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PubMed1999

[Event-related desynchronization and synchronization. Reactivity of electrocortical rhythms in relation to the planning and execution of voluntary movement].

Cortical electroencephalographic rhythms reactivity may be quantified using event-related desynchronization (ERD) and synchronization (ERS) methods. We therefore studied cortical activation occurring during programming and performance of voluntary movement in healthy subjects. EEG power evolution within the reactive frequency bands (mu and beta central rhythms) was averaged before, during and after a minimum of 50 self-paced flexions of the thumb. Recordings in 18 normal adults showed that ERD (decrease in power) of mu rhythm started 2,000 ms before movement onset, while ERD of beta rhythm started 1,500 ms before movement onset. Early ERD of mu and beta rhythms were located over the contralateral central region covering primary motor cortex. They were followed by bilateral ERD occurring over ipsilateral and contralateral central regions during performance of the movement. At the end of the movement, an ERS (increase in power) of beta rhythm occurred. These results suggest that programming of voluntary movement induces early activation in contralateral sensorimotor areas, while performance of the movement induces bilateral activation in sensorimotor areas. ERS of beta rhythm occurring at the end of the movement could correspond to inactivation of motor areas activated by movement. Based on EEG activity, ERD and ERS prove to be useful methods to analyze cortical activation during programming and performance of voluntary movements with good spatial and temporal resolution.

Adult↗
PubMed1975

A successful respirator program.

This discussion covers the successful implementation of a respirator program on a voluntary basis in a large industrial plant. The program had the stated objective of mandatory usage at the end of a specified period of time. It was successfully implemented in an 1100-man department. This practical approach is applicable to large and small plants.

Attitude↗
PubMed2004

Translating research into practice: voluntary reporting of medication errors in critical access hospitals.

CONTEXT: Low service volume, insufficient information technology, and limited human resources are barriers to learning about and correcting system failures in small rural hospitals. PURPOSE: This paper describes the implementation of and initial findings from a voluntary medication error reporting program developed by the Nebraska Center for Rural Health Research (NCRHR) to overcome these barriers in 6 Nebraska critical access hospitals (CAHs). METHODS: Participating Nebraska CAHs mailed copies of medication error reports to the NCRHR monthly for entry into a database. Quarterly summaries enabled each CAH to compare its reports by severity, type, phase of the medication use process, contributing factors, and causes to those of its peers and MEDMARX, a national medication error reporting program. Workshops emphasized learning from the reported errors by identifying system sources of variation in medication use and initiating change to achieve best practices. FINDINGS: Similar to MEDMARX, 99% of medication errors reported by 6 Nebraska CAHs were not harmful, reported errors most often originated in the administration phase, and the most common error type was omission. The CAHs reported significantly smaller proportions of "near miss" errors and errors originating in the prescribing phase than in MEDMARX. CONCLUSIONS: By collaborating with CAHs, an academic medical center, and a national reporting program, the NCRHR is translating the Institute of Medicine's recommendation for voluntary error reporting into practices that allow CAHs to learn about and improve their medication use systems. However, limited presence of pharmacists in CAHs is a barrier to implementing double checks and learning from system failures in the medication use system.

Adverse Drug Reaction Reporting Systems↗
PubMed1997

Rapid HIV testing and counseling for voluntary testing centers in Africa.

