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PubMed1985

[Oral and intravenous bepridil in the treatment of recurrent sustained ventricular tachycardias. Electropharmacological study].

The antiarrhythmic properties of bepridil on ventricular tachycardia (VT) termination and prevention were studied in 16 patients using programmed electrical stimulation techniques. All patients were admitted for documented sustained VT resistant to 3.5 +/- 2.4 antiarrhythmic agents. Intravenous bepridil (2 mg/kg) successfully terminated 4 out of 8 and prevented 3 out of 8 patients with hemodynamically well tolerated sustained VT. Oral bepridil (800 mg day 500-600 mg the following days) prevented successfully pacing-induced VT in 7 patients (43.7 p. cent) and a partial result was obtained in additional 3 (18.7 p. cent). In 6 patients bepridil failed to prevent pacing-induced VT including 2 patients with a shorter cycle length on bepridil (classified as aggravation). Tachycardia cycle length lengthened in the remaining 4 a mean of 11 +/- 12 p. cent. One of the 7 patients with a good result presented on bepridil evidence of sinus node dysfunction. The remaining 6 underwent long-term therapy (600 mg/24 h). During a mean follow up of 19 +/- 4 months, 4 patients are well controlled, 1 presented a side-effect (paralytic ileus) and 1 a recurrence. This study emphasizes the antiarrhythmic properties of bepridil at the ventricular level and provides evidence of its usefulness in patients with recurrent sustained VT.

Administration, Oral↗
PubMed2000

Metabolic aspects of programmed cell survival and cell death in the heart.

Normal cardiac function requires a tight interaction between metabolism, contractile function and gene expression. The main perturbation challenging this equilibrium in vivo is ischemia, which alters energy flux through the control of key enzymes. The review highlights metabolic imprints and energetic aspects of programmed cell survival, programmed cell death, and of necrosis. When sustained and severe, ischemia leads to a total collapse of energy transfer, to the accumulation of metabolic endproducts, and to the development of myocardial necrosis. When moderate, ischemia results in a coordinated cellular response including enhanced anaerobic glucose metabolism, a modification of cardiac gene expression, and the development of specific mechanisms for programmed cell survival (preconditioning, stunning, hibernation). Repetitive stress results in a decrease of contractile function, a downregulation of gene expression and an impairment of energy transfer, which eventually cause the heart to fail. When the failing heart becomes energy-depleted, the programs of cell survival are no longer operational and programmed cell death ensues. To define the point of departure from programmed cell survival to cell death remains a major challenge.

Adenosine Triphosphate↗
PubMed2002

Forest inventory and analysis: a national inventory and monitoring program.

Forests provide significant commodity and noncommodity values to the citizens of the United States. An important and substantial role in ensuring the continued health, productivity, and sustainability of these resources is a reliable and credible inventory and monitoring program. The Forest Inventory and Analysis (FIA) program of the US Forest Service has been monitoring and reporting on status, condition, and trends in the nation's forests for over 70 years and the Forest Health Monitoring (FHM) program for the last 11 years. Recent legislation included in the 1998 Farm Bill, along with efforts to integrate inventory and monitoring networks to deliver Criteria and Indicators of Sustainable Forests, are redefining the role and operation of the recently integrated FIA and FHM programs. This paper provides a brief history and a look at new directions for the enhanced FIA Program.

Conservation of Natural Resources↗
PubMedDate not supplied

Chronic ventricular tachyarrhythmias in the conscious dog: prevention by UM-272 (dimethylpropranolol).

