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PubMed2003

[Sheltering: whose responsibility is it? An experience report].

This paper is about the sheltering of users in a basic health unit in Porto Alegre/RS according to the experience during the Integrated Residency Program in Collective Health at the Public Health School and reflections about specific bibliography. Sheltering is the manner in which the health service is organized to attend to its users and to answer their demands, relying on health education processes aiming to build a different relation than that established in "emergency rooms". It is believed that the nurse is the professional indicated for this task because of its basic education in collectivity and integralized human care.

Attitude of Health Personnel↗
PubMed1996

Developing effective strategies for malaria prevention programs for pregnant African women.

The control of malaria in pregnant African women, one of several child survival strategies applied through antenatal care, has been particularly challenging. Prevention and control recommendations for typical areas of high Plasmodium falciparum transmission have promoted the use of antimalarial chemoprophylaxis to prevent placental infection. Persistently low program coverage coupled with diminishing intervention effectiveness have forced a re-evaluation of the relative importance of malaria in pregnancy. The Mangochi Malaria Research Project (MMRP), a prospective evaluation of malaria prevention in pregnant women in rural Malawi conducted during 1987-1990, contributed to establishing new criteria for policy and program development for malaria prevention in pregnancy. The principle findings of the MMRP include: 1) populations at risk of the adverse consequences of malaria in pregnancy include women with low parity, women infected with human immunodeficiency virus, pregnancy during the high malaria transmission season, and the use of a malaria drug that is suboptimally efficacious; 2) the estimated maximum benefits of an antimalarial intervention that clears placental and umbilical cord parasitemia are a 5-12% reduction of low birth weight (LBW), an approximately 35% reduction in the risk of LBW for risks that are actually preventable once a woman has become pregnant (e.g., risks such as infectious disease or poor nutrition during gestation), and a 3-5% reduction in the rate of infant mortality; 3) the intervention must be capable of rendering the woman malaria parasite free, including clearance of parasites from the placental vascular space and umbilical cord blood; 4) other diseases adversely affect pregnancy outcome and, while the control of malaria in pregnancy may not warrant independent programming, if coupled with prevention programs to provide a range of antenatal services, the incremental costs of malaria control may prove to be highly cost-effective; and 5) the choice of a regimen must balance intervention efficacy with safety, availability, affordability, and simplicity of delivery, and several antimalarials may meet these criteria. The Malawi Ministry of Health has modified its malaria prevention in pregnancy recommendations and now faces the challenge of effective programming to improve child survival.

Africa↗
PubMed2001

Aerobic and anaerobic performance before and after a short-term body mass reduction program in obese subjects.

The cardiovascular response to an aerobic cycloergometer exercise test (ACET, 15 min at 60 W, 60 rpm) and the maximally attainable muscle power output, assessed by a stair climbing test (SCT), were evaluated in 60 obese patients (41 females and 19 males; age: 18-68 yr; body mass index, BMI: 40.8+/-4.8 kg/m2) before and after a 3-week body mass reduction (BMR) program, entailing integrated energy-restricted diet (1200-1500 kcal/day), low-grade aerobic exercise conditioning and individual and/or group psychological therapy. The daily conditioning protocol (5 days/week) consisted of: 1) 30 min of indoor jogging and dynamic aerobic standing and floor exercises performed with arms and legs, under the guidance of a therapist; 2) 30 min of cycloergometer exercise at 60 W; and/or 3) 4-km outdoor leisure walking on flat terrain. Three weeks of BMR program induced a significant weight loss (-4.5 %; p<0.001), a reduction of systolic (-11+/-14 mmHg, -7.3%,p<0.001) and diastolic (-7+/-9 mmHg, -7.3%,p<0.001) resting arterial blood pressure, as well as a reduction of heart rate at rest (-18.6%,p<0.001), during ACET (-11.3%,p<0.001) and 5 min thereafter (-14.8%,p<0.001). The subjective rating of perceived exertion in terms of breathlessness and general fatigue during ACET, scored on a 0-100 visual analogic scale, was significantly reduced (p<0.001) after BMR program. A 11.2% decrease in SCT time (p<0.001) was also observed, corresponding to a 9.6% increase (p<0.001) in average muscle power (W) and 14.6% increase (p<0.001) in specific muscle power (W.kg(-1)). In conclusion, a combination of energy restricted diet, low intensity aerobic exercise and psychological counselling appears to significantly improve both aerobic and anaerobic performance in morbidly obese subjects. Different factors (ie, reduction of body mass, shift in the balance between parasympathetic and sympathetic activity, a weight-loss dependent shift toward a more favourable region of the muscle power-velocity curve, acquisition of a certain degree of motor skillfulness during the conditioning program, improvement of self-esteem and motivation) might be responsible, alone or in combination, for these short-term positive effects of BMR program.

