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PubMed2003

Use of the stages of change model in improving nutrition and exercise habits in enlisted Air Force men.

Thirty-nine U.S. Air Force enlisted men participated in a randomized controlled study that evaluated an experimental program designed to enhance fitness. Subjects were assigned to either a treatment (access to the program) or control (no access to program) group for 6 months. To improve treatment group fitness (as measured by VO2, subjects received individually tailored information (based on a behavior change model) via the Internet to encourage adoption of positive diet and exercise behaviors. Results showed no significant effect in improving fitness in treatment. However, significant effects were observed for secondary outcomes such as weight (controls, +1.0 kg vs. treatment, -2.2 kg, p < 0.05), body mass index (+0.3 kg/m2 vs. -0.7 kg/m2, p < 0.05), and percent body fat (+0.6% vs. -1.5%, p < 0.001). The data suggest that the individually tailored exercise information was not effective in encouraging sufficient exercise intensity to impact fitness. However, the dietary tailored information appears to have encouraged the adoption of more positive nutritional practices as demonstrated by the beneficial effects reflected in secondary outcomes.

Adult↗
PubMed1984

Retirement preparation programs: differentials in opportunity and use.

Two issues rarely addressed in the retirement planning field are (a) the proportion of older workers who participate, or have the opportunity to participate, in retirement preparation programs; and (b) socioeconomic differentials in access to such programs. Data from the National Longitudinal Surveys of older men were used to investigate these two issues. The data indicate that fewer than 4% of this sample of men aged 60 to 74 in 1981 had participated in a retirement preparation program. Logistic multiple regression analysis indicated that level of education, occupational status, government employment, and private pension coverage were positively related to the likelihood of participation as well as the likelihood of opportunity to participate. Conclusions from this analysis are (a) very few older men are ever exposed to retirement preparation programs and (b) those who would seem to benefit most from preparation programs, low status and low income workers, are the least likely to have access to these programs.

Aged↗
PubMed2003

American Academy of Pediatrics Community Access to Child Health (CATCH) Program: a model for supporting community pediatricians.

Advocacy on behalf of children who are medically underserved and the pediatricians who care for them has been a long-standing core commitment of the Royal College of Paediatrics and Child Health and the American Academy of Pediatrics. Although different in etiology, barriers to adequate health care exist in both nations. In the United States, almost 18 million children have either no health insurance or inadequate coverage, whereas in the United Kingdom, parents can, in most cases, readily enroll their youngsters in a universal health insurance program that is not dependent on employers or employment.(1) However, despite universal access to health care in the United Kingdom, as in the United States, there are infants and children who do not regularly use or otherwise connect to available health care delivery systems. Many of these families are not participants in other social systems (eg, church, school, voting, employment, property ownership/rental) and therefore are not known to governments, agencies, authorities, or health care professionals. Both nations have citizens living in extreme poverty with its associated environmental and health hazards and tendencies to health risk behaviors. Both the Royal College of Paediatrics and Child Health and the American Academy of Pediatrics have strategies and programs to address these issues and to support pediatricians who work in their communities to improve the lives of children. The following describes the American Academy of Pediatrics Community Access to Child Health infrastructure that supports practicing community pediatricians in these efforts and opportunities to develop collaborative international endeavors to advance the practice of community pediatrics.

Child↗
PubMed1996

Software for genetic linkage analysis: an update.

Recent developments in human genetic linkage analysis have included the appearance of new software and collections of data and program resources, accessible by means of the Internet. Many of these new programs and collections are described, including their availability, literature background, and specific technical information.

Computer Communication Networks↗
PubMed2005

A computerised guidance tree (decision aid) for hypertension, based on decision analysis: development and preliminary evaluation.

This paper discusses the piloting of a computerised decision aid that provides individualised information about hypertension to patients. The program is based on decision analysis, using decision trees as a way of structuring information. It incorporates the Framingham risk equation to assess a users' risk of coronary artery disease, together with a detailed assessment of the patient's current lifestyle and their willingness to change behaviour. Users of the program can decide how much or how little information they access. The program assesses individual's preferences for different treatment outcomes, before providing them with guidance on what might be the best treatment option for them. The program was evaluated by 10 patients with a diagnosis of mild to moderate hypertension and 8 health care professionals. Overall, both health care professionals and patients assessed the program positively. The use of a decision aid based on decision analysis may be a useful way of providing information to patients in order to promote shared decision making.

Aged↗
PubMed2002

Endovascular intervention for the failing vascular access.

Endovascular interventions have replaced surgical repair as the primary treatment of the failing or thrombosed vascular access. However, endovascular and surgical techniques are complementary: the limitations of one are the strengths of the other. Endovascular management of access-related problems is a critical component of a successful vascular access monitoring program. The identification and early treatment of developing stenoses, before access thrombosis are essential roles that are ideally suited to percutaneous, image-guided techniques. Despite recent advances in endovascular techniques and devices, angioplasty continues to be the primary method for treatment of access-related stenoses. When appropriate lesions are treated, angioplasty is a fast, easy, and safe procedure that can extend to patency of a hemodialysis graft or fistula.

