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Developing workplace health promotion programs through university and corporate collaboration. A review of the Corporate Health Promotion Research Program.

The unique collaboration of the UCSF School of Medicine with community and national leaders in corporate health promotion has, in less than three years, made the Corporate Health Promotion Research Program a valuable resource to participating corporations. We are able to offer them sound consultation on health promotion programs, based on state-of-the-art research, at minimal cost to the employer or employees. In addition, we are educating employers about quality programs and the process and need for evaluation, in an effort to generate sound findings on the effects of corporate health promotion programs. Corporations are beginning to see that instead of being reactive and spending great sums of money only after employees become ill, it makes good sense to institute programs designed to prevent employees from becoming ill in the first place. With such programs, corporations not only improve the health of their employees (a worthy objective in its own right), but they contribute to containing medical costs at the same time--a clear "win-win" situation for all concerned. In short, corporations are finding that an ongoing, active interest in the health of their employees has a direct bearing on their own long-range health as a business. With this in mind, we feel that medical benefit plans of the future will be comprised of three elements: medical care plus cost-containment plus health promotion programs. With this order of complexity, no one company or professional organization has all the answers--and that should be acknowledged from the outset.(ABSTRACT TRUNCATED AT 250 WORDS)

Data Collection

A microcomputer system for the practising cardiac surgeon.

The authors present a computer program designed for the practising cardiac surgeon who wishes to computerize patient data. The program is efficient, versatile and can be adapted to individual needs. It can be used with any IBM PC-compatible machine and requires little knowledge of computer science. More than 250 items on 30 000 patients can be stored and all this information analysed simultaneously. The program can chart a patient's profile and tabulate the information of the entire registry. It can generate lists of patients with their surgeons, cardiologists, diagnoses, operations and dates of intervention. It can also be used for mailing purposes.

Cardiac Surgical Procedures

Coordination of regional libraries with Regional Medical Program projects.

The Medical Library Assistance Act authorized the Regional Medical Library Program to improve information services in health fields, as well as other programs designed to help the health worker. Both the RMLP and the Regional Medical Program are based on regional cooperation to enhance the value of available resources, and to enable health workers away from main centers to use them. Services which Regional Medical Libraries must supply are described. As this program develops, more than conventional library services will be provided. Regional Medical Programs stress the continuing education of health-related personnel, and their need for health information; libraries are necessarily involved in such programs. The regions of the RMP are smaller than those of the RMLP, and the smaller regional focus may be an advantage. Specific examples of the coordination of library services and library-oriented programs are given.

Information Services

The EPIGRAM computer program for analyzing mortality and population data sets.

EPIGRAM is a computer program designed to improve access to State-level underlying cause mortality data. The program produces results for population, deaths, death rate, age-adjusted death rate, years of potential life lost (YPLL), YPLL rate, and confidence intervals. Results can be compared variously among age groups, counties, causes of death, races, regions, and years. The program's menu-driven interface facilitates the selection or modification of analysis parameters. Current selections are retained so the user can modify one parameter at a time. Based on the parameters that the user selects, the program produces a series of tables, one for each instance of a particular parameter. Each output table has columns for male, female, and both sexes combined, and an indefinite number of user-defined rows for age groups, causes of death, counties, races, regions, or years. EPIGRAM has major advantages over other methods for analyzing mortality and population data. The program uses relatively small amounts of memory and disk space, executes rapidly, is flexible, can be used by inexperienced computer users, provides online help screens and tutorials, and runs under DOS or UNIX without modification. The program currently is used to analyze mortality and population data for Texas. Although it is not currently available for distribution, support is being sought for its evaluation and possible implementation in State health departments to analyze data for other States, or other data sets, such as hospital discharge data or cancer incidence data.

Cause of Death

A driving program for the visually impaired.

This driving program for the visually impaired individual was devised in 1986, as a specific adjunct to the pre-existing training program, designed for the cognitive and physically impaired patients. Two important purposes of the program are: 1) To give the low vision practitioner and staff the capability to be able to recommend a specific training program for telescopic and visually impaired drivers. 2) To try to ensure that every visually impaired telescopic driver (prescribed with a telescopic system by the low vision center) would not only meet legal visual acuity and visual field requirements for the State of Michigan, but would also improve the competency of using their telescopic system for driving.

Automobile Driver Examination

Prenatal education in the work place.

