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PubMed2000

Utilization of empirically supported psychotherapy treatments for individuals with eating disorders: A survey of psychologists.

OBJECTIVE: The purpose of this study was to assess the primary methods used by psychotherapists in treating individuals with eating disorders and to determine the extent to which certain empirically supported psychotherapies (i.e., cognitive behavioral therapy [CBT] and interpersonal psychotherapy [IPT]) are used in clinical settings. METHOD: Surveys developed for this study were sent to 500 psychologists randomly selected from a list of all licensed doctoral-level psychologists in an upper midwestern state. RESULTS: Despite the findings that CBT techniques were reported to be frequently used, most respondents identified something other than CBT or IPT as their primary theoretical approach. In addition, the majority of respondents indicated not having received training in the use of manual-based, empirically supported treatment approaches for working with individuals with eating disorders, although most reported a desire to obtain such training. CONCLUSIONS: Although commonly referred to as the "treatments of choice" in research literature, manual-based, empirically supported approaches to working with individuals with eating disorders has not received adequate dissemination.

Adolescent↗

PubMed2001

The inheritance of rheumatoid arthritis in Iceland.

OBJECTIVE: Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis. Although there is a large body of evidence suggesting that RA is immune mediated, the etiology remains unresolved. Twin studies have shown disease concordance rates of approximately 15% in monozygotic twins and 4% in dizygotic twins, while the estimated risk ratio for siblings of RA patients ranges from 5 to 8. Our goal was to use genealogic data from Iceland to further investigate the genetic component of RA. METHODS: Data were obtained from a population-based, computerized genealogy database that was developed to examine multigenerational relationships among individuals in the relatively homogeneous population of Iceland. Using an algorithm, the minimum founder test, we calculated the least number of founders required to account for a list of RA patients, and compared it with 1,000 sets of same-sized matched control groups. In addition, we estimated the kinship coefficient and risk ratios for relatives of the RA patients. RESULTS: Several familial clustering tests demonstrated that the RA patients were more related to each other than were the average control set of Icelanders. A significantly fewer number of founders was necessary to account for our patient list than for the random sets of matched controls (P < 0.001), and the average pairwise identity-by-descent sharing was greater among the patients than among the control sets (P < 0.001). In addition, there was an increased risk of RA in first- and second-degree relatives of the patients; e.g., for siblings, the risk ratio was 4.38 (95% confidence interval 3.26-5.67), and for uncles/aunts, the risk ratio was 1.95 (95% confidence interval 1.52-2.43). CONCLUSION: The familial component of RA is shown to extend beyond the nuclear family, thus providing stronger evidence for a significant genetic component to RA.

Algorithms↗

PubMed2007

Statins and risk of cancer: a systematic review and metaanalysis.

We conducted a systematic review of the association between HMG-CoA reductase inhibitor (statin) use and cancer risk. We searched MEDLINE, EMBASE, Web of Science, ISI Proceedings and BIOSIS Previews bibliographic databases, electronic trials registers and reference lists for potentially eligible randomized trials and observational studies. Thirty-eight individual studies (26 randomized trials involving 103,573 participants and 12 observational studies with 826,854 participants) were included. Median follow-up was 3.6 and 6.2 years for trials and observational studies, respectively. In metaanalyses of randomized trials, there was no evidence that statin therapy was associated with incidence of all-cancers (26 trials; pooled risk ratio = 1.00; 95% CI 0.95-1.05; I(2) = 0%) or the following site-specific cancers: breast (7 trials; risk ratio = 1.01; 0.79-1.30; I(2) = 43%), prostate (4 trials; risk ratio = 1.00; 0.85-1.17; I(2) = 0%), colorectum (9 trials; risk ratio = 1.02; 0.89-1.16; I(2) = 0%), lung (9 trials; risk ratio = 0.96; 0.84-1.09; I(2) = 0%), genito-urinary (5 trials; risk ratio = 0.95; 0.83-1.09; I(2) = 0%), melanoma (4 trials; risk ratio = 0.86; 0.62-1.20; I(2) = 17%) or gastric (1 trial; risk ratio = 1.00; 0.35-2.85). There was no evidence of differential effects by length of follow-up, statin type (lipophilic vs. lipophobic) or potency. Trial results were generally consistent with observational studies. We conclude that statin use is not associated with short-term cancer risk, but longer-latency effects remain possible.

