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PubMed1999

Problems and our solutions for implementing telemedicine systems.

There are several problems on the practical use of telemedicine, for example, the difficulties involved in promoting communication between medical facilities, uncooperative clinicians, and the absence of high-speed circuits and high-resolution CRT. From the Japanese point of view, we suggest ways to resolve these problems. We will analyze and propose scenarios for realizing successful communications among medical institutions, medical communication and its characteristics, barriers to the promotion of communications among medical institutions, second-opinion centers, and separate satellites and separate circuits. We also mention the World Wide Web for teleconsultation, provision of assistance to people with data handicaps via a communications satellite, and assistance to programs designed for training telemedicine specialists. Using a communication satellite, we offer programs that explain preventive medicine, support activities for nursing at home, explain the risks of fast food, and support activities for the handicapped and women in a simple manner to computer illiterates.

Communication↗
PubMed1995

Importance of communication training for psychiatric residents and mental health trainees.

Through the illustration of a clinical vignette and excerpts from interviews with trainees, this paper suggests that communication and communication disorders are essential issues in child psychiatry training. The vignette shows how communication issues pervade a multidisciplinary psychoeducational day treatment program. The importance of communication in the clinical experience and its impact on the professional preparation of psychiatry residents and mental health trainees are examined, and conclusions and recommendations for the goals of a training program in child psychiatry are presented which expand upon those findings.

Child↗
PubMed1996

Transformational leadership of clinical nutrition managers.

OBJECTIVE: To identify leadership qualities of clinical nutrition managers and associate these leadership qualities with selected demographic variables (eg, training/degree, length of time in management, number of people supervised, income, and participation in advanced practice activities). DESIGN: The theory of transformational leadership, that is, leadership that incorporates specific interpersonal behaviors of the leader and his or her actions within the organization, provided the framework for the study. Specific transformational leadership qualities--leader behavior, leader personal characteristics, and the effect of the leader on organizational functioning and culture--were measured using the Leadership Behavior Questionnaire (LBQ). The reliability and validity of the LBQ have been reported previously. Other data were obtained using two demographic surveys. SAMPLE: Demographic surveys were mailed to 1,599 members of the Clinical Nutrition Management dietetic practice group. From the 951 (59.8%) respondents, a study sample of 150 clinical nutrition managers and their subordinates was selected to receive the LBQ; 116 (77.3%) instrument sets were used for analysis. STATISTICAL ANALYSIS: Descriptive statistics were used to analyze the demographic surveys. A specified mixed linear model repeated measures Statistical Analysis System procedure was used to compare the clinical manager and subordinate LBQ scores. Association of the selected demographic variables with leadership qualities was measured by lambda, a predictive value measure, using the BMDP 4F program. RESULTS: Clinical nutrition managers exhibited transformational leadership qualities as rated by the LBQ, rating lowest on the communication leadership score and highest on the respectful leadership score. Most of the clinical nutrition manager self LBQ scores were significantly higher than the clinical nutrition manager LBQ scores rated by subordinates. The selected demographic variables appeared to have the strongest predictive effect for the visionary culture building subscore of the LBQ. The visionary culture building subscore is a measure of how well the leader interacts with and affects the functioning of an organization. APPLICATIONS/CONCLUSIONS: More research is needed to define leadership in dietetics: this study can serve as a possible model. One way clinical nutrition managers may be able to enhance their leadership behaviors is to strengthen their skills in communicating their vision. Programs are needed to help clinical nutrition managers shape their organizations to foster leadership development in their subordinates.

Dietetics↗
PubMedDate not supplied

IEC interventions for health: a 20 year retrospective on dichotomies and directions.

