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PubMed2003

Next generation of preventive interventions.

OBJECTIVE: With increasing numbers of efficacious prevention programs, the field needs strategies to disseminate the interventions broadly. METHOD: The authors examined the life course of prevention programs, identified barriers to dissemination, and outlined an alternative dissemination model. RESULTS: Private enterprise models of product development can be viable strategies for increasing the dissemination of the intervention to the general public. Market principles suggest that the next generation of interventions would be facilitated if interventions are initiated by teams committed to a specific problem and investigators receive training in management; if the acceptability of the program's design features to consumers, providers, and funding agencies is established prior to the development and evaluation of the program; if data from national marketing surveys are used to tailor intervention designs and delivery formats for different subgroups; if essential ingredients of the intervention are identified to facilitate adaptation of the program; if the program is implemented with a goal to maintain change over extended periods of time; if the implementation plan includes program evolution over time, rather than replication with fidelity; and if interventions are branded and certified by a credible agency. CONCLUSIONS: Private enterprise models may be useful; however, investigators are likely to be resistant given a priori biases, potential ethical conflicts of interest, and the challenges presented by new technologies (e.g., the Internet and Human Genome Project).

Forecasting↗
PubMed1986

Surgical infections--the general surgeon's perspective. Defining the problem, seeking solutions.

Infection has been historically the greatest threat to patients undergoing surgery, but with effective surveillance programs, the risk of surgical infection can be markedly reduced. An effective approach to infection control involves attention to the triad complex of infection--asepsis (keeping bacteria below the "critical inoculum"), antisepsis (disciplined use of antibiotics), and host defense mechanisms (altering factors that reduce immunity). Several large studies indicate a national trend toward decreased wound infection rates. This trend is probably attributable to a wide acceptance of surveillance programs, shorter length of hospitalization, and better use of antibiotic therapy.

Anti-Bacterial Agents↗
PubMed2004

Depressive mood after a cardiac event: gender inequality and participation in rehabilitation programme.

BACKGROUND: Depressive mood after a cardiac event is common with serious consequences for the patient. AIMS: To compare gender in depressive mood during the first year after a cardiac event and to evaluate the effect of participating in a multidimensional secondary prevention program on depressive mood. METHODS: 166 men and 54 women, <73 years, consecutively answered a questionnaire concerning depressive mood at 2 weeks, 6 weeks, 5 months and 1 year after discharge after a cardiac event. At 2 weeks, each patient met a nurse, and was informed about the disease and received individual support about lifestyle changes. Of those invited to participate in a secondary prevention program, 127 patients accepted, and 93 declined participation. RESULTS: At each of the four follow-ups, women had significantly higher depression scores than men. Depressive mood in both women and men was significantly reduced at 6 weeks. Thereafter, it increased to the 2-week level in women and to above the 2-week level in men. No differences were seen in patients participating or not in secondary prevention programs. CONCLUSION: Women had higher depressive mood scores than men and secondary prevention programs failed to improve depressive mood in both women and men.

Angioplasty, Balloon, Coronary↗
PubMed1994

A strength training program for postmenopausal women: a pilot study.

This pilot study examined a specific exercise program designed for skeletal muscle strengthening in postmenopausal women. The program consisted of patterns of movement using diagonal and spiral patterns, superimposed on a progressive weight-bearing sequence from prone lying to standing. Progressive resistance was provided with the use of progressively thicker elastic straps. Eighteen of an initial 22 healthy volunteer women aged 50 to 64 years completed 8 weekly hour-long group exercise sessions supplemented with twice weekly sessions at home to pilot test the program's safety, acceptability, and effectiveness in changing muscle strength. A physical therapist conducted baseline and final quadriceps, hamstrings, and grip strength assessments using a portable isokinetic dynamometer. Participants achieved a 21% increase in quadriceps (p < or = .001), 9% increase in hamstrings (p < or = .07), and a 14% increase in grip strength (p < or = .002). A positive dose-response relationship was observed between strength gains and compliance with the program. This approach to strength training in postmenopausal women is feasible and effective in increasing muscle strength. It has considerable promise and deserves further testing and evaluation.

Biomechanical Phenomena↗
PubMedDate not supplied

A school reentry program for burned children. Part I: Development and implementation of a school reentry program.

Sustaining a burn injury is a devastating and painful experience. After acute concerns have been dealt with, continued support of the child and family is important in achieving a smooth return to normal activities. Reports from burned patients for whom physical therapy was a concern identified a need for physical therapy involvement in school reentry to facilitate a resumption of normal school routine. Physical therapy involvement in school reentry has been successful and rewarding with a reasonable commitment of manpower. Utilization of personnel in the administrative structure of state and local school systems promoted the acceptance of the program by local school personnel. Although this program is designed to meet the needs of burned children, the goals of the school reentry program may meet similar needs of children with other chronic illnesses.

