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PubMed1990

Recent trends in the development of alcohol and drug treatment services in Ontario.

This article summarizes the major trends in the development of alcohol and drug treatment services in Ontario since 1979. These trends are contrasted to the objectives of a province-wide Addiction Research Foundation (ARF) community development program designed to establish or expand addiction services within this same time period. Data were obtained from all treatment services in the province by surveys undertaken in 1980, 1983 and 1986. Across the period of analysis, there have been rapid increases in the number of addiction programs, their total cost and the total treatment caseload. Some specific changes have been quite consistent with ARF objectives: a stabilization in the use of hospital beds for addictions treatment, an increase in community-based versus hospital-based treatment resources, an increase in the province-wide capacity for comprehensive client assessment and a larger representation of women in addictions programs. Other ARF objectives have yet to be achieved. In particular, a major increase in nonresidential treatment alternatives and an increase in the proportion of treated cases from special populations such as youth or the elderly are still required. Suggestions are made concerning future program development.

Adult↗
PubMed2000

Review of programs for persons who are homeless and mentally ill.

Despite recent prosperity in the U.S., homelessness is still a widespread social problem. It is estimated that 25% of homeless persons have a serious mental illness. This article will review the literature evaluating prevention services and specialized outreach, treatment, and housing programs designed to reduce homelessness for individuals who are mentally ill. Although these interventions have been helpful in addressing the complex needs of the homeless mentally ill, it is difficult to measure how they have improved outcomes. It is even more challenging to determine whether the programs are cost-effective. Since public resources are used to maintain services for the homeless mentally ill, policy-makers must be informed about whether the best outcomes are achieved at the lowest possible cost. Following a discussion of the successes of the individual programs and the challenges they confront, several important questions are identified related to improving the efficiency of these programs. Although the establishment of such programs indicates that progress has been made toward alleviating the burdens facing people who are homeless and mentally ill, collaboration among all stakeholders-especially between the mental health community and consumer advocates-needs to be further enhanced. New research can be conducted in a way that improves how information is evaluated and used.

Adult↗
PubMed2002

Community-based exercise program reduces risk factors for falls in 65- to 75-year-old women with osteoporosis: randomized controlled trial.

BACKGROUND: Exercise programs improve balance, strength and agility in elderly people and thus may prevent falls. However, specific exercise programs that might be widely used in the community and that might be "prescribed" by physicians, especially for patients with osteoporosis, have not been evaluated. We conducted a randomized controlled trial of such a program designed specifically for women with osteoporosis. METHODS: We identified women 65 to 75 years of age in whom osteoporosis had been diagnosed by dual-energy X-ray absorptiometry in our hospital between 1996 and 2000 and who were not engaged in regular weekly programs of moderate or hard exercise. Women who agreed to participate were randomly assigned to participate in a twice-weekly exercise class or to not participate in the class. We measured baseline data and, 20 weeks later, changes in static balance (by dynamic posturography), dynamic balance (by a timed figure-eight run) and knee extension strength (by dynamometry). RESULTS: Of 93 women who began the trial, 80 completed it. Before adjustment for covariates, the intervention group tended to have greater, although nonsignificant, improvements in static balance (mean difference 4.8%, 95% confidence interval [CI] -1.3% to 11.0%), dynamic balance (mean difference 3.3%, 95% CI -1.7% to 8.4%) and knee extension strength (mean difference 7.8%, 95% CI -5.4% to 21.0%). Mean crude changes in the static balance score were -0.85 (95% CI -2.91 to 1.21) for the control group and 1.40 (95% CI -0.66 to 3.46) for the intervention group. Mean crude changes in figure-eight velocity (dynamic balance) were 0.08 (95% CI 0.02 to 0.14) m/s for the control group and 0.14 (95% CI 0.08 to 0.20) m/s for the intervention group. For knee extension strength, mean changes were -0.58 (95% CI -3.02 to 1.81) kg/m for the control group and 1.03 (95% CI -1.31 to 3.34) kg/m for the intervention group. After adjustment for age, physical activity and years of estrogen use, the improvement in dynamic balance was 4.9% greater for the intervention group than for the control group (p = 0.044). After adjustment for physical activity, cognitive status and number of fractures ever, the improvement in knee extension strength was 12.8% greater for the intervention group than for the control group (p = 0.047). The intervention group also had a 6.3% greater improvement in static balance after adjustment for rheumatoid arthritis and osteoarthritis, but this difference was not significant (p = 0.06). INTERPRETATION: Relative to controls, participants in the exercise program experienced improvements in dynamic balance and strength, both important determinants of risk for falls, particularly in older women with osteoporosis.

