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PubMed1995

A priori prediction of activity for HIV-1 protease inhibitors employing energy minimization in the active site.

We have observed a high correlation between the intermolecular interaction energy (Einter) calculated for HIV-1 protease inhibitor complexes and the observed in vitro enzyme inhibition. A training set of 33 inhibitors containing modifications in the P1' and P2' positions was used to develop a regression equation which relates Einter and pIC50. This correlation was subsequently employed to successfully predict the activity of proposed HIV-1 protease inhibitors in advance of synthesis in a structure-based design program. This included a precursor, 47, to the current phase II clinical candidate, L-735,524 (51). The development of the correlation, its applications, and its limitations are discussed, and the force field (MM2X) and host molecular mechanics program (OPTIMOL) used in this work are described.

Binding Sites↗

PubMed1999

The development of a nurse-directed computerized functional electrical stimulation program.

Today's spinal-cord-injured (SCI) person is discharged from the inpatient clinical setting very early in his or her recovery process. Faced with the tremendous challenges of relearning the skills of daily living and psychologically adjusting to a catastrophic injury, the newly injured person is thrust into an overwhelming environment. As early as 1994, when inpatient stays were longer, concern was expressed about the impact of early discharge on the health and well-being of persons with SCI (Ditunno & Formal, 1994). For over 10 years, the Medical Illness Counseling Center (MICC) has offered a community-based, nurse-directed program of Computerized Functional Electrical Stimulation (CFES) for persons with SCI. The program is founded on the belief that when multi-system deterioration associated with paralysis is avoided and a behavioral approach is used, the person with SCI will have a renewed sense of well-being that enables him or her to overcome the challenges of daily living. Over time, the need for expansion of the program became apparent; it evolved into a comprehensive package of medical, nursing, and psychological care. This article describes the essential elements that comprised a successful program design, the benefits of participation in CFES, and the significance of this technology in a nurse-managed setting.

Activities of Daily Living↗

PubMed1998

Has the California tobacco control program reduced smoking?

CONTEXT: Comprehensive community-wide tobacco control programs are considered appropriate public health approaches to reduce population smoking prevalence. OBJECTIVE: To examine trends in smoking behavior before, during, and after the California Tobacco Control Program. DESIGN: Per capita cigarette consumption data (1983-1997) were derived from tobacco industry sales figures. Adult (> or =18 years) smoking prevalence data were obtained from the National Health Interview Surveys (1978-1994), the California Tobacco Surveys (1990-1996), the Current Population Surveys (1992-1996), and the California Behavioral Risk Factor Survey and its supplement (1991-1997). Trends were compared before and after introduction of the program, with the period after the program being divided into 2 parts (early, 1989-1993; late, 1994-1996). MAIN OUTCOME MEASURES: Change in cigarette consumption and smoking prevalence in California compared with the rest of the United States. RESULTS: Per capita cigarette consumption declined 52% faster in California in the early period than previously (from 9.7 packs per person per month at the beginning of the program to 6.5 packs per person per month in 1993), and the decline was significantly greater in California than in the rest of the United States (P<.001). In the late period, the decline in California slowed to 28% of the early program so that in 1996 an average of 6.0 packs per person per month were consumed. No decline occurred in the rest of the United States, and in 1996, 10.5 packs per person per month were consumed. Smoking prevalence showed a similar pattern, but in the late period, there was no significant decline in prevalence in either California or the rest of the United States. In 1996, smoking prevalence was 18.0% in California and 22.4% in the rest of the United States. CONCLUSIONS: The initial effect of the program to reduce smoking in California did not persist. Possible reasons include reduced program funding, increased tobacco industry expenditures for advertising and promotion, and industry pricing and political activities. The question remains how the public health community can modify the program to regain its original momentum.

California↗

PubMed1994

Secondary prevention of childhood firesetting.

