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Programs of safety surveillance and control of fishery products.

In the United States, fishery product safety at the federal level falls primarily under the authority of the Food and Drug Administration. However, other federal agencies play an important role. The Environmental Protection Agency is responsible for setting and recommending pesticide limits in seafood, and the National Marine Fisheries Service operates a voluntary inspection program. The Centers for Disease Control is responsible for the collection and evaluation of data characterizing the source of seafood-borne illness. Individual states also play a dominant role in the control of seafood-borne risk because of the important differences in consumption and contaminant levels across regions of the country. State public health, environmental protection, and resource management agencies have developed programs designed to mitigate that risk. Because of the complication and variability of the fishery industry, an effective safety system can be developed based on partnership among federal and state agencies, in which state governments retain the dominant role and the federal government develops and updates guidance programs and provides oversight. The international community has developed practices and protocols impacting the regulation of seafood safety in the United States. In view of developing trade agreements, the international community should address the criteria of setting equivalent contaminant levels and consider the option of establishing import contract criteria for fishery products.

Animals↗

The program implications of administrative relationships between local health departments and state and local government.

A typology of organizational arrangements between state and local public health agencies was used as a framework within which the organizational environment of the local health department was studied for its effects on program development and implementation by local public health departments. Data collected in a national sample of local health officers were used in measuring the effect of four different patterns of administrative relationships on the selected characteristics of local health department programs. Important differences were observed among the four organizational types with regard to constraints on programs and program priorities, and health officers' perceptions of the primary functions of local health departments and sources of local health department funding. These findings were then used as a baseline from which to consider the possible impact of recent federal health budgetary proposals (specifically, block grants) both on existing patterns of intergovernmental relations and on the funding and operation of local health department programs. It was determined that the most likely general development arising from these proposed changes in federal budgetary policy is that the administrative control of state health agencies over those at the local level is likely to be enhanced. Other likely developments include changes in the programs and priorities of local health departments related to reductions in overall funding levels for human services and forced competition for fewer dollars by an enlarged constituency.

Community Health Services↗

Health Services Development Plan, 1983-1987.

The following are excerpts from this Plan [Health Services Development Plan] relating to family planning: "5. Family Life Development: Emphases must be given to Family Life Development in place of Family Planning. As a result the demographic characteristics of the population must be studied in relation to their impact on health and the quality of life, and programs developed in answer to these needs. This Government interprets Family Planning as much more than reduction of the birthrate. It accepts as its concept a program which includes Family and Family Life Development. The concept fundamentally includes programs for raising the quality of life and social well-being. The basic tenet to be stressed is the return to a greater sense of respect for womanhood and a greater responsibility for men and women in terms of their interpersonal relationships and ultimately the total development of the individual and family in society. The Government sees family life development as the main stay and principal fabric of the society and its heritage. However it accepts that in the short term both traditional and improved procedures of family planning will have to be followed until the message of family life development can bring about the desired results. Further, the Government now firmly intends to develop policies in population planning and to cause the Ministry of Health in conjunction with other Ministries and organizations to develop and introduce new policies in family planning and family life development which will be consonant with the high standard of life and lifestyle now being enjoyed by Barbadians."

Americas↗

Evaluation of a language program for young autistic children.

This report presents retrospective data comparing an individualized language development program for preschool autistic children receiving language remediation (experimental subjects) with a group receiving the basic school curriculum only (control subjects). All findings favored the language remediation group, as indicated: (1) experimental subjects made significant gains in one year while the control group required two years; (2) after one year, experimental subjects surpassed controls on four measures; (3) only experimental subjects made significant gains in communicative speech, noteworthy because interpersonal interaction is so difficult for the autistic child; and (4) after two years, 58% of the experimental subjects, but only 14% of the controls, had mastered all seven skills. These results support the hypothesis that an individualized language remediation program facilitates the acquisition of prelinguistic and linguistic skills.

Autistic Disorder↗

Juvenile hormone prevents the onset of programmed cell death in the prothoracic glands of Manduca sexta.

During normal pupal-adult development, programmed cell death of the prothoracic gland of Manduca sexta proceeds via apoptosis. By employing the DNA laddering technique, the earliest sign of DNA fragmentation in the cells comprising the gland occurred on Day 5 of pupal-adult development and DNA fragmentation peaked 1 day later. Since juvenile hormone (JH) is known to prevent adult development and since prothoracic gland degeneration occurs during the initial stages of adult development, we wished to determine the possible role of JH in prothoracic gland maintenance. JH was injected into pupae and the glands analyzed by DNA laddering and in situ TUNEL labeling. The administration of JH prevented apoptosis of the prothoracic gland even 11 days after JH injection into young pupae. The prothoracic glands remained intact and their ability to synthesize ecdysteroids was maintained at a fairly active level as ascertained by radioimmunoassay after in vitro incubation. The control glands had degenerated by this time and were almost devoid of ecdysteroidogenesis capability. Ultrastructural analysis confirmed that JH-treated prothoracic gland cells were rescued from the apoptotic sequence, i.e., nuclear condensation, cytoplasmic budding, and cell fragmentation. They exhibited a preserved smooth endoplasmic reticulum and intercellular channel system typical of active prothoracic gland cells. The composite data suggest that JH can both maintain and stimulate the prothoracic gland. Therefore, during normal pupal-adult metamorphosis the absence of JH is prerequisite for both the initiation and completion of prothoracic gland degeneration.