Humans↗

PubMed1984

Prospective study on the relationship between cervical neoplasia and herpes simplex type-2 virus. I. Epidemiological characteristics.

To determine the risk associated with previous herpes simplex type-2 (HSV-2) infection and possibly other virus infections, a prospective study of cervical neoplasia in more than 10,000 women was performed in the 1975-1983 period. The subjects were selected at random from an alphabetical listing of eligible women living in one district of Prague. At enrollment colposcopy and cervical cytology were performed, a blood sample was taken and data regarding education, socio-economic status, personal habits and sexual and reproduction-associated attributes were obtained from each woman. A total of 10,683 women were enrolled; a complete set of data was obtained in 10,389 women. Women with normal or non-significant findings were invited for further colposcopical and cytological investigations after 2 years and 4 years, the other women were followed at 3- to 6-monthly intervals. In women with highly significant findings, histological investigation was performed. The total of 150 cases of moderate to severe dysplasia (i.e. cervical intraepithelial neoplasia, grade II, CIN II), 83 cases of carcinoma in situ (CIN III) and 21 cases of invasive carcinoma (INCA) were detected. More than 60% of the patients were ill at enrollment, the other cases developed in subjects with originally slightly suspicious (27 CIN II, 17 CIN III, 3 INCA) or negative findings (30 CIN II, 12 CIN III, 3 INCA). Analysis of the data indicated significantly positive correlation of one or more of these clinical conditions with a number of sexual and reproduction-related attributes of which early age at first intercourse was most consistent. Among the other attributes, the smoking habit was associated with the highest risk of developing the disease. A negative correlation of cervical neoplasia with several attributes was demonstrated; of these diathermoelectrocoagulation of the ectopic epithelium and transformation zone of cervix was the most important single protective factor. On the basis of these findings, control subjects were selected for serological studies.

Adult↗

PubMed1994

Primary care physicians and the cost of drugs: a study of prescribing practices based on recognition and information sources.

Rapidly inflating health care costs limit patient care, and prescription drug costs constitute a major component of this expenditure. This study examines attitudes toward and knowledge of prescription drug costs of primary care physicians. Access to information about drug costs and implications for medical education are also explored. A questionnaire survey was sent to 137 internists, family, and general practitioners, randomly selected from a list provided by the Ohio State Medical Board. The questionnaire elicited information on demographic characteristics of respondents, influence of drug costs on prescribing habits, actual knowledge of prices of the 20 most commonly used drugs, attitudes toward generic drug use, sources of information on costs, and desire for emphasis on drug costs in medical education. Responding physicians indicated consideration of drug costs in therapeutic decisions, but lacked information and often made inaccurate assumptions about costs of drugs prescribed. Most felt they could provide better service and reduce costs if information about drug prices was readily available. Most agreed medical education should address drug costs. Drug cost estimates varied widely; correct responses ranged from 9% to 53%. No statistically significant pattern emerged regarding demographics of respondents or information sources used. Primary care physicians consider drug costs important and realize that cost-effective prescribing may lower health care costs. However, because physician knowledge of drug costs is inadequate and costs are not readily accessible, implications for better physician education and improved abscess are substantial.

Drug Costs↗

PubMed1994

A case-control study of Parkinson's disease in a horticultural region of British Columbia.

We compared personal histories of 127 cases and 245 controls to identify possible environmental risk factors for idiopathic parkinsonism (IP). Of our controls, 121 had cardiac disease (CD) and 124 were randomly selected from electoral lists (voters). Using logistic regression and adjusting for sex and age, we ran separate analyses: IP versus CD and IP versus voters. A full occupational history was collected, as was known contact with all pesticides associated with the tree fruit sector of the agricultural industry. We found a significant association between IP and having had an occupation in which exposure through handling or directly contacting pesticides was probable, but no specific chemicals were associated with IP. We conclude that although occupations involving the use of agricultural chemicals may predispose to the development of IP, it seems likely that the pathogenesis is multifactorial rather than related to a specific agent.