In January 1997, the World Health Organization's Family Planning and Population Unit (WHO/FPP) commissioned a retrospective qualitative study of 20 years of experience in information, education, and communication (IEC) as it had been applied to public health initiatives globally. The purpose of the study, which relied on a literature search, a field survey, and in-depth interviews, was to examine lessons learned from two decades of experience in applying IEC interventions in support of public health in order to improve the integration of reproductive health services through IEC initiatives. While the focus of the study was on ways in which IEC can support reproductive health strategies, the discourse surrounding this effort pointed to a number of generic issues of interest or concern to all health education, communication, and promotion practitioners. An analysis and synthesis of "best practices" as perceived by IEC program managers, field implementers, donors, and evaluators revealed significant dichotomies and differences of opinion that have emerged in the field of IEC in recent years and helped to identify several areas for future operations research. This article articulates those divergent opinions, cites major areas for further research, and highlights a strategic approach to partnerships aimed at improving the delivery of health and communication programs.

Communication↗
PubMed1999

Randomized trial testing the effect of peer education at increasing fruit and vegetable intake.

BACKGROUND: The National Cancer Institute recommends that Americans eat at least five daily servings of fruits and vegetables. National strategies to increase consumption may not reach minority and lower socioeconomic populations. In a randomized trial, peer education was tested for effectiveness at increasing fruit and vegetable intake among lower socioeconomic, multicultural labor and trades employees. METHODS: Employees (n = 2091) completed a baseline survey and received an 18-month intervention program through standard communication channels (e.g., workplace mail, cafeteria promotions, and speakers). Ninety-three social networks (cliques) of employees were identified, which were pair matched on intake. At an interim survey (during months 8 and 9), 11 cliques no longer existed and 41 matched pairs of cliques containing 905 employees remained, with one clique per pair being randomly assigned to the peer education intervention. Employees who were central in the communication flow of the peer intervention cliques served as peer educators during the last 9 months of the intervention program. Fruit and vegetable intake was measured with 24-hour intake recall and with food-frequency questions in baseline, outcome (i.e., at 18 months), and 6-month follow-up surveys. All P values are two-sided. RESULTS: By use of multiple regression, statistically significant overall effects of the peer education program were seen in the intake recall (increase of 0.77 total daily servings; P<.0001) and the food-frequency (increase of 0.46 total daily servings; P =.002) questions at the outcome survey. The effect on the total number of servings persisted at the 6-month follow-up survey when measured by the intake recall (increase of 0.41 total daily servings; P =.034) but not the food-frequency (decrease of 0.04 total daily servings; P =.743) questions. CONCLUSIONS: Peer education appears to be an effective means of achieving an increase in fruit and vegetable intake among lower socioeconomic, multicultural adult employees.

Adult↗
PubMedDate not supplied

Explaining demographic trends in teenage fertility, 1980-1995.

CONTEXT: The teenage birthrate rose sharply in the late 1980s and early 1990s, and then declined in the 1990s. Attempts to explain these changes have failed to account for the changing environment in which adolescents live. METHODS: Data from the 1995 cycle of the National Survey of Family Growth are used to compare the experiences of three cohorts of teenage females in the 1980s and 1990s. A life-course framework is used to examine trends in characteristics of adolescents and adolescent mothers over time, and event-history analyses are conducted to determine which characteristics are associated with the risk of a teenage birth in each cohort. A comparison of the predicted probabilities from hazard analyses shows how changes in the context of adolescence across the cohorts help explain changes in the probability of a teenage birth over time. RESULTS: Factors associated with the increase in the teenage birthrate in the 1980s include negative changes in family environments (such as increases in family disruption) and an increase in the proportion of teenagers having sex at an early age. Factors associated with the recent decline in the teenage birthrate include positive changes in family environments (such as improvements in maternal education), formal sex education programs and discussions with parents about sex, stabilization in the proportion of teenagers having sex at an early age and improved contraceptive use at first sex. Sexually experienced teenagers in the mid- 1990s were younger, on average, at first sex than were their counterparts in the 1980s, and thus are at an increased risk of a teenage birth. Partner factors, including nonvoluntary first sexual experiences, were not associated with the risk of a adolescent birth in any cohort. CONCLUSIONS: Programs to further reduce the teenage birthrate should take into account the role of family stability, parent-child communication, sex education programs and engagement in school, as well as attempt to reduce the proportion of adolescents having sex at an early age and to improve contraceptive use. The increasing risk levels among sexually experienced teenagers suggest that current programs may be reducing sexual activity among adolescents already at a low risk of a teenage birth, without addressing the needs of those at highest risk.

