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PubMedDate not supplied

Functional impact of unvarying exercise program in women after menopause.

Low bone mass, functional impairment, low muscle strength, and postural instability are predictors of the risk of fracture in an elderly person. The purpose of this study was to investigate the functional impact of an unvarying long-term exercise program to be carried out at home. The exercises had been shown to delay bone loss in an elderly population. At the Department of Physical Medicine and Rehabilitation, University of Vienna, postmenopausal women who had been stratified into exercise or control groups 5 to 10 yr ago were called in for a follow-up examination. Frequency of training, habits, and pain causing disability in activities of daily living were recorded. Walking velocity, muscle strength, and postural stability were measured. Functional assessment, blood analysis, and x-rays of the spine were performed additionally. One hundred twenty-four women aged 68.3 +/- 6.8 yr (mean +/- SD) underwent a follow-up investigation at the outpatient clinic. After 7.7 +/- 1.1 yr the compliance of the training group was still 36%. Self-chosen gait velocity was slightly higher in the regular exercisers than in the controls. No intergroup differences were found for pain induced disability, muscle strength, body sway, and fracture rate. The pain disability index was significantly associated with corrected self-chosen gait velocity. The results suggest that an unvarying home-based exercise program may support general agility but does not yield enough force to improve muscle strength and postural stability in healthy, nondisabled, postmenopausal women who start exercising at the age of 60 yr. Further studies are needed to define more appropriate exercise programs for a comprehensive improvement of functional outcome in a population at high risk for osteoporosis.

Accidental Falls↗
PubMed2003

Public health surveillance for disease prevention: lessons from the behavioral risk factor surveillance system.

The burden of chronic diseases is increasing worldwide. Surveillance of behavioral risk factors is a crucial element for prevention and control of chronic diseases. Adequate surveillance data will provide the basis for developing and implementing appropriate preventive programs at the local and country level. A standardized surveillance system worldwide will allow data comparability, and will decrease the cost of the surveillance system. By using lessons from the Behavioral Risk Factor Surveillance System, a large, ongoing, state-based surveillance system in the United States, countries may save limited resources, and expedite the initiation of their own surveillance systems. To prevent cardiovascular diseases worldwide, it is time to develop and implement appropriate surveillance systems at a country level, in order to track risk factors. This strategy will provide the basis for developing intervention programs designed to reduce, or prevent a further increase in, the burden of chronic diseases.

Behavioral Risk Factor Surveillance System↗
PubMed1978

Cooperation between an academic subspecialty department and a community-based family medicine department: a developmental model.

While new, community-based family practice residency programs desperately need support from sister departments in academic centers, a variety of problems frequently prevents such cooperation. At the University of Wisconsin, Madison, the Department of Human Oncology, which is University Hospital-based, has worked to develop an appropriate educational program in oncology, together with and for the Department of Family Medicine and Practice, which is community-based. This paper, relating how and why these two departments have cooperated in this project, is presented to assist other departments in similar situations.

Family Practice↗
PubMedDate not supplied

Myositis ossificans in early childhood.

A 5-year-old boy underwent arthroscopic surgery because of a lateral discoid meniscus, which was followed by an overly strenuous rehabilitation program. At 6-week follow-up, a painful mass at the distal part of the thigh and a flexion restriction of the operated knee were detected, caused by myositis ossificans inside the vastus medialis muscle. The symptoms disappeared with an appropriate rehabilitation program and the patient recovered.

Arthroscopy↗
PubMedDate not supplied

Discharge of mothers and babies from hospital after birth of a healthy full-term infant: developing criteria through a community-wide consensus process.

OBJECTIVE: To ensure safe care of mothers and babies after birth, irrespective of length of hospital stay, and to ensure effective links between hospital and community postnatal services. METHODS: Program aimed toward consumers and professionals working with them in Ottawa-Carleton (750,000 persons.) All pregnant women in the community included. Program developed by professionals, institutions and community agencies. Information on current practices elsewhere and early discharge literature studied. New provincial survey on practice changes performed in Ontario. Emergency room utilization data analyzed. Discharge and post-discharge criteria, and a common prenatal education curriculum, developed. RESULTS: Multidisciplinary, multi-sectoral committees, institutions and agencies have developed programs for appropriate discharge practice and improved postnatal follow-up. Professionals have supported flexible discharge guidelines. CONCLUSIONS: Provided discharge criteria and follow-up are available, flexible discharge timing and safety appear compatible. The Ottawa-Carleton process to develop criteria and programs has allowed a collaborative, consensus-based approach to 'early' newborn discharge.

