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PubMed1991

The surgical treatment of atrial fibrillation. II. Intraoperative electrophysiologic mapping and description of the electrophysiologic basis of atrial flutter and atrial fibrillation.

Computerized mapping of atrial fibrillation was performed in animals and man. To study atrial fibrillation in a systematic manner, we developed a clinically relevant experimental model of atrial fibrillation. Chronic mitral regurgitation was created surgically in 25 dogs without opening the pericardium. After several months of chronic mitral regurgitation, the atria became enlarged and sustained atrial fibrillation could be induced by standard programmed electrical stimulation techniques. Computerized isochronous activation maps of the atria were recorded during atrial fibrillation from 208 bipolar electrodes simultaneously. In a parallel study, human atrial fibrillation was mapped with a separate 160-channel intraoperative mapping system in patients with paroxysmal atrial fibrillation who were undergoing surgical correction of the Wolff-Parkinson-White syndrome. The canine activation sequence maps demonstrated a spectrum of rhythm abnormalities ranging from simple atrial flutter to complex atrial fibrillation. They also showed that macroreentrant circuits within the atrial myocardium were responsible for the entire spectrum of arrhythmias. Atrial reentry was also documented during human atrial fibrillation. All patients had nonuniform conduction around regions of bidirectional block in both atria resulting in multiple discrete wave fronts. In addition, six patients had a single reentrant circuit in the right atrium in which bidirectional block of the activation wave front occurred along the sulcus terminals between the venae cavae. The left atrium in all patients demonstrated multiple wave fronts and conduction block, but left atrial reentry could not be detected. Both the experimental study and the clinical study demonstrated that multiple wave fronts, nonuniform conduction, bidirectional block, and large (macroreentrant) reentrant circuits occur during atrial fibrillation. The presence of macroreentrant circuits and the absence of either microreentrant circuits or evidence of atrial automaticity suggests that atrial fibrillation should be amenable to surgical ablation.

Adult↗
PubMed1990

A comparison of smoking patterns in the People's Republic of China with the United States. An impending health catastrophe in the middle kingdom.

Half of the global increase in tobacco use from 1976 to 1986 occurred in the People's Republic of China. In 1984, the first national smoking survey was conducted in China, involving over a half-million subjects. Sixty-one percent of Chinese males over age 15 smoke, with higher rates in all occupational groups than for corresponding groups in the United States. Current smoking patterns in China are similar to those in the United States during the 1950s, and these patterns forecast a steadily increasing epidemic of smoking-related deaths. It is estimated that by 2025, two million Chinese men will die annually from smoking. Foreign tobacco companies are mounting massive production and advertising campaigns in China. Government health education programs lack funds to counter these influences with sustained and comprehensive educational and interventional campaigns. To avert an impending national health catastrophe, China must launch a comprehensive smoking-control initiative aimed at public education, cessation, and legislation and policy.

Adolescent↗
PubMed1987

Adolescent obesity intervention: validation of the SHAPEDOWN program.

The effectiveness of the adolescent obesity intervention SHAPEDOWN was evaluated for 15 months through a randomized experimental design study. Test groups (no. = 37) participating in the intervention were compared with a no-treatment control group (no. = 29) at four sites in northern California. The program employs a variety of cognitive, behavioral, and affective techniques adapted to make successive small modifications in diet, exercise, communication, and affect that are sustainable. Very-low-calorie or restrictive diets are avoided in the program. Parents are instructed on strategies for supporting their adolescents' weight-loss efforts. Participation in the group application of the program was associated with significant improvement in relative weight, weight-related behavior, depression, and knowledge of weight management concepts at post-treatment and at 1-year follow-up. Self-esteem increased significantly regardless of condition. Change in relative weight for the test group was -9.9 +/- 14.9% (mean +/- standard deviation) and for the control group was -0.10 +/- 13.2%. At month 15 of the study period, weight change in the test group compared with the controls was -5.15 kg. For all subject variables examined in the test group, mean change in relative weight at 1-year follow-up was negative, suggesting that none of the characteristics examined contraindicate program participation among obese adolescents seeking care. Drop-out rate was 16%. The study suggests that the program produces significant long-term outcomes in obese adolescents and is transferable to a variety of settings.

Adolescent↗
PubMed1993

Establishing the epidemiologic basis for prevention of cardiovascular diseases in Africa.

