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PubMed2006

Ecological factors associated with STD risk behaviors among detained female adolescents.

The authors used Bronfenbrenner's conceptual framework of an ecological systems model to examine factors that are independently associated with sexually transmitted disease (STD) risk behaviors among 280 sexually active detained female adolescents. Using computer-assisted self-interviewing procedures, the authors assessed individual characteristics, peer relations, community factors, and media influences and their association to STD risk behaviors. Findings indicated that factors such as greater substance use, stronger risk-taking attitudes, lower perceived parental monitoring and familial support, gender roles supporting male dominance, risky peer norms, and lower student-teacher connectedness, were independently associated with increased STD risk behaviors. Findings suggest a multisystemic approach to STD prevention among this population.

Adolescent↗
PubMed1998

Dealing with the news media: effective communication strategies for medical examiners.

Medical examiners have responsibilities that often result in news media coverage that can bring unwanted attention. Dealing with the news media is always a learning process, but various resources exist to help in maintaining credibility. Local offices should consider establishing proactive community relations and media relations programs. Appropriate steps should be taken to manage media relations, including the appointment of an official spokesperson and regular use of the prepared statement. This article also explores the benefits of being prepared for media interviews, offers advice for responding to the media following a mass disaster, and examines options for dealing with a media investigation. Medical examiners, coroners, investigators, and other forensic experts have responsibilities that frequently bring them in contact with the news media. Today, a crime scene investigation is not complete without media attention. We now live in an era of "CNN journalism," in which local investigations may be propelled into the national spotlight. Unfortunately, the result can be unwanted attention. What resources can medical examiners rely on to better manage the news media? What can you do to maintain credibility? There are a number of options available, all of which can easily put into practice.

Communications Media↗
PubMedDate not supplied

Evaluation of early airway disease in smokers: cost effectiveness of pulmonary function testing.

We studied 73 young adults who were presently cigarette smokers to evaluate whether the identification of abnormalities in pulmonary function tests had a detectable influence on modification of smoking habits. Utilizing rate schedules for these tests presently applicable in Rochester, New York, we determined the potential cost to these subjects and community relative to the number of subjects who stopped smoking as a result of test findings. Subjects were evaluated by questionnaire and function testing including spirometry, flow-volume curves, body plethysmography and single breath nitrogen washout test (SBN2). Functional abnormalities were present in 75% of subjects screened. The SBN2 test was most sensitive, identifying 97% of subjects with any abnormality. The presence of common respiratory symptoms was found to be highly predictive of test abnormalities. Subjects were informed of results and counseled. At six-month follow-up, 7% of subjects with abnormal test results had stopped smoking. Utilizing even our most cost-effective test, the SBN2, it would cost +1,392 for each "benefit" defined as one subject not smoking for six months. Application of these screening techniques is unlikely to be effective in altering smoking habits in the absence of continued physician support.

Adult↗
PubMed2002

Malpractice risk prevention for primary care physicians.

The recent medical malpractice "crisis" has seen skyrocketing liability premiums and increasing fear of liability. Primary care physicians, especially family medicine and internal medicine physicians, have historically experienced low rates of malpractice claims, both in number and amount of payment. This can be attributed to several factors: the esteem held by internal medicine and family medicine physicians in their communities, relatively low numbers of invasive procedures, reluctance of patients to include "their" primary care physician in any potential litigation, and, probably most importantly, the atmosphere of mutual trust and communication between the internist or family physician and the patient. Recent years have seen this trend erased, as insurance industry data suggest primary care physicians presently face significant potential exposure for medical malpractice claims. It is imperative that primary care physicians take steps to insure they are adequately covered in case of a malpractice claim and that they practice aggressive but appropriate risk management to lessen the likelihood of a claim.

Humans↗
PubMed1978

Observations on the vegetation of northeastern Mato Grosso II. Forests and soils of the Rio Suiá--Missu area.

The vegetation of the well drained soils along the Suiá--Missu road in the Serra do Roncador region of NE Mato Grosso is Evergreen Seasonal forest of Amazonian type. The area lies close to the meeting place of the Amazonian forest (the hylaea) and the cerrado (savanna) formation of Central Brazil. The structure of the forest is simple: the canopy is at about 18--23 m, and is exceeded by a few scattered emergents; no recognizable strata can be distinguished among the understorey trees and the shrub and herb layers are sparse. Table 1 lists the most important species and gives information on stratification and general distribution. Most of the species appear to have a hylaean centre of distribution but extend into other vegetation types. The forest differs from related communities which lie closer to the cerrado/forest boundary in its greater height and luxuriance, the presence of additional tall tree species, and the great reduction in abundance of a cerrado floristic element. A survey on the Xavantina--São Felix road allowed us to extend previous observations on the distance to which the cerrado tree Pterodon pubescens extends into the forest. The results obtained indicate a considerable extension of forest into cerrado during the life of an individual tree. A characteristic low forest occurs in the flood plain of the Rio Suiá--Missu while Swampy Gallery forests occur on permanently waterlogged soils around the headwaters of streams. The well drained soils of the Suiá--Missu forest are very uniform, deep latosols (oxisols) of very dystrophic nature with pH (in water) between 4.0 and 5.0 (see table 2, p. 203).

