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PubMed1998

Impact of the hepatitis B mass vaccination program in the southern part of Thailand.

By 1992, hepatitis B vaccine had been included in the Expanded Program of Immunization (EPI) on a nation-wide scale in Thailand. With the results now available from Songkhla Province in the south of Thailand, we are able to fully evaluate its impact on the prevalence of HBV infection and carrier rate. The population studied comprised 180 randomly selected children aged between 2 months and 15 years who had attended Hat Yai hospital due to any acute illness affecting neither the liver nor the immune system. Their sera were examined for the hepatitis markers HBsAg, anti-HBs and anti-HBc, respectively, using a commercially available test kit. We detected anti-HBs in 106 of the 180 children (58.9%) with its prevalence peaking within the age groups of 0-2 (94.4%) and 3-5 years (75.6%), respectively. Six children, five within the age groups of 6-10 and 11-15 years showed anti-HBc, one of them was diagnosed as a chronic carrier; the sixth one of the age group of 0-2 years most probably displayed passive maternal antibodies. The overall HBV carrier rate amounted to 0.55%. The hepatitis B mass vaccination program has proved highly efficient in protecting newborns from infection and heralds the promise of eventually eradicating hepatitis B virus in the not so far future.

Adolescent↗
PubMed1996

[A case-based and multi-media computer learning program on the topic of myocardial infarct, angina pectoris and mitral valve stenosis].

BACKGROUND: Principles in the field of cognitive psychology and problem-based learning together with recent progress in multimedia technologies are providing the basis for the development of case-based and computer-assisted learning systems. With reference to the information-overload of theoretical and factual knowledge in medical education these programs can be an efficient tool to satisfy the current need for new, practical, skill-related forms of knowledge transfer. METHODS: Apple-Macintosh Computers were selected to develop interactive, multimedia patient-simulations on mitral stenosis, angina pectoris and myocardial infarction. INSTRUCTIONAL AIM AND CONTENTS: The user acquires knowledge and skills about the leading symptoms, differential diagnoses, the use and analysis of laboratory examinations and the process of diagnostic reasoning while working through the computer-simulated cases. PEDAGOGICAL DESIGN AND CONCLUSION: Important pedagogical principles associated with computer-assisted learning were employed in the program. Clinical situations can be simulated repeatedly and for every student in an authentic manner. Therefore the program can serve as a preparation for and a supplement to practical clinical education. Compared to conventional teaching media the development of instructional multimedia software requires a tremendous amount of time and resources. Thus, controlled studies are important to objectify the overall advantages such programs can have.

Angina Pectoris↗
PubMed2004

Insemination with isolated and virologically tested spermatozoa is a safe way for human immunodeficiency type 1 virus-serodiscordant couples with an infected male partner to have a child.

OBJECTIVE: To enable serodiscordant couples to reproduce while minimizing the risk of infecting the female partner and to demonstrate the feasibility of including these couples in an insemination program. DESIGN: Prospective follow-up study. SETTING: Ambulatory IUIs. PATIENT(S): Fifty-six HIV-1-serodiscordant couples with a male infected partner. INTERVENTION(S): Sperm cell separation by the gradient density method followed by the swim-up method, virological detection, and IUI after ovarian stimulation. MAIN OUTCOME MEASURE(S): Pregnancy rate, HIV-1 test, and p24 antigenemia in women. RESULT(S): Two hundred thirteen IUIs were performed, and 37 pregnancies occurred, resulting in 33 births and 2 ongoing pregnancies. Fifty percent of couples have a child. No women were infected. CONCLUSION(S): Our study demonstrates the efficiency of an IUI program with prepared and virologically tested spermatozoa in serodiscordant couples with an HIV-1-infected male partner, allowing the couples to have children without transmission of the virus to the female partner.

Adult↗
PubMed2000

Signal-dependent nuclear export of a histone deacetylase regulates muscle differentiation.

