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PubMed1990

Use of the signal-averaged ECG to predict maximum ventricular tachycardia rate.

Rapid ventricular tachycardia is poorly tolerated, and estimation of maximum ventricular tachycardia rate prior to programmed ventricular stimulation is difficult. A method to estimate maximum ventricular tachycardia rate using late potential duration from the signal-averaged ECG and ventricular functional refractory period is described. Late potentials recorded in patients with ventricular tachycardia may represent delayed conduction through arrhythmogenic ventricular myocardium. This delay may be rate limiting in determining the minimum cycle length of reentrant ventricular tachycardia originating from these areas. Using the ratio of ventricular activation time (VAT), which equals QRS plus late potential duration, to unfiltered QRS duration (QRS) as estimate of this delay, the following relationship is proposed: Minimum ventricular tachycardia cycle length = (FRP 400 - 12.5 ms) (VAT/QRS). Twenty patients with late potentials who had sustained, monomorphic ventricular tachycardia at programmed stimulation were evaluated. Predicted cycle lengths ranged from 326 to 214 ms. Predicted and observed cycle lengths were significantly correlated (r = 0.91, SEE = 11.9 ms, p less than 0.0005), with predicted and observed cycle lengths differing by less than 3.5%. Predicted cycle lengths were more accurate than cycle lengths estimated using FRP alone (p less than 0.01). Accurate prediction of minimum ventricular tachycardia cycle length using this relationship suggests that late potential duration is proportional to the conduction delay occurring in arrhythmogenic ventricular myocardium.

Cardiac Pacing, Artificial↗
PubMed1995

An assessment of research on breastfeeding promotion strategies in developing countries.

Breastfeeding and its impact on child survival in developing countries have been well documented. Governments are being urged to encourage breastfeeding through legislation and promotional campaigns. The success of promotional programs depends not only on the interventions themselves but on the acceptance and acquisition of the desired knowledge, skills and behaviors. During the past decade, a variety of strategies have been used in an attempt to promote breastfeeding. These efforts include: (1) modifying hospital policies; (2) using social supports; (3) providing incentives; (4) educating mothers and health workers; and (5) initiating legislation and political action to create policies aimed toward healthier infant feeding practices. Research regarding these promotional activities has been both qualitative and quantitative in nature, designed to provide answers concerning the relative success of different promotional approaches. To varying degrees, findings and conclusions of breastfeeding promotion research can enhance the design, implementation and sustainability of these projects. However, programs and research designs are poorly described in the literature, providing vague conclusions and little guidance for future program planning.

Adult↗
PubMed2002

Interventions for preventing eating disorders in children and adolescents.

