Enhancing Nurse Assessment of Alcohol and Drug Dependency: A Preliminary Study

The purpose of this project was to prepare nurses to provide brief interventions for clients with alcohol or other drug (AOD) dependency in order to reduce hospitalization, morbidity, and mortality. The project was a collaborative process between a major medical center and a school of nursing. Nurses were surveyed for understanding of alcohol and other drug assessment, and a day long training was provided to teach techniques of brief interventions. The short-term results included increased knowledge of nurses about AOD assessment. Long-term results indicated that 95% of patients referred to the AOD team were confirmed to have AOD problems (Dunn & Ries, 1997). This project documents the need for nurses to have more knowledge about AOD problems and brief intervention techniques.     

Possible effect of gender and season on the length of hospitalisation in unipolar major depressives

BACKGROUND: Seasonal variation as well as gender differences of several phenomena of affective disorders are a common topic of interest. METHODS: The authors analysed the possible effect of season and gender on the length of hospital stay in 529 in-patients with unipolar major depressive episode. RESULTS: Age and menopausal status alone did not influence the length of hospitalisation but there was a statistical tendency (only for females) for the shortest hospital stay in summer, that reached significance in females younger than 50 years. CONCLUSIONS: The results suggest a possible seasonal and gender effect on recovery from major depression. LIMITATIONS: Retrospective nature of the study, lack of systematic assessment of clinical response and no data collection about marital status and living conditions, that also can influence the time of discharge.     

Her-2 protein expression, cellular localization, and gene amplification in colorectal carcinoma.

This study was sought to evaluate the relationship between Her-2 protein expression, cellular localization, gene amplification, and other clinicopathologic parameters in colorectal carcinomas. Her-2 protein expression and gene amplification were assessed in paraffin sections from 106 primary colorectal adenocarcinoma cases using immunohistochemistry and fluorescence in situ hybridization. Both membranous and cytoplasmic immunostaining was evaluated. The results were correlated with each other and with tumor grade, stage, and overall survival. Membranous and cytoplasmic protein expression was identified in 6 (5.6%) and 13 (12.26%) cases, respectively. Gene amplification was detected in 4 (3.7%) cases. There was a high concordance between membranous protein expression and gene amplification (kappa=0.791). No apparent association with any of the clinicopathologic parameters was identified. Membranous Her-2 protein expression and gene amplification are encountered in a small subset of colorectal carcinomas and are highly concordant events. Cytoplasmic protein expression might be either artifactual or it might represent a cross-reacting protein or a precursor form of the mature protein.     

The effect of neonatal BCG vaccination on atopy and asthma at age 7 to 14 years: an historical cohort study in a community with a very low prevalence of tuberculosis infection and a high prevalence of atopic disease

BACKGROUND: There are conflicting reports on the effect of BCG vaccination on the subsequent development of atopy and asthma. There are no data on the effects of neonatal BCG vaccination on cytokine responses of lymphocytes that are exposed in vitro to allergens. OBJECTIVES: We sought to test the hypothesis that neonatal BCG vaccination or, alternatively, evidence of an immunologic memory of this vaccination is associated with a reduced prevalence of allergic sensitization, asthma, eczema, and hay fever during childhood. METHODS: An historical cohort study was conducted among 7- to 14-year-old children who were born in 2 districts in Sydney, Australia, and whose mothers were born in southeast Asia. One district had routinely administered BCG vaccination to infants born to overseas-born mothers and the other had not. Eligible subjects were identified from birth registers. Consenting subjects completed questionnaires, performed spirometric and airway hyperresponsiveness testing, and had allergen skin prick testing and tuberculin skin testing. Blood was collected to measure total serum IgE levels and for in vitro lymphocyte culture in the presence of an extract of house dust mite, the dominant allergen in this region, and purified protein derivative of Mycobacterium tuberculosis (tuberculin). IL-4, IL-5, IL-10, and IFN-gamma were measured in the culture supernatant. RESULTS: The cohort included 309 BCG-vaccinated subjects and 442 non-BCG-vaccinated subjects. BCG-vaccinated subjects did not have a lower rate of allergic sensitization than nonvaccinated subjects. However, among the subgroup of subjects with a family history of rhinitis or eczema, BCG vaccination was associated with a lower prevalence of current asthma (defined as recent wheezing plus airway hyperresponsiveness; relative risk, 0.46; 95% CI, 0.22-0.95). BCG vaccination was also associated with lower levels of allergen-stimulated IL-10 production in vitro. Among the BCG-vaccinated subjects, the 44 (14.3%) who had tuberculin skin test reaction sizes of 5 mm or greater and the 31 (18.3%) who demonstrated an in vitro IFN-gamma response to purified protein derivative of M tuberculosis did not have lower rates of allergic sensitization and, overall, did not have a lower prevalence of allergic disease than tuberculin skin test or IFN-gamma nonreactors. CONCLUSION: We conclude that neonatal BCG vaccination has an effect on T-cell allergen responsiveness 7 to 14 years after vaccination and that among a subgroup of subjects with an inherited predisposition to allergic disease, this is associated with clinically relevant beneficial effects. The findings of this study encourage the view that external influences on the immune system in the neonatal period have consequences that extend into later childhood and influence the expression of asthma. Genetic factors are likely to modify the effect of those external factors.     

