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PubMed2006

A clinical and laboratory evaluation of methionine cycle-transsulfuration and androgen pathway markers in children with autistic disorders.

BACKGROUND/AIMS: The prevalence of autism spectrum disorders (ASDs) is 1 in 300 children in the US. ASDs are characterized by impairments in social relatedness and communication, repetitive behaviors, abnormal movement patterns, and sensory dysfunction. Pre-pubertal age children with ASDs were assessed for metabolites in the methionine cycle-transsulfuration and androgen pathways, and for present physical development/behaviors indicative of hyperandrogenicity. METHODS: The Institutional Review Board of the Institute for Chronic Illnesses (Office for Human Research Protections, US Department of Health and Human Services IRB number: IRB00005375) approved the present study. Sixteen consecutive pre-pubertal age children (</=11 years old; mean +/- SD: 5.9 +/- 2.1 years old) with previously diagnosed ASDs that presented to the Genetic Centers of America for outpatient care were evaluated. RESULTS: Significantly (p < 0.01) increased levels of serum/plasma dehydroepiandrosterone and serum total testosterone relative to the age- and sex-specific normal laboratory reference ranges were observed. Conversely, serum follicle-stimulating hormone levels were significantly (p < 0.01) decreased. Plasma-reduced glutathione (p < 0.01), plasma cysteine (p < 0.01), plasma methionine (p < 0.01), serum cystathionine (p < 0.05), and serum homocysteine (p < 0.01) were all significantly decreased. CONCLUSION: The results suggest a possible cyclical interaction between the methionine cycle-transsulfuration and androgen pathways in some children with ASDs.

Androgens↗
PubMed2006

Randomized trial of psychiatric care with representative payeeship for persons with serious mental illness.

OBJECTIVES: This randomized clinical trial assessed whether a community-based representative payee program that was coordinated with psychiatric care from the Department of Veterans Affairs was more effective than customary treatment. METHODS: In the experimental condition representative payeeship was provided by a community agency that worked to enroll clients and coordinate payeeship with clinical care through communication with clinical staff. The control condition consisted of customary clinical care that included the typical availability of representative payeeship. Hypotheses were that, compared with the control group, the experimental group would experience greater enrollment in a representative payee program; improved residential status; improved quality of life, including fewer symptoms of mental illness; less substance abuse; and improved money management. Participants were interviewed at baseline and at six and 12 months. Outcomes were analyzed with analysis of covariance by using covariates from the baseline. RESULTS: A total of 184 participants were enrolled at baseline (94 in the experimental group and 90 in the control group). A total of 152 interviews were completed at six months, and 149 were completed at 12 months. At 12 months, 31 percent of patients in the experimental group and 14 percent of those in the control group were receiving representative payee services. At 12 months, significant positive effects were observed for the experimental group on enrollment in a representative payeeship, alcohol and drug use, quality of life, and money management. Residential status approached significance. CONCLUSIONS: Use of a coordinated representative payee program was found to be effective in improving outcomes at 12 months. Although this evidence supports the wider implementation of a coordinated representative payee program, only 31 percent of the experimental group had their money banked with a representative payee. Therefore, future studies should focus on achieving a better understanding of the causal components of the intervention.

Community Mental Health Services↗
PubMed1995

High quality and lower cost: they can coexist!

The need to control costs must be balanced with consumers' demands for high quality in their health care. An integrated approach that uses a multidisciplinary team, a case manager, and a clinical path to improve the quality of patient care offers one method by which both goals may be achieved. The report details the results of a case study in which these three elements were applied to the care of patients undergoing total hip replacement surgery. Results included a length of patients' stay of 3.92 days, cost reduction of $667 per patient in direct costs, no reported cases of readmission for complications during the 2 year process, reductions in length of stay for patients referred to extended care facilities, and a shortened period in home health services. These results are attributed to extensive use of prior screening for all patients by multiple care disciplines, better patient education processes before admission and surgery, improved communication between team members on patient progress, and coordination of care across the continuum.

Cost Control↗
PubMed1994

Practice nurses: characteristics, workload and training needs.

