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PubMed2005

[Utilization of external hip protectors in frail elderly residents of nursing homes].

Falls are common among the elderly and stem from multiple causes. Much attention has been given to the development of falls-prevention programs, mainly because of the substantial risk for hip fracture sustained after a fall. The population of frail elderly nursing home residents is a high-risk group for falls. The utilization of an external hip protector that covers the greater trochanter of the femur has been shown to reduce the incidence of hip fractures. However, low compliance remains a major obstacle in the effective use of hip protector systems.

Aged↗
PubMed1994

Rehabilitation compliance in an athletic training environment.

The purpose of this study was to determine the relationship between the rehabilitation adherence of athletes and their self-reported assessment of six variables that might influence rehabilitation adherence: pain, support from others, exertion, scheduling, motivation, and environment. Each of 44 Division II athletes sustained a musculoskeletal injury and was placed on a rehabilitation program. Adherence to the program was measured by attendance at and participation in scheduled rehabilitation sessions. Each athlete was classified as adherent (n = 27) or nonadherent (n = 17). Pain and support were significantly correlated to adherence. Pain and support from others were significantly different between the adherent and nonadherent groups. Principal components analysis was also performed and confirmed the t-test results that pain and support are the only subscales strongly associated with adherence scores. We conclude that controlling pain and providing emotional support is associated with sport rehabilitation adherence.

Journal Article↗
PubMed1990

A prospective, multi-center clinical trial of the Taylor intragastric balloon for the treatment of morbid obesity.

This report describes the result of a prospective, multicenter clinical trial of the Taylor intragastric balloon for the treatment of morbid obesity. Sixty patients, who had failed sustained weight loss on prior dietary restriction and behavior modification programs, were enrolled in four clinical centers. The Taylor intragastric balloon, a 550-ml, pear-shaped, liquid-filled, silicone device, was inserted in all patients for a period of 16 wk, and patients were maintained on a dietary restriction and behavior modification program. During the study period, patients experienced a 11.6% decrease in mean weight and an 11.4% decrease in body mass index. Seven balloons deflated spontaneously. Examination of these balloons revealed a manufacturing defect that was subsequently corrected. No further deflations occurred. Effects of the balloons on gastric mucosa were minimal with no gastric erosions or ulcerations noted.

Adult↗
PubMedDate not supplied

PHS grants for minority group HIV infection education and prevention efforts.

The Office of Minority Health (OMH) was established in December 1985 in response to recommendations developed by the Secretary's Task Force on Black and Minority Health. Originally, OMH's mission emphasized six health problems identified by the Task Force as priority areas: cancer, cardiovascular disease and stroke; chemical dependency; diabetes; homicide, suicide, and unintentional injuries; and infant mortality and low birth weight. OMH added HIV infection to the six health priority areas after epidemiologic data showed that the representation of blacks and Hispanics was disproportionately high among persons reported with AIDS. Strategies to eliminate or reduce high-risk behaviors associated with HIV infection need to mobilize racial and ethnic minority communities and rebuild social networks in order to foster sustained behavioral changes. OMH created the Minority HIV Education/Prevention Grant Program to demonstrate the effectiveness of strategies to expand the activities of minority community-based and national organizations involved in HIV education and prevention, as well as to encourage innovative approaches to address appropriately the diversities within and among minority populations. In 1988, grants totaling $1.4 million were awarded to four national and 23 community-based minority organizations. Project workers conduct information, education, and prevention interventions directed to specific groups within racial and ethnic minority communities. Interventions include education and prevention training, information activities, developing educational materials, and providing technical assistance. Project innovations include conducting HIV education and prevention training for families at home, presenting a play produced and performed by local teenagers, and developing a workshop and a manual to help minority service organizations to recruit and train volunteer staff members. Working with minority community-based and national organizations is an essential component of effective strategies for preventing HIV infection among racial and ethnic minorities. OMH's Minority HIV Education/Prevention Grant Program encourages minority groups to participate as partners in Federal, State, and local HIV prevention efforts.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Encircling endocardial resection with complete removal of endocardial scar without intraoperative mapping for the ablation of drug-resistant ventricular tachycardia.

