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PubMed2006

[Limited geriatric assessment of the elderly in Kibbutzim of the Upper Galilee].

BACKGROUND: Since comprehensive geriatric assessment (CGA) is very time and money consuming, its implementation is limited in Israel. OBJECTIVE: Implementation of the ambulatory limited geriatric assessment (LGA). TARGET POPULATION: Persons over 65 years of age living in Kibbutzim in the Upper Galilee. METHODS: As in the case of CGA, the emphasis in LGA is mainly placed on the functional status of the elderly. In order to identify geriatric syndromes, we used routine screening methods. According to the agreement with Clalit Health Services, a geriatrician is allowed to spend one hour per person. The elderly to be checked were selected by the medical staff. At the time of LGA, medical staff and patients' relatives supplied all information needed, including this data in computerized ambulatory cards. In such a way, a considerable amount of medical, functional, epidemiological, and psychosocial information was retrieved thus enabling a geriatrician to elaborate individual programs of follow-up and treatment. A geriatrician could request additional consultations and analyses. Two years later the medical staff in the kibbutzim completed anonymous questionnaires referring to the remote results of LGA. RESULTS: A total of 121 elderly persons were included in the LGA, performed during the period 2001-2003. The main causes of patients' referral to LGA were the known geriatric syndromes, namely functional and cognitive decline, anxiety and depression, falls etc. We assessed: (1) epidemiological data: age, gender, familial state, education, number of children, place of residence, (2) clinical data: number of both geriatric syndromes and drugs, recent changes in weight, hearing, and vision, (3) functional status: activities of daily living (ADL) and instrumental activities of daily living (IADL), falls, risk of self-inflicted injury, work, hobbies, social activity, the need for familial and social support, (4) cognitive and psychosocial status including depressive symptoms and anxiety, sleep disturbances, casualties in families or among friends, changes in mood and fears. After conducting the LGA, we recommended changes in the drug treatment, nursing, rehabilitation, institutionalization, and social help, if needed. Analysis of anonymous questionnaires showed that both medical staff and elderly in kibbutzim were satisfied with LGA implemented at the old persons' residence, they noted availability and high professional levels of LGA, additionally, they reported on the successful implementation of recommendations. The method became routine in the Upper Galilee. CONCLUSION: Since CGA is a very time- and money-consuming procedure, LGA has been tested and appears to be effective in the identification of geriatric syndromes. Within one hour of assessment, a geriatrician could retrieve a lot of the relevant information that allowed him to build individual programs for follow-up, prophylactic measures, drug and rehabilitation treatment and institutionalization.

Aged↗
PubMed1993

Hepatitis C virus in pregnancy: seroprevalence and risk factors for infection.

OBJECTIVES: Our purpose was to define the prevalence of antibodies to hepatitis C virus among inner-city prenatal patients. We also sought to examine both the reliability of traditional hepatitis risk factors to predict evidence of infection among these women and the incidence of coinfection in this population with other blood-borne and sexually transmissible agents. STUDY DESIGN: An anonymous serosurvey was performed to define and compare anti-hepatitis C virus prevalences among women registering for prenatal care at both an inner-city, university hospital-based clinic and an academic private practice based at the same institution. RESULTS: Anti-hepatitis C virus antibodies were detected in 4.3% of 599 pregnant women screened. In comparison, 0.8% had positive antibody tests for human T-lymphotropic virus and 0.5% were positive for antibodies to human immunodeficiency virus. Evidence of chronic hepatitis B infection was seen in 0.8%. The relative risk of other coexisting infections was significantly higher among women with anti-hepatitis C virus antibodies than among those who were antibody negative. Substance abuse was the most commonly identified risk factor for anti-hepatitis C virus-positive status, although risk factor-targeted screening would have failed to detect half of the anti-hepatitis C virus-positive women in this study. CONCLUSIONS: Hepatitis C virus infection among inner-city pregnant women, with its potential for maternal-fetal transmission, represents a public health issue of sufficient magnitude to warrant more extensive study. More information is needed, given this documented reservoir of maternal seropositivity, regarding the vertical transmissibility of the virus and the effects of coinfections on neonatal disease.

