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PubMed1980

Studies of parkinsonian movement: 1. Programming and execution of eye movements.

Rapid voluntary eye movements in bradykinetic parkinsonian patients and normal subjects were recorded when the movement was executed with visual feedback (closed-loop mode) and in darkness without visual feedback (open-loop mode). The patients had a tendency to generate abnormal saccades consisting of multiple small steps (multiple step saccade), both in the closed-loop and open-loop mode. They were, however, also capable of generating large amplitude saccades. The amplitude-velocity relation of both the small step saccades and the large saccades was normal. The presence of multiple step saccades in the open loop mode suggests that the patients used internal rather than external (visual) feedback to compare the actual eye position with the desired (programmed) eye position and the program for rapid movement is normal but its execution is defective. Horizontal eye movements were also recorded when the head was stationary with a target moving sinusoidally, and when the target was stationary with the head rotated sinusoidally. In both cases the amplitude of the eye movement relative to the head was about 50 degrees. The patients were observed to generate irregular, saccadic eye movements in pursuit of a slowly moving target when the head was stationary, but their eyes could follow a stationary target smoothly when their eyes could follow a stationary target smoothly when their head was moved sinusoidally. These findings suggest that the neuronal circuitry in the paramedian pontine reticular formation, responsible for the final integration of different types of eye movements, is physiologically normal in Parkinsonism.

Adult↗
PubMed1985

The community residential treatment service: developing a continuum of prosthetic environments for the chronically disabled.

Among the many issues regarding the care of chronic mental patients, none is more pressing than the need for administrative and clinical models designed to organize and systematize the efforts of diverse community service providers. This paper describes the functioning of the Community Residential Treatment Service of the South Beach Psychiatric Center, a large-scale project of a state facility created to respond to this tissue. By blending sophisticated clinical and administrative technology, programs operated by the state, voluntary, and proprietary health care sectors have been integrated to form a balanced service delivery system. This system provides a broad continuum of inpatient and outpatient residential settings developed in accordance with social learning principles. The components of the system, with the Community Residential Treatment Service as the major integrative force, are linked together by detailed contracts as well as common behavioral clinical and behavioral administrative language. The treatment successes f this system have been significant enough to suggest that a positive synergistic effect is generated by this programming combination.

Community Mental Health Services↗
PubMed1993

Sterilization. Determining a good candidate.

After 4 years, 10% of the 1800 low-income women in a 5-year study felt some regrets after the procedure. Although each individual is different, if a woman has 1 or more of the following characteristics, she may not be a good candidate for sterilization: under age 30; has few or no children; not involved in a stable relationship; made the decision to be sterilized alone and with minimal reflection; recently experienced a personal life crisis; feels sterilization will solve a sexual problem; expectations about sterilization are unrealistic; pressured by others to be sterilized. Although women who have had the procedure sometimes experience regret, other women regret not having been sterilized. Approximately 40% of the women who decided for sterilization but had their intentions blocked expressed regret at the short-term follow-up, and one-third reported regret at the second interview 4 years later. Also, women who chose not to be sterilized and then experienced a subsequent pregnancy were 7 times more likely to express regret than women who went through with the procedure. To counsel a woman who wants no more children but does not want sterilization, ask her how she would feel if she became pregnant again, and try to determine how badly she does not want to be pregnant, says Libby Antarsh, PhD, director of US programs for the Association of Voluntary Surgical Contraception in New York City. Also, make sure she has accurate information about other methods of birth control, she says.

Ambulatory Care Facilities↗
PubMed2004

Counselling, HIV testing and adjunctive cotrimoxazole for TB patients in Malawi: from research to routine implementation.

