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PubMed2001

[Being a male or female doctor is different in medical practice].

OBJECTIVES: To identify the differences between the clinical practice (conduct) of male and female doctors and its determining factors; and to find the variability in the various conducts studied which is explained by a set of variables, gender among them. DESIGN: Cross-sectional, multi-centre descriptive study. SETTING: Andalusian health centres with populations of over 100000 inhabitants. PARTICIPANTS: Selection of 159 primary care doctors with postgraduate training by means of simple randomised sampling. 56% were men, 44% women, with power of comparisons at 68%. MEASUREMENTS AND MAIN RESULTS: Self-administered questionnaire to measure the dependent variable, overall conduct (clinical practice) and 11 dimensions of this conduct. Independent variables were: determinants of conduct identified by the theory of reasoned action (attitudes and subjective norm) and by the theory of social learning (self-efficacy and control locus), gender and other social and demographic variables and work conditions variables. Multiple linear regression models were constructed to explain each conduct analysed. Being a female doctor affects positively overall conduct and conduct in information, psycho-social guidance, prevention of obesity, active recruitment for family planning and collaboration with nurses. CONCLUSIONS: In Andalusia women general practitioners have a more marked orientation towards the psycho-social sides of care than their male colleagues. They give more information to their patients and more frequently perform preventive activities linked to their gender. They also rely on the work of their nurses more than male doctors.

Adult↗
PubMed1977

Two-year follow-up of the patients included in the WHO International Pilot Study of Schizophrenia.

Over 90% of the 1202 patients investigated in the 9 centres collaborating in the International Pilot Study of Schizophrenia were traced 2 years after the initial examination and on the average over 75% of them were re-examined, using standardized instruments and methods. Results indicate that patients diagnosed as schizophrenic on the basis of standardized assessments and clearly specified diagnostic criteria demonstrated very marked variations of course and outcome over a 2-year period. Schizophrenic patients in the centres in developing countries had considerably better course and outcome than schizophrenic patients in the centres in developed countries.

Adolescent↗
PubMed1996

Ground-based detectability of terrestrial and Jovian extrasolar planets: observations of CM Draconis at Lick Observatory.

The detection of terrestrial-sized extrasolar planets from the ground has been thought to be virtually impossible due to atmospheric scintillation limits. However, we show that this is not the case especially selected (but nevertheless main sequence) stars, namely small eclipsing binaries. For the smallest of these systems, CM Draconis, several months to a few years of photometric observations with 1-m-class telescopes will be sufficient to detect the transits of any short-period planets of sizes > or = 1.5 Earth radii (RE), using cross-correlation analysis with moderately good photometry. Somewhat larger telescopes will be needed to extend this detectability to terrestrial planets in larger eclipsing binary systems. (We arbitrarily define "terrestrial planets" herein as those whose disc areas are closer to that of Earth's than Neptune's i.e., less than about 2.78 RE.) As a "spin-off" of such observations, we will also be able to detect the presence of Jovian-mass planets without transits using the timing of the eclipse minima. Eclipse minima will drift in time as the binary system is offset by a sufficiently massive planet (i.e., one Jupiter mass) about the binary/giant-planet barycenter, causing a periodic variation in the light travel time to the observer. We present here an outline of present observations taking place at the University of California Lick Observatory using the Crossley 0.9-m telescope in collaboration with other observatories (in South Korea, Crete, France, Canary Islands, and New York) to detect or constrain the existence of terrestrial planets around main sequence eclipsing binary star systems, starting with CM Draconis. We demonstrate the applicability of photometric data to the general detection of gas giant planets via eclipse minima timings in many other small-mass eclipsing binary systems as well.

Astronomy↗
PubMed2004

Effectiveness of hotline, advocacy, counseling, and shelter services for victims of domestic violence: a statewide evaluation.

The authors report the results of an evaluation of services provided by 54 Illinois domestic violence agencies. In collaboration with the University of Illinois at Chicago evaluation team, domestic violence advocates identified services to be evaluated, specified desired outcomes of those services, and participated in developing measures of those outcomes in both English and Spanish. With in the limitations of the study, outcomes were positive in all four program areas: hotline, counseling, advocacy, and shelter. The authors then discuss implications for evaluation of domestic violence programs that maintain victim safety as a guiding principle.

