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PubMed2006

Federal communication about obesity in the Dietary Guidelines and checkoff programs.

The new Dietary Guidelines for Americans focus on obesity prevention. They recommend increased consumption of whole grains, fruits, vegetables, fish, and low-fat dairy products, within a balanced diet whose total calories have been moderately reduced. Meanwhile, other well-known and well-funded federally sponsored consumer communications promote increased total consumption of beef, pork, and dairy products, including energy dense foods such as bacon cheeseburgers, barbecue pork ribs, pizza, and butter. These latter communications are sponsored by the federal government's commodity promotion programs, known as "checkoff" programs. The programs are established by Congress, approved by a majority of the commodity's producers, managed jointly by a producer board and the U.S. Department of Agriculture, and funded through a tax on the producers. The federal government enforces the collection of more than 600 million US dollars annually in mandatory assessments, approves the advertising and marketing programs, and defends checkoff communication in court as the federal government's own message-in legal jargon, as its own "government speech." Federal support for promoting fruits and vegetables is small by comparison. The checkoff programs recently have become more clearly identified as federal programs. After a recent decision by the U.S. Supreme Court upholding the constitutionality of the checkoff programs, calls for consistency with the Dietary Guidelines may get louder. The current inconsistencies in federal communication undermine the effectiveness of the Dietary Guidelines as an antidote to the shortcomings of the private sector market for information about weight and obesity.

Advertising↗
PubMed2001

Insurance case managers' perception of quality in back pain programs: a focus study group.

OBJECTIVES: Insurance case managers commonly interact with physiatrists and rehabilitation programs. They influence referrals and patients' decision making. This study was designed to determine which factors affect case managers' perception of back pain program quality. DESIGN: Repeated focus group interview in a neutral facility in an urban Midwestern United States community. Subjects were two groups (n = 12 and 11) of insurance case managers employed by case management firms (large and small), insurers, and self-insured employers. Outcome measures included group and individual responses to a pre-scripted interview and were collected on tape, transcribed, and interpreted by two different persons: the independent expert interviewer and a pain psychologist. RESULTS: There was substantial agreement between the two interpreters. Both groups overwhelmingly chose physiatrists over other specialists. They emphasized timeliness, communication, functionally oriented programs, concrete program goals and time frames, physician knowledge of the legal aspects of disability, and rapid communication of patient noncompliance. CONCLUSIONS: Rehabilitation programs may strive to meet many of these qualities but, in doing so, should be aware that the legal and ethical roles of case managers differ from that of clinicians.

Attitude of Health Personnel↗
PubMed2006

Reconstructing tuberculosis services after major conflict: experiences and lessons learned in East Timor.

BACKGROUND: Tuberculosis (TB) is a major public health problem in developing countries. Following the disruption to health services in East Timor due to violent political conflict in 1999, the National Tuberculosis Control Program was established, with a local non-government organisation as the lead agency. Within a few months, the TB program was operational in all districts. METHODS AND FINDINGS: Using the East Timor TB program as a case study, we have examined the enabling factors for the implementation of this type of communicable disease control program in a post-conflict setting. Stakeholder analysis was undertaken, and semi-structured interviews were conducted in 2003 with 24 key local and international stakeholders. Coordination, cooperation, and collaboration were identified as major contributors to the success of the TB program. The existing local structure and experience of the local non-government organisation, the commitment among local personnel and international advisors to establishing an effective program, and the willingness of international advisers and local counterparts to be flexible in their approach were also important factors. This success was achieved despite major impediments, including mass population displacement, lack of infrastructure, and the competing interests of organisations working in the health sector. CONCLUSIONS: Five years after the conflict, the TB program continues to operate in all districts with high notification rates, although the lack of a feeling of ownership by government health workers remains a challenge. Lessons learned in East Timor may be applicable to other post-conflict settings where TB is highly prevalent, and may have relevance to other disease control programs.

Communicable Disease Control↗
PubMed1993

Superfund and one community program.

The U.S. Environmental Protection Agency--Region II conducted a pilot program in risk communication and notification of hazardous waste information at a Superfund site in Toms River, New Jersey. The program was designed to assess the levels of awareness and concern among local citizens and to provide accurate information about health risks associated with potential exposure to environmental contaminants. The purpose of this program was to develop linkages among the community; local, state, and federal governments; industry; health professionals; and educators in dealing with environmental problems. A Community Leaders Network was formed and became actively involved in the program. Following a community needs assessment for risk information, a series of fact sheets was developed, pretested, disseminated, and evaluated. The analysis of the program highlights the important lesson of being able to respond to the specific changing dynamics of the community and offers guidelines useful for risk communication in many communities.