SETTING: Fifteen hospitals in Malawi that offer voluntary counselling and testing (VCT) for the human immunodeficiency virus (HIV) for tuberculosis (TB) patients and cotrimoxazole (CTX) for patients found to be HIV-positive. OBJECTIVES: 1) To describe the process of developing a national TB-HIV plan, conducting a country-wide situational assessment, and producing national guidelines on VCT and CTX for TB patients, and 2) to assess the implementation of VCT and CTX for TB patients registered between July and September 2003. DESIGN: A descriptive study. RESULTS: The 3-year HIV-TB plan was finalised in 2002. Between January and March 2003, an assessment was carried out of HIV/AIDS and joint HIV-TB services in Malawi and a decision made to support 15 hospitals in implementing VCT and CTX for TB patients. Between April and June 2003, national guidelines on VCT and CTX were developed through a consultative process, and treatment units were prepared for implementation. Between July and September 2003, 2397 TB patients were registered, and 1404 (59%) accepted VCT; 956 (68%) were HIV-positive, of whom 927 (97%) started CTX. Deficiencies in the registration process and in patient understanding about VCT and CTX were identified. CONCLUSION: The results show that it is feasible to routinely implement VCT and CTX for TB patients.

AIDS Serodiagnosis↗
PubMed2002

Use of UNAIDS tools to evaluate HIV voluntary counselling and testing services for mineworkers in South Africa.

HIV voluntary counselling and testing (VCT) is now an integral part of many HIV care and control programmes. However, very little work has been done to assess the quality of VCT services. An evaluation of VCT services for mineworkers in Welkom, South Africa was conducted to assess client and counsellor satisfaction, the quality of the services and to identify barriers to uptake of VCT. A cross-sectional survey was carried out using tools developed by UNAIDS, consisting of semi-structured interviews and observation of counselling sessions. Twenty-two nurse counsellors and six community volunteers were interviewed. Twenty-four counselling sessions were observed and 24 client exit interviews were conducted. Although nine of the 22 nurse counsellors had only in-service rather than formal training for HIV counselling whereas all community volunteers had been formally trained, nurse counsellors demonstrated better interpersonal skills than did community volunteers. Both clients and counsellors identified fear of a positive result as a major barrier to HIV testing. Clients also raised concerns about confidentiality. UNAIDS evaluation tools were a feasible and an acceptable method of assessing VCT in this operational setting. The study identified areas where training needs to be strengthened and suggested ways of improving the services, and changes to the service have now been implemented in line with these recommendations.

Counseling↗
PubMed1978

Evidence that the amount of food consumed in early life fixes appetite in the rat.

Rats were raised in litters of 22 (low caloric intake) or litters of 4 (high caloric intake). At the end of 62 wk, rats from large litters were approximately 140 g lighter than those from small litters even though all animals were permitted unrestricted access to food after weaning. One factor responsible for the smaller body size was a lower voluntary food intake after weaning (8,188 +/- 205 g vs. 9,808 +/- 193 g; P less than 0.001). These results provide evidence that the amount of food consumed during suckling plays an important role in determining the habitual food intake of rats in later life. In a separate experiment, rats were raised in litters of 4, 13, 17, or 22. The results show that as litter size increased from 4 to 22, a corresponding reduction in the voluntary intake of food occurred. These results provide evidence that by controlling the food intake of the newborn rat it is possible to "program" the animal for a desired voluntary food intake in later life.

Aging↗
PubMed1992

[Professional risk: hepatitis B. Vaccination strategies in a general hospital].

The risk of contracting hepatitis B: (HBV) by health workers is widely accepted. In 1989 our Hepatology Service started a voluntary anti-HBV vaccination program, employing recombinant vaccine (SKF) by intramuscular route with a 0-1-6 month schedule after screening with antibody against the anti-core HBV antigen (AntiHBc Elisa Abbott). Initially, it was planned to monitor antibody titers against superficial antigen (Anti-HBs) 30 days after the last dose. An epidemiological form listing personal data, working area, profession, seniority, written consent for blood extraction and tentative acceptance of vaccination, was completed by 357 hospital staff members. After serological screening, only 184 (51%) workers agreed to receive vaccination. Given the paucity of volunteers, an attempt was made to explain this degree of reluctance by a randomized blind voluntary survey, to which 349 hospital staff members and 40 medical students replied. Questions were related to knowledge concerning vaccination in general, hepatitis and particularly hepatitis B, and specific anti-HBV vaccination. An appraisal of data gathered disclosed a considerable lack of information not only on the risk of HBV infection and its complications, but also on the existence of a suitable vaccine. Non-existent adverse effects of vaccination were mentioned, including AIDS (Acquired Immuno-Deficiency Syndrome), hepatitis and cirrhosis, among others. To overcome this obstacle, we held a two-day workshop on hepatitis B prevention and prophylaxis intended for medical and ancillary staff. After the meeting, which were attended by 221 members, 48 individuals, comprising 25 physicians and 23 nurses, spontaneously requested to be vaccinated.(ABSTRACT TRUNCATED AT 250 WORDS)

