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PubMedDate not supplied

Communicating about resuscitation: problems and prospects.

BACKGROUND: The Patient Self-Determination Act of 1991 implicitly encourages physicians to discuss advance directives and no-code orders with their patients. The medical literature to date, however, has done little to place resuscitative decision making in the context of how physicians, patients, and families communicate with one another. This paper investigates how interactions between involved parties affect the process and outcome of this decision making. METHODS: Participant observation and open-ended interviews were conducted with patients, their families, resident physicians, and family medicine faculty members. RESULTS: This report describes three social and cultural issues that commonly influence and shape the process of do-not-resuscitate decision making: judging competency and capacity, dealing with uncertainty, and recognizing attitudes toward death. CONCLUSIONS: Improved understanding of the communicative process can facilitate the establishment of meaningful, therapeutic alliances between physicians, patients, and families at an influential juncture in the family life cycle.

Advance Care Planning↗

PubMedDate not supplied

Child control of food choices in Head Start families.

OBJECTIVE: To describe parents' perceived feeding practices of their Head Start children as related to 6 feeding constructs based on the literature about the division of mealtime responsibilities. DESIGN: A qualitative study involving 45-minute audiotaped and transcribed discussion groups with items that probed constructs of interest. SETTING: Five discussion groups were conducted in local, urban Head Start sites in a north central state. PARTICIPANTS: Head Start staff recruited 29 limited-income parents. PHENOMENA OF INTEREST: Parental comments were coded into categories related to the 6 feeding constructs and perceived barriers to their implementation. ANALYSIS: Researchers independently coded the discussion group transcripts based on common themes and feeding constructs. Codes were discussed until consensus was reached and data analyzed using Ethnograph 5.0. RESULTS: Parents frequently reported that their children decided which foods were offered for meals and snacks. Most parents reported such child control of foods to be a barrier to pleasant meal times. IMPLICATIONS: Nutrition educators can suggest solutions to improve parental self-efficacy for practicing mealtime responsibilities, such as offering a choice of several healthy foods from which a child might choose. The importance of planned meal and snack times might be promoted based on aiding children's appetites at meals and reducing mealtime conflicts.

Child Nutrition Sciences↗

PubMed1999

No association between atopic asthma and a coding variant of Fc epsilon R1 beta in a Japanese population.

Susceptibility to atopic diseases is known to involve genetic factors. The Gly237 allele of a polymorphism (Glu237Gly) of the Fc epsilon R1 beta gene is reportedly associated with atopic asthma in Japanese. To confirm this association, we conducted transmission disequilibrium tests in 76 families identified through atopic asthmatics. A case-control study was also carried out in atopic asthmatic subjects and non-atopic controls. The Gly237 allele was not preferentially transmitted to atopic asthma-affected offspring. Neither the Gly237 allele nor the Gly237/Gly237 + Glu237/Gly237 genotypes were significantly more prevalent in the atopic asthmatics than in the controls. This study failed to confirm a substantial role of the Gly237Glu polymorphism of the Fc epsilon R1 beta gene in the genetic predisposition for atopic asthma in this Japanese population.

Amino Acid Substitution↗

PubMed2002

Results of a cooperative educational program to improve prostate pathology reports among patients undergoing radical prostatectomy.

The information contained in pathology reports of radical prostatectomy specimens is critically important to treating physicians for the selection of adjuvant therapy, the evaluation of therapy, estimating prognosis, and analyzing outcomes. This information is also important to patients and their families. The first phase of this study consisted of a retrospective chart review of 554 cases of radical prostatectomy (ICD-9-CM procedure code of 60.5) in New York State for the second six-month period of 1996. This review focused on ten elements (quality indicators): submission of a frozen section, location of the adenocarcinoma, proportion of specimen involved by adenocarcinoma, perineural involvement, vascular involvement, seminal vesicle status, periprostate fat status, number of nodes submitted, status of nodes, and PIN (prostate intra-epithelial neoplasia). The second phase of this project consisted of an educational feedback program involving the directors of pathology laboratories in all hospitals in New York State. A post-intervention review of the medical charts of all male Medicare patients discharged from New York State acute care hospitals with the ICD-9-CM procedure code of 60.5 (radical prostatectomy) was conducted for the six-month period February 1 through July 31, 1999. A total of 304 charts were reviewed. Performance on the ten indicators in the first phase of the study varied from 14.8% (periprostate fat status) to 85.9% (seminal vesicle involvement). Performance for all hospitals was 50% for four quality indicators and less than 70% for seven. Post-intervention improvements in performance occurred with nine of the ten quality indicators. These improvements ranged from 1.4% (status of lymph nodes submitted) to 23.9% (proportion of specimen involved by adenocarcinoma). The results of this study demonstrate that the issues identified in the baseline with radical prostatectomy pathology reports were amenable to a cooperative educational intervention.

