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At least 433 records · Page 24Linked to original sources
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↗
PubMed1994

An examination of demographic, socio-cultural, and health differences between congregate and home diners in a senior nutrition program.

Building upon prior research, this study investigates characteristics of participants in a senior nutrition program in Hillsborough County, Florida. The Senior Citizens Nutrition and Activities Program serves approximately 2,600 meals per day to county residents 60 years of age and over. In this study, a sample of 1,071 participants are surveyed for background characteristics, interpersonal relationships and emotional closeness, health and economic condition, emotional condition, and participation in the program. Crosstabular analyses are performed on the collected data with age, sex, and race controlled. The results indicate that the program is reaching its goals of promoting good health among the older population of Hillsborough County by providing nutritious meals and reducing social isolation, which often accompanies aging.

Aged↗
PubMed1981

Alcoholism treatment in Canada: a review of current programs and policy issues.

An overview of the specialized alcoholism treatment field in Canada is presented based on a 1976 national survey of 338 programs. Descriptive information on these programs is presented to provide an understanding of the state of current treatment efforts and to identify emersent policy issues in this field. Programs activities are described under six headings: (1) the pattern of program development, (2) types of treatment agencies, (3) treatment capacity and utilization, (4) the characteristics of persons using treatment services, (5) approaches employed in treatment, and (6) program costs and financing of alcoholism treatment. Findings from the national study are related to three policy issues: access, quality, and cost. The need for future research aimed at these issues is discussed.

Alcoholism↗
PubMedDate not supplied

The medical and surgical determinants of heart transplantation outcomes: the results of a consensus survey in the United States.

Heart transplantation may well be the most successful transplantation procedure performed today. One-year patient survival rates now exceed 80%. Many factors are thought to account for differences in outcomes among transplantation centers. No attempt has been made to assess consensus among transplantation program directors regarding the major determinants of patient outcome. In the National Cooperative Transplantation Study we evaluated consensus through a detailed survey of all heart transplantation programs active in the United States in 1988. Of the eligible programs, 104 (91%) returned completed surveys. Data on the medical and surgical determinants of outcomes have been analyzed descriptively. Considerable consensus occurred among program directors about the importance of several factors. For example, over 90% of the respondents felt that heart biopsy should be used as the standard rejection monitoring technique and that left and right heart catheterization should be performed annually with coronary arteriography. Over 60% believed that the availability of a left ventricular assist device for temporary use would also enhance patient outcome. Several approaches were considered to have little beneficial effect on outcome. These included cytoimmunologic monitoring and electrocardiography as standard rejection monitoring techniques. Nearly one half of the respondents opposed steroid discontinuation after transplantation. On several other approaches there was a lack of consensus including the use of heterotopic heart transplantation and conversion from cyclosporine because of renal dysfunction. Consensus conferences are now regarded as a means by which technologic innovations can be evaluated and medical practice guidelines can be set. This analysis suggests that consensus is a useful approach toward assessing medical and surgical practices in heart transplantation.

Data Collection↗
PubMed2000

Findings from case studies of state and local immunization programs.

BACKGROUND: As part of its examination of federal support for immunization services during the past decade, the Institute of Medicine (IOM) Committee on Immunization Finance Policies and Practices (IFPP) commissioned eight case studies of the states of Alabama, Maine, Michigan, New Jersey, North Carolina, Texas, and Washington; and a two-county study of Los Angeles and San Diego in California. Specifically, the IOM Committee and these studies reviewed the use of Section 317 grants by the states. Section 317 is a discretionary grant program that supports vaccine purchase and other immunization-related program activities. These studies afforded the Committee an in-depth look at local policy choices, the performance of immunization programs, and federal and state spending for immunization during the past decade. METHODS: The case-study reports were developed through interviews with state and local health department officials, including immunization program directors, Medicaid agency staff, budget analysts, and Centers for Disease Control and Prevention public health advisors to the jurisdiction. Other sources included state and federal administrative records and secondary sources on background factors and state-level trends. The case studies were supplemented by site visits to Detroit, Houston, Los Angeles, Newark, and San Diego. OBSERVATIONS: The nature of immunization "infrastructure" supported by the Section 317 program is shifting from primarily service delivery to a broader set of roles that puts the public effort at the head of a broad immunization partnership among public health, health financing, and other entities in both the public and private sectors. The rate and intensity of transition vary across the case-study areas. In the emerging pattern, service delivery increasingly takes place in the private sector and is related to managed care. "Infrastructure" is moving beyond supporting a core state staff and local health department service delivery to include such activities as immunization registries, quality improvement, and coordination with programs outside public health agencies. At the same time, the recent decline in federal Section 317 support is forcing difficult choices between old and new activities at the state and local levels. CONCLUSIONS: Immunization programs function as an organic component of the local health care financing and delivery systems of which they are a part. Immunization efforts are organized and conducted within distinctive state and local fiscal, economic, and health care contexts. Section 317 Financial Assistance grants, while playing a vital role in supporting immunization "infrastructure," have been too unstable and unpredictable to elicit the strategic planning, programming, and own-source spending that would be optimal for state and local programs. The predominant immunization function of state and local public health agencies is becoming assurance of age-appropriate immunization throughout the lifespan. To be successful in this emerging role, the health agencies must be supported with appropriate staffing, interagency collaboration, and clearly articulated authority.

