Biomedical subjects
Publications and source records attributed to M J Kerr.
1. Increasing work force diversity is reflected in the Healthy People 2010 goal to eliminate health disparities. 2. At the organization level, a framework of cultural competence defines the developmental process toward cultural proficiency. 3. Strategies are suggested for organizations and nurses to engage in cultural competence.
In this project we tested the effectiveness of a theory-based intervention (video, pamphlets, and guided practice session) to increase the use of hearing protection devices (HPDs) among Midwestern construction workers and a national group of plumber/pipefitter trainers. Posttest measures were collected 10-12 months following this intervention. Pender's Health Promotion Model (1987) provided the conceptual basis for development of the training program. A total of 837 high-noise-exposed workers were included in the analysis: 652 regional Midwestern construction workers and 185 national plumber/pipefitter trainers. Effectiveness of the intervention was determined through the sequence of analyses recommended by Braver and Braver (1988) for the Solomon Four-Group Design. Analysis of variance and covariance of postintervention use and intention to use HPDs and a meta-analytic test were done. These analyses indicated that the intervention significantly increased use of HPDs but had no effect on intention to use HPDs in the future. Pretesting had no effect on use. Actual or potential applications of this research include guidance in the development of successful theory-based interventions to increase use of HPDs.
The purpose of this study was to describe construction workers' use of hearing protection devices (HPDs) and determine their perceptions of noise exposure and hearing loss. Operating engineers, carpenters, and plumbers/pipe fitters in the Midwest (n = 400) completed a written questionnaire regarding their use of HPDs and their perceptions of noise exposure and hearing loss. Subjects were recruited through their trade union groups. Mean reported use of HPDs and mean perceived noise exposure were compared across trade groups. Bivariate and multivariate analysis techniques were used to assess relationships between use of HPDs and trade category, education, age, years of employment, noise exposure, and hearing loss. Bivariate analyses identified significant differences in mean use of HPDs by age, years of employment, and trade group. Multivariate logistic regression assessing the independent effects of these variables found significant differences only by trade group. Results indicate a need for significant improvement in all three trade groups' use of HPDs, and suggest a need to consider use and exposure levels, demographics, and trade group membership in designing hearing conservation programs.
BACKGROUND: Transition to the International Society of Blood Transfusion (ISBT) bar code-labeling standard known as ISBT 128 is scheduled to begin July 1, 1997. Blood centers play a pivotal role in educating and assisting hospitals with the implementation of the new standard. A communication plan and hospital guidelines to facilitate the actual transition to ISBT 128 are integral parts of a blood center's comprehensive implementation strategy. STUDY DESIGN AND METHODS: In Phase 1, the blood center identified specific target groups within the hospitals and developed educational materials for them. A survey tool was used to identify unique hospital needs. Subsequent blood center newsletters and customer service forums included ISBT 128 updates. In Phase 2, guidelines to assist hospitals with the identification of critical elements, milestones, and target dates for the transition were developed with hospital staff input. RESULTS: Survey results on the change to ISBT 128 showed that many hospitals were unfamiliar with this change and its effects on operational issues. Various forums to disseminate information about ISBT 128 are needed to provide education and assistance to diverse groups within the hospital. CONCLUSION: A partnership approach between hospitals and the regional blood center should promote a successful transition from the current bar code symbology, American Blood Commission Codabar, to ISBT 128.
In this study, we used the conceptual Health Promotion Model to identify predictors of hearing protection use among blue-collar workers (N = 504). The strongest predictors were self-efficacy, benefits, value, and barriers. Items in the barriers scale were most strongly correlated with use and had the greatest potential for change. Therefore, items from this scale are being used as the primary basis for development of a training intervention program.
1. With increasing national concern about adult health and reducing health care costs, more research about these issues is being carried out in the worksite. 2. The worksite generates a variety of complications that may not be present in many other research settings; these include management policies, plant regulations, and management/labor relations. 3. The researchers review issues related to conducting research at the worksite and, based on their experience in this setting, make recommendations for resolving these issues.