OBJECTIVE: The Juvenile Fire Awareness and Intervention Program was established to develop and evaluate an intervention to be offered by fire fighters for children who set fires. METHOD: One hundred thirty-eight children, aged 5 to 16 years, with a history of firesetting participated in a randomized, controlled trial. The intervention involved education about fire safety and a behavior modification program designed to extinguish the desire to set fires through satiation. The frequency and severity of firesetting were recorded for 12 months after the intervention to measure outcome. RESULTS: There was a significant decrease in the frequency and severity of firesetting across all groups, with no additional improvement resulting from participation in the fire fighters' intervention. CONCLUSIONS: There is no evidence to suggest that the multicomponent program offered by trained fire fighters is effective in reducing firesetting. The marked reduction in firesetting across all groups suggests that fire safety education by the fire fighters is the most appropriate approach to this serious community problem.

Adolescent↗

PubMed2006

Asthma screening, case identification and treatment in school-based programs.

PURPOSE OF REVIEW: Asthma is an important health problem in school-aged children and schools seem an obvious site to find and work with under-recognized and under-treated asthma. Teachers and coaches often must deal with asthma-related symptoms or emergencies requiring knowledge, skills, and written plans and policies. In 2005, school-based asthma work focused on two areas: identification of unrecognized asthma and management of under-treated asthma. RECENT FINDINGS: Effective school-based screening requires a simple, effective screening tool. Three new asthma screening tools continue to identify more false-positive than true positive cases of asthma. Public health experts question whether asthma even fits the usual criteria for 'screening' because it does not have an asymptomatic phase. 'Case-finding' is presented as a better use of resources, allowing schools to focus on children with asthma that has been diagnosed but remains symptomatic. No school-based program based on letters, reminders, or recommendations sent to parents or community physicians changed asthma care. Three reports describe programs designed to supplement usual asthma care by providing in-school interventions, but none appeared ready for implementation in all schools in the USA. A major barrier was the continuing lack of school nurses, who must have asthma-related education and medical support to provide school-based asthma management. SUMMARY: Schools continue to be a site for asthma interventions but few of the programs, even the most intensive, influence children's asthma-related health. Most programs require modifications and further evaluation, and all require careful assessment of the burden on schools.

Asthma↗

PubMed1976

Education for adolescent mothers in a hospital setting.

This paper describes an innovative service program designed to help adolescent mothers become more effective parents. Mother-infant pairs are recruited in the postpartum unit of Cincinnati (Ohio) General Hospital, and weekly classes are held in a pediatric clinic waiting room until infants are approximately six months of age. Medical consultation and/or treatment and education for parenthood in the areas of health, nutrition, and infant stimulation are the foci of the program. The interest and participation of the mothers, the opinion of professionals, tests of maternal knowledge, and measurements of maternal-infant interaction attest to the value and success of this program.

Adolescent↗

PubMed2000

The burden of cancer in Kentucky: the 1997 Kentucky cancer incidence report.

The purpose of collecting this important disease burden information is of course not simply for reports like this one. The real value lies in use of data for program planning, resource allocation, program design, and evaluation. Data in the annual KCR report and on the website should be a valuable resource for district and county health departments in their assessment of health problems in their area and as critical decisions are made about how to utilize limited intervention resources. The Kentucky Cancer Registry will continue to work very closely with the Community Outreach Division of the Kentucky Cancer Program to make this data available on an annual basis to District Cancer Councils to help guide their assessment and planning process. District and local health departments are encouraged to actively participate in the District Cancer Councils and in the cancer control activities guided by the regional community outreach coordinators.

Adolescent↗

PubMed1995

Exercise training for tennis.

Tennis is a physically demanding sport. A complete conditioning program designed to address both the demands of the sport and the individual player's musculoskeletal base is important in tennis, particularly at the competitive junior and professional levels. Recreational players can certainly use conditioning to improve their level of performance, but the primary concern in this group is general fitness development and injury prevention. In the junior player, physical development should begin with a sound program for physical fitness, including flexibility, cardiorespiratory endurance, general strength, and muscular endurance. Once a sound fitness base has been developed, the competitive junior players should progress to conditioning for sport specific movements and for injury prevention. At the elite level, tennis players should have previously developed a sound general physical fitness base. These players can then spend a greater percentage of their conditioning time on athletic fitness and sport specific movement training, as well as injury prevention. By addressing all of the components of a total body conditioning program, the possibility of peak performance of the individual tennis player is enhanced.

