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PubMed1996

Epidemiological analysis of rare polydactylies.

This work includes all cases with extra digits (polydactyly) registered from a birth sample of over four million births aggregated from two comparable birth series: the Latin-American Collaborative Study of Congenital Malformations: ECLAMC (3,128,957 live and still births from the 1967 to 1993 period), and the Spanish Collaborative Study of Congenital Malformations: ECEMC (1,093,865 livebirths from April 1976 to September 1993, and 7,271 stillbirths from January 1980 to September 1993). All but 2 of 6,912 registered polydactyly cases fit well into one of the following 11 preestablished polydactyly types (observed number of cases in parentheses): Postaxial hexadactyly (5,345), Preaxial-I hexadactyly (1,018), Seven or more digits (57), synpolydactyly (15), crossed polydactyly (45), 1st digit triphalangism (33), 2nd digit duplication (39), 3rd digit duplication (18), 4th digit duplication (22), Haas polysyndactyly (3), and high degree of duplication (4). The birth prevalence rates observed in both series were similar except for postaxial polydactyly, which was more frequent in the ECLAMC (150.2/100,000) than in the ECEMC (67.4/100,000), as expected due to the higher African Black ethnic extraction of the South-American than of the Spanish populations. This similar frequency for the rare polydactylies (5.4 per 100,000 in South America and 5.7 in Spain), and for each one of the 9 categories, suggests that the values reported here are valid for most populations. The rare polydactylies are frequently syndromal: one third of them (77/236) were found in association with other congenital anomalies, 11.0% (26/236) in MCA cases and 21.6% (51/236) in recognized syndromes.

Fingers↗
PubMed1997

The role of clinical dietitians as perceived by dietitians and physicians.

OBJECTIVE: The purpose of this study was to examine dietitians' and physicians' perceptions regarding the role of clinical dietitians. SUBJECTS AND DESIGN: Four hundred ten physicians and clinical dietitians were randomly identified from the American Board of Medical Specialties Directory of Board Certified Medical Specialists and from Michigan district dietetic association directories. A survey containing demographic, situational, and role and responsibility questions was administered. STATISTICAL ANALYSES PERFORMED: Cronbach's alpha coefficient was computed to determine the internal consistency of the measurement instrument. A series of two-tailed t tests was performed to determine between-group differences on the perception questions. Analysis of covariance was completed to control for potential confounds. chi 2 Tests were performed to determine the relationship among a change of diet order question and participants' occupation, area of specialty, and practice setting. RESULTS: Of the surveys mailed, 73% were returned and 58% overall were usable. The internal consistency of the measure was .72. Most dietitians' and physicians' responses to the role and responsibility questions differed significantly, with particularly large differences noted for 6 of 10 questions; however, "total score" differences were not significant. Significant associations were found for the level of specialization and type of occupation on the change of diet order question. APPLICATION/CONCLUSIONS: Routine contact, communication, and interaction between physicians and dietitians are vital if physicians are to know dietitians' responsibilities and competencies and collaborate with them when providing medical nutrition therapy to patients. Future studies that differentiate areas of responsibility of clinical dietitians and inquire into dietitians' and physicians' interactions during their education or training may provide further insights into this topic.

Cross-Sectional Studies↗
PubMed2004

A positive aspect of caregiving: the influence of social support on caregiving gains for family members of relatives with schizophrenia.

This study examines family members' caregiving gains as a result of caring for their relatives with schizophrenic spectrum disorders, and the influence of formal and informal social support on these positive experiences. The results from interviews with 560 family members support that the experience of caregiving gains is prevalent. Moreover, formal support from mental health professionals through information sharing and collaborative interactions with family members, and informal support from other family members, support group participation, and contributions from the relative with mental illness all have significant, positive associations with family members' experiences of caregiving gains.

Adult↗
PubMed2001

A new paradigm for practice education.

