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PubMed2004

Epidemiology of hand dermatitis among rural nursing students in mainland China: results from a preliminary study.

INTRODUCTION: Although hand dermatitis (HD) is known to affect nursing students worldwide, no studies of this disease have yet been conducted in China. Similarly, rural populations are often neglected in international research. METHODS: A preliminary study of female students from both grades of a hospital-based nursing school was conducted in Hebei Province, China, approximately 280 km south of Beijing. There were 27 students from the 2nd year of the course (47.4%) and 30 students from the 3rd year (52.6%). The study protocol involved an anonymous questionnaire distributed to a convenience sample of both grades from the nursing school. Statistical differences in prevalence by year of study were calculated using Fisher's exact test for discrete variables and One-way Analysis of Variance (ANOVA) for continuous variables. Statistical associations between HD and demographic items were investigated using the chi2 test. Where statistical association with HD were identified, simple logistic regression was also performed to establish a basic risk magnitude. Results were compared with similar populations of student nurses from previous studies in Australia, Japan, Denmark, the Netherlands and Germany. RESULTS: HD prevalence fell from 29.6% in the 2nd year to 13.3% in the 3rd year and averaged 21.1% across both grades. Systemic allergic disease among family members was found to be statistically associated with HD (p < 0.05). Overall, our preliminary study showed that HD probably affects Chinese nursing students at rates similar to that of their Japanese counterparts, but at a higher rate than students in other investigations from Germany, Holland and Australia. The identification of familial allergic disease as a possible risk factor for HD was also novel. CONCLUSION: The investigation was conducted as a preliminary investigation, and as such, our results need to be treated with caution. Further research is recommended to more carefully elucidate the prevalence of HD among larger groups of Chinese nursing students.

Journal Article↗
PubMedDate not supplied

Sources of occupational stress among firefighter/EMTs and firefighter/paramedics and correlations with job-related outcomes.

INTRODUCTION/OBJECTIVE: This paper reports the results of an initial effort to develop and test a measure of the various sources of job-related stress in firefighter and paramedic emergency service workers. METHODS: A 57-item paper and pencil measure of occupational stressors in firefighter/Emergency Medical Technicians (EMTs) and firefighter/paramedics was developed and administered by anonymous mail survey. RESULTS: More than 2,000 (50% rate of return) emergency service workers completed and returned the surveys. The responses of 1,730 firefighter/EMTs and 253 firefighter/paramedics were very similar in terms of the degree to which job stressors were bothersome. A factor analysis of replies yielded 14 statistically independent "Occupational Stressor" factors which together accounted for 66.3% of the instrument's variance. These Sources of Occupational Stress (SOOS) factor scale scores essentially did not correlate with a measure of the social desirability test-taking bias. Finally, SOOS factors were identified that correlated with job satisfaction and work-related morale of the respondents. Conflict with administration was the job stressor factor that most strongly correlated with reports of low job satisfaction and poor work morale in both study groups. CONCLUSION: The findings suggest that firefighter and paramedic job stress is very complicated and multi-faceted. Based on this preliminary investigation, the SOOS instrument appears to have adequate reliability and concurrent validity.

Adult↗
PubMed2005

Use of the serologic testing algorithm for recent HIV seroconversion (STARHS) to identify recently acquired HIV infections in men with early syphilis in Los Angeles County.

