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PubMed2005

Community-based organizations' perspective on health information outreach: a panel discussion.

OBJECTIVE: A panel was convened to elicit guidance for librarians in initiating and implementing community-based health information outreach. PARTICIPANTS: Participants included a panel of individuals from communities or community organizations who represented the types of groups with which librarians or information specialists need to interact and an audience who represented health sciences libraries, public libraries, academic institutions, government agencies, funding agencies, and community-based organizations and could contribute to a discussion on community-based health information outreach. PROGRAM: The panel was presented with a hypothetical community setting and asked to respond to a series of questions: What do librarians need to learn about the community before they make their visits? What methods of outreach have been successful in your work? How would you implement and sustain a health information program in your community? How would health information interventions reduce racial and ethnic disparities in health? MAIN RESULTS: The panel helped to frame many of the issues that may confront librarians as they initiate information-related programs in communities. CONCLUSION: There is clear consensus on the need for librarians to make the effort to reach out into the community, to make the contacts, to seek to understand the community, to talk with leaders, and to respect the community as they promote and teach the use of health information resources. It was confirmed that librarians and libraries have an important role in diminishing health disparities by improving access to health information.

Community-Institutional Relations↗
PubMed2006

Characterization and incidence of inducible monomorphic ventricular tachycardia in a postinfarction rabbit model.

OBJECTIVE: Ventricular tachycardia (VT), occurring late after myocardial infarction, is an important cause of sudden death. Animal models are useful for the investigation of this arrhythmia. The aim of this study is to develop and characterize a model of late postinfarction monomorphic VT in the rabbit. METHODS AND RESULTS: Myocardial infarction was created by ligation of the left circumflex artery. Cardiac electrophysiologic studies were performed 10 to 17 days postinfarction in 39 rabbits, in 10 sham-operated rabbits, and 6 control rabbits. Ventricular tachycardia was defined as a broad-complex tachycardia with a cycle length of more than 100 milliseconds, a duration of more than 10 seconds, and monomorphic QRS complexes. Using programmed stimulation, we induced VT in 9 rabbits (23%) in the infarct group but in none of the sham or control animals. The mean infarct size was 23% +/- 9% (mean +/- SD) of the left ventricle. CONCLUSION: Coronary ligation in the rabbit creates a substrate, which allows the induction of sustained monomorphic VT with programmed stimulation. Monomorphic VT is not inducible in rabbits without myocardial infarction. This model might allow the testing of interventions that reduce the incidence of VT late after myocardial infarction.

Animals↗
PubMedDate not supplied

Whither seniors' pharmacare: lessons from (and for) Canada.

Canada's provincial governments have, until relatively recently, provided virtually all seniors with generous prescription drug coverage. Managers of these programs have implemented a variety of policies to contain spending while ensuring access to necessary medicines. Some of these policies have been successful in temporarily slowing cost growth. However, the lack of comprehensive utilization management tools has resulted in ongoing spending increases that now constitute a threat to the sustainability of a public drug subsidy for Canadian seniors. Sustainable and equitable pharmacare programs require the political willingness to confront opposition to policies that will, if successful, contain program costs without obstructing access.

Aged↗
PubMed1988

Hypertension, exercise, and beta-adrenergic blockade.

