Challenges in qualitative social pharmacy research: Reflections based on a conference workshop.

A methodological debate within social pharmacy is ongoing regarding how to apply a qualitative approach. This paper emanates from a workshop at the Nordic Social Pharmacy Conference in 2019, named 'How do we know it's good? A workshop on quality criteria in qualitative social and clinical pharmacy research', that addressed this debate. The aim of this paper is twofold (1) to present the main key points raised during the workshop and (2) based on these inputs to contribute to the ongoing discussion on qualitative methodology within social pharmacy research. This paper starts with what was discussed at the workshop and further elaborated are some of the challenges with conducting qualitative research within social pharmacy. These include methodological and disciplinary competence and insecurity, reflections on the consequences of that many social pharmacy researchers come from a natural science background and how this (possibly) shapes the practice of qualitative research within the field. For example, how concepts like transparency and saturation, together with checklists and quality criteria are understood and used. Finally, we make suggestions for the next step for qualitative research in social pharmacy.

The two part picture in detection of visuospatial neglect.

Thirty-four patients with right hemispheric cerebrovascular accident and 31 control subjects were examined with a new picture scanning task, the Two Part Picture, as well as with two picture scanning tasks and conventional tests from the Behavioural Inattention Test (BIT). The sensitivity of these tasks in detecting visuospatial neglect was evaluated, and compared to conventional neglect tests. The three pictures varied markedly in their ability to identify neglect. The Two Part Picture was clearly the most sensitive picture scanning task, also showing high agreement with the conventional tests of the BIT. The Two Part Picture is recommended as a useful detector for screening of visuospatial neglect.

Single-nucleotide polymorphism characterization in species with limited available sequence information: high nucleotide diversity revealed in the avian genome.

As a case study for single-nucleotide polymorphism (SNP) identification in species for which little or no sequence information is available, we investigated several approaches to identifying SNPs in two passerine bird species: pied and collared flycatchers (Ficedula hypoleuca and F. albicollis). All approaches were successful in identifying sequence polymorphism and over 50 candidate SNPs per species were identified from approximately 9.1 kb of sequence. In addition, 17 sites were identified in which the frequency of alternative bases differed by > 50% between species (termed interspecific SNPs). Interestingly, polymorphism of microsatellite/intron loci in the source species appeared to be a positive predictor of nucleotide diversity in homologous flycatcher sequences. The overall nucleotide diversity of flycatchers was 2.3-2.7 x 10(-3), which is approximately 3-6 times higher than observed in recent studies of human SNPs. Higher nucleotide diversity in the avian genome could be due to the relatively older age of flycatcher populations, compared with humans, and/or a higher long-term effective population size.

Speciation, introgressive hybridization and nonlinear rate of molecular evolution in flycatchers.

Evolutionary history of Muscicapidae flycatchers is inferred from nuclear and mitochondrial DNA (mtDNA) sequence comparisons and population genetic analysis of nuclear and mtDNA markers. Phylogenetic reconstruction based on sequences from the two genomes yielded similar trees with respect to the order at which the species split off. However, the genetic distances fitted a nonlinear, polynomial model reflecting diminishing divergence rate of the mtDNA sequences compared to the nuclear DNA sequences. This could be explained by Haldane's rule because genetic isolation might evolve more rapidly on the mitochondrial rather than the nuclear genome in birds. This is because hybrid sterility of the heterogametic sex (females) would predate that of the homogametic sex (males), leading to sex biased introgression of nuclear genes. Analyses of present hybrid zones of pied (Ficedula hypoleuca) and collared flycatchers (F. albicollis) may indicate a slight sexual bias in rate of introgression, but the introgression rates were too low to allow proper statistical analyses. It is suggested, however, that the observed deviation from linearity can be explained by a more rapid mutational saturation of the mtDNA sequences than of the nuclear DNA sequences, as supported by analyses of third codon position transversions at two protein coding mtDNA genes. A phylogeographic scenario for the black and white flycatcher species is suggested based on interpretation of the genetic data obtained. Four species appear to have diverged from a common ancestor relatively simultaneously during the Pleistocene. After the last glaciation period, pied and collared flycatchers expanded their breeding ranges and eventually came into secondary contact in Central and Eastern Europe and on the Baltic Isles.

Reduced mobility in the cervico-thoracic motion segment--a risk factor for musculoskeletal neck-shoulder pain: a two-year prospective follow-up study.