BACKGROUND: Eating disorders represent an extremely difficult condition to treat and patients consume an enormous amount of mental health energy and resources. Being young, female, and dieting are some of the few identified risk factors that have been reliably linked to the development of eating disorders, and several prevention eating disorder prevention programs have been developed and trialed with children and adolescents. The purpose of this systematic review is to evaluate the effectiveness of eating disorder prevention programs for children and adolescents both in the general population and those determined to be at risk. OBJECTIVES: 1. To determine if eating disorder prevention programs are effective in promoting healthy eating attitudes and behaviours in children and adolescents; 2. To determine if eating disorder prevention programs are effective in promoting psychological factors that protect children and adolescents from developing eating disorders; 3. To determine if eating disorder prevention programs are effective in promoting satisfactory physical health in children and adolescents; 4. To determine if eating disorder prevention programs have a long-term, sustainable, and positive impact on the mental and physical health of children and adolescents; and, 5. To determine the safety of eating disorder prevention programs in terms of possible harmful consequences on the mental or physical health of children and adolescents. SEARCH STRATEGY: Relevant trials are identified through searching the Cochrane Controlled Trial Register (CCTR) and relevant biomedical and social science databases. All terms necessary to detect prevention programs and the participant groups are used. A strategy to locate randomised controlled trials is used. Other sources of information are the bibliographies of systematic and non-systematic reviews and reference lists from articles identified through the search strategy. In order to identify unpublished studies, experts in the field are contacted by letter and/or electronic mail. SELECTION CRITERIA: Randomised controlled trials (RCT) with a major focus on eating disorder prevention programs for children and adolescents, where there is no known DSM-IV diagnosis of an eating disorder, are eligible for inclusion in the review. Trials must include a control group and at least one objective outcome measure (eg. BMI) or a standardised psychological measure used with the intervention and control group, pre- and post-intervention. DATA COLLECTION AND ANALYSIS: A total of 1379 titles have been identified through the search to date. 13 studies were located that reported use of a randomised controlled trial methodology and were critically appraised by two independent reviewers. Five (5) studies were excluded as data were not reported in a useable form or useable data could not be obtained from the trial authors, one dissertation could not be obtained, one study had no "true" no-treatment or usual treatment control group, and one study did not use a pre-test outcome measure. Eight (8) studies met the selection criteria outlined above. MAIN RESULTS: Only one of eight pooled comparisons of two or more studies using similar outcome measures and similar intervention types demonstrated the statistically significant effect of a particular type of eating disorder prevention program for children and adolescents. Combined data from two eating disorder prevention programs based on a media literacy and advocacy approach indicate a reduction in the internalisation or acceptance of societal ideals relating to appearance at a 3- to 6-month follow-up (Kusel, unpublished; Neumark-Sztainer2000) [SMD -0.28, -0.51 to -0.05, 95% CI]. However, there is insufficient evidence to conclude that this approach also demonstrated a significant impact on awareness of societal standards relating to appearance. There is insufficient evidence to support the effect of four programs designed to address eating attitudes and behaviours and other adolescent issues on body weight, eating disorder symptoms, associated eating disorder psychopathology or general psychological and physical well-being in the general sample or those classified as being at high risk for eating disorder (Buddeberg-F 1998; Killen 1993/1996; Santonastaso 1999; Zanetti 1999). Given only one program used a psychoeducation approach to prevent bulimia nervosa (Jerome, unpublished) and only one program adopted a focus on self-esteem (O'Dea 2000), the effect of these approaches could not be evaluated via meta-analyses. In relation to potential harmful effects, there is not sufficient evidence to suggest that harm resulted from any of the prevention programs included in the review. REVIEWER'S CONCLUSIONS: The one significant pooled effect in the current review does not allow for any firm conclusions to be made about the impact of prevention programs for eating disorders in children and adolescents, although none of the pooled comparisons indicated evidence of harm. From a clinical perspective, the development and refinement of prevention programs is complicated by a lack of knowledge about risk factors associated with eating disorders and the need to strike a balance between delivering preventive interventions for eating disorders and considering the potential to cause harm. From a research perspective, the idea of "thresholds" for identifying young people at risk of developing eating disorders has been raised, and denial of concern or denial of illness represents a further issue complicating early identification in relation to eating disorder symptomatology. Longer-term effects of the intervention approaches will need to be monitored across development in order to demonstrate a decline in the incidence of eating disorders and associated risk factors.

Adolescent↗
PubMedDate not supplied

Group parent training: a novel approach for the treatment of eating disorders.

This paper describes the rationale, development, and implementation of a group parent training program designed to assist caregivers in the management of their child's eating disorder while facilitating the development of a healthy home environment for sustained change. The content of this program instructs caregivers in disorder management and capitalizes on caregivers as role models of adaptive behavior. Strategies are provided to address acute disorder management, features of caregivers that may impede task implementation, and environmental and attitudinal changes. The group format enhances social support, accountability, and self-efficacy. A preliminary qualitative evaluation and future directions are described to assist healthcare professionals in better meeting the needs of caregivers of these disorders.

Journal Article↗
PubMed2005

Sustainable and tenable renal health model: a Latin American proposal of classification, programming, and evaluation.