AIM: This study set out to identify the present and future training needs of practice nurses in South West Thames Regional Health Authority and to examine these needs within the nurses' current and changing workloads and social, educational and occupational profiles. METHOD: A questionnaire was sent to 899 practice staff identified by family health services authority records whose salaries were in part reimbursed and in whose job title the word nurse appeared. The questionnaire enquired about personal and practice demography, tasks and activities currently undertaken, perceived role development and training requirements, and preferred organization of training. RESULTS: A total of 620 completed questionnaires were returned (69%). Nurses' work involved treatments, immunizations investigations, administration, first contact with patients, support to the general practitioner and health promotion. The areas of role development selected most commonly by nurses were counselling skills (60%) and health promotion (54%); in terms of training the most popular areas were communication skills (62%) and the theory and practice of health promotion (48%). Fewer than one third of the nurses who were engaged in health checks for elderly people or the provision of diabetes care, asthma care or advice about the human immunodeficiency virus (HIV) and the acquired immune deficiency syndrome (AIDS) held an appropriate qualification. CONCLUSION: Practice nurses in the region were engaged in a wide range of activities for which many have had little formal training; the majority wished to develop their role and undertake further training. If practice nurses are to play a key part in the development of primary care services they must be adequately prepared for their clinical and health promotion role.

Education, Nursing, Continuing↗
PubMed1997

Total charge movement per channel. The relation between gating charge displacement and the voltage sensitivity of activation.

One measure of the voltage dependence of ion channel conductance is the amount of gating charge that moves during activation and vice versa. The limiting slope method, introduced by Almers (Almers, W. 1978. Rev. Physiol. Biochem. Pharmacol. 82:96-190), exploits the relationship of charge movement and voltage sensitivity, yielding a lower limit to the range of single channel gating charge displacement. In practice, the technique is plagued by low experimental resolution due to the requirement that the logarithmic voltage sensitivity of activation be measured at very low probabilities of opening. In addition, the linear sequential models to which the original theory was restricted needed to be expanded to accommodate the complexity of mechanisms available for the activation of channels. In this communication, we refine the theory by developing a relationship between the mean activation charge displacement (a measure of the voltage sensitivity of activation) and the gating charge displacement (the integral of gating current). We demonstrate that recording the equilibrium gating charge displacement as an adjunct to the limiting slope technique greatly improves accuracy under conditions where the plots of mean activation charge displacement and gross gating charge displacement versus voltage can be superimposed. We explore this relationship for a wide variety of channel models, which include those having a continuous density of states, nonsequential activation pathways, and subconductance states. We introduce new criteria for the appropriate use of the limiting slope procedure and provide a practical example of the theory applied to low resolution simulation data.

Electrophysiology↗
PubMed1994

ATP depletion: a novel method to study junctional properties in epithelial tissues. II. Internalization of Na+,K(+)-ATPase and E-cadherin.

MDCK and JTC cells were subjected to ATP depletion by treating the cells with 10 microM antimycin A and 10 mM 2-deoxyglucose. As visualized by confocal fluorescence microscopy, E-cadherin and Na+,K(+)-ATPase were rapidly internalized following depletion of the intracellular ATP stores. The time course of internalization was similar to the depolymerization of the cortical actin network and dissolution of the actin ring (see companion paper, this volume, pp. 3301-3313). Cell surface biotinylation was used to assay the amount of surface-accessible E-cadherin and Na+,K(+)-ATPase during ATP depletion. At 30 minutes of ATP depletion, 74% and 69% of E-cadherin and Na+,K(+)-ATPase were internalized, respectively, in MDCK cells. By 60 minutes of ATP depletion, internalization increased to 95% and 89%, respectively. The redistribution of both plasma membrane proteins was not microtubule dependent. Similar results were observed in JTC cells. Total biotinylated protein decreased by 67% and 82%, after 30 minutes and 60 minutes of ATP depletion, respectively. The E-cadherin internalization strongly suggests that disruption of adherens junctions occurred following ATP depletion. These results, along with the previously described loss of tight junction integrity, suggest that ATP depletion may be a useful method to study the assembly and disassembly of junctional complexes in epithelial cells.

Actins↗
PubMed1999

Endoscopic procedures for resection of arteriovenous malformations.

