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At least 217 records · Page 12Linked to original sources
PubMed2006

Using participatory action research in a community-based initiative addressing complex mental health needs.

OBJECTIVE: This paper describes the first phase of a larger project that utilizes participatory action research to examine complex mental health needs across an extensive group of stakeholders in the community. METHOD: Within an objective qualitative analysis of focus group discussions the social ecological model is utilized to explore how integrative activities can be informed, planned and implemented across multiple elements and levels of a system. Seventy-one primary care workers, managers, policy-makers, consumers and carers from across the southern metropolitan and Gippsland regions of Victoria, Australia took part in seven focus groups. All groups responded to an identical set of focusing questions. RESULTS: Participants produced an explanatory model describing the service system, as it relates to people with complex needs, across the levels of social ecological analysis. Qualitative themes analysis identified four priority areas to be addressed in order to improve the system's capacity for working with complexity. These included: (i) system fragmentation; (ii) integrative case management practices; (iii) community attitudes; and (iv) money and resources. CONCLUSIONS: The emergent themes provide clues as to how complexity is constructed and interpreted across the system of involved agencies and interest groups. The implications these findings have for the development and evaluation of this community capacity-building project were examined from the perspective of constructing interventions that address both top-down and bottom-up processes.

Adult↗
PubMed2003

Developing experimental models to address traumatic brain injury in children.

Traumatic brain injury (TBI) is the leading cause of injury-related death and disability among children under the age of 15 years in the United States. Epidemiological studies have revealed that even within the pediatric population there are differences in incidence, gender differences, causes, types of injuries sustained, and mortality within age subdivisions. This heterogeneity must be taken into account when developing appropriate models to address TBI in children. This review explores the current developmental TBI models, including fluid percussion, weight drop, and controlled cortical impact. It also addresses unique considerations to modeling pediatric brain injury that require special attention when modeling and designing studies: age appropriateness, injury severity, evaluation of recovery, plasticity, and anesthesia.

Animals↗
PubMed2002

Addressing consumer grievances in medicine: policies and practices of newborn screening programs in the United States.

Newborn screening programs collectively administer the largest genetic testing initiative in the United States. The redress of grievances is an important mechanism for consumers to provide input into clinical and public health programs. In this study, we evaluated mechanisms for addressing consumer grievances in newborn screening programs. To do this, we surveyed all 50 state plus the District of Columbia newborn screening programs by questionnaire regarding protocols for receipt and redress of problems reported by parents of newborns and ascertained the existence and nature of complaints and how complaints were documented and addressed. Pertinent state and federal legislation and regulation were also reviewed. Six of 49 newborn screening programs reported having formal policies for handling consumer grievances. Four states reported having pertinent legislation or regulation. Thirty-eight of 49 states reported having received complaints from 1993 to 1995. Thirteen of 49 newborn screening programs reported that they actively seek feedback from consumers. Consumer grievances ranged from minor complaints to potentially life-threatening concerns. In general, complaints are managed on an ad hoc basis; formal policies are typically lacking. As newborn screening programs affect a vast number of Americans, a proactive and comprehensive approach, including solicitation of consumer feedback, could benefit both newborn screening programs and the public served by them.

Community Participation↗
PubMed2006

Home-based behavioral health intervention: Use of a telehealth model to address poor adherence to type-1 diabetes medical regimens.

Youth with insulin-dependent diabetes mellitus face complex treatment regimens and often have difficulty adhering to treatment requirements. Many behavioral-health intervention strategies, such as psychoeducational groups, diabetes summer camps, individual therapy, and residential treatment have been utilized to address this issue. While some have been effective, many barriers exist that limit the number of youth who are able to utilize these treatments. Additionally, the effectiveness of these treatments does not typically generalize to the home environment. Telephone-based, intensive, behavioral-health interventions may address barriers to treatment access by providing lower cost treatment that is easier to access for youth who do not live near a knowledgeable behavioral-health specialist. Additionally, delivery via telephone enables the interventions to take place in the home. This, in combination with parental involvement in the treatment, may increase generalization of the positive treatment outcomes to the home environment. The purpose of this paper is to describe a controlled trial of a telehealth intervention for youth whose diabetes is poorly managed. Preliminary outcome data for the trial are promising. Representative cases from the trial are presented in case-study format.