Accidental Falls↗
PubMed1975

Pulmonary embolism with factor XI deficiency.

A patient with factor XI deficiency had pulmonary embolism, although his factor XI assay was less than 1% of normal and his postoperative course was complicated by prolonged bleeding. Programs designed to prevent postoperative venous thrombosis should be carried out in factor XI-deficient patients, since the deficient state offers no protection from a pulmonary embolus. All surgical patients who are to receive low-dose heparin therapy as a part of such a program should be screened by means of preoperative determination of the partial thromboplastin time, to identify previously unsuspected bleeding disorders.

Aged↗
PubMed2005

[Differences in the polychlorinated biphenyl levels in follicular fluid in individual types of sterility].

OBJECTIVE: To find the differences of polychlorinated biphenyls (PCBs) levels in follicular fluid in different indications to treatment with IVF + ET program. DESIGN: Pilot study. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General Faculty Hospital, Prague, AXYS Varilab, s.r.o., Vrané nad Vltavou, Prague, Euromise Centrum, Charles University and Academy of Art, Prague. METHODS: We examinated 100 infertile women undergoing IVF + ET program in our pilot study. After ovarian pick-up, frozen follicular fluid were transported to the laboratory. We detected the levels of polychlorinated biphenyls in follicular fluid of infertile women. The levels were compared according to the different indications of treatment. The control group consist of patients with male factor of sterility. RESULTS: We confirmed the higher levels of PCB 114, 153, 156, 157, 180 and 189 in indication endometriosis compared with the others and with control group. The levels of PCBs were in ng/gram of fat. CONCLUSION: It has become apparent that higher levels of PCB 114, 153, 156, 157, 180 and 189 in endometriosis patients may be one of many factors participating in the origin of the disease.

Adult↗
PubMed2006

Teaching children about mental health and illness: a school nurse health education program.

A mental health education program designed by school nurses for children ages 10- 12 was developed in 2000-2001 and expanded with broader distribution in 2004-2005. Six classroom sessions, each 45 minutes in length, provided information and activities to increase children's awareness of mental health and illness. Education program content included facts about the brain's connection to mental health, information about healthy ways to manage stress, resources and activities to promote mental health, common mental health problems experienced by children, and how to seek help for mental health problems. Classes included a combination of didactic presentation and open discussion, encouraging students to ask questions and allowing the school nurse to correct misinformation. Analysis of pre- and posttests from 370 elementary and middle school students revealed statistically significant improvements in their knowledge of mental health and mental illness.

Adaptation, Psychological↗
PubMed2006

The effect of loss of body weight on lipid profile in overweight individuals.

OBJECTIVE: To determine the effect of reducing body weight and body mass index on serum lipid. METHODS: This is a prospective longitudinal study, which was implemented in Naim Primary Health Care Center in the Kingdom of Bahrain during May and June of 2004. The study included 55 individuals who were willing to participate. The criteria for the sample selection included being overweight, having high serum lipid and patients' willingness to reduce their weight. The patients were followed up for a 26 weeks period consisting of continuous health education program, maintenance on low caloric diet and exercise to help them reduce their body weight. This period included a lifestyle enhancement awareness program that included 4 health education sessions on weight loss, 4 sessions on weight loss maintenance and frequent and regular visits to the clinic to make sure that those patients were compliant with the given instructions. RESULTS: The study showed that patients who completed the designed program had a reduction in body weight, body mass index, and lipid level and an increase in physical activity and dietary readiness to control over-eating. Although in both genders there was a significant drop in all the parameters, only body mass index (p<0.002) and cholesterol (p=0.007) showed a statistically significant difference between men and women. In men, cholesterol level at the initial stage of the study was strongly related to the body weight (r=0.65, p<0.002) and body mass index (r=0.83, p<0.0005). Despite that the cholesterol level reduced more in women than men; women decreased less in weight (p<0.0005) and body mass index (p<0.0005) than men. CONCLUSION: Overweight individuals would benefit from a life enhancement program that increases their awareness on the danger of obesity and helps them in reducing body weight and serum lipid level.

