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PubMed2000

Quantifying the process and outcomes of person-centered planning.

Although person-centered planning is a popular approach in the field of developmental disabilities, there has been little systematic assessment of its process and outcomes. To measure person-centered planning, we developed three instruments designed to assess its various aspects. We then constructed variables comprising both a Process and an Outcome Index using a combined rational-empirical method. Test-retest reliability and measures of internal consistency appeared adequate. Variable correlations and factor analysis were generally consistent with our conceptualization and resulting item and variable classifications. Practical implications for intervention integrity, program evaluation, and organizational performance are discussed.

Adult↗
PubMedDate not supplied

[Building sensitive knowledge in mental health].

This is a report of an experience presented by the faculty of the subarea Promoting and Recovering Mental Health, by the Nursing School, from State University of Rio de Janeiro, Brazil. This subarea is offered in eight of the total nine terms of the undergraduate program, integrating into the themes of other subareas at each term. Based on students' experiences regarding those themes, and connecting them to theory later on, we hope they will grow on sensitiveness and empathy, thus strengthening their role of carers for clients in different fields. The evaluation of this subarea points out to the qualitative change in the teaching/learning process.

Education, Nursing↗
PubMedDate not supplied

[Gender based violence: knowledge and attitudes of health care providers in Nicaragua].

OBJECTIVE: To assess the knowledge and attitudes of health care personnel towards the identification and referral of gender-based violence victims (GBV). Also, to identify barriers to identification and referral of GBV, and to assess the levels of knowledge about Norms and Procedures for Intra-Family Violence Care by the health care personnel of the Nicaraguan's Minister of Health (MINSA, for its initials in Spanish). MATERIAL AND METHODS: A cross-sectional study was conducted among healthcare professionals, including physicians, nurses and nursing technical aides (n=213), in 5 of the 17 Local Systems of Integral Attention (SILAIS) from the Integral Program of Attention for Women, Children and Adolescence (AIMNA) in the primary level of attention in MINSA, from April to June 2003. Attitude was measured with a Likert scale and an awareness index was created for intra-family violence care guidelines. The information was obtained using a self-administered instrument, based on the questionnaire of the study made among the personnel of the Mexican Institute for Social Security (IMSS, for its initials in Spanish), Morelos, Mexico. A logistic regression model was used to evaluate the association between attitude and several factors, as well as with the knowledge of care guidelines. RESULTS: In our population, 76.06% showed an attitude opposing GBV. In the multivariate analysis, the factors associated with opposition to GBV were: medical profession (OR 6.5, 95%CI 2.70-15.82), having a middle (OR 4.3, 95%CI 1.87-10.26) or high level (OR 3.3, 95%CI 1.03-10.75) of knowledge about intra-family violence guidelines and the closeness to relatives or friends who were victims of gender violence (OR 3.2, 95%CI 1.56-6.80). The lack of training on the subject (59.9%), fear of getting involved in legal issues (52.6%), and the concept that violence is a private affair and not a social one (50.7%), constituted the most important barriers to providing medical care. CONCLUSIONS: The health care personnel generally were observed to have high values in regard to an attitude of rejection towards GBV. However, we found barriers that show persisting traditional beliefs, such as considering violence to be a personal issue. Therefore, in order, to ensure a substantial improvement, better training about this subject is needed in medical school curricula with an emphasis on the gender perspective. The finding of the present study will allow improvements in health care reforms at the first level of care in the health sector in Nicaragua.

Adolescent↗
PubMedDate not supplied

Social inequality and child malnutrition in four Andean countries.

