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PubMed1979

[Overlearning of a pursuit tracking task and change in pulse rate and finger skin blood flow (author's transl)].

Eight subjects were given overlearning of a pursuit tracking task twice which they experienced once either half or one year previously. Distributed practice was employed in the present experiments. Finger skin blood flow (SBF) and pulse rate (PR) were measured throughout the experiments. SBF was smaller during trials and during intertrial rests than during rest with eyes closed, but the difference between during trials and during intertrial rests was not significant. It was supposed that the reason for this effect of overlearning was that the increase in motivation resulted in a high level of activation during intertrial rests. The changing pattern of SBF during trials became similar to that in adding task of the previous study (1977) because of learning or habituation. In the second half of the trials, however, SBF during trials gradually became smaller.

Adult↗
PubMed2000

The effect of hormone replacement therapy and route of administration on selected cardiovascular risk factors in post-menopausal women.

BACKGROUND: There is increasing use of hormone replacement therapy (HRT) by post-menopausal women. Observational epidemiological studies have shown reductions in cardiovascular risk factors in HRT users in the USA, but no randomized controlled trials of HRT have been carried out in the primary practice setting. Previous studies of cardiovascular risk factors have shown a variety of responses according to type of progestagen and oral or topical administration. None has examined the effect of route using an identical progestagen. OBJECTIVES: Our aim was to establish differences, if any, in alteration in cardiovascular risk factors with HRT in post-menopausal women according to route of administration of HRT, oral, transdermal and implant, using first oestrogen alone then oestrogen plus norethisterone, or testosterone for implant. METHODS: Subjects were recruited by letter of invitation to women aged 50-65 years from lists in general practices local to the Charing Cross Hospital Lipid Clinic in West London. Their menopausal status was confirmed and they were randomized to one of three treatment groups or acted as controls. They attended for three visits; at baseline, HRT was initiated as oestrogen alone, oral or transdermal. At the 3-month visit, HRT with the progestagen, norethisterone, was given cyclically, continuously or transdermally until the final visit at 6 months. A separate group of women from the menopause clinic at Chelsea and Westminster Hospital were studied on oestrogen implant then on implanted oestrogen and testosterone. The outcome measures studied were the separate effects of the four regimes as compared with controls on lipoproteins, glucose, insulin, fibrinogen, factor VII and E-selectin, together with weight, waist:hip ratio and blood pressure. RESULTS: The continuous combined oestrogen-progestagen therapy had similar effects on cardiovascular risk factors as oestrogen with cyclical progestagen. All regimes lowered low-density lipoprotein cholesterol, the oral route being more potent than the parenteral; the effect of transdermal HRT was similar to the implant. Lp(a) was reduced only with the oral route. Reductions in factor VII and E-selectin were observed in both the oral and transdermal routes. There was no increase in body mass index, waist:hip ratio, blood pressure or glucose and insulin levels with any of the HRT regimes used. Systolic blood pressure was reduced with the transdermal route. CONCLUSIONS: This study supports the evidence that oestrogen-progestagen HRT, both oral and transdermal, although attenuating some of the benefit of oestrogen alone on fibrinogen and high-density lipoprotein, significantly reduces cardiovascular risk factors, which should diminish post-menopausal risk of coronary disease.

Cardiovascular Diseases↗
PubMed2002

Effect of generalist preceptor specialty in a third-year clerkship on career choice.

BACKGROUND AND OBJECTIVES: An association exists between student participation in a family medicine clerkship and student selection of family practice as a career. The effect of student exposure to other generalist specialties on career choice is unknown. This study determined if the specialty of an assigned generalist preceptor during a third-year ambulatory clerkship affected medical students' choice of a generalist career. METHODS: We conducted a retrospective cohort study of 464 medical students who were randomly assigned to either a family physician or a general internist for a 4-week, third-year ambulatory clerkship. RESULTS: There was no significant relationship between preceptor assignment and students' generalist career choice. Students assigned to general internal medicine preceptors were not more likely to choose careers in general internal medicine, nor were students assigned to family medicine preceptors more likely to select careers in family practice. CONCLUSIONS: Previous studies have suggested that generalist experiences during medical school can influence students' career preference. This study, however, indicates that the type of generalist experience received during the third year did not affect students' choice of a generalist career, nor did it influence their career choice between the generalist specialties.

Adult↗
PubMed2004

Determinants of impaired growth among hospitalized children: a case-control study.

