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PubMed1991

Physical training programs and their effects on aerobic capacity and coronary risk profile in sedentary individuals. Design of a long-term exercise training program.

Currently the prevalent perception is that regular exercise training, besides increasing maximal oxygen uptake (VO2max), may have a beneficial effect on blood pressure and plasma lipid fractions. This is the basis for recommending exercise training for health maintenance and as a part of any prevention program for middle aged and older individuals. The purpose of this work was first, to review whether a basis exists for these recommendations and if so, to secondly design an exercise training program adjusted to these groups. Its parameters should be efficient enough to cause improvements in VO2max and risk profile, yet prevent cardial and orthopedic problems. The structure and the results of exercise programs in 27 experimental studies (n = 1153) were reviewed. The findings indicate that significant changes in VO2max, apart from individuals having least favourable values initially, do not necessarily effect simultaneous improvements in either blood pressure or plasma lipid fractions. Results strongly indicate the permanent benefits of participating in a long-term exercise program. This program should therefore provide a very useful and natural addition to the accepted dietary and pharmacological therapies.

Adult↗

PubMed1990

Industry's voluntary program: Community Awareness and Emergency Response Program and the Emergency Planning and Community Right-to-Know Act.

This paper describes the chemical industry's Community Awareness and Emergency Response (CAER) Program, and voluntary and mandatory actions by the chemical industry to comply with the major environmental legislation. The chemical industry started the voluntary CAER Program soon after the Bhopal Disaster in 1984; it is coordinated through the Chemical Manufacturer's Association. This program, which began in March 1985, is a long-term industry commitment to develop a community outreach program and to improve local emergency response planning. The Congress of the United States began, in 1985, to consider proposals for mandatory programs. This led to enactment of the Superfund Amendments and Reauthorization Act of 1986, known as SARA. A portion of this Act, entitled Title III is also known as the Emergency Planning and Community Right-to-Know Act. Although this legislation has many mandatory requirements, it should be emphasized that a significant degree of voluntary industrial participation is needed if the purposes of the statute are to be achieved. Title III has created an intricate and still evolving system that ties together the EPA, industrial plant managers, state emergency response commissions, local emergency planning committees and fire departments with jurisdiction over the facility. Each of these groups has a different role and responsibilities but must work cooperatively with other participants. Because of the intricate network of participants, the magnitude of the information flow, and the continuing evolution of the system, unique public relations problems exist in order to comply with Title III.(ABSTRACT TRUNCATED AT 250 WORDS)

Awareness↗

PubMed1988

Comparison of a Bayesian program with three microcomputer programs for predicting gentamicin concentrations.

A recently developed Bayesian regression program was compared with three other aminoglycoside pharmacokinetic dosing programs available for clinical use. From 30 adult patients, 152 measured serum gentamicin concentrations (SGC) were evaluated retrospectively (78 peak and 74 trough). Predictive performance was compared for each method by using the first peak and trough SGC pair to predict subsequent serum concentrations, making a total of 92 predictions (48 peak and 44 trough). The two Bayesian programs (Brater and Koup) were further evaluated using only one initial peak or trough SGC to make the same predictions. Mean predicted error (ME), mean absolute error (MAE), and root mean squared error (RMSE) were calculated for each method. Prediction bias and precision were compared statistically, between each method, by calculating the 95% confidence intervals for the delta ME and delta MAE, respectively. No statistically significant differences were found in the MAEs among any of the methods for predicting peak SGCs, with the exception of the Brater program, using a single trough SGC, which was statistically less precise (less than 0.05). There were few statistically significant differences in the MAEs for trough SGCs; however, Koup's Bayesian program using a single trough concentration yielded statistically more precise predictions than the other methods. The ME was found to differ significantly (p less than 0.05) among estimates for peak and trough SGCs provided by some of the predictive methods.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1988

A note on sampling variance estimates for Social Security program participants from the Survey of Income and Program Participation.

The Census Bureau's Survey of Income and Program Participation (SIPP) provides data that can be used to study the characteristics of Old-Age, Survivors, and Disability Insurance (OASDI) and Supplemental Security Income (SSI) program participants. It is important that estimates of sampling errors accompany such studies because the estimates may have large sampling errors due to the small number of sample cases available for specific analyses. The generalized sampling variances provided by the Census Bureau did not identify separately either program's participants and, therefore, do not pertain directly to analyses of these groups. This article describes an approach to the direct computation of sampling variances for OASDI and SSI program participants. The approach uses the pseudo stratum and half-sample codes available in SIPP public use data files. A table of generalized standard errors is constructed for participants of both programs aged 18 or older. Generalized standard errors could not be computed for child beneficiaries under age 18 because of a wide variation of design effects across subpopulation estimates.

