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PubMed1995

Quality of care for depressed elderly patients hospitalized in the specialty psychiatric units or general medical wards.

BACKGROUND: Studies to assess quality of care have become increasingly important for research and policy purposes. OBJECTIVE: To evaluate the difference in quality of care between elderly depressed patients hospitalized in specialty psychiatric units and those hospitalized in general medical wards. METHODS: We reviewed retrospectively the medical charts of 2746 patients with depression hospitalized in 297 general medical hospitals in five different states. Quality of care was assessed by clinical review of explicit and implicit information contained in the medical records of patients in specialty psychiatric units (n = 1295) and general medical wards (n = 1451). We also used other secondary data sources to determine postdischarge outcomes. RESULTS: We found that (1) a higher percentage of admissions on the psychiatric units were considered appropriate, (2) overall psychological assessment was better on the psychiatric unit, (3) patients were more likely to receive psychological services on the psychiatric wards but more likely to receive traditional general medical services on medical wards, (4) there were more inpatient general medical complications on the psychiatric wards, and (5) implicit measures of clinical status at discharge were better for those on the psychiatric unit. CONCLUSIONS: Although limited by reliance on medical record abstraction and a retrospective study design, our data indicate that the quality of care for the psychological aspects of the treatment of depression may be better on psychiatric units, while the quality of general medical components of care may be better on general medical wards.

Aged↗
PubMed1999

Describing time and age variations in the risk of radiation-induced solid tumour incidence in the Japanese atomic bomb survivors using generalized relative and absolute risk models.

Generalized relative and absolute risk models, in which various functions of time and age modify the excess relative or absolute risk of radiation-induced cancer, are fitted to the Japanese atomic bomb survivor cancer incidence data set. Among generalized relative risk models, those in which a product of powers of time since exposure and attained age modify the relative risk provide the best fit. There are indications that the Armitage-Doll model (in its formulation as a generalized relative risk model) provides a poor fit to the data, possibly in part because of increasing age-adjusted cancer incidence rates in the Japanese cohort. Generalized absolute risk models, and in particular models in which either powers of time since exposure and attained age, or powers of time since exposure and age at exposure modify the excess absolute risk, provide a superior fit to any of the generalized relative risk models for all solid cancer sites analysed together. When six cancer subtypes are examined separately, only for respiratory cancers does this finding remain true, and for two other sites (female breast cancer and thyroid cancer) the generalized relative risk model yields a better fit than the generalized absolute risk model.

Age Factors↗
PubMed2002

Fatigue in cancer patients compared with fatigue in the general United States population.

BACKGROUND: Although fatigue is a common symptom among cancer patients, it is also a common experience in the general, healthy population. Its universality has made it difficult to appreciate whether the fatigue experienced by patients with cancer is distinguishable from the fatigue experienced by the general population. Because the etiology of fatigue is multifactorial, it also has been difficult to appreciate fully the relative contribution of anemia to cancer-related fatigue. METHODS: To address this issue, responses to a brief, standardized set of 13 questions from the Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System were compared across three groups: anemic cancer patients (n = 2369 patients), nonanemic cancer patients (n = 113 patients), and the general United States population (n = 1010 persons). RESULTS: Fatigue scores of the anemic cancer patients (at both baseline and upon completion of anemia therapy) were significantly worse compared with the scores of nonanemic cancer patients that, in turn, were worse compared with the scores of the general United States population (P < 0.001). Score distributions were quite distinct for these three groups. Within the group of anemic cancer patients, the degree of anemia (mild, moderate, or severe) also was predictive of the degree of fatigue (P < 0.001), although the distributions were not dramatically distinct. CONCLUSIONS: Although anemia is clearly a factor that contributes to the severity of disease-related fatigue among cancer patients, hemoglobin levels explain only part of the difference compared with fatigue among the general United States population. The distinct distributions of fatigue scores of anemic cancer patients compared with the general United States population and the substantial sample sizes of these two groups enabled a discriminant analysis approach that allowed the differentiation of anemic cancer patients from the general population with high sensitivity (0.92) and reasonable specificity (0.69). Thus, although fatigue is a symptom most anyone can relate to, the fatigue of cancer patients, particularly those who are anemic, is decidedly worse. Interventions targeting this common and life-disrupting symptom likely would be of considerable value to patients with cancer.

