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A continuing education program for hospital and public health nurses to guide families of very low birth-weight infants in caregiving.

Nurses have a critical role in family development of competencies for giving care to very low birth-weight infants, However, current information-based methods of preparation may be inadequate for competency development. This article describes a continuing education program designed to strengthen nurses' support of families in developing caregiving competencies through processes of guided participation. Program effectiveness was explored with: (1) a survey of participant and non-participant nurse satisfaction with family work and with organizational resources and practices; (2) a description of relationship and caregiving competencies for mothers who had and had not received guided participation; and (3) a review of mothers' reports of their experience either with or without guided participation. Organizational arrangements and mechanisms for establishing guided participation practice within an agency, including ongoing reflective supervision sessions, peer collaboration, and documentation of competency development, are discussed.

Attitude of Health Personnel↗

Employee advisory boards as a vehicle for organizing worksite health promotion programs.

PURPOSE: The purpose of this article is to describe the "employee advisory board model" applied in the Treatwell program, a worksite nutrition intervention program. DESIGN: The employee advisory boards of five of the seven intervention worksites participating in the Treatwell program were surveyed. Results were compared with results of employee surveys conducted in these five worksites. SETTING: The five worksites included in this study are among 16 participating worksites from Massachusetts and Rhode Island. SUBJECTS: Of the 95 board members represented in the five worksites, 88% responded to the survey. This article also presents results from the 698 respondents of the five intervention worksites where the board surveys were conducted. INTERVENTION: The boards in each worksite participated in planning, promoting, and implementing this program in each worksite. MEASURES: Respondents to the board survey were asked about their participation on and satisfaction with the board and factors they thought contributed to its effectiveness. A survey of all employees included information on demographics and program participation. RESULTS: Board members reported that they were highly satisfied with the board's functioning. Board member hours spent on Treatwell activities were directly related to the proportion of employees aware of the program. (r = .82). The boards' effectiveness was limited by conflicting priorities between the job and board responsibilities. CONCLUSION: The employee advisory board model provides promise for increasing worker awareness of worksite health promotion programs through enhanced worker ownership.

Adult↗

Factors influencing the adoption and maintenance of Canadian, facility-based worksite health promotion programs.

PURPOSE: The purpose of this study was to determine senior management's rationale for adopting and maintaining worksite health promotion programs and the congruence of this rationale with the program objectives of health professionals who manage the programs. DESIGN: A multiple case study design was used. SETTING: Nine major Canadian organizations which had adopted facility-based health promotion programs were the settings for this study. DATA COLLECTION: Semi-structured interviews (22 conducted) and two questionnaires (36 completed) were the methods used to collect data. RESPONDENTS: Senior managers involved in program adoption, senior managers responsible for program budgets, and senior health professionals responded to the interviews and questionnaires. RESULTS: Impetus for health promotion program adoption in the organizations we studied had more to do with tangential issues such as an organization moving to a new facility or having access to unused space than with employee health or organizational performance considerations. The most common program adoption rationale was related to employee recruitment/retention. Program continuance was based on process issues such as participation rates and the quality of activity offerings rather than on health or organizational outcomes. While health professionals and senior management both considered human relations and morale more important than cost savings outcomes, health professionals considered cost savings outcomes more important than did senior management. CONCLUSIONS: It is important for health promotion professionals to develop program objectives which are shared by organizational management. Future program adoptions and maintenance will be influenced by closer analyses of the effect of these programs on organizational performance.

Canada↗

Exploring self-care and wellness: a model for pharmacist compensation by managed care organizations.

Self-care and wellness are rapidly becoming mainstays of practice for many pharmacists. Consumer confidence and trust in pharmacists provides continuing opportunities for pharmacists to create products and services to satisfy consumer demands related to disease prevention and healthcare delivery. We outline two pharmacy wellness programs designed to meet consumer needs, and offer them as models for pharmacists. Issues related to the program and extent of involvement by pharmacists are raised, including the role of the pharmacists in behavior modification efforts; selecting areas of focus (e.g., smoking cessation); working with physicians for referrals; enlightening community business leaders and managed care organizations to the economic benefits of the program; and developing strategies for fair purchase of services to achieve program goals and provide adequate compensation in return.

Community Participation↗

[The evaluation of the program "Prejudices...I did not know!" by high school students].