Territorywide Study of Early Coronavirus Disease Outbreak,Hong Kong,China

Initial cases of coronavirus disease in Hong Kong were imported from mainland China. A dramatic increase in case numbers was seen in February 2020. Most case-patients had no recent travel history, suggesting the presence of transmission chains in the local community. We collected demographic, clinical, and epidemiologic data from 50 patients, who accounted for 53.8% of total reported case-patients as of February 28, 2020. We performed whole-genome sequencing to determine phylogenetic relationship and transmission dynamics of severe acute respiratory syndrome coronavirus 2 infections. By using phylogenetic analysis, we attributed the community outbreak to 2 lineages; 1 harbored a common mutation, Orf3a-G251V, and accounted for 88.0% of the cases in our study. The estimated time to the most recent common ancestor of local coronavirus disease outbreak was December 24, 2019, with an evolutionary rate of 3.04 × 10⁻³ substitutions/site/year. The reproduction number was 1.84, indicating ongoing community spread.     

The percentage of articles which were accepted or rejected for publication in the Dutch Journal of Medicine in 1997

OBJECTIVE: To determine the acceptance and rejection percentages of articles submitted to the editors of the Nederlands Tijdschrift voor Geneeskunde (NTvG) in 1997. DESIGN: Retrospective. METHOD: The data on all articles reviewed by the editors of the NTvG in 1997 were extracted from the registration system in April 1998. These included the outcome of the review process (rejection or acceptance for publication or no definite decision yet), the article category (e.g., original article, review article), and whether the article had been solicited by the editors or was a spontaneous submission. RESULTS: In 1997, 845 articles were received. Of these 28% (240) were rejected and 59% (497) were accepted for publication. On 13% (108) no decision had been made (in April 1998). Of the articles decided upon 36% were rejected (extrapolated). 705/845 (83%) articles were unsolicited: of these 33% (235) were rejected and 54% (382) accepted; on 13% (88) the decision was pending. The solicited articles numbered 140 (17%); of these 4% (5) were rejected and 82% (115) were accepted; on 14% (20) no decision had been made yet. CONCLUSION: The rejection of articles submitted to NTvG in 1997 was 36% (in 1990 38%). Solicited articles were rejected less frequently than unsolicited ones. The yearly number of articles submitted and the rejection percentage have not changed drastically during the last eight years.     

Progesterone for the prevention of preterm birth in women with multiple pregnancies: the AMPHIA trial

Background

Adequate vitamin D concentrations during pregnancy are necessary to neonatal calcium homeostasis, bone maturation and mineralization. The aim of study is to evaluate serum vitamin D concentrations in mothers and their newborns and effect of vitamin D deficiency on pregnancy outcomes.

Methods

552 pregnant women were recruited from Tehran University educating hospitals in the winter of 2002. Maternal and cord blood samples were taken at delivery. The serum was assayed for 25-hydroxyvitamin D3, calcium, phosphorus and parathyroid hormone.

Results

The prevalence of vitamin D deficiency in maternal and cord blood samples were 66.8% and 93.3%, respectively (<35 nmol/l). There was significant correlation between maternal and cord blood serum concentrations of vitamin D. In mothers with vitamin D deficiency, cord blood vitamin D concentrations was lower than those from normal mothers (P = .001). Also, a significant direct correlation was seen between maternal vitamin D intake and weight gain during pregnancy.

Conclusion

Consideration to adequate calcium and vitamin D intake during pregnancy is essential. Furthermore, we think it is necessary to reconsider the recommendation for vitamin D supplementation for women during pregnancy.     

Actions of Competence in Occupational Therapy Practice: A phenomenological study of practice in narrative form

This study examined the phenomenon ?what are occupational therapists doing when they feel competent?. Data were provided by eleven occupational therapists who narrated clinical cases in which they had felt themselves to be competent. The empirical phenomenological psychological (EPP) method was used to analyse and interpret the data. The result revealed that on a general level the experience of feeling competent as an occupational therapist derived from achieving results in the rehabilitation project that were satisfying for both participants (the therapist and the client). The strategies for accomplishing this were related to the empathic competence of the therapists. This competence involved interpreting clinical situations as well as understanding the relationship between motive, meaning, decision and time. Further it involved bringing objects, in the form of adaptations, technical aids, structures, simplifications or compensations, into the clinical situation. These abilities together had a great impact on the therapeutic outcome by shaping the clients' lifeworld to make it richer and more active.     