Adolescent↗
PubMed2006

Improving the retention of underrepresented minority faculty in academic medicine.

BACKGROUND: Although several studies have outlined the need for and benefits of diversity in academia, the number of underrepresented minority (URM) faculty in academic health centers remains low, and minority faculty are primarily concentrated at the rank of assistant professor. In order to increase the diversity of the faculty of the University of California, San Diego (UCSD) School of Medicine, the UCSD National Center for Leadership in Academic Medicine, in collaboration with the UCSD Hispanic Center of Excellence, implemented a junior faculty development program designed in part to overcome the differential disadvantage of minority faculty and to increase the academic success rate of all faculty. METHODS: Junior faculty received counseling in career and research objectives; assistance with academic file preparation, introduction to the institutional culture; workshops on pedagogy and grant writing; and instrumental, proactive mentoring by senior faculty. RESULTS: After implementation of the program, the retention rate of URM junior faculty in the school of medicine increased from 58% to 80% and retention in academic medicine increased from 75% to 90%. CONCLUSION: A junior faculty development program that integrates professional skill development and focused academic career advising with instrumental mentoring is associated with an increase in the retention of URM faculty in a school of medicine.

Academic Medical Centers↗
PubMedDate not supplied

[Adolescent social integration through the "Cuidar cuidando" program].

The "Care Caring program" is a device of social reinsertion, carried out by a multidisciplinary and a multi-institutional practice of more than fifteen years. Those who sustain it, have always presented the necessity of articulating the cure with social reinsertion, therefore the purpose of the Program itself is not only to favour a clinical psychiatric recovery, but also to prompt changes in the manner of social liaison of the children and youngsters taking part. Animal contact in many way produce therapeutic effects. We describe here those we have seen and discuss the "popular" term zootherapy. After 16 years of non stop activity, more than 500 children and adolescents benefited from this innovative experience. We learned also that without broad social integration policies, the devices of reinsertion are limited in their long term effects. Breaking the differentiation circuit is impossible only with these resources. Working out these difficulties will allow us to answer if it is possible to think of strategies of rehabilitation in psychology and psychiatry for infancy and adolescence using communal resources.

Adolescent↗
PubMed1991

HIV/AIDS education in a prenatal clinic: an assessment.

An HIV/AIDS education and counseling program was integrated into the routine medical care of women attending the prenatal clinic of a major urban, inner-city, teaching hospital that serves mostly indigent minority women in an area hard hit by the HIV/AIDS epidemic. Pre- and post-intervention questionnaires were administered to a consecutive historical Control Group (n = 98) who did not receive the HIV/AIDS information and an Intervention Group (n = 515) who received all information. The data support our hypothesis that an HIV/AIDS education program would increase the level of general knowledge, but fail to support our hypothesis of a positive effect on attitudes around HIV-antibody testing and an increase in desire for voluntary testing. Our hypothesis that women reporting more risk behaviors would be more likely to agree to HIV-antibody testing was only partially supported.

Acquired Immunodeficiency Syndrome↗
PubMed1980

Considering the use and usefulness of juvenile detention: operationalizing social theory.

