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PubMedDate not supplied

Utilization of and barriers to public sector tuberculosis services in India.

BACKGROUND: Tuberculosis control in India still faces many challenges related to the provision of services under the Directly Observed Treatment, Short-course (DOTS) strategy. We assessed the utilization of and barriers to the Revised National Tuberculosis Control Programme (RNTCP) services based on DOTS in 4 states of India, and recommend actions to optimize utilization of the RNTCP services. METHODS: Two districts each in 4 states with more than 50% of the population covered under the RNTCP in 2002, representing diverse levels of general health indicators, were selected. Sex-disaggregated data on patients who reported to the RNTCP facilities for the diagnosis and treatment of tuberculosis in 2002 were reviewed from the laboratory and tuberculosis registers to assess the utilization of these services. Data on barriers to utilization of the RNTCP services were collected through interviews of 4310 patients with tuberculosis who were 16 years of age or older. RESULTS: A total of 83,099 patients had reported for the diagnosis of tuberculosis in the study areas, of whom 29,279 were women (35.2%). The proportion of sputum-positive diagnosis was lower in women (10.8% [95% CI 10.5%-11.1%]) than men (17% [95% CI 16.7%-17.3%]). For the treatment of tuberculosis, 21592 patients were registered in the study areas; 6789 were women (31.4%). Among new smear-positive tuberculosis patients, 79.9% of women (95% CI 78.4%-81.4%) and 74.4% of men (95% CI 73.4%-75.4%) were cured. Multivariate analysis revealed that the odds of not completing the process of diagnosis of tuberculosis were significantly higher for patients > 50 years of age, those who were never married or married currently, those with symptoms for < or = 15 days, those who had gone alone for diagnosis, and those who were not informed about a suspicion of tuberculosis by the health personnel at the time of diagnosis. Among the reasons for not completing the process of diagnosis of tuberculosis, health provider-related barriers were cited most frequently (45.9%), followed by improvement in symptoms. Health provider-related barriers were also cited most frequently (40.4%) by those who had completed the process of diagnosis but did not start treatment in the RNTCP facility. On multivariate analysis, the odds of not completing the treatment of tuberculosis were significantly higher for men, those who were ever married, those who were not informed that tuberculosis was curable, those who were not informed of the duration of treatment at the time of starting treatment, those who were dissatisfied with the DOTS provider, and those who had health facility staff as the DOTS provider compared with those who had an anganwadi/health worker. Medicine-related barriers were cited most frequently by patients who had defaulted in the intensive (37.1%) or continuation (23.1%) phase of treatment. CONCLUSION: Of the persons utilizing the RNTCP services, about one-third are women. The health services-related factors indicated in the multivariate analysis for less than optimal utilization of the RNTCP services, and the health provider-related and treatment-related barriers to utilization of the RNTCP services at various levels cited by the patients suggest the need to adopt a patient-centred approach to improve utilization of the RNTCP services.

Adolescent↗
PubMed1984

Age differences in Wechsler Memory Scale performance.

Calculated mean scores for older persons utilizing data from previous studies that measured Wechsler Memory Scale performance in healthy samples and compared with those of younger adults and a sample of neurologically impaired aged (N = 384). Statistical analysis indicated that in total raw scores, as well as in all subtest scores but Digit Span, there are significant differences in the performance of different age groups. The degree to which age is associated with subtest performance varies depending on the particular subtest involved. Results are discussed in terms of their clinical implications and current theories of aging and memory.

Adult↗
PubMed1975

Investigative studies of the dermatitis caused by the larva of the brown-tail moth (Euproctis chrysorrhoea Linn.) I. Clinical and experimental findings.

A description is given of both naturally occurring and experimentaly produced brown-tail moth caterpillar dermatitis. Epicutaneous test reactions were studied in a group of 45 persons, utilizing different setae preparations obtained from Euproctis chrysorrhoea L. About 70% of the individuals developed marked reactions upon contact with untreated nettling hairs. The early skin lesions were as a rule erythematous and wheal-like in character (urticarial), gradually becoming more infiltrated and developing into erythematous papules or vesicles. Treatment of the nettling hairs either by heating or saline extraction resulted in a partial loss only of their skin irritating properties; heat treatment being slightly more effective in this respect. Intracutaneous tests with a sline extract of nettling hairs elicited positive skin reactions in all individuals tested. Biochemical analysis of the crude extract revealed the presence of a potent esterolytic enzyme. Apart from their skin irritating action, the nettling hairs were found capable to induce the formation of spherocytes when mixed in vitro with human erythrocytes. The relevance of this phenomenon is discussed. On the basis of our findings and those of other it is suggested that the action of the nettling hairs upon the human skin is dependent both on a toxic and mechanical traumatic principle.