BACKGROUND: Syphilis outbreaks among men who have sex with men (MSM) in the United States, many of whom are HIV infected, have prompted increased concern for HIV transmission. METHODS: To identify whether men are acquiring HIV concomitantly or within the critical period of syphilis infection, banked Treponema pallidum particle agglutination-positive serum specimens from men with early syphilis infection were screened for HIV-1 antibody. Samples that were positive for HIV antibody were then tested with a less sensitive (LS) HIV-1 antibody enzyme immunoassay (serologic testing algorithm for recent HIV seroconversion [STARHS]) to identify HIV infections that occurred on average within the previous 6 months. RESULTS: Of the 212 specimens banked from men with early syphilis, 74 (35%) were HIV-positive. Of these, 15 tested non-reactive by the LS assay. Twelve of these 15 were considered to be recent infections by the LS assay and testing history. Eleven (92%) of the recent infections were among MSM. One man had primary syphilis, 6 (50%) had secondary syphilis, and 5 (42%) had early latent syphilis. Eight men (67%) reported sex with anonymous partners, and 3 (25%) reported consistent condom use. The estimated HIV incidence was 17% per year (95% confidence interval [CI]: 12%-22%) among all men with early syphilis, and it was 26% per year (95% CI: 91%-33%) among MSM. CONCLUSIONS: Syphilis epidemics in MSM may be contributing to HIV incidence in this population. The STARHS can be applied as a surveillance tool to assess HIV incidence in various at-risk populations, but further studies are necessary for validation.

Adult↗
PubMed1994

Stored Guthrie cards as DNA "banks".

Recently there has been much discussion about the possibility of using dried blood spots on Guthrie cards as a source of DNA for research or testing purposes. The collections of Guthrie cards stored by state newborn-screening laboratories can thus be viewed as inchoate "DNA banks." This has generated concern among some persons who are interested in preserving the privacy of medical records. This study examines the policies of state newborn-screening laboratories in the United States, regarding their retention of Guthrie cards and the degree to which they permit the sharing of those cards with various third parties. We found that although most laboratories retain their cards, if at all, for only a short time, a growing number plan to keep them for an extended period--and, in several cases, indefinitely. We also found that although most laboratories would decline to release individually identifiable blood spots from the cards to third parties without a written release or other explicit authorization, a large number would at least consider sharing anonymous cards for research purposes.

Biological Specimen Banks↗
PubMed1988

Alcoholism, Alcoholics Anonymous attendance, and outcome in a prison system.

The purpose of this study was to assess the relationship between attendance at meetings of Alcoholics Anonymous (AA) and follow-up status in a sample of prison inmates. Subjects (N = 102) were administered three self-report measures of alcoholism: the MAST, CAGE, and Rosett Quantity-Frequency tests. AA attendance during incarceration was recorded. One-year follow-up status, ranging from transfer to a more secure facility to discharge from the prison system, was used as an outcome indicator. ResuLts revealed that 56% of the subjects met the criteria for alcoholism on at least one measure, and that scores on the alcoholism measures were significantly correlated with AA attendance. Thus, the most severe alcoholics were the best AA attenders. The hypothesis that greater AA attendance would predict follow-up outcome was not confirmed. However, the extent of drinking reported prior to admission (average alcohol quantity per week) was related to security status at 1-year follow-up. The greater the drinking quantity, the more likely the inmate was to be in a more secure facility. Possible explanations for the findings and the need for a longer follow-up period are discussed.

Alcoholics Anonymous↗
PubMed1998

The reported training and experience of editors in chief of specialist clinical medical journals.

CONTEXT: The majority of the peer-reviewed clinical literature is edited by editors whose training in editorial matters may be limited or nonexistent. We suspect that editors are selected for their clinical or academic rather than editorial ability. OBJECTIVE: To test the hypothesis that editors of medical specialist clinical journals were recruited from active clinicians rather than those with evident ability or training as editors. DESIGN, SETTING, AND SUBJECTS: Anonymous mail survey to editors of the 262 peer-reviewed clinical journals that had received at least 1000 citations in the 1994 Science Citation Index. MAIN OUTCOME MEASURES: Training and editorial practices of editors. RESULTS: Replies were received from 191 editors (73%): in 1994 the journals they edited had 6060 (27300/1000 [maximum/minimum]) citations, 234 (740/31) source items, and an impact factor of 2.10 (18.3/0.2); nonresponders' journals had similar characteristics. Of the responding editors, 181 (95%) were part-time, 132 (69%) treated patients, and 164 (86%) were recruited by one of the following methods: election by a scientific society (49 [30%]), nomination by the previous editor (41 [25%]), or response to an advertisement (29 [18%]). There was no strong association between method of recruitment or formal editorial training and the status of the journal. Only 9% of editors in the United States send at least half of the papers to reviewers outside their own country, compared with 41% of editors in the United Kingdom and 73% in other countries, and 69% do not feel bound to follow the advice they receive concerning acceptance of papers. CONCLUSIONS: Clinical journals are usually edited by practicing clinicians who are self-taught part-time editors, but willing to accept further training. They usually consult 2 reviewers, but exercise independent judgment on the acceptability of papers.

