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PubMedDate not supplied

[Adolescent social integration through the "Cuidar cuidando" program].

The "Care Caring program" is a device of social reinsertion, carried out by a multidisciplinary and a multi-institutional practice of more than fifteen years. Those who sustain it, have always presented the necessity of articulating the cure with social reinsertion, therefore the purpose of the Program itself is not only to favour a clinical psychiatric recovery, but also to prompt changes in the manner of social liaison of the children and youngsters taking part. Animal contact in many way produce therapeutic effects. We describe here those we have seen and discuss the "popular" term zootherapy. After 16 years of non stop activity, more than 500 children and adolescents benefited from this innovative experience. We learned also that without broad social integration policies, the devices of reinsertion are limited in their long term effects. Breaking the differentiation circuit is impossible only with these resources. Working out these difficulties will allow us to answer if it is possible to think of strategies of rehabilitation in psychology and psychiatry for infancy and adolescence using communal resources.

Adolescent↗
PubMedDate not supplied

Clinical application of the Omaha system with the Nightingale Tracker: a community health nursing student home visit program.

The application of computer use in the clinical and educational arena needs to be emphasized for both the improved management of patient data and nursing knowledge. Faculty commitment to automation of home visit documentation records was essential to sustain the trial of implementing the Nightingale Trackers in the clinical area. The Nightingale Tracker is a software program that automates the Omaha system, a community-friendly nursing language that encourages a focus on health promotion. A team approach involving students, faculty, and technical support enabled the automation of the patient record of a home visiting program in a community health nursing course.

Clinical Competence↗
PubMed2005

Achieving cholesterol target in a managed care organization (ACTION) trial.

STUDY OBJECTIVES: To objectively compare the results of a collaborative approach using pharmacists with the results of usual care for achieving a low-density lipoprotein cholesterol (LDL) goal of 100 mg/dl or less in outpatients with documented coronary heart disease (CHD) who are not at goal, and to document the effect on LDL after removal of such a collaborative model from the study population. DESIGN: Prospective, multiclinic, controlled study. SETTING: Four clinics of a 19-clinic staff model health maintenance organization in Minneapolis and St. Paul, Minnesota. Two clinics treated the intervention patients, two the controls; one clinic for each group was suburban, and one for each was urban. PATIENTS: Four hundred eighty-one patients aged 18 years or older with CHD and whose LDL levels were not at goal. INTERVENTION: Clinical pharmacists implemented the physician-approved care plan for each intervention patient; activities included managing lipid-lowering drug therapy and educating patients on cardiovascular risk reduction. MEASUREMENTS AND MAIN RESULTS: Primary outcomes were changes in LDL level and the proportion of patients achieving goal LDL in the intervention versus the usual care (control) group. Secondary outcomes were the sustainability of the impact observed up to 18 months after discontinuation of the intervention. Mean+/-SD baseline LDL levels were 131+/-28 and 131+/-26 mg/dl (p=NS) for the intervention and control groups, respectively. After a mean of 6.5 months follow-up, 107 (72%) patients in the intervention group and 61 (18%) patients in the control group had attained their LDL goal (p<0.001). Mean LDL levels were reduced by 35.6 mg/dl (27.5%) and 6.7 mg/dl (4.6%) in the intervention and control groups, respectively (p<0.001). When the active program was discontinued, results of the 18-month follow-up indicated that 85 (65%) intervention patients remained at goal compared with 96 (42%) controls (p<0.001). CONCLUSION: This trial provides quantitative evidence to support the effectiveness of the collaborative approach as an intervention to optimize management of patients with CHD whose LDL levels are not at goal; this approach is specifically called for in the executive summary of the National Cholesterol Education Program Adult Treatment Panel III. Furthermore, this study documents both the magnitude and sustainability of the impact collaborative care models can have in managed care environments.

Aged↗
PubMed2005

Syphilis in children: congenital and acquired.

