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PubMed1998

Seventeen-year evaluation of breast cancer screening: the DOM project, The Netherlands. Diagnostisch Onderzoek (investigation) Mammacarcinoom.

The DOM project is a non-randomized population-based breast cancer screening programme in Utrecht which started in 1974-75. The 17-year effect has been evaluated by a case-control study of breast cancer deaths during the period 1975-92 in women living in the city of Utrecht, born between 1911 and 1925, whose breast cancers were diagnosed after the initiation of the DOM project. Controls (three for each case) were defined as women having the same year of birth as the case, living in the city of Utrecht at the time the case died, and having had the opportunity of screening in the DOM project. Screening in the period 1975-92 indicated a breast cancer mortality reduction of 46% (odds ratio of 0.54, 95% confidence interval 0.37-0.79). The strongest protective effect was found at a screening interval of 2 years or less (mortality reduction of 62%, odds ratio of 0.38), and for the highest number of screens (mortality reduction of 68%, odds ratio of 0.32 for more than four screens). Exclusion of breast cancer deaths that occurred within 1 year of diagnosis, to allow for 'lead-time' bias, gave an odds ratio of 0.61. Early diagnosis of breast cancer by screening reduces breast cancer mortality in the long term. Bias due to the study design may slightly overestimate the protective effect. A screening programme with a 2-yearly, or smaller, interval between successive screens will improve the protection of screening.

Aged↗
PubMed1996

Two-dimensional crystallography of TFIIB- and IIE-RNA polymerase II complexes: implications for start site selection and initiation complex formation.

SUMMARY: Transcription factors IIB (TFIIB) and IIE (TFIIE) bound to RNA polymerase II have been revealed by electron crystallography in projection at 15.7 A resolution. The results lead to simple hypotheses for the roles of these factors in the initiation of transcription. TFIIB is suggested to define the distance from TATA box to transcription start site by bringing TATA DNA in contact with polymerase at that distance from the active center of the enzyme. TFIIE is suggested to participate in a key conformational switch occurring at the active center upon polymerase-DNA interaction.

Binding Sites↗
PubMed1988

The dot plot. A starting point for evaluating test performance.

We suggest that evaluations of diagnostic tests start with dot plots that depict multiple test results over multiple clinical states. From this starting point we can calculate posttest probabilities for multiple clinical states at multiple test results. Also, we can project one subset of clinical states as "disease positive" and a second subset as "disease negative" to provide standard analyses such as likelihood ratios, relative operating characteristic curves, posttest/pretest probability plots, sensitivity, specificity, and predictive value. Finally, this starting point provides an excellent basis for comparing multiple studies of diagnostic performance. The advantages of dot plots are illustrated with data on serum ferritin levels over multiple clinical states.

Ferritins↗
PubMed1998

Ontario's attempt at primary care reform hits another snag.

Ontario is the latest province to step into the health care reform spotlight. Proponents hope its proposed series of primary care pilot projects, built around the concept of patient rostering, will improve the delivery of care. If the project goes ahead, doctors in 5 participating sites will be paid under a capitation system, with payments starting at $70.29 annually for men aged between 25 and 35.

Adult↗
PubMed2004

From ORFeomes to protein interaction maps in viruses.

Although cloned viral ORFeomes are particularly well suited for genome-wide interaction mapping due to the limited size of viral genomes, only a few such studies have been published. Here, we summarize virus interaction mapping projects involving vaccinia virus, hepatitis C virus (HCV), potato virus A (PVA), pea seed-borne mosaic virus (PSbMV), and bacteriophage T7, as well as some projects in progress. The studies reported suggest that virus-specific coding and replication strategies must be taken into account to yield accurate numbers of protein interactions. In particular, the number of false negatives can be significant for RNA viruses expressing precursor polyproteins (because interactions between full-length mature proteins are often not detected due to incorrect processing) and for viruses replicating in the cytoplasm whose transcripts have not been selected for splicing signals. In conclusion, the studies on viral protein interaction maps suggest that cloned pathogen ORFeomes will contribute to a holistic picture of the pathogenesis of infectious diseases and are ideal starting points for new approaches in systems biology. Both viral ORFeome and interaction mapping projects are being documented on our Web site (http://itgmv1.fzk.de/www/itg/uetz/virus/).

Cloning, Molecular↗
PubMed1997

Pilot phase studies on the accuracy of dietary intake measurements in the EPIC project: overall evaluation of results. European Prospective Investigation into Cancer and Nutrition.

