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PubMed1999

A randomized outcome evaluation of group exercise programs in long-term care institutions.

BACKGROUND: Physical activity programs in nursing homes typically consist of seated, range of motion (ROM) exercises, regardless of resident abilities. The Functional Fitness for Long-Term Care (FFLTC) Program was designed not only to maintain ROM, but also to improve strength, balance, flexibility, mobility, and function. In addition, it was tailored to meet the needs of both high and low mobility residents. METHODS: The feasibility and efficacy of the FFLTC Program were evaluated with 68 residents (mean age 80) from five institutions. Persons were classified as low or high mobility and randomized into either the FFLTC program or a seated ROM program. Classes were conducted in groups of 4 to 10 residents by trained facility staff for 45 minutes, three times per week. Assessments at baseline and 4 months consisted of mobility, balance, gait, flexibility, functional capacity, and several upper and lower extremity strength measures. RESULTS: Attendance averaged 86% for the FFLTC and 79% for the ROM classes. Four months of exercise led to significant improvements in mobility (16%), balance (9%), flexibility (36%), knee (55%), and hip (12%) strength for the FFLTC group. Shoulder strength was the only improvement found for the ROM group. The ROM group significantly deteriorated in some areas, particularly hip strength, mobility, and functional ability. CONCLUSIONS: Institutionalized seniors, even those who are physically frail, incontinent and/or have mild dementia, can respond positively to a challenging exercise program. The FFLTC program demonstrated clear benefits over typical, seated ROM exercises. Moreover, with minimal training, the program can be safely delivered at low cost by institutional staff and volunteers.

Activities of Daily Living↗
PubMed1998

Lifestyle physical activity interventions. History, short- and long-term effects, and recommendations.

INTRODUCTION: Lifestyle physical activity interventions have resulted in response to the public health problem of promoting regular amounts of physical activity to the majority of U.S. adults who remain inadequately or completely inactive. These lifestyle interventions allow a person to individualize his/her physical activity programs to include a wide variety of activities that are at least of moderate intensity and to accumulate bouts of these activities in a manner befitting his/her life circumstances. METHODS: We reviewed the history of lifestyle physical activity interventions and defined lifestyle physical activity based on this review. We located 14 studies that met this definition. RESULTS: Lifestyle physical activity interventions are effective at increasing and maintaining levels of physical activity that meet or exceed public health guidelines for physical activity in representative samples of previously sedentary adults and obese children. The majority of these interventions have been delivered by face-to-face contact in small groups, which limits their public health impact. However, a small number of studies demonstrate that these interventions can be delivered by mail and telephone, which may enhance their generalizability. Most of these studies utilized behavior change theories such as Social Cognitive Theory, the Transtheoretical Model, and Behavior Learning to shape the interventions. Lifestyle interventions aimed at modifying the environment, such as signs posted to increase stair climbing, also have been shown to be effective over the short term. CONCLUSIONS: The major issues concerning lifestyle physical activity interventions are: (1) testing their ability to be implemented on a large scale; (2) examining cost-effectiveness for different modes of delivery; and (3) researching the efficacy in populations such as the elderly, minorities, economically disadvantaged, and individuals with concurrent disease. More studies aimed at manipulating the environment to increase physical activity need to be tested over periods of one year or longer. It is possible that lifestyle interventions could be integrated and delivered by new technologies such as interactive computer-mediated programs, telephone, or computer web-based formats. All of these recommended approaches should utilize valid and reliable measures of physical activity and should examine the health effects, particularly on a longitudinal basis. Basic dose-response studies in controlled settings also are needed to help us understand the health effects of accumulated moderate intensity activity.

Adult↗
PubMed1994

Using concept mapping to develop a conceptual framework of staff's views of a supported employment program for individuals with severe mental illness.

This article describes the use of concept mapping to develop a pictorial multivariate conceptual framework of staff views of a program of supported employment (SE) for individuals with severe mental illness. The SE program involves extended individualized supported employment for clients through a mobile job support worker (MJSW) who maintains contact with the client after job placement and supports the client in various ways. All 14 staff members of a psychiatric rehabilitation agency with assignments associated with the SE program. They brainstormed a large number of specific program activity statements (N = 96), sorted and rated the statements, and interpreted the map that was produced through multidimensional scaling and hierarchical cluster analysis. The resulting map enabled identification of 4 issues that should be included in any theory of SE programs--the specific activity sequences that characterize the program itself; the pattern of local program evolution; the definition of program staff roles; and the influence of key contextual factors such as the client's family or the program's administrative structure. The implications of concept mapping methodology for theory development and program evaluation are considered.

