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PubMed2006

Emerging role of epidemiologic literacy.

BACKGROUND: The ability to understand and apply epidemiology methods is a growing part of pharmacy practice, pharmacy accreditation standards, and evidence-based practice. OBJECTIVE: To examine the trends in epidemiology-related terminology used in the literature over the past 20 years. METHODS: The frequency of the use of epidemiology-related terminology in 3 representative pharmacy journals, 2 representative medical journals, and 1 public health journal from January through December 1984, 1994, and 2004 was recorded. The 3 pharmacy journals were the American Journal of Health-System Pharmacy (formerly American Journal of Hospital Pharmacy), The Annals of Pharmacotherapy (formerly Drug Intelligence and Clinical Pharmacy), and Pharmacotherapy. The 2 medical journals were the New England Journal of Medicine and The Journal of the American Medical Association (JAMA), and the public health journal was the American Journal of Public Health. The number of times an epidemiology-related term was used was summed for each year and each journal. RESULTS: For all the journals examined in this study combined, the proportion of epidemiologic terms used in the literature has increased over the past 20 years. In 1984, of the total articles published in the 6 journals, 7.02% contained epidemiologic terms increasing to 12.27% and 15.46% in 1994 and 2004, respectively. The most dramatic differences in the 20-year comparisons were noted for Pharmacotherapy (0 to 17.75%) and JAMA (7.32 to 26.72%). CONCLUSIONS: The increase in the use of epidemiology-related terms has implications for both curricular planning in schools and colleges of pharmacy, as well as for continuing education programs and effective interprofessional communication.

Epidemiology↗
PubMed1995

Eye care knowledge and practices among Malawian traditional healers and the development of collaborative blindness prevention programmes.

Many African traditional healers provide treatment for eye diseases, yet there is little published information about eye care knowledge and practices among these healers; the information is necessary for the development of collaborative eye care activities with healers. Focus group discussions, in-depth interviews, and a representative sample survey of 107 randomly selected traditional healers in Chikwawa District, Malawi were conducted regarding eye care knowledge and practices. In the survey 68% of healers treated at least one of six common eye conditions. The most common eye condition treated by healers was cataract, followed by conjunctivitis/inflammatory trachoma. The size of the healer's practice, literacy, and great distance to a health facility were positively associated with the provision of eye care. Traditional healers have considerably more eye care interactions with the rural population than existing biomedical health personnel in Chikwawa District. Interviews revealed that most healers were aware of the availability of treatment for common eye conditions at biomedical health facilities and were interested in collaborating with existing biomedical eye care providers. We subsequently developed a collaborative eye care programme with healers in the district and report on early findings. Collaboration with healers in eye care programmes is advocated and recommendations are provided.

Adult↗
PubMed1990

The problems of a social survey in epidemiology: an experience from a Zambian rural community.

A socio-economic study of 1097 people was carried out between November and December 1979. Demographic data and other health characteristics were obtained by census of the entire study population. Interviews covered disease awareness, perceived morbidity, health-care utilization, knowledge, attitudes and practices; all adults aged 15 years and above were interviewed 2 weeks before physical examinations were made. Age and literacy level were found to have no effect on the people's health-seeking behaviour in Kabinga. The results of this social survey failed to reveal the real practices of the community's use of both ethno-medicine and biomedicine.

Adolescent↗
PubMed2004

Pharmacist computer skills and needs assessment survey.