Adolescent↗
PubMed1986

Six propositions on public participation and their relevance for risk communication.

New societal obligations for communicating risk information are emerging in a variety of contexts. This article draws upon the lengthy societal experience with citizen participation programs to identify how risk communication efforts may be effectively structured and implemented. Six major propositions address such themes as means/ends differences in expectations, the timing of the program, the role of credibility and trust, the need for technical and analytical resources, differing thresholds of public involvement, and limitations upon current understandings. Key conclusions for the design of risk communication programs are set forth.

Accident Prevention↗
PubMed2000

The path to professionalism: cultivating humanistic values and attitudes in residency training.

Though few question the importance of incorporating professionalism and humanism in the training of physicians, traditional residency programs have given little direct attention to the processes by which professional and humanistic values, attitudes, and behaviors are cultivated. The authors discuss the underlying philosophy of their primary care internal medicine residency program, in which the development of professionalism and humanism is an explicit educational goal. They also describe the specific components of the program designed to create a learner-centered environment that supports the acquisition of professional values; these components include a communication-skills training program, challenging-case conferences, home visits with patients, a resident support group, and a mentoring program. The successful ten-year history of the program shows how a residency program can enable its trainees to develop not only the requisite excellent diagnostic and technical tools and skills but also the humane and professional attributes of the fully competent physician.

Attitude of Health Personnel↗
PubMed2002

Dietary fats, eating guides, and public policy: history, critique, and recommendations.

Controversies over the nutrition science of dietary fat, and equally over the advice furnished to consumers about dietary fat, have confounded US nutrition policies and eating guidance for the last 90 years. This is so despite the remarkable congruence between the first US food guides (1916) and the most recent (2000 Dietary Guidelines for Americans), both of which state that dietary fats should be consumed "moderately." The 2002 Report of the US Food and Nutrition Board (issued jointly by the United States and Canada) quantifies this by stating that healthy dietary fat should constitute "25-35 percent of calories." However, the US consumer guide, the Food Guide Pyramid (released in 1992 but based on data from the early 1980s) states that dietary fats should be consumed "sparingly," which is explained to be "a diet low in fat." This direct conflict in official dietary policies causes consumer confusion and erodes efforts of public and private health promotion efforts to stem the increasing incidence of overweight and obesity in Americans. The most successful population-wide dietary behavior modification program in US history was the food rationing program in World War II. Its successes were based equally on consensus nutrition profiles for good health and messages that communicated the rationing program effectively. The current US incidence of overweight and obesity, and the chronic diseases to which they are precursors, will be mitigated and prevented only with major changes in national dietary policies and programs based on successful experiences and models. The first step in this much-needed process is acknowledgment that current dietary guidance and education policies have been and are unsatisfactory.

Diet, Mediterranean↗
PubMed2004

British Columbia Provincial Eating Disorders Program: an organizational description.

The British Columbia Provincial Eating Disorders Program (BCEDP) is a small government funded body that communicates eating disorder treatment needs to the government, helps communication between primary, secondary, and tertiary care givers, gives treatment advice and teaching to primary and secondary care givers, and assists the Provincial Eating Disorders Resource Centre in decision making and communication with government. The program deals with anorexia nervosa and bulimia nervosa, but not obesity, for budgetary reasons.

Adolescent↗
PubMed2006

Dual selection enhances the signaling specificity of a variant of the quorum-sensing transcriptional activator LuxR.