This paper presents an evaluation of the impact of a program designed to reduce negative attitudes in adolescents towards individuals suffering from mental illness and their relatives. In a quasi-experimental design involving 16 senior high school classes, a group of 214 students participating in the prevention program "Les préjugés ... j'connais pas!" completed a knowledge questionnaire, a questionnaire focusing on attitudes towards persons with mental illness and a social distance instrument, and were compared to a control group of 159 adolescents. Results indicate that high school students participating in the prevention program show greater knowledge and report more favourable attitudes towards individuals with mental illness than control students. Moreover, data suggest that those students who took part in the program are less negative about social relationships with people who have mental illness problems.

Adult↗

SILMUT: a computer program for the identification of regions suitable for silent mutagenesis to introduce restriction enzyme recognition sequences.

We describe a set of IBM-compatible computer programs designed to selectively identify the potential sites for silent mutagenesis within a target DNA sequence. This program is based on a novel strategy of identifying amino acid motifs compatible with each restriction site (BioTechniques 12:382-384, 1991). The programs can be used to identify the suitability for the introduction of any 6-base nucleic acid sequences, such as restriction enzyme sites in cassette mutagenesis strategies. The Table program generates a table of multiple amino acid motifs for each restriction enzyme, obtained by translating each unique recognition sequence in all three reading frames. The Silmut program, which utilizes the features of Table, will further identify the presence of a match between any amino acid motif of each restriction enzyme and the input target sequence. Minor manipulations of the data base files will enable the individual researcher to identify the potential for introduction of any 6-base sequences by silent mutagenesis.

Base Sequence↗

Assessment of the graduate studies background of CLS faculty in university-based programs.

OBJECTIVE: To identify the degrees held and the graduate majors or fields of study for faculty teaching full-time and part-time in university-based, baccalaureate-degree clinical laboratory science/medical technology (CLS/MT) programs. DESIGN AND PARTICIPANTS: A survey and letter of project explanation was sent electronically to the 110 program directors of NAACLS-accredited university-based CLS/MT programs in the United States in May, 2003. Program directors were requested to provide for each full-time and part-time faculty member the following information: titles for all degrees held, major/field of study for each degree held, all specialist certifications held, all other formal degrees or certificates held, and all courses/areas taught in the CLS curriculum. RESULTS: Information was provided on 288 faculty in 52 CLS/MT programs, for a response rate of 47%. The majority of faculty (75%) described were full-time. A doctorate was held by 43% of the reported faculty, while 46% held a master's degree as their highest degree, and 11 % only a BS in CLS or in biology plus a certificate from a hospital-based CLS/MT program. Graduate degrees in a science major or field represented 52% of the degrees held by the reported faculty, while 48% of the graduate degrees were in education, public health, or administration. Only 13% of the reported faculty held master's degrees specifically in CLS. Detailed results are provided for degrees held, majors/fields of study, and specialist certifications by specific courses/areas of the curriculum taught. CONCLUSIONS: The results of this survey indicate that many faculty teaching in university-based CLS/MT programs are extending their preparation as scientists to the graduate level. This should prepare these faculty for their responsibilities in not only teaching but also research. A case cannot be made that a doctorate, as opposed to a master's degree, is viewed as the 'terminal degree' as less than half of the reported faculty in this study as well as others, held a doctorate. The results reported provide a national perspective on the graduate backgrounds of CLS faculty for comparison to an individual program's faculty during programmatic or institutional accreditation reviews.

Education, Graduate↗

[Birth in the rural area: an evaluation of prevention of perinatal risk in rural areas].

A study was designed and implemented between 1983 and 1985 in order to evaluate the effectiveness of a personalized health education program designed for pregnant women in the specific context of rural areas. The action succeeded in increasing the proportion of women benefiting from a monthly antenatal surveillance but many other results underline the limitations of such prevention programs that would be restricted to the information of the general public and health professionals. Perinatal morbidity in the north-alpine rural area ranks very favourably compared to the regional or national figures.

Evaluation Studies as Topic↗

Cognitive modifiability in retarded adolescents: effects of instrumental enrichment.