OBJECTIVE: Voluntary HIV testing and counseling (VTC) has been shown to reduce the incidence of HIV in cohabiting couples who now represent the majority of new infections in many African cities. Community and client perceptions of a 1-day voluntary testing and counseling program in Lusaka, Zambia, were assessed, and a rapid HIV-testing algorithm was evaluated for VTC centers. METHODS AND DESIGN: Between May 1995 and June 1996, outreach workers distributed written invitations door to door. The 1-day program was held 6 days/week including weekends. Transport, child care and lunch were provided. Community and client surveys followed in July 1996. RESULTS: Over 3500 couples married for a median of 4-5 years requested testing: 23% were HIV+/+, 57% were HIV-/- and 20% were discordant with one HIV+ and one HIV- partner. Sixty-eight per cent of couples surveyed had made the decision to be tested before attending the 1-day program and 80% had not previously known where to obtain HIV testing. Knowledge that couples could show discordant results rose from 29 before to 88% after pretest counseling. Clients reported high levels of satisfaction with the services and 90 out of 99 (92%) preferred to receive their results the same day. Clients at another center who waited 10 days for their results reported more fear, and 19 out of 31 (61%) would have preferred to get their results the same day. Over 99% of those who attended the program thought active promotion of voluntary HIV testing in the community was a positive thing, as did 90% of those who were invited but did not attend. Sensitivity and specificity of the rapid test algorithm were both 99.4% in this setting. CONCLUSIONS: Active promotion of voluntary HIV testing and counseling in couples is needed to reduce the spread of HIV in high-prevalence areas. The use of rapid, on-site HIV testing allows clients to receive result-specific counseling in a single visit. Ongoing quality control of a subset of samples at an outside laboratory is essential.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Characteristics of, and HIV infection among, women served by publicly funded HIV counseling and testing services--United States, 1989-1990.

In 1990, the number of reported acquired immunodeficiency syndrome (AIDS) cases among women in the United States exceeded 15,000, an increase of 34% from 1989 (1). Public health surveillance of the human immunodeficiency virus (HIV)/AIDS epidemic has included monitoring of publicly funded voluntary counseling and testing (CT) programs, such as the voluntary client record system (representing 43% of all reported CT visits) that collects detailed information for each CT visit. This report summarizes findings based on information from the client record system for women who received public CT services during 1989 and 1990.

Black People↗
PubMed2001

Characteristics of staff victims of patient assault: ten year analysis of the Assaulted Staff Action Program (ASAP).

Patient assaults on staff have been a continuing risk for inpatient and community-based psychiatric healthcare providers. This study presents a ten-year analysis of the characteristics of staff victims of patient assaults in one public mental health system of care, a period which included the transition to managed care initiatives within this system. Assault data was gathered within the context of the Assaulted Staff Action Program (ASAP), a voluntary, system-wide, peer-help, crisis intervention program that is designed to assist employees with the psychological sequelae of these patient events. In general, the findings were consistent with previously reported inpatient and community studies. Less experienced, less formally trained employees remain at high risk. The impact of managed care initiatives was found in community residences where younger female staff were most at risk. The implications of the findings and possible risk management strategies are discussed.

Adult↗
PubMed1998

Rates of tuberculosis infection in healthcare workers providing services to HIV-infected populations. Terry Beirn Community Programs for Clinical Research on AIDS.

OBJECTIVE: To assess the prevalence of tuberculosis (TB) or a positive skin test in healthcare workers (HCWs) providing services to human immunodeficiency virus (HIV)-infected individuals and to determine prospectively the incidence of new infections in this population. DESIGN: This prospective cohort study enrolled 1,014 HCWs working with HIV-infected populations from 10 metropolitan areas. Purified protein derivative (PPD) tuberculin skin tests were placed at baseline and every 6 months afterwards on those without a history of TB or a positive PPD. Demographic, occupational, and TB exposure data also were collected. SETTING: Outpatient clinics, hospitals, private practice offices, and drug treatment programs providing HIV-related healthcare and research programs. PARTICIPANTS: A voluntary sample of staff and volunteers from 16 Community Programs for Clinical Research on AIDS units. RESULTS: Factors related to prior TB or a positive skin test at baseline included being foreign-born, increased length of time in health care, living in New York City, or previous bacille Calmette-Guerin vaccination. The rate of PPD conversion was 1.8 per 100 person years of follow-up. No independent relation was found between the amount or type of contact with HIV-infected populations and the risk of TB infection. CONCLUSION: These data provide some reassurance that caring for HIV-infected patients is not related to an increased rate of TB infection among HCWs in these settings.

