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PubMed1990

Aphasic and tactile--perceptual deficits of disabled readers.

As part of a psychoeducational battery, 36 children, referred for reading and/or other learning difficulties, were administered the Aphasia Screening Test. the Tactile Finger Recognition Test, and the Finger-tip Number Writing Perception Test from the Halstead-Reitan Neuropsychological Test Battery for Older Children. The children were divided into two groups: 18 determined on the basis of a severe discrepancy to be eligible for learning disabilities services in the area of reading (RD) and 18 determined to be ineligible for such services (NRD). Statistical comparisons of the two groups revealed the RD group to display significantly more impairment on the Aphasia Screening Test and the Finger-tip Number Writing Perception Test.

Journal Article↗
PubMed2005

The effect of the presence of others on caloric intake in homebound older adults.

BACKGROUND: Undernutrition in homebound older adults is a significant problem. The purpose of this study was to investigate the effect of the presence of others, both within the household and during meals, on caloric intake in homebound older adults. METHODS: In-depth interviews and three 24-hour dietary recalls were obtained from 50 older adults who were receiving home health services. Descriptive statistics were used to characterize participants, and hierarchical linear modeling was performed to evaluate predictors of caloric intake per meal. RESULTS: Participants' mean age was 77. Females composed 65% and African Americans composed 42% of the sample. Analyses are based on 553 meal observations. The majority (84%) of participants consumed all meals for each of the 3 days of data collection; however, they consumed an average of only 1305 calories per day. Hierarchical linear modeling analysis indicated that persons who had others present during meals consumed an average of 114.0 calories more per meal than those who ate alone (p =.009) and that women consumed 76.7 fewer calories per meal than did men (p =.045). The presence of others within the household had no effect on caloric intake. CONCLUSION: This research suggests that a simple and inexpensive way to increase caloric intake in homebound older adults is to make arrangements for family members or caregivers to eat with them.

Aged↗
PubMed2000

The Western Australian School Health Project: comparing the effects of intervention intensity on organizational support for school health promotion.

The aim of this study was to evaluate changes in school health promotion practice related to two levels of intervention in the Western Australian School Health (WASH) Project: (1) a low-intensity intervention involving a single mail-out of WASH Project resources, and (2) a high-intensity intervention involving training, planning time and expert support. The schools involved in the study were divided into three groups. Treatment group 1 received the high-intensity intervention, treatment group 2 received the low-intensity intervention and a comparison group received no intervention. Two scales were developed to assess change, i.e. a school organizational scale (Chronbach's alpha = 0.76) and a health promotion activity scale (Chronbach's alpha = 0.79). The results indicate that a high-intensity intervention, such as the WASH Project, which provides training to a critical mass of school community members from each school, ongoing access to an expert in the field, as well as dedicated planning time, is able to increase the comprehensiveness and quality of health strategic planning by schools. Furthermore, the results suggest that a low-intensity mail-out intervention is no more successful in initiating change that providing no intervention at all.

Adolescent↗
PubMed1990

Evaluation of a village health worker programme: the use of village health worker retained records.

A village health worker (VHW) programme in a rural area in South Africa is evaluated, a year after the introduction of VHW-retained child record cards. The programme's success in promoting immunization and breastfeeding and the coverage of and contact with the community by the VHWs was investigated. A population survey on children under one year was matched to VHW records, showing that VHWs were reaching 70.8% of the target population. VHWs were more likely to visit a child with a Road to Health Card (RTHC) and who was born in the village. VHWs generally visit mothers once a month and make contact with most children in their first month of life. Children born before the start of the new VHW programme were compared with those born after, using survival analysis techniques and data from the RTHC on the first year of life of all children under two. An increase in polio immunization coverage was detected but there was a drop in measles immunization coverage. We conclude that a VHW-retained child record for the first year of life plays a valuable role in ongoing health care evaluation.

Breast Feeding↗
PubMed2004

Feeding patterns, diarrhoeal illness and linear growth in 0-24-month-old children.

The aim was to study the impact of simple healthcare interventions in 0-24-month-old children living in rural communities outside Lahore, Pakistan. Newborns belonging to four birth cohorts were followed monthly from 0-24 months of age living in rural communities. Three cohorts were from the same village: Cohort A (1984-1987), n = 485; Cohort B (1990-1992), n = 544; and Cohort C (1995-1997), n = 518. A fourth, Cohort D, was from neighbouring villages (1995-1997), n = 444. Findings from Cohort A formed the basis of a healthcare programme, including promotion of optimal breastfeeding practices, advice on oral rehydration therapy, and continued feeding during diarrhoea. The outcome measures studied were time of initiation of breastfeeding, feeding of prelacteals, exclusive breastfeeding, diarrhoeal illnesses, and postnatal linear growth. The median time of initiation of breastfeeding decreased from 47 to 3 h and exclusive breastfeeding increased from 5 per cent in Cohort A to more than 80 per cent in the subsequent cohorts, at 1 month of age. No prelacteals were given to 34 per cent of newborns in later cohorts compared with 100 per cent in Cohort A. Diarrhoeal illnesses during the first 6 months had reduced significantly. Postnatal linear growth improved by about 3 cm in the later cohorts. Appropriate changes in breastfeeding practices through integrated and focused healthcare, especially antenatally, can reduce diarrhoeal illnesses, and sustain and improve linear growth in young children.