A child born today in the rich countries of the world will inherit the expectation of living into the mid-70s. In Africa, of those surviving to the age of 5 years, the expectation of reaching the mid-50s remains in doubt. Inequality in the opportunity to experience life itself remains the cruelest inequality of all. As in many other fields, the technological experience accumulated by the economically wealthy countries can be put to useful purposes in underdeveloped regions. Given the longer history of chronic disease epidemiology in wealthy societies, much has been learned and many successes have been achieved. These lessons are, to a large extent, exportable. An opportunity to avoid the transition to high rates of CVDs and cancer therefore exists through implementation of primary prevention programs. Despite the competing priorities, a coordinated and sustained effort to achieve this goal should be initiated without further delay.

Adult↗
PubMedDate not supplied

Case study of the integration of a local health department and a community health center.

As rural communities struggle to sustain health services locally, innovative alternatives to traditional programs are being developed. A significant adaptation is the rural health network or alliance that links local health departments and community health centers. The authors describe how a rural local health department and community health center, the core organizations in publicly sponsored primary care, came to share a building and administrative and service activities. Both the details of this alliance and its development are examined. The case history reveals that circumstance and State involvement were the catalysts for service integration, more so than the need for or the benefits of the arrangement. The closure of a county-owned hospital created a situation in which State officials were able to broker a cooperative agreement between the two agencies. This case study suggests two hypotheses: that need for integrated services alone may not be sufficient to catalyze the development of primary care alliances and that strong policy support may override any local and internal resistance to integration.

Community Health Centers↗
PubMed1999

[Control of the transmission of Trypanosoma cruzi in Argentina 1999].

Approximately 2 million people in Argentina are infected with Trypanosoma cruzi, the etiologic agent of Chagas disease, thereby constituting the major tropical disease in the country. As in other six Southern Cone countries, Triatoma infestans is the only or major vector of T. cruzi among human and domestic animals. In Argentina, a vertically structured National Chagas Control Program was established in 1962. Such a program pursued the elimination of domestic and peri-domestic populations of T. infestans through insecticidal spraying, and the serological control of blood donors to prevent transfusion-related infections. This program strongly reduced the nation-wide serological prevalence of T. cruzi in the population. For example, in 18 or 20 year-old men drafted into military service, the seroprevalence decreased from 10.1% in 1964 for those who had been born in 1944 to 1.9% in 1993 for those born in 1975. However, the vertical strategy failed to reach and sustain the surveillance phase in widespread rural areas with disperse populations due to its intrinsic limitations and the reduced priority level assigned to rural health programs. An alternative, horizontally-structured control strategy of T. infestans was developed and assayed in the Province of Santiago del Estero between 1985-1989, and 1991-1992. The projects demonstrated that insecticidal spraying carried out with community participation combined effectiveness and commitment in such a way as to produce a strong impact on house reinfestation and the extension of the area under entomological surveillance. This experience has been transferred in a chain of responsibilities to the personnel of the National Chagas Control Program, using participating workshops, procedural guidelines, and practical training. This personnel transferred the strategy using similar methods to the field health care agents and volunteers chosen by their own communities (community leaders). After the workshops, the leaders received all the materials needed to install and develop the ongoing surveillance activities: third generation pyrethroid insecticides, manuals, hand-operated sprayers, and sensor boxes to detect domiciliary infestations. From 1993 to 1998, a total of 15,000 health care agents or community leaders were trained. A total of 675,000 houses were sprayed with residual insecticides in the attack phase, and 850,000 houses entered the surveillance phase. This is the first time that such large coverage has been accomplished in Argentina. The network of laboratories installed a quality assurance program to current serological procedures applied to blood donors, organ transplant, and the detection and treatment of newborns to women sero-reactive for T. cruzi in Argentina. We expect to interrupt the vector-mediated transmission of T. cruzi in the next 18 months, but the sustainability of such a program depends on, at least, additional work with the community to achieve a change of attitudes and practices related to house infestation for the next 10 years. A social effort will be needed to cover those expenses, but the expected economic returns exceed largely the cost of any such program, as suggested by cost-benefit studies. To illustrate, the annual treatment costs of one Chagas patient can help maintain 25 households free from triatomine bugs in Argentina.

Adult↗
PubMed1991

Muscle rehabilitation: its effect on muscular and functional performance of patients with knee osteoarthritis.

Muscle function and functional performance are limited in patients with osteoarthritis (OA). Although aerobic exercise can increase aerobic power and reduce fatigue, it does not appear to improve muscle function. The purpose of this study was to demonstrate the effect of a muscle rehabilitation program on muscle strength, endurance, speed, and function for patients with OA of the knees. Fifteen men (67.6 +/- 6.1 years) with OA of the knees underwent a four-month exercise program, three times per week. Muscle strength, endurance, and speed were 50% less in OA patients than in controls. After rehabilitation, there was a significant increase in strength (35%), endurance (35%), and speed (50%). Deficiencies and improvements in the muscles were greater at longer muscle lengths. Increases in muscle function were associated with decreased dependency (10%), difficulty (30%), and pain (40%). The average increase in all measured parameters was 10% and 25% after two and four months of rehabilitation, respectively. Improvements were sustained for eight months after rehabilitation. The muscle rehabilitation program was designed specifically to improve function; the improved muscle function was translated into improved functional performance.

