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PubMed1988

School-based clinics: their role in helping students meet the 1990 objectives.

Service statistics and observations from site visits across the country indicate that school-based clinics (SBCs) may be having an impact on several of the problems targeted in the 1990 health objectives, including unplanned pregnancy and substance abuse. At least 120 junior and senior high schools in 61 communities are currently operating or developing clinics. Growth is attributed to increasing concern about high-risk youth, especially among educators in their roles of "surrogate parents"; to disillusion with categorical interventions and a movement toward more comprehensive services; and to student, parent, school, and community approval of the new programs. This article describes the comprehensive school-based clinic model, including its history, organizational strategies, school/community partnerships, and services.

Adolescent↗
PubMed2002

[Possibilities of utilising official statistics for health services research].

This report deals with the experiences and problems with using official statistics on a limited area level of Germany's 440 administrative districts. The data comprised health-related issues and were used for an ecological analysis of the determinants of hospital use. We obtained health statistics data from homepages of the German health report, the Federal statistics office, and the 16 statistics offices of the Federal states. We also made use of the data base of the joint regional statistics published by the Federal and regional statistics offices. Finally, there was a co-ordinated inquiry to the regional statistics offices about the supply of data on mortality, hospital discharges, structure of hospital care and several socio-economic indicators. The process of data collecting was mostly unproblematic. On the other hand, not all of the data were available on a limited area level in a satisfying form and quality. For reasons of data protection some information of small districts was transmitted incompletely. Additionally, there are procedural differences between regional statistics offices regarding the differentiation between some variables and in the exchange of data between the federal states. Finally, some problems were due to varying age classifications for different health indicators. For health services research the use of official statistics becomes increasingly comfortable via health reports and Internet. However, for specific questions of research some problems still remain, rising from missing standardised health indicators and deficient availability of limited area health data. Data collection is exacerbated by restrictive interpretation of data protection acts and the different handling of data inquiries in the regional statistics offices. Finally, there is a lack of data on morbidity and use of ambulatory care.

Data Collection↗
PubMed1991

Scottish dentists' use of and opinions regarding bitewing radiography.

This study examined Scottish dentists' claimed use of and opinions regarding bitewing radiography. Information was obtained from a questionnaire sent to all dentists practising in Scotland in 1987 and from national statistics published in the Annual Reports of the Dental Practice Boards in the UK. The response rate to the questionnaire was 72% (926 general dental practitioners and 201 clinical community dental officers). Respondents considered radiography to be of value for the detection of approximal caries, assessment of caries progression and evaluation of alveolar periodontal support. They considered it to be of less value for a variety of other tasks, including detecting occlusal caries, unerupted teeth or calculus. One hundred and fifty-eight dentists (15% of respondents) claimed not to have taken any bitewings of their 12-year-old patients in the preceding year. Those respondents who did claim to have exposed some bitewings said that approximately one-quarter of this patient group had received the examination in the past year. The overall Health Service statistics appear to confirm that the utilization of radiography by dentists practising in Scotland is somewhat lower than that by dentists in England and Wales, a factor which requires further investigation.

Attitude of Health Personnel↗
PubMed1986

Censuses of population and housing in Africa: some issues and problems.

"A census of population and housing, which contributes immensely to the development of social statistics and national statistical services in general, has been carried out at least once in every African country except Chad. The common issues and widespread practices of design, implementation, processing, and evaluation of this census are reviewed. Also reviewed are the problems that arise at each of these stages of conducting the census; problems arising as a result of the socio-economic and physical peculiarities of African conditions."

Africa↗
PubMedDate not supplied

A comparison of census and family planning program data on contraceptive prevalence, Indonesia.

Indonesian family planning (FP) service statistics indicate that three out of five couples of childbearing age nationwide are now using modern contraception provided by the FP program. The 1980 Indonesian Census provided a unique opportunity to cross-check the FP program's contraceptive prevalence figures for every province. The results of that comparison indicate considerable variation, particularly in Java, between the FP program estimates of numbers of current users and the census estimates. Possible explanations for these differences are sought in the FP program approach to estimation of prevalence levels from acceptor data, and by examining the possibility of census underestimation of prevalence levels.

