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PubMed1998

Evaluating the use of Snoezelen and chronic pain: the findings of an investigation into its use (Part II).

This is the second of two papers which describes a research project which was designed to evaluate the use of Snoezelen for the management of chronic pain. Part I explored the concepts underpinning both chronic pain and the Snoezelen itself which subsequently resulted in the development of an appropriate study design. The purpose of the study was to compare the use of Snoezelen for the management of chronic pain as a potential relaxation and distraction strategy, compared to the traditional relaxation approach used within the clinic. This paper will present the results that were obtained with the research project and in the light of these findings the author will discuss implications for future investigation and practice.

Adaptation, Psychological↗

PubMedDate not supplied

Supply and demand for neonatal intensive care: trends and implications.

OBJECTIVE: Access to high-risk newborn care is determined by supply of services, demand, and financing. Major changes in health care have occurred since the advent of perinatal regionalization in the mid-1970s. This article explores access from the point of view of the supply and demand for neonatal intensive care within the changing financing environment. STUDY DESIGN: An analysis was done of the 1983, 1989, and 1991 American Hospital Association survey data, combined with birth data from the National Center for Health Statistics. RESULTS: By 1991 supply of hospital-based high-risk newborn care exceeded demand; nationally, there were roughly 300,000 excess bed-days available in 1991. Regional figures revealed that these estimates are, if anything, conservative. CONCLUSIONS: Payers are increasingly price sensitive and have the ability to shift blocks of patients from one facility to another. A surplus encourages a shift of patients to low-price locations. Differentiation of quality and monitoring will become an important means of ensuring access to high-quality care in a surplus environment.

Bed Occupancy↗

PubMed2003

Nonattended home automated continuous positive airway pressure titration: comparison with polysomnography.

OBJECTIVE: Automatic adjusting nasal continuous positive airway pressure titration (APAP) has been introduced as an alternative method of establishing pressures for patients with sleep apnea. The performance and accuracy of APAP in nonattended home environment are controversial. This study assessed APAP polysomnographic outcomes and accuracy in a nonattended home environment. STUDY DESIGN AND SETTING: We conducted a retrospective consecutive case series of 24 consecutive patients who had nonattended APAP and simultaneous full polysomnography (PSG). RESULTS: APAP was tolerated and reduced obstructive Apnea-Hypopnea Index (AHI) to <10 events/h in all patients. Mean AHI decreased from 38.4 (21.2) to 5.9 (6.6) events/h. Central apneas worsened in one patient. A therapeutic pressure was determined in 91% of patients. Autoset accurately measured residual AHI compared with PSG (R = 0.77, P < 0.001). APAP overestimated the AHI by 1.4 events/h. CONCLUSIONS: Nonattended APAP is successful in many patients in determining a therapeutic positive pressure setting. Reported AHI via Autoset is similar to that of PSG. SIGNIFICANCE: APAP reduces AHI and is tolerated in a nonattended environment.

Adult↗

PubMed2003

An evaluation of vernal pool creation projects in New England: project documentation from 1991-2000.

Vernal pools are vulnerable to loss through development and agricultural and forestry practices owing to their isolation from open water bodies and their small size. Some vernal pool-dependent species are already listed in New England as Endangered, Threatened, or Species of Special Concern. Vernal pool creation is becoming more common in compensatory mitigation as open water ponds, in general, may be easier to create than wooded wetlands. However, research on vernal pool creation is limited. A recent National Research Council study (2001) cites vernal pools as "challenging to recreate." We reviewed documentation on 15 vernal pool creation projects in New England that were required by federal regulatory action. Our purpose was to determine whether vernal pool creation for compensatory mitigation in New England replaced key vernal pool functions by assessing project goals and documentation (including mitigation plans, pool design criteria, monitoring protocols, and performance standards). Our results indicate that creation attempts often fail to replicate lost pool functions. Pool design specifications are often based on conjecture rather than on reference wetlands or created pools that function successfully. Project monitoring lacks consistency and reliability, and record keeping by regulatory agencies is inadequate. Strengthening of protection of isolated wetlands in general, and standardization across all aspects of vernal pool creation, is needed to ensure success and to promote conservation of the long-term landscape functions of vernal pools.

