Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Program Sustainability”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,333 records · Page 74Linked to original sources
PubMed1979

Human rights, health, and capital accumulation in the Third World.

This article examines the relationship between human rights and the pattern of capital accumulation in the Third World. The repressive authoritarian State increasingly constitutes the means for enforcing the intensive exploitation of labor in Third World industrial enclaves and commercial agriculture. While the development of center capitalism has evolved toward "the Welfare State" and a framework of liberal sociodemocracy, the "peripheral State" is generally characterized by nondemocratic forms of government. This bipolarity in the state structure between center and periphery is functionally related to the international division of labor and the unity of production and circulation on a world level. The programs and policies of the center Welfare State (health, education, social security, etc.) constitute an input of "human capital" into the high-technology center labor process. Moreover, welfare programs in center countries activate the process of circulation by sustaining high levels of consumer demand. In underdeveloped countries, the underlying vacuum in the social sectors and the important allocations to military expenditure support the requirements of the peripheral labor process. Programs in health in the center and periphery are related to the bipolarity (qualification/dequalification) in the international division of labor. The social and economic functions of health programs are intimately related to the organic structure of the State and the mechanics whereby the State allocates its financial surplus in support of both capitalist production and circulation.

Africa↗
PubMed1980

Nonclinical polymorphic ventricular tachycardia induced by programmed cardiac stimulation: incidence, mechanisms and clinical significance.

We analyzed the morphology and rate of ventricular tachycardia induced by programmed cardiac stimulation in 18 patients with recurrent sustained ventricular tachycardia who had only one type of ventricular tachycardia during spontaneous episodes. In nine of 18 patients, we induced only one type of ventricular tachycardia, with a morphology and rate similar to those noted during spontaneous ventricular tachycardia. In the other nine patients, the induced ventricular tachycardia was either different from spontaneous ventricular tachycardia (two patients) or was polymorphic (seven patients). The multiple morphologies were induced in addition to those similar to spontaneous ventricular tachycardia. Seven of these nine patients had ischemic heart disease. Only one patient had a left ventricular aneurysm. The morphology and rate of induced tachycardia could be changed by changing the basic cycle length (two patients), the method of initiation of tachycardia (one patient), and by introducing paced ventricular beats during tachycardia (four patients). Our data suggest that ventricular tachycardia induced by programmed cardiac stimulation is nonclinical in 50% of patients with recurrent ventricular tachycardia. The clinical course and prognosis of patients with polymorphic ventricular tachycardia compared with those without polymorphic tachycardia are not known.

Aged↗
PubMed1991

[Programmed ventricular stimulation in unexplained syncope: risk factors for induction of ventricular tachycardia].

The aim of this study was to identify the factors associated with the induction of ventricular tachycardia (TV) by programmed ventricular stimulation in patients with unexplained syncope. Sustained VT was induced in 71 out of 619 patients (11.5%) with syncope. A comparison of subjects with inducible VT and those without inducible VT showed underlying cardiac disease to be more common (89% versus 16%), more Holter abnormalities (Grade IVa ventricular extrasystoles) (60.5% versus 10%) in the first group but that signal-averaged ECG, recorded in 51 cases, was not sufficiently specific to differentiate the two groups (delayed potentials in 57% versus 43%). When syncope occurred in a subject without apparent cardiac disease with a normal Holter recording, inducible VT was rare (1%). On the other hand, when syncope was associated with cardiac disease and/or an abnormal Holter recording, VT could be induced in 45 to 64% of cases. In addition, as inducible VT was associated with severe infrahisian conduction defects in 3 cases, the following strategy is suggested in patients with unexplained syncope: programmed ventricular stimulation should be performed systematically during endocavitary electrophysiological investigation of AV conduction in patients with cardiac disease and if the non-invasive investigations, Holter monitoring or echocardiography, are abnormal.

