Keynote address at the Fifth Congress of the International Association for Adolescent Health.
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Adolescent↗
SEARCH · PubMed Health
Results for “Program Appropriateness”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Tobacco use, secondhand smoke exposure and their related knowledge, attitudes and behaviors among Asian Americans.
The present study examined tobacco use, secondhand smoke exposure and related knowledge, attitudes and behaviors among Asian Americans in the Delaware Valley of Pennsylvania and New Jersey, and the relationship between acculturation and smoking, social influence patterns on smoking, and stages of change of smoking among Asian subgroups. Study sample was 1174 Chinese, Koreans, Vietnamese, Cambodians, and other Asians. Findings revealed mean age of initiation to be 18.3, 40% ever and 30% current users. Significant differences were reflected in smoking by gender, ethnicity, educational level, marital and employment status. While knowledge and attitudes about smoking and secondhand smoke were associated with these variables, ethnic pride and smoking status played significant roles. Fathers and brothers had greater social influence on young male smoking behavior; smoking friends had influence on both genders. Stages of change of smoking and acculturation impact on smoking varied with gender, age, and time living in the U.S. Findings provide comprehensive insights into tobacco use and related KAB among Asian Americans that reflect the need for developing culturally appropriate programs for this underserved population.
Acculturation↗
Compliance with Universal/Standard Precautions among health care workers in rural north India.
BACKGROUND: Universal Precautions (UPs) and more recently Standard Precautions have been widely promoted in high-income countries to protect health care workers (HCWs) from occupational exposure to blood and the consequent risk of infection with bloodborne pathogens. In low-income countries, the situation is very different: UPs are often practiced partially, if at all, thereby exposing the HCWs to unnecessary risk of infection. The aim of this study is to describe rural north Indian HCWs knowledge and understanding of UPs and identify predictors of compliance to target intervention programs appropriately. METHODS: A cross-sectional survey was undertaken, involving 266 HCWs (response rate, 87%) from 7 rural north Indian health care settings. Information was gathered regarding compliance with UPs and a range of other relevant variables that potentially influence compliance (eg, demographic information, perception of risk, knowledge of bloodborne pathogen transmission, perception of safety climate, and barriers to safe practice). RESULTS: Knowledge and understanding of UPs were partial, and UPs compliance was suboptimal, eg, only 32% wore eye protection when indicated, and 40% recapped needles at least sometimes. After controlling for confounding, compliance with UPs was associated with being in the job for a longer period, knowledge of bloodborne pathogen transmission, perceiving fewer barriers to safe practice and a strong commitment to workplace safety climate. CONCLUSION: Interventions to improve UPs compliance among HCWs in rural north India need to address not only their knowledge and understanding but also the safety climate created by the organizations that employ them.
Adult↗
Effect of different land use on soil erosion in the pre-alpine fringe (North-East Italy): Ion budget and sediment yield.
Data concerning ion budget from rainfall, runoff and soil loss measurements from two experimental plots located in North-East Italy, under different land cover (beech forest and vineyard, respectively), are reported. The chemical composition of rainfall, soil solution and runoff was determined to study the solute cycle within the soil, and the relationships between water, soil and vegetation. The forest ecosystem is more prone to acidification than the agricultural one; the elemental concentration of runoff water is considerably lower than that of soil solution. Comparing the ion input (rainfall) and output (runoff) at the two sites, it was possible to estimate the ion budget in the two soil-vegetation systems. The runoff amount and the ion balance are related to rainfall volumes and composition; the measured runoff under vineyard is 59% in comparison to the one under beech. The soil loss at the two experimental sites (170 kg/ha and 132 kg/ha, respectively) is quite limited. The measured sediment yield of the two catchments (0.24-0.19 t/ha/year, respectively) is consistent with data reported for native forests of western Europe. Comparing rainfall and soil loss at the two sites proved that maintenance of some form of land cover is advisable if runoff and erosion are to be minimized. In the European context, where the most important consequences of erosion are sedimentation downstream and loss of productivity, this type of data will yield valuable information for the understanding of such processes occurring at catchment scale, and will help policy-makers develop appropriate programs for the territory safeguard.
Agriculture↗
Predictors of pre- and postoperative anxiety in emergency surgery patients.
