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At least 73 records · Page 4Linked to original sources
PubMed1996

Implementation of a breast and cervical cancer screening program in a public hospital emergency department. Cancer Control Center of Harlem.

STUDY OBJECTIVE: To assess the feasibility and yields of screening for breast and cervical cancer in an urban public hospital emergency department. METHODS: Women who presented to the ED of a large, urban public hospital during the study period with nonurgent conditions were eligible for a Papanicolaou test (Pap smear) and a clinical breast examination (CBE) if they were 18 years of age or older and for a mammogram if they were 40 years of age or older, provided they had not had the screening examination within the past year. The Pap smear and CBE were performed by a nurse, and mammography was scheduled for a later date. Women with gynecologic complaints were excluded. RESULTS: On the basis of screening history, medical status, and age, 1,850 (32%) of the 5,830 women seen in the ER during the 23-month study period were eligible for both mammography and CBE, and 2,361 (41%) were eligible for Pap smears. Of these women, 116 (6%) completed mammography and CBE, and 644 (27%) received Pap smears. Among screened women, 10 (9%) and 20 (3%), respectively, had results that were suspicious or positive for breast or cervical cancer. Follow-up rates were low: 20% for breast screening and 50% for Pap smears. Among those receiving follow-up, 1 woman was found to have breast cancer and 8 were found to have cervical neoplasia. CONCLUSION: ED cancer screening was feasible and yielded a high rate of cancer detection. Program efficiency was hampered by low volume and high numbers of patients lost to follow-up after abnormal screening results. Greater integration into the acute care setting and more intensive recruitment and follow-up strategies are needed to maximize the potential yield and cost effectiveness of such programs.

Adolescent↗
PubMed1992

[Health policies and sickle cell disease].

Issues of public health raised by sickle cell disease and available solutions vary greatly between countries. Two main variables lead the choices: the affordable health resources, and the distribution of the abnormal genes in the population. Three examples have been chosen to illustrate these challenges. 1. In continental France, the level of health resources is good but the distribution of sickle traits is very heterogeneous among the population. Health policies against sickle cell disease aim at organizing screening and care to reach populations at risk, and concentrate the efforts upon them. This task is made difficult by two usual characteristics of these minorities: their rather poor social condition, and their cultural isolation. 2. In Guadeloupe (French West Indies) available health resources are similar to those of France but the sickle trait is common and has a homogeneous distribution in the population (14% carriers). Sickle cell disease is a health priority. Such conditions have recently favoured the organization of an efficient program for prevention and care of the disease. 3. In Benin (West Africa) a very high prevalence of sickle trait (more than 30% individuals are carriers, and about 4% have the disease) comes along with quite precarious resources that have to be shared with several other health priorities. An efficient and sustained policy against sickle cell disease has not yet been developed, which impedes a rational use of the few available resources, and creates much distress for diseased individuals.

Anemia, Sickle Cell↗
PubMed1999

Case management services for injured workers. Providers' perspectives.

The perceptions of service providers involved in case management services are described here. The service providers included claims managers, occupational nurse consultants, attending physicians, and nurse case managers. The purposes of this phase of the study were to describe these providers' perceptions about the case management program; to organize findings according to the quality assessment model that guided this study (including structure, function, and outcomes); and to identify barriers and facilitators to satisfaction with case management services. Structural factors that affected services included the workers' compensation system, construction of the service team, roles within the program, and individual attributes of service providers. Process factors were conflicts among parties, role of communication, and interaction with workers. Outcomes were described in terms of program efficiency and effectiveness. Data are used to illustrate and explain each of these themes.

Accidents, Occupational↗
PubMed1998

Efficient identification of point mutations by automated DNA sequencing of artificial heterozygote samples.

DNA sequencing templates of individual point mutants of the lacI target gene were amplified by polymerase chain reaction (PCR). By mixing the PCR fragments from two individual mutants in a defined ratio, samples of artificial heterozygous composition were prepared. These samples were then submitted to automated DNA sequencing. The simultaneous, visual comparison of the mixed mutant traces using a graphics program efficiently revealed all heterozygous positions. Based on the individual intensities of the heterozygous base signals the identified point mutations could be assigned to the corresponding mutants. This efficient approach doubles the sample throughput for both the sequencing reactions and the gel electrophoresis using an automated DNA sequencing system.

