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PubMed1989

Delay in the execution of voluntary movement by electrical or magnetic brain stimulation in intact man. Evidence for the storage of motor programs in the brain.

Experiments were undertaken to study the effect on voluntary movement of an electrical or magnetic stimulus delivered to the brain through the scalp. Subjects were trained to flex or extend their wrist rapidly in response to an auditory tone. A single brain stimulus (electrical or magnetic) delivered after the tone and before the usual time of onset of the voluntary reaction could delay the execution of the movement for up to 150 ms, without affecting the pattern of the agonist and antagonist EMG bursts. The delay increased with increasing stimulus intensity and with stimuli which were applied nearer to the usual time of onset of the voluntary reaction. A stimulus given after the onset of the first voluntary agonist EMG burst only delayed the onset of the first antagonist and later EMG bursts. Movement was not delayed when similar experiments were performed with supramaximal stimulation of the median nerve instead of the brain stimulus. The delay following a cortical shock was not due to spinal motoneurons being inaccessible to descending input during the delay period since a second brain stimulus, given in the middle of the delay period, was capable of producing a direct muscle response. Neither could the delay be explained by the brain stimulus altering the time of the subject's intention to respond since a stimulus delivered to one hemisphere before an attempted simultaneous bilateral wrist movement produced a far greater delay of the contralateral than the ipsilateral movement. We suggest that the brain stimulus delayed movement by inhibiting a group of strategically placed neurons in the brain (probably in the motor cortex) which made them unresponsive for a brief period to the command signals they receive which initiate the motor program of agonist and antagonist muscle activity. The results have implications for the issues of the storage of motor programs, internal monitoring of central movement commands and the site of organization of the antagonist EMG burst.

Adult↗
PubMed2003

Development of the Dutch Johne's disease control program supported by a simulation model.

The development of a simulation model, "JohneSSim", was part of a research program aimed at designing a national Johne's disease control program for The Netherlands. Initially, the focus was mainly directed towards different compulsory "test-and-cull" strategies. However, the results from the JohneSSim model showed that eradication of Johne's disease based on such strategies would not be possible within 20 years and that it was also economically unattractive. However, improved calf management seemed to be more effective in reducing the prevalence within the same time period. Simulation of a strategy using an "ideal test" (80% sensitivity in all infected animals) showed a considerably faster decrease in prevalence. However, this strategy proved to be economically unattractive because of the high culling rate of (young) test-positive animals. The simulation model was also adapted to study beef cow herds. However, the results indicated that none of the strategies were able to reduce the mean true prevalence to almost zero for such herds. Only strategies based on "separation of calves and adult animals" proved to significantly reduce the prevalence but such a strategy is unpractical and uneconomic for Dutch beef cow herds. Due to this finding and the relative low number of Dutch beef cow farms, first priority has been given to the development of a Johne's disease control program for dairy farms. Based on the results of the "JohneSSim" model, the new national voluntary Johne's disease control program for dairy, Paratuberculosis Program Netherlands (PPN), started in September 2000. The PPN is based on a stepwise improvement of calf hygiene, with little dependency on "test and culling". The model results indicated that, if dairy farmers consistently carried out the necessary management adaptations, PPN considerably decreased prevalence and that it was economically more attractive than any previous plans.

Animal Husbandry↗
PubMed1980

Are voluntary agencies helping to improve health in Bangladesh?

Since independence in 1971, a large number of health programs run by local and foreign voluntary organizations have been started in Bangladesh. This paper is the result of a survey undertaken on behalf on the Oxford Famine Relief Committee of ten of the most interesting of these projects. On the basis of an analysis of the underlying causes of ill health in Bangladesh, a criterion for the assessment of these health programs is developed. Following an overview of the performance of these "innovative" projects, the pertinent issues which have been and have to be dealt with by appropriate projects are addressed by means of a case study of one of the best of these projects. A basic premise of this analysis is that ill health in particular communities is not simply a result of local conditions; rather, the structural determinants of ill health are frequently national and even international in scope. The effect of these structural determinants of the presence and funding policies of the many voluntary agencies in Bangladesh is assessed by analyzing the performance of the Oxford Famine Relief Committee, one of the more enlightened of these agencies.

