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PubMed2004

A software program combining sequence motif searches with keywords for finding repeats containing DNA sequences.

MOTIVATION: One of the most interesting features of genomes (both coding and non-coding regions) is the presence of relatively short tandemly repeated DNA sequences known as tandem repeats (TRs). We developed a new PC-based stand-alone software analysis program, combining sequence motif searches with keywords such as organs, tissues, cell lines or development stages for finding exact, inexact and compound, TRs. Tandem Repeats Analyzer 1.5 (TRA) has several advanced repeat search parameters/options over other repeat finder programs as it does not only accept GenBank, FASTA and expressed sequence tag (EST) sequence files but also does analysis of multifiles with multisequences. Advanced user-defined parameters/options let the researchers use different motif lengths search criteria for varying motif lengths simultaneously. The outputs show statistical results to be evaluated by the user. The discovery of TRs in ESTs could be useful for both gene mapping and association studies and discovering TRs located in coding regions of important genes that are expressed under various conditions of environment, stress, organ, tissue and development stage. RESULTS: In this paper, we demonstrated applications of TRA using 175 899 ESTs sequences for three Arabidopsis spp. downloaded from GenBank. The EST-SSRs/ESTs ratios were found 43.1%, 15.3% and 2.34% in A.lyrata, A.thaliana and A.halleri, respectively. Analysis revealed that organs, tissues and development stages possessed different amounts of repeats and repeat compositions. This indicated that the distribution of TRs among the tissues or organs may not be random differing from the untranscribed repeats found in genomes. AVAILABILITY: The program can be obtained free by anonymous FTP from ftp.akdeniz.edu.tr/Araclar/TRA.

Arabidopsis↗
PubMedDate not supplied

Preceptor program evaluation demonstrates improved orientation.

Although the preceptor method of orientation is generally accepted as an effective mechanism for orienting newly employed nurses, very few evaluation studies of preceptor programs have been reported in the literature. This article describes a study designed prior to implementing a preceptor program at the University of Wisconsin Hospital and Clinics in order to measure the outcomes of the program. Data were collected on the satisfaction of orientees, preceptors, other staff nurses, and nurse managers. The preceptor role and preceptor's level of comfort and skill were studied. To quantify the economic impact, both length of orientation and nursing turnover were considered.

Education, Nursing, Continuing↗
PubMed1997

Conflict, the continuum and chronic emergencies: a critical analysis of the scope for linking relief, rehabilitation and development planning in Sudan.

The concept of the 'relief-to-development continuum' has been the subject of renewed interest in recent years. Concerned by the rise in relief budgets over the past decade and the absolute fall in development aid resources, support has been growing for the concept of developmental relief. In the context of complex political emergencies, it has been argued further that as effective development aid can reduce vulnerability to the impact of natural hazards, so it might also be used to contribute to a process of conflict prevention. In this way, the concept of the relief-development continuum has become entwined with broader discussions about the contribution of official development assistance management. Drawing on a Review of Operation Lifeline Sudan (OLS), this paper cautions against uncritical application of the concept of the continuum in complex political emergencies and rehabilitation in particular, in the current Sudanese context. It argues that in order to move legitimately from relief aid programming to development aid programming, three fundamental conditions must be in place: first, a minimum level of security, respect for human rights and humanitarian access. Second, empirical evidence from the field needs to demonstrate that the emergency is over. Finally, moving from relief to development aid programming is contingent on donor governments accepting the legitimacy of national governmental structures and of the rebel movements. In other words, for donor governments, moving along the continuum is in significant part determined by foreign policy considerations, not only technical ones. Consideration needs to be given to the actual and perceived legitimation of the different movements that a move to rehabilitation might be seen to imply. The paper argues that none of these conditions had been satisfied in Sudan by mid-1997. Instead of a process of normalisation paving the way to long-term development, the current situation in Sudan is better described as a chronic political emergency. In such a context, uncritical pursuit of developmental strategies may negatively affect the welfare of conflict-affected populations.

Humans↗
PubMedDate not supplied

[Influence of nutritional education on management of infantile-juvenile obesity].