Aged↗

PubMed2000

Nutrition knowledge and food intake.

In many studies, correlations between nutrition knowledge and dietary behaviour have failed to reach statistical significance, leading researchers to question the relevance of nutrition knowledge to food choice, and the value of nutrition education campaigns. This study aimed to investigate the relationship between knowledge and intake of fat, fruit and vegetables using a well-validated measure of nutrition knowledge. The study was a postal survey, using 1040 adult participants selected at random from General Practitioners' lists in England. Nutrition knowledge and food intake followed the expected demographic patterns. Knowledge was significantly associated with healthy eating, and the effect persisted after controlling for demographic variables. Logistic regression showed that respondents in the highest quintile for knowledge were almost 25 times more likely to meet current recommendations for fruit, vegetable and fat intake than those in the lowest quintile. Nutrition knowledge was shown to be a partial mediator of the socio-demographic variation in intake, especially for fruit and vegetables. This demonstrates the value of using more sophisticated statistical techniques to investigate associations between knowledge and food intake and indicates that knowledge is an important factor in explaining variations in food choice. The results support the likely value of including nutrition knowledge as a target for health education campaigns aimed at promoting healthy eating.

Adolescent↗

PubMed1994

Survey of the attitudes to management of acute pyelonephritis in children. GEP.

Although urinary tract infections are of particular concern in young children, as they may lead to permanent health problems, there is no consensus for their acute management. We carried out a mailed survey of 455 general practitioners, 143 paediatricians (randomly selected from a list of physicians in the Rhône-Alpes region of France) and 45 paediatric nephrologists (all the members of the "Société de Néphrologie Pédiatrique") to examine their attitudes to the management of a fictitious case of a young girl with symptoms indicative of acute pyelonephritis. The responses given by the general practitioners and paediatricians were similar, whereas those given by the paediatric were similar, whereas those given by the paediatric nephrologists were often different, for example 20% of the general practitioners and 17% of the paediatricians said they would hospitalize the child, compared with 69% of the paediatric nephrologists. The majority of the general practitioners and paediatricians favoured single oral antibiotic therapy, whereas the paediatric nephrologists were split between single and combined antibiotic therapy, but preferred intravenous administration. The most frequently prescribed drug was a penicillin. The heterogeneity of the results from this survey stresses the need for the assessment of various strategies in terms of their efficacy for preventing kidney scarring and their risk-to-benefit ratios in well-designed randomised controlled trials.

Acute Disease↗

PubMed1986

Faecal occult blood screening of first degree relatives of patients with colorectal cancer.

A full first-degree family history was taken from 161 patients with colorectal cancer (Group 1) and from a group of 203 subjects previously investigated and found to have no colorectal neoplasia (Group 2). Twenty-six (16%) of patients in Group 1 compared with 23 (11%) in Group 2 had at least 1 first-degree relative with colorectal cancer (p = 0.23). Contact of first-degree relatives was possible in 123 patients in Group 1. Of these, 4 were members of 'cancer families' with 26 available first-degree relatives. The remaining 119 patients had 341 contactable first-degree relatives. They were approached by post and offered faecal occult blood (FOB) screening. One hundred and sixty-two (47%) completed FOB tests of which 12 (8%) were positive. Investigation of these individuals detected 4 adenomas. In the subgroup of 20 patients with 1 or 2 first-degree relatives with colorectal cancer, there were 78 potential relatives of whom 71 were contacted. Thirty-two (45%) FOB tests yielded 1 positive found to have an adenoma. A control group of 332 individuals was selected randomly from general practitioners' lists and offered FOB testing. One hundred and fifty-five (47%) complied of whom 7 (4.5%) were positive. Investigation yielded 1 adenoma. Thirteen of the 26 relatives of the 4 'cancer family' patients were investigated by endoscopy and 2 (15%) had large polyps detected. Although there may be an increased risk of colorectal neoplasia in first-degree relatives of patients with sporadic colorectal cancer, this risk is not sufficiently high to justify separate screening.

Adult↗

PubMed1992

Doctors' perception of pertinent information. Results of a survey of a random sample of French general practitioners. GEP (Groupe d'Etude de la Prescription).