Agriculture↗

PubMed2003

Analysis of design attributes and crashes on the Oregon highway system.

This paper estimates the relationship between crash activity and roadway design attributes on the Oregon state highway system. Crash models are estimated from roadway segments distinguished by functional classification and location. A number of design attributes were found to be related to crash activity in the various models, including number of lanes, curve characteristics, vertical grade, surface type, median type, turning lanes, shoulder width and lane width. In selected instances, crash reduction factors (CRFs) calculated from model results are compared with those presently used to evaluate projects in the Oregon Department of Transportation's Safety Improvement Program. The number of design attributes specified in the crash models is limited in comparison with the number of CRFs presently used to evaluate safety improvement projects. However, the attributes included in the crash models represent countermeasures associated with the more costly outlays that states make to improve safety. Thus, crash models of this type provide states with an opportunity to validate the CRFs that are most important economically.

Accidents, Traffic↗

PubMed1999

A high voltage, constant current stimulator for electrocutaneous stimulation through small electrodes.

A high-voltage stimulator has been designed to allow transcutaneous stimulation of tactile fibers of the fingertip. The stimulator's output stage was based upon an improved Howland current pump topology, modified to allow high load impedances and small currents. The compliance voltage of approximately 800 V is achieved using commercially available high-voltage operational amplifiers. The output current accuracy is better than +/- 5% over the range of 1 to 25 mA for 30 microseconds or longer pulses. The rise time for square pulses is less than 1 microsecond. High-voltage, common-mode, latch-up power supply problems and solutions are discussed. The stimulator's input stage is optically coupled to the controlling computer and complies with applicable safety standards for use in a hospital environment. The design presented here is for monophasic stimulation only, but could be modified for biphasic stimulation.

Calibration↗

PubMed2005

Contributing factors to preschool unintentional injury.

Injury is the leading cause of death and disability for preschoolers in the United States. Young children suffer disproportionate morbidity and mortality when injured. Pediatric nurses modify injury risk through injury prevention strategies and child and family education. Effective injury prevention programs cannot be designed, implemented, or evaluated without a fundamental understanding of the factors that contribute to the phenomenon of preschool unintentional injury. This article includes a discussion of the factors that contribute to preschool unintentional injury occurrence and is based on a combination of epidemiology theory and the health belief model. Evidence-based suggestions for modification of nursing practice are provided.

Accident Prevention↗

PubMed2004

The epidemiology and prevention of drowning in Singapore.

INTRODUCTION: The aim of this study was to derive a profile of drowning victims in Singapore in the 10-year period 1992-2001 and determine if there are any patterns, trends or factors which may affect the risk profile of victims. Another objective was to recommend measures for reducing deaths from drowning through a review of some of the current literature and studies on drowning prevention. METHODS: Data for epidemiological analysis were studied and analysed. Data was primarily obtained from the annual drowning statistics reported in the annual reports of the Singapore Life Saving Society, which were in turn obtained from the Registry of Births and Deaths, and the Coroner's Court. The review of current literature and studies on drowning was concentrated on the publications of leading drowning experts and agencies and on the papers presented at two important international conferences, the International Drowning Symposium in May 1996 and the first World Congress on Drowning in June 2002. The review was done with a view to identify successful drowning prevention measures that may be adopted or enhanced in Singapore. RESULTS: The study revealed a few important findings. Firstly, Singapore had a drowning rate per 100,000 population that varied from a low of 0.88 in one year to a high of 1.72 in another in the period 1992-2001. Secondly, the male drowning mortality rate in Singapore was much higher than the female drowning mortality rate. Thirdly, persons in the age group of 20-29 years were at the highest risk. Fourthly, the sea, rivers and swimming pools were the locations with the highest number of drowning victims. The study also showed that the main measures of drowning prevention may be broadly divided into supervision, environmental design changes, legislation, swimming lessons and aquatic safety education. CONCLUSION: The situation in Singapore is generally comparable to that in high income or developed countries although there are some differences. Further studies and research need to be done to provide a better understanding of the epidemiology and prevention of drowning in Singapore. In the meantime, the main measures of drowning prevention should, as far as possible, be followed or enhanced.