Humans↗

PubMed1992

An improved medium for long-term culture of human embryos overcomes the in vitro developmental block and increases blastocyst formation.

OBJECTIVE: To determine if a culture medium, designated CZB after the authors who first described it, which is supplemented with 0.11 mM ethylenediaminetetraacetic acid, 1.0 mM glutamine, 31.30 mM lactate, and 0.27 mM pyruvate and is lacking glucose for the initial stages of culture that overcomes the in vitro two-cell block of mouse embryos, can improve the rate of blastocyst formation of human embryos in long-term cultures and increase the pregnancy rate (PR) when used in a clinical in vitro fertilization (IVF) program. DESIGN: The study is in two parts. Initially, excess oocytes from IVF and gamete intrafallopian transfer patients were fertilized in vitro and then placed in long-term culture of either CZB plus 10% heat-inactivated human serum (32 zygotes) or Earle's balanced salt solution (EBSS) supplemented with 0.45 mM pyruvate plus 10% human serum (28 zygotes) to determine if CZB medium could enhance in vitro development and increase blastocyst formation when compared with EBSS. Subsequently, CZB or EBSS medium was used for short-term cultures of embryos in a clinical IVF program to determine if the use of CZB could increase the clinical IVF PR. SETTING: Private practice of one author (M.D.). PATIENTS: The excess oocytes were donated by couples not wishing to have cryopreservation. In the clinical trial, 49 couples presenting with tubal or male factor infertility and who had three or more fertilized zygotes were randomly assigned to one of the culture media being used. RESULTS: In long-term cultures, embryos were observed at 42, 66, 90, 114, and 138 hours after fertilization and scored for blastomere number, degree of fragmentation, and developmental arrest. When CZB- and EBSS-cultured embryos were evaluated over 138 hours, there was a significant increase in the number of CZB-cultured embryos reaching the blastocyst stage (56% versus 20%; P less than 0.009) and less fragmentation of CZB-cultured embryos (18.8% versus 50%; P less than 0.01). In short-term cultures, pronuclear stage embryos from patients undergoing IVF were cultured in CZB or EBSS for 24 hours, graded, and then used in embryo transfers. Of the 28 patients assigned to EBSS, 6 became pregnant (21.4%), and of the 21 assigned to CZB, 5 attained pregnancy (23.8%). These results were not significantly different. CONCLUSIONS: The use of CZB for the long-term culture of human embryos is highly beneficial and increases the rate of blastocyst formation, but its use in an IVF program does not increase the clinical PR.

Analysis of Variance↗

PubMed1996

National survey of hospital-based pharmacokinetic services.

The status of pharmacokinetic services in the nation's hospitals was studied. A questionnaire was mailed in February 1995 to all 252 respondents to ASHP's 1994 national survey of hospital-based pharmaceutical services who indicated the provision of pharmacokinetic services in their institution. Ninety-eight completed questionnaires were returned (40.2% response rate). The pharmacokinetic services provided required an average of 19.1 person-hours per week, tended to be provided by staff pharmacists, were managed by the pharmacy department, tended to be most focused on aminoglycosides and vancomycin, required an average of 60 notes in patient charts per month, and relied on both computers and calculators for deriving values. There was little contact with patients during the consultation process. Drug concentration measurements tended to be scheduled by service providers, but confidence in the accuracy of the timing of dose administration and blood sampling was limited. Respondents believed that the services tended to be supported by other hospital personnel and that they were successful. There was very little expectation that the workload for providing pharmacokinetic services would increase in the near future. A national survey of hospital-based pharmacokinetic services showed that it took 19 hours per week on average to provide the services, that the focus was on aminoglycosides and vancomycin, and that the services were perceived to be supported by other departments.

Drug Monitoring↗

PubMed2003

Towards evidence-based clinical practice: an international survey of 18 clinical guideline programs.

