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PubMed1995

The effect of minimal exercise on fitness in elderly women after hip surgery.

To determine the effect of minimal exercise on functional fitness following total hip replacement in elderly women, 20 women (13 exercisers, 7 controls) who had undergone unilateral or bilateral hip replacement surgery for primary osteoarthritis were studied. An exercise treadmill test with respiratory gas and blood lactate analyses, and a field test of walking speed on a measured course, were administered before and after a twice weekly exercise programme of three months' duration. Markers of cardiorespiratory fitness, including peak achieved oxygen uptake (VO2) and ventilatory and lactate thresholds were measured. Maximum self-selected walking speed was also measured over a flat course. Peak VO2 increased in the exercise group when compared to baseline (P < 0.05) but did not differ from the control group. The exercise group significantly improved their walking speed by 10.1% compared with non-exercising controls (1.41 vs 1.20 m/sec, P < 0.05), and increased VO2 at lactate threshold. The improvements occurred despite the twice weekly exercise sessions being below the recommended frequency of exercise for improving cardiorespiratory fitness. Minimal exercise in elderly women after hip surgery can substantially improve submaximal exercise capacity, as well as walking speed.

Aged↗

PubMed1995

A comparison of the range of walking speeds between normal and hemiplegic subjects.

It is known that people who have suffered stroke walk slower than normal. However, their ability to deviate from a preferred speed of walking has not been reported. This study investigated the range of walking speeds of 20 hemiplegic subjects and compared the results with those of 20 normal age- and gender-matched controls. All subjects traversed a computerized grid walkway which measured selected temporal and spatial gait parameters. Subjects walked at five self-selected speeds: "normal"; "slower than normal"; "slowest"; "faster than normal"; and "fastest". Comparisons were made between velocity, range of velocity, stride time and stride length. The hemiplegic group walked significantly slower at all speeds, were less capable of adapting the speed of their gait, possessed a markedly reduced range of walking speed, and walked more cautiously than the controls. These deficiencies are likely to limit the stroke person's ability to respond to environmental demands.

Adult↗

PubMed1996

Energy expenditure with indoor exercise machines.

OBJECTIVE: To compare the rates of energy expenditure at given rating of perceived exertion (RPE) levels among 6 different indoor exercise machines. DESIGN: Repeated measures design. PARTICIPANTS: Healthy young-adult volunteers, including 8 men and 5 women. INTERVENTIONS: Subjects underwent a 4-week habituation period to become familiar with the RPE scale and exercise on an Airdyne, a cross-country skiing simulator, a cycle ergometer, a rowing ergometer, a stair stepper, and a treadmill. Following habituation, each subject completed an exercise test with each exercise machine. The exercise test comprised 3 stages of 5 minutes at self-selected work rates corresponding to RPE values of 11 (fairly light), 13 (somewhat hard), and 15 (hard). Oxygen consumption, from which the rate of energy expenditure was calculated, was measured during the last minute of each 5-minute exercise stage. Heart rate was measured during the last minute of each stage of the exercise test, and blood lactate levels were obtained immediately after each exercise stage. MAIN OUTCOME MEASURE: Rate of energy expenditure at specified RPE values. RESULTS: Rates of energy expenditure at a given RPE varied by 1093 kJ/h (261 kcal/h) for the exercise machines. The treadmill induced higher (P < .05) rates of energy expenditure for fixed RPE values than all other exercise machines. The cross-country skiing simulator, rowing ergometer, and stair stepper induced higher (P < .05) rates of energy expenditure than the Airdyne and cycle ergometer. Heart rate varied significantly (P < .01) among exercise machines, with the highest values associated with the treadmill and the stair stepper. Lactate concentration varied significantly (P = .004), with highest values associated with use of the stair stepper and the rowing ergometer. CONCLUSIONS: Under the conditions of the study, the treadmill is the optimal indoor exercise machine for enhancing energy expenditure when perceived exertion is used to establish exercise intensity.

Adult↗

PubMed1996

Athletic performance in relation to training load.

