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PubMed1995

Purposes, problems, and proposals for progress in cancer staging.

OBJECTIVE: To learn the opinions of selected members of the American Society for Head and Neck Surgery about the purpose of cancer staging and the problems with the current system, and to use these opinions to suggest improvements. DESIGN: Questionnaire survey. PARTICIPANTS: One hundred one physicians, based on their prominence in the field of head and neck cancer, selected from the society membership directory. OUTCOME MEASUREMENT: Responses to the six questions and other comments provided by the responding physicians. RESULTS: Sixty-six physicians returned the questionnaire. Of the six purposes of cancer staging, comparing end results was rated most important. Considerable variation existed among the respondents in the rank order of importance of the six purposes. The TNM strengths were its simplicity, low cost, relative accuracy, objectivity, universal acceptance, and lack of need for special technology. Weaknesses included inconsistencies, inaccuracies, observer variability, and problems with various T, N, and M classification criteria. Most believed that the TNM system should be expanded to include host factors, such as functional status, severity of comorbidity, immunocompetence, and symptom severity. CONCLUSIONS: These results suggest a wide range of opinion about the purpose of cancer staging. Several problems with the present TNM system, such as the exclusion of additional prognostic factors, limit the usefulness of the system. Progress in cancer staging will occur when the current system is augmented by these prognostic factors.

Attitude of Health Personnel↗
PubMed1998

Parental leave: comparing children's hospitals with Fortune 500 companies.

OBJECTIVE: To identify parental leave policies and availability of support systems for new parents employed by children's hospitals and compare these benefits with those offered by Fortune 500 companies. DESIGN: Telephone or facsimile survey of all (n=118) children's hospitals and pediatric medical centers in the National Association of Children's Hospitals and Related Institutions 1995 Directory of Members, and 118 geographically matched Fortune 500 companies. Policies for maternity and paternity leave, adoption benefits, and support services for new parents were compared. RESULTS: Ninety-four children's hospitals (80%) and 82 Fortune 500 companies (69%) responded to the survey. No difference in duration of maternity (P>.30) or paternity (P=.12) leave was found. Sixty-two companies (77%) classified maternity leave as short-term disability while 47 hospitals (50%) classified it as sick time (P<.005). Classifying maternity leave as short-term disability generally gives better benefits to employees with short duration of service, whereas classifying maternity leave as sick time usually favors employees with longer employment. Companies provided more financial support for adoption expenses (P<.05), but there was no difference in duration of paid or unpaid leave for adoption (P=.14). Hospitals provided more on-site day care (69% vs 42%; P<.001) and better support systems for breast-feeding mothers (49% vs 24%; P<.002). CONCLUSIONS: Children's hospitals do not offer better parental leave benefits than Fortune 500 companies; however, they offer better support systems for parents returning to work after the birth of a child.

Commerce↗
PubMed2002

If we prescribe it, will it come? Access to asthma equipment for Medicaid-insured children and adults in the Bronx, NY.

