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PubMed1976

Physiopathologic responses of the rhesus monkey to live Escherichia coli.

The present study was designed to develop an animal model applicable to the clinical patient in the investigation of the pathogenesis of septic shock. The model currently described is a lightly anesthetized, unrestrained monkey, carefully monitored during a 24 hour observation period. Varying doses of live Excherichia coli organisms were infused intravenously during a 30 minute period, and a variety of hemodynamic, respiratory and metabolic parameters were monitored. Doses of organisms varied between 7.6X10(9) and 3.0X10(11) organisms per kilogram of body weight, and there was no obvious correlation between size of dose and survival time. Two of nine experimental monkeys survived the Excherichia coli, while times of death of the remaining monkeys varied between three and 27 hours. Two control monkeys, not administered organisms, survived the 24 hour period with minimal changes in all measured parameters. Results reveal two patterns in response to organism administration. These were early acute death, after three to four hours, and prolonged life, death after 20 to 27 hours. The acute response was characterized by marked systemic hypotension, hypoglycemia, hypoinsulinemia, increased lactate level, decreased pH or respiratory depression. The other type of response involved profound sustained hypotension with hypoglycemia and hypoinsulinemia in most monkeys and elevations in lactate, blood urea nitrogen potassium creatinine, serum glutamicoxalacetic, lactic dehydrogenase and fractionatedlactic dehydrogenase levels. Depressions in respiration were not evident in the group which survived a longer period of time. Renal fibrin thrombi, prominent in baboons administered Escherichia coli, were absent in the rhesus monkey regardless of the size of the dose of organisms. The results of this study suggest the operation of a multifactiorial mechanism in septic shock with interactions between hemodynamic and metabolic factors varying within the species.

Animals↗
PubMedDate not supplied

[Evaluation of the degree of compliance of Spanish scientific biomedical journals with international standards of presentation of periodicals].

BACKGROUND: Because standardization is important to ensure the successful transfer of scientific information, compliance with international standards for the presentation of periodicals in 205 Spanish biomedical journals, with the aim of improving their quality as instruments of information transfer, is evaluated. METHODS: Journals were identified by consulting five printed bibliographies and four electronic databases. A total of 136 parameters of evaluation for the presentation of periodicals derived from ISO (International Standardization Organization) standards (86%) and recommendations published by UNESCO, the International Committee of Medical Journal Editors, The Council of Biology Editors, and EJ Huth (14%) were evaluated. Three features (inclusion, presentation and location) were recorded for most data item, and the total number of items studied was 342. RESULTS: The rate of compliance with standards in Spanish biomedical journals was 33.5% +/- 8.5 (DE). Compliance was highest for items related with the identification of the journal in the text pages and the issue contents list. The lowest rates of compliance were found for items related the volume and the abstract sheet. The worst standardized journals were those published by private firms and public administration organizations. As a group, journals published annually were the best standardized. CONCLUSIONS: The low rate of compliance with standards did not reflect inadequate compliance with all items, but was rather the result of complete noncompliance with particular standards, especially those relating to the abstract sheet, volume front cover, volume contents list and volume index. To improve compliance a change in the policies governing the availability of standards, the preparation of guides and manuals for scientific periodical publishing, and the development of training programs aimed at authors, editors, publishers, librarians and information scientists, is suggested.

Bibliographies as Topic↗
PubMed1996

Interactive effects between 2,3,7,8-tetrachlorodibenzo-p-dioxin and 2,2',4,4',5,5'-hexachlorobiphenyl in female B6C3F1 mice: tissue distribution and tissue-specific enzyme induction.

The distribution of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and 2,2',4,4',5,5'-hexachlorobiphenyl (PCB 153) was studied in female B6C3F1 mice. Single doses of TCDD alone (0, 0.1, 1, or 10 micrograms [3H]TCDD/kg), PCB 153 alone (0, 3.58, 35.8, or 358 mg [14C]PCB 153/kg), and all possible combinations of these doses were administered in corn oil, po. At 7 days after dosing, 11 different tissues were analyzed for radioactivity. When TCDD was administered alone, TCDD-derived radioactivity distributed to all tissues in a dose-dependent manner, increasing with dose in the liver, while decreasing (as a percentage of the administered dose) in all other tissues. When PCB 153 was administered alone, the PCB 153 concentration was dose-dependently (percentage of dose) decreased in liver, skin, lung, adrenals, kidney, and blood; no dosimetric effects were observed in the other organs. Coadministration of low doses of both TCDD and PCB 153 resulted in little or no effect on the distribution of either compound. Interactive effects occurred in the pharmacokinetic behavior of both compounds only at higher doses. For example, the amount of TCDD in the liver was increased by 358 mg PCB 153/kg. In most other organs administration of PCB 153 resulted in a dose-dependent decrease in the TCDD content. Coadministration of PCB 153 with 10 micrograms TCDD/kg increased PCB 153 in the liver, but not in other tissues. These results clearly demonstrate that interactive effects on pharmacokinetic behavior occur only at high doses.

