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PubMed1998

Chronic gastrointestinal problems and bowel dysfunction in patients with spinal cord injury.

Amongst complications arising from spinal cord injury (SCI), chronic gastrointestinal (G-I) problems and bowel dysfunction have not received as much research attention as many other medical and rehabilitation problems, even although their incidence is not negligible. We therefore investigated chronic G-I problems and bowel dysfunction in SCI patients where the degree of these was such that activities of daily living (ADL) were significantly affected and/or long-term medical management was required. Detailed semi-structured individual interviews were conducted with 72 traumatic SCI patients. The history of SCI was longer than 6 months, bowel habits had settled, and neurological recovery was completed. The incidence of chronic G-I problems was very high (62.5%), most were associated with defecation difficulties such as severe constipation, difficult with evacuation, pain associated with defecation, or urgency with incontinence. These problems had an extensive impact on ADL, and in particular, restricted diet (80%), restricted outdoor ambulation (64%) and caused unhappiness with bowel care (62%). Bowel care was performed once per 2.85 +/- 1.96 days and occupied an average of 42.1 +/- 28.7 min. To improve bowel habits, 43% of the patients took oral medication, and 36.1% controlled their diet. The usual methods of bowel care were anal massage (34.7%), unaided self-defecation with or without oral medication and abdominal massage (29.2%), finger enema (18.1%), rectal suppository (15.2%) and in two patients a colostomy tube had been inserted because of rectal cancer and traumatic colorectal injury. These chronic G-I symptoms were vague and very subjective, but significant enough to affect the quality of life. Bowel dysfunction was not related to age, duration of, or the neurological level of injury, ASIA score of ADL level, and bowel habits had generally settled within 6 months of SCI. With regard to frequency, time, and method of defection, bowel care habits varied considerably amongst individuals, and in relation to the extent to which practical results matched the level of expectation generated by physicians' recommended care program. Individual satisfaction was also very subjective. We therefore suggest that during the early stage of rehabilitation, an appropriate bowel program should be properly designed and adequate training provided.

Activities of Daily Living↗
PubMed2000

An ethnographic study of a day care center for Iranian immigrant seniors.

Late-in-life immigrants are often at risk for psychological stress and social isolation because of language problems, small social networks, and cultural differences from the host society. Community intervention programs can reduce such stress and isolation. In this article, the authors describe a Swedish municipality's culturally appropriate intervention program for elderly Iranian immigrants based on ethnographic data gathered during a 12 month period. The description includes the activities provided by the program and the experiences of the elderly Iranian immigrants who participate regularly in these activities. The findings document the positive impact of regular participation in the center's activities on the elders' well-being and health.

Aged↗
PubMed2002

An English-language clinic-based literacy program is effective for a multilingual population.

OBJECTIVE: To assess the effectiveness of a clinic-based pediatric literacy intervention on a multilingual population. BACKGROUND: Clinic-based literacy interventions are effective among English- and Spanish-speaking children. No data exist for multilingual populations. SETTING: Pediatric clinic in an urban county hospital. Design/Methods. Reading practices of 2 cross-sectional groups were assessed by standardized interview before and after the intervention. The intervention consisted of waiting-room volunteers reading to children, literacy counseling, and gift of a children's book at each well-child visit from 6 months to 5 years. Outcomes were assessed separately for primary English-speaking and primary non-English-speaking families. RESULTS: The baseline (N=85) and postintervention (N=95) groups were similar with respect to child age and sex, parental education, and length of time in the United States. Fourteen languages were represented in total, the most common being English (41%), Somali (28%), Spanish (9%), Vietnamese (7%), Oromo (3%), and Tigrinyan (3%). Compared with baseline, postintervention respondents were more likely to report reading as a favorite activity for the child (10% vs 25%) and parent (18% vs 40%), to read to their child before bed at least weekly (45% vs 71%), and to possess over 10 children's books at home (49% vs 63%). Among English-speaking families (N=30 baseline, N=40 postintervention), weekly bedtime reading increased (63% to 93%), reading as child's favorite activity increased (7% vs 30%), and reading as the parent's favorite activity to do with child increased (33% vs 58%). The proportion of English-speaking families possessing over 10 books at home and those reading with their children at least weekly showed no difference between the baseline and postintervention groups. Among non-English-speaking families (N=55 baseline, N=55 postintervention), weekly bedtime reading increased (36% vs 56%), reading as the parent's favorite activity increased (11% vs 27%), and the number of families to possess >10 children's books in the home increased (31% vs 49%). Reading as child's favorite activity (13% vs 24%) and weekly book sharing (60% vs 76%) showed nonsignificant trends between the non-English-speaking baseline and postintervention groups. CONCLUSIONS: This clinic-based literacy intervention influences home literacy behavior in this multiethnic setting, in both English-speaking and non-English-speaking families. Although efforts should be made to make such programs more appropriate for linguistic minorities, non-English-speaking families do stand to benefit from English-language-oriented programs. literacy, Reach Out and Read, pediatrics, reading, child development.