Effect of Acculturation on Variations in Having a Usual Source of Care Among Asian Americans and Non-Hispanic Whites in California

Objectives. We examined variations in having a usual source of care (USC) among non-Hispanic White and Asian American adults in California.Methods. Data were from the 2005 and 2009 California Health Interview Survey. Using a modified Anderson model, we used multiple logistic regression to compare odds of having a USC between non-Hispanic White (n = 38 554) and Asian American adults (n = 7566) and to examine associations with acculturation factors (English proficiency, length of residence, residence in a racially concordant neighborhood) and key enabling (employment, income, insurance) and predisposing (education) factors.Results. Race-related disparities between Asian Americans and non-Hispanic Whites in having a USC were no longer significant after accounting for acculturation factors. Limited English proficiency and short time in the United States (< 5 years) were significantly associated with not having a USC for both races. Increasing levels of education and insurance were not associated with better access among Asian Americans.Conclusions. Key differences exist in how Asian American and non-Hispanic White adults access care. Acculturation factors are key drivers of disparities and should be included in access-to-care models with Asians. Insurance and education are differentially significant for Asian Americans and non-Hispanic Whites.The percentage of Asian Americans having a primary care provider has been persistently lower than that of Whites (68.4% vs 76.7%, respectively, in 2009).1 This disparity is important because having a usual source of care (USC) has consistently been associated with increased utilization of primary care services and better health outcomes.2–5 Asian Americans are disproportionately burdened because of their increased risks of easily preventable and chronic diseases.6 Because Asian Americans are the fastest growing minority population in the United States,7 understanding their health care access is important for improving health and health care outcomes of Asian Americans.The literature has revealed persistent disparities in access to care, specifically having a USC, between Asian Americans and non-Hispanic Whites.8,9 However, few studies have explored what factors influence this disparity. Variation in behavior to access health care among immigrants has been attributed to linguistic barriers and the lack of familiarity and comfort with the US health care system.10–14 Given the high percentage of immigrants among Asian Americans (66% in 2012¹⁵), studies of Asian Americans should consider the cultural and psychological effects of immigration and acculturation.12,13,16–19 Commonly used measures of acculturation are English language proficiency and length of residence.11,20,21 Both measures have been found to significantly influence access to care and are often included in survey data studies.11,13,20,22,23 Conceptualizations of acculturation also recognize the importance of understanding how communities might affect health and access to care.20,24–26 Ethnic neighborhoods (communities with high proportions of ethnic minorities) provide cultural goods and social ties that may alter adaptation to a new culture and may serve as a primary resource of health knowledge for immigrants and less-acculturated individuals.20,25,27The Andersen health behavioral model is the most widely used model to study access to health services.28–30 For the general population, an individual’s propensity (predisposing characteristics), means (enabling resources), and need for health care services are all associated with having a USC.30–34 In the general population, earlier studies have found the following predisposing characteristics to be positively associated with having a USC: older age, female gender, married, and more education.32–35 Among enabling resources and need, having health insurance, employment, higher household income, and higher health need have been positively associated with access to care.4,32,33,35,36 Although modified Andersen models that include acculturation have been proposed, these models have not been standardized and generally include a mix of predisposing and enabling factors that are specific to the minority population studied.11,18,37–41 Many studies have found longer length of residence to be positively associated with access to care,12,18,42,43 but findings for English proficiency have been mixed, and population-level research on the impact of ethnic neighborhoods on access among Asian Americans is lacking.11,23,26,37,42,44 Additionally, relationships among commonly used predisposing and enabling factors and having a USC are not well established in Asian Americans.29,30 Although, on average, Asian Americans have high socioeconomic status, they also have higher rates of poverty, unemployment, and lack of insurance than non-Hispanic Whites.45–47 Although health insurance significantly influences access among all Asian Americans,48–51 associations among access to care and education, income, and employment for Asian Americans are unclear.11,48–53The lack of research on and clarity regarding access to care for Asian American adults suggests that a better understanding of the associations among having a USC, acculturation factors, and predisposing and enabling factors for Asian Americans is needed. In this study, we aimed to (1) determine whether Asian American adults are less likely to have a USC than non-Hispanic White adults and (2) examine how acculturation and key predisposing and enabling factors differentially influence having a USC in non-Hispanic White and Asian American adults. Although previous research has largely focused on personal acculturation measures, we also included environmental influences to more fully understand the effect of acculturation on having a USC.