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PubMedDate not supplied

Health research in the developing world: a gastroenterological view from Bangladesh.

Ill health is a serious impediment to progress in most poor countries, yet health is not a high priority on foreign aid agendas. Health research, which provides the essential base for sustainable progressive health programs, is barely visible in developing countries. For example, in Bangladesh, one finds unacceptably high morbidity and mortality rates among infants and children, health programs that are struggling and a rudimentary health research establishment; for the huge foreign donor community in that country, health programs and research do not appear to warrant major investments. Diarrheal diseases are at the top of the list of killers in many poor nations including Bangladesh. Recent advances in our understanding of diarrhea suggest that when prevention may not be possible soon, improved active treatment can evolve from an aggressive research effort centered in a developing country and linked to appropriate international partners. Global agencies such as the World Health Organization have demonstrated a declining interest in health research, as reflected in the policies of their Diarrhoeal Disease Control Programme. Major donors to the developing world, the Canadian International Development Agency for example, have had a relatively minor involvement in health and little commitment to health research. University links with the west, private enterprises and specially targeted programs are involved in developing world health research but they have not been able to foster and leave behind sustainable, high quality research programs. The problem should be attacked directly by supporting focused, relevant health research centres in regions of the world where the burden of disease continues to impede progress and where the environment is conducive to high quality research that is well integrated with care delivery programs. An instructive model of this approach is the International Centre for Diarrhoeal Disease Research in Dhaka, Bangladesh.

Bangladesh↗
PubMed1998

Sustaining curricular change at Sherbrooke through external, formative program evaluations.

In this case study, the authors discuss external, formative program evaluation as a means to monitor and sustain ongoing curricular change and to prepare for periodic accreditation reviews. The Faculty of Medicine at Sherbrooke (in Quebec, Canada), following a major curricular reform begun in the mid-1980s, held three external, formative program evaluations in 1988, 1991, and 1994, using expert judgment and "connoisseur" models of evaluation. The authors present the goals of the evaluations (e.g., to evaluate the implementation of intended curricular changes) and the 17-step process used (e.g., "involve as many faculty and students as possible before and during the visit"), and describe the preparation for the evaluations, the selection of the external evaluators (e.g., a chief medical officer from the World Health Organization, a high-profile basic sciences teacher, the chairman of the previous accreditation team, and others), and on-site activities and reporting. Recommendations from the evaluators and the subsequent actions taken (and in a few cases, not taken) by the school are presented and discussed in terms of program planning, curricular content, basic sciences, problem-based learning and tutors' training, assessment of students, resource constraints, clerkships, community orientation, students' self-directedness, and medical humanism. The three evaluations helped guide and support the major curricular undertakings and encouraged continued changed and refinements. They also had a significant effect on the curriculum itself, on the faculty, and on the socioeducational climate of the school.

Curriculum↗
PubMed1987

[Importance of programmed ventricular stimulation in patients with ventricular salvos].

The yield of programmed ventricular stimulation in asymptomatic patients with documented ventricular salvoes is not definitely known. Therefore, we retrospectively evaluated the data of 57 patients in whom ventricular salvoes had been observed, either during resting ECG or 24-hour ECG monitoring, and who had been studied using programmed ventricular stimulation. Of these patients, 63% were male, with a mean age of 49 years. 28% had coronary artery disease, 21% dilated cardiomyopathy, 16% mitral valve prolapse, 9% hypertrophic cardiomyopathy, 9% valvular heart disease and 14% had no structural heart disease. Using a maximum of two premature ventricular extrastimuli during programmed ventricular stimulation, sustained ventricular tachycardia or ventricular fibrillation was induced in nine patients (16%). In 30 patients (53%) nonsustained ventricular tachycardia was induced (3-35 ventricular echo beats), in 18 patients only one to two ventricular echo beats could be induced. In 8/16 patients (50%) with coronary artery disease, sustained ventricular tachycardia/ventricular fibrillation could be induced. Mean left ventricular ejection fraction did not differ between patients with inducible sustained ventricular tachyarrhythmia and those with inducible non-sustained ventricular tachycardia or those with a normal result during programmed ventricular stimulation. 33 patients were treated with antiarrhythmic drugs; the efficacy of antiarrhythmic therapy was either controlled by "serial electrophysiologic testing" in four patients, or by repeated 24-hour long-term ECG in 29 patients. During a mean follow-up period of 31 +/- 24 months five patients died, two of them suddenly. None of the remaining patients had experienced a symptomatic sustained ventricular tachycardia or a syncope.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Are Head Start effects sustained? A longitudinal follow-up comparison of disadvantaged children attending Head Start, no preschool, and other preschool programs.

