Improving outcomes for persons with aphasia in advanced community-based treatment programs.
BACKGROUND AND PURPOSE: Studies have yet to document that community-based aphasia treatment programs routinely produce results comparable or superior to published research protocols. We explore this issue here in an outcome study of individuals with aphasia enrolled in 2 community-based, comparably managed and equipped therapy programs, which use a specially designed computer-based tool that is employed therapeutically in adherence to an extensive, detailed, and formally trained patient care algorithm. METHODS: Patients (n=60) were assessed before and after treatment with standardized instruments at both the impairment and the disability levels. Pretreatment and posttreatment means were calculated and compared, with statistical significance of differences established with the use of 1-tailed matched t tests. One-way ANOVAs were used to analyze the comparability of patient performance changes among various subgroups, eg, patients in acute versus chronic stages of aphasia, patients by aphasia diagnostic type at start of care, patients by severity level at start of care, and patients by treatment location. RESULTS: Analysis shows that patients spanned a wide range of aphasia diagnostic types, impairment severity levels at start of care, and times after onset. Patients' mean performance scores improved significantly in response to treatment in all measures assessed at both the impairment level and the functional communication level. Mean overall improvements ranged from 6.6% to 19.8%, with statistical significance ranging from P=0.0006 to P<0.0001. ANOVAs revealed no significant differences between improvements in patients in the acute versus chronic stages of aphasia, between those at different impairment severity levels at start of care, between those treated at different locations, or, at the functional level, between those with different diagnostic types of aphasia at start of care. CONCLUSIONS: Measures of both language impairment and functional communication can be broadly, positively, and significantly influenced by therapy services that are delivered to persons with aphasia in these community-based programs. The significant improvements are shown to be available to individuals with chronic as well as acute aphasia and independent of diagnostic type of aphasia, impairment severity at start of care, or geographic program location. (+info)
Computer-based teaching of pathology at the Zagreb University School of Medicine.
AIM: To review the experience gained in transferring USA computer-based teaching system of medical school pathology to Croatia. METHODS: Computer-based teaching program of pathology developed at the University of Kansas School of Medicine, Kansas City, Kansas, USA, was transferred to the University of Zagreb School of Medicine, Zagreb, Croatia. The experimental group of 49 students was enrolled into this computer-based program. Their performance was compared with that of 195 classmates enrolled in the standard course. Objective (performance on the examinations) and subjective data (students' interviews and written evaluations of the course) were analyzed. RESULTS: The computer program was operational 5 months from the inception of the transfer. It was well received by the students, even though many initially complained that it required more effort and a continuous commitment. The major problems concerned scheduling, reflecting various requirements i mposed on students by other departments teaching in parallel with the Pathology course. Objective data gathered so far indicate that the students enrolled in the computer-based program took the first midterm examination at a significantly higher rate than the rest of the class (p<0.001), and passed the examination with significantly better grades (p<0.001). CONCLUSION: Computer-based teaching programs can be readily transferred to other countries. Full implementation of the program, however, may require significant changes in the existing curriculum in the medical school to which such a program has been transferred or considerable modifications in the program adopted for transfer. It appears that the students enrolled in the computer-based program perform better than students in the standard pathology course. (+info)
Ascertainment of secondary cases of hepatitis A--Kansas, 1996-1997.
Each year, 25,000-30,000 cases of hepatitis A are reported in the United States. The most common infection source (22%-26%) is household or sexual contact with a person already infected with hepatitis A virus (HAV) (i.e., the source-patient). In Kansas during 1992-1997, contact with a source-patient was reported by 39% of persons with hepatitis A. Cases reported in 1996 and 1997 were studied retrospectively to determine the reasons for the apparently high proportion of secondary cases and to evaluate missed opportunities for prevention (i.e., postexposure prophylaxis with immune globulin [IG]). Results of this investigation indicate that persons with hepatitis A often were classified incorrectly as secondary cases and that some correctly identified secondary cases represented missed opportunities for prevention. (+info)
Effects of a replication of a multicomponent model for preventing adolescent pregnancy in three Kansas communities.
