Can it be a 'sin' to understand disease? On 'genes' and 'eugenics' and an 'unconnected connection'

Particularly, but not exclusively, in Germany, concerns are uttered as to the consequences of modern biotechnological advances and their range of applications in the field of human genetics. Whereas the proponents of this research are mainly focussing on the possible knowledge that could be gained by understanding the causes of developmental processes and of disease on the molecular level, the critics fear the beginnings of a new eugenics movement. Without claiming a logical relationship between genetic sciences and eugenics movements, it is nevertheless suggested in this article that a connection between both can become established when the distinction between scientifically validated statements on one hand and guiding hypotheses and assumptions on the other hand is blurred, as is observed particularly when scientists report their results to the public. This claim is demonstrated in comparisons between the current state of scientific knowledge on the role of genes in development and causation of diseases, and the way this is presented to the public. It is required that a debate on biotechnology should include reflections on the validity of claims made by scientists.This revised version was published online in October 2005 with corrections to the Cover Date.     

Conditions for research in general practice. Can the Dutch and British experiences be applied to other countries, for example Spain?

The aim of this study is to identify conditions for research as part of professional development in general practice. Based on the work of Andrew Abbott, who studied the dynamics of professional development, five conditions were identified. These are: the creation of associations among professionals; control of work; the establishment of specialised education; the development of professional knowledge; and the creation of organised structures for professional work. Two countries with a well-established research tradition in general practice (the UK and the Netherlands) and one country where GP research development is still limited (Spain) were evaluated on the basis of these conditions. The conditions identified as favourable were as follows: the existence of a scientific association; a peer-reviewed journal; a defined population resulting in a population denominator for practices; a gatekeeping system; chairs and departments of general practice at universities; the integration of education centres and research centres; GPs working in group practices or health centres; a certain degree of independence from the Ministry of Health; and financial support for practicing GPs to conduct research activities. We showed that most conditions for the successful scientific progress of general practice in Spain are present. However there is still a gap between academia and general practice and a lack of research organisation and support.     

Can pretreatment screening for dhps and dhfr point mutations in Plasmodium falciparum infections be used to predict sulfadoxine-pyrimethamine treatment failure?

This study examines the relationship between malaria treatment failure after sulfadoxine-pyrimethamine (S-P) chemotherapy and presence of mutations in the Plasmodium falciparum dihydropteroate synthase (dhps) and dihydrofolate reductase (dhfr) genes (associated with resistance in vitro to S and P) before treatment. In Kenya, 38 malaria patients in a holoendemic area, and 21 in an epidemic area, participated in the trial in 1997-98. In the 2 areas, drug failure occurred in 76% and 75% of cases where any mutation in dhfr was seen (positive predictive values 76% and 75%: P = 0.003 and 0.008) and an identical association was seen with dhfr Asn-108. In the holoendemic area all occurrences of > or = 2 mutations in dhfr predicted drug failure. Only 3 instances were seen in the epidemic focus, but treatment failed in all. Only in the epidemic focus, 7 (88%) of 8 occurrences of > or = 1 mutations in dhps, and all occurrences of the Gly-437 allele of dhps, predicted failure. Association between mutations in dhps and mutations in dhfr was noted in the combined sites, irrespective of outcome. Although this makes the relationship of combined dhfr and dhps mutations to failure more difficult to interpret, it nevertheless supports S-P selection acting on both genes. In the holoendemic site, treatment success increased with age. In this location, acquired immunity may mask the impact of mutations in dhps, since sulfadoxine is a less effective treatment than pyrimethamine.     

Can self-reported height and weight be used to calculate 10 year risk of osteoporotic fracture?

AObjectives

1) To determine the magnitude of error between self reported height and weight and measured height and weight, 2) To measure what affect this has on calculating 10 year probability of osteoporotic fracture using the World Health Organisation Fracture Risk Assessment Tool (FRAX®).

Design

Data collection from a nurse led community osteoporosis clinic.

Participants

214 post-menopausal women with at least one risk factor for osteoporosis.

Measurements

Self reported and measured height and weight, risk factors for osteoporosis, demographic details, and 10 year probability of hip fracture or any major osteoporotic fracture as measured by FRAX®.

Results

Patients over-reported their height by a mean (95% confidence interval) of 2.8 (2.3–3.2) cm and under reported their weight by a mean of 2.1 (1.3–2.6) Kg. The resulting underestimation of body mass index was 1.8 (1.3–2.0) units. Using self reported height and weight resulted in a significant over-estimation of 10 year risk of hip fracture and any major osteoporotic fracture when compared to measured height and weight; Median 10 probability of hip fracture 3.75% Vs 3.25% (p < 0.001 ), median 10 year probability of any major osteoporotic fracture 15% Vs. 14% (p < 0.001).

