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PubMed2001

Urbanisation and coronary heart disease risk factors in South Asian children.

BACKGROUND: Coronary Heart Disease (CHD) and other Non Communicable Diseases (NCDs) are increasing globally. Comparison of various sections of the South Asian populations living at different levels of urbanization can help in understanding the role of demographic transition in the increased prevalence of these diseases in urbanized populations. OBJECTIVE: To compare the prevalence of certain CHD risk factors in 10-12 year old school children living at different levels of urbanization. METHOD: Differences in height, Body Mass Index (BMI), Waist Hip Ratio (WHR), Fasting Blood Glucose (FBG) and Total Blood Cholesterol (TBC) were studied. SUBJECTS: Anthropometric and biochemical measurements of six groups of 10-12 year old children, representing various urbanization categories, were studied. Three groups of children were recruited from Punjab, Pakistan: rural, middle income urban and high income urban and they were assigned urbanization rank (UR) 1, 2 and 3. Another three groups of children were recruited from Slough, UK: British Pakistani, British Indian, and British Caucasian and they were assigned urbanization rank 4, 5 and 6 respectively. RESULTS: Proportion of children having high CHD risk increased with urbanization rank. Increase in BMI and TBC with urbanization status was steadier than the increase in FBG and WHR. Stunting which have been found to have a positive association with obesity and increased risk of CHD was higher among the less urbanized groups. BMI and TBC of the urbanized South Asian groups were lower, but FBG was higher than the British Caucasian, who served as controls. CONCLUSION: These findings support the hypothesis that high CHD death rate among South Asians in UK may have its origin in the genetic predisposition to diabetes but are not likely to be solely due to this factor. The environmental factors like under nourishment in early life, adoption of urbanized life style or a combination of both could be the major determinants of CHD morbidity and mortality.

Anthropometry↗
PubMed1997

[Surgical strategy for Stanford type A aortic dissection with Marfan syndrome].

Between January 1979 and May 1996, 23 Marfan patients underwent surgeries for type A aortic dissection; 8 patients with localized type dissection and 15 with extensive type. All of the 23 patients suffered from annuloaortic ectasia (AAE) which was treated by composite graft replacement, 10 of these patients had a concomitant replacement of the aortic arch. The operative mortality rate was 8.7%, and the causes were associated with the methods of coronary artery reattachment to the graft. Of the 15 patients with the extensive type dissection, there were 11 patients who had a non-thrombotic communicating false lumen in the untreated segments of the distal dissected aorta after the first operation and from this group there were seven patients who had anastomotic leakage around the distal suture line of the graft replacement that was demonstrated by aortography. Extensive graft replacement ranging from the entire thoracic aorta to the total aorta were performed in 10 (43.5%). Late deaths occurred in three patients (13.0%) and these causes were LOS and graft infection after the second operation and prosthetic valve endcarditis 6 months after the first operation. The present data indicate that Stanford type A aortic dissection with Marfan syndrome should be undertaken on the basis of a prior achievable plan to perform an entire aortic replacement. The dissection should also be performed using a procedure which doesn't leave distal anastomotic leakage.

Adolescent↗
PubMed2004

Implementing a public web based GIS service for feedback of surveillance data on communicable diseases in Sweden.

BACKGROUND: Surveillance data allow for analysis, providing public health officials and policy-makers with a basis for long-term priorities and timely information on possible outbreaks for rapid response (data for action). In this article we describe the considerations and technology behind a newly introduced public web tool in Sweden for easy retrieval of county and national surveillance data on communicable diseases. METHODS: The web service was designed to automatically present updated surveillance statistics of some 50 statutory notifiable diseases notified to the Swedish Institute for Infectious Disease Control (SMI). The surveillance data is based on clinical notifications from the physician having treated the patient and laboratory notifications, merged into cases using a unique personal identification number issued to all Swedish residents. The web service use notification data from 1997 onwards, stored in a relational database at the SMI. RESULTS: The web service presents surveillance data to the user in various ways; tabulated data containing yearly and monthly disease data per county, age and sex distribution, interactive maps illustrating the total number of cases and the incidence per county and time period, graphs showing the total number of cases per week and graphs illustrating trends in the disease data. The system design encompasses the database (storing the data), the web server (holding the web service) and an in-the-middle computer (to ensure good security standards). CONCLUSIONS: The web service has provided the health community, the media, and the public with easy access to both timely and detailed surveillance data presented in various forms. Since it was introduced in May 2003, the system has been accessed more than 1,000,000 times, by more than 10,000 different viewers (over 12.600 unique IP-numbers).