Adolescent↗
PubMed1996

[The legend of 150,000 deceased from tuberculosis per year].

This article analyzes the stages by which it was concluded that there were 150,000 deaths from tuberculosis in France at the end of the nineteenth century. The calculations made by Brouardel are broken down and the inappropriate nature of some of his choices is pointed out. In addition to these oddities in calculation, the contemporary social and political factors warrant our attention. The estimation can also be explained by the growing fears regarding demographic and social perils. Did not tuberculosis and the falling birth rate jeopardize all hope of taking revenge on Germany? In fact, the "enemy" had decided to undertake a vast program for the construction of sanatoriums, thus tempting the French public health authorities to use the figures to mobilize the attention of the public and politicians. In the collective imagination, tuberculosis and its 150,000 fatalities replaced the great epidemic of the nineteenth century, cholera, whose most destructive appearance in 1854 killed precisely 150,000 persons. In spite of the more probable estimation from the statistical services (fewer than 100,000 deaths), this figure of 150,000 deaths from tuberculosis was revived in the period between the World Wars and again in the last decade by certain historians, which proves that it became engraved in memory. However, from the turn of the century, and especially between 1918 and 1940, the proponents of these numbers have admitted that they used them to influence opinion. Here we have an excellent example of a dual language: depending on where he was speaking, the same scientist of political authority could simply double the estimations of mortality from tuberculosis.

France↗
PubMed2001

Evidence of diffusion from a targeted HIV/AIDS intervention in the Dominican Republic.

The diffusion potential of a targeted HIV/AIDS intervention that enlisted peer educators to disseminate 'safer sex' messages and condoms among female commercial sex workers and their clients was evaluated in the Dominican Republic. Levels of interurban interaction potential were ascertained that linked the targeted city of La Romana with the proximate cities of San Pedro de Macoris and Guaymate. Weekly service statistics generated over an 8-month period were analysed to establish activity areas for the peer educators. Data were entered and analysed using a geographic information system and interurban linkages were established. Project outcomes were examined via a series of three cross-sectional Knowledge, Attitudes and Practices (KAP) surveys conducted among convenience samples of commercial sex workers at the start of the intervention and at 4 and 8 months. The results attest to a high degree of interconnectivity between the targeted and proximate cities, and a pattern of interurban mobility that links commercial sex workers, clients and establishments in all three cities. The examination of project outcomes revealed statistically significant changes in condom use in the targeted city of La Romana among commercial sex workers, as well as among their counterparts interviewed in the proximate cities of San Pedro de Macoris and Guaymate. These data suggest a diffusion effect. It is concluded that a targeted intervention may influence proximate cities within a relatively compressed period of time. The findings suggest the importance of considering geographic diffusion principles, such as urban hierarchies, regional nodes and transportation linkages, when designing HIV/AIDS prevention efforts. It also has important implications in the selection of control sites when conducting experimental studies of HIV/AIDS interventions.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The correlation between family planning program inputs and contraceptive use in Indonesia.

Using 1980 Census and 1986 service statistics program inputs, this paper evaluates the net correlation of socioeconomic, region, and program variables with 1987 contraceptive prevalence and method-specific use rates for Indonesian regencies and municipalities. The region variables--primarily, though not exclusively, reflecting program design and maturity--correlate most strongly with the contraceptive prevalence rates. Field-worker activities, field-worker supervisor activities, and community-based distributors also have a correlation with these rates. Pill use is highest in the areas that are predominantly Islamic and least developed, whereas the pattern is reversed for use of the IUD, condom, and other modern methods (mainly female sterilization). The findings are assessed in terms of their implications for policymaking.

Community Health Services↗
PubMed2002

A study of bedside ocular ultrasonography in the emergency department.