Cardiac Pacing, Artificial↗
PubMed2000

Role of beta2 integrins in the prevention of apoptosis induction in chronic lymphocytic leukemia B cells.

Immunologically committed lymphocytes, especially mature, leukemic B cells, proliferate then accumulate without further cell division in chronic lymphocytic leukemia patients (CLL). These mature, leukemic B cells often produce autoantibodies. Under normal circumstances, immunologically committed lymphocytes that are autoreactive are deleted by a programmed cell death mechanism. In CLL cells, these mechanisms appear to be inhibited; therefore, cells accumulate rather than be destroyed. To understand the mechanism by which cell survival is selected over death in CLL cells, we studied the role of beta2 integrins and their ligands in the regulation of apoptosis. CLL cells were treated with monoclonal antibodies directed against beta2 integrins. Antibodies directed against the I-domain of the alpha chain of CD11b/CD18 inhibited apoptosis. The identity of the physiological ligand or counter-receptor for beta2 integrins that was required for the inhibition of apoptosis induction was sought. The ligand iC3b, but not ICAM-1 or fibrinogen, was identified as a ligand that could prevent apoptosis of CLL B cells. Free iC3b levels were elevated in CLL patients indicating that this ligand is available in vivowhere it may interact with beta2 integrins on CLL B cells and sustain their viability by preventing activation of the programmed cell death pathway. Leukemia (2000) 14, 34-39.

Animals↗
PubMed1986

Verapamil and 24-hour ambulatory blood pressure monitoring in essential hypertension.

The antihypertensive effects of oral regular and slow-release verapamil, a calcium-channel blocking agent, were evaluated in 22 patients with mild to moderate hypertension (sitting diastolic blood pressure [DBP] 95 to 112 mm Hg). The dose required to control blood pressure varied from 80 to 120 mg, 3 times a day. All patients received regular verapamil for a further 3 to 4 months, when systolic blood pressure (SBP) and DBP had risen from the end of the open-label phase. During a double-blind phase patients were randomly assigned to continue the same dose of regular verapamil, 3 times a day, or an equivalent daily dose of sustained-release verapamil (240 to 360 mg once a day). Seven of the 11 patients on regular and 3 of the 11 on sustained-release verapamil were also taking diuretics. This antihypertensive program was continued for at least 4 weeks. During the efficacy period, 24-hour ambulatory blood pressure monitoring was carried out. Mean 24-hour SBP and DBP were 133 +/- 20 and 89 +/- 13 mm Hg, respectively, on regular and 131 +/- 22 and 87 +/- 12 mm Hg, respectively, on sustained-release verapamil. There were no statistically significant differences noted between the 2 groups. Mean SBP and DBP varied similarly during awake and sleep hours with both formulations of verapamil. With regular verapamil, SBP was 139 +/- 18 and 124 +/- 20 mm Hg and DBP 92 +/- 11 and 84 +/- 13 mm Hg during awake and sleep hours, respectively; with sustained release, SBP was 138 +/- 21 and 122 +/- 22 mm Hg and DBP 92 +/- 10 and 80 +/- 10 mm Hg during awake and sleep hours, respectively. Heart rate fell during the entry period and continued during the entire study period. No other adverse effects were noted during the double-blind phase. In summary, verapamil is an effective antihypertensive medication and can be administered once a day as a sustained-release preparation; it is most useful in patients in whom adrenergic blocking drugs are indicated.

Administration, Oral↗
PubMedDate not supplied

A support group for nursing assistants: caring for nursing home residents at the end of life.

Certified nursing assistants (CNAS) provide the hands-on care to residents in nursing homes, often developing close relationships with those in their care. The current study used a support program model to explore CNAS' feelings, experiences, and needs when caring for the dying. Special attention was given to the experience of caring for residents who opted not to continue life-sustaining treatment. Second, the efficacy of this type of support program for CNAS was examined. Care of the dying elicited complex reactions: most CNAS reported that caring for dying residents can be a very rewarding experience. At the same time, most thought that caring for a dying person is always emotionally draining. Moreover, CNAS said they felt sad and felt stressed at least some of the time when caring for the dying. CNAS participated openly in the discussion and expressed positive feelings about participating in this type of support program.

