bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effectiveness of Screening for Obesity in Primary Care: Weighing the Evidence
Authors: Wilson Amy R. , McAlpine Donna D.
Published: September 2006

In response to growing alarm about the increase in the prevalence of obesity in the United States, several organizations have recommended that physicians screen their adult patients for this condition and initiate treatment. Screening can be an effective intervention when the condition is grave and prevalent, when an accurate test exists, when effective treatment exists, when the screening program itself does not pose undue risks, and when early detection and treatment improve outcomes. This article critically reviews the evidence supporting these criteria in the case of obesity in adults. It extends previous reviews by assessing the potential impact that uncertainties in the evidence base may have on the effectiveness a screening program. It also examines the feasibility of such a program. We conclude that following the recommendation to screen all adults for obesity is unlikely to improve outcomes.
Using Propensity Stratification to Compare Patient Outcomes in Hospital-Based versus Freestanding Skilled-Nursing Facilities
Authors: Stearns Sally C. , Dalton Kathleen , Holmes George M. , Seagrave Susanne M.
Published: September 2006

Medicare skilled-nursing facility (SNF) patients exhibit differences in resource use and outcomes by whether the SNF is hospital-based or freestanding. Some of the differences may be attributable to patient selection rather than underlying institutional differences. This study adjusts for patient selection by stratifying Medicare SNF patients by their likelihood of hospital-based SNF referral. Three outcomes are analyzed to illustrate this approach: Medicare SNF length of stay, discharge to home within 30 days, and preventable hospital readmissions. The estimations use claims and patient-assessment data merged with facility and market characteristics. The results provide strong evidence that good candidates for faster recovery and discharge to the community are preferentially selected into hospital-based units. While the unstratified regression approach controls for much of the selection, stratified regressions provide further reductions in setting-specific differences. Remaining differences may be because of patterns of care or reflect residual bias from unobserved factors.
What Happens to Children Who Lose Public Health Insurance Coverage?
Authors: Mitchell Janet B. , Haber Susan G. , Hoover Sonja
Published: September 2006

Little is known about what happens to children who disenroll from public health-insurance programs. A telephone survey was conducted of children who recently had disenrolled from either Oregon's State Children's Health Insurance Program (SCHIP) or FHIAP (premium assistance) programs, both of which have identical eligibility requirements. Access for these disenrolled children was driven largely by health insurance coverage. Insured children were more likely to have a usual source of care and to have seen a physician when they needed one. While FHIAP-disenrolled children were more likely to have private health-insurance coverage than those leaving SCHIP, absolute levels were low (53 percent and 33 percent, respectively). Thus, these programs generally did not provide a bridge to nonsubsidized private health insurance. Despite higher incomes (the main reason for losing coverage), many families did not purchase private health insurance, presumably because they still could not afford to do so.
Development and Validation of a Patient-Reported Measure of Physician Cultural Competency
Authors: Thom David H. , Tirado Miguel D.
Published: September 2006

While cultural competency is widely promoted, the lack of a measure of cultural competency limits our ability to evaluate interventions and to understand the effects of cultural competency on health care quality. Based on a conceptual framework of cultural competency derived from expert focus groups, we developed a patient-reported measure of physician culturally competent communication behaviors that we validated in a group of 429 adult primary-care patients with diabetes and/or hypertension and their 53 physicians. Construct validity was supported by a moderate association with both patient satisfaction (r = .32, p < .001) and patient trust (r = .53, p < .001). Predictive validity was supported by an association with a decrease in blood pressure among hypertensive patients (r = –.18; p < .05). This new measure may be useful in assessing levels of culturally competent provider behavior and investigating associations between provider cultural competency and health care processes and outcomes.
Developing a participatory multidisciplinary team approach to enhance the quality of school start
Authors: Iversen Synnøve , Ellertsen Bjørn , Joacobsen Svein Roar , Råheim Målfrid , Knivsberg Ann-Mari
Published: September 2006

The article discusses how participatory action research was applied during a three-year project at 27 schools in Norway in order to enhance the quality of school start. A multidisciplinary on-site team approach was developed, supported by workshops and dialogue seminars. External professionals from the supportive municipal health care system and special education/school psychology services assisted children and teachers in the first grade, focusing on early health promotion and support to children at risk of developing problems. The project was reported to improve multidisciplinary teamwork and relationships, to increase focus on developmental and health care issues, to develop professional knowledge and practical skills, to increase support to local educational staff, and to provide a better school-start for all and particularly vulnerable children. Local creativity and ownership within supportive administrative structures were reported as promoting factors, while available time and external professional resources were the main constraints. The building of learning partnerships based on face-to-face interaction appeared to be a particular strength of the approach.
Collaborative enquiry, action research, and curriculum development in rural China
Authors: Li Peidong , Laidlaw Moira
Published: September 2006