Community Mental Health Services↗
PubMed1997

The effect of aspartame as part of a multidisciplinary weight-control program on short- and long-term control of body weight.

This study investigated whether the addition of the high-intensity sweetener aspartame to a multidisciplinary weight-control program would improve weight loss and long-term control of body weight. One hundred sixty-three obese women were randomly assigned to consume or to abstain from aspartame-sweetened foods and beverages during 16 wk of a 19-wk weight-reduction program (active weight loss), a 1-y maintenance program, and a 2-y follow-up period. Women in both treatment groups lost approximately 10% of initial body weight (10 kg) during active weight loss. Among women assigned to the aspartame-treatment group, aspartame intake was positively correlated with percentage weight loss during active weight loss (r = 0.32, P < 0.01). During maintenance and follow-up, participants in the aspartame group experienced a 2.6% (2.6 kg) and 4.6% (4.6 kg) regain of initial body weight after 71 and 175 wk, respectively, whereas those in the no-aspartame group gained an average of 5.4% (5.4 kg) and 9.4% (9.4 kg), respectively. The aspartame group lost significantly more weight overall (P = 0.028) and regained significantly less weight during maintenance and follow-up (P = 0.046) than did the no-aspartame group. Percentage weight losses at 71 and 175 wk were also positively correlated with exercise (r = 0.32, P < 0.001; and r = 0.34, P < 0.01, respectively) and self-reported eating control (r = 0.37, P < 0.001; and r = 0.33, P < 0.01, respectively). These data suggest that participation in a multidisciplinary weight-control program that includes aspartame may facilitate the long-term maintenance of reduced body weight.

Adult↗
PubMedDate not supplied

The impact of service delivery frequency on family planning program output and efficiency.

Operations research is the study of factors that can be controlled by program administrators. Among such factors is the frequency of performing program activities. The present experiment, conducted in Lima, Peru during 1985-86, tested the impact of holding family planning post sessions once per month, twice per month, and weekly. Frequency was shown to have a major impact on program outputs, costs, and cost-effectiveness. Depending on the indicator, sessions held twice per month produced between 1.5 and 2.1 times the output of those conducted once per month. Weekly sessions produced between 1.3 and 1.6 times the output of those held twice per month. At an output level of nearly 11,200 visits per year, twice-per-month sessions were estimated to be 7-38 percent more cost-effective, depending on the indicator, than once-per-month sessions, and 6-28 percent more cost-effective than weekly sessions.

Community Health Services↗
PubMed1996

Quality of care at school-aged child-care programs: regulatable features, observed experiences, child perspectives, and parent perspectives.

This study investigates children's experiences at 30 school-aged child-care (SACC) programs. Regulatable features such as total enrollment, child-staff ratio, and staff education were assessed via director report. Observers recorded positive/neutral and negative staff-child interactions, and rated programs in terms of flexibility and age appropriateness. Negative staff-child interactions were more frequent when child-staff ratios were larger and when staff had less formal education. The presence of a greater number of different types of program activities was associated with staff having more frequent positive interactions with children and with observers rating programs as flexible and age appropriate. These regulatable and observed features were examined in relation to children's (N = 180) and parents' (N = 152) perceptions of program psychosocial climate. Children's reports of overall climate, emotional support from staff, and autonomy/privacy provisions were predicted by program features. Children reported poorer program climate when programs had larger enrollments and when observers recorded more frequent negative staff-child interactions. Children had more positive program perceptions when programs offered a greater variety of activities. Children's reports of program climate in addition to observed child-staff ratios were associated with parental perceptions of the programs. Parents had more positive perceptions when child-adult ratios were smaller and when their children reported more positive climates. This study suggests a convergence between observer, child, and parent about factors contributing to quality of after-school programs.

Attitude↗
PubMed2000

[Evaluation of the operation of supporting programs for social activity of the elderly by city, town, village governments in Japan].