Adult↗
PubMed1982

Linguistically based speechreading assessment.

A videotaped speechreading test, Eyes and Spoken Language, has been designed to assess how effectively a person utilizes linguistic constraints in responding to spoken language via the visual pathway. Concurrent validity and test-retest reliability has been established using responses of 68 non-hearing-impaired young adults. A significant learning effect has been demonstrated from one administration to another 2 wk later. The clinical implications of this finding are discussed.

Adolescent↗
PubMed1996

Implementation of a reference management system, MacRefer, under HyperCard.

We have developed a reference management system, MacRefer, using HyperTalk on Macintosh personal computers. Using this program, one can automatically acquire data from databases created by EndNote Plus and from OVID- or Medlar-formatted records downloaded via an online use of Medline. The MacRefer's capability of formatting bibliographic database in user-defined formats is comparable with the exemplified bibliography maker, EndNote Plus. Moreover, MacRefer has several competitive features, which are insufficiently equipped with EndNote Plus. For example, MacRefer is capable of (1) maintaining subsets within a database, (2) executing complex, structured searches combining up to nine keywords for any data field with the results and search conditions preserved, and (3) easily browsing (a portion of) reference database. Although MacRefer cannot be recognized as an absolute alternative of EndNote Plus because of several limitations inherent to HyperCard, the compensatory use of these two programs will expand the personal utilization of bibliographic databases.

Computers↗
PubMed1995

Respiratory protection devices.

OSHA authority and responsibility have led to the requirement that health care workers potentially exposed to patients with active tuberculosis in situations where engineering controls are not feasible for protection must utilize personal protective equipment at least equivalent to HEPA respirators. ICPs generally believe that this approach is unnecessarily conservative and imposes undue burdens on patient care. The arguments on both sides of this controversy have some merit. Reported cases of tuberculosis and skin-test conversions among health care workers since 1988 and the absence of a demonstrated safe level of exposure have led many to the conclusion that HEPA respirators are justified. On the other side, tuberculosis currently is not a major problem in some areas of the country, and many believe that less stringent personal protective devices (e.g., DM respirators) may provide protection equivalent to HEPA filters--at least in terms of preventing infection if not in terms of filtration efficiency. They believe that the lesser discomfort and lower cost associated with DM respirators justify the argument for a more flexible standard. Perhaps additional research can help to resolve the remaining controversy. Definitive answers are unlikely to surface quickly, however, and it is likely that the controversy and confusion will continue for at least awhile longer.

Health Personnel↗
PubMed1987

Wheat production in controlled environments.

Our goal is to optimize conditions for maximum yield and quality of wheat to be used in a controlled-environment, life-support system (CELSS) in a Lunar or Martian base or perhaps in a space craft. With yields of 23 to 57 g m-2 d-1 of edible biomass, a minimum size for a CELSS would be between 12 and 30 m2 per person, utilizing about 600 W m-2 of electrical energy for artificial light. Temperature, irradiance, photoperiod, carbon-dioxide levels, humidity, and wind velocity are controlled in state-of-the-art growth chambers. Nutrient solutions (adjusted for wheat) are supplied to the roots via a recirculating system that controls pH by adding HNO3 and controlling the NO3/NH4 ratio in solution. A rock-wool plant support allows direct seeding and densities up to 10,000 plants per meter2. Densities up to 2000 plants m-2 appear to increase seed yield. Biomass production increases almost linearly with increasing irradiance from 400 to 1700 micromoles m-2 s-1 of photosynthetic photon flux (PPF), but the efficiency of light utilization decreases over this range. Photoperiod and temperature both have a profound influence on floral initiation, spikelet formation, stem elongation, and fertilization. High temperatures (25 to 27 degrees C) and long days shorten the life cycle and promote rapid growth, but cooler temperatures (20 degrees C) and shorter days greatly increase seed number per head and thus yield (g m-2). The life cycle is lengthened in these conditions but yield per day (g m-2 d-1) is still increased. We have evaluated about 600 cultivars from around the world and have developed several breeding lines for our controlled conditions. Some of our ultra-dwarf lines (30 to 50 cm tall) look especially promising with high yields and high harvest indices (percent edible biomass).

Biomass↗
PubMed2004

A genotoxic screen: rapid analysis of cellular dose-response to a wide range of agents that either damage DNA or alter genome maintenance pathways.