This article shows how two colleagues, one Chinese, one British, are learning to work together in a Teachers’ College in northwest China as we help to facilitate change in our organization. The change constitutes the setting up of action research enquiries as a way of enhancing learning and professional development together with changes in The New Curriculum for the teaching of English. Tentative conclusions are drawn about our educational influence on each other, colleagues in our department and beyond, as well as its effects on curriculum development. By working through our assumptions we show some of the benefits of our collaboration and how we have overcome some fundamentally different precepts about education. The most profound of these are concerned with the differing epistemological norms and attitudes to collectivism and individualism. We discover the significance of keeping open minds in enhancing our insights and actions and in our conclusion look to the possible characteristics of our collaboration in the future.
The North-South convergence
Authors: Borda Orlando Fals
Published: September 2006

We are very pleased to have the reflections of Orlando Fals Borda, eminent action researcher and politician from Columbia, on the start up and diffusion of participatory action research. Professor Fals Borda writes from the vantage of his personal involvement in PAR over the last 30 years. He recalls points of departure, the pioneers, theoretical advances and institutional assimilation, as well as challenges and obstacles in knowledge formation. Pertinent current sources and schools of thought are pointed out. The need for related social movements for promoting significant change in societies in northern and southern countries is stressed, with recommendations for the productive and worthwhile role of scientists committed to PAR endeavours.
INNO-406, a novel BCR-ABL/Lyn dual tyrosine kinase inhibitor, suppresses the growth of Ph+ leukemia cells in the central nervous system, and cyclosporine A augments its in vivo activity
Authors: Yokota Asumi , Kimura Shinya , Masuda Satohiro , Ashihara Eishi , Kuroda Junya , Sato Kiyoshi , Kamitsuji Yuri , Kawata Eri , Deguchi Yasuyuki , Urasaki Yoshimasa , Terui Yasuhito , Ruthardt Martin , Ueda Takanori , Hatake Kiyohiko , Inui Ken-ichi , Maekawa Taira
Published: September 2006

Central nervous system (CNS) relapse accompanying the prolonged administration of imatinib mesylate has recently become apparent as an impediment to the therapy of Philadelphia chromosome–positive (Ph+) leukemia. CNS relapse may be explained by limited penetration of imatinib mesylate into the cerebrospinal fluid because of the presence of P-glycoprotein at the blood-brain barrier. To overcome imatinib mesylate–resistance mechanisms such as bcr-abl amplification, mutations within the ABL kinase domain, and activation of Lyn, we developed a dual BCR-ABL/Lyn inhibitor, INNO-406 (formerly NS-187), which is 25 to 55 times more potent than imatinib mesylate in vitro and at least 10 times more potent in vivo. The aim of this study was to investigate the efficacy of INNO-406 in treating CNS Ph+ leukemia. We found that INNO-406, like imatinib mesylate, is a substrate for P-glycoprotein. The concentrations of INNO-406 in the CNS were about 10% of those in the plasma. However, this residual concentration was enough to inhibit the growth of Ph+ leukemic cells which expressed not only wild-type but also mutated BCR-ABL in the murine CNS. Furthermore, cyclosporine A, a P-glycoprotein inhibitor, augmented the in vivo activity of INNO-406 against CNS Ph+ leukemia. These findings indicate that INNO-406 is a promising agent for the treatment of CNS Ph+ leukemia.
Staphylococcus aureus enterotoxins induce IL-8 secretion by human nasal epithelial cells
Authors: O'Brien Garrett J , Riddell Gareth , Elborn J Stuart , Ennis Madeleine , Skibinski Grzegorz
Published: September 2006

Background

Staphylococcus aureusproduces a set of proteins which act both as superantigens and toxins. Although their mode of action as superantigens is well understood, little is known about their effects on airway epithelial cells.

Methods

To investigate this problem, primary nasal epithelial cells derived from normal and asthmatic subjects were stimulated with staphylococcal enterotoxin A and B (SEA and SEB) and secreted (supernatants) and cell-associated (cell lysates) IL-8, TNF-α, RANTES and eotaxin were determined by specific ELISAs.

Results

Non-toxic concentrations of SEA and SEB (0.01 μg/ml and 1.0 μg/ml) induced IL-8 secretion after 24 h of culture. Pre-treatment of the cells with IFN-γ (50 IU/ml) resulted in a further increase of IL-8 secretion. In cells from healthy donors pretreated with IFN-γ, SEA at 1.0 μg/ml induced release of 1009 pg/ml IL-8 (733.0–1216 pg/ml, median (range)) while in cells from asthmatic donors the same treatment induced significantly higher IL-8 secretion – 1550 pg/ml (1168.0–2000.0 pg/ml p = 0.04). Normal cells pre-treated with IFN-γ and then cultured with SEB at 1.0 μg/ml released 904.6 pg/ml IL-8 (666.5–1169.0 pg/ml). Cells from asthmatics treated in the same way produced significantly higher amounts of IL-8 – 1665.0 pg/ml (1168.0–2000.0 pg/ml, p = 0.01). Blocking antibodies to MHC class II molecules added to cultures stimulated with SEA and SEB, reduced IL-8 secretion by about 40% in IFN-γ unstimulated cultures and 75% in IFN-γ stimulated cultures. No secretion of TNF-α, RANTES and eotaxin was noted.

