Effects of parental viewing of children's risk behavior on home safety practices

OBJECTIVE: To examine the effects of parent viewing of their child's actual risk behavior on home safety practices. METHODS: Sixty-one 4-to 7-year-old children and their caregivers participated in a three session project. Parents were exposed to one of three videos: (a) their own child with simulated home hazards, (b) a pilot child with hazards, or (c) a control child development video. Observations of home hazards as well as parent measures of supervision and vulnerability were completed pre and post-intervention. RESULTS: Exposure to a video of a parent's own child playing with simulated hazards resulted in improved home safety practices. Exposure to a pilot child interacting with home hazards did not increase parent safety behaviors. No group differences in levels of vulnerability were found. CONCLUSIONS: Parental attitudes are an important consideration in designing successful injury interventions. Increasing parental awareness of their child's risk to injury may be a valuable tool to change safety behaviors.     

Teaching inpatient communication skills to medical students: an innovative strategy.

At the University of Washington, a group of medical educators defined a set of communication skills, or "benchmarks," that are expected of second-year medical students conducting history and physical examinations on hospitalized patients. In order to teach the skills listed in the communication benchmarks, an educational strategy was devised that included training sessions for 30 medical teachers and the development of an innovative videotape tool used to train the teachers and their students. The benchmarks were designed in 2003 for the developmental level of the students and were based on key communication concepts and essential elements of medical communication. A set of five short videotaped scenarios was developed that illustrated various segments of a student history and physical examination. Each scenario consisted of an "OK" version of communication and a "better" version of the same scenario. The video scenarios were used in teaching sessions to help students identify effective communication techniques and to stimulate discussion about the communication benchmarks. After the training sessions, teachers and students were surveyed to assess the effectiveness of the educational methods. The majority of students felt that the educational design stimulated discussion and improved their understanding of communication skills. Faculty found the educational design useful and 95% felt that the curriculum and videotape contributed to their own education. The development of communication benchmarks illustrated with short videotaped scenarios contrasting "OK" with "better" communication skills is a useful technique that is transferable to other institutions.     

Effects of anonymous information about potential organ transplant recipients on attitudes toward organ transplantation and the willingness to donate organs

Two approaches for educating college students about the need for organ donors were compared. The experimental group (N = 162) watched a videotaped dramatization of an organ procurement coordinator asking the family members of a recently deceased loved one if they would donate their loved one's organs. Contained in this videotape was demographic information about three adults who needed an organ transplant. The control group (N = 169) saw the same videotape minus the demographic information. Extrapolating from research on altruism, we hypothesized that information about potential organ recipients would increase the viewer's willingness to donate a next-of-kin's organs and their own willingness to become an organ donor. Results supported this hypothesis. Compared to the control group, the experimental group was more willing to donate a next-of-kin's organs and take action to become an organ donor. We tentatively conclude that providing information about potential organ recipients increases the willingness of college students to become organ donors.     

Concepts of Illness in Icelandic Children

Objective: To investigate the development of illness conceptsamong healthy Icelandic children. Methods: Participants were 68 schoolchildren, 6–7, 10–11,and 14–15 years of age, and their parents. Cognitive developmentallevel and understanding of physical illness were assessed withina Piagetian framework. In addition, illness experience and illnessbehaviors (Child Illness Behavior Questionnaire) were assessed. Results: Results were consistent with previous studies in thatthe development of illness concepts among Icelandic childrenwas consistent with Piaget's theory of cognitive development.No relation was found between illness experience and understandingof illness. A more mature understanding of illness was relatedto willingness to report the onset of illness. Conclusions: The results suggest that findings from previousstudies may be generalized to a broader population.     

Age and Gender Differences in School-Age Children's Appraisals of Injury Risk

Objective: To examine age and gender differences in children'sperception of injury risk and to evaluate cognitive factorsthat relate to their appraisal of risk. Methods: The participants were 120 children (6 to 10 years ofage), who used a series of photographs, which depicted playactivities that varied from no to high risk, to appraise injuryrisk. Results: Children were able to distinguish varying degrees ofinjury risk. Boys rated risk as lower than girls, and 6-year-oldchildren identified fewer risk factors and did so more slowlythan 10-year-old children. For girls, perceived vulnerabilityto injury was the best predictor of injury risk ratings, whereasfor boys it was judged severity of potential injury. Conclusions: Children's appraisal of risk and age and genderdifferences in related factors highlight important componentsfor injury prevention programs.     