Peer Review↗
PubMed1991

Human immunodeficiency virus-1 infection in an infertile population.

OBJECTIVE: The aim of our study was to determine the prevalence of human immunodeficiency virus-1 (HIV-1) in an infertile population. DESIGN: The study design included a retrospective anonymous survey of clinical data and screening for HIV-1 antibody by enzyme-linked immunoabsorbent assay (ELISA) in stored sera. Samples that were ELISA-positive were further tested by Western blot assay. Frequency distributions were analyzed by Fisher's exact test. SETTING: University tertiary care center. PARTICIPANTS: Based on availability of stored frozen sera, the total study population included 182 of 304 consecutively registered infertile couples. RESULTS: Seventy-five percent of the study population were found to have one or more risk factors for HIV infection. Of the 252 sera tested, 10 were repeatedly reactive by ELISA, and Western blot testing confirmed HIV-1 infection in one woman and two men. CONCLUSIONS: This relatively high HIV-1 seroprevalence (male: 2.6%; female: 0.6%) in a low-middle class infertile population emphasizes the urgent need to implement on-site HIV-infection counseling aimed at preventing the spread of disease to the healthy partner and fetus and to discuss therapeutic and reproductive options.

Adolescent↗
PubMed2001

The potential impact of incentives on future blood donation behavior.

BACKGROUND: It is important to assess the potential efficacy and safety of offering donation incentives as part of recruitment and retention programs. STUDY DESIGN AND METHODS: In 1995, 7489 allogeneic donors responded to an anonymous mail survey that inquired about demographics, donation history, infectious disease risks, and the potential appeal of incentives. RESULTS: The projected net effect of offering blood credits and medical testing would be to motivate, respectively, 58 percent and 46 percent of donors to return, whereas offering an item of limited value would motivate 20 percent to do so. First-time and younger donors reported more frequently than repeat or older donors that incentives would appeal to them. Donors attracted by cash were 60 percent more likely to have a risk for transfusion-transmissible infections (p = 0.03). Although not statistically significant, the odds of being an at-risk donor were higher among individuals attracted by tickets to events (OR 1.5) and extra time off work (OR 1.2). CONCLUSION: These findings suggest that offering blood credits and (though to a lesser extent) items of limited value could be safe and effective strategies for retaining donors. Although medical tests were found to have broad appeal, studies are needed to identify tests in which donors would be most interested.

Behavior↗
PubMed2005

Human-zebrafish non-coding conserved elements act in vivo to regulate transcription.

Whole genome comparisons of distantly related species effectively predict biologically important sequences--core genes and cis-acting regulatory elements (REs)--but require experimentation to verify biological activity. To examine the efficacy of comparative genomics in identification of active REs from anonymous, non-coding (NC) sequences, we generated a novel alignment of the human and draft zebrafish genomes, and contrasted this set to existing human and fugu datasets. We tested the transcriptional regulatory potential of candidate sequences using two in vivo assays. Strict selection of non-genic elements which are deeply conserved in vertebrate evolution identifies 1744 core vertebrate REs in human and two fish genomes. We tested 16 elements in vivo for cis-acting gene regulatory properties using zebrafish transient transgenesis and found that 10 (63%) strongly modulate tissue-specific expression of a green fluorescent protein reporter vector. We also report a novel quantitative enhancer assay with potential for increased throughput based on normalized luciferase activity in vivo. This complementary system identified 11 (69%; including 9 of 10 GFP-confirmed elements) with cis-acting function. Together, these data support the utility of comparative genomics of distantly related vertebrate species to identify REs and provide a scaleable, in vivo quantitative assay to define functional activity of candidate REs.