Chemical Industry↗
PubMed2002

Stereotyped and specific gene expression programs in human innate immune responses to bacteria.

The innate immune response is crucial for defense against microbial pathogens. To investigate the molecular choreography of this response, we carried out a systematic examination of the gene expression program in human peripheral blood mononuclear cells responding to bacteria and bacterial products. We found a remarkably stereotyped program of gene expression induced by bacterial lipopolysaccharide and diverse killed bacteria. An intricately choreographed expression program devoted to communication between cells was a prominent feature of the response. Other features suggested a molecular program for commitment of antigen-presenting cells to antigens captured in the context of bacterial infection. Despite the striking similarities, there were qualitative and quantitative differences in the responses to different bacteria. Modulation of this host-response program by bacterial virulence mechanisms was an important source of variation in the response to different bacteria.

Bacteria↗
PubMed1979

Interdisciplinary cooperation in an integrated psychiatric rehabilitation program.

The development of psychiatry is at present stormy with discussions dividing, polarising and partly paralysing. Current experience shows that psychotherapeutic approaches are not alternatives to psychopharmacological ones but necessary complements. An integrated therapy which treats the patient as a social, psychological and organic entity has not yet been spread to the poorly-equipped psychiatric periphery but is mainly restricted to the modern richly-endowed psychiatric centers. Modern psychiatric rehabilitation principles according to this integrated synoptic view seem however to be applicable even to custodial-treated patients at peripheral psychiatric institutions. In this article we present the special psycho-social, epidemiological, administrative and economical structure of the island of Gotland due to its geographical isolation. We describe the construction and forming of a rehabilitation program under greatly limited economical conditions. The program combines communication-oriented group therapy with consequent pharmacotherapy and a structured ergotherapeutic and ADL-therapeutic program and is applied to a primarily unselected sample of patients. We also describe the education and supervision of the staff as well as the components of our program. Positive results in spite of limited resources have been achieved. Problems are discussed.

Hospitals, Psychiatric↗
PubMedDate not supplied

Organizational capacity's effects on the delivery and outcomes of health education programs.

Community-based public health efforts to change health behaviors and health outcomes generally involve the implementation of complex, multipronged programs, which utilize many resources, both inside and outside a single community-based organization or agency. It is becoming more apparent that the organizational capacities of these agencies influence the implementation and success of health promotion programs. However, research is limited on the specific organizational capacities (e.g., resources, training, workload, trust, communication) that influence program implementation and, thus, the ultimate impact of these programs. This article seeks to address this gap in the literature by identifying organizational capacity variables that may have influenced the delivery of a dietary change program.

Adolescent↗
PubMed1995

Good grieving--an intervention program for grieving children.

PURPOSE/OBJECTIVES: To describe a program for grieving children including the agenda, activities, and logistics of organizing the program. DATA SOURCES: Clinical observations and evaluations from the program; literature review. DATA SYNTHESIS: A series of four seasonal programs were designed to promote a child's normal grieving process and enhance adjustment to the loss. Programs are cyclic, children are grouped by age, and activities are intended to promote expression of feelings, understanding of the loss, and good coping skills. A concurrent program for caregivers facilitates family communication and support. CONCLUSIONS: The program demonstrated positive behavioral changes in grieving children and provides a model for other nurses to use in organizing similar programs. IMPLICATIONS FOR NURSING PRACTICE: Nurses should be familiar with key elements of children's grief and incorporate this into their practice, especially when caring for terminally ill patients who have children.

Adaptation, Psychological↗
PubMed2003

Oncologists and family physicians. Using a standardized letter to improve communication.

PROBLEM BEING ADDRESSED: Communication between oncologists at a regional cancer centre and family physicians caring for palliative cancer patients in the community was ineffective. OBJECTIVE OF PROGRAM: To improve communication between oncologists and family physicians by routine use of a template for dictated letters concerning follow-up care. PROGRAM DESCRIPTION: A consultation letter template was constructed and tested at a single clinic. The template was designed to guide oncologists dictating letters to family physicians for patients' follow-up visits. Effectiveness of the standardized letter was evaluated with a before-after survey. CONCLUSION: Using the template letter improved communication with respect to the relevance, timeliness, format, and amount of information. As care for patients at the end of life increasingly shifts to the community, ongoing efforts are required to improve communication between cancer centres and primary care physicians.