Encircling endocardial resection, with complete removal of endocardial scar unguided by intraoperative mapping, was employed in 10 patients with drug-resistant sustained ventricular tachycardia. Reproducible sustained ventricular tachycardia was induced in all patients preoperatively with programmed electrical stimulation. A trial of conventional antiarrhythmics had failed in all 10 patients; seven patients required frequent cardioversion, and three patients required overdrive suppression with temporary transvenous pacing. Encircling endocardial resection was performed in all patients, with complete removal of endocardial scar; partial reimplantation of the mitral apparatus was required in nine patients. Eight patients underwent aneurysmectomy, and the nine patients who required concomitant aorta-coronary bypass received a total of 13 grafts (mean 1.3 grafts per patient). There were no spontaneous postoperative arrhythmias. One patient without postoperative clinical arrhythmias, who had required daily preoperative cardioversion, had inducible ventricular tachycardia with postoperative programmed electrical stimulation, but not after loading with procainamide. Mean follow-up was 17.3 months. Eight patients are alive and well. There were two late deaths. One patient died with recurrent ventricular septal defects 2.5 months following extensive septal encircling endocardial resection, and one patient was readmitted after 4 months with massive pulmonary embolus and right-sided heart failure. This early experience suggests that this procedure, with complete removal of endocardial scar, successfully ablates reentrant ventricular tachycardia. We believe that the procedure will prove to be more effective than localized endocardial resection because the encircling procedure removes all ventricular sites that have the potential to generate reentrant ventricular tachycardia.

Aged↗
PubMed1995

[Automatic implantable defibrillators. Clinical experience apropos of 45 patients].

The aim of this study was to analyse the efficacy and survival after implantation of an automatic cardioverter-defibrillator.. Forty-five patients including 37 men were followed up for 0 to 51 months. The indications were ventricular fibrillation with no curable cause (n = 27) and sustained resistant or poorly tolerated ventricular tachycardia (n = 17) when programmed ventricular pacing with antiarrhythmic therapy was not applicable or gave poor results. One patient was implanted with this device for torsades de pointes. The underlying cardiac disease was ischaemic in 34 cases, non-ischaemic in 8 cases, and 3 patients had no apparent cardiac disease. Twenty patients were implanted with an epicardial system (group I) and 25 patients with endocardial system (group II). In group II, there was one complete failure of implantation requiring the use of an epicardial system and 2 partial failures requiring an additional epicardial patch electrode. The perioperative mortality was 2/45 (4.4%), both cases being due to permanent arrhythmias. In 5 patients, the minimal effective energy of defibrillation was over 25 Joules at implantation, without any untoward consequences on the clinical outcome. Ten non-fatal complications were observed including two major problems (haemopericardium); there were two cases of late increase of the minimal effective energy of defibrillation requiring the addition of a subcutaneous patch. Twenty-four patient (53%) received at least one appropriate therapy; 14 patients (36%) had at least one inappropriate shock during follow-up. During follow-up, 7 patients died, 6 of a cardiac cause and 3 of an arrhythmic problem.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Progress toward tuberculosis control--India, 2001.

Every year, approximately 2 million persons in India develop tuberculosis (TB), accounting for one fourth of the world's new TB cases. Organized TB control activities have existed in India for 40 years; however, the quality of diagnosis and treatment of TB in the public and private sectors has been variable, and TB incidence and prevalence trends have not changed substantially over this time. In 1992, the Indian government established a Revised National Tuberculosis Control Programme (RNTCP) using the directly observed treatment, short-course (DOTS) strategy recommended by the World Health Organization (WHO) (3). The DOTS strategy consists of sustained government commitment, effective laboratory-based diagnosis, standard treatment given under direct observation, secure drug supply, and systematic monitoring and evaluation. RNTCP was implemented in pilot areas beginning in 1993; large-scale implementation of the program began in late 1998. This report summarizes the process, outcomes, and challenges of RNTCP in India. RNTCP has implemented DOTS rapidly and has yielded positive results in TB control; however, continued commitment from Indian government authorities and the international community is needed to sustain and expand this ongoing program.