CONTEXT: Asthma is a major cause of morbidity in the United States. Self-management of asthma requires access to appropriate equipment. Clinical experience in an inner-city practice suggests that families encounter difficulties in filling prescriptions for spacers/holding chambers, peak flow (PF) meters, and nebulizer machines. OBJECTIVES: To determine whether Bronx, NY, pharmacies (1) carry spacers/holding chambers, PF meters, and nebulizer machines; (2) accept Medicaid insurance for them; and (3) perceive barriers to reimbursement by Medicaid for this equipment. DESIGN AND SETTING: Structured telephone survey of 100 Bronx pharmacies randomly selected from the 1999 telephone directory. PARTICIPANTS: Ninety-eight pharmacists and 2 pharmacy technicians in 100 different pharmacies. MAIN OUTCOME MEASURES: Pharmacists' reports of equipment availability, Medicaid acceptance, and reasons for not carrying equipment or accepting Medicaid. RESULTS: Overall equipment availability was as follows: spacers (68%), spacers with masks (57%), adult PF meters (40%), child-range PF meters (24%), and nebulizer machines (56%). For Medicaid recipients, equipment was less available: spacers (45%), spacers with masks (35%), adult PF meters (27%), child-range PF meters (17%), and nebulizer machines (33%). Surveyed pharmacists reported misconceptions about requirements for Medicaid reimbursement, which included the following: that Durable Medical Equipment permits are required (64% spacers and 33% PF meters), that special forms are needed (17% PF meters), or that this equipment is not covered by Medicaid (14% spacers and 8% PF meters). Of the 100 surveyed pharmacists, 32 reported difficulties with Medicaid reimbursement and 41 had never tried to receive reimbursement. CONCLUSIONS: These results suggest that (1) access to spacers/holding chambers, PF meters, and nebulizers for Medicaid-insured families is severely limited in Bronx pharmacies; (2) misunderstandings regarding Medicaid reimbursement policies are common; and (3) interventions to increase the proportion of pharmacies that dispense equipment are needed.

Administration, Inhalation↗
PubMed1988

Syrup of ipecac. The case for distribution from physicians' offices.

Data from a nationally representative sample of household interviews were analyzed to examine public preparedness for childhood poisoning episodes. Eighty-eight percent (61% to 77% in nonwhite groups) of respondents from households with children younger than 10 years had heard of poison control centers and 70% (50% to 57% in nonwhites) stated that they had the telephone number of such a center. In contrast only 25% stated they had syrup of ipecac in their home. Among blacks and Hispanics this proportion was 9%. To explore possible reasons for this we telephoned a sample of 65 physicians listed in the greater Washington, DC, telephone directory as providers of care for infants and children. Of the 45 (69%) who agreed to be interviewed, 73% informed their patients about poison control centers and 53% provided the appropriate telephone number. Although 78% believed parents should have ipecac in the house, only three (7%) of 45 actually dispensed ipecac to parents. We conclude that ipecac is not widely available in the homes of American children. By regularly dispensing it in the course of pediatric care, physicians could largely remedy this deficiency.

Attitude of Health Personnel↗
PubMed1997

Current positions of graduates of internal medicine-pediatrics training programs.

OBJECTIVE: To determine what positions graduates of internal medicine-pediatrics programs currently hold. DESIGN: A survey of the program directors of residencies in internal medicine-pediatrics. PARTICIPANTS: Program directors of the 85 internal medicine-pediatrics training programs listed in the 1993-1994 Graduate Medical Education Directory. MAIN OUTCOME MEASURES: A 1-page survey that described the current positions of trainees graduating between 1987 and 1993. RESULTS: Seventy-four (87%) of the 85 program directors completed the survey. Of the 708 graduates reported on, 68% were practicing as generalists. The generalists of this cohort (n = 480) were primarily in private practice settings (n = 390, 81%) and most were practicing internal medicine-pediatrics (n = 416, 85%). Only 12% of the generalists had chosen to practice either pediatrics or internal medicine. Twenty-one percent of the total graduates had entered subspecialty training. CONCLUSIONS: To our knowledge, the sample of 708 graduates is the largest survey of graduates of internal medicine-pediatrics programs to date and shows that 68% of graduates are practicing in primary care fields. Graduates of internal medicine-pediatrics programs should be considered as an important source of primary care physicians.

Education↗
PubMed1997

Sun protection counseling by pediatricians.