Bangladesh↗
PubMed1995

Equity in the Medicaid program: changes in the latter 1980s.

The possibility of health care reform has helped focus attention on equity in the receipt of health care. This is a particular issue for the Medicaid program, as State variations in eligibility and payment policies have historically created inequity. This study examines equity for Medicaid beneficiaries and State taxpayers during the latter 1980s. Findings indicate that federally mandated expansions significantly increased equity in the coverage of the poor, but inequality in real resources per enrollee remained significant. Although equity improved from 1984 through 1991, the increased use of provider-specific tax and voluntary donation (T&D) programs by traditionally high-spending States played an important role in the 1992 figures.

Eligibility Determination↗
PubMed1998

The Assaulted Staff Action Program (ASAP): common issues in fielding a team.

Thirty-five years of empirical research have continuously documented the potential negative impact of patient assaults on staff. The Assaulted Staff Action Program (ASAP) is a voluntary, peer-help, systems-wide crisis intervention debriefing approach for employee victims of these assaults. ASAP has been associated with providing needed clinical support for victims, declines in violence, and cost-effectiveness in service delivery. A previous paper outlined the basic steps needed to field and ASAP team. This paper continues to address this need by outlining the most commonly encountered ASAP problems and solutions that have evolved in the first eight years of ASAP programs. The implications are discussed.

Counseling↗
PubMed1993

Compartmentalized cerebellar functions upon the stabilization of body posture.

This paper reviews the features and topodiagnostical meaning of pathological body posture in cerebellar disorders and presents knowledge as to the physiology and pathophysiology of postural disturbances attributed to the cerebellum. Lesions of the spinocerebellar (upper vermal and intermediate) part of the anterior lobe lead to spontaneous anterior-posterior body sway, with a frequency of about 3 Hz with mild or absent ataxia of the upper limbs, but prominent ataxia of the lower limbs. The tremor is provoked by eye closure and by body displacement. Increased gain and poor cerebellar control of the duration and gain of stabilizing reflexes may be the mechanisms of this oscillation. Lesions of the lower (vestibulocerebellar) vermis cause postural ataxia of the head and trunk while sitting, standing, and walking. Postural ataxia is omnidirectional, sometimes of excessive amplitude and contains frequency components below 1 Hz. Dysmetria of the upper and lower limbs is not prominent. Visual stabilization is less than in the other groups of cerebellar patients. Lesions of the cerebellar hemispheres alone, do not cause an increase of postural sway. Lesions of spinocerebellar afferents (Friedreich's disease) lead to a low frequency large amplitude lateral sway with the most of its power below 1.1 Hz. Visual stabilization is preserved. Latencies of early and late EMG responses to sudden displacements are normal in patients with cerebellar disorders. The cerebellum is, therefore, unlikely to be the primary generator of these reflexive responses. On the other hand, the temporal composition of the orderly time sequence of a complex motor program--be it a voluntary act or its postural balancing--is deranged in cerebellar lesions. It is hypothesized that the cerebellum helps to coordinate the timing not only within but also between the single components involved in each subunit of a complex movement in three-dimensional space and that is scales the size and duration of each muscular action. The cerebellum possibly specifies the cortical movement command and sends it back to the motor cortex. The basic structure of a motor program, however, does not seem to be generated within the cerebellum.

Cerebellar Diseases↗
PubMed2000

Are amplitude and duration of anticipatory postural adjustments identically scaled to focal movement parameters in humans?

Anticipatory postural adjustments (APA), are known to precede the onset of voluntary movement. The aim of this study was to determine whether APA amplitude and duration are programmed identically according to the voluntary movement parameters. Subjects performed shoulder flexions at maximal and sub-maximal velocities, with and without an additional inertial load. APA amplitude and duration were plotted against kinetic energy and work of the forthcoming voluntary limb movement and showed a significant linear relation. When APA duration was plotted against mechanical work, two distinct APA duration values corresponded to a given value of work depending on the weight of the load, but this was not the case for APA amplitude. It is suggested that the APA amplitude and duration are scaled according to the same movement parameters, but not in the same way, APA duration being additionally sensitive to the postural effect which results from an additional weight.

