Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi, and European origin populations: cross sectional study

OBJECTIVE

To compare coronary risk factors and disease prevalence among Indians, Pakistanis, and Bangladeshis, and in all South Asians (these three groups together) with Europeans.

DESIGN

Cross sectional survey.

SETTING

Newcastle upon Tyne.

PARTICIPANTS

259 Indian, 305 Pakistani, 120 Bangladeshi, and 825 European men and women aged 25-74 years.

MAIN OUTCOME MEASURES

Social and economic circumstances, lifestyle, self reported symptoms and diseases, blood pressure, electrocardiogram, and anthropometric, haematological, and biochemical measurements.

RESULTS

There were differences in social and economic circumstances, lifestyles, anthropometric measures and disease both between Indians, Pakistanis, and Bangladeshis and between all South Asians and Europeans. Bangladeshis and Pakistanis were the poorest groups. For most risk factors, the Bangladeshis (particularly men) fared the worst: smoking was most common (57%) in that group, and Bangladeshis had the highest concentrations of triglycerides (2.04 mmol/l) and fasting blood glucose (6.6 mmol/l) and the lowest concentration of high density lipoprotein cholesterol (0.97 mmol/l). Blood pressure, however, was lowest in Bangladeshis. Bangladeshis were the shortest (men 164 cm tall v 170 cm for Indians and 174 cm for Europeans). A higher proportion of Pakistani and Bangladeshi men had diabetes (22.4% and 26.6% respectively) than Indians (15.2%). Comparisons of all South Asians with Europeans hid some important differences, but South Asians were still disadvantaged in a wide range of risk factors. Findings in women were similar.

CONCLUSION

Risk of coronary heart disease is not uniform among South Asians, and there are important differences between Indians, Pakistanis, and Bangladeshis for many coronary risk factors. The belief that, except for insulin resistance, South Asians have lower levels of coronary risk factors than Europeans is incorrect, and may have arisen from combining ethnic subgroups and examining a narrow range of factors.

Synthesis and evaluation of potential complement inhibitory semisynthetic analogs of oleanolic acid

A number of semisynthetic analogs of oleanolic acid have been synthesized and tested for their complement inhibitory, cytotoxic and apoptotic activities. Among these, compounds 10 and 17 exhibited complement inhibitory potency superior to oleanolic acid. Both have also shown a moderate improvement in in vitro therapeutic index (T.I.).

Identification of an SCF ubiquitin-ligase complex required for auxin response in Arabidopsis thaliana

The plant hormone auxin regulates diverse aspects of plant growth and development. We report that in Arabidopsis, auxin response is dependent on a ubiquitin-ligase (E3) complex called SCFTIR1. The complex consists of proteins related to yeast Skp1p and Cdc53p called ASK and AtCUL1, respectively, as well as the F-box protein TIR1. Mutations in either ASK1 or TIR1 result in decreased auxin response. Further, overexpression of TIR1 promotes auxin response suggesting that SCFTIR1 is limiting for the response. These results provide new support for a model in which auxin action depends on the regulated proteolysis of repressor proteins.

The Notch/Jagged pathway inhibits proliferation of human hematopoietic progenitors in vitro

The cell surface receptor Notch1 is expressed on CD34+ hematopoietic precursors, whereas one of its ligands, Jagged1, is expressed on bone marrow stromal cells. To examine the role of Notch signaling in early hematopoiesis, human CD34+ cells were cultured in the presence or absence of exogenous cytokines on feeder layers that either did or did not express Jagged1. In the absence of recombinant growth factors, Jagged1 decreased myeloid colony formation by CD34+ cells, as well as 3H-thymidine incorporation and entry into S phase. In the presence of a strong cytokine signal to proliferate and mature, (interleukin 3 [IL-3] and IL-6, stem cell factor [SCF], and G-CSF), Jagged1 did not significantly alter either the fold expansion or the types of colonies formed by CD34+ cells. However, in the presence of SCF alone, Jagged1 increased erythroid colony formation twofold. These results demonstrate that Notch can modulate a growth factor signal, and that in the absence of growth factor stimulation, the Jagged1-Notch pathway preserves CD34+ cells in an immature state.