Animals↗

Clinical teaching improvement: past and future for faculty development.

Faculty development programs have focused on the improvement of clinical teaching for several decades, resulting in a wide variety of programs for clinical teachers. With the current constraints on medical education, faculty developers must reexamine prior work and decide on future directions. This article discusses 1) the rationale for providing faculty development for clinical teachers, 2) the competencies needed by clinical teachers, 3) the available programs to assist faculty to master those competencies, and 4) the evaluation methods that have been used to assess these programs. Given this background, we discuss possible future directions to advance the field.

Clinical Clerkship↗

Meeting the challenge of mobility in nursing education: one program's response.

Plans for the future include exploring linkages with baccalaureate programs, developing online offerings for courses at the ADN level, and tracking retention according to admission requirements. The department head has presented a proposal to the local BSN programs that will allow selected students in the ADN program to take one of their nursing courses at the RN-BSN level prior to graduation. A lead instructor at the ADN level is participating in a Title III grant to design online course offerings. A faculty member has been assigned the responsibility to track retention and develop a retention plan for the division. So far, we have recognized the following advantages of the new curriculum. 1) The liberal articulation for CNA and LPN means that these individuals can become registered nurses in less time. 2) Students have the opportunity to become credentialed at an earlier level and enter the workforce prior to becoming a registered nurse. 3) Implementation of the new curriculum has been a way to capitalize on college resources in order to maximize enrollment. In the past, some slots in the low enrollment NA and PN programs were not filled. As a result of the implementation of the new curriculum, we admitted a total of 65 (37%) more students in 2001 than we did in 2000 because we were able to fill available spaces in these low enrollment programs with ADN students. In a time of tight fiscal resources and increasing demands for healthcare providers, this multiple entry, multiple exit program provides an effective strategy for meeting the challenges confronting nursing education in the 21st century.

Career Mobility↗

Pediatric asthma self-management: current concepts.

The concept of asthma self-management began in asthma camps in the 1970s. Today all asthma camps are required to provide an educational asthma self-management program. The interaction between children and educators is brief, and if the children do not continue in an associated program after camp, the benefits may be lost. Open Airways, the first program developed specifically for minority children, has been the prototype for community asthma self-management. School-based intervention programs have incorporated asthma education into the health curriculum. Some asthma education programs include an emphasis on the environment. Another approach is to develop intervention projects with parents, as in the Head Start program. This program has been very effective in increasing early recognition of asthma and decreasing recidivism in a high-risk population. Another type of project addressed the reading ability and reading comprehension of asthmatic children. Improvement in reading skills resulted in a 47% decrease in asthma recidivism. After 18 months, there were only two hospitalizations among the enrolled participants. Asthma self-management programs that are most effective for inner-city children provide an interactive, culturally relevant form of asthma education and address issues such as literacy and continuity.

Asthma↗

Strengthening the public health workforce: three CDC programs that prepare managers and leaders for the challenges of the 21st century.

To address the need for management development in public health, the Centers for Disease Control and Prevention (CDC) established three independent workforce development initiatives aimed primarily at strengthening management and leadership capacity: the Sustainable Management Development Program, the Management Academy for Public Health, and the CDC Leadership and Management Institute. Though independently designed and implemented, the programs share similar guiding principles in their approach to management development: interactive (adult) learning, management tools that reinforce evidence-based decision making, individual feedback, continuous improvement of the learning process, posttraining support for networking and life-long learning, and teamwork. This article will discuss important lessons learned regarding best practices in management and leadership development.

Centers for Disease Control and Prevention, U.S.↗

Teaching ophthalmology to primary care physicians. The Association of University Professors of Ophthalmology Education Committee.

