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PubMed2005

Functional genomics databases on the web.

Experiments involving high-throughput methods for measuring transcripts, proteins and metabolites constitute the area of functional genomics. These experiments are highly context dependent and require much more detail about the experimental design, sample and protocols used than in genomics. Functional genomics databases are needed that follow established and emerging standards. Functional genomic databases are not yet very common; however, there are a few focused on microbial genomes and a couple integrative systems are available for setting up functional genomics databases.

Computational Biology↗
PubMed2005

Prevalence and consequences of insomnia in New Zealand: disparities between Maori and non-Maori.

OBJECTIVE: To investigate the prevalence of self-reported insomnia symptoms among Maori (Indigenous people) and non-Maori adults in the general population of New Zealand. To explore the consequences for health and quality of life experienced by those who report common insomnia complaints and sleeping problems. METHODS: In 2001, a two-page questionnaire was mailed to a stratified random sample of 4,000 adults aged 20-59 years nationwide. Participants were selected from the New Zealand electoral roll. The sample design aimed for equal numbers of Maori and non-Maori participants, men and women, and participants in each decade of age (72.5% response rate). RESULTS: Population prevalence estimates indicate that self-reported insomnia symptoms and sleeping problems are higher among Maori than non-Maori. Multiple logistic regression analyses showed that self-reported insomnia symptoms and/or sleeping problems are significantly associated with reporting poor or fair health and quality of life outcomes. CONCLUSIONS: Approximately one-quarter of adults in New Zealand may suffer from a chronic sleep problem, highlighting insomnia as a major public health issue in New Zealand. IMPLICATIONS: Significant differences in the prevalence of insomnia symptoms and current sleeping problems with respect to ethnicity have implications in the purchase and development of treatment services, with greater need for these services among Maori than non-Maori.

Adult↗
PubMed2004

Stressful major life events are associated with a higher frequency of cutaneous sensory symptoms: an empirical study of non-clinical subjects.

BACKGROUND: Psychological stress resulting from stressful major life events is known to exacerbate a wide range of skin disorders. OBJECTIVE: To examine the relationship between stressful major life events and dermatological symptoms among a non-clinical sample. DESIGN: A cross-sectional survey. SETTING: Community-based subjects from London, Ontario, Canada were recruited from the local university, schools and churches. PARTICIPANTS: Out of 600 consecutive, consenting volunteers 316 subjects [73 men and 243 women; age 38.7 +/- 14.8 (mean +/- SD) years; marital status 54% married; race 94%'white'] completed the survey for this study. The exclusion criterion was a history of a major dermatological or medical disorder. MAIN OUTCOME MEASURE: The number of major life events experienced over the previous 6 months measured using the Social Readjustment Rating Scale (SRRS) of Holmes and Rahe, and the frequency and severity of a range of cutaneous symptoms ('burning', 'crawling sensation', 'tingling', 'pricking' or 'pins and needles', 'pain', 'tenderness' of skin, 'numbness', 'moderate to severe itching', and 'easy bruising') that the subject may have experienced over the previous month. RESULTS: The most frequently reported body region affected was the scalp (59.5%) and the most frequently reported symptom was itching (69.3%). The total number of major life events experienced over the previous 6 months correlated with the severity of the individual cutaneous symptoms (0.22 < or = Pearson r < or = 0.41, P < 0.001) and with the total cutaneous symptom severity score (sum of all cutaneous severity ratings) (Pearson r = 0.40, P < 0.001). This correlation remained significant after the possible confounding effect of psychological factors on cutaneous symptoms was partialled out statistically (partial r = 0.19, P = 0.001). DISCUSSION: We observed a direct correlation between the number of major life events experienced over the previous 6 months and cutaneous symptoms experienced over the previous 1 month by non-clinical subjects. The correlation remained significant after the effect of psychological factors was partialled out, suggesting that this relationship holds even if the subject does not acknowledge psychological distress in reaction to the major life event.

Adolescent↗
PubMed1995

Working memory and preparation elicit different patterns of slow wave event-related brain potentials.