Adult↗
PubMed1996

The voluntary community health movement in India: a strengths, weaknesses, opportunities, and threats (SWOT) analysis.

There has been a prolific growth of voluntary organizations in India since independence in 1947. One of the major areas of this growth has been in the field of community health. The purpose of this article is to historically trace the voluntary movement in community health in India, analyze the current status, and predict future trends of voluntary efforts. A review of the literature in the form of a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was the method of this study. Some of the key trends which emerged as the priority areas for progress and for strengthening voluntary organizations in the future were enhancing linkages between health and development; building upon collective force; greater utilization of participatory training; establishing egalitarian and effectual linkages for decision making at the international level; developing self-reliant community-based models; and the need for attaining holistic empowerment at individual, organizational, and community levels through "duty consciousness" as opposed to merely asking for rights.

Community Health Services↗
PubMed1992

Magnetic stimulation of the brain: starting or stopping.

A very brief magnetic pulse is able to stimulate cortical neurons through the intact scalp. It can elicit movement of a limb by activation of pyramidal cells either directly or via interneurons. When making a voluntary movement, a corresponding program of the task is thought to be compiled beforehand. In patients with ideomotor apraxia who can not perform a task, a lesion of the left hemisphere is frequently found. A magnetic cortical stimulus given directly before a movement is executed is known to delay the onset without altering the pattern. When it will become feasible to deliver a localized stimulus to one hemisphere, this will induce a temporary pause in that area and thus simulating a lesion in intact brain. In this way information can be gathered on the localization of voluntary action in intact brains.

Brain Mapping↗
PubMed2000

Effectiveness of HIV prevention interventions in developing countries.

OBJECTIVE: To review the effectiveness of projects and programs in developing countries that aim to reduce sexual transmission of HIV infection or transmission related to injection drug use. DESIGN: We identified 34 published studies undertaken in 18 developing countries that met rigorous inclusion criteria. These criteria included the length of follow-up, use of statistical analysis, the inclusion of a comparison group, and type of outcomes measured. RESULTS: We found that behavioral change interventions are effective when targeted to populations at high risk, particularly female sex workers and their clients. Few studies have evaluated harm reduction interventions in injecting drug users (IDUs). Evidence on the effectiveness of voluntary counseling and testing programs was promising, and VCT was most effective when directed at discordant couples. Treatment of sexually transmitted diseases (STD) appears highly effective in reducing HIV/STD transmission, particularly in the earlier stages of the epidemic. CONCLUSIONS: This review demonstrates that HIV prevention interventions can be effective in changing risk behaviors and preventing transmission in low and middle-income countries. When the appropriate mix of interventions is applied, they can lead to significant reductions in the prevalence of HIV at the national level. Additional research is needed to identify effective interventions, particularly in men who have sex with men, youth, IDUs and HIV-infected persons. Structural and environmental interventions show great promise, although more evaluation is needed.

Developing Countries↗
PubMed1994

AIDS: human rights and responsibilities.

As epidemiology changes and new therapies emerge, the focus of disease control is shifting from the voluntary to the mandatory. This is reflected in debates about routine HIV testing of newborns and the confidentiality of HIV-infected adults. Other issues include access to unproven drugs, the problems posed by co-infection with TB, and prevention through needle and condom distribution.

AIDS Serodiagnosis↗
PubMed2003

Racial and ethnic disparities in the purchase of nongroup health insurance: the roles of community and family-level factors.

OBJECTIVE: To evaluate the influence of community- and family-level factors on racial/ethnic disparities in the uptake of nongroup (individual) health insurance. DATA SOURCES: Responses to the 1996-1997 Community Tracking Study Household Survey plus community-level descriptors from several sources including census data, the Area Resource File, and community and migrant health center Medicare cost reports. STUDY DESIGN: Logistic regression was used to compare families in which at least one person had nongroup health insurance to families without nongroup insurance in which at least one person was uninsured. Sequential models were constructed examining family- and community-level factors. RESULTS: Twenty-three percent of families with otherwise-uninsured persons purchased nongroup insurance, ranging from 11% to 41% among the 60 communities sampled. Disadvantaged minority group members, especially Spanish-speaking Hispanics, had half or less the odds of whites of purchasing nongroup insurance. Education had a weaker association with purchasing nongroup insurance among minority group members than among whites. Community-level factors had minimal effect on disparities in uptake, although greater housing segregation was associated with lower uptake among blacks. CONCLUSIONS: Minority group members are much less likely to purchase nongroup insurance than whites. Family income and community factors do not explain this gap. Programs aimed at stimulating voluntary insurance purchase will continue to underenroll disadvantaged minorities if nonfinancial barriers to acquiring insurance coverage, including the interplay between race/ethnicity and education, are not better understood and addressed.