The transcription factor LuxR activates gene expression in response to binding the signaling molecule 3-oxo-hexanoyl-homoserine lactone (3OC6HSL), an acyl-HSL with a carbonyl substituent at the third carbon of the acyl chain. We previously described a LuxR variant, LuxR-G2E, that activates gene expression by binding a broader range of acyl-HSLs, including straight-chain acyl-HSLs to which LuxR does not respond. Here, we use a dual positive-negative selection system to identify a variant of LuxR-G2E that retains the response to straight-chain acyl-HSLs, but no longer responds to 3OC6HSL. A single mutation, R67M, reduces LuxR-G2E's response to acyl-HSLs having a carbonyl substituent at the third carbon of the acyl chain. This specificity-enhancing mutation would not have been identified by positive selection alone. The dual selection system provides a rapid and reliable method for identifying LuxR variants that have or lack the desired response to a given set of acyl-HSL signals. LuxR variants with altered signaling specificities might become useful components for constructing artificial cell-cell communication systems that program population level behaviors.

Cell Communication↗
PubMed2001

Reflections on building community: a different perspective on academic-community partnerships using the integration matrix.

Implementation of interdisciplinary rehabilitation services and clinical training in community settings is a complex process. Documented methods for analyzing, evaluating and monitoring the process within federally funded grant projects are limited. This paper reports on the use of one proposed method, the Integration Matrix of Konrad, as a framework for formative assessment and analysis of project operations. Based upon ongoing experiences implementing a Health Resources and Services Administration (HRSA) funded clinical training program in a community setting, a revision of the Integration Matrix is proposed to better reflect a community-centered, pervasive communication approach to program operations and analysis.

Academic Medical Centers↗
PubMed1986

In vivo efficacy of chloroquine treatment for Plasmodium falciparum in Malawian children under five years of age.

In 1984 the government of Malawi instituted a program to reduce malaria mortality and morbidity in children less than 5 years of age as a part of the Combatting Childhood Communicable Diseases (CCCD) program. To define the appropriate malaria therapy regimen, investigators used a quality assurance design in a simplified 7-day in vivo drug response study with follow-up observations on day 2 (D2), D3, and D7 after the initial day of the study (D0). The efficacy of oral chloroquine was assessed in 224 children who were enrolled at 6 sites, 2 in each of the 3 administrative regions of Malawi. Parasitological failure, defined as failure of parasitemia to decrease by 75% of the value by D3 or presence of any detectable parasitemia on D7, ranged from 41%-65% following administration of chloroquine 25 mg (base)/kg. However, only 8% of children who were parasitemic on D7 were febrile or judged to be ill. Considering these therapeutic results and the higher cost and limited availability of alternative therapies, chloroquine 25 mg/kg therapy was adopted as the primary therapy for malaria.

Administration, Oral↗
PubMed2003

Targeted laboratory screening for sexually transmitted and bloodborne infections in Wisconsin.

Public health laboratories play an important role in screening programs for asymptomatic diseases of public health importance in high-risk and underserved populations. The implementation of targeted screening strategies for communicable diseases requires thorough planning and evaluation. The Wisconsin State Laboratory of Hygiene (WSLH) systematically selects and evaluates laboratory tests used in communicable disease control programs coordinated by the Wisconsin Division of Public Health. To do this, the epidemiologic features of the disease in potential target populations are carefully assessed, with the choice of laboratory tests based on performance as well as practical and cost considerations. Laboratory testing at WSLH plays a crucial role in screening programs for sexually transmitted and bloodborne infections. Hallmarks of these programs are cross-sector collaboration, empirical selection of laboratory testing methods, and the use of epidemiologic data to develop and evaluate targeted screening strategies.

Blood-Borne Pathogens↗
PubMed2006

Preceptor and employer evaluation of health administration student competencies.

A survey tool was designed to ascertain preceptors' and employers' perceptions of students after completion of one-year residencies/fellowships or other employment. Five-year results from two graduate MHA programs that administer the survey are described, along with ways the results have been used in program administration. Interpersonal communication skills and working in teams were ranked first and second as the most important skills by employers and preceptors of both programs. Findings generally show a high level of satisfaction with health administration graduates. It is recommended that programs adopt similar tools to better attune health administration curricula to marketplace demands.

Data Collection↗