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PubMed2004

Adolescent suicide myths in the United States.

In the United States, teen suicide rates tripled over several decades, but have declined slightly since the mid-1990s. Suicide, by its nature, is a complex problem. Many myths have developed about individuals who complete suicide, suicide risk factors, current prevention programs, and the treatment of at-risk youth. The purpose of this article is to address these myths, to separate fact from fiction, and offer recommendations for future suicide prevention programs. Myth #1: Suicide attempters and completers are similar Myth #2: Current prevention programs work. Myth #3: Teenagers have the highest suicide rate. Myth #4: Suicide is caused by family and social stress. Myth #5: Suicide is not inherited genetically. Myth #6: Teen suicide represents treatment failure. Psychiatric illnesses are often viewed differently from other medical problems. Research should precede any public health effort, so that suicide prevention programs can be designed, implemented, and evaluated appropriately. Too often suicide prevention programs do not use evidence-based research or practice methodologies. More funding is warranted to continue evidence-based studies. We propose that suicide be studied like any medical illness, and that future prevention efforts are evidence-based, with appropriate outcome measures.

Adolescent↗
PubMedDate not supplied

Developing a collaborative preceptor program involving registered nurses, student nurses and faculty.

This paper addresses a collaborative preceptorship program involving a group of undergraduate nursing students, their registered nurse preceptors employed on the paediatric ward of an acute care hospital, and academic staff from a university school of nursing. The project utilised a fourth generation evaluation model, adapted from action research methods, which comprised a series of parallel focussed group discussions with a registered nurse preceptor group and a student nurse group. During the project, members of the two groups explored the issues around the supervision of students in practice in an acute paediatric context. This resulted in the development of innovative approaches to the supervisory practices utilised by preceptors. It also highlighted the benefits of collaboration between universities and hospital staff in developing preceptorship programs which respond appropriately to the needs of both preceptors and students.

Clinical Competence↗
PubMed1987

Otosclerosis surgery in a resident training program.

Controversy exists regarding the appropriateness of offering all residents training in stapes surgery due to dwindling case loads in residency programs nationally. A recent study indicated poorer results for stapes surgery performed by residents than results obtained by practicing otologists. One hundred consecutive stapedectomies performed by residents over a three-year period at our institution were reviewed retrospectively, with the objective of determining whether these results should be generalized.

Adult↗
PubMed1992

[Care and prevention of drug dependence in primary care].

Evaluate the assistencial drug-dependence program. DESIGN. Transversal retrospective study. Primary care (Unitat de Prevenció i Seguiment de Drogodependéncies). PATIENTS OR OTHER PARTICIPANTS. Sixty patients treated from 23.02.90 to 31.06.91. MEASUREMENTS AND MAIN RESULTS. It was made 165 interviews. Sixty patients were treated: 2 (3.3%) with methadone substitution and 58 (96.6%) started the "drug free program". In this program, 7 (12%) patients accomplished hospital desintoxication and 51 (88%) home desintoxication. At the end of the period control, 48 patients were in "drug free program". At the beginning of treatment 32 (53.3%) patients were 22-27 years old. The most usual illegal drugs at consultation were: cannabis 57 (95%), cocaine 53 (88.3%), heroine 51 (85%) and benzodiazepines 50 (83.3%). Twenty-five patients (41.6%) needed derivation to another health services. From 51 patients addicted to intravenous heroin, only ten (19.6%) were positive to HIV antibodies. CONCLUSIONS. The increase of patients number who started and remained the "drug free program" and the low percent of patients who stopped treatment show that the assistant program in primary care is working. This program has been appropriate to know the characteristics of this group in our area: low age at initiation, progressive use of more than one drug and low prevalence of HIV positivity.

Adolescent↗
PubMed1999

[Professional quality assurance. A new ethic frame for the practice of medicine].