Adipose Tissue↗
PubMed1978

Policy, politics, and child health: four decades of federal initiative and state response.

This paper analyzes the continuity and change in the relationship between federal and state governments in the formation and implementation of child-health programs. After reviewing developments in federal child-health policy since the Sheppard-Towner Act of 1923, methods of implementation and changes in state laws and administrative organization in Vermont and Connecticut are compared with a focus on the major programs authorized by Title V of the Social Security Act. Four broad interactive areas of comparison--governmental relations, program delivery systems, expenditure patterns, and private interests--serve as vantage points for exploring, understanding and explaining the process of policy implementation. Specific conclusions are drawn regarding each area and the overall conclusion is that federal efforts under Title V have not lessened the general neglect of child health in state legislation; nor have they greatly expanded the volume of direct services for child care. They have been sufficiently ambiguous and diffuse to leave the providers dominant, treating diseases and existing conditions rather than focusing energy on preventive measures. Federal resources have been absorbed by expanding administrative overhead, state bureaucracies have been inflated rather than motivated.

Adolescent↗
PubMed1994

[Argyrophilic proteins of nucleolar organizer regions of macrophages and lymphocytes in bronchoalveolar lavage fluid from patients with diffuse lung diseases].

Alveolar macrophages and T-lymphocytes in bronchoalveolar lavage fluid from patients with diffuse lung diseases have been shown to be activated. The object of this study was to investigate whether the numbers of nucleolar organizer regions (NORs) in alveolar macrophages and lymphocytes were abnormally high in these patients or not. Alveolar macrophages and lymphocytes were collected by bronchoalveolar lavage from 7 control subjects, 36 patients with pulmonary sarcoidosis, 10 patients with hypersensitivity pneumonitis, 6 patients with measles pneumonia, 6 patients with mycoplasma pneumonia, and 6 patients with progressive systemic sclerosis related to interstitial pneumonitis. These cells were cytocentrifuged and stained by one-step silver staining. Argyrophilic proteins of the nucleolar organizer regions (Ag-NORs) were counted in 300 alveolar macrophages and lymphocytes. The numbers found in control subjects were compared to those found in patients with diffuse lung diseases. In the patients with sarcoidosis, these numbers were also compared among subgroups divided according to staging, involvement of other organs, administration of steroids, and differences in deposition of 67Ga. We also examined correlations between Ag--NORs and known markers of activation in sarcoidosis. The numbers of Ag-NORs were significantly greater in patients with diffuse lung diseases than in control subjects. There were no significant differences in the numbers of Ag-NORs among subgroups of patients with sarcoidosis. No correlations were seen between the Ag-NORs and the markers of activation of disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchoalveolar Lavage Fluid↗
PubMed2006

Effectiveness of oral route isosorbide 5-mononitrate on peritoneal solute and fluid transports in CAPD patients.

