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An epidemiologic surveillance program for evaluating occupational reproductive hazards.

A noninvasive and inexpensive epidemiologic program for evaluating the possible effects of occupational exposures on fertility is proposed. This surveillance program utilizes reproductive information obtainable from a short questionnaire (1-2 pages in length) or directly from existing medical, employment, or insurance records, and results can be generated readily on a routine basis. This program examines the reproductive experience of the exposed workers in terms of live births compared with that of the US general population with the proper statistical adjustments. It calculates the standardized birth ratios (SBR), adjusting for maternal age, parity, calendar time, and race. Such an analysis will detect whether there is a significant decrease in fertility among a group of employees, and is, therefore, a useful surveillance tool. The proposed method should be viewed as a mechanism to provide an early signal for any potential hazard and to direct priority for other more in-depth epidemiologic or physiologic studies. The procedure is illustrated with data from individuals exposed to EDB, DBCP, and waste-water treatment plant processes. The method can be modified to compare the reproductive performance of an exposed group to that of an internal control group. With an internal control group, additional confounding factors can be taken into consideration. The relative merits of this approach compared to another method of fertility evaluation, semen analysis, are discussed.

Adult↗

Development and evaluation of a tobacco cessation motivational program for adolescents based on physical attractiveness and oral health.

PURPOSE: Little is known about how to motivate youth to participate in smoking cessation programs. This paper reports an investigation of the feasibility and acceptability of an intervention that used vanity and oral health issues associated with tobacco use to motivate adolescent tobacco users to enter a school-based tobacco cessation program. METHODS AND MATERIALS: Sixty-four continuation high school students aged 14 to 19 (31% female) and living in rural California participated in a youth-oriented, vanity and oral health-focused intervention designed to motivate tobacco users to join a six-week tobacco cessation group. RESULTS: Following the intervention, 21 of 37 (57%) regular smokers signed up for the cessation program. Of these smokers, seven (33%) did not indicate on the baseline questionnaire any desire to quit smoking. Of the 21 smokers who signed up to participate in the cessation program, 16 (76%) actually participated (10 males and six females), eight (50%) completed all treatment sessions, and four (25%) reported that they quit smoking at the end of the program. CONCLUSIONS: Overall program evaluations were very favorable. Findings were interpreted to provide support for the feasibility and acceptability of using physical appearance and oral health-oriented programs to motivate adolescent tobacco users to enter school-based cessation programs. Further study is needed to determine the effectiveness of such programs.

Adolescent↗

Evaluating very small and rapidly evolving programs. Consultation in the case of a health careers information program.

The case of a health careers program evaluation illustrates some aspects of evaluating very small and rapidly evolving programs. Such programs can change quickly, since there is no massive bureaucracy to restrain them. Rigid evaluation research methods would frustrate both researchers and program staff. The authors suggest that flexible design, use of specialized interviewing and analytical experiments--in this case, telephone surveys testing program response--and a recognition that a consultative relationship exists will result in outcomes useful to the program and rich in evaluation data.

Career Choice↗

[Perspective evaluation of the post-graduate courses of the Nursing Department at UFRN (1980-1992)].

The purpose of the study was to evaluate the "lato sensu" graduate programs of study of the Department of Nursing in the UFRN, and to know the perspectives of its students and faculty. A total of 67 questionnaires were applied to 14 professors and 53 ex-students. The sources of data were: a survey of the scientific knowledge produced by the faculty; specialization program final reports; partial 1989-1991 program evaluations; and, the final report of the first Graduate Program Evaluation Seminar (1992). Eventhough the results of the evaluation were positive, some aspects of the program were found to need further analysis so that future graduate studies might be improved. These aspects were: revision of the curriculum content, improvement of the space environment, and improvement of the bibliographic resources.

Brazil↗

Evaluation of an HIV/AIDS continuing education program.

An HIV/AIDS education model was implemented for rural nurses as a demonstration project in Georgia. The overall goal of the project was to increase the quality of and access to HIV/AIDS-specific services in rural communities. Public health and community nurses were the focus of this effort due to their current roles in providing health care to rural and underserved populations and their potential for networking across health care and social services agencies to form an HIV/AIDS response network. One hundred and seventy-five nurses completed the program. Program evaluations revealed that, after completing the HIV/AIDS course, participants' professional preparedness, attitudes toward people with HIV/AIDS, and knowledge had improved. Consistently, participants' scores in each of these areas increased from the pretest to the posttest. Additionally, nurses participating in the program reported in a follow-up survey that they felt better prepared to care for people with HIV/AIDS. While there is a need for further HIV/AIDS education in rural communities, results of the program support its potential use as a model for other rural communities.

