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This article is designed for hospice leaders and volunteers to explore creative ways to deal with the stagnancy that can occur in volunteer programs. Specific strategies, such as nurturing caregivers, transitioning into a gift-based program, and integrating spirituality and creativity into volunteer efforts, provide the focus of the article.
Despite the democratization of South Africa in 1994, which brought the agricultural sector within the ambit of legal protection, farm workers remain vulnerable to an undue burden of social and health problems. Alcohol abuse due to the DOP system, pesticide poisonings, and other occupational hazards illustrate that the likely success of efforts at redress depends on a greater awareness of the rights and justice dimensions of the health problems facing these workers. International trade policies may exacerbate inequalities that deprive them of opportunities to realize their rights at national level. A public health agenda must integrate into programs and policies to address the health of farm workers the recognition that violations of their rights underlie much of their burden of ill health.
BACKGROUND: We recently developed the Paired End diTag (PET) strategy for efficient characterization of mammalian transcriptomes and genomes. The paired end nature of short PET sequences derived from long DNA fragments raised a new set of bioinformatics challenges, including how to extract PETs from raw sequence reads, and correctly yet efficiently map PETs to reference genome sequences. To accommodate and streamline data analysis of the large volume PET sequences generated from each PET experiment, an automated PET data process pipeline is desirable. RESULTS: We designed an integrated computation program package, PET-Tool, to automatically process PET sequences and map them to the genome sequences. The Tool was implemented as a web-based application composed of four modules: the Extractor module for PET extraction; the Examiner module for analytic evaluation of PET sequence quality; the Mapper module for locating PET sequences in the genome sequences; and the Project Manager module for data organization. The performance of PET-Tool was evaluated through the analyses of 2.7 million PET sequences. It was demonstrated that PET-Tool is accurate and efficient in extracting PET sequences and removing artifacts from large volume dataset. Using optimized mapping criteria, over 70% of quality PET sequences were mapped specifically to the genome sequences. With a 2.4 GHz LINUX machine, it takes approximately six hours to process one million PETs from extraction to mapping. CONCLUSION: The speed, accuracy, and comprehensiveness have proved that PET-Tool is an important and useful component in PET experiments, and can be extended to accommodate other related analyses of paired-end sequences. The Tool also provides user-friendly functions for data quality check and system for multi-layer data management.
BACKGROUND: Smoking, alcohol drinking and cannabis use ("risk behaviors") are often initiated at a young age but few epidemiological studies have assessed their joined prevalence in children in developing countries. This study aims at examining the joint prevalence of these behaviors in adolescents in the Seychelles, a rapidly developing country in the Indian Ocean. METHODS: Cross-sectional survey in a representative sample of secondary school students using an anonymous self-administered questionnaire (Global Youth Tobacco Survey). The questionnaire was completed by 1,321 (92%) of 1,442 eligible students aged 11 to 17 years. Main variables of interest included smoking cigarettes on > or =1 day in the past 30 days; drinking any alcohol beverage on > or =1 day in the past 30 days and using cannabis at least once in the past 12 months. RESULTS: In boys and girls, respectively, prevalence (95% CI) was 30% (26-34)/21% (18-25) for smoking, 49% (45-54)/48% (43-52) for drinking, and 17% (15-20)/8% (6-10) for cannabis use. The prevalence of all these behaviors increased with age. Smokers were two times more likely than non-smokers to drink and nine times more likely to use cannabis. Drinkers were three times more likely than non-drinkers to smoke or to use cannabis. Comparison of observed versus expected frequencies of combination categories demonstrated clustering of these risk behaviors in students (P < 0.001). CONCLUSION: Smoking, drinking and cannabis use were common and clustered among adolescents of a rapidly developing country. These findings stress the need for early and integrated prevention programs.
