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PubMed2004

A national dissemination of an evidence-based self-management program: a process evaluation study.

While evidence exists regarding the effectiveness of many health education interventions, few of these evidence-based programs have been systematically or widely disseminated. This paper reports on the dissemination of one such intervention, the 6-week peer-led Chronic Disease Self-Management Program, throughout a large health-care system, Kaiser Permanente. We describe the dissemination process and, using qualitative analysis of interviews and surveys, discuss the factors that aided and hindered this process and make recommendations for similar dissemination projects. Six years after the beginning of the dissemination process, the program is integrated in most of the Kaiser Permanente regions and is being offered to several thousand people a year.

Aged↗
PubMed2004

The Horizontal Gene Pool: an ESF workshop summary.

The European Science Foundation (ESF) funds a limited number of exploratory workshops each year that enable scientists to meet and develop plans for a program of integrated research which would benefit from a coordinated European effort. In summer 2003, the Standing Committee for Life and Environmental Sciences (LESC) sponsored such a workshop called The Horizontal Gene Pool: The Functional Role of Mobile Genetic Information--How Bacteria Perceive, Sample, and Utilize Genetic Elements in evolution and Local Adaptation. The workshop took place at St. Catherine's College, Oxford, UK. Its purpose was to identify how recent advances in the application of genomics and microbial ecology can be harnessed to determine the genetic mechanisms that underpin the biological role of the horizontal gene pool. Scientific excellence at the workshop was contributed by senior scientists and young investigators from research institutes located in nine European countries.

Bacteria↗
PubMed2004

Hippotherapy.

Hippotherapy refers to the use of the movement of the horse asa treatment tool by physical therapists, occupational therapists,and speech-language therapists to address impairments, functional limitations, and disabilities in clients with neuromusculoskeletal dysfunction, such as cerebral palsy. Hippotherapy is used as part of an integrated treatment program to achieve functional outcomes. Hippotherapy engages the client in activities on the horse that are enjoyable and challenging. In the controlled hippotherapyenvironment, the therapist modifies the horse's movement and carefully grades sensory input, establishing a foundation for improved neurologic function and sensory processing. This foundation can be generalized to a wide range of daily activities,making the horse a valuable therapeutic tool for rehabilitation.

Animals↗
PubMed2004

Medical comorbidity in addictive disorders.

Greater risks exist for medical comorbidities in persons with addictive disorders. Clinicians should screen for early comorbidities such as hepatitis C and HIV. During acute intoxications and overdoses, patients are at greater risk for major respiratory and cardiac events. Long-term management of persons with addictions and medical disorders requires integrative care programs involving comprehensive primary and psychiatric care.

Behavior, Addictive↗
PubMed2004

Rovibrational energy levels of hydrogen peroxide, studied by MULTIMODE with a reaction path Hamiltonian.

Recently, Carter and Handy [J. Chem. Phys. 113 (2000) 987] have introduced the theory of the reaction path Hamiltonian (RPH) [J. Chem. Phys. 72 (1980) 99] into the variational scheme MULTIMODE, for the calculation of the J=0 vibrational levels of polyatomic molecules, which have a single large-amplitude motion. In this theory the reaction path coordinate s becomes the fourth dimension of the moment-of-inertia tensor, and must be treated separately from the remaining 3N-7 normal coordinates in the MULTIMODE program. In the modified program, complete integration is performed over s, and the M-mode MULTIMODE coupling approximation for the evaluation of the matrix elements applies only to the 3N-7 normal coordinates. In this paper the new algorithm is extended to the calculation of rotational-vibration energy levels (i.e. J>0) with the RPH, following from our analogous implementation for rigid molecules [Theoret. Chem. Acc. 100 (1998) 191]. The full theory is given, and all extra terms have been included to give the exact kinetic energy operator. In order to validate the new code, we report studies on hydrogen peroxide (H2O2), where the reaction path is equivalent to torsional motion. H2O2 has previously been studied variationally using a valence coordinate Hamiltonian; complete agreement for calculated rovibrational levels is obtained between the previous results and those from the new code, using the identical potential surface. MULTIMODE is now able to calculate rovibrational levels for polyatomic molecules which have one large-amplitude motion.

Algorithms↗
PubMed2006

Rape perpetration by young, rural South African men: Prevalence, patterns and risk factors.