Adolescent↗
PubMed2003

Barriers to addressing the societal determinants of health: public health units and poverty in Ontario, Canada.

Despite Canada's reputation as a leader in health promotion and population health concepts, actual public health practice for the most part remains wedded to downstream strategies focussed on behaviour change. In Canada's largest province this has led to the implementation of a heart health promotion approach focussed on diet, activity and tobacco use. This is so despite increasing evidence that these approaches are generally ineffective, particularly for those at greatest risk. In addition, these strategies appear to divert public and governmental attention away from addressing the broader societal determinants of health. Examples of Ontario public health units that have begun to address societal determinants of health provide a counterbalance to the dominant paradigm that frames health as an individual responsibility. These new approaches focus attention upon the health-threatening effects of governments' regressive social and economic policies in a manner consistent with the best principles of health promotion.

Cardiovascular Diseases↗
PubMed2006

The role of workplace health promotion in addressing job stress.

The enormous human and economic costs associated with occupational stress suggest that initiatives designed to prevent and/or reduce employee stress should be high on the agenda of workplace health promotion (WHP) programmes. Although employee stress is often the target of WHP, reviews of job stress interventions suggest that the common approach to combating job stress is to focus on the individual without due consideration of the direct impacts of working conditions on health as well as the effects of working conditions on employees' ability to adopt and sustain 'healthy' behaviours. The purpose of the first part of this paper is to highlight the criticisms of the individual approach to job stress and to examine the evidence for developing strategies that combine both individual and organizational-directed interventions (referred to as the comprehensive approach). There is a risk that WHP practitioners may lose sight of the role that they can play in developing and implementing the comprehensive approach, particularly in countries where occupational health and safety authorities are placing much more emphasis on identifying and addressing organizational sources of job stress. The aim of the second part of this paper is therefore to provide a detailed description of what the comprehensive approach to stress prevention/reduction looks like in practice and to examine the means by which WHP can help develop initiatives that address both the sources and the symptoms of job stress.

Comprehensive Health Care↗
PubMed2003

Community participation in a multisectoral intervention to address health determinants in an inner-city community in central Havana.

It is increasingly acknowledged that the process of community involvement is critical to the successful implementation of community-based health interventions. Between 1995 and 1999, a multisectoral intervention called Plan Cayo Hueso was launched in the inner-city community of Cayo Hueso in Havana, Cuba, to address a variety of health determinants. To provide a better understanding of the political structures and processes involved, the Cuban context is described briefly. The interventions included improvements in housing, municipal infrastructure, and social and cultural activities. A qualitative study, consisting of interviews of key informants as well as community members, was conducted to evaluate the community participatory process. Questions from an extensive household survey pre- and postintervention that had been conducted in Cayo Hueso and a comparison community to assess the effectiveness of the intervention also informed the analysis of community participation, as did three community workshops held to choose indicators for evaluating effectiveness and to discuss findings. It was found that formal leaders led the interventions, providing the institutional driving force behind the plan. However, extensive community involvement occurred as the project took advantage of the existing community-based organizations, which played an active role in mobilizing community members and enhanced linkage systems critical to the project's success. Women played fairly traditional roles in interventions outside their households, but had equivalent roles to men in interventions within their household units. Most impressive about this project was the extent of mobilization to participate and the multidimensional ecosystem approach adopted. Indeed, Plan Cayo Hueso involved a massive mobilization of international, national, and community resources to address the needs of this community. This, as well as the involvement of community residents in the evaluation process, was seen as resulting in improved social interactions and community well-being and enhanced capacity for future action. While Cuba is unique in many respects, the lessons learned about enhancing community participation in urban health intervention projects, as well as in their evaluation, are applicable worldwide.

Community Health Planning↗
PubMedDate not supplied

Bateson's two Toronto addresses, 1921: 1. Chromosomal skepticism.