Syphilis rates in women and congenital syphilis rates have declined steadily in the United States in recent years. However, syphilis remains a worldwide public health problem, with more than 12 million cases in adults and more than half a million pregnancies affected yearly. Prenatal screening and treatment programs are limited or nonexistent in many developing countries. The genome of Treponema pallidum, one of the smallest among prokaryotes, has been sequenced, but methods for continuous in vitro cultivation of the microbe remain elusive. There are no promising candidates for future vaccines at this time. Serologic testing, for both specific treponemal and nontreponemal antibodies, continues to be a primary means of diagnosis. Penicillin remains the drug of choice for congenital and acquired syphilis in childhood. The diagnosis of syphilis beyond early infancy raises concerns for possible child sexual abuse, although progression of congenital syphilis may account for some cases. Syphilis is a potentially eradicable disease, but this can be achieved only with sustained international will and cooperation to fund the necessary screening and treatment programs.

Adult↗
PubMed2000

Predictors of ventricular tachycardia recurrence in 100 patients receiving tiered therapy defibrillators.

BACKGROUND AND HYPOTHESIS: Programmed electrical stimulation (PES) is a time-honored diagnostic tool in patients with ventricular tachyarrhythmias. The response to PES can be used to assess efficacy of pharmacologic or electrical therapy, as well as to obtain prognostic information. Reproducible induction of ventricular tachycardia with invasive electrophysiologic testing, or stimulation through defibrillator lead systems, can help optimize antiarrhythmic drug therapy and device programming during clinical follow-up. METHODS: We present our experience with 100 patients who had inducible sustained monomorphic ventricular tachycardia (SMVT) during invasive PES at baseline, and received a third-generation implantable cardioverter-defibrillator (ICD) alone, or in combination with antiarrhythmic drug therapy. Noninvasive programmed stimulation (NIPS) was performed prior to hospital discharge in 61 patients. RESULTS: The inducibility of SMVT was concordant between the invasive study and NIPS in a subgroup of 40 (82%) patients who had invasive PES on the same drug regimen. During a mean follow-up of 16 months, there were 12 nonarrhythmic deaths and recurrence of spontaneous SMVT in 36 (40%) of the surviving patients. Using a Cox proportional hazards model, the following variables were associated with early arrhythmia recurrence: persistent inducibility of SMVT during the NIPS session (relative risk 11, range 2.6-47); induction of SMVT with a cycle length > 280 ms during invasive baseline PES (2.5, 1.2-5) and presence of prior inferior myocardial infarction (2.1, 1-4.2). Timing to initial recurrence of spontaneous tachycardia was unaffected by other clinical variables or concomitant antiarrhythmic drug use. CONCLUSION: Programmed electrical stimulation techniques offer insight into the patterns of spontaneous ventricular tachycardia recurrence and have significant practical utility in the management of patients receiving third-generation ICDs.

Adolescent↗
PubMed1986

Usefulness of programmed stimulation in idiopathic dilated cardiomyopathy.

The response to programmed electrical stimulation and the clinical outcome was determined in 47 patients with nonischemic dilated cardiomyopathy (DC). Thirteen patients (group 1) presented with sustained uniform ventricular tachycardia (VT), 14 (group 2) presented with cardiac arrest and 20 (group 3) presented with nonsustained VT. The mean ejection fraction of the study population was 28 +/- 9%. The response to programmed stimulation was related to arrhythmia presentation. In all patients in group 1 sustained, uniform VT was induced, compared with 1 patient in group 2 and 2 patients in group 3 (p less than 0.001). There were 14 sudden cardiac deaths and 1 cardiac arrest during a mean follow-up of 18 +/- 14 months. The only 4 patients who presented with sustained VT or a cardiac arrest in whom sustained arrhythmia induction was suppressed with antiarrhythmic therapy remain alive. Nine of the 23 patients (4 in group 2 and 5 in group 3) in whom no sustained ventricular arrhythmia was induced died suddenly, with 5 of the 9 receiving empiric antiarrhythmic therapy. Three other patients, who had a slower and hemodynamically tolerated VT at the time of arrhythmia induction, died suddenly. Thus, in patients with nonischemic DC, uniform, sustained VT is always and almost solely initiated in patients who present with this arrhythmia; although few patients presenting with sustained VT or cardiac arrest have inducibility of the arrhythmias suppressed with therapy, if it is suppressed the patient appears to have a good prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2003

Models of CD8+ responses: 1. What is the antigen-independent proliferation program.

