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PubMed2000

Environmental practices for biomedical research facilities.

As a result of the Leadership Conference on Biomedical Research and the Environment, the Facilities Committee focused its work on the development of best environmental practices at biomedical research facilities at the university and independent research facility level as well as consideration of potential involvement of for-profit companies and government agencies. The designation "facilities" includes all related buildings and grounds, "green auditing" of buildings and programs, purchasing of furnishings and sources, energy efficiency, and engineering services (lighting, heating, air conditioning), among other activities. The committee made a number of recommendations, including development of a national council for environmental stewardship in biomedical research, development of a system of green auditing of such research facilities, and creation of programs for sustainable building and use. In addition, the committee recommended extension of education and training programs for environmental stewardship, in cooperation with facilities managers, for all research administrators and researchers. These programs would focus especially on graduate fellows and other students, as well as on science labs at levels K--12.

Biomedical Technology↗
PubMed2003

The impact of the national polio immunization campaign on levels and equity in immunization coverage: evidence from rural North India.

Few studies have investigated the impact of immunization campaigns conducted under the global polio eradication program on sustainability of polio vaccination coverage, on coverage of non-polio vaccines (administered under Expanded Program on Immunization (EPI)), and on changes in social inequities in immunization coverage. This study proposes to fill the gaps in the evidence by investigating the impact of a polio immunization campaign launched in India in 1995. The study uses a before-and-after study design using representative samples from rural areas of four North Indian states. The National Family Health Survey I (NFHS I) and NFHS II, conducted in 1992-93 and 1998-99 respectively, were used as pre- and post-intervention data. Using pooled data from both the surveys, multivariate logistic regression models with interaction terms were used to investigate the changes in social inequities. During the study period, a greater increase was observed in the coverage of first dose of polio compared to three doses of polio. Moderate improvements in at least one dose of non-polio EPI vaccinations, and no improvements in complete immunization against non-polio EPI diseases were observed. The polio campaign was successful, to some extent, in reducing gender-, caste- and wealth-based inequities, but had no impact on religion- or residence-based inequities. Social inequities in non-polio EPI vaccinations did not reduce during the study period. Significant dropouts between first and third dose of polio raise concerns of sustainability of immunization coverage under a campaign approach. Similarly, little evidence to support synergy between polio campaign and non-polio EPI vaccinations raises questions about the effects of polio campaign on routine health system's functions. However, moderate success of the polio campaign in reducing social inequities in polio coverage may offer valuable insights into the routine health systems for addressing persistent social inequities in access to health care.

BCG Vaccine↗
PubMed2005

Television health promotion in four countries.

OBJECTIVE: The research plan was to conduct a comparative, longitudinal field experiment in Russia, Hungary, the Czech Republic, and Poland to evaluate the effect of a nutritional and general health promotion television series. The series addressed four health topics: a healthy diet, avoidance of tobacco use and alcohol abuse, and enhanced physical activity. METHODS: Because of different infrastructure and contingency conditions in the four countries, data collection ranged from group-administered surveys at a central location to individual personal interviews using a quasi-experiment comparing viewers and non-viewers 18 y and older. It occurred between 1996 and 1998. RESULTS: Overall, the television programs were found to provide new, useful, and practical information to viewers. Most (53.4% to 64.0%) learned useful information. Nearly 33% or more (29.5% to 37.9%) intended to change their lifestyle, with about 25% or more (24.0% to 60.2%) of this group indicating that they would eat more fruits and vegetables. Subsequently, 16.7% to 45.0% reported actual dietary changes consistent with health promotion. CONCLUSIONS: The study addressed diet and nutritional patterns in this region and the underlying social and behavioral factors, topics on which there is very limited information. Methodologic equivalence was sought through consistent measures despite the differential research infrastructure in the four countries. Results indicated that viewers rated the nutritional and general health promotion television programs favorably and that media messages can be used to motivate and educate viewers. More sustained television programs focused on health promotion will benefit audiences in Central and Eastern Europe.

Adult↗
PubMedDate not supplied

Sustaining a diabetes in pregnancy program: a continuous quality improvement process.