Black or African American↗
PubMed1992

National TV smoking cessation program and contest in Finland.

BACKGROUND: In the fall of 1986 the North Karelia Project in cooperation with Finnish TV 2 arranged an eight-part nationwide smoking cessation TV program. The Project, also arranged a smoking cessation contest coinciding with the TV program in cooperation with four major voluntary public health organizations and the national health service. The TV program featured two studio groups of local volunteers: one from Turku (southwestern Finland) and the other from North Karelia, where there was more intensive community support for the activity. RESULTS: Based on a national survey of a representative population sample, the reported viewing rates (at least one part) of the working-age population (15-64 years, smokers and nonsmokers) were 64% in North Karelia, 45% in Turku, and 46% nationally (P less than 0.001). Among smokers who had watched at least one session of the TV program, 7.7% reported to have tried to quit smoking in North Karelia, 4.1% in Turku, and 7.5% nationally. Altogether, 16,089 smokers participated in the contest; again the highest participation rate was in North Karelia. The 6-month success rate among the smokers who participated in the contest was 22% in North Karelia, 18% in Turku, and 17% nationally (P less than 0.05). Men were more likely to succeed in quitting: among men the 6-month success rate was 22% and among women 15% (P less than 0.001). CONCLUSIONS: The results and experiences indicate high viewing and participation and a beneficial cost-effect ratio. They also stress the importance of community support activities in enhancing the effects of a media-based health promotion program.

Adolescent↗
PubMed2004

The distribution of Mycobacterium avium ssp. paratuberculosis in the environment surrounding Minnesota dairy farms.

The objective of this study was to characterize the distribution of Mycobacterium paratuberculosis (Map) in the environment of infected and uninfected Minnesota dairy farms. Eighty herds known to be infected from Minnesota's Johne's Disease Control Program (JDCP) and 28 herds known to be uninfected from Minnesota Voluntary Johne's Disease Herd Status Program (VJDHSP) were sampled. Fecal samples from up to 100 cows in each herd were cultured in pools of 5 cows. Two environmental samples were obtained from each farm from various locations. All samples were tested using bacterial culture for Map. Eighty percent of the JDCP herds had at least one positive pool. Environmental samples were cultured positive in 78% of the JDCP herds. Two (7%) of the VJDHSP herds had one positive pool, and one herd had one positive environmental sample. Environmental samples were cultured positive in cow alleyways (77% of the herds), manure storage (68%), calving area (21%), sick cow pen (18%), water runoff (6%), and postweaned calves areas (3%). There was an association between maximum level of colonies per tube from cow alleyways and manure storage and fecal pool prevalence. Herds with both areas cultured negative were estimated to have 0.3 to 4% fecal pool prevalence. Herds with both areas having a heavy load of bacteria were estimated to have 53 to 73% fecal pool prevalence. The study results indicate that targeted sampling of cow alleyways and manure storage areas appears to be an alternative strategy for herd screening and Johne's infection status assessment and for estimating herd fecal prevalence.

Animals↗
PubMed2005

Antiretroviral medication errors in a national medication error database.

