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Role of programmed cell death in development.

Programmed cell death (PCD) is an integral part of both animal and plant development. In animals, model systems such as Caenorhabditis elegans, Drosophila melanogaster, and mice have shown a general cell death profile of induction, caspase mediation, cell death, and phagocytosis. Tremendous strides have been made in cell death research in animals in the past decade. The ordering of the C. elegans genes Ced-3, 4 and 9, identification of caspase-activated DNase that degrades nuclear DNA during PCD, identification of signal transduction modules involving caspases as well as the caspase-independent pathway, and the involvement of mitochondria are some of the findings of immense value in understanding animal PCDs. Similarly, the caspase inactivation mechanisms of infecting viruses to stall host cell death give a new dimension to the viral infection process. However, plant cell death profiles provide an entirely different scenario. The presence of a cell wall that cannot be phagocytosed, absence of the hallmarks of animal PCDs such as DNA laddering, formation of apoptotic bodies, a cell-death-specific nuclease, a biochemical machinery of killer enzymes such as caspases all point to novel ways of cell elimination. Large gaps in our understanding of plant cell death have prompted speculative inferences and comparisons with animal cell death mechanisms. This paper deals with both animals and plants for a holistic view on cell death in eukaryotes.

Animals↗

Characteristics of critical care nursing internship programs.

Development of programs to prepare new graduate nurses to work in critical care units has been a priority for nurse educators for many years. Despite the presence of many such internship programs, little data are available about the characteristics of such programs. Results of this study suggest that the development of internship programs designed to prepare new graduate nurses in critical care nursing continues to be a priority. The standards used by these programs are individualized and are often reflective of the unique needs of the institution. Costs of these programs are quite high. Recommendations for future directions based upon the results of the study are offered.

Clinical Clerkship↗

[Development of a smoking cessation program during health checkups. Preliminary study to evaluate the usefulness of this program].

Development of a simple and effective smoking cessation program is needed to provide cessation counseling during health checkups. A new cessation program, which consists of brief individual counseling and 4 follow-up telephone calls, was developed based on the stage model for life-style change. This program was performed during health checkups in the town of Nose to evaluate its usefulness. Smoking status questionnaires were completed to assess the smoking habits of subjects and to evaluate their smoking stage before the counseling session. Then, stage-matched cessation counseling was provided using a self-help guide. During the counseling, carbon monoxide measurement of expired air and Health Risk Appraisal feedback were performed to enhance self-perception of smoking. Follow-up calls were provided for only those clients who set a quit date during the individual counseling. It was easy to implement this program, and it required between 15 and 20 minutes to conduct. The cessation rate was 19% at 8 months after the health checkups. This result was more effective than data for other programs reported previously. Therefore, this program was effective and could be used at health checkups. This trial had no control group, so further studies are needed to clarify the efficacy and effectiveness of this program. In addition, training courses for health professionals must be developed to disseminate this program into general use.

Adult↗

Why do many NMDA antagonists fail, while others are safe and effective at blocking excitotoxicity associated with dementia and acute injury?

Similar to drug development programs for stroke and traumatic brain injury, programs developed for Alzheimer's disease (AD) have not been very effective in treating dementia. Recently, researchers have explored modulating excitatory synaptic neurotransmission via the N-methyl-D-aspartate receptor (NMDAR) to treat AD. However, many investigators doubt that NMDA antagonists are safe and effective for treating persons with AD because they have failed in stroke and trauma programs. This article explores the role of NMDA-mediated excitotoxicity in AD, reviews how the NMDAR functions, highlights the side effects and alternate signaling pathways that are initiated from NMDAR activation, provides examples of NMDA antagonists that do not exhibit the typical side effects, and discusses why some NMDA antagonist compounds are effective and safe in limiting cascades of excitotoxicity in dementia or acute brain injury.

Animals↗

The National Institute for Program Director Development: a school for program directors.

