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PubMed2002

Sustainable control of iodinedeficiency in Iran: beneficial results of the implementation of the mandatory law on salt iodization.

Iodine deficiency disorders (IDD) were prevalent in the Islamic Republic (IR) of IRAN before 1989, when the national salt iodization program with 40 mg l/k of salt was initiated. Despite a comprehensive IDD control program, less than 50% of the households in rural areas consumed iodized salt by 1994. A law for the mandatory production of iodized salt for households was passed in 1994. The purpose of this study was to evaluate goiter status and urinary iodine excretion 2 yr after this law was implemented. In each of 26 provinces, 30 groups of 40 schoolchildren, total 36,178, were examined for goiter and classified according to World Health Organization (WHO) classification. Urinary iodine excretion was measured in 2,917 children by digestion method. Goiter was endemic in all provinces, but the majority were small (grade 1) goiter. Median urinary iodine was 20.5 microg/dl 85.1% had urinary iodine > or =10 microg/dl. Median urinary iodine was above 13 microg/dl in all 26 provinces. In all provinces the percentage of schoolchildren with urinary iodine <5 microg/dl was less than 16%. In nine provinces the median urinary iodine was between 13 to 20 microg/dl; urinary iodine of their schoolchildren was <5 microg/dl in 10.8% and <2 microg/dl in 6-9%. No significant difference was observed between boys and girls or children of rural and urban regions in urinary iodine excretion. We conclude that 7 yr after the beginning of salt iodization and 2 yr following mandatory iodized salt consumption, urinary iodine excretion is adequate in schoolchildren; considering the data of the percent of households consuming iodized salt and programmatic setting of the IDD program, The IR of Iran has reached a sustainable control program for iodine deficiency.

Child↗
PubMed1998

OSHA's new respiratory protection standard. Applicability to the worksite.

1. OSHA's new Respiratory Protection Standard requires employers to fully comply with its provisions by October 5, 1998 though a 90 day enforcement extension has been granted since the Standard's issuance. 2. The Standard specifies many new minimum requirements for protecting the health and safety of respirator users. A critical determinant of excellence in respiratory protection will be the thoroughness with which the mandated written program addresses essential worksite applications. 3. Highlights of the Standard include a mandatory medical questionnaire (or equivalent examination) for all (voluntary and nonvoluntary) respirator users (with the exception of voluntary filtering facepiece users), expanded respirator fit testing protocols, information/training provisions, and program evaluation requirements.

Air Pollution, Indoor↗
PubMedDate not supplied

How the surveillance system may bias the results of analytical epidemiological studies on BSE: prevalence among dairy versus beef suckler cattle breeds in France.

Until recently, epidemiological studies on Bovine Spongiform Encephalopathy (BSE) were based on Mandatory Reporting Systems (MRS) of clinically suspect bovines only, but rapid diagnostic tests were validated in 1999 and are used for targeted surveillance in Switzerland, France and other countries, as a complementary and secondary tool. Data on 30491 cattle issued from a French pilot program targeted at cattle having died on the farm, subjected to euthanasia or sent for emergency slaughter, did not show any significant difference in BSE risk between dairy and beef suckler breeds. The data also revealed that part of the clinical cases of BSE escaped the MRS, which permitted to detect more dairy than beef suckler affected cattle compared to the targeted surveillance in the same period (from August to December 2000) and region (Bretagne, Pays de la Loire and Basse Normandie regions). Analyzing together the data of the targeted surveillance and mandatory reporting system programs with a non-conditional logistic regression, we found that the odds of a dead cow being a BSE case among all dead cattle was 3.2 times higher for dairy breeds compared to beef suckler breeds. This confirmed British findings but points out to the fact that considering either MRS or targeted surveillance data alone may possibly create biases in epidemiological studies on BSE.

Animals↗
PubMedDate not supplied

Evaluating a staff development physical assessment program.