Total energy expenditure (TEE) was measured simultaneously in 36 free-living children aged 7, 9, 12, and 15 y over 10-15 d by the doubly labeled water (DLW) method and for 2-3 separate days by heart-rate (HR) monitoring. The 95% confidence limits of agreement (mean difference +/- 2SD) were -1.99 to +1.44 MJ/d. HR TEE discrepancies ranged from -16.7% to +18.8% with 23 values lying within +/- 10% of DLW TEE estimates. Boys and girls spent 462 +/- 108 and 318 +/- 120 min/d, respectively, in total physical activity (P less than 0.01). Time spent in moderate and vigorous physical activity (MVPA) was 68 +/- 37 min/d by younger children (7-9 y) and 34 +/- 24 min/d by older children (12-15 y) (P less than 0.001). Younger boys engaged in MVPA (91 +/- 33 min/d) and vigorous physical activity (VPA) (35 +/- 15 min/d) significantly longer than younger girls (MVPA, 39 +/- 16 min/d, P less than 0.001; VPA, 10 +/- 4 min/d, P less than 0.01) as did older boys (MVPA, 52 +/- 21 min/d; VPA, 30 +/- 18 min/d) compared with older girls (MVPA, 15 +/- 10 min/d; VPA, 8 +/- 5 min/d). HR monitoring provides a close estimation of the TEE of population groups and objective assessment of associated patterns of physical activity.
This study was conducted with 62 Mexican-American migrant farm workers at four different sites in northern Illinois. An established English and a newly developed pilot Spanish version of the health-promoting lifestyle profile was used. The concept of health-promoting lifestyle appeared to be culturally relevant to study participants. English-speaking migrant workers scored significantly lower than Spanish-speaking workers on the dimensions of self-actualization, exercise, and stress management. Patterns of scores among both groups were highest in self-actualization and interpersonal support, and lowest in health responsibility and exercise. Further research in health-promoting behaviors with all cultural groups and socioeconomic levels of society will contribute to achievement of the World Health Organization's goal, health for all by the year 2000.
The effect of clindamycin on Fc receptor expression has been investigated with mouse peritoneal macrophages and human peripheral blood monocytes. When monolayers of these cells were treated with therapeutic concentrations of clindamycin for periods up to 1 hr at 37 degrees C binding of IgG2b coated sheep erythrocytes (EAG) was inhibited. No effect was observed at 4 degrees C or 22 degrees C. An independent effect of the antibiotic on the sheep erythrocytes was noted when they were pretreated with clindamycin that resulted in enhanced binding to the mouse but not the human phagocytes. These findings are discussed in relation to possible in vivo actions of the antibiotic.
The effects of intravenously administered 8-(3-diethylaminopropyl)-6,6-dimethyl-(2-phenyl-1H-imidazo (4,5H))-isoquinoline-7,9-(6H)-dione dihydrochloride (AR-LH31) on experimentally induced ventricular tachycardia were studied in dogs. Ventricular tachycardia was produced in 6 anaesthetised dogs by the intravenous injection of ouabain (66.7 +/- 4.9 mg/kg). AR-LH31 administered by increasing bolus injections every 5 min completely suppressed the ventricular tachycardia with a return to sinus rhythm in 1 out of 6 dogs, with a partial return of sinus beats in a second dog. There was no return to sinus rhythm in the 4 remaining dogs after doses ranging from 1.75 to 15.75 mg/kg. Observations were made in 9 conscious dogs 22-24 hours after ligation of the anterior descending branch of the left coronary artery when a ventricular tachycardia was present. The administration of AR-LH31 by bolus intravenous injection in 4 dogs did not abolish the arrhythmia in any dog but increased the number of sinus beats. In 3 out of 4 dogs after a cumulative dose of 7.75 mg/kg, 60% of ventricular beats were of sinus origin. The effects of larger doses could not be studied be cause of adverse effects. In 5 dogs the administration of AR-LH31 by constant intravenous infusion at 16 mg/kg/h restored sinus rhythm in all dogs after a mean dose of 9.9 +/- 0.9 mg/kg. These studies indicate that AR-LH31 has anti-arrhythmic activity in dogs and highlight the importance of the method of administration in determining the effects of a drug.