UNLABELLED: The use of ocular ultrasonography for the evaluation of emergency patients has recently been described in the emergency medicine (EM) literature. There are a number of potential uses that may greatly aid the emergency physician (EP) and avoid lengthy consultation or other diagnostic tests. OBJECTIVE: To examine the accuracy of bedside ultrasonography as performed by EPs for the evaluation of ocular pathology. METHODS: This prospective, observational study took place in a high-volume, suburban community hospital with an EM residency program. All patients arriving with a history of eye trauma or acute change in vision were eligible to participate in the study. A 10-MHz linear-array transducer was used for imaging. All imaging was performed through a closed eyelid, using water-soluble ultrasound gel. Investigators filled out standardized data sheets and all examinations were taped for review. All ultrasound examinations were followed by orbital computed tomography or complete ophthalmologic evaluation from the ophthalmology service. Statistical analysis included sensitivity, specificity, and positive and negative predictive values. RESULTS: Sixty-one patients were enrolled in the study; 26 were found to have intraocular pathology on ultrasound. Of these, three had penetrating globe injuries, nine had retinal detachments, one had central retinal artery occlusion, and two had lens dislocations. The remaining pathology included vitreous hemorrhage and vitreous detachment. Emergency sonologists were in agreement with the criterion standard examination in 60 out of 61 cases. CONCLUSIONS: Emergency bedside ultrasound is highly accurate for ruling out and diagnosing ocular pathology in patients presenting to the emergency department. Further, it accurately differentiates between pathology that needs immediate ophthalmologic consultation and that which can be followed up on an outpatient basis.

Emergency Medicine↗
PubMed1980

Teaching family planning management and evaluation skills.

In the last several years the need for training schemes in family planning programme administration has become increasingly apparent with the rapid growth of family planning services throughout the world. This paper reports on the development and use of a series of 16 practical classroom training exercises designed for teaching planning, management and evaluation skills. Each exercise can be introduced, worked and discussed in a morning or an afternoon. It is available in an individual booklet, which contains worksheets, blank tables and step-by-step instructions for working the exercise, along with a discussion of the skills being taught. Topics covered include demographic rates and concepts, the Dryfoos-Polgar-Varkey formula, risk factor analysis, target-setting, case load forecasting, service statistics, contraceptive supplies, manpower planning, couple-year of protection, cost-effectiveness, contraceptive use-effectiveness, life table techniques, numerator analysis, fertility pattern method, sampling methods and questionnaire design. These curriculum materials concentrate on imparting through the medium of actual experience a series of specific management techniques of a quantitative nature that will enhance the ability of the trainees to plan, administer and evaluate any family planning programme anywhere in the world. The exercises in this series have been tested in the family planning training programmes at Columbia University and at Downstate Medical Center in New York. They have also been used in WHO workshops in Thailand and Tanzania and in training programmes in France, Kenya and Nicaragua.

Family Planning Services↗
PubMedDate not supplied

An assessment of the nine-month lactational amenorrhea method (MAMA-9) in Rwanda.

This report presents a secondary data analysis based on prospectively collected records gathered during a field assessment that was carried out in Rwanda in August 1993. The assessment used service statistics and follow-up interviews to evaluate the efficacy of a modified lactational amenorrhea method (LAM) as a nine-month introductory postpartum natural family planning method. The program, carried out by Action Familiale Rwandaise (AFR), reflects high efficacy of the method in a compliant sample that sought this method followed by another form of family planning. These results are promising and provide guidance for the extended use of LAM past six months. Programmatic findings suggest that studies be conducted of the contribution of extended LAM to improved weaning practices, the high efficacy of continued reliance on substantial lactation and amenorrhea beyond nine months, and male involvement in LAM and breastfeeding.

Algorithms↗
PubMed1993

Appropriateness of hospitalization in a Canadian pediatric hospital.

Allocation of limited resources in the Canadian health care system is hampered by a lack of studies addressing the appropriateness of the pediatric patient days in hospital. The authors retrospectively reviewed one hospital day per month in 1988, using a Pediatric Appropriateness Evaluation Protocol previously used in the United States. Of 878 inpatients, 852 charts were reviewed, and 26 charts were unavailable for study. The patients ranged in age from premature newborns to 20 years old. There were 475 medical days, 359 surgical days, and 18 patients to other services. Statistical significance was tested using the chi 2 test for contingency tables. Twenty-four percent of patient days were inappropriate. Younger children and shorter lengths of stay were more likely to result in appropriate hospital days. For infants younger than 60 days, 11% of days in hospital were inappropriate, 21% of days for infants between 2 months and 1 year of age, 25% for children between 1 and 5 years, and 36% for children older than 5 years of age. Children hospitalized 2 days or less had inappropriate hospital days accounting for 16% of the reviewed days. This increased to 33% for 3 to 14 days of hospitalization. Inappropriate hospital days did not vary significantly from month to month. Surgical patients had more appropriate hospital days than medical patients. Admission route (elective, emergency, or transferred from another hospital) did not affect the appropriateness of the subsequent day reviewed. It is concluded that inappropriate hospitalization in a Canadian pediatric hospital occurs only slightly more frequently than in an American pediatric hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Very brief psychological interventions with university students.

