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Pathways, a culturally appropriate obesity prevention study for third-, fourth-, and fifth-grade American Indian schoolchildren includes an intervention that promotes increased physical activity and healthful eating behaviors. The Pathways intervention, developed through a collaboration of universities and American Indian nations, schools, and families, focuses on individual, behavioral, and environmental factors and merges constructs from social learning theory with American Indian customs and practices. We describe the Pathways program developed during 3 y of feasibility testing in American Indian schools, with special emphasis on the activities developed for the third grade; review the theoretical and cultural underpinnings of the program; outline the construction process of the intervention; detail the curriculum and physical education components of the intervention; and summarize the formative assessment and the school food service and family components of the intervention.
Printed materials meant to convey health messages are apt to make a more striking and lasting impression on their audience if they are well illustrated. But coming up with good illustrations takes time, effort and care. The Program for Appropriate Technology in Health (PATH) has found that the best way of ensuring that illustrations will be understood and accepted is to develop them with the help of representatives of the target audience.
It is a truism of health education that programs and interventions will be more effective when they are culturally appropriate for the populations they serve. In practice, however, the strategies used to achieve cultural appropriateness vary widely. This article briefly describes five strategies commonly used to target programs to culturally defined groups. It then explains how a sixth approach, cultural tailoring, might extend these strategies and enhance our ability to develop effective programs for cultural groups. The authors illustrate this new approach with an example of cultural tailoring forcancer prevention in a population of lower income urban African American women.
This article has two goals: (1) to outline a conceptual model for culturally appropriate HIV prevention capacity building; (2) to present the experiences from a 3-year program provided by Asian Pacific AIDS Intervention Team to Asian Pacific Islander (API) organizations in southern California. The participating organizations were of two types: lesbian, gay, bisexual, transgender, and questioning (LGBTQ) social organizations and social service agencies not targeting LGBTQ. These organizations were selected for participation because of their commitment to HIV/AIDS issues in API communities. An organizational survey and staff observations were used to explore changes in capacity. The organizations were mostly small, targeted diverse populations, served a large geographic area (southern California as a region), and were knowledgeable about HIV. Organizations became more viable (more capacity in human resources, financial, external relations, and strategic management), but also more unstable (large growth in paid staff and board members), and showed more capacity in HIV knowledge environments (especially less stigma and more sensitivity to diverse populations). The results suggest that capacity can expand over a short period of time, but as capacity increases, organizational viability/stability and HIV knowledge environments change, meaning that different types of technical assistance would be needed for sustainability.
Individuals with anxiety disorders experience substantial delays in obtaining treatment, but little is known about whether people with specific anxiety subcategories are differentially affected. The present study used a modified Encounter Form to examine the cause and length of delays in reaching primary care and specialist services amongst patients with panic disorder (PD/PD-Ag), social phobia (SP), and generalized anxiety disorder (GAD). Participants were 142 consecutive patients attending a specialist anxiety clinic in South Western Sydney. On average, participants with SP took much longer to consult a primary health care provider. Primary care assessments of those with SP often failed to detect anxiety as the key problem, and subsequently, those with SP reported longer delays in reaching specialist care (>9 years). It is not possible to extrapolate the findings to all individuals with SP, as the study was based on specialist service attenders. Nevertheless, the data supports previous findings in suggesting that SP may not be well-recognized as a disorder needing treatment, either by the patient or the primary health care provider. Appropriate educational programs seem warranted to ensure appropriate treatment for this condition.
Published reports of several statewide and hospital-based systems for universal newborn hearing screening demonstrate that successful large-scale programs that appropriately identify infants with hearing loss in the earliest months of life can be developed. These programs are characterized by nursery-based screening rates of 95% or higher, referral rates of 6% or less, and reasonable per-infant costs. Less data are available regarding the outcome of these screening programs in ensuring confirmation of hearing loss by 3 months of age and initiation of intervention by 6 months of age. The results of the MDNC survey provide important information on the status of newborn hearing screening, audiologic assessment, and intervention services in 16 states. The survey reveals that hospitals have initiated universal newborn hearing screening programs using appropriate technology but that confirmation of hearing loss, fitting of amplification, and enrollment in early intervention are often delayed beyond the JCIH recommendations. Several factors might contribute to late confirmation of hearing loss and delayed amplification and intervention. First, as shown in the Colorado report, lack of a mandatory statewide system for tracking and reporting may delay transition of infants and families from screening to diagnosis, and diagnosis to intervention. In addition, many states lack a centralized system for reporting confirmed hearing loss. Successful statewide programs for universal newborn hearing screening, audiologic diagnosis, and early intervention depend on data-reporting strategies that facilitate transition of infants and families through a system of care. Second, lack of understanding about the urgent need for intervention in the earliest months of life may hinder referral to early intervention programs. Recent data from Colorado's universal newborn hearing screening program reveals that infants who are deaf or who have hearing losses achieve significantly better language development outcomes if intervention begins before age 6 months than infants whose intervention begins after 6 months of age. Hopefully, as these data become more widely available, the compelling need for early intervention will facilitate transition into these services. Although universal newborn hearing screening programs are increasing rapidly, states have not yet developed the coordinated systems for linking universal newborn hearing screening programs to audiologic diagnostic services and audiologic diagnostic services to early intervention programs. Key issues impeding development of these systems may be lack of tracking and reporting systems, lack of standardized guidelines for screening, diagnostic audiologic assessment, hearing aid fitting for very young infants, and lack of understanding about the compelling need for intervention in the earliest months of life. Development of complete systems of care must become a priority for universal newborn hearing screening to provide its ultimate benefit.