Adenocarcinoma↗

PubMed2004

HIV/AIDS risk among brothel-based female sex workers in China: assessing the terms, content, and knowledge of sex work.

BACKGROUND: Sexual transmission of HIV in China is rapidly increasing, in part driven by commercial sex work. GOAL: This article examines variations in occupational control among one type of brothel-based prostitutes in China, and the relationship between the terms and content of this work and the risk of HIV/AIDS. Organizational factors are discussed as part of the current political, economic, and social context of sex work in China. STUDY: The analysis is based on ethnographic observation and in-depth interviews conducted in south China in 2000 and 2001 involving 158 female prostitutes from 45 brothels in 4 red light districts. Qualitative analysis of interview and observational data used development of thematic codes measuring occupational control. RESULTS: Brothel-based female sex workers in China are a heterogeneous population, displaying considerable variability in the organization of life and work, relationships with managers and clients, ability to negotiate condom use, knowledge of sexually transmitted diseases and HIV, and occupational identity, all of which may result in different risks of acquiring HIV. CONCLUSION: HIV prevention activities in China must focus on sociocultural aspects of sex work. Such interventions depend on detailed knowledge of its organization. The results of this study demonstrate the importance of prevention activities directed at the brothel managers and clients, as well as the sex workers.

Adolescent↗

PubMed2000

Statistical assessment of between batch stability equivalence.

A statistical method for testing the equivalence between batches regarding their stability is proposed. This method is based on the statistical linear model making use of a set of dummy variables to code the different batches. The method gives us the point estimates of the slope and zero intercept of one batch, and the differences and the corresponding confidence intervals with the remaining batches. In a second step, zero intercepts and slopes are estimated for all the batches. Stability equivalence assessment is based on the comparison of the confidence intervals for the differences between batches with the maximum difference allowable. The main advantages of this method are the possibility to compare several batches, to disclose the equivalence stability criteria from the statistical hypothesis about the equality between slopes, and the joint estimated of the residual variance whatever the decision to pool or not the data from different batches. This method is illustrated with two data set; the first one, previously published by other authors, involved six batches; the second data set include two batches and arose in a stability study of a commercial human insulin conducted in our laboratory.

Confidence Intervals↗

PubMed2006

Tracking the development of professional values in undergraduate nursing students.

In the current nursing shortage, nurses are frequently making significant patient care decisions concerning value-laden clinical issues. A program evaluation study was conducted to track professional values over time from entry into a baccalaureate program to graduation. Nursing students completed a survey measuring professional values upon entry into and exit from the program. Comparative analysis of pretest and posttest group means demonstrated statistically significant increases in total scores. The highest pretest value items were also the highest on the posttest, with the addition of patient advocacy. Patient advocacy jumped 16 places from pretest to posttest to become the highest-ranked statement upon exit from the program. All of the values rated as least valued at pretest remained least valued at posttest; however, the means of all but two (participating in nursing research and providing consumer education about products/services) increased significantly. The value statements with mean scores that increased significantly centered on aspects of nursing practice less visible to the lay public and involving interaction with other health care providers.

Codes of Ethics↗

PubMed2006

Occupational sun exposure and mycosis fungoides: a European multicenter case-control study.