BACKGROUND: Complementary/alternative medicine and integrative medicine (CAM/IM) are increasingly used in the U.S. We set out to develop and validate a brief questionnaire measuring health care provider and medical student attitudes regarding these approaches to healthcare. METHODS: IMAQ is a 29-item, 7-point Likert scale rated instrument, developed from focus groups consisting of faculty, fellows, visiting residents, and medical students at a university based integrative medicine program. Respondents included 111 (of 574 contacted) internal medicine physicians on an academic medical center CME list and 85 healthcare providers (mostly physicians) attending an American Holistic Medical Association Annual Conference (296 attending). Cohorts were selected for expected differences in attitudes toward CAM/IM. RESULTS: Factor analysis demonstrated that a 2 factor solution best explained the variance in responses (38%). Factor 1 ("openness to new ideas and paradigms") explained 26% of variance with loadings ranging from 0.79 to 0.3, with factor 2 ("value of both introspection and relationship to patient") contributing an additional 12% of the explained variance with loadings ranging from 0.69 to 0.42. Both factors demonstrated adequate reliability. Factor 1 had a Cronbach's alpha of 0.91, while factor 2 was 0.72. As expected, AHMA conference attendees scored higher (F = 120.00, p < 0.001) than the internists on the IMAQ, supporting the construct validity. Although 63% of the AHMA subjects, and only 32% of the internists were female, analysis revealed that gender did not explain the score differences (F = 2.6, p > 0.05). CONCLUSIONS: Analysis of the IMAQ provided evidence of its reliability and validity in measuring attitudes toward CAM/IM, specifically openness to new ideas and paradigms, and the value of relationship to self and patient. Initial findings support use of the IMAQ in measuring attitudes of students and practitioners towards CAM/IM interventions as a first step in understanding willingness to use these approaches to healing. It is our desire that this preliminary instrument will continue to be refined as the field of CAM/IM matures.
BACKGROUND: Plant viral diseases present major constraints to crop production. Effective sampling of the viruses infecting plants is required to facilitate their molecular study and is essential for the development of crop protection and improvement programs. Retaining integrity of viral pathogens within sampled plant tissues is often a limiting factor in this process, most especially when sample sizes are large and when operating in developing counties and regions remote from laboratory facilities. FTA is a paper-based system designed to fix and store nucleic acids directly from fresh tissues pressed into the treated paper. We report here the use of FTA as an effective technology for sampling and retrieval of DNA and RNA viruses from plant tissues and their subsequent molecular analysis. RESULTS: DNA and RNA viruses were successfully recovered from leaf tissues of maize, cassava, tomato and tobacco pressed into FTA Classic Cards. Viral nucleic acids eluted from FTA cards were found to be suitable for diagnostic molecular analysis by PCR-based techniques and restriction analysis, and for cloning and nucleotide sequencing in a manner equivalent to that offered by tradition isolation methods. Efficacy of the technology was demonstrated both from sampled greenhouse-grown plants and from leaf presses taken from crop plants growing in farmer's fields in East Africa. In addition, FTA technology was shown to be suitable for recovery of viral-derived transgene sequences integrated into the plant genome. CONCLUSION: Results demonstrate that FTA is a practical, economical and sensitive method for sampling, storage and retrieval of viral pathogens and plant genomic sequences, when working under controlled conditions and in the field. Application of this technology has the potential to significantly increase ability to bring modern analytical techniques to bear on the viral pathogens infecting crop plants.
PURPOSE/OBJECTIVES: To describe the use of a logic model methodology in the development, implementation, and evaluation of a regionally based cancer health network. DATA SOURCES: Published articles; online references; published reports from government, state, and private organizations; and regional breast health project results. DATA SYNTHESIS: Through the use of the logic model, the program objectives and outcomes were identified and actualized. CONCLUSIONS: The logic model served as a framework for developing the key components of the program: infrastructure, implementation, and sustainability. Supportive structures, such as the timeline, process evaluation, and outcome evaluation plan, enhanced the use of the logic model by adding clarity to program development and program evaluation. IMPLICATIONS FOR NURSING: Nurses, particularly advanced practice nurses and nurse managers, play a key role in leading program development. A logic model can be used to guide program development, implementation, and evaluation. It serves as an excellent framework for developing a program that integrates service, practice, and research.
Complementary and alternative medicine (CAM) is popular among patients with cancer and often is used in conjunction with conventional medicine, mostly without the knowledge or guidance of healthcare professionals. The popularity of CAM has brought into sharp focus clinical issues such as the lack of disclosure and concern about interactions among dietary supplements, prescribed medications, and diseases. Those clinical issues underscore the need for a coordinated approach to integrate CAM therapies safely into conventional medicine. This article describes how an integrative CAM program in an outpatient oncology center addresses some of the clinical issues. The CAM program uses a nurse specialist to interface between CAM and conventional medicine. An interesting aspect of the CAM program is the provision of patient consultation and the creation of an individualized complementary therapies plan.
