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PubMed1999

Health care incentives in immunisation.

BACKGROUND: Australia has introduced a nationwide immunisation incentive scheme. This yet to be evaluated two-year program offers financial rewards to providers and parents to encourage childhood immunisations. OBJECTIVES: To review the use of incentives in immunisation uptake, identify issues in developing an incentive program for childhood immunisation and examine the findings within the context of the Australian scheme. METHOD: Medline was searched under 'immunization and financial incentive' and 'immunization and incentive' in English 1966 to 1998. RESULTS: The search identified six and 93 articles respectively, of which six examined the role of material incentives influencing coverage of immunisation. References and reviews identified a further three studies. Among these nine studies (two British, six American, one Nicaraguan), two reported the same intervention. Of the eight incentives examined, four referred to non-financial incentives such as food vouchers and four to monetary incentives for parents (1) or providers (3). Groups receiving the incentives were up to three times more likely to be immunised and had overall immunisation rates up to 17% higher than comparison groups. CONCLUSIONS: Effective incentives require collaboration of key players, using a program appropriate to the characteristics of the population. Although varying in cost-effectiveness, both monetary and non-monetary incentives can improve childhood immunisation uptake. Evaluation of current programs including the Australian ones will assist future allocation of resources.

Child↗
PubMed1991

Community responsibility for the self-neglectful client.

Self-neglectful clients, including the elderly, are in jeopardy, partly through their refusal to accept community services that could help them; they require protection from the community. These people are alienated and isolated, and need to be integrated into the community. Their individual rights to control their own lives, however, must be protected. It is the responsibility of the community to structure services in a way that will engage these people. A comprehensive community service program appropriate to their needs would integrate formal and informal care systems by interweaving professional services, informal assistance, and mutual aid within structures that facilitate coordination of formal care programs.

Aged↗
PubMed1971

An investigation of the educational needs of health sciences library manpower. 3. Manpower supply and demand in health sciences libraries.

An investigation of the manpower requirements of health sciences libraries and of educational programs appropriate to these manpower needs was begun in March 1968. To date, 4,727 libraries have been identified as being used by 14,000 health sciences institutions and programs. Of this total, 2,628 are hospital libraries; 1,328 are health sciences libraries and collections located outside of hospitals; and 771 are academic or public libraries. Within these libraries some 14,938 persons are directly involved, either full- or part-time, in the delivery of health sciences library services. Of the total work force, 5,861 persons are employed in hospital libraries and 9,077 are employed in health sciences libraries and collections. The ratio between professional and nonprofessional employees is 1:2; professional and nonprofessional status was assigned by the chief librarian. Survey data indicate a 7 percent manpower shortage in positions classified as professional, and a 3 percent shortage in positions classified as nonprofessional.

Journal Article↗
PubMed2001

Automatic external defibrillator intervention in the workplace. A comprehensive approach to program development.

1. The planning and implementation of an automatic external defibrillator (AED) intervention in the workplace necessitates a comprehensive approach to program development. 2. Initiation of an AED intervention program at the worksite, based on an informed decision, requires each company to conduct a detailed assessment of need. 3. Prior to initiating an AED intervention program, appropriate resources should be consulted to examine national, state, and local law provisions and legal factors governing AED use in each specific community. 4. Essential components of an AED intervention program include: the combined cardiopulmonary resuscitation and AED use training program; written policies, procedures, and medical directives; a plan for the purchase, maintenance, and location of the AED equipment and supplies; an integrated emergency response plan; and an ongoing quality improvement process.

Electric Countershock↗
PubMed1983

Continuing education and the geographically isolated therapist.

The relationship between therapists' geographic location and three program planning variables in continuing education was studied using the descriptive survey method. The findings suggested that learning needs were high in evaluation related competencies and that family responsibility and lack of appropriate programs were major barriers to participation. The overwhelming preference in delivery systems was the one or two day workshop. The study concluded that there were few significant differences between urban and rural therapists in relation to the variables studied indicating restraint rather than innovation in programming for the geographically isolated therapist.

Analysis of Variance↗
PubMed1990

Rehabilitation of the pediatric patient with a neuromuscular disease.