Attitude towards clinical trials: Results of a survey of persons interested in research

Objective and design:Patient recruitment is a major problem in clinical trials. In a survey, the attitude of a public sample towards clinical trials was assessed. Subjects:In a survey 225 visitors to the Heinrich-Heine University were interviewed with respect to their attitude towards clinical trials. Methods:Visitors were interviewed with regard to sociodemographic variables, disease status, knowledge about and experience of trials and attitude towards clinical trials. Three scenarios for clinical trials were presented (dental trial, surgical trial, pharmaceutical trial). Results:In general, a positive attitude was found. Clinical trials were judged important by 89.5% of the survey participants; however, only 25% would take part in clinical trials. The likelihood of potential participation was lower in the surgical trial than in the dental or pharmaceutical trial scenarios. The willingness to participate was significantly higher in persons, who considered trials to be important, with general knowledge about clinical trials and with previous trial participation. Conclusions:The willingness to participate in a clinical trial is still low in the public. More information and involvement in clinical trials may improve the general attitude.     

The influence of risk labeling on risk perception and willingness to seek help in an experimental simulation of preventive medical examinations

Objective

To study the influence of the presentation of results of a preventive medical examination on risk perception and willingness to seek help for work-related fatigue or being overweight.

Effect of static and dynamic heat pain stimulus profiles on the temporal dynamics and interdependence of pain qualities, intensity, and affect

Acute and chronic pains are characterized by a particular constellation of pain qualities, such as burning, aching, stinging, or sharp feelings. However, the temporal pattern of specific pain qualities and their relationship with pain and affect is not well understood. In addition, little is known about how the temperature time course of the stimulus impacts the temporal dynamics of pain qualities and the relationship between pain qualities. Therefore we applied two types of stimuli to the feet of 16 healthy subjects, each calibrated to evoke a similar pain magnitude (50/100): static stimulus held at constant intensity and dynamic stimulus increased in intensity in small steps. Stimulus runs consisted of three 30-s stimuli (either static or dynamic) with an interstimulus interval of 60 s. Continuous on-line ratings of pain, burning, sharp, stinging, cutting, and annoyance were obtained in separate runs, and the evoked responses were characterized by within-stimulus adaptation (early: 0- to 15-s peak vs. late: 25- to 40-s peak) and by their temporal properties (time to onset, peak, and end). The temporal profile of the burning sensation was similar to the pain and annoyance evoked by the static and dynamic stimuli. However, the sharp, stinging and cutting sensations attenuated in response to the static stimuli (P < 0.01) but intensified along with pain and affect in response to the dynamic stimuli (P < 0.05), whereas there was no attenuation in the evoked profiles of pain (P = 0.61), annoyance (P = 0.27), or burning quality (P = 0.27). These data demonstrate that specific pain qualities with known differences in underlying mechanisms have distinct temporal dynamics that depend on the stimulus intensity dynamics.     

A pivotal role of IL-12 in Th1-dependent mouse liver injury

Intravenous injection of Proplonibacterium acnes and llpopolysaccharide(LPS) with a 7 day interval caused CD4⁺ T cell-dependent severeliver injury in the C57BL/6 (H-2^b) mouse strain. In contrast,BALB/c (H-2^d mice were resistant to P. acnes and LPS-inducedliver injury. The different susceptibilities of the two mousestrains to liver injury appeared to be closely correlated withtheir different abilities to produce IFN- after P. acnea priming.Namely, the sensitive C57BL/6 mouse strain produced a significantlevel of IFN- 7–10 days after P. acnes injection, whereasno significant amount of serum IFN- was detected in the resistantBALB/c mouse strain. The important role of IFN- in liver injurywas demonstrated from the finding that In vivo administrationof anti-IFN- mAb abrogated P. acnes and LPS-induced liver injuryin C57BL/6 mice. Moreover, it was demonstrated that In vivoadministration of recombinant IL-12, a key cytokine for theinduction of IFN-, into mice induced P. acnes and LPS-inducedliver injury in the resistant BALB/c mouse strain. Conversely,In vivo administration of anti-IL-12 mAb blocked the developmentof liver injury in the sensitive C57BL/6 mouse strain. Moreover,it was demonstrated that the failure of the induction of liverinjury in BALB/c mice appeared to be derived from the lack ofexpression of IL-12 at the local site of liver in P. acnes-prlmedmice. These results strongly indicated that endogenous IL-12,which stimulates T^h 1-dominant cellular immunity and IFN- production,may be an essential cytokine on the course of T cell-dependentliver injury.     

