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PubMed2005

Interview with Alberto Zanchetti, MD.

This month, The Journal of Clinical Hypertension features a hypertension icon from outside of the United States. Professor Alberto Zanchetti of Milan, Italy has been one of the most prominent researchers and teachers in the field of hypertension in Europe for the past 40 years. Those of us who have attended the European or International Society of Hypertension meetings have marveled at his energy, breadth of knowledge, and his ability to translate science into clinical practice. He has been in the forefront of new drug research for many years and has chaired or participated in almost all of the guideline committees in Europe that have set policy and established hypertension treatment recommendations. My own memories of Alberto conjure images of a man who truly had influence, not only in medicine, but in the outside world as well. Professor Zanchetti delayed a TWA flight from Milan to New York when I was late in arriving at the airport. He convinced La Scala to present an unscheduled opera for attendees at the European Society of Hypertension in Milan. That gives a picture of the man who gets things done. For these gracious acts, and for his enormous positive influence on generations of physicians not only in Europe, but also around the world, we salute him as one of the icons in hypertension.

Antihypertensive Agents↗
PubMed1995

The JIM interview. Samuel O. Thier, MD.

Although the public has grown increasingly accustomed to consolidation in the health care industry, the announcement on December 8, 1993, that the Massachusetts General Hospital (MGH) and the Brigham and Women's Hospital would merge merited front page coverage across the nation. These hospitals, long considered the crown jewels of the Harvard Medical School, have a history rich in tradition and a reputation for fierce independence. The merged entity, subsequently named Partners Healthcare System, Inc., has a payroll of 17,500 employees, making it the largest employer in Boston and the third largest in Massachusetts. Shortly after the merger, Boston newspapers reported that the announced plan had circumvented plans for Harvard to merge all five of its major teaching hospitals. The MGH-Brigham merger included no provisions for the other three Harvard-affiliated hospitals, the Massachusetts Deaconess, the Beth Israel, or the Dana Farber Cancer Institute. Speculation that the move was accomplished with little input from Harvard Medical School Dean Daniel Tosteson further accentuated the delicate politics of the merger. To run this powerhouse of health care, teaching, and research, the directors of Partners turned to Dr. Samuel O. Thier. Thier, who had honed his leadership skills as Medicine Chairman at Yale and President of the Institute of Medicine (IOM), has lifelong ties to the MGH. Indeed during his recent tenure as President of Brandeis University, he still made rounds at the hospital. Largely credited with revitalizing the IOM and restoring financial health to Brandeis, Thier must now lead an entity playing in a quickly changing and unpredictable marketplace.(ABSTRACT TRUNCATED AT 250 WORDS)

Boston↗
PubMed2006

Sensitive topics, survey nonresponse, and considerations for interviewer training.

This paper discusses current challenges in achieving higher survey participation rates in random-digit-dial telephone surveys and proposes steps to address them through interviewer training to avoid refusals. It describes features of surveys that contribute to respondent reluctance to participate and offers a brief overview of current refusal aversion training methods to reduce nonresponse. It then identifies what challenges that unique features of random-digit-dial telephone surveys on sensitive topics might contribute to nonresponse. Recommendations are then proposed for changes in refusal aversion training, standard survey introductions, and informed consent procedures. Finally, further research is called for to identify which methods best balance the need to improve response rates with respondent safety and privacy in surveys with sensitive questions.

Domestic Violence↗
PubMed1996

[Evaluation of occupational programs in the city of Zurich].

Occupational and job integration programs are components of low threshold drug policies. Since the mid-eighties many such projects have been realized not least to counteract the increasing pauperization of drug addicts and the spreading of AIDS. Two of these occupational programs, the "job-Bus" and the "Förderband (Conveyor Belt)", were evaluated by the means of two quantitative cross-sectional studies and by a qualitative topic oriented interview in the second phase. The results presented refer to the second phase of the evaluation. The proportion of women in the programs is low with only 10%. The average age of 38.4 is higher than in other institutions for drug users. The work program is well accepted among the participants, and there is a high demand for such programs in the target group. Non-material aspects such as structuring of days, contact opportunities and fulfillment give the institution an additional significance. The author therefore recommends expansion of these programs under occupational and socio-pedagogical aspects in doing so, the underrepresented women and young adults ought to be reached. Furthermore it should be examined whether stable users can be employed permanently.

Adult↗
PubMed2026

Content validity, face validity and comprehensiveness of generic quality-of-life measures in adults and children with rare genetic conditions and their carers: a think aloud qualitative study.

