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PubMed1995

Predictive testing for Huntington's disease: risk perception, reasons for testing and psychological profile of test applicants.

In the Center for Human Genetics in Leuven, predictive DNA-testing for Huntington's disease is available as a clinical service since November 1987, initially by DNA-linkage and since mid 1993 by direct mutation analysis. The multidisciplinary approach as well as the detailed test protocol are described. The present paper gives a sociodemographic description of the test applicants, their subjective evaluation of the risk and their motives for requesting the predictive test. Major attention is paid to the personality profile of the applicants who proceeded with testing. Psychometric testing revealed that this group of test applicants did not differ significantly from the general population for most characteristics and even had a number of more positive characteristics e.g. a higher ego-strength. The latter may reflect a self-selection of a more resourceful and emotionally healthier subgroup of at-risk persons. Nevertheless psychological evaluation also has identified a number of applicants with extremely high anxiety levels and other problems, who needed extra pretest and posttest counseling. The relatively high number of withdrawals from the test programme is another indication of the importance of adequate pretest counseling.

Adult↗

PubMed1995

Standardization of glycohemoglobin results and reference values in whole blood studied in 103 laboratories using 20 methods.

We investigated the effect of calibration with lyophilized calibrators on whole-blood glycohemoglobin (glyHb) results. One hundred three laboratories, using 20 different methods, determined glyHb in two lyophilized calibrators and two whole-blood samples. For whole-blood samples with low (5%) and high (9%) glyHb percentages, respectively, calibration decreased overall interlaboratory variation (CV) from 16% to 9% and from 11% to 6% and decreased intermethod variation from 14% to 6% and from 12% to 5%. Forty-seven laboratories, using 14 different methods, determined mean glyHb percentages in self-selected groups of 10 nondiabetic volunteers each. With calibration their overall mean (2SD) was 5.0% (0.5%), very close to the 5.0% (0.3%) derived from the reference method used in the Diabetes Control and Complications Trial. In both experiments the Abbott IMx and Vision showed deviating results. We conclude that, irrespective of the analytical method used, calibration enables standardization of glyHb results, reference values, and interpretation criteria.

Calibration↗

PubMed1994

Effect of carbohydrate ingestion on performance of non-fasted cyclists during a simulated 80-mile time trial.

The purpose of this study was to determine the effect of carbohydrate supplementation on finishing time of a realistically simulated 80 mile bicycle time trial. Fourteen trained cyclists pedalled at self-selected pace on their own bicycles on windload simulators. Two trials were performed one week apart. Each trial was preceded by two days of prescribed diet, with a final feeding 3-4 h prior to exercise. Following each 10 mile segment, subjects ingested either a non-caloric placebo (PL) or the carbohydrate maltodextrin supplement (MD; 5% maltodextrin +2% fructose) at dosage of 0.25 g.kg-1 body weight (mean intake rate, total: 37 g.h-1, 148 g) in a double blind, counter-balanced design. Mean (+/- SEM) finishing times were faster by 5% with MD (241.0 +/- 2.1 minutes versus 253.2 +/- 2.1 minutes), p < 0.05. With MD, serum glucose levels rose sharply after 40 miles and were significantly higher than PL (p < 0.05). Final glucose values were 6.0 +/- 0.2 mmol.l-1 and 4.1 +/- 0.2 mmol.l-1 for MD and PL, respectively. With MD, free fatty acid levels were significantly lower (p < 0.05), and riders sustained higher average intensity over the entire distance. At the finish, intensities were 64.7 +/- 1.9% VO2max and 55.3 +/- 1.9% VO2max for GP and PL, respectively. Mean carbohydrate oxidation was significantly higher (p < 0.05) for MD, 2.01 +/- 0.2 g.min-1 and 1.64 +/- 0.2 g.min-1 for MD and PL, respectively. These data show that ingestion of MD, during ultraendurance exercise, in comparison to PL, decreases the time to finish a self-paced bicycle time trial.

Adult↗

PubMed1994

[Accommodation function and its clinical evaluation].