OBJECTIVE: To establish a national baseline regarding pediatricians' sun protection counseling perceptions and behaviors. INTERVENTIONS: A survey was mailed to a random sample of 600 pediatricians selected from the 1996 American Academy of Pediatrics Directory using a 3-wave mailing technique to maximize the response rate. The 3-wave mailing resulted in 414 returned surveys of 583 surveys (17 surveys were nondeliverable) (a 71% response rate). RESULTS: Most (60%) of the pediatricians lacked formal training on how to counsel parents and children about sun protection. Approximately 3 (78%) of 4 indicated that not enough time was spent in their residency program on how to educate parents and children about sun protection. Greater than half (60%) of the respondents indicated that they usually (47%) or always (13%) counseled about sun protection. Seventy-seven percent of the respondents indicated that pediatricians have a professional responsibility to counsel parents and children about sun protection. CONCLUSIONS: The results of this investigation suggest that most pediatricians surveyed believed that they had a professional responsibility to counsel about sun protection and that such counseling would be effective in decreasing skin cancer and the number of sunburns. Although most had not had training on sun protection counseling in their residency program, 6 of 10 indicated that they usually or always counseled about sun protection. Sun protection counseling training in residency programs can potentially extend pediatricians' knowledge of skin cancer and the importance of a broad spectrum of preventive measures, as well as increase their ability to counsel about such measures.

Adult↗
PubMed2000

Hospital informed consent for procedure forms: facilitating quality patient-physician interaction.

BACKGROUND: Informed consent forms should document and reflect the goals of informed consent and shared decision making. We conducted this study to examine the extent to which informed consent for procedure forms meet accepted informed consent standards, how well state informed consent statutes correlate with these standards, and whether existing forms can enhance the interactions between patients and physicians or other health care providers. HYPOTHESIS: Informed consent forms do not meet accepted standards. A different format may be more useful for patient-physician interactions. DESIGN: A content analysis was conducted of hospital informed consent for procedure forms from a random selection of hospitals in the 1994 American Hospital Association membership directory. Forms were examined for evidence of the basic elements of informed consent (nature of the procedure, risks, benefits, and alternatives) and items that might enhance patient-physician interactions and encourage shared decision making. UNIT OF ANALYSIS: From 157 hospitals nationwide, 540 hospital informed consent for procedure forms were examined. MEASUREMENTS AND MAIN RESULTS: Ninety-six percent of forms indicated the nature of the procedure, but risks, benefits, and alternatives were found less often. Only 26% of forms included all 4 basic elements, 35% included 3 of 4 elements, 23% had 2 of 4 elements, 14% had only 1 element, and 2% had none of the elements. Forms appear to authorize treatment (75%) or protect hospitals and caregivers from liability (59%) rather than clarify information about procedures (40%) or aid patients in decision making (14%). Forms from states with statutes that require that all 4 elements be provided were no more likely than other states to include them (Fisher exact test = 1.000). Fewer than 40% of forms supported models of shared decision making. CONCLUSIONS: The content of most forms did not meet accepted standards of informed consent or patient-physician interactions. We propose a form that more fully supports the models of ideal informed consent and shared decision making to enhance the applicability of informed consent in the clinical setting.

Ethics, Medical↗
PubMed2004

Educational programs in US medical schools, 2003-2004.

CONTEXT: US medical schools continue to change their organizational structures, staffing patterns, and educational programs. OBJECTIVE: To review the status of US medical school educational programs in the 2003-2004 academic year, compared with 1993-1994. DATA SOURCES: The Liaison Committee on Medical Education (LCME) Annual Medical School Questionnaire for 2003-2004 and the Association of American Medical Colleges Directory of American Medical Education for the years 1983-1984, 1993-1994, and 2003-2004. DATA SYNTHESIS: The number of full-time faculty members in the 126 LCME-accredited medical schools increased from 90 975 in 1993-1994 to 114 549 in 2003-2004 (+26%), whereas the number of enrolled students remained essentially unchanged (66 453 in 1993-1994 and 67 166 in 2003-2004). In 2003-2004, 48% of medical school deans held another title at the medical center or university level, such as vice president for health affairs. There are 94 medical schools that have a comprehensive clinical examination using the standardized patient/objective structured clinical examination format; 59 schools require students to pass this examination for graduation. As of spring 2004, 58 schools will require students in the class of 2005 to pass the new US Medical Licensing Examination Step 2 Clinical Skills examination. CONCLUSIONS: The role of the medical school dean has expanded over time and is associated with the creation of a discrete administrative structure for the educational program. The number of full-time medical school faculty continues to increase, whereas the number of enrolled students remains steady. Considerable variability exists among medical schools in their use of standardized clinical evaluations.

