Sexism, Homophobia and Transphobia in a Sample of Italian Pre-Service Teachers: The Role of Socio-Demographic Features

ERIC Educational Resources Information Center

Scandurra, Cristiano; Picariello, Simona; Valerio, Paolo; Amodeo, Anna Lisa

2017-01-01

Although recent research has highlighted that lesbian, gay, bisexual and transgender (LGBT) youths represent a resilient population, they still suffer from social stigma and oppression, being potentially at additional risk of developing negative mental health outcomes. One of the main environments where violence and harassment against this…

Importance of Thinking Locally for Mental Health: Data from Cross-Sectional Surveys Representing South East London and England

PubMed Central

Hatch, Stephani L.; Woodhead, Charlotte; Frissa, Souci; Fear, Nicola T.; Verdecchia, Maria; Stewart, Robert; Reichenberg, Abraham; Morgan, Craig; Bebbington, Paul; McManus, Sally; Brugha, Traolach; Kankulu, Bwalya; Clark, Jennifer L.; Gazard, Billy; Medcalf, Robert; Hotopf, Matthew

2012-01-01

Background Reliance on national figures may be underestimating the extent of mental ill health in urban communities. This study demonstrates the necessity for local information on common mental disorder (CMD) and substance use by comparing data from the South East London Community Health (SELCoH) study with those from a national study, the 2007 English Adult Psychiatric Morbidity Study (APMS). Methodology/Principal Findings Data were used from two cross-sectional surveys, 1698 men and women residing in south London and 7403 men and women in England. The main outcome, CMD, was indicated by a score of 12 or above on the Revised Clinical Interview Schedule. Secondary outcomes included hazardous alcohol use and illicit drug use. SELCoH sample prevalence estimates of CMD were nearly twice that of the APMS England sample estimates. There was a four-fold greater proportion of depressive episode in the SELCoH sample than the APMS sample. The prevalence of hazardous alcohol use was higher in the national sample. Illicit drug use in the past year was higher in the SELCoH sample, with cannabis and cocaine the illicit drugs reported most frequently in both samples. In comparisons of the SELCoH sample with the APMS England sample and the APMS sample from the Greater London area in combined datasets, these differences remained after adjusting for socio-demographic and socioeconomic indicators for all outcomes. Conclusions/Significance Local information for estimating the prevalence of CMD and substance use is essential for surveillance and service planning. There were similarities in the demographic and socioeconomic factors related to CMD and substance use across samples. PMID:23251330

Does Assessing Suicidality Frequently and Repeatedly Cause Harm? A Randomized Control Study

PubMed Central

Law, Mary Kate; Furr, R. Michael; Arnold, Elizabeth Mayfield; Mneimne, Malek; Jaquett, Caroline; Fleeson, William

2015-01-01

Assessing suicidality is common in mental health practice and is fundamental to suicide research. Although necessary, there is significant concern that such assessments have unintended harmful consequences. Using a longitudinal randomized control design, we evaluated whether repeated and frequent assessments of suicide-related thoughts and behaviors negatively affected individuals, including those at-risk for suicide-related outcomes. Adults (N = 282), including many diagnosed with Borderline Personality Disorder (BPD), were recruited through psychiatric outpatient clinics and from the community at large, and were randomly assigned to assessment groups. A Control Assessment group responded to questions regarding negative psychological experiences several times each day during a 2-week Main Observation phase. During the same observation period, an Intensive Suicide Assessment group responded to the same questions, along with questions regarding suicidal behavior and ideation. Negative psychological outcomes were measured during the Main Observation phase (for BPD symptoms unrelated to suicide and for BPD-relevant emotions) and/or at the end of each week during the Main Observation phase and monthly for 6 months thereafter (for all outcomes, including suicidal ideation and behavior). Results revealed little evidence that intensive suicide assessment triggered negative outcomes, including suicidal ideation or behavior, even among people with BPD. A handful of effects did reach or approach significance, though these were temporary and non-robust. However, given the seriousness of some outcomes, we recommend that researchers or clinicians who implement experience sampling methods including suicide-related items carefully consider the benefits of asking about suicide and to inform participants about possible risks. PMID:25894705

Does assessing suicidality frequently and repeatedly cause harm? A randomized control study.

PubMed

Law, Mary Kate; Furr, R Michael; Arnold, Elizabeth Mayfield; Mneimne, Malek; Jaquett, Caroline; Fleeson, William

2015-12-01

Assessing suicidality is common in mental health practice and is fundamental to suicide research. Although necessary, there is significant concern that such assessments have unintended harmful consequences. Using a longitudinal randomized control design, the authors evaluated whether repeated and frequent assessments of suicide-related thoughts and behaviors negatively affected individuals, including those at-risk for suicide-related outcomes. Adults (N = 282), including many diagnosed with borderline personality disorder (BPD), were recruited through psychiatric outpatient clinics and from the community at large, and were randomly assigned to assessment groups. A control assessment group responded to questions regarding negative psychological experiences several times each day during a 2-week main observation phase. During the same observation period, an intensive suicide assessment group responded to the same questions, along with questions regarding suicidal behavior and ideation. Negative psychological outcomes were measured during the main observation phase (for BPD symptoms unrelated to suicide and for BPD-relevant emotions) and/or at the end of each week during the main observation phase and monthly for 6 months thereafter (for all outcomes, including suicidal ideation and behavior). Results revealed little evidence that intensive suicide assessment triggered negative outcomes, including suicidal ideation or behavior, even among people with BPD. A handful of effects did reach or approach significance, though these were temporary and nonrobust. However, given the seriousness of some outcomes, the authors recommend that researchers or clinicians who implement experience sampling methods including suicide-related items carefully consider the benefits of asking about suicide and to inform participants about possible risks. (c) 2015 APA, all rights reserved).

Impacts of making sense of adversity on depression, posttraumatic stress disorder, and posttraumatic growth among a sample of mainly newly diagnosed HIV-positive Chinese young homosexual men: the mediating role of resilience.

PubMed

Yu, Nancy Xiaonan; Chen, Lihua; Ye, Zhi; Li, Xiaoming; Lin, Danhua

2017-01-01

The experience of HIV, as a life-transforming event, might produce both negative and positive outcomes. Guided by the stress appraisal model, the present study investigated the hypothesized pathways in predicting symptomatology and posttraumatic growth (PTG) in a sample of Chinese male patients with HIV (PHIV) who were mainly newly diagnosed, young, and homosexual. In this cross-sectional study, 141 Chinese male PHIV (87.2% of them were homosexual) completed measures of making negative/positive sense of adversity, resilience, depression, posttraumatic stress disorder (PTSD), and PTG. The path analysis results showed that making negative sense of adversity was associated with depression and PTSD, partially mediated by low levels of resilience, whereas making positive sense of adversity was associated with PTG, partially mediated by resilience. The results suggest that negative and positive outcomes of trauma are impacted by making negative and positive sense of adversity, respectively, via two separate pathways, both mediated by resilience. Our findings contribute to an understanding of the cognitive process of symptomatology and PTG in the HIV context. Theoretical considerations, clinical implications, and future directions are discussed.

Control of diabetes and fibrinogen levels as well as improvement in health care might delay low cognitive performance in societies aging progressively.

PubMed

Lopes, Daniele Almeida; Moraes, Suzana Alves de; Freitas, Isabel Cristina Martins de

2015-01-01

To know the prevalence and factors associated to low cognitive performance in a representative sample of the adult population in a society aging progressively. Cross-sectional population-based study carried out in a three-stage sampling: 81 census tracts (primary sampling unity) were randomly selected, followed by 1,672 households and 2,471 participants (weighted sample) corresponding to the second and third stages, respectively. The outcome prevalence was calculated according sociodemographic, behavioral and health related variables. Crude and adjusted prevalence ratios were estimated using Poisson regression. The prevalence of low cognitive performance was high, mainly among females, and indicated linear trends into categories of age, schooling, income, plasma fibrinogen and self-reported health status. In multivariate models, gender, diabetes, fibrinogen and self-reported health status presented positive associations, while schooling, employment and sitting time presented negative associations with the outcome. Interventions related to diabetes and fibrinogen levels control as well as improvement in health care might delay low cognitive performance in societies aging progressively as such the study population.

Homophobia and Communal Coping for HIV risk management among Gay Men in Relationships

PubMed Central

Stachowski, Courtney; Stephenson, Rob

2015-01-01

Men who have sex with men (MSM) remain disproportionately affected by the HIV epidemic in the US and estimates suggest that one to two-thirds of new infections occur among main partners. Previous research has focused on individual MSM and their risk for HIV, yet couples’ ability to manage risk has been largely understudied. In particular, the role that homophobia plays in shaping the ability of gay male couples to cope with HIV risk is currently under-studied. A sample of 447 gay/bisexual men with main partners was taken from a 2011 survey of gay and bisexual men in Atlanta. Linear regression models were fitted for three couples’ coping outcome scales (outcome efficacy, couple efficacy, communal coping) and included indicators of homophobia (internalized homophobia and homophobic discrimination). Findings indicate that reporting of increased levels of internalized homophobia were consistently associated with decreased outcome measures of couples’ coping ability regarding risk management. The results highlight the role that homophobia plays in gay male couples’ relationships and HIV risk, extending the existing literature in the field of same-sex relationships as influenced by homophobia. PMID:25614049

Homophobia and communal coping for HIV risk management among gay men in relationships.

PubMed

Stachowski, Courtney; Stephenson, Rob

2015-02-01

Men who have sex with men (MSM) remain disproportionately affected by the HIV epidemic in the US and estimates suggest that one to two-thirds of new infections occur among main partners. Previous research has focused on individual MSM and their risk for HIV, yet couples' ability to manage risk has been largely understudied. In particular, the role that homophobia plays in shaping the ability of gay male couples to cope with HIV risk is currently understudied. A sample of 447 gay/bisexual men with main partners was taken from a 2011 survey of gay and bisexual men in Atlanta. Linear regression models were fitted for three couples' coping outcome scales (outcome efficacy, couple efficacy, communal coping) and included indicators of homophobia (internalized homophobia and homophobic discrimination). Findings indicate that reporting of increased levels of internalized homophobia were consistently associated with decreased outcome measures of couples' coping ability regarding risk management. The results highlight the role that homophobia plays in gay male couples' relationships and HIV risk, extending the existing literature in the field of same-sex relationships as influenced by homophobia.

Feasibility of a Humor Training to Promote Humor and Decrease Stress in a Subclinical Sample: A Single-Arm Pilot Study

PubMed Central

Tagalidou, Nektaria; Loderer, Viola; Distlberger, Eva; Laireiter, Anton-Rupert

2018-01-01

The present study investigates the feasibility of a humor training for a subclinical sample suffering from increased stress, depressiveness, or anxiety. Based on diagnostic interviews, 35 people were invited to participate in a 7-week humor training. Evaluation measures were filled in prior training, after training, and at a 1-month follow-up including humor related outcomes (coping humor and cheerfulness) and mental health-related outcomes (perceived stress, depressiveness, anxiety, and well-being). Outcomes were analyzed using repeated-measures ANOVAs. Within-group comparisons of intention-to-treat analysis showed main effects of time with large effect sizes on all outcomes. Post hoc tests showed medium to large effect sizes on all outcomes from pre to post and results remained stable until follow-up. Satisfaction with the training was high, attrition rate low (17.1%), and participants would highly recommend the training. Summarizing the results, the pilot study showed promising effects for people suffering from subclinical symptoms. All outcomes were positively influenced and showed stability over time. Humor trainings could be integrated more into mental health care as an innovative program to reduce stress whilst promoting also positive emotions. However, as this study was a single-arm pilot study, further research (including also randomized controlled trials) is still needed to evaluate the effects more profoundly. PMID:29740368

The relationship between personality and attainment in 16-19-year-old students in a sixth form college: II: Self-perception, gender and attainment.

PubMed

Summerfield, M; Youngman, M

1999-06-01

A related paper (Summerfield & Youngman, 1999) has described the development of a scale, the Student Self-Perception Scale (SSPS) designed to explore the relationship between academic self-concept, attainment and personality in sixth form college students. The study aimed to identify groups of students exhibiting varying patterns of relationship using a range of measures including the SSPS. Issues of gender and also examined. The samples comprised a pilot sample of 152 students (aged 16-17 years from two sixth form colleges) and a main sample of 364 students (mean age, 16 yrs 10 mths range 16:0 to 18:6 years, from one sixth form college). The main sample included similar numbers of male and female students (46% male, 54% female) and ethnic minority students comprised 14% of this sample. Data comprised responses to two personality measures (the SSPS, Summerfield, 1995, and the Nowicki-Strickland Locus of Control Scale, Nowicki & Strickland, 1973), various student and tutor estimates of success, and performance data from college records. Students were classified using relocation cluster analysis and cluster differences verified using discriminant function analysis. Thirty outcome models were tested using covariance regression analysis. Eight distinct and interpretable groups, consistent with other research, were identified but the hypothesis of a positive, linear relationship between mastery and academic attainment was not sustained without qualification. Previous attainment was the major determinant of final performance. Gender variations were detected on the personality measures, particularly Confidence of outcomes, Prediction discrepancy, Passivity, Mastery, Dependency and Locus of control, and these were implicated in the cluster characteristics. The results suggest that a non-linear methodology may be required to isolate relationships between self-concept, personality and attainment, especially where gender effects may exist.

The Development and Validation of the Client Expectations of Massage Scale

PubMed Central

Boulanger, Karen T.; Campo, Shelly; Glanville, Jennifer L.; Lowe, John B; Yang, Jingzhen

2012-01-01

Background: Although there is evidence that client expectations influence client outcomes, a valid and reliable scale for measuring the range of client expectations for both massage therapy and the behaviors of their massage therapists does not exist. Understanding how client expectations influence client outcomes would provide insight into how massage achieves its reported effects. Purpose: To develop and validate the Client Expectations of Massage Scale (CEMS), a measure of clients’ clinical, educational, interpersonal, and outcome expectations. Setting: Offices of licensed massage therapists in Iowa. Research Design: A practice-based research methodology was used to collect data from two samples of massage therapy clients. For Sample 1, 21 volunteer massage therapists collected data from their clients before the massage. Factor analysis was conducted to test construct validity and coefficient alpha was used to assess reliability. Correlational analyses with the CEMS, previous measures of client expectations, and the Life Orientation Test–Revised were examined to test the convergent and discriminant validity of the CEMS. For Sample 2, 24 massage therapists distributed study materials for clients to complete before and after a massage therapy session. Structural equation modeling was used to assess the construct, discriminant, and predictive validity of the CEMS. Participants: Sample 1 involved 320 and Sample 2 involved 321 adult massage clients. Intervention: Standard care provided by licensed massage therapists. Main Outcomes: Numeric Rating Scale for pain and Positive and Negative Affect Schedule–Revised (including the Serenity subscale). Results: The CEMS demonstrated good construct, convergent, discriminant and predictive validity, and adequate reliability. Client expectations were generally positive toward massage and their massage therapists. Positive outcome expectations had a positive effect on clients’ changes in pain and serenity. High interpersonal expectations had a negative effect on clients’ changes in serenity. Conclusions: Client expectations contribute to the nonspecific effects of massage therapy. PMID:23087774

High Diversity and Variability in the Vaginal Microbiome in Women following Preterm Premature Rupture of Membranes (PPROM): A Prospective Cohort Study

PubMed Central

Paramel Jayaprakash, Teenus; Wagner, Emily C.; van Schalkwyk, Julie; Albert, Arianne Y. K.; Hill, Janet E.; Money, Deborah M.

2016-01-01

Objective To characterize the vaginal microbiota of women following preterm premature rupture of membranes (PPROM), and determine if microbiome composition predicts latency duration and perinatal outcomes. Design A prospective cohort study Setting Canada Population Women with PPROM between 24+0 and 33+6 weeks gestational age (GA). Methods Microbiome profiles, based on pyrosequencing of the cpn60 universal target, were generated from vaginal samples at time of presentation with PPROM, weekly thereafter, and at delivery. Main Outcome Measures Vaginal microbiome composition, latency duration, gestational age at delivery, perinatal outcomes. Results Microbiome profiles were generated from 70 samples from 36 women. Mean GA at PPROM was 28.8 wk (mean latency 2.7 wk). Microbiome profiles were highly diverse but sequences representing Megasphaera type 1 and Prevotella spp. were detected in all vaginal samples. Only 13/70 samples were dominated by Lactobacillus spp. Microbiome profiles at the time of membrane rupture did not cluster by gestational age at PPROM, latency duration, presence of chorioamnionitis or by infant outcomes. Mycoplasma and/or Ureaplasma were detected by PCR in 81% (29/36) of women, and these women had significantly lower GA at delivery and correspondingly lower birth weight infants than Mycoplasma and/or Ureaplasma negative women. Conclusion Women with PPROM had mixed, abnormal vaginal microbiota but the microbiome profile at PPROM did not correlate with latency duration. Prevotella spp. and Megasphaera type I were ubiquitous. The presence of Mollicutes in the vaginal microbiome was associated with lower GA at delivery. The microbiome was remarkably unstable during the latency period. PMID:27861554

Factors influencing polymerase chain reaction outcomes in patients with clinically suspected ocular tuberculosis.

PubMed

Balne, Praveen Kumar; Modi, Rohit Ramesh; Choudhury, Nuzhat; Mohan, Neha; Barik, Manas Ranjan; Padhi, Tapas Ranjan; Sharma, Savitri; Panigrahi, Satya Ranjan; Basu, Soumyava

2014-03-25

Polymerase chain reaction (PCR) assay can be a useful method for definitive diagnosis in paucibacillary infections such as ocular tuberculosis (TB). In this study, we have evaluated factors affecting PCR outcomes in patients with clinically suspected ocular TB. Patients with clinically suspected ocular TB were investigated by PCR of aqueous or vitreous samples. Three control groups were also tested: group 1 included culture-proven non-tuberculous endophthalmitis, group 2 culture-negative non-tuberculous endophthalmitis, and group 3 patients undergoing surgery for uncomplicated cataract. PCR targeted one or more of following targets: IS6110, MPB64, and protein b genes of Mycobacterium tuberculosis complex. Multiple regression analysis (5% level of significance) was done to evaluate the associations between positive PCR outcome and laterality of disease, tuberculin skin test (TST)/interferon-gamma release assay (IGRA), chest radiography, and type of sample (aqueous or vitreous). The main outcome measures were positive PCR by one or more gene targets, and factors influencing positive PCR outcomes. All 114 samples were tested for MPB64, 110 for protein b, and 88 for IS6110. MPB64 was positive in 70.2% (n = 80) of tested samples, protein b in 40.0% (n = 44), and IS6110 in only 9.1% (n = 8). DNA sequencing of amplicons from four randomly chosen PCR reactions showed homology for M. tuberculosis complex. Of the 80 PCR-positive patients, 71 completed a full course of antitubercular therapy, of which 65 patients (91.5%) had complete resolution of inflammation at final follow-up. Among controls, 12.5% (3 out of 24) in group 1 and 18.7% (6 out of 32) in group 2 also tested positive by PCR. No PCR-positive outcome was observed in control group 3 (n = 25). Multiple regression analysis revealed significant association of positive PCR outcome with bilateral presentation, but not with a positive TST/IGRA, chest radiography, or type of sample (aqueous/vitreous) used. Careful selection of gene targets can yield high PCR positivity in clinically suspected ocular TB. Bilateral disease presentation but not any evidence of latent systemic TB influences PCR outcomes. False-positive results may be seen in ocular inflammation unrelated to ocular TB.

Risk Factors and Risk Stratification for Adverse Obstetrical Outcomes After Appendectomy or Cholecystectomy During Pregnancy

PubMed Central

Guglielminotti, Jean; Miller, Russell; Landau, Ruth; Smiley, Richard; Li, Guohua

2017-01-01

Importance Identification of risk factors for adverse obstetrical outcomes after appendectomy and cholecystectomy during pregnancy is necessary for evidence-based risk reduction and adequate patient counseling. Objectives To identify risk factors for adverse obstetrical outcomes after appendectomy and cholecystectomy during pregnancy and stratify the risk of such outcomes. Design, Setting, and Participants A cohort study was conducted using the Nationwide Inpatient Sample, a nationally representative sample of patients discharged from community hospitals in the United States, from January 1, 2003, to December 31, 2012. Multivariable analysis of risk factors for adverse obstetric outcomes was performed for 19 926 women undergoing appendectomy or cholecystectomy during pregnancy and a scoring system for such risk factors was developed. Data analysis was conducted from January 1, 2015, to July 31, 2016. Main Outcomes and Measures A composite measure including 7 adverse obstetrical outcomes throughout pregnancy and occurring before hospital discharge. Results Of the 19 926 women (mean [SD] age, 26 [6] years) in the study, 1018 adverse obstetrical events were recorded in 953 pregnant women (4.8%). The 3 most frequent adverse events were preterm delivery (360 [35.4%]), preterm labor without preterm delivery (269 [26.4%]), and miscarriage (262 [25.7%]). The risk factors associated most strongly with an adverse obstetrical outcome included cervical incompetence (adjusted odds ratio, 24.29; 95% CI, 7.48-78.81), preterm labor during current pregnancy (adjusted odds ratio, 18.34; 95% CI, 4.95-67.96), vaginitis or vulvovaginitis (adjusted odds ratio, 5.17; 95% CI, 2.19-12.23), and sepsis (adjusted odds ratio, 3.39; 95% CI, 2.08-5.51). A scoring system based on statistically significant variables classified the study sample into 3 risk groups corresponding to predicted probabilities of adverse obstetrical outcomes of 2.5% (≤4 points), 8.2% (5-8 points), and 21.8% (≥9 points). Conclusions and Relevance Approximately 5% of women experience adverse obstetrical outcomes after appendectomy or cholecystectomy during pregnancy. The major risk factors for such outcomes are cervical incompetence, preterm labor during current pregnancy, vaginitis or vulvovaginitis, and sepsis. PMID:28114513

Intimacy-Enhancing Psychological Intervention for Men Diagnosed with Prostate Cancer and Their Partners: A Pilot Study

PubMed Central

Manne, S. L.; Kissane, D. W.; Nelson, C. J.; Mulhall, J. P.; Winkel, G.; Zaider, T.

2011-01-01

Introduction Few couple-focused interventions have been developed to improve distress and relationship outcomes among men diagnosed with localized prostate cancer and their partners. Aims We examined the effects of a five session Intimacy-Enhancing Therapy (IET) versus Usual Care (UC) on the psychological and relationship functioning of men diagnosed with localized prostate cancer and their partners. Pre-intervention levels of psychological and relationship functioning were evaluated as moderators of intervention effects. Methods Seventy one survivors and their partners completed a baseline survey and were subsequently randomly assigned to receive five sessions of IET or Usual Care (no treatment). Eight weeks after the baseline assessment, a follow-up survey was administered to survivor and partner. Main outcome measures Distress, well-being, relationship satisfaction, relationship intimacy, and communication were investigated as the main outcomes.. Results IET effects were largely moderated by pre-intervention psychosocial and relationship factors. Those survivors who had higher levels of cancer concerns at pre-treatment had significantly reduced concerns following IET. Similar moderating effects for pre-intervention levels were reported for the effects of IET on self-disclosure, perceived partner disclosure, and perceived partner responsiveness. Among partners beginning the intervention with higher cancer-specific distress, lower marital satisfaction, lower intimacy, and poorer communication, IET improved these outcomes. Conclusions IET had a marginally significant main effect upon survivor well-being but was effective among couples with fewer personal and relationship resources. Subsequent research is needed to replicate these findings with a larger sample and a longer follow-up. PMID:21210958

Completeness of reporting of patient-relevant clinical trial outcomes: comparison of unpublished clinical study reports with publicly available data.

PubMed

Wieseler, Beate; Wolfram, Natalia; McGauran, Natalie; Kerekes, Michaela F; Vervölgyi, Volker; Kohlepp, Petra; Kamphuis, Marloes; Grouven, Ulrich

2013-10-01

Access to unpublished clinical study reports (CSRs) is currently being discussed as a means to allow unbiased evaluation of clinical research. The Institute for Quality and Efficiency in Health Care (IQWiG) routinely requests CSRs from manufacturers for its drug assessments. Our objective was to determine the information gain from CSRs compared to publicly available sources (journal publications and registry reports) for patient-relevant outcomes included in IQWiG health technology assessments (HTAs) of drugs. We used a sample of 101 trials with full CSRs received for 16 HTAs of drugs completed by IQWiG between 15 January 2006 and 14 February 2011, and analyzed the CSRs and the publicly available sources of these trials. For each document type we assessed the completeness of information on all patient-relevant outcomes included in the HTAs (benefit outcomes, e.g., mortality, symptoms, and health-related quality of life; harm outcomes, e.g., adverse events). We dichotomized the outcomes as "completely reported" or "incompletely reported." For each document type, we calculated the proportion of outcomes with complete information per outcome category and overall. We analyzed 101 trials with CSRs; 86 had at least one publicly available source, 65 at least one journal publication, and 50 a registry report. The trials included 1,080 patient-relevant outcomes. The CSRs provided complete information on a considerably higher proportion of outcomes (86%) than the combined publicly available sources (39%). With the exception of health-related quality of life (57%), CSRs provided complete information on 78% to 100% of the various benefit outcomes (combined publicly available sources: 20% to 53%). CSRs also provided considerably more information on harms. The differences in completeness of information for patient-relevant outcomes between CSRs and journal publications or registry reports (or a combination of both) were statistically significant for all types of outcomes. The main limitation of our study is that our sample is not representative because only CSRs provided voluntarily by pharmaceutical companies upon request could be assessed. In addition, the sample covered only a limited number of therapeutic areas and was restricted to randomized controlled trials investigating drugs. In contrast to CSRs, publicly available sources provide insufficient information on patient-relevant outcomes of clinical trials. CSRs should therefore be made publicly available. Please see later in the article for the Editors' Summary.

Randomized comparison of the clinical outcome of single versus multiple arterial grafts: the ROMA trial-rationale and study protocol.

PubMed

Gaudino, Mario; Alexander, John H; Bakaeen, Faisal G; Ballman, Karla; Barili, Fabio; Calafiore, Antonio Maria; Davierwala, Piroze; Goldman, Steven; Kappetein, Peter; Lorusso, Roberto; Mylotte, Darren; Pagano, Domenico; Ruel, Marc; Schwann, Thomas; Suma, Hisayoshi; Taggart, David P; Tranbaugh, Robert F; Fremes, Stephen

2017-12-01

The primary hypothesis of the ROMA trial is that in patients undergoing primary isolated non-emergent coronary artery bypass grafting, the use of 2 or more arterial grafts compared with a single arterial graft (SAG) is associated with a reduction in the composite outcome of death from any cause, any stroke, post-discharge myocardial infarction and/or repeat revascularization. The secondary hypothesis is that in these patients, the use of 2 or more arterial grafts compared with a SAG is associated with improved survival. The ROMA trial is a prospective, unblinded, randomized event-driven multicentre trial comprising at least 4300 subjects. Patients younger than 70 years with left main and/or multivessel disease will be randomized to a SAG or multiple arterial grafts to the left coronary system in a 1:1 fashion. Permuted block randomization stratified by the centre and the type of second arterial graft will be used. The primary outcome will be a composite of death from any cause, any stroke, post-discharge myocardial infarction and/or repeat revascularization. The secondary outcome will be all-cause mortality. The primary safety outcome will be a composite of death from any cause, any stroke and any myocardial infarction. In all patients, 1 internal thoracic artery will be anastomosed to the left anterior descending coronary artery. For patients randomized to the SAG group, saphenous vein grafts will be used for all non-left anterior descending target vessels. For patients randomized to the multiple arterial graft group, the main target vessel of the lateral wall will be grafted with either a radial artery or a second internal thoracic artery. Additional grafts for the multiple arterial graft group can be saphenous veins or supplemental arterial conduits. To detect a 20% relative reduction in the primary outcome, with 90% power at 5% alpha and assuming a time-to-event analysis, the sample size must include 845 events (and 3650 patients). To detect a 20% relative reduction in the secondary outcome, with 80% power at 5% alpha, the sample size must include 631 events (and 3650 patients). To be conservative, the sample size will be set at 4300 patients. The primary outcome will be tested according to the intention-to-treat principle. The primary analysis will be a Cox proportional hazards regression model, with the treatment arm included as a covariate. If non-proportional hazards are observed, alternatives to Cox proportional hazards regression will be explored. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

A Test of Major Assumptions about Behavior Change: A Comprehensive Look at the Effects of Passive and Active HIV-Prevention Interventions Since the Beginning of the Epidemic

ERIC Educational Resources Information Center

Albarracin, Dolores; Gillette, Jeffrey C.; Earl, Allison N.; Glasman, Laura R.; Durantini, Marta R.; Ho, Moon-Ho

2005-01-01

This meta-analysis tested the major theoretical assumptions about behavior change by examining the outcomes and mediating mechanisms of different preventive strategies in a sample of 354 HIV-prevention interventions and 99 control groups, spanning the past 17 years. There were 2 main conclusions from this extensive review. First, the most…

Stroke Location Is an Independent Predictor of Cognitive Outcome.

PubMed

Munsch, Fanny; Sagnier, Sharmila; Asselineau, Julien; Bigourdan, Antoine; Guttmann, Charles R; Debruxelles, Sabrina; Poli, Mathilde; Renou, Pauline; Perez, Paul; Dousset, Vincent; Sibon, Igor; Tourdias, Thomas

2016-01-01

On top of functional outcome, accurate prediction of cognitive outcome for stroke patients is an unmet need with major implications for clinical management. We investigated whether stroke location may contribute independent prognostic value to multifactorial predictive models of functional and cognitive outcomes. Four hundred twenty-eight consecutive patients with ischemic stroke were prospectively assessed with magnetic resonance imaging at 24 to 72 hours and at 3 months for functional outcome using the modified Rankin Scale and cognitive outcome using the Montreal Cognitive Assessment (MoCA). Statistical maps of functional and cognitive eloquent regions were derived from the first 215 patients (development sample) using voxel-based lesion-symptom mapping. We used multivariate logistic regression models to study the influence of stroke location (number of eloquent voxels from voxel-based lesion-symptom mapping maps), age, initial National Institutes of Health Stroke Scale and stroke volume on modified Rankin Scale and MoCA. The second part of our cohort was used as an independent replication sample. In univariate analyses, stroke location, age, initial National Institutes of Health Stroke Scale, and stroke volume were all predictive of poor modified Rankin Scale and MoCA. In multivariable analyses, stroke location remained the strongest independent predictor of MoCA and significantly improved the prediction compared with using only age, initial National Institutes of Health Stroke Scale, and stroke volume (area under the curve increased from 0.697-0.771; difference=0.073; 95% confidence interval, 0.008-0.155). In contrast, stroke location did not persist as independent predictor of modified Rankin Scale that was mainly driven by initial National Institutes of Health Stroke Scale (area under the curve going from 0.840 to 0.835). Similar results were obtained in the replication sample. Stroke location is an independent predictor of cognitive outcome (MoCA) at 3 months post stroke. © 2015 American Heart Association, Inc.

[Cardiovascular risk and cardiovascular events in the general population of the sanitary area of Toledo. RICARTO Study].

PubMed

Rodríguez-Roca, G C; Rodríguez-Padial, L; Alonso-Moreno, F J; Segura-Fragoso, A; Villarín-Castro, A; Rodríguez-García, M L; Menchén-Herreros, A; Rojas-Martelo, G A; Fernández-Conde, J A; Artigao-Rodenas, L M; Carbayo-Herencia, J A; Escobar-Cervantes, C; Hernández-Moreno, J; Fernández-Martín, J

2018-03-01

The main aim of this study is to ascertain the prevalence of cardiovascular risk factors (CVRF), target organ damage (TOD), cardiovascular disease (CVD), as well as life habits (physical exercise, alcohol consumption, and Mediterranean diet) in the population of a Health Area in Toledo, Spain, to assess cardiovascular risk (CVR). Epidemiological and observational study that will analyse a sample from the general population aged 18 years or older, randomly selected from a database of health cards, and stratified by age and gender. Clinical history, physical examination, and complementary tests will be performed. Aliquots of whole blood and serum samples will be stored at a temperature of-85°C to evaluate future genetic studies. CVR will be estimated by using SCORE project scales calibrated for Spanish population and the Framingham Heart Study scale. When the estimated sample size has been achieved and after a minimum follow-up of 5 years, a final visit will performed in which CVRF, TOD, CVD, CVRF control, and fatal and non-fatal outcomes will be evaluated. The RICARTO study is aimed to assess the prevalence of the main CVRF, TOD and CVD in order to determine the CVR in the general population of a health area of Toledo. An analysis will be repeated on the final sample after at least 5 years of follow-up to ascertain the incidence of CV outcomes and the temporal trends of life style, as well as the prevalence of CVRF, TOD, and CVD. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Payers' Perspectives: Health Economics Outcomes in Managed Care

PubMed Central

Bankhead, Charles

2015-01-01

The following summaries represent a sample of the many studies presented at the 27th Annual Meeting of the Academy of Managed Care Pharmacy (AMCP), April 7–10, 2015, in San Diego, CA. These summaries highlight some of the main trends in the current US healthcare, reflecting the impact of real-world, evidence-based issues of high interest for payers, employers, drug manufacturers, providers, patients, and other healthcare stakeholders. PMID:26085902

Intensity and breadth of participation in organized activities during the adolescent years: multiple associations with youth outcomes.

PubMed

Denault, Anne-Sophie; Poulin, François

2009-10-01

The goal of this study was to examine initial levels and rates of change in the intensity and breadth of participation in organized activities during the adolescent years, and how these participation practices were related to youth outcomes in later adolescence. The main objectives were (a) to examine growth curves of intensity and breadth of participation from Grades 7 through 11 and their interrelations, and (b) to test the associations between these dimensions of participation and academic orientation, risky behaviors, internalizing problems, and civic development in Grade 11. A homogenous sample of 299 youth (mean age = 13.37, SD = .41; 62% girls) were surveyed annually using questionnaires and phone interviews. The main results revealed that (a) even though both intensity and breadth of participation decreased over time, intensity of participation showed steeper declines by later grades, and (b) initial levels of participation were better predictors of later outcomes than rates of change over time. Regardless of the levels of change taking place over time, results revealed that youth with high initial levels of participation (both intensity and breadth) were more committed to school and developed more positive values towards society by Grade 11 than those who participated less. This might suggest that a high level of participation during early-to-mid-adolescence is particularly important when it comes to later outcomes.

Clinical evaluation of a Mucorales-specific real-time PCR assay in tissue and serum samples.

PubMed

Springer, Jan; Lackner, Michaela; Ensinger, Christian; Risslegger, Brigitte; Morton, Charles Oliver; Nachbaur, David; Lass-Flörl, Cornelia; Einsele, Hermann; Heinz, Werner J; Loeffler, Juergen

2016-12-01

Molecular diagnostic assays can accelerate the diagnosis of fungal infections and subsequently improve patient outcomes. In particular, the detection of infections due to Mucorales is still challenging for laboratories and physicians. The aim of this study was to evaluate a probe-based Mucorales-specific real-time PCR assay (Muc18S) using tissue and serum samples from patients suffering from invasive mucormycosis (IMM). This assay can detect a broad range of clinically relevant Mucorales species and can be used to complement existing diagnostic tests or to screen high-risk patients. An advantage of the Muc18S assay is that it exclusively detects Mucorales species allowing the diagnosis of Mucorales DNA without sequencing within a few hours. In paraffin-embedded tissue samples this PCR-based method allowed rapid identification of Mucorales in comparison with standard methods and showed 91 % sensitivity in the IMM tissue samples. We also evaluated serum samples, an easily accessible material, from patients at risk from IMM. Mucorales DNA was detected in all patients with probable/proven IMM (100 %) and in 29 % of the possible cases. Detection of IMM in serum could enable an earlier diagnosis (up to 21 days) than current methods including tissue samples, which were gained mainly post-mortem. A screening strategy for high-risk patients, which would enable targeted treatment to improve patient outcomes, is therefore possible.

Extending the Theory of Normative Social Behavior to Predict Hand-Washing among Koreans.

PubMed

Chung, Minwoong; Lapinski, Maria Knight

2018-04-10

The current study tests the predictions of the theory of normative social behavior (TNSB) in a hand-washing context in a Korean sample and extends the theory to examine the role of perceived publicness, a variable believed to activate face concerns, as a moderator of the norm-behavior relationship. The findings show substantial main effects for all of the study variables on behavior. In addition, the descriptive norm-behavior relationship is moderated by perceived publicness and outcome expectations, but the nature of the interactions is not consistent with that evidenced in previous literature on US samples. Implications for normative theory and communication campaigns are discussed.

Does Money Matter: Earnings Patterns Among a National Sample of the US State Governmental Public Health Agency Workforce

PubMed Central

Castrucci, Brian C.; Leider, Jonathon P.; Liss-Levinson, Rivka; Sellers, Katie

2015-01-01

Context: Earnings have been shown to be a critical point in workforce recruitment and retention. However, little is known about how much governmental public health staff are paid across the United States. Objective: To characterize earnings among state health agency central office employees. Design: A cross-sectional survey was conducted of state health agency central office employees in late 2014. The sampling approach was stratified by 5 (paired HHS) regions. Balanced repeated replication weights were used to correctly calculate variance estimates, given the complex sampling design. Descriptive and bivariate statistical comparisons were conducted. A linear regression model was used to examine correlates of earnings among full-time employees. Setting and Participants: A total of 9300 permanently employed, full-time state health agency central office staff who reported earnings information. Main Outcome Measure: Earnings are the main outcomes examined in this article. Results: Central office staff earn between $55 000 and $65 000 on average annually. Ascending supervisory status, educational attainment, and tenure are all associated with greater earnings. Those employed in clinical and laboratory positions and public health science positions earn more than their colleagues in administrative positions. Disparities exist between men and women, with men earning more, all else being equal (P < .001). Racial/ethnic disparities also exist, after accounting for other factors. Conclusions: This study provides baseline information to characterize the workforce and key challenges that result from earnings levels, including disparities in earnings that persist after accounting for education and experience. Data from the survey can inform strategies to address earnings issues and help reduce disparities. PMID:26422496

Caregiver Insightfulness and Young Children’s Violence Exposure: Testing a Relational Model of Risk and Resilience

PubMed Central

Gray, Sarah A. O.; Forbes, Danielle; Briggs-Gowan, Margaret; Carter, Alice S.

2016-01-01

This study employed a relational post-traumatic stress frame to explore the co-contribution of young children’s exposure to violence and caregiver insightfulness on child behavioral outcomes in a high-risk, non-referred sample of caregivers and preschoolers (n = 64; mean age 3.83 years, SD = .77). Caregiver insightfulness did not have a main effect on child outcomes but did moderate the relation between violence exposure and child behavior across all observed outcomes. Violence-exposed children with non-insightful caregivers demonstrated higher caregiver-rated internalizing and externalizing behaviors and observer-rated negative affect than all other groups. Among children not exposed to violence, insightfulness was not related to children’s behavior problems or negative affect, suggesting violence-specific processes. Though cross-sectional, results suggest that the effects of violence and caregiver insightfulness on child outcomes are contingent on one another and that caregiver insightfulness may play a protective role in contexts of violence. PMID:26503175

Volunteers in Circles of Support and Accountability Job Demands, Job Resources, and Outcome.

PubMed

Höing, Mechtild; Bogaerts, Stefan; Vogelvang, Bas

2017-09-01

In Circles of Support and Accountability (CoSA), volunteers support a medium- to high-risk sex offender in his process toward desistance by developing a long-term empathic relationship. More knowledge is needed about the impact of this work on volunteers themselves. In a sample of 40 Dutch CoSA volunteers-at the time constituting 37% of the national population of 108 then active CoSA volunteers-we measured outcome in terms of volunteer satisfaction, determination to continue, compassion satisfaction, burnout and secondary stress, vicarious growth, civic capacities, and professional skills. We explored theoretically derived predictors of positive and negative outcome, and conceptualized them within the Job Demands-Resources model (JD-R). Volunteers reported mainly positive effects, especially high levels of volunteer satisfaction, compassion satisfaction, and determination to continue. Results indicated that job demands and most of the internal job resources were of minor importance. External job resources, especially social support and connectedness, were associated with positive outcome. Connectedness mediated the effect of social support on compassion satisfaction.

Completeness of Reporting of Patient-Relevant Clinical Trial Outcomes: Comparison of Unpublished Clinical Study Reports with Publicly Available Data

PubMed Central

Wieseler, Beate; Wolfram, Natalia; McGauran, Natalie; Kerekes, Michaela F.; Vervölgyi, Volker; Kohlepp, Petra; Kamphuis, Marloes; Grouven, Ulrich

2013-01-01

Background Access to unpublished clinical study reports (CSRs) is currently being discussed as a means to allow unbiased evaluation of clinical research. The Institute for Quality and Efficiency in Health Care (IQWiG) routinely requests CSRs from manufacturers for its drug assessments. Our objective was to determine the information gain from CSRs compared to publicly available sources (journal publications and registry reports) for patient-relevant outcomes included in IQWiG health technology assessments (HTAs) of drugs. Methods and Findings We used a sample of 101 trials with full CSRs received for 16 HTAs of drugs completed by IQWiG between 15 January 2006 and 14 February 2011, and analyzed the CSRs and the publicly available sources of these trials. For each document type we assessed the completeness of information on all patient-relevant outcomes included in the HTAs (benefit outcomes, e.g., mortality, symptoms, and health-related quality of life; harm outcomes, e.g., adverse events). We dichotomized the outcomes as “completely reported” or “incompletely reported.” For each document type, we calculated the proportion of outcomes with complete information per outcome category and overall. We analyzed 101 trials with CSRs; 86 had at least one publicly available source, 65 at least one journal publication, and 50 a registry report. The trials included 1,080 patient-relevant outcomes. The CSRs provided complete information on a considerably higher proportion of outcomes (86%) than the combined publicly available sources (39%). With the exception of health-related quality of life (57%), CSRs provided complete information on 78% to 100% of the various benefit outcomes (combined publicly available sources: 20% to 53%). CSRs also provided considerably more information on harms. The differences in completeness of information for patient-relevant outcomes between CSRs and journal publications or registry reports (or a combination of both) were statistically significant for all types of outcomes. The main limitation of our study is that our sample is not representative because only CSRs provided voluntarily by pharmaceutical companies upon request could be assessed. In addition, the sample covered only a limited number of therapeutic areas and was restricted to randomized controlled trials investigating drugs. Conclusions In contrast to CSRs, publicly available sources provide insufficient information on patient-relevant outcomes of clinical trials. CSRs should therefore be made publicly available. Please see later in the article for the Editors' Summary PMID:24115912

Arabian nights—1001 tales of how pharmaceutical companies cater to the material needs of doctors: case report

PubMed Central

Giannakakis, Ioannis A; Ioannidis, John P A

2000-01-01

Objective To describe how pharmaceutical companies cater to the material needs of doctors. Design Case report of memoirs. Setting Facilities that have nothing to do with medicine, somewhere in the Arabian peninsula. Patient population Random sample of doctors. Interventions Promotion by the pharmaceutical industry. Main outcome measures Short term outcomes were travel, pleasure, amusement, and gifts, and long term outcomes were the market share of specific companies. Results Short term outcomes were heterogeneous, underlying the diversity of the means employed by the pharmaceutical industry to subvert, divert, and influence medical practice. Overall, 200 doctors were dressed in white gowns, a doctor in preventive medicine quoted Hippocrates in favour of smoking, a senior doctor became a poet, a doctor trying to understand the Methods section of a poster paper wondered whether he should have been sunbathing at the beach instead, and two women doctors were kidnapped by Bedouin warriors. Long term outcomes on the sales of the company drugs are pending but are likely to be most favourable. Conclusions Eat, drink, be merry, and boost prescriptions. PMID:11124175

Income Transfers and Maternal Health: Evidence from a National Randomized Social Cash Transfer Program in Zambia.

PubMed

Handa, Sudhanshu; Peterman, Amber; Seidenfeld, David; Tembo, Gelson

2016-02-01

There is promising recent evidence that poverty-targeted social cash transfers have potential to improve maternal health outcomes; however, questions remain surrounding design features responsible for impacts. In addition, virtually no evidence exists from the African region. This study explores the impact of Zambia's Child Grant Program on a range of maternal health utilization outcomes using a randomized design and difference-in-differences multivariate regression from data collected over 24 months from 2010 to 2012. Results indicate that while there are no measurable program impacts among the main sample, there are heterogeneous impacts on skilled attendance at birth among a sample of women residing in households having better access to maternal health services. The latter result is particularly interesting because of the overall low level of health care availability in program areas suggesting that dedicated program design or matching supply-side interventions may be necessary to leverage unconditional cash transfers in similar settings to impact maternal health. Copyright © 2015 John Wiley & Sons, Ltd.

Income transfers and maternal health: Evidence from a national randomized social cash transfer program in Zambia

PubMed Central

Handa, Sudhanshu; Peterman, Amber; Seidenfeld, David; Tembo, Gelson

2017-01-01

There is promising recent evidence that poverty-targeted social cash transfers have potential to improve maternal health outcomes, however questions remain surrounding design features responsible for impacts. In addition, virtually no evidence exists from the African region. This study explores the impact of Zambia’s Child Grant Program on a range of maternal health utilization outcomes using a randomized design and difference-in-differences multivariate regression from data collected over 24 months from 2010 to 2012. Results indicate that while there are no measurable program impacts among the main sample, there are heterogeneous impacts on skilled attendance at birth among a sample of women residing in households having better access to maternal health services. The latter result is particularly interesting because of the overall low level of healthcare availability in program areas suggesting dedicated program design or matching supply-side interventions may be necessary to leverage unconditional cash transfers in similar settings to impact maternal health. PMID:25581062

Child maltreatment and violent delinquency: disentangling main effects and subgroup effects.

PubMed

Mersky, Joshua P; Reynolds, Arthur J

2007-08-01

This study employs data from the Chicago Longitudinal Study (CLS) to investigate the relation between child maltreatment and the incidence and frequency of violent delinquency. The authors also examine if effects vary between physically abused and neglected children and if select indicators (sex, cumulative risk, public aid receipt) moderate the connections between maltreatment and violent outcomes. The CLS follows a cohort of 1,539 low-income, minority children who attended public kindergarten programs in 1985-1986. The primary sample includes 1,404 participants for whom maltreatment and delinquency status were verified. Maltreatment is significantly associated with all violent outcomes investigated. Effects are comparable for physically abused and neglected children. Results indicate that public assistance, particularly persistent receipt, moderates the association between maltreatment and multiple outcomes. Findings support the hypothesized connection between maltreatment and violent delinquency while highlighting certain subgroups that may be at elevated risk. Implications for research design and program development are discussed.

Factors influencing trust in doctors: a community segmentation strategy for quality improvement in healthcare

PubMed Central

Gopichandran, Vijayaprasad; Chetlapalli, Satish Kumar

2013-01-01

Background Trust is a forward-looking covenant between the patient and the doctor where the patient optimistically accepts his/her vulnerability. Trust is known to improve the clinical outcomes. Objectives To explore the factors that determine patients’ trust in doctors and to segment the community based on factors which drive their trust. Setting Resource-poor urban and rural settings in Tamil Nadu, a state in southern India. Participants A questionnaire was administered to a sample of 625 adult community-dwelling respondents from four districts of Tamil Nadu, India, chosen by multistage sampling strategy. Outcome measures The outcomes were to understand the main domains of factors influencing trust in doctors and to segment the community based on which of these domains predominantly influenced their trust. Results Factor analysis revealed five main categories, namely, comfort with the doctor, doctor with personal involvement with the patient, behaviourally competent doctor, doctor with a simple appearance and culturally competent doctor, which explained 49.3% of the total variance. Using k-means cluster analysis the respondents were segmented into four groups, namely, those who have ‘comfort-based trust’, ‘emotionally assessed trust’, who were predominantly older and belonging to lower socioeconomic status, those who had ‘personal trust’, who were younger people from higher socioeconomic strata of the community and the group who had ‘objectively assessed trust’, who were younger women. Conclusions Trust in doctors seems to be influenced by the doctor's behaviuor, perceived comfort levels, personal involvement with the patient, and to a lesser extent by cultural competence and doctor's physical appearance. On the basis of these dimensions, the community can be segmented into distinct groups, and trust building can happen in a strategic manner which may lead to improvement in perceived quality of care. PMID:24302512

Cohort Profile: Tracing Achievements, Key processes and Efforts in professional care for Children and Adolescents REsearch; TAKECARE.

PubMed

Verhage, Vera; Noordik, Erik; Knorth, Erik J; Reijneveld, Sijmen A

2016-12-01

TAKECARE is a prospective cohort study designed in The Netherlands to obtain evidence on the care chain for children and adolescents with psychosocial problems, and its long-term outcomes. Little is known about the content of care as offered and on whether the care is adequate. The cohort consists of children and adolescents entering care for psychosocial problems (care sample, n = 1382) and a random sample of the general population (community sample, n = 666). Children were eligible for participation if they were aged 4-18 years (inclusive) and had estimated IQs of 70 and over. The care sample covers the fields of Preventive Child Healthcare (PCH), Child and Adolescent Social Care (CASC) and Child and Adolescent Mental Healthcare (CAMH). Children, parents or guardians and involved practitioners completed five questionnaires (baseline, and at 3, 12, 24 and 36 months thereafter). The main categories of data concern the sociodemographic characteristics of children and their parents or guardians, the characteristics of entry into care and care content, and intermediate and final treatment outcomes. Information about data access can be requested by e-mail: c4youth@umcg.nl. © The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

Discrepancy between results and abstract conclusions in industry- vs nonindustry-funded studies comparing topical prostaglandins.

PubMed

Alasbali, Tariq; Smith, Michael; Geffen, Noa; Trope, Graham E; Flanagan, John G; Jin, Yaping; Buys, Yvonne M

2009-01-01

To investigate the relationship between industry- vs nonindustry-funded publications comparing the efficacy of topical prostaglandin analogs by evaluating the correspondence between the statistical significance of the publication's main outcome measure and its abstract conclusions. Retrospective, observational cohort study. English publications comparing the ocular hypotensive efficacy between any or all of latanoprost, travoprost, and bimatoprost were searched from the MEDLINE database. Each article was reviewed by three independent observers and was evaluated for source of funding, study quality, statistically significant main outcome measure, correspondence between results of main outcome measure and abstract conclusion, number of intraocular pressure outcomes compared, and journal impact factor. Funding was determined by published disclosure or, in cases of no documented disclosure, the corresponding author was contacted directly to confirm industry funding. Discrepancies were resolved by consensus. The main outcome measure was correspondence between abstract conclusion and reported statistical significance of the publications' main outcome measure. Thirty-nine publications were included, of which 29 were industry funded and 10 were nonindustry funded. The published abstract conclusion was not consistent with the results of the main outcome measure in 18 (62%) of 29 of the industry-funded studies compared with zero (0%) of 10 of the nonindustry-funded studies (P = .0006). Twenty-six (90%) of the industry-funded studies had proindustry abstract conclusions. Twenty-four percent of the industry-funded publications had a statistically significant main outcome measure; however, 90% of the industry-funded studies had proindustry abstract conclusions. Both readers and reviewers should scrutinize publications carefully to ensure that data support the authors' conclusions.

Duration of untreated illness in panic disorder: a poor outcome risk factor?

PubMed

Altamura, A Carlo; Santini, Annalisa; Salvadori, Daniele; Mundo, Emanuela

2005-12-01

The aim of this naturalistic study was to evaluate the impact of the duration of untreated illness (DUI) on the outcome and treatment response of panic disorder (PD). Ninety-six outpatients with PD who underwent an 8-week open-label treatment with serotonergic antidepressants were subdivided into two subgroups: those with DUI 1 year. The main baseline demographic and clinical variables were calculated and compared between the two subgroups of patients (chi-square test or t-test for independent samples). The effect of the antipanic medication was evaluated by analysis of variance with repeated measures considering Hamilton Rating Scale for Anxiety, Clinical Global Impression rating scores, and the number of panic attacks/week as the dependent variables (outcome measures), while the subgroups were the independent ones. Comorbidity with onset later than PD was also considered. There were no differences between patients with DUI 1 year with respect to the outcome measures considered. However, patients with DUI > 1 year (N = 64) had a higher frequency of comorbid major depressive disorder (MDD) with onset later than PD (p = 0.006). Results from this study suggest that the DUI may be a predictor of the development of comorbid MDD in PD. Further investigations on larger samples and with longer follow-up are warranted.

Duration of untreated illness in panic disorder: a poor outcome risk factor?

PubMed Central

Altamura, A Carlo; Santini, Annalisa; Salvadori, Daniele; Mundo, Emanuela

2005-01-01

Objective The aim of this naturalistic study was to evaluate the impact of the duration of untreated illness (DUI) on the outcome and treatment response of panic disorder (PD). Methods Ninety-six outpatients with PD who underwent an 8-week open-label treatment with serotonergic antidepressants were subdivided into two subgroups: those with DUI ≤ 1 year and those with DUI > 1 year. The main baseline demographic and clinical variables were calculated and compared between the two subgroups of patients (chi-square test or t-test for independent samples). The effect of the antipanic medication was evaluated by analysis of variance with repeated measures considering Hamilton Rating Scale for Anxiety, Clinical Global Impression rating scores, and the number of panic attacks/week as the dependent variables (outcome measures), while the subgroups were the independent ones. Comorbidity with onset later than PD was also considered. Results There were no differences between patients with DUI ≤ 1 year and patients with DUI > 1 year with respect to the outcome measures considered. However, patients with DUI > 1 year (N = 64) had a higher frequency of comorbid major depressive disorder (MDD) with onset later than PD (p = 0.006). Conclusions Results from this study suggest that the DUI may be a predictor of the development of comorbid MDD in PD. Further investigations on larger samples and with longer follow-up are warranted. PMID:18568114

Computer-assisted cognitive remediation therapy: cognition, self-esteem and quality of life in schizophrenia.

PubMed

Garrido, Gemma; Barrios, Maite; Penadés, Rafael; Enríquez, Maria; Garolera, Maite; Aragay, Núria; Pajares, Marta; Vallès, Vicenç; Delgado, Luis; Alberni, Joan; Faixa, Carlota; Vendrell, Josep M

2013-11-01

Quality of life (QoL) is an important outcome in the treatment of schizophrenia. Cognitive deficits have an impact on functional outcomes. Cognitive remediation therapy is emerging as a psychological intervention that targets cognitive impairment, but the effect of computer-assisted cognitive remediation on neuropsychology and social functioning and wellbeing remains unclear. The aim of the current study is to investigate the neurocognitive outcomes of computer-assisted cognitive remediation (CACR) therapy in a sample of schizophrenia patients, and to measure the quality of life and self-esteem as secondary outcomes. Sixty-seven people with schizophrenia were randomly assigned to computer-assisted cognitive remediation or an active control condition. The main outcomes were neuropsychological measures and secondary outcomes (self-esteem and quality of life). Measurements were recorded at baseline and post-treatment. The CACR therapy group improved in speed of processing, working memory and reasoning and problem-solving cognitive domains. QoL and self-esteem measures also showed significant improvements over time in this group. Computer-assisted cognitive remediation therapy for people with schizophrenia achieved improvements in neuropsychological performance and in QoL and self-esteem measurements. © 2013 Elsevier B.V. All rights reserved.

Nature, Decay, and Spiraling of the Effects of Fear-Inducing Arguments and HIV Counseling and Testing: A Meta-Analysis of the Short- and Long-Term Outcomes of HIV-Prevention Interventions

PubMed Central

Earl, Allison; Albarracín, Dolores

2009-01-01

Objective To examine the long-term efficacy of both fear-inducing arguments and HIV counseling and testing at encouraging and maintaining knowledge about HIV transmission and prevention, as well as condom use. Design Analyses were conducted with a sample of 150 treatment groups and 34 controls and included measures of change at an immediate follow-up and a delayed follow-up. Main outcome measures The main outcome measures were perceived risk of HIV infection, knowledge about HIV, and condom use. Results Results indicated that receiving fear-inducing arguments increased perceptions of risk at the immediate follow-up but decreased knowledge and condom use, whereas resolving fear via HIV counseling and testing decreased perceptions of risk and increased knowledge and condom use at both the immediate and delayed follow-ups. The effects on perceived risk and knowledge decreased over time, but the effects on condom use became more pronounced. Conclusion Inducing fear is not an effective way to promote HIV-relevant learning or condom use either immediately following the intervention or later on. However, HIV counseling and testing can provide an outlet for HIV-related anxiety and, subsequently, gains in both knowledge and behavior change immediately and longitudinally. PMID:17605570

Relations and effects of transformational leadership: a comparative analysis with traditional leadership styles.

PubMed

Molero, Fernando; Cuadrado, Isabel; Navas, Marisol; Morales, J Francisco

2007-11-01

This study has two main goals: (a) to compare the relationship between transformational leadership and other important leadership styles (i.e., democratic versus autocratic or relations- and task-oriented leadership) and (b) to compare the effects of transformational leadership and the other styles on some important organizational outcomes such as employees' satisfaction and performance. For this purpose, a sample of 147 participants, working in 35 various work-teams, was used. Results show high correlations between transformational leadership, relations-oriented, democratic, and task-oriented leadership. On the other hand, according to the literature, transformational leadership, especially high levels, significantly increases the percentage of variance accounted for by other leadership styles in relevant organizational outcome variables (subordinates' performance, satisfaction and extra effort).

Model-driven meta-analyses for informing health care: a diabetes meta-analysis as an exemplar.

PubMed

Brown, Sharon A; Becker, Betsy Jane; García, Alexandra A; Brown, Adama; Ramírez, Gilbert

2015-04-01

A relatively novel type of meta-analysis, a model-driven meta-analysis, involves the quantitative synthesis of descriptive, correlational data and is useful for identifying key predictors of health outcomes and informing clinical guidelines. Few such meta-analyses have been conducted and thus, large bodies of research remain unsynthesized and uninterpreted for application in health care. We describe the unique challenges of conducting a model-driven meta-analysis, focusing primarily on issues related to locating a sample of published and unpublished primary studies, extracting and verifying descriptive and correlational data, and conducting analyses. A current meta-analysis of the research on predictors of key health outcomes in diabetes is used to illustrate our main points. © The Author(s) 2014.

MODEL-DRIVEN META-ANALYSES FOR INFORMING HEALTH CARE: A DIABETES META-ANALYSIS AS AN EXEMPLAR

PubMed Central

Brown, Sharon A.; Becker, Betsy Jane; García, Alexandra A.; Brown, Adama; Ramírez, Gilbert

2015-01-01

A relatively novel type of meta-analysis, a model-driven meta-analysis, involves the quantitative synthesis of descriptive, correlational data and is useful for identifying key predictors of health outcomes and informing clinical guidelines. Few such meta-analyses have been conducted and thus, large bodies of research remain unsynthesized and uninterpreted for application in health care. We describe the unique challenges of conducting a model-driven meta-analysis, focusing primarily on issues related to locating a sample of published and unpublished primary studies, extracting and verifying descriptive and correlational data, and conducting analyses. A current meta-analysis of the research on predictors of key health outcomes in diabetes is used to illustrate our main points. PMID:25142707

Latent classes of emotional and behavioural problems in epidemiological and referred samples and their relations to DSM-IV diagnoses.

PubMed

Bianchi, Valentina; Brambilla, Paolo; Garzitto, Marco; Colombo, Paola; Fornasari, Livia; Bellina, Monica; Bonivento, Carolina; Tesei, Alessandra; Piccin, Sara; Conte, Stefania; Perna, Giampaolo; Frigerio, Alessandra; Castiglioni, Isabella; Fabbro, Franco; Molteni, Massimo; Nobile, Maria

2017-05-01

Researchers' interest have recently moved toward the identification of recurrent psychopathological profiles characterized by concurrent elevations on different behavioural and emotional traits. This new strategy turned to be useful in terms of diagnosis and outcome prediction. We used a person-centred statistical approach to examine whether different groups could be identified in a referred sample and in a general-population sample of children and adolescents, and we investigated their relation to DSM-IV diagnoses. A latent class analysis (LCA) was performed on the Child Behaviour Checklist (CBCL) syndrome scales of the referred sample (N = 1225), of the general-population sample (N = 3418), and of the total sample. Models estimating 1-class through 5-class solutions were compared and agreement in the classification of subjects was evaluated. Chi square analyses, a logistic regression, and a multinomial logistic regression analysis were used to investigate the relations between classes and diagnoses. In the two samples and in the total sample, the best-fitting models were 4-class solutions. The identified classes were Internalizing Problems (15.68%), Severe Dysregulated (7.82%), Attention/Hyperactivity (10.19%), and Low Problems (66.32%). Subsequent analyses indicated a significant relationship between diagnoses and classes as well as a main association between the severe dysregulated class and comorbidity. Our data suggested the presence of four different psychopathological profiles related to different outcomes in terms of psychopathological diagnoses. In particular, our results underline the presence of a profile characterized by severe emotional and behavioural dysregulation that is mostly associated with the presence of multiple diagnosis.

Sex differences in left main coronary artery stenting: Different characteristics but similar outcomes for women compared with men.

PubMed

Shin, Eun-Seok; Lee, Cheol Whan; Ahn, Jung-Min; Lee, Pil Hyung; Chang, Mineok; Kim, Min-Ju; Yoon, Sung-Han; Park, Duk-Woo; Kang, Soo-Jin; Lee, Seung-Whan; Kim, Young-Hak; Park, Seong-Wook; Park, Seung-Jung

2018-02-15

The clinical outcomes for women compared with men undergoing left main PCI were sparse. We compared the characteristics and long-term outcomes in women versus men after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for unprotected left main CAD. We identified 2328 patients (545 women; 1783 men) with unprotected left main CAD who received PCI with DES between January 2007 and December 2013 in the Interventional Cardiology Research In-cooperation Society-left MAIN revascularization (IRIS-MAIN) registry. The primary outcome was a composite of death from any cause, myocardial infarction, or stroke. The median follow-up time was 2.9years (interquartile range: 1.0-4.1years). Women were older, had a higher incidence of insulin-requiring diabetes mellitus and hypertension, and more commonly presented with acute coronary syndrome than men. Left main ostial lesion was more common in women, whereas left main bifurcation lesion with more extensive CAD was more common in men. The incidence of primary outcome was similar between the two groups (10.8% vs. 10.8%, respectively, log-rank p=0.587). The results were similar after adjustment for baseline variables and consistent across major subgroups. The need for target lesion revascularization was significantly higher in women than in men (8.8% vs. 5.7%, respectively, p<0.05) but the sex bias was not confirmed after adjusting for confounders. Women, as compared to men, had different clinical and lesion characteristics but similar long-term outcomes after PCI with DES for left main CAD. Copyright © 2017 Elsevier B.V. All rights reserved.

Injectable, sustained-release naltrexone for the treatment of opioid dependence: a randomized, placebo-controlled trial

PubMed Central

Comer, Sandra D.; Sullivan, Maria A.; Yu, Elmer; Rothenberg, Jami L.; Kleber, Herbert D.; Kampman, Kyle; Dackis, Charles; O'Brien, Charles P.; Chiang, C. Nora; Hawks, Richard L.

2013-01-01

Context Naltrexone is a medication available in oral form that can completely block the effects produced by opioid agonists, such as heroin. However, poor medication compliance with naltrexone has been a major obstacle to the effective treatment of opioid dependence. Objective To evaluate the safety and efficacy of a sustained-release depot formulation of naltrexone in treating opioid dependence. Design, Setting, and Participants Randomized, double-blind, placebo-controlled, 8-week multi-center trial of male and female heroin-dependent patients who participated in the study between September 2000 and November 2003. Participants were stratified by years of heroin use (≥5, <4.9) and gender, and then randomized to receive one of three doses: placebo, 192 mg, or 384 mg depot naltrexone. Doses were administered at the beginning of Week 1 and then again four weeks later at the beginning of Week 5. All participants received twice-weekly relapse prevention therapy, provided observed urine samples, and completed other assessments at each visit. Main Outcome Measures Primary outcome measures were retention in treatment and percentage of opioid-negative urine samples. Results A total of 60 patients were randomized at two centers. Retention in treatment was dose related with 39%, 60%, and 68% of the patients in the placebo, naltrexone 192 mg, and naltrexone 384 mg groups, respectively, remaining in treatment at the end of the two-month treatment period. Analysis of the time to dropout revealed a significant main effect of dose with mean time to dropout of 27, 36, and 48 days, respectively, for the placebo, naltrexone 192 mg, and naltrexone 384 mg groups. The percentage of urine samples negative for opioids varied significantly as a function of dose, as did the percentage of urine samples negative for methadone, cocaine, benzodiazepines, and amphetamine. The percentage of urine samples negative for cannabinoids was not significantly different across groups. When the data were recalculated without the assumption that missing urine samples were positive, however, a main effect of group was not found for any of the drugs tested with the exception of cocaine, where the percentage of cocaine-negative urines was lower in the placebo group. Adverse events were minimal and generally mild in severity. This sustained-release formulation of naltrexone was well tolerated and produced a robust and dose-related increase in treatment retention. Conclusion The present data provide exciting new evidence for the feasibility, efficacy, and tolerability of long-lasting antagonist treatments for opioid dependence. PMID:16461865

Power Calculations to Select Instruments for Clinical Trial Secondary Endpoints. A Case Study of Instrument Selection for Post-Traumatic Stress Symptoms in Subjects with Acute Respiratory Distress Syndrome

PubMed Central

Schoenfeld, David A.; Brown, Samuel M.; Hough, Catherine L.; Yealy, Donald M.; Moss, Marc; Angus, Derek C.; Iwashyna, Theodore J.

2017-01-01

Rationale: After the sample size of a randomized clinical trial (RCT) is set by the power requirement of its primary endpoint, investigators select secondary endpoints while unable to further adjust sample size. How the sensitivity and specificity of an instrument used to measure these outcomes, together with their expected underlying event rates, affect an RCT’s power to measure significant differences in these outcomes is poorly understood. Objectives: Motivated by the design of an RCT of neuromuscular blockade in acute respiratory distress syndrome, we examined how power to detect a difference in secondary endpoints varies with the sensitivity and specificity of the instrument used to measure such outcomes. Methods: We derived a general formula and Stata code for calculating an RCT’s power to detect differences in binary outcomes when such outcomes are measured with imperfect sensitivity and specificity. The formula informed the choice of instrument for measuring post-traumatic stress–like symptoms in the Reevaluation of Systemic Early Neuromuscular Blockade RCT (www.clinicaltrials.gov identifier NCT02509078). Measurements and Main Results: On the basis of published sensitivities and specificities, the Impact of Events Scale-Revised was predicted to measure a 36% symptom rate, whereas the Post-Traumatic Stress Symptoms instrument was predicted to measure a 23% rate, if the true underlying rate of post-traumatic stress symptoms were 25%. Despite its lower sensitivity, the briefer Post-Traumatic Stress Symptoms instrument provided superior power to detect a difference in rates between trial arms, owing to its higher specificity. Conclusions: Examining instruments’ power to detect differences in outcomes may guide their selection when multiple instruments exist, each with different sensitivities and specificities. PMID:27788018

Interactions of Sexual Activity, Gender, and Depression with Immunity

PubMed Central

Lorenz, Tierney; van Anders, Sari

2015-01-01

Introduction Depression can suppress immune function, leading to lower resistance against infection and longer healing times in depressed individuals. Sexuality may also influence immune function, with evidence that sexual activity is associated with lowered immune function in women and mixed results in men. Immune mediators like immunoglobulin A (IgA) are immediately relevant to sexual health, since they are the first line of defense against pathogens at mucous membranes like the vagina. Aim This study aims to determine if and how depression, sexual activity, and their interaction impact salivary IgA (SIgA) in men and women. Methods In Study 1, a community-based sample of 84 women and 88 men provided saliva samples and completed questionnaires on their demographic background, level of depression, and frequency of partnered and solitary sexual activity. Study 2, conducted separately in an undergraduate student sample of 54 women and 52 men, had similar methods. Main Outcome Measures The main outcome measures were scores on the General Well-Being Schedule depression subscale, reported frequency of sexual activity, and SIgA levels as measured by enzyme immunoassay. Results Across studies, higher levels of partnered sexual activity were associated with lower SIgA for women with high depression scores, but not for women with low depression scores. In contrast, higher levels of partnered sexual activity were associated with higher SIgA for men with high depression scores, but not for men with low depression scores. Conclusion Our results show that partnered sexual activity is a risk factor for lowered immunity in women with depressive symptoms but a possible resilience factor for men with depressive symptoms. This suggests a role for sexual activity in determining the impact of depression on physical health parameters. PMID:23448297

Outcomes of organ donation in brain-dead patient's families: Ethical perspective.

PubMed

Ahmadian, Shamsi; Rahimi, Abolfazl; Khaleghi, Ebrahim

2017-01-01

The families of brain-dead patients have a significant role in the process of decision making for organ donation. Organ donation is a traumatic experience. The ethical responsibility of healthcare systems respecting organ donation is far beyond the phase of decision making for donation. The principles of donation-related ethics require healthcare providers and organ procurement organizations to respect donor families and protect them against any probable harm. Given the difficult and traumatic nature of donation-related experience, understanding the outcomes of donation appears crucial. The aim of this study was to explore the outcomes of organ donation for the families of brain-dead patients. This was a qualitative descriptive study to which a purposeful sample of 19 donor family members were recruited. Data were collected through holding in-depth semi-structured interviews with the participants. Data analysis was performed by following the qualitative content analysis approach developed by Elo and Kyngäs. The main category of the data was "Decision to organ donation: a challenge from conflict to transcendence." This main category consisted of 10 subcategories and 3 general categories. The general categories were "challenging outcomes," "reassuring outcomes," and "transcending outcomes." Ethical considerations: The study was approved by the regional ethical review board. The ethical principles of informed consent, confidentiality, and non-identification were used. Donor families experience different challenges which range from conflict and doubtfulness to confidence, satisfaction, and transcendence. Healthcare providers and organ procurers should not discontinue care and support provision to donor families after obtaining their consent to donate because the post-decision phase is also associated with different complexities and difficulties with which donor families may not be able to cope effectively. In order to help donor families achieve positive outcomes from the tragedy of significant loss, healthcare professionals need to facilitate the process of achieving confidence and transcendence by them.

Critical analysis of consecutive unilateral cleft lip repairs: determining ideal sample size.

PubMed

Power, Stephanie M; Matic, Damir B

2013-03-01

Objective : Cleft surgeons often show 10 consecutive lip repairs to reduce presentation bias, however the validity remains unknown. The purpose of this study is to determine the number of consecutive cases that represent average outcomes. Secondary objectives are to determine if outcomes correlate with cleft severity and to calculate interrater reliability. Design : Consecutive preoperative and 2-year postoperative photographs of the unilateral cleft lip-nose complex were randomized and evaluated by cleft surgeons. Parametric analysis was performed according to chronologic, consecutive order. The mean standard deviation over all raters enabled calculation of expected 95% confidence intervals around a mean tested for various sample sizes. Setting : Meeting of the American Cleft Palate-Craniofacial Association in 2009. Patients, Participants : Ten senior cleft surgeons evaluated 39 consecutive lip repairs. Main Outcome Measures : Preoperative severity and postoperative outcomes were evaluated using descriptive and quantitative scales. Results : Intraclass correlation coefficients for cleft severity and postoperative evaluations were 0.65 and 0.21, respectively. Outcomes did not correlate with cleft severity (P  =  .28). Calculations for 10 consecutive cases demonstrated wide 95% confidence intervals, spanning two points on both postoperative grading scales. Ninety-five percent confidence intervals narrowed within one qualitative grade (±0.30) and one point (±0.50) on the 10-point scale for 27 consecutive cases. Conclusions : Larger numbers of consecutive cases (n > 27) are increasingly representative of average results, but less practical in presentation format. Ten consecutive cases lack statistical support. Cleft surgeons showed low interrater reliability for postoperative assessments, which may reflect personal bias when evaluating another surgeon's results.

Integrating clinical and biological information in a shanghai biobank: an introduction to the sample repository and information sharing platform project.

PubMed

Cui, Wenbin; Zheng, Peiyong; Yang, Jiahong; Zhao, Rong; Gao, Jiechun; Yu, Guangjun

2015-02-01

Biobanks are important resources and central tools for translational medicine, which brings scientific research outcomes to clinical practice. The key purpose of biobanking in translational medicine and other medical research is to provide biological samples that are integrated with clinical information. In 2008, the Shanghai Municipal Government launched the "Shanghai Tissue Bank" in an effort to promote research in translational medicine. Now a sharing service platform has been constructed to integrate clinical practice and biological information that can be used in diverse medical and pharmaceutical research studies. The platform collects two kinds of data: sample data and clinical data. The sample data are obtained from the hospital biobank management system, and mainly include the donors' age, gender, marital status, sample source, sample type, collection time, deposit time, and storage method. The clinical data are collected from the "Hospital-Link" system (a medical information sharing system that connects 23 tertiary hospitals in Shanghai). The main contents include donors' corresponding medication information, test reports, inspection reports, and hospital information. As of the end of September 2014, the project has a collection of 16,020 donors and 148,282 samples, which were obtained from 12 medical institutions, and automatically acquired donors' corresponding clinical data from the "Hospital-Link" system for 6830 occurrences. This project will contribute to scientific research at medical institutions in Shanghai, and will also support the development of the biopharmaceutical industry. In this article, we will describe the significance, the construction phases, the application prospects, and benefits of the sample repository and information sharing service platform.

Antibody titres at diagnosis and during follow-up of anti-NMDA receptor encephalitis: a retrospective study.

PubMed

Gresa-Arribas, Nuria; Titulaer, Maarten J; Torrents, Abiguei; Aguilar, Esther; McCracken, Lindsey; Leypoldt, Frank; Gleichman, Amy J; Balice-Gordon, Rita; Rosenfeld, Myrna R; Lynch, David; Graus, Francesc; Dalmau, Josep

2014-02-01

Anti-N-methyl-d-aspartate (NMDA) receptor encephalitis is a severe but treatable autoimmune disorder which diagnosis depends on sensitive and specific antibody testing. We aimed to assess the sensitivity and specificity of serum and CSF antibody testing in patients with anti-NMDA receptor encephalitis, and the relation between titres, relapses, outcome, and epitope repertoire. In this observational study, we used rat brain immunohistochemistry and cell-based assays (CBA) with fixed or live NMDA receptor-expressing cells to determine the sensitivity and specificity of antibody testing in paired serum and CSF samples. Samples were obtained at diagnosis from patients with anti-NMDA receptor encephalitis and from control participants worldwide. We deemed a patient to be antibody positive if their serum, their CSF, or both tested positive with both immunohistochemistry and CBA techniques; we determined titres with serial sample dilution using brain immunohistochemistry. We examined samples from 45 patients (25 with good outcome [modified Rankin Scale, mRS 0-2], ten with poor outcome [mRS 3-6], and ten with relapses) at three or more timepoints. We determined the epitope repertoire in the samples of 23 patients with CBA expressing GluN1-NMDA receptor mutants. We analysed samples from 250 patients with anti-NMDA receptor encephalitis and 100 control participants. All 250 patients had NMDA receptor antibodies in CSF but only 214 had antibodies in serum (sensitivity 100.0% [98.5-1000%] vs 85.6% [80.7-89.4%], p<0.0001). Serum immunohistochemistry testing was more often in agreement with CBA with fixed cells (77 [71%] of 108) than with CBA with live cells (63 [58%] of 108, p=0.0056). In multivariable analysis, CSF and serum titres were higher in patients with poor outcome than in those with good outcome (CSF dilution 340 vs 129, difference 211, [95% CI 1-421], p=0.049; serum dilution 7370 vs 1243, difference 6127 [2369-9885], p=0.0025), and in patients with teratoma than in those without teratoma (CSF 395 vs 110, difference 285 [134-437], p=0.0079; serum 5515 vs 1644, difference 3870 [548-7193], p=0.024). Over time there was a decrease of antibody titres in the 35 patients with good or poor outcome and samples followed at three timepoints regardless of outcome (from diagnosis to last follow-up: CSF 614 to 76, difference 538 [288-788]; serum 5460 to 1564, difference 3896 [2428-5362]; both p<0.0001). Relapses were associated with a change in titre more often in CSF than in serum (14 of 19 vs seven of 16, p=0.037). After recovery, 24 of 28 CSF samples and 17 of 23 serum samples from patients remained antibody positive. Patients' antibodies targeted a main epitope region at GluN1 aminoacid 369; the epitope repertoire did not differ between patients with different outcomes, and did not change during relapses. The sensitivity of NMDA receptor antibody testing is higher in CSF than in serum. Antibody titres in CSF and serum were higher in patients with poor outcome or teratoma than in patients with good outcome or no tumour. The titre change in CSF was more closely related with relapses than was that in serum. These findings emphasise the importance of including CSF in antibody studies, and that antibody titres can complement clinical assessments. Dutch Cancer Society, National Institutes of Health, McKnight Neuroscience of Brain Disorders award, the Fondo de Investigaciones Sanitarias, ErasmusMC fellowship, and Fundació la Marató de TV3. Copyright © 2014 Elsevier Ltd. All rights reserved.

Mortality and Morbidity During Delivery Hospitalization Among Pregnant Women With Epilepsy in the United States

PubMed Central

MacDonald, Sarah C.; Bateman, Brian T.; McElrath, Thomas F.; Hernández-Díaz, Sonia

2016-01-01

IMPORTANCE Between 0.3% and 0.5% of all pregnancies occur among women with epilepsy. Evidence suggests an increase in perinatal morbidity and mortality among women with epilepsy. However, these risks have not been quantified in large population-based samples. OBJECTIVE To report on the risk for death and adverse outcomes at the time of delivery for women with epilepsy in the United States. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of pregnant women identified through delivery hospitalization records from the 2007-2011 Nationwide Inpatient Sample. From this representative sample of 20% of all US hospitals, we obtained a weighted sample of delivery hospitalizations from 69 385 women with epilepsy and 20 449 532 women without epilepsy. MAIN OUTCOMES AND MEASURES Obstetrical outcomes including maternal death, cesarean delivery, length of stay, preeclampsia, preterm labor, and stillbirth. RESULTS Women with epilepsy had a risk of death during delivery hospitalization of 80 deaths per 100 000 pregnancies, significantly higher than the 6 deaths per 100 000 pregnancies found among women without epilepsy (adjusted odds ratio [OR], 11.46 [95% CI, 8.64-15.19]). Women with epilepsy were also at a heightened risk for other adverse outcomes, including preeclampsia (adjusted OR, 1.59 [95% CI, 1.54-1.63]), preterm labor (adjusted OR, 1.54 [95% CI, 1.50-1.57]), and stillbirth (adjusted OR, 1.27 [95% CI, 1.17-1.38]), and had increased health care utilization, including an increased risk of cesarean delivery (adjusted OR, 1.40 [95% CI, 1.38-1.42]) and prolonged length of hospital stay (>6 days) among both women with cesarean deliveries (adjusted OR, 2.13 [95% CI, 2.03-2.23]) and women with vaginal deliveries (adjusted OR, 2.60 [95% CI, 2.41-2.80]). CONCLUSIONS AND RELEVANCE Findings suggest that women with epilepsy are at considerably heightened risk for many adverse outcomes during their delivery hospitalization, including a more than 10-fold increased risk of death, and that increased clinical attention is imperative for these pregnancies. PMID:26147878

Study protocol for the translating research in elder care (TREC): building context – an organizational monitoring program in long-term care project (project one)

PubMed Central

Estabrooks, Carole A; Squires, Janet E; Cummings, Greta G; Teare, Gary F; Norton, Peter G

2009-01-01

Background While there is a growing awareness of the importance of organizational context (or the work environment/setting) to successful knowledge translation, and successful knowledge translation to better patient, provider (staff), and system outcomes, little empirical evidence supports these assumptions. Further, little is known about the factors that enhance knowledge translation and better outcomes in residential long-term care facilities, where care has been shown to be suboptimal. The project described in this protocol is one of the two main projects of the larger five-year Translating Research in Elder Care (TREC) program. Aims The purpose of this project is to establish the magnitude of the effect of organizational context on knowledge translation, and subsequently on resident, staff (unregulated, regulated, and managerial) and system outcomes in long-term care facilities in the three Canadian Prairie Provinces (Alberta, Saskatchewan, Manitoba). Methods/Design This study protocol describes the details of a multi-level – including provinces, regions, facilities, units within facilities, and individuals who receive care (residents) or work (staff) in facilities – and longitudinal (five-year) research project. A stratified random sample of 36 residential long-term care facilities (30 urban and 6 rural) from the Canadian Prairie Provinces will comprise the sample. Caregivers and care managers within these facilities will be asked to complete the TREC survey – a suite of survey instruments designed to assess organizational context and related factors hypothesized to be important to successful knowledge translation and to achieving better resident, staff, and system outcomes. Facility and unit level data will be collected using standardized data collection forms, and resident outcomes using the Resident Assessment Instrument-Minimum Data Set version 2.0 instrument. A variety of analytic techniques will be employed including descriptive analyses, psychometric analyses, multi-level modeling, and mixed-method analyses. Discussion Three key challenging areas associated with conducting this project are discussed: sampling, participant recruitment, and sample retention; survey administration (with unregulated caregivers); and the provision of a stable set of study definitions to guide the project. PMID:19671166

Accuracy of reading liquid based cytology slides using the ThinPrep Imager compared with conventional cytology: prospective study

PubMed Central

d'Assuncao, Jefferson; Irwig, Les; Macaskill, Petra; Chan, Siew F; Richards, Adele; Farnsworth, Annabelle

2007-01-01

Objective To compare the accuracy of liquid based cytology using the computerised ThinPrep Imager with that of manually read conventional cytology. Design Prospective study. Setting Pathology laboratory in Sydney, Australia. Participants 55 164 split sample pairs (liquid based sample collected after conventional sample from one collection) from consecutive samples of women choosing both types of cytology and whose specimens were examined between August 2004 and June 2005. Main outcome measures Primary outcome was accuracy of slides for detecting squamous lesions. Secondary outcomes were rate of unsatisfactory slides, distribution of squamous cytological classifications, and accuracy of detecting glandular lesions. Results Fewer unsatisfactory slides were found for imager read cytology than for conventional cytology (1.8% v 3.1%; P<0.001). More slides were classified as abnormal by imager read cytology (7.4% v 6.0% overall and 2.8% v 2.2% for cervical intraepithelial neoplasia of grade 1 or higher). Among 550 patients in whom imager read cytology was cervical intraepithelial neoplasia grade 1 or higher and conventional cytology was less severe than grade 1, 133 of 380 biopsy samples taken were high grade histology. Among 294 patients in whom imager read cytology was less severe than cervical intraepithelial neoplasia grade 1 and conventional cytology was grade 1 or higher, 62 of 210 biopsy samples taken were high grade histology. Imager read cytology therefore detected 71 more cases of high grade histology than did conventional cytology, resulting from 170 more biopsies. Similar results were found when one pathologist reread the slides, masked to cytology results. Conclusion The ThinPrep Imager detects 1.29 more cases of histological high grade squamous disease per 1000 women screened than conventional cytology, with cervical intraepithelial neoplasia grade 1 as the threshold for referral to colposcopy. More imager read slides than conventional slides were satisfactory for examination and more contained low grade cytological abnormalities. PMID:17604301

Esthetic, Functional, and Everyday Life Assessment of Individuals with Cleft Lip and/or Palate

PubMed Central

Papamanou, Despina A.; Karamolegkou, Marina; Dorotheou, Domna

2015-01-01

Objectives. To evaluate the level of satisfaction of individuals with cleft lip and/or palate (CLP) and their parents concerning the esthetic and functional treatment outcomes, the impact of the cleft on everyday life, and potential associations with treatment outcome satisfaction. Subjects and Methods. The sample consisted of 33 patients (7 CP, 20 unilateral CLP, and 6 bilateral CLP; median age: 17.1, range: 9.0–33.1 years) and 30 parents, who responded to a questionnaire in an interview-guided session. All participants received their orthodontic treatment at the Department of Orthodontics in the University of Athens. Results. Patients and their parents were quite satisfied with esthetics and function. Patients with UCLP primarily were concerned about nose esthetics (BCLP about lip esthetics and CP about speech). Increased satisfaction was associated with decreased influence of the cleft in everyday life (0.35 < rho < 0.64, P < 0.05). Parents reported significant influence of the cleft on family life, while patients did not. Conclusions. Despite the limited sample size of subgroups, the main concerns of patients with different cleft types and the importance of satisfying lip, nose, and speech outcomes for an undisturbed everyday life were quite evident. Thus, the need for targeted treatment strategies is highlighted for individuals with cleft lip and/or palate. PMID:26064918

Esthetic, Functional, and Everyday Life Assessment of Individuals with Cleft Lip and/or Palate.

PubMed

Gkantidis, Nikolaos; Papamanou, Despina A; Karamolegkou, Marina; Dorotheou, Domna

2015-01-01

To evaluate the level of satisfaction of individuals with cleft lip and/or palate (CLP) and their parents concerning the esthetic and functional treatment outcomes, the impact of the cleft on everyday life, and potential associations with treatment outcome satisfaction. The sample consisted of 33 patients (7 CP, 20 unilateral CLP, and 6 bilateral CLP; median age: 17.1, range: 9.0-33.1 years) and 30 parents, who responded to a questionnaire in an interview-guided session. All participants received their orthodontic treatment at the Department of Orthodontics in the University of Athens. Patients and their parents were quite satisfied with esthetics and function. Patients with UCLP primarily were concerned about nose esthetics (BCLP about lip esthetics and CP about speech). Increased satisfaction was associated with decreased influence of the cleft in everyday life (0.35 < rho < 0.64, P < 0.05). Parents reported significant influence of the cleft on family life, while patients did not. Despite the limited sample size of subgroups, the main concerns of patients with different cleft types and the importance of satisfying lip, nose, and speech outcomes for an undisturbed everyday life were quite evident. Thus, the need for targeted treatment strategies is highlighted for individuals with cleft lip and/or palate.

Central Auditory Maturation and Behavioral Outcome in Children with Auditory Neuropathy Spectrum Disorder who Use Cochlear Implants

PubMed Central

Cardon, Garrett; Sharma, Anu

2013-01-01

Objective We examined cortical auditory development and behavioral outcomes in children with ANSD fitted with cochlear implants (CI). Design Cortical maturation, measured by P1 cortical auditory evoked potential (CAEP) latency, was regressed against scores on the Infant Toddler Meaningful Auditory Integration Scale (IT-MAIS). Implantation age was also considered in relation to CAEP findings. Study Sample Cross-sectional and longitudinal samples of 24 and 11 children, respectively, with ANSD fitted with CIs. Result P1 CAEP responses were present in all children after implantation, though previous findings suggest that only 50-75% of ANSD children with hearing aids show CAEP responses. P1 CAEP latency was significantly correlated with participants' IT-MAIS scores. Furthermore, more children implanted before age two years showed normal P1 latencies, while those implanted later mainly showed delayed latencies. Longitudinal analysis revealed that most children showed normal or improved cortical maturation after implantation. Conclusion Cochlear implantation resulted in measureable cortical auditory development for all children with ANSD. Children fitted with CIs under age two years were more likely to show age-appropriate CAEP responses within 6 months after implantation, suggesting a possible sensitive period for cortical auditory development in ANSD. That CAEP responses were correlated with behavioral outcome highlights their clinical decision-making utility. PMID:23819618

Impact of peer review on reports of randomised trials published in open peer review journals: retrospective before and after study

PubMed Central

Collins, Gary S; Boutron, Isabelle; Yu, Ly-Mee; Cook, Jonathan; Shanyinde, Milensu; Wharton, Rose; Shamseer, Larissa; Altman, Douglas G

2014-01-01

Objective To investigate the effectiveness of open peer review as a mechanism to improve the reporting of randomised trials published in biomedical journals. Design Retrospective before and after study. Setting BioMed Central series medical journals. Sample 93 primary reports of randomised trials published in BMC-series medical journals in 2012. Main outcome measures Changes to the reporting of methodological aspects of randomised trials in manuscripts after peer review, based on the CONSORT checklist, corresponding peer reviewer reports, the type of changes requested, and the extent to which authors adhered to these requests. Results Of the 93 trial reports, 38% (n=35) did not describe the method of random sequence generation, 54% (n=50) concealment of allocation sequence, 50% (n=46) whether the study was blinded, 34% (n=32) the sample size calculation, 35% (n=33) specification of primary and secondary outcomes, 55% (n=51) results for the primary outcome, and 90% (n=84) details of the trial protocol. The number of changes between manuscript versions was relatively small; most involved adding new information or altering existing information. Most changes requested by peer reviewers had a positive impact on the reporting of the final manuscript—for example, adding or clarifying randomisation and blinding (n=27), sample size (n=15), primary and secondary outcomes (n=16), results for primary or secondary outcomes (n=14), and toning down conclusions to reflect the results (n=27). Some changes requested by peer reviewers, however, had a negative impact, such as adding additional unplanned analyses (n=15). Conclusion Peer reviewers fail to detect important deficiencies in reporting of the methods and results of randomised trials. The number of these changes requested by peer reviewers was relatively small. Although most had a positive impact, some were inappropriate and could have a negative impact on reporting in the final publication. PMID:24986891

Positive Attributes Buffer the Negative Associations Between Low Intelligence and High Psychopathology With Educational Outcomes.