The ability of chronic UM-272 (dimethylpropranolol) treatment to prevent the induction of reentrant ventricular tachyarrhythmias was assessed in the conscious dog subjected to serial programmed electrical stimulation on days 3--5 after myocardial infarction. In 20 untreated control animals, programmed electrical stimulation produced nonsustained ventricular tachycardia in 6 animals (30%), sustained ventricular tachycardia in 8 animals (40%), and ventricular fibrillation in 6 animals (30%) on the third day after occlusion and reperfusion of the left anterior descending coronary artery. On day 4, programmed electrical stimulation produced nonsustained ventricular tachycardia in 5 animals (36%), sustained ventricular tachycardia in 7 animals (50%), and ventricular fibrillation in 2 animals (14%). UM-272, 5 or 10 mg/kg, i.v., was administered every 12 hr to a separate group of 8 dogs after the induction of ischemic myocardial injury. Programmed electrical stimulation on day 3 after myocardial infarction failed to elicit ventricular arrhythmias in 4 animals (50%, p = 0.014), with acute administration of the next UM-272 dose preventing the induction of ventricular tachyarrhythmias in 7 animals (88%, p less than 0.0001). On day 4, programmed electrical stimulation failed to elicit ventricular arrhythmias in 5 aminals (63%, p = 0.0021). Thirty-six hours after the withdrawal of UM-272, programmed electrical stimulation produced ventricular fibrillation in 5 animals (63%) and sustained ventricular tachycardia which degenerated to ventricular fibrillation in 3 animals (37%). UM-272 significantly (p less than 0.05) depressed conduction in both normal and ischemically injured myocardium while also increasing (p less than 0.05) ventricular effective refractory periods. The results of these investigations suggest that UM-272 may be effective in preventing reentrant ventricular rhythms in hearts subjected to chronic myocardial ischemic damage and, therefore, may be of potential value in preventing reentrant ventricular arrhythmias in man.

Animals↗
PubMed2003

Home-based versus hospital-based exercise programs in patients with coronary artery disease: effects on coronary vasomotion.

BACKGROUND: In a randomized study, we recently documented that a vigorous, hospital-based exercise training (ET) program improves coronary endothelial function in coronary artery disease. The aim of this consecutive study was to assess whether a home-based exercise program with reduced average training duration can sustain previously achieved effects on coronary endothelial function. METHODS: Nineteen patients with coronary endothelial dysfunction documented by acetylcholine-induced vasoconstriction were randomly assigned to a training group (n = 10) or a control group (n = 9). After 4 weeks of inhospital training (60 min of bicycle ergometry per day), all training patients were enrolled in a 5-month home-based program of 20 minutes' ergometry training per day and 1 group training session per week. At baseline, after 4 weeks and 6 months, endothelium-mediated vasodilation was assessed by quantitative coronary angiography after intracoronary infusions of acetylcholine. Average peak velocity (APV) was measured with a Doppler wire. Coronary blood flow (CBF) was calculated by multiplying vascular cross-sectional area and APV. RESULTS: CBF increased in response to 7.2 microg/min acetylcholine, from 27% +/- 11% at the beginning of the study to 110% +/- 24% after 4 weeks (P <.01 vs control group). After 6 months, the increase in CBF was lower versus inhospital training (67% +/- 18%, P <.05 vs 4 weeks). Changes in APV between 1 and 6 months correlated with daily training durations (r = 0.65, P =.03). CONCLUSIONS: Home-based ET sustained part of the effects of hospital-based ET on endothelium-dependent vasodilation in coronary artery disease. However, acetylcholine-induced increases in CBF were lower after home-based ET, suggesting a relation between daily training duration and improvement of coronary vasomotion.

Aged↗
PubMed2003

Addressing urban health in Detroit, New York City, and Seattle through community-based participatory research partnerships.

OBJECTIVE: This study describes key activities integral to the development of 3 community-based participatory research (CBPR) partnerships. METHODS: We compared findings from individual case studies conducted at 3 urban research centers (URCs) to identify crosscutting adaptations of a CBPR approach in the first 4 years of the partnerships' development. RESULTS: Activities critical in partnership development include sharing decision-making, defining principles of collaboration, establishing research priorities, and securing funding. Intermediate outcomes were sustained CBPR partnerships, trust within the partnerships, public health research programs, and increased capacity to conduct CBPR. Challenges included the time needed for meaningful collaboration, concerns regarding sustainable funding, and issues related to institutional racism. CONCLUSIONS: The URC experiences suggest that CBPR can be successfully implemented in diverse settings.