BACKGROUND: Addition of sodium nitroprusside (NaNTP), a nitric oxide (NO) donor to peritoneal solution could enlarge the effective peritoneal surface area and the peritoneal pore size. This would be leading to increased clearance of all solutes. Generalized clinical usage of NaNTP in CAPD patients however is not practical because it has a very short half-life and needs a specific route of administration. Organic nitrate, another NO donor, has a longer half-life and could be more easily absorbed via many routes. OBJECTIVE: The present study was conducted to determine the effect and mechanism of oral active nitrate (isosorbide 5-mononitrate: ISMN) on solute andfluid transports in stable CAPD patients. MATERIAL AND METHOD: A prospective randomized placebo control with a crossover study was performed in nine stable CAPD patients. In group I (n = 4), the treatment included 1) oral ISMN at the dose of 20 mg bid for 5 days 2) wash out period for 7 days, and 3) placebo for 5 days. In group 2 (n = 5), the treatment regimens were placebo, wash out, and ISMN periods. RESULTS: The MTACs of low molecular weight (LMW) solutes in the ISMN period were greater than the placebo period: median urea, 16.7 vs 13.8 ml/min; creatinine (Cr), 7.9 vs 6.9 ml/min; and urate, 6.1 vs 5.5 ml/min (p < 0.05 for all except MTAC of urea). Administration of ISMN could also enhance the clearances of high molecular weight (HMW) solute with a magnitude of increase as follows: 10% for beta2-microglobulin, 50% for albumin, and 15% for immunoglobulin G (p < 0.05 for all). However, the values of restrictive coefficient of LMW as well as HMW solutes of both groups were not different, indicating that the increased solute transports are not due to alteration in the peritoneal membrane permeability. Despite the increased peritoneal solute clearance, net ultrafiltration (UF) was unchanged after drug administration, 110 (ISMN group) vs 120 ml (placebo group), (NS). CONCLUSION: ISMN has a similar effect as NaNTP in enhancing peritoneal clearances of both LMW and HMW solutes. The effect of ISMN, however, is mediated only via expansion of peritoneal surface area without significant change in pore size. As such, administration of oral ISMN to stable CAPD patients would be practically beneficial in enhancing the achievement of target solute clearances suggested by NKF- DOQI Guidelines.

Administration, Oral↗
PubMed1995

Innovations in patient care: changing clinical practice and improving quality.

BACKGROUND: In the traditional hospital organization, administrators supply the resources while physicians determine their use. Given this dichotomy, a partnership between clinicians and hospital management is essential for efforts to enhance the quality of care while controlling costs. To foster this partnership, in 1986 the University of Rochester's Strong Memorial Hospital developed its Innovations in Patient Care (IPC) program, which several other medical centers have duplicated. CURRENT STATUS AND LOGISTICS: Hospital operating revenues of approximately $175,000 per year are provided to both fund proposals and support core IPC staff. Clinical staff submit proposals to study innovations to promote higher quality care and/or the efficient and appropriate use of diagnostic and therapeutic services. Many of the 77 projects funded to date have led to important changes in clinical practice. CASE STUDIES: One study, whose principal investigator was assistant director of emergency medicine, showed that structured, condition-specific (for example, asthma, pharyngitis, lacerations, and isolated closed-head injury) quicksheets improved documentation of clinical findings, resource use, and clinical practice. A study organized by the leadership of surgical nursing revealed that a nursing case management model led to reductions in patient length of stay and increases in nurse satisfaction. Another study, designed by a fellow in neonatalogy, developed and tested guidelines for the use of head ultrasounds in screening very-low-birthweight infants for intraventricular hemorrhage. CONCLUSIONS: IPC programs, which integrate well with initiatives in total quality management, can be effectively used to change clinical practice and improve the quality and efficiency of patient care.

Case Management↗
PubMed1997

[Adequate preservation of organs in brain-dead patients with a view to transplantation].

There exists a shortage of donor organs. Inadequate medical treatment of brain-dead patients results in one-third of the available organs not being suitable for transplantation. Adequate preservation of organs in brain-dead patients increases the supply and quality of donor organs. This preservation comprises the following measures: management of hypotension with a view to adequate perfusion of the organs (administration of fluid, if necessary erythrocytes, and of sympathicomimetic agents); adjustment of artificial respiration to the reduced carbon dioxide production in the tissues (lowering the respiratory minute volume) and to desired oxygenation (positive end-expiratory pressure, increase of the proportion of oxygen in the inhaled air, lengthening of the inspiration time); preventing excessive cooling of the body of the brain-dead patient due to failure of the temperature regulation (heating blanket, heating mattress, warming infusion fluids and inhaled air); treatment of diabetes insipidus in hypophyseal insufficiency (intravenous desmopressin); prevention and treatment on infections (antibiotics, bronchial toilet, variation of position).

Body Temperature Regulation↗
PubMed1989

Managed health care.