Attitude of Health Personnel↗
PubMed2003

Overlap between genitourinary medicine and public health in the surveillance and control of sexually transmitted infection in England, Wales and Northern Ireland.

The control of sexually transmitted infections (STI), and in particular outbreaks and other acute incidents of STI, often requires resources outside the genitourinary medicine (GUM) clinic. This study of Consultants in Communicable Disease Control (CsCDC) in England, Wales and Northern Ireland, explored the level of collaboration between district public health departments and GUM clinics and the usefulness at local level of STI surveillance data. The results show an inconsistent working relationship between GUM and public health throughout the country and highlight deficiencies in current surveillance systems. Participants in the survey suggested potential remedies to the problems identified including enhanced surveillance of STI and formalised relationships between GUM and local public health departments. Enactment of these suggested remedies may contribute to meeting the challenge of reversing current disease trends.

Communicable Disease Control↗
PubMed2006

An exon skipping-associated nonsense mutation in the dystrophin gene uncovers a complex interplay between multiple antagonistic splicing elements.

A nonsense mutation c.4250T>A (p.Leu1417X) in the dystrophin gene of a patient with an intermediate phenotype of muscular dystrophy induces partial in-frame skipping of exon 31. On the basis of UV cross-linking assays and pull-down analysis, we present evidence that the skipping of this exon is because of the creation of an exonic splicing silencer, which acts as a highly specific binding site (UAGACA) for a known repressor protein, hnRNP A1. Recombinant hnRNP A1 represses exon inclusion both in vitro and in vivo upon transient transfection of C2C12 cells with Duchenne muscular dystrophy (DMD) minigenes carrying the c.4250T>A mutation. Furthermore, we identified a downstream splicing enhancer in the central region of exon 31. This region functions as a Tra2beta-dependent exonic splicing enhancer (ESE) in vitro when inserted into a heterologous splicing reporter, and deletion of the ESE showed that incorporation of exon 31 depends on the Tra2beta-dependent enhancer both in the wild-type and mutant context. We conclude that dystrophin exon 31 contains juxtaposed sequence motifs that collaborate to regulate exon usage. This is the first elucidation of the molecular mechanism leading to exon skipping in the dystrophin gene and allowing the occurrence of a milder phenotype than the expected DMD phenotype. The knowledge of which cis-acting sequence within an exon is important for its definition will be essential for the alternative gene therapy approaches based on modulation of splicing to bypass DMD-causing mutations in the endogenous dystrophin gene.

Amino Acid Motifs↗
PubMedDate not supplied

Organizational and professional characteristics predicting external communications in Canadian public health units.

This study is a survey of administrative divisions involved in tobacco programs in Canadian public health units. It aims to identify correlates of public health units' contacts and collaborations with external agencies, as predisposing factors in their capacity to innovate. Heads of 124 divisions involved in tobacco control completed a questionnaire about their budgets, staff, and management practices. In each of these divisions, professionals involved in tobacco programs also completed a questionnaire about their characteristics and experience. Results showed a high level of contacts and collaborations with external agencies. Four variables emerged as correlates of external communications: professionals' degree of access to public health information sources, the diversity of disciplines within the administrative division, the decentralization of authority, and the level of professionals' participation in decision-making. Because of the potential relationship between innovation and external communication, public health units should consider fostering external communication by management practices and policies, such as favouring professional diversity, increasing access to sources of information, and adopting more decentralized, participatory management.

Canada↗
PubMed1998

[Predictive value of the allergologic profile in anesthesia and resuscitation].

The allergic history to anaesthetics in general and especially to synthetic myorelaxants, poses few etiological diagnostic problems in practice, because of on one hand the excellent collaboration between Anesthetists and Allergologists in the CHU at Angers and on the other because of the great sensitivity of skin testing. Why then have a predictive history for myorelaxants? The results of a study at the CHU at Angers on 15 patients showed sensitivity to anaesthetics in general (myorelaxants 86%, Diprivan) and/or an antibiotic, latex were very encouraging. One 15 new general anaesthetics a single minor incident was seen: the 15 patients had benefited from a predictive history.