Advances in neonatal care have improved survival rates among premature and low-birth-weight (LBW) infants, but highly technical care for these infants costs more than $2 billion a year in the United States. The incidence of premature and LBW infants can be reduced by prenatal education programs that focus on nutrition, obtaining prenatal care, avoiding dangerous substances, and recognizing preterm labor. In an effort to contain health care costs, many companies self-insure employee health benefits and offer health promotion programs designed to improve life style behaviors. This article examines providing a prenatal education program in the work place as a way of reducing the incidence and costs of prematurity and low birth weight.

Curriculum

The impact of worksite-based safety belt programs: a review of the literature.

PURPOSE: The purpose of this paper is to provide a literature review of the research that examines the effectiveness of worksite intervention programs designed to increase the use of safety belts by employees. SEARCH METHODS: The literature search, which identified 14 research studies on worksite safety belt programs conducted between 1968 and 1994, originated as part of a larger review on the health impact of worksite health promotion programs that was conducted by the Centers for Disease Control and Prevention (CDC). In addition, the authors conducted an additional search in an effort to validate the CDC search, but found no additional research articles. SUMMARY OF IMPORTANT FINDINGS: The literature specific to the effectiveness of safety belt programs is limited to only 14 studies. The safety belt intervention most commonly evaluated used behavioral modification principles involving incentives. These and other interventions demonstrated effective increases in seat belt utilization that, upon withdrawal of the intervention, achieved a recidivism rate above baseline levels. However, the vast majority of studies failed to incorporate control groups into their research design, which caused significant threats to internal validity. Thus, a summary of findings is only suggestive at best. MAJOR CONCLUSIONS: Based on the literature, there appears to be an insufficient number of quality research studies from which to derive a clear view of the impact of worksite safety belt programs. While the evidence is suggestive of a positive impact on safety belt use, there is a clear need for new, well-designed research initiatives on the effectiveness of theory-based safety belt intervention programs.

Accidents, Traffic

Using a computer simulation program to assess the decision-making process in child health care.

The purpose of this paper was to describe the development and testing of a computer simulation program designed to assess the decision-making process in the public health nurses' work in child health care. The work was based primarily on theories of problem-solving and decision making; on knowledge of child development, health care, and education; and on the soft systems methodology. An authoring program and two simulations were designed and produced at the University of Turku by a team of two nurse researchers, a computer specialist, and three public health nurses. The simulations presented two typical situations encountered by the public health nurses' work in child health care. A total of 61 public health nurses from 11 health centers in the southwestern part of Finland completed the simulations. The public health nurses responded positively to the simulations and the program worked very well. The results revealed some inconsistencies in the decision-making process of the public health nurses with respect to the needs of the child and the family. The public health nurses' decisions were more closely related to the developmental stage of the child than to the unique needs of each family. The simulation is acting to test the public health nurses' ability to make decisions "here and now" but not about caring it forward. These shortcomings can be corrected by asking them to explain their decisions and thoughts after each stage and by tape recording their answers. The findings gave many answers to the question of how the computer simulation program can be developed.

Computer Simulation

A case study in contesting the conventional wisdom: school-based fluoride mouthrinse programs in the USA.

This paper presents the events surrounding the dissemination of the results of a major preventive dentistry demonstration program designed and conducted to provide evidence of the effectiveness and actual costs of a combination of commonly used preventive procedures. It then reviews the controversy provoked when the results of that program were counter to the conventional wisdom of the day, prevailing national policy, and public health practice. An analysis of possible reasons for this reaction follows. The paper concludes with some observations about how such a situation might be approached to minimize similar controversy in the future.

Child

Hawaii Asian-American response to the Staying Healthy After Fifty program.

A nationwide project conducted by the American Association of Retired Persons, the American Red Cross, and the Dartmouth Institute for Better Health to disseminate a health promotion program for older adults included a study to test its ability to serve different ethnic minorities. This article reports how the Staying Healthy After Fifty Program, designed for the general United States population, was introduced into the State of Hawaii, how it was adapted for use with two Asian-American groups, the Japanese and Filipinos, and on the benefits reported by participants. To determine the appropriateness and effectiveness of the adapted SHAF program, a quasi-experimental design, involving a test group and a comparison group whose members completed questionnaires at three points in time, was used. The results of the data collected from the Hawaiian population were consistent with the results of the general U.S. population skills, health activities, and health care cost skills areas. Participants were very pleased with the course and its quality, as noted in the high ratings of course satisfaction.