Aged↗
PubMedDate not supplied

A community expands access to health care: the case of access health in Michigan.

Access Health, a Michigan-based "three-share plan," is viewed as a successful community-based approach to expanding health benefits in the workplace. It was the stimulus for recently proposed legislation to federally fund similar plans nationally. The program evolved with the support of the W.K. Kellogg Foundation. Its sustained viability is attributable in part to the creative use of a state statute to draw down federal Medicaid disproportionate-share hospital (DSH) funds. Although it faces obstacles common to programs of its type, the program's greatest financial vulnerability rests on the uncertain continued availability of the monies it uses to subsidize the program.

Community Participation↗
PubMed1991

Programmed death of nonproliferating androgen-independent prostatic cancer cells.

Androgen ablation induces an energy-dependent process of programmed death in nonproliferating androgen-dependent prostatic cancer cells which involves fragmentation of genomic DNA into nucleosomal oligomers catalyzed by nuclear Ca2+, Mg(2+)-dependent endonuclease enzymes activated following a sustained elevation in intracellular free Ca2+ (Cai). In contrast, androgen-independent prostatic cancer cells are not induced to undergo such programmed cell death by androgen ablation. One explanation for the inability of androgen ablation to induce programmed death of androgen-independent prostatic cancer cells is that such ablation does not result in a sustained elevation in Cai in these cells. This raises the issue of whether androgen-independent prostatic cancer cells can be induced to undergo programmed death if an elevation in the Cai is sufficiently sustained by nonhormonal means. To test this possibility, androgen-independent, highly metastatic Dunning R-3327 AT-3 rat prostatic cancer cells were chronically exposed in vitro to the calcium ionophore ionomycin to sustain an elevation in their Cai. These studies demonstrated that an elevation of Cai as small as only 3-6-fold above baseline can induce the death of these cells if sustained for greater than 12 h. Temporal analysis demonstrated that the death of these cells does not require cell proliferation and involves Ca(2+)-induced fragmentation of genomic DNA into nucleosome-sized pieces as the commitment step in this process. These results demonstrate that even nonproliferating androgen-independent prostatic cancer cells can be induced to undergo programmed cell death if a modest elevation in the Cai is sustained for a sufficient time. These observations identify Cai as a potential target for therapy for androgen-independent prostatic cancer cells.

Calcium↗
PubMed2003

Maintenance of effects of the CATCH physical education program: results from the CATCH-ON study.

Long-term maintenance effects of physical education (PE) curriculum and staff development programs have not been studied. The authors assessed the sustainability of the Child and Adolescent Trial for Cardiovascular Health (CATCH) PE intervention using direct observations of 1,904 PE lessons in former intervention and control schools in four U.S. states 5-years postintervention. Student physical activity levels, lesson contexts, and level of CATCH PE training of teachers were analyzed. Student energy expenditure levels and proportion of PE time in moderate-to-vigorous physical activity in intervention schools were maintained 5 years later, but vigorous activity declined sharply. Meanwhile, postintervention gains in former control schools, influenced by delayed program implementation and secular trends, resulted in a convergence of activity levels in intervention and control schools. Use of CATCH PE curricula was associated with increased levels of teacher training and school support for PE in both former intervention and control schools.

Child↗
PubMed2002

Initiating malaria control programs in the third world: directives for short- and long-term solutions.

Although malaria is a growing problem affecting several hundred million people each year, many malarial countries lack successful disease control programs. Worldwide malaria incidence rates are dramatically increasing, generating fear among many people who are witnessing malaria control initiatives fail. In this paper, we explore two options for malaria control in poor countries: (1) the production and distribution of a malaria vaccine and (2) the control of mosquitoes that harbor the malaria parasite. We first demonstrate that the development of a malaria vaccine is indeed likely, although it will take several years to produce because of both biological obstacles and insufficient research support. The distribution of such a vaccine, as suggested by some economists, will require that wealthy states promise a market to pharmaceutical companies who have traditionally failed to investigate diseases affecting the poorest of nations. But prior to the development of a malaria vaccine, we recommend the implementation of vector control pro- grams, such as those using Bti toxin, in regions with low vector capacity. Our analysis indicates that both endogenous programs in malarial regions and molecular approaches to parasite control will provide pragmatic solutions to the malaria problem. But the successful control of malaria will require sustained support from wealthy nations, without whom vaccine development and vector control programs will likely fail.