Athletic performance generally is thought to improve with increases in training load. However, few data exist showing the quantitative relationship between training load and performance. We followed 56 athletes (16 runners; 40 cyclists/speed skaters) during 12 weeks of training. We recorded index performances (3.2 km time trial or 5 or 10 km bicycle ergometry) after 6 weeks of baseline training and 6 weeks of a self-selected training increases. Training load was quantitated as the product of intensity (global rating of perceived exertion (RPE)) and the duration (time) of each training session. Load was expressed as the weekly average over the 6 weeks preceding each index performance. We also recorded the duration of high intensity training (RPE>5, hard) (inten). From 6 to 12 weeks, performance improved 12.95 +/- 3.83 to 12.66 +/- 3.00 min (p < .01). Training time (345 +/- 282 to 355 +/- 273 min/wk) and inten (61 +/- 88 to 71 +/- 91 min/wk) did not change significantly, although RPE (3.8 +/- 0.7 to 4.0 +/- 0.8) and load (1242 +/- 957 to 1386 +/- 978) increased significantly. No strong correlations existed between changes in performance and changes in any training measure (TIME, r = -0.031, RPE, r = -0.039, LOAD, r = 0.29, INTEN, r = 0.025.) Data suggest that improved performance in events of 7-20 minutes duration in response to intensified training is primarily dependent upon increases in total load and overall RPE during training and; that a 10-fold increase in training load may be associated with an approximately 10% improvement in performance. These data suggest the possibility of understanding the training responses of athletes on a quantitative basis.

Adult↗

PubMed1995

[Characteristics of corneal topography in candidates for surgery for myopia].

INTRODUCTION: Videokeratography analyses the corneal anterior topography. It is necessary in refractive surgery to estimate the anatomical effect of the surgery and to eliminate early Keratoconus. METHODOLOGY: Corneal anterior topography was studied on 70 consecutive patients (140 eyes) candidates for low myopia surgery (-1 to -6); 87 eyes were wearing regularly contact lenses. With the topographic analysis machine of EYESYS compagny, keratometry (Km) at 3 mm, astigmatism (delta K) at 3 mm, I-S value at 3 mm and 5 mm according to Rabinowitz method were measured in each eye. RESULTS: The average keratometry was 43.50 +/- 1.87 D. The average astigmatism was 0.909 +/- 0.75 D. 51 eyes presented an asymmetric corneal and among them 32 ware contact lenses regularly; 8 eyes out of 140 (6%) presented the association of an high central Keratometry value (> or = 47 D) and corneal asymmetry (I-S > 0.5 value). COMMENTS: The incidence of Keratoconus is higher in a candidate population for refractive surgery by self-selection. Its frequency is difficult to evaluate accurately because of the present limits for the diagnostic measures. In this population, it seems to represent about 6%. CONCLUSION: The videokeratography before refractive surgery is necessary to reveal corneal anterior topography abnormalities and to eliminate early Keratoconus.

Astigmatism↗

PubMed1995

The effect of five prosthetic feet on the gait and loading of the sound limb in dysvascular below-knee amputees.

The purpose of this study was to determine the effects of prosthetic foot design on the vertical ground reaction forces experienced by the sound and amputated limbs in a group of persons with dysvascular below-knee amputations. Stride characteristics, joint motion, and ground reaction forces were recorded simultaneously during a self-selected free walking velocity in seven subjects wearing five different prosthetic feet (SACH, Flex-Foot, Carbon Copy II, Seattle, Quantum). Subjects used each foot for one month prior to testing. Results indicated that the sound limb was exposed to higher vertical ground reaction forces than normal despite a reduced walking velocity. Use of the Flex-Foot resulted in the lowest sound limb vertical forces, which appears to be related to its large arc of dorsiflexion motion. In addition, there was increased loading response knee flexion of the sound limb indicating an attempt by these subjects to modulate floor impact. These results suggest that the intact lower extremity is susceptible to excessive floor impact, and that prosthetic foot design can have an effect on the magnitude of the vertical forces experienced by the limb.

Aged↗

PubMed1996

Do historic studies of fish consumers support the widely accepted LOEL for methylmercury in adults.