AIDS-Related Opportunistic Infections↗
PubMed1992

Community participation in the malaria control program in Thailand: a review.

The focus of this paper is on community participation in the Thai Malaria Control Program. Two projects concerned are reviewed. First, the Village Voluntary Malaria Collaborator Program has been established for case detection. Second, the Village Malaria Self-Reliance Project aims at malaria prevention. Both projects have been able to get community participation at a certain level. The success of the projects depend on the community, the structures of the projects and the malaria situation in the communities.

Community Health Services↗
PubMed2005

Primary and secondary prevention of drink driving by the use of alcolock device and program: Swedish experiences.

To prevent drinking and driving, alcolock (or alcohol-interlock) devices and programs were introduced in Sweden in 1999. Two types of prevention programs were begun. A primary prevention strategy was initiated to prevent alcohol impaired driving by individuals not pre-selected for having prior DWI offences. This approach was first applied as a pilot project in three commercial transport companies (buses, trucks, taxis). Also a secondary prevention trial was begun as a voluntary 2-year program for DWI offenders involving strict medical requirements, including counseling and regular checkups by a medical doctor. The program did not require a prior period of hard suspension and focused on changing alcohol use habits. Alcolocks in commercial vehicles have been well accepted by professional drivers, their employers, and their passengers, and the number of vehicles with alcolocks as a primary prevention measure is rapidly growing in Sweden. Three of 1000 starts in the primary prevention program were blocked by the alcolock after measuring a BAC higher than the legal limit and lock point of 0.02% (20mg/dl). Only 11% of eligible DWI offenders took part in the voluntary, secondary prevention program. Of these, 60% had diagnoses of alcohol dependence or abuse. During the program, alcohol consumption generally decreased significantly as measured through five biological alcohol markers, and the rate of DWI recidivism fell sharply from a yearly rate of approximately 5% to almost 0. These effects on DWI recidivism are paralleled by reduced rates of police-reported traffic accidents involving injuries and hospital admissions due to road accidents. Successful completion of the program appears to have lasting effects (even 2.5 years later) in terms of far lower rates of DWI recidivism and maybe also lower crash rates. On the other hand those being dismissed from the program appear to rapidly return to previous behaviour. Hard suspension seems almost to have an adverse effect on DWI recidivism, but crashes resulting in injuries may be reduced during revocation.

Accidents, Traffic↗
PubMed1992

Determining the lower limit of detection for personnel dosimetry systems.

A simple method for determining the lower limit of detection (LLD) for personnel dosimetry systems is described. The method relies on the definition of a critical level and a detection level. The critical level is the signal level above which a result has a small probability of being due to a fluctuation of the background. All results below the critical level should not be reported as an indication of a positive result. The detection level is the net signal level (i.e., dose received) above which there is a high confidence that a true reading will be detected and reported as a qualitatively positive result. The detection level may be identified as the LLD. A simple formula is derived to allow the calculation of the LLD under various conditions. This type of formula is being used by the Department of Energy Laboratory Accreditation Program (DOELAP) for personnel dosimetry. Participants in either the National Voluntary Laboratory Accreditation Program (NVLAP) for personnel dosimetry or DOELAP can use performance test results along with a measurement of background levels to estimate the LLDs for their dosimetry system. As long as they maintain their dosimetry system such that the LLDs are less than half the lower limit of the NVLAP or DOELAP test exposure ranges, dosimetry laboratories can avoid testing failures due to poor performance at very low exposures.

Humans↗
PubMed1995

Beyond the schools: strategies for implementing successful drug prevention programs in community youth-serving organizations.

