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PubMed1978

Chilean experience with fortified children's formulas.

In this paper we have described all the steps needed to develop an efficient program for distributing children's fortified formulas. The easiest steps are to develop the formulas on an experimental and laboratory basis. The real obstacles lie in implementation at the national level. All that has been described applies to experience in Chile, which we consider very successful because of the acceptance of the program as well as spectacular advances in preventing malnutrition. The figures for 1977 show that combining all degrees of malnutrition in the under six age group, the prevalence is now 12.2% compared to nearly 60% found 10 years ago. This progress is due, not only to the specific program, but also to the many others that constitute the national food and nutrition policy (CONPAN, 1976). This success is due to the persistent, skilled effort of many professional and technical staff members. It is impractical to acknowledge all individual contributions here. The National Food and Nutrition Council, the National Health Service, Universities, Research Bodies, and private enterprizes have all contributed to this joint effort. The purpose of this presentation is that this experience may benefit other countries with similar problems.

Animals↗
PubMedDate not supplied

[Effect of swimming on asthmatic children].

Thirteen asthmatic children were enrolled in a swimming program during five days. Pulmonary function test before and after swimming training was evaluated. Training did not change pulmonary function values, and asthmatic children improved swimming distance and enhanced swimming ability. No side effects were observed during study. After asthma can questionnaires indicated a high degree of enthusiasm and acceptance of the program by children and parents.

Adolescent↗
PubMed1991

Comprehensive therapeutic interchange program in a community hospital.

The implementation of a comprehensive therapeutic interchange program is described. The need to reduce the number of telephone calls to physicians about nonformulary drug orders, reduce drug costs, and maximize the effectiveness of drug therapy prompted the development of an automatic therapeutic interchange program at a 273-bed nonteaching community hospital. Pharmacists and physicians agreed that a telephone call to discuss every nonformulary drug order was unnecessary. The pharmacy department presented the automatic interchange program to the pharmacy and therapeutics committee. The program was reviewed by the committee, the hospital attorney, and medical staff members and was instituted in 1986 for drug products, such as vitamins and antacids, for which interchanges are noncontroversial. A newsletter describing the program was distributed, and inservice education sessions were held. A reminder was placed on order forms that an interchange for nonformulary drugs would be made unless the nonformulary agent was deemed "medically necessary" by the physician. In such cases, the physician is contacted to discuss the therapeutic alternative. As acceptance of the program and cost efficiencies were demonstrated, more controversial agents were phased in during subsequent years. It was difficult to obtain approval to add some agents, such as third-generation cephalosporins, to the program, but noncompliance and confusion have been minimal. An automatic therapeutic interchange program has worked well at this institution since 1986.

Florida↗
PubMed1983

Oral hygiene instruction using a self inspection plaque index.

The need for proper oral hygiene requires large amounts of time and manpower, and relapse is still common. This paper describes a self instructional manual and self inspection plaque index that was tested in a periodontal recall population. The program was tested on 18 periodontal recall patients over a period of 6 weeks. Questionnaires were completed at the start, at 2 weeks, and at the end of the experimental period to evaluate patient opinions. Presence of plaque near the gingival margin was recorded at the start, at 2 weeks, and at 6 weeks. Patients were provided with a self instructional manual which taught them to recognize plaque on six teeth. Also, they were given a lighted mouth mirror, a toothbrush, and disclosing wafers. Initial, before-brushing plaque scores of 47% decreased to 18% during the 6 weeks of the study. After-brushing plaque scores also were significantly improved during the study. Patients were able to perform the plaque index without guidance to a high level of agreement with a dental hygienist (r = 0.72). Furthermore, the program was well accepted by the patients according to their answers on the questionnaire.

Adult↗
PubMed1999

A single issue program in an isolated area: mammography screening in Darwin, NT.

OBJECTIVE: A process evaluation of the Northern Territory (NT) mammography program, NT Breast Screen (NTBS), during its initial 18 months of operation. METHODS: The study was undertaken in Darwin, NT, from December 1994 to May 1996. Clinical outcomes were obtained by reviewing computerised and manual program records to determine waiting times for results, recall rates and cancer detection rates. Client satisfaction was assessed by a questionnaire sent to all women with normal results over a 12-week period. General practitioner satisfaction was assessed by a questionnaire sent to all general practitioners in the region who had one or more clients who had attended the service. RESULTS: During this time, 2,882 screening mammograms were performed; 98 women were recalled for assessment (3.4%). Breast cancer was detected in 10 women (3.5 per 1000 women screened). The program was well accepted by clients and general practitioners. Performance criteria were not met for waiting times for results. CONCLUSIONS: NTBS faced challenges because of its small and dispersed population, a lack of local radiologists with mammographic experience and the conflict with other pressing health issues, particularly in Aboriginal health. Despite these challenges, the program functioned effectively during its initial 18 months. IMPLICATIONS: Mammography screening programs in isolated areas can function effectively. The constraints encountered by NTBS are likely to apply to similar programs. Issues identified requiring further research are the psychological consequences of long waiting times for results, and the prioritisation of mammography for Aboriginal women.

