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PubMed2004

Fifty years of hope and concern for the future of occupational medicine.

Recently, there has been considerable concern expressed from a number of sources about the future of occupational medicine. A review of the literature and other sources reveals that over the past 50 years there has been continuous hope and concern for the specialty. Occupational medicine became a certified specialty in 1955, growing slowly until 1970, when the passage of the Occupational Safety and Health Act, growth accelerated. The marked decrease in classic occupational diseases, injuries, and deaths is a major triumph but may also be a factor in declining interest in specialization by physicians. Potential conflicts of interest have been at issue for over 50 years. Occupational medicine is now mostly clinical, in contrast to previous years. However, occupational medicine is a distinct and solid specialty that still offers many challenges.

History, 20th Century↗

PubMed2007

Identification of putative cis-regulatory elements in Cryptosporidium parvum by de novo pattern finding.

BACKGROUND: Cryptosporidium parvum is a unicellular eukaryote in the phylum Apicomplexa. It is an obligate intracellular parasite that causes diarrhea and is a significant AIDS-related pathogen. Cryptosporidium parvum is not amenable to long-term laboratory cultivation or classical molecular genetic analysis. The parasite exhibits a complex life cycle, a broad host range, and fundamental mechanisms of gene regulation remain unknown. We have used data from the recently sequenced genome of this organism to uncover clues about gene regulation in C. parvum. We have applied two pattern finding algorithms MEME and AlignACE to identify conserved, over-represented motifs in the 5' upstream regions of genes in C. parvum. To support our findings, we have established comparative real-time -PCR expression profiles for the groups of genes examined computationally. RESULTS: We find that groups of genes that share a function or belong to a common pathway share upstream motifs. Different motifs are conserved upstream of different groups of genes. Comparative real-time PCR studies show co-expression of genes within each group (in sub-sets) during the life cycle of the parasite, suggesting co-regulation of these genes may be driven by the use of conserved upstream motifs. CONCLUSION: This is one of the first attempts to characterize cis-regulatory elements in the absence of any previously characterized elements and with very limited expression data (seven genes only). Using de novo pattern finding algorithms, we have identified specific DNA motifs that are conserved upstream of genes belonging to the same metabolic pathway or gene family. We have demonstrated the co-expression of these genes (often in subsets) using comparative real-time-PCR experiments thus establishing evidence for these conserved motifs as putative cis-regulatory elements. Given the lack of prior information concerning expression patterns and organization of promoters in C. parvum we present one of the first investigations of gene regulation in this important human pathogen.

Algorithms↗

PubMed2003

A qualitative study exploring midwives' perceptions and views of extending their role to the examination of the newborn baby.

OBJECTIVES: to explore midwives' attitudes and perceptions about extending their role to the examination of the newborn baby, as well as their general perceptions and attitudes to new role developments. DESIGN: qualitative, data collected using semi-structured interviews, which were exploratory and interactive in form. SETTING: six maternity hospitals in South-east England. PARTICIPANTS: ten midwives were purposefully selected, including five trained in the examination of the newborn baby and currently conducting examinations and five who had not. Most of the midwives had been qualified for over ten years and had a wide range of clinical experience in hospital and community settings. FINDINGS: midwives identified many benefits to themselves, to their profession and to the mothers as a result of developing their role into the examination of the newborn baby. The major benefit cited was improved job satisfaction, which was directly related to their ability to give continuity and total care to mothers and babies. Midwives also perceived that undertaking the examination strengthened their position as autonomous practitioners, by enabling them to provide total care to mothers and babies who fitted their criteria of normality. Moreover, midwives thought that improvements in the overall quality of care to mothers would result from them performing the examination, including improved communication, greater continuity of care and a more holistic examination. Although midwives were concerned about possible increase in workloads and pressure to take on new roles, the examination was generally perceived as being easily incorporated into their current practice without compromising overall standards in midwifery care. Midwives expressed concern about 'extending' practice into areas that did not fit their perceptions of normality and about being 'pressurised' into taking on new roles. IMPLICATIONS FOR PRACTICE: it would appear from this study that an important consideration for midwives in their acceptance of new roles, is the relationship of that role to their position as experts in normality. Midwives in this study viewed the examination of the newborn baby as 'fitting in' with their perceptions of the core values of midwifery.