Age Distribution↗
PubMed2003

Print versus website physical activity programs: a randomized trial.

BACKGROUND: Mediated physical activity interventions can reach large numbers of people at low cost. Programs delivered through the mail that target the stage of motivational readiness have been shown to increase activity. Communication technology (websites and e-mail) might provide a means for delivering similar programs. METHODS: Randomized trial conducted between August and October 2001. Participants included staff at an Australian university (n=655; mean age=43, standard deviation, 10 years). Participants were randomized to either an 8-week, stage-targeted print program (Print) or 8-week, stage-targeted website (Web) program. The main outcome was change in self-reported physical activity. RESULTS: There was no significant increase in total reported physical activity within or between groups when analyzed by intention to treat (F [1,653]=0.41, p=0.52). There was a significant increase in total physical activity reported by the Print participants who were inactive at baseline (t [1,173]=-2.21, p=0.04), and a significant decrease in the average time spent sitting on a weekday in the Web group (t [1,326]=2.2, p=0.03). CONCLUSIONS: There were no differences between the Print and Web program effects on reported physical activity. The Print group demonstrated slightly larger effects and a higher level of recognition of program materials.

Adult↗
PubMed2001

Application of "VITALS": visual indicators of teaching and learning success in reporting student evaluations of clinical teachers.

CONTEXT: At the College of Medicine and Medical Sciences, Arabian Gulf University, Bahrain, a system has been introduced in which clerkship students evaluate clinical faculty using Visual Indicators of Teaching and Learning Success (VITALS). OBJECTIVE: To describe the use of VITALS in reporting student feedback on teaching and learning effectiveness of clinical faculty in the clerkship. DESIGN: Descriptive study. SUBJECTS: A total of 210 clerkship students evaluated 76 clinical tutors over a period of 3 years. Feedback was also obtained from seven programme managers and one supportive staff member. METHOD: Nine indicators of effective clinical teaching were identified through a literature search. Students individually reported on clinical faculty teaching capabilities using a 5-point, Likert-type scale. Cumulative reports of students' feedback on clinical faculty teaching were prepared using opposing bar graphs, reflecting perceived areas of strength or weakness in each teacher's performance. RESULTS: A total of 1450 evaluation forms were completed by 180 of 210 students (85.7%). VITALS graph representations of students' perceptions of clinical tutors were communicated to each clinical tutor at the end of each clerkship and academic year. Twenty-one students out of 53 who gave written comments were related to VITALS. They reflected a positive view of VITALS as a process or tool of faculty evaluation. Clinical faculty (18), programme managers(7) and supporting staff (1) gave comments indicating acceptance of the system. CONCLUSION: This preliminary study suggests that VITALS could be an effective tool for improving clinical teaching. It is acceptable to students, faculty and managers of educational programmes. The database reflecting their teaching and educational profiles were used to provide clinical faculty with constructive feedback.

Journal Article↗
PubMed1996

The Facial Disability Index: reliability and validity of a disability assessment instrument for disorders of the facial neuromuscular system.

