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PubMed1979

Cost containment education efforts in United States medical schools.

Noting the increasing nationwide concern with factors relating to rising health care costs, the Association of American Medical Colleges surveyed 119 U.S. medical schools in the summer of 1978 to ascertain the degree of program activity in the area of cost containment education. A 100 percent response was achieved. An analysis of this data indicates that considerable activity is underway. Forty-one institutions (34 percent) have programs underway or planned specifically to teach health care cost containment to undergraduate medical students or residents or both. The majority of such programs were introduced during the past two years. The costs of such programs are fairly modest, averaging $22,680 per year. Respondents indicated that further activities might be enhanced by development of a primer for faculty and students on elements of cost containment education and the organization of a series of regional workshops related to this subject.

Cost Control↗
PubMed2002

Harnessing motivational forces in the promotion of physical activity: the Community Health Advice by Telephone (CHAT) project.

Physical inactivity among middle- and older-aged adults is pervasive, and is linked with numerous chronic conditions that diminish health and functioning. Counselor-directed physical activity programs may enhance extrinsic motivation (reflected in social influence theories, such as self-presentation theory) and, in turn, physical activity adherence, while the counselor is in charge of program delivery. However, external influences can undermine intrinsic motivation, making it more difficult to maintain physical activity once counselor-initiated contact ends. In contrast, programs that diminish the socially evaluative and controlling aspects of the counseling interchange may promote intrinsic motivation (described in cognitive evaluation theory), and, thus, physical activity maintenance, even when counselor-initiated contact ceases. The objective of the Community Health Advice by Telephone (CHAT) project is to compare these two theories by conducting a randomized controlled trial evaluating the effects of a telephone-administered counseling program delivered by a person (social influence enhancement) or computer (cognitive evaluation enhancement) on physical activity adoption and maintenance over 18 months. Healthy, sedentary adults (n = 225) aged 55 years and older are randomized to one of these programs or to a control arm. This study will contribute to advancing motivational theory as well as provide information on the sustained effectiveness of interventions with substantial public health applicability.

Aged↗
PubMed2000

Disrupted mitochondrial electron transport function increases expression of anti-apoptotic bcl-2 and bcl-X(L) proteins in SH-SY5Y neuroblastoma and in Parkinson disease cybrid cells through oxidative stress.

Death of dopamine neurons in Parkinson disease (PD) may arise from consequences of the complex I (C-I) defect in the mitochondrial electron transport chain (ETC). Whether cells activate programmed death (apoptosis) pathways derives, in part, from relative activities of proteins such as bcl-2 and bcl-X(L), that have anti-apoptotic actions. We studied the responses of bcl-2 and bcl-X(L) genes in pharmacologic (acute incubation with methylpyridinium (MPP+)) and mitochondrial transgenic ("cybrid") models of Parkinson disease C-I defects. MPP+ incubation increased levels of bcl-2 and bcl-X(L) proteins in native SH-SY5Y cells but not in rho(0) cells devoid of ETC activity. MPP+ increased bcl-2 mRNA levels by 40% at 8 hr. Confocal microscopic imaging showed that the intracellular distribution of immunoreactive bcl-2 was not significantly associated with mitochondrial membranes at baseline but was associated with mitochondria after 12 hr of MPP+. Immunoreactive bcl-X(L) protein was significantly and equally associated with mitochondrial membranes both at baseline and after MPP+. PD cybrids showed increased basal levels of bcl-2 and bcl-X(L) proteins, similar to the maximum levels found after MPP+ treatment of control SY5Y cells. After MPP+ exposure, bcl-2 protein levels increased in control cybrids but did not increase further in PD cybrids. Both pharmacologically generated and transgenically induced C-I inhibition increases levels of anti-apoptotic bcl proteins, possibly from increased gene transcription. Augmentation of bcl-2 and bcl-X(L) expression may delay neurodegeneration in PD.

1-Methyl-4-phenylpyridinium↗
PubMed1995

Issues in estimating the cost of innovative mental health programs.