Child, Preschool↗
PubMed1995

Study of developmental abnormalities and deaths after human zygote exposure.

Experimental studies indicated that the mouse zygote is susceptible to experimental induction of developmental anomalies including defects (mainly hydrops), growth retardation and mid- and late-gestational death with certain mutagenic agents. The material of the Hungarian Optimal Family Planning Program is appropriate to check this finding in a human material because participants were asked to visit the coworkers of the Program immediately after the first missed menstrual period and data concerning potentially hazardous environmental factors were obtained. At that time participants were immediately after the pre- and implantation period and they had no knowledge about their pregnancy outcomes. In 1994 the data of their pregnancy outcomes are available. Of 5453 evaluated pregnancies, 1167 were selected for this study because they visited the coworkers of the Program within 28 days post conception. Of 1167 pregnancies, 316 (27%) were exposed to some environmental factors, mainly drugs. A mild intrauterine growth retardation was found in the exposed group. The rate of congenital abnormalities and infant death did not differ between the exposed and unexposed groups. The detailed analysis of different congenital abnormality groups also did not show any significant difference between the exposed and unexposed groups. These negative results are explained by the fact that the observed environmental factors are not mutagenic, at least not in the dosage which was used, or the human zygote is not sensitive to mutagenic agents in the post-conceptional days.

Abnormalities, Drug-Induced↗
PubMedDate not supplied

Frontal lobe system maturational lag in juvenile delinquents shown in narratives test.

The aim of the present study was to test the hypothesis that a brief clinical test of frontal lobe system (FLS) maturity levels, designated as Stages I, II, III, IV, can differentiate between three experimental groups (all of age 9-16): normal Ss, Ss with emotional problems, and juvenile delinquents. The stages represent 1) disjointedness of activities; 2) inability to switch the principle of action of an ongoing activity appropriately; 3) planning, and 4) ability to switch the principle of action of an ongoing activity and to re-program it appropriately in accordance with new circumstances. By means of a blindly performed brief form analysis of action patterns expressed through narratives, it was shown that 70% of the normal Ss attained stage IV, but only 47% of the delinquent Ss did so. These findings support the previously proposed new conceptual model about ethical action behavior in general (Pontius, 1972) and in particular with regard to a subgroup of juvenile delinquents who reveal signs of a neuro-physiological dysfunction, probably a maturational lag of the FLS. In the present sample, this appears to be especially revealed in the specific inability to switch in a flexible manner the principle or plan of action of an ongoing activity according to new circumstances, resorting to re-programming. Such specific inability calls for specific classification as such, thereby enabling the formulation of specific remedial efforts, which are discussed.

Adolescent↗
PubMed2006

Adaptive response of a gene network to environmental changes by fitness-induced attractor selection.