Occupational-level interactions between physical hazards and cognitive ability and skill requirements in predicting injury incidence rates

Interactions between occupational-level physical hazards and cognitive ability and skill requirements were examined as predictors of injury incidence rates as reported by the U. S. Bureau of Labor Statistics. Based on ratings provided in the Occupational Information Network (O*NET) database, results across 563 occupations indicate that physical hazards at the occupational level were strongly related to injury incidence rates. Also, as expected, the physical hazard-injury rate relationship was stronger among occupations with high cognitive ability and skill requirements. In addition, there was an unexpected main effect such that occupations with high cognitive ability and skill requirements had lower injury rates even after controlling for physical hazards. The main effect of cognitive ability and skill requirements, combined with the interaction with physical hazards, resulted in unexpectedly high injury rates for low-ability and low-skill occupations with low physical hazard levels. Substantive and methodological explanations for these interactions and their theoretical and practical implications are offered. Results suggest that organizations and occupational health and safety researchers and practitioners should consider the occupational level of analysis and interactions between physical hazards and cognitive requirements in future research and practice when attempting to understand and prevent injuries.     

The effect of different styles of medical illustration on information comprehension,the perception of educational material and illness beliefs

ObjectiveTo explore how the addition of a medical illustration and its style affected information comprehension, perception of educational material and illness beliefs.Methods204 people recruited in a supermarket were randomised to read one of the four leaflets about gout and fill out a questionnaire. Three leaflets had a picture showing gout in the form of a cartoon, an anatomical drawing or a computed tomography scan (CT). The control leaflet did not contain images.ResultsSeeing an illustrated leaflet helped correctly identify treatment for gout X²(1, N = 204) = 5.51, p=0.019. Out of the three images, only the cartoon was better than text in conveying information about treatment X²(1, n = 102) = 8.84, p=0.018. Participants perceived illustrated leaflets as more visually appealing t(70) = 3.09, p = 0.003, and the anatomical image was seen as more helpful for understanding of the illness than the cartoon. Pictures did not significantly influence lay illness perceptions about gout.ConclusionPictures aid the understanding of health information and increase the visual appeal of materials. While simpler illustrations convey information more effectively, people prefer more detailed anatomical images; CT scans offer no benefits over simpler images.Practice implicationsThe results can help guide the use of images in gout education material.     

Saddlepoint approximations for stochastic processes with truncated cumulant generating functions

Only in the simplest scenarios of population dynamics can theKolmogorov forward differential equation for the cumulant generatingfunction be solved explicitly. A device which is currently gainingin popularity is the differentiation of this equation up toorder j, thereby obtaining a set of j equations for the cumulants{k_i}, and then solving these equations by placing K_i 0 forall i > j. Here we show how the saddlepoint approximationmay be used to investigate the effect that this technique hason the underlying probability structure through applicationto the logistic and power-law logistic processes.     

The opinions of postgraduate tutors on continuing education for general practitioners

The recent big increase in learning opportunities for general practitioners, particularly in postgraduate medical centres, has been accompanied by increasing suspicion that educational activities may not be fulfilling the aims of continuing education, and that there is dissatisfaction with existing courses.

This study took place in the north-western region, and 18 clinical tutors were interviewed using a structured interview schedule.

Very few of the clinical tutors were aware of the existence of the book The Future General Practitioner—Learning and Teaching, and most activities consisted of lectures, lecturers usually being local and regional consultants, with occasional national authorities. Small group teaching rarely occurred, and all the centres had been supplied with videotape equipment.

Most of the tutors had attended a course on audiovisual aids, or a meeting organized by the National Association of Clinical Tutors, but the tutors appeared ill at ease when answering questions about educational aims and objectives, and most tutors were unable to identify an educational objective from a group of statements.

