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PubMed1997

[Health promotion and prevention in foreign populations in Switzerland:step-by-step progress].

The national office for public health (Bundesamt für Gesundheitswesen) aims to integrate the specific features of its target groups into its health promotion and prevention activities. This same strategy was applied to target the immigrant population. Initially these activities exclusively addressed prevention of Aids in immigrants from Spain, Portugal and Turkey. After 1993 they were extended to a wider range of issues and target groups. Women's health was one of the main topics which were added and activities were extended to groups from Africa, Latin America and to asylum seekers. Since 1995 drug and alcohol addiction became additional targets. In the course of these new activities groups from Italy and former Yugoslavia have also been addressed with respect to the various health promotion and prevention programmes. The cornerstones of the programme are (1) collaboration with the countries of origin of the various immigrant groups, (2) involvement of the target groups into the various activities and (3) the creation of awareness within Swiss institutions, organisations and immigrant administration offices towards specific problems of immigrants and their involvement into the various activities. A wide range of strategies have been employed which have already been evaluated. Amongst others those are training of health workers, who are themselves members of the various target groups, information events in immigrant clubs, telephone counselling in various languages. The results of the evaluation, problems and prospects for the future will be presented.

Community Health Workers↗
PubMedDate not supplied

[Spinal anesthesia: a step backward or a step forward?].

The authors analyze the evolution of methods of segmentary blocking over 100 years of their application. They compare the potentialities of and indications for epidural and spinal anesthesia. Variants of spinal anesthesia based on high technologies (making use of fine atraumatic needles for spinal anesthesia, microcatheter technique of prolonged spinal anesthesia, and combined technique of spinal epidural anesthesia) and the pharmacology of new local anesthetics used for both spinal and epidural segmentary blocking are characterized. The authors analyze the surgical pathophysiology of a segmentary conduction block and compare the efficacy of protection from operation stress under total and segmentary anesthesia and the structure and incidence of intra- and postoperative complications. They validate the perspectives of spinal anesthesia methods which can be widely used in practical anesthesiology.

Anesthesia, Epidural↗
PubMed1994

Anterior apicos in general practice: step-by-step guidelines.

Apicoectomy and retroseal procedures should continue to be a mainstay of dental treatment because not all root canal therapy is successful, even when it is amenable to retreatment. Currently accepted methods for performing this operation have been reviewed. With appropriate case selection and the careful implementation of these techniques, the general dentist can confidently provide this service to patients.

Apicoectomy↗
PubMed1976

Anatomic localization and step by step advancement of the fiberoptic colonoscope.

Anatomic localization of the tip of a colonoscope without the aid of fluoroscopy is adequate in a majority of patients. External check points of transilluminated light within the colon on the abdominal wall, characteristic internal appearance of the colon and gross anatomic landmarks have been used. An improved technique for advancement results if a routine sequence of maneuvers is used in a similar manner in all patients.

Colon↗
PubMed1998

Step by step.

Explore the source record for details and available documents.

Accidental Falls↗
PubMed1999

Factors influencing the quick onset of stepping following postural perturbation.

It has been shown that the stepping to recover balance following a forward fall occurs at a constant time (on average 293 ms) (Do et al. Journal of Biomechanics 15, 1982, 933-939). In this study, we tested the hypothesis according to which programming to make fast movement could trigger the movement earlier than when programming self-pace movement. The same experimental paradigm of forward fall was used (see Do et al., 1982) to induce stepping. Different extents of stepping were manipulated by instructions: Subjects were instructed to step to recover their balance naturally (control condition); to make shorter steps than in the control condition; longer steps; faster steps. Lastly, a fast step was also induced by the biomechanical constraint on the initial posture, i.e. by inclining the subject forward at his maximum capacity. Data were collected from 12 subjects. The variables analyzed were the onset latency of step execution and other classical parameters (time of heel-contact, duration of the swing phase, step length, center of mass progression velocity, and step velocity). The results showed that the onset of stepping was unchanged in the longer- and faster-step conditions, relative to the control condition (mean control value = 280 ms). In contrast, the onset of stepping was significantly earlier in the short-step condition, and when the initial inclination was greater (250 and 252 ms, respectively). The swing phase duration in these two conditions averaged 140 and 185 ms, was significantly shorter than in the other conditions, whereas step length was obviously expected to be shorter in the shorter-step condition and longer in the longer-step condition than in the other conditions. Step length was similar between the other conditions. We conclude that neither step length or step velocity programming could induce an earlier onset latency of stepping. Step programming in relation to these specific instructions seemed to concern the extent of step execution and not the time of triggering of the stepping. We suggest that the control of short swing phase duration resulted in an earlier onset latency of stepping to recover the balance. This control depends on the combination of biomechanical constraints and cognitive processes, including subject's interpretation of the instructions and evaluation of the risk of fall.

