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Experimental foundations of EMG biofeedback with the upper extremity: a review of the literature.

This article reviews the experimental foundations of EMG biofeedback with the upper extremity. Considered are investigations on recruitment and training of single and multiple motor units in both normal and nonnormal subjects, on transfer of training effects from trained to untrained muscles, and on the relationship of reduced muscle output to relaxation. Examined are procedures, results, and conclusions of these basic studies. Problems noted in the research are discussed and suggestions are made for further work in the area.

Arm↗

Quality of life as outcome in the treatment of osteoporosis: the development of a questionnaire for quality of life by the European Foundation for Osteoporosis.

The morbidity of osteoporosis is caused by fractures. Vertebral fractures lead to pain and disability and a decrease in quality of life. A Working Party of the European Foundation for Osteoporosis has developed a specific questionnaire for patients with established vertebral osteoporosis. This questionnaire is intended for use in clinical trials. The questionnaire consists of questions and visual analogue scales in the following domains: pain, activities of daily living, jobs around the house, mobility, leisure and social activities, general health perception and mood. The questionnaire has been translated from English into French, German, Italian, Hebrew, Swedish and Dutch. The questionnaire is currently being validated in a multicentre study involving patients with stable osteoporosis and control subjects. Preliminary results indicate that the reproducibility is sufficient and that the questionnaire is able to discriminate between patients with vertebral osteoporosis and control subjects.

Activities of Daily Living↗

An epidemiological and clinical approach to adolescent suicide. A comparison between suicidal and non-suicidal clinical groups in a health foundation center for French students.

Suicidal behaviour among young people represents a major public health problem. This study seeks to compare the major sociological, clinical, schooling and family features of suicidal and non-suicidal subgroups of adolescents hospitalised in the Health Foundation Center for French Students of neufmoutiers en Brie (France). All these adolescents suffered from the severe mental disorders. The adolescents from the suicidal subgroup presented significantly fewer psychoses and more mood disorders than those of the non-suicidal subgroup. Half of the patients from the suicidal subgroup presented some features of personality disorders, mostly borderline personality disorders. Nevertheless, their global functioning was more frequently improved between admission and discharge than was the case for the non-suicidal group.

Adolescent↗

[Community prevention by the "Turning Aarau into a Healthy City Foundation". 10 years' activity 1977-1987. Retrospect and prospect].

In 1987, the foundation "Aarau-healthy city" celebrated the 10th anniversary of its activities in community-oriented prevention (including the National Research Program No. 1 NRP 1). This article presents the prevention activities within the last four years, discusses the results of a random sample survey among the Aarau population and draws conclusions for the future.

Cardiovascular Diseases↗

The foundations and the development of modern medical ethics.

Modern bioethics is based on a pluralistic and multidisciplinary approach, deriving its sources from medicine, biology, philosophy, law, theology, social and behavioral sciences, and history. The moral foundation of modern biomedical ethics is based upon four prima facie principles: respect of autonomy, beneficence, nonmaleficence, justice. This approach, however, has been seriously criticized and challenged. A wide range of issues is discussed and debated in biomedical ethics. Several causes have intensified the recent flourishing of medical ethics: The enormous advancements in scientific and technological knowledge; the intense and widespread interest in bioethics by professionals as well as by the public at large; and the wide sociocultural and economic changes in western society, and in the conduct of medicine. The objectives of clinical medical ethics is outlined in the article.

Bioethical Issues↗

[Tasks and functions of the "Senate Commission for the Evaluation of Healthy Harmless aspects of Food" of the German Research Foundation].

The Senate Commission on Food Safety (SKLM) of the German Research Foundation (DFG) advises authorities and the government on food safety. The risk assessment of foodstuffs, including novel and functional foods, covers the evaluation of food ingredients and additives as well as the evaluation of novel processing methods. In carrying out this task the Commission expresses its opinion primarily on those aspects which are concerned with the safety assessment. In addition, questions relating to the technological need and to nutritional or physiological benefits are also considered. The topics considered may originate from enquiries of the Ministry for Consumer Protection, Nutrition and Agriculture (BMVEL). Other topics may be selected by the Commission on its own initiative, if they are considered to be of particular importance for consumer protection. Within the context of this activity the SKLM also organises symposia and expert discussions, their outcome subsequently being published as resolutions, conclusions or opinions.