Breast Feeding↗
PubMed1998

Improving quality of sexually transmitted disease case management in rural South Africa.

OBJECTIVE: To measure quality of sexually transmitted disease (STD) syndromic case management and aspects of health-seeking behaviour at baseline in an intervention trial. SETTING: Ten rural primary care clinics, Hlabisa district, South Africa. DESIGN: Simulated patients (fieldworkers trained to present with STD syndromes) made a total of 44 clinic visits; 49 STD patients were interviewed when exiting clinics; facilities were assessed for availability of necessary equipment and drugs; 10 focus group discussions were held with staff; and STD syndrome surveillance was performed in all 10 clinics. RESULTS: A total of 9% of simulated patients were correctly managed (given correct drugs, plus condoms and partner notification cards), recommended drug treatment was given in only 41% of visits, and appropriate counselling was given in 48% of visits. Among patients leaving the clinic, although 39% waited over an hour to be seen and only 37% were consulted in private, all reported staff attitudes as satisfactory or good. Only six clinics had syndromic management protocols available, three reported intermittent drug shortages, and seven lacked partner notification cards. Focus group discussions revealed good staff knowledge about STD, but showed lack of training in syndromic management and low morale. Surveillance data showed that while 75% of those presenting for care did so within 1 week of symptom onset, 27% had been treated for an STD in the preceding 3 months, and only 6% of those treated were contacts. CONCLUSIONS: Quality of STD case management was poor despite good staff knowledge and availability of most essential resources. An intervention comprising staff training and STD syndrome packets has been designed to improve quality of case management.

Case Management↗
PubMed2001

School-based behavioral treatment for social anxiety disorder in adolescents: results of a pilot study.

OBJECTIVE: To provide preliminary estimates of feasibility and effectiveness for school-based behavioral treatment in adolescents with social anxiety disorder. METHOD: Six adolescents with social anxiety disorder were treated in a 14-session group treatment program conducted at their school. Assessments were conducted at baseline and after treatment. RESULTS: All participants were classified as treatment responders (markedly or moderately improved). Half of the participants did not meet diagnostic criteria for social phobia after treatment. Clinician severity ratings, as measured by the Anxiety Disorders Interview Schedule for Children for DSM-IV: Child Version and the Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA), decreased significantly after intervention, with effect sizes of 2.5 and 1.8, respectively. All LSAS-CA scale scores decreased significantly after treatment. Self-reported social phobia symptoms on the Social Phobia and Anxiety Inventory for Children were not significantly reduced. Fear and avoidance ratings of the 10 most feared situations significantly decreased after treatment, with effect sizes of 1.5 for anxiety and 2.1 for avoidance. CONCLUSIONS: This study provides preliminary support for the promise of school-based behavioral intervention for treating social phobia in adolescents. The school environment may be a rich and innovative setting for implementation of behavioral treatment because this is the setting where adolescents with social phobia endure the most distress.

Adolescent↗
PubMed1989

The use of oral hydration in the treatment of children with acute diarrhea in primary care.

The use of oral rehydration solutions (ORSs) for treating children with diarrhea is spreading in hospitals in Chile, but it has not yet been incorporated into routine primary care programs. We sequentially compared the effectiveness of an ORS, with 60 mmol/L of Na+, with the standard treatment for diarrhea used in primary care centers, in a study with 285 diarrheal children under 2 years of age who consulted a health center in a low-income periurban neighborhood of Santiago. When compared with the control group, the patients treated with ORS showed a significantly higher percentage weight gain in the first few days after treatment was begun, required fewer medical visits for follow-up treatment at other facilities (8.4 vs. 15.5%; p less than 0.05), and experienced fewer episodes of subsequent clinical dehydration that needed rehydration (oral or intravenous) in emergency services (2.8 vs. 10.6%; p less than 0.01). In addition, there were no metabolic complications in either group. Our results reinforce the feasibility, efficaciousness, and safety of programs that use ORS at the primary care level and indicate that this is an effective method of preventing metabolic complications and reducing hospitalizations of children with acute diarrhea.

Chile↗
PubMed1983

The selective utilization of prenatal genetic diagnosis. Experiences of a regional program in upstate New York during the 1970s.