Sexual violence is a well-recognised global health problem, but there has been remarkably little research on men as perpetrators. The objectives of this paper are to describe the prevalence, patterns and factors associated with rape of an intimate partner and a woman who was not a partner with men aged 15-26 years in rural South Africa. The analysis presented here is of data collected during a baseline survey of participants in a cluster randomised controlled trial of an HIV behavioural intervention. A total of 1370 male volunteers were recruited from 70 rural South African villages. They completed a questionnaire asking about background, sexual practices and perpetration of rape and intimate partner violence. Among these men 16.3% had raped a non-partner, or participated in a form of gang rape; 8.4% had been sexually violent towards an intimate partner; and 79.1% had done neither. The mean age of first rape was 17 years. There was overlap between rape of a non-partner and partner, in that 44.3% of men who raped an intimate partner had also raped a non-partner, but overall the great majority of men who raped did not disclose both types of rape. The factors associated with rape of an intimate partner and non-partner had similarities and differences. After adjusting for the other variables, both forms of rape were strongly associated with ever having been physically violent to a partner, having had transactional sex with a casual partner and more sexual partners. Non-partner rape was also associated with peer-related variables, including gang membership and peer pressure to have sex, and also drug use. Non-partner rape was more common among wealthier and relatively more socially advantaged men. Both types of rape were associated with having more adverse childhood experiences. There was considerable overlap between rape-associated factors and known HIV risk factors, suggesting a need for further research on the interface of rape and HIV, and integrated prevention programming.

Adolescent↗
PubMed2004

Resonant bar simulations in media with localized damage.

As a rule, problems of wave propagation in finite media with non-uniform spatial distribution of material properties can only be tackled by numerical models. In addition, the modeling of damage features in a material requires the introduction of locally non-linear and--more important--non-unique equations of state. Using a multiscale approach, we have implemented a non-linear hysteretic stress-strain relation based on the Preisach-Mayergoyz (PM) model, into a numerical elastodynamic finite integration technique program, which has originally been developed for linearly elastic wave propagation in inhomogeneous media. The simulation results show qualitatively good agreement with data of non-linear resonant bar experiments in homogeneously non-linear and hysteretic media. When the PM density distribution of hysteretic units at the mesoscopic level is not uniform and/or confined to a finite area in stress-stress space, the response at high amplitude excitation tend to deviate from the quasi-analytical results obtained in the case of a uniform PM-space density. Localized microdamage features in an intact medium can be modeled by conceiving finite zones with pronounced hysteretic stress-strain relations within a "linear" surrounding. Forward calculations reveal a significant influence of the amplitude dependent resonance behavior on the location (edge versus center of a bar), the extend (width of the zone) and the degree (density of hysteretic units) of damage.

Journal Article↗
PubMed2005

Treatment of men complaining of short penis.

OBJECTIVES: To report the outcome of a sex education-integrated treatment program of men complaining of a short-sized penis. METHODS: This study included 92 patients presenting to our department in the past 2 years complaining of a small-sized penis. History, with particular stress on the duration of the complaint and sexual habits of the patients, was collected from all patients. All patients were asked to complete the International Index of Erectile Function short-form questionnaire. Also all patients were tutored by an andrologist on sex education. Penile length and girth were measured twice using a tape measure in both flaccid and fully stretched states. Every patient was informed that if his flaccid and stretched penis size was 4 cm and 7 cm or more, respectively, it was considered normal. RESULTS: All patients complained of a short penis in either the flaccid or erect state. Of the 92 patients, 66 (71.7%) complained of a short penis only in the flaccid state, and 26 (28.3%) complained of a short penis in both the flaccid and the erect state. None of the patients had erectile dysfunction. None of the patients had short penis according to our measurements. Almost all patients overestimated the normal penile size. Most men found the combination of sex education with standard penile measurements helpful and relieving. CONCLUSIONS: Men complaining of short penis could be treated using basic principles of sex education with objective methods of penile size evaluation. This combination can correct any previous sexual misconceptions, relieve unnecessary anxiety concerning penile size, and decrease the desire to undertake still-to-be verified lengthening procedures.

Adult↗
PubMed2002

Cardiovascular risk management in clinical practice: the Midwest Heart Specialists experience.

