Multipoint Linkage Disequilibrium Mapping Using Multilocus Allele Frequency Data

This paper describes a likelihood based fine scale linkage disequilibrium mapping method for estimating the position of a disease predisposing gene relative to a battery of typed marker loci. The method uses multilocus allele frequency data from a sample of unrelated diseased individuals and from a sample of unrelated control individuals, that is, a case and control type design. This type of data could be obtained by typing DNA pools, which is less expensive than typing individuals separately. The method described uses a nonparametric model that makes it robust to the shape of the genealogy at the disease locus. It can be implemented efficiently, making a multipoint analysis of a data set of a thousand markers feasible. An example power analysis uses simulations to estimate the amount of information that can be extracted from fully resolved haplotype data, relative to multilocus allele frequency data. For the assumed parameter values and a battery of 10 markers, roughly three times narrower region estimates can be derived from haplotype data than from allele frequency data only. Depending on how we choose to measure information, allele frequency data at an additional ～18 or ～33 markers is needed to compensate for this loss of information.     

Assessment of anger coping skills in individuals with intellectual disabilities

Recent controlled studies have supported the effectiveness of anger management training for people with intellectual disabilities (IDs). This report describes an evaluation instrument designed to assess their usage of specific anger coping skills. The Profile of Anger Coping Skills (PACS) is designed for completion by a staff member or carer. Three situations are first elicited in which a client frequently displays anger. The respondent then rates each situation for the extent to which the client deploys each of eight behavioural and cognitive coping skills. In a preliminary reliability study, 20 users of a day service for people with IDs were rated independently by two staff members, with one of them completing the assessment on two separate occasions: the PACS showed good test–retest reliability and lower, but still acceptable, interrater reliability. The PACS was subsequently used, in a different day service, as part of the assessment pack administered before and after a 12-week anger management group, with a parallel assessment of an untreated control group. The treated group showed substantial decreases in measures of anger, which were maintained at 6-month follow-up. Increases in PACS-rated anger coping skills were also seen in all participants in the anger management group, but not in the control group. There were differences in the extent to which different coping skills were acquired by the treated group, and there were also individual differences in the profile of specific skills acquired. It is concluded that the PACS is a reliable instrument for assessing anger coping skills, particularly when used repeatedly with the same informant. It provides information that is useful for both individual care planning and the design of future anger management programmes.     

Fetal head and abdominal circumferences: effect of profile shape on the accuracy of ellipse equations

Images of 122 fetal heads and abdomens were obtained with ultrasound for the determination of head and abdominal circumferences. The profile shapes were characterized by the cephalic or abdominal index (D1/D2 x 100), D1 and D2 being the shortest and longest diameters of either the head or abdomen. The mean of the cephalic index was 79.1% +/- 5.2%, and that of the abdominal index was 89.1% +/- 7.0%. All equations were equally accurate in calculating head and abdominal circumferences regardless of the profile shape. Therefore, the simplest equation, (D1 + D2) x 1.57, should be utilized when calculating circumferences except in situations of extreme dolichocephaly.     

Assessment of quality of life with the Nottingham Health Profile among patients with coronary heart disease

The aim was to describe the quality of life of people suffering from coronary artery disease. The patients had been treated with medication (n=80), percutaneous transluminal coronary angioplasty (n=100) and coronary artery bypass surgery (n=100). Of the 280 patients, 189 were men and 91 women. The patients who participated in this study were seriously ill, as nearly half of them had three or more stenosed coronary arteries. Male patients were most numerous in the bypass surgery group and female patients in the angioplasty group. The quality of life was evaluated using the Nottingham Health Profile (NHP) instrument relation to an age-and sex-matched general population, the background factors and the severity of the coronary disease. The NHP questionnaire consists of 38 statements on health problems, making up six dimensions of subjective health: physical mobility, pain, sleep, energy, emotional reactions and social isolation. The health-related quality of life of coronary patients before the invasive procedures was significantly poorer on all the six dimensions than the quality of life in an age-and sex-matched general population. The most obvious differences were seen on the following dimensions: energy, pain, emotional reactions, sleep and physical mobility. The smallest differences occurred in social isolation. Both males and females had the lowest value for energy and social isolation in the youngest age group (35–54 years). The index values of emotional reactions in the two youngest groups were significantly higher among females than males, which reflects poor quality of life. The women in the age group of 35–54 years found the manifestation of a serious disease extremely hard to face. Our findings clearly suggest that while choosing the mode of treatment, the patient's quality of life should be considered along with the clinical severity of the disease, especially in the case of young women. From the societal and social points of view, the patient's symptoms and quality of life are even more important than the objective medical outcome. In clinical decision-making, the goal is to integrate the results of health-related quality of life assessments with clinical decisions, and this underlines the need to evaluate whether the treatment given is congruent with the patient's quality of life. On the basis of the present findings, the NHP instrument seems to be applicable to quality of life measurements among coronary patients. It does not, however, necessarily give an accurate and profound view of an individual's overall quality of life.     