Detention can be a tool provided the juvenile caseworker. Current use depends largely upon professional judgments operating within a framework of laws and broad guides. Overuse and misuse would indicate that practitioners need more helpful guides for sound detention. Failure to recognize the impact of detention upon children and their families prohibits employment of sound, principled casework approaches. Objective research and evaluation of the effects of detention is needed. It may be that the use of juvenile detention should be diminished. Meanwhile, social casework experience suggests methods and techniques useful to those willing to adapt. In Respect to Intake: 1. Only the most seriously disturbed children should be detained in the first place. This requires stringent intake policies. 2. Every effort should be made to work with the children in the community and in their own home if possible rather than sending them to detention. Detention as a Helping Process: When the detention community is fulfilling its philosophy and stated purposes in helping adolescents, the following contributions are possible: 1. A system of controls or limits to protect both the child and the community while insuring the child's legal rights. 2. A life experience which enables the child to be studied in his physical, social-emotional, and spiritual dimensions. 3. Resources such as a program, personnel, and facilities especially equipped and oriented to meet both the normal and special physical, social and emotional needs during a time of crisis in the child's life. 4. A sociological climate conducive to working on the problems of the detained child through understanding, acceptance, consistency, limits, structure, and individual and group counseling which together provide emotional security and first aid and enable the child to have constructive experiences contributing to personality growth. 5. A sound and integrated detention program outlining and specifying the limited treatment goals for each child. If the detention community is to provide a sociologically healthy climate, and discharge its responsibilities to the child, the community, and the law for protecting both the best interest of the child and the community, then opportunities for furthering the child's growth and development must be made available; and the nature and quality of the detention experience rather than its limited or extended duration, must be the primary consideration.

Adolescent↗
PubMedDate not supplied

Suppression of transmission of malaria through source reduction: antianopheline measures applied in Israel, the United States, and Italy.

To provide a conceptual basis applicable to future antimalarial efforts, we sought to identify the sources of success in three notable campaigns that were consummated largely before DDT became available. A variety of measures directed against the aquatic stages of the anopheline vectors provided the main strategy for the antimalarial programs in Palestine/Israel, Italy, and the Tennessee River Valley of the United States. Source reduction-the modification or elimination of aquatic habitats to reduce mosquito breeding-was applied extensively and proved decisive. In all three regions, transmission of malaria was reduced to the point of extinction. Effective measures against anopheline larvae, in particular through source reduction, depend upon locally derived ecologic concepts that can be adapted to each vector species and applied continuously without limit of time. An integrated control program based on the long-term application of such measures can suppress transmission of malaria in edemic areas, as well as contain episodes of locally increased transmission of malaria.

Animals↗
PubMed1991

Managing for change: a departmental quality improvement program (QIP).

The development and implementation of an integrated Quality Improvement Program (QIP) for the Department of Surgery at The Hospital for Sick Children was approached as a problem-solving process by which departmental managers could bring about change so that actual results would align more closely with desired outcomes. A planned and systematic process was developed, through which managers are able to reach decisions about when and where to make useful changes that result in improved quality of care and services provided. Three useful techniques were employed: team-building, continuing education and quality circles.

Education, Continuing↗
PubMed2002

Interaction between smooth anticipation and saccades during ocular orientation in darkness.

A saccade triggered during sustained smooth pursuit is programmed using retinal information about the relative position and velocity of the target with respect to the eye. Thus the smooth pursuit and saccadic systems are coordinated by using common retinal inputs. Yet, in the absence of retinal information about the relative motion of the eye with respect to the target, the question arises whether the smooth and saccadic systems are still able to be coordinated possibly by using extraretinal information to account for the saccadic and smooth eye movements. To address this question, we flashed a target during smooth anticipatory eye movements in darkness, and the subjects were asked to orient their visual axis to the remembered location of the flash. We observed multiple orientation saccades (typically 2-3) toward the memorized location of the flash. The first orienting saccade was programmed using only the position error at the moment of the flash, and the smooth eye movement was ignored. However, subsequent saccades executed in darkness compensated gradually for the smooth eye displacement (mean compensation congruent with 70%). This behavior revealed a 400-ms delay in the time course of orientation for the compensation of the ongoing smooth eye displacement. We conclude that extraretinal information about the smooth motor command is available to the saccadic system in the absence of visual input. There is a 400-ms delay for smooth movement integration, saccade programming and execution.

Darkness↗
PubMed1995

[Comparative analysis of mental health treatment of various groups of competitive athletes].

1) There is sense and necessity of psychohygiene in sports. This could be stated with 3 compared groups, namely: a national team, a team of handicapped, a team of juveniles. 2) We have used a complex program with integrated autogenic training (this however, not in an isolated way). Earlier experiences (of last author) over many years and hundreds of sportives were integrated in our evaluation. 3) Its to our knowledge the first time in world literature that effectiveness of psychohygiene within sports could be proved with statistical significance using world cup points within comparable groups. 4) Only possible can be possible, and psychohygiene will help to optimate this goal but not overrun it. This is main differentiation against doping. The human and the humanity is the main goal and not the so-called "necessities" of sport dictatorship. Its a good sign that several of our candidates told us that our psychohygienic program has reached over their period of sports activities into their "normal" lives.