Aged↗
PubMed1987

Comparison of programmed stimulation and Holter monitoring for predicting long-term efficacy and inefficacy of amiodarone used alone or in combination with a class 1A antiarrhythmic agent in patients with ventricular tachyarrhythmia.

The values of two Holter ambulatory electrocardiographic monitoring criteria and one programmed stimulation efficacy criterion reported to be predictive of the efficacy of amiodarone were compared in 70 patients taking amiodarone for sustained ventricular tachyarrhythmias. At baseline, all patients had ventricular tachycardia inducible by programmed stimulation. After amiodarone loading (935 +/- 271 mg for 16 +/- 7 days), efficacy was determined by a programmed stimulation criterion (ventricular tachycardia no longer inducible or less than or equal to 15 beats) and two Holter monitoring criteria (Holter I = greater than or equal to 85% reduction of ventricular premature complexes and abolition of couplets and triplets in 64 patients who had greater than or equal to 10 ventricular premature complexes/h or couplets or triplets or both before therapy; Holter II = abolition of triplets in 41 patients who had triplets before therapy). Amiodarone was effective in 12 of 70 patients by the programmed stimulation criterion, in 49 of 64 patients by Holter criterion I and in 37 of 41 patients by Holter criterion II. In assessing efficacy of amiodarone, programmed stimulation and Holter criteria were discordant in 69% of patients or more (p less than 0.001). There were 16 recurrences or sudden deaths during the entire follow-up period (19 +/- 19 months). Arrhythmia-free survival rates at 24 months of patients with efficacy and inefficacy by each criterion, respectively, were 90 and 78% by programmed stimulation, 84 and 62% by Holter criterion I (p less than 0.05) and 73 and 50% by Holter criterion II (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1983

Role of electrophysiologic techniques in the selection of antiarrhythmic drug regimens for ventricular arrhythmias.

Programmed electrical stimulation of the heart provides a useful new technique for guiding the selection of antiarrhythmic drug regimens in selected patients with ventricular tachycardia (VT) or ventricular fibrillation. The technique of programmed electrical stimulation has been applied successfully in patients with recurrent sustained VT, out-of-hospital ventricular fibrillation and unexplained syncope in the presence of structural heart disease. The complete suppression of VT induced by programmed electrical stimulation by a drug regimen is highly predictive of freedom from both recurrent VT and sudden death. In addition, this technique may hold promise as a means of assessing the arrhythmogenic effects of antiarrhythmic drugs in selected patients.

Anti-Arrhythmia Agents↗
PubMed1995

Does the induction of ventricular flutter or fibrillation at electrophysiologic testing after myocardial infarction have any prognostic significance?

This study examines the significance of inducing sustained ventricular fibrillation (VF) or ventricular flutter by programmed stimulation after infarction. Programmed ventricular stimulation was performed for prognostic reasons from the right ventricular apex at twice diastolic threshold using a protocol containing 4 extrastimuli. Of 502 patients tested 11 +/- 4 days after acute infarction, VF was induced in 164 (33%), ventricular flutter in 134 (27%), ventricular tachycardia (VT) in 44 (9%), and no arrhythmia in 160 (32%). All groups were similar in age, sex distribution, and sites of index infarction. Those with inducible VT had a higher incidence of multiple infarctions and a lower mean left ventricular ejection fraction at the time of testing. Without antiarrhythmic drug therapy, 8 patients (18%) with inducible VT experienced spontaneous VT or died instantaneously during the first year of follow-up. By contrast, only 1 (0.6%) patient with inducible VF, 1 (0.7%) with ventricular flutter, and 1 (0.6%) without any inducible arrhythmias experienced similar events in the same period (p < 0.001). By relating the cycle length of the induced monomorphic arrhythmia to later spontaneous electrical events, induced arrhythmias with cycle length as low as 230 ms still identified patients at high risk for spontaneous arrhythmias. Only the induction of sustained monomorphic VT with a cycle length > 230 ms indicates patients with ventricular electrical instability after infarction. The induction of VF or ventricular flutter is a negative test result with no adverse long-term prognostic significance.

