Showing papers by "McMaster University published in 2004"
TL;DR: Significant differences in the relation of psychosocial factors to risk of myocardial infarction in 24767 people from 52 countries were found, suggesting that approaches aimed at modifying these factors should be developed.
2,110 citations
TL;DR: The EPHPP has demonstrated the ability to adapt the most current methods of systematic literature reviews of effectiveness to questions related to public health nursing and has been successful in attracting external funds.
Abstract: Background: Several groups have outlined methodologies for systematic literature reviews of the effectiveness of interventions. The Effective Public Health Practice Project (EPHPP) began in 1998. Its mandate is to provide research evidence to guide and support the Ontario Ministry of Health in outlining minimum requirements for public health services in the province. Also, the project is expected to disseminate the results provincially, nationally, and internationally. Most of the reviews are relevant to public health nursing practice. Aims: This article describes four issues related to the systematic literature reviews of the effectiveness of public health nursing interventions: (1) the process of systematically reviewing the literature, (2) the development of a quality assessment instrument, (3) the results of the EPHPP to date, and (4) some results of the dissemination strategies used. Methods: The eight steps of the systematic review process including question formulation, searching and retrieving the literature, establishing relevance criteria, assessing studies for relevance, assessing relevant studies for methodological quality, data extraction and synthesis, writing the report, and dissemination are outlined. Also, the development and assessment of content and construct validity and intrarater reliability of the quality assessment questionnaire used in the process are described. Results: More than 20 systematic reviews have been completed. Content validity was ascertained by the use of a number of experts to review the questionnaire during its development. Construct validity was demonstrated through comparisons with another highly rated instrument. Intrarater reliability was established using Cohen’s Kappa. Dissemination strategies used appear to be effective in that professionals report being aware of the reviews and using them in program planning/policymaking decisions. Conclusions: The EPHPP has demonstrated the ability to adapt the most current methods of systematic literature reviews of effectiveness to questions related to public health nursing. Other positive outcomes from the process include the development of a critical mass of public health researchers and practitioners who can actively participate in the process, and the work on dissemination has been successful in attracting external funds. A program of research in this area is being developed.
1,540 citations
TL;DR: Only mast cells in close proximity to nerves were significantly correlated with severity and frequency of abdominal pain/discomfort, and mediator release in proximity to mucosal innervation may contribute to abdominal pain perception in IBS patients.
1,310 citations
TL;DR: The precautions and criteria necessary to ascertain to the greatest extent possible that results represent authentic ancient DNA sequences are discussed, which highlight some significant results and areas of promising future research.
Abstract: ▪ Abstract About 20 years ago, DNA sequences were separately described from the quagga (a type of zebra) and an ancient Egyptian individual. What made these DNA sequences exceptional was that they were derived from 140- and 2400-year-old specimens. However, ancient DNA research, defined broadly as the retrieval of DNA sequences from museum specimens, archaeological finds, fossil remains, and other unusual sources of DNA, only really became feasible with the advent of techniques for the enzymatic amplification of specific DNA sequences. Today, reports of analyses of specimens hundreds, thousands, and even millions of years old are almost commonplace. But can all these results be believed? In this paper, we critically assess the state of ancient DNA research. In particular, we discuss the precautions and criteria necessary to ascertain to the greatest extent possible that results represent authentic ancient DNA sequences. We also highlight some significant results and areas of promising future research.
1,146 citations
TL;DR: The authors propose that learning is related to the information arising from performance, which should be optimized along functions relating the difficulty of the task to the skill level of the performer.
Abstract: The authors describe the effects of practice conditions in motor learning (e.g., contextual interference, knowledge of results) within the constraints of 2 experimental variables: skill level and task difficulty. They use a research framework to conceptualize the interaction of those variables on the basis of concepts from information theory and information processing. The fundamental idea is that motor tasks represent different challenges for performers of different abilities. The authors propose that learning is related to the information arising from performance, which should be optimized along functions relating the difficulty of the task to the skill level of the performer. Specific testable hypotheses arising from the framework are also described.
1,098 citations
TL;DR: A meta-analysis of studies that used magnetic resonance imaging to assess the volume of the hippocampus and related structures in patients with major depressive disorder found inclusion of the amygdala with the hippocampus appears to have decreased the likelihood of detecting volumetric differences in either structure.
