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PubMed2005

Strength training: what the team physician needs to know.

Strength training has become an integral part of preparing for and participating in sports. Strength is one of the four components of athleticism, along with power, speed, and agility. Optimal strength training and conditioning workouts are best directed by a coach with formal training in this discipline. Unfortunately, many high school and some college programs do not have access to certified strength and conditioning coaches. This task often falls to the individual sport coaches and medical staff (athletic trainers and physicians). In this article we present a framework for practical strength training knowledge including the concepts of specificity, prioritization, periodization, and progressive overload. We also discuss concepts of the sports medicine team and its approach to training and conditioning. This framework will give physicians and other athletic heath care providers the basic information needed to design and implement a safe and effective strength training program.

Adolescent↗
PubMed2005

HTHquery: a method for detecting DNA-binding proteins with a helix-turn-helix structural motif.

SUMMARY: HTHquery is a web-based service to determine if a protein structure has a helix-turn-helix structural motif which could bind to DNA. It is based on a similarity with a set of structural templates, the accessibility of a putative structural motif and a positive electrostatic potential in the neighbourhood of the putative motif. A set of scores are computed, based on each template, using a linear predictor. From the training set used, the predictor has a true positive rate of 83.5% and a false positive rate of 0.8%. The emphasis for the website is on providing a straightforward interface which can be easily used by a bench-based scientist. AVAILABILITY: HTHquery is implemented using a set of Perl scripts and C program and can be accessed freely on the website http://www.ebi.ac.uk/thornton-srv/databases/HTHquery.

Amino Acid Motifs↗
PubMed2004

[Issues on user participation in health care management in Africa].

The 1990s witnessed great progress in increasing community participation in the management of health care services as an objective for reform of healthcare systems especially in urban areas benefiting from funding from the international community. Community participation has taken various forms from one country to another in terms of sources of healthcare training (public, private, or both), organization of management committees (inclusion or not of healthcare personnel), and scope of public service assigned to district health care units (preventive and/or curative care, management of proceeds from provision of health care procedures and/or medication, etc.). These strategies have had variable results and, although some urban programs have been evaluated, no attempt has been made to use this experience as a basis for analyzing the political implications of issues involving citizenship and public health. This report presents some ideas on these issues from the point of view of both governments and citizens and restates the purpose of user participation in healthcare services in Africa. That intent involves the need not only to increase household contributions to the cost of healthcare especially within the uncertain economic environment of urban areas but also to improve access to as well as quality of healthcare services.

Africa↗
PubMed1990

[A prospective study of access to medical services following a community-based screening program].

Participants in a multiphasic screening program, 454 men and 767 women, were followed up for a period of several months (117 days on the average) in order to evaluate their needs for medical services after screening. Five hundred sixty-two (47.1%) visited outpatient clinics in the study area; 185 as continuing visits for existing diseases (prevalent), 167 because of symptoms which developed after the screening (clinical), and 65 for further investigations of abnormal findings from the screening (screened). The ratio of prevalent to incident (= clinical + screened) cases, which is related to the duration of clinical phase, was the highest in hypertensive, thyroid, ophthalmologic disorders. This indicates that health services for prevalent cases of those diseases are needed in addition to primary and secondary preventive efforts. The proportion of screened cases in the incident cases, which reflects the ability of the screening program to detect diseases in the preclinical phase, was the highest for anemia, disorders of lipid metabolism, and hypertensive disorders. The smaller proportions in dermatologic, urologic and orthopedic disorders indicate that preventive methods for these disorders should be considered in the future. In conclusion, monitoring of screening participants by prospective follow-up and analysis by two measures proposed in this study seem promising for continuing evaluation of the effectiveness of an on-going screening program. A network system of hospitals and physicians' offices should be developed, by which the information on the visits to outpatient clinics after screening is collected and analyzed periodically for monitoring.

Adult↗
PubMedDate not supplied

A survey of vision screening policy of preschool children in the United States.