Adolescent↗

PubMed1985

Neural mechanisms of motor program switching in the mollusc Pleurobranchaea. I. Central motor programs underlying ingestion, egestion, and the "neutral" rhythm(s).

The buccal musculature of the carnivorous gastropod Pleurobranchaea is used in three cyclic patterns of coordination underlying, respectively, ingestion, egestion, and a third, unknown behavior(s) (Croll, R. P., and W. J. Davis (1981) J. Comp. Physiol. 145: 277-287; Croll, R. P., and W. J. Davis (1982) J. Comp. Physiol. 147: 143-154). The corresponding three motor programs can be identified and distinguished in the intact animal (Croll, R. P., and W. J. Davis (1981) J. Comp. Physiol. 145: 277-287), the reduced preparation (Croll, R. P., and W. J. Davis (1982) J. Comp. Physiol. 147: 143-154, and the present paper), and the isolated CNS (present paper), on the basis of several qualitative and quantitative criteria. Distinguishing parameters developed here include: the activity of the salivary duct, which bursts in phase with protraction during ingestion, is silent during egestion, and usually bursts biphasically and in antiphase with protraction during the third ("neutral") rhythm(s); and the protractor duty cycle, which is generally 33 to 50% during ingestion, greater than 50% during egestion, and less than 33% during the neutral rhythm(s). Retractor duty cycles did not differ significantly between the three motor programs. The neutral rhythm(s) may be a low-intensity version of the ingestion motor program, with which it shares most features. The three buccal motor programs can be elicited in the reduced preparation (sensory feedback intact) and in the isolated, deafferented CNS. Therefore, multiple motor programs in this metastable motor system are each endogenous to the CNS; i.e., they can each be generated by a central pattern generator(s) in the absence of sensory feedback.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1979

Allied health careers special resources and services program: increasing the probabilities of success for 'high risk' students in allied health career programs.

This article describes a successful developmental program specifically designed for academically "high risk" students entering a two-year community college career program in allied health. The program consisted of providing an intensive three-week instructional program to students before they entered the allied health career program, and subsequently providing an ongoing support system of tutoring, counseling and career development activities. Participants attained higher levels of academic performance and retention than nonparticipants.

Achievement↗

PubMed1978

Patient participation in a hypertension control program. Hypertension Detection and Follow-up Program Cooperative Group.

In the Hypertension Detection and Follow-up Program, the largest standardized hypertension detection, follow-up, and treatment program to date in the United States, participation rates have been high at all stages. More than 75% of those with suspected hypertension at screening attended follow-up rescreening, and more than 80% of the 5,314 hypertensive patients assigned to program treatment remained active at the end of one year. Differences in participation rates were generally small. To accomplish this, intensive efforts were required to maximize attendance, and the program was shaped to reduce known barriers to initial attendance and long-term adherence. Against the background of a high overall program response rate for all sex-race groups, factors that might be associated with variations in response were examined: age, socioeconomic characteristics, health status, and appointment schedule.

Black People↗

PubMed1978

Vocational adjustment of EMR youth in a work-study program and a work program.

Adjustment measures for students who took part in two work programs for EMR graduates of special schools were compared. Fifty students took part in a work program (direct placement in the work) and 50 students, a work-study program. The students, their parents, and their employers were interviewed regarding vocational satisfaction and adjustment. The work-study program graduates were significantly more stable, satisfied, and adjusted than were the work-program graduates (p is less than .001), but their professional opportunities (reflected by the number of different jobs held) were limited.

Adaptation, Psychological↗

PubMed1990

The role of thematic evaluation in program assessment: the case of the Community Clinical Oncology Program.

The evaluation of programs with multiple, and potentially conflicting, goals requires the integration of measures of goal achievement that often are not easily combined. One approach is the development of analytical themes which span the various goals of a particular program. The themes provide a mechanism by which the policy concerns of individuals with varying perspectives can be integrated into the evaluation framework. As well, the themes allow for flexibility in the development of new analysis as the program matures and environments change. This paper describes the application of the thematic approach to the evaluation of a complex, community-oriented cancer research program.

Clinical Trials as Topic↗

PubMedDate not supplied

Alumni perspectives comparing a general internal medicine program and a traditional medicine program.

