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PubMed1997

Guidelines for school and community programs to promote lifelong physical activity among young people. Centers for Disease Control and Prevention.

Regular physical activity is linked to enhanced health and to reduced risk for all-cause mortality and the development of many chronic diseases in adults. However, many U.S. adults are either sedentary or less physically active than recommended. Children and adolescents are more physically active than adults, but participation in physical activity declines in adolescence. School and community programs have the potential to help children and adolescents establish lifelong, healthy physical activity patterns. This report summarizes recommendations for encouraging physical activity among young people so that they will continue to engage in physical activity in adulthood and obtain the benefits of physical activity throughout life. These guidelines were developed by CDC in collaboration with experts from universities and from national, federal, and voluntary agencies and organizations. They are based on an in-depth review of research, theory, and current practice in physical education, exercise science, health education, and public health. The guidelines include recommendations about 10 aspects of school and community programs to promote lifelong physical activity among young people; policies that promote enjoyable, lifelong physical activity; physical and social environments that encourage and enable physical activity; physical education curricula and instruction; health education curricula and instruction; extracurricular physical activity programs that meet the needs and interests of students involvement of parents and guardians in physical activity instruction and programs for young people, personnel training; health services for children and adolescents; developmentally appropriate community sports and recreation programs that are attractive to young people; and regular evaluation of physical activity instruction, programs, and facilities.

Adolescent↗
PubMed1987

Immunizations among hospital personnel.

To minimize the likelihood of transmission of certain infectious diseases within the hospital, the 5 million US health care personnel are becoming a special target group for immunization programs. A review of immunizations conducted by a hospital employee health service demonstrated that 80% of hospital employees are adequately protected against tetanus/diphtheria, and 97% are immune to rubella. In contrast, only 28% of at-risk employees are immunized against hepatitis B and only 2% are immunized against influenza. Vaccination programs for tetanus/diphtheria and rubella, which are supported by appropriate legislation, are more effective than vaccination programs for hepatitis B and influenza, which are not supported by appropriate legislation.

Diphtheria↗
PubMed1984

Personal computer word processing for veterinary article writing: selecting a suitable word processing program.

Word processing makes the writing and altering of scientific articles faster, easier, and more accurate. Personal computers that are ideally suited to this use are now available. The major problem affecting the veterinarian who wishes to purchase a personal computer word processing system, is that of spending the time to acquire sufficient information in order to choose the computer and the programs that will be appropriate to his or her requirements. These will include the specialized word processing demands of scientific article writing and many other applications, as applicable. Despite this obstacle, the acquisition of a personal computer and a suitable word processing program, soon results in time saving. The use of the computer for many other tasks logically follows. An additional benefit is the understanding of computers, their abilities and their limitations--a decided benefit in the 1980s.

Computers↗
PubMed2002

[Estimate of expected cesarean section rate for maternal indications in a population of pregnant women in West Africa (MOMA survey)].

OBJECTIVES: There is still some debate about the optimal rate of cesarean section (CS) needed to achieve better outcome for both mothers and infants in developing countries. We examine here two aspects of the question: i) a simple method to estimate the expected rate of CS according to obstetrical risk; ii) a test of the method to estimate the appropriate rate for maternal indications in a general population of pregnant women in West Africa. METHODS: This population-based study was conducted in a cohort of pregnant women in six West African countries (MOMA survey): Abidjan (Ivory Coast), Bamako (Mali), Niamey (Niger), Nouakchott (Islamic Republic of Mauritania), Ouagadougou (Burkina Faso), and in three areas of Senegal, two small towns (Fatick and Kafrine, Kaolack region), and one major city (Saint-Louis). 19,459 women with singleton pregnancies with expected breech presentation were followed to delivery and puerperium. Maternal indications for CS were defined as dystocia (prolonged labor over 12 hours), malpresentation, previous cesarean section, abruptio placentae, placenta paevia and eclampsia. A standardized method was used to calculate the number of expected CS in the MOMA population, according to the level of the obstetrical risk. RESULTS: The minimal needs for Cs for maternal indications were estimated between 3.6 and 6.5 per 100 deliveries. However, we observed a rate of 1.3 CS per 100 deliveries. DISCUSSION: These findings underline the lack of CS for maternal indications in urban West Africa. The method of standardization we propose could help policy makers, health planners and obstetricians to design programs to reach the appropriate level of CS and to monitor and follow-up these programs.

Abruptio Placentae↗
PubMed2000

Programming for cytotoxic effector function occurs concomitantly with CD4 extinction during CD8(+) T cell differentiation in the thymus.