Annual college mental health service statistics reveal that 50% to 60% of all students served are seen for very brief psychological interventions--5 or fewer sessions. A substantial portion of the students benefit from these very brief contacts. The authors review the selection criteria for student and therapist that make very brief intervention possible. The student must be motivated for and seek a brief encounter and must enter the therapeutic relationship with the capacity for trust already in place and the professional qualifications of the therapist already established. The problem presented should be sufficiently clear and manageable to be resolved, or to begin being resolved, in a few sessions. Finally, the student must have the capacity for rapid insight and learning. The therapist brings to the relationship a belief in the value of very limited sessions, the capacity to develop a positive relationship quickly, and the ability to determine when it is appropriate to work in such a short time frame and to use the time most effectively. Four ways that students may benefit from very brief psychological interventions include (1) psychodynamic therapy, (2) crisis intervention, (3) mental health consultation, and (4) managed referral. Case illustrations and clinical methods are presented.

Adolescent↗
PubMed1998

Design and implementation of the United States National Animal Health Monitoring System 1995 National Swine Study.

The United States Department of Agriculture's National Animal Health Monitoring System 1995 National Swine Study was designed to estimate management, health and productivity parameters on pig operations in the United States. Sixteen major swine-producing states that accounted for nearly 91% of June 1, 1995 swine inventory and nearly three-fourths of United States swine producers were included in the study. In the initial phase of the study, National Agricultural Statistics Service enumerators collected information from 1477 producers involved in all phases of swine production (farrowing, nursery, and grower/finisher). Of these, 405 operations with > or = 300 finisher pigs (with at least one finisher pig > or = 54 kg) participated in the subsequent component of the study, which involved on-farm visits by state and federal veterinary medical officers and animal health technicians, and which concentrated on the grower/finisher phase of production. Of those eligible to take part in the second phase of the study, participation was higher among independent producers (48.3%) than among contract producers (15.3%). Participation was also higher among operations that used advanced record-keeping systems (such as record cards for individual breeding hogs or a computer-based record-keeping system). Thus, study results could have been influenced by response biases. As a biosecurity measure, 40.5 +/- 2.1% of operations restricted entry to employees only. For operations that permitted non-employees to enter the premises, relatively few enforced other biosecurity measures on visitors (0.4 +/- 0.1% required feed-delivery personnel and livestock handlers to shower before entering the premises; 3.3+/- 0.9% required a footbath; and 7.0 +/- 1.5% required feed-delivery personnel and livestock handlers not to have visited another operation with pigs on that day). The most common method of waste storage (used by 49.9 +/- 3.8% of operations with > or = 300 finisher pigs) was below-floor slurry or deep pit.

Animal Husbandry↗
PubMed2001

Unequal cluster sizes for trials in English and Welsh general practice: implications for sample size calculations.

Cluster randomized trials are often used in primary care settings. In the U.K., general practices are usually the unit of allocation. The effect of variability in practice list size on sample size calculations is demonstrated using the General Medical Services Statistics for England and Wales, 1997. Summary statistics and tables are given to help design such trials assuming that a fixed proportion of patients are to be recruited from each cluster. Three different weightings of the cluster means are compared: uniform, cluster size and minimum variance weights. Minimum variance weights are shown to be superior to uniform, particularly when clusters are small, and to cluster size weights, particularly when clusters are large. Where there are large numbers of participants per cluster and cluster size weights are used, the power actually falls as more patients are recruited to large clusters. When minimum variance weights are used the increase in the design effect due to variation in list size is small, regardless of the size of intracluster correlation coefficient or the number of participants per cluster, provided there is no loss of randomized units. When the expected number of participants per practice is low a greater loss in power comes from practices which fail to recruit patients. A method to estimate the likely effect and allow for it is presented.

