Knowledge of good clinical practice among Danish physicians. A questionnaire study among hospital-employed physicians in the Copenhagen area

Differences in cord serum low density lipoprotein (LDL) composition between male and female neonates with normal or high (> or = 100 mg/dl or > or = 2.59 mmol/l) serum cholesterol levels were studied in 548 full-term newborn infants of the Toledo Study (Spain), where the absence of known perinatal factors that would alter lipid levels in cord blood was confirmed. The percentage of females with a high serum total cholesterol (TC) level was higher (p < 0.02) than that of males. ANOVA two-way analysis shows significant interaction of gender and cholesterol level upon LDL-cholesterol, triglycerides and LDL-cholesterol/Apoprotein (Apo) B ratio. However, Apo B was higher in those neonates, both male and female, with high cholesterol levels. The LDL fraction carried about 55% of TC in females with high TC levels (HF), whereas it transported just 40% in males with high TC levels (HM). LDL appeared more enriched in cholesterol than in Apo B in HF than in HM (p < 0.01). An increased level of small LDL particles should be associated with the higher triglyceride level found amongst HM. Results in LDL composition suggest that metabolic gender-related differences in infants with normal or high TC are presented at birth.     

Reproducibility and validity of an extensive semiquantitative food frequency questionnaire among Greek school teachers

The involvement of mental health professionals in determinations of dangerousness is both common and controversial. Among the various contexts for these evaluations, the release of potentially violent forensic patients from maximum security facilities evokes justified concern from involved experts and apprehension to outrage from the immediate community. We sought to examine how conclusions are reached on dangerousness at two sequential stages: clinical recommendations and Manifest Dangerousness Hearings decisions. In an archival study of 245 patients, we found that lack of progress in the institution and physical assaultiveness were the strongest correlates with dangerousness. In contrast, experts and review boards appeared to be relatively less influenced by diagnosis, types of treatment, and sociodemographic variables.     

Occurrence of asthma and chronic bronchitis among female hairdressers. A questionnaire study

AIMS: We examined the relationship between apoptosis and three different major stages of human breast carcinoma: intraductal carcinoma (DCIS), infiltrating duct carcinoma (IDC) and metastatic carcinoma in lymph nodes. We also determined the correlation between apoptosis and oestrogen receptor (ER), progesterone receptor (PR) and p53. METHODS AND RESULTS: The study investigates the extent of apoptosis in 63 breast carcinomas by in-situ end-labelling, in formalin-fixed, paraffin-processed tissue sections. The 63 breast carcinomas, included 22 DCISs, 26 IDCs, three infiltrating lobular carcinomas (ILC) and 12 metastatic lymph nodes. The apoptotic labelling index was higher in DCIS than IDC and metastatic carcinoma (P < 0.001, P < 0.007, respectively). By immunohistochemistry, we also analysed p53, ER and PR. Apoptosis correlated significantly with p53 (r = 0.748, P = 0.0004) in IDC. Also, ER correlated significantly with PR (r = 0.629, P = 0.00001). No apparent correlation was found between the apoptosis and ER or PR. CONCLUSION: Our data suggest that not only does apoptosis differ between intraductal carcinoma and infiltrating carcinoma but also it might be regulated by altered p53 expression.     

Treatment routines of flexor tendon injuries. Results of a questionnaire study

A questionnaire was distributed to the surgical departments of all Norwegian hospitals, asking about the routines for treating flexor tendon injuries in 1990. The response rate was 95.5%. Some of the smaller hospitals did their own flexor tendon surgery, but referred patients with a complex injury to a hospital with better trained hand surgeons. In 1990, a total of 573 flexor tendon repairs were carried out in Norwegian hospitals. After surgery, all patients had a cast or a brace for a period ranging from three to six weeks. Most of the hospitals used dynamic traction and had a programme for training the patient, which was supervised by a hand therapist. Active flexion was allowed from two to eight weeks after the operation. We recommend referral of all flexor tendon injuries in zone II to a surgical unit with trained hand surgeons. After surgery, a programme including dynamic traction and training supervised by the surgeon and a hand therapist should be compulsory.     

Knowledge of asthma among parents of asthmatic children

The knowledge and attitude towards asthma, of parents, of 85 asthmatic children was assessed using a 17 item questionnaire. Results showed that 34.1% believed asthma to be contagious, 48.2% of the parents hesitated in referring to their child's illness as asthma. Other commonly held beliefs were that asthma is a life long illness (35.3%); food items are important precipitating factors for acute attacks (88.2%); mild exacerbations need to be treated with bronchodilators (6.3%); bronchodilators should be started at home before consulting a physician in case of an acute attack (61.2%); and cure of asthma is possible through modern drugs (30.6%) or through alternative systems of medicine (65%). Ninety one per cent of parents lacked an awareness of the side effects of anti-asthma medication. It is concluded that parental education through improved physician parent communication is necessary for enhancing the quality of care being provided to children with asthma, a fact also highlighted by the International Consensus Report on Management of Asthma.     