Abstract: OBJECTIVE: A number of studies have used magnetic resonance imaging to examine volumetric differences in temporal structures in subjects suffering from major depressive disorder. Studies have reported lower hippocampal and amygdala volume, but results have been inconsistent. The authors were interested, therefore, in examining these studies in the aggregate in order to determine whether hippocampal volume is lower in major depressive disorder. They also examined factors that may contribute to the disparate results in the literature. METHOD: A meta-analysis was conducted of studies that used magnetic resonance imaging to assess the volume of the hippocampus and related structures in patients with major depressive disorder. RESULTS: Patients were seen to have lower hippocampal volume relative to comparison subjects, detectable if the hippocampus was measured as a discrete structure. CONCLUSIONS: Although the effect of major depressive disorder on amygdala volume remains to be conclusively established, inclu...
1,059 citations
TL;DR: For the first time, a mathematical motivation is presented and SM is placed into the context of classical optimization to achieve a satisfactory solution with a minimal number of computationally expensive "fine" model evaluations.
Abstract: We review the space-mapping (SM) technique and the SM-based surrogate (modeling) concept and their applications in engineering design optimization. For the first time, we present a mathematical motivation and place SM into the context of classical optimization. The aim of SM is to achieve a satisfactory solution with a minimal number of computationally expensive "fine" model evaluations. SM procedures iteratively update and optimize surrogates based on a fast physically based "coarse" model. Proposed approaches to SM-based optimization include the original algorithm, the Broyden-based aggressive SM algorithm, various trust-region approaches, neural SM, and implicit SM. Parameter extraction is an essential SM subproblem. It is used to align the surrogate (enhanced coarse model) with the fine model. Different approaches to enhance uniqueness are suggested, including the recent gradient parameter-extraction approach. Novel physical illustrations are presented, including the cheese-cutting and wedge-cutting problems. Significant practical applications are reviewed.
1,044 citations
TL;DR: The objective was to critically appraise six prominent systems for grading levels of evidence and the strength of recommendations as a basis for agreeing on characteristics of a common, sensible approach.
Abstract: A number of approaches have been used to grade levels of evidence and the strength of recommendations. The use of many different approaches detracts from one of the main reasons for having explicit approaches: to concisely characterise and communicate this information so that it can easily be understood and thereby help people make well-informed decisions. Our objective was to critically appraise six prominent systems for grading levels of evidence and the strength of recommendations as a basis for agreeing on characteristics of a common, sensible approach to grading levels of evidence and the strength of recommendations. Six prominent systems for grading levels of evidence and strength of recommendations were selected and someone familiar with each system prepared a description of each of these. Twelve assessors independently evaluated each system based on twelve criteria to assess the sensibility of the different approaches. Systems used by 51 organisations were compared with these six approaches. There was poor agreement about the sensibility of the six systems. Only one of the systems was suitable for all four types of questions we considered (effectiveness, harm, diagnosis and prognosis). None of the systems was considered usable for all of the target groups we considered (professionals, patients and policy makers). The raters found low reproducibility of judgements made using all six systems. Systems used by 51 organisations that sponsor clinical practice guidelines included a number of minor variations of the six systems that we critically appraised. All of the currently used approaches to grading levels of evidence and the strength of recommendations have important shortcomings.
975 citations
01 Jan 2004
TL;DR: The purpose of this paper is to introduce and describe the basic use of the R Commander GUI and the manner in which it can be extended.
Abstract: Unlike S-PLUS, R does not incorporate a statistical graphical user interface (GUI), but it does include tools for building GUIs. Based on the tcltk package (which furnishes an interface to the Tcl/Tk GUI builder) the Rcmdr package provides a basic-statistics graphical user interface to R called the "R Commander." The design objectives of the R Commander were as follows: to support, through an easy-to-use, extensible, cross-platform GUI, the statistical functionality required for a basic-statistics course (though its current functionality has grown to include support for linear and generalized-linear models); to make it relatively difficult to do unreasonable things; and to render visible the relationship between choices made in the GUI and the R commands that they generate. The R Commander uses a simple and familiar menu/dialog-box interface. Top-level menus include File, Edit, Data, Statistics, Graphs, Models, Distributions ,a ndHelp ,w ith the complete menu tree given in the paper. Each dialog box includes a Help button, which leads to a relevant help page. Menu and dialog-box selections generate R commands, which are recorded in a log/script window and are echoed, along with output, to an output window. The log/script window also provides the ability to edit, enter, and re-execute commands. Data sets in the R Commander are simply R data frames, and can be read from attached packages or imported from files. Although several data frames may reside in memory, only one is "active" at any given time. The purpose of this paper is to introduce and describe the basic use of the R Commander GUI and the manner in which it can be extended. Most of the paper can serve as an introductory guide for students who will use the R Commander
882 citations
TL;DR: A 'gallery' of CEACs is presented in order to identify the fallacies and illustrate the facts surrounding the CEAC to serve as a reference tool to accompany the increased use ofCEACs within major medical journals.
