bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of the Timing of Puberty with a Chromosome 2 Locus
Authors: Wehkalampi Karoliina , Widén Elisabeth , Laine Tiina , Palotie Aarno , Dunkel Leo 
Published: September 2008

Context: Twin studies indicate that the timing of pubertal onset is under strong genetic control. However, genes controlling pubertal timing in the general population have not yet been identified.
Objective: To facilitate the identification of genes influencing the timing of pubertal growth and maturation, we conducted linkage mapping of constitutional delay of growth and puberty (CDGP), an extreme variant of normal pubertal timing, in extended families.
Participants and Methods: Fifty-two families multiply affected with CDGP were genotyped with 383 multiallelic markers. CDGP was defined based on growth charts (the age at onset of growth spurt, peak height velocity, or attaining adult height taking place at least 1.5 sd later than average). Chromosomal regions cosegregating with CDGP were identified with parametric affected-only linkage analysis using CDGP as a dichotomized trait.
Results: The genome-wide scan detected linkage of CDGP to a region on chromosome 2p13-2q13. The two-point heterogeneity LOD (HLOD) score was 1.62 (α = 0.27), and the corresponding multipoint HLOD was 2.54 (α = 0.31). Fine-mapping the region at 1 cM resolution increased the multipoint HLOD score to 4.44 (α = 0.41). The linkage became weaker if family members diagnosed with CDGP without growth data were also included in the analyses.
Conclusions: The pericentromeric region of chromosome 2 harbors a gene predisposing to pubertal delay in multiply affected pedigrees. Our data suggest that this locus may be a component of the internal clock controlling the timing of the onset of puberty.
Increasing appropriateness of hospital admissions in the Emilia-Romagna region of Italy
Authors: Louis Daniel , Taroni Francesco , Melotti Rita , Rabinowitz Carol , Vizioli Maria , Fiorini Monica , Gonnella Joseph 
Published: September 2008

Objectives: The Emilia-Romagna region of Italy has reduced the number of available hospital beds and introduced financial incentives to curb hospital use. The goal of this study was to assess the impact of these policies on changes over time in the number of acute hospital admissions classified in diagnosis related groups (DRGs) that could be treated safely and effectively in alternative, less costly settings. Methods: The assessment of the appropriate site of care was based on analysis of hospital discharge data for all hospitals for the selected diagnosis related groups in the Emilia-Romagna region for 2001 to 2005. The necessity for acute hospital admission was based on the severity of a patient's principal diagnosis, co-morbid diseases and, for surgical admissions, procedure performed. Results: From 2001 to 2005, potentially inappropriate medical admissions of more than one day decreased from 20,076 to 11,580, a 42% decrease. Inappropriate admissions decreased in both public and private hospitals but there remained a higher rate of inappropriate admissions to private hospitals. Potentially inappropriate medical admissions accounted for 128,319 bed-days in 2001 and 68,968 bed-days in 2005, a reduction of 59,351 bed-days. Potentially inappropriate surgical admissions decreased from 7383 in 2001 to 4349 in 2005, a 41% decrease. Bed-days consumed by inappropriate surgical admissions decreased from 23,181 in 2001 to 13,660 in 2005. Conclusions: The Emilia-Romagna region has succeeded in reducing the use of acute hospital beds for patients in selected diagnosis related groups. However, there are still substantial numbers of admissions that could potentially be treated in less costly settings.
Designing and implementing behaviour change interventions to improve population health
Authors: Michie Susan 
Published: September 2008

Improved population health depends on changing behaviour: of those who are healthy (e.g. stopping smoking), those who are ill (e.g. adhering to health advice) and those delivering health care. To design more effective behaviour change interventions, we need more investment in developing the scientific methods for studying behaviour change. Behavioural science is relevant to all phases of the process of implementing evidence-based health care: developing evidence through primary studies, synthesizing the findings in systematic reviews, translating evidence into guidelines and practice recommendations, and implementing these in practice. ‘Behaviour change: Implementation and Health’, the last research programme to be funded within the MRC HSRC, aimed to develop innovative ways of applying theories and techniques of behaviour change to understand and improve the implementation of evidence-based practice, as a key step to improving health. It focused on four areas of study that apply behaviour change theory: • defining and developing a taxonomy of behaviour change techniques to allow replication of studies and the possibility of accumulating evidence; • conducting systematic reviews, by categorizing and synthesizing interventions on the basis of behaviour change theory; • investigating the process by which evidence is translated into guideline recommendations for practice; • developing a theoretical framework to apply to understanding implementation problems and designing interventions. This work will contribute to advancing the science of behaviour change by providing tools for conceptualizing and defining intervention content, and linking techniques of behaviour change to their theoretical base.
Decision analysis for resource allocation in health care
Authors: Griffin Susan , Claxton Karl , Sculpher Mark 
Published: September 2008