Recent experimental results show that even brief stimulation with antigen can cause antigen-specific CD8 T-cells to undergo sustained proliferation followed by differentiation into memory cells. These results show that the dynamics of these immune responses are not governed by constant monitoring of antigen levels, but rather that following stimulation immune cells commit to a "program". At present relatively little is known about the program which governs CD8 cell proliferation and differentiation. For example, we do not know whether the program is completely specified by the initial encounter of a T cell with antigen, or whether it subsequently can be modified by the amount of antigen present. Nor do we know whether the entire program for T cell proliferation and differentiation resides within the T cell itself, or whether some component(s) of the program are determined by cells or molecules external to the CD8 cell. In this paper we construct simple mathematical models which incorporate antigen-independent proliferation and differentiation of CD8 cells during acute infections. We use these models to determine what characteristics the program must have in order to be consistent with the existing data on the dynamics of CD8 responses, and in particular to answer the questions posed above. Our results suggest that the program is not completely defined by the initial encounter of T cell with antigen but may be augmented by exposure to antigen in a brief window shortly after infection; furthermore, parts of the program may reside external to the T-cells. Finally we examine some of the consequences of the "program" for pathogen-host coevolution.

Animals↗
PubMedDate not supplied

The impact of outreach on the continuity of contraceptive use in rural Bangladesh.

In 1978, the Bangladesh family planning program launched a national program of outreach services that continues to the present. Young married women were hired and trained to visit women in their homes, offer contraceptive services, provide information, and support sustained use over time. This report uses data from two rural districts to assess the effect of the household visitation program on the continuity of contraceptive use. Results of a multivariate analysis show that household outreach has had a pronounced net effect on the continuity of contraceptive use throughout the study period and that the magnitude of this effect has increased with time. This finding suggests that sustained contraceptive use continues to benefit from home-based outreach even after a decade of service encounters. Policy implications of this finding are discussed.

Adolescent↗
PubMed1995

Characteristics of effective day treatment programming for persons with borderline personality disorder.

Day treatment, or partial hospitalization, may have unique advantages for the treatment of patients with borderline personality disorder. Such treatment may offer patients the optimal level of intensiveness and containment, resulting in less regressive dependency and acting-out behavior. To be successful in treatment of patients with borderline personality disorder, a day treatment program should facilitate the patient's need to experience and express affect safely, optimize the program's ability to provide less restrictiveness than inpatient treatment but more sustained and intensive support than outpatient treatment, and use verbal and nonverbal approaches to help patients maintain primary responsibility for their well-being. A length of stay of three weeks allows patients to regain baseline functioning and resume long-term outpatient care. Treatment goals should be clear and resolvable in three weeks.

Acting Out↗
PubMed2000

The impact on retention of expansion of an Australian public methadone program.

Although rapid expansion of methadone programs has occurred in many countries, there are few studies of the impact on treatment success. The one public methadone maintenance program in Canberra was expanded from 85 places in 1991 to 350 places in late 1992. While this responded to a real need, it also led to a temporary increase in drop-outs. Retention was considerably improved in 1996 when clients began to be transferred from the public program to fee-for-service primary health care, but the improvement was also not sustained. In recent years, one-quarter to one-half of clients dropped out before stabilization. Multiple entries into treatment were common and overall retention was not affected by previous treatment episodes or length of time between episodes. Methadone programs should monitor retention as part of on-going evaluation and improvement of treatment policy.

