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International Databases (international + databases)
Selected AbstractsThe 5/95 gap in the indexation of psychiatric journals of low- and middle-income countriesACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2010J. J. Mari Mari JJ, Patel V, Kieling C, Razzouk D, Tyrer P, Herrman H. The 5/95 gap in the indexation of psychiatric journals of low- and middle-income countries. Objective:, To investigate the relationship between science production and the indexation level of low- and middle-income countries (LAMIC) journals in international databases. Method:, Indicators of productivity in research were based on the number of articles produced over the 1994,2004 period. A survey in both Medline and ISI/Thomson was conducted to identify journals according to their country of origin. A WPA Task Force designed a collaborative process to assess distribution and quality of non-indexed LAMIC journals. Results:, Twenty LAMIC were found to present more than 100 publications and a total of 222 indexed psychiatric journals were found, but only nine were from LAMIC. The Task Force received 26 questionnaires from editors of non-indexed journals, and concluded that five journals would meet criteria for indexation. Conclusion:, Barriers to indexation of journals contribute to the difficulties in achieving fair representation in the main literature databases for the scientific production in these countries. [source] ORIGINAL ARTICLE Laboratory science: Spectrum of F8 gene mutations in haemophilia A patients from a region of Italy: identification of 23 new mutationsHAEMOPHILIA, Issue 5 2010F. RICCARDI Summary., Haemophilia A (HA) is an X-linked recessive bleeding disorder caused by a lack or decrease of coagulation factor VIII activity. The molecular diagnosis of HA is challenging and a variety of different mutations have been identified throughout the F8 gene. Our aim was to detect the causative mutation in 266 HA patients from Emilia-Romagna region (Italy) and in all suspected carriers. Molecular analysis of F8 in 201 HA patients (152 index cases) was performed with a combination of several indirect and direct molecular approaches, such as long distance polymerase chain reaction, multiplex ligation-dependent probe amplification, denaturing high performance liquid chromatography and direct sequencing. The analysis revealed 78 different mutations, 23 of which were novel, not having been reported in national or international databases. The detection rate was 100%, 86% and 89% in patients with severe, moderate and mild HA, respectively. The information provided by this registry will be helpful for monitoring the treatment of HA patients in Emilia-Romagna and also for reliable genetic counselling of affected families in the future. [source] Exploring the cost-effectiveness of Helicobacter pylori screening to prevent gastric cancer in China in anticipation of clinical trial resultsINTERNATIONAL JOURNAL OF CANCER, Issue 1 2009Jennifer M. Yeh Abstract Gastric cancer is the second leading cause of cancer-related deaths worldwide. Treatment for Helicobacter pylori infection, the leading causal risk factor, can reduce disease progression, but the long-term impact on cancer incidence is uncertain. Using the best available data, we estimated the potential health benefits and economic consequences associated with H. pylori screening in a high-risk region of China. An empirically calibrated model of gastric cancer was used to project reduction in lifetime cancer risk, life-expectancy and costs associated with (i) single lifetime screening (age 20, 30 or 40); (ii) single lifetime screening followed by rescreening individuals with negative results and (iii) universal treatment for H. pylori (age 20, 30 or 40). Data were from the published literature and national and international databases. Screening and treatment for H. pylori at age 20 reduced the mean lifetime cancer risk by 14.5% (men) to 26.6% (women) and cost less than $1,500 per year of life saved (YLS) compared to no screening. Rescreening individuals with negative results and targeting older ages was less cost-effective. Universal treatment prevented an additional 1.5% to 2.3% of risk reduction, but incremental cost-effectiveness ratios exceeded $2,500 per YLS. Screening young adults for H. pylori could prevent one in every 4 to 6 cases of gastric cancer in China and would be considered cost-effective using the GDP per capita threshold. These results illustrate the potential promise of a gastric cancer screening program and provide rationale for urgent clinical studies to move the prevention agenda forward. © 2008 Wiley-Liss, Inc. [source] Efficacy of integrated interventions combining psychiatric care and nursing home care for nursing home residents: a review of the literatureINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 1 2010Janine Collet Abstract Background Nursing home residents needing both psychiatric care and nursing home care for either somatic illness or dementia combined with psychiatric disorders or severe behavioural problems are referred to as Double Care Demanding patients, or DCD patients. Integrated models of care seem to be necessary in order to improve the well-being of these residents. Objectives Two research questions were addressed. First, which integrated interventions combining both psychiatric care and nursing home care in DCD nursing home residents are described in the research literature? And second, which outcomes of integrated interventions combining both psychiatric care and nursing home care in DCD nursing home residents are reported in the literature? Method A critical review of studies was done that involved integrated interventions combining both psychiatric care and nursing home care on