Adult↗
PubMedDate not supplied

[Transverse study on sex behavior associated with HIV transmission among homosexual men in Catalonia].

In 1993, a cross sectional study was carried out on the sexual behaviour of a sample of homosexual men recruited in saunas, sex shops and a gay community-beased organisation of Catalonia. A total of 551 men with an average age of 34 years and a high educational level sent in an anonymous questionnaire. In the previous 6 months the mean number of male sexual partners was 6 and for penetrative partners 3. In the previous month, 94% had had oral sex (22% with ejaculation) and 76% anal intercourse (38% without a condom and 21% with ejaculation). During sex, 51% used alcohol, 34% nitrite inhalants, 20% hashish and 10% cocaine, 61% had had the HIV test, with a self-reported HIV prevalence of 21%. 86% stated that they knew of one or more people infected by HIV or with AIDS. The high percentage of men who had unprotected anal intercourse and the high self-reported HIV prevalence highlights the need to increase efforts in AIDS prevention and research in this group. Monitoring HIV associated sexual behaviours provides valuable indicators of the evolution of the epidemic, useful for designing and evaluating preventive interventions.

Adolescent↗
PubMed2002

Improving compliance in on-line, structured self-help programs: evaluation of an eating disorder prevention program.

Compliance rates from four iterations of Student Bodies, an 8-10 week computer assisted health education (CAHE) program for the prevention of eating disorders in college-aged women, were measured. Each iteration was modified with the hope of increasing participant compliance. Participants were 116 undergraduate women from two large West Coast universities who were randomly assigned to either the CAHE program or a wait-list group. Model 1 was delivered via CD-ROM, was anonymous, used an unstructured "grazing" approach, and participants received 10 dollars. Model 2 was web-based, had recommended assignments with telephone reminders, and participants received 25 dollars. Model 3 used a more structured approach to assignments. Model 4 eliminated anonymity, added an academic component, used email reminders, and offered course units as an incentive. Compliance was defined as percentage of screens read per number of screens assigned (n = 27-33). In Model 1, compliance was self-reported at 53%. In Models 2, 3, and 4, compliance, measured directly via computer logs, was 66%, 85%, and 84%, respectively. A Mann-Whitney test showed that the increase in compliance between Models 2 and 3 and Models 2 and 4 was statistically significant (p < 0.01). Compliance was significantly correlated with improvement on outcome. Suggestions for increasing compliance in other CAHE programs are offered.

Journal Article↗
PubMed2000

Use of preventive health behaviors by lesbian, bisexual, and heterosexual women: questionnaire survey.

OBJECTIVES: To determine whether lesbians and bisexual women are less likely than heterosexual women to use preventive health measures. DESIGN: Written, anonymous, self-administered questionnaire. SETTING: 33 physicians' offices and community clinics mainly in urban areas of 13 states. PARTICIPANTS: 524 lesbians, 143 bisexual women, and 637 heterosexual women. RESULTS: Bisexual women were less likely than heterosexual women to have had appropriate cholesterol screening (odds ratio 0.29, 95% confidence interval 0.11 to 0.73) or appropriate mammography (0.33, 0.13 to 0.84). Human immunodeficiency virus testing was more common in lesbians (2.38, 1. 51 to 3.74) and bisexual women (1.99, 1.17 to 3.38) than in heterosexual women. Illicit drug use was higher in lesbians (2.04, 1. 14 to 3.70) and bisexual women (1.96, 1.07 to 3.57) than in heterosexual women. Lesbians were more likely than heterosexual women to practice safer sex (2.60, 1.23 to 5.49) and less likely to have ever been infected with human papillomavirus (0.48, 0.25 to 0. 89). CONCLUSION: There were important differences in the preventive health measures taken by lesbians and bisexual women and those taken by heterosexual women. All patients should receive standard health tests, such as cholesterol screening and mammography, regardless of their sexual orientation. Lesbians and bisexual women who report illicit drug use should receive counseling, as appropriate.