The evolution of our health care system toward managed care has placed primary care "gatekeeper" physicians in a position where they must examine and treat patients with diseases that are ordinarily treated by medical and surgical subspecialists. Many of these physicians may be poorly prepared to accept this new responsibility. The Association of University Professors of Ophthalmology (AUPO) has published a Policy Statement on Medical Student Education that suggests the minimum level of competence expected of general physicians when dealing with ophthalmologic problems. A recent survey of directors of residency programs in family practice, internal medicine, and pediatrics revealed that the training of primary care physicians (as opposed to academicians or subspecialists) has become a nearly universal programmatic goal. Most program directs believe that less than half of their residents meet the AUPO standard at the completion of medical school, and a significant minority do not meet the AUPO standard at the completion of their residency. An overwhelming majority of program directors believe that additional training in ophthalmology and other subspecialties should be incorporated into the training programs of primary care physicians. Ophthalmologists and other subspecialists should develop programs at the medical student level directed toward the education of primary care physicians, and should participate in the training of primary care physicians, as well as their own subspecialty residents. In the future, the primary care physician must be considered part of the "eye care team." Enhancing the ophthalmologic education of primary care physicians is in the best interest of quality patient care.

Family Practice↗

Peer coaching as a technique to foster professional development in clinical ambulatory settings.

INTRODUCTION: Few studies have examined how peer coaching is an effective educational and development technique in contexts outside the classroom. This research focused on peer coaching as a platform to study the process of professional development for physicians. The purpose was to identify perceived benefits coaches received from a coaching encounter and how this relates to their own process of professional development. METHODS: Critical incident interviews with 13 physician coaches were conducted and tape recorded. Themes were identified using a thematic analysis technique. RESULTS: Themes emerged clustering around two distinct benefit orientations. Group 1, reflection and teaching coaches, tended to focus on others and discuss how positively they experienced the encounter. Group 2, personal learning and change coaches, expressed benefits along more personal lines. DISCUSSION: Peer coaching contributes to physicians' professional development by encouraging reflection time and learning. Peer coaching affords positive impact to those who coach in addition to those who receive the coaching. The two clusters of benefits support the performance, learning, and development theory in that there are multiple modes to describe adult growth and development. Programs of this type should be considered in medical faculty development activities associated with medical education.

Adult↗

An improved method to evaluate the precision of computer ECG measurement programs.

We present a new graphical evaluation method aimed at displaying the main characteristics of computer ECG measurement program results. The proposed graphs provide information on the number of rejected measurements and gross program errors, and on the precision of the results, i.e. the scatter of the differences between fiducial point estimates given by the programs and the reference. 'Scatter-graphs' concerning P, QRS and T wave boundary recognition from the programs participating in the European Concerted Action on 'Common Standards for Quantitative Electrocardiography (C.S.E.)' are analysed and discussed (10 standard 12-lead ECG programs and 9 Vectorcardiographic (VCG) programs from 10 European, 5 American and 1 Japanese Centers). The method proved to be a powerful tool for a direct and global qualitative comparison of the efficiency of the algorithms elaborated by the program developers, and allowed some of the strategies adopted in these programs to be highlighted.

Algorithms↗

Diabetic late complications: will aldose reductase inhibitors or inhibitors of advanced glycosylation endproduct formation hold promise?

Patients suffering from the severe complications associated with both insulin- (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM): nephropathy, retinopathy, neuropathy, and atherosclerosis are still largely left without a prospect of an efficient treatment. This is the case even if it has been assumed for decades and now finally proved by the results from the Diabetes Control and Complications Trial (DCCT) that hyperglycemia is the single main cause of these complications. Improved glycemic control as a result of intensive insulin treatment has the potential to reduce the incidence and progression of complications, but implementation and monitoring of improved glycemic control in all groups of IDDM and NIDDM patients in different communities will be difficult and expensive. Results from the recently terminated DCCT have shown that even with intensive insulin treatment, there will be a significant burden of complications on the diabetic population. It will, therefore, still be of immense importance for the long-term quality of life for the diabetic patient that additional possibilities are developed for prevention and intervention against diabetic complications. Almost two decades of research, animal model testing, and clinical trials have been conducted on various efficient aldose reductase inhibitors. Now the concept of inhibition of formation of advanced glycosylation endproducts on proteins and lipids resulting from extra- and intracellular hyperglycemia is entering the scene as an alternative or perhaps supplementary approach to reduce the occurrence of diabetic complications. An overview of the results from these two fields of research and associated drug-development programs will be presented along with thoughts on possible future developments.

Aldehyde Reductase↗

How to improve drug development for functional disorders.

Although several studies and publications have been devoted to the evaluation of novel pharmacotherapeutic approaches in functional bowel disorders, the number of successful drug development programs has been disappointingly small. The difficulties of adequate drug development are related to the heterogeneity of the functional disorders, the lack of understanding of the underlying pathophysiology, and the lack of short-term mechanistic studies that predict clinical outcome. When drugs address a single pathophysiological mechanism, the heterogeneity has a negative impact on the possible margin when patients are not selected on the basis of the specific pathophysiological disorder. Although mechanistic studies may provide a rationale for drug development, they do not predict symptomatic success and do not identify the most appropriate dose for clinical trials. Further mechanistic studies are badly needed to improve our understanding of the pathophysiological basis of functional disorders. Future studies might aim at the development of non-invasive test that identify relevant pathophysiological mechanisms, at refining assessment of symptom pattern and at the development of short-term therapeutic trials.