Some event-related brain potential (ERP) studies of working memory have used delayed match-to-sample designs in which a stimulus (S1) is held in memory for comparison with a subsequent stimulus (S2). During the S1-S2 interval, ERP slow negatives varied with both the type and amount of material held in working memory. One interpretation is that these slow waves index working memory operations. An alternative explanation is that they only reflect general preparatory processing for the response to S2. To decide between these explanations, we used two visual processing tasks that required similar preparation for S2. In one task, visual memory rehearsal operations were required. During the S1-S2 interval, there were clear differences between the amplitudes, topographies, and the effect of information load on the slow waves in two tasks, thus ruling out preparation only as an explanation.

Adult↗
PubMed1989

A prospective longitudinal study of social, psychological and obstetric factors in pregnancy: response rates and demographic characteristics of the 8556 respondents.

This paper introduces the Mater Misericordiae Mothers' Hospital-University of Queensland Study of Pregnancy, a prospective study of 8556 pregnant women interviewed at their first clinic visit, and subsequently interviewed some days after the birth of the baby and again 6 months later. Additional data were derived from the medical record of the pregnancy and delivery. The study was designed to assess the impact of social, psychological and obstetric factors on pregnancy outcome. We present here details of the study design, sampling, response rates and demographic characteristics of the sample.

Age Factors↗
PubMed2006

Agreement between hospital records and maternal recall of mode of delivery: evidence from 12 391 deliveries in the UK Millennium Cohort Study.

OBJECTIVE: The objective of this study was to measure the agreement between hospital records and maternal reporting of mode of delivery in a representative UK sample. DESIGN: Population-based survey (Millennium Cohort Study). SETTING: UK. POPULATION: A total of 12,391 singleton infants born in 2000-2002. METHODS: Mothers were interviewed when infants were approximately 9 months old. Information was collected by interview on many obstetric and perinatal factors including mode of delivery. Record linkage to the mother's delivery hospital records was undertaken in those who gave consent (90%). A matching record was found for 83%. Maternal report and hospital records were compared using mode of delivery classified into three (normal, assisted and caesarean) and six groups. Factors associated with disagreement between the two data sources were identified. MAIN OUTCOME MEASURE: Proportion of records in which there was agreement between the two data sources. RESULTS: Agreement between maternal report and hospital records was at least 94% using six mode of delivery groups and 98% using three groups. Much of the disagreement (57-63%, depending on country) was between forceps and ventouse, and between planned and emergency caesarean. Disagreement was more common in women whose babies were first born and in women not born in the UK. CONCLUSION: Our study confirms that maternal reporting of mode of delivery is highly reliable. This is important for clinical staff caring for women and those conducting epidemiological studies. Additional data sources may be necessary to gather reliable data from ethnic minority women, particularly those born outside the UK, or to distinguish forceps from ventouse, or planned from emergency caesarean section.

Cohort Studies↗
PubMedDate not supplied

Differences between parish nurses and parish nurse associates: results of a statewide survey of an ecumenical network.

OBJECTIVES: To gather data that would help a parish nurse network to better understand its participants and to explore differences between parish nurses who had completed the basic preparation class versus those who had not in terms of engagement in activities. DESIGN, SAMPLE, AND MEASUREMENTS: A mail survey, including items related to communal orientation, was developed and sent to members of a state-wide parish nurse network (n=265), with 165 surveys returned for a 62% response rate for this descriptive study. RESULTS: Approximately half of the parish nurses indicated that they entered this specialty through church contacts (27.0%) or through the encouragement of family/friends (22.7%). Nurses not completing parish nursing education/training (47%) were significantly more likely to (a) be younger (55 vs. 59 years of age), (b) work fewer hours (8 vs. 16), and (c) provide fewer activities/services for their congregations (4.8 vs. 6.2). Overall, the nurses described themselves as being "communally oriented," that is, desiring to give and receive benefits in response to others' needs. CONCLUSIONS: The findings support previous speculations that some self-identified parish nurses function in an "associate" role. Such associates lack the basic preparation class in parish nursing and work fewer hours each month.

Career Choice↗
PubMedDate not supplied

Congregational health ministries: a national study of pastors' views.