Adolescent↗

PubMed1997

Environmental and behavioral circumstances associated with falls at home among healthy elderly individuals. Atlanta FICSIT Group.

OBJECTIVE: To conduct an in-depth examination of the environmental and behavioral circumstances associated with falls and near-falls experienced by elderly individuals and to evaluate the usefulness of reenactment as a method for studying falls. DESIGN: Observational and self-report data of incidents were obtained through a reenactment procedure. Environmental characteristics were documented with physical measurements, visual inspection, and photography. SETTING: Incidents occurred inside participants' homes, and reenactments were conducted at incident sites. PARTICIPANTS: Subjects were 15 community-dwelling, relatively healthy individuals, age 70 to 81 years. MAIN OUTCOME MEASURES: Incidents were analyzed to determine patterns of interaction of individuals' personal characteristics, environmental use behaviors, and environmental characteristics. RESULTS: Seven patterns were identified: collisions in the dark, failing to avoid temporary hazards, preoccupation with temporary conditions, frictional variations between shoes and floor coverings, excessive environmental demands, habitual environmental use, and inappropriate environmental use. CONCLUSIONS: There is a dynamic interaction between environmental conditions and behavior involving use of the environment and its implications for falls in older people. Although some incidents involved familiar environmental and behavioral risk factors, less familiar factors also were critical contributors to the incidents. Successful elimination of these factors is likely to be closely related to an individual's perception that an environmental or environmental use problem is correctable, motivation to undertake changes in the environment, and a desire to integrate changes into daily activities.

Accidental Falls↗

PubMed2003

Implications of spatial heterogeneity for management of marine protected areas (MPAs): examples from assemblages of rocky coasts in the northwest Mediterranean.

Marine protected areas (MPAs) are increasingly used as a management tool to preserve species and habitats. Testing hypotheses about the effectiveness of MPAs is important for their implementation and to identify informative criteria to support management decisions. This study tested the general proposition that MPAs affected assemblages of algae and invertebrates between 0.0 and 0.5 m above the mean low water level of rocky coasts on two islands in the Tuscan Archipelago (northwest Mediterranean). Protection was concentrated mainly on the west coasts of the islands, raising the possibility that neither the full range of assemblages nor the relevant scales of variation were properly represented within MPAs. This motivated the comparison of assemblages on opposite sides of islands (habitats). The effects of MPAs and habitat were assessed with a multifactorial sampling design; hypotheses were tested about differences in structure of assemblages, in mean abundance of common taxa and in univariate and multivariate measures of spatial variation. The design consisted of three replicate shores for each condition of protected and reference areas on the west side of each island and three unprotected shores on the eastern side. Assemblages were sampled independently four times on each island between June 1999 and January 2001. At each time of sampling two sites were selected randomly at each of two tidal heights to represent midshore and lowshore assemblages on each shore. Estimates of abundance were obtained using non-destructive sampling methods from five replicate 20x20 cm quadrats at each site. Results indicated differences among habitats in structure of assemblages, in mean abundance of common taxa and in univariate and multivariate measures of spatial variation at the scale of shores. Most of these patterns were inconsistent with the predicted effect of management through MPAs. The data suggest that designation of MPAs in the Tuscan Archipelago should proceed through management of multiple shores and types of habitat selected to guarantee protection to a representative sample of assemblages and to the processes responsible for maintenance of spatial patchiness at different scales. This study also shows that considerations of spatial heterogeneity are important to underpin management decisions about the number, size and location of MPAs.

Animals↗

PubMed2000

Landmarks in burn prevention.

The objective of this paper is to highlight landmarks in burn prevention. Novel strategies in the areas of law and regulation, environmental and consumer product design, and educational programs are identified and discussed. Notwithstanding marked reductions in burn morbidity and mortality, especially in economically developed countries, burn injuries remain an important public health concern throughout the world. More, and more effective, burn prevention programs coupled with renewed efforts to reduce the social and environmental correlates of burn injuries (poverty, overcrowding, family stress, and educational deficits) are needed to further reduce burn incidence and its long-term sequelae.