This paper reviews problems encountered in estimating the unit cost of services provided by innovative mental health programs and illustrates methods for addressing these problems. Generally, the cost of a health care service is determined by identifying all resources used in its production and the cost of those resources. These costs are divided by appropriate workload measures to determine the cost per unit of service or per client. Issues that must be addressed include: 1) direct program costs; 2) indirect costs (including administration and capital costs); 3) program resources used to support research and other non-program activities; and 4) identification of "typical" workloads as the program is implemented. Application of these methods is illustrated with data from a multi-site study of intensive psychiatric community care conducted at nine Department of Veterans Affairs Medical Centers in the Northeast. A sensitivity analysis revealed that estimates of program costs vary by 59% over the entire program, and from 17%-168% at individual sites, depending on which cost estimation methods were included. The average cost of case management in this program varied considerably across sites, primarily reflecting differences in caseload size and staffing levels. Adjusting for inflation, the cost of this program falls below the cost of other published intensive community programs.

Community Mental Health Services↗
PubMed1998

Faculty development: a field of dreams.

This chapter describes the faculty development efforts of the eight schools that participated in The Robert Wood Johnson Foundation's "Preparing Physicians for the Future: Program in Medical Education." The authors define "faculty development" as the "enhancement of educational knowledge and skill of faculty members so that their educational contributions can extend to advancing the educational program rather than just teaching within it." Faculty development programs varied widely among the schools. Some schools had active programs in place, others initiated programs at the start of the project. This chapter explores the faculty development topics and methods, both shared and unique, among the eight schools. It then looks at the ways the schools motivated their faculties to participate in their programs. Finally, it describes some of the outcome measures that were used to gauge the effectiveness of the faculty development programs. The authors conclude that the eight schools' approaches and levels of commitment to their faculty development programs varied. They present lessons learned from the successes and failures of the various programs.

Curriculum↗
PubMed1975

Evaluating family planning program effectiveness and efficiency.

This article proposes an integrated in-house evaluation model for family planning programs. The model is designed to meet the need of program management for an operational and internal evaluation system suited to the ongoing character of program activities and focused on the feedback of information for program planning. The ideas presented are applied to the context of the Albany County Family Planning Service, Inc., Wyoming.

Adolescent↗
PubMed1993

Bone marrow transplantation at the University of Nebraska Medical Center.

The bone marrow transplant program at UNMC is currently one of the most active programs in the country. The benefits to patients who are cured of disease by transplantation cannot be measured. The large volume of clinical and basic science research related to transplantation has enhanced the academic stature of UNMC. The combination of patient care, education, clinical research, and basic science research provides an excellent model for the operation of an academic medical institution.

Adult↗
PubMed1996

Oligonucleotides induce apoptosis restricted to the t(14;18) DHL-4 cell line.

Most human follicular B-cell lymphomas are associated with t(14;18) chromosome translocation that joins the bcl-2 gene with the IgH locus. This hybrid gene causes upregulation of BCL-2 protein expression, endowing cells with survival advantage. Although early BCL-2 overexpression is definitely responsible for immortalization/transformation, its exact role in the overt transformation as well as in the maintenance of the tumor phenotype is not known. The capacity of oligodeoxynucleotides (ODN) to modulate gene expression specifically has been exploited to downregulate the overexpression of BCL-2 protein in the SU-DHL-4 human follicular B-cell lymphoma line by the use of sense ODN or antisense ODN or antisense ODN designed to encompass the unique nucleotide sequence in the fusion region of the hybrid transcript. The specific downregulation of the bcl-2 transcript and of the relevant BCL-2 protein in the treated cells activated programed cell death and inhibited growing cells. The antitumor activity was restricted to the DHL-4 cell line carrying the specific nucleotide sequence at the bcl-2/IgH joining region. Thus, DHL-4 lymphoma cells derived from the acute phase of human follicular B-cell lymphoma, although endowed with additional activated oncogenes, were growth inhibited by bcl-2 downregulation with additional activated oncogenes, were growth inhibited by bcl-2 downregulation in a genetically restricted fashion. The biological activity was exerted exclusively by ODNs synthesized in the sense orientation. The sense ODNs have been proposed to anneal the hybrid bcl-2/IgH antisense RNA as identified in this study.

Amino Acid Sequence↗
PubMed1994

Dynamic systems-modeling as a means to estimate community-based prevention effects.