BACKGROUND: The role of residency program director is unique in medicine and medical education. Most program directors learn the job through trial and error, with a fortunate few benefiting from the wisdom and experience of their predecessors and mentors. In 1994, the Association of Family Practice Residency Directors (AFPRD) made the development of training and support resources for program directors a top priority. METHODS: With the support of the strategic plan of the AFPRD, the focus on excellence in residency education by the ABFP, and a survey documenting need, the National Institute for Program Director Development (NIPDD) was formed, with its sentinel product, a school for family practice residency directors. RESULTS: A fellowship-format 9-month training program was constructed using a multidimensional educational model. To date, there have been more than 300 participants. The curriculum emphasizes leadership development, resource allocation, a thorough familiarity with regulations and standards, educational options, and personnel management skills. A follow-up survey in 1999 documented an increase in program director tenure and an overall positive impact on family practice residency programs. CONCLUSIONS: Enhanced preparation for the job of residency program director results in a positive impact on both the director and the program.

Curriculum↗

Self-esteem in a broad-spectrum approach for mental health promotion.

Self-evaluation is crucial to mental and social well-being. It influences aspirations, personal goals and interaction with others. This paper stresses the importance of self-esteem as a protective factor and a non-specific risk factor in physical and mental health. Evidence is presented illustrating that self-esteem can lead to better health and social behavior, and that poor self-esteem is associated with a broad range of mental disorders and social problems, both internalizing problems (e.g. depression, suicidal tendencies, eating disorders and anxiety) and externalizing problems (e.g. violence and substance abuse). We discuss the dynamics of self-esteem in these relations. It is argued that an understanding of the development of self-esteem, its outcomes, and its active protection and promotion are critical to the improvement of both mental and physical health. The consequences for theory development, program development and health education research are addressed. Focusing on self-esteem is considered a core element of mental health promotion and a fruitful basis for a broad-spectrum approach.

Adaptation, Psychological↗

Recent trends in the development of alcohol and drug treatment services in Ontario.

This article summarizes the major trends in the development of alcohol and drug treatment services in Ontario since 1979. These trends are contrasted to the objectives of a province-wide Addiction Research Foundation (ARF) community development program designed to establish or expand addiction services within this same time period. Data were obtained from all treatment services in the province by surveys undertaken in 1980, 1983 and 1986. Across the period of analysis, there have been rapid increases in the number of addiction programs, their total cost and the total treatment caseload. Some specific changes have been quite consistent with ARF objectives: a stabilization in the use of hospital beds for addictions treatment, an increase in community-based versus hospital-based treatment resources, an increase in the province-wide capacity for comprehensive client assessment and a larger representation of women in addictions programs. Other ARF objectives have yet to be achieved. In particular, a major increase in nonresidential treatment alternatives and an increase in the proportion of treated cases from special populations such as youth or the elderly are still required. Suggestions are made concerning future program development.

Adult↗

The Nursing Fellowship: innovation in staff development.

The Nursing Fellowship is an example of a staff development program developed to meet the current day needs of nurses and hospitals. Across the country, hospitals are confronted with a paucity of specialty-prepared registered nurses. The Fellowships prepare RNs for certification examinations offered by the national specialty organizations. The Fellowships are under the umbrella of the Institute for Advanced Nursing Clinical Education and include: Oncology, Critical Care, Gerontology, Psychiatry, Medical Surgical, Perinatal and Perioperative Nursing. They are didactic and clinical and are developed and led by Master's-prepared clinical nurse specialists who are certified in the specialty area. The Fellowships continue to evolve but appear both subjectively and objectively to be successful in increasing knowledge in the specialty area. Early evaluation of the Fellowships suggests they may be an important tool for recruitment purposes and in retention of nursing staff.

Certification↗

[Education-service integration].