BACKGROUND: To use technology effectively for the advancement of patient care, pharmacists must possess a variety of computer skills. We recently introduced a novel applied informatics program in this Canadian hospital clinical service unit to enhance the informatics skills of our members. OBJECTIVE: This study was conducted to gain a better understanding of the baseline computer skills and needs of our hospital pharmacists immediately prior to the implementation of an applied informatics program. METHODS: In May 2001, an 84-question written survey was distributed by mail to 106 practicing hospital pharmacists in our multi-site, 1500-bed, acute-adult-tertiary care Canadian teaching hospital in Vancouver, British Columbia. RESULTS: Fifty-eight surveys (55% of total) were returned within the two-week study period. The survey responses reflected the opinions of licensed BSc and PharmD hospital pharmacists with a broad range of pharmacy practice experience. Most respondents had home access to personal computers, and regularly used computers in the work environment for drug distribution, information management, and communication purposes. Few respondents reported experience with handheld computers. Software use experience varied according to application. Although patient-care information software and e-mail were commonly used, experience with spreadsheet, statistical, and presentation software was negligible. The respondents were familiar with Internet search engines, and these were reported to be the most common method of seeking clinical information online. Although many respondents rated themselves as being generally computer literate and not particularly anxious about using computers, the majority believed they required more training to reach their desired level of computer literacy. Lack of familiarity with computer-related terms was prevalent. Self-reported basic computer skill was typically at a moderate level, and varied depending on the task. Specifically, respondents rated their ability to manipulate files, use software help features, and install software as low, but rated their ability to access and navigate the Internet as high. Respondents were generally aware of what online resources were available to them and Clinical Pharmacology was the most commonly employed reference. In terms of anticipated needs, most pharmacists believed they needed to upgrade their computer skills. Medical database and Internet searching skills were identified as those in greatest need of improvement. CONCLUSIONS: Most pharmacists believed they needed to upgrade their computer skills. Medical database and Internet searching skills were identified as those in greatest need of improvement for the purposes of improving practice effectiveness.

Adult↗
PubMed1997

An interactive computer program for educating and counseling patients about genetic susceptibility to breast cancer.

Educating individuals who seek information about genetic testing for cancer susceptibility is a complex task. Because of the psychological and social risks to patients of being identified as susceptible to a genetic disorder, it is important that education take place before a patient undergoes gene testing. However, it is not known who will provide such education. Since primary care physicians have limited knowledge, time, and confidence with genetic counseling, they are not ideal educators. Genetic counselors are well trained to provide the service, but many patients lack access to them. Other specialists are scare. Interactive computers hold much promise as a supplemental or alternative modality for education. The authors describe their experience with developing an interactive CD-ROM on gene testing and breast cancer, and respond to anticipated criticisms of this technology.

Aged↗
PubMed2004

Computerized symptom and quality-of-life assessment for patients with cancer part II: acceptability and usability.

PURPOSE/OBJECTIVES: To determine the acceptability and usability of a computerized quality-of-life (QOL) and symptom assessment tool and the graphically displayed QOL and symptom output in an ambulatory radiation oncology clinic. DESIGN: Descriptive, cross-sectional. SETTING: Radiation oncology clinic located in an urban university medical center. SAMPLE: 45 patients with cancer being evaluated for radiation therapy and 10 clinicians, who submitted 12 surveys. METHODS: Acceptability of the computerized assessment was measured with an online, 16-item, Likert-style survey delivered as 45 patients undergoing radiation therapy completed a 25-item QOL and symptom assessment. Usability of the graphic output was assessed with clinician completion of a four-item paper survey. MAIN RESEARCH VARIABLES: Acceptability and usability of computerized patient assessment. FINDINGS: The patient acceptability survey indicated that 70% (n = 28) liked computers and 10% (n = 4) did not. The program was easy to use for 79% (n = 26), easy to understand for 91% (n = 30), and enjoyable for 71% (n = 24). Seventy-six percent (n = 25) believed that the amount of time needed to complete the computerized survey was acceptable. Sixty-six percent (n = 21) responded that they were satisfied with the program, and none of the participants chose the very dissatisfied response. Eighty-three percent (n = 10) of the clinicians found the graphic output helpful in promoting communication with patients, 75% (n = 9) found the output report helpful in identifying appropriate areas of QOL deficits or concerns, and 83% (n = 10) indicated that the output helped guide clinical interactions with patients. CONCLUSIONS: The computer-based QOL and symptom assessment tool is acceptable to patients, and the graphically displayed QOL and symptom output is useful to radiation oncology nurses and physicians. IMPLICATIONS FOR NURSING: Wider application of computerized patient-generated data can continue in various cancer settings and be tested for clinical and organizational outcomes.

Academic Medical Centers↗
PubMedDate not supplied

Psychological risk factors in pregnant inmates. A challenge for nursing.