45岁以下青年女性急性心肌梗死的临床和冠状动脉病变特点

目的 回顾分析45岁以下女性急性心肌梗死的临床和冠状动脉病变特点及C-反应蛋白与女性急性心肌梗死之间的相关性,探讨急性心肌梗死危险因素及C-反应蛋白对青年女性急性心肌梗死诊断的预测价值.方法 选取2000年1月-2010年6月住院行冠状动脉造影证实为急性心肌梗死的45岁以下女性患者31例的急性心肌梗死患者临床资料、冠状动脉病变特点,检测C-反应蛋白、血脂、纤维蛋白原、血尿酸水平,应用logistic回归分析危险因素与青年女性急性心肌梗死的关联性.结果 青年女性急性心肌梗死较同龄男性,急性心肌梗死家族史、高血压、糖尿病、心源性休克、C-反应蛋白水平显著升高.冠状动脉造影显示多支血管病病变为主,左前降支冠状动脉相关的急性心肌梗死病变约32.3%.完全血运重建率及PCI术后TIMI 3级血流所占比例也较少,与男性比较差异有显著性(P<0.05).两组出院30天死亡率(OR=1.23,95%CI为0.81-1.89)差异无显著性,但青年女性院内死亡率(OR=1.15,95%CI为1.04-1.37)高,男性患者1年死亡率更高(OR=1.21,95%CI为1.07-1.47).接受介入治疗年青女性急性心肌梗死院内死亡率(OR=0.96,95%CI为0.74-1.26)及出院30天死亡率(OR=1.07,95%CI为0.90-1.29)差异无显著性,但1年死亡率更高(OR=1.13,95%CI为1.01-1.29).结论 45岁以下女性急性心肌梗死患者合并高血压、糖尿病、急性心肌梗死家族史、心源性休克、多支血管病和C-反应蛋白的比例较高,但完全血运重建率低,PCI术后1年死亡率高.因而有必要对年青女性人群最佳的急性心肌梗死治疗策略作进一步的研究.     

Emotional state and coping style among gynecologic patients undergoing surgery

The aim of the present study was to investigate changes in emotional state and the relationship between emotional state and demographic/clinical factors and coping style among gynecologic patients undergoing surgery. Using the Japanese version of the Profile of Mood States (POMS), 90 patients (benign disease: 32, malignancy: 58) were examined on three occasions: before surgery, before discharge, and 3 months after discharge. They were also examined using the Coping Inventory for Stressful Situations (CISS) on one occasion before discharge. The scores for the subscales depression, anger, and confusion were the highest after discharge while those for anxiety were the highest before surgery. The average scores of the POMS subscales for all subjects were within the normal range. With regard to the relationship between these emotional states and other factors, multiple regressions showed that the principal determinants of anxiety before surgery were religious belief, psychological symptoms during hospitalization and emotion-oriented (E) coping style; further, it was found that depression after discharge could be explained by chemotherapy, duration of hospitalization, and E coping style. The principal determinants of anger after discharge and vigor before surgery were length of education and E coping style, and severity of disease, chemotherapy, E coping style and task-oriented coping style, respectively. Those of post-discharge fatigue and confusion were length of education, psychological symptoms, and E coping style. In summary it is suggested that the following should be taken into account in patients undergoing gynecologic surgery: anxiety before surgery, depression, anger, and confusion after surgery, including coping styles.     

Predictors of general quality of life and the mediating role of health related quality of life in patients with schizophrenia

Introduction  The concept ‘quality of life’ (QoL) has become increasingly important as an outcome measure in the evaluation of services and in clinical trials of people with schizophrenia. This study examines the mediating role of health related quality of life (HRQoL) in the prediction of general quality of life (GQoL). Method  QoL and other patient- and illness characteristics (psychopathology, overall functioning, illness history, self-esteem and social integration) were measured in a group of 143 outpatients with schizophrenia. GQoL was measured by the Lancashire Quality of Life Profile and HRQoL was measured by the MOS SF-36. To test the temporal stability of our findings, assessments were performed twice with an 18-month interval. Results  We found that patient’s GQoL is predicted mainly by anxiety and depression and self-esteem and to a lesser extent by global functioning and social integration. At both time intervals HRQoL appeared to be a significant mediator of the relationship between anxiety and depression and self esteem versus patient’s GQoL. Conclusions  The results of this study are important for mental health professionals, as these provide more insight in the mechanisms by which they could improve the GQoL of their patients with schizophrenia. The results confirm that diagnosis and treatment of anxiety and depression in outpatients with schizophrenia deserves careful attention of clinicians. Also strategies and specific interventions to improve self-esteem of patients with schizophrenia are very important to maximise patient’s QoL.     