This article discusses why community-based youth-serving organizations are natural settings for drug prevention programming. Based on a three-year study of a school-based drug prevention program adapted to the Boys & Girls Club setting and serving high-risk youths, we identify organizational impediments to implementing a structured prevention program in youth organizations. We also present some strategies the clubs used to achieve success in a nonschool setting where program participation is voluntary. Strategies include: 1) employing a team approach and making program institutionalization a goal; 2) choosing the "right" prevention program leader; 3) creating a special prosocial bonding group for program youths; 4) involving program graduates as recruiters and positive role models; and 5) developing community support. Drug prevention programming in youth-serving organizations can reinforce, supplement, and enhance school-based prevention efforts, thus providing communities with important drug prevention alternatives that go beyond the schools.

Adolescent↗
PubMed1999

Acceptable HLA mismatches for highly immunized patients.

Highly sensitized patients have developed antibodies against many different HLA antigens due to previous pregnancies, blood transfusions or failed transplants. These antibodies cause a positive crossmatch with almost all potential organ donors. As a positive crossmatch is a contra-indication for transplantation, highly sensitized patients have a low chance of transplantation unless special strategies are introduced. One such strategy is the acceptable mismatch program, which has led to transplantation of more than 300 of these highly sensitized patients within Eurotransplant. Centers are participating in the program on a voluntary basis. Before a patient can be included in this program, extensive antibody screening is necessary to define those HLA-A and -B antigens towards which the patient has never formed antibodies. Organ donor selection is based on complete compatibility with the patients own HLA antigens in combination with the acceptable mismatches. If such a combination is identified, mandatory exchange takes place. Despite the success of the acceptable mismatch program, about 25% of the patients will never receive a donor offer. These are patients with rare HLA antigens or rare combinations of HLA antigens. In the last few years, this group of patients has had the advantage of two additional programs running within Eurotransplant. In the HIT (highly immunized tray) program, sera of highly sensitized patients are sent to the different centers and crossmatched with all ABO compatible donors. In the case of a negative crossmatch, mandatory exchange takes place. Secondly, these patients can benefit from the extra points they receive for their waiting time, high antibody reactivity and rare HLA type in the standard Eurotransplant allocation system. We conclude that the application of these three strategies will lead to a significantly increased transplantation rate of highly sensitized patients.

Cross Reactions↗
PubMed1995

Evaluating cholesterol screening. The importance of controlling for regression to the mean.

OBJECTIVES: To determine the overall impact of a voluntary cholesterol screening program and to assess the importance of controlling for regression to the mean when evaluating the impact on higher-risk subgroups. DESIGN: Longitudinal study comparing baseline survey and cholesterol results with those obtained 17 months later, with adjustment for regression to the mean. SETTING: Participants were seen at three sites: an academic teaching hospital, an intermediate-care hospital, and a suburban community center. PARTICIPANTS: One thousand fifty-three participants were enrolled in a voluntary cholesterol screening program. MEASUREMENTS/MAIN RESULTS: Of 1053 study enrollees, 785 (75%) completed a follow-up questionnaire and 656 (62%) returned for follow-up cholesterol tests. Among all participants at high risk, measured cholesterol levels were 0.66 mmol/L (25.5 mg/dL) lower at follow-up, but 58% of this apparent change (0.38 mmol/L [14.7 mg/dL]) was attributable to the statistical phenomenon of regression to the mean. Among all participants at increased (both high and moderate) risk, after controlling for regression to the mean, reductions in cholesterol levels were significant for those younger than 60 years (-0.28 mmol/L [-10.8 mg/dL]; 95% confidence interval, -0.43 to -0.13; n = 390) but not for those 60 years or older (+0.007 mmol/L [+0.3 mg/dL]; 95% confidence interval, -0.16 to +0.17; n = 266). CONCLUSIONS: For subjects found at high risk in a cholesterol screening program, more than half of the apparent beneficial change in cholesterol level is attributable to regression to the mean. For participants older than 60 years, no clear benefit of cholesterol screening was documented.

Adult↗
PubMed2003

Differential effects of the Müller-Lyer illusion on reflexive and voluntary saccades.