BACKGROUND: Resection of arteriovenous malformations (AVMs), particularly those located in functional areas, requires precision. To enhance that precision, endoscope-assisted microsurgery has been employed at Loma Linda University. METHODS: Twenty-five consecutive cases of AVM were treated microsurgically with endoscopic assistance. Patients were divided into two groups: (1) those having AVMs in functional areas, and (2) those whose AVMs extended into the ventricle, either in the trigonal area or the capsulocaudatothalamic area. The endoscope was inserted into the subarachnoid space to interrupt communicating venules around the major draining vein and into the cleavage developed between the AVM venous loops and surrounding brain tissue as shunting arterioles and communicating venules were interrupted. For surgery of intraventricular AVMs, the curved endoscope was inserted into the ventricle, providing visualization of the AVM core, which was dissected from the ventricular side. RESULTS: AVMs were totally resected in all cases except for two patients with capsulocaudatothalamic AVMs, which were decreased in size sufficiently to receive radiosurgery. CONCLUSION: Endoscope-assisted microsurgery enhances magnification, illumination, and technical precision while the surgeon is dissecting the AVM core vessels and while operating on AVMs extending into the ventricle.

Adult↗
PubMed2002

Important health provider characteristics: the perspective of urban ninth graders.

Clinicians caring for adolescents may be better positioned to provide health care when equipped with an understanding of adolescents' preferences regarding provider characteristics. The purpose of this study is to obtain a manageable framework of adolescents' concerns about health care providers. A series of qualitative and quantitative data-collection methods were used to elicit and organize ideas about health care providers from ninth-grade students in Philadelphia. A 5-point Likert survey, based on ideas generated and prioritized in earlier qualitative stages, was administered in school. Exploratory and confirmatory factor analysis was used to uncover latent factors. A total of 2602 students returned usable surveys. A confirmatory factor analysis model including four latent factors (patient's interpersonal relationship with provider, concern for physical safety, concern for emotional safety, and provider counseling ability) explained 51.6% of the model variability. Urban ninth graders want providers with whom they can develop strong relationships, feel emotionally and physically safe, and turn to for counseling. Communication with adolescent-aged patients should be a standard component of health care training and should promote provider sensitivity to adolescent fears and needs in the health care setting.

Adolescent↗
PubMedDate not supplied

Keepin' it R.E.A.L.!: results of a mother-adolescent HIV prevention program.

BACKGROUND: The concern that adolescents may be placing themselves at risk for contracting HIV has led to widespread public and parental support for HIV prevention programs. Several programs on increasing communication between parents and teenagers have been tested, but the study of the impact of these programs on resulting sexual behavior is lacking. OBJECTIVE: To test the efficacy of two interventions for mothers and their adolescents in delaying initiation of sexual intercourse for youth who are not sexually active and encouraging the use of condoms among sexually active youth. METHODS: Employed were a control group and two treatment groups: one based on social cognitive theory (SCT) and the other a life skills program (LSK) based on problem behavior theory. Assessments were conducted before the intervention (baseline) and at 4, 12, and 24 months after the baseline assessment. RESULTS: Adolescents and their mothers (total N = 582) enrolled in the trial. At baseline, the adolescents ranged in age 11-14 years and were mostly male and African American. The mean age of the mothers was 37.9 years, and most were African American and single. The primary analyses showed no difference among groups in abstinence rates for adolescents. However, adolescents in the LSK group demonstrated an increase in the condom use rate, and those in the SCT and control groups scored higher on human immunodeficiency virus (HIV) knowledge than those in the LSK group. Mothers showed substantial increases over time in comfort talking about sex and self-efficacy. For HIV knowledge, mothers in the SCT group scored significantly higher than those in the LSK and control groups. CONCLUSION: The results of this study are comparable to previous studies that have included mothers in the HIV education of their adolescents. Although the program did not demonstrate a substantial effect on abstinence rates, increases were observed in condom use among adolescents and in mother's sex-based discussions and comfort in talking about sexual issues.

Adolescent↗
PubMed2000

Hypochondriasis: the patient's perspective.