This paper explores the complex nature of professional practice. It suggests that educating for all practice disciplines is about to undergo a paradigm shift whereby the value of practical education and experience will be better understood, more rigorously analyzed and integrated with propositional knowledge in the construction of personal professional knowledge and identity. It relates this cross disciplinary position to the present problems of skills deficits which are evident in nurses at the point of registration and demonstrates how routinization and internalization of process and tacit knowledge can create problems for students and newly qualified staff nurses. It also suggests how this can be addressed. It discusses the present culture of 'clinical education by default', unavailability of mentors and resources, and general lack of formal collaborative structures between education and service institutions and suggests that the present system cannot sustain the complex demands, expectations and pace of the clinical context and the evolution of nursing practice. Clinical credibility is an issue as is the current heavy clinical workload of staff nurse mentors, and several collaborative clinical education models are outlined which ensure that staff nurses or resident clinical educators are available and can make clinical teaching their priority. History and the present crisis in nursing suggest that there is a case for mandatory collaborative education/service structures to ensure adequate funding and to monitor the effectiveness of selected models so that staff nurse mentors can work with lecturer colleagues to articulate and teach the complexities of clinical practice through related research. It is predicted that this collaborative approach is capable of addressing both the skills deficits and the wider intellectual challenge of developing a new paradigm of practice education and providing an integrated base for continuing professional development.

Clinical Competence↗
PubMed1982

Training primary health care workers in Upper Volta.

In collaboration with aid agencies and government health workers, Save the Children Fund medical staff have been involved in the training of primary health care workers in the Sahel region of upper Volta. This report deals specifically with the problems involved in training illiterate health workers.

Burkina Faso↗
PubMed1998

Genetic and epidemiological research at the National Institute on Alcoholism, Kurihama National Hospital.

The National Institute on Alcoholism, Kurihama National Hospital, Japan, was designated as a WHO Collaborating Center on Research and Training of alcohol-related problems in 1988. As part of the collaboration and contribution to the WHO, the institute has made significant efforts for the advancement of alcohol research. This article summarizes recent research activities at the institute, focusing on two areas of research: epidemiological and genetic studies.

Academies and Institutes↗
PubMed1994

[Introduction of an infection registration program for surgical wound infection based on the WHOCARE software of WHO].

Surveillance of surgical wound-infection (SWI) is an important instrument in the internal and external quality control in surgery. In the past it has been shown that statistics on surgical wound infection are helpful for reduction of wound infection rates. With the engagement of nurses for clinical hygiene at our hospital we had the possibility to evaluate programs for surveillance of nosocomial infection. In a pilot study we began with the surveillance of SWI. The set of data registered was defined by WHOCARE, the software-package used in the study which is distributed by the WHO Europe. Criteria of the NNIS-Study for SWI were applied. Between March and December 1992 approximately 1.300 surgical interventions had been registered. Although the dataset in WHOCARE is limited with regard to an easy surveillance, it was possible to find out infection rates dependent on all major parameters. Additionally reports on individual infection rates and tables containing information of infected cases were sent to every surgeon. By analyzing some of the problems detected during the study, we developed an improved protocol for routine surveillance of SWI. In the future it will save time and will allow the best quality of collected data in narrow collaboration between the departments of microbiology, clinical hygiene and surgery. This protocol should be transferable to other hospitals and represents an anticipated precautious measure with regard to legal regulations on quality control in medicine.

Cross Infection↗
PubMed2005

Routine vs selective invasive strategies in patients with acute coronary syndromes: a collaborative meta-analysis of randomized trials.