PubMed

Hoffmann, Mauricio Scopel; Leibenluft, Ellen; Stringaris, Argyris; Laporte, Paola Paganella; Pan, Pedro Mario; Gadelha, Ary; Manfro, Gisele Gus; Miguel, Eurípedes Constantino; Rohde, Luis Augusto; Salum, Giovanni Abrahão

2016-01-01

This study examines the extent to which children's positive attributes are distinct from psychopathology. We also investigate whether positive attributes change or "buffer" the impact of low intelligence and high psychopathology on negative educational outcomes. In a community sample of 2,240 children (6-14 years of age), we investigated associations among positive attributes, psychopathology, intelligence, and negative educational outcomes. Negative educational outcomes were operationalized as learning problems and poor academic performance. We tested the discriminant validity of psychopathology versus positive attributes using confirmatory factor analysis (CFA) and propensity score matching analysis (PSM), and used generalized estimating equations (GEE) models to test main effects and interactions among predictors of educational outcomes. According to both CFA and PSM, positive attributes and psychiatric symptoms were distinct constructs. Positive attributes were associated with lower levels of negative educational outcomes, independent of intelligence and psychopathology. Positive attributes buffer the negative effects of lower intelligence on learning problems, and higher psychopathology on poor academic performance. Children's positive attributes are associated with lower levels of negative school outcomes. Positive attributes act both independently and by modifying the negative effects of low intelligence and high psychiatric symptoms on educational outcomes. Subsequent research should test interventions designed to foster the development of positive attributes in children at high risk for educational problems. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. All rights reserved.

Positive Attributes Buffer the Negative Associations Between Low Intelligence and High Psychopathology With Educational Outcomes

PubMed Central

Hoffmann, Mauricio Scopel; Leibenluft, Ellen; Stringaris, Argyris; Laporte, Paola Paganella; Pan, Pedro Mario; Gadelha, Ary; Manfro, Gisele Gus; Miguel, Eurípedes Constantino; Rohde, Luis Augusto; Salum, Giovanni Abrahão

2016-01-01

Objective This study examines the extent to which children’s positive attributes are distinct from psychopathology. We also investigate whether positive attributes change or “buffer” the impact of low intelligence and high psychopathology on negative educational outcomes. Method In a community sample of 2,240 children (6–14 years of age), we investigated associations among positive attributes, psychopathology, intelligence, and negative educational outcomes. Negative educational outcomes were operationalized as learning problems and poor academic performance. We tested the discriminant validity of psychopathology versus positive attributes using confirmatory factor analysis (CFA) and propensity score matching analysis (PSM), and used generalized estimating equations (GEE) models to test main effects and interactions among predictors of educational outcomes. Results According to both CFA and PSM, positive attributes and psychiatric symptoms were distinct constructs. Positive attributes were associated with lower levels of negative educational outcomes, independent of intelligence and psychopathology. Positive attributes buffer the negative effects of lower intelligence on learning problems, and higher psychopathology on poor academic performance. Conclusion Children’s positive attributes are associated with lower levels of negative school outcomes. Positive attributes act both independently and by modifying the negative effects of low intelligence and high psychiatric symptoms on educational outcomes. Subsequent research should test interventions designed to foster the development of positive attributes in children at high risk for educational problems. PMID:26703909

A randomized controlled trial of pre-conception treatment for periodontal disease to improve periodontal status during pregnancy and birth outcomes.

PubMed

Jiang, Hong; Xiong, Xu; Su, Yi; Zhang, Yiming; Wu, Hongqiao; Jiang, Zhijun; Qian, Xu

2013-12-09

Evidence has suggested that periodontal disease is associated with an increased risk of various adverse pregnancy and birth outcomes. However, several large clinical randomized controlled trials failed to demonstrate periodontal therapy during pregnancy reduced the incidence of adverse pregnancy and birth outcomes. It has been suggested that the pre-conception period may be an optimal period for periodontal disease treatment rather than during pregnancy. To date, no randomized controlled trial (RCT) has examined if treating periodontal disease before pregnancy reduces adverse birth outcomes. This study aims to examine if the pre-conception treatment of periodontal disease will lead to improved periodontal status during late pregnancy and subsequent birth outcomes. A sample of 470 (235 in each arm of the study) pre-conception women who plan to conceive within one year and with periodontal disease will be recruited for the study. All participants will be randomly allocated to the intervention or control group. The intervention group will receive free therapy including dental scaling and root planning (the standard therapy), supragingival prophylaxis, and oral hygiene education. The control group will only receive supragingival prophylaxis and oral hygiene education. Women will be followed throughout their pregnancy and then to childbirth. The main outcomes include periodontal disease status in late pregnancy and birth outcomes measured such as mean birth weight (grams), and mean gestational age (weeks). Periodontal disease will be diagnosed through a dental examination by measuring probing depth, clinical attachment loss and percentage of bleeding on probing (BOP) between gestational age of 32 and 36 weeks. Local and systemic inflammatory mediators are also included as main outcomes. This will be the first RCT to test whether treating periodontal disease among pre-conception women reduces periodontal disease during pregnancy and prevents adverse birth outcomes. If the effect of pre-pregnancy periodontal treatment is confirmed, this intervention could be recommended for application in low- or middle-income countries to improve both oral health and maternal and child health. This trial is registered with Chinese Clinical Trial Registry (ChiCTR): ChiCTR-TRC-12001913.

The use and correlates of illicit silicone or “fillers” in a population-based sample of transwomen, San Francisco, 2013

PubMed Central

Wilson, Erin; Rapues, Jenna; Jin, Harry; Raymond, H. Fisher

2014-01-01

Introduction There is a dearth of studies to quantify the use of illicit fillers by transwomen. Case studies of illicit filler injections have pointed to an array of serious health complications, including death. Aim The aim of this study was to determine the population prevalence of filler use among transwomen, and to identify correlations with filler use. Methods An analysis of data collected in 2013 with a population-based sample of 234 transwomen recruited using respondent driven sampling (RDS). We used RDS weights to conduct bivariate and multivariate analyses of correlates of filler use. Main Outcome measures Main outcome measures were an RDS-weighted population prevalence of filler use among transwomen and differences in demographic characteristics, transition-related care factors and self-esteem related to appearance. Results Weighted filler prevalence among transwomen was 16.7%. Being a transwomen between 30–49 years of age, owning/renting or living with a partner/family/friend, having had and planning to have surgery in the future and having used non-prescribed hormones were all associated with filler use. HIV was not associated with filler use. Conclusions This study provides the first known estimate to date of the prevalence of filler use in a population-based sample of transwomen in San Francisco. Accessing illicit fillers may be the only choice available for many transwomen due to the cost of legal surgeries and other procedures to change one’s appearance. An important next step in this research is to determine the overall prevalence and long-term consequences of filler use among transwomen, to explore how the use of fillers is protective to the safety and wellbeing of transwomen, and to find safe and affordable alternatives to this method that meets important gender-related appearance needs. PMID:24810672

Maternal thyroid function and the outcome of external cephalic version: a prospective cohort study

PubMed Central

2011-01-01

Background To investigate the relation between maternal thyroid function and the outcome of external cephalic version (ECV) in breech presentation. Methods Prospective cohort study in 141 women (≥ 35 weeks gestation) with a singleton fetus in breech. Blood samples for assessing thyroid function were taken prior to ECV. Main outcome measure was the relation between maternal thyroid function and ECV outcome indicated by post ECV ultrasound. Results ECV success rate was 77/141 (55%), 41/48 (85%) in multipara and 36/93 (39%) in primipara. Women with a failed ECV attempt had significantly higher TSH concentrations than women with a successful ECV (p < 0.001). Multiple logistic regression showed that TSH (OR: 0.52, 95% CI: 0.30-0.90), nulliparity (OR: 0.11, 95% CI: 0.03-0.36), frank breech (OR: 0.30, 95% CI: 0.10-0.93) and placenta anterior (OR: 0.31, 95% CI: 0.11-0.85) were independently related to ECV success. Conclusions Higher TSH levels increase the risk of ECV failure. Trial registration number ClinicalTrials.gov: NCT00516555 PMID:21269431

An extended review of couple-centred interventions in dementia: Exploring the what and why - Part B.

PubMed

Bielsten, Therése; Hellström, Ingrid

2017-01-01

This scoping review is an extended version of a narrative review of couple-centred interventions in dementia shared in part A and the previous publication in this edition. The rationale for expanding study A emerged through the fact that most dyadic interventions have samples consisting of a majority of couples. The exclusion of interventions with samples of mixed relationships in part A therefore contributed to a narrow picture of joint dyadic interventions for couples in which one partner has a dementia. The aim of this second review is to explore the 'what' (types of interventions) and the 'why' (objectives and outcome measures) of dyadic interventions in which sample consists of a majority of couples/spouses and in which people with dementia and caregivers jointly participate. Method A five-step framework for scoping reviews guided the procedure. Searches were performed in Academic Search Premier, CINAHL, PsycINFO, PubMed, Scopus, and Web of Science. Results Twenty-one studies with various types of psychosocial interventions were included. The main outcome measure for people with dementia was related to cognitive function, respectively caregiver burden and depression for caregivers. Conclusions The findings of this extended review of joint dyadic interventions in dementia are in line with the findings of part A regarding the negative approach of outcomes, lack of a genuine dyadic approach, lack of tailored support, neglect of interpersonal issues and the overlook of the views of people with dementia. This review also recognises that measures of caregiver burden, as well as relationship quality should be considered in samples of mixed relationships due to the different significance of burden and relationship quality for a spouse as opposed to an adult child or friend.

Data article on the effect of work engagement strategies on faculty staff behavioural outcomes in private universities.

PubMed

Falola, Hezekiah Olubusayo; Olokundun, Maxwell Ayodele; Salau, Odunayo Paul; Oludayo, Olumuyiwa Akinrole; Ibidunni, Ayodotun Stephen

2018-06-01

The main objective of this study was to present a data article that investigate the effect of work engagement strategies on faculty behavioural outcomes. Few studies analyse how work engagement strategies could help in driving standard work behaviour particularly in higher institutions. In an attempt to bridge this gap, this study was carried out using descriptive research method and Structural Equation Model (AMOS 22) for the analysis of four hundred and forty one (441) valid questionnaire which were completed by the faculty members of the six selected private universities in Nigeria using stratified and simple random sampling techniques. Factor model which shows high-reliability and good fit was generated, while construct validity was provided through convergent and discriminant analyses.

Bullying at elementary school and problem behaviour in young adulthood: a study of bullying, violence and substance use from age 11 to age 21.

PubMed

Kim, Min Jung; Catalano, Richard F; Haggerty, Kevin P; Abbott, Robert D

2011-04-01

The main aim of this paper is to investigate to what extent self-reported bullying at Grade 5 predicts later violence, heavy drinking and marijuana use at age 21. Univariate and multivariate associations between bullying and later outcomes were examined based on a longitudinal community sample of 957 young people from the Raising Healthy Children project. Childhood bullying was significantly associated with violence, heavy drinking and marijuana use at age 21. These associations held up after controlling for prior risk factors. Childhood bullying had unique associations with risk of later violence and substance use among young adults. Early intervention to prevent childhood bullying may also reduce other adverse outcomes later in life. Copyright © 2011 John Wiley & Sons, Ltd.

Beyond Detention: A 12-Year Longitudinal Study of Positive Outcomes in Delinquent Youth

PubMed Central

Abram, Karen M.; Azores-Gococo, Nicole M.; Emanuel, Kristin M.; Aaby, David A.; Welty, Leah J.; Hershfield, Jennifer A.; Rosenbaum, Melinda S.; Teplin, Linda A.

2017-01-01

Importance Longitudinal studies of delinquent youth have focused on criminal recidivism, not on psychosocial outcomes in adulthood. This omission is critical because most youth return to the community where they become the responsibility of pediatric health care providers. Objective To investigate 8 positive outcomes among delinquent youth 5 and 12 years after detention, focusing on sex and racial/ethnic differences. Design The Northwestern Juvenile Project, the first comprehensive longitudinal US study of long-term outcomes of delinquent youth after detention (n=1829). Youth were interviewed in detention and reinterviewed up to 9 times over 12 years. Setting Project staff conducted face-to-face structured interviews at the Cook County Juvenile Temporary Detention Center (Chicago, Illinois) between November 20, 1995, and June 14, 1998. At follow-ups, participants were interviewed wherever they were living, in the community or in correctional facilities. Participants Stratified random sample, 1172 males and 657 females (1005 African Americans, 524 Hispanics, 296 non-Hispanic whites, and 4 of other race/ethnicity). At baseline, median age was 15 years. Twelve years later, at median age 28 years, 1520 (83.1%) of the original sample remained. Main Outcome and Measures Achievement of positive outcomes in 8 domains: educational attainment, residential independence, gainful activity, desistance from criminal activity, mental health, abstaining from substance abuse, interpersonal functioning, and parenting responsibility. Outcomes were assessed with widely used measures supplemented by correctional records. Results Females were significantly more likely than males to achieve most positive outcomes. Twelve years after detention, only 21.9% of males and 54.7% of females had achieved more than half of the outcomes. As youth aged, the number of positive outcomes increased only modestly. Among males, non-Hispanic whites were significantly more likely to achieve most positive outcomes compared with minorities, but less likely to abstain from substance abuse. Latent class analysis shows that African American males fared the worst, with lives characterized by incarceration, criminal activity, and few positive outcomes. Conclusions and Relevance Findings highlight racial/ethnic disparities in achieving positive outcomes. To improve outcomes, pediatric health care professionals should recognize the importance of psychosocial health, facilitate access to services in the community, and partner with on-site systems of care. PMID:27992626

Long-term outcomes and predictors of internet-delivered cognitive behavioral therapy for childhood anxiety disorders.

PubMed

Vigerland, Sarah; Serlachius, Eva; Thulin, Ulrika; Andersson, Gerhard; Larsson, Jan-Olov; Ljótsson, Brjánn

2017-03-01

This study investigated the long-term outcomes of internet-delivered cognitive behavior therapy (ICBT) for children with anxiety disorders, and potential pre-treatment predictors of treatment outcome. The sample included eighty-four children (8-12 years old) with anxiety disorders, from both a treatment group and a waitlist control (after participants had crossed over to treatment) of a previous randomized controlled study. Participants were assessed at post-treatment and three- and twelve-months after treatment using a semi-structured interview and parent ratings. Pre-treatment data were used to investigate predictors of treatment outcome at three-month follow-up. Intention-to-treat analysis showed that treatment gains were maintained at twelve-month follow-up, including clinician rated severity of the principal anxiety disorder, parent rated anxiety symptoms and global functioning, with mainly large effect sizes (Cohen's d = 0.63-2.35). Completer analyses showed that suspected autism spectrum disorder was associated with less change in symptom severity. No other pre-treatment measures significantly predicted treatment outcome. This study suggests that internet-delivered CBT can have long-term beneficial effects for children with anxiety disorders. Predictors of treatment outcome need to be evaluated further. Clinicaltrials.gov; NCT01533402. Copyright © 2016 Elsevier Ltd. All rights reserved.

Health Outcomes of Sexual-Minority Youth in Canada: An Overview

PubMed Central

Blais, Martin; Bergeron, Félix-Antoine; Duford, Julie; Boislard, Marie-Aude; Hébert, Martine

2016-01-01

Objectives The objectives of this review are to (1) document health outcomes among sexual-minority youth (SMY) in Canada; and (2) identify sexual-minority-specific risk and protective factors Data Sources We conducted a review of Canadian data published after 2005 on the mental, physical and sexual health outcomes of SMY using relevant keywords. A total of 19 empirical studies and 2 research reports was included. Data Synthesis The study reviewed included 53 to 30 588 respondents (total = 81 567). SMY counted for 15.86% of the total sample. Overall, SMY in Canada show negative health outcomes in proportions varying from 7% to 69.4%, the most common issues being psychological distress and maladjustment. SMY are more likely than their heterosexual peers to report psychological distress/malfunctioning, suicidality, substance misuse, condomless intercourse, pregnancy involvement. Main SMY-specific risk factors were family rejection of one’s minority sexual orientation, homophobic bullying and victimization, and internalized homophobia. Among the few protective factors that were reported, school and family connectedness, school safety, parental support and sports involvement decreased the odds of negative health outcomes. Conclusions Canadian data show that SMY are more likely to experience negative health outcomes than their heterosexual peers. These results are consistent with data from around the world. Recommendations for research and intervention are discussed. PMID:28111592

Listeria monocytogenes endophthalmitis - case report and review of risk factors and treatment outcomes.

PubMed

Bajor, Anna; Luhr, Anke; Brockmann, Dorothee; Suerbaum, Sebastian; Framme, Carsten; Sedlacek, Ludwig

2016-07-16

The majority of cases of endophthalmitis are caused by exogenous pathogens; only 5-10 % are of endogenous origin. One cause of these rare cases of endogenous endophthalmitis is Listeria monocytogenes. Twenty-six cases of endophthalmitis due to this pathogen have been published over the last twenty years. The aim of this review is to summarize the main risk factors and common clinical findings of endogenous endophthalmitis due to Listeria monocytogenes. We report on a 62-year-old female presenting with a sterile hypopyon iritis with secondary glaucoma and an underlying rheumatoid disease. In microbiological analysis we identified Listeria monocytogenes. Further we searched through all published cases for typical signs, risk factors, details of medical and surgical treatment and outcome of endogenous endophthalmitis due to this rare pathogen. Ocular symptoms in almost all of these published cases included pain, redness of the eye, and decreased vision. Main clinical features included elevated intraocular pressure and fibrinous anterior chamber reaction, as well as a dark hypopyon. While the infection is typically spread endogenously, neither an exogenous nor endogenous source of infection could be identified in most cases. Immunocompromised patients are at higher risk of being infected than immunocompetent patients. The clinical course of endophthalmitis caused by Listeria monocytogenes had different visual outcomes. In some cases, the infection led to enucleation, blindness, or strong visual loss, whereas most patients showed a tendency of visual improvement during therapy. Early diagnosis and treatment initiation are crucial factors in the outcome of endogenous endophthalmitis caused by Listeria monocytogenes. This possible differential diagnosis should be kept in mind while treating patients with presumable sterile hypopyon and anterior uveitis having a high intraocular pressure. A bacterial source should be considered with a prompt initiation of systemic antibiotic treatment, mainly in immunocompromised patients, who develop endogenous anterior uveitis. An appropriate microbiological sampling is essential to detect atypical microorganisms and to choose an effective antibiotic treatment.

Diagnostic value of JC/BK virus antibody immunohistochemistry staining in urine samples from posttransplant immunosuppressed patients in relation to polyomavirus reactivation.

PubMed

Yuste, Rosario Sanchez; Frías, Carolina; López, Ana; Vallejo, Carlos; Martín, Paloma; Bellas, Carmen

2008-01-01

To compare the diagnostic value of cytology and immunohistochemistry staining (IHS) of urine samples for polyomavirus reactivation diagnosis. Sixty-eight urine samples collected from 18 immunosuppressed patients were analyzed by Papanicolaou and IHS with a JC/BK virus-specific monoclonal antibody. Overall, polyomavirus BK (BKV) was positive in 11 of 18 patients (61.1%) (3 of whom developed hemorrhagic cystitis) and in 23 of 68 urine samples (28%). Of 23 samples, 4 (17%) were positive by 1 of the 2 techniques, only. Of 23 samples, 19 (83%) were positive by both methods. In matching urine samples from the same patient, the number of BKV-infected positive cells detected by IHS in urine slides was higher than those detected by Papanicolaou staining (71.3%). The main advantage of LHS is that it allowed confirmation of BKV infection diagnosis in urine samples. IHS detected more BKV-infected cells in samples with few positive urothelial cells, which would have gone undetected if only Papanicolaou staining had been used as the BKV screening method. Urine samples testing for BKV by both techniques will improve diagnosis in asymptomatic patients, allowing early therapeutic intervention and a better clinical outcome.

An fMRI investigation of expectation violation in magic tricks.

PubMed

Danek, Amory H; Öllinger, Michael; Fraps, Thomas; Grothe, Benedikt; Flanagin, Virginia L

2015-01-01

Magic tricks violate the expected causal relationships that form an implicit belief system about what is possible in the world around us. Observing a magic effect seemingly invalidates our implicit assumptions about what action causes which outcome. We aimed at identifying the neural correlates of such expectation violations by contrasting 24 video clips of magic tricks with 24 control clips in which the expected action-outcome relationship is upheld. Using fMRI, we measured the brain activity of 25 normal volunteers while they watched the clips in the scanner. Additionally, we measured the professional magician who had performed the magic tricks under the assumption that, in contrast to naïve observers, the magician himself would not perceive his own magic tricks as an expectation violation. As the main effect of magic - control clips in the normal sample, we found higher activity for magic in the head of the caudate nucleus (CN) bilaterally, the left inferior frontal gyrus and the left anterior insula. As expected, the magician's brain activity substantially differed from these results, with mainly parietal areas (supramarginal gyrus bilaterally) activated, supporting our hypothesis that he did not experience any expectation violation. These findings are in accordance with previous research that has implicated the head of the CN in processing changes in the contingency between action and outcome, even in the absence of reward or feedback.

Thickened Endometrium in Postmenopausal Women With an Initial Biopsy of Limited, Benign, Surface Endometrium: Clinical Outcome and Subsequent Pathologic Diagnosis.

PubMed

Dermawan, Josephine K T; Hur, Christine; Uberti, Maria G; Flyckt, Rebecca; Falcone, Tommaso; Brainard, Jennifer; Abdul-Karim, Fadi W

2018-05-10

Endometrial biopsy or curetting is indicated for postmenopausal women with abnormal uterine bleeding and/or thickened endometrium. Often, endometrial biopsy or curetting yields limited benign surface endometrium, which may indicate insufficient sampling. This study addresses the clinical outcome and subsequent pathologic diagnoses in postmenopausal women who received this initial diagnosis. Among a total of 370 endometrial biopsy or curetting between 2012 and 2015, 192 (52%) were diagnosed as limited benign surface endometrial epithelium. The women ranged in age from 55 to 91 yr old. Their clinical presentations mainly included postmenopausal bleeding, pelvic pain, and enlarged uterus. Primarily because the initial report was interpreted as "benign," 108 (57%) had no subsequent follow-up. Interestingly, women with an increased endometrial thickness were more likely to receive repeat evaluation. Among the 84 women who underwent follow-up endometrial sampling, 6 (7%) had hyperplasia with atypia or malignancy, 21 (25%) had a repeat diagnosis of limited surface sample, 4 (5%) had insufficient materials, and 53 (63%) had other benign findings. Among the subset of women who did receive subsequent follow-up, endometrial atypia or malignancies are more likely found in those with increased body mass index. In conclusion, a slight majority of women with postmenopausal bleeding and/or thickened endometrium had an initial limited surface endometrial sample. Most had no subsequent endometrial sampling. Among those with subsequent follow-up, the majority had benign findings. The study highlights the inconsistencies in adequacy criteria for endometrial sampling and the lack of standardization of subsequent management.

Young Adult Outcomes of Children Growing up with Chronic Illness: An analysis of the National Longitudinal Study of Adolescent Health

PubMed Central

Maslow, Gary R.; Haydon, Abigail; Ford, Carol Ann; Halpern, Carolyn Tucker

2012-01-01

Objective To examine young adult outcomes in a nationally representative US cohort of young adults who grew up with a chronic illness. Design Secondary analysis of nationally representative data from Wave III (2001) of the National Longitudinal Study of Adolescent Health. Setting United States Participants The analytic sample included 13,236 young adults 18–28 years old at Wave III. Main Exposure Self-report of a chronic physical illness (asthma, cancer, diabetes or epilepsy) in adolescence. Respondents with (1) asthma or (2) non-asthma chronic illness (cancer, diabetes, or epilepsy) were compared to subjects without these conditions. Main Outcome Measures Self-report of high school graduation, ever having a job, having a current job, living with parents, and ever receiving public assistance. Results Three percent of young adults had non-asthma chronic illness (cancer, diabetes, or epilepsy) and 16% had asthma. The majority of young adults with chronic illness graduated high school (81%) and were currently employed (60%). However, compared to healthy young adults, those with a non-asthma chronic illness were significantly less likely to graduate high school, ever have a job, or have a current job and were more likely to receive public assistance. When compared to young adults with asthma, young adults with non-asthma chronic illness again had significantly worse young adult outcomes on all measures. Conclusions Most young adults growing up with chronic illness graduate high school and are employed. However, these young adults are significantly less likely than their healthy peers to achieve these important educational and vocational milestones. PMID:21383274

Analysis of and reflection on bachelor thesis in nursing students: A descriptive study in Spain.

PubMed

Roca, Judith; Gros, Silvia; Canet, Olga

2018-06-11

The bachelor thesis, a final year subject to obtain a nursing degree, presents an ideal opportunity for the development and assessment of professional competencies. Thus, it is necessary to specify that the structure of the bachelor thesis works as an element of review and reflection from both a pedagogical and professional perspective. To analyse the main elements of the bachelor thesis in the nursing degree 2015-16 in Spain. A transversal descriptive study was conducted using a quantitative documentary analysis via study guides or grade reports. The variables were the main academic elements of the bachelor thesis subject (credits, competencies, learning outcomes, contents, methodologies, training activities and assessment). A probabilistic sample of 66 institutions was studied using descriptive statistics with statistical measures of central tendency and measures of variability. The results showed a maximum range of 12 and a minimum of 6 European Credit Transfer and Accumulation System. The definition and number of competencies to be developed varied and the learning outcomes were formulated in only 40.9% of the guides consulted. The most widely used teaching methodologies and training activities were academic supervision (87.9%) and autonomous work (80.3%). Regarding types of work, basic investigation (34.8%), care plans (33.3%) and literature review (30,3%) ranked highest. No specific descriptors could be linked to the contents. Finally, two main assessment tools were found: process and product. The rubric is presented as a main element of the assessment. The bachelor thesis is conceived as autonomous, personal and original academic work. But no homogeneity was observed in the key development elements such as competencies, teaching strategies, or type of bachelor thesis. Therefore, the findings from the analysis and the bibliographic review are presented as recommendations as regards the outcome, structure and/or teaching elements linked to the bachelor thesis. Copyright © 2018 Elsevier Ltd. All rights reserved.

On the effects of signal processing on sample entropy for postural control.

PubMed

Lubetzky, Anat V; Harel, Daphna; Lubetzky, Eyal

2018-01-01

Sample entropy, a measure of time series regularity, has become increasingly popular in postural control research. We are developing a virtual reality assessment of sensory integration for postural control in people with vestibular dysfunction and wished to apply sample entropy as an outcome measure. However, despite the common use of sample entropy to quantify postural sway, we found lack of consistency in the literature regarding center-of-pressure signal manipulations prior to the computation of sample entropy. We therefore wished to investigate the effect of parameters choice and signal processing on participants' sample entropy outcome. For that purpose, we compared center-of-pressure sample entropy data between patients with vestibular dysfunction and age-matched controls. Within our assessment, participants observed virtual reality scenes, while standing on floor or a compliant surface. We then analyzed the effect of: modification of the radius of similarity (r) and the embedding dimension (m); down-sampling or filtering and differencing or detrending. When analyzing the raw center-of-pressure data, we found a significant main effect of surface in medio-lateral and anterior-posterior directions across r's and m's. We also found a significant interaction group × surface in the medio-lateral direction when r was 0.05 or 0.1 with a monotonic increase in p value with increasing r in both m's. These effects were maintained with down-sampling by 2, 3, and 4 and with detrending but not with filtering and differencing. Based on these findings, we suggest that for sample entropy to be compared across postural control studies, there needs to be increased consistency, particularly of signal handling prior to the calculation of sample entropy. Procedures such as filtering, differencing or detrending affect sample entropy values and could artificially alter the time series pattern. Therefore, if such procedures are performed they should be well justified.

Obesity in the Transition to Adulthood: Predictions across Race-Ethnicity, Immigrant Generation, and Sex

PubMed Central

Harris, Kathleen Mullan; Perreira, Krista; Lee, Dohoon

2009-01-01

Objectives With longitudinal data we traced how race, ethnic, and immigrant disparities in body mass index (BMI) change over time as adolescents (ages 11–19) transition to young adulthood (ages 20–28). Design We used growth curve modeling to estimate the pattern of change in BMI from adolescence through the transition to adulthood. Setting All participants in the study were residents of the United States enrolled in high school or junior high school during the 1994–95 school year. Participants We used nationally representative data on 20,000+ adolescents interviewed at Wave I (1994–95) of Add Health, followed in Wave II (1996) and Wave III (2001–02) when the sample was in early adulthood. Main Exposure(s) Exposures of interest include race-ethnicity, immigrant generation, and sex. Main Outcome Measure(s) Our main outcome measure is BMI. Results Findings indicate significant differences in both the level and change in BMI across age by sex, race-ethnicity, and immigrant generation. Females, second and third generation immigrants, and Hispanics and blacks experience more rapidly increasing BMI as adolescents age into young adulthood. Increases in BMI are relatively lower for males, first generation immigrants, and whites and Asians. Conclusions Disparities in BMI and percent overweight and obese widen with age as adolescents leave home and begin independent lives as young adults in their 20s. PMID:19884593

Prevalence of visual impairment and outcomes of cataract surgery in Chaonan, South China

PubMed Central

Zhang, Xiujuan; Li, Emmy Y.; Leung, Christopher Kai-Shun; Musch, David C.; Tang, Xin; Zheng, Chongren; He, Mingguang; Chang, David F.

2017-01-01

Purpose To estimate the prevalence and causes of blindness and visual impairment (VI), and report the outcomes of cataract surgery in Chaonan Region, Guangdong Province, southern China Design Cross-sectional population-based survey Participants A total of 3484 participants including 1397 men (40.1%) and 2087 women (59.9%) aged ≥50 years were examined (94.2% response rate). Method A two-stage cluster sampling procedure was used to select 3700 participants aged ≥50 years from 74 clusters of Chaonan Region. Participants were examined according to the Rapid Assessment of Avoidable Blindness (RAAB) method. Blindness and visual impairment (VI) were defined by the World Health Organization criteria. Participants with visual acuity (VA) < 6/18 in either eye were examined by ophthalmologists. The primary causes of blindness and VI were reported with reference to the participant’s better eye. Main outcome measures Prevalence and main causes of blindness, severe visual impairment (SVI), VI and the outcomes of cataract surgery Results The standardized prevalence rates of blindness, SVI, and VI were 2.4% (95% confidence interval [CI], 1.9–2.9%), 1.0% (95% CI, 0.7–1.4%), and 6.4% (95% CI, 5.6%– 7.1%), respectively. The principal cause of blindness and SVI was cataract, accounting for 67.1% and 67.6% respectively, and the principal cause of VI was refractive error (46.9%). One hundred and fifty five out of 3484 (4.4%) people (211 eyes) had cataract surgery. Of the 211 eyes that had cataract surgery, 96.7% were pseudophakic. 67.2% of the 211 operated eyes had a presenting visual acuity (PVA) of 6/18 or better. Conclusions The prevalence of blindness, SVI, and VI was high among rural residents in Chaonan. Cataract remained the leading cause of avoidable blindness. Outcomes of cataract surgery performed in rural private clinics were suboptimal. Quality-control initiatives such as hands-on training program should be introduced to improve cataract surgery outcomes. PMID:28797099

Work stress, substance use, and depression among young adult workers: an examination of main and moderator effect model.

PubMed

Wiesner, Margit; Windle, Michael; Freeman, Amy

2005-04-01

In this cross-sectional study, main and moderated relationships between 5 job stressors and alcohol consumption, drug use, and depression were examined using data from a community sample of 583 young adults (mean age = 23.68 years). Analyses revealed a few direct associations between high job boredom, low skill variety, and low autonomy and depression measures and heavy alcohol use. There were no direct relationships between job stress and binge drinking, alcohol consumption, drug use, or heavy drug use. In a few cases, job stress-outcome relationships were moderated by intrinsic job motivation or gender. The findings supported a specificity-of-effects hypothesis and underscored the need for examining the processes linking occupational stress to substance use and depression. Copyright 2005 APA, all rights reserved.

Effects of vitamin D supplementation on markers for cardiovascular disease and type 2 diabetes: an individual participant data meta-analysis of randomized controlled trials.

PubMed

Swart, Karin Ma; Lips, Paul; Brouwer, Ingeborg A; Jorde, Rolf; Heymans, Martijn W; Grimnes, Guri; Grübler, Martin R; Gaksch, Martin; Tomaschitz, Andreas; Pilz, Stefan; Eiriksdottir, Gudny; Gudnason, Vilmundur; Wamberg, Louise; Rejnmark, Lars; Sempos, Christopher T; Durazo-Arvizu, Ramón A; Dowling, Kirsten G; Hull, George; Škrabáková, Zuzana; Kiely, Mairead; Cashman, Kevin D; van Schoor, Natasja M

2018-06-01

Evidence from randomized controlled trials (RCTs) for the causal role of vitamin D on noncommunicable disease outcomes is inconclusive. The aim of this study was to investigate whether there are beneficial or harmful effects of cholecalciferol (vitamin D3) supplementation according to subgroups of remeasured serum 25-hydroxyvitamin D [25(OH)D] on cardiovascular and glucometabolic surrogate markers with the use of individual participant data (IPD) meta-analysis of RCTs. Twelve RCTs (16 wk to 1 y of follow-up) were included. For standardization, 25(OH)D concentrations for all participants (n = 2994) at baseline and postintervention were re-measured in bio-banked serum samples with the use of a certified liquid chromatography-tandem mass spectrometry method traceable to a reference measurement procedure. IPD meta-analyses were performed according to subgroups of remeasured 25(OH)D. Main outcomes were blood pressure and glycated hemoglobin (HbA1c). Secondary outcomes were LDL, HDL, and total cholesterol and triglycerides; parathyroid hormone (PTH); fasting glucose, insulin, and C-peptide; and 2-h glucose. In secondary analyses, other potential effect modifiers were studied. Remeasurement of 25(OH)D resulted in a lower mean 25(OH)D concentration in 10 of 12 RCTs. Vitamin D supplementation had no effect on the main outcomes of blood pressure and HbA1c. Supplementation resulted in 10-20% lower PTH concentrations, irrespective of the 25(OH)D subgroups. The subgroup analyses according to achieved 25(OH)D concentrations showed a significant decrease in LDL-cholesterol concentrations after vitamin D supplementation in 25(OH)D subgroups with <75, <100, and <125 nmol of -0.10 mmol/L (95% CI: -0.20, -0.00 mmol/L), -0.10 mmol/L (95% CI: -0.18, -0.02 mmol/L), and -0.07 mmol/L (95% CI: -0.14, -0.00 mmol/L), respectively. Patient features that modified the treatment effect could not be identified. For the main outcomes of blood pressure and HbA1c, the data support no benefit for vitamin D supplementation. For the secondary outcomes, in addition to its effect on PTH, we observed indications for a beneficial effect of vitamin D supplementation only on LDL cholesterol, which warrants further investigation. This trial was registered at www.clinicaltrials.gov as NCT02551835.

Recruitment and retention of participants in randomised controlled trials: a review of trials funded and published by the United Kingdom Health Technology Assessment Programme

PubMed Central

Bonacho dos Anjos Henriques-Cadby, Inês; Bortolami, Oscar; Flight, Laura; Hind, Daniel; Knox, Christopher; Nadin, Ben; Rothwell, Joanne; Surtees, Michael; Julious, Steven A

2017-01-01

Background Substantial amounts of public funds are invested in health research worldwide. Publicly funded randomised controlled trials (RCTs) often recruit participants at a slower than anticipated rate. Many trials fail to reach their planned sample size within the envisaged trial timescale and trial funding envelope. Objectives To review the consent, recruitment and retention rates for single and multicentre randomised control trials funded and published by the UK's National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme. Data sources and study selection HTA reports of individually randomised single or multicentre RCTs published from the start of 2004 to the end of April 2016 were reviewed. Data extraction Information was extracted, relating to the trial characteristics, sample size, recruitment and retention by two independent reviewers. Main outcome measures Target sample size and whether it was achieved; recruitment rates (number of participants recruited per centre per month) and retention rates (randomised participants retained and assessed with valid primary outcome data). Results This review identified 151 individually RCTs from 787 NIHR HTA reports. The final recruitment target sample size was achieved in 56% (85/151) of the RCTs and more than 80% of the final target sample size was achieved for 79% of the RCTs (119/151). The median recruitment rate (participants per centre per month) was found to be 0.92 (IQR 0.43–2.79) and the median retention rate (proportion of participants with valid primary outcome data at follow-up) was estimated at 89% (IQR 79–97%). Conclusions There is considerable variation in the consent, recruitment and retention rates in publicly funded RCTs. Investigators should bear this in mind at the planning stage of their study and not be overly optimistic about their recruitment projections. PMID:28320800

The role of parenting in the prediction of criminal involvement: findings from a nationally representative sample of youth and a sample of adopted youth.

PubMed

Beaver, Kevin M; Schwartz, Joseph A; Connolly, Eric J; Al-Ghamdi, Mohammed Said; Kobeisy, Ahmed Nezar

2015-03-01

The role of parenting in the development of criminal behavior has been the source of a vast amount of research, with the majority of studies detecting statistically significant associations between dimensions of parenting and measures of criminal involvement. An emerging group of scholars, however, has drawn attention to the methodological limitations-mainly genetic confounding-of the parental socialization literature. The current study addressed this limitation by analyzing a sample of adoptees to assess the association between 8 parenting measures and 4 criminal justice outcome measures. The results revealed very little evidence of parental socialization effects on criminal behavior before controlling for genetic confounding and no evidence of parental socialization effects on criminal involvement after controlling for genetic confounding. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Adolescent cannabis and tobacco use and educational outcomes at age 16: birth cohort study

PubMed Central

Hickman, Matthew; Munafò, Marcus R.; Heron, Jon; Yip, Vikki L.; Macleod, John

2015-01-01

Abstract Aims To investigate the relationship between cannabis and tobacco use by age 15 and subsequent educational outcomes. Design Birth cohort study. Setting England. Participants The sample was drawn from the Avon Longitudinal Study of Parents and Children; a core sample of 1155 individuals had complete information on all the variables. Measurements The main exposures were cannabis and tobacco use at age 15 assessed in clinic by computer‐assisted questionnaire and serum cotinine. The main outcomes were performance in standardized assessments at 16 [Key Stage 4, General Certificate of Secondary Education (GCSE)] in English and mathematics (mean scores), completion of five or more assessments at grade C level or higher and leaving school having achieved no qualifications. Analyses were sequentially adjusted for multiple covariates using a hierarchical approach. Covariates considered were: maternal substance use (ever tobacco or cannabis use, alcohol use above recommended limits); life course socio‐economic position (family occupational class, maternal education, family income); child sex; month and year of birth; child educational attainment prior to age 11 (Key Stage 2); child substance use (tobacco, alcohol and cannabis) prior to age 15 and child conduct disorder. Findings In fully adjusted models both cannabis and tobacco use at age 15 were associated with subsequent adverse educational outcomes. In general, the dose–response effect seen was consistent across all educational outcomes assessed. Weekly cannabis use was associated negatively with English GCSE results [grade point difference (GPD), –5.93, 95% confidence interval (CI) = –8.34, –3.53] and with mathematics GCSE results (GPD, –6.91, 95% CI = –9.92, –3.89). Daily tobacco smoking was associated negatively with English GCSE (GPD, –11.90, 95% CI = –13.47, –10.33) and with mathematics GCSE (GPD, –16.72, 95% CI = –18.57, –14.86). The greatest attenuation of these effects was seen on adjustment for other substance use and conduct disorder. Following adjustment, tobacco appeared to have a consistently stronger effect than cannabis. Conclusions Both cannabis and tobacco use in adolescence are associated strongly with subsequent adverse educational outcomes. Given the non‐specific patterns of association seen and the attenuation of estimates on adjustment, it is possible that these effects arise through non‐causal mechanisms, although a causal explanation cannot be discounted. © 2015 Society for the Study of Addiction PMID:25488831

Adolescent cannabis and tobacco use and educational outcomes at age 16: birth cohort study.

PubMed

Stiby, Alexander I; Hickman, Matthew; Munafò, Marcus R; Heron, Jon; Yip, Vikki L; Macleod, John

2015-04-01

To investigate the relationship between cannabis and tobacco use by age 15 and subsequent educational outcomes. Birth cohort study. England. The sample was drawn from the Avon Longitudinal Study of Parents and Children; a core sample of 1155 individuals had complete information on all the variables. The main exposures were cannabis and tobacco use at age 15 assessed in clinic by computer-assisted questionnaire and serum cotinine. The main outcomes were performance in standardized assessments at 16 [Key Stage 4, General Certificate of Secondary Education (GCSE)] in English and mathematics (mean scores), completion of five or more assessments at grade C level or higher and leaving school having achieved no qualifications. Analyses were sequentially adjusted for multiple covariates using a hierarchical approach. Covariates considered were: maternal substance use (ever tobacco or cannabis use, alcohol use above recommended limits); life course socio-economic position (family occupational class, maternal education, family income); child sex; month and year of birth; child educational attainment prior to age 11 (Key Stage 2); child substance use (tobacco, alcohol and cannabis) prior to age 15 and child conduct disorder. In fully adjusted models both cannabis and tobacco use at age 15 were associated with subsequent adverse educational outcomes. In general, the dose-response effect seen was consistent across all educational outcomes assessed. Weekly cannabis use was associated negatively with English GCSE results [grade point difference (GPD), -5.93, 95% confidence interval (CI) = -8.34, -3.53] and with mathematics GCSE results (GPD, -6.91, 95% CI = -9.92, -3.89). Daily tobacco smoking was associated negatively with English GCSE (GPD, -11.90, 95% CI = -13.47, -10.33) and with mathematics GCSE (GPD, -16.72, 95% CI = -18.57, -14.86). The greatest attenuation of these effects was seen on adjustment for other substance use and conduct disorder. Following adjustment, tobacco appeared to have a consistently stronger effect than cannabis. Both cannabis and tobacco use in adolescence are associated strongly with subsequent adverse educational outcomes. Given the non-specific patterns of association seen and the attenuation of estimates on adjustment, it is possible that these effects arise through non-causal mechanisms, although a causal explanation cannot be discounted. © 2015 Society for the Study of Addiction. © 2014 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

Workplace Violence and Job Outcomes of Newly Licensed Nurses.

PubMed

Chang, Hyoung Eun; Cho, Sung-Hyun

2016-12-01

The purpose of this study was to examine the prevalence of workplace violence toward newly licensed nurses and the relationship between workplace violence and job outcomes. An online survey was conducted of newly licensed registered nurses who had obtained their license in 2012 or 2013 in South Korea and had been working for 5-12 months after first being employed. The sample consisted of 312 nurses working in hospitals or clinics. The Copenhagen Psychosocial Questionnaire II was used to measure violence and nurse job outcomes. Multiple linear and logistic regression analyses were conducted to examine the relationship between violence and job outcomes. Verbal abuse was most prevalent (59.6%), followed by threats of violence (36.9%), physical violence (27.6%), bullying (25.6%), and sexual harassment (22.4%). Approximately three quarters of the nurses had experienced at least one type of violence. The main perpetrators were patients and nurse colleagues, although the distribution of perpetrators varied depending on the type of violence. Bullying had a significant relationship with all four job outcomes (job satisfaction, burnout, commitment to the workplace, and intent to leave), while verbal abuse was associated with all job outcomes except for intent to leave. Violence perpetrated by nurse colleagues had a significant relationship with all four job outcomes, while violence by physicians had a significant inverse relationship with job satisfaction. Workplace violence is experienced by a high percentage of newly licensed nurses, and is associated with their job outcomes. Copyright © 2016. Published by Elsevier B.V.

Unhealthy Weight-control Behaviours, Dieting and Weight Status: A Cross-cultural Comparison between North American and Spanish Adolescents

PubMed Central

López-Guimerà, Gemma; Neumark-Sztainer, Dianne; Hannan, Peter; Fauquet, Jordi; Loth, Katie; Sánchez-Carracedo, David

2013-01-01

The aim of the current study was to examine and compare dieting and unhealthy weight-control behaviours (UWCB) in population-based samples in two large urban areas in Spain (Barcelona) and in the USA (Twin Cities of Minneapolis and St. Paul, Minnesota). Additionally, use of UWCB across weight categories was explored in both samples. Participants included 1501 adolescents from Barcelona (48% girls, 52% boys) and 2793 adolescents from the Twin Cities (53% girls, 47% boys). The main outcome measures were dieting, UWCB (less extreme and extreme) and weight status. Although dieting and UWCB were prevalent in both samples, particularly among girls, the prevalence was higher in the US sample. In both countries, the report of dieting and use of UWCB was highest among overweight and obese youth. Prevention interventions that address the broad spectrum of eating and weight-related problems should be warranted in light of the high prevalence and co-occurrence of overweight and unhealthy weight-related behaviours. PMID:23055262

Intensivist-reported Facilitators and Barriers to Discussing Post-Discharge Outcomes with Intensive Care Unit Surrogates. A Qualitative Study.

PubMed

Turnbull, Alison E; Davis, Wesley E; Needham, Dale M; White, Douglas B; Eakin, Michelle N

2016-09-01

Intensive care unit (ICU) patients' expected post-discharge outcomes are rarely discussed in family meetings despite this information being centrally important to patients and their families. To characterize intensivist-identified barriers and facilitators to discussing post-discharge outcomes with surrogates of ICU patients. Qualitative study conducted via one-on-one, semistructured telephone interviews with 23 intensivists from 20 hospitals with accreditation council for graduate medical education-accredited critical care medicine programs in 16 states. A limited application of grounded theory methods was used to code transcribed interviews and identify themes and illustrative quotes. Intensivists reported tension between their professional responsibility to discuss likely functional outcomes versus uncertainty about their ability to predict those outcomes for an individual patient. They cited three main barriers as limiting their ability to conduct conversations about post-discharge outcomes with ICU surrogates: (1) incorrectly optimistic expectations for recovery among ICU surrogates, (2) having little or no contact with their patients after ICU discharge, and (3) minimal confidence applying existing outcomes research to individual patients. Despite these barriers, experience talking to ICU surrogates, seeing ICU survivors in the outpatient setting, and trusted research on functional outcomes were identified as important facilitators to discussing likely patient outcomes with surrogates. Intensivists generally welcomed questions from surrogates about post-discharge outcomes as opportunities to initiate conversations about prognosis and patient values. In this sample of intensivists from 20 academic hospitals, experience conducting conversations with surrogates and interactions with ICU survivors as outpatients were identified as facilitating discussion of expected post-discharge outcomes while optimistic surrogate expectations and prognostic uncertainty were barriers. There was tension between self-perceived ability to prognosticate and belief in a professional obligation to discuss patient outcomes.

Role of Social Media in Diabetes Management in the Middle East Region: Systematic Review

PubMed Central

2018-01-01

Background Diabetes is a major health care burden in the Middle East region. Social networking tools can contribute to the management of diabetes with improved educational and care outcomes using these popular tools in the region. Objective The objective of this review was to evaluate the impact of social networking interventions on the improvement of diabetes management and health outcomes in patients with diabetes in the Middle East. Methods Peer-reviewed articles from PubMed (1990-2017) and Google Scholar (1990-2017) were identified using various combinations of predefined terms and search criteria. The main inclusion criterion consisted of the use of social networking apps on mobile phones as the primary intervention. Outcomes were grouped according to study design, type of diabetes, category of technological intervention, location, and sample size. Results This review included 5 articles evaluating the use of social media tools in the management of diabetes in the Middle East. In most studies, the acceptance rate for the use of social networking to optimize the management of diabetes was relatively high. Diabetes-specific management tools such as the Saudi Arabia Networking for Aiding Diabetes and Diabetes Intelligent Management System for Iraq systems helped collect patient information and lower hemoglobin A1c (HbA1c) levels, respectively. Conclusions The reviewed studies demonstrated the potential of social networking tools being adopted in regions in the Middle East to improve the management of diabetes. Future studies consisting of larger sample sizes spanning multiple regions would provide further insight into the use of social media for improving patient outcomes. PMID:29439941

The SF36 health survey questionnaire: an outcome measure suitable for routine use within the NHS?

PubMed Central

Garratt, A M; Ruta, D A; Abdalla, M I; Buckingham, J K; Russell, I T

1993-01-01

OBJECTIVE--To assess the validity, reliability, and acceptability of the short form 36 (SF 36) health survey questionnaire (a shortened version of a battery of 149 health status questions) as a measure of patient outcome in a broad sample of patients suffering from four common clinical conditions. DESIGN--Postal questionnaire, followed up by two reminders at two week intervals. SETTING--Clinics and four training practices in north east Scotland. SUBJECTS--Over 1700 patients aged 16-86 with one of four conditions--low back pain, menorrhagia, suspected peptic ulcer, or varicose veins--and a comparison sample of 900 members of the general population. MAIN OUTCOME MEASURES--The eight scales within the SF36 health profile. RESULTS--The response rate exceeded 75% in the patient population (1310 respondents). The SF36 satisfied rigorous psychometric criteria for validity and internal consistency. Clinical validity was shown by the distinctive profiles generated for each condition, each of which differed from that in the general population in a predictable manner. Furthermore, SF36 scores were lower in referred patients than in patients not referred and were closely related to general practitioners' perceptions of severity. CONCLUSIONS--These results provide support for the SF36 as a potential measure of patient outcome within the NHS. The SF36 seems acceptable to patients, internally consistent, and a valid measure of the health status of a wide range of patients. Before it can be used in the new health service, however, its sensitivity to changes in health status over time must also be tested. PMID:8518640

Serum aminoacylase-1 is a novel biomarker with potential prognostic utility for long-term outcome in patients with delayed graft function following renal transplantation

PubMed Central

Welberry Smith, Matthew P; Zougman, Alexandre; Cairns, David A; Wilson, Michelle; Wind, Tobias; Wood, Steven L; Thompson, Douglas; Messenger, Michael P; Mooney, Andrew; Selby, Peter J; Lewington, Andrew J P; Banks, Rosamonde E

2013-01-01

Early identification and prognostic stratification of delayed graft function following renal transplantation has significant potential to improve outcome. Mass spectrometry analysis of serum samples, before and on day 2 post transplant from five patients with delayed graft function and five with an uncomplicated transplant, identified aminoacylase-1 (ACY-1) as a potential outcome biomarker. Following assay development, analysis of longitudinal samples from an initial validation cohort of 55 patients confirmed that the ACY-1 level on day 1 or 2 was a moderate predictor of delayed graft function, similar to serum creatinine, complementing the strongest predictor cystatin C. A further validation cohort of 194 patients confirmed this association with area under ROC curves (95% CI) for day 1 serum (138 patients) of 0.74 (0.67–0.85) for ACY-1, 0.9 (0.84–0.95) for cystatin C, and 0.93 (0.88–0.97) for both combined. Significant differences in serum ACY-1 levels were apparent between delayed, slow, and immediate graft function. Analysis of long-term follow-up for 54 patients with delayed graft function showed a highly significant association between day 1 or 3 serum ACY-1 and dialysis-free survival, mainly associated with the donor–brain–dead transplant type. Thus, proteomic analysis provides novel insights into the potential clinical utility of serum ACY-1 levels immediately post transplantation, enabling subdivision of patients with delayed graft function in terms of long-term outcome. Our study requires independent confirmation. PMID:23739232

Development of a tool to measure person-centered maternity care in developing settings: validation in a rural and urban Kenyan population.

PubMed

Afulani, Patience A; Diamond-Smith, Nadia; Golub, Ginger; Sudhinaraset, May

2017-09-22

Person-centered reproductive health care is recognized as critical to improving reproductive health outcomes. Yet, little research exists on how to operationalize it. We extend the literature in this area by developing and validating a tool to measure person-centered maternity care. We describe the process of developing the tool and present the results of psychometric analyses to assess its validity and reliability in a rural and urban setting in Kenya. We followed standard procedures for scale development. First, we reviewed the literature to define our construct and identify domains, and developed items to measure each domain. Next, we conducted expert reviews to assess content validity; and cognitive interviews with potential respondents to assess clarity, appropriateness, and relevance of the questions. The questions were then refined and administered in surveys; and survey results used to assess construct and criterion validity and reliability. The exploratory factor analysis yielded one dominant factor in both the rural and urban settings. Three factors with eigenvalues greater than one were identified for the rural sample and four factors identified for the urban sample. Thirty of the 38 items administered in the survey were retained based on the factors loadings and correlation between the items. Twenty-five items load very well onto a single factor in both the rural and urban sample, with five items loading well in either the rural or urban sample, but not in both samples. These 30 items also load on three sub-scales that we created to measure dignified and respectful care, communication and autonomy, and supportive care. The Chronbach alpha for the main scale is greater than 0.8 in both samples, and that for the sub-scales are between 0.6 and 0.8. The main scale and sub-scales are correlated with global measures of satisfaction with maternity services, suggesting criterion validity. We present a 30-item scale with three sub-scales to measure person-centered maternity care. This scale has high validity and reliability in a rural and urban setting in Kenya. Validation in additional settings is however needed. This scale will facilitate measurement to improve person-centered maternity care, and subsequently improve reproductive outcomes.

Cognitive coping styles of women sexually abused in childhood: a qualitative study.

PubMed

Perrott, K; Morris, E; Martin, J; Romans, S

1998-11-01

The aim was to investigate cognitive coping strategies used by a nonclinical sample of women with a history of childhood sexual abuse, to examine whether cognitive appraisals affected their current coping strategies and psychological well-being. Qualitative research methods were used to enable the sample to convey their own ideas about factors and meanings they attributed to their experience of child sexual abuse. The sample of 40 was drawn from one of two stratified sub samples randomly selected from electoral rolls for interview in 1989 and re-interviewed in 1995. One sub sample had reported childhood sexual abuse and the other had reported none. Inductive content analysis and coding of themes were carried out using appropriate software and supplemented by quantitative interview data. Six main coping strategies were identified and then assessed to determine their mediating influence on psychiatric disorder, self-esteem and self reported difficulties experienced as adults. Overall, abuse characteristics did not predict outcome but women who "deliberately suppressed" the abuse incidents were more likely to have low self-esteem and women who "reframed" were significantly less likely to have a psychiatric diagnosis. Some cognitive coping strategies employed after experiencing child sexual abuse impinge on later psychological well-being or subsequent relationships with other people. One of the more challenging findings to come out of the study was that women who "reframed" the sexual abuse event were more likely to have favorable mental health outcomes but were also more likely to report that their own child had been sexually abused.

Organizational climate, services, and outcomes in child welfare systems.

PubMed

Glisson, Charles; Green, Philip

2011-08-01

This study examines the association of organizational climate, casework services, and youth outcomes in child welfare systems. Building on preliminary findings linking organizational climate to youth outcomes over a 3-year follow-up period, the current study extends the follow-up period to 7 years and tests main, moderating and mediating effects of organizational climate and casework services on outcomes. The study applies hierarchical linear models (HLMs) analyses to all 5 waves of the National Survey of Child and Adolescent Well-being (NSCAW) with a US nationwide sample of 1,678 maltreated youth aged 4-16 years and 1,696 caseworkers from 88 child welfare systems. Organizational climate is assessed on 2 dimensions, Engagement and Stress, with scales from the well established measure, Organizational Social Context (OSC); youth outcomes are measured as problems in psychosocial functioning with the Child Behavior Checklist (CBCL); and casework services are assessed with original scales developed for the study and completed by the maltreated youths' primary caregivers and caseworkers. Maltreated youth served by child welfare systems with more engaged organizational climates have significantly better outcomes. Moreover, the quantity and quality of casework services neither mediate nor interact with the effects of organizational climate on youth outcomes. Organizational climate is associated with youth outcomes in child welfare systems, but a better understanding is needed of the mechanisms that link organizational climate to outcomes. In addition, there is a need for evidence-based organizational interventions that can improve the organizational climates and effectiveness of child welfare systems. Copyright © 2011 Elsevier Ltd. All rights reserved.

Individual- and organizational-level consequences of organizational citizenship behaviors: A meta-analysis.

PubMed

Podsakoff, Nathan P; Whiting, Steven W; Podsakoff, Philip M; Blume, Brian D

2009-01-01

Although one of the main reasons for the interest in organizational citizenship behaviors (OCBs) is the potential consequences of these behaviors, no study has been reported that summarizes the research regarding the relationships between OCBs and their outcomes. Therefore, the purpose of this study is to provide a meta-analytic examination of the relationships between OCBs and a variety of individual- and organizational-level outcomes. Results, based on 168 independent samples (N = 51,235 individuals), indicated that OCBs are related to a number of individual-level outcomes, including managerial ratings of employee performance, reward allocation decisions, and a variety of withdrawal-related criteria (e.g., employee turnover intentions, actual turnover, and absenteeism). In addition, OCBs were found to be related (k = 38; N = 3,611 units) to a number of organizational-level outcomes (e.g., productivity, efficiency, reduced costs, customer satisfaction, and unit-level turnover). Of interest, somewhat stronger relationships were observed between OCBs and unit-level performance measures in longitudinal studies than in cross-sectional studies, providing some evidence that OCBs are causally related to these criteria. The implications of these findings for both researchers and practitioners are discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Financial ties of principal investigators and randomized controlled trial outcomes: cross sectional study

PubMed Central

Ahn, Rosa; Woodbridge, Alexandra; Abraham, Ann; Saba, Susan; Korenstein, Deborah; Madden, Erin; Boscardin, W John

2017-01-01

Objective To examine the association between the presence of individual principal investigators’ financial ties to the manufacturer of the study drug and the trial’s outcomes after accounting for source of research funding. Design Cross sectional study of randomized controlled trials (RCTs). Setting Studies published in “core clinical” journals, as identified by Medline, between 1 January 2013 and 31 December 2013. Participants Random sample of RCTs focused on drug efficacy. Main outcome measure Association between financial ties of principal investigators and study outcome. Results A total of 190 papers describing 195 studies met inclusion criteria. Financial ties between principal investigators and the pharmaceutical industry were present in 132 (67.7%) studies. Of 397 principal investigators, 231 (58%) had financial ties and 166 (42%) did not. Of all principal investigators, 156 (39%) reported advisor/consultancy payments, 81 (20%) reported speakers’ fees, 81 (20%) reported unspecified financial ties, 52 (13%) reported honorariums, 52 (13%) reported employee relationships, 52 (13%) reported travel fees, 41 (10%) reported stock ownership, and 20 (5%) reported having a patent related to the study drug. The prevalence of financial ties of principal investigators was 76% (103/136) among positive studies and 49% (29/59) among negative studies. In unadjusted analyses, the presence of a financial tie was associated with a positive study outcome (odds ratio 3.23, 95% confidence interval 1.7 to 6.1). In the primary multivariate analysis, a financial tie was significantly associated with positive RCT outcome after adjustment for the study funding source (odds ratio 3.57 (1.7 to 7.7). The secondary analysis controlled for additional RCT characteristics such as study phase, sample size, country of first authors, specialty, trial registration, study design, type of analysis, comparator, and outcome measure. These characteristics did not appreciably affect the relation between financial ties and study outcomes (odds ratio 3.37, 1.4 to 7.9). Conclusions Financial ties of principal investigators were independently associated with positive clinical trial results. These findings may be suggestive of bias in the evidence base. PMID:28096109

A Systematic Review of Application and Effectiveness of mHealth Interventions for Obesity and Diabetes Treatment and Self-Management.

PubMed

Wang, Youfa; Xue, Hong; Huang, Yaqi; Huang, Lili; Zhang, Dongsong

2017-05-01

The use of mobile and wireless technologies and wearable devices for improving health care processes and outcomes (mHealth) is promising for health promotion among patients with chronic diseases such as obesity and diabetes. This study comprehensively examined published mHealth intervention studies for obesity and diabetes treatment and management to assess their effectiveness and provide recommendations for future research. We systematically searched PubMed for mHealth-related studies on diabetes and obesity treatment and management published during 2000-2016. Relevant information was extracted and analyzed. Twenty-four studies met inclusion criteria and varied in terms of sample size, ethnicity, gender, and age of the participating patients and length of follow-up. The mHealth interventions were categorized into 3 types: mobile phone text messaging, wearable or portable monitoring devices, and applications running on smartphones. Primary outcomes included weight loss (an average loss ranging from -1.97 kg in 16 wk to -7.1 kg in 5 wk) or maintenance and blood glucose reduction (an average decrease of glycated hemoglobin ranging from -0.4% in 10 mo to -1.9% in 12 mo); main secondary outcomes included behavior changes and patient perceptions such as self-efficacy and acceptability of the intervention programs. More than 50% of studies reported positive effects of interventions based on primary outcomes. The duration or length of intervention ranged from 1 wk to 24 mo. However, most studies included small samples and short intervention periods and did not use rigorous data collection or analytic approaches. Although some studies suggest that mHealth interventions are effective and promising, most are pilot studies or have limitations in their study designs. There is an essential need for future studies that use larger study samples, longer intervention (≥ 6 mo) and follow-up periods (≥ 6 mo), and integrative and personalized innovative mobile technologies to provide comprehensive and sustainable support for patients and health service providers. © 2017 American Society for Nutrition.

Psychosocial stressors and alcohol use, severity, and treatment receipt across human immunodeficiency virus (HIV) status in a nationally representative sample of US residents.

PubMed

Williams, Emily C; Joo, Young Sun; Lipira, Lauren; Glass, Joseph E

2017-01-01

Human immunodeficiency virus (HIV) is stigmatized and disproportionately impacts vulnerable populations. Thus, people living with HIV (PLWH) may have greater exposure to psychosocial stressors than those without HIV. Exposure to psychosocial stressors may increase alcohol use and serve as barriers to alcohol treatment receipt. The authors evaluate whether psychosocial stressors and alcohol use, symptom severity, and treatment receipt vary across HIV status in a general population sample of US residents and assess whether psychosocial stressors mediate identified associations. Data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were used to assess associations between HIV status and psychosocial stressors (perceived stress, alcohol-related stigma, and perceived discrimination based on race/ethnicity, sexual orientation, or sex) and alcohol-related outcomes (any use, heavy drinking, symptom severity, and treatment receipt). For each outcome, regression models were fit and iteratively adjusted for sociodemographic characteristics and comorbidities. Indirect effects of HIV on alcohol-related outcomes through stressors were estimated to assess mediation when main effects were significant. Among 34,653 NESARC Wave 2 respondents, 161 were PLWH. PLWH were more likely than those without HIV to experience discrimination and had higher levels of perceived stress than those without HIV (P values <.05), but the 2 groups did not differ regarding alcohol-related stigma. PLWH were less likely to use alcohol and had similar rates of heavy drinking relative to participants without HIV, but alcohol symptom severity and treatment receipt were greater among PLWH. Perceived stress but not discrimination mediated associations. Findings from this first study of variation in psychosocial stressors and alcohol use, severity, and treatment receipt across HIV status further highlight PLWH as a population that is particularly vulnerable to experiences of psychosocial stress and certain adverse alcohol-related outcomes. Future longitudinal research is needed in a larger sample of PLWH to identify intervention targets.

Neighborhood Disorder, Social Support, and Outcomes Among Violence-Exposed African American Women.

PubMed

Pickover, Alison M; Bhimji, Jabeene; Sun, Shufang; Evans, Anna; Allbaugh, Lucy J; Dunn, Sarah E; Kaslow, Nadine J

2018-06-01

Intimate partner violence (IPV) against women, particularly those living in poverty who have multiple marginalized identities, is a significant public health issue. IPV is associated with numerous mental health concerns including depression, hopelessness, and suicidal behavior. The present study examined the ecological determinants of these mental health outcomes in a high-risk sample of 67 low-income, African American women survivors of IPV. Based on an ecological framework that conceptualizes individuals as nested in multiple, interactive systems, we examined, longitudinally, the main and interactive effects of self-reported neighborhood disorder and social support from family members and friends on participants' mental health (i.e., self-reported depressive symptoms, hopelessness, and suicide intent). In multiple regression analyses, neighborhood disorder interacted with social support from family members to predict depressive symptoms and hopelessness over time. Neighborhood disorder also interacted with social support from friends to predict hopelessness and suicide intent over time. High levels of social support buffered against the dangerous effects of neighborhood disorder on depressive symptoms, hopelessness, and suicide intent; at low levels of social support, there was no significant association between neighborhood disorder and those mental health outcomes. Neighborhood disorder and social support did not yield significant main effects. These findings underscore the importance of interventions that target individuals, families, and communities (e.g., community empowerment programs). Group interventions may also be important for low-income, African American women survivors of IPV, as they can help survivors establish and strengthen relationships and social support.

Intimacy-enhancing psychological intervention for men diagnosed with prostate cancer and their partners: a pilot study.

PubMed

Manne, Sharon L; Kissane, David W; Nelson, Christian J; Mulhall, John P; Winkel, Gary; Zaider, Talia

2011-04-01

Few couple-focused interventions have been developed to improve distress and relationship outcomes among men diagnosed with localized prostate cancer and their partners. We examined the effects of a five-session Intimacy-Enhancing Therapy (IET) vs. Usual Care (UC) on the psychological and relationship functioning of men diagnosed with localized prostate cancer and their partners. Pre-intervention levels of psychological and relationship functioning were evaluated as moderators of intervention effects. Seventy-one survivors and their partners completed a baseline survey and were subsequently randomly assigned to receive five sessions of IET or UC (no treatment). Eight weeks after the baseline assessment, a follow-up survey was administered to survivor and partner. Distress, well-being, relationship satisfaction, relationship intimacy, and communication were investigated as the main outcomes. IET effects were largely moderated by pre-intervention psychosocial and relationship factors. Those survivors who had higher levels of cancer concerns at pretreatment had significantly reduced concerns following IET. Similar moderating effects for pre-intervention levels were reported for the effects of IET on self-disclosure, perceived partner disclosure, and perceived partner responsiveness. Among partners beginning the intervention with higher cancer-specific distress, lower marital satisfaction, lower intimacy, and poorer communication, IET improved these outcomes. IET had a marginally significant main effect upon survivor well-being but was effective among couples with fewer personal and relationship resources. Subsequent research is needed to replicate these findings with a larger sample and a longer follow-up. © 2010 International Society for Sexual Medicine.

High Baseline Postconcussion Symptom Scores and Concussion Outcomes in Athletes

PubMed Central

Custer, Aimee; Sufrinko, Alicia; Elbin, R. J.; Covassin, Tracey; Collins, Micky; Kontos, Anthony

2016-01-01

Context:  Some healthy athletes report high levels of baseline concussion symptoms, which may be attributable to several factors (eg, illness, personality, somaticizing). However, the role of baseline symptoms in outcomes after sport-related concussion (SRC) has not been empirically examined. Objective:  To determine if athletes with high symptom scores at baseline performed worse than athletes without baseline symptoms on neurocognitive testing after SRC. Design:  Cohort study. Setting:  High school and collegiate athletic programs. Patients or Other Participants:  A total of 670 high school and collegiate athletes participated in the study. Participants were divided into groups with either no baseline symptoms (Postconcussion Symptom Scale [PCSS] score = 0, n = 247) or a high level of baseline symptoms (PCSS score > 18 [top 10% of sample], n = 68). Main Outcome Measure(s):  Participants were evaluated at baseline and 2 to 7 days after SRC with the Immediate Post-concussion Assessment and Cognitive Test and PCSS. Outcome measures were Immediate Post-concussion Assessment and Cognitive Test composite scores (verbal memory, visual memory, visual motor processing speed, and reaction time) and total symptom score on the PCSS. The groups were compared using repeated-measures analyses of variance with Bonferroni correction to assess interactions between group and time for symptoms and neurocognitive impairment. Results:  The no-symptoms group represented 38% of the original sample, whereas the high-symptoms group represented 11% of the sample. The high-symptoms group experienced a larger decline from preinjury to postinjury than the no-symptoms group in verbal (P = .03) and visual memory (P = .05). However, total concussion-symptom scores increased from preinjury to postinjury for the no-symptoms group (P = .001) but remained stable for the high-symptoms group. Conclusions:>  Reported baseline symptoms may help identify athletes at risk for worse outcomes after SRC. Clinicians should examine baseline symptom levels to better identify patients for earlier referral and treatment for their injury. Additional investigation of baseline symptoms is warranted to help delineate the type and severity of premorbid symptoms. PMID:26885702

Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review

PubMed Central

Hall, William J.; Lee, Kent M.; Merino, Yesenia M.; Thomas, Tainayah W.; Payne, B. Keith; Eng, Eugenia; Day, Steven H.; Coyne-Beasley, Tamera

2015-01-01

Background. In the United States, people of color face disparities in access to health care, the quality of care received, and health outcomes. The attitudes and behaviors of health care providers have been identified as one of many factors that contribute to health disparities. Implicit attitudes are thoughts and feelings that often exist outside of conscious awareness, and thus are difficult to consciously acknowledge and control. These attitudes are often automatically activated and can influence human behavior without conscious volition. Objectives. We investigated the extent to which implicit racial/ethnic bias exists among health care professionals and examined the relationships between health care professionals’ implicit attitudes about racial/ethnic groups and health care outcomes. Search Methods. To identify relevant studies, we searched 10 computerized bibliographic databases and used a reference harvesting technique. Selection Criteria. We assessed eligibility using double independent screening based on a priori inclusion criteria. We included studies if they sampled existing health care providers or those in training to become health care providers, measured and reported results on implicit racial/ethnic bias, and were written in English. Data Collection and Analysis. We included a total of 15 studies for review and then subjected them to double independent data extraction. Information extracted included the citation, purpose of the study, use of theory, study design, study site and location, sampling strategy, response rate, sample size and characteristics, measurement of relevant variables, analyses performed, and results and findings. We summarized study design characteristics, and categorized and then synthesized substantive findings. Main Results. Almost all studies used cross-sectional designs, convenience sampling, US participants, and the Implicit Association Test to assess implicit bias. Low to moderate levels of implicit racial/ethnic bias were found among health care professionals in all but 1 study. These implicit bias scores are similar to those in the general population. Levels of implicit bias against Black, Hispanic/Latino/Latina, and dark-skinned people were relatively similar across these groups. Although some associations between implicit bias and health care outcomes were nonsignificant, results also showed that implicit bias was significantly related to patient–provider interactions, treatment decisions, treatment adherence, and patient health outcomes. Implicit attitudes were more often significantly related to patient–provider interactions and health outcomes than treatment processes. Conclusions. Most health care providers appear to have implicit bias in terms of positive attitudes toward Whites and negative attitudes toward people of color. Future studies need to employ more rigorous methods to examine the relationships between implicit bias and health care outcomes. Interventions targeting implicit attitudes among health care professionals are needed because implicit bias may contribute to health disparities for people of color. PMID:26469668

Exploring cardiovascular health: the Healthy Life in Suriname (HELISUR) study. A protocol of a cross-sectional study

PubMed Central

Diemer, Frederieke S; Aartman, Jet Q; Karamat, Fares A; Baldew, Sergio M; Jarbandhan, Ameerani V; van Montfrans, Gert A; Oehlers, Glenn P; Brewster, Lizzy M

2014-01-01

Introduction Obesity, hypertension and diabetes are on a dramatic rise in low-income and middle-income countries, and this foretells an overwhelming increase in chronic disease burden from cardiovascular disease. Therefore, rapid action should be taken through preventive population-based programmes. However, in these regions, data on the population distribution of cardiovascular risk factors, and of intermediate and final end points for cardiovascular disease are scarce. The Healthy Life in Suriname (HELISUR) study is a cardiovascular population study in Suriname, which is part of the Caribbean Community. The HELISUR study is dedicated to provide data on risk factors and prevalent cardiovascular disease in the multiethnic population, which is mainly of African and Asian descent. Methods and analysis In a cross-sectional, observational population-based setting, a random representative sample of 1800 citizens aged between 18 and 70 years will be selected using a cluster household sampling method. Self-reported demographic, socioeconomic and (cardiovascular) health-related data will be collected. Physical examination will include the assessment of cardiovascular risk factors and prevalent cardiovascular disease. In addition, we will study cardiovascular haemodynamics non-invasively, as a novel intermediate outcome. Finally, fasting blood and overnight urine samples will be collected to monitor cardiometabolic risk factors. The main outcome will be descriptive in reporting the prevalence of risk factors and measures of (sub) clinical end organ damage, stratified for ethnicity and sex-age groups. Ethics and dissemination Ethical approval has been obtained from the State Secretary of Health. Data analysis and manuscript submission are scheduled for 2016. Findings will be disseminated in peer-reviewed journals, and at national, regional and international scientific meetings. Importantly, data will be presented to Surinamese policymakers and healthcare workers, to develop preventive strategies to combat the rapid rise of cardiovascular disease. PMID:25537786

Exploring cardiovascular health: the Healthy Life in Suriname (HELISUR) study. A protocol of a cross-sectional study.

PubMed

Diemer, Frederieke S; Aartman, Jet Q; Karamat, Fares A; Baldew, Sergio M; Jarbandhan, Ameerani V; van Montfrans, Gert A; Oehlers, Glenn P; Brewster, Lizzy M

2014-12-23

Obesity, hypertension and diabetes are on a dramatic rise in low-income and middle-income countries, and this foretells an overwhelming increase in chronic disease burden from cardiovascular disease. Therefore, rapid action should be taken through preventive population-based programmes. However, in these regions, data on the population distribution of cardiovascular risk factors, and of intermediate and final end points for cardiovascular disease are scarce. The Healthy Life in Suriname (HELISUR) study is a cardiovascular population study in Suriname, which is part of the Caribbean Community. The HELISUR study is dedicated to provide data on risk factors and prevalent cardiovascular disease in the multiethnic population, which is mainly of African and Asian descent. In a cross-sectional, observational population-based setting, a random representative sample of 1800 citizens aged between 18 and 70 years will be selected using a cluster household sampling method. Self-reported demographic, socioeconomic and (cardiovascular) health-related data will be collected. Physical examination will include the assessment of cardiovascular risk factors and prevalent cardiovascular disease. In addition, we will study cardiovascular haemodynamics non-invasively, as a novel intermediate outcome. Finally, fasting blood and overnight urine samples will be collected to monitor cardiometabolic risk factors. The main outcome will be descriptive in reporting the prevalence of risk factors and measures of (sub) clinical end organ damage, stratified for ethnicity and sex-age groups. Ethical approval has been obtained from the State Secretary of Health. Data analysis and manuscript submission are scheduled for 2016. Findings will be disseminated in peer-reviewed journals, and at national, regional and international scientific meetings. Importantly, data will be presented to Surinamese policymakers and healthcare workers, to develop preventive strategies to combat the rapid rise of cardiovascular disease. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Progression of aging in Mexico: the Mexican Health and Aging Study (MHAS) 2012.

PubMed

Wong, Rebeca; Michaels-Obregón, Alejandra; Palloni, Alberto; Gutiérrez-Robledo, Luis Miguel; González-González, César; López-Ortega, Mariana; Téllez-Rojo, Martha María; Mendoza-Alvarado, Laura Rosario

2015-01-01

To describe the third wave of the Mexican Health and Aging Study (MHAS), completed in 2012, and present preliminary results. Descriptive analyses by gender and age group of demographic and socioeconomic characteristics, health conditions and health behaviors, as well as social support and life satisfaction measures are presented. In addition, external validations are presented by comparing MHAS 2012 indicators with other national data sources. For the panel of older adults in the sample, the rate of health care insurance coverage increased greatly between 2001 and 2012, a significantly higher change in rural compared to urban areas. The results for 2012 are consistent with the previous two waves for the main indicators of health and physical disability prevalence, risk factors,and behaviors. The MHAS offers a unique opportunity to study aging in Mexico, as well as to complete cross-national comparisons. The cumulative number of deaths in the cohort should support the study of mortality and its association with health outcomes and behaviors over the life cycle. In addition, the sub-samples of objective markers will enable methodological research on self-reports and associations of biomarkers in old age with similar health outcomes and behaviors.

Progression of aging in Mexico: the Mexican Health and Aging Study (MHAS) 2012

PubMed Central

Wong, Rebeca; Michaels-Obregón, Alejandra; Palloni, Alberto; Gutiérrez-Robledo, Luis Miguel; González-González, César; López-Ortega, Mariana; Téllez-Rojo, Martha María; Mendoza-Alvarado, Laura Rosario

2015-01-01

Objective To describe the third wave of the Mexican Health and Aging Study (MHAS), completed in 2012, and present preliminary results. Materials and methods Descriptive analyses by gender and age group of demographic and socioeconomic characteristics, health conditions and health behaviors, as well as social support and life satisfaction measures are presented. In addition, external validations are presented by comparing MHAS 2012 indicators with other national data sources. Results For the panel of older adults in the sample, the rate of health care insurance coverage increased greatly between 2001 and 2012, a significantly higher change in rural compared to urban areas. The results for 2012 are consistent with the previous two waves for the main indicators of health and physical disability prevalence, risk factors, and behaviors. Conclusions The MHAS offers a unique opportunity to study aging in Mexico, as well as to complete cross-national comparisons. The cumulative number of deaths in the cohort should support the study of mortality and its association with health outcomes and behaviors over the life cycle. In addition, the sub-samples of objective markers will enable methodological research on self-reports and associations of biomarkers in old age with similar health outcomes and behaviors. PMID:26172238

Group exposure therapy treatment for post-traumatic stress disorder in female veterans.

PubMed

Castillo, Diane T; C' de Baca, Janet; Qualls, Clifford; Bornovalova, Marina A

2012-12-01

The purpose of this study was to examine the application of a group exposure therapy model, the content of which consisted solely of repeated imaginal exposure during sessions, in a clinical sample of female veterans with post-traumatic stress disorder (PTSD). Establishing group delivery of exposure therapy will expand options, increase efficiency, and introduce group curative factors. Eighty-eight female veterans with PTSD completed a six-session exposure group, three participants per group, as a component of a larger treatment program. The PTSD symptom checklist (PCL) was used as the outcome measure and administered in each session. Pre/post-paired t-tests showed significant improvement in PTSD on the PCL, with 40% of completers showing at least a 10-point drop in the PCL scores. In addition, a repeated measures analysis of variance showed a significant main effect and a significant quadratic equation, with expected initial increases in the PCL followed by a decrease below baseline at session 6. The group exposure treatment protocol showed positive outcomes on PTSD symptoms in a real-world clinical sample of female veterans. The implications include an expansion of exposure treatment choices for veterans with PTSD and increased options for therapists.

HRM and its effect on employee, organizational and financial outcomes in health care organizations

PubMed Central

2014-01-01

Background One of the main goals of Human Resource Management (HRM) is to increase the performance of organizations. However, few studies have explicitly addressed the multidimensional character of performance and linked HR practices to various outcome dimensions. This study therefore adds to the literature by relating HR practices to three outcome dimensions: financial, organizational and employee (HR) outcomes. Furthermore, we will analyze how HR practices influence these outcome dimensions, focusing on the mediating role of job satisfaction. Methods This study uses a unique dataset, based on the ‘ActiZ Benchmark in Healthcare’, a benchmark study conducted in Dutch home care, nursing care and care homes. Data from autumn 2010 to autumn 2011 were analyzed. In total, 162 organizations participated during this period (approximately 35% of all Dutch care organizations). Employee data were collected using a questionnaire (61,061 individuals, response rate 42%). Clients were surveyed using the Client Quality Index for long-term care, via stratified sampling. Financial outcomes were collected using annual reports. SEM analyses were conducted to test the hypotheses. Results It was found that HR practices are - directly or indirectly - linked to all three outcomes. The use of HR practices is related to improved financial outcomes (measure: net margin), organizational outcomes (measure: client satisfaction) and HR outcomes (measure: sickness absence). The impact of HR practices on HR outcomes and organizational outcomes proved substantially larger than their impact on financial outcomes. Furthermore, with respect to HR and organizational outcomes, the hypotheses concerning the full mediating effect of job satisfaction are confirmed. This is in line with the view that employee attitudes are an important element in the ‘black box’ between HRM and performance. Conclusion The results underscore the importance of HRM in the health care sector, especially for HR and organizational outcomes. Further analyses of HRM in the health care sector will prove to be a productive endeavor for both scholars and HR managers. PMID:24938460

HRM and its effect on employee, organizational and financial outcomes in health care organizations.

PubMed

Vermeeren, Brenda; Steijn, Bram; Tummers, Lars; Lankhaar, Marcel; Poerstamper, Robbert-Jan; van Beek, Sandra

2014-06-17

One of the main goals of Human Resource Management (HRM) is to increase the performance of organizations. However, few studies have explicitly addressed the multidimensional character of performance and linked HR practices to various outcome dimensions. This study therefore adds to the literature by relating HR practices to three outcome dimensions: financial, organizational and employee (HR) outcomes. Furthermore, we will analyze how HR practices influence these outcome dimensions, focusing on the mediating role of job satisfaction. This study uses a unique dataset, based on the 'ActiZ Benchmark in Healthcare', a benchmark study conducted in Dutch home care, nursing care and care homes. Data from autumn 2010 to autumn 2011 were analyzed. In total, 162 organizations participated during this period (approximately 35% of all Dutch care organizations). Employee data were collected using a questionnaire (61,061 individuals, response rate 42%). Clients were surveyed using the Client Quality Index for long-term care, via stratified sampling. Financial outcomes were collected using annual reports. SEM analyses were conducted to test the hypotheses. It was found that HR practices are - directly or indirectly - linked to all three outcomes. The use of HR practices is related to improved financial outcomes (measure: net margin), organizational outcomes (measure: client satisfaction) and HR outcomes (measure: sickness absence). The impact of HR practices on HR outcomes and organizational outcomes proved substantially larger than their impact on financial outcomes. Furthermore, with respect to HR and organizational outcomes, the hypotheses concerning the full mediating effect of job satisfaction are confirmed. This is in line with the view that employee attitudes are an important element in the 'black box' between HRM and performance. The results underscore the importance of HRM in the health care sector, especially for HR and organizational outcomes. Further analyses of HRM in the health care sector will prove to be a productive endeavor for both scholars and HR managers.

The effects of narrative and message framing on engagement and eating intention among a sample of adult Hispanics.

PubMed

Wirtz, John G; Kulpavaropas, Supathida

2014-01-01

To test the effect of narrative messages and gain- and loss-framed messages on persuasive outcomes with a sample of Hispanic adults. A 2 (message type: narrative, non-narrative) × 2 (message frame: gain-framed, loss-framed) between subjects posttest only. Data were collected at 2 outdoor festivals in West Texas. Participants were a convenience sample of 72 Hispanic adults (mean age, 40.6 years). Main outcome measures were message engagement, message relevance, attitude toward message, healthy eating intention, and physical activity intention. Data analysis included analysis of variance and multivariate analysis of variance. There was no significant difference between narrative and non-narrative messages. Gain-framed messages were rated more positively, whereas loss-framed messages were considered more engaging and also produced higher intentions to eat healthy and to become physically active. The interaction between message type and message framing was not significant. Loss-framed messages produced the unanticipated effect of higher message engagement and higher intention. This finding suggests that messages emphasizing losses associated with unhealthy eating and lack of physical activity may be more effective when targeting Hispanic adults than messages emphasizing potential gains. The lack of difference between narrative and non-narrative messages suggests there is no disadvantage to using narratives, but also no advantage. Copyright © 2014 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Treatment of alcohol use disorder and co-occurring PTSD.

PubMed

Taylor, Mandrill; Petrakis, Ismene; Ralevski, Elizabeth

2017-07-01

Alcohol use disorder (AUD) is a serious psychiatric disorder with medical, psychiatric, and social consequences. In individuals with comorbid post-traumatic stress disorder (PTSD), treatment outcomes are notably worse in comparison with treatment outcomes associated with either disorder occurring alone. There is a growing literature evaluating treatments, both pharmacotherapy and psychotherapy focused, in individuals with co-occurring AUD and PTSD. The main objective of this review was to evaluate pharmacotherapy and psychotherapy studies that were specifically designed to evaluate the treatment of individuals with comorbid AUD and PTSD. MEDLINE and PUBMED databases were searched with no specific time period. Studies focusing on SUD treatments were excluded. Because the number of random clinical trial (RCT) studies was small, all publications (including open label, single case, and secondary analyses) were included. Sixteen studies met criteria and were organized based on whether they evaluated the efficacy of pharmacotherapy, psychotherapy, or both. Pharmacological interventions with either AUD or PTSD agents were mainly effective in reducing drinking outcomes; only one study using sertraline found that the active study medication was superior to placebo in reducing PTSD symptoms. Psychotherapies were not superior to a comparative treatment in reducing drinking outcomes. Only 1 study showed reduction in PTSD symptoms in a small sample of completers. The single RCT that evaluated the efficacy of naltrexone in combination with psychotherapies (prolonged exposure or supportive counseling) found that naltrexone in combination with prolonged exposure was better for drinking outcomes at follow-up. Although these studies represent a good start in terms of research in treatment interventions of co-occurring AUD and PTSD, the studies are very limited, most lack adequate power, and the majority suffer from inadequate control groups. In particular, there is a strong need to develop and evaluate the combined medication and psychological-based treatment interventions for those with comorbid AUD and PTSD.

Understanding and using quality information for quality improvement: The effect of information presentation.

PubMed

Zwijnenberg, Nicolien C; Hendriks, Michelle; Delnoij, Diana M J; de Veer, Anke J E; Spreeuwenberg, Peter; Wagner, Cordula

2016-12-01

To examine how information presentation affects the understanding and use of information for quality improvement. An experimental design, testing 22 formats, and showing information on patient safety culture. Formats differed in visualization, outcomes and benchmark information. Respondents viewed three randomly selected presentation formats in an online survey, completing several tasks per format. The hospital sector in the Netherlands. A volunteer sample of healthcare professionals, mainly nurses, working in hospitals. Main Outcome Measure(s): The degree to which information is understandable and usable (accurate choice for quality improvement, sense of urgency to change and appraisal of one's own performance). About 115 healthcare professionals participated (response rate 25%), resulting in 345 reviews. Information in tables (P = 0.007) and bar charts (P < 0.0001) was better understood than radars. Presenting outcomes on a 5-point scale (P < 0.001) or as '% positive responders' (P < 0.001) was better understood than '% negative responders'. Formats without benchmarks were better understood than formats with benchmarks. Use: Bar charts resulted in more accurate choices than tables (P = 0.003) and radars (P < 0.001). Outcomes on a 5-point scale resulted in more accurate choices than '% negative responders' (P = 0.007). Presenting '% positive responders' resulted in a higher sense of urgency to change than outcomes on a 5-point scale (P = 0.002). Benchmark information had inconsistent effects on the appraisal of one's own performances. Information presentation affects healthcare professionals' understanding and use of quality information. Our findings supplement the further understanding on how quality information can be best communicated to healthcare professionals for realizing quality improvements. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

MEMENTA-'Mental healthcare provision for adults with intellectual disability and a mental disorder'. A cross-sectional epidemiological multisite study assessing prevalence of psychiatric symptomatology, needs for care and quality of healthcare provision for adults with intellectual disability in Germany: a study protocol.

PubMed

Koch, Andrea; Vogel, Anke; Holzmann, Marco; Pfennig, Andrea; Salize, Hans Joachim; Puschner, Bernd; Schützwohl, Matthias

2014-05-20

The study 'Mental healthcare provision for adults with intellectual disability and a mental disorder' (MEMENTA) is a cross-sectional epidemiological study carried out in three different regions of Germany. Its main aim is to assess the prevalence of mental disorders in adults with intellectual disability (ID) as well as quality of mental healthcare for this population. The target population are persons aged between 18 and 65 years with a mild or moderate ID. The study population will be recruited through service providers. A representative sample is realised by two-stage sampling. First, institutions providing services for people with ID (sheltered workshops) are selected in a stratified cluster sampling, with strata being (1) types of service-providing non-governmental organisations and (2) sizes of their sheltered workshops. Then persons working in selected sheltered workshops are selected by simple random sampling. An estimated number of 600 adults with ID will be included. Information will be obtained from the group leaders in the sheltered workshops, informal carers or staff members in sheltered housing institutions and the person with ID. Besides the main outcome parameter of psychiatric symptomatology and problem behaviour, other outcome parameters such as needs for care, quality of life, caregiver burden, health services utilisation and costs for care are assessed using well-established standardised instruments. If a comorbid mental disorder is diagnosed, quality of mental healthcare will be assessed with open questions to all interview partners and, in addition, problem-focused interviews with a small subgroup. Analyses will be carried out using quantitative and qualitative methods. Approval of all three local ethics committees was obtained. Research findings will add much needed empirical information in order to improve services provided to this vulnerable group of patients. NCT01695395. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The effects of familism and cultural justification on the mental and physical health of family caregivers.

PubMed

Sayegh, Philip; Knight, Bob G

2011-01-01

We aimed to examine the effects of 2 factors of familism (Familial Obligations and Expected Support from the Family) and Cultural Justification on caregivers' mental and physical health as mediated by coping style. We used a probability sample of 95 African American and 65 White family caregivers for people with dementia to test hypotheses based on the updated sociocultural stress and coping model using path analysis. Main outcome measures included depressive symptomatology, various psychological symptoms, and subjective physical health. Both Familial Obligations and Cultural Justification had an indirect effect on poor mental health and subjective physical health via avoidant coping. Expected Support from the Family had no effect on caregivers' health outcomes. These findings suggest that feelings of obligation may be accounting for a significant proportion of the negative effects of familism on caregivers' mental and subjective physical health. Expectations of familial social support may be relatively inconsequential in this process.