Adolescent↗
PubMed1975

The pediatric internship as a teaching technique: a comparison of learning experiences in five hospitals.

Five interns joined in a collaborative study to assess their learning experiences during the internship year. A 3 times 5-inch data form was completed for each patient for whom the intern was responsible. Information was gathered on demongraphic characteristics of the patient, the teaching that involved this patient, and what skills were acquired. Nearly 30% of the patients were under 1 year of age; 55% were boys. More than one half of the contacts were in an outpatient or emergency department. Over 80% of the patients had not been seen before; continuity patients made up less than 9% of the contacts. Well-child care was the largest care category (19%), followed by respiratory problems (15%) and injuries (9%). About 40% of the contacts involved a teaching input, mainly from residents, attending physicians, and faculty. Care skills most frequently acquired were physical examination (49%), reading (15%), and interviewing (11%). Cross-tabulations showed that most learning was reported for inpatients, for patients with rare diseases, and when some teaching was involved.

Child↗
PubMed2004

Public-private mix for DOTS implementation: what makes it work?

OBJECTIVE: To compare processes and outcomes of four public-private mix (PPM) projects on DOTS implementation for tuberculosis (TB) control in New Delhi, India; Ho Chi Minh City, Viet Nam; Nairobi, Kenya; and Pune, India. METHODS: Cross-project analysis of secondary data from separate project evaluations was used. Differences among PPM project sites in impact on TB control (change in case detection, treatment outcomes and equity in access) were correlated with differences in chosen intervention strategies and structural conditions. FINDINGS: The analysis suggests that an effective intervention package should include the following provider-side components: (1) orienting private providers (PPs) and the staff of the national TB programme (NTP); (2) improving the referral and information system through simple practical tools; (3) the NTP adequately supervising and monitoring PPs; and (4) the NTP providing free anti-TB drugs to patients treated in the private sector. CONCLUSION: Getting such an intervention package to work requires that the NTP be strongly committed to supporting, supervising and evaluating PPM projects. Further, using a local nongovernmental organization or a medical association as an intermediary may facilitate collaboration. Investing time and effort to ensure that sufficient dialogue takes place among all stakeholders is important to help build trust and achieve a high level of agreement.

Communicable Disease Control↗
PubMed2002

Rho(0) meson production in the pp-->pppi(+)pi(-) reaction at 3.67 GeV/c.

Total and differential cross sections for the exclusive reaction pp-->pp rho observed via the pi(+)pi(-) decay channel have been measured at p(beam)=3.67 GeV/c. The observed total meson production cross section is determined to be (23.4+/-0.8+/-8) mu b and is significantly lower than typical cross sections used in model calculations for heavy-ion collisions. The differential cross sections measured indicate a strong anisotropy (approximately cos(theta(CM)(rho)) in the rho(0) meson production.

Journal Article↗
PubMed2006

The roles of critical care advanced practice nurse.

PURPOSE: To determine and compare the perception among nurses and doctors of the roles and tasks of critical care advanced practice nurses (APNs) in order to establish standardized and formally agreed role criteria for such critical care APNs. METHOD: This study measured and analyzed the necessity of each of the roles and tasks of critical care APNs, as perceived by nurses and doctors, through a survey of 121 participants: 71 nurses in 7 intensive care units (ICUs) at a general hospital in Seoul, and 50 doctors who used ICUs. Data collection utilized a questionnaire of 128 questions in the following fields: direct practice (79), leadership and change agent (17), consultation and collaboration (15), education and counseling (11), and research (6). RESULTS: Both the nurses' and the doctors' groups confirmed the necessity of critical care APNs, with doctors who frequently used ICUs indicating a particularly strong need. As for the priority of each role of critical care APNs, the nurses considered direct practice to be the most critical, followed by education and counseling, research, consultation and collaboration, and leadership and change agent. The doctors also considered direct practice to be the most critical, followed by education and counseling, consultation and collaboration, research, and leadership and change agent. There was a statistically significant difference between how the two groups regarded all the roles, except for the consultation and collaboration roles. As for the necessity of each role of critical care APNs, the nurses considered research to be the most necessary, followed by education and counseling, consultation and collaboration, leadership and change agent, and direct practice. The doctors, on the other hand, considered education and counseling to be the most necessary, followed by research, consultation and collaboration, leadership and change agent, and direct practice. The responses of the two groups to all the roles, except for education and counseling roles, were significantly different. CONCLUSION: Nurses and doctors have different perceptions of the roles and tasks of critical care APNs. Thus, it is necessary for the combined nursing and medical fields to reach an official agreement on a set of criteria to standardize for the roles and tasks of critical care APNs.

