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Rehabilitation and biomechanics.

In the area of rehabilitation and biomechanics, several articles divided into five categories, including therapeutic heat, foot and ankle orthotics, exercise in elderly arthritis patients, muscle strengthening in rheumatoid arthritis, and arthroplasty and immobilization are reviewed. Superficial heat was demonstrated to increase intra-articular temperature, and therefore, may be detrimental. On the other hand, local deep microwave hyperthermia appears to have potential therapeutic benefits. The role and effectiveness of foot orthotic devices are reviewed. The problem and treatment of forefoot varus is emphasized. A new technique of measuring subpedal pressure in the shoe is presented, demonstrating reduced foot pressures by certain types of footwear. Rheumatoid arthritis and osteoarthritis wee present in 23% of a nursing home population, but were a substantial factor for placement in only 15%. However, this group had higher pain scores, depended more on wheelchair use, and was more likely to have significant functional limitations. Exciting new data on strengthening the quadriceps in the frail elderly, whose mean age was 90.2 years, are reviewed. The relationship of quadriceps muscle strength and maximum voluntary strength as a function of age and gender and the effects of an endurance training program in 15 physically compromised nursing home residents is discussed. A static and a dynamic training program for rheumatoid arthritis patients were compared. The dynamic group significantly increased muscle strength, endurance, and aerobic capacity as compared to the static group, without any increase in disease activity. The results further showed that a home program was beneficial. Interesting data presented show that using a Cybex isokinetic dynamometer (Lumex, Bayshore, NY) test was reliable for normal control and for rheumatoid arthritis patients who were stronger.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical Phenomena

SQUID: a program for the analysis and display of data from crystallography and molecular dynamics.

SQUID is a flexible computer program that allows the analysis and display of molecular coordinates from crystallography, NMR, and molecular dynamics. The program can also display two-dimensional and three-dimensional data using many graph types, as well as perform array processing of data with numerous intrinsic functions. Graphics are based on the use of "move" and "draw" instructions, allowing easy development of new device drivers, including vector plotters.

Computer Graphics

Program evaluation. Part 1: Four generations of theory.

Program evaluation is necessary for understanding and improving educational programs in nursing, but it is frequently surrounded by a climate of unease and perplexity. This first article in a two-part series reviews and evaluates extant models of program evaluation using Guba and Lincoln's four generations of evaluation as a theoretical framework. The second article (November/December 1990) examines the state-of-the-art of program evaluation in nursing education and proposes implementation of a responsive model of program evaluation in schools of nursing. The series aims to foster more dynamic, efficient program analysis, thereby enhancing the effectiveness of nursing's educational programs.

Humans

Changing men's attitudes and behavior: the Zimbabwe Male Motivation Project.

A multimedia communication campaign was conducted between 1988 and 1989 to promote family planning among men in Zimbabwe. The campaign consisted of a 52-episode semiweekly radio soap opera, about 60 motivational talks, and two pamphlets about contraceptive methods. Changes over time were measured by comparing a subset of a follow-up survey conducted from October to December 1989 to a baseline survey conducted from April to June 1988. Men exposed to the campaign were also compared to men who were not exposed. The follow-up survey revealed that the campaign reached 52 percent of men aged 18 to 55. Among married Shona-speaking men, use of modern contraceptive methods increased from about 56 percent to 59 percent during the campaign. Condom use increased from about 5 percent to 10 percent. Awareness and current use of modern contraceptives was also higher among men exposed to the campaign, primarily because of their greater awareness of condoms. Men exposed to the campaign were significantly more likely than other men to make the decision to use family planning and to say that both spouses should decide how many children to have.

Adolescent

Contraceptive use and fertility decline in Chogoria, Kenya.

This article describes the results pertaining to fertility and family planning from a 1985 survey conducted in the catchment area of Chogoria Hospital in central Kenya. Current contraceptive prevalence was found to be quite high, 43 percent as opposed to 17 percent for Kenya as a whole. The total fertility rate of 5.2 births per woman was 2.5 births lower than the national rate. Very few women reported wanting to have large numbers of children or thinking that fate or God should determine family size. Although these data cannot conclusively demonstrate that the family planning program operating in the area has been responsible for reduced fertility there, they do provide some support for this hypothesis.

Adolescent

[Endemic situation of leprosy in the municipality of Rondonopolis-Mato Grosso].

Here we show a report about the incidence of leprosy in Rondonópolis, State of Mato Grosso in Brazil. We direct attention to the fact that the contemporary index of prevalence in Brazil doesn't correspond to our reality when one makes a program of dynamic research of new cases and clearances to the population, medical staff and co-workers, through lectures and programs on radio and television, besides articles in local papers.

Brazil

The impact of service delivery frequency on family planning program output and efficiency.