BACKGROUND: As part of the European Prospective investigation into Cancer and Nutrition (EPIC), preliminary studies were conducted to evaluate the accuracy of individuals' dietary intake measurements from newly developed questionnaires. METHODS: In six countries that adhered from the very beginning to the multicentre, co-ordinated EPIC project, the validity studies were based on two repeat questionnaire measurements at the start and at the end of a 1-year period, in groups of about 100 volunteers of both sexes. In addition, during this year, up to 12 24-hour recalls per person were taken monthly, and up to four blood and urine specimens were collected for measurement of biochemical markers. In three countries that joined EPIC later, the designs of the validity studies and type of 'reference' measurement chosen were somewhat different. The results presented in this overview paper are taken partly from more detailed, country-specific publications, and partly from a central (re-)analysis of the original data, to ensure a uniform approach to the statistical analyses and presentation. RESULTS: Averaged over subgroups by country and gender, Spearman coefficients of correlation between questionnaire measurements and the individuals' average 24-hour recalls ranged from 0.37 for fish to 0.68 for dairy products and 0.79 for alcoholic beverages. For energy-adjusted nutrient intakes (or nutrient densities, in the UK), mean Pearson correlation coefficients, corrected for residual attenuation due to day-to-day variations in the 24-hour recalls in all but two countries, ranged from 0.37 for retinol and 0.48 for vitamin E to 0.60 for carbohydrates and 0.12 for total alcohol intake. Correlations between energy-adjusted nutrient intakes and biochemical markers on average were low, but varied considerably between study centres. CONCLUSIONS: On average, most estimated correlation coefficient were of similar magnitude to those observed by independent research groups. The role of the preliminary validity studies, and various benefits drawn from these studies for further planning of the EPIC project are discussed.

Diet↗
PubMed2004

Interim 2003-based national population projections for the United Kingdom and constituent countries.

The 2003-based national population projections, carried out by the Government Actuary in consultation with the Registrars General, and using essentially the same underlying assumptions as for the previous 2002-based projections, show the population of the United Kingdom rising from 59.6 million in 2003, passing 60 million during 2005, to reach 65.7 million by 2031. Longer-term projections suggest the population will peak around 2050 at nearly 67 million and then very gradually start to fall. The population will become older with the median age expected to rise from 38.4 years in 2003 to 43.3 years by 2031. In 2003, there were around 700 thousand (six per cent) more children aged under 16, than people of state pensionable age. However, from 2007, the population of pensionable age is projected to exceed the number of children.

Adolescent↗
PubMed2005

NSF for CHD: 3 years of 12-month follow-up audit after cardiac rehabilitation.

BACKGROUND: The coronary heart disease (CHD) National Service Framework (NSF) sets standards and milestones. For acute myocardial infarction (AMI) or coronary revascularization, 'Milestone 3, of Standard 12 requires that, by April 2002, every hospital should have clinical audit data no more than 12 months old showing 'total number and % of those recruited to cardiac rehabilitation who, one year after discharge, report: regular physical activity of at least 30 minutes duration on average five times a week, not smoking and a Body Mass Index (BMI) of <30 kg/m2'. This study looked at cost, method and practicalities of retrieving this data. METHODS: A postal questionnaire was used to follow-up coronary patients who started our cardiac rehabilitation programme between 1 April 2001 and 31 March 2004. The project was costed. RESULTS: Three hundred and seventy-five (33 per cent) AMI patients, 412 (36 per cent) coronary artery bypass grafting (CABG) patients and 343 (30 per cent) percutaneous coronary intervention (PCI) patients entered the cardiac rehabilitation programme over 3 years. Completed questionnaires were received from 903 (80 per cent). Post-AMI patients or those stratified as high risk for further cardiac events were least likely to respond. Of responders, 74 per cent were exercising regularly, 95 per cent were not smoking and 79 per cent had a BMI <30 kg/m2. CONCLUSION: Targets for smoking and BMI set by the NSF are too low and were achieved by most patients before the start of cardiac rehabilitation. Patients who are post-AMI or are stratified as high risk need to be targeted if a high level of follow-up is to be achieved.

Body Mass Index↗
PubMed2005

Genome projects and the functional-genomic era.

The problems we face today in public health as a result of the -- fortunately -- increasing age of people and the requirements of developing countries create an urgent need for new and innovative approaches in medicine and in agronomics. Genomic and functional genomic approaches have a great potential to at least partially solve these problems in the future. Important progress has been made by procedures to decode genomic information of humans, but also of other key organisms. The basic comprehension of genomic information (and its transfer) should now give us the possibility to pursue the next important step in life science eventually leading to a basic understanding of biological information flow; the elucidation of the function of all genes and correlative products encoded in the genome, as well as the discovery of their interactions in a molecular context and the response to environmental factors. As a result of the sequencing projects, we are now able to ask important questions about sequence variation and can start to comprehensively study the function of expressed genes on different levels such as RNA, protein or the cell in a systematic context including underlying networks. In this article we review and comment on current trends in large-scale systematic biological research. A particular emphasis is put on technology developments that can provide means to accomplish the tasks of future lines of functional genomics.

