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PubMed1996

Barriers to health promotion activities in public hospitals.

Despite the central role hospitals have in the health care system, relatively few health promotion activities are conducted in Australian public hospitals. This study investigated the types of obstacles that were perceived to inhibit health promotion activities in hospitals. A questionnaire for self-completion was sent to medical superintendents in all public hospitals in Queensland and 112 questionnaires were returned (92.6 per cent response rate). The results indicated that lack of finance, lack of interest by relevant others, and needs (for appropriate programs, training and patient receptivity) were the barriers reported by superintendents. The barriers of 'interest' and 'needs' were related to a lack of written policies in some areas, but not directly to levels of other health promotion activities being conducted in the hospitals. Success in facilitating health promotion programs in hospitals will need to include a change in the environment, in particular the views of medical superintendents. The combination of attitude change and the availability of a motivated person (such as a health promotion officer) to lead the activities may be needed in order to produce an increase in the level of health promotion in public hospitals.

Chi-Square Distribution↗
PubMedDate not supplied

Mutationism and the dual causation of evolutionary change.

The rediscovery of Mendel's laws a century ago launched the science that William Bateson called "genetics," and led to a new view of evolution combining selection, particulate inheritance, and the newly characterized phenomenon of "mutation." This "mutationist" view clashed with the earlier view of Darwin, and the later "Modern Synthesis," by allowing discontinuity, and by recognizing mutation (or more properly, mutation-and-altered-development) as a source of creativity, direction, and initiative. By the mid-20th century, the opposing Modern Synthesis view was a prevailing orthodoxy: under its influence, "evolution" was redefined as "shifting gene frequencies," that is, the sorting out of pre-existing variation without new mutations; and the notion that mutation-and-altered-development can exert a predictable influence on the course of evolutionary change was seen as heretical. Nevertheless, mutationist ideas re-surfaced: the notion of mutational determinants of directionality emerged in molecular evolution by 1962, followed in the 1980s by an interest among evolutionary developmental biologists in a shaping or creative role of developmental propensities of variation, and more recently, a recognition by theoretical evolutionary geneticists of the importance of discontinuity and of new mutations in adaptive dynamics. The synthetic challenge presented by these innovations is to integrate mutation-and-altered-development into a new understanding of the dual causation of evolutionary change--a broader and more predictive understanding that already can lay claim to important empirical and theoretical results--and to develop a research program appropriately emphasizing the emergence of variation as a cause of propensities of evolutionary change.

Animals↗
PubMed1975

Observations on the psychopharmacology of the aged.

Psychotropic drugs are discussed under the descriptive categories of antipsychotic, antidepressive, antimanic, anti-anxiety, and cognitive acting. In the antipsychotic classification, special attention is given to side effects (extrapyramidal motor signs, tardive dyskinesias, akathisis) and to dosage for the elderly. The section on congenitive acting drugs includes some pertinent observations on cognitive ability in the aging, the importance of correct diagnosis, and therapeutic strategy. The aged are a population at risk for not only disease, but iatrongenic illness due to direct and indirect drug action. Rational therapy involves understanding the underlying dynamics of the disease and thus the selection of the most effective treatment. Psychotropic drugs in an appropriate program are valuable therapeutic assets.

Aged↗
PubMed1991

One-year follow-up of automatic adaptation of the rate response algorithm of the QT sensing, rate adaptive pacemaker.

Optimal functioning of a rate adaptive pacemaker depends upon reliable sensing of the sensor and appropriate programming of the rate of response algorithm. QT sensing pacemakers use data derived from the endocardial electrogram in the programming of the rate response algorithm. In the latest versions of these pacemakers, programming of the rate response algorithm may be performed using either a semiautomatic Fast Learn (FL) procedure or by using the newly developed, fully Automatic Slope Adaptation (ASA) mechanism. We report our experience in a prospective study of 17 patients in the first year postimplantation. ASA was characterized by significant changes only in the values of the slope settings at the lower rate limit (3.7 msec/msec at time 0 to 5.77 msec/msec at 2 weeks, P less than 0.001) during the first 2 weeks after its enablement. Further adaptation between weeks 2 to 4 was observed (5.77 msec/msec to 6.4 msec/msec, P = 0.2) but this was not significant. The slope settings derived using the FL procedure were also checked at 2 and 4 weeks and were reproducible. They were closest in value to the values attained by the automated mechanism at 4 weeks. This suggests that the final value of the slope setting at the lower rate limit using ASA is reached between weeks 2 to 4. Both methods of slope determination result in satisfactory and similar rate response profiles but the time to achieve slope stability will necessarily be slower with ASA.