OBJECTIVE: To describe systematically the structures and working methods of guideline programs. DESIGN: Descriptive survey using a questionnaire with 32 items based on a framework derived from the literature. Answers were tabulated and checked by participants. STUDY PARTICIPANTS: Key informants of 18 prominent guideline organizations in the United States, Canada, Australia, New Zealand, and nine European countries. MAIN OUTCOME MEASURES: History, aims, methodology, products and deliveries, implementation, evaluation, procedure for updating guidelines, and future plans. RESULTS: Most guideline programs were established to improve the quality and effectiveness of health care. Most use electronic databases to collect evidence and systematic reviews to analyze the evidence. Consensus procedures are used when evidence is lacking. All guidelines are reviewed before publication. Authorization is commonly used to endorse guidelines. All guidelines are furnished with tools for application and the Internet is widely used for dissemination. Implementation strategies vary among different organizations, with larger organizations leaving this to local organizations. Almost all have a quality assurance system for their programs. Half of the programs do not have formal update procedures. CONCLUSIONS: Principles of evidence-based medicine dominate current guideline programs. Recent programs are benefiting from the methodology created by long-standing programs. Differences are found in the emphasis on dissemination and implementation, probably due to differences in health care systems and political and cultural factors. International collaboration should be encouraged to improve guideline methodology and to globalize the collection and analysis of evidence needed for guideline development.

Consensus↗

PubMed2006

Functionally oriented rehabilitation program for patients with fibromyalgia: preliminary results.

OBJECTIVE: To evaluate function and disability in patients with fibromyalgia before and after participation in a functionally oriented, multidisciplinary, 8-wk treatment program. DESIGN: A total of 23 patients who met American College of Rheumatology criteria for the diagnosis of fibromyalgia were enrolled in the study. Outcome measures included: range of motion, 6-min walk test, a modified Fibromyalgia Impact Questionnaire, a modified SF-36 Physical Functioning Scale, and the Fibromyalgia Health Assessment Questionnaire. Pretreatment and posttreatment scores were analyzed using paired t tests. RESULTS: All subjects completed the program, and there were no reported injuries. Three subjects failed to complete the survey instruments at the conclusion of the study. Intention to treat analysis including these subjects was carried out but did not significantly change results. For the remaining subjects (n = 20), a significant improvement was found on the Physical Functioning Scale (P = 0.01). Trends toward improvement on the Fibromyalgia Impact Questionnaire (P = 0.40) and Fibromyalgia Health Assessment Questionnaire (P = 0.14) were seen but did not achieve statistical significance. Range of motion testing revealed significant improvements in lumbar spine extension (P < 0.001), straight-leg raise (P < 0.001), cervical spine flexion (P < 0.01), cervical spine rotation (P < 0.05), and cervical spine side bending (P < 0.05). Distance traveled during the 6-min walk test increased significantly (P < 0.01), whereas perceived exertion as measured by the Borg scale did not change. There were no injuries or other adverse consequences of the program. CONCLUSIONS: This study utilized multiple functional outcome measures to demonstrate improved function and decreased disability in patients with fibromyalgia. Our patients reported significantly improved physical function after participation in the 8-wk intensive multidisciplinary treatment program. This progressive, functionally based exercise training program was well tolerated by all participants and outlines an effective exercise prescription for patients with fibromyalgia. Fibromyalgia patients in this study responded favorably to a treatment program that focused on function instead of pain.

Cervical Vertebrae↗

PubMed2001

A cluster randomized controlled trial of a dental health education program for 10-year-old children.

OBJECTIVE: Using a cluster randomized trial, this study tested the effectiveness of a dental health education program designed to improve the oral hygiene and dental knowledge of 10-year-old children. METHODS: Thirty-two primary schools in the northwest of England participated. After a baseline assessment of plaque and the completion of a dental knowledge questionnaire by the children, the schools were allocated randomly to active or control groups. Children in schools allocated to the active group received the dental health program, which consisted of four one-hour lessons. After four months the children were examined clinically and scored for plaque, and a second questionnaire was administered. The schools in the control group were then allocated randomly to receive the program or not over the following three months, the program being withdrawn from the schools who initially received it. A further assessment of plaque was made and a questionnaire administered seven months after the baseline of the study. RESULTS: The active groups had 20 percent and 17 percent lower mean plaque scores than the control group at four and seven months (P < .001). The children's knowledge of which type of toothbrush should be used and the role of disclosing tablets improved in the initial test group when compared with the control group and this was retained over the second part of the study. CONCLUSION: The children receiving the program had significantly lower mean plaque scores and greater knowledge about toothbrushes and disclosing tablets than the control children who had not received the program.