psychiatric disorders and severe behavioural problems in nursing home patients. A systematic literature search was performed in a number of international databases. Results Eight intervention trials, including four RCTs (2b level of evidence), were identified as relevant studies for the purpose of this review. Seven studies, three of which were RCTs, showed beneficial effects of a comprehensive, integrated multidisciplinary approach combining medical, psychiatric and nursing interventions on severe behavioural problems in DCD nursing home patients. Conclusions Important elements of a successful treatment strategy for DCD nursing home patients include a thorough assessment of psychiatric, medical and environmental causes as well as programmes for teaching behavioural management skills to nurses. DCD nursing home patients were found to benefit from short-term mental hospital admission. This review underlines the need for more rigorously designed studies to assess the effects of a comprehensive, integrated multidisciplinary approach towards DCD nursing home residents. Copyright © 2009 John Wiley & Sons, Ltd. [source] Developing health indicators for people with intellectual disabilities.JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 6 2007The method of the Pomona project Abstract Aim Recently, attention has focused on the health inequalities experienced by people with intellectual disabilities (ID) when compared with the general population. To inform policies aimed at equalizing health opportunities, comparable evidence is needed about the aspects of their health that may be amenable to intervention. Method Applying the framework of the European Community Health Indicators (ECHI) for the general population, the Pomona group developed a set of health indicators reflecting aspects of the health of people with ID: socio-demographic data, health status, health determinants and health systems. Results This paper documents the procedures that partners carried out in 13 European countries. The process comprised a search for evidence in published literature; consultation with advocates, family members and health professionals; and analyses of national and international databases. Indicators were selected if they were appraised as important, useful, measurable and if resulting data would enable comparisons between the health of people with ID and that of the general population. Conclusion The thus developed indicator set that is aligned with ECHI will permit investigators to compare key aspects of health of people with ID with those of people in the general population within Europe. The final set of 18 indicators will be applied in the Pomona 2 project (2005,08) to gather information about the health of samples of adults in 14 participating European countries. [source] Training doctors in general practices: A review of the literatureAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 5 2006Karen Larsen Abstract Objective:,This study was undertaken to assess the evidence of whether new forms of medical training, where substantial training takes place in general practice, will be acceptable to GPs. In particular, we asked the questions: Are GPs willing to act as trainers and supervisors in their practices? Do GPs have the appropriate skills to be trainers? Do practices have the infrastructure and resources to support placements? And, are patients happy to be seen by medical students and General Practice Registrars? Design:,Key Australian and international databases, key Australian journals and key Australian websites were searched for literature on general practice-based training of medical students and General Practice Registrars. Results:,In the international and Australian literature, we found that many GPs consider training medical students and General Practice Registrars to be intrinsically satisfying. They vary in their skills, and most medical schools have made significant investments in training and support activities. Many practices do not have the necessary infrastructure, and investments need to be made if extended placements are to be successful. Many patients are happy to be seen by students and Registrars, but careful thought needs to be given to implementing appropriate models so that students have good learning opportunities, patients are not disadvantaged and general practices can operate efficiently. Conclusion:,The success of this new model of clinical placements is dependent on medical schools having a detailed understanding of the needs and expectations of GPs. [source] Clinical geneticists in birth defects surveillance and epidemiology research programs: Past, present and future roles,BIRTH DEFECTS RESEARCH, Issue 1 2009Angela E. Lin Abstract Clinical geneticists have contributed to the creation and operation of birth defects surveillance systems and epidemiology research programs. Over the years, many continue to assist the multidisciplinary staff at state-based and regional programs, national networks, and international databases. Currently, all centers participating in the National Birth Defects Prevention Study include a clinical geneticist, which has increased awareness of this role. It is generally assumed that the medical skills and expertise acquired from clinical practice of a clinical geneticist can assist in the tasks of record review, case classification, coding, staff education, peer networking, and research, but these activities have not been formally reviewed. To increase the general knowledge base, this article used the framework of an historical descriptive review focusing on a sample of birth defects surveillance systems presented as illustrative case studies. We examined the contribution of clinical geneticists to a sample of epidemiologic research studies from each program. Looking