Cancer Care Facilities↗
PubMed1998

Targeted intervention research studies on sexually transmitted diseases (STD): methodology, selected findings and implications for STD service delivery and communications.

OBJECTIVE: To report the findings of qualitative studies designed for use in improving sexually transmitted disease (STD) programs. The studies explore illness conceptions and treatment behaviors for STD in five African countries. These targeted intervention research (TIR) studies were performed on clinic-based and community-based samples in representative communities and utilized a variety of qualitative research methods (e.g. in-depth and key informant interviews, focus group discussions). FINDINGS: Study findings revealed that community members' explanations of symptoms, classification of illnesses, and perceptions of whether symptoms are pathological or serious influence individual health-care-seeking behaviors. Data also showed that local terms for STD are often disparaging and do not fit into biomedical designations. STD patient care-seeking frequently reflects an ordered, albeit loosely constructed, process of elimination in pursuit of symptom relief, wherein alternative treatments are tried and proven effective or abandoned. CONCLUSIONS: The TIR studies highlight the importance of community-specific strategies aimed at increasing prompt care seeking at qualified biomedical facilities. Information from study data should lead programs to sensitize health professionals to community understanding about STD and to design services and communication programs that are meaningful and appropriate to local contexts.

Developing Countries↗
PubMed1999

Assessment of a cooperative-creative program of assertive behavior and self-concept.

This study examined the effects of a game program of assertive behavior, helpful behavior, and self-concept in children aged 8 to 10. A pretest-intervention-posttest design was used with a sample of 126 experimental and 28 control subjects. Three instruments were administered before and after intervention: the Children's Assertive Behavior Scale, Sensitivity Scale, and the Adjective Check List. Assertive behavior, helpful behavior, and self-concept were the dependent variables. Intervention consisted of a group play-session carried out once a week during the whole academic year. The program's games encourage children to cooperate and share, as well as to develop creative play. The program included presentation, communication, help, cooperation, creativity, and emotional expression games. Results of multiple variance analyses suggest that the program caused significant improvement in assertive behavior (p < .001) and self-concept (p < .01). This paper reveals empirical evidence of the positive contribution of cooperative-creative play to child development.

Assertiveness↗
PubMedDate not supplied

Keepin' it R.E.A.L.!: results of a mother-adolescent HIV prevention program.

BACKGROUND: The concern that adolescents may be placing themselves at risk for contracting HIV has led to widespread public and parental support for HIV prevention programs. Several programs on increasing communication between parents and teenagers have been tested, but the study of the impact of these programs on resulting sexual behavior is lacking. OBJECTIVE: To test the efficacy of two interventions for mothers and their adolescents in delaying initiation of sexual intercourse for youth who are not sexually active and encouraging the use of condoms among sexually active youth. METHODS: Employed were a control group and two treatment groups: one based on social cognitive theory (SCT) and the other a life skills program (LSK) based on problem behavior theory. Assessments were conducted before the intervention (baseline) and at 4, 12, and 24 months after the baseline assessment. RESULTS: Adolescents and their mothers (total N = 582) enrolled in the trial. At baseline, the adolescents ranged in age 11-14 years and were mostly male and African American. The mean age of the mothers was 37.9 years, and most were African American and single. The primary analyses showed no difference among groups in abstinence rates for adolescents. However, adolescents in the LSK group demonstrated an increase in the condom use rate, and those in the SCT and control groups scored higher on human immunodeficiency virus (HIV) knowledge than those in the LSK group. Mothers showed substantial increases over time in comfort talking about sex and self-efficacy. For HIV knowledge, mothers in the SCT group scored significantly higher than those in the LSK and control groups. CONCLUSION: The results of this study are comparable to previous studies that have included mothers in the HIV education of their adolescents. Although the program did not demonstrate a substantial effect on abstinence rates, increases were observed in condom use among adolescents and in mother's sex-based discussions and comfort in talking about sexual issues.

Adolescent↗
PubMed1990

Integrating the halfway house with day-hospital treatment: three perspectives.