Adult↗
PubMed1993

Smokeless tobacco cessation: report of a preliminary trial using nicotine chewing gum.

BACKGROUND: Smokeless tobacco use is a major public health hazard whose incidence is increasing, particularly among male adolescents. Little research has been done on cessation programs designed to assist smokeless tobacco users in ending their habit. There have been no studies on the use of nicotine polacrilex chewing gum as an adjunct to cessation. METHODS: Fourteen of 88 male smokeless tobacco users in a professional baseball organization enrolled in a cessation program and were followed for up to 12 months. The program consisted of two support group sessions at the spring training camp followed by adjunctive use of nicotine polacrilex chewing gum during the baseball season as monitored by the athletic trainers. RESULTS: At 2 to 4 months, only 3 of 14 participants were completely abstinent from smokeless tobacco. Follow-up data at 6 to 12 months revealed that only one participant was abstinent. The 14 ballplayers experienced various side effects of nicotine chewing gum: bad taste (6), nausea (4), headache (4), jaw discomfort (3), and dizziness (1). Despite these side effects, 11 of the 14 participants replied that they would recommend the gum to others trying to quit. Most participants (10) felt that quitting the smokeless tobacco habit was "very difficult." CONCLUSIONS: We conclude that nicotine chewing gum as an adjunct to smokeless tobacco cessation had limited effectiveness. Further study on smokeless tobacco cessation methods is needed.

Adult↗
PubMed2003

Application of NMR screening in drug discovery.

The application of NMR screening in drug discovery has recently attained heightened importance throughout the pharmaceutical industry. NMR screening can be applied at various points in a drug discovery program, ranging from very early in the program, when new targets can be screened long before an HTS enzymatic assay is developed, to later in the program, as in the case where no useful hits have been detected by HTS using biological assays. The binders determined in primary NMR screens are used to guide secondary screens, which can be either completely NMR driven or use NMR in combination with other biophysical techniques. In this review we briefly discuss the methods and techniques used in NMR screening. Then, we describe in detail the NMR screening strategies and their applications to specific targets, including successful examples from actual drug design programs at our own and other pharmaceutical companies.

Binding Sites↗
PubMed1987

Design and evaluation of a back injury prevention program within a geriatric hospital.

Two phases of a back injury prevention program were studied using 2035 accident reports filed between 1979 and 1984. Phase 1, Personnel Program, was designed to decrease the duration of wage-loss claims by increasing the effectiveness of the existing procedures used to process these claims. This program significantly lowered the proportion of high-hour claims (P less than .05) and significantly reversed a trend of increasing accident rates (P less than .05). Phase 2, Back Program, was designed to lower the incidence of back injuries through a feedback-oriented educational program. The Back Program itself could not demonstrate a significant reduction in back injuries primarily due to the powerful and confounding effect of the Personnel Program. The combination of the Personnel Program and the Back Program significantly lowered back injuries for nurses when compared with a similar group of injuries that occurred at geriatric hospitals (P less than .001). The large effect of the Personnel Program and the small effect of the Back Program have design implications for any injury prevention program.

Aged↗
PubMed1994

The Thoracic Surgery Residency Program at Chapel Hill.

The success of the cardiothoracic surgery residency program in Chapel Hill is due to a number of contributing factors. The first important ingredient is the faculty. Their ability, stability, and dedication, with each faculty member developing an area of expertise, has contributed greatly to the success of our program. The second important aspect is the program design itself--all three years: the first to allow the resident time to reflect on educational priorities and do some innovative thinking; the second and third as chief resident on their respective services--for an entire, continuous year. The third and most important aspect of our program is the quality of the residents we have been able to attract--uniformly a splendid group of individuals who regularly gave more than they received and who continue to be a source of inspiration, hope, and pride for those of us who have been privileged to be their teachers.