Anemia↗
PubMed2001

Body image and weight consciousness among South Asian, Italian and general population women in Britain.

Italians in Britain have low rates of coronary heart disease while South Asians have high rates, which correspond to a tendency to central abdominal fat deposition and overweight. World variations in attitudes to body size are thought to be related to economic security. This cross-sectional study employed a range of measures including photographic silhouettes of known BMI to investigate the attitudes of 259 South Asian, Italian and general population women (aged 20-42 years) towards body size. Migrants are compared with British-born minority members. Our results indicate that although migrant South Asians were less happy with their weight than migrant Italians, fewer had tried to lose weight in the past or had experienced external pressures to change their bodies. More migrant South Asians than Italians or general population women equated one of the four largest shapes (BMI 28-38) with health and successful reproduction. All groups wanted to resemble one of the two thinnest shapes, equating them with longevity, likelihood of marriage and job success. British-born South Asians generally showed a considerable degree of convergence towards general population women's negative attitudes to large body size, but British-born Italians' attitudes were significantly more negative even than general population women. The study's conclusions were that South Asian health beliefs are an important focus of resistance to slimness. The tendency of migrant South Asians to equate large size with health contrasts with the opposing views of Italian and general population women. British-born South Asians' views are modifying from those of migrants, but significant differences remain when compared with general population women and British-born Italians. Present differences in economic security offer only a partial explanation; South Asian attitudes may be explained by economic insecurity in the past.

Adult↗
PubMed1988

Neural-space generalization of a topological transformation.

An investigation is performed to assess the generalization capability found in neural network paradigms to approximate a 2-dimensional coordinate (topological) transformation. A developed strategy uses the example to give a physical meaning to what is meant by generalization. The example shows how to use a neural network paradigm to generalize a two-degree of freedom topological transformation from cartesian end-point coordinates to corresponding joint angle coordinates based only on examples of the mapping. The importance of this example is that it provides a clear understanding of how and what a neural network is actually communications and brings a theoretical idea to a useful understanding. When examples characterize the topology, a collective generalization property begins to emerge and the network learns the topology. If the network is presented with additional examples of the transformation, the network can generate the corresponding joint angles to any unseen position, that is, by generalization. It is also significant that the network's generalization property emerges from the network based on very few training examples! Further, the networks power exists with very few neurons. Results suggest the use of the paradigm's generalization capability to provide solutions to unknown or intractable algorithms for applications.

Artificial Intelligence↗
PubMedDate not supplied

Feline generalized penicillin epilepsy.

Feline generalized penicillin epilepsy represents an experimental model of generalized spike-and-wave discharges occurring during clinical absence attacks. Spike-and-wave discharges of feline generalized penicillin epilepsy also have a pharmacological profile that is similar to that encountered in human absence attacks. Studies on the respective roles played by the thalamus and cortex in the generation of spike-and-wave discharges indicate that both structures are important in the elaboration of such generalized activity. Moreover, GABAA-mediated, intracortical inhibitory mechanisms are preserved and eventually enhanced at a time when generalized spike-and-wave discharges of feline generalized penicillin epilepsy are recorded. A preservation of GABA-mediated mechanisms in pure absence epilepsy might explain the differences in prognostic outlook that characterizes this type of epilepsy from seizures in which GABAergic mechanisms break down (e.g., generalized convulsive and partial epileptic attacks).

Animals↗
PubMed2001

Opinions and experiences in general practice on osteoporosis prevention, diagnosis and management.