OBJECTIVE: To analyze the effects of socioeconomic, regional, and ethnic conditions on chronic malnutrition in four Andean countries of South America: Bolivia, Colombia, Ecuador, and Peru. METHODS: The study was based on Demographic and Health Surveys (DHS) for Colombia (1995), Peru (1996), and Bolivia (1997), and on a Living Standard Measurement Survey for Ecuador (1998). We developed an index of household socioeconomic status using categorical principal components analysis. We broke down the prevalence of stunting by socioeconomic status (SES), ethnicity, place of residence (large cities, small cities, towns, and countryside), and region (highland region versus other areas of the country). We applied smoothed regression curves and linear functions to analyze SES effects on stunting, with specific models for Bolivia, Ecuador, and Peru. RESULTS: Bolivia, Ecuador, and Peru have similar characteristics, with high stunting prevalences overall; higher stunting prevalences in their highland areas, particularly among indigenous populations; and strong socioeconomic disparities. Colombia, in contrast, has a lower stunting prevalence and smaller regional disparities. The socioeconomic gradient of stunting is strong in all four countries, with prevalence rates in the poorest deciles at least three times as high as those in the top decile. DISCUSSION: The sharp contrast between the conditions found in Bolivia, Ecuador, and Peru and those in Colombia may be the result of specific ethnic factors affecting indigenous groups; a particular diet profile in the highland areas, with low protein and micronutrient intake; and differences in the long-term economic and social development paths that the countries have taken. Along with the strong socioeconomic gradient in all the countries, the weight of ethnic and regional factors suggests the need to reduce inequality as well as to comprehensively improve education and housing, better target health and nutrition programs, and implement participatory programs integrated into indigenous cultures.

Adolescent↗
PubMed2005

Cost-effectiveness of free HIV voluntary counseling and testing through a community-based AIDS service organization in Northern Tanzania.

OBJECTIVES: We evaluated the cost-effectiveness of fee-based and free testing strategies at an HIV voluntary counseling and testing (VCT) program integrated into a community-based AIDS service organization in Moshi, Tanzania. METHODS: We waived the usual fee schedule during a 2-week free, advertised VCT campaign; analyzed the number of clients testing per day during prefree, free, and postfree testing periods; and estimated the cost-effectiveness of limited and sustained free testing strategies. RESULTS: The number of clients testing per day increased from 4.1 during the prefree testing interval to 15.0 during the free testing campaign (P<.0001) and remained significantly increased at 7.1 (P<.0001) after resumption of the standard fees. HIV seroprevalence (16.7%) and risk behaviors were unchanged over these intervals. Modeled over 1 year, the costs per infection averted with the standard fee schedule, with a 2-week free VCT campaign, and with sustained free VCT year-round were $170, $105, and $92, respectively, and the costs per disability-adjusted life year gained were $8.72, $5.40, and $4.72, respectively. CONCLUSIONS: The provision of free VCT enhances both the number of clients testing per day and its cost-effectiveness in resource-limited settings.

AIDS Serodiagnosis↗
PubMed1976

The community hospital as a focus for health planning.

A community hospital focus for health planning has been developed by a Department of Community Medicine in a "non-teaching" voluntary hospital. Results of three years of planning experience have included: descriptions of service area populations and utilizer populations; implementation of neighborhood based health centers with transportation and outreach programs; integration of emergency services with other ambulatory care resources; and proposals for geriatric day-care, ambulatory surgery, and patient education. Working relationships have been developed between the hospital Department and local planning bodies, among them the Comprehensive Health Planning agency, the County Health Services Department, consumer groups, voluntary agencies and a University Health Services Center.

Aged↗
PubMed1995

Policy as intervention: environmental and policy approaches to the prevention of cardiovascular disease.

This paper describes the evolution of efforts to prevent cardiovascular disease, from individual health education approaches to broader community education efforts and, finally, to comprehensive and integrated programs addressing environmental, policy, and individual behavior change. Policies are divided into two areas: legislation/regulation and organizational policy. Environmental strategies are measures that alter or control the physical or social environment. Dimensions along which these strategies might be implemented are provided. Policy and environmental approaches can be justified on economic, strategic, and theoretical grounds. Experiences from other fields and other countries provide a framework for conceptualizing cardiovascular disease prevention approaches.

Cardiovascular Diseases↗
PubMed2006

Natural products from marine invertebrates and microbes as modulators of antitumor targets.

Over the last twenty-five to thirty years, exploration of the marine fauna and microbial flora has progressed from a random search by natural product chemists who liked to dive and wished to combine their hobby with their profession, to fully integrated programs of systemic investigation of the chemical agents elaborated by marine organisms of all phyla (as presumably defensive agents against predators) for their potential as leads to human-use drug candidates where the putative mechanisms have been identified as modulation of, and/or interaction with, potential molecular targets, rather than just exhibiting general cytotoxicity. This review is not exhaustive but is meant to cover the highlights of such agents and is arranged on a (nominal) target basis rather than by organism or chemical class.