Cells switch between various stable genetic programs (attractors) to accommodate environmental conditions. Signal transduction machineries efficiently convey environmental changes to the gene regulation apparatus in order to express the appropriate genetic program. However, since the number of environmental conditions is much larger than that of available genetic programs so that the cell may utilize the same genetic program for a large set of conditions, it may not have evolved a signaling pathway for every environmental condition, notably those that are rarely encountered. Here we show that in the absence of signal transduction, switching to the appropriate attractor state expressing the genes that afford adaptation to the external condition can occur. In a synthetic bistable gene switch in Escherichia coli in which mutually inhibitory operons govern the expression of two genes required in two alternative nutritional environments, cells reliably selected the "adaptive attractor" driven by gene expression noise. A mathematical model suggests that the "non-adaptive attractor" is avoided because in unfavorable conditions, cellular activity is lower, which suppresses mRNA metabolism, leading to larger fluctuations in gene expression. This, in turn, renders the non-adaptive state less stable. Although attractor selection is not as efficient as signal transduction via a dedicated cascade, it is simple and robust, and may represent a primordial mechanism for adaptive responses that preceded the evolution of signaling cascades for the frequently encountered environmental changes.

Adaptation, Biological↗
PubMed2005

Continuation of benefit payments to certain individuals who are participating in a program of vocational rehabilitation services, employment services, or other support services. Final rule.

We are publishing final rules that amend the rules for the continuation of disability benefit payments under titles II and XVI of the Social Security Act (the Act) to certain individuals who recover medically while participating in an appropriate vocational rehabilitation (VR) program with a State vocational rehabilitation agency. We are amending these rules to conform with statutory amendments that extend eligibility for these continued benefit payments to certain individuals who recover medically while participating in an appropriate program of services. These include individuals participating in the Ticket to Work and Self-Sufficiency Program or another program of vocational rehabilitation services, employment services, or other support services approved by the Commissioner of Social Security. We are also extending eligibility for these continued benefit payments to students age 18 through 21 who recover medically, or whose disability is determined to have ended as a result of an age-18 redetermination, while participating in an individualized education program developed under the Individuals with Disabilities Education Act with an appropriate provider of services. Providers of services we may approve include a public or private organization with expertise in the delivery or coordination of vocational rehabilitation services, employment services, or other support services; or a public, private or parochial school that provides or coordinates a program of vocational rehabilitation services, employment services, or other support services carried out under an individualized program or plan.

Adolescent↗
PubMedDate not supplied

Establishing a cancer risk evaluation program.

PURPOSE: Presymptomatic genetic testing for cancer susceptibility is a new practice arena that raises many complex issues. This article presents one model of a cancer risk evaluation program that specifically addresses the unique issues associated with genetic testing for cancer risk. DESCRIPTION OF PROGRAM: The Cancer Risk Evaluation Program is designed to care for any individual concerned about his or her risk for cancer, offering predisposition genetic testing if appropriate. The program includes clinical and psychosocial assessment, education, cancer risk analysis, and genetic counseling; it offers long-term screening and surveillance and provides a forum for ongoing genetic and clinical research. RESULTS: Program evaluations from participants have shown that the program is successfully meeting the needs of the participants. This program also ensures that the University of Pennsylvania Cancer Center is delivering cancer genetic services consistent with the existing position statements on genetic testing for cancer susceptibility, which have included guidelines and indications for predisposition genetic testing and informed consent. CLINICAL IMPLICATIONS: Researchers anticipate a substantial demand for predisposition genetic testing for cancer susceptibility. However, not all individuals interested in testing are eligible or willing to undergo direct gene analysis because of the potential risks. Therefore, clinical programs must address the complex issues surrounding presymptomatic genetic testing and incorporate cancer risk assessment strategies. Additionally, healthcare providers in this new practice arena should be fully informed and current in the state of the knowledge regarding cancer risk assessment; predisposition genetic testing; and the ethical, legal, and social issues pertaining to cancer risk assessment and management.

Adult↗
PubMed2006

Obtaining pediatric indications for new anti-epileptic drugs: how and when.