One subjective examination in accommodation, we found fundamental fault in the self-selection of clear vision against stimulus target and the time control of examination. On the other hand, it was difficult to objectively judge clear vision or check subjects consciousness for the tests. In this study, we made a trial instrument called new accommodometer which was able to confirm the time limit for clear vision, and measured response time for accommodation in constriction and relaxation. Young healthy subjects could obtain clear vision within 0.5 seconds on the new accommodometer, but this took over 0.8 seconds with scattered distribution on an accommodopolyrecorder. The required time for clear vision tended to increase in diabetic cases, and also in pseudophakia corrected bifocal lenses, over 0.6 seconds. We analyzed the form of accommodative response under clear vision, using on infrared optometer with stimulus-targets prepared outside, meanwhile changing the size of targets and amplitude of accommodative stimulus. When we compare these results to those of the new accommodometer, it will be easily seen that accommodative clear vision may be acquired in a rapid response stage after a latent period of constrictive accommodation, and usually with a steady running time under 4 D stimulus. For getting clear vision in far and near objects simultaneously, in pseudophakia, moderate astigmatism plays an important part, but it tends to cause deteriorated quality of clear vision. In diffractive intraocular lenses, we can find patients who are able to see using arbitrarily both areas, the refractive or diffractive part. We analyzed microfluctuation of accommodation by the maximum entropy method, and one of the typical cases revealed three-dimensional drawings reconstructed from it. In analyzing the spectral power of young healthy subjects, the response waves tend to increase in blurred conditions for targets.

Accommodation, Ocular↗

PubMed1994

Exercise reduces fat selection in female Sprague-Dawley rats.

This study investigates the relationship between exercise and dietary macronutrient selection. Female Sprague-Dawley rats (5 months old) were placed on a macronutrient self-selection diet for 15 wk. Three food cups, each containing a separate vitamin and mineral supplemented macronutrient, i.e., fat, carbohydrate, or protein, were placed in the cage. Animals were either sedentary (Sed) or treadmill exercised (Ex) at 20 m.min-1, 60 min.d-1, for 6 d.wk-1. Cumulative daily energy and macronutrient intake were determined during this period. Energy intake was not different between Sed and Ex, 211.4 vs 213.5 kjoules.d-1, respectively. However, macronutrient intake differed with less fat eaten for Ex than Sed (81.5 kjoules and 38% for Ex; 114.0 kjoules and 47% for Sed). Carbohydrate and protein intake did not differ significantly between groups. Fifteen weeks of exercise training decreased dietary fat selection, but daily energy intake was not affected.

Animals↗

PubMed1993

Serum lipid concentrations in the Koki community: a preliminary report.

Serum cholesterol and triglyceride concentrations were estimated in a self-selected sample of 9% of the adults over the age of 18 years in the urban community of Koki in Port Moresby, in which there is a high prevalence of diabetes. There were 84 males and 58 females in the sample. The mean age was 32.6 years, with the males significantly older than the females. Mean cholesterol and triglyceride levels were 4.7 mmol/l and 1.2 mmol/l respectively, and significant sex differences were observed, with males demonstrating higher levels, even in the younger age group. A high prevalence of obesity was observed in both males (40%) and females (55%). The prevalence of hyperlipidaemia was higher in males than females and was also more frequently observed in obese than non-obese subjects of either sex. A significant number (25%) of young subjects (18-30 years) exhibited serum lipid concentrations in excess of recommended levels. Our results suggest that, in contrast to previous reports, elevated serum cholesterol and triglyceride levels are present in this community, and may represent an increased risk for the development of ischaemic heart disease.

Adolescent↗

PubMed1994

An investigation into the management of patients with erection problems in general practice.