OBJECTIVE: To evaluate a primary care internal medicine curriculum, the authors surveyed four years (1983-1986) of graduates of the primary care and traditional internal medicine residency programs at their institution concerning the graduates' preparation. DESIGN: Mailed survey of alumni of a residency training program. SETTING: Teaching hospital alumni. SUBJECTS/METHODS: Of 91 alumni of an internal medicine training program for whom addresses had been found, 82 (90%) of the residents (20 primary care and 62 traditional) rated on a five-point Likert scale 82 items for both adequacy of preparation for practice and importance of training. These items were divided into five groups: traditional medical disciplines (e.g., cardiology), allied disciplines (e.g., orthopedics), areas related to medical practice (e.g., patient education), basic skills and knowledge (e.g., history and physical), and technical procedures. MAIN RESULTS: Primary care residents were more likely to see themselves as primary care physicians versus subspecialists (84% versus 45%). The primary care graduates felt significantly better prepared in the allied disciplines and in areas related to medical practice (p less than 0.01). There was no significant difference overall in perceptions of preparation in the traditional medical disciplines, basic skills and knowledge, and procedures. The same results were obtained when the authors looked only at graduates from the two programs who spent more than 50% of their time as primary care physicians versus subspecialists. There was no significant difference between the two groups in the perceived importance of these areas to current practice. CONCLUSIONS: These results suggest that the primary care curriculum has prepared residents in areas particularly relevant to primary care practice. Additionally, these individuals feel as well prepared as do their colleagues in the traditional medical disciplines, basic skills and knowledge, and procedural skills.

Attitude of Health Personnel↗

PubMed1992

Infant Health and Development Program for low birth weight, premature infants: program elements, family participation, and child intelligence.

The Infant Health and Development Program was an eight-site randomized controlled trial testing the efficacy of early intervention to enhance the cognitive, behavioral, and health status of low birth weight, premature infants. The 377 intervention families received for the first 3 years of life: (1) pediatric follow-up, (2) home visits, (3) parent support groups, and (4) a systematic educational program provided in specialized child development centers. The control group (n = 608) received the same pediatric follow-up and referral services only. This paper describes the delivery of the intervention and its outcomes. A Family Participation Index that was the sum of participation frequencies in each of the program modalities unique to the intervention revealed that program implementation was not different across the eight sites. Index scores did not vary systematically with mother's ethnicity, age, or education or with child's birth weight, gender, or neonatal health status; but they were positively related to children's IQ scores at age 3. Only 1.9% of children of families in the highest tercile of participation scored in the mentally retarded range (IQ less than or equal to 70), whereas 3.5% and 13% of children in the middle and lowest participation terciles, respectively, scored in the retarded range. Similar findings were obtained for borderline intellectual functioning. These findings are consistent with previous research linking intensity of intervention services with degree of positive cognitive outcomes for high-risk infants. The determinants of variations in individual family participation remain unknown.

Child Day Care Centers↗

PubMed1989

Skin cancer awareness programs: success of a statewide program of education and screening in Ohio.

Skin cancer has been increasingly identified as an important public health concern. Dramatic increases in the incidence of skin malignancies have led the dermatologic community in Ohio to organize a statewide program of education and free public screenings. The program reached multiple geographic areas throughout Ohio. Educational programs were presented on television and radio, in newspapers, in independent programs, and in schools. Skin cancer screenings ultimately evaluated 5,492 patients. Six hundred and twenty-three patients were found to have suspected malignancies, while an additional 1,647 patients were found to have premalignant lesions of skin. A total of 2,370 patients were therefore found to have significant findings (43.2%). These results emphasize the need for public education concerning this condition.

Health Education↗

PubMed1987

Applying the criteria for the development of health promotion and education programs to AIDS risk reduction programs for gay men.

As a result of the AIDS (Acquired Immune Deficiency Syndrome) epidemic, many community health agencies are faced with the task of planning and implementing programs to prevent or reduce the risks of HIV (Human Immunodeficiency Virus) infection. Furthermore, the urgency of AIDS will force community groups to develop prevention programs prior to an analysis of substantial data relating to intervention efficacy. By using the five criteria for the development of health promotion and education programs enumerated by the American Public Health Association, planners can benefit from the experience of past health promotion initiatives, and insure a comprehensive approach to planning. The authors describe, using specific examples, how these criteria were used to develop and implement an AIDS risk reduction program for gay and bisexual men.

Acquired Immunodeficiency Syndrome↗

PubMed1992

In vitro fertilization program based on programmed cycles monitored by ultrasound only.