Accident Prevention↗

PubMed2006

Discussion groups with parents of children with cerebral palsy in Europe designed to assist development of a relevant measure of environment.

BACKGROUND: An instrument to measure environmental factors relevant to physically impaired children is being developed in a European context. Preliminary work in England had identified some potentially important themes. Further inquiry was needed to identify issues important in other European countries. OBJECTIVE: To inform the content of a questionnaire relevant to the environment of children with cerebral palsy (CP) living in Europe. DESIGN: A qualitative study using discussion groups. PARTICIPANTS: Parents of 28 children with CP from five countries; Denmark, France, Italy, Ireland and Sweden. One discussion group was held in each country with an average of seven parents per group. RESULTS: The four themes identified in the preliminary work done in England were strongly confirmed across Europe - namely: Mobility, Transport, Support by and to parents, and Attitudes of individuals and institutions towards children. Two new themes identified in the discussion groups were Bureaucracy and Access to information about rights and entitlements. CONCLUSIONS: The environmental factors that cause concern to parents of children with CP are similar across Europe. A prototype environmental questionnaire has been developed based on these findings. The environmental questionnaire is in use in a study in nine European centres.

Adolescent↗

PubMed2001

Water quality response to riparian restoration in an agricultural watershed in Vermont, USA.

Achievement of management goals for Lake Champlain (Vermont/New York, USA and Quebec, Canada) will require reduction of agricultural phosphorus loads, the dominant nonpoint source in the Basin. Cost-effective phosphorus reduction strategies need reliable treatment techniques beyond basic cropland and waste management practices. The Lake Champlain Basin Agricultural Watersheds National Monitoring Program (NMP) Project evaluates the effectiveness of livestock exclusion, streambank protection, and riparian restoration practices in reducing concentrations and loads of nutrients, sediment, and bacteria in surface waters. Treatment and control watersheds in northwestern Vermont have been monitored since 1994 according to a paired-watershed design. Monitoring consists of continuous stream discharge recording, flow-proportional sampling for total P, total Kjeldahl N, and total suspended solids, grab sampling for indicator bacterial, and land use/agricultural monitoring. Strong statistical calibration between the control and treatment watersheds has been achieved. Installation of riparian fencing, protected stream crossings, and streambank bioengineering was completed in 1997. Early post-treatment data suggest significant reduction in P concentrations and loads and in bacteria counts in the treated watershed. Monitoring is scheduled to continue through 2000.

Agriculture↗

PubMed2005

Compressibility of municipal solid waste codisposed with fly ash.

If a municipal solid waste (MSW) landfill is used as the foundation for a construction site, the change in the loading conditions may cause considerable compression of the landfill. Therefore, reinforcement to compensate for the loose compression nature of a MSW landfill is a very important design factor for geotechnical engineers when considering the end-use of the landfill. In this study, we discuss a possible technique for stabilizing MSW landfills through the codisposal of municipal solid waste and fly ash. To estimate the stabilization based on the compression characteristics of the codisposed landfill, we performed tests using a large compression set and experimental cells. According to the test results, if the proportion of fly ash is increased, initial and long-term compression could be reduced.

Carbon↗

PubMed2003

A dugwell program to provide arsenic-safe water in West Bengal, India: preliminary results.

In 1982, Dr. K. C. Saha, a dermatologist of Calcutta, West Bengal, identified patients with skin lesions from the district of 24 Parganas, leading him and others to search for a cause. The cause was soon identified to be arsenic in drinking water, but even today, 20 years later, large number of people continue to drink arsenic contaminated water and patients are increasing in number. Project Well is a program chosen for implementation in some villages of North 24 Parganas. Arsenic safe drinking water is provided for adopted villages by constructing shallow, concrete dugwells designed to tap the water of the unconfined aquifer, 20-30 feet below ground level, that contains low levels (< 0.05 mg/L) of arsenic in the target region. The traditional dugwell design is modified by use of tube well hand pumps to withdraw water. The project includes community involvement, programs to increase awareness of the need to drink arsenic safe water, and training in monitoring of dugwell water for arsenic and harmful pathogens. Disinfecting of the water and regulating the water hazard diagram are also included in the training program. The plan is to make the system sustainable at the village level using indigenous labor and materials.

