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PubMed2003

Changes of patients' satisfaction with the health care services in Lithuanian Health Promoting Hospitals network.

The aim of this study is to evaluate the changes of patients' satisfaction with health care services in Lithuanian Health Promoting Hospitals network. In a survey, which was carried out by Lithuanian Health Promoting Hospitals network, 1271 patients took part in 2000 and 1467 patients in 2002. The patient's satisfaction with health care services was evaluated using a uniform anonymous questionnaire. The patients were asked to evaluate hospital environment (neatness, cleanliness, and food quality), the quality of health personnel work (attentiveness, care, risk factors, and tests used for diagnosis and treatment) rating from 1 (very bad) to 6 (excellent). It was ascertained that, during the period between both surveys, the number of patients who evaluated the sanitary conditions in the ward as excellent and very good, increased from 49.2% to 59.9%, p<0.05. According to the data received from both surveys, the hospital food quality was rated more critically than the hospital environment. The number of patients, who noted that the food quality was satisfactory, decreased from 29.8% to 22.0%, p<0.05 within the period analyzed. However the number of patients who had a positive opinion of the health care personnel's attentiveness and help while explaining the causes and consequences of various illnesses increased. Patients' assessment of the physician work remained the same. The majority of the patients (95.1% in 2000 and 94.9% in 2002) appreciated the overall performance of the physicians, and rated it very good and excellent. The analysis of patients' satisfaction is a simple study of a constituent part of the health care service quality assessment and an objective prerequisite for the improvement of the quality of the health care services.

Food Service, Hospital↗
PubMed2003

Better bone density reporting: T-score report versus fracture risk report with outcome analysis.

OBJECTIVE: To determine whether different classification systems for bone fracture risk result in different diagnoses and treatments. STUDY DESIGN: Assessment of 2 diagnostic classification systems by physicians who routinely read bone density scans, using a survey administered by an audience response system. METHODS: At a professional meeting, 103 rheumatologists were asked to read bone density results from 9 case studies in 2 formats: a standard format using T-scores and a format using absolute fracture risk. As physicians were shown each of the 18 scans, they diagnosed each patient with (1) normal bone, (2) osteopenia, (3) osteoporosis, or (4) unknown, and provided a treatment recommendation. Test scans included hip dual-energy x-ray absorptiometry (DEXA) (60%), spine DEXA (10%), phalangeal DEXA (10%), and calcaneal ultrasound (20%). RESULTS: Approximately 1850 anonymous responses were recorded. For women, diagnostic agreement between physicians was 17% for the T-score report and 89% for the absolute risk report (P < .001). For men, diagnostic agreement also was better with the absolute risk report (66% vs 10%; P < .001). With DEXA, overall diagnostic agreement improved from 30% to 68% with the absolute risk report (P < .001). With ultrasound, diagnostic agreement improved from 4% to 63% with the absolute risk report (P < .001). Bisphosphonates were more likely to be prescribed in cases of increasing age and risk if scans were reported in terms of absolute fracture risk. CONCLUSION: A direct, risk-based bone density assessment may improve consistency and efficiency of diagnosis and treatment of osteoporosis.

Absorptiometry, Photon↗
PubMed1995

Expression of cell growth regulated genes in the fetal kidney: relevance to in utero obstruction.

Previous studies of fetal urinary tract obstruction (bladder outlet obstruction and ureteral obstruction) in lambs have shown that obstructions created relatively early in gestation (4/10 to 6/10 term) can significantly affect growth of the developing kidney. This suggests that urinary tract obstruction in utero can alter normal mechanisms of kidney growth. However, a mechanism for these effects has not yet been proposed. In this study we have used mRNA expression analysis to characterize the temporal sequence of expression of several growth-regulated genes during normal ovine kidney development. The purpose of this study was to test the hypothesis that early obstructions, such as those believed to arise in congenital obstructive uropathy in humans, might have a disproportionate effect on hyperplastic growth if the cellular growth fraction (percent of cells in the organ undergoing DNA synthesis) was greater in the second trimester than in the last. Northern blot analysis of the cell cycle-dependent genes histone H3, c-myc and ornithine decarboxylase (ODC) indicated a progressive, gradual decline in cellular proliferation in the kidney from approximately 60 to 135 days (4/10 term to term) gestation, as evidenced by decreases in the respective mRNA levels. The greatest levels of cell proliferation occurred near the midpoint of gestation. This indirect measurement of decline in cellular growth fraction was reflected in direct measurements of change in relative kidney weight. To test whether this decline in mRNA levels occurs widely among genes expressed in the fetal kidney during this period, relative expression levels of more than 300 anonymous mRNA transcripts were evaluated by differential display analysis. This method showed that genes whose expression patterns resembled the growth-regulated genes constituted less than 5% of the expressed mRNAs identified. These data indicate that intrauterine urinary tract obstructions that arise at or near the midpoint of gestation coincide with the highest rates of cell proliferation occurring in the second and third trimesters and, therefore, might adversely affect mechanisms of cell proliferation.