This study investigates the sustained effects into kindergarten and grade 1 of Project Head Start for disadvantaged black children. Participation in generic Head Start programs was compared to both no preschool and other preschool experience for disadvantaged children in two American cities in 1969-1970. Incorporating both pretest/posttest and comparison group information, the study has advantages over other Head Start impact studies. Both preprogram background and cognitive differences were controlled in a covariance analysis design, using dependent measures in the cognitive, verbal, and social domains. Children who attended Head Start maintained educationally substantive gains in general cognitive/analytic ability, especially when compared to children without preschool experience. These effects were not as large as those found immediately following the Head Start intervention. Findings suggest an effect of preschool rather than of Head Start per se. Initial findings of greater effectiveness of Head Start for children of below average initial ability were reduced but not reversed. The diminution of effects over time, especially for low-ability children, may reflect differences in quality of subsequent schooling or home environment.

Achievement↗
PubMed2000

Definition of animal breeding goals for sustainable production systems.

What we do is determined by the way we "view" a complex issue and what sample of issues or events we choose to deal with. In this paper, a model based on a communal, cultural, or people-centered worldview, informed by a subjective epistemology and a holistic ontology, is considered. Definitions and interpretations of sustainable agriculture are reviewed. Common elements in published definitions of sustainable agriculture and animal production among those who seek long-term and equitable solutions for food production are resource efficiency, profitability, productivity, environmental soundness, biodiversity, social viability, and ethical aspects. Possible characteristics of future sustainable production systems and further development are presented. The impact of these characteristics on animal breeding goals is reviewed. The need for long-term biologically, ecologically, and sociologically sound breeding goals is emphasized, because animal breeding determined only by short-term market forces leads to unwanted side effects. Hence, a procedure for defining animal breeding goals with ethical priorities and weighing of market and non-market values is suggested. Implementation of non-market as well as market economic trait values in the aggregate genotype, as suggested, may allow for breeding programs that contribute to sustainable production systems. Examples of breeding goals in salmon, cattle, and pigs are given, and the resulting genetic responses are evaluated with respect to economic profit (or costs) and other criteria of sustainability. Important prerequisites for breeding programs for sustainable production are appropriate governmental policies, awareness of our way of thinking, and a more communal worldview informed by a subjective epistemology and a holistic ontology.

Animal Husbandry↗
PubMed2005

Sustainability of teacher implementation of school-based mental health programs.

Evidence-based prevention and intervention programs are increasingly being implemented in schools and it therefore is becoming increasingly important to understand the complexities of program implementation under real-world conditions. Much research has focused on the contextual factors that influence program implementation but less work has attempted to provide an integrated understanding of mechanisms (e.g., teacher-training processes) that affect teachers' program implementation. In this paper, we review literature on factors related to teachers' implementation of school-based prevention and intervention programs, then from this review abstract what we believe are four basic ingredients that characterize potentially sustainable teacher-implemented classroom programs. Finally, we present a sequential model, based on these ingredients, of the naturalistic processes underlying sustainability of teachers' program implementation and describe how this sustainability can be enhanced through provision of teacher training and performance feedback from a classroom consultant.

Adolescent↗
PubMed1992

[Risk stratification and long-term therapy with amiodarone in patients with idiopathic dilated cardiomyopathy].