The Instrumental Enrichment program, designed to modify the cognitive structures of retarded, disadvantaged adolescents, was contrasted with a General Enrichment program both in a residential setting and a day center. This study is based on 57 matched pairs drawn from the total research sample of 218 adolescents. One group in a residential center (n = 24) and one group in a day center (n = 33) received Instrumental Enrichment; one group in a residential center (n = 24) and one group in a day center (n = 33) received General Enrichment. The Instrumental Enrichment program extended over 2 years, and the subjects were pre- and posttested on a battery of criterion measures: general and specific cognitive tests, scholastic achievement, classroom interaction, and self-concept. The results indicated significantly better performance by the groups receiving Instrumental Enrichment than by the groups receiving General Enrichment on the tests of specific cognitive functions and scholastic achievement and on some of the classroom interaction scales. Results for the residential groups compared with the day-center groups revealed significant differences on the tests of scholastic achievement, in favor of the residential groups and on the classroom interaction scales in favor of the day-center groups.

Achievement↗

Public and professional aspects of the use of education in the control and prevention of cancer.

Studies of educational programs designed to encourage (i) regular systematic breast self-examination and (ii) participation in cervical screening programs demonstrate the necessity for precision in defining and evaluating cancer education aims and methods. Preteaching and postteaching and one-year follow-up data from both studies compare the immediate and longer-term effects of teaching on opinions and knowledge and relate these to behavior.

Attitude to Health↗

Cumulative number and morphological score of embryos resulting in success: realistic expectations from in vitro fertilization-embryo transfer.

OBJECTIVE: To define statistical thresholds for the number and morphological score of embryos transferred that would be predictive of reproductive success in an IVF program. DESIGN: A retrospective review of patient records. SETTING: The Mount Sinai Medical Center Assisted Reproductive Technologies Program. PARTICIPANTS: One hundred women who underwent IVF-ET for a diagnosis of tubal occlusion and later delivered viable infants. RESULTS: The mean number of embryos transferred before achieving live birth was 10.7 +/- 7.9 (mean +/- SD), with one half of patients achieving success within the first seven embryos transferred, and 95% achieving success within 25 embryos. For high quality embryos, the numbers were 7.5 +/- 6.3, 5, and 17, respectively, and, for the cumulative embryo score, a measure of both embryo morphology and metabolic activity, were 114.2 +/- 86.0, 83, and 280, respectively. Greater than 50% of live births occurred within the first two ET attempts. CONCLUSIONS: Although more than half of patients achieved reproductive success within the first two ETs and the first five high quality embryos transferred, after this threshold, fecundity declined rapidly. The calculation of cumulative embryo scores offered additional prognostic information. While all prior attempts to define IVF-ET failure have done so by including patients who did not become pregnant, we have found an analysis of our successes to be a useful adjunct in counseling patients.

Adult↗

Functional communication with AD patients: a caregiver training program.

The loss of functional communication in Alzheimer disease (AD) results from the disproportionate breakdowns in the pragmatic and semantic areas of language in these patients. Communication breakdown is regularly listed among the top four stressors in measures of stress and burden of AD caregivers. A caregiver training program designed around seven specific communication strategies can be used to alter communication interactions. As a pilot program, the acronym FOCUSED organized the seven strategies for easy recall (Face-to-face, Orientation, Continuity, Unsticking, Structure, Exchanges, and Direct). Significant differences in both attitude toward AD patients, knowledge of AD, and knowledge of communication strategies were shown in comparisons of pre- and posttraining assessments.

Adult↗

A systematic approach to continuing education for radiologic technologists.

As continuing education programs for radiologic technologists expand, it is important that needs be properly assessed and well-designed programs be developed. This reports on the step-by-step process of a regional medical education center to provide continuing education for technologists that would be most beneficial to them and indirectly to the patients they serve.

Curriculum↗

Residents' experiences of abuse, discrimination and sexual harassment during residency training. McMaster University Residency Training Programs.

OBJECTIVE: To assess the prevalence of psychological abuse, physical assault, and discrimination on the basis of gender and sexual orientation, and to examine the prevalence and impact of sexual harassment in residency training programs. DESIGN: Self-administered questionnaire. SETTING: McMaster University, Hamilton, Ont. PARTICIPANTS: Residents in seven residency training programs during the academic year from July 1993 to June 1994. Of 225 residents 186 (82.7%) returned a completed questionnaire, and 50% of the respondents were women. OUTCOME MEASURES: Prevalence of psychological abuse, physical assault and discrimination on the basis of gender and sexual orientation experienced by residents during medical training, prevalence and residents' perceived frequency of sexual harassment. RESULTS: Psychological abuse was reported by 50% of the residents. Some of the respondents reported physical assault, mostly by patients and their family members (14.7% reported assaults by male patients and family members, 9.8% reported assaults by female patients and family members), 5.4% of the female respondents reported assault by male supervising physicians. Discrimination on the basis of gender was reported to be common and was experienced significantly more often by female residents than by male residents (p < 0.01). Ten respondents, all female, reported having experienced discrimination on the basis of their sexual orientation. Most of the respondents experienced sexual harassment, especially in the form of sexist jokes, flirtation and unwanted compliments on their dress or figure. On average, 40% of the respondents, especially women (p < 0.01), reported experiencing offensive body language and receiving sexist teaching material and unwanted compliments on their dress. Significantly more female respondents than male respondents stated that they had reported events of sexual harassment to someone (p < 0.001). The most frequent emotional reactions to sexual harassment were embarassment (reported by 24.0%), anger (by 23.4%) and frustration (20.8%). CONCLUSION: Psychological abuse, discrimination on the basis of gender and sexual harassment are commonly experienced by residents in training programs. A direct, progressive, multidisciplinary approach is needed to label and address these problems.