Animals↗
PubMed2003

Perioperative adenotonsillectomy management in children: current practices.

OBJECTIVE: To determine the current practices of preoperative evaluation, surgical techniques, and postoperative treatment of pediatric adenotonsillectomy. STUDY DESIGN: Forty-one-item survey measuring the frequency of different evaluations, procedures, and treatments performed, including selected case scenarios, with all items scored on a five-point ordinal scale ranking frequency. METHODS: The entire membership of the American Society of Pediatric Otolaryngology (ASPO) and active fellows and members of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) residing in New York state were anonymously surveyed through mail-in questionnaires. RESULTS: History alone was the most frequent modality for diagnosing both adenoid enlargement and obstructive sleep apnea. The most common preoperative laboratory test ordered before an adenotonsillectomy is a complete blood cell count; ASPO members ordered fewer preoperative laboratory tests than AAO-HNS members. Unipolar cautery is the most frequently used tonsillectomy technique, and curettage followed by cautery is the most popular adenoidectomy technique. Steroids are the most common intraoperative medication administered during an adenotonsillectomy, and office visits remain the most frequently used methods of assessing adenotonsillectomy patients postoperatively. CONCLUSIONS: Although there are statistically significant trends uncovered by the survey, the results reflect a lack of consensus regarding adenotonsillectomy management. Further randomized controlled trials or large-scale outcomes projects are much needed to evaluate critically the current practices of pediatric adenotonsillectomies. Additional efforts may also be required to use the information from these studies in effecting changes in actual practice patterns, moving us toward a more evidence-based paradigm of treating pediatric adenotonsillar disease.

Adenoidectomy↗
PubMed2004

Accuracy in identification of patients with 22q11.2 deletion by likely care providers using facial photographs.

Numerous facial characteristics are associated with velocardiofacial syndrome. Care providers may use these facial characteristics to identify patients who may benefit from fluorescence in situ hybridization genetic testing to determine the presence of the 22q11.2 deletion. The purpose of this study was to test the hypothesis that experienced care providers were able to correctly diagnose the 22q11.2 deletion on the basis of studying frontal facial photographs. After approval was obtained from the human studies committee, patients who had undergone fluorescence in situ hybridization genetics testing for the presence of a 22q11.2 deletion were asked to submit two frontal photographs: one at infancy and one beyond the second birthday. These photographs were randomized, made anonymous, and then placed on a secure Web site. Specialists in the fields of plastic surgery, otolaryngology, genetics, and speech pathology were asked to evaluate their experience and confidence levels in diagnosing a 22q11.2 deletion and were then asked to rate the photographs by likelihood of deletion using a five-point Likert scale. Thirty-two specialists (10 surgeons, nine geneticists, and 13 speech pathologists) participated in the study. On the basis of clear responses, respondents predicted the presence (sensitivity) and absence (specificity) of the 22q11.2 deletion at chance levels. Of the remaining responses, 20 to 25 percent were unsure and 20 to 25 percent were clearly wrong. When an unsure response was treated as a weak positive, the results favored sensitivity slightly, with a sensitivity of 70 percent and a specificity of 50 percent. Sensitivity improved somewhat with experience, as measured by the number of patients seen per year. The prediction of the presence or absence of the 22q11.2 deletion at chance levels suggests that the ability to diagnose on the basis of appearance alone is not a sufficient diagnostic tool. Although the ability does increase with experience, it is of statistical but not clinical significance.

Abnormalities, Multiple↗
PubMed2006

Modelling the force of infection for hepatitis B and hepatitis C in injecting drug users in England and Wales.