Algorithms↗
PubMed1997

Age and sex related changes in heart rate to ventilation coupling: implications for rate adaptive pacemaker algorithms.

Minute ventilation (VE) controlled rate adaptive pacemakers determine the paced rate increase during exercise by measuring changes in transthoracic impedance that have been shown to correlate well with VE. To determine the normal coupling of heart rate (HR) to VE this relationship was evaluated in 30 younger and 25 older, healthy subjects using peak cardiopulmonary exercise testing. After determining the anaerobic threshold (AT), the linear HR to VE slope was determined both below and above the AT. In addition, the entire curve of the HR to VE relationship was assessed by a "best fit" regression analysis method. The relationship of HR to VE was more often logarithmic in younger as compared to older subjects. The HR to VE slope below the AT was always steeper than above the AT in younger subjects. Females of both age subgroups demonstrated a significantly greater slope below and above the AT. For the appropriate programming of VE controlled, rate responsive pacemakers, one should take into consideration age- and sex-specific differences in the HR to VE relationship throughout exercise. Therefore, age- and sex-specific programmable features for rate responsive parameters should be incorporated into pacemakers using VE controlled rate adaptive algorithms.

Adult↗
PubMed1995

Creating a community of caring for families with special needs.

When parents are faced with the realization that their child has a disability or chronic illness, life is significantly changed. There can be tremendous emotional and economic stress as families seek diagnosis and treatment and face a bewildering search for appropriate programs. Uncertainty about the future and frustration with the present often leave caregivers overwhelmed. For these fragile families, a philosophy of family-centered care in their community is important. Ideally, this seamless system should offer continuity of care from birth through the childhood years and bridge medical, educational, and social services. Only in this environment can we assure that we are saving not only the infant but also the family.

Child↗
PubMed2005

Preferences, knowledge, communication and patient-physician discussion of living kidney transplantation in African American families.

It is unknown whether patient-physician discussion about live kidney transplantation (LT) among African Americans (AA) is affected by preferences, knowledge and family discussions regarding LT. We recruited 182 AA dialysis patients and their families and assessed the relation of preferences, knowledge and family discussions regarding LT to the occurrence of patient-physician discussion using multivariable logistic regression. Most patients (76%) desired a transplant, and most patients (93%), spouses (91%) and children (88%) had knowledge of LT. Nearly half of the families discussed transplantation. Only 68% of patients and less than half of their spouses (41%) and children (31%) had discussed transplantation with physicians. Patient-physician discussion was more common among patients: whose spouses acknowledged their interest in transplantation (adjusted odds ratio (AOR) (95% CI):3.5 (1.61-7.8)); who discussed transplantation with spouses (AOR(95% CI):5.25 (2.22-12.41)); whose spouses agreed that they discussed transplantation with patients (AOR (95%CI):5.20 (1.76-15.37)) and whose children discussed transplantation with patients' physicians (AOR (95%CI):7.4 (1.3-40.0)). Universal patient-physician discussion of LT does not occur despite patient preferences. Rates of family-physician discussions are low, and rates of family discussions vary. Early family-physician discussion of LT, use of allied health professionals to promote family discussion of LT and the institution of culturally appropriate programs to enhance discussion of LT in AA families could improve rates of discussion and enhance patients' access to LT.

Adult↗
PubMed2006

Spatiometabolic stratification of Shewanella oneidensis biofilms.

Biofilms, or surface-attached microbial communities, are both ubiquitous and resilient in the environment. Although much is known about how biofilms form, develop, and detach, very little is understood about how these events are related to metabolism and its dynamics. It is commonly thought that large subpopulations of cells within biofilms are not actively producing proteins or generating energy and are therefore dead. An alternative hypothesis is that within the growth-inactive domains of biofilms, significant populations of living cells persist and retain the capacity to dynamically regulate their metabolism. To test this, we employed unstable fluorescent reporters to measure growth activity and protein synthesis in vivo over the course of biofilm development and created a quantitative routine to compare domains of activity in independently grown biofilms. Here we report that Shewanella oneidensis biofilm structures reproducibly stratify with respect to growth activity and metabolism as a function of size. Within domains of growth-inactive cells, genes typically upregulated under anaerobic conditions are expressed well after growth has ceased. These findings reveal that, far from being dead, the majority of cells in mature S. oneidensis biofilms have actively turned-on metabolic programs appropriate to their local microenvironment and developmental stage.