Members of the myocyte enhancer factor-2 (MEF2) family of transcription factors associate with myogenic basic helix-loop-helix transcription factors such as MyoD to activate skeletal myogenesis. MEF2 proteins also interact with the class II histone deacetylases HDAC4 and HDAC5, resulting in repression of MEF2-dependent genes. Execution of the muscle differentiation program requires release of MEF2 from repression by HDACs, which are expressed constitutively in myoblasts and myotubes. Here we show that HDAC5 shuttles from the nucleus to the cytoplasm when myoblasts are triggered to differentiate. Calcium/calmodulin-dependent protein kinase (CaMK) signalling, which stimulates myogenesis and prevents formation of MEF2-HDAC complexes, also induces nuclear export of HDAC4 and HDAC5 by phosphorylation of these transcriptional repressors. An HDAC5 mutant lacking two CaMK phosphorylation sites is resistant to CaMK-mediated nuclear export and acts as a dominant inhibitor of skeletal myogenesis, whereas a cytoplasmic HDAC5 mutant is unable to block efficiently the muscle differentiation program. Our results highlight a mechanism for transcriptional regulation through signal- and differentiation-dependent nuclear export of a chromatin-remodelling enzyme, and suggest that nucleo-cytoplasmic trafficking of HDACs is involved in the control of cellular differentiation.

Animals↗
PubMed1989

The utilization review program. Essential for hospital survival.

The survival of a health care institution in today's economic climate is dependent on, among other things, the efficiency of its utilization review program. The purpose of this article is to serve as a basic guideline for an institution to develop an adequate utilization review program. It emphasizes that a utilization review program is essential for the economic survival of any health care industry. The utilization review program should be an integrated organization with the support of administration, and the participation of staff physicians, physician advisors, review nurses, and important hospital departments, such as social service, laboratory, medical records, preplanning, and so forth. Following the format presented in this paper, an institution may easily develop a utilization review program. The ideas presented in this paper have been time-proven at our institution. There must be educational programs for physicians on the basics of managing patients according to the prospective payment system and the economic impact physicians can make on the hospital's economic status. These educational presentations must take place as often as necessary to reinforce policy and procedure, and to carry out effective patient management. The utilization review department, as well as the medical staff, must work in close harmony with administration to assist the facility in surviving trying economical times.

Hospital Administration↗
PubMed2005

[Entomological surveillance for Chagas disease in the mid-western region of Minas Gerais State, Brazil, from 2000 to 2003].

In Minas Gerais State, Brazil, after the elimination of Triatoma infestans by the Brazilian Chagas Disease Control Program, some triatomine species, such as Panstrongylus megistus, have merited the attention of entomological surveillance authorities. After the decentralization of the Brazilian health system, certain administrative and operational difficulties have been observed in some municipalities (counties). This study aims to evaluate entomological surveillance for Chagas disease in the 54 municipalities supervised by the Division of Decentralized Health Activities in Divinopolis, Minas Gerais, from 2000 to 2003. In 46 municipalities, 1,531 triatomines were captured, of which 94.1% were P. megistus. The infection rate for T. cruzi in the vectors was 1.3%. A total of 850 reports were received and 835 site visits were conducted, showing that the program is active and efficient in the majority of the municipalities analyzed. The importance of the maintenance and improvement of entomological surveillance in the region was demonstrated, since triatomine bugs continue to invade (and can colonize) the domiciliary environment, although with low density.

Animals↗
PubMedDate not supplied

Centering pregnancy. An interdisciplinary model of empowerment.

This is a time of change within the health care system. This has created a challenge for health care providers to develop creative new patterns that will provide quality service within a system that is mandating more economy and efficiency. The Centering Pregnancy program abolishes routine prenatal care by bringing women out of examination rooms and into groups for their care. The design incorporates the three components of prenatal care--risk assessment, education, and support--into one entity. Women are placed into groups of 8 to 12 based on estimated dates of delivery and meet for ten 90-minute prenatal or postpartum visits at regular intervals. At these visits, standard prenatal risk assessment is completed within the group setting, an educational format is followed that uses a didactic discussion format, and time is provided for women to talk and share with one another. By incorporating these three components into one whole, emphasis is placed on their collective importance. Women are encouraged to take responsibility for themselves; this leads to a shift in the client-provider power base. Evaluative data demonstrated that 96% of the women preferred receiving their prenatal care in groups. This model is interdisciplinary in design and demonstrates provider satisfaction, as well as efficiency in delivery of care. It is an excellent model for the care of teens and for midwives and nurse practitioners to lead. The combination of satisfaction, good outcomes, and effective delivery of care makes this an attractive model for agencies to implement.

Adolescent↗
PubMed2003

Instructional multimedia programs for self-directed learning in undergraduate and postgraduate training in orthodontics.