Adult↗

Program planning, evaluation, and the problem of alcoholism.

Rational program planning and evaluation has been suggested as a necessary skill. First, a conceptual framework for planning and evaluation was presented and discussed, using the example of preventing alcoholism and providing services and rehabilitation for alcoholics. Second, a case study was presented, which is similar to that used by many professionals in their efforts to plan programs. Finally, some of the marked limitations of the case study were pointed out, when it was projected upon the conceptual framework.

Age Factors↗

An evaluation of the "Youth en Route" program.

Youth En Route (YER) is a transition program for youth and young adults with multiple disabilities. It offers a multifaceted approach that includes self-discovery, skill development, and community experience. Underlying the service delivery model is a philosophy of self-determination. This program evaluation measured the self-determination skills, sense of personal control over life choices, and community participation of 34 youth prior to and one year following their involvement with YER. Youth reported statistically and clinically significant improvement from pretest to posttest with respect to both self-determination and sense of personal control. Moreover, youth reported spending significantly more time at posttest than at pretest engaged in volunteer/work activities and community leisure activities. On average, youth reported high satisfaction with YER services. Practical and research implications are discussed.

Adolescent↗

Descriptive methods for evaluation of state-based intervention programs.

In this article, the authors discuss program evaluation of intervention studies when the outcome of interest is collected routinely at equally spaced intervals of time. They illustrate concepts using data from the American Stop Smoking Intervention Study, where the outcome is state per capita tobacco consumption. States differ widely in mean tobacco consumption, and these differences should be accounted for in the analysis. A large difference in the variance of the intervention effect may be obtained depending on whether the variation in the between-state effects are considered. The confidence limits obtained by ignoring between-state effects are too optimistic in many cases.

Humans↗

Evaluating a staff development physical assessment program.

This program evaluation assessed whether nursing staff who took a mandatory physical assessment course were using the information in their daily practice. A questionnaire designed to assess clinical usage of 17 physical assessment skills was sent to the nurses who completed the first four classes of the assessment course. The results showed that the majority of the nurses used only nine of the 17 skills on a daily basis. Skills used most frequently were mental status and skin system assessments. The skills reported as least used were assessments for extraocular movements, cranial nerves, and jugular vein distention. These results imply that nurses may be applying only those skills required by the patient population on their particular unit. Staff development educators need to reassess physical assessment course content and tailor the courses to teach the skills required for specialty patient populations.

Adult↗

Preventing young worker fatalities. The Fatality Assessment and Control Evaluation (FACE) Program.

During the period between 1992 through 1998, the Bureau of Labor Statistics identified an average of 67 work related deaths of individuals younger than 18 each year. This article describes the Fatality Assessment and Control Evaluation (FACE) program and summarizes indepth data collected on 59 young worker fatalities in 26 states. These investigations were conducted between May 1986 and February 2002. Young workers ranged in age from 9 to 17 years, with a mean age of 15.3 years: 21 were working in the agriculture, forestry, and fishing industry; 12 in construction; 10 in manufacturing; 8 in services; and 8 in the retail industry. The majority worked as laborers. Ninety-three percent were young men. Each investigation resulted in the formulation and dissemination of strategies to help prevent future similar occurrences. As an example of state FACE activities, the article describes the Wisconsin FACE program's efforts to foster collaboration between regulatory agencies, researchers, educators, and occupational safety and health professionals, and to integrate efforts aimed at improving safety for young workers.

Accidents, Occupational↗

Efficacy and effectiveness trials (and other phases of research) in the development of health promotion programs.

The concepts of efficacy and effectiveness are examined from the viewpoints of the traditions and philosophies of health-care research and social program evaluation. Consideration of the status of the program being assessed, its availability to, and its acceptance by the target audience leads to the derivation of four levels of health promotion program testing: efficacy trials, under optimum conditions of program implementation and recipient participation; treatment effectiveness trials, with expected variation in target audience acceptance; implementation effectiveness trials, under varying conditions of implementation; and program evaluation of previously untested programs. These four levels of testing, together with experience in one area of health promotion research (smoking prevention), suggest eight phases of research for the development of health promotion programs: basic research, hypothesis development, pilot applied research, prototype evaluation studies, efficacy trials, treatment effectiveness trials, implementation effectiveness trials, and demonstration evaluations. Issues of design, the use of random assignment, the use of blinding procedures, and of the role of process evaluation in these different research levels, particularly efficacy and effectiveness trials, are considered in light of the terminologies and methods of health-care and social program evaluation research. Suggestions are made for improved health promotion research.