Medicaid eligibility workers discuss Medicaid estate planning for nursing home care

This study was part of a multiphase project examining the perceptions of elder law attorneys, certified financial planners, and Medicaid eligibility workers regarding Medicaid estate planning (MEP) for nursing home care. Focus group methodology (5 groups, N = 32 participants) was used to explore the perspectives and experiences of Medicaid eligibility workers, who are responsible for interpreting, administering, and enforcing federal and state regulations. Findings describe factors influencing MEP, enforcement of regulations, and potential policy responses to MEP. Participants identified numerous impediments to effective implementation of current regulations. Recommendations for improved policy include redefinition of spousal assessment policies, other valuable consideration determinations, and penalty period formulas.

Developing individualized care in nursing homes: integrating the views of nurses and certified nurse aides

Despite recent attention devoted to the development of individualized care in nursing homes, empirical research assessing changes in practice is quite limited, and very few studies have explored specifically the experiences and perceptions of certified nurse aides (CNAs). This study reports findings from a comparative analysis conducted on a data set including quantitative and qualitative data from CNAs (N = 289) and nurses in Connecticut (N = 245). Measures of obstacles to individualized care and needs for future supports were explored. A number of significant differences in perceptions of obstacles to providing individualized care were found. The nurses were significantly more likely to identify the following impediments to change: cost (p < .0001), concepts not integrated into work (p < .0001), lack of administrative support (p < .10), and staff attitudes (p < .10). The CNAs were significantly more likely to report inadequate staffing (p < .001), lack of interdisciplinary teams (p < .001), and resident and family attitudes (p < .01) as problematic. These findings suggest substantial discordance among nurses and CNAs on a number of important issues surrounding individualized care. Such disparate perceptions pose challenges to nursing homes committed to the implementation of individualized care alternatives. Successful approaches must consider the various vantage points of caregivers and administrators.

Validity of three measures of severity of AIDS for use in health services research studies

Policy makers and hospital managers often use severity adjustments as a control for patient mix differences when evaluating outcomes of care. Unfortunately, few indices are carefully examined and therefore the evaluations based on these methods of severity adjustment are suspect. This paper examines the accuracy of three indices for measuring the severity of illness of AIDS patients. We examine the Diagnosis-Based Severity Index (DBSI), a modified version of DBSI referred to as MDBSI and the Composite Laboratory Index (CLI) in predicting survival of AIDS patients at one medical centre. We analysed the correlation between indices and months of survival. We also examined the percentage of variance in survival months explained by each index separately and together. Finally, we used survival analysis to examine whether DBSI classifies patients in groups with distinct patterns of survival. Only patients who had died were included in the analysis so that information on the patients' full course of illness was available. Of the 91 patients abstracted, 81 cases had date of AIDS, date of death, and the CLI. These 81 cases were the focus of the analysis. Both CLI and DBSI were predictive of months of survival but were not correlated to each other. Predictions of months of survival were improved if both indices were used together rather than separately. Survival analysis confirmed that patients classified by DBSI had distinctly different survival patterns. Each index measures different aspects of the severity of the patient's condition and when possible both indices should be used together. When laboratory data are not available, e.g. in Medicaid administrative files, the use of DBSI may be reasonable.

'We want an allocation to theatre!' Diploma level nursing students have their say

The aim of this study was to ascertain the perceptions of diploma level nursing students towards theatre nursing and whether these perceptions had any influenced on their choosing a career in operating department nursing. The study was qualitative in its approach, using a questionnaire as the main research tool, to focus on thirty-three second year diploma level nursing students. The main findings were that 94% of the students felt that a set allocation to the operating theatre would be invaluable, as it would enhance the nursing care they gave to their patients on the ward. The study also found that the students did not have a real understanding of the theatre nurse's role, with only one third of the students seeing the theatre nurse carrying out patient care. This perceived lack of patient care had a major effect on them not wishing to choose theatre nursing as a career, once qualified. The results of this study suggest that the profile of theatre nursing must be raised to attract greater numbers of students to the speciality.

Real-time quantitative measurement of autocrine ligand binding indicates that autocrine loops are spatially localized

Autocrine ligands are important regulators of many normal tissues and have been implicated in a number of disease states, including cancer. However, because by definition autocrine ligands are synthesized, secreted, and bound to cell receptors within an intrinsically self-contained "loop," standard pharmacological approaches cannot be used to investigate relationships between ligand/receptor binding and consequent cellular responses. We demonstrate here a new approach for measurement of autocrine ligand binding to cells, using a microphysiometer assay originally developed for investigating cell responses to exogenous ligands. This technique permits quantitative measurements of autocrine responses on the time scale of receptor binding and internalization, thus allowing investigation of the role of receptor trafficking and dynamics in cellular responses. We used this technique to investigate autocrine signaling through the epidermal growth factor receptor by transforming growth factor alpha (TGFalpha) and found that anti-receptor antibodies are far more effective than anti-ligand antibodies in inhibiting autocrine signaling. This result indicates that autocrine-based signals can operate in a spatially restricted, local manner and thus provide cells with information on their local microenvironment.