Adult↗
PubMed1999

Ligand solvation in molecular docking.

Solvation plays an important role in ligand-protein association and has a strong impact on comparisons of binding energies for dissimilar molecules. When databases of such molecules are screened for complementarity to receptors of known structure, as often occurs in structure-based inhibitor discovery, failure to consider ligand solvation often leads to putative ligands that are too highly charged or too large. To correct for the different charge states and sizes of the ligands, we calculated electrostatic and non-polar solvation free energies for molecules in a widely used molecular database, the Available Chemicals Directory (ACD). A modified Born equation treatment was used to calculate the electrostatic component of ligand solvation. The non-polar component of ligand solvation was calculated based on the surface area of the ligand and parameters derived from the hydration energies of apolar ligands. These solvation energies were subtracted from the ligand-receptor interaction energies. We tested the usefulness of these corrections by screening the ACD for molecules that complemented three proteins of known structure, using a molecular docking program. Correcting for ligand solvation improved the rankings of known ligands and discriminated against molecules with inappropriate charge states and sizes.

Aniline Compounds↗
PubMed1999

Spilling the beans on java 3D: a tool for the virtual anatomist.

The computing world has just provided the anatomist with another tool: Java 3D, within the Java 2 platform. On December 9, 1998, Sun Microsystems released Java 2. Java 3D classes are now included in the jar (Java Archive) archives of the extensions directory of Java 2. Java 3D is also a part of the Java Media Suite of APIs (Application Programming Interfaces). But what is Java? How does Java 3D work? How do you view Java 3D objects? A brief introduction to the concepts of Java and object-oriented programming is provided. Also, there is a short description of the tools of Java 3D and of the Java 3D viewer. Thus, the virtual anatomist has another set of computer tools to use for modeling various aspects of anatomy, such as embryological development. Also, the virtual anatomist will be able to assist the surgeon with virtual surgery using the tools found in Java 3D. Java 3D will be able to fulfill gaps, such as the lack of platform independence, interactivity, and manipulability of 3D images, currently existing in many anatomical computer-aided learning programs.

Anatomy↗
PubMed2001

Docking molecules by families to increase the diversity of hits in database screens: computational strategy and experimental evaluation.

Molecular docking programs screen chemical databases for novel ligands that fit protein binding sites. When one compound fits the site well, close analogs typically do the same. Therefore, many of the compounds that are found in such screens resemble one another. This reduces the variety and novelty of the compounds suggested. In an attempt to increase the diversity of docking hit lists, the Available Chemicals Directory was grouped into families of related structures. All members of every family were docked and scored, but only the best scoring molecule of a high-ranking family was allowed in the hit list. The identity and scores of the other members of these families were recorded as annotations to the best family member, but they were not independently ranked. This family-based docking method was compared with molecule-by-molecule docking in screens against the structures of thymidylate synthase, dihydrofolate reductase (DHFR), and the cavity site of the mutant T4 lysozyme Leu99 --> Ala (L99A). In each case, the diversity of the hit list increased, and more families of known ligands were found. To investigate whether the newly identified hits were sensible, we tested representative examples experimentally for binding to L99A and DHFR. Of the six compounds tested against L99A, five bound to the internal cavity. Of the seven compounds tested against DHFR, six inhibited the enzyme with apparent K(i) values between 0.26 and 100 microM. The segregation of potential ligands into families of related molecules is a simple technique to increase the diversity of candidates suggested by database screens. The general approach should be applicable to most docking methods. Proteins 2001;42:279-293.

Algorithms↗
PubMed2001

Galantamine for Alzheimer's disease.