PURPOSE: This study aims to assess the content validity, face validity and comprehensiveness of the: (a) EQ-5D-5L, EQ-HWB, and ASCOT SCT4, for adults with rare genetic conditions; (b) the EQ-5D-5L, EQ-HWB, and ASCOT-carer for carers of adults or children with rare genetic conditions; and (c) the EQ-5D-Y-5L carer proxy-complete for children with rare genetic conditions. METHODS: In total, 60 qualitative think-aloud interviews were conducted in Australia and England to understand individuals' thought process during the completion of the QoL measures. Participants were subsequently led through a semi-structured discussion. Transcripts were analysed for whether participants demonstrated understanding of the measures and thematic analysis was conducted on responses to the semi-structured discussion. RESULTS: The majority of participants showed good understanding and supported the validity of the measures for people experiencing rare conditions. For carers, however, a broader evaluative space than health-related QoL was preferred. Several non-health domains were identified as important to both patients and carers, including treatment availability, impact on employment and finance, information and uncertainty, medication and carer burden, impact of passing on a condition, relationships and social connection, and experience with the healthcare system. CONCLUSION: This study provides some support for the face validity and comprehensiveness of the measures for people experiencing rare conditions. However, several participants felt that the narrow health domains were inadequate to capture the breadth of their lived experience. Future research should explore the extent to which the measures capture differences and changes in the QoL domains identified as important to patients and carers.

Humans↗
PubMed1984

Adherence measures and their utility.

This article addresses the variety of adherence measures available to the researcher, with particular reference to the utility of markers. It is proposed that the generic nature of the research question will suggest both the adherence definition and the appropriate assessment methodology. Each measurement procedure offers somewhat different information and has unique advantages and disadvantages. It is suggested that markers are limited by the relatively short duration of the measurement period, the lack of quantitative data on adherence, and, with some, the potential for confounding influences on their specificity. The probable value of markers lies in validating the subject's recent self-report, determining recent medication ingestion, and estimating the probability of adherence over time.

Clinical Trials as Topic↗
PubMed2005

Predicting the use of single versus multiple types of violence towards children in a representative sample of Quebec families.

OBJECTIVE: The purpose of this study is to determine which factors best predict parental use of single versus multiple types of violence. METHODOLOGY: The study uses data from a Quebec telephone survey conducted with a representative sample of 2,469 mothers of children aged 0-17 years. The interview covered topics such as mother's attitudes and reports of violence towards children, mother's experiences of childhood violence, level of marital discord, and socioeconomic factors. A discriminant function analysis was performed using individual and family factors to predict membership in five distinct groups: (a) no violence reported; (b) reports of psychological aggression only; (c) reports of minor physical violence only; (d) reports of psychological aggression and minor physical violence; and (e) reports of psychological aggression, minor and severe physical violence. RESULTS: One-way ANOVAs revealed that the groups differed significantly on factors such as child's age and gender, mother's attitudes, mother's experiences of childhood violence, level of marital discord, and number of children in the household. Discriminant function analysis revealed that the groups differed in two ways. The first function maximally separated the report of psychological aggression from minor physical violence only. The second function discriminated between the combined reports of all three types of violence versus the reports of minor physical violence only. Mother's attitudes and experiences of childhood violence were the two factors that best distinguished among groups and best predicted group membership. CONCLUSION: These results offer new insights for the prediction of mother's reports of one type versus multiple types of violence and highlight the importance of distinguishing between types and combinations of family violence in future research.

Adolescent↗
PubMed2004

Jonathan Hodgkin.

Jonathan Hodgkin graduated from Oxford in 1971 and then did a PhD with Sydney Brenner at MRC LMB in Cambridge, studying behavioural genetics in the nematode Caenorhabditis elegans. Later, after a couple of years working with myxobacteria as a postdoc in Dale Kaiser's lab at Stanford, he returned to LMB as a staff member, where he remained for most of the subsequent two decades. In the year 2000, he moved to Oxford as Professor of Genetics in the Department of Biochemistry, switching his major research interests from developmental genetics and sex determination to the study of host-pathogen interactions in the worm. For the past ten years, he has acted as curator of the C. elegans genetic map and gene nomenclature, and he is currently President of the Genetics Society of Great Britain.

Animals↗
PubMed2006

Compliance with the Australian national physical activity guidelines for children: relationship to overweight status.