CONTEXT: A significant amount of attention has been devoted to the complex issue of teenage pregnancy and to programs for reducing pregnancy among adolescents. Careful evaluations of such programs are needed to ascertain what strategies will be most effective at reducing teenage pregnancy. METHODS: A pretest-posttest comparison group design was used to analyze the effects of a comprehensive multicomponent school and community intervention on estimated pregnancy rates and birthrates among young people in three Kansas communities: Geary County, Franklin County and selected neighborhoods of Wichita. RESULTS: There were high levels of program activity in all three communities during the intervention period, including teacher training and sexuality education for students. Survey respondents rated highly such project interventions as the extension of school-linked clinic hours to accommodate student schedules and support groups established in middle schools. Between 1994 and 1997, the proportions of adolescents reporting that they had ever had sex decreased significantly among all ninth and 10th graders in Geary County, from 51% to 38% among females and from 63% to 43% among males. In Franklin County, more males in grades 11 and 12 reported using condoms in 1996 (55%) than had done so in 1994 (39%). Age at first intercourse remained relatively stable in Franklin and Geary counties during the intervention period. The estimated pregnancy rate among adolescents aged 14-17 decreased between 1994 and 1997 in Geary Country, while it increased in comparison areas. The estimated pregnancy rates among 14-17-year-olds decreased in both Franklin County and its comparison communities. The birthrate declined both in one target area of Wichita and in its comparison area from 1991-1993 to 1994-1996. Over the same time period, the birthrate increased in a second target area of Wichita, while it decreased in the comparison community. CONCLUSIONS: This evaluation of a comprehensive multicomponent program for adolescent pregnancy prevention contributes to our understanding of this model and its replicability in diverse communities. Ongoing program evaluation is important for developing initiatives and for refining strategies so they respond to local conditions. (+info)
During 1996-1998, CDC received reports from approximately 16 state health departments of Salmonella infections in persons who had direct or indirect contact with reptiles (i.e., lizards, snakes, or turtles). Salmonella infection can result in invasive illness including sepsis and meningitis, particularly in infants. Despite educational efforts, some reptile owners remain unaware that reptiles place them and their children at risk for salmonellosis. This report summarizes clinical and epidemiologic information in four cases and provides information about state regulations to prevent transmission of Salmonella spp. from reptiles to humans. (+info)
Prevalence of Escherichia coli O157:H7 in range beef calves at weaning.
This study was designed to determine the prevalence of Escherichia coli O157:H7 infection of beef calves at weaning, prior to arrival at the feedlot or mixing with cattle from other sources. Fifteen range cow-calf herds, which weaned calves in October and November, were sampled in Kansas, Missouri, Montana, Nebraska and South Dakota. Faecal culture for E. coli O157:H7 was performed and anti-O157 serum antibody titres were determined by blocking ELISA. Thirteen of the 15 herds (87%) were found to have at least one positive isolation of E. coli O157:H7 in faecal samples. Within positive herds, prevalence ranged from 1.7-20.0%, with an average of 7.4+/-6.2% S.D. of individual animals shedding E. coli O157:H7 in faeces. All herds had high prevalence of anti-O157 antibodies, ranging 63-100% of individuals within herds seropositive. This study indicates that E. coli O157:H7 infection before weaning, prior to entry into feedlots, is widespread. Furthermore, serologic evidence suggests that most calves (83%) and all herds (100%) have been exposed to E. coli O157. (+info)
Magnitude of subunit inequivalence for oxygen release from hemoglobin: reinvestigation of the oxygen-pulse experiment.
Two hypotheses have been presented to explain the grossly biphasic oxygen release kinetics observed when hemoglobins are studied with the oxygen pulse technique [Gibson (1973) Proc. Nat. Acad. Sci. USA 70, 1-4]. Hypothesis I suggests that the two phases result from cooperativity, with the fast phase being oxygen release from the low affinity (T) state and the slow phase being oxygen release from molecules that have switched to the high affinity (R) state. Hypothesis II suggests that the biphasic curves are due to a large (factor of 20-30) difference in oxygen release from the two types of subunits within deoxyhemoglobin. In order to experimentally discriminate between these two hypotheses, we reinvestigated the oxygen pulse reaction for hemoglobin Kansas (alpha2 beta2 102 Asn leads to Thr) in the absence and presence of inositol hexaphosphate, since recent high resolution nuclear magnetic resonance studies have shown that this allosteric cofactor stabilizes hemoglobin Kansas in T even when fully liganded [Ogawa, Mayer, and Shulman (1972) Biochem. Biophys. Res. Commun. 49, 1485-1491]. The results of these studies clearly favor hypothesis I over hypothesis II as being the correct interpretation for the oxygen pulse results. However, we have found evidence that suggests that oxygen release and binding in T are surprisingly faster than previously observed. Furthermore, within T, there is some spectral and kinetic heterogeneity for oxygen release from adult hemoglobin and hemoglobin Kansas. The magnitude of this kinetic heterogeneity in T appears to be about the same as that seen in the high affinity, R, state. The exchange of hypothesis II for hypothesis I more strongly favors views of cooperative oxygen binding involving both types of subunits, as required if the allosteric model of Monod, Wyman, and Changeux [(1965) J. Mol. Biol. 12, 88-118] is considered operative. (+info)
Rubella among Hispanic adults--Kansas, 1998, and Nebraska, 1999.
Since 1994, the incidence of rubella has been low; most reported rubella cases have been associated with outbreaks (1,2). Recent outbreaks have occurred primarily among adult Hispanics, many of whom are natives of countries where rubella vaccination is not routine or has been implemented recently (1). This report describes two workplace-associated outbreaks of rubella and summarizes the characteristics of the recent outbreaks in the United States. (+info)