BACKGROUND AND PURPOSE: Disorders of the facial neuromuscular system can result in marked disfigurement of the face and difficulties in activities of daily living such as eating, drinking, and communicating. No systematic means of measuring the disability associated with facial nerve disorders exists. The purpose of this investigation was to examine the reliability and construct validity of the Facial Disability Index (FDI), a disease-specific, self-report instrument for the assessment of disabilities of patients with facial nerve disorders. SUBJECTS AND METHODS: The FDI was administered to 46 ambulatory patients of the University of Pittsburgh Medical Center's Facial Nerve Center. The relationship of the FDI subscale and total scores with clinical impairment measures was determined, and a comparison of the use of the FDI and subscales of the more general SF-36 was made. RESULTS: The FDI subscales produced reliable scores (theta reliability: physical function = .88; social/well-being function = .83). Construct validity of the FDI physical function subscale was demonstrated by a correlation with the clinician's physical examination of facial movement. The FDI social/well-being subscale was associated with the FDI physical function subscale and with a clinical assessment of psychosocial status within a subset of the sample (n = 14). The FDI represented the relationship between impairments, disability, and psychosocial status better than the generic SF-36 did. CONCLUSION AND DISCUSSION: The FDI subscales produce reliable measurements, with construct validity for measuring patient-focused focused disability of individuals with disorders of the facial motor system.

Activities of Daily Living↗
PubMed2000

Exploring Hindu Indian emotion expressions: evidence for accurate recognition by Americans and Indians.

Subjects were presented with videotaped expressions of 10 classic Hindu emotions. The 10 emotions were (in rough translation from Sanskrit) anger, disgust, fear, heroism, humor-amusement, love, peace, sadness, shame-embarrassment, and wonder. These emotions (except for shame) and their portrayal were described about 2,000 years ago in the Natyasastra, and are enacted in the contemporary Hindu classical dance. The expressions are dynamic and include both the face and the body, especially the hands. Three different expressive versions of each emotion were presented, along with 15 neutral expressions. American and Indian college students responded to each of these 45 expressions using either a fixed-response format (10 emotion names and "neutral/no emotion") or a totally free response format. Participants from both countries were quite accurate in identifying emotions correctly using both fixed-choice (65% correct, expected value of 9%) and free-response (61% correct, expected value close to zero) methods.

Adolescent↗
PubMed1975

Improved biuret procedure for routine determination of urinary total proteins in clinical proteinuria.

This communication describes and evaluates an improved routine methodology for quantitating clinical proteinuria. Based on investigations of Piscator and of Savory et al., a modified Tsuchiya's reagent (ethanolic HCI-phosphotungstic acid) is used to precipitate proteins at 56 degrees C, followed by biuret spectrophotometry at 540 nm. The accuracy of the proposed procedure was assessed by comparisons with results obtained by using an ultrafiltration membrane that retains solutes with an average molecular weight in excess of 10 000 for separating of urinary proteins before they are measured with the biuret reaction. Precision of the method (coefficient of variation) is typically 2-3%.

Evaluation Studies as Topic↗
PubMed2003

A new method of partial deafness treatment.

BACKGROUND: There is a significant group of patients whose hearing impairment is characterized by normal or slightly elevated thresholds in the low frequency band with nearly total deafness in high frequency range. These patients remain beyond the scope of effective treatment by hearing aids. We name this kind of hearing loss 'partial deafness'. CASE REPORT: A new method of partial deafness treatment was applied in the case of a young woman. A partially-inserted cochlear implant was used to restore hearing at high frequencies, while preserving low-frequency acoustic hearing in the implanted ear. CONCLUSIONS: The results demonstrate a substantial improvement in speech discrimination and communication skills when electric stimulation on one side was combined with acoustic stimulation on both sides.

Acoustic Stimulation↗
PubMed1994

Treatment of thoracic outlet syndrome with combined scalenectomy and transaxillary first rib resection.