OBJECTIVE: Emergency surgery is a highly stressful life event. Patients experience distressing anxiety both before and after surgery and this anxiety affects their recovery process. The aim of the present study is to examine variables related to pre- and postoperative anxiety in emergency surgery patients. METHODS: The sample consisted of 146 emergency surgery patients who had abdominal surgery in an emergency surgery clinic. The research instruments were administered before and after the surgery. State Anxiety Inventory (STAI-A State), Anxiety Specific to Surgery Questionnaire (ASSQ), a scale tapping fears and worries specific to surgery developed for the present study, Ways of Coping Inventory (WCI), and the Multidimensional Scale of Perceived Social Support (MSPSS) were administered. DATA ANALYSIS: Data were analyzed by using the appropriate programs of the Statistical Package for the Social Sciences (SPSS). RESULTS: There was a significant drop in anxiety from the pre- to the postoperative period. Female patients had higher preoperation anxiety than males. Females and males did not differ in anxiety at the postoperation period. Being female, waiting for primary suture for peptic ulcer perforation operation, and helplessness and self-blaming coping appeared as significant predictors of anxiety specific to surgery. Being female and awaiting for primary suture for peptic ulcer perforation were significant predictors of preoperative state anxiety. Finally, years of education were negatively and use of active coping was positively related to postoperative state anxiety. CONCLUSION: Patient sociodemographic and psychological characteristics and type of surgery need to be considered for identifying patients at risk of experiencing anxiety both before and after surgery and psychological support and clinical management needs to be tailored to the needs of the patients to alleviate their anxiety.
Adaptation, Psychological↗
WHO's blood-safety initiative: a vain effort?
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Blood Transfusion↗
Guinea pig husbandry and medicine.
Guinea pigs are hardy, gentle, virtually odor-free rodents. Their adverse, often lethal response to antibiotics requires an appropriate program of nutrition, husbandry, and handling, which are reviewed in this article. A summary of anatomical characteristics, basic biology, and reproductive data is provided. Diseases of practical clinical significance, primarily those of bacterial or nutritional origin, are also reviewed.
Animal Diseases↗
Meeting the goals of academia: characteristics of emergency medicine faculty academic work styles.
STUDY OBJECTIVES: Emergency medicine faculty have 24-hour clinical responsibilities in addition to the academic requirements of research and administration/teaching. This study was undertaken to determine the existing and ideal work style of such faculty by professional rank, administrative title, and/or tenure versus clinical track. DESIGN: Data analysis from department or residency directors of Accreditation Council for Graduate Medical Education-approved emergency medicine residency programs. SETTING: ACGME-approved emergency medicine residency programs. TYPE OF PARTICIPANTS: Emergency medicine faculty. RESULTS: Ninety-three percent of programs submitted appropriate data. Programs averaged 11 full- and four part-time faculty. Mean time ranged from 15 to 30 hours per week with an average mean of 23 hours (48% of total work week) for clinical responsibilities, from ten to 32 hours per week with an average mean of 19 hours per week (38%) for administrative/teaching efforts, and from three to 14 hours per week with an average mean of seven hours per week (15%) for research. Total time averaged between 44 and 51 hours per week. Ideal work style emphasized less clinical time and a shorter work week. Responsibilities varied by rank, administrative position, and clinical versus tenure track. CONCLUSION: Emergency medicine faculty accomplish the clinical, research, and teaching/administrative demands of academia by increasing the number of faculty, varying the faculty responsibilities by rank and title, and shortening the total work week. Research time is extremely limited.
Clinical Medicine↗
Diabetes mellitus and cancer.
Although an association between diabetes and cancer was found over 100 years ago, the issue underwent different interpretations over the subsequent decades, and only modern, prospective, epidemiological cohort and case-control studies conducted in several countries have provided reliable evidence of an increased cancer risk in diabetic patients, mainly in those with type 2 diabetes. This risk varies according to the tumor site: it is the greatest for primary liver cancer, moderately elevated for pancreatic cancer, and relatively low for colorectal, endometrial, breast, and renal cancers. The cause of the association is not clear and remains the subject of different hypotheses. The most frequently cited reason is the potential effect of insulin. Found in high concentrations, due to insulin resistance in most patients with type 2 diabetes, this hormone is believed to express a mitogenic effect. This hypothesis needs to be confirmed in appropriately programmed prospective studies, but it may already be helpful in choosing an adequate treatment for type 2 diabetes to achieve optimal metabolic control with a simultaneous reduction in hyperinsulinemia, such as diet, physical exercise, metformin, and acarbose.
Journal Article↗
Associations between lifestyle and cardiovascular risk factors in 18-year-old Australians.