OBJECTIVES: The aim of this study is to clarify the operative situation of the supporting programs for social activity of the elderly by city, town, village governments in 1997. METHODS: We conducted a study of 3,255 of cities, towns and villages in Japan using a mailed questionnaire, which had been developed to assess the activities of supporting programs for social activity of the elderly. The questionnaire asks government officers whether they had each of the 33 programs in 1997. Each one of these programs belongs to one of the four different aspects of social activities: 1. employment, 2. social participation/volunteering, 3. education/training, 4. individual activities. For each program, the frequency of regions having the program were counted in total, as well as for each of four levels on governments scale: 1. ordinance-designated city, 2. city, 3. town, 4. village. The number of programs operated by the municipality were also evaluated. The main results were as follows One thousand six hundred (49.2%) of cities, towns and villages responded to our questionnaire. 1. Four programs, the promotion of clubs for elderly people, class/lecture meetings for the elderly, sporting events/athletic meetings for the elderly, and a respect-for-age congratulatory gift/money, were put into operation by over 80% of cities, towns and village governments. 2. The number of programs in total or for each of the three aspects of social activities except for social participation/volunteering tended to be high for the large scale governments. There were wide gaps in the number of programs among the regions even of the same level of the government scale. 3. The regions having supporting programs for employment consisted mainly of cities. Seventy-five percent of villages had no supporting program for employment. CONCLUSION: The operational situation of the supporting programs for social activity of the elderly by city, town, village governments was clarified. Furthermore, results obtained by this study can be used for self-assessment of operational situations by municipalities and can contribute to the activation of their supporting programs.

Aged↗
PubMedDate not supplied

Residency orientation: what we present and its effect on our residents.

BACKGROUND AND OBJECTIVES: This study describes the content of family practice residency orientation programs, presents data about resident satisfaction with orientation, and determines if residents feel prepared for residency duties. METHODS: We surveyed program directors and first-year residents at 100 family practice residency programs. We used questionnaires to collect data about orientation activities; program demographics; and resident characteristics, satisfaction, and preparation. RESULTS: Sixty-nine percent of directors and 68% of their residents responded. The activity most frequently presented was a social event with faculty, while the least frequently presented was an assessment of cognitive knowledge. Even though residents desire orientation to clinical programs, and directors wish to promote group cohesion, the greatest number of orientation activities were presented to introduce hospital services and administration. Eighty-seven percent of residents were at least "somewhat satisfied," and 83% felt at least "somewhat prepared" for clinical duties after completing orientations. Residents from military programs were more likely not to be satisfied with their orientations. Extreme satisfaction was associated with residents in community-based programs. Being totally prepared was associated with having had prior graduate medical education. CONCLUSIONS: While residents had previously reported having clinical needs from an orientation, the most frequently reported activities were nonclinical. Most residents reported having been satisfied with their orientations and having felt prepared for their new duties. Directors should consider increasing the clinical content of their orientations, including an assessment of residents' knowledge and clinical skills.

Consumer Behavior↗
PubMed1994

Locked posterior dislocation of the shoulder: treatment using rotational osteotomy of the humerus.

This study reports the use of rotational osteotomy in 10 patients with locked posterior dislocation of the shoulder. The average interval between injury and diagnosis was 155 days (range, 21-400 days). Patients were aged 40-78 years old, with an average age of 53 years. Articular impaction fracture of the humeral head involved 20-40% of the articular surface as determined by CT analysis. There were no postoperative complications except a transient axillary nerve palsy. Patients were started on immediate passive motion followed by an active program at 2-3 weeks. Using the Rowe/Zarins scale, six patients had good-excellent results, two fair results, and two poor results. The poor results were seen in cases where articular cartilage damage was advanced. Rotational osteotomy is an effective procedure at restoring glenohumeral congruity and early functional activity in the patient with locked posterior shoulder dislocation given the following criteria: (a) healthy articular cartilage, (b) a humeral head defect involving less than 40% of the articular surface, and (c) a patient who is able to participate in an active rehabilitation program.

Adult↗
PubMed1999

Activation of a cAMP pathway and induction of melanogenesis correlate with association of p16(INK4) and p27(KIP1) to CDKs, loss of E2F-binding activity, and premature senescence of human melanocytes.