Animals↗
PubMed1999

Worksite influenza immunization. Successful program.

The planning, implementation, and evaluation of worksite health promotion programs can benefit from adapting and using the steps in each phase of the PRECEDE-PROCEED model. The model provides a framework to build and sustain support from employers and employees, and a valuable tool to increase program efficiency, effectiveness, and accountability. During the PRECEDE phases of planning, the model provides opportunities for continuous communication and feedback to all levels of management. The evaluation phases in PROCEED provide occupational health nurses with valuable information to share with corporate planners, influence management behavior, and contribute to evidence based decisions for future programming.

Humans↗
PubMed1984

[Programmed stimulation in patients with malignant ventricular arrhythmias. I: Diagnostic value].

Sudden cardiac death is a leading cause of death in industrially developed countries and accounts for approximately 90 000 deaths yearly in the FRG. While the majority of victims have severe coronary heart disease, sudden cardiac death is infrequently caused by acute myocardial infarction (20%) but is predominantly related to malignant ventricular arrhythmias (i.e., ventricular fibrillation or sustained ventricular tachycardia). Patients with a history of such malignant ventricular arrhythmias are at high risk for sudden death. Spontaneous occurrence of sustained ventricular tachycardia and of ventricular fibrillation is critically related to two factors: 1. trigger-arrhythmias consisting usually of complex ventricular extrasystoles (Lown classification IV to V); 2. increased vulnerability of the myocardium representing the target organ for trigger-arrhythmias. While trigger-arrhythmias can be easily recorded by noninvasive techniques including Holter monitoring or exercise and stress ECG, ventricular vulnerability is more difficult to determine and often requires ventricular stimulation with intracardiac electrocatheters. In patients with documented spontaneous malignant ventricular arrhythmias, two aspects of programmed stimulation must be considered: 1. diagnostic, and more importantly, 2. therapeutic purposes of this method. Diagnostic purposes include determination of the mode of initiation and unequivocal ventricular localization of the tachycardia excluding other arrhythmias with broad QRS complex. In patients with spontaneous sustained ventricular tachycardia, programmed stimulation can reproducibly initiate the clinical arrhythmia in 85% (sensitivity and specificity of the method approximately 90%). In patients with cardiac arrest due to ventricular fibrillation, programmed stimulation is less reliable (50%). However, the main purpose of programmed stimulation in patients with documented clinical malignant arrhythmias is not diagnostic or prognostic evaluation but is serial electrophysiological studies for individual optimization of antiarrhythmic therapy.

Arrhythmias, Cardiac↗
PubMed1995

Public education projects in skin cancer. Experience of the Canadian Dermatology Association.

The mandate of the Canadian Dermatology Association's Sun Awareness Program is to increase awareness of the dangers of the sun's ultraviolet (UV) rays and to provide information on prevention and early detection of skin cancer. Major projects include an annual national press campaign, which reaches an increasing number of Canadians each year, and the production and distribution of educational materials. Each year during Sun Awareness Week, screening stations have been established across the country, staffed by volunteer dermatologists and members of the Canadian Cancer Society. In Vancouver between 1991 and 1993, 1767 people were screened for skin cancer. Results indicate that these events can attract people at risk for skin cancer, even though people older than age 65 are probably underrepresented as a group. Although popular with the public, these screenings are difficult to organize and are limited by human resources. These events continue in limited numbers, because they provide an excellent venue for the dissemination of educational material. Cooperation with federal agencies has been a major focus of the program. For the past 2 years, educational material on protecting newborns and children from the sun has been made available free to every new mother in Canada, while Environment Canada's Ultraviolet index program provides daily information on UV intensity along with public health messages. With the realization that health promotion requires a sustained change in behavior of an individual, we are now embarking on a national program to evaluate the knowledge, attitudes, and behavior of Canadians concerning UV radiation. With this information, we hope to adapt our educational materials so that people will adopt and maintain healthy behavior choices while out in the sun.

Adolescent↗
PubMed1984

[Treatment of morning migraine. Clinical and biokinetic correlation of programmed-release dihydroergotamine].

The authors have tested a new preparation of dihydroergotamine (microgranules in a capsule) by comparing the clinical results obtained in 30 patients suffering from morning migraine with the plasma levels of the active substance measured in 8 healthy subjects. The microgranules were administered in doses of 30 mg/24 hours and compared with a similar dose of a dihydroergotamine solution. The close correlation observed between sustained plasma levels and prolonged therapeutic effects indicates a truly programmed delivery of dihydroergotamine by the microgranule preparation.