Advisory Committees↗

PROFILE: Integrated Environmental Management: The Foundations for Successful Practice.

/ Integrated environmental management (IEM) is a holistic and goal-oriented approach to environmental management that addresses interconnections through a strategic approach. Although no models of IEM have emerged, practitioners throughout the world are forging ahead with the concept. The literature indicates that stakeholder collaboration and public involvement are central to operationalizingthis model, because this interaction produces a more integrated approach and generates support for implementation. However, it is not clear what steps and conditions are necessary for successful translation of IEM into operation. The author draws on twenty-three case studies from the United States and Australia, a survey of 285 Australian stakeholders and the literature to produce a framework for IEM. The framework identifies 20 elements that-if attained-will increase the likelihood of successful operationalization of IEM. These elements address structuring of an integrated approach, operation of stakeholder processes, and outputs and outcomes. The elements do not constitute a formula for success, but a generic set of attributes that constitute a foundation for effective practice.KEY WORDS: Integrated environmental management; Stakeholder collaboration; Ecosystem managementhttp://link.springer-ny.com/link/service/journals/00267/bibs/24n2p151.html

Journal Article↗

The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: I. Conceptual foundation and item development.

In the past two decades, noteworthy advances have been made in measuring the physiologic outcomes of dysphagia, including measurement of duration of structure and bolus movements, stasis, and penetration-aspiration. However, there is a paucity of data on health outcomes from the patients' perspective, such as quality of life and patient satisfaction. A patient-based, dysphagia-specific outcomes tool is needed to enhance information on treatment variations and treatment effectiveness. We present the conceptual foundation and item generation process for the SWAL-QOL, a quality of life and quality of care outcomes tool under development for dysphagia researchers and clinicians.

Aged↗

Maribor General Hospital from its foundation until World War II.

The author describes the history of Maribor General Hospital from its foundation in 1799 until the beginning of World War II. In 1799 the magistrate of the town of Maribor issued a memorandum regarding the establishment of a town hospital in the renovated building of the town hospice, providing space for 24 patients. The work of the hospital was carried out in the former hospice building until 1855. In the period between its establishment and eventual relocation 26 beds were added. The last two decades of the hospital's operation at the original location were marked by the assiduous work of the town's physicist, Dr. Anton Kuker. In the first half of the 19th century, the population of Maribor grew rapidly as a consequence of the construction of the Southern Railway. The town authorities therefore purchased the Prosenjak family villa in the Magdalena suburbs and relocated the hospital to it in 1855, providing 28 rooms for 110 patients. For a whole century, the care of patients was taken over by the Daughters of Charity of Saint Vincent de Paul. The hospital was soon admitting over 1000 patients a year, the most common complaints being pulmonary catarrh, gastritis and fever. In 1872, when the Master of Surgery Feliks Ferk joined the hospital, the internal "medical" and the "external" surgical departments were formed. Although medical studies were not easily accessible, there were a number of Slovene physicians working in the hospital and the town in that period. In the last decades of the 19th century, the hospital was often renovated and enlarged. The infrastructure (telephone, water supply system, heating, lighting) had also been modernized before World War I. In 1914, the first X-ray apparatus was purchased. Between the wars, the hospital's development was boosted by recruitment of the Slovene physicians Ivan Matko, Mirko Cernic, Janko Dernovsek and Hugon Robic. The initial external and medical departments split into several departments: internal medicine, surgery, dermatovenereology, gynecology and obstetrics, infectious diseases, X-ray institute, autopsy department, and pulmonary department. A department of otology and ophthalmology was also founded. After the disintegration of the Austro-Hungarian Empire, Maribor Hospital was no longer overshadowed by the formerly dominant regional hospital in Graz in present-day Austria. A greater number of patients entailed more rapid professional development. At the beginning of World War II, the hospital comprised six departments, two institutes and a dispensary, and had an elaborate administrative structure with numerous support services.

Delivery of Health Care↗

A model of palliative care: the palliative medicine program of the Cleveland Clinic Foundation. A World Health Organization Demonstrations Project.