Arsenic↗

PubMed2006

Participatory methods effective for ergonomic workplace improvement.

Recent experiences in using participatory methods for ergonomic workplace improvement are reviewed to know how these methods can be effective in different settings. The review covered participatory programmes for managers and workers in small enterprises, home workers, construction workers and farmers in Asian countries. To meet diversifying ergonomic needs, participatory steps reviewed are found to usually follow a good-practice approach easily adjustable according to local needs. These steps are found to usually focus on low-cost improvements. They can thus lead to concrete results particularly by addressing multiple technical areas together. Typical areas include materials handling, workstation design, physical environment and work organization. Further, the review confirms that the participatory methods are always modified according to each local situation. This is done by developing a group-work toolkit comprising action checklists and illustrated manuals and by building a support network of trained trainers. It is suggested that participatory methods taking a good-practice approach by multi-area low-cost improvements through the group use of locally adjusted toolkits are effective for improving small-scale workplaces including those in developing countries.

Agriculture↗

PubMed2003

Assessing stock and change in land cover and biodiversity in GB: an introduction to Countryside Survey 2000.

Countryside Survey 2000 (CS2000) is the latest in a series of surveys designed to measure and evaluate stock and change of land cover, landscape features, freshwaters, habitats and the vegetation of Great Britain. The ideas behind CS2000 developed during the 1960s and 1970s and culminated in the first survey of vegetation and land cover in 1978. One kilometer sample squares were selected at random using an environmental stratification. Subsequent surveys took place in 1984, 1990 and 1998, revisiting the original sample locations, whilst progressively expanding in scope and sample size; CS2000 included soils, breeding birds, remotely sensed imagery, freshwater biota and hydromorphology. Countryside Survey data may be interpreted using the pressure-state-response model, by selecting indicators of process and quality, and by identifying models of expected responses to different pressures. Thus, results showing losses of hedgerows between 1984 and 1990 stimulated new protection for these features. Ideally, CS2000 data should be used to stimulate experiments to distinguish between different pressures, in order to ensure that policy and management responses are both appropriate and achievable.The experience from CS2000 may prove helpful for the design and management of other large scale monitoring programmes of ecosystems. In particular, the scope of the survey, and the use to which the data are applied, have evolved through time, and yet continuity was essential for change to be detected efficiently. These objectives were reconciled by collecting the data in a disaggregated form, allowing a high degree of flexibility in both analysis and reporting.

Animals↗

PubMed1996

Recent advances in the genetics of Alzheimer's disease and vascular dementia with an emphasis on gene-environment interactions.

OBJECTIVE: To review recent findings in the genetics of Alzheimer's disease (AD) and vascular dementia (VaD) with particular emphasis on gene-environment interactions. DESIGN: A survey and critique of recent literature on the genetic etiology of AD and VaD. CONCLUSIONS: Recent research has identified several genes associated with AD, including loci on chromosome 1, 14, 19, and 21. Two of these loci, encoding the beta-amyloid precursor protein and apolipoprotein E, have gene products that are well characterized and of evident significance in the pathogenesis of AD. The four genes together probably account for little more than 50% of all cases of AD, but other undiscovered loci are likely. Interaction of genetic effects with environmental influences may affect both onset and expression of AD. By contrast, only a small minority of VaD cases can be attributed to a pure genetic etiology. The majority of VaD is caused by both genetic and environmental factors. Many of the environmental antecedents also have genetic determinants (e.g., smoking). Knowledge of the gene-environment interactions for both AD and VaD will facilitate identification of early preclinical symptoms of disease, a stage of the disease process during which treatment may be most beneficial.

Alzheimer Disease↗