STUDY OBJECTIVE: To determine whether beta-adrenergic blocking agents affect exercise tolerance, exercise conditioning response, and blood pressure response to conditioning in hypertensive patients. DESIGN: Randomized, double-blinded, placebo-controlled trial with a 10-week exercise period. SETTING: Outpatient, monitored exercise program at a community-based, university-sponsored cardiac rehabilitation facility. PATIENTS: Thirty adults with mean resting blood pressure of 145 mm Hg or greater (systolic), 95 mm Hg or greater (diastolic), or a combined systolic and diastolic pressure of 140/90 mm Hg or greater. Mean systolic pressure of 170 mm Hg or more or mean diastolic pressure of 105 mm Hg or more was exclusionary. Mean blood pressure was 145/95 mm Hg; mean age was 46.5 years. INTERVENTION: The beta-1-nonselective blocker was propranolol, 80 mg twice daily. The beta-1-selective blocker was metoprolol, 100 mg twice daily, compared with placebo. All patients did exercise conditioning consisting of 40 sessions of aerobic exercise with heart rate monitoring. MEASUREMENTS AND MAIN RESULTS: Resting systolic blood pressure measured without drug therapy was lowered markedly after exercise conditioning on placebo (146 to 135 mm Hg) and on metoprolol (144 to 133 mm Hg) (P less than 0.05), but not on propranolol (no change). Acutely, propranolol decreased both maximal oxygen consumption (VO2max) and exercise duration compared with metoprolol and placebo. Chronically, VO2max increased 24% (95% CI, 8 to 40) in response to training on placebo and 8% on metoprolol (95% CI, 3 to 14); it did not increase on propranolol (95% CI, -10 to 15). CONCLUSIONS: If an exercise program is to be recommended as an adjunct to pharmacologic beta-blockade for hypertension, blood-pressure-lowering effects are preserved and exercise capacity is less affected with a beta-1-selective agent than with a beta-1-nonselective agent. Antihypertensive medications may be avoided altogether for selected patients who sustain an aerobic exercise program.

Adrenergic beta-Antagonists↗
PubMed2004

Multiple intervention research programs in community health.

The authors describe an organizing framework for multiple interventions in community health. The framework provides a foundation for programmatic research on multiple interventions and poses critical questions that need to be addressed in the next generation of research in this field. Multiple intervention programs are characterized by the use of multiple strategies targeted at multiple levels of the socio-ecological system and delivered to multiple target audiences. Consequently, they complement the growing literature on the broad determinants of health and health promotion. The authors describe a 4-stage framework and identify gaps and challenges in this field of research. There are 5 key research areas requiring concerted action; researchers must: examine nested determinants, develop integrated conceptual frameworks, examine ways to optimize synergies among interventions, describe spin-offs from multiple intervention programs, and monitor the sustainability of their impact.

Canada↗
PubMedDate not supplied

Training to improve awareness of disabilities in clients with unilateral neglect.

OBJECTIVE: Awareness of disabilities is known to be a central problem of rehabilitation among clients with large right cerebrovascular lesions and unilateral neglect. The aim of this study was to evaluate the effect of an intervention program focused on improving the awareness of disabilities in four participants with unilateral neglect. The intervention program developed for this study was based on the assumption that awareness of disabilities is a prerequisite for being able to learn and use compensatory techniques in the performance of activities of daily living (ADL). METHOD: The study followed a single-case experimental ABA design. The Assessment of Awareness of Disability was used to measure awareness of disabilities; the Assessment of Motor and Process Skills was used to measure ADL ability; and neuropsychological tests were used to assess unilateral neglect and sustained attention. The intervention program used meaningful and purposeful occupations as therapeutic change agents to improve awareness of disabilities. RESULTS: Awareness of disabilities and ADL ability improved in all four participants; unilateral neglect decreased in three participants; and sustained attention improved in two participants. CONCLUSION: The preliminary findings indicate that training to improve awareness of disabilities might improve the ability to learn the use of compensatory techniques in the performance of ADL in clients with unilateral neglect. The effects of the intervention strategy need to be evaluated further in future research.

Aged↗
PubMed1990

Facilitation of ventricular tachycardia initiation by procainamide during programmed ventricular stimulation in patients with heart failure.

