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PubMed1992

Oncostatin M.

Oncostatin M (OSM) was initially identified as a polypeptide cytokine which inhibited the in vitro growth of cells from melanoma and other solid tumors. OSM shows significant similarities in primary amino acid sequence and predicted secondary structure to leukemia inhibitory factor (LIF), ciliary neurotrophic factor (CNTF), granulocyte colony-stimulating factor (G-CSF), interleukin 6 (IL-6), and interleukin 11 (IL-11). Analysis of the genes encoding these proteins reveals a shared exon organization suggesting evolutionary descent from a common ancestral gene. Recent data indicates that OSM also shares a number of in vitro activities with other members of this cytokine family. The overlapping biological effects appear to be explained by the sharing of receptor subunits.

Amino Acid Sequence↗
PubMed2005

Receiving marijuana and cocaine as gifts and through sharing.

This paper presents estimates of the probability that individuals who use marijuana and cocaine receive some of their drug as a gift or through sharing. The analysis utilizes data from the National Household Survey of Drug Abuse in the United States of America. This research expands upon the observation of field researchers that sharing and gift giving are common distribution mechanisms in drug markets. The likelihood an individual marijuana or cocaine user receives drug gifts or receives drugs through sharing by others depends on age, race, gender, income and the amount they consume. These findings should assist policy makers designing drug abstinence programs and drug rehabilitation administrators trying to prevent relapse.

Adolescent↗
PubMed2006

Differences in infant and parent behaviors during routine bed sharing compared with cot sleeping in the home setting.

OBJECTIVES: To observe the behavior of infants sleeping in the natural physical environment of home, comparing the 2 different sleep practices of bed sharing and cot sleeping quantifying to factors that have been identified as potential risks or benefits. METHODS: Forty routine bed-sharing infants, aged 5-27 weeks were matched for age and season of study with 40 routine cot-sleeping infants. Overnight video and physiologic data of bed-share infants and cot-sleep infants were recorded in the infants' own homes. Sleep time, sleep position, movements, feeding, blanket height, parental checks, and time out of the bed or cot were logged. RESULTS: The total sleep time was similar in both groups (bed-sharing median: 8.6 hours; cot-sleeping median: 8.2 hours). Bed-sharing infants spent most time in the side position (median: 5.7 hours, 66% of sleep time) and most commonly woke at the end of sleep in this position, whereas cot-sleeping infants most commonly slept supine (median: 7.5 hours, 100%) and woke at the end of sleep in the supine position. Prone sleep was uncommon in both groups. Head covering above the eyes occurred in 22 bed-sharing infants and 1 cot-sleeping infant. Five of these bed-sharing infants were head covered at final waking time, but the cot-sleeping infant was not. Bed-sharing parents looked at or touched their infant more often (median: 11 vs 4 times per night) but did not always fully wake to do so. Movement episodes were shorter in the bed-sharing group as was total movement time (37 vs 50 minutes respectively), whereas feeding was 3.7 times more frequent in the bed-sharing group than the cot-sleeping group. CONCLUSIONS: Bed-share infants without known risk factors for sudden infant death syndrome (SIDS) experience increased maternal touching and looking, increased breastfeeding, and faster and more frequent maternal responses. This high level of interaction is unlikely to occur if maternal arousal is impaired, for example, by alcohol or overtiredness. Increased head covering and side sleep position occur during bed-sharing, but whether these factors increase the risk of SIDS, as they do in cot sleeping, requires further investigation.

Arousal↗
PubMed1998

HLA typing in the United Kingdom multiple sclerosis genome screen.

