The effect of changes in the health care environment on rehabilitation research: a survey of rehabilitation physicians.

OBJECTIVE: To assess what effect organizational, funding, and system changes in the health care environment may have on rehabilitation research. DESIGN: National survey. SETTING: Academic and clinical research programs. PARTICIPANTS: A total of 138 physicians participated in the survey. INTERVENTION: Mailed instrument requesting information on demographics, research activities, and indicators of change. MAIN OUTCOME MEASURES: Percentage of respondents reporting specific perceptions on (1) how academic and research programs are affected by organizational changes, (2) availability of research funds, and (3) the overall impact that health care changes have on research; between-group comparisons on survey responses. RESULTS: Usable responses were obtained from 138 physicians (response rate, 42.5%). Responding physicians reported workplace changes that included organizational restructuring (32.6%), affiliation with managed care plans (24%), and staff decreases (45.9%). Over half (54.8%) indicated that facility changes had detracted from their abilities to conduct research. A third (34.8%) reported declines in numbers of inpatient beds, and 89.6% reported decreased length of stay (LOS). Decreased LOS was cited as detracting from ongoing research by 36.6% and as discouraging new research by 33.3% of respondents. Although not reflected in measures of scholarly productivity, 53.6% reported having less time to devote to scholarship and 48.5% reported decreased professional activities. Over two thirds (67.4%) of responding physicians indicated that health care system changes had a negative impact on current research, and 54.5% indicated that such changes made it less likely that they would pursue new research. CONCLUSION: Changes in the health care system have had a dampening effect on rehabilitation physicians' research pursuits.

Trichophytic incisional approaches to upper facial rejuvenation.

OBJECTIVE: To analyze the efficacy of frontal and peritemporal trichophytic incisions in upper facial rejuvenation. METHODS: Retrospective study evaluating data from 99 consecutive patients who underwent upper facial rejuvenation. RESULTS: Central forehead-lift was performed in 65% (57/88) of the women but in only 1 man (9%), with coronal and frontal trichophytic hairline approaches used in 28% (16/58) and 72% (42/58) of patients, respectively. Lateral brow-lift and lateral periorbital rejuvenation were performed in all the patients, with the peritemporal trichophytic approach used in 43% (38/88) of female patients. Frontal trichophytic and peritemporal trichophytic incisions were commonly used in both revision and primary procedures; nearly all patients with elevation of the frontal hairline or temporal tuft underwent trichophytic incisional approaches. Depending on the anatomical deformities present preoperatively, patients were categorized into 1 of 6 treatment groups; trichophytic incisional approaches were used successfully in 4 of the 6 groups. CONCLUSIONS: Frontal and/or peritemporal trichophytic incisions are upper facial rejuvenation surgery and should be offered as an option. Since they avoid anterior hairline elevation and maintain preoperative temporal tuft position, trichophytic incisions are especially valuable in revision procedures in which the hairline has previously been elevated to or beyond an acceptable anatomical position.

The effect of changes in the U.S. health care system on rehabilitation research: the results of a survey of rehabilitation health professionals.

To obtain empirical data on the impact of changes in the health care system on rehabilitation research, physicians, psychologists, nurses, physical therapists, and occupational therapists involved in such research were surveyed to determine: 1) how the changes had affected their research productivity; 2) whether their scholarly activities (e.g., publications) had been affected; and 3) whether working in an academic vs non-academic institution made a difference. There were 438 usable responses (38% response rate) to the survey, which was sent to members of national organizations. Although the results somewhat supported suggestions that changes in the system had had a dampening effect on research, they were ambiguous, failing to clearly demonstrate a negative impact of managed care. More rigorous study is needed to enable firm conclusions and the formulation of actions to address factors that may influence rehabilitation research.

Nontraumatic atlantoaxial rotary subluxation in the pediatric otolaryngology patient. A report of four cases.

Nontraumatic atlantoaxial rotary subluxation (NAARS) is a relatively uncommon entity, with inconsistent presentations. It most commonly follows infectious processes or operative procedures. We present our experience with 4 pediatric otolaryngology patients with NAARS who were treated at the University of Iowa Hospitals and Clinics during a 2-year period beginning in 1997. A review of the symptoms, physical findings, and radiographic abnormalities is presented. Treatment options, varying from muscle relaxants to surgical fusion, are discussed. A high index of suspicion in evaluating children with a stiff neck or pain on attempted motion is essential in order to facilitate prompt diagnosis and appropriate intervention.