OBJECTIVES: The objectives of this study were to develop and evaluate an interactive multimedia courseware package in orthodontics and to provide dental undergraduate and postgraduate students with an interactive means of self-study and self-evaluation. METHODS: A commercially available software authoring system was used to develop the courseware package. The courseware was presented for evaluation through a questionnaire to four different groups of undergraduate and postgraduate students. Each group consisted of 25 students. The first three groups were third, fourth, and fifth year of dental curriculum at the Katholieke Universiteit Leuven, Belgium. The fourth group comprised postgraduate students. A one-way ANOVA was carried out in order to check for statistical differences, whereas a Scheffe's test was used in order to locate the statistical differences between groups. The p value was set at 0.05. RESULTS: The majority of undergraduate and postgraduate students in this study were very enthusiastic about this form of educational approach (74/100) because it was experienced as very helpful in understanding the orthodontic curriculum more efficiently (98/100). CONCLUSIONS: The program provides both undergraduate and postgraduate dental students with a useful interactive means of self-study and self-evaluation.

Analysis of Variance↗
PubMed1982

A program for infection surveillance utilizing an infection control liaison nurse.

Today's infection control programs require a practical, efficient, and effective surveillance system. The Epidemiology Section of a 650-bed, university-affiliated hospital has implemented a two-phase approach. Phase I is surveillance by service. Each service receives a minimum of 2 months' concentrated surveillance, with critical care units monitored each month. The entire hospital is covered within a year. Monthly statistics are issued for each surveyed service and the individual patient units within that service. Phase II involves the infection control liaison nurse (ICLN). An ICLN, established in each patient unit, monitors infection control practices and acts as a liaison between the unit and the epidemiology section. Selected candidates are trained by the epidemiology section. The ICLN aids in more immediate identification of problems and better monitoring of aseptic practices. This approach is effective and manageable. Better understanding of unit problems result in more relevant educational programs with time to conduct additional activities. Statistics have more meaning and support for infection control is improved.

Connecticut↗
PubMed2000

[Molecular characteristics of multiresistant clinical strains of Mycobacterium tuberculosis isolated in Russia].

The efficiency of tuberculosis control programs is largely determined by methods for rapid diagnosis of the agent. In comparison with the traditional methods, new molecular technologies for characterization of mycobacteria appear to be more promising, because the result can be obtained in almost no time. Sixty-five strains of M. tuberculosis isolated in various regions of Russia were investigated. Drug resistance and strain appurtenance of this sample were determined by classical (absolute concentrations method, IS6110-RFLP) and modern molecular genetic methods (detection of mutations in rpo B gene, DRE-PCR). The spectrum of mutations of the rpoB gene associated with rifampicin resistance was evaluated by direct sequencing. Mutations involving codons 531 (62.7%), 526 (18.6%), and 516 (10.2%) of rpoB gene predominated in the studied sample. The studied strains were discriminated into 52 individual strains by IS6110-RFLP and DRE-PCR typing. Analysis of the resultant genetic variants showed the predominance of M. tuberculosis family W. The efficiency of combined approach to screening for M. tuberculosis is discussed.

DNA-Directed RNA Polymerases↗
PubMedDate not supplied

Cost analysis as a management tool for improving the efficiency of primary care: some examples from Java.

Health programs in developing countries increasingly face limited or even reduced budgets. More and better services might be produced from these resources by improving efficiency through better management and program design. Cost analysis at individual health units can help identify sources of inefficiency, and provide guidance to managers as to where they can achieve important gains in productivity. This paper presents several examples from health centers and sub-centers in rural Java. Indonesia, showing how inefficiencies in staffing patterns, personnel management, and drug management can affect cost-efficiency. Routine analysis of cost data could provide the basis for management incentives to local health units to increase both outputs and quality of care.

Cost-Benefit Analysis↗
PubMed1996

Effects of dietary crude protein, breed, parity, and health status on the fertility of dairy cows.

A study was conducted to determine the impact of dietary CP (13% vs. 20%), parity (first vs. second lactation or later), and breed (Holstein vs. Jersey) on the reproductive efficiency of dairy cows. Sixty-four cows were blocked by parity and breed and assigned to one of two treatments. Cows were removed from treatments on d 100 or 120 depending on pregnancy status. Cows were categorized by health status based on the occurrence of postparturient disorders. Plasma urea N concentrations were influenced by diet (8.6 vs. 21 mg/dl, 13 and 20% CP, respectively), parity, and breed. Reproductive indices were not influenced by diet except that days to first estimated ovulation increased for cows fed the 20% CP diet when health status was added to the model. Days to first observed estrus, first AI service, and cumulative pregnancy rate were affected by health status. Regression analysis for survival showed an interaction of diet and health status for days open. High CP diets tended to increase days open when cows had major health problems; otherwise, a high CP diet decreased days open. The implementation of a strict reproductive management program allowed high reproductive efficiency goals to be achieved regardless of plasma urea N concentrations.