Animals↗
PubMed1988

Accommodation for elderly persons in newly industrializing countries: the Hong Kong experience.

The newly industrializing countries seem set to follow many developed countries with a rapid growth in numbers of elderly people. This will throw considerable strain on their resources, particularly in the provision of services and accommodation for this group in society. Hong Kong is a leader amongst the newly industrializing countries, both in terms of its aging population (more than 11 percent of its people are now over 60 years of age) and in terms of economic growth. It has, however, only relatively recently embarked upon a comprehensive and integrated program to provide a wide range of accommodation for the elderly. This includes sheltered housing within Hong Kong's well-known public housing schemes, old people's homes, care-and-attention homes, and infirmaries. The private sector has also been growing rapidly in the 1980s with a considerable recent increase of old people's homes. A voluntary code of conduct for this sector was introduced in late 1986, but concerns remain about the quality of care and the rapid growth of private homes in the territory. The approaches to the provision of accommodation for the elderly are set in the context of Hong Kong's overall social policy development. Whilst the experience of relatively wealthy Hong Kong may not prove to be of relevance for the majority of Third World countries, it is argued that it may provide a model for other newly industrializing countries.

Adult↗
PubMed2006

Correlation of relative permeability and relative cerebral blood volume in high-grade cerebral neoplasms.

OBJECTIVE: The purpose of this study was to correlate the degree of contrast enhancement on dynamic contrast-enhanced T1-weighted MRI and the relative cerebral blood volume (rCBV) values on T2*-weighted MRI in patients with high-grade brain neoplasms. SUBJECTS AND METHODS: Ten patients with biopsy-proven high-grade gliomas underwent dynamic contrast-enhanced MRI using T1-weighted fast spoiled gradient-echo technique (TR/TE, 8.3/1.5) during i.v. infusion of 0.1 mmol/kg of MR contrast medium. This sequence was followed within 5 minutes by dynamic susceptibility contrast (DSC) imaging (1,500/80) during i.v. infusion of 0.2 mmol/kg of MR contrast medium. Dynamic contrast-enhanced analysis was performed using the maximum-signal-intensity algorithm, and DSC analysis was performed using the negative enhancement integral program. For each tumor, we performed two comparisons: first, the average dynamic contrast-enhanced and rCBV values within a region of interest drawn around the entire contrast-enhancing tumor on a single image through the center of the lesion and, second, the highest dynamic contrast-enhanced and highest rCBV values within each tumor. Statistical analyses of the first comparison were performed using Pearson's correlation coefficient, R2 correlation coefficient, and Spearman's rank correlation and for the second comparison using Kendall's tau correlation. RESULTS: The mean signal intensity values ranged between 3.48 and 7.16 SDs above baseline values (mean, 4.89 SDs). The mean rCBV values ranged between 57.9% and 122.7% of the normal lentiform nucleus (mean, 76.6%). The Pearson's correlation coefficient was 0.867, the R2 correlation coefficient was 0.752, and the Spearman's rank correlation was 0.794 (p = 0.001). Dynamic contrast-enhanced values from the region of highest signal intensity ranged between 7.7 and 48.6 SDs above baseline values (mean, 17.3 SDs). The highest rCBV values ranged between 105% and 400% of the normal lentiform nucleus (mean, 292%). The correlation was estimated to be 0.7778 and was statistically significant at the 0.01 level of statistical significance (p = 0.0035). CONCLUSION: We found a high correlation between degree of contrast enhancement on dynamic contrast-enhanced images and rCBV values in whole tumors and in regions having the highest degree of contrast enhancement in this small study. Our findings, which suggest that relative permeability and rCBV values may be correlated in high-grade glial neoplasms, deserve further study in a larger patient population.

Adult↗
PubMedDate not supplied

Electronic flow rate controller for a portable insulin infusion pump.