A state-by-state survey regarding preschool vision screening guidelines, policies, and procedures was conducted. Currently 34 states provide vision screening guidelines and 15 states require vision screening of at least some of their preschool-aged children. The Department of Public Health administers the programs in 26 states, the Department of Education in 13. A wide range of professional and lay personnel conduct preschool vision screenings, and nurses participate in the screening process in 22 states. Visual acuity is assessed in 30 states, eye alignment in 24 states, refractive error in eight states, and color vision in 10 states. A combination of screening tests is recommended in 24 states. Currently, 45 states do not require screening of all preschool children. Thus, although laws, guidelines, and recommendations exist in most states, many preschool-age children do not have access to vision screening programs.

Child, Preschool↗
PubMed2004

Spectral Repeat Finder (SRF): identification of repetitive sequences using Fourier transformation.

MOTIVATION: Repetitive DNA sequences, besides having a variety of regulatory functions, are one of the principal causes of genomic instability. Understanding their origin and evolution is of fundamental importance for genome studies. The identification of repeats and their units helps in deducing the intra-genomic dynamics as an important feature of comparative genomics. A major difficulty in identification of repeats arises from the fact that the repeat units can be either exact or imperfect, in tandem or dispersed, and of unspecified length. RESULTS: The Spectral Repeat Finder program circumvents these problems by using a discrete Fourier transformation to identify significant periodicities present in a sequence. The specific regions of the sequence that contribute to a given periodicity are located through a sliding window analysis, and an exact search method is then used to find the repetitive units. Efficient and complete detection of repeats is provided together with interactive and detailed visualization of the spectral analysis of input sequence. We demonstrate the utility of our method with various examples that contain previously unannotated repeats. A Web server has been developed for convenient access to the automated program. AVAILABILITY: The Web server is available at http://www.imtech.res.in/raghava/srf and http://www2.imtech.res.in/raghava/srf

Algorithms↗
PubMed1983

The U.S. Uranium Registry tissue program.

The U.S. Uranium Registry tissue program was established in December 1980. It is patterned after the U.S. Transuranium Registry program. Both are funded by DOE. The objectives of the program are to: (1) detect the presence and distribution of uranium, if any, in human tissue in occupationally exposed workers, (2) compare bioassay and in vivo measurements for exposed individuals with the results of analysis of tissue obtained at autopsy, (3) seek evidence of histopathological changes related to any uranium deposition found, (4) conduct analyses of whole bodies, when available, to obtain more precise data on the uranium burdens, if any, in the body and organs, and especially the distribution in parts of the body, such as most of the skeleton, that are not usually accessible for sampling. The program will include (1) participants who have been permissibly exposed, (2) participants who were exposed at a time when current limits did not exist and (3) reference individuals without exposure. The program will develop data that will assist in evaluating (1) the accuracy of current in vivo measurement techniques, (2) the propriety of existing regulations and (3) the adequacy of current protection programs. Enrollment in the program is voluntary.

Autopsy↗
PubMed2001

Current state of distance continuing medical education in North America.

BACKGROUND: Every continuing medical education (CME) provider is confronted one day or another with deciding whether to develop distance education programs that may enhance access to CME for health professionals. To make a judicious decision, one needs to understand the features of distance education and the experiences of other providers. METHODS: Since there was a lack of information in the literature regarding the actual state of distance CME in North America, a Web-based survey aimed at CME providers was conducted including a description of the providers, the users, the activities offered, the technologies employed, and the administration of the systems. RESULTS: The results from this study indicate that the majority (68%) of CME providers had not developed distance education programs at the time of the survey; 30% of the providers, mainly from private companies, were offering nondegree distance education programs, and 2% of the university providers were offering degree programs. The technologies mainly used to develop distance education programs were printed material (69%), videoconferencing (58%), and, to a lesser degree, videotape. The revenue sources to develop degree programs were government funding, tuition, and fees. Other sources such as commercial support and sales were used for nondegree programs. IMPLICATIONS: This study revealed that there was considerable interest in distance education, especially from the organizations not offering this type of program. Since distance CME features are now better known, this is a step toward the advancement and development of more and better distance education programs.