Anaerobiosis↗
PubMed1980

Malignant lymphoma of the gastrointestinal tract. Erskine Memorial Lecture, 1979.

This paper reviews the literature concerning malignant lymphoma of the gastrointestinal tract. The diagnosis, pattern of dissemination, histologic data, prognosis, and results of treatment are discussed. The results suggest that localized lymphoma of the gastrointestinal tract is compatible with long-term survival and possible cure. A more careful look at the staging of the disease is warranted, as well as the development of appropriate programs of surgery, chemotherapy, and radiotherapy to maximize the potential for control of the disease while minimizing damage to normal tissue.

Adolescent↗
PubMed2006

Is the ipsilateral cortex surrounding the lesion or the non-injured contralateral cortex important for motor recovery in rats with photochemically induced cortical lesions?

PRIMARY OBJECTIVE: To determine whether the ipsilateral cortex surrounding the lesion or the non-injured contralateral cortex is important for motor recovery after brain damage in the photochemically initiated thrombosis (PIT) model. RESEARCH DESIGN: We induced PIT in the sensorimotor cortex in rats and examined the recovery of motor function using the beam-walking test. METHODS AND PROCEDURES: In 24 rats, the right sensorimotor cortex was lesioned after 2 days of training for the beam-walking test (group 1). After 10 days, PIT was induced in the left sensorimotor cortex. Eight additional rats (group 2) received 2 days training in beam walking, then underwent the beam-walking test to evaluate function. After 10 days of testing, the left sensorimotor cortex was lesioned and recovery was monitored by the beam-walking test for 8 days. MAIN OUTCOMES AND RESULTS: In group 1 animals, left hindlimb function caused by a right sensorimotor cortex lesion recovered within 10 days after the operation. Right hindlimb function caused by the left-side lesion recovered within 6 days. In group 2, right hindlimb function caused by induction of the left-side lesion after a total of 12 days of beam-walking training and testing recovered within 6 days as with the double PIT model. The training effect may be relevant to reorganization and neuromodulation. Motor recovery patterns did not indicate whether motor recovery was dependent on the ipsilateral cortex surrounding the lesion or the cortex of the contralateral side. CONCLUSION: The results emphasize the need for selection of appropriate programs tailored to the area of cortical damage in order to enhance motor functional recovery in this model.

Animals↗
PubMed1981

Overview: deinstitutionalization of psychiatric patients, a critical review of outcome studies.

The authors performed a critical review of experimental studies on the outcomes for psychiatric patients of 1) alternatives to hospital admission, 2) modifications of conventional hospitalization, and 3) alternatives to continued long-term hospitalization. The internal validity of many of the studies was compromised by shortcomings in design and performance and generalizability limited by selection of patient populations. With these qualifications experimental alternatives to hospital care of patients have led to psychiatric outcomes not different from and occasionally superior to those of patients in control groups. This conclusion is best supported for alternatives to admission and for modifications of conventional hospitalization. The available studies do not permit firm conclusions regarding alternatives to continued long-term hospitalization of chronically ill patients or for a critical analysis of the optimal management of specific subpopulations of psychiatric patients. Satisfactory deinstitutionalization appears to depend on the availability of appropriate programs for care in the community.

Adult↗
PubMed2004

Depression and the ability to work.