A rehabilitation program for a patient with a neuromuscular disease can be developed only after an accurate diagnosis has been established. The diagnosis and its ramifications should suggest a natural course of disease which, it is hoped, can be improved upon with a rational and realistic program. The program is best developed by an interdisciplinary team, including a pediatric neurologist, who should have the greatest understanding of the patient's problem and should ultimately be responsible for the implementation and monitoring of the program. A child with cerebral palsy commonly requires the services of physical and occupational therapists as well as knowledgeable orthopedists. Is the program appropriate? Does it consider the child's potential as well as his limitations? A child with a traumatic brain injury requires, in addition to the above, psychological intervention and an intensive educational program. Will the child and family need help from mental health professionals? A child with a motor unit disease such as Duchenne's muscular dystrophy requires, in addition to the above services, a "philosophy" of care. Will the child ever ambulate independently? If so, at what cost? What will be necessary for the child to reach this potential, including items such as orthoses and adaptive equipment? Will respirator care become necessary? What issues must be addressed for this form of care to be established? There is no one program for all children. The programs must be individualized to meet the needs of the patient and the family. This point cannot be overemphasized.

Brain Damage, Chronic↗
PubMed1998

The Healthy for Life project: sexual risk behavior outcomes.

Sexual risk behavior outcome data from the Healthy for Life (HFL) project is presented. Using a social influences model, the intervention was designed to positively affect the health behaviors of middle school students in five related areas: alcohol use, tobacco use, marijuana use, nutrition, and sexuality. The in-school program was supplemented by parent, community and peer components. The research used self-report data on an initial sample of 2,483 middle school students followed from Grade 6 to Grade 10. Twenty-one schools were assigned to three conditions--age appropriate (program taught in Grades 6, 7, and 8), intensive (program taught in Grade 7) and control--using blocked randomization. Attrition was 20% (by Year 4) and 33% (by Year 5). By ninth grade the lifetime intercourse rate among both groups of HFL subjects was significantly higher than for controls (controlling for baseline substance use risk and involvement with the opposite sex), but reported past month intercourse rates and condom use did not differ. At the tenth grade follow-up, the age appropriate subjects reported higher adjusted rates of lifetime and past month intercourse than did the controls. Intensive subjects perceived significantly lower normative rates of intercourse than controls at ninth grade follow-up, but age appropriate subjects perceived significantly higher norms at tenth grade. Our expectation that this approach would be effective in reducing adolescent sexual risk behavior has not been supported. The influence of social and community norms and contextual factors has a far greater influence on the behavior of students (even 6 years later) than this school-based social influences program targeting only one grade cohort.

Adolescent↗
PubMed1998

The mean ventricular fibrillation cycle length: a potentially useful parameter for programming implantable cardioverter defibrillators.

In programming the implantable cardioverter defibrillator (ICD), the ventricular tachycardia (VT) detection cycle length (CL) is based on the CL of the documented tachycardia but the ventricular fibrillation (VF) detection CL is set arbitrarily. Appropriate programming of VF detection may not only reduce the incidence of inappropriate ICD shocks for non-VF rhythms but can also avoid the fatal underdetection of VF. The mean VFCL may provide a useful parameter for optimal ICD programming for VF detection if it is reproducible. This study examined the intrapatient reproducibility and interpatient variation of the mean VFCL in 30 ICD patients (25 men and 5 women, mean age 63 +/- 13 years). A total of 210 VF episodes (7 +/- 4 per patient, range 3-17) induced by T-wave shocks (166) or AC (44) at the ICD implant (30 patients) and the predischarge test (12 of 30 patients) were analyzed. The mean VFCL was calculated from the stored V-V intervals in the ICDs. Although the mean VFCL varied significantly from 171 +/- 6 to 263 +/- 11 ms (P < 0.01) among different patients, it was reproducible among different VF episodes in an individual patient (maximal variation 4-50 ms, P > 0.05). The mean VFCL was not significantly different between patients with and without antiarrhythmic drugs (210 +/- 32 vs 210 +/- 23 ms, P > 0.05) and was correlated with the ventricular effective refractory period (r = 0.5, P < 0.05). The mean VFCL varies greatly among different patients but remains reproducible in an individual patient, suggesting that the mean VFCL may serve as a reference for ICD programming of VF detection.

Adult↗
PubMed1994

Interagency coordination: the key to mainstreaming children with special needs into day care.

While the need for mainstreamed day-care services continues to increase, many barriers remain that prevent or delay providers from enrolling children with special needs. The suggestions in this article to coordinate local resources will help programs begin to provide initial necessary services to children with special needs. The use of volunteers will help supplement the staffing needs of a day-care center and allow for more individualized care of the children. Unfortunately, the absence of public funds for child day care continues to be a major barrier to creating appropriate programs for children with special needs. State and federal policies need to be expanded to support day care in general and children with special needs specifically. Part H of PL 99-457 (now Part H of IDEA PL102-119) is a national impetus to promote interagency collaboration at state and local levels. This is a beginning, but more state and federal funding is needed. In addition, regulations need to be developed that will make it easier rather than more difficult for local agencies to participate. Day-care providers and professionals in every community must work together to provide appropriate services to children with special needs. The most effective services use interdisciplinary teams to work together to plan and implement the care. Let us pick up the challenge of this mandate and develop programs that will help future generations recognize and accept the differences between individuals as well as see the similarities.