Attitude to Health↗

PubMed2003

Potential barriers to work for substance-abusing women on welfare. Findings from the CASAWORKS for Families pilot demonstration.

AIM: To assess the prevalence and relationship to later employment of potential barriers to work for substance-abusing women on Temporary Assistance to Needy Families (TANF) enrolled in a multiservice welfare-to-work program. DESIGN: A field study with repeated measures and intent-to-treat sampling. INTERVENTION: The CASAWORKS for Families (CWF) was delivered in 11 sites in nine states across the nation and featured integration of substance-abuse treatment and employment and work readiness services. MEASUREMENT: The Addiction Severity Index, supplemented with subject-appropriate questions. SAMPLE: A total of 366 CWF women who completed interviews at program enrollment, and at 6 and 12 months later. FINDINGS: Substance-abusing women on TANF in the CWF program exhibited multiple potential barriers to work at enrollment, averaging 6 out of 14 potential barriers assessed. They reported significantly more obstacles than a general welfare sample of women from the same locales. Few single barriers were significantly related to employment at 12 months. However, the total number of potential barriers to work experienced, particularly at 6 months, was related to employment at 12 months.

Adult↗

PubMed1995

Aiming for consistency in the way teachers sign.

A four year study examined the effects of a sign communication intervention program designed to enhance teachers' ability to consistently code English into sign. The secondary goal of the project was to help teachers use American Sign Language as an intervention tool for enhancing students' comprehension of instructions. Starting with an initial sign to speech ratio of 59.8% and 66.2%, two teachers were able to improve their ratio to 98.9% and 89.7% respectively. The basic components of the intervention program are presented along with their rationale. A breakdown of the sign to speech ratio is provided in an examination of how effectively the teachers coded articles, pronouns, sign markers, and the verb "to be."

Deafness↗

PubMed1987

The economic crisis and its impact on health and health care in Latin America and the Caribbean.

The economic crisis that struck most Latin American and Caribbean countries beginning in 1982 has caused sharp reductions in domestic investment and in imports; domestic consumption has been less affected, while public sector spending has responded in different degrees in different countries. In general, public spending on health decreased, sometimes quite dramatically, but some countries were able to maintain the real value of noninvestment spending for health by central governments. It is much harder to tell what may have happened to output of health services, and still harder to know how health status has been affected. Scattered evidence suggests two conclusions. First, worsened economic conditions can seriously damage health status, with effects on infant mortality and on the patterns of disease and death, especially for children. Second, these repercussions do not have to occur, and public programs designed specifically to maintain basic health services and to assure adequate nutrition are effective in offsetting the worst consequences of economic hardship.

Child↗

PubMed1975

Assessing the attitude of veterans toward a smoking cessation program in a hospital setting.

110 male patients in a V. A. Hospital were surveyed in regard to their smoking behavior, attitudes toward smoking, and their willingness to participate in a treatment program designed to eliminate smoking. Some of the more important findings were that 68% of the patient population smoked as compared to 50% for the ggeneral male population. Only 57% of the smokers felt that smoking was harmful to their health. Many of the smokers (60%) had tried to stop smoking but were unsuccessful. 58% of the smokers stated that they would participate in a smoking treatment program. The results of this survey are interpreted to indicate the need for hospital and institutional treatment programs for elimination of smoking.

Adult↗

PubMed1975

Certificate of need: the Massachusetts experience.

Certificate of Need legislation is one of several regulatory programs designed to control the allocation of health care delivery resources. This paper examines the Massachusetts experience with Certificate of Need, focusing on two major administrative law controversies--the extent of the regulatory agency's power to participate actively in the planning process, and the scope of review of agency decisions permitted under a non-judicial appeals mechanism. The study concludes that any Certificate of Need program may be strengthened by accurately defining the roles of the participants and by providing for safeguards within the system itself.

Decision Making↗