Adult↗

Evaluation of a classroom program of creative expression workshops for refugee and immigrant children.

OBJECTIVE: This evaluative study assessed the effect of a creative expression program designed to prevent emotional and behavioral problems and to enhance self-esteem in immigrant and refugee children attending multiethnic schools. METHOD: The 12-week program involved 138 children, aged 7 to 13, registered in both integration classes designed for immigrant children and regular classes at two elementary schools. Pretest and posttest data were collected from the children themselves and from their teacher. Teachers used Achenbach's Teacher's Report Form to assess the emotional and behavioral symptoms of their pupils whereas children self-reported their symptoms with the Dominic, a computerized questionnaire. Self-esteem was measured with the Piers-Harris Self-Concept Scale administered by interviewers to the children. RESULTS: At the end of the program, the children in the experimental groups reported lower mean levels of internalizing and externalizing symptoms and higher mean levels of feelings of popularity and satisfaction than the children in the control groups, when controlling for baseline data. In integration classes, the effect on self-esteem was especially notable in boys. The intervention's effect on internalizing and externalizing symptoms was not modified by gender, age or fluency in the mainstream language. CONCLUSION: The study provides some evidence that creative workshops in the classroom can have a beneficial effect on the self-esteem and symptomatology of immigrant and refugee children from various cultures and backgrounds. These quantitative results support previous qualitative analysis showing that the workshops participate in the reconstruction of a meaningful personal world while simultaneously strengthening the link of the child to the group. They also transform the teachers' perceptions of newcomers by placing an emphasis on their strength and their resilience, while not negating their vulnerabilities.

Adaptation, Psychological↗

Using qualitative methods to develop contextually relevant measures and preventive interventions: an illustration.

Qualitative methods were used to develop a contextually relevant quantitative measure of parenting stress and inform the design of family-focused interventions aimed at preventing adolescent mental and behavioral health problems. The study focused on the experiences of low-income one- and two-parent families representing three ethnic groups (Mexican, African, and European Americans) living in low-income neighborhoods in a large Southwestern city. This report describes the place of this study in a broader program of prevention research, the qualitative methods and data analysis procedures employed, and how the results were used to develop a new measure of parenting stress and inform future program design. The report also includes reflective comments on the methods used and lessons gained.

Adolescent↗

Community-oriented primary care: a path to community development.

Although community development and social change are not explicit goals of community-oriented primary care (COPC), they are implicit in COPC's emphasis on community organization and local participation with health professionals in the assessment of health problems. These goals are also implicit in the shared understanding of health problems' social, physical, and economic causes and in the design of COPC interventions. In the mid-1960s, a community health center in the Mississippi Delta created programs designed to move beyond narrowly focused disease-specific interventions and address some of the root causes of community morbidity and mortality. Drawing on the skills of the community itself, a selfsustaining process of health-related social change was initiated. A key program involved the provision of educational opportunities.

Black or African American↗

Influencing physicians: the three critical elements of a successful strategy.

UNLABELLED: This activity is designed for leaders and managers of healthcare organizations, particularly those involved in the development of physician incentive and physician management programs. GOAL: To describe the challenges inherent in influencing physicians and review the essential elements of any successful strategy for achieving physician support and participation. OBJECTIVES: 1. Describe the reasons why healthcare organizations and medical groups need to influence physicians to be successful. 2. Cite the reasons why it is difficult to influence physicians. 3. Review the current strategies healthcare organizations and medical groups use to influence physicians. 4. Outline the three essential elements of any program designed to influence physicians.

Behavior↗