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PubMed1998

Developing a model to reduce blindness in India: The International Centre for Advancement of Rural Eye Care.

With the continuing high magnitude of blindness in India, fresh approaches are needed to effectively deal with this burden on society. The International Centre for Advancement of Rural Eye Care (ICARE) has been established at the L.V. Prasad Eye Institute in Hyderabad to develop such an approach. This paper describes how ICARE functions to meet its objective. The three major functions of ICARE are design and implementation of rural eye-care centres, human resource development for eye care, and community eye-health planning. ICARE works with existing eye-care centres, as well as those being planned, in underserved areas of India and other parts of the developing world. The approach being developed by ICARE, along with its partners, to reduce blindness is that of comprehensive eye care with due emphasis on preventive, curative and rehabilitative aspects. This approach involves the community in which blindness is sought to be reduced by understanding how the people perceive eye health and the barriers to eye care, thereby enabling development of strategies to prevent blindness. Emphasis is placed on providing good-quality eye care with attention to reasonable infrastructure and equipment, developing a resource of adequately trained eye-care professionals of all cadres, developing a professional environment satisfactory for patients as well as eye-care providers, and the concept of good management and financial self-sustainability. Community-based rehabilitation of those with incurable blindness is also part of this approach. ICARE plans to work intensively with its partners and develop these concepts further, thereby effectively bringing into practice the concept of comprehensive eye care for the community in underserved parts of India, and later in other parts of the developing world. In addition, ICARE is involved in assessing the current situation regarding the various aspects of blindness through well-designed epidemiologic studies, and projecting the eye-care needs for the future with the help of reliable information. With balanced attention to infrastructure, manpower, financial self-sustenance, and future planning, ICARE intends to develop a practical model to effectively reduce blindness in India on a long-term basis.

Blindness↗
PubMed1988

The history and current status of child and adolescent psychiatric day-treatment programs in The Netherlands.

Although its history in Netherlands is a short one, day treatment for children and adolescents is in great demand and an increase in the number of centers throughout the country has been planned. It serves as both a primary and a secondary treatment modality. While the theoretical frames of reference among day units vary, psychoanalytic and systems thinking are the leading orientations. All day units operate with a multidisciplinary staff who work intensively and therapeutically with the children and their families. The day unit at Sophia Children's Hospital in Rotterdam is described as an example of an existing program.

Adolescent↗
PubMed1976

Combined influences of ambient temperature and graded work on cardiopulmonary functions.

Several cardiopulmonary items were measured in eight adult females who had performed stationary ergometer cycling of 75-450 kgm/min in air temperature between 14 degrees and 35 degreesC. The experiments were designed on the basis of the Latin square method and the results were analyzed by computing the analysis of variance and multiple regression equations for each item linked with work rate and air temperature. In view of the degree of affinity of the effect of work rate and that of air temperature, the items could be divided into three groups. The first group consisted of items of pulmonary functions closely related with work rate but independent of air temperature, such as pulmonary ventilation, oxygen intake, carbon dioxide production, respiratory exchange ratio, and ratio of oxygen removal. The second group characterized by linear dependency on air temperature included mean skin temperature and mean innermost air temperature. The third group consisting of heart rate, pulse sum during work, and work pulse sum was intermediate. In spite of the confusion in the literature about the attitude of oxygen intake or mean skin temperature during work in heat, the former was the most stable in relation to change in air temperature and the latter was independent of work intensity.

Adult↗
PubMed1998

Plants showing antiplasmodial activity--from crude extracts to isolated compounds.

The derivation of important antimalarial compounds started with the discovery of Cinchona bark powder with wine. Subsequently, post World War-I was a period of intensive work in maintaining such ethnobotanical records, in which the use of quinine has remained the drug of choice in malaria. After World War-II new chemical techniques were used to fractionate and isolate, and also for structure determinations, which led to an ever increasing number of potential antiplasmodial compounds. Recently experimental studies in animals and in clinical trials, showed the emergence of CQ-sensitive and CQ-resistant strains of Plasmodium. This paper is an attempt to update a historical list of antimalarial plants and their natural products as studied by pharmacognostic extraction methods of crude drug research of those times. Further an attempt has been undertaken to list the compounds as classified into three major groups, namely alkaloids, terpenes and quassinoids and aromatic and miscellaneous compounds. The most promising is a quassinoid, artemisinin derived from Artemisia annua which has caused a resurgence for the quest of newer antimalarial compounds.

Alkaloids↗
PubMed2000

[Prediction of physiological response from mathematical models].