OBJECTIVE: The purpose of this investigation was to learn how patients with hypochondriasis view their physicians and medical care. METHOD: To accomplish this, we identified 20 patients with DSM-III-R hypochondriasis and 26 nonhypochondriacal patients from a general medicine clinic. Using a semistructured interview, we obtained information from patients about their recent health problems and medical care. The investigators then reviewed transcribed interviews and assigned comments to a series of categories. RESULTS: Hypochondriacal and non-hypochondriacal patients made equal numbers of positive comments, but hypochondriacal patients made significantly more negative comments about physicians' professional characteristics, characteristics of the patients themselves and total negative comments. Many viewed physicians they had seen as unskilled and uncaring. They indicated that, in many instances, their relationships with physicians had suffered from poor communication and collaboration. CONCLUSION: Since successful management of patients with hypochondriasis rests upon positive relationships, ways must be found to improve the frustrating and costly situation that currently exists.

Adult↗
PubMed2004

Collaboration between the national tuberculosis programme and a non governmental organisation in TB/HIV care at a district level: experience from Tanzania.

BACKGROUND: The increase in tuberculosis and HIV/AIDS patients in many countries in Africa including Tanzania, is outstripping the ability of public health services to cope. This calls for a closer collaboration between tuberculosis programmes and other stakeholders involved in HIV/AIDS care. OBJECTIVE: To determine the feasibility of establishing collaboration between the tuberculosis programme and an NGO in TB/ HIV care at a district level in Tanzania. METHODS: Quantitative and qualitative study designs involving TB as well as HIV suspects and patients together with health workers, were conducted between December, 2001 and September, 2002. RESULTS: A total of 72 patients and 28 key informants were involved. The collaboration was in the following areas; voluntary counselling and testing for HIV, diagnosis and treatment of TB, referral and follow up of patients and suspects, home based care, psychological support and training. Both the tuberculosis programme and NGO benefited from the collaboration. TB case detection among PLWA increased more than three folds and TB treatment was integrated in home based care of NGO. The main barriers identified in this study were; poor communication, poor referral system and lack of knowledge and skills among health staff. CONCLUSION: The study has shown that it is possible for a tuberculosis programme and a non governmental organisation to collaborate in TB/HIV care. The study has also identified potential areas of collaboration and barriers that needed to be overcome in order to provide such comprehensive services at a district level.

Communication↗
PubMed2004

[New method of partial deafness treatment].

At present, hearing loss is treated using prosthetic devices--either a hearing aid or a cochlear implant. Hearing aids are chiefly used for mild to severe hearing loss. In profound hearing loss and deafness, current treatment is based on cochlear implant placement. There is another large group of patients whose hearing impairment is characterized by normal or slightly elevated thresholds in the low-frequency band with nearly total deafness in higher frequencies. We propose to describe this type of hearing impairment as partial deafness. The patients in this group remain beyond the scope of effective treatment by hearing aids only. Such patients have not been considered before for cochlear implantation, because it was feared that this intervention would damage the functioning part of the cochlea. A new method for the treatment of partial deafness treatment was applied in the case of a young woman. A partially-inserted cochlear implant was used to restore hearing at high frequencies, while preserving low-frequency acoustic hearing in the implanted ear. The results demonstrate a substantial improvement in speech discrimination and communication skills when electric stimulation on one side was combined with acoustic stimulation on both sides.

Acoustic Stimulation↗
PubMed1991

Tufts assessment of motor performance: an empirical approach to identifying motor performance categories.

The Tufts Assessment of Motor Performance (TAMP) is a criterion-referenced test that measures motor performance capabilities of basic self-care skills, mobility and physical aspects of communication. Discrete motor performance tasks were identified within each of the 32 items. The purpose of this paper is to report the results of an empirical method of determining the factor structure underlying the motor performance tasks of the TAMP. Initially, motor performance tasks were categorized into a priori groupings based on previous literature and clinical judgment. The TAMP was administered to 206 children and adults (age range 6 to 86 years) with physical disabilities. Diagnoses included a variety of musculoskeletal and neurologic disorders. A principal-factor analysis was used to organize and cluster the item tasks into appropriate common factors. Seven factors were identified that accounted for 70.6% of the total variance for the assistance dimension; similar results were obtained for other measurement dimensions of the TAMP. The defined factor structure has patterns of similarity to the motor performance variables as defined by clinical judgment; however, the tasks were organized into factors that were more functionally oriented than expected. The results provide a framework for which the motor performance tasks of the TAMP might be organized into scales that identify essential performance constructs for rehabilitation. The results permit examination of the nature and clinical importance of these common motor performance factors for clinical evaluation and the description of functional disability.