Conclusion

Staphylococcal enterotoxins may have a role in the pathogenesis of asthma.
Distill: a suite of web servers for the prediction of one-, two- and three-dimensional structural features of proteins
Authors: Baú Davide , Martin Alberto JM , Mooney Catherine , Vullo Alessandro , Walsh Ian , Pollastri Gianluca
Published: September 2006

Background

We describe Distill, a suite of servers for the prediction of protein structural features: secondary structure; relative solvent accessibility; contact density; backbone structural motifs; residue contact maps at 6, 8 and 12 Angstrom; coarse protein topology. The servers are based on large-scale ensembles of recursive neural networks and trained on large, up-to-date, non-redundant subsets of the Protein Data Bank. Together with structural feature predictions, Distill includes a server for prediction of C
α
traces for short proteins (up to 200 amino acids).

Results

The servers are state-of-the-art, with secondary structure predicted correctly for nearly 80% of residues (currently the top performance on EVA), 2-class solvent accessibility nearly 80% correct, and contact maps exceeding 50% precision on the top non-diagonal contacts. A preliminary implementation of the predictor of protein C
α
traces featured among the top 20 Novel Fold predictors at the last CASP6 experiment as group Distill (ID 0348). The majority of the servers, including the C
α
trace predictor, now take into account homology information from the PDB, when available, resulting in greatly improved reliability.

Conclusion

All predictions are freely available through a simple joint web interface and the results are returned by email. In a single submission the user can send protein sequences for a total of up to 32k residues to all or a selection of the servers. Distill is accessible at the address: http://distill.ucd.ie/distill/.
Assessment of whole genome amplification-induced bias through high-throughput, massively parallel whole genome sequencing
Authors: Pinard Robert , de Winter Alex , Sarkis Gary J , Gerstein Mark B , Tartaro Karrie R , Plant Ramona N , Egholm Michael , Rothberg Jonathan M , Leamon John H
Published: September 2006

Background

Whole genome amplification is an increasingly common technique through which minute amounts of DNA can be multiplied to generate quantities suitable for genetic testing and analysis. Questions of amplification-induced error and template bias generated by these methods have previously been addressed through either small scale (SNPs) or large scale (CGH array, FISH) methodologies. Here we utilized whole genome sequencing to assess amplification-induced bias in both coding and non-coding regions of two bacterial genomes.Halobacteriumspecies NRC-1 DNA andCampylobacter jejuniwere amplified by several common, commercially available protocols: multiple displacement amplification, primer extension pre-amplification and degenerate oligonucleotide primed PCR. The amplification-induced bias of each method was assessed by sequencing both genomes in their entirety using the 454 Sequencing System technology and comparing the results with those obtained from unamplified controls.

Results

All amplification methodologies induced statistically significant bias relative to the unamplified control. For theHalobacteriumspecies NRC-1 genome, assessed at 100 base resolution, the D-statistics from GenomiPhi-amplified material were 119 times greater than those from unamplified material, 164.0 times greater for Repli-G, 165.0 times greater for PEP-PCR and 252.0 times greater than the unamplified controls for DOP-PCR. ForCampylobacter jejuni, also analyzed at 100 base resolution, the D-statistics from GenomiPhi-amplified material were 15 times greater than those from unamplified material, 19.8 times greater for Repli-G, 61.8 times greater for PEP-PCR and 220.5 times greater than the unamplified controls for DOP-PCR.

Conclusion

Of the amplification methodologies examined in this paper, the multiple displacement amplification products generated the least bias, and produced significantly higher yields of amplified DNA.
Genomic organization and evolution of the ULBP genes in cattle
Authors: Larson Joshua H , Marron Brandy M , Beever Jonathan E , Roe Bruce A , Lewin Harris A
Published: September 2006

Background

The cattleUL16-binding protein 1(ULBP1) andULBP2genes encode members of the MHC Class I superfamily that have homology to the humanULBPgenes. Human ULBP1 and ULBP2 interact with the NKG2D receptor to activate effector cells in the immune system. The human cytomegalovirus UL16 protein is known to disrupt the ULBP-NKG2D interaction, thereby subverting natural killer cell-mediated responses. Previous Southern blotting experiments identified evidence of increasedULBPcopy number within the genomes of ruminant artiodactyls. On the basis of these observations we hypothesized that the cattleULBPs evolved by duplication and sequence divergence to produce a sufficient number and diversity of ULBP molecules to deliver an immune activation signal in the presence of immunogenic peptides. Given the importance of the ULBPs in antiviral immunity in other species, our goal was to determine the copy number and genomic organization of theULBPgenes in the cattle genome.

Results

Sequencing of cattle bacterial artificial chromosome genomic inserts resulted in the identification of 30 cattleULBPloci existing in two gene clusters. Evidence of extensive segmental duplication and approximately 14 Kbp of novel repetitive sequences were identified within the major cluster. Ten ULBPs are predicted to be expressed at the cell surface. Substitution analysis revealed 11 outwardly directed residues in the predicted extracellular domains that show evidence of positive Darwinian selection. These positively selected residues have only one residue that overlaps with those proposed to interact with NKG2D, thus suggesting the interaction with molecules other than NKG2D.

