Health care and disease prevention through genetic counseling: a regional approach.
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The Colorado-Wyoming Regional Genetic Counseling Program has demonstrated the feasibility and utility of providing genetic counseling services over a very large area of the Rocky Mountain Region. A basis for preventing genetic and congenital disorders has been established and the patient care provided has been as comprehensive, sophisticated and effective as for any genetic counseling clinic operating in a medical center, with the added advantage of being accessible to a much larger and less financially able patient population. Utilization data and consumer assessment of the values of this service confirm these impressions. (+info)
An accelerated rural training program.
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BACKGROUND: Several authors have pointed out the need for enhanced training for those residents contemplating rural practices. Most students and policy makers are reluctant to commit to primary care training beyond the required 3 years. METHODS: The University of Nebraska Medical Center received approval for an accelerated family practice training program in 1993, and developed a 4-year program that requires a 1-year rural procedures fellowship and a commitment to practice in rural Nebraska. RESULTS: The Nebraska accelerated rural training program has recruited 10 classes to this program and has placed more than 50% of the graduates in communities with a population of less than 8,000. CONCLUSION: The requirements of this program are unique. Special consideration must address the issues of recruitment of students, integration into the basic program, licensure issues, determination of fellowship training needs, and faculty recruitment. (+info)
The experience of native peer facilitators in the campaign against type 2 diabetes.
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CONTEXT: The use of peer facilitators in health programs has great potential. One important application is prevention and control of type 2 diabetes among American Indians. PURPOSE: To explore the experience of American Indian facilitators in a culturally appropriate intervention (Talking Circles) on 2 Northern Plains reservations. The Talking Circles offered a forum for educational dialogue on diabetes risk factors and the management of type 2 diabetes. METHODS: Phenomenology, a qualitative research approach, was used to answer the research question: "What did Native Talking Circle facilitators experience?" Participants were 4 lay health workers from the intervention reservations who had been trained to present a diabetes curriculum while coordinating and guiding the group discussion. During open-ended, taped interviews, the facilitators shared their experiences conducting the Talking Circles. Analysis categorized the experiences into common themes to explain the phenomena and cultural construction of oral discussions (Talking Circles) of diabetes. FINDINGS: Themes included the concept of "a calling" to do the work, which included a self-growth process, a blending of 2 worldviews as a diabetes intervention strategy, the importance of translating educational materials in a liaison role, and commitment to tribal people and communities. CONCLUSIONS: The experience of the facilitators was positive because they were knowledgeable about American Indian culture and worldview and were trained in both Talking Circle facilitation and type 2 diabetes. (+info)
Evaluation of urine specimen integrity in a public health STD screening program.
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Detection of Chlamydia trachomatis and/or Neisseria gonorrhoeae infection in urine using molecular amplification assays has permitted institutions with limited medical facilities to offer testing for these sexually transmitted diseases (STDs). The Nebraska Public Health Laboratory (NPHL) investigated the validity of urine samples submitted for C trachomatis and/or N gonorrhoeae amplification after receiving a substantial number of clear specimens. Approximately 75% of all urine specimens submitted for STD testing to the NPHL were from correctional facilities. The falsification of urine specimens submitted for microbiology studies is not evaluated routinely, and this problem was previously undocumented. By using the criteria for specific gravity of 1.001 or less and a creatinine concentration of less than 5 mg/dL (442 mumol/L), approximately 8% of all specimens submitted during the study interval were determined to be inconsistent with urine. The microbiology laboratory should be aware of the possibility for specimen manipulation to identify facilities submitting falsified specimens, to initiate appropriate intervention, and to minimize false-negative reporting. (+info)
Alternating chemotherapy with etoposide plus cisplatin and topotecan plus paclitaxel in patients with untreated, extensive-stage small cell lung carcinoma: a phase II trial of the North Central Cancer Treatment Group.
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BACKGROUND: The objective of this study was to test the response rate and toxicity of alternating chemotherapy in previously untreated patients with extensive-stage small cell lung carcinoma (SCLC). METHODS: Patients with histologically proven, extensive-stage SCLC, with a performance status of 0-2, and who had received no prior chemotherapy were eligible. The design was a two-stage, Phase II, multicenter trial. Treatment consisted of alternating chemotherapy every 3 weeks with etoposide (100 mg/m(2) on Days 1-3) and cisplatin (30 mg/m(2) on Days 1-3) on Cycles 1, 3, 5 and with topotecan (1 mg/m(2) on Days 1-5) and paclitaxel (200 mg/m(2) on Day 5) on Cycles 2, 4, and 6. Filgrastim support was given with Cycles 2, 4, 6. RESULTS: Forty-four patients were eligible and evaluable. The primary toxicity was myelosuppression. The median absolute neutrophil count was 300/microL with 70% Grade 4 neutropenia. The median platelet count was 58,000/microL with 23% Grade 4 thrombocytopenia. Grade 4 nonhematologic toxicities occurred in 16% of patients. Overall toxicities were not different between the two regimens. There were no treatment-related deaths. Complete or partial responses occurred in 34 patients (77%). The median time to progression was 6.9 months, with a median survival of 10.5 months and with 1-year and 2-year survival rates of 37% and 12%, respectively. CONCLUSIONS: The regimen of alternating chemotherapy was associated with substantial myelosuppression and resulted in a high response rate and good overall survival. The results were similar to those reported in prior trials and did not suggest any improvement in therapy for patients with SCLC. (+info)
Managing N inputs and the effect on N losses following excretion in open-dirt feedlots in Nebraska.