Child↗
PubMed1999

The characteristics of asthma education programs within New South Wales.

The aim of the study was to examine the characteristics of asthma education programs within NSW. A cross-sectional questionnaire survey concerning the aims and characteristics of 42 asthma education programs was administered to members of the Asthma Educators Association (AEA) of NSW. While most programs sought to improve asthma knowledge (78%), only a small number sought to improve asthma management skills (38%), asthma control (33%) and attitudes (10%). Most programs performed one-to-one (69%) education. Medical intervention was under-utilized by most programs and only 4% gave feedback to the referring doctor. Program evaluation was incompletely linked to program aims. There was incomplete evaluation of knowledge gain as an outcome. The study reviewed the characteristics of education programs within NSW Existing programs appropriately employ a variety of educational methods and target a broad range of people with asthma. There remains a need to use a combined approach utilizing education and medical management, and to employ methods to evaluate programs.

Adolescent↗
PubMed2000

Prevalence of suicide programs in schools and roadblocks to implementation.

We surveyed all school districts in Washington State for information on the prevalence of suicide programs and on major roadblocks to implementing programs. With 163 districts responding (62%), we found that the majority did not have suicide programs or policies and procedures. The largest perceived roadblock was insufficient staff and the greatest perceived need was more information. Although establishing policies and procedures is considered by many as a necessary first step to establishing suicide programs, we did not find schools choosing this option as often as others. This raises questions as to what are effective ways to have schools start suicide programs. We analyzed the data by school district size and by the title of the staff member making the report. We discuss the implications of these findings as well as the need for further efforts to develop appropriate programs for schools.

Adolescent↗
PubMed1976

Summer day camp for multihandicapped children.

A six-week enriched sensorimotor, communication, and recreational summer day camp for twenty multihandicapped preschool children is described. The program, planned and supervised by therapists and mental retardation counselors, provided training for students who worked as camp counselors. Each counselor was assigned to work with one child and family and was responsible for assessing, establishing goals, designing appropriate programs, attending the child throughout the day, and relating to the family. The camp provided a trial for use of the Functional Skills Profile (FSP), an assessment battery designed by physical and occupational therapists to measure performance changes in low functioning, developmentally handicapped persons in order to determine the value of therapy programs. The camp is evaluated in terms of improvement in the children, the effectiveness of the student training, and parent satisfaction.

Aftercare↗
PubMed2003

Health education in an inner-city Catholic grade school.

The purpose of this article is to outline the process, content, and evaluation of a 14-week health education program for 6th, 7th, and 8th grade students in an inner city Catholic grade school who are at risk for multiple health problems. The process includes a needs assessment with findings, followed by construction of an age-appropriate program. A content outline displays the topics and information presented to the students. In conclusion, an evaluation presents the results and effectiveness of the program.

Catholicism↗
PubMed1990

Synergism of testosterone propionate with growth hormone in promoting growth of hypophysectomized rats: effect of sexual differentiation.

The effect of testosterone propionate (TP), alone and in combination with porcine GH, on the growth of hypophysectomized rats was investigated. An initial study determined doses of TP and GH which would result in a synergistic response. Hypophysectomized male rats, approximately 40 days of age, received GH at doses of 5, 25 and 62.5 micrograms/day administered in two injections/day at 08.00 and 16.00 h. At all doses of GH, administration of TP at 100 micrograms/day significantly enhanced the GH-stimulated rate of growth. This growth enhancement by TP was greatest in combination with GH at 25 micrograms/day. In a subsequent study, growth responses to 25 micrograms GH/day and 100 micrograms TP/day were examined in animals with differing degrees of sexual differentiation. Sex groups were: intact males, males castrated at 11 days of age and females administered 100 micrograms TP at 3 days of age (masculinized rats), and males castrated at 2 days of age and normal females (non-masculinized rats). In all sex groups, growth of hypophysectomized rats was stimulated by GH. Genetic sex and masculinization did not influence the response to GH. Masculinized hypophysectomized rats exhibited significantly greater rates of growth and final live, empty body, liver and kidney weights than non-masculinized hypophysectomized rats. All sex groups other than normal females responded synergistically to the combination treatment of GH plus TP. Rats that experienced neonatal exposure to testosterone became programmed to respond to testosterone and demonstrated greater rates of growth and body and organ weights when administered the combination of GH plus TP. These data indicate that TP synergizes with GH to promote growth of hypophysectomized rats appropriately programmed to respond.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Report of the Commission on the Evaluation of Pain.