Education, Distance↗
PubMed2004

The Governor's Wellmobile: Maryland's mobile primary care clinic.

This article describes the development and implementation of the Governor's Wellmobile program. Designed to increase access to community-based health care for uninsured, underserved populations and to provide innovative clinical practice, research, and education opportunities for students and faculty, this fleet of four full-service, primary care clinics "on wheels" is managed and operated by the University of Maryland School of Nursing, demonstrating that nurse-managed practice models are valuable to the state's health care delivery system. Issues of long-term financial sustainability are presented, as well as lessons learned about the importance of public, private, and philanthropic partnerships and political support in ensuring the success of such programs.

Community Health Nursing↗
PubMed1995

Oral health policies and programs affecting the preschool child.

Although many policies and programs address the oral health of children, those specifically dealing with the preschool child are few. Review of existing policy suggests a lack of coherence or emphasis on the preschooler as a separate focus for oral health efforts. The importance of locating preschool children within existing policies and programs lies in insuring their access to care and to the benefits of educational and other preventive efforts directed to oral health. The experience of dentists advocating for children in California illustrates the value of an awareness of policies and programs directed at the preschool population. In 1990, a lawsuit brought forth by a coalition of dentists and other child advocates resulted in changes in the Denti-Cal (Medicaid) program for the benefit of children served. These changes increased both access and use by increasing fees and attracting more providers. Two years later, California attempted to stem the costs of success and tried to switch to a mandated capitated program for all Medicaid recipients. Again, through legal action, child advocates were able to argue successfully that such a move would have a negative impact on the children of California. The outcome of the legal action in this situation is still to be decided at this writing, but the series of events and the success of the advocate-dentists speak to the value of a working knowledge of the programs available for children. An individual dentist can also benefit individual children by knowing approved and covered procedures for their care, programmatic characteristics for situations requiring referral, and resources for educational materials. In many cases, knowledge of policies and programs is as valuable as the care dentists render.

Bottle Feeding↗
PubMed1998

Striking against managed care: the last gasp of la médicine libérale?

The French health care system combines a strong tradition of autonomous private practice with nearly universal health care coverage through the social security system. The French state's responses to rising health care expenditures have included limitation of the number of medical students, control over physician fees, rules to prohibit certain clinical practices, experiments with generalist physicians coordinating care and access to specialists, and collective physician responsibility for expenditures beyond the health care budget. The failure of physicians' protests, including a strike of French residents and fellows in 1997, may signify the end of traditional private practice in the face of France's statist version of managed care.

Delivery of Health Care↗
PubMed2004

[Impact of a program to improve appropriate prescribing of medications in residential facilities for older persons. Results after one year].

OBJECTIVE: To evaluate the impact after one year of a program to improve appropriate prescribing of medications, medical care products and supplies at a group of residential centers for older persons. DESIGN: Multicenter, controlled, quasi-experimental, before-after study of all outpatient prescriptions charged from each center to the Catalonian Health Service during the study period (reference year 2001, monitoring year 2002). SETTING: A total of 107 residential centers in the Barcelonés Norte y Maresme (Barcelona) health region. PARTICIPANTS: After situation analysis the centers were divided into two groups: intervention (n=21) and control (n=86). A total of 4789 older persons were residents at participating centers during the study. Interventions. The actions carried out in the intervention group were: a). letter describing the program; b). face-to-face interview to provide information; c). distribution of printed information about the study's aims and the indicators recorded, and d). monitoring with several follow-up interviews. MAIN MEASURES: We recorded quantitative indicators (general, specific and urinary incontinence products), qualitative indicators (use of medications with high intrinsic pharmacological value and generic pharmaceutical specialties) and relative drug use. The data were analyzed with a program written for Microsoft Access. RESULTS: In the intervention group we found that pharmaceutical costs were contained, a result we attributed to the greater efficiency achieved with the intervention (interannual increase of 0.7% in the reference period to 16.2% in the monitoring period; P=.000). The contribution of urinary incontinence supplies to cost reductions was noteworthy. Total costs in terms of numbers of packages dispensed for all therapeutic subgroups decreased by 4.8% (P=.000). The use of generic pharmaceutical specialties increased by from 7.9% to 13.1%, and the results for qualitative indictors for antiasthmatics and recommended NSAIDs also revealed improvements in prescribing quality. CONCLUSIONS: The preliminary results of the program show it to be effective in improving the efficiency of drug prescribing at participating nursing homes. The research method was useful in promoting the rational use of medications and improving the quality of prescribing practices.