In a study on the diagnosis and treatment of erectile dysfunction (ED) in general practice, a self-selected sample of 90 general practitioners (GPs) (76 males, 14 females) from a predominantly urban population of 525 GPs were interviewed. It appeared that 59% would not actively interrogate a patient when an erection problem was suspected, either because of lack of time or lack of competence. A specific strategy for the management of erection problems was reported by 60% of the GPs. In practice, most GPs treated their own patients. About 60% of the GPs tried to keep up to date through reading and postgraduate courses. Impediments acknowledged in the interaction with patients were the experience of lack of knowledge and skills (63%) and emotional inhibitions to detailed questioning (49%). None of the GPs in this study had as yet utilized more recent treatment methods such as intracavernous drug injections and vacuum constriction devices. It is recommended that in postgraduate training courses GPs receive practical training in proper history taking and in the application of modern treatment methods.

Adult↗

PubMed1994

Metabolic and hemodynamic responses to walking with hand weights in older individuals.

The purpose of this study was to examine metabolic and hemodynamic responses of older adults (age = 66.2 +/- 5.6 yr) to walking with hand-held weights (HHW). Nineteen volunteers participated in eight randomly assigned, 10-min, submaximal, self-selected constant speed (CSP) or constant heart rate (CHR) exercise bouts using the following HHW conditions: no weight, W0; 0.45 kg, W1; 1.36 kg, W3; 2.27 kg, W5. Oxygen uptake (VO2) was recorded every 30 s, heart rate (HR) each minute, and blood pressure (BP) every 2 min. Mean values for the last 5 min of exercise were analyzed using repeated measures ANOVA. Contrast comparison tests were used to determine differences among means. During CS, significant differences between means (P < or = 0.05) existed for: VO2 (W0, W1 < W3, W5); HR, SBP, DBP, SBPmax, DBPmax (W0 < W1, W3, W5); HR, rate pressure product (RPP), DBPmax (W1 < W5); SBP, DBP, SBPmax, RPP (W3 < W5). During CHR, significant differences (P < or = 0.05) between means existed for: SBP, DBP, RPP (W0, W1, W3 < W5); DBP (W0 < W3; W1, W3 < W5). These results indicate that the use of HHW significantly increases metabolic responses at W3 and W5 during CS exercise in older adults, while hemodynamic responses increase significantly across HHW for both CS and CHR. Due to the increases in hemodynamic responses, the use of HHW may be contraindicated for older individuals with suspected or diagnosed cardiovascular disease.

Aged↗

PubMed1994

[Health economic analysis of the effects of offered complementary medical procedures on health insurance].

A randomized trial is being conducted to determine whether the offer of unconventional medicine as a health benefit by the health insurance funds has a substitutional or additional effect on the use of conventional medicine. For this purpose, a stratified random sample of 5000 enrollees of the largest Swiss health insurance fund is receiving, as an experiment group, an insurance supplement for unconventional medicine during the next three years free of charge. The rest of the insured population with comparable health insurance but without coverage of unconventional medicine is the control group. The third group to be examined are insured persons who have already chosen the unconventional health insurance supplement on their own account. Data of inpatient and outpatient costs and use of conventional and unconventional health services will be collected and analyzed. The third group with self-selected insurance supplement for unconventional medicine will be compared systematically with the other two groups. A further random sample of persons from each of the three groups will be interviewed at different points of time about their health perceptions.

Complementary Therapies↗

PubMed1993

Effects of early discharge from hospital after surgery for primary breast cancer.

OBJECTIVE: To evaluate the effects of early discharge from hospital on women being operated on for primary breast cancer. DESIGN: Open study in self-selected patients. SETTING: Karolinska and Sabbatsberg Hospitals, Stockholm. SUBJECTS: 169 consecutive patients operated on for primary breast cancer. MAIN OUTCOME MEASURES: All patients were asked to fill in a questionnaire about their perception of their disease and factors associated with the operation. RESULTS: 118/169 patients participated, and of these 28 (24%) chose early discharge with the drain still in place. They were compared with the 90 patients (76%) who were discharged without a drain. The median stay in hospital for those who chose early discharge was 2 days, and for those who remained in hospital until the drain was removed, 6 days. There were no differences between the groups in type or incidence of complications, and the groups were equally satisfied with their length of hospital stay and their treatment in hospital. Those who opted for early discharge were significantly younger than those who did not (mean SD) 52 (14) compared with 62 (13) years, p = 0.001). CONCLUSION: Early discharge from hospital with the drain still in place after operation for primary breast cancer was not found to be associated with any untoward events.