Patients with cardiomyopathy are known to suffer from a high prevalence of tachyarrhythmic complications and sudden cardiac death. In a prospective study, 30 patients (25 men, 5 women, mean age: 52 +/- 12 years) with dilated cardiomyopathy underwent 48-h-Holter monitoring and programmed electrical stimulation and, independent from the results of the diagnostic work-up, were then randomized either to amiodarone or to a conventional or no antiarrhythmic therapy. At baseline, frequent ventricular arrhythmias (> 30 ventricular premature beats/h) were observed in 15/30 patients (50%), 13 patients (43%) had repetitive ventricular arrhythmias, additionally. Four patients suffered spontaneous sustained tachyarrhythmias. During programmed electrical stimulation, sustained monomorphic ventricular tachycardia was induced in 3/3 patients with and in 1/25 patients (4%) without a history of sustained tachycardia. Sustained monomorphic ventricular tachycardia was induced with one to two extrastimuli; three extrastimuli only increased the incidence of inducible ventricular fibrillation (8 patients, 28%). During a mean follow-up of 28 +/- 6 months 10/30 patients (33%) died for cardiac reasons (sudden cardiac death: 4/10 patients). Cardiac death was most likely in patients with a left-ventricular ejection fraction < 35% (5/18 patients, 28% versus 1/12 patients with ejection fraction > 35%, 8%) and further increased in the presence of reduced exercise tolerance and frequent and repetitive ventricular arrhythmias (4/7 patients, 57%). In the amiodarone group 4/15 patients died (27%, sudden cardiac death: one patient), while in patients not treated by amiodarone 8/15 patients died (54%; sudden cardiac death: three patients). Amiodarone therapy was well tolerated in all but one patient.

Adult↗
PubMed2005

Measuring success in a pesticide risk reduction program among migrant farmworkers in Colorado.

BACKGROUND: Farmworkers in the US largely consist of young undocumented Hispanics with a median education of 6 years and limited English skills. The High Plains Intermountain Center for Agricultural Health and Safety bilingual pesticide risk reduction program, which complied with the Worker Protection Standard for migrant farmworkers was evaluated. METHODS: A pretest/posttest comparison of farmworkers (n = 152) assigned to either the experimental or control group was used. Independent variables included demographics, agricultural experience, and health locus of control. Dependent variables were pesticide knowledge, safety risk perception (SRP), and safety-behavior outcomes. RESULTS: The bilingual pesticide program effectively increased farmworker's pesticide knowledge (P = 0.0001), SRP (P = 0.0001), and two (out of four) behavior outcomes. Workers with external health locus of control were less likely to adopt safety behaviors (P = 0.0001). CONCLUSIONS: The cognitive decision-making process whereby farmworkers' readiness to change and permanently adopt safety behaviors was supported by the pesticide program. Our results support the need for long-term sustained bilingual, intervention programs that demonstrated effectiveness using integrative methodology.

Adolescent↗
PubMedDate not supplied

Peer power: how Dare County, North Carolina, is addressing chronic disease through innovative programming.

Peer Power is an innovative school-based program that trains high school students as health educators and mentors for middle school students. The program was designed to produce positive health behavior changes in youth and reduce long-term incidence of chronic diseases of the heart and lung. This program, developed at the Management Academy for Public Health, has been successful in receiving grant funds and has demonstrated positive behavioral changes in youth in the areas of physical activity, nutrition, and tobacco use. Peer Power has far exceeded the anticipated outcomes and proven to be a catalyst for improved health behaviors throughout the community. Positive unintended consequences of Peer Power include the development of an effective social marketing campaign, reduction in tobacco sales to minors, and an increase in smoke-free restaurants in Dare County. Benefits received by Management Academy participants are evident through improved business and administrative skills at the Dare County Department of Public Health, the number of new and innovative programs that have succeeded in securing grant funds, and the sustainability of the programs developed.

Adolescent↗
PubMed2002

Controlled evaluation of a community based injury prevention program in Australia.

OBJECTIVE: To evaluate the effects of a community based, all age, all injury prevention program, the Safe Living Program, on injury risk and injury rates. DESIGN: A quasiexperimental population based evaluation using an intervention and comparison community design. SETTING: The intervention community (Shire of Bulla, n = 37,257) is an outer metropolitan area of Melbourne, Australia. The demographically matched comparison community (Shire of Melton, n=33,592) is located nearby. SUBJECTS AND METHODS: The Safe Living Program in the Shire of Bulla targeted injury reduction in all settings with a focus on high risk groups. Strategies included program publicity, education and training, injury hazard reduction, and environmental change. Baseline and follow up measures of program reach, risk factors, and injury rates in both communities were used to evaluate program process, impact, and outcome. RESULTS: Increase in program awareness was moderate and similar to other community based programs. The program achieved injury hazard reduction on the road, in schools, and, to a more limited extent, in the home. Other changes in injury risk factors could not necessarily be attributed to the program as similar changes were observed in the comparison community. No significant changes were found in rates of injury deaths, hospitalisations, or emergency department presentations in the Shire of Bulla after six years. Self reported household injuries, mostly minor, were reduced in the intervention community, but had been higher at program launch than in the comparison community. CONCLUSIONS: The Safe Living Program was unable to replicate the significant reductions in injuries reported in other community based interventions. Replication of apparently successful community based injury prevention programs in different settings and populations requires evidence based interventions, sustained and effective program penetration, reliable data systems to measure change, at least one control community, and sufficient budget and time for effects to be observable.

