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PubMed1995

Networks for medical nutrition education--a review of the US experience and future prospects.

Nutrition education for physicians in the United State and Canada, remains an orphan discipline with no improvement or changes in the past decade. This status has led to the creation of regional nutrition centers and networks to develop nutrition education programs in health professional schools. The expanded network concept now covers geographic areas in the northeastern, southeastern, and middle United States, with plans to extend to the far West and to establish a national coordinating center or "network of networks." The barriers to progress in nutrition education must be overcome, and their conquest could form the basis for initiating new regional networks or a coordinating center. Strategies for nutrition networking are applicable to other disciplines and provide guidance for creating consortia to deal with the diminished need for medical and surgical subspecialties and play an important role in the training of generalist physicians.

Area Health Education Centers↗
PubMedDate not supplied

Well-being changes in response to 30 years of regional integration in Maya populations from Yucatan, Mexico.

Infant mortality rate (IMR), overall frequency of linear enamel hypoplasia (LEH), sexual dimorphism in LEH, age of onset of LEH, and age at menarche were used as indicators to test the hypothesis that the origin and development of the tourist industry and increased state participation on Maya subsistence agriculturists in the early 1970s had improved the well-being of the Maya. Two historical moments where inferred from the data. The first was derived from cheap and effective immunization and sanitation campaigns that reduced IMR from 143.4/1,000 live births in the early 1960s to 97.4 in the early 1970s. State participation broke the undernutrition-disease cycle enough to reduce LEH frequencies significantly (from 71.9% in individuals born before 1971 to 51.5% in those born in 1971 or after, chi(2) = 55.72; 1 df; alpha = 0.00001) and to eliminate the sex difference in LEH expression (from a 14.8% LEH difference between men and women before 1971 [Male/Female Odds Radio = 0.45, alpha significant at 0.05] to a nonsignificant 2% difference). Improvement in overall living conditions reflected in a "modern stage" infant mortality regime and an almost disappearance of LEHs, resulted from gradual improvements in living conditions that did not become apparent until the 1980s. Trends in the age at menarche are not statistically significant, probably due to methodological limitations. However, if overall living conditions continue to improve or stay as they are today, accelerations in maturation should become noticeable.

Adolescent↗
PubMedDate not supplied

The "drip-and-ship" approach: starting IV t-PA for acute ischemic stroke at outside hospitals prior to transfer to a regional stroke center.

PURPOSE: Acute stroke therapy with intravenous (IV) tissue plasminogen activator (t-PA) is vastly underutilized. Increasingly, patients are being started on IV t-PA and being transferred to regional Stroke Center programs, where additional therapies can be offered in a multimodal format. We describe our experience at the Stroke Center at Hartford Hospital with interhospital patient transfers who received IV t-PA prior to transfer to our medical center. METHODS: A retrospective analysis of our Acute Stroke Therapies database was undertaken, encompassing the intial four-year period of our Stroke Center program (May 1, 2001 to April 30, 2005). We evaluated the patient characteristics, clinical outcomes, and adjunctive therapies of patients who were started on IV t-PA at referring hospitals prior to their emergent transfer to our Stroke Center. RESULTS: From a total of 229 patients who received IV and/or IA thrombolysis and newer catheter-delivered devices or clinical trials at our Stroke Center, a total of 33 (14.4%) were started on IV t-PA at an outside hospital prior to transfer. Symptomatic hemorrhage occurred in one of the 33 patients (3.0%), and in-hospital mortality rate for these patients was 6.1%. A total of 26 patients (78.8%) had a positive outcome in that they were discharged either to home or to acute rehabilitation. CONCLUSIONS: Use of IV t-PA in a "drip-and-ship" approach is growing at the regional Stroke Center at Hartford Hospital. This protocol is safe and offers several advances for the care of patients with AIS: (a) empowering emergency physicians and neurologists at outside hospitals, via access to a 24/7 Acute Stroke Hotline, to treat patients with AIS; (b) facilitating the early initiation of IV t-PA; and (c) offering adjunctive therapeutic approaches, following arrival at our facility, for patients not sufficiently improving with IV t-PA alone.

Acute Disease↗