BACKGROUND: Galantamine (also called galanthamine, marketed as Reminyl (Janssen)) can be isolated from several plants, including daffodil bulbs, and now synthesized. Galantamine is a specific, competitive, and reversible acetylcholinesterase inhibitor. It is also an allosteric modulator at nicotinic cholinergic receptor sites potentiating cholinergic nicotinic neurotransmission. A small number of early studies showed mild cognitive and global benefits for patients with Alzheimer's disease, and recently several multicentre clinical trials have been published with positive findings. Galantamine has received regulatory approval in Sweden, is available in Austria, and awaits marketing approval in the United States, Europe, and other countries. OBJECTIVES: The objective of this review is to assess the clinical effects of galantamine in patients with probable Alzheimer's disease, and to investigate potential moderators of an effect. SEARCH STRATEGY: The Cochrane Dementia Group specialized register of clinical trials was searched using the terms 'galantamine,' and 'galanthamine' (15 February 2000) as was the Cochrane Controlled Trials Register (2000, Issue 2). These terms were also used to search the following databases: EMBASE, MEDLINE, PsychLit; Combined Health Information Database, NRR (National Research Register), ADEAR (Alzheimer's Disease Education and Referral Centre clinical database, BIOMED (Biomedicine and Health), Glaxo-Wellcome Clinical Trials Register, National Institutes of Health Clinical Trials Databases, Current Controlled Trials, Dissertation Abstracts (mainly North American dissertations) 1961-1994, Index to UK Theses (British dissertations) 1970-1994. Published reviews were inspected for further sources. Additional information was collected from an unpublished investigational brochure for galantamine. SELECTION CRITERIA: Trials selected were randomized, double-blind, parallel-group, and unconfounded comparisons of galantamine with placebo for a treatment duration of greater than 4 weeks in people with Alzheimer's disease. DATA COLLECTION AND ANALYSIS: Data were extracted independently by the reviewers and pooled where appropriate and possible. The pooled odds ratios (95%CI) or the average differences (95%CI) were estimated. Intention-to-treat and observed cases data were both reported, if the data were available to be reported. -Outcomes of interest include the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog), clinical global impression of change (CIBIC-plus or CGIC), Alzheimer's Disease Cooperative Study/Activities of Daily Living (ADCS-ADL), Disability Assessment for Dementia scale (DAD) and Neuropsychiatric Inventory (NPI). - Potential moderating variables of a treatment effect included trial duration and dose. MAIN RESULTS: Seven trials were identified that met criteria for entry, with 6 being Phase II or III industry-sponsored multicentre trials. One was of 12 weeks duration; one of 5 months; one of 29 weeks; and the rest of 6 months duration. Trials of 5 months or more were aggregated in the analyses as '6 months'. Overall, galantamine showed significant treatment effects at daily doses of 16-32 mg/d for trials of 3- to 6-months duration. For global ratings, trials of 3 months duration with doses of 24-32mg/d (Odds Ratio (OR) 2.2; 95%CI 1.4 to 3.7) and 36mg/d (OR 3.3; 95%CI 1.2 to 9.3) were statistically significant in favour of treatment. For trials of 6 months duration (5-months to 29 weeks), only doses of 8mg/d failed to be statistically significant (24mg: OR 2.0; 95%CI 1.5 to2.5; 32mg: OR 1.9; 95%CI 1.4 to 2.5). For cognitive function over 6 months duration: at a 24mg/d, improvements measured -3.5 points (k=3; 95%CI -4.3 to -2.8) on weighted mean difference on the ADAS-Cog scale, and -4.0 points at 32mg/d (k=2; 95%CI -5.0 to -3.0). Both observed cases (WMD 3.8; 95%CI 0.3 to 7.3) and intention to treat analyses using the Disability Assessment of Dementia gave statistically significant results in favour of treatment for daily doses of 32mg for 6 months duration. The small number of trials available for analysis, however, limited the power of analyses to detect differences. Galantamine consistently failed to show statistically significant treatment effects at doses of 8mg/day. Galantamine's adverse effects appear similar to those of other cholinesterase inhibitors, in that it tends to produce gastrointestinal effects acutely and with dosage increases. Overall, people treated with galantamine at doses of 24-32 mg/d were more likely to discontinue participation in most trials than were people treated with lower doses or placebo, but in the one trial with a slower rate of titration the discontinuation rate was not significantly greater than placebo for the 16 mg/day dose. (ABSTRACT TRUNCATED)

Alzheimer Disease↗
PubMed2004

Physical fitness training for stroke patients.