The ability to predict the physiological responses of workers exposed to extreme environmental conditions, has been a challenge to environmental physiologists for more than 3 decades. Therefore, mathematical models have been developed to predict metabolic rate under various levels of work intensity and dynamic changes in body temperature and heart rate. Based on the effect of exercise on the cardiovascular system, a model was developed to predict mean arterial blood pressure as a function of heart rate. Physiological strain could also be estimated on the basis of thermoregulatory and cardiovascular strains. This paper summarizes knowledge accumulated during 25 years of studies in the field of mathematical modeling of physiological parameters. Besides analyzing the logic underlying each model, it explains the scientific approach in developing a model from its early concept to the model's application in the field.

Blood Pressure↗
PubMedDate not supplied

[Human factor in anesthesiology].

The authors analyze the role of "human factor" in anesthesiology as a combination of characteristics which can influence the efficiency of physician's work. Anesthesiologists should possess professional skills directly concerned with mental adaptation of personality responsible for decision making in stress or emergency. Examination of 37 anesthesiologists who had given their informed consent helped determine the psychodiagnostic criteria of professional skills and gave grounds for forming groups liable to maladaptation under high psychoemotional strain. Relationships between age, sex and professional activity were assessed. It is recommended to introduce a system of professional selection of candidates wishing to become an anesthesiologist, of individual approach to optimization of the work intensity for practicing anesthesiologists. Psychological relaxation for anesthesiologists is also essential.

Adaptation, Psychological↗
PubMed1975

Ergonomic studies of standardized domestic work in patients with neuromuscular handicap.

A model for ergonomic studies of domestic work in varying patient groups has been constructed. A control group of 15 healthy women, 30-59 years of age, 9 female patients with hemiplegia and 13 with multiple sclerosis (MS) were studied with exercise test on a bicycle ergometer. Recordings of time consumption, heart rate and subjectively perceived exertion were made during a 4.5-5 hour domestic work program. Four of the more strenuous work elements were restudied also with respect to oxygen uptake. The hemiplegic patients required more time and had higher perceived exertion, but lower heart rate and oxygen uptake for the same work tasks than did the controls. The MS-patients also had higher perceived exertion. There was a rather poor relationship between determined and indirectly estimated energy expenditure. Various explanations are discussed. The results demonstrate the importance of the perceived exertion in choosing the work intensity.

Activities of Daily Living↗
PubMedDate not supplied

Circuit resistance training in persons with complete paraplegia.

BACKGROUND/OBJECTIVE: We assessed the metabolic and heart rate (HR) responses to a single session of circuit resistance training (CRT) in six subjects with complete paraplegia (T5-T12 levels) in order to determine the caloric cost of the exercise. METHODS: Subjects underwent isoinertial weight training exercises with interspersed periods of high-cadence, low-resistance arm ergometry (AE). Following protocol familiarization, subjects completed one session of CRT during which continuous monitoring of HR, oxygen uptake (VO2), and respiratory exchange ratio (RER = VCO2/VO2) was performed. Caloric cost was calculated from the exercise VO2 values across the CRT session. A peak arm exercise test allowed data to be expressed as percentages of peak VO2 and HR. RESULTS: Subjects displayed mean VO2 values of 11.6 +/- 2.4 ml/kg/min (mean +/- SD) and a mean HR of 136 +/- 17 beats/min across the CRT session, corresponding with 49.0% of peak VO2 and 76.8% of peak HR. The RER values ranged from 0.96 to 1.19 and averaged above unity throughout the CRT session. CONCLUSION: Despite the modest absolute VO2 during exercise, CRT satisfies operational criteria developed for cardiorespiratory exercise prescriptions in persons without disability. The RER values recorded indicate that CRT is intense work that relies primarily on glycolytic metabolism.

Adult↗
PubMed2002

[Creation of an educational CD-ROM using a PACS].

Presentation of MIRIAM 2: We describe the materials used for the creation of and the content of a CD-ROM entitled '77 neuroradiological case reports'. We mention the gathering of clinical and imaging data, exclusively provided by a PACS. Our work demonstrates that a CD-ROM is an appropriate interactive medium for radiological teaching. Its creation can be simplified thanks to a PACS, but it nonetheless remains work intensive.

Brain Diseases↗
PubMed2002

Problem-based learning, work demands and psychological distress in pre-registration house officers: a preliminary study.

There has been little work examining the longer term occupational and psychological outcomes of problem-based learn-ing (PBL). The authors aimed to investigate the relationship between psychological distress, occupational factors and experience of PBL in the first cohort of UK pre-registration house officers to be trained exclusively using problem-based methods. Questionnaires were sent to al pre-registration house officers working in the three teaching hospitals in the Manchester area. Measures included demographic items, hours of actual work and the GHQ-12 as a measure of psychological distress, as well as validated Likert scales of job satisfaction, perceived work demands, support from superior,and experience and attitudes towards PBL. The response rate was 87% (66/76). Almost one-third of respondents (20/66) worked more than 72 hours a week. The occupational and psychological measures were significantly interrelated. The multiple regression analysis revealed that work demands and job satisfaction together accounted for over 45% of the variance in psychological distress. The other demographic, occupational and PBL-related factors did not make an independent contribution to distress. Scores were similar for respondents with high and low levels of exposure to PBL, and similar to scores obtained from a previous cohort of house officers graduating from a traditional course. These findings should be interpreted cautiously because of the small size of the current study and the setting. It is possible that as staff and students grow accustomed to new styles of teaching, and work intensity for junior doctors reduces, the effect of PBL will become more evident. Further research is needed examining the occupational and psychological outcomes of medical students taught by problem-based methods indifferent settings.