We determined to survey the general practice population regarding their attitudes to and knowledge of osteoporosis as a baseline prior to publication of national guidelines for the management of osteoporosis. All 2515 general practitioners registered in the 10 Health Authorities of the North Thames region, London, UK were surveyed by a postal questionnaire. Responses relating to epidemiology, public health and education on osteoporosis were analyzed. The overall response was 1153 (46%). General practitioners who responded were younger, predominantly female and in group practice. There is considerable awareness of the importance of preventing osteoporosis. General practitioners are active in identifying groups at risk, particularly those who are aged 40 years and older. A prevention strategy for osteoporosis is viewed as effective. However, two thirds of general practitioners remain unconvinced about the efficacy of drug therapy. Education on osteoporosis is considered inadequate. General practitioners would welcome further information on management issues and access to osteoporosis services. In conclusion, educational initiatives will be important both at undergraduate and postgraduate levels to increase awareness and knowledge of osteoporosis. General practitioners are aware of the public health impact of this condition and express a preference for educational material of direct relevance to the care of their patients. Therefore better cooperation between primary and secondary care should lead to ways of breaking down barriers to change in clinical practice and promoting fully integrated care of patients with osteoporosis.

Attitude of Health Personnel↗
PubMed2002

The generalized matching law as a predictor of choice between cocaine and food in rhesus monkeys.

RATIONALE: The generalized matching law predicts that the relative rate of behavior maintained by different reinforcers will match the relative rate of reinforcement. It has previously been shown that responding maintained by either food deliveries or cocaine injections under concurrent variable-interval (conc VI) schedules is well described by the generalized matching law. However, the generality of this conclusion to the choice between a drug and a non-drug reinforcer has not been well established. OBJECTIVE: The objective of the present study was to determine the extent to which the generalized matching law could account for choice between cocaine and food. METHODS: Four male rhesus monkeys (Macaca mulatta) lever pressed under various pairs of conc VI schedules with food and/or cocaine injection as the maintaining events. Two doses of cocaine (0.025 and 0.05 mg/kg per injection) were selected to provide information about reinforcer magnitude. RESULTS: As has been found in a context of choice between identical reinforcers, the generalized matching law accounted for most behavior. As in earlier studies with identical reinforcers, there was less responding apportioned to the alternative with the greater reinforcement frequency than predicted by the generalized matching law, i.e., undermatching was observed frequently. There was a tendency for more responding to be emitted toward the food alternative when the lower dose of cocaine was available and toward the drug alternative when the higher dose of cocaine was available. CONCLUSION: These results suggest that, as proposed by the generalized matching law, relative reinforcement rate is an important determinant of choice between a drug and a non-drug reinforcer.

Animals↗
PubMed2003

Doctors perceptions of the influences on their prescribing: a comparison of general practitioners based in rural and urban Australia.

OBJECTIVES: To compare and contrast the influences on prescribing perceived by general practitioners in an urban area of Queensland, Australia, to those perceived by general practitioners in rural Queensland. METHOD: An investigation was undertaken with a group of general practitioners in urban and rural locations of Australia. A self-administered questionnaire requested the doctors' demographic details and their opinions on statements about prescribing. They also reported their prescribing of six recently marketed drugs. RESULTS: One hundred and forty-two general practitioners from rural areas of Queensland (55% of the eligible population of these doctors) and one hundred and thirty-seven from the urban area (54% response) returned the surveys. The urban group were older and had more experience as general practitioners. Similarities and differences were detected between the two groups. The urban group considered that continuing medical education had a lesser influence on their prescribing than the rural group. The rural general practitioners were more likely than the urban doctors to agree that their information needs on prescribing were not being met in their practice, that their practice location had an effect on their prescribing (and also an effect on their prescribing of new drugs) as well as the remoteness of the patient's address having an effect. The rural doctors agreed more than the urban doctors that they try to avoid drugs requiring a significant amount of monitoring, reinforced by their agreement that they would be more likely to prescribe a newly marketed drug requiring less monitoring. When relating to whether the doctors in the two groups had reported initiating a supply of specific newly marketed drugs, independent of a specialist, rural general practitioners had initiated fewer of these selected new medicines. CONCLUSION: This study has highlighted some of the differences in perceptions of doctors on the influences on prescribing in rural relative to urban areas of Australia. An understanding of these perceptions will allow targeting and development of location-relevant prescribing interventions and messages.

Adult↗
PubMed1983

The medical chief residency and its relation to academic sections of general medicine.