CD4(+) T cells are generally specialized to function as helper cells and CD8(+) T cells are generally specialized to function as cytotoxic effector cells. To explain how such concordance is achieved between co-receptor expression and immune function, we considered two possibilities. In one case, immature CD4(+)CD8(+) thymocyte precursors might first down-regulate expression of one co-receptor molecule, with the remaining co-receptor molecule subsequently activating the appropriate helper or cytotoxic functional program. Alternatively, we considered that the same intrathymic signals that selectively extinguished expression of one or the other co-receptor molecule might simultaneously initiate the appropriate helper or cytotoxic functional program. In the present study, we attempted to distinguish between these alternatives by examining thymocyte precursors of CD8(+) T cells for expression of Cathepsin C and Cathepsin W, molecules important for cytotoxic effector function. We report in developing thymocytes that Cathepsin C and Cathepsin W are expressed coordinately with extinction of CD4 co-receptor expression. We conclude that CD4 extinction and initiation of the cytotoxic functional program occurs simultaneously during differentiation of CD8(+) T cells in the thymus.

Animals↗
PubMed1975

Following up the physical therapist assistant graduate; a curriculum evaluation process.

Graduates of the physical therapist assistant program at St. Mary's Junior College in Minneapolis, Minnesota, were studied to ascertain how well prepared they had been for the demands of their jobs and to discover what revisions in the program curriculum might be appropriate. Working graduates and their supervisors were surveyed to obtain information about the frequency and independence of performance of 111 tasks appropriate to physical therapy departments. The response was 90 percent. The St. Mary's curriculum was considered appropriate in most respects. More than 25 percent of the supervisors considered emphasis inadequate only for facilitation, breathing, and mat exercises. Graduates' recommended changes were more extensive, suggesting a desire to expand their knowledge. A manual was designed to guide program faculties through follow-up of their own graduates. The manual includes questionnaires, worksheets, and a guide to analysis. The authors suggest that the process may also be useful for other technical-level allied health occupations.

Clinical Competence↗
PubMed1996

Rationale for a medical society sponsored expert witness program.

The medical profession has many avenues by which to improve the present tort system as it regards medical negligence cases. One such avenue is a medical society sponsored expert witness program through which medical societies can assure that each case is being evaluated properly by an ethical and responsible physician. This effort will assist attorneys in weeding out medical negligence cases that are without merit and shepherding meritorious cases towards appropriate settlement. Such a program would be a positive step in discouraging the legal profession's use of the "professional expert." Finally, such a program might also provide funds for other worthwhile medical/legal projects.

Expert Testimony↗
PubMed1983

Nutritional blindness in Africa.

Nutritional blindness is loss of useful vision resulting from vitamin deficiency. A malnutrition Xerophthalmia means all the ocular manifestations of inadequate metabolism of vitamin A, nutritional blindness being the end result of the most severe cases. The estimated overall prevalence of nutritional blindness in Africa is very low, below the WHO levels of significance, although isolated clusters of locally high prevalence exist, usually in arid, sparsely-populated regions. The peak age group affected is 2-year olds, with most nutritional blindness having its effect before age 6 years. Xerophthalmia may be considered as a serious side effect of protein-energy malnutrition (PEM). When associated with corneal sequelae of xerophthalmia, PEM has an estimated overall mortality of 50%. Intervention programs, therefore, are more appropriately aimed at the broader condition of life-threatening PEM than at the specifically vision-threatening problem of xerophthalmia. Parameters of significant prevalence detection are discussed, and the relative merits of different forms of vitamin A-specific intervention programs are weighed.

Africa↗
PubMed1987

Traditional media.

Explore the source record for details and available documents.

Communication↗
PubMed2004

Residents' working hours in a consortium-wide surgical education program.