Conclusion

TheULBPloci in the cattle genome apparently arose by gene duplication and subsequent sequence divergence. Substitution analysis of the ULBP proteins provided convincing evidence for positive selection on extracellular residues that may interact with peptide ligands. These results support our hypothesis that the cattle ULBPs evolved under adaptive diversifying selection to avoid interaction with a UL16-like molecule whilst preserving the NKG2D binding site. The large number of ULBPs in cattle, their extensive diversification, and the high prevalence of bovine herpesvirus infections make this gene family a compelling target for studies of antiviral immunity.
Genome sequence alterations detected upon passage of Burkholderia mallei ATCC 23344 in culture and in mammalian hosts
Authors: Romero Claudia M , DeShazer David , Feldblyum Tamara , Ravel Jacques , Woods Donald , Kim H Stanley , Yu Yan , Ronning Catherine M , Nierman William C
Published: September 2006

Background

More than 12,000 simple sequence repeats (SSRs) have been identified in the genome of Burkholderia mallei ATCC 23344. As a demonstrated mechanism of phase variation in other pathogenic bacteria, these may function as mutable loci leading to altered protein expression or structure variation. To determine if such alterations are occurring in vivo, the genomes of various single-colony passaged B. mallei ATCC 23344 isolates, one from each source, were sequenced from culture, a mouse, a horse, and two isolates from a single human patient, and the sequence compared to the published B. mallei ATCC 23344 genome sequence.

Results

Forty-nine insertions and deletions (indels) were detected at SSRs in the five passaged strains, a majority of which (67.3%) were located within noncoding areas, suggesting that such regions are more tolerant of sequence alterations. Expression profiling of the two human passaged isolates compared to the strain before passage revealed alterations in the mRNA levels of multiple genes when grown in culture.

Conclusion

These data support the notion that genome variability upon passage is a feature of B. mallei ATCC23344, and that within a host B. mallei generates a diverse population of clones that accumulate genome sequence variation at SSR and other loci.
Insights into age- and sickle-cell-disease- interaction using principal components analysis
Authors: Sharma Mamta , Mamtani Manju R , Amin Manik , Thakre Tushar P , Sharma Smita , Amin Amit , Kulkarni Hemant
Published: September 2006

Background

In the context of sickle cell anemia, peripheral blood indexes provide key information that is also potentially influenced by age. Therefore, it is necessary to understand the extent and nature of interactions between sickle cell anemia and age, especially in situations where there is a high prevalence of sickle cell anemia.

Methods

In a cross-sectional study of 374 subjects with varying hemoglobin S (HbS) status, we characterized the interaction between age and sickle hemoglobin using principal components analysis.

Results

Factor analysis in subjects with hemoglobin AA identified three orthogonal factors – normal erythropoiesis, presence of thalassemia and the aggregability potential of the blood. These three factors were differentially associated with hemoglobin status. Age influenced the association of factors #2 and #3 with hemoglobin status.

Conclusion

Our findings suggest that the interaction between age and hemoglobin status needs to be considered in both clinical and public health settings.
Extensive myocardial infiltration by hemopoietic precursors in a patient with myelodysplastic syndrome
Authors: Mateen Farrah J , Harding Sheila R , Saxena Anurag
Published: September 2006

Background

Although myocardial infiltration with leukemic blasts is a known finding in patients with acute leukemia, this phenomenon in myelodysplasia is not reported in the literature. Cardiac symptoms in patients with myelodysplasia are often due to anemia and may be due to iron overload and side effects of therapy.

Case presentation

Herein we report the first case of neoplastic infiltration of the heart with associated myocardial necrosis in a patient with myelodysplasia. It was associated with unicellular and multifocal geographic areas of necrosis in the left ventricle and the interventricular septum. It is likely that cardiac compromise in our patient was due to a combination of restrictive cardiomyopathy due to leukemic infiltration, concomitant anemia, cardiac dilatation, conduction blocks and myocardial necrosis. Myocardial necrosis was most likely due to a combination of ischemic damage secondary to anemia and prolonged hypotension and extensive leukemic infiltration. Markedly rapid decrease in ejection fraction from 66% to 33% also suggests the role of ischemia, since leukemic infiltration is not expected to cause this degree of systolic dysfunction over a 24-hour period. The diagnosis was not suspected during life due to concomitant signs and symptoms of anemia, pulmonary infections, and pericardial and pleural effusions. The patient succumbed to cardiac failure.

Conclusion

Hemopoietic cell infiltration was not considered in the differential diagnosis and contributed to this patient's morbidity and mortality. This case highlights the clinical importance of considering myocardial infiltration in patients with myelodysplasia and cardiac symptoms.
Excessive weight gain after remission of depression in a schizophrenic patient treated with risperidone: case report
Authors: Theleritis Christos G , Papadimitriou George N , Papageorgiou Charalabos C , Dikeos Dimitris G , Masdrakis Vasilis , Kostoulas Constantin , Psarros Constantin , Soldatos Constantin R
Published: September 2006

Background

The use of atypical antipsychotics in schizophrenic patients has been associated with a risk of weight gain. Similarly, recovery from depression is often followed by improved appetite, greater food intake and potential increase in weight.

