The costs and effects of a nutritional education program following work-site cholesterol screening

OBJECTIVES

The purpose of this study was to assess the costs and impact of a nutrition education program following a cholesterol screening.

METHODS

Forty work-sites were randomly assigned to one of two educational interventions: a "usual" intervention of 5 minutes of counseling, or a "special" intervention of 2 hours of behaviorally based education on dietary changes to lower serum cholesterol. Costs were monitored, and cholesterol levels were retested 6 and 12 months later.

RESULTS

The total per-person cost for screening and the educational intervention was about $50. Cholesterol levels differed little between the two intervention groups 6 months after screening, but after 12 months those in the special intervention worksites showed a 6.5% drop in cholesterol, whereas those at the usual intervention worksites showed a drop of only 3.0%. Hence a 3.5% cholesterol reduction was attributable to the special intervention.

CONCLUSIONS

A behaviorally based nutrition education program following cholesterol screening can have a meaningful impact on long-term cholesterol levels at a low cost. Nutrition education in work-sites may therefore be a useful way to lower the risk of heart disease in communities.

Geriatric education centers address medication issues affecting older adults

Serious problems have been identified in the prescribing of medications for elderly patients and use of prescription and nonprescription drugs by older persons. Overuse, underuse, and inappropriate use of drugs by the elderly have been widely documented, and the harmful consequences have been described. This paper reviews information concerning the need for action to improve health professionals' knowledge and skills with respect to drugs and the elderly and activities being undertaken by geriatric education centers (GECs) to enhance these capacities. Grant support for the centers from the Health Resources and Services Administration, a Public Health Service component agency, began in 1983. In fiscal year 1992 there are 31 centers operating in 26 States. The centers are multi-institutional and conduct four types of educational activities. These include review of pharmacological issues for multidisciplinary groups, specialized training for pharmacists, discipline-specific programs focusing on medication issues, and activities aimed at educating the public. Examples of the GECs' educational activities are given.

Tracheoesophageal speech: with and without tracheostoma valve

The tracheostoma valve, developed by Blom and Singer combines the advantages of pulmonary air for phonation with hands-free speech. Patients have anecdotally reported "more normal speech" with the use of the valve. This study was designed to objectively determine if speech acoustic and temporal measures existed between tracheoesophageal puncture using the valve, and those without the valve prosthesis, during speech production among the same subjects. The speech samples of nine male laryngectomees were recorded with and without the valve. Six speech acoustic and temporal measures were calculated and compared under both speaking conditions. No statistically significant differences were found between the two speaking conditions for the six tasks measured. However, other advantages and disadvantages were observed and reported under the valve condition.

Bopindolol for the treatment of chronic stable angina pectoris--a clinical study of the relationship between dose and effect

Following a 4-week placebo period, 19 patients (12 male, average age 62.3 years) with chronic stable angina pectoris and a positive exercise test were treated with the beta-adrenoceptor antagonists bopindolol at increasing doses of 0.5, 1 and 2 mg, each being given once daily for 4 weeks. For the final 4 weeks of the study, active treatment was replaced by placebo. Maximum tolerated exercise (bicycle ergometry, performed 24 h after drug administration) increased dose-dependently from 519 +/- 59 s (baseline) to 758 +/- 95 s with 2 mg (p less than 0.001) and fell again to 508 +/- 48 s (placebo). The frequency of anginal attacks also fell dose-dependently from an average of 5.4 per week (baseline) to 0.5 with 2 mg (p less than 0.001) and rose again to 5.1 per week when active treatment was stopped.

National standards for diabetes patient education programs: pilot study results and implementation plan. A report by the National Standards Steering Committee of the National Diabetes Advisory Board

National Standards for Diabetes Patient Education Programs and a plan to implement them have been developed and pilot tested by the diabetes community in a four-year process conducted under the auspices of the Na tional Diabetes Advisory Board. The pilot study demonstrated the feasibil ity of implementing a na tional quality assurance process for diabetes pa tient education programs. Evidence from the pilot study also suggested that a national quality assur ance plan will foster third-party reimbursement for ambulatory diabetes patient education. The National Coalition for Recognition has been established to conduct for mal review and recogni tion of programs seeking to meet the National Standards.

Microdissection demonstration of the lesion of the endocrine kidney in children

Microdissection of nephrons of kidneys of children showing advanced ischemic tubular atrophy, and removed for control of hypertension, demonstrates marked proximal convoluted tubular atrophy, with formation of multiple small proximal tubular diverticula. These diverticula presumably contribute to the microscopic appearance of large numbers of small tubules lined by low epithelial cells with pale or clear cytoplasm, adjacent to glomeruli in the cortices of kidneys showing ischemic tubular atrophy (endocrine kidney). Segmentation of such atrophic tubules leads to formation of blind segments (microcysts), as demonstrated in this study and by Oliver. The distinctive microscopic appearance of the endocrine kidney, a not infrequent finding in kidneys of children with chronic renal insufficiency who require nephrectomy for control of hypertension, has not hitherto been emphasized in the literature on pediatric renal disease.