[Multifactor Organizational Stress Risk Questionnaire--MOSRQ: a preliminary study of dimensions and structure].

PubMed

Zuffo, Riccardo Giorgio; Ferretti, Maria Santa

2012-01-01

INTRODUCTION. The aim of the present study is to demonstrate the validity of the MOSRQ, a questionnaire for the assessment of work related stress risk. This questionnaire has 38 items: 19 related to organizational stressors and 19 to strains. Firstly, it was performed a critical analysis of instruments reported in scientific literature; then relevant items about sources and consequences of work related stress were selected in order to obtain the questionnaire. Finally MOSRQ was administered to a sample of 2314 subjects mainly employed in private firms belonging to industry and service sectors. MOSRQ obtains a good index of reliability (alpha = .89 for organizational stressor/antecedents and alpha = .92 for strain/outcome). Factor analysis presents a structure with 3 factors both for the antecedents and for the outcomes of work related stress. In conclusion, it is claimed that MOSRQ has the necessary psychometric characteristics for use in research as well as in organizational contexts.

[Effectiveness of social mobilization and social marketing in promoting NaFeEDTA-fortified soya sauce in adult women].

PubMed

Wang, Bo; Chen, Junshi; Zhan, Siyan; Sun, Jing; Li, Liming

2011-05-01

To assess the effectiveness of social mobilization and social marketing in promoting NaFeEDTA-fortified soy sauce in an iron deficient population. This study was an uncontrolled, community-based, before-after study, which was implemented in three counties of Shijiazhuang Municipality. The intervention was a social mobilization and social marketing strategy. Adult women older than 20 years of age participated in the evaluation protocol. The main outcomes included KAP relevant to IDA. Cross-sectional samples were used to assess the outcomes at baseline and 1 year later. Knowledge and attitudes of adult women had changed positively, and the percentage of women who had adopted NaFeEDTA-fortified soy sauce increased from 8.9% to 36.6% (P < 0.001). Social mobilization and social marketing had a positive impact on the KAP of adult women in the iron deficient population.

Parents' nonstandard work schedules and child well-being: a critical review of the literature.

PubMed

Li, Jianghong; Johnson, Sarah E; Han, Wen-Jui; Andrews, Sonia; Kendall, Garth; Strazdins, Lyndall; Dockery, Alfred

2014-02-01

This paper provides a comprehensive review of empirical evidence linking parental nonstandard work schedules to four main child developmental outcomes: internalizing and externalizing problems, cognitive development, and body mass index. We evaluated the studies based on theory and methodological rigor (longitudinal data, representative samples, consideration of selection and information bias, confounders, moderators, and mediators). Of 23 studies published between 1980 and 2012 that met the selection criteria, 21 reported significant associations between nonstandard work schedules and an adverse child developmental outcome. The associations were partially mediated through parental depressive symptoms, low quality parenting, reduced parent-child interaction and closeness, and a less supportive home environment. These associations were more pronounced in disadvantaged families and when parents worked such schedules full time. We discuss the nuance, strengths, and limitations of the existing studies, and propose recommendations for future research.

Parental Experiences of Raising a Child With Medium Chain Acyl-CoA Dehydrogenase Deficiency.

PubMed

Piercy, Hilary; Machaczek, Katarzyna; Ali, Parveen; Yap, Sufin

2017-01-01

Newborn screening enabling early diagnosis of medium chain acyl-CoA dehydrogenase deficiency (MCADD) has dramatically improved health outcomes in children with MCADD. Achieving those outcomes depends on effective management by parents. Understanding parental management strategies and associated anxieties and concerns is needed to inform provision of appropriate care and support. Semistructured interviews were conducted with a purposive sample of parents of children aged 2 to 12 years. Thematic analysis identified two main themes. Managing dietary intake examined how parents managed day-to-day dietary intake to ensure adequate intake and protection of safe fasting intervals. Managing and preventing illness events explored parental experiences of managing illness events and their approach to preventing these events. Management strategies were characterized by caution and vigilance and influenced by a lack of confidence in others to manage the condition. The study identifies the need for increased awareness of the condition, particularly in relation to emergency treatment.

Development of a case-mix funding system for adults with combined vision and hearing loss.

PubMed

Guthrie, Dawn M; Poss, Jeffrey W

2013-04-15

Adults with vision and hearing loss, or dual sensory loss (DSL), present with a wide range of needs and abilities. This creates many challenges when attempting to set the most appropriate and equitable funding levels. Case-mix (CM) funding models represent one method for understanding client characteristics that correlate with resource intensity. A CM model was developed based on a derivation sample (n = 182) and tested with a replication sample (n = 135) of adults aged 18+ with known DSL who were living in the community. All items within the CM model came from a standardized, multidimensional assessment, the interRAI Community Health Assessment and the Deafblind Supplement. The main outcome was a summary of formal and informal service costs which included intervenor and interpreter support, in-home nursing, personal support and rehabilitation services. Informal costs were estimated based on a wage rate of half that for a professional service provider ($10/hour). Decision-tree analysis was used to create groups with homogeneous resource utilization. The resulting CM model had 9 terminal nodes. The CM index (CMI) showed a 35-fold range for total costs. In both the derivation and replication sample, 4 groups (out of a total of 18 or 22.2%) had a coefficient of variation value that exceeded the overall level of variation. Explained variance in the derivation sample was 67.7% for total costs versus 28.2% in the replication sample. A strong correlation was observed between the CMI values in the two samples (r = 0.82; p = 0.006). The derived CM funding model for adults with DSL differentiates resource intensity across 9 main groups and in both datasets there is evidence that these CM groups appropriately identify clients based on need for formal and informal support.

IKZF1 deletion is an independent predictor of outcome in pediatric acute lymphoblastic leukemia treated according to the ALL-BFM 2000 protocol.

PubMed

Dörge, Petra; Meissner, Barbara; Zimmermann, Martin; Möricke, Anja; Schrauder, André; Bouquin, Jean-Pierre; Schewe, Denis; Harbott, Jochen; Teigler-Schlegel, Andrea; Ratei, Richard; Ludwig, Wolf-Dieter; Koehler, Rolf; Bartram, Claus R; Schrappe, Martin; Stanulla, Martin; Cario, Gunnar

2013-03-01

IKZF1 gene deletions have been associated with a poor outcome in pediatric precursor B-cell acute lymphoblastic leukemia. To assess the prognostic relevance of IKZF1 deletions for patients treated on Berlin-Frankfurt-Münster Study Group trial ALL-BFM 2000, we screened 694 diagnostic acute lymphoblastic leukemia samples by Multiplex Ligation-dependent Probe Amplification. Patients whose leukemic cells bore IKZF1 deletions had a lower 5-year event-free survival (0.69±0.05 vs. 0.85±0.01; P<0.0001) compared to those without, mainly due to a higher cumulative incidence of relapses (0.21±0.04 vs. 0.10±0.01; P=0.001). Although IKZF1 deletions were significantly associated with the P2RY8-CRLF2 rearrangement, their prognostic value was found to be independent from this association. Thus, IKZF1 deletion is an independent predictor of treatment outcome and a strong candidate marker for integration in future treatment stratification strategies on ALL-BFM protocols. Clinicaltrials.gov identifier: NCT00430118.

Benefits of using a hybrid problem-based learning curriculum to improve long-term learning acquisition in undergraduate biology education.

PubMed

Carrió, Mar; Agell, Laia; Baños, Josep Eladi; Moyano, Elisabeth; Larramona, Pilar; Pérez, Jorge

2016-08-01

Although problem-based learning (PBL) has been used for over 40 years, with many studies comparing the benefits of PBL versus other educational approaches, little attention has been paid to the effectiveness of hybrid PBL (H-PBL) curricula. Here we aimed to compare the learning outcomes of two groups of undergraduate biology students working towards a bachelor's degree: one group used an H-PBL approach, while the second used a lecture-based learning (LBL) approach. Specifically, the H-PBL group used a PBL module with interdisciplinary problems, which represented 20% of the entire curriculum. The main outcomes of evaluation were the long-term acquisition of factual knowledge and the problem-solving skills at the end of the bachelor's degree. The sample included 85 students, 39 in the H-PBL group and 46 in the LBL group. We found that an H-PBL curriculum can improve the students' learning outcomes such as long-term knowledge acquisition, problem solving skills and generic competences. © FEMS 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Adjusting for outcome misclassification: the importance of accounting for case-control sampling and other forms of outcome-related selection.

PubMed

Jurek, Anne M; Maldonado, George; Greenland, Sander

2013-03-01

Special care must be taken when adjusting for outcome misclassification in case-control data. Basic adjustment formulas using either sensitivity and specificity or predictive values (as with external validation data) do not account for the fact that controls are sampled from a much larger pool of potential controls. A parallel problem arises in surveys and cohort studies in which participation or loss is outcome related. We review this problem and provide simple methods to adjust for outcome misclassification in case-control studies, and illustrate the methods in a case-control birth certificate study of cleft lip/palate and maternal cigarette smoking during pregnancy. Adjustment formulas for outcome misclassification that ignore case-control sampling can yield severely biased results. In the data we examined, the magnitude of error caused by not accounting for sampling is small when population sensitivity and specificity are high, but increases as (1) population sensitivity decreases, (2) population specificity decreases, and (3) the magnitude of the differentiality increases. Failing to account for case-control sampling can result in an odds ratio adjusted for outcome misclassification that is either too high or too low. One needs to account for outcome-related selection (such as case-control sampling) when adjusting for outcome misclassification using external information. Copyright © 2013 Elsevier Inc. All rights reserved.

The development of a Simplified, Effective, Labour Monitoring-to-Action (SELMA) tool for Better Outcomes in Labour Difficulty (BOLD): study protocol.

PubMed

Souza, João Paulo; Oladapo, Olufemi T; Bohren, Meghan A; Mugerwa, Kidza; Fawole, Bukola; Moscovici, Leonardo; Alves, Domingos; Perdona, Gleici; Oliveira-Ciabati, Livia; Vogel, Joshua P; Tunçalp, Özge; Zhang, Jim; Hofmeyr, Justus; Bahl, Rajiv; Gülmezoglu, A Metin

2015-05-26

The partograph is currently the main tool available to support decision-making of health professionals during labour. However, the rate of appropriate use of the partograph is disappointingly low. Apart from limitations that are associated with partograph use, evidence of positive impact on labour-related health outcomes is lacking. The main goal of this study is to develop a Simplified, Effective, Labour Monitoring-to-Action (SELMA) tool. The primary objectives are: to identify the essential elements of intrapartum monitoring that trigger the decision to use interventions aimed at preventing poor labour outcomes; to develop a simplified, monitoring-to-action algorithm for labour management; and to compare the diagnostic performance of SELMA and partograph algorithms as tools to identify women who are likely to develop poor labour-related outcomes. A prospective cohort study will be conducted in eight health facilities in Nigeria and Uganda (four facilities from each country). All women admitted for vaginal birth will comprise the study population (estimated sample size: 7,812 women). Data will be collected on maternal characteristics on admission, labour events and pregnancy outcomes by trained research assistants at the participating health facilities. Prediction models will be developed to identify women at risk of intrapartum-related perinatal death or morbidity (primary outcomes) throughout the course of labour. These predictions models will be used to assemble a decision-support tool that will be able to suggest the best course of action to avert adverse outcomes during the course of labour. To develop this set of prediction models, we will use up-to-date techniques of prognostic research, including identification of important predictors, assigning of relative weights to each predictor, estimation of the predictive performance of the model through calibration and discrimination, and determination of its potential for application using internal validation techniques. This research offers an opportunity to revisit the theoretical basis of the partograph. It is envisioned that the final product would help providers overcome the challenging tasks of promptly interpreting complex labour information and deriving appropriate clinical actions, and thus increase efficiency of the care process, enhance providers' competence and ultimately improve labour outcomes. Please see related articles ' http://dx.doi.org/10.1186/s12978-015-0027-6 ' and ' http://dx.doi.org/10.1186/s12978-015-0028-5 '.

Influence of peer review on the reporting of primary outcome(s) and statistical analyses of randomised trials.

PubMed

Hopewell, Sally; Witt, Claudia M; Linde, Klaus; Icke, Katja; Adedire, Olubusola; Kirtley, Shona; Altman, Douglas G

2018-01-11

Selective reporting of outcomes in clinical trials is a serious problem. We aimed to investigate the influence of the peer review process within biomedical journals on reporting of primary outcome(s) and statistical analyses within reports of randomised trials. Each month, PubMed (May 2014 to April 2015) was searched to identify primary reports of randomised trials published in six high-impact general and 12 high-impact specialty journals. The corresponding author of each trial was invited to complete an online survey asking authors about changes made to their manuscript as part of the peer review process. Our main outcomes were to assess: (1) the nature and extent of changes as part of the peer review process, in relation to reporting of the primary outcome(s) and/or primary statistical analysis; (2) how often authors followed these requests; and (3) whether this was related to specific journal or trial characteristics. Of 893 corresponding authors who were invited to take part in the online survey 258 (29%) responded. The majority of trials were multicentre (n = 191; 74%); median sample size 325 (IQR 138 to 1010). The primary outcome was clearly defined in 92% (n = 238), of which the direction of treatment effect was statistically significant in 49%. The majority responded (1-10 Likert scale) they were satisfied with the overall handling (mean 8.6, SD 1.5) and quality of peer review (mean 8.5, SD 1.5) of their manuscript. Only 3% (n = 8) said that the editor or peer reviewers had asked them to change or clarify the trial's primary outcome. However, 27% (n = 69) reported they were asked to change or clarify the statistical analysis of the primary outcome; most had fulfilled the request, the main motivation being to improve the statistical methods (n = 38; 55%) or avoid rejection (n = 30; 44%). Overall, there was little association between authors being asked to make this change and the type of journal, intervention, significance of the primary outcome, or funding source. Thirty-six percent (n = 94) of authors had been asked to include additional analyses that had not been included in the original manuscript; in 77% (n = 72) these were not pre-specified in the protocol. Twenty-three percent (n = 60) had been asked to modify their overall conclusion, usually (n = 53; 88%) to provide a more cautious conclusion. Overall, most changes, as a result of the peer review process, resulted in improvements to the published manuscript; there was little evidence of a negative impact in terms of post hoc changes of the primary outcome. However, some suggested changes might be considered inappropriate, such as unplanned additional analyses, and should be discouraged.

Therapist strategies early in therapy associated with good or poor outcomes among clients with low proactive agency.

PubMed

von der Lippe, Anna Louise; Oddli, Hanne Weie; Halvorsen, Margrethe Seeger

2017-09-10

Within a mixed methods program of research the present study aimed at expanding knowledge about interactions in the initial therapeutic collaboration by combining focus on client interpersonal style and therapist contribution. The study involves in-depth analyses of therapist-client interactions in the initial two sessions of good and poor outcome therapies. Based on interpersonal theory and previous research, the Inventory of Interpersonal Problems (IIP-64-C) was used to define poor outcome cases, that is, low proactive agency cases. To compare good and poor outcome cases matched on this interpersonal pattern, cases were drawn from two different samples; nine poor outcome cases from a large multi-site outpatient clinic study and nine good outcome cases from a process-outcome study of highly experienced therapists. Qualitative analysis of therapist behaviors resulted in 2 main categories, fostering client's proactive agentic involvement in change work and discouraging client's proactive agentic involvement in change work, 8 categories and 22 sub-categories. The findings revealed distinct and cohesive differences in therapist behaviors between the two outcome groups, and point to the particular therapist role of fostering client agency through engagement in a shared work on change when clients display strong unassertiveness and low readiness for change. Clinical or Methodological Significance Summary: The present analysis combines focus on client interpersonal style, therapist strategies/process and outcome. The categories generated from the present grounded theory analysis may serve as a foundation for identifying interactions that are associated with agentic involvement in future process research and practice, and hence we have formulated principles/strategies that were identified by the analysis.

Defining “Normophilic” and “Paraphilic” Sexual Fantasies in a Population‐Based Sample: On the Importance of Considering Subgroups

PubMed Central

2015-01-01

Abstract Introduction According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM‐5), a sexual fantasy (SF) is paraphilic if it concerns activities outside the realm of “genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners” (normophilic). Intensity of the paraphilic SF is also “greater than or equal to normophilic interests.” Surprisingly, however, very few data are available to corroborate that definition of a paraphilic SF. Although the relatively high prevalence of paraphilic SF in the general population is well known, the magnitude of difference between intensity of “normophilic” and “paraphilic” SF remains to be assessed. Aim The main goal of this study was to analyze the SF of adults recruited in the general population to obtain person profiles based on the nature and intensity of their SF. Methods Multiple correspondence analysis (MCA) were used with data collected from 1,501 adults recruited in the general population to generate subgroups of participants based on the nature and intensity of their SF. Main outcome measures The main outcome measures used was a revised version of the Wilson Sex Fantasy Questionnaire. Results When all participants are considered as a unique group, the mean intensity of the most intense “normophilic” SF (oral sex) is significantly higher than the mean intensity of the most intense “paraphilic” SF (being sexually dominated for women and watching two women having sex for men), as expected from the DSM‐5. When clusters of participants are considered separately, however, conclusions are nuanced. Four significant clusters of participants (two predominantly female and two predominantly male) reported at least one paraphilic SF with intensity as high as that of their most intense “normophilic” SF. In fact, 57% of this sample met the criteria of paraphilia. Conclusion These results suggest that the current criteria for paraphilia are too inclusive. Suggestions are given to improve the definition of pathological sexual interests, and the crucial difference between SF and sexual interest is underlined. Joyal CC. Defining “normophilic” and “paraphilic” sexual fantasies in a population‐based sample: On the importance of considering subgroups. Sex Med 2015;3:321–330. PMID:26797067

Role of Social Media in Diabetes Management in the Middle East Region: Systematic Review.

PubMed

Alanzi, Turki

2018-02-13

Diabetes is a major health care burden in the Middle East region. Social networking tools can contribute to the management of diabetes with improved educational and care outcomes using these popular tools in the region. The objective of this review was to evaluate the impact of social networking interventions on the improvement of diabetes management and health outcomes in patients with diabetes in the Middle East. Peer-reviewed articles from PubMed (1990-2017) and Google Scholar (1990-2017) were identified using various combinations of predefined terms and search criteria. The main inclusion criterion consisted of the use of social networking apps on mobile phones as the primary intervention. Outcomes were grouped according to study design, type of diabetes, category of technological intervention, location, and sample size. This review included 5 articles evaluating the use of social media tools in the management of diabetes in the Middle East. In most studies, the acceptance rate for the use of social networking to optimize the management of diabetes was relatively high. Diabetes-specific management tools such as the Saudi Arabia Networking for Aiding Diabetes and Diabetes Intelligent Management System for Iraq systems helped collect patient information and lower hemoglobin A 1c (HbA 1c ) levels, respectively. The reviewed studies demonstrated the potential of social networking tools being adopted in regions in the Middle East to improve the management of diabetes. Future studies consisting of larger sample sizes spanning multiple regions would provide further insight into the use of social media for improving patient outcomes. ©Turki Alanzi. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 13.02.2018.

Developmental trajectories of externalizing and internalizing behaviors: Factors underlying resilience in physically abused children

PubMed Central

Lansford, Jennifer E.; Malone, Patrick S.; Stevens, Kristopher I.; Dodge, Kenneth A.; Bates, John E.; Pettit, Gregory S.

2009-01-01

Using a multisite community sample of 585 children, this study examined how protective and vulnerability factors alter trajectories of teacher-reported externalizing and internalizing behavior from kindergarten through Grade 8 for children who were and were not physically abused during the first 5 years of life. Early lifetime history of physical abuse (11.8% of sample) was determined through interviews with mothers during the prekindergarten period; mothers and children provided data on vulnerability and protective factors. Regardless of whether the child was abused, being African American; being male; having low early social competence, low early socioeconomic status (SES), and low adolescent SES; and experiencing adolescent harsh discipline, low monitoring, and low parental knowledge were related to higher levels of externalizing problems over time. Having low early social competence, low early SES, low adolescent SES, and low proactive parenting were related to higher levels of internalizing problems over time. Furthermore, resilience effects, defined as significant interaction effects, were found for unilateral parental decision making (lower levels are protective of externalizing outcomes for abused children), early stress (lower levels are protective of internalizing outcomes for abused children), adolescent stress (lower levels are protective of internalizing outcomes for abused children), and hostile attributions (higher levels are protective of internalizing outcomes for abused children). The findings provide a great deal of support for an additive or main effect perspective on vulnerability and protective factors and some support for an interactive perspective. It appears that some protective and vulnerability factors do not have stronger effects for physically abused children, but instead are equally beneficial or harmful to children regardless of their abuse status. PMID:16478551

Problem-Solving After Traumatic Brain Injury in Adolescence: Associations With Functional Outcomes

PubMed Central

Wade, Shari L.; Cassedy, Amy E.; Fulks, Lauren E.; Taylor, H. Gerry; Stancin, Terry; Kirkwood, Michael W.; Yeates, Keith O.; Kurowski, Brad G.

2017-01-01

Objective To examine the association of problem-solving with functioning in youth with traumatic brain injury (TBI). Design Cross-sectional evaluation of pretreatment data from a randomized controlled trial. Setting Four children’s hospitals and 1 general hospital, with level 1 trauma units. Participants Youth, ages 11 to 18 years, who sustained moderate or severe TBI in the last 18 months (N=153). Main Outcome Measures Problem-solving skills were assessed using the Social Problem-Solving Inventory (SPSI) and the Dodge Social Information Processing Short Stories. Everyday functioning was assessed based on a structured clinical interview using the Child and Adolescent Functional Assessment Scale (CAFAS) and via adolescent ratings on the Youth Self Report (YSR). Correlations and multiple regression analyses were used to examine associations among measures. Results The TBI group endorsed lower levels of maladaptive problem-solving (negative problem orientation, careless/impulsive responding, and avoidant style) and lower levels of rational problem-solving, resulting in higher total problem-solving scores for the TBI group compared with a normative sample (P<.001). Dodge Social Information Processing Short Stories dimensions were correlated (r=.23–.37) with SPSI subscales in the anticipated direction. Although both maladaptive (P<.001) and adaptive (P=.006) problem-solving composites were associated with overall functioning on the CAFAS, only maladaptive problem-solving (P<.001) was related to the YSR total when outcomes were continuous. For the both CAFAS and YSR logistic models, maladaptive style was significantly associated with greater risk of impairment (P=.001). Conclusions Problem-solving after TBI differs from normative samples and is associated with functional impairments. The relation of problem-solving deficits after TBI with global functioning merits further investigation, with consideration of the potential effects of problem-solving interventions on functional outcomes. PMID:28389109

Screening for coronary artery disease in patients with type 2 diabetes: a meta-analysis and trial sequential analysis

PubMed Central

Leitão, Cristiane B; Gross, Jorge L

2017-01-01

Objective To evaluate the efficacy of coronary artery disease screening in asymptomatic patients with type 2 diabetes and assess the statistical reliability of the findings. Methods Electronic databases (MEDLINE, EMBASE, Cochrane Library and clinicaltrials.org) were reviewed up to July 2016. Randomised controlled trials evaluating coronary artery disease screening in asymptomatic patients with type 2 diabetes and reporting cardiovascular events and/or mortality were included. Data were summarised with Mantel-Haenszel relative risk. Trial sequential analysis (TSA) was used to evaluate the optimal sample size to detect a 40% reduction in outcomes. Main outcomes were all-cause mortality and cardiac events (non-fatal myocardial infarction and cardiovascular death); secondary outcomes were non-fatal myocardial infarction, myocardial revascularisations and heart failure. Results One hundred thirty-five references were identified and 5 studies fulfilled the inclusion criteria and totalised 3315 patients, 117 all-cause deaths and 100 cardiac events. Screening for coronary artery disease was not associated with decrease in risk for all-cause deaths (RR 0.95(95% CI 0.66 to 1.35)) or cardiac events (RR 0.72(95% CI 0.49 to 1.06)). TSA shows that futility boundaries were reached for all-cause mortality and a relative risk reduction of 40% between treatments could be discarded. However, there is not enough information for firm conclusions for cardiac events. For secondary outcomes no benefit or harm was identified; optimal sample sizes were not reached. Conclusion Current available data do not support screening for coronary artery disease in patients with type 2 diabetes for preventing fatal events. Further studies are needed to assess the effects on cardiac events. PROSPERO CRD42015026627. PMID:28490559

Analysis of correlation factors and pregnancy outcomes of hypertensive disorders of pregnancy - a secondary analysis of a random sampling in Beijing, China.

PubMed

Zhu, Yu-Chun; Yang, Hui-Xia; Wei, Yu-Mei; Zhu, Wei-Wei; Meng, Wen-Ying; Wang, Yong-Qing; Shang, Li-Xin; Cai, Zhen-Yu; Ji, Li-Ping; Wang, Yun-Feng; Sun, Ying; Liu, Jia-Xiu; Wei, Li; Sun, Yu-Feng; Zhang, Xue-Ying; Luo, Tian-Xia; Chen, Hai-Xia; Yu, Li-Jun

2017-03-01

We aimed to assess the prevalence and risk factors for hypertensive disorders and to study the main pregnancy outcomes in the Beijing area of China. This study randomly sampled 15 hospitals in Beijing from Jun 2013 to Nov 2013 and evaluated 15 194 deliveries. Logistic regression analysis was used to study the association between risk factors and hypertensive disorders. Pregnancy outcomes included preterm birth, cesarean delivery and small for gestational age (SGA). The prevalence of hypertensive disorders, preeclampsia (PE) and severe PE was 4.4, 2.7 and 1.8%, respectively. The risk factors for hypertensive disorders and severe PE were maternal body mass index before pregnancy, gestational weight gain (GWG), gestational diabetes and pre-gestational diabetes, and third trimester cholesterol (CHOL) levels. First trimester high-density lipoprotein was a protective factor for severe PE. The incidence of hypertensive disorders increased with maternal age. Preterm delivery, cesarean delivery and small infant size for gestational age were more prevalent in the severe PE group compared with the non-hypertensive group. In the Beijing area of China, maternal body mass index before pregnancy, GWG, maternal complications of gestational diabetes and pre-gestational diabetes, and third trimester CHOL levels are risk factors for both hypertensive disorders of pregnancy and severe PE. First trimester high-density lipoprotein is a protective factor for severe PE. Severe preeclampsia leads to a higher incidence of preterm delivery, cesarean delivery and SGA infants.

Investigation of the association between the outcomes of sperm chromatin condensation and decondensation tests, and assisted reproduction techniques.

PubMed

Irez, T; Sahmay, S; Ocal, P; Goymen, A; Senol, H; Erol, N; Kaleli, S; Guralp, O

2015-05-01

The main purpose of this prospective study is to examine possible influences of abnormalities of sperm nuclear condensation and chromatin decondensation with sodium dodecyl sulphate (SDS)-EDTA on outcomes of intrauterine insemination (IUI) or intracytoplasmic sperm injection (ICSI) cycles. Semen samples from 122 IUI and 236 ICSI cycles were evaluated. Before semen preparation for IUI or ICSI, basic semen analysis was performed and a small portion from each sample was spared for fixation. The condensation of sperm nuclear chromatin was evaluated with acidic aniline blue, followed by sperm chromatin decondensation by SDS-EDTA and evaluation under light microscope. Ongoing pregnancy rate was 24% and 26.2% in the IUI and ICSI groups respectively. The chromatin condensation rate was significantly higher in the ongoing pregnancy-positive group compared to the negative group, both in IUI (P = 0.042) and ICSI groups (P = 0.027), and it was positively correlated with ongoing pregnancy rate in both IUI and ICSI groups (P = 0.015, r = 0.214 and P = 0.014, r = 0.312 respectively). Chromatin decondensation rates were not significantly different in neither of the groups. These results indicate that IUI and ICSI outcome is influenced by the rate of spermatozoa with abnormal chromatin condensation. Sperm chromatin condensation with aniline blue is useful for selecting assisted reproduction techniques (ART) patients. © 2014 Blackwell Verlag GmbH.

Development of a Self-Report Physical Function Instrument for Disability Assessment: Item Pool Construction and Factor Analysis

PubMed Central

McDonough, Christine M.; Jette, Alan M.; Ni, Pengsheng; Bogusz, Kara; Marfeo, Elizabeth E; Brandt, Diane E; Chan, Leighton; Meterko, Mark; Haley, Stephen M.; Rasch, Elizabeth K.

2014-01-01

Objectives To build a comprehensive item pool representing work-relevant physical functioning and to test the factor structure of the item pool. These developmental steps represent initial outcomes of a broader project to develop instruments for the assessment of function within the context of Social Security Administration (SSA) disability programs. Design Comprehensive literature review; gap analysis; item generation with expert panel input; stakeholder interviews; cognitive interviews; cross-sectional survey administration; and exploratory and confirmatory factor analyses to assess item pool structure. Setting In-person and semi-structured interviews; internet and telephone surveys. Participants A sample of 1,017 SSA claimants, and a normative sample of 999 adults from the US general population. Interventions Not Applicable. Main Outcome Measure Model fit statistics Results The final item pool consisted of 139 items. Within the claimant sample 58.7% were white; 31.8% were black; 46.6% were female; and the mean age was 49.7 years. Initial factor analyses revealed a 4-factor solution which included more items and allowed separate characterization of: 1) Changing and Maintaining Body Position, 2) Whole Body Mobility, 3) Upper Body Function and 4) Upper Extremity Fine Motor. The final 4-factor model included 91 items. Confirmatory factor analyses for the 4-factor models for the claimant and the normative samples demonstrated very good fit. Fit statistics for claimant and normative samples respectively were: Comparative Fit Index = 0.93 and 0.98; Tucker-Lewis Index = 0.92 and 0.98; Root Mean Square Error Approximation = 0.05 and 0.04. Conclusions The factor structure of the Physical Function item pool closely resembled the hypothesized content model. The four scales relevant to work activities offer promise for providing reliable information about claimant physical functioning relevant to work disability. PMID:23542402

Sexual Behavior and Concerns in a Sample of Elderly, Former Indentured Swiss Child Laborers

PubMed Central

Burri, Andrea; Maercker, Andreas

2015-01-01

Abstract Introduction Past research suggests a link between post‐traumatic stress disorder (PTSD) and an increased risk for sexual problems. However, there is still no clear picture whether these higher rates are related to trauma exposure or to PTSD itself. Aim The aim of the present study was to complement existing knowledge on the relative impact of trauma and PTSD on sexuality in later life, considering different aspects of trauma exposure on both men and women. Methods The study was conducted on a unique population sample of former Swiss indentured child laborers (55 men, M age 78, age range 60–95 years) who have repeatedly experienced a variety of severe childhood traumas. Main Outcome Measures Sexual outcomes were measured using two scales from the Trauma Symptom Inventory—Dysfunctional Sexual Behavior (DSB) and Sexual Concerns (SC). PTSD symptoms and trauma were assessed with the Short Screening Scale for PTSD and the Composite International Diagnostic Interview, respectively. Results Twenty‐two individuals showed PTSD symptoms, and 53 reported having experienced childhood trauma. Significant differences between men and women were reported for DSB and SC. Men reported a significantly higher prevalence of both SC and DSB compared with women. Conclusions This is the very first study investigating DSB and SC in a sample of older adults exposed to similar traumatic experiences and settings. However, some study limitations need to be considered such as the small sample size. Additional studies are needed to further explore the relative role of traumatization and PTSD on sexual behavior and well‐being, especially to improve sexual therapy for patients who experience trauma. Rechsteiner K, Burri A, and Maercker A. Sexual behavior and concerns in a sample of elderly, former indentured Swiss child laborers. Sex Med 2015;3:305–314. PMID:26797066

Endotoxin Exposure: Predictors and Prevalence of Associated Asthma Outcomes in the United States

PubMed Central

Mendy, Angelico; Metwali, Nervana; Salo, Päivi; Co, Caroll; Jaramillo, Renee; Rose, Kathryn M.; Zeldin, Darryl C.

2015-01-01

Rationale: Inhaled endotoxin induces airway inflammation and is an established risk factor for asthma. The 2005–2006 National Health and Nutrition Examination Survey included measures of endotoxin and allergens in homes as well as specific IgE to inhalant allergens. Objectives: To understand the relationships between endotoxin exposure, asthma outcomes, and sensitization status for 15 aeroallergens in a nationally representative sample. Methods: Participants were administered questionnaires in their homes. Reservoir dust was vacuum sampled to generate composite bedding and bedroom floor samples. We analyzed 7,450 National Health and Nutrition Examination Survey dust and quality assurance samples for their endotoxin content using extreme quality assurance measures. Data for 6,963 subjects were available, making this the largest study of endotoxin exposure to date. Log-transformed endotoxin concentrations were analyzed using logistic models and forward stepwise linear regression. Analyses were weighted to provide national prevalence estimates and unbiased variances. Measurements and Main Results: Endotoxin exposure was significantly associated with wheeze in the past 12 months, wheeze during exercise, doctor and/or emergency room visits for wheeze, and use of prescription medications for wheeze. Models adjusted for age, sex, race and/or ethnicity, and poverty-to-income ratio and stratified by allergy status showed that these relationships were not dependent upon sensitization status but were worsened among those living in poverty. Significant predictors of higher endotoxin exposures were lower family income; Hispanic ethnicity; participant age; dog(s), cat(s), cockroaches, and/or smoker(s) in the home; and carpeted floors. Conclusions: In this U.S. nationwide representative sample, higher endotoxin exposure was significantly associated with measures of wheeze, with no observed protective effect regardless of sensitization status. PMID:26258643

Selective reporting bias of harm outcomes within studies: findings from a cohort of systematic reviews.

PubMed

Saini, Pooja; Loke, Yoon K; Gamble, Carrol; Altman, Douglas G; Williamson, Paula R; Kirkham, Jamie J

2014-11-21

To determine the extent and nature of selective non-reporting of harm outcomes in clinical studies that were eligible for inclusion in a cohort of systematic reviews. Cohort study of systematic reviews from two databases. Outcome reporting bias in trials for harm outcomes (ORBIT II) in systematic reviews from the Cochrane Library and a separate cohort of systematic reviews of adverse events. 92 systematic reviews of randomised controlled trials and non-randomised studies published in the Cochrane Library between issue 9, 2012 and issue 2, 2013 (Cochrane cohort) and 230 systematic reviews published between 1 January 2007 and 31 December 2011 in other publications, synthesising data on harm outcomes (adverse event cohort). A 13 point classification system for missing outcome data on harm was developed and applied to the studies. 86% (79/92) of reviews in the Cochrane cohort did not include full data from the main harm outcome of interest of each review for all of the eligible studies included within that review; 76% (173/230) for the adverse event cohort. Overall, the single primary harm outcome was inadequately reported in 76% (705/931) of the studies included in the 92 reviews from the Cochrane cohort and not reported in 47% (4159/8837) of the 230 reviews in the adverse event cohort. In a sample of primary studies not reporting on the single primary harm outcome in the review, scrutiny of the study publication revealed that outcome reporting bias was suspected in nearly two thirds (63%, 248/393). The number of reviews suspected of outcome reporting bias as a result of missing or partially reported harm related outcomes from at least one eligible study is high. The declaration of important harms and the quality of the reporting of harm outcomes must be improved in both primary studies and systematic reviews. © Saini et al 2014.

The relationship of undernutrition/psychosocial factors and developmental outcomes of children in extreme poverty in Ethiopia.

PubMed

Worku, Berhanu Nigussie; Abessa, Teklu Gemechu; Wondafrash, Mekitie; Vanvuchelen, Marleen; Bruckers, Liesbeth; Kolsteren, Patrick; Granitzer, Marita

2018-02-09

Extreme poverty is severe deprivation of basic needs and services. Children living in extreme poverty may lack adequate parental care and face increased developmental and health risks. However, there is a paucity of literature on the combined influences of undernutrition and psychosocial factors (such as limited play materials, playground, playtime, interactions of children with their peers and mother-child interaction) on children's developmental outcomes. The main objective of this study was, therefore, to ascertain the association of developmental outcomes and psychosocial factors after controlling nutritional indices. A community-based cross-sectional study design was used to compare the developmental outcomes of extremely poor children (N = 819: 420 girls and 399 boys) younger than 5 years versus age-matched reference children (N = 819: 414 girls and 405 boys) in South-West Ethiopia. Using Denver II-Jimma, development in personal-social, language, fine and gross motor skills were assessed, and social-emotional skills were evaluated using the Ages and Stages Questionnaires: Social-Emotional (ASQ: SE). Nutritional status was derived from the anthropometric method. Independent samples t-test was used to detect mean differences in developmental outcomes between extremely poor and reference children. Multiple linear regression analysis was employed to identify nutritional and psychosocial factors associated with the developmental scores of children in extreme poverty. Children in extreme poverty performed worse in all the developmental domains than the reference children. Among the 819 extremely poor children, 325 (39.7%) were stunted, 135 (16.5%) were underweight and 27 (3.3%) were wasted. The results also disclosed that stunting and underweightness were negatively associated with all the developmental skills. After taking into account the effects of stunting and being underweight on the developmental scores, it was observed that limited play activities, limited child-to-child interactions and mother-child relationships were negatively related mainly to gross motor and language performances of children in extreme poverty. Undernutrition and psychosocial factors were negatively related to the developmental outcomes, independently, of children living in extreme poverty. Intervention, for these children, should integrate home-based play-assisted developmental stimulation and nutritional rehabilitation.

Temporal framing and the hidden-zero effect: rate-dependent outcomes on delay discounting.

PubMed

Naudé, Gideon P; Kaplan, Brent A; Reed, Derek D; Henley, Amy J; DiGennaro Reed, Florence D

2018-05-01

Recent research suggests that presenting time intervals as units (e.g., days) or as specific dates, can modulate the degree to which humans discount delayed outcomes. Another framing effect involves explicitly stating that choosing a smaller-sooner reward is mutually exclusive to receiving a larger-later reward, thus presenting choices as an extended sequence. In Experiment 1, participants (N = 201) recruited from Amazon Mechanical Turk completed the Monetary Choice Questionnaire in a 2 (delay framing) by 2 (zero framing) design. Regression suggested a main effect of delay, but not zero, framing after accounting for other demographic variables and manipulations. We observed a rate-dependent effect for the date-framing group, such that those with initially steep discounting exhibited greater sensitivity to the manipulation than those with initially shallow discounting. Subsequent analyses suggest these effects cannot be explained by regression to the mean. Experiment 2 addressed the possibility that the null effect of zero framing was due to within-subject exposure to the hidden- and explicit-zero conditions. A new Amazon Mechanical Turk sample completed the Monetary Choice Questionnaire in either hidden- or explicit-zero formats. Analyses revealed a main effect of reward magnitude, but not zero framing, suggesting potential limitations to the generality of the hidden-zero effect. © 2018 Society for the Experimental Analysis of Behavior.

Association between latent toxoplasmosis and cognition in adults: a cross-sectional study.

PubMed

Gale, S D; Brown, B L; Erickson, L D; Berrett, A; Hedges, D W

2015-04-01

Latent infection from Toxoplasma gondii (T. gondii) is widespread worldwide and has been associated with cognitive deficits in some but not all animal models and in humans. We tested the hypothesis that latent toxoplasmosis is associated with decreased cognitive function in a large cross-sectional dataset, the National Health and Nutrition Examination Survey (NHANES). There were 4178 participants aged 20-59 years, of whom 19.1% had IgG antibodies against T. gondii. Two ordinary least squares (OLS) regression models adjusted for the NHANES complex sampling design and weighted to represent the US population were estimated for simple reaction time, processing speed and short-term memory or attention. The first model included only main effects of latent toxoplasmosis and demographic control variables, and the second added interaction terms between latent toxoplasmosis and the poverty-to-income ratio (PIR), educational attainment and race-ethnicity. We also used multivariate models to assess all three cognitive outcomes in the same model. Although the models evaluating main effects only demonstrated no association between latent toxoplasmosis and the cognitive outcomes, significant interactions between latent toxoplasmosis and the PIR, between latent toxoplasmosis and educational attainment, and between latent toxoplasmosis and race-ethnicity indicated that latent toxoplasmosis may adversely affect cognitive function in certain groups.

Intrathecal application of the nimodipine slow-release microparticle system eg-1962 for prevention of delayed cerebral ischemia and improvement of outcome after aneurysmal subarachnoid hemorrhage.

PubMed

Etminan, Nima; Macdonald, R Loch; Davis, Cara; Burton, Kevin; Steiger, Hans-Jakob; Hänggi, Daniel

2015-01-01

The effective reduction of delayed cerebral ischemia (DCI), a main contributor for poor outcome following aneurysmal subarachnoid hemorrhage (SAH), remains challenging. Previous clinical trials on systemic pharmaceutical treatment of SAH mostly failed to improve outcome, probably because of insensitive pharmaceutical targets and outcome measures, small sample size, insufficient subarachnoid drug concentrations and also detrimental, systemic effects of the experimental treatment per se. Interestingly, in studies that are more recent, intrathecal administration of nicardipine pellets following surgical aneurysm repair was suggested to have a beneficial effect on DCI and neurological outcome. However, this positive effect remained restricted to patients who were treated surgically for a ruptured aneurysm. Because of the favorable results of the preclinical data on DCI and neurological outcome in the absence of neurotoxicity or systemic side effects, we are initiating clinical trials. The PROMISE (Prolonged Release nimOdipine MIcro particles after Subarachnoid hemorrhage) trial is designed as an unblinded, nonrandomized, single-center, single-dose, dose-escalation safety and tolerability phase 1 study in patients surgically treated for aSAH and will investigate the effect of intracisternal EG-1962 administration. The NEWTON (Nimodipine microparticles to Enhance recovery While reducing TOxicity after subarachNoid hemorrhage) trial is a phase 1/2a multicenter, controlled, randomized, open-label, dose-escalation, safety, tolerability, and pharmacokinetic study comparing EG-1962 and nimodipine in patients with aneurysmal SAH.

Intimate partner violence among Egyptian pregnant women: incidence, risk factors, and adverse maternal and fetal outcomes.

PubMed

Ibrahim, Z M; Sayed Ahmed, W A; El-Hamid, S A; Hagras, A M

2015-01-01

To assess incidence and risk factors of intimate partner violence (IPV) during pregnancy among a sample of women from Egypt and to evaluate its impact on maternal and fetal adverse health outcomes. After obtaining ethical approval, a total of 1,857 women aged 18 - 43 years completed the study and were investigated using an interview questionnaire. The questionnaire contains five main items: demographic characteristics of women, intimate partner characteristics, assessment of IPV during current pregnancy, and assessment of maternal as well as fetal/neonatal adverse outcomes. Women were also examined to detect signs of violence and identify injuries. Exposure to IPV during pregnancy was reported among 44.1% of the studied women. Emotional violence was the most common form. Women exposed to violence were of younger age, higher parity, and lower educational level. Their partners were older, less educated, and more likely to be addicted to drugs and alcohol. Women were also found to have significantly higher incidence of adverse pregnancy outcomes (miscarriage, preterm labor, and premature rupture of membrane), and fetal/neonatal adverse outcomes (fetal distress, fetal death, and low birth weight). A total of 297 cases had been exposed to physical violence (15.9%) vs 32.6% and 10% exposed to emotional and sexual violence, respectively. The most common form of physical violence was kicking. Violence during pregnancy is prevalent among Egyptian women. Exposure to violence was a significant risk factor for multiple adverse maternal and fetal health outcomes.

Multivariate analysis of historical data (2004-2013) in assessing the possible environmental impact of the Bellolampo landfill (Palermo).

PubMed

Indelicato, Serena; Bongiorno, David; Tuzzolino, Nicola; Mannino, Maria Rosaria; Muscarella, Rosalia; Fradella, Pasquale; Gargano, Maria Elena; Nicosia, Salvatore; Ceraulo, Leopoldo

2018-03-14

Multivariate analysis was performed on a large data set of groundwater and leachate samples collected during 9 years of operation of the Bellolampo municipal solid waste landfill (located above Palermo, Italy). The aim was to obtain the most likely correlations among the data. The analysis results are presented. Groundwater samples were collected in the period 2004-2013, whereas the leachate analysis refers to the period 2006-2013. For groundwater, statistical data evaluation revealed notable differences among the samples taken from the numerous wells located around the landfill. Characteristic parameters revealed by principal component analysis (PCA) were more deeply investigated, and corresponding thematic maps were drawn. The composition of the leachate was also thoroughly investigated. Several chemical macro-descriptors were calculated, and the results are presented. A comparison of PCA results for the leachate and groundwater data clearly reveals that the groundwater's main components substantially differ from those of the leachate. This outcome strongly suggests excluding leachate permeation through the multiple landfill lining.

Cervical cancer screening performed by a nurse. Evaluation in family practice.

PubMed Central

Thommasen, H.; Lenci, P.; Brake, I.; Anderson, G.

1996-01-01

OBJECTIVE: To determine whether a nurse practitioner could collect adequate Papanicolaou smear samples from the transformation zone of the cervix. DESIGN: A retrospective, descriptive study. SETTING: The Bella Coola Medical Clinic, a primary care facility located in the isolated, small village of Bella Coola, BC. PARTICIPANTS: All women who presented for Pap smears between July 1993 and June 1994. MAIN OUTCOME MEASURES: Endocervical or metaplastic cells in smear samples. RESULTS: All Pap smears performed in the Bella Coola Medical Clinic over 1 year by either the nurse or a member of the physician group (which includes family practice residents) were reviewed. Between July 1, 1993, and June 30, 1994, 149 Pap smears were done, 55 by the nurse and 94 by the physicians. All smears collected by the nurse practitioner showed endocervical or metaplastic cells. More than 90% of physician samples showed endocervical or metaplastic cells. CONCLUSIONS: A Canadian nurse practitioner can be trained to collect adequate Pap smears. PMID:8939319

Variations in thermo-optical properties of neutral red dye with laser ablated gold nanoparticles

NASA Astrophysics Data System (ADS)

Prakash, Anitha; Pathrose, Bini P.; Mathew, S.; Nampoori, V. P. N.; Radhakrishnan, P.; Mujeeb, A.

2018-05-01

We have investigated the thermal and optical properties of neutral red dye incorporated with different weight percentage of gold nanoparticles prepared by laser ablation method. Optical absorption studies confirmed the production of spherical nanoparticles and also the interactions of the dye molecules with gold nanoparticles. The quenching of fluorescence and the reduction in the lifetime of gold incorporated samples were observed and was due to the non-radiative energy transfer between the dye molecules and gold nanoparticles. Dual beam thermal lens technique has been employed to measure the heat diffusion in neutral red with various weight percentage of gold nano sol dispersed in ethanol. The significant outcome of the experiment is that, the overall heat diffusion is slower in the presence of gold nano sol compared to that of dye alone sample. Brownian motion is suggested to be the main mechanism of heat transfer under the present conditions. The thermal diffusivity variations of samples with respect to different excitation power of laser were also studied.

Secondary outcome analysis for data from an outcome-dependent sampling design.

PubMed

Pan, Yinghao; Cai, Jianwen; Longnecker, Matthew P; Zhou, Haibo

2018-04-22

Outcome-dependent sampling (ODS) scheme is a cost-effective way to conduct a study. For a study with continuous primary outcome, an ODS scheme can be implemented where the expensive exposure is only measured on a simple random sample and supplemental samples selected from 2 tails of the primary outcome variable. With the tremendous cost invested in collecting the primary exposure information, investigators often would like to use the available data to study the relationship between a secondary outcome and the obtained exposure variable. This is referred as secondary analysis. Secondary analysis in ODS designs can be tricky, as the ODS sample is not a random sample from the general population. In this article, we use the inverse probability weighted and augmented inverse probability weighted estimating equations to analyze the secondary outcome for data obtained from the ODS design. We do not make any parametric assumptions on the primary and secondary outcome and only specify the form of the regression mean models, thus allow an arbitrary error distribution. Our approach is robust to second- and higher-order moment misspecification. It also leads to more precise estimates of the parameters by effectively using all the available participants. Through simulation studies, we show that the proposed estimator is consistent and asymptotically normal. Data from the Collaborative Perinatal Project are analyzed to illustrate our method. Copyright © 2018 John Wiley & Sons, Ltd.

Preferential Type II Muscle Fiber Damage From Plyometric Exercise

PubMed Central

Macaluso, Filippo; Isaacs, Ashwin W.; Myburgh, Kathryn H.

2012-01-01

Context Plyometric training has been successfully used in different sporting contexts. Studies that investigated the effect of plyometric training on muscle morphology are limited, and results are controversial with regard to which muscle fiber type is mainly affected. Objective To analyze the skeletal muscle structural and ultrastructural change induced by an acute bout of plyometric exercise to determine which type of muscle fibers is predominantly damaged. Design Descriptive laboratory study. Setting Research laboratory. Patients or Other Participants Eight healthy, untrained individuals (age = 22 ± 1 years, height = 179.2 ± 6.4 cm, weight = 78.9 ± 5.9 kg). Intervention(s) Participants completed an acute bout of plyometric exercise (10 sets of 10 squat-jumps with a 1-minute rest between sets). Main Outcome Measure(s) Blood samples were collected 9 days and immediately before and 6 hours and 1, 2, and 3 days after the acute intervention. Muscle samples were collected 9 days before and 3 days after the exercise intervention. Blood samples were analyzed for creatine kinase activity. Muscle biopsies were analyzed for damage using fluorescent and electron transmission microscopy. Results Creatine kinase activity peaked 1 day after the exercise bout (529.0 ± 317.8 U/L). Immunofluorescence revealed sarcolemmal damage in 155 of 1616 fibers analyzed. Mainly fast-twitch fibers were damaged. Within subgroups, 7.6% of type I fibers, 10.3% of type IIa fibers, and 14.3% of type IIx fibers were damaged as assessed by losses in dystrophin staining. Similar damage was prevalent in IIx and IIa fibers. Electron microscopy revealed clearly distinguishable moderate and severe sarcomere damage, with damage quantifiably predominant in type II muscle fibers of both the glycolytic and oxidative subtypes (86% and 84%, respectively, versus only 27% of slow-twitch fibers). Conclusions We provide direct evidence that a single bout of plyometric exercise affected mainly type II muscle fibers. PMID:22889657

A randomized factorial trial of disulfiram and contingency management to enhance cognitive behavioral therapy for cocaine dependence.

PubMed

Carroll, Kathleen M; Nich, Charla; Petry, Nancy M; Eagan, Dorothy A; Shi, Julia M; Ball, Samuel A

2016-03-01

This study evaluated the extent to which the addition of disulfiram and contingency management for adherence and abstinence (CM), alone and in combination, might enhance the effects of cognitive behavioral therapy (CBT) for cocaine use disorders. Factorial randomized double blind (for medication condition) clinical trial where CBT served as the platform and was delivered in weekly individual sessions in a community-based outpatient clinic. 99 outpatients who met DSM-IV criteria for current cocaine dependence were assigned to receive either disulfiram or placebo, and either CM or no CM. Cocaine and other substance use was assessed via a daily calendar with thrice weekly urine sample testing for 12 weeks with a one-year follow-up (80% interviewed at one year). The primary hypothesis that CM and disulfiram would produce the best cocaine outcomes was not confirmed, nor was there a main effect for disulfiram. For the primary outcome (percent days of abstinence, self report), there was a significant interaction, with the best cocaine outcomes were seen for the combination of CM and placebo, with the two groups assigned to disulfiram associated with intermediate outcomes, and poorest cocaine outcome among those assigned to placebo and no CM. The secondary outcome (urinalysis) indicated a significant effect favoring CM over no CM but the interaction effect was not significant. One year follow-up data indicated sustained treatment effects across conditions. CM enhances outcomes for CBT treatment of cocaine dependence, but disulfiram provided no added benefit to the combination of CM and CBT. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Comparative effects of meditation and exercise on physical and psychosocial health outcomes: a review of randomized controlled trials.

PubMed

Edwards, Meghan K; Loprinzi, Paul D

2018-03-01

No review papers have examined studies that have directly compared non-active forms of meditation with exercise to evaluate effects on physical or psychosocial outcomes, which was the purpose of this paper. Studies were included if they had a randomized controlled trial (RCT) design, included a non-active form of meditation and exercise as intervention arms, and evaluated physical or psychosocial outcomes. The quality of included RCTs was rated using the Cochrane Collaboration's tool for assessing risk of bias in randomized trials. Five RCTs met the inclusion criteria. The total sample size across all studies was N = 325. Of the main outcomes assessed across the five studies, meditation was shown to be more effective than the exercise comparison arm when evaluating the psychosocial outcomes of anxiety, altruism, and life changes. Additionally, meditation was more effective at reducing chronic neck pain at rest and pain-related bothersomeness. Exercise, however, was more effective in improving physical health-related quality of life, HDL and LDL cholesterol, and fasting blood glucose levels. The interventions were found to be comparable when evaluating the outcomes of well-being, ethanol consumption, and perceived stress levels. Four of the evaluated studies were determined to have an overall 'unclear' risk of bias and one study was found to have a 'high' risk of bias. Exercise and non-active meditation may uniquely influence various health-related outcomes. A continued exploration of the effects of exercise and non-active meditation in controlled trials may yield a better understanding of their benefits.

Prevalence, risk factors and outcome of childhood abuse reported by female university students in jeddah.

PubMed

Ibrahim, Nahla K; Jalali, Ekram A; Al-Ahmadi, Jawaher R; Al-Bar, Adnan A

2008-01-01

Child abuse constitutes all forms of physical and /or emotional ill treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power. The objective of the study was to determine the prevalence, types, main predictors and outcome of child abuse, retrospectively reported by female university students in Jeddah. A cross sectional study was conducted and the Standardized Arabic Version of Child Abuse Screening Tool for Young Adult (18-24 years old) was used. Ethical standards of confidentiality and freedom to participate were followed. Multistage stratified random sample was used with selection of 1,897 females. About two-thirds (68.3 %) of students reported exposure to some form of child abuse. Physical and emotional forms were recalled by 45.1 % & 50.6 % of students, respectively, while, 2.9 % reported exposure to forced contact sexual assault. Parents and siblings were the commonest perpetrators of both physical & emotional abuse, while other relatives and extra-familial persons were the main offenders of sexual violence. The predictors of exposure to three forms of abuse together were: existence of parent who hit the other (aOR= 2.54; 95 % CI: 1.88-3.42), non-university graduated mother (aOR =1.83; p

Perceived Discrimination and Health among Immigrants in Europe According to National Integration Policies.

PubMed

Borrell, Carme; Palència, Laia; Bartoll, Xavier; Ikram, Umar; Malmusi, Davide

2015-08-31

Discrimination harms immigrants' health. The objective of this study was to analyze the association between perceived discrimination and health outcomes among first and second generation immigrants from low-income countries living in Europe, while accounting for sex and the national policy on immigration. Cross-sectional study including immigrants from low-income countries aged ≥15 years in 18 European countries (European Social Survey, 2012) (sample of 1271 men and 1335 women). The dependent variables were self-reported health, symptoms of depression, and limitation of activity. The independent variables were perceived group discrimination, immigrant background and national immigrant integration policy. We tested for association between perceived group discrimination and health outcomes by fitting robust Poisson regression models. We only observed significant associations between perceived group discrimination and health outcomes in first generation immigrants. For example, depression was associated with discrimination among both men and women (Prevalence Ratio-, 1.55 (95% CI: 1.16-2.07) and 1.47 (95% CI: 1.15-1.89) in the multivariate model, respectively), and mainly in countries with assimilationist immigrant integration policies. Perceived group discrimination is associated with poor health outcomes in first generation immigrants from low-income countries who live in European countries, but not among their descendants. These associations are more important in assimilationist countries.

Gender Differences in the Consequences of Divorce: A Study of Multiple Outcomes.

PubMed

Leopold, Thomas

2018-06-01

In this study, I examined gender differences in the consequences of divorce by tracing annual change in 20 outcome measures covering four domains: economic, housing and domestic, health and well-being, and social. I used data from the German Socio-Economic Panel Study (SOEP) and fixed-effects panel regression models on a sample of N = 18,030 individuals initially observed in a marital union, N = 1,220 of whom divorced across the observation period (1984-2015). Three main findings emerged from the analysis. First, men were more vulnerable to short-term consequences of divorce for subjective measures of well-being, but postdivorce adaptation alleviated gender differences in these outcomes. Second, a medium-term view on multiple outcomes showed more similarity than differences between women and men. The medium-term consequences of divorce were similar in terms of subjective economic well-being; mental health, physical health, and psychological well-being; residential moves, homeownership, and satisfaction with housework; and chances of repartnering, social integration with friends and relatives, and feelings of loneliness. Third, the key domain in which large and persistent gender differences emerged were women's disproportionate losses in household income and associated increases in their risk of poverty and single parenting. Taken together, these findings suggest that men's disproportionate strain of divorce is transient, whereas women's is chronic.

A Pilot Study Evaluating "Dojo," a Videogame Intervention for Youths with Externalizing and Anxiety Problems.

PubMed

Schuurmans, Angela A T; Nijhof, Karin S; Vermaes, Ignace P R; Engels, Rutger C M E; Granic, Isabela

2015-10-01

Externalizing problems, which are the main reason for youth referrals to mental health agencies, are highly persistent and predict a range of negative outcomes. Youths with externalizing problems are also frequently comorbid with anxiety. Among the most widely recognized evidence-based treatments is cognitive behavioral therapy (CBT). Although CBT principles seem to be sound, effect sizes remain moderate, suggesting improvements could be made to this conventional treatment approach. The main premise of the current pilot study is to investigate the feasibility of implementing a videogame intervention ("Dojo" [Gamedesk, Los Angeles, CA]) that incorporates CBT principles and aims to address the limitations of conventional CBT delivery models, with the ultimate goal of improving outcomes for this difficult-to-treat population. "Dojo" is an emotion management game that helps youths to recognize and control their physiological and emotional arousal. We explored the implementation and user experience of "Dojo" in a sample of eight adolescents in residential treatment for both externalizing and anxiety problems. Participants attended all sessions without complaints. They evaluated "Dojo" very positively and exhibited high compliance during the training sessions. We encountered some problems with session scheduling and obtaining mentor reports. Quantitative data show the predicted decrease in three out of four measurements. The smooth implementation, high user satisfaction, high self-reported compliance during training sessions, and initial outcome results all indicate the high potential "Dojo" holds as an innovative intervention. If additional rigorously designed randomized controlled trials prove to be successful, "Dojo" can be a cost-effective way to engage high-risk youths in effective intervention.

Slum upgrading strategies involving physical environment and infrastructure interventions and their effects on health and socio-economic outcomes.

PubMed

Turley, Ruth; Saith, Ruhi; Bhan, Nandita; Rehfuess, Eva; Carter, Ben

2013-01-31

Slums are densely populated, neglected parts of cities where housing and living conditions are exceptionally poor. In situ slum upgrading, at its basic level, involves improving the physical environment of the existing area, such as improving and installing basic infrastructure like water, sanitation, solid waste collection, electricity, storm water drainage, access roads and footpaths, and street lighting, as well as home improvements and securing land tenure. To explore the effects of slum upgrading strategies involving physical environment and infrastructure interventions on the health, quality of life and socio-economic wellbeing of urban slum dwellers in low and middle income countries (LMIC). Where reported, data were collected on the perspectives of slum dwellers regarding their needs, preferences for and satisfaction with interventions received. We searched for published and unpublished studies in 28 bibliographic databases including multidisciplinary (for example Scopus) and specialist databases covering health, social science, urban planning, environment and LMIC topics. Snowballing techniques included searching websites, journal handsearching, contacting authors and reference list checking. Searches were not restricted by language or publication date. We included studies examining the impact of slum upgrading strategies involving physical environment or infrastructure improvements (with or without additional co-interventions) on the health, quality of life and socio-economic wellbeing of LMIC urban slum dwellers. Randomised controlled trials (RCTs), controlled before and after studies (CBAs) and interrupted time series (ITS) were eligible for the main analysis. Controlled studies with only post-intervention data (CPI) and uncontrolled before and after (UBA) studies were included in a separate narrative to examine consistency of results and to supplement evidence gaps in the main analysis. Two authors independently extracted data and assessed risk of bias for each study. Differences between the included study interventions and outcomes precluded meta-analysis so the results were presented in a narrative summary with illustrative harvest plots. The body of evidence for outcomes within the main analysis was assessed according to GRADE as very low, low, moderate or high quality. We identified 10,488 unique records, with 323 screened as full text. Five studies were included for the main analysis: one RCT with a low risk, two CBAs with a moderate risk and two CBAs with a high risk of bias. Three CBAs evaluated multicomponent slum upgrading strategies. Road paving only was evaluated in one RCT and water supply in one CBA. A total of 3453 households or observations were included within the four studies reporting sample sizes.Most health outcomes in the main studies related to communicable diseases, for which the body of evidence was judged to be low quality. One CBA with a moderate risk of bias found that diarrhoeal incidence was reduced in households which received water connections from a private water company (risk ratio (RR) 0.53; 95% confidence interval (CI) 0.27 to 1.04) and the severity of diarrhoeal episodes (RR 0.48; 95% CI 0.19 to 1.22). There was no effect for duration of diarrhoea. Road paving did not result in changes in parasitic infections or sickness in one RCT. After multicomponent slum upgrading, claims for a waterborne disease as opposed to a non-waterborne disease reduced (RR 0.64; 95% CI 0.27 to 0.98) in one CBA with a high risk of bias but there was no change in sanitation-related mortality in a CBA with a moderate risk of bias.The majority of socio-economic outcomes reported within the main studies related to financial poverty, for which the body of evidence was of very low quality. Results were mixed amongst the main studies; one RCT and two CBAs reported no effect on the income of slum dwellers following slum upgrading. One further CBA found significant reduction in monthly water expenditure (mean difference (MD) -17.11 pesos; 95% CI -32.6 to -1.62). One RCT also showed mixed results for employment variables, finding no effect on unemployment levels but increased weekly worked hours (MD 4.68; 95% CI -0.46 to 9.82) and lower risk of residents intending to migrate for work (RR 0.78; 95% CI 0.60 to 1.01).There was no evidence available to assess the impact of slum upgrading on non-communicable diseases or social capital. Maternal and perinatal conditions, infant mortality, nutritional deficiencies, injuries, self-reported quality of life, education and crime were evaluated in one study each.Nine supporting studies were included that measured varying outcomes (6794 households or observations within eight studies reporting sample sizes). One CPI evaluated cement flooring only while three UBAs and five CPIs evaluated multicomponent slum upgrading strategies. All studies but one had a high risk of bias.The studies reinforced main study findings for diarrhoea incidence and water-related expenditure. Findings for parasitic infections and financial poverty were inconsistent with the main studies. In addition, supporting studies reported a number of disparate outcomes that were not evaluated in the main studies.Five supporting studies included some limited information on slum dweller perspectives. They indicated the importance of appropriate siting of facilities, preference for private facilities, delivering synergistic interventions together, and ensuring that infrastructure was fit for purpose and systems were provided for cleaning, maintenance and repair. A high risk of bias within the included studies, heterogeneity and evidence gaps prevent firm conclusions on the effect of slum upgrading strategies on health and socio-economic wellbeing. The most common health and socio-economic outcomes reported were communicable diseases and indicators of financial poverty. There was a limited but consistent body of evidence to suggest that slum upgrading may reduce the incidence of diarrhoeal diseases and water-related expenditure. The information available on slum dwellers' perspectives provided some insight to barriers and facilitators for successful implementation and maintenance of interventions.The availability and use of reliable, comparable outcome measures to determine the effect of slum upgrading on health, quality of life and socio-economic wellbeing would make a useful contribution to new research in this important area. Given the complexity in delivering slum upgrading, evaluations should look to incorporate process and qualitative information alongside quantitative effectiveness data to determine which particular interventions work (or don't work) and for whom.

Does substance misuse moderate the relationship between criminal thinking and recidivism?

PubMed Central

Caudy, Michael S.; Folk, Johanna B.; Stuewig, Jeffrey B.; Wooditch, Alese; Martinez, Andres; Maass, Stephanie; Tangney, June P.; Taxman, Faye S.

2014-01-01

Purpose Some differential intervention frameworks contend that substance use is less robustly related to recidivism outcomes than other criminogenic needs such as criminal thinking. The current study tested the hypothesis that substance use disorder severity moderates the relationship between criminal thinking and recidivism. Methods The study utilized two independent criminal justice samples. Study 1 included 226 drug-involved probationers. Study 2 included 337 jail inmates with varying levels of substance use disorder severity. Logistic regression was employed to test the main and interactive effects of criminal thinking and substance use on multiple dichotomous indicators of recidivism. Results Bivariate analyses revealed a significant correlation between criminal thinking and recidivism in the jail sample (r = .18, p < .05) but no significant relationship in the probation sample. Logistic regressions revealed that SUD symptoms moderated the relationship between criminal thinking and recidivism in the jail-based sample (B = −.58, p < .05). A significant moderation effect was not observed in the probation sample. Conclusions Study findings indicate that substance use disorder symptoms moderate the strength of the association between criminal thinking and recidivism. These findings demonstrate the need for further research into the interaction between various dynamic risk factors. PMID:25598559

Strategies for informed sample size reduction in adaptive controlled clinical trials

NASA Astrophysics Data System (ADS)

Arandjelović, Ognjen

2017-12-01

Clinical trial adaptation refers to any adjustment of the trial protocol after the onset of the trial. The main goal is to make the process of introducing new medical interventions to patients more efficient. The principal challenge, which is an outstanding research problem, is to be found in the question of how adaptation should be performed so as to minimize the chance of distorting the outcome of the trial. In this paper, we propose a novel method for achieving this. Unlike most of the previously published work, our approach focuses on trial adaptation by sample size adjustment, i.e. by reducing the number of trial participants in a statistically informed manner. Our key idea is to select the sample subset for removal in a manner which minimizes the associated loss of information. We formalize this notion and describe three algorithms which approach the problem in different ways, respectively, using (i) repeated random draws, (ii) a genetic algorithm, and (iii) what we term pair-wise sample compatibilities. Experiments on simulated data demonstrate the effectiveness of all three approaches, with a consistently superior performance exhibited by the pair-wise sample compatibilities-based method.

Maine Technical College System Annual Report, 1996.

ERIC Educational Resources Information Center

Fitzsimmons, John

Focusing on the 1995-96 academic year, this report discusses programs and outcomes for the seven colleges in the Maine Technical College System (MTCS). Following a message from the System President, general outcomes for the MTCS are described. This section indicates that systemwide enrollment in fall 1995 was 4,475, representing a 24% increase…

Recent progresses in outcome-dependent sampling with failure time data.

PubMed

Ding, Jieli; Lu, Tsui-Shan; Cai, Jianwen; Zhou, Haibo

2017-01-01

An outcome-dependent sampling (ODS) design is a retrospective sampling scheme where one observes the primary exposure variables with a probability that depends on the observed value of the outcome variable. When the outcome of interest is failure time, the observed data are often censored. By allowing the selection of the supplemental samples depends on whether the event of interest happens or not and oversampling subjects from the most informative regions, ODS design for the time-to-event data can reduce the cost of the study and improve the efficiency. We review recent progresses and advances in research on ODS designs with failure time data. This includes researches on ODS related designs like case-cohort design, generalized case-cohort design, stratified case-cohort design, general failure-time ODS design, length-biased sampling design and interval sampling design.

Recent progresses in outcome-dependent sampling with failure time data

PubMed Central

Ding, Jieli; Lu, Tsui-Shan; Cai, Jianwen; Zhou, Haibo

2016-01-01

An outcome-dependent sampling (ODS) design is a retrospective sampling scheme where one observes the primary exposure variables with a probability that depends on the observed value of the outcome variable. When the outcome of interest is failure time, the observed data are often censored. By allowing the selection of the supplemental samples depends on whether the event of interest happens or not and oversampling subjects from the most informative regions, ODS design for the time-to-event data can reduce the cost of the study and improve the efficiency. We review recent progresses and advances in research on ODS designs with failure time data. This includes researches on ODS related designs like case–cohort design, generalized case–cohort design, stratified case–cohort design, general failure-time ODS design, length-biased sampling design and interval sampling design. PMID:26759313

Chronic stress and sexual function in women

PubMed Central

Hamilton, Lisa Dawn; Meston, Cindy M.

2014-01-01

Introduction Chronic stress is known to have negative effects on reproduction, but little is known about how it affects the sexual response cycle. The present study examined the relationship between chronic stress and sexual arousal and the mechanisms that mediate this relationship. Aim To test the relationship between chronic stress and sexual arousal and identify mechanisms that may explain this relationship. We predicted that women experiencing high levels of chronic stress would show lower levels of genital arousal & DHEAS and higher levels of cortisol and cognitive distraction compared to women with average levels of stress. Methods Women who were categorized as high in chronic stress (high stress group, n = 15) or average in chronic stress (average stress group; n = 15) provided saliva samples and watched an erotic film while having their genital and psychological arousal measured. Main Outcome Measures Main outcome measures were vaginal pulse amplitude, psychological arousal, salivary cortisol, salivary DHEAS, and heart rate and compared them between women with high and average levels of chronic stress. Results Women in the high stress group had lower levels of genital, but not psychological arousal, had higher levels of cortisol, and reported more distraction during the erotic film than women in the average stress group. The main predictor of decreased genital sexual arousal was participants’ distraction scores. Conclusions High levels of chronic stress were related to lower levels of genital sexual arousal. Both psychological (distraction) and hormonal (increased cortisol) factors were related to the lower levels of sexual arousal seen in women high in chronic stress, but distraction was the only significant predictor when controlling for other variables. PMID:23841462

[The Analysis of Traditional Lime Mortars from Zhejiang Province, China].

PubMed

Liu, Xiao-bin; Cui, Biao; Zhang, Bing-jian

2016-01-01

The components of ancient mortars have always been an important research field in historic building conservation. It has been well known that using traditional mortars in conservation projects have many advantages, such as compatibility and stability. So, developing new binding materials based on traditional mortar has become an international study hotspot. With China's economic development, the protection of ancient buildings also began to put on the agenda, but the understanding on Chinese traditional mortar is limited, and rare literatures are reported. In the present work, the authors investigate seven ancient city wall sites in Zhejiang Province in situ, and subsequently laboratory analysis were carried out on collected mortar samples. The characterizations of mortar samples were made by multi-density gauge, XRD, FTIR, TG-DSC and wet chemical analysis. The experimental results showed that: the main component of masonry mortars is calcium carbonate, the content between 75% - 90%, and they should be made from relatively pure lime mortar. The raw materials of mortar samples were mainly calcareous quick lime, and sample from Taizhou city also contained magnesium quick lime. There are four city walls were built by sticky-rice mortars. It suggests that the technology of adding the sticky rice soup into mortar was universal in the Ming Dynasties. These mortars have lower density between 1.2 and 1.9 g x cm(-3); this outcome should be the result of long-term natural erosion. We have also analyzed other chemical and physical characteristics of these masonry mortars. The results can afford the basic data for the future repairmen programs, development of new protective materials, and comparative study of mortars.

Insulin-like growth factor 1 as a predictor of ischemic stroke outcome in the elderly.

PubMed

Denti, Licia; Annoni, Valentina; Cattadori, Evelina; Salvagnini, Maria Angela; Visioli, Sandra; Merli, Maria Francesca; Corradi, Francesco; Ceresini, Graziano; Valenti, Giorgio; Hoffman, Andrew R; Ceda, Gian Paolo

2004-09-01

To examine whether serum insulin-like growth factor 1 (IGF-1) and IGF binding protein 3 (IGFBP-3) concentrations, determined early after the onset of stroke, are predictive of clinical outcome in elderly patients. The sample comprised 85 patients (mean [+/- SD] age, 83 +/- 7.4 years; range, 67 to 99 years; 34% male) who were admitted with acute stroke to a geriatric ward between January 1998 and June 2000, and 88 control patients who were similar in age and sex. Clinical and laboratory assessments, computed tomographic scan of the head, carotid ultrasonography, and electrocardiography were employed to define the clinical and etiologic stroke subtype. Fasting blood samples were collected within 24 hours of admission for IGF-I and IGFBP-3 measurement. Univariate and multiple logistic regression analyses, with adjustment for other related clinical covariates, were used to assess the relation of IGF-I and IGFBP-3 to poor outcome, defined as severe disability (Barthel index <60/100) or death, at 1 month (or at discharge), 3 months, and 6 months. Mean (+/- SD) IGF-1 levels were lower in patients with stroke than in controls (69 +/- 45 ng/mL vs. 102 +/- 67 ng/mL, P adjusted for age = 0.001). The mean IGF-1/IGFBP-3 molar ratio was also lower in stroke patients (0.12 +/- 0.07 vs. 0.19 +/- 0.09, P adjusted for age <0.0001). However, there was no relation of hormone levels to either the clinical subtype of stroke or the extent of neurologic impairment. IGF-1 levels were inversely related to poor outcome (mainly death) at 3 and 6 months, independent of other clinical covariates that were highly predictive of outcome, such as age and stroke scale score on admission (hazard ratio for death at 6 months for each 20-ng/mL increase = 0.7; 95% confidence interval: 0.5 to 0.9). An independent association of the molar ratio with death at 3 and 6 months was also found. Low levels of circulating IGF-1 may predict the clinical outcome of stroke in elderly patients.

Maine Technical College System 1993/1994 Annual Report.

ERIC Educational Resources Information Center

Maine Technical Coll. System, Augusta.

Focusing on data from the 1993-94 academic year, this report discusses programs and outcomes for the seven colleges in the Maine Technical College System (MTCS). Following a message from the System President, general outcomes for the MTCS are described. This section indicates that systemwide enrollment in 1993-94 was 4,305, representing a 19%…

Frequency rates and correlates of contrapower harassment in higher education.

PubMed

DeSouza, Eros R

2011-01-01

The current study investigated incivility, sexual harassment, and racial-ethnic harassment simultaneously when the targets were faculty members and the perpetrators were students (i.e., academic contrapower harassment; ACH). The sample constituted 257 faculty members (90% were White and 53% were women) from a medium-sized state university in the Midwestern United States. They completed an anonymous survey, including an openended question about a critical ACH incident. The findings revealed that 72% of the total sample had experienced some type of mistreatment from students during the past 2 years. The author hypothesized gender differences in frequency rates for overall ACH, incivility, and sexual harassment; however, there were none. Hence, this hypothesis was not supported. The author also hypothesized that incivility would predict sexual and ethnic harassment. This hypothesis was generally supported. Furthermore, he hypothesized that demographic, work-related, and tolerance for faculty-student romance would predict ACH and its subscales. The findings generally supported this hypothesis, with somewhat different predictors by gender. He also hypothesized that harassed faculty, especially women, would experience worse job-related outcomes than never harassed faculty. Neither gender nor the interaction was significant, but the main effect for harassment was, with harassed faculty members experiencing worse job-related outcomes than nonharassed faculty members. Thus this hypothesis was partially supported. Practical implications are discussed.

Effectiveness of a controlled drinking self-help manual: one-year follow-up results.

PubMed

Heather, N; Robertson, I; MacPherson, B; Allsop, S; Fulton, A

1987-11-01

Following the description of six-month follow-up results by Heather et al. (1986), this article reports one-year follow-up for a cohort of media-recruited problem drinkers sent either a controlled drinking self-help manual or a general advice and information booklet. Among those remaining in the sample, mean reduction in drinking at six months had been retained at the one-year point. This stability of reduced consumption included respondents showing evidence of late dependence or high consumption at initial assessment. When respondents who had received other forms of treatment had been excluded, the results confirmed the superior effectiveness of the self-help manual in enabling problem drinkers to reduce consumption. Evidence for a superior outcome among respondents interviewed by telephone, rather than contacted solely by post, was again observed. Some limited evidence is presented as to the reliability and validity of self-reports of consumption in the main sample.

Relationship of Genital Injuries and Age in Adolescent and Young Adult Rape Survivors

PubMed Central

Baker, Rachel B.; Sommers, Marilyn S.

2013-01-01

Objective To examine the associations between age and genital injuries in adolescent and young adult women examined following rape. Design & Setting A retrospective review of 234 medical records from an emergency department sexual assault program. Sample Women aged 14 to 29 years. Fifty percent of the sample was African American, 48% was White, and 2% was either Asian or an “other” race. Main Outcome Measures Genital injury was described by injury prevalence, frequency, and anatomical locations of injuries. Results Overall genital injury prevalence was 62.8%. Younger age was not significantly associated with the presence or absence of genital injury. However, younger age was significantly associated with an increased number of genital injuries overall and to the thighs, labia minora, periurethral area, fossa navicularis, and vagina. Conclusion These findings support the need for further research to determine if the current care provided to rape survivors is age appropriate. PMID:18507599

Exploring the Correlation Between Nontraditional Variables and Student Success: A Longitudinal Study.

PubMed

Strickland, Haley Perkins; Cheshire, Michelle Haney

2017-06-01

The purpose of this project was to determine whether a correlation exists between the traditional admission criteria of grade point averages with the potential admission criteria of emotional intelligence (EI) scores or critical thinking (CT) scores to predict upper division student outcomes. A quantitative, longitudinal design was selected to examine the identified variables to predict undergraduate student success. The recruiting sample included a convenience sample drawn from 112 junior-level undergraduate nursing students beginning their first of a five-semester nursing program. EI and HESI ® CT scores did not significantly correlate with main analysis variables. Although EI and CT scores were not significant in this study, it remains vital to incorporate EI and CT activities throughout the curriculum to develop students' ability to think like a nurse and, therefore, be successful in nursing practice. [J Nurs Educ. 2017;56(6):351-355.]. Copyright 2017, SLACK Incorporated.

A Systematic Review of Application and Effectiveness of mHealth Interventions for Obesity and Diabetes Treatment and Self-Management123

PubMed Central

Wang, Youfa; Xue, Hong; Huang, Yaqi; Huang, Lili; Zhang, Dongsong

2017-01-01

The use of mobile and wireless technologies and wearable devices for improving health care processes and outcomes (mHealth) is promising for health promotion among patients with chronic diseases such as obesity and diabetes. This study comprehensively examined published mHealth intervention studies for obesity and diabetes treatment and management to assess their effectiveness and provide recommendations for future research. We systematically searched PubMed for mHealth-related studies on diabetes and obesity treatment and management published during 2000–2016. Relevant information was extracted and analyzed. Twenty-four studies met inclusion criteria and varied in terms of sample size, ethnicity, gender, and age of the participating patients and length of follow-up. The mHealth interventions were categorized into 3 types: mobile phone text messaging, wearable or portable monitoring devices, and applications running on smartphones. Primary outcomes included weight loss (an average loss ranging from −1.97 kg in 16 wk to −7.1 kg in 5 wk) or maintenance and blood glucose reduction (an average decrease of glycated hemoglobin ranging from −0.4% in 10 mo to −1.9% in 12 mo); main secondary outcomes included behavior changes and patient perceptions such as self-efficacy and acceptability of the intervention programs. More than 50% of studies reported positive effects of interventions based on primary outcomes. The duration or length of intervention ranged from 1 wk to 24 mo. However, most studies included small samples and short intervention periods and did not use rigorous data collection or analytic approaches. Although some studies suggest that mHealth interventions are effective and promising, most are pilot studies or have limitations in their study designs. There is an essential need for future studies that use larger study samples, longer intervention (≥ 6 mo) and follow-up periods (≥ 6 mo), and integrative and personalized innovative mobile technologies to provide comprehensive and sustainable support for patients and health service providers. PMID:28507010

Stuttering treatment for a school-age child with Down syndrome: a descriptive case report.

PubMed

Harasym, Jessica; Langevin, Marilyn

2012-12-01

Little is known about optimal treatment approaches and stuttering treatment outcomes for children with Down syndrome. The purpose of this study was to investigate outcomes for a child with Down syndrome who received a combination of fluency shaping therapy and parent delivered contingencies for normally fluent speech, prolonged speech, and stuttered speech. In-clinic speech measures obtained at post-treatment and at 4 months follow-up reflected improvements in fluency of 89.0% and 98.6%, respectively. The participant's beyond-clinic follow-up sample reflected an improvement of 95.5%. Following treatment, the participant demonstrated improved self-confidence, self-esteem, and improved participation and functioning at school. Findings suggest that fluency shaping with parental contingencies may be a viable treatment approach to reduce stuttering in children with Down syndrome. Future research using an experimental research design is warranted. Readers will be able to describe (a) prevalence estimates of stuttering in individuals with Down syndrome, (b) the main components of a fluency shaping program for a child with Down syndrome who stutters and has co-occurring speech and language delays, and (c) speech and parent-, teacher-, and self-report treatment outcomes. Copyright © 2012 Elsevier Inc. All rights reserved.

Experiences of Intimate Partner and Neighborhood Violence and Their Association With Mental Health in Pregnant Women.

PubMed

Barcelona de Mendoza, Veronica; Harville, Emily W; Savage, Jane; Giarratano, Gloria

2018-03-01

Both intimate partner violence and neighborhood crime have been associated with worse mental health outcomes, but less is known about cumulative effects. This association was studied in a sample of pregnant women who were enrolled in a study of disaster exposure, prenatal care, and mental and physical health outcomes between 2010 and 2012. Women were interviewed about their exposure to intimate partner violence and perceptions of neighborhood safety, crime, and disorder. Main study outcomes included symptoms of poor mental health; including depression, pregnancy-specific anxiety (PA), and posttraumatic stress disorder (PTSD). Logistic regression was used to examine predictors of mental health with adjustment for confounders. Women who experienced high levels of intimate partner violence and perceived neighborhood violence had increased odds of probable depression in individual models. Weighted high cumulative (intimate partner and neighborhood) experiences of violence were also associated with increased odds of having probable depression when compared with those with low violence. Weighed high cumulative violence was also associated with increased odds of PTSD. This study provides additional evidence that cumulative exposure to violence is associated with poorer mental health in pregnant women.

The multimedia computer for office-based patient education: a systematic review.

PubMed

Wofford, James L; Smith, Edward D; Miller, David P

2005-11-01

Use of the multimedia computer for education is widespread in schools and businesses, and yet computer-assisted patient education is rare. In order to explore the potential use of computer-assisted patient education in the office setting, we performed a systematic review of randomized controlled trials (search date April 2004 using MEDLINE and Cochrane databases). Of the 26 trials identified, outcome measures included clinical indicators (12/26, 46.1%), knowledge retention (12/26, 46.1%), health attitudes (15/26, 57.7%), level of shared decision-making (5/26, 19.2%), health services utilization (4/26, 17.6%), and costs (5/26, 19.2%), respectively. Four trials targeted patients with breast cancer, but the clinical issues were otherwise diverse. Reporting of the testing of randomization (76.9%) and appropriate analysis of main effect variables (70.6%) were more common than reporting of a reliable randomization process (35.3%), blinding of outcomes assessment (17.6%), or sample size definition (29.4%). We concluded that the potential for improving the efficiency of the office through computer-assisted patient education has been demonstrated, but better proof of the impact on clinical outcomes is warranted before this strategy is accepted in the office setting.

The Use of Online Modules and the Effect on Student Outcomes in a High School Chemistry Class

NASA Astrophysics Data System (ADS)

Lamb, Richard L.; Annetta, Len

2013-10-01

The purpose of the study was to review the efficacy of online chemistry simulations in a high school chemistry class and provide discussion of the factors that may affect student learning. The sample consisted of 351 high school students exposed to online simulations. Researchers administered a pretest, intermediate test and posttest to measure chemistry content knowledge acquired during the use of online chemistry laboratory simulations. The authors also analyzed student journal entries as an attitudinal measure of chemistry during the simulation experience. The four analyses conducted were Repeated Time Measures Analysis of Variance, a three-way Analysis of Variance, Logistic Regression and Multiple Analysis of Variance. Each of these analyses provides for a slightly different aspect of factors regarding student attitudes and outcomes. Results indicate that there is a statistically significant main effect across grouping type (experimental versus control, p = 0.042, α = 0.05). Analysis of student journal entries suggests that attitudinal factors may affect student outcomes concerning the use of online supplemental instruction. Implications for this study show that the use of online simulations promotes increased understanding of chemistry content through open-ended and interactive questioning.

A longitudinal test of video game violence influences on dating and aggression: a 3-year longitudinal study of adolescents.

PubMed

Ferguson, Christopher J; San Miguel, Claudia; Garza, Adolfo; Jerabeck, Jessica M

2012-02-01

In 2011 the field of video game violence experienced serious reversals with repudiations of the current research by the US Supreme Court and the Australian Government as non-compelling and fundamentally flawed. Scholars too have been calling for higher quality research on this issue. The current study seeks to answer this call by providing longitudinal data on youth aggression and dating violence as potential consequences of violent video game exposure using well-validated clinical outcome measures and controlling for other relevant predictors of youth aggression. A sample of 165, mainly Hispanic youth, were tested at 3 intervals, an initial interview, and 1-year and 3-year intervals. Results indicated that exposure to video game violence was not related to any of the negative outcomes. Depression, antisocial personality traits, exposure to family violence and peer influences were the best predictors of aggression-related outcomes. The current study supports a growing body of evidence pointing away from video game violence use as a predictor of youth aggression. Public policy efforts, including funding, would best be served by redirecting them toward other prevention programs for youth violence. Copyright © 2011 Elsevier Ltd. All rights reserved.

Performance of informative priors skeptical of large treatment effects in clinical trials: A simulation study.

PubMed

Pedroza, Claudia; Han, Weilu; Thanh Truong, Van Thi; Green, Charles; Tyson, Jon E

2018-01-01

One of the main advantages of Bayesian analyses of clinical trials is their ability to formally incorporate skepticism about large treatment effects through the use of informative priors. We conducted a simulation study to assess the performance of informative normal, Student- t, and beta distributions in estimating relative risk (RR) or odds ratio (OR) for binary outcomes. Simulation scenarios varied the prior standard deviation (SD; level of skepticism of large treatment effects), outcome rate in the control group, true treatment effect, and sample size. We compared the priors with regards to bias, mean squared error (MSE), and coverage of 95% credible intervals. Simulation results show that the prior SD influenced the posterior to a greater degree than the particular distributional form of the prior. For RR, priors with a 95% interval of 0.50-2.0 performed well in terms of bias, MSE, and coverage under most scenarios. For OR, priors with a wider 95% interval of 0.23-4.35 had good performance. We recommend the use of informative priors that exclude implausibly large treatment effects in analyses of clinical trials, particularly for major outcomes such as mortality.

An application of the TROFLEI in secondary-school science classes in New Zealand

NASA Astrophysics Data System (ADS)

Bhan Koul, Rekha; Fisher, D. L.; Shaw, Toni

2011-07-01

Background and purpose: The present study reports on the findings of a study conducted in New Zealand using the actual and preferred forms of a classroom environment instrument, the Technology-Rich Outcomes-focussed Learning Environment Inventory (TROFLEI) and three affective outcome scales. Main aims of this study were to validate the instrument for use in New Zealand; to investigate differences between students' perceptions of (a) actual and preferred learning environments, (b) year levels and (c) gender; and to investigate associations between science classroom learning environment, attitude and self-efficacy. Sample TROFLEI was administered to 1027 high-school students from 30 classes. Design and method The 80-item TROFLEI assesses 10 classroom environment dimensions: student cohesiveness, teacher support, involvement, investigation, task orientation, cooperation, equity, differentiation, computer usage and young adult ethos. The three affective outcome scales used in the study are attitude to subject, attitude to computers and academic efficacy. Results The validity and reliability of the TROFLEI and three affective outcome scales for use in New Zealand were established. Differences in actual and preferred scores confirmed that students participating in the study sought better learning environments. Female students generally perceived their technology-related learning environment more positively. Year-13 students had consistently higher means for most (8 out of 13) of the learning environment dimensions. Statistically significant associations were found between the scales of TROLFLEI and three affective outcome scales. Conclusions The results of this study assist us in understanding the psychosocial learning environments in New Zealand in a technology-supported classroom and to determine its effectiveness in terms of selected learner outcomes.

Areas of disadvantage: a systematic review of effects of area-level socioeconomic status on substance use outcomes.

PubMed

Karriker-Jaffe, Katherine J

2011-01-01

This review examines whether area-level disadvantage is associated with increased substance use and whether study results are impacted by the size of the area examined, definition of socioeconomic status (SES), age or ethnicity of participants, outcome variables or analytic techniques. Five electronic databases and the reference sections of identified papers were searched to locate studies of the effects of area-level SES on substance use published through the end of 2007 in English-language, peer-reviewed journals or books. The 41 studies that met inclusion criteria included 238 effects, with a subsample of 34 studies (180 effects) used for the main analyses. Study findings were stratified by methodological characteristics and synthesised using generalised estimating equations to account for clustering of effects within studies. There was strong evidence that substance use outcomes cluster by geographic area, but there was limited and conflicting support for the hypothesis that area-level disadvantage is associated with increased substance use. Support for the disadvantage hypothesis appeared to vary by sample age and ethnicity, size of area examined, type of SES measure, specific outcome considered and analysis techniques. Future studies should use rigorous methods to yield more definitive conclusions about the effects of area-level SES on alcohol and drug outcomes, including composite measures of SES and both bivariate and multivariate analyses. Further research is needed to identify confounds of the relationship between area-level SES and substance use and to explain why the effects of area-level SES vary by outcome and residents' age. © 2010 Australasian Professional Society on Alcohol and other Drugs.

The Effects of Nurse Staffing and Nurse Education on Patient Deaths in Hospitals With Different Nurse Work Environments

PubMed Central

Aiken, Linda H.; Cimiotti, Jeannie P.; Sloane, Douglas M.; Smith, Herbert L.; Flynn, Linda; Neff, Donna F.