The role and function of chief medical residents in academic programs were reexamined in light of the advent of departmental units of general internal medicine. Of 87 chief medical residents responding to a questionnaire, 74 worked in departments with active general internal medicine sections. There was much interaction between chief medical residents and general internal medicine faculty: 36 percent of chief medical residents participated formally in general internal medicine section activities, 54 percent shared teaching responsibilities with general internal medicine faculty, and 45 percent of chief medical residents interacted with general internal medicine faculty in administrative activities. Despite this interaction, most basic administrative tasks were handled by chief medical residents alone. Forty-eight percent of chief medical residents thought the position had declined in prestige. Recent literature on the evolution of the chief residency in internal medicine and in other specialties is reviewed, and recommendations for capitalizing on the presence of general internal medicine faculty to make the position more rewarding are made.

Faculty, Medical↗
PubMed1991

Psychoactive drug use among medical doctors is higher than in the general population.

We surveyed a representative sample of practising physicians and a representative sample of subjects from the Swiss general population (SOMIPOPS Survey) concerning their annual use of sleeping pills and tranquillizers. 77% of the physicians (n = 466) and 72% of the general population (n = 4255) responded. After adjustment for age and sex 37.1% of the doctors (general population 21.1% P less than 0.001) claimed to have taken these drugs for therapeutic purposes. The proportion of psychiatrists who reported taking sleeping pills and tranquillizers daily (10.6%) were significantly greater than for the population of doctors as a whole and for the general population (P less than 0.05). Regular users (i.e. subjects taking one mood altering drug at least once a week) accounted for 11.1% of the medical population compared with 6.8% of the general population (P less than 0.01). This over-consumption was wholly due to the greater number of regular users of psychoactive drugs amongst doctors less than 50 years of age relative to the general population or to subjects in higher management (from P less than 0.05 to P less than 0.001). Without this specific over-use, members of the medical profession would not have been found to use more psychoactive drugs than the general population and the executives. This result suggests that it would be worth investigating the mechanisms of response and adjustment (coping) to the specific stress that appears to be inherent in the exercise of medical practice.

Adaptation, Psychological↗
PubMed1994

General practitioner distribution and population dynamics: Munich, 1950-1990.

The problem of variable geographic distribution of physicians appears to be universal and intransigent. There is growing evidence from several developed countries of primary physicians avoiding areas in large cities increasingly populated by poor and ethnic minorities. This paper extends the research to Germany. Here, the changing population structure of Munich from 1950 through 1990, characterized by a large influx of foreign guestworkers, is illustrated. Selected changes in the medical care system and the role of the general practitioner pertinent to the question of supply and distribution are also discussed. Within this context, the geographic distribution of general practitioners' offices is examined for possible response to the concentration of foreigners in Districts within the City. In the aggregate, the distribution of general practitioners follows the geographic trends of the general population during the study period. However, geographic distribution of general practitioners varies widely on a District by District assessment. Though the exception, in several Districts there are indications that general practitioners may be avoiding locating offices in areas characterized by high density of foreign populations. This paper also draws attention to the importance of investigative scale to conclusions relating general practitioner distribution to spatial-temporal population trends.

Avoidance Learning↗
PubMed1992

The effect of intrauterine growth retardation on the quality of general movements in the human fetus.

The effect of severe intrauterine growth retardation on the quality of general movements was studied longitudinally in 17 human fetuses. During the prenatal and postnatal periods, fetal movements were recorded by means of weekly 1 h ultrasound and video registrations. Neurological examinations were performed at 1, 3, 6 and 12 months after birth. No clear effect of uncomplicated intrauterine growth retardation could be detected on the quality of general movements. General movements became slow and small in amplitude (4/5) in cases where there was a reduction in the amount of amniotic fluid. Parallel to the onset of abnormal fetal heart rate patterns, general movements became poor in repertoire (7/7), while they were hardly discernible after further deterioration of the fetal condition (5/7). With the exception of 3 infants with cerebral haemorrhages, the quality of general movements observed just before and after birth was identical (13/16). In these infants, the quality of general movements as well as the results of the standardized neurological examination tended to normalize at 3 months and 1 year, respectively. Uncomplicated IUGR had no marked effect on the quality of general movements or on the results of the neurological examination at the age of 1 year.

Aging↗
PubMed2006

Generalized tonic-clonic seizures detected by implantable loop recorder devices: diagnosing more than cardiac arrhythmias.