William Bateson gave two addresses at the Toronto meeting of the American Association for the Advancement of Science in December 1921. Although both were controversial, the text of the second, "The Outlook of Genetics," was never published. I present a transcript of a partial text and notes of this address in which Bateson explains, for the first time in public, a recent change in his views on the chromosome theory of heredity which resulted from a week spent with T. H. Morgan's group in New York en route to Toronto. He now accepts "the main essentials" but withholds assent from what he calls "the many extensions" of chromosome theory (such as linkage theory). He devotes considerably more space to discussing what he sees as difficulties precluding an unqualified acceptance of chromosome theory in its entirety. All in all, his tone is defiant rather than penitent.

Chromosomes↗
PubMedDate not supplied

Bateson's two Toronto addresses, 1921: 2. Evolutionary faith.

William Bateson's plenary address to the American Association for the Advancement of Science meeting in Toronto in 1921 was titled "Evolutionary Faith and Modern Doubts." In it he expressed his deep-seated skepticism about the causes of evolution (and in particular, his dissatisfaction with Darwinian natural selection) while reaffirming his belief in the reality of evolution itself. The address led to controversy at both the scientific and popular levels. Scientific criticism centered on Bateson's rejection of natural selection; popular controversy, as evidenced by contemporary newspaper clippings, was very widespread, not least because religious fundamentalists misrepresented Bateson in their campaign against evolution. I draw attention to the forgotten case of F.E. Dean, a superintendent of schools at Fort Sumner, New Mexico, who in 1922 was forced to resign his post for merely challenging a resolution of the local school board banning the teaching of evolution in schools. Dean deserves to be remembered, along with John T. Scopes, as an early hero of the continuing fight for the right to teach evolution in U.S. schools.

Biological Evolution↗
PubMed2001

Exploring the unique pharmacology of a novel opioid receptor, ZFOR1, using molecular modeling and the 'message-address' concept.

Previous studies have probed the structural basis of ligand selectivity in the mu, delta and kappa opioid receptors through the application of molecular modeling techniques in concert with the 'message-address' concept. Here, this approach was used in an attempt to rationalize the unique pharmacological profile of a recently cloned novel opioid receptor, ZFOR1 (ZebraFish Opioid Receptor 1). Specifically, a model of the transmembrane domains of ZFOR1 was constructed and used to explore the binding modes of various prototypical opioid ligands. The results show that the 'message' portion of the binding pocket of ZFOR1 is highly conserved; hence, the binding modes of non-selective opioid ligands are well preserved. In contrast, a small number of variant residues at the extracellular end of the binding pocket, particularly Lys288 (VI:26) and Trp304 (VII:03), are shown to create adverse steric interactions with all delta and kappa selective ligands examined, thereby disrupting their binding modes. These results are consistent with, and serve as an explanation for, the observed pharmacology of this receptor, lending support to both the validity of the 'message-address' concept itself and to the use of molecular modeling approaches in its application.

Animals↗
PubMed1999

Redesigning the surgery clerkship at MCP Hahnemann School of Medicine to address the educational needs of generalists.

This article describes how the surgery clerkship at MCP Hahnemann School of Medicine was redesigned to provide all students a well-rounded general professional education and to address the specific educational needs of generalists. During the 12-week clerkship, students spend eight weeks on two different general surgery rotations, which include significant experiences in outpatient settings. The evaluation and management of common general surgical problems, as well as the holistic approach to patient care, are emphasized. A nurse educator, recruited through funding obtained from The Robert Wood Johnson Foundation's Generalist Physician Initiative, provides formal instruction in holistic care and teaches bedside procedures. Two weeks are devoted to focused surgical subspecialty experiences addressing common conditions and are conducted primarily in outpatient settings. The remaining two weeks include an integrated musculoskeletal disease rotation, including orthopaedic surgery, rheumatology, physiatry, and radiology. Didactic teaching includes criteria for referral of patients from generalists to specialists. The new clerkship model has been well received by the students. Review of student logs for the first six months indicates the breadth of surgical experience has been maintained and appropriate balance achieved between simple and complex surgical cases. Further evaluation of the model will continue through longitudinal follow-up.

Clinical Clerkship↗
PubMedDate not supplied

Addressing barriers to health promotion in underserved women.