PURPOSE: To explore pregnant prisoners' experiences with childhood violence and substance abuse, their parenting attitudes, and their psychological health. DESIGN: This study used a prospective design to describe incarcerated pregnant women's experiences with childhood violence, substance abuse, parenting attitudes, and psychological health and the relationships among these factors. METHODS: Sixty-three pregnant prisoners in their third trimester were interviewed. Owing to the low literacy of this population, all questions were read to participants to maximize comprehension and reliability. RESULTS: Over 60% of respondents reported experiencing family violence during childhood or adolescence. Almost one-half of the women reported using drugs and alcohol during the past year and in their current pregnancy. Substance-abusing respondents were twice as likely to have been victims of physical abuse. All of the women who had been sexually abused during childhood were substance abusers; women who did not use drugs had no such history. Many women in the study had parenting and child rearing attitudes indicative of risk for poor parenting and abuse. More than 70% of the women reported depressive symptoms above the level considered indicative of clinical depression. Women reported low levels of social support; further, 50% of the women had lost an important relationship within the last year and 80% were not in a relationship with a partner at the time of their interview. CLINICAL IMPLICATIONS: The essential components of caring for pregnant prisoners should include extensive screening for substance abuse as well as history of past and current violence. Pregnant prisoners, with their many risk factors, are a group that could benefit from programs that address substance abuse and violence to decrease mental distress.

Adolescent↗
PubMed2006

Knowledge, attitude and practices of mothers regarding home management of acute diarrhoea in Sunsari, Nepal.

In Nepal, 45,000 children less than five years age die due to diarrhoea annually. Home management of diarrhoea is the hallmark of control of diarrhoeal diseases program in Nepal, which also aims to increase the correct use of Oral Rehydration Solution (ORS) by mothers, so mothers play a great role in the reducing the morbidity and mortality of children. The aim of the study was to assess knowledge, attitude and practices of the mother regarding home management of acute diarrhea in their children. The list of 330 children on Plan 'A' treatment was prepared at 11 peripheral health institutions of Sunsari district. Their identification data were recorded by health workers. The mothers were interviewed by the same health worker at the time of home visit after 24 hrs to know the improvement in the child and also preparation and use of ORS. Majority (97.6%) of the mother had information about ORS and also its usefulness in the management of dehydration due to diarrhea. Fifty percent mothers could make ORS properly and gave ORS to their children ideally (after each stool). The correct preparation and ideal use of ORS have not reached in proper way to the mothers of Sunsari district. Use of ORS definitely lowers the mortality due to dehydration, an effect that can clearly be seen in the short term. Intervention such as increasing women's literacy, improving basic sanitation and health care services, and raising the general nutritional status of the population can only be expected to decrease the diarrhoeal diseases morbidity and mortality in long term.

Acute Disease↗
PubMed1995

Teaching literature searching in the context of the World Wide Web.

As part of the required curriculum for medical students, we devised a literature-searching practicum that has been used for two years. In both years, we stressed going beyond the skills needed for using a particular searching program, towards a more conceptual approach to information searching. In the first year, the practicum was taught in a traditional lecture/hands-on format. In the second year, the lecture was replaced by a World Wide Web-based tutorial (http:@www.welch.jhu.edu/Education/tutorials/pra cticum.html). To our knowledge, this is the first Web-based resource intended to teach students about appropriate use of search technology. Comparison of student evaluations showed no difference in attitude toward the two versions of the practicum, and observation of student performance suggested similar levels of proficiency. We conclude that placing these educational materials on the Web (1) makes us practice what we preach; (2) is as effective as traditional teaching methods; and (3) gives students a resource for reinforcement learning.

Computer Communication Networks↗
PubMedDate not supplied

Health promotion and risk reduction in Malawi, Africa, village women.

OBJECTIVE: A train-the-trainer intervention was evaluated in which village leaders in Malawi, Africa, taught other villagers how to improve their health. DESIGN: Health knowledge and reported health practices were compared before and after the educational intervention in 15 villages in Chimutu, Malawi, Africa. SETTING: Surveys were completed by trained data gatherers in the village setting. PATIENTS/PARTICIPANTS: All men and women of childbearing age who were present in the village when data collection occurred were asked to participate. There were 187 participants in the preintervention survey and 175 participants in the postintervention survey. INTERVENTION: Seventy-six village women were trained, using low literacy techniques, to provide content on health promotion and risk reduction in pregnancy. Over 20,000 persons have received at least one health teaching session from the village trainers. RESULTS: The intervention resulted in reported changes in prenatal and postpartum care and in more births occurring in the hospital or clinic. Some positive nutritional changes were reported, although few changes in beliefs about use of herbal medicines or about the use of witchcraft were reported. CONCLUSIONS: A train-the-trainer approach is a sustainable intervention that appears to have positive benefits on the health of village women living in Malawi, Africa.