Education regarding diabetes management is of utmost importance, especially during pregnancy when there are 2 patients being managed at the same time, a mother and a fetus. The level of education the mother receives affects both patients. The constant reevaluation and change in treatment plans based on those evaluations positively affects the outcomes for each of them. There are a number of complications associated with having uncontrolled diabetes during pregnancy. A diabetes in pregnancy management program can offer education, provide continuous evaluation of management options, decrease hospitalizations for glucose control, and decrease complications associated with uncontrolled diabetes. All programs must have a goal, a benchmark by which to measure themselves. Plans must be formulated using current and acceptable standards of care. Once implemented, there must be ongoing evaluation of outcomes to determine whether goals are being met. With implementation of the appropriate quality tools, programs can learn to formulate their plans, implement them, measure the results, improve outcomes, and sustain themselves.

Diabetes Complications↗
PubMed1994

Usefulness of oral quinidine-mexiletine combination therapy for sustained ventricular tachyarrhythmias as assessed by programmed electrical stimulation when quinidine monotherapy has failed.

In patients presenting with sustained ventricular tachyarrhythmias, when oral quinidine monotherapy fails as determined by programmed electrical stimulation, the degree of benefit observed with combination therapy with mexiletine is debated. We prospectively studied 20 consecutive patients (16 men and 4 women) aged 33 to 77 years (mean age, 62 +/- 11 years) who were treated with maximally tolerated quinidine and mexiletine combination therapy and who had ventricular tachyarrhythmias induced at baseline and during oral quinidine monotherapy. Coronary artery disease was present in 19 patients (95%). Programmed electrical stimulation was performed at 2 drive train cycle lengths with up to 3 extrastimuli at two ventricular sites. During follow-up study with combination quinidine-mexiletine therapy ventricular tachyarrhythmias were rendered noninducible in four patients (20%). The remaining 16 patients showed a significant slowing of their tachycardia cycle length (267 +/- 56 msec baseline vs 320 +/- 75 msec with quinidine vs 345 +/- 53 msec with combination therapy, p < 0.05). There was also an increase in the mean QTc interval (452 +/- 50 msec baseline vs 477 +/- 79 msec after quinidine vs 486 +/- 65 msec with combination quinidine-mexiletine therapy, p = not significant) and in the mean ventricular effective refractory period (246 +/- 25 msec baseline vs 281 +/- 37 msec after quinidine vs 290 +/- 25 msec with combination quinidine-mexiletine therapy, p < 0.05). We conclude that sustained ventricular tachyarrhythmias induced during quinidine monotherapy were rendered noninducible by oral combination therapy with quinidine-mexiletine in 20% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Acute and long-term efficacy of propafenone in patients with sustained ventricular tachyarrhythmias: assessment with programmed ventricular stimulation.

To determine the electrophysiological properties of oral propafenone, 50 patients (39 male and 11 female, aged 31 to 80 years) with sustained ventricular tachycardia or ventricular fibrillation underwent serial electrophysiological drug testing, using propafenone (750 to 900 mg daily) as the anti-arrhythmic regimen of first choice. During baseline study, all patients had inducible sustained ventricular tachyarrhythmias. After oral loading of propafenone, 37 patients (74%) remained inducible whereas 13 were rendered non-inducible. Among the still inducible patients, the mean VT rate decreased from 223 +/- 38 b.min-1 (baseline) to 172 +/- 32 b.min +/- 1 (P less than 0.001). Four patients showed an increase of VT rate during propafenone compared to the VT rate at control. Non-inducible patients were discharged on propafenone. During a mean follow-up period of 20 +/- 15 months, there were three non-fatal VT recurrences among the responders, two of them due to non-compliance. Thus, propafenone used as the anti-arrhythmic agent of first choice among patients undergoing serial electrophysiological drug testing for ventricular tachyarrhythmias proved effective in suppressing VT induction in 26%. With regard to arrhythmic events, these patients have a favourable outcome.

Administration, Oral↗
PubMed1998

NIMH during the tenure of Director Herbert Pardes, M.D. (1978-1984): The President's Commission on Mental Health and the reemergence of NIMH's scientific mission.