Adult↗
PubMed1998

Universal diagnostic RT-PCR protocol for arboviruses.

A selected number of PCR protocols were evaluated to determine if they could serve as a universal protocol for detecting and identifying all arboviruses. In this study, four parameters that affect the efficacy of RT-PCR (RNA extraction method, choice of reverse transcriptase, choice of DNA polymerase and thermocycling program) were evaluated in combination. The most optimal combination of those parameters employed use of silica gel membrane spin column, RAV-2 reverse transcriptase, Tth DNA polymerase, and a simple modification of a published thermocycling program. By this modified protocol, viral RNA could be amplified satisfactorily with more than 50 pairs of primers designed for diagnosis of arboviruses representing five families. The sensitivity and specificity obtained by this universal protocol were comparable to those obtained by the original protocol for each primer pair tested; and for some primers, improved sensitivity was observed. It was also found that a simple modification of a suggested protocol of a commercial RT-PCR kit could produce nearly identical results and serve as another universal protocol. With the use of a universal diagnostic reverse transcriptase-polymerase chain reaction (RT-PCR) protocol, simultaneous screening of clinical or biological specimens against a large number of RNA viruses belonging to many families can be performed more efficiently for etiologic determination in the situations complicated by the difficulty of differential diagnosis. Furthermore, such a universal protocol facilitates reducing the cost of PCR-based diagnostic operation and standardizing the qualities of PCR-based diagnosis within an institution or among collaborating institutions. A logical strategy is to conduct diagnosis in two stages by using broadly group-reactive primers in the first stage to narrow the range of possible etiologic agents and using virus-specific primers in the second stage for identification. Before such a strategy is employed, however, more group-reactive primers for a large number of arboviruses, for which no such primers currently exist, must be made available. Furthermore, the best pair or pairs of primers need to be selected for each virus for the second stage of the strategy.

Animals↗
PubMedDate not supplied

Aggregate-level predictors of the prevalence of selected drinking patterns in multiple studies: a research synthesis from the Collaborative Alcohol-Related Longitudinal Project.

This paper examines the prevalence of two "at-risk" alcohol drinking patterns (infrequent heavy drinking and frequent heavy drinking) within age/gender groups in multiple general population studies. When heterogeneity in findings across studies is found, we test the hypotheses that suicide, divorce, unemployment rates, and the per capita consumption of alcohol in each country are associated with the prevalence of these drinking patterns. These analyses should inform the literature on the relationships between societal factors and the prevalence of persons in different societies and periods in history that drink at these levels.

Adolescent↗
PubMed1999

Typologies of anxiety, depression and somatization symptoms among primary care attenders with no formal mental disorder.

BACKGROUND: Typologies of anxiety, depression and somatization symptoms were investigated in individuals with no formal mental disorders, making no a priori assumptions about symptom distribution and inter-relationship. METHOD: The subjects were 1617 adult primary care attenders from the WHO Collaborative Project on Psychological Problems in General Health Care, with at least three symptoms of anxiety, depression and/or somatization, but with no formal ICD-10 disorders. Analyses were based on the grade of membership model, a multivariate statistical procedure exploring indistinct boundaries between disease categories and preserving the heterogeneity of clinical picture within each category. RESULTS: Six prototype categories (or pure types) best described the structure of symptoms included in analyses. Pure type I included the full set of somatization symptoms. Pure type II was characterized by most anxiety and depression symptoms. Pure type III resembled generalized anxiety disorder. Pure type IV consisted of individuals reporting sporadic symptoms of anxiety, depression or somatization. Pure type V defined individuals with sleep problems. Finally, pure type VI was characterized by anxiety symptoms, including panic-like symptoms. CONCLUSIONS: These findings provide support to the existence of a mixed anxiety-depression category crossing the diagnostic boundaries of current anxiety and depression disorders. Moreover, criteria of anxiety and somatization disorders may be re-examined to assess whether lower diagnostic thresholds can be identified that both preserve the symptom profile and clinical features of current diagnostic categories and allow for a better characterization of individuals with substantial psychopathology though not meeting the high symptom thresholds required for a diagnosis of formal mental disorders.