Case presentation

A Caucasian 33-year-old schizophrenic female patient was being treated with 6 mg/day of risperidone and 15 mg/day of clorazepate. She developed depressive symptomatology and 40 mg/day of fluoxetine was gradually added to her treatment regimen for about 9 months. After the remission of depression, and the discontinuation of fluoxetine, she experienced an increase in appetite and subsequently excessive weight gain of 52 kg. Re-administration of fluoxetine did not reverse the situation. The patient developed diabetes mellitus, which was successfully controlled with metformin 1700 mg/day. The addition at first of orlistat 360 mg/day and later of topiramate 200 mg/day has helped her to lose a significant part of the weight gained (30 kg).

Conclusion

The case suggests a probable association between the remission of depressive symptomatology and weight gain in a schizophrenic patient.
The effects of economic deprivation on psychological well-being among the working population of Switzerland
Authors: Vetter Stefan , Endrass Jerome , Schweizer Ivo , Teng Hsun-Mei , Rossler Wulf , Gallo William T
Published: September 2006

Background

The association between poverty and mental health has been widely investigated. There is, however, limited evidence of mental health implications of working poverty, despite its representing a rapidly expanding segment of impoverished populations in many developed nations. In this study, we examined whether working poverty in Switzerland, a country with substantial recent growth among the working poor, was correlated with two dependent variables of interest: psychological health and unmet mental health need.

Methods

This cross-sectional study used data drawn from the first 3 waves (1999–2001) of the Swiss Household Panel, a nationally representative sample of the permanent resident population of Switzerland. The study sample comprised 5453 subjects aged 20–59 years. We used Generalized Estimating Equation models to investigate the association between working poverty and psychological well-being; we applied logistic regression models to analyze the link between working poverty and unmet mental health need. Working poverty was represented by dummy variables indicating financial deficiency, restricted standard of living, or both conditions.

Results

After controlling other factors, restricted standard of living was significantly (p < .001) negatively correlated with psychological well-being; it was also associated with approximately 50% increased risk of unmet mental health need (OR = 1.55; 95% CI 1.17 – 2.06).

Conclusion

The findings of this study contribute to our understanding of the potential psychological impact of material deprivation on working Swiss citizens. Such knowledge may aid in the design of community intervention programs to help reduce the individual and societal burdens of poverty in Switzerland.
Association between anemia and quality of life in a population sample of individuals with chronic obstructive pulmonary disease
Authors: Krishnan Gokul , Grant Brydon J , Muti Paola C , Mishra Archana , Ochs-Balcom Heather M , Freudenheim Jo L , Trevisan Maurizio , Schünemann Holger J
Published: September 2006

Background

Several studies investigated the association of anemia with health related quality of life (HRQL) in patients with chronic disease. However, there is little evidence regarding the association of anemia with HRQL in patients with chronic obstructive pulmonary disease (COPD).

Methods

This is a post-hoc analysis of a study which enrolled a population of adults aged 35–79 randomly selected from residents of Erie and Niagara Counties, NY, between 1996 and 2000. In addition to demographic information and physical measurements, we obtained spirometry data and hemoglobin levels. We used modified Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria to define COPD, and World Health Organization (WHO) criteria to define anemia. To assess HRQL we used the Short Form-36 (SF-36) to assess physical functioning (PF), physical component summary (PCS) measures and mental component summary (MCS) measures.

Results

In the entire study population (n = 2704), respondents with anemia had lower scores on the physical functioning domain [45.4 (SD10.9) vs. 49.2 (SD 9.1); p < 0.0001]. Among patients with COPD (n = 495) the PF scores (39.9 vs. 45.4) and the PCS (41.9 vs. 45.9) were significantly lower in individuals with anemia compared to those without. In multiple regression analysis, the association between hemoglobin and PCS was positive (regression coefficient 0.02, p = 0.003). There was no significant association of hemoglobin with PF scores or the mental component summary measure after adjusting for covariates in patients with COPD.

Conclusion

In patients with moderate to very severe COPD anemia may be associated with worse HRQL. However, co-morbidities may explain part or all of this association in these patients.
Psychological process from hospitalization to death among uninformed terminal liver cancer patients in Japan
Authors: Maeda Yuko , Hagihara Akihito , Kobori Eiko , Nakayama Takeo
Published: September 2006

Background

Although the attitude among doctors toward disclosing a cancer diagnosis is becoming more positive, informing patients of their disease has not yet become a common practice in Japan. We examined the psychological process, from hospitalization until death, among uninformed terminal cancer patients in Japan, and developed a psychological model.

Methods

Terminal cancer patients hospitalized during the recruiting period voluntarily participated in in-depth interviews. The data were analyzed by grounded theory.

Results

Of the 87 uninformed participants at the time of hospitalization, 67% (N = 59) died without being informed of their diagnosis. All were male, 51–66 years of age, and all experienced five psychological stages: anxiety and puzzlement, suspicion and denial, certainty, preparation, and acceptance. At the end of each stage, obvious and severe feelings were observed, which were called "gates." During the final acceptance stage, patients spent a peaceful time with family, even talking about their dreams with family members.