OBJECTIVES: Since the 1980s, there has been a growing, but little studied, movement that organizes church-based health services under the direction of a coordinator, usually a registered nurse. These Congregational Health Ministries (CHMs) emphasize health promotion and disease prevention. We compared the perceptions of pastors with and without organized CHMs and the characteristics of their congregations' health ministries. DESIGN: We used a quantitative, cross-sectional survey design. SAMPLE: We surveyed a national multidenominational sample of 349 pastors representing over 80 Christian denominations. RESULTS: With limited resources, CHMs provide significant health promotion, disease prevention, and support services. Pastors with CHMs were significantly more involved in health promotion and disease prevention activities. Pastors without CHMs perceived a need for congregations to be involved in health-related services and were willing to become involved if they have adequate resources. CONCLUSIONS: Because of long-term trusting relationships that exist between congregants and those who minister to them, religious congregations may be ideally suited to provide cost-effective, community-based health promotion and disease prevention services as well as health-supporting services to community-dwelling elderly and persons with chronic illnesses.

Adult↗
PubMed2004

Disparities in care for depression among primary care patients.

CONTEXT: Ethnic minorities traditionally receive less care for depression than do white populations; we examine ethnic minority care for depression in a large cross-national primary care sample. DESIGN: This is a cross-sectional study of identification and treatment of depression among diverse primary care patients, using self-report of symptoms and care. SUBJECTS: One thousand four hundred and ninety-eight depressed primary care patients participating in four large studies of quality improvement for depression care are examined at baseline. RESULTS: Primary care providers recommend depression treatments for Latino and African-American patients as frequently as they do for white patients. However, Latino and African-American patients are less likely to take antidepressant medications (adjusted odds ratio [OR], 0.30; 95% confidence interval [CI], 0.21 to 0.42 and adjusted OR, 0.56; 95% CI, 0.36 to 0.87, respectively) and Latinos are less likely to obtain specialty mental health care (adjusted OR, 0.50; 95% CI, 0.36 to 0.75). CONCLUSIONS: Primary care providers are now able to recognize depression and recommend treatment for Latino and African-American patients, with this care recommended at equal rates to that of white patients. However, Latino and African-American patients remain less likely to obtain appropriate care, such as antidepressant medications or specialty care. New approaches to improving access to appropriate care for Latino and African-American primary care patients are needed.

Adolescent↗
PubMed1997

Criteria for enrolling dementia patients in hospice.

OBJECTIVE: Because survival time varies greatly, it is difficult for dementia patients to meet a key criterion for eligibility for the Medicare hospice benefit: a 6-month survival time. We have developed criteria for the Medicare hospice benefit that include the characteristics of advanced dementia and related medical complications. The purpose of the study was to determine survival time among dementia patients who met these criteria. Additionally, because the National Hospice Organization (NHO) developed its own guidelines while the study was in progress, we retrospectively examined the application of these guidelines to our sample. DESIGN: Two cohorts of hospice patients were studied longitudinally, each for 2 years. SETTING: Nine Midwestern hospice programs. PARTICIPANTS: Forty-seven patients were enrolled in home hospice and institutional hospice settings. MEASUREMENTS: Survival time consisted of the number of days between enrollment in the hospice program and death or the end of the study. Other measures included Activities of Daily Living, ratings of Appetite, Nourishment, and Mobility, Functional Assessment Staging (FAST), a Medical Complications Checklist, and a care plan concerning the use of medications for acute illness. RESULTS: Our hospice enrollment criteria predicted a median survival time of 4 months and a mean survival time of 6.9 months; 38% of patients survived for more than 6 months. FAST scores and Mobility ratings were significantly related to survival time. However, 41% could not be scored on the FAST as their disease progression was not ordinal. Among patients who could be scored on the FAST and who had reached Stage Seven C, their mean survival time was 3.2 months compared with 18 months among those who could be scored and had not reached this stage and 8.6 months among patients whose disease progression was not ordinal, P < .001. When the palliative care plans were examined, less aggressive care plans resulted in shorter survival times, P < .01. CONCLUSION: Our hospice enrollment criteria identified a group with a median survival time of 4 months and a mean survival time of 6.9 months. Using NHO criteria relying on the FAST allows the identification of a subgroup with very high mortality and a short time until death. Although the FAST can identify a subgroup of appropriate candidates for hospice, sole reliance on this measure might decrease access to hospice care for many dementia patients.