Adolescent↗
PubMed2006

Improving the global management of the neurogenic bladder patient: part I. The complexity of patients.

BACKGROUND: The management of urinary incontinence in patients with neurological disease is complex. Physicians face a multitude of challenges related to progression of the primary condition, the presence of a diversity of other related and unrelated symptoms, the safety, efficacy and tolerability issues associated with multiple therapies being required and the changing need for collaboration with other specialities. SCOPE: Current guidelines produced by the urological communities, as well as the disease-focused organizations, aim to standardize care in their specific group of patients. A passive approach to implementation, however, means that guidelines produced are all too frequently not readily available to, read by or followed by the wider audience. In addition, each speciality has its own guidelines and a different view of the primary focus of care in neurological patients, which may lead to variations in recommendations and, subsequently, in clinical practice. A review of current urological and disease specific guidelines was made to evaluate differences between the published guidance between the specialities and within urology itself. CONCLUSIONS: Although availability of effective therapies remains a cornerstone of neurogenic bladder treatment, consideration must also be given to the non-pharmacological and surgical issues related to the global management of this population. Improved cross-speciality interactions and development of patient-specific treatment and follow-up plans, which are in keeping with the current guidelines of each speciality involved, may serve to enhance physicians' understanding of the importance of effective urinary incontinence treatment as well as the overall management of the patient.

Europe↗
PubMed1996

Susceptibility of respiratory strains of Staphylococcus aureus to fifteen antibiotics: results of a collaborative surveillance study (1992-1993). The Alexander Project Collaborative Group.

As part of the Alexander Project during 1992 and 1993, 690 Staphylococcus aureus strains isolated from community-acquired lower respiratory tract infections by clinical microbiology centres located in Europe and the USA were analysed by a co-ordinating laboratory that determined minimal inhibitory concentrations of 15 antimicrobial agents using a standardised microdilution technique. The prevalence of penicillin-susceptible microorganisms in this collection of pathogens was significantly higher in Europe (21.2%) than it was in the USA (12.1%). Most isolates (72.5%), however, were strains that had acquired the ability to synthesise a beta-lactamase but which were sensitive to methicillin. The incidence of methicillin-resistance (9.1% overall) was highly variable depending on geographic location and year of isolation. Analysis of MIC50, MIC90, MIC range and modal MIC of the 15 antibiotics assayed disclosed no major differences between the data sets obtained during the 2-year survey. Except for methicillin-resistant S. aureus, the activity of all the beta-lactams tested, with the exclusion of penicillin, amoxycillin and cefixime (that were completely inactive), was satisfactory. The effect of beta-lactamase synthesis was inhibited by the combination of amoxycillin with clavulanate, and by cefuroxime and ceftriaxone. Cefaclor was slightly less effective. Erythromycin, clarithromycin and azithromycin showed identical cross-resistance rates (around 10%). Resistance to the macrolides was more frequent in the USA than in Europe and was the sole trait found to increase during the survey. Doxycycline, chloramphenicol, co-trimoxazole and the two fluoroquinolones tested (ofloxacin and ciprofloxacin) were remarkably effective (resistance lower than 1%). Only doxycycline and, to a lesser extent, co-trimoxazole were partially active against methicillin-resistant strains.

Anti-Bacterial Agents↗
PubMed1999

Laboratory role in the management of hospital acquired infections.

The microbiology laboratory has many important roles. It must collaborate with the infection control team on the investigations of outbreaks. During outbreaks, it must save relevant samples, look for reservoirs and undertake typing techniques, all of which should be timely. New technology should be available to detect, identify and characterize micro-organisms. Molecular biological techniques have enhanced the speed and sensitivity of detection methods and have allowed the laboratory to identify organisms that do not grow or grow slowly in culture. Molecular techniques also enable the microbiologist to identify antibiotic resistance genes and to 'fingerprint' hospital organisms, thereby facilitating studies of nosocomial transmission.

Cross Infection↗