Conclusion

Unlike in other studies, the uninformed patients in this study accepted death peacefully, with no exceptional cases. Despite several limitations, this study showed that almost 70% of the uninformed terminal cancer patients at hospitalization died without being informed, suggesting an urgent need for culturally specific and effective terminal care services for cancer patients in Japan.
Satisfaction of patients hospitalised in psychiatric hospitals: a randomised comparison of two psychiatric-specific and one generic satisfaction questionnaires
Authors: Peytremann-Bridevaux Isabelle , Scherer Frédy , Peer Laurence , Cathieni Federico , Bonsack Charles , Cléopas Agatta , Kolly Véronique , Perneger Thomas V , Burnand Bernard
Published: September 2006

Background

While there is interest in measuring the satisfaction of patients discharged from psychiatric hospitals, it might be important to determine whether surveys of psychiatric patients should employ generic or psychiatry-specific instruments. The aim of this study was to compare two psychiatric-specific and one generic questionnaires assessing patients' satisfaction after a hospitalisation in a psychiatric hospital.

Methods

We randomised adult patients discharged from two Swiss psychiatric university hospitals between April and September 2004, to receive one of three instruments: the Saphora-Psy questionnaire, the Perceptions of Care survey questionnaire or the Picker Institute questionnaire for acute care hospitals. In addition to the comparison of response rates, completion time, mean number of missing items and mean ceiling effect, we targeted our comparison on patients and asked them to answer ten evaluation questions about the questionnaire they had just completed.

Results

728 out of 1550 eligible patients (47%) participated in the study. Across questionnaires, response rates were similar (Saphora-Psy: 48.5%, Perceptions of Care: 49.9%, Picker: 43.4%; P = 0.08), average completion time was lowest for the Perceptions of Care questionnaire (minutes: Saphora-Psy: 17.7, Perceptions of Care: 13.7, Picker: 17.5; P = 0.005), the Saphora-Psy questionnaire had the largest mean proportion of missing responses (Saphora-Psy: 7.1%, Perceptions of Care: 2.8%, Picker: 4.0%; P < 0.001) and the Perceptions of Care questionnaire showed the highest ceiling effect (Saphora-Psy: 17.1%, Perceptions of Care: 41.9%, Picker: 36.3%; P < 0.001). There were no differences in the patients' evaluation of the questionnaires.

Conclusion

Despite differences in the intended target population, content, lay-out and length of questionnaires, none appeared to be obviously better based on our comparison. All three presented advantages and drawbacks and could be used for the satisfaction evaluation of psychiatric inpatients. However, if comparison across medical services or hospitals is desired, using a generic questionnaire might be advantageous.
Gender differences in health care use among the elderly population in areas of Norway and Finland. A cross-sectional analysis based on the HUNT study and the FINRISK Senior Survey
Authors: Suominen-Taipale Anna Liisa , Martelin Tuija , Koskinen Seppo , Holmen Jostein , Johnsen Roar
Published: September 2006

Background

The aim of the study was to examine gender differences in the self-reported use of health care services by the elderly in rural and metropolitan areas of two Nordic countries with slightly different health care systems: Finland and Norway.

Methods

Population based, cross-sectional surveys conducted in Nord-Tröndelag Norway (1995–97) and in rural and metropolitan areas of Finland (1997) were employed. In the Norwegian data, a total of 7,919 individuals, aged 65–74 years old were included, and the Finnish data included 1,500 individuals. The outcome variables comprised whether participants had visited a general practitioner or a specialist, or had received hospital care or physiotherapy during the past 12 months. Gender differences in the use of health care services were analysed by multiple logistic regression, controlling for health status and socio-demographic characteristics.

Results

In Norway, elderly women visited a specialist or were hospitalised less often than men. In Finland, elderly women used all health care services except hospital care more often than men. In Norway, less frequent use of specialist care by women was not associated with self-reported health or chronic diseases.

Conclusion

The findings revealed differences in self-reported use of secondary care among different genders in areas of Norway and Finland.
Personally addressed hand-signed letters increase questionnaire response: a meta-analysis of randomised controlled trials
Authors: Scott Pippa , Edwards Phil
Published: September 2006

Background

Postal questionnaires are commonly used to collect data for health studies, but non-response reduces study sample sizes and can introduce bias. Finding ways to increase the proportion of questionnaires returned would improve research quality. We sought to quantify the effect on response when researchers address participants personally by name on letters that accompany questionnaires.

Methods

All randomised controlled trials in a published systematic review that evaluated the effect on response of including participants' names on letters that accompany questionnaires were included. Odds ratios for response were pooled in a random effects meta-analysis and evidence for changes in effects over time was assessed using random effects meta-regression.

Results

Fourteen randomised controlled trials were included covering a wide range of topics. Most topics were unrelated to health or social care. The odds of response when including participants' names on letters were increased by one-fifth (pooled OR 1.18, 95% CI 1.03 to 1.34; p = 0.015). When participants' names and hand-written signatures were used in combination, the effect was a more substantial increase in response (OR 1.45, 95% CI 1.27 to 1.66; p < 0.001), corresponding to an absolute increase in the proportion of questionnaires returned of between 4% and 10%, depending on the baseline response rate. There was no evidence that the magnitude of these effects had declined over time.