To summarize these 5-1/2 years, I would offer the following. NIMH--which, like the mental health field in general, has focused principally on services and broad social issues in the 1960s and 1970s--was modified to be a more scientific institute focused on basic biology and behavioral science, major clinical disorders, diagnosis, treatment, and epidemiology. NIMH in its entirety regained a high level of respect in the general NIH community and won increasing support from Congress and the Administration. Increasingly positive perceptions of NIMH may have had a positive effect on the recruitment issue in psychiatry; the numbers of U.S. recruits started to turn back upward. After the early assault by the OMB and the Reagan Administration on the NIMH budget, the year 1982 and 1983 led to a more supportive attitude, and so the threat to the vitality of NIMH and to its overall fiscal support relented. Programs in research training and mental health clinical training and the intramural program were sustained along with the preeminent focus on building extramural support. We recognized that support of the intramural program accounted for an unduly high proportion of overall NIMH research expenditures. In response, we set firm policies designed to build the extramural program while maintaining the strength of the intramural program without expanding it. I might note parenthetically that I had the opportunity to chair an Intramural Research Program Planning Committee convened by NIMH. Without anticipating Dr. Hyman's comments regarding this effort, I will say that we found the intramural research program to be a national resource that, with continued emphasis on scientific quality, should contribute greatly to the nation's mental health and scientific goals in the years ahead. Perhaps in the most global terms the era can be remembered as one in which NIMH shifted toward becoming a predominantly research institute with related education programs. On the one hand, we drew some limits regarding what was considered the purview of NIMH, and we focused much more on illness. On the other hand, we retained much of the richness of NIMH and its focus on the relationships between various disciplines, while catalyzing the extraordinary explosion of the capacity to understand brain and behavior and thereby bring greater promise to the effort to control psychiatric disorders. The excitement of the research and the greater enthusiasm of the government, along with NIMH's encouragement of citizen group activity, contributed to destigmatization and set the groundwork for a much stronger overall advocacy effort on behalf of NIMH, which has continued over the last 10 to 15 years. Simultaneously, attempts were made to secure more data regarding the usefulness of psychiatric treatments and their effectiveness. This too would serve us well in terms of a more favorable attitude toward improving insurance through Medicare and through other areas of mental health care reimbursement. It is an honor to have worked at NIMH. The staff members there are superb, and I want to express my thanks to them. The dedication of outstanding federal leaders is one of the powerful assets of this nation and has been central to the many accomplishments of NIMH.

Administrative Personnel↗
PubMed1987

Amiodarone in patients with recurrent sustained ventricular tachyarrhythmias: results of programmed electrical stimulation and long-term clinical outcome in chronic treatment.

Thirty-three patients with clinically recurrent ventricular tachyarrhythmias were treated with amiodarone (200 to 600 mg/day) during a mean follow-up period of 23.7 months. Prior to amiodarone therapy, sustained ventricular tachycardia or ventricular fibrillation was initiated in all patients at control electrophysiologic study; patients failed a mean of 5.7 drugs, as assessed by programmed electrical stimulation. At electrophysiologic study after a loading phase (1000 mg/day for 10 days), 10 patients had no inducible ventricular tachycardia, nine patients had nonsustained ventricular tachycardia, 13 patients had persistent sustained ventricular tachycardia, and one patient had ventricular fibrillation. Patients were continued on amiodarone alone regardless of the findings at the electrophysiologic study, and during follow-up patients with no inducible sustained ventricular tachycardia or fibrillation on amiodarone had no recurrent arrhythmias or sudden death. Six of 14 patients (43%) with sustained ventricular tachyarrhythmias still inducible had recurrent ventricular tachycardia/fibrillation, and four of them died suddenly (29%). Programmed electrical stimulation predicts a good clinical long-term outcome during amiodarone therapy. Patients with persisting fast tachyarrhythmias (cycle length less than or equal to 300 msec) on amiodarone and a low ejection fraction (less than 35%) seem to have a higher incidence of sudden death. In these patients, therapeutic approaches such as antiarrhythmic surgery or implantation of antitachycardia devices should be considered.

Amiodarone↗
PubMed1996

Teaching safety: evaluation of a children's village in Maryland.