     

Managing incidental genomic findings: legal obligations of clinicians

PurposeClinical whole-exome and whole-genome sequencing will result in a broad range of incidental findings, but clinicians’ obligations to identify and disclose such findings are a matter of debate. We sought legal cases that could offer insights into clinicians’ legal liability.MethodsWe searched for cases in which incidental findings were related to the cause of action, using the search engines WestLaw, WestLaw Next, Lexis, and Lexis Advance.ResultsWe found no case law related to incidental findings from genetic testing but identified eight cases involving incidental findings in medical imaging. These cases suggest that clinicians may face liability for failing to disclose incidental findings that would have offered an opportunity for interventions to improve health outcome, if under the applicable standard of care, they fail to identify or appreciate the significance of the incidental finding or they negligently fail to notify other clinicians and/or the patient of the identified incidental finding. Other cases support liability for failure to refer appropriately to a clinician with greater expertise.ConclusionsClinicians may face liability if they fail to disclose incidental information that could inform interventions to improve health outcome; information lacking clinical actionability is likely to have less import.Genet Med 2013:15(8):624–629     

Physical mapping of the Tec and Gabrb1 loci reveals that the Wsh mutation on mouse chromosome 5 is associated with an inversion

In the mouse, mutations in the c-Kit proto-oncogene, a memberof the receptor tyrosine kinase (RTK) gene family, have pleiotropiceffects on hematopoiesis, pigmentation and fertility (dominantspotting, W). However, in the W^sh allele the defect is confinedto abnormal pigmentation caused by the disruption of 5' regulatorysequences of Kit leaving an intact structural gene. In thisreport, the previously published physical map around the Pdgfra-Kit-Flk1RTK loci is extended by mapping the loci encoding the GABA_A(-aminobutyric acid) receptor subunit beta 1, Gabrb1 and a cytoplasmickinase (Tec) 3 Mb proximal to Kit. PFGE analysis of the wild-type(C57BL/6J) chromosome demonstrates the following gene order:cen-Gabrb1-Tec-Pdgfra-Kit, whereas the analysis of W^sh/W^sh DNAis consistent with the order: cen-Gabrb1-Pdgfra-Tec-Kit. Thisaltered physical map can be explained by an inversion on theW^sh chromosome located proximally to the Kit locus and spanningthe 2.8 Mb Pdgfra-Tec chromosomal segment. This high resolutionphysical mapping study identifies large DNA fragments that spanthe two inversion breakpoints and potentially carry Kit upstreamregulatory elements involved in the control of Kit expressionduring embryonic development.     

Diseño e implantación de un proyecto docente para la formación de la identidad médica en estudiantes de Medicina

We describe the process of designing and implementation of a new teaching project in the University of Navarra. The aim of the project is to promote a patient-centered professional and personal identity for the future doctors. The educational process has 3 consecutive phases. First, workshops that take place prior to clerkships, where students actively reflect on a selected professional identity quality. Then, the student will identify real clinical scenarios during their clerkships where this professional behavior takes place. They should reflect on this, and they should learn through their own reactions and emotions and write a self-reflection. The educational process finishes with the formative and personal feedback from the clinical tutor.     

Sharing digital teaching resources: breaking down barriers by addressing the concerns of faculty members.

PURPOSE: Regional and institutional databases have been created to improve access to educational resources and to avert unnecessary duplication. The growth and success of these databases depend upon the willingness of faculty members to contribute their materials. This qualitative study seeks to identify the barriers that block the free exchange of educational multimedia and the incentives that could be created to overcome educators' concerns. METHOD: In 2001, 34 faculty members from 13 U.S. medical schools each participated in one of five focus groups. They responded to three hypothetical scenarios depicting opportunities for sharing educational resources. Participants' responses were categorized hierarchically and sent back to them for feedback. RESULTS: Participants strongly supported multimedia databases, particularly those that serve a national audience. Obstacles for contributing materials included the lack of institutional recognition for educational innovation, confusing intellectual property policies, the hassle involved in sharing materials, and the perceived commercial potential of the materials. Peer review of educational materials was seen as an important incentive. CONCLUSIONS: Medical schools could benefit from the free exchange of high-quality educational multimedia but need to address the concerns of faculty by clarifying institutional copyright rules, streamlining the donation process, and providing assistance with cataloging assets. Removing departmental pressures to commercialize materials and recognizing peer-reviewed donations as academic achievement could foster a culture of sharing.     