Relationship between Oral Health-Related Quality of Life, Satisfaction, and Personality in Patients with Prosthetic Rehabilitations

Purpose: This study investigated the relationship between oral health‐related quality of life, satisfaction with dentition, and personality profiles among patients with fixed and/or removable prosthetic rehabilitations. Materials and Methods: Thirty‐seven patients (13 males, 24 females; mean age 37.6 ± 13.3 years) with fitted prosthetic rehabilitations and 37 controls who matched the patients by age and gender were recruited into the study. The Dental Impact on Daily Living (DIDL) questionnaire was used to assess dental impacts on daily living and satisfaction with the dentition. The Oral Health Impact Profile (OHIP) was used to measure self‐reported discomfort, disability, and dysfunction caused by oral conditions. Oral health‐related quality of life was assessed by the United Kingdom Oral Health‐Related Quality of Life (OHQoL‐UK) measure. Moreover, the NEO five‐factor inventory was used to assess participants’ personality profiles. Results: Prosthetic factors had no relationship to the DIDL, OHIP, and OHQoL‐UK scores. Patients with the least oral health impacts had better oral health‐related quality of life (p= 0.023, r =–0.37), higher levels of total satisfaction, and satisfaction with appearance, pain, oral comfort, general performance, and eating (p < 0.05, r =–0.79, –0.35, –0.59, –0.56, –0.58, and –0.50, respectively). Patients with better oral health‐related quality of life (QoL) had higher total satisfaction, satisfaction with oral comfort, general performance, and eating (p < 0.05, r = 0.34, 0.39, 0.33, and 0.37, respectively). Patients with lower neuroticism scores had less oral health impact (p= 0.006, r = 0.44), better oral health‐related QoL (p= 0.032, r =–0.35), higher total satisfaction, satisfaction with appearance, pain, oral comfort, and eating (p < 0.05, r =–0.58, –0.35, –0.33, –0.39, and –0.35, respectively). Conclusion: Patients’ satisfaction with their dentition and prosthetic rehabilitations has positive effects on oral health‐related QoL and oral health impacts and improves patients’ daily living and dental perceptions. Neuroticism might influence and predict patients’ satisfaction with their dentition, oral health impacts, and oral health‐related QoL. Satisfaction with the dentition might predict a patient's level of neuroticism.     

Prospective analysis of depression and psychological distress before and after surgical resection of lung cancer

Objectives The psychological effects of surgery have received little attention in patients with lung cancer, so it is unclear how much psychological support is required by these patients. This study was done to assess the mental state of patients with lung cancer before and after surgery and to determine their need for psychological care. Methods A group of 165 patients with lung cancer scheduled for surgical treatment were included in this study. They were asked to complete the Profile of Mood States questionnaire before surgery and on discharge after completion of treatment. The data on mood from the questionnaires were analyzed. Results Tension-anxiety improved significantly after surgery, whereas the fatigue score increased significantly. The scores for depression-dejection and confusion were elevated before surgery and were unchanged afterward. Conclusions Patients with lung cancer were depressed before surgery and remained depressed after their operations, although postoperative tension-anxiety diminished. These results indicate that lung cancer patients need psychological support to alleviate depression during the perioperative period.     

Age and Angina as Predictors of Quality of Life after Myocardial Infarction. A Prospective Comparative Study

Objectives - The objectives were to compare quality of life (QoL) after first myocardial infarction with an age- and sex-adjusted normative population and to test whether the 1-month QoL had predictive properties. Design - QoL was assessed by self-administered questionnaires (SF-36 and Cardiac Health Profile) 1, 3 and 6 months after index-event. Participants were 60 consecutive patients (20% women) with a mean age of 58 &#45 7.4 years. Results - Patients &#83 59 years improved in Physical (PCS) and Mental Component Summary (MCS), scoring comparable to community norms at 6 months. However, patients <59 years improved in PCS but not in MCS, and scored significantly below community norms in both PCS (x- macron = 44.7, CI 40.6-48.7 vs x- macron = 50.3, CI 49.3-51.4) and MCS (x- macron = 45.9, CI 41.8-49.9 vs x- macron = 51.3, CI 50.3-52.4) at 6 months. Predictors for MCS were age ( p = 0.025) and Vitality ( p = 0.020) both positively related to QoL. Predictors for PCS were Physical Function ( p = 0.003) and CCS score ( p < 0.001) where angina grade was negatively related to QoL. Conclusion - Because of impaired mental recovery in younger post-infarction patients, their need of special attention in the rehabilitation process must not be overlooked.