BACKGROUND: End-stage renal disease (ESRD) presents a major problem to public health, with complex implications for social and economic structures in every nation of the world. Clearly, Latin American and Caribbean countries are not able to meet the needs of every patient requiring dialysis treatment at ESRD. Consequently, a considerable number of patients die every year as a result of lack of resources. Aware of this serious social, ethical, and economic problem, the Latin American Society of Nephrology and Hypertension proposed a new renal health concept in the region. In December 2002, at the workshop in Valdivia, Chile, a modification to the National Kidney Foundation Classification of Chronic Kidney Disease was approved. PROJECT: According to modifications to the concept of chronic kidney disease approved in the Declaration of Valdivia, a new Renal Health Model was proposed. It consists of including orderly follow-up in patients' charts, starting from the earliest stage, and a model establishing a guideline for the reallocation of financial resources to guarantee continuity of treatment to patients with ESRD. CONCLUSION: The implementation of the Renal Health Program in health ministries of Latin American and Caribbean countries would allow for a substantial improvement in renal health prevention and management, as a result of better distribution of financial and human resources.

Health Planning↗
PubMed1999

Inducibility of sustained ventricular tachycardia in a closed-chest ovine model of myocardial infarction.

The two goals of this study were (1) to develop a closed-chest animal model of monomorphic ventricular tachycardia; and (2) to investigate the effect of dual site pacing on inducibility of ventricular tachycardia. In the first part of the study, 10 of 14 sheep underwent successful induction of myocardial infarction by temporary balloon occlusion of the left anterior descending coronary artery. After a follow-up period of 21-43 days, sustained monomorphic ventricular tachycardia could be induced during programmed electrical stimulation using a "clinical" stimulation protocol in 8 of the 10 sheep. The number of ventricular tachycardia episodes per animal varied between 5 and 70. Ventricular fibrillation was never induced during programmed electrical stimulation. Ventricular tachycardia episodes lasted from 30 seconds up to 15 minutes and were terminated by antitachycardia pacing or DC cardioversion. In the second part of the study, the effect of dual site stimulation on ventricular tachycardia inducibility was investigated. High current stimuli from an area within the infarcted zone were given with the S1 programmed stimulation protocol. This dual site stimulation showed no effect on ventricular tachycardia induction during programmed electrical stimulation. This animal model shows a high induction rate of sustained monomorphic ventricular tachycardia in the chronic phase of myocardial infarction. The high incidence of ventricular tachycardia inducibility provides a reliable tool to study new techniques for the prevention of ventricular tachyarrhythmias.

Animals↗
PubMed1985

Prediction of sudden death and spontaneous ventricular tachycardia in survivors of complicated myocardial infarction: value of the response to programmed stimulation using a maximum of three ventricular extrastimuli.

The prognostic significance of ventricular arrhythmias induced by programmed electrical stimulation was evaluated in 50 survivors of acute myocardial infarction complicated by a major new conduction disturbance (38 patients), congestive heart failure (33 patients) or sustained ventricular tachyarrhythmias (22 patients), alone or in combination. Programmed stimulation was performed in patients in stable condition 7 to 36 days (mean 16) after infarction using one to three extrastimuli at four times diastolic threshold at a maximum of two right ventricular sites. Two groups were identified by the response to programmed stimulation: 17 patients with sustained (greater than 15 seconds) or nonsustained (greater than 7 beats but less than or equal to 15 seconds) ventricular tachycardia (group I), and 33 patients with 0 to 7 intraventricular reentrant complexes in response to maximal stimulation efforts (group II). Group I patients had a higher incidence of anterior infarction than that of patients in group II (71 versus 42%), had lower left ventricular ejection fraction (mean 0.35 versus 0.48) and were more often treated with antiarrhythmic drugs (47 versus 18%, p less than 0.05). There were no significant differences between groups in the occurrence of congestive failure, new conduction disorders or sustained ventricular arrhythmias with infarction, or in the proportions treated with a beta-receptor blocking agent, coronary bypass grafting or a permanent pacemaker. Total cardiac mortality was 24% during a mean follow-up period of 23 months and did not differ between groups; however, the response to programmed stimulation identified a group at high risk of late sudden death or spontaneous ventricular tachycardia: 7 (41%) of 17 group I patients compared with 0 of 33 group II patients (p less than 0.001). The induction of sustained or nonsustained ventricular tachycardia identified all patients who died suddenly or had spontaneous tachycardia (sensitivity 100%), but triple extrastimuli were required to induce prognostically significant arrhythmias in five of these seven patients; the specificity of this protocol was only 57%. When the clinical variables of the group were evaluated individually, the response to programmed stimulation had a stronger association with occurrence of late sudden death than did any other factor (Fisher's exact test, p less than 0.001); however, a type II error could not be excluded.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1985