A randomised controlled trial of postal versus interviewer administration of a questionnaire measuring satisfaction with, and use of, services received in the year before death

STUDY OBJECTIVES

To develop a short form of an interview schedule used successfully in previous national surveys of care for the dying, and to investigate the effect of administering it by post on response rate, response bias and on the nature of responses to questions.

DESIGN

Randomised controlled trial.

SETTING

An inner London health authority.

PARTICIPANTS

Informants (person registering death) of random sample of cancer deaths between June 1995 and July 1996.

MAIN RESULTS

The shortened questionnaire (VOICES) has 158 questions. Response rate did not differ significantly between postal and interview groups (interview; 56% (69 of 123), postal: 52% (161 of 308). Responders in the two groups did not differ in terms of their sociodemographic characteristics. Postal questionnaires had significantly more missing data, particularly on questions about service provision and satisfaction with services. Responses to questions differed between the groups on 11 of 158 questions. Interview group respondents were more likely to give top ranking responses to questions on service satisfaction and symptom control.

CONCLUSIONS

Postal questionnaires are an acceptable alternative to interviews in retrospective post-bereavement surveys of care for the dying, at least in terms of response rate and response bias. However, the increased costs of interview surveys need to be balanced against the fact that postal questionnaires result in more missing data, and possibly less reliable answers to some questions. Caution is needed in combining results from the two data collection methods as interview respondents gave more positive answers to some questions.

Why nursing students need an allocation to operating theatres

Student placements in operating theatres are being discontinued in some hospitals. Here, the author explores the reasons for this and highlights what nursing students can achieve during a placement in theatre.

Molecular mechanisms of auxin action

The plant growth hormone auxin has an important role in a variety of plant growth and developmental processes. Identification of transcription factors, some with defined genetic function, has shed new light on the mechanisms of auxin regulated gene expression. In addition, the molecular characterization of genes required for auxin response indicates that regulated protein degradation by the ubiquitin-proteosome pathway has an important function in auxin action.

Medicaid estate planning: practices and perceptions of Medicaid workers, elder law attorneys, and certified financial planners

This study examined Medicaid estate planning (MEP) through the experiences and perceptions of three groups in Connecticut: Medicaid eligibility workers (n = 128), elder law attorneys (n = 41), and certified financial planners (n = 29). Respondent groups varied significantly with regard to their perceptions of prevalence and magnitude of MEP, the nature of transferred assets, mechanisms for transfers, and characteristics of the "typical" client participating in asset divestiture for the purpose of qualifying for Medicaid. This substantial lack of concordance among those professionals most closely involved with MEP poses challenges for policy and research in this area.

[Contribution of chromosomal abnormalities to in vitro fertilization failures]

BACKGROUND

Present knowledge of mechanisms involved in human fertilization has uncovered a new group of pathologic conditions that have been generically named fertilization abnormalities.

AIM

To determine the contribution of chromosomal alterations to in vitro fertilization failures.

MATERIALS AND METHODS

A cytogenetic analysis of oocytes that were not fertilized after insemination with normal spermatozoa. Oocytes were obtained from patients subjected to in vitro fertilization in a public hospital of Metropolitan Santiago. Ovulation was induced in these patients administering GnRh-a, FSH, HMG and HCG. The double fixation technique described by Wramsby was used to obtain chromosomes.

RESULTS

One hundred and seven oocytes coming from 45 women aged 25 to 42 years old were studied. The frequency of aneuploidy in these oocytes was 37.3%, with a 11.8% of hypohaploidy, a 21.6% of hyperhaploidy and a 3.9% of diploid oocytes. In hyperhaploid as well as in hypohaploid oocytes, the chromosomes involved in aneuploidy pertained to groups D. and G.

CONCLUSIONS

Although the total frequency of aneuploidy is within normal ranges, the frequency of hyperhaploidy is superior to previous reports. An explanation for this finding could be that the occurrence of a lack of disjunction with chromosomal retention in the parental cell occurs with a higher frequency than that in which the chromosomes are retained in the polocyte. We also suggest that oocyte chromosomal aneuploidy could contribute to the failure of in vitro fertilization procedures.