Patients with advanced diseases, both cancer and noncancer, experience high symptom prevalence and psychosocial distress. Multiple unmet needs in the physical, psychosocial and spiritual domains are common. In the United States, palliative medicine is an emerging discipline that focuses on meeting these needs to achieve optimal quality of life for the patient-family unit. The majority of palliative care programs in the U.S. are consultation based. In contrast, the Palliative Medicine Program of the Cleveland Clinic Foundation offers multidisciplinary, comprehensive care from a primary or a consultative focus. The program has clinical, research, and educational components. Established as a consultation service in 1987, the clinical component now includes inpatient and outpatient consultation services, a dedicated acute care inpatient hospital unit, outpatient palliative medicine and cancer pain clinics, palliative home care, hospice home care and hospice residential care. Over 800 new patient consultations took place in 1997. In this paper, development of the program and its structure are described. Challenges to effective communication in a large program within a tertiary care institution are discussed, and strategies designed to meet these challenges are presented.

Communication↗

Cycloid psychoses -- from clinical concepts to biological foundations.

The modern concept of cycloid psychoses is primarily based upon the clinical delineation of their phenotypes according to Leonhard. By settling the dilemma of Kraepelinean "atypical psychoses", their description may be considered one of the major achievements of clinical psychiatry in the last century. In particular, this had been facilitated by the work of Wernicke and Kleist. Albeit not yet generally recognized, cycloid psychoses have already stimulated great efforts of research yielding remarkable results. In this article, we elucidate the concept of cycloid psychoses and present recent findings pertaining to their putative biological foundations. Finally, future perspectives for the field of biological psychiatry are proposed fostering the heuristics of Leonhard's nosology.

Brain↗

The reliability and validity of the Turkish version of Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO).

The purpose of this study was to investigate the reliability and validity of the Turkish version of Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). The patient group included 43 females aged between 55 and 78 years with vertebral fractures due to osteoporosis. The control group consisted of 43 healthy female volunteers whose ages matched those of the patients. All of the participants were evaluated using both QUALEFFO and SF-36. In the reliability studies, internal consistency within the domain of QUALEFFO was generally good, with Cronbach's alpha values ranging between 0.70 and 0.96. Convergent and discriminant validity rates of domains were both found to be between 89% and 100%. Significant correlations existed between scores of similar domains of QUALEFFO and the SF-36, especially for pain, physical function, social function and general health perception. The receiver operating characteristic (ROC) curve analysis of QUALEFFO and the SF-36 indicated that all five domains in each questionnaire were significantly predictive of vertebral fractures. However, when comparing similar domains of the two questionnaires, the social function domain of QUALEFFO demonstrated a significantly better performance. In conclusion, the Turkish version of QUALEFFO was found to be reliable and valid in the evaluation of patients with vertebral fractures due to osteoporosis. Our study also suggests that the patients with vertebral fractures due to osteoporosis have impairment in quality of life.

Aged↗

Differences in students' perceptions of learning compulsory foundation biochemistry in the health sciences professions.

Student approaches to learning vary from surface approaches to meaningful, deep learning practices. Differences in approach may be related to students' conceptions of the subject, perceptions of the learning environment, prior study experiences and performance on assessment. This study aims to explore entering students' conceptions of the unit they are about to study and how they intend to approach their studies. It involved a survey of 203 (of 250) first year students in a cross disciplinary unit in the Faculty of Health Sciences. They were asked to complete an open-ended response survey, including questions on what they thought they needed to do to learn biochemistry and what they thought the study of biochemistry was about. A phenomenographic methodology was used to identify categories of description for the questions. The paper will describe the categories in detail, the structural relationship between the categories and the distribution of responses within categories. The study reports a relationship between conception of the topic and approaches to learning. Students with more complex and coherent conceptions of the topic report that they were more likely to adopt deeper approaches to study than those with more fragmented conceptions. However, compared to previous studies, a surprisingly high proportion of students with more cohesive conceptions still intended to adopt more surface approaches. This may reflect the particular context of their learning, namely in a compulsory unit involving material for which most students have minimal background and difficulty seeing its relevance. Implications for teaching such foundation material are discussed.