PURPOSE: This study aimed to examine associations between cardiovascular risk factors and variables reflecting health-related behaviors in 18-year-old Australians. METHODS: Anthropometry, blood pressure, nonfasting serum cholesterol, and physical fitness were measured in 301 male and 286 female Australian 18-year-olds. Usual physical activity, smoking, and drinking habits were assessed by questionnaire. RESULTS: Systolic (SBP), with mean SBP higher by 14 mm Hg in males, related positively to weight for height for age and "unsafe" drinking (exceeding Australian national guidelines) and negatively to fitness and birth weight. Total cholesterol, which was positively associated with waist-hip ratio and negatively with fitness, was higher in females [mean 4.4 mmol/L, 95% confidence interval (CI) 4.3, 4.5] than in males (mean 4.1 mmol/L, 95% CI 4.0, 4.2). In 24% of males and 48% of females, usual levels of physical activity were low, consistent with lower scores on fitness tests in females. Thirty percent of males and 24% of females regularly drank at "unsafe," levels while 26% of males and 29% of females smoked. Smoking was associated with "unsafe" drinking. CONCLUSION: Cardiovascular risk factors in 18-year-olds are related to smoking, "unsafe" drinking, and physical inactivity, particularly in females. These behaviors should be targeted in designing multimodal health promotion programs appropriate for these young adults.
Adolescent↗
Women prisoners and HIV/AIDS.
In the last decade, both the number of female inmates and the average length of their sentences have increased dramatically. A by-product of the recent "confinement era" within criminal justice is the influx of ill and generally unhealthy female offenders into this nation's correctional institutions. As women in prison have different treatment needs and problems than their male counterparts, there is a need for gender-appropriate programs. The impact of such inmates on correctional health care services represents a potentially critical issue confronting correctional managers and correctional health service administrators. This article highlights the need for correctional policy to address the health care needs of women prisoners with HIV/AIDS.
Acquired Immunodeficiency Syndrome↗
Asthma: benchmarking for quality improvement.
BACKGROUND: Linked medical and pharmacy claims can be used to identify patients with asthma and benchmark current practice standards. METHOD: This was a 3-year study of five independent practice association style health maintenance organizations with an annual enrollment of 870,000. More than 28,000 members were identified with claims for asthma. OBJECTIVE: The intent of this study was to benchmark current asthma practice. Before quality improvement projects can be implemented baseline data are required. RESULTS: The prevalence of asthma varied by geographic regions. Specialty care was associated with greater use of anti-inflammatory medications and more refills of these drugs. Refill rates for inhaled corticosteroids for all patients was low. Specialty care of asthmatic members was associated with a lower rate of emergency service events and hospitalizations. CONCLUSIONS: Linked medical and pharmacy claims' databases can be used to benchmark current practice performance and serve as a reference for quality improvement programs. Appropriate use of specialty care may improve asthma outcomes.
Adolescent↗
Functional anticodon architecture of human tRNALys3 includes disruption of intraloop hydrogen bonding by the naturally occurring amino acid modification, t6A.
The structure of the human tRNA(Lys3) anticodon stem and loop domain (ASL(Lys3)) provides evidence of the physicochemical contributions of N6-threonylcarbamoyladenosine (t(6)A(37)) to tRNA(Lys3) functions. The t(6)A(37)-modified anticodon stem and loop domain of tRNA(Lys3)(UUU) (ASL(Lys3)(UUU)- t(6)A(37)) with a UUU anticodon is bound by the appropriately programmed ribosomes, but the unmodified ASL(Lys3)(UUU) is not [Yarian, C., Marszalek, M., Sochacka, E., Malkiewicz, A., Guenther, R., Miskiewicz, A., and Agris, P. F., Biochemistry 39, 13390-13395]. The structure, determined to an average rmsd of 1.57 +/- 0.33 A (relative to the mean structure) by NMR spectroscopy and restrained molecular dynamics, is the first reported of an RNA in which a naturally occurring hypermodified nucleoside was introduced by automated chemical synthesis. The ASL(Lys3)(UUU)-t(6)A(37) loop is significantly different than that of the unmodified ASL(Lys3)(UUU), although the five canonical base pairs of both ASL(Lys3)(UUU) stems are in the standard A-form of helical RNA. t(6)A(37), 3'-adjacent to the anticodon, adopts the form of a tricyclic nucleoside with an intraresidue H-bond and enhances base stacking on the 3'-side of the anticodon loop. Critically important to ribosome binding, incorporation of the modification negates formation of an intraloop U(33).A(37) base pair that is observed in the unmodified ASL(Lys3)(UUU). The anticodon wobble position U(34) nucleobase in ASL(Lys3)(UUU)-t(6)A(37) is significantly displaced from its position in the unmodified ASL and directed away from the codon-binding face of the loop resulting in only two anticodon bases for codon binding. This conformation is one explanation for ASL(Lys3)(UUU) tendency to prematurely terminate translation and -1 frame shift. At the pH 5.6 conditions of our structure determination, A(38) is protonated and positively charged in ASL(Lys3)(UUU)-t(6)A(37) and the unmodified ASL(Lys3)(UUU). The ionized carboxylic acid moiety of t(6)A(37) possibly neutralizes the positive charge of A(+)(38). The protonated A(+)(38) can base pair with C(32), but t(6)A(37) may weaken the interaction through steric interference. From these results, we conclude that ribosome binding cannot simply be an induced fit of the anticodon stem and loop, otherwise the unmodified ASL(Lys3)(UUU) would bind as well as ASL(Lys3)(UUU)-t(6)A(37). t(6)A(37) and other position 37 modifications produce the open, structured loop required for ribosomal binding.