Adult↗
PubMed2004

Na Liko Noelo: a program to develop Native Hawaiian researchers.

Native Hawaiians are underrepresented in health research. They also have expressed dissatisfaction with the way in which many non-native researchers have formulated research questions, conducted research, and disseminated findings about Native Hawaiians. 'Imi Hale - Native Hawaiian Cancer Network was funded by the National Cancer Institute to increase research training and mentorship opportunities for Native Hawaiians. To this end, 'Imi Hale has followed principles of community-based participatory research to engage community members in identifying research priorities and assuring that research is beneficial, and not harmful, to Native Hawaiians. Developing indigenous researchers is a cornerstone of the program and, in its first 4 years 'Imi Hale enrolled 78 Native Hawaiian "budding researchers (called Na Liko Noelo in Hawaiian), of which 40 (68%) have participated in at least one training and 28 (36%) have served as investigators, 40 (51%) as research assistants, and 10 (13%) as mentors on cancer prevention and control studies. The major challenge for Nă Liko Noelo is finding the time needed to devote to research and writing scientific papers, as most have competing professional and personal obligations. Program evaluation efforts suggest, however, that 'Imi Hale and its Na Liko Noelo program are well accepted and are helping develop a cadre of community-sensitive indigenous Hawaiian researchers.

Biomedical Research↗
PubMedDate not supplied

A preventive program for community-dwelling elderly at risk of functional decline: a pilot study.

A program has been designed to assess and survey community-dwelling elderly over 75, identified at risk of functional decline by a postal questionnaire. The objectives were to verify the acceptability and the feasability of the program and to explore its impact, mainly on the functional status. A randomized controlled study took place in an urban community where 99 participants were drawn from those having responded positively to two or more of the six questions asked in the postal questionnaire, previously studied in Sherbrooke, in 1992. The program consisted in a home visit by a nurse who administered a standardized assessment battery on risk factors identified specifically for functional decline. When problems were identified, experimental subjects were referred to their general practitioner or to other health professionals for diagnosis and interventions. The control subjects received the usual health services. Both process and outcome measures were utilized in the study. The process measures allowed to know whether the program was acceptable or not to subjects and if it was feasible when using the existing health care services. The outcome measures included the number of eliminated risk factors, the functional autonomy level, the general well-being, the perceived state of health and the social support. The results showed that the program was feasible to implement and acceptable by the subjects and by health professionals. After 6 months, study subjects did not loose autonomy whereas the control ones significantly declined (P<0.001). If preventive programs could be effective in reducing the loss of autonomy, the use and cost of health care services could also be reduced and the other health and wellfare problems could be also prevented.

Journal Article↗
PubMed1994

[Secondary costs of the disposition of preoperatively withdrawn autologous blood preserves].

Preoperative autogenous blood (PAB) deposit programs are expensive. Aside from primary costs of preparing PAB, the user incurs major secondary costs from additional preadmission visits with the surgeon and from excess production, utilization and outdating of PAB (transfer into the allogeneic blood supply is not permitted here). These costs will exceed 200 Mio DM annually, increasing with better acceptance of PAB programs. However, PAB deposits are only indicated if transfusion incidence for the intended elective procedure exceeds 30%. Below that, preoperative, isovolemic hemodilution is considered the method of choice for limiting exposure to allogeneic blood.

Blood Banks↗
PubMed1990

[Results and evaluation of a pilot study for the implementation of a program of preventive activities in primary health care].

Following the guidelines for preventive and health promoting activities in Primary Health Care presented by the S.E.M.F.Y.C., we developed a study to evaluate the adequacy of the parallel nurse clinic for their implementation. 209 individuals (94 males and 115 females, mean age 36,4 +/- 13 years) were included in the study. The results showed a remarkably high prevalence of risk factors in the study series and a good acceptance of the program by the users. The opportunistic screening by means of a referral to a nurse clinic was shown to be an adequate strategy for the development of the program, with a multimplicator effect on the whole of nursing activities to be evaluated at the time of planning their implementation rate.

Adolescent↗
PubMed2003

Cryopreservation of mobilized blood stem cells at a higher cell concentration without the use of a programmed freezer.