The aim of this study was to evaluate the variations in C7-T1 mobility in order to decide whether inverse C7-T1 function, defined as equal or less mobility in motion segment C7-T1 compared with T1-T2, could be used for prediction of neck-shoulder pain (NSP). One hundred and sixty-one female laundry workers participated in a prospective two-year follow-up study which included a self-report questionnaire and clinical examinations. The present study showed that the incidence of inverse C7-T1 function was 33% per year and subjects classified as having an inverse C7-T1 function three or more times during the follow-up period had an elevated risk of NSP (RR 3.1, CI 95% 1.1-6.9). According to the authors' interpretation, lack of synchronous mobility distribution between adjacent motion segments might be a provoking factor. Inverse C7-T1 function predicts NSP related to the cervico-thoracic articulations and yields a positive predictive value of 84%. Assessments must be repeated, however.

Purification of allantoinase from soybean seeds and production and characterization of anti-allantoinase antibodies.

Allantoinase catalyzes the hydrolysis of allantoin to allantoic acid, a reaction important in both biogenesis and degradation of ureides. Ureide production in cotyledons of germinating soybean (Glycine max L.) seeds has not been studied extensively but may be important in mobilizing nitrogen reserves. Allantoinase was purified approximately 2500-fold from a crude extract of soybean seeds by differential centrifugation, heat treatment, ammonium sulfate fractionation, ethanol fractionation, and fast protein liquid chromatography (Pharmacia) with Mono-Q and Superose columns. The purified enzyme had a subunit size of 30 kD. Polyclonal antibodies produced against the purified protein titrated allantoinase activity in a crude extract of seed proteins. Antibodies recognized the 30-kD band in western blot analysis of crude seed extracts, indicating that they were specific for allantoinase.

Use of smokeless tobacco: blood pressure elevation and other health hazards found in a large-scale population survey.

Health hazards associated with the use of smokeless tobacco were evaluated in a cross-sectional study of 97,586 Swedish construction workers undergoing health examinations in 1971-74. All users of smokeless tobacco only (5014 subjects) and all exclusive smokers of > or = 15 cigarettes daily (8823 subjects) were compared with all non-users of any tobacco (23,885). Both smokeless tobacco users and smokers showed higher prevalences of circulatory and respiratory disorders. Hypertension was most common in smokeless tobacco users. In the 45- to 56-years age group, the odds ratio for a diastolic blood pressure of > 90 mmHg was 1.8 (95% CI, 1.5-2.1), and for a systolic blood pressure > 160 mmHg, 1.7 (95% CI, 1.3-2.1). Smokers showed the lowest prevalence of hypertension. Disability pensions due to cardiovascular disease were nearly 50% more frequent in both smokeless tobacco users and smokers. These findings indicate that an increased cardiovascular risk is also associated with the use of smokeless tobacco.

Low back and neck/shoulder pain in construction workers: occupational workload and psychosocial risk factors. Part 1: Relationship to low back pain.

The prevalence rate of musculoskeletal problems, especially low back pain and severe low back pain in a randomly selected sample of 1,773 construction workers was studied. Its relationship to physical and psychosocial factors was analyzed. The workers answered a postal questionnaire. Workload was measured by means of eight manual materials handling indices and ten psychosocial indices, based on results from factor analyses. The 1-year prevalence rate of low back pain was 54% and of severe low back pain 7%. The relationship to heavy manual materials handling differed with age in such a manner that it could be interpreted as a healthy worker effect. Between severe low back pain and both stooping or kneeling a dose-response relationship was found. The most prominent of the psychosocial factors associated with low back pain and severe low back pain were the stress index and the psychosomatic and psychic indices. The age-standardized prevalence rate ratio of low back pain was 1.6 (95% confidence interval 1.4-1.8) and for severe low back pain 3.1 (95% confidence interval 2.3-4), when workers reporting "high" stress were compared to workers reporting "low" stress.

Low back and neck/shoulder pain in construction workers: occupational workload and psychosocial risk factors. Part 2: Relationship to neck and shoulder pain.

The prevalence rate of neck and shoulder trouble and considerable neck and shoulder pain in a randomly selected sample of 1773 construction workers were studied. The relationship to physical and psychosocial factors was analyzed. The workers answered a postal questionnaire. Workload was measured by means of eight manual materials handling indices and ten psychosocial indices, based on results from factor analyses. The 1-year prevalence rate of considerable neck and shoulder trouble was 56% and of neck and shoulder pain 12%. To work with hands above shoulder level showed a dose-response relationship to both neck and shoulder trouble and neck and shoulder pain. The psychosocial factors were more prominently associated with neck and shoulder trouble and neck and shoulder pain than the physical workload factors. The psychosocial indices; psychosomatic and psychic symptoms, stress and job satisfaction showed the highest age-standardized prevalence rate ratios for both neck and shoulder trouble and neck and shoulder pain.