School nurses' perceptions of parental involvement in school health. Results of a statewide study

The purpose of this study was to determine how school nurses attempt to involve parents of seventh graders in school health programs, identify nurses' perceptions of barriers to parental involvement, and identify related staff development needs. A questionnaire was sent to the school nurse in each school in Indiana that had a seventh grade (n = 447); 279 questionnaires were returned, a response rate of 63%. Most respondents worked in situations without written policies for parental involvement. A minority of school nurses reported receiving input from parents through advisory committees or parent surveys. The most common involvement activities were related to providing parents with information about the school health program. Less than half of the respondents reported offering health education through activities such as parent health education classes, health fairs, health education resource centers, or health newsletters. Lack of time was identified as the major barrier faced by school nurses. Several staff development needs were identified.     

Unnecessary medical interventions. A questionnaire study among physicians and laymen

The aim of the study was to survey attitudes among medical doctors and lay people to unsolicited medical intervention. The design of the study was an anonymous questionnaire study including three scenarios implying ethical considerations. A total of 445 medical doctors working within different areas received the questionnaire, as did 75 medical students and 600 lay people. The results showed a response rate of 67%, highest among medical doctors and students. The lay people had significantly higher expectations concerning the medical intervention in two out of three scenarios compared to medical doctors and students. The participants were offered the opportunity to comment on the questionnaire. The conclusion of the Danish survey is that there is a significantly different approach to unsolicited medical intervention among lay people compared to medical doctors and students. Medical doctors are less disposed to perform unsolicited intervention compared with the wishes/expectations of the lay people. More open attitudes and information as well as better communication is recommended.     

Underrecognition and undertreatment of asthma in Cape Town primary school children

BACKGROUND: In view of the high local prevalence of asthma, the extent of recognition and appropriate management of childhood asthma was studied in a large suburban area of Cape Town. DESIGN: Cross-sectional study based on random community sample of schools. METHOD: 1,955 parents of sub B pupils from 16 schools completed a questionnaire, followed by: (i) an interview of the parents of 348 symptomatic children; and (ii) bronchial responsiveness testing on 254 children. The final case group consisted of 242 children with reported asthma or multiple asthma symptoms on both questionnaires. Children in whom asthma was acknowledged were compared with those in whom it was not. RESULTS: Overall, any past or current ('ever') asthma was acknowledged by respondents in only 53% of the children, and current asthma in only 37.1%. While most children had received treatment in the previous 12 months, 66.1% of the recognised group were on current treatment (23.2% on daily treatment), compared with 37% of the unrecognised group (3% daily). Salbutamol and theophylline syrups were the most common types of medication, while inhalers and anti-inflammatory medications were underused. Only a minority of parents reported the child ever having used a peak flow meter, or volunteered knowledge of preventive measures. Current treatment, and to a lesser degree recognition of asthma by parents, were more common among children on medical aid and of higher socio-economic status. CONCLUSIONS: These findings suggest that ways need to be found: (i) to increase the use of current asthma treatment guidelines by practitioners; (ii) to provide access to comprehensive care by children not on medical aid; and (iii) to improve education of parents in home management measures such as severity assessment and avoidance of smoking, allergen and dietary triggers.     

Results of a questionnaire on sperm morphology assessment

This survey describes the results of a questionnaire on the methodology of sperm morphology assessment. A questionnaire form was sent to 410 fertility centres. A total of 170 answer forms (41.5%) from 40 different countries was evaluated. Most responding centres (147 or 86.5%) treat more than 200 new couples per year. According to our results, a wide and complex variation in different methods of sperm preparation, staining procedures and classification systems is observed world wide. WHO recommendations for sperm preparation seem to be poorly followed. Only 86 centres (50.6%) reported the use of a single approach to both semen preparation and sperm morphology evaluation. Our results indicate an urgent need for standardization and consensus on sperm morphology methodology to regain the power of this important sperm parameter.     

Operative treatment of carpal tunnel syndrome in Denmark. Results of a questionnaire

The aim of our study was to determine the incidence of operative treatment for carpal tunnel syndrome in Denmark and to see whether there was a consensus about the place of preoperative electromyography and nerve conduction studies. A questionnaire was mailed to all surgical departments (n = 70) and all registered private surgical practices (n = 214) in Denmark. The incidence of operation was about 0.61 per 1,000 population. Most surgeons used preoperative electromyograms and nerve conduction studies in less than 50% of cases. The use of preoperative testing was related to the surgical speciality.     