OBJECTIVES: The purpose of this study was to evaluate Children's Village, a life safety education facility for children. SETTING: The study took place in Washington County, Maryland, a rural county. METHODS: Eight elementary schools with 20 second grade classrooms (410 students aged 7 and 8) were selected to participate. Using a quasiexperimental design, tests were administered to two cohorts of children before (pretest) and after (post-test) they attended the Children's Village during 1993-4. Parent and teacher surveys were also completed after the program. RESULTS: Among children who attended in December 1993-January 1994, there was a significant improvement in average test scores between the pretest (58% correct) and post-test (78%). Among children who attended in April 1994, there also was a significant improvement in test scores between pretest (74%) and post-test (85%). Among parents, 70% reported that their child learned a great deal at Children's Village and 33% reported having made changes in their home as a result. The parent survey also revealed that 25% of children and 35% of adults did not always wear their seat belts, and 74% of children did not always wear bicycle helmets. Teachers' responses to the program were generally positive. CONCLUSIONS: Children's Village brought together an extensive network of community leaders, parents, and teachers dedicated to safety education of children. The curriculum had a positive impact on children's knowledge and, to a lesser extent, on parents' safety practices. Program impact could be enhanced by more emphasis on automobile restraints and helmets (behaviors that parents reported were not consistently practiced) and by expanding the village services to parents as well as children. Others considering creating similar programs need to identify community leaders willing to commit the time, effort, and resources required to develop and sustain such programs.

Accident Prevention↗
PubMed2002

Building research capacity in family medicine: evaluation of the Grant Generating Project.

OBJECTIVE: To evaluate the Grant Generating Project (GGP), a program designed to train and assist family medicine researchers to secure funding as part of an overall strategy to increase research capacity in family medicine. STUDY DESIGN: Cross-sectional mail survey. POPULATION: First- through fourth-year participants in the GGP program starting from 1995. Participants were faculty members of American and Canadian family medicine departments. OUTCOME MEASURED: We measured cardinal features of primary care quality including first-contact care (accessibility and utilization), longitudinality (strength of affiliation and interpersonal relationship), comprehensiveness (services offered and received), and coordination of care. RESULTS: Most (18 of 23) GGP participants completed the survey. A total of 58 grants/contracts were submitted by respondents, representing approximately US$19.3 million. Currently, 17 (29%) are pending, representing $10.8 million (including training grants). Given the current track record, $4.8 million additional grants funds could be generated. GGP strengths cited by respondents included an effort to enhance family medicine research; personal attention, guidance, motivation, and feedback from GGP faculty and mentors; development of grant-writing skills; encouragement to attend family medicine meetings; ability to meet and learn from peers; mock study section experience; and the ability to teach, mentor, and encourage others as the GGP experience did for them. Major challenges cited were a variable degree of commitment from mentors, lack of a long-term commitment to participants, and difficulty accommodating the research focus and skill level of participants. In general, most respondents regarded the GGP program as well worth the time and effort invested. CONCLUSIONS: One to 2 years after participating in the program, participants achieved a remarkable track record of grant submissions. Moreover, the GGP program has had a substantial impact on participants; many are now teaching and mentoring others in their department. If sustained, the program will greatly increase the research capacity of the discipline of family medicine.

Adult↗
PubMed2003

Cancer prevention in underserved African American communities: barriers and effective strategies--a review of the literature.

African Americans suffer significantly more cancer morbidity and mortality than the white population. In order to decrease this differential, it is critical to understand the particular barriers to health and health care that underserved African Americans face. It is also important to identify the critical components of effective cancer prevention programs for this population. The barriers that impede care for underserved African Americans have been identified as: 1) inadequate access to and availability of health care services; 2) competing priorities; 3) lack of knowledge of cancer prevention and screening recommendations; 4) culturally inappropriate or insensitive cancer control materials; 5) low literacy; 6) mistrust of the health care system; and 7) fear and fatalism. Effective programs must incorporate community participation, innovative outreach, use of social networks and trusted social institutions, cultural competence, and a sustained approach. Programs that include these strategies are much more likely to be effective in reducing cancer incidence. Cancer ranks second only to cardiovascular disease as the leading cause of death in the United States. For the majority population, cancer incidence and prevalence have declined in recent years and cure rates for certain cancer diagnoses have improved. This can be attributed to progress in the development and implementation of prevention, early detection, and treatment strategies. However, despite these gains, medically underserved African American populations have not fared as well. When African American-white mortality rates are compared, African Americans are 1.3 times more likely to die of cancer than the general population. Data from the Bureau of Health Information, Wisconsin Department of Health and Family Services indicate that from 1996 to 2000, cancer accounted for 33% of deaths in African Americans aged 45-64 and 34% of deaths for those aged 65-74. To decrease the disparities in cancer morbidity and mortality between the African American and white population, it is critical to understand the particular barriers to health and health care that African Americans face. This paper is a literature review of the barriers that low-income African American populations confront in obtaining needed cancer prevention and detection and the characteristics of programs that have been effective in reaching these populations.