The best applications of prevention programming now are believed to be community-supported strategies, comprehensive in scope, implemented in stages, and delivered by public and private agencies and organizations. Despite the flurry of program activity, research directed toward comprehensive, community-based prevention programming remains a largely uncharted domain. Communities need to know what will work-in their specific contexts. The essential question communities are asking themselves and consultants is, "Which mix of interventions will yield maximum reduction in alcohol and other drug (AOD) abuse in our community?" Computer-based dynamic simulation modeling holds promise in helping provide an answer to this question. These models are designed to replicate the historic patterns and dynamics of target communities with regard to substance availability, use, and misuse and then to simulate future patterns and dynamics under alternative assumptions and intervention mixes. Researchers can use these models to construct structural relationships that reflect alternative theories or explanations for important processes. The models afford community planners and decision-makers with mechanisms for asking "what if" questions regarding alternative intervention mixes and, consequently, for determining which politically acceptable mix of feasible interventions will yield the most reduction in AOD-related problem behaviors. In this chapter, a model under development by the Prevention Research Center of the Pacific Institute for Research and Evaluation is described that focuses on alcohol use and misuse in communities and allows the testing of a wide range of prevention options.

Health Education↗
PubMed2001

The Alaska Native diabetes program.

OBJECTIVES: To provide optimum health care to indigenous people with diabetes, to prevent diabetes, and to monitor the epidemiology of diabetes and selected complications. The purposes of this paper are to describe the program and to present data that highlights the major problems and successes. STUDY DESIGN: Descriptive epidemiology report of diabetes and population service program based on yearly chart review data. METHODS: Almost half of Alaska Natives with diabetes have no direct access to physicians or hospitals. Health care delivery is now managed by the tribes themselves. Program emphases include maintenance of a population-based registry, formal training for village health aides, physical activity programs, patient education, primary prevention activities and adherence to standards of care to prevent complications. A centralized registry is maintained to assure that epidemiological data is available and patients are not lost to follow-up. Each year a random sample of charts at each major facility is audited against nationally standardized care guidelines. RESULTS: The prevalence of diabetes among Alaska Natives increased 80% over the 13 years from 1985 to 1998 (15.7/1000 to 28.3/1000, age adjusted to U.S. 1980 population). For the years 1986-1998 the incidence rates of lower extremity amputation and end stage renal disease were 6.1/1000 and 2.0/1000 respectively. The level of care provided to Alaska Native patients is comparable to that provided to the general diabetic patient population seen in Alaskan urban clinics. CONCLUSIONS: In spite of logistic challenges, care provided to Alaska Native people with diabetes compares favorably to that provided in other settings. Incidence rates of lower extremity amputation and end stage renal disease also remain comparable to or lower than those in other U.S. populations. Many aspects of our system could be extended to other chronic disease programs serving isolated indigenous populations. Primary prevention of diabetes remains a major challenge as life styles change.

Alaska↗
PubMed2003

Community gardens: lessons learned from California Healthy Cities and Communities.

Community gardens enhance nutrition and physical activity and promote the role of public health in improving quality of life. Opportunities to organize around other issues and build social capital also emerge through community gardens. California Healthy Cities and Communities (CHCC) promotes an inclusionary and systems approach to improving community health. CHCC has funded community-based nutrition and physical activity programs in several cities. Successful community gardens were developed by many cities incorporating local leadership and resources, volunteers and community partners, and skills-building opportunities for participants. Through community garden initiatives, cities have enacted policies for interim land and complimentary water use, improved access to produce, elevated public consciousness about public health, created culturally appropriate educational and training materials, and strengthened community building skills.

California↗
PubMed1999

[Pediatric medical emergencies: clinical classification on basis of severity of illness, distribution between work days and non-working days].

OBJECTIVES: Assess one year of activity in a pediatric medical emergency unit of a non-university hospital to detail the degree of gravity of patients admitted to pediatric wards and the distribution of non-programmed activity between and work days and non-work days. METHODS: Prospective classification into 5 degrees of emergency of all admitted children and count of non-programmed medical and surgical activity. RESULTS: A significantly growing number of consultations for minor problems was observed during non-work days. Most hospitalizations were for problems of a rather relative emergency nature. CONCLUSION: The creation of a "day-hospital" would allow evaluation and/or treatment of a large number of pediatric patients without requiring hospitalization. The problem of controlling the flow of consultations to the hospital remains a difficult problem. The many reasons leading to hospital consultation are poorly assessed. It appears indispensable to promote population "education" and development of closer physician's office-hospital collaboration.

Adolescent↗
PubMed1996

Gender differences in physical activity and determinants of physical activity in rural fifth grade children.