The article broadly reviews the conceptual basis of the integration of service and education and the history of the process and of the programs in progress in the countries of the Americas. A study of the different definitions given and uses made of the concept and practice yields a definition of the integration of services and education as "a process of progressive articulation between institutions providing health services and those imparting instruction in the health field in order to improve health care and guide the generation of knowledge and the training of personnel on the basis of the epidemiological profile of a given region and population. This ongoing education process takes place in the course of work, which it is capable of changing by virtue of its own momentum." This definition embodies the features common to all those used: The process itself, articulation between teaching and service establishments, and objectives. The story of the process in the Old World is briefly reviewed; its stages in the New World are considered at greater length, and the positions taken by the Pan American Health Organization since 1963 are stated. The emphasis today is on the technical cooperation provided in the different aspects of the process: institutional and program development, program supervision, the setting of standards and priorities for research, personnel utilization, etc. The article closes with an account of the mechanisms for interaction (formal, informal, operational, and policy-making) and a discussion of the different fields, practices and coverage that have been affected by this process, and comes to the conclusion that the integration of service and education has been essential to the student's training in exposing him to the practical realities of the local and general situation of his country.

Health Occupations↗

Determining continuing education interests of medical technologists: an initial step.

Continuing education is an ever-increasing need for medical technologists who want to maintain and upgrade their professional knowledge and skills. Professional groups strive to develop programs to meet a diversity of needs. Planning groups often encounter difficulty during the program development process as they identify topics and select effective educational strategies for presentation. In order to help identify topics of interest and desirable educational methods for the continuing education of laboratory personnel, a continuing medical technology education interest assessment tool was developed and used by a medical technology continuing education committee. Development and use of this assessment tool and resulting statistical survey results formed the basis for two continuing education courses, both considered highly successful.

Education, Continuing↗

Suicidal behavior in a bicultural society: a review of gender and cultural differences in adolescents and young persons of Aotearoa/New Zealand.

During the 1990s, Aotearoa/New Zealand has experienced an alarming increase in youth suicide in the Maori and non-Maori populations. Among 23 Organization for Economic Cooperation and Development countries surveyed by the World Health Organization's (1995) World Health Statistics Annual, New Zealand ranks first for fatal suicidal behavior, in males 15-24 years of age, and third for fatal suicidal behavior in females. A United Nations Children's Fund (UNICEF, 1996) survey of 32 countries places New Zealand males as third highest for fatal suicidal behavior, and females as eighth highest in the age group 15-24 years. New Zealand has recently undergone a number of social and economic changes that have created dramatic social and cultural shifts. Given the rapidity of these changes, the shock on such a small country has been difficult to absorb. These shifts have placed tremendous pressures on families and service support systems, such as health and mental health services, to develop programs that are relevant and acceptable for a bicultural society. This article focuses on these changes and the effect they have had on cultural narratives of gender and suicidal behavior, the different cultural etiologies that underlie these statistics, and recommendations for intervention and prevention program development.

Adolescent↗

Programmed neuronal death in insect development.

Programmed death in the developing nervous system of insects serves to remove obsolete neurons, generate segmental specializations and sexual dimorphism, as well as adjust neuronal number. This diversity is also reflected in the mechanisms which control the death of these neurons. In general, but not without exception, these deaths occur independent of target fate, while endocrine cues, segmental identity, and neural signalling often play critical roles. In addition, the programmed death of at least some neurons can be delayed by behavioral feedback. The study of neuronal death in Drosophila and the cloning of an ecdysteroid receptor bring the promise of understanding the genetic factors and molecular events that regulate this phenomenon.

Animals↗

[Education needs for the development of binational programs of health care].

The purpose of this article is to describe a research project carried out in Virginia, Maryland, Delaware and Pennsylvania. The main objective was to find out the continuing education needs of the staff implementing Primary Health Care (phc) programs developed with Mexican migrant workers. The methodology was based on applied research techniques. It was divided into two stages. The first stage was an interview which was applied to the coordinators of three programs: medical care, health education and sexually transmitted diseases. The second part of the methodology was to design a continuing education course with the input of the first stage. The course was implemented in the School of Public Health of Mexico in 1990. It had three main components: sociology and health in Mexico; health programmes in Mexico, and traditional medicine. The course also included a set of visits to clinics, hospitals and curanderos. The course has generated a group of scholars who are planning projects in this field to define the health needs of the migrant Mexican population in that area and the impact in Mexico. The course is also part of the regular Continuing Education Programme of the School of Public Health of Mexico now.