Age Factors↗

PubMed1993

Personality types of oncology nurses.

Personality type influences the choice of occupation. The breadth of specialty areas within oncology nursing allows for divergent activities and relationships and, thus, the accommodation of different personality characteristics. This exploratory study examined personality types for a convenience sample of oncology nurses predominantly employed in hospitals. According to the personality typology defined by Carl Jung, a person demonstrates a preference among four dimensions, i.e., extraversion/introversion, sensory/intuition, thinking/feeling, and judging/perceiving. The type with the strongest self-selection for these oncology nurses was ISFJ, where feeling is introverted and perception is practical, so that helping others is both a responsibility and a pleasure. The discussion relates the personality types to Jung's theory and their impact in clinical practice. Strengths and weaknesses of each personality type are described.

Adult↗

PubMed1993

Combined mother and baby care: does it meet the needs of families?

Combined mother/baby care is thought to be an effective way to prepare a family for the changing roles and added responsibilities that the arrival of a new baby entails, but few studies have evaluated this care delivery system. Therefore, the postpartum staff at Sudbury General Hospital conducted a post-test control group study design with a self-selected sample of postpartum mothers when the unit was changing from traditional to combined mother/baby care. One hundred and three mothers who received traditional care and 102 who had combined mother/baby care completed a questionnaire to assess perceptions of their own competence and satisfaction with the type of care administered. There were no significant differences between the two study groups. Factors that may have confounded the results include: insufficient time between institution of the program and its evaluation, and the quality of prenatal education received. Multiparous mothers scored higher on self care, infant care, and maternal competence than did primiparous mothers regardless of the care delivery system. Maternal concerns related to immediate needs. Future research should take the differences between primiparas and multiparas into account, and focus on the less immediate needs of mothers.

Adolescent↗

PubMed1993

Comprehensive analysis of energy storing prosthetic feet: Flex Foot and Seattle Foot Versus Standard SACH foot.

This study compared the mechanical and biomechanical functions, metabolic demand, and shock absorption of two dynamic elastic response (DER) prosthetic foot designs with the SACH foot. Nine individuals who had undergone unilateral below knee amputation were studied. Mechanical properties of the feet were related to gait biomechanics. Forefoot compliance is greatest for the Flex Foot and least for the SACH foot, hence, Flex Foot demonstrates (1) the longest midstance phase, (2) the greatest ankle angle range, and (3) greater forward movement of the center of pressure. There was some evidence that the DER feet produced a better push-off. However, neither the self-selected walking speed nor the metabolic rate or efficiency over a spectrum of walking speeds (73 to 120m/min) and running speeds (140 to 200m/min) was significantly different. Because no energy savings resulted for the DER feet, the release of stored energy in the flexible feet may not occur at the proper time to assist in ambulation as a result of the natural frequency of oscillation.

Adult↗

PubMed1993

A comparison of university and community-based family practice physician educators.

BACKGROUND: Differences in satisfaction with training and perceived preparation for practice have been observed among residents trained in community and university family practice residency programs. Our study was undertaken to determine the degree to which faculty training, experience, or practice patterns may contribute to these different resident experiences. METHODS: Questionnaires addressing prior training, experience, current practice content, motivation for entering academic medicine, and satisfaction with current teaching position were sent to full-time physician faculty at 60 family practice residency programs. RESULTS: The 208 faculty responses showed no differences in faculty at various types of residency programs with respect to demographic factors, prior training, or past experience. Only small differences were found in the proportion of time devoted to most professional activities or in the content of clinical practice. CONCLUSIONS: Few differences were found between faculty at university- and community-based family practice residency programs. This implies that differences in residents' perceptions of training may be due to other factors, such as institutional philosophy or self-selection. However, qualitative differences in family practice faculty activities that were not measured in this research cannot be ruled out as factors influencing residents' perceptions of their training experiences.

Attitude of Health Personnel↗

PubMed1993

Wellness testing. Design and experience of an established program.