Aged

Improved continuity of care in a community teaching hospital model.

HYPOTHESIS: We created an ambulatory resident clinic in a community teaching hospital to improve the continuity of care in a surgery residency program. DESIGN: A retrospective chart review analysis. SETTING: A community hospital, general surgery residency training program, and its ambulatory practice. INTERVENTIONS: Providence Hospital, Southfield, Mich, has established a new model, the Surgical Associates of Michigan, which is an association comprising private practice physicians serving as full-time faculty in the Department of Surgery. In addition to clarification of teaching requirements and reimbursement for educational activities, the most dramatic feature is the relocation of private practice offices and the staff surgical office to one central location within the hospital. The proximity of the staff and private surgical offices facilitates closer interaction of attending physicians, residents, and patients. MAIN OUTCOME MEASURES: Compliance rates of continuity of patient care provided by the same resident, as presented by the Surgery Residency Review Committee, including confirmation of diagnosis, provision of preoperative care, discussion with attending physician, selection and provision of intervention, direction of postoperative care, and postdischarge follow-up. RESULTS: Since the inception of this arrangement at our institution, surgical residents have seen 229 staff patients and 465 private patients in the offices under supervision. Compliance rate of continuity of care was defined as patient follow-up with the same senior surgical resident who performed an operation or evaluated the patient on initial presentation to the emergency department or offices. We achieved a compliance rate of 92.8% (169/182) in the staff surgical clinics. A compliance rate of 63.5% (205/323) for private general surgical patients and 70.4% (100/142) for vascular surgical patients was obtained. With the establishment of the teaching faculty group and the relocation of offices, we were able to achieve a dramatic improvement in continuity of care. CONCLUSIONS: In addition to fulfilling the Surgery Residency Review Committee requirements, we believe our model facilitates broader education of surgical residents and improves risk management. We recommend further similar studies, greater involvement of primary care specialties in recruiting staff surgical referrals, and implementation of a specialized computer program to continue to improve continuity of care in surgery residency programs.

Continuity of Patient Care

Proposal to develop a detailed safety program for general/laser surgical patients infected with AIDS.

Medical health personnel have acquired serious and rarely fatal infections in the operating room from AIDS patients. Yet, there are no officially approved AIDS safety programs designed to protect medical health care personnel in the operating room. A sequential safety program is proposed beginning with the following steps: 1) evaluation and staging of the patient and associated complications; 2) protection of the major surgical and laser instruments; 3) use of an efficient evacuator system to avoid plumes of laser fragments from polluting the operating room environment; 4) protection of the operating room staff with special eye protection including helmets and shields, fluid-soak-resistant fabrics for garments, double surgical gloves, and special orderly trays with safety holders for syringes, needles, sharp instruments, and suture holders; 5) reporting and treatment of accidents, such as needlestick puncture wounds, that require immediate attention and an infectious disease consultation; 6) postoperative care, which includes providing medical health care personnel protection from bloody bandages, needles, and the infectious patient; and 7) and finally, the washing and sterilizing of contaminated instruments by medical health care personnel using face shields and masks, gloves, and protective fabrics for garments. Continued experience with this proposed safety program will determine its future value for AIDS surgical patients and for all health care workers.

Acquired Immunodeficiency Syndrome

Comparison of eight microcomputer dietary analysis programs with the USDA Nutrient Data Base for Standard Reference.

OBJECTIVE: To compare the general operating features and nutrient databases of eight microcomputer dietary analysis programs. DESIGN: A 3-day food record with 73 food items was entered into each program by the authors. The general operating features of the program were summarized and evaluated. The nutrient database was evaluated by comparing the nutrient analysis output with the 1993 US Department of Agriculture (USDA) Nutrient Data Base for Standard Reference (NDB), full version, release 10, for microcomputers. RESULTS: The programs varied in cost, number of foods and nutrients in the database, use of non-USDA data, and inputting of data for missing values. We also found differences in the quality of user manuals and help screens, ease of food entry and averaging of 3-day nutrient intake, speed of analyzing and printing results, quality and number of print/export options, and overall ease of learning and using the program. All but one of the programs were within 15% of the USDA NDB for energy, protein, total fat, and total carbohydrates. However, there was some difference in the number of other nutrients and food components varying more than 15% from the USDA NDB. These differences occurred because of variations in the number of food items included in each programs' database and the number of missing nutrient values in the database. APPLICATIONS: Our results demonstrate the importance of carefully choosing a microcomputer dietary analysis program that is suitable to the user's specific and predetermined needs.