Community Health Planning↗
PubMed2005

Comparing environmental issues in Cuba before and after the Special Period: balancing sustainable development and survival.

Following the Earth Summit in 1992, Cuba designed and implemented a variety of programs, administrative structures, and public awareness activities to promote sound environmental management and sustainable development. This came shortly after the fall of the Soviet Union and the strengthening of the US blockade in 1990, which resulted in a 35% drop in Cuban GDP. This period, referred to as the Special Period, witnessed a decrease in many environmentally damaging activities both by choice and by necessity, but also resulted in many decisions to resuscitate the Cuban economy. The purpose of this work was to compare and rank the environmental risks Cuba faced before and during the Special Period (1990-2000) using two Comparative environmental risk assessments (CERAs). To do so, an ecosystem integrity risk assessment matrix was constructed with 42 risk end points. The matrix assessed the risk posed by 17 problem areas including air pollution, water contamination, solid waste sites, pesticides and ecosystem degradation. The risks were calculated using five criteria: area affected, vulnerability of affected population, severity of impact, irreversibility of effect and uncertainty. To construct this matrix, both literature reviews and expert interviews in Cuba were conducted in 2000. The results showed a general decrease in risk scores during the Special Period. Before the Special Period, high risks were posed by: terrestrial degradation and industrial wastewater and sludge, followed by freshwater degradation, surface water stressors, and pesticides. After the Special Period, industrial wastewater and sludge and pesticides were no longer high-risk areas, but municipal wastewater and marine coastal degradation ranked higher than previously. Also, the risk endpoints most stressed after 1990 were affected by activities controlled by the government, such as mining and tourism, and lack of infrastructure. Therefore, the claims that public environmental education is the main pathway to sustainable development in Cuba seem uninformed and other management practices should be evaluated.

Cuba↗
PubMed1992

[Computer simulation of blood level profiles. Drug liberation from two sustained-release preparations and computer simulation of single- and multiple-dose pharmacokinetics].

A series of computer programs (BASIC) is introduced for the evaluation of in vitro dissolution data as well as for the calculation of pharmacokinetic parameters and for blood level curve fitting to the respective in vitro data. Furthermore, programs are offered for the simulation of blood level profiles under variable conditions. In order to demonstrate the practical use of these programs, the expected blood level profiles following the administration of two commercial sustained-release dosage forms containing the drug pentoxifylline have been compared.

Computer Simulation↗
PubMed1999

Iron supplementation as a strategy for the control of iron deficiency and ferropenic anemia.

Iron supplementation is a public health strategy designed for the prevention of iron deficiency and its consecutive anemia. It should be targeted, safe, flexible, long term and ideally, community based under the supervision of the health sector. It must be differentiated from iron therapy, even though, in the intermediate and long term it corrects mild-moderate deficiency of iron and ferropenic anemia. It should complement other measures for the control of iron deficiency. A summary of results comparing daily and intermittent iron supplementation (every 3-days in rats, and weekly in humans) is presented, including studies in an animal model, human supplementary-iron absorption studies, clinical research and field studies. It is concluded that intermittent iron supplementation is efficacious and, that in the long term it achieves an increase in iron reserves while avoiding sustained oxidative stress caused by current practices of excess daily iron supplementation, particularly in the developing world. The stage is set for long-term weekly iron supplementation programs in large population groups to determine its sustainability and effectiveness.

Anemia, Iron-Deficiency↗
PubMed1992

Famine-affected, refugee, and displaced populations: recommendations for public health issues.