Adult↗
PubMed2003

Assessing the effectiveness of a walking program on physical function of residents living in an assisted living facility.

The purpose of this study was to assess the effectiveness of a resident-led walking program at an assisted living facility (ALF). Seventeen women (mean age 80, range 62-99) agreed to participate in a "walking club." Pre and post measurements included the Tinetti Performance-Oriented Assessment of Mobility Problems in Elderly Patients, the Functional Reach Test, and the Barthel Index to measure independence in activities of daily living (ADLs). Participants set their own goals for walking distance and frequency, with the assistance of the lead researcher if requested. Distances ranged from 75 ft to over 1 mile. At the end of the 9-week intervention, there was a significant increase in all of the pre-test measurements. In addition, post-test assessment included individual interviews with participants about their experiences with the physical activity program. Four positive themes about the walking program emerged: (a) as a pleasurable activity, (b) as a way to manage current health problems, (c) as a way to continue life-long activity, and (d) because of perceived physical and psychological benefits from the activity. The participants planned to continue the walking program. The results of this pilot study suggest that a walking program can be instituted in an assisted living facility with minimal staff effort and significant benefit to residents.

Activities of Daily Living↗
PubMed1994

Physical activity patterns in American high school students. Results from the 1990 Youth Risk Behavior Survey.

OBJECTIVE: To assess by self-reported participation in vigorous physical activity, the quantity and quality of school physical education, team sports, and television watching among 11,631 American high school students. RESULTS: Of all students in grades 9 through 12, 37% reported engaging in 20 minutes of vigorous physical activity three or more times per week. Participation in vigorous physical activity was higher among boys than girls (P < .01) and higher among white students than among those of other races and ethnic groups (P < .01). Overall, 43.7% of boys and 52% of girls reported that they were not enrolled in physical education classes. Of the students who reported attending physical education class during the past 2 weeks, 33.2% reported exercising 20 minutes or more in physical education class three to five times per week. In contrast, rates of participation in varsity and junior varsity sports remained constant across grade levels, but participation in recreational physical activity programs showed a lesser magnitude and also decreased with advancing grade. More than 70% of students reported spending at least 1 hour watching television each school day, and more than 35% reported watching television 3 hours or more each school day. CONCLUSIONS: Participation in vigorous physical activity and physical education class time devoted to physical activity are substantially below the goals set in Healthy People 2000. As students move toward graduation, we observed disturbing declines in participation in community recreation programs and overall vigorous activity. Students appear to spend considerably more time watching television than participating in physical activity. Public health efforts should focus on increasing the physical activity levels of our youth to enhance their current well-being and to reduce the risks of future chronic disease.

Adolescent↗
PubMed1988

Ministerial Resolution No. 379-8-SA/DM, 18 October 1988.

This Resolution approves the Regulations for the organization and functioning of the Autonomous Authority of the Special Project for Primary Attention and Basic Health Services created by Peru Supreme Decree No. 005-86-SA. The objectives of the Authority are 1) to implement basic health services; 2) to bring about the construction of health centers; 3) to give medical equipment and medicines to these centers, as well as to the people with the poorest levels of health within its jurisdiction; 4) to supply means of communication and transportation; 5) to obtain the participation of the community in all steps of the project; and 6) to train personnel. Further provisions of the Resolution deal with the directorate, the executive presidency, departments, and resources of the Authority, among other things.

Americas↗