Bethanidine sulfate: efficacy in prevention of ventricular tachyarrhythmias during programmed stimulation. Report of a multicenter study of 56 patients.

Twelve cardiac electrophysiology centers conducted an open label prospective trial of bethanidine sulfate, an oral bretylium analog, for the prevention of ventricular tachyarrhythmias during programmed electrical stimulation. The study group included 56 patients (44 men, 12 women; mean age 60 years; 55 with structural heart disease). Sixteen patients had both ventricular tachycardia and fibrillation, 30 had ventricular tachycardia alone and 10 had ventricular fibrillation alone. Programmed stimulation on no antiarrhythmic drugs induced sustained ventricular tachycardia in 46 patients, nonsustained ventricular tachycardia in 4 patients and ventricular fibrillation in 6 patients. During programmed ventricular stimulation after 59 trials of 20 to 30 mg/kg body weight of oral bethanidine (acute dosing in 40 patients, and divided dosing over 24 hours in 19 patients), no ventricular tachyarrhythmias were inducible in 6 patients (11%), sustained ventricular tachycardia was converted to nonsustained ventricular tachycardia in 3 patients (5%), ventricular tachyarrhythmias remained inducible in 39 patients (70%) and spontaneous ventricular tachyarrhythmias occurred more frequently in 4 patients (7%). Side effects prevented repeat testing in four patients. The 10 patients presenting with only ventricular fibrillation appeared to have a higher response rate: no ventricular tachyarrhythmias were inducible in 2 patients and sustained ventricular tachycardia was converted to nonsustained ventricular tachycardia in 2 patients. Despite protriptyline administration in 54 of 59 bethanidine trials, symptomatic hypotension occurred in 30 trials (51%). In conclusion, the efficacy of bethanidine for preventing ventricular tachyarrhythmias as assessed by programmed stimulation is low. Patients presenting with only ventricular fibrillation may have a more favorable response to bethanidine sulfate. Symptomatic hypotension occurs frequently despite concomitant use of protriptyline.

Adult↗
PubMed2000

[Stratification of the arrhythmia risk after acute myocardial infarct].

Recent studies clearly support the role of the cardioverter implantable defibrillator in reducing arrhythmic and all-cause mortality in patients with a previous myocardial infarction. However, the use of the cardioverter implantable defibrillator cannot be extended to all myocardial infarction patients despite its effectiveness because implantation is an invasive procedure and the cost of the device is high. Thus, the correct and effective identification of patients at high risk of life-threatening ventricular arrhythmias represents a clinically relevant problem owing to the availability of an effective but expensive therapeutic tool. Many non-invasive tests have been studied in past years to assess the risk of ventricular arrhythmias after myocardial infarction; moreover, also programmed ventricular stimulation has been used to evaluate inducibility of ventricular tachycardia. Nevertheless, the positive predictive value of both non-invasive and invasive testing is low and not adequate to make a clinical decision. This finding is probably related to the multifactorial genesis of malignant ventricular arrhythmias which need several concomitant factors to trigger arrhythmias. For this reason the combined use of multiple risk markers is needed in order to improve diagnostic accuracy and identify subgroups of patients at high enough risk to define specific prophylactic options. In this scenario, according to available data, patients with two or more non-invasive risk markers should undergo electrophysiologic testing. In fact, patients with a recent myocardial infarction who have positive non-invasive tests and also show inducibility of sustained monomorphic ventricular tachycardia at programmed ventricular stimulation have a high incidence of arrhythmic events during the subsequent follow-up period and, in the author's opinion, should undergo a cardioverter defibrillator implantation. In the present review, an analysis of the main diagnostic tests for risk stratification of postinfarction patients will be performed and operative suggestions will be provided.