Self-Reported Willingness to Have Cancer Screening and the Effects of Sociodemographic Factors

BackgroundThe relative effects of race/ethnicity and other sociodemographic factors, compared to those of attitudes and beliefs on willingness to have cancer screening, are not well understood.MethodsWe conducted telephone interviews with 1148 adults (31% African American, 27% Puerto Rican American, 43% white) from 3 cities in mainland United States and Puerto Rico. Respondents reported their sociodemographic characteristics, attitudes about barriers and facilitators of cancer screening, and willingness to have cancer screening under 4 scenarios: when done in the community vs one's doctor's office, and whether or not one had symptoms.ResultsRacial/ethnic minority status, age, and lower income were frequently associated with increased willingness to have cancer screening, even after including attitudes and beliefs about screening. Having screening nearby was important for community screening, and anticipation of embarrassment from screening for when there were no cancer symptoms. Associations varied across 4 screening scenarios, with the fewest predictors for screening by one's doctor when there were symptoms.ConclusionsSociodemographic characteristics not only were related to willingness to have cancer screenings in almost all cases, but were generally much stronger factors than attitudinal barriers and facilitators. Cancer screening campaigns should affect attitudinal change where possible, but should also recognize that targeting screening to specific population groups may be necessary.     

Identification and chromosomal assignment of two heterozygous mutations in the Trp53 gene in L5178Y\Tk +\--3.7.2C mouse lymphoma cells

The thymidine kinase locus (Tk1) in Tk ^+\–-3.7.2C mouselymphoma cells is widely used to identify mutagenic agents.Because Trp53 (the mouse homolog of human TP53) is located withTk1 on chromosome 11 and is critical in regulating cellularresponses following exposure to DNA damaging agents, we wantedto determine if these mouse lymphoma cells harbor mutationsin Trp53. Single-stranded conformation polymorphism (SSCP) analysisof PCRamplified exons 4–9 of Trp53 indicated mutationsin both exons 4 and 5. We sequenced exons 4–9 from isolatedclones of Tk^+\–-3.7.2C cells and a Tk^–\– mutant(G4). Mutant G4 has two copies of the chromosome arrying theTk1^– allele and no copy of the chromosome carrying theTk1⁺ allele and thus could establish linkage of the individualTrp53 and Tk1 alleles. DNA sequence analysis revealed no mutationsin exons 6–9 in any Tk^+\–-3.7.2C or G4 clones. Assuggested by SSCP, there was a nonsense mutation in exon 4 atbp 301 (codon 101) in one Trp53 allele. Tk^+\–-3.7.2C cloneshave both mutant and wild-type sequences at bp 301; G4 cloneshave wild-type exon 4 sequence. These data allow assignmentof the Trp53 exon 4 mutated allele to chromosome 11 carryingthe Tk1+ allele. The exon 4 mutation leads to a stop codon earlyin translation, thus functionally deleting the Trp53 alleleon the ^+\–bearing chromosome. As previously reported,we find a missense mutation in exon 5 at bp 517 (codon 173)in one Trp53 allele. Using the G4 clones we determined thatthe exon 5 mutation is linked to the Tk1^– allele. Thusthe Tk^+\–-3.7.2C mouse lymphoma cells have two mutantTrp53 alleles, likely accounting for their rapid cell growthand contributing to their ability to detect the major typesof mutational damage associated with the etiology of tumor development.This ability to integrate across the mutational events seenin the multiple stages of tumor development further supportsthe use of the assay in chemical and drug safety studies andits recommendation as part of the required screening batteryfor regulatory agency submissions. ⁵To whom correspondence should be addressed at: MD–68, Genetic and Cellular Toxicology Branch, Environmental Carcinogenesis Division, US EPA, Research Triangle Park, NC 27711, USA. Tel: +1 919 541 2248; Fax: +1 919 541 0694; Email: clark.scott{at}epamail.epa.gov     

Serum placental protein 14 concentrations in the first trimester of ovum donation pregnancies

The concentration of the endometrial glycoprotein placentalprotein 14 (PP14) has been measured at weekly intervals duringthe first trimester in serum obtained from women who had becomepregnant naturally (n = 15, all singleton) or following ovumdonation (n = 16, 15 singleton and one twin) after ovarian failure(n = 13), Turner's syndrome (n = 2) or post-chemotherapy (n= 1). The concentration of PP14 failed to rise in ovum donationpregnancies, and was significantly reduced compared to the concentrationin natural conceptions from 5 to 13 weeks gestation (P <0.05–0.01). These findings demonstrate that the corpusluteum is essential for the normal increase in serum PP14 inthe first trimester. Furthermore, they suggest that progesteroneis not the major stimulus to PP14 synthesis in early pregnancy.