Black People↗
PubMed2003

Evaluation of the Florida coordinated school health program pilot schools project.

The Florida Department of Education, with CDC funding, designed the Florida Coordinated School Health Program Pilot Schools Project (PSP) to encourage innovative approaches to promote coordinated school health programs (CSHP) in Florida schools. Each of eight pilot schools received $15,000 in project funding, three years of technical assistance including on-site and off-site assistance, a project office resource center, mailings of resource materials, needs assessment and evaluation assistance, and three PSP Summer Institutes. Project evaluators created a context evaluation, approaching each school independently as a "case study" to measure the school's progress in meeting goals established at baseline. Data were collected using the How Healthy is Your School? needs assessment instrument, a School Health Portfolio constructed by each school team, a Pilot Schools Project Team Member Survey instrument, midcourse team interviews, final team interviews, and performance indicator data obtained from pilot and control schools. The PSP posed two fundamental questions: "Can financial resources, professional training, and technical assistance enable individual schools to create and sustain a coordinated school health program?" and "What outcomes reasonably can one expect from a coordinated school health program, assuming programs receive adequate support over time?" First, activities at the eight schools confirmed that a coordinated school health programs can be established and sustained. Program strength and sustainability depend on long-term resources, qualified personnel, and administrative support. Second, though coordinated school health programs may improve school performance indicators, the PSP yielded insufficient evidence to support that belief. Future projects should include robust measurement and evaluation designs, thereby producing conclusive evidence about the influence of a coordinated school health program on such outcomes.

Adolescent↗
PubMed2004

Impact of peer group education on HIV prevention among women in Botswana.

A peer group HIV prevention intervention based on social-cognitive learning theory, gender inequality, and the primary health care model for community-based health promotion was developed for more than 300 urban employed women in Botswana. All women volunteered to participate in the intervention. To control for self-selection, matched workplaces were assigned to the intervention group or to the delayed control group. Compared with women in the delayed control group, women in the intervention group had significantly higher postintervention levels of knowledge of HIV transmission, sexually transmitted diseases (STDs), and HIV prevention behaviors; positive condom attitudes and confidence in condom use; personal safer sex behaviors; and positive attitudes toward persons living with HIV/AIDS and community HIV/AIDS-related activities. The peer group leaders have sustained the program for more than 5 years after the end of research funding. Peer groups are a low-cost and sustainable intervention that can change HIV prevention knowledge, attitudes, and behaviors for ordinary urban employed women in sub-Saharan Africa.

Botswana↗
PubMed2002

The challenge of implementing and sustaining integrated dual disorders treatment programs.

Integrated dual disorders treatment programs for people with severe mental illness and co-occurring substance use disorder have been implemented in a variety of community mental health center sites across the U.S. and in several other countries over the past 15 years. Consumers who receive services from programs that offer integrated dual diagnosis treatments that are faithful to evidence-based principles achieve significant improvements in their outcomes. Unfortunately, not all programs that attempt implementation are successful, and the quality of high-fidelity programs sometimes erodes over time. This article outlines implementation strategies that have been used by successful programs. As a general rule, success is achieved by involving all major participants (consumers, family members, clinicians, program leaders, and state or county mental health authorities) in the process and attending to the three phases of change: motivating, enacting, and sustaining implementation.

Community Mental Health Services↗
PubMed2006

Hepatitis B virus infection: epidemiology and vaccination.