Animals↗
PubMed2005

R&P: the multiple meaning of a research project in general practice.

Rischio e Prevenzione (Risk and Prevention) is a research project that is becoming the paradigm of the Italian research on General Practice. It started from a survey showing that treatment and control of cardiovascular risk is still far from optimal even in very high-risk patients. A group of general practitioners, coordinated by Istituto Mario Negri, wrote the protocol of the study with various proposals: Creating a research network. Building research infrastructure with good research capacity. Building a 'therapeutic alliance' with the patient while presenting the research, not only obtaining their signature for a 'bureaucratic' informed consent. Having the 'Collaborative Group' as the 'sponsor' of a research even if the funds are coming from Pharmaceutical Industry. It is a randomised controlled trial (RCT) carried out in primary care with the normal patient of our daily work, so transferability is very possible. The way to enroll the patients and the request to specify the reason for not joining the project of the outcome study are a kind of participatory research. The outcome study can become a model for implementing new strategy on cardiovascular risk. A specific questionnaire will enquire the different point of view of the patient and of the general practitioner/researcher. The result of this project will help us understand the phenomenon of the poor compliance of the high-risk patients. First results during enrollment allow some optimism.

Cardiovascular Diseases↗
PubMed2003

Establishing a Maori case management clinic.

AIMS: The Maori Case Management Clinic Project aims to improve Maori health outcomes by establishing low cost, high quality, culturally appropriate primary care facilities in targeted areas, with a focus on the management of chronic illness. Further, the project aims to evaluate this 'by Maori for Maori' model of community healthcare delivery. METHODS: Working in partnership with local Maori health providers, we analysed the available health utilisation and demographic data to choose the three best sites to establish new primary care facilities. We established the facilities with initial start-up funding from Counties Manukau District Health Board. Rigorous evaluation processes have been built into the project. RESULTS: Enrollments at the first of the three clinics exceeded expectations. Client satisfaction as reported by independent evaluators was very high, with cost, cultural acceptability and convenience of location being the three most common reasons given for high satisfaction. CONCLUSIONS: The model adopted has been positively received by the targeted population. Further evaluation will reveal whether this resulted in improved health outcomes.

Adolescent↗
PubMed1994

Education in methodology for health care--EuroMISE.

In January 1993 the Joint European Project "Education in the methodology field of health care", EuroMISE (European Education in Medical Informatics, Statistics and Epidemiology) started under the European TEMPUS program. Training and education in EuroMISE consist of three overlapping methodology branches: medical informatics, medical statistics, and epidemiology. A teaching scheme has been developed in cooperation between Charles University, Prague, and EC universities and organizations involved in the EuroMISE project. One of the main tasks of the project is to design a modularly structured EuroMISE course set, to develop teaching materials and tools in the English language, and to link the EuroMISE project with other programs and projects in this field. Running EuroMISE courses, firstly for university teachers, will have a major impact in disseminating the acquired knowledge and skills.

Epidemiology↗
PubMed2004

[Smoking among secondary school students in Stalowa Wola].

Smoking is recognized as major, the most prevalent, and at the same time the only removable factor of many diseases. The major causes of starting smoking are: stress, curiosity and staying among people who smoke tobacco. The research was conducted among students of secondary school in Stalowa Wola in the form of an anonymous poll. The sample group included 2763 people. The group of smokers included 334 people (12.09%). Results of the research were subjected to a precise statistical analysis. The fact that 24.55% young age smokers smoke more than 20 cigarettes a day is worth stressing. In spite of short time of tobacco smoking, the investigated group has reported some negative health ailments. An attempt was made to identify the combination of features affecting smoking, including sex, origin, company of smokers, economic conditions (p < 0.05). The statistical analysis revealed a significant correlation between the number of cigarette smoked, economic conditions and the intention to stop smoking (p < 0.05). The obtained results may be helpful in preparing effective educational and preventive project among students, which can eliminate or lower the influence of factors predisposing to start and continue smoking tobacco.

Adolescent↗
PubMed1998

[Assessment of clinical competence of medical school graduates in Italy with standardized patients. The opinion of the examinees].

An international collaborative project for the evaluation of clinical competence at the end of the Medical School curriculum using the ECFMG-CSA (Educational Commission for Foreign Medical Graduates--Clinical Skills Assessment) prototype was started in Italy in April 1996. Faculty representatives from Italian Medical Schools and experts from the ECFMG in Philadelphia participated in the Project. The CSA consists of integrated clinical encounters with 10 standardized patients during which the examinee is asked to obtain a focused history, perform a relevant physical examination and communicate initial diagnoses and management plan to the Standardized Patient (SP). The SP then completes checklists that are scored by Faculty members. The project was concluded in Spring 1998 and a total of 173 new graduates were examined. The data elaborated by the primary site in Chieti University will be available in the Fall 1998 by the ECFMG in Philadelphia. This preliminary communication reports the opinions of the examinees on the ECFMG-CSA, contained in the questionnaires administered after the test. Most of the examinees considered this new methodology as a valid tool for the assessment of clinical competence, especially history-taking and interpersonal skills and stated that the SP simulations were realistic. The 72% of examinees indicated that the Medical School curriculum does not adequately prepare for the CSA examination. Lastly, 68% was in favour of including the SP in the Medical Licensing Examination.