This program evaluation assessed whether nursing staff who took a mandatory physical assessment course were using the information in their daily practice. A questionnaire designed to assess clinical usage of 17 physical assessment skills was sent to the nurses who completed the first four classes of the assessment course. The results showed that the majority of the nurses used only nine of the 17 skills on a daily basis. Skills used most frequently were mental status and skin system assessments. The skills reported as least used were assessments for extraocular movements, cranial nerves, and jugular vein distention. These results imply that nurses may be applying only those skills required by the patient population on their particular unit. Staff development educators need to reassess physical assessment course content and tailor the courses to teach the skills required for specialty patient populations.

Adult↗
PubMed2005

Management and performance of Taiwan's waste recycling fund.

Taiwan's resource recycling program was formally established in 1989, starting with the mandatory recycling of polyethylene terephthalate bottles. The number of mandatory regulated materials was extended to 8 categories with 27 items by 2002. Because of false data reporting, financial scandal, lack of transparency of the system, and the demand from parliament, the recycling policy has gradually changed from entirely privatized to being nationalized. Currently, the structure is built on six main bodies: fund management committee, consumers, industries responsible, recyclers, fee reviewing committee, and auditing agents. The industries that are responsible submit a fee, which is set by the fee reviewing committee, to the waste recycling fund (WRF), which is operated by the fund management committee. The auditing agents routinely check the responsible industries by documentation review as well as on-site counting to ensure that the fee is correctly submitted. The WRF provides initiatives to collect and dispose of the end-of-life products. The fund is split into a trust fund and a nonbusiness fund to deal with the collection, disposal, and treatment of the listed materials. The latter deals with the supporting works and ensures that the system runs effectively. The ratio of trust fund to nonbusiness fund is 80-20%. It is no doubt that the current practice achieves some improvements. Household waste has been reduced by 22%. And, most importantly, the benefit-to-cost ratio was as high as 1.24. However, similar to other state-owned systems, the resource recycling program has been criticized for false reporting from the responsible industries, a rigid system, and complicated procedures. To build a sustainable enterprise, the recycling program should be privatized as the recycling market and operating procedures are well established and fully mature.

Conservation of Natural Resources↗
PubMedDate not supplied

Texas nurses respond to mandatory continuing education.

This study investigated Texas nurses' attitudes toward mandatory continuing education, and their perceptions of skill improvement, knowledge enrichment, and improvement of health care to the public as a result of participation in continuing education programs. Seventy-two percent of the respondents had a positive attitude toward mandatory continuing education. Significant relationships were present between the attitudes and the perceptions of psychomotor skills improvement, cognitive improvement, affective skills improvement, and health care to the public. Four variables were predictive of the attitude toward mandatory education. In addition, the nurses preferred lecture or discussion formats and independent providers of continuing education.

Adult↗
PubMed1999

Mandated tuberculosis screening in a community of homeless people.

BACKGROUND: To examine the effects of a community program on tuberculosis incidence, prevalence, and transmission requiring users of public facilities to carry cards certifying their compliance with a tuberculosis screening, prophylaxis, and treatment program. Community knowledge of tuberculosis and costs and benefits of the program are described. SETTING: A West Coast "skid row" community with historically high rates of tuberculosis, homelessness, poverty, and use of drugs and alcohol. DESIGN: Analysis of tuberculosis activity in communities in Oregon using Oregon Health Division Tuberculosis Data Bank data. Description of community response and cost considerations. MAIN OUTCOME MEASURES: Rates of active disease, mortality, and skin-test response. Compliance with card use and understanding of tuberculosis control measures. Program expenditures. RESULTS: An 89% drop in active disease in the highest-risk community in Oregon occurred over the first 10 years of the program. Compliance with the program permitting the use of public facilities, based on cooperation with skin testing, radiology, sputum collection, and therapy has been between 33% of converters completing prophylaxis in the worst year to 100% of active cases completing 4-drug therapy in the best. Facilities that provide services have been almost universal in requiring cooperation for participants. Costs have been reduced. CONCLUSION: A program of mandated compliance with tuberculosis skin testing, radiologic and sputum examination and treatment, coupled with education and outreach, succeeded in drastically reducing active tuberculosis, transmission, deaths, and cost in a homeless community.