This paper addresses the use of economic evaluation to inform resource allocation decisions within health care systems about which interventions to reimburse and whether additional research should be funded. A social decision-making view of economic evaluation, that is to maximize health gains subject to an exogenous budget constraint, is adopted. A brief overview of the components of an economic evaluation is presented. Particular attention is paid to how uncertainty is inherent to decisions about resource allocation, the consequences of that uncertainty and how it can be incorporated informatively into economic evaluation. A Bayesian approach to uncertainty is used as it meets the needs of social decision-making, allowing analysts to quantify the probability that an intervention is cost-effective given the available evidence and to quantify the expected value of further research. The discussion covers methods to represent parameter and structural uncertainty and considers the role of formal elicitation of expert judgements. The association between decisions to approve interventions for reimbursement and decisions about future research funding, and how value of information analysis can be used to formalize this link, is explained. Recent developments in the UK highlight the evolving policy environment for economic evaluation, such as the Cooksey report on the funding of UK health research, the review of the Pharmaceutical Price Regulation Scheme by the Office of Fair Trading and the update of the methodological guidelines issued by the National Institute for Health and Clinical Excellence. The paper concludes by describing ongoing methodological work designed to meet the challenges of undertaking decision analysis for resource allocation in health care.
The impact of income on private patients’ access to GP services in Ireland
Authors: Nolan Anne 
Published: September 2008

Objectives: To examine the extent to which proximity to the income threshold for free GP care results in significant differences in GP visiting. Approximately 30% of the Irish population receives free GP care (medical card patients), while the remaining 70% pays in full (private patients). Medical card eligibility exerts a significant influence on GP visiting, but how do GP visiting rates differ among private patients on differing incomes, and has the differential in visiting among private patients changed over time? Methods: Using micro-data from three nationally representative surveys of the Irish population undertaken in 1987, 1995 and 2001, multivariate models of GP utilization are estimated. Results: There is little evidence that proximity to the income threshold results in significant differences in GP visiting. The most significant difference is between medical card and private patients, rather than between private patients on differing incomes. There is also little evidence that the differential in GP visiting between private patients on different incomes changed over time. Conclusions: While recent commentary has focused on the plight of individuals just above the income threshold for free GP care, these results suggest that the key difference in GP visiting is between those with, and without, eligibility for free care. If private patients are prevented from accessing GP care due to cost, this is as much an issue for those at the top of the income distribution as for those at the bottom.
Moving specialist care into the community: An initial evaluation
Authors: Sibbald Bonnie , Pickard Susan , McLeod Hugh , Reeves David , Mead Nicola , Gemmell Islay , Coast Joanna , Roland Martin , Leese Brenda 
Published: September 2008

Objectives: To assess the likely impact on patients and local health economies of shifting specialist care from hospitals to the community in 30 demonstration sites in England. Methods: The evaluation comprised: interviews with service providers at 30 sites, supplemented by interviews with commissioners, GPs and hospital doctors at 12 sites; economic case studies in six sites; and patient surveys at 30 sites plus at nine conventional outpatient services. Outcomes comprised: staff views of service organization and development, impact on primary and secondary care, and benefits for patients; cost per consultation and cost per patient in new services compared to estimates of the price of services if undertaken by hospitals; patients’ views of waiting time, access, quality (technical and interpersonal), coordination and satisfaction. Results: New services required high initial investment in staff, premises and equipment, and the support of hospital consultants. Most new services were added to existing hospital services so expanded capacity. Patient reported waiting times (6.7 versus 10.1 weeks; p = 0.001); technical quality of care (96.2 versus 94.5; p < 0.001), overall satisfaction (88.2 versus 85.4; p = 0.04); and access (72.2 versus 65.8; p = 0.001) were significantly better for new compared to conventional services but there was no significant difference in coordination or interpersonal quality of care. Some service providers expressed concerns about service quality. New services dealt with less complex conditions and undercut the price tariff applied to hospitals thus providing a cost saving to commissioners. There was some concern that expansion of new services might destabilize hospitals. Conclusions: Moving specialist care into the community can improve patient access, particularly when new services are added to existing hospital services. Wider impacts on health care quality, capacity and cost merit closer scrutiny before rollout.
Health care professionals’ views of implementing a policy of open disclosure of errors
Authors: Sorensen Ros , Iedema Rick , Piper Donella , Manias Elizabeth , Williams Allison , Tuckett Anthony 
Published: September 2008