Brazil↗
PubMedDate not supplied

Molecular identification of nanoplanktonic protists based on small subunit ribosomal RNA gene sequences for ecological studies.

Nanoplanktonic protists are comprised of a diverse assemblage of species which are responsible for a variety of trophic processes in marine and freshwater ecosystems. Current methods for identifying small protists by electron microscopy do not readily permit both identification and enumeration of nanoplanktonic protists in field samples. Thus, one major goal in the application of molecular approaches in protistan ecology has been the detection and quantification of individual species in natural water samples. Sequences of small subunit ribosomal RNA (SSU rRNA) genes have proven to be useful towards achieving this goal. Comparison of sequences from clone libraries of protistan SSU rRNA genes amplified from natural assemblages of protists by the polymerase chain reaction (PCR) can be used to examine protistan diversity. Furthermore, oligonucleotide probes complementary to short sequence regions unique to species of small protists can be designed by comparative analysis of rRNA gene sequences. These probes may be used to either detect the RNA of particular species of protists in total nucleic acid extracts immobilized on membranes, or the presence of target species in water samples via in situ hybridization of whole cells. Oligonucleotide probes may also serve as primers for the selective amplification of target sequences from total population DNA by PCR. Thus, molecular sequence information is becoming increasingly useful for identifying and enumerating protists, and for studying their spatial and temporal distribution in nature. Knowledge of protistan species composition, abundance and variability in an environment can ultimately be used to relate community structure to various aspects of community function and biogeochemical activity.

Animals↗
PubMed2004

Comparative performance data for critical access hospitals.

CONTEXT: Among small rural hospitals, there is a growing recognition of the need to measure and report on the use of resources and the safety and quality of the services provided. Dashboards, clinical value compasses, and balanced scorecards are approaches to performance measurement that have been adopted by many health care organizations. However, there exists very little comparative performance data specific for critical access hospitals. PURPOSE: To identify how comparative performance data for critical access hospitals (CPD-CAH) might facilitate performance and quality improvement, to assess the potential benefits and drawbacks of such data, and to identify some of the critical issues in the development and implementation of CPD-CAH. METHODS: Assessment of discussions by participants at a rural hospital performance improvement summit and authors' analyses. FINDINGS: CPD-CAH potentially could improve quality of care and patient outcomes, provide comparative data and benchmarks, inform policy development, facilitate collaboration, and enhance community relations. However, CPD-CAH could also impose an unaffordable cost, produce poor information, require complex coordination, induce a negative public reaction, and result in perverse hospital behavior. Development and implementation of CPD-CAH would require including stakeholders' assessment of its desirability and feasibility, setting objectives, establishing guiding principles, developing a method, collecting and analyzing data, and disseminating results. CONCLUSIONS: CPD-CAH could significantly advance CAH performance and quality improvement. However, development and implementation would be a complicated exercise requiring academic expertise and practitioner consultation. The potential value of CPD-CAH should be carefully weighed against its potential cost.

Benchmarking↗
PubMed1997

Aspects of assessment and management of velopharyngeal dysfunction in developing countries.

Proper assessment of patients with velopharyngeal valve incompetence is a mandatory prerequisite for optimal management. The protocol of assessment of Ain Shams University, Phoniatric Department, uses three levels of assessment of velopharyngeal valve incompetence according to the complexity of the armamentarium used. This allows application of those parts of the protocol that suit the needs of the different socioeconomic levels and geographical locations. Firstly, the elementary diagnostic procedures, which are rather simple, noninvasive, but essentially subjective. Despite the clinical feasibility of these procedures, documentation of the data is made utilizing the tools at the second level of assessment in that protocol (clinical diagnostic aids). This level comprises video-nasofiberscopy and high fidelity voice recording. An attempt to extract quasi-quantitative measures from the hitherto qualitative video-nasofiberscopy is made. The third level of assessment, namely additional instrumental measures, comprises CT scanning of the velopharyngeal port, aerodynamics, and acoustic analysis. The results of the three levels of the protocol are presented. Their significance and clinical efficacy are discussed. Some community-related problems that have faced the cleft palate team are outlined. Their sociocultural significance in a developing country is discussed.

Adult↗
PubMed2005

Condom use predictors for low-income African American women.