CONTEXT: Patients with unstable angina or non-ST-segment elevation myocardial infarction (NSTEMI) can be cared for with a routine invasive strategy involving coronary angiography and revascularization or more conservatively with a selective invasive strategy in which only those with recurrent or inducible ischemia are referred for acute intervention. OBJECTIVE: To conduct a meta-analysis that compares benefits and risks of routine invasive vs selective invasive strategies. DATA SOURCES: Randomized controlled trials identified through search of MEDLINE and the Cochrane databases (1970 through June 2004) and hand searching of cross-references from original articles and reviews. STUDY SELECTION: Trials were included that involved patients with unstable angina or NSTEMI who received a routine invasive or a selective invasive strategy. DATA EXTRACTION: Major outcomes of death and myocardial infarction (MI) occurring from initial hospitalization to the end of follow-up were extracted from published results of eligible trials. DATA SYNTHESIS: A total of 7 trials (N = 9212 patients) were eligible. Overall, death or MI was reduced from 663 (14.4%) of 4604 patients in the selective invasive group to 561 (12.2%) of 4608 patients in the routine invasive group (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.72-0.93; P = .001). There was a nonsignificant trend toward fewer deaths (6.0% vs 5.5%; OR, 0.92; 95% CI, 0.77-1.09; P = .33) and a significant reduction in MI alone (9.4% vs 7.3%; OR, 0.75; 95% CI, 0.65-0.88; P<.001). Higher-risk patients with elevated cardiac biomarker levels at baseline benefited more from routine intervention, with no significant benefit observed in lower-risk patients with negative baseline marker levels. During the initial hospitalization, a routine invasive strategy was associated with a significantly higher early mortality (1.1% vs 1.8% for selective vs routine, respectively; OR, 1.60; 95% CI, 1.14-2.25; P = .007) and the composite of death or MI (3.8% vs 5.2%; OR, 1.36; 95% CI, 1.12-1.66; P = .002). But after discharge, the routine invasive strategy was associated with fewer subsequent deaths (4.9% vs 3.8%; OR, 0.76; 95% CI, 0.62-0.94; P = .01) and the composite of death or MI (11.0% vs 7.4%; OR, 0.64; 95% CI, 0.56-0.75; P<.001). At the end of follow-up, there was a 33% reduction in severe angina (14.0% vs 11.2%; OR, 0.77; 95% CI, 0.68-0.87; P<.001) and a 34% reduction in rehospitalization (41.3% vs 32.5%; OR, 0.66; 95% CI, 0.60-0.72; P<.001) with a routine invasive strategy. CONCLUSIONS: A routine invasive strategy exceeded a selective invasive strategy in reducing MI, severe angina, and rehospitalization over a mean follow-up of 17 months. But routine intervention was associated with a higher early mortality hazard and a trend toward a mortality reduction at follow-up. Future strategies should explore ways to minimize the early hazard and enhance later benefits by focusing on higher-risk patients and optimizing timing of intervention and use of proven therapies.

Aged↗
PubMed2003

Transcranial magnetic stimulation for the treatment of obsessive-compulsive disorder.

BACKGROUND: Transcranial magnetic stimulation (TMS) was introduced as a neurophysiological technique in 1985 when Anthony Barker and his team developed a compact machine that permitted non-invasive stimulation of the cerebral cortex (Barker 1985). Since its introduction, TMS has been used to evaluate the motor system, to study the function of several cerebral regions, and for the pathophysiology of several neuropsychiatric illnesses. In addition, it has been suggested that TMS might have therapeutic potential. Some controlled studies have evaluated the effects of repetitive TMS (rTMS) in patients with obsessive-compulsive disorder (OCD). Greenberg (Greenberg 1997) observed that a single session of right prefrontal cortex stimulation produced a significant decrease in compulsive urges in OCD patients lasting over eight hours. Other studies have reported transitory improvements in mood but there are no observations for changes in anxiety or obsessions. OBJECTIVES: To develop a systematic review on the clinical efficacy and safety of transcranial magnetic stimulation from randomised controlled trials in the treatment of obsessive-compulsive disorder. SEARCH STRATEGY: An electronic search was performed including the Cochrane Collaboration Depression, Anxiety and Neurosis Review Group trials register (last searched June, 2002), the Cochrane Controlled Trials Register (Issue 2, 2002), MEDLINE (1966-2002), EMBASE (1974-2002), PsycLIT (1980-2002), and bibliographies from reviewed articles. SELECTION CRITERIA: Randomised controlled trials assessing the therapeutic efficacy and safety of transcranial magnetic stimulation for obsessive-compulsive disorder. DATA COLLECTION AND ANALYSIS: All reviewers independently extracted the information and verified it by cross-checking. Disagreements were resolved through discussion. MAIN RESULTS: Three trials were included in the review and only two contained data in a suitable form for quantitative analysis. It was not possible to pool any results for a meta-analysis. No difference was seen between rTMS and sham TMS using the Yale-Brown Obsessive-Compulsive Scale or the Hamilton Depression Rating Scale for all time periods analysed. REVIEWER'S CONCLUSIONS: There are currently insufficient data from randomised controlled trials to draw any conclusions about the efficacy of transcranial magnetic stimulation in the treatment of obsessive-compulsive disorder.