An electronic controller is described that regulates the flow of infusate by controlling the fraction of time that a pump is energized. Using the integral programming capability of the device, any one of 256 possible basal rates between 0 and 49.6% of the maximum rate can be chosen. An externally triggerable single meal-associated pulse can also be configured. The rate during the meal pulse can be any one of the 255 equally spaced rates in the range of 0--99.7%. The duration of this pulse can be chosen in 3-min steps to a maximum of 12.75 h, after which the rate automatically returns to the basal value. The controller consumes a minimum amount of power and can continuously operate a dc motor-driven pump at 3.0 V for 36 h. It drives the pump in an on-off mode in order to control the average flow rate digitally. In this way a significant reduction in the power requirements is realized and the system can be run for many days using small rechargeable batteries. One year of experience with 20 of these controllers was obtained in the research laboratory and clinical investigation unit. The results of this experience indicated the reliability and precision of these controllers, gave insight into their modes of failure, and provided valuable biomedical data for their improvement.

Animals↗
PubMed1983

Communication through physical activity for learning disabled children.

To measure the extent to which an integrated program of motor and cognitive tasks might enhance the learning disabled children's motor and basic cognitive skills, a treated group of 8 had three 1/2-hr. sessions per week for 6 mo. 8 control subjects continued regular physical education and reading programs with their classroom teacher. All subjects were tested before and after 6 mo. Over-all the treated group showed greater improvement on tests of both motor and cognitive skills than the control group. This study suggests a physical activity program can influence basic cognitive skills as well as motor skills.

Child↗
PubMed2002

Sleep Dynamic Therapy for Cerro Grande Fire evacuees with posttraumatic stress symptoms: a preliminary report.

BACKGROUND: Sleep disturbance is common among disaster survivors with posttraumatic stress symptoms but is rarely addressed as a primary therapeutic target. Sleep Dynamic Therapy (SDT), an integrated program of primarily evidence-based, nonpharmacologic sleep medicine therapies coupled with standard clinical sleep medicine instructions, was administered to a large group of fire evacuees to treat posttraumatic insomnia and nightmares and determine effects on posttraumatic stress severity. METHOD: The trial was an uncontrolled, prospective pilot study of SDT for 66 adult men and women, 10 months after exposure to the Cerro Grande Fire. SDT was provided to the entire group in 6, weekly, 2-hour sessions. Primary and secondary outcomes included validated scales for insomnia, nightmares, posttraumatic stress, anxiety, and depression, assessed at 2 pretreatment baselines on average 8 weeks apart, weekly during treatment, posttreatment, and 12-week follow-up. RESULTS: Sixty-nine participants completed both pretreatment assessment, demonstrating small improvement in symptoms prior to starting SDT. Treatment and posttreatment assessments were completed by 66 participants, and 12-week follow-up was completed by 59 participants. From immediate pretreatment (second baseline) to posttreatment, all primary and secondary scales decreased significantly (all p values < .0001) with consistent medium-sized effects (Cohen's d = 0.29 to 1.09), and improvements were maintained at follow-up. Posttraumatic stress disorder subscales demonstrated similar changes: intrusion (d = 0.56), avoidance (d = 0.45), and arousal (d = 0.69). Fifty-three patients improved, 10 worsened, and 3 reported no change in posttraumatic stress. CONCLUSION: In an uncontrolled pilot study, chronic sleep symptoms in fire disaster evacuees were treated with SDT, which was associated with substantive and stable improvements in sleep disturbance, posttraumatic stress, anxiety, and depression 12 weeks after initiating treatment.

Clinical Protocols↗
PubMed1986

Effects of chloroquine, amodiaquine and pyrimethamine-sulfadoxine on Plasmodium falciparum gametocytemia.

The effects of chloroquine, amodiaquine and pyrimethamine-sulfadoxine (SP) (Fansidar) on the infection rate and density of Plasmodium falciparum gametocytes were studied in 198 patients with falciparum malaria from an area in the Punjab where malaria is endemic but seasonally transmitted. One month following treatment of 100 patients, SP had reduced the gametocyte carrier rate from 37% to 6% and the mean gametocyte density from 80 to 1.4 per mm3 of blood. Chloroquine and amodiaquine were much less effective. Since SP has no gametocytocidal properties and the reduction in gametocytes coincided with clearance of asexual parasitemias, gametocytes were probably reduced subsequent to the cure of the asexual malaria infections. If used during the nontransmission season, SP might be an effective component of an integrated program for reducing malaria transmission in the Punjab and other areas where 4-aminoquinoline-resistant and SP-sensitive falciparum malaria exists.

