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PubMedDate not supplied

Finishing big by starting small. Continuous improvement is the key to enhancing community health.

Although healthcare organizations increasingly seek involvement in community health improvement, they are often unprepared to do so because of their inexperience in disease and injury prevention. In recent years, however, continuous improvement (Cl) methodology has produced insights that are useful in such projects. An organization considering a community health improvement project should, from the start, test it through "Plan, Do, Study, Act" (PDSA) cycles. The project's leaders should begin by selecting an issue to work on. They must accurately define the community and involve its members in the project, because health improvement work is most effective when the people who care most strongly about a problem help solve it. Leaders should clearly define the project's aim, perhaps through analyzing hospital records and other databases. In forming a collaborative group to work on the project, leaders should begin with a "core team," perhaps adding other members later. This team should track data using three kinds of measurement--global, intermediate, and process--building data evaluation into its daily practices. The team would do well to get the guidance of someone familiar with Cl methodology. It should also use a process involving regular meetings, time lines, a means of communicating with experts outside the area, and a format that enables it to document progress and capture lessons learned.

Community Health Planning↗
PubMed2006

Can oral health promotion help develop masticatory function and prevent dental caries?

OBJECTIVE: In an effort to promote adequate development of the masticatory system and prevent dental diseases, the Oral Health Promotion Project (OHPP), which focuses on diet, was started in 1984. The intervention was carried out over eight years and then followed up for a further nine years, in a district with no regular dental service, on Miyako Island, Okinawa, Japan. The aims of this study were to evaluate the project's effect on dental caries and masticatory function. RESEARCH DESIGN: Longitudinal data on the complete deciduous dentitions(IIA) at age 4 (n=163) and on the permanent dentition (IVA) at age 13-15 (n=112) were compared to control age-matched groups, aged 4 (n=105) and aged 13-15 (n=70). The control data were collected from a neighbouring district. Instructions on diet were gradually introduced to those in charge of the subjects' food regimes. RESULTS: Mothers reported that children born after the OHPP was begun took less snacks and caloric drinks (p<0.001) and more fibre-rich food (p<0.05) than those who born before the start of the project. The number of carious teeth decreased significantly among subjects born after the start of the project. The masticatory function was summarized in one factor using chewing performance, bite force, muscle activity duration time (using EMG) and mean amplitude of muscle activity. The factor score was higher for those born after 1984 than for those born in 1981-1983 and for those in the control district (GLM, p<0.001). CONCLUSION: It is suggested that OHPP can promote the masticatory function and prevent dental caries, but that it would be crucial to begin intervention soon after birth.

Adolescent↗
PubMed1986

On psychoanalysis and neuroscience: Freud's attitude to the localizationist tradition.

This study examines the relationship between psychoanalysis and neuroscience. It argues that the Project, the traditional starting-point for such an examination, provides few substantial links between Freud's neurological and psychoanalytic careers. The neurological model that the Project endorsed was not derived from Freud's formal neurological education, as has so often been assumed. It was based, instead, on the Jacksonian model that he developed in 'On aphasia' in 1891. 'On aphasia' appears to be the real 'missing link' between Freud's neurological and psychological years. The fundamental principles that it endorsed provided the framework within which psychoanalysis developed. After Freud's death, Luria developed the science of dynamic neuropsychology, which is based on the same fundamental neurological assumptions as 'On aphasia'. Dynamic neuropsychology approaches brain functioning in a way that would have been entirely acceptable to Freud. Considering the deep-rooted compatibility between Luria's neuropsychology and Freud's psychoanalysis, it would be beneficial for both sciences if they were to collaborate on issues of common interest. This makes Freud's lifelong ambition that psychoanalysis be rejoined with neuroscience a very real possibility.

Aphasia↗
PubMed2001

Guidelines for appropriate care: the importance of empirical normative analysis.