Adult↗
PubMed2006

[Status of the clinical laboratory in the mandatory postgraduate medical training system: in our Kyoto Prefectural University of Medicine (KPUM) University Hospital].

Since the beginning of mandatory postgraduate medical training in 2004, our clinical laboratory has introduced an obligatory training program for all medical trainees in our university hospital. This program is a two-hour course consisting of Gram's staining method, the laboratory ordering system, blood gas analysis and personal protective equipment against hospital infection. In addition, four medical trainees had applied to study our advanced elective training program for clinical laboratory medical education in 2005. This program requires two months for each trainee, consisting of a three-step curriculum from "basic" to "maniac". In the "basic" step, each trainee studies to acquire fundamental knowledge and techniques in such fields as electrocardiography, ultrasonic cardiography, respiratory function, blood transfusion and laboratory hematology. Assistant work in the laboratory information office is also included in this step. On the other hand, highly specific laboratory techniques such as flow cytometry (FCM) and cardiopulmonary exercise testing (CPX) are classified as "maniac". The remaining laboratory fields such as blood chemistry, therapeutic drug monitoring (TDM) or urinary sedimentation are classified as "special", and each trainee is expected to master them during the training period. To date, all trainees who have finished our elective training program feel moderate to great satisfaction. I believe that clinical laboratories in both university hospitals and clinical teaching hospitals play an important role in mandatory postgraduate medical training for each trainee to learn fundamental medical knowledge and techniques, and moreover, to learn how to work and co-operate with various co-medical partners.

Curriculum↗
PubMed2001

MOSES: an educational program for patients with epilepsy and their relatives.

The knowledge of patients with epilepsy about their own condition is poor, and thus the need for educational programs for people with epilepsy has long been recognized. However, no such programs have been established in their routine care. The Modular Service Package Epilepsy (MOSES) now tries to fill this gap for patients in German-speaking countries. The program was developed by a multidisciplinary group (neurologists, nonmedical professional helpers, and representatives of national epilepsy associations) for people with epilepsy older than 16 years, independent of the kind and severity of their epilepsy. MOSES is designed for group education and can be used in inpatient and outpatient settings in epilepsy centers, in clinics, and by neurologists in private practice. The program aims to help patients achieve a better understanding of their disease, to gain more self-confidence, and to take over responsibility, thus supporting patients to become experts in managing their own illness. Being modular in structure, MOSES includes nine units: living with epilepsy, epidemiology, basic knowledge, diagnostics, therapy, self-control, prognosis, psychosocial aspects, and network epilepsy. MOSES consists of a workout manual for patients and a trainer manual. For potential trainers, special "train-the-trainer seminars" are offered and considered mandatory. About 400 patients have participated in a MOSES training program in Germany, Switzerland, and Austria. The efficacy of the program is currently been evaluated.

Attitude to Health↗
PubMed1994

Medicaid program; eligibility and coverage requirements--HCFA. Final Rule.

This final rule withdraws regulations setting forth a mandatory budgetary method for determining financial eligibility for individuals who are not receiving or deemed to be receiving Federal cash assistance but whose financial eligibility for Medicaid is being determined through the application of financial criteria of the Aid to Families with Dependent Children (AFDC) program. These regulations were previously issued as part of a final rule with comment period originally published on January 19, 1993, and were to be effective October 18, 1994. This final rule also makes conforming technical changes, as a result of this withdrawal, to the remainder of the January 19, 1993, final rule and reaffirms the August 18, 1994, effective date of this remaining part. These changes are being made as a result of consideration of public comments received.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1994

High throughput and economical mutation detection and RFLP analysis using a minimethod for DNA preparation from whole blood and acrylamide gel electrophoresis.