Objectives: To understand the views of doctors, nurses, allied health professionals and health managers of open disclosure of medical errors. Methods: Semi-structured interviews were conducted with 131 health professionals to understand their experiences of implementing open disclosure in 21 providers in Australia. Results: Health professionals are positive about open disclosure and are applying the model to patient- clinician communication encounters more generally. Workforce and systems competencies enable clinicians and health service managers to implement open disclosure principles and practices, although a propensity to hide errors, wavering commitment and to exacerbate the problem inhibits implementation as policy intends. The gap between policy objectives and their implementation limits the benefits to health professionals. Conclusion: Health services must develop organizing capabilities if open disclosure is to be implemented as intended. Activities should identify and address factors that impede implementation and enable workforce and system competencies to develop. These activities will allow health services to adapt central open disclosure policy to local conditions and to embed its principles and practices organization-wide.
The impact of an educational pamphlet on knowledge and anxiety in women with preeclampsia
Authors: Sauvé Nadine , Powrie Raymond O , Larson Lucia , Phipps Maureen G , Weitzen Sherry , Fitzpatrick Donna , Rosene-Montella Karen 
Published: September 2008

Objective: This study was undertaken to evaluate whether or not an educational pamphlet could improve knowledge without increasing anxiety in women with preeclampsia. Methods: One hundred women recruited from an inpatient setting with suspected or proven preeclampsia were asked to answer a questionnaire assessing demographics, knowledge (primary outcome), anxiety and satisfaction (secondary outcomes) after being randomized to an intervention group (who received a pamphlet) or a control group (who did not received a pamphlet). The pamphlet and questionnaire, both designed by a multidisciplinary team, were read and answered at the same time. Results: Baseline and demographic characteristics were similar between the two groups. Knowledge about the symptoms of pre-eclampsia was excellent in both groups (61% to 100% correct answers). Women in both groups were well aware that preeclampsia in the past ( P = 0.22) and a family history of preeclampsia ( P = 0.57) were risk factors. There was a significant difference in knowledge about the risk of some fetal complications, including death (90% versus 39%, P < 0.01) and all maternal complications ( P < 0.05) favouring the intervention group. Despite increased knowledge about preeclampsia and its risks, anxiety was not greater in the intervention group. Overall, there was a trend towards less knowledge in vulnerable subgroups (non-white, low income and schooling levels), but the improvement of knowledge with the pamphlet was equivalent. Baseline anxiety was higher in the vulnerable groups, but was generally not increased by the pamphlet. Conclusion: An educational pamphlet for women with suspected preeclampsia was able to increase knowledge without increasing anxiety.
Maternal mortality in the developing world: why do mothers really die?
Authors: Lewis Gwyneth 
Published: September 2008

Every year some eight million women suffer preventable or remediable pregnancy-related complications and over half a million will die unnecessarily. Most of these deaths could be averted at little or no extra cost, even where resources are limited, but in order to take action, and develop and implement changes to maternity services to save mothers and newborns lives, a change in cultural attitudes and political will, as well as improvements in the provision of health and social care, is required. Further, to aid programme planners, more in-depth information than that which may already be available through national statistics on maternal mortality rates or death certificate data is urgently needed. What is required is an in-depth understanding of the clinical, social, cultural or any other underlying factors which lead to mothers' deaths. Such information can be obtained by using any of the five methodologies outlined in the World Health Organizations programme and philosophy for maternal death or disability reviews, ‘Beyond the Numbers’, briefly described here and which are now being introduced in a number of countries around the world.
Physician, affective, and cognitive variables differentially predict initiation versus maintenance PSA screening profiles in diverse groups of men
Authors: Consedine Nathan S. , Christie Michael A. , Neugut Alfred I. 
Published: September 2008

Objectives To evaluate the relevance of demographic, physician, and psychological characteristics to PSA screening in ethnic subpopulations and ascertain whether the same characteristics distinguish men who have never had a PSA from those who screen infrequently and those who screen yearly (adhere).Design and methods Stratified cluster‐sampling was used to recruit 533 men (45–70 years) from four ethnic groups: African‐American; European‐American; immigrant Jamaican; and immigrant men from Trinidad and Tobago. Men provided demographic and structural (insurance, regular physician, annual exam, and physician recommendation), cognitive (risk and efficacy perceptions, knowledge), and emotional variables (cancer worry and embarrassment), and reported on PSA screening history. Multinomial logistic regression used these variables to predict three screening classifications (never screened, partially adherent, and adherent).Results Multinomial logistic regression showed that minority men were less likely to report either never screening or yearly screening, while younger men were more likely. Lack of a regular physician (OR=2.87, 95% CI 1.39–5.84), an annual exam (OR=1.73, 95% CI 0.91–3.28), and low recommendation (OR=3.76, 95% CI 2.13–6.66) were associated with being categorized as a never (vs. partially adherent) screener, but only annual exam (OR=0.26, 95% CI 0.10–0.63) was associated with yearly screening. Lower cancer worry was marginally associated with never screening (OR=0.59, 95% CI 0.38–1.04), while knowledge was associated with screening yearly over time (OR=0.46, 95% CI 0.28–0.77).Conclusions Demographic, physician, and psychological variables are differentially associated with never, less than yearly, and yearly screening classifications. Minority men were unlikely to have never screened, but were also less likely to screen yearly. Physician variables were associated with the difference between not screening and partially adherent, but not between partially adherent and yearly screening suggesting that the role of physicians in PSA behaviour over time would benefit from further study.
Five factor model personality factors moderated the effects of an intervention to enhance chronic disease management self‐efficacy
Authors: Franks Peter , Chapman Benjamin , Duberstein Paul , Jerant Anthony 
Published: September 2008