Boston↗
PubMed1992

Programs of safety surveillance and control of fishery products.

In the United States, fishery product safety at the federal level falls primarily under the authority of the Food and Drug Administration. However, other federal agencies play an important role. The Environmental Protection Agency is responsible for setting and recommending pesticide limits in seafood, and the National Marine Fisheries Service operates a voluntary inspection program. The Centers for Disease Control is responsible for the collection and evaluation of data characterizing the source of seafood-borne illness. Individual states also play a dominant role in the control of seafood-borne risk because of the important differences in consumption and contaminant levels across regions of the country. State public health, environmental protection, and resource management agencies have developed programs designed to mitigate that risk. Because of the complication and variability of the fishery industry, an effective safety system can be developed based on partnership among federal and state agencies, in which state governments retain the dominant role and the federal government develops and updates guidance programs and provides oversight. The international community has developed practices and protocols impacting the regulation of seafood safety in the United States. In view of developing trade agreements, the international community should address the criteria of setting equivalent contaminant levels and consider the option of establishing import contract criteria for fishery products.

Animals↗
PubMed1985

Assessing generalization of treatment effects and self-efficacy in the modification of eating styles in obese children.

The present study implemented a brief behavioral treatment program designed to alter the eating styles of 16 obese children and assessed the generalizability of children's eating styles from a laboratory setting to a school cafeteria. Results indicated that obese children exhibited significantly different eating styles at different mealtimes across the two settings. The treatment program was also found effective in altering eating styles in both settings. Although no significant differences between the eating styles of obese and normal weight children were observed prior to treatment, the 2-week follow-up observation in the natural setting demonstrated a different eating style between obese and normal weight peers. Results also indicated that a self-efficacy rating scale was no more effective than a control measure in predicting post-treatment eating styles.

Behavior Therapy↗
PubMed1999

Implementation of Fetal and Infant Mortality Review (FIMR): experience from the national Healthy Start program.

OBJECTIVES: The implementation of the Fetal and Infant Mortality Review (FIMR) process was examined as part of the evaluation of the national Healthy Start program, a federal program designed to reduce infant mortality in several communities. The implementation of the FIMR process over the 5-year funding period is described in terms of productivity, barriers and facilitators to implementation, and project expenditures. METHODS: Data were derived from grant continuation applications and personal interviews with program staff to produce a qualitative description. RESULTS: As of the summer of 1996, 14 of the 15 Healthy Start sites in the national evaluation had successfully implemented the FIMR process. Most sites had developed a two-tiered review process for examination of case data in which a review by health and social services professionals was followed by community review. In the period 1993 to 1995, the percentage of fetal and infant deaths reviewed had a median of 34% with a range of 4-79% across the sites at a cost of $600 to $3400 per death reviewed. Recommendations were variably implemented. CONCLUSIONS: The FIMR process provides an important opportunity to contribute to the knowledge base regarding infant mortality in these communities. The process, however, has important logistical requirements and may require substantial financial resources that may affect implementation of confidential inquiries into infant mortality and other health problems.

Data Collection↗
PubMed2003

A national survey on the current status of general internal medicine residency education in geriatric medicine.

OBJECTIVES: The dramatic increase in the U.S. elderly population expected over the coming decades will place a heavy strain on the current health care system. General internal medicine (GIM) residents need to be prepared to take care of this population. In this study, we document the current and future trends in geriatric education in GIM residency programs. DESIGN, SETTING, PARTICIPANTS: An original survey was mailed to all the GIM residency directors in the United States (N = 390). RESULTS: A 53% response rate was achieved (n = 206). Ninety-three percent of GIM residencies had a required geriatrics curriculum. Seventy one percent of the programs required 13 to 36 half days of geriatric medicine clinical training during the 3-year residency, and 29% required 12 half days or less of clinical training. Nursing homes, outpatient geriatric assessment centers, and nongeriatric ambulatory settings were the predominant training sites for geriatrics in GIM. Training was most often offered in a block format. The average number of physician faculty available to teach geriatrics was 6.4 per program (2.8 full-time equivalents). Conflicting time demands with other curricula was ranked as the most significant barrier to geriatric education. CONCLUSIONS: A required geriatric medicine curriculum is now included in most GIM residency programs. Variability in the amount of time devoted to geriatrics exists across GIM residencies. Residents in some programs spend very little time in specific, required geriatric medicine clinical experiences. The results of this survey can guide the development of future curricular content and structure. Emphasizing geriatrics in GIM residencies helps ensure that these residents are equipped to care for the expanding aging population.