Antitubercular Agents↗
PubMed2005

Osteoblasts lacking the vitamin D receptor display enhanced osteogenic potential in vitro.

1,25-dihydroxyvitamin D plays an important role in the regulation of osteoblast gene expression, regulating the expression of bone matrix proteins as well as that of Runx2, a key regulator of osteoblast differentiation. Studies in mice lacking the vitamin D receptor (VDR) have revealed that the actions of the VDR on the skeleton are not required in the setting of normal mineral ion homeostasis. Since paracrine and endocrine factors can compensate for gene defects in vivo, studies were performed to determine whether ablation of the VDR alters the program of osteoblast differentiation in vitro. Studies in primary calvarial cultures revealed that ablation of the VDR enhanced osteoblast differentiation. The cells from the VDR null mice exhibited an earlier onset and increased magnitude of alkaline phosphatase activity, as well as an earlier and sustained increase in mineralized matrix formation, demonstrating that this enhancement persists throughout the program of osteoblast differentiation. The expression of bone sialoprotein, which enhances mineralization, was also increased in the VDR null cultures. To determine whether the increase in osteoblast differentiation was associated with an increase in the number of osteogenic progenitors, the number of osteoblastic colony forming units (CFU-OB) was evaluated. There was a twofold increase in the number of CFU-OB in the cultures isolated from the VDR null mice. Furthermore, the VDR null CFU-OB demonstrated an earlier onset and higher magnitude of expression of alkaline phosphatase activity when compared to the CFU-OB from their wild-type control littermates. These studies demonstrate that the VDR attenuates osteoblast differentiation in vitro and suggest that other endocrine and paracrine factors modulate the effect of the VDR on osteoblast differentiation in vivo.

Animals↗
PubMed1999

Effect of an emergency department asthma program on acute asthma care.

STUDY OBJECTIVE: To examine the effect of an emergency department program on acute asthma care. METHODS: We conducted a before-after study of an acute asthma quality improvement initiative in an urban teaching hospital with 65,000 annual ED visits. In mid-1994, a multidisciplinary group identified deficiencies in acute asthma care, developed and implemented a local version of the National Asthma Education Program's practice guidelines (including a standard asthma order sheet), and provided new peak flow (PF) meters. The "before" group comprised all adults with acute asthma seen during January 1994 (n=51); "after" groups comprised all adults with acute asthma seen during October 1994, February 1995, and June 1995 (n=145). Data were compared across months using a nonparametric test for trend. RESULTS: Although patient demographic characteristics and asthma severity were similar across months, ED process of care significantly changed. Initial PF measurements were obtained in 20% of patients before intervention, compared with 82%, 84%, and 83% during the postintervention months ( P for trend <.001). Follow-up PF readings were obtained in 22%, 70%, 78%, and 62% ( P <.001). Median delays to beta-agonist and steroid therapy decreased by approximately 16 minutes ( P <.001) and 34 minutes ( P =.04), respectively. Outcomes improved, with median ED length of stay decreasing by 58 minutes ( P =.01), and fewer inpatient admissions ( P =.05); there was no significant change in 4-week relapse to our hospital. CONCLUSION: A guideline-based ED asthma program changed clinical practice and improved acute asthma care in a sustained fashion. The effect of this intervention on cost and other outcomes is uncertain.

Acute Disease↗
PubMed2026

Exhausted CD8+ T cell fate is programmed by dynamic CTCF-mediated enhancer activation and invariant CTCF-imposed barriers.