Of a total of 225 patients with suspected thoracic outlet syndrome, 37 (16.4%) underwent surgery. Some eight patients required bilateral operations. One patient had a cervical rib and one a prominent C7 transverse process. A total of 45 limbs were operated on. Thirty-nine procedures were performed as combined scalenectomy and transaxillary first rib resection, four as two-stage scalenectomy and transaxillary first rib resection and two as simple scalenectomy alone. Follow-up from 6 to 60 (mean 17) months was available for 39 operations. A two-tier assessment method was used to improve the accuracy of the results of surgery, including the patient's own evaluation of the benefit of operation communicated to an independent observer and the surgeon's clinical appraisal. Assessment of outcome by the physician was excellent in 54%, good in 28%, fair in 10% and 8% had recurrent symptoms. Similar results were achieved in the patients' subjective evaluation with approximately 50% reporting an excellent outcome, about 40% good and 10% fair. A poor result was not recorded in those who underwent combined scalenectomy and transaxillary first rib resection. A radical surgical approach combining scalenectomy and transaxillary first rib resection is advocated to minimize the recurrence rate and improve results.

Adolescent↗
PubMed1999

Common errors of reasoning in child protection work.

OBJECTIVE: Repeated public inquiries into child abuse tragedies in Britain demonstrate the level of public concern about the services designed to protect children. These inquiries identify faults in professionals' practice but the similarities in their findings indicate that they are having insufficient impact on improving practice. This study is based on the hypothesis that the recurrent errors may be explicable as examples of the typical errors of human reasoning identified by psychological research. METHODS: The sample comprised all child abuse inquiry reports published in Britain between 1973 and 1994 (45 in total). Using a content analysis and a framework derived from psychological research on reasoning, a study was made of the reasoning of the professionals involved and the findings of the inquiries. RESULTS: It was found that professionals based assessments of risk on a narrow range of evidence. It was biased towards the information readily available to them, overlooking significant data known to other professionals. The range was also biased towards the more memorable data, that is, towards evidence that was vivid, concrete, arousing emotion and either the first or last information received. The evidence was also often faulty, due, in the main, to biased or dishonest reporting or errors in communication. A critical attitude to evidence was found to correlate with whether or not the new information supported the existing view of the family. A major problem was that professionals were slow to revise their judgements despite a mounting body of evidence against them. CONCLUSIONS: Errors in professional reasoning in child protection work are not random but predictable on the basis of research on how people intuitively simplify reasoning processes in making complex judgements. These errors can be reduced if people are aware of them and strive consciously to avoid them. Aids to reasoning need to be developed that recognize the central role of intuitive reasoning but offer methods for checking intuitive judgements more rigorously and systematically.

Child↗
PubMed2006

[Z-plasty for valgus deformity in total knee arthroplasty].