Clinical Competence↗
PubMed2001

Lifelong learning in ethical practice: a challenge for continuing medical education.

BACKGROUND: Formal education in the identification, analysis, and resolution of ethical issues in clinical practice is now an essential component of undergraduate and postgraduate medical education. Physicians educated before the 1980s have had little or no formal education in ethics. This article describes a project for assessing the content and format appropriate for the continuing education needs of practicing physicians. METHODS: A questionnaire and follow-up facilitated small-group discussions with a physician ethicist around case-based problems were used to identify the ethical issues in practice where participants felt the need for continuing education. RESULTS: The project confirmed that practitioners had very little formal ethics in medical school and less since starting practice despite encountering ethical issues. The most frequently used method of learning about ethics was informal discussion among those who have the same lack of formal education. Physicians did not feel that they needed a "very high" level of confidence and competence in handling ethical issues, even those commonly encountered. Participants indicated strongly that they lacked a systematic approach to the identification and analysis of ethical issues and suggest incorporation of the ethical component into regular CME. FINDINGS: In spite of the small study population and the volunteer nature of the participants, the project demonstrated the identification of ethics content for CME similar to that used in medical education. Further work is needed to assess objective needs for ethics education in addition to the perceived needs of clinicians.

Education, Medical, Continuing↗
PubMed2001

MRA of hemodialysis access grafts and fistulae using selective contrast injection and flow interruption.

MR is a potentially attractive modality for evaluating hemodialysis access anatomy and function. However, the wide range of flow rates in the hemodialysis access complicates interpretation of phase contrast, time-of-flight, and even contrast-enhanced MR angiograms. At high flow rates, signal voids may easily arise at mild narrowings or sharp-angled anastomoses. A method is proposed which visualizes hemodialysis accesses without flow artifacts. Diluted Gd-DTPA is hand-injected directly into the access, while a cuff is used to reduce and subsequently interrupt access flow. Filling of the access is monitored using a fast projection technique with complex subtraction. When filling is satisfactory, a 3D acquisition is started. The feasibility of this selective contrast-enhanced MR angiography technique is demonstrated in four Cimino-fistulae and four PTFE grafts. Magn Reson Med 45:557-561, 2001.

Arteriovenous Shunt, Surgical↗
PubMed2002

Fast adjustments of ongoing movements in hemiparetic cerebral palsy.

The present study focuses on the ability of participants with spastic hemiparesis caused by cerebral palsy to adjust an ongoing movement. Typical symptoms associated with the disorder would lead one to expect that people with spastic hemiparesis would be unable to adjust their movements quickly and proportionally to a sudden change in the environment with their spastic arm. The results of the present experiment, however, prove otherwise. Eight hemiparetic adolescents with cerebral palsy and eight healthy control participants were asked to quickly hit a target projected onto a fronto-parallel screen. The target either remained stationary or started to move immediately after hand movement onset. Participants needed to adapt the ongoing movement to hit moving targets. The task was performed with the spastic and non-spastic arm by the hemiparetic participants and with the dominant arm by the healthy participants. Kinematic analyses showed that although the spastic arm of the hemiparetic participants displayed a significant increase in spatial variability which led to more errors, they were capable of successfully adapting their movement in a qualitative manner. The latency of the response to the change in target position was longer for the hemiparetic participants compared to the healthy control participants, but only 25 ms. Surprisingly, no between arm latency difference was found in the hemiparetic participants. Given the commonly observed movement deficits of the spastic arm, these results show that participants with spastic hemiparesis displayed a remarkable ability in adjusting movements quickly.

Adaptation, Physiological↗
PubMed1998

Writing tips for authors.

Writing an article for publication may seem intimidating to you at first, but believe it or not, it can be exciting and fun. When you initially accept a writing assignment, research a clinical "gut feeling," or describe a nursing scenario, it may seem like a gargantuan task, but when you break it into small segments or steps you may be surprised how quickly you will complete your project. This article will offer some helpful hints or tips to get you started. Many of the tips will apply specifically for submission of an article to insight; absorb all clues that might be helpful and disregard anything that won't help you. Remember, you can get your article published, and the insight editorial board and peer reviewers only want to facilitate your success!

Humans↗