Effectiveness of a Multidisciplinary Education Protocol in Children with Asthma (0-4 Years) in Primary Health Care

This paper describes the results of an asthma self-management protocol delivered to parents of children aged 0-4 years. The protocol was delivered by general practitioners (GPs), community nurses, asthma nurses, and doctors in child health centers. It consisted of 16 educational modules developed after an initial needs assessment of parents and a task analysis of primary care practitioners. The program was evaluated by means of an experimental design. Parents participating in the program had significantly more knowledge, a more favorable attitude toward asthma, and a higher self-efficacy score with respect to performing asthma self-management behaviors. Also, they reported performing self-management behaviors more frequently than parents in the control group. One-year follow-up results, which were collected for parents in the treatment group only, showed that the described changes were sustained. Further, the treatment group was found to have decreased its emergency and nonemergency use of the physician's office and to have a reduction in (reported) asthma severity. Process evaluation indicated that most modules were provided by the GPs to nearly all parents. After parents had read the modules at home, almost all the information was discussed in the next contact. GPs seldom referred patients to the community nurses, although this was suggested in the protocol.     

Patellofemoral joint: kinematic MR imaging to assess tracking abnormalities

The patellofemoral joint was imaged with magnetic resonance (MR) in the axial plane while the knee was positioned from 0 degrees to 32 degrees of flexion (nine positions). These multiple sequential images obtained within the early phases of flexion of the knee were viewed in a "cine-loop" format, producing a kinematic study that clearly demonstrated the relationship of the patella to the trochlear groove. Four healthy subjects and one patient with known bilateral subluxing patellae were studied. The preliminary results suggest that kinematic MR imaging of the patellofemoral joint is potentially useful for the evaluation of patellar tracking abnormalities.     

Sampling methods for a matrix ionization chamber system.

To achieve increased image acquisition speed or better image quality, several read-out methods for a matrix ionization chamber system have been investigated. In this device, which is applied for portal imaging in radiation therapy, 256 x 256 small liquid-filled ionization chambers are scanned by switching the polarizing voltage applied to rows of chambers. The ionization current of each column is measured by a separate amplifier. In this approach, instead of measuring row by row, more complex switching schemes can be applied for the polarizing voltage. These schemes are useful either for varying speed and spatial resolution of the imaging device or for coded sampling of the ionization signal. The former option allows for doubling or quadrupling the acquisition speed with a small loss in image quality, or for obtaining a large improvement in signal-to-noise ratio at the cost of image resolution. In the latter option, coded sampling, the image is reconstructed mathematically from the measured signals. It is shown that in this case the application of Hadamard or derived matrices for sampling leads, under certain circumstances, to a noise reduction in the reconstructed image.     

A method for the measurement of field placement errors in digital portal images

Correct placement of radiation fields relative to patient anatomy is essential in radiotherapy in order to minimise serious side effects to reduce the probability of recurrence of the tumour. One way to determine patient setup accuracy is to analyse portal images obtained in the therapy beam distal to the patient. A field placement analysis (FPA) method has been developed for detailed evaluation of patient setup by comparing positions of corresponding radiation field edges in digitised simulator and portal images. A simulator image is matched to a portal image using similar anatomical landmarks in both images and mapping these landmarks against each other applying a least squares minimisation approach. Discrepancies between the simulator field edge (reference) and a portal field edge are determined by comparing the distances between the central axis of the beam and corresponding edge segments and the angles of these segments with a reference line. Uncertainties in these distances and angles are to a large extent determined by the magnification, rotation and translation procedure. Uncertainties due to the FPA method itself are of about 1.0 mm and 0.5 degrees in portal images of head and neck fields. These FPA uncertainties are in general smaller than the variations due to patient setups. Matching of simulator and portal images of lateral pelvic fields revealed larger uncertainties: 1.7 mm and 1.1 degrees. Setup variations in this kind of pelvic radiation field are usually also larger, and therefore meaningful results can be obtained with the new FPA method.     

Nutritional characterization by anthropometrics of institutionalized and non-institutionalized elderly Venezuelan

In order to evaluate nutritional status by anthropometry, a group of elderly (60 to 83 years old) was studied: 63 institutionalized and 37 non-institutionalized elderly from Valencia city, Venezuela. Weight, height, triceps skinfold and mid-arm circumference were measured and the body mass index (weight/height2) was calculated. The average age for the institutionalized group was 77.3 +/- 7.5 years old and 69.5 +/- 7.6 years old for the free-living elderly group. Tricipital skinfold (TSF) and mid-arm circumference (MAC) means were within the normal reference range for both groups, without significant differences by sex. Body mass index (BMI) was higher in the institutionalized group. Lower BMI and MAC were found in older elderly (> or =80 y). According to the nutritional classification by BMI, 16% of nutritional deficit, 45% of normal status and 39.7% with of excess weight were found in institutionalized elderly; while in free-living elderly, prevalences were 8%, 62% and 29.7% respectively. Even though normal nutritional status was highly prevalent, institutionalized elderly showed higher prevalences of nutritional alterations (underweight and overweight).     

Pediatric asthma, a qualitative and quantitative approach to needs assessment

This article describes an approach to needs assessment in a specific location using both focus group interviews and a written questionnaire. In this case study, the target population consists of parents of asthmatic children (0-4 years of age). Six focus group interviews were conducted with the purpose of discussing parents' experiences with health care for asthma, their beliefs and knowledge of general aspects of asthma, medication and preventive actions. As a supplement, parents completed a written questionnaire providing additional quantitative information on parental knowledge and misconceptions. Results indicated that parental knowledge of asthma in general was not adequate, especially with respect to medication, preceding signs and preventive activities. Important misconceptions, which might contribute to noncompliance with self-management behaviors, were revealed during discussions with the parents. Several differences were found between results of the interviews and the questionnaire, for instance regarding parental knowledge about preventive measures, medication and perceived parental satisfaction with health care for asthma. These differences indicate the value of using both a survey and a focus group.     

Marrow regeneration after mechanical depletion

The origin of marrow regeneration after mechanical depletion was reinvestigated in mouse chimeras. The results were compatible with the local origin of stem cells from remnants of incompletely removed marrow, but not with their origin from a common precursor of both bone and hemopoietic cell lines. In transplanted femurs depleted by a modified technique of in vivo evacuation of marrow, hemopoietic regeneration failed to occur. The presence of hemopoietic stem cells in the Haversian canals was thus excluded. The demonstration of ample hemopoiesis with minimal bone formation in nondepleted controls in which bone marrow initially became necrotic provided new evidence that osteogenesis was not a prerequisite of hemopoietic regeneration.