The fundamental components of managed-care plans are described; the development of managed-care programs is discussed; and the impact of managed care on pharmacy services and the price, quality, and accessibility of health care are reviewed. Health care can be considered to be managed when at least one of the following fundamental components is present: prospective pricing, "UCR" (usual, customary, and reasonable) pricing of services, peer review, mandatory use review, benefit redesign, capitation payments, channeling, quality criteria, and health promotion. The managed-care industry consists of health maintenance organizations (HMOs), preferred provider organizations (PPOs), and managed fee-for-service plans. Managed-care reimbursement principles involve transferring some or all of the impetus for controlling use of services to the health-care provider. Means by which this is done include prospective pricing, services bundling, price discounts and negotiated fees, and capitation financing and reimbursement. Financial risk-sharing arrangements with providers--including hospitals, physicians, pharmacies, and home-care companies--are necessary for any managed-care plan to attain true control over its service costs. Use-review and use-management services are also fundamental to containing health-care spending. These include retrospective, concurrent, and prospective reviews of the necessity and appropriateness of medical services. Use management, like services bundling and prospective pricing, has been more effective in reducing costs of hospital inpatient services than costs associated with ambulatory care. Per case payments and services bundling have made individual charges for items irrelevant to hospital revenue. This has forced hospital pharmacy managers to become more sensitive to cost management. Drug formularies, improved productivity, and use of prescribing protocols are means by which hospital pharmacies have controlled costs. However, since shorter hospital stays are not associated with a linear decline in the need for drug therapy, reducing pharmacy operating expenses in proportion to the decline in hospital occupancy is probably not possible. Community pharmacies have responded to managed care by forming pharmacy services administrative organizations. Application of managed-care principles has reduced the use of inpatient hospital services by Medicare beneficiaries, helped HMOs and PPOs to lower prices for some services, reduced use of hospital services by HMO members, and redirected some inpatient hospital care to alternate-care providers.(ABSTRACT TRUNCATED AT 400 WORDS)

Capitation Fee↗
PubMed1988

The effect of the antiprogestin RU 486 on uterine contractility and sensitivity to prostaglandin and oxytocin.

The effect of RU 486, a steroid acting as an antiprogestin at the receptor level, on uterine contractility and sensitivity to the prostaglandin analogue, 16-phenoxy-PGE2 methyl sulfonylamide (16-phenoxy-PGE2) and to oxytocin was studied in 29 women in early pregnancy. Seven untreated women at the same stage of pregnancy served as controls. In the untreated women no spontaneous uterine contractility was recorded and the response to 0.25 mg 16-phenoxy-PGE2 was characterized by an increase in uterine tonus with superimposed irregular contractions of low amplitude. Treatment with 25 mg RU 486 twice daily resulted in the appearance of regular uterine contractions at 24 h in two out of five patients and in all patients at 36, 48 and 72 h after the start of RU 486 treatment. The withdrawal of progesterone influence changed the inactive early pregnant uterus into an active organ. Administration of 16-phenoxy-PGE2 caused an obvious stimulation of both frequency and amplitude of the contractions. In addition, the significantly increased sensitivity to the prostaglandin analogue, but not to oxytocin, was already apparent 24 h after the start of RU 486 treatment. We have previously shown that the addition of one intramuscular injection of 16-phenoxy-PGE2 on the fourth day of treatment with RU 486 (25 mg twice daily) significantly increased the abortifacient effect of the antiprogestin during early pregnancy. The present study suggests that a shorter treatment may be possible.

Abortion, Therapeutic↗
PubMed1975

[Experimental course in medicine at the University of São Paulo].

The structure, general objectives, characteristics, and administrative organization of the experimental course in medicine at the University of São Paulo, Brazil, are examined. The individual course subjects are then described, as are the six cycles, together with the class hours allotted to each, into which the course is divided: (1) basic instruction; (2) studies vertically integrated into the system; (3) the preclinical course; (4) the clinical course (corresponding to the fourth year); (5) the rotating internship; and (6) the elective internship. Including the internship system adopted in the last four years, the course comprises a total of 10,000 hours. Emphasized are: teacher training of instructors; position in the course of social sciences and medical psychology; factors adversely affecting the teaching of community medicine; effects on the student of the characteristics of the system adopted for practice during internship and in the teaching hospital. Establishment of a continuing process for stimulating attainment of the objectives, improving teaching methods, and securing the desired results is recommended as part of the experimental course.