OBJECTIVE: To analyze the therapeutic response in a group of obese patients to a therapy program based on nutritional education, auto-management, and intensive follow-up. MATERIAL AND METHODS: Sixty clinical charts have been reviewed of patients with exogenous obesity (42 female and 18 male patients) submitted to management program and intensive follow-up (every three months controls) for a continuous period of 24 months. The following variables were registered: sex, chronological age (CA), bone age (BA), and percent body mass index (%BMI) in he first visit; %BMI in each control day, and therapeutic response (drop-outs, improvements, and failures) at 12 and 24 months of follow-up. RESULTS: Mean values for age and CA/BA ratio were 9.7 years (males: 9.7; and females: 9.7), and 1.12 (males: 1.1; and females: 1.12), respectively. Average basal %BMI was 144.7 (95% CI: 4.4), being significantly higher in male patients. There was a progressive decrease from basal %BMI that was statistically significant from 18 months of follow-up in female patients (p < 0.05). At 12 and 24 months of follow-up, 20% and 30% had mild improvement, although 58.3% and 60% had a decreased basal %BMI, respectively. At 24 months of follow-up, the rate failure was significantly higher (p < 0.05) in males (83.3% vs 42.8%), where the success rate was higher among females (40.5% vs 5.5%), the total dropout rate being 15%. Growth was kept normal independently of gender and/or therapeutic response. CONCLUSIONS: Individualized information and intensive follow-up favor good acceptance and/or adhesion to the therapeutic program, and it allows for instilling health education to patients and/or relatives that, particularly in motivated patients, conditions a series of behavioral rules essential for controlling obesity.

Adolescent↗
PubMed2005

What is quality in a transplant program?

Abstract Hematopoietic stem cell transplantation (HSCT) as a field of medicine has been subject to rapid development and evolution since its inception. Traditionally, HSCT has been used for therapy of a diverse group of malignancies, bone marrow failure states, and inherited disorders. The rapid evolution of transplantation technology coupled with the diverse outcomes associated with a heterogeneous group of patients has stymied the development of consensus over objective programmatic indicators of quality, especially as they pertain to outcomes. In some regard, the lack of consensus has caused transplant programs to respond to a more consumer-driven paradigm of evaluation. The community of providers of transplantation therapies has responded by establishing standards for accreditation of facilities and uniform presentation of programmatic data. Rapid acceptance of the need for meaningful quality programs to address all aspects of the transplant facility has moved HSCT to the forefront of implementing standards for medical practice. Because definition of optimal outcomes in HSCT is likely to remain elusive, it is imperative that providers involved with HSCT continue to take a leadership role in defining program quality through further research.

Hematopoietic Stem Cell Transplantation↗
PubMed1999

The immunization programme in Bangladesh: impressive gains in coverage, but gaps remain.

The paper reviews the achievements in tetanus immunization coverage and child immunization in Bangladesh. It uses data from the 1993-94 Bangladesh Demographic and Health Survey to identify and examine the programmatic and non-programmatic factors that influence the coverage of tetanus (TT) immunization during pregnancy, and full immunization among children 12-23 months old in rural Bangladesh. The purpose of this analysis is to identify the areas that need further programme attention. The logistic regression results show that the coverage of TT immunization was significantly associated with proximity to outreach clinics and the presence of a health worker in the community. Home visits by health/family planning fieldworkers and the proximity to outreach clinics had larger influences on TT coverage of poorer households compared to those better-off. The effect of distance to static clinics varied by regions. Among children, full immunization coverage (coverage of all of BCG, DPT1, DPT2, DPT3, Polio1 Polio2, Polio3) was significantly associated with distance to outreach clinics, the greater the distance to the clinics, the less the likelihood of immunization.

Adult↗
PubMedDate not supplied

Lack of relationship between acceptance and knowledge of asthma in school-age children and early adolescents.

ISSUES AND PURPOSE: Early adolescents diagnosed with asthma have difficulty accepting their condition. This study is part of an ongoing program of research designed to increase understanding of the adolescent process of coming to acceptance. The purpose was to explore relationships among variables in the Acceptance of Asthma Model. DESIGN AND METHODS: A cross-sectional, theory-testing design with a sample of 94 students ages 9 to 14 years. RESULTS: Acceptance was dependent on psychosocial influences and disease characteristics rather than knowledge of asthma. PRACTICE IMPLICATIONS: Psychosocial interventions are needed to facilitate acceptance.

Adaptation, Psychological↗
PubMed1999

The effect of a Medicaid managed care program on the adequacy of prenatal care utilization in Rhode Island.