BACKGROUND: Injecting drug use is a key risk factor, for several infections of public health importance, especially hepatitis B (HBV) and hepatitis C (HCV). In England and Wales, where less than 1% of the population are likely to be injecting drug users (IDUs), approximately 38% of laboratory reports of HBV, and 95% of HCV reports are attributed to injecting drug use. METHODS: Voluntary unlinked anonymous surveys have been performed on IDUs in contact with specialist agencies throughout England and Wales. Since 1990 more than 20,000 saliva samples from current IDUs have been tested for markers of infection for HBV, HCV testing has been included since 1998. The analysis here considers those IDUs tested for HBV and HCV (n = 5,682) from 1998-2003. This study derives maximum likelihood estimates of the force of infection (the rate at which susceptible IDUs acquire infection) for HBV and HCV in the IDU population and their trends over time and injecting career length. The presence of individual heterogeneity of risk behaviour and background HBV prevalence due to routes of transmission other than injecting are also considered. RESULTS: For both HBV and HCV, IDUs are at greatest risk from infection in their first year of injecting (Forces of infection in new initiates 1999-2003: HBV = 0.1076 95% C.I: 0.0840-0.1327 HCV = 0.1608 95% C.I: 0.1314-0.1942) compared to experienced IDUs (Force of infection in experienced IDUs 1999-2003: HBV = 0.0353 95% C.I: 0.0198-0.0596, HCV = 0.0526 95% C.I: 0.0310-0.0863) although independently of this there is evidence of heterogeneity of risk behaviour with a small number of IDUs at increased risk of infection. No trends in the FOI over time were detected. There was only limited evidence of background HBV infection due to factors other than injecting. CONCLUSION: The models highlight the need to increase interventions that target new initiates to injecting to reduce the transmission of blood-borne viruses. Although from the evidence here, identification of those individuals that engage in heightened at-risk behaviour may also help in planning effective interventions. The data and methods described here may provide a baseline for monitoring the success of public health interventions.

England↗
PubMedDate not supplied

Eating disorders in graduate students: exploring the SCOFF questionnaire as a simple screening tool.

The results of several studies have established the validity of the SCOFF questionnaire (a 5-question screening tool for eating disorders), but researchers need to explore further replicability using the US version in the graduate school population. In this study, the authors asked 335 graduate students attending the Northwestern student health clinic on the Chicago campus to complete a written survey anonymously. A total of 305 (91%) patients completed the survey. The sensitivity and specificity for the SCOFF was 53.3% and 93.2%, respectively. This produced a PPV (the proportion who tested positive on the screen and actually had an eating disorder) of 66.7% and an NPV (the proportion of those who tested negative on the screen and actually did not have an eating disorder) of 88.7%. More than 80% of respondents were dissatisfied with their shape and weight, with over one third having a moderate to severe body image disturbance. The SCOFF is an easy instrument to administer that health care providers can use to screen for eating disorders in the primary care setting.

Adult↗
PubMed1992

Substance abuse during pregnancy in a rural population.

Drug abuse during pregnancy in rural populations has received less attention than that in urban populations. Urban studies have reported alarming rates, but it is unknown whether the situation is the same in rural areas. To investigate this, urine samples were collected anonymously from 181 pregnant women who presented to the University of Missouri clinics for care and who resided in communities of less than 25,000. Each urine specimen was tested for cocaine, marijuana, amphetamines, barbiturates, opiates, phencyclidine, benzodiazepines, ethanol, and nicotine. Of the 181 specimens, 83 (46%) contained nicotine, 17 (9.4%) contained marijuana, and one each (0.6%) tested positive for cocaine, barbiturates, ethanol, and benzodiazepines. No other tested substances were detected. Excluding nicotine and ethanol, 20 (11%) of the urine samples tested positive for the screened substances. Review of the prenatal records revealed that 46% of the women reported using tobacco, 15% reported using alcohol, and 8.3% reported illicit drug use during pregnancy. This study indicates that there is a substantial drug abuse problem in rural populations, and that the profile of abuse differs from that of urban populations. Tobacco, ethanol, and marijuana were the most prevalent substances abused during pregnancy, but cocaine was a minor problem. This information may help in directing resources to reduce drug abuse during pregnancy.

Female↗
PubMed2000

Work-related stress and occupational burnout in AIDS caregivers: test of a coping model with nurses providing AIDS care.