Evaluating cardiovascular risk and managing hypercholesterolemia are essential components in the identification and treatment of coronary artery disease. A collaborative care-based lipid clinic is a beneficial part of an integrated prevention program and can result in improved lipid management. Advances in technology now enable use of the electronic medical record in combination with a virtual lipid clinic to promote superior cholesterol management.

Ambulatory Care Facilities↗
PubMed1997

Systemic sclerosis (scleroderma): an integrated challenge in rehabilitation.

Systemic sclerosis (SSc), a multisystem disease involving the microvascular system and the connective tissue, is considered one of the most difficult rheumatic diseases to treat. The natural history of the disease evolves from an edematous to a scleroatrophic phase following two different temporal patterns: acute or chronic. The former leads to early death, and the latter evolves slowly toward severe disability that deserves rehabilitative intervention. Despite the poor prognosis, recent improvements in diagnosis and treatment have led to longer patient survival, thus increasing the need to intervene against the development of tissue fibrosis and contractures by using appropriate integrated rehabilitation programs. This article does not review the medico-pharmacological management of visceral manifestations of the disease. Rather, it is divided into six parts, which include analyses of the changes in skin, joints and tendons, and muscle induced by SSc; examination of the existing literature on rehabilitation strategies and treatments; discussions of the pain and peripheral sensory-motor system involvement that are present to a greater or lesser extent in almost all patients and influence not only the duration and outcome of rehabilitation but also the patient's family, social life, and working ability; and consideration of ergonomic and occupational interventions. No controlled studies have been done on the few rehabilitation guidelines and specific protocols identified, so it must be emphasized that this article is a summary of opinions expressed in the literature and the authors' own findings. Particularly lacking are studies on such aspects as ergonomics, work intervention, or the management of sexual dysfunction. Experience gained in the rehabilitation of skin burns and other rheumatic diseases forms the basis for a logical approach to SSc patients.

Acute Disease↗
PubMed2006

Active involvement and long-term goals influence long-term adherence to behavioural graded activity in patients with osteoarthritis: a qualitative study.

QUESTION: Why do some patients who have received a behavioural graded activity program successfully integrate the activities into their daily lives and others do not? DESIGN: Qualitative study. PARTICIPANTS: 12 patients were selected according to the model of deliberate sampling for heterogeneity, based on their success with the intervention as assessed on the Patient Global Assessment. INTERVENTION: Behavioural graded activity. OUTCOME MEASURES: Data from 12 interviews were coded and analysed using the methods developed in grounded theory. The interviews covered three main themes: aspects related to the content of behavioural graded activity, aspects related to experience with the physiotherapist, and aspects related to characteristics of the participant. RESULTS: Interview responses suggest that two factors influence long-term adherence to exercise and activity.First, initial long-term goals rather than short-term goals seem to relate to greater adherence to performing activities in the long term. Second, active involvement by participants in the intervention process seems to relate to greater adherence to performing activities in the long term. CONCLUSION: Although involvement of patients in the intervention process is already part of behavioural graded activity, it would be beneficial to emphasise the importance of active involvement by patients right from the start of the intervention. Furthermore, to increase the success of behavioural graded activity, physiotherapists should gain a clear understanding of the patient's initial motives in undergoing intervention.

Activities of Daily Living↗
PubMed2002

Apparent transducer non-reciprocity in an ultrasonic flow meter.

This paper investigates the effects of non-identical ultrasonic transducers on reciprocity and zero-flow calibration in transit time flow meters. According to the theorem of reciprocity, there should not be any difference between the up- and downstream acoustic times of flight in a zero-flow situation. This would thus eliminate zero-flow estimation drifts. The flow meter is modeled as a one dimensional system with equivalent electrical circuits and simulated with simulation program with integrated circuits emphasis. The work shows that variations between the two transducers cause false estimates of flow and indicate which parameters have the largest influence. It indicates that reciprocity holds only for identical transducers.

Journal Article↗
PubMed2006

Antigen presentation and the ubiquitin-proteasome system in host-pathogen interactions.