Adult↗
PubMed2006

External postural perturbations induce multiple anticipatory postural adjustments when subjects cannot pre-select their stepping foot.

Previous research on human balance recovery suggests that, prior to an externally triggered postural perturbation, healthy subjects can pre-select their postural response based on the environmental context, but it is unclear whether this pre-selection includes the selection of a stepping leg when performing compensatory steps. We sought to determine how pre-selecting a stepping limb affects the compensatory steps and stability of young, healthy subjects when responding to postural perturbations. Nine healthy subjects (24-37 years of age) stepped in response to backward translations of a platform under their feet when, prior to the perturbations, the subjects either knew whether they were to step with their left or right leg to a visual target (the Predictable condition) or did not know whether to step with their left or right leg until one of two targets appeared at perturbation onset (the Unpredictable condition). The Unpredictable condition also included randomly inserted trials of toes-up rotations and backward translations without targets (catch trials). The results showed that, in the Predictable condition, the subjects consistently exhibited one anticipatory postural adjustment (APA; a lateral weight shift toward the stance limb) before stepping accurately to the target with the correct leg. In the Unpredictable condition, the subjects either (1) exhibited multiple APAs, late step onsets, and forward center-of-mass (CoM) displacements that were farther beyond their base of support, or (2) exhibited an early step with only one APA and kept their CoM closer to the base of support, but also stepped more often with the incorrect leg. Thus, when the subjects had to select a stepping leg at perturbation onset, they either became more unstable and used multiple APAs to delay stepping in order to provide enough time to select the correct stepping leg, or they stepped earlier to remain stable but often stepped with the incorrect leg. In addition, responses to catch trials in the Unpredictable condition included distorted step placements that resembled steps to anticipated targets, despite allowing the subjects to step with a leg of their choice and to a location of their choice. Lastly, the subjects' voluntary stepping latencies to visual targets presented without perturbations were twice as long as their stepping latencies to the backward platform translations. Therefore, healthy subjects appear to pre-select their stepping limb, even when the perturbation characteristics are unpredictable, because relying on visual input provided at perturbation onset requires a delayed response that leads to greater instability.

Adaptation, Physiological↗
PubMed1998

Locomotor capacity attributable to step training versus spontaneous recovery after spinalization in adult cats.

Locomotor performance, hindlimb muscle activity and gait patterns during stepping were studied in step-trained and non-trained female, adult spinal cats. Changes in locomotor characteristics relative to prespinalization bipedal and quadrupedal stepping patterns were used to evaluate the effects of step training on the capacity to execute full weight-bearing stepping after spinalization. Step training consisted of full weight-bearing stepping of the hindlimbs at the greatest range of treadmill speeds possible at any given stage of locomotor recovery. In the initial stages of training the limbs were assisted as needed to execute successful steps. On the basis of two behavioral criteria, the maximum speed of treadmill stepping and the number of successful steps per unit time, the ability to step was at least 3 times greater in animals trained to step versus those allowed to recover spontaneously, i.e., the non-trained. The greater success in stepping was reflected in several physiological and kinematic properties. For example, the amplitude of electromyograph (EMG) bursts in the tibialis anterior (an ankle dorsiflexor), the amount of extension at the end of both the stance (E3) and swing (E1) phases of the step cycle, and the amount of lift of the hindlimb during swing were greater in step-trained than in non-trained spinal cats. The changes that occurred in response to training reflected functional adaptations at specific phases of the step cycle, e.g., enhanced flexor and extensor function. The improved stepping capacity attributable to step training is interpreted as a change in the probability of the appropriate neurons being activated in a temporally appropriate manner. This interpretation, in turn, suggests that step training facilitated or reinforced the function of extant sensorimotor pathways rather than promoting the generation of additional pathways. These results show that the capacity of the adult lumbar spinal cord to generate full weight-bearing stepping over a range of speeds is defined, in large part, by the functional experience of the spinal cord after supraspinal connectivity has been eliminated. These results have obvious implications with regards to 1) the possibility of motor learning occurring in the spinal cord; 2) the importance of considering "motor experience" in assessing the effect of any postspinalization intervention; and 3) the utilization of use-dependent interventions in facilitating and enhancing motor recovery.

Animals↗