Occupational stress and burnout are potential threats to quality of care for people living with HIV/AIDS. A total of 445 nurses who provide care to people living with HIV/AIDS responded to an anonymous postal survey that consisted of: demographic and work history questions, the Maslach Burnout Inventory, Rotter's Internal-External Locus of Control scale, and internal and external coping styles as measured by the Ways of Coping scale. Path analyses showed that both external (13.6% of the variance) and internal (3.1% of the variance) coping styles significantly predicted levels of burnout among AIDS caregivers, over and above participants' age, perceived workload and locus of control. Mediation analyses further showed that external coping mediates the effect of locus of control on burnout, but internal coping styles do not exhibit mediation. Results therefore replicate and extend previous research demonstrating the important roles of cognitive and behavioural coping styles in understanding burnout among providers of AIDS care.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Linkage map integration.

The algorithms that drive the map+ program for locus-oriented linkage mapping are presented. They depend on the enhanced location database program ldb+ to specify an initial comprehensive map that includes all loci in the summary lod file. Subsequently the map may be edited or order constrained and is automatically improved by estimating the location of each locus conditional on the remainder, beginning with the most discrepant loci. Operating characteristics permit rapid and accurate construction of linkage maps with several hundred loci. The map+ program also performs nondisjunction mapping with tests of nonstandard recombination. We have released map+ on Internet as a source program in the C language together with the location database that now includes the LODSOURCE database. The anonymous ftp is cedar.genetics.soton.ac.uk and the World Wide Web address is http://cedar.genetics.soton.ac.uk/public_html.

Algorithms↗
PubMed1991

Resident evaluation of surgical faculty.

This study examines the association between resident evaluations of surgical faculty and measures of teaching activity and practice characteristics. Twenty-three of 33 general surgery residents, anonymously and voluntarily rated 62 faculty surgeons in 10 areas of performance. This was repeated 1 year later with 24 of 28 residents and 64 surgeons. Ratings were reliable (test-retest on overall mean rating, r = 0.91, P less than 0.01). Factor analysis of ratings by residents in postgraduate year (PGY) 5 extracted a judgment factor and an interpersonal skills factor. Ratings by other PGYs were unidimensional. Faculty subgroups that performed more than two major procedures per week at the hospital (P less than 0.01) attended the weekly Mortality and Morbidity conference more than once per month (P less than 0.05) and/or published one or more research reports (P less than 0.05) received higher ratings than those who did not. Among general surgeons (n = 35), ratings of interpersonal skill by PGY 5 residents correlated inversely with complication rate (r = -0.41, P less than 0.05) and overall ratings by PGYs 3 and 4 correlated inversely with mean patient length-of-stay (LOS; r = -0.44, P less than 0.05). These remained significant after statistical adjustment for case mix differences and differences in the amount of contact with residents. Resident ratings were unrelated to mean patient age, the mean number of diagnoses per patient, and the mean number of procedures per patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation Studies as Topic↗
PubMed1991

Fanconi anemia: evidence for linkage heterogeneity on chromosome 20q.

Fanconi anemia is a rare autosomal recessive disorder in which affected individuals are predisposed to acute myelogenous leukemia and other malignancies. We report the results of a genetic linkage study involving 34 families enrolled in the International Fanconi Anemia Registry. A significant lod score was obtained between D20S20, an anonymous DNA segment from chromosome 20q, and Fanconi anemia (Zmax 3.04, theta max = 0.12). However, six other anonymous DNA segments from chromosome 20q, including D20S19, which is highly polymorphic and tightly linked to D20S20, showed no or only weak evidence for linkage to Fanconi anemia. An admixture test revealed significant evidence for linkage heterogeneity (chi 2 = 6.10, P = 0.01) at the D20S19 locus. Lod scores suggestive of linkage between Fanconi anemia and this locus were obtained with two of the largest kindreds studied (lods = 2.6 and 2.1, at theta = 0.001). Thus, our data support the provisional assignment of a Fanconi anemia gene to chromosome 20q.

Chromosome Mapping↗