Animals↗
PubMed2005

Young, male, and infected: the forgotten victims of chlamydia in primary care.

OBJECTIVES: To identify current levels of testing men for chlamydia and establish levels of knowledge relating to chlamydia infection among practice nurses in primary care in one north Wales local area health group (LHG) as part of a study to improve delivery of sexual health services in primary care. METHODS: Anonymous confidential self completed postal questionnaires were sent to 46 practice nurses employed at 22 GP practices within one north Wales LHG. On return of the questionnaires and analysis of the data using SPSS, semistructured interviews with seven practice nurses were undertaken. RESULTS: Responses were obtained from 33/46 (71.7%) practice nurses. The majority, 30 (90.9%), do not examine male genitalia and 18 (54.5%) have never tested male patients for chlamydia infection. 28 (84.8%) practice nurses do not consider contact tracing as part of their role. CONCLUSIONS: Primary care has a pivotal part to play in reducing prevalence of chlamydia. The paucity of male testing for chlamydia and a lack of consistent uniform testing and contact tracing in primary care has implications for the prevalence and long term consequences of infection. There is scope to greatly increase male testing for chlamydia both for those presenting with signs and symptoms of infection and those asymptomatic. This cannot be achieved without both educational and financial support for practice nurses.

Adolescent↗
PubMed1999

Heuristic approach to deriving models for gene finding.

Computer methods of accurate gene finding in DNA sequences require models of protein coding and non-coding regions derived either from experimentally validated training sets or from large amounts of anonymous DNA sequence. Here we propose a new, heuristic method producing fairly accurate inhomogeneous Markov models of protein coding regions. The new method needs such a small amount of DNA sequence data that the model can be built 'on the fly' by a web server for any DNA sequence >400 nt. Tests on 10 complete bacterial genomes performed with the GeneMark.hmm program demonstrated the ability of the new models to detect 93.1% of annotated genes on average, while models built by traditional training predict an average of 93.9% of genes. Models built by the heuristic approach could be used to find genes in small fragments of anonymous prokaryotic genomes and in genomes of organelles, viruses, phages and plasmids, as well as in highly inhomogeneous genomes where adjustment of models to local DNA composition is needed. The heuristic method also gives an insight into the mechanism of codon usage pattern evolution.

Codon↗
PubMedDate not supplied

Hepatitis C--knowledge & practices among the family physicians.

BACKGROUND: Hepatitis C virus (HCV) is an important cause of end stage chronic liver disease worldwide. There is plethora of informations on hepatitis C virus in the recent hepatology related periodicals. However, family physicians to whom such patients initially present, should be aware of various aspects of hepatitis C virus infection. Therefore, the present study evaluated the information on hepatitis C virus known to practicing family physician in the state of Punjab. MATERIAL & METHODS: Nine hundred thirty six family physicians were randomly selected from 7 districts of Punjab and were mailed a questionnaire designed to test their knowledge on HCV, its transmission, clinical presentation, complications and treatment. In addition, questions were asked to assess commonly employed mode of therapy for short duration illnesses and the practice of reusing syringes/needles. All question had unequivocal answer. The questionnaire reply was anonymous. RESULTS: Only 28% (n = 262) doctors returned the questionnaire. The response to different sections of questionnaire was variable. Seventy six percent doctors (n = 176) were aware that HCV is parenterally transmitted. 18% (n = 41) doctors were still reusing needles and syringes. Fifty eight percent (n = 134) doctors considered hepatitis C as a common cause of acute viral hepatitis. Only 72% (n = 166) of doctors knew about the relevant tests for diagnosis of hepatitis C. CONCLUSIONS: Despite having knowledge about parenteral route of transmission of HCV infection, a sizeable proportion of family physicians in the Punjab state continues to reuse needles and syringes. Information on the virology, clinical presentation, diagnostic tests and management approaches were lacking among a substantial proportion of family physician. Therefore, awareness about HCV need to be increased among the practicing physicians.

Clinical Competence↗
PubMed2006

Genetic research and testing in critical care: surrogates' perspective.