During the past three decades, the most common emergencies affecting the health of large populations in developing countries have involved famine and forced migrations. The public health consequences of mass population displacement have been extensively documented. On some occasions, these migrations have resulted in extremely high rates of mortality, morbidity, and malnutrition. The most severe consequences of population displacement have occurred during the acute emergency phase, when relief efforts are in the early stage. During this phase, deaths--in some cases--were 60 times the crude mortality rate (CMR) among non-refugee populations in the country of origin (1). Although the quality of international disaster response efforts has steadily improved, the human cost of forced migration remains high. Since the early 1960s, most emergencies involving refugees and displaced persons have taken place in less developed countries where local resources have been insufficient for providing prompt and adequate assistance. The international community's response to the health needs of these populations has been at times inappropriate, relying on teams of foreign medical personnel with little or no training. Hospitals, clinics, and feeding centers have been set up without assessment of preliminary needs, and essential prevention programs have been neglected. More recent relief programs, however, emphasize a primary health care (PHC) approach, focusing on preventive programs such as immunization and oral rehydration therapy (ORT), promoting involvement by the refugee community in the provision of health services, and stressing more effective coordination and information gathering. The PHC approach offers long-term advantages, not only for the directly affected population, but also for the country hosting the refugees. A PHC strategy is sustainable and strengthens the national health development program.

Aged↗
PubMed2003

Sustainable management for the eastern Mediterranean coast of Turkey.

The objective of this article is to propose a program for the integrated coastal zone management that is required to stimulate and guide sustainable development of the Mediterranean coastal zone of Turkey. Improved data collection, quality control, analysis, and data management will provide a firm basis for future scientific understanding of the East Mediterranean coast of Turkey and will support long-term management. Various innovative procedures were proposed for a promising ecosystem-based approach to manage coastal wetlands in the Mediterranean: remote data acquisition with new technologies; environmental quality monitoring program that will provide a baseline for monitoring; linking a Geographic Information System (GIS) with natural resource management decision routines in the context of operational wetlands, fisheries, tourism management system; environmental sensitivity analysis to ensure that permitted developments are environmentally sustainable; and use of natural species to restore the wetlands and coastal dunes and sustain the system processes. The proposed management scheme will benefit the scientific community in the Mediterranean and the management/planning community in Eastern Turkey.

Conservation of Natural Resources↗
PubMed2004

Cancer mortality surveillance--United States, 1990-2000.

PROBLEM/CONDITION: Cancer is the second leading cause of death in the United States and is expected to become the leading cause of death within the next decade. Considerable variation exists in cancer mortality between the sexes and among different racial/ethnic populations and geographic locations. The description of mortality data by state, sex, and race/ethnicity is essential for cancer-control researchers to target areas of need and develop programs that reduce the burden of cancer. REPORTING PERIOD COVERED: 1990-2000. DESCRIPTION OF SYSTEM: Mortality data from CDC were used to calculate death rates and trends, categorized by state, sex, and race/ethnicity. Trend analyses for 1990-2000 are presented for all cancer sites combined and for the four leading cancers causing death (lung/bronchus, colorectal, prostate, and breast) categorized by state, sex, and race/ethnicity. Death rates per 100,000 population for the 10 primary cancer sites with the highest age-adjusted rates are also presented for each state and the District of Columbia by sex. For males, the 10 primary sites include lung/bronchus, prostate, colon/rectum, pancreas, leukemia, non-Hodgkin lymphoma, liver/intrahepatic bile duct, esophagus, stomach, and urinary bladder. For females, the 10 primary sites include lung/bronchus, breast, colon/rectum, pancreas, ovary, non-Hodgkin lymphoma, leukemia, brain/other nervous system, uterine corpus, and myeloma. RESULTS: For 1990-2000, cancer mortality decreased among the majority of racial/ethnic populations and geographic locations in the United States. Statistically significant decreases in mortality among all races combined occurred with lung and bronchus cancer among men (--1.7%/year); colorectal cancer among men and women (--2.0%/year and--1.7%/year, respectively); prostate cancer (--2.6%/year); and female breast cancer (--2.3%/year). For 1990-2000, cancer mortality remained stable among American Indian/Alaska Native populations. Statistically significant increases in lung and bronchus cancer mortality occurred among women of all racial/ethnic backgrounds, except among Asian/Pacific Islanders. INTERPRETATION: Although cancer remains the second leading cause of death in the United States, the overall declining trend in cancer mortality demonstrates considerable progress in cancer prevention, early detection, and treatment. PUBLIC HEALTH ACTION: More effective tobacco-cessation programs are necessary to reduce lung and bronchus cancer mortality among women and sustain the decrease in lung and bronchus cancer mortality among men. Additional programs that deter smoking initiation among adolescents are essential to ensure future decreases in lung and bronchus cancer mortality. Continued research in primary prevention, screening methods, and therapeutics is needed to further reduce disparities and improve quality of life and survival among all populations.