Research has produced conflicting evidence as to whether saccade programming is or is not biased by perceptual illusions. However, previous studies have generally not distinguished between effects of illusory percepts on reflexive saccades, programmed automatically in response to an external visual signal, and voluntary saccades, programmed purposively to a location where no signal has occurred. Here we find that voluntary and reflexive saccades are differentially susceptible to the Müller-Lyer illusion; reflexive movements are reliably but modestly affected by the illusion, whereas voluntary movements show an effect similar to that of perceptual judgments. Results suggest that voluntary saccade programming occurs within a non-retinotopic spatial representation similar to that of visual consciousness, whereas reflexive saccade programming occurs within a representation integrating retinotopic and higher level spatial frames. The effects of the illusion on reflexive saccades are not subject to endogenous control, nor are they modulated by the strength of an exogenous target signal.

Humans↗
PubMedDate not supplied

Hope as a predictor of entering substance abuse treatment.

Identification of characteristics that predict entry into substance abuse treatment programs may facilitate efforts to make effective programs more attractive to people who could benefit from them. We examined dispositional hope as a predictor of entering a voluntary substance abuse treatment program for federal prison inmates. Controlling statistically for demographics, comorbid diagnoses, and drug-use history, increased hope was associated with lower probability of entering treatment. Discussion focused on the possibility that in the context of incarceration and substance abuse, high levels of hope may serve as a marker of excessive self-reliance and underestimation of the need for professional treatment.

Adult↗
PubMed2005

Evaluation of a voluntary, military-style residential treatment program for adolescents with academic and conduct problems.

This study evaluated the effectiveness of a military-style residential treatment program for adolescents with academic and conduct problems. Two hundred twelve referred adolescents were separated into 3 groups for analyses: (a) adolescents who completed the 22-week program, (b) adolescents who prematurely withdrew, and (c) wait-list controls. Adolescents' socioemotional and behavioral functioning were measured at baseline and 6 months after treatment. Results showed statistically and clinically significant reductions in externalizing symptoms and increases in adaptive behavior associated with treatment. Treatment was also associated with increased likelihood of high school completion or employment and decreased likelihood of alcohol or drug problems and arrest. The relation between treatment participation and outcomes was moderated by adolescents' living environments after treatment, but it was not moderated by age of symptom onset. The benefits of treatment may be partially attributable to the voluntary nature of the intervention.

Adolescent↗
PubMed2002

Exercise adherence and 10-year mortality in chronically ill older adults.

OBJECTIVES: To compare mortality of adherents and nonadherents of an exercise program. DESIGN: Prospective intervention study. SETTING: Supervised geriatric fitness program called Gerofit. PARTICIPANTS: One hundred thirty-five adults aged 65 and older who enrolled in Gerofit between January 1, 1990, and November 30, 1999. All participants had a baseline medical screen and exercise test. They were classified as adherent (n = 70) if they participated in Gerofit for more than 47 sessions or nonadherent (n = 65) if they did not complete 47 sessions within the first 6-month period. INTERVENTION: Program participation was voluntary and consisted of aerobic, strength, flexibility, and balance exercises. The program met three times week for 90 minutes. MEASUREMENTS: All-cause mortality. RESULTS: Twenty-six deaths occurred within the 10-year follow-up period. Using proportional hazards, time to death was not related to adherence group. However, in multivariate analyses controlling for age, sex, race, baseline risk/health status, history of heart disease, cancer, diabetes mellitus, and baseline smoking status, there was significant group-by-time interaction (P =.004), indicating a crossover in mortality risk. The initial survival benefit observed in nonadherers changed over time, resulting in a long-term protective survival effect on mortality for the adherent group (hazard rate = 0.75, 95% confidence interval = 0.61-0.91 for the interaction term). CONCLUSIONS: Older adults with chronic diseases experience a long-term beneficial mortality effect from participation in exercise programs. Physicians should strongly encourage their patients, including those with comorbidities, to maintain a regular exercise program.

Aged↗