Investigating magnetically aligned phospholipid bilayers with EPR spectroscopy at 94 GHz.

In this paper, we report our initial results on studying magnetically aligned phospholipid bilayers (bicelles) at high magnetic fields (approximately 3.4 T) with electron paramagnetic resonance (EPR) spectroscopy at 95 GHz (W-band). In order to characterize this system for W-band EPR studies, we have utilized the nitroxide spin probe 3beta-doxyl-5alpha-cholestane to demonstrate the effects of macroscopic bilayer alignment. At W-band due to the increase in magnetic field strength (when compared to X-band studies at 9.5 GHz) (S. M. Garber et al., J. Am. Chem. Soc. 121, 3240-3241 (1999)), we were able to examine magnetically aligned phospholipid bilayers at two orientations with the bilayer normal oriented either perpendicular or parallel (upon addition of YbCl3) with respect to the direction of the static magnetic field. Additionally, at a magnetic field of 3.4 T (g=2 resonance at W-band), we were able to study the parallel alignment with a lower concentration of Yb3+, thereby eliminating the possible unwanted effects associated with lanthanide-protein interactions and paramagnetic shifts and/or line broadening induced by the lanthanide ions. The development of this new spin label alignment technique will open up a whole new area of investigation for phospholipid bilayer systems and membrane protein EPR studies at high magnetic fields.

Use of focus groups to identify health promotion strategies for the early detection of diabetic retinopathy.

BACKGROUND: People with diabetes do not regularly utilise eye services for the early prevention of vision loss due to diabetic eye disease. A community-based screening program has been initiated in Victoria to address this issue. To encourage people to take preventive eye health care measures, the most effective health promotion strategies were identified. METHODS: Thirty-three health professionals were invited to attend focus groups. A sample of 35 people with diabetes was approached by their GPs or diabetes educators because of their motivation to participate in diabetes activities. Each group consisted of 10 members. Discussion points included the type of education messages available to people with diabetes; use of eye services among the participants with diabetes; and strategies required promoting the screening service. RESULTS: Five focus groups were conducted. The discussions highlighted that a great deal could be achieved by using local community networks to promote the benefits of early detection of diabetic retinopathy and local screening program. The group members recommended that particular attention be directed to general practitioners and their distribution of materials to patients. Key issues for planning and implementing the program were highlighted. The groups urged development of strategies to encourage people with diabetes in rural Victoria to participate in a program for the early detection of diabetic retinopathy.

Development and validation of the Curtin Back Screening Questionnaire (CBSQ): a discriminative disability measure.

Disability accompanying occupational low back pain (LBP) can include a wide range of incapacitating symptoms which, for the practitioner, can be time-consuming and difficult to identify systematically. A questionnaire designed for case-finding and assessment could assist in both the early recognition of disability and in planning management. A suitable questionnaire for clinical use could not be found in the literature. The Curtin Back Screening Questionnaire (CBSQ) was developed, therefore, as a discriminative screening instrument to serve this purpose. The methods and results of the development and validation of the CBSQ are presented herein. Development of the questionnaire followed the principles of Kirschner and Guyatt (1985) employing data from 74 subjects with at least moderately severe work-related LBP. The research design for the validation was multiple-group repeated-measures with a study population of 150 subjects. The screening function of the questionnaire was developed through selecting 8 questions from the whole questionnaire using regression analysis. The questionnaire includes 79 items based on the subjects' perceived health status. The response structure of the CBSQ has been adapted from that of the General Health Questionnaire (GHQ) and some items in the CBSQ have been developed from items in the Sickness Impact Profile (SIP) and GHQ. The questionnaire discriminates effectively between subjects with different degrees of disability, it correlates quite well with the SIP, test-retest reliability for the whole questionnaire is 0.98, the receiver-operating characteristics are more favourable than those for the SIP, and the CBSQ screening score provides an index of severity which correlates with work incapacity.(ABSTRACT TRUNCATED AT 250 WORDS)

An epidemiological description of physical, social and psychological problems in multiple sclerosis.

Chronic disorders such as multiple sclerosis have important behavioural consequences on the lives of patients. The purpose of this study was to describe the frequency distribution of psychosocial disability among a referral clinic population of multiple sclerosis patients and to identify associated factors. A cross-sectional survey was conducted of 301 patients using four health indexes to assess quality of life. An 82% response rate was obtained. In the results are presented the frequencies of behavioural problems compared with the general population and a family practice group. While physical function was found to be closely associated with disease severity, psychosocial disability bore little relationship to the underlying disease or to sociodemographic variables including social class. Eighty percent of psychosocial disability remained unexplained. The physical aspects of multiple sclerosis were not predictive of emotional or social morbidity. The major implication of these findings is that the impact of disease on patients, as distinct from the disease itself, should be dealt with as health problems in their own right.

The epidemiology of urethral-vesical dysfunction in the female patient.

The specific purposes of this report are twofold: (1) to summarize the descriptive epidemiology of urethral-vesical dysfunction in a population of 1439 female patients referred for urodynamic evaluation of symptoms and (2) to analyze the association between demographic, clinical, and investigative data. On the basis of urodynamic studies, abnormalities were classified into four types: anatomic dysfunction, 60%; neuromuscular dysfunction, 20%; neuropathic dysfunction, 12%; and miscellaneous dysfunction, 8%. Analyses and cross tabulations of clinical data vis-à-vis investigative studies reveal poor correlation between subjective clinical data and urodynamic diagnoses. The clinical symptoms of urethral-vesical dysfunction in the female patient may be confusing and complex. Urodynamic evaluation of symptoms and clinical data is of value in the design of a rational therapeutic program for such patients.