Conclusion

When calculating 10 year risk of fracture using the FRAX on line assessment tool, measured height and weight should be used instead of self-reported height and weight.

     

Can the vaccine adverse event reporting system be used to increase vaccine acceptance and trust?

Vaccine refusal has an impact on public health, and the human pappillomavirus (HPV) vaccine is particularly underutilized. Research suggests that it may be difficult to change vaccine-related attitudes, and there is currently no good evidence to recommend any particular intervention strategy. One reason for vaccine hesitancy is lack of trust that vaccine harms are adequately documented and reported, yet few communication strategies have explicitly attempted to improve this trust. This study tested the possibility that data from the vaccine adverse event reporting system (VAERS) can be used to increase trust that vaccine harms are adequately researched and that potential harms are disclosed to the public, and thereby improve perceptions of vaccines. In the study, participants were randomly assigned to one of three communication interventions. All participants read the Centers for Disease Control (CDC) vaccine information statement (VIS) for the HPV vaccine. Two other groups were exposed to additional information about VAERS, either summary data or full detailed reports of serious adverse events from 2013. Results showed that the CDC's VIS alone significantly increased perceptions of vaccine benefits and decreased perceived risks. Participants who were also educated about VAERS and given summary data about the serious adverse events displayed more trust in the CDC and greater HPV vaccine acceptance relative to the VIS alone. However, exposure to the detailed VAERS reports significantly reduced trust in the CDC and vaccine acceptance. Hence, general information about the VAERS data slightly increased trust in the CDC and improved vaccine acceptance, but the specific VAERS reports negatively influenced both trust and acceptance. Implications for communicating about vaccines are discussed.     

Can sediment total organic carbon and grain size be used to diagnose organic enrichment in estuaries?

Eutrophication (i.e., nutrient enrichment, organic enrichment, and oxygen depletion) is one of the most common sources of impairment in Clean Water Act 303(d)-listed waters in the United States. Although eutrophication can eventually cause adverse effects to the benthos, it may be difficult to diagnose. Sediment organic carbon (OC) content has been used as an indicator of enrichment in sediments, but the amount of surface area available for carbon adsorption must be considered. We investigated the utility of the relationship between OC and sediment grain size as an indicator of eutrophication. Data from the U.S. Environmental Protection Agency's Environmental Monitoring and Assessment Program was used to test this relationship. However, anthropogenic contaminants are also capable of causing adverse effects to the benthos and often co-occur with elevated levels of OC. Contaminant analysis and toxicity tests were not consistently related to enrichment status as defined by relationship between total OC and grain size. Although variability in response occurred, reflecting the variance in the water column factors (dissolved oxygen, chlorophyll a, and nutrients) and limited sample sizes, the data supported the hypothesis that sites designated as enriched were eutrophied. Dissolved oxygen levels were reduced at enriched sites, whereas chlorophyll a and nutrients were higher at enriched sites. This suggests that the relationship of OC to grain size can be used as a screening tool to diagnose eutrophication.     

Can AIDS stigma be reduced to poverty stigma? Exploring Zimbabwean children's representations of poverty and AIDS

Objective We use children's drawings to investigate social stigmatization of AIDS‐affected and poverty‐affected children by their peers, in the light of suggestions that the stigmatization of AIDS‐affected children might derive more from the poverty experienced by these children than from their association with AIDS. Methods A qualitative study, in rural Zimbabwe, used draw‐and‐write techniques to elicit children's (10–12 years) representations of AIDS‐affected children (n= 30) and poverty‐affected children (n= 33) in 2009 and 2010 respectively. Results Representations of children affected by AIDS and by poverty differed significantly. The main problems facing AIDS‐affected children were said to be the psychosocial humiliations of AIDS stigma and children's distress about sick relatives. Contrastingly, poverty‐affected children were depicted as suffering from physical and material neglect and deprivation. Children affected by AIDS were described as caregivers of parents whom illness prevented from working. This translated into admiration and respect for children's active contribution to household survival. Poverty‐affected children were often portrayed as more passive victims of their guardians' inability or unwillingness to work or to prioritize their children's needs, with these children having fewer opportunities to exercise agency in response to their plight. Conclusions The nature of children's stigmatization of their AIDS‐affected peers may often be quite distinct from poverty stigma, in relation to the nature of suffering (primarily psychosocial and material respectively), the opportunities for agency offered by each affliction, and the opportunities each condition offers for affected children to earn the respect of their peers and community. We conclude that the particular nature of AIDS stigma offers greater opportunities for stigma reduction than poverty stigma.     