2011-01-01

Context Better hospital nurse staffing, more educated nurses, and improved nurse work environments have been shown to be associated with lower hospital mortality. Little is known about whether and under what conditions each type of investment works better to improve outcomes. Objective To determine the conditions under which the impact of hospital nurse staffing, nurse education, and work environment are associated with patient outcomes. Design, Setting, and Participants Outcomes of 665 hospitals in four large states were studied through linked data from hospital discharge abstracts for 1,262,120 general, orthopedic, and vascular surgery patients, a random sample of 39,038 hospital staff nurses, and American Hospital Association data. Main outcome measures 30-day inpatient mortality and failure-to-rescue. Results The effect of decreasing workloads by one patient/nurse on deaths and failure-to-rescue is virtually nil in hospitals with poor work environments, but decreases the odds on both deaths and failures in hospitals with average environments by 4%, and in hospitals with the best environments by 9 and 10% respectively. The effect of 10% more BSN nurses decreases the odds on both outcomes in all hospitals, regardless of their work environment, by roughly 4%. Conclusions While the positive effect of increasing percentages of BSN nurses is consistent across all hospitals, lowering the patient-to-nurse ratios markedly improves patient outcomes in hospitals with good work environments, slightly improves them in hospitals with average environments, and has no effect in hospitals with poor environments. PMID:21945978

Developing and validating a model to predict the success of an IHCS implementation: the Readiness for Implementation Model.

PubMed

Wen, Kuang-Yi; Gustafson, David H; Hawkins, Robert P; Brennan, Patricia F; Dinauer, Susan; Johnson, Pauley R; Siegler, Tracy

2010-01-01

To develop and validate the Readiness for Implementation Model (RIM). This model predicts a healthcare organization's potential for success in implementing an interactive health communication system (IHCS). The model consists of seven weighted factors, with each factor containing five to seven elements. Two decision-analytic approaches, self-explicated and conjoint analysis, were used to measure the weights of the RIM with a sample of 410 experts. The RIM model with weights was then validated in a prospective study of 25 IHCS implementation cases. Orthogonal main effects design was used to develop 700 conjoint-analysis profiles, which varied on seven factors. Each of the 410 experts rated the importance and desirability of the factors and their levels, as well as a set of 10 different profiles. For the prospective 25-case validation, three time-repeated measures of the RIM scores were collected for comparison with the implementation outcomes. Two of the seven factors, 'organizational motivation' and 'meeting user needs,' were found to be most important in predicting implementation readiness. No statistically significant difference was found in the predictive validity of the two approaches (self-explicated and conjoint analysis). The RIM was a better predictor for the 1-year implementation outcome than the half-year outcome. The expert sample, the order of the survey tasks, the additive model, and basing the RIM cut-off score on experience are possible limitations of the study. The RIM needs to be empirically evaluated in institutions adopting IHCS and sustaining the system in the long term.

Should English healthcare providers be penalised for failing to collect patient-reported outcome measures? A retrospective analysis

PubMed Central

Street, Andrew; Gomes, Manuel; Bojke, Chris

2015-01-01

Summary Objective The best practice tariff for hip and knee replacement in the English National Health Service (NHS) rewards providers based on improvements in patient-reported outcome measures (PROMs) collected before and after surgery. Providers only receive a bonus if at least 50% of their patients complete the preoperative questionnaire. We determined how many providers failed to meet this threshold prior to the policy introduction and assessed longitudinal stability of participation rates. Design Retrospective observational study using data from Hospital Episode Statistics and the national PROM programme from April 2009 to March 2012. We calculated participation rates based on either (a) all PROM records or (b) only those that could be linked to inpatient records; constructed confidence intervals around rates to account for sampling variation; applied precision weighting to allow for volume; and applied risk adjustment. Setting NHS hospitals and private providers in England. Participants NHS patients undergoing elective unilateral hip and knee replacement surgery. Main outcome measures Number of providers with participation rates statistically significantly below 50%. Results Crude rates identified many providers that failed to achieve the 50% threshold but there were substantially fewer after adjusting for uncertainty and precision. While important, risk adjustment required restricting the analysis to linked data. Year-on-year correlation between provider participation rates was moderate. Conclusions Participation rates have improved over time and only a small number of providers now fall below the threshold, but administering preoperative questionnaires remains problematic in some providers. We recommend that participation rates are based on linked data and take into account sampling variation. PMID:25827906

Identification of the Infection Source of an Outbreak of Mycobacterium Chelonae Keratitis After Laser in Situ Keratomileusis.

PubMed

Nascimento, Heloisa; Viana-Niero, Cristina; Nogueira, Christiane Lourenço; Martins Bispo, Paulo José; Pinto, Fernando; de Paula Pereira Uzam, Camila; Matsumoto, Cristianne Kayoko; Oliveira Machado, Antônia Maria; Leão, Sylvia Cardoso; Höfling-Lima, Ana Luisa; de Freitas, Denise

2018-01-01

Nontuberculous mycobacteria keratitis is a rare but challenging complication of laser in situ keratomileusis (LASIK). This study was conducted to determine the source(s) of infection in a cluster of cases of keratitis after LASIK and to describe this outbreak and patients' outcomes. In this retrospective, case series, single-center study, 86 patients were included who underwent LASIK or photorefractive keratectomy between December 2011 and February 2012. Corneal scrapes from the affected eyes, samples of tap and distilled water, water from the reservoir of the distilling equipment, steamer, and autoclave cassette; antiseptic and anesthetic solutions and surgical instrument imprints were cultivated in liquid and on solid media. Gram-negative bacteria and yeasts were identified using automated systems and mycobacteria by polymerase chain reaction-restriction enzyme analysis of the hsp65 gene (PRA-hsp65) and DNA sequencing. Mycobacterial isolates were typed by pulsed-field gel electrophoresis. The cases and outcomes are described. The main outcome measure was identification of the source(s) of the mycobacterial infections. Eight (15 eyes) of 86 patients (172 eyes) who underwent LASIK developed infections postoperatively; no patients who underwent photorefractive keratectomy developed infections. Mycobacterium chelonae was isolated from 4 eyes. The distilled water collected in the surgical facility contained the same M. chelonae strain isolated from the patients' eyes. Different gram-negative bacteria and yeasts were isolated from samples collected at the clinic but not from the patients' eyes. Tap water distilled locally in surgical facilities may be a source of infection after ocular surgery and its use should be avoided.

Association between funding, risk of bias, and outcome of randomised controlled trials in oral and maxillofacial surgery.

PubMed

Oomens, M A E M; Lazzari, S; Heymans, M W; Forouzanfar, T

2016-01-01

The influence of funding on the main outcome of a random control trial (RCT) is important, as it could potentially lead to bias towards industry, and results that are too optimistic. We investigated the association between funding, the published outcome, and the risk of bias in trials in oral and maxillofacial surgery (OMFS) published from January 2000 to May 2013 listed in PubMed. The methods used were scored using the risk of bias items given in a Delphi List. Sources of funding were recorded and categorised five ways: not funded, funded by industry, not funded by industry, supported by industry, and source of funds not clear. A total of 390 RCT met the inclusion criteria, and there was a correlation between funding and favourable main outcomes, although this was not significant. There was no correlation between the risk of bias and favourable results of the main outcome of a trial, or between the risk of bias and the reported source of funding in post-hoc analysis. We were unable to show a significant correlation between funding and a higher likelihood of a favourable result for the primary outcome in RCT in OMFS. We also failed to show a significant correlation between the risk of bias of a trial and its main outcome. In contrast, the source of funding proved to affect the risk of bias of a trial significantly, although not in post-hoc analysis. Funded trials were better organised, and so had a lower risk of bias. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

An intervention to improve program implementation: findings from a two-year cluster randomized trial of Assets-Getting To Outcomes

PubMed Central

2013-01-01

Background Studies have shown that communities have not always been able to implement evidence-based prevention programs with quality and achieve outcomes demonstrated by prevention science. Implementation support interventions are needed to bridge this gap between science and practice. The purpose of this article is to present two-year outcomes from an evaluation of the Assets Getting To Outcomes (AGTO) intervention in 12 Maine communities engaged in promoting Developmental Assets, a positive youth development approach to prevention. AGTO is an implementation support intervention that consists of: a manual of text and tools; face-to-face training, and onsite technical assistance, focused on activities shown to be associated with obtaining positive results across any prevention program. Methods This study uses a nested and cross-sectional, cluster randomized controlled design. Participants were coalition members and program staff from 12 communities in Maine. Each coalition nominated up to five prevention programs to participate. At random, six coalitions and their respective 30 programs received the two-year AGTO intervention and the other six maintained routine operations. The study assessed prevention practitioner capacity (efficacy and behaviors), practitioner exposure to and use of AGTO, practitioner perceptions of AGTO, and prevention program performance. Capacity of coalition members and performance of their programs were compared between the two groups across the baseline, one-, and two-year time points. Results We found no significant differences between AGTO and control group’s prevention capacity. However, within the AGTO group, significant differences were found between those with greater exposure to and use of AGTO. Programs that received the highest number of technical assistance hours showed the most program improvement. Conclusions This study is the first of its kind to show that use of an implementation support intervention-AGTO -yielded improvements in practitioner capacity and consequently in program performance on a large sample of practitioners and programs using a randomized controlled design. ClinicalTrials.gov identifier NCT00780338 PMID:23924279

Predictive relevance of clinical scores and inflammatory parameters in secondary peritonitis.

PubMed

Zügel, Nikolaus P; Kox, Martin; Lichtwark-Aschoff, Michael; Gippner-Steppert, Cornelia; Jochum, Marianne

2011-01-01

To measure and evaluate clinical scores and various inflammation parameters for providing a better outcome assessment of patients with secondary peritonitis. Prospective study. ICU of a university and a university affiliated hospital. Fifty-six patients with severe secondary peritonitis were enrolled in this study executed within 4 years. Blood samples were taken preoperatively and 2, 6, 8, 12, 18, 24, 30, 36, 42 and 48 hours post operation, thereafter every 12th hour until day 5 respectively once daily until day 14. Etiology of peritonitis, clinical score systems (APACHE II, MOF and SOFA), and 27 mainly with activity tests or enzyme-immunoassays measurable inflammation parameters were simultaneously analyzed and stratified into lethal outcome (n = 11) or survival (n = 45), respectively. The etiological distribution of peritonitis was identical among both groups. Proportion of intraperitoneal fungi, E. coli, and bacteroids was substantially higher during the primary operation in the group with lethal outcome. With increasing significance initial and follow-up APACHE II, MOF and SOFA scores provided higher values in this group. Various plasma/serum parameters of hemostasis, leukocyte proteolytic system, acute phase reaction, cytokine system, cell adhesion, opsonization, and main organ functions showed significantly different values between both groups at the preoperative stage and/or during observation period I (day 0-4). Logistic regression analysis revealed the SOFA score and neopterin concentration as the combination with the best sensitivity (63.6%) and specificity (93.2%) for predicting the patients' survival even at the preoperative stage. For the observation period I, the combination of SOFA score and TNF receptor II showed the highest predictive sensitivity (72.7%) and specificity (95.6%). Evaluation of the severity of secondary peritonitis using a scoring system with high prognostic relevance could conceivably result in an earlier and adequate application of intensive care such as hemofiltration, administration of immunoglobulins and serial abdominal lavage to improve successful outcome.

Involuntary vs. voluntary hospital admission. A systematic literature review on outcome diversity.

PubMed

Kallert, Thomas W; Glöckner, Matthias; Schützwohl, Matthias

2008-06-01

This article systematically reviews the literature on the outcome of acute hospitalization for adult general psychiatric patients admitted involuntarily as compared to patients admitted voluntarily. Inclusion and exclusion criteria qualified 41 out of 3,227 references found in Medline and PSYNDEXplus literature searches for this review. The authors independently rated these articles on six pre-defined indicators of research quality, carried out statistical comparisons ex-post facto where not reported, and computed for each adequate result the effect size index d for the comparison of means, and the Phi- or contingency coefficient for cross-tabulated data. Methodological quality of the studies, coming mostly from North American and European countries, showed significant variation and was higher concerning service-related than clinical or subjective outcomes. Main deficits appeared in sample size estimation, lack of clear follow-up time-points, and the absence of standardized instruments used to assess clinical outcomes. Length of stay, readmission risk, and risk of involuntary readmission were at least equal or greater for involuntary patients. Involuntary patients showed no increased mortality, but did have higher suicide rates than voluntary patients. Further, involuntary patients demonstrated lower levels of social functioning, and equal levels of general psychopathology and treatment compliance; they were more dissatisfied with treatment and more frequently felt that hospitalization was not justified. Future methodologically-sound studies exploring this topic should focus on patient populations not represented here. Further research should also clarify if the legal admission status is sufficiently valid for differentiating the outcome of acute hospitalization.

The effect of procedure room temperature and humidity on LASIK outcomes

PubMed Central

Seider, Michael I.; McLeod, Stephen D.; Porco, Travis C.; Schallhorn, Steven C.

2013-01-01

Objective To determine if procedure room temperature and humidity during LASIK affects refractive outcomes in a very large patient sample. Design Retrospective cohort study. Participants 202,394 eyes of 105,712 patients aged 18 to 75 years old who underwent LASIK at an Optical Express, Inc. location in their United Kingdom and Ireland centers from January 1, 2008 to June 30, 2011 who met inclusion criteria. Methods Patient age, gender, pre- and one month post-LASIK manifest refraction and flap creation technique were recorded as well as the ambient temperature and humidity during LASIK. Effect size determination, in addition to univariate and multivariate analysis was performed to characterize the relationships between LASIK procedure room temperature and humidity and post-operative refractive outcome. Main Outcome Measures One month post-LASIK manifest refraction. Results No clinically significant effect of procedure room temperature or humidity was found on LASIK refractive outcomes. When considering all eyes in our population, an increase of one degree Celsius during LASIK was associated with a 0.003 diopter more hyperopic refraction one month post-operatively and an increase in one percent humidity was associated with a 0.0004 more myopic refraction. These effect sizes were the same or similar when considering only myopic eyes, only hyperopic eyes and subgroups of eyes stratified by age and pre-operative refractive error. Conclusions Procedure room temperature or humidity during LASIK was found to have no clinically significant relationship with post-operative manifest refraction in our population. PMID:23769199

Patient-reported outcome measures in arthroplasty registries

PubMed Central

Eresian Chenok, Kate; Bohm, Eric; Lübbeke, Anne; Denissen, Geke; Dunn, Jennifer; Lyman, Stephen; Franklin, Patricia; Dunbar, Michael; Overgaard, Søren; Garellick, Göran; Dawson, Jill

2016-01-01

The International Society of Arthroplasty Registries (ISAR) Steering Committee established the Patient-Reported Outcome Measures (PROMs) Working Group to convene, evaluate, and advise on best practices in the selection, administration, and interpretation of PROMs and to support the adoption and use of PROMs for hip and knee arthroplasty in registries worldwide. The 2 main types of PROMs include generic (general health) PROMs, which provide a measure of general health for any health state, and specific PROMs, which focus on specific symptoms, diseases, organs, body regions, or body functions. The establishment of a PROM instrument requires the fulfillment of methodological standards and rigorous testing to ensure that it is valid, reliable, responsive, and acceptable to the intended population. A survey of the 41 ISAR member registries showed that 8 registries administered a PROMs program that covered all elective hip or knee arthroplasty patients and 6 registries collected PROMs for sample populations; 1 other registry had planned but had not started collection of PROMs. The most common generic instruments used were the EuroQol 5 dimension health outcome survey (EQ-5D) and the Short Form 12 health survey (SF-12) or the similar Veterans RAND 12-item health survey (VR-12). The most common specific PROMs were the Hip disability and Osteoarthritis Outcome Score (HOOS), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Oxford Hip Score (OHS), the Oxford Knee Score (OKS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and the University of California at Los Angeles Activity Score (UCLA). PMID:27168175

Has general practitioner computing made a difference to patient care? A systematic review of published reports.

PubMed Central

Sullivan, F.; Mitchell, E.

1995-01-01

OBJECTIVE--To review findings from studies of the influence of desktop computers on primary care consultations. DESIGN--Systematic review of world reports from 1984 to 1994. SETTING--The computerised catalogues of Medline, BIDS, and GPlit were searched, as well as conference proceedings, books, bibliographies, and references in books and journal articles. SUBJECTS--30 papers met the inclusion criteria and were included for detailed review. INTERVENTIONS--A validated scheme for assessing methodological adequacy was used to score each paper. MAIN OUTCOME MEASURES--Papers were rated on sample formation, baseline differences, unit of allocation, outcome measures, and follow up. Differences in outcomes were also recorded. RESULTS--Four of the six papers dealing with the consultation process showed that consultations took longer. Doctor initiated and "medical" content of consultations increased at the expense of a reduction in patient initiated and "social" content. Each of the 21 studies which looked at clinician performance showed an improvement when a computer was used (from 8% to 50%, with better results for single preventive measures). Only one of the three studies looking at patient outcomes showed an improvement (diastolic blood pressure control 5 mm Hg better after one year, with fewer doctor-patient consultations). CONCLUSIONS--Using a computer in the consultation may help improve clinician performance but may increase the length of the consultation. More studies are needed to assess the effects on patient outcomes of using a computer in consultations. PMID:7580494

Long-term outcome of major depressive disorder in psychiatric patients is variable.

PubMed

Holma, K Mikael; Holma, Irina A K; Melartin, Tarja K; Rytsälä, Heikki J; Isometsä, Erkki T

2008-02-01

The prevailing view of outcome of major depressive disorder (MDD), based on mostly inpatient cohorts sampled from tertiary centers, emphasizes chronicity and frequent recurrences. We investigated the long-term outcome of a regionally representative psychiatric MDD cohort comprising mainly outpatients. The Vantaa Depression Study included 163 patients with DSM-IV MDD (71.5% of those eligible) diagnosed using structured and semistructured interviews and followed up at 6 months, 18 months, and 5 years with a life chart between February 1, 1997, and April 30, 2004. The effects of comorbid disorders and other predictors on outcome were comprehensively investigated. Over the 5-year follow-up, 98.8% of patients achieved a symptom state below major depressive episode (MDE) criteria, and 88.4% reached full remission, with the median time to full remission being 11.0 months. Nearly one third (29.3%) had no recurrences, whereas 30.0% experienced 1, 12.9% experienced 2, and 27.9% experienced 3 or more recurrences. Preceding dysthymic disorder (p = .028), cluster C personality disorder (p = .041), and longer MDE duration prior to entry (p = .011) were the most significant predictors of longer time in achieving full remission. Severity of MDD and comorbidity, especially social phobia, predicted probability of, shorter time to, and number of recurrences. Previous literature on mostly inpatient MDD may have, by generalizing from patients with the most severe psychopathology, overemphasized chronicity of MDD. The long-term outcome of MDD in psychiatric care is variable, with about one tenth of patients having poor, one third having intermediate, and one half having favorable outcomes. In addition to known predictors, cluster C personality disorders and social phobia warrant further attention as predictors of MDD outcome among outpatients.

[Measuring the impact of nursing on health: a literature review].

PubMed

Ausili, Davide

2013-01-01

Measuring nursing contribution to health services' outcomes represents a primary issue for nursing research internationally. The aim of this literature review was to outline main research lines studying the effect of nursing practice on health. A search of the literature was performed asking health and nursing-specific major database and consulting websites of authoritative nursing associations and scientific societies. Four main nursing research lines were found in literature and they concerned, nurse staffing and patient and staff-related outcomes; level of nursing care needed to achieve attended outcomes in hospitals; practice environments and patient and staff-related outcomes; the use of nursing terminologies and classifications to describe nursing-specific and nursing sensitive outcomes. Although researchers report the need to strengthen available evidences, recommendations suggest to empower nurses and nursing in clinical, educational, organizational and policy-making settings in order to draw toward the best health outcomes for communities.

Recruiting migrants for health research through social network sites: an online survey among chinese migrants in australia.

PubMed

Hu, Jie; Wong, Kam Cheong; Wang, Zhiqiang

2015-04-27

Traditionally, postal surveys or face to face interviews are the main approaches for health researchers to obtain essential research data. However, with the prevalence of information technology and Internet, Web-based surveys are gaining popularity in health research. This study aims to report the process and outcomes of recruiting Chinese migrants through social network sites in Australia and to examine the sample characteristics of online recruitment by comparing the sample which was recruited by an online survey to a sample of Australian Chinese migrants collected by a postal survey. Descriptive analyses were performed to describe and compare the process and outcomes of online recruitment with postal survey questionnaires. Chi square tests and t tests were performed to assess the differences between the two samples for categorical and continuous variables respectively. In total, 473 Chinese migrants completed the online health survey from July to October 2013. Out of 426 participants recruited through the three Chinese social network sites in Australia, over 86.6% (369/426) were recruited within six weeks. Participants of the Web-based survey were younger, with a higher education level or had resided in Australia for less time compared to those recruited via a postal survey. However, there was no significant difference in gender, marital status, and professional occupation. The recruitment of Chinese migrants through social network sites in our online survey was feasible. Compared to a postal survey of Chinese migrants, the online survey attracted different group of Chinese migrants who may have diverse health needs and concerns. Our findings provided insightful information for researchers who are considering employing a Web-based approach to recruit migrants and ethnic minority participants.

Manchester Triage System: main flowcharts, discriminators and outcomes of a pediatric emergency care 1

PubMed Central

Amthauer, Camila; da Cunha, Maria Luzia Chollopetz

2016-01-01

ABSTRACT Objetive: to characterize the care services performed through risk rating by the Manchester Triage System, identifying demographics (age, gender), main flowcharts, discriminators and outcomes in pediatric emergency Method: cross-sectional quantitative study. Data on risk classification were obtained through a search of computerized registration data from medical records of patients treated in the pediatric emergency within one year. Descriptive statistics with absolute and relative frequencies was used for the analysis. Results: 10,921 visits were conducted in the pediatric emergency, mostly male (54.4%), aged between 29 days and two years (44.5%). There was a prevalence of the urgent risk category (43.6%). The main flowchart used in the care was worried parents (22.4%) and the most prevalent discriminator was recent event (15.3%). The hospitalization outcome occurred in 10.4% of care performed in the pediatric emergency, however 61.8% of care needed to stay under observation and / or being under the health team care in the pediatric emergency. Conclusion: worried parents was the main flowchart used and recent events the most prevalent discriminator, comprising the hospitalization outcomes and permanency in observation in the pediatric emergency before discharge from the hospital. PMID:27579934

The Effects of Familism and Cultural Justification on the Mental and Physical Health of Family Caregivers

PubMed Central

Knight, Bob G.

2011-01-01

Objectives. We aimed to examine the effects of 2 factors of familism (Familial Obligations and Expected Support from the Family) and Cultural Justification on caregivers’ mental and physical health as mediated by coping style. Methods. We used a probability sample of 95 African American and 65 White family caregivers for people with dementia to test hypotheses based on the updated sociocultural stress and coping model using path analysis. Main outcome measures included depressive symptomatology, various psychological symptoms, and subjective physical health. Results. Both Familial Obligations and Cultural Justification had an indirect effect on poor mental health and subjective physical health via avoidant coping. Expected Support from the Family had no effect on caregivers’ health outcomes. Discussion. These findings suggest that feelings of obligation may be accounting for a significant proportion of the negative effects of familism on caregivers’ mental and subjective physical health. Expectations of familial social support may be relatively inconsequential in this process. PMID:20797972

THE DYNAMIC INTER-RELATIONSHIP BETWEEN OBESITY AND SCHOOL PERFORMANCE: NEW EMPIRICAL EVIDENCE FROM AUSTRALIA.

PubMed

Nghiem, Son; Hoang, Viet-Ngu; Vu, Xuan-Binh; Wilson, Clevo

2017-12-04

This paper proposes a new empirical model for examining the relationship between obesity and school performance using the simultaneous equation modelling approach. The lagged effects of both learning and health outcomes were included to capture both the dynamic and inter-relational aspects of the relationship between obesity and school performance. The empirical application of this study used comprehensive data from the first five waves of the Longitudinal Study of Australian Children (LSAC), which commenced in 2004 (wave 1) and was repeated every two years until 2018. The study sample included 10,000 children, equally divided between two cohorts (infants and children) across Australia. The empirical results show that past learning and obesity status are strongly associated with most indicators of school outcomes, including reading, writing, spelling, grammar and numeracy national tests, and scores from the internationally standardized Peabody Picture Vocabulary Test and the Matrix Reasoning Test. The main findings of this study are robust due to the choice of obesity indicator and estimation methods.

Role of Personality Functioning in the Quality of Life of Patients with Depression.

PubMed

Crempien, Carla; Grez, Marcela; Valdés, Camila; López, María José; de la Parra, Guillermo; Krause, Mariane

2017-09-01

Depression is associated with reduced quality of life (QoL), and personality pathology is associated with higher impairment and poorer treatment outcomes in patients with depression. This study aims to analyze the effects of personality functioning on the QoL of patients with depression. Severity of depressive symptoms (Beck Depression Inventory), level of personality functioning (Operationalized Psychodynamic Diagnosis Structure Questionnaire), and QoL (Medical Outcome Study 36-item Short-Form) were assessed in a sample of 84 depressive outpatients. Personality functioning showed main effects on both the mental and physical components of QoL. A moderating effect of personality functioning on the relationship between depressive symptoms and QoL was tested but not confirmed. Severity of depressive symptoms was found to mediate the effect of personality functioning on the mental component of QoL. These results suggest that the effect of personality functioning on the QoL of patients with depression may be related to the higher severity of depressive symptoms found in patients with lower levels of personality functioning.

Coping strategies, emotional outcomes and spiritual quality of life in palliative care nurses.

PubMed

Desbiens, Jean-Francois; Fillion, Lise

2007-06-01

It is in accompanying the dying that palliative care nurses say they find meaning in their work. To further explore this phenomenon, consideration of coping strategies is proposed. The main objective of this correlational study was to describe the association between coping strategies (using a revised version of the COPE scale (Carver et al, 1999)), emotional outcomes (distress and vigour; profile of mood states (POMS)), and spiritual quality of life (using the Functional Assessment of Chronic Illness Therapy - Spiritual Wellbeing Scale (FACIT-sp)). A sample of 120 nurses providing palliative care in acute care hospitals and the community in Quebec was included. Positive reinterpretation (beta=.27; p<.01) and turning to religion (beta=.33; p<.001), two strategies related to meaning-making coping and disengagement (beta=-.19; p<.05), were the best predictors, accounting for 22% of variance of spiritual quality of life. These findings are consistent with recent studies and highlight the importance of meaning-making strategies in psychological adjustment to bereavement for palliative care nurses.

Miniaturized pre-clinical cancer models as research and diagnostic tools

PubMed Central

Håkanson, Maria; Cukierman, Edna; Charnley, Mirren

2014-01-01

Cancer is one of the most common causes of death worldwide. Consequently, important resources are directed towards bettering treatments and outcomes. Cancer is difficult to treat due to its heterogeneity, plasticity and frequent drug resistance. New treatment strategies should strive for personalized approaches. These should target neoplastic and/or activated microenvironmental heterogeneity and plasticity without triggering resistance and spare host cells. In this review, the putative use of increasingly physiologically relevant microfabricated cell-culturing systems intended for drug development is discussed. There are two main reasons for the use of miniaturized systems. First, scaling down model size allows for high control of microenvironmental cues enabling more predictive outcomes. Second, miniaturization reduces reagent consumption, thus facilitating combinatorial approaches with little effort and enables the application of scarce materials, such as patient-derived samples. This review aims to give an overview of the state-of-the-art of such systems while predicting their application in cancer drug development. PMID:24295904

Frailty among Mexican community-dwelling elderly: a story told 11 years later. The Mexican Health and Aging Study

PubMed Central

Aguilar-Navarro, Sara G; Amieva, Hélène; Gutiérrez-Robledo, Luis Miguel; Avila-Funes, José Alberto

2015-01-01

Objective To describe the characteristics and prognosis of subjects classified as frail in a large sample of Mexican community-dwelling elderly. Materials and methods An eleven-year longitudinal study of 5 644 old adults participating in the Mexican Health and Aging Study (MHAS). Frailty was defined loss, weakness, exhaustion, slow walking speed and low physical activity. The main outcomes were incident disability and death. Multiple covariates were used to test the prognostic value of frailty. Results Thirty-seven percent of participants (n = 2 102) met the frailty criteria. Frail participants were significantly older, female, less disease, lower income, and poorer self-reported health status, in comparison with their non-frail counterparts. Frailty was a predictor both for disability activities of daily living and for mortality. Conclusion After a follow-up of more than ten years, the phenotype of frailty was a predictor for adverse health-related outcomes, including ADL disability and death. PMID:26172236

Accounting for twin births in sample size calculations for randomised trials.

PubMed

Yelland, Lisa N; Sullivan, Thomas R; Collins, Carmel T; Price, David J; McPhee, Andrew J; Lee, Katherine J

2018-05-04

Including twins in randomised trials leads to non-independence or clustering in the data. Clustering has important implications for sample size calculations, yet few trials take this into account. Estimates of the intracluster correlation coefficient (ICC), or the correlation between outcomes of twins, are needed to assist with sample size planning. Our aims were to provide ICC estimates for infant outcomes, describe the information that must be specified in order to account for clustering due to twins in sample size calculations, and develop a simple tool for performing sample size calculations for trials including twins. ICCs were estimated for infant outcomes collected in four randomised trials that included twins. The information required to account for clustering due to twins in sample size calculations is described. A tool that calculates the sample size based on this information was developed in Microsoft Excel and in R as a Shiny web app. ICC estimates ranged between -0.12, indicating a weak negative relationship, and 0.98, indicating a strong positive relationship between outcomes of twins. Example calculations illustrate how the ICC estimates and sample size calculator can be used to determine the target sample size for trials including twins. Clustering among outcomes measured on twins should be taken into account in sample size calculations to obtain the desired power. Our ICC estimates and sample size calculator will be useful for designing future trials that include twins. Publication of additional ICCs is needed to further assist with sample size planning for future trials. © 2018 John Wiley & Sons Ltd.

Ethics and Animal Numbers: Informal Analyses, Uncertain Sample Sizes, Inefficient Replications, and Type I Errors

PubMed Central

2011-01-01

To obtain approval for the use vertebrate animals in research, an investigator must assure an ethics committee that the proposed number of animals is the minimum necessary to achieve a scientific goal. How does an investigator make that assurance? A power analysis is most accurate when the outcome is known before the study, which it rarely is. A ‘pilot study’ is appropriate only when the number of animals used is a tiny fraction of the numbers that will be invested in the main study because the data for the pilot animals cannot legitimately be used again in the main study without increasing the rate of type I errors (false discovery). Traditional significance testing requires the investigator to determine the final sample size before any data are collected and then to delay analysis of any of the data until all of the data are final. An investigator often learns at that point either that the sample size was larger than necessary or too small to achieve significance. Subjects cannot be added at this point in the study without increasing type I errors. In addition, journal reviewers may require more replications in quantitative studies than are truly necessary. Sequential stopping rules used with traditional significance tests allow incremental accumulation of data on a biomedical research problem so that significance, replicability, and use of a minimal number of animals can be assured without increasing type I errors. PMID:21838970

From Evidence-Based Research to Practice-Based Evidence: Disseminating a Web-Based Computer-Tailored Workplace Sitting Intervention through a Health Promotion Organisation

PubMed Central

Bennie, Jason A.; Kolbe-Alexander, Tracy; Meester, Femke De

2018-01-01

Prolonged sitting has been linked to adverse health outcomes; therefore, we developed and examined a web-based, computer-tailored workplace sitting intervention. As we had previously shown good effectiveness, the next stage was to conduct a dissemination study. This study reports on the dissemination efforts of a health promotion organisation, associated costs, reach achieved, and attributes of the website users. The organisation systematically registered all the time and resources invested to promote the intervention. Website usage statistics (reach) and descriptive statistics (website users’ attributes) were also assessed. Online strategies (promotion on their homepage; sending e-mails, newsletters, Twitter, Facebook and LinkedIn posts to professional partners) were the main dissemination methods. The total time investment was 25.6 h, which cost approximately 845 EUR in salaries. After sixteen months, 1599 adults had visited the website and 1500 (93.8%) completed the survey to receive personalized sitting advice. This sample was 38.3 ± 11.0 years, mainly female (76.9%), college/university educated (89.0%), highly sedentary (88.5% sat >8 h/day) and intending to change (93.0%) their sitting. Given the small time and money investment, these outcomes are positive and indicate the potential for wide-scale dissemination. However, more efforts are needed to reach men, non-college/university educated employees, and those not intending behavioural change. PMID:29789491

From Evidence-Based Research to Practice-Based Evidence: Disseminating a Web-Based Computer-Tailored Workplace Sitting Intervention through a Health Promotion Organisation.

PubMed

Cocker, Katrien De; Cardon, Greet; Bennie, Jason A; Kolbe-Alexander, Tracy; Meester, Femke De; Vandelanotte, Corneel

2018-05-22

Prolonged sitting has been linked to adverse health outcomes; therefore, we developed and examined a web-based, computer-tailored workplace sitting intervention. As we had previously shown good effectiveness, the next stage was to conduct a dissemination study. This study reports on the dissemination efforts of a health promotion organisation, associated costs, reach achieved, and attributes of the website users. The organisation systematically registered all the time and resources invested to promote the intervention. Website usage statistics (reach) and descriptive statistics (website users' attributes) were also assessed. Online strategies (promotion on their homepage; sending e-mails, newsletters, Twitter, Facebook and LinkedIn posts to professional partners) were the main dissemination methods. The total time investment was 25.6 h, which cost approximately 845 EUR in salaries. After sixteen months, 1599 adults had visited the website and 1500 (93.8%) completed the survey to receive personalized sitting advice. This sample was 38.3 ± 11.0 years, mainly female (76.9%), college/university educated (89.0%), highly sedentary (88.5% sat >8 h/day) and intending to change (93.0%) their sitting. Given the small time and money investment, these outcomes are positive and indicate the potential for wide-scale dissemination. However, more efforts are needed to reach men, non-college/university educated employees, and those not intending behavioural change.

Evaluation of community pharmacists' knowledge and awareness of food-drug interactions in Palestine.

PubMed

Radwan, Asma; Sweileh, Anwar; Shraim, We'am; Hroub, Amr; Elaraj, Josephean; Shraim, Naser

2018-05-02

Background Food-drug interactions can produce undesirable outcomes during the therapy process. The pharmacist is responsible for providing patients counseling about common food-drug interactions. Knowledge of such interactions is important to avoid their occurrence. Objective This study aimed to assess the knowledge and awareness of community pharmacists about common food-drug interactions. Setting Pharmacists working in community pharmacies across Northern Palestine. Method This is a cross-sectional study, which involved a convenience sample of 259 pharmacists working in community pharmacies in Palestine. A self-administered questionnaire consisted of 29 questions (mainly yes/no questions) was used to assess pharmacists' knowledge towards the most common and clinically significant interactions between food and medicines. Main outcome measure Pharmacists' issues related to the knowledge of food drug interactions were evaluated. Results A total of 320 questionnaires were distributed of which 259 were completed providing a response rate 80.9%. One pharmacist from each community pharmacy was asked to complete the questionnaire. The overall knowledge score of food-drug interactions for the pharmacists was 17.9 (61.7%) out of a possible maximum of 29. The pharmacists surveyed in this study have demonstrated good knowledge of some interactions; but poor knowledge of others. Conclusion Pharmacists' knowledge about common food-drug interactions is inadequate. These findings support the need for training and educational courses for pharmacists regarding food-drug interactions.

Experiences and outcomes of maternal Ramadan fasting during pregnancy: results from a sub-cohort of the Born in Bradford birth cohort study.

PubMed

Petherick, Emily S; Tuffnell, Derek; Wright, John

2014-09-26

Observing the fast during the holy month of Ramadan is one of the five pillars of Islam. Although pregnant women and those with pre-existing illness are exempted from fasting many still choose to fast during this time. The fasting behaviours of pregnant Muslim women resident in Western countries remain largely unexplored and relationships between fasting behaviour and offspring health outcomes remain contentious. This study was undertaken to assess the prevalence, characteristics of fasting behaviours and offspring health outcomes in Asian and Asian British Muslim women within a UK birth cohort. Prospective cohort study conducted at the Bradford Royal Infirmary UK from October to December 2010 comprising 310 pregnant Muslim women of Asian or Asian British ethnicity that had a live singleton birth at the Bradford Royal Infirmary. The main outcome of the study was the decision to fast or not during Ramadan. Secondary outcomes were preterm births and mean birthweight. Logistic regression analyses were used to investigate the relationship between covariables of interest and women's decision to fast or not fast. Logistic regression was also used to investigate the relationship between covariables and preterm birth as well as low birth weight. Mutually adjusted analysis showed that the odds of any fasting were higher for women with an obese BMI at booking compared to women with a normal BMI, (OR 2.78 (95% C.I. 1.29-5.97)), for multiparous compared to nulliparous women(OR 3.69 (95% C.I. 1.38-9.86)), and for Bangladeshi origin women compared to Pakistani origin women (OR 3.77 (95% C.I. 1.04-13.65)). Odds of fasting were lower in women with higher levels of education (OR 0.40 (95% C.I. 0.18-0.91)) and with increasing maternal age (OR 0.87 (95% C.I. 0.80-0.94). No associations were observed between fasting and health outcomes in the offspring. Pregnant Muslim women residing in the UK who fasted during Ramadan differed by social, demographic and lifestyle characteristics compared to their non-fasting peers. Fasting was not found to be associated with adverse birth outcomes in this sample although these results require confirmation using reported fasting data in a larger sample before the safety of fasting during pregnancy can be established.

Well London Phase-1: results among adults of a cluster-randomised trial of a community engagement approach to improving health behaviours and mental well-being in deprived inner-city neighbourhoods

PubMed Central

Phillips, Gemma; Bottomley, Christian; Schmidt, Elena; Tobi, Patrick; Lais, Shahana; Yu, Ge; Lynch, Rebecca; Lock, Karen; Draper, Alizon; Moore, Derek; Clow, Angela; Petticrew, Mark; Hayes, Richard; Renton, Adrian

2014-01-01

Background We report the main results, among adults, of a cluster-randomised-trial of Well London, a community-engagement programme promoting healthy eating, physical activity and mental well-being in deprived neighbourhoods. The hypothesis was that benefits would be neighbourhood-wide, and not restricted to intervention participants. The trial was part of a multicomponent process/outcome evaluation which included non-experimental components (self-reported behaviour change amongst participants, case studies and evaluations of individual projects) which suggested health, well-being and social benefits to participants. Methods Twenty matched pairs of neighbourhoods in London were randomised to intervention/control condition. Primary outcomes (five portions fruit/vegetables/day; 5×30 m of moderate intensity physical activity/week, abnormal General Health Questionnaire (GHQ)-12 score and Warwick–Edinburgh Mental Well-being Scale (WEMWBS) score) were measured by postintervention questionnaire survey, among 3986 adults in a random sample of households across neighbourhoods. Results There was no evidence of impact on primary outcomes: healthy eating (relative risk [RR] 1.04, 95% CI 0.93 to 1.17); physical activity (RR:1.01, 95% CI 0.88 to 1.16); abnormal GHQ12 (RR:1.15, 95% CI 0.84 to 1.61); WEMWBS (mean difference [MD]: −1.52, 95% CI −3.93 to 0.88). There was evidence of impact on some secondary outcomes: reducing unhealthy eating-score (MD: −0.14, 95% CI −0.02 to 0.27) and increased perception that people in the neighbourhood pulled together (RR: 1.92, 95% CI 1.12 to 3.29). Conclusions The trial findings do not provide evidence supporting the conclusion of non-experimental components of the evaluation that intervention improved health behaviours, well-being and social outcomes. Low participation rates and population churn likely compromised any impact of the intervention. Imprecise estimation of outcomes and sampling bias may also have influenced findings. There is a need for greater investment in refining such programmes before implementation; new methods to understand, longitudinally different pathways residents take through such interventions and their outcomes, and new theories of change that apply to each pathway. PMID:24489043

Oral pathology diagnosis by means of micro-Raman spectroscopy on biopsies and blood serum

NASA Astrophysics Data System (ADS)

Zenone, F.; Lepore, M.; Perna, G.; Carmone, P.; Delfino, I.; Gaeta, G. M.; Capozzi, V.

2007-02-01

Pemphigus vulgaris is a chronic, autoimmune, blistering disease of the skin and mucous membranes with a potentially fatal outcome. In this case micro-Raman spectroscopy (μ-RS) can provide a powerful tool for a not invasive analysis of biological tissue for biopsy and in vivo investigation. Based on the evaluation of molecular vibration frequencies, the μ-RS is able to detect the main molecular bonds of protein constituents, as the C-H and C-C ones. Changes in frequency or in the relative intensity of the vibration modes revealed by μ-RS can be related to changes of chemical bond and of protein structure induced by pathology. Quantitative information on the intensity variation of specific Raman lines can be extracted by Partial Least Square (PLS) analysis. μ-RS was performed on some samples of oral tissue and blood serum from informed patients affected by pemphigus vulgaris (an oral pathology) at different pathology stages. The spectra were measured by means of a Raman confocal microspectrometer apparatus using the 633 nm line of a He- Ne laser source. The main protein bonds are clearly detectable in the considered samples giving important information on the integrity and on the state of tissue and blood serum components (lipids and proteins), and consequently on the occurrence of pathology.

How does uncertainty shape patient experience in advanced illness? A secondary analysis of qualitative data.

PubMed

Etkind, Simon Noah; Bristowe, Katherine; Bailey, Katharine; Selman, Lucy Ellen; Murtagh, Fliss Em

2017-02-01

Uncertainty is common in advanced illness but is infrequently studied in this context. If poorly addressed, uncertainty can lead to adverse patient outcomes. We aimed to understand patient experiences of uncertainty in advanced illness and develop a typology of patients' responses and preferences to inform practice. Secondary analysis of qualitative interview transcripts. Studies were assessed for inclusion and interviews were sampled using maximum-variation sampling. Analysis used a thematic approach with 10% of coding cross-checked to enhance reliability. Qualitative interviews from six studies including patients with heart failure, chronic obstructive pulmonary disease, renal disease, cancer and liver failure. A total of 30 transcripts were analysed. Median age was 75 (range, 43-95), 12 patients were women. The impact of uncertainty was frequently discussed: the main related themes were engagement with illness, information needs, patient priorities and the period of time that patients mainly focused their attention on (temporal focus). A typology of patient responses to uncertainty was developed from these themes. Uncertainty influences patient experience in advanced illness through affecting patients' information needs, preferences and future priorities for care. Our typology aids understanding of how patients with advanced illness respond to uncertainty. Assessment of these three factors may be a useful starting point to guide clinical assessment and shared decision making.

High school students' perceptions of EFL teacher control orientations and their English academic achievement.

PubMed

Kiany, Gholam Reza; Shayestefar, Parvaneh

2011-09-01

BACKGROUND. Theories distinguish between student-initiated and teacher-initiated regulation of students' learning activities, or between strong, shared, or loose teacher control during the completion of learning tasks. Empirical validations for such distinctions are scarce, however. AIM. The present study aimed at (a) investigating students' perceptions of control behaviours exhibited by their English teachers; and (b) exploring the contribution of different types of teacher control behaviours to students' cognitive outcomes (English Achievement). SAMPLE. The sample comprised 732 English as a Foreign Language (EFL) students studying in three major fields of high school (Mathematics, Natural Science, and Humanities). The participants (16-17 years of age) were selected from third-grade classes of 27 EFL teachers working in 25 high schools of 6 main different geographical regions in the Isfahan province, Iran. METHOD. To obtain a comprehensive picture of different control types exhibited by Iranian EFL teachers, the control subscales of the two existing questionnaires, i.e., the Questionnaire on Instructional Behaviours (QIB), adapted by Den Brok et al. (2004) and the Questionnaire on Lesson Activities (QLA) used by Den Brok (2001) were merged to form the Questionnaire of Teacher Control (QTC). The development of this Persian instrument involved several steps: translation and back translation by the researchers, one expert translator, and two EFL teachers; piloting; and a final administration of the questionnaire to the student sample. With respect to the second aim of the study, data regarding students' performances on the Standardized National English Achievement Tests were gathered from local educational offices and schools. RESULTS AND CONCLUSION. Statistical analyses supported acceptable reliability and validity of the instrument. A main factor structure with three types of teacher control (strong/high, shared/mid, and loose/low) was found to underlie students' perceptions. The results of multi-level analyses indicated that a relatively large amount of variance was explained by the control variables and student variables, and teacher control had a statistically significant effect on student outcomes. Students' English achievement was lowest when they felt control was their teachers' prerogative, higher when they themselves exerted their own control (low teacher control), and highest under shared (mid) control behaviours. ©2010 The British Psychological Society.

Rest and Return to Activity After Sport-Related Concussion: A Systematic Review of the Literature

PubMed Central

McLeod, Tamara C. Valovich; Lewis, Joy H.; Whelihan, Kate; Bacon, Cailee E. Welch

2017-01-01

Objective: To systematically review the literature regarding rest and return to activity after sport-related concussion. Data Sources: The search was conducted in the Cochrane Central Register of Controlled Trials, CINAHL, SPORTDiscus, Educational Resources Information Center, Ovid MEDLINE, and PubMed using terms related to concussion, mild traumatic brain injury, physical and cognitive rest, and return to activity. Study Selection: Studies were included if they were published in English; were original research; and evaluated the use of, compliance with, or effectiveness of physical or cognitive rest or provided empirical evidence supporting the graded return-to-activity progression. Data Extraction: The study design, patient or participant sample, interventions used, outcome measures, main results, and conclusions were extracted, as appropriate, from each article. Data Synthesis: Articles were categorized into groups based on their ability to address one of the primary clinical questions of interest: use of rest, rest effectiveness, compliance with recommendations, or outcome after graded return-to-activity progression. A qualitative synthesis of the results was provided, along with summary tables. Conclusions: Our main findings suggest that rest is underused by health care providers, recommendations for rest are broad and not specific to individual patients, an initial period of moderate physical and cognitive rest (eg, limited physical activity and light mental activity) may improve outcomes during the acute postinjury phase, significant variability in the use of assessment tools and compliance with recommended return-to-activity guidelines exists, and additional research is needed to empirically evaluate the effectiveness of graded return-to-activity progressions. Furthermore, there is a significant need to translate knowledge of best practices in concussion management to primary care providers. PMID:28387547

Ortho-geriatric service--a literature review comparing different models.

PubMed

Kammerlander, C; Roth, T; Friedman, S M; Suhm, N; Luger, T J; Kammerlander-Knauer, U; Krappinger, D; Blauth, M

2010-12-01

In the fast-growing geriatric population, we are confronted with both osteoporosis, which makes fixation of fractures more and more challenging, and several comorbidities, which are most likely to cause postoperative complications. Several models of shared care for these patients are described, and the goal of our systematic literature research was to point out the differences of the individual models. A systematic electronic database search was performed, identifying articles that evaluate in a multidisciplinary approach the elderly hip fracture patients, including at least a geriatrician and an orthopedic surgeon focused on in-hospital treatment. The different investigations were categorized into four groups defined by the type of intervention. The main outcome parameters were pooled across the studies and weighted by sample size. Out of 656 potentially relevant citations, 21 could be extracted and categorized into four groups. Regarding the main outcome parameters, the group with integrated care could show the lowest in-hospital mortality rate (1.14%), the lowest length of stay (7.39 days), and the lowest mean time to surgery (1.43 days). No clear statement could be found for the medical complication rates and the activities of daily living due to their inhomogeneity when comparing the models. The review of these investigations cannot tell us the best model, but there is a trend toward more recent models using an integrated approach. Integrated care summarizes all the positive features reported in the various investigations like integration of a Geriatrician in the trauma unit, having a multidisciplinary team, prioritizing the geriatric fracture patients, and developing guidelines for the patients' treatment. Each hospital implementing a special model for geriatric hip fracture patients should collect detailed data about the patients, process of care, and outcomes to be able to participate in audit processes and avoid peerlessness.

A One Month Review of the Types of Medical Emergencies and their Treatment Outcomes at Two Urban Public Health Clinics.

PubMed

Chew, B H; Than, T L; Chew, K S; Jamaludin, N K; Hassan, H

2012-12-01

Our study was to examine prevalence and treatment outcomes of medical emergencies at two urban public health clinics in the Petaling district, Selangor, Malaysia. A prospective universal sampling was employed to recruit all emergencies over one month period (12 April to 11 May 2011). A structured case record form was used to capture demographic data, whether the index case was selfpresenting or decided by health care workers as a medical emergency, presenting complaints, diagnoses, concurrent chronic diseases and their treatment outcomes at the clinic level. Emergency presentations and diagnoses were classified according to the International Classification of Primary Care, revised second edition (ICPC-2-R). A total of 125 medical emergencies with 276 presenting complaints were recorded. The mean age was 30.7 years old (SD 19.9). The prevalence of medical emergency was 0.56% (125/22,320). Chief complaints were mainly from ICPC-2-R chapter R (respiratory system) and chapter A (general and unspecified), 40.0% and 28.0% respectively. The most common diagnosis was acute exacerbation of bronchial asthma (34.6%). Forty percent were referred to hospitals. After adjusting for age and gender, patients who presented with painful emergency (OR 4.9 95% CI 2.0 to 11.7), cardiovascular emergency (OR 63.4 95% CI 12.9 to 310.4) and non-respiratory emergency were predictors of hospital referral (OR 4.6 95% CI 1.1 to 19.1). There was about one medical emergency for every 200 patients presenting to these urban public polyclinics which were mainly acute asthma. More than half were discharged well and given a follow-up.

Decreased visual acuity resulting from glistening and sub-surface nano-glistening formation in intraocular lenses: A retrospective analysis of 5 cases

PubMed Central

Matsushima, Hiroyuki; Nagata, Mayumi; Katsuki, Yoko; Ota, Ichiro; Miyake, Kensaku; Beiko, George H.H.; Grzybowski, Andrzej

2015-01-01

Background To report on five patients with decreased visual acuity due to glistening and severe sub-surface nano-glistening (SSNG) formation within their intraocular lenses (IOLs). Design Case reports and analysis of extracted IOLs. Participants and samples We report improved visual acuity when IOLs with severe glistening and SSNG were exchanged for clear IOLs in five patients. Methods Case reports. Main outcome measures The main outcome measure was visual acuity. The secondary outcome measure was light transmission. Explanted IOLs were subjected to investigation. Pre- and postoperative slit lamp images of the anterior eye and microscopic images of the extracted IOLs were taken and compared. Light transmission of the IOL was measured using a double beam type spectrophotometer. An integrated value of the percentage light transmittance in the visible light spectrum was calculated. Results We report on five patients whose visual acuity improved when IOLs were exchanged because of severe glistening and SSNG. All of the affected IOLs were MA60BM (Alcon, Forth Wroth Texas, USA) and the original implantation had occurred over a range of 6–15 years prior to the IOL exchange. Light transmission was decreased in all affected lenses compared to a similar control IOL. Conclusions Although only a few reports of cases in which glistening and SSNG have progressed to the level of decreased visual function have been published, the likelihood is that this phenomena will increase as the severity and incidence of these inclusions have been shown to increase with time. Appropriate evaluations of visual function in such patients are needed and consideration should be given to IOL exchange in symptomatic patients. PMID:26586975

Functional Impairment and Occupational Outcome in Adults with ADHD

ERIC Educational Resources Information Center

Gjervan, Bjorn; Torgersen, Terje; Nordahl, Hans M.; Rasmussen, Kirsten

2012-01-01

Objective: ADHD is associated with poor functional outcomes. The objectives were to investigate the prevalence of functional impairment and occupational status in a clinically referred sample of adults with ADHD and explore factors predicting occupational outcome. Method: A sample of 149 adults with a confirmed diagnosis of ADHD participated in…

Dependence of the clustering properties of galaxies on stellar velocity dispersion in the Main galaxy sample of SDSS DR10

NASA Astrophysics Data System (ADS)

Deng, Xin-Fa; Song, Jun; Chen, Yi-Qing; Jiang, Peng; Ding, Ying-Ping

2014-08-01

Using two volume-limited Main galaxy samples of the Sloan Digital Sky Survey Data Release 10 (SDSS DR10), we investigate the dependence of the clustering properties of galaxies on stellar velocity dispersion by cluster analysis. It is found that in the luminous volume-limited Main galaxy sample, except at r=1.2, richer and larger systems can be more easily formed in the large stellar velocity dispersion subsample, while in the faint volume-limited Main galaxy sample, at r≥0.9, an opposite trend is observed. According to statistical analyses of the multiplicity functions, we conclude in two volume-limited Main galaxy samples: small stellar velocity dispersion galaxies preferentially form isolated galaxies, close pairs and small group, while large stellar velocity dispersion galaxies preferentially inhabit the dense groups and clusters. However, we note the difference between two volume-limited Main galaxy samples: in the faint volume-limited Main galaxy sample, at r≥0.9, the small stellar velocity dispersion subsample has a higher proportion of galaxies in superclusters ( n≥200) than the large stellar velocity dispersion subsample.

Perceived Discrimination and Health among Immigrants in Europe According to National Integration Policies

PubMed Central

Borrell, Carme; Palència, Laia; Bartoll, Xavier; Ikram, Umar; Malmusi, Davide

2015-01-01

Background: Discrimination harms immigrants’ health. The objective of this study was to analyze the association between perceived discrimination and health outcomes among first and second generation immigrants from low-income countries living in Europe, while accounting for sex and the national policy on immigration. Methods: Cross-sectional study including immigrants from low-income countries aged ≥15 years in 18 European countries (European Social Survey, 2012) (sample of 1271 men and 1335 women). The dependent variables were self-reported health, symptoms of depression, and limitation of activity. The independent variables were perceived group discrimination, immigrant background and national immigrant integration policy. We tested for association between perceived group discrimination and health outcomes by fitting robust Poisson regression models. Results: We only observed significant associations between perceived group discrimination and health outcomes in first generation immigrants. For example, depression was associated with discrimination among both men and women (Prevalence Ratio-, 1.55 (95% CI: 1.16–2.07) and 1.47 (95% CI: 1.15–1.89) in the multivariate model, respectively), and mainly in countries with assimilationist immigrant integration policies. Conclusion: Perceived group discrimination is associated with poor health outcomes in first generation immigrants from low-income countries who live in European countries, but not among their descendants. These associations are more important in assimilationist countries. PMID:26334284

Neurolinguistic programming: a systematic review of the effects on health outcomes.

PubMed

Sturt, Jackie; Ali, Saima; Robertson, Wendy; Metcalfe, David; Grove, Amy; Bourne, Claire; Bridle, Chris

2012-11-01

Neurolinguistic programming (NLP) in health care has captured the interest of doctors, healthcare professionals, and managers. To evaluate the effects of NLP on health-related outcomes. Systematic review of experimental studies. The following data sources were searched: MEDLINE, PsycINFO, ASSIA, AMED, CINAHL, Web of Knowledge, CENTRAL, NLP specialist databases, reference lists, review articles, and NLP professional associations, training providers, and research groups. Searches revealed 1459 titles from which 10 experimental studies were included. Five studies were randomised controlled trials (RCTs) and five were pre-post studies. Targeted health conditions were anxiety disorders, weight maintenance, morning sickness, substance misuse, and claustrophobia during MRI scanning. NLP interventions were mainly delivered across 4-20 sessions although three were single session. Eighteen outcomes were reported and the RCT sample sizes ranged from 22 to 106. Four RCTs reported no significant between group differences with the fifth finding in favour of the NLP arm (F = 8.114, P<0.001). Three RCTs and five pre-post studies reported within group improvements. Risk of bias across all studies was high or uncertain. There is little evidence that NLP interventions improve health-related outcomes. This conclusion reflects the limited quantity and quality of NLP research, rather than robust evidence of no effect. There is currently insufficient evidence to support the allocation of NHS resources to NLP activities outside of research purposes.

Do race, neglect, and childhood poverty predict physical health in adulthood? A multilevel prospective analysis

PubMed Central

Nikulina, Valentina

2015-01-01

Childhood neglect and poverty often co-occur and both have been linked to poor physical health outcomes. In addition, Blacks have higher rates of childhood poverty and tend to have worse health than Whites. This paper examines the unique and interacting effects of childhood neglect, race, and family and neighborhood poverty on adult physical health outcomes. This prospective cohort design study uses a sample (N = 675) of court-substantiated cases of childhood neglect and matched controls followed into adulthood (Mage = 41). Health indicators (C-Reactive Protein [CRP], hypertension, and pulmonary functioning) were assessed through blood collection and measurements by a registered nurse. Data were analyzed using hierarchical linear models to control for clustering of participants in childhood neighborhoods. Main effects showed that growing up Black predicted CRP and hypertension elevations, despite controlling for neglect and childhood family and neighborhood poverty and their interactions. Multivariate results showed that race and childhood adversities interacted to predict adult health outcomes. Childhood family poverty predicted increased risk for hypertension for Blacks, not Whites. In contrast, among Whites, childhood neglect predicted elevated CRP. Childhood neighborhood poverty interacted with childhood family poverty to predict pulmonary functioning in adulthood. Gender differences in health indicators were also observed. The effects of childhood neglect, childhood poverty, and growing up Black in the United States are manifest in physical health outcomes assessed 30 years later. Implications are discussed. PMID:24189205

The European Innovation Partnership on Active and Healthy Ageing Synergies: Protocol for a Prospective Observational Study to Measure the Impact of a Community-Based Program on Prevention and Mitigation of Frailty (ICP - PMF) in Community-Dwelling Older Adults.

PubMed

Liotta, G; Orfila, F; Vollenbroek-Hutten, M; Roller-Winsberger, R; Illario, M; Musian, D; Alvino, S; O'Caoimh, R; Cano, A; Molloy, W; Iaccarino, G; Marazzi, M C; Inzerilli, M C; Madaro, O; Paul, C; Csonka, P; Vince, A C; Menditto, E; Maggio, M; Scarcella, P; Gilardi, F; Lucaroni, F; Abete, P; Girardi, V; Barra, R; Palombi, L

2016-11-01

Aim of this paper is to describe the protocol of the study "Impact of a Community-based Program on Prevention and Mitigation of Frailty in community-dwelling older adults" developed in the framework of the European Innovation Partnership on Active and Healthy Ageing. This proposal has been developed by the Partnership Action groups on frailty, fall prevention and polypharmacy in older. The proposal wants to assess the impact of community-based programs aimed to counteract three main outcomes related to frailty: hospitalization, institutionalization and death. Bringing together researchers from seven European countries, the proposal aims to achieve the critical mass and the geographical extension enough to provide information useful to all older European citizens. An observational study will be carried out to calculate the incidence of the different outcomes in relation to the various interventions that will be assessed; results will be compared with data coming from already established national, regional and local dataset using the observed/expected approach. The sample will be made up by at least 2000 citizens for each outcome. All the citizens will be assessed at the baseline with two multidimensional questionnaires: the RISC questionnaire and the Short Functional Geriatric Evaluation questionnaire. The outcomes will be assessed every six-twelve months.

Neurolinguistic programming: a systematic review of the effects on health outcomes

PubMed Central

Sturt, Jackie; Ali, Saima; Robertson, Wendy; Metcalfe, David; Grove, Amy; Bourne, Claire; Bridle, Chris

2012-01-01

Background Neurolinguistic programming (NLP) in health care has captured the interest of doctors, healthcare professionals, and managers. Aim To evaluate the effects of NLP on health-related outcomes. Design and setting Systematic review of experimental studies. Method The following data sources were searched: MEDLINE®, PsycINFO, ASSIA, AMED, CINAHL®, Web of Knowledge, CENTRAL, NLP specialist databases, reference lists, review articles, and NLP professional associations, training providers, and research groups. Results Searches revealed 1459 titles from which 10 experimental studies were included. Five studies were randomised controlled trials (RCTs) and five were pre-post studies. Targeted health conditions were anxiety disorders, weight maintenance, morning sickness, substance misuse, and claustrophobia during MRI scanning. NLP interventions were mainly delivered across 4–20 sessions although three were single session. Eighteen outcomes were reported and the RCT sample sizes ranged from 22 to 106. Four RCTs reported no significant between group differences with the fifth finding in favour of the NLP arm (F = 8.114, P<0.001). Three RCTs and five pre-post studies reported within group improvements. Risk of bias across all studies was high or uncertain. Conclusion There is little evidence that NLP interventions improve health-related outcomes. This conclusion reflects the limited quantity and quality of NLP research, rather than robust evidence of no effect. There is currently insufficient evidence to support the allocation of NHS resources to NLP activities outside of research purposes. PMID:23211179

Development of a case-mix funding system for adults with combined vision and hearing loss

PubMed Central

2013-01-01

Background Adults with vision and hearing loss, or dual sensory loss (DSL), present with a wide range of needs and abilities. This creates many challenges when attempting to set the most appropriate and equitable funding levels. Case-mix (CM) funding models represent one method for understanding client characteristics that correlate with resource intensity. Methods A CM model was developed based on a derivation sample (n = 182) and tested with a replication sample (n = 135) of adults aged 18+ with known DSL who were living in the community. All items within the CM model came from a standardized, multidimensional assessment, the interRAI Community Health Assessment and the Deafblind Supplement. The main outcome was a summary of formal and informal service costs which included intervenor and interpreter support, in-home nursing, personal support and rehabilitation services. Informal costs were estimated based on a wage rate of half that for a professional service provider ($10/hour). Decision-tree analysis was used to create groups with homogeneous resource utilization. Results The resulting CM model had 9 terminal nodes. The CM index (CMI) showed a 35-fold range for total costs. In both the derivation and replication sample, 4 groups (out of a total of 18 or 22.2%) had a coefficient of variation value that exceeded the overall level of variation. Explained variance in the derivation sample was 67.7% for total costs versus 28.2% in the replication sample. A strong correlation was observed between the CMI values in the two samples (r = 0.82; p = 0.006). Conclusions The derived CM funding model for adults with DSL differentiates resource intensity across 9 main groups and in both datasets there is evidence that these CM groups appropriately identify clients based on need for formal and informal support. PMID:23587314

The Relationship between Parent Expectations and Postschool Outcomes of Adolescents with Disabilities

ERIC Educational Resources Information Center

Doren, Bonnie; Gau, Jeff M.; Lindstrom, Lauren E.

2012-01-01

A secondary analysis was conducted of the National Longitudinal Transition Study-2 to examine (a) main effects of parents' school and postschool outcome expectations on the actual outcomes achieved, (b) demographic moderators, and (c) adolescent autonomy as a mediator of parent expectations and outcomes. Parent expectations were found to…

Using Propensity Score Methods to Approximate Factorial Experimental Designs to Analyze the Relationship between Two Variables and an Outcome

ERIC Educational Resources Information Center

Dong, Nianbo

2015-01-01

Researchers have become increasingly interested in programs' main and interaction effects of two variables (A and B, e.g., two treatment variables or one treatment variable and one moderator) on outcomes. A challenge for estimating main and interaction effects is to eliminate selection bias across A-by-B groups. I introduce Rubin's causal model to…

Assessing the potential for racial bias in hair analysis for cocaine: examining the relative risk of positive outcomes when comparing urine samples to hair samples.

PubMed

Mieczkowski, Tom

2011-03-20

This article examines the conjecture that hair analysis, performed to detect cocaine use or exposure, is biased against African Americans. It does so by comparing the outcomes of 33,928 hair and 105,792 urine samples collected from both African American and white subjects. In making this comparison the analysis seeks to determine if there is a departure in rates of positive and negative outcomes when comparing the results of hair analysis for cocaine to the results from urinalysis for cocaine by racial group. It treats urine as an unbiased test. It compares both the relative ratios of positive outcomes when comparing the two groups and it calculates the relative risk of outcomes for each group for having positive or negative outcomes. The findings show that the ratios of each racial group are effectively same for hair and urine assays, and they also show that the relative risk and risk estimates for positive and negative outcomes are the same for both racial groups. Considering all samples, the cocaine positive risk estimate for the hair samples comparing the two racial groups is 3.28 and for urinalysis the risk estimate is 3.10 (Breslow-Day χ(2) .250, 1 df, p = 0.617) a non-significant difference in risk. For pre-employment samples, the cocaine positive risk estimate for the hair samples comparing the two racial groups is 3.10 and for urinalysis the risk estimate is 2.90 (Breslow-Day χ(2) .281, df = 1, p = 0.595), also a non-significant difference in risk. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Correlational analysis and predictive validity of psychological constructs related with pain in fibromyalgia

PubMed Central

2011-01-01

Background Fibromyalgia (FM) is a prevalent and disabling disorder characterized by a history of widespread pain for at least three months. Pain is considered a complex experience in which affective and cognitive aspects are crucial for prognosis. The aim of this study is to assess the importance of pain-related psychological constructs on function and pain in patients with FM. Methods Design Multicentric, naturalistic, one-year follow-up study. Setting and study sample. Patients will be recruited from primary care health centres in the region of Aragon, Spain. Patients considered for inclusion are those aged 18-65 years, able to understand Spanish, who fulfil criteria for primary FM according to the American College of Rheumatology, with no previous psychological treatment. Measurements The variables measured will be the following: main variables (pain assessed with a visual analogue scale and with sphygmomanometer and general function assessed with Fibromyalgia Impact Questionnaire, and), psychological constructs (pain catastrophizing, pain acceptance, mental defeat, psychological inflexibility, perceived injustice, mindfulness, and positive and negative affect), and secondary variables (sociodemographic variables, anxiety and depression assessed with Hospital Anxiety and Depression Scale, and psychiatric interview assessed with MINI). Assessments will be carried at baseline and at one-year follow-up. Main outcome Pain Visual Analogue Scale. Analysis The existence of differences in socio-demographic, main outcome and other variables regarding pain-related psychological constructs will be analysed using Chi Square test for qualitative variables, or Student t test or variance analysis, respectively, for variables fulfilling the normality hypothesis. To assess the predictive value of pain-related psychological construct on main outcome variables at one-year follow-up, use will be made of a logistic regression analysis adjusted for socio-demographic and clinical variables. A Spearman Rho non-parametric correlation matrix will be developed to determine possible overlapping between pain-related psychological constructs. Discussion In recent years, the relevance of cognitive and affective aspects for the treatment of chronic pain, not only in FM but also in other chronic pain diseases, has been widely acknowledged. However, the relative importance of these psychological constructs, the relationship and possible overlapping between them, or the exact meaning of them in pain are not enough known. PMID:21214948

Rumination in migraine: Mediating effects of brooding and reflection between migraine and psychological distress

PubMed Central

Kokonyei, Gyongyi; Szabo, Edina; Kocsel, Natalia; Edes, Andrea; Eszlari, Nora; Pap, Dorottya; Magyar, Mate; Kovacs, David; Zsombok, Terezia; Elliott, Rebecca; Anderson, Ian Muir; William Deakin, John Francis; Bagdy, Gyorgy; Juhasz, Gabriella

2016-01-01

Objective: The relationship between migraine and psychological distress has been consistently reported in cross-sectional and longitudinal studies. We hypothesised that a stable tendency to perseverative thoughts such as rumination would mediate the relationship between migraine and psychological distress. Design and Main Outcomes Measures: Self-report questionnaires measuring depressive rumination, current psychological distress and migraine symptoms in two independent European population cohorts, recruited from Budapest (N = 1139) and Manchester (N = 2004), were used. Structural regression analysis within structural equation modelling was applied to test the mediational role of brooding and reflection, the components of rumination, between migraine and psychological distress. Sex, age and lifetime depression were controlled for in the analysis. Results: Migraine predicted higher brooding and reflection scores, and brooding proved to be a mediator between migraine and psychological distress in both samples, while reflection mediated the relationship significantly only in the Budapest sample. Conclusions: Elevated psychological distress in migraine is partially attributed to ruminative response style. Further studies are needed to expand our findings to clinical samples and to examine how rumination links to the adjustment to migraine. PMID:27616579

Psychosocial working conditions and work-related stressors among UK veterinary surgeons.

PubMed

Bartram, David J; Yadegarfar, Ghasem; Baldwin, David S

2009-08-01

Anecdotally, veterinary surgeons report high levels of work-related stress. To investigate psychosocial working conditions, self-reported causes of work-related stress and satisfaction among a representative sample of vets practising in the UK. A cross-sectional study using a questionnaire mailed to a stratified random sample of 3200 vets. The Health & Safety Executive Management Standards Indicator Tool and a series of bespoke questions were embedded in a 120 item questionnaire, which also assessed anxiety and depressive symptoms, alcohol consumption, suicidal ideation, positive mental well-being and work-home interaction. A total of 1796 useable questionnaires were returned (response rate 56%). Number of hours worked and making professional mistakes were the main reported contributors to stress. Good clinical outcomes and relationships with colleagues were the greatest sources of satisfaction. Anxiety and depressive symptoms are associated with less favourable working conditions. Compared to the general population, the sample reported higher risk of work-related stress for demands and managerial support but lower risk for relationships and change. The results could be used to inform the development of targeted interventions.

Promotional methods used by representatives of drug companies: A prospective survey in general practice

PubMed Central

Schramm, Jesper; Andersen, Morten; Vach, Kirstin; Kragstrup, Jakob; Peter Kampmann, Jens; Søndergaard, Jens

2007-01-01

Objective To examine the extent and composition of pharmaceutical industry representatives’ marketing techniques with a particular focus on drug sampling in relation to drug age. Design A group of 47 GPs prospectively collected data on drug promotional activities during a six-month period, and a sub-sample of 10 GPs furthermore recorded the representatives’ marketing techniques in detail. Setting Primary healthcare. Subjects General practitioners in the County of Funen, Denmark. Main outcome measures. Promotional visits and corresponding marketing techniques. Results The 47 GPs recorded 1050 visits corresponding to a median of 19 (range 3 to 63) per GP in the six months. The majority of drugs promoted (52%) were marketed more than five years ago. There was a statistically significant decline in the proportion of visits where drug samples were offered with drug age, but the decline was small OR 0.97 (95% CI 0.95;0.98) per year. Leaflets (68%), suggestions on how to improve therapy for a specific patient registered with the practice (53%), drug samples (48%), and gifts (36%) were the most frequently used marketing techniques. Conclusion Drug-industry representatives use a variety of promotional methods. The tendency to hand out drug samples was statistically significantly associated with drug age, but the decline was small. PMID:17497486

Association Between Objectively Measured Physical Activity and Erectile Dysfunction among a Nationally Representative Sample of American Men.

PubMed

Loprinzi, Paul D; Edwards, Meghan

2015-09-01

Emerging work suggests an inverse association between physical activity and erectile dysfunction (ED). The majority of this cross-sectional research comes from convenience samples and all studies on this topic have employed self-report physical activity methodology. Therefore, the purpose of this brief-report, confirmatory research study was to examine the association between objectively measured physical activity and ED in a national sample of Americans. Data from the 2003-2004 National Health and Nutrition Examination Survey were used. Six hundred ninety-two adults between the ages of 50 and 85 years (representing 33.2 million adults) constituted the analytic sample. Participants wore an ActiGraph 7164 accelerometer (ActiGraph, Pensacola, FL, USA) for up to 7 days with ED assessed via self-report. The main outcome measure used was ED assessed via self-report. After adjustments, for every 30 min/day increase in moderate-to-vigorous physical activity, participants had a 43% reduced odds of having ED (odds ratioadjusted  = 0.57; 95% confidence interval: 0.40-0.81; P = 0.004). This confirmatory study employing an objective measure of physical activity in a national sample suggests an inverse association between physical activity and ED. © 2015 International Society for Sexual Medicine.

Evaluation of radioisotope electric propulsion for selected interplanetary science missions

NASA Technical Reports Server (NTRS)

Oh, David; Bonfiglio, Eugene; Cupples, Mike; Belcher, Jeremy; Witzberger, Kevin; Fiehler, Douglas; Robinson Artis, Gwen

2005-01-01

This study assessed the benefits and applicability of REP to missions relevant to the In-Space Propulsion Program (ISPP) using first and second generation RPS with specific powers of 4 We/kg and 8 We/kg, respectively. Three missions representing small body targets, medium outer planet class, and main belt asteroids and comets were evaluated. Those missions were a Trojan Asteroid Orbiter, Comet Surface Sample Return (CSSR), and Jupiter Polar Orbiter with Probes (JPOP). For each mission, REP cost and performance was compared with solar electric propulsion system (SEPS) and SOA chemical propulsion system (SCPS) cost and performance. The outcome of the analysis would be a determinant for potential inclusion in the ISPP investment portfolio.

Child ADHD severity and positive and negative parenting as predictors of child social functioning: evaluation of three theoretical models.

PubMed

Kaiser, Nina M; McBurnett, Keith; Pfiffner, Linda J

2011-04-01

Prior research has established links between child social functioning and both parenting and child ADHD severity; however, research examining the way that these variables work together is lacking. The current article aims to test three possible models (main effects, mediation, and moderation) by which ADHD severity and positive and negative parenting on the part of both mothers and fathers may work together to predict child social functioning. In a combined sample of children ages 5 to 11 with and without ADHD (N = 143), multiple regression was used to assess: (a) the main effects of ADHD severity and of positive and negative parenting by both mothers and fathers on child social skill and aggressive behavior; (b) parenting as a potential mediator of the relation between ADHD severity and child social skill and aggressive behavior; and (c) ADHD severity as a potential moderator of the relation between parenting and child social skill and aggressive behavior dependent variables. Significant main effects of both ADHD severity and parenting on child social skill and aggression were found. There was some evidence to support parenting (particularly negative parenting) as a mediator of the relation between ADHD severity and child social skill and aggression. There was no evidence of significant moderational effects. Parenting and ADHD severity are independently associated with child social skill and aggressive behavior.To the extent that these associations are causal, multimodal treatment targeting both symptom reduction and improved parenting may be especially effective for the treatment of social problems related to childhood ADHD. Furthermore, evidence for parenting as a mediator of the relation between ADHD severity and child outcomes suggests that changes in child symptoms may also improve parenting practices, thus leading to improved child outcomes.

A comparison of Kneipp hydrotherapy with conventional physiotherapy in the treatment of osteoarthritis: a pilot trial.

PubMed

Schencking, Martin; Wilm, Stefan; Redaelli, Marcus

2013-01-01

An increasingly aging population implies an increasing prevalence of osteoarthritis (OA) of hip or knee. It has been ascertained that unspecific hydrotherapy of OA according to Sebastian Kneipp not only improves the range of mobility but also reduces pain significantly and increases the quality of life of the patients affected. The main aim of this pilot study was to determine the effects of hydrotherapy in comparison to conventional physiotherapy, and to analyze the feasibility of the study design under clinical circumstances. The study design is a prospective randomized controlled three-arm clinical pilot trial, carried out at a specialist clinic for integrative medicine. Thirty patients diagnosed with symptomatic OA of hip or knee and radiologic findings were randomly assigned to one of two intervention groups and a control group: hydrotherapy (group 1), physiotherapy (group 2), and both physiotherapy and hydrotherapy (group 3, control group) of the affected joint. pain intensity of the affected joint in the course of inpatient treatment; secondary outcome: health-related quality of life, joint-specific pain and mobility in the course of the study. Concerning the main outcome, intervention group 1 showed most beneficial effects in the course of inpatient treatment, followed by groups 3 and 2, and also the indirect flexion ability of hip or knee together with the general patient mobility through the "timed up and go" test were mainly improved within group 1 followed by groups 3 and 2. The results of this pilot study demonstrate beneficial effects of hydrotherapy. The study design is feasible. For statistically significant evidence and a robust conclusion of efficacy of Kneipp's hydrotherapy, a larger sample size is necessary. NCT 00950326.

Patient Safety Outcomes in Small Urban and Small Rural Hospitals

ERIC Educational Resources Information Center

Vartak, Smruti; Ward, Marcia M.; Vaughn, Thomas E.

2010-01-01

Purpose: To assess patient safety outcomes in small urban and small rural hospitals and to examine the relationship of hospital and patient factors to patient safety outcomes. Methods: The Nationwide Inpatient Sample and American Hospital Association annual survey data were used for analyses. To increase comparability, the study sample was…

Calibration of an electronic nose for poultry farm

NASA Astrophysics Data System (ADS)

Abdullah, A. H.; Shukor, S. A.; Kamis, M. S.; Shakaff, A. Y. M.; Zakaria, A.; Rahim, N. A.; Mamduh, S. M.; Kamarudin, K.; Saad, F. S. A.; Masnan, M. J.; Mustafa, H.

2017-03-01

Malodour from the poultry farms could cause air pollution and therefore potentially dangerous to humans' and animals' health. This issue also poses sustainability risk to the poultry industries due to objections from local community. The aim of this paper is to develop and calibrate a cost effective and efficient electronic nose for poultry farm air monitoring. The instrument main components include sensor chamber, array of specific sensors, microcontroller, signal conditioning circuits and wireless sensor networks. The instrument was calibrated to allow classification of different concentrations of main volatile compounds in the poultry farm malodour. The outcome of the process will also confirm the device's reliability prior to being used for poultry farm malodour assessment. The Multivariate Analysis (HCA and KNN) and Artificial Neural Network (ANN) pattern recognition technique was used to process the acquired data. The results show that the instrument is able to calibrate the samples using ANN classification model with high accuracy. The finding verifies the instrument's performance to be used as an effective poultry farm malodour monitoring.

Smooth time-dependent receiver operating characteristic curve estimators.

PubMed

Martínez-Camblor, Pablo; Pardo-Fernández, Juan Carlos

2018-03-01

The receiver operating characteristic curve is a popular graphical method often used to study the diagnostic capacity of continuous (bio)markers. When the considered outcome is a time-dependent variable, two main extensions have been proposed: the cumulative/dynamic receiver operating characteristic curve and the incident/dynamic receiver operating characteristic curve. In both cases, the main problem for developing appropriate estimators is the estimation of the joint distribution of the variables time-to-event and marker. As usual, different approximations lead to different estimators. In this article, the authors explore the use of a bivariate kernel density estimator which accounts for censored observations in the sample and produces smooth estimators of the time-dependent receiver operating characteristic curves. The performance of the resulting cumulative/dynamic and incident/dynamic receiver operating characteristic curves is studied by means of Monte Carlo simulations. Additionally, the influence of the choice of the required smoothing parameters is explored. Finally, two real-applications are considered. An R package is also provided as a complement to this article.

Outcomes of Moral Case Deliberation - the development of an evaluation instrument for clinical ethics support (the Euro-MCD)

PubMed Central

2014-01-01

Background Clinical ethics support, in particular Moral Case Deliberation, aims to support health care providers to manage ethically difficult situations. However, there is a lack of evaluation instruments regarding outcomes of clinical ethics support in general and regarding Moral Case Deliberation (MCD) in particular. There also is a lack of clarity and consensuses regarding which MCD outcomes are beneficial. In addition, MCD outcomes might be context-sensitive. Against this background, there is a need for a standardised but flexible outcome evaluation instrument. The aim of this study was to develop a multi-contextual evaluation instrument measuring health care providers’ experiences and perceived importance of outcomes of Moral Case Deliberation. Methods A multi-item instrument for assessing outcomes of Moral Case Deliberation (MCD) was constructed through an iterative process, founded on a literature review and modified through a multistep review by ethicists and health care providers. The instrument measures perceived importance of outcomes before and after MCD, as well as experienced outcomes during MCD and in daily work. A purposeful sample of 86 European participants contributed to a Delphi panel and content validity testing. The Delphi panel (n = 13), consisting of ethicists and ethics researchers, participated in three Delphi-rounds. Health care providers (n = 73) participated in the content validity testing through ‘think-aloud’ interviews and a method using Content Validity Index. Results The development process resulted in the European Moral Case Deliberation Outcomes Instrument (Euro-MCD), which consists of two sections, one to be completed before a participant’s first MCD and the other after completing multiple MCDs. The instrument contains a few open-ended questions and 26 specific items with a corresponding rating/response scale representing various MCD outcomes. The items were categorised into the following six domains: Enhanced emotional support, Enhanced collaboration, Improved moral reflexivity, Improved moral attitude, Improvement on organizational level and Concrete results. Conclusions A tentative instrument has been developed that seems to cover main outcomes of Moral Case Deliberation. The next step will be to test the Euro-MCD in a field study. PMID:24712735

Outcomes of moral case deliberation--the development of an evaluation instrument for clinical ethics support (the Euro-MCD).

PubMed

Svantesson, Mia; Karlsson, Jan; Boitte, Pierre; Schildman, Jan; Dauwerse, Linda; Widdershoven, Guy; Pedersen, Reidar; Huisman, Martijn; Molewijk, Bert

2014-04-08

Clinical ethics support, in particular Moral Case Deliberation, aims to support health care providers to manage ethically difficult situations. However, there is a lack of evaluation instruments regarding outcomes of clinical ethics support in general and regarding Moral Case Deliberation (MCD) in particular. There also is a lack of clarity and consensuses regarding which MCD outcomes are beneficial. In addition, MCD outcomes might be context-sensitive. Against this background, there is a need for a standardised but flexible outcome evaluation instrument. The aim of this study was to develop a multi-contextual evaluation instrument measuring health care providers' experiences and perceived importance of outcomes of Moral Case Deliberation. A multi-item instrument for assessing outcomes of Moral Case Deliberation (MCD) was constructed through an iterative process, founded on a literature review and modified through a multistep review by ethicists and health care providers. The instrument measures perceived importance of outcomes before and after MCD, as well as experienced outcomes during MCD and in daily work. A purposeful sample of 86 European participants contributed to a Delphi panel and content validity testing. The Delphi panel (n = 13), consisting of ethicists and ethics researchers, participated in three Delphi-rounds. Health care providers (n = 73) participated in the content validity testing through 'think-aloud' interviews and a method using Content Validity Index. The development process resulted in the European Moral Case Deliberation Outcomes Instrument (Euro-MCD), which consists of two sections, one to be completed before a participant's first MCD and the other after completing multiple MCDs. The instrument contains a few open-ended questions and 26 specific items with a corresponding rating/response scale representing various MCD outcomes. The items were categorised into the following six domains: Enhanced emotional support, Enhanced collaboration, Improved moral reflexivity, Improved moral attitude, Improvement on organizational level and Concrete results. A tentative instrument has been developed that seems to cover main outcomes of Moral Case Deliberation. The next step will be to test the Euro-MCD in a field study.

Sample size and number of outcome measures of veterinary randomised controlled trials of pharmaceutical interventions funded by different sources, a cross-sectional study.

PubMed

Wareham, K J; Hyde, R M; Grindlay, D; Brennan, M L; Dean, R S

2017-10-04

Randomised controlled trials (RCTs) are a key component of the veterinary evidence base. Sample sizes and defined outcome measures are crucial components of RCTs. To describe the sample size and number of outcome measures of veterinary RCTs either funded by the pharmaceutical industry or not, published in 2011. A structured search of PubMed identified RCTs examining the efficacy of pharmaceutical interventions. Number of outcome measures, number of animals enrolled per trial, whether a primary outcome was identified, and the presence of a sample size calculation were extracted from the RCTs. The source of funding was identified for each trial and groups compared on the above parameters. Literature searches returned 972 papers; 86 papers comprising 126 individual trials were analysed. The median number of outcomes per trial was 5.0; there were no significant differences across funding groups (p = 0.133). The median number of animals enrolled per trial was 30.0; this was similar across funding groups (p = 0.302). A primary outcome was identified in 40.5% of trials and was significantly more likely to be stated in trials funded by a pharmaceutical company. A very low percentage of trials reported a sample size calculation (14.3%). Failure to report primary outcomes, justify sample sizes and the reporting of multiple outcome measures was a common feature in all of the clinical trials examined in this study. It is possible some of these factors may be affected by the source of funding of the studies, but the influence of funding needs to be explored with a larger number of trials. Some veterinary RCTs provide a weak evidence base and targeted strategies are required to improve the quality of veterinary RCTs to ensure there is reliable evidence on which to base clinical decisions.

Changes in Body Composition in Anorexia Nervosa: Predictors of Recovery and Treatment Outcome

PubMed Central

Arcelus, Jon; Sánchez, Isabel; Riesco, Nadine; Jiménez-Murcia, Susana; González-Gómez, Jana; Granero, Roser; Custal, Nuria; Montserrat-Gil de Bernabé, Monica; Tárrega, Salomé; Baños, Rosa M.; Botella, Cristina; de la Torre, Rafael; Fernández-García, José C.; Fernández-Real, José M.; Frühbeck, Gema; Gómez-Ambrosi, Javier; Tinahones, Francisco J.; Crujeiras, Ana B.; Casanueva, Felipe F.; Menchón, José M.; Fernández-Aranda, Fernando

2015-01-01

The restoration of body composition (BC) parameters is considered to be one of the most important goals in the treatment of patients with anorexia nervosa (AN). However, little is known about differences between AN diagnostic subtypes [restricting (AN-R) and binge/purging (AN-BP)] and weekly changes in BC during refeeding treatment. Therefore, the main objectives of our study were twofold: 1) to assess the changes in BC throughout nutritional treatment in an AN sample and 2) to analyze predictors of BC changes during treatment, as well as predictors of treatment outcome. The whole sample comprised 261 participants [118 adult females with AN (70 AN-R vs. 48 AN-BP), and 143 healthy controls]. BC was measured weekly during 15 weeks of day-hospital treatment using bioelectrical impedance analysis (BIA). Assessment measures also included the Eating Disorders Inventory-2, as well as a number of other clinical indices. Overall, the results showed that AN-R and AN-BP patients statistically differed in all BC measures at admission. However, no significant time×group interaction was found for almost all BC parameters. Significant time×group interactions were only found for basal metabolic rate (p = .041) and body mass index (BMI) (p = .035). Multiple regression models showed that the best predictors of pre-post changes in BC parameters (namely fat-free mass, muscular mass, total body water and BMI) were the baseline values of BC parameters. Stepwise predictive logistic regressions showed that only BMI and age were significantly associated with outcome, but not with the percentage of body fat. In conclusion, these data suggest that although AN patients tended to restore all BC parameters during nutritional treatment, only AN-BP patients obtained the same fat mass values as healthy controls. Put succinctly, the best predictors of changes in BC were baseline BC values, which did not, however, seem to influence treatment outcome. PMID:26600309

Physical fitness in children with high motor competence is different from that in children with low motor competence.

PubMed

Haga, Monika

2009-10-01

Physical therapists often treat children with low motor competence. Earlier studies have demonstrated poor physical fitness outcomes and a reduced level of physical activity for these children compared with their peers with normal motor skills. The aim of this study was to examine how physical fitness developed over time in 2 groups of children: those with a low level of competence in motor skills (low motor competence [LMC]), and those with a high level of competence in motor skills (high motor competence [HMC]). From an initial sample of 67 children, a group of 18 was identified as having HMC or LMC on the Movement Assessment Battery for Children and was selected for the present study. Eight children (3 girls and 5 boys) comprised the LMC group, and 10 children (4 girls and 6 boys) made up the HMC group. A longitudinal design was implemented, and physical fitness in the 2 groups was evaluated by measuring different fitness components over a period of 32 months. A mixed-effects analysis of variance revealed significant main effects for group and for time but no group x time interaction effect. The LMC group performed less well on all physical fitness measures than the HMC group, and both groups scored significantly higher on the physical fitness test after a period of 32 months. The lack of a significant interaction effect indicated that the relative differences in physical fitness outcomes between the groups were relatively constant over time. This study was limited by the small sample size and lack of assessment of anthropometric variables and children's perceived self-efficacy. Children with LMC are likely to have poor physical fitness compared with children with HMC. The differences in physical fitness outcomes between the groups were relatively constant over time. Given that various physical fitness components are linked to different health outcomes, these consequences are matters of concern for both current health status and later health status in children with LMC.

Wildcat wellness coaching feasibility trial: protocol for home-based health behavior mentoring in girls.

PubMed

Cull, Brooke J; Rosenkranz, Sara K; Dzewaltowski, David A; Teeman, Colby S; Knutson, Cassandra K; Rosenkranz, Richard R

2016-01-01

Childhood obesity is a major public health problem, with one third of America's children classified as either overweight or obese. Obesity prevention and health promotion programs using components such as wellness coaching and home-based interventions have shown promise, but there is a lack of published research evaluating the impact of a combined home-based and wellness coaching intervention for obesity prevention and health promotion in young girls. The main objective of this study is to test the feasibility of such an intervention on metrics related to recruitment, intervention delivery, and health-related outcome assessments. The secondary outcome is to evaluate the possibility of change in health-related psychosocial, behavioral, and biomedical outcomes in our sample of participants. Forty girls who are overweight or obese (aged 8-13 years) will be recruited from a Midwestern college town. Participants will be recruited through posted flyers, newspaper advertisements, email, and social media. The volunteer convenience sample of girls will be randomized to one of two home-based wellness coaching interventions: a general health education condition or a healthy eating physical activity skills condition. Trained female wellness coaches will conduct weekly hour-long home visits for 12 consecutive weeks. Assessments will occur at baseline, post-intervention (3 months after baseline), and follow-up (6 months after baseline) and will include height, weight, waist circumference, body composition, pulmonary function, blood pressure, systemic inflammation, physical activity (Actical accelerometer), and self-reported survey measures (relevant to fruit and vegetable consumption, physical activity, and quality of life). This study will evaluate the feasibility of home-based wellness coaching interventions for overweight and obese girls and secondarily assess the preliminary impact on health-related psychosocial, behavioral, and biomedical outcomes. Results will provide information regarding the feasibility of this new model for use in girls as an approach to reduce the burden of overweight and obesity toward the prevention of chronic disease. NCT01845480.