Failure of weight reduction to reduce mildly elevated blood pressure: a randomized trial.

To determine the value of weight reduction on blood pressure, we randomly allocated 60 untreated, mildly hypertensive, obese individuals to a no-treatment control group or to a behaviourly-oriented weight loss ('diet') programme administered by professional dietitians. Behavioural techniques included self-monitoring, shaping, reinforcement and modelling. Subjects were reassessed after six months by an observer who was unaware of their study group. Fifty-four subjects (90%) completed the study. Diet subjects lost 4.1 kg and controls only 0.8 kg (P = 0.018). However, neither systolic nor diastolic blood pressures differed. The chance that we missed a clinically important diastolic difference of 6 mmHg (our pre-study target) is less than 1%. We conclude that our weight loss programme was successful in reducing weight but that weight loss is not useful in lowering blood pressure in mild, otherwise untreated hypertensives.

Community medicine for clinicians in Canada: a recommendation for postgraduate training.

A large gap presently exists between the predominantly biologic expertise of the medical profession and the complex mixture of biologic, behavioural and epidemiologic components of health problems today. Furthermore, the development of community medicine in Canada has been relatively separate from that of the clinical disciplines. To enable clinicians to acquire the knowledge and skills to manage these health problems, much more community-oriented research, applied behavioural science and clinical epidemiology is needed within the clinical sector of medicine. I have proposed a definition of clinical community medicine and presented a strategy for training clinicians in community medicine skills that calls for administrators of clinical postgraduate programs to develop training in clinical community medicine. Residency programs in community medicine cannot be expected to provide such training given their nonclinical priorities, which focus mainly on the training of public health physicians.

Effect of delivery method on outcomes in the very low-birth weight breech infant: is the improved survival related to cesarean section or other perinatal care maneuvers?

The perinatal mortality rate among very low-birth weight infants has been decreased by 20% during the last 4 years of the 1973 to 1980 period here reported. The concurrent increase in the cesarean section rate from 11.9% to 49.1% during the same time frames has been assumed to be responsible for the improved outcome. The changes were most marked in the extremely low-birth weight group (less than 1,000 gm). The survival rates and cesarean section rates were examined among infants of similar birth weight and gestational age in the vertex presentation, in the same time frames. A similar or greater reduction in mortality rate (from 85% to 45%) was noted in the very low-birth weight vertex infants, whereas the cesarean section rate remained minimally and not significantly increased (14.2% to 22.2%). The interpretation of this finding is by no means clear but must include the hypothesis that the increased cesarean section rate may be incidental and in no way related to the improved outcome. The most statistically significant determinants of outcome remain birth weight and gestational age strata, with no significant difference in outcomes when the extremely low-birth weight group is analyzed separately from the entire very low-birth weight group. As yet unidentified perinatal care practices, other than cesarean section, may be more likely to affect outcome in this high-risk group.

Difficulties in clinical skills evaluation.

A case-specific method of evaluating clinical skills is presented. The instrument is described together with its evaluation based on results from ninety-two medical students. The method involves direct observation, by pairs of teachers, of student encounters with simulated patients. The purpose of this paper is to explore the methodology of assessing clinical competence. Three aspects of this are addressed: reliability between teachers acting as observers, and the relationship of both observations of process measures and self-assessments with the students' understanding of the patient. Three aspects of clinical skills were evaluated; interviewing, problem orientation and physical examination. The results showed the observers to be highly reliable in observing physical examination but to have a wide range of reliability across cases in their observations of the other aspects of clinical skill. There was no correlation between both teachers' observations and the students' self-assessments with the students' understanding of the patient. This is a worrying finding. The implications of this study are that evaluation of the process of clinical skills is difficult methodologically and, added to which, it is not clear what relevance these observations have to clinical competence. Rather than effort being devoted to refining instruments to measure the process of clinical skills it would seem preferable to devote energy to assessing students' abilities in diagnosis and management, at least until we understand what observations of clinical skills are measuring.

Research methods workshop for health professionals in Sierra Leone: an international collaborative project.

In 1979 a research methods seminar for health professionals in Sierra Leone was conducted as part of an international medical education collaborative project between Sierra Leone, Canada, the United Kingdom and the European Economic Community. The aim of the seminar was to promote research and inquiry into national health problems. Planning and administration was conducted by Sierra Leone with Canada providing teaching materials and four tutors. Twenty-seven participants attended the seminar. Participants prepared research protocols prior to the seminar which they developed and refined during the 7 days of the workshop. Using a problem-based method Sierra Leonean health problems were used as the focus to teach epidemiological and biostatistical methods. The seminar was evaluated on the basis of a number of parameters. There was 89% attendance at the nineteen sessions. Twenty-one of the twenty-seven participants presented protocols at the final evaluation session. Self-evaluation of protocols showed improvement in most aspects but particularly in research design, methods of data gathering, analysis and ethical aspects. An opinion survey of participants showed the seminar to be viewed positively. Twelve months later six participants had submitted their protocols for funding of whom four were successful. A further seminar has been conducted in which Sierra Leoneans participated as co-tutors. This seminar format has been presented as an effective means of providing professional assistance from one country to another.