Animals↗
PubMed1999

Worksite influenza immunization. Successful program.

The planning, implementation, and evaluation of worksite health promotion programs can benefit from adapting and using the steps in each phase of the PRECEDE-PROCEED model. The model provides a framework to build and sustain support from employers and employees, and a valuable tool to increase program efficiency, effectiveness, and accountability. During the PRECEDE phases of planning, the model provides opportunities for continuous communication and feedback to all levels of management. The evaluation phases in PROCEED provide occupational health nurses with valuable information to share with corporate planners, influence management behavior, and contribute to evidence based decisions for future programming.

Humans↗
PubMed1991

Pathogenesis and recent therapeutic approaches to graft-versus-host disease.

Effective prophylaxis of acute GVHD should bring about improved patient survival by decreasing severe infections during the first 3 months after transplantation and reducing the incidence of chronic GVHD while not compromising the quality of hematopoietic engraftment or increasing the incidence of leukemic relapse by impairing the graft-versus-leukemia effect. None of the current approaches to prevention of GVHD succeed at meeting these expectations, although postgrafting immunosuppressive therapy comes closest to the ideal. The technique of T cell depletion has been very effective in reducing the incidence of GVHD, but conditioning programs must be developed that will be more successful at eliminating host immune and malignant cells. It is doubtful that this will be achieved with systemic chemotherapy and total body irradiation. Innovative approaches such as the use of monoclonal antibodies, either alone or linked to short-lived radioactive isotopes with short linear energy transfer, promise to result in less toxic but more efficient programs, not only providing better eradication of malignant disease but also ameliorating the problem of graft failure. It is conceivable, however, that it will never be possible to kill all leukemic cells with chemoradiotherapy of any form, and the graft-versus-leukemia effect may be essential. Perhaps in the future it will be possible to distinguish lymphocytes causing the graft-versus-leukemia effect from those causing GVHD, isolate them, and use them in attempts at therapy. In the meantime, postgrafting immunosuppressive drugs are used most frequently to prevent and treat GVHD, and steadily improving survival statistics can be expected.

Bone Marrow Transplantation↗
PubMed1998

Back to the future: community involvement in the Healthy Start Program.

This article discusses how community involvement is incorporated into Healthy Start, a major initiative to reduce infant mortality in selected communities with disproportionately high levels of infant mortality. Based on site visits to each of the fifteen original Healthy Start project areas, we discovered that two main community involvement strategies were used: a service consortium model and a community empowerment model. In the service consortium model, the community is involved primarily through a consortium of local providers, other professionals, and some governmental representatives who help to plan services. The community empowerment model involves the community by engaging neighborhood-based groups, contracting with community-based organizations, employing community residents as lay workers in the Healthy Start program, and creating other economic development initiatives. Important lessons drawn from this study are that the purpose and commitment to community involvement is not always clear; that it is difficult to involve community residents; that efforts to involve the community are extremely labor intensive; that given monetary incentives, it is easier to involve community providers than residents; that community involvement may conflict with efficient program operations; that increased community involvement may create program goals that differ from the program's original goals; and that community involvement may slow program development.

Community Health Centers↗
PubMed2000

SPSS and SAS programs for determining the number of components using parallel analysis and velicer's MAP test.

Popular statistical software packages do not have the proper procedures for determining the number of components in factor and principal components analyses. Parallel analysis and Velicer's minimum average partial (MAP) test are validated procedures, recommended widely by statisticians. However, many researchers continue to use alternative, simpler, but flawed procedures, such as the eigenvalues-greater-than-one rule. Use of the proper procedures might be increased if these procedures could be conducted within familiar software environments. This paper describes brief and efficient programs for using SPSS and SAS to conduct parallel analyses and the MAP test.

Factor Analysis, Statistical↗
PubMed1983

Effects of a physical training program on physical efficiency, work capacity and classroom-attention of handicapped children.