Aged↗
PubMedDate not supplied

Providing oral health care to individuals with severe disabilities residing in the community: alternative care delivery systems.

For some individuals with disabilities who reside in the community, comprehensive oral health care is inaccessible. This deficiency has been noted by health care professionals and advocacy organizations. For example, most dentists who provide care to people with disabilities who reside in the institutional setting perceive that present resources within the community, both private and public, are generally unprepared to provide comprehensive dental care to the adult with severe disabilities; they also believe that special facilities and programs are needed that will be geographically and financially accessible to these individuals. Fortunately, several "special programs" have been established that successfully provide dental care to this population. This article describes these alternative care delivery systems and discusses their characteristics, advantages, and disadvantages. In addition, given the continuing process of community placement, implications for institutional dental programs are presented.

Ambulatory Care Facilities↗
PubMed2001

High prevalence of genotypic and phenotypic HIV-1 drug-resistant strains among patients receiving antiretroviral therapy in Abidjan, Côte d'Ivoire.

To describe prevalence of antiretroviral (ARV) drug-resistant HIV-1 strains among patients with a history of earlier treatment with ARV drugs in Abidjan, Côte d'Ivoire, we determined mutations that confer HIV-1 ARV drug resistance by sequencing the viral reverse-transcriptase and protease genes derived from plasma viral RNA of 68 individuals consecutively enrolled in the Joint United Nations Program on AIDS Drug Access Initiative (UNAIDS-DAI) with a history of earlier ARV drug treatment in Abidjan between August 1998 and April 1999. Phenotypic ARV drug resistance was assessed using a recombinant virus assay. Primary mutations associated with ARV drug resistance to at least one of the reverse-transcriptase inhibitors or protease inhibitors were detected in 39 (57.4%) of the 68 patients. The prevalence of mutations associated with resistance to ARV drugs was: 29 (42.6%) to zidovudine, 10 (14.7%) to lamivudine, one (1.5%) to didanosine, one K103N mutation (associated with resistance to delavirdine, nevirapine, and efavirenz), one Y181C mutation (associated with resistance to delavirdine and nevirapine), two to both indinavir (M46I/L and V82A) and saquinavir (G48V and L90M), and one each to ritonavir (V82A) and nelfinavir (D30N). Phenotypic resistance to at least one nucleoside reverse transcriptase inhibitor (RTI) was seen in 25 (39.7%) patients, to nonnucleoside RTIs in 5 (8%) patients, and to protease inhibitors in 4 (6%) patients. The high prevalence we observed in this study may limit in future the effectiveness of ARV programs in the Côte d'Ivoire.

Anti-HIV Agents↗
PubMed2000

System of telemedicine services designed for family doctors' practices.

The main goal of the most European telemedicine programs is to increase access to emergency and primary care; however, telemedicine presents both profound opportunities and challenges to general practice/family medicine. The aim of this project is to develop and demonstrate a regional primary care teleconsulting system in Poland linking an academic family medicine center and 10 family doctors' practices (both urban and rural) within a range of 100-200 km, serving a local population of 25,000 individuals. It is designed to support real-time consultations among health care providers via a computer network, provide secure access to multimedia patient records, and facilitate an innovative home monitoring and remote care from doctors to their patients. The entire process (planned for 3 years) includes: selecting the best technology (i.e., teletransmission system, communication protocols, etc.) and equipment; preparing the assumptions and conditions for formats and transmission rates; analysis of the existing techniques of compression and preparing own specific solution; finding an optimal infrastructure (i.e., equipment and communication configuration); implementing the system; evaluation of the medical, economic, organizational, and sociological aspects of the system (i.e., accessibility to primary health care, cost feasibility and cost-effectiveness of telemedicine services, quality of care assessment, etc.). The project offers the potential to improve: access to high-quality primary health care; the patient-physician bond and the attending physician's level of confidence; education of family doctors; use of expensive resources; and a convenient mode of delivering medical services to the patient.