1 Observations were made in five healthy subjects who exercised before and 2, 3, 6, 8 and 24 h after the oral administration on separate occasions of 160 mg oxprenolol, 160 mg slow release oxprenolol, 160 mg slow release oxprenolol with 0.25 mg cyclopenthiazide and placebo. Blood samples were obtained before and at 1, 2, 3, 6, 8, 12 and 24 h after drug administration and assayed for oxprenolol concentration. 2 The three formulations produced maximum reductions of 29% in the exercise tachycardia 3 to 6 h after drug administration. At 24 h the effects of the three preparations were not significantly different from placebo. 3 There were no significant differences in the plasma concentrations produced by the three formulations during the 24 h period. 4 These observations suggest that the slow release formulations of oxprenolol should be given twice daily to maintain cardiac beta-adrenoceptor blockade throughout a period of 24 h.
The University of Minnesota has developed a limited-cohort distance education graduate program to overcome geographic barriers and address the shortage of master's-prepared specialty nurses in rural areas of the upper Midwest. Such a program offers graduate nursing education in various specialty areas to distance sites for a predetermined, relatively short period.
In animals and man, the selective alpha 1-adrenoceptor antagonist indoramin reduces arterial pressure without increasing heart rate. We studied this mechanism of absence of reflex tachycardia in anaesthetised dogs. Indoramin reduced (p less than 0.05) arterial pressure with no reflex increase in heart rate, whereas phenoxybenzamine reduced (p less than 0.05) pressure but increased (p less than 0.05) heart rate. Atropine and propranolol pretreatment, vagotomy and division of the cardio-accelerator nerve did not prevent the reduction (p less than 0.05) in arterial pressure and heart rate seen with indoramin. Mexiletine, a drug which has membrane-stabilising activity, had no effect on heart rate or arterial pressure. Mexiletine and indoramin did not affect the increases in heart rate produced by stimulation of the cardio-accelerator nerve. Indoramin reduced (p less than 0.05) the increases in heart rate and arterial pressure produced by bilateral carotid occlusion, and potentiated the arterial pressure reduction but attenuated the heart rate response to intravenous isoprenaline. It also reduced (nonsignificantly) the responses to intravenous noradrenaline and phenylethylamine but had no effect on the arterial pressure and heart rate responses to bilateral central vagal stimulation. We conclude that the absence of the reflex tachycardia with hypotensive doses of indoramin does not result from the myocardial membrane-stabilising action of indoramin or from alteration in sympathetic and parasympathetic activity, but may occur partly from a reduction in baroreceptor sensitivity.
Encainide (E) is a class I antiarrhythmic agent which is metabolised in humans, with the formation in the majority of patients of O-demethyl encainide (ODE) and 3-methoxy-O-demethyl encainide (MODE). As it has been suggested that these metabolites may contribute to the antiarrhythmic effect of E in humans, we have investigated the effects of E, ODE, and MODE on ventricular arrhythmias produced by ouabain and by coronary artery ligation. In the ouabain model, E restored sinus rhythm (SR) in eight of 13 dogs after a mean dose of 0.81 +/- 0.19 mg/kg (mean +/- SEM). ODE returned SR in five of 10 dogs after 0.30 +/- 0.06 mg/kg, and MODE returned SR in two of nine dogs after doses of 0.40 and 0.68 mg/kg, respectively. For comparison, mexiletine returned SR in six of six dogs after 3.50 +/- 1.02 mg/kg. In conscious dogs with ventricular arrhythmias 24 h after two-stage coronary artery ligation E restored SR in four of four dogs after 2.38 +/- 0.50 mg/kg. ODE restored SR in four of four dogs after 0.63 +/- 0.14 mg/kg, and MODE restored SR in four of four dogs after 1.39 +/- 0.30 mg/kg. Thus, ODE and MODE have antiarrhythmic activity which may contribute to the effects of E in patients with cardiac arrhythmias.