The multicultural sensitivity of physician assistant students.

Using a specially designed instrument, the authors examined physician assistant students' multicultural sensitivity at four points before, during, and after the 30 months of a master's degree program. The students (n = 19) were found to have become more multiculturally sensitive by the end of the program, even in the absence of specific relevant instruction. The greatest improvement followed the end of clerkship rotations, where the students had experiences with low-income patients of other racial/ethnic backgrounds. The authors suggest that increasing such experiences during training may enhance students' multicultural sensitivity.

Tailored, interactive soap operas for breast cancer education of high-risk Hispanic women.

BACKGROUND: While Hispanic women have lower rates of breast cancer than do women of other ethnic groups, they are the least likely to undergo screening examinations. This study evaluated a culturally sensitive and linguistically appropriate, tailored, computer-based, educational program for early detection of breast cancer aimed at high-risk Hispanic women. METHODS: Spanish-speaking Hispanic women from an inner-city community health clinic were recruited and randomly assigned either to a computer intervention with an interactive soap-opera format (n = 118) or to a comparison group (n = 60). Pre- and posttests were used to identify any change in breast-cancer-related knowledge and beliefs. RESULTS: Both younger (18-40 years old) and older (41-65 years old) women in the intervention group demonstrated significant increases in their breast cancer screening knowledge and beliefs as compared with the younger and older women in the comparison group (n < 0.05). CONCLUSIONS: Computer-based tailored and interactive soap operas that are linguistically and culturally appropriate are effective in increasing breast cancer screening knowledge and beliefs among underserved Spanish-speaking Hispanic women.

Evaluation of Jump Into Action: a program to reduce the risk of non-insulin dependent diabetes mellitus in school children on the Texas-Mexico border.

Jump Into Action, a school-based non-insulin dependent diabetes mellitus (NIDDM) prevention program, encourages students to eat low-fat foods and exercise regularly to reduce their risks for developing NIDDM. A study was conducted in a school district with a predominately Hispanic enrollment to assess the effectiveness of Jump Into Action in improving fifth-graders' knowledge, self-efficacy, and behaviors regarding NIDDM prevention. Jump Into Action was found effective in increasing knowledge and self-efficacy regarding NIDDM prevention and improving dietary and exercise-related behaviors. These gains were sustained from posttest to follow-up four weeks later.

Training school counselors in substance abuse risk reduction techniques for use with children and adolescents.

A training project prepared school counselors for expanded roles in the prevention, early detection, and appropriate referral of students at high risk of substance abuse. The project trained middle and high school counselors to work as facilitators of support groups for students at greatest risk for substance abuse; the results were: 1) greater perceived self-efficacy, comfort, confidence, and competence by counselors as a result of Initial, Experiential, and Concurrent training, and 2) improved ability to use group counseling techniques as a result of training.

Effects of modulation of NMDA neurotransmission on response rate and duration in a conflict procedure in rats.

N-Methyl-D-aspartate (NMDA) antagonists and gamma-aminobutyric acid agonists share a number of common pharmacological properties, including motor and anticonvulsant effects. In the present study, site-selective NMDA antagonists were evaluated for potential anxiolytic efficacy and motor impairment in a modified Geller-Seifter conflict procedure, an animal model widely used to screen drugs for anxiolytic effects. Male Sprague-Dawley rats were trained to respond for food reward under a multiple FI 30 s (food only), FR 10 (food + shock) operant schedule. Consistent with the results of previous studies, the benzodiazepines chlordiazepoxide and diazepam selectively increased punished responding and increased response durations at higher doses. The competitive NMDA antagonist CGP 37,849 increased punished responding at some doses, though not selectively, and also increased response duration in both schedule components. The glycine-site modulators milacemide, ACEA 1011 and ACEA 1021, the NR2B-selective polyamine site antagonist eliprodil and NMDA did not produce anticonflict effects at any dose and had inconsistent effects on response durations. These results suggest that the anticonflict effects of NMDA antagonists are not as reliable as those of the benzodiazepines. Further research is needed to clarify the experimental conditions under which the anxiolytic potential of NMDA antagonists is most evident.

