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At least 541 records · Page 30Linked to original sources

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↗

Media campaign influences parents' opinions about their children and tobacco.

UNLABELLED: The study assessed the effectiveness of a media campaign in convincing parents that children are targeted by the tobacco industry and that children should be banned from tobacco use. An 800-parent sample survey was conducted prior to a statewide anti-tobacco campaign, and another survey sample of 790 parents was conducted afterward. THE RESULTS: Though parents who smoked in high school and those who did not agreed that children are targeted and should be banned from tobacco use, parents who did not smoke in high school believed it more strongly. Parents who had a history of smoking changed more on the issue of banning, perhaps because they had more room to change. The study concluded that media campaigns can change parents' attitudes.

Adolescent↗

Outcome of cochlear implantation in pediatric auditory neuropathy.

OBJECTIVE: Auditory neuropathy, characterized by absence or abnormality of auditory brainstem responses and normal otoacoustic emissions, is often associated with particularly poor response to amplification. Outcome data from four such pediatric patients who received cochlear implants are discussed. STUDY DESIGN: Four patients from the Carolina Children's Communicative Disorders Program were identified as having received a diagnosis of auditory neuropathy before implantation with a Clarion cochlear implant. Speech data collected after implantation were compared with data from control pediatric implant patients, matched for age at implantation and duration of implant use. Electrically evoked auditory brainstem response data and electrically evoked acoustic reflex data were also obtained. METHODS: Routine clinical procedures were used to obtain speech outcome data. A 75-micros biphasic 21.1-Hz pulse train served as the eliciting stimulus for both evoked auditory brainstem responses and reflex measures, which were obtained contralateral to the implant. RESULTS: Speech data were comparable with those obtained from the general population of pediatric patients receiving cochlear implants at this center. Identifiable evoked auditory brainstem response data were obtained in all subjects on at least two of the three electrodes tested, and variability was comparable with that observed in other children with implants. A robust electrically evoked acoustic reflex with no decay was observed at estimated M-level in all children. CONCLUSION: The data gathered to date suggest that the outcome of cochlear implantation in these four patients is not significantly different from that in other pediatric implant patients. Physiologic data suggest that the implant was able to overcome the desynchronization hypothesized to underlie auditory neuropathy.

Child, Preschool↗

Regulated expression of the beta-globin gene locus in synthetic nuclei.

Regulated gene expression within a complex chromosomal locus requires multiple nuclear processes. We have analyzed the transcriptional properties of the cloned chick beta-globin gene family when assembled into synthetic nuclei made by use of Xenopus egg extracts. Assembly in an erythroid protein environment correctly recapitulates tissue-specific chromatin structure and long-range promoter-enhancer interaction within the chromosomal locus, resulting in beta-globin gene activation. Nucleosome-repressed beta-globin templates can be transcriptionally activated by double-stranded DNA replication in the presence of staged erythroid proteins by remodeling of the chromatin structure within the promoter region and establishment of distal promoter-enhancer communication. The programmed transcriptional state of a gene, as encoded by its chromatin structure and long-range promoter-enhancer interactions, is stable to nuclear decondensation and DNA replication unless active remodeling occurs in the presence of specific DNA-binding proteins.

Animals↗

Responses of HMO medical directors to trust building in managed care.

Managed care organizations (MCOs) are facing intense criticism at national, state, and local levels and battling initiatives that would impose stricter regulation. Medical directors of HMOs were surveyed regarding their organizations' strategies of communication, the programs they have instituted to build trust, and their commitment to sponsoring family and patient support groups. The responses obtained from 252 directors indicate that nonprofit and free-standing organizations are more likely than either for-profit HMOs or organizations that are part of a chain to sponsor community activities and programs and to offer family and patient support groups. Staff- and group-model HMOs are more likely than other organizational configurations to initiate many types of "trust programs." The results indicate that more dispersed and "virtual-type" organizations must explore ways to respond meaningfully to community concerns--and to public health, prevention, and health promotion needs as well--while continuing to improve their practice patterns.

Attitude of Health Personnel↗

Preferred sources of information on AIDS among high school students from selected schools in Zimbabwe.

Following various national HIV and AIDS awareness campaign activities under the auspices of the Ministries of Health and Education, Zimbabwe, an AIDS KABP survey was undertaken. The study sample comprised 478 high school students randomly selected and stratified to represent sex and Forms 1 through to 6. The study instrument was a 31-item questionnaire designed to assess the students' knowledge, attitudes, practices and sources of information in relation to HIV syndrome. This report reviews only that part of the study dealing with sources of information. Newspapers, television, radio and magazine were the most frequently cited sources of first information. Classmates were cited by 20% to over 30% of respondents as first sources of information. Authority figures like health workers, parents, teachers, the Church did not emerge as significant sources of first information. Doctors were identified as the most preferred source of information in future. Sources of first information were related to age, form level, sex and location of school attended. There were notable differences between boarding school respondents and day scholars. No regional differences were noted.

Acquired Immunodeficiency Syndrome↗

Increasing mouthguards usage among junior rugby and basketball players.

OBJECTIVE: To evaluate a Western Australian mouthguard promotion campaign, launched at the start of the 1997/98 junior rugby union and junior basketball seasons, aimed at increasing mouthguard usage at competition and training. METHOD: A quasi-experimental field design was used to assess the impact of the mouthguard campaign on behavioural change. Observational data were collected pre- and post-campaign on mouthguard usage by players present at a rugby and basketball competition event and at a training session. Junior Australian Rules Football players were used as a control group. RESULTS: Pre-post observational surveys showed a significantly greater increase in mouthguard usage in competition games among rugby union (77% to 84%) and basketball players (23% to 43%) compared with the control group (72% to 73%). All codes showed a post-campaign increase in mouthguard usage at training, but the intervention codes' increases were greater than the control's increase (rugby union: 29% to 40%; basketball: 11% to 36%; football: 34% to 40%). CONCLUSIONS: The campaign had a significant and substantial effect on behaviour and provides evidence of the benefits of leveraging a sponsorship to modify the behaviour of the target group. IMPLICATIONS: This campaign provides a model for promoting mouthguard usage in other sports among junior players.

Adolescent↗

Introduction.

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Communication↗

Can media advocacy influence newspaper coverage of tobacco: measuring the effectiveness of the American stop smoking intervention study's (ASSIST) media advocacy strategies.

OBJECTIVE: To compare the rate and slant of local tobacco control print media coverage in ASSIST (American stop smoking intervention study) states as compared with non-ASSIST states. METHODS: Local tobacco control policy articles, editorials, and letters to the editors published from 1994 to 1998 clipped from all daily local newspapers in the USA were analysed (n = 95 911). The main hypothesis tested for the existence of an interaction between ASSIST intervention and time. This interaction would represent a change in the difference between ASSIST and non-ASSIST states over the course of the intervention. RESULTS: No evidence of an ASSIST-year interaction was found. However, a main effect for ASSIST was significant for the percentage of articles with the model predicting higher rates of articles for ASSIST states. Similarly the rate of letters to the editor expressing protobacco control views was higher in ASSIST states than non-ASSIST states. No main effects or interactions were found for analyses of percentage of protobacco control editorials. Models controlled for a measure of preintervention tobacco control conditions at baseline. CONCLUSIONS: The presence of an ASSIST main effect should be interpreted with caution because of the quasi-experimental design and the lack of information on article rates before the ASSIST intervention. Nonetheless, these preliminary findings suggest some possible effects of the media advocacy activities of ASSIST when controlling for differences in states' initial tobacco control conditions.

Bibliometrics↗