Traditional work schedules of surgical residents have been cited as a factor that negatively influences education and the quality of patient care. Demands by federal and state legislators as well as the general public have forced a re-evaluation of the issue. Long working hours and resulting sleep deprivation affect the lives of residents profoundly, but the question remains does it lower the quality of medical care? The justification for the long hours is that they are vital to medical education, but residents are so drained by their schedules that they are rarely in the best state of mind to learn from their experiences. Under the scrutiny of the Resident Review Committee (RRC), many programs and institutions have been cited in the recent past in violation of resident working hour requirements. As a result, many institutions have implemented reforms, thereby reducing the number of citations they received. In spite of having the highest number of citations, the field of general surgery has failed to show any improvement. The Oakland Health Education Programme Center for Medical Education (OHEP), a consortium of 16 teaching hospitals in the State of Michigan, set out to review the components of general surgery residency training in order to be able to make recommendations that might assist program directors in making appropriate changes where necessary to enhance resident education and the quality of patient care as well as to meet the personal demands of residents. Questionnaires on residents' attitudes concerning their working hours and possible reforms were sent to all general surgery residency programs in the OHEP consortium. The questionnaire consisted of 25 questions divided into three major sections: the first section encompassed demographic information including current work hours and on-call schedules. The second section consisted of questions relating to attitudes toward work hours and the options for change. The third section consisted of questions that viewed the perceived effects of limited work hours. From the seven participating hospitals with surgery residency programs in OHEP, 92 residents responded to our survey. The majority of residents were in the first 3 years of postgraduate training. The mean age of residents was 30 years old. Sixty-four per cent of respondents were male, and 18 per cent were female. Residents reported an average of 56 with a range of 0 to 110 hours on call. Variations in the number of hours had to do with the various rotations residents were on, in that during certain elective rotations, residents were not assigned to any call. The on-call schedule varied; alternate nights were reported by 11 per cent, every third night by 33 per cent, and every fourth night or more by 53 per cent. The majority of surgical residents did express the need for reform and did not feel that reforms would affect the quality of resident education. However, residents did not want to lengthen residency training beyond the 5 years. The results of our study indicates that the majority of residents in general surgery programs in Michigan perceive a need for reform of work schedules. Surgical educators may have underestimated this need in the past. Most residents thought that long hours impaired their educational experience and at times compromised their clinical care.

Attitude of Health Personnel↗
PubMed1993

Women and exercise. ACOG Technical Bulletin Number 173--October 1992.

Exercise programs for women can serve many purposes, including developing fitness; controlling weight; improving strength, flexibility, and coordination; enhancing competition with other athletes, and promoting general good health. Depending upon the goal, a realistic method of exercise should be chosen and a program should be developed and followed carefully. Most programs will require aerobic training, which is best maintained by using training heart rates. Exercise is not without the potential for problems, and any warning signs should not be ignored. As the intensity of the program increases, it may have effects on the reproductive system varying from minor menstrual changes to amenorrhea. The physician needs to be aware of these occurrences, and evaluation is necessary to ensure that no other pathology has occurred. When carefully selected and appropriately followed, an exercise program will result in a healthier patient.

Body Weight↗
PubMedDate not supplied

A framework for selecting performance measures for opioid treatment programs.

As a result of new federal regulations released in early 2001 that move the monitoring and evaluation of opioid treatment programs from a government regulation to an accreditation model, program staff members are now being challenged to develop performance measurement systems that improve care and service. Using measurement selection criteria is the first step in developing a performance measurement system as a component of an overall quality management (QM) strategy. Opioid treatment programs can "leapfrog" the development of such systems by using lessons learned from the healthcare quality industry. This article reviews performance measurement definitions, proposes performance measurement selection criteria, and makes a business case for Internet automation and accessibility. Performance measurement sets that are appropriate for opioid treatment programs are proposed, followed by a discussion on how performance measurement can be used within a comprehensive QM program. It is hoped that through development, adoption, and implementation of such a performance measurement program, treatment for clients and their families will continuously improve.

Accreditation↗
PubMed2001

Hospital policy on appropriate use of life-sustaining treatment. University of Toronto Joint Centre for Bioethics/Critical Care Medicine Program Task Force.

OBJECTIVE: To describe the issues faced, and how they were addressed, by the University of Toronto Critical Care Medicine Program/Joint Centre for Bioethics Task Force on Appropriate Use of Life-Sustaining Treatment. The clinical problem addressed by the Task Force was dealing with requests by patients or substitute decision makers for life-sustaining treatment that their healthcare providers believe is inappropriate. DESIGN: Case study. SETTING: The University of Toronto Joint Centre for Bioethics/Critical Care Medicine Program Task Force on Appropriate Use of Life-Sustaining Treatment. PARTICIPANTS: The 24-member Task Force included physician and nursing leaders from five critical care units, bioethicists, a legal scholar, a health administration expert, a social worker, and a hospital public relations professional. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Our specific lessons learned include a) a policy focus on process; b) use of a negotiation and mediation model, rather than a hospital ethics committee model, for this process; and c) the policy development process is itself a negotiation, so we recommend equal involvement of interested groups including patients, families, and the public. CONCLUSIONS: This article describes the key issues faced by the Task Force while developing its policy. It will provide a useful starting point for other groups developing policy on appropriate use of life-sustaining treatment.

Hospital Administration↗
PubMed1991

Application of non parametric methods to pharmacokinetic models of the Michaelis-Menten type.