Clinical Trials as Topic↗

Panoramic radiographic survey of dentists participating in ADA health screening programs: 1976, 1977, and 1978.

Results of the panoramic examination of dentists participating in the health evaluation program of the ADA annual sessions held at Las Vegas (1976), Miami Beach (1977), and Anaheim (1978) were reported and compared as accurately as possible with the results of the panoramic examinations of dentists taking part in the health evaluation programs of the ADA annual sessions in 1964, 1966, and 1968. The panoramic radiograph continues to serve as a diagnostic aid in dental health evaluation programs. Only general impressions may be drawn from surveys of this nature for various reasons: the inability to follow up each case with a clinical examination; the lack of correlation of findings between examiners; and the use of different criteria each year. Generally, dentists examined in the health evaluation programs in 1976, 1977, and 1978 were in good dental health.

Adult↗

Toward building a typology for the evaluation of services in family support programs.

This article briefly reviews the history, philosophy, practice principles, and foci of family support programs, examines the typologies currently in use to classify these programs, and discusses the difficulties these classifications pose for program evaluators. The authors introduce a new typology that deconstructs family support programs into their component services and discuss the potential of this typology for evaluation of family support services.

Adult↗

Hospital-based evaluation of programs to prevent perinatal hepatitis B virus transmission.

OBJECTIVE: To evaluate the frequency of hepatitis B surface antigen (HBsAg) screening of pregnant women in the United States and factors associated with the lack of screening. DESIGN: A random sample of 200 hospitals with 100 or more births per year was surveyed with regard to policy and practices. Each hospital was also asked to provide maternal screening and infant follow-up data for the first 25 infants who were born on or after March 1, 1993. RESULTS: Of 183 participating hospitals, 137 (75%) had maternal HBsAg screening policies, and 102 (56%) had standing orders for HBsAg testing of pregnant women who were admitted without prior screening. Hospitals that were located in states with laws that required maternal HBsAg screening were more likely to have a written screening policy (prevalence ratio [PR], 1.7; 95% confidence interval [CI], 1.2-2.4) and a standing order (PR, 1.7; 95% CI, 1.4-2.2). A lack of screening was related to delivery in hospitals without screening policies (PR, 3.4; 95% CI, 1.3-8.9) or standing orders (PR, 2.8; 95% CI, 1.2-6.2), and to the infant's provider being a family practitioner (PR, 1.7; 95% CI, 1.1-2.7). Among the 3982 infants for whom data were available, 3342 (84%) were born to mothers who had undergone screening for HBsAg. CONCLUSIONS: These findings suggest that hospitals should develop specific policies for HBsAg screening, states should enact laws that require maternal screening, and additional education of health care providers is needed with regard to the screening of all pregnant women for HBsAg.

Chronic Disease↗

The New England division Tell A Friend program implementation evaluation.

Tell A Friend (TAF) is the nationwide program of the American Cancer Society that aims to decrease breast cancer mortality by encouraging unscreened women to have mammograms using a peer-to-peer approach. An evaluation via the Collaborative Evaluation Fellows Project attempted to identify barriers and facilitators to successful implementation of TAF in the New England division. The proposed method included three surveys; this was revised because of a low response rate to the initial e-mailed survey. The actual method included one shortened survey and one follow-up survey. Results are presented for an initial and shortened survey for staff and a follow-up survey of respondents. Initial TAF implementation timelines were unrealistic, and the field staff encountered many barriers to implementation of TAF in the targeted communities. Changes are being made in training, management, and resources to ensure successful implementation. Continuous re-evaluation is planned to ensure the successful implementation and conduct of the program.

Breast Neoplasms↗

The North Carolina AHEC Self-Paced RN Refresher Program: an evaluation of the first two years.

The North Carolina Area Health Education Centers (AHEC) Self-Paced RN Refresher Program was designed to promote reentry into practice for inactive nurses. The program consists of a didactic self-study correspondence course and a clinical practicum whereby the refresher nurse works one-on-one with a nurse preceptor. At the end of the first two years, the program was evaluated to determine its effectiveness in terms of participant satisfaction and return to nursing practice and to describe the nurse refresher population demographically. Participants reported a high degree of satisfaction; 69% of nurses who completed the program returned to nursing practice. The typical refresher student is a female Caucasian in her forties, married, and graduated from a diploma nursing program.

Adult↗