The following is a reprint of the report to Congress transmitted by the Department of Health and Human Services in response to a provision of the Social Security Disability Benefits Reform Acto of 1984 (Public Law 98-460). It also includes some of the report's appendix material. The congressional mandate called for a study, performed in consultation with the National Academy of Sciences, of how pain is evaluated in determining disability under titles II and XVI of the Social Security Act and for recommendations on how pain should be considered in evaluating disability under these programs. In addition to several recommendations for improvements in interviewing, applications, questionnaires, and development practices in "pain" cases by including pain specialists for consultative examinations, the Commission strongly advocated experiments to determine if individuals with impairment due primarily to pain can be reactivated and vocationally rehabilitated under appropriate programs or if such individuals should be allowed disability benefits.

Chronic Disease↗
PubMed1998

Peer helping/involvement: an efficacious way to meet the challenge of reducing alcohol, tobacco, and other drug use among youth?

Peer-led drug prevention programs for middle school youth are reviewed as to whether or not they are a vital resource in an overall effort to minimize the use of alcohol, tobacco, and other drugs (ATOD). The paper focuses on the following: a) results of a 120-study meta-analysis of school-based drug prevention programs and positive program features; b) considerations for falsely concluding that peer programs are ineffective; c) features of two model or stellar programs that compared interactive (peer leadership) to teacher/researcher-led (non-interactive) programs that followed National Peer Helpers Association (NPHA) Programmatic Standards; and d) suggestions for designing and implementing high-quality, peer-led programs. The authors conclude that interactive peer interventions for middle school students are statistically superior to non-interactive didactic, lecture programs led by teachers/researchers. Programs implemented according to NPHA Programmatic Standards may eliminate Type II (false negative) and III ("implementation failure" or ineffectively designed and implemented program) errors. Opportunities for prudent application of well-designed peer programs appropriately implemented and evaluated must remain a salient priority.

Adolescent↗
PubMedDate not supplied

[Sports programs for the elderly in Germany in 1991].

The percentage of older people in the population will permanently increase. An attendant phenomenon is a rising demand for special exercise programs. In 1991, a survey of those programs was done in the unified FRG. The investigation was ordered by the Sportministerkonferenz der Länder to substantiate further promotion. Organizers and sponsors of exercise programs for older people originate from public and private non-profit institutions in the fields of sports (administration), social welfare, public health, and educational work. Concerning the structure and the extent of special exercise programs there exist large regional differences between the eastern vs. western part of the FRG and rural vs. urban areas. People of over 50 years of age have to be separated into different groups corresponding to their age, physical condition, experience, and needs; not all of them find appropriate programs. The Deutsche Turner-Bund, private charitable institutions, and a few private health-care organizations preferentially serve untrained and/or inexperienced women over 60-65 years of age with recreationally oriented exercise programs. The younger, more athletic find more competitively oriented programs within the scope of other sports federations. Recreational sports programs in age-independent groups are often attended by older physically fit people.

Adult↗
PubMed1992

First derivative of right ventricular pressure, dP/dt, as a sensor for a rate adaptive VVI pacemaker: initial experience.

Ten patients underwent implantation of a rate adaptive ventricular pacing system with a new pulse generator and lead. The unipolar lead has a steroid eluting tip and a pressure sensor. The first derivative of the signal from this sensor, dP/dt, is determined and the pacemaker rate is varied in response to changes in the right ventricular dP/dtMAX. During implantation, dP/dt values were in the range of 180-720 mm Hg/sec. The autothreshold for pacing at 2.5 V remained unchanged 1 month after implantation (0.065 +/- 0.045 msec, range 0.05-2.00 msec) and only slightly increased after 3 months (0.075 +/- 0.045 msec, range 0.05-2.00 msec). A significant correlation existed between the dP/dt measured during implantation and the right ventricular pressure measured by telemetry at follow-up visits (r = 0.93, P = 0.0001). Initial pacemaker programming was performed on the second day after implantation following a short walk and was adjusted subsequent to follow-up visits according to the patient's subjective assessment and in accordance with the results of exercise tests and Holter monitoring. Exercise and Holter tests did not significantly change initial programming. There was a significant correlation between right ventricular systolic pressure and the rate response setting (r = -0.66, P less than 0.05). During dP/dt pacing, all patients felt well, and eight of these reported an improvement compared to nonrate adaptive pacing. The heart rate response to effort and recovery was appropriate. It was concluded that: (1) right ventricular dP/dt is a suitable parameter for controlling the pacing rate; (2) appropriate programming of the dP/dt pacemaker results in a suitable heart rate response to exercise and recovery.

Aged↗