Abstract: Cost-effectiveness acceptability curves (CEACs) have been widely adopted as a method to quantify and graphically represent uncertainty in economic evaluation studies of health-care technologies. However, there remain some common fallacies regarding the nature and shape of CEACs that largely result from the ‘textbook’ illustration of the CEAC. This ‘textbook’ CEAC shows a smooth curve starting at probability 0, with an asymptote to 1 for higher money values of the health outcome (λ). But this familiar ‘ogive’ shape which makes the ‘textbook’ CEAC look like a cumulative distribution function is just one special case of the CEAC. The reality is that the CEAC can take many shapes and turns because it is a graphic transformation from the cost-effectiveness plane, where the joint density of incremental costs and effects may ‘straddle’ quadrants with attendant discontinuities and asymptotes. In fact CEACs: (i) do not have to cut the y-axis at 0; (ii) do not have to asymptote to 1; (iii) are not always monotonically increasing in λ; and (iv) do not represent cumulative distribution functions (cdfs). Within this paper we present a ‘gallery’ of CEACs in order to identify the fallacies and illustrate the facts surrounding the CEAC. The aim of the paper is to serve as a reference tool to accompany the increased use of CEACs within major medical journals. Copyright © 2004 John Wiley & Sons, Ltd.
831 citations
TL;DR: This review focuses on the remodeling of brain circuitry associated with epilepsy, particularly in excitatory glutamate and inhibitory GABA systems, including alterations in synaptic efficacy, growth of new connections, and loss of existing connections.
Journal Article•
TL;DR: Data from imaging studies suggest both structural changes in the volume of the HC and functional alterations in frontotemporal and limbic circuits that may be critical for mood regulation in patients with MDD.
Abstract: Converging lines of research suggest that the hippocampal complex (HC) may have a role in the pathophysiology of major depressive disorder (MDD). Although postmortem studies show little cellular death in the HC of depressed patients, animal studies suggest that elevated glucocorticoid levels associated with MDD may negatively affect neurogenesis, cause excitotoxic damage or be associated with reduced levels of key neurotrophins in the HC. Antidepressant medications may counter these effects, having been shown to increase HC neurogenesis and levels of brain-derived neurotrophic factor in animal studies. Neuropsychological studies have identified deficits in hippocampus-dependent recollection memory that may not abate with euthymia, and such memory impairment has been the most reliably documented cognitive abnormality in patients with MDD. Finally, data from imaging studies suggest both structural changes in the volume of the HC and functional alterations in frontotemporal and limbic circuits that may be critical for mood regulation. The extent to which such functional and structural changes determine clinical outcome in MDD remains unknown; a related, but also currently unanswered, question is whether the changes in HC function and structure observed in MDD are preventable or modifiable with effective treatment for the depressive illness.
TL;DR: The Gasoline as discussed by the authors is an extension of the Pkdgrav parallel N-body code using smoothed particle hydrodynamics, which is used to simulate galaxy clusters, galaxy formation and gas-giant planets.
TL;DR: The findings suggest the value of models that include a wide range of health and health-determinant variables, and affirm the importance of looking more closely at gender differences in health, are affirm.
TL;DR: This Consensus Conference was funded by Canadian Blood Services and Hema-Quebec, with additional support from the International Society of Blood Transfusion’s Biomedical Excellence for Safer Transfusions (BEST) subcommittee.
TL;DR: Particular PtRu catalysts prepared in this work display enhanced activities for the CH(3)OH electro-oxidation reaction when compared to two commercial catalysts, and are of the same composition independent of the catalyst size.