Australia↗
PubMed2006

Community-based environmental management in Atlantic Canada: the impacts and spheres of influence of the Atlantic Coastal Action Program.

The Atlantic Coastal Action Program (ACAP) is a unique, community-based program initiated by Environment Canada in 1991 to help Atlantic Canadians restore and sustain watersheds and adjacent coastal areas. ACAP is the eastem-most Environment Canada Ecosystem Initiative. The ACAP family is currently made up of 14 ecosystem-based organizations in the four Atlantic provinces. Each one of these non-profit organizations operates independently, but is formally linked under the umbrella of ACAP to represent a force stronger than the individual parts. In Environment Canada's experience, the program consistently demonstrates the value of a community-based approach and produces results on an ecosystem basis. This paper will examine some of the impacts of ACAP in terms of economics, credible community science, and environmental results which most often align with Environment Canada's objectives. It will explore the influences of the community-based approach to environmental management on multiple scales (local, regional, etc.). Through examples, the paper will demonstrate the effectiveness of ACAP in influencing some of the policies, programs and attitudes of various levels of government and industry in the region, as well as describe how the community-based model has been exported internationally. The paper will conclude with a discussion on a planned path forward for ACAP.

Atlantic Ocean↗
PubMed2004

Issues in disseminating and replicating effective prevention programs.

The new frontier for prevention research involves building a scientific knowledge base on how to disseminate and implement effective prevention programs with fidelity. Toward this end, a brief overview of findings from the Blueprints for Violence Prevention-Replication Initiative is presented, identifying factors that enhance or impede a successful implementation of these programs. Findings are organized around five implementation tasks: site selection, training, technical assistance, fidelity, and sustainability. Overall, careful attention to each of these tasks, together with an independent monitoring of fidelity, produced a successful implementation with high fidelity and sustainability. A discussion of how these findings inform the present local adaptation-fidelity debate follows.

Diffusion of Innovation↗
PubMed1998

Two distinct signaling pathways mediate DIF induction of prestalk gene expression in Dictyostelium.

During Dictyostelium development, the differentiation inducing factor (DIF) triggers expression of the prestalk gene ecmB and induces stalk cell differentiation, a form of programmed cell death. The effects of DIF are mediated by a sustained increase in cytosolic Ca2+ levels. The Ca2+ ATPase inhibitor BHQ causes a similar rise in Ca2+ levels and also induces prestalk gene expression. We show here that Ca2+ is a specific intermediate for prestalk gene induction, since BHQ represses transcription of the cAMP-inducible aggregative gene PDE, the postaggregative gene CP2, and the prespore gene D19. The prestalk gene ecmA is also induced by DIF, but induction appears to occur in two steps, which occur within 1 h and after 2 h, respectively. The slow step shows the same kinetics as ecmB induction and similar to ecmB induction, this step is BHQ inducible and requires an initial round of protein synthesis. The fast step does not require protein synthesis and cannot be induced by BHQ. This indicates that in addition to the slow Ca2+-mediated pathway, there is probably a second fast Ca2+-independent signal transduction pathway for DIF.

Animals↗
PubMed2003

Brassinolide improves embryogenic tissue initiation in conifers and rice.