Adult↗

PubMed2002

Egg donation--the donor's view: an aid to future recruitment.

The major stumbling block for egg donation lies in the recruitment of sufficient suitable donors. This study ascertained the views of egg donors in the UK by analysing 113 completed questionnaires that asked questions about demographics, stimulus to donate, support network available, ethics, the 'process' of donation and payment. Ideas for future recruitment were also sought. The mean age of donors was 31.7 years, and most donors were donating for the first time. Ninety-one per cent of donors were Caucasian and 93% had children of their own. Ninety-six (85%) donors felt fully supported in their decision to become an egg donor and 60 (53%) discussed their donation with their GP. Information regarding egg donation came from many sources. The main motivation to donate was a desire to help childless couples. Many respondents had themselves suffered, or knew of couples with, infertility. Eighty-three (73.5%) respondents felt that expenses alone should be paid to egg donors, and many expressed concerns that large financial incentives may attract the 'wrong women' to donate. Forty-nine (43%) respondents found the procedure painful or stressful in some way, although 95% had no regrets concerning their donation, and 72% would donate again. A common reason for donors not wishing to donate again was age restriction. Respondents were asked their opinion with regard to recruitment and the enthusiasm they expressed needs to be harnessed if the current shortcomings in available donors are to be overcome. Specific recommendations to achieve this are made.

Adult↗

PubMed1995

Differential distribution of alpha 2-adrenoceptor subtypes and messenger RNA expression between renal cortex of salt-sensitive and salt-resistant Sabra rats.

OBJECTIVE: To assess whether alterations of alpha 2-adrenoceptor subtypes in distribution and gene expression in the renal cortex could explain the predisposition to salt-sensitivity or salt-resistance in Sabra rats. DESIGN: Studies were performed using plasma membranes and RNA preparations from renal cortex of 8- to 10-week-old Sabra salt-sensitive (SBH) and salt-resistant (SBN) rats on a normal-sodium diet. METHODS: The alpha 2-adrenoceptor subtypes were determined by competition experiments with [3H]-yohimbine or [3H]-RX821002. Their gene expression was studied by RNA-directed complementary DNA synthesis followed by Taq DNA polymerase amplification. RESULTS: Binding studies showed that alpha 2B- and alpha 2A-adrenoceptor subtypes represented in SBN 72 and 28% of the maximal binding capacities of the two radioligands, respectively. In contrast, only the alpha 2B subtype was detected in the SBH rat. However, the use of guanoxabenz disclosed alpha 2B-adrenoceptors in alpha 2B1 and alpha 2B2 subtypes. The densities of those alpha 2B subtypes appeared to be higher in the SBH rat than in the SBN rat. Messenger RNA corresponding to alpha 2A and alpha 2B subtypes were found both in SBH rats and in SBN rats. The expression of the alpha 2B subtype was permanently higher in the SBH rats than in the SBN rats. The expression of the alpha 2A gene in the SBH rats suggests a specific SBH post-transcriptional regulation resulting in the absence of alpha 2A-adrenoceptor. CONCLUSIONS: Differences exist in the renal cortex concerning expression and distribution of alpha 2-adrenoceptor subtypes between SBH and SBN rats. From these differences there might result different alpha 2-adrenoceptor-mediated renal functions in SBH and in SBN rats, which could lead to a predisposition to sensitivity or resistance to a high sodium intake.

Animals↗

PubMed1984

Do government training schemes for unemployed school leavers achieve their objectives? A psychological perspective.