Health Knowledge, Attitudes, Practice↗
PubMed1999

Minority student persistence in clinical laboratory education programs.

The objective of this study was to characterize minority student persistence in clinical laboratory scientist (CLS) and clinical laboratory technician (CLT) education programs and relate persistence to student characteristics and involvement in academic and social dimensions of college programs. A prospective, longitudinal study was done using written survey and follow-up data collection. Participants were 2,426 CLS and CLT students in academic-based educational programs across the United States. The participants completed a forced-choice survey eliciting demographic information and determining their interactions with social and academic dimensions of college and the clinical laboratory education program. Program outcome groups, i.e., graduates, voluntary withdrawals, and academic dismissals, were compared on each of 14 variables. Of the 2,426 participants, 80.7% graduated, 10.8% voluntarily withdrew, and 8.5% were dismissed for academic reasons. The outcome groups differed significantly on seven of eight academic involvement measures and five of six measures of social involvement. Student persistence behaviors varied by ethnic group, with African Americans more likely to leave for academic reasons than others. Graduation rates varied among the five ethnic groups. Differences were found among ethnic groups on five of eight measures of academic involvement and on two of six measures of social involvement. The results suggest that ethnic groups may differ in their levels of involvement in aspects of social and academic programs, thus explaining their different persistence behaviors. Understanding why some students are unsuccessful may form the basis for effective retention efforts.

Analysis of Variance↗
PubMed1996

Controlling hypertension. A research success story.

In the past 2 decades, deaths from stroke have decreased by 59% and deaths from heart attack by 53%. An important component of this dramatic change has been the increased use of antihypertensive drugs. This remarkable success resulted from broad-based and diverse research programs supported by the federal government, pharmaceutical companies, voluntary health agencies, and private foundations. It included basic research, drug development programs, epidemiologic studies, health surveys of US citizens, clinical research, and large-scale drug trials. Four of the categories of antihypertensive drugs in wide use--diuretics, beta-blockers, calcium antagonists, and angiotensin-converting enzyme inhibitors--emerged from widely different areas of investigation. In the beginning, the major breakthroughs that led to the development of these drugs were impossible to forecast, and their ultimate applications were impossible to predict. Although decreases in hypertension-related mortality are impressive, enthusiasm must be tempered because the mechanisms of hypertension are still incompletely understood and prevention is not yet possible. Continued research is needed to extend these advances.

Antihypertensive Agents↗
PubMed1992

Methods of smoking cessation.