Accreditation of physicians and medical education programs are progressively standing as well established procedures in most related institutions and countries, worldwide. Yet, an ample and consistent review of this issue is still required for a more complete knowledge and universal acceptance. Quality health care is a goal of the profession and a demanding requirement of society. Reaching high standards in medicine is a major responsibility of the medical schools and of the pertinence and appropriateness of the programs. This is a useful and sound frame for the model that is being developed in Chile, to better regulate and improve both medical education and practice. The bioethics implications that merge from this perspective are underlined to give the accreditation system a deep moral relevance as are expression of people's wills and expectations on medical professional services.

Accreditation↗
PubMedDate not supplied

Elderly clients' perceptions: individual health counselling and group sessions.

This descriptive, exploratory study examined elderly clients' perceptions of individualized health counselling and group wellness sessions that were offered by public health nurses in clinic settings. The sample included 36 elderly persons living independently in the community. The participants reported that individualized health counselling and group wellness sessions provided different kinds of benefits and services. Monitoring of health status, support, and health teaching were valued nursing activities within individualized health counselling. Participants said that group wellness sessions were an effective means of acquiring general knowledge about aging and lifestyle choices but this format could not totally meet all their health care needs. Regardless of clinic type, blood pressure monitoring was viewed as important. Recognition of elderly clients' perceptions is crucial in planning and implementing programs that are appropriate and acceptable for improving the quality of life for this age group.

Aged↗
PubMed1987

Regional program for prevention of premature birth in northwestern North Carolina.

We present our experience with introducing and implementing a prematurity prevention program in a 20-county region in northwest North Carolina. The program is based on the risk assessment and educational model. In the first 25 months of results available, 17,370 births occurred in women enrolled in the project. During 1985, 42.5% of all births in the region occurred in the project. During the time span examined, a downward trend was seen for rates of low birth weight births in public and private patients and for very low birth weight births in private patients. During 1985, private births in the project were significantly less likely to be low birth weight or very low birth weight than private births to women not in the project. These results suggest that regional implementation of prematurity prevention programs is feasible and that such programs are particularly appropriate for private patients.

Costs and Cost Analysis↗
PubMedDate not supplied

Using disease management and market reforms to address the adverse economic effects of drug budgets and price and reimbursement regulations in Germany.

OBJECTIVE: Germany spends the highest share (10.4%) of its gross domestic product on health care among European Union countries. The majority of this financing comes from an earmarked tax on labor earnings. Drug spending, as a share (12.7%), is relatively low, as is per-capita drug spending. Over the past decade, a number of specific budgeting initiatives were introduced to control drug spending-with some success, at least until the 11% increase in the first 6 months of 2001. METHODS: This article describes and analyzes these governmental initiatives as well as other market reforms. RESULTS: Germany has had a "drug budget silo mentality" throughout this period. But the focus of the mentality moved rapidly from the central budget to regional budgets and to drug budgets per physician based on historical data. These amounts do not correspond to either medical necessity or economic considerations. An analysis of the health-care system as a whole shows that the efforts to constrain spending with budget in one area can lead to higher total costs. This article also considers the impact of introducing other actual or proposed reforms such as a positive list to replace the negative list, generic substitution, retail price competition among pharmacies, and E-health commerce. There is also a new national institute constructing a database of information on health technology assessments. CONCLUSIONS: To overcome the strong segmentation of the health system in physician, drug, and hospital budgets, we recommend using this information from proper cost-effectiveness evaluations to develop clear guidelines for disease management programs, reinforced by appropriate financial incentives.

Budgets↗
PubMed2025

Intersectionality in a sociogenomic world: How do race, disability, socioeconomic status, and polygenic prediction interact to affect perceptions of educational trajectories?