PURPOSE OF THE STUDY: Several options for treatment of valgus deformity in total knee arthroplasty (TKA) have been described. In 2002 the lateral approach to the valgus knee with Z-plasty of the articular capsule involving part of Hoffa's fat pad started to be used in our department. In this study the surgical technique, including steps for gradual deformity correction, is described and shortterm results are evaluated. MATERIAL: A total of 1136 TKAs were carried out in the period from 1994 to 2004; of these 131 (11 %) were performed on valgus knee. After a visit to the Schulthess Klinik and personal communication with Dr. med. T. Drobny, we began to use the lateral approach to the valgus knee, with Z-plasty of the articular capsule and involvement of Hoffa's fat pad. Forty-two patients (35 women and 7 men) were treated by this technique. The average age of this group was 71 years, and the average preoperative valgus deformity was 20.5 degrees. METHODS SURGICAL TECHNIQUE: A skin incision is made along the midline and, in its lower part, it is led toward the lateral border of the tibial tubercle. The joint capsule is incised in the superficial layer at about 2 cm lateral to the patella. Dissection of the superficial and deep layers of the capsule is made laterally, extending up to 4 cm. After joint exposure, the fat pad is separated from the medial attachment and preserved, on a lateral pedicle, with the patellar ligament. If needed, this flap can be used to close a defect in the distal articular capsule. By including both parts of the joint capsule produced by Z-plasty, medial transposition of the patella is achieved after suture. The deformity is corrected in a sequential manner according to its severity and the effect of release in each step, as follows: 1) Point incisions of the iliotibial band at a 5-cm distance above the articular fissure (piecrusting). 2) Subperiosteal elevation of the iliotibial band attachment from Gerdy's tubercle. 3) Release of the posterolateral capsule. 4) Subperiosteal release of the femoral attachment of the lateral collaterall ligament and dissection of the popliteal muscle. 5) Release of the lateral head of the gastrocnemius muscle. The evaluation of patients was based on the Knee Society Clinical Rating System. RESULTS: Using this surgical technique, correction of deformity was achieved in all patients. The knee axis after surgery improved to 6.6 degrees on the average. The more extensive dissection of lateral structures resulted in larger blood losses, which were on average 1150 ml, and the procedure also required a longer tourniquet application (55 min). The patients were followed up on average for 22 months. The Knee Score assessment in the whole group (42 knees) was on average 90.6 points, with 92.0, 93.3 and 87.9 for rating system categories A, B and C, respectively. The average range of motion was 0 to 118 degrees , and none of the patients reported femoropatellar problems. Revision surgery for hematoma was performed in one patient and puncture of the knee joint had to be done in several patients. Redress for postoperative motion restriction was carried out in three patients and one patient underwent repeat surgery for infection. DISCUSSION: The lateral approach with Z-plasty of the capsule and fat pad involvement provides maximal release of and access to the lateral structures, reduces the risk of insufficient blood supply of the patella and also resolves patellar subluxation. This technique thus allows us to reduce the probability of developing femoropatellar problems that are frequently responsible for poor TKA outcomes in the valgus knee. CONCLUSIONS: The technique described here is an effective approach to the valgus knee requiring total replacement. It provides good access to exposed lateral structures and, with the use of Z-plasty, permits correct alignment and tracking of the patella. In addition, it minimally interferes with blood supply to the patella and completely avoids problems associated with suture of the articular capsule.

Aged↗
PubMed1988

[Usefulness of CT angiography for demonstrating cerebral aneurysms].

We report the usefulness of computed cerebral angiotomography (CT angiography) for demonstrating cerebral aneurysm and the clinical significance of CT angiography for ruptured cerebral aneurysm. Our modified method of CT angiography was easy and less time-consuming. Fifteen seconds after starting a single bolus injection, 1 ml/kg/25 seconds via cubital vein, of contrast medium (60% urograffin), 5 serial 5 mm thick-CT slices were scanned in every 6.5 seconds including 2 seconds of interval, beginning from an axial level 20 mm above the orbitomeatal line and ending at a level 40 mm. A total of 103 patients were examined in this report, consisting of 70 unruptured asymptomatic, 8 unruptured symptomatic (oculomotor nerve palsy) and 25 subarachnoid hemorrhage (SAH). Seven unruptured aneurysms in 4 asymptomatic cases, 2 unruptured aneurysms in 2 symptomatic cases 27 aneurysms in 24 SAH cases were suspected by CT angiography. Of these 36 aneurysms suspected by CT angiography 32 aneurysms were confirmed by cerebral angiography. The detection rate of CT angiography in this report was 89%, higher than those of previous reports. Thirteen aneurysms were located at internal carotid-posterior communicating artery (ICPC) junction. 11 at anterior communicating artery (Acom), 7 at middle cerebral artery (MCA). CT angiography showed a false positive findings in 4 cases, which were all located at Acom. Four aneurysms were not detected in CT angiography, which were all located at MCA and were very small (2-3 mm) in diameter. There were no deteriorated cases during and after CT angiography. We suggest that CT angiography is a useful and safe method for predicting the location of not only unruptured but ruptured aneurysms.

Aged↗
PubMed2005

Computed tomography in the assessment of periacetabular osteolysis.