Humans↗
PubMed2005

Dissecting the correlation structure of a bivariate phenotype: common genes or shared environment?

High correlations between two quantitative traits may be either due to common genetic factors or common environmental factors or a combination of both. In this study, we develop statistical methods to extract the genetic contribution to the total correlation between the components of a bivariate phenotype. Using data on bivariate phenotypes and marker genotypes for sib-pairs, we propose a test for linkage between a common QTL and a marker locus based on the conditional cross-sib trait correlations (trait 1 of sib 1 - trait 2 of sib 2 and conversely) given the identity-by-descent (i.b.d.) sharing at the marker locus. We use Monte-Carlo simulations to evaluate the performance of the proposed test under different trait parameters and quantitative trait distributions. An application of the method is illustrated using data on two alcohol-related phenotypes from a project on the collaborative study on the genetics of alcoholism.

Alcoholism↗
PubMed1994

Opportunities and challenges in international collaborative epidemiologic research of dementia and its subtypes: studies between Japan and the U.S.

Estimates of the prevalence rates for dementia vary significantly among countries. Such variation may be explained, at least in part, by methodologic differences in studies. The disparities in prevalence rates of dementia subtypes, particularly Alzheimer's disease and multi-infarct dementia, are especially apparent in studies conducted in Eastern and Western countries. In Japan and China, the prevalence of multi-infarct dementia exceeds that of Alzheimer's disease, whereas in the West, Alzheimer's disease predominates in the vast majority of studies. Clearly, cross-cultural studies of incidence using standard methods are needed to investigate whether a true difference in risk exists, and which risk factors differentially contribute to this variation. Migrant studies of genetically homogeneous populations offer a unique opportunity to answer these questions. This article explores the value of migrant studies, their application to etiologic questions of dementia and its subtypes, and recommendations concerning how to conduct such studies.

Aged↗
PubMed1991

In vitro studies with nine known or suspected spindle poisons: results in tests for chromosome malsegregation in Aspergillus nidulans.

Within the framework of a coordinated collaborative study for evaluating assays for aneuploidy, nine known or suspected spindle poisons were tested in mitotic segregation assays with Aspergillus nidulans. Experiments with A. nidulans diploid strain P1 revealed a statistically significant increase of whole chromosome segregants (non-disjunctional diploids and haploids) after treatments with chloral hydrate (CH), thiabendazole (TB), thimerosal (TM) econazole (EZ) and hydroquinone (HQ). The latter two chemicals also increased the frequency of mitotic cross-overs. Colchicine (COL), diazepam (DZ), cadmium chloride (CD) and pyrimethamine (PY) were ineffective. Further experiments with CH, TB, TM and EZ in the haploid strain 35 demonstrated that CH, TB and TM induced hyperploid types, thus indicating a primary effect on chromosome segregation in A. nidulans. However, since EZ did not induce putative hyperploids in strain 35 and trisomics in diploid 31, it is suggested that EZ affects chromosome segregation by an indirect mechanism, possibly related to induced structural chromosome damage, as previously shown for HQ.

Aneuploidy↗
PubMed1995

Correlative morphologic and functional imaging for diagnosis, staging and follow up in AIDS: an overview.