Neurogenesis and cell death in olfactory epithelium.

The olfactory epithelium (OE) of the mammal is uniquely suited as a model system for studying how neurogenesis and cell death interact to regulate neuron number during development and regeneration. To identify factors regulating neurogenesis and neuronal death in the OE, and to determine the mechanisms by which these factors act, investigators studied OE using two major experimental paradigms: tissue culture of OE; and ablation of the olfactory bulb or severing the olfactory nerve in adult animals, procedures that induce cell death and a subsequent surge of neurogenesis in the OE in vivo. These studies characterized the cellular stages in the olfactory receptor neuron (ORN) lineage, leading to the realization that at least three distinct stages of proliferating neuronal precursor cells are employed in generating ORNs. The identification of a number of factors that act to regulate proliferation and survival of ORNs and their precursors suggests that these multiple developmental stages may serve as control points at which cell number is regulated by extrinsic factors. In vivo surgical studies, which have shown that all cell types in the neuronal lineage of the OE undergo apoptotic cell death, support this idea. These studies, and the possible coregulation of neuronal birth and apoptosis in the OE, are discussed.

Factors affecting neuronal birth and death in the mammalian olfactory epithelium.

To identify factors regulating neurogenesis and neuronal death in mammals and to determine the mechanisms by which these factors act, we have studied mouse olfactory epithelium using two different experimental paradigms: tissue culture of olfactory epithelium purified from mouse embryos; and ablation of the olfactory bulb in adult mice, a procedure that induces olfactory receptor neuron (ORN) death and neurogenesis in vivo. Studies of olfactory epithelium cultures have allowed us to characterize the cellular stages in olfactory neurogenesis and to identify factors regulating proliferation and differentiation of precursor cells in the ORN lineage. Studies of adult olfactory epithelium have enabled us to determine that all cell types in this lineage-proliferating neuronal precursors, immature ORNs and mature ORNs-undergo cell death following olfactory bulb ablation and that this death has characteristics of programmed cell death or apoptosis. In vitro studies have confirmed that neuronal cells of the olfactory epithelium undergo apoptotic death and have permitted identification of several polypeptide growth factors that promote survival of a fraction of ORNs. Using this information, we have begun to explore whether these factors, as well as genes known to play crucial roles in cell death in other systems, function to regulate apoptosis and neuronal regeneration in the adult olfactory epithelium following lesion-induced ORN death.

Apoptosis in the neuronal lineage of the mouse olfactory epithelium: regulation in vivo and in vitro.

The olfactory epithelium (OE) of the mouse provides a unique system for understanding how cell birth and cell death interact to regulate neuron number during development and regeneration. We have examined cell death in the OE in normal adult mice; in adult mice subjected to unilateral olfactory bulbectomy (surgical removal of one olfactory bulb, the synaptic target of olfactory receptor neurons (ORNs) of the OE); and in primary cell cultures derived from embryonic mouse OE. In vivo, cells at all stages in the neuronal lineage--proliferating neuronal precursors, immature ORNs, and mature ORNs--displayed signs of apoptotic cell death; nonneuronal cells did not. Bulbectomy dramatically increased the number of apoptotic cells in the OE on the bulbectomized side. Shortly following bulbectomy, increased cell death involved neuronal cells of all stages. Later, cell death remained persistently elevated, but this was due to increased apoptosis by mature ORNs alone. In vitro, apoptotic death of both ORNs and their precursors could be inhibited by agents that prevent apoptosis in other cells: aurintricarboxylic acid (ATA), a membrane-permeant anlog of cyclic AMP (CPT-cAMP), and certain members of the neurotrophin family of growth factors (brain-derived neurotrophic factor, neurotrophin 3, and neurotrophin 5), although no neurotrophin was as effective at promoting survival as ATA or CPT-cAMP. Consistent with observed effects of neurotrophins, immunohistochemistry localized the neurotrophin receptors trkB and trkC to fractions of ORNs scattered throughout neonatal OE. These results suggest that apoptosis may regulate neuronal number in the OE at multiple stages in the neuronal lineage and that multiple factors-potentially including certain neurotrophins--may be involved in this process.