The results of a survey aimed at investigating which tools prescribers have at hand to help them to identify pertinent information from a background of "noise" are reported. A questionnaire was sent to 250 general practitioners randomly selected from a list of those practicing in the Rhône-Alpes region in France, of whom 117 (46.8%) replied. The questionnaire consisted of three sections, the first explored how they dealt with intermediate and clinical outcomes in trials, the second presented a series of statements to identify what would make them prescribe a new drug, and the third looked at their knowledge of therapy assessment methodology. It was found that most general practitioners had not been trained to identify the most salient information for selecting the best treatment. This implies that both medical students and qualified doctors should be taught to recognise pertinent information.

Clinical Protocols↗

PubMedDate not supplied

Epidemiology of endemic cretinism in Sikkim, India.

A survey was conducted in Sikkim to determine the prevalence of endemic cretinism in the state. A household was the basic sampling unit. Villages were selected randomly in the state and from these households were selected randomly using the electoral lists. All members of the households were studied. Total of 17,837 individuals from 3,197 households from 249 villages were studied. There were 8,953 males and 8,884 females. A total of 617 endemic cretins were identified: 316 males and 301 females. The overall prevalence of endemic cretinism was 3.46%: (males 3.53% and females 3.39%). Endemic cretinism was observed in 194 (77.9%) villages studied. Neurological cretinism was the predominant form (98.7%). Deaf-mutism was the most salient neurological feature seen in 472 (76.5%) subjects. Motor system examination revealed proximal spasticity and brisk reflexes, both more marked in the lower limbs. Recording of daily life activities revealed 14.1% of the cretins to be totally dependent and another 23% to be requiring considerable assistance for their daily routine activities. The overall prevalence of goitre found in this survey was 54%. Urinary iodine concentration was estimated from a representative sample of the population; mean 4 micrograms/dl (SD 2.68). This survey shows the existence of severe iodine deficiency in Sikkim.

Adolescent↗

PubMed2000

Estimation of the prevalence of low bone density in Canadian women and men using a population-specific DXA reference standard: the Canadian Multicentre Osteoporosis Study (CaMos).

The Canadian Multicentre Osteoporosis Study (CaMos) is a prospective cohort study which will measure the incidence and prevalence of osteoporosis and fractures, and the effect of putative risk factors, in a random sample of 10,061 women and men aged > or = 25 years recruited in approximately equal numbers in nine centers across Canada. In this paper we report the results of studies to establish peak bone mass (PBM) which would be appropriate reference data for use in Canada. These reference data are used to estimate the prevalence of osteoporosis and osteopenia in Canadian women and men aged > or = 50 years. Participants were recruited via randomly selected household telephone listings. Bone mineral density (BMD) of the lumbar spine and femoral neck were measured by dual-energy X-ray absorptiometry using Hologic QDR 1000 or 2000 or Lunar DPX densitometers. BMD results for lumbar spine and femoral neck were converted to a Hologic base. BMD of the lumbar spine in 578 women and 467 men was constant to age 39 years giving a PBM of 1.042 +/- 0.121 g/cm2 for women and 1.058 +/- 0.127 g/cm2 for men. BMD at the femoral neck declined from age 29 years. The mean femoral neck BMD between 25 and 29 years was taken as PBM and was found to be 0.857 +/- 0.125 g/cm2 for women and 0.910 +/- 0.125 g/cm2 for men. Prevalence of osteoporosis, as defined by WHO criteria, in Canadian women aged > or = 50 years was 12.1% at the lumbar spine and 7.9% at the femoral neck with a combined prevalence of 15.8%. In men it was 2.9% at the lumbar spine and 4.8% at the femoral neck with a combined prevalence of 6.6%.

Absorptiometry, Photon↗

PubMed2006

Development of a questionnaire to assess dentists' knowledge, opinion, education resources, physician cooperation, and clinical practice regarding obstructive sleep apnea (OSAQ-D).