Adult↗
PubMed2002

[Fiber and enteral nutrition].

Dietary fibre is a mixture of various substances and is essential for maintaining appropriate intestinal functionality and it is currently considered to be a necessary part of a healthy diet. Current recommendations for fibre consumption by adults range from 20 to 35 g/day. Enteral nutrition is an emerging therapeutic variation in both hospital and domestic settings. To a great extent, this development has been made possible thanks to the design of new formulas that adapt better and better to the clinicla conditions or our patients. The type of fibre used in these preparations varies greatly. Some have only one source of fibre while others use differnet combinations. There are currently 32 formulas available on the Spanish market, without counting the modules or specific preparations of individual types of fibre. Despite the enormous advances in the knowledge of the beneficial effects of fibre, the fact of the matter is that enteral nutrition that we routinely prescribe in normal clinical practice does not contain fibre. The are several explanations for this, perhaps the most plausible is that these formulas may lead to problems in their administration and tolerance. It is necessary to choose the correct calibre of catheter and define the best infusion method and timing. Another difficulty may be the gastrointestinal tolerance of the formulas containing fibre. No large-scale problems of intolerance have however been described in healthy volunteers nor in patients with acute or chronic pathologies, although it is of fundamental importance to monitor the rhythm of depositions in all patients with enteral nutrition (EN) and ensure proper intake of liquids, which would also be useful to prevent occlusion of the catheter. The theoretical benefits of EN with fibre with a view to maintaining or improving normal intestinal structure and function are very varied. Nonetheless, it has noit yet been possible to prove many of these effects in controlled clinical trials. At the present time, there are sufficient reasons of a physiological nature for using EN with fibre in many patients, particularly in those predisposed to constipation or suffering from diarrhoea, in those requiring long-term EN and in some intestinal pathologies. In the near future, fibre can be expected to form part of EN as standard component and we should define its optimal composition for different pathologies. In the meantime, we need to continue working intensely in this highly promising area of knowledge.

Dietary Fiber↗
PubMed2003

[10-year dynamics of attitude to health problems in the male population of Novosibirsk (epidemiological study based on the WHO MONICA program)].

AIM: To evaluate changes for a decade in the attitude of men in Novosibirsk to health problems. MATERIAL AND METHODS: WHO program MONICA has covered males aged 25-64 years (a representative sample from the population in one of the districts of Novosibirsk city). A total of 3 trials were made (in 1984, 1988 and 1994) which included questioning, registration of ECG, arterial pressure, height, body mass, biochemical tests of the blood. RESULTS: Attitude of men to their health depended on their age. There was a trend to evaluate their health as more and more poor in men at the age of 25-43 and 35-44 years. In the group of 45-54-year-olds positive assessment of health was encountered 1.9 times more frequently, but the difference was not significant. At the age 55-64 years a growing number of men tend to assess their health as good. Since 1994 alcoholics among the elderly men grew in number as a response to the social and economic crisis. CONCLUSION: The change in health evaluation from negative to positive in older men may relate to less intensive work.

Adult↗
PubMed2002

[Comparative study of respiratory mechanisms between professional lyrical singers and beginners].

The apprenticeship for classical singing requires years of training due to its complexity. This training is directed at the different levels of the vocal apparatus: the source of energy or air flow (lungs), the vibrator (vocal cords) and the resonators (bucco-pharyngeal cavity). For this study we have concentrated on the first level, that is, respiration. When a greater demand of vocal activity is required respiration becomes more sustained and more complex; this is when difficulties may be observed. Singers overcome these difficulties through different strategies according to their level of vocal training. Our study compared respiratory strategies used by professional singers and singing students (first year conservatoire students) during singing tasks; none of the subjects had any history of vocal pathology. Electromyographic analysis of muscle activity was registered for the rectus abdominals muscle, external oblique muscle and transverse muscle with surface electrodes. Kinetic analysis was used to measure thoracic cage displacement: pressure sensitive belts were placed around the pubis, the epigastric region and thorax. The subjects were asked to perform two vocal tasks: vocalization of a sustained "i" and singing of an extract of a vaccaï. Results were compared between the 7 professional singers and the 6 singing students. They allowed us to confirm the existence of distinct respiratory strategies according to the level of vocal training, as described in literature. Professional singers inhibited the activity of their rectus abdominals muscles during singing and used mostly their external oblique and transverse muscles, thus, sustaining an expanded ribcage and a longer expiratory breath. Singing students, on the other hand, worked intensively all the abdominal muscles leading to a collapse of the ribcage. Management of air was more difficult and breath was shorter. Future studies will consider a larger population sample in order to define quantitative parameters that might allow a significant differentiation of respiratory strategies between professional singers and singing students.