Adolescent↗
PubMed1992

Prediction of antiarrhythmic efficacy of class I and III agents in patients with ventricular tachycardia by signal-averaged ECG analysis.

The effects of procainamide and dofetilide (pure Class III antiarrhythmic agent) on the signal-averaged ECG (SAECG) were examined in relation to the results of programmed ventricular stimulation studies in 25 patients with inducible sustained monomorphic ventricular tachycardia. Procainamide prolonged significantly the total QRS and low amplitude signal durations (140 +/- 31 msec vs 166 +/- 48 msec, P < 0.0001; 50 +/- 25 msec vs 65 +/- 38 msec, P < 0.002, respectively) whereas the root mean square voltage of the last 40 msec of the QRS complex was significantly reduced (22 +/- 21 microV vs 13 +/- 12 microV, P < 0.006). Procainamide was effective (prevention of the inducibility of sustained ventricular tachycardia or prolongation of the cycle length of ventricular tachycardia by > 100 msec) in 15 of 27 drug trials. Of the procainamide induced SAECG changes, the fractional prolongation of the total QRS duration was the best parameter that identified effectively treated patients (24% +/- 16% in responders vs 10% +/- 11% in nonresponders, P < 0.014). A fractional prolongation of the total QRS duration by > 15% identified effectively treated patients with a sensitivity of 87%, specificity of 81%, and an overall predictive accuracy of 84%. Dofetilide did not change the SAECG, and no SAECG parameter predicted the results of programmed ventricular stimulation. The effects of both drugs on the spectral analysis (area ratios) and on the spectral temporal mapping (the values of normality factor) of the SAECG were not consistent. In conclusion, antiarrhythmic efficacy of procainamide can be predicted by the degree of drug induced prolongation of the signal-averaged QRS complex.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Arrhythmia Agents↗
PubMed1988

Antiarrhythmic and arrhythmogenic actions of methyl lidocaine during the recovery phase after canine myocardial infarction.

Programmed electrical stimulation was used to evaluate the electrophysiologic and antiarrhythmic actions of methyl lidocaine in both conscious and anesthetized dogs, 4-7 days after myocardial infarction. When administered to animals demonstrating sustained ventricular tachycardia (n = 6), methyl lidocaine (5 and 10 mg/kg i.v.) prevented the induction of the original ventricular tachycardia in 2 dogs, and in the remaining 4 dogs slowed the tachycardia (cycle length 163 +/- 18 ms vs. 198 +/- 11 and 219 +/- 11 ms, respectively, p less than 0.05). New morphologic forms of sustained tachycardia were observed after drug administration in 4 of 6 experiments. When administered to animals developing only nonsustained ventricular tachycardia or no arrhythmias with programmed stimulation, methyl lidocaine administration enabled programmed stimulation to produce monomorphic sustained ventricular tachycardia in 10 of 13 experiments. The drug increased activation delays in both normal and ischemically injured epicardium, with larger activation delays always observed in ischemically injured tissue. The drug increased refractoriness in ischemically injured myocardium without altering refractoriness in normal tissue. The data suggest that the depression of conduction and prolonged refractoriness produced by methyl lidocaine in ischemically injured tissue may extinguish or slow some forms of ventricular arrhythmia while promoting the formation of new reentry pathways.

Animals↗
PubMed1992

Evaluation of a program to prevent head and spinal cord injuries: a comparison between middle school and high school.

This study was designed to test whether the Oregon THINK FIRST-Head and Spinal Cord Injury Prevention Program, developed for the high school audience and previously shown to have a beneficial effect, would have the same effect on students in middle school. During the spring of 1989, four schools (two high schools and two middle schools) participated. Two weeks before and after the presentation of the THINK FIRST program, 830 student questionnaires were distributed in classrooms. Questionnaire items were designed to measure knowledge, attitude, behavior, and demographic features. There was a significant difference between high school and middle school students on pretest knowledge (P = 0.0001). The average knowledge increase among all students was 0.81 correct responses (95% confidence interval: +/- 0.22) among 15 questions. The increment in knowledge did not differ significantly (P = 0.37) between high school and middle school students. One-way analysis of variance revealed no significant differences in pretest knowledge or knowledge increase associated with membership in Students Against Drunk Driving or acquaintance with someone having sustained a head or spinal cord injury. After the program, students were more likely to believe that there were actions they could take to keep from getting injured (P less than 0.0001). However, there was no change in self-reported seat belt use and most students reported that they "never" wore a bike helmet. The findings suggest that the THINK FIRST program is appropriate and beneficial for viewing by middle school-aged students.

Adolescent↗