Prevalence of asthma and wheeze in primary school children in northern Jordan

While the existence of chimeric cells in host tissue following organ transplantation is well documented, its distribution, temporal evolution and relationship to allograft survival is less clear. To explore this phenomenon, Lewis recipients of ACI cardiac allografts representing a wide range of immunosuppressive protocols and graft survival times were examined for the presence of chimerism using a sensitive polymerase chain reaction assay. Four groups of animals were examined: untransplanted animals receiving donor specific transfusion (DST)/cyclosporine A (CsA); allograft recipients with no treatment; recipients treated with DST/CsA/supplementary immunosuppression with rejection at 21-183 days; and recipients sacrificed with functioning allografts, treated with DST/CsA/supplementary immunosuppression and surviving > 200 days. To elucidate variations in the tissue distribution of chimeric cells, bone marrow, skin, liver, spleen, and thymus were examined in each animal. Untransplanted animals receiving DST/CsA displayed no evidence of chimerism. In animals receiving a cardiac allograft but no treatment, there was extensive evidence of chimerism in four of five animals. Chimerism was also detected in seven of nine animals with intermediate graft survival at the time of rejection. In animals with long-term graft survival, only four of eight displayed chimerism. These results suggest that, without immunosuppression, early chimerism does not lead to prolonged graft survival and that, even when graft survival is moderately prolonged, these cells are not sufficient to prevent rejection. In conclusion, chimerism appears to be a common phenomenon following transplantation, is not a result of DST, and may not be necessary for maintenance of long-term graft survival.     

Polypharmacy and the risk of drug-drug interactions among Danish elderly. A prescription database study

BACKGROUND AND OBJECTIVES: Interscalene block can be chosen for complete anesthesia for shoulder surgery. Phrenic nerve block occurs with almost all interscalene blocks, but is well tolerated in most patients. This may not be the case in selected geriatric patients. METHODS: The patient is a 90-year-old female with osteoarthritis of the left shoulder scheduled for total shoulder anthroplasty. Past medical history revealed hypertension, mild mitral valve insufficiency, and a remote episode of congestive heart failure. She underwent interscalene block with 40 mL of 1.4% mepivacaine, 1:200,000 epinephrine freshly added, alkalinized with sodium bicarbonate. RESULTS: The onset of the block was rapid and complete. The patient had minimal intravenous sedation (0.5 mg midazolam) and was resting comfortably with a respiratory rate of 12-14 breaths/min. Approximately 5 minutes after the injection of local anesthetic, the patient was noted to be alert, cyanotic, denying dyspnea, with an oxygen saturation of 75-85%. A chest radiograph revealed elevation of the ipsilateral hemidiaphragm and no pneumothorax or other pathology. Despite supplemental oxygen by face mask, desaturation persisted and general anesthesia was induced. On emergence from anesthesia, the patient had a complete interscalene block. Repeat chest radiograph after resolution of the block revealed return of hemidiaphragm position and no other pathology. The patient was extubated in the recovery room without difficulty. Following extubation the patient demonstrated stable respirations and normal oxyhemoglobin saturation. CONCLUSIONS: Ipsilateral phrenic nerve paralysis caused significant respiratory compromise in an elderly patient without known significant pulmonary disease.     

Domestic violence and emotional distress among Nicaraguan women: Results from a population-based study.

This study aimed to measure the prevalence of emotional distress among women in León, Nicaragua, and to identify risk factors for emotional distress, with special reference to wife abuse. A survey was performed among a representative sample of women aged 15–49. Among ever-married women, 20% were classified as experiencing emotional distress at the time of the interview, and 52% reported physical partner abuse at some point in their lives. Women reporting abuse were 6 times more likely to experience emotional distress. An estimated 70% of all cases of emotional distress found among ever-married women were attributable to wife abuse. The study underscores the need to improve screening and care for battered women within mental health services in Nicaragua. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting grade-point average with a forced-choice study activity questionnaire.

"In an attempt to introduce the lesser transparency of forced-choice technique into the study test area, preference and discrimination indices were first computed from the responses of 99 over- and underachievers to 300 attitude, skill, and unclassified items. 30 Richardson-type forced-choice blocks were next submitted to 300 students… . Skill and attitude statements appeared to contribute about equally to the validity. The total test scores did not correlate significantly with sex or class (year) membership. Discussion of the results has centered about possible reasons for the lesser validity of the forced-choice technique in this test as compared with other areas." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Results of a questionnaire about smoking distributed at the 36th annual meeting of the Japan Society of Chest Diseases

To gather data about smoking habits among members of the Japan Society of Chest Diseases, a questionnaire was distributed during the 36th annual meeting. A total of 2411 out of 3725 questionnaires were returned (65%). The percentage of smokers was 23%. Smoking was prohibited in the hospitals of 281 respondents (8%). Seventy-nine percent reported that patients smoking areas were separated from patients' non-smoking areas, but only 41% reported that physicians' smoking areas were separated from physicians' non-smoking areas. Tobacco was being solid in over 50% of the hospitals represented, either via vending machines or through hospital retail stores. However, 79% of the respondents indicated that hospitals should be smoke-free. Questions of ethics in medicine are highlighted by this questionnaire. The obvious issues involved are whether or nor both patients and physicians should be required to stop smoking in health-care facilities. The larger issue is the degree and method by which the Japan Society of Chest Diseases should involve itself actively in smoking reform for the sake of society in general.