Changes in Body Composition in Anorexia Nervosa: Predictors of Recovery and Treatment Outcome.

PubMed

Agüera, Zaida; Romero, Xandra; Arcelus, Jon; Sánchez, Isabel; Riesco, Nadine; Jiménez-Murcia, Susana; González-Gómez, Jana; Granero, Roser; Custal, Nuria; Montserrat-Gil de Bernabé, Monica; Tárrega, Salomé; Baños, Rosa M; Botella, Cristina; de la Torre, Rafael; Fernández-García, José C; Fernández-Real, José M; Frühbeck, Gema; Gómez-Ambrosi, Javier; Tinahones, Francisco J; Crujeiras, Ana B; Casanueva, Felipe F; Menchón, José M; Fernández-Aranda, Fernando

2015-01-01

The restoration of body composition (BC) parameters is considered to be one of the most important goals in the treatment of patients with anorexia nervosa (AN). However, little is known about differences between AN diagnostic subtypes [restricting (AN-R) and binge/purging (AN-BP)] and weekly changes in BC during refeeding treatment. Therefore, the main objectives of our study were twofold: 1) to assess the changes in BC throughout nutritional treatment in an AN sample and 2) to analyze predictors of BC changes during treatment, as well as predictors of treatment outcome. The whole sample comprised 261 participants [118 adult females with AN (70 AN-R vs. 48 AN-BP), and 143 healthy controls]. BC was measured weekly during 15 weeks of day-hospital treatment using bioelectrical impedance analysis (BIA). Assessment measures also included the Eating Disorders Inventory-2, as well as a number of other clinical indices. Overall, the results showed that AN-R and AN-BP patients statistically differed in all BC measures at admission. However, no significant time×group interaction was found for almost all BC parameters. Significant time×group interactions were only found for basal metabolic rate (p = .041) and body mass index (BMI) (p = .035). Multiple regression models showed that the best predictors of pre-post changes in BC parameters (namely fat-free mass, muscular mass, total body water and BMI) were the baseline values of BC parameters. Stepwise predictive logistic regressions showed that only BMI and age were significantly associated with outcome, but not with the percentage of body fat. In conclusion, these data suggest that although AN patients tended to restore all BC parameters during nutritional treatment, only AN-BP patients obtained the same fat mass values as healthy controls. Put succinctly, the best predictors of changes in BC were baseline BC values, which did not, however, seem to influence treatment outcome.

Ultrastructural analysis of different-made staplers' staples.

PubMed

Gentilli, S; Portigliotti, L; Aronici, M; Ferrante, D; Surico, D; Milanesio, M; Gianotti, V; Gatti, G; Addante, A; Garavoglia, M

2012-10-01

Recently, Chinese-made mechanical staplers with lower price respect to American-made ones have been introduced in clinical practice. In literature, small case series compare the clinical outcomes of different staplers concluding that the new stapler devices perform as well as the American ones. The aim of this study is to compare with an ultrastructural analysis the staples of different staplers in order to verify the existence of differences that might explain significant price disparity and condition clinical outcomes. Each stapler was subjected to morphological analysis, energy dispersive X-Ray spectroscopy, metal release assessment followed by inductively coupled plasma mass spectroscopy. P-values were considered statistically significant when <0.05. Autosuture staples have square section whereas the other American one and Chinese made staples have round sections. Roughness index and chips presence before and after ageing tests were comparable for all samples except for Ethicon Endo-Surgery stapler. Energy dispersive X-Ray spectroscopy showed that all staplers are made of pure Titanium but Ethicon Endo-Surgery staples are made with an alloy. Metal release analysis release statistically significant differences between samples in simulated body fluid 20 days solution (P=0.002) and in Aquaregia at 14 days solution. Discussion. Stapling devices have became routinely used in gastrointestinal surgery mainly because of operative time reduction. Recently, new Chinese-made mechanical staplers, with significantly lower prices, have been introduced in clinical practice. In literature, there are some studies that compare clinical outcomes of American-made and Chinese-made staplers on small groups of patients but doesn't exist any work which consider structural differences between traditional and new devices. In our study, for the first time, we propose a comparison between two American-made staplers and three Chinese-made staplers which evaluate morphology, metal composition and chemical staples release. Our study suggest that there are some ultrastructural differences between commercially available staplers with no correlation to price disparity. More studies are needed to confirm our results and to verify if our findings could condition clinical outcomes.

Impact of locus of control on clinical outcomes in renal dialysis.

PubMed

Dec, Elaine

2006-01-01

This study focused on the relationship between patients' locus of control and their ability to improve selected clinical outcomes related to kidney dialysis. The main hypothesis of this study stated that patients who viewed themselves as having control over their situation would be more successful at improving targeted clinical outcomes than those who believed someone other than themselves had control over their situation. The study found that interventions aimed at increasing awareness of who has control and reducing the aspect of chance had a more significant positive impact on outcomes than did pure cognitive or educational interventions geared mainly toward emotional issues or educational deficits. Interventions that work with the dominant locus of control to increase awareness of where control lies appeared to be more effective in assisting the patients to improve their targeted clinical outcomes rather than are interventions to change the locus of control between internal and powerful others (external).

Quality of reporting of randomized clinical trials in implant dentistry. A systematic review on critical aspects in design, outcome assessment and clinical relevance.

PubMed

Cairo, Francesco; Sanz, Ignacio; Matesanz, Paula; Nieri, Michele; Pagliaro, Umberto

2012-02-01

The aim of this systematic review (SR) was to assess the quality of reporting randomized clinical trials (RCTs) in the field of implant dentistry, its evolution over time and the possible relations between quality items and reported outcomes. RCTs in implant dentistry were retrieved through electronic and hand searches. Risk of bias in individual studies was assessed focusing on study design, outcome assessment and clinical relevance. Associations between quality items and year of publication of RCTs or reporting of statistically significant outcomes were tested. Among the 495 originally screened manuscripts published from 1989 to April 2011, 276 RCTs were assessed in this SR; 59% of them were published between 2006 and 2011. RCTs were mainly parallel (65%), with a single centre (83%) and a superiority design (88%). Trials in implant dentistry showed several methodological flaws: only 37% showed a random sequence generation at low risk of bias, 75% did not provide information on allocation concealment, only 12% performed a correct sample size calculation, the examiner was blind solely in 42% of studies where blinding was feasible. In addition, only 21% of RCTs declared operator experience and 31% reported patient-related outcomes. Many quality items improved over time. Allocation concealment at high risk of bias (p = 0.0125), no information on drop-out (p = 0.0318) and lack of CONSORT adherence (p = 0.0333) were associated with statistically significant reported outcomes. The overall quality of reporting of RCTs in implant dentistry is poor and only partially improved in the last years. Caution is suggested when interpreting these RCTs since risk of bias was associated with higher chance of reporting of statistically significant results. © 2012 John Wiley & Sons A/S.

Different labour outcomes in primiparous women that have been subjected to childhood sexual abuse or rape in adulthood: a case–control study in a clinical cohort

PubMed Central

Nerum, H; Halvorsen, L; Straume, B; Sørlie, T; Øian, P

2013-01-01

Objective To compare the duration and outcome of the first labour in women who have been subjected to childhood sexual abuse (CSA) and women who have been raped in adulthood (RA). Design Case–control study in a clinical cohort. Setting University Hospital of North Norway. Sample In all, 373 primiparas: 185 subjected to CSA, 47 to RA and 141 controls without a history of abuse. Methods Data on birth outcomes were retrieved from the patient files. Information on sexual abuse was reported in consultation with specialised midwives in the mental health team. Birth outcomes were analysed by multinominal regression analysis. Main outcome measures Vaginal births, delivery by caesarean section, operative vaginal delivery and duration of labour. Results As compared with controls, the RA group showed a significantly higher risk for caesarean section (adjusted OR 9.9, 95% CI 3.4–29.4) and operative vaginal delivery (adjusted OR 12.2, 95% CI 4.4–33.7). There were no significant differences between the CSA and the control group. The RA group displayed significantly longer duration of labour in all phases as compared with the control and CSA groups. Conclusions There were major differences in the duration of labour and birth outcomes in the two abuse groups. Despite a higher proportion of obstetric risk factors at onset of labour in the CSA group, women subjected to CSA had shorter labours and less risk for caesarean section and operative vaginal deliveries than women subjected to RA. The best care for birthing women subjected to sexual abuse needs to be explored in further studies. PMID:23157417

Efficacy of Naltrexone for the Treatment of Alcohol Dependence in Latino Populations.

PubMed

López, Cristina M; Barr, Simone C; Reid-Quiñones, Kathryn; de Arellano, Michael A

2017-05-01

Naltrexone has been identified as a promising psychopharmacological treatment for alcohol dependence. Previous studies have suggested that its efficacy may vary based on ethnic background. The current study examined the efficacy of naltrexone in the treatment of alcohol dependence in Latino adults, a previously unexplored population. This was a secondary analysis of the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) Study. The overall COMBINE sample consisted of 1,383 adult participants who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for alcohol dependence, including 155 Latinos, who are the focus of this report. Consistent with the main trial, primary drinking outcomes, including percentage of days abstinent (PDA) and time to first heavy drinking day (TTHD), were examined. In addition, we examined the effects of naltrexone on a clinically relevant secondary outcome measure, global clinical outcome of alcohol consumption and alcohol-related problems. As seen with the subsample of African Americans from the COMBINE Study, results of the present analysis indicated that there were no significant effects of naltrexone on PDA and TTHD despite these significant effects in the original study. However, contrary to findings in the African American subsample, for Latino participants naltrexone was a significant predictor of a good global clinical outcome (i.e., abstinence or moderate drinking without problems). Naltrexone was not significantly associated with improvements in the primary drinking outcomes of PDA or TTHD at the end of treatment or at follow-up. However, Latinos appeared to benefit from naltrexone as demonstrated by improved ratings of global clinical outcome. These results indicate mixed findings for the efficacy of naltrexone among Latinos in the COMBINE Study.

A review of blood sample handling and pre-processing for metabolomics studies.

PubMed

Hernandes, Vinicius Veri; Barbas, Coral; Dudzik, Danuta

2017-09-01

Metabolomics has been found to be applicable to a wide range of clinical studies, bringing a new era for improving clinical diagnostics, early disease detection, therapy prediction and treatment efficiency monitoring. A major challenge in metabolomics, particularly untargeted studies, is the extremely diverse and complex nature of biological specimens. Despite great advances in the field there still exist fundamental needs for considering pre-analytical variability that can introduce bias to the subsequent analytical process and decrease the reliability of the results and moreover confound final research outcomes. Many researchers are mainly focused on the instrumental aspects of the biomarker discovery process, and sample related variables sometimes seem to be overlooked. To bridge the gap, critical information and standardized protocols regarding experimental design and sample handling and pre-processing are highly desired. Characterization of a range variation among sample collection methods is necessary to prevent results misinterpretation and to ensure that observed differences are not due to an experimental bias caused by inconsistencies in sample processing. Herein, a systematic discussion of pre-analytical variables affecting metabolomics studies based on blood derived samples is performed. Furthermore, we provide a set of recommendations concerning experimental design, collection, pre-processing procedures and storage conditions as a practical review that can guide and serve for the standardization of protocols and reduction of undesirable variation. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Outcomes of Nigeria's HIV/AIDS Treatment Program for Patients Initiated on Antiretroviral Treatment between 2004-2012

PubMed Central

Odafe, Solomon; Abiri, Oseni; Debem, Henry; Agolory, Simon; Shiraishi, Ray W.; Auld, Andrew F.; Swaminathan, Mahesh; Dokubo, Kainne; Ngige, Evelyn; Asadu, Chukwuemeka; Abatta, Emmanuel; Ellerbrock, Tedd V.

2016-01-01

Background The Nigerian Antiretroviral therapy (ART) program started in 2004 and now ranks among the largest in Africa. However, nationally representative data on outcomes have not been reported. Methods We evaluated retrospective cohort data from a nationally representative sample of adults aged ≥15 years who initiated ART during 2004 to 2012. Data were abstracted from 3,496 patient records at 35 sites selected using probability-proportional-to-size (PPS) sampling. Analyses were weighted and controlled for the complex survey design. The main outcome measures were mortality, loss to follow-up (LTFU), and retention (the proportion alive and on ART). Potential predictors of attrition were assessed using competing risk regression models. Results At ART initiation, 66.4 percent (%) were females, median age was 33 years, median weight 56 kg, median CD4 count 161 cells/mm3, and 47.1% had stage III/IV disease. The percentage of patients retained at 12, 24, 36 and 48 months was 81.2%, 74.4%, 67.2%, and 61.7%, respectively. Over 10,088 person-years of ART, mortality, LTFU, and overall attrition (mortality, LTFU, and treatment stop) rates were 1.1 (95% confidence interval (CI): 0.7–1.8), 12.3 (95%CI: 8.9–17.0), and 13.9 (95% CI: 10.4–18.5) per 100 person-years (py) respectively. Highest attrition rates of 55.4/100py were witnessed in the first 3 months on ART. Predictors of LTFU included: lower-than-secondary level education (reference: Tertiary), care in North-East and South-South regions (reference: North-Central), presence of moderate/severe anemia, symptomatic functional status, and baseline weight <45kg. Predictor of mortality was WHO stage higher than stage I. Male sex, severe anemia, and care in a small clinic were associated with both mortality and LTFU. Conclusion Moderate/Advanced HIV disease was predictive of attrition; earlier ART initiation could improve program outcomes. Retention interventions targeting men and those with lower levels of education are needed. Further research to understand geographic and clinic size variations with outcome is warranted. PMID:27829033

The Effects of Technological Advances on Outcomes for Elderly Persons with Exudative Age-Related Macular Degeneration

PubMed Central

Sloan, Frank A.; Hanrahan, Brian W.

2014-01-01

Importance Exudative age-related macular degeneration (AMD) is the major cause of blindness among U.S. elderly. Developing effective therapies for this disease has been difficult. Objective This study assessed the impacts of introducing new therapies for treating exudative AMD on vision of the affected population and other outcomes among newly diagnosed Medicare beneficiaries. Design The study used data from a 5% sample of Medicare claims and enrollment data with a combination of a regression continuity design and propensity score matching (PSM) to assess the impacts on introduction/receipt of new technologies on study outcomes during a two-year follow-up period. Setting The analysis was based on longitudinal data for the U.S., 1994–2011, for Medicare beneficiaries with fee-for-service coverage. Participants The sample was limited to beneficiaries aged 68+ newly diagnosed with exudative AMD as indicated by beneficiaries having no claims with this diagnosis in a three-year look-back period. Exposures The comparisons with vision outcomes were after versus before introduction of photodynamic therapy (PDT) and anti-VEGF therapy. The comparisons for depression and long-term care facility admission were between beneficiaries newly diagnosed with exudative AMD who received PDT or anti-VEGF therapy compared to beneficiaries with the diagnosis receiving no therapy for this disease. Main Outcome and Measure Onset of decrease in vision, vision loss or blindness, depression, and admission to long term care facilities. Results Introduction of anti-VEGF therapy reduced vision loss and onset of severe vision loss and blindness of beneficiaries newly diagnosed with exudative AMD by 43% [0.50 0.66] on average. Such beneficiaries who received anti-VEGF therapy and were not admitted to a long-term care facility during the look-back period were 19% less likely on average to be admitted to a long-term care facility during follow-up. Conclusions and Relevance This study demonstrates gains in population vision from the introduction of anti-VEGF therapy for patients with an exudative AMD diagnosis aged 68+ in community-based settings in the U.S. PMID:24458013

Prevention of chronic PTSD with early cognitive behavioral therapy. A meta-analysis using mixed-effects modeling.

PubMed

Kliem, Sören; Kröger, Christoph

2013-11-01

Post-traumatic stress disorder (PTSD) is of great interest to public health, due to the high burden it places on both the individual and society. We meta-analyzed randomized-controlled trials to examine the effectiveness of early trauma-focused cognitive-behavioral treatment (TFCBT) for preventing chronic PTSD. Systematic bibliographic research was undertaken to find relevant literature from on-line databases (Pubmed, PsycINFO, Psyndex, Medline). Using a mixed-effect approach, we calculated effect sizes (ES) for the PTSD diagnoses (main outcome) as well as PTSD and depressive symptoms (secondary outcomes), respectively. Calculations of ES from pre-intervention to first follow-up assessment were based on 10 studies. A moderate effect (ES = 0.54) was found for the main outcome, whereas ES for secondary outcomes were predominantly small (ES = 0.27-0.45). The ES for the main outcome decreased to small (ES = 0.34) from first follow-up to long-term follow-up assessment. The mean dropout rate was 16.7% pre- to post-treatment. There was evidence for the impact of moderators on different outcomes (e.g., the number of sessions on PTSD symptoms). Future studies should include survivors of other trauma types (e.g., burn injuries) rather than predominantly survivors of accidents and physical assault, and should compare early TFCBT with other interventions that previously demonstrated effectiveness. Copyright © 2013 Elsevier Ltd. All rights reserved.

Methodological issues in the design and evaluation of supported communication for aphasia training: a cluster-controlled feasibility study

PubMed Central

Horton, Simon; Clark, Allan; Barton, Garry; Lane, Kathleen; Pomeroy, Valerie M

2016-01-01

Objective To assess the feasibility and acceptability of training stroke service staff to provide supported communication for people with moderate–severe aphasia in the acute phase; assess the suitability of outcome measures; collect data to inform sample size and Health Economic evaluation in a definitive trial. Design Phase II cluster-controlled, observer-blinded feasibility study. Settings In-patient stroke rehabilitation units in the UK matched for bed numbers and staffing were assigned to control and intervention conditions. Participants 70 stroke rehabilitation staff from all professional groups, excluding doctors, were recruited. 20 patients with moderate-severe aphasia were recruited. Intervention Supported communication for aphasia training, adapted to the stroke unit context versus usual care. Training was supplemented by a staff learning log, refresher sessions and provision of communication resources. Main outcome measures Feasibility of recruitment and acceptability of the intervention and of measures required to assess outcomes and Health Economic evaluation in a definitive trial. Staff outcomes: Measure of Support in Conversation; patient outcomes: Stroke and Aphasia Quality of Life Scale; Communicative Access Measure for Stroke; Therapy Outcome Measures for aphasia; EQ-5D-3L was used to assess health outcomes. Results Feasibility of staff recruitment was demonstrated. Training in the intervention was carried out with 28 staff and was found to be acceptable in qualitative reports. 20 patients consented to take part, 6 withdrew. 18 underwent all measures at baseline; 16 at discharge; and 14 at 6-month follow-up. Of 175 patients screened 71% were deemed to be ineligible, either lacking capacity or too unwell to participate. Poor completion rates impacted on assessment of patient outcomes. We were able to collect sufficient data at baseline, discharge and follow-up for economic evaluation. Conclusions The feasibility study informed components of the intervention and implementation in day-to-day practice. Modifications to the design are needed before a definitive cluster-randomised trial can be undertaken. Trial registration number ISRCTN37002304; Results. PMID:27091825

Ocular Toxocariasis: Clinical Features and Long-term Visual Outcomes in Adult Patients.

PubMed

Despreaux, Raphaelle; Fardeau, Christine; Touhami, Sara; Brasnu, Emmanuelle; Champion, Emmanuelle; Paris, Luc; Touitou, Valérie; Bodaghi, Bahram; Lehoang, Phuc

2016-06-01

To investigate clinical characteristics and treatment outcomes of proven ocular toxocariasis (OT) in adult patients. Retrospective, consecutive, interventional case series. setting: Institutional. Consecutive OT patients with positive serum serology and positive western blot (WB) on ocular sample. Clinical features, optical coherence tomography (OCT), and treatment outcomes. Best-corrected visual acuity (BCVA) and OCT central foveal thickness (CFT). Fourteen patients were included between 2011 and 2013. Mean age at diagnosis was 45.6 years. Mean duration between the first symptoms and diagnosis was 15.1 months. Uveitis was unilateral in all cases and all patients displayed vitreous inflammation. The main baseline findings were presence of ≥1 peripheral granulomas (57.1%), vasculitis (57.1%), vitreoretinal traction (57.1%), and chronic macular edema (ME) (71.4%). Delayed diagnosis (>8 months) seemed to be associated with higher rate of ME. All patients received albendazole. Systemic (n = 5) and/or local corticosteroids (CS) (n = 7) were administered in case of ME and/or posterior segment inflammation. Vitrectomy was performed when vitreous inflammation was severe and persistent despite CS or in case of threatening traction or visually significant epimacular membrane (28.6%). Overall, this regimen allowed significant decrease of CFT (P = .01). In the vitrectomy subgroup, mean BCVA increased (P = .01) and CFT decreased (P = .017). While some features such as granuloma are typical signs of OT, atypical features can delay the diagnosis. In doubtful situations, WB on ocular samples seems to be more specific than serum antibodies alone. ME seems to be a common complication of longstanding OT in the adult. Copyright © 2016 Elsevier Inc. All rights reserved.

Is the relationship between the built environment and physical activity moderated by perceptions of crime and safety?

PubMed

Bracy, Nicole L; Millstein, Rachel A; Carlson, Jordan A; Conway, Terry L; Sallis, James F; Saelens, Brian E; Kerr, Jacqueline; Cain, Kelli L; Frank, Lawrence D; King, Abby C

2014-02-24

Direct relationships between safety concerns and physical activity have been inconsistently patterned in the literature. To tease out these relationships, crime, pedestrian, and traffic safety were examined as moderators of built environment associations with physical activity. Exploratory analyses used two cross-sectional studies of 2068 adults ages 20-65 and 718 seniors ages 66+ with similar designs and measures. The studies were conducted in the Baltimore, Maryland-Washington, DC and Seattle-King County, Washington regions during 2001-2005 (adults) and 2005-2008 (seniors). Participants were recruited from areas selected to sample high- and low- income and walkability. Independent variables perceived crime, traffic, and pedestrian safety were measured using scales from validated instruments. A GIS-based walkability index was calculated for a street-network buffer around each participant's home address. Outcomes were total physical activity measured using accelerometers and transportation and leisure walking measured with validated self-reports (IPAQ-long). Mixed effects regression models were conducted separately for each sample. Of 36 interactions evaluated across both studies, only 5 were significant (p< .05). Significant interactions did not consistently support a pattern of highest physical activity when safety was rated high and environments were favorable. There was not consistent evidence that safety concerns reduced the beneficial effects of favorable environments on physical activity. Only pedestrian safety showed evidence of a consistent main effect with physical activity outcomes, possibly because pedestrian safety items (e.g., crosswalks, sidewalks) were not as subjective as those on the crime and traffic safety scales. Clear relationships between crime, pedestrian, and traffic safety with physical activity levels remain elusive. The development of more precise safety variables and the use of neighborhood-specific physical activity outcomes may help to elucidate these relationships.

Is the relationship between the built environment and physical activity moderated by perceptions of crime and safety?

PubMed Central

2014-01-01

Background Direct relationships between safety concerns and physical activity have been inconsistently patterned in the literature. To tease out these relationships, crime, pedestrian, and traffic safety were examined as moderators of built environment associations with physical activity. Methods Exploratory analyses used two cross-sectional studies of 2068 adults ages 20–65 and 718 seniors ages 66+ with similar designs and measures. The studies were conducted in the Baltimore, Maryland-Washington, DC and Seattle-King County, Washington regions during 2001–2005 (adults) and 2005–2008 (seniors). Participants were recruited from areas selected to sample high- and low- income and walkability. Independent variables perceived crime, traffic, and pedestrian safety were measured using scales from validated instruments. A GIS-based walkability index was calculated for a street-network buffer around each participant’s home address. Outcomes were total physical activity measured using accelerometers and transportation and leisure walking measured with validated self-reports (IPAQ-long). Mixed effects regression models were conducted separately for each sample. Results Of 36 interactions evaluated across both studies, only 5 were significant (p < .05). Significant interactions did not consistently support a pattern of highest physical activity when safety was rated high and environments were favorable. There was not consistent evidence that safety concerns reduced the beneficial effects of favorable environments on physical activity. Only pedestrian safety showed evidence of a consistent main effect with physical activity outcomes, possibly because pedestrian safety items (e.g., crosswalks, sidewalks) were not as subjective as those on the crime and traffic safety scales. Conclusions Clear relationships between crime, pedestrian, and traffic safety with physical activity levels remain elusive. The development of more precise safety variables and the use of neighborhood-specific physical activity outcomes may help to elucidate these relationships. PMID:24564971

Mediation of Family Alcoholism Risk by Religious Affiliation Types*

PubMed Central

Haber, Jon Randolph; Jacob, Theodore

2009-01-01

Objective: Religious affiliation is inversely associated with alcohol dependence (AD). Our previous findings indicated that when a religious affiliation differentiated itself from cultural norms, then high-risk adolescents (those having parents with alcoholism history) raised with these affiliations exhibited fewer AD symptoms compared with adolescents of other religious affiliations and nonreligious adolescents. The first of two studies reported here provides a needed replication of our previous findings for childhood religious affiliation using a different sample, and the second study extends examination to current religious affiliation. Method: A national sample of male and female adolescents/young adults (N = 1,329; mean age = 19.6 years) was selected who were the offspring of members of the Vietnam Era Twin Registry. Parental alcoholism, religious affiliation types, and their interactions were examined as predictors of offspring AD symptoms. Results: (1) Offspring reared with a differentiating religious affiliation during childhood exhibited significantly fewer AD symptoms as young adults; (2) offspring with current differentiating religious affiliation also exhibited fewer AD symptoms; this main effect was not weakened by adding other measures of religiousness to the model; (3) differentiating religious affiliation was correlated with both family alcoholism risk and offspring outcome, and removed the association between family alcoholism risk and offspring outcome, thus indicating that differentiating religious affiliation was at least a partial mediator of the association between family AD history risk and offspring AD outcome. Conclusions: Current results indicate that religious differentiation is an inverse mediator of alcoholism risk for offspring with or without parental AD history and regardless of the influence of other religion variables. Results replicated our previous report on religious upbringing between ages 6 and 13 years and indicated an even stronger effect when current differentiating affiliation was examined. PMID:19895764

Comparison of access, outcomes and experiences of older adults and working age adults in psychological therapy.

PubMed

Chaplin, Robert; Farquharson, Lorna; Clapp, Melissa; Crawford, Mike

2015-02-01

This study aimed to evaluate the access, experiences and outcomes of older adults receiving psychological therapies in comparison with adults of working age Primary and secondary care providers of psychological therapy services participated in the National Audit of Psychological Therapies. The main standards of access, experience and outcomes were measured by retrospective case records audits of people who completed therapy and a service user questionnaire. Outcomes were measured pre-treatment and post-treatment on the PHQ-9 and GAD-7. A total of 220 services across 97 organisations took part, 137 (62%) in primary care. Service user questionnaires were received from 14 425 (20%) respondents. A total of 122 740 records were audited, of whom 7794 (6.4%) were older adults. They were under represented as 13% of the sample would have been expected to be over 65 years according to age adjusted psychiatric morbidity figures. People over 75 years had the third expected referral rate. Significantly, more older adults than working age adults completed therapy (59.6% vs 48.6%) and were assessed as having 'recovered' post-treatment (58.5% vs 45.5%). Older adults were more satisfied with waiting times and numbers of sessions, but there were no differences in self-reported experience of therapy. Although older adults are less likely to gain access to psychological therapies, they appear to have better outcomes than working age adults. Further work is needed to improve access for older people. Copyright © 2014 John Wiley & Sons, Ltd.

More effective and less expensive: lessons from five studies examining community approaches to care.

PubMed

Browne, G; Roberts, J; Gafni, A; Weir, R; Watt, S; Byrne, C

1995-11-01

Does the nature of community health services used by chronically ill clients and their caregivers have an impact on utilization of services, expenditure and well-being outcomes? A series of five studies, (four historic cohort and one randomized trial) examined clients suffering from a variety of chronic conditions in a number of community settings in different regions of Southern Ontario. Study sample composition and size varied. Each study was designed to quantify the well-being outcomes, and expenditure associated with different community approaches is covered under a nation-wide system of health insurance plans. As a collective, these studies represent increasing methodological rigor. Multiple-perspective client well-being outcome measures were used. Caregiver burden was also analyzed. A common approach to quantification and evaluation of expenditure for service consumption was applied across all five studies. The nature of community health services (proactive versus reactive approaches to care) was found to have direct and measurable impact on total expenditure for health service utilization and client well-being outcomes. A recurring pattern of lower expenditure for community health service utilization and equal or better client outcomes was associated with well-integrated proactive services when compared with individual fragmented, reactive approaches to care. The main lesson emerging from examining the five studies on approaches to community care is that it is as, or more, effective and less expensive to offer complete proactive health care services to chronically ill people in the early stages of their illness than to provide services on demand in a piecemeal manner.

Parent-child Relationships, Parental Attitudes towards Sex, and Birth Outcomes among Adolescents

PubMed Central

Harville, Emily W.; Madkour, Aubrey Spriggs; Xie, Yiqiong

2014-01-01

Study objective To examine how parent-child relationships, parental control, and parental attitudes towards sex were related to pregnancy outcomes among adolescent mothers. Design Prospective cohort study. Parental report of relationship satisfaction, disapproval of adolescent having sex, discussion around sexual health, and sexual communication attitudes, and adolescent report of relationship satisfaction, parental control, and parental disapproval of sex were examined as predictors of self-reported birth outcomes. Weighted multivariable linear regression models were run incorporating interactions by race. Setting United States Participants 632 females who participated in Waves I and IV of the National Longitudinal Study of Adolescent Health (Add Health), a nationally-representative sample of students enrolled in grades 7–12 in 1994–95 and followed up in 2007–2008 Main Outcome Measures birthweight and gestational age Results For Black adolescents, better parent-child relationship was associated with higher birthweight (0.14 kg, p<0.05) and gestational age (0.75 weeks, p<0.01), while higher parental disapproval of having sex (adjusted beta 0.15 kg, p<0.05) were associated with higher birthweight. For non-Black adolescents, a moderate amount of discussion of birth control was associated with higher birthweight (0.19 kg, p<0.01 and lower child-perceived parental disapproval of having sex was associated with higher birthweight (0.08 kg, p<0.05) and gestational age (0.37 weeks, p<0.05). Higher parental control was associated with a reduced likelihood of smoking during pregnancy and a greater likelihood of early prenatal care. Conclusion Parent-child relationships and attitudes about sex affect outcomes of pregnant adolescents. PMID:25023982

Consumer satisfaction with the Child and Adolescent Mental Health Service and its association with treatment outcome: a 3-4-year follow-up study.

PubMed

Solberg, Cathrine; Larsson, Bo; Jozefiak, Thomas

2015-04-01

Consumer satisfaction studies with the Child and Adolescent Mental Health Service (CAMHS) have mainly assessed evaluations in a short-term follow-up perspective. Adolescent reports with CAMHS have not been included nationally. The purposes of this study were to explore adolescent and parental satisfaction with the CAMHS in a 3-4-year follow-up perspective, and to examine the relationships between reported consumer satisfaction and clinical parameters such as reason for adolescent referral, emotional/behavioral symptoms and treatment outcome. Of 190 adolescent-parent pairs in a sample of CAMHS outpatients, 120 completed a Consumer Satisfaction Questionnaire. Parents assessed adolescent emotional/behavior problems both at baseline and at follow-up by completing the Child Behavior Checklist (CBCL). Correlations were examined between adolescent and parental evaluations. The relationships between service satisfaction and symptom load at baseline and follow-up and treatment outcome at follow-up were explored. Overall, adolescents and parents were satisfied with the services received from the CAMHS. The correlations between adolescent and parent consumer satisfaction ratings were low to moderate. Consumer satisfaction was significantly and negatively correlated with symptom load on the CBCL Total Problems scores at baseline, but not at follow-up. There was no difference in satisfaction levels between those who improved after treatment and those who did not. Given the differences in informant ratings of consumer satisfaction, it is important to include both adolescent and parental perceptions in evaluations of CAMHS services and treatment outcomes. Consumer satisfaction should serve as a supplement to established standardized outcome measures.

Increased serum brain-derived neurotrophic factor (BDNF) is predictive of cocaine relapse outcomes: A prospective study

PubMed Central

D’Sa, Carrol; Fox, Helen C.; Hong, Adam K.; Dileone, Ralph J.; Sinha, Rajita

2011-01-01

Background Cocaine dependence is associated with high relapse rates but few biological markers associated with relapse outcomes have been identified. Extending preclinical research showing a role for central Brain Derived Neurotrophic Factor (BDNF) in cocaine seeking, we examined whether serum BDNF is altered in abstinent, early recovering, cocaine-dependent individuals and if it is predictive of subsequent relapse risk. Methods Serum samples were collected across three consecutive mornings from 35 treatment-engaged, 3 week abstinent cocaine-dependent inpatients (17M/18F) and 34 demographically matched hospitalized healthy control participants (17M/17F). Cocaine dependent individuals were prospectively followed on days 14, 30 and 90 post-treatment discharge to assess cocaine relapse outcomes. Time to cocaine relapse, number of days of cocaine use (frequency), and amount of cocaine use (quantity) were the main outcome measures. Results High correlations in serum BDNF across days indicated reliable and stable serum BDNF measurements. Significantly higher mean serum BDNF levels were observed for the cocaine-dependent patients compared to healthy control participants (p<.001). Higher serum BDNF levels predicted shorter subsequent time to cocaine relapse (hazard ratio: HR: 1.09, p<.05), greater number of days (p<.05) and higher total amounts of cocaine used (p = .05). Conclusions High serum BDNF levels in recovering cocaine-dependent individuals are predictive of future cocaine relapse outcomes and may represent a clinically relevant marker of relapse risk. These data suggest that serum BDNF levels may provide an indication of relapse risk during early recovery from cocaine dependence. PMID:21741029

Psychological and behavioural reactions to the bombings in London on 7 July 2005: cross sectional survey of a representative sample of Londoners

PubMed Central

Rubin, G James; Brewin, Chris R; Greenberg, Neil; Simpson, John; Wessely, Simon

2005-01-01

Objectives To assess the impact of the bombings in London on 7 July on stress levels and travel intentions in London's population. Design A cross sectional telephone survey using random digit dialling was conducted to contact a representative sample of adults. Respondents were asked to participate in an interview enquiring about current levels of stress and travel intentions. Setting Interviews took place between 18 and 20 July. Participants 1010 participants (10% of the eligible people we contacted) completed the interviews. Main outcome measures Main outcomes were presence of substantial stress, measured by using an identical tool to that used to assess the emotional impact of 11 September 2001 in the US population, and intention to travel less on tubes, trains, and buses, or into central London, once the transport network had returned to normal. Results 31% of Londoners reported substantial stress and 32% reported an intention to travel less. Among other things, having difficulty contacting friends or family by mobile phone (odds ratio 1.7, 95% confidence interval 1.1 to 2.7), having thought you could have been injured or killed (3.8, 2.4 to 6.2), and being Muslim (4.0, 2.5 to 6.6) were associated with a greater presence of substantial stress, whereas being white (0.3, 0.2 to 0.4) and having previous experience of terrorism (0.6, 0.5 to 0.9) were associated with reduced stress. Only 12 participants (1%) felt that they needed professional help to deal with their emotional response to the attacks. Conclusions Although the psychological needs of those intimately caught up in the attacks will require further assessment, we found no evidence of a widespread desire for professional counselling. The attacks have inflicted disproportionately high levels of distress among non-white and Muslim Londoners. PMID:16126821

Fit-for-purpose: species distribution model performance depends on evaluation criteria - Dutch Hoverflies as a case study.

PubMed

Aguirre-Gutiérrez, Jesús; Carvalheiro, Luísa G; Polce, Chiara; van Loon, E Emiel; Raes, Niels; Reemer, Menno; Biesmeijer, Jacobus C

2013-01-01

Understanding species distributions and the factors limiting them is an important topic in ecology and conservation, including in nature reserve selection and predicting climate change impacts. While Species Distribution Models (SDM) are the main tool used for these purposes, choosing the best SDM algorithm is not straightforward as these are plentiful and can be applied in many different ways. SDM are used mainly to gain insight in 1) overall species distributions, 2) their past-present-future probability of occurrence and/or 3) to understand their ecological niche limits (also referred to as ecological niche modelling). The fact that these three aims may require different models and outputs is, however, rarely considered and has not been evaluated consistently. Here we use data from a systematically sampled set of species occurrences to specifically test the performance of Species Distribution Models across several commonly used algorithms. Species range in distribution patterns from rare to common and from local to widespread. We compare overall model fit (representing species distribution), the accuracy of the predictions at multiple spatial scales, and the consistency in selection of environmental correlations all across multiple modelling runs. As expected, the choice of modelling algorithm determines model outcome. However, model quality depends not only on the algorithm, but also on the measure of model fit used and the scale at which it is used. Although model fit was higher for the consensus approach and Maxent, Maxent and GAM models were more consistent in estimating local occurrence, while RF and GBM showed higher consistency in environmental variables selection. Model outcomes diverged more for narrowly distributed species than for widespread species. We suggest that matching study aims with modelling approach is essential in Species Distribution Models, and provide suggestions how to do this for different modelling aims and species' data characteristics (i.e. sample size, spatial distribution).

Outcome of cataract surgery at one year in Kenya, the Philippines and Bangladesh.

PubMed

Lindfield, R; Kuper, H; Polack, S; Eusebio, C; Mathenge, W; Wadud, Z; Rashid, A M; Foster, A

2009-07-01

To assess the change in vision following cataract surgery in Kenya, Bangladesh and the Philippines and to identify causes and predictors of poor outcome. Cases were identified through surveys, outreach and clinics. They underwent preoperative visual acuity measurement and ophthalmic examination. Cases were re-examined 8-15 months after cataract surgery. Information on age, gender, poverty and literacy was collected at baseline. 452 eyes of 346 people underwent surgery. 124 (27%) eyes had an adverse outcome. In Kenya and the Philippines, the main cause of adverse outcome was refractive error (37% and 49% respectively of all adverse outcomes) then comorbid ocular disease (26% and 27%). In Bangladesh, this was comorbid disease (58%) then surgical complications (21%). There was no significant association between adverse outcome and gender, age, literacy, poverty or preoperative visual acuity. Adverse outcomes following cataract surgery were frequent in the three countries. Main causes were refractive error and preoperative comorbidities. Many patients are not attaining the outcomes available with modern surgery. Focus should be on correcting refractive error, through operative techniques or postoperative refraction, and on a system for assessing comorbidities and communicating risk to patients. These are only achievable with a commitment to ongoing surgical audit.

An in silico approach helped to identify the best experimental design, population, and outcome for future randomized clinical trials.

PubMed

Bajard, Agathe; Chabaud, Sylvie; Cornu, Catherine; Castellan, Anne-Charlotte; Malik, Salma; Kurbatova, Polina; Volpert, Vitaly; Eymard, Nathalie; Kassai, Behrouz; Nony, Patrice

2016-01-01

The main objective of our work was to compare different randomized clinical trial (RCT) experimental designs in terms of power, accuracy of the estimation of treatment effect, and number of patients receiving active treatment using in silico simulations. A virtual population of patients was simulated and randomized in potential clinical trials. Treatment effect was modeled using a dose-effect relation for quantitative or qualitative outcomes. Different experimental designs were considered, and performances between designs were compared. One thousand clinical trials were simulated for each design based on an example of modeled disease. According to simulation results, the number of patients needed to reach 80% power was 50 for crossover, 60 for parallel or randomized withdrawal, 65 for drop the loser (DL), and 70 for early escape or play the winner (PW). For a given sample size, each design had its own advantage: low duration (parallel, early escape), high statistical power and precision (crossover), and higher number of patients receiving the active treatment (PW and DL). Our approach can help to identify the best experimental design, population, and outcome for future RCTs. This may be particularly useful for drug development in rare diseases, theragnostic approaches, or personalized medicine. Copyright © 2016 Elsevier Inc. All rights reserved.

Academic and social integration on campus among sexual minority students: the impacts of psychological and experiential campus climate.

PubMed

Woodford, Michael R; Kulick, Alex

2015-03-01

A heterosexist campus climate can increase risk for mental health problems for sexual minority students; however, the relationship between campus climate for sexual minorities and academic outcomes remains understudied. Using a sample of sexual minority respondents extracted from a campus climate survey conducted at a large university in the Midwest, we examine relationships between multiple dimensions of psychological and experiential campus climate for sexual minorities with academic integration (academic disengagement, grade-point average [GPA]) and social integration (institutional satisfaction, acceptance on campus). We also investigate the protective role of engagement with informal academic and peer-group systems. Findings suggest campus climate affects sexual minority students' integration. In multivariate analyses, perceptions of whether lesbian, gay, and bisexual (LGB) people could be open about their sexual identity was positively associated with acceptance on campus; personal heterosexist harassment was positively associated with academic disengagement and negatively with GPA. Students' informal academic integration (instructor relations) and informal social integration (LGB friends) demonstrated influential main effects but did not moderate any of the climate-outcome relationships. Researchers should further explore the relationships between climate and academic outcomes among sexual minority students, both collectively and among specific sub-groups, and address the role of other protective factors.

Pathways maintaining physical health problems from childhood to young adulthood: The role of stress and mood

PubMed Central

Hammen, Constance L.; Brennan, Patricia A; Najman, Jake M.

2016-01-01

Objective Poor physical health in childhood is associated with a variety of negative health-related outcomes in adulthood. Psychosocial pathways contributing to the maintenance of physical health problems from childhood to young adulthood remain largely unexamined, despite evidence that factors such as negative mood and stress impact physical health. Design The current study tested the direct and indirect effects of ongoing health, chronic stress, health-related chronic stress, and depressive symptoms at age 20 on the link between health problems in childhood and young adulthood (age 21) in a longitudinal sample (n = 384). Main Outcome Measures The hypotheses were tested using a multiple mediation path analysis framework; the primary outcome measure was a composite index of health status markers in young adulthood. Results The proposed model provided an adequate fit for the data, with significant total indirect effects of the four mediators and significant specific indirect effects of health-related chronic stress and depressive symptoms in maintaining health problems from childhood into young adulthood. Conclusions Health problems are maintained from early childhood into young adulthood in part through psychosocial mechanisms. Depressive symptoms and health-related chronic stress have significant, unique effects on the relationship between health problems in early childhood and young adulthood. PMID:27329508

Can individual health differences be explained by workplace characteristics?--A multilevel analysis.

PubMed

Marklund, Staffan; Bolin, Malin; von Essen, Jan

2008-02-01

Research on work-related health has mainly focused on individual factors. The present study expands the focus by exploring the role of organizational characteristics of workplaces for different individual health outcomes. The aim of the study was to look at differences in relative effect of workplace variations on five health outcomes, and to explain those differences in health outcomes by organizational characteristics. The sample encompassed 90 workplaces in Sweden and about 4300 individuals employed within these workplaces. Measurement of the workplace characteristics was carried out independently of the measurement of the individual's working conditions and health. Organizational data were collected by interviews with local managers at participating workplaces, and individual data were obtained by means of a survey of the employees. The results showed that a significant proportion of the variance in sickness absence, work ability, general health, and musculoskeletal disorders was attributed to the workplace. Of eight tested organizational characteristics, customer adaptation, lean production, and performance control could explain some of this workplace variance. The results also showed that only one organizational effect remained significant when controlled for the individual confounder of age and gender. High customer adaptation is associated with higher sickness absence. This association is not mediated via differences in mental and physical job strain.

Life Span Studies of ADHD-Conceptual Challenges and Predictors of Persistence and Outcome.

PubMed

Caye, Arthur; Swanson, James; Thapar, Anita; Sibley, Margaret; Arseneault, Louise; Hechtman, Lily; Arnold, L Eugene; Niclasen, Janni; Moffitt, Terrie; Rohde, Luis Augusto

2016-12-01

There is a renewed interest in better conceptualizing trajectories of attention-deficit/hyperactivity disorder (ADHD) from childhood to adulthood, driven by an increased recognition of long-term impairment and potential persistence beyond childhood and adolescence. This review addresses the following major issues relevant to the course of ADHD in light of current evidence from longitudinal studies: (1) conceptual and methodological issues related to measurement of persistence of ADHD, (2) estimates of persistence rate from childhood to adulthood and its predictors, (3) long-term negative outcomes of childhood ADHD and their early predictors, and (4) the recently proposed new adult-onset ADHD. Estimates of persistence vary widely in the literature, and diagnostic criteria, sample characteristics, and information source are the most important factors explaining variability among studies. Evidence indicates that ADHD severity, comorbid conduct disorder and major depressive disorder, and treatment for ADHD are the main predictors of ADHD persistence from childhood to adulthood. Comorbid conduct disorder and ADHD severity in childhood are the most important predictors of adverse outcomes in adulthood among children with ADHD. Three recent population studies suggested the existence of a significant proportion of individuals who report onset of ADHD symptoms and impairments after childhood. Finally, we highlight areas for improvement to increase our understanding of ADHD across the life span.

Life Span Studies of ADHD—Conceptual Challenges and Predictors of Persistence and Outcome

PubMed Central

Caye, Arthur; Swanson, James; Thapar, Anita; Sibley, Margaret; Arseneault, Louise; Hechtman, Lily; Arnold, L. Eugene; Niclasen, Janni; Moffitt, Terrie

2018-01-01

There is a renewed interest in better conceptualizing trajectories of attention-deficit/hyperactivity disorder (ADHD) from childhood to adulthood, driven by an increased recognition of long-term impairment and potential persistence beyond childhood and adolescence. This review addresses the following major issues relevant to the course of ADHD in light of current evidence from longitudinal studies: (1) conceptual and methodological issues related to measurement of persistence of ADHD, (2) estimates of persistence rate from childhood to adulthood and its predictors, (3) long-term negative outcomes of childhood ADHD and their early predictors, and (4) the recently proposed new adult-onset ADHD. Estimates of persistence vary widely in the literature, and diagnostic criteria, sample characteristics, and information source are the most important factors explaining variability among studies. Evidence indicates that ADHD severity, comorbid conduct disorder and major depressive disorder, and treatment for ADHD are the main predictors of ADHD persistence from childhood to adulthood. Comorbid conduct disorder and ADHD severity in childhood are the most important predictors of adverse outcomes in adulthood among children with ADHD. Three recent population studies suggested the existence of a significant proportion of individuals who report onset of ADHD symptoms and impairments after childhood. Finally, we highlight areas for improvement to increase our understanding of ADHD across the life span. PMID:27783340

Stress and Coping with Racism and Their Role on Sexual Risk for HIV among African American, Asian/Pacific Islander, and Latino Men Who Have Sex With Men

PubMed Central

Han, Chong-suk; Ayala, George; Paul, Jay; Boylan, Ross; Gregorich, Steven E.; Choi, Kyung-Hee

2014-01-01

The deleterious effects of racism on a wide range of health outcomes, including HIV risk, is well documented among racial/ethnic minority groups in the United States. However, little is known about how men of color who have sex with men (MSM) cope with stress from racism and whether the coping strategies they employ buffer against the impact of racism on sexual risk for HIV transmission. We examined associations of stress and coping with racism with unprotected anal intercourse (UAI) in a sample of African American (n = 403), Asian/Pacific Islander (n = 393), and Latino (n = 400) MSM recruited in Los Angeles County, CA during 2008–2009. Almost two-thirds (65%) of the sample reported being stressed as a consequence of racism experienced within the gay community. Overall, 51% of the sample reported having UAI in the prior six months. After controlling for race/ethnicity, age, nativity, marital status, sexual orientation, education, HIV serostatus, and lifetime history of incarceration, the multivariate analysis found statistically significant main effects of stress from racism and avoidance coping on UAI; no statistically significant main effects of dismissal, education/confrontation, and social-support seeking were observed. None of the interactions of stress with the four coping measures were statistically significant. Although stress from racism within the gay community increased the likelihood of engaging in UAI among MSM of color, we found little evidence that coping responses to racism buffered stress from racism. Instead, avoidance coping appears to suggest an increase in UAI. PMID:25060122

Using full-cohort data in nested case-control and case-cohort studies by multiple imputation.

PubMed

Keogh, Ruth H; White, Ian R

2013-10-15

In many large prospective cohorts, expensive exposure measurements cannot be obtained for all individuals. Exposure-disease association studies are therefore often based on nested case-control or case-cohort studies in which complete information is obtained only for sampled individuals. However, in the full cohort, there may be a large amount of information on cheaply available covariates and possibly a surrogate of the main exposure(s), which typically goes unused. We view the nested case-control or case-cohort study plus the remainder of the cohort as a full-cohort study with missing data. Hence, we propose using multiple imputation (MI) to utilise information in the full cohort when data from the sub-studies are analysed. We use the fully observed data to fit the imputation models. We consider using approximate imputation models and also using rejection sampling to draw imputed values from the true distribution of the missing values given the observed data. Simulation studies show that using MI to utilise full-cohort information in the analysis of nested case-control and case-cohort studies can result in important gains in efficiency, particularly when a surrogate of the main exposure is available in the full cohort. In simulations, this method outperforms counter-matching in nested case-control studies and a weighted analysis for case-cohort studies, both of which use some full-cohort information. Approximate imputation models perform well except when there are interactions or non-linear terms in the outcome model, where imputation using rejection sampling works well. Copyright © 2013 John Wiley & Sons, Ltd.

Theory and practice of corrosion related to ashes and deposits in a WtE boiler.

PubMed

Verbinnen, Bram; De Greef, Johan; Van Caneghem, Jo

2018-03-01

Corrosion of heat-exchanging components is one of the main operational problems in Waste-to-Energy plants, limiting the electrical efficiency that can be reached. Corrosion is mainly related to the devolatilization and/or formation of chlorides, sulphates and mixtures thereof on the heat-exchanging surfaces. Theoretical considerations on this corrosion were already put forward in literature, but this paper now for the first time combines theory with a large scale sampling campaign of several Waste-to-Energy plants. Based on the outcome of elemental and mineralogical analysis, the distribution of Cl and S in ashes sampled throughout the plant during normal operation is explained. Cl concentrations are high (15-20%) in the first empty pass, decrease in the second and third empty pass, but increase again in the convective part, whereas the S concentrations show an inverse behavior, with the highest concentrations (30%) observed in the second and third empty pass. Sampling of deposits on specific places where corrosion possibly occurred, gives a better insight in the mechanisms related to corrosion phenomena in real-scale WtE plants and provides practical evidence for some phenomena that were only assumed on the basis of theory or lab scale experiments before. More specific, it confirms the role of oxygen content, temperatures in the different stages of the boiler, the presence of polysulphates, Pb and Zb, and the concentrations of HCl and SO 2 in the flue gas for different types of boiler corrosion. Copyright © 2017 Elsevier Ltd. All rights reserved.

Factors Influencing Consumption of Fruits and Vegetables in Older Adults in New Orleans, Louisiana.

PubMed

Clum, G; Gustat, J; O'Malley, K; Begalieva, M; Luckett, B; Rice, J; Johnson, C

2016-01-01

The objective of this study was to identify demographic, social and structural factors associated with intake of fruit and vegetables in older adults in New Orleans, Louisiana. A cross-sectional randomly sampled, address-based telephone survey of households in Orleans Parish, Louisiana was conducted with the household's main grocery shopper. All participants were in the New Orleans metro area and were surveyed in 2011. Participants were 2,834 residents identified as the households' main grocery shopper in Orleans Parish, Louisiana. Participants were primarily female (75%), African-American (53%), approximately 10 percent of the sample reported receipt of government assistance. Approximately 37% of the sample was age 65 and older. Measures included a telephone administered survey assessing demographic characteristics, food intake, access to supermarkets and other food sources, transportation, self-reported health, and frequency of grocery shopping. Older adults consumed fewer fresh fruits and vegetables (FV) than younger adults (p<0.01). Bivariate associations with decreased FV included older age, receipt of government assistance, African American race, use of mobility aid, and poorer health. Multivariate factors associated with lower consumption include age, African American race, and poorer self-reported health. Women reported more fruit and vegetable consumption than men. FV consumption is associated with improved health and reduced mortality. Older adults are less likely to consume fruits and vegetables, therefore addressing reduced FV consumption in older adults is a potential target for improving health outcomes in older adults. Specifically targeting African Americans and those with poorer health, as well as males may be an important focus for interventions.

Recent and Past Intimate Partner Abuse and HIV Risk Among Young Women

PubMed Central

Teitelman, Anne M.; Ratcliffe, Sarah J.; Dichter, Melissa E.; Sullivan, Cris M.

2011-01-01

Objective To examine the associations between past intimate partner abuse experienced during adolescence (verbal and physical), recent intimate partner abuse (verbal, physical, and sexual), and HIV risk (as indicated by lack of condom use) for sexually active young adult women in relationships with male partners. Design Secondary data analysis of waves II and III of the National Longitudinal Study of Adolescent Health (Add Health). Setting The Add Health Study is a longitudinal, in-home survey of a nationally representative sample of adolescents. Sample Analyses involved 2,058 sexually active young adult women. Main Outcome Measures HIV risk was measured by consistent condom use over the past 12 months. Results Physical and verbal abuse experienced in adolescence were associated with physical/verbal abuse experienced in young adulthood. Young, sexually active women experiencing no abuse in their relationships were more likely to consistently use condoms in the past 12 months than were their abused counterparts. Conclusion A causal pathway may exist between prior abuse, current abuse, and HIV risk. PMID:18336447

The Use of Infrared Thermography for Porosity Assessment of Intact Rock

NASA Astrophysics Data System (ADS)

Mineo, S.; Pappalardo, G.

2016-08-01

Preliminary results on a new test for the indirect assessment of porosity through infrared thermography are presented. The study of the cooling behavior of rock samples in laboratory, through the analysis of thermograms, proved an innovative tool for the estimation of such an important property, which is one of the main features affecting the mechanical behavior of rocks. A detailed experimentation was performed on artificially heated volcanic rock samples characterized by different porosity values. The cooling trend was described both graphically and numerically, with the help of cooling curves and Cooling Rate Index. The latter, which proved strictly linked to porosity, was employed to find reliable equations for its indirect estimation. Simple and multiple regression analyses returned satisfactory outcomes, highlighting the great match between predicted and measured porosity values, thus confirming the goodness of the proposed model. This study brings a novelty in rock mechanics, laying the foundation for future researches aimed at refining achieved results for the validation of the model in a larger scale.

Discrimination and Depression among Urban Hispanics with Poorly Controlled Diabetes

PubMed Central

March, Dana; Williams, Jasmine; Wells, Shayla; Eimicke, Joseph P.; Teresi, Jeanne A.; Almonte, Casandra; Link, Bruce G.; Findley, Sally E.; Palmas, Walter; Carrasquillo, Olveen; Luchsinger, José A.

2017-01-01

Objectives We had three objectives for our study: 1) to describe the prevalence and burden of experiences of discrimination among Hispanics with poorly controlled diabetes; 2) to evaluate associations among discrimination experiences and their burden with comorbid depression among Hispanics with poorly controlled diabetes; and 3) to evaluate whether discrimination encountered in the health care context itself was associated with comorbid depression for Hispanic adults with diabetes. Design We conducted a cross-sectional analysis of baseline data of a randomized controlled trial (RCT). Setting We collected data in the context of an RCT in a clinical setting in New York City. Participants Our sample comprised 221 urban-dwelling Hispanics, largely of Caribbean origin. Main Outcome Measures The main outcome measure was major depression, measured by the Euro-D (score>3). Results Of 221 participants, 58.8% reported at least one experience of everyday discrimination, and 42.5% reported at least one major experience of discrimination. Depression was associated significantly with counts of experiences of major discrimination (OR=1.46, 95% CI=1.09-1.94, P=.01), aggregate counts of everyday and major discrimination (OR=1.13, 95%CI=1.02-1.26, P=.02),andtheexperienceofdiscrimination in getting care for physical health (OR=6.30, 95%CI=1.10-36.03). Conclusions Discrimination may pose a barrier to getting health care and may be associated with depression among Hispanics with diabetes. Clinicians treating Caribbean-born Hispanics should be aware that disadvantage and discrimination likely complicate a presentation of diabetes. PMID:26118138

Analysis of the Development of Available Soil Water Storage in the Nitra River Catchment

NASA Astrophysics Data System (ADS)

Tárník, Andrej; Leitmanová, Mária

2017-10-01

World is changing dramatically. Every sphere of our life is influenced by global climate changes, including agriculture sector. Rising air temperature and temporal variability of rainfall are crucial outcomes of climate changes for agricultural activities. Main impact of these outcomes on agriculture is the change of soil water amount. Soil water is an exclusive resource of water for plants. Changes of soil water storage are sensed very sensitively by farmers. Development of soil water storage was analysed in this paper. The Nitra River catchment is covered by nets of hydrological and meteorological stations of Department of Biometeorology and Hydrology, Slovak University of Agriculture in Nitra. Quantity of available soil water storage for plants was calculated every month in the years from 2013 to 2016. Calculations were done based on real measurements for soil horizon 0-30 cm. Ratio between a real available soil water storage and a potential available soil water storage was specified. Amount of potential available soil water storage was derived by retention curves of soil samples. Map of risk areas was created in GIS in pursuance of these calculations. We can see the negative trends of available soil water storage in years 2015 and 2016. Main addition of this paper is a selection of areas where soil moisture is a limiting factor of agriculture. In these areas, it is necessary to do the mitigation measures for sustainable development of agricultural activities.

Comparación de costos y resultados sanitarios de usuarios con neumonia adquirida en comunidad atendidos en domicilio o en hospitalización tradicional: estudio exploratorio de 40 casos.

PubMed

Macaya, Mario Carvajal; Ridulfo, Alberto Hernández; Ramírez-Santana, Muriel

2015-12-01

Economic evaluations of health technologies and health interventions are considered in many countries as the fourth barrier for adopting new services or drugs; followed by safety, efficacy and quality. The validity and reliability of the results will depend on the perspective of the study, timeframe of the analysis, discount rate, the model used and the costs involved. This study aims to assess the cost effectiveness of home care treatment in users with diagnosis of uncomplicated community acquired pneumonia compared with traditional hospitalization at inpatient wards. The hypothesis is that home based care would be more cost effective compared to traditional hospitalization. The study perspective was from the health provider. Microcosting was used to determine the costs of both treatment modalities in a sample of 20 users treated with each modality during 2013 at main Hospitals of Coquimbo Region, Chile. The main outcome of effectiveness was the number of inpatient care days saved. Additionally, number of infections associated to health care (IAHC) and type of discharge were measured. The study concludes that there is a better cost effectiveness relationship for the home care modality, with fewer days of treatment, at lower costs and without risk of IAHC. However, further studies are needed in order to achieve accurate results. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Vaginal cytokines do not correlate with postmenopausal vulvovaginal symptoms.

PubMed

Kollmann, Zahraa; Bersinger, Nick; von Wolff, Michael; Thurman, Andrea R; Archer, David F; Stute, Petra

2015-04-01

Exploratory pilot study to determine the correlation between postmenopausal vulvovaginal symptoms and vaginal cytokine levels. Postmenopausal women (n = 34) not using menopausal hormone therapy and presenting with or without symptoms of vulvovaginal irritation were screened. Each participant underwent a vaginal examination and screening for vaginitis. A cervicovaginal lavage (CVL) with sterile saline and a peripheral blood sample were obtained. Main outcome measures were assessed by Luminex® X-map method on the Bio-Plex® platform. Main outcome measures were cervicovaginal and serum interleukin (IL)-4, IL-5, IL-10, IL-12, IL-13, TNF-α, GM-CSF, MIP-1-alpha and RANTES level. Cervicovaginal cytokines were adjusted to total protein concentration [pg/mcg protein]. Twenty-six postmenopausal women were enrolled (symptomatic: n = 15; asymptomatic: n = 11). There were no significant differences between groups: age, age at menopause, vaginal pH and all CVL and serum cytokines (IL-4, IL-5, IL-10, IL-12, IL-13, TNF-α, GM-CSF, MIP-1-alpha and RANTES). GM-CSF was the most abundant vaginal cytokine (symptomatic: 146.5 ± 165.6 pg/mcg protein; asymptomatic: 146.0 ± 173.5 pg/mcg protein; p = 0.99). Postmenopausal vulvovaginal symptoms did not correlate with vaginal inflammatory marker. There was no difference in serum or CVL cytokines between symptomatic and asymptomatic postmenopasual women. Vaginal symptoms after menopause are not related to the vaginal cytokine changes associated with loss of estrogen.

The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial

PubMed Central

Rocco, Michael V.; Lockridge, Robert S.; Beck, Gerald J.; Eggers, Paul W.; Gassman, Jennifer J.; Greene, Tom; Larive, Brett; Chan, Christopher T.; Chertow, Glenn M.; Copland, Michael; Hoy, Christopher D.; Lindsay, Robert M.; Levin, Nathan W.; Ornt, Daniel B.; Pierratos, Andreas; Pipkin, Mary F.; Rajagopalan, Sanjay; Stokes, John B.; Unruh, Mark L.; Star, Robert A.; Kliger, Alan S.

2013-01-01

Prior small studies have shown multiple benefits of frequent nocturnal hemodialysis compared to conventional three times per week treatments. To study this further, we randomized 87 patients to three times per week conventional hemodialysis or to nocturnal hemodialysis six times per week, all with single-use high-flux dialyzers. The 45 patients in the frequent nocturnal arm had a 1.82-fold higher mean weekly stdKt/Vurea, a 1.74-fold higher average number of treatments per week, and a 2.45-fold higher average weekly treatment time than the 42 patients in the conventional arm. We did not find a significant effect of nocturnal hemodialysis for either of the two coprimary outcomes (death or left ventricular mass (measured by MRI) with a hazard ratio of 0.68, or of death or RAND Physical Health Composite with a hazard ratio of 0.91). Possible explanations for the left ventricular mass result include limited sample size and patient characteristics. Secondary outcomes included cognitive performance, self-reported depression, laboratory markers of nutrition, mineral metabolism and anemia, blood pressure and rates of hospitalization, and vascular access interventions. Patients in the nocturnal arm had improved control of hyperphosphatemia and hypertension, but no significant benefit among the other main secondary outcomes. There was a trend for increased vascular access events in the nocturnal arm. Thus, we were unable to demonstrate a definitive benefit of more frequent nocturnal hemodialysis for either coprimary outcome. PMID:21775973

Roles, responsibilities and characteristics of lay community health workers involved in diabetes prevention programmes: A systematic review

PubMed Central

Oldenburg, Brian

2017-01-01

Aim To examine the characteristics of community health workers (CHWs) involved in diabetes prevention programmes (DPPs) and their contributions to expected outcomes. Methods Electronic databases including PubMed-MEDLINE, EBSCOHost, and SCOPUS/EMBASE were searched for studies published between January 2000 and March 2016. All studies that used CHWs to implement DPP in ≥18-year-old participants without diabetes but at high risk for developing the condition, irrespective of the study design, setting or outcomes measured, were included. Results were synthesized narratively. Results Forty papers of 30 studies were identified. Studies were mainly community-based and conducted in minority populations in USA. Sample sizes ranged from 20 participants in a single community to 2369 participants in 46 communities. Although CHWs were generally from the local community, their qualifications, work experience and training received differed across studies. Overall the training was culturally sensitive and/or appropriate, covering topics such as the importance of good nutrition and the benefits of increased physical activity, communication and leadership. CHWs delivered a variety of interventions and also screened or recruited participants. The shared culture and language between CHWs and participants likely contributed to better programme implementation and successful outcomes. Conclusions The complexity of DPPs and the diverse CHW roles preclude attributing specific outcomes to CHW involvement. Nevertheless, documenting potential CHW roles and the relevant training required may optimise CHW contributions and facilitate their involvement in DPPs in the future. PMID:29216263

Do race, neglect, and childhood poverty predict physical health in adulthood? A multilevel prospective analysis.

PubMed

Nikulina, Valentina; Widom, Cathy Spatz

2014-03-01

Childhood neglect and poverty often co-occur and both have been linked to poor physical health outcomes. In addition, Blacks have higher rates of childhood poverty and tend to have worse health than Whites. This paper examines the unique and interacting effects of childhood neglect, race, and family and neighborhood poverty on adult physical health outcomes. This prospective cohort design study uses a sample (N=675) of court-substantiated cases of childhood neglect and matched controls followed into adulthood (M(age)=41). Health indicators (C-Reactive Protein [CRP], hypertension, and pulmonary functioning) were assessed through blood collection and measurements by a registered nurse. Data were analyzed using hierarchical linear models to control for clustering of participants in childhood neighborhoods. Main effects showed that growing up Black predicted CRP and hypertension elevations, despite controlling for neglect and childhood family and neighborhood poverty and their interactions. Multivariate results showed that race and childhood adversities interacted to predict adult health outcomes. Childhood family poverty predicted increased risk for hypertension for Blacks, not Whites. In contrast, among Whites, childhood neglect predicted elevated CRP. Childhood neighborhood poverty interacted with childhood family poverty to predict pulmonary functioning in adulthood. Gender differences in health indicators were also observed. The effects of childhood neglect, childhood poverty, and growing up Black in the United States are manifest in physical health outcomes assessed 30 years later. Implications are discussed. Copyright © 2013 Elsevier Ltd. All rights reserved.

Roles, responsibilities and characteristics of lay community health workers involved in diabetes prevention programmes: A systematic review.

PubMed

Hill, Jillian; Peer, Nasheeta; Oldenburg, Brian; Kengne, Andre Pascale

2017-01-01

To examine the characteristics of community health workers (CHWs) involved in diabetes prevention programmes (DPPs) and their contributions to expected outcomes. Electronic databases including PubMed-MEDLINE, EBSCOHost, and SCOPUS/EMBASE were searched for studies published between January 2000 and March 2016. All studies that used CHWs to implement DPP in ≥18-year-old participants without diabetes but at high risk for developing the condition, irrespective of the study design, setting or outcomes measured, were included. Results were synthesized narratively. Forty papers of 30 studies were identified. Studies were mainly community-based and conducted in minority populations in USA. Sample sizes ranged from 20 participants in a single community to 2369 participants in 46 communities. Although CHWs were generally from the local community, their qualifications, work experience and training received differed across studies. Overall the training was culturally sensitive and/or appropriate, covering topics such as the importance of good nutrition and the benefits of increased physical activity, communication and leadership. CHWs delivered a variety of interventions and also screened or recruited participants. The shared culture and language between CHWs and participants likely contributed to better programme implementation and successful outcomes. The complexity of DPPs and the diverse CHW roles preclude attributing specific outcomes to CHW involvement. Nevertheless, documenting potential CHW roles and the relevant training required may optimise CHW contributions and facilitate their involvement in DPPs in the future.

What have we learned in minimally invasive colorectal surgery from NSQIP and NIS large databases? A systematic review.

PubMed

Batista Rodríguez, Gabriela; Balla, Andrea; Corradetti, Santiago; Martinez, Carmen; Hernández, Pilar; Bollo, Jesús; Targarona, Eduard M

2018-06-01

"Big data" refers to large amount of dataset. Those large databases are useful in many areas, including healthcare. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and the National Inpatient Sample (NIS) are big databases that were developed in the USA in order to record surgical outcomes. The aim of the present systematic review is to evaluate the type and clinical impact of the information retrieved through NISQP and NIS big database articles focused on laparoscopic colorectal surgery. A systematic review was conducted using The Meta-Analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. The research was carried out on PubMed database and revealed 350 published papers. Outcomes of articles in which laparoscopic colorectal surgery was the primary aim were analyzed. Fifty-five studies, published between 2007 and February 2017, were included. Articles included were categorized in groups according to the main topic as: outcomes related to surgical technique comparisons, morbidity and perioperatory results, specific disease-related outcomes, sociodemographic disparities, and academic training impact. NSQIP and NIS databases are just the tip of the iceberg for the potential application of Big Data technology and analysis in MIS. Information obtained through big data is useful and could be considered as external validation in those situations where a significant evidence-based medicine exists; also, those databases establish benchmarks to measure the quality of patient care. Data retrieved helps to inform decision-making and improve healthcare delivery.

Differential effects of parenting in preterm and full-term children on developmental outcomes.

PubMed

Maupin, Angela N; Fine, Jodene Goldenring

2014-12-01

To examine the relations between preterm birth, parenting behavior during early childhood, cognitive development, and social-emotional outcomes at Kindergarten entry, and to determine whether parenting behavior differentially influences this developing system in children born preterm compared to children born full-term. The nationally representative sample comprised 3600 full-term and 1300 preterm children born in the US in the year 2001. All children who entered Kindergarten and who participated in data collection at 9 months, 24 months, and Kindergarten entry were included in the study. Measures of parenting behavior were collected at 9 and 24 months and cognitive development at 24 months via home visits. Social-emotional outcomes were assessed at Kindergarten entry via parent and teacher report. Multiple-sample Structural Equation Modeling was used to analyze group differences in a model whereby early childhood parenting behavior predicted cognitive outcomes, and social-emotional outcomes at Kindergarten entry, and indirectly predicted social-emotional outcomes via early cognitive processes. The full sample developmental model indicated excellent fit to the data. Preterm birth status indirectly influenced social-emotional outcomes at Kindergarten entry via its effect on early childhood parenting behavior and cognitive development. The multi-sample model revealed significant differences in the way in which early parenting behavior exerted its influence on outcomes at Kindergarten entry in preterm children compared to full-term children. For preterm children, parenting indirectly influenced social-emotional outcomes via early cognitive functioning. Findings highlight the importance of early identification and targeted parenting programs to support early cognitive development in preterm children. Copyright © 2014 Elsevier Ltd. All rights reserved.

Who Is at Greatest Risk of Adverse Long-Term Outcomes? The Finnish from a Boy to a Man Study

ERIC Educational Resources Information Center

Sourander, Andre; Jensen, Peter; Davies, Mark; Niemela, Solja; Elonheimo, Henrik; Ristkari, Terja; Helenius, Hans; Sillanmaki, Lauri; Piha, Jorma; Kumpulainen, Kirsti; Tamminen, Tuula; Moilanen, Irma; Almqvist, Fredrik

2007-01-01

Objective: To study associations between comorbid psychopathology and long-term outcomes in a large birth cohort sample from age 8 to early adulthood. Method: The sample included long-term outcome data on 2,556 Finnish boys born in 1981. The aim was to study the impact of early childhood psychopathology types (externalizing versus internalizing…

Phlebotomines (Diptera: Psychodidae) in a Hydroelectric System Affected Area from Northern Amazonian Brazil: Further Insights into the Effects of Environmental Changes on Vector Ecology

PubMed Central

Furtado, Nercy Virginia Rabelo; Galardo, Allan Kardec Ribeiro; Galardo, Clicia Denis; Firmino, Viviane Caetano

2016-01-01

During 2012–2015, an entomological survey was conducted as part of a phlebotomine (Diptera: Psychodidae) monitoring program in an area influenced by the Santo Antônio do Jari hydroelectric system (Amapá State, Brazil). The purpose was to study aspects of Amazon/Guianan American cutaneous leishmaniasis (ACL) vectors subjected to stresses by anthropogenic environmental changes. For sampling, CDC light traps were positioned 0.5, 1, and 20 m above ground at five capture locations along the Jari River Basin. Fluctuations in phlebotomine numbers were analyzed to determine any correlation with rainfall, dam waterlogging, and/or ACL cases, from May 2012 to March 2015. We captured 2,800 individuals, and among 45 species identified, Bichromomyia flaviscutellata, Nyssomyia umbratilis, and Psychodopygus squamiventris s.l. were determined to be the main putative vectors, based on current knowledge of the Amazon/Guianan ACL scenario. Rainfall, but not complete flooding, was relatively correlated with phlebotomine fluctuation, mainly observed for Ps. squamiventris s.l., as were ACL cases with Ny. umbratilis. Behavioral changes were observed in the unexpected high frequency of Bi. flaviscutellata among CDC captures and the noncanopy dominance of Ny. umbratilis, possibly attributable to environmental stress in the sampled ecotopes. Continuous entomological surveillance is necessary to monitor the outcomes of these findings. PMID:28042300

Meta-analysis of multiple outcomes: a multilevel approach.

PubMed

Van den Noortgate, Wim; López-López, José Antonio; Marín-Martínez, Fulgencio; Sánchez-Meca, Julio

2015-12-01

In meta-analysis, dependent effect sizes are very common. An example is where in one or more studies the effect of an intervention is evaluated on multiple outcome variables for the same sample of participants. In this paper, we evaluate a three-level meta-analytic model to account for this kind of dependence, extending the simulation results of Van den Noortgate, López-López, Marín-Martínez, and Sánchez-Meca Behavior Research Methods, 45, 576-594 (2013) by allowing for a variation in the number of effect sizes per study, in the between-study variance, in the correlations between pairs of outcomes, and in the sample size of the studies. At the same time, we explore the performance of the approach if the outcomes used in a study can be regarded as a random sample from a population of outcomes. We conclude that although this approach is relatively simple and does not require prior estimates of the sampling covariances between effect sizes, it gives appropriate mean effect size estimates, standard error estimates, and confidence interval coverage proportions in a variety of realistic situations.

Mapping of lead, magnesium and copper accumulation in plant tissues by laser-induced breakdown spectroscopy and laser-ablation inductively coupled plasma mass spectrometry

NASA Astrophysics Data System (ADS)

Kaiser, J.; Galiová, M.; Novotný, K.; Červenka, R.; Reale, L.; Novotný, J.; Liška, M.; Samek, O.; Kanický, V.; Hrdlička, A.; Stejskal, K.; Adam, V.; Kizek, R.

2009-01-01

Laser-Induced Breakdown Spectroscopy (LIBS) and Laser Ablation Inductively Coupled Plasma Mass Spectrometry (LA-ICP-MS) were utilized for mapping the accumulation of Pb, Mg and Cu with a resolution up to 200 μm in a up to cm × cm area of sunflower ( Helianthus annuus L.) leaves. The results obtained by LIBS and LA-ICP-MS are compared with the outcomes from Atomic Absorption Spectrometry (AAS) and Thin-Layer Chromatography (TLC). It is shown that laser-ablation based analytical methods can substitute or supplement these techniques mainly in the cases when a fast multi-elemental mapping of a large sample area is needed.

Understanding the Cycle

PubMed Central

Currie, Janet; Tekin, Erdal

2013-01-01

Child maltreatment is a major social problem. This paper focuses on measuring the relationship between child maltreatment and crime using data from the National Longitudinal Study of Adolescent Health (Add Health). We focus on crime because it is one of the most costly potential outcomes of maltreatment. Our work addresses two main limitations of the existing literature on child maltreatment. First, we use a large national sample, and investigate different types of maltreatment in a unified framework. Second, we pay careful attention to controlling for possible confounders using a variety of statistical methods that make differing assumptions. The results suggest that maltreatment greatly increases the probability of engaging in crime and that the probability increases with the experience of multiple forms of maltreatment. PMID:24204082

Sugars consumption in a low-income sample of British young people and adults.

PubMed

Ntouva, A; Tsakos, G; Watt, R G

2013-07-01

To report the consumption of non-milk extrinsic sugars (NMES) among a low-income UK sample, compare it with nationally representative estimates and examine the association between socioeconomic position and NMES consumption among low income adults.Design Secondary analysis of the Low Income Diet and Nutrition Survey (LIDNS) data. Two thousand, seven hundred and ninety-six adults and 415 young people from 2,477 households.Main outcome measures Mean NMES intakes (grams) and their percentage contribution to food energy, from dietary data collected via a 24-hour recall 'multiple pass' method. The low income sample consumed more NMES than the general population sample. The percentage of food energy from NMES exceeded the 11% target, especially among adolescents (17.2% in males, 16.3% in females). After adjusting for age, men who finished full-time education aged 16 years consumed significantly more sugar (p = 0.028), whereas those who finished aged 18 consumed significantly less sugar (p = 0.023) than the reference group (finished aged 15). No significant associations were found between NMES and socioeconomic variables in women. Compared to the general population, the nutritional disadvantage of the most deprived segments of society relates primarily to excessive NMES consumption. In men, higher educational level appears to play a protective role against high sugar intakes.

[Psychiatry of the life span?--relevance of age in psychiatric research].

PubMed

Sikorski, Claudia; Motzek, Tom

2010-11-01

The aim of this study was to determine to what extent studies published in two German journals took the age of their sample into consideration. All publications of the two journals were viewed. Only empirical research papers were included. It was then assessed whether they included information on age of the sample and, if that was the case, the studies were further categorized as only giving descriptive sample information, reporting age-specific results of dependent variables or using age as a predictor in regression analyses. Furthermore, the age range covered was assessed. 88 % of all studies included information on age. Of those, about half only provided descriptive information on the age of the study sample, while more than one third used the age variable as a predictor in multivariate models. Few studies reported age-specific outcomes. Main focus of research was on adult populations aged 18 to 65. Only few studies concentrated on children and adolescents. In light of demographic change and age specificity of psychological disorders, it will be necessary to further differentiate and report age-specific results of psychiatric research. A change in what is considered normative aging and developmental tasks for certain age groups calls for further research in those age groups. © Georg Thieme Verlag KG Stuttgart · New York.

The new ISO 6579-1: A real horizontal standard for detection of Salmonella, at last!

PubMed

Mooijman, Kirsten A

2018-05-01

Up to 2016, three international standard methods existed for the detection of Salmonella spp. in food, animal feed and samples from the primary production stage: ISO 6785:2001 for milk and milk products, ISO 6579:2002 for (other) food and animal feed and Annex D of ISO 6579:2007 for samples from the primary production stage. In 2009, an ISO/CEN working group started with the revision of ISO 6579:2002 with two main aims: combining the three aforementioned standards in one document and improving the information in ISO 6579:2002. Additionally it was decided to split ISO 6579 into three parts, where part 1 describes the detection, part 2 the enumeration by mini-MPN (published in 2012) and part 3 the serotyping of Salmonella (published in 2014). This paper describes the experiments and choices made for improving the part on detection of Salmonella (ISO 6579-1). The final voting stage on (draft) ISO 6579-1 was finished by the end of December 2016, with a positive outcome. Finally, a real horizontal standard became available for detection of Salmonella in food, animal feed, environmental samples in the area of food production and food handling and in samples from the primary production stage in 2017. Copyright © 2017 Elsevier Ltd. All rights reserved.

Key personality traits of sales managers.

PubMed

Lounsbury, John W; Foster, Nancy A; Levy, Jacob J; Gibson, Lucy W

2014-01-01

Sales managers are crucial for producing positive sales outcomes for companies. However, there has been a relative dearth of scholarly investigations into the personal attributes of sales managers. Such information could prove important in the recruitment, selection, training needs identification, career planning, counseling, and development of sales managers. Drawing on Holland's vocational theory, we sought to identify key personality traits that distinguish sales managers from other occupations and are related to their career satisfaction. The main sample was comprised of a total of 978 sales managers employed in a large number of companies across the United States (along with a comparison sample drawn from 79,512 individuals from other professional occupations). Participants completed an online version of Resource Associates' Personal Style Inventory as well a measure of career satisfaction. Our sample of 978 sales managers had higher levels of Assertiveness, Customer Service Orientation, Extraversion, Image Management, Optimism, and Visionary Style; and lower levels of Conscientiousness, Agreeableness, Intrinsic Motivation, Openness, and Tough-Mindedness than a sample of 79,512 individuals in a variety of other occupations. Nine of these traits were significantly correlated with sales managers' career satisfaction. Based on the results, a psychological profile of sales managers was presented as were implications for their recruitment, selection, training, development, and mentoring.

Sample size determinations for group-based randomized clinical trials with different levels of data hierarchy between experimental and control arms.

PubMed

Heo, Moonseong; Litwin, Alain H; Blackstock, Oni; Kim, Namhee; Arnsten, Julia H

2017-02-01

We derived sample size formulae for detecting main effects in group-based randomized clinical trials with different levels of data hierarchy between experimental and control arms. Such designs are necessary when experimental interventions need to be administered to groups of subjects whereas control conditions need to be administered to individual subjects. This type of trial, often referred to as a partially nested or partially clustered design, has been implemented for management of chronic diseases such as diabetes and is beginning to emerge more commonly in wider clinical settings. Depending on the research setting, the level of hierarchy of data structure for the experimental arm can be three or two, whereas that for the control arm is two or one. Such different levels of data hierarchy assume correlation structures of outcomes that are different between arms, regardless of whether research settings require two or three level data structure for the experimental arm. Therefore, the different correlations should be taken into account for statistical modeling and for sample size determinations. To this end, we considered mixed-effects linear models with different correlation structures between experimental and control arms to theoretically derive and empirically validate the sample size formulae with simulation studies.

Single-step solubilization of milk samples with N,N-dimethylformamide for inductively coupled plasma-mass spectrometry analysis and classification based on their elemental composition.

PubMed

Azcarate, Silvana M; Savio, Marianela; Smichowski, Patricia; Martinez, Luis D; Camiña, José M; Gil, Raúl A

2015-10-01

A single-step procedure for trace elements analysis of milk samples is presented. Solubilization with small amounts of dymethylformamide (DMF) was assayed prior to inductively coupled plasma mass spectrometry (ICPMS) detection with a high efficiency sample introduction system. All main instrumental conditions were optimized in order to readily introduce the samples without matrix elimination. In order to assess and mitigate matrix effects in the determination of As, Cd, Co, Cu, Eu, Ga, Gd, Ge, Mn, Mo, Nb, Nd, Ni, Pb, Pr, Rb, Sm, S, Sr, Ta, Tb, V, Zn, and Zr, matrix matching calibration with (103)Rh as internal standard (IS) was performed. The obtained limits of detection were between 0.68 (Tb) and 30 (Zn) μg L(-1). For accuracy verification, certified Skim milk powder reference material (BCR 063R) was employed. The developed method was applied to trace elements analysis of commercially available milks. Principal components analysis was used to correlate the content of trace metals with the kind of milk, obtaining a classification according to adults, baby or baby fortified milks. The outcomes highlight a simple and fast approach that could be trustworthy for routine analysis, quality control and traceability of milks. Copyright © 2015 Elsevier B.V. All rights reserved.

The Prenatal Environment in Twin Studies: A Review on Chorionicity.

PubMed

Marceau, Kristine; McMaster, Minni T B; Smith, Taylor F; Daams, Joost G; van Beijsterveldt, Catharina E M; Boomsma, Dorret I; Knopik, Valerie S

2016-05-01

A literature search was conducted to identify articles examining the association of chorionicity (e.g., whether twins share a single chorion and thus placenta or have separate chorions/placentas) and genetics, psychiatry/behavior, and neurological manifestations in humans twins and higher-order multiples. The main aim was to assess how frequently chorionicity has been examined in relation to heritability estimates, and to assess which phenotypes may be most sensitive to, or affected by, bias in heritability estimates because of chorionicity. Consistent with the theory that some chorionicity effects could lead to overestimation and others to underestimation of heritability, there were instances of each across the many phenotypes reviewed. However, firm conclusions should not be drawn since some of the outcomes were only examined in one or few studies and often sample sizes were small. While the evidence for bias due to chorionicity was mixed or null for many outcomes, results do, however, consistently suggest that heritability estimates are underestimated for measures of birth weight and early growth when chorionicity is not taken into account.

Role of religious involvement and spirituality in functioning among African Americans with cancer: testing a mediational model

PubMed Central

Holt, Cheryl L.; Wang, Min Qi; Caplan, Lee; Schulz, Emily; Blake, Victor; Southward, Vivian L.

2013-01-01

The present study tested a mediational model of the role of religious involvement, spirituality, and physical/emotional functioning in a sample of African American men and women with cancer. Several mediators were proposed based on theory and previous research, including sense of meaning, positive and negative affect, and positive and negative religious coping. One hundred patients were recruited through oncologist offices, key community leaders and community organizations, and interviewed by telephone. Participants completed an established measure of religious involvement, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-SP-12 version 4), the Positive and Negative Affect Schedule (PANAS), the Meaning in Life Scale, the Brief RCOPE, and the SF-12, which assesses physical and emotional functioning. Positive affect completely mediated the relationship between religious behaviors and emotional functioning. Though several other constructs showed relationships with study variables, evidence of mediation was not supported. Mediational models were not significant for the physical functioning outcome, nor were there significant main effects of religious involvement or spirituality for this outcome. Implications for cancer survivorship interventions are discussed. PMID:21222026

Work-family conflict and well-being in university employees.

PubMed

Winefield, Helen R; Boyd, Carolyn; Winefield, Anthony H

2014-01-01

This is one of the first reported studies to have reviewed the role of work-family conflict in university employees, both academic and nonacademic. The goal of this research was to examine the role of work-family conflict as a mediator of relationships between features of the work environment and worker well-being and organizational outcomes. A sample of 3,326 Australian university workers responded to an online survey. Work-family conflict added substantially to the explained variance in physical symptoms and psychological strain after taking account of job demands and control, and to a lesser extent to the variance in job performance. However, it had no extra impact on organizational commitment, which was most strongly predicted by job autonomy. Despite differing in workloads and work-family conflict, academic ("faculty") and nonacademic staff demonstrated similar predictors of worker and organizational outcomes. Results suggest two pathways through which management policies may be effective in improving worker well-being and productivity: improving job autonomy has mainly direct effects, while reducing job demands is mediated by consequent reductions in work-family conflict.

When managers and their teams disagree: a longitudinal look at the consequences of differences in perceptions of organizational support.

PubMed

Bashshur, Michael R; Hernández, Ana; González-Romá, Vicente

2011-05-01

The authors argue that over time the difference between team members' perception of the organizational support received by the team (or team climate for organizational support) and their manager's perception of the organizational support received by the team has an effect on important outcomes and emergent states, such as team performance and team positive and negative affect above and beyond the main effects of climate perceptions themselves. With a longitudinal sample of 179 teams at Time 1 and 154 teams at Time 2, the authors tested their predictions using a combined polynomial regression and response surface analyses approach. The results supported the authors' predictions. When team managers and team members' perceptions of organizational support were high and in agreement, outcomes were maximized. When team managers and team members disagreed, team negative affect increased and team performance and team positive affect decreased. The negative effects of disagreement were most amplified when managers perceived that the team received higher levels of support than did the team itself.

Physiotherapy in patients with facial nerve paresis: description of outcomes.

PubMed

Beurskens, Carien H G; Heymans, Peter G

2004-01-01

The purpose of this study was to describe changes and stabilities of long-term sequelae of facial paresis in outpatients receiving mime therapy, a form of physiotherapy. Archived data of 155 patients with peripheral facial nerve paresis were analyzed. Main outcome measures were (1) impairments: facial symmetry in rest and during movements and synkineses; (2) disabilities: eating, drinking, and speaking; and (3) quality of life. Symmetry at rest improved significantly; the average severity of the asymmetry in all movements decreased. The number of synkineses increased for 3 out of 8 movements; however, the group average severities decreased for 6 movements; substantially fewer patients reported disabilities in eating, drinking, and speaking; and quality of life improved significantly. During a period of approximately 3 months, significant changes in many aspects of facial functioning were observed, the relative position of patients remaining stable over time. Observed changes occurred while the patients participated in a program for facial rehabilitation (mime therapy), replicating the randomized controlled trial-proven benefits of mime therapy in a more varied sample of outpatients.

Organizational Climate, Services, and Outcomes in Child Welfare Systems

ERIC Educational Resources Information Center

Glisson, Charles; Green, Philip

2011-01-01

Objective: This study examines the association of organizational climate, casework services, and youth outcomes in child welfare systems. Building on preliminary findings linking organizational climate to youth outcomes over a 3-year follow-up period, the current study extends the follow-up period to 7 years and tests main, moderating and…

A Participative Approach to Evaluation of Graduates' Professional Outcomes

ERIC Educational Resources Information Center

Clerici, Renata; Castiglioni, Maria; Grion, Valentina; Zago, Giuseppe; Da Re, Lorenza

2014-01-01

This work discusses the professional outcomes of University of Padova graduates in academic year 2007/08. Its aim was to carry out an overall assessment of higher education professional outcomes, involving all the main actors of the learning process, students, teachers and tutors, in a perspective of participatory evaluation, to improve teaching…

Electrofishing effort requirements for estimating species richness in the Kootenai River, Idaho

USGS Publications Warehouse

Watkins, Carson J.; Quist, Michael C.; Shepard, Bradley B.; Ireland, Susan C.

2016-01-01

This study was conducted on the Kootenai River, Idaho to provide insight on sampling requirements to optimize future monitoring effort associated with the response of fish assemblages to habitat rehabilitation. Our objective was to define the electrofishing effort (m) needed to have a 95% probability of sampling 50, 75, and 100% of the observed species richness and to evaluate the relative influence of depth, velocity, and instream woody cover on sample size requirements. Sidechannel habitats required more sampling effort to achieve 75 and 100% of the total species richness than main-channel habitats. The sampling effort required to have a 95% probability of sampling 100% of the species richness was 1100 m for main-channel sites and 1400 m for side-channel sites. We hypothesized that the difference in sampling requirements between main- and side-channel habitats was largely due to differences in habitat characteristics and species richness between main- and side-channel habitats. In general, main-channel habitats had lower species richness than side-channel habitats. Habitat characteristics (i.e., depth, current velocity, and woody instream cover) were not related to sample size requirements. Our guidelines will improve sampling efficiency during monitoring effort in the Kootenai River and provide insight on sampling designs for other large western river systems where electrofishing is used to assess fish assemblages.