Underserved women face numerous barriers to adopting healthy eating behaviors. To develop effective health-promotion interventions for underserved women, barriers specific to the individual need should be addressed. Influenced by individual characteristics, experiences, and culture, different types of barriers (internal, interpersonal, and environmental) can overlap to impede healthy eating in underserved women. On the basis of literature review and qualitative research experiences with underserved women, 4 potential approaches for addressing barriers to health promotion were identified: (1) individualizing interventions; (2) developing collaborative partnerships within the community; (3) using positive deviance inquiry to build on community assets; and (4) changing public policy.

Adult↗
PubMed2005

Addressing the developmental and mental health needs of young children in foster care.

Research over the past two decades has consistently documented the high rates of young children entering the child protective services/child welfare system with developmental and mental health problems. There is an emerging evidence base for the role of early intervention services in improving outcomes for children with developmental and mental health problems in the general population that heavily relies on accurate and appropriate screening and assessment practices. The Child Welfare League of America, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry have all published guidelines concerning the importance of comprehensive assessments and appropriate referral to early intervention services for children entering out-of-home care. Recent federal legislation (P.L. 108-36) calls for increased collaboration between child welfare and public agencies to address the developmental and mental health needs of young children in foster care. This paper provides a framework for health, developmental, and mental health professionals seeking to partner with child welfare to develop and implement programs addressing these critical issues.

Child↗
PubMed2004

Decision and management algorithms to address patient and food and drug administration concerns regarding breast augmentation and implants.

During the U.S. Food and Drug Administration's advisory panel hearings to evaluate the premarket approval for conventional silicone gel implants on October 14 and 15, 2003, panel members and patient advocate representatives focused on four specific areas of concern: reoperation rates in primary breast augmentation; levels, depth, and methods of patient education and informed consent; modes, frequency, and management of silicone gel implant device failures, including management of "silent" ruptures; and methods of monitoring and managing symptoms or symptom complexes that may or may not be associated with connective tissue disease or other undefined symptom complexes. These concerns, with a reported 20 percent reoperation rate for primary augmentation within just 3 years, and a lack of concise, definitive management protocols addressing these areas of concern may have contributed to the Food and Drug Administration's rejection of the premarket approval, despite the panel's recommendation for approval. This article presents decision and management algorithms that have been used successfully for 7 years in a busy breast augmentation practice (Tebbetts and Tebbetts). The algorithms have been further expanded and refined by a group of surgeons with diverse experiences and expertise to address the following clinical situations that coincide with concerns expressed by patients and the Food and Drug Administration: implant size exchange, grade III to IV capsular contracture, infection, stretch deformities (implant bottoming or displacement), silent rupture of gel implants, and undefined symptom complexes (connective tissue disease or other). In one practice (Tebbetts and Tebbetts) that uses the TEPID system (tissue characteristics of the envelope, parenchyma, and implant and the dimensions and fill distribution dynamics of the implant), implant selection is based on quantified patient tissue characteristics, pocket selection is based on quantified soft-tissue coverage, and anatomic saline implants have fill volumes that are designed to minimize shell collapse and fold fatigue; in this practice, the algorithms contributed to a 3 percent overall reoperation rate in 1662 reported cases with up to 7 years of follow-up, compared with a 20 percent reoperation rate at 3 years in the 2003 premarket approval study.

Algorithms↗
PubMed2004

Effective trauma center partnerships to address firearm injury: a new paradigm.

BACKGROUND: Firearm violence is the second leading cause of injury-related death. This study examined the use of local trauma centers as lead organizations in their communities to address firearm injury. METHODS: Three trauma centers in cities with populations less than 100,000 were linked with a university-based firearm injury research center. A trauma surgeon director and coordinator partnered with communities, recruited and directed advisory boards, established a local firearm injury surveillance system, and informed communities using community-specific profiles. Primary process and outcome measures included completeness of data, development of community-specific profiles, number of data-driven consumer media pieces, number of meetings to inform policy makers, and an analysis of problems encountered. RESULTS: Local trauma centers in smaller communities implemented a firearm injury surveillance system, produced community-specific injury profiles, and engaged community leaders and policy makers to address firearm injury. Community-specific profiles demonstrated consistent firearm suicide rates (6.58-6.82 per 100,000) but variation in firearm homicide rates (1.08-12.5 per 100,000) across sites. There were 63 data-driven media pieces and 18 forums to inform community leaders and policy makers. Completeness of data elements ranged from 57.1% to 100%. Problems experienced were disconnected data sources, multiple data owners, potential for political fallout, limited trauma center data, skills sets of medical professionals, and sustainability. CONCLUSION: Trauma centers, when provided resources and support, with the model described, can function as lead organizations in partnering with the community to acquire and use community-specific data for local firearm injury prevention.