Cryopreservation of peripheral blood stem cells (PBSC) mobilized by chemotherapy combined with or without granulocyte colony-stimulating factor (G-CSF) is an essential part of procedure for anti-cancer strategies. We evaluated whether a higher cell concentration (2 x 10(8)/ml) without the use of a programmed freezer was acceptable for the storage of mobilized PBSC in an autologous setting. Mobilized PBSC were enriched to mononuclear cells (MNC) by Percoll separation and then frozen at cell concentrations of 2-5 x 10(7)/ml (group I, n=20) or 2 x 10(8)/ml (group II, n=44) without the use of a programmed freezer using 5% DMSO, 6% hydroxy ethyl starch, and 4% autologous serum or human albumin. CD34+ cells purified by ISOLEX300 were frozen at 2 x 10(7)/ml (group III, n=22) using the same method. The median recovery rates of CD34+ cells and CFU-GM were, respectively, n.d. (not determined) and 88% in group I, 103 and 64% in group II, and 98 and 53% in group III. There was a statistical significance between the recovery rate of CFU-GM in group III and that in group I ( p=0.02). The median percentage of cell viability after thawing in each group was 89, 87, and 75%, respectively. The median numbers of days after PBSCT to achieve a WBC of >1.0 x 10(9)/l, an absolute neutrophil count of >0.5 x 10(9)/l, and a platelet count of >50 x 10(9)/l were, respectively, 11, 11 and 15 in group I; 12, 12 and 16 in group II; and 12, 12 and 27 in group III. These results suggest that enriched MNC from mobilized PBSC could be frozen at a higher cell concentration (2 x 10(8)/ml) without the use of a programmed freezer, leading to reduction of the toxicities associated with infusion of thawed cells and of costly space required for cell storage.

Adolescent↗
PubMed1994

Cadaveric organ donation in Scandinavia, 1992.

In countries with active organ transplant programs and wide acceptance criteria for transplant recipients, such as the four Scandinavian countries, the need for organ grafts has outgrown the supply of cadaveric organs. We cannot expect to attain the maximum number of cadaveric donors every year and in every procurement area because the number of donors depends not only on the efficacy of the procurement program but also on the age of the population, incidence of road traffic accidents, treatment facilities, and other factors. The maximum numbers are set as a goal to strive for, however, Countries that participate in an exchange of cadaver organs to obtain well-matched kidneys for uremic patients and life-saving grafts at a suitable time for heart, lung, and liver recipients, must all have the same approximate number of cadaver donors. Major imbalances in the number of donors and also in the number of patients waiting for a transplantation may result in the supply of organ allografts for one country or region being met by the population of another region. With confidence we are looking forward to the impact of intensified public information and education of hospital personnel on the gap between demand and supply of organ allografts.

Attitude↗
PubMed1979

Issues in multivariate assessment of a large-scale behavioral program.

Several social and research issues directly affected the development and implementation of multivariate assessment in a large community-based applied research program. Examples are drawn from experiences of the Preparation through Responsive Educational Programs Project for disruptive and skill deficient adolescents in suburban, rural, and urban junior high school settings, focusing on the assessment of academic and social skill development and long-term skill maintenance. The social context altered both project treatment and follow-up plans, requiring assessment of potentially unintended effects and decreasing consistency across sites. Future community acceptance of such programs may depend on the investigators' adaptation to diverse community pressures for program conduct and assessment and the measurement of phenomena that are not always directly observable.

Journal Article↗
PubMed2003

Development of a Medical Humanities Program at Dalhousie University Faculty of Medicine, Nova Scotia, Canada, 1992-2003.

The Medical Humanities Program at Dalhousie University Faculty of Medicine in Nova Scotia, Canada, was initiated in 1992 to incorporate the medical humanities into the learning and experiences of medical students. The goal of the program was to gain acceptance as an integral part of the medical school. The program assumed a broad concept of the medical humanities that includes medical history, literature, music, art, multiculturalism, philosophy, epistemology, theology, anthropology, professionalism, history of alternative therapies, writing, storytelling, health law, international medicine, and ethics. Phase I of the program has provided the same elective and research opportunities in the medical humanities that are available to the students in clinical and basic sciences, and has encouraged and legitimized the involvement of the humanities in the life and learning of the medical student through a wide array of programs and activities. Phase II will focus on further incorporation of the humanities into the curriculum. Phase III will be the development of a graduate program in medical humanities to train more faculty who will incorporate the humanities into their teaching and into the development of education programs.

Curriculum↗
PubMed1998

Community support for needle exchange programs and pharmacy sale of syringes: a household survey in Baltimore, Maryland.