Adult↗
PubMed2003

[Perspectives in the treatment of allergy to latex: immunotherapy].

At present, allergy to latex is an important problem due to the severity of the symptomatology that it produces and the risk groups involved. Complete avoidance of latex is practically impossible, which is why in recent years there has been intense work on standardizing an extract in order not only to improve its clinical diagnosis but also to be able to offer a therapeutic alternative other than avoidance, such as immunotherapy. Since 1998, timely approaches to immunotherapy with latex have been published, with oral desensitization (three patients), subcutaneous (one patient) and sublingual (one patient). In every case there was an evident clinical improvement. At present, subcutaneous immunotherapy with latex, although efficient, is a high risk treatment. Sublingual immunotherapy with latex has recently been commercialized in Spain and we know of its efficacy through the results of an open test on 26 adult patients. The safety expectations are shown to be better than those for subcutaneous immunotherapy.

Humans↗
PubMedDate not supplied

Cisplatin and platinum drugs at the molecular level. (Review).

Over twenty years of intensive work toward improvement of cisplatin, and with hundreds of platinum drugs tested, has resulted in the introduction of the widely used carboplatin and of oxaliplatin used only for a very narrow spectrum of cancers. A number of interesting platinum compounds including the orally administered platinum drug JM216, nedaplatin, the sterically hindered platinum(II) complex ZD0473, the trinuclear platinum complex BBR3464, and the liposomal forms Lipoplatin and SPI-77 are under clinical evaluation. This review summarizes the molecular mechanisms of platinum compounds for DNA damage, DNA repair and induction of apoptosis via activation or modulation of signaling pathways and explores the basis of platinum resistance. Cisplatin, carboplatin, oxaliplatin and most other platinum compounds induce damage to tumors via induction of apoptosis; this is mediated by activation of signal transduction leading to the death receptor mechanisms as well as mitochondrial pathways. Apoptosis is responsible for the characteristic nephrotoxicity, ototoxicity and most other toxicities of the drugs. The major limitation in the clinical applications of cisplatin has been the development of cisplatin resistance by tumors. Mechanisms explaining cisplatin resistance include the reduction in cisplatin accumulation inside cancer cells because of barriers across the cell membrane, the faster repair of cisplatin adducts, the modulation of apoptotic pathways in various cells, the upregulation in transcription factors, the loss of p53 and other protein functions and a higher concentration of glutathione and metallothioneins in some type of tumors. A number of experimental strategies to overcome cisplatin resistance are at the preclinical or clinical level such as introduction of the bax gene, inhibition of the JNK pathway, introduction of a functional p53 gene, treatment of tumors with aldose reductase inhibitors and others. Particularly important are combinations of platinum drug treatments with other drugs, radiation and the emerging gene therapy regimens.

Antineoplastic Agents↗
PubMed2003

[Effect of stress on calcium homeostasis in muscular tissues].

A dynamics of the content of calcium (Ca) in aorta, heart and skeletal muscles was studied in rats exposed to a stress factor for 21 weeks. We observed a 7-fold increase in its content in all the organs examined by the middle of an experiment and its progressive decrease by the 21-st week. It might result from the stages of stress and development of hypercholisterinemia. An inhibitor of L-type calcium channels niphidipine did not change the dynamics of Ca content qualitatively but it decreased its quantitative parameters, especially at final stages of experiments. We suggest that possible mechanism of keeping calcium homeostasis in the organs examined at different stages of stress is an intensive work of ligand- and potential-dependent calcium channels.

Animals↗
PubMed2003

Indexing method of digital audiovisual medical resources with semantic Web integration.

Digitalization of audio-visual resources combined with the performances of the networks offer many possibilities which are the subject of intensive work in the scientific and industrial sectors. Indexing such resources is a major challenge. Recently, the Motion Pictures Expert Group (MPEG) has been developing MPEG-7, a standard for describing multimedia content. The good of this standard is to develop a rich set of standardized tools to enable fast efficient retrieval from digital archives or filtering audiovisual broadcasts on the internet. How this kind of technologies could be used in the medical context? In this paper, we propose a simpler indexing system, based on Dublin Core standard and complaint to MPEG-7. We use MeSH and UMLS to introduce conceptual navigation. We also present a video-platform with enables to encode and give access to audio-visual resources in streaming mode.

Abstracting and Indexing↗