Activities of Daily Living↗
PubMed1998

That was the year that was: an evidence-based clinical geriatrics update.

BACKGROUND: Physicians are faced with an ever-growing information base in medical practice. Studies regularly show a disparity between science and patient care, with scientifically validated practices often taking 20 years and more to enter mainstream clinical practice. OBJECTIVES: To review the recent medical literature for high quality studies that practicing geriatricians should be aware of, either because they provide evidence that might lead to a change in clinical practice or because they provide insight into common geriatric syndromes. DESIGN: Overview. DATA SOURCES: All articles abstracted or noted in ACP Journal Club, Evidence-Based Medicine, or The New York Times from July 1996 to June 1997. STUDY SELECTION: Studies that met the standards for inclusion in ACP Journal Club. STUDY DESIGN: Sampling plan (including eligibility criteria), sample size, response rate, data analysis plan, proportion available for follow-up, main outcomes and measures, main results. RESULTS: Review of the 98 articles that met criteria resulted in the identification of several themes of importance to geriatricians, including the hazards of hospitalization, the prevention of NSAID-induced peptic ulcers, and the treatment and prevention of Alzheimer's disease. The results of these studies expand the therapeutic armamentarium of practicing geriatricians, provide new insights into geriatric syndromes, and raise cautions about the use of certain therapies in older adults. CONCLUSIONS: Many methodologically rigorous studies relevant to the medical care of older people have recently been published. Evidence-based medicine and the use of journals of secondary publication are useful tools to enhance the efficiency of journal reading for geriatric practitioners whose interests span the journals of several disciplines and subspecialties.

Aged↗
PubMed1999

Association of interleukin-6 and other biologic variables with depression in older people living in the community.

OBJECTIVES: The prevalence of depression increases with age, as does the prevalence of higher levels of the cytokine interleukin-6 (IL-6). This analysis was performed to determine the association between increased levels of this cytokine and depression in a population-based sample. DESIGN: Cross-sectional cohort study. SETTING: Rural and urban counties in North Carolina. PARTICIPANTS: Community-dwelling older people. MEASUREMENTS: The association between IL-6 and other biologic variables with self-report depression was examined in 1686 persons aged 70 years and older in the third in-person survey wave (1991) of the Duke Established Population for Epidemiologic Studies of the Elderly (EPESE). Bivariate associations were established by the Spearman correlation, adjusted for age. A stepwise linear logistic regression model was used to derive a final model to assess multivariable effects on CES-D scores. RESULTS: Depression was correlated with IL-6 (P = .011), D-Dimer (P = .017), alpha-1-globulin (P = .023), alpha-2-globulin (P = .002), and beta globulin (P = .012). After controlling for age, race, and gender, IL-6 levels remained the only biologic variable significantly associated with depression (P = .035). CONCLUSION: These data suggest that the inflammatory marker, IL-6, is associated with depression in older people in this cross-sectional study. These results are compatible with the hypothesis of cytokine (IL-6) stimulation in geriatric depression as part of an overall immunoendocrine dysregulation.

Age Distribution↗
PubMed2005

Cognitive deficits 3 to 6 years before dementia onset in a population sample: the Honolulu-Asia aging study.

OBJECTIVE: To determine the type of cognitive deficits occurring 3 to 6 years before onset of dementia in a population sample. DESIGN: A prospective study in which cognitive deficits in participants who had incident dementia at the 6-year follow-up were examined at baseline and 3 years. SETTING: Honolulu, Hawaii. PARTICIPANTS: Three thousand seven hundred thirty-four Japanese-American men aged 71 to 93 at baseline. At the 6-year follow-up, there were 52 incident cases of dementia, and 1,559 controls. MEASUREMENTS: The Cognitive Abilities Screening Instrument (CASI) and a questionnaire on subjective memory problems were administered at baseline. Dementia was assessed at baseline and at 3-year and 6-year follow-ups. RESULTS: Subjects who had incident dementia at 6-year follow-up, had showed deficits 3 to 6 years earlier in the CASI domain of episodic memory and in the questionnaire covering subjective memory problems. Up to 3 years before onset, there was worsening of the episodic memory deficit from baseline and new deficits in language, verbal fluency, and orientation. CONCLUSION: Cognitive deficits and awareness of memory problems are frequently present several years before dementia onset. The predictive value of these deficits is not large enough to allow earlier diagnosis of dementia, but information about such deficits may be useful as criteria for mild cognitive impairment.