Accident Prevention↗
PubMed1984

Localized reentry. Mechanism of induced sustained ventricular tachycardia in canine model of recent myocardial infarction.

This study was undertaken to investigate the mechanism underlying sustained monomorphic ventricular tachycardia (VT) in late experimental canine myocardial infarction. The hypothesis that sustained and "organized" continuous electrical activity (CEA) displaying a reproducible pattern with recurrent components recorded by bipolar endocardial, intramural, or epicardial electrodes in 10 animals during electrically induced sustained monomorphic VT represented reentrant excitation in an anatomically small area of the ventricle, was evaluated in the light of the following observations: Organized CEA always preceded the first monomorphic ventricular complex (QRS) of VT as well as the discrete local electrograms from closely surrounding sites during the initiation of VT. The site of organized CEA corresponded to the site of origin of sustained VT determined by iso-chronous contour map analysis of activation sequence. Ventricular pacing at rates more rapid than that of VT failed to terminate VT despite ventricular capture unless it transformed CEA into discrete local electrograms. VT could be terminated in three animals, with a single, critically timed premature stimulus delivered at a critically located focus close to the site of CEA, which would result in local capture and interrupted CEA. In six animals, surgical ablation of the site of organized CEA effectively prevented the reinitiation of sustained VT by programmed cardiac stimulation. These data showed that organized CEA and sustained VT were closely associated phenomena and suggested that organized CEA probably represented an important component of the tachycardia circuit.

Animals↗
PubMed1997

Patients with valvular heart disease presenting with sustained ventricular tachyarrhythmias or syncope: results of programmed ventricular stimulation and long-term follow-up.

BACKGROUND: Programmed ventricular stimulation is commonly used to guide therapy in post-myocardial infarction patients with sustained monomorphic ventricular tachycardia (VT) or ventricular fibrillation (VF). In patients with valvular heart disease presenting with spontaneous VT, VF, or syncope, the usefulness of this technique is still unclear. The aim of the study was to analyze whether programmed ventricular stimulation was helpful in guiding therapy and determining prognosis in 97 patients with valvular heart disease presenting with VT (60%), VF (18%), or syncope (22%). METHODS AND RESULTS: Patients were classified as having either predominant ventricular pressure or volume overload or no significant pressure or volume overload. Overall, sustained VT or VF was inducible in 38 (39%) and 19 (20%) patients, respectively. Forty-six (47%) patients were discharged on antiarrhythmic drugs, 29 (30%) received an implantable cardioverter-defibrillator, and 22 (23%) remained without therapy. With serial drug testing, inducibility was completely or partially suppressed in 18 (19%) and 9 (9%) patients, respectively. During a mean follow-up of 51 months (n=97), 17 patients (18%) died (sudden death, n=7; heart failure, n=4; noncardiac causes, n=6). One-, 2- and 3-year event-free survival for sudden death, sustained VT, or VF was 77%, 68%, and 61%, respectively. Only inducibility of VT during baseline study (P<.0003) and left ventricular volume overload (P<.008) were significant predictors of arrhythmic events. Recurrence of arrhythmic events occurred in 56% and 56% of patients with complete or partial suppression of inducibility during serial drug testing as well as in 10 of 19 (53%) patients without a change in inducibility. CONCLUSIONS: Although programmed ventricular stimulation seems to predict adverse outcome, serial drug testing is unreliable in guiding therapy. The type of workload imposed on the ventricles influences outcome, being worse in patients with left ventricular volume overload. Therefore, implantation of a cardioverter-defibrillator should be considered early for the management of these patients.