to the future, we discuss the education of other clinical geneticists, the need to evaluate performance, and the geneticist's participation with other public health colleagues in the shared goal of birth defects prevention. Birth Defects Research (Part A), 2009. © 2008 Wiley-Liss, Inc. [source] Results from the International Cataract Surgery Outcomes StudyACTA OPHTHALMOLOGICA, Issue thesis2 2007Jens Christian Norregaard MD Abstract It is widely accepted that cataract extraction with intraocular lens implantation is a highly effective and successful procedure. However, quality assessments and studies of effectiveness should still be undertaken. As with any surgical treatment modality, complications may occur, leading to suboptimal outcomes, additional health costs and deterioration in patients' functional capacity. International variation in clinical practice patterns and outcomes can serve as important pointers in the attempt to identify areas amenable to improvements in quality and cost-effectiveness. Once demonstrated, similar clinical results obtained in different health care systems can improve the level of confidence in a clinical standard against which the quality of care can be evaluated. The International Cataract Surgery Outcomes Study was established in 1992. The objective of this international comparative research project was to compare cataract management, outcomes of surgery and quality of care in four international sites. The study was conducted in the 1990s, since when many developments and refinements have emerged within cataract surgery. The actual figures reported in this thesis may no longer be of specific relevance as a decade has passed since their collection. However, the research questions and methods used in the study are still highly important and justify the publication of this report. The report deals with problems related to quality assessment, benchmarking, and the establishment and design of nationwide clinical databases , issues that are currently the focus of much attention. Moreover, the problems related to cross-national comparisons are increasingly relevant as more international databases are established. The study makes suggestions on how to report and compare objective as well as subjective criteria for surgery. The issue of how to report subjective criteria is a particular subject of current discussion. Four sites with high-quality health care systems were examined in this study: the USA, Denmark, the Province of Manitoba (Canada), and Barcelona (Spain). The design of the international research programme was based on methods developed by the US National Cataract Surgery Outcomes Study conducted by the US Cataract Patients Outcomes Research Team. The International Cataract Surgery Outcomes Study comprised three separate studies: a survey of ophthalmologists; a prospective cohort study, and a retrospective register-based cohort study. The survey study was based on data generated by a self-administered questionnaire completed by ophthalmologists in the four study areas. The questionnaire examined routine clinical practice involving patients considered for cataract surgery, and included questions on anaesthesia, monitoring and surgical techniques. The prospective cohort study was a large-scale, longitudinal observational study of patients undergoing first-eye cataract surgery in each study site. Patients were sampled consecutively from multiple clinics and followed for 4 months postoperatively. The retrospective cohort study was based on the Danish National Patient Register and claims data from the USA. This study could not be carried out in Barcelona or Manitoba as no suitable administrative databases were available. The papers based on register databases deal with retinal detachment and endophthalmitis but are not included in this thesis as the material was previously reported in my PhD thesis. The application of the studies was highly co-ordinated among the four sites and similar methods and instruments were used for data collection. The development of the data collection strategy, questionnaires, clinical data forms and data analyses were co-ordinated through weekly telephone conferences, annual in-person conferences, correspondence by mail or fax, and the exchange of sas programs and data files via the Internet. The survey study was based on responses from 1121 ophthalmologists in the four sites and results were presented in two papers. Within the previous year the participating ophthalmologists had performed a total of 212 428 cataract surgeries. With regard to preoperative ophthalmic testing, the present study reveals that refraction, fundus examination and A-scanning were performed routinely by most surgeons in all four sites. Other tests were reported to be performed routinely by some surgeons. It is unclear why any surgeon would use these other tests routinely in cataract patients with no ocular comorbidity. It appears that if this recommendation from the US Clinical Practice Guidelines Panel was broadly accepted, the use of these procedures and costs of care could be reduced, especially in Barcelona, the USA and Canada. Restricted use of medical screening tests was reported in Denmark. If this restricted screening were to be implemented in the USA, Canada and Barcelona, it would have significant resource implications. The most striking finding concerned the difference in monitoring practice between Denmark and each of the other three sites. In Denmark, monitoring equipment is seldom used and only occasionally is an anaesthesiologist present during cataract surgery. By contrast, in the other study sites, the presence of an anaesthesiologist using monitoring equipment is the norm. Adopting the Danish model in other sites would potentially yield significant cost