Antiarrhythmic drugs occasionally facilitate, rather than prevent, ventricular tachycardia. The purpose of this study was to assess the incidence of procainamide facilitation of ventricular tachycardia initiation during programmed electrical stimulation in patients with no history of spontaneous sustained ventricular tachycardia but who are at high risk. Twenty patients with advanced heart failure (mean left ventricular ejection fraction 0.19 +/- 0.09) and nonsustained ventricular tachycardia and in whom sustained ventricular tachycardia was not inducible by programmed electrical stimulation in the basal state were studied. Six patients had coronary artery disease, 13 had idiopathic dilated cardiomyopathy, and 1 had valvular heart disease. All patients received programmed stimulation from the right ventricular apex with one to three extra-stimuli before and after the intravenous infusion of 10 mg/kg of procainamide (serum level 6.6 +/- 2.4 mcg/l). In two patients (10%) sustained monomorphic ventricular tachycardia was initiated only after the administration of procainamide. One of these patients later died in ventricular tachycardia during hyperkalemia. Of the noninducible patients, during a follow-up period of 6 +/- 5 months, two died suddenly and one developed symptomatic ventricular tachycardia. Thus, procainamide can unmask potential reentry circuits in some patients who have not had spontaneous sustained ventricular tachycardia. In patients with heart failure, this risk, as assessed by programmed stimulation after a single dose of procainamide, appears to be low.

Adult↗
PubMed1987

HMO promotion and the privatization of health care in Chile.

Since 1973 the Chilean junta has privatized sectors of the national economy. This paper analyzes the country's policy process of promoting private medical programs through HMO-like plans (ISAPREs, or Institutes of Provisional Health). These plans have captured less than half of their originally anticipated market share. It is argued that the future performance of ISAPREs will be undermined by their limited maternal benefits, their targeting to a small upper-income group which cannot sustain many private medical programs, and competition with less expensive yet equally competent public medical programs. The paper briefly compares privatization in Chile with the experiences of other countries, and specifically contrasts the restructuring of health services under military rule in Chile with those of Argentina and Uruguay. The paper concludes that the Chilean experience with HMOs epitomizes the perils of planning health care during short-term periods of economic prosperity as well as failing to consult medical care providers and consumers.

Chile↗
PubMed1985

Histopathologic factors conducive to experimental ventricular tachycardia.

Ventricular tachyarrhythmia is the leading cause of sudden cardiac death. Determination of the substrates conducive to the initiation of this arrhythmia remains an important clinical goal. The purpose of this study was to correlate histopathologic findings, specifically: pattern (heterogeneous versus homogeneous infarct morphology), distribution (viable epicardial and/or endocardial rim), and infarct size, with susceptibility to the initiation of sustained ventricular tachycardia employing programmed electrical stimulation in two canine models of experimental myocardial infarction. Twenty-one adult dogs were randomly divided into two groups: 12 dogs underwent two-stage, 2-hour occlusion of the proximal left anterior descending coronary artery and nine animals underwent permanent, complete occlusion of the left anterior descending coronary artery with latex embolization. With programmed ventricular pacing with two premature ventricular extrastimuli, initiation of ventricular tachycardia was attempted, open chest, two weeks after infarction. Electrophysiologic evaluation of the infarct type correlated significantly with the histologic morphology of the infarction (p less than 0.001). The presence of a viable epicardial rim was an extremely important variable for ability to induce sustained ventricular tachycardia (p = 0.04). The presence of an endocardial rim was not significant (p = 1.0). Infarct size alone was only marginally related to ventricular tachycardia inducibility (p = 0.08). Nonuniform infarcts were more conducive to the initiation of sustained ventricular tachycardia than were homogeneous infarcts (p = 0.025). The presence of a large, nonuniform infarct correlated best with inducibility (p = 0.0002). Thus in these experimental models, specific infarct morphologies correlate significantly with susceptibility to inducible sustained ventricular tachyarrhythmias.

Animals↗
PubMed1996

Continuation of antiarrhythmic drugs, or arrhythmia surgery after multiple drug failures. A randomized trial in the treatment of postinfarction ventricular tachycardia.