OBJECTIVE: Depression can have a serious impact on a person's ability to work. The purpose of this study was to describe depressed persons who work and depressed persons who do not work and to identify factors related to depressed persons' working. METHODS: The combined 1994 and 1995 National Health Interview Survey Disability Supplement was used to identify persons aged 18 to 69 with depression. Sociodemographic, health, functional, and disability characteristics of working depressed persons and nonworking depressed persons were compared with use of a chi square test of significance. After adjustment for sociodemographic variables, multiple logistic regression analysis was used to identify factors associated with work among depressed persons. RESULTS: Approximately half of the persons who reported major depression were in the labor force. Compared with nonworking depressed persons, working depressed persons tended to be younger, to be male, to be better educated, to have a higher income, to live alone or with a nonrelative, and to live in an urban or suburban location. They less often perceived themselves as unable to work or as disabled and were healthier and less impaired by social, cognitive, and physical limitations than their nonworking counterparts. After sociodemographic factors were controlled for, health and functional characteristics were strongly associated with depressed persons' working. CONCLUSIONS: Depressed persons who work and who do not work differed across sociodemographic, health, functional, and disability factors. Understanding the factors associated with depressed persons' working and not working may help policy makers, employers, and clinicians shape health care benefits packages, employee assistance programs, disability programs, and treatment programs appropriately. In particular, it may be important to focus on individuals with depression and comorbid general health conditions.

Adolescent↗
PubMed1986

Towards better nutrition: lip service or a realistic fight?

Progress towards the objective of the World Food Conference of 1974 that "no child should go to bed hungry" is reviewed. The low market price of primary products keeps developing countries poor. Yet in these countries industry rather than agriculture has been supported by governments. All regions are increasing total food production but population growth threatens to offset this increase. In some areas there is decrease in food production per head of population. In many countries the social situation of women affects the nutrition of families. Other causes of malnutrition are discussed and future policies are recommended.

Africa↗
PubMed1997

Potential for community relocation among residents of Alberta's psychiatric facilities: a needs assessment.

OBJECTIVE: To identify the proportion of residents in Alberta's psychiatric hospitals who would be relocatable to community-based alternatives to care if appropriate programs were made available. METHODS: A Survey of a representative sample of residents in all psychiatric hospitals and care centres was undertaken, excluding patients in specialized programs for forensic psychiatry, brain injury, and substance abuse. RESULTS: Findings indicate that 11% of institutionalized patients could be considered good candidates for relocation to community-based alternative care. A further 35% were considered to have potential for relocation provided an intensive and complex array of services was first made available. CONCLUSION: Results support a phased-in approach to hospital downsizing and the need for considerable transitional funding. Because hospital downsizing is unlikely to save dollars, at least in the short term, reforms must remain guided by humanitarian motivations to improve quality of life for persons with severe and persistent mental illnesses.

Activities of Daily Living↗
PubMed1992

Satisfaction of senior citizens in a nutrition education program with and without computer-assisted instruction.

This study assessed the receptiveness of senior citizens to the use of microcomputers in a nutrition education program at participating senior citizen subsidized housing sites. Participants in group A received the nutrition education program with computer-assisted instruction (CAI). Group B participants received the same nutrition education program, but without CAI. A validated Program Satisfaction Questionnaire was administered to assess overall satisfaction, satisfaction with the method of instruction, and satisfaction with the dietary analysis printout. Independent t-test analysis showed that group A was as satisfied as group B. The majority in group A indicated that learning to use the computer was not difficult and was "somewhat enjoyable" to "very enjoyable." These results indicated that senior citizens were receptive to CAI. Additionally, the use of the microcomputer with older adults was deemed possible for health-related educational programming. Appropriate modification of software was recommended to meet the physical limitations which occur with this age group.

Aged↗
PubMed2005

A qualitative study of exercise in older African American and white women in rural South Carolina: perceptions, barriers, and motivations.

Six focus groups were conducted with underactive African American (n = 16) and white (n = 23) women aged 50 years and older, residing in a nonmetropolitan county in South Carolina, to examine perceptions, barriers, and motivators related to exercise. Transcripts were coded and codes were entered into NUD*IST to assist with organizing and reporting themes. Participants could not reach consensus on the frequency, intensity, and duration of exercise needed for older women, and emphasized that PA recommendations should consider age, health, and physical abilities. While benefits and barriers to exercise were similar to those found in other groups, the risk of "overdoing it," being "too old," and environmental barriers specific to rurality were unique. Exercise enablers were also similar to those found in other groups, but rural women discussed the role that the church played in supporting exercise. Other enablers included transportation, free facilities, and age-appropriate programs. Results indicate the need to tailor recommendations and advice to older women, and to consider the rural context in which they live.

Black or African American↗