Databases, Factual

Detailed analysis of menstrual bleeding patterns after postmenstrual and postabortal insertion of a copper IUD or a levonorgestrel-releasing intrauterine system.

Detailed information on the menstrual bleeding patterns in users of copper-releasing intrauterine devices (IUDs) and levonorgestrel-releasing intrauterine systems (IUSs) is lacking. Even less is known about the menstrual bleeding patterns associated with postabortal insertion of IUDs. We postulated that the scarcity of IUD studies including detailed analysis of bleeding could be a result of the lack of an easy-to-use computer program designed for this purpose. We therefore developed a set of graphical user interface (Windows) programs for entering, editing, and analyzing menstrual diary data. With these programs, we reanalyzed the menstrual diaries of the subjects of one of the hospital clinics that participated in a previous multicenter study comparing copper IUDs and LNg IUSs. The group included patients who had the IUD inserted postabortally. Copper IUD users had patterns of bleeding that were stable over time, and clearly more bleeding than LNg IUS users, many of whom had either infrequent bleeding, bleeding completely replaced by regularly occurring spotting, or amenorrhea. Postabortal insertion of LNg IUSs was associated with slightly better patterns of bleeding than postmenstrual insertion. Detailed statistics on bleeding help clinicians in counseling patients regarding these methods. The statistics permit assumptions to be made about the probabilities of specific menstrual disturbances and their changes over time.

Abortion, Induced

Embryo implantation rates in oocyte donation: a prospective comparison of tubal versus uterine transfers.

OBJECTIVE: To compare pregnancy and implantation rates in tubal and uterine transfers during a hormonal replacement cycle in an oocyte donation program. DESIGN: Prospective randomized. PATIENTS: Forty-two consecutive patients who entered an oocyte donation program. INTERVENTIONS: Twenty-two patients were assigned for uterine transfer and 20 for tubal embryo transfer (ET). RESULTS: Twenty-three pregnancies were achieved, 12 (54.5%) after uterine transfers and 11 (57.9%) after tubal transfers. Implantation rates in both groups are not significantly different (17.4% uterine transfers versus 21.5% tubal ETs). CONCLUSIONS: Our results suggest that in hormonal replacement cycles (uniform endometrial stimulation) there is no advantage in transferring embryos to the fallopian tube. Furthermore, embryo quality and endometrial receptivity appear to be significantly more important than the time of entrance of an embryo to the uterine cavity in determining its chances of implantation.

Embryo Implantation

Short-term family-based residential treatment: an alternative to psychiatric hospitalization for children.

A short-term treatment program designed as an alternative to psychiatric hospitalization for children and adolescents is described. The program utilizes a multidisciplinary professional team and specially trained individuals (mentors) who work with the child and the child's biological family in the context of a mentor's home. Admission, discharge, and follow-up data on a group of patients are reported.

Adolescent

An interactive graphics program for comparing and aligning nucleic acid and amino acid sequences.

This paper describes a computer program designed to look for similarities between pairs of nucleic or amino acid sequences. The program looks both for segments of perfect identity or for regions where, using a scoring matrix, a minimum value is exceeded. The results of comparisons are presented as a matrix which is displayed on a simple graphics terminal. Use of a graphics terminal allows the user to display the whole of the two sequences in one screenful or to home-in on regions of interest to examine them in more detail. The program is interactive and so the user can easily see the effect of changes to variables and can use inbuilt editing functions to make insertions to produce alignments of the two sequences. These aligned sequences can then be saved on disk files for further processing.

Amino Acid Sequence

Physical fitness program for patients with psychiatric disorders. A clinical report.

The current practice of physical therapy rarely addresses the needs of patients with psychiatric disorders. The literature has shown that physical and psychological health are related intimately. This article describes a physical fitness training program designed for inpatients with mental illness in an acute care hospital setting. A training program consisting of group exercise sessions conducted three times a week for six weeks may enhance the patients' self-esteem and body image in a unique way. Physical therapy intervention should be broadened to address the special needs of the mentally disabled.

Adolescent