OBJECTIVE: Genetic testing is increasingly a component of clinical research in critical illness and has potential for integration into routine care. This study explored the perspectives of surrogate decision-makers (SDMs) for acutely ill patients with respect to social, legal, and ethical aspects of genetic testing. SETTING: Medical and surgical intensive care units in an urban tertiary care hospital. INTERVENTION: Questionnaires administered to SDMs for critically ill patients over a 12-month period. MEASUREMENTS AND MAIN RESULTS: A majority of eligible SDMs participated (117/146; 80.8%). SDMs were more likely to permit genetic testing for purposes of diagnosing a treatable life-threatening disease (114/117; 97.4%) or chronic disease (111/117; 94.9%) than for an untreatable life-threatening illness (95/117; 81.2%) (p < .001). SDMs were receptive to testing to explain familial traits (112/117; 95.7%) or ethnic traits (105/117; 89.7%) (p = .131). SDMs were concerned about potential for economic discrimination, with a majority expressing reluctance to permit testing if employers (93/117; 79.5%), health insurers (90/117; 76.9%), or life insurers (92/117; 78.6%) could access results. There was a greater willingness to allow participation in studies in which data were collected anonymously (90/117; 76.9%) vs. nonanonymously (75/117; 64.1%) (p = .04). Finally, SDMs placed greater trust in universities and nonprofit organizations (107/117; 91.4%) than either the federal government (75/117; 64.1%) or pharmaceutical companies (46/117; 39.3%) to perform genetic research (p < .01). CONCLUSIONS: SDMs expressed concerns regarding economic discrimination, confidentiality of data, and trust in entities conducting clinical investigation that may represent barriers both to performing studies in which genetic information is collected and to implementation of gene-based technologies in the critical care environment.

Biomedical Research↗
PubMed1997

Affiliation with Alcoholics Anonymous after treatment: a study of its therapeutic effects and mechanisms of action.

Relatively little is known about how substance abuse treatment facilitates positive outcomes. This study examined the therapeutic effects and mechanisms of action of affiliation with Alcoholics Anonymous (AA) after treatment. Patients (N = 100) in intensive 12-step substance abuse treatment were assessed during treatment and at 1- and 6-month follow-ups. Results indicated that increased affiliation with AA predicted better outcomes. The effects of AA affiliation were mediated by a set of common change factors. Affiliation with AA after treatment was related to maintenance of self-efficacy and motivation, as well as to increased active coping efforts. These processes, in turn, were significant predictors of outcome. Findings help to illustrate the value of embedding a test of explanatory models in an evaluation study.

Adaptation, Psychological↗
PubMed2006

Quantitative analysis of SNRPN(correction of SRNPN) gene methylation by pyrosequencing as a diagnostic test for Prader-Willi syndrome and Angelman syndrome.

BACKGROUND: Angelman syndrome (AS) and Prader-Willi syndrome (PWS) are 2 distinct neurodevelopmental disorders caused primarily by deficiency of specific parental contributions at an imprinted domain within the chromosomal region 15q11.2-13. In most cases, lack of paternal contribution leads to PWS either by paternal deletion (approximately 70%) or maternal uniparental disomy (UPD; approximately 30%). Most cases of AS result from the lack of a maternal contribution from this same region by maternal deletion (approximately 70%) or by paternal UPD (approximately 5%). Analysis of allelic methylation differences at the small nuclear ribonucleoprotein polypeptide N (SNRPN) locus can differentiate the maternally and paternally inherited chromosome 15 and can be used as a diagnostic test for AS and PWS. METHODS: Sodium bisulfite-treated genomic DNA was PCR-amplified for the SNRPN gene. We used pyrosequencing to individually quantify the resulting artificial C/T sequence variation at CpG sites. Anonymized DNA samples from PWS patients (n = 40), AS patients (n = 31), and controls (n = 81) were analyzed in a blinded fashion with 2 PCR and 3 pyrosequencing reactions. We compared results from the pyrosequencing assays with those obtained with a commonly used methylation-specific PCR (MS-PCR) diagnostic protocol. RESULTS: The pyrosequencing assays had a sensitivity and specificity of 100% and provided quantification of methylation at 12 CpG sites within the SNRPN locus. The resulting diagnoses were 100% concordant with those obtained from the MS-PCR protocol. CONCLUSIONS: Pyrosequencing is a rapid and robust method for quantitative methylation analysis of the SNRPN locus and can be used as a diagnostic test for PWS and AS.

Angelman Syndrome↗
PubMed2002

Prevalence of and risk factors for methamphetamine use in northern Thai youth: results of an audio-computer-assisted self-interviewing survey with urine testing.