BACKGROUND: In patients with postinfarction sustained ventricular tachycardia showing one or more antiarrhythmic drug failures, the question is how long to proceed with new drug trials before deciding to perform map-guided arrhythmia surgery. Although the techniques of this surgery developed rapidly in the early 1980s, this therapy may be offset by damage to residual left ventricular function. However, surgery has been shown to be very effective in selected groups of patients. METHODS: A randomized study was carried out in patients with postinfarction ventricular tachycardia and eligible for arrhythmia surgery based on residual left ventricular function. Therapy failure was defined by the occurrence of the following events: spontaneous recurrence of ventricular tachycardia or ventricular fibrillation, sudden cardiac death, inducibility of sustained ventricular tachycardia or ventricular fibrillation with programmed stimulation of the heart, symptomatic non-sustained ventricular tachycardia requiring therapy or side-effects of antiarrhythmic drugs requiring withdrawal. In the drug limb, failure of the first antiarrhythmic drug was accepted but failure of a second and different drug was regarded as true therapy failure. RESULTS: After randomization, antiarrhythmic drug therapy was administered in 33 patients, and 30 patients underwent surgery. Neither group differed in baseline characteristics, and the mean number of drug failures before randomization was 2.7. The Kaplan-Meier therapeutic failure of antiarrhythmic drugs was 39 +/- 11%, 42 +/- 11% and 51 +/- 18% at 0.5-, 1- and 4-year follow-up, respectively, whereas the therapeutic failure of cardiac surgery was 37 +/- 11%, 37 +/- 11% and 50 +/- 20% at 0.5, 1 and 4 years, respectively, showing no statistical difference. The 1- and 4-year Kaplan-Meier survival of the antiarrhythmic drug-treated group was 91 +/- 6% and 78 +/- 15%, respectively, and of the surgical group 92 +/- 6% and 59 +/- 20%, respectively, and did not differ between either group. However, the relative risk for total cardiac death was higher in the surgical limb than in the drug limb (relative risk 2.2, CI 0.68-7.48). CONCLUSION: This study demonstrated no difference between the therapeutic result of continuation of two different antiarrhythmic drugs and that of arrhythmia surgery. Despite the small number of patients studied, it is recommended that drug therapy should continue as long as this regimen is tolerated by the patient. When true drug refractoriness or side-effects of drugs arise, arrhythmia surgery offers a valuable alternative. However, when additional reasons for cardiac surgery exist, arrhythmia surgery should be undertaken earlier and may become the first choice of treatment of postinfarction ventricular tachycardia.

Adult↗
PubMed1985

Intraindividual comparison of intravenous ajmaline and quinidine in patients with sustained ventricular tachycardia: effects on normal myocardium and on arrhythmia characteristics.

Intraindividual comparison of the acute response to intravenous quinidine and to intravenous ajmaline was performed in 23 patients with sustained ventricular tachycardia (VT) who underwent serial electrophysiological studies. In each patient, sustained VT could be reproducibly initiated by programmed ventricular stimulation during control studies. Inducibility of sustained VT was prevented after quinidine in 6 of the 23 patients (26%) and after ajmaline in 8 of the same 23 cases (35%). Agreement between the effects of both drugs was not significant: 2 patients had a similar response to both quinidine and ajmaline and 11 patients did not have a response to either of the two drugs, resulting in a total of only 13 patients (57%) who had a similar response to both drugs. In the 11 non-responders with inducible sustained VT before and after both drugs, quinidine and ajmaline caused qualitatively and quantitatively similar alterations of VT characteristics including a significant prolongation of the interval between the initiation extrastimulus and the first beat of VT by 38 and 42% (P less than 0.01), an increase in VT cycle length by 15 and 22% (P less than 0.01) and a prolongation of the QRS duration during VT by 15 and 18% (P less than 0.01), respectively. In all 23 patients, quinidine and ajmaline caused a quantitatively similar prolongation of ventricular refractoriness by 11 and 9% (P less than 0.05), of the QRS duration at sinus rhythm by 10 and 15% (P less than 0.01) and of the QTc interval by 13 and 10% (P less than 0.05), respectively. Thus, ajmaline and quinidine appear to have similar electrophysiological effects on both normal myocardium and on indirect parameters of reentry; in individual patients with sustained VT, however, such electrophysiological similarities do not result in significant agreement of preventive responses.