Adult↗
PubMed2004

Targeting community-dwelling urinary incontinence sufferers: a multi-disciplinary community based model for conservative continence services.

This paper presents an argument that there is a need to provide services that target community-dwelling incontinence sufferers, and presents a demonstration case study of a multi-disciplinary, community-based conservative model of service delivery: The Waterworx Model. Rationale for approaches taken, implementation of the model, evaluation and lessons learned are discussed. In this paper community-dwelling sufferers of urinary incontinence are identified as an underserved group, and useful information is provided for those wishing to establish services for them. The Waterworx Model of continence service delivery incorporates three interrelated approaches. Firstly, client access is achieved by using community-based services via clinic and home visits, creating referral pathways and active promotion of services. Secondly, multi-disciplinary client care is provided by targeting a specific client group, multi-disciplinary assessment, promoting client self-management and developing client knowledge and health literacy. Finally, interdisciplinary collaboration and linkages is facilitated by developing multidisciplinary assessment tools, using interdisciplinary referrals, staff development, multi-disciplinary management and providing professional education. Implementation of the model achieved greater client access, improvement in urinary incontinence and client satisfaction. Our experiences suggest that those suffering urinary incontinence and living in the community are an underserved group and that continence services should be community focussed, multi-disciplinary, generalist in nature.

Adult↗
PubMed2003

Formative evaluation of an intervention to increase compliance to HIV therapies: the ALP project.

Non-adherence to highly effective antiretroviral medications can lead to treatment failure and the development of drug-resistant strains of HIV, and may result in an epidemic of treatment resistant HIV. This article describes a theory-based intervention (ALP) that was developed to increase adherence to HIV therapies among low-literacy populations of HIV positive African American women. The ALP intervention consists of a cartoon book and a cassette tape suitable for individuals with less than a 3rd-grade reading level. Qualitative data were collected through focus groups and expert panel interviews to conduct a formative evaluation. The results indicated that constructs of the Health Belief Model and Social Cognitive Theory were recognizable by behavioral scientists and that the materials would be used as intended by the target population to achieve the desired behavior change. This type of evaluation is a cost-effective method that can be used to develop effective interventions and obtain community buy-in.

Black or African American↗
PubMedDate not supplied

Public health nurses' perceptions of mobile computing in a school program.

The use of mobile computing (MC) in healthcare practice has grown substantially in recent years, yet little is known about its impact. This descriptive, exploratory, qualitative study explored the perceptions of public health nurses (PHNs) in a school health program about their use of MC. Public health nurses participated in focus group interviews and completed weekly reflections. They perceived that MC (a) increased PHNs' flexibility although they were constrained by work rules, (b) increased peer and employer connectedness yet increased isolation, (c) and increased PHNs' status while creating a wider gap between PHNs and their clients. Public health nurses described their practice as being more efficient and client-focused with MC. Over time, PHNs grew more comfortable with the tool, developed a dependence on it, and learned to deal with technological problems. Although this new technology shows promise, there is a need for further research to examine its impact as a tool to promote public health nursing practice.

Adaptation, Psychological↗
PubMedDate not supplied

Will more inputs improve the delivery of health services? Analysis of district vaccination coverage in Pakistan.

In order to determine whether physical resources or technical inputs can make a difference to the delivery of health services, we carried out a study that examined the large variation in district level vaccination coverage in Pakistan. Vaccination coverage was assessed by district-wise cluster surveys and the predictor variables were collected from census data and from a survey of 99 district health offices. Information was collected on basic supplies, physical infrastructure, management, training, socio-economic variables, and a variety of other indicators. Univariate and multivariate analyses were carried out. A model including female literacy rate, TV ownership, and provincial dummies explained 48% of the variation in DTP3 coverage. Very few of the other variables examined were significantly correlated to coverage. Possible explanatory variables like adequacy of syringe and vaccine supply, the number of vaccinators per capita, recent training of managers, frequency of supervision, availability of micro-plans, and turnover of managers were not correlated with coverage. While the Government of Pakistan has ensured that many physical resources and technical inputs have been provided to the district health offices, this does not appear able to explain the relatively low overall coverage or the variation between districts. Bolder initiatives and innovations are likely needed to improve delivery of basic health services.