Adolescent↗
PubMed2001

A smoking reduction and cessation program with registered nurses: findings and implications for community health nursing.

A smoking reduction and cessation program was implemented with registered nurses in 3 Canadian provinces. Nurses (n = 117) participated in either an 8-week group or self-directed program using a resource specifically designed for nurses. Questionnaires were administered prior to and at the end of the 8-week interventions and at 6 and 12 months postintervention. Statistically significant changes at 8 weeks in nurses' smoking practices were found on the number of nurses continuing to smoke, mean number of cigarettes smoked, and movement in the stage of behavioral change. Attrition and variation in patterns of quitting over the 12-month study period made assessing participants' longer term outcomes difficult. This study highlights the complexity of assisting nurses to quit smoking and of implementing and evaluating a program based on accepted community health models of practice.

Adult↗
PubMedDate not supplied

Culturally tailored diabetes education program for Chinese Americans: a pilot study.

BACKGROUND: The prevalence of type 2 diabetes among Chinese Americans is rising, and cultural and socioeconomic factors prevent this population from achieving optimal diabetes management. OBJECTIVES: To assess the feasibility and acceptability of a culturally appropriate diabetes management program tailored to Chinese Americans with type 2 diabetes and the preliminary outcomes of the intervention. METHOD: Forty eligible subjects were recruited from the community to participate in this 10-session program developed by integrating Chinese cultural values into an established Western diabetes management program. Feasibility and acceptability of the program were evaluated by the percentage of participants meeting the course objectives and satisfaction with the program. Outcomes measures included the Diabetes Quality-of-Life (DQOL) survey, body weight, blood pressure, and HbA1c levels measured before, after, and 3 months after the intervention. RESULTS: Thirty-three participants completed all 10 sessions and the outcome measurements. Attrition rate was 17.5%. The majority of the participants understood the course content (75%) and identified and demonstrated various diabetes management skills (70% and 82.5%, respectively). All participants who completed the program were "very satisfied" with the program. With regard to the outcome variables, 43.6% of the participants lost more than 5 pounds and most had a reduction in blood pressure at 3 months after completion of the program. Mean HbA1c decreased from 7.11 to 6.12 postintervention. Significant improvements on the DQOL also were reported. DISCUSSION: Culturally tailored diabetes management may be effective in Chinese Americans with type 2 diabetes. Further study, with a larger sample size and a control group, is recommended.

Adult↗
PubMed2007

The acceptability to older drivers of different types of licensing restriction.

The primary objective of this study was to determine the acceptability of various driving restrictions to older drivers. Licensed drivers aged 65 years or more living in the community in the Ottawa, Ontario area were recruited by means of posters and advertisements in regional and local newspapers. We recruited 86 subjects, 56 men and 30 women with a mean age of 75 years (50 urban and 36 rural residents). The subjects completed a one-hour interview with one of two trained study nurses during which their driving restriction preferences (utilities) were determined using a modified standard gamble technique. Highly endorsed restrictions included regular assessment by the Ministry of Transportation (mean utility 0.94), driving with vehicle adaptations (0.94) and daytime driving only (0.93). Less acceptable restrictions included avoidance of roads with a speed limit greater than 60 km/h (0.50), limitation of destinations (0.45), driving only within a 10-km radius of home (0.45) and requirement of another licensed driver in the vehicle (0.42). Our subjects' preferences appeared to be inversely related to the impact on autonomy and the ability to access the community. These findings may be useful to motor transport administrators in designing effective restricted licensing programs that are acceptable to older drivers.

Age Factors↗
PubMedDate not supplied

Measuring hepatitis B uptake in a new universal infant program.

BACKGROUND: Vancouver-Richmond Health Board has the highest reported rate of hepatitis B in Canada, including an annual average of 25 cases in children under 12 years of age, based on reports from 1994-1997 inclusive. The current provincial adolescent grade-six hepatitis B immunization program does not protect against childhood infection. The regional health board implemented universal infant hepatitis B immunization in September 1998. METHOD: Immunization coverage data were obtained on a random sample of 191 infants born in March 1999 one year after initiation of the program. RESULTS: By eight months of age, 97.9% of children had received some vaccinations. 73.8% of infants had received three doses of hepatitis B vaccine and 12.6% had received two doses. In comparison, 89% had received three doses and 7.9% two doses of DPTP-Hib vaccine. 13.1% of infants had not received any hepatitis B vaccine. For a majority (67%) of these children, their physician's lack of awareness or lack of acceptance of the program constituted the reason for no hepatitis B vaccine uptake. Only one parent cited adverse publicity as the reason for refusing vaccination. INTERPRETATION: This survey reveals a successful first year of the program without harm to the pre-existing childhood vaccination programs. Hepatitis B vaccine uptake can be improved by increased awareness among physicians and parents.