The purpose was to investigate whether an HIV-prevention curriculum and a health maintenance curriculum produced different rates of change in reported consistent condom use and to explore what mediating variables predicted reported consistent condom use over time. A longitudinal crossover research design with extended posttest observations was used with a sample of 279 African American women. After pretesting, women received the designated curriculum and were posttested at completion, 3, 6, and 9 months. After the 9-month posttest, the curriculum was switched, and the above procedure was repeated. Using SAS macro GLIMMIX, the data revealed that the HIV curriculum yielded higher consistent condom use than did the health maintenance curriculum and that the mediating variables that predicted consistent condom use over time were self-efficacy for low-risk HIV behavior, HIV-related community behavior, and social norms. Enhancing consistent condom use over time may require the promotion and reinforcement of these mediating variables.

Adult↗
PubMedDate not supplied

A short impact of epidemiological features of colorectal cancer in Iran.

AIMS AND BACKGROUND: The incidence of colorectal cancer varies from one country to another although the variation is not much different in neighboring countries. Even in one country there is no relevant variation in incidence from one province to another. A study of different provinces in a vast developing country, Iran, was performed to determine the incidence of colorectal cancer. METHODS: Information from cancer registries of four provinces in the north, north-west and central-south of Iran regarding colorectal cancer was gathered for analysis. A total of 1628 cases with colorectal cancer in a total population of 6,435,549 was identified. RESULTS AND CONCLUSIONS: In all provinces, there were more male than female patients with colorectal cancer. The study also showed that the incidence of the disease in young patients was higher than expected. Except for Israel because of genetic factors, these provinces showed one of the highest ASR among Asian countries. This finding probably indicates more westernization in the Iranian diet with a genetic influence. Some social habits including dietary and tobacco smoking may also influence the incidence of colorectal cancer in the Iranian population. Community-related risk factors need further investigation, especially in the high-risk Northern part of the country.

Colorectal Neoplasms↗
PubMed1991

The effects of rooming-in on the success of breastfeeding and the decline in abandonment of children.

This study analyzed the effect of management of rooming-in, conducted in one of the regional hospitals in Thailand, on the success of breastfeeding. Data based on 2,000 infants born in 1987 and 1990 showed a significant improvement on separation time of infant and mother after delivery and predominant breastfeeding, where the infant's predominant source of nourishment has been breastmilk. Separation time was reduced from 6.3 +/- 3.2 to 1.62 +/- 0.42 hours and predominant breastfeeding was significantly increased from 85 to 99 percent. Data obtained from the community related to the initiation and predominant breastfeedings showed a significant increase (p less than 0.05). No significant difference was demonstrated, however, on current breastfeeding among infants who were delivery before and after initiation of the rooming-in system. Also analyzed were data on prevalence of deserted children. The findings showed a progressive reduction of deserted children after management of rooming-in. The study concludes that the practices of obstetricians were a key to successful breastfeeding. Promotion and management of rooming-in significantly improves the success of breastfeeding and reduction of deserted children in the hospital.

Breast Feeding↗
PubMed2002

Examining ethics in practice: health service professionals' evaluations of in-hospital ethics seminars.

This article reviews practitioners' evaluations of in-hospital ethics seminars. A qualitative study included 11 innovative in-hospital ethics seminars, preceded and followed by interviews with most participants. The settings were obstetric, neonatal and haematology units in a teaching hospital and a district general hospital in England. Fifty-six health service staff in obstetric, neonatal, haematology, and related community and management services participated; 12 attended two seminars, giving a total of 68 attendances and 59 follow-up evaluation interviews. The 11 seminars facilitated by an ethicist addressed the key local concerns of staff about the social and ethical consequences of advances in genetics and their impact on professional policies and practice. Seminar agendas were drawn from prior interviews with 70 staff members. During evaluation interviews, participants commented on general aspects that they had enjoyed, how the sessions could be improved, timing, the mix of participants, the quality of the facilitation, whether sessions should be more challenging, after-effects of sessions, and interest in attending seminars and contacting the ethicist in future. Participants valued the increased interprofessional understanding and coherent discussion of many pressing issues that addressed important though seldom discussed ethical questions. The seminars worked well in the different hospitals and specialties.

Bioethical Issues↗
PubMed1994

Knowing and acting in medical practice: the epistemological politics of outcomes research.

Recent health care policymaking favors outcomes research as a response to the putative ineffectiveness, as well as the undeniable expense, of American medicine. This small-scale ethnographic study conducted in a department of internal medicine evaluates claims that probabilistic knowledge will improve clinical practice. It finds that physicians are primarily determinists and that although they reason probabilistically in some instances, they rely on personal experience over research data at these times; that doctors view outcomes research as useful but not definitive and in no way immune to the social influences on medical knowledge generally; and that their mix of determinism and probabilism is well suited to the nature of medical work. The recent ascendancy of outcomes research is as much political as scientific, empowering the research community relative to practicing physicians, lending medical legitimacy to payer-promulgated practice guidelines, and creating additional clinical work around a false standard of medical certainty.