Lack of demonstrated neurotoxicity among fish-eating populations has been cited by the World Health Organization and others as supporting an adult LOEL (lowest observed effect level) of > or = 200 ppb blood mercury equivalent. We reviewed 13 published evaluations of neurologic status as related to tissue mercury or methylmercury concentration in long-term fish-eating populations. Review criteria included study size, design (sampling strategy, characterization of exposure, characterization of outcome) and data analysis. No case of classic Minimata disease is described in the 13 studies. Also, no study clearly shows a threshold tissue level above which any form of neurologic dysfunction occurs. A study by Valciukas et al. shows no evidence of neurologic impairment in groups with blood mercury of 10-20 ppb. Studies by Spitzer et al. and McKeown-Eyssen and Reudy suggest correlation of neurologic dysfunction with rising blood mercury concentrations in the 60-120 ppb range. While other studies show no effects associated with rising mercury dose, numbers are small, participant self-selection likely and the clinical assessment limited. Together the 13 studies describe neurologic examinations in approximately 50 fish eaters having a blood mercury equivalent above 200 ppb; of these subjects, neurologic dysfunction consistent with methylmercury exposure was found in as few as six and as many as 15. We conclude that the oft-cited LOEL for (methyl)mercury of 200 ppb in blood is not supported by these studies.

Animals↗

PubMed1996

Cost-effectiveness of hospice care.

Is hospice cost-effective? What is perfectly clear is that hospice care overall provides different care than conventional care for the dying. There is much more home care, aimed at goals of comfort, dignity, and remaining at home, and that care is distributed over longer periods of time. There is less hospital care and less anticancer therapy. Nonhospice oncologic care provides more hospital services, particularly in the last month of life, and more effort to directly attack the malignant disease. There will always be those individuals whose goals and medical condition at a particular time make one type of care the best choice for that person. Current research strongly supports hospice care as cost-saving in the last month of life. The overall effect of hospice care on costs appears to be weakly positive. This is despite the fact that hospice benefits under Medicare include absence of co-payment, medications for the primary condition, and substantially more supportive services, which represent extra value and decreased out-of-pocket expenses to the consumer. A factor strongly favoring the development of cost-effective programs is the fact that most hospices began and developed as capitated systems of care. Thus the benefits derived from providers working with patients to control costs have accrued over time. The not-for-profit structures led savings to be put back into patient care, allowing more help for families and patients. An unresolved bias of available research is the question of the extent to which hospice patients are self-selected at the time of entry for their low interest in intensive and expensive services. The most positive estimates of cost-savings in hospice have required case-mix or time-of-entry adjustments to demonstrate savings. There is little support for cost-savings in the raw data comparing total costs in hospice and conventional care groups. However, there is also no evidence that hospice care adds to costs of care for the dying. Differences in outcomes between hospice- and conventional-care have been modest. Satisfaction with care has often been higher in hospice care, but care giver burden may also be higher. Other outcome measures have been inconsistently affected. The task of measuring differences is a difficult one. Hospice patients themselves are largely unavailable for measurement during the most critical periods of care, and proxy measures of benefit are necessary. Families also tend to be grateful (or critical) around the death of a loved one; this is related to complex family relationships and emotions not likely to be influenced by any health care program. It should also be noted that the task of measuring the success of hospice care has largely used measures originally developed for understanding the impact of conventional oncologic care. The tools for understanding the effects of spiritual counseling or homemaker assistance are much less well developed. The initial goals of the Medicare hospice benefit appear to have been met: a choice is available that responds to the needs and concerns of many dying people and their families, at no additional cost to the taxpayer. In addition, millions of families have received the benefit of the lower out-of-pocket costs for health services and medications. They have benefited from the broader definition of health which made simple, continuous support services such as homemaking and personal care available at no charge. The question of hospice cost-effectiveness would seem to be a question of the past. Other questions offer even more substantial challenges to continuing hospice care as it is now offered and into the future. There are no data to allow a critique of the current structure of hospice services, or to support the link between individual components of service and outcomes. This leaves the hospice concept open to considerable manipulation.(ABSTRACT TRUNCATED)

Cost-Benefit Analysis↗

PubMed1995

Dietary oxalate and its intestinal absorption.

Dietary oxalate is currently believed to make only a minor contribution (< 20%) to urinary oxalate excretion. A recent prospective study of stone disease suggested that dietary oxalate may be a significant risk factor. This observation led us to re-evaluate the contribution of dietary oxalate to urinary oxalate excretion. Previous studies have been hampered by inaccurate food composition tables for oxalate and inadequate methods for studying intestinal oxalate absorption. This evidence as well as factors that modify oxalate absorption are reviewed. New approaches to measure food oxalate and intestinal oxalate absorption have been examined. Capillary electrophoresis appears to be well suited for the analysis of the oxalate content of food. Two individuals consumed an oxalate-free formula diet for 7 days. This diet decreased urinary oxalate excretion by an average of 67% (18.6 mg per 24 hours) compared to oxalate excretion on self-selected diets. The absence of detectable oxalate in feces by day 6 of the diet suggested that the intestinal absorption was minimal. However, an effect of the formula diet on endogenous oxalate synthesis cannot be excluded. Restoring oxalate to the formula diet increased urinary oxalate excretion and illustrates that this experimental protocol may be well-suited for studying oxalate absorption and factors that modify it. Our results suggest that the intestinal absorption of dietary oxalate makes a substantial contribution to urinary oxalate excretion and that this absorption can be modified by decreasing oxalate intake or increasing the intakes of calcium, magnesium, and fiber.