Brazil↗
PubMed1992

Cardiac catheterization laboratory survey: 1990. Society for Cardiac Angiography and Interventions, Laboratory Performance Standards Committee.

A survey of 117 member cardiac catheterization laboratories was undertaken by the Society for Cardiac Angiography and Interventions. The survey included numbers and types of procedures, both diagnostic and interventional, in adult as well as pediatric age groups. Radiation safety, various laboratory policies, frequency of short stay, and outpatient procedures were tabulated. Report generation, training programs, administrative organization, and laboratory equipment were all included. The results were compared with a 1978 survey. Areas of concern in terms of safety of the patient and possible underutilization of laboratories were identified.

Angioplasty, Balloon, Coronary↗
PubMed2005

S100b counteracts effects of the neurotoxicant trimethyltin on astrocytes and microglia.

Central nervous system degenerative diseases are often characterized by an early, strong reaction of astrocytes and microglia. Both these cell types can play a double role, protecting neurons against degeneration through the synthesis and secretion of trophic factors or inducing degeneration through the secretion of toxic molecules. Therefore, we studied the effects of S100B and trimethyltin (TMT) on human astrocytes and microglia with two glial models, primary cultures of human fetal astrocytes and a microglia cell line. After treatment with 10(-5) M TMT, astrocytes showed morphological alterations associated with an increase in glial fibrillary acidic protein (GFAP) expression and changes in GFAP filament organization. Administration of S100B before TMT treatment prevented TMT-induced changes in morphology and GFAP expression. A decrease in inducible nitric oxide synthase expression was observed in astrocytes treated with TMT, whereas the same treatment induced iNOS expression in microglia. In both cases, S100B prevented TMT-induced changes. Tumor necrosis factor-alpha mRNA expression in astrocytes was not modified by TMT treatment, whereas it was increased in microglia cells. S100B pretreatment blocked the TMT-induced increase in TNF-alpha expression in microglia. To trace the mechanisms involved in S100B activity, the effect of BAY 11-7082, an inhibitor of nuclear factor-kappaB (NF-kappaB) activation, and of PD98059, an inhibitor of MEK-ERK1/2, were investigated. Results showed that the protective effects of S100B against TMT toxicity in astrocytes depend on NF-kappaB, but not on ERK1/2 activation. These results might help in understanding the role played by glial cells in brain injury after exposure to chemical neurotoxicants and support the view that S100B may protect brain cells in case of injury. (c) 2005 Wiley-Liss, Inc.

Astrocytes↗
PubMed1985

Is the retina sensitive to the effects of prolonged blur?

Two preparations were used to study the developmental effects of prolonged blurring of retinal images on the acuities of retinal ganglion cells. Five kittens were raised from three weeks to six months of age with daily administration of atropine to one eye. Another two kittens were raised from three weeks to 16 weeks with a contact lens of high refractive power fitted to one eye. Behavioural estimates of the visual acuity were made for two animals from each group. Animals of both groups demonstrated an amblyopia in the experimental eye: visual acuity varied from 1.8 to 2.5 cycles per degree compared with 6.0 to 7.5 cycles per degree when using the normal eye. The spatial resolving properties were measured for retinal ganglion cells within the amblyopic eyes of two lens-reared cats and three atropinized cats. Brisk-sustained (X) cells were recorded from along the naso-temporal division. The acuities of ganglion cells from the lens-reared cats were indistinguishable from those from normal cats at comparable eccentricities. However, for the cats raised with atropine administration, sub-normal acuities were determined for retinal ganglion cells from all regions that were studied in the experimental eye. We conclude that blur of retinal images produced by external means has no effect on the resolving power of retinal ganglion cells. The lowered ganglion cell acuities encountered with the atropinized cats must be attributable to a secondary effect of the atropine administration. Organic changes in the retinal blood vessel pattern support this contention.

Animals↗
PubMed1996

Imipenem or cefoperazone-sulbactam combined with vancomycin for therapy of presumed or proven infection in neutropenic cancer patients.