OBJECTIVE: We sought to study the association between occupational sun exposure and mycosis fungoides (MF), a peripheral T-cell lymphoma. SUBJECTS AND METHODS: A European multicenter case-control study including seven rare cases (one being MF) was conducted between 1995 and 1997. From the 118 accepted cases, 104 were interviewed, of which 76 were definite cases. Population controls were selected randomly from the regions of case ascertainment. Information based on occupational experiences was coded according to industry types. A job exposure matrix was created according to the expected exposure to sunlight. RESULTS: Once exposures to aromatic halogenated hydrocarbons were eliminated (odds ratio = 2.3; 95% confidence interval = 0.9-6.2), a high MF risk was associated with exposures to solar radiation. CONCLUSION: It would appear that workers exposed to sunlight have a higher risk of MF. However, this factor is not the only one involved.

Aged↗

PubMed2001

Value of unstructured time (breaks) during formal continuing medical education events.

BACKGROUND: Unstructured time (breaks) at formal continuing medical education (CME) events is nonaccredited in some jurisdictions. Program participants, however, perceive this time as valuable to their learning. The purpose of this research was to determine what activities occur during unstructured time in formal CME events and how these activities impact learning for physicians. METHODS: A qualitative method based on grounded theory was used to determine themes of behavior. Both individual and focus group interviews were conducted. Data were analyzed and coded into themes, which were then further explored and validated by the use of a questionnaire survey. RESULTS: One hundred ninety-seven family physicians were involved in the study. Several activities related to the enhancement of learning were identified and grouped into themes. There were few differences in the ranking of importance between the themes identified, nor were differences determined based on gender or type of CME in which the break occurred. FINDINGS: The results suggest that unstructured time (breaks) should be included in formal CME events to help physician learners integrate new material, solve individual practice problems, and make new meaning out of their experience. The interaction between colleagues that occurs as a result of the provision of breaks is perceived as crucial in aiding the process of applying knowledge to practice.

Behavior↗

PubMed2005

Perceptions of growth monitoring and promotion among an international panel of district medical officers.

The growth chart has been proposed as an educational tool to make the child's growth visible to both health workers and caregivers and to enhance communication between them. In the case of growth faltering, this would trigger timely corrective measures. Although the relevance of growth monitoring and promotion (GMP) has often been questioned in the literature, opinions of District Medical Officers responsible for local implementation of GMP are unknown. The aim of this qualitative research was to explore the perceptions and difficulties of an international panel of District Medical Officers regarding GMP. As an exploratory study, in-depth interviews of an international panel of District Medical Officers (n=19) were conducted. Data were coded using the QSR Nudist 5.0 software. A discrepancy between intended purposes and practice of GMP was detected at two levels. First, lack of participation of care-givers was reported. Second, the District Medical Officers expressed a restrictive interpretation of the concept of growth monitoring. The communication with parents was never reported as a means or a result of GMP, neither as an evaluation criterion of programme efficiency. The growth chart was mainly considered a tool intended to be used by health services for the purpose of diagnosis. This two-fold discrepancy between the intention of international policy-planners and practice of local programme implementers could be a crucial factor affecting the performance of GMP. More emphasis should be put on social communication and involvement of caregivers.

Adult↗

PubMed2006

Spatial coding for the Simon effect in visual search.

Two experiments were conducted to examine the Simon effect (i.e., faster responding when irrelevant stimulus location corresponds with response location than when it does not) in visual search tasks. The search items were arranged in a 4 x 4 grid, and grid locations were coded into sets of four, two involving inner columns and two involving outer columns. In experiment 1, three different types of inefficient search tasks were used. The Simon effects were shown to be larger when the target appeared in one of the outer columns than in one of the inner columns ("laterality effect"). This pattern of results was not observed when distractors were absent, suggesting that the laterality effect depends on the operation of selective attention. In experiment 2, a pop-out search task was used, and no significant effect of target location on the Simon effect was found. Interpretations of the results based on the attention-shift account and referential-coding account were discussed.

Adult↗

PubMed1995

Deletion and insertion mutations in short tandem repeats in the coding regions of human genes.