Abstract: A rapid synthesis method for the preparation of PtRu colloids and their subsequent deposition on high surface area carbons is presented. The reaction mechanism is shown to involve the oxidation of the solvent, ethylene glycol, to mainly glycolic acid or, depending on the pH, its anion, glycolate, while the Pt(+IV) and Ru(+III) precursor salts are reduced. Glycolate acts as a stabilizer for the PtRu colloids and the glycolate concentration, and hence the size of the resulting noble metal colloids is controlled via the pH of the synthesis solution. Carbon-supported PtRu catalysts of controlled size can be prepared within the range of 0.7-4 nm. Slow scan X-ray diffraction and high-resolution transmission electron microscopy show the PtRu catalysts to be crystalline. The Ru is partly dissolved in the face-centered cubic Pt lattice, but the catalysts also consist of a separate, hexagonal Ru phase. The PtRu catalysts appear to be of the same composition independent of the catalyst size in the range of 1.2-4 nm. Particular PtRu catalysts prepared in this work display enhanced activities for the CH(3)OH electro-oxidation reaction when compared to two commercial catalysts.
TL;DR: The biotic ligand model is critically evaluated for copper, silver, zinc, and nickel and gill binding approaches for cadmium, lead, and cobalt on which BLMs could be based and issues of concern include the arbitrary nature of LA50 adjustments.
Abstract: The biotic ligand model (BLM) is a mechanistic approach that greatly improves our ability to generate site-specific ambient water quality criteria (AWQC)for metals in the natural environment relative to conventional relationships based only on hardness. The model is flexible; all aspects of water chemistry that affect toxicity can be included, so the BLM integrates the concept of bioavailability into AWQC--in essence the computational equivalent of water effect ratio (WER) testing. The theory of the BLM evolved from the gill surface interaction model (GSIM) and the free ion activity model (FIAM). Using an equilibrium geochemical modeling framework, the BLM incorporates the competition of the free metal ion with other naturally occurring cations (e.g., Ca2+, Na+, Mg2-, H+), togetherwith complexation by abiotic ligands [e.g., DOM (dissolved organic matter), chloride, carbonates, sulfide] for binding with the biotic ligand, the site of toxic action on the organism. On the basis of fish gill research, the biotic ligands appear to be active ion uptake pathways (e.g., Na+ transporters for copper and silver, Ca2+ transporters for zinc, cadmium, lead, and cobalt), whose geochemical characteristics (affinity = log K, capacity = Bmax) can be quantified in short-term (3-24 h) in vivo gill binding tests. In general, the greater the toxicity of a particular metal, the higher the log K. The BLM quantitatively relates short-term binding to acute toxicity, with the LA50 (lethal accumulation) being predictive of the LC50 (generally 96 h for fish, 48 h for daphnids). We critically evaluate currently available BLMs for copper, silver, zinc, and nickel and gill binding approaches for cadmium, lead, and cobalt on which BLMs could be based. Most BLMs originate from tests with fish and have been recalibrated for more sensitive daphnids by adjustment of LA50 so as to fit the results of toxicity testing. Issues of concern include the arbitrary nature of LA50 adjustments; possible mechanistic differences between daphnids and fish that may alter log K values, particularly for hardness cations (Ca2+, Mg2+); assumption of fixed biotic ligand characteristics in the face of evidence that they may change in response to acclimation and diet; difficulties in dealing with DOM and incorporating its heterogeneity into the modeling framework; and the paucity of validation exercises on natural water data sets. Important needs include characterization of biotic ligand properties at the molecular level; development of in vitro BLMs, extension of the BLM approach to a wider range of organisms, to the estuarine and marine environment, and to deal with metal mixtures; and further development of BLM frameworks to predict chronic toxicity and thereby generate chronic AWQC.
TL;DR: In this paper, the authors found that dexrazoxane decreases doxorubicin-associated injury of cardiomyocytes in children with acute lymphoblastic leukemia (ALL) but also injures myocardial cells.