Accidental Falls↗
PubMed1993

Childhood thermal injuries in New Zealand resulting in death and hospitalization.

Thermal injury is a significant contributor to the overall problem of injury among children. Children are at greater risk of hospitalization due to thermal injury than any other age group, and their fatality rate is second only to those over 60 years of age. This study provides an overview of thermal injury in New Zealand children, age 0-14 years, resulting in death or hospitalization. Eighty-one thermal fatalities were identified from Health Statistical Services (HSS), Department of Health, data accessed for the 10-year period from 1978 to 1987. The records of the Coroners' Court, held by the Justice Department, were also accessed in order to gather additional information about the circumstances of fatal injury in each case. Thermal injury hospital admissions (n = 634) were identified from HSS data for the year 1988. Children were more likely to die in house fires than any other thermal injury event. Most house fires were started by smoking paraphernalia or electrical appliances. Two-thirds of the childhood thermal injury hospitalizations were due to contact with hot water, the most commonly identified source being a hot beverage. Thermal injury rates for New Zealand children are higher than reported overseas. Prevention strategies that have proven effective elsewhere are discussed with recommendations for New Zealand.

Adolescent↗
PubMed1997

Design and implementation of the United States National Animal Health Monitoring System 1994-95 Cattle on Feed Evaluation, and an evaluation of the impact of response biases.

The 1994-95 Cattle on Feed Evaluation was a cooperative project (sponsored by the United States Department of Agriculture) involving Washington State University, state agricultural departments, and several agencies of the United States Department of Agriculture). The project focused on cattle-on-feed operations in 13 states that accounted for over 85% of the United States cattle on feed inventory. Participants were selected from National Agricultural Statistics Service list frames. Questionnaires were administered by telephone to operations with a one-time capacity of fewer than 1000 cattle; larger operations were visited twice to administer questionnaires. The participation rate for the first phase of the study was 56.7%. Ninety-one percent of eligible operations completed the second phase of the study. Data summarized from this national study can be used to profile management practices on cattle-feeding operations in the United States. Differences between participants and non-participants did not appear to be great. However, one does need to be mindful of the fact that a small percentage of the producers accounted for the vast majority of feedlot cattle marketed when interpreting the results.

Animal Feed↗
PubMed1998

The availability of state-level data on interstate cattle movements in the United States.

Knowledge about the patterns of animal movement--particularly feeder-cattle movement--within the USA is necessary in order to anticipate how diseases might be spread geographically. This study was conducted to explore the availability of interstate-level movement data which might be used to develop a more coherent national picture of interstate feeder-cattle movement. State Statistical Offices of the National Agricultural Statistics Service, 1996 (NASS) and Departments of Agriculture in all 50 states were contacted to determine the type of information collected regarding the import and export of feeder cattle. Eighteen of the 50 states contacted recorded updated import and export information by using certificates of veterinary inspection and (occasionally) entry permits for verification. The 18 states were: Alabama, Colorado, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Maryland, Massachusetts, Minnesota, New Jersey, Pennsylvania, Texas, West Virginia, Wisconsin, and Wyoming. Profiles of import and export data from Kansas, Texas, Colorado and Iowa (the primary receivers of 51% of total 1995 imports) were developed. These four states received at least 50% of their cattle imports from < 9 different states. As a result, approximately half of the nation's import movement can be explained by a total of 13 states and Mexico (excluding duplicates). Also, > 50% of the exports from Kansas, Texas, Colorado, and Iowa go to < or = 3 states. This import and export information confirms conclusions of others that cattle tend to move toward the center of the USA. However, if more states kept comprehensive, up-to-date records of movement information, knowledge about cattle-movement patterns in the USA would be importantly increased. The lack of specific notations on certificates of veterinary inspection can lead only to perceived trends; the present records have limited value in tracking animal movement.

Animal Welfare↗