Adolescent↗
PubMed1988

Models of occupational therapy service provision in the school system.

Occupational therapy is a related service when provided within the public schools, which means that services must enhance or support educational goals. Three service provision models have been described for school therapists: direct service, monitoring, and consultation. Direct service addresses individualized needs that require specialized intervention strategies which can safely be performed only by the occupational therapist. Monitoring, which is sometimes referred to as integrated programming, uses therapeutic expertise within functional tasks to maximize opportunities for practice and generalization. Consultation addresses problems by enabling others to work more effectively on the educational goals they have set for the students. Evidence is accumulating to demonstrate that each model is effective when chosen and applied appropriately. This paper reviews each model, provides examples of studies that have been conducted, and suggests directions for future research.

Humans↗
PubMed2006

The importance of body weight and weight management for military personnel.

Weight or fat reduction and maintenance among military personnel and attainment of desired body composition and physical appearance are considered important. A high level of body fat has been shown to have an adverse effect on performance in a number of military activities. The effect of rapid weight loss on performance appears to depend on the method of weight loss, the magnitude of weight loss, and the type of exercise or activity performance test used. Personnel who undertake imprudent weight-loss strategies, that is, personnel who try to change their usual body size by chronically restricting their food and fluid intake, may suffer a number of problems. Overweight personnel and their military coaches are just as susceptible to false ideas about weight loss and dieting as the rest of the community. Inappropriate weight loss causes a loss of lean tissue and can reduce, rather than enhance, performance. The understanding and promotion of safe, effective, appropriate weight-loss and weight-maintenance strategies represent important functions of the military system and officials. The greatest likelihood of success requires an integrated program, both during and after the weight-loss phase, in which assessment, increased energy expenditure through exercise and other daily activities, energy intake reduction, nutrition education, lifestyle changes, environmental changes, and psychological support are all components.

Body Fat Distribution↗
PubMed1988

Rabies and rabies control in striped skunks (Mephitis mephitis) in three prairie regions of western North America.

The number and geographic distribution of rabies cases in striped skunks (Mephitis mephitis) from Saskatchewan (n = 2,506 cases), Montana (n = 1,142), and Alberta (n = 199) since 1963 were reviewed. In Saskatchewan the number of cases increased steadily for 5 yr and then fluctuated consistently in a 4 yr cyclic pattern. Similarly an initial sweep across the province was followed by a cyclic pattern of geographic expansion (3 to 4 yr) and reduction (1 to 2 yr). No organized control efforts were conducted in Saskatchewan. Similar cyclic pattern were not seen in data from Montana or Alberta. In the latter areas, the number and distribution of rabies cases in skunks appeared to reflect efforts to reduce the population of skunks. An integrated program of skunk removal using poison and live-traps in association with research and public education successfully contributed to limiting the spread and establishment of rabies in striped skunks within prairie habitats. Rabies did not persist in skunks in other habitats.

Alberta↗
PubMedDate not supplied

The AARP (American Association of Retired Persons) perspective.

To summarize, five areas have been targeted by the AARP for improvement: Market and price stability Geriatric training for medical and support staff Emphasis on preventive care and maintenance programs Integration of health care services with social services Provision of useful consumer information on quality of care as a marketing tool AARP is concerned about the universe of health care problems facing this nation. I do not for an instant suggest that these issues will be easily resolved or resolved quickly. We are all anxious to find solutions that work. One of the most promising solutions is with you, in your experience, commitment and willingness to forge new ground. HMOs and Social HMOs serving this older population are leaders in the health care industry. Many of you have demonstrated that HMOs can provide quality medical care for elderly patients. It is AARP's hope that working together we can create an environment in which HMOs adopt policies and practices that ensure comprehensive quality health for the elderly.

Aged↗