Adult↗
PubMedDate not supplied

[Attention process training application within an intervention project on attentional processes in children with cancer].

INTRODUCTION: Childhood cancer treatments have made a spectacular advance in recent years, obtaining survival rates of about 70%. These survival rates have permitted many children to reach adulthood, but also involve the appearance of previously unknown neurocognitive sequelae because of high mortality. DEVELOPMENT: Neuropsychological evaluation allows the detection of these deficits and the design of intervention. In children, rather than a loss of function there is a loss of the capacities that should develop in comparison with his/her peers. To obtain a base line to determine the affected and altered areas, it is equally vital to assess the acute and long term effects so as to evaluate the success of the intervention program. Attention Process Training (APT) is an individualized application program of attentional exercises of varying complexity in sustained, selective, alternating and divided attention. This program combines methods and techniques of cerebral damage rehabilitation, as well as educational and clinical psychology. It is completed with a self instruction training which is applied in situations of daily life. CONCLUSIONS: Child cancer treatment continues to carry long term neurocognitive sequelae. Neuropsychological evaluation is basic for its detection, allowing relevant information to be offered to parents and teachers, so as to facilitate design of individualized rehabilitation procedures. Attention training is basic for this type of population with generalized damage related to white matter, and forms part of a wider rehabilitation process that enhance the ecological validity of the program.

Antineoplastic Agents↗
PubMed2001

Advancing women and closing the leadership gap: the Executive Leadership in Academic Medicine (ELAM) program experience.

Women are persistently underrepresented in the higher levels of academic administration despite the fact that they have been entering the medical profession in increasing numbers for at least 20 years and now make up a large proportion of the medical student body and fill a similar proportion of entry level positions in medical schools. Although there are no easy remedies for gender inequities in medical schools, strategies have been proposed and implemented both within academic institutions and more broadly to achieve and sustain the advancement of women faculty to senior level positions. Substantial, sustained efforts to increase programs and activities addressing the major obstacles to advancement of women must be put in place so that the contributions of women can be fully realized and their skills fittingly applied in meeting the medical education and healthcare needs of all people in the 21st century.

Career Mobility↗
PubMed1997

Comparison of class Ia/Ib versus class III antiarrhythmic drugs for the suppression of inducible sustained ventricular tachycardia associated with coronary artery disease.

Previous studies suggest that class Ia drugs are ineffective in suppression of sustained ventricular tachycardia by programmed stimulation. More favorable results have been described with combinations of Ia and Ib drugs and also with class III antiarrhythmic drugs, but there have been no direct comparisons between these 2 regimens. The present study was undertaken to compare the electrophysiologic efficacy and predictors of success of these 2 regimens in patients with ischemic heart disease and inducible sustained monomorphic ventricular tachycardia. The population consisted of 136 patients with documented coronary artery disease. All had sustained monomorphic ventricular tachycardia inducible during baseline electrophysiologic study and following intravenous procainamide. Follow-up studies were performed with a combination of oral class Ia and Ib or class III antiarrhythmic drugs. A positive response was the inability to induce a sustained ventricular arrhythmia with up to 3 extrastimuli at 2 right ventricular pacing sites. Response rates were 13% for Ia/Ib combination and 19% for class III agents (p = 0.40). Congestive heart failure differentially affected response rates. Only 8% of those responding to Ia/Ib therapy had heart failure compared with 59% of responders to class III (p <0.01). Multivariate analysis identified heart failure (RR 12.2, p = 0.03) as the only parameter with independent predictive value of response to Ia/Ib therapy. These results indicate that congestive heart failure is a potent predictor of a negative response to a combination of class Ia and Ib antiarrhythmic drugs. In this population, class III drugs or nonpharmacologic therapy should be considered as initial treatment.

Aged↗
PubMed2004

Program of cell survival underlying human and experimental hibernating myocardium.