Adolescent↗
PubMed2000

The bacterial elicitor flagellin activates its receptor in tomato cells according to the address-message concept.

flg22, a peptide corresponding to the most conserved domain of bacterial flagellin, acts as a potent elicitor in plants. Here, we have used an iodinated derivative of flg22 ((125)I-labeled Tyr-flg22) as a molecular probe for the flagellin receptor in tomato cells. This radioligand showed rapid binding to a single class of specific, saturable, high-affinity receptor sites in intact cells and membrane preparations. Binding, although essentially nonreversible under physiological conditions, was not covalent, and chemical cross-linking was required to specifically label a single polypeptide of 115 kD. Intact flagellin and elicitor-active flagellin peptides but not biologically inactive analogs efficiently competed for binding of radioligand. Peptides lacking the C terminus of the conserved domain, previously found to act as competitive antagonists of elicitor action in tomato cells, also competed for binding of radioligand. Thus, this novel, high-affinity binding site exhibited all the characteristics expected of a functional receptor of bacterial flagellin. For a model of receptor activation, we propose a two-step mechanism according to the address-message concept, in which binding of the N terminus (address) is the first step and activation of responses with the C terminus (message) is the second step.

Alkalies↗
PubMed2006

A novel DDS using nonlinear ROM addressing with improved compression ratio and quantization noise.

This paper presents a novel direct digital frequency synthesis (DDFS) ROM compression technique based on two properties of a sine function: (a) piecewise linear technique to approximate a sinusoid, and (b) variation in the slope of the sinusoid at different phase angles. In the proposed DDFS architecture the ROM stores a few of the sinusoidal values, and the interpolation points between the successive stored values are calculated using linear and nonlinear addressing schemes. The nonlinear addressing scheme is used to adaptively vary the number of interpolation points as the slope of the sinusoid changes, leading to a greatly reduced ROM size. The proposed architecture achieves a high compression ratio with a spurious response comparable to that of recent ROM compression techniques. To validate the proposed DDS architecture, the linear, nonlinear, and conventional DDS ROM architectures were implemented in a Xilinx Spartan II FPGA and their spurious performances were compared.

Journal Article↗
PubMed2001

Addressing an idiosyncrasy in estimating survival curves using double sampling in the presence of self-selected right censoring.

We investigate the use of follow-up samples of individuals to estimate survival curves from studies that are subject to right censoring from two sources: (i) early termination of the study, namely, administrative censoring, or (ii) censoring due to lost data prior to administrative censoring, so-called dropout. We assume that, for the full cohort of individuals, administrative censoring times are independent of the subjects' inherent characteristics, including survival time. To address the loss to censoring due to dropout, which we allow to be possibly selective, we consider an intensive second phase of the study where a representative sample of the originally lost subjects is subsequently followed and their data recorded. As with double-sampling designs in survey methodology, the objective is to provide data on a representative subset of the dropouts. Despite assumed full response from the follow-up sample, we show that, in general in our setting, administrative censoring times are not independent of survival times within the two subgroups, nondropouts and sampled dropouts. As a result, the stratified Kaplan-Meier estimator is not appropriate for the cohort survival curve. Moreover, using the concept of potential outcomes, as opposed to observed outcomes, and thereby explicitly formulating the problem as a missing data problem, reveals and addresses these complications. We present an estimation method based on the likelihood of an easily observed subset of the data and study its properties analytically for large samples. We evaluate our method in a realistic situation by simulating data that match published margins on survival and dropout from an actual hip-replacement study. Limitations and extensions of our design and analytic method are discussed.

Arthroplasty, Replacement, Hip↗