There is strong evidence that the senescent phenotype, whether induced by telomere shortening, oxidative damage, or oncogenic stimuli, is an important tumor suppressive mechanism. The melanocyte is a cell of neural crest origin that produces the pigment melanin and can develop into malignant melanomas. To understand how malignant cells escape senescence, it is first crucial to define what genes control senescence in the normal cell. Prolonged exposure to high levels of cAMP results in accumulation of melanin and terminal differentiation of human melanocytes. Here we present evidence that activation of a cAMP pathway correlates with multiple cellular changes in these cells: (1) increased expression of the transcription factor microphthalmia; (2) increased melanogenesis; (3) increased association of the cyclin-dependent kinase inhibitors (CDK-Is) p27(KIP1) and p16(INK4) with CDK2 and CDK4, respectively; (4) failure to phosphorylate the retinoblastoma protein (pRB); (5) decreased expression of E2F1, E2F2, and E2F4 proteins; (6) loss of E2F DNA-binding activity; and (7) phenotypic changes characteristic of senescent cells. Senescent melanocytes have potent E2F inhibitory activity, because extracts from these cells completely abolished E2F DNA-binding activity that was present in extracts from the early proliferative phase. We propose that increased activity of the CDK-Is p27 and p16 and loss of E2F activity in human melanocytes characterize a senescence program activated by the cAMP pathway. Disruption of cAMP-mediated and melanogenesis-induced senescence may cause immortalization of human melanocytes, an early step in the development of melanomas.

Carrier Proteins↗
PubMedDate not supplied

Home health cardiac rehabilitation.

The Cardiac Rehabilitation Home Program provides the structural framework for patient access to cardiac recovery in the home setting. Using an interdisciplinary team approach, the program standardizes patient education, establishes a personalized activity program, and provides psychosocial support to the patient and family during the recovery process. The Cardiac Rehabilitation Home Program reduces the cost of delivering healthcare to the cardiac population while improving customer satisfaction, strategically positioning home health agencies for managed care contracts.

Aged↗
PubMed1992

Acetylcholinesterase in murine erythroleukemia (Friend) cells: evidence for megakaryocyte-like expression and potential growth-regulatory role of enzyme activity.

Features of true acetylcholinesterase (AChE) regulation during growth and differentiation of Friend murine erythroleukemia cells (MELC) have been investigated with respect to other erythroid and nonerythroid murine elements. Enzyme levels of uninduced MELC were in between the very low AChE contents of erythroid cells and the huge amounts of activity exhibited by megakaryocytes and platelets. After MELC commitment to terminal division, the enzyme-specific activity increased largely, approaching values that were much closer to those of thrombocytic than of normal erythroid elements. The bulk of AChE activity in MELC, megakaryocytes, and platelets was found to be located in the cytosol as a free-soluble form. Moreover, during incubation, MELC actively released large amounts of AChE into the medium, like it occurs in murine thrombocytes. Conversely, the enzyme of the erythroid elements was mainly associated with the membranes and was not released extracellularly. Experiments with inducers showed that changes in AChE-specific activity of MELC correlated directly with the arrest of cell proliferation rather than with the activation of differentiated erythroid functions. The inverse relationship existing between MELC growth rates and AChE levels was further supported by the relative enzyme activities of the slow- and fast-growing subclones. We conclude that uninduced MELC potentially share properties of both the erythroid and megakaryoblastic phenotype. The latter might be revealed by typical regulation of AChE activity according to a thrombocytic-like program activated upon MELC commitment to terminal division. Eventually, the inhibition of MELC growth by exogenous pure bovine AChE suggested that the secreted murine enzyme might serve as a potential negative signal of cellular replication.

Acetylcholinesterase↗
PubMed1996

Social determinants of loneliness among older Americans.

To further understand loneliness among older persons, a conceptual model, predicated on a social-support perspective, was examined. Results were based on 1,071 participants in the congregate and home-delivered meal programs of the Senior Citizens Nutrition and Activities Program in Hillsborough County, Florida. A series of stepwise multiple regression analyses showed that loneliness was greater among men, those with no children, those with no friends, those more physically disabled, those who subjectively felt that their health was poorer, and those who subjectively felt that their economic condition was inadequate. Not related directly to loneliness but with indirect influence were age, race, education, marital status, and poverty status. Those variables with no direct or indirect effect included rural or urban location, identification of emotional closeness with existing children or friends, and living alone. Theoretically, the results do not fully support the social-support perspective but point to the impact of a broad spectrum of demographic, health, economic, and social factors.