OBJECTIVE: Programmed oocyte retrieval was performed in order to make the in vitro fertilization (IVF) program cheaper and work of the IVF team easier. METHOD: In a group of 77 patients included in the IVF program, the menstrual cycle was modified with estrogen-progesterone contraceptive pills. For this reason, it was possible to start the stimulation protocol in all patients on the same day. The stimulation protocol was a combination of clomiphene (100 mg) for 5 days and HMG (150 IU) every other day. Cycles were monitored by ultrasound only. RESULT: The implantation rate per embryo transfer was 22.4%. The number of embryos per embryo transfer was low (2.6 +/- 1.4) and eliminated the need for cryopreservation. Fertilization rate (82%) and embryo transfer rate (87%) were high. The take home baby rate was 14.3%. CONCLUSION: Seventy percent of all punctures were performed in 3 days in the middle of the week. In our conditions, programmed oocyte retrieval is associated with significant economic benefits.

Clinical Protocols↗

PubMed1988

Program adherence and coping strategies as predictors of success in a smoking treatment program.

Ninety-four participants in a 6-week behaviorally oriented smoking cessation program were administered weekly questionnaires assessing their use of the major program recommendations and other quitting strategies throughout treatment. An "affect-regulation" coping inventory was administered at the beginning and end of treatment as well. Adequate adherence was reported for most of the program recommendations. Although a composite measure of adherence did not predict quitting success, adherence and coping assessments were associated with maintenance of treatment gains. Short-term maintenance was associated with an extensive affect-regulation repertoire and use of "stimulus control" strategies during the program, and long-term maintenance was associated with consistent self-monitoring of smoking during treatment. These prospective findings highlight some behavioral characteristics that may be useful targets in future efforts to foster maintenance of smoking behavior change.

Adaptation, Psychological↗

PubMed1989

A model to nationally replicate a locally successful rural family caregiver program: the Volunteer Information Provider Program.

A local program can be successfully transplanted beyond state lines if it contains the seeds for its own dissemination and replication. One such program, the Volunteer Information Provider Program (VIPP), was first piloted in Missouri and then disseminated to 20 states. The strategy, steps taken, and key elements of this successful model are delineated. The VIPP, a rural family caregiver program, was utilized, in just the dissemination phase, by 657 professionals and volunteers to aid 7,213 rural family caregivers across the United States.

Aged↗

PubMed1989

Epidemiologic programs for computers and calculators. A microcomputer program for multiple logistic regression by unconditional and conditional maximum likelihood methods.

A frequent procedure in matched case-control studies is to report results from the multivariate unmatched analyses if they do not differ substantially from the ones obtained after conditioning on the matching variables. Although conceptually simple, this rule requires that an extensive series of logistic regression models be evaluated by both the conditional and unconditional maximum likelihood methods. Most computer programs for logistic regression employ only one maximum likelihood method, which requires that the analyses be performed in separate steps. This paper describes a Pascal microcomputer (IBM PC) program that performs multiple logistic regression by both maximum likelihood estimation methods, which obviates the need for switching between programs to obtain relative risk estimates from both matched and unmatched analyses. The program calculates most standard statistics and allows factoring of categorical or continuous variables by two distinct methods of contrast. A built-in, descriptive statistics option allows the user to inspect the distribution of cases and controls across categories of any given variable.

Algorithms↗

PubMed1989

A model for the objective assessment of clinical training programs: the initial application to two pulmonary medicine fellowship programs.

A model is presented for the objective assessment of clinical training programs. The model documents the clinical trainee's experience by the diagnoses seen and procedures performed during a full year of experience. It also surveys faculty impressions of the trainee's experience and their judgment of what is necessary to constitute an adequate experience. In the pilot study applying this model to two pulmonary medicine fellowship programs, several important observations were made: (1) faculty members may not have an accurate perception of the fellow's actual clinical experience, (2) faculty impressions of the fellow's experience often do not correspond to their own conception of an adequate clinical experience, (3) interprogram variability exists, (4) pulmonary fellows may have inadequate experience with certain invasive procedures. These observations suggest that wilder application of such a model could provide valuable information to program directors and subspecialty boards. In addition, directors of pulmonary disease training programs have been asked by the American Board of Internal Medicine to establish systems to evaluate, document, and substantiate those components of overall clinical competence considered essential for certification in the subspecialty. The model presented here provides an accurate and efficient means for such evaluation and documentation.

Clinical Competence↗