Exhausted CD8+ T (TEX) cells undergo extensive genome reorganization during differentiation, yet the drivers of this process remain elusive. Here we show that CTCF programmed CD8+ TEX cell fates through two distinct modes of action. CTCF acquired de novo binding sites and concordantly induced open chromatin in early CD8+ TEX cells responding to chronic viral infection. The dynamic CTCF binding activated enhancers and promoted chromatin looping. Consequently, genetic ablation of CTCF diminished chromatin accessibility and interaction strength, impairing CD8+ TEX cell proliferation, effector function and bioenergetic mobilization. Conversely, invariant CTCF binding acted as essential chromatin barriers, and loss of CTCF disrupted insulation and caused aberrant chromatin self-association and undue RNA polymerase II pausing, leading to excessive activation of exhaustion- and stemness-linked genes. Thus, CTCF balanced CD8+ TEX cell differentiation by gaining dynamic binding to induce cytotoxicity and sustain metabolic fitness, while its invariant binding compartmentalized exhaustion and stemness program genes to prevent their overexuberant activation.

CCCTC-Binding Factor↗
PubMed1985

Clinical significance of ventricular fibrillation-flutter induced by ventricular programmed stimulation.

Two hundred twenty-four patients underwent ventricular programmed stimulation (VPS) without prior documentation of the clinical occurrence of sustained ventricular tachycardia (VT) or ventricular fibrillation-flutter (VF). Indications for VPS were: palpitations or nonsustained VT during ambulatory monitoring (85 patients), syncope or presyncope (137 patients), and a family history of sudden death (two patients). Sustained VF requiring transthoracic defibrillation was initiated by VPS in 18 patients (8.0%). Four patients were treated for inducible VF with antiarrhythmic agents directed by electropharmacologic testing; five patients were treated empirically; nine patients received no therapy. No patient has had a cardiac arrest or sudden death during a follow-up period 25.2 +/- 13.8 months (mean +/- standard deviation). VF was initiated by two ventricular extrastimuli in three patients and by three extrastimuli in 15 patients. The incidence of VF was similar in patients with and without previous symptoms (8.8% vs 6.9%) or heart disease (7.1% vs 9.6%). It was significantly higher when VPS at three ventricular sites with a current of 5 mA (pulse width 2 msec) was compared to programmed stimulation at two ventricular sites with a current twice diastolic threshold (pulse width 2 msec) (15.2% vs 3.0%, p less than 0.05). VF initiated by VPS in patients without prior VT or VF appears to be a nonspecific finding. Antiarrhythmic therapy for VF may not be necessary in these patients.

Adult↗
PubMed1993

Patient Self-Determination Act. Implementing an information program in a nursing facility.

1. Several legal landmarks regarding the withdrawal or refusal of life-sustaining treatments led to the development of advance directive documents. Advance directive documents allow an individual to indicate preference for medical treatment while he or she is capable. 2. The Patient Self-Determination Act (1991) was enacted to ensure that patients are advised of their right to accept or refuse medical care, and to promote the right to execute an advance directive. 3. Implementing an information program about advance directives in a nursing facility requires an understanding of the process of change.

Advance Directives↗
PubMed1986

Electrophysiologic effects and clinical efficacy of mexiletine used alone or in combination with class IA agents for refractory recurrent ventricular tachycardias or ventricular fibrillation.