Arrhythmias, Cardiac↗
PubMed1999

Is inappropriate therapy a resolved issue with current implantable cardioverter defibrillators?

Patients with an implantable cardioverter defibrillator (ICD) can undergo inappropriate therapies if electrical activity not originating in the ventricle is wrongly recognized as ventricular by the device. Inappropriate therapy can be the result of detection of supraventricular tachycardias or over-sensing of other artifacts by the device. Enhanced detection criteria in third-generation ICD have been implemented to recognize fast supraventricular arrhythmias. Analysis of the use of these criteria in patients with an ICD has shown that arrhythmias detected in the ventricular tachycardia zone are frequently supraventricular (193 supraventricular of 690 tachycardia episodes in 23 of 59 patients). Use of sudden onset was very effective in detecting sinus tachycardia (65 of 67 episodes) and stability was very useful in detecting atrial fibrillation (31 of 32 episodes). However sensitivity in detecting ventricular tachycardia was only 90% (451 of 497 episodes). Application of the sustained, rate duration criteria allowed appropriate treatment of all ventricular tachycardia episodes, increasing sensitivity to 100%; however, specificity in appropriate nontreatment of supraventricular episodes decreased from 96% to 83%. Subsequent analysis of different algorithms showed that sudden onset > 9% and stability < 40 msec was the algorithm with the best specificity and sensitivity. Programming sudden onset and stability detection criteria with a sustained, rate duration safety net for triggering tachycardia therapy results in appropriate device management in most patients with supraventricular and relatively slow ventricular tachycardia.

Adult↗
PubMed2006

Transcriptional basis of lymphocyte tolerance.

Signaling through lymphocyte antigen receptors has the potential to initiate several distinct outcomes: proliferation, differentiation, apoptosis, or functional unresponsiveness. Expansion and differentiation of effector T cells is required for defense against foreign antigens, whereas functional unresponsiveness, termed anergy, is a cell-intrinsic mechanism that contributes to peripheral self-tolerance. Other mechanisms of peripheral tolerance include the 'dominant' tolerance imposed by regulatory T cells and immunosuppression mediated by interleukin-10 and transforming growth factor-beta. T- and B-cell antigen receptor ligation induces an increase in intracellular calcium levels as well as activating additional signaling pathways that are further potentiated by costimulatory receptors. In this review, we argue that cell-intrinsic programs of peripheral anergy and tolerance are imposed by sustained calcium signaling in lymphocytes. We address in particular the role of the calcium-dependent transcription factor nuclear factor for activation of T cells, which is activated by antigen receptor stimulation and, depending on the presence or absence of input from its transcriptional partner, activator protein-1, dictates two distinct transcriptional programs: activation or tolerance.

Animals↗
PubMedDate not supplied

Nurse visitation for adolescent mothers: two-year infant health and maternal outcomes.