Animals↗

PubMed1996

The fertility impact of alternative family planning distribution channels in Indonesia.

Clinic-based distribution of contraceptive commodities is expensive per unit distributed. This situation has fueled the search for alternative means of delivery. Comparing the performance of alternatives is straightforward if the output measure is a count of commodities distributed, but comparing actual fertility impacts is another matter. I use data from the 1991 Indonesia Demographic and Health Survey to assess the extent of difference among the eventual fertility outcomes of users supplied with similar commodities through varying sources. When the "modern" methods of pill, IUD, and injection are grouped together, the fertility of users supplied with these commodities differs markedly according to their source of supply. I find little evidence for self-selecting of users into supply channels. This result implies that fertility differentials by source are likely due to characteristics of the distribution channels.

Age Factors↗

PubMed1996

The effect of death education on attitudes of hospital nurses toward care of the dying.

PURPOSE/OBJECTIVES: To determine the effect of death education on attitudes and behavioral intentions of experienced nurses who care for hospitalized terminally ill adults and their families and to determine the influence of death education on nurses' self-perceptions regarding supervision or peer review of their behavior toward dying patients and their families. DESIGN: Experimental. SETTING: Adult medical-surgical units in an urban teaching hospital. SAMPLE: Self-selected sample (n = 28) of registered nurses randomly assigned into experimental (n = 14) and control (n = 14) groups. METHODS: Both groups completed Waltman's questionnaire Attitudes, Subjective Norms, and Behavioral intentions of Nurses Toward Care of Dying Patients and their Families, using a pretest/post-test format. The experimental group also received an educational intervention consisting of three two-hour didactic/experiential classes; the control group received no intervention. MAIN RESEARCH VARIABLES: Death education and nurses' attitudes, subjective norms, and behavioral intentions toward care of dying patients and their families. FINDINGS: The researcher detected no significant difference in attitude between the two groups. The educational intervention had a significant positive effect on subjective norms. No significance was detected in overall analysis of behavioral intentions. CONCLUSIONS: Death education had no effect on the attitudes or behavioral intentions of RNs toward care of dying patients and their families. The educational program did have a significant positive effect on nurses' perceptions of how others might perceive their behavior toward dying patients and their families. IMPLICATIONS FOR NURSING PRACTICE: Death education for nurses, especially in areas of communication with patients and families, potentially may affect terminal care. The significant influence on subjective norms suggests a need to expand death education to include all healthcare personnel.

Attitude of Health Personnel↗

PubMed1995

Therapeutic feeding in Sarajevo during the war.

OBJECTIVE: To monitor the growth of underweight children enrolled in a therapeutic feeding programme in Sarajevo during the war. DESIGN: About 17% of the total child population in the age group one to 14 years were assessed for eligibility to join a therapeutic feeding programme. All those who were found to be underweight (weight for age < 10th percentile), or suffering from certain diseases or disabilities were included in the programme. SETTING: Monitoring took place in health centres and clinics in besieged Sarajevo. SUBJECTS: A total of 49,780 children aged one to 14 years were estimated to be living in Sarajevo between May 1993 and March 1994 and 8361 (16.8%) were assessed during this period. Of these, 1283 (2.6% of the total child population) were found to be underweight and enrolled in the programme. INTERVENTIONS: The public were informed about the therapeutic feeding programme through the media. All children who came forward for initial assessment were weighed, had their heights measured and were medically examined by a team of medical personnel. Those found to be underweight were included in the programme which provided high quality food items, donated as food parcels. Children were re-weighed at three monthly intervals. When a child's weight increased to 0.5 kg above 10th percentile, the child left the programme. RESULTS: Of 1283 children enrolled in the programme, 650 (50.7%) were suffering from chronic diseases while the remaining 633 (49.3%) were underweight only. Undernutrition was highest in the four to six year old age group (19.3% with low weight for age). Over half (58.3%) of the children who were underweight but not sick gained a satisfactory weight during the study period and left the programme. CONCLUSIONS: The results suggest that the therapeutic feeding programme was successful in improving growth in a self-selected sample of underweight children.