CONTEXT: Protein energy malnutrition constitutes a public health problem, especially in less affluent countries. The identification of amenable predictive risk factors is of major importance for policy makers to plan interventions to reduce infant malnutrition. OBJECTIVE: To identify risk factors for protein energy malnutrition among hospitalized low-income children aged 6 to 24 months. TYPE OF STUDY: Case-control study. SETTING: Two public hospitals in Recife, Brazil. PARTICIPANTS: The cases were 124 infants with length-for-age below the 10th percentile of the National Center for Health Statistics curve and the controls were 241 infants with length-for-age equal to or above the 10th percentile who were recruited in the same infirmary. METHODS: Cases and controls were compared in relation to a variety of sociodemographic, environmental and reproductive factors, and their healthcare, previous feeding practice and morbidity. Logistic regression analysis was used to investigate the net effect of risk factors on infant malnutrition, after adjusting for potential confounding variables. RESULTS: The mother's age, possession of a TV set, type of water supply, family size and location of the home were significantly associated with child malnutrition in the bivariate analysis. However, these associations lost their significance after adjusting for other explanatory variables in the hierarchical logistic regression analysis. This analysis showed that low birth weight contributed the largest risk for impaired growth. Increased risks of infant malnutrition were also significantly associated with households that had no toilet facilities or refrigerator, high parity for the mother, no breastfeeding of the infant, inadequate vaccination coverage and previous hospitalization for diarrhea and pneumonia. DISCUSSION: The literature shows that chronic malnutrition, as assessed by low length-for-age indexes, is often related to low income. However, this was not the case in this study, in which other variables had greater impact on child growth. CONCLUSIONS: In view of the multiple causes of malnutrition, the interrelationship among its determinants should be taken into account when adopting strategies for its reduction and prevention.

Body Height↗
PubMed2000

Use assessment of self-administered epinephrine among food-allergic children and pediatricians.

BACKGROUND AND OBJECTIVES: Food allergy is a common cause of anaphylaxis, and early treatment with epinephrine can be life-saving. We sought to determine the ability of families with food allergic children and pediatricians to properly use self-injectable epinephrine. METHODS: We enrolled families of consecutive, food-allergic pediatric patients newly referred to our allergy practice but previously prescribed epinephrine and a sampling of pediatricians. Parents or teenage patients answered a structured questionnaire concerning use of self-injectable epinephrine and demonstrated the use of devices with which they were familiar. Demonstrations were scored in a standard manner. RESULTS: One hundred one families of food-allergic children (mean age of patients, 6.4 years) were enrolled. Self-injectable epinephrine was prescribed (mean of 2.7 years previously) primarily by pediatricians (n = 46) and allergists (n = 49). Patients were prescribed EpiPen (n = 93), EpiE-Z Pen (n = 11), and Ana-Kit (n = 3). Eighty-six percent of the families responded that they had the device with them "at all times," but only 71% of this group had epinephrine at the visit. Among those with the epinephrine, 10% had devices beyond the labeled expiration date. Thus, only 55% of the 101 families had unexpired epinephrine on-hand at the time of the survey. Among children in school, 77% had the medication available in school, and 81% stated that the school knew the indications for administration. Only 32% of the participants correctly demonstrated the use of the device. Twenty-nine attending pediatricians were enrolled (mean 14 yrs in practice; mean 4 epinephrine prescriptions/year). Familiarity with the devices was as follows: EpiPen (86%), EpiE-Z Pen (17%) and Ana-Kit (7%). Only 24% generally gave patients written materials concerning indications. Overall, 18% were familiar with and able to demonstrate correct use of at least 1 device (21% correctly demonstrated Epi-Pen). Seventeen pediatric residents were enrolled; 65% were familiar with the EpiPen; 36% demonstrated it correctly and only 1 resident was familiar with Ana-Kit. CONCLUSIONS: Many parents of severely food-allergic children, and food-allergic teenagers cannot correctly administer their self-injectable epinephrine and may not have the medication readily available. Pediatricians are not familiar with these devices and may fail to review their use with patients. Improved patient and physician education is needed to ensure proper use of this life-saving medication.

Adolescent↗
PubMed2005

Veterinary students as elite performers: preliminary insights.

The KPMG ''Mega Study'' (Brown JP, Silverman JD. The current and future market for veterinarians and veterinary medical services in the United States. J Am Vet Med Assoc 215:161-183, 1999) and other studies (Cron WL, Slocum JV, Goodnight DB, Volk JO. Impact of management practices and business behaviors on small animal veterinarians' incomes. J Am Vet Med Assoc 217:332-338, 1999; Lewis RE. Non-technical Competencies Underlying Career Success as a Veterinarian: A New Model for Selecting and Training Veterinary Students. Minneapolis: Personnel Decisions, 2002) concur that improvement in veterinary practitioner performance is necessary. Improvement in practitioners' non-technical competencies is considered most vital. Little research exists that identifies underlying psychological factors harbored by veterinary students that inhibit ability to achieve sustained maximum professional performance. Left unaddressed, these same characteristics may lead to coping behaviors that disrupt or, in the worst cases, lead to voluntary or involuntary termination of professional careers. Several performance-related characteristics and interpersonal dynamics are investigated in this study that provide preliminary evidence for the long-term shortcomings addressed in previous veterinary practice management literature. Pedagogical recommendations for addressing these student psychological characteristics are submitted for consideration.