The increasing rates of youth unemployment have given rise to concern in academic and political circles as well as amongst the general public. So much so that successive governments have introduced employment schemes specifically for this age group. Although a variety of opinions have been expressed concerning the value of such schemes and much thought and planning has gone into the design of successive generations of schemes, there appears to be little hard evidence concerning the effects they have on the well-being of young people. In the course of a study of the wider aspects of unemployment amongst school leavers, the authors collected evidence which they believe bears directly on this question. In a prospective study, which began by assessing fifth formers before they left school, it was found that in general those who went on to YOP schemes occupied an intermediate position between those who obtained work and those who remained unemployed, on a variety of measures of psychological well-being. However, it was found that those on Schemes were less likely than those in either of the other two groups to believe that they had a measure of personal control over their lives. The findings are discussed in relation to the design of employment schemes and the longer term implications.

Adolescent↗

PubMed2003

Analgesic use and pain coping among patients with haemophilia.

Pain is an important consequence of bleeding episodes in haemophilia. Previous research has included pain frequency and severity among measures of illness-related disability and quality of life in haemophilia, but little systematic evidence exists about analgesic use and pain coping in haemophilia. This paper reports cross-sectional findings from a national survey of patients with severe haemophilia type A and type B. Respondents provided information about pain frequency, pain coping strategies (using the haemophilia-adapted CSQ), use of analgesics and other drugs, and described any concerns they had about their drug use. Participants registered with comprehensive care haemophilia centres did not differ from the rest of the sample on any of the factors recorded. Over one-third of participants expressed concerns about their drug use, the most frequent of which were about dependence on prescribed analgesics. Pain frequency was the most important predictor of analgesic use, but pain coping, and specifically negative thoughts about pain, was associated with concerns about drug use independently of other factors, including analgesic use and pain frequency. Further research will be needed to evaluate possible interventions to promote more effective pain coping in haemophilia, and to examine the possible effects of pain coping on illness outcomes beyond analgesic use, such as well-being and quality of life.

Adaptation, Psychological↗

PubMed2002

CXC chemokine receptors in the central nervous system: Role in cerebellar neuromodulation and development.

Chemokines and their receptors are constitutively present in the central nervous system (CNS), expressed in neurons and glial cells. Much evidence suggests that, beyond their involvement in neuroinflammation, these proteins play a role in neurodevelopment and neurophysiological signaling. The goal of this review is to summarize recent information concerning expression, signaling, and function of CXC chemokine receptor in the CNS, with the main focus on the developmental and neuromodulatory actions of chemokines in the cerebellum.

Cerebellum↗

PubMed1987

A review of the high-level nuclear waste repository siting analysis.

We critique two 1986 Department of Energy reports concerning the selection of sites for characterization as the nation's first high-level nuclear waste repository. We find that the multiattribute utility analysis of the five nominated sites was well done, although we express concern about the assessed probabilities, question the construction of two important attribute scales, and disagree with some of the value tradeoffs that were used. In contrast, we find the logic of the recommendations report to be weak and unconvincing.

Radioactive Waste↗

PubMed1997

Smoking-specific weight gain concerns and smoking cessation in a working population.

Smoking cessation rates, progression in stage of change for smoking cessation, and serious quit attempts were examined over 2 years in a cohort of 242 men and women smokers (mean age 39.7 years, mean body mass index [BMI] 26.3) as a function of expressing concern about gaining weight because of quitting smoking. Participants were employees of 25 companies who were in a worksite health promotion program aimed at reducing risk factors for cardiovascular disease. Multivariate odds ratios (controlled for age, education, job class, sex, and BMI) for quitting smoking, attempting to quit smoking, and progressing in stage of change for smoking cessation as a function of weight concern were not significant. Interactions between sex and weight concern, and BMI and weight concern were also not significant. These findings, in a working, predominantly blue-collar population, and those of other studies, suggest that concern about gaining weight is, at best, a weak predictor of change in smoking behavior among most smokers.

Adult↗

PubMed2002

Attitudes to the public release of comparative information on the quality of general practice care: qualitative study.