The regional prenatal diagnosis program of the Finger Lakes Health Systems Area in upstate New York has been monitored since its start in 1971. By the end of 1980, more than 1,250 diagnostic procedures had been successfully completed. Based on analyses of regional vital statistics, genetic services data, repeated surveys of obstetricians, and an ongoing survey of recent mothers older than 34 years of age, the authors concluded that: 1) in the study region, most women with an indication for prenatal diagnosis because of age are aware of the possibility of prenatal diagnosis; 2) the majority of obstetricians discuss amniocentesis with their patients; 3) after a period of rapid growth the utilization rate in the study region reached about 40% in 1981; 4) nonuse of prenatal diagnosis is based mostly on a patient's decision rather than system deficiencies; and 5) a community approach to increase utilization will have to focus on how to provide a supportive social climate for these services rather than on increasing awareness among potential patients or more referrals by providers.

Abortion, Induced↗
PubMed2002

Association between health insurance coverage of office visit and cancer screening among women.

BACKGROUND: Little is known regarding the nuances of insurance benefit design that may affect the receipt of clinical preventive services. OBJECTIVE: To evaluate whether differences in insurance coverage of physician office visits influences the receipt of cancer screening in women who have full coverage for the screening services. DESIGN: Cohort study of women enrolled in fee-for-service (FFS) or Preferred Provider Organization (PPO) health plans, where FFS plans have less generous office visit coverage, for the period 1995 to 1997. SETTINGS AND PARTICIPANTS: General Motors Corporation's employees and their dependents. MAIN OUTCOME MEASURES: Papanicolaou and mammography rates in women aged 21 to 64 years (n = 139,294) and 52 to 64 years (n = 56,554), respectively. RESULTS: Compared with FFS plans, enrollees in PPO plans were significantly more likely to obtain a Papanicolaou smear and mammogram (adjusted relative risk [RRa] = 1.22; 95% CI, 1.21-1.24; and RRa, 1.17; 95% CI, 1.15-1.18, respectively). The association was more pronounced among hourly individuals (RRa, 1.27; 95% CI, 1.26-1.29 for Papanicolaou smears; RRa, 1.17; 95% CI, 1.16-1.19 for mammograms) than among salaried individuals (RRa, 1.10; 95% CI, 1.08-1.12 for Papanicolaou smears and RRa, 1.10; 95% CI, 1.06-1.12 for mammograms), corresponding to a greater differential in office visit coverage among the hourly group. CONCLUSIONS: Benefit structure appears to have an important effect on receipt of cancer screening in women. The findings highlight the need to ensure that future reforms of the health care system do not adversely affect the use of preventive services.

Adult↗
PubMed1998

Patterns of general health care and STD services use among high-risk youth in Denver participating in community-based urine chlamydia screening.

BACKGROUND: In the United States, youth are at highest risk for STDs, and innovative programs have been called for to increase their access to essential STD-related services. To guide the development of such programs, locally relevant information is needed on current use of general health care and STD services in this population. GOAL: To study access to and use of general health care and STD services in a purposive sample of high-risk youth in inner-city Denver. STUDY DESIGN: An interview-based survey conducted as part of a community program for urine chlamydia screening targeting black and Hispanic youth 13 years to 25 years. RESULTS: Of 221 sexually experienced youth in the survey, 72% had accessed general health services in the past year and 39% reported an STD evaluation at any time in the past. Community and school clinics were reported by 50% as a source for general health care and by 62% as a source for STD services. STD clinics were reported by only 14% as a source for STD services. Routine checkups were the most important reasons to seek general health care, yet of those who went for a routine checkup, only 34% reported an STD evaluation. Although few barriers appeared to exist in accessing general health care, anticipated anxiety about procedures and results formed the major barrier to accessing STD services. CONCLUSIONS: Use of general health services was common in this population of high-risk adolescents; however, the provision of STD services as part of general health care visits appeared to be low. On the basis of these findings, a comprehensive STD prevention strategy may be envisioned, which would include provider interventions to increase the provision of STD prevention services in general health care settings; community interventions to enhance access to general health care and STD services; and community-based screening programs for those not able or willing to seek clinic-based services.

Adolescent↗
PubMed2006

Decision making for physical therapy service delivery in schools: a nationwide analysis by geographic region.

PURPOSE: This study investigated the relationship between geographic practice location and recommendations for the contexts and frequencies of physical therapy service delivery in schools. METHODS: Participants were 626 school-based physical therapists from all 50 states. Four case descriptions were presented in the survey: a four-year-old girl with motor delays and typical cognitive functioning, a four-year-old girl with motor and cognitive delays, a six-year-old boy with spastic diplegic cerebral palsy, and the same boy at 12 years of age. RESULTS: Proportionally fewer respondents in the Northeast recommended providing services in exclusively natural settings, as compared with other regions. Respondents in the Northeast recommended mean monthly frequencies of at least one more session for each case (3.7-7.6) than those in the other regions: West (2.5-5.5), South (1.6-4.7), and Midwest (1.6-4.5). CONCLUSIONS: These findings suggest an association between geographic region of practice among school-based physical therapists and the contexts and frequencies of service delivery.

Analysis of Variance↗