Conclusion

This meta-analysis of the best available evidence indicates that researchers using postal questionnaires can increase response by addressing participants by name on cover letters. The effect appears to be enhanced by including hand-written signatures.
An analysis of patient house calls in the area of Attica, Greece
Authors: Peppas George , Theocharis George , Karveli Efthymia A , Falagas Matthew E
Published: September 2006

Background

Physicians house calls to patients have been declining in many countries of the world. The objective of this study was to describe the patterns of utilization of house call services provided by SOS doctors in the area of Attica, Greece.

Methods

We performed a retrospective analysis of data regarding house call visits of patients in the area of Attica (metropolitan area of Athens and surrounding cities), Greece. Characteristics of patients who received house call services by a physician, including diagnosis, and recommended management plan, including advice for hospitalization were analyzed.

Results

SOS doctors in the area of Attica, Greece performed 98,009 house calls during the 5-year study period (1/11/2000 – 31/10/2005). Patients older than 65 yeas requested 47.8% of the house calls. Females requested more house calls during the studied period compared to males (59.4% versus 40.6%, p < 0.001). The majority of the diagnoses (18.4%) were infections of the upper and lower respiratory tract. 9.1% of patients were advised after the evaluation at home to be admitted to a hospital to receive inpatient services.

Conclusion

Our analysis documents the utilization of house calls by SOS doctors in the area of Attica, Greece during a 5-year period. We believe that house calls provided by individual practitioners, physician group practices, or organized companies and organizations should re-gain their well-deserved position in the modern health care systems.
Specific down-regulation of XIAP with RNA interference enhances the sensitivity of canine tumor cell-lines to TRAIL and doxorubicin
Authors: Spee Bart , Jonkers Martijn DB , Arends Brigitte , Rutteman Gerard R , Rothuizen Jan , Penning Louis C
Published: September 2006

Background

Apoptosis resistance occurs in various tumors. The anti-apoptotic XIAP protein is responsible for inhibiting apoptosis by reducing caspase-3 activation. Our aim is to evaluate whether RNA inhibition against XIAP increases the sensitivity of canine cell-lines for chemotherapeutics such as TRAIL and doxorubicin. We used small interfering RNA's (siRNA) directed against XIAP in three cell-lines derived from bile-duct epithelia (BDE), mammary carcinoma (P114), and osteosarcoma (D17). These cell-lines represent frequently occurring canine cancers and are highly comparable to their human counterparts. XIAP down-regulation was measured by means of quantitative PCR (Q-PCR) and Western blotting. The XIAP depleted cells were treated with a serial dilution of TRAIL or doxorubicin and compared to mock- and nonsense-treated controls. Viability was measured with a MTT assay.

Results

All XIAP siRNA treated cell-lines showed a mRNA down-regulation over 80 percent. Western blot analysis confirmed mRNA measurements. No compensatory effect of IAP family members was seen in XIAP depleted cells. The sensitivity of XIAP depleted cells for TRAIL was highest in BDE cells with an increase in the ED50of 14-fold, compared to mock- and nonsense-treated controls. The sensitivity of P114 and D17 cell-lines increased six- and five-fold, respectively. Doxorubicin treatment in XIAP depleted cells increased sensitivity in BDE cells more than eight-fold, whereas P114 and D17 cell-lines showed an increase in sensitivity of three- and five-fold, respectively.

Conclusion

XIAP directed siRNA's have a strong sensitizing effect on TRAIL-reduced cell-viability and a smaller but significant effect with the DNA damaging drug doxorubicin. The increase in efficacy of chemotherapeutics with XIAP depletion provides the rationale for the use of XIAP siRNA's in insensitive canine tumors.
Giant hepatic adenoma with bone marrow metaplasia not associated with oral contraceptive intake
Authors: Ramacciato Giovanni , Nigri Giuseppe R , Aurello Paolo , D'Angelo Francesco , Pezzoli Francesca , Rossi Simone , Pilozzi Emanuela , Ercolani Giorgio , Ravaioli Matteo
Published: September 2006

Background

Hepatocellular adenomas are the most common benign liver tumors. They are usually related to oral contraceptive intake.

Case presentation

This case describes a 58-year-old woman admitted to our institution for a hepatic mass incidentally discovered during a routine examination. The patient, who was never on oral contraceptives, was asymptomatic upon admission. She underwent a thorough diagnostic evaluation and then a hepatic right trisegmentectomy. The histologic evaluation of the mass showed that it was a hepatocellular adenoma with areas of bone marrow metaplasia.

Conclusion

Bone marrow metaplasia has rarely been found associated to liver tumors. The presence of marrow-derived hepatic progenitor cells might be the source of both adenoma hepatocytes and bone marrow differentiated cells. To our knowledge, this is only the second case in the English literature in which areas of bone marrow metaplasia were found in a hepatocellular adenoma.
Mental health and resiliency following 44 months of terrorism: a survey of an Israeli national representative sample
Authors: Bleich Avi , Gelkopf Marc , Melamed Yuval , Solomon Zahava
Published: September 2006

Background

Israeli citizens have been exposed to intense and ongoing terrorism since September 2000. We previously studied the mental health impact of terrorism on the Israeli population (Bleich et al., 2002), however the long-term impact of ongoing terrorism has not yet been examined. The present study evaluated the psychological sequelae of 44 months of terrorism in Israel, and sought to identify factors that may contribute to vulnerability and resilience.