Adult↗
PubMed2004

The impact of the demand for clinical productivity on student teaching in academic emergency departments.

OBJECTIVE: Because many emergency medicine (EM) attending physicians believe the time demands of clinical productivity limit their ability to effectively teach medical students in the emergency department (ED), the purpose of this study was to determine if there is an inverse relationship between clinical productivity and teaching evaluations. METHODS: The authors conducted a prospective, observational, double-blind study. They asked senior medical students enrolled in their EM clerkship to evaluate each EM attending physician who precepted them at three academic EDs. After each shift, students anonymously evaluated 10 characteristics of clinical teaching by their supervising attending physician. Each attending physician's clinical productivity was measured by calculating their total relative value units per hour (RVUs/hr) during the nine-month study interval. The authors compared the total RVUs/hr for each attending physician to the medians of their teaching evaluation scores at each ED using a Spearman rank correlation test. RESULTS: Seventy of 92 students returned surveys, evaluating 580 shifts taught by 53 EM attending physicians. Each attending physician received an average of 11 evaluations (median score, 5 of 6) and generated a mean of 5.68 RVUs/hr during the study period. The correlation between evaluation median scores and RVUs/hr was -0.08 (p = 0.44). CONCLUSIONS: The authors found no statistically significant relationship between clinical productivity and teaching evaluations. While many EM attending physicians perceive patient care responsibilities to be too time consuming to allow them to be good teachers, the authors found that a subset of our more productive attending physicians are also highly rated teachers. Determining what characteristics distinguish faculty who are both clinically productive and highly rated teachers should help drive objectives for faculty development programs.

Academic Medical Centers↗
PubMed2000

[Beliefs, attitudes and knowledge about sex education].

BACKGROUND: Previous reports show that Chilean teenagers have an inadequate knowledge about sexuality and reproduction. AIM: To compare the knowledge about sexuality among adolescents coming from private and public schools, with and without sexual education programs. MATERIAL AND METHODS: A structured anonymous inquiry, containing multiple choice and open questions, was applied to a sample of 229 adolescents attending seventh and eighth grade of junior school, in private and public schools of Temuco, Chile. RESULTS: Eleven percent of adolescents had already their first sexual intercourse at a mean age of 12.2 +/- 2.4 years old. Of these, 96% came from public schools. An overall analysis of tests, disclosed a 53% of correct answers to the inquiry. Adolescents coming from private schools had a better performance than those coming from public schools. Sexual attitudes were not influenced by sexual education programs. CONCLUSIONS: Adolescents coming from private schools have a better sexual knowledge level and more conservative attitudes towards sexuality. Overall knowledge is inadequate albeit overvalued. These teenagers are high risk group for unwanted pregnancies and sexually transmitted diseases and require efficient sexual education programs.

Adolescent↗
PubMed1996

Monte Carlo exact methods used for analysing interethnic unions in Great Britain.

The value of using exact rather than asymptotic tests to measure intermarriage in the United Kingdom is examined. "We develop Markov chain Monte Carlo methods for estimating the exact conditional p-value and the exact distribution of the residuals, for quasi-independence and quasi-symmetry. These methods are used to analyse a sparse 10 x 10 symmetric table of interethnic unions, extracted from the 1% household sample of anonymized records from the 1991 U.K. census. With the exception of Pakistani/White and Other Asian/White unions, there is no evidence against quasi-symmetry. We conclude that, with these exceptions, there are no gender differences in the affinities between ethnic groups."

Culture↗
PubMed2003

Factors influencing medical informatics examination grade--can biorhythm, astrological sign, seasonal aspect, or bad statistics predict outcome?