BACKGROUND: Stroke patients have impaired physical fitness and this may exacerbate their disability. It is not known whether improving physical fitness after stroke reduces disability. OBJECTIVES: The primary aims of the review were to establish whether physical fitness training reduces death, dependence and disability after stroke. The secondary aims of the review included an investigation of the effects of fitness training on secondary outcome measures (including, physical fitness, mobility, physical function, health and quality of life, mood and the incidence of adverse events). SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (June 2003). In addition, the following electronic databases were searched: Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2002 Issue 4), MEDLINE (1966 to December 2002), EMBASE (1980 to December 2002), CINAHL (1982 to December 2002), SPORTDiscus (1949 to December 2002), Science Citation Index Expanded (1981 to December 2002), Web of Science Proceedings (1982 to December 2002), Physiotherapy Evidence Database (December 2002), REHABDATA (1956 to December 2002) and Index to UK Theses (1970 to December 2002). We hand searched relevant journals and conference proceedings and screened reference lists. To identify unpublished and ongoing trials we searched trials directories and contacted experts in the field. SELECTION CRITERIA: Randomised controlled trials were included when an intervention represented a clear attempt to improve either muscle strength and/or cardiorespiratory fitness, and whose control groups comprised either usual care or a non-exercise intervention. DATA COLLECTION AND ANALYSIS: Data from eligible studies were independently extracted by two reviewers. The primary outcome measures were death, disability and dependence. The lack of common outcome measures prevented some of the intended analysis. MAIN RESULTS: A total of twelve trials were included in the review. No trials reported death and dependence data. Two small trials reporting disability showed no evidence of benefit. The remaining available secondary outcome data suggest that cardiorespiratory training improves walking ability (mobility). Observed benefits appear to be associated with specific or 'task-related' training. REVIEWER'S CONCLUSIONS: There are few data available to guide clinical practice at present with regard to fitness training interventions after stroke. More general research is needed to explore the efficacy and feasibility of training, particularly soon after stroke. In addition more specific studies are required to explore the effect of content and type of training. Further research will require careful planning to address a number of issues peculiar to this type of intervention.

Exercise Therapy↗
PubMed1981

A note on choosing a service provider from telephone listings: focus on community mental health centers.

178 college students searched telephone directories with instruction to find help for a friend with a serious emotional problem. There were no significant differences between white and yellow pages or between fine or bold print in the relative frequency with which CMHCs were found. The most important listing in the white pages was "Mental Health Center" and in the yellow pages was under "Clinics." More than two listings did not increase the relative frequency with which CMHCs were found and listed by a proper name was effective only in the absence of generic names.

Choice Behavior↗
PubMedDate not supplied

Geography of surnames in the Azores: specificity and spatial distribution analysis.

In order to obtain a better understanding of the genetic structure of the Azorean population, a specificity and spatial distribution analysis was performed, based on 2,454 different surnames present in the Azorean telephone directory (2002). We considered as specific surnames those with an absolute frequency ratio equal to or higher than 50%. The results revealed 51 specific surnames in the whole archipelago. The smallest island presents the only surname with 100% specificity (Pedras). In addition, São Miguel island, which contains 54% of the Azorean population, has the highest number of specific surnames (25 specific surnames). The spatial distribution analysis was used to detect genetic similarity between municipalities through the calculation of spatial autocorrelation (Moran's I coefficient). Of 240 surnames included in the analysis, 113 showed statistically significant patterns. Five different patterns were obtained, of which the most relevant was isolation by distance and depression (41.6%). However, 43.4% had no defined pattern. The overall correlogram shows a majority of positive values for distances lower than 49 km and between 269-309 km, indicating high similarity between closer municipalities and between distant municipalities whose populations show historic and sociocultural affinities. In conclusion, our data are in agreement with the historical background of the Azorean population.