Community Participation↗
PubMed1998

daf-12 regulates developmental age and the dauer alternative in Caenorhabditis elegans.

From egg through adult, C. elegans has six life stages including an option for dauer formation and diapause at larval stage L3 in adverse environments. Somatic cells throughout the organism make consistent choices and advance in unison, suggesting a mechanism of coordinate regulation at these stage transitions. Earlier studies showed that daf-12, which encodes a nuclear receptor (W. Yeh, 1991, Doctoral Thesis. University of Missouri-Columbia), regulates dauer formation; epistasis experiments placed daf-12 near the end of the dauer signaling pathway. Here we describe novel daf-12 alleles that reveal a general role in advancing L3 stage programs. In these mutants, somatic cells repeat L2-specific cellular programs of division and migration at the L3 stage; epistasis experiments place daf-12 between lin-14 and lin-28 within the heterochronic pathway. We propose daf-12 and other heterochronic genes provide cellular memories of chronological stage for selecting stage-appropriate developmental programs. Endocrine factors could coordinate these stage transitions and specify developmental alternatives.

Aging↗
PubMed1995

Health physics and aviation: 1990-1994.

For several years, the U.S. Federal Aviation Administration has explicitly recognized flight crew members as workers who are occupationally exposed to radiation. To help these workers assess their radiation risks, the FAA has developed a computer program that will estimate cosmic-ray exposures from individual flights. They have published documents which inform crew members of the statistical risks associated with their radiation exposure, and they have issued an advisory to the commercial air carriers suggesting that they institute an appropriate educational program for their employees. These developments represent a significant change from ten years ago when the Federal Aviation Administration concluded that, in the area of in-flight radiation exposure, any regulatory involvement on their part would be unwarranted because the vast majority of crew members would not exceed the recommended maximum permissible dose limits then applicable to members of the general public.

Aviation↗
PubMed1995

Victimization prevention programs: a national survey of children's exposure and reactions.

The National Youth Victimization Prevention Study interviewed a representative sample of 2,000 U.S. children and their caretakers about the children's experience with child abuse and victimization prevention programs. Two-thirds of the children reported being exposed to at least one program at some time, 37% within the last year. Programs that gave children a chance to practice, that prompted discussions with parents, and that included information on dealing with bullies were more likely to result in utilization of the program skills. Although satisfaction levels were generally high for all groups, girls, black children, and children from lower socioeconomic status families, as well as their parents, had more positive reactions and reported more skill utilization. Some children did report, and their parents confirmed, more worry about abuse and fear of adults. However, the children with increased worry and fear were also the children who themselves and their parents reported the most positive feelings about the programs and the most skill utilization. This suggests that the level of worry and fear induced by the programs was appropriate to the subject.

Adolescent↗
PubMed1994

Thoracic Outlet Syndrome.

The manifestations of thoracic outlet syndrome vary according to which of the neurovascular structures are affected. To provide optimal treatment, the pathogenesis must be understood in terms of both the anatomic variants and the dynamic factors. The diagnosis is primarily clinical, although ancillary diagnostic studies are useful in selected patients. Following a careful examination, the orthopaedic surgeon should be able to initiate a program of appropriate therapy depending on the nature and severity of the clinical manifestations. Initial treatment is oriented toward postural reeducation and periscapular muscle strengthening. Glenohumeral instabilities and painful upper-limb conditions that cause disuse atrophy must be addressed. Operative treatment is reserved for patients in whom a conservative program has failed and for those with significant neural or vascular deficits. The surgeon must be cognizant of the potential complications of the various procedures used to correct thoracic outlet syndrome. Proper selection of surgical candidates should produce significant improvement in most patients.

Journal Article↗
PubMed1995

Assessment of human immunodeficiency virus/acquired immunodeficiency syndrome audiovisual materials designed for grades 7 through 12.

Nurses are often involved in formulating and implementing HIV/AIDS education programs in the public schools. A tool was developed to assess the inclusion of components that deal with factual information, social implications of HIV/AIDS, abstinence, condom usage, and attitudes in audiovisual materials. This information, in checklist format, can assist nurses in evaluating audiovisual materials and in selecting the most appropriate materials dealing with HIV/AIDS for groups of adolescents. Twenty-four audiovisual materials from a rural education agency were evaluated using this checklist; the tool provided a method to analyze and convey information regarding the components of the HIV/AIDS audiovisual materials, which can assist nurses in choosing or recommending educational resources appropriate in programs for teaching adolescents about sexuality and HIV/AIDS prevention.

Adolescent↗
PubMed1984

Resolution of multiple fluorescence lifetimes in heterogeneous systems by phase-modulation fluorometry.