Aged↗
PubMed2006

Characteristics of frail older adult drivers.

OBJECTIVES: To determine the prevalence of driving in older adults with mild to moderate physical frailty and to compare characteristics of current frail older adult drivers with those of former drivers in the sample. DESIGN: Retrospective study of frail older adults enrolled in randomized trials of exercise and hormone replacement therapy. SETTING: Urban, academic medical center. PARTICIPANTS: One hundred eighty-three sedentary community-dwelling men and women aged 75 and older with mild to moderate physical frailty, as defined by two of the following three criteria: modified Physical Performance Test (PPT) score between 18 and 32, peak oxygen uptake (VO2) between 10 and 18 mL/kg per minute, and self-report of difficulty or assistance with one activity of daily living (ADL) or two instrumental ADLs. Participants were classified as current or former drivers. MEASUREMENTS: Demographic characteristics, medical diagnoses, medication use, modified PPT score, and psychometric tests. RESULTS: The majority (85%) of the participants were drivers. Former drivers were more likely to be older, be female, reside in congregate independent living for the elderly, have a higher incidence of arthritis and congestive heart failure, take sedating medications, have lower total ADL scores, have lower VO2 peak scores, and have more impairment on tests of cognition and physical strength, although only age, type of residence, and grip strength were independent predictors of driving cessation in the regression analysis. CONCLUSION: Despite the presence of physical frailty, many older adults choose to continue to drive. Further studies are needed to better understand the driving behaviors of frail older adults and explore opportunities for optimizing driving abilities.

Activities of Daily Living↗
PubMedDate not supplied

An in vitro biomechanical comparison of the breaking strength and stiffness of polydioxanone (sizes 2, 7) and polyglactin 910 (sizes 3, 6) in the equine linea alba.

OBJECTIVE: To determine failure strength, stiffness, and failure mode of 4 suture materials in equine linea alba. STUDY DESIGN: Randomized complete block design. SAMPLE POPULATION: Linea albas collected from 12 adult horses (mean weight, 475 kg; mean age, 10 years). METHODS: The ventral abdominal fascia, including the linea alba, was collected and bisected along the linea alba into right and left halves. Each half was divided into four, 5-cm sections extending from the umbilicus cranially, and randomly assigned to 1 of 4 suture materials: 2 polydioxanone (2 PD), 3 polyglactin 910 (3 PG), 6 polyglactin 910 (6 PG), and 7 polydioxanone (7 PD). A single cycle to failure test was performed on each specimen at a distraction rate of 100 mm/min. Differences in failure strength and stiffness for the materials were evaluated using a mixed linear model with significance set at P<.05. RESULTS: In 94 of 96 test sections, constructs failed by suture failure. There were significant differences in failure strength (P<.0001) and stiffness (P<.001) among the suture/tissue constructs. 7 PD had the highest breaking strength (316.8 N) followed by 6 PG (281.3 N), 3 PG (229.9 N), and 2 PD (193.0 N). Six PG had the largest stiffness (14 N/mm) followed by 3 PG (12.7 N/mm), 7 PD (10.1 N/mm), and 2 PD (7.2 N/mm). Suture breaking strength and stiffness were not affected by linea or fascia thickness, individual horse, half of the linea alba, or abdominal wall position. Eighty-five (90.4%) suture loops failed adjacent the knot. CONCLUSIONS: When tested in single cycle to failure, suture material was more likely to fail than the linea alba. Larger suture materials had higher breaking strengths than smaller suture materials and stiffness was also affected by suture material and size. CLINICAL RELEVANCE: Given its high initial breaking strength and its relatively longer in vivo strength retention, 7 PD seems an appropriate choice of suture material for closure of the equine linea alba when maximal short-term failure strength is desired.

Abdominal Muscles↗
PubMedDate not supplied

Bursting tension of medium and large canine arteries sealed with ultrasonic energy or suture ligation.