Pinacidil, a new vasodilator compound, has been shown to lower blood pressure in animals and humans by a direct vasodilator effect. We have studied the effects of pinacidil on experimental cardiac arrhythmias in dogs. Pinacidil did not exhibit antiarrhythmic activity on ouabain-induced arrhythmias. In contrast, verapamil had minor antiarrhythmic activity on the ouabain arrhythmia, restoring sinus rhythm in one-third of the dogs studied. Pinacidil suppressed the arrhythmia present 22-24 h after coronary artery ligation at doses which produced a significant reduction in mean arterial pressure. The antiarrhythmic action of pinacidil was not modified by pretreatment with propranolol but appeared to be blunted by the infusion of the alpha-agonist, phenylephrine. Other hypotensive agents, hydralazine and sodium nitroprusside, although producing similar reductions in mean arterial pressure to pinacidil, did not exhibit a consistent antiarrhythmic action in dogs 22-24 h after coronary artery ligation. The calcium antagonist verapamil did not display antiarrhythmic activity on this model. The mechanisms by which pinacidil exerted an antiarrhythmic action have not yet been elucidated. The results of the present study suggest that further studies with pinacidil on myocardial infarct size, myocardial perfusion, and experimental cardiac arrhythmias would be advantageous.
INTRODUCTION: Consistent use of hearing protection devices (HPDs) decreases noise-induced hearing loss, however, many workers do not use them consistently. Past research has supported the need to use a conceptual framework to understand behaviors and guide intervention programs; however, few reports have specified a process to translate a conceptual model into an intervention. PURPOSE: The strongest predictors from the Health Promotion Model were used to design a training program to increase HPD use among construction workers. SUBJECTS/SETTING: Carpenters (n = 118), operating engineers (n = 109), and plumber/pipefitters (n = 129) in the Midwest were recruited to participate in the study. DESIGN: Written questionnaires including scales measuring the components of the Health Promotion Model were completed in classroom settings at worker trade group meetings. MEASURES: All items from scales predicting HPD use were reviewed to determine the basis for the content of a program to promote the use of HPDs. Three selection criteria were developed: (1) correlation with use of hearing protection (at least .20), (2) amenability to change, and (3) room for improvement (mean score not at ceiling). RESULTS: Linear regression and Pearson's correlation were used to assess the components of the model as predictors of HPD use. Five predictors had statistically significant regression coefficients: perceived noise exposure, self-efficacy, value of use, barriers to use, and modeling of use of hearing protection. Using items meeting the selection criteria, a 20-minute videotape with written handouts was developed as the core of an intervention. A clearly defined practice session was also incorporated in the training intervention. CONCLUSION: Determining salient factors for worker populations and specific protective equipment prior to designing an intervention is essential. These predictors provided the basis for a training program that addressed the specific needs of construction workers. Results of tests of the effectiveness of the program will be available in the near future.
PURPOSE: Laffrey's Health Conception Scale (LHCS), an instrument designed to measure personal definitions of health, was reduced with the intent of creating a useful yet less cumbersome version of the LHCS. DESIGN: The original form of the LHCS was tested in a preliminary study, and results were used as a basis for the reduction of the instrument. The original clinical and new overall wellness subscales were subsequently tested with a larger population of manufacturing plant workers. SETTING: One chemical plant and three Midwestern manufacturing plants. SUBJECTS: The sample for the preliminary study comprised 94 chemical plant workers. For the larger study, the sample comprised 892 subjects; because this instrument was part of a larger questionnaire to identify predictors of workers' use of hearing protection, only those workers who spent some part of their work time in areas of the plant which required hearing protection use were eligible to participate. MEASURES: The original LHCS was used in the preliminary study. The reduced LHCS was used in the larger study and psychometrically evaluated. RESULTS: The reduced LHCS accounted for 51% of the variance in definition of health; all but one item had loaded on one of the two factors with a loading of .41 or greater. The revised LHCS demonstrated excellent internal consistency. Two distinct factors, the clinical subscale and the overall wellness subscale, were isolated. CONCLUSIONS: The researchers recommend the reduced LHCS be used for assessing subjects' definition of health; the reduced instrument requires fewer items, and therefore less time, to measure individuals' definitions of health with excellent reliability.