A systems-based approach to improving educational quality via community-oriented faculty development.
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Biomedical subjects
Publications and source records attributed to B Schell.
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The results of postoperative epidural administration of saline solution (a placebo), morphine, methylprednisolone, and a combination of morphine and methylprednisolone for the reduction of pain after an operation for spinal stenosis or a herniated intervertebral disc were compared in a prospective, randomized blinded study. Epidural administration of morphine and methylprednisolone--either alone or in combination--significantly reduced the need for analgesia after an operation for spinal stenosis (p < 0.05) but not after an operation for a herniated intervertebral disc. Morphine and methylprednisolone did not have an addictive effect on the reduction of pain. Itching was significantly more common in the patients who had received morphine than in those who had received the placebo (p = 0.04). Although urinary retention was more frequent after the use of morphine than after the use of the placebo, the difference was not significant with the size of the sample that was analyzed (p = 0.25).
In order to observe the nutritional and health status of pre-school children, the output and outcome of two formal health services -health post and creche- for this vulnerable group in two urban slum areas of Belo Horizonte, Brazil were studied in 1986. A total of 420 children were surveyed, 254 children randomly selected from the communities and 156 from three creches. Growth monitoring was not undertaken systematically, and mothers did not have growth control charts. When a child had diarrhea, mothers preferred to apply home remedies or to buy proprietary drugs rather than to consult medical personnel. 72% of mothers reported using ORT, and 11% suspending feeding completely. After three month of life, 50% of infants were receiving some breast milk. 75% of children were immunized completely. The prevalence of health and nutrition indicators such as anemia (50% vs. 30%), parasitosis (87% vs. 70%), and stunting (28% vs. 20%) was worse in the creches than in the communities.
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During the second half of 1986 the health and nutritional status of 254 children aged up to six years was studied, as well as the socio-economic situation of their parents in two favelas (shantytowns) in Belo Horizonte, Brazil. The nutritional status of the children was characterized by stunting (Z-score: 20.1% less than -2) but not by wasting (Z-score: 3.7% less than -2). Consideration was also given to how far stunting was caused by high morbidity such as acute respiratory infections (point prevalence: 38.5%), diarrheal diseases (point prevalence: 11.5%) and parasitosis (point prevalence: 70.3%). Furthermore, anemia (point prevalence: 29.7%) appeared as another health problem. The most important determinant of anthropometric indices turned out to be the mother's schooling. From the present data it can be hypothesized that the nutritional status of the children was limited less by the lack of food than by their poor health status.
During the second half of 1986 the impact of the improvement of water supply and excreta disposal facilities on diarrheal diseases and intestinal parasitosis was studied in 254 children up to six years of age from two favelas (shanty towns) of Belo Horizonte, Brazil. The estimated incidence of diarrhea was 6.2 episodes/child year and the estimated period prevalence reached 31.0 episode days/child/year. The point prevalence of parasitosis was 70.7% (Ascaris lumbricoides: 55.4%, Trichuris trichiura: 19.6%, Giardia lamblia: 17.9%). The estimated prevalence of diarrhea decreased with improvement of water supply and sanitation facilities to 45% and 44% respectively, but no statistically significant impact was observed in the case of parasitosis. School education and weaning practice were found to be other important determinants of diarrhea.
This project studied the effects of weather variables and size of the population on minor and major violence rates within six prisons in the Kingston, Ontario, Canada area from January, 1980 through December, 1983. While weather variables have been studied in relation to mood changes within the general population, this study was the first to analyze the impact of weather variables on rates of violence within the prison setting using forward inclusion multiple regression. Analysis showed that population size consistently appeared positively correlated with assaults on other inmates among the male medium-security prisoners during the summer months. In the summer months, temperature tended to be positively related to some minor kinds of offenses, but in the winter months the relationship was negative. Humidity, rain, sunshine hours, snow, and snow on the ground were not consistently related to incidences of minor and major violence. Indices of geomagnetic disturbances had statistically significant inverse relationships with attempted suicide/self-inflicted injury rates among the male prisoners during the summer months. Over 12 months, wind was generally negatively correlated with incidences of major and minor violence among the male inmates. For 6-mo. periods, wind was generally positively correlated with violence rates during the winter months and negatively correlated during the summer months among the male inmates. The findings relating weather variables to violence rates in the women's prison were consistently in opposition to those found for male prisoners during the 4-yr. period.
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BACKGROUND: An emerging trend in the field of gerontology is the recognition that older adults, especially the frail elderly population, can increase their levels of strength and thus improve functional capability. Social acceptance of physical frailty and provision of care and assistance to dependent persons has now turned to helping the frail elderly adults maintain or improve functional independence. METHODS: The purpose of our study was to show the feasibility and effectiveness of a low-cost strength-training program using free weights for increasing strength and functional fitness among older adult volunteers. Participants aged 73 to 94 years were residents of a multilevel care retirement community in Columbia, SC. The strength-training program, led by an instructor, used dumbbells and ankle weights and was conducted in a multipurpose recreation room at the retirement facility. RESULTS: Functional performance measures (timed chair stand, 6-meter walk, stair climb, balance) handgrip strength, and self-assessment of activity level were outcome measures. All 25 participants completed the strength-training program. The average program adherence rate of all participants was 87 percent. No participant injuries or other adverse effects were observed. Functional performance measures improved significantly among program participants, with the greatest improvement in the timed chair stand (33.5 percent improvement) and the stair climb (17.6 percent improvement). CONCLUSION: Free-weight strength-training programs are appropriate for older adults, can be implemented in community settings, and are associated with significant improvement in functional performance.