Operations research is the study of factors that can be controlled by program administrators. Among such factors is the frequency of performing program activities. The present experiment, conducted in Lima, Peru during 1985-86, tested the impact of holding family planning post sessions once per month, twice per month, and weekly. Frequency was shown to have a major impact on program outputs, costs, and cost-effectiveness. Depending on the indicator, sessions held twice per month produced between 1.5 and 2.1 times the output of those conducted once per month. Weekly sessions produced between 1.3 and 1.6 times the output of those held twice per month. At an output level of nearly 11,200 visits per year, twice-per-month sessions were estimated to be 7-38 percent more cost-effective, depending on the indicator, than once-per-month sessions, and 6-28 percent more cost-effective than weekly sessions.

Community Health Services

Localization of small renal tumor by dynamic computerized tomography.

Herein we report on 4 cases of renal tumor whose diameter was less than 3 cm. A mass lesion was suggested by renal echography in mass screening program. Renal dynamic computerized tomography (CT) with bolus injection can delineate a mass lesion clearer than ordinary plain and enhanced CT, and renal angiography. In renal dynamic CT, tumor lesion is well depicted because of the difference between the time density curve in the tumor lesion and that in the surrounding renal parenchyma. Renal dynamic CT is considered to be an especially versatile modality to diagnose small tumors which are hardly delineated by ordinary enhanced CT.

Aged

The establishment of a centralised referral service leads to earlier abortion.

In 1988 a centralised referral service for termination of pregnancy was established in Edinburgh. This has led to a significant reduction in the time women who have requested termination wait to see a gynaecologist (mean 4.7 days) and in the time it takes before suction termination of pregnancy is undertaken (total wait 10.2 days). In 1988 only 40% of induced abortions in Edinburgh were carried out at 9 weeks gestation or before while in 1989 that figure had risen to 60%. In 1989 less than 10% of pregnancies were terminated at or after 12 weeks gestation, compared with 21% in 1988. Reasons for delays in obtaining an abortion are multifactorial but rapid referral once a woman has made the decision to seek help will be essential if she is to avail herself of the advantages of medical termination--only available until eight weeks of pregnancy.

Abortion, Legal

Mortality pattern in the Emergency Paediatric Unit of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.

Three hundred and seven (307) deaths were recorded out of 3,155 admissions into the Emergency Paediatric Unit of Ahmadu Bello University Teaching Hospital Zaria between January 1st and December 31st 1986, giving a percentage mortality of 9.9 percent. 67 percent of the patients who died were aged between one month and twenty four months, and the overall male: female ratio of deaths was 1:1.04. Measles with complications was the commonest cause of death (24.1 percent) closely followed by protein energy malnutrition (23 percent) and respiratory tract infection (18 percent). Over half of the patients (57.6 percent) died less than 24 hours after admission. As most deaths resulted from preventable conditions, the implications of this finding, and suggestions on how to improve the situation are discussed.

Cause of Death

Program evaluation. Part 2: A responsive model proposal.

While program evaluation is necessary for understanding and improving educational programs in nursing, it is frequently surrounded by a climate of unease and perplexity. The first article (September/October 1990) in this two-part series reviewed models of program evaluation. This second article examines the state-of-the-art of program evaluation in nursing education and proposes implementation of a responsive model of evaluation in schools of nursing. The series aims to foster more dynamic, efficient program analysis, thereby enhancing the effectiveness of nursing education programs.

Education, Nursing

Fertility reduction and the quality of family planning services.

The purpose of this paper is to determine whether a focus on quality of family planning services is consistent with meeting demographic objectives. An analytical framework that links the six elements of quality with fertility is described. A review of existing literature and analysis suggest that improvements in quality of family planning services by enhancing the choice of contraceptive methods available in a country would increase the overall practice of contraception and thus would result in fertility reduction.

Contraception

Sex education and family planning services for young adults: alternative urban strategies in Mexico.

In Mexico, youth face difficulties in obtaining reliable information on sex education and family planning through existing community programs. Two alternative strategies to provide these services are being tested in poor urban areas of Monterrey. In one experimental area, Integrated Youth Centers were established, which provide sex education and family planning services as well as counseling, academic tutoring, and recreational activities. In another area, trained young adults and community counselors work through informal networks to provide sex education and family planning information. Both utilization and the cost of these services are examined in the context of plans for expanding coverage in Mexico-U.S. border areas.

Adolescent

Family planning services in the United States.

In recent years the United States has made considerable progress in providing family planning services for those in need. This does not mean, however, that the problems posed by unwanted pregnancies and unwanted births have been completely overcome. Estimates of the number of low-income women needing and receiving family planning services indicate that roughly 3.6 million women at risk of an unwanted pregnancy were receiving family planning services in 1973. This represented almost two-thirds of those in need at the time. Many programs are also seeking to meet the teenage need demonstrated by very high rates of out-of-wedlock births, premarital conceptions, obstetric problems, and legal abortion demands of women 15 to 19 years of age. As of 1973, it appeared that between 1.3 and 2.2 million never-married teenagers were in need of organized family planning services, and that of these, services were being received by between 25 and 42 per cent.

Abortion, Legal