Procedures are described for the treatment of phase and modulation lifetime data in fluorescent systems having multiexponential decay. All computer procedures (called FIT programs) arise from the lifetime resolution theory for phase-modulation measurements (Weber, G. (1981) J. Phys. Chem. 85, 949-953). The programs most successful in resolving heterogeneous lifetimes use a Monte Carlo approach in which phase and modulation lifetime data at three modulation frequencies are simultaneously utilized. These programs are shown to have more utility than the final closed form procedure presented by Weber (1981). The FIT routines are simple and require little computer time while yielding excellent results. To illustrate the applicability of these programs, defined binary (carbazole and pyrene) and ternary systems (carbazole, pyrene and POPOP) were examined. In most cases, the resolved lifetimes were within 5% of the independently measured value and the fractional fluorescence contributions were within 10% of that expected. These results demonstrate that phase-modulation measurements analyzed by appropriate computer programs are capable of solving for lifetimes in both binary and, in selected cases, ternary systems. An example is given from the recent literature (Dalbey, R., Weiel, J. and Yount, R.G. (1983) Biochemistry 22, 4696-4706) in which the above programs allowed the resolution of both binary and ternary lifetimes of a dansyl label on myosin, where Förster energy transfer was occurring. These lifetimes were used to quantify changes in distances between two activity-related thiols on myosin upon the addition of Mg-ATP or its analogs.

Computers↗
PubMed1980

Rapid assessment of cardiac output and central blood volumes from indicator dilution curves without precalculation using programmable calculators.

The program described here provides complete analysis of the indicator dilution curve by incorporating densitometric calibration and logarithmic downslope fit for the widely used Hewlett-Packard 67/97 hand calculator series. Densitometric sensitivity is calculated from the linear regression as the dye calibration factor; thus, direct entry of the dye curve deflections eliminate the necessity to precalculate curve concentration. The program displays appropriate sequential time intervals prompting deflection entry of the upslope and initial exponential downslope of the curve. The remainder of the curve is generated from the logarithmically extrapolated initial downslope, and the area of the curve is then obtained for calculation of cardiac output, mean transit time, and central blood volume. Programming versatility and the rapid (4--5 min) immediate analysis of indicator dilution curves are thus available.

Blood Volume↗
PubMed1995

[AIDS/HIV related knowledge, attitude and behavior of acupuncture therapists in Aichi Prefecture].

To promote AIDS prevention measures in Japan, the actual state of knowledge, attitudes and behaviors (KAB) of workers at risk for HIV infection requires clarification. In the present study, acupuncture therapists in Aichi Prefecture were evaluated for level of their KAB. By using a self-administered questionnaire, the KAB condition of 500 acupuncture therapists was surveyed from September-November in 1993. Responses from 494 (98.8%) were available for analysis. Results showed that knowledge level on general issues regarding HIV epidemics was good. The main sources for information on AIDS/HIV were TV, general lectures, public reports and magazines. More than 80% of acupuncture therapists sterilize their needles by autoclave or boiling and 60% of them use disposable needles. Furthermore, 97% of the therapists reported utilizing one or the other of these methods. More than a half of them have participated in AIDS education programs. While about 30% of them responded that they are able to accept HIV carriers as clients, 20% of them expressed negative responses. There appears to be a discrepancy between their level of knowledge of HIV transmission routes and their practical attitude towards clients with AIDS and/or HIV carriers. A more appropriate education program based on behavioral science is desirable to lessen discrepancy distance between general knowledge and preferable behavior regarding AIDS/HIV.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Use of the NCA-modified assessment with a population of intoxicated drivers.

Given the proliferation of state laws affecting drunk drivers, the recently passed Wisconsin provision which mandates alcohol assessment for all convicted offenders is of particular interest. When applied during a 2-yr. period in Racine County, WI (1 yr. prior to the enactment of the policy and 1 yr. after passage), most of the persons assessed for operating a vehicle while intoxicated were judged to be irresponsible users of alcohol (social drinkers). Those assessed as alcohol dependent were numerous and were sent to treatment rather than educationally oriented rehabilitation programs. Addressing the issue of predicting which factors would influence the referral to education versus treatment programs, the study showed that repeaters, users of the human services, and those persons having higher concentrations of blood alcohol tended to be sent to treatment. Use of the MOD-CRIT assessment instrument provides the state alcohol treatment system with a means by which drinking drivers can systematically be referred to appropriate rehabilitation programs. Although some margin of error may exist during the assessment process, mandatory assessment is deemed preferable to individualized reports that are open to bias and interpretation.