Dynamics of MASH1 expression in vitro and in vivo suggest a non-stem cell site of MASH1 action in the olfactory receptor neuron lineage.

Disruption of the mouse gene encoding the transcription factor MASH1 leads to loss of certain classes of neurons, including receptor neurons of the olfactory epithelium (OE). Here we investigate the nature of the cell type expressing MASH1 in mouse OE by manipulating olfactory receptor neuron (ORN) neurogenesis in vitro and in vivo to alter the dynamics of neuronal production. The results indicate that MASH1 is expressed in cells of the ORN lineage, but not in ORNs themselves nor in their immediate precursors. Data on how changes in the numbers and proliferative states of MASH+ cells correlate with induced changes in overall neurogenesis strongly suggest that MASH1-expressing cells give rise to the immediate precursors of ORNs, but are not the self-renewing stem cells of the OE. The results imply that multiple progenitor stages are employed in generating ORNs and suggest that the action of MASH1 occurs predominantly at an intermediate stage.

Teacher ratings of student risk for substance use as a function of specialized training.

The purpose of this study was to determine if teachers' abilities to identify accurately students who are at risk for substance abuse can be improved through attendance at a specialized training program. Sixty-three eighth-grade teachers participated in the study. Of these, thirty-six teachers participated in the training sequence (intervention group), while the remaining twenty-seven teachers served as a comparison group. All eighth-grade students in the school district were surveyed regarding their substance usage. Teachers rated the students regarding their risk for substance usage. Teachers' ratings and students' reported substance usage were compared to assess the percentage of matching responses. After training, the intervention teachers provided more accurate ratings among usage categories than did the comparison teachers. The trained teachers were better at correctly identifying the students who were at risk for substance use.

Reducing substance abuse risk factors among children through a teacher as facilitator program.

A Teachers as Facilitators (TAF) Program used classroom teachers as leaders of small groups that promoted social, emotional, and academic development of children at high risk of adopting potentially destructive substance abuse patterns. The program was intended to increase participating students' positive socialization experiences and academic achievement by successfully integrating these students into the school's social system. A longer-range goal was to increase students' sense of worth as it affects their attitudes toward relationships with other people and academic demands. Program results were: 1) school personnel were found capable of accurately identifying and referring to the TAF Program children who were at risk of substance usage and in need of assistance; 2) the TAF Program was effective in improving at-risk students' perceived academic self-concept, but was less effective in increasing students' perceived sense of social support; and 3) the program was endorsed by participating teachers, counselors, and administrators.

Selected predictors of health promotion counseling by three groups of allied health professionals.

Three groups of allied health professionals, including dental hygienists, dietitians, and certified nurse-midwives, were surveyed to determine current practice, beliefs, and attitudes regarding health promotion and disease prevention. The study aimed to explore the power of selected variables drawn from social learning theory in predicting self-reported level of counseling. We conducted separate analyses for 10 areas of health promotion and disease prevention: high blood pressure, smoking, lack of exercise, overweight, high-fat diet, alcohol abuse, illicit drug use, stress, isolation and loneliness, and nonuse of safety belts. The predictor variables were respondents' professional group membership, confidence that they possess appropriate skills and knowledge to counsel patients (self-efficacy), belief that patients will follow through on recommendations (adherence expectation), and belief that reduction of risk will improve patients' health status (expectation of health impact). The level of counseling activity varied markedly across the risk areas, with blood pressure and weight receiving the most emphasis on average and isolation and loneliness and nonuse of safety belts receiving markedly less attention. There also was variation across the professional groups. Certified nurse-midwives had higher mean counseling scores in all topics except those related to diet, where the dietitians' mean scores were approximately the same. Of all the areas about which counseling might be increased, use of safety belts stands out as having the lowest reported prevalence, the least complexity in terms of implementation, and the most relevance to at least two of the professional groups. These findings suggest the importance of skills training, including the provision of actual or simulated counseling experience and modeling by others in the same professional group.(ABSTRACT TRUNCATED AT 250 WORDS)