The United Kingdom multiple sclerosis genome screen demonstrated a peak maximum lod score of 2.8 in the HLA region, together with statistically significant excess transmission of the 121-base pair (bp) allele of the tumour necrosis factor-a marker. In order to determine whether this association is independent of the established HLA association, or simply a consequence of the 121-bp allele being part of the same haplotype, we HLA-DR and -DQ typed the 227 sibling-pair families used in the original screen. The expected associations of multiple sclerosis with the DR15 (p=8.7E-18), DQ6 (p=2.0E-09) and DR51 (p=2.8E-16) phenotypes were confirmed, and excess transmission of the DRB1*1501 and DQB1*0602 alleles was demonstrated. Combining HLA typing with the original microsatellite data demonstrated extensive linkage disequilibrium between the 121-bp allele and the 1501-0602 haplotype. Outside this extended haplotype (121-1501-0602), none of the alleles demonstrated significant transmission distortion. Having established the importance of this extended haplotype, we reanalysed the entire genome screen data after excluding those sibling pairs sharing the extended haplotype (n=27). Conditioning the full genome screen data on the basis of identity by state sharing showed that some potential linkage regions identified in the original screen clustered in families, in which the extended haplotype was shared (1p, 2p and 17q), whereas others grouped with those in which it was not (5cen, 7p and Xq). This suggests complexity in the genetics of multiple sclerosis.

Genetic Markers↗
PubMed2004

Bed-sharing and the infant's thermal environment in the home setting.

AIMS: To study bed-sharing and cot-sleeping infants in the natural setting of their own home in order to identify differences in the thermal characteristics of the two sleep situations and their potential hazards. METHODS: Forty routine bed-sharing infants and 40 routine cot-sleeping infants aged 5-27 weeks were individually matched between groups for age and season. Overnight video and physiological data of bed-share infants and cot-sleeping infants were recorded in the infants' own homes including rectal, shin, and ambient temperature. RESULTS: The mean rectal temperature two hours after sleep onset for bed-share infants was 36.79 degrees C and for cot-sleeping infants, 36.75 degrees C (difference 0.05 degrees C, 95% CI -0.03 to 0.14). The rate of change thereafter was higher in the bed-share group than in the cot group (0.04 degrees C v 0.03 degrees C/h, difference 0.01, 0.00 to 0.02). Bed-share infants had a higher shin temperature at two hours (35.43 v 34.60 degrees C, difference 0.83, 0.18 to 1.49) and a higher rate of change (0.04 v -0.10 degrees C/h, difference 0.13, 0.08 to 0.19). Bed-sharing infants had more bedding. Face covering events were more common and bed-share infants woke and fed more frequently than cot infants (mean wake times/night: 4.6 v 2.5). CONCLUSIONS: Bed-share infants experience warmer thermal conditions than those of cot-sleeping infants, but are able to maintain adequate thermoregulation to maintain a normal core temperature.

Adult↗
PubMedDate not supplied

A defined minimum data set. Will it work for direct patient care?

As health care becomes geographically and institutionally distributed, sharing clinical information becomes necessary for efficiency but harder to achieve. The computerization of patient data promises to facilitate its sharing and reuse. The kind and specificity of data needed, however, vary with the intended use, so defining a data set that is limited in size but broad in application has been problematic. Collecting information that is relevant to direct patient care, and useful for ancillary purposes, requires an understanding of how clinical data are recorded and used. There must be agreement on the vocabulary and the definitions of words. To support clinical decision-making, it must be possible to represent information at various cognitive levels and to different degrees of specificity. Accommodation of ambiguity and uncertainty should be possible. The contextual, temporal, and relational properties of clinical facts must be capable of representation in the data that are shared.

Data Collection↗
PubMed2006

Heritabilities and shared environmental effects were estimated from household clustering in national health survey data.

OBJECTIVES: The relative contributions of genetic and environmental variables to within-household clustering of quantitative traits in household surveys are poorly characterized. We estimated shared genetic and shared environmental contributions to within-household correlation for anthropometric variables and cardiovascular disease risk factors. STUDY DESIGN AND SETTING: Data were analyzed for the Health Survey for England 1998, a representative national household survey. Two-generation pedigrees were defined using information for relationships within households. After standardizing for age and sex, data were analyzed for 11 quantitative traits. Variance components models were fitted to estimate the proportion of variance due to additive genetic variance or shared environmental effects. RESULTS: Within-household correlation coefficients for all related and unrelated subjects ranged from 0.10 for C-reactive protein to 0.31 for height. Pairwise correlations between related individuals within households were consistently higher than those between unrelated individuals. Estimated heritability ranged from 6% for diastolic blood pressure to 40% for serum cholesterol. The proportion of variance attributable to shared environmental effects ranged from 8% for cholesterol to 24% for height. CONCLUSION: In this large, representative national sample of generally small families, estimates for heritability were generally lower than previously reported, whereas the contribution of shared environment and individual-level variation were greater.