SNP analysis has come to the forefront of genomics since the mouse and human genomes have been sequenced. High throughput functional screens are necessary to evaluate these sequence databases. Described here is a genotoxic screen: a rapid method that determines the cellular dose-response to a wide range of agents that either damage DNA or alter basic cellular pathways important for maintaining genomic integrity. Importantly, a single person utilizing standard tissue culture equipment may perform these assays composed of 20 agents that attack genomic integrity or maintenance at many different levels. Thus, a small lab may perform this screen to determine the integrity of a wide range of DNA repair, chromatin metabolism, and response pathways without the limitations of investigator bias. A genotoxic screen will be useful when analyzing cells with either known genetic alterations (generated directly by the investigator or derived from individuals with known mutations) or unknown genetic alterations (cells with spontaneous mutations such as cancer-derived cells). Screening many genotoxins at one time will aid in determining the biological importance of these altered genes. Here we show the dose-response curves of mouse embryonic stem (ES) cells and HeLa cells exposed to 20 genotoxic agents. ES cells were chosen since they are amenable to genetic alteration by the investigator. HeLa cells were chosen since they were derived from cancer and are commonly used. Comparing the dose-response curves of these two cell lines show their relative sensitivity to these agents and helps define their genotoxic profile. As a part of phenomics, a large genotoxic profile database for cancer-derived cells, when integrated with other databases such as expression profiles and comparative genomic hybridization, may aid in maximizing the effectiveness of developing anti-cancer protocols.

Alkylating Agents↗
PubMed2006

Cortisol effects of D-amphetamine relate to traits of fearlessness and aggression but not anxiety in healthy humans.

UNLABELLED: The current study utilized personality measures thought to relate to noradrenergic and catecholamine function (i.e., sensation seeking, anxiety and aggression) to investigate individual differences in amphetamine-induced increases in cortisol. The goal of the study was to better understand variations in responses to psychostimulants in healthy volunteers. METHOD: A placebo-controlled within-subjects investigation of salivary cortisol responses to oral D-amphetamine (20 mg) was conducted in seventy (N=70) young adults. Personality traits were assessed using the Eysenck Personality Inventory (EPI), Sensation Seeking Scale Form V (SSS-V) and the Multidimensional Personality Questionnaire-Brief Form (MPQ-BF). RESULTS: A more rapid rise in salivary cortisol after d-amphetamine was associated with SSS-V Thrill Seeking (r=-0.32 with time to peak, p<0.05). A greater peak increase in cortisol and a greater recovery after amphetamine was positively associated with MPQ-BF Aggression (r=+0.35, p<0.05; r=+0.38, p<0.05). In contrast, cortisol responses were unrelated to a composite measure of trait anxiety (EPI/MPQ-BF Anxiety Index). CONCLUSIONS: The findings suggest that the personality traits of aggression and thrill seeking are related to cortisol responses to d-amphetamine, raising the possibility that personality may predispose certain individuals to use drugs through a glucocorticoid pathway. The data also suggest a distinction between fear and anxiety, as amphetamine-induced cortisol responses were associated with measures of trait fear but not measures of trait anxiety in the current sample.

Adolescent↗
PubMed2004

Expenditures associated with preventive healthcare.

BACKGROUND: The Office of Disease Prevention and Health Promotion emphasizes the use of preventive healthcare interventions to "increase quality and years of healthy life". The objective of this study is to evaluate over a 1-year period the total individual healthcare expenditures based upon the likelihood of the person utilizing preventive healthcare measures. METHODS: We analyzed data from the 1998 Medical Expenditure Panel Survey (MEPS) to compare healthcare expenditures of respondents who have and have not followed generally accepted preventive healthcare measures including influenza vaccination, blood pressure checkup, prostate examination, cholesterol determination, and mammography. RESULTS: In general, respondents who lacked evidence of pursuing accepted preventive healthcare practices had lower overall healthcare expenditures in 1998 compared to those who pursued such practices. Specifically, they had lower expenditures for office-based visits and for prescriptions. CONCLUSIONS: People who pursue accepted preventive healthcare measures spent more for their total healthcare over a given year.

Aged↗
PubMedDate not supplied

Maximizing therapist effectiveness with geriatric hand patients.