Aged↗
PubMed1992

The impact of an interinstitutional relocation on nursing home residents requiring a high level of care.

Residents of two older nursing homes (n = 196) were relocated to a new 238-bed facility. A nonequivalent control group (n = 74) design with two pretests and two posttests was used to assess the impact of this move on their well-being and health. The relocated residents and control-group residents required a similar level of nursing care. Residents to be relocated participated in a preparation program designed to enhance their sense of control and predictability over the move. Analyses of medical records, nurses' ratings, and interviews strongly suggest that the move had no negative effect on the residents as a group or on vulnerable subgroups of residents.

Aged↗
PubMed1996

Five-year performance trends for older exercisers: a hierarchical model of endurance, strength, and flexibility.

OBJECTIVE: To examine 5-year trends in measures of physical performance, and the impact of disease upon performance, in three domains: cardiovascular fitness, musculo-skeletal strength, and flexibility among older adults participating in a medically supervised exercise program. DESIGN: Longitudinal analyses of data obtained in an observational cohort study. SETTING: Department of Veterans Affairs Medical Center in Durham, North Carolina. PARTICIPANTS: Seventy-three community-dwelling veterans between 64 and 90 years of age. INTERVENTION: Voluntary participation in a medically supervised outpatient exercise program meeting 3 days per week for 90 minutes per session. MAIN OUTCOME MEASURES: Changes over time in cardiovascular fitness, musculoskeletal strength, and flexibility. RESULTS: Forty-nine percent of the original study participants remained in the program for a full 5 years. They had lower baseline rates of cardiorespiratory and musculoskeletal diseases than did the dropouts. Dropouts were significantly more impaired in baseline measures of cardiovascular fitness (P = .038) and strength (P = .007). Changes over time for cardiovascular fitness and strength were similar. Only linear (P < .05) and quadratic time (P < .001) were significant. Only linear time was significant for measures of flexibility (P < .05). Baseline cardiorespiratory disease, baseline musculoskeletal disease, and interaction terms were not significant. Overall, measures of physical performance demonstrated gradual improvement for 2 to 3 years, followed by a gradual decline in performance irrespective of baseline disease status. CONCLUSION: Older adults who exercise regularly, including those with multiple chronic diseases, can achieve significant gains in measures of physical performance, and these gains can be sustained for 2 to 3 years.

Aged↗
PubMed1997

The PATHWAYS church-based weight loss program for urban African-American women at risk for diabetes.

OBJECTIVE: This study was carried out to test the effectiveness of PATHWAYS, a weight loss program designed specifically for urban African-American women, when administered in urban churches by trained lay facilitators. RESEARCH DESIGN AND METHODS: Thirty-nine obese women were recruited from three urban African-American churches. After randomization and the collection of baseline data on weight and lifestyle practices, subjects in the experimental group (n = 19) were assigned to receive a 14-week weight loss program (PATHWAYS) conducted by trained lay volunteers; control group subjects (n = 20) were put on a waiting list to receive the program at the conclusion of the study period. RESULTS: Of the 39 women enrolled, 15 experimental group subjects and 18 control group subjects were available for posttreatment data collection. After completing the program, PATHWAYS participants lost an average of 10.0 lb, and the control group subjects gained an average of 1.9 lb. Posttreatment difference in weight loss between the groups was statistically significant (P < 0.0001). Waist circumference among PATHWAYS participants decreased 2.5 inches, while waist circumference among control group subjects remained relatively the same. This difference between the groups was statistically significant (P < 0.05). CONCLUSIONS: A weight loss program administered by trained lay volunteers was effective in producing significant and clinically meaningful weight loss among African-American women who often do not benefit from typical weight loss programs. Ongoing research is focusing on whether the weight loss can be maintained or enhanced through monthly reinforcement sessions.

Black or African American↗