This report describes the construction of a questionnaire to assess dentists' knowledge, opinion, education resources, clinical practice, and physician cooperation regarding obstructive sleep apnea (OSA) based on the PRECEDE-PROCEED model. The scale development included such steps as generating an item pool, expert review of initial item pool, pilot test, and final test. After the expert review, a total of 78 items made up the pilot test instrument including five demographic (age, year graduated from dental school, gender, years in practice dentistry, and membership of the Academy of Dental Sleep Medicine), 22 knowledge, 15 opinion, 11 education resources, 10 physician cooperation, and 15 clinical practice questions. The pilot test samples were third or fourth year dental school students and dentists from the University of Florida. Nineteen dentists and 26 students returned the survey. Based on the results of item analysis and content review, a total of 70 questions were remained for the final test. The final questionnaire was mailed to 450 dentists who were randomly selected from a list of 10,838 dentists with a Florida license and also delivered to 65 dental school students and postgraduates of the University of Florida. A total of 163 participants including 112 dentists and 51 students and postgraduates responded. The average age was 42.87 years, and most of them are males (77.8%). Only one dentist was a current member of the Academy of Dental Sleep Medicine. The item analysis was performed for five scales. 8 items with poor item difficulty, lower item discrimination, or having big effect on the item consistency were removed from the instrument, and 62 questions were kept for the further evaluation. The reliability coefficient alpha of knowledge, opinion, education resources, physician cooperation, and clinical practice scales was 0.77, 0.86, 0.67, 0.75, and 0.86, respectively. According to the standard from DeVellis (Scale development: theory and applications, Sage, Thousand Oaks, 2003), they were acceptable, or respectable, or even very good.

Adult↗

PubMed1992

An extension of the acquaintanceship procedure in family studies of mental disorder.

The acquaintanceship procedure is a method for obtaining a control group matched to relatives of probands on demographic variables. Relatives are asked to name six acquaintances who are the same gender, and who are about the same age and social class as themselves. An acquaintance is randomly selected from this list and contacted for recruitment. Rates of mental disorder in this group are assumed to approximate general population rates in a group with these demographic characteristics. This report focuses on an extension of the acquaintanceship procedure in which "super-normal" controls are used in a family study design. Two questions were addressed: (1) Does the acquaintance group (n = 166), as a whole, show a higher rate of illness than the relatives of acquaintances with no mental disorder (n = 129)? (2) Is there a relationship between mental disorder in acquaintances and in providers of acquaintance names? The prevalence of mental illness was significantly greater among acquaintances compared to relatives of "never ill" acquaintances. There was no evidence of assortative selection. We concluded that using the relatives of well acquaintances is a cost-effective control selection methodology which maximizes the detection of intergenerational transmission in family studies of mental disorder.

Adult↗

PubMed1990

Memory for the temporal order of events in patients with frontal lobe lesions and amnesic patients.

Patients with frontal lobe lesions, amnesic patients with Korsakoff's syndrome, other (non-Korsakoff) amnesic patients, and control subjects were given tests of memory for temporal order. In the first experiment, subjects were presented with a list of 15 words and then asked to reproduce the list order from a random array of the words. In the second experiment, they were asked to arrange in chronological order a random display of 15 factual events that occurred between 1941 and 1985. In both experiments, patients with frontal lobe lesions were impaired in placing the items in the correct temporal order, despite normal item memory (i.e. normal recall and recognition memory for the words and facts). The two groups of amnesic patients exhibited impaired memory for temporal order as well as impaired item memory. Patients with Korsakoff's syndrome exhibited poorer temporal order memory than the other amnesic patients, despite similar levels of item memory. These findings demonstrate that patients with frontal lobe lesions have difficulty organizing information temporally. Patients with Korsakoff's syndrome, who have both diencephalic and frontal damage, have memory impairment together with a disproportionate deficit in memory for temporal order.

Alcohol Amnestic Disorder↗

PubMed2003

[Phoning study about postoperative practice and application of non-invasive ventilation].