The "graying of America" is resulting in higher proportions of older persons utilizing the health care system. Current trends indicate that the geriatric population represents a growing portion of the hand therapy patient population. Appreciating the unique needs of the geriatric hand patient and developing an appropriate treatment program require special interventions that may seem unappealing due to the likelihood of prolonged initial treatment time. However, such steps can strongly enhance therapist effectiveness, patient compliance, and ultimate outcome. The purposes of this paper are: (1) to address frustrations that may be encountered in the treatment of some elderly hand patients; (2) to introduce the reader to the phenomenon of age bias; (3) to present a well-accepted and effective assessment tool of memory, orientation, and ability to follow commands as these competencies pertain to hand therapy; (4) to address concepts in the gerontology literature that can be applied clinically as treatment guidelines to boost treatment effectiveness; and, finally, (5) to suggest communication techniques to use with the elderly hand patient. Maximizing therapist effectiveness with geriatric hand patients will serve to reinforce the dignity and value of this unique population.

Aged↗
PubMed2001

Aspiration pneumonia: dental and oral risk factors in an older veteran population.

OBJECTIVES: To investigate the importance of medical and dental factors in aspiration pneumonia in an older veteran population. DESIGN: Prospective enrollment of subjects with retrospective analysis of data. SETTING: Department of Veterans Affairs outpatient clinic, inpatient ward, and nursing home. PARTICIPANTS: 358 veterans age 55 and older; 50 subjects with aspiration pneumonia. MEASUREMENTS: Demographic and medical data; functional status; health-related behaviors; dental care utilization; personal oral hygiene; comprehensive dental examination; salivary assays including IgA antibodies; and cultures of saliva, throat, and dental plaques. RESULTS: Two logistic regression models produced estimates of significant risk factors. One model using dentate patients included: requiring help with feeding (odds ratio (OR) = 13.9), chronic obstructive pulmonary disease (COPD) (OR = 4.7), diabetes mellitus (OR = 3.5), number of decayed teeth (OR = 1.2), number of functional dental units (OR = 1.2), presence of important organisms for decay, Streptococcus sobrinus in saliva (OR = 6.2), and periodontal disease, Porphyromonous gingivalis in dental plaque (OR = 4.2), and Staphylococcus aureus presence in saliva (OR = 7.4). The second model, containing both dentate and edentulous patients included: requiring help with feeding (OR = 4.7), COPD (OR = 2.5), diabetes mellitus (OR = 1.7), and presence of S. aureus in saliva (OR = 8.3). CONCLUSION: This study supports the significance of oral and dental factors while controlling for established medical risk factors in aspiration pneumonia incidence.

Activities of Daily Living↗
PubMed2001

The self-reported functional measure: Predictive validity for health care utilization in multiple sclerosis and spinal cord injury.

OBJECTIVE: To examine the predictive validity of the Self-Reported Functional Measure (SRFM), a new measure derived from the FIMtrade mark instrument, for health care utilization in multiple sclerosis (MS) and spinal cord injury (SCI). DESIGN: Prospective cohort study using a mailed survey in 1995 and administrative records from 1996 and 1997. SETTING: Veterans Health Administration hospitals and outpatient clinics. PATIENTS: A total of 6361 veterans with SCI and 1789 veterans with MS. MAIN OUTCOME MEASURES: SRFM score was compared with subsequent outpatient visits, hospitalizations, hospital lengths of stay (LOSs), and residence peri-hospitalization. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for these variables. RESULTS: A total of 3836 subjects (47.6%) were hospitalized during 1996-1997, and all but 874 (10.7%) had 1 or more outpatient visits. SRFM score predicted inpatient, but not outpatient health care utilization. Persons in the lowest SRFM quartile were over 90% (OR = 1.91, 95% CI = 1.71-2.13) more likely to be hospitalized compared with those in the highest SRFM quartile; also, they were over 2 times (OR = 2.18, 95% CI = 1.85-2.57) more likely to have a LOS greater than 7 days, were over 2 times (OR = 2.41, 95% CI = 1.62-3.58) more likely to die in hospital, and were nearly 3 times (OR = 2.86, 95% CI = 2.00-4.08) more likely to be discharged to an institution. CONCLUSIONS: SRFM had excellent predictive validity for hospitalization, LOS, and discharge destination among patients with MS or SCI.

Confidence Intervals↗
PubMed2006

Improving the quality of preventive cardiovascular care provided by primary care physicians: insights from a US Quality Improvement Organization.