AIM: To investigate whether and to what extent various parameters, such as individual characteristics, computer habits, situational factors, and pseudoscientific variables, influence Medical Informatics examination grade, and how inadequate statistical analysis can lead to wrong conclusions. METHODS: The study included a total of 382 second-year undergraduate students at the Rijeka University School of Medicine in the period from 1996/97 to 2000/01 academic year. After passing the Medical Informatics exam, students filled out an anonymous questionnaire about their attitude toward learning medical informatics. They were asked to grade the course organization and curriculum content, and provide their date of birth; sex; study year; high school grades; Medical Informatics examination grade, type, and term; and describe their computer habits. From these data, we determined their zodiac signs and biorhythm. Data were compared by the use of t-test, one-way ANOVA with Tukey's honest significance difference test, and randomized complete block design ANOVA. RESULTS: Out of 21 variables analyzed, only 10 correlated with the average grade. Students taking Medical Informatics examination in the 1998/99 academic year earned lower average grade than any other generation. Significantly higher Medical Informatics exam grade was earned by students who finished a grammar high school; owned and regularly used a computer, Internet, and e-mail (p< or =0.002 for all items); passed an oral exam without taking a written test (p=0.004), or did not repeat the exam (p<0.001). Better high-school students and students with better grades from high-school informatics course also scored significantly better (p=0.032 and p<0.001, respectively). Grade in high-school mathematics, student's sex, and time of year when the examination was taken were not related to the grade, and neither were pseudoscientific parameters, such as student zodiac sign, zodiac sign quality, or biorhythm cycles, except when intentionally inadequate statistics was used for data analysis. CONCLUSION: Medical Informatics examination grades correlated with general learning capacity and computer habits of students, but showed no relation to other investigated parameters, such as examination term or pseudoscientific parameters. Inadequate statistical analysis can always confirm false conclusions.

Astrology↗
PubMed2003

Maternal views and acceptance of antenatal HIV screening in a university teaching hospital in Hong Kong.

OBJECTIVE: To assess maternal acceptance, knowledge, attitude, perceived risks and barriers toward antenatal HIV screening. STUDY DESIGN: Prospective anonymous survey of 1,519 pregnant women recruited in a university teaching hospital RESULTS: Women demonstrated fairly good knowledge of and a positive attitude toward HIV screening. Condom usage was 61.4%, and 25.3% of women had at least 1 risk factor for HIV infection. Support for mandatory and universal screening was 31.4% and 48.8%, respectively. A total of 82.6% women agreed to HIV testing. The major reason for declining the test was that women considered themselves to be at low risk (84.3%). Women with risk factors tended to prefer more aggressive methods of antenatal testing (P < .001) and more readily accepted HIV screening (89.8% vs. 73.1%, P < .001). CONCLUSION: Given the high acceptance rate in our local population, universal offering but voluntary testing is the optimal mode of antenatal HIV screening in Hong Kong.

Adult↗
PubMed1998

Controlling for selection bias in the evaluation of Alcoholics Anonymous as aftercare treatment.

OBJECTIVE: The purpose of this research was to control for self-selection bias in the evaluation of Alcoholics Anonymous (AA) as aftercare treatment. Observational studies of alcoholism aftercare treatment are subject to selection bias whenever the self-selection process results in important differences in unobserved casemix dimensions between treatment groups. METHOD: The sample included 118 male veterans discharged from inpatient alcohol treatment, 85% of whom were followed-up at 3 months. Drinking outcomes were measured by self-reported abstinence in the third month after discharge. The aftercare treatment effect of AA was estimated using standard logistic regression analysis and instrumental variables analysis. Instruments included the subject's ability to drive oneself to AA meetings and the presence/absence of an AA meeting in the subject's town of residence. A Hausman exogeniety test was used to determine whether the standard logistic regression results were subject to self-selection bias. RESULTS: Estimates from the standard logistic regression yielded a positive (OR = 3.7) and significant (p = .018) treatment effect for AA attendance. However, the instrumental variables analysis yielded a smaller (OR* = 1.7) and insignificant treatment effect estimate (p = .782). The Hausman exogeniety test indicated that the treatment effect estimate from the standard logistic regression was subject to significant self-selection bias (chi2 = 83.9, 1 df, p <.01). CONCLUSIONS: The AA aftercare treatment effect observed in this sample was due to differences in unobserved casemix factors between the treatment groups. Results suggest that previous AA aftercare research may have also been subject to self-selection bias. Researchers of substance abuse outcomes should consider analyzing nonexperimental data using instrumental variables methodologies.