Adult↗
PubMed2005

Maintenance of effects of the home environmental skill-building program for family caregivers and individuals with Alzheimer's disease and related disorders.

BACKGROUND: Few studies evaluate whether short-term intervention effects are maintained over time for families caring for persons with dementia. This article examines whether treatment effects found at 6 months following active treatment were sustained at 12 months for 127 family caregivers who participated in an occupational therapy intervention tested as part of the National Institutes of Health Resources for Enhancing Alzheimer's Caregiver Health (REACH) initiative. METHODS: A randomized two-group design was implemented with three assessment points: baseline, 6 months, and 12 months. Caregivers were randomly assigned to a usual care control group or intervention that consisted of six occupational therapy sessions to help families modify the environment to support daily function of the person with dementia and reduce caregiver burden. Following 6-month active treatment, a maintenance phase consisted of one home and three brief telephone sessions to reinforce strategy use and obtain closure. Non-inferiority statistical analysis was used to evaluate whether intervention caregivers maintained treatment benefits from 6 to 12 months in comparison to controls. RESULTS: For the sample of 127 at 6 months, caregivers in intervention reported improved skills (p = .028), less need for help providing assistance (p = .043), and fewer behavioral occurrences (p = .019) compared to caregivers in control. At 12 months, caregiver affect improved (p = .033), and there was a trend for maintenance of skills and reduced behavioral occurrences, but not for other outcome measures. CONCLUSION: An in-home skills training program helps sustain caregiver affect for those enrolled for more than 1 year. More frequent professional contact and ongoing skills training may be necessary to maintain other clinically important outcomes such as reduced upset with behaviors.

Activities of Daily Living↗
PubMed2006

Effects of a cognitive-behavioural internet program on depression, vulnerability to depression and stigma in adolescent males: a school-based controlled trial.

This study evaluated the effectiveness of a cognitive behaviour therapy Internet program (MoodGYM) for depressive symptoms, attributional style, self-esteem and beliefs about depression, and on depression and depression-vulnerable status in male youth. A total of 78 boys age 15 and 16 years were allocated to either undertake MoodGYM or to standard personal development activities. Outcomes were measured before commencement, post-program and 16 weeks post-program. There were no significant between-group differences in change scores pre- to post- or pre- to follow-up using the intention to treat sample or for participants with post- and/or follow-up data. For boys completing 3 or more modules there were small relative benefits of MoodGYM for depressive symptoms (Effect Size, ES = 0.34), attributional style (ES = 0.17) and self-esteem (ES = 0.16) at post-program, although only the effect for self-esteem was sustained at follow-up. Both groups showed improvement in their beliefs about depression at follow-up, with the control group showing a moderate relative benefit (ES = 0.40). While the numbers are small, there was a reduction in the risk of being depressed in the MoodGYM group of 9% at post-treatment compared with a slightly increased risk for the control group. The risk of being classified as vulnerable to depression reduced by 17% in the MoodGYM group at post-treatment compared with no change in risk for the control group. These reductions in risk for the MoodGYM group were not sustained at follow-up. The limitations of the study highlight several important challenges for MoodGYM and other self-directed Internet cognitive behaviour therapy programs. These include how to ensure enough of the program is received and that people who could potentially benefit access the program and continue to remain engaged with it, and how to enhance the sustainability of any benefits.