Computed tomography (CT) has become the first modality to provide the patient's self-brain map for stereotactic neurosurgery. This paper describes our development of a nearly artifact-free stereotactic frame designed for CT imaging. The surgical procedure is performed within the CT scanner itself. The scanner's computer, via a new software program, spatially integrates the new stereotactic frame with the CT images of the patient and with the scanner gantry to provide rapid coordinate determinations, calculate potential probe trajectories, obtain target accuracy within 1 mm, and observe for any procedural complications. Our initial clinical experience with this system is described.
Sexual health is topical with many factors impacting upon its concept and hence provision. In 1995 the Sexual Health Service in East Berkshire was formed by the integration of the clinical services of Family Planning, Genitourinary and HIV Medicine with Sexual Health Promotion. The philosophy of the service is to provide holistic sexual healthcare in one visit, on one site by one clinical team. This article outlines the practical developments and the strengths and weaknesses of this model of service.
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Converging themes from the fields of environmental health, ecology and health, and human ecology highlight opportunities for innovation and advancement in environmental health theory and practice. In this commentary we outline the role of research and applied programs that integrate biophysical and social sciences with environmental health practice in order to address deficiencies in each field when taken on its own. New opportunities for environmental health protection and promotion are outlined based on the three converging themes: integrated approaches to research and policy, methodological acknowledgment of the synergies between the social and biophysical environments, and incorporation of core ecosystem principles into research and practice. These converging themes are discussed in relation to their implications for new types of intervention to achieve health gains across different spatial and temporal scales at the interface between biophysical and social environments.
In the U.S., where heavy use of insecticides has been commonplace for years, the development of proper integrated insect pest control cannot get underway unless there is a changed use pattern for such chemicals. A changed use pattern, however, cannot be accomplished without much study to establish the requirements for integrated control for each major crop situation. In this paper recent developments in a number of crop areas in the U.S. in which the necessary study has been begun are reviewed. Important phases in the development of integrated control programs include: the single tactics phase, the multitactic phase, phase, the biological monitoring phase, the modeling phase, the management and optimization phase, and the implementation phase. Several crops are discussed in relation to how far along we are in the development of practical programs of insect pest control. These are cotton, apples, alfalfa, soybeans, citrus, corn, cereal grains, tobacco and pine forests. Several of these programs have already made substantial headway, e.g., those for cotton, alfalfa, apples, tobacco, and soybeans, although the accomplishments have not been even or parellel with respect to the phases of development where progress has been good. The review of developments in these crops suggests that programs of control for individual crops and perhaps for complexes of associated crops will be developed according to specific needs of the crop, the geographic area and the pests, the technologies available and the socioeconomic and political factors of relevance. The tendency will be toward greater use of science in pest control decision-making, with extensive use of biological monitoring to establish realistic levels of threatened damage to the crop, and greater concern given to possible profit reductions and environmental disturbances of applying an insecticide, as well as the possible gain from doing so.
This paper draws upon experience gained in the recent restructuring of cancer services in Ontario that can provide insights for broader regionalization efforts. Although Ontario is the only province in Canada not to regionalize its healthcare system, the Ontario cancer services system, like most others in Canada, is based on a regionalized system. However, the growing burden of cancer and predictable crises in cancer services in Ontario necessitated a rethinking of how the cancer system should be structured and how services should be delivered. Based on recommendations by the Cancer Services Implementation Committee in 2001, Ontario's cancer services system has recently gone through major restructuring, which has established new institutional arrangements for the Ministry of Health and Long-Term Care, Cancer Care Ontario (CCO) (the provincial cancer agency) , a new Quality Council and 11 new regionally based Integrated Cancer Programs (ICPs). This restructuring has created several levers for promoting regional change and motivating performance improvement, including (1) public reporting on performance with a new quality mandate, (2) fiscal and performance-based agreements between CCO and the ICPs, (3) leading and coordinating communities of practice and (4) direct ministerial access. While institutional relationships are still developing, these experiences may provide important insights for regionalization efforts in other jurisdictions and sectors in Canada.