Premature death of adult adoptees: analyses of a case-cohort sample.

PubMed

Petersen, Liselotte; Andersen, Per Kragh; Sørensen, Thorkild I A

2005-05-01

Genetic and environmental influence on risk of premature death in adulthood was investigated by estimating the associations in total and cause-specific mortality of adult Danish adoptees and their biological and adoptive parents. Among all 14,425 non-familial adoptions formally granted in Denmark during the period 1924 through 1947, we selected the study population according to a case-cohort sampling design. As the case-control design, the case-cohort design has the advantage of economic data collection and little loss in statistical efficiency, but the case-cohort sample has the additional advantages that rate ratio estimates may be obtained, and re-use of the cohort sample in future studies of other outcomes is possible. Analyses were performed using Kalbfleisch and Lawless's estimator for hazard ratio, and robust estimation for variances. In the main analyses the sample was restricted to birth years of the adoptees 1924 and after, and age of transfer to the adoptive parents before 7 years, and age at death was restricted to 16 to 70 years. The results showed a higher mortality among adoptees, whose biological parents died in the age range of 16 to 70 years; this was significant for deaths from natural causes, vascular causes and all causes. No influence was seen from early death of adoptive parents, regardless of cause of death. (c) 2005 Wiley-Liss, Inc.

Adolescent Outcomes of Childhood Attention-Deficit/Hyperactivity Disorder in a Diverse Community Sample

ERIC Educational Resources Information Center

Bussing, Regina; Mason, Dana M.; Bell, Lindsay; Porter, Phillip; Garvan, Cynthia

2010-01-01

Objective: To describe adolescent outcomes of childhood attention-deficit/hyperactivity disorder (ADHD) in a diverse community sample. Method: ADHD screening of a school district sample of 1,615 students aged 5 to 11 years was followed by a case-control study 8 years later. High-risk youths meeting full (n = 94) and subthreshold (n = 75) DSM-IV…

Determination of Minimum Training Sample Size for Microarray-Based Cancer Outcome Prediction–An Empirical Assessment

PubMed Central

Cheng, Ningtao; Wu, Leihong; Cheng, Yiyu

2013-01-01

The promise of microarray technology in providing prediction classifiers for cancer outcome estimation has been confirmed by a number of demonstrable successes. However, the reliability of prediction results relies heavily on the accuracy of statistical parameters involved in classifiers. It cannot be reliably estimated with only a small number of training samples. Therefore, it is of vital importance to determine the minimum number of training samples and to ensure the clinical value of microarrays in cancer outcome prediction. We evaluated the impact of training sample size on model performance extensively based on 3 large-scale cancer microarray datasets provided by the second phase of MicroArray Quality Control project (MAQC-II). An SSNR-based (scale of signal-to-noise ratio) protocol was proposed in this study for minimum training sample size determination. External validation results based on another 3 cancer datasets confirmed that the SSNR-based approach could not only determine the minimum number of training samples efficiently, but also provide a valuable strategy for estimating the underlying performance of classifiers in advance. Once translated into clinical routine applications, the SSNR-based protocol would provide great convenience in microarray-based cancer outcome prediction in improving classifier reliability. PMID:23861920

The feasibility of manual parameter tuning for deformable breast MR image registration from a multi-objective optimization perspective.

PubMed

Pirpinia, Kleopatra; Bosman, Peter A N; Loo, Claudette E; Winter-Warnars, Gonneke; Janssen, Natasja N Y; Scholten, Astrid N; Sonke, Jan-Jakob; van Herk, Marcel; Alderliesten, Tanja

2017-06-23

Deformable image registration is typically formulated as an optimization problem involving a linearly weighted combination of terms that correspond to objectives of interest (e.g. similarity, deformation magnitude). The weights, along with multiple other parameters, need to be manually tuned for each application, a task currently addressed mainly via trial-and-error approaches. Such approaches can only be successful if there is a sensible interplay between parameters, objectives, and desired registration outcome. This, however, is not well established. To study this interplay, we use multi-objective optimization, where multiple solutions exist that represent the optimal trade-offs between the objectives, forming a so-called Pareto front. Here, we focus on weight tuning. To study the space a user has to navigate during manual weight tuning, we randomly sample multiple linear combinations. To understand how these combinations relate to desirability of registration outcome, we associate with each outcome a mean target registration error (TRE) based on expert-defined anatomical landmarks. Further, we employ a multi-objective evolutionary algorithm that optimizes the weight combinations, yielding a Pareto front of solutions, which can be directly navigated by the user. To study how the complexity of manual weight tuning changes depending on the registration problem, we consider an easy problem, prone-to-prone breast MR image registration, and a hard problem, prone-to-supine breast MR image registration. Lastly, we investigate how guidance information as an additional objective influences the prone-to-supine registration outcome. Results show that the interplay between weights, objectives, and registration outcome makes manual weight tuning feasible for the prone-to-prone problem, but very challenging for the harder prone-to-supine problem. Here, patient-specific, multi-objective weight optimization is needed, obtaining a mean TRE of 13.6 mm without guidance information reduced to 7.3 mm with guidance information, but also providing a Pareto front that exhibits an intuitively sensible interplay between weights, objectives, and registration outcome, allowing outcome selection.

The feasibility of manual parameter tuning for deformable breast MR image registration from a multi-objective optimization perspective

NASA Astrophysics Data System (ADS)

Pirpinia, Kleopatra; Bosman, Peter A. N.; E Loo, Claudette; Winter-Warnars, Gonneke; Y Janssen, Natasja N.; Scholten, Astrid N.; Sonke, Jan-Jakob; van Herk, Marcel; Alderliesten, Tanja

2017-07-01

Deformable image registration is typically formulated as an optimization problem involving a linearly weighted combination of terms that correspond to objectives of interest (e.g. similarity, deformation magnitude). The weights, along with multiple other parameters, need to be manually tuned for each application, a task currently addressed mainly via trial-and-error approaches. Such approaches can only be successful if there is a sensible interplay between parameters, objectives, and desired registration outcome. This, however, is not well established. To study this interplay, we use multi-objective optimization, where multiple solutions exist that represent the optimal trade-offs between the objectives, forming a so-called Pareto front. Here, we focus on weight tuning. To study the space a user has to navigate during manual weight tuning, we randomly sample multiple linear combinations. To understand how these combinations relate to desirability of registration outcome, we associate with each outcome a mean target registration error (TRE) based on expert-defined anatomical landmarks. Further, we employ a multi-objective evolutionary algorithm that optimizes the weight combinations, yielding a Pareto front of solutions, which can be directly navigated by the user. To study how the complexity of manual weight tuning changes depending on the registration problem, we consider an easy problem, prone-to-prone breast MR image registration, and a hard problem, prone-to-supine breast MR image registration. Lastly, we investigate how guidance information as an additional objective influences the prone-to-supine registration outcome. Results show that the interplay between weights, objectives, and registration outcome makes manual weight tuning feasible for the prone-to-prone problem, but very challenging for the harder prone-to-supine problem. Here, patient-specific, multi-objective weight optimization is needed, obtaining a mean TRE of 13.6 mm without guidance information reduced to 7.3 mm with guidance information, but also providing a Pareto front that exhibits an intuitively sensible interplay between weights, objectives, and registration outcome, allowing outcome selection.

Does Race-Ethnicity Moderate the Relationship between CPAP Adherence and Functional Outcomes of Sleep in US Veterans with Obstructive Sleep Apnea Syndrome?

PubMed Central

Wallace, Douglas M.; Wohlgemuth, William K.

2014-01-01

Background: Little is known about the association of race-ethnicity and the relationship of continuous positive airway pressure (CPAP) adherence with functional outcomes of sleep in American samples with obstructive sleep apnea syndrome (OSAS). This retrospective study examines whether race-ethnicity moderates the relationship between CPAP adherence and functional outcomes of sleep in OSAS. Methods: Over 4 months, consecutive OSAS patients had CPAP data downloads and completed questionnaires (demographics, Functional Outcomes of Sleep Questionnaire [FOSQ], Epworth Sleepiness Scale [ESS], Insomnia Severity Index [ISI]) at the Miami VA sleep center. Medical diagnoses and polysomnography data were obtained from medical record. CPAP adherence was measured as mean daily hours of use. Hierarchical regression modeling was used to explore the differential impact of race-ethnicity and CPAP adherence on functional outcomes of sleep. Results: Two hundred twenty-seven veterans (93% male, age 59 ± 11 years) were included; 142 (63%) participants self-reported as white or Hispanic, and 85 participants (37%) as black. Hierarchical regression analyses failed to show main effects for race-ethnicity or CPAP use and FOSQ scores; however, the interaction of race-ethnicity with CPAP adherence was significantly associated with the total FOSQ (p = 0.04), Social (p = 0.02), and Intimacy (p = 0.01) subscale scores. For blacks, in adjusted analyses, CPAP adherence was positively associated with Social and Intimacy FOSQ subscales; however, no significant relationship was noted between CPAP use and FOSQ scores in whites/Hispanics. Conclusions: Race-ethnicity may moderate the relationship between CPAP adherence and some functional outcomes of sleep; however, further studies are needed. Citation: Wallace DM, Wohlgemuth WK. Does race-ethnicity moderate the relationship between CPAP adherence and functional outcomes of sleep in US veterans with obstructive sleep apnea syndrome? J Clin Sleep Med 2014;10(10):1083-1091. PMID:25317089

A descriptive study of access to services in a random sample of Canadian rural emergency departments

PubMed Central

Fleet, Richard; Poitras, Julien; Maltais-Giguère, Julie; Villa, Julie; Archambault, Patrick

2013-01-01

Objective To examine 24/7 access to services and consultants in a sample of Canadian rural emergency departments (EDs). Design Cross-sectional study—mixed methods (structured interview, survey and government data bases) with random sampling of hospitals. Setting Canadian rural EDs (rural small town (RST) definition—Statistics Canada). Participants 28% (95/336) of Canadian rural EDs providing 24/7 physician coverage located in hospitals with acute care hospitalisation beds. Main outcome measures General characteristics of the rural EDs, information about 24/7 access to consultants, equipment and services, and the proportion of rural hospitals more than 300 km from levels 1 and 2 trauma centres. Results Of the 336 rural EDs identified, 122 (36%) were randomly selected and contacted. Overall, 95 EDs participated in the study (participation rate, 78%). Hospitals had, on an average, 23 acute care beds, 7 ED stretchers and 13 500 annual ED visits. The proportion of rural hospitals with local access to the following 24/7 services was paediatrician, 5%; obstetrician, 10%; psychiatrist, 11%; internist, 12%; intensive care unit, 17%; CT scanner, 20%; surgeon, 26%; ultrasound, 28%; basic X-ray, 97% and laboratory services, 99%. Forty-four per cent and 54% of the RST EDs were more than 300 km from a level 1 and level 2 trauma centre, respectively. Conclusions This is the first study describing the services available in Canadian rural EDs. Apart from basic laboratory and X-ray services, most rural EDs have limited access to consultants, advanced imaging and critical care services. A detailed study is needed to evaluate the impact of these limited services on patient outcomes, costs and interfacility transport demands. PMID:24285633

Depression and Retirement in Late Middle-Aged U.S. Workers

PubMed Central

Doshi, Jalpa A; Cen, Liyi; Polsky, Daniel

2008-01-01

Objective To determine whether late middle-aged U.S. workers with depression are at an increased risk for retirement. Data Source Six biennial waves (1992–2002) of the Health and Retirement Study, a nationally representative panel survey of noninstitutionalized 51–61-year-olds and their spouses started in 1992. Study Design Workers aged 53–58 years in 1994 were followed every 2 years thereafter, through 2002. Depression was coded as lagged time-dependent variables measuring active depression and severity of depression. The main outcome variable was a transition to retirement which was measured using two distinct definitions to capture different stages in the retirement process: (1) Retirement was defined as a transition out of the labor force in the sample of all labor force participants (N = 2,853); (2) In addition a transition out of full time work was used as the retirement definition in the subset of labor force participants who were full time workers (N = 2,288). Principal Findings In the sample of all labor force participants, the presence of active depression significantly increased the hazard of retirement in both late middle-aged men (adjusted OR: 1.37 [95 percent CI 1.05, 1.80]) and women (adjusted OR: 1.40 [95 percent CI 1.10, 1.78]). For women, subthreshold depression was also a significant predictor of retirement. In the sample of full time workers, the relationship between depression and retirement was considerably weaker for women yet remained strong for men. Conclusions Depression and depressive symptoms were significantly associated with retirement in late middle-aged U.S. workers. Policymakers must consider the potentially adverse impact of these labor market outcomes when estimating the cost of untreated depression and evaluating the value of interventions to improve the diagnosis and treatment of depression. PMID:18370974

Homeopathic prescribing for chronic and acute periodontal conditions in 3 dental practices in the UK.

PubMed

Farrer, S; Baitson, E S; Gedah, L; Norman, C; Darby, P; Mathie, R T

2013-10-01

This investigation extends our previous dental data collection pilot study with the following main aims: to gain insight into the periodontal complaints that dentists in the UK treat using individualised homeopathic prescription; to record patient-assessed change in severity of treated complaint (acute or chronic); to determine periodontal pocket depth (PPD). Three dentists recorded data systematically at 249 homeopathic appointments in 51 patients over a period of 18 months. A spreadsheet enabled the data collection of the following records: date of appointment; anonymised patient identity; main periodontal problem treated; whether the condition was acute or chronic; patient-assessed clinical outcome on a 7-point Likert scale, ranging from -3 to +3, to compare the first and any subsequent appointments; whether any interventional dental surgery (IDS) had been carried out; clinician-assessed PPD measurements. At least one follow-up (FU) appointment was reported for each of 46 patients (22 chronic [6 with IDS, 16 without IDS]; 24 acute [10 with IDS, 14 without IDS]). In chronic cases, strongly positive outcomes (score of +2 or +3) were reported by 2 (33.3%) of 6 IDS patients and by 1 (6.3%) of 16 non-IDS patients. In acute cases, strongly positive outcomes were reported by 7 (70%) of 10 IDS patients and by 8 (57.2%) of 14 non-IDS patients (no statistically significant difference between sub-groups). The FU conditions most frequently treated with homeopathy were chronic periodontitis (19 patients) and acute periodontal abscess (11 patients). Analysis of PPD data was not feasible due to the small numbers of patients involved. Limited insight has been gained into the periodontal complaints treated by homeopathy in the UK. Due to small sample size and equivocal results, the interpretation of the patient-reported outcomes data is unclear. Positive findings obtained in the acute treatment setting suggest that this may be a promising area for research in periodontal homeopathy. Copyright © 2013 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

Sample size considerations for paired experimental design with incomplete observations of continuous outcomes.

PubMed

Zhu, Hong; Xu, Xiaohan; Ahn, Chul

2017-01-01

Paired experimental design is widely used in clinical and health behavioral studies, where each study unit contributes a pair of observations. Investigators often encounter incomplete observations of paired outcomes in the data collected. Some study units contribute complete pairs of observations, while the others contribute either pre- or post-intervention observations. Statistical inference for paired experimental design with incomplete observations of continuous outcomes has been extensively studied in literature. However, sample size method for such study design is sparsely available. We derive a closed-form sample size formula based on the generalized estimating equation approach by treating the incomplete observations as missing data in a linear model. The proposed method properly accounts for the impact of mixed structure of observed data: a combination of paired and unpaired outcomes. The sample size formula is flexible to accommodate different missing patterns, magnitude of missingness, and correlation parameter values. We demonstrate that under complete observations, the proposed generalized estimating equation sample size estimate is the same as that based on the paired t-test. In the presence of missing data, the proposed method would lead to a more accurate sample size estimate comparing with the crude adjustment. Simulation studies are conducted to evaluate the finite-sample performance of the generalized estimating equation sample size formula. A real application example is presented for illustration.

Sample size calculation for stepped wedge and other longitudinal cluster randomised trials.

PubMed

Hooper, Richard; Teerenstra, Steven; de Hoop, Esther; Eldridge, Sandra

2016-11-20

The sample size required for a cluster randomised trial is inflated compared with an individually randomised trial because outcomes of participants from the same cluster are correlated. Sample size calculations for longitudinal cluster randomised trials (including stepped wedge trials) need to take account of at least two levels of clustering: the clusters themselves and times within clusters. We derive formulae for sample size for repeated cross-section and closed cohort cluster randomised trials with normally distributed outcome measures, under a multilevel model allowing for variation between clusters and between times within clusters. Our formulae agree with those previously described for special cases such as crossover and analysis of covariance designs, although simulation suggests that the formulae could underestimate required sample size when the number of clusters is small. Whether using a formula or simulation, a sample size calculation requires estimates of nuisance parameters, which in our model include the intracluster correlation, cluster autocorrelation, and individual autocorrelation. A cluster autocorrelation less than 1 reflects a situation where individuals sampled from the same cluster at different times have less correlated outcomes than individuals sampled from the same cluster at the same time. Nuisance parameters could be estimated from time series obtained in similarly clustered settings with the same outcome measure, using analysis of variance to estimate variance components. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Fine Mapping of 6q23.1 Identifies TULP4 as Contributing to Clefts.

PubMed

Vieira, Alexandre R; de Carvalho, Flavia M; Johnson, Lindsay; DeVos, Lauren; Swailes, Alexa L; Weber, Megan L; Deeley, Kathleen

2015-03-01

Objective : The aim of this work was to fine-map the region 6q23.1, which obtained suggestive linkage signal (logarithm of the odds [LOD] score = 2.22 under a recessive model) to cleft lip with or without cleft palate (CL±P) in our previous genome-wide linkage scan to identify possible genetic variants that may contribute to CL±P. Design : We used densely spaced markers spanning the entire 6q23.1 region to test for association with CL±P in a family cohort sample. Setting : Clinical information and DNA samples were obtained from families in the Philippines at their homes or primary health care clinics. Participants : The study sample consisted of 477 subjects (224 females and 253 males), segregating isolated CL±P, from 72 living in the same area in the Philippines. Main Outcome Measure : Overtransmission of alleles to persons born with CL±P. Results : We found statistical evidence of association between a marker of TULP4 (rs651333) with CL±P (P = .00007). Conclusions : Our results further support the linkage results for the chromosome 6q region and reveal a novel candidate gene for CL±P.

Comparative analysis of whole mount processing and systematic sampling of radical prostatectomy specimens: pathological outcomes and risk of biochemical recurrence.

PubMed

Salem, Shady; Chang, Sam S; Clark, Peter E; Davis, Rodney; Herrell, S Duke; Kordan, Yakup; Wills, Marcia L; Shappell, Scott B; Baumgartner, Roxelyn; Phillips, Sharon; Smith, Joseph A; Cookson, Michael S; Barocas, Daniel A

2010-10-01

Whole mount processing is more resource intensive than routine systematic sampling of radical retropubic prostatectomy specimens. We compared whole mount and systematic sampling for detecting pathological outcomes, and compared the prognostic value of pathological findings across pathological methods. We included men (608 whole mount and 525 systematic sampling samples) with no prior treatment who underwent radical retropubic prostatectomy at Vanderbilt University Medical Center between January 2000 and June 2008. We used univariate and multivariate analysis to compare the pathological outcome detection rate between pathological methods. Kaplan-Meier curves and the log rank test were used to compare the prognostic value of pathological findings across pathological methods. There were no significant differences between the whole mount and the systematic sampling groups in detecting extraprostatic extension (25% vs 30%), positive surgical margins (31% vs 31%), pathological Gleason score less than 7 (49% vs 43%), 7 (39% vs 43%) or greater than 7 (12% vs 13%), seminal vesicle invasion (8% vs 10%) or lymph node involvement (3% vs 5%). Tumor volume was higher in the systematic sampling group and whole mount detected more multiple surgical margins (each p <0.01). There were no significant differences in the likelihood of biochemical recurrence between the pathological methods when patients were stratified by pathological outcome. Except for estimated tumor volume and multiple margins whole mount and systematic sampling yield similar pathological information. Each method stratifies patients into comparable risk groups for biochemical recurrence. Thus, while whole mount is more resource intensive, it does not appear to result in improved detection of clinically important pathological outcomes or prognostication. Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

The effect of sample size and disease prevalence on supervised machine learning of narrative data.

PubMed Central

McKnight, Lawrence K.; Wilcox, Adam; Hripcsak, George

2002-01-01

This paper examines the independent effects of outcome prevalence and training sample sizes on inductive learning performance. We trained 3 inductive learning algorithms (MC4, IB, and Naïve-Bayes) on 60 simulated datasets of parsed radiology text reports labeled with 6 disease states. Data sets were constructed to define positive outcome states at 4 prevalence rates (1, 5, 10, 25, and 50%) in training set sizes of 200 and 2,000 cases. We found that the effect of outcome prevalence is significant when outcome classes drop below 10% of cases. The effect appeared independent of sample size, induction algorithm used, or class label. Work is needed to identify methods of improving classifier performance when output classes are rare. PMID:12463878

REFOCUS Trial: protocol for a cluster randomised controlled trial of a pro-recovery intervention within community based mental health teams.

PubMed

Slade, Mike; Bird, Victoria; Le Boutillier, Clair; Williams, Julie; McCrone, Paul; Leamy, Mary

2011-11-23

There is a consensus about the importance of 'recovery' in mental health services, but the evidence base is limited. A two centre, cluster randomised controlled trial. Participants are community-based mental health teams, and service users aged 18-65 years with a primary clinical diagnosis of psychosis. In relation to the REFOCUS Manual researchintorecovery.com/refocus, which describes a 12-month, pro-recovery intervention based on the REFOCUS Model, the objectives are: (1) To establish the effectiveness of the intervention described in the REFOCUS Manual; (2) To validate the REFOCUS Model; (3) To establish and optimise trial parameters for the REFOCUS Manual; and (4) To understand the relationship between clinical outcomes and recovery outcomes. The hypothesis for the main study is that service users in the intervention arm will experience significantly greater increases in measures of personal recovery (as measured by the QPR) compared to service users receiving care from control teams. The hypothesis for the secondary study is that black service users in the intervention arm will experience significantly greater increases in measures of personal recovery (as measured by the QPR) and client satisfaction (as measured by the CSQ) compared to Black service users receiving care from control teams. The intervention comprises treatment as usual plus two components: recovery-promoting relationships and working practices. The control condition is treatment as usual. The primary outcme is the Process of Recovery Questionnaire (QPR). Secondary outcomes are satisfaction, Goal setting - Personal Primary Outcome, hope, well-being, empowerment, and quality of life. Primary outcomes for the secondary study will be QPR and satisfaction. Cost data will be estimated, and clinical outcomes will also be reported (symptomatology, need, social disability, functioning). 29 teams (15 intervention and 14 control) will be randomised. Within each team, 15 services users will be randomly chosen, giving a total sample of 435 service users (225 in intervention and 210 in control). Power for the main study: 336 service users will give power to detect a medium effect size of 0.4 (alpha 0.05, power = 0.8) on both QPR sub-scales. Power for the secondary study: 89 participants will give power to detect an effect size of 0.67 on both QPR sub-scales and on CSQ. A range of approaches are used to minimise bias, although service users and clinicians cannot be blinded. This cluster-RCT will evaluate a pro-recovery intervention in community mental health teams. ISRCTN: ISRCTN02507940.

REFOCUS Trial: protocol for a cluster randomised controlled trial of a pro-recovery intervention within community based mental health teams

PubMed Central

2011-01-01

Background There is a consensus about the importance of 'recovery' in mental health services, but the evidence base is limited. Methods/Design A two centre, cluster randomised controlled trial. Participants are community-based mental health teams, and service users aged 18-65 years with a primary clinical diagnosis of psychosis. In relation to the REFOCUS Manual researchintorecovery.com/refocus, which describes a 12-month, pro-recovery intervention based on the REFOCUS Model, the objectives are: (1) To establish the effectiveness of the intervention described in the REFOCUS Manual; (2) To validate the REFOCUS Model; (3) To establish and optimise trial parameters for the REFOCUS Manual; and (4) To understand the relationship between clinical outcomes and recovery outcomes. The hypothesis for the main study is that service users in the intervention arm will experience significantly greater increases in measures of personal recovery (as measured by the QPR) compared to service users receiving care from control teams. The hypothesis for the secondary study is that black service users in the intervention arm will experience significantly greater increases in measures of personal recovery (as measured by the QPR) and client satisfaction (as measured by the CSQ) compared to Black service users receiving care from control teams. The intervention comprises treatment as usual plus two components: recovery-promoting relationships and working practices. The control condition is treatment as usual. The primary outcme is the Process of Recovery Questionnaire (QPR). Secondary outcomes are satisfaction, Goal setting - Personal Primary Outcome, hope, well-being, empowerment, and quality of life. Primary outcomes for the secondary study will be QPR and satisfaction. Cost data will be estimated, and clinical outcomes will also be reported (symptomatology, need, social disability, functioning). 29 teams (15 intervention and 14 control) will be randomised. Within each team, 15 services users will be randomly chosen, giving a total sample of 435 service users (225 in intervention and 210 in control). Power for the main study: 336 service users will give power to detect a medium effect size of 0.4 (alpha 0.05, power = 0.8) on both QPR sub-scales. Power for the secondary study: 89 participants will give power to detect an effect size of 0.67 on both QPR sub-scales and on CSQ. A range of approaches are used to minimise bias, although service users and clinicians cannot be blinded. Discussion This cluster-RCT will evaluate a pro-recovery intervention in community mental health teams. Trial registration ISRCTN: ISRCTN02507940 PMID:22112008

Psychiatric disorders and the labor market: an analysis by disorder profiles.

PubMed

Cowell, Alexander J; Luo, Zhehui; Masuda, Yuta J

2009-03-01

A key societal cost of mental illness is its impact on the labor market. In examining the relationship between psychiatric disorders and the labor market, the literature to date either examines psychiatric disorders in broad classes or focuses on the impact of specific conditions. The aim is to examine the relationships among meaningful profiles of concurrent past year disorders and labor market outcomes by gender. Data are from the National Epidemiologic Survey on Alcohol and Related Conditions for 2001/2002 (NESARC), a representative sample of the noninstitutionalized population aged 18 or older residing in the United States. The analysis sample contains 18,429 women and 16,426 men (unweighted). We examined the relationship between profiles of psychiatric disorders and three labor market outcomes: labor force participation; employment, conditional on labor force participation; and working full-time conditional on being employed. Because no attempt was made to control for potential endogeneity between the labor market outcomes and the psychiatric profiles, we are unable to establish the causal direction of the associations estimated. First, anxiety disorders among women appear to be associated with labor market outcomes (e.g., anxiety profile in employment outcome: OR=0.76, p<.05). Second, for employment among women large effects were seen for mood disorder and mood and anxiety; in contrast for men, these disorder profiles had significant associations with working full-time rather than employment. Third, for women, of the three labor market outcomes, employment status is particularly sensitive to the profiles of disorders. For men, no such pattern was found for any single labor market outcome. Concurrent psychiatric disorder profiles affect men and women differently in the labor market. The greatest differences are in (i) the relationship between labor market outcomes and profiles exhibiting anxiety disorders, and (ii) which labor market outcomes are influenced. The main methodological limitation is that the approach does not attempt to assert a direction of causation between mental health conditions and the labor market outcomes. Unobserved heterogeneity and endogeneity are both possible and likely to some degree. Other limitations pertain to the data, which are cross-sectional and exclude some relatively rare disorders (e.g., schizophrenia). The results may have significant implications for access to appropriate treatment, which may vary greatly by psychiatric disorder profile and by gender. In the United States, private third-party coverage for treatment is obtained either directly through working full-time at a medium to large firm or through a spouse being employed. The findings thus suggest that mental health policy may need to account for labor market policy. Additional research is needed to disentangle the findings presented. For example, it is important to separate the influence of substance use disorders from mood disorder and uncover the pathways by which the different conditions in substance use disorders may influence the job market.

Risk Factors for Physical Impairment after Acute Lung Injury in a National, Multicenter Study

PubMed Central

Wozniak, Amy W.; Hough, Catherine L.; Morris, Peter E.; Dinglas, Victor D.; Jackson, James C.; Mendez-Tellez, Pedro A.; Shanholtz, Carl; Ely, E. Wesley; Colantuoni, Elizabeth

2014-01-01

Rationale: Existing studies of risk factors for physical impairments in acute lung injury (ALI) survivors were potentially limited by single-center design or relatively small sample size. Objectives: To evaluate risk factors for three measures of physical impairments commonly experienced by survivors of ALI in the first year after hospitalization. Methods: A prospective, longitudinal study of 6- and 12-month physical outcomes (muscle strength, 6-minute-walk distance, and Short Form [SF]-36 Physical Function score) for 203 survivors of ALI enrolled from 12 hospitals participating in the ARDS Network randomized trials. Multivariable regression analyses evaluated the independent association of critical illness–related variables and intensive care interventions with impairments in each physical outcome measure, after adjusting for patient demographics, comorbidities, and baseline functional status. Measurements and Main Results: At 6 and 12 months, respectively, mean (± SD) values for strength (presented as proportion of maximum strength score evaluated using manual muscle testing) was 92% (± 8%) and 93% (± 9%), 6-minute-walk distance (as percent-predicted) was 64% (± 22%) and 67% (± 26%), and SF-36 Physical Function score (as percent-predicted) was 61% (± 36%) and 67% (± 37%). After accounting for patient baseline status, there was significant association and statistical interaction of mean daily dose of corticosteroids and intensive care unit length of stay with impairments in physical outcomes. Conclusions: Patients had substantial impairments, from predicted values, for 6-minute-walk distance and SF-36 Physical Function outcome measures. Minimizing corticosteroid dose and implementing existing evidence-based methods to reduce duration of intensive care unit stay and associated patient immobilization may be important interventions for improving ALI survivors’ physical outcomes. PMID:24716641

Specificity of Incident Diagnostic Outcomes in Patients at Clinical High Risk for Psychosis

PubMed Central

Webb, Jadon R; Addington, Jean; Perkins, Diana O; Bearden, Carrie E; Cadenhead, Kristin S; Cannon, Tyrone D; Cornblatt, Barbara A; Heinssen, Robert K; Seidman, Larry J; Tarbox, Sarah I; Tsuang, Ming; Walker, Elaine; McGlashan, Thomas H; Woods, Scott W

2015-01-01

Abstract It is not well established whether the incident outcomes of the clinical high-risk (CHR) syndrome for psychosis are diagnostically specific for psychosis or whether CHR patients also are at elevated risk for a variety of nonpsychotic disorders. We collected 2 samples (NAPLS-1, PREDICT) that contained CHR patients and a control group who responded to CHR recruitment efforts but did not meet CHR criteria on interview (help-seeking comparison patients [HSC]). Incident diagnostic outcomes were defined as the occurrence of a SIPS-defined psychosis or a structured interview diagnosis from 1 of 3 nonpsychotic Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) groups (anxiety, bipolar, or nonbipolar mood disorder), when no diagnosis in that group was present at baseline. Logistic regression revealed that the CHR vs HSC effect did not vary significantly across study for any emergent diagnostic outcome; data from the 2 studies were therefore combined. CHR (n = 271) vs HSC (n = 171) emergent outcomes were: psychosis 19.6% vs 1.8%, bipolar disorders 1.1% vs 1.2%, nonbipolar mood disorders 4.4% vs 5.3%, and anxiety disorders 5.2% vs 5.3%. The main effect of CHR vs HSC was statistically significant (OR = 13.8, 95% CI 4.2–45.0, df = 1, P < .001) for emergent psychosis but not for any emergent nonpsychotic disorder. Sensitivity analyses confirmed these findings. Within the CHR group emergent psychosis was significantly more likely than each nonpsychotic DSM-IV emergent disorder, and within the HSC group emergent psychosis was significantly less likely than most emergent nonpsychotic disorders. The CHR syndrome is specific as a marker for research on predictors and mechanisms of developing psychosis. PMID:26272875

Relationship between quality of care and choice of clinical computing system: retrospective analysis of family practice performance under the UK's quality and outcomes framework

PubMed Central

Kontopantelis, Evangelos; Buchan, Iain; Reeves, David; Checkland, Kath; Doran, Tim

2013-01-01

Objectives To investigate the relationship between performance on the UK Quality and Outcomes Framework pay-for-performance scheme and choice of clinical computer system. Design Retrospective longitudinal study. Setting Data for 2007–2008 to 2010–2011, extracted from the clinical computer systems of general practices in England. Participants All English practices participating in the pay-for-performance scheme: average 8257 each year, covering over 99% of the English population registered with a general practice. Main outcome measures Levels of achievement on 62 quality-of-care indicators, measured as: reported achievement (levels of care after excluding inappropriate patients); population achievement (levels of care for all patients with the relevant condition) and percentage of available quality points attained. Multilevel mixed effects multiple linear regression models were used to identify population, practice and clinical computing system predictors of achievement. Results Seven clinical computer systems were consistently active in the study period, collectively holding approximately 99% of the market share. Of all population and practice characteristics assessed, choice of clinical computing system was the strongest predictor of performance across all three outcome measures. Differences between systems were greatest for intermediate outcomes indicators (eg, control of cholesterol levels). Conclusions Under the UK's pay-for-performance scheme, differences in practice performance were associated with the choice of clinical computing system. This raises the question of whether particular system characteristics facilitate higher quality of care, better data recording or both. Inconsistencies across systems need to be understood and addressed, and researchers need to be cautious when generalising findings from samples of providers using a single computing system. PMID:23913774

Parameters Associated with Adverse Fetal Outcomes in Parvovirus B19 Congenital Infection.

PubMed

Agra, Isabela Karine Rodrigues; Amorim Filho, Antonio Gomes; Lin, Lawrence Hsu; Biancolin, Sckarlet Ernandes; Francisco, Rossana Pulcineli Vieira; Brizot, Maria de Lourdes

2017-11-01

Objective  To investigate the clinical and sonographic parameters associated with adverse fetal outcomes in patients with congenital parvovirus B19 infection managed by intrauterine transfusion. Methods  This was a single-center retrospective study conducted from January 2005 to December 2016 that assessed patients with singleton pregnancies with fetal parvovirus infection confirmed by a polymerase chain reaction of the amniotic fluid or fetal blood samples who underwent at least one intrauterine transfusion. The maternal characteristics, sonographic findings and parameters related to intrauterine transfusion were compared between the two groups (recovery/non-recovery), who were categorized based on fetal response after in-utero transfusions. Progression to fetal death or delivery without fetal recovery after the transfusions was considered non-recovery and categorized as an adverse outcome. Results  The final analysis included ten singleton pregnancies: seven of which were categorized into the recovery group and three of which into the non-recovery group. The baseline characteristics were similar between the groups. All fetuses were hydropic at the time of diagnosis. No significant differences related to sonographic or intrauterine transfusion parameters were identified between the groups; however, the non-recovery group tended to have an increased number of sonographic markers and lower fetal hemoglobin and platelet levels before the transfusion. Conclusion  We were unable to firmly establish the clinical or sonographic parameters associated with adverse fetal outcomes in patients with parvovirus infection managed with intrauterine transfusions; however, edema, placental thickening and oligohydramnios may indicate greater fetal compromise and, subsequently, adverse outcomes. However, further studies are necessary, mainly due to the small number of cases analyzed in the present study. Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.

Optimizing adalimumab treatment in psoriasis with concomitant methotrexate (OPTIMAP): study protocol for a pragmatic, single-blinded, investigator-initiated randomized controlled trial.

PubMed

Busard, C I; Menting, S P; van Bezooijen, J S; van den Reek, J M; Hutten, B A; Prens, E P; de Jong, E M; van Doorn, M B; Spuls, P I

2017-02-02

The introduction of anti-tumor necrosis factor medications has revolutionized the treatment of psoriasis with achievement of treatment goals (Psoriasis Area and Severity Index score 75, remission) that are not usually met with conventional systemics. Nevertheless, some patients continue to experience persistent disease activity or treatment failure over time. Strategies to optimize treatment outcomes include the use of concomitant methotrexate, which has demonstrated beneficial effects on pharmacokinetics and treatment efficacy in psoriasis and other inflammatory diseases. This is an investigator-initiated, multicenter randomized controlled trial (RCT) designed to compare the combination treatment of adalimumab and methotrexate with adalimumab monotherapy in patients with psoriasis. The primary outcome is adalimumab drug survival at week 49. Other outcomes include improvement in disease severity and quality of life, tolerability, and safety. Moreover, anti-adalimumab antibodies and adalimumab serum concentrations will be measured and correlations between genotypes and clinical outcomes will be assessed. Patient recruitment started in March 2014. Up to now, 36 patients have been randomized. Many more patients have been (pre)screened. A total of 93 patients is desired to meet an adequate sample size. In our experience, the main limitation for recruitment is prior adalimumab therapy and intolerability or toxicity for methotrexate in the past. OPTIMAP is the first RCT to examine combination therapy with adalimumab and methotrexate in a psoriasis population. With data derived from this study we expect to provide valuable clinical data on long-term treatment outcomes. These data will be supported by assessment of the impact of concomitant methotrexate on adalimumab pharmacokinetics. Furthermore, the influence of several single nucleotide polymorphisms on adalimumab response will be analyzed in order to support the development of a more personalized approach for this targeted therapy. NTR4499 . Registered on 7 April 2014.

Does adolescent motherhood affect education and labor market outcomes of mothers? A study on young adult women in Chile during 1990-2013.

PubMed

Berthelon, Matias; Kruger, Diana I

2017-03-01

We analyze the impact of adolescent motherhood on several education and labor market outcomes in Chile over the 1990-2013 period. We explore whether effects are different across income levels, timing of adolescent births, and three sub-periods. Using the CASEN national household survey, we applied propensity score-matching methods on two samples of women aged 24: one for women in the 2009-2013 period and another sample of 24-year-old women living with their mother between 1990-2013. In both samples, adolescent motherhood has negative effects on educational outcomes (high school completion, enrollment in technical institutes and universities, and years of education) and on labor outcomes of non-poor women. Childbearing in early adolescence is associated with worse outcomes, and the adverse effects of adolescent motherhood on education and labor outcomes have diminished over the period. Similar to results in developed countries, adolescent motherhood has negative consequences on women's education and labor outcomes, particularly on women that become mothers early in adolescence. Public policies aimed at reducing teen motherhood will have important effects on young women's education and employment.

The Effect of Principal's Leadership Style on School Environment and Outcome

ERIC Educational Resources Information Center

Al-Safran, Eissa; Brown, David; Wiseman, Alexander

2014-01-01

The main objective of this study was to investigate the effect of principal's leadership style on school outcome. This study focused on the indirect relationship between the leadership style and the school environment. An additional objective was to investigate the impact of culture on leadership style as related to school environment and outcome.…

Privileging Practice: Facing the Challenge of Integrated Working for Outcomes for Children

ERIC Educational Resources Information Center

Canavan, John; Coen, Liam; Dolan, Pat; Whyte, Liam

2009-01-01

Integrated working for outcomes is complex and challenging in theory and practice. Yet, outcomes and integrated working are central to the policy goals for children and families in Ireland. In this article, the authors present two main arguments: first, that reflective practice offers a useful general methodology for engaging with the theoretical…

Student Outcomes: Investigating Competency-Based Curriculum in Adult Basic Education. Research Report No. 5.

ERIC Educational Resources Information Center

Hazell, Pat

The outcomes attained by Australian adults enrolled in competency-based Certificate in Adult Foundation Education (CAFE) courses were examined. Special attention was paid to the outcomes achieved by students in the two lowest of the CAFE program's four levels. The main data sources were as follows: literature review; enrollment data from the…

Wound healing outcomes: Using big data and a modified intent-to-treat method as a metric for reporting healing rates.

PubMed

Ennis, William J; Hoffman, Rachel A; Gurtner, Geoffrey C; Kirsner, Robert S; Gordon, Hanna M

2017-08-01

Chronic wounds are increasing in prevalence and are a costly problem for the US healthcare system and throughout the world. Typically outcomes studies in the field of wound care have been limited to small clinical trials, comparative effectiveness cohorts and attempts to extrapolate results from claims databases. As a result, outcomes in real world clinical settings may differ from these published studies. This study presents a modified intent-to-treat framework for measuring wound outcomes and measures the consistency of population based outcomes across two distinct settings. In this retrospective observational analysis, we describe the largest to date, cohort of patient wound outcomes derived from 626 hospital based clinics and one academic tertiary care clinic. We present the results of a modified intent-to-treat analysis of wound outcomes as well as demographic and descriptive data. After applying the exclusion criteria, the final analytic sample includes the outcomes from 667,291 wounds in the national sample and 1,788 wounds in the academic sample. We found a consistent modified intent to treat healing rate of 74.6% from the 626 clinics and 77.6% in the academic center. We recommend that a standard modified intent to treat healing rate be used to report wound outcomes to allow for consistency and comparability in measurement across providers, payers and healthcare systems. © 2017 by the Wound Healing Society.

INVESTIGATE-I (INVasive Evaluation before Surgical Treatment of Incontinence Gives Added Therapeutic Effect?): study protocol for a mixed methods study to assess the feasibility of a future randomised controlled trial of the clinical utility of invasive urodynamic testing

PubMed Central

2011-01-01

Background Urinary incontinence is an important health problem to the individual sufferer and to health services. Stress and stress predominant mixed urinary incontinence are increasingly managed by surgery due to advances in surgical techniques. Despite the lack of evidence for its clinical utility, most clinicians undertake invasive urodynamic testing (IUT) to confirm a functional diagnosis of urodynamic stress incontinence before offering surgery for this condition. IUT is expensive, embarrassing and uncomfortable for women and carries a small risk. Recent systematic reviews have confirmed the lack of high quality evidence of effectiveness. The aim of this pilot study is to test the feasibility of a future definitive randomised control trial that would address whether IUT alters treatment decisions and treatment outcome in these women and would test its clinical and cost effectiveness. Methods/design This is a mixed methods pragmatic multicentre feasibility pilot study with four components:- (a) A multicentre, external pilot randomised trial comparing basic clinical assessment with non-invasive tests and IUT. The outcome measures are rates of recruitment, randomisation and data completion. Data will be used to estimate sample size necessary for the definitive trial. (b) Qualitative interviews of a purposively sampled sub-set of women eligible for the pilot trial will explore willingness to participate, be randomised and their overall trial experience. (c) A national survey of clinicians to determine their views of IUT in this context, the main outcome being their willingness to randomise patients into the definitive trial. (d) Qualitative interviews of a purposively sampled group of these clinicians will explore whether and how they use IUT to inform their decisions. Discussion The pilot trial will provide evidence of feasibility and acceptability and therefore inform the decision whether to proceed to the definitive trial. Results will inform the design and conduct of the definitive trial and ensure its effectiveness in achieving its research aim. Trial registration number Current Controlled Trials ISRCTN71327395 assigned 7th June 2010. PMID:21733166

Adjusting for multiple prognostic factors in the analysis of randomised trials

PubMed Central

2013-01-01

Background When multiple prognostic factors are adjusted for in the analysis of a randomised trial, it is unclear (1) whether it is necessary to account for each of the strata, formed by all combinations of the prognostic factors (stratified analysis), when randomisation has been balanced within each stratum (stratified randomisation), or whether adjusting for the main effects alone will suffice, and (2) the best method of adjustment in terms of type I error rate and power, irrespective of the randomisation method. Methods We used simulation to (1) determine if a stratified analysis is necessary after stratified randomisation, and (2) to compare different methods of adjustment in terms of power and type I error rate. We considered the following methods of analysis: adjusting for covariates in a regression model, adjusting for each stratum using either fixed or random effects, and Mantel-Haenszel or a stratified Cox model depending on outcome. Results Stratified analysis is required after stratified randomisation to maintain correct type I error rates when (a) there are strong interactions between prognostic factors, and (b) there are approximately equal number of patients in each stratum. However, simulations based on real trial data found that type I error rates were unaffected by the method of analysis (stratified vs unstratified), indicating these conditions were not met in real datasets. Comparison of different analysis methods found that with small sample sizes and a binary or time-to-event outcome, most analysis methods lead to either inflated type I error rates or a reduction in power; the lone exception was a stratified analysis using random effects for strata, which gave nominal type I error rates and adequate power. Conclusions It is unlikely that a stratified analysis is necessary after stratified randomisation except in extreme scenarios. Therefore, the method of analysis (accounting for the strata, or adjusting only for the covariates) will not generally need to depend on the method of randomisation used. Most methods of analysis work well with large sample sizes, however treating strata as random effects should be the analysis method of choice with binary or time-to-event outcomes and a small sample size. PMID:23898993

SALGOT - Stroke Arm Longitudinal study at the University of Gothenburg, prospective cohort study protocol

PubMed Central

2011-01-01

Background Recovery patterns of upper extremity motor function have been described in several longitudinal studies, but most of these studies have had selected samples, short follow up times or insufficient outcomes on motor function. The general understanding is that improvements in upper extremity occur mainly during the first month after the stroke incident and little if any, significant recovery can be gained after 3-6 months. The purpose of this study is to describe the recovery of upper extremity function longitudinally in a non-selected sample initially admitted to a stroke unit with first ever stroke, living in Gothenburg urban area. Methods/Design A sample of 120 participants with a first-ever stroke and impaired upper extremity function will be consecutively included from an acute stroke unit and followed longitudinally for one year. Assessments are performed at eight occasions: at day 3 and 10, week 3, 4 and 6, month 3, 6 and 12 after onset of stroke. The primary clinical outcome measures are Action Research Arm Test and Fugl-Meyer Assessment for Upper Extremity. As additional measures, two new computer based objective methods with kinematic analysis of arm movements are used. The ABILHAND questionnaire of manual ability, Stroke Impact Scale, grip strength, spasticity, pain, passive range of motion and cognitive function will be assessed as well. At one year follow up, two patient reported outcomes, Impact on Participation and Autonomy and EuroQol Quality of Life Scale, will be added to cover the status of participation and aspects of health related quality of life. Discussion This study comprises a non-selected population with first ever stroke and impaired arm function. Measurements are performed both using traditional clinical assessments as well as computer based measurement systems providing objective kinematic data. The ICF classification of functioning, disability and health is used as framework for the selection of assessment measures. The study design with several repeated measurements on motor function will give us more confident information about the recovery patterns after stroke. This knowledge is essential both for optimizing rehabilitation planning as well as providing important information to the patient about the recovery perspectives. Trial registration ClinicalTrials.gov: NCT01115348 PMID:21612620

Inference and sample size calculation for clinical trials with incomplete observations of paired binary outcomes.

PubMed

Zhang, Song; Cao, Jing; Ahn, Chul

2017-02-20

We investigate the estimation of intervention effect and sample size determination for experiments where subjects are supposed to contribute paired binary outcomes with some incomplete observations. We propose a hybrid estimator to appropriately account for the mixed nature of observed data: paired outcomes from those who contribute complete pairs of observations and unpaired outcomes from those who contribute either pre-intervention or post-intervention outcomes. We theoretically prove that if incomplete data are evenly distributed between the pre-intervention and post-intervention periods, the proposed estimator will always be more efficient than the traditional estimator. A numerical research shows that when the distribution of incomplete data is unbalanced, the proposed estimator will be superior when there is moderate-to-strong positive within-subject correlation. We further derive a closed-form sample size formula to help researchers determine how many subjects need to be enrolled in such studies. Simulation results suggest that the calculated sample size maintains the empirical power and type I error under various design configurations. We demonstrate the proposed method using a real application example. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Understanding health-related quality of life in caregivers of civilians and service members/veterans with traumatic brain injury: Establishing the reliability and validity of PROMIS Fatigue and Sleep Disturbance item banks.

PubMed

Carlozzi, Noelle E; Ianni, Phillip A; Tulsky, David S; Brickell, Tracey A; Lange, Rael T; French, Louis M; Cella, David; Kallen, Michael A; Miner, Jennifer A; Kratz, Anna L

2018-06-19

To examine the reliability and validity of Patient Reported Outcomes Measurement Information System (PROMIS) measures of sleep disturbance and fatigue in TBI caregivers and to determine the severity of fatigue and sleep disturbance in these caregivers. Cross-sectional survey data collected through an online data capture platform. Four rehabilitation hospitals and Walter Reed National Military Medical Center. Caregivers (N=560) of civilians (n=344) and service member/veterans (n=216) with TBI. Not Applicable MAIN OUTCOME MEASURES: PROMIS sleep and fatigue measures administered as both computerized adaptive tests (CATs) and 4-item short forms (SFs). For both samples, floor and ceiling effects for the PROMIS measures were low (<11%), internal consistency was very good (all alphas ≥0.80), and test-retest reliability was acceptable (all r≥0.70 except for the fatigue CAT in the service member/veteran sample r=0.63). Convergent validity was supported by moderate correlations between the PROMIS and related measures. Discriminant validity was supported by low correlations between PROMIS measures and measures of dissimilar constructs. PROMIS scores indicated significantly worse sleep and fatigue for those caring for someone with high levels versus low levels of impairment. Findings support the reliability and validity of the PROMIS CAT and SF measures of sleep disturbance and fatigue in caregivers of civilians and service members/veterans with TBI. Copyright © 2018. Published by Elsevier Inc.

Preoperative Lateralization Modalities for Cushing Disease: Is Dynamic Magnetic Resonance Imaging or Cavernous Sinus Sampling More Predictive of Intraoperative Findings?

PubMed

Sun, Hai; Yedinak, Chris; Ozpinar, Alp; Anderson, Jim; Dogan, Aclan; Delashaw, Johnny; Fleseriu, Maria

2015-06-01

Objective To analyze whether cavernous sinus sampling (CSS) and dynamic magnetic resonance imaging (dMRI) are consistent with intraoperative findings in Cushing disease (CD) patients. Design Retrospective outcomes study. Setting Oregon Health & Science University; 2006 and 2013. Participants A total of 37 CD patients with preoperative dMRI and CSS to confirm central adrenocorticotropic hormone (ACTH) hypersecretion. Patients were 78% female; mean age was 41 years (at diagnosis), and all had a minimum of 6 months of follow-up. Main Outcome Measures Correlations among patient characteristics, dMRI measurements, CSS results, and intraoperative findings. Results All CSS indicated presence of CD. Eight of 37 patients had no identifiable tumor on dMRI. Three of 37 patients had no tumor at surgery. dMRI tumor size was inversely correlated with age (rs = - 0.4; p = 0.01) and directly correlated to intraoperative lateralization (rs = 0.3; p < 0.05). Preoperative dMRI was directly correlated to intraoperative lateralization (rs = 0.5; p < 0.002). CSS lateralization showed no correlation with intraoperative findings (rs = 0.145; p = 0.40) or lateralization observed on preoperative dMRI (rs = 0.17; p = 0.29). Postoperative remission rate was 68%. Conclusion dMRI localization was most consistent with intraoperative findings; CSS results were less reliable. Results suggest that small ACTH-secreting tumors continue to pose a challenge to reliable preoperative localization.

Clinical and prognostic significance of muscle biopsy in sarcoidosis.

PubMed

Yanardag, Halil; Tetikkurt, Cuneyt; Bilir, Muammer

2018-04-30

The main objective of this study was to evaluate the influence of muscle involvement on the clinical features, prognostic outcome, extrapulmonary organ, and endobronchial involvement in sarcoidosis patients. The second aim was to assess the diagnostic yield of muscle biopsy for the histopathologic identification of sarcoidosis.  Fifty sarcoidosis patients participated in the study. The patients were classified into two groups according to the histopathologic presence of non-caseating granulomatous inflammatory pattern of the muscle biopsy samples and were evaluated retrospectively in regard to clinical features, prognosis, extrapulmonary, and endobronchial disease involvement. Pathologic examination of the muscle biopsy samples revealed non-caseating granulomas in eighteen and myositis in seven patients compatible with sarcoidosis. The diagnostic yield of muscle biopsy for demonstrating non-caseating granulomatous inflammation was fifty percent. Patients with muscle sarcoidosis showed a worse prognosis and a more severe extrapulmonary organ involvement than the patients without muscle disease. Muscle biopsy was not statistically significant to delineate diffuse endobronchial involvement while it was suggestive for endobronchial disease clinically. The results of our study reveal that muscle biopsy appears to be a useful diagnostic tool along with its safety and easy clinical applicability. It is a rewarding utility to predict the prognostic outcome and extrapulmonary involvement in sarcoidosis patients. Positive biopsy on the other hand confirms the identification of sarcoidosis in patients with single organ involvement carrying an equivocal diagnostic clinical pattern. Muscle biopsy may be considered as the initial step for the final diagnosis of sarcoidosis in such cases.

Biogas Stoves Reduce Firewood Use, Household Air Pollution, and Hospital Visits in Odisha, India.

PubMed

Lewis, Jessica J; Hollingsworth, John W; Chartier, Ryan T; Cooper, Ellen M; Foster, William Michael; Gomes, Genna L; Kussin, Peter S; MacInnis, John J; Padhi, Bijaya K; Panigrahi, Pinaki; Rodes, Charles E; Ryde, Ian T; Singha, Ashok K; Stapleton, Heather M; Thornburg, Jonathan; Young, Cora J; Meyer, Joel N; Pattanayak, Subhrendu K

2017-01-03

Traditional cooking using biomass is associated with ill health, local environmental degradation, and regional climate change. Clean stoves (liquefied petroleum gas (LPG), biogas, and electric) are heralded as a solution, but few studies have demonstrated their environmental health benefits in field settings. We analyzed the impact of mainly biogas (as well as electric and LPG) stove use on social, environmental, and health outcomes in two districts in Odisha, India, where the Indian government has promoted household biogas. We established a cross-sectional observational cohort of 105 households that use either traditional mud stoves or improved cookstoves (ICS). Our multidisciplinary team conducted surveys, environmental air sampling, fuel weighing, and health measurements. We examined associations between traditional or improved stove use and primary outcomes, stratifying households by proximity to major industrial plants. ICS use was associated with 91% reduced use of firewood (p < 0.01), substantial time savings for primary cooks, a 72% reduction in PM 2.5 , a 78% reduction in PAH levels, and significant reductions in water-soluble organic carbon and nitrogen (p < 0.01) in household air samples. ICS use was associated with reduced time in the hospital with acute respiratory infection and reduced diastolic blood pressure but not with other health measurements. We find many significant gains from promoting rural biogas stoves in a context in which traditional stove use persists, although pollution levels in ICS households still remained above WHO guidelines.

Suicide Rates After Discharge From Psychiatric Facilities: A Systematic Review and Meta-analysis.

PubMed

Chung, Daniel Thomas; Ryan, Christopher James; Hadzi-Pavlovic, Dusan; Singh, Swaran Preet; Stanton, Clive; Large, Matthew Michael

2017-07-01

High rates of suicide after psychiatric hospitalization are reported in many studies, yet the magnitude of the increases and the factors underlying them remain unclear. To quantify the rates of suicide after discharge from psychiatric facilities and examine what moderates those rates. English-language, peer-reviewed publications published from January 1, 1946, to May 1, 2016, were located using MEDLINE, PsychINFO, and EMBASE with the search terms ((suicid*).ti AND (hospital or discharg* OR inpatient or in-patient OR admit*).ab and ((mortality OR outcome* OR death*) AND (psych* OR mental*)).ti AND (admit* OR admis* or hospital* OR inpatient* OR in-patient* OR discharg*).ab. Hand searching was also done. Studies reporting the number of suicides among patients discharged from psychiatric facilities and the number of exposed person-years and studies from which these data could be calculated. The meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. A random-effects model was used to calculate a pooled estimate of postdischarge suicides per 100 000 person-years. The suicide rate after discharge from psychiatric facilities was the main outcome, and the association between the duration of follow-up and the year of the sampling were the main a priori moderators. A total of 100 studies reported 183 patient samples (50 samples of females, 49 of males, and 84 of mixed sex; 129 of adults or unspecified patients, 20 of adolescents, 19 of older patients, and 15 from long-term or forensic discharge facilities), including a total of 17 857 suicides during 4 725 445 person-years. The pooled estimate postdischarge suicide rate was 484 suicides per 100 000 person-years (95% CI, 422-555 suicides per 100 000 person-years; prediction interval, 89-2641), with high between-sample heterogeneity (I2 = 98%). The suicide rate was highest within 3 months after discharge (1132; 95% CI, 874-1467) and among patients admitted with suicidal ideas or behaviors (2078; 95% CI, 1512-2856). Pooled suicide rates per 100 000 patients-years were 654 for studies with follow-up periods of 3 months to 1 year, 494 for studies with follow-up periods of 1 to 5 years, 366 for studies with follow-up periods of 5 to 10 years, and 277 for studies with follow-up periods longer than 10 years. Suicide rates were higher among samples collected in the periods 1995-2004 (656; 95% CI, 518-831) and 2005-2016 (672; 95% CI, 428-1055) than in earlier samples. The immediate postdischarge period is a time of marked risk, but rates of suicide remain high for many years after discharge. Patients admitted because of suicidal ideas or behaviors and those in the first months after discharge should be a particular focus of concern. Previously admitted patients should be able to access long-term care and assistance.

The professional nursing practice environment and nurse-reported job outcomes in two European countries: a survey of nurses in Finland and the Netherlands.

PubMed

Hinno, Saima; Partanen, Pirjo; Vehviläinen-Julkunen, Katri

2012-03-01

The working environment of nurses is receiving international interest, because there is a growing consensus that identifying opportunities for improving working conditions in hospitals is essential to maintain adequate staffing, high-quality care, nurses' job satisfaction and hence their retention. Thus, the aim of this study was to investigate the relationship between nurse work environment characteristics and nurse-reported job outcomes in hospital settings in Finland and the Netherlands and to compare these results. A comparative cross-sectional nurse survey was conducted. Data were collected from the two countries randomly sampling the countries' National Nurses Association' membership databases. In this paper, the results from Registered Nurses working in hospital settings are used. In total, 869 hospital nurses participated: 535 from Finland and 334 from the Netherlands with the response rate of 44.9 and 33.4%, respectively. Fifty-five items from the Nursing Work Index-Revised were used as a main tool for the practice environment. Exploratory factor analysis was used to identify a set of internally consistent subscales. Further, logistic regression analysis and T-tests were used. Three practice environment characteristics were identified: adequacy of resources, supportiveness of management and assurance of care quality via collaborative relationships. Favourable evaluations of the adequacy of resources and supportiveness of management were positively correlated with nurse-assessed quality of care and job-related positive feelings and negatively correlated with intentions to leave a unit, organization or the entire profession. In neither of the participating countries were adverse incidents affecting nurses related to nurses' evaluations of their current professional practice environment. Compared with Finland, in the Netherlands, RN appears to evaluate the majority of work environment characteristics more positively; nevertheless, to some extent, the results were uniform as adequacy of resources and supportiveness of management were main predictors for nurse-reported job outcomes considered. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.

The Relationship between Obsessive Compulsive Personality and Obsessive Compulsive Disorder Treatment Outcomes: Predictive Utility and Clinically Significant Change.

PubMed

Sadri, Shalane K; McEvoy, Peter M; Egan, Sarah J; Kane, Robert T; Rees, Clare S; Anderson, Rebecca A

2017-09-01

The evidence regarding whether co-morbid obsessive compulsive personality disorder (OCPD) is associated with treatment outcomes in obsessive compulsive disorder (OCD) is mixed, with some research indicating that OCPD is associated with poorer response, and some showing that it is associated with improved response. We sought to explore the role of OCPD diagnosis and the personality domain of conscientiousness on treatment outcomes for exposure and response prevention for OCD. The impact of co-morbid OCPD and conscientiousness on treatment outcomes was examined in a clinical sample of 46 participants with OCD. OCPD diagnosis and scores on conscientiousness were not associated with poorer post-treatment OCD severity, as indexed by Yale-Brown Obsessive Compulsive Scale (YBOCS) scores, although the relative sample size of OCPD was small and thus generalizability is limited. This study found no evidence that OCPD or conscientiousness were associated with treatment outcomes for OCD. Further research with larger clinical samples is required.

Tracking the conversion of nitrogen during pyrolysis of antibiotic mycelial fermentation residues using XPS and TG-FTIR-MS technology.

PubMed

Zhu, Xiangdong; Yang, Shijun; Wang, Liang; Liu, Yuchen; Qian, Feng; Yao, Wenqing; Zhang, Shicheng; Chen, Jianmin

2016-04-01

Antibiotic mycelial fermentation residues (AMFRs), which are emerging solid pollutants, have been recognized as hazardous waste in China since 2008. Nitrogen (N), which is an environmental sensitivity element, is largely retained in AMFR samples derived from fermentation substrates. Pyrolysis is a promising technology for the treatment of solid waste. However, the outcomes of N element during the pyrolysis of AMFRs are still unknown. In this study, the conversion of N element during the pyrolysis of AMFRs was tracked using XPS (X-ray photoelectron spectroscopy) and online TG-FTIR-MS (Thermogravimetry-Fourier transform infrared-Mass spectrometry) technology. In the AMFR sample, organic amine-N, pyrrolic-N, protein-N, pyridinic-N, was the main N-containing species. XPS results indicated that pyrrolic-N and pyridinic-N were retained in the AMFR-derived pyrolysis char. More stable species, such as N-oxide and quaternary-N, were also produced in the char. TG-FTIR-MS results indicated that NH3 and HCN were the main gaseous species, and their contents were closely related to the contents of amine-N and protein-N, and pyrrolic-N and pyridinic-N of AMFRs, respectively. Increases in heating rate enhanced the amounts of NH3 and HCN, but had less of an effect on the degradation degree of AMFRs. N-containing organic compounds, including amine-N, nitrile-N and heterocyclic-N, were discerned from the AMFR pyrolysis process. Their release range was extended with increasing of heating rate and carbon content of AMFR sample. This work will help to take appropriate measure to reduce secondary pollution from the treatment of AMFRs. Copyright © 2015 Elsevier Ltd. All rights reserved.

Stress and coping with racism and their role in sexual risk for HIV among African American, Asian/Pacific Islander, and Latino men who have sex with men.

PubMed

Han, Chong-suk; Ayala, George; Paul, Jay P; Boylan, Ross; Gregorich, Steven E; Choi, Kyung-Hee

2015-02-01

The deleterious effects of racism on a wide range of health outcomes, including HIV risk, are well documented among racial/ethnic minority groups in the United States. However, little is known about how men of color who have sex with men (MSM) cope with stress from racism and whether the coping strategies they employ buffer against the impact of racism on sexual risk for HIV transmission. We examined associations of stress and coping with racism with unprotected anal intercourse (UAI) in a sample of African American (N = 403), Asian/Pacific Islander (N = 393), and Latino (N = 400) MSM recruited in Los Angeles County, CA during 2008-2009. Almost two-thirds (65 %) of the sample reported being stressed as a consequence of racism experienced within the gay community. Overall, 51 % of the sample reported having UAI in the prior 6 months. After controlling for race/ethnicity, age, nativity, marital status, sexual orientation, education, HIV serostatus, and lifetime history of incarceration, the multivariate analysis found statistically significant main effects of stress from racism and avoidance coping on UAI; no statistically significant main effects of dismissal, education/confrontation, and social-support seeking were observed. None of the interactions of stress with the four coping measures were statistically significant. Although stress from racism within the gay community increased the likelihood of engaging in UAI among MSM of color, we found little evidence that coping responses to racism buffered stress from racism. Instead, avoidance coping appears to suggest an increase in UAI.

Model-based inference for small area estimation with sampling weights

PubMed Central

Vandendijck, Y.; Faes, C.; Kirby, R.S.; Lawson, A.; Hens, N.

2017-01-01

Obtaining reliable estimates about health outcomes for areas or domains where only few to no samples are available is the goal of small area estimation (SAE). Often, we rely on health surveys to obtain information about health outcomes. Such surveys are often characterised by a complex design, stratification, and unequal sampling weights as common features. Hierarchical Bayesian models are well recognised in SAE as a spatial smoothing method, but often ignore the sampling weights that reflect the complex sampling design. In this paper, we focus on data obtained from a health survey where the sampling weights of the sampled individuals are the only information available about the design. We develop a predictive model-based approach to estimate the prevalence of a binary outcome for both the sampled and non-sampled individuals, using hierarchical Bayesian models that take into account the sampling weights. A simulation study is carried out to compare the performance of our proposed method with other established methods. The results indicate that our proposed method achieves great reductions in mean squared error when compared with standard approaches. It performs equally well or better when compared with more elaborate methods when there is a relationship between the responses and the sampling weights. The proposed method is applied to estimate asthma prevalence across districts. PMID:28989860

Systematic Analysis of Main Constituents in Rat Biological Samples after Oral Administration of the Methanol Extract of Fructus Aurantii by HPLC-ESI-MS/MS.

PubMed

Zhang, Jingze; Gao, Wenyuan; Liu, Zhen; Zhang, Zhidan; Liu, Changxiao

2014-01-01

High performance liquid chromatography (HPLC) with diode array detection (DAD) and electrospray ionization tandem mass spectrometry (ESI/MS/MS) was used to analyze the main components in the methanol extract of Fructus Aurantii (FA) and the metabolites in rat biological samples after oral administration of the methanol extract of FA. There were 31 constituents identified in the extract of FA including 2 alkaloids, 1 coumarin, 10 flavonoid glycosides and 18 ploymethoxylated flavones. According to the UV spectrum and MS fragment character of main components in the methanol extract of FA, 18 parent constituents and 11 metabolites were tentatively identified in rat biological samples. Three groups of components in biological samples detected included flavonoid glycosides, their glucuronides and ploymethoxylated flavones. It was interested that flavonoid glycosides, their glucuronides and ploymethoxylated flavones can be investigated in rat plasma and urine, while in rat feces samples only flavonoid glycosides were detected. Triglycosyl, naringenin, neoeriocitrin, neoeriocitrin narirutin and hesperidin were the main components in rat feces which were found either in the plasma or in urine samples. However, naringin and neohesperidin were the main flavonoid glycosides which absorbed after oral administration. Except flavonoid glycosides and their glucuronides, ploymethoxylated flavones also the constituents absorbed because it was investigated mainly in rat plasma and urine but not in feces samples. The identification and elucidation of parent and metabolism components analyzed in biological samples provided the data for further pharmacological and clinical research on FA.

[Patient-reported and patient-weighted outcomes in ophthalmology].

PubMed

Scheibler, F; Finger, R P; Grosselfinger, R; Dintsios, C-M

2010-03-01

Considering patients' values and preferences in comparative effectiveness research (CER) is one of the main challenges in ophthalmology (value-based medicine). This article defines core terms in CER. The concept of patient-relevant (or patient-important) outcomes is distinguished from patient-reported outcomes (PRO) by means of examples in the field of ophthalmology. In order to be able to give a consistant recommendation if an intervention leads to conflicting results for different outcomes (trade-off), a ranking of outcomes will be necessary. Examples of studies in glaucoma patients are provided that demonstrate the possibilities of ranking of outcomes based on patient preferences.

Long term compliance with California's Smoke-Free Workplace Law among bars and restaurants in Los Angeles County

PubMed Central

Weber, M; Bagwell, D; Fielding, J; Glantz, S

2003-01-01

Objective: To assess long term compliance with the California Smoke-Free Workplace Law in Los Angeles County freestanding bars and bar/restaurants. Design: Population based annual site inspection survey of a random sample of Los Angeles County freestanding bars and bar/restaurants was conducted from 1998 to 2002. Main outcome measures: The primary outcomes of interest were patron and employee smoking. The secondary outcomes of interest were the presence of ashtrays and designated outdoor smoking areas. Results: Significant increases in patron non-smoking compliance were found for freestanding bars (45.7% to 75.8%, p < 0.0001) and bar/restaurants (92.2% to 98.5%, p < 0.0001) between 1998 and 2002. Increases in employee non-smoking compliance were found for freestanding bars (86.2% to 94.7%, p < 0.0003) and bar/restaurants (96.5% to 99.2%, p < 0.005). Conclusions: This study provides clear evidence that the California Smoke-Free Workplace Law has been effective at reducing patron and employee smoking in Los Angeles County bars and restaurants. Recommendations include educational campaigns targeted to freestanding bar owners and staff to counter perceptions of lost revenue, more rigorous enforcement, and more severe penalties for repeat violators such as alcohol licence revocation. Policymakers can enact smoke-free restaurant and bar policies to protect employees and patrons from secondhand smoke, confident that these laws can be successfully implemented. PMID:12958386

Women in the Persian Gulf: lack of gender differences in long-term health effects of service in United Kingdom Armed Forces in the 1991 Persian Gulf War.

PubMed

Unwin, Catherine; Hotopf, Matthew; Hull, Lisa; Ismail, Khalida; David, Anthony; Wessely, Simon

2002-05-01

A cross-sectional postal survey was conducted to evaluate the health of a random sample of United Kingdom Armed Forces personnel who were deployed to the 1990-1991 Persian Gulf conflict compared with nondeployed controls and controls deployed to Bosnia. The health of service women was examined and compared with that of United Kingdom service men. The main outcome measures were physical symptoms and ailments, functional capacity on the 36-item Short-Form Health Survey, the 12-item General Health Questionnaire, the Centers for Disease Control and Prevention multisymptom criteria for Gulf War illness, and post-traumatic stress reactions. There were 645 (65.3%) valid responses. The women from the Gulf cohort reported each symptom and the majority of health outcomes more frequently than either control group. No gender differences were found for 32 of the 50 symptoms assessed. Of the remaining 18 symptoms, women reported significantly more than men for only 6 of them, and there were no gender differences in 5 of the 6 principal health outcome measures. Women deployed to the Persian Gulf had similar rates of ill health as their male counterparts. Nothing was found to suggest that, other than for gender-specific health effects, any special considerations need to be made on health grounds for service women in any future deployments.

SurvExpress: an online biomarker validation tool and database for cancer gene expression data using survival analysis.

PubMed

Aguirre-Gamboa, Raul; Gomez-Rueda, Hugo; Martínez-Ledesma, Emmanuel; Martínez-Torteya, Antonio; Chacolla-Huaringa, Rafael; Rodriguez-Barrientos, Alberto; Tamez-Peña, José G; Treviño, Victor

2013-01-01

Validation of multi-gene biomarkers for clinical outcomes is one of the most important issues for cancer prognosis. An important source of information for virtual validation is the high number of available cancer datasets. Nevertheless, assessing the prognostic performance of a gene expression signature along datasets is a difficult task for Biologists and Physicians and also time-consuming for Statisticians and Bioinformaticians. Therefore, to facilitate performance comparisons and validations of survival biomarkers for cancer outcomes, we developed SurvExpress, a cancer-wide gene expression database with clinical outcomes and a web-based tool that provides survival analysis and risk assessment of cancer datasets. The main input of SurvExpress is only the biomarker gene list. We generated a cancer database collecting more than 20,000 samples and 130 datasets with censored clinical information covering tumors over 20 tissues. We implemented a web interface to perform biomarker validation and comparisons in this database, where a multivariate survival analysis can be accomplished in about one minute. We show the utility and simplicity of SurvExpress in two biomarker applications for breast and lung cancer. Compared to other tools, SurvExpress is the largest, most versatile, and quickest free tool available. SurvExpress web can be accessed in http://bioinformatica.mty.itesm.mx/SurvExpress (a tutorial is included). The website was implemented in JSP, JavaScript, MySQL, and R.

SurvExpress: An Online Biomarker Validation Tool and Database for Cancer Gene Expression Data Using Survival Analysis

PubMed Central

Aguirre-Gamboa, Raul; Gomez-Rueda, Hugo; Martínez-Ledesma, Emmanuel; Martínez-Torteya, Antonio; Chacolla-Huaringa, Rafael; Rodriguez-Barrientos, Alberto; Tamez-Peña, José G.; Treviño, Victor

2013-01-01

Validation of multi-gene biomarkers for clinical outcomes is one of the most important issues for cancer prognosis. An important source of information for virtual validation is the high number of available cancer datasets. Nevertheless, assessing the prognostic performance of a gene expression signature along datasets is a difficult task for Biologists and Physicians and also time-consuming for Statisticians and Bioinformaticians. Therefore, to facilitate performance comparisons and validations of survival biomarkers for cancer outcomes, we developed SurvExpress, a cancer-wide gene expression database with clinical outcomes and a web-based tool that provides survival analysis and risk assessment of cancer datasets. The main input of SurvExpress is only the biomarker gene list. We generated a cancer database collecting more than 20,000 samples and 130 datasets with censored clinical information covering tumors over 20 tissues. We implemented a web interface to perform biomarker validation and comparisons in this database, where a multivariate survival analysis can be accomplished in about one minute. We show the utility and simplicity of SurvExpress in two biomarker applications for breast and lung cancer. Compared to other tools, SurvExpress is the largest, most versatile, and quickest free tool available. SurvExpress web can be accessed in http://bioinformatica.mty.itesm.mx/SurvExpress (a tutorial is included). The website was implemented in JSP, JavaScript, MySQL, and R. PMID:24066126

Do educational outcomes correspond with the requirements of nursing practice: educators' and managers' assessments of novice nurses' professional competence

PubMed Central

Numminen, Olivia; Laine, Tuija; Isoaho, Hannu; Hupli, Maija; Leino-Kilpi, Helena; Meretoja, Riitta

2014-01-01

Objective This study evaluated weather educational outcomes of nurse education meet the requirements of nursing practice by exploring the correspondence between nurse educators' and nurse managers' assessments of novice nurses' professional competence. The purpose was to find competence areas contributing to the acknowledged practice–theory gap. Design A cross-sectional, comparative design using the Nurse Competence Scale was applied. Subjects The sample comprised nurse educators (n = 86) and nurse managers (n = 141). Methods Descriptive and inferential statistics were used in the data analysis. Main outcome measures Educators assessed novice nurses' competence to a significantly higher level than managers in all competence areas (p < 0.001). The biggest correspondence between educators' and mangers' assessments were in competencies related to immediate patient care, commitment to ethical values, maintaining professional skills and nurses' care of the self. The biggest differences were in competencies related to developmental and evaluation tasks, coaching activities, use of evidence-based knowledge and in activities which required mastering a comprehensive view of care situations. However, differences between educators' and managers' assessments were strongly associated with their age and work experience. Active and improved collaboration should be focused on areas in which the differences between educators' and managers' assessments greatly differ in ensuring novice nurses′ fitness for practice. PMID:24512685

Unstudied infants: outcomes of moderately premature infants in the neonatal intensive care unit

PubMed Central

Escobar, G J; McCormick, M C; Zupancic, J A F; Coleman‐Phox, K; Armstrong, M A; Greene, J D; Eichenwald, E C; Richardson, D K

2006-01-01

Background Newborns of 30–34 weeks gestation comprise 3.9% of all live births in the United States and 32% of all premature infants. They have been studied much less than very low birthweight infants. Objective To measure in‐hospital outcomes and readmission within three months of discharge of moderately premature infants. Design Prospective cohort study including retrospective chart review and telephone interviews after discharge. Setting Ten birth hospitals in California and Massachusetts. Patients Surviving moderately premature infants born between October 2001 and February 2003. Main outcome measures (a) Occurrence of assisted ventilation during the hospital stay after birth; (b) adverse in‐hospital outcomes—for example, necrotising enterocolitis; (c) readmission within three months of discharge. Results With the use of prospective cluster sampling, 850 eligible infants and their families were identified, randomly selected, and enrolled. A total of 677 families completed a telephone interview three months after hospital discharge. During the birth stay, these babies experienced substantial morbidity: 45.7% experienced assisted ventilation, and 3.2% still required supplemental oxygen at 36 weeks. Readmission within three months occurred in 11.2% of the cohort and was higher among male infants and those with chronic lung disease. Conclusions Moderately premature infants experience significant morbidity, as evidenced by high rates of assisted ventilation, use of oxygen at 36 weeks, and readmission. Such morbidity deserves more research. PMID:16611647

Bullying by peers in childhood and effects on psychopathology, suicidality, and criminality in adulthood.

PubMed

Klomek, Anat Brunstein; Sourander, Andre; Elonheimo, Henrik

2015-10-01

Bullying is shown to be associated with adverse outcomes in cross-sectional studies, but only a few studies have prospectively examined the effects of childhood bullying on adult outcomes. Our Series paper focuses on prospective longitudinal studies that used large, population-based, community samples analysed through quantitative methods and published between 1960 and 2015. We describe the results of childhood bullying in adulthood in three of the most burdensome areas: psychopathology, suicidality, and criminality. We note that the different groups involved (ie, victims, bullies, and bully-victims) are at risk of difficulties later in life, but their risk profiles differ and the contributions are probably not independent. Controlling for confounders reduces the risk and sometimes eliminates it. Victims are at a high risk of internalising disorders. Bullies seem to be at risk of later externalising disorders and criminality, mainly violent crime and illicit drug misuse. Bully-victims seem to be at risk of internalising disorders, externalising disorders, and criminality, but not all studies examined bully-victims as a separate group. Boys and girls differ in their long-term outcomes. A dose effect exists in which frequent bullying involvement in childhood is most strongly associated with adult adversities. Future studies need to control for additional factors (including genetic, psychosocial, and environmental) to account for the mechanisms behind the reported longitudinal associations. Copyright © 2015 Elsevier Ltd. All rights reserved.

Birth outcomes of male and female patients with infantile hypertrophic pyloric stenosis--a population-based case-control study.

PubMed

Vermes, Gabor; Mátrai, Ákos; Czeizel, Andrew E; Ács, Nándor

2016-01-01

Most of the patients are affected by isolated infantile hypertrophic pyloric stenosis (IHPS) beyond the polygenic predisposition, the other factors in the multifactorial etiology are largely unknown. The main characteristic of IHPS is the robust male predominance, thus the aim of this study was to analyze birth outcomes in males and females whether they are different or not. The study samples included 241 cases with IHPS, 357 matched, and 38,151 population controls without any defect in the population-based large dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980-1996. The findings of this case-control study confirmed the well-known strong male excess (85.5%). The mean gestational age was somewhat longer and it is associated with a lower rate of preterm births. Mean birth weight did not show significant differences among the study groups, but the rate of low birthweight was higher in cases with IHPS. However, these differences were found only in males. Thus, intrauterine fetal growth restriction is characteristic only for male cases with IHPS. Our study confirmed the well-known obvious male excess of cases with IHPS, but our findings suggest some differences in birth outcomes of male and female cases. Male cases with IHPS had intrauterine fetal growth restriction while females did not. These data may indicate some differences in the pathogenesis of IHPS in males and females.

Design and Implementation of the International Genetics and Translational Research in Transplantation Network.

PubMed

2015-11-01

Genetic association studies of transplantation outcomes have been hampered by small samples and highly complex multifactorial phenotypes, hindering investigations of the genetic architecture of a range of comorbidities which significantly impact graft and recipient life expectancy. We describe here the rationale and design of the International Genetics & Translational Research in Transplantation Network. The network comprises 22 studies to date, including 16494 transplant recipients and 11669 donors, of whom more than 5000 are of non-European ancestry, all of whom have existing genomewide genotype data sets. We describe the rich genetic and phenotypic information available in this consortium comprising heart, kidney, liver, and lung transplant cohorts. We demonstrate significant power in International Genetics & Translational Research in Transplantation Network to detect main effect association signals across regions such as the MHC region as well as genomewide for transplant outcomes that span all solid organs, such as graft survival, acute rejection, new onset of diabetes after transplantation, and for delayed graft function in kidney only. This consortium is designed and statistically powered to deliver pioneering insights into the genetic architecture of transplant-related outcomes across a range of different solid-organ transplant studies. The study design allows a spectrum of analyses to be performed including recipient-only analyses, donor-recipient HLA mismatches with focus on loss-of-function variants and nonsynonymous single nucleotide polymorphisms.

When Service-Learning Is Not a "Border-Crossing" Experience: Outcomes of a Graduate Spanish Online Course

ERIC Educational Resources Information Center

Carracelas-Juncal, Carmen

2013-01-01

Research on Spanish service-learning has focused mainly on the outcomes of service-learning for undergraduate students learning Spanish as a second language. This article examines the role of service-learning in a graduate online course for practicing Spanish teachers and the outcomes of the service-learning experience for three participants who…

Association Between Mutation Clearance After Induction Therapy and Outcomes in Acute Myeloid Leukemia

PubMed Central

Klco, Jeffery M.; Miller, Christopher A.; Griffith, Malachi; Petti, Allegra; Spencer, David H.; Ketkar-Kulkarni, Shamika; Wartman, Lukas D; Christopher, Matthew; Lamprecht, Tamara L.; Helton, Nicole M.; Duncavage, Eric J.; Payton, Jacqueline E.; Baty, Jack; Heath, Sharon E.; Griffith, Obi L.; Shen, Dong; Hundal, Jasreet; Chang, Gue Su; Fulton, Robert; O'Laughlin, Michelle; Fronick, Catrina; Magrini, Vincent; Demeter, Ryan T.; Larson, David E.; Kulkarni, Shashikant; Ozenberger, Bradley A.; Welch, John S; Walter, Matthew J; Graubert, Timothy A.; Westervelt, Peter; Radich, Jerald P.; Link, Daniel C.; Mardis, Elaine R.; DiPersio, John F.; Wilson, Richard K.; Ley, Timothy J.

2015-01-01

IMPORTANCE Tests that predict outcomes for patients with acute myeloid leukemia (AML) are imprecise, especially for those with intermediate risk AML. OBJECTIVES To determine whether genomic approaches can provide novel prognostic information for adult patients with de novo AML. DESIGN, SETTING, AND PARTICIPANTS Whole-genome or exome sequencing was performed on samples obtained at disease presentation from 71 patients with AML (mean age, 50.8 years) treated with standard induction chemotherapy at a single site starting in March 2002, with follow-up through January 2015. In addition, deep digital sequencing was performed on paired diagnosis and remission samples from 50 patients (including 32 with intermediate-risk AML), approximately 30 days after successful induction therapy. Twenty-five of the 50 were from the cohort of 71 patients, and 25 were new, additional cases. EXPOSURES Whole-genome or exome sequencing and targeted deep sequencing. Risk of identification based on genetic data. MAIN OUTCOMES AND MEASURES Mutation patterns (including clearance of leukemia-associated variants after chemotherapy) and their association with event-free survival and overall survival. RESULTS Analysis of comprehensive genomic data from the 71 patients did not improve outcome assessment over current standard-of-care metrics. In an analysis of 50 patients with both presentation and documented remission samples, 24 (48%) had persistent leukemia-associated mutations in at least 5%of bone marrow cells at remission. The 24 with persistent mutations had significantly reduced event-free and overall survival vs the 26 who cleared all mutations. Patients with intermediate cytogenetic risk profiles had similar findings. Digital Sequencing (n=50)Intermediate CytogeneticRisk Profile (n=32)PersistentMutations(n=24)ClearedMutations(n=26)HR(95% CI)PersistentMutations(n=14)ClearedMutations(n=18)HR(95% CI)Event-free survival,median (95% CI), mo6.0(3.7–9.6)17.9(11.3–40.4)3.67(1.93–7.11)8.8(3.7–14.6)25.6(11.4-notestimable)3.32(1.44–7.67)Overall survival,median (95% CI), mo10.5(7.5–22.2)42.2(20.6-notestimable)2.86(1.39–5.88)19.3(7.5–42.3)46.8(22.6-notestimable)2.88(1.11–7.45) CONCLUSIONS AND RELEVANCE The detection of persistent leukemia-associated mutations in at least 5%of bone marrow cells in day 30 remission samples was associated with a significantly increased risk of relapse, and reduced overall survival. These data suggest that this genomic approach may improve risk stratification for patients with AML. PMID:26305651

A mixed methods study to assess the feasibility of a randomised controlled trial of invasive urodynamic testing versus clinical assessment and non-invasive tests prior to surgery for stress urinary incontinence in women: the INVESTIGATE-I study.

PubMed

Hilton, Paul; Armstrong, Natalie; Brennand, Catherine; Howel, Denise; Shen, Jing; Bryant, Andrew; Tincello, Douglas G; Lucas, Malcolm G; Buckley, Brian S; Chapple, Christopher R; Homer, Tara; Vale, Luke; McColl, Elaine

2015-09-08

The position of invasive urodynamic testing (IUT) in diagnostic pathways for urinary incontinence is unclear, and systematic reviews have called for further trials evaluating clinical utility. The objective of this study was to inform the decision whether to proceed to a definitive randomised trial of IUT compared to clinical assessment with non-invasive tests, prior to surgery in women with stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence (MUI). A mixed methods study comprising a pragmatic multicentre randomised pilot trial, a qualitative face-to face interview study with patients eligible for the trial, an exploratory economic evaluation including value of information study, a survey of clinicians' views about IUT, and qualitative telephone interviews with purposively sampled survey respondents. Only the first and second of these elements are reported here. Trial participants were randomised to either clinical assessment with non-invasive tests (control arm) or clinical assessment with non-invasive tests plus IUT (intervention arm). The main outcome measures of these feasibility studies were confirmation that units can identify and recruit eligible women, acceptability of investigation strategies and data collection tools, and acquisition of outcome data to determine the sample size for a definitive trial. The primary outcome proposed for a definitive trial was ICIQ-FLUTS (total score) 6 months after surgery or the start of nonsurgical treatment. Of 284 eligible women, 222 (78%) were recruited, 165/219 (75%) returned questionnaires at baseline, and 125/200 returned them (63%) at follow-up. Most women underwent surgery; management plans were changed in 19 (19%) participants following IUT. Participants interviewed were positive about the trial and the associated documentation. All elements of a definitive trial were rehearsed. Such a trial would require between 232 and 922 participants, depending on the target difference in the primary outcome. We identified possible modifications to our protocol for application in a definitive trial including clarity over inclusion/exclusions, screening processes, reduction in secondary outcomes, and modification to patient questionnaire booklets and bladder diaries. A definitive trial of IUT versus clinical assessment prior to surgery for SUI or stress predominant MUI is feasible and remains relevant. Current Controlled Trials: ISRCTN 71327395, registered 7 June 2010.

Etiology of Ibrutinib Discontinuation and Outcomes in Chronic Lymphocytic Leukemia Patients

PubMed Central

Maddocks, Kami J.; Ruppert, Amy S.; Lozanski, Gerard; Heerema, Nyla A.; Zhao, Weiqiang; Abruzzo, Lynne; Lozanski, Arletta; Davis, Melanie; Gordon, Amber; Smith, Lisa L.; Mantel, Rose; Jones, Jeffrey A.; Flynn, Joseph M.; Jaglowski, Samantha M.; Andritsos, Leslie A.; Awan, Farrukh; Blum, Kristie A.; Grever, Michael R.; Johnson, Amy J.; Byrd, John C.; Woyach, Jennifer A.

2015-01-01

Importance The Bruton’s Tyrosine Kinase inhibitor ibrutinib is effective in patients with chronic lymphocytic leukemia (CLL). Reasons for discontinuation from this drug and outcomes following discontinuation have not been evaluated outside of clinical trials with relatively short follow-up. Objective To determine features associated with discontinuation of ibrutinib and outcomes. Design 308 patients participating in four sequential trials of ibrutinib were included. These trials accrued patients included in this analysis from May 2010 until April 2014, and data were locked in June 2014. Setting The Ohio State University Comprehensive Cancer Center Participants Patients with CLL enrolled on 4 sequential clinical trials. Main Outcome Measure Patients were evaluated for time to discontinuation, reasons for discontinuation, and survival following discontinuation. For patients who discontinued due to progression, targeted deep sequencing was performed in samples at baseline and relapse. Results With a median follow-up of 20 months, 232 patients remain on therapy, 31 have discontinued because of progression, and 45 have discontinued for other reasons. Disease progression includes Richter’s transformation or progressive CLL. Richter’s appeared to occur early and CLL progressions later (cumulative incidence at 12 months: 4.5% (95% CI: 2.0% to 7.0%) and 0.3% (95% CI: 0% to 1.0%), respectively). Median survival following Richter’s transformation was 3.5 months (95% CI: 0.3–6.0), and 17.6 months (95% CI: 4.7-not reached) following CLL progression. Sequencing on peripheral blood from 8 patients with Richter’s transformation revealed 2 with mutations in BTK, and a lymph node sample showed no mutations in BTK or PLCγ2. Deep sequencing on 11 patients with CLL progression revealed BTK or PLCγ2 mutations in all. These mutations were not identified pre-treatment in any patient. Conclusions and Relevance This single institution experience with ibrutinib confirms it to be an effective therapy and identifies, for the first time, baseline factors associated with ibrutinib discontinuation. Outcomes data show poor prognosis after discontinuation, especially for those patients with Richter’s transformation. Finally, sequencing data confirm initial reports associating mutations in BTK and PLCγ2 with progression and clearly show that CLL progressions are associated with these mutations, while Richter’s transformation is likely not. PMID:26182309

Early blood glucose profile and neurodevelopmental outcome at two years in neonatal hypoxic-ischaemic encephalopathy

PubMed Central

2011-01-01

Background To examine the blood glucose profile and the relationship between blood glucose levels and neurodevelopmental outcome in term infants with hypoxic-ischaemic encephalopathy. Methods Blood glucose values within 72 hours of birth were collected from 52 term infants with hypoxic-ischaemic encephalopathy. Hypoglycaemia [< 46.8 mg/dL (2.6 mmol/L)] and hyperglycaemia [> 150 mg/dL (8.3 mmol/L)] were correlated to neurodevelopmental outcome at 24 months of age. Results Four fifths of the 468 blood samples were in the normoglycaemic range (392/468:83.8%). Of the remaining 76 samples, 51.3% were in the hypoglycaemic range and (48.7%) were hyperglycaemic. A quarter of the hypoglycaemic samples (28.2%:11/39) and a third of the hyperglycaemic samples (32.4%:12/37) were recorded within the first 30 minutes of life. Mean (SD) blood glucose values did not differ between infants with normal and abnormal outcomes [4.89(2.28) mmol/L and 5.02(2.35) mmol/L, p value = 0.15] respectively. In term infants with hypoxic-ischaemic encephalopathy, early hypoglycaemia (between 0-6 hours of life) was associated with adverse outcome at 24 months of age [OR = 5.8, CI = 1.04-32)]. On multivariate analysis to adjust for grade of HIE this association was not statistically significant. Late hypoglycaemia (6-72 hours of life) was not associated with abnormal outcome [OR = 0.22, CI (0.04-1.14)]. The occurrence of hyperglycaemia was not associated with adverse outcome. Conclusion During the first 72 hours of life, blood glucose profile in infants with hypoxic-ischaemic encephalopathy varies widely despite a management protocol. Early hypoglycaemia (0-6 hours of life) was associated with severe HIE, and thereby; adverse outcome. PMID:21294901

Comparison of anticipated and actual control group outcomes in randomised trials in paediatric oncology provides evidence that historically controlled studies are biased in favour of the novel treatment.