OBJECTIVE: To compare bursting tension of arteries > or =3 mm in diameter sealed with ultrasonic energy (UE) with arteries ligated with suture. STUDY DESIGN: Experimental, nested factorial design. SAMPLE POPULATION: Vascular segments from canine cadavers. METHODS: Arterial segments (12) were collected from each of 16 canine cadavers and equally divided into 2 groups based on vessel diameter (medium, 3.0- < 4.5 mm; large, 4.5 - < or =6.0 mm). Arterial specimens (3) from each group were sealed with either UE (Harmonic Scalpel, HS, power level 3) or suture ligation. The mean bursting pressure and tension were determined and compared. RESULTS: Bursting tension was significantly higher (P< .0001) for sutured arteries than UE-occluded arteries, irrespective of size. Bursting tension was significantly higher (P=.0013) for medium than large UE-occluded arteries, whereas there was no difference associated with size for ligated arteries. UE energy failed to seal 1 medium artery and 7 large arteries. Compared with normal blood pressure, bursting pressures were 3.5 times greater for sutured arteries irrespective of size, 1.8 times greater for medium UE-occluded arteries, and approached normal blood pressure for large UE-occluded arteries. CONCLUSION: At the power level tested, UE should not be used to seal arteries > 4.5 mm in diameter. Suture provided an optimal seal for arteries < or =6.0 mm in diameter. CLINICAL RELEVANCE: Use of UE to occlude arteries during laparoscopic surgery is advantageous because only 1 instrument is required to simultaneously cut and coagulate tissue, but care should be exercised where large arteries might be encountered.

Animals↗
PubMed1994

Development of a standard soil-to-skin adherence probability density function for use in Monte Carlo analyses of dermal exposure.

It has recently been suggested that "standard" data distributions for key exposure variables should be developed wherever appropriate for use in probabilistic or "Monte Carlo" exposure analyses. Soil-on-skin adherence estimates represent an ideal candidate for development of a standard data distribution: There are several readily available studies which offer a consistent pattern of reported results, and more importantly, soil adherence to skin is likely to vary little from site-to-site. In this paper, we thoroughly review each of the published soil adherence studies with respect to study design, sampling, and analytical methods, and level of confidence in the reported results. Based on these studies, probability density functions (PDF) of soil adherence values were examined for different age groups and different sampling techniques. The soil adherence PDF developed from adult data was found to resemble closely the soil adherence PDF based on child data in terms of both central tendency (mean = 0.49 and 0.63 mg-soil/cm2-skin, respectively) and 95th percentile values (1.6 and 2.4 mg-soil/cm2-skin, respectively). Accordingly, a single, "standard" PDF is presented based on all data collected for all age groups. This standard PDF is lognormally distributed; the arithmetic mean and standard deviation are 0.52 +/- 0.9 mg-soil/cm2-skin. Since our review of the literature indicates that soil adherence under environmental conditions will be minimally influenced by age, sex, soil type, or particle size, this PDF should be considered applicable to all settings. The 50th and 95th percentile values of the standard PDF (0.25 and 1.7 mg-soil/cm2-skin, respectively) are very similar to recent U.S. EPA estimates of "average" and "upper-bound" soil adherence (0.2 and 1.0 mg-soil/cm2-skin, respectively).

Adhesiveness↗
PubMedDate not supplied

Bone fragility: assessment of risk and strategies for prevention.

OBJECTIVE: To review the literature related to risk factors for bone fragility and strategies for prevention. DATA SOURCES: Computerized searches. STUDY SELECTION: All human research articles from indexed journals in the English language related to the topics in this review and published after 1982 (except for earlier classic pieces) were evaluated. DATA EXTRACTION: The author extracted data independently using tables that included the following headings: author, year, design, sample size, age range of subjects, results, and comments. Power analyses were done on all reports that included enough information. DATA SYNTHESIS: The following are determinants of bone fragility: peak bone mass, genetic influences, hormonal status, dietary factors, exercise patterns, and personal exposures. CONCLUSIONS: Women should be informed of the risk factors and helped to determine whether they are at risk for osteoporosis. All women, starting with young girls, should be taught what methods can be used to decrease their risk. Additional research is needed on methods of improving bone health and decreasing risk.

Age Factors↗