BACKGROUND: Children of adolescent mothers have higher rates of morbidity and unintentional injuries and hospitalizations during the first 5 years of life than do children of adult mothers. OBJECTIVE: The purpose of this study was to evaluate the 2-year postbirth infant health and maternal outcomes of an early intervention program (EIP) of home visitation by public health nurses (PHNs). METHODS: In a randomized controlled trial, a sample of predominantly Latina and African American adolescent mothers was followed from pregnancy through 2 years postpartum. The experimental group (EIP, n = 56) received preparation-for-motherhood classes plus intense home visitation by PHNs from pregnancy through 1 year postbirth; the control group (TPHNC, n = 45) received traditional public health nursing care (TPHNC). Health outcomes were determined based on medical record data; other measures evaluated selected maternal behaviors, social competence, and mother-child interactions. RESULTS: The total days of non-birth-related infant hospitalizations during the first 24 months was significantly lower in the EIP (143 days) than the TPHNC group (211 days) and episodes of hospitalization were fewer; more EIP than THHNC infants were never seen in the emergency room. The EIP mothers had 15% fewer repeat pregnancies in the first 2 years postbirth than TPHNC mothers. The TPHNC mothers significantly increased marijuana use over time, whereas EIP mothers did not. CONCLUSIONS: The EIP improved in selected areas of infant and maternal health, and these improvements were sustained for a period of 1 year following program termination. These findings have important implications for healthcare services.

Adolescent↗
PubMed1992

Significance of ventricular arrhythmias in systemic hypertension with left ventricular hypertrophy.

Hypertensive patients with the electrocardiographic (ECG) pattern of left ventricular (LV) hypertrophy and strain are at increased risk of sudden death. It has been suggested that ventricular arrhythmias may be responsible. The prevalence and significance of ventricular arrhythmias was therefore studied in 90 hypertensive patients with LV hypertrophy and strain by undertaking 48-hour ambulatory ECG monitoring, ECG signal-averaging and programmed ventricular stimulation. Complex ventricular ectopic activity (Lown grade greater than or equal to 3) was detected in 59 patients (66%). Eleven patients (12%) had episodes of nonsustained ventricular tachycardia. There were no sustained arrhythmias either on ambulatory ECG monitoring or induced by programmed ventricular stimulation. Only 1 patient had ventricular late potentials recorded by the signal-averaged electrocardiogram. Therefore, there was little to suggest an underlying arrhythmogenic substrate in these patients. In conclusion, whereas ventricular arrhythmias occur often in patients with LV hypertrophy associated with systemic hypertension, their significance, if any, remains to be established.

Adult↗
PubMed1994

Development of clinical methods for utilization review in psychiatric day treatment.

When a time-limited day treatment program was reconfigured to serve individuals with long-standing psychotic disorders, the number of treatment episodes exceeding six months rose to 70%. To justify this concentration of resources, the program needed methods to identify individuals for whom sustained treatment was appropriate. This report describes development of utilization review methods adapted to publicly funded day treatment of individuals with serious mental illness and training of clinicians in new documentation skills. Data from three years of operation suggest that symptom severity is not a reliable indicator of medical necessity in day treatment. As expected with a clinically based system, a composite measure of benefit and medical necessity indicators weighted toward functioning in living, learning, working, and socializing environments predicted physician reviewer denial of continued day treatment, but length of stay did not.

Day Care, Medical↗
PubMed1992

The automatic implantable cardioverter-defibrillator. Long-term clinical experience and outcome at a hospital without an open-heart surgery program.

From November 1982 through April 1989, 111 patients with refractory sustained ventricular tachycardia/fibrillation had the automatic cardioverter-defibrillator implanted at our institution, the first community hospital involved in implantation of such a device. We have reviewed our long-term clinical experience to assess the feasibility, learning curve, and efficacy of device implantation in a facility with cardiac electrophysiology expertise but without open-heart surgery facilities. All patients were considered inoperable or at high risk for other concomitant surgery. Eighty-six patients (77%) underwent uneventful implantation. Nine patients (8%) died prior to hospital discharge. Operative mortality declined from 10.9% to 5.4% during the first half (55 patients; November 1982 through September 1986) and second half (56 patients; October 1986 through April 1989) of the experience. Other postoperative complications occurred in 16 patients (14%), 12 of whom experienced complications during the first half of the experience. At 22 +/- 20 (mean +/- SD) months' follow-up, 78 (76%) of 102 patients discharged were alive, and 24 patients (24%) had died. Fifty patients (49%) had experienced at least one automatic cardioverter-defibrillator discharge associated with hypotensive symptoms. The actuarial incidence of sudden death at 1, 2, and 3 years was 1.2%, 5.5%, and 6.2%, respectively. We concluded that the automatic implantable cardioverter-defibrillator is an effective therapy for refractory ventricular tachycardia/fibrillation and that device implantation at community hospitals with an experienced cardiac electrophysiology team is both feasible and practical.