Adolescent↗
PubMed1968

Profesional medical library education in the United States in relation to the qualifications of medical library manpower in Ohio.

THE PRESENT SYSTEM OF EDUCATION FOR MEDICAL LIBRARY PRACTICE IN THE UNITED STATES CONSISTS OF FOUR MAJOR COMPONENTS: graduate degree programs in library science with specialization in medical librarianship; graduate degree programs in library science with no such specialization; postgraduate internships in medical libraries; continuing education programs. Data are presented illustrating the flow of graduates along these several educational pathways into medical library practice.The relevance of these educational components to the current medical library work force is discussed with reference to manpower data compiled for Ohio. The total number of medical library personnel in Ohio in 1968 is 316. Of this total, only forty-two (approximately 14 percent) have received any formal library training. Seventy persons have only a high school education. From these figures, it is concluded that there is no standard or essential qualification which is universally accepted as educational preparation for work in medical libraries; that the comparative sophistication of the educational programs in medical librarianship has yet to be reflected widely in general medical library practice; that an increasingly large number of non-professional or ancillary personnel are being, and will continue to be, utilized in medical libraries; that large numbers of untrained persons have sole responsibility for medical libraries; and that appropriate educational programs will have to be designed specifically for this type of personnel.

Curriculum↗
PubMed1997

Quality assurance.

Every pulmonary function laboratory should develop and implement a quality assurance program to minimize various technical sources of variation. This article has discussed six major components. First, the education and training of the technologists in the pulmonary function laboratory is probably the most important factor in obtaining accurate and reproducible results. A college-level education with an emphasis on math and science is recommended. After an appropriate training program, continued evaluation and feedback are important. Second, instrument maintenance should be performed on a scheduled basis to reduce or prevent instrument malfunctions. Corrective maintenance, which is usually unscheduled, should be performed by knowledgeable individuals and any repairs should be documented. Third, a procedure manual is very important to any successful quality assurance program. It should contain a broad range of information including administrative issues, quality-control procedures, stepwise instructions on test performance, and infection-control policies and procedures. Fourth, the procedures should be performed using published guidelines to help minimize the effects of the many variables. Fifth, a method to quality control each test procedure should be developed. The specific method(s) will vary according to the type of instrumentation and the manufacturer. Finally, the well-run quality assurance program must properly analyze and store the data collected. Sound statistical methods should be applied and various logs and lists should be developed.

Humans↗
PubMed1983

Attitudes of house officers toward a hospice on a medical service.

A hospice program (HP) was established on the medical service at the Denver Veterans Administration Medical Center (DVAMC) for the care of the terminally ill cancer patients and to integrate such care into house staff training. A two-bed inpatient unit was managed by an intern, a resident, and the attending physician with the aid of a multidisciplinary team. During the program's first year, 29 patients were cared for with an average inpatient stay of 26 days. Twenty-nine out of a possible 33 house officers returned questionnaires evaluating their hospice experience. Twenty-eight respondents felt that the hospice program was appropriate in a teaching hospital. Over half indicated improved awareness of the psychological problems of their patients and families. Two-thirds of the house staff members felt that the HP changed their approach to pain control and made them more comfortable in dealing with terminally ill patients. From this study, it can be concluded that a hospice program can be successfully integrated into an active medical teaching service.

Attitude of Health Personnel↗
PubMed2002

Health sector reform in Pakistan: future directions.

The health care system in Pakistan is beset with numerous problems--structural fragmentation, gender insensitivity, resource scarcity, inefficiency and lack of functional specificity and accessibility. Faced with a precarious economic situation characterized by heavy external debt and faltering productivity, Pakistan's room to maneuver with health sector reform is quite limited. Although the recently announced Devolution Plan provides a window of opportunity, it must go beyond and introduce far-reaching changes in the health and social sectors. Regionalization of health care services in an integrated manner with functional specificity for each level of care is an essential step. Integration of current vertical programs within the framework of a need-based comprehensive primary health care system is another necessary step. Most importantly, fostering a public-private partnership to share the cost of basic primary health care and public health services must be an integral part of any reform. Pakistan must also make the health care system more gender sensitive through appropriate training programs for the service providers along with wide community participation in decision-making processes. Relevant WHO/World Bank/UNDP developed tools could be extremely useful in this respect. The article is based on a critical analysis of secondary data from the public domain as well as from various research projects undertaken by the Aga Khan University. It also draws from the experiences of health sector reform carried out in other countries, particularly those in the Asia-Pacific region. The purpose is to inform and hopefully influence, public policy as the country moves towards devolution.

Health Care Reform↗