Worldwide, two billion people have been infected with hepatitis B virus (HBV), 360 million have chronic infection, and 600,000 die each year from HBV-related liver disease or hepatocellular carcinoma. This comprehensive review of hepatitis B epidemiology and vaccines focuses on definitive and influential studies and highlights current trends, policies, and directions. HBV can be transmitted vertically, through sexual or household contact, or by unsafe injections, but chronic infections acquired during infancy or childhood account for a disproportionately large share of worldwide morbidity and mortality. Vaccination against HBV infection can be started at birth and provides long-term protection against infection in more than 90% of healthy people. In the 1990s, many industrialized countries and a few less-developed countries implemented universal hepatitis B immunization and experienced measurable reductions in HBV-related disease. For example, in Taiwan, the prevalence of chronic infection in children declined by more than 90%. Many resource-poor nations have recently initiated universal hepatitis B immunization programs with assistance from the Global Alliance for Vaccines and Immunization. Further progress towards the elimination of HBV transmission will require sustainable vaccination programs with improved vaccination coverage, practical methods of measuring the impact of vaccination programs, and targeted vaccination efforts for communities at high risk of infection.

Child Health Services↗
PubMed2005

Adapting the 'family wellbeing' empowerment program to the needs of remote indigenous school children.

OBJECTIVE: To adapt the Family Wellbeing empowerment program, which was initially designed to support adults to take greater control and responsibility for their decisions and lives, to the needs of Indigenous school children living in remote communities. METHOD: At the request of two schools in remote Indigenous communities in far north Queensland, a pilot personal development and empowerment program based on the adult Family Wellbeing principles was developed, conducted and evaluated in the schools. The main aims of the program were to build personal identity and to encourage students to recognise their future potential and be more aware of their place in the community and wider society. RESULTS: Participation in the program resulted in significant social and emotional growth for the students. Outcomes described by participating students and teachers included increased analytical and reflective skills, greater ability to think for oneself and set goals, less teasing and bullying in the school environment, and an enhanced sense of identity, friendship and 'social relatedness'. CONCLUSION: This pilot implementation of the Family Wellbeing Program adapted for schools demonstrated the program's potential to enhance Indigenous young people's personal growth and development. Challenges remain in increasing parental/ family involvement and ensuring the program's sustainability and transferability. The team has been working with relevant stakeholders to further develop and package the School-based Family Wellbeing program for Education Queensland's New Basics curriculum framework.

Child↗
PubMed2001

Ensuring the success of women faculty at AMCs: lessons learned from the National Centers of Excellence in Women's Health.

Since the early 1970s, the numbers of women entering medical school and, subsequently, academic medicine have increased substantially. However, women faculty have not advanced at the expected rate to senior academic ranks or positions of leadership. In 1996, to counter this trend, the U.S. Department of Health and Human Services (DHHS) Office on Women's Health included women's leadership as a required component of the nationally funded Centers of Excellence in Women's Health to identify effective strategies and initiate model programs to advance women faculty in academic medicine. The authors describe the experience of Centers at seven U.S. medical schools in initiating and sustaining leadership programs for women. The processes used for program formation, the current programmatic content, and program evaluation approaches are explained. Areas of success (e.g., obtaining support from the institution's leaders) and difficulties faced in maintaining an established program (such as institutional fiscal constraints and the diminishing time available to women to participate in mentoring and leadership activities) are reviewed. Strategies to overcome these and other difficulties (e.g., prioritize and tightly focus the program with the help of an advisory group) are proposed. The authors conclude by reviewing issues that programs for women in academic medicine will increasingly need to focus on (e.g., development of new kinds of skills; issues of recruitment and retention of faculty; and increasing faculty diversity).

Faculty, Medical↗
PubMed1987

Work group design in pharmacy: the pharmacist-technician team.

The contemporary pharmacy practice manager faces the challenge of designing pharmacy service programs that not only satisfy the needs of the patient, but at the same time satisfy and motivate the pharmacists and technicians who sustain the programs. This research examined the team design, which has been recommended but not fully described in the literature. This application did not explore the full potential of the team design in the hospital pharmacy setting. More study is needed in this area to assess the impact of work group design on the expansion of clinical programs, employee turnover rates, quality and quantity of work produced, and, most important, the impact on job satisfaction enjoyed by pharmacists and technicians.

Data Collection↗