The Royal Dutch Medical Association recently completed a research project aimed at investigating how guidelines for 'appropriate medical care' should be construed. The project took as a starting point that explicit attention should be given to ethical and political considerations in addition to data about costs and effectiveness. In the project, two research groups set out to design guidelines and cost-effectiveness analyses (CEAs) for two circumscribed medical areas (angina pectoris and major depression). Our third group was responsible for the normative analysis. We undertook an explorative, qualitative pilot study of the normative considerations that played a role in constructing the guidelines and CEAs, and simultaneously interviewed specialists about the normative considerations that guided their diagnostic and treatment decisions. Explicating normative considerations, we argue, is important democratically: the issues at stake should not be left to decision analysts and guideline developers to decide. Moreover, it is a necessary condition for a successful implementation of such tools: those who draw upon these tools will only accept them when they can recognize themselves in the considerations implied. Empirical normative analysis, we argue, is a crucial tool in developing guidelines for appropriate medical care.

Angina Pectoris↗
PubMed2004

Risk factors for coronary heart disease in children and young adults.

This review covers two ongoing studies in Finland: the Cardiovascular Risk in Young Finns study, which started in 1978, and the Special Turku Coronary Risk Factor Intervention Project for Children (STRIP), which started in 1989. In the cross-sectional Cardiovascular Risk in Young Finns study, cardiovascular risk factors were first assessed in 1980 in 3596 children and adolescents covering ages between 3 and 18 y at 3-y intervals. The latest follow-up examination was performed in 2001, when risk factors and early markers of atherosclerosis in carotid and brachial arteries were examined in 2264 subjects from the original cohorts, now covering ages from 24 to 39 y. The results clearly show that an individual's coronary heart disease (CHD) risk factor profile is regulated by early lifestyle-related factors and that exposure to risk factors in childhood induces changes in arteries that contribute to the development of atherosclerosis in adulthood. In the STRIP study, 1062 infants were randomized into an intervention group (n = 540; low-saturated-fat, low-cholesterol diet) or a control group (n = 522) at 7 mo of age. Fat, saturated fat and cholesterol intakes have been lower, while the polyunsaturated to saturated fat ratio has been higher in the intervention children than in the control children throughout the ongoing trial. During the first 7 y of life, serum cholesterol concentration was 0.2-0.3 mmol/l lower in the intervention boys than in the control boys, but the difference was negligible in girls. Neurological development of the intervention children at age 5 y was at least as good as that of the control children. Counselling had no effect on children's growth.

Adolescent↗
PubMed1980

Aspirin in coronary heart disease. The Coronary Drug Project Research Group.

The Coronary Drug Project Aspirin Study (CDPA), started in late 1972 and terminated in early 1974, involved men selected from three groups originally receiving dextrothyroxine or estrogen therapy in the Coronary Drug Project. All patients had a history of myocardial infarction, most of them several years earlier. Length of follow-up ranged from 10-28 months (average 22 months). A total of 1529 patients were recruited and were randomly assigned on a double-blind basis to aspirin therapy -- one 324-mg tablet three times daily or a corresponding placebo treatment. Data indicate a high level of adherence to the study protocol. No major differences were recorded in use of nonstudy medications in the two treatment groups. Overall mortality was 5.8% in the aspirin group and 8.3% in the placebo group (an observed difference of 30%). This difference, suggestive of a beneficial effect for aspirin in the treatment of post-myocardial infarction men, was not large enough to be conclusive.

Aspirin↗
PubMed2004

Implementing a hospital-based animal therapy program for children with cancer: a descriptive study.