PubMed

Moroz, Veronica; Wilson, Jayne S; Kearns, Pamela; Wheatley, Keith

2014-12-10

Historically controlled studies are commonly undertaken in paediatric oncology, despite their potential biases. Our aim was to compare the outcome of the control group in randomised controlled trials (RCTs) in paediatric oncology with those anticipated in the sample size calculations in the protocols. Our rationale was that, had these RCTs been performed as historical control studies instead, the available outcome data used to calculate the sample size in the RCT would have been used as the historical control outcome data. A systematic search was undertaken for published paediatric oncology RCTs using the Cochrane Central Register of Controlled Trials (CENTRAL) database from its inception up to July 2013. Data on sample size assumptions and observed outcomes (timetoevent and proportions) were extracted to calculate differences between randomised and historical control outcomes, and a one-sample t-test was employed to assess whether the difference between anticipated and observed control groups differed from zero. Forty-eight randomised questions were included. The median year of publication was 2005, and the range was from 1976 to 2010. There were 31 superiority and 11 equivalence/noninferiority randomised questions with time-to-event outcomes. The median absolute difference between observed and anticipated control outcomes was 5.0% (range: -23 to +34), and the mean difference was 3.8% (95% CI: +0.57 to +7.0; P = 0.022). Because the observed control group (that is, standard treatment arm) in RCTs performed better than anticipated, we found that historically controlled studies that used similar assumptions for the standard treatment were likely to overestimate the benefit of new treatments, potentially leading to children with cancer being given ineffective therapy that may have additional toxicity.

Impact of cooking and home food preparation interventions among adults: outcomes and implications for future programs

PubMed Central

Reicks, Marla; Trofholz, Amanda C.; Stang, Jamie S; Laska, Melissa N.

2014-01-01

Objective Cooking programs are growing in popularity; however an extensive review has not examined overall impact. Therefore, this study reviewed previous research on cooking/home food preparation interventions and diet and health-related outcomes among adults and identified implications for practice and research. Design Literature review and descriptive summative method. Main outcome measures Dietary intake, knowledge/skills, cooking attitudes and self-efficacy/confidence, health outcomes. Analysis Articles evaluating effectiveness of interventions that included cooking/home food preparation as the primary aim (January 1980 through December 2011) were identified via OVID MEDLINE, Agricola and Web of Science databases. Studies grouped according to design and outcomes were reviewed for validity using an established coding system. Results were summarized for several outcome categories. Results Of 28 studies identified, 12 included a control group with six as non-randomized and six as randomized controlled trials. Evaluation was done post-intervention for five studies, pre- and post-intervention for 23 and beyond post-intervention for 15. Qualitative and quantitative measures suggested a positive influence on main outcomes. However, non-rigorous study designs, varying study populations, and use of non-validated assessment tools limited stronger conclusions. Conclusions and Implications Well-designed studies are needed that rigorously evaluate long-term impact on cooking behavior, dietary intake, obesity and other health outcomes. PMID:24703245

Main and interaction effects of iron, zinc, lead, and parenting on children's cognitive outcomes.

PubMed

Hubbs-Tait, Laura; Mulugeta, Afework; Bogale, Alemtsehay; Kennedy, Tay S; Baker, Eric R; Stoecker, Barbara J

2009-01-01

This study examined relations of blood lead < 10 microg/dL, iron, zinc, and parenting to Head Start children's (N = 112) scores on Peabody Picture Vocabulary Test-III (PPVT-III) and McCarthy Scales of Children's Abilities (MSCA). Venous whole blood and plasma samples were analyzed for lead and zinc by ICP-MS and iron status was assessed by serum transferrin receptors. Hierarchical regressions revealed significant effects of lead on MSCA perceptual scores and iron on PPVT-III and MSCA verbal scores. Children with lead > 2.5 microg/dL had significantly lower MSCA perceptual scores than children < 2.5 microg/dL. Permissive parenting significantly exacerbated negative effects of higher lead or lower iron on children's perceptual or verbal scores, respectively.

Action Civics for Promoting Civic Development: Main Effects of Program Participation and Differences by Project Characteristics

PubMed Central

Cohen, Alison K.; Littenberg-Tobias, Joshua

2017-01-01

Using both quantitative and qualitative data, this study examined the effect of participating in an action civics intervention, Generation Citizen (GC), on civic commitment, civic self-efficacy, and two forms of civic knowledge. The sample consisted of 617 middle and high schools students in 55 classrooms who participated, or were soon to participate, in Generation Citizen. Hierarchical linear models revealed that participating in Generation Citizen was associated with positive gains in action civics knowledge and civic self-efficacy. Qualitative coding identified three types of project characteristics that captured variability in the action projects student chose to complete: context, content, and contact with decision makers. Interactions between project characteristics and participation in GC revealed differences in civic outcomes depending on project characteristics. PMID:27982470

Lactobacillus plantarum 299v for the treatment of recurrent Clostridium difficile-associated diarrhoea: a double-blind, placebo-controlled trial.

PubMed

Wullt, Marlene; Hagslätt, Marie-Louise Johansson; Odenholt, Inga

2003-01-01

A double-blind, placebo-controlled trial was performed to analyse the ability of Lactobacillus plantarum 299v to prevent further recurrent episodes of Clostridium difficile-associated diarrhoea (RCDAD). Recurrence of clinical symptoms (main outcome) was seen in 4 of 11 patients who received metronidazole in combination with L. plantarum 299v and in 6 of 9 treated with metronidazole in combination with placebo. The lactobacilli treatment had no side-effects. Although the small sample size does not allow any conclusion to be drawn concerning the efficacy of L. plantarum in patients with RCDAD, these results may contribute to the ongoing discussion about the benefits of probiotics in patients with RCDAD and encourage the performance of larger multicentre studies.

Chemical Characterization of Potentially Prebiotic Oligosaccharides in Brewed Coffee and Spent Coffee Grounds.

PubMed

Tian, Tian; Freeman, Samara; Corey, Mark; German, J Bruce; Barile, Daniela

2017-04-05

Oligosaccharides are indigestible carbohydrates widely present in mammalian milk and in some plants. Milk oligosaccharides are associated with positive health outcomes; however, oligosaccharides in coffee have not been extensively studied. We investigated the oligosaccharides and their monomeric composition in dark roasted coffee beans, brewed coffee, and spent coffee grounds. Oligosaccharides with a degree of polymerization ranging from 3 to 15, and their constituent monosaccharides, were characterized and quantified. The oligosaccharides identified were mainly hexoses (potentially galacto-oligosaccharides and manno-oligosaccharides) containing a heterogeneous mixture of glucose, arabinose, xylose, and rhamnose. The diversity of oligosaccharides composition found in these coffee samples suggests that they could have selective prebiotic activity toward specific bacterial strains able to deconstruct the glycosidic bonds and utilize them as a carbon source.

Assessment of Environmental Cockroach Allergen Exposure

PubMed Central

Chew, Ginger L.

2016-01-01

In the past, cockroach allergen exposure assessment mainly focused on settled dust in homes in low-income urban cities in the United States. That choice was not wrong; without measureable levels of cockroach allergen, it is difficult to show associations with any home characteristics much less with health outcomes (e.g., allergy, asthma). However, recent studies in other suburban areas, schools, and other countries have elucidated the importance of cockroach allergen in these environments too. In addition, characterizing the underlying factors that give rise to cockroach allergen exposure (or protect against it) can lead to more targeted public health interventions. This review discusses different approaches to sampling indoor environments, interprets recent asthma and allergy studies, compares cockroach allergen levels from past studies with those of recent studies, and describes strategies to decrease exposures. PMID:22825884

OMERACT-based fibromyalgia symptom subgroups: an exploratory cluster analysis.

PubMed

Vincent, Ann; Hoskin, Tanya L; Whipple, Mary O; Clauw, Daniel J; Barton, Debra L; Benzo, Roberto P; Williams, David A

2014-10-16

The aim of this study was to identify subsets of patients with fibromyalgia with similar symptom profiles using the Outcome Measures in Rheumatology (OMERACT) core symptom domains. Female patients with a diagnosis of fibromyalgia and currently meeting fibromyalgia research survey criteria completed the Brief Pain Inventory, the 30-item Profile of Mood States, the Medical Outcomes Sleep Scale, the Multidimensional Fatigue Inventory, the Multiple Ability Self-Report Questionnaire, the Fibromyalgia Impact Questionnaire-Revised (FIQ-R) and the Short Form-36 between 1 June 2011 and 31 October 2011. Hierarchical agglomerative clustering was used to identify subgroups of patients with similar symptom profiles. To validate the results from this sample, hierarchical agglomerative clustering was repeated in an external sample of female patients with fibromyalgia with similar inclusion criteria. A total of 581 females with a mean age of 55.1 (range, 20.1 to 90.2) years were included. A four-cluster solution best fit the data, and each clustering variable differed significantly (P <0.0001) among the four clusters. The four clusters divided the sample into severity levels: Cluster 1 reflects the lowest average levels across all symptoms, and cluster 4 reflects the highest average levels. Clusters 2 and 3 capture moderate symptoms levels. Clusters 2 and 3 differed mainly in profiles of anxiety and depression, with Cluster 2 having lower levels of depression and anxiety than Cluster 3, despite higher levels of pain. The results of the cluster analysis of the external sample (n = 478) looked very similar to those found in the original cluster analysis, except for a slight difference in sleep problems. This was despite having patients in the validation sample who were significantly younger (P <0.0001) and had more severe symptoms (higher FIQ-R total scores (P = 0.0004)). In our study, we incorporated core OMERACT symptom domains, which allowed for clustering based on a comprehensive symptom profile. Although our exploratory cluster solution needs confirmation in a longitudinal study, this approach could provide a rationale to support the study of individualized clinical evaluation and intervention.

Are Treatment Outcomes Determined by Type of Gambling? A UK Study.

PubMed

Ronzitti, Silvia; Soldini, Emiliano; Smith, Neil; Bayston, Andrew; Clerici, Massimo; Bowden-Jones, Henrietta

2018-01-30

One of the main difficulties faced in treating gambling disorder is compliance with psychological treatment. Gambling takes many forms and can differ greatly in its features such as speed of play and skill requirements. The type of gambling a pathological gambler opts for may play a key role in treatment compliance. The aim of the present study was to determine whether within treatment seeking sample of gambling disorder clients, gambling activity has any correlation with their resultant treatment outcomes. The study incorporated 524 treatment-seeking individuals who are clients of the National Problem Gambling Clinic in London. All of the clients were assessed prior to treatment and fulfilled the Problem Gambling Severity Index criteria for problem gambling. Data concerning clients' gambling behavior over the previous year was gathered using self-reports. Subsequently, the data was fitted to a multinomial logistic regression model, with the treatment outcome (i.e. pre-treatment dropouts, during treatment dropouts, and completed treatment) as the dependent variable and gambling behavior as the independent variable, whilst controlling for socio-demographic factors. The use of gaming machines was a significant predictor of dropping out pre-treatment (p < 0.05, RRR 1.616), whilst betting on sports events was a significant predictor of dropping out during treatment (p < 0.01, RRR 2.435). Treatment outcomes have been found to significantly differ based on participation in certain gambling activities. Further research into the salient features of these gambling activities may help to further explain pre-treatment and during treatment dropouts within this population.

Transcutaneous electrical nerve stimulation and interferential current demonstrate similar effects in relieving acute and chronic pain: a systematic review with meta-analysis.

PubMed

Almeida, Camila Cadena de; Silva, Vinicius Z Maldaner da; Júnior, Gerson Cipriano; Liebano, Richard Eloin; Durigan, Joao Luiz Quagliotti

2018-02-02

Transcutaneous electrical nerve stimulation and interferential current have been widely used in clinical practice. However, a systematic review comparing their effects on pain relief has not yet been performed. To investigate the effects of transcutaneous electrical nerve stimulation and interferential current on acute and chronic pain. We use Pubmed, Embase, LILACS, PEDro and Cochrane Central Register of Controlled Trials as data sources. Two independent reviewers that selected studies according to inclusion criteria, extracted information of interest and verified the methodological quality of the studies made study selection. The studies were selected if transcutaneous electrical nerve stimulation and interferential current were used as treatment and they had pain as the main outcome, as evaluated by a visual analog scale. Secondary outcomes were the Western Ontario Macmaster and Rolland Morris Disability questionnaires, which were added after data extraction. Eight studies with a pooled sample of 825 patients were included. The methodological quality of the selected studies was moderate, with an average of six on a 0-10 scale (PEDro). In general, both transcutaneous electrical nerve stimulation and interferential current improved pain and functional outcomes without a statistical difference between them. Transcutaneous electrical nerve stimulation and interferential current have similar effects on pain outcome The low number of studies included in this meta-analysis indicates that new clinical trials are needed. Copyright © 2018 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

Toward a new understanding of legacy of early attachments for future antisocial trajectories: Evidence from two longitudinal studies

PubMed Central

KOCHANSKA, GRAZYNA; KIM, SANGHAG

2013-01-01

Early parent–child attachment has been extensively explored as a contributor to children’s future adaptive or antisocial outcomes, but the specific developmental mechanisms remain to be fully understood. We examined long-term indirect developmental sequelae of early security in two longitudinal community samples followed from infancy to early school age: the Family Study (102 mothers, fathers, and infants) and the Parent–Child Study (112 mothers and infants). Constructs at multiple levels (child characteristics, parent–child security, parental discipline, and child antisocial outcomes) were assessed using a range of methods (extensive behavioral observations in a variety of settings, informants’ ratings). Both studies supported the proposed model of infant attachment as a potent catalyst that moderates future developmental socialization trajectories, despite having few long-term main effects. In insecure dyads, a pattern of coercion emerged between children who were anger prone as toddlers and their parents, resulting in parents’ increased power-assertive discipline. Power assertion in turn predicted children’s rule-breaking conduct and a compromised capacity to delay in laboratory paradigms, as well as oppositional, disruptive, callous, and aggressive behavior rated by parents and teachers at early school age. This causal chain was absent in secure dyads, where child anger proneness was unrelated to power assertion, and power assertion was unrelated to antisocial outcomes. Early insecurity appeared to act as a catalyst for the parent–child dyad embarking on a mutually adversarial path toward antisocial outcomes, whereas security defused such a maladaptive dynamic. The possible mechanisms of those effects were proposed. PMID:22781855

Which parenting style is more protective against adolescent substance use? Evidence within the European context.

PubMed

Calafat, Amador; García, Fernando; Juan, Montse; Becoña, Elisardo; Fernández-Hermida, José Ramón

2014-05-01

This study examines whether authoritative parenting style (characterized by warmth and strictness) is more protective against adolescent substances use than authoritarian (strictness but not warmth), indulgent (warmth but not strictness) and neglectful (neither warmth nor strictness) parenting styles. Emergent research in diverse cultural contexts (mainly Southern European and Latin American countries) questions the fact that authoritative would always be the optimum parenting style. Multi-factorial MANOVAs. A sample of 7718 adolescents, 3774 males (48.9%), 11-19 year-olds (M=14.63 year-olds, SD=1.9 years) from Sweden, United Kingdom, Spain, Portugal, Slovenia, and the Czech Republic. Parenting style dimensions (warmth and strictness) and adolescent substance use (alcohol, tobacco, and illegal drugs); additionally another three adolescent outcomes were also measured (self-esteem, school performance and personal disturbances) all of them related in the literature with substance use. Both indulgent and authoritative parenting styles were associated with better outcomes than authoritarian and neglectful parenting in all the countries studied. Overall, our results support the idea that in Europe the indulgent parenting style performs as well as the authoritative one since adolescents' scores in the youth outcomes were equal (on substance use and personal disturbances) or even better (on self esteem and school performance) than for authoritative parenting style. Parenting styles relate to substance use and other outcomes in the same way in different countries explored. The so-called indulgent parenting style appears to be as good as the authoritative in protecting against substance abuse. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Methodologic considerations in the design and analysis of nested case-control studies: association between cytokines and postoperative delirium.

PubMed

Ngo, Long H; Inouye, Sharon K; Jones, Richard N; Travison, Thomas G; Libermann, Towia A; Dillon, Simon T; Kuchel, George A; Vasunilashorn, Sarinnapha M; Alsop, David C; Marcantonio, Edward R

2017-06-06

The nested case-control study (NCC) design within a prospective cohort study is used when outcome data are available for all subjects, but the exposure of interest has not been collected, and is difficult or prohibitively expensive to obtain for all subjects. A NCC analysis with good matching procedures yields estimates that are as efficient and unbiased as estimates from the full cohort study. We present methodological considerations in a matched NCC design and analysis, which include the choice of match algorithms, analysis methods to evaluate the association of exposures of interest with outcomes, and consideration of overmatching. Matched, NCC design within a longitudinal observational prospective cohort study in the setting of two academic hospitals. Study participants are patients aged over 70 years who underwent scheduled major non-cardiac surgery. The primary outcome was postoperative delirium from in-hospital interviews and medical record review. The main exposure was IL-6 concentration (pg/ml) from blood sampled at three time points before delirium occurred. We used nonparametric signed ranked test to test for the median of the paired differences. We used conditional logistic regression to model the risk of IL-6 on delirium incidence. Simulation was used to generate a sample of cohort data on which unconditional multivariable logistic regression was used, and the results were compared to those of the conditional logistic regression. Partial R-square was used to assess the level of overmatching. We found that the optimal match algorithm yielded more matched pairs than the greedy algorithm. The choice of analytic strategy-whether to consider measured cytokine levels as the predictor or outcome-- yielded inferences that have different clinical interpretations but similar levels of statistical significance. Estimation results from NCC design using conditional logistic regression, and from simulated cohort design using unconditional logistic regression, were similar. We found minimal evidence for overmatching. Using a matched NCC approach introduces methodological challenges into the study design and data analysis. Nonetheless, with careful selection of the match algorithm, match factors, and analysis methods, this design is cost effective and, for our study, yields estimates that are similar to those from a prospective cohort study design.

Physiotherapy for sleep disturbance in chronic low back pain: a feasibility randomised controlled trial

PubMed Central

2010-01-01

Background Sleep disturbance is becoming increasingly recognised as a clinically important symptom in people with chronic low back pain (CLBP, low back pain >12 weeks), associated with physical inactivity and depression. Current research and international clinical guidelines recommend people with CLBP assume a physically active role in their recovery to prevent chronicity, but the high prevalence of sleep disturbance in this population may be unknowingly limiting their ability to participate in exercise-based rehabilitation programmes and contributing to poor outcomes. There is currently no knowledge concerning the effectiveness of physiotherapy on sleep disturbance in people with chronic low back pain and no evidence of the feasibility of conducting randomized controlled trials that comprehensively evaluate sleep as an outcome measure in this population. Methods/Design This study will evaluate the feasibility of a randomised controlled trial (RCT), exploring the effects of three forms of physiotherapy (supervised general exercise programme, individualized walking programme and usual physiotherapy, which will serve as the control group) on sleep quality in people with chronic low back pain. A presenting sample of 60 consenting patients will be recruited in the physiotherapy department of Beaumont Hospital, Dublin, Ireland, and randomly allocated to one of the three groups in a concealed manner. The main outcomes will be sleep quality (self-report and objective measurement), and self-reported functional disability, pain, quality of life, fear avoidance, anxiety and depression, physical activity, and patient satisfaction. Outcome will be evaluated at baseline, 3 months and 6 months. Qualitative telephone interviews will be embedded in the research design to obtain feedback from a sample of participants' about their experiences of sleep monitoring, trial participation and interventions, and to inform the design of a fully powered future RCT. Planned analysis will explore trends in the data, effect sizes and clinically important effects (quantitative data), and thematic analysis (qualitative data). Discussion This study will evaluate the feasibility of a randomised controlled trial exploring the effects of three forms of physiotherapy (supervised general exercise programme, individualized walking programme and usual physiotherapy, which will serve as the control group) on sleep quality in people with chronic low back pain. Trial Registration Current controlled trial ISRCTN54009836 PMID:20398349

Postnatal Depression among Rural Women in South India: Do Socio-Demographic, Obstetric and Pregnancy Outcome Have a Role to Play?

PubMed Central

Shivalli, Siddharudha; Gururaj, Nandihal

2015-01-01

Introduction Postnatal depression (PND) is one of the most common psychopathology and is considered as a serious public health issue because of its devastating effects on mother, family, and infant or the child. Objective To elicit socio-demographic, obstetric and pregnancy outcome predictors of Postnatal Depression (PND) among rural postnatal women in Karnataka state, India. Design Hospital based analytical cross sectional study Setting A rural tertiary care hospital of Mandya District, Karnataka state, India. Sample PND prevalence based estimated sample of 102 women who came for postnatal follow up from 4th to 10th week of lactation. Method Study participants were interviewed using validated kannada version of Edinburgh Postnatal Depression Scale (EPDS). Cut-off score of ≥13 was used as high risk of PND. The percentage of women at risk of PND was estimated, and differences according to socio-demographic, obstetric and pregnancy outcome were described. Logistic regression was applied to identify the independent predictors of PND risk. Main Outcome Measures Prevalence, Odds ratio (OR) and adjusted (adj) OR of PND Results Prevalence of PND was 31.4% (95% CI 22.7–41.4%). PND showed significant (P<0.05) association with joint family, working women, non-farmer husbands, poverty, female baby and pregnancy complications or known medical illness. In binomial logistic regression poverty (adjOR: 11.95, 95% CI:1.36–105), birth of female baby (adjOR: 3.6, 95% CI:1.26–10.23) and pregnancy complications or known medical illness (adjOR: 17.4, 95% CI:2.5–121.2) remained as independent predictors of PND. Conclusion Risk of PND among rural postnatal women was high (31.4%). Birth of female baby, poverty and complications in pregnancy or known medical illness could predict the high risk of PND. PND screening should be an integral part of postnatal care. Capacity building of grass root level workers and feasibility trials for screening PND by them are needed. PMID:25848761

Characterizing decision-making and reward processing in bipolar disorder: A cluster analysis.

PubMed

Jiménez, E; Solé, B; Arias, B; Mitjans, M; Varo, C; Reinares, M; Bonnín, C M; Salagre, E; Ruíz, V; Torres, I; Tomioka, Y; Sáiz, P A; García-Portilla, M P; Burón, P; Bobes, J; Martínez-Arán, A; Torrent, C; Vieta, E; Benabarre, A

2018-05-25

The presence of abnormalities in emotional decision-making and reward processing among bipolar patients (BP) has been well rehearsed. These disturbances are not limited to acute phases and are common even during remission. In recent years, the existence of discrete cognitive profiles in this psychiatric population has been replicated. However, emotional decision making and reward processing domains have barely been studied. Therefore, our aim was to explore the existence of different profiles on the aforementioned cognitive dimensions in BP. The sample consisted of 126 euthymic BP. Main sociodemographic, clinical, functioning, and neurocognitive variables were gathered. A hierarchical-clustering technique was used to identify discrete neurocognitive profiles based on the performance in the Iowa Gambling Task. Afterward, the resulting clusters were compared using ANOVA or Chi-squared Test, as appropriate. Evidence for the existence of three different profiles was provided. Cluster 1 was mainly characterized by poor decision ability. Cluster 2 presented the lowest sensitivity to punishment. Finally, cluster 3 presented the best decision-making ability and the highest levels of punishment sensitivity. Comparison between the three clusters indicated that cluster 2 was the most functionally impaired group. The poorest outcomes in attention, executive function domains, and social cognition were also observed within the same group. In conclusion, similarly to that observed in "cold cognitive" domains, our results suggest the existence of three discrete cognitive profiles concerning emotional decision making and reward processing. Amongst all the indexes explored, low punishment sensitivity emerge as a potential correlate of poorer cognitive and functional outcomes in bipolar disorder. Copyright © 2018 Elsevier B.V. and ECNP. All rights reserved.

Relationship of Psychosocial Resources with Allostatic Load: A Systematic Review

PubMed Central

Wiley, Joshua F.; Bei, Bei; Bower, Julienne E.; Stanton, Annette L.

2016-01-01

Objective Allostatic load (AL) represents cumulative wear-and-tear on the body, and is operationalized as a multi-system index of biomarkers. AL is associated with morbidities and mortality, leading to a growing body of literature that uses AL as an outcome on its own right. Psychosocial resources (PSRs), such as mastery and social support, may influence health outcomes in part via AL, and the current review seeks to characterize the relations between PSRs and AL. Methods A systematic review was conducted by searching PubMed, CINAHL Plus, PsycINFO, Scopus, and Embase for studies examining the relation between PSR(s) and AL in humans. From 1,417 abstracts screened, 60 full-text articles were reviewed, and 24 studies met inclusion criteria. Results Mixed evidence exists for a relationship between PSRs and AL. Most (14/24) studies used a cross-sectional design and only one study investigated whether a PSR predicted change in AL. Compared to cross-sectional studies, longitudinal studies were more likely to report a significant relationship (8/14 versus 8/10, respectively). Studies with statistically significant main or moderated effects had larger sample sizes than those reporting null effects. Whether a study reported a significant main or moderated relationship did not differ by whether psychological (8/11) or social (10/16) resources were assessed. Conclusions Evidence for a relationship between PSRs and AL is equivocal, and obtained significant relationships are generally small in magnitude. Gaps in the current literature and directions for future research are discussed. Longitudinal studies are needed that repeatedly assess PSRs and AL. PMID:27768647

Combining employment and family in Europe: the role of family policies in health.

PubMed

Artazcoz, Lucía; Cortès, Imma; Puig-Barrachina, Vanessa; Benavides, Fernando G; Escribà-Agüir, Vicenta; Borrell, Carme

2014-08-01

The objectives of this study were: (i) to analyse the relationship between health status and paid working hours and household composition in the EU-27, and (ii) to examine whether patterns of association differ as a function of family policy typologies and gender. Cross-sectional study based on data from the 5th European Working Conditions Survey of 2010. The sample included married or cohabiting employees aged 25-64 years from the EU-27 (10,482 men and 8,882 women). The dependent variables were self-perceived health status and psychological well-being. Irrespective of differences in family policy typologies between countries, working long hours was more common among men, and part-time work was more common among women. In Continental and Southern European countries, employment and family demands were associated with poor health status in both sexes, but more consistently among women. In Anglo-Saxon countries, the association was mainly limited to men. Finally, in Nordic and Eastern European countries, employment and family demands were largely unassociated with poor health outcomes in both sexes. The combination of employment and family demands is largely unassociated with health status in countries with dual-earner family policy models, but is associated with poorer health outcomes in countries with market-oriented models, mainly among men. This association is more consistent among women in countries with traditional models, where males are the breadwinners and females are responsible for domestic and care work. © The Author 2013. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Treatment effectiveness of PMTO for children's behavior problems in Iceland: assessing parenting practices in a randomized controlled trial.

PubMed

Sigmarsdóttir, Margrét; Degarmo, David S; Forgatch, Marion S; Guðmundsdóttir, Edda Vikar

2013-12-01

Findings are presented from an Icelandic randomized control trial (RCT) evaluating parent management training - Oregon model (PMTO™), a parent training intervention designed to improve parenting practices and reduce child behavior problems. In a prior report from this effectiveness study that focused on child outcomes, children in the PMTO condition showed greater reductions in reported child adjustment problems relative to the comparison group. The present report focuses on observed parenting practices as the targeted outcome, with risk by treatment moderators also tested. It was hypothesized that mothers assigned to the PMTO condition would show greater gains in pre-post parenting practices relative to controls. The sample was recruited from five municipalities throughout Iceland and included 102 participating families of children with behavior problems. Cases were referred by community professionals and randomly assigned to either PMTO (n = 51) or community services usually offered (n = 51). Child age ranged from 5 to 12 years; 73% were boys. Contrary to expectations, findings showed no main effects for changes in maternal parenting. However, evaluation of risk by treatment moderators showed greater gains in parenting practices for mothers who increased in depressed mood within the PMTO group relative to their counterparts in the comparison group. This finding suggests that PMTO prevented the expected damaging effects of depression on maternal parenting. Failure to find hypothesized main effects may indicate that there were some unobserved factors regarding the measurement and a need to further adapt the global observational procedures to Icelandic culture. © 2013 The Scandinavian Psychological Associations.

Patient preferences and treatment safety for uncomplicated vulvovaginal candidiasis in primary health care

PubMed Central

2011-01-01

Background Vaginitis is a common complaint in primary care. In uncomplicated candidal vaginitis, there are no differences in effectiveness between oral or vaginal treatment. Some studies describe that the preferred treatment is the oral one, but a Cochrane's review points out inconsistencies associated with the report of the preferred way that limit the use of such data. Risk factors associated with recurrent vulvovaginal candidiasis still remain controversial. Methods/Design This work describes a protocol of a multicentric prospective observational study with one year follow up, to describe the women's reasons and preferences to choose the way of administration (oral vs topical) in the treatment of not complicated candidal vaginitis. The number of women required is 765, they are chosen by consecutive sampling. All of whom are aged 16 and over with vaginal discharge and/or vaginal pruritus, diagnosed with not complicated vulvovaginitis in Primary Care in Madrid. The main outcome variable is the preferences of the patients in treatment choice; secondary outcome variables are time to symptoms relief and adverse reactions and the frequency of recurrent vulvovaginitis and the risk factors. In the statistical analysis, for the main objective will be descriptive for each of the variables, bivariant analysis and multivariate analysis (logistic regression).. The dependent variable being the type of treatment chosen (oral or topical) and the independent, the variables that after bivariant analysis, have been associated to the treatment preference. Discussion Clinical decisions, recommendations, and practice guidelines must not only attend to the best available evidence, but also to the values and preferences of the informed patient. PMID:21281464

Augmentation of Conventional Medical Management of Moderately Severe or Severe Asthma with Acupuncture and Guided Imagery/Meditation

PubMed Central

Mehl-Madrona, Lewis

2008-01-01

Objective: I sought to determine if a combination of acupuncture and guided imagery could augment the conventional medical management of moderately severe or severe asthma. Design: This was an early-phase study with a convenience sample of self-selecting patients compared with self—year before, during treatment, and one year after treatment. Setting: Patients were recruited from an outpatient practice. Patients: All participants were adults with moderately severe or severe asthma (class 3 or 4). Interventions: The study employed acupuncture and guided imagery/meditation for a 24-week period. Main Outcome Measures: The main outcome measures were number of days of hospitalization, number of Emergency Department (ED) visits, number of physician visits, days per year taking steroids, puffs per week of inhaled β-agonists, FVC (forced vital capacity), FEV1 (forced expiratory volume in the first second), and FEF25-75 (forced expiratory flow between 25% and 75% of the FVC). Results: With the addition of acupuncture and guided imagery to conventional medical management, members of the study group experienced improvement. The number of hospitalized days and the number of ED visits not leading to hospitalizations decreased, as did number of medical visits and total days taking oral corticosteroids. Parameters of respiratory function improved despite reduced use of inhaled β-agonists. Conclusion: With acupuncture and guided imagery and meditation together, a self-selecting group of patients with moderately severe or severe asthma experienced improvement in respiratory function, taking less medication than before and having fewer emergencies and hospitalizations at a lower cost of care. PMID:21339915

Idiopathic environmental intolerance attributed to electromagnetic fields: a content analysis of British newspaper reports.

PubMed

Eldridge-Thomas, Buffy; Rubin, G James

2013-01-01

Idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) is a controversial condition in which people describe symptoms following exposure to electromagnetic fields from everyday electrical devices. However, double-blind experiments have found no convincing evidence that electromagnetic fields cause these symptoms. In this study, we assessed whether recent newspaper reporting in the UK reflected this scientific evidence. We searched a database of newspaper articles to identify all those that contained IEI-EMF related keywords and selected a random sample of 60 for content analysis. For our primary outcomes, we assessed how many articles mainly or wholly presented an electromagnetic cause for IEI-EMF and how many discussed unproven treatments for the condition such as strategies intended to reduce exposure to electromagnetic fields or the use of complementary and alternative therapies. We also assessed whether the type of information source used by a newspaper article (e.g. scientist, person with IEI-EMF, politician) or the type of newspaper (broadsheet, tabloid, local or regional) was associated with either outcome. Of the 60 articles, 43 (71.7%) presented a mainly electromagnetic cause, compared to 13 (21.7%) which presented mainly non-electromagnetic causes and 4 (6.7%) which did not discuss a cause. 29 (48.3%) did not mention any potential treatment, while 24 (40.0%) mentioned eletromagnetic field related strategies and 12 (20.0%) mentioned complementary or alternative therapies. Articles which quoted someone with IEI-EMF were significantly more likely to report an electromagnetic cause and to present unproven treatments. Those which used a scientist as a source were more likely to present a non-electromagnetic cause for the condition. The widespread poor reporting we identified is disappointing and has the potential for to encourage more people to misattribute their symptoms to electromagnetic fields. Scientists should remain engaged with the media to counteract this effect.

Health-related quality of life two years after injury due to terrorism.

PubMed

Tuchner, Maya; Meiner, Zeev; Parush, Shula; Hartman-Maeir, Adina

2010-01-01

During the past few decades, terrorist acts have been an unfortunate reality worldwide. There is a striking paucity of research investigating the multitude of long-term outcomes after severe physical injury due to terrorist attacks, a unique subgroup of trauma patients. The purpose of this study was to provide a profile of the long-term health-related quality of life (HR-QOL) after injury due to terrorist attacks and to explore the relationships between Post Traumatic Stress Disorder (PTSD), occupational status and injury severity with HR-QOL. We included 35 survivors of terrorist attacks living in the community, two years on average after the injury, mean age at follow-up = 32.1 (±13.8), mean Injury Severity Score (ISS) = 27 (±14.2). The subjects were recruited from consecutive admissions to a rehabilitation department in a tertiary care center between September 2000 - June 2004. Most of the subjects suffered multiple trauma. The main outcome measures were the Short-Form Health Survey (SF-36), Post Traumatic Diagnostic Scale and return to work rates. The mean scores on 6/8 of the SF-36 subscales were significantly lower among the survivors compared to normative population norms. Post Traumatic Stress Disorder (PTSD) was found in 39% of the sample and 43% did not resume their main occupation two years after the injury. Multivariate analysis of variance of PTSD and occupational status (returned vs. did not return to work) on quality of life scores revealed significant main effects for both PTSD (p=. 000) and occupational status (p=. 005) with no interaction effect (p=. 476). No significant correlations were found between injury severity and the SF-36 scores. This study demonstrated the long-term impact of injury due to terrorism. Results showed independent effects of PTSD and occupational status on health related quality of life, two years after injury. These findings suggest that this group may benefit from intervention focusing on their emotional and occupational status in order to improve their quality of life.

Functional outcome and patient satisfaction after laser in situ keratomileusis for correction of myopia and myopic astigmatism.

PubMed

Bamashmus, Mahfouth A; Hubaish, Khammash; Alawad, Mohammed; Alakhlee, Hisham

2015-01-01

The purpose was to evaluate subjective quality of vision and patient satisfaction after laser in situ keratomileusis (LASIK) for myopia and myopic astigmatism. A self-administered patient questionnaire consisting 29 items was prospectively administered to LASIK patients at the Yemen Magrabi Hospital. Seven scales covering specific aspects of the quality of vision were formulated including; global satisfaction; quality of uncorrected and corrected vision; quality of night vision; glare; daytime driving and; night driving. Main outcome measures were responses to individual questions and scale scores and correlations with clinical parameters. The scoring scale ranged from 1 (dissatisfied) to 3 (very satisfied) and was stratified in the following manner: 1-1.65 = dissatisfied; 1.66-2.33 = satisfied and; 2.33-3 = very satisfied. Data at 6 months postoperatively are reported. This study sample was comprised of 200 patients (122 females: 78 males) ranging in age from 18 to 46 years old. The preoperative myopic sphere was - 3.50 ± 1.70 D and myopic astigmatism was 0.90 ± 0.82 D. There were 96% of eyes within ± 1.00 D of the targeted correction. Postoperatively, the uncorrected visual acuity was 20/40 or better in 99% of eyes. The mean score for the overall satisfaction was 2.64 ± 0.8. A total of 98.5% of patients was satisfied or very satisfied with their surgery, 98.5% considered their main goal for surgery was achieved. Satisfaction with uncorrected vision was 2.5 ± 0.50. The main score for glare was 1.98 ± 0.7 at night. Night driving was rated more difficult preoperatively by 6.2%, whereas 79% had less difficulty driving at night. Patient satisfaction with uncorrected vision after LASIK for myopia and myopic astigmatism appears to be excellent and is related to the residual refractive error postoperatively.

Functional Outcome and Patient Satisfaction after Laser In Situ Keratomileusis for Correction of Myopia and Myopic Astigmatism

PubMed Central

Bamashmus, Mahfouth A.; Hubaish, Khammash; Alawad, Mohammed; Alakhlee, Hisham

2015-01-01

Purpose: The purpose was to evaluate subjective quality of vision and patient satisfaction after laser in situ keratomileusis (LASIK) for myopia and myopic astigmatism. Patients and Methods: A self-administered patient questionnaire consisting 29 items was prospectively administered to LASIK patients at the Yemen Magrabi Hospital. Seven scales covering specific aspects of the quality of vision were formulated including; global satisfaction; quality of uncorrected and corrected vision; quality of night vision; glare; daytime driving and; night driving. Main outcome measures were responses to individual questions and scale scores and correlations with clinical parameters. The scoring scale ranged from 1 (dissatisfied) to 3 (very satisfied) and was stratified in the following manner: 1-1.65 = dissatisfied; 1.66-2.33 = satisfied and; 2.33-3 = very satisfied. Data at 6 months postoperatively are reported. Results: This study sample was comprised of 200 patients (122 females: 78 males) ranging in age from 18 to 46 years old. The preoperative myopic sphere was − 3.50 ± 1.70 D and myopic astigmatism was 0.90 ± 0.82 D. There were 96% of eyes within ± 1.00 D of the targeted correction. Postoperatively, the uncorrected visual acuity was 20/40 or better in 99% of eyes. The mean score for the overall satisfaction was 2.64 ± 0.8. A total of 98.5% of patients was satisfied or very satisfied with their surgery, 98.5% considered their main goal for surgery was achieved. Satisfaction with uncorrected vision was 2.5 ± 0.50. The main score for glare was 1.98 ± 0.7 at night. Night driving was rated more difficult preoperatively by 6.2%, whereas 79% had less difficulty driving at night. Conclusion: Patient satisfaction with uncorrected vision after LASIK for myopia and myopic astigmatism appears to be excellent and is related to the residual refractive error postoperatively. PMID:25624684

Why did an effective Dutch complex psycho-social intervention for people with dementia not work in the German healthcare context? Lessons learnt from a process evaluation alongside a multicentre RCT.

PubMed

Voigt-Radloff, Sebastian; Graff, Maud; Leonhart, Rainer; Hüll, Michael; Rikkert, Marcel Olde; Vernooij-Dassen, Myrra

2011-08-09

Background The positive effects of the Dutch Community Occupational Therapy in Dementia programme on patients' daily functioning were not found in a multicentre randomised controlled trial (RCT) in Germany. Objectives To evaluate possible effect modification on the primary outcome within the German RCT with regard to (1) participant characteristics, (2) treatment performance and (3) healthcare service utilisation; and (4) to compare the design and primary outcome between the German and the original Dutch study. Methods (1) The impact of participant baseline data on the primary outcome was analysed in exploratory ANCOVA and regression analyses. (2) Therapists completed questionnaires on context and performance problems. The main problems were identified by a qualitative content analysis and focus-group discussion. Associations of the primary outcome with scores of participant adherence and treatment performance were evaluated by regression analysis. (3) Utilisation rates of healthcare services were controlled for significant group differences. (4) Differences in the Dutch and German study design were identified, and the primary outcome was contrasted at the item level. Results (1) Participant characteristics could not explain more than 5% of outcome variance. (2) The treatment performance of some active intervention components was poor but not significantly associated with the primary outcome. (3) There were no significant group differences in the utilisation of healthcare resources. (4) In contrast to the Dutch waiting-control group, the active intervention in the German control group may have reduced group differences in the current RCT. The German patients demonstrated a higher independence at baseline and less improvement in instrumental activities of daily living. Conclusion The differences in outcome may be explained by a more active control treatment, partially poor experimental treatment and less room for improvement in the German sample. Future cross-national transfers should be prepared by pilot studies assessing the applicability of the intervention and patient needs specific to the target country. Trial registration International Clinical Trials Registry Platform, DRKS00000053.

Clinical and social outcomes of adolescent self harm: population based birth cohort study

PubMed Central

Heron, Jon; Crane, Catherine; Hawton, Keith; Lewis, Glyn; Macleod, John; Tilling, Kate; Gunnell, David

2014-01-01

Objectives To investigate the mental health, substance use, educational, and occupational outcomes of adolescents who self harm in a general population sample, and to examine whether these outcomes differ according to self reported suicidal intent. Design Population based birth cohort study. Setting Avon Longitudinal Study of Parents and Children (ALSPAC), a UK birth cohort of children born in 1991-92. Participants Data on lifetime history of self harm with and without suicidal intent were available for 4799 respondents who completed a detailed self harm questionnaire at age 16 years. Multiple imputation was used to account for missing data. Main outcome measures Mental health problems (depression and anxiety disorder), assessed using the clinical interview schedule-revised at age 18 years, self reported substance use (alcohol, cannabis, cigarette smoking, and illicit drugs) at age 18 years, educational attainment at age 16 and 19 years, occupational outcomes at age 19 years, and self harm at age 21 years. Results Participants who self harmed with and without suicidal intent at age 16 years were at increased risk of developing mental health problems, future self harm, and problem substance misuse, with stronger associations for suicidal self harm than for non-suicidal self harm. For example, in models adjusted for confounders the odds ratio for depression at age 18 years was 2.21 (95% confidence interval 1.55 to 3.15) in participants who had self harmed without suicidal intent at age 16 years and 3.94 (2.67 to 5.83) in those who had self harmed with suicidal intent. Suicidal self harm, but not self harm without suicidal intent, was also associated with poorer educational and employment outcomes. Conclusions Adolescents who self harm seem to be vulnerable to a range of adverse outcomes in early adulthood. Risks were generally stronger in those who had self harmed with suicidal intent, but outcomes were also poor among those who had self harmed without suicidal intent. These findings emphasise the need for early identification and treatment of adolescents who self harm. PMID:25335825

Melancholic and atypical depression as predictor and moderator of outcome in cognitive behavior therapy and pharmacotherapy for adult depression.

PubMed

Cuijpers, Pim; Weitz, Erica; Lamers, Femke; Penninx, Brenda W; Twisk, Jos; DeRubeis, Robert J; Dimidjian, Sona; Dunlop, Boadie W; Jarrett, Robin B; Segal, Zindel V; Hollon, Steven D

2017-03-01

Melancholic and atypical depression are widely thought to moderate or predict outcome of pharmacological and psychological treatments of adult depression, but that has not yet been established. This study uses the data from four earlier trials comparing cognitive behavior therapy (CBT) versus antidepressant medications (ADMs; and pill placebo when available) to examine the extent to which melancholic and atypical depression moderate or predict outcome in an "individual patient data" meta-analysis. We conducted a systematic search for studies directly comparing CBT versus ADM, contacted the researchers, integrated the resulting datasets from these studies into one big dataset, and selected the studies that included melancholic or atypical depressive subtyping according to DSM-IV criteria at baseline (n = 4, with 805 patients). After multiple imputation of missing data at posttest, mixed models were used to conduct the main analyses. In none of the analyses was melancholic or atypical depression found to significantly moderate outcome (indicating a better or worse outcome of these patients in CBT compared to ADM; i.e., an interaction), predict outcome independent of treatment group (i.e., a main effect), or predict outcome within a given modality. The outcome differences between patients with melancholia or atypical depression versus those without were consistently very small (all effect sizes g < 0.10). We found no indication that melancholic or atypical depressions are significant or relevant moderators or predictors of outcome of CBT and ADM. © 2016 Wiley Periodicals, Inc.

Infant formula samples: perinatal sources and breast-feeding outcomes at 1 month postpartum.

PubMed

Thurston, Amanda; Bolin, Jocelyn H; Chezem, Jo Carol

2013-01-01

The purpose was to describe sources of infant formula samples during the perinatal period and assess their associations with breast-feeding outcomes at 1 month postpartum. Subjects included expectant mothers who anticipated breast-feeding at least 1 month. Infant feeding history and sources of formula samples were obtained at 1 month postpartum. Associations between sources and breast-feeding outcomes were assessed using partial correlation. Of the 61 subjects who initiated breast-feeding, most were white (87%), married (75%), college-educated (75%), and planned exclusive breast-feeding (82%). Forty-two subjects (69%) continued breast-feeding at 1 month postpartum. Subjects received formula samples from the hospital (n = 40; 66%), physician's office (n = 10; 16%), and mail (n = 41; 67%). There were no significant correlations between formula samples from the hospital, physician's office, and/or mail and any or exclusive breast-feeding at 1 month (P > .05). In addition to the hospital, a long-standing source of formula samples, mail was also frequently reported as a route for distribution. The lack of statistically significant associations between formula samples and any or exclusive breast-feeding at 1 month may be related to small sample size and unique characteristics of the group studied.

The Effect of Self-Efficacy on Return-to-Work Outcomes for Workers with Psychological or Upper-Body Musculoskeletal Injuries: A Review of the Literature.

PubMed

Black, Oliver; Keegel, Tessa; Sim, Malcolm R; Collie, Alexander; Smith, Peter

2018-03-01

Purpose Work absence can result in substantial losses to the economy and workers. As a result, identifying modifiable factors associated with return-to-work (RTW) following an injury or illness is the focus of many empirical investigations. Self-efficacy, the belief about one's ability to undertake behaviours to achieve desired goals, has been identified as an important factor in RTW for injured workers. This paper systematically reviewed the literature on the association between self-efficacy and RTW outcomes for workers with an upper-body musculoskeletal injury or psychological injury. Methods A systematic search was conducted across five databases using two main search concepts- 'self-efficacy' and 'RTW'. After removing duplicates, our search strategy identified 836 studies, which were screened for relevance using titles and abstracts. Results A two stage screening process reduced the study pool to six studies using psychological injury cohorts and three using upper-body musculoskeletal (UB-MSK) cohorts. Eight cohorts from seven prospective cohort studies and one sample from a randomised control trial (RCT) were subjected to a risk of bias assessment. Higher levels of self-efficacy appeared to have a consistent and positive association with RTW across return-to-work status and work absence outcomes, injury type and follow-up periods. Effect ratios ranged from 1.00 to 5.26 indicating a potentially large impact of self-efficacy on RTW outcomes. The relationship between self-efficacy and RTW strengthened as the domain of self-efficacy became more specific to RTW and job behaviours. Studies assessing workers with psychological injuries were of a lower quality compared to those assessing workers with UB-MSK injuries. Conclusions Higher self-efficacy had consistent positive associations with RTW outcomes. Further empirical research should identify the determinants of self-efficacy, and explore the processes by which higher self-efficacy improves RTW outcomes.

Uncovering the Benefits of Participatory Research: Implications of a Realist Review for Health Research and Practice

PubMed Central

Jagosh, Justin; Macaulay, Ann C; Pluye, Pierre; Salsberg, Jon; Bush, Paula L; Henderson, Jim; Sirett, Erin; Wong, Geoff; Cargo, Margaret; Herbert, Carol P; Seifer, Sarena D; Green, Lawrence W; Greenhalgh, Trisha

2012-01-01

Context Participatory research (PR) is the co-construction of research through partnerships between researchers and people affected by and/or responsible for action on the issues under study. Evaluating the benefits of PR is challenging for a number of reasons: the research topics, methods, and study designs are heterogeneous; the extent of collaborative involvement may vary over the duration of a project and from one project to the next; and partnership activities may generate a complex array of both short- and long-term outcomes. Methods Our review team consisted of a collaboration among researchers and decision makers in public health, research funding, ethics review, and community-engaged scholarship. We identified, selected, and appraised a large-variety sample of primary studies describing PR partnerships, and in each stage, two team members independently reviewed and coded the literature. We used key realist review concepts (middle-range theory, demi-regularity, and context-mechanism-outcome configurations [CMO]) to analyze and synthesize the data, using the PR partnership as the main unit of analysis. Findings From 7,167 abstracts and 591 full-text papers, we distilled for synthesis a final sample of twenty-three PR partnerships described in 276 publications. The link between process and outcome in these partnerships was best explained using the middle-range theory of partnership synergy, which demonstrates how PR can (1) ensure culturally and logistically appropriate research, (2) enhance recruitment capacity, (3) generate professional capacity and competence in stakeholder groups, (4) result in productive conflicts followed by useful negotiation, (5) increase the quality of outputs and outcomes over time, (6) increase the sustainability of project goals beyond funded time frames and during gaps in external funding, and (7) create system changes and new unanticipated projects and activities. Negative examples illustrated why these outcomes were not a guaranteed product of PR partnerships but were contingent on key aspects of context. Conclusions We used a realist approach to embrace the heterogeneity and complexity of the PR literature. This theory-driven synthesis identified mechanisms by which PR may add value to the research process. Using the middle-range theory of partnership synergy, our review confirmed findings from previous PR reviews, documented and explained some negative outcomes, and generated new insights into the benefits of PR regarding conflicts and negotiation between stakeholders, program sustainability and advancement, unanticipated project activity, and the generation of systemic change. PMID:22709390

Uncovering the benefits of participatory research: implications of a realist review for health research and practice.

PubMed

Jagosh, Justin; Macaulay, Ann C; Pluye, Pierre; Salsberg, Jon; Bush, Paula L; Henderson, Jim; Sirett, Erin; Wong, Geoff; Cargo, Margaret; Herbert, Carol P; Seifer, Sarena D; Green, Lawrence W; Greenhalgh, Trisha

2012-06-01

Participatory research (PR) is the co-construction of research through partnerships between researchers and people affected by and/or responsible for action on the issues under study. Evaluating the benefits of PR is challenging for a number of reasons: the research topics, methods, and study designs are heterogeneous; the extent of collaborative involvement may vary over the duration of a project and from one project to the next; and partnership activities may generate a complex array of both short- and long-term outcomes. Our review team consisted of a collaboration among researchers and decision makers in public health, research funding, ethics review, and community-engaged scholarship. We identified, selected, and appraised a large-variety sample of primary studies describing PR partnerships, and in each stage, two team members independently reviewed and coded the literature. We used key realist review concepts (middle-range theory, demi-regularity, and context-mechanism-outcome configurations [CMO]) to analyze and synthesize the data, using the PR partnership as the main unit of analysis. From 7,167 abstracts and 591 full-text papers, we distilled for synthesis a final sample of twenty-three PR partnerships described in 276 publications. The link between process and outcome in these partnerships was best explained using the middle-range theory of partnership synergy, which demonstrates how PR can (1) ensure culturally and logistically appropriate research, (2) enhance recruitment capacity, (3) generate professional capacity and competence in stakeholder groups, (4) result in productive conflicts followed by useful negotiation, (5) increase the quality of outputs and outcomes over time, (6) increase the sustainability of project goals beyond funded time frames and during gaps in external funding, and (7) create system changes and new unanticipated projects and activities. Negative examples illustrated why these outcomes were not a guaranteed product of PR partnerships but were contingent on key aspects of context. We used a realist approach to embrace the heterogeneity and complexity of the PR literature. This theory-driven synthesis identified mechanisms by which PR may add value to the research process. Using the middle-range theory of partnership synergy, our review confirmed findings from previous PR reviews, documented and explained some negative outcomes, and generated new insights into the benefits of PR regarding conflicts and negotiation between stakeholders, program sustainability and advancement, unanticipated project activity, and the generation of systemic change. © 2012 Milbank Memorial Fund.

Multilevel modelling of built environment characteristics related to neighbourhood walking activity in older adults

PubMed Central

Li, F.; Fisher, K; Brownson, R.; Bosworth, M.

2005-01-01

Objective: To examine the relation between built environment factors (representing several dimensions of urban form of neighbourhoods) and walking activity at both the neighbourhood level and the resident level, in an older adult sample. Design, setting, participants: A cross sectional, multilevel design with neighbourhoods as the primary sampling unit and senior residents as the secondary unit. Five hundred and seventy seven residents (mean age = 74 years, SD = 6.3 years) participated in the survey, which was conducted among 56 city defined neighbourhoods in Portland, Oregon, USA. Neighbourhood level variables were constructed using geographical information systems. Resident level variables consisted of a mix of self reports and geocoded data on the built environment. Main outcome measure: Self reported neighbourhood walking. Main results: A positive relation was found between built environment factors (density of places of employment, household density, green and open spaces for recreation, number of street intersections) and walking activity at the neighbourhood level. At the resident level, perceptions of safety for walking and number of nearby recreational facilities were positively related to high levels of walking activity. A significant interaction was observed between number of street intersections and perceptions of safety from traffic. Conclusions: Certain neighbourhood built environment characteristics related to urban form were positively associated with walking activity in the neighbourhoods of senior residents. Public health promotion of walking activity/urban mobility and the design of interventions need to consider the contribution of neighbourhood level built environment influences. PMID:15965138

Maternal employment and children's achievement in context: a meta-analysis of four decades of research.

PubMed

Goldberg, Wendy A; Prause, Joann; Lucas-Thompson, Rachel; Himsel, Amy

2008-01-01

This meta-analysis of 68 studies (770 effect sizes) used random effects models to examine whether children's achievement differed depending on whether their mothers were employed. Four achievement outcomes were emphasized: formal tests of achievement and intellectual functioning, grades, and teacher ratings of cognitive competence. When all employment was compared with nonemployment for combined and separate achievement outcomes without moderators, effects were nonsignificant. Small beneficial effects of part-time compared with full-time employment were apparent for all achievement outcomes combined and for each individual achievement outcome. Significant sample-level moderators of the associations between maternal employment and achievement for all outcomes combined included family structure, race/ethnicity, and socioeconomic status; associations were positive when samples were majority 1-parent families and mixed 1- and 2-parent families, racially/ethnically diverse or international in composition, and not middle-upper class. Analyses of child gender indicated more positive effects for girls. Children's age was a significant moderator for the outcome of intellectual functioning. The identification of sample-level moderators of the relationship between maternal employment and children's achievement highlights the importance of social context in understanding work-family linkages. Copyright (c) 2008 APA.

Quality Markers in Cardiology. Main Markers to Measure Quality of Results (Outcomes) and Quality Measures Related to Better Results in Clinical Practice (Performance Metrics). INCARDIO (Indicadores de Calidad en Unidades Asistenciales del Área del Corazón): A SEC/SECTCV Consensus Position Paper.

PubMed

López-Sendón, José; González-Juanatey, José Ramón; Pinto, Fausto; Cuenca Castillo, José; Badimón, Lina; Dalmau, Regina; González Torrecilla, Esteban; López-Mínguez, José Ramón; Maceira, Alicia M; Pascual-Figal, Domingo; Pomar Moya-Prats, José Luis; Sionis, Alessandro; Zamorano, José Luis

2015-11-01

Cardiology practice requires complex organization that impacts overall outcomes and may differ substantially among hospitals and communities. The aim of this consensus document is to define quality markers in cardiology, including markers to measure the quality of results (outcomes metrics) and quality measures related to better results in clinical practice (performance metrics). The document is mainly intended for the Spanish health care system and may serve as a basis for similar documents in other countries. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

A Semantic Differential Evaluation of Attitudinal Outcomes of Introductory Physical Science.

ERIC Educational Resources Information Center

Hecht, Alfred Roland

This study was designed to assess the attitudinal outcomes of Introductory Physical Science (IPS) curriculum materials used in schools. Random samples of 240 students receiving IPS instruction and 240 non-science students were assigned to separate Solomon four-group designs with non-equivalent control groups. Random samples of 60 traditional…

Academic Outcomes among a Sample of Learning Support Community College Students

ERIC Educational Resources Information Center

Skinner, Amy D.

2014-01-01

This research examined the relationship between placement in a learning support college program and subsequent academic outcomes. The sample consisted of 275 entering freshmen students who were enrolled in the Learning Support reading courses in the fall of 2005. Data were collected from the Gordon College Office of Institutional Research. The…

An Outcomes-Based Assessment of Quality of Life in Social Services

ERIC Educational Resources Information Center

Gomez, Laura Elisabet; Arias, Benito; Verdugo, Miguel Angel; Navas, Patricia

2012-01-01

The goal of this article consists of describing the calibration of an instrument to assess quality of life-related personal outcomes using Rasch analysis. The sample was composed of 3.029 recipients of social services from Catalonia (Spain) and was selected using a probabilistic polietapic sample design. Results related to unidimensionality, item…

The Effects of Client-Counselor Racial Matching on Therapeutic Outcome

ERIC Educational Resources Information Center

Kim, Eunha; Kang, Minchul

2018-01-01

This study explored the effects of ethnic/racial matching on psychotherapy outcomes via the number of counseling sessions attended by clients, using clinical data collected from a university's counseling center. A total sample of 644 clients (193 men, 448 women) was selected and the ethnic/racial distribution of the sample comprised 499…

[Transabdominal chorionic villus sampling using biopsy forceps or needle: pregnancy outcomes by technique used].

PubMed

Spallina, J; Anselem, O; Haddad, B; Touboul, C; Tsatsaris, V; Le Ray, C

2014-11-01

To compare pregnancy outcomes after transabdominal chorionic villus sampling using biopsy forceps or needle. Retrospective bicentric study including all women who had a transabdominal chorionic villus sampling between 2005 and 2009 (172 using biopsy forceps and 160 using needle). The primary endpoint was the rate of fetal loss, after excluding medical abortion due to the result of the biopsy. The secondary endpoint was the rate of premature rupture of the membrane. All cases were reviewed to try to determine the responsibility of the biopsy. The pregnancy outcomes were not different between the two groups: 4 (4.4%) fetal losses in the biopsy forceps group and 6 (7.4%) in the needle group (P=0.52). Only one case (1.2%) of fetal loss can be attributed to the biopsy, using a needle, and none (0%) following a forceps biospy (P=0.29). The rate of premature rupture of the membrane was comparable in the two groups. The pregnancy outcomes following chorionic villus sampling using a biopsy forceps or a needle seem comparable. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Copy number profiling of adult relapsed B-cell precursor acute lymphoblastic leukemia reveals potential leukemia progression mechanisms.

PubMed

Ribera, Jordi; Zamora, Lurdes; Morgades, Mireia; Mallo, Mar; Solanes, Neus; Batlle, Montserrat; Vives, Susana; Granada, Isabel; Juncà, Jordi; Malinverni, Roberto; Genescà, Eulàlia; Guàrdia, Ramon; Mercadal, Santiago; Escoda, Lourdes; Martinez-Lopez, Joaquín; Tormo, Mar; Esteve, Jordi; Pratcorona, Marta; Martinez-Losada, Carmen; Solé, Francesc; Feliu, Evarist; Ribera, Josep-Maria

2017-11-01

The outcome of relapsed adult acute lymphoblastic leukemia (ALL) remains dismal despite new therapeutic approaches. Previous studies analyzing relapse samples have shown a high degree of heterogeneity regarding gene alterations without an evident relapse signature. Bone marrow or peripheral blood samples from 31 adult B-cell precursor ALL patients at first relapse, and 21 paired diagnostic samples were analyzed by multiplex ligation probe-dependent amplification (MLPA). Nineteen paired diagnostic and relapse samples of these 21 patients were also analyzed by SNP arrays. A trend to acquire homozygous CDKN2A/B deletions and a significant increase in the number of copy number alterations (CNA) was observed from diagnosis to first relapse. Evolution from an ancestral clone was the main pattern of clonal evolution. Relapse samples were extremely heterogeneous regarding CNA frequencies. However, CDKN2A/B, PAX5, ETV6, ATM, IKZF1, VPREB1, and TP53 deletions and duplications of 1q, 8q, 17q, 21, X/Y PAR1, and Xp were frequently detected at relapse. Duplications of genes involved in cell proliferation, drug resistance and stem cell homeostasis regulation, as well as deletions of KDM6A and STAG2 genes emerged as specific alterations at relapse. Genomics of relapsed adult B-cell precursor ALL is highly heterogeneous, although some recurrent lesions involved in essential pathways deregulation were frequently observed. Selective and simultaneous targeting of these deregulated pathways may improve the results of current salvage therapies. © 2017 Wiley Periodicals, Inc.

High anaplastic lymphoma kinase immunohistochemical staining in neuroblastoma and ganglioneuroblastoma is an independent predictor of poor outcome.

PubMed

Duijkers, Floor A M; Gaal, José; Meijerink, Jules P P; Admiraal, Pieter; Pieters, Rob; de Krijger, Ronald R; van Noesel, Max M

2012-03-01

Anaplastic lymphoma kinase (ALK) mutations occur in 3% to 11% of neuroblastoma (NBL) cases and are associated with high ALK levels. However, high ALK levels appear to be a mutation-independent hallmark of NBL. Evidence about the prognostic relevance of ALK mutations and ALK tumor positivity in patients with NBL has been inconclusive. In this study, we investigated the prognostic relevance of ALK positivity by IHC and ALK mutation status by PCR sequencing in 71 NBL, 12 ganglioneuroblastoma (GNBL), and 20 ganglioneuroma samples in a multivariate model. ALK mutations were present in 2 of 72 NBL and 2 of 12 GNBL samples, which all contained many ALK-positive cells (>50%). In addition, half of all NBL samples showed ALK positivity in most (>50%) of tumor cells, whereas half of the GNBL showed staining in <20% of the tumor cells. In most ganglioneuroma samples, a low percentage of tumor cells stained positive for ALK, which mainly involved ganglion cells. Higher percentages of ALK-positive cells in NBL and GNBL patient samples correlated with inferior survival in univariate and multivariate analyses with established prognostic factors, such as stage, age, and MYCN status. In conclusion, ALK positivity by IHC is an independent, poor prognostic factor in patients with GNBL and NBL. ALK IHC is an easy test suitable for future risk stratification in patients with NBL and GNBL. Copyright © 2012 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

A multidimensional model of police legitimacy: A cross-cultural assessment.

PubMed

Tankebe, Justice; Reisig, Michael D; Wang, Xia

2016-02-01

This study used survey data from cross-sectional, university-based samples of young adults in different cultural settings (i.e., the United States and Ghana) to accomplish 2 main objectives: (1) to construct a 4-dimensional police legitimacy scale, and (2) to assess the relationship that police legitimacy and feelings of obligation to obey the police have with 2 outcome measures. The fit statistics for the second-order confirmatory factor models indicated that the 4-dimensional police legitimacy model is reasonably consistent with the data in both samples. Results from the linear regression analyses showed that the police legitimacy scale is related to cooperation with the police, and that the observed association is attenuated when the obligation to obey scale is included in the model specification in both the United States and Ghana data. A similar pattern emerged in the U.S. sample when estimating compliance with the law models. However, although police legitimacy was associated with compliance in the Ghana sample, this relationship along with the test statistic for the sense of obligation to obey estimate were both null in the fully saturated equation. The findings provide support for the Bottoms and Tankebe's (2012) argument that legitimacy is multidimensional, comprising police lawfulness, distributive fairness, procedural fairness, and effectiveness. However, the link between police legitimacy and social order appears to be culturally variable. PsycINFO Database Record (c) 2016 APA, all rights reserved.

Whites but Not Blacks Gain Life Expectancy from Social Contacts.

PubMed

Assari, Shervin

2017-10-16

Background . Recent research suggests that the health gain from economic resources and psychological assets may be systematically larger for Whites than Blacks. Aim . This study aimed to assess whether the life expectancy gain associated with social contacts over a long follow up differs for Blacks and Whites. Methods . Data came from the Americans' Changing Lives (ACL) Study, 1986-2011. The sample was a nationally representative sample of American adults 25 and older, who were followed for up to 25 years ( n = 3361). Outcome was all-cause mortality. The main predictor was social contacts defined as number of regular visits with friends, relatives, and neighbors. Baseline demographics (age and gender), socioeconomic status (education, income, and employment), health behaviors (smoking and drinking), and health (chronic medical conditions, obesity, and depressive symptoms) were controlled. Race was the focal moderator. Cox proportional hazard models were used in the pooled sample and based on race. Results . More social contacts predicted higher life expectancy in the pooled sample. A significant interaction was found between race and social contacts, suggesting that the protective effect of more social contacts is smaller for Blacks than Whites. In stratified models, more social contacts predicted an increased life expectancy for Whites but not Blacks. Conclusion . Social contacts increase life expectancy for White but not Black Americans. This study introduces social contacts as another social resource that differentially affects health of Whites and Blacks.

Quantity and quality of information, education and communication during antenatal visit at private and public sector hospitals of Bahawalpur, Pakistan.

PubMed

Mahar, Benazeer; Kumar, Ramesh; Rizvi, Narjis; Bahalkani, Habib Akhtar; Haq, Mahboobul; Soomro, Jamila

2012-01-01

Information, education and communication (IEC) by health care provider to pregnant woman during the antenatal visit are very crucial for healthier outcome of pregnancy. This study analysed the quality and quantity of antenatal visit at a private and a public hospital of Bahawalpur, Pakistan. An exit interview was conducted from 216 pregnant women by using validated, reliable and pre-tested adapted questionnaire. First sample was selected by simple random sampling, for rest of the sample selection systematic random sampling was adapted by selecting every 7th women for interview. Ethical considerations were taken. Average communication time among pregnant woman and her healthcare provider was 3 minute in public and 8 minutes in private hospital. IEC mainly focused on diet and nutrition in private (86%) and (53%) public, advice for family planning after delivery was discussed with 13% versus 7% in public and private setting. None of the respondents in both facilities got advice or counselling on breastfeeding and neonatal care. Birth preparedness components were discussed, woman in public and private hospital respectively. In both settings antenatal clients were not received information and education communication according to World Health Organization guidelines. Quality and quantity of IEC during antenatal care was found very poor in both public and private sector hospitals of urban Pakistan.

[Impact of acquired brain injury towards the community integration: employment outcome, disability and dependence two years after injury].

PubMed

Luna-Lario, P; Ojeda, N; Tirapu-Ustarroz, J; Pena, J

2016-06-16

To analyze the impact of acquired brain injury towards the community integration (professional career, disability, and dependence) in a sample of people affected by vascular, traumatic and tumor etiology acquired brain damage, over a two year time period after the original injury, and also to examine what sociodemographic variables, premorbid and injury related clinical data can predict the level of the person's integration into the community. 106 adults sample suffering from acquired brain injury who were attended by the Neuropsychology and Neuropsychiatry Department at Hospital of Navarra (Spain) affected by memory deficit as their main sequel. Differences among groups have been analyzed by using t by Student, chi squared and U by Mann-Whitney tests. 19% and 29% of the participants who were actively working before the injury got back their previous status within one and two years time respectively. 45% of the total sample were recognized disabled and 17% dependant. No relationship between sociodemographic and clinical variables and functional parameters observed were found. Acquired brain damage presents a high intensity impact on affected person's life trajectory. Nevertheless, in Spain, its consequences at sociolaboral adjustment over the the two years following the damage through functional parameters analyzed with official governmental means over a vascular, traumatic and tumor etiology sample had never been studied before.

The Interaction Effects of Program Training, Dosage, and Implementation Quality on Targeted Student Outcomes for The RULER Approach to Social and Emotional Learning

ERIC Educational Resources Information Center

Reyes, Maria Regina; Brackett, Marc A.; Rivers, Susan E.; Elbertson, Nicole A.; Salovey, Peter

2012-01-01

This study examined how training, dosage, and implementation quality of a social and emotional learning program, The RULER Approach, were related to students' social and emotional competencies. There were no main effects for any of the variables on student outcomes, but students had more positive outcomes when their teachers (a) attended more…

Heart-lung transplantation: pediatric indications and outcomes

PubMed Central

2014-01-01

As indications for heart-lung transplant (HLT) have changed to some degree in the past 30 years, this treatment is being used less frequently in children due to more advanced care of severe heart and lung disease. This is fortunate as the outcomes for HLT are poor compared to other solid organ transplants and this is mainly due to the poorer outcome of the lung graft. PMID:25132980

Cumulus cells surrounding oocytes with high developmental competence exhibit down-regulation of phosphoinositol 1,3 kinase/protein kinase B (PI3K/AKT) signalling genes involved in proliferation and survival

PubMed Central

Artini, P G; Tatone, C; Sperduti, S; D’Aurora, M; Franchi, S; Di Emidio, G; Ciriminna, R; Vento, M; Di Pietro, C; Stuppia, L; Gatta, V

2017-01-01

Abstract STUDY QUESTION Is the phosphoinositol 1,3-kinase/protein kinase B (PI3K/AKT) pathway expression profile in cumulus cells (CCs) a potential marker of oocyte competence and predictive of pregnancy outcome? SUMMARY ANSWER Eleven genes (AKT1, ARHGEF7, BCL2L1, CCND1, E2F1, HRAS, KCNH2, PIK3C2A, SHC1, SOS1 and SPP1) in the PI3K/AKT pathway were significantly down-regulated in CCs from oocytes that went on to produce a pregnancy compared to CCs associated with a negative outcome. WHAT IS KNOWN ALREADY The PI3K/AKT pathway plays a pivotal role in the interdependence and continuous feedback between the oocyte and CCs. STUDY DESIGN SIZE, DURATION The expression analysis of 92 transcripts in the PI3K/AKT pathway in CCs from patients with negative or positive pregnancy outcome, after single embryo transfer, was performed. Mouse CCs target gene expression was conducted to associate the expression profile of PI3K/AKT pathway to oocyte developmental profile. PARTICIPANTS/MATERIALS, SETTING, METHODS Fifty-five good prognosis IVF patients who had been referred to IVF or intracytoplasmic sperm injection treatment for male-factor infertility or tubal disease were enroled. CCs from single cumulus-oocyte complexes (COCs) from 16 patients who underwent a single embryo transfer were analyzed. Twenty-five CD-1 mice were used to assess gene expression in CCs associated with oocytes with different competence in relation to hCG priming. A total 220 human COCs were collected. The RNA extracted from CCs of 16 selected patients was used to analyze PI3K/AKT pathway gene expression employing a 96-well custom TaqMan Array. Expression data of CCs associated to positive IVF outcome were compared to data from negative outcome samples. Mice were sacrificed after 9, 12, 15, 21 and 24 h post-hCG administration to obtain CCs from MII oocytes with different developmental competence. Akt1, Bcl2l2 and Shc1 expression were tested in the collected mouse CCs. In addition, the expression of upstream regulator ESR1, the gene encoding for the oestrogen receptor ERβ, and the downstream effectors of the pathway FOXO1, FOXO3 and FOXO4 was evaluated in human and mouse samples. MAIN RESULTS AND THE ROLE OF CHANCE Transcripts involved in the PI3K Signaling Pathway were selectively modulated according to the IVF/ICSI outcome of the oocyte. Eleven transcripts in this pathway were significantly down-regulated in all samples of CCs from oocytes with positive when compared those with a negative outcome. These outcomes were confirmed in mouse CCs associated with oocytes at different maturation stages. Expression data revealed that the down-regulation of ESR1 could be related to oocyte competence and is likely to be the driver of expression changes highlighted in the PI3K/AKT pathway. LIMITATIONS REASONS FOR CAUTION Small sample size and retrospective design. WIDER IMPLICATIONS OF THE FINDINGS The CCs expression profile of PI3K/AKT signaling genes, disclosed a specific CCs gene signature related to oocyte competence. It could be speculated that CCs associated with competent oocytes have completed their role in sustaining oocyte development and are influencing their fate in response to metabolic and hormonal changes by de-activating anti-apoptotic signals. STUDY FUNDING/COMPETING INTEREST(S) Supported by Merck Serono an affiliate of Merck KGaA, Darmstadt, Germany (research grant for the laboratory session; Merck KGaA reviewed the manuscript for medical accuracy only before journal submission. The authors are fully responsible for the content of this manuscript, and the views and opinions described in the publication reflect solely those of the authors). The authors declare no conflict of interest. PMID:29087515

Outcomes of Zika virus infection during pregnancy: contributions to the debate on the efficiency of cohort studies.

PubMed

Duarte, Elisabeth Carmen; Garcia, Leila Posenato; de Araújo, Wildo Navegantes; Velez, Maria P

2017-12-02

Zika infection during pregnancy (ZIKVP) is known to be associated with adverse outcomes. Studies on this matter involve both rare outcomes and rare exposures and methodological choices are not straightforward. Cohort studies will surely offer more robust evidences, but their efficiency must be enhanced. We aim to contribute to the debate on sample selection strategies in cohort studies to assess outcomes associated with ZKVP. A study can be statistically more efficient than another if its estimates are more accurate (precise and valid), even if the studies involve the same number of subjects. Sample size and specific design strategies can enhance or impair the statistical efficiency of a study, depending on how the subjects are distributed in subgroups pertinent to the analysis. In most ZIKVP cohort studies to date there is an a priori identification of the source population (pregnant women, regardless of their exposure status) which is then sampled or included in its entirety (census). Subsequently, the group of pregnant women is classified according to exposure (presence or absence of ZIKVP), respecting the exposed:unexposed ratio in the source population. We propose that the sample selection be done from the a priori identification of groups of pregnant women exposed and unexposed to ZIKVP. This method will allow for an oversampling (even 100%) of the pregnant women with ZKVP and a optimized sampling from the general population of pregnant women unexposed to ZIKVP, saving resources in the unexposed group and improving the expected number of incident cases (outcomes) overall. We hope that this proposal will broaden the methodological debate on the improvement of statistical power and protocol harmonization of cohort studies that aim to evaluate the association between Zika infection during pregnancy and outcomes for the offspring, as well as those with similar objectives.

Characteristics of randomised trials on diseases in the digestive system registered in ClinicalTrials.gov: a retrospective analysis.

PubMed

Wildt, Signe; Krag, Aleksander; Gluud, Liselotte

2011-01-01

Objectives To evaluate the adequacy of reporting of protocols for randomised trials on diseases of the digestive system registered in http://ClinicalTrials.gov and the consistency between primary outcomes, secondary outcomes and sample size specified in http://ClinicalTrials.gov and published trials. Methods Randomised phase III trials on adult patients with gastrointestinal diseases registered before January 2009 in http://ClinicalTrials.gov were eligible for inclusion. From http://ClinicalTrials.gov all data elements in the database required by the International Committee of Medical Journal Editors (ICMJE) member journals were extracted. The subsequent publications for registered trials were identified. For published trials, data concerning publication date, primary and secondary endpoint, sample size, and whether the journal adhered to ICMJE principles were extracted. Differences between primary and secondary outcomes, sample size and sample size calculations data in http://ClinicalTrials.gov and in the published paper were registered. Results 105 trials were evaluated. 66 trials (63%) were published. 30% of trials were registered incorrectly after their completion date. Several data elements of the required ICMJE data list were not filled in, with missing data in 22% and 11%, respectively, of cases concerning the primary outcome measure and sample size. In 26% of the published papers, data on sample size calculations were missing and discrepancies between sample size reporting in http://ClinicalTrials.gov and published trials existed. Conclusion The quality of registration of randomised controlled trials still needs improvement.

Metabolomics-Based Discovery of Small Molecule Biomarkers in Serum Associated with Dengue Virus Infections and Disease Outcomes

PubMed Central

Voge, Natalia V.; Perera, Rushika; Mahapatra, Sebabrata; Gresh, Lionel; Balmaseda, Angel; Loroño-Pino, María A.; Hopf-Jannasch, Amber S.; Belisle, John T.; Harris, Eva; Blair, Carol D.; Beaty, Barry J.

2016-01-01

Background Epidemic dengue fever (DF) and dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) are overwhelming public health capacity for diagnosis and clinical care of dengue patients throughout the tropical and subtropical world. The ability to predict severe dengue disease outcomes (DHF/DSS) using acute phase clinical specimens would be of enormous value to physicians and health care workers for appropriate triaging of patients for clinical management. Advances in the field of metabolomics and analytic software provide new opportunities to identify host small molecule biomarkers (SMBs) in acute phase clinical specimens that differentiate dengue disease outcomes. Methodology/Principal Findings Exploratory metabolomic studies were conducted to characterize the serum metabolome of patients who experienced different dengue disease outcomes. Serum samples from dengue patients from Nicaragua and Mexico were retrospectively obtained, and hydrophilic interaction liquid chromatography (HILIC)-mass spectrometry (MS) identified small molecule metabolites that were associated with and statistically differentiated DHF/DSS, DF, and non-dengue (ND) diagnosis groups. In the Nicaraguan samples, 191 metabolites differentiated DF from ND outcomes and 83 differentiated DHF/DSS and DF outcomes. In the Mexican samples, 306 metabolites differentiated DF from ND and 37 differentiated DHF/DSS and DF outcomes. The structural identities of 13 metabolites were confirmed using tandem mass spectrometry (MS/MS). Metabolomic analysis of serum samples from patients diagnosed as DF who progressed to DHF/DSS identified 65 metabolites that predicted dengue disease outcomes. Differential perturbation of the serum metabolome was demonstrated following infection with different DENV serotypes and following primary and secondary DENV infections. Conclusions/Significance These results provide proof-of-concept that a metabolomics approach can be used to identify metabolites or SMBs in serum specimens that are associated with distinct DENV infections and disease outcomes. The differentiating metabolites also provide insights into metabolic pathways and pathogenic and immunologic mechanisms associated with dengue disease severity. PMID:26913918

Expressive writing interventions in cancer patients: a systematic review.

PubMed

Merz, Erin L; Fox, Rina S; Malcarne, Vanessa L

2014-01-01

Decades of research have suggested that expressive writing produces physical and psychological benefits in controlled laboratory experiments among healthy college students. This work has been extended to clinical and medical populations, including cancer patients. Although expressive writing could be a promising and inexpensive intervention for this population, the effects have not been systematically examined in oncology samples. A systematic review using PRISMA guidelines was conducted for experimental trials of cancer patients who participated in an expressive writing intervention. PsycINFO and PubMed/Medline were searched for peer-reviewed studies. Thirteen articles met the inclusion/exclusion criteria. Although the majority of the intervention effects were null, there were several main effects for expressive writing on sleep, pain, and general physical and psychological symptoms. Several moderators were identified, suggesting that expressive writing may be more or less beneficial based on individual characteristics such as social constraints. The reviewed studies were limited due to representativeness of the samples, performance, detection and patient-reported outcomes biases, and heterogeneity of the intervention protocol and writing prompts. Future studies with rigorous designs are needed to determine whether expressive writing is therapeutically effective in cancer patients.

Representing infant feeding: content analysis of British media portrayals of bottle feeding and breast feeding

PubMed Central

Henderson, Lesley; Kitzinger, Jenny; Green, Josephine

2000-01-01

Objective To examine how breast feeding and bottle feeding are represented by the British media. Design Content analysis. Subjects Television programmes and newspaper articles that made reference to infant feeding during March 1999. Setting UK mass media. Main outcome measures Visual and verbal references to breast or bottle feeding in newspapers and television programmes. Results Overall, 235 references to infant feeding were identified in the television sample and 38 in the newspaper sample. Bottle feeding was shown more often than breast feeding and was presented as less problematic. Bottle feeding was associated with “ordinary” families whereas breast feeding was associated with middle class or celebrity women. The health risks of formula milk and the health benefits of breast feeding were rarely mentioned. Conclusions The media rarely present positive information on breast feeding, even though this feeding practice is associated with the most health benefits. Health professionals and policy makers should be aware of patterns in media coverage and the cultural background within which women make decisions about infant feeding. PMID:11073512

Video game addiction test: validity and psychometric characteristics.

PubMed

van Rooij, Antonius J; Schoenmakers, Tim M; van den Eijnden, Regina J J M; Vermulst, Ad A; van de Mheen, Dike

2012-09-01

The study explores the reliability, validity, and measurement invariance of the Video game Addiction Test (VAT). Game-addiction problems are often linked to Internet enabled online games; the VAT has the unique benefit that it is theoretically and empirically linked to Internet addiction. The study used data (n=2,894) from a large-sample paper-and-pencil questionnaire study, conducted in 2009 on secondary schools in Netherlands. Thus, the main source of data was a large sample of schoolchildren (aged 13-16 years). Measurements included the proposed VAT, the Compulsive Internet Use Scale, weekly hours spent on various game types, and several psychosocial variables. The VAT demonstrated excellent reliability, excellent construct validity, a one-factor model fit, and a high degree of measurement invariance across gender, ethnicity, and learning year, indicating that the scale outcomes can be compared across different subgroups with little bias. In summary, the VAT can be helpful in the further study of video game addiction, and it contributes to the debate on possible inclusion of behavioral addictions in the upcoming DSM-V.

Leadership styles across hierarchical levels in nursing departments.

PubMed

Stordeur, S; Vandenberghe, C; D'hoore, W

2000-01-01

Some researchers have reported on the cascading effect of transformational leadership across hierarchical levels. One study examined this effect in nursing, but it was limited to a single hospital. To examine the cascading effect of leadership styles across hierarchical levels in a sample of nursing departments and to investigate the effect of hierarchical level on the relationships between leadership styles and various work outcomes. Based on a sample of eight hospitals, the cascading effect was tested using correlation analysis. The main sources of variation among leadership scores were determined with analyses of variance (ANOVA), and the interaction effect of hierarchical level and leadership styles on criterion variables was tested with moderated regression analysis. No support was found for a cascading effect of leadership across hierarchical levels. Rather, the variation of leadership scores was explained primarily by the organizational context. Transformational leadership had a stronger impact on criterion variables than transactional leadership. Interaction effects between leadership styles and hierarchical level were observed only for perceived unit effectiveness. The hospital's structure and culture are major determinants of leadership styles.

Outcome Expectancies and Risk Behaviors in Maltreated Adolescents

ERIC Educational Resources Information Center

Nickoletti, Patrick; Taussig, Heather N.

2006-01-01

This study examined positive and negative outcome expectancies for risk behaviors, and their association with engagement in risk behaviors, in a sample of 149 maltreated adolescents. "Outcome Expectancies" are evaluative social cognitions about what will occur as a consequence of one's actions. Risk behaviors and outcome expectancies for substance…

Is the maturity of hospitals' quality improvement systems associated with measures of quality and patient safety?

PubMed Central

2011-01-01

Background Previous research addressed the development of a classification scheme for quality improvement systems in European hospitals. In this study we explore associations between the 'maturity' of the hospitals' quality improvement system and clinical outcomes. Methods The maturity classification scheme was developed based on survey results from 389 hospitals in eight European countries. We matched the hospitals from the Spanish sample (113 hospitals) with those hospitals participating in a nation-wide, voluntary hospital performance initiative. We then compared sample distributions and explored associations between the 'maturity' of the hospitals' quality improvement system and a range of composite outcomes measures, such as adjusted hospital-wide mortality, -readmission, -complication and -length of stay indices. Statistical analysis includes bivariate correlations for parametrically and non-parametrically distributed data, multiple robust regression models and bootstrapping techniques to obtain confidence-intervals for the correlation and regression estimates. Results Overall, 43 hospitals were included. Compared to the original sample of 113, this sample was characterized by a higher representation of university hospitals. Maturity of the quality improvement system was similar, although the matched sample showed less variability. Analysis of associations between the quality improvement system and hospital-wide outcomes suggests significant correlations for the indicator adjusted hospital complications, borderline significance for adjusted hospital readmissions and non-significance for the adjusted hospital mortality and length of stay indicators. These results are confirmed by the bootstrap estimates of the robust regression model after adjusting for hospital characteristics. Conclusions We assessed associations between hospitals' quality improvement systems and clinical outcomes. From this data it seems that having a more developed quality improvement system is associated with lower rates of adjusted hospital complications. A number of methodological and logistic hurdles remain to link hospital quality improvement systems to outcomes. Further research should aim at identifying the latent dimensions of quality improvement systems that predict quality and safety outcomes. Such research would add pertinent knowledge regarding the implementation of organizational strategies related with quality of care outcomes. PMID:22185479

Perfluoroalkyl substances in older male anglers in Wisconsin.

PubMed

Christensen, Krista Y; Raymond, Michelle; Thompson, Brooke A; Anderson, Henry A

2016-05-01

Perfluoroalkyl substances (PFAS) are an emerging class of contaminants. Certain PFAS are regulated or voluntarily limited due to concern about environmental persistence and adverse health effects, including thyroid disease and to dyslipidemia. The major source of PFAS exposure in the general population is seafood. In this analysis we examine PFAS levels and their determinants, as well as associations between PFAS levels and self-reported health outcomes, in a group of older male anglers in Wisconsin with high fish consumption. A biomonitoring study of male anglers aged 50 and older living in Wisconsin collected detailed information on fish consumption, demographics and self-reported health outcomes, along with hair and blood samples for biomarker analysis. Sixteen different PFAS were extracted from serum samples. Regression models were used to identify factors (demographic characteristics and fish consumption habits) associated with PFAS biomarker levels in blood, as well as associations between PFAS and self-reported health outcomes, adjusting for potential confounders. Seven PFAS were detected in at least 30% of participants and were used in subsequent analyses (PFDA, PFHpS, PFHxS, PFNA, PFOA, PFOS, PFuDA). The PFAS with the highest levels were PFOS, followed by PFOA, PFHxS and PFNA (medians of 19.0, 2.5, 1.8 and 1.4ng/mL). In general, increasing age was associated with higher PFAS levels, while increasing BMI were associated with lower PFAS levels. Greater alcohol consumption was associated with higher levels of PFHpS, PFHxS and PFOA. Associations with smoking and employment did not show a consistent pattern. Associations between fish consumption and PFAS were generally weak, with the exception of notably higher PFDA and PFHpS with both other locally-caught fish, and restaurant-purchased fish. Regarding associations with health outcomes, PFuDA, PFNA and PFDA were all associated with increased risk of pre-diabetes and/or diabetes. PFHpS was associated with a significantly increased risk of high cholesterol; PFDA and PFuDA also showed notable, though non-significant associations. All PFAS evaluated were associated with lower risk of hypertension although the only significant odds ratio was that for PFNA. There were no associations between any of the PFAS examined and either coronary heart disease, or the grouped outcome of any cardiovascular condition. PFAS are emerging contaminants with widespread exposure, persistence, and potential for adverse health effects. In this study population, demographic patterns may reflect differences in exposure sources, or possibly differences in adsorption and metabolism. PFAS were associated mainly with endocrine related outcomes, with a general trend towards increased risk of glucose intolerance and high cholesterol. Continued research on the risks and benefits of fish consumption is important due to potential exposure to PFAS and noted associations with highly prevalent adverse health outcomes. Published by Elsevier Ltd.

Towards a unified sampling terminology: clarifying misperceptions.

PubMed

Thiex, Nancy; Paoletii, Claudia; Esbensen, Kim H

2015-01-01

International acceptance of data is a much-desired wish in many sectors to ensure equal standards for valid information and data exchange, facilitate trade, support food safety regulation, and promote reliable communication among all parties involved. However, this cannot be accomplished without a harmonized approach to sampling and a joint approach to assess the practical sampling protocols used. Harmonization based on a nonrepresentative protocol, or on a restricted terminology tradition forced upon other sectors would negate any constructive outcome. An international discussion on a harmonized approach to sampling is severely hampered by a plethora of divergent sampling definitions and terms. Different meanings for the same term are frequently used by the different sectors, and even within one specific sector. In other cases, different terms are used for the same concept. Before efforts to harmonize can be attempted, it is essential that all stakeholders can at least communicate effectively in this context. Therefore, a clear understanding of the main vocabularies becomes an essential prerequisite. As a first step, commonalities and dichotomies in terminology are here brought to attention by providing a comparative summary of the. terminology as defined by the Theory of Sampling {TOS) and those in current use by the International Organization for Standardization, the World Health Organization, the Food and Agriculture Organization Codex Alimentarius, and the U.S. Food and Drug Administration. Terms having contradictory meaning to the TOS are emphasized. To the degree possible, we present a successful resolution of some of the most important issues outlined, sufficient to support the objectives of the present Special Section.

