, patient communication behavior and the exchange process between both parties has been understudied. A total of 16 studies (41%) used a retrospective design. All studies used a cross-sectional design, with varying modes of data collection such as mail surveys, telephone interviews, nonparticipant observation, and shopper studies. Taped encounters are rare. SUMMARY/IMPLICATIONS: This review revealed that most studies have focused on a one way communication of pharmacists to patients. A need for examining the patient-pharmacist dyad is apparent. Future research could explore a greater use of taped encounters to analyze the interactive communication process, affective components of communication such as collaborative problem solving, interpersonal relationship development, and the expertise that patients bring into the encounter.

Communication↗
PubMed2001

Capnocytophaga granulosa and Capnocytophaga haemolytica: novel species in subgingival plaque.

BACKGROUND: The oral cavity accommodates one of the most diverse microfloras in the human body. Knowledge of this microflora, and of the periodontal microflora in particular, proves crucial towards an understanding of the bacterial-host interactions which lead to the development of infectious inflammatory periodontal diseases. Capnocytophaga species have been implicated as putative periodontal pathogens. To date, only 3 members of this genus (C. gingivalis, C. ochracea and C. sputigena) have been isolated from subgingival plaque. AIM: This communication reports the isolation of 2 recently-speciated strains, namely C. granulosa and C. haemolytica, from subgingival plaque collected from adult periodontitis patients. MATERIAL AND METHODS: Subgingival plaque was collected from 29 patients with chronic adult periodontitis. Plaque samples were inoculated onto fastidious anaerobe agar and incubated anaerobically for 5 days. Routine identification of clinical isolates was performed by 16S rRNA PCR-RFLP analysis, using Cfo I as restriction enzyme and corroborated by 16S rRNA gene sequencing. RESULTS: 16 of 29 patients (55%) tested positive for either C. granulosa and or C. haemolytica. A total of 70 isolates (63 C. granulosa and 7 C. haemolytica) were cultivated from subgingival plaque. 15 (51%) patients tested positive for C. granulosa, and 3 (10%) patients tested positive for C. haemolytica. CONCLUSION: This is the 1st report which recounts the presence of C. granulosa and C. haemolytica in subgingival plaque. Further research is required to establish the relative proportions of these species subgingivally in health and disease.

Adult↗
PubMedDate not supplied

Perceptions of speech and language therapy amongst UK school and college students: implications for recruitment.

BACKGROUND: Communication disorders affect both sexes and people from all ethnic groups, but members of minority ethnic groups and males in the UK are underrepresented in the speech and language therapy profession. Research in the area of recruitment is limited, but a possible explanation is poor awareness and understanding of speech and language therapy as a profession. AIMS: To investigate factors influencing attitudes to a career in speech and language therapy amongst UK school and college students focusing on the similarities and differences between males and females, and between minority ethnic and white students. METHODS & PROCEDURES: A total of 651 male and female school and college students from a range of ethnic groups and all close to selecting degree courses completed a questionnaire designed to examine the attitudes and awareness of speech and language therapy. Eleven semi-structured follow-up interviews were conducted to help understand the questionnaire findings. Quantitative and qualitative analyses examined differences in attitudes and the awareness of speech and language therapy amongst these groups. OUTCOMES & RESULTS: Overall, one-third of participants said they knew nothing about speech and language therapy, and males were significantly less familiar with it. Less than half the participants were aware that speech and language therapy is a degree course, and minority ethnic participants were significantly less likely to know this. Compared with males, females were almost five times as likely to say they would consider a career in speech and language therapy. Participants with relatives in health-related jobs were significantly more likely to consider speech and language therapy than those without such relatives. Compared with white participants, minority ethnic participants said they placed greater importance on studying for a degree, a profession and a scientific career, and were more influenced by a career's prestige and a high salary. CONCLUSIONS: In order to increase the ethnic and gender diversity of speech and language therapists, the profile of the profession needs to be raised with increased awareness of the degree level courses, the scientific, evidence-based nature of the work, and current salary scales.

Adolescent↗
PubMed2003

Oropharyngeal reconstruction: current state of the art.

Oropharyngeal reconstruction represents one of the greatest challenges in the surgical rehabilitation of patients with head and neck cancer. This article reviews several reconstruction methods, starting with the primary closure and healing by secondary intention all the way to the complex sensate microvascular flap reconstructions. Small defects such as tonsillar, small tongue base, and partial palatal defects may be closed primarily or left to granulate. This is assuming that there is no communication with the neck or bone exposure. Local flaps such as the palatal island, submental, and buccal mucosal flaps are used to close small to moderate-sized defects. Split-thickness skin grafts are also appropriate for small to moderate-sized defects. Larger defects such as total palatal, more than 50% of the tongue base, and composite tongue base/palatal/pharyngeal defects may be closed with regional myocutaneous pedicled flaps such as the pectoralis major, lower trapezius, or latissimus dorsi pedicled flaps. Microvascular tissue transfer is an excellent alternative for closure of moderate to large-sized defects. Free tissue transfer includes the radial forearm and the lateral arm free flaps. Both of these can have a sensory component. Free jejunal flaps are used for total or subtotal hypopharyngeal defects. Free gastro-omental flaps may be used for oropharyngeal and hypopharyngeal reconstruction as well. For defects involving bone, fibular flaps are an excellent option and can provide sensation. The scapular free flap may be used as well and offers the advantage of having two skin paddles (scapular and parascapular) for internal and external lining. Following a reconstructive ladder is extremely important in ensuring good function and, hence, improved quality of life.

Humans↗