OBJECTIVES: To examine the attitudes of service users, general practitioners, and clinical governance leads based in primary care trusts to the public dissemination of comparative reports on quality of care in general practice, to guide the policy and practice of public disclosure of information in primary care. DESIGN: Qualitative focus group study using mock quality report cards as prompts for discussion. SETTING: 12 focus groups held in an urban area in north west England and a semirural area in the south of England. PARTICIPANTS: 35 service users, 24 general practitioners, and 18 clinical governance leads. RESULTS: There was general support for the principle of publishing comparative information, but all three stakeholder groups expressed concerns about the practical implications. Attitudes were strongly influenced by experience of comparative reports from other sectors-for example, school league tables. Service users distrusted what they saw as the political motivation driving the initiative, expressed a desire to "protect" their practices from political and managerial interference, and were uneasy about practices being encouraged to compete against each other. General practitioners focused on the unfairness of drawing comparisons from current data and the risks of "gaming" the results. Clinical governance leads thought that public disclosure would damage their developmental approach to implementing clinical governance. The initial negative response to the quality reports seemed to diminish on reflection. CONCLUSIONS: Despite support for the principle of greater openness, the planned publication of information about quality of care in general practice is likely to face considerable opposition, not only from professional groups but also from the public. A greater understanding of the practical implications of public reporting is required before the potential benefits can be realised.

Access to Information↗

PubMed1989

Delegates approve protocol for third-party telephone review.

The Texas Medical Association Physician-Patient Advocacy Committee has conducted an extensive study of the telephone utilization review activities of private third-party payers and self-insured arrangements. Many of these organizations contract with private firms to conduct pre-certification and concurrent review of hospital admissions. These reviews often are accomplished by telephoning the attending physician's office. The procedures and criteria used by these firms and the qualifications of their review staff vary greatly. Physicians and their office staff are spending an increasing amount of time dealing with telephone utilization review. These review firms are not regulated or controlled by any agency. In response to the concerns expressed by physicians in dealing with telephone utilization review, Texas Medical Association's House of Delegates has approved the "Texas Medical Association Recommended Protocol for Physicians Responding to Private Third Party Telephone Review." The guidelines address concerns about confidentiality, physician documentation, patient advocacy, appeals, and cost and billing.

Confidentiality↗

PubMed1984

Labeled cells in patients with malignancy.

The use of radioisotopes for cell labeling has been a major tool in hematology laboratory research. Chromium-51-labeling of hematologic cells and lymphocytes has been used for years to study the migration and sequestration of these cells in the spleen and other sites. The substantial recirculation of lymphocytes from blood into lymphoid tissue and back into blood is well described. Recently, new approaches for radiosotopic cell labeling have gained prominence in the investigation of various aspects of malignant diseases and in the clinical care of such patients. Isotopes such as indium-111 can be visualized with standard scanning techniques providing further information about the migration of normal and malignant cells has been discovered. In vivo studies have been performed with indium-111 in animals and humans, including comparisons of the migration of abnormal cells (malignant) and of lymphocytes to abnormal nodes. Evaluation and comparison of the migration of carcinoma cells, normal lymphoid cells, and malignant lymphoid cells in animals show markedly different patterns of distribution, which could have bearing on investigations of mechanisms of metastasis. In vivo human studies also have evaluated the migration patterns of lymphoid cells from patients with chronic lymphocytic leukemia and well-differentiated lymphoma, showing very different migrating behavior between these two polarities of a similar disease. These types of studies, while initially phenomenonologic, may provide a basis for a better understanding of these diseases. There are concerns about the use of an isotope such as indium-111 for the labeling of long-lived cells such as lymphocytes. Laboratory studies have demonstrated impaired cell function at high concentrations of radioactivity. Some workers have expressed concern about long-term changes in cells that recirculate. Others cite precedents of other long-term uses of isotopes, therapeutically, without detrimental effects. These concerns continue to be investigated. Finally, an area of much interest in the use of indium-111 is the labeling of granulocytes. This technique has been useful diagnostically, to localize infections. The major value in patients with malignancy, primarily with hematologic malignancies, is to evaluate the potential benefit of granulocyte transfusions. Many of these patients develop prolonged granulocytopenia and become infected, and granulocyte transfusions may become a therapeutic consideration.(ABSTRACT TRUNCATED AT 400 WORDS)

Agranulocytosis↗

PubMed2001

Swedish teenagers' attitudes toward the emergency contraceptive pill.