Somatic embryogenesis (SE), the most promising technology for the large-scale production of high-value coniferous trees from advanced breeding and genetic engineering programs, is expected to play an important role in increasing productivity, sustainability, and the uniformity of future U.S. forests. To be successful for commercial use, SE technology must work with a variety of genetically diverse trees. Initiation in loblolly pine ( Pinus taeda L.), our main focus species, is often recalcitrant for desirable genotypes. Initiation percentages of loblolly pine, Douglas-fir [ Pseudotsuga menziesii (Mirb.) Franco], and Norway spruce ( Picea abies L., Karst.) were improved through the use of brassinolide. Brassinosteroids, which include brassinolide, are a relatively new group of natural plant growth regulators that are found in many plant species. They have been shown to have diverse, tissue-specific, and species-specific effects, including the stimulation of cell elongation and ethylene production and increasing resistance to abiotic stress. In our media, brassinolide was effective at concentrations ranging from 0.005-0.25 micro M. Using control medium (no brassinolide) and brassinolide-supplemented (0.1 micro M) medium, we achieved improved initiation percentages in loblolly pine, Douglas-fir, Norway spruce, and rice-15.0% to 30.1%, 16.1% to 36.3%, 34.6% to 47.4%, and 10%, respectively. Brassinolide increased the weight of loblolly pine embryogenic tissue by 66% and stimulated initiation in the more recalcitrant families of loblolly pine and Douglas-fir, thus compensating somewhat for genotypic differences in initiation. Initiation percentages in loblolly pine were improved through the combination of modified 1/2-P6 salts, 50 mg/l activated carbon (AC), adjusted levels of Cu and Zn (to compensate for adsorption by AC), 1.5% maltose, 2% myo-inositol (to raise the osmotic level, partially simulating the megagametophyte environment), 500 mg/l casamino acids, 450 mg/l glutamine, 2 mg/l alpha-naphthaleneacetic acid, 0.63 mg/l 6-benzylaminopurine, 0.61 mg/l kinetin, 3.4 mg/l silver nitrate, 10 micro M cGMP, 0.1 micro M brassinolide, and 2 g/l Gelrite. Across 12 open-pollinated families of loblolly pine, initiation percentages ranged from 2.5% to 50.7%, averaging 22.5%.

Brassinosteroids↗
PubMed2004

Gibberellin inhibitors improve embryogenic tissue initiation in conifers.

Somatic embryogenesis (SE), the most promising technology to multiply high-value coniferous trees from advanced breeding and genetic engineering programs, is expected to play an important role in increasing productivity, sustainability, and uniformity of future forests in the United States. For commercial use, SE technology must work with a variety of genetically diverse trees. Initiation in loblolly pine (LP; Pinus taeda L.), our main focus species, is often recalcitrant for desirable genotypes. Initiation of LP, slash pine (SP; Pinus elliottii), Douglas-fir (DF; Pseudotsuga menziesii), and Norway spruce (NS; Picea abies) were improved through the use of paclobutrazol, a gibberellin synthesis inhibitor. Paclobutrazol was effective at concentrations ranging from 0.25 mg/l to 3.0 mg/l (0.85-10.2 microM) and optimal in LP at 1.0 mg/l. Using control media (no paclobutrazol) and 0.33-1.0 mg/l paclobutrazol, initiation percentages in LP, SP, DF, and NS were improved from 37.7% to 44.2% (across experiments), 19.3% to 28.5%, 16.9% to 23.7%, and 38.8% to 48.5%, respectively. Other gibberellin inhibitors such as flurprimidol, chlormequat-Cl, and daminozide also caused statistically significant increases in LP initiation when added to the medium at concentrations of 0.34, 10.0, and 1.0 microM, respectively. No detrimental effects on subsequent embryo development were observed when 29 new initiations from medium without GA inhibitor and 28 new initiations from medium containing paclobutrazol were tracked through culture capture, liquid culture establishment, cotyledonary embryo development, and germination.

Culture Techniques↗
PubMed2006

Hydrogen peroxide homeostasis and signaling in plant cells.

The increases of H2O2 concentrations in plant cells often occur under biotic and abiotic stress conditions (e.g. light, environmental stresses and plant hormone abscisic acid). Atmospheric H202 as an ancient signal molecule not only plays the key role in inducing evolution of oxygenic photosynthesis, but also modulates many physiological events, such as stomatal movement, hypersensitive responses, programmed cell death and gene expressions. H2O2 levels in cells must sustain a fine equilibrium between production and scavenging. H2O2 enters cells from the apoplast or generated sources, and in turn is distributed in sub-cellular compartments. H202 can modulate the activities of many components in signaling, such as protein phosphatases, protein kinases, transcription factors (TFs), and calcium channels. Elevated cytosolic calcium concentrations will initiate further downstream responses, via the action of calcium-binding proteins. On the other hand, the research of H2O2 as a signal molecule is still in a comparatively juvenile stage, for example, little is known about how the cells sense H2O2, what the rate-limiting steps and most important cellular events are in cell signaling and what kind of genes is specific or necessary to H2O2 signaling. The answers to all the questions depend on the functional genomic and molecular genetics analysis.