Periotest values of dental implants in the first 2 years after second-stage surgery: DICRG interim report no. 8. Dental Implant Clinical Research Group

In 1991, the Dental Implant Clinical Research Group initiated a long-term clinical study in cooperation with the Department of Veterans Affairs to investigate the influence of implant design, application, and site of placement on clinical performance and crestal bone height. As part of this investigation, Periotest values for 2,212 root from implants were determined at second-stage surgery and during a 24-month follow-up period. Mean Periotest values decreased for implants placed in quality 1 and 2 bone, did not change for implants in quality 3 bone, and increased for implants in quality 4 bone. Implants in the posterior maxilla and single implants in the anterior maxilla had increasing mean Periotest values as compared with decreasing values for implants in other regions. Mean Periotest values for uncoated implants decreased gradually to approach those of hydroxyapatite-coated implants.

Microbial contamination of three-way taps on arterial lines

Arterial lines with three-way taps are used to measure blood pressure and aspirate blood, and are a potential source of catheter-related sepsis. Swabs were taken daily from 118 three-way taps on 98 arterial lines in a general intensive care unit. Infusion lines were changed weekly but arterial cannulae were not changed routinely. An overall contamination rate of 24.6% was found with the predominant organism being coagulase negative staphylococcus. The three-way taps became increasingly contaminated with time but this was shown to be unrelated to the manipulation rates. Blood culture organisms in those showing contamination of the three-way taps showed no relationship to the bacteria causing the contamination.

Perceptions of the psychiatric nurse's role: a pilot study

In this article, the authors report on a face-to-face survey of members of the public regarding the role of psychiatric nurses. One open-ended question was asked of 100 pedestrians in a city centre. The resulting data were analysed and then validated by a panel of senior psychiatric nurses. The researchers found a generally positive perception of the role, certainly in relation to the esteem in which nurses continue to be held, but detected that the stigma of mental illness still surrounds those who have to come in contact with mental health professionals. The researchers believe mental health nurses must be better prepared to articulate their contribution to mental health care to counteract public fear, and that the media can play an important role in this process.

Resisting constraints, creating opportunities. The experiences of some early medical women

This paper aims to document the experiences of some women doctors who graduated between 1924 and 1940. It highlights some of the difficulties they encountered in establishing themselves as respected medical practitioners and briefly describes the social context in which they worked. The data for this paper were gathered through the use of one qualitative research method, viz. intensive interviewing. This paper draws on seven in-depth interviews. It focuses on two aspects of these women's professional lives: their medical training and their career paths. It seeks to demonstrate that while some were subject to discriminatory practices by a male-dominated medical profession, they were also involved in pioneering work and made their mark as respected practitioners.

'Since male doctors were pushing us aside, we had to elbow our way through'. A history of the South African Society of Medical Women

This paper aims to document the history of the South African Society of Medical Women (SASMW). It examines the aims and objectives of the society and the work it undertook, and briefly assesses its impact and the reasons for its decline. The material presented in this paper is based on data gathered through the use of two qualitative research methods, viz. intensive interviewing and archival/documentary analysis. This paper demonstrates that the SASMW was established in response to gender discrimination within and outside the medical profession. It argues that these women played an important role in challenging discriminatory practices and legislation, and suggests that the society's impact was most significant in the first two decades of its existence. Furthermore, it argues that it was unable to sustain its membership and activities during the late 1970s and 1980s as it did not respond adequately to the changing social and political climate and the altered racial and gender composition of the medical profession.

Radiographic appearance of the middle ear after ventral bulla osteotomy in five dogs with otitis media

Radiographs of the middle ear were made in five dogs 60 to 78 months after ventral bulla osteotomy was performed to treat otitis media. The clinical results of surgery were considered satisfactory in four dogs and unsatisfactory in one. In 4 dogs with satisfactory results, radiographs demonstrated complete reformation of the bulla in 3 operated middle ears (3 dogs), with partial bulla reformation in the three middle ears (3 dogs). Radiographs in one dog with unsatisfactory results showed complete bulla reformation with no increase in lumen opacity. The proliferative bony response obliterating the middle ear previously reported in normal dogs after ventral bulla osteotomy was not seen in any of these patients.