Adolescent↗

PubMedDate not supplied

Dying from heart disease.

OBJECTIVES: To describe the symptoms experienced in the last year of life by people with heart disease, their relation to quality of life, and informal carers' satisfaction with hospital services. METHODS: Interview survey of informal carers of 600 patients aged 15 and over, approximately ten months after their death from heart disease in 1990 in 20 English health districts. The districts, while self-selected, were nationally representative in social characteristics and indicators of health service provision and use. RESULTS: Pain, dyspnoea and low mood were reported to have been experienced by more than half the patients in their last year of life. Anxiety, constipation, nausea/vomiting, urinary incontinence and faecal incontinence, although not suffered by the majority of patients, also caused much distress. Hospital symptom control was reported to be limited: little or no symptom relief was reported for 35% patients with pain, 31% with constipation, 24% with dyspnoea and 24% with nausea/vomiting. Nevertheless, high levels of satisfaction with hospital staff were reported. CONCLUSIONS: Patients dying from heart disease experience a wide range of symptoms, which are frequently distressing, and often last for more than six months. There is room for an improvement in palliative care for patients with heart disease in hospital.

Adolescent↗

PubMed1996

Reliability and validity of a submaximal treadmill test to estimate aerobic capacity in women with rheumatic disease.

OBJECTIVE: To assess reliability and validity of a single stage submaximal treadmill test to estimate aerobic capacity in women with rheumatic disease. METHODS: 30 women with rheumatic disease (rheumatoid arthritis = 19; systemic lupus erythematosus = 5; mixed connective tissue disease = 2; psoriatic arthritis = 4) performed a submaximal exercise test at a self-selected walking speed between 3.2 and 7.2 km/h on 2 occasions, and one subjective maximal exercise test with respiratory gas analysis. Estimation of aerobic capacity from the submaximal test was obtained from a regression equation using age, walking speed, and exercise heart rate. Aerobic capacity from maximal testing was determined by observed peak oxygen consumption and by estimation using test duration in a regression equation. Correlation and regression analyses were performed to assess test-retest reliability and criterion validity of the submaximal method. RESULTS: Intraclass correlation coefficient for the submaximal test was ICC = 0.97 (95% CI = 0.94-0.99). Comparison of results from the submaximal test to the maximal test using both observation and estimation methods to determine aerobic capacity ranged from r = 0.77 to 0.80, with R2 of 0.59 to 0.65. The submaximal regression model, originally developed and validated in a sample of persons without rheumatic disease, was significantly different in this sample of women with rheumatic disease. CONCLUSION: This single stage treadmill test, suitable for use in clinical and community settings, appears to be a reliable and valid method to safely assess aerobic capacity in women with rheumatic disease. There was a tendency for the submaximal method to overestimate aerobic capacity in this sample.

Adult↗

PubMed1996

Hemodynamic effects of aerobic vs resistance exercise.

Previous studies suggest that aerobic exercise lowers blood pressure (BP), while isometric exercise increases BP, at least transiently. The purpose of this study was to examine the hemodynamic effect of a 6-week training period of aerobic exercise or weight training. Twenty deconditioned healthy males ages 18-36, self-selected a training regimen. The aerobic group exercised 30 min/day, 4 times each week to achieve 60-80% maximal heart rate. The resistance group lifted weights at 65-80% maximal voluntary contraction; 3-4 sets of 8-12 repetitions; 3 day/week using large muscle groups. Hemodynamic measurements of heart rate, BP, venous capacitance, forearm blood flow, and vascular resistance were made at baseline and week 6 by plethysmography and analyzed by 2-way ANOVA. The groups showed no differences in baseline characteristics. A training effect was confirmed by a decrease in resting heart rate in the aerobic group (71.5 +/- 4.4 to 64.5 +/- 3.7, beats per minute, P = 0.004), and an increase in total work capacity in the weight lifting group (6231 vs 7508, P = 0.01). Forearm blood flow increased similarly in both groups, averaging 17% (3.5 +/- 0.2 vs 4.2 +/- 0.2 ml 100 g/min, P = 0.03), while forearm vascular resistance fell 19% (28.8 +/- 1.7 vs 24.3 +/- 1.7 mm Hg/ml/min 100 g, P = 0.08). The main differences between the groups after training was found in their response to isometric stress (1/3 maximal handgrip). The weight-lifting group had a greater increase of forearm blood flow and venous capacitance, less increase in systolic BP (SBP) and a greater fall of forearm vascular resistance, (P < 0.05) while the aerobic group had less increase in SBP and heart rate (P < 0.04) but no significant change of forearm hemodynamics. We conclude that both aerobic and repetitive weight programs have short term favorable effects on resting forearm BP and resistance. The exercise programs differ in altering the individual's physiologic response to subsequent isometric stress. However, exercise training of longer duration or greater intensity or frequency could alter these results.