Adaptation, Psychological↗
PubMed1995

Vascular medicine: an alternative approach to arterial disease.

The National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) is leading a nationwide initiative to develop comprehensive programs that integrate clinical care, education, and research in vascular disease by developing vascular centers designed to provide comprehensive patient care through a multidisciplinary approach. Only a few medical centers have a dedicated vascular medicine specialty. To date, 11 centers nationwide have received NIH support devoted to creating vascular centers and promoting vascular medicine as a specialty. In June 1992, Northwestern University/Northwestern Memorial Hospital received one of these awards. The NIH recognizes the complex medical problems in patients with vascular disease. The resulting necessity for care by multiple physicians has traditionally led to duplication and fragmentation of services. Until recently, vascular surgery programs have focused primarily on the surgical treatment of vascular disease. This approach does not address risk reduction and the diverse care needs of the population of patients with vascular disease.

Academic Medical Centers↗
PubMed1997

Efficient discovery of conserved patterns using a pattern graph.

MOTIVATION: We have previously reported an algorithm for discovering patterns conserved in sets of related unaligned protein sequences. The algorithm was implemented in a program called Pratt. Pratt allows the user to define a class of patterns (e.g. the degree of ambiguity allowed and the length and number of gaps), and is then guaranteed to find the conserved patterns in this class scoring highest according to a defined fitness measure. In many cases, this version of Pratt was very efficient, but in other cases it was too time consuming to be applied. Hence, a more efficient algorithm was needed. RESULTS: In this paper, we describe a new and improved searching strategy that has two main advantages over the old strategy. First, it allows for easier integration with programs for multiple sequence alignment and data base search. Secondly, it makes it possible to use branch-and-bound search, and heuristics, to speed up the search. The new search strategy has been implemented in a new version of the Pratt program.

Algorithms↗
PubMed2007

Patients with addiction and personality disorder: Treatment outcomes and clinical implications.

PURPOSE OF REVIEW: The present review examines the outcomes of treatments focusing on substance abuse, on personality disorders, and on both the foci simultaneously. Clinical guidelines for the treatment of dually diagnosed patients are described. RECENT FINDINGS: Recent studies continued the tradition of examining the importance of factors such as the chronicity of substance abuse and the impact of sex with regard to the prognosis of the treatment of substance abuse and the development of effective treatment programs. Overall, the multifaceted and risky nature of dual problems is stressed, and as a logical consequence, an early detection of dual problems is promoted. Several studies show the risk of suicidal and harmful behavior associated with this population, even when the treatment for substance abuse has been successful. For the first time, the issue of dropout is studied from the client's perspective. SUMMARY: Knowledge about the effectiveness of dually focused treatments is emerging. Results show that the treatment of dually diagnosed patients with severe problems needs to include both the foci because it leads to enormous gains for the patients when personality disorders are also addressed. Yet, integrated treatment programs are lacking and research is still too limited.

Combined Modality Therapy↗
PubMed2006

RegRNA: an integrated web server for identifying regulatory RNA motifs and elements.

Numerous regulatory structural motifs have been identified as playing essential roles in transcriptional and post-transcriptional regulation of gene expression. RegRNA is an integrated web server for identifying the homologs of regulatory RNA motifs and elements against an input mRNA sequence. Both sequence homologs and structural homologs of regulatory RNA motifs can be recognized. The regulatory RNA motifs supported in RegRNA are categorized into several classes: (i) motifs in mRNA 5'-untranslated region (5'-UTR) and 3'-UTR; (ii) motifs involved in mRNA splicing; (iii) motifs involved in transcriptional regulation; (iv) riboswitches; (v) splicing donor/acceptor sites; (vi) inverted repeats; and (vii) miRNA target sites. The experimentally validated regulatory RNA motifs are extracted from literature survey and several regulatory RNA motif databases, such as UTRdb, TRANSFAC, alternative splicing database (ASD) and miRBase. A variety of computational programs are integrated for identifying the homologs of the regulatory RNA motifs. An intuitive user interface is designed to facilitate the comprehensive annotation of user-submitted mRNA sequences. The RegRNA web server is now available at http://RegRNA.mbc.NCTU.edu.tw/.