Bundle-Branch Block↗
PubMed2026

BACH1 orchestrates macrophage state transitions to coordinate regenerative inflammation.

Efficient tissue regeneration requires the precise coordination of inflammatory and regenerative programs, principally mediated by monocyte-derived macrophages. However, the transcriptional wiring and epigenomic processes behind complex macrophage subtype specification and transition between the different states are not known. Here we have identified the transcriptional repressor BACH1 as a critical, cell-intrinsic regulator of monocyte-derived macrophage specification during skeletal muscle regeneration. Using a myeloid-specific BACH1 knockout mouse model, we demonstrate that BACH1 deficiency disrupts the temporal coordination of monocyte-to-macrophage differentiation, leading to aberrant macrophage subsets with concurrent opposing pro- and anti-inflammatory features. Single-cell RNA-sequencing profiling reveals that BACH1 controls a core transcriptional network, including Nfkb1, Cebpb, and interferon signaling, governing inflammatory resolution and functional macrophage specialization. Mechanistically, BACH1 loss accelerates macrophage differentiation but also affects its core cellular identity, resulting in sustained, rather than declining inflammatory programs including upregulation of Il1b and thus, defective tissue remodeling. These immune alterations compromise the paracrine landscape during regenerative inflammation and impair muscle stem cell differentiation. Our findings establish BACH1 as a molecular tuner or controller that integrates early innate immune signaling with regenerative output, positioning it as a central node linking transcriptional control, immune fate decisions, and tissue repair.

Animals↗
PubMed1984

Experience with electrophysiologically guided therapy of ventricular tachycardia with flecainide: summary of long-term follow-up.

In a heterogeneous group of 15 patients with clinical syncope or documented sustained ventricular tachycardia (VT), with induced sustained or nonsustained VT at programmed electrical stimulation, flecainide prevented tachycardia induction in 9 of 15 patients (60%) and improved responses in 2, for a 73% initial favorable response rate. Cycle length of induced rhythms increased an average of 141 ms after the drug. Antiarrhythmic response rate was higher in the absence of coronary artery disease. Ten of these patients were selected for a long-term drug trial. After a median follow-up of 13.5 months, 8 patients (53%) continue to receive flecainide, 6 (40%) successfully treated with flecainide alone and 1 each treated with concomitant therapy with amiodarone and a programmable antitachycardia pacemaker. Minor dosage adjustments were made during early outpatient therapy in 5 patients. Those continuing on therapy show a remarkable absence of side effects and stable drug concentrations. Therapy failed in 2 patients at 0.5 and 4 months, in 1 in association with progression of cardiomyopathy and in another with recurrence of sustained (slow) VT. Although our results have been favorable, preliminary reports from other laboratories have been mixed. Therefore, further experience is needed. In summary, flecainide appears promising in selected patients with VT using a carefully monitored approach including electrophysiologic induction studies.

Adult↗
PubMed2004

Progressive apoptotic cell death triggered by transient oxidative insult in H9c2 rat ventricular cells: a novel pattern of apoptosis and the mechanisms.