BACKGROUND: During 2000-03, Qualidigm, a US Quality Improvement Organization, conducted a project to improve the care received by elderly Medicare patients with coronary artery disease or cardiovascular risk factors. METHODS: We recruited primary care physicians in private practice in the state of Connecticut. Then, we identified approximately 30-50 patients per physician from the periods 1 January 2000 to 31 December 2000 and 1 November 2001 to 31 October 2002. We abstracted medical records to assess processes and outcomes of care, and we provided the physicians with performance data and a variety of practice-enhancing materials. The physicians utilized those materials that they perceived to be most helpful. RESULTS: We identified and recruited 974 primary care physicians to participate. Of these, 103 (10.6%) committed to participate, and 85 of the 103 completed the project. Among the intervention tools, physicians and their office personnel utilized personal digital assistants (PDAs) (36.5%) and patient education materials (34.1%) most commonly. Overall, quality of care improved for most physicians (mean quality score 62.0 to 67.8%, P < 0.001). However, not all improved, and most improvements were modest [mean absolute improvement in quality score 5.8%, standard deviation (SD) 6.8%]. CONCLUSIONS: Quality Improvement Organizations and others interested in improving outpatient quality of care face significant challenges in recruiting self-employed primary care physicians to quality improvement projects and in bringing about transformational change. Future primary care quality improvement projects should include careful assessments of practice-specific barriers, interventions that are linked to these barriers, and support of the practices on implementation.

Aged↗
PubMed1975

Student evaluations of professors: are they of value?

Recent studies of the validity of student ratings of teaching leave much to be desired. Five of these studies are evaluated on the basis of adequacy of design, validity, and generalizability; and one of the studies is used as a model for further inquiry in this area. It is then argued that student evaluations of teaching can provide useful information relevant to the improvement of instruction. However, in order to use such evaluations, improved methods of data collection and analysis are needed. A primary improvement would be in the area of generalizability. A plan for expanding the use of student evaluations from personal utility to general applicability is outlined.

Achievement↗
PubMed1989

The General Health Questionnaire by interview. Performance in relation to recent use of health services.

The General Health Questionnaire (GHQ) is a widely used method of assessing psychiatric distress in clinical settings and in the community. The authors administered a 20-item interview version of the GHQ and a battery of survey items on use of ambulatory health care services to 3,389 respondents in eastern Baltimore as part of the Epidemiologic Catchment Area survey. In addition, a subsample of these respondents (n = 810) was examined by research psychiatrists who provided a reference mental disorder diagnosis for comparison with GHQ results. Psychiatrists determined that 102 respondents had American Psychiatric Association's Diagnostic and Statistical Manual, third edition, (DSM-III) disorders suitable for detection by the GHQ. These respondents were categorized by the health service use they reported over the previous 6 months. A comparison indicated that 82% of the diagnosed cases with recent specialty care also had elevated GHQ scores. Among cases with recent general medical care, 52% had elevated GHQ scores. Among diagnosed cases reporting no recent ambulatory health care, only 38% had elevated GHQ scores. Receiver operating characteristic analysis demonstrated a similar trend. Cases of depression were separated into less severe cases (adjustment disorder with depressed mood) and more severe cases (major depression). There were relatively more cases of severe depression than cases of mild depression in those respondents reporting recent health service use compared with those respondents reporting no recent service use. This may account for the higher sensitivity of the GHQ in detecting psychiatric disorders for those persons utilizing health services compared with individuals using no health services.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care↗
PubMed2001

Detection of Treponema denticola in atherosclerotic lesions.

We examined 26 atherosclerotic lesions and 14 nondiseased aorta specimens to detect the periodontopathogenic part of the bacterial 16S rRNA locus by PCR. Treponema denticola sequence of the 16S rRNA locus was found in 6 out of 26 DNA samples (23.1%) from the formalin-fixed, paraffin-embeded atherosclerotic lesions obtained during surgery but not in any of the 14 nondiseased aorta samples from deceased persons. Utilizing immunofluorescence microscopy, we observed aggregated antigenic particles reacting with rabbit antiserum against T. denticola in thin sections of the PCR-positive samples, but we could not detect any reacting particles in the PCR-negative thin sections.

Adult↗
PubMed1985

A life skills program for physically disabled adolescents.

Successful management of one's life involves the ability to solve problems, set realistic goals, make and evaluate decisions, and utilize personal and interpersonal skills. Adolescence is that time during which individuals are expected to develop these "life skills" that will enable them to cope effectively with the demands of daily living. Due to many factors, physically disabled adolescents frequently experience delay and difficulty in mastering the developmental tasks of this period. Formalized training in life skills is one approach that has the potential to equip these young people with the skills and strategies needed for adult independence. This paper describes the unique stresses of adolescence as experienced by the physically disabled population and the development of a Life Skills Program at the Hugh MacMillan Medical Centre designed to address some of these issues.

Adolescent↗