Adult↗
PubMed2002

Treating obesity: a follow-up study. Can the stages of change model be used as a postal screening tool?

AIMS: We have previously shown that although a postal questionnaire based on the stages of change model (SCQ) failed to distinguish outpatients most likely to lose weight, it appeared to influence attendance rates. We therefore audited attendance upon receiving a pre-appointment SCQ in the post and compared this to previous standard practice in 1996. METHODOLOGY AND RESULTS: Seventy-eight obese outpatients (BMI 36.7 +/- 6.7 kg m-2, age 43 +/- 15 years) (mean +/- SD) were included. Twenty-nine per cent of patients failed to return an SCQ and were not sent an appointment and therefore did not block dietetic time. Eleven per cent returned an SCQ but did not attend (DNA) visit 1, whilst 21% attended visit 1 but DNA visit 2. Thirty-nine per cent attended both appointments and lost a significant amount of weight (105 +/- 23 vs. 103.2 +/- 23 kg, P < 0.0001) in 4 weeks. There was no difference in SCQ results between groups. Overall attendance rate at initial and follow-up appointments increased by 11%, while DNA rates fell by 20% compared with the 1996 audit. CONCLUSION: The SCQ has sifted out one in four patients who previously DNA an initial dietetic outpatient appointment. This has reduced waiting-list time as appointments are only book on return on the SCQ form, increased effective use of dietetic time through increased attendance rates, and lowered the DNA rate of follow-up appointments.

Adolescent↗
PubMed1995

Professional and business characteristics of radiology groups in the United States: 1992.

PURPOSE: In response to requests, to present information on the professional and business characteristics of radiology groups. MATERIALS AND METHODS: The American College of Radiology surveyed a stratified random sample of radiology groups, defining radiology group as any practice with two or more radiologists or radiation oncologists, including academic departments, units in multispecialty groups, and staff of government facilities. The 465 responses (69% response rate) were weighted so the data show what findings would have been if all radiology groups in the country had responded. RESULTS: ACR professional standards are widely used, particularly those for mammography and radiation oncology. Seventy-eight percent of groups required continuing training of their technologists. On average, groups required 2.7 years for new members to become full partners. The average group gave full-time radiologists 11 holidays, 26 vacation days, and 11 days for continuing medical education each year. On average, groups collected 71% of total billings. Net collections (after "allowances" for Blue Shield, Medicare, and other payers are deducted from billings) averaged 86%; half of services were provided by groups with net collection rates of 90% or more. CONCLUSION: In general, changes since 1989 (when the previous Group Practice Survey was conducted) were small.

Data Collection↗
PubMed2005

A randomized, controlled trial of a multifaceted intervention including alcohol-based hand sanitizer and hand-hygiene education to reduce illness transmission in the home.

OBJECTIVE: Good hand hygiene may reduce the spread of infections in families with children who are in out-of-home child care. Alcohol-based hand sanitizers rapidly kill viruses that are commonly associated with respiratory and gastrointestinal (GI) infections. The objective of this study was to determine whether a multifactorial campaign centered on increasing alcohol-based hand sanitizer use and hand-hygiene education reduces illness transmission in the home. METHODS: A cluster randomized, controlled trial was conducted of homes of 292 families with children who were enrolled in out-of-home child care in 26 child care centers. Eligible families had > or =1 child who was 6 months to 5 years of age and in child care for > or =10 hours/week. Intervention families received a supply of hand sanitizer and biweekly hand-hygiene educational materials for 5 months; control families received only materials promoting good nutrition. Primary caregivers were phoned biweekly and reported respiratory and GI illnesses in family members. Respiratory and GI-illness-transmission rates (measured as secondary illnesses per susceptible person-month) were compared between groups, adjusting for demographic variables, hand-hygiene practices, and previous experience using hand sanitizers. RESULTS: Baseline demographics were similar in the 2 groups. A total of 1802 respiratory illnesses occurred during the study; 443 (25%) were secondary illnesses. A total of 252 GI illnesses occurred during the study; 28 (11%) were secondary illnesses. The secondary GI-illness rate was significantly lower in intervention families compared with control families (incidence rate ratio [IRR]: 0.41; 95% confidence interval [CI]: 0.19-0.90). The overall rate of secondary respiratory illness was not significantly different between groups (IRR: 0.97; 95% CI: 0.72-1.30). However, families with higher sanitizer usage had a marginally lower secondary respiratory illness rate than those with less usage (IRR: 0.81; 95% CI: 0.65-1.09). CONCLUSIONS: A multifactorial intervention emphasizing alcohol-based hand sanitizer use in the home reduced transmission of GI illnesses within families with children in child care. Hand sanitizers and multifaceted educational messages may have a role in improving hand-hygiene practices within the home setting.

Anti-Infective Agents, Local↗