Drug development in children poses a number of challenges that must be overcome to obtain adequate information in product labeling. Trials in children must be supported by appropriate toxicology and formulation work, which tends to delay completion of work in children until after the drug is available for adults. The Pediatric Research Equity Act (PREA) contains a decision tree to help companies devise an appropriate pediatric program for drugs in development. The medical community does not currently endorse the assumption that the progression of epilepsy and response to treatment is the same in adults and children. Therefore, a complete drug development program in children is necessary and includes efficacy and safety trials along with pharmacokinetic studies. These studies are needed to justify the risk/benefit in children. Formulations appropriate for children are needed. Seizure diaries must be maintained by caretakers and in the case of infants, seizures may need to be counted by EEG. Early planning and discussion of a pediatric program with regulatory agencies will facilitate this work.

Anticonvulsants↗
PubMed1975

A computer program that evaluates patients with hypercalcemia.

A computer program has been developed to assist the physician in managing patients with hypercalcemia. The program requests appropriate information, such as the patient's serum calcium concentration, age and x-ray results. Based on the abnormalities detected, the program asks additional questions needed to suggest the most helpful course of action for evaluating or treating the patient's hypercalcemia. As soon as the data have been entered, the program generates an evaluation note that includes diagnostic possibilities, suggestions for additional laboratory studies, therapeutic recommendations and references to the medical literature. The program can be used from any general purpose teletype-compatible terminal (including cathode ray tube displays) connected to the Bell Telephone System. The time required to enter the data and obtain the evaluation note is approximately 4 minutes with a teletypewriter, and less if a faster terminal is used. The cost for computer time is comparable to that of a laboratory test. Comparison of diagnoses produced by the program with those obtained from pathologic examination of from consulting endocrinolgists shows that the program is sufficiently accurate for clinical use. Finnally, the explanation of the pathophysiology contained in the evaluation note may be useful to the student.

Adolescent↗
PubMed2005

[Development and evaluation of a Web-based support program for the maternal role of primiparas].

PURPOSE: This study was conducted to develop and evaluate a Web-based program for the maternal role of primiparas who use the internet. METHOD: The study process was a systems requirements analysis, design and development of a program, program testing by experts, program implementation, and program evaluation by users. A nonequivalent control group non-synchronized design was used. The data was collected from October 5th, 2002 to February 24th, 2003. RESULT: 1. Based on inquiries into mothers' needs, a Web-based support program was developed. The program was then modified from feedback received from experts. 2. In a sub-scale analysis of mothers' perception of a baby, amenability and persistence was significantly higher in the intervention group. The differences in the mean score of maternal self-confidence and maternal satisfaction were significant. 3. Cyber counseling was done for a total of 73 cases and the most frequent problems for counseling were feeding and nutrition (28.8%), followed by baby care, and health problems. CONCLUSION: It was proven that a Web-based support program provided appropriate support to primiparas and was effective in promoting their maternal role. Therefore, this study suggests that a Web-based support program for primiparas can become a powerful nursing intervention on virtually all mother and infant health concerns.

Adult↗
PubMed1993

Recent advances in the treatment of childhood obesity.

The multidisciplinary, four-phase approach, which includes PSMF, BEM, and MPE is successful in treating mild, moderate, and severe degrees of childhood and adolescent obesity. The MPE program is appropriate for use with PSMF and BEM due to its progressive nature, variety of options, and moderate intensity level. In addition, the MPE program is of sufficient intensity, duration, and frequency to promote a significant increase in estimated aerobic capacity (VO2max) and to promote the maintenance of lean body mass and resting energy expenditure. The short-term intervention of PSMF, BEM, and MPE also results in an improvement in body composition, lipid profiles, and IGF-1 and T3 levels. The 1200-calorie balanced diet, MPE, and BEM also provide a successful method of weight maintenance in children and adolescents, as indicated by further improvement in body composition at the 26-week measure. Additional studies are needed to assess the contribution of exercise to the maintenance of lean body mass and resting energy expenditure in obese children and adolescents. In addition, it will be important to assess long-term weight maintenance in obese adolescents who effectively lose weight in this multidisciplinary program.