Antiretroviral medications have reduced the morbidity and mortality associated with HIV. In contrast to these benefits, medication errors involving antiretrovirals represent opportunities for causing harm. We analyzed 400 medication errors that involved at least one single or combined HIV antiretroviral product that had been reported to a national medication error reporting program (MEDMARX). Our analysis revealed that 3% of the errors were harmful. Most of the errors (45%) occurred in the dispensing phase of the medication use process, a finding that differs significantly from many published studies. The most frequent types of errors were wrong dose (37.5%) and wrong medication (32%). Lamivudine (Epivir, Glaxo-SmithKline, Research Triangle Park, NC) was the most commonly identified product to be involved in the errors. Community hospitals were more likely to have prescribing errors than teaching hospitals. Similar brand and generic names were associated with many of the errors. With frequent dosing of many HIV medications, health care organizations must have a process to clarify orders rapidly and maintain current references (including photos) of antiretrovirals. Prescribers should clearly spell out the intended product and avoid abbreviations. Participating in voluntary medication error reporting programs increases the awareness of the threats of medication errors involving antiretrovirals.

Adverse Drug Reaction Reporting Systems↗
PubMed2005

Cost-effectiveness of HIV screening for incarcerated pregnant women.

Antiretroviral therapy (ART) initiated on a prenatal basis in HIV-infected pregnant women is a highly effective method for preventing mother-to-child HIV transmission. We developed a decision analytic model to project the clinical and economic outcomes of alternative HIV screening strategies (voluntary prenatal screening [VPS], routine prenatal screening [RPS], and mandatory newborn screening [MNS]) for a high-risk population of incarcerated pregnant women. Data for the decision model came from the HIV voluntary counseling and testing program at Connecticut's sole correctional facility for women and a comprehensive anonymously linked serosurvey of all inmates who entered the facility during the 2-year period beginning in October 1994. Based on serosurvey results, in the absence of any HIV screening program, 2.5 cases of pediatric HIV infection would be expected per 1000 pregnancies. Multiplied by the discounted lifetime cost per case of $247,000, this translates to a cost of $624 per testing-eligible prison entrant. Entrants were considered eligible if they were pregnant and their HIV status was unknown. MNS would save money, cost $364 per eligible entrant, and simultaneously reduce the rate of infections to 1.1 per 1000 pregnancies. Doing both MNS and RPS is most effective in reducing the rate of new infections (down to 0.2 per 1000 pregnancies). It would, however, increase costs to $430 per eligible entrant. This would result in an incremental cost of $73,603 per additional pediatric HIV case averted when compared with MNS alone. If mandatory newborn testing was not considered a feasible option, RPS would dominate VPS and would be cost-saving compared with no screening. RPS compares favorably with alternative uses of HIV prevention and treatment resources. In correctional facilities where voluntary newborn screening is already in place, our findings show that there remains a small marginal benefit to be realized from switching to RPS. In settings where HIV screening policies are not in place, however, the implementation of RPS can be expected to significantly reduce pediatric HIV cases and net health care expenditures.

Adult↗
PubMed2005

Are somatosensory saccades voluntary or reflexive?

The present study examines whether the distinction between voluntary (endogenous) and reflexive (stimulus-elicited) saccades made in the visual modality can be applied to the somatosensory modality. The behavioural characteristics of putative reflexive pro-saccades and voluntary anti-saccades made to visual and somatosensory stimuli were examined. Both visual and somatosensory pro-saccades had much shorter latency than voluntary anti-saccades made in the direction opposite to a peripheral stimulus. Furthermore, erroneous pro-saccades were made towards both visual and somatosensory stimuli on approximately 11-13% of anti-saccade trials. The observed difference in pro- and anti-saccade latency and the presence of pro-saccade errors in the anti-saccade task indicates that a somatosensory stimulus can elicit a form of reflexive saccade comparable to pro-saccades made in the visual modality. It is proposed that a peripheral somatosensory stimulus can elicit a form of reflexive saccade and that somatosensory saccades do not depend exclusively on higher level endogenous control processes for their generation. However, a comparison of the underlying latency distributions and of peak-velocity profiles of saccades made to visual and somatosensory stimuli showed that this distinction may be less clearly defined for the somatosensory modality and that modality-specific differences (such as differences in neural conduction rates) in the underlying oculomotor structures involved in saccade target selection also need to be considered. It is further suggested that a broader conceptualisation of saccades and saccade programming beyond the simple voluntary and reflexive dichotomy, that takes into account the control processes involved in saccade generation for both modalities, may be required.

Adult↗