Anthropometry↗
PubMed2001

Improving patient recruitment to multicentre clinical trials: the case for employing a data manager in a district general hospital-based oncology centre.

One of the most frequently cited reasons for poor recruitment to multicentre randomized clinical trials is the additional workload placed on clinical staff. We report the effect on patient recruitment of employing a data manager to support clinical staff in an English district general hospital (DGH). In addition, we explore the effect data managers have on the quality of data collected, proxied by the number of queries arising with the trial organizers. We estimate that the cost of employing a data manager on a full-time basis is 502 per patient recruited but may amount to 326 if the appointment is part-time. Data quality is high when full responsibility lies with a data manager but falls when responsibility is shared. Whether the costs of employing a data manager to recruit patients from a DGH are worth incurring depends on the value placed on the speed at which multicentre trials can be completed, how important it is to broaden the research base beyond the traditional setting of teaching hospitals, and the amount of evaluative data required.

Clinical Trials as Topic↗
PubMed2000

Get your fair share of HMO premium increases.

Data Insight: The latest InterStudy HMO statistics show that premiums are up, administrative costs are down, and membership is falling slightly. Do these trends mean more money is on the way for physician groups?

Capitation Fee↗
PubMed1990

[Personal laboratory data management system using optical card].

This paper describes the development and state of the medical optical card system. Recently, computerized medical information systems have been developed in many hospitals and they allow quick access and automatic processing of the patient's data in medical practice and research. However, the use of the information stored by such a system has been limited to each hospital while it is not rare for a patient to change hospitals. It is desirable to develop a personal medical data management system which allows the patient to carry his own medical records for a long period of time, and hospitals to share the information about the patient. The optical card is a transportable information medium with a large capacity. Since data are recorded optically with a laser beam, the card is tolerant to environmental factors such as static electricity, magnetism and impact which injure other transportable media such as IC card, magnetic stripe card and floppy disk. Therefore, the optical card suits our purpose. We developed a prototype of the medical optical card system. In our system, the card can contain character data, numerical data, two-valued image data and electrocardiographical data. In order to share laboratory data among different database systems, we defined a data descriptive language which enables complete and compact data description without any external code tables. The recorded patient data are presented in the original multi-window system, which allows the doctor to see any combination of any part of the patient's information simultaneously.

Clinical Laboratory Information Systems↗
PubMed1996

The effect of cost sharing on the use of chiropractic services.

OBJECTIVES: Chiropractic care is increasing in the United States, and there are few data about the effect of cost sharing on the use of chiropractic services. This study calculates the effect of cost sharing on chiropractic use. METHODS: The authors analyzed data from the RAND Health Insurance Experiment, a randomized controlled trial of the effect of cost sharing on the use of health services. Families in six US sites were randomized to receive fee-for-service care that was free or required one of several levels of cost sharing, or to receive care from a health maintenance organization (HMO). Enrollees were followed for 3 or 5 years. All fee-for-service plans covered chiropractic services. Persons assigned to the HMO experimental group received free fee-for-service chiropractic care; persons in the HMO control group had 95% cost sharing for chiropractic services. The authors calculated the mean annual chiropractic expense per person in each of the fee-for-service plans, and also predicted their chiropractic expenditures using a two-equation model. Chiropractic use among persons receiving HMO and fee-for-service care were compared. RESULTS: Chiropractic care is very sensitive to price, with any level of coinsurance of 25% or greater decreasing chiropractic expenditures by approximately half. Access to free chiropractic care among HMO enrollees increased chiropractic use ninefold, whereas access to free medical care decreased fee-for-service chiropractic care by 80%. CONCLUSIONS: Chiropractic care is more sensitive to price than general medical care, outpatient medical care, or dental care, or and nearly as sensitive as outpatient mental health care. A substantial cross-price effect with medical care may exist.