savings. The results represent part of the background data used to inform the decision to conduct the two large-scale, multicentre Studies of Medical Testing for Cataract Surgery. The current study is an example of how surveys of clinical practice can pinpoint topics that need to be examined in randomized clinical trials. For the second study, 1422 patients were followed from prior to surgery until 4 months postoperatively. Preoperatively, a medical history was obtained and an ophthalmic examination of each patient performed. After consent had been obtained, patients were contacted for an in-depth telephone interview. The interview was repeated 4 months postoperatively. The interview included the VF-14, an index of functional impairment in patients with cataract. Perioperative data were available for 1344 patients (95%). The 4-month postoperative interview and clinical examination were completed by 1284 patients (91%). Main reasons for not re-evaluating patients were: surgery was cancelled (3%); refusal to participate (2%); lost to follow-up (1%), and death or being too sick (1%). The results have been presented in several papers, of which four are included in this thesis. One paper compared the preoperative clinical status of patients across the four sites and showed differences in both visual acuity (VA) and VF-14 measures. The VF-14 is a questionnaire scoring disability related to vision. The findings suggest that indications for surgery in comparable patients were similar in the USA and Denmark and were more liberal than in Manitoba and Barcelona. The results highlight the need to control for patient case mix when making comparisons among providers in a clinical database. This information is important when planning national databases that aim to compare quality of care. A feasible method may be to use one of the recently developed systems for case severity grading before cataract surgery. In another paper, perioperative clinical practice and rates of early complications following cataract surgery were compared across the four health care systems. Once again, the importance of controlling for case mix was demonstrated. Significant differences in clinical practice patterns were revealed, suggesting a general trend towards slower diffusion of new medical technology in Europe compared with North America. There were significant differences across sites in rates of intra- and early postoperative events. The most important differences were seen for rates of capsular rupture, hyphaema, corneal oedema and elevated pressure. Rates of these adverse events might potentially be minimized if factors responsible for the observed differences could be identified. Our results point towards the need for further research in this area. In a third paper, 4-month VA outcomes were compared across the four sites. When mean postoperative VA or crude proportions of patients with a visual outcome of <,0.67 were compared across sites, a much poorer outcome was seen in Barcelona. However, higher age, poorer general health status, lower preoperative VA and presence of ocular comorbidity were found to be significant risk factors associated with increased likelihood of poorer postoperative VA. The proportions of patients with these risk factors varied across sites. After controlling for the different distributions of these factors, no significant difference remained across the four sites regarding risk of a poor visual outcome. Once again the importance of controlling for case mix was demonstrated. In the fourth paper, we examined the postoperative VF-14 score as a measure of visual outcomes for cataract surgery in health care settings in four countries. Controlling for case mix was also necessary for this variable. After controlling for patient case mix, the odds for achieving an optimal visual function outcome were similar across the four sites. Age, gender and coexisting ocular pathology were important predictors of visual functional outcome. Despite what seemed to be an optimal surgical outcome, a third of patients still experienced visual disabilities in everyday life. A measure of the VF-14 might help to elucidate this issue, especially in any study evaluating the benefits of cataract surgery in a public health care context. [source] The Global Absence of Child and Adolescent Mental Health PolicyCHILD AND ADOLESCENT MENTAL HEALTH, Issue 3 2004Jess P. Shatkin Background:, Few policies designed specifically to support child and adolescent mental health exist worldwide. The absence of policy is a barrier to the development of coherent systems of mental healthcare for children and adolescents. Method:, This study collected data on existing policies from international databases, WHO headquarters in Geneva, Switzerland, and in consultation with experts in child and adolescent psychiatry from around the world. A set of criteria for ranking the adequacy of these policies was developed. Results:, Though no single country was found to have a mental health policy strictly pertaining to children and adolescents alone, 35 countries (corresponding to 18% of countries worldwide) were found to have identifiable mental health policies, which may have some beneficial impact on children and adolescents. Though little has been achieved worldwide in this area, there has been a significant degree of movement towards policy development in the past 10 years. The policies identified vary greatly in terms of their provisions for delivering services, initiating research, training professionals, and educating the public. Conclusions:, The development of mental health policies is feasible and would substantially aid in the expansion of service systems, the institutionalisation of culturally relevant data gathering, and the facilitation of funding. [source] | ||||||||||