Children living with cancer must cope with the disease, frequent hospitalizations, aggressive treatments and numerous treatment side effects. Combined, these stressors can lead to adverse biopsychosocial effects. An animal therapy program called "A Magical Dream" was instituted for children hospitalized in pediatric oncology to promote their well-being during hospitalization and facilitate their adaptation to the therapeutic process. The main goal of this preliminary study was to complete a descriptive assessment of the program implementation using Donabedian's quality model. This study aims more specifically at documenting the observed connection between participating in the program, quality of care and satisfaction of participating parents and nurses. A total of 16 parents of children and 12 nurses took part in the implementation study and composed the sample. Data were collected through two self-administered questionnaires intended for parents and one questionnaire for nurses. Evaluating the quality of the animal therapy program includes issues related to user profiles, animal therapy intervention process, organizational structure and client outcomes. It appears that dog-assisted therapy may contribute to alleviate psychological distress in children and parents, facilitate their adaptation to the therapeutic process, and promote their well-being while hospitalized. The goal of a second phase to the project will be to verify the effectiveness of the animal therapy intervention by targeting more specifically children hospitalized with solid tumours. Stemming from a nursing initiative started in 1999, this project aims to promote the well-being of children living with cancer during their hospitalization, reduce their emotional distress and facilitate their adaptation to the therapeutic (psychological, physical and social) process by promoting the emergence of special bonds between children and animals. The animal therapy program at CHUQ allows children accompanied by a parent to spend a whole day with a dog while being hospitalized in a room that is safe, warm and family friendly (Landry et al., 2000). In addition to facilitating the child's adaptation, this initiative may contribute to improving the quality of care, especially by offering a service for which client outcomes have already been noted (refreshing rest, better nourishment, physical exercise, socialization, participation in recreational activities, verbalization of fears and concerns, feeling less anxious, happier, etc.). Animal therapy is defined as a clinical method aiming to promote the natural and healing bonds that exist between humans and animals, both for preventive and therapeutic reasons (Daoust, 1987). The rationale behind this practice is that animals naturally stimulate an attraction and involvement response in humans (Brodie & Biley, 1999), which is then reflected in the person's well-being. As well-being is inconsistent with the state of emotional distress, animal-assisted therapy may be a beneficial intervention to alleviate distress in the child, his family and caregivers.

Adaptation, Psychological↗
PubMed1988

[Development of projective reduplication in psychosomatic patients. II. Attempt at an assessment].

Starting with a clinical description of the "projective reduplication" this construct is being critically evaluated on the basis of recent publications on the psychosomatic patient's "pseudo-normality". These studies cast further doubt on the assumption of a "projective reduplication" mechanism as a valid, specific characteristic of this patient population. Recent research results suggest a non-projective, specific sensibility in perception in psychosomatic patients rather than a deficit. The assumption of non-differentiation between self and others as part of the "projective reduplication" mechanism is finally being interpreted as a sequel to the specific "patient career" of psychosomatic patients and the effects of their being clinically evaluated for psychosomatic illness.

Humans↗
PubMed2006

[Family health nursing in Germany: a process of consensus finding as basis].

The "Project design- and consensus phase for implementation of the Family Health Nurse in Germany" ordered by the German professional association for nurses (DBfK) was realized by the Institute of Nursing Science at the University of Witten/Herdecke. Aim of this study was to find out if there is a consensus between eleven stakeholders from ten different institutions of the German health care system before starting the real "pilot project for the feasibility of the Family Health Nurse in Germany", which should strengthen the prevention and the health promotion in Germany corresponding to the WHO's policy framework "Health 21". The investigation included also the identification of the need and the complexity of the new role for nurses and midwives. Furthermore, a statement should be made about the virtual feasibility. Methodically, multi-level analyses were used. First, the stakeholders were interviewed about the possible role of the Family Health Nurse in Germany. All their statements were determined by qualitative content analyses. From these results different areas of responsibilities for the Family Health Nurse in Germany were developed by using the scenario technique. These scenarios were discussed by the stakeholders in focus groups and revised several times until five consented scenarios could be developed. The contents of the scenarios were generalized and structured to according the variables target group, reason for care, need, access, skills, settlement and financing. Like that, the characteristic features of the new areas of responsibilities for the Family Health Nurse in Germany could be defined. Finally, all stakeholders formulated the consensus for the implementation of the planned pilot project with an integrated educational course for nurses and midwives, which immediately has started in autumn 2005 with an accompanying research evaluation.

Family Nursing↗
PubMed2005

Development and application of physiologically based pharmacokinetic-modeling tools to support drug discovery.