Minimising missed opportunities to promote and deliver immunization services to middle and older age adults: Can hospital-based programs be a solution?

BackgroundThere has been a recent recognized shift towards a whole-of-life or life-course approach to immunisation. However, coverage amongst at-risk adults for recommended vaccines continues to be suboptimal. This study examined the perceptions of middle and older aged Australian adults towards hospital-based immunization programs and their previous exposures to receiving vaccines via tertiary care.MethodsA cross-sectional survey was conducted with Australian adults 45 years and older in late 2019 to capture influenza and pneumococcal vaccine uptake, exposure to hospital-based immunization programs, missed opportunities to vaccinate and receptiveness towards the promotion and/or delivery of vaccines in the hospital setting.ResultsOnly 13 respondents reported receiving a vaccine at hospital, yet 72.2% (931/1292) indicated that they were willing to be vaccinated in that setting. Amongst those who attended hospital during 2019 and were eligible for vaccination, 57.2% and 28.3% of respondents were not immunized for pneumococcal and influenza, respectively. Missed opportunities for both vaccines were significantly higher amongst those at low-risk for influenza (≤65 years (low-risk): 52.9%, ≤65 years (high-risk): 18.3%, >65 years: 15.1%; p < 0.001) and pneumococcal (≤65 years (low-risk): 79.1%, ≤65 years (high-risk): 52.4%, >65 years: 44%; p < 0.001). Among those with a missed opportunity for hospital-based vaccination, the most common reason for not getting immunized was a lack of recommendation. Most (86.4%) reported that their general practitioner was the person or group they trusted most to receive vaccine information from.ConclusionsThe findings from this Australian study support international work that shows very low rates of opportunistic vaccination in hospitals despite national recommendations to vaccinate prior to discharge. Considering the need for high levels of uptake of the COVID-19 vaccine, hospitals may need to be considered to opportunistically capture those not accessing the vaccine in other settings.     

Can mifepristone medical abortion be simplified? A review of the evidence and questions for future research

Mifepristone medical abortion has been a valuable addition to the reproductive health options of women. Aspects of its provision have however sometimes limited its accessibility and use. This article summarizes existing evidence for simplifying the provision of medical abortion and thus increasing its availability. We identify three ways through which medical abortion provision might be simplified based on existing evidence and suggest five additional simplifications that require further research to confirm their safety and efficacy.     

Can the job content questionnaire be used to assess structural and organizational properties of the work environment?

Objective  

The theory behind the Job Content Questionnaire (JCQ) presumes that the “objective” social environment is measurable via self-report inventories such as the JCQ. Hence, it is expected that workers in identical work will respond highly similar. However, since no studies have evaluated this basic assumption, we decided to investigate whether workers performing highly similar work also responded similarly to the JCQ.     

Can the unemployed be trained to care for the elderly? The effects of subsidized training in elderly care

Demographic change has increased the need for elderly care. Training unemployed workers might be one way to increase the supply of elderly care nurses. This study analyzes the effectiveness of subsidized training for unemployed individuals in the elderly care professions in Germany over 11.5 years. We find that short further training and long retraining courses significantly increase workers' long‐term employment. As approximately 25% to 50% of trained nurses have permanent jobs in the care sector, we estimate that approximately 5% of all employed nurses are formerly trained unemployed workers.     

Can utilization review criteria be used to determine appropriate pediatric patient placement for a critical care bed expansion?

The rising trend in critical care utilization has led to the expansion of critical care beds in many hospitals across the country. Traditional models of estimating bed capacity requirements use administrative data such as inpatient admissions, length of stay, and case mix index. The use of such data has been limited in quantifying the complexities of demand variables in critical care bed needs. Mathematical modeling is another method for estimating numbers of beds required. It captures the dynamic changes in the management of critically ill patients that occur when units become full. Depending on data analysis methods used, bed need underestimation or overestimation can occur. In our study, we used utilization review criteria to understand changes in level of care (LOC) during the course of patients' stays and to validate critical care bed expansion needs. Using LOC criteria, we studied the proportion of our intermediate care patients in an acute care unit that met acute, intermediate, or critical care criteria. We also evaluated whether these proportions were related to specific factors such as census ratios, staffing proportions, or severity of illness. Using LOC criteria was helpful in validating our critical care bed projection, which was previously derived from mathematical modeling. The findings also validated our assessment for additional specialty acute care beds.