The purpose of this prospective randomized study was to compare the efficacy and safety of imipenem and cefoperazone-sulbactam combined with vancomycin for the treatment of fever in neutropenic cancer patients. Patients were assigned to either imipenem 500 mg/m2 (500 mg for bone marrow transplant recipients) every 6 h or cefoperazone (2 g)-sulbactam (1 g) every 8 h All patients received vancomycin 1 g every 12 h. A total of 457 febrile or infectious episodes occurring in 407 patients were entered in the study. The response rate was 73% for imipenem plus vancomycin and 74% for cefoperazone-sulbactam plus vancomycin among the 369 episodes that could be evaluated. Response rates were comparable for the two regimens with regard to infecting organism, administration of antimicrobial prophylaxis, and neutrophil count and trend. The frequency of side-effects was significantly higher for imipenem plus vancomycin (11% vs.5%, p = 0.02), due to therapy-associated nausea and vomiting (5.3% vs. 0%, p = 0.0004). The overall frequency of superinfections was similar with both regimens, but Clostridium difficile colitis occurred significantly more often in patients receiving imipenem plus vancomycin (5 vs. 0, p = 0.02). In this study cefoperazone-sulbactam plus vancomycin was an effective alternative to imipenem plus vancomycin for initial therapy of fever in neutropenic patients.

Adolescent↗
PubMed1989

Socialized medicine or state-ruled medicine: the Venezuelan dilemma.

The economic crisis in which Venezuela is living, caused by the fall in oil prices, has forced the government to reorganize its medical services. A central administrative organ, the National Health Service, has been created. It seeks to develop a social medicine directed at the less favored classes of the population. Notwithstanding the continuously rising costs of private medicine, which, until now, the government has permitted without restrictions, the shadow of government intervention looms ominously over private practice, where subemployment of doctors already exists, along with the growing tendencies of insurance companies to impose economic conditions. The Venezuelan Medical Federation, which, by law, groups all Venezuelan doctors, has began a battle on two main fronts: against the State intervention and against the insurance companies who hope to benefit at the expense of the already underpaid doctors.

Education, Medical↗
PubMed2006

Northern Rivers Ecosystem Initiative: context and prevailing legacy.

The Northern River Ecosystem Initiative (NREI), 1997-2004, has provided new scientific knowledge in response to specific recommendations from its predecessor, the Northern River Basins Study (NRBS), 1990-1996. The two initiatives together provide a remarkable body of science which is, and will continue to be, used by resource managers responsible for economic and environmental sustainability in the northern watersheds of Alberta. The NREI focused its investigative efforts on improving our understanding related to ecological considerations of changes in river flow, effect of climate change on flow, ecological responses to pollution and cumulative effects, vulnerability of drinking water quality, and to a lesser degree, wildlife (birds) response to large scale changes within the watersheds. Key findings are briefly presented in this paper and discussed in greater detail in the other NREI papers included in this. Commensurate with the undertakings of NREI, provincial and territorial governments, First Nation and Métis communities, and other administrative organizations such as the Mackenzie River Basin Board, undertook policy, regulatory, and watershed initiatives towards achieving sustainability and providing reliable drinking water quality.

Alberta↗
PubMed1994

Public health nutrition: a historical perspective.

This historical perspective describes important milestones and selected threads of concern in the development of public health nutrition services. Emphasis is given to nutrition service for mothers, children, and families from the mid-1800s through the 20th century. Efforts in the 1800s were primarily directed to building the foundation for public health nutrition services: organizing state health departments and voluntary health agencies, initiating early nutrition investigations, and establishing milk stations and school lunch programs in large cities to supplement the food of the poor and to combat the high rates of morbidity and mortality of infants and children. During the 20th century, demographic changes; advances in nutrition science and technology; and social, political, and economic changes influenced the growth and development of public health nutrition services. Such changes included the high rates of disease and deaths among mothers and children, foods shortages during the wars; an increasing number of children in day care as more mothers went to work; the development of new programs to serve special groups such as the mentally retarded, chronically ill and handicapped, recent immigrants, and the aged; the continuing presence of poverty and hunger; the rising prevalence of behavior-related problems (eg, adolescent pregnancy and substance abuse); and a greater recognition of the benefits of health promotion and disease prevention. The number of public health nutritionists employed at national, state, and local levels increased to meet the rising demand for nutrition services. Graduate-level training programs and continuing education opportunities were developed and a broad range of nutrition standards and guidelines evolved. Throughout the 20th century, continuing threads of concern included nutrition policy and planning; development and evaluation of public health nutrition programs; organization, administration, and management of programs; quality of public health nutrition services, and the transfer and application of research into public health nutrition practice.

Dietary Services↗