The immunocompromised patient can be affected by different opportunistic infections and tumors, that can involve all organ systems, and particularly, the central nervous system, the respiratory system, the gastrointestinal tract. The extreme variability of AIDS presentations requires a specific preparation and cooperation between the different diagnostic imaging specialists and a close collaboration with the clinicians. With AIDS, different morphologic and functional imaging techniques can be used for detection of disease sites, assessment of the extent of the disease and monitoring of disease changes over time and response to treatment. The complexity of AIDS presentations is such that full integration of the complementary information obtained with different techniques could be most useful. Image registration (coregistration, fusion) indicates approaches where precise spatial cross-references are obtained, in order to combine the information acquired with different imaging modalities, in particular by blending morphologic CT/MRI data with functional SPET/PET data. In this paper, an overview of the developments in the field of "image fusion" follows some comments on the results of morphologic and functional assessment of brain, chest and abdominal diseases in the course of AIDS, as illustrative examples of the potential benefits of multimodality image correlation.

AIDS-Related Opportunistic Infections↗
PubMed1991

The use of conditional probabilities to examine age-period-cohort data: further evidence for a period effect in major depressive disorder.

There is growing evidence that rates of major depression have been increasing over this century, with successive birth cohorts showing increased lifetime risks and earlier ages of onset. In this paper, we describe and compare onset rates in six birth cohorts of first degree relatives of probands with affective disorders from the NIMH Collaborative Study, using graphs of conditional probabilities of first onset. There is evidence of a period effect and age-period interaction for both men and women.

Adult↗
PubMed1996

The role of policy in community pharmacies' response to injection-drug use: results of a nationwide Canadian survey.

The response rate to this survey reflects the salience of the topic and the professional concern about and interest in issues presented by HIV. The HIV/AIDS epidemic has presented pharmacists with one of the greatest challenges to their professional training, ethics, and practice. It further expedites a current re-examination that is occurring among community pharmacies concerning their roles in community health practices. In response to HIV there have been dramatic and unprecedented changes in pharmacy policy and practices. Clearly, some community pharmacies have led the way and influenced policy and practices. In view of the recent introduction of many of these policies and practices, it is likely that change will continue. Survey respondents were, in general, very comfortable with an expanded role involving counseling, health promotion, and disease prevention, consistent with a broader role for community pharmacies in general that has been recently advocated. Community pharmacies serve all areas of the country, in communities large and small; many are open seven days a week, and some provide extended hours of service. Community pharmacies may provide an important complement to community outreach programs as a source of clean needles and syringes for IDUs in most communities, and as an alternative service in some communities where more elaborate programs are not feasible. Safer needle use, as part of a health-promotion approach, is divergent from conventional practice. While major changes have occurred, it appears that there has been some polarization of attitudes and response. The explanation for this is not simple, and further analysis is required to determine the full impact from several ethical perspectives that include professional, business, and public health viewpoints. We have highlighted the role that policy has in moving toward preventive and harm-reduction approaches. From a policy perspective, we have found that support from the federal government, regulatory bodies, and professional associations may be an important catalyst to pharmacists' participation in programs. Further, it does not appear to be possible to implement such policies without professional development and continuing education, and collaboration with the community. Based on data on knowledge and educational need, we believe that our study population's lowest levels of information were in such areas as the role of methadone in HIV prevention and the availability of needle-exchange programs. As with other health-promotion campaigns, additional skills training may be important. Movement forward with expanded preventive and harm-reduction strategies by pharmacies will require careful planning. It is anticipated that change in this area will be incremental in nature, and that it is necessary to introduce programs and services into community pharmacies gradually. Successful implementation will require extensive community development and collaboration with other health professionals, public health officials, police, groups who represent IDUs, and persons living with HIV/AIDS. Careful monitoring and evaluation of these programs will be necessary to enhance their effectiveness.

Canada↗
PubMed1992

Quantitative and qualitative approaches to the evaluation of the medical dialogue.

Increasing availability of audio and videotape of medical encounters has drawn the attention of researchers from diverse disciplines and perspectives. Unfortunately, the result has more frequently been interdisciplinary competition than collaboration. Most striking are the differences in approach between researchers applying qualitative and quantitative methods. Advocates of each of these methods have not only argued their own relative merits, but have maintained unusually critical and intellectually isolated positions. The purpose of this paper is to demonstrate that the paradigmatic perspective which promotes mutual exclusivity is in error. We present several examples of research findings which demonstrate the rich potential for cross-method research. Examples have been taken from the areas of most fruitful qualitative and quantitative research--information gathering, patient disclosure, and information-giving.