The electrophysiologic effects and clinical efficacy of mexiletine used alone or in combination with class IA agents were studied in 35 patients with recurrent sustained ventricular tachycardia (VT) or ventricular fibrillation refractory to nonexperimental antiarrhythmic agents. At baseline before therapy, all patients had inducible VT by programmed stimulation (1 to 3 extrastimuli) and frequent (at least 30/hour) ventricular premature complexes (VPCs) during Holter monitoring. Mexiletine therapy was effective by programmed stimulation (VT no longer inducible or 15 or less beats) in 8 and ineffective in 27 patients. Twenty patients were discharged with mexiletine (14 of whom took an additional class IA agent). The discharge regimen was effective by programmed stimulation in 6 of these 20 patients. In 14 patients the discharge regimen was ineffective by programmed stimulation, but all patients had a marked reduction of ventricular ectopic activity (at least 83% reduction of VPCs and abolition of non sustained VT). During the follow-up period of 18 +/- 13 months (mean +/- standard deviation), 4 patients had recurrences (3 with an ineffective regimen by programmed stimulation and 1 with an effective regimen by programmed stimulation). Arrhythmia-free survival rates at 12 and 24 months were 86% and 77%, as determined by the Kaplan-Meier method, in patients with an ineffective regimen by programmed stimulation, and 80% and 80% in patients with an effective regimen by programmed stimulation (p = 0.979 by log rank test).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2005

Environmental programming of stress responses through DNA methylation: life at the interface between a dynamic environment and a fixed genome.

Early experience permanently alters behavior and physiology. These effects are, in part, mediated by sustained alterations in gene expression in selected brain regions. The critical question concerns the mechanism of these environmental "programming" effects. We examine this issue with an animal model that studies the consequences of variations in mother-infant interactions on the development of individual differences in behavioral and endocrine responses to stress in adulthood. Increased levels of pup licking/grooming by rat mothers in the first week of life alter DNA structure at a glucocorticoid receptor gene promoter in the hippocampus of the offspring. Differences in the DNA methylation pattern between the offspring of high- and low-licking/grooming mothers emerge over the first week of life; they are reversed with cross-fostering; they persist into adulthood; and they are associated with altered histone acetylation and transcription factor (nerve growth factor-induced clone A [NGFIA]) binding to the glucocorticoid receptor promoter. DNA methylation alters glucocorticoid receptor expression through modifications of chromatin structure. Pharmacological reversal of the effects on chromatin structure completely eliminates the effects of maternal care on glucocorticoid receptor expression and hypothalamic-pituitary-adrenal (HPA) responses to stress, thus suggesting a causal relation between the maternally induced, epigenetic modification of the glucocorticoid receptor gene and the effects on stress responses in the offspring. These findings demonstrate that the structural modifications of the DNA can be established through environmental programming and that, in spite of the inherent stability of this epigenomic marker, it is dynamic and potentially reversible.

Animals↗
PubMed2003

Sustainability of collaborative capacity in community health partnerships.

Sustainability is a key requirement for partnership success and a major challenge for such organizations. Despite the critical importance of sustainability to the success of community health partnerships and the many threats to sustainability, there is little evidence that would provide partnerships with clear guidance on long-term viability. This article attempts to (1) develop a conceptual model of sustainability in community health partnerships and (2) identify potential determinants of sustainability using comparative qualitative data from four partnerships from the Community Care Network (CCN) Demonstration Program. Based on a grounded theory examination of qualitative data from the CCN evaluation, the authors hypothesize that there are five primary attributes/ activities of partnerships leading to consequential value and eventually to sustainability of collaborative capacity. They include outcomes-based advocacy, vision-focus balance, systems orientation, infrastructure development, and community linkages. The context in which the partnership operates provides the conditions for determining the appropriateness and relative impact of each of the factors related to creating consequential value in the partnership.

Community Networks↗
PubMed1988

Utility of the signal-averaged electrocardiogram in patients presenting with sustained ventricular tachycardia or fibrillation while on an antiarrhythmic drug.

The utility of the signal-averaged electrocardiogram (SAECG) for predicting ventricular tachycardia (VT) induction in patients presenting with sustained VT or ventricular fibrillation (VF) while on an empirically chosen antiarrhythmic agent was assessed in 17 patients. At the time of presentation with a malignant arrhythmia, 12 patients were taking quinidine, three patients were taking procainamide, and two patients were taking flecainide. All patients underwent programmed ventricular stimulation when not taking antiarrhythmic drugs; 12 patients had no inducible sustained VT and five patients had inducible sustained monomorphic VT. The SAECG done in the control state without antiarrhythmic agents was negative for late potentials in 11 of 12 patients in the noninducible group and positive for late potentials in four of five patients in the inducible group (sensitivity = 80% and specificity = 92%). We conclude that in patients presenting with life-threatening ventricular arrhythmias while taking an antiarrhythmic drug, the SAECG distinguishes patients with possible proarrhythmic events from those who have the substrate for inducible sustained VT.