Academic Medical Centers↗
PubMed2002

Risk-taking behaviors among injecting drug users who obtain syringes from pharmacies, fixed sites, and mobile van needle exchanges.

Needle-exchange programs (NEPs) have been shown to be effective in reducing harm related to injection drug use and to act as an important link between the injection drug using community and preventive/treatment services. Different needle-exchange distribution methods may reach different subpopulations of injecting drug users (IDUs). We undertook this study to characterize risk behaviors by primary source of clean needles accessed by IDUs in a city with pharmacy access and fixed and mobile exchange programs. We hypothesized there would be a gradient of risk across the three types of distribution. Data were collected from within the Vancouver Injection Drug Users Study (VIDUS), a prospective cohort study. Participants who primarily obtained clean needles from pharmacies, fixed sites, or mobile exchange vans were compared using the Cochran-Armitage trend test to test for trends in increasing risk behaviors across the three types of distribution. Ordinal multivariate regression was used to adjust the associations for potential confounders. Results illustrate clear trends for increasing risk profiles from pharmacy to fixed site to mobile exchange vans. Van users were generally at higher risk than fixed-site and pharmacy users. Independent predictors of van use were fewer years injecting, difficulty finding needles, Aboriginal ethnicity, incarceration in the previous 6 months, and injecting cocaine daily. An important component of needle-exchange programs is outreach to access those who are at highest risk. Use of distribution beyond fixed sites will improve such outreach, thereby increasing program effectiveness and further preventing the transmission of blood-borne infections.

Adult↗
PubMed2003

Pediatricians' reported practices regarding early education and Head Start referral.

BACKGROUND: Early learning programs have proven benefits for impoverished children; Head Start is the most widespread of such programs. The current involvement of pediatricians in the Head Start enrollment process is unknown. OBJECTIVES: 1) To assess the knowledge, attitudes, and reported practices of pediatricians on referring families to Head Start; 2) to assess pediatricians' receptivity to a potential practice-based intervention to enhance their ability to make Head Start referrals. METHODS: Mail survey to stratified random sample of pediatricians practicing in poor and non-poor US zip codes. Prevalence estimates and logistic regression models were estimated using weighted data. RESULTS: Of 1000 surveys distributed, 472 of 772 presumed-eligible subjects completed surveys for a response rate of 61%. Respondents and nonrespondents were similar with regard to age, gender, years in practice, and urban/rural practice setting. Eighty percent of pediatricians reported discussing child care arrangements with a majority of their preschool-aged patients' families, while only 14% reported actually assisting these families in applying to Head Start. Lack of time (77% of pediatricians) and nonphysician office staff (71%) were listed as the most significant barriers to helping families apply to Head Start. Unfamiliarity with early childhood education (10%) was generally not seen as a barrier to this practice. Head Start knowledge (adjusted odds ratio [aOR]: 1.43; 95% confidence interval [CI]: 1.01, 2.02), self-efficacy in advising families how to access local Head Start programs (aOR: 3.49; 95% CI: 1.46, 8.38), and the belief that it is the pediatrician's responsibility to do so (aOR: 9.98; 95% CI: 3.91, 25.48) were significantly associated with assisting families with Head Start enrollment. The majority of respondents (77%) reported a willingness to participate in a proposed computer-based intervention to aid eligible families in applying to Head Start. Having access to a social worker (aOR: 2.48; 95% CI: 1.17, 5.21) and respondent age (aOR: 0.96 for each year; 95% CI: 0.93, 0.99) were significantly associated with likely participation in the intervention. CONCLUSIONS: Although pediatricians report commonly discussing child care issues, few actively assist patients in the application process for Head Start. An intervention to facilitate Head Start referral from the physician's office must address time and staff limitations; education of pediatricians is a secondary need.

Child, Preschool↗