We report a simple, rapid, and high throughput method which allows the simultaneous processing of multiple whole blood samples for routine DNA purification and analysis. The method is based on a microscale DNA preparation and digestion using minimal amounts of reagents and handling. The amount of material necessary for a Southern blot analysis (5-7 micrograms) is obtained from 200 microliters of whole blood. All steps involved in DNA preparation and restriction digestion are processed in a single 1.5-ml Eppendorf tube. DNA preparation is performed using a salting out procedure with a proteinase K digestion step but no phenol/chloroform extraction. Restricted fragments are separated by electrophoresis through polyacrylamide slab gels followed by electrotransfer to nylon membranes. By varying the electrophoresis parameters (V/cm or duration), fragments of interest up to 12 kb length can be separated with high resolution. At least 80 samples can be processed at once per DNA preparation, and multiples of this number depend on the available equipment. This economical and rapid method allows routine DNA analysis for mutation or RFLP detection to be performed on a large scale which is a mandatory feature in any DNA-based population screening program. In addition, the DNA purified by the minimethod can be used as an economical source for PCR analysis.

Blotting, Southern↗
PubMed2004

Past, present and future of bovine spongiform encephalopathy in France.

The bovine spongiform encephalopathy (BSE) epidemic has been monitored in France since the end of 1990. The surveillance has been considerably enhanced since 2000, and today every cow aged 2 years or more is tested at the time of slaughter, culling or death. As of 1 May 2002, 613 native cases have been identified, 287 of them by the mandatory reporting system of suspect clinical cases or complementary programs, 213 by active surveillance of fallen stock and 113 by testing at the abattoir. The analysis of reported BSE cases shows a higher number of cases born between 1993 and 1995, which can be linked to a greater exposure at that time and to an increase in surveillance efficiency. When the clinical onset related to overexposure ends, the future trend of the BSE epidemic in France will depend on the efficiency of the control measures implemented since 1996. An indicator of this will be the number of BSE cases born among recent cohorts. Bovine spongiform encephalopathy (BSE) was described first in 1987 in Great Britain (Wells et al. 1987), where a huge epidemic started, and more than 180,000 cases have been detected since then in this country. A risk analysis undertaken in France in 1990, in part because of the amount of meat and bone meal (MBM) imported from Great Britain during the 1980s, led to the conclusion that BSE might have spread to France, and that sporadic cases might be observed (Savey et al. 1991). Epidemiological surveillance was therefore set up at the end of 1990, and control measures were taken to prevent the development of the disease. The trends in the number of BSE cases detected in France must be analyzed in the light of both the detection system and the control measures, as well as their changes over time.

Animals↗
PubMed2005

[Multimedia preoperative patient information].

Due to heavy workloads and shortage of staff, doctors often find it difficult to explain operations to their patients with the legally required detail and timing (in Germany, 24 h preop). This is however mandatory for obtaining informed consent. We developed a computer program that generates films explaining 24 common orthopedic operations and blood transfusion. They explain the operation, early postoperative phase, and benefits and risks to the patient. At our clinic, this program is used in daily routine and precedes the actual doctor-patient conversation for informed consent. We asked 300 patients about their satisfaction with the newly developed program. The multimedia presentation gives the patient more time, enough detail and clarity, and the chance to repeat parts of the film. For the doctor, it saves time. The time gap required in Germany between explanation and operation is thus easily adhered to. In case of legal problems, the film can be used for evidence. The use of this multimedia presentation to help in getting informed consent is improving workflow considerably.

Computer-Assisted Instruction↗
PubMed1993

Dispositional traits as risk in problem drinking.