Abstract: Background Doxorubicin chemotherapy is very effective in children with acute lymphoblastic leukemia (ALL) but also injures myocardial cells. Dexrazoxane, a free-radical scavenger, may protect the heart from doxorubicin-associated damage. Methods To determine whether dexrazoxane decreases doxorubicin-associated injury of cardiomyocytes, we randomly assigned 101 children with ALL to receive doxorubicin alone (30 mg per square meter of body-surface area every three weeks for 10 doses) and 105 to receive dexrazoxane (300 mg per square meter) followed immediately by doxorubicin. Serial measurements of serum cardiac troponin T were obtained in 76 of 101 patients in the doxorubicin group and 82 of 105 patients in the group given dexrazoxane and doxorubicin. A total of 2377 serum samples (mean, 15.1 samples per patient) were obtained before, during, and after treatment with doxorubicin. Troponin T levels were evaluated in a blinded fashion to determine whether they were elevated (>0.01 ng per milliliter) — the pr...
University of Calgary1, University of Milan2, Semmelweis University3, University of Mainz4, Queen Mary University of London5, University of California, San Diego6, Goethe University Frankfurt7, Pennsylvania State University8, University of Toronto9, Laval University10, University of Alberta11, University of British Columbia12, St. John's University13, McMaster University14, Dalhousie University15, Ottawa Hospital16, Université de Montréal17, Halifax18, Queen's University19, University of Manitoba20, University of Auckland21, University of Cincinnati22, Odense University Hospital23, Duke University24, University of Tromsø25, Tel Aviv University26, University of Bern27, Peking Union Medical College Hospital28
TL;DR: Consensus approach is only an interim guide to a complex disorder such as HAE and should be replaced as soon as possible with large phase III and IV clinical trials, meta analyses, and using data base registry validation of approaches.
Abstract: C1 inhibitor deficiency (hereditary angioedema [HAE]) is a rare disorder for which there is a lack of consensus concerning diagnosis, therapy, and management, particularly in Canada. European initiatives have driven the approach to managing HAE with 3 C1-INH Deficiency Workshops held every 2 years in Hungary starting in 1999, with the third Workshop having recently been held in May 2003. The European Contact Board has established a European HAE Registry that will hopefully advance our knowledge of this disorder. The Canadian Hereditary Angioedema Society/Societe d'Angioedeme Hereditaire du Canada organized a Canadian International Consensus Conference held in Toronto, Ontario, Canada, on October 24 to 26, 2003, to foster consensus between major European and North American HAE treatment centers. Papers were presented by investigators from Europe and North America, and this consensus algorithm approach was discussed. There is a paucity of double-blind placebo-controlled trials in the treatment of HAE, making levels of evidence to support the algorithm less than optimal. Enclosed is the consensus algorithm approach recommended for the diagnosis, therapy, and management of HAE and agreed to by the authors of this article. This document is only a consensus algorithm approach and requires validation. As such, participants agreed to make this a living 2003 algorithm (ie, a work in progress) and agreed to review its content at future international HAE meetings. The consensus, however, has strength in that it was arrived at by the meeting of patient-care providers along with patient group representatives and individual patients reviewing information available to date and reaching agreement on how to approach the diagnosis, therapy, and management of HAE circa 2003. Hopefully evidence to support approaches to the management of HAE will approach the level of meta-analysis of randomized controlled trials in the near future.
TL;DR: This work has attempted to develop a multiple sample approach to the personal interview, Hypothesising that many of the problems with the personal interviews might be explained by it being yet another measurement tool that is plagued by context specificity.
Abstract: Context Although health sciences programmes continue to value non-cognitive variables such as interpersonal skills and professionalism, it is not clear that current admissions tools like the personal interview are capable of assessing ability in these domains. Hypothesising that many of the problems with the personal interview might be explained, at least in part, by it being yet another measurement tool that is plagued by context specificity, we have attempted to develop a multiple sample approach to the personal interview.
Methods A group of 117 applicants to the undergraduate MD programme at McMaster University participated in a multiple mini-interview (MMI), consisting of 10 short objective structured clinical examination (OSCE)-style stations, in which they were presented with scenarios that required them to discuss a health-related issue (e.g. the use of placebos) with an interviewer, interact with a standardised confederate while an examiner observed the interpersonal skills displayed, or answer traditional interview questions.
Results The reliability of the MMI was observed to be 0.65. Furthermore, the hypothesis that context specificity might reduce the validity of traditional interviews was supported by the finding that the variance component attributable to candidate–station interaction was greater than that attributable to candidate. Both applicants and examiners were positive about the experience and the potential for this protocol.