OBJECTIVES: The purpose of this study was to determine whether adequacy of prenatal care utilization improved after the implementation of a Medicaid managed care program in Rhode Island. METHODS: Rhode Island birth certificate data (1993-1995; n = 37021) were used to analyze pre- and post-program implementation changes in adequacy of prenatal care utilization. Logistic regression models were used to characterize the variation in prenatal care adequacy as a function of both time and the various covariates. RESULTS: Adequacy of prenatal care utilization for Medicaid patients improved significantly after implementation of the program, from 57.1% to 62.1% (odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.1, 1.3). After the program was implemented, Medicaid patients who went to private physicians' offices for prenatal care were 1.4 times as likely as before to receive adequate prenatal care (OR = 1.4, 95% CI = 1.2, 1.7). CONCLUSIONS: Unlike many other Medicaid expansions for pregnant women, the RIte Care program in Rhode Island has resulted in significant improvement in adequacy of prenatal care utilization for its enrollees. This improvement was due to specific program interventions that addressed and changed organizational and delivery system barriers to care.

Adolescent↗
PubMed1990

Interpretation of pathophysiology by laboratory data (3). A consultation program based on clinical laboratory data.

Based on previous studies, a consultation program using clinical laboratory data has been constructed. After converting all data into the standard deviation index (SDI), the score for preregistered diseases was calculated by integrating products of SDI and the weighting factors (WF) pre-determined empirically by medical experts for each item. Ten diseases in order of their maximum scores, the most predictable ones, and additional comments were printed out. The principle of our consultation program is based on the modified Bayesian theory which employs, instead of probability a posteriori, weighting factors (WF) corresponding to the grade of membership in the "fuzzy set" concept. Evaluations based on this interpretation performed 2-3 times during the clinical course in nine patients were found to agree qualitatively with each clinical course and diagnosis. This report also contains 1) an outline of the progress of this consultation program in Japan and abroad, 2) the actual level of acceptance of this system by physicians, 3) and the characteristics and problems of our program. We are now planning to report a quantitative evaluation of this program using many cases in some specified field, instead of one case of each disease.

Clinical Laboratory Techniques↗
PubMed1992

Drug information quality assurance program used to appraise students' performance.

A quality assurance program developed for a drug information service was used to objectively measure the performance of doctor of pharmacy degree students on rotation in the service. Two five-point rating scales based on objective criteria were developed so that judgmental and nonjudgmental drug information responses could be evaluated separately. Preceptors used the scales to evaluate 30 randomly selected responses from each of 22 Pharm.D. students (15 responses from midrotation and 15 from the end of the rotation). Written responses were also evaluated on a five-point scale by the requesters. In all of the evaluations, a score of 5 was excellent and a score of 1 was unacceptable. The preceptors assigned a score of 5 to 52.3% of the 660 responses evaluated, 4 to 29.1%, 3 to 12.9%, 2 to 4.5%, and 1 to 1.2%. No significant difference was found based on the academic quarter during which the rotation took place. The difference in scores between judgmental and nonjudgmental responses was not significant. End-of-rotation scores tended to be higher than midrotation scores, although the difference was not significant. Testing for interrater reliability revealed moderate agreement between raters. Requesters gave mean scores higher than 4 for accuracy, completeness, objectivity, and usefulness of the written responses. Timeliness scores were significantly lower but still acceptable. A drug information quality assurance program provided a structured, objective means of evaluating student performance.

Drug Information Services↗
PubMed2005

Negative attitude of highly educated parents and health care workers towards future vaccinations in the Dutch childhood vaccination program.

BACKGROUND: It is unknown whether further expansion of the Dutch childhood vaccination program with other vaccines will be accepted and whom should be targeted in educational strategies. AIM: To determine attitudes of parents towards possible future vaccinations for their children and the behavioural determinants associated with a negative attitude. DESIGN: Questionnaire study. METHODS: Parents of children aged between 3 months and 5 years of day-care centres were asked to fill out a questionnaire. Determinants of a negative attitude to comply with possible future vaccinations against example diseases such as pneumonia or influenza, hepatitis B, TBC, smallpox and SARS were assessed using polytomous logistic regression analysis. RESULTS: Of the 283 respondents, 123 (43%) reported a positive attitude towards all vaccinations, 129 (46%) reported to have a positive attitude to have their child vaccinated against some diseases and 31 (11%) had no intention to comply with any new vaccination. Determinants of a fully negative attitude were a high education of the parent (odds ratio [OR] 3.3, 95% confidence interval [95% CI]: 1.3-8.6), being a health care worker (OR 4.2, 95% CI: 1.4-12.6), absence of religion (OR 2.6, 95% CI: 1.0-6.7), perception of vaccine ineffectiveness (OR 6.9, 95% CI: 2.5-18.9) and the perception that vaccinations cause asthma or allergies (OR 82.4, 95% CI: 8.9-766.8). CONCLUSION: Modifiable determinants for a negative attitude to comply with new vaccinations are mainly based on lack of specific knowledge. These barriers to vaccinations might be overcome by improving health education in the vaccination program, especially when targeted at educated parents and health care workers.