Homeostasis↗
PubMed1985

Programmed electrical stimulation and long-term follow-up in asymptomatic, nonsustained ventricular tachycardia.

Thirty-three patients with ventricular tachycardia (VT) (3 or more beats, less than 30 seconds in duration, rate more than 100 per minute) on 24-hour Holter monitoring and no history of clinical arrhythmia (presyncope, syncope or sudden death) were studied using programmed electrical stimulation (PES). PES induced VT in 14 patients (42%), sustained VT in 7 (21%) and nonsustained VT in 7 (21%). Inducible VT was associated with underlying heart disease in 9 of 19 patients with coronary artery disease, 3 of 6 patients with idiopathic dilated cardiomyopathy and 2 of 4 patients with mitral valve prolapse. Patients without structural heart disease did not have inducible VT. Ejection fraction (EF) was not significantly different in patients with or without inducible VT. Twenty-three patients were discharged with drug therapy and 10 patients without therapy. At 23 +/- 16 months (mean +/- standard deviation) follow-up, 28 patients (85%) were alive, 4 (12%) had died from a cardiac cause (EF 49 +/- 17% vs 28 +/- 20%, p less than 0.03). Another patient died from cerebrovascular accident. Twenty-six patients (79%) were free of clinical arrhythmia and 7 patients (21%) had arrhythmic events (EF 49 +/- 18% vs 31 +/- 17%, p less than 0.04). Two of 8 patients with noninducible VT who were discharged without drug treatment had clinical arrhythmic events and neither of 2 patients with inducible VT discharged off drugs had such events.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Pacing, Artificial↗
PubMed2006

Physical activity for bone health in inactive teenage girls: is a supervised, teacher-led program or self-led program best?

PURPOSE: To investigate the effect of a six-month teacher-led osteogenic physical activity program, vs. a self-led activity program, on ultrasound measurements of bone in inactive teenage girls. METHODS: Ninety sedentary girls [mean (SD) age 16.3 (.6) years] were identified from 300 assessed for physical activity across five schools in southeast Ireland. Schools were matched and randomly assigned to a teacher-led physical activity (TLPA) program, a self-led physical activity (SLPA) program, or a control group. Broadband ultrasound attenuation (BUA), speed of sound (SOS), and os calcis stiffness index (OCSI) were measured using a portable ultrasound machine. Anthropometry, aerobic fitness, calcium intake, and physical activity were assessed, and focus groups held one month after program completion. Descriptive statistics, paired t-tests, and analysis of variance were used to analyze the data. RESULTS: Both intervention groups demonstrated significant improvements (p < .05) in BUA, SOS, OCSI and aerobic fitness, i.e., TLPA: +14.9%, +21.9%, + 15.9%, and +8.5%, respectively, and SLPA: +10.6%, +30.3%, + 15.6%, and +5.1%, respectively, with no change in controls. Differences between intervention groups and controls were significant for BUA and OCSI (p < .05). TLPA and SLPA groups engaged in an average of 4.5 and 3.4 hours/week of physical activity, respectively, over the intervention period. The SLPA group continued to exercise after the intervention had ceased, whereas the TLPA group did not. CONCLUSIONS: Previously inactive teenage girls can adhere to an osteogenic activity program whether supervised or directing their own activity. Longer-term, sustainable initiatives with this age group are needed and might focus on developing personal skills for physical activity.

Absorptiometry, Photon↗