Methods

This was a telephone survey using strata sampling of 828 households, which reached a representative sample of 702 adult Israeli residents (84.8% contact rate). In total, 501 people (60.5%) agreed to participate. The methodology was similar to that of our previous study. Exposure to terrorism and other traumatic events, number of traumatic stress-related symptoms (TSRS), percentage of respondents with symptom criteria for post-traumatic stress disorder (PTSD), traumatic stress (TS) resiliency and feelings of depression, anxiety, optimism, sense of safety, and help-seeking were the main outcome measures.

Results

In total, 56 participants (11.2%) were directly exposed to a terrorist incident, and 101 (20.2%) had family members or friends exposed. Respondents reported a mean ± SD of 5.0 ± 4.5 TSRS; 45 (9%) met symptom criteria for PTSD; and 72 (14.4%) were TS-resilient. There were 147 participants (29.5%) who felt depressed, 50 (10.4%) felt anxious, and almost half (235; 47%) felt life-threatening danger; 48 (9.7%) felt the need for professional help. Women and people of Arab ethnicity had more TSRS, more PTSD, and less TS resiliency. Injury following a life-threatening experience, a major stressful life event, and a major loss of income were associated with PTSD. Immigrant status, lower education, low sense of safety, low sense of social support, high societal distress, and injury following life-threatening experiences were associated with TSRS. TSRS did not increase with exposure severity. This study revealed less depression and functional impairment, similar rates of PTSD, increased help-seeking and poorer TSRS and TS resiliency than our initial study, 2 years previously.

Discussion

The response of people in Israel to 4 years of terrorism is heterogeneous. Vulnerability factors change over time; Arab ethnicity, immigrant status and less education, not found to be risk factors in our previous study, were found in the present study to contribute to trauma-related distress. Prior experience of highly stressful events increases vulnerability to adverse psychological effects of terror.
Induction of neutralising antibodies by virus-like particles harbouring surface proteins from highly pathogenic H5N1 and H7N1 influenza viruses
Authors: Szécsi Judit , Boson Bertrand , Johnsson Per , Dupeyrot-Lacas Pia , Matrosovich Mikhail , Klenk Hans-Dieter , Klatzmann David , Volchkov Viktor , Cosset François-Loïc
Published: September 2006

There is an urgent need to develop novel approaches to vaccination against the emerging, highly pathogenic avian influenza viruses. Here, we engineered influenza viral-like particles (Flu-VLPs) derived from retroviral core particles that mimic the properties of the viral surface of two highly pathogenic influenza viruses of either H7N1 or H5N1 antigenic subtype. We demonstrate that, upon recovery of viral RNAs from a field strain, one can easily generate expression vectors that encode the HA, NA and M2 surface proteins of either virus and prepare high-titre Flu-VLPs. We characterise these Flu-VLPs incorporating the HA, NA and M2 proteins and we show that they induce high-titre neutralising antibodies in mice.
The signaling helix: a common functional theme in diverse signaling proteins
Authors: Anantharaman Vivek , Balaji S , Aravind L
Published: September 2006

Background

The mechanism by which the signals are transmitted between receptor and effector domains in multi-domain signaling proteins is poorly understood.

Results

Using sensitive sequence analysis methods we identify a conserved helical segment of around 40 residues in a wide range of signaling proteins, including numerous sensor histidine kinases such as Sln1p, and receptor guanylyl cyclases such as the atrial natriuretic peptide receptor and nitric oxide receptors. We term this helical segment the signaling (S)-helix and present evidence that it forms a novel parallel coiled-coil element, distinct from previously known helical segments in signaling proteins, such as the Dimerization-Histidine phosphotransfer module of histidine kinases, the intra-cellular domains of the chemotaxis receptors, inter-GAF domain helical linkers and the α-helical HAMP module. Analysis of domain architectures allowed us to reconstruct the domain-neighborhood graph for the S-helix, which showed that the S-helix almost always occurs between two signaling domains. Several striking patterns in the domain neighborhood of the S-helix also became evident from the graph. It most often separates diverse N-terminal sensory domains from various C-terminal catalytic signaling domains such as histidine kinases, cNMP cyclase, PP2C phosphatases, NtrC-like AAA+ ATPases and diguanylate cyclases. It might also occur between two sensory domains such as PAS domains and occasionally between a DNA-binding HTH domain and a sensory domain. The sequence conservation pattern of the S-helix revealed the presence of a unique constellation of polar residues in the dimer-interface positions within the central heptad of the coiled-coil formed by the S-helix.

Conclusion

Combining these observations with previously reported mutagenesis studies on different S-helix-containing proteins we suggest that it functions as a switch that prevents constitutive activation of linked downstream signaling domains. However, upon occurrence of specific conformational changes due to binding of ligand or other sensory inputs in a linked upstream domain it transmits the signal to the downstream domain. Thus, the S-helix represents one of the most prevalent functional themes involved in the flow of signals between modules in diverse prokaryote-type multi-domain signaling proteins.

Reviewers

This article was reviewed by Frank Eisenhaber, Arcady Mushegian and Sandor Pongor.