Data Collection↗
PubMedDate not supplied

Six rules for computers and other stumbling blocks to obtaining an advanced degree.

BACKGROUND: The decision to return for an advanced degree in nursing, after many years outside the academic environment, can be fraught with uncertainty, doubt, and panic. The majority of returning students attempt to juggle career, family, community obligations, and school simultaneously. Nurse educators are in the perfect position to act as well-informed resource people, facilitators, and mentors for these returning students. METHOD: The expression "experience is the best teacher" proved to be true. The first author's (B.C.) return to a master of science program after 18 years out of school provided the opportunity to "learn as you go." This article was written with the desire to help ease the transition and lessen the fear for others. RESULTS: The first author (B.C.) graduates in May 1999 with a MS as a Family Nurse Practitioner, enriched and stronger because of the experience, enthusiastic, and facing the future of the nursing profession with a positive and energetic outlook. CONCLUSION: Provision of support; networking with other returning students; and understanding the basic tool in modern education, the computer, eases the return for an advanced degree. Nurse educators' involvement in educational growth, both individually and as proponents for nurses who are dependent on those educators' expertise, is vital to nursing and its evolution as a profession.

Adaptation, Psychological↗
PubMed2004

Multidisciplinary intervention for reducing malnutrition among children in the Islamic Republic of Iran.

A multidisciplinary intervention to reduce protein-energy malnutrition among children in rural areas was piloted in 3 provinces of the Islamic Republic of Iran. Based on an initial situation analysis, a range of interventions were implemented through local nongovernmental organizations, including nutrition, health and literacy education for mothers, improved growth monitoring and fostering rural cooperatives and income generation schemes. Malnutrition before and after the intervention (in 1996 and 1999) was assessed using anthropometric measurements of random samples of children aged 6-35 months in control and intervention areas. Three years into the intervention, all indicators of malnutrition had consistently decreased in all intervention areas and the prevalence of underweight and stunting was significantly lower. Control areas showed a mixed pattern of small increases and decreases in malnutrition indicators.

Anthropometry↗
PubMedDate not supplied

Diabetic education, special consideration of Oriental patients.

The important of patient education program in the management of diabetes has been widely recognized. We studied to find out in general what the patients and their parents know about diabetes and their self-care by using a questionnaire. Then, the diabetic education was given by one-to-one basis to every patient. Thirty four insulin-dependent diabetes mellitus attended the diabetic the clinic at Siriraj Hospital, Bangkok age ranged from 4 to 22 years with peak age at 11 to 15 years. Male to female ratio was l:i. Majority came from low socioeconomic families. 23.5 percent were from separated families, one patient lived with neither her mother nor father. Only one patient had home glucose monitoring. Fourteen cases (41.2%) had been hospitalized with diabetic ketoacidosis (DKA) over the past year, however, there was no statistically significant difference between admission with DKA and low socioeconomic status. In addition to insulin, there were 8 patients taking herbs to cure diabetes. Only 6 patients were able to follow their meal plan and only one case ever used the food exchange list. Most patients accepted being diabetic and attended the clinic regularly mainly to get financial supports. The situation in our country is different from that in the western countries as the patients are low in literacy and socioeconomic status. A well-planned educational programme is essential to cater to the need to the oriental patients.

Adolescent↗
PubMed2006

Cookin' Up Health: developing a nutrition intervention for a rural Appalachian population.

Cookin' Up Health is a culturally targeted and individualized tailored nutrition intervention using a computer-based interactive format. Using a cooking show theme, the program demonstrates step-by-step meal preparation emphasizing healthy selection and portion control. Focus groups were conducted with women in two rural counties in West Virginia to guide the development of the intervention. Women felt more susceptible to heart disease because the changing role of women creates more stress and less time; weight loss was a greater motivator for dietary change than was preventing heart disease; social support is a barrier and facilitator for dietary change; cultural heritage and the way women were raised were major barriers to making health changes as adults; convenience and the cost of eating healthier were major factors when trying to make changes in diet; and women did not feel confident in their ability to maintain dietary changes.

Appalachian Region↗