Hibernating myocardium refers to chronically dysfunctional myocardium in patients with coronary artery disease in which cardiac viability is maintained and whose function improves after coronary revascularization. It is our hypothesis that long-term adaptive genomic mechanisms subtend the survival capacity of this ischemic myocardium. Therefore, the goal of this study was to determine whether chronic repetitive ischemia elicits a gene program of survival protecting hibernating myocardium against cell death. Accordingly, we measured the expression of survival genes in hibernating myocardium, both in patients surgically treated for hibernation and in a chronic swine model of repetitive ischemia reproducing the features of hibernation. Human hibernating myocardium was characterized by an upregulation of genes and corresponding proteins involved in anti-apoptosis (IAP), growth (VEGF, H11 kinase), and cytoprotection (HSP70, HIF-1alpha, GLUT1). In the swine model, the same genes and proteins were upregulated after repetitive ischemia, which was accompanied by a concomitant decrease in myocyte apoptosis. These changes characterize viable tissue, because they were not found in irreversibly injured myocardium. Our report demonstrates a novel mechanism by which the activation of an endogenous gene program of cell survival underlies the sustained viability of the hibernating heart. Potentially, promoting such a program offers a novel opportunity to salvage postmitotic tissues in conditions of ischemia.

Adult↗
PubMed1977

The Harlem regional stroke program: an overview.

The Harlem regional stroke program has been a demonstration model designed to detect, treat, and follow up stroke and hypertension patients through collaboration with a municipal teaching hospital, community practitioners, local service organizations and a major medical school. Many aspects of the stroke program appear suitable for replication at the local or regional levels in varied settings. In particular, the program has demonstrated the need to link community outreach programs, stressing early detection and preventive-care education, with sustained treatment and follow-up programs. The stroke program has also suggested ways in which specialized programs can be incorporated into long-term comprehensive health planning and care facilities at local and regional levels.

Adolescent↗
PubMed2004

HIV prevention in Africa: programs and populations served by non-governmental organizations.

The AIDS epidemic in Africa remains an urgent health crisis. Non-governmental organizations (NGOs) in Africa play a critical role in the delivery of HIV prevention services and assistance to persons living with AIDS. African NGOs are conducting numerous HIV prevention programs with several at-risk populations, yet their efforts have only rarely been systematically documented. To address this gap in the literature, the authors surveyed one NGO in each of 29 African countries regarding their HIV prevention activities and populations served. This report provides details concerning HIV prevention activities across the continent and describes in detail innovative programs from Togo and South Africa. NGOs in the present sample operate with modest budgets and small staff sizes, yet conduct programs that reach large segments of their communities. NGOs were most likely to report community-level interventions such as peer-education or community outreach. Faced with an epidemic where the main transmission occurs via heterosexual activity, African NGOs were most likely to direct their attention to the general public and to youth. NGOs in Africa are struggling to implement sustainable, cost-effective programs with few resources. Strengthening the infrastructure and capacity of these key agencies is crucial to fighting the AIDS epidemic in Africa.

Africa↗
PubMed1995

Splenic B lymphocyte programmed cell death is prevented by nitric oxide release through mechanisms involving sustained Bcl-2 levels.

Incubation of ex vivo cultured mature B cells in the presence of nitric oxide or nitric oxide-donor substances delays programmed cell death as determined by the appearance of DNA laddering in agarose gel electrophoresis or by flow-cytometry analysis of DNA. Nitric oxide also rescues B cells from antigen-induced apoptosis but fails to provide a co-stimulatory signal that converts the signal elicited by the antigen into a proliferative response. The protective effects of nitric oxide against programmed cell death can be reproduced by treatment of the cells with permeant analogues of cyclic GMP. Regarding the mechanisms by which nitric oxide prevents apoptosis in B cells, we have observed that nitric oxide release prevents the drop in the expression of the protooncogene bcl-2, both at the mRNA and protein levels, suggesting the existence of an unknown pathway that links nitric oxide signaling with Bcl-2 expression.

Animals↗