Quantitative analysis of the accumulation of Zein mRNA during maize endosperm development.

In order to characterize the heterogeneity and expression of maize zein genes, we constructed and characterized a cDNA library of endosperm mRNAs. Clones from the library that were of sufficient size to be full-length or near full-length copies of zein mRNA were characterized by restriction enzyme mapping and cross-hybridization analysis. Based on these comparisons we found three classes of zein sequences corresponding to proteins of Mr 22,000, five corresponding to proteins of Mr 19,000, and a single one corresponding to a protein of Mr 15,000. Representative clones from these nine groups were used as probes to measure levels of the corresponding mRNAs in developing endosperms. It was found that these groups represent varying amounts of transcripts that range from 2 to 20% of the total endosperm mRNA population. For the Mr 19,000 and Mr 22,000 zein clones there is a correlation between the amount of mRNAs and the apparent number of genes in the genome. The relative level of mRNA for the Mr 15,000 zein was found to be 3 times that of the Mr 22,000 and Mr 19,000 zeins, suggesting that these genes are transcribed at a higher rate during endosperm development or that their mRNAs are more stable.

Nucleotide sequence analysis of zein mRNAs from maize endosperm.

A comparison of the DNA and protein sequences of a group of zein cDNA clones reveals that they share extensive sequence homology and probably originated from a common ancestral gene. A comparison of clones corresponding to Mr 22,000 polypeptides shows they are 92% homologous, while five clones corresponding to the Mr 19,000 zeins vary in homology from 75 to 95%. The clones corresponding to the Mr 22,000 proteins are 60-65% homologous to clones encoding the Mr 19,000 zein proteins. A clone corresponding to the Mr 15,000 zein has little homology to either the Mr 22,000 or 19,000 zeins. Clones corresponding to both the Mr 22,000 and 19,000 zeins have two putative polyadenylation signals. S1 nuclease mapping indicates that the first polyadenylation signal following the stop codon is utilized by the Mr 22,000 sequences, while primarily the second polyadenylation signal is utilized by the Mr 19,000 sequences.

Post-partum release of prostaglandin F(2alpha) and uterine involution in the cow.

Peripheral plasma levels of the main blood plasma metabolite of PGF(2alpha) (15-keto-13,14-dihydro-PGF(2alpha)) and progesterone were investigated during the immediate, post-partum period in 59 normally calving cows. Uterine involution was monitored by weekly rectal palpations. The levels of the prostaglandin metabolite were high at parturition and remained thereafter elevated for periods varying up to 7-23 days. Uterine involution was completed during periods ranging from 16-53 days. According to the clinical findings, the animals were divided into three groups. Group A comprises 46 animals which had an uncomplicated, puerperal period. A significant (p<0.001) correlation between the duration of elevated prostaglandin levels and the time for completed uterine involution (Y=29.6 - 1.3 (X - 13.5)) was found for these animals. Group B animals (n=8) had periods of varying length with uterine discharge during the first 30 days post-partum. When compared to group A animals, the animals in group B had comparatively longer periods of prostaglandin release and also longer periods for completion of uterine involution. Group C animals (n=5) at times had palpable, thin-walled, cystlike structures in the ovaries during the first 30 days post-partum. In this group of animals, the periods of high prostaglandin levels, as well as for the completion of uterine involution, were similar to those for the animals in group A. Progesterone levels remained low during the immediate post-partum period and in no case were elevated levels found until the prostaglandin release had ceased.

On the control of prostaglandin release during the bovine estrous cycle. Effects of cloprostenol injections.

The study comprise seven cows which were injected i.m. with 500 microgram of a synthetic prostaglandin analogue (cloprostenol) at different stages of their estrous cycles. Peripheral blood plasma levels of progesterone and the main blood plasma metabolite of prostaglandin F2 alpha, 15-keto-13,14-dihydroprostaglandin F2 alpha were determined. The injection of cloprostenol initiated luteolysis in all cases as evidenced by decreasing progesterone levels and occurrence of heat. In two animals injected on days 6 and 12, respectively, of the estrous cycle no release of endogenous prostaglandin F2 alpha was found. In animals injected on day 13 and 15 of their estrous cycles, respectively, a minor but sustained release of prostaglandin F2 alpha was found. In three animals injected on days 17, 17 and 19 of their estrous cycles, respectively, the endogenous release of prostaglandin F2 alpha had already started and no specific effect attributed to the injection of cloprostenol could be observed. It is concluded that the injection of cloprostenol initiates luteolysis with subsequent heat and ovulation. The release of endogenous prostaglandin F2 alpha occasionally seen in conjunction with the induced luteolysis is different and less pronounced as compared to the release seen during normal luteolysis in the cow.