Adolescent↗
PubMed1999

Persistent functional and social benefit 5 years after a multidisciplinary arthritis training program.

OBJECTIVE: To assess the sustainable benefits of a professional, multidisciplinary training program for patients with rheumatoid arthritis. DESIGN: Two studies with different observation periods. Study I was a prospective, randomized trial for 1 year. Study II was a noncontrolled observation over 5 years. SETTING: The 9-day program for eight patient groups encompassed a multidisciplinary cooperation between rheumatologists, orthopedists, physicotherapists, psychologists and social workers. PATIENTS: Sixty-eight consecutive patients with rheumatoid arthritis participated in an arthritis training program either immediately after enrollment in the program or after 1 year. INTERVENTIONS: The program covered the following fields: pathogenesis of rheumatoid arthritis, drug therapy, physicotherapy, practical exercise in remedial gymnastics, use of joint protection devices, orthopedic perspectives, psychological counseling, dietetics, information about unproven cures and social assistance. MAIN OUTCOME MEASURES: Clinical outcome was assessed by self-report questionnaires: (1) Stanford Health Assessment Questionnaire, (2) Freiburg Questionnaire of Coping with Illness, (3) Beck Depression Inventory, and (4) a 21-point scale to evaluate cognitive-behavioral and environmental impact. RESULTS: A significant and persistent improvement of all investigated parameters was demonstrated in the 1-year controlled trial. Between the end-point of the 1-year study and the 5-year evaluation, this improvement increased even more for functional status and coping with illness, whereas depression returned to baseline values. These effects were seen even without reinforcement of the training. CONCLUSION: A professional, multidisciplinary approach to educate patients with rheumatoid arthritis leads to a significant and sustained improvement of the clinical outcome and is an approach that should be established as a part of conventional therapy.

Activities of Daily Living↗
PubMed2000

Physician orders for life-sustaining treatment (POLST): outcomes in a PACE program. Program of All-Inclusive Care for the Elderly.

OBJECTIVES: To evaluate whether terminal care was consistent with Physician Orders for Life-Sustaining Treatment (POLST), a preprinted and signed doctor's order specifying treatment instructions in the event of serious illness for CPR, levels of medical intervention, antibiotics, IV fluids, and feeding tubes. DESIGN: Retrospective chart review. SETTING: ElderPlace, a Program of All-Inclusive Care for the Elderly (PACE) site in Portland, Oregon. PARTICIPANTS: All ElderPlace participants who died in 1997 were eligible (n = 58). Reasons for exclusion were no POLST (1), missing POLST (1), and insufficient documentation of care (2). MEASUREMENTS: POLST instructions for each participant and whether or not each of the treatments addressed by the POLST was administered in the final 2 weeks of life. RESULTS: The POLST specified "do not resuscitate" for 50 participants (93%); CPR use was consistent with these instructions for 49 participants (91%). "Comfort care" was the designated level of medical intervention in 13 cases, "limited interventions" in 18, "advanced interventions" in 18, and "full interventions" in 5. Interventions administered were at the level specified in 25 cases (46%); at a less invasive level in 18 (33%), and at a more invasive level in 11 (20%). Antibiotic administration was consistent with POLST instructions for 86% of 28 subjects who had infections in the last 2 weeks of life, and less invasive for 14%. Care matched POLST instructions in 84% of cases for IV fluids and 94% for feeding tubes. CONCLUSIONS: POLST completion in ElderPlace exceeds reported advance directive rates. Care matched POLST instructions for CPR, antibiotics, IV fluids, and feeding tubes more consistently than previously reported for advance directive instructions. Medical intervention level was consistent with POLST instructions for less than half the participants, however. We conclude that the POLST is effective for limiting the use of some life-sustaining interventions, but that the factors that lead physicians to deviate from patients' stated preferences merit further investigation.

Advance Directives↗
PubMed1983

Treatment of recurrent sustained ventricular tachycardia with mexiletine and disopyramide. Control by programmed ventricular stimulation.