This study determined if gender differences in physical activity could be accounted for by differences in selected social-cognitive determinants of activity behavior. Some 334 fifth grade, predominantly African-American students provided information regarding after-school physical activity and the hypothesized determinants of activity behavior. Boys reported significantly greater participation in vigorous ( > or = 6 METs) and in moderate to vigorous ( > or = 4 METs). Relative to girls, boys demonstrated higher levels of physical fitness, greater self-efficacy in overcoming barriers to physical activity, greater amounts of television watching, and higher levels of participation in community sports and physical activity organizations. When mean physical activity scores for girls and boys were adjusted for the effects of these determinant variables, the significant gender difference in physical activity remained. However, adjustment for self-efficacy in overcoming barriers and community sports reduced the gender gap by 5% and 7%, respectively. In contrast, adjustment for television watching increased the gender gap by about 8%. Results indicated perceived confidence in overcoming barriers to physical activity and participation in community physical activity programs are factors related to the gender difference in physical activity.

Child↗
PubMed2001

The public health perspective in health promotion and disability prevention for older adults: the role of the Centers for Disease Control and Prevention.

As the United States federal public health agency, the role of the Centers for Disease Control and Prevention (CDC) in health promotion and disability prevention with older adults encompasses research, surveillance and program activities in aging. This article characterizes the objectives and context of prevention in later life and summarizes CDCs functions, collaborative partnerships with public health agencies and other organizations, and range of activities in older adult health. As a major focus of these efforts, chronic disease risk reduction is examined through CDC's efforts in the area of physical activity; a longitudinal investigation of osteoarthritis in an older biracial rural population; and chronic illness self-management programs as a prototype for secondary prevention. Other CDC activities highlighted include addressing the burden of vaccine-preventable diseases through CDC-funded programs to improve immunization coverage in older adults, and falls prevention interventions and resources. Future directions in aging at CDC are also outlined.

Accidental Falls↗
PubMed1978

Identification of the structural gene for the hook subunit protein of Escherichia coli flagella.

Previous studies showed that the structural gene for the flagellar hook subunit protein (molecular weight 42,000) was one of a group of flagellar genes located on the Escherichia coli genome near pyrC. Several lines of evidence indicate that the flaK gene is the structural gene for the hook subunit protein. Fla+ strains that were insensitive to chi infection could be isolated as revertants of an FlaK- amber mutant strain but from no other Fla- strain. The hook subunit proteins isolated from such chi-sensitive revertants of the FlaK- strain were shown to be antigenically and electrophoretically different from the hook protein isolated from the wild-type strain. Thus, reversion of a mutation in the flaK gene resulted in alteration of the structure of the hook protein. Furthermore, in programming experiments with hybrid lambda containing flagellar genes, lambdafla with flaK genetic activity programmed the synthesis of a 42,000-molecular weight protein, whereas lambdafla without flaK genetic activity did not.

Bacterial Proteins↗
PubMed1991

Randomized 4-week exercise program in patients with impaired left ventricular function.

BACKGROUND: This study was designed to determine the controlled effects of a short-term exercise rehabilitation program on patients with moderate-to-severe left ventricular dysfunction after a recent myocardial infarction. METHODS AND RESULTS: Thirty-nine male patients 51 +/- 8 years old with a large anterior myocardial infarction less than 10 weeks old were recruited for the study. The patients were randomly assigned to either one of two training or control groups on the basis of their resting ejection fraction: training, less than 30%; control, less than 30%; training, 31-50%; or control, 31-50%. Patients were evaluated for filling pressures, radionuclide ventriculography, heart volume, echocardiography, and work capacity. Patients who underwent training participated in an intensive 4-week in-hospital exercise program, whereas the control patients were restricted to a minimal activity program. Results indicated that there were no significant improvements in resting, submaximal, and maximal hemodynamic measurements as a result of the program. Mean work capacity and peak oxygen consumption improved significantly in the less-than-30% training group but was accompanied by a significant increase in mean pulmonary wedge pressure. Resting ejection fraction improved markedly in both less-than-30% training and control patients, but ejection fraction measures were not associated with work capacity. Training did not cause further deterioration in ventricular function. CONCLUSIONS: It was concluded that in the present study, exercise training had little or no effect on hemodynamic measurements and that the training effects achieved in patients with left ventricular dysfunction are most likely due to corrected impaired vasodilation, not necessarily to cardiac function. The importance of using a control group in this type of study and the wide interindividual variations in training responses are emphasized.

Exercise Therapy↗