AIMS: Data from drug treatment facilities, drug seizures and drug arrests suggest rapidly increasing methamphetamine use by adolescents in Thailand. However, limited quantitative data are available about the prevalence of its use or correlates of use. The purpose of our study was therefore to estimate the prevalence of methamphetamine use and to identify possible risk factors. DESIGN: Cross-sectional survey using anonymous audio-computer-assisted self-interview and urine specimen analysis. SETTING: Chiang Rai Province, Thailand. PARTICIPANTS: 1725 students, 15-21 years of age (893 male and 832 female) attending one of three vocational schools in Chiang Rai Province. FINDINGS: Three hundred and fifty male and 150 female students reported a history of having ever used methamphetamine. In addition, 128 male and 49 female students had positive urine test results, indicating recent methamphetamine use; 27 of these students denied having ever used methamphetamine. According to history, urine test, or both, 41.3% of male students and 19.0% of female students used methamphetamine. In multivariate analysis, methamphetamine use was highly correlated with the use of other substances, sexual activity, peer pressure, positive attitudes toward methamphetamine, and absence of a family confidant. CONCLUSIONS: Methamphetamine use is common among adolescent students in northern Thailand. Demographic, behavioral and psychosocial correlates of methamphetamine use identified in this study may be helpful for the design and implementation of preventive interventions.

Adolescent↗
PubMed2005

Patient preference regarding first-trimester aneuploidy risk assessment.

OBJECTIVE: We assessed patient views regarding disclosure of first-trimester Down syndrome risk assessment results compared with withholding results until a single, more accurate second-trimester screening result is available. STUDY DESIGN: A prospective, institutional review board-approved, voluntary, anonymous survey was presented to patients with singleton pregnancies who were undergoing first-trimester nuchal translucency and biochemical screening at our institution. Options included immediate (sequential testing) or later disclosure (integrated testing). Descriptions and a comparison of the options were included in the survey. RESULTS: One hundred one women completed the questionnaires; 69.3% of the patients preferred sequential testing, compared with 30.7% of the patients who were either unsure or preferred integrated testing. Older patients and those patients with better background knowledge of screening tests preferred earlier disclosure of screening results (P = .035 and P = .026, respectively). Patients who preferred earlier disclosure also preferred termination of a Down syndrome pregnancy (P = .013). CONCLUSION: Older patients and those patients with a better understanding of screening tests preferred immediate disclosure of first-trimester risk assessment results; these women were more likely to prefer to terminate an affected pregnancy.

Adult↗
PubMed2004

Sexual differences in oral health behaviour and factors associated with oral health behaviour in Japanese young adults.

The aim of this study is to compare the state of oral health behaviour between genders and to analyse factors associated with oral health behaviour by gender in young adults. Anonymous questionnaire data were collected from 527 adults (245 men and 282 women) aged 20-29 years who consulted dentists in Chiba City. The Chi-square test, Mann-Whitney analysis, and logistic regression analysis were used to examine the differences in oral health behaviour and determinants of oral health behaviour between young men and young women. The rate of good behaviour among women were significantly higher than those among men in each oral health behaviour item (toothbrushing frequency p < 0.001; using dental floss p = 0.042; dental check-ups p < 0.001). In women, factors associated with each oral health behaviour were as follows: toothbrushing frequency (family composition p = 0.030); using dental floss (dental health knowledge p = 0.025, employment status p = 0.031), and dental check-ups (age group p = 0.024). In men, a significant relationship was seen only between using dental floss and age group p = 0.025). This study indicated that young women had better oral health behaviour and that more factors were associated with their oral health behaviour in comparison with young men.

Adult↗
PubMed2003

Risk and risk assessment in pregnancy - do we scare because we care?

OBJECTIVE: To assess whether being labelled 'high-risk' affects women's psychosocial state in pregnancy. DESIGN: Prospective, cross-sectional, non-experimental, case-control study. SETTING: a large city in Germany. PARTICIPANTS: Women between 22 and 41 weeks gestation were identified at antenatal classes and invited to participate in the study. Of the 147 women who were given a questionnaire, 82% (122) responded but only 75% (111) were eligible for inclusion in the study. Of these 111 women, 57 were classified as 'labelled high-risk' and 54 as 'no-risk' according to the risks documented in their antenatal records. MEASUREMENTS: Women's psychosocial state was assessed using a validated, anonymous, self-completed questionnaire, the Abbreviated Scale for the Assessment of Psychosocial State in Pregnancy (Goldenberg et al. 1997). Analysis of covariance (ANCOVA) was performed to test the effect of the risk label on psychosocial state. The effect of other variables, such as parity or education, was also tested. FINDINGS: The effect of the risk label on psychosocial state after adjusting for age was statistically significant (R(2)=0.07, F=7.59, df=1, p=0.001). No significant differences were found for the other independent variables. The data showed that a large number of women had one or more risk factors and that 71% were booked for obstetrician-led care. A high variability in obstetrician's documentation of women's risk factors was also found. CONCLUSION: The data suggest that labelling women to be 'at risk' may negatively affect their psychosocial state. The findings highlight the need to re-evaluate the risk catalogue in the German antenatal record (Mutterpass) as well as the German maternity guidelines (Mutterschaftsrichtlinien). Although this study was conducted within the German system of antenatal care, the findings raise questions about the effects of risk labelling in maternity care wherever it is practised. Further research is needed to assess women's psychosocial state in a more representative sample, to explore women's experiences and satisfaction with the practice of risk assessment and to investigate the reasons for the high variability in documenting women's risk factors.