Smoking-cessation treatment consists of three phases: preparation, intervention, and maintenance. Preparation aims to increase the smoker's motivation to quit and to build confidence that he or she can be successful. Intervention can take any number of forms (or a combination of them) to help smokers to achieve abstinence. Maintenance, including support, coping strategies, and substitute behaviors, is necessary for permanent abstinence. Although most smokers who successfully quit do so on their own, many use cessation programs at some point during their smoking history. Moreover, many people act on the advice of a health professional in deciding to quit. Some are also aided by a smoking-cessation kit from a public or voluntary agency, a book, a tape, or an over-the-counter product. Still others receive help from mass-media campaigns, such as the Great American Smokeout, or community programs. Counseling, voluntary and commercial clinics, nicotine replacement strategies, hypnosis, acupuncture, and behavioral programs are other methods used by smokers to break the habit. Programs that include multiple treatments are more successful than single interventions. The most cost-effective strategy for smoking cessation for most smokers is self-care, which includes quitting on one's own and might also include acting on the advice of a health profession or using an aid such as a quit-smoking guide. Heavier, more addicted smokers are more likely to seek out formal programs after several attempts to quit. Many people can quit smoking, but staying off cigarettes requires maintenance, support, and additional techniques, such as relapse prevention. Physicians, dentists, and other health professionals can provide important assistance to their patients who smoke. Quit rates can be improved if clinicians provide more help (e.g., counseling, support) than just simple advice and warnings. Clinicians also play an important role in providing nicotine replacement products such as nicotine gum or transdermal patches. These products are particularly useful for smokers who show evidence of strong physiologic addiction to nicotine. Attitudes toward smoking have shifted dramatically. In the 1950s, fewer than 50% of American adults believed that cigarette smoking caused lung cancer. In 1986, this proportion had increased to 92%. A majority of the public favors policies restricting smoking in public places and worksites. Half of all Americans who ever smoked had stopped smoking by 1988. Of those who continue to smoke, more than 70% report that they would like to quit. By increasing their knowledge about smoking-cessation methods, health professionals can support and encourage the large majority of smokers who want to quit.

Acupuncture Therapy↗
PubMed1987

Human jaw muscle motor behaviour. I. Motor drive.

Jaw muscle motor behaviour, however complicated, has important implications for the every day dental practice. In recent years the understanding of jaw and other skeletal muscle function has increased considerably. Direct recording of primary afferent discharge in conscious human beings and animals during normal function has caused radical changes of the concepts of muscle receptor function. Central pattern generators at segmental levels and suprasegmental programming centres are important mechanisms behind voluntary and automatic movements of different kinds. The most important proprioceptive function is probably to provide reassurance of correct movement pattern, to adjust the central programming to environmental changes and to directly influence slow movements requiring precision. Muscle spindle receptors contribute to mandibular kinesthesia. Muscle spindles are rarely present in jaw opening muscles. Despite this fact an excitatory reflex similar to the stretch reflex but with longer latency has been demonstrated. Further on a reciprocal organisation with antagonist inhibition has been shown to exist between jaw openers and closers. Motor behaviour of jaw and limb muscles thus seem to have many characteristics in common.

Humans↗
PubMed2006

Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda.

BACKGROUND: The impact of antiretroviral therapy (ART) on sexual risk behavior and HIV transmission among HIV-infected persons in Africa is unknown. OBJECTIVE: To assess changes in risky sexual behavior and estimated HIV transmission from HIV-infected adults after 6 months of ART. DESIGN AND METHODS: A prospective cohort study was performed in rural Uganda. Between May 2003 and December 2004 a total of 926 HIV-infected adults were enrolled and followed in a home-based ART program that included prevention counselling, voluntary counseling and testing (VCT) for cohabitating partners and condom provision. At baseline and follow-up, participants' HIV plasma viral load and partner-specific sexual behaviors were assessed. Risky sex was defined as inconsistent or no condom use with partners of HIV-negative or unknown serostatus in the previous 3 months. The rates of risky sex were compared using a Poisson regression model and transmission risk per partner was estimated, based on established viral load-specific transmission rates. RESULTS: Six months after initiating ART, risky sexual behavior reduced by 70% [adjusted risk ratio, 0.3; 95% confidence interval (CI), 0.2-0.7; P = 0.0017]. Over 85% of risky sexual acts occurred within married couples. At baseline, median viral load among those reporting risky sex was 122 500 copies/ml, and at follow-up, < 50 copies/ml. Estimated risk of HIV transmission from cohort members declined by 98%, from 45.7 to 0.9 per 1000 person years. CONCLUSIONS: Providing ART, prevention counseling, and partner VCT was associated with reduced sexual risk behavior and estimated risk of HIV transmission among HIV-infected Ugandan adults during the first 6 months of therapy. Integrated ART and prevention programs may reduce HIV transmission in Africa.