Physiologically based pharmacokinetic (PBPK) modeling integrates physicochemical (PC) and in vitro pharmacokinetic (PK) data using a mechanistic framework of principal ADME (absorption, distribution, metabolism, and excretion) processes into a physiologically based whole-body model. Absorption, distribution, and clearance are modeled by combining compound-specific PC and PK properties with physiological processes. Thereby, isolated in vitro data can be upgraded by means of predicting full concentration-time profiles prior to animal experiments. The integrative process of PBPK modeling leads to a better understanding of the specific ADME processes driving the PK behavior in vivo, and has the power to rationally select experiments for a more focussed PK project support. This article presents a generic disposition model based on tissue-composition-based distribution and directly scaled hepatic clearance. This model can be used in drug discovery to identify the critical PK issues of compound classes and to rationally guide the optimization path of the compounds toward a viable development candidate. Starting with a generic PBPK model, which is empirically based on the most common PK processes, the model will be gradually tailored to the specifics of drug candidates as more and more experimental data become available. This will lead to a growing understanding of the 'drug in the making', allowing a range of predictions to be made for various purposes and conditions. The stage is set for a wide penetration of PK modeling and simulations to form an intrinsic part of a project starting from lead discovery, to lead optimization and candidate selection, to preclinical profiling and clinical trials.

Drug Evaluation, Preclinical↗
PubMed1991

Choosing a research project.

It is essential for a doctor wishing to have a career in almost any branch of hospital medicine to have undertaken some form of research and to have had it published. The purpose of this article is to provide guidance for the junior doctor thinking about starting his/her first research project, which will usually be at senior house officer/registrar level.

Internship and Residency↗
PubMed2005

One-year follow-up after a collaborative breakthrough series on reducing falls and fall-related injuries.

BACKGROUND: Multisite facilitated quality improvement (QI) projects, called collaborative Breakthrough Series (BTS), have been shown to improve care, but it is also important to evaluate the lasting effects and spread of changes of BTSs. A project focused on fall and injury-related prevention started in Spring 2001; after the project's end, support was provided through e-mail and periodic conference calls. METHODS: One year after project completion, team contacts were interviewed to determine if they had maintained gains or made further improvements. RESULTS: For the 34 (of 37 teams) interviewed, 82.4% reported they had stayed together as a team; 97.1%, that they continued to collect data; 93.9%, that they had maintained gains; 82.4%, that they had spread changes to new locations; and 85.3%, that they had begun to work on new topics. High team performance at one year correlated with first-meeting team characteristics Leadership Support (r = .456, p = .019) and Prior Experience with Quality Improvement and Teamwork (r = .393, p = .047) and with follow-up team characteristics Leadership Support (r = .614, p < .001), Teamwork Skills (r = .377, p = .033), and Skills Gained from the Project (r = .410, p = .020). CONCLUSIONS: Leadership support, experience with quality improvement and teamwork, teamwork skills, and skills gained from the project were correlated with teams' abilities to achieve and maintain success.

Accidental Falls↗
PubMed1981

Privacy Act of 1974; new system of records--Department of Health and Human Services; Public Health Service. Notification of a new system of records: 09-25-0143.

In accordance with the requirements of the Privacy Act, the Public Health Service (PHS) is publishing notice of a proposal to establish a new system of records, 09-25-0143, Biomedical Research: Records of Subjects in Clinical, Epidemiologic and Biometric Studies of the National Institute of Allergy and Infectious Diseases, HHS/NIH/NIAID. We are also proposing routine uses for this system. This system will be used to support (1) epidemiologic, clinical and biometric investigations into the causes, nature (morbidity and mortality), outcome, therapy and cost of infectious, immunologic and related diseases; (2) review and evaluation of the progress of these research projects, and identification and planning for improvements or for additional research. The population and statistical studies supported by this system may be conducted or managed by Institute staff as well as others outside the Institute. This system comprises records maintained in a number of distinct research projects. The number and specific nature of projects will change over time as new ones are started and as work on existing projects is completed.

Communicable Disease Control↗
PubMed2001

[Effect of estrogen therapy on the growth of Turner syndrome in girls treated with growth hormone].

Two groups of patients with Turner Syndrome (TS) were studied to analyse the effect of estrogens on their growth. Group 1 (G1): 14 patients treated with growth hormone (GH) who started estrogens (SO) (Premarín) at 15.3 +/- 0.9 years old. Group 2 (G2): 10 girls not treated with GH who started Premarín at 14.3 +/- 2.3 years old. Height SDS improvement in periods of time of GH and GH plus estrogen treatment was evaluated and compared between both groups. The gain in stature during estrogen therapy (final height-projected height at SO) was calculated. In G1 multiple regression was used to examine factors influencing the gain in stature during GH treatment (final height-projected height at the start of GH): bone age at the SO, chronological age at the SO and the time of GH treatment prior to SO. In G1 the height SDS improvement was 0.43 +/- 0.11 cm during GH treatment and 0.59 +/- 0.18 cm during GH plus oestrogens (p = 0.064). The height SDS improvement during estrogen therapy in G2 was 0.14 +/- 0.19 cm, smaller than in G1 (p < 0.001). Gain in stature during estrogen therapy was 5.3 +/- 1.8 cm in G1 and -0.6 +/- 4.2 cm in G2 (p = 0.001). In G1 the time of GH treatment prior to SO was the strongest predictor of the gain in stature during GH treatment (r = 0.89).