Adolescent↗
PubMed1994

Weight gain as a function of smoking cessation and 2-mg nicotine gum use among middle-aged smokers with mild lung impairment in the first 2 years of the Lung Health Study.

The extent and predictors of weight change were assessed among sustained nonsmoking special intervention participants in the Lung Health Study. The intervention included a 12-session group program and 2-mg nicotine gum. At 12 months, female sustained quitters (SQs; n = 248) had gained a mean of 8.4% (5.3 kg) of their baseline weight, whereas male SQs (n = 443) had gained 6.7% (5.5 kg). By 24 months, female SQs had gained 9.8% of their baseline weight compared with 6.9% for men. Nicotine gum usage delayed a portion of the weight gain. Multiple regression analysis showed that weight gain at 12 months was associated with a higher baseline salivary cotinine level, a lower baseline body mass index, drinking less alcohol per week, and a lower cotinine level at 12 months (indicating less or no nicotine gum use). We conclude that moderate weight gain is a long-term consequence of smoking cessation--a portion of which can be delayed with 2-mg nicotine gum.

Adult↗
PubMed2000

Hospice in prison: the Louisiana State Penitentiary Hospice Program.

This article by the hospice case manager and inmate volunteer coordinator at the Louisiana State Penitentiary (LSP) hospice program describes the program's major features, how it was started and is sustained within the confines and culture of prison life, and how the challenges to implementing a hospice program within a maximum security prison continue to be met. Recommendations are offered for undertaking a hospice initiative in a correctional facility. The LSP Hospice Program was honored in May 2000 with the Circle of Life Award from the American Hospital Association. This article is excerpted from a thematic issue, "Hospice in Prison," Volume 2, Number 3, 2000 of the online journal, Innovations in End-of-Life Care at http://www.edc.org/lastacts/

Journal Article↗
PubMed1979

Electrophysiologic approach to therapy of recurrent sustained ventricular tachycardia.

The refinement of the techniques of programmed stimulation and intracardiac recording has led to understanding of the mechanism of ventricular tachycardia and these techniques can be applied clinically to the development of therapeutic regimens. The efficacy of drug therapy can be assessed in sequential studies evaluating the ability of drugs to prevent initiation of the arrhythmia by electrical stimulation. The efficacy of pacemaker therapy can be evaluated by assessing the effects of stimulation during the tachycardia. The recent development of endocardial mapping provides the surgeon with a tool to guide therapeutic surgical ablation of the site of origin of the tachycardia. Such an electrophysiologic approach to recurrent ventricular tachycardia can lead to the rapid development of successful therapy under controlled conditions.

Adolescent↗
PubMed2003

Fate of organics during soil-aquifer treatment: sustainability of removals in the field.

A 5-year program of study was conducted at the Sweetwater Recharge Facilities (SRF) to assess the performance of surface spreading operations for organics attenuation during field-scale soil-aquifer treatment (SAT) of municipal wastewater. Studies were conducted utilizing both mature (approximately 10 yr old) and new infiltration basins. Removals of dissolved organic carbon (DOC) were robust, averaging >90 percent during percolation through the local 37-m vadose zone. The hydrophilic (most polar) fraction of DOC was preferentially removed during SAT; removals were attributed primarily to biodegradation. Reductions in trihalomethane formation potential (THMFP) averaged 91 percent across the vadose zone profile. The reactivity (specific THMFP) of post-SAT organic residuals with chlorine decreased slightly from pre-SAT levels (60 vs. 72 microg THM per mg DOC, respectively). Variations in the duration of wetting/drying periods did not significantly impact organic removal efficiencies.

Conservation of Natural Resources↗