Adolescent↗
PubMed2005

A case study of a retracted systematic review on interactive health communication applications: impact on media, scientists, and patients.

BACKGROUND: In October 2004, a flawed systematic review entitled "Interactive Health Communication Applications for People with Chronic Disease" was published in the Cochrane Library, accompanied by several press releases in which authors warned the public of the negative health consequences of interactive health communication applications, including the Internet. Within days of the review's publication, scientists identified major coding errors and other methodological problems that invalidated the principal conclusions of the study and led to a retraction. While the original study results and their negative conclusions were widely publicized in the media, the retraction seemed to go unnoticed. OBJECTIVE: This paper aims to document an unprecedented case of misinformation from a Cochrane review and its impact on media, scientists, and patients. As well, it aims to identify the generic factors leading to the incident and suggest remedies. METHODS: This was a qualitative study of the events leading to the retraction of the publication and of the reactions from media, scientists, and patients. This includes a review and content analysis of academic and mass media articles responding to the publication and retraction. Mass media articles were retrieved in May 2005 from LexisNexis Academic and Google and were classified and tallied. The extended case method is employed, and the analysis is also applied to comparable publishing events. RESULTS: A search on LexisNexis Academic database with the query "Elizabeth Murray AND health" for the period of June 2004 to May 2005 revealed a total of 15 press reports, of which only 1 addressed the retraction. Google was searched for references to the review, and the first 200 retrieved hits were analyzed. Of these, 170 pages were not related to the review. Of the remaining 30 pages, 23 (77%) were reports about the original publication that did not mention the retraction, 1 (3%) was a bibliography not mentioning the retraction, and 6 (20%) addressed the retraction, of which only 1 was a non-Cochrane-related source. CONCLUSIONS: Analyzed retrievals showed that the mass media gave more coverage to the Cochrane review than to the retraction or to a related systematic review with a similar scope but a different conclusion. Questionable results were prematurely disseminated, oversimplified, and sensationalized, while the retraction was hardly noticed by the public. Open commentary by scientists and patients helped to rapidly identify the errors but did not prevent or correct the dissemination of misinformation.

Humans↗
PubMed2006

Evaluation of the lumbar and ventricular infusion test in the diagnostic strategy of pediatric hydrocephalus and the therapeutic implications.

AIM: To evaluate the infusion test as a diagnostic tool behind the choice of intervention in pediatric hydrocephalus. MATERIALS AND METHODS: Intracranial pressure (ICP) measurement and infusion test were performed intraventricularly, by lumbar route, or combined in 40 consecutive children as a part of the standard diagnostic program in 1996-1999. RESULTS: The median age was 18.5 months, ranging from 2 weeks to 13 years. In the subgroup of patients with radiological aqueductal stenosis (N=14), mean lumbar/intraventricular ICP was 13 (3-35)/10 (2-27). Mean lumbar/ventricular R(out) were 18 (4-49)/17 (6-37). For patients with radiological communication between the third and fourth ventricles (N=14), the mean lumbar/intraventricular ICP was 11 (7-17)/9 (1-16). Mean lumbar/ventricular R(out) were 8 (3-11)/8 (4-12). A total of 13 patients had a shunt insertion, 10 had an endoscopic third ventriculostomy (ETV), 5 had endoscopic fenestration of a cyst, and 12 had no surgery. Of the patients initially treated with EVT, 50% had a shunt insertion shortly after. For communicating hydrocephalus, 75% of the patients initially not operated based on normal R(out) values ended up having a shunt insertion. DISCUSSION: R(out) has doubtful value as an indicator for conducting an operation or not and in the choice between EVT and shunt in children. This should be interpreted in the light of a growing understanding of hydrocephalus on a molecular level.

Adolescent↗
PubMed2004

Patients' and professionals' opinions of services for people at an increased risk of colorectal cancer: an exploratory qualitative study.