Angioplasty↗
PubMed2006

Effects of a cognitive-behavioural internet program on depression, vulnerability to depression and stigma in adolescent males: a school-based controlled trial.

This study evaluated the effectiveness of a cognitive behaviour therapy Internet program (MoodGYM) for depressive symptoms, attributional style, self-esteem and beliefs about depression, and on depression and depression-vulnerable status in male youth. A total of 78 boys age 15 and 16 years were allocated to either undertake MoodGYM or to standard personal development activities. Outcomes were measured before commencement, post-program and 16 weeks post-program. There were no significant between-group differences in change scores pre- to post- or pre- to follow-up using the intention to treat sample or for participants with post- and/or follow-up data. For boys completing 3 or more modules there were small relative benefits of MoodGYM for depressive symptoms (Effect Size, ES = 0.34), attributional style (ES = 0.17) and self-esteem (ES = 0.16) at post-program, although only the effect for self-esteem was sustained at follow-up. Both groups showed improvement in their beliefs about depression at follow-up, with the control group showing a moderate relative benefit (ES = 0.40). While the numbers are small, there was a reduction in the risk of being depressed in the MoodGYM group of 9% at post-treatment compared with a slightly increased risk for the control group. The risk of being classified as vulnerable to depression reduced by 17% in the MoodGYM group at post-treatment compared with no change in risk for the control group. These reductions in risk for the MoodGYM group were not sustained at follow-up. The limitations of the study highlight several important challenges for MoodGYM and other self-directed Internet cognitive behaviour therapy programs. These include how to ensure enough of the program is received and that people who could potentially benefit access the program and continue to remain engaged with it, and how to enhance the sustainability of any benefits.

Adolescent↗
PubMed1978

A problem orientated information system.

It has been suggested several times that care of patients with medical problems is not carried out in a consistent manner. Emergency medical care is most usually given by junior medical staff. It seems possible that their inexperience may further increase the inconsistency of care given. An information system HOISS (House Officer Information and Scheduling System) is described. It consists principally of a data-base of 80 clinical problems and a suite of programs to access the data-base. There is also a scheduling program which prints-out a worksheet of tests needed to be done that day. A review of the care of 86 patients is given. It is seen that there is considerable variation in the investigations done for a particular clinical problem. Also routine tests are not asked for and many investigations are done which cannot be justified from the patients condition. The results of five months experience with the system are presented. It is shown for the one problem considered that management was more consistent, the routine tests were done more regularly and there were less spurious tests performed.

Emergency Service, Hospital↗
PubMed1990

Screening, diagnosis, and management of dyslipoproteinemia in children.

The authors provide an extensive and comprehensive review of dyslipoproteinemia in children. An effective program for CVD reduction in this population will include an accessible screening program to identify high-risk children, high-quality measurements of TC and LP-C, careful follow-up of screening results with multiple measurement to classify risk status and diagnose primary dyslipidemia, a key role for family and education, and consistent and long-term follow-up for diet and drug adherence, efficacy, and safety.

Adolescent↗
PubMedDate not supplied

Fertility policy and family planning in the Arab countries.

An increasing number of Arab countries are instituting family planning programs to lower their populations' high fertility rates. This article examines Arab governments' perceptions of their countries' fertility situation, their desire to intervene in order to reduce or increase the rate of population growth, and the measures they have taken to influence the level of fertility. Special attention is given to family planning programs and access to methods of fertility regulation. A combination of stronger program effort and improved socioeconomic conditions account for much of the variation in contraceptive prevalence rates in 11 countries. Socioeconomic setting and political factors are found to be of primary importance in determining Arab fertility policies.

Family Planning Services↗
PubMed2002

Novel computer program for fast exact calculation of accessible and molecular surface areas and average surface curvature.

New computer programs, SurfRace and FastSurf, perform fast calculations of the solvent accessible and molecular (solvent excluded) surface areas of macromolecules. Program SurfRace also calculates the areas of cavities inaccessible from the outside. We introduce the definition of average curvature of molecular surface and calculate average molecular surface curvatures for each atom in a structure. All surface area and curvature calculations are analytic and therefore yield exact values of these quantities. High calculation speed of this software is achieved primarily by avoiding computationally expensive mathematical procedures wherever possible and by efficient handling of surface data structures. The programs are written initially in the language C for PCs running Windows 2000/98/NT, but their code is portable to other platforms with only minor changes in input-output procedures. The algorithm is robust and does not ignore either multiplicity or degeneracy of atomic overlaps. Fast, memory-efficient and robust execution make this software attractive for applications both in computationally expensive energy minimization algorithms, such as docking or molecular dynamics simulations, and in stand-alone surface area and curvature calculations.

Algorithms↗
PubMed1995

Medicaid program; rescission of the guidelines for documenting Medicaid recipient access to immunizations under the Vaccines for Children (VFC) Program--HCFA. Notice.

This notice rescinds the guidelines that we published in the Federal Register on October 3, 1994, that required States to document equal access to immunizations for Medicaid children if States elected to use lower vaccine administration fees than the maximum charges that were published and applicable under the Vaccines for Children program. These guidelines are rescinded in response to public comments on the October 3, 1994 notice. States indicated that there were numerous problems regarding the collection of useable data.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1996

Cybersex: regulating sexually explicit expression on the Internet.