Adenosine↗
cis-Dichloro(alpha,omega-diamino carboxylate ethyl ester)palladium(II) as Palladium(II) versus Platinum(II) Model Anticancer Drugs: Synthesis, Solution Equilibria of Their Aqua, Hydroxo, and/or Chloro Species, and in Vitro/in Vivo DNA-Binding Properties.
cis-Dichloro(d,l-2,3-diaminopropionate ethyl ester)palladium(II), cis-[Pd(Etdap)Cl(2)] (I), and cis-dichloro(d,l-2,4-diaminobutyrate ethyl ester)palladium(II), cis-[Pd(Etdab)Cl(2)] (II), were synthesized and characterized by elemental analysis, IR spectroscopy, and TG-DTA thermal analysis. The equilibrium model and log beta(pqr) constants of hydrolytic species of I and II were also investigated by potentiometric methods (I = 0.15 M (NaClO(4)) and 37 degrees C). Aqueous solutions of cis-[Pd(Etdaa)(H(2)O)(2)](ClO(4))(2) (Etdaa = Etdap (III) or Etdab (IV)) were prepared by stoichiometric reaction of I or II with AgClO(4). Thus, log beta(pqr) of the corresponding cis-aquahydroxo (pqr = 1,0,-1) and di(&mgr;-hydroxo) (pqr = 2,0,-2) species were obtained from E(H(+)) data of alkalimetric titrations of solutions of III or IV. Such constants were then used as fixed values to obtain log beta(pqr)() of chloro-containing species (cis-dichloro (1,2,0), cis-chloroaqua (1,1,0), and cis-chlorohydroxo (1,1,-1)) from E(H(+)) and E(Cl(-)) data pairs simultaneously obtained by titration of solutions of III or IV with NaOH and NaCl. All log beta(pqr) were fitted by the SUPERQUAD program. Appropriate log beta(pqr)() sets give good simulations of experimental titration curves and several species distribution diagrams. In addition the interaction of I and/or II with DNA in vitro and in vivo was studied by various methods. UV spectral data and melting and renaturation curves indicate that both compounds destabilize the DNA helicoidal structure. Compound II disrupts in vivo the structure and transcription process of polytene chromosomes of Drosophila hydei.
Journal Article↗
Multiple perspectives on nutrition education needs of low-income Hispanics.
As part of a multi-level nutrition intervention for low-income Hispanics (LIH) and the professionals and paraprofessionals who serve them, focus groups were used to 1) identify nutrition education needs and preferred means of receiving nutrition information, 2) identify the LIH's barriers/motivators to dietary behavior change, and 3) assess the feasibility of using abuelas (Hispanic grandmothers) as educators. Nine focus groups were conducted using trained, local bilingual and bicultural moderators. Low-income Hispanics' primary concerns were their children's nutritional habits and ways to prepare quick, nutritious meals and snacks. Their major barriers to dietary change were financial limitations, lack of time, and family customs/habits. Professionals were concerned with the lack of interagency cooperation. Paraprofessionals were most interested in training on how to teach. All audiences preferred to receive nutrition education through classes with hands-on, interactive formats. Professionals and paraprofessionals noted advantages and disadvantages to using abuelas as educators. Including three populations in the needs assessment allowed comparisons of perspectives across groups and allowed the design of nutrition education programs appropriately targeted to these populations.