In this paper, three treaters from three different psychiatric hospitals delineate specific criteria for developing a mutually beneficial, interactive relationship between day hospitals and halfway houses. Ideas for setting up such a cooperative venture are based on the strengths of these three existing programs at the Menninger Clinic, Timberlawn Psychiatric Hospital, and Harding Hospital. Potential problem areas are discussed such as admission and discharge criteria, communication between separate program components, treatment responsibility, staff roles, and program goals and boundaries.

Communication↗
PubMed1993

Behavior management techniques in predoctoral and postdoctoral pediatric dentistry programs.

This study surveyed predoctoral and postdoctoral pediatric dental programs, to determine what behavior management techniques are being taught. The expected didactic and clinical proficiency levels were determined for behavior management techniques in four categories: sedation, restraint, parental presence, and communicative behavior management. Postdoctoral programs expect clinical proficiency in most of the 20 selected management techniques while predoctoral programs expect clinical basic competency in some techniques and do not teach others. Both program levels emphasize communicative behavior management techniques. A high percentage of both programs anticipate no change in the teaching of most of the 20 selected techniques. For both types of programs, less emphasis or elimination of "hand-over-mouth" techniques but more emphasis on parental presence for the introductory visit, using positive reinforcement, and using age-appropriate language and descriptions is anticipated. The two most influential factors affecting these anticipated changes were parental preference and changing standards in pediatric dentistry.

Anesthesia, Dental↗
PubMed2001

Five-year surveillance of patients with communicable diseases nursed in isolation.

During a five year surveillance program of patients with communicable diseases nursed in isolation, we gathered information on 2880 patients who were nursed in isolation for 28 145 days, from January 1994 to December 1998. The mean number of patients nursed in isolation was 575.4 (range, 427-709) per year. On average 2.4% of patients admitted yearly to the University Medical Center (UMC) were nursed in isolation. The mean number of days nursed in isolation was 9.8 days per patient.1996 was a peak year in isolations due to outbreaks of gentamicin-resistant enterobacteriaceae (GRB) and methicillin resistant Staphylococcus aureus (MRSA). The main reasons for requiring isolation were: GRB, MRSA (proven and suspected cases), Clostridium difficile, viral infections and Mycobacterium tuberculosis. Registration of quantitative data on nursing patients in isolation, as presented in this paper, makes it possible to gain insight into the type and number of isolation indications, the required isolation room capacity on different wards, the workload of healthcare workers resulting from isolation and the trends in incidence of communicable diseases.

Communicable Diseases↗
PubMed1981

Using the long-term care information system for effective community care.

Obtaining appropriate long-term care is a problem common to individuals in need, community service providers, regulatory agencies, and fiscal intermediaries. The fragmented nature of the long-term care system precludes natural linkages among service programs. The Long-Term Care Information System Assessment Process was developed and demonstrated to be a communication link among programs and agencies concerned with long-term care. The use of its common language tools for decision making and program organization leads to the provision of appropriate long-term care, efficient use of resources, and effective community care.

Health Services Needs and Demand↗
PubMed1995

Analysis of telemedicine from an organizational perspective.

OBJECTIVES: To conduct an in-depth case analysis of the University of Kansas Telemedicine Program in order to identify organizational and communications elements that may be hindering the program's effectiveness. METHODS: A case analysis was done, employing a combination of methodologies (direct observation, interview, and survey) involving extensive data collection from telemedicine program personnel throughout the state of Kansas. Analysis of this program's organizational communication focused on structure and boundaries, definitions and goals, leadership and decision making, and membership and roles. RESULTS: Significant organizational communication deficits were identified. These included a dearth of perceived central leadership, lack of information about the technology itself, poorly designed and cumbersome means for scheduling and utilizing telemedicine technology, absence of explicit strategic goals; and poor communication in introducing this technology to medical personnel and to the public. Other important findings were: organizational members expanded the scope of this organization beyond the providing of a simple consultation; the perception that decision making falls into the hands of almost everyone but the referring physician; and the role that language (or lack of common terminology) plays in confusion about this innovation. CONCLUSION: Organizational factors may be critical determinants of success or failure of a telemedicine program. Innovations in telemedicine technology need to be matched by innovations in organizational communication and structure. Findings from this study can be applied to existing or planned programs. Examples include redefinition of the roles and responsibilities of certain personnel, increasing the efficiency and decreasing the complexity of the consultation scheduling process, clarification and formalization of leadership and decision making, and development of a universal terminology of telemedicine.

Academic Medical Centers↗