PURPOSE: To explore knowledge, attitudes toward, and experience with, the emergency contraceptive pill (ECP) among teenagers in Sweden. METHODS: A questionnaire with 23 questions concerning the students' demographics, knowledge of, attitudes toward, and experience of the ECP was delivered to a random sample of 20 classes in senior high school in two medium-sized cities in Sweden. The participation rate was 100% (n = 408). Differences in responses between teenagers in the two cities, boys and girls, theoretical and practical classes, or native Swedish and immigrant teenagers were calculated with the Chi-square test. RESULTS: The mean age was 16.5 years. Almost half (45.4%) of the teenagers had had sexual intercourse and of those, 28.3% stated that they themselves or their partner had used ECP. Four of five teenagers knew about ECP and where to obtain it if necessary. Many teenagers (67.3%) also knew that ECP prevented implantation. The main sources of information about ECP were youth clinics (n = 179) and friends (n = 159). The attitude toward using ECP in an emergency situation was positive, but the teenagers, especially girls, were restrictive as to whether ECP should be available without a prescription. The girls believed ECP could be used much more, and two-thirds of both sexes thought it could lead to negligence with ongoing contraception. Seventy-seven percent of teenagers preferred turning to a youth clinic when in need of ECP. One in four believed that concerns for side effects could deter them from using ECP. CONCLUSIONS: Based on the results in the present study, the importance of counseling in this situation is confirmed. The awareness about ECP was good, but teenagers also expressed concerns about side effects. The girls were more hesitant than the boys about having ECP available over the counter.

Adolescent↗

PubMed1992

Working through conflict with self-destructive preschool children.

This case history charts the treatment of a preschooler who first presented at the age of three years and ten months with aggressive and self-destructive behaviors. During the initial months of treatment, the therapist focused upon establishing a therapeutic alliance with the child in order to evoke a transference reaction. Compelling evidence of the transference in this case occurred in the ninth month of treatment when the therapist told the child that she would be going on vacation. The child, whose own mother had abandoned him several times, responded with uncharacteristic physical and verbal abuse. Although the child engaged in aggressive and self-destructive play enactments almost from the onset of treatment, these behaviors intensified from the fifth month of treatment onwards, as it became evident that he had entered the working-through phase. Aggressive impulses were shown in his manipulation of toys and other objects, and self-destructive episodes emerged in the child's incessant efforts to jump from chairs and tables, as well as in repeated threats to "shoot" himself with a toy gun. The therapist was sensitive to the child's need to continually repeat and gradually modify these behaviors. She permitted their display without exhibiting shock or alarm, but at the same time, expressed concern for the child's safety and reinforced this concern by setting limits on his unacceptable behavior. Gradually, the child's self-destructive and aggressive tendencies abated. Further evidence that the conflict had been worked through was also seen in the child's ability to express a more realistic assessment of his home environment, one which reconciled the conflict between "good" and "bad" impulses. This advancement in perception was demonstrated by the child's verbal recognition that while his mother was capable of doing "bad" things, she was still his mother and he loved her. Prior to the termination of treatment, both the child's grandmother and teachers reported significant improvement in the child's behavior and linguistic abilities.

Child, Preschool↗

PubMed1999

Abused women's concerns about safety and the therapeutic environment during psychiatric hospitalization.