BACKGROUND: Computed tomography recently has been proposed as an accurate method for diagnosing periacetabular osteolytic lesions. Several investigators have attempted to validate the accuracy of this technique, but they employed cadaveric and animal models, which cannot replicate the adaptive changes that occur over time in vivo. This study was performed to determine the accuracy of computed tomography in identifying and measuring periacetabular osteolytic lesions in hemipelves retrieved at autopsies of individuals with a previously well-functioning total hip prosthesis. METHODS: We evaluated nine hemipelves, retrieved at autopsy, that contained a cementless porous-coated acetabular component. The fresh specimens were examined with conventional radiographs and computed tomography and then were embedded and sectioned into 1.5-mm slices for evaluation with slab radiographs. Anteroposterior and iliac oblique plain radiographs as well as axial, coronal, and sagittal computed tomography scans were reviewed to determine the presence and location of any periacetabular osteolytic lesions. These results were then compared with those identified on the slab radiographs. Lesion volume was calculated from computed tomography scans with use of post-processing software. RESULTS: A total of twenty-three periacetabular osteolytic lesions were identified on the slab radiographs of the nine hemipelves. The plain radiographs identified twelve (52%) of the twenty-three lesions, and the computed tomography scans identified twenty (87%) of the twenty-three lesions. Three medial wall perforations were identified on the computed tomography scans but were not detected on the plain radiographs. Computed tomography was accurate in measuring the volume of the osteolytic lesions (r(2) = 0.997) but tended to overestimate the volumes measured on the slab radiographs. Periacetabular osteolytic lesions appeared on the computed tomography scans and slab radiographs as areas devoid of trabecular bone that were delineated by a sclerotic border and communicated with the joint space. CONCLUSIONS: In this autopsy model, computed tomography was an accurate method for detecting the location and measuring the volume of periacetabular osteolytic lesions.

Acetabulum↗
PubMed1987

Autoradiographic study of regional protein synthesis in focal cerebral ischemia with TCA wash and image subtraction techniques.

The standard biochemical method of trichloracetic acid (TCA) wash and the image processing technique were combined to differentiate and visualize the distributions of polypeptide-incorporated and unincorporated tracers in an autoradiographic study of regional protein synthesis. The validity of applying TCA wash procedures to cryostat sections was considered by histologic and chemical evaluations. For the autoradiographic study of in vivo protein synthesis, a tracer dose of L-[14C]valine was administered 30 min after occlusion of the posterior communicating artery in gerbils. Images of total (polypeptide-incorporated and unincorporated) radioactivity and of polypeptide-incorporated radioactivity were obtained from an identical cryostat section before and after TCA wash. The polypeptide-unincorporated radioactivity image was produced with an image processing system by subtracting pixel by pixel the polypeptide-incorporated radioactivity from the total radioactivity. The present study clearly demonstrated that in spite of the sufficient delivery of tracer amino acids, the polypeptide synthesis was completely lost in the ischemic focus. Free tracer was markedly accumulated in the brain adjacent to the ischemic focus. This kind of autoradiographic technique seems to be indispensible in studying the topographical complexity of the altered protein metabolism in the pathologic brain.

Animals↗
PubMed2001

Age, gender, socioeconomic, and ethnic differences in patients' assessments of primary health care.

BACKGROUND: Patients' evaluations are an important means of measuring aspects of primary care quality such as communication and interpersonal care. This study aims to examine variations in assessments of primary care according to age, gender, socioeconomic, and ethnicity variables. METHODS: A cross sectional survey of consecutive patients attending 55 inner London practices was performed over a 2 week period using the General Practice Assessment Survey (GPAS) instrument which assesses 13 important dimensions of primary care provision. Variations in scale scores were investigated for differences relating to age, gender, socioeconomic, and ethnic status as reported by respondents. RESULTS: A total of 7692 questionnaires were returned (71% response rate). Valid information on age, gender, socioeconomic status, and ethnicity was available for 4819 out of 5496 adult respondents. Approximately half the respondents reported their ethnic group as "white" and most of the remaining respondents reported belonging to "black" or South Asian groups. Significant differences existed between groups of patients defined by age or ethnicity for most of the scale scores examined. Black, South Asian, and Chinese respondents reported lower scores (representing less favourable assessments) than white respondents; older respondents reported more favourable evaluations of care than younger respondents; and less affluent groups reported lower scores than more affluent groups for two of the 13 dimensions. There was no significant difference between gender groups with respect to assessment of primary care. Age and ethnicity were independent predictors of respondents' assessments of primary care. CONCLUSIONS: Differences exist between identifiable subgroups of the population in their assessments of primary health care measured using the GPAS instrument. This work adds to the literature on variation in healthcare experience and the potential for patient assessment of primary care. Further work is required to investigate these differences in more detail and to relate them to differences in the nature and process of primary care provision. Primary care providers need to ensure that services provided are appropriate for all patient groups within their communities.