Oral antiarrhythmic treatment with mexiletine and disopyramide was evaluated in 34 patients with recurrent sustained ventricular tachycardias by programmed ventricular stimulation, except in a few instances where spontaneous attacks occurred under therapy. Coronary heart disease was present in 17 patients, cardiomyopathy in 11, myocarditis in five, and mitral valve prolapse in one. Complete suppression of ventricular tachycardia was observed in three of 30 patients under mexiletine and in one of 25 patients under disopyramide. Disopyramide slowed the rate of the ventricular tachycardia considerably, while mexiletine had no such influence. For a mean of 24 months, 19 patients were maintained on either substance. Complete suppression of ventricular tachycardia during programmed stimulation predicted freedom from recurrences. Ventricular tachycardias recurred less frequently and at a slower rate in the other patients, but 31% have died. This study shows that complete suppression of ventricular tachycardia by mexiletine or disopyramide can be achieved only in a minority of patients with previously drug-resistant tachycardias.

Adult↗
PubMed2003

Program to enhance health literacy and treatment adherence in low-income HIV-infected Latino men and women.

This paper reports the initial results of a pilot study to evaluate the acceptability and effectiveness of a program to enhance health literacy in low-income HIV-infected Latino men and women receiving antiretroviral therapy. Participants rated the program highly on measures of satisfaction, providing evidence of its acceptability. The effectiveness of the program was assessed in comparisons of the intervention (n = 41) and standard care only (n = 40) groups at baseline and 6-week intervals. Program participants showed significant improvement over comparison group participants on measures of HIV/AIDS and treatment-related knowledge and recognition and understanding of HIV terms. Although there were no significant changes in adherence mastery and behaviors during the 6-week follow up period, there were significant changes in program participants' knowledge about medication adherence. Future steps to examine the sustainability of the program in the medical management of patients are planned in addition to determining its long-range relative impact.

Adult↗
PubMed2004

Are rural people getting HeartSmart?

OBJECTIVE: This study evaluates the impact of a cardiac rehabilitation program (HeartSmart) in a rural area on the quality of life, dietary behaviour, weight loss and physical activity participation of patients with cardiovascular disease (CVD) or at high risk of CVD. DESIGN: The evaluation of the program consisted of a single group pre and post-test design with follow-up at 3, 6 and 12 months after program completion, complemented with a cross-sectional survey of non-participants as a pseudo comparison group. SETTING: The HeartSmart program is a hospital-based cardiac rehabilitation program in Bunbury, a regional centre of Western Australia. SUBJECTS: A total of 203 participants and 159 non-participants. INTERVENTIONS: The program consisted of 7 weeks of education and exercise sessions. RESULTS: The program had a high rate of completion (92%). Evaluation results suggested that HeartSmart participants demonstrated significant improvements in quality of life, compliance with medication, dietary behaviour, weight loss and physical activity participation. The largest changes were mostly observed between pre and post-program stages, with sustained behaviour change at 6 months after the completion of the program. Further evidence of the HeartSmart benefits was provided through significantly better health-related behaviour, confidence to diet and exercise, dietary fat intake, cardiac knowledge and quality of life scores among HeartSmart participants compared with non-participants. CONCLUSIONS: While this program has achieved its objectives, there are a few issues that need to be considered by similar programs: the post-program stage of patient follow-up by general practitioners; the geographical disadvantage of those living outside regional centres to access the service; enhancing the primary prevention aspect of the program; adapting the program to the needs of Aboriginal clients; facilitating evaluations by resourcing and training program staff in computer skills. WHAT IS ALREADY KNOWN ON THIS SUBJECT: The viability of establishing cardiac rehabilitation programs in rural Australia has been questioned and few if any have been formally evaluated, particularly using a follow-up design and a control group. WHAT THIS PAPER ADDS: This study ascertains the benefits of secondary prevention programs in rural areas not only on the quality of life but also shows positive outcomes in lifestyle modification for program participants compared to non-participants. The lessons learnt can improve the effectiveness of similar prevention programs.

Aged↗
PubMedDate not supplied

A field study comparing a pregrazing treatment with the morantel sustained release bolus with a strategic deworming program in first year grazing cattle.

A field trial was designed to compare the efficacy of a pregrazing treatment with a morantel sustained release bolus and two strategic treatments of levamisole in the prevention and control of gastrointestinal parasitism in first year grazing cattle. The infection of calves, pasture contamination and the subsequent effects on performance were recorded.

Animals↗