Location of the vibratory segment in tracheoesophageal speakers

The Singer-Blom tracheoesophageal puncture procedure for surgical-prosthetic voice restoration has proved to be a viable option for alaryngeal speech rehabilitation. Following tracheoesophageal puncture, occlusion of the tracheostoma shunts pulmonary air through the Blom-Singer prosthesis into the cervical esophagus. The pulmonary air passing through the cervical esophagus and into the hypopharynx causes a portion of the upper alimentary tract to vibrate in a manner similar to that of the pharyngoesophageal segment during the production of esophageal speech. To study the location and shape of the vibratory segment in tracheoesophageal speakers, videofluoroscopy and simultaneous voice recording were performed with 16 patients. To analyze the vibratory segment(s), photographs were made of the videotaped image while it was stopped during the patients' production of the /a/ sound. The most frequent location of the vibratory segment was in the lower third of the neck, which corresponds to cervical vertebrae C5 through C7. Five of the subjects had two separate vibratory segments and two other subjects had long vibratory segments. The vibratory segment(s) in tracheoesophageal speakers was found to be similar to the vibratory segment(s) in esophageal speakers.

Long-term results of the Blom-Singer speech rehabilitation procedure

We report a 64% long-term success rate in our series of 66 patients who have undergone the tracheoesophageal puncture (TEP) procedure with follow-up ranging from one to 3 1/2 years. Poor motivation and compliance were the most common factors noted in patients who failed to obtain or maintain tracheoesophageal speech. Other problems causing failure were technical problems relating to the TEP and medical problems. The success rate in the last 24 cases of our series has improved to 83%. The "collared" prosthesis, more careful patient selection, and emphasis on a team approach seem to be important factors for the higher success rate. The Blom-Singer TEP procedure is a safe, simple, and effective means of alaryngeal communication for selected patients.

Modulation of synapse formation by cyclic adenosine monophosphate

Synapses between neuroblastoma-hybrid cells and myotubes exhibit a high degree of plasticity. Increase of cyclic adenosine monophosphate (AMP) levels of the hybrid cells for several days results in the appearance of functional voltage-sensitive Ca2+ channels, which are required for evoked secretion of acetylcholine. The results show that cyclic AMP regulates synaptogenesis by regulating the expression of voltage-sensitive Ca2+ channels, and suggest that cyclic AMP affects posttranslational modifications of some glycoproteins and cellular levels of certain proteins.

The Singer-Blom speech rehabilitation procedure

Singer and Blom have recently reported a new surgical method for speech rehabilitation of the alaryngeal patient. The method consists of a tracheoesophageal, puncture (TEP) followed 2 to 3 days later by insertion of a silicone "duckbill" prosthesis which acts as a one-way valve allowing pulmonary air to enter and vibrate the esophagus but preventing aspiration. Along with more rapid acquisition of speech, the advantage of tracheoesophageal speech over esophageal speech is the greater volume of air flow through the vibrating segment of the esophagus, which allows smoother and more prolonged speech. Thirteen of our 18 patients (72%) who have undergone TEP are currently using tracheoesophageal speech. The complications associated with this procedure include the TEP tract closing, tracheal mucositis, stenosis of the tracheostoma, aspiration of the prosthesis, esophageal tear, and aspiration from the esophagus. Although we have encountered several problems, we enthusiastically endorse this procedure since it provides oral communication which is comparable to, and in many cases better than, that of the majority of esophageal speakers.

Sampling of speech pathology treatment activities: an evaluation of momentary and interval sampling procedures

Videotaped samples of aphasia treatment sessions were coded, using the Clinical Interaction Analysis System (CIAS), a 39-category system for recording the events that occur in clinician-patient interactions during aphasia treatment sessions. These coded records were then sampled according to various schedules and procedures and the fidelity with which each sampling schedule and procedure represented the content of the entire treatment record was evaluated. In addition, trained observers coded videotaped samples of treatment, using the CIAS with a number of sampling schedules and procedures. The fidelity with which these observers' records represented the content of the treatment sessions sampled was then evaluated. The results of the analysis indicated that momentary sampling at intervals distributed throughout the session generates more accurate records of session content than single longer samples taken from the session, unless those single samples comprise a major part of the session, and that sampling representativeness remains high even when only one event in ten is sampled, if sampled events are uniformly distributed throughout the session.