OBJECTIVES: Incidence and management of positive pressure non-invasive ventilation (NIV) in intensive care unit (ICU) in the postoperative period. STUDY DESIGN: Phoning study performed on September 2001 in 60 ICU of south of France (public: 47, private: 13, medical: 11, surgical: 20, medical-surgical: 29), which were randomized from a national list. RESULTS: NIV was used currently on 55% and casually on 35% of the units. Ten percent of ICU, which never use NIV, were surgical on 83% with a lower number of bed (7 +/- 3 vs. 12 +/- 5). The most often humidification device used was a Heat and Moisture Exchanger (HME) (52%), a Heated Humidifier (HH) (26%), either (4%) and none device (19%). ICU that never used a humidification device used a home ventilator in 30%. Ventilators used were more often heavy ICU ventilators (80%) with a facial mask (89%). NIV was performed exclusively by physicians in 15% of cases and in collaboration after the first application in 71% of cases. Sixty-nine % of intensivists used NIV as a first choice for the treatment of acute postoperative respiratory failure and 54% of intensivists for the treatment of postoperative atelectasis. CONCLUSION: Use of NIV increases in ICU, particularly in surgical units. Practices are different between ICU. An HME is the most frequently humidification device used.

Data Collection↗

PubMed2006

Prevalence of hepatitis B among Afghan refugees living in Balochistan, Pakistan.

OBJECTIVE: Continued civil war and political instability in Afghanistan have lead to a huge influx of refugees into the neighboring provinces in Pakistan. This study was conducted to estimate seroprevalence of hepatitis B and to identify potential risk factors for hepatitis B virus (HBV) transmission among the refugees living in the camps of Balochistan Province, Pakistan. METHODS: A cross-sectional survey of hepatitis B surface antigen (HBsAg) was conducted during October 2003. We obtained the registration list to select families randomly from the refugee camps. A husband, wife and one of their children, selected at random, were enrolled in the study. Study subjects with positive laboratory results for HBsAg were compared with those who were negative for HBsAg. RESULTS: Field workers interviewed 301 families with a total of 903 study subjects. Blood specimens of 75 study subjects (8.3%, 95% CI 6.6-10.3) were positive for HBsAg. There were 37 husbands (12.3%, 95% CI 7.2-14.4) and 21 wives (7.0%, 95% CI 4.5-10.6) positive for HBsAg. Out of 301 children, 17 (5.6%, 95% CI 3.4-9.1) were positive for HBsAg. Receiving more than ten injections during the previous year increased the risk of HBV infection (OR 3.5, 95% CI 1.8-6.7). A child positive for HBsAg was more likely to have a positive parent compared to an HBsAg negative child (OR 5.7, 95% CI 2.0-16.5). CONCLUSION: Hepatitis B is highly endemic among Afghan refugees living in these camps. Unsafe injection practices will continue to cause a steady increase in the magnitude of this health problem until appropriate control measures are taken. The possibility of mother-to-child transmission underscores the need to include vaccination against hepatitis B as part of routine immunization in this population.

Adolescent↗

PubMed2006

Modeling in biomedical informatics: an exploratory analysis part 2.

OBJECTIVE: Modeling is a significant part of research, education and practice in biomedical and health informatics. Our objective was to explore which types of models of processes are used in current biomedical/health informatics research, as reflected in publications of scientific journals in this field. Also, the implications for medical informatics curricula were investigated. METHODS: Retrospective, prolective observational study on recent publications of the two official journals of the International Medical Informatics Association (IMIA), the International Journal of Medical Informatics (IJMI) and Methods of Information in Medicine (MIM). All publications of the years 2004 and 2005 from these journals were indexed according to a given list of model types. Random samples out of these publications were analysed in more depth. RESULTS: Three hundred and eighty-four publications have been analysed, 190 of IJMI and 194 of MIM. For publications in special issues (121 in IJMI) and special topics (132 in MIM) we found differences between theme-centered and conference-centered special issues/special topics (SIT) publications. In particular, we could observe a high variation between modeling in publications of theme-centered SITs. It became obvious that often sound formal knowledge as well as a strong engineering background is needed for carrying out this type of research. Usually, this knowledge and the related skills can be best provided in consecutive B.Sc. and M.Sc. programs in medical informatics (respectively, health informatics, biomedical informatics). If the focus should be primarily on health information systems and evaluation this can be offered in a M.Sc. program in medical informatics. CONCLUSIONS: In analysing the 384 publications it became obvious that modeling continues to be a major task in research, education and practice in biomedical and health informatics. Knowledge and skills on a broad range of model types are needed in biomedical/health informatics.

Bibliometrics↗