Adult↗
PubMed1995

An oleate 12-hydroxylase from Ricinus communis L. is a fatty acyl desaturase homolog.

Recent spectroscopic evidence implicating a binuclear iron site at the reaction center of fatty acyl desaturases suggested to us that certain fatty acyl hydroxylases may share significant amino acid sequence similarity with desaturases. To test this theory, we prepared a cDNA library from developing endosperm of the castor-oil plant (Ricinus communis L.) and obtained partial nucleotide sequences for 468 anonymous clones that were not expressed at high levels in leaves, a tissue deficient in 12-hydroxyoleic acid. This resulted in the identification of several cDNA clones encoding a polypeptide of 387 amino acids with a predicted molecular weight of 44,407 and with approximately 67% sequence homology to microsomal oleate desaturase from Arabidopsis. Expression of a full-length clone under control of the cauliflower mosaic virus 35S promoter in transgenic tobacco resulted in the accumulation of low levels of 12-hydroxyoleic acid in seeds, indicating that the clone encodes the castor oleate hydroxylase. These results suggest that fatty acyl desaturases and hydroxylases share similar reaction mechanisms and provide an example of enzyme evolution.

Base Sequence↗
PubMed2006

Driving plastered: who does it, is it safe and what to tell patients.

BACKGROUND: The number and safety of patients who drive in an upper limb fracture cast has been largely untested. This study investigates the proportion of persons who drive in their casts and the capability of a casted persons driving is also assessed. The stance of government and insurance bodies is reviewed. The aim is to provide a guide for when a doctor should advise a patient not to drive while wearing an upper limb fracture cast. METHODS: Patients attending fracture clinic in upper limb casts were anonymously surveyed and asked (along with demographics) if they drove while in a cast and if they believed it illegal or covered by insurance to drive. Driving tests of the author wearing upper limb fracture casts were undertaken. The Queensland police traffic branch, the Queensland Department of Transport and the RACQ insurance company were contacted to review the legal and insurance issues involved. RESULTS: Two-thirds of male and one-third of female patients (half overall) were found to drive while in an upper limb cast. The author failed driving instructor tests in all casts and occupational therapist driving assessments while wearing long arm casts. The author passed occupational therapy driving assessments in left and right short arm casts. CONCLUSIONS: According to these results, a doctor's advice should be to patients not to drive in a long arm upper limb fracture cast and to consider concomitant patient factors when advising patients in short arm casts. Although we do not suggest that patients drive while wearing any cast, we have found a large proportion do. Our limited study has found that a young, fit and pain-free person may be able to drive well enough to pass a driving test while wearing a short arm cast.

Adult↗
PubMed2005

Hepatitis C virus infection, HIV co-infection, and associated risk among injecting drug users in Togliatti, Russia.

The objective of this study was to estimate the prevalence of hepatitis C virus (HCV) infection and co-infection with HIV among injecting drug users (IDUs) in Togliatti City, Russia. Unlinked anonymous cross-sectional survey of IDUs recruited from community settings, with oral fluid sample collection for HCV and HIV antibody (anti-HCV, anti-HIV) testing, was carried out. The anti-HCV prevalence was 87% (357/411), anti-HIV prevalence 56% (234/418), and 93% (214/230) of HIV-positive IDUs were co-infected with HCV. Only 23% (94/411) of those HCV positive self-reported as such. In an adjusted model, increased odds of HCV positivity were associated with needle and syringe, as well as injecting paraphernalia sharing in the last four weeks. IDUs injecting more than once with the same needle also had raised odds. There were no marked associations between HCV positivity and the duration of injecting or age group. Almost all IDUs were HCV positive, and almost all HIV-positive IDUs were HCV co-infected. There is an urgent need to maximize syringe distribution coverage, develop health promotion targeting HCV prevention for IDUs, and improve access among IDUs to treatments for HIV and HCV infection.

Adult↗