Many pathophysiological processes are associated with oxidative stress and progressive cell death. Oxidative stress is an apoptotic inducer that is known to cause rapid cell death. Here we show that a brief oxidative insult (5-min exposure to 400 microM H(2)O(2)), although it did not kill H9c2 rat ventricular cells during the exposure, triggered an intracellular death cascade leading to delayed time-dependent cell death starting from 1 h after the insult had been withdrawn, and this post-H(2)O(2) cell death cumulated gradually, reaching a maximum level 8 h after H(2)O(2) withdrawal. By comparison, sustained exposure to H(2)O(2) caused complete cell death within a narrow time frame (2 h). The time-dependent post-H(2)O(2) cell death was typical of apoptosis, both morphologically (cell shrinkage and nuclear condensation) and biochemically (DNA fragmentation, extracellular exposure of phosphatidylserines, and caspase-3 activation). A dichlorofluorescein fluorescent signal showed a time-dependent endogenous increase of reactive oxygen species (ROS) production, which was almost abolished by inhibition of the mitochondrial electron transport chain. Application of antioxidants (vitamin E or DTT) before H(2)O(2) addition or after H(2)O(2) withdrawal prevented the H(2)O(2)-triggered progressive ROS production and apoptosis. Sequential appearance of events associated with activation of the mitochondrial death pathway was found, including progressive dissipation of mitochondrial membrane potential, cytochrome c release, and late activation of caspase-3. In conclusion, transient oxidative stress triggers an intrinsic program leading to self-sustained apoptosis in H9c2 cells via cumulative production of mitochondrial ROS and subsequent activation of the mitochondrial death pathway. This pattern of apoptosis may contribute to the progressive and long-lasting cell loss in some degenerative diseases.

Animals↗
PubMed1999

Community decision-making about critical access hospitals: lessons learned from Montana's Medical Assistance Facility Program.

Limited-service hospitals have been used as a means of maintaining health care services in rural communities with full-service hospitals at risk of closure. The Medical Assistance Facility (MAF) limited-service hospital model has been implemented in 12 communities in Montana and has been evaluated by the Health Care Financing Administration as a viable alternative to a full-service hospital in frontier communities. The 1997 federal Critical Access Hospital (CAH) legislation is the most recent nationwide alternative for maintaining health care in rural communities, and it incorporates many of the features of the MAF model. The purpose of this study was to examine rural community decision making regarding MAF conversion from the perspectives of key informants who were involved in the decision-making process. A descriptive multiple case study design was used. Data were obtained through interviews with community members during site visits. The research focused on identification of local issues that were influential in the decision to convert to or reopen as an MAF, features of the MAF model that made it a locally acceptable alternative, and elements that characterized the decision-making process. The issues found to be influential in the conversion decision and the features that made the MAF locally acceptable were those that made the provision of basic services more stable and sustainable. The study suggests that programs to maintain health care services in isolated communities should allow for and encourage an expanded role for nonphysician providers. The lessons learned from the communities included in this study are instructive to rural communities nationwide that are considering a CAH as well as to policy-makers, researchers, and regional and national health care decision makers.

Community-Institutional Relations↗
PubMed2003

Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years.

OBJECTIVE: To evaluate the impact of an interventional multidisciplinary antibiotic management program on expenditures for antibiotics and on the incidence of nosocomial infections caused by Clostridium difficile and antibiotic-resistant pathogens during 7 years. DESIGN: Prospective study with comparison with preintervention trends. SETTING: University-affiliated teaching hospital. PATIENTS: All adult inpatients. INTERVENTION: A multidisciplinary antibiotic management program to minimize the inappropriate use of third-generation cephalosporins was implemented in 1991. Its impact was evaluated prospectively. The incidence of nosocomial C. difficile and resistant Enterobacteriaceae infections as well as the rate of vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) were compared with those of National Nosocomial Infections Surveillance System hospitals of similar size. RESULTS: Following implementation of the program, there was a 22% decrease in the use of parenteral broad-spectrum antibiotics (P < .0001) despite a 15% increase in acuity of patient care during the following 7 years. Concomitantly, there was a significant (P = .002) decrease in nosocomial infections caused by C. difficile and a significant (P = .02) decrease in nosocomial infections caused by resistant Enterobacteriaceae. The program also appeared to have a favorable impact on VRE rates without a sustained impact on MRSA rates. CONCLUSION: These results suggest that an ongoing multidisciplinary antibiotic management program may have a sustained beneficial impact on both expenditures for antibiotics and the incidence of nosocomial infection by C. difficile and resistant bacterial pathogens.

Anti-Bacterial Agents↗
PubMedDate not supplied

The role of information dissemination in sustainability of international partnerships.