In the present study the effects of a ten-week physical training program on physical efficiency, work capacity and classroom-attention of 11 motorically handicapped children (between 8 and 14 years old) were examined. A physical training program for the children in the experimental group (n = 6) consisted of an intensification of the activities (assessed by means of heart rate recordings) of the scheduled physical education lessons, while the control group (n = 5) followed the same lessons without the intensity of the activities being changed. During all the lessons, the experimental group was required to achieve a minimum heart rate value of 160 beats X min-1. Physical efficiency and physical work capacity scores were calculated from the obtained relationships of respectively oxygen uptake versus workload and of oxygen uptake versus heart rate, determined during a submaximal bicycle ergometer test. Attention in the classroom was measured by means of a previously developed observation instrument. At the end of the ten-week training program a significant increase in physical efficiency and classroom-attention scores was demonstrated for the children in the experimental group. Such effects could not be demonstrated for the children in the control group. The implication that can be drawn from this finding is that the motorically handicapped children in the experimental group after having received special physical training can perform the same amount of external work with less energy expenditure. Further, their attention behaviour in the classroom situation appears to be facilitated. A follow-up study, carried out some months after the end of the training program, showed for both groups a deterioration in physical efficiency scores, while the experimental group also deteriotated in terms of their attention scores. It is suggested that an intensification of activities during the scheduled physical education lesson can have positive effects both physical and psychological on motorically handicapped children.

Adolescent↗
PubMed2002

Efficacy of a 2-year-old sexual assault nurse examiner program in a Canadian hospital.

INTRODUCTION: The purpose of this study was to describe a sexual assault nurse examiner (SANE) program at a hospital-based sexual assault care center in Ontario, Canada, and assess its efficacy in comparison with physician examiners. METHODS: Data obtained from the hospital records of 515 women who came to a Toronto sexual assault care center were examined. A number of variables relevant to this assessment of services were examined, including client demographics and presenting history, aspects of the sexual assault, and characteristics of the treatment. RESULTS: Average assessment times were shorter for victims seen by SANEs than for victims seen by physicians (approximately 3(1/4) hours versus 4 hours). Physicians had more interruptions (25.1%) than did SANEs (20.0%). Client characteristics and presentation were similar regardless of who provided care, with some exceptions. DISCUSSION: The results of the study support the utility of the SANE model as an efficient program for the assessment and treatment of victims of sexual assault.

Adolescent↗
PubMed1998

Medicare program; Medicare integrity program, intermediary and carrier functions, and conflict of interest requirements--HCFA. Proposed rule.

This proposed rule would implement section 1893 of the Social Security Act (the Act) by establishing the Medicare integrity program (MIP) to carry out Medicare program integrity activities that are funded from the Medicare Trust Funds. Section 1893 expands our contracting authority to allow us to contract with "eligible entities" to perform Medicare program integrity activities. These activities include review of provider and supplier activities, including medical, fraud, and utilization review: cost report audits; Medicare secondary payer determinations; education of providers, suppliers, beneficiaries, and other persons regarding payment integrity and benefit quality assurance issues; and developing and updating a list of durable medical equipment items that are subject to prior authorization. This proposed rule would set forth the definition of eligible entities, services to be procured, competitive requirements based on Federal acquisition regulations and exceptions (guidelines for automatic renewal), procedures for identification, evaluation, and resolution of conflicts of interest, and limitations on contractor liability. In addition, this proposed rule would bring certain sections of the Medicare regulations concerning fiscal intermediaries and carriers into conformity with the Act. The rule would distinguish between those functions that the statute requires be included in agreements with intermediaries and those that may be included in the agreements. It would also provide that some or all of the listed functions may be included in carrier contracts. Currently all these functions are mandatory for carrier contracts. These changes would give us the flexibility to transfer functions from one intermediary or carrier to another or to otherwise limit the functions an intermediary or carrier performs if we determine that to do so would result in more effective and efficient program administration.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1984

Development and validation of an automatic treatment referral system.

The alcoholism literature abounds with reports of the alcoholic personality and alcoholic subtypes. However, very minimal research on the relationship between the subtypes and treatment procedures is available. With the power of computer technology now accessible so readily, it is possible to apply sophisticated statistical methods to determine the extent of the association. The present paper describes the development of an automatic referral system (Autorf) on an inpatient alcohol and day unit (N = 150). More importantly, preliminary results with regard to the validity of the Autorf system are reported. Implications for treatment of alcoholics and program efficiency are discussed.

Adult↗
PubMed2000

Dual renin gene targeting by Cre-mediated interchromosomal recombination.