Adolescent↗
PubMed1990

American College of Sports Medicine position stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults.

The combination of frequency, intensity, and duration of chronic exercise has been found to be effective for producing a training effect. The interaction of these factors provide the overload stimulus. In general, the lower the stimulus the lower the training effect, and the greater the stimulus the greater the effect. As a result of specificity of training and the need for maintaining muscular strength and endurance, and flexibility of the major muscle groups, a well-rounded training program including resistance training and flexibility exercises is recommended. Although age in itself is not a limiting factor to exercise training, a more gradual approach in applying the prescription at older ages seems prudent. It has also been shown that endurance training of fewer than 2 d.wk-1, at less than 50% of maximum oxygen uptake and for less than 10 min.d-1, is inadequate for developing and maintaining fitness for healthy adults. In the interpretation of this position statement, it must be recognized that the recommendations should be used in the context of participants' needs, goals, and initial abilities. In this regard, a sliding scale as to the amount of time allotted and intensity of effort should be carefully gauged for both the cardiorespiratory and muscular strength and endurance components of the program. An appropriate warm-up and cool-down, which would include flexibility exercises, is also recommended. The important factor is to design a program for the individual to provide the proper amount of physical activity to attain maximal benefit at the lowest risk. Emphasis should be placed on factors that result in permanent lifestyle change and encourage a lifetime of physical activity.

Cardiovascular Physiological Phenomena↗
PubMed1993

The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Position stand of the American College of Sports Medicine.

The combination of frequency, intensity, and duration of chronic exercise has been found to be effective for producing a training effect. The interaction of these factors provide the overload stimulus. In general, the lower the stimulus the lower the training effect, and the greater the stimulus the greater the effect. As a result of specificity of training and the need for maintaining muscular strength and endurance, and flexibility of the major muscle groups, a well-rounded training program including resistance training and flexibility exercises is recommended. Although age in itself is not a limiting factor to exercise training, a more gradual approach in applying the prescription at older ages seems prudent. It has also been shown that endurance training of fewer than 2 d/wk, at less than 50% of maximum oxygen uptake and for less than 10 min/d, is inadequate for developing and maintaining fitness for healthy adults. In the interpretation of this position statement, it must be recognized that the recommendations should be used in the context of participants' needs, goals, and initial abilities. In this regard, a sliding scale as to the amount of time allotted and intensity of effort should be carefully gauged for both the cardiorespiratory and muscular strength and endurance components of the program. An appropriate warm-up and cool-down, which would include flexibility exercises, is also recommended. The important factor is to design a program for the individual to provide the proper amount of physical activity to attain maximal benefit at the lowest risk. Emphasis should be placed on factors that result in permanent lifestyle change and encourage a lifetime of physical activity.

Adult↗
PubMed1995

The role of program quality in producing early childhood program benefits.

It is widely accepted by the field of early childhood education and by the public that high-quality preschool programs for young children from low-income families can have long-term benefits, although studies of early childhood programs in typical communities have often failed to find similar long-term effects. Some argue that variations in the quality or developmental appropriateness of programs can account for differences in effectiveness. This article reviews studies designed to define and measure the effects of quality in early care and education, and it analyzes the programs provided in successful long-term studies to look for common elements that may be critical to the long-term effectiveness of preschool. The conclusions of the analysis are that effective programs were characterized by combinations of most of the following elements: (1) small class sizes with low ratios of children to teachers; (2) teachers who received support to reflect on and improve their teaching practices; (3) a concentrated or long-lasting intervention; (4) ongoing, child-focused communication between home and school; and (5) use of some curriculum content and classroom processes that are similar to what children encounter in traditional schooling. Recommendations for policy, practice, and research are offered to promote the adoption of these effective practices in all types of early childhood programs.

Adolescent↗
PubMed1992

Use of event markers during exercise testing to optimize morphology criterion programming of implantable defibrillator.