Adult↗
PubMed2002

Is there a kink in consumers' threshold value for cost-effectiveness in health care?

BACKGROUND: A reproducible observation is that consumers' willingness-to-accept (WTA) monetary compensation to forgo a program is greater than their stated willingness-to-pay (WTP) for the same benefit. Several explanations exist, including the psychological principle that the utility of losses weighs heavier than gains. We sought to quantify the WTP-WTA disparity from published literature and explore implications for cost-effectiveness analysis accept-reject thresholds in the south-west quadrant of the cost-effectiveness plane (less effect, less cost). METHODS: We reviewed published studies (health and non-health) to estimate the ratio of WTA to WTP for the same program benefit for each study and to determine if WTA is consistently greater than WTP in the literature. RESULTS: WTA/WTP ratios were greater than unity for every study we reviewed. The ratios ranged from 3.2 to 89.4 for environmental studies (n=7), 1.9 to 6.4 for health care studies (n=2), 1.1 to 3.6 for safety studies (n=4) and 1.3 to 2.6 for experimental studies (n=7). CONCLUSIONS: Given that WTA is greater than WTP based on individual preferences, should not societal preferences used to determine cost-effectiveness thresholds reflect this disparity? Current convention in cost-effectiveness analysis is that any given accept-rejection criterion (e.g. $50 k/QALY gained) is symmetric - a straight line through the origin of the cost-effectiveness plane. The WTA-WTP evidence suggests a downward 'kink' through the origin for the south-west quadrant, such that the 'selling price' of a QALY is greater than the 'buying price'. The possibility of 'kinky cost-effectiveness' decision rules and the size of the kink merits further exploration.

Attitude to Health↗
PubMed1988

Comprehensive vision screening program: Illinois' approach.

This article discusses a statewide vision screening program that utilizes trained and certified vision screening technicians under the auspices of the Department of Public Health. Public Act 81-174, the Child Vision and Hearing Test Act, mandates periodic vision screening of children using accepted and approved instruments and standards. The program receives consultation from the Children's Vision Services Advisory Committee, consisting of optometrists, ophthalmologists and others in health and education programs. Topics addressed include: training and certification of technicians; screening, referral and follow-up; program summary of statewide screening statistics of 1.2 million children for fiscal year 1985, etc.

Adolescent↗
PubMed1977

AME seminar program in the United States: genesis, goals, and cost-benefit reflections.

The practicing physician's requirement for continuing postgraduate medical education is generally accepted and has generated a number of postgraduate education programs. In 1960, the FAA inaugurated a seminar program to serve the special educational needs of its approximately 7,500 designated Aviation Medical Examiners. These doctors, the majority of whom are civilian physicians representing almost every specialty, are charged with issuing or withholding the pilot's medical license to fly. Under the administration of coauthor Harris, the AME Seminar Program undergoes modification and change as improvements are suggested by accrued experience. Evaluation of data acquired from a variety of sources indicates that the AME does, in fact, need refresher training in civil aviation medicine. In helping fulfill that need, the AME Seminar Program is working effectively.

Aerospace Medicine↗
PubMed1997

Image processing for femoral endosteal anatomy detection: description and testing of a computed tomography based program.

A computed tomography (CT)-based image processing computer program was developed for three-dimensional (3D) femoral endosteal cavity shape modelling. For the examinations 50 cadaver femora were used. In the CT imaging 30 axial slices were taken above and below the lesser trochanter area from each femur. Different image analysis methods were used for femoral cavity detection depending on the structure of the processed slice. In the femoral shaft area simple thresholding methods succeeded, but in the problem areas of the metaphyseal femur edge, detection operators and local thresholding were required. In contour tracking several criteria were used to check the validity of the border pixels. The results were saved as four output data files: (i) a file for the longest anteroposterior (ap), mediolateral (ml) and oblique diameters computed by a Euclidian method, (ii) and (iii) files for 2D and 3D data respectively, and (iv) a file for centre points of each slice. Finally, testing of the results and dimensions obtained from the image analysis were carried out manually by sawing the femora into 10 stipulated horizontal slices. The ap and ml dimensions were measured with a caliper ruler. The CT-based image processing yielded a peak distribution of dimensions with a negative difference to those obtained in manual measurements. The mean difference between the image processing and the manual measurements was 1.1 mm (+/-0.7 mm, +/-1 SD). The difference was highest in the proximal slices of the femora of group I (with lowest cortical thickness), i.e. 1.3 mm (+/-0.8 mm) and lowest in the distal slices of the femora from group III (with highest cortical thickness), i.e. 0.9 mm (+/-0.6 mm). The results are acceptable for further use of the program to study endosteal anatomy for individual femoral component selection and designing basis.