In vitro studies in bacterial, yeast and eukaryotic systems have demonstrated the existence of deletion and insertion 'hot-spots' involving repetitive sequences. Slipped-strand mispairing (SSM) has been suggested to be the mechanism involved. Progress in human molecular genetics has allowed the identification of many mutations causing diseases. Analysis of sequences involved in these mutations provides an opportunity to investigate the contribution of short tandem repeats to the naturally occurring mutations in coding regions of human genes. We have analyzed the sequences surrounding 625 disease-causing mutations in the coding regions of three genes: the cystic fibrosis transmembrane conductance regulator, beta globin and factor IX. Altogether, 134 (21%) insertion and deletion mutations of 4 base pairs or less were identified. In 47% of these mutations, the deletions and insertions occurred within a unit repeated tandemly 2- to 7-fold. These were classified as SSM mutations. The proportion of SSM mutations was significantly higher than expected by chance. The estimated net proportion of deletion and insertion mutations attributed to SSM was 27%. These results indicate that very short repetitive sequences contribute significantly to the generation of deletion and insertion mutations in human genes, and to the evolution of diversity of their coding regions.

Base Composition↗

PubMed2005

Varicella and its complications as cause of hospitalization.

Varicella is an acute contagious disease that most commonly occurs in childhood. Although normally benign, varicella can occasionally develop into a more serious illness. Moreover, the infection can lead to serious complications, such as Staphylococcus aureus infections, otitis media, endocarditis, pneumonia, and rare central nervous system (CNS) events like cerebellar ataxia and encephalitis. This study was conducted to analyze the hospitalization rate due to varicella or its complications in a tertiary care hospital in Italy, where varicella vaccination has not yet been implemented. The review was carried out on cases of children with varicella identified by ICD9 and ICD9-CM diagnostic codes and admitted to the Giannina Gaslini Children's Research Hospital of Genoa, Italy, from January 1st, 1995 to December 31st, 2004. For each case reporting complications, the clinical report form was extracted and the events recorded. Varicella was recorded in 346 (0,16%) out of 212,647 total hospital discharges. Chickenpox with detailed complications and cerebrovascular diseases accounted for 56 discharges (12.14%), for a total of 728 days. Fifteen patients needed more than one hospitalization because of severe sequelae as result of CNS involvement. We reported three particular cases of invasive infections and four children affected with cerebrovascular diseases following varicella. Our retrospective data regarding a single tertiary care pediatric hospital shows that hospitalization due to varicella or its sequelae may present an important medical and indirect economic problem.

Cerebellar Ataxia↗

PubMed2007

Differences in replication capacity between enterovirus 71 isolates obtained from patients with encephalitis and those obtained from patients with herpangina in Taiwan.

The cellular-tropism and biological characteristics of enterovirus 71 (EV71) isolates in Taiwan (TW) were studied. Growth curve experiments were conducted using cell lines that were possibly exhibited pathogenesis, and RT-PCR and sequencing tests were undertaken to amplify the 5' non-coding region (5'-NCR). The encephalitis isolate EV71 TW98NTU2078 was PBMC-tropic, temperature-resistant (Tr) at 40 degrees C, and easier to replicate in HTB-14 (astrocytoma) than the herpangina isolate EV71 TW98NTU1186 (The viral yields were 100-fold higher than those of the herpangina isolate EV71 TW98NTU1186 at 96 hr post infection.). The herpangina isolate EV71 TW98NTU1186 was non-PBMC-tropic, and temperature-sensitive (Ts) at 40 degrees C. The replication of EV71 TW98NTU1186 in HTB-14 was lower. No EV71 isolate infected HTB-37 (human colon adenocarcinoma cells). The encephalitis EV71 isolate exhibited better replication and transmission in PBMCs and astrocytes than did the EV71 isolate without CNS involvement.

Animals↗

PubMed2001

A review of measures of quality of life for children with chronic illness.

AIMS: To identify currently available generic and disease specific measures of quality of life (QoL) for work with children; and make recommendations about the future development and application of QoL measures. METHODS: Systematic searches were conducted to identify measures of QoL. Primary research papers were coded by the authors on the basis of predefined inclusion and exclusion criteria. RESULTS: Of the 137 papers included in the review, 43 involved the development of a new measure. These included 19 generic and 24 disease specific measures. Almost half the measures were developed in the USA. Measures were identified which were appropriate for children across a broad age range, and included provision for completion by different respondents (child only, parent only, or both). There were no clear distinctions between measures of QoL, health, or functional status. CONCLUSIONS: We have identified a small number of measures which fulfil basic requirements and could be used to assess QoL in clinical trials or following interventions. However, there remain a number of problems in measuring QoL in children. These include limited availability of disease specific measures; discrepancies between child and parent ratings; limited availability of measures for self completion by children; lack of precision regarding the content of domains of QoL; and the cultural appropriateness of measures developed elsewhere for children in the UK.

