ABSTRACT
OBJECTIVE: To examine patterns of familial aggregation and factors influencing onset age in a sample of siblings with PD. METHODS: Sibling pairs (n = 203) with PD were collected as part of the GenePD study. Standardized family history, medical history, and risk factor data were collected and analyzed. RESULTS: The mean age at onset was 61.4 years and did not differ according to sex, exposure to coffee, alcohol, or pesticides. Head trauma was associated with younger onset (p = 0.03) and multivitamin use with later onset (p = 0.007). Age at onset correlation between sibling pairs was significant (r = 0.56, p = 0.001) and was larger than the correlation in year of onset (r = 0.29). The mean difference in onset age between siblings was 8.7 years (range, 0 to 30 years). Female sex was associated with increased frequency of relatives with PD. The frequency of affected parents (7.0%) and siblings (5.1%) was increased when compared with frequency in spouses (2.0%). CONCLUSIONS: The greater similarity for age at onset than for year of onset in sibling pairs with PD, together with increased risk for biological relatives over spouses of cases, supports a genetic component for PD. Risk to siblings in this series is increased over that seen in random series of PD cases; however, patients in this sample have similar ages at onset and sex distribution as seen for PD generally. These analyses suggest that factors influencing penetrance are critical to the understanding of this disease.
Subject(s)
Parkinson Disease/epidemiology , Parkinson Disease/genetics , Age of Onset , Female , Humans , Male , Middle Aged , Risk Factors , SiblingsABSTRACT
A genome-wide scan for idiopathic PD in a sample of 113 PD-affected sibling pairs is reported. Suggestive evidence for linkage was found for chromosomes 1 (214 cM, lod = 1.20), 9 (136 cM, lod = 1.30), 10 (88 cM, lod = 1.07), and 16 (114 cM, lod = 0.93). The chromosome 9 region overlaps the genes for dopamine beta-hydroxylase and torsion dystonia. Although no strong evidence for linkage was found for any locus, these results may be of value in comparison with similar studies by others.
Subject(s)
Genetic Testing , Genome , Parkinson Disease/genetics , Aged , Chromosomes, Human, Pair 1 , Chromosomes, Human, Pair 10 , Chromosomes, Human, Pair 16 , Chromosomes, Human, Pair 9 , Dopamine beta-Hydroxylase/genetics , Dystonia Musculorum Deformans/genetics , Genetic Linkage/genetics , Genetic Markers/genetics , Humans , Male , Middle Aged , Parkinson Disease/diagnosisABSTRACT
This qualitative study describes the perspectives of diploma nursing students and staff nurses on the student-staff relationship and the impact this relationship has on student learning. Staff and students, working in a clinical practice model setting in a large urban hospital, participated in focused interviews following a 15-week clinical practice assignment. Findings revealed there were several commonalities in staff and student perceptions of the relationship. Both staff and students described role perception, staff characteristics, and the workplace environment as important factors influencing the relationship and student learning. Students also identified working in a collegial relationship as being important to learning and their socialization into the nursing profession.
Subject(s)
Education, Nursing, Baccalaureate/methods , Interpersonal Relations , Mentors , Nursing Staff, Hospital , Preceptorship , Adult , Decision Making , Female , Humans , Male , Models, Organizational , Ontario , Patient-Centered Care , Role , Socialization , WorkloadABSTRACT
Parkinson's disease (PD) is a neurodegenerative disorder in which relatives of the probands are affected approximately 4 times as frequently as relatives of control subjects. Several genes have been implicated as genetic risk factors for PD. We investigated the presence of six reported genetic variations in the SCNA, NR4A2, and DJ-1 genes in 292 cases of familial Parkinson's disease from the GenePD study. None of the variants were found in the GenePD families. Our results suggest that other variants or genes account for the familial risk of PD within the GenePD study.
Subject(s)
DNA-Binding Proteins/genetics , Oncogene Proteins/genetics , Parkinson Disease/genetics , Transcription Factors/genetics , alpha-Synuclein/genetics , Aged , Gene Deletion , Genetic Predisposition to Disease , Genetic Variation/genetics , Genotype , Humans , Intracellular Signaling Peptides and Proteins , Middle Aged , Nuclear Receptor Subfamily 4, Group A, Member 2 , Point Mutation/genetics , Polymerase Chain Reaction , Protein Deglycase DJ-1 , Risk FactorsABSTRACT
Healthcare organizations are undergoing tremendous change in an attempt to become more flexible and adaptive. To be successful in any such transformation, organizations must build processes and systems that allow them to move with change and create a culture that allows individuals to thrive amid change. The authors describe how a community teaching hospital has attempted this through its partnership in a vertically integrated delivery system, its reorganization to product line management, its adoption of a shared governance structure, and its commitment to building a culture with strong relationships. Many of these processes and systems are in their infancy, but an examination of the journey will inform other organizations as they respond to change.
Subject(s)
Delivery of Health Care, Integrated/organization & administration , Hospital Restructuring/organization & administration , Hospitals, General/organization & administration , Humans , Models, Organizational , Ontario , Organizational Innovation , Systems IntegrationABSTRACT
OBJECTIVE: To identify a haplotype influencing onset age for Parkinson's disease (PD) in the PARK3 region on chromosome 2p13. METHODS: Single nucleotide polymorphisms (SNP) spanning 2.2 Mb and located in or near potential candidate genes were used to fine map the PARK3 region in 527 patients with familial PD, from 264 families. RESULTS: TT homozygotes for rs1876487 (G/T) had a 7.4-year younger mean age at onset (p = 0.005) compared to patients with GT and GG genotypes. Furthermore, SNP flanking the sepiapterin reductase (7,8-dihydrobiopterin: NADP+ oxidoreductase) (SPR) gene, rs1876487 (p = 0.02) and rs1150500 (p = 0.04), were associated with younger onset age among persons who did not carry the 174 allele of D2S1394. The SPR gene is implicated in dopamine synthesis. Haplotype analysis of three SNP-rs2421095, rs1876487, rs1561244-revealed an association with onset age (p = 0.023) and a haplotype of A-T-G alleles was associated with younger onset for PD (p = 0.005). CONCLUSIONS: A haplotype at the PARK3 locus, harboring the SPR gene, is associated with onset age of PD. This may suggest a role for the SPR gene in modifying the age at onset of PD.