Haphazard reporting of deaths in clinical trials: a review of cases of ClinicalTrials.gov records and matched publications–a cross-sectional study

PubMed Central

Earley, Amy; Lau, Joseph; Uhlig,, Katrin

2013-01-01

Context A participant death is a serious event in a clinical trial and needs to be unambiguously and publicly reported. Objective To examine (1) how often and how numbers of deaths are reported in ClinicalTrials.gov records; (2) how often total deaths can be determined per arm within a ClinicalTrials.gov results record and its corresponding publication and (3) whether counts may be discordant. Design Registry-based study of clinical trial results reporting. Setting ClinicalTrials.gov results database searched in July 2011 and matched PubMed publications. Selection criteria A random sample of ClinicalTrials.gov results records. Detailed review of records with a single corresponding publication. Main outcome measure ClinicalTrials.gov records reporting number of deaths under participant flow, primary or secondary outcome or serious adverse events. Consistency in reporting of number of deaths between ClinicalTrials.gov records and corresponding publications. Results In 500 randomly selected ClinicalTrials.gov records, only 123 records (25%) reported a number for deaths. Reporting of deaths across data modules for participant flow, primary or secondary outcomes and serious adverse events was variable. In a sample of 27 pairs of ClinicalTrials.gov records with number of deaths and corresponding publications, total deaths per arm could only be determined in 56% (15/27 pairs) but were discordant in 19% (5/27). In 27 pairs of ClinicalTrials.gov records without any information on number of deaths, 48% (13/27) were discordant since the publications reported absence of deaths in 33% (9/27) and positive death numbers in 15% (4/27). Conclusions Deaths are variably reported in ClinicalTrials.gov records. A reliable total number of deaths per arm cannot always be determined with certainty or can be discordant with number reported in corresponding trial publications. This highlights a need for unambiguous and complete reporting of the number of deaths in trial registries and publications. PMID:23335556

Inadequate Dietary Intake in Patients with Thalassemia

PubMed Central

Fung, Ellen B.; Xu, Yan; Trachtenberg, Felicia; Odame, Isaac; Kwiatkowski, Janet L.; Neufeld, Ellis J.; Thompson, Alexis A.; Boudreaux, Jeanne; Quinn, Charles T.; Vichinsky, Elliott P.

2012-01-01

Background Patients with thalassemia have low circulating levels of many nutrients, but the contribution of dietary intake has not been assessed. Objective Assess dietary intake in a large contemporary sample of patients with thalassemia. Design Prospective, longitudinal cohort study using a validated food frequency questionnaire Participants 221 patients (19.7±11.3 yrs, 106 female) categorized into three age groups: young children (3–7.9 y), older children/adolescents (8–18.9 yr), and adult (≥ 19 yr). 78.8% β-thalassemia; 90% chronically transfused. Setting 10 hematology outpatient clinics in the United States and Canada. Main outcome measures Comparison of intake with U.S. Dietary Reference Intakes, and correlation with serum 25-OH vitamin D and total body iron stores. Statistical Analyses Performed Intake was defined as inadequate if less than the estimated average requirement (EAR). Chi-square, Fisher’s exact and Student’s t-test were utilized to compare intake between age categories and logistic regression analysis to test the relationship between intake and outcomes, controlling for age, gender and race. Results Over 30% of patients consumed inadequate levels of vitamin A, D, E, K, folate, calcium, and magnesium. The only nutrients for which >90% of patients consumed adequate amounts were riboflavin, vitamin B12 and selenium. Dietary inadequacy increased with increasing age group (p<0.01) for vitamins A, C, E, B6, folate, thiamin, calcium, magnesium and zinc. Over half the sample took additional supplements of calcium and vitamin D, although circulating levels of 25-OH vitamin D remained insufficient in 61% of patients. Dietary iron intake was not related to total body iron stores. Conclusion Patients with thalassemia have reduced intake of many key nutrients. These preliminary findings of dietary inadequacy is concerning and supports the need for nutritional monitoring to determine which patients are at greatest risk for nutritional deficiency. Future research should focus on the effect of dietary quality and nutritional status on health outcomes in thalassemia. PMID:22551675

Learning to care for older patients: hospitals and nursing homes as learning environments.

PubMed

Huls, Marije; de Rooij, Sophia E; Diepstraten, Annemie; Koopmans, Raymond; Helmich, Esther

2015-03-01

A significant challenge facing health care is the ageing of the population, which calls for a major response in medical education. Most clinical learning takes place within hospitals, but nursing homes may also represent suitable learning environments in which students can gain competencies in geriatric medicine. This study explores what students perceive as the main learning outcomes of a geriatric medicine clerkship in a hospital or a nursing home, and explicitly addresses factors that may stimulate or hamper the learning process. This qualitative study falls within a constructivist paradigm: it draws on socio-cultural learning theory and is guided by the principles of constructivist grounded theory. There were two phases of data collection. Firstly, a maximum variation sample of 68 students completed a worksheet, giving brief written answers on questions regarding their geriatric medicine clerkships. Secondly, focus group discussions were conducted with 19 purposively sampled students. We used template analysis, iteratively cycling between data collection and analysis, using a constant comparative process. Students described a broad range of learning outcomes and formative experiences that were largely distinct from their learning in previous clerkships with regard to specific geriatric knowledge, deliberate decision making, end-of-life care, interprofessional collaboration and communication. According to students, the nursing home differed from the hospital in three aspects: interprofessional collaboration was more prominent; the lower resources available in nursing homes stimulated students to be creative, and students reported having greater autonomy in nursing homes compared with the more extensive educational guidance provided in hospitals. In both hospitals and nursing homes, students not only learn to care for older patients, but also describe various broader learning outcomes necessary to become good doctors. The results of our study, in particular the specific benefits and challenges associated with learning in the nursing home, may further inform the implementation of geriatric medicine clerkships in hospitals and nursing homes. © 2015 John Wiley & Sons Ltd.

Preventing childhood obesity, phase II feasibility study focusing on South Asians: BEACHeS

PubMed Central

Adab, Peymané; Pallan, Miranda J; Cade, Janet; Ekelund, Ulf; Barrett, Timothy; Daley, Amanda; Deeks, Jonathan; Duda, Joan; Gill, Paramjit; Parry, Jayne; Bhopal, Raj; Cheng, K K

2014-01-01

Objective To assess feasibility and acceptability of a multifaceted, culturally appropriate intervention for preventing obesity in South Asian children, and to obtain data to inform sample size for a definitive trial. Design Phase II feasibility study of a complex intervention. Setting 8 primary schools in inner city Birmingham, UK, within populations that are predominantly South Asian. Participants 1090 children aged 6–8 years took part in the intervention. 571 (85.9% from South Asian background) underwent baseline measures. 85.5% (n=488) were followed up 2 years later. Interventions The 1-year intervention consisted of school-based and family-based activities, targeting dietary and physical activity behaviours. The intervention was modified and refined throughout the period of delivery. Main outcome measures Acceptability and feasibility of the intervention and of measurements required to assess outcomes in a definitive trial. The difference in body mass index (BMI) z-score between arms was used to inform sample size calculations for a definitive trial. Results Some intervention components (increasing school physical activity opportunities, family cooking skills workshops, signposting of local leisure facilities and attending day event at a football club) were feasible and acceptable. Other components were acceptable, but not feasible. Promoting walking groups was neither acceptable nor feasible. At follow-up, children in the intervention compared with the control group were less likely to be obese (OR 0.41; 0.19 to 0.89), and had lower adjusted BMI z-score (−0.15 kg/m2; 95% CI −0.27 to −0.03). Conclusions The feasibility study informed components for an intervention programme. The favourable direction of outcome for weight status in the intervention group supports the need for a definitive trial. A cluster randomised controlled trial is now underway to assess the clinical and cost-effectiveness of the intervention. Trial registration number ISRCTN51016370. PMID:24722198

Impact of violence against women on severe acute maternal morbidity in the intensive care unit, including neonatal outcomes: a case–control study protocol in a tertiary healthcare facility in Lima, Peru

PubMed Central

Ayala Quintanilla, Beatriz Paulina; Pollock, Wendy E; McDonald, Susan J; Taft, Angela J

2018-01-01

Introduction Preventing and reducing violence against women (VAW) and maternal mortality are Sustainable Development Goals. Worldwide, the maternal mortality ratio has fallen about 44% in the last 25 years, and for one maternal death there are many women affected by severe acute maternal morbidity (SAMM) requiring management in the intensive care unit (ICU). These women represent the most critically ill obstetric patients of the maternal morbidity spectrum and should be studied to complement the review of maternal mortality. VAW has been associated with all-cause maternal deaths, and since many women (30%) endure violence usually exerted by their intimate partners and this abuse can be severe during pregnancy, it is important to determine whether it impacts SAMM. Thus, this study aims to investigate the impact of VAW on SAMM in the ICU. Methods and analysis This will be a prospective case-control study undertaken in a tertiary healthcare facility in Lima-Peru, with a sample size of 109 cases (obstetric patients admitted to the ICU) and 109 controls (obstetric patients not admitted to the ICU selected by systematic random sampling). Data on social determinants, medical and obstetric characteristics, VAW, pregnancy and neonatal outcome will be collected through interviews and by extracting information from the medical records using a pretested form. Main outcome will be VAW rate and neonatal mortality rate between cases and controls. VAW will be assessed by using the WHO instrument. Binary logistic followed by stepwise multivariate regression and goodness of fit test will assess any association between VAW and SAMM. Ethics and dissemination Ethical approval has been granted by the La Trobe University, Melbourne-Australia and the tertiary healthcare facility in Lima-Peru. This research follows the WHO ethical and safety recommendations for research on VAW. Findings will be presented at conferences and published in peer-reviewed journals. PMID:29540421

What do patients expect from treatment with Dental Implants? Perceptions, expectations and misconceptions: a multicenter study.

PubMed

Yao, Jie; Li, Ming; Tang, Hua; Wang, Peng-Lai; Zhao, Yu-Xiao; McGrath, Colman; Mattheos, Nikos

2017-03-01

While research in terms of patient-centered care in implant therapy is growing, few studies have investigated patients' initial perceptions prior to consultation with the implant dentist. The aim of this cross-sectional study was to capture patients' initial information level, perceptions, as well as expectations from the implant therapy. A 34-item questionnaire was developed to investigate patients' preoperative information, perceptions and expectations from treatment with Dental Implants. The study was conducted in three locations (Hong Kong, SiChuan and JiangSu) during 2014-2015 with 277 patients. The main information source about implant therapy was the dentist or hygienist for less than half of the patients (n = 113, 42%). About 62.8% of participants considered that they were in general informed about implants, but only 17.7% felt confident with the information they had. More than 30% of the sample appeared to maintain dangerous misperceptions about Dental Implants: "Dental Implants require less care than natural teeth"; "Treatment with Dental Implants is appropriate for all patients with missing teeth"; "Dental Implants last longer than natural teeth"; and "Treatments with Dental Implants have no risks or complications." Patients were divided when asked whether "Dental Implants are as functional as natural teeth" (agreement frequency = 52.7%). Expectations from treatment outcome were commonly high, while there was a significant correlation between the overall mean of perception scores and outcome expectation scores (r = 0.32, P < 0.001). Overall, younger subjects (<45 years) and those with higher education level (bachelor and postgraduate) tended to present more realistic perceptions and lower outcome expectations. The majority of patients in this study presented relatively realistic perceptions. However, an alarming portion of the sample presented with inaccurate perceptions and unrealistic expectations, which the dental team would need to diagnose and correct prior to initiating implant treatment. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

StereoTactic radiotherapy for wet Age-Related macular degeneration (STAR): study protocol for a randomised controlled clinical trial.

PubMed

Neffendorf, James E; Desai, Riti; Wang, Yanzhong; Kelly, Joanna; Murphy, Caroline; Reeves, Barnaby C; Chakravarthy, Usha; Wordsworth, Sarah; Lewis, Cornelius; Peacock, Janet; Uddin, Shahir; O'Sullivan, Joe M; Jackson, Timothy L

2016-11-24

The standard of care for neovascular age-related macular degeneration (nAMD) involves ongoing intravitreal injections of anti-angiogenic drugs targeting vascular endothelial growth factor (VEGF). The most commonly used anti-VEGF drugs are ranibizumab, bevacizumab and aflibercept. The main objective of the STAR trial is to determine if stereotactic radiotherapy can reduce the number of anti-VEGF injections that patients with nAMD require. STAR is a multicentre, double-masked, randomised, sham-controlled clinical trial. It evaluates a new device (manufactured by Oraya, Newark, CA, USA) designed to deliver stereotactic radiotherapy (SRT) to nAMD lesions. The trial enrols participants with chronic, active nAMD. Participants receive a single SRT treatment (16 Gy or sham) with a concomitant baseline intravitreal injection of 0.5 mg ranibizumab. Thereafter, they attend every month for 24 months, and ranibizumab is administered at the visit if retreatment criteria are met. The primary outcome is the number of pro re nata ranibizumab injections during the first 24 months. Secondary outcomes include visual acuity, lesion morphology, quality of life and safety. Additional visits occur at 36 and 48 months to inspect for radiation retinopathy. The target sample size of 411 participants (randomised 2:1 in favour of radiation) is designed to detect a reduction of 2.5 injections against ranibizumab monotherapy, at 90% power, and a significance level (alpha) of 0.025 (one-sided two-sample t test). This gives 97% power to detect non-inferiority of visual acuity at a five-letter margin. The primary analyses will be by intention to treat. The safety and efficacy outcomes will help determine the role of SRT in the management of chronic, active nAMD. International Standard Randomised Controlled Trial Number: ISRCTN12884465. Registered on 28 November 2014. ClinicalTrials.gov: NCT02243878 . Registered on 17 September 2014.

Factors associated with anxiety and depression among type 2 diabetes outpatients in Malaysia: a descriptive cross-sectional single-centre study

PubMed Central

Ganasegeran, Kurubaran; Renganathan, Pukunan; Manaf, Rizal Abdul; Al-Dubai, Sami Abdo Radman

2014-01-01

Objective To determine the prevalence and factors associated with anxiety and depression among type 2 diabetes outpatients in Malaysia. Design Descriptive, cross-sectional single-centre study with universal sampling of all patients with type 2 diabetes. Setting Endocrinology clinic of medical outpatient department in a Malaysian public hospital. Participants All 169 patients with type 2 diabetes (men, n=99; women, n=70) aged between 18 and 90 years who acquired follow-up treatment from the endocrinology clinic in the month of September 2013. Main outcome measures The validated Hospital Anxiety and Depression Scale (HADS), sociodemographic characteristics and clinical health information from patient records. Results Of the total 169 patients surveyed, anxiety and depression were found in 53 (31.4%) and 68 (40.3%), respectively. In multivariate analysis, age, ethnicity and ischaemic heart disease were significantly associated with anxiety, while age, ethnicity and monthly household income were significantly associated with depression. Conclusions Sociodemographics and clinical health factors were important correlates of anxiety and depression among patients with diabetes. Integrated psychological and medical care to boost self-determination and confidence in the management of diabetes would catalyse optimal health outcomes among patients with diabetes. PMID:24760351

Perceptions of Clinical Athletic Trainers on the Spiritual Care of Injured Athletes

PubMed Central

McKnight, Cynthia M.; Juillerat, Stephanie

2011-01-01

Context: Treating both the body and the mind of an injured or ill patient is accepted as necessary for full healing to occur. However, treating the spiritual needs of the patient has less consensus. Objective: To determine the perceptions and practices of certified athletic trainers (ATs) working in the college/university setting pertaining to spiritual care of the injured athlete. Design: Cross-sectional study. Setting: A survey instrument was e-mailed to a stratified random sample of 2000 ATs at 4-year colleges and universities. Patients or Other Participants: Five hundred sixty-four participants (296 men, 234 women; 34 did not specify sex). Main Outcome Measure(s): We measured the ATs' perceptions and practices related to spiritual care for athletes. Results: We found that 82.4% of respondents agreed that addressing spiritual concerns could result in more positive therapeutic outcomes for athletes; however, 64.3% disagreed that ATs are responsible for providing the spiritual care. Positive correlations were found between personal spirituality and items favoring implementing spiritual care. Conclusions: Athletic trainers have a conceptual appreciation of the importance of spiritual care for athletes, but the practicalities of how to define, acquire skills in, and practice spiritual care are unresolved. PMID:21669101

[The Brazilian Hospital Information System and the acute myocardial infarction hospital care].

PubMed

Escosteguy, Claudia Caminha; Portela, Margareth Crisóstomo; Medronho, Roberto de Andrade; de Vasconcellos, Maurício Teixeira Leite

2002-08-01

To analyze the applicability of the Brazilian Unified Health System's national hospital database to evaluate the quality of acute myocardial infarction hospital care. It was evaluated 1,936 hospital admission forms having acute myocardial infarction (AMI) as primary diagnosis in the municipal district of Rio de Janeiro, Brazil, in 1997. Data was collected from the national hospital database. A stratified random sampling of 391 medical records was also evaluated. AMI diagnosis agreement followed the literature criteria. Variable accuracy analysis was performed using kappa index agreement. The quality of AMI diagnosis registered in hospital admission forms was satisfactory according to the gold standard of the literature. In general, the accuracy of the variables demographics (sex, age group), process (medical procedures and interventions), and outcome (hospital death) was satisfactory. The accuracy of demographics and outcome variables was higher than the one of process variables. Under registration of secondary diagnosis was high in the forms and it was the main limiting factor. Given the study findings and the widespread availability of the national hospital database, it is pertinent its use as an instrument in the evaluation of the quality of AMI medical care.

[Clinical research IV. Relevancy of the statistical test chosen].

PubMed

Talavera, Juan O; Rivas-Ruiz, Rodolfo

2011-01-01

When we look at the difference between two therapies or the association of a risk factor or prognostic indicator with its outcome, we need to evaluate the accuracy of the result. This assessment is based on a judgment that uses information about the study design and statistical management of the information. This paper specifically mentions the relevance of the statistical test selected. Statistical tests are chosen mainly from two characteristics: the objective of the study and type of variables. The objective can be divided into three test groups: a) those in which you want to show differences between groups or inside a group before and after a maneuver, b) those that seek to show the relationship (correlation) between variables, and c) those that aim to predict an outcome. The types of variables are divided in two: quantitative (continuous and discontinuous) and qualitative (ordinal and dichotomous). For example, if we seek to demonstrate differences in age (quantitative variable) among patients with systemic lupus erythematosus (SLE) with and without neurological disease (two groups), the appropriate test is the "Student t test for independent samples." But if the comparison is about the frequency of females (binomial variable), then the appropriate statistical test is the χ(2).

Childhood sexual abuse, intimate partner violence during pregnancy, and posttraumatic stress symptoms following childbirth: a path analysis.

PubMed

Oliveira, Aline Gaudard E Silva de; Reichenheim, Michael Eduardo; Moraes, Claudia Leite; Howard, Louise Michele; Lobato, Gustavo

2017-04-01

The aim of the study was to explore the pathways by which childhood sexual abuse (CSA), psychological and physical intimate partner violence (IPV) during pregnancy, and other covariates relate to each other and to posttraumatic stress disorder (PTSD) symptoms in the postpartum period. The sample comprised 456 women who gave birth at a maternity service for high-risk pregnancies in Rio de Janeiro, Brazil, interviewed at 6-8 weeks after birth. A path analysis was carried out to explore the postulated pathways between exposures and outcome. Trauma History Questionnaire, Conflict Tactics Scales and Posttraumatic Stress Disorder Checklist were used to assess information about exposures of main interest and outcome. The link between CSA and PTSD symptoms was mediated by history of trauma, psychiatric history, psychological IPV, and fear of childbirth during pregnancy. Physical IPV was directly associated with postnatal PTSD symptoms, whereas psychological IPV connection seemed to be partially mediated by physical abuse and fear of childbirth during pregnancy. The role of CSA, IPV, and other psychosocial characteristics on the occurrence of PTSD symptoms following childbirth as well as the intricate network of these events should be acknowledged in clinic and intervention approaches.

Xanthogranulomatous cholecystitis: a European and global perspective

PubMed Central

Hale, Matthew David; Roberts, Keith J; Hodson, James; Scott, Nigel; Sheridan, Maria; Toogood, Giles J

2014-01-01

Introduction Xanthogranulomatous cholecystitis (XGC) is often mistaken for, and may predispose to, gallbladder carcinoma (GB Ca). This study reviews the worldwide variation of the incidence, investigations, management and outcome of patients with XGC. Methods Data from 29 studies, cumulatively containing 1599 patients, were reviewed and results summarized by geographical region (Europe, India, Far East and Americas) with 95% confidence intervals (CIs) to present variability within regions. The main study outcomes were incidence, association with GB Ca and treatment of patients with XGC. Results Overall, the incidence of XGC was 1.3–1.9%, with the exception of India where it was 8.8%. The incidence of GB Ca associated with XGC was lowest in European studies (3.3%) varying from 5.1–5.9% in the remaining regions. Confusion with or undiagnosed GB Ca led to 10.2% of patients receiving over or under treatment. Conclusions XGC is a global disease and is associated with GB Ca. Characteristic pathological, radiological and clinical features are shared with GB Ca and contribute to considerable treatment inaccuracy. Tissue sampling by pre-operative endoscopic ultrasound or intra-operative frozen section is required to accurately diagnose gallbladder pathology and should be performed before any extensive resection is performed. PMID:23991684

Data processing has major impact on the outcome of quantitative label-free LC-MS analysis.

PubMed

Chawade, Aakash; Sandin, Marianne; Teleman, Johan; Malmström, Johan; Levander, Fredrik

2015-02-06

High-throughput multiplexed protein quantification using mass spectrometry is steadily increasing in popularity, with the two major techniques being data-dependent acquisition (DDA) and targeted acquisition using selected reaction monitoring (SRM). However, both techniques involve extensive data processing, which can be performed by a multitude of different software solutions. Analysis of quantitative LC-MS/MS data is mainly performed in three major steps: processing of raw data, normalization, and statistical analysis. To evaluate the impact of data processing steps, we developed two new benchmark data sets, one each for DDA and SRM, with samples consisting of a long-range dilution series of synthetic peptides spiked in a total cell protein digest. The generated data were processed by eight different software workflows and three postprocessing steps. The results show that the choice of the raw data processing software and the postprocessing steps play an important role in the final outcome. Also, the linear dynamic range of the DDA data could be extended by an order of magnitude through feature alignment and a charge state merging algorithm proposed here. Furthermore, the benchmark data sets are made publicly available for further benchmarking and software developments.

Integrated HTA-FMEA/FMECA methodology for the evaluation of robotic system in urology and general surgery.

PubMed

Frosini, Francesco; Miniati, Roberto; Grillone, Saverio; Dori, Fabrizio; Gentili, Guido Biffi; Belardinelli, Andrea

2016-11-14

The following study proposes and tests an integrated methodology involving Health Technology Assessment (HTA) and Failure Modes, Effects and Criticality Analysis (FMECA) for the assessment of specific aspects related to robotic surgery involving safety, process and technology. The integrated methodology consists of the application of specific techniques coming from the HTA joined to the aid of the most typical models from reliability engineering such as FMEA/FMECA. The study has also included in-site data collection and interviews to medical personnel. The total number of robotic procedures included in the analysis was 44: 28 for urology and 16 for general surgery. The main outcomes refer to the comparative evaluation between robotic, laparoscopic and open surgery. Risk analysis and mitigation interventions come from FMECA application. The small sample size available for the study represents an important bias, especially for the clinical outcomes reliability. Despite this, the study seems to confirm the better trend for robotics' surgical times with comparison to the open technique as well as confirming the robotics' clinical benefits in urology. More complex situation is observed for general surgery, where robotics' clinical benefits directly measured are the lowest blood transfusion rate.

Pause for thought: response perseveration and personality in gambling.

PubMed

Corr, Philip J; Thompson, Stephen J

2014-12-01

In a sample of normal volunteers, response perseveration (RP) on a computerised gambling task, the card perseveration task, was examined under two conditions: No pause (Standard task) and a 5-s pause (Pause task) following feedback from previous bet. Behavioural outcomes comprised number of cards played (and cash won/lost) and latency of response. Individual differences in these outcomes were conceptualised in terms of the reinforcement sensitivity theory of personality. Results showed that, on the Standard task only, sub-scales of the Carver and White (J Pers Social Psychol 67:319-333, 1994) Behavioural Approach System scale positively correlated with number of cards played and amount of money lost (indicative of impaired RP), but these associations were abolished with the imposition of a 5-s pause between feedback and the opportunity to make the next bet-this pause also had an overall main effect of improving RP and reducing losses. As related research shows that such a pause normalises the RP deficit seen in pathological gamblers, these findings hold potentially valuable implications for informing practice in the prevention and treatment of pathological gambling, and point to the role played by individual differences in approach motivation.

Evaluation of the Capillary Blood Glucose Self-monitoring Program

PubMed Central

Augusto, Mariana Cristina; Nitsche, Maria José Trevizani; Parada, Cristina Maria Garcia de Lima; Zanetti, Maria Lúcia; Carvalhaes, Maria Antonieta de Barros Leite

2014-01-01

OBJECTIVE: to evaluate the structure, process and results of the Capillary Blood Glucose Self-monitoring Program in a Brazilian city. METHOD: epidemiological, cross-sectional study. The methodological framework of Donabedian was used to construct indicators of structure, process and outcome. A random sample (n = 288) of users enrolled and 96 health professionals who worked in the program was studied. Two questionnaires were used that were constructed for this study, one for professionals and one for users, both containing data for the evaluation of structure, process and outcome. Anthropometric measures and laboratory results were collected by consulting the patients' health records. The analysis involved descriptive statistics. RESULTS: most of the professionals were not qualified to work in the program and were not knowledgeable about the set of criteria for patient registration. None of the patients received complete and correct orientations about the program and the percentage with skills to perform conducts autonomously was 10%. As regards the result indicators, 86.4% of the patients and 81.3% of the professionals evaluated the program positively. CONCLUSION: the evaluation indicators designed revealed that one of the main objectives of the program, self-care skills, has not been achieved. PMID:25493676

Serum PARC/CCL-18 Concentrations and Health Outcomes in Chronic Obstructive Pulmonary Disease

PubMed Central

Sin, Don D.; Miller, Bruce E.; Duvoix, Annelyse; Man, S. F. Paul; Zhang, Xuekui; Silverman, Edwin K.; Connett, John E.; Anthonisen, Nicholas A.; Wise, Robert A.; Tashkin, Donald; Celli, Bartolome R.; Edwards, Lisa D.; Locantore, Nicholas; MacNee, William; Tal-Singer, Ruth; Lomas, David A.

2011-01-01

Rationale: There are no accepted blood-based biomarkers in chronic obstructive pulmonary disease (COPD). Pulmonary and activation-regulated chemokine (PARC/CCL-18) is a lung-predominant inflammatory protein that is found in serum. Objectives: To determine whether PARC/CCL-18 levels are elevated and modifiable in COPD and to determine their relationship to clinical end points of hospitalization and mortality. Methods: PARC/CCL-18 was measured in serum samples from individuals who participated in the ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints) and LHS (Lung Health Study) studies and a prednisolone intervention study. Measurements and Main Results: Serum PARC/CCL-18 levels were higher in subjects with COPD than in smokers or lifetime nonsmokers without COPD (105 vs. 81 vs. 80 ng/ml, respectively; P < 0.0001). Elevated PARC/CCL-18 levels were associated with increased risk of cardiovascular hospitalization or mortality in the LHS cohort and with total mortality in the ECLIPSE cohort. Conclusions: Serum PARC/CCL-18 levels are elevated in COPD and track clinical outcomes. PARC/CCL-18, a lung-predominant chemokine, could be a useful blood biomarker in COPD. Clinical trial registered with www.clinicaltrials.gov (NCT 00292552). PMID:21216880

The academic, personality, and physical outcomes of only children in China.

PubMed

Falbo, T; Poston, D L

1993-02-01

Representative samples of 1,000 schoolchildren from 4 Chinese provinces were surveyed to compare the outcomes of only children to those of firstborn and later-born children. The children's ages ranged from 8 to 17 years, with half of the sample in the third grade and the other half in the sixth grade. 3 types of outcomes were considered. In terms of academics, differences between only children and others were found in 3 of the 4 provincial samples, with onlies being most likely to outscore others in verbal tests. In terms of personality evaluations, very few only-child effects were found. In 2 of the 4 provincial samples, only children were found to be taller or to weigh more than others. Taken together, these results suggest that the one-child policy in China is not producing a generation of "little emperors."

Racial Disparities in Mental Health Outcomes after Psychiatric Hospital Discharge among Individuals with Severe Mental Illness

ERIC Educational Resources Information Center

Eack, Shaun M.; Newhill, Christina E.

2012-01-01

Racial disparities in mental health outcomes have been widely documented in noninstitutionalized community psychiatric samples, but few studies have specifically examined the effects of race among individuals with the most severe mental illnesses. A sample of 925 individuals hospitalized for severe mental illness was followed for a year after…

Confidence intervals from single observations in forest research

Treesearch

Harry T. Valentine; George M. Furnival; Timothy G. Gregoire

1991-01-01

A procedure for constructing confidence intervals and testing hypothese from a single trial or observation is reviewed. The procedure requires a prior, fixed estimate or guess of the outcome of an experiment or sampling. Two examples of applications are described: a confidence interval is constructed for the expected outcome of a systematic sampling of a forested tract...

Socioeconomic Background, Education, and Labor Force Outcomes: Evidence from a Regional US Sample

ERIC Educational Resources Information Center

Caro, Daniel H.; Cortina, Kai S.; Eccles, Jacquelynne S.

2015-01-01

This paper examines the long-term association of family socioeconomic status (SES), educational, and labor force outcomes in a regional US longitudinal sample (N = 2264). The results offer insights into the mechanisms underlying the role of family SES in transitions from secondary schooling to early work experiences. It was found that the academic…

Investigating self-esteem in individuals with schizophrenia: relevance of the Self-Esteem Rating Scale-Short Form.

PubMed

Lecomte, Tania; Corbière, Marc; Laisné, François

2006-06-30

Studies investigating self-esteem in individuals with severe mental illness, either as a treatment goal, outcome or correlate to other variables, have increased over the past few years. One of the main difficulties in assessing self-esteem is the assessment itself, often measuring global and stable self-esteem as in the Rosenberg Self-Esteem Scale, or requiring extensive training and long interviews. The present article aims at demonstrating the relevance of the French and English versions of the Self-Esteem Rating Scale-Short Form with individuals with severe mental illness. The instrument's reliability and validity were investigated in a sample of 250 French Canadian college students, 247 British college students and three samples of English- or French-speaking individuals with severe mental illness (N=254, N=150 and N=171). Confirmatory factor analysis revealed that a shorter version of the instrument (20 items), with a positive and a negative self-esteem factor, had a great validity for all the samples studied. The Self-Esteem Rating Scale-Short Form, with its positive and negative self-esteem subscales, appears to be a valid and reliable self-esteem measure for individuals with mental health problems. Limitations of this study and future directions are discussed.

Heavy metal contaminants in yerberia shop products.

PubMed

Levine, Michael; Mihalic, Jason; Ruha, Anne-Michelle; French, Robert N E; Brooks, Daniel E

2013-03-01

Complementary and alternative medications, including the use of herbal medications, have become quite popular in the USA. Yerberias are found throughout the southwest and specialize in selling Hispanic herbal products. The products sold in these stores are not regulated by any governmental agency. Previous reports have found Ayurvedic medications contain high levels of lead, mercury, and arsenic. The primary purpose of this study is to examine the prevalence of heavy metal contaminants sold at Yerberia stores in the southwest. Yerberias in the Phoenix, Arizona area were identified via search of an on-line search engine using the words "Yerberia Phoenix." Every second store was selected, and products were purchased using a standard script. The products were subsequently analyzed for mercury, lead, and arsenic. The main outcome is the prevalence of heavy metal content in over-the-counter "cold" medications purchased at a Yerberia. Twenty-two samples were purchased. One product contained pure camphor (2-camphone) and was subsequently not further analyzed. Of the 21 samples analyzed, lead was found in 4/21 (19.4 %). Arsenic and mercury were in 1/21 (4.8 %) each. Because two samples contained two heavy metals, the total prevalence of heavy metals was 4/21 (19.4). Heavy metal contaminants are commonly encountered in over-the-counter herbal "cold" medications purchased at Yerberias in the southwest.

Sputum colour for diagnosis of a bacterial infection in patients with acute cough

PubMed Central

Altiner, Attila; Wilm, Stefan; Däubener, Walter; Bormann, Christiane; Pentzek, Michael; Abholz, Heinz-Harald; Scherer, Martin

2009-01-01

Objective Sputum colour plays an important role in the disease concepts for acute cough, both in the patients’ and the doctors’ view. However, it is unclear whether the sputum colour can be used for diagnosis of a bacterial infection. Design Cross-sectional study. Setting A total of 42 GP practices in Düsseldorf, Germany. Subjects Sputum samples obtained from 241 patients suffering from an episode of acute cough seeing their doctor within a routine consultation. Main outcome measures Relation of sputum colour and microbiological proof of bacterial infection defined as positive culture and at least a moderate number of leucocytes per low magnification field. Results In 28 samples (12%) a bacterial infection was proven. Yellowish or greenish colour of the sputum sample and bacterial infection showed a significant correlation (p = 0.014, Fisher's exact test). The sensitivity of yellowish or greenish sputum used as a test for a bacterial infection was 0.79 (95% CI 0.63–0.94); the specificity was 0.46 (95% CI 0.038–0.53). The positive likelihood-ratio (+LR) was 1.46 (95% CI 1.17-1.85). Conclusions The sputum colour of patients with acute cough and no underlying chronic lung disease does not imply therapeutic consequences such as prescription of antibiotics. PMID:19242860

Outcomes of a pilot study in chiropractic practices in Western Australia.

PubMed

Amorin-Woods, Lyndon G; Parkin-Smith, Gregory F; Nedkoff, Lee; Fisher, Colleen

2016-01-01

This paper reports the quantitative outcomes of a mixed-methods pilot study of the characteristics and demographics of chiropractic practices and patients in Western Australia. This was a mixed-methods data transformation model (qualitative to quantitative) pilot study. A non-random sample of chiropractic practices across Western Australia was recruited and data collected anonymously from consecutive new patients using an online platform. Data covered practice and patient demographics and characteristics, alongside quality of life measures. A descriptive quantitative analysis characterised the sample, and the patient population was stratified by main reason for presentation to compare characteristics according to the presence of secondary complaints. Odds ratios were calculated to estimate the odds of a secondary complaint for various combinations of main complaints, from univariate logistic regression models. Of the 539 registered practitioners in WA in July 2014, 33 agreed to participate, from 20 different practices. Ten participating practices provided data on 325 adult new patients. The recruited practices (metropolitan n  = 8, regional n  = 2) had a positive response rate of 79.7 % ( n  = 301 metropolitan and n  = 24 regional patients), mean age 36.3 years (range 18-74) (53.2 % female). Spinal problems were reported as the main reason for consultation by 67 % and as secondary reasons by 77.2 % of patients. People presented primarily for health maintenance or a general health check in 11.4 %, and as a secondary reason 14.8 %. There were 30 % of people below societal norms for the SF-12 Physical Component Score (mean 47.19, 95 % CI; 46.27-48.19) and 86 % for the Mental Component Score (mean 36.64, 95 % CI; 35.93-37.65), Pain Impact Questionnaire mean scores were 54.60 (95 % CI; 53.32-55.88). Patients presented to chiropractors in Western Australia with a fairly wide range of conditions, but primarily spinal and musculoskeletal-related problems. A significant proportion of patients had associated, or found to be at risk of, depression. Consequently, there are responsibilities and opportunities for chiropractors with respect to providing care services that include health promotion and well-being education related to musculoskeletal/spinal and mental health. This pilot study supports the feasibility of a future confirmatory study where the potential role of chiropractors in spinal/musculoskeletal health management may be explored. ACTRN12616000434493: Australian New Zealand Clinical Trials Registry (ANZCTR), Registered 5 April 2016, First participant enrolled 01 July 2014 Retrospectively Registered.

Perceived Neighborhood Violence, Parenting Styles, and Developmental Outcomes among Spanish Adolescents

ERIC Educational Resources Information Center

Gracia, Enrique; Fuentes, Maria C.; Garcia, Fernando; Lila, Marisol

2012-01-01

This article analyzed perceptions of neighborhood violence of Spanish adolescents (N = 1,015) from authoritative, authoritarian, indulgent, and neglectful families, and its association with three sets of developmental outcomes (psychological, behavioral, and academic). Tests of main and interactive effects were conducted to answer research…

The Efficacy of a Web-Based Screening and Brief Intervention for Reducing Alcohol Consumption Among Japanese Problem Drinkers: Protocol for a Single-Blind Randomized Controlled Trial.

PubMed

Hamamura, Toshitaka; Suganuma, Shinichiro; Takano, Ayumi; Matsumoto, Toshihiko; Shimoyama, Haruhiko

2018-05-30

The literature shows that computer-delivered interventions with personalized normative feedback can reduce problem drinking for up to 6 months in the West. Meanwhile, no studies have been conducted to examine the effects of such interventions among Japanese problem drinkers. Possible moderators associated with effectiveness of the intervention need to be also explored. The purpose of this study is to conduct a trial and examine the efficacy of a brief intervention with personal normative feedback and psychoeducation on several measures of alcohol consumption among Japanese problem drinkers. Additionally, this study will examine whether the level of alcohol use disorder and beliefs about the physical and psychological outcomes of drinking moderate the effect of the intervention on outcome measures. This study will conduct a single-blind, 2-armed randomized controlled trial. Japanese adults with an Alcohol Use Disorder Identification Test score of 8 or higher will be enrolled in the trial. Participants allocated to the intervention group will receive the intervention immediately after the baseline measurements, and participants allocated to the waitlist group will receive the intervention at the end of the trial. Outcome measures include drinking quantity, drinking frequency, and alcohol-related consequences. Follow-up assessment will take place at 1 month, 2 months, and 6 months following the baseline measurement. The authors will not know the group allocation during trial. The authors will plan to collect a sample of 600 participants. Mixed-effect analyses of variance will be used to examine the main effects of condition, the main effects of time, and the interaction effects between condition and time on outcome variables. Enrollment for the trial began on January 6, 2018 and data are expected to be available by August 2018. This study will contribute to the literature by demonstrating the efficacy of Web-based screenings and brief interventions among Japanese problem drinkers and indicating several possible moderators between the intervention and outcomes. This type of Web-based brief intervention has the possibility of being implemented in Japanese schools and workplaces as a prevention tool. UMIN Clinical Trials Registry R000034388; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi? recptno=R000034388 (Archived by WebCite at http://www.webcitation.org/6xmOoTfTI). RR1-10.2196/10650. ©Toshitaka Hamamura, Shinichiro Suganuma, Ayumi Takano, Toshihiko Matsumoto, Haruhiko Shimoyama. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 30.05.2018.

Evaluation of three sampling methods to monitor outcomes of antiretroviral treatment programmes in low- and middle-income countries.

PubMed

Tassie, Jean-Michel; Malateste, Karen; Pujades-Rodríguez, Mar; Poulet, Elisabeth; Bennett, Diane; Harries, Anthony; Mahy, Mary; Schechter, Mauro; Souteyrand, Yves; Dabis, François

2010-11-10

Retention of patients on antiretroviral therapy (ART) over time is a proxy for quality of care and an outcome indicator to monitor ART programs. Using existing databases (Antiretroviral in Lower Income Countries of the International Databases to Evaluate AIDS and Médecins Sans Frontières), we evaluated three sampling approaches to simplify the generation of outcome indicators. We used individual patient data from 27 ART sites and included 27,201 ART-naive adults (≥15 years) who initiated ART in 2005. For each site, we generated two outcome indicators at 12 months, retention on ART and proportion of patients lost to follow-up (LFU), first using all patient data and then within a smaller group of patients selected using three sampling methods (random, systematic and consecutive sampling). For each method and each site, 500 samples were generated, and the average result was compared with the unsampled value. The 95% sampling distribution (SD) was expressed as the 2.5(th) and 97.5(th) percentile values from the 500 samples. Overall, retention on ART was 76.5% (range 58.9-88.6) and the proportion of patients LFU, 13.5% (range 0.8-31.9). Estimates of retention from sampling (n = 5696) were 76.5% (SD 75.4-77.7) for random, 76.5% (75.3-77.5) for systematic and 76.0% (74.1-78.2) for the consecutive method. Estimates for the proportion of patients LFU were 13.5% (12.6-14.5), 13.5% (12.6-14.3) and 14.0% (12.5-15.5), respectively. With consecutive sampling, 50% of sites had SD within ±5% of the unsampled site value. Our results suggest that random, systematic or consecutive sampling methods are feasible for monitoring ART indicators at national level. However, sampling may not produce precise estimates in some sites.

Global Risk Score and Clinical SYNTAX Score as Predictors of Clinical Outcomes of Patients Undergoing Unprotected Left Main Percutaneous Catheter Intervention

PubMed Central

Cuenza, Lucky; Collado, Marianne P.; Ho Khe Sui, James

2017-01-01

Background Risk stratification is an important component of left main percutaneous catheter intervention (PCI) which has emerged as a feasible alternative to cardiac surgery. We sought to compare the clinical SYNTAX score and the global risk score in predicting outcomes of patients undergoing unprotected left main PCI in our institution. Methods Clinical, angiographic and procedural characteristics of 92 patients who underwent unprotected left main PCI (mean age 62 ± 12.1 years) were analyzed. Patients were risk stratified into tertiles of high, intermediate and low risk using the global risk score (GRS) and the clinical SYNTAX score (CSS) and were prospectively followed up at 1 year for the occurrence of major adverse cardiovascular events (MACEs), defined as a composite of all cause mortality, cardiac mortality, non-fatal myocardial infarction, stroke, coronary artery bypass, and target vessel revascularization. Results There were 26 (28.2%) who experienced MACEs, of which 10 (10.8%) patients died. Multivariable hazards analysis showed that the GRS (hazard ratio (HR) = 5.5, P = 0.001) and CSS (HR = 4.3, P = 0.001) were both independent predictors of MACEs. Kaplan-Meier analysis showed higher incidence of MACEs with the intermediate and higher risk categories compared to those classified as low risk. Receiver-operator characteristic analysis showed that the GRS has better discriminatory ability than the CSS in the prediction of 1 year MACEs (0.891 vs. 0.743, P = 0.007). Conclusion The GRS and CSS are predictive of outcomes after left main PCI. The GRS appears to have superior predictive and prognostic utility compared to the CSS. This study emphasizes the importance of combining both anatomic and clinical variables for optimum prognostication and management decisions in left main PCI. PMID:29317974

Reliability of risk-adjusted outcomes for profiling hospital surgical quality.

PubMed

Krell, Robert W; Hozain, Ahmed; Kao, Lillian S; Dimick, Justin B

2014-05-01

Quality improvement platforms commonly use risk-adjusted morbidity and mortality to profile hospital performance. However, given small hospital caseloads and low event rates for some procedures, it is unclear whether these outcomes reliably reflect hospital performance. To determine the reliability of risk-adjusted morbidity and mortality for hospital performance profiling using clinical registry data. A retrospective cohort study was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program, 2009. Participants included all patients (N = 55,466) who underwent colon resection, pancreatic resection, laparoscopic gastric bypass, ventral hernia repair, abdominal aortic aneurysm repair, and lower extremity bypass. Outcomes included risk-adjusted overall morbidity, severe morbidity, and mortality. We assessed reliability (0-1 scale: 0, completely unreliable; and 1, perfectly reliable) for all 3 outcomes. We also quantified the number of hospitals meeting minimum acceptable reliability thresholds (>0.70, good reliability; and >0.50, fair reliability) for each outcome. For overall morbidity, the most common outcome studied, the mean reliability depended on sample size (ie, how high the hospital caseload was) and the event rate (ie, how frequently the outcome occurred). For example, mean reliability for overall morbidity was low for abdominal aortic aneurysm repair (reliability, 0.29; sample size, 25 cases per year; and event rate, 18.3%). In contrast, mean reliability for overall morbidity was higher for colon resection (reliability, 0.61; sample size, 114 cases per year; and event rate, 26.8%). Colon resection (37.7% of hospitals), pancreatic resection (7.1% of hospitals), and laparoscopic gastric bypass (11.5% of hospitals) were the only procedures for which any hospitals met a reliability threshold of 0.70 for overall morbidity. Because severe morbidity and mortality are less frequent outcomes, their mean reliability was lower, and even fewer hospitals met the thresholds for minimum reliability. Most commonly reported outcome measures have low reliability for differentiating hospital performance. This is especially important for clinical registries that sample rather than collect 100% of cases, which can limit hospital case accrual. Eliminating sampling to achieve the highest possible caseloads, adjusting for reliability, and using advanced modeling strategies (eg, hierarchical modeling) are necessary for clinical registries to increase their benchmarking reliability.

Evaluation of outreach clinics held by specialists in general practice in England

PubMed Central

Bond, M.; Bowling, A.; Abery, A.; McClay, M.; Dickinson, E.

2000-01-01

OBJECTIVES—To measure the processes of care, health benefits and costs of outreach clinics held by hospital specialists in primary care settings.
DESIGN—The study was designed as a case-referent (comparative) study in which the features of 19 outreach clinics (cases) were compared with matched outpatient clinics (controls). The measuring instruments were self administered questionnaires. Patients were followed up at six months to reassess health status. The specialties included in the study were cardiology, ENT, general medicine, general surgery, gynaecology and rheumatology.
SETTING—Specialist outreach clinics in general practice in England, with matched outpatient clinic controls.
SUBJECTS—Consecutive patient attenders in the outreach and outpatient clinics, their specialists, the outreach patients' general practitioners, practice managers and trust accountants. Patients' response rate at baseline: 78% (1420).
MAIN OUTCOME MEASURES—Patient satisfaction, doctors' attitudes, processes and health outcomes, costs.
RESULTS—Outreach patients were more satisfied with the processes of their care than outpatients, their access to specialist care was better than that for outpatients and they were more likely to be discharged. Doctors reported that the main advantages of the outreach clinic were improved patient access to specialists and convenience for patients, in comparison with outpatients, and most GPs and specialists felt the outreach clinic was "worthwhile". At six month follow up, the health status of the outreach sample had significantly improved more than that of the outpatients on all eight sub-scales of the HSQ-12, but this was probably because of their better starting point at baseline. The impact of outreach on health outcomes was small. The NHS costs of outreach were significantly higher than outpatients. An increase in outreach clinic size would reduce cost per patient, but would lead to the loss of most of the clinics' benefits.
CONCLUSIONS—While the process of care was of higher quality in outreach than in outpatients, and the efficiency of care was also greater in the latter, the effect on patients' health outcomes was small. Responsiveness to patients' views and preferences is an essential component of good quality service provision. However, the greater cost of outreach raises the issue of whether improvements in the quality and efficiency of health care, without a substantial impact on health outcomes, is money well spent in a publicly funded health service. On the other hand, the real costs of outreach in comparison with outpatients clinics can probably only be truly estimated in a longitudinal study with a resource based costing model derived from documented patient attendances and treatment costs over time in relation to longer term outcome (for example, at a two year end point).


Keywords: outreach clinics; general practice PMID:10715749

Randomized comparison of 3 different-sized biopsy forceps for quality of sampling in Barrett’s esophagus

PubMed Central

Gonzalez, Susana; Yu, Woojin M.; Smith, Michael S.; Slack, Kristen N.; Rotterdam, Heidrun; Abrams, Julian A.; Lightdale, Charles J.

2011-01-01

Background Several types of forceps are available for use in sampling Barrett’s esophagus (BE). Few data exist with regard to biopsy quality for histologic assessment. Objective To evaluate sampling quality of 3 different forceps in patients with BE. Design Single-center, randomized clinical trial. Patients Consecutive patients with BE undergoing upper endoscopy. Interventions Patients randomized to have biopsy specimens taken with 1 of 3 types of forceps: standard, large capacity, or jumbo. Main Outcome Measurements Specimen adequacy was defined a priori as a well-oriented biopsy sample 2 mm or greater in diameter and with at least muscularis mucosa present. Results A total of 65 patients were enrolled and analyzed (standard forceps, n = 21; large-capacity forceps, n = 21; jumbo forceps, n = 23). Compared with jumbo forceps, a significantly higher proportion of biopsy samples with large-capacity forceps were adequate (37.8% vs 25.2%, P = .002). Of the standard forceps biopsy samples, 31.9% were adequate, which was not significantly different from specimens taken with large-capacity (P = .20) or jumbo (P = .09) forceps. Biopsy specimens taken with jumbo forceps had the largest diameter (median, 3.0 mm vs 2.5 mm [standard] vs 2.8 mm [large capacity]; P = .0001). However, jumbo forceps had the lowest proportion of specimens that were well oriented (overall P = .001). Limitations Heterogeneous patient population precluded dysplasia detection analyses. Conclusions Our results challenge the requirement of jumbo forceps and therapeutic endoscopes to properly perform the Seattle protocol. We found that standard and large-capacity forceps used with standard upper endoscopes produced biopsy samples at least as adequate as those obtained with jumbo forceps and therapeutic endoscopes in patients with BE. PMID:21034895

[Frequency of Candida in root canals of teeth with primary and persistent endodontic infections].

PubMed

Bernal-Treviño, Angel; González-Amaro, Ana María; Méndez González, Verónica; Pozos-Guillen, Amaury

Microbiological identification in endodontic infections has focused mainly on bacteria without giving much attention to yeasts, which, due to their virulence factors, can affect the outcomes of root canal treatment. To determine the frequency of Candida in anaerobic conditions in root canals with primary and persistent endodontic infection, as well as to evaluate a microbiological sampling method using aspiration compared to the traditional absorption method with paper points. Fifty microbiological samples were obtained from teeth of 47 patients requiring endodontic treatments, due to either primary or persistent infections. Two microbiological sampling methods were used: an aspiration method, and the traditional paper point absorption method. In each of these methods, two types of medium were used (M 1 -M 4 ). Samples were cultured under anaerobic conditions until reaching 0.5 McFarland turbidity, and then inoculated on Sabouraud dextrose, as well as on anaerobic enriched blood agar plates. Macroscopic and microscopic observations of the colonies were performed. The germ-tube test, growth on CHROMagar, and biochemical identification were performed on the isolated yeasts. Fungal infection was found in 18 (36%) samples out of the 50 teeth evaluated. In the 18 samples positive for fungal infection, 15 out of 36 (41.6%) teeth were taken from a primary infection, and 3 out of 14 (21.4%) from a persistent infection. The aspiration method using Sabouraud dextrose medium recovered a greater diversity of species. Yeasts frequency was higher in teeth with primary infections compared to teeth with persistent infections. The predominant yeast species was Candida albicans. The aspirating sampling method was more efficient in the recovery of Candida isolates than the traditional absorption method. Copyright © 2018 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.

The prediction of disability by self-reported physical frailty components of the Tilburg Frailty Indicator (TFI).

PubMed

Gobbens, R J J; van Assen, M A L M; Schalk, M J D

2014-01-01

Disability is an important health outcome for older persons; it is associated with impaired quality of life, future hospitalization, and mortality. Disability also places a high burden on health care professionals and health care systems. Disability is regarded as an adverse outcome of physical frailty. The main objective of this study was to assess the predictive validity of the eight individual self-reported components of the physical frailty subscale of the TFI for activities of daily living (ADL) and instrumental activities of daily living (IADL) disability. This longitudinal study was carried out with a sample of Dutch citizens. At baseline the sample consisted at 429 people aged 65 years and older and a subset of all respondents participated again two and a half years later (N=355, 83% response rate). The respondents completed a web-based questionnaire comprising the TFI and the Groningen Activity Restriction Scale (GARS) for measuring disability. Five components together (unintentional weakness, weakness, poor endurance, slowness, low physical activity), referring to the phenotype of Fried et al., predicted disability, even after controlling for previous disability and other background characteristics. The other three components of the physical frailty subscale of the TFI (poor balance, poor hearing, poor vision) together did not predict disability. Low physical activity predicted both total and ADL disability, and slowness both total and IADL disability. In conclusion, self-report assessment using the physical subscale of the TFI aids the prediction of future ADL and IADL disability in older persons two and a half years later. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Motor vehicle driver injury and socioeconomic status: a cohort study with prospective and retrospective driver injuries

PubMed Central

Whitlock, G; Norton, R; Clark, T; Pledger, M; Jackson, R; MacMahon, S

2003-01-01

Study objective: To investigate the association between motor vehicle driver injury and socioeconomic status. Design: Cohort study with prospective and retrospective outcomes. Setting: New Zealand. Participants: 10 525 adults (volunteer sample of a multi-industry workforce, n=8008; and a random sample of urban electoral rolls, n=2517). Outcome measure: Motor vehicle driver injury resulting in admission of the driver to hospital or the driver's death, or both, during the period 1988–98; hospitalisation and mortality data were obtained by record linkage to national health databases. Main results: After adjustment for age and sex, driver injury risk was inversely associated with both occupational status (p for linear trend <0.0001) and educational level (p for linear trend =0.007). Participants in the lowest approximate quartile of occupational status were four times as likely (HR 4.17, 95% CI 2.31 to 7.55) to have experienced a driver injury during follow up as participants in the highest approximate quartile. Participants who had been to secondary school for less than two years were twice as likely (HR 2.26, 95% CI 1.34 to 3.81) to have experienced a driver injury as those who had been to university or polytechnic. There was little evidence that driver injury risk was associated with neighbourhood income (p for linear trend =0.12) Conclusions: Occupational status and educational level seem to be important determinants of driver injury risk. Driver injury countermeasures should be targeted to people in low status occupations, as well as to people with comparatively little formal education. PMID:12821697

Motor vehicle driver injury and marital status: a cohort study with prospective and retrospective driver injuries

PubMed Central

Whitlock, G; Norton, R; Clark, T; Jackson, R; MacMahon, S

2004-01-01

Objective: To investigate the association of marital status with risk of motor vehicle driver injury. Design: A cohort study with prospective and retrospective outcomes. Setting: New Zealand. Participants: A total of 10 525 adults (a volunteer sample of a multi-industry workforce, n = 8008; and a random sample of urban electoral rolls, n = 2517). Exposure variable: Self reported marital status, assessed from a questionnaire administered in 1992–93 (baseline). Main outcome measure: Motor vehicle driver injury resulting in admission of the driver to hospital and/or the driver's death, during the period 1988–98; hospitalisation and mortality data were obtained by record linkage to national health databases. Results: During 108 741 person-years of follow up, 139 driver injury cases occurred (85 before baseline, 54 after). After adjustment for age, sex, and study cohort, never married participants had twice the risk of driver injury (hazard ratio [HR] 2.06, 95% confidence interval [CI] 1.35 to 3.16) as married participants (HR 1.00). The relative risk for never married participants was slightly higher (HR 2.29), though less precise (95% CI 1.39 to 3.76), after further adjustment for alcohol intake, driving exposure, area of residence, body mass index, and occupational status. Conclusions: After taking age, sex, and other variables into account, never married people had a substantially higher risk of driver injury than married people. While requiring corroboration, these findings imply that it may be appropriate for driver injury countermeasures to be targeted to never married people. PMID:14760024

Firefighter willingness to participate in a stem cell clinical trial for burns: A mixed methods study.

PubMed

Horch, Jenny D; Carr, Eloise C J; Harasym, Patricia; Burnett, Lindsay; Biernaskie, Jeff; Gabriel, Vincent

2016-12-01

Adult stem cells represent a potentially renewable and autologous source of cells to regenerate skin and improve wound healing. Firefighters are at risk of sustaining a burn and potentially benefiting from a split thickness skin graft (STSG). This mixed methods study examined firefighter willingness to participate in a future stem cell clinical trial, outcome priorities and factors associated with this decision. A sequential explanatory mixed methods design was used. The quantitative phase (online questionnaire) was followed by the qualitative phase (semi-structured interviews). A sample of 149 firefighters completed the online survey, and a purposeful sample of 15 firefighters was interviewed. A majority (74%) reported they would participate in a future stem cell clinical trial if they experienced burn benefiting from STSG. Hypothetical concerns related to receiving a STSG were pain, itch, scarring/redness and skin durability. Participants indicated willingness to undergo stem cell therapy if the risk of no improvement was 43% or less. Risk tolerance was predicted by perceived social support and having children. Interviews revealed four main themes: a desire to help others, improving clinical outcomes, trusting relationships, and a belief in scientific investigation. Many participants admitted lacking sufficient knowledge to make an informed decision regarding stem cell therapies. Firefighters indicated they were largely willing to participate in a stem cell clinical trial but also indicated a lack of knowledge upon which to make a decision. Public education of the role of stem cells in STSG will be increasingly important as clinical trials are developed. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

5-year results comparing mineral trioxide aggregate and adhesive resin composite for root-end sealing in apical surgery.

PubMed

von Arx, Thomas; Hänni, Stefan; Jensen, Simon Storgård

2014-08-01

Recent meta-analyses of the outcome of apical surgery using modern techniques including microsurgical principles and high-power magnification have yielded higher rates of healing. However, the information is mainly based on 1- to 2-year follow-up data. The present prospective study was designed to re-examine a large sample of teeth treated with apical surgery after 5 years. Patients were recalled 5 years after apical surgery, and treated teeth were classified as healed or not healed based on clinical and radiographic examination. (The latter was performed independently by 3 observers). Two different methods of root-end preparation and filling (primary study parameters) were to be compared (mineral trioxide aggregate [MTA] vs adhesive resin composite [COMP]) without randomization. A total of 271 patients and teeth from a 1-year follow-up sample of 339 could be re-examined after 5 years (dropout rate = 20.1%). The overall rate of healed cases was 84.5% with a significant difference (P = .0003) when comparing MTA (92.5%) and COMP (76.6%). The evaluation of secondary study parameters yielded no significant difference for healing outcome when comparing subcategories (ie, sex, age, type of tooth treated, post/screw, type of surgery). The results from this prospective nonrandomized clinical study with a 5-year follow-up of 271 teeth indicate that MTA exhibited a higher healing rate than COMP in the longitudinal prognosis of root-end sealing. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Does parent-child agreement vary based on presenting problems? Results from a UK clinical sample.

PubMed

Cleridou, Kalia; Patalay, Praveetha; Martin, Peter

2017-01-01

Discrepancies are often found between child and parent reports of child psychopathology, nevertheless the role of the child's presenting difficulties in relation to these is underexplored. This study investigates whether parent-child agreement on the conduct and emotional scales of the Strengths and Difficulties Questionnaire (SDQ) varied as a result of certain child characteristics, including the child's presenting problems to clinical services, age and gender. The UK-based sample consisted of 16,754 clinical records of children aged 11-17, the majority of which were female (57%) and White (76%). The dataset was provided by the Child Outcomes Research Consortium , which collects outcome measures from child services across the UK. Clinicians reported the child's presenting difficulties, and parents and children completed the SDQ. Using correlation analysis, the main findings indicated that agreement varied as a result of the child's difficulties for reports of conduct problems, and this seemed to be related to the presence or absence of externalising difficulties in the child's presentation. This was not the case for reports of emotional difficulties. In addition, agreement was higher when reporting problems not consistent with the child's presentation; for instance, agreement on conduct problems was greater for children presenting with internalising problems. Lastly, the children's age and gender did not seem to have an impact on agreement. These findings demonstrate that certain child presenting difficulties, and in particular conduct problems, may be related to informant agreement and need to be considered in clinical practice and research. Trial Registration This study was observational and as such did not require trial registration.

OA Go Away: Development and Preliminary Validation of a Self-Management Tool to Promote Adherence to Exercise and Physical Activity for People with Osteoarthritis of the Hip or Knee

PubMed Central

Toupin April, Karine; Backman, Catherine; Tugwell, Peter

2016-01-01

Purpose: To determine the face and content validity, construct validity, and test–retest reliability of the OA Go Away (OGA), a personalized self-management tool to promote adherence to exercise and physical activity for people with osteoarthritis (OA) of the hip or knee. Methods: The face and content validity of OGA version 1.0 were determined via interviews with 10 people with OA of the hip or knee and 10 clinicians. A revised OGA version 2.0 was then tested for construct validity and test–retest reliability with a new sample of 50 people with OA of the hip or knee by comparing key items in the OGA journal with validated outcome measures assessing similar health outcomes and comparing scores on key items of the journal 4–7 days apart. Face and content validity were then confirmed with a new sample of 5 people with OA of the hip or knee and 5 clinicians. Results: Eighteen of 30 items from the OGA version 1.0 and 41 of 43 items from the OGA version 2.0 journal, goals and action plan, and exercise log had adequate content validity. Construct validity and test–retest reliability were acceptable for the main items of the OGA version 2.0 journal. The OGA underwent modifications based on results and participant feedback. Conclusion: The OGA is a novel self-management intervention and assessment tool for people with OA of the hip or knee that shows adequate preliminary measurement properties. PMID:27909359

Evaluation of subset matching methods and forms of covariate balance.

PubMed

de Los Angeles Resa, María; Zubizarreta, José R

2016-11-30

This paper conducts a Monte Carlo simulation study to evaluate the performance of multivariate matching methods that select a subset of treatment and control observations. The matching methods studied are the widely used nearest neighbor matching with propensity score calipers and the more recently proposed methods, optimal matching of an optimally chosen subset and optimal cardinality matching. The main findings are: (i) covariate balance, as measured by differences in means, variance ratios, Kolmogorov-Smirnov distances, and cross-match test statistics, is better with cardinality matching because by construction it satisfies balance requirements; (ii) for given levels of covariate balance, the matched samples are larger with cardinality matching than with the other methods; (iii) in terms of covariate distances, optimal subset matching performs best; (iv) treatment effect estimates from cardinality matching have lower root-mean-square errors, provided strong requirements for balance, specifically, fine balance, or strength-k balance, plus close mean balance. In standard practice, a matched sample is considered to be balanced if the absolute differences in means of the covariates across treatment groups are smaller than 0.1 standard deviations. However, the simulation results suggest that stronger forms of balance should be pursued in order to remove systematic biases due to observed covariates when a difference in means treatment effect estimator is used. In particular, if the true outcome model is additive, then marginal distributions should be balanced, and if the true outcome model is additive with interactions, then low-dimensional joints should be balanced. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Outcome of adrenal vein sampling performed during concurrent mineralocorticoid receptor antagonist therapy.

PubMed

Haase, Matthias; Riester, Anna; Kröpil, Patric; Hahner, Stefanie; Degenhart, Christoph; Willenberg, Holger S; Reincke, Martin

2014-12-01

Pharmacological inhibition of mineralocorticoid receptor (MR) signaling in patients with primary aldosteronism (PA) reestablishes aldosterone synthesis by nondiseased zona glomerulosa cells through activation of the renin-angiotensin-aldosterone system. In this context, current guidelines recommend discontinuing MR blockade for diagnostic procedures, including adrenal vein sampling (AVS). Discontinuation of MR blockade in high-risk patients may be harmful because of uncontrolled hypertension and severe hypokalemia. We hypothesize that MR antagonist therapy can be continued during AVS as long as renin levels remain suppressed. The objective of this study was to assess the validity of AVS results in the context of MR antagonistic therapy. We retrospectively analyzed all AVS studies in Munich (since 2008) and Düsseldorf (since 2011) and identified four of 237 (1.7%) patients with PA who underwent AVS while treated with an MR antagonist. Adrenalectomy was recommended based on the results of AVS in all four patients. After adrenalectomy, follow-up data were obtained to confirm improvement or remission of PA. Main outcome measures included blood pressure values, daily defined doses of antihypertensive medication, as well as levels of aldosterone, renin, and potassium, and the aldosterone/renin ratio. In all patients, renin remained low or suppressed during AVS despite MR antagonist treatment. AVS clearly demonstrated unilateral aldosterone excess in each case. After adrenalectomy, all patients showed remission of PA as demonstrated by blood pressure values, potassium levels, and the aldosterone/renin ratio. In selected cases of PA, MR antagonist therapy might be continued during AVS, provided that renin values remain low.

A low cost virtual reality system for home based rehabilitation of the arm following stroke: a randomised controlled feasibility trial

PubMed Central

Standen, PJ; Threapleton, K; Richardson, A; Connell, L; Brown, DJ; Battersby, S; Platts, F; Burton, A

2016-01-01

Objective: To assess the feasibility of conducting a randomised controlled trial of a home-based virtual reality system for rehabilitation of the arm following stroke. Design: Two group feasibility randomised controlled trial of intervention versus usual care. Setting: Patients’ homes. Participants: Patients aged 18 or over, with residual arm dysfunction following stroke and no longer receiving any other intensive rehabilitation. Interventions: Eight weeks’ use of a low cost home-based virtual reality system employing infra-red capture to translate the position of the hand into game play or usual care. Main measures: The primary objective was to collect information on the feasibility of a trial, including recruitment, collection of outcome measures and staff support required. Patients were assessed at three time points using the Wolf Motor Function Test, Nine-Hole Peg Test, Motor Activity Log and Nottingham Extended Activities of Daily Living. Results: Over 15 months only 47 people were referred to the team. Twenty seven were randomised and 18 (67%) of those completed final outcome measures. Sample size calculation based on data from the Wolf Motor Function Test indicated a requirement for 38 per group. There was a significantly greater change from baseline in the intervention group on midpoint Wolf Grip strength and two subscales of the final Motor Activity Log. Training in the use of the equipment took a median of 230 minutes per patient. Conclusions: To achieve the required sample size, a definitive home-based trial would require additional strategies to boost recruitment rates and adequate resources for patient support. PMID:27029939

Cost-effectiveness of Collaborative Care for Depression in Human Immunodeficiency Virus Clinics

PubMed Central

Fortney, John C; Gifford, Allen L; Rimland, David; Monson, Thomas; Rodriguez-Barradas, Maria C.; Pyne, Jeffrey M

2015-01-01

Objective To examine the cost-effectiveness of the HITIDES intervention. Design Randomized controlled effectiveness and implementation trial comparing depression collaborative care with enhanced usual care. Setting Three Veterans Health Administration (VHA) HIV clinics in the Southern US. Subjects 249 HIV-infected patients completed the baseline interview; 123 were randomized to the intervention and 126 to usual care. Intervention HITIDES consisted of an off-site HIV depression care team that delivered up to 12 months of collaborative care. The intervention used a stepped-care model for depression treatment and specific recommendations were based on the Texas Medication Algorithm Project and the VA/Department of Defense Depression Treatment Guidelines. Main outcome measure(s) Quality-adjusted life years (QALYs) were calculated using the 12-Item Short Form Health Survey, the Quality of Well Being Scale, and by converting depression-free days to QALYs. The base case analysis used outpatient, pharmacy, patient, and intervention costs. Cost-effectiveness was calculated using incremental cost effectiveness ratios (ICERs) and net health benefit (NHB). ICER distributions were generated using nonparametric bootstrap with replacement sampling. Results The HITIDES intervention was more effective and cost-saving compared to usual care in 78% of bootstrapped samples. The intervention NHB was positive and therefore deemed cost-effective using an ICER threshold of $50,000/QALY. Conclusions In HIV clinic settings this intervention was more effective and cost-saving compared to usual care. Implementation of off-site depression collaborative care programs in specialty care settings may be a strategy that not only improves outcomes for patients, but also maximizes the efficient use of limited healthcare resources. PMID:26102447

Neighborhood Disadvantage and Adult Alcohol Outcomes: Differential Risk by Race and Gender

PubMed Central

Karriker-Jaffe, Katherine J.; Zemore, Sarah E.; Mulia, Nina; Jones-Webb, Rhonda; Bond, Jason; Greenfield, Thomas K.

2012-01-01

Objective: We examined whether relationships of neighborhood disadvantage with drinker status, heavy drinking, alcohol-related consequences, and dependence differed by race and/or gender. We hypothesized that neighborhood disadvantage would be negatively associated with drinker status but positively associated with heavy and problem drinking, with more pronounced relationships among African American and Hispanic men than other groups. Method: Data consisted of nationally representative, randomly selected, cross-sectional samples of White, African American, and Hispanic adults (N = 13,864, of which 52% were female; with 7,493 drinkers, of which 48% were female) from the 2000 and 2005 National Alcohol Surveys merged with 2000 Census data. Analyses included logistic and linear regression using weights to adjust for sampling and nonresponse. Results: Hypotheses were partly supported. Bivariate relationships were in the expected direction. Multivariate main effect models showed that neighborhood disadvantage was significantly associated with increased abstinence and marginally associated with increased negative consequences experienced by drinkers, but race/ethnicity and gender modified these associations. Disadvantage was significantly associated with increased abstinence for all groups except African American and Hispanic men. Among drinkers, disadvantage was significantly negatively associated with heavy drinking by Whites but significantly positively associated with heavy drinking by African Americans. Disadvantage also was associated with elevated alcohol-related consequences for White women and African American men. Conclusions: The findings have implications for the development of targeted interventions to reduce the unequal impacts of neighborhood disadvantage on alcohol outcomes. Future research should examine the contribution of multiple types of disadvantage to heavy drinking and alcohol problems. PMID:23036203

Linear Combinations of Multiple Outcome Measures to Improve the Power of Efficacy Analysis ---Application to Clinical Trials on Early Stage Alzheimer Disease

PubMed Central

Xiong, Chengjie; Luo, Jingqin; Morris, John C; Bateman, Randall

2018-01-01

Modern clinical trials on Alzheimer disease (AD) focus on the early symptomatic stage or even the preclinical stage. Subtle disease progression at the early stages, however, poses a major challenge in designing such clinical trials. We propose a multivariate mixed model on repeated measures to model the disease progression over time on multiple efficacy outcomes, and derive the optimum weights to combine multiple outcome measures by minimizing the sample sizes to adequately power the clinical trials. A cross-validation simulation study is conducted to assess the accuracy for the estimated weights as well as the improvement in reducing the sample sizes for such trials. The proposed methodology is applied to the multiple cognitive tests from the ongoing observational study of the Dominantly Inherited Alzheimer Network (DIAN) to power future clinical trials in the DIAN with a cognitive endpoint. Our results show that the optimum weights to combine multiple outcome measures can be accurately estimated, and that compared to the individual outcomes, the combined efficacy outcome with these weights significantly reduces the sample size required to adequately power clinical trials. When applied to the clinical trial in the DIAN, the estimated linear combination of six cognitive tests can adequately power the clinical trial. PMID:29546251

Influence of safety motivation and climate on safety behaviour and outcomes: evidence from the Saudi Arabian construction industry.

PubMed

Panuwatwanich, Kriengsak; Al-Haadir, Saeed; Stewart, Rodney A

2017-03-01

Over the last three decades, safety literature has focused on safety climate and its role in forecasting injuries and accidents. However, research findings regarding the relationships between safety climate and other key outcome constructs are somewhat inconsistent. Recent safety climate literature suggests that examining the role of safety motivation may help provide a better explanation of such relationships. The research presented in this article aimed to empirically analyse the relationships among safety motivation, safety climate, safety behaviour and safety outcomes within the context of the Saudi Arabian construction industry. A conceptual model was developed to examine the relationships among four main constructs: safety motivation, safety climate, safety behaviour and safety outcomes. Based on the survey data collected in Saudi Arabia from site engineers and project managers (n = 295), statistical analyses were carried out, including confirmatory and exploratory factor analysis, and structural equation modelling to assess the model and test the hypotheses. The main results indicated that safety motivation could positively influence safety behaviour through safety climate, which plays a mediating role for this mechanism. The results also confirmed that safety behaviour could predict safety outcomes within the context of the Saudi Arabian construction industry.

I came, I saw, I reflected: a qualitative study into learning outcomes of international electives for Japanese and British medical students.

PubMed

Nishigori, Hiroshi; Otani, Takashi; Plint, Simon; Uchino, Minako; Ban, Nobutaro

2009-05-01

Although medical students have increasingly more opportunities to participate in international electives, their experiences are usually unstructured and the literature referring to their learning outcomes, educational environment, and assessment is scanty. This study was undertaken to clarify qualitatively what students learn from their international electives. We carried out semi-structured individual interviews with 15 Japanese students studying clinical medicine in British medical schools and six British students studying in Japanese medical schools. The thematic synthesis method was used in analysing the transcribed data and triangulation by multiple researchers was used to achieve higher reliability. The main learning outcomes identified were skills in history taking and physical examination with clinical reasoning and in management of diseases rarely seen in the students' own countries; awareness of clinical ethics and merits and demerits of different systems of healthcare and medical education; sensitivity to issues in doctor-patient relationships and work ethics; enhancement of cultural competence; and personal development. Most learning outcomes of international electives are culture- or system-dependent. Students achieved outcomes related closely to medical professionalism, mainly through reflection. International electives may give students opportunities to learn both professionalism and cultural competence.

Statistical inferences for data from studies conducted with an aggregated multivariate outcome-dependent sample design

PubMed Central

Lu, Tsui-Shan; Longnecker, Matthew P.; Zhou, Haibo

2016-01-01

Outcome-dependent sampling (ODS) scheme is a cost-effective sampling scheme where one observes the exposure with a probability that depends on the outcome. The well-known such design is the case-control design for binary response, the case-cohort design for the failure time data and the general ODS design for a continuous response. While substantial work has been done for the univariate response case, statistical inference and design for the ODS with multivariate cases remain under-developed. Motivated by the need in biological studies for taking the advantage of the available responses for subjects in a cluster, we propose a multivariate outcome dependent sampling (Multivariate-ODS) design that is based on a general selection of the continuous responses within a cluster. The proposed inference procedure for the Multivariate-ODS design is semiparametric where all the underlying distributions of covariates are modeled nonparametrically using the empirical likelihood methods. We show that the proposed estimator is consistent and developed the asymptotically normality properties. Simulation studies show that the proposed estimator is more efficient than the estimator obtained using only the simple-random-sample portion of the Multivariate-ODS or the estimator from a simple random sample with the same sample size. The Multivariate-ODS design together with the proposed estimator provides an approach to further improve study efficiency for a given fixed study budget. We illustrate the proposed design and estimator with an analysis of association of PCB exposure to hearing loss in children born to the Collaborative Perinatal Study. PMID:27966260

Ethnic Gaps in Educational Attainment and Labor-Market Outcomes: Evidence from France

ERIC Educational Resources Information Center

Langevin, Gabin; Masclet, David; Moizeau, Fabien; Peterle, Emmanuel

2017-01-01

We use data from the "Trajectoires et Origines" survey to analyze ethnic gaps in education and labor-market outcomes between second-generation immigrants and their French-native counterparts. Our three main findings underscore the importance of family background in explaining lifelong ethnic inequalities. First, second-generation…

A Test of Major Assumptions About Behavior Change: A Comprehensive Look at the Effects of Passive and Active HIV-Prevention Interventions Since the Beginning of the Epidemic

PubMed Central

Albarracín, Dolores; Gillette, Jeffrey C.; Earl, Allison N.; Glasman, Laura R.; Durantini, Marta R.; Ho, Moon-Ho

2009-01-01

This meta-analysis tested the major theoretical assumptions about behavior change by examining the outcomes and mediating mechanisms of different preventive strategies in a sample of 354 HIV-prevention interventions and 99 control groups, spanning the past 17 years. There were 2 main conclusions from this extensive review. First, the most effective interventions were those that contained attitudinal arguments, educational information, behavioral skills arguments, and behavioral skills training, whereas the least effective ones were those that attempted to induce fear of HIV. Second, the impact of the interventions and the different strategies behind them was contingent on the gender, age, ethnicity, risk group, and past condom use of the target audience in ways that illuminate the direction of future preventive efforts. PMID:16351327

Optical Spectroscopy and Imaging for the Noninvasive Evaluation of Engineered Tissues

PubMed Central

Rice, William L.; Hronik-Tupaj, Marie; Kaplan, David L.

2008-01-01

Optical spectroscopy and imaging approaches offer the potential to noninvasively assess different aspects of the cellular, extracellular matrix, and scaffold components of engineered tissues. In addition, the combination of multiple imaging modalities within a single instrument is highly feasible, allowing acquisition of complementary information related to the structure, organization, biochemistry, and physiology of the sample. The ability to characterize and monitor the dynamic interactions that take place as engineered tissues develop promises to enhance our understanding of the interdependence of processes that ultimately leads to functional tissue outcomes. It is expected that this information will impact significantly upon our abilities to optimize the design of biomaterial scaffolds, bioreactors, and cell systems. Here, we review the principles and performance characteristics of the main methodologies that have been exploited thus far, and we present examples of corresponding tissue engineering studies. PMID:18844604

Feasibility of group intervention for bereaved siblings after pediatric cancer death.

PubMed

Greenwald, Naomi; Barrera, Maru; Neville, Alexandra; Hancock, Kelly

2017-01-01

This study evaluated the feasibility (acceptability, recruitment, retention rates, treatment fidelity, and outcome measures) of implementing a manualized group intervention for bereaved siblings after pediatric cancer death. A convenience sample of 10 siblings participated. The intervention consisted of eight 2-hour sessions that focused on strategies for coping with grief, relationships, and emotional growth. Positive outcomes were obtained with respect to acceptability, recruitment, retention rates, and treatment fidelity. Preliminary outcomes were mixed. Parent pre- and post-intervention outcomes suggested improvements in siblings' overall emotional and social quality of life. Siblings' self-reports reflected no improvements. These data support the feasibility of conducting this intervention and suggest beneficial outcomes based on parental reports. Further research is recommended to evaluate the group intervention efficacy with a large sample using a randomized controlled trial to address the needs of bereaved siblings.

Evaluation of the International Outcome Inventory for Hearing Aids in a veteran sample.

PubMed

Smith, Sherri L; Noe, Colleen M; Alexander, Genevieve C

2009-06-01

The International Outcome Inventory for Hearing Aids (IOI-HA) was developed as a global hearing aid outcome measure targeting seven outcome domains. The published norms were based on a private-pay sample who were fitted with analog hearing aids. The purpose of this study was to evaluate the psychometric properties of the IOI-HA and to establish normative data in a veteran sample. Survey. The participants were 131 male veterans (mean age of 74.3 years, SD = 7.4) who were issued hearing aids with digital signal processing (DSP). Hearing aids with DSP that were fitted bilaterally between 2005 and 2007. Veterans were mailed two copies of the IOI-HA. The participants were instructed to complete the first copy of the questionnaire immediately and the second copy in two weeks. The completed questionnaires were mailed to the laboratory. The psychometric properties of the questionnaire were evaluated. As suggested by Cox and colleagues, the participants were divided into two categories based on their unaided subjective hearing difficulty. The two categories were (1) those with less hearing difficulty (none-to-moderate category) and (2) those who report more hearing difficulty (moderately severe+ category). The norms from the current veteran sample then were compared to the original, published sample. For each hearing difficulty category, the critical difference values were calculated for each item and for the total score. A factor analysis showed that the IOI-HA in the veteran sample had the identical subscale structure as reported in the original sample. For the total scale, the internal consistency was good (Chronbach's alpha = 0.83), and the test-retest reliability was high (lambda = 0.94). Group and individual norms were developed for both hearing difficulty categories in the veteran sample. For each IOI-HA item, the critical difference scores were < 1.0. This finding suggests that for any item on the IOI-HA, there is a 95 percent chance that an observed change of one response unit between two test sessions reflects a true change in outcome for a given domain. The results of this study confirmed that the psychometric properties of the IOI-HA questionnaire are strong and are essentially the same for the veteran sample and the original private-pay sample. The veteran norms, however, produced higher outcomes than those established originally, possibly because of differences in the population samples and/or hearing aid technology. Clinical and research applications of the current findings are presented. Based on the results from the current study, the norms established here should replace the original norms for use in veterans with current hearing aid technology.

Outcome Measurement Using Naturalistic Language Samples: A Feasibility Pilot Study Using Language Transcription Software and Speech and Language Therapy Assistants

ERIC Educational Resources Information Center

Overton, Sarah; Wren, Yvonne

2014-01-01

The ultimate aim of intervention for children with language impairment is an improvement in their functional language skills. Baseline and outcome measurement of this is often problematic however and practitioners commonly resort to using formal assessments that may not adequately reflect the child's competence. Language sampling,…

Initial abstinence status and contingency management treatment outcomes: does race matter?

PubMed

Montgomery, LaTrice; Carroll, Kathleen M; Petry, Nancy M

2015-06-01

Limited research has evaluated African American substance users' response to evidence-based treatments. This study examined the efficacy of contingency management (CM) in African American and White cocaine users. A secondary analysis evaluated effects of race, treatment condition, and baseline cocaine urine sample results on treatment outcomes of African American (n = 444) and White (n = 403) cocaine abusers participating in one of six randomized clinical trials comparing CM to standard care. African American and White patients who initiated treatment with a cocaine-negative urine sample remained in treatment for similar durations and submitted a comparable proportion of negative samples during treatment regardless of treatment type; CM was efficacious in both races in terms of engendering longer durations of abstinence in patients who began treatment abstinent. Whites who began treatment with a cocaine positive sample remained in treatment longer and submitted a higher proportion of negative samples when assigned to CM than standard care. African Americans who initiated treatment with a cocaine positive sample, however, did not remain in treatment longer with CM compared with standard care, and gains in terms of drug use outcomes were muted in nature relative to Whites. This interaction effect persisted through the 9-month follow-up period. CM is not equally effective in reducing drug use among all subgroups, specifically African American patients who are using cocaine upon treatment entry. Future research on improving treatment outcomes in this population is needed. (c) 2015 APA, all rights reserved).

Childhood trauma and health outcomes in adults with comorbid substance abuse and mental health disorders.

PubMed

Wu, Nancy S; Schairer, Laura C; Dellor, Elinam; Grella, Christine

2010-01-01

This study describes the prevalence of childhood traumatic events (CTEs) among adults with comorbid substance use disorders (SUDs) and mental health problems (MHPs) and assesses the relation between cumulative CTEs and adult health outcomes. Adults with SUDs/MHPs (N=402) were recruited from residential treatment programs and interviewed at treatment admission. Exposures to 9 types of adverse childhood experiences were summed and categorized into 6 ordinal levels of exposure. Descriptive analyses were conducted to assess the prevalence and range of exposure to CTEs in comparison with a sample from primary health care. Logistic regression analyses were conducted to examine the association between the cumulative exposure to CTEs and adverse health outcomes. Most of the sample reported exposure to CTEs, with higher exposure rates among the study sample compared with the primary health care sample. Greater exposure to CTEs significantly increased the odds of several adverse adult outcomes, including PTSD, alcohol dependence, injection drug use, tobacco use, sex work, medical problems, and poor quality of life. Study findings support the importance of early prevention and intervention and provision of trauma treatment for individuals with SUDs/MHPs.

Chinese My Trauma Recovery, a Web-based intervention for traumatized persons in two parallel samples: randomized controlled trial.

PubMed

Wang, Zhiyun; Wang, Jianping; Maercker, Andreas

2013-09-30

Guided self-help interventions for PTSD (post-traumatic stress disorder) are a promising tool for the dissemination of contemporary psychological treatment. This study investigated the efficacy of the Chinese version of the My Trauma Recovery (CMTR) website. In an urban context, 90 survivors of different trauma types were recruited via Internet advertisements and allocated to a randomized controlled trial (RCT) with a waiting list control condition. In addition, in a rural context, 93 survivors mainly of the 2008 Sichuan earthquake were recruited in-person for a parallel RCT in which the website intervention was conducted in a counseling center and guided by volunteers. Assessment was completed online on a professional Chinese survey website. The primary outcome measure was the Post-traumatic Diagnostic Scale (PDS); secondary outcome measures were Symptom Checklist 90-Depression (SCL-D), Trauma Coping Self-Efficacy Scale (CSE), Post-traumatic Cognitive Changes (PCC), and Social Functioning Impairment (SFI) questionnaires adopted from the My Trauma Recovery website. For the urban sample, findings indicated a significant group×time interaction in post-traumatic symptom severity (F₁,₈₈=7.65, P=.007). CMTR reduced post-traumatic symptoms significantly with high effect size after one month of treatment (F₁,₄₅=15.13, Cohen's d=0.81, P<.001) and the reduction was sustained over a 3-month follow-up (F₁,₄₅=17.29, Cohen's d=0.87, P<.001). In the rural sample, the group×time interaction was also significant in post-traumatic symptom severity (F₁,₉₁=5.35, P=.02). Post-traumatic symptoms decreased significantly after treatment (F₁,₄₈=43.97, Cohen's d=1.34, P<.001) and during the follow-up period (F₁,₄₈=24.22, Cohen's d=0.99, P<.001). Additional outcome measures (post-traumatic cognitive changes, depression) indicated a range of positive effects, in particular in the urban sample (group×time interactions: F₁,₈₈=5.32-8.37, all Ps<.03), contributing to the positive evidence for self-help interventions. Differences in the effects in the two RCTs are exploratorily explained by sociodemographic, motivational, and setting feature differences between the two samples. These findings give support for the short-term efficacy of CMTR in the two Chinese populations and contribute to the literature that self-help Web-based programs can be used to provide mental health help for traumatized persons. Australia New Zealand Clinical Trials Registry (ANZCTR): ACTRN12611000951954; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000951954 (Archived by WebCite at http://www.webcitation.org/6G7WyNODk).

Collaborative research in the model spinal cord injury systems: process and outcomes.

PubMed

Richards, J Scott

2002-01-01

To review the way in which collaborative research has been conducted under the National Institute on Disability and Rehabilitation Research (NIDRR)-funded Model Spinal Cord Injury Systems (MSCIS) Program, changes made in that process, and significant outcomes. A comparison of changes by NIDRR in the way collaborative research was competed and funded in the 1 995 and 2001 competitions. A review of outcomes of the 1 995 collaborative projects was based on queries to lead centers. Collaborative research through the model SCI systems has been conducted and continues to be conducted through 2 main venues: The National Spinal Cord Injury Statistical Center (NSCISC) database, which has provided data for a number of collaborative studies, and specifically funded proposals for collaborative research. In the 1995 competition for NIDRR funding, collaborative research proposals were submitted as part of the Model SCI Systems competitive applications. In the 2001 competition, collaborative research was parceled out and a separate competition held. There have been a number of publications stemming from the 1 995 competition; some of the data from these projects are still being explored and used for manuscripts. The outcomes for the 2001 competition will not be known for several years. Collaborative research has the advantage of generating larger numbers more quickly than any 1 center can typically generate, producing a more broadly based sample and, therefore, generalizable result, and facilitating the use of expertise not always available in a single center. Collaborative research activities have been among the most productive aspects of the Model Systems program; the change in the way this component is competed in the most recent competition is yet to be evaluated in terms of its efficacy compared with methods used for funding collaborative research in past competitions.

A qualitative study of emergency physicians’ perspectives on PROMS in the emergency department

PubMed Central

Dainty, Katie N; Seaton, Bianca; Laupacis, Andreas; Schull, Michael; Vaillancourt, Samuel

2017-01-01

Introduction There is a growing emphasis on including patients' perspectives on outcomes as a measure of quality care. To date, this has been challenging in the emergency department (ED) setting. To better understand the root of this challenge, we looked to ED physicians' perspectives on their role, relationships and responsibilities to inform future development and implementation of patient-reported outcome measures (PROMs). Methods ED physicians from hospitals across Canada were invited to participate in interviews using a snowballing sampling technique. Semistructured interviews were conducted by phone with questions focused on the role and practice of ED physicians, their relationship with their patients and their thoughts on patient-reported feedback as a mechanism for quality improvement. Transcripts were analysed using a modified constant comparative method and interpretive descriptive framework. Results Interviews were completed with 30 individual physicians. Respondents were diverse in location, training and years in practice. Physicians reported being interested in ‘objective’ postdischarge information including adverse events, readmissions, other physicians’ notes, etc in a select group of complex patients, but saw ‘patient-reported’ feedback as less valuable due to perceived biases. They were unsure about the impact of such feedback mainly because of the episodic nature of their work. Concerns about timing, as well as about their legal and ethical responsibilities to follow-up if poor patient outcomes are reported, were raised. Conclusions Data collection and feedback are key elements of a learning health system. While patient-reported outcomes may have a role in feedback, ED physicians are conflicted about the actionability of such data and ethical implications, given the inherently episodic nature of their work. These findings have important implications for PROM design and implementation in this unique clinical setting. PMID:28183828

Who are the Women Who Work in Their Last Month of Pregnancy? Social and Occupational Characteristics and Birth Outcomes of Women Working Until the Last Month of Pregnancy in France.

PubMed

Vigoureux, Solène; Blondel, Béatrice; Ringa, Virginie; Saurel-Cubizolles, Marie-Josèphe

2016-09-01

Introduction The prenatal leave law in France protects women during pregnancy and their employment. We aimed to estimate the proportion of women who worked late in their pregnancy, to analyze the occupational, social and medical factors associated with late prenatal leave and to compare the pregnancy outcome of these women and those who left earlier in the pregnancy. Methods The sample was extracted from the 2010 French National Perinatal Survey. All women who delivered within a 1-week period were interviewed before discharge from the maternity unit. Women with a singleton live birth at or after 37 weeks' gestation and who were working during pregnancy (n = 8463) were included. Data were collected on employment, date of leave, and sociodemographic and medical characteristics. Results Overall, 328 women (3.9 %) took a late prenatal leave (at or after 37 weeks' gestation). Women who left late were older than 30 years old, with a high educational level and were living in an urban area. Being self-employed and having a managerial or upper-intellectual occupation was highly associated with late leave, before and after controlling for relevant variables. Perinatal and delivery outcomes were similar for women who took a late leave and those who left before 37 weeks' gestation. Discussion Occupational characteristics are the main determinants of late prenatal leave. Women working in the last month of pregnancy had a favorable social and occupational situation and did not did not experience an adverse pregnancy or birth outcome. Other studies are needed to understand the reasons for late leave and evaluate the post-partum fatigue and health of these women.