British Columbia↗
PubMedDate not supplied

Management of the pregnant, insulin-dependent diabetic woman.

An intensive care program was offered to all insulin-dependent, pregnant diabetic women who presented to The New York Hospital Obstetrical Clinic in their eighth week or less of gestation. The patients were hospitalized for 1 wk to normalize their blood glucose and to teach the technique of self-monitored glucose determination, diet and exchange lists, and the method to titrate insulin according to the blood glucose determination. The mean blood glucose for the first 10 patients accepted to the program was 169 mg/dl at the start of the program with a mean hemoglobin A1c of 9.4% for the group (normal < 5.5%) and glucosuria up to 50 g/24 h. After discharge, mean glucose was 91 mg/dl, and urinary glucose excretion was 1.4 g/24 h. HbA1c fell into the normal range 5 wk after normoglycemia was achieved (3.4%) (nl < 5.5%). Normoglycemia was maintained as outpatients until 3 wk before delivery when the patients were readmitted for tests of fetal well-being. Mean weight gain for the mothers was 12.2 kg. Mean glucose at delivery was 87 mg/dl and HbA1c was 3%. Hormonal profiles (hCG, hPRL, estrogens, progesterone, hPL) normalized after normoglycemia was achieved and remained normal until delivery. Mean gestational age at time of delivery was 38.8 wk with a mean infant birth weight of 2988 g. No infant manifested hypoglycemia, hypocalcemia, erythremia, or respiratory disease. The use of self-monitored blood glucose allows for optimal care of the insulin-dependent, pregnant diabetic woman while she remains at home with her family.

Adult↗
PubMedDate not supplied

Food and Drug Administration Pesticide Program. Residues in foods--1987.

A total of 14,492 samples of domestically produced and imported food from 79 countries were analyzed for pesticide residues in 1987. No residues were found in over 50% of the samples. When residues were found, they were usually at low levels and rarely exceeded tolerances. Most violative residues were found in commodities where a tolerance had not been established for a specific pesticide/commodity combination. Less than 1% of the 14,492 samples contained residues that exceeded regulatory limits. These findings are supported by the Total Diet Study data, which show that the dietary intake of pesticide residues is only a small fraction of acceptable limits. The program described in this report continues with modifications designed to place additional emphasis on imports, better target both domestic and imported foods, increased the number of selective surveys to add information on residue occurrence, and expand FDA/state cooperative activities.

Diet↗
PubMed1990

[Quality control in the process of health care of infants].

We are having an internal, retrospective audic of 302 medical care histories corresponding to all infants between 0 and 18 months registered at the health centre between 1st Nov. 1986 and 30th April 1988, with purpose of determining the degree of quality achieved by the professional staff in the completion of the medical records, systematic examinations of health and objectives proposed in the Centre's Program for Infants, similarly assessing the adeherance of patients to the same. We found a level of those registered globally, of 81 por 100 of all analysed data, which we assessed as improvable. The ratio obtained of securance, cover and maintainance of maternal lactancy, the correct iniciation of beikot and vaccination, although satisfactory, did not reach proposed standards except in the maternal lactancy objective initiated, which improved (67.66% vs 60.0%). The ratios relative to the adeherance to and acceptance of the program by the users are satisfactory: the infants who left it constituted only 3.3%. Atendance of those summored is 97.03% and 24% of failures to attend were due to changes of address. We are however proposing concrete corrective measures to make early contact with the gestative mother and the newborn in order to improve the process of health care.

Humans↗
PubMed1990

Paperless Poison Center: an alternative to bubbling.

The Paperless Poison Center (PPC) is a computer software program which allows for direct entering of data collection, data submission to the American Association of Poison Control Centers (AAPCC) and on-site analysis of data using RBASE. A comparison of the computer collection system vs bubbling of AAPCC sheets is discussed as to speed and ease of use, accuracy and cost. A summary of our comparison concludes that the computerized system is cost effective, more efficient, and more accurate than the paper method. Poison Information Specialist (PIS) acceptance of the program has been overwhelmingly positive.

Data Collection↗
PubMed1978

A hypertension control program based on the workplace. Report on the Chicago Center.