Animals↗
PubMed1977

[Models of community participation in health programs].

Study of some Latin American experiences of community participation in health programs permit consideration of the following as minimum requirements for the establishment of interrelationships between local health agencies and the community: a local health system; a participating health team; respect for the community; contact with community organizations; and contact with private and governmental organizations at a local level. The models for community participation in health are manifold and the experiences have been countless. For teaching purposes and based on Latin American experiences several considerations are made regarding: community health volunteers; local health councils; local councils for community development; and health brigades. Finally, it is stressed that active and organized community participation in health activities is the best guarantee of success in implementing integral health programs.

Community Health Services↗
PubMed1991

Significant efficiency findings while controlling for the frequent confounders of CAI research in the PlanAlyzer project's computer-based, self-paced, case-based programs in anemia and chest pain diagnosis.

Richard E. Clark in his widely published comprehensive studies and meta-analyses of the literature on computer assisted instruction (CAI) has decried the lack of carefully controlled research, challenging almost every study which shows the computer-based intervention to result in significant post-test proficiency gains over a non-computer-based intervention. We report on a randomized study in a medical school setting where the usual confounders found by Clark to plague most research, were carefully controlled. PlanAlyzer is a microcomputer-based, self-paced, case-based, event-driven system for medical education which was developed and used in carefully controlled trials in a second year medical school curriculum to test the hypothesis that students with access to the interactive programs could integrate their didactic knowledge more effectively and/or efficiently than with access only to traditional textual "nonintelligent" materials. PlanAlyzer presents cases, elicits and critiques a student's approach to the diagnosis of two common medical disorders: anemias and chest pain. PlanAlyzer uses text, hypertext, images and critiquing theory. Students were randomized, one half becoming the experimental group who received the interactive PlanAlyzer cases in anemia, the other half becoming the controls who received the exact same content material in a text format. Later in each year there was a crossover, the controls becoming the experimentals for a similar intervention with the cardiology PlanAlyzer cases. Preliminary results at the end of the first two full trials shows that the programs have achieved most of the proposed instructional objectives, plus some significant efficiency and economy gains. 96 faculty hours of classroom time were saved by using PlanAlyzer in their place, while maintaining high student achievement. In terms of student proficiency and efficiency, the 328 students in the trials over two years were able to accomplish the project's instructional objectives, and the experimentals accomplished this in 43% less time than the controls, achieving the same level of mastery. However, in spite of these significant efficiency findings, there have been no significant proficiency differences (as measured by current factual and higher order multiple choice post-tests) between the experimental and control groups. Very careful controls were used to avoid what Clark has found to be the most common confounders of CAI research. Accordingly, this research proved Clark's rival hypothesis, that the computer, in itself, does not appear to contribute to proficiency gains, at least as measured by our limited post-testing. Clark's position is that the computer is primarily a vehicle--as is either a pill or a hypodermic needle for delivering a drug.(ABSTRACT TRUNCATED AT 400 WORDS)

Anemia↗
PubMed2006

The big bang? An eventful year in workers' compensation.

Workers' compensation in the past two years has been dominated by events in California, which have been so fundamental as to merit the term big bang. Passage of Senate Bill 899 has led to a comprehensive program of reform in access to medical care, access to rehabilitation services, temporary and permanent disability, evidence-based management, dispute resolution, and system innovation. Two noteworthy developments thus arose: a new requirement for apportionment by cause in causation analysis, and the adoption of evidence-based criteria for impairment assessment, treatment guidelines, and, soon, utilization review. Elsewhere in the United States, changes were modest, but extensive legislative activity in Texas suggests that Texas will be next to make major changes. In Canada, the Workers' Compensation Board of British Columbia has adopted an ambitious strategic initiative, and there is a Canadawide movement to establish presumption for certain diseases in firefighters. Suggestions for future directions include an increased emphasis on prevention, integration of programs, worker participation, enhancing the expertise of health care professionals, evidence-based management, process evaluation, and opportunities for innovation.

British Columbia↗