Consumers have responded to available information and generated a large demand for self-initiated testing. Carefully planned testing can provide significant benefits to these self-selected subjects. Most notable examples include using sensitive and specific tests for iron metabolism and thyroid dysfunction. Cholesterol and lipid concerns are also motivators for testing. Nutrition and laboratory professionals must get involved with self-initiated testing to assure proper design, proper methods, proper reporting, and proper follow-up. It is hoped that this article and accompanying references will aid the implementation of effective wellness testing.

Adult↗

PubMedDate not supplied

[The prevalence of caries in marginal rural and peripheral urban areas].

A descriptive study of caries prevalence in peripheral urban and rural underprivileged groups was undertaken in self-selected populations demanding basic dental therapy in seven states of Mexico. Dental therapy services were delivered as part of a mobile oral health care program in the Mexican countryside implemented by the Dental School of Universidad Nacional Autónoma de México, during 1990 and 1991. Partial examination of clinical histories of 2,596 patients (mean age 21.8 years) revealed a mean DMFT (the sum of decayed, missing and filled teeth) of 9.21. Only 6.3 per cent of patients had DMFT = 0 and 10.7 per cent were caries-free. The largest component of DMFT were decayed teeth and the smallest one filled teeth. In general, results suggested that caries prevalence was high within the study populations, highlighting the little restorative treatment previously undertaken. The convenience of implementing oral health care schemes to deal with caries morbidity is discussed from the perspective of both the traditional dental treatment approach and preventive public health policies, taking into account the background of complex treatment needs present in these population groups.

Adolescent↗

PubMed1993

Frequency and determinants of screening for breast cancer in primary care group practice.

BACKGROUND: Many studies reporting the frequency of breast cancer screening have been based only on physician and patient surveys or on data from quality assurance studies and do not assess the reliability of information obtained from these various sources. METHODS: To obtain more complete data we studied mammography performed in a 3-year period, 1988 through 1991, in 24 nonacademic primary care group practices by both auditing the medical records and obtaining questionnaire responses from 1819 women aged 53 to 62 years and from their 98 physicians in the nonmetropolitan Midwest. RESULTS: Medical record data indicated that mammography was performed in all 3 years in 16.7%, in at least two of 3 years in 49.8%, and in at least one of 3 years in 81.7% of women. While patient reports of a family history of breast cancer, health insurance coverage for mammography, and greater annual household income were each significant predictors, a patient report that a clinic staff member had discussed mammography was the strongest predictor of greater frequency of mammography. CONCLUSIONS: In this study of self-selected physicians and their patients, record-documented mammographic examinations were considerably more frequent than has been reported in some studies, but occurred at rates consistent with quality assurance data for the region. These data suggest that clinic staff initiatives with screening mammography have a large impact.

Breast Neoplasms↗

PubMed1977

Enrollment choice in a mutli-HMO setting:the roles of health risk, financial vulnerability, and access to care.

Results of an analysis of enrollment decisions in HMO-type plans are reported. Previous studies concern dual-choice situations; this paper deals with a quadruple-choice situation involving one open- and two closed-panel HMO-type plans as well as Blue Cross/Blue Shield (BC/BS). The risk-vulnerability hypothesis is disaggregated into its components and the results show that there is no adverse health risk self-selection in an employed population. The hypothesis of economic vulnerability is maintained when tested in terms of per capita income rather than the previously used measure of family income. It is shown that those who enroll in any HMO-type plan are younger and have younger and larger families and lower per capita income than those who do not. No meaningful differences in terms of health status, health concerns, or prior utilization are found. Of the few differences found between those who enroll in closed- and open-panel HMO-type plans, having a private physician as the usual source of care is the most significant: those with an established physician relationship who join any HMO-type plan tend to follow their physician into the open-panel plan. The results should not be generalized to situations involving premium differences since the premium cost to subscribers in any of the plans considered here was fully paid by the employer. The validity of the results in terms of nonfinancial factors, on the other hand, is enhanced by the removal of cost considerations.

Adolescent↗