Adult↗
PubMed2000

The use of anonymous DNA markers in assessing worldwide relatedness in the yeast species Pichia kluyveri Bedford and Kudrjavzev.

Pichia kluyveri, a sexual ascomycetous yeast from cactus necroses and acidic fruit, is divided into three varieties. We used physiological, RAPD, and AFLP data to compare 46 P. kluyveri strains collected worldwide to investigate relationships among varieties. Physiology did not place all strains into described varieties. Although the combined AFLP and RAPD data produced a single most parsimonious tree, separate analysis of AFLP and RAPD data resulted in significantly different trees (by the partition homogeneity test). We then compared the distribution of strains per band to an expected distribution. This suggested we could separate both the AFLP and RAPD datasets into bands from rapidly and slowly changing DNA regions. When only bands from slowly changing regions (from each dataset) were included in the analysis, both the RAPD and AFLP datasets supported a single tree. This second tree did not differ significantly from the cladogram based on all of the DNA data, which we accepted as the best estimate of the phylogeny of these yeast strains. Based on this phylogeny, we were able to demonstrate the strong influence of geography on the population structure of this yeast, confirm the monophyly of one variety, question the utility of maintaining another variety, and demonstrate that the physiological differences used to separate the varieties did not do so in all cases.

Americas↗
PubMed1990

Localization of a locus for Charcot-Marie-Tooth neuropathy type Ia (CMT1A) to chromosome 17.

Phenotypic data for 71 genetic markers for members of five Caucasian kindreds were tested for linkage with the autosomal dominant mutations causing Charcot-Marie-Tooth (hereditary motor sensory) neuropathy type I, characterized by markedly reduced nerve conduction velocities. Lod score analysis gave no evidence of linkage to the closely linked chromosome 1 loci SPTA1-FY-F5-AT3 and APOA2. In contrast, these mutations were found to map closely (zeta = 10.828, theta = 0.0) to D17S58, an anonymous segment of DNA from 17p11.2-p11.1, and thus define the CMT1A locus. Segregation information data for an inferred recombinant offspring indicated that the CMT1A locus is probably proximal to MYH2, the locus encoding adult skeletal muscle myosin heavy polypeptide 2, which maps to 17p13. Analysis of the lod scores on a per kindred basis gave no evidence of genetic heterogeneity.

Charcot-Marie-Tooth Disease↗
PubMed1993

Screening for HIV infection in pregnancy.

Antenatal HIV screening policies throughout the British Isles were surveyed and results linked to data on HIV-infected pregnant women notified through the Royal College of Obstetricians and Gynaecologists. Units offering HIV testing to all pregnant women were compared with those offering it only to women considered to be at risk, and in both situations fewer than 50% of infected women were identified as HIV infected for the first time in antenatal clinics. Based on laboratory reports of HIV infection in women of childbearing age, paediatric reports of children born to HIV positive women and unlinked anonymous neonatal screening programmes, there was evidence of under-recognition of HIV infection in pregnancy, particularly in England and Wales.

AIDS Serodiagnosis↗
PubMed1998

Patients' understanding and opinion about informed consent for coronary angiography in a rural Japanese hospital.

Based on an anonymous questionnaire obtained from 102 Japanese in-patients at a rural Japanese hospital who underwent coronary angiography, the patients understanding of information about the procedure, their perception of consent and their attitude toward it were investigated. The patients were able to recall 63.8% of the contents of the information. There was a statistically significant correlation between the patients' educational status and the recall test score of the information. Older (65 years old and above) patients had a tendency to entrust decision making to their physicians. Only 19.6% of the patients made the decision to undergo a coronary angiography by themselves. After being informed of the risks 40.2% of the patients felt more anxious. In conclusion, our patients could not recall the contents of the information sufficiently. There still existed a tendency to entrust important decisions to the physician especially in older patients. The patients had a tendency not to face difficult problems solely by themselves but with the support of family members.

Aged↗
PubMed2005

[A study of various causes of influence on inter-child emotions--from a survey conducted on postpartum mothers].