Adult↗
PubMed2003

Human health and environmental risk assessment: the need for a more harmonised and integrated approach.

Historically the procedures for human risk assessment and for risk assessment have developed separately with different terminologies and separate data bases. The identification that there are many common features and that sharing of certain types of data for risk assessment purposes would be beneficial is a driver towards a better integration of their procedures. Risk assessors are facing increasing challenges from governments, stimulated by public pressure for (i) human and environmental risk assessments of an ever growing number of products and processes, (ii) further restrictions of the use of animal tests and human studies on ethical grounds, (iii) the requirement to demonstrate that the assessments are independent, transparent and of high quality, (iv) reducing resources in particular a diminishing number of individuals with the scientific depth, breadth and independence act as risk assessors, (v) the need to incorporate new sciences continually and new discoveries into the risk assessment process. It is important for society that these challenges are met successfully. This requires changes in both risk assessment procedures and in the infrastructure needed to support them. Risk assessment is a science based process for establishing the likelihood of adverse effects to human health and to the environment from specific chemical, biological and physical agents. In the last few years there has been a renewed effort, by international bodies such as WHO, OECD and the EU, to achieve a more integrated and harmonised approach to risk assessment. Before examining the potential for a more integrated approach to risk assessment it is timely to consider the key factors which have led to the current position.

Databases, Factual↗
PubMed1995

Manipulative therapy versus education programs in chronic low back pain.

STUDY DESIGN: A randomized trial was conducted on a representative sample of patients with untreated low back pain lasting 7 weeks or longer, or having more than 6 episodes in 12 months. OBJECTIVES: To contrast the effectiveness of manipulation, a manipulation mimic, and a back education program. Methodologic criticisms of earlier studies were addressed. SUMMARY OF BACKGROUND DATA: Published meta-analyses suggest clinical benefit from manipulation for acute patients. Data are inconclusive for patients having symptoms for longer than 1 month. METHODS: A total of 1267 consecutive patients were screened. Block randomization was used to assign 209 qualifying patients to treatment groups. Self-reported pain and activity tolerance served as primary outcome measures. Patients were assessed at enrollment, after 2 weeks of treatment, and again after 2 weeks without treatment. Multiple teams conducted recruitment, randomization, assessment, treatment, and data analysis independently without sharing information. Treatments were carefully described, monitored, and balanced for physician attention and physical contact effects. RESULTS: A total of 81.3% of subjects completed the study. Confounding factors and missing data were identified in approximately 20% of those completing the final follow-up. Analysis of the remaining data was carried out. A strong time effect under treatment was observed. Greater improvement was noted in pain and activity tolerance in the manipulation group. Immediate benefit from pain relief continued to accrue after manipulation, even for the last encounter at the end of the 2-week treatment interval. CONCLUSION: Time is a strong ally of the low back pain patient. In human terms, however, there appears to be clinical value to treatment according to a defined plan using manipulation even in low back pain exceeding 7 weeks' duration.

Adult↗
PubMed2006

Major histocompatibility complex and kin discrimination in Atlantic salmon and brook trout.

Many species of salmonids can discriminate kin from unrelated conspecifics using olfactory cues. In this study, we determined the role of the major histocompatibility complex (MHC) in kin discrimination by juvenile Atlantic salmon (Salmo salar) and brook trout (Salvelinus fontinalis). Genetic variation at the highly polymorphic exon coding for peptide-binding region of an MHC class II gene was studied using polymerase chain reaction and denaturing gradient gel electrophoresis. Experiments compared discrimination ability based on MHC haplotypes both within and among kin and non-kin groups. Juveniles chose kin sharing both alleles over kin sharing no alleles. Juveniles also preferred non-kin sharing both alleles to non-kin sharing no alleles. These data suggest that the MHC class II gene influence kin discrimination in juvenile Atlantic salmon and brook trout. The influence of additional genes was also apparent in trials where juveniles were able to recognize kin sharing no alleles over non-kin sharing no alleles. However, the inability of juveniles to discriminate between kin sharing no alleles and non-kin sharing either one or both alleles indicates that MHC is as potent as the rest of the genome in producing distinguishable odours.