Attitude↗

The Personality Disorders Institute/Borderline Personality Disorder Research Foundation Randomized Control Trial for Borderline Personality Disorder: reliability of Axis I and II diagnoses.

The Personality Disorder Institute/Borderline Personality Disorder Research Foundation randomized control trial (PDI/BPDRF RCT) is a randomized control trial comparing three treatments for borderline personality disorder (BPD). An important issue for any RCT is diagnostic reliability, demonstration of which is necessary to evaluate claims of a treatment's efficacy for a given population. The present paper examines the interrater reliability of Axis I and II disorders in the context of a high base rate of BPD features for participants referred for inclusion in the RCT. Our results indicate good to excellent levels of interrater reliability for all Axis I and II disorders in this context. Assessors were able to reliably diagnose BPD, exclusionary criteria, and comorbid diagnoses. This data is important for comparing findings and sample composition across different studies using similar sampling strategies, especially as treatments are increasingly being developed and tested for BPD.

Adult↗

Laying the foundation for Connect to Protect: a multi-site community mobilization intervention to reduce HIV/AIDS incidence and prevalence among urban youth.

Despite the considerable resources that have been dedicated to HIV prevention interventions and services over the past decade, HIV incidence among young people in the United States remains alarmingly high. One reason is that the majority of prevention efforts continue to focus solely on modifying individual behavior, even though public health research strongly suggests that changes to a community's structural elements, such as their programs, practices, and laws or policies, may result in more effective and sustainable outcomes. Connect to Protect is a multi-city community mobilization intervention that focuses on altering or creating community structural elements in ways that will ultimately reduce youth HIV incidence and prevalence. The project, which spans 6 years, is sponsored by the Adolescent Medicine Trials Network for HIV/AIDS Interventions at multiple urban clinical research sites. This paper provides an overview of the study's three phases and describes key factors in setting a firm foundation for the initiation and execution of this type of undertaking. Connect to Protect's community mobilization approach to achieving structural change represents a relatively new and broad direction in HIV prevention research. To optimize opportunities for its success, time and resources must be initially placed into laying the groundwork. This includes activities such as building a strong overarching study infrastructure to ensure protocol tasks can be met across sites; tapping into local site and community expertise and knowledge; forming collaborative relationships between sites and community organizations and members; and fostering community input on and support for changes at a structural level. Failing to take steps such as these may lead to insurmountable implementation problems for an intervention of this kind.

Adolescent↗

Coronary artery surgery in Australia. Report from the Committee of the National Heart Foundation Coronary Artery Surgery Register.

Clinical data on all patients who have undergone coronary artery surgery in Australia are collected, audited, and published each year by the National Heart Foundation of Australia. These data from 1971 to 1980 are summarized and show the indications for operation, the variation in numbers of patients operated on in each state and unit, and the overall increase in number of operations during the decade.

Australia↗

The biological foundation of the Gompertz model.

The paper examines the biological reasoning of the Gompertz model for tumor growth: the increase and loss rates of the tumor volume are both proportional to the volume itself. The statement is proved mathematically. The theoretical foundation is therefore established, this ensures the application of the Gompertz model as an effective aid for the understanding of the experimental and clinical tumor process.

Animals↗

Adaptive control of drug dosage regimens: basic foundations, relevant issues, and clinical examples.

In this paper we examine several of the fundamental foundations and relevant clinical issues in adaptive control of drug dosage regimens for patients. Truly individualized therapy with drugs having narrow margins of safety first requires a practical pharmacokinetic/dynamic model of the behavior of a drug. Past experience with a drug is stored in the form of a population model. Next, using the information in such a model and its relationship to the incidence of adverse reactions, a specific, explicit therapeutic goal must be selected by the responsible clinician, based on the patient's need for the drug and the risk of adverse reactions felt to be justified by each patient's need, small, moderate, or great. Individualized drug therapy thus begins with the selection of individualized therapeutic goals (low, moderate, or high) for each patient. Using subsequent feedback from the patient's serum drug levels, and using Bayesian fitting, the model is then linked to each patient as a patient-specific model. Control of the model by the dosage regimen increasingly controls the patient, to better obtain the desired explicit therapeutic goals. This process is essentially similar to that of a flight control or missile guidance system.

Bayes Theorem↗