Animals↗
PubMed2000

Surgery versus conservative management in adult isthmic spondylolisthesis--a prospective randomized study: part 1.

STUDY DESIGN: A prospective randomized study was performed. OBJECTIVE: To determine whether posterolateral fusion in patients with adult isthmic spondylolisthesis results in an improved outcome compared with an exercise program. SUMMARY OF BACKGROUND DATA: In spondylolisthesis, satisfactory results have been reported with both surgical and conservative management. The evidence for treatment efficacy, however, is weak because prospective randomized studies are lacking. METHODS: In this study, 111 patients were randomly allocated to an exercise program (n = 34) or posterolateral fusion with or without transpedicular fixation (n = 77). The inclusion criteria were lumbar isthmic spondylolisthesis of any grade, at least 1 year of low back pain or sciatica, and a severely restricted functional ability in individuals 18 to 55 years of age. Pain and functional disability were quantified before treatment and at 1- and 2-year follow-up assessments by visual analog scales (VAS). RESULTS: The 2-year follow-up rate was 93%. The functional outcome, as assessed by the Disability Rating Index and the pain reduction, was better in the surgically treated group than in the exercise group at both the 1- and 2-year follow-up assessments (P < 0.01). In the longitudinal analysis, the mean Disability Rating Index and pain improved in the surgical group (P < 0.0001). In the exercise group, the Disability Rating Index did not change at all, whereas the pain decreased slightly (P < 0.02). CONCLUSIONS: Surgical management of adult isthmic spondylolisthesis improves function and relieves pain more efficiently than an exercise program.

Adult↗
PubMedDate not supplied

New communications tools expand educational options.

Administrators must make well-informed decisions regarding new communications technology to disseminate information to diverse constituencies in the facility and its service area. For example, communicating and using information about rapidly changing regulations is important in today's competitive environment. Administrators are faced with choosing from among such electronic media as satellite programming, telephone systems, cable television, and microwave radio to meet their institutions' needs. Teleconferences and closed-circuit educational programming also offer cost-efficient choices. Consultants can assist the management team in developing an appropriate system, whether sharing in an existing program or private network or installing an independent satellite-receiving dish, or "downlink." The team, including medical personnel, must choose the hardware that the institution can use most effectively in accomplishing its objectives. Studying other facilities' systems, such as St. Joseph Hospital, Providence, RI, with its independent receiving dish, shows the practical applications of the often confusing technology. Administrators should not be put off by "'technology frenzy." About 600 U.S. institutions have receiving stations or access to them; most will have them in the future. Even smaller facilities can become leaders with this cost-effective technology. Administrations must lead in accepting the challenge to improve health care communications.

Decision Making↗
PubMed1989

Evaluation of two management procedures for the control of maedi-visna.

Two control programs were evaluated for their efficiency in eradicating the maedi-visna (M-V) virus from a single sheep flock. In both programs, the agar gel immunodiffusion test was used for the detection of M-V infected animals at regular intervals. In program 1, the test and remove program, ewes that were serologically positive for M-V were immediately removed along with their offspring. The prevalence of infected sheep decreased gradually and a seronegative flock was obtained after 30 months of monitoring. Program 2 entailed the removal of replacement ewe lambs at birth prior to the ingestion of colostrum. Maedi-visna antibodies have not been detected in this flock. These results show that under conditions similar to the industry norms, M-V can be expelled. Although the approach of program 1 is more practical for sheep producers, program 2 is more effective because of the earlier development of a M-V seronegative flock. Because of the nature of the humoral response, a longer time period than four years is required to ensure that M-V has been completely eradicated from each flock.

Animal Husbandry↗
PubMed2026

The potential of considering photosynthesis parameters in crop yield breeding by genomic prediction.