Objectives. Peer led interventions can enhance patient self‐efficacy for managing chronic illnesses, but little is known regarding the moderators or duration of their effects. We hypothesized Homing in on Health (HIOH), a variant of the Chronic Disease Self‐Management Program, would be most effective in patients high in neuroticism and low in extraversion, openness, agreeableness, and/or conscientiousness.Design. Analysis of data from subjects (N = 415) enrolled in an ongoing randomized controlled trial.Methods. Regression analyses were conducted to explore whether Five Factor Model (FFM) personality factors moderated the effects of HIOH, delivered in subjects' homes or via telephone, on disease management self‐efficacy. Data were collected at 6 time points over the course of 1 year.Results. Compared with control and telephone HIOH, home HIOH significantly increased self‐efficacy, an effect peaking at 6 weeks and fully attenuating by 1year. Moderation analyses revealed the benefit was confined to patients higher in neuroticism and/or lower in conscientiousness, agreeableness, and extraversion.Conclusions. A peer led intervention to enhance disease management self‐efficacy had only short‐term effects, and FFM personality factors moderated those effects. Measuring personality factors in chronically ill individuals may facilitate targeting of self‐management interventions to those most likely to respond.
Predicting breakfast consumption: An application of the theory of planned behaviour and the investigation of past behaviour and executive function
Authors: Wong Cara L. , Mullan Barbara A. 
Published: September 2008

Objectives. The objective of the current study is to examine the determinants of breakfast consumption with the application of the Theory of Planned Behaviour (TPB; 1991) and investigate the additional variables of past behaviour and executive function.Design. A prospective 1‐week study investigating the predictive ability of TPB variables, past behaviour and executive function was utilized.Methods. Ninety‐six participants were administered two measures of executive function (response inhibition and planning) and completed self‐report questionnaires regarding their attitudes, subjective norms, perceived control, intentions and past behaviour of breakfast consumption. One week later, participants returned a follow‐up questionnaire on their behaviour.Results. The result of the study showed that the TPB significantly predicted intentions and prospective behaviour of breakfast consumption, however, past behaviour was found to be the strongest predictor of future behaviour. Considering executive function, response inhibition was not found to predict behaviour, however, planning ability explained unique variance in behaviour and moderated the association between intention and behaviour.Conclusions. The findings support the use of the TPB in explaining breakfast eating habits, and suggest that executive function of planning may be somewhat useful to predict this behaviour. The significance of past behaviour also suggests that breakfast consumption may commonly be a stable, habitual behaviour that may undermine the need for self‐regulation. Implications for creating behavioural‐change interventions are discussed.
Laboratory evaluation of kidney function in the elderly1
Authors: Holdt Birgit , Schuff-Werner Peter 
Published: September 2008

Abstract
Demographic changes and the increasing proportion of elderly among the overall population call for consideration of the morphology and function of the ageing kidney. Its hallmarks include progressive loss of kidney function reserve and potential for compensation. Differentiation from true kidney disease and/or injury is important, since early diagnosis allows for treatment that may delay progression of renal disease in the elderly.
The glomerular filtration rate (GFR) is the recommended laboratory parameter to describe glomerular function of the kidney and hence to distinguish the different stages of chronic renal diseases. Current discussions focus on estimated GFR formulas based on endogenous substances (creatinine and cystatin C). Unfortunately, these estimated GFR formulas were not specifically developed for the aged population and reference ranges for a normal renal function are not defined beyond the age of 70 years. There are inconsistencies between data sets of formulas depending on age and disease. No methods have been validated for determination of glomerular and tubular renal function in the elderly.
Until the validation of estimated GFR formulas or new biomarkers, one relies on formulas tested and additional renal and non-renal laboratory parameters. These should be applied according to recent physical findings. Age, disease and ongoing therapy should influence the selection of a formula with the least deviation from the gold standard (exogenous clearance). The consistent use of standardised methods and calibrators will advance the estimation of renal function in the elderly.
The initial assessment of the ageing kidney remains a challenge with the risk of both over- and underestimating kidney function. Follow-up investigation is essential to monitor changes from individual baseline kidney function.
The main goal of current and future studies will be the individual assessment of kidney function in the elderly considering its functional reserve.