Discussion The principles used in developing this new admissions instrument, the flexibility inherent in the multiple mini-interview, and its feasibility and cost-effectiveness are discussed.
TL;DR: New empirical search strategies in Medline can optimise retrieval of articles reporting high quality clinical studies of diagnosis, and outperformed other validated search strategies except for one strategy that had slightly higher sensitivity but lower specificity.
Abstract: Objective To develop and test optimal Medline search strategies for retrieving sound clinical studies on prevention or treatment of health disorders.
Design Analytical survey.
Data sources 161 clinical journals indexed in Medline for the year 2000.
Main outcome measures Sensitivity, specificity, precision, and accuracy of 4862 unique terms in 18 404 combinations.
Results Only 1587 (24.2%) of 6568 articles on treatment met criteria for testing clinical interventions. Combinations of search terms reached peak sensitivities of 99.3% (95% confidence interval 98.7% to 99.8%) at a specificity of 70.4% (69.8% to 70.9%). Compared with best single terms, best multiple terms increased sensitivity for sound studies by 4.1% (absolute increase), but with substantial loss of specificity (absolute difference 23.7%) when sensitivity was maximised. When terms were combined to maximise specificity, 97.4% (97.3% to 97.6%) was achieved, about the same as that achieved by the best single term (97.6%, 97.4% to 97.7%). The strategies newly reported in this paper outperformed other validated search strategies except for two strategies that had slightly higher specificity (98.1% and 97.6% v 97.4%) but lower sensitivity (42.0% and 92.8% v 93.1%).
Conclusion New empirical search strategies have been validated to optimise retrieval from Medline of articles reporting high quality clinical studies on prevention or treatment of health disorders.
TL;DR: The results of the most recent American Productivity and Quality Center study on performance and best practices in new product development have been reported in this paper, with a focus on the people side of NPD.
Abstract: OVERVIEW:This first of three articles reports the results of the most recent American Productivity and Quality Center study on performance and best practices in new product development. Performance results achieved on a number of NPD metrics are reported first, followed by a set of Best Performing businesses, what these businesses have in common and—most important—what differentiates them from the rest. This first article focuses on the “people side” of NPD—on how project teams are organized and on other winning characteristics of teams. The climate and culture for innovation within the business proves to be one of the strongest drivers of NPD performance, and the specifics of what the Best Performers have done to achieve this positive climate are outlined. Finally the role of senior management in setting the stage for the business's NPD effort is examined.
TL;DR: In this article, the authors compared varying models of the perfectionism construct using the best known measures of perfectionism, and found that maladaptive evaluative concerns was more strongly associated with depression, anxiety, stress, and test taking anxiety.
TL;DR: In this article, the authors consider the dynamics of a categorical indicator of self-assessed health using eight waves (1991-1998) of the British Household Panel Survey (BHPS).
Abstract: This paper considers the dynamics of a categorical indicator of self-assessed health using eight waves (1991–1998) of the British Household Panel Survey (BHPS). Our analysis has three focal points: the relative contributions of state dependence and heterogeneity in explaining the dynamics of health, the existence and consequences of health-related sample attrition, and the investigation of the effects of measures of socioeconomic status, with a particular focus on educational attainment and income. To investigate these issues we use dynamic panel ordered probit models. There is clear evidence of health-related attrition in the data but this does not distort the estimates of state dependence and of the socioeconomic gradient in health. The models show strong positive state dependence and heterogeneity accounts for around 30% of the unexplained variation in health. Copyright © 2004 John Wiley & Sons, Ltd.
TL;DR: This chapter about the use of antithrombotic agents during pregnancy is part of the Seventh ACCP Conference on AntithromBotic and Thrombolytic Therapy: Evidence Based Guidelines.
TL;DR: An overview of several different approaches to image texture analysis is provided and insight into their space/frequency decomposition behavior is used to show why they are generally considered to be state of the art in texture analysis.
TL;DR: The biological dysregulation caused by gestational depression has not received appropriate attention: most studies focus on the potential but unproven risks of psychotropic medication and no in-depth discussion of the role of psychotherapy is available.
