36 research outputs found

    Immigrants and the Community

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    First in a series based on the research project "Integrating the Needs of Immigrant Workers and Rural Communities," which attempts to inform New York communities about the nature and consequences of increasing immigrant settlement.Many upstate New York communities have experienced population loss and decline in the last decade. Increasing numbers of immigrants have settled in many of these communities, which poses possible community development challenges and opportunities. Because each community must address these issues in its own way, this report is intended to make communities aware of changes in their populations and highlight issues they may choose to address.USDA Fund for Rural America (grant #2001-36201-11283) and Cornell University Agricultural Experiment Station (grant #33452

    Group motivational intervention in overweight/obese patients in primary prevention of cardiovascular disease in the primary healthcare area

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    Background The global mortality caused by cardiovascular disease increases with weight. The Framingham study showed that obesity is a cardiovascular risk factor independent of other risks such as type 2 diabetes mellitus, dyslipidemia and smoking. Moreover, the main problem in the management of weight-loss is its maintenance, if it is achieved. We have designed a study to determine whether a group motivational intervention, together with current clinical practice, is more efficient than the latter alone in the treatment of overweight and obesity, for initial weight loss and essentially to achieve maintenance of the weight achieved; and, secondly, to know if this intervention is more effective for reducing cardiovascular risk factors associated with overweight and obesity. Methods This 26-month follow up multi-centre trial, will include 1200 overweight/obese patients. Random assignment of the intervention by Basic Health Areas (BHA): two geographically separate groups have been created, one of which receives group motivational intervention (group intervention), delivered by a nurse trained by an expert phsychologist, in 32 group sessions, 1 to 12 fortnightly, and 13 to 32, monthly, on top of their standard program of diet, exercise, and the other (control group), receiving the usual follow up, with regular visits every 3 months. Discussion By addressing currently unanswered questions regarding the maintenance in weight loss in obesity/overweight, upon the expected completion of participant follow-up in 2012, the IMOAP trial should document, for the first time, the benefits of a motivational intervention as a treatment tool of weight loss in a primary care setting

    Rationale and design of a randomised controlled trial evaluating the effectiveness of an exercise program to improve the quality of life of patients with heart failure in primary care : the EFICAR study protocol

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    Background: Quality of life (QoL) decreases as heart failure worsens, which is one of the greatest worries of these patients. Physical exercise has been shown to be safe for people with heart failure. Previous studies have tested heterogeneous exercise programs using different QoL instruments and reported inconsistent effects on QoL. The aim of this study is to evaluate the effectiveness of a new exercise program for people with heart failure (EFICAR), additional to the recommended optimal treatment in primary care, to improve QoL, functional capacity and control of cardiovascular risk factors. Methods/Design: Multicenter clinical trial in which 600 patients with heart failure in NYHA class II-IV will be randomized to two parallel groups: EFICAR and control. After being recruited, through the reference cardiology services, in six health centres from the Spanish Primary Care Prevention and Health Promotion Research Network (redIAPP), patients are followed for 1 year after the beginning of the intervention. Both groups receive the optimized treatment according to the European Society of Cardiology guidelines. In addition, the EFICAR group performs a 3 month supervised progressive exercise program with an aerobic (high-intensity intervals) and a strength component; and the programme continues linked with community resources for 9 months. The main outcome measure is the change in health-related QoL measured by the SF-36 and the Minnesota Living with Heart Failure Questionnaires at baseline, 3, 6 and 12 months. Secondary outcomes considered are changes in functional capacity measured by the 6-Minute Walking Test, cardiac structure (B-type natriuretic peptides), muscle strength and body composition. Both groups will be compared on an intention to treat basis, using multi-level longitudinal mixed models. Sex, age, social class, co-morbidity and cardiovascular risk factors will be considered as potential confounding and predictor variables. Discussion: A key challenges of this study is to guarantee the safety of the patients; however, the current scientific evidence supports the notion of there being no increase in the risk of decompensation, cardiac events, hospitalizations and deaths associated with exercise, but rather the opposite. Safety assurance will be based on an optimized standardised pharmacological therapy and health education for all the participants

    Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

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    Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

    Immigrants and the Community: Former Farmworkers

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    Many upstate New York communities have experienced population loss and decline in the last decade. Increasing numbers of immigrants have settled in many of these communities, which poses possible community development challenges and opportunities. As we reported earlier (Immigrants and the Community: Farmworkers with Families), a growing proportion of farmworkers with families is settling in rural communities. This trend may create both opportunities and problems for rural communities, but how can we anticipate what those might be? In an effort to understand the integration of new immigrants into rural communities, we interviewed former farmworkers and other community members in five upstate townships. A look at the experiences of former farmworkers who have resided in the community for some time can provide some valuable insights. Because each community must address these issues in its own way, this report is intended to make communities aware of changes in their populations and highlight issues they may choose to address. Description: Third in a series based on the research project "Integrating the Needs of Immigrant Workers and Rural Communities," which attempts to inform New York communities about the nature and consequences of increasing immigrant settlement

    The neutrino factory: beam and experiments

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    The discovery of neutrino oscillations marks a major milestone in the history of neutrino physics, and opens a new window to the still mysterious origin of masses and flavour-mixing. Many current and forthcoming experiments will answer open questions; however, a major step forward, up to and possibly including CP violation in the neutrino-mixing matrix, requires the neutrino beams from a \nf .The \nf\ is a new concept for producing neutrino beams of unprecedented quality in terms of intensity, flavour composition, and precision of the beam parameters. Most importantly,the \nf\ is the only known way to generate a high-intensity beam of electron neutrinos of high energy. The neutrino beam from a \nf , in particular the electron-neutrino beam enables the exploration of otherwise inaccessibledomains in neutrino oscillation physics by exploiting baselines ofplanetary dimensions. Suitable detectors pose formidable challenges butseem within reach with only moderate extrapolations from existingtechnologies. Although the main physics attraction of the \nf\ is in thearea of neutrino oscillations, an interesting spectrum of further opportunitiesranging from high-precision, high-rate neutrino scattering to physics withhigh-intensity stopped muons comes with it
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