Activities of Daily Living↗

PubMed2002

Quality of life after postmastectomy breast reconstruction.

PURPOSE/OBJECTIVES: To explore women's expectations about postmastectomy reconstruction and factors affecting their quality of life after reconstruction. DESIGN: Qualitative focus group study. SETTING: Integrated healthcare system in a midwestern suburban community. SAMPLE: 17 women who had undergone mastectomies with immediate reconstruction between 1.4 and 5 years previously and had participated in a study of women newly diagnosed with breast cancer. METHODS: An experienced focus group moderator conducted two focus group sessions. Comments from the sessions were audiotaped and transcribed verbatim. The sessions involved semistructured, open-ended questions about perceptions of preparation, experience, and satisfaction regarding postmastectomy reconstruction. Thematic content analysis began with open coding at the level of individual comments and proceeded through two levels of higher-order categorization. FINDINGS: Although women felt well informed about breast surgery, they wished they had been more informed about some issues. Ratings of satisfaction generally were high despite some concerns about cosmetic outcome and persistent anxiety about recurrence. CONCLUSIONS: Reconstruction allows women to feel comfortable in clothing, but recovery can be difficult, and reconstruction does not neutralize the biggest emotional challenge of breast cancer: fear of recurrence. IMPLICATIONS FOR PRACTICE: Women appreciate thorough information to prepare them for reconstruction and recovery. For aspects of recovery in which substantial variation exists, the range of experiences should be provided.

Female↗

PubMed1995

Amodal completion and vernier acuity: evidence of 'top-but-not-very-far-down' processes?

Vernier thresholds were measured by means of a forced-choice paradigm for physically separated bars that were perceived either as separate or as amodally completed behind an occluder. The finding that thresholds were not reduced (improved) with amodal completion argues against an early neural code for amodal completion that is equivalent to physical completion of the vernier bars (ie neural propagation/interpolation) and limits the stage at which amodal representations could arise via bottom-up processes to neural sites located centrally with respect to those involved in position coding. An alternative explanation is also considered, that this result reflects the activity of top-down processes that mediate amodal completion by imposing grouping/organizational constraints upon earlier representations of position. In support of this proposition it was found that when tested by means of a non-forced-choice paradigm without feedback, observers demonstrated a reduced tendency to report the presence of a vernier offset when the bars were perceived as amodally completed (ie a shift in response bias occurred). This separability of vernier acuity and response bias suggests the existence of 'top-but-not-very-far-down' grouping processes whose influence does not extend to early representations of relative position.

Analysis of Variance↗

PubMed1998

The meanings of tuberculosis for Mexican migrant farmworkers in the United States.

The timely diagnosis and treatment of tuberculosis is an important public health problem in both developed and developing nations. In the United States, migrant farmworkers are estimated to be about six times more likely than other employed adults to develop tuberculosis. The purpose of this study was to investigate explanatory models of tuberculosis among Mexican migrant farmworkers working in western New York state. In-depth interviews were conducted with 26 farmworkers using an open-ended question format. All interviews were conducted in migrant camps and were audio-taped, translated and transcribed by the researcher. Data analysis was performed using Glaser and Strauss' grounded theory method of analysis which involves continuous and simultaneous data collection, coding, and analysis. Study participants included 21 males and 5 females ranging in age from 18 to 65. Respondents had worked as migrant farmworkers an average of 10 years and had an average of five years of schooling. Two-thirds of the participants had previously attended a tuberculosis education program, and four had received treatment for tuberculosis infection in the past. Farmworkers' explanations of tuberculosis etiology, severity, symptoms, prevention, treatment, and social significance are described as well as their beliefs about tuberculosis skin testing and the bacillus Calmette-Guérin (BCG) vaccine. Migrant farmworkers' explanatory models were similar in many aspects to the medical model of tuberculosis, although farmworkers had numerous misconceptions about BCG vaccination. Health care workers should be aware that Mexican migrant farmworkers may have beliefs about tuberculosis that are very compatible with participation in testing and treatment programs if such programs are made accessible to them.

Adolescent↗