Drug Design↗

Aerobic exercise and the post myocardial infarction patient: a review of the literature.

Meta analyses of randomized controlled tests of cardiac rehabilitation after myocardial infarction demonstrate that regular exercise reduces the risk of overall mortality and cardiovascular mortality. In patients with established coronary artery disease, exercise is associated with improved activity tolerance, modification of risk factors, and improvement in quality of life. Randomized controlled tests demonstrate that whereas older patients after coronary events are substantially less fit than younger patients, they obtain a similar relative improvement of aerobic capacity with a graded conditioning program. However, older adults are enrolled in such programs at a lower rate than other age groups. Despite similar clinical profiles to men, women are less likely to participate in exercise rehabilitation. In this article we discuss the principles of program development, guidelines for monitoring of patients, and facilitation of exercise programs in the Australian context.

Coronary Artery Disease↗

STAT proteins and transcriptional responses to extracellular signals.

Signal transducer and activator of transcription (STAT) transcription factors are implicated in programming gene expression in biological events as diverse as embryonic development, programmed cell death, organogenesis, innate immunity, adaptive immunity and cell growth regulation in organisms ranging from slime molds to insects to man. Rapid progress has unearthed much about the activation of STATs by Janus kinases (JAKs) and other tyrosine kinases and their ability to interface with other signaling systems. Once inside the nucleus, the STATs bind to promoters and join other transcriptional activators in the regulation of gene expression.

Animals↗

Influence of sodium valproate on medium-late luteal phase pulsatile LH secretion in normal women.

OBJECTIVE: It is not known whether gamma-aminobutyric acid (GABA) is involved in control of pulsatile LH secretion in human beings. Previous work by our group has shown that manipulation of the GABAergic system with sodium valproate does not affect pulsatile LH secretion in normal women in the late follicular phase. However, it has been suggested that steroid levels are critical for the influence of GABA upon hormone secretion; in particular, progesterone has been said to enhance inhibition by GABA. In this work we studied the effect of sodium valproate on pulsatile LH secretion in medium-late luteal phase of normal women. DESIGN: Six normal young women were studied over an 8-hour period in two successive menstrual cycles. On each occasion blood samples were taken every 10 minutes between 1000 and 1800 h. We administered 400 mg of sodium valproate every 8 hours on the 7 days preceding their second cycle and additional 400 mg at 0900 and 1400 h on the day of the study. Ovulation day was estimated by means of serial ovarian ultrasound examinations and confirmed by serum progesterone concentrations. MEASUREMENTS: In each cycle, LH, oestradiol and progesterone were determined by radioimmunoassay and sodium valproate by repolarization fluorescence spectrophotometry. The series of LH levels was smoothed for 1-minute sampling periods by means of a spline function and analysed by means of a program developed in our laboratory and written in Fortran 77. The program deconvolved the signal and calculated the pulse area, pulse duration, interpulse interval and number of pulses. LH pulse identification on the deconvolved signals was performed using our own method based on Friedman's non-parametric statistic. The statistical significance of differences between parameters was estimated using the Mann-Whitney test and Wilcoxon signed rank test. RESULTS: There were no significant differences in LH pulse area, pulse duration, interpulse interval or number of pulses with the administration of sodium valproate. CONCLUSIONS: Activation of the GABAergic system with sodium valproate had no biologically significant effect on the mid-late luteal phase pulsatile LH secretion in normal women.

Adult↗

Chronic disease self-management improved with enhanced self-efficacy.

This pilot study used a quasi-experimental pretest-posttest design to examine if participation in a chronic disease self-management program (CDSMP) improved self-efficacy, self-efficacy health, and self-management behaviors in an underserved, poor, rural population. The sample, recruited from two clinics in a south central state, consisted of 48 adults (59.70 +/- 11.22 years) and was 79.2% Caucasian (n = 38) and 20.8% (n = 10) African American. Trained lay leaders with chronic illnesses directed the interactive CDSMP based on Bandura's self-efficacy theory that included strategies for personal exercise program development, cognitive symptom management, problem solving, and communication skills. Program-specific paper-and-pencil instruments were completed prior to and immediately after completion of the 6-week program. Significant improvements (p <.10) in self-efficacy, self-efficacy health, and self-management behaviors occurred. Results underscore the need to evaluate intervention programs for specific populations and for a new paradigm that focuses on patient-provider partnerships that can improve health outcomes in underserved, poor, rural populations.

Adult↗