This study describes a new approach to targeting clustered genes. Our study began with the establishment of two lines of mice carrying different mutations in either Ren1 or Ren2. These two genes, both encoding renin, span over 40 kb in tandem on chromosome 1. Each gene was mutated by gene targeting to contain loxP sites. These two mutants and Cre transgenic mice were mated to produce offspring carrying the mutant Ren1 and Ren2 genes, as well as the Cre transgene concurrently. Initially, two mutant Ren genes were located on separate chromosomes. Southern analysis of mice from the second generation revealed that the mutant Ren1 and Ren2 were interchromosomally recombined at the loxP sites to produce a new dually mutated allele on the chromosome at the rate of 9.6% (7/73). Thus, interchromosomal recombination can be efficiently programmed by mating as designed using the Cre-loxP system.

Animals↗
PubMed1995

Reconciling science and policy in setting federal drinking water standards--four states' perspectives.

After almost 20 years of experience with implementing the Safe Drinking Water Act and eight with Amendments to the Act, the individual states within the United States have gained valuable experience while trying to reconcile the legal mandates provided by the statutes with the science underlying them. This paper presents four different topics illustrating the problems of reconciling these two issues in the regulation of toxic chemicals in drinking waters. It presents these from the perspectives of the states of Massachusetts, Rhode Island, Connecticut, and New Jersey and offers suggestions for improved program efficiency based on considerations of comparative human health risks. The approach and schedule for controlling toxic chemicals used through 1994 are first examined and a recommendation is made for more flexibility in the rate at which chemicals are regulated. Recent U.S. EPA proposals to more stringently control radon in drinking waters are presented in the context of all sources of radon exposures, illustrating the intersection of science, laws, and economic consequences of regulatory initiatives. Inhalation and dermal exposures as a result of using chemically contaminated drinking waters are then discussed with the suggestion of the possible underprotectiveness of some present standards. Finally, the difficulty faced by the states and federal government in the control of naturally occurring arsenic exposures through drinking water is also presented and an argument is made for more local flexibility in the application of health-based standards.

Administration, Cutaneous↗
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↗
PubMed1996

[The distribution of selected cardiac risk factors in employed and studying youths in the rural region of Steiermark (Austria)].

Demographic data, components of lifestyles such as risk behavior, health complaints, illnesses and utilization of preventive and curative services were surveyed through a health survey conducted in 79 selected rural communities of Styria between 1989 and 1933. Our research focussed on the stratification of cardiovascular risk factors such as smoking, high blood pressure, unhealthy nutrition, low physical activity and obesity in adolescents employed or attending school. The sample comprises 1239 adolescents divided into two groups: 651 were employed and 588 were in school. We could show that even at such a young age significant differences occur in the distribution of cardiovascular risk factors between these two groups. The employed adolescents were far more stressed than those of their age group attending school. Generally, the females are less strained than the males. Our results suggest that efficient programs to prevent cardiovascular disease need to specifically focus on the various life contexts of young people. Such programs should start at an early date.

Adolescent↗
PubMed1989

Shifting ditypic site analysis: heuristics for expanding the phylogenetic range of nucleotide sequences in Sankoff analyses.

We describe and illustrate a simple heuristic approach to the Sankoff methods for construction of parsimonious evolutionary trees from nucleotide sequence data. The procedure is intended to permit more valid inferences, particularly from relatively short sequences, concerning relationships among taxa separated for long time intervals. The procedure is based on the great variability of evolutionary plasticity among sites in the molecules and removes from consideration the more highly variable sites. Editing is accomplished after classifying sites in carefully aligned arrays of sequences. Only "ditypic sites," i.e., sites observed in only two evolutionary states within the array, are used in making phylogenetic inferences. This strategy makes possible the construction of good approximations to the most parsimonious Steiner trees, by means of efficient programs that require "dense species arrays," i.e., species sets that differ from each other by relatively small numbers of differences in conservative sites. The technique is illustrated with 5S and 5.8S rRNA sequence data from published catalogs.

Base Sequence↗
PubMed1985

A simple hidden line removal algorithm for serial section reconstruction.

A simple and efficient program for removing the hidden lines from the computer graphics display of a three-dimensional structure has been developed. The algorithm is optimized for serial section reconstruction, that is, for three-dimensional structures composed of a series of stacked planar outlines. Using the algorithm, an anatomist can generate a realistic static picture of a reasonably complex reconstruction in about 20 s on a small laboratory computer.

Anatomy↗