Relatively small genomes and high replication rates allow viruses and bacteria to accumulate mutations. This continuously presents the host immune system with new challenges. On the other side of the trenches, an increasingly well-adjusted host immune response, shaped by coevolutionary history, makes a pathogen's life a rather complicated endeavor. It is, therefore, no surprise that pathogens either escape detection or modulate the host immune response, often by redirecting normal cellular pathways to their advantage. For the purpose of this chapter, we focus mainly on the manipulation of the class I and class II major histocompatibility complex (MHC) antigen presentation pathways and the ubiquitin (Ub)-proteasome system by both viral and bacterial pathogens. First, we describe the general features of antigen presentation pathways and the Ub-proteasome system and then address how they are manipulated by pathogens. We discuss the many human cytomegalovirus (HCMV)-encoded immunomodulatory genes that interfere with antigen presentation (immunoevasins) and focus on the HCMV immunoevasins US2 and US11, which induce the degradation of class I MHC heavy chains by the proteasome by catalyzing their export from the endoplasmic reticulum (ER)-membrane into the cytosol, a process termed ER dislocation. US2- and US11-mediated subversion of ER dislocation ensures proteasomal degradation of class I MHC molecules and presumably allows HCMV to avoid recognition by cytotoxic T cells, whilst providing insight into general aspects of ER-associated degradation (ERAD) which is used by eukaryotic cells to purge their ER of defective proteins. We discuss the similarities and differences between the distinct pathways co-opted by US2 and US11 for dislocation and degradation of human class I MHC molecules and also a putatively distinct pathway utilized by the murine herpes virus (MHV)-68 mK3 immunoevasin for ER dislocation of murine class I MHC. We speculate on the implications of the three pathogen-exploited dislocation pathways to cellular ER quality control. Moreover, we discuss the ubiquitin (Ub)-proteasome system and its position at the core of antigen presentation as proteolysis and intracellular trafficking rely heavily on Ub-dependent processes. We add a few examples of manipulation of the Ub-proteasome system by pathogens in the context of the immune system and such diverse aspects of the host-pathogen relationship as virus budding, bacterial chromosome integration, and programmed cell death, to name a few. Finally, we speculate on newly found pathogen-encoded deubiquitinating enzymes (DUBs) and their putative roles in modulation of host-pathogen interactions.

Animals↗
PubMed2001

Network thermodynamics and complexity: a transition to relational systems theory.

Most systems of interest in today's world are highly structured and highly interactive. They cannot be reduced to simple components without losing a great deal of their system identity. Network thermodynamics is a marriage of classical and non-equilibrium thermodynamics along with network theory and kinetics to provide a practical framework for handling these systems. The ultimate result of any network thermodynamic model is still a set of state vector equations. But these equations are built in a new informative way so that information about the organization of the system is identifiable in the structure of the equations. The domain of network thermodynamics is all of physical systems theory. By using the powerful circuit simulator, the Simulation Program with Integrated Circuit Emphasis (SPICE), as a general systems simulator, any highly non-linear stiff system can be simulated. Furthermore, the theoretical findings of network thermodynamics are important new contributions. The contribution of a metric structure to thermodynamics compliments and goes beyond other recent work in this area. The application of topological reasoning through Tellegen's theorem shows that a mathematical structure exists into which all physical systems can be represented canonically. The old results in non-equilibrium thermodynamics due to Onsager can be reinterpreted and extended using these new, more holistic concepts about systems. Some examples are given. These are but a few of the many applications of network thermodynamics that have been proven to extend our capacity for handling the highly interactive, non-linear systems that populate both biology and chemistry. The presentation is carried out in the context of the recent growth of the field of complexity science. In particular, the context used for this discussion derives from the work of the mathematical biologist, Robert Rosen.

Biological Transport↗
PubMed1996

Baltimore Vision Screening Project.

PURPOSE: This study estimates the prevalence of common visual disorders (amblyopia, strabismus, refractive errors) in a group of inner-city school children. In addition, the study addresses the issue of access to care for vision-screening programs, specifically for children with recognized difficulties in obtaining routine medical care. METHODS: School children from an inner-city elementary school were enrolled into a prospective vision-screening program combining the identification arm (screening) and diagnostic/treatment arm (ophthalmic examination). The screening consisted of Snellen E optotypes presented at a 10-foot test distance. Each child failing the vision screening was examined by an ophthalmologist at the school using standard protocol. This allowed the authors to examine all children identified through the vision-screening program. RESULTS: Six-hundred eighty children were screened during the 1993 to 1994 school year. Eleven percent (76) failed the vision screening and were examined, 68 of whom failed the ophthalmic examination. The estimated prevalence of visual morbidity was as follows: amblyopia, 3.9%; strabismus, 3.1%, and refractive errors, 8.2%. CONCLUSION: Amblyopia, strasbismus, and refractive errors were found in relatively high frequencies for this population sample of inner city children. These findings underscore the necessity of comprehensive vision-screening programs that integrate follow-up care. Children with limited access to specialized eye care must be provided with a mechanism for obtaining these services.