In October 1995, community attitudes toward needle exchange programs were assessed in Baltimore, Maryland. Household interviews were conducted with a random sample of residents living within six contiguous census tracts. Multivariate logistic regression was used to determine which factors were independently associated with acceptance of needle exchange programs. Of 274 eligible respondents contacted, 138 (50%) completed the interview. Respondents were statistically similar to the 1990 census population by income but were more likely to be female, black, between the ages of 35 and 44 years, and to have attended college or be a college graduate. Although 72% of respondents thought needle exchange programs would attract injection drug users to the neighborhood, 65% favored needle exchange, and 47% favored selling needles in a pharmacy without a prescription. Factors independently associated with acceptance of needle exchange programs included the perceptions that needle exchange programs decrease the number of discarded needles on the street, that needle exchange programs do not encourage a person's injection drug use, and that needle exchange programs decrease HIV incidence. Despite concern about attracting injection drug users to the neighborhood, support for needle exchange programs was high.

Adult↗
PubMed2006

Does sex affect the success rate of Canadian ophthalmology residency applicants?

BACKGROUND: Despite equalization of the ratio of men and women among matriculating medical students, it is possible that different rates of success for applicants at the level of resident selection in the annual residency match may occur on the basis of sex. As part of a larger project, we examined this issue across the medical specialties. In the current article, the effect of sex on resident selection within the specialty of ophthalmology is explored. METHODS: Data were obtained from the Canadian Medical Association, Canadian Institute for Health Information, Royal College of Physicians and Surgeons of Canada, Canadian Ophthalmological Society, and Canadian Residency Matching Service regarding sex- and age-specific demographics, as well as success rates for male and female applicants ranking an ophthalmology residency program as their top choice. The proportion of men who ranked ophthalmology as their top choice but did not match to any ophthalmology program was compared to the corresponding proportion of women. RESULTS: The female: male ratio of practicing ophthalmologists has slowly increased over the past decade and is highest (0.41:1) within the under-45 age group. By grouping data from 1993 to 2004, we found that men who ranked an ophthalmology program as their first choice had odds of not being accepted to an ophthalmology program that were 1.1 times (95% confidence interval 0.8-2.0; p=0.34) the corresponding odds for women. INTERPRETATION: Our data suggest that discrimination on the basis of sex does not occur at the level of residency selection. The lower level of female recruitment may be due to decreased interest in this specialty among women. Nonetheless, the proportion of female ophthalmologists within the Canadian workforce continues to increase.

Canada↗
PubMed1975

Pediatric interviewing skills taught by nonphysicians.

We cannot assume that medical students develop, through unstructured educational happenings, the skills of interviewing a mother about her child. Teaching these skills requires extensive one-to-one faculty-student involvement, which is almost prohibitive if pediatricians are expected to do this teaching. This article describes (1) a current pediatric interviewing teaching program that uses nonphysicians as teachers; (2) the selection and training of nonphysicians to teach the skill of pediatric interviewing to third-year medical students; and (3) an assessment of these teachers by comparing their techniques with those of three pediatric faculty members. The nonphysician teachers fared most favorably when their teaching methods were compared with those of three pediatricians. Acceptance of the program by the students, faculty, and administration has been most encouraging.

Education, Medical, Undergraduate↗
PubMed1998

Effectiveness of one-year participation in school-based volunteer-facilitated peer support groups.

This study evaluated the effectiveness of one-year participation in a program of volunteer-facilitated peer support groups conducted in a southeast Texas high school. One hundred eighteen students who experienced emotional distress or behavioral problems voluntarily participated in weekly groups facilitated by adult volunteers who were not mental health professionals. Seventy-six participants anonymously assessed the program using an instrument developed to evaluate the group experience. Results indicated that the program was highly accepted by the students even though two-thirds had initially felt uncomfortable in the groups. There was significant improvement in the interpersonal, internal, and school domains. Two-thirds of the alcohol and substance users reported reducing their intake or abstaining. The beneficial effects reported by a majority of the participants indicate that schools opting to implement this early intervention program can look forward to encouraging results within one year.

Adolescent↗
PubMed2003

Intention to apply or accept an alternative job among participants of extended employment programs.

The research studied 249 people employed in extended employment programs in northern Israel with respect to their intention to apply for an alternative job (an active step) or to accept a new job offer (a passive step). Findings indicated that young, single people who were living with their parents and perceived their level of disability as mild indicated more intention to apply for an alternative job or to accept a new job offer. Furthermore, people with low monthly wages, less satisfaction with their income and with the extended employment program in general, and a lack of participation in non-employment activities expressed a greater inclination to apply for an alternative job or to accept a new job offer. The only difference between people's intentions to apply for an alternative job (an active step) or to accept a job offer (a passive step) was in regard to their perception of their disability. The intention to apply for an alternative job was associated with mild disability, whereas the acceptance of a new job offer was related to mild and moderate disability.

Adolescent↗