While the First Amendment restricts the power of the government to control access by adults to sexually explicit expression that is not obscene, the government may restrict access by children, provided that those restrictions do not limit adults to reading only "what is fit for children." Controlling access by children presents special problems in the context of broadcasting, because broadcast programming is accessible to children too young to read and because of the impossibility of segregating adults and children in the audience. The Supreme Court therefore permits the government to require "channeling" of sexually explicit programming to times when fewer unsupervised children are in the audience, to facilitate parental control over children's access to sexually explicit material. Although Internet content includes less than one percent of sexually explicit expression, that material has been the subject of intensive media and government attention. Much of that attention ignores (1) the high level of constitutional protection applicable to non-obscene, sexually explicit expression; (2) features of the Internet which facilitate controlling access by children to sexually explicit expression far more effectively than in broadcasting or print media; and (3) the First Amendment values served by permitting expression of all forms on the Internet.

Adult↗
PubMed2006

Better access to psychology services in primary mental health care: an evaluation.

INTRODUCTION: The Access to Allied Psychological Services program was introduced as part of the Better Outcomes in Mental Health Care initiative in 2001-2002. Divisions of General Practice are funded to establish programs that allow GPs to refer patients for psychological treatments. The University of New South Wales evaluated programs run by the Southern Highlands and Illawarra Divisions of General Practice. This paper presents the findings of these evaluations. METHOD: Both evaluations analysed process and patient outcomes. This was obtained from a combination of program data and qualitative satisfaction data. RESULTS: The two program models differed in the mechanism of retention of the psychologists and the method of referral of patients. Anxiety and depression were the main reasons for referral, and clinical data showed there was improvement in patient outcomes. Patients, GPs and psychologists expressed satisfaction with the programs. DISCUSSION: The Access to Allied Psychological Services programs in both Divisions have proven popular. Flexibility in the program structure allows Divisions to develop a model which suits their local circumstances. There is support for ongoing Commonwealth funding and the challenge is to find the most effective and financially sustainable model of delivery for psychological services in primary care.

Adult↗
PubMedDate not supplied

[Accessibility to methadone substitution treatment: the role of a low-threshold program].

OBJECTIVE: To evaluate the accessibility to a Montreal low-threshold methadone program (Relais-Méthadone). This program is aimed at a marginalized population of heroin addicts who are injection drug users (IDU). METHOD: The data (n = 141 clients) were collected during the first year of the program implementation with questionnaires administered by the programme workers. RESULTS: Analysis of the characteristics of the clients revealed that the program does reach the target population. The program's clientele is characterized by long-time and frequent heroin use, unstable lifestyles, and the presence of numerous behaviours that put them at high risk for HIV transmission. The retention of clients in the program is very high (88%) within the first 30 days. INTERPRETATION: These results demonstrate the importance and value of flexible intervention programs in reaching a marginalized clientele exposed to the HIV virus, who would not have access to regular programs characterized by restrictive selection criteria and limited availability.

Adult↗
PubMed1995

Medical decision support: experience with implementing the Arden Syntax at the Columbia-Presbyterian Medical Center.

We began implementation of a medical decision support system (MDSS) at the Columbia-Presbyterian Medical Center (CPMC) using the Arden Syntax in 1992. The Clinical Event Monitor which executes the Medical Logic Modules (MLMs) runs on a mainframe computer. Data are stored in a relational database and accessed via PL/I programs known as Data Access Modules (DAMs). Currently we have 18 clinical, 12 research and 10 administrative MLMs. On average, the clinical MLMs generate 50357 simple interpretations of laboratory data and 1080 alerts each month. The number of alerts actually read varies by subject of the MLM from 32.4% to 73.5%. Most simple interpretations are not read at all. A significant problem of MLMs is maintenance, and changes in laboratory testing and message output can impair MLM execution significantly. We are now using relational database technology and coded MLM output to study the process outcome of our MDSS.

Academic Medical Centers↗
PubMed1986

Spreadsheet statistics.

Four spreadsheet templates are presented to carry out routine statistical analyses with relatively small amounts of data: two-sample Student's t test, one-factor analysis of variance with replication, two-factor analysis of variance with replication, and Wilcoxon's non-parametric two-sample T-test (Mann and Whitney U-test). The use of sometimes complex IF and logic (AND, OR) functions in these templates is a means of maintaining a neat output presentation by avoiding error values, selection of appropriate forms of the t-test, and iteratively assigning mean ranks to data in the non-parametric test. The advantages of the spreadsheet approach accrue through using a multi-purpose package rather than dedicated statistics programs, having usually unobstructed access to the program for modification, relative ease of programming spreadsheets, and ease of correction and alteration of input data. Disadvantages are the limited size of templates and the small number of templates available. Spreadsheets represent a declarative form of programming rather than procedural, with consequent advantages in specifying the problem to be solved, which may have particular application in teaching statistics and programming at undergraduate level.

Algorithms↗