In several large Chicago companies and institutions, workplace screening of 7,151 persons yielded 833 suspect hypertensives. Of these, 91% attended a follow-up verification visit, where for 513 persons high diastolic pressure was confirmed. One-half of these persons were referred to their physicians for treatment and one-half were randomly assigned to be treated directly by HDFP, in a step-wise pharmacologic regimen to normalize diastolic pressure. Of the 257 persons assigned to program treatment, 94% accepted such treatment, and over 90% of these still living in the community were active participants at one year. Average diastolic pressure of these active participants was 83.1 mm Hg at one year, compared to 102.6 at first screen and 98.8 at the second confirmatory screening. A strenuous effort has been made to reduce or eliminate obstacles to treatment, including lack of understanding of the need for long-term therapy, cost barriers and barriers of inconvenience of treatment. The medical team conducting the program combined physicians with nonphysician therapist-health counselors, plus "outreach" staff, to maximize program adherence. Preliminary experiences in the Chicago Center of the Hypertension Detection and Follow-Up Program (HDFP) give encouraging evidence that the workplace is a useful base for successful hypertension control efforts.

Chicago↗
PubMed1995

Older Alabamians System of Information and Services (OASIS): a model Title VII chapter 2 low vision rehabilitation program.

BACKGROUND: Little attention has been paid in the ophthalmic literature to programmatic issues of low vision rehabilitation services delivery. The Older Alabamians System of Information and Services (Project OASIS) is a model low vision rehabilitation program functioning within the state of Alabama. This program is funded through Title VII, chapter 2 of the Rehabilitation Act, Independent Living Services for Older Blind Individuals. The program provides a comprehensive array of independent living services, including optometric low vision evaluation and low vision devices, to persons who are older and blind. Through intergency agreements between various state agencies and private entities, OASIS is able to maximize limited resources and reduce service redundancies. METHODS: Components of the OASIS consortium are reviewed along with outcomes of participants in fiscal year 1993-94. RESULTS: In fiscal year 1993-94 1,114 persons were entered into Project OASIS. Over half (569/1,114) of individuals accepted into the program received traditional optometric low vision rehabilitation services. More than 80% (586/717) of persons were able to achieve their independent living goals. CONCLUSIONS: Through a consortium effort between aging and rehabilitative services, minimal resources have been maximized to allow older visually impaired adults to benefit from comprehensive low vision rehabilitation services.

Activities of Daily Living↗
PubMed1981

The Swedish methadone maintenance program: a controlled study.

Thirty-four drug addicts, aged 20 - 24 years, with a history of 4 - 8 years of intravenous heroin abuse, were randomly assigned either to a methadone maintenance treatment (MMT) (17) or to an untreated group (17). The untreated controls could not apply for entrance to the program until two years later. It was found that after two years 12 MMT patients had abandoned their drug habits and begun work, whereas 5 had recurrent drug abuse problems. Of the controls, one was drug-free and gainfully employed, 12 were continuously abusing heroin (3 of these had incurred potentially fatal diseases in consequence), 2 were in prison and 2 had diet. Two to seven years after their first visit to the Psychiatric Research Center 8 of the original control group have been accepted into the program. At present 19 (out of 25 admitted) are gainfully employed and no longer abusing drugs. Among the remaining controls 4 are dead, 3 are in prison, one in spite of a serious heart condition abuses heroin and one is drug-free. The rehabilitation rate was thus 76 per cent in the program as compared to 6 per cent among the control group. In addition, MMT obviously reduced the high morbidity and mortality rates found in a selection of heroin addicts who fulfilled the admittance criteria of the Swedish program.

Adult↗
PubMedDate not supplied

[Results of health examination by age and sex groups].

The present study describes the results achieved 6 months after the establishment of a health examination, with different features depending on age and sex groups, which was progressively applied to the population of the C.A.P. "Virgen de la Fuensanta" (Valencia). The preventive activities included: vaccination (rubella, tetanus and influenza), tuberculin skin testing, determination of body weight and mass (BMI), measurement of blood pressure and heart rate, cervical cytology, breast examination and search for occult blood in feces. Among the 388 evaluated individuals (69.4% females and 30.6% males), 10 cases of hypertension, 2 of diabetes, 65 of obesity, 20 of hypercholesterolemia, 23 women with benign breast abnormalities and 8 instances of occult blood in feces were detected. In the age group of 15-26 years, 7 positive tuberculin reactions were detected. In 175 cytological studies no case of malignant disease was discovered. The degree of acceptance of the program by the users was satisfactory, as assessed by the compliance with both the appointments (85%) and the individual interventions (88-100%).

Adolescent↗