To meet the growing demand for agricultural products, optimizing photosynthesis is a promising strategy to improve crop yields. Phenotypic variance in photosynthesis has been observed within or between species. To explore the potential of integrating photosynthetic parameters into crop breeding programs, we explored the genetic variation in photosynthesis by assessing photosynthesis-related parameters across plant development in 631 barley recombinant inbred lines (RILs) from eight HvDRR subpopulations under field conditions. The genetic complexity of these parameters was resolved by analyses of bi-parental and multi-parental quantitative trait loci (QTLs). Finally, we examined the merit of integrating photosynthesis-related parameters in genomic prediction of yield and its components. Significant genotypic variations of the photosynthesis-related parameters were found among the RILs, with their heritability ranging from 0.38 to 0.54. The multiple QTLs and dynamic QTLs for photosynthesis observed across different developmental stages underlined the complexity of the genetics of photosynthesis in barley. The considerably higher percentage of phenotypic variance explained for genomic prediction than multi-parental QTL analysis illustrates that the photosynthesis-related parameters are inherited in a more complex way than classical agronomic traits. Notably, the prediction ability for yield was increased by integrating the photosynthesis-related parameters of some developmental stages into genomic prediction models. Thus, our results suggest a novel perspective on increasing the efficiency of crop breeding programs by integrating photosynthesis-related parameters into prediction models.

Photosynthesis↗
PubMed2001

Using clinical practice analysis to improve care.

BACKGROUND: Improving clinical outcomes requires that physicians examine and change their clinical practice. Sustaining outcome improvements requires a dedicated and dynamic program of analyzing and improving patient care. In 1992 North Mississippi Health Services (NMHS) implemented a program to improve physicians' clinical efficiency. CLINICAL PRACTICE ANALYSIS ( CPA): CPA uses evidenced-based guidelines and examines each physician's resource utilization, processes, and outcomes for a diagnosis or procedure. Clinical practice profiles are developed, and individual performance is compared to local and national benchmarks and presented to physicians. The CPA process is used on its own or as a component of more comprehensive performance improvements projects. Physicians have been engaged in outcome improvement by more than 55 CPA projects. RESULTS: NHMS has progressively reduced its Medicare loss and its length of stay (LOS) to 4.9 days. Mortality and readmission rates have been reduced in specific diagnoses. The community-acquired pneumonia project reduced the LOS from 7.7 to 5.1 days, decreaesed the mortality rate from 8.9% to 5.0%, and decreased the cost of care from $4,269 to $3,834. The ischemic stroke project reduced the aspiration pneumonia rate from 6.4% to 0% and mortality from 11.0% to 4.6%. Patients' average LOS decreased from 10.7 days to 6.5 days, and their cost of care was reduced by $1,100 per patient. DISCUSSION: Providing individualized data has engaged physicians in improving outcomes. The program has evolved from improving efficiency to managing outcomes and from simple CPA projects to integrated performance improvement projects; however, the CPA process remains the cornerstone of the current process.

Anti-Bacterial Agents↗
PubMed2026

Dissecting genetic variance structure and evaluating genomic prediction models for single-cross hybrids derived from Stiff Stalk and Non-Stiff Stalk maize heterotic groups.

The early 20th-century discovery of heterosis and the establishment of heterotic groups transformed maize (Zea mays L.) into a keystone of global agriculture. However, maize breeding faces two significant challenges: the gradual decline of general combining ability (GCA) variance within heterotic groups and the impracticality of testing all possible single crosses in the early stages of a breeding program. Here, we developed genomic best linear unbiased prediction (GBLUP)-based multikernel models, using additive and two alternative nonadditive genomic relationship matrices, to estimate the variance components associated with the general combining ability of Stiff Stalk (SS) and Non-Stiff Stalk (NSS) heterotic groups and the specific combining ability arising from their crosses. We further applied these models to predict the performance of untested single-cross combinations under varying levels of parental information. We showed that the SS and NSS groups retained significant GCA variance across traits in both early- and late-maturity groups. The SS group, in contrast, exhibited no detectable GCA variance in grain yield for the intermediate-flowering subset of hybrids, highlighting a limitation for future genetic improvement. Furthermore, our results showed that GBLUP-based multikernel models effectively identified superior hybrids when parental information was available. In the absence of this information, however, these models underperformed compared to covariance-based approaches. Both nonadditive matrices yielded similar results, indicating that they capture comparable genetic relationship patterns despite their distinct formulations. Overall, this study sheds light on the future use of US maize commercial germplasm and demonstrates how GBLUP-based multikernel models can improve the efficiency of hybrid breeding programs.

Zea mays↗