BACKGROUND: Both syncope and seizures are important causes of recurrent, unexplained episodes of loss of consciousness. Implantable loop recorders have identified serious arrhythmias in patients with repeated syncope; however, implantable loop recorder detection of seizures is less well established. OBJECTIVES: The purpose of this study was to provide in-depth analysis of a characteristic myopotential pattern recorded by implantable loop recorders during generalized tonic-clonic seizures. METHODS: Fourteen patients with refractory, video-EEG-documented epilepsy (complex partial, atonic, tonic, or generalized tonic-clonic seizures) underwent implantable loop recorder placement as part of a study protocol evaluating cardiac rhythm abnormalities in patients at high risk for sudden unexpected death in epilepsy. RESULTS: Twelve generalized tonic-clonic seizure episodes were detected by the implantable loop recorder in six patients. Implantable loop recorder and EEG recordings of generalized tonic-clonic seizures were identical and revealed a tonic phase (sustained, rapid, high-frequency myopotentials) transitioning to a clonic phase (periodic bursts of high-frequency myopotentials with a decelerating burst frequency from 3-6 Hz to 1-2 Hz) prior to seizure termination. With the nonprogrammable bandpass filter of 0.85 to 32 Hz in the implantable loop recorder, all generalized tonic-clonic seizure episodes had escaped automatic detection and required activation by family members. None of the 76 nongeneralized tonic-clonic seizure episodes recorded on the implantable loop recorder in the 14 patients exhibited the stereotypical tonic-clonic pattern that defines generalized seizures. CONCLUSION: Recognizing this specific myopotential pattern on an implantable loop recorder might help diagnose generalized tonic-clonic seizures as a cause of recurrent, unexplained episodes of loss of consciousness. Having a programmable bandpass filter in the implantable loop recorder might increase its diagnostic yield for such patients.

Adult↗
PubMed2006

Attitudes of hand surgeons, hand surgery patients, and the general public regarding psychologic influences on illness.

PURPOSE: Psychologic influences on illness are well recognized but infrequently addressed in the interactions of hand surgeons and patients. This study assessed the attitudes of hand surgery patients and hand surgeons regarding psychologic influences on illness and compared their attitudes with those of the general population. METHODS: An 8-question survey regarding participant's attitudes toward psychologic influences on illness was given to the general public (people waiting in an airport), patients presenting to a hand surgery practice, and members of the American Society for Surgery of the Hand. RESULTS: A total of 474 surgeons, 85 patients, and 42 public participants completed the survey. There were no notable differences between patients and the general public, but the surgeons' attitudes were markedly different from both patients and the general public with respect to 4 items: the surgeons underestimated the openness of patients and the general public to discussing psychologic influences and willingness to see a psychologist or psychiatrist; and they were more supportive than the general public or patients regarding the opinion that the placebo effect reflects the strong influence of psychologic factors in healing and that psychologic stress often is expressed as a physical complaint. The distribution of patient responses showed 2 subgroups with respect to the idea that psychologic stress often is expressed as a physical complaint and with regard to willingness to see a mental heath professional, reflecting that a subset of patients with a hand illness may be resistant to these concepts. CONCLUSIONS: Hand surgery patients and the general public are not as aware of the psychologic influences on illness as are hand surgeons, but they are more willing to consider and discuss psychologic factors-and even psychologic treatment-than their surgeons realize. Surgeons' views may be colored by a few negative interactions with challenging patients, but a dialogue with our patients regarding the influence of psychologic issues on illness will be well received by most patients and may facilitate recovery.

Attitude of Health Personnel↗
PubMed2006

Generalized joint hypermobility is more common in chronic fatigue syndrome than in healthy control subjects.