This research was conducted as a self-reporting anonymous survey of 185 postpartum mothers in hospitals in order to clarify the causes of influence on the inter-child emotions of mothers, who are usually the main fosterers of the child. SPSS 12.0 J for Windows was used for statistical analysis, and the relationship between points of inter-child emotion and each questioned item was analyzed with Mann-Whitney U test and Kruskal-Wallis test. As a result, the following causes of influence on inter-child emotions were found: the existence of a key person, having a concrete birth plan during pregnancy, that it was a desired pregnancy, and that the mother was satisfied with her delivery. From this result, the following supports are thought to be important to realize: the importance of puberty education or contraception counseling, the establishment of a support system for mothers, and consistent support during pregnancy to postpartum at medial institutions where parturition is carried out.

Adult↗
PubMed2000

Differences between urologists in the United States and Canada in the approach to prostate cancer.

PURPOSE: We examine differences in screening, detection, staging and treatment of prostate cancer between urologists in the United States and Canada. MATERIALS AND METHODS: An anonymous questionnaire was developed and mailed to 700 randomly selected American and 350 Canadian urologists. The 7 domains of prostate cancer management comprised screening/case identification, radical prostatectomy indications, staging evaluations, neoadjuvant therapy, nerve sparing techniques, postoperative management and treatment of biochemical recurrence. The Dillman method of questionnaire administration was used. All data were stratified by country and analyzed using the generalized chi-square test. RESULTS: Surveys were adequately completed by 45% and 79% of American and Canadian urologists, respectively. Practice experience and clinical volumes were not significantly different between the 2 cohorts. Overall, there were few differences in prostate cancer screening, staging, postoperative management, biochemical failure and use of neoadjuvant therapy. However, practicing American urologists tended to pursue more aggressive case finding practices, such as a higher age cutoff for prostate specific antigen testing (p = 0.0001) and more frequent use of transition zone biopsies (p = 0.0001). American urologists also displayed a tendency toward more liberal indication for extirpative surgery. They were more likely to perform radical prostatectomy in men older than 70 years, those with higher prostate specific antigen and those with node positive disease. Among both national cohorts there was considerable variation in management patterns for all domains of prostate cancer. Variation was most common among treatment of patients with adverse pathological conditions (positive margins, seminal vesicle involvement) and postoperative biochemical failure. Even when credible evidence exists (biopsy technique, preoperative staging) significant proportions of urologists in both countries continued to practice contrary to existing data. CONCLUSIONS: American and Canadian practice patterns for prostate cancer differ significantly only in the domains of case identification and surgical indications. In addition, considerable intra-national variation in practice patterns exists. These data highlight the necessity to support randomized clinical trials in prostate cancer.

Canada↗
PubMed1977

[Silent pyloroduodenal gastrinomas. Apropos of 3 cases].

The authors report three anatomoclinical studies concerning apparently moderately aggressive endocrine tumors developped in the sub-mucosa of the duodenal bulb (2 cases) and of the pyloro-bulbar region (1 case), not connected with the pancreas, and occuring in the absence of a parietal ectopic pancreas. Two of these tumors were ulcerous but the associated syndromes (pains and hemorrhage) did not evoke, clinically, a Zollinger-Ellison syndrome. However, examination with immunofluorescence showed the presence of immunoreactive gastrine in a large number of cells. Having found some similar cases in the literature, the authors precise the features of these silent pyloro-duodenal gastrinomas: it is a variety of carcinoids or of "carcinoid-islet cell tumors". The cells contain argyrophile granules (Grimelius stain) which correspond in electron microscopy to neuro-secretory granules that may be quite different from G. granules. In the absence of significant clinical signs and of a radio-immunologic blood test, the presence of immunoreactive gastrin in the cells is the main feature for the diagnostic of these tumors. These tumors seem to arise from the gastrin cells of the mucosa or from their precursors as is suggested by the transitional forms with the fundus of the glands. Whatever the reason of the peculiar functional behavior, these neoplasms can be easily isolated from the anonymous group of duodenal carcinoids.

Aged↗