The purposes of this study were to identify the concerns of women who have a history of abuse regarding safety and the inpatient environment during psychiatric hospitalization, and to identify environmental changes they would like to see. A qualitative design was used to explore the women's concerns through semi-structured interviews. Instruments measuring sexual and physical abuse were administered. Of the 20 women recruited from 3 hospitals, 18 reported a history of sexual and/or physical abuse. One investigator interviewed the participants and one acted as recorder. After each interview, a list of identified concerns was generated; these concerns were raised in the next interview if not spontaneously brought up by the participant. Seventeen women reported feeling unsafe in mixed-gender units and said they would prefer segregated areas for programming and meals; 16 expressed concerns about nighttime routines and the traditional practices of restricting medications and contact with staff at night; 15 considered primary nursing extremely important to feeling understood and safe. The participants said they wanted to be heard and to be included in decision-making.

Adult↗

PubMed2002

[Study on the effects of telephone counseling for family caregivers of demented patients].

PURPOSE: The purposes of this study were to clarify the impact of telephone counseling on the actual state of family caregivers of demented patients, and to investigate strategies of public health care for such caregivers. METHODS: We classified 206 counseling cases, including 103 cases in 1999 and 103 cases through mid-2000, using several checklists, and analyzed date with the chi 2 test. RESULTS: 1) The most common symptom of demented patients was "forgetfulness." (106 cases) 2) 87 caregivers (42.2%) lived separately from demented patients, and in 60 cases the caregivers were daughters. 3) 104 caregivers suffered from stress because of caregiving difficulties, 89 (43.2%) having "emotional difficulties in caregiving," 33 (16.0%) "social difficulties with caregiving," 28 (13.6%) "physical difficulties with caregiving," and 8 (3.9%) "financial difficulties." While 102 caregivers (49.5%) reported no caregiving difficulties. 42 (40.4%) belonged to more than two of the listed categories. 4) The greatest concern of caregivers was "how to care for senile patients' mental symptoms." followed by "whether suffering from dementia" in 36 cases, "how to use welfare services" in 35, "whether the doctor should be consulted" in 30, and "expression of emotion" in 30 cases. The caregivers for whom "expression of emotion was an issue" had emotional, social and physical caregiving difficulties, prompting the contact for telephone counseling. 5) Public health nurses who had been working for more than 10 years tended to deal with the caregivers' "emotional caregiving difficulties" (P = 0.05). There were no differences regarding other items. CONCLUSIONS: 1) The results suggest that living apart, especially for daughters, has an effect on caregiving with senile patients if the number of family caregivers is reduced. In the future, we should consider ways to support families living apart from senile patients. 2) The results also reveal that caregivers of senile patients have emotional, social and physical caregiving difficulties. Therefore, a necessity for support of caregivers' emotional and physical health maintenance, and provision of community education is indicated. 3) Caregivers can talk more freely on the telephone than face-to-face, and get help when senile patients' symptoms are in the early stages. Therefore, it is possible to mitigate caregiving difficulties by intervening in their problems before these become serious and entrenched. 4) Telephone counseling gives caregivers the opportunity to express their emotions. Therefore, it can be expected to mitigate caregiving difficulties through appropriate targets of their expressed concerns.

Aged↗

PubMed2000

The last resort would be to go to the GP'. Understanding the perceptions and use of general practitioner services among people with HIV/AIDS.

In England and Wales, departments of Genito-Urinary Medicine have led the clinical response to HIV infection and AIDS (HIV/AIDS). They provide an open-access self-referral service on a basis of strict confidentiality. People with HIV/AIDS have been found to be reluctant to involve their general practitioner (GP) in their care. Previous research has not investigated their decisions about service use in the context of their broader strategies for coping with the multiple psychological and social challenges, which are posed by HIV/AIDS as a chronic, stigmatised condition. We report a depth-interview study of twenty people with HIV/AIDS in a low-prevalence nonmetropolitan urban area of England. Their health care choices were products of complex judgements. Five concerns predominated: expertise, security, rights to care, confidentiality and the maintenance of normality. Transfer to GP care signified a transition from essential wellness to essential illness and represented a loss of biographical continuity. Their other concerns express problems of information management, which are universal features of stigmatising conditions. These may be heightened in the case of locally provided services, where any leakage of discrediting information is likely to impact directly on everyday life. These concerns should be understood and respected in policy initiatives to develop services.

Confidentiality↗