A trait-dispositional paradigm for conceptualizing personality provided the framework for investigating the relationship between personality dispositions and drinking problems. This approach was compared directly with personality research based on the Minnesota Multiphasic Personality Inventory (MMPI). A total of 241 subjects (192 men and 49 women) were tested at a mandatory Driving While Intoxicated (DWI) first-offender education program. Information was gathered from the Michigan Alcoholism Screening Test (MAST), Blood Alcohol Concentration (BAC) at time of arrest, and two personality tests--the MacAndrew Alcoholism Scale (MAC) and the Problem Drinker Trait List (PDTL). The psychometric properties of the PDTL were analyzed and compared with those of the MAC. In comparing the two personality tests in terms of their capacity to predict drinking problems over a wide range of drinking severity, the PDTL performed as well or better than the MAC, particularly for drinkers with low arrest BAC. Comparative analysis between the best predictor items of the MAC and of the PDTL revealed little relationship between the item domains. The predictive trait clusters of the PDTL for men were Emotionality/Depressiveness, Impulsivity, and Low Self-Confidence, whereas predictive clusters for women included Depressiveness, Overcontrol, and Alienation.

Adult↗
PubMed2005

Regulating insect resistance management: the case of non-Bt corn refuges in the US.

In this paper, we analyze the insect resistance management (IRM) plan put in place by the US Environmental Protection Agency (EPA) to delay the evolution of resistance to Bt corn in natural populations of the European corn borer, Ostrinia nubilalis Hübner. This IRM plan is the most impressive mandatory IRM system ever developed. It forms a coherent whole and includes mandatory refuges, actions to increase growers' compliance and a program for monitoring the evolution of resistance. However, our analysis suggests that two components of this IRM plan are not entirely satisfactory: growers' compliance and monitoring of the evolution of resistance. Moreover, the implementation of these two components of IRM has been required of the registrants, whose incentives for IRM are probably lower than the social optimum. Our analysis suggests that alternatives to the IRM plan currently in place could improve these two components.

Animals↗
PubMed1998

[Cord blood banks--unrelated transplants].

Hematopoietic progenitor cells are present in umbilical cord blood; placental blood (PB) previously considered as waste product now constitutes an alternative source of hematopoietic stem cells for bone marrow reconstitution. This has promoted the establishment of cord blood banks for use in unrelated transplants. The banking of PB offers many advantages: the donors do not require anesthesia, stored PB can be a valuable source of stem cells for patients from ethnic minorities underrepresented in volunteer registers, and stored PB can be made available much faster than bone marrow from unrelated donors. Preliminary clinical experience suggests that, due to the immunological immaturity of PB cells, graft versus host disease might be lower than when using bone marrow from adult donors and HLA restrictions might be less stringent. If the number of nucleated cells in PB often appears low for patients weighing more than 40 kg, clinical data suggest that the number of stem cells may be sufficient for adult transplantation. The number of cord blood banks throughout the world is increasing rapidly. In the USA and Europe, more than 10,500 PB units are stored and available for transplantation. In the next 5 years, a total of 50,000 PB will be reached which may be sufficient to provide for the majority of candidates for unrelated BM transplantation. The practices of umbilical cord blood collection, mother selection, infectious disease screening, cell manipulation and storage must be standardized. Some accreditation process should be mandatory for assessing operating procedures and the quality assurance programs of the banks, and for allowing the international exchange of placental blood between transplant centers.

Adult↗
PubMed1986

Bench testing of the CPU-1 ventilator.

An artificial patient capable of spontaneous and artificial ventilation has been used for bench testing of the Ohmeda CPU-1. This ventilator has an extensive capacity for interaction with the spontaneous breathing of the patient, and provides a wide variety of operating modes. These include spontaneous breathing with or without continuous positive pressure, volume-cycled and pressure-cycled artificial ventilation, with or without positive end-expiratory pressure or synchronization. In addition, there is a facility for ensuring a mandatory minute volume. The ventilator is controlled by a microprocessor with sophisticated decision-taking functions based on input from an expiratory hot-wire anemometer. Intended and measured ventilatory variables are displayed separately. The anemometer has satisfactory accuracy and pressure control is adequate. The synchronization permits adaptation of the ventilator to spontaneous respiration according to a wide range of harmonics. In any mode, artificial ventilation is initiated if spontaneous respiration is inadequate. The mandatory minute volume mode is based on a complicated program of a cautious nature which reacts instantly to inadequate spontaneous breathing, but is slow to discontinue artificial ventilation.

Humans↗