Azores↗
PubMed1995

Automated linkage analysis in psychiatric disorders.

A genome-wide search for linkage of microsatellite markers to chromosomal loci containing genes responsible for the major psychoses is a laborious task which can be carried out with greater speed and economy by introducing automation to several steps in the procedure. We describe the use of the Automated Linkage Preprocessor (ALP) program for the computer analysis of the waveform generated by fluorescein-labelled markers after electrophoretic separation. (To obtain a copy send a request to A.F. Brown at the below MRC address or use Anonymous FTP to ftp.hgu.mrc.ac.uk. Software is in directory pub/ALP). The program runs on a PC in the Microsoft Windows environment, and is used in conjunction with an automated laser fluorescence (ALF) sequencer (Pharmacia) and its Fragment Manager software to detect and size the PCR products, filter out peaks of fluorescence due to nonallele fragments, and generate genotypes in a format suitable for direct input to standard linkage analysis programs. The method should offer the advantages of speed, accuracy, and reduced cost. Its use in linkage studies in a large family with manic-depressive illness is discussed.

Automation↗
PubMed2006

A preliminary comparison of the hopes of researchers, clinicians, and families for the future ethical use of genetic findings on schizophrenia.

A written questionnaire about genetic testing was distributed to all registrants at The 2004 World Congress of Psychiatric Genetics, mailed to clinical psychiatrists obtained from a directory of clinicians practicing in New York City, and mailed to members of families who have multiple affected family members with schizophrenia. A total of 274 individuals responded (162 researchers, 64 clinicians, and 48 family members). This survey shows that the majority of family members who completed the questionnaire (83.3%) would want to be tested if a genetic test were to become available. Over half of the family members (56.2%) would want prenatal testing. Similarly, over half of the clinicians (56.3%) would recommend it, despite only 25% of the researchers reporting that it would be a future useful tool. All of the clinicians surveyed thought adoption agencies should inform families about a family history of schizophrenia, while only half of the researchers thought this should be done (51.9%). These differences in opinions between consumers, their clinicians, and researchers could be based on a lack of understanding of the amount of risk conferred to family members by reported gene variants. Providing public discussions for placing these risks in perspective should be the responsibility of researchers. Open public discussion of the ethical and social uses of the information gained from psychiatric genetic research and its limitations is encouraged.

Adult↗
PubMed2003

Brief communication: coexistence of two distinct patterns in the surname structure of Sicily.

The extent of variation in the migratory movements that occurred in Sicily was evaluated using surname data taken from the telephone directories of the 390 communes of the island. The surname distribution of each commune was linearized by a log-log transformation, and a significant fit to a linear regression model was found in almost all cases. Interestingly, the slope of the regression line appeared to be a sensitive indicator of the different level of isolation associated with each Sicilian commune. By this approach, two distinct groups of communes, showing a higher or lower degree of isolation, were obtained, and two independent analyses of the surname structure of Sicily were carried out. A first multidimensional scaling analysis, based on the more isolated communes, yielded evidence for a more ancient pattern, characterized by a geographical gradient along the east-west axis. The same analysis, addressed to the less isolated communes, instead highlighted a wide network of interactions between geographically distant zones of the island. The fitting of the surname distribution to the log-log model allowed for the detection of a narrow subset of 35 Sicilian communes, whose significantly higher degree of isolation was statistically proved by the parallelism test. We believe that a genetic analysis focused on such specific zones of the island could reveal ancient patterns of differentiation, thus helping to answer the controversial question of the genetic history of Sicily.

Emigration and Immigration↗