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Nutrition will play an important role in meeting the environmental challenges of beef cattle feedlots. Nutritionists are continually refining protein requirements, and have recently adopted a new metabolizable protein (MP) system to more efficiently use nitrogen (N) and allow more accurate diet formulation. Protein requirements vary by animal age and weight during the finishing period. Our hypothesis was that formulating diets with the MP system would decrease N inputs and lead to decreased excretion and losses. Comparing industry average diets (13.5% crude protein) to phase-fed diets formulated to not exceed MP requirements decreased N inputs by 10 to 20% for calves and yearlings without affecting average daily gain. Decreasing inputs led to a concomitant decrease in N excretion (12 to 21%) and losses (15 to 33%) in open-dirt feedlot pens. N losses are variable with time of year, with averages of 60 to 70% of excreted N lost during the summer months and 40% lost during the November to May feeding periods. Protein requirements are being refined continually as more research data are collected. However, formulation to meet protein requirements, but not exceed them, is an important nutritional management option for feedlots to become sustainable. (+info)
Nutrient management programs, nitrogen fertilizer practices, and groundwater quality in Nebraska's Central Platte Valley (U.S.), 1989-1998.
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Given the societal concern about groundwater pollution from agricultural sources, public programs have been proposed or implemented to change farmer behavior with respect to nutrient use and management. However, few of these programs designed to change farmer behavior have been evaluated due to the lack of detailed data over an appropriate time frame. The Central Platte Natural Resources District (CPNRD) in Nebraska has identified an intensively cultivated, irrigated area with average groundwater nitrate-nitrogen (N) levels about double the EPA"s safe drinking water standard. The CPNRD implemented a joint education and regulatory N management program in the mid-1980s to reduce groundwater N. This analysis reports N use and management, yield, and groundwater nitrate trends in the CPNRD for nearly 3000 continuous-corn fields from 1989 to 1998, where producers faced limits on the timing of N fertilizer application but no limits on amounts. Groundwater nitrate levels showed modest improvement over the 10 years of this analysis, falling from the 1989-1993 average of 18.9 to 18.1 mg/l during 1994-1998. The availability of N in excess of crop needs was clearly documented by the CPNRD data and was related to optimistic yield goals, irrigation water use above expected levels, and lack of adherence to commercial fertilizer application guidelines. Over the 10-year period of this analysis, producers reported harvesting an annual average of 9729 kg/ha, 1569 kg/ha (14%) below the average yield goal. During 1989-1998, producers reported annually applying an average of 162.5 kg/ha of commercial N fertilizer, 15.7 kg/ha (10%) above the guideline level. Including the N contribution from irrigation water, the potential N contribution to the environment (total N available less estimated crop use) was estimated at 71.7 kg/ha. This is an estimate of the nitrates available for denitrification, volatilization, runoff, future soil N, and leaching to groundwater. On average, between 1989-1993 and 1994-1998, producers more closely followed CPNRD N fertilizer recommendations and increased their use of postemerge N applications--an indication of improved synchrony between N availability and crop uptake. (+info)
Nutritional methods to decrease N losses from open-dirt feedlots in Nebraska.
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Nitrogen (N) losses from cattle feedlots are of concern due to loss of valuable N and enrichment of the atmospheric N pool. Nutritional methods to decrease such losses would have economic and environmental benefits. One method to decrease N losses is by increasing carbon (C) on the pen surface. The most cost effective method of decreasing N losses with C may be feeding diets lower in digestibility compared to adding C directly to pens. Therefore, three experiments evaluated feeding corn bran (which is less digestible than corn) as either 0, 15, or 30% of the diet. The 15- and 30%-bran diets increase organic matter (OM) excretion by approximately 0.5 and 1.0 kg per steer per day, respectively. Compared with no bran, feeding 15 and 30% decreased feed efficiency by 7.8 and 10.4%, respectively. Nutrient balance was assessed in two trials from October through May and in one trial from June to September. During the trials from October to May, N losses were decreased by 14.5 and 20.7% for the 15- and 30%-bran diets compared with no bran. Feeding 15 or 30% bran did not influence N losses in the experiment from June to September. Increasing the C:N ratio of manure prior to cleaning open-dirt feedlots had variable results depending on time of year. (+info)