A case study of the long-term sustainability of an oral health program for persons experiencing homelessness

Stakeholders engaged in funding health programs and investing in human capital are concerned that their investments lead to beneficial long-term outcomes and do not fade from existence when funding streams dry up. However, dissemination and implementation researchers often pay little attention to what happens after programs are implemented. An essential function of the public health nurse operating at the executive management or leadership level is to evaluate overall effectiveness, quality, and sustainability of programs and to design systems-level quality initiatives and evaluation plans that foster program sustainability. This article applies a conceptual framework for sustainability to an oral health program serving persons experiencing homelessness, exploring the essential programmatic, community, and organizational factors that have positively impacted the long-term sustainability of the program. Lessons learned from a model program that has thrived in a political and economic resource poor climate may assist the public health nurse in planning and developing health programs that can withstand the test of time even in the most challenging of circumstances.     

Nitric oxide contributes to the regulation of vasomotor tone but does not modulate O(2)-consumption in exercising swine

OBJECTIVE: The role of nitric oxide (NO) in the regulation of vasomotor tone and tissue O(2)-consumption is incompletely understood. We therefore determined the contribution of endogenous NO to regulation of systemic, pulmonary and coronary vasomotor tone and myocardial (MV(O(2))) and whole body (BV(O(2))) O(2)-consumption in exercising swine. METHODS AND RESULTS: Exercise (1-5 km/h) up to 85% of maximum heart rate in 11 swine produced a 4-fold increase in BV(O(2)), which was accommodated for by 2-fold increases in both cardiac output (CO) and body O(2)-extraction. The NO synthase inhibitor N(omega)-nitro-L-arginine (NLA, 20 mg/kg, i.v.) increased mean aortic pressure by 30 mmHg both at rest and during exercise, due to a decrease in systemic vascular conductance from 37+/-2 to 22+/-1 ml/min mmHg(-1) at rest and from 88+/-3 to 60+/-3 ml/min mmHg(-1) at 5 km/h (all P< or =0.05 versus control). NLA produced vasoconstriction at rest and at 5 km/h in virtually all regional beds but did not affect the exercise-induced redistribution of CO. NLA increased mean pulmonary artery pressure from 15+/-1 to 21+/-1 mmHg at rest and from 30+/-2 to 40+/-2 mmHg at 5 km/h, due to a decrease in pulmonary vascular conductance (all P< or =0.05). BV(O(2)) remained unchanged and consequently the decrease in CO resulted in a compensatory increase in O(2)-extraction. NLA in a dose of 40 mg/kg produced similar responses. NLA had no significant effect on myocardial O(2)-demand or MV(O(2)) either at rest or during exercise, but decreased coronary vascular conductance which resulted in a decrease in coronary venous PO(2) from 24.5+/-1.1 to 21.9+/-0.8 mmHg at rest and from 23.5+/-0.5 to 21.0+/-0.6 mmHg at 5 km/h (all P< or =0. 05). CONCLUSIONS: Endogenous NO dilates the systemic, pulmonary and coronary vascular bed, but does not modify MV(O(2)) or BV(O(2)) in swine at rest and during exercise.     

造血干细胞移植与临床感染的防治

学术背景:造血干细胞移植技术在临床上已得到广泛应用,移植后感染是关系到移植成败的重要因素。目的:探讨造血干细胞移植后各阶段的感染的特点、预防及治疗,以进一步减低造血干细胞移植后感染的发生率及死亡率。检索策略:由作者应用计算机检Medline 1994-01/2007-05关于造血干细胞移植及移植后感染的文章,检索词为"hematopoietic stem cell transplantation,infection",限定语言种类为"English";同时检索中国期刊全文数据库1994-01/2007-05相关文章,检索词"造血干细胞移植,感染,防治",限定语言种类为中文。纳入标准:随机对照研究;实验或临床研究包含平行对照组。排除标准:重复性研究文献评价:初检得到212篇文献,初审后选取与造血干细胞移植后感染有关的文章126篇,删除明显无关及相关性不强的文章,进一步查找全文,29个实验符合标准,予以纳入。29个研究包括324例患者和140个实验动物,分别阐述了造血干细胞移植后感染的原因、途径、特点、种类及各种感染的预防及治疗措施。资料综合:造血干细胞移植后感染发病隐匿,由于患者免疫力低下,感染不易控制,在不同阶段致病菌的种类有所不同,细菌感染普遍,在移植后各个时期均可出现,真菌感染和病毒感染致死性强,故预防和治疗感染至关重要,其治疗分为预防治疗、抢先治疗、经验性治疗和针对治疗。结论:造血干细胞移植后感染的治疗已成为影响移植疗效的一个重要原因,及早的诊断及正确的治疗将成为移植后感染治疗成功的关键。     

Evidence Regarding Relationship Between Breastfeeding and Breast Cancer Remains Unclear

Yang L, Jacobsen KH. A systematic review of the association between breastfeeding and breast cancer. J Womens Health 2008;17:1635–45.