First-line managers (head nurses) are increasingly accountable for all aspects of nursing care delivery and resource management on a unit. However, traditional methods of training head nurses may not adequately prepare them to meet their increasing responsibilities. A structured first-line manager development program can help correct this deficiency. However, the successful implementation of such a program requires an understanding of organizational culture as well as substantive knowledge about management. This article describes how a hospital-based first-line manager development program was designed and implemented by using strategies appropriate to the values, norms, and resources within the organization.
Levels-of-analysis issues arise whenever individual-level data are collected from more than one person from the same dyad, family, classroom, work group, or other interaction unit. Interdependence in data from individuals in the same interaction units also violates the independence-of-observations assumption that underlies commonly used statistical tests. This article describes the data analysis challenges that are presented by these issues and presents SPSS and SAS programs for conducting appropriate analyses. The programs conduct the within-and-between-analyses described by Dansereau, Alutto, and Yammarino (1984) and the dyad-level analyses described by Gonzalez and Griffin (1999) and Griffin and Gonzalez (1995). Contrasts with general multilevel modeling procedures are then discussed.
In 1986 73,400 new cases of invasive gynecologic cancer and 45,000 new cases of in situ carcinoma of the uterine cervix (about 9% of all cancers in women) were diagnosed in the US. A significant proportion of these patients die of local failure. In dealing with the wide variety of gynecologic cancers, extreme care must be used in choosing the appropriate treatment program for each problem. Therefore, the full extent of the disease at the time of initial presentation and recurrence must be determined. It is only with these data that appropriate treatment programs can be designed with the maximum potential for long-term control or cure and with the minimum in treatment complication. There are no groups of disease processes like those seen in advanced or recurrent gynecologic cancer that offer such a challenge to the clinical practitioner.
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Obesity as a chronic condition among large numbers of people is a disease of recent origin, often but by no means always associated with dietary habits and sedentary lifestyle. Many obese people want to lose weight, and may have tried to do so numerous times with self-help or proprietary weight-loss programs. When they seek a physician for help in losing weight-or when a physician advises an obese patient to lose weight as part of a clinical strategy-care must be taken to "match" the patient to an appropriate therapeutic program with appropriate therapeutic goals. History and physical examination and psychologic evaluation are essential elements of patient screening. Complications of obesity must be taken into account in any treatment plan. The multidisciplinary management strategy is most likely to succeed in helping the patient lose weight. It also avoids untoward events associated with complications or concomitant disease. The multidisciplinary approach is especially important when the patient does not lose weight, and alternative strategies must be considered, such as surgical approaches.
Pre- and postnatal prevention programs may significantly improve the oral health of mother and child. The overall aim of this project was to assess the need for and develop an oral health promotion program for low-income immigrant pregnant women in New York City. Results from the baseline survey showed very low awareness of the importance of maternal oral health and its relationship to an infant's general and oral health among the participants. Based on these results, we developed culturally appropriate educational materials and workshops to promote oral health among pregnant women. As of September 2005, we had conducted more than 500 workshops, distributed educational packages to close to 10,000 women and disseminated about 20,000 brochures in four languages to health care centers and maternal health centers across New York State.
People often think that "technology" means "machines". But according to WHO a technology is an association of methods, procedures, techniques, and equipment which, together with the people using them, can contribute to solving a health problem. An appropriate technology is one that is scientifically sound, adapted to local needs, acceptable to those who use it or for whom it is used, and that can be maintained and utilized with resources that the community can afford. Many different technologies have contributed enormously to reducing maternal and perinatal mortality and morbidity. Yet, very often, not enough attention is paid to the economic, human, and infrastructure implications of the technology or to the implications of introducing it into a new setting. This issue of Safe Motherhood looks at some of the technologies currently widely available in maternal and neonatal health care and asks two simple questions. Has this technology been evaluated in different settings? And at which level of the health care system can this technology be used appropriately?
Our clinical experience agrees with most of the recent literature that infants with an apparent life-threatening event (ALTE) form a heterogeneous entity. A specific medical or surgical cause for the event could be found in 61% of the cases. Only 14% of the infants with an apparently severe event entered a home monitoring program. The other infants were treated whenever appropriate. All infants survived the first year of life. Home monitoring was shown to require continuous assistance to the parents. The follow-up of the infants up to 10 years after the ALTE reveals no neurodevelopmental abnormality in most of the infants. A systematic exclusional study of the infants with an ALTE, together with appropriate treatment programs, could thus provide the possibility of a good survival for most infants.
The treatment received by children aged under 5 years with diarrhoea was studied in the Hospital Infantil de México (Federico Goméz), Mexico City. The costs of treatment were calculated and estimates were made of how these had changed since the establishment of an oral rehydration unit in the hospital in 1985. The results indicate that drug treatment of outpatients was generally appropriate and inexpensive. In contrast, the cost of drugs for inpatients was considerably higher. The seriousness of the cases justified much of this additional expense for inpatients, but there is evidence that the costs could be reduced further without jeopardizing the quality of the care. Diagnostic tests were relatively expensive, frequently failed to identify diarrhoeal etiology, and their results correlated poorly with the treatment prescribed. The oral rehydration unit resulted in significant savings by causing a 25% fall in the number of inpatients with diarrhoea.