Adult↗
PubMed2006

Decline in cervical cancer incidence and mortality in New South Wales in relation to control activities (Australia).

BACKGROUND: To examine time trends in cervical cancer incidence and mortality in NSW women aged yen20 years in relation to important health service initiatives and programs. METHODS: Data on cervical cancer incidence and mortality were obtained from the NSW Central Cancer Registry for 1972-2001, and corresponding annual populations obtained from the Australian Bureau of Statistics. Direct age-standardised rates in the yen20 year population were calculated using the 2001 NSW census population as standard. Proportional reductions in incidence and mortality since 1972-1974 were also calculated and related to key health service factors and to published NSW 5-year cervical cancer relative survival for similar periods. RESULTS: Declines in cervical cancer incidence (-10%) and mortality (-20%), and increased degree-of-spread specific survival following the introduction of universal health care in 1975 suggest effects of greater access to Pap screening, earlier access to diagnosis and treatment services, and improved effectiveness of treatment. Incidence plateaued during the 1980s, but mortality fell further (-7%) due to an increased proportion of localised cancers (without change to degree-of-spread specific survival). The 1980s mortality reduction was a consequence of earlier diagnosis and/or secondary prevention, not improved treatment effectiveness or reduced incidence. A marked and sustained incidence decline to 2001 (-35%) occurred after the introduction of the NSW Cervical Screening Program in 1992. This was followed 3 years later by a sustained mortality decline (-20%). During the 1990s survival across all degrees of spread remained unchanged and the mortality reduction was due entirely to reduction in incidence. CONCLUSIONS: The substantial reduction of cervical cancer incidence and mortality in NSW over the last 3 decades is associated with important health service interventions that relate to control of cervical cancer, particularly the implementation of a population-based organised cervical screening program.

Australia↗
PubMed1992

[Evaluation of the arrhythmogenic potential 3 months after myocardial infarction].

An evaluation of the ventricular arrhythmia potential was conducted 3 months after a myocardial infarction (anterior n = 32, inferior n = 58) in 90 patients with a group mean age of 58 +/- 9.3 years, using 24-hour ambulatory ECG monitoring, an exercise test, recording of late ventricular potentials and programmed right ventricular stimulation. Eighteen patients (20%) had a ventricular extrasystole > or = Lown grade III on the Holter, which was more frequent in patients with ventricular dyskinesia (41% vs 15%; p < 0.05); 10 patients (11.1%) had ventricular extrasystoles > or = Lown grade III during the exercise test; 19 patients had late ventricular potentials. Programmed ventricular stimulation induced monomorphic ventricular tachycardia in 10 patients (11.1%) (sustained, n = 5, unsustained n = 5) and the prevalence of late ventricular potentials was higher in this group (60% vs 16.2%; p < 0.01). In the medium term (32 months), 2 patients had died: one suddenly and the other of a recurrence of myocardial infarction. Five patients had an episode of spontaneous ventricular tachycardia. The risk of sudden death or ventricular tachycardia was higher in patients with late ventricular potentials (positive predictive value = 21%) and in patients with electro-induced ventricular tachycardia (positive predictive value = 66%). In the absence of late ventricular potentials, the risk of a serious arrhythmic event is slight (2.8%). After myocardial infarction, the presence of late ventricular potentials can be used to isolate a group of patients with a high risk of serious ventricular arrhythmia; this risk is higher if programmed ventricular stimulation triggers monomorphic ventricular tachycardia.

Action Potentials↗