Amblyopia↗
PubMed2000

Visual acuity in children with coloboma: clinical features and a new phenotypic classification system.

OBJECTIVE: The aims of this study were to describe the clinical features and biometric findings in the eyes of children with coloboma and to develop a classification of coloboma that correlates with visual function. DESIGN: Retrospective observational case series. PARTICIPANTS: One hundred thirteen children and young adults (48 female, 65 male) aged 0 to 20 years with 196 eyes having coloboma. METHODS: Children with coloboma were recruited from schools for the blind, integrated education programs, schools for the mentally handicapped, community-based rehabilitation services, and hospital clinics in Andhra Pradesh, India, between January 1998 and January 1999. Visual function was assessed, including distance and near visual acuity (VA), and navigational vision. The corneal diameter and axial length of eyes were measured wherever possible. MAIN OUTCOME MEASURES: Anatomic site of coloboma, association with microcornea and/or microphthalmos, VA, presence of navigational vision and reading vision. RESULTS: Of 196 eyes with colobomatous malformations, 11 had microphthalmos with cyst, and 185 eyes had coloboma (associated with microcornea in 155 eyes and with a normal corneal diameter in 30). Microphthalmos was present in 72 of the 185 eyes with coloboma, of which 71 of 72 also had microcornea. The prognosis for vision depended on the phenotype of the better eye. Microphthalmos with cyst had the worst prognosis (VA < 3/60, 100%; reading and navigational vision, 0%). Microcornea with microphthalmos had a worse prognosis than microcornea without microphthalmos (VA < 3/60: 66.7% vs. 23.3%; unable to read N10: 66.7% vs. 34.1 %; no navigational vision: 30.6% vs. 6.73%). Simple coloboma (no microcornea or microphthalmos) had the best prognosis (VA < 3/60: 6.7%; able to read N10: 93.3%; navigational vision: 100%). A corneal diameter <6 mm had a poor visual prognosis, whereas a corneal diameter >10 mm had a good prognosis. CONCLUSIONS: A phenotypic classification of coloboma is proposed, which in this study showed a good correlation with visual acuity, reading, and navigational vision. Microphthalmos with cyst had the worst prognosis, coloboma with microcornea and microphthalmos a poor prognosis, coloboma with only microcornea had an intermediate prognosis, and simple coloboma had the best prognosis.

Adolescent↗
PubMed1986

A community approach to diabetes education in Australia--The Region 8 (Victoria) Diabetes Education and Control Program.

The Australian Region 8 (Victoria) Diabetes Education and Control Program (DECP) is a community-based program which seeks to integrate ambulatory diabetes education programs into primary health care centres. The overall goal of the DECP is to reduce the human and economic costs of diabetes in a health region which covers 25% of the population of Victoria. Several implementation models are being tested and a rigorous evaluation has been built into the program. Diabetes education activities are targeted at 3 levels--the community, persons with diabetes, and health professionals. The DECP may provide of useful model for establishing diabetes and other chronic disease education and control programs, within community settings, in other parts of Australia and other countries.

Australia↗
PubMed1998

Public health policy, community services, and outcomes for patients with schizophrenia.

Amidst the specter of managed care, individual mental health services are struggling to redefine their niche, consolidate with partners and provide a realistic continuum of care for persons with serious and persistent mental illness. Because of the chronicity of schizophrenia, its economic and social ramifications, the disparity in health insurance for these patients and limited resources, the development of community services has often proceeded in a fragmentary manner. Several states have well coordinated community programs with integration between private and public services. The Assertive Community Treatment (ACT) model has proved successful, although this is costly to maintain. Services that synergize optimum pharmacologic and psychosocial treatments can achieve favorable patient outcome, as evaluated across clinical, rehabilitative, humanitarian, and public welfare domains.

Community Mental Health Services↗