Adolescent↗
PubMedDate not supplied

Occupational safety, health, and hygiene in the urban informal sector of sub-Saharan Africa: an application of the Prevention and Control Exchange (PACE) program to the informal-sector workers in healthy city projects.

In October 2000, at an international meeting in Pretoria, South Africa, chaired by the World Health Organization (WHO), 45 delegates from Sub-Saharan Africa, Europe, and the United States discussed the results of the Healthy City project in the region and the possibilities for incorporating occupational safety, health, and hygiene items into the project. Working conditions play only a minor role in current Healthy City projects. This is partly the result of a low profile of occupational safety, health, and hygiene on political agendas, and partly a result of a lack of convincing demonstration projects. To tackle these points WHO will start two initiatives. First, a document for decision makers will be issued, to highlight the subject and bring it to the attention of local, national, and international bodies. Second, demonstration projects will be started, making use of the methods developed in the Work Improvement In Small Enterprises (WISE) projects and the experience of the Prevention and Control Exchange (PACE) project.

Accidents, Occupational↗
PubMed2001

Fine structural studies on the intestinal trematode, Gyliauchen volubilis Nagaty 1956 from fish Siganus luridus in the Red Sea, Egypt.

For the fine structure of Gyliauchen volubilis, sections of the finger-like projections showed the structure of a segmented body, which is not attached with the outer membrane of the tegument. Each projection consists of one to four segments, the smallest segment is triangular in shape and located on the top of the projection, enveloped by a triple layered membrane, with electron dense structures in the cytoplasm. Two types of vesicles are scattered in the tegumental matrix; vesicle with electron dense body, and multigranulated vesicle. Spherical fragment also contains electron dense structures and starts as a round projection of the tegument that detaches itself from the rest of the tegument. The presence of these fragments could be evidence of exocytosis for this trematoda. A layer of vacuoles measuring 1 to 1.5 microm long and 0.5 to 0.8 microm wide, are located beneath the matrix of the tegument which could be the douse of release product. For some areas of trematode, larger vacuoles measure 2.6 to 4.3 microm long and 0.5 to 0.8 microm wide, are found near the tegumental surface but in small number. There are two layers of subtegumental myofibers, circular and longitudinal. The circular muscle myofibers are grouped in bundles whereas the longitudinal myofibers are densely distributed adjacent to the circular fibers. Numerous polygonal structures whose function has not yet been determined are located beneath the muscle layers.

Animals↗
PubMed2003

Mass newborn screening in Singapore.

Births in Singapore are almost exclusively in hospitals and this is conducive to mass newborn screening. Mass newborn screeningbegan in 1965 for G6PD deficiency and has led to successful eradication of the complicating kernicterus. Screening has also identified the distinct ethnic and sex linked variations in incidence. The predominant molecular abnormality is the Canton variant. Congenital hypothyroidism screening was started as a pilot project in 1981, then became institution-based in 1985 and nationwide in 1990. The screening is carried out on the cord blood and is now a primary TSH screen. Anincidence of about 1 in 3000 is being obtained and treatment has been started within 2 weeks of birth in almost all babies. A pilot Newborn Screening for hearing impairment started in 1999. Ituses the measurement of Transient Evoked Oto-Acoustic Emissions, is hospital based andcovers about 10% of the newborn population. The program has identified hearing impairment requiring intervention at a rate of about 1:1000 births. A program covering about 50% of the national births has been commissioned by the Ministry of Health to establish epidemiologic data and to document the outcome of early intervention. Mass newborn screening for inborn errors of metabolism is being considered.

Congenital Hypothyroidism↗