Alleles↗
PubMed1998

Researching the public/private mix in health care in a Thai urban area: methodological approaches.

The private health sector has been growing rapidly in many low and middle income countries, yet not enough is known about its sources of finance or characteristics of its users. Moreover, health care reform measures are leading to alterations in the mix of public and private finance and provision, increasing further the need for information. This paper presents and evaluates some research methods which can be used to collect information relevant to considering policies on the public/private mix. They comprise a household survey, a health diary and interview survey, a bed census, and a health resource survey. Each method is described as it was used in a study in a large urban setting in Thailand, and strengths and weaknesses of the methods are identified. The use of data to estimate the shares of public and private finance and provision, and particularly private sources of finance of public hospitals and public sources of finance for private hospitals, is demonstrated. Policy issues highlighted by the data are identified.

Health Care Reform↗
PubMed2005

Lessons learned: geographic information systems and farmworkers in the Lake States.

Agencies serving the estimated 42,000 to 137,000 migrant and seasonal farmworkers in the Lake States (Wisconsin, Michigan, and Minnesota) face distinct challenges, including inadequate access to farmworker data to address their needs. This project developed and evaluated a geographical information system (GIS) database for compiling and displaying existing farmworker data in the Lake States. A three-step study was conducted in the Lake States: (1) a preliminary resource and needs assessment was conducted among agencies serving farmworkers, (2) a GIS product was created using data available from state agencies, and (3) the GIS product was evaluated by an advisory board of qualified occupational health and safety representatives for appropriateness, applications, and ease of use. Agencies participated by sharing their available farmworker data. The GIS product consisted of a CD-ROM with data displayed in a graphic format and downloadable spreadsheet files consolidated by county demographic, crop, housing, and migrant health clinic information. Evaluators of the GIS product found it to be an accessible, unique clearinghouse for farmworker-related data. The GIS product can become a valuable tool for agencies serving farmworkers and those researching farmworker-related issues. Agencies and health professionals require useful and comprehensive databases to track and serve farmworkers, and a multi-agency partnership using GIS technology could provide this capability. Further research is required with improved definitions and resources to apply the GIS product.

Agricultural Workers' Diseases↗
PubMedDate not supplied

[Kinetics of deoxyribonuclease I action on the DNA of different white rat tissues].

Studies have been made on the kinetics of the effect of DNAse I on nuclear DNA from the brain cortex, liver, spleen and kidney of albino rats. In all the nuclei studied, two DNA sites revealed which especially differ in the rate of their splitting. The share of rapidly splitted DNA amounts in the nuclei of the kidney and brain cortex up to 30%, in those of the liver and spleen -- about 25%. These findings are discussed in relation to the data available on the share of transcribed chromatin in the same tissues obtained by hybridization with nuclear RNA. For the brain and liver this method yields the same values, whereas for the spleen and kidney this test yields significantly lower values, i. e. about 10%.

Animals↗
PubMed1996

Shared care: a review of the literature.

This review examines broad issues of concern regarding the primary/secondary care interface. The main purpose was to identify areas of good practice which could be adapted for more general use. One of the most fundamental aspects identified was communication, which is discussed in some detail. Also covered are shared prescribing and disease management. The data suggest that the most effective system(s) of shared care has yet to be established. Further qualitative and economic evaluations are required, taking into account patient preferences. Although the literature does describe certain practice exemplars, it is clear that inter- and intra-professional communication continues to be a problem. Whilst information technology may provide some of the solutions, it is concluded that a culture change, which compels health professionals to make sharing of patient information a much higher priority, is required.

Continuity of Patient Care↗