Adult↗
PubMed2004

Trend analysis of minority student enrollment in graduate health management education programs: implications for the field.

The need for broad representation of minorities in healthcare management has been an on-going concern for healthcare administrators and professional organizations such as the National Association of Health Services Executives (NAHSE), and the American College of Healthcare Executives (ACHE). Despite the best intentions of healthcare organizations, many have failed to attain a desired racial and ethnic balance in the composition of their senior-level management ranks. This problem will persist unless there is a sustained and collaborative effort between the healthcare professional associations and organizations and the educational programs, especially programs affiliated with the Association of University Programs in Health Administration (AUPHA). Using enrollment data published in the AUPHA directory, this paper examines the enrollment trends of minority students in graduate programs in health management education. The results of this investigation reveal an upward trend in minority student enrollment and that graduate programs with high minority enrollment are located in geographical areas with high minority populations. Suggestions to further increase and sustain minority student enrollment in graduate health management educational programs are advanced.

Career Choice↗
PubMed1985

Comparison of buccal nitroglycerin and oral isosorbide dinitrate for nitrate tolerance in stable angina pectoris.

Sixteen patients with chronic stable angina pectoris were studied to compare the hemodynamic and antianginal effects of buccal nitroglycerin (GTN) in a dose of 3 mg administered 3 times daily and oral isosorbide dinitrate (ISDN) in a dose of 30 mg administered 4 times daily. Compared with placebo, both oral ISDN and buccal GTN treatment induced a decrease in systolic blood pressure at rest over a 5-hour period during acute but not during sustained therapy. Neither buccal GTN nor oral ISDN modified the changes in systolic blood pressure during exercise. Both treatment programs were associated with a higher exercise heart rate during acute therapy. During sustained treatment with buccal GTN, the heart rate during exercise remained greater than that during placebo throughout the 5-hour test period, but during treatment with oral ISDN, only the exercise heart rate at 1 hour was greater than that seen with placebo. Treadmill walking time to the onset of angina and to the development of moderate angina increased significantly during acute therapy with both buccal GTN and oral ISDN. The clinical efficacy of buccal GTN was maintained after 2 weeks of 3-times-daily therapy. In contrast, during 4-times-daily therapy with oral ISDN, treadmill walking time was prolonged for only 1 hour after drug administration. This investigation indicates that tolerance develops during 4-times-daily therapy with oral ISDN, but 3 times daily therapy with buccal GTN is not associated with diminished antianginal effects.

Aged↗
PubMedDate not supplied

Psychopathological symptomatology in brain-injured patients before and after a rehabilitation program.

The Symptom Checklist-90 revised (SCL-90-R) was used to evaluate subjective experience of psychopathological symptomatology in 30 patients before and after an intensive four-month neuropsychological rehabilitation program and again one year after completion of the program. The patients were all adults and had suffered acute brain injury as a result of head injury (37%), cerebro vascular accident (37%), anoxia (16%) or other causes (10%). Most had entered the program within two years after injury and at that time they showed slight to moderate elevation on all ten scales of the SCL-90-R. At program completion eight of the scales showed significant or near significant reductions. There were only small and non-significant changes in the scales between program completion and one year follow-up. Among the individual items of the SCL-90-R, the most common complaints related to cognitive difficulties and depression. The same pattern of sustained improvement was largely found for these items. Overall the results suggest, first, that the subjectively perceived distress in the brain-injured patient is diminished by the rehabilitation program, and second, that this reduction sustained at least up to one year following the completion of the program.

Journal Article↗