Aged↗
PubMed1995

Induction of apoptosis in catecholaminergic PC12 cells by L-DOPA. Implications for the treatment of Parkinson's disease.

The hypothesis that L-DOPA therapy in Parkinson's disease may augment neuronal damage and thus accelerate the progression of the disease remains controversial. In this study, we demonstrate that L-DOPA induces death of catecholaminergic cells in vitro via an active program of apoptosis. Treatment of PC12 cells with clinically applicable concentrations of L-DOPA (25-100 microM) induced cell death via a mechanism which exhibited morphological and biochemical characteristics of apoptosis, including chromatin condensation, membrane blebbing, and internucleosomal DNA fragmentation. L-DOPA-induced apoptosis was cell and drug-type specific. Toxicity is an intrinsic property of the drug molecule since it was not suppressed by inhibiting conversion of L-DOPA to dopamine. However, L-DOPA toxicity was inhibited by antioxidants, suggesting that activation of apoptosis is mediated by oxygen radicals. Our finding that L-DOPA-induced cell death in vitro occurs via apoptosis explains the lack of evidence supporting its toxicity in vivo, since apoptotic neurons are rapidly phagocytosed in vivo without causing damage to surrounding tissue. Furthermore, since apoptosis is an active cellular program which can be modulated, we suggest clinical approaches for decreasing L-DOPA toxicity, thus preventing acceleration of neuronal damage in Parkinson's disease.

Animals↗
PubMed1985

Planning a statewide genetic screening program: defining program functions to achieve desired outcomes.

When responsibility for administering the Genetic Screening Program in Georgia was transferred from an academic institution to state authority in 1982, the need was identified to reassess program planning. Accordingly, a cooperative effort was initiated between the Director of the Genetic Screening Program and representatives of the Centers for Disease Control to define desired program outcomes and the functions that should be performed to achieve these outcomes. This cooperative effort resulted in the development of specific and measurable outcomes for Georgia's Genetic Screening Program. These desired outcomes indicate the degree of reduction in morbidity and mortality associated with genetic diseases the Program is expected to achieve within a specified period of time. The major actions that should be taken to achieve these outcomes were also identified and delineated in sequence using flowchart format. These explicit descriptions of desired program outcomes and the functions necessary to achieve these outcomes provide the Genetic Screening Program Director with a valuable resource to use in planning program activities and assessing the extent to which the Program is successful in achieving its overall goal of reducing morbidity and mortality associated with genetic diseases.

Anemia, Sickle Cell↗
PubMed1996

Immunopharmacology of rapamycin.

The potent immunosuppressive drugs FK506 and rapamycin interfere with signal transduction pathways required for T cell activation and growth. The distinct inhibitory effects of these drugs on the T cell activation program are mediated through the formation of pharmacologically active complexes with members of a family of intracellular receptors termed the FK506 binding proteins (FKBPs). The FKBP12.FK506 complex specifically binds to and inhibits calcineurin, a signaling protein required for transcriptional activation of the interleukin (IL)-2 gene in response to T cell antigen receptor engagement. The FKBP12. rapamycin complex interacts with a recently defined target protein termed the mammalian target of rapamycin (mTOR). Accumulating data suggest that mTOR functions in a previously unrecognized signal transduction pathway required for the progression of IL-2-stimulated T cells from G1 into the S phase of the cell cycle. Here we review the immunopharmacology of rapamycin, with particular emphasis on the characterization of mTOR.

Animals↗
PubMed1995

Obstetric early discharge versus traditional hospital stay.

Recent research and media reports have suggested that obstetric early discharge is not cost-effective for postnatal care in the Australian health care system, based on the work of the Centre for Health Economic Research and Evaluation. This is probably an erroneous conclusion because the centre excludes the important cost category of medical costs, and its conclusions depend on survey estimates of 'community costs' which are empirically of poor quality and theoretically of doubtful relevance to health care system decision-making. This study finds that obstetric early discharge is more cost-effective than a traditional hospital stay even when community costs are included; and highly cost-effective when considering health system costs alone. Further cost advantages are simulated by increasing obstetric early discharge program activity and reducing length of stay for both programs. Our results suggest that safe, cost-effective options for low-risk obstetric care deserve further investigation in Australia.

Adult↗