Delivery of Health Care↗

Using theory and basic research to target primary prevention programs: recent developments and future prospects.

This paper is concerned with recent attempts within the field of primary prevention to use theory and basic research to develop intervention programs. It starts by reviewing a number of recent large scale studies based upon the dominant theoretical perspective within this field--the social influences model. It argues that the results of such evaluations suggest that a 'universal' prevention strategy (i.e. one aimed in an undifferentiated manner at all individuals within a given population) is out of touch with our current knowledge concerning the etiological processes underlying substance use and misuse. As an alternative, it is suggested that prevention programs be developed according to a number of 'specific' strategies (i.e. ones targeted at vulnerable subgroups within larger populations). The rationale underlying this approach, as well as a number of theoretical models upon which such interventions might be developed, is then outlined.

Alcoholism↗

Institutional impact of a part-time faculty development fellowship program for osteopathic community-based physicians.

Evaluation of faculty development programs for medical educators has often focused on the satisfaction of individual learners. Long-term outcomes of skills and knowledge acquired during faculty development programs have been more difficult to evaluate. The impact on the institutions where the "developed" faculty teaches has been even less studied. This article discusses the results of a survey that focused on the institutional impact of a year-long part-time faculty development fellowship program for community-based physician faculty. The Statewide Campus System of Michigan State University College of Osteopathic Medicine (SCS MSU-COM) faculty development program conducted a survey of its graduates to ascertain the impact on the educational processes in their home institutions and the impact of the program on the graduates as medical educators. Responding graduates reported increased use of educational concepts and greater participation in the educational activities of their home institutions. The study demonstrates that a faculty development program addressing the needs of community-based physician faculty changes the perceptions of participants as medical educators and appears to have a positive impact on the educational process in their home institutions.

Faculty, Medical↗

Extending the pipeline for minority physicians: a comprehensive program for minority faculty development.

Medical schools must become more successful in training minority faculty. Minority faculty development programs at schools of medicine must involve trainees from the undergraduate years (if not before) through junior faculty and must involve MD and combine-degree (MD-PhD) students. The authors describe the comprehensive minority faculty development program at the University of Pennsylvania School of Medicine, which involves minority undergraduates, medical students, residents, fellows, and faculty. This program provides the administrative staff and research methodologists to assist trainees at all levels across all departments in the school of medicine. The principal student recruitment program is the undergraduate premedicine enrichment program. The medical student component provides general counseling, research development, and activities to enhance performance in the clinical courses. The components for advanced trainees (residents, fellows, and postdoctoral trainees) and faculty consist of training in research methods, mentoring, teaching skills, and scientific writing skills. Through this program, the University of Pennsylvania School of Medicine has increased the number of under-represented minority faculty by 32% since 1993-94 and created an environment conducive to the professional growth and development of minority faculty.

Black or African American↗

Development and maintenance of hemophilia programs in developing countries.

A hemophilia care program should be able to provide comprehensive medical care to the person with hemophilia and fundamental to the provision of such care is the ability to provide adequate hemostatic support to the hemophilic person with his congenital hemorrhagic diathesis. Development of such a program depends on the presence and commitment of key medical and paramedical personnel and on the recognition of the fact that hemophilia exists in a particular country or community. Support programs ultimately require government assistance for provision of diagnostic facilities and most importantly for a blood transfusion service where production of blood and preparation of blood components for therapy can be undertaken. To maintain a hemophilia care program there should be viability and education of staff and an undertaking by governments for the provision of an on-going infrastructural financial support. As patients mature, new problems will arise, some of which may be a direct complication of hemophilia. Involved medical staff require support and continuing education to continue to provide essential support to the people with hemophilia. Finally, it must be stressed that hemophilia care does not stand alone but must be incorporated into the network of provision of health care based on an efficient and viable blood transfusion service.

Blood Banks↗