OBJECTIVES: To explore the views and opinions of patients with a family history of colorectal cancer, and of primary and secondary care health professionals, on how to improve current services for individuals with a family history of colorectal cancer. DESIGN: Focus group and interview study. SETTING: Primary and secondary care centres in south east London, UK. PARTICIPANTS: A total of 53 people participated in this qualitative study: 18 individuals with a family history of colorectal cancer were interviewed in three focus groups and 35 health professionals were interviewed either in focus groups or individually. Visual qualitative analysis of transcribed interviews was used to identify the key themes which emerged. MAIN OUTCOME MEASURES: Interviewees' needs, views and opinions of current services and ways to improve them. RESULTS: Several areas of concern were identified. The role of primary care needs to be clarified. Education and information about services should be provided for patients and caregivers and better support is required for those undergoing screening and surveillance. Methods to ensure effective and meaningful risk communication are inadequate and require further exploration. Standardisation of care is required to ensure consistency of advice and treatment. CONCLUSION: These interviews revealed substantial shortfalls in the provision of services for patients at increased genetic risk of colorectal cancer. Current systems for the assessment of risk, delivery of advice, and for surveillance are inconsistent and sometimes maybe inadequate. The role of primary care physicians in service delivery requires clarification. Significant opportunities exist for the development of new, more appropriate models of service to provide better standards of care.

Colonoscopy↗
PubMed2000

Application of pericardial graft in the surgical management of Peyronie's disease.

PURPOSE: We investigated the use of Tutoplast cadaveric pericardium as an alternative material for grafting the tunica albuginea defect after Peyronie's plaque excision. MATERIALS AND METHODS: A total of 11 patients with significant penile curvature interfering with sexual intercourse were evaluated after at least 12 months of conservative therapy. Preoperative evaluation in all cases included penile duplex Doppler ultrasound studies. Chemically processed and gamma irradiated pericardium was used to graft the cavernosal defect after surgical excision of the penile plaque. In 3 patients a penile prosthesis was simultaneously placed secondary to documented erectile dysfunction at duplex Doppler ultrasound evaluation. RESULTS: Penile curvature resolved in all patients, allowing for normal sexual function after a mean followup of 14 months (range 9 to 19). No postoperative evidence of tissue rejection or infection was noted. In 1 patient urethro-corporal communication developed and a single penile cylinder was explanted. Another patient had a mild dorsal bulge at the site of graft placement when the prosthesis was fully inflated. CONCLUSIONS: Polymeric silicone material used to provide satisfactory results in the surgical treatment of Peyronie's disease but it is no longer available for biomedical use. We demonstrate the effective use of cadaveric pericardium as a graft material for cavernosal defects after Peyronie's plaque excision. Overall patient satisfaction, absence of a second surgical incision, relative low risk and ease of surgical placement make this material ideal for the surgical treatment of this disease process.

Adult↗
PubMed2001

Changing risk behaviours for non-communicable disease in New Zealand working men--is workplace intervention effective?

AIMS: To evaluate the effectiveness of a health promotion programme targeting dietary behaviours and physical activity among male hourly-paid workers and to explore demographic and attitudinal influences on dietary patterns at baseline. METHODS: A controlled field trial compared workers at one intervention and one control worksite. The intervention comprised nutrition displays in the cafeteria and monthly 30-minute workshops for six months. Key outcome measures at six and twelve-months were self-reported dietary and lifestyle behaviours, nutrition knowledge, body mass index (BMI), waist circumference and blood pressure. RESULTS: 132 men at the intervention site and 121 men at the control site participated in the study and a high retention rate (94% at 6-months and 89% at 12-months) was achieved. At baseline, 40% of the total sample (253) were obese, 30% had elevated blood pressure, 59% indicated an excessive fat intake and 92% did not meet the recommended vegetable and fruit intake. The intervention reduced fat intake, increased vegetable intake and physical activity, improved nutrition knowledge and reduced systolic blood pressure when compared to the control site. There was no difference in change in mean BMI or waist circumference. Reduction in BMI was associated with reduction in fat intake. DISCUSSION: Low intensity workplace intervention can significantly improve reported health behaviours and nutrition knowledge although the impact on more objective measures of risk was variable. A longer duration or more intensive intervention may be required to achieve further reduction in risk factors.

Adult↗