Child↗
Selection bias in prenatal care use by Medicaid recipients.
OBJECTIVE: This study examines whether four types of selection bias in estimates of the effectiveness of prenatal care utilization for improving birthweight occur in a population of economically disadvantaged women. METHODS: We categorized adequacy of prenatal care use using the Adequacy of Prenatal Care Utilization Index (APNCU) and the Revised-GINDEX for 142,381 Medicaid recipients who gave birth to a live, singleton infant in Washington State (1994-1998). Multinomial logistic regression was used to model categories of adequacy of prenatal care use as functions of variables chosen to indicate high- or low-risk status. A series of linear regression models were estimated to quantify the magnitude and direction of any bias in the effects of prenatal care on birthweight that could be attributed to accounting for each risk covariate. Results were examined for patterns of risk, prenatal care use, and estimation bias equated with the four selection processes. RESULTS: We found modest evidence of adverse, favorable, confidence, and estrangement selection biases. The overriding effect, relative to low prenatal care use, was overestimation of the adequate care coefficient by 8.68 g with the APNCU, and underestimation by 3.36 g with the R-GINDEX because of competing confidence and estrangement selection biases. Relative to intensive use, the effect of adequate care on birthweight was underestimated (17.58 g with the APNCU; 13.34 g with the R-GINDEX) because of adverse selection bias and a small countervailing favorable selection process. CONCLUSIONS: The underestimation of birthweight associated with prenatal care noted in prior studies appears to result from multiple selection processes working in different directions. Understanding selection processes can help the assessment of the contribution of prenatal care to birth outcomes and development of appropriate programs and policies.
Adult↗
Outpatient total body irradiation as a component of a comprehensive outpatient transplant program.
Outpatient total body irradiation (TBI) as part of a comprehensive outpatient transplant program was delivered to 142 of 167 (85%) consecutive patients receiving TBI-based conditioning therapy. Outpatients received either a single fraction of 500 cGy (110 patients) or 1200 cGy in six fractions over 3 days (32 patients). Patients were assessed daily and were administered oral ondansetron and dexamethasone for prophylaxis of nausea and vomiting as well as i.v. hydration. Accommodation during outpatient TBI-based conditioning was either the patient's home if within 30 min of the hospital, a hotel on the hospital grounds or on a closed hospital ward. None of the 142 patients required admission to the inpatient program during their TBI. There was no difference in 100-day mortality between those receiving TBI as an outpatient (9%) vs as an inpatient (16%). Of four deaths occurring within the first 14 days post transplant, none could be attributed to receiving TBI as an outpatient. Two hundred and six inpatient days were saved through the delivery of outpatient TBI. A comprehensive outpatient program, appropriate patient selection, daily hydration, the use of prophylactic 5HT3 antagonist anti-emetic therapy all contribute to the safe delivery of outpatient TBI.
Adolescent↗
Analysis of the circumstances at the end of life in children with cancer: symptoms, suffering and acceptance.
BACKGROUND: In an effort to improve the quality of life of children with cancer, this study analyzes the signs and symptoms at the end of life in such children. It is hoped that these data will contribute to the development of appropriate programs to address the challenges faced by these children. PROCEDURE: Between 1994 and 2000, 28 children died after treatment for cancer at Hamamatsu University Hospital, Japan. The circumstances, signs and symptoms at the end of life of these children were analyzed through their medical records. RESULTS: Of the 28 children, the underlying diseases were leukemia/lymphoma (LL group; n=11), brain tumors (BT group; n=7), and other solid tumors (OST group; n=10). Records showed poor appetite (100%), dyspnea (82.1%), pain (75.0%), fatigue (71.4%), nausea/vomiting (57.1%), constipation (46.4%) and diarrhea (21.4%) among these children. Anxiety was reported in 53.6% of the entire group of 28 children; however, no child in the BT group manifested anxiety. However, disturbance of consciousness was reported in all children in the BT group, which was significantly greater than in the other groups. Awareness, fear or acceptance of the imminence of his/her own death as indicated by verbal expression was reported in nine children (32.1%). CONCLUSIONS: Using the data obtained in the present study, we describe situations faced in the terminal care of children. It is important to address the problems revealed by this analysis in order to achieve improvements in both the physical and psychological care of children with terminal cancer.
Adolescent↗