Adult↗

PubMed1996

Use of the Pap test by a population group in Buenos Aires.

The study reported here sought to assess Pap test coverage of a group of asymptomatic Argentine women from the poor urban district of La Matanza in the Buenos Aires metropolitan area Initially, all 2495 women who voluntarily enrolled in a program for early detection of breast cancer between January 1991 and June 1993 were included. After removing those who did not meet various study criteria, there remained 779 study subjects with no gynecologic or mammary symptomatology. Two subgroups of these 779 were established-women who had received a Pap test at any time and those who had received such a test within the previous three years. Using these subgroups, the influence of certain sociodemographic and other variables upon the likelihood of Pap testing was assessed. The results indicated significant associations between past Pap testing and age, formal education, parity, and a family history of cancer Likewise, significant associations were found between Pap testing within the preceding three years and age, formal education, and parity. The study findings affirm the idea that it would be advisable to seek Pap testing for all study population women once every three years instead of every year. Since the study population was not necessarily representative of Buenos Aires population, however, and the findings could have been affected by self-selection and other biases, additional studies are needed to determine actual Pap test coverage among women of the metropolitan area.

Adult↗

PubMed1997

Step treadmill exercise training and blood pressure reduction in women with mild hypertension.

Stepping as an exercise modality has gained increasing popularity. The step treadmill is an exercise machine which simulates actual stair-climbing. The purpose of this study was to determine the effectiveness of a 16-week supervised aerobic step treadmill exercise training protocol in reducing resting blood pressure in women with unmedicated mild hypertension. During the training protocol, subjects exercised during a self-selected appointment three times a week on the step treadmill, increasing from 20 minutes up to 60 minutes per session, at a target heart rate corresponding to 70-80% heart rate reserve for 16 weeks. Utilizing paired t-test analysis, mean resting systolic blood pressure decreased from 142.2 +/- 9.1 to 132.7 +/- 8.2 mm Hg (p < .01) and mean resting diastolic blood pressure decreased from 93 +/- 4.9 to 87.4 +/- 5.4 mm Hg (p < .01) during the 16-week protocol. Mean maximal oxygen uptake was significantly increased, whereas mean body weight did not change significantly over the 16-week period. Large scale trials are needed to further delineate the effectiveness of stepping as a health care intervention in adults with unmedicated mild hypertension, especially in women.

Adult↗

PubMed1997

The effects of the ALSO course as an educational intervention for residents. Advanced Life Support in Obstetrics.

BACKGROUND AND OBJECTIVES: Previous descriptions of the Advanced Life Support in Obstetrics (ALSO) course have indicated increases in physician comfort in managing obstetric emergencies and in their intentions to continue offering maternity care after taking the course. No previous studies have been done about the educational outcomes of the ALSO course on family practice residents. This study compared residents' pre- and post-ALSO course confidence to manage obstetrical emergencies and their intention to provide maternity care when they enter practice. METHODS: A self-selected group of 55 family practice residents completed questionnaires before and after ALSO training. The questionnaire was designed to measure confidence, using Bandura's model of self efficacy, and future intention, using Ajzen's Theory of Planned Behavior. RESULTS: Residents' confidence in their abilities to manage obstetrical emergencies increased significantly after the ALSO course. Residents' intent to provide maternity care when the residents enter practice did not change. CONCLUSIONS: The ALSO course is a valuable teaching intervention that can improve family practice residents' perceived self-confidence in managing obstetric emergencies. The study had sufficient power to detect a moderate effect size of the ALSO course on resident intention to provide maternity care but did not do so.

Analysis of Variance↗