Adolescent↗
PubMed2004

Use of the roter interaction analysis system to analyze veterinarian-client-patient communication in companion animal practice.

OBJECTIVE: To identify specific components of veterinarian-client-patient communication during clinical appointments in companion animal practice. DESIGN: Cross-sectional descriptive study. SAMPLE POPULATION: A random sample of 50 companion animal practitioners in southern Ontario and a convenience sample of 300 clients and their pets. PROCEDURE: For each practitioner, 6 clinical appointments (3 wellness appointments and 3 appointments related to a health problem) were videotaped, and the Roter interaction analysis system (RIAS) was used to analyze the resulting 300 videotapes. Statements made during each appointment were classified by means of a communication framework reflecting the 4 essential tasks of the appointment (ie, data gathering, education and counseling, relationship building, and activation and partnership). RESULTS: 57% of the veterinarians contacted (50/87) and 99% of the clients contacted agreed to participate in the study. Mean duration of the appointments was 13 minutes. Typically, veterinarians contributed 62% of the total conversation and clients contributed 38%. Fifty-four percent of the veterinarian interaction was with the client, and 8% was with the pet. Data gathering constituted 9% of the veterinarian-to-client communication and was primarily accomplished through closed-ended questioning; 48% of veterinarian-to-client communication involved client education and counseling, 30% involved relationship building, and 7% involved activation and partnership (the remaining 6% constituted orientation). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that the RIAS was a reliable method of assessing the structure, process, and content of veterinarian-client-patient communication and that some veterinarians do not use all the tools needed for effective communication.

Adolescent↗
PubMedDate not supplied

Review of spiritual health: definition, role, and intervention strategies in health promotion.

PURPOSE OF THE REVIEW. Recognition of the spiritual dimension as a vital component of human wellness has led to an increased interest in spirituality education, yet very little progress has been made in identifying possible intervention methods for enhancing spirituality. The purpose of this article is to review current definitions of spiritual health; provide an overview of several successful intervention methods that may enhance spiritual health; and outline potential relationships between spiritual health interventions and behavioral, emotional, and physical health outcomes. SEARCH METHOD USED. Research and review articles were identified through a CD-ROM computer search of ERIC (1966 to 1994), PSYCHLIT (1974 to 1994), and MEDLINE (1991 to 1994) databases using appropriate key words. Cumulative indexes from Advances (1984 to 1993) were manually searched, and reference lists from identified studies and literature reviews were analyzed. A total of 71 articles were identified and considered. Model interventions were chosen for presentation on the basis of soundness of research design, peer-review publication, clear description of intervention method, and relationship to spiritual health components. SUMMARY OF IMPORTANT FINDINGS. Imagery, meditation, and group support activities may address various components of spiritual health such as meaning and purpose in life; self-awareness; and connectedness with self, others, and a larger reality. In turn, positive changes in health behaviors such as communication, diet activity, and treatment compliance were noted, and a variety of beneficial physical and emotional health outcomes such as heart disease reversal, decreased cancer mortality, reduced anxiety, and improved mood states were reported. MAJOR CONCLUSIONS. Health educators are in a position to develop, implement, and evaluate spiritual health interventions within the context of comprehensive programs. There is a need for training in the theoretical and methodologic foundations of interventions like meditation, imagery, and group support and a need for more evaluation research in the impact of such interventions.

Complementary Therapies↗