Childhood obesity incidence has increased substantially and it has been argued that decreasing physical activity levels, coinciding with an increase in sedentary behaviours, are responsible. Australian guidelines were published in 2004, recommending that children participate in a minimum of 60 min of physical activity daily and spend no more than 2h a day using electronic media for entertainment. We aimed to compare compliance with these guidelines amongst children of differing weight status. The Childhood Injury Prevention Study (CHIPS) collected data from a randomly selected sample of Brisbane primary and preschool children aged 5-12 years. The following data were available for 518 participants: age, gender, measured height and weight and estimated time per week from a parent-completed 7 days diary in physical activity out of school and sedentary leisure activities including television viewing and computer use. Using age standardised body mass index estimates, approximately 20% of the cohort were overweight. Non-compliance with guidelines was 14.7% for out of school physical activity participation, and 30.9% for excess electronic media entertainment use. There was a 63% increase in the odds of overweight status amongst children who were non-compliant with the electronic entertainment recommendations than those who were compliant (adjusted odds ratio=1.63; 95% CI=1.05-2.54). Female gender and school level socioeconomic category were also independently associated with overweight status. Non-compliance with the minimal physical activity guideline increased the odds of being overweight by 28%, however this difference was not statistically significant. One in seven children from the Greater Brisbane area are at risk for being insufficiently active whilst a third overuse electronic media. Given that overuse of electronic entertainment was positively associated with childhood obesity, these children should be the target of public health campaigns to promote alternative leisure time activities.

Child↗
PubMed2000

A conversation with the leaders of the Gates Foundation's Global Health Program: Gordon Perkin and William Foege.

Over the past 3 years, the Bill & Melinda Gates Foundation has committed more than $1.7 billion to help prevent and eradicate diseases that afflict people living in the world's poorest nations. The gifts have revitalized a number of major global health initiatives that in recent years had lost momentum and helped to refocus the world's attention on the health crises facing many developing nations.

Communicable Disease Control↗
PubMed1976

History-taking for medical students. I-Deficiencies in performance.

A videotape analysis of histories conducted by 50 senior medical students was carried out to assess their history-taking skills. As predicted, serious deficiencies (similar to those evident in inexperienced medical students) were found. It is argued that traditional methods of clinical training fail to equip medical students with adequate history-taking skills. They should be given a more appropriate history-taking scheme, the opportunity to practice this under conditions of direct observation within strict time-limits, and detailed feedback about their performance.

Education, Medical, Undergraduate↗
PubMed2003

Health technology assessment in its local contexts: studies of telehealthcare.

Health technology assessment (HTA) is one of the major research enterprises of late modernity, reaching into fields of previously autonomous professional practice, and critically interrogating the organisation and delivery of health care. The 'evaluation' of new health technologies within the field of HTA is increasingly a normative political expectation, as discourses of 'evidence-based' practice run through health policy in the UK and elsewhere. Despite its importance in governing the direction of innovation in health care delivery, there are hardly any empirical studies of HTA in practice. In this paper, we draw on two ethnographic studies of telehealthcare implementation and evaluation in the UK to explore the practical conduct of HTA, and we focus specifically on the social organisation and conduct of randomised controlled trials of these new technologies. The paper examines how evaluation forms a mediating set of practices that make the embedding or normalisation of a new technology possible; and present a simple model of the social and technical contingencies within the evaluation process.

Anthropology, Cultural↗
PubMed1988

Patterns of discourse cohesion and coherence in Alzheimer's disease.

Patterns of discourse--as reflected in the use of propositions, cohesion devices, and in judgments of coherence--in the speech of 6 well elderly and 6 patients with senile dementia of the Alzheimer type (SDAT) during topic-centered interviews were compared. Compared to the well elderly, SDAT patients used significantly more words and conversational turns. The interviewer also used more words and turns when interviewing SDAT patients, making those interviews more lengthy and more interactive than those of the elderly comparison group. Although significant differences in propositional form and cohesion devices were not found, a pattern of cohesion disruptions in SDAT patients was identified that appears consistent with previously noted patterns of language dissolution. Coherence judgements by four listeners showed significant differences between the two groups. The breakdowns in coherence were related to one subtype of cohesion disruption, missing element. This suggests that incoherence may result in part from a loss of the ability to take the listener's perspective in developing thematic structure during conversation. It is argued that SDAT results not only in the impairment of linguistic abilities but also in the impairment of discourse abilities that contribute to Alzheimer patients' incoherent speech.

Aged↗
PubMed1999

Nursing and the research assessment exercise: past, present and future.

In this paper we examine approaches to undertaking nursing research and building research capacity in higher education institutions in the United Kingdom (UK). First we review some of the main responses in the literature to the last two Research Assessment Exercises (RAE), then we report findings from a small study of nursing departments which entered the last RAE and finally we speculate on the likely future of nursing research in the light of recent education and health policy. We suggest that many of the difficulties experienced are an effect of contradictory health and education policies and rival ways of assessing research performance. Nursing education is caught in the 'pincer movement' of stringency in both sectors. In addition, the challenges of the RAE and the necessity to earn income from contracting with National Health Service (NHS) education and training consortia for teaching represent an outworking of two rival views of the role of higher education, broadly an elitist view and one that sees higher education as a supplier of the workforce needs of industry. In addition to this, the NHS R&D (research and development) strategy provides an alternative arena for collaboration, funding and reputation to that constructed by the RAE.

Evaluation Studies as Topic↗