Communication↗
PubMed2005

Increasing rates of sexually transmitted diseases in homosexual men in Western europe and the United States: why?

The recent increases in acute STDs among MSM must be viewed in the context of a post-AIDS era that is characterized by demographic shifts,changing sexual attitudes, and rapidly changing social contexts. A key driver seems to be the growing prevalent pool of HIV-positive MSM for whom the crucial motivator for safer sex (primary HIV prevention) no longer exists and where, given the prevalence of seroconcordant sexual mixing, consider-able uncertainty and conflicting advice regarding the rationale and benefits for continued safer-sex practice are unclear [105,106]. Although it is tempting to ascribe these changes to increases in risk behavior, it is essential that the contexts in which the changes are occurring are also considered. It may also be appropriate to contemplate whether further changes to the social environment (eg, structural interventions) are a suitable adjunct to our traditional prevention activities that operate largely in isolation from each other. It seems natural to advocate that interventions that adopt holistic approaches to the sexual health of MSM and that address upstream factors such as mental health, drug use, discrimination, and internalized homophobia should be included in the efforts to create more healthy environments for MSM. However, there is still some way to go in identifying which of these upstream interventions are effective, how they may be implemented within or alongside existing health care systems, and what impact, if any, they are likely to have on STD transmission. Such interventions are also likely to belong on implementation time, require consider political will, and be extremely hard to evaluate, and the benefits may not be seen within the same generation in which they are implemented. Therefore, there must be confidence that this is the appropriate route of travel. The consistency of findings from across industrialized countries confirms an increasing connectivity within the global MSM community;a community that is decreasingly defined by geographic boundaries and, in the era of the Internet and easier foreign travel, increasingly linked by shared interests and social and sexual networks. This is powerfully demonstrated in the near-simultaneous syphilis and LGV outbreaks among MSM in Europe and the United States [29]. In this regard, greater collaboration between researchers and providers working with MSM indifferent countries is now required. More specifically, consideration should be given to creating closer partnerships between sentinel cities, such as London, New York, San Francisco, Berlin, Paris, and Amsterdam, that have large MSM populations and are likely to be emerging, or rapid diffusion sites for new social and sexual trends that may impact on disease transmission. There are many benefits to such cross-national working,including earlier recognition and improved response to emerging threats,sharing innovative practice, avoiding duplication of effort, and creating a united front for dealing with what must be considered a cause for concern domestically and globally.

Europe↗
PubMed2004

International research networks in pediatric rheumatology: the PRINTO perspective.

PURPOSE OF REVIEW: The purpose of this review is to highlight the problems and possible solutions for the conduct of international collaborative research for pediatric rheumatic diseases. RECENT FINDINGS: Pediatric rheumatic diseases are rare conditions associated with important sequelae on the quality of life and long-term outcome. The research aimed at studying new therapeutic approaches is difficult because of logistic, methodological, and ethical problems. To face these problems, two international networks have been founded: the Pediatric Rheumatology Collaborative Study Group (or PRCSG) and the Paediatric Rheumatology international Trials Organization (or PRINTO). The two networks have the goal to promote, facilitate, and conduct high-quality research into pediatric rheumatic diseases. In particular they have been able to standardize the evaluation of response to therapy in juvenile idiopathic arthritis, juvenile systemic lupus erythematosus, and juvenile dermatomyositis; to draft clinical remission criteria in juvenile idiopathic arthritis; and to provide cross-cultural adapted and validated quality-of-life instruments like the Childhood Health Assessment Questionnaire and the Child Health Questionnaire in 32 different languages. SUMMARY: The creation of large international trial networks such as PRINTO and PRCSG, the definition of internationally recognized and standardized outcome measures and definitions of improvement, the validation of quality-of-life instruments, and the adoption of adequate legislative measures (pediatric rule) have created the basic premises for the best future assessment of pediatric rheumatic diseases. This progress now affords children with pediatric rheumatic diseases the same opportunities as adults to be treated with drugs whose safety and efficacy have been assessed through legitimate scientifically valid investigations.

Adolescent↗