Attitude of Health Personnel↗
PubMedDate not supplied

Home health services for the elderly: the English way.

Strengthening home health and related community services for the care of the elderly at home has received high priority in policy statements on the National Health Service. Findings from a series of recent studies and reports on these issues are reviewed, highlighting accomplishments and problems of primary health care teams, especially the district nurses, and the many other contributing community services. Seven lessons are discussed, emphasizing the relationships among home health and other community services, the importance of voluntary services, the impact of hospital and psychiatric services, needs for special training, difficulties of cost analyses, and the slow pace of progress.

Aged↗
PubMed2006

Do U.S. family planning clinics encourage parent-child communication? Findings from an exploratory survey.

CONTEXT: Clinics that receive Title X funding have a mandate to encourage parent-child communication for minors seeking family planning services. Little is known about the programs and practices that clinics have adopted to achieve this goal, or whether clinics not receiving Title X funds encourage family participation. METHODS: As part of a larger project examining parental engagement among adolescents using family planning clinics, 81 clinics that served 200 or more adolescent contraceptive clients in 2001 completed a questionnaire containing closed- and open-ended items. Topic areas included clinic counseling and policies regarding clients younger than 18, activities to improve parent-child communication and community relations. Frequency distributions were calculated for the prevalence of activities, and cross-tabulations were used to compare prevalence by clinic characteristics. RESULTS: Every clinic engaged in at least one activity to promote parent-child communication, and nine in 10 offered multiple activities. Most of the clinics used counseling sessions to talk to adolescent clients about the importance of discussing sexual health issues with parents (73-94%, depending on the reason for the visit). More than eight in 10 clinics (84%) distributed pamphlets on how to talk about these issues. A substantial minority (43%) offered or referred interested individuals to educational programs designed to improve communication. Some of these exploratory findings reflect the prevalence of activities among all U.S. family planning clinics that serve adolescent clients. CONCLUSIONS: Evaluation and expansion of clinic efforts to promote voluntary communication about sexual health issues between parents and children could help encourage family participation.

Adolescent↗
PubMed2005

TOPS: the Optimum Performance Scale approach to improving nursing home performance.

Although nursing homes, a major and expensive institution in American life, are dedicated to caring for our elders when they need nursing care, they largely fail in that mission. Instead, nursing homes are widely feared as the place where elders go to die, neglected. Staffing is chronically short, as staff do not see nursing homes as preferred places to work. Society's efforts to cure this situation have generally failed, in that we all paid for decades of foundation support, academic research, expert consultants, and government financial support and regulation in an effort to improve nursing homes, without getting significant results. Nursing homes taken as a whole have proven strongly resistant to even incremental improvements, let alone wholesale change, and as a result the failure persists. Most nursing homes are blind to the possibility of success. The issue and problem highlighted by these general failures of outside pressure to bring improvement, coupled with general blindness to potential success is: How can we get the nursing home industry to improve itself. The response outlined in this article is TOPS, The Optimum Performance System. TOPS works by delivering to participating managers (and their staff and board) a personal computer application (the TOPS Tool) that compares the performance of the participant to its peers, including descriptions of what all participants have done to produce their performance. The comparison is holistic, measuring all the main components of performance (quality of living medical health, and cost) and all the sources of performance (management and operations, facilities, and community relations). The instinctual competitive needs of each manager will urge them to use this knowledge to improve their own performance.

Aged↗
PubMed1984

Leisure-dance instruction for severely and profoundly retarded persons: teaching an intermediate community-living skill.

We evaluated an approach for teaching an intermediate community living skill via a leisure-dance activity to institutionalized severely and profoundly retarded persons. The targeted skill was considered as intermediate in contrast to a community living skill per se because it was based on successful performances of higher functioning, noninstitutionalized retarded persons as opposed to nonhandicapped individuals. Definitions for appropriate dancing were established and then validated through observations of the performance of retarded persons living in the local community. The dance skills were then taught to four participants through serial training in leg movements, arm movements, and coordinated leg and arm movements, plus follow-up trainer supervision. Generalization was also programmed by way of multiple trainers and training settings. Results during structured assessments showed that all four residents acquired the dance skills and that both serial training and follow-up supervision were necessary for skill acquisition. Generalized increases in appropriate dancing at dances attended by the participants and retarded persons from the community were also demonstrated. However, in most cases some active supervision by caregivers was needed to enhance the generalized improvements. Results are discussed in terms of the applicability of this approach for validating goals when training other community-related skills to low-functioning populations.

Adolescent↗