Adult↗
PubMed1996

Influence of knowledge on iodine content in foodstuffs and prophylactic usage of iodized salt on urinary iodine excretion and thyroid volume of adults in southern Germany.

Thyroid volume, urinary iodine excretion as well as personal nutritional knowledge and individual iodine prophylaxis were determined during a health education program on iodine deficiency and prophylaxis in 1992. Participants were 472 male and 568 female (mean age 27.7 years) students and employees of five universities in the southern part of Germany. The study aimed to clarify the relationship between personal knowledge on iodine, individual iodine prophylaxis and parameters of iodine deficiency (thyroid volume, iodine excretion) in a well known iodine deficient area. Mean thyroid volume (mean +/- SD) was 19.7 +/- 8.3 ml in males and 15.8 +/- 7.1 ml in females. 25.5% of females and 19.9% of males showed thyroid volume above the upper normal values. Total mean urinary iodine excretion was 70.7 +/- 42 micrograms I/g creatinine reflecting WHO-grade-I iodine deficiency. 80.8% of total subjects used iodized salt and 43.2% stated to consume salt-water fish to meet their iodine requirement. The female non-users had significantly lower iodine excretion (no iodized salt, no salt-water fish: 61.4 +/- 31.3 vs. +iodized salt, +salt-water fish: 83.9 +/- 47.6 micrograms I/g creatinine; p < 0.05), however, thyroid volume was identical in these groups. The area of residence over the last 10 years did not significantly influence the thyroid volume. The goiter incidence increased with age. Although our study population was highly educated (81.8% students) and the subjects were provided with educational brochures immediately prior to the study, knowledge about iodine content of food was poor. We conclude that despite a high degree of voluntary iodine prophylaxis and educational programs the iodine intake is insufficient. The use of iodized salt in households, cafeterias, and also in food manufacturing must be increased for sufficient iodine prophylaxis.

Adult↗
PubMed1993

The Minnesota Clinical Comparison and Assessment Program: a resource for clinical quality improvement programs.

UNLABELLED: Project Overview: MCCAP is a voluntary, statewide initiative of more than 50 hospitals designed to improve patient outcomes by reducing variation among healthcare providers. Elective cholecystectomy, both open and laparoscopic, has been one area of focus. KEY FINDINGS: Physicians are particularly interested in information about patient care that they do not routinely receive in a standardized format, such as the time required for patients to return to normal activities. Patients who did not meet guideline criteria but who were given prophylactic antibiotics prior to surgery experienced the same, minimal infection rate as patients who received no antibiotics prior to surgery. Participating hospitals are shifting their focus from looking at average occurrence rates (LOS, resource use by procedure) to identifying appropriate resource use. Although 82 percent of elective cholecystectomies met guideline requirements, 25 percent of all patients continue to experience their most distressing symptoms six months after surgery. Many physicians continue to use routine intraoperative cholangiography; however, MCCAP's guideline did a good job of differentiating patients who were more likely to benefit from the procedure from those who were not.

Angiography↗
PubMed1983

The pathology residency review process.

This report describes the accreditation process and summarizes data on the actions of the Residency Review Committee (RRC) for Pathology. Emphasis is placed on the adverse actions, including the most commonly cited deficiencies that lead to the RRC recommending probation and withdrawal of accreditation of anatomic and clinical pathology (APCP) programs, and on the types of hospitals that have requested voluntary withdrawal of accreditation and that have had accreditation withdrawn from their APCP programs. A content analysis was conducted of the RRC's adverse decisions regarding APCP residencies over the past 5 years. The RRC's most commonly cited deficiencies were counted and categorized. Most of the deficiencies were categorized in the areas of anatomic pathology, clinical pathology, and the organizational aspects of residency training. Most voluntary withdrawals of accreditation and RRC decisions to withdraw accreditation of APCP programs occurred in nongovernment, not-for-profit hospitals with an average of four residents.

Accreditation↗