Abstract: Objective:To review the literature on the perinatal risks involved in untreated depression during pregnancy.Method:We searched Medline and medical texts for all studies pertaining to this area up to the end of April 2003. Key phrases entered were depression and pregnancy, depression and pregnancy outcome, and depression and untreated pregnancy. We did not include bipolar depression.Results:While there is wide variability in reported effects, untreated depression during pregnancy appears to carry substantial perinatal risks. These may be direct risks to the fetus and infant or risks secondary to unhealthy maternal behaviours arising from the depression. Recent human data suggest that untreated postpartum depression, not treatment with antidepressants in pregnancy, results in adverse perinatal outcome.Conclusion:The biological dysregulation caused by gestational depression has not received appropriate attention: most studies focus on the potential but unproven risks of psychotropic medication. No in-depth d...
TL;DR: The NICI is also used within a structural equation model to test several hypotheses related to national intellectual capital development as mentioned in this paper, and the main outcomes of the NICI are the development of a national Intellectual Capital measurement methodology and index.
Abstract: The intellectual capital of a nation (or a region of nations) requires the articulation of a system of variables that helps to uncover and manage the invisible wealth of a country Most importantly, an emphasis on human capital allows for a better understanding of the hidden values, individuals, enterprises, institutions, and communities that are both current and potential future sources of intellectual wealth This paper endeavours to address the five research questions The main outcomes of this paper are the development of a national intellectual capital measurement methodology and index The NICI is also used within a structural equation model to test several hypotheses related to national intellectual capital development
TL;DR: Compared with the general population of CGs, CGs of children with cerebral palsy (CP) had lower incomes and were less likely to report working for pay, and more likely to list caring for their families as their main activity.
Abstract: Background. Caring for any child involves considerable resources, but the demands for these resources are often increased when caring for a child with a disability. These demands have implications for the psychologic and physical health of the caregiver (CG). Although a number of recent trends in health care stress the importance of studying and promoting the health of CGs of children with disabilities, the literature in this area exhibits 2 major weaknesses, ie, most studies draw conclusions from relatively small, potentially biased, clinic-based samples and the majority of work has focused on the psychologic health of CGs, whereas little research has been undertaken to study their physical well-being. The goal of this study was to compare the physical and psychologic health of CGs of children with cerebral palsy (CP) with that of the general population of CGs. Methods. Data on the physical and psychologic health of 468 primary CGs of children with CP, drawn from 18 of 19 publicly funded children9s rehabilitation centers in Ontario, Canada, were collected with a self-completed questionnaire and a face-to-face interview. Identical items and scales had been administered previously to nationally representative samples of the Canadian population in 2 large-scale Canadian surveys, ie, the National Population Health Survey (NPHS) and the National Longitudinal Study of Children and Youth (NLSCY). Subsamples of those data, restricted to adult residents of the province of Ontario who were parents, allowed a comparison of our sample of CGs of children with CP with parent samples from both the NLSCY ( n = 2414) and the NPHS ( n = 5549). Outcome Measures. Demographic variables included CG age, gender, education, income, and work-related variables. Psychologic health and support variables included social support, family functioning, frequency of contacts, distress, and emotional and cognitive problems. Physical health variables included the number and variety of chronic conditions, vision, hearing, and mobility problems, and experience of pain. Results. CGs of children with CP had lower incomes than did the general population of CGs (proportion with income over $60 000: CG: 40.9%; NLSCY: 51.4%), despite the absence of any important differences in education between the 2 samples. Results showed that CGs of children with CP were less likely to report working for pay (CG: 66%; NLSCY: 81.2%), less likely to be engaged in full-time work (CG: 67.5%; NLSCY: 73.2%), and more likely to list caring for their families as their main activity (CG: 37.2%; NLSCY: 28.4%). Measures of support showed no difference in reported social support (CG: mean score: 14.5; SD: 3.4; NLSCY: mean score: 14.3; SD: 2.7) or family functioning (CG: mean score: 8.6; SD: 5.6; NLSCY: mean score: 9.0; SD: 4.9) between the 2 samples, although the CG sample did report a statistically greater number of support contacts (CG: mean score: 4.5; SD: 0.7; NPHS: mean score: 4.2; SD: 0.9). Measures of psychologic health showed greater reported distress (CG: mean score: 4.7; SD: 4.4; NPHS: mean score: 2.2; SD: 2.7), chronicity of distress (CG: mean score: 5.5; SD: 1.4; NPHS: mean score: 5.2; SD: 1.1), emotional problems (CG: 25.3% indicating problems; NPHS: 13.7%), and cognitive problems (CG: 38.8%; NPHS: 14.3%) among CGs of children with CP. They also reported a greater likelihood of a variety of physical problems, including back problems (CG: 35.5% reporting the condition; SE: 2.2%; NLSCY: 12.2%; SE: 0.7%), migraine headaches (CG: 24.2%; SE: 2.0%; NLSCY: 11.2%; SE: 0.7%), stomach/intestinal ulcers (CG: 8.4%; SE: 1.3%; NLSCY: 1.7%; SE: 0.3%), asthma (CG: 15.8%; SE: 1.7%; NLSCY: 6.3%; SE: 0.5%), arthritis/rheumatism (CG: 17.3%; SE: 1.8%; NLSCY: 7.3%; SE: 0.5%), and experience of pain (CG: 28.8%; SE: 2.1%; NPHS: 11.0%; SE: 0.5), as well as a greater overall number of chronic physical conditions (CG: 24.1% reporting no chronic conditions; NLSCY: 55.2%). Conclusions. Although many families cope well despite the added challenges of caring for a child with a disability, our findings suggest that the demands of their children9s disabilities can explain differences in the health status of parents and that parents of children with CP are more likely to have a variety of physical and psychologic health problems. Many of these findings are consistent with a stress process model, in which stress from caregiving can directly or indirectly affect a variety of measures of health, although some of the findings (asthma and arthritis) seem to strain this hypothesis. Alternate interpretations of these findings include the possibility that parents who are in regular contact with the health care system may have more opportunities to discuss and receive attention for their own health concerns than do comparison adults or that the greater number of health issues reported by CGs is related to the nature of our study, perhaps leading these parents to focus on their health and well-being in more depth than is usually feasible in a population survey. CGs of children with CP also had lower incomes, despite the absence of any important differences in education. The findings are consistent with the idea that the financial burden of caring for a child with a disability results in part from a reduced availability of these parents to work for pay. Implications for Service Providers. Physicians and other health care professionals should be aware of the important relationship between child disability and CG health. Family-centered policies and services that explicitly consider CG health are likely to benefit the well-being of both CGs and their families. Future work should address the extent to which the family-centeredness of services, as experienced by CGs, is associated with better health outcomes for parents and their families.
Journal Article•
TL;DR: Industry-funded trials are more likely to be associated with statistically significant pro-industry findings, both in medical trials and surgical interventions.
Abstract: Background: Conflicting reports exist in the medical literature regarding the association between industry funding and published research findings. In this study, we examine the association between industry funding and the statistical significance of results in recently published medical and surgical trials. Methods: We examined a consecutive series of 332 randomized trials published between January 1999 and June 2001 in 8 leading surgical journals and 5 medical journals. Each eligible study was independently reviewed for methodological quality using a 21-point index with 5 domains: randomization, outcomes, eligibility criteria, interventions and statistical issues. Our primary analysis included studies that explicitly identified the primary outcome and reported it as statistically significant. For studies that did not explicitly identify a primary outcome, we defined a “positive” study as one with at least 1 statistically significant outcome measure. We used multivariable regression analysis to determine whether there was an association between reported industry funding and trial results, while controlling for study quality and sample size. Results: Among the 332 randomized trials, there were 158 drug trials, 87 surgical trials and 87 trials of other therapies. In 122 (37%) of the trials, authors declared industry funding. An unadjusted analysis of this sample of trials revealed that industry funding was associated with a statistically significant result in favour of the new industry product (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.3–3.5). The association remained significant after adjustment for study quality and sample size (adjusted OR 1.8, 95% CI 1.1–3.0). There was a nonsignificant difference between surgical trials (OR 8.0, 95% CI 1.1–53.2) and drug trials (OR 1.6, 95% CI 1.1–2.8), both of which were likely to have a pro-industry result (relative OR 5.0, 95% CI 0.7–37.5, p = 0.14). Interpretation: Industry-funded trials are more likely to be associated with statistically significant pro-industry findings, both in medical trials and surgical interventions.