The Fogarty-supported International Training Program of the Southwest Center for Occupational and Environmental Health (SWCOEH) at the University of Texas School of Public Health was initiated in 1995, with its activities focused primarily on Latin America. As this program has matured, its participants have been concerned about including elements that increase the likelihood that its trainees and projects will have a sustainable impact on occupational and environmental health in collaborating countries. The Center recently reviewed the experiences of various international organizations and national development agencies with established track records involving donor-supported projects. The authors summarize factors associated with project sustainability and describe how some of them are being incorporated into the SWCOEH program. Particular mention is made of the importance of supporting an infrastructure for broad information dissemination in the language of the intended audience. An example of a project to support a peer-reviewed Spanish-language journal devoted to occupational and environmental health, Salud de los Trabajadores, is presented.

Developing Countries↗
PubMed2005

Clinical study of interference with cardiac pacemakers by a magnetic field at power line frequencies.

OBJECTIVES: This study examined the risk of interference by high magnetic flux density with permanent pacemakers. BACKGROUND: Several forms of electromagnetic energy may interfere with the functions of implanted pacemakers. No clinical study has reported specific and relevant information pertaining to magnetic fields near power lines or electrical appliances. METHODS: A total of 250 consecutive tests were performed in 245 recipients of permanent pacemakers during 12-lead electrocardiographic monitoring. A dedicated exposure system generated a 50-Hz frequency and maximum 100-microT flux density, while the electrical field was kept at values on the order of 0.10 V/m. RESULTS: A switch to the asynchronous mode was recorded in three patients with devices programmed in the unipolar sensing configuration. A sustained mode switch was followed by symptomatic pacing inhibition in one patient. No effect on devices programmed in bipolar sensing was observed, except for a single interaction with a specific capture monitoring algorithm. CONCLUSIONS: The overall incidence of interaction by a magnetic field was low in patients tested with a wide variety of conventionally programmed pacemaker models. A magnetic field pulsed at power frequency can cause a mode switch and pacing inhibition in patients with devices programmed in the unipolar sensing configuration. The risk of interference appears negligible in patients with bipolar sensing programming.

Adolescent↗
PubMed1994

Community participation in vector control: lessons from Chagas' disease.

As applied to vector-borne disease control, the term community participation has been broadly interpreted. Community-based vector control projects have been described as having both active and passive components. Recently, community participation in organized efforts to control Chagas' disease has become more dynamic, with increasingly active involvement by local community members. Chagas' disease is a particularly significant vector-borne disease problem in the South American countries of Brazil, Venezuela, and Bolivia, and health officials there are beginning to emphasize horizontal or decentralized approaches to control of triatomine vectors. Experience suggests that vector control programs using community participation have significant and sustainable impact on vector density, appear to be more cost-effective than purely vertically structured programs, are readily integrated with other health or development programs, promote an enduring sense of pride in home and community, and are politically viable vector control strategies. Community participation per se has inherent value because of its positive effect on social relationships and community solidarity. Moreover, it is a dynamic process that results in accrued benefits for public health that exceed most vector control program goals and persist well beyond program termination.

Animals↗
PubMed1979

Effect of substantial gainful activity level on disabled beneficiary work patterns.

Analysis of disabled beneficiaries' earnings records from the 1-percent Continuous Work History Sample over a 15-year period indicates that increases in the substantial gainful activity (SGA) level in 1966, 1968, and 1974 were not followed by incremental increases in beneficiary earnings. This article examines the flow of disabled-worker beneficiaries through the disability program in relation to their work history and earnings patterns. The recovery rate dropped steadily during the late 1960's and early 1970's. The earnings patterns indicate that about 10 percent of the beneficiaries were employed; about 3 percent had earnings above the SGA level. Median annual earnings remained well below $1,000, whatever the SGA level. Findings of the study suggest that policy considerations on changing the SGA level should not center on the implications for marginal part-time employment. Most of the evidence from beneficiary work and earnings patterns indicates that the SGA level has not operated as an effective work incentive. The program-flow analysis suggests that the allowance process rather than termination of benefits for recovery after sustained work holds the key to controlling program growth.

Employment↗