Non linear parametric regression methods for data fitting as applied to complex pharmacokinetic models give rise to convergence difficulties which have not been completely solved. The Cornich-Bowden non parametric method was applied by Shelver to the one compartment open model with first order absorption to simulated data with different error structures. The application of his procedure was extended to a pharmacokinetic model with Michaelis-Menten elimination. Simulated concentration/time data were generated by a microcomputer program which imposed the appropriate error structure:constant and proportional standard deviation with or without one outlier of different magnitude. Parameter optimization was performed using either a Newton-Raphson algorithm based on the integrated form of the Michaelis-Menten equation and a standard non linear regression program: NONLIN. In the case of the non parametric method, the median of the parameter values obtained for each combination of data points was used as best estimate of the parameters. One hundred data sets were used and performance of the two methods was assessed by comparing bias and standard deviation of the mean parameter value thus obtained, given the true values of the parameters used to generate the data. The non parametric performed well with homoscedastic data and was less sensitive to the presence of outliers than the non linear regression technique. In the case of heterosocedastic data both methods performed poorly but the non parametric method was more sensitive to the presence of outliers.

Algorithms↗
PubMed1995

Social skills training for young adolescents: symbolic and behavioral components.

The assertiveness program developed by Wise, Bundy, Bundy, and Wise (1991), which focused on the unique problems and peer interactions of young adolescents, was expanded to a 12-week program and presented to a group of 28 sixth graders. Cognitive acquisition and retention of the symbolic information was measured with a pretest, posttest, and follow-up administration of the multiple-choice tests that were designed and used in the prior study. Verbal content of assertive behavior was measured in a pretest and posttest role-play situation. When trained students were compared to a control group on the symbolic measures, a significant effect for treatment (p < or = .000); a significant effect for measures (p < or = .000); and a significant Treatment x Measure interaction (p < or = .000) were found. A comparison of means showed a significant difference between pretest vs. posttest and follow-up (p < or = .000). However, no difference between posttest and follow-up was found (p < .351). Unlike the earlier study, in which girls benefited more from training than did boys, no treatment by gender interaction was found for the cognitive measure (p < .691). Boys and girls benefited similarly in terms of the cognitive acquisition of assertiveness information from this program. However, the results did not show that these students were able to demonstrate assertiveness on the behavioral level. Results are discussed in terms of the difference between simply having stored symbolic information regarding assertive responses and recognizing contexts in which accessing the information would be appropriate. Suggestions for designing programs aimed at bringing about changes in adolescents' assertive behavior that will generalize to their lives beyond the training context are also offered.

Analysis of Variance↗
PubMed1993

Child care centers: a community resource for injury prevention.

Child passenger safety, a major public health concern, has been addressed by state laws mandating use of child restraint devices. Usage rates in poor and minority communities are disproportionately low. To determine the influence of the child care center within these communities to improve routine use, an educational clinical trial, based on social learning theory was designed. Two urban child care centers enrolling high-risk 2- through 6-year-old children were monitored for correct child restraint use during a 5-month educational intervention at one center. Key features of intervention programming included weekly, developmentally appropriate presentations by the staff to the children and documented parental awareness of the child care center's policy advisory regarding child restraint use. Results demonstrate statistically significant (p < .01) increases in use at the intervention center. This study finds that child care center policy and programming can be effective in promoting child passenger safety.

Accidents, Traffic↗
PubMed1998

Screening for chlamydial infection. A model program based on prevalence.

BACKGROUND: Chlamydial infection accounts for substantial health care costs. The high frequency of asymptomatic infections necessitates screening to detect affected persons. Selective screening using risk assessment criteria attempts to target limited resources to women at increased risk. However, most risk assessment criteria have not accounted for prevalence of infection. OBJECTIVES: To describe currently available screening options, to demonstrate the relationship between prevalence and probability of infection, and to propose a model program incorporating clinic prevalence in selective screening decisions. STUDY DESIGN: A simple model demonstrating the relationship between clinic prevalence, a risk score based on risk assessment, and probability of infection was developed using basic clinical epidemiological principles. RESULTS: The probability of infection can be estimated from the clinic prevalence and risk score. If the estimated probability of infection exceeds previously established test thresholds, laboratory testing is warranted. As the clinic prevalence increases, the risk score necessary to justify laboratory testing decreases. Thus, the cutoffs for risk assessment criteria should be adjusted to account for clinic prevalence. In the proposed model program, the availability of resources, such as the number of tests available to a screening program, can be accommodated by appropriate adjustment of thresholds for laboratory testing. CONCLUSION: The prevalence-based chlamydial screening program may provide a pragmatic strategy for areas with limited resources.

Adult↗