Cadaver↗
PubMed2006

[Sociodemographic differences in the participation in "early detection of cancer examinations" in Germany--a review].

In 1971 a statutory programme aiming at the early detection of cancer was established in Germany. Since then, acceptance has been low, especially among men. In 2002, 49 % of the women, but only 20 % of the men entitled to screening, took part in the free preventive medical screening. This paper gives an overview of the research done in Germany between 1973 and 2003, examining the associations of sociodemographic factors with participation in cancer screening. All studies show that participation rates increase steadily with age in men, but decrease in elderly women (55 years and older). Participation rates among women are significantly associated with educational level and occupational status. Among men, however, the relationship between socio-economic status and attendance appears to be less pronounced. Since 1971, participation rates have increased much more among women than among men, but, interestingly, the reasons for the gender differences in attendance rates have not been studied until now. Variables which were identified in international studies as predictors of participation, such as physician's recommendation or marital status, should be acknowledged in future research.

Adult↗
PubMed1975

Family planning in Bali.

Despite low per capita income and little evidence of economic development, the response to the government-sponsored family planning program in Bali has been remarkably favorable. After five years of government involvement, a total of 29 percent of eligible women are estimated to be using program methods, including 25 percent who have accepted IUDs, and 4 percent more are estimated to be using nonprogram methods. This level of performance is higher than in most other developing areas of the world. A number of the factors that might help to explain the success of the program in Bali are identified, and the future prospects for continued success are assessed.

Adolescent↗
PubMed2001

Diabetic nephropathy and end-stage renal failure: the Norwegian story.

Diabetic nephropathy is the most common single cause of end-stage renal failure (ESRF) in the Western world, recorded as the cause of renal failure in up to 40% to 45% of those entering renal replacement therapy (RRT) programs. However, marked differences exist between countries; the percentage of patients entering RRT in Norway because of diabetic nephropathy is 10% of the incident RRT population. The percentage in the United States is approximately 40%; therefore, the purpose of the present study was to compare data from Norway with data from the United States in an attempt to detect factors that might explain some of the differences. To make the comparisons as valid as possible, an attempt has been made to focus on populations of similar genetic make-up. The incidence of type 1 diabetes is a little higher in Norway than in the United States, whereas the prevalence of type 2 diabetes may be twice as high in the United States as in Norway; marked differences in the prevalence of obesity is probably a significant causative factor. There seems to be no striking difference in the prevalence of microalbuminuria in people with diabetes in the two populations, whereas there are insufficient data to compare the prevalence of overt proteinuria. The incidence of patients with a diagnosis of diabetic nephropathy as the cause of ESRF entering RRT in the two study populations showed marked differences; the incidence for 1997 was 8.9/million population in Norway and 113/million population in the United States. The proportion of type 2 diabetes was 46% in Norway and 64% in the US (1997). It is unlikely that the marked difference in incidence of RRT can be explained by differences in type 2 diabetes prevalence alone. The populations may not be directly comparable, and differences in the size of study populations and in the choice of renal diagnosis in patients with diabetes as a comorbid factor at the beginning of RRT may introduce uncertainties. Further, data on other factors--such as incidence of death before RRT is indicated, quality of care, and health care delivery, expressed as degree of blood pressure and metabolic control--were not available. Differences in acceptance of diabetes patients into RRT programs are not believed to contribute significantly. Norway is seeing a development toward increasing body weight and a change toward a more sedentary lifestyle, together with an increasing prevalence of type 2 diabetes earlier in life than has previously been the case. An increase in diabetic nephropathy and need for RRT because of type 2 diabetes must therefore be expected in Norway. To understand differences and to best design preventive programs, further comparative studies of the two populations seem warranted.

Diabetes Mellitus, Type 1↗