OBJECTIVES: This study aimed at (1) comparing the prevalence of generalized hypermobility in patients with chronic fatigue syndrome (CFS) and healthy volunteers, (2) examining the clinical importance of generalized hypermobility in patients with CFS, and (3) examining whether knee proprioception is associated with hypermobility in patients with CFS. METHODS: Sixty-eight patients with CFS filled out two self-reported measures (for the assessment of symptom severity and disability), were questioned about muscle and joint pain, and were screened for generalized hypermobility. Afterward, the patients performed a knee repositioning test (assessment of knee proprioception), and it was examined whether or not they fulfilled the criteria for benign joint hypermobility syndrome (BJHS). Sixty-nine age- and sex-matched healthy volunteers were screened for generalized joint hypermobility and performed the same knee repositioning test. RESULTS: Compared with the healthy volunteers (4.3%, 3/68), significantly more patients with CFS (20.6%, 14/69) fulfilled the criteria for generalized joint hypermobility (Fisher exact test, P < .004). No associations were found between generalized joint hypermobility and the self-reported measures (including pain severity) or knee proprioception (Spearman correlation analysis). Knee proprioception was similar in both groups (Mann-Whitney U = 1961, z = -1.745, P = .81). Forty patients with CFS (58.8%) fulfilled the criteria for BJHS. CONCLUSIONS: These data indicate that a subgroup of patients with CFS present with generalized joint hypermobility and most patients with of CFS fulfill the diagnostic criteria for BJHS. There appears to be no association between musculoskeletal pain and joint hypermobility in patients with CFS.

Adult↗
PubMed2004

The neural origins of specific and general memory: the role of the fusiform cortex.

Recognition of an object can be based on memory for specific details of a prior encounter with the object, or on a more general memory for the type of object previously encountered. Responding on the basis of general information alone can sometimes produce memory errors involving both distortion and forgetting, but little is known about the neural origins of general versus specific recognition. We extended the standard subsequent memory paradigm to examine whether neural activity at encoding predicts whether an object will subsequently elicit specific as compared to general memory. During event-related functional magnetic resonance imaging (fMRI), participants viewed objects and made size judgments about them. Later, they viewed same, similar, and new objects, labeling each as "same," "similar," or "new." Specific recognition was indicated by a "same" response to a same object. By contrast, general, non-specific recognition was indicated by either a "same" response to a similar object (false memory) or a "similar" response to a same object (partial memory). As predicted, specific recognition, as compared to non-specific recognition, was associated with encoding-related activity in the right fusiform cortex, while non-specific recognition, as compared to forgetting, was associated with encoding-related activity in the left fusiform cortex. Furthermore, all successful recognition (specific and general), as compared to forgetting, was associated with encoding-related activity in bilateral fusiform cortex. These results suggest that the right fusiform cortex is associated with specific feature encoding, while the left fusiform cortex is involved in more general object encoding.

Adult↗
PubMed2006

Exploration in outbred mice covaries with general learning abilities irrespective of stress reactivity, emotionality, and physical attributes.

Across multiple learning tasks (that place different sensory, motor, and information processing demands on the animals), we have found that the performance of mice is commonly regulated by a single factor ("general learning") that accounts for 30-40% of the variance across individuals and tasks. Furthermore, individuals' general learning abilities were highly correlated with their propensity to engage in exploration in an open field, a behavior that is potentially stress-inducing. This relationship between exploration in the open field and general learning abilities suggests the possibility that variations in stress sensitivity/responsivity or related emotional responses might directly influence individuals' general learning abilities. Here, the relationship of sensory/motor skills and stress sensitivity/emotionality to animals' general learning abilities were assessed. Outbred (CD-1) mice were tested in a battery of six learning tasks as well as 21 tests of exploratory behavior, sensory/motor function and fitness, emotionality, and stress reactivity. The performances of individual mice were correlated across six learning tasks, and the performance measures of all learning tasks loaded heavily on a single factor (principal component analysis), accounting for 32% of the variability between animals and tasks. Open field exploration and seven additional exploratory behaviors (including those exhibited in an elevated plus maze) also loaded heavily on this same factor, although general activity, sensory/motor responses, physical characteristics, and direct measures of fear did not. In a separate experiment, serum corticosterone levels of mice were elevated in response to a mild environmental stressor (confinement on an elevated platform). Stress-induced corticosterone levels were correlated with behavioral fear responses, but were unsystematically related to individuals' propensity for exploration. In total, these results suggest that although general learning abilities are strongly related to individuals' propensity for exploration, this relationship is not attributable to variations in sensory/motor function or the individuals' physiological or behavioral sensitivity to conditions that promote stress or fear.

Animals↗