The present generation implantable defibrillator introduced on-line event markers that can be used to evaluate tachycardia detection in the electrophysiological testing mode. These markers were used to assess the appropriateness of programming the morphology criterion for detection of ventricular tachycardia. Twenty-one consecutive patients (19 men, 2 women) performed 29 bicycle exercise tests with real-time recording of the electrocardiogram and the event markers on a multichannel recorder. Mean ejection fraction was 29% (range 15%-69%). Seven patients were taking antiarrhythmic agents. Twelve patients satisfied the morphology criterion at rest (n = 1) or during exercise (group I), and nine patients did not (group II). One patient was excluded from analysis because of continuous ventricular pacing. Mean peak heart rate was 130 beats/min in group I and 125 beats/min in group II. No statistical differences existed between the groups in relation to cycle length of ventricular tachycardia and mode of induction of arrhythmia, QRS duration on the electrocardiogram, during native rhythm, amplitude and duration of defibrillation patch R wave, calculated duty cycle at peak heart rate, and number of discharges of the automatic implantable cardioverter defibrillator at 2 to 14 months of follow-up time. It is concluded that clinical, electrocardiographic, and implantation data are unreliable in predicting satisfaction of the morphology criterion during high heart rates in native rhythm. Formal exercise testing in the electrophysiological mode enables a rational decision to be made about the appropriateness of the use of probability density function in each patient.

Algorithms↗
PubMed1994

Sports and nutrition--an out-patient program for adipose children (long-term experience).

Sports activity (3 times per week), nutritional changes and modification of behavior are the basic tenets of an outpatient program run for 9- to 12-year-old adipose children since 1987. The following goals are to be attained: increase in physical performance capacity and body awareness, long-lasting change in eating habits, weight loss to under 20% overweight compared to the age-normal (height/normal weight), and understanding of the permanence of body weight problems. Individual nutritional consultation is offered in addition to the initial examination consisting of physical examination, skin fat-fold measurement, blood chemical parameters, spiroergometry and a detailed consultation with parents and children. The eating habits of the children are recorded in a dietary history (3-day dietary protocol, questionnaire) and discussed in individual meetings with the parents and children. Moreover, the nutritional program includes regular nutritional consultations and parents' meetings every month. Cooking instructions for children and parents provide practical knowledge of food preparation to preserve nutrients in an energy-reduced, tasty diet, as well as theoretical basics of nutrition. The control examinations show individual weight loss or stability and improvement in blood lipid parameters. Awareness and controlled nutritional habits were learned especially by the children of parents who, for their part, tried to tailor their nutrition to be better balanced, more nutritional and more need-oriented. Children who maintain the learned nutritional habits after completion of the outpatient program, and who remain active in sports, show long-lasting constant weight. Prevention must begin in childhood. Intensive nutritional support combined with an appropriate sports program should be offered as a preventive measure.

Ambulatory Care↗
PubMedDate not supplied

The effect of disease prevention and health promotion on workplace productivity: a literature review.

This report was prepared by the Center for Disease Prevention and Health Promotion in the Institute for Health and Productivity Management as part of an effort to improve understanding of the connection between employee health and performance and to begin to identify new strategies through which treating health as an investment in human capital can lead to greater business success. Computer database searches of peer-reviewed literature published between 1993 and 1998 and manual reviews of 20 journals were used to identify research on the link between employee health and performance. Data was extracted to summarize the overall findings on the magnitude of health problems addressed by health promotion and disease prevention programs, and the impact of interventions on improving health risk, reducing medical care cost, and improving worker performance. From this summary, major conclusions on early detection of disease, the impact of behavior change programs, and appropriate care-seeking were drawn. This systematic review is supplemented with summaries of 15 seminal articles and descriptions of five leading-practices programs. The influence of developments in work/family issues, complementary and alternative medicine, and quality of care and health outcomes research are briefly discussed. Finally, a conceptual framework for studying the impact of health and productivity is described.

Decision Support Techniques↗