The paper describes interactions between primary care physicians (PCP's) and mental health clinicians (MHC's) in a "team collaborative model." A study of the interactions showed there were about two consultations a day with PCP's for each MHC, that they were largely unscheduled, took place mostly in PCP or MHC offices or in corridors, and increased in frequency over a two-year period. Role definition was a continuing process; PCP's and MHC's each learned through repeated discussions what to expect from the other in patient care. It is found that a model with close working arrangements between PCP's and MHC's is of therapeutic value for that large population of emotionally disturbed patients seen often by PCP's much less often by MHC's.
In an effort to provide special relationships and attention for the children and adolescents hospitalized on the acute care psychiatry wards, one hospital established a unit of foster grandparents. The article describes the problems encountered in the development of similar programs, particularly in multidiscipline settings. The article also describes how the foster grandparents became active members on the service's multidiscipline teams, participating in the assessment of patients and contributing to their treatment.
UNLABELLED: The role of angiogenesis during mechanically induced bone formation is incompletely understood. The relationship between the mechanical environment, angiogenesis, and bone formation was determined in a rat distraction osteogenesis model. Disruption of either the mechanical environment or endothelial cell proliferation blocked angiogenesis and bone formation. This study further defines the role of the mechanical environment and angiogenesis during distraction osteogenesis. INTRODUCTION: Whereas successful fracture repair requires a coordinated and complex transcriptional program that integrates mechanotransductive signaling, angiogenesis, and osteogenesis, the interdependence of these processes is not fully understood. In this study, we use a system of bony regeneration known as mandibular distraction osteogenesis (DO) in which a controlled mechanical stimulus promotes bone induction after an osteotomy and gradual separation of the osteotomy edges to examine the relationship between the mechanical environment, angiogenesis, and osteogenesis. MATERIALS AND METHODS: Adult Sprague-Dawley rats were treated with gradual distraction, gradual distraction plus the angiogenic inhibitor TNP-470, or acute distraction (a model of failed bony regeneration). Animals were killed at the end of distraction (day 13) or at the end of consolidation (day 41) and examined with muCT, histology, and immunohistochemistry for angiogenesis and bone formation (n = 4 per time-point per group). An additional group of animals (n = 6 per time-point per group) was processed for microarray analysis at days 5, 9, 13, 21, and 41. RESULTS AND CONCLUSIONS: Either TNP-470 administration or disruption of the mechanical environment prevented normal osteogenesis and resulted in a fibrous nonunion. Subsequent analysis of the regenerate showed an absence of angiogenesis by gross histology and immunohistochemical localization of platelet endothelial cell adhesion molecule in the groups that failed to heal. Microarray analysis revealed distinct patterns of expression of genes associated with osteogenesis, angiogenesis, and hypoxia in each of the three groups. Our findings confirm the interdependence of the mechanical environment, angiogenesis, and osteogenesis during DO, and suggest that induction of proangiogenic genes and the proper mechanical environment are both necessary to support new vasculature for bone induction in DO.
The National Institutes of Health Consensus Development Conference on Gastrointestinal Surgery for Severe Obesity brought together surgeons, gastroenterologists, endocrinologists, psychiatrists, nutritionists, and other health care professionals as well as the public to address the nonsurgical treatment options for severe obesity, the surgical treatments for severe obesity and the criteria for selection, the efficacy and risks of surgical treatments for severe obesity, and the need for future research on and epidemiological evaluation of these therapies. Following 2 days of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel recommended that 1) patients seeking therapy for severe obesity for the first time should be considered for treatment in a nonsurgical program with integrated components of a dietary regimen, appropriate exercise, and behavioral modification and support, 2) gastric restrictive or bypass procedures could be considered for well-informed and motivated patients with acceptable operative risks, 3) patients who are candidates for surgical procedures should be selected carefully after evaluation by a multidisciplinary team with medical, surgical, psychiatric, and nutritional expertise, 4) the operation be performed by a surgeon substantially experienced with the appropriate procedures and working in a clinical setting with adequate support for all aspects of management and assessment, and 5) lifelong medical surveillance after surgical therapy is a necessity. The full text of the consensus panel's statement follows.