PURPOSE: Education is important for lifelong skills and economic growth; however, student placement decisions may be shaped by social biases. As genomic information captured via polygenic scores becomes more available, it may also inform student placement decisions. We assessed the intersectional effects of polygenic scores, race, disability, and socioeconomic status on US adults' views of educational trajectories using an online experimental survey design. METHODS: A total of 1367 US adults were randomized to one of 16 conditions and prompted to read a short vignette about a boy named Michael, also depicted in an image. Each condition varied Michael's race (Black/White), disability (wheelchair user/no), socioeconomic status (high/low), and polygenic score (high/low) for educational attainment (EA-PGS). After reading the vignette, the respondents were asked to answer multichoice questions about Michael's immediate and long-term educational trajectories. RESULTS: Variation in Michael's EA-PGS strongly influenced participants' expectations regarding (1) the most appropriate immediate educational program for Michael (ie, general, special, or gifted education), (2) whether he would graduate high school, and, if so, (3) the highest educational degree he would complete in his lifetime (associate, bachelor, master, or PhD). Across these responses, high EA-PGS was associated with more socially desirable outcomes, whereas the opposite was true for low EA-PGS. Depicting Michael in a wheelchair significantly influenced respondents' expectations that his most appropriate immediate educational trajectory would be special. There were significant interactions between Michael's race, disability, socioeconomic status, and the EA-PGS. CONCLUSION: Information about children's EA-PGS may affect their views about their immediate and long-term educational trajectories. The negative effects of low EA-PGS were comparable to those of high EA-PGS. The EA-PGS may be interpreted in ways that compound the existing stereotypes related to a child's race, disability, and socioeconomic status.

Humans↗
PubMed2005

Influence of known psychosocial smoking risk factors on Egyptian adolescents' cigarette smoking behavior.

The morbidity and mortality associated with cigarette smoking is shifting from the developed world to developing countries, especially developing Arab countries. One such country is Egypt, which has the highest rate of tobacco consumption in the Arab world. To curb the rising smoking epidemic in Egypt, appropriate adolescent smoking prevention programs need to be developed. Most of the effective adolescent smoking prevention programs are based on the social influence approach, which targets the proximal psychosocial variables believed to promote adolescent smoking. However, most of our understanding of adolescents' psychosocial smoking risk factors is based mainly on Western studies. Whether these factors have the same influence on Egyptian adolescents' smoking behavior has not been investigated to date. An understanding of the psychosocial correlates of smoking behavior among Egyptian adolescents may help in designing the appropriate smoking prevention program aimed at this population. This study reports the results of a cross-sectional survey administered to a random sample of 1930 students in grades 7, 9 and 12 in the city of Alexandria, Egypt, in May 2003. Adolescent smoking behavior was positively associated with positive beliefs about smoking, sibling, parent and peer smoking, and social smoking norms, with sibling smoking and perceived adult smoking norms having a stronger influence on adolescents' smoking behavior than peer smoking and perceived peer smoking norms. Refusal self-efficacy was protective against smoking behavior, while knowledge of the short-term negative consequences of smoking was protective against susceptibility to future smoking among females only. The results suggest that adolescents from collective cultures, like Egypt, are more influenced by their family's smoking behavior and perceived adult smoking norms than their peers' smoking behavior and perceived peer smoking norms. Smoking prevention programs aimed at Egyptian adolescents should be accompanied by smoking cessation programs for the family and adult community members.

Adolescent↗
PubMed2003

Effect of an educational program on the treatment of RSV lower-respiratory-tract infection.

The effectiveness and outcomes of an educational program to decrease ribavirin and antimicrobial prescribing rates and associated costs for patients with respiratory syncytial virus (RSV) lower-respiratory-tract infection are described. An educational program on the appropriate treatment for RSV infections was conducted for attending physicians and medical residents with multiple methods and forums during the 1994-95 RSV season. A retrospective chart review of 2396 patients admitted to a pediatric teaching hospital from July 1, 1991, through June 30, 1998, was conducted to measure the frequencies of ribavirin and antimicrobial prescribing in infants and young children hospitalized with RSV lower-respiratory-tract infection. The results before and after the educational program were compared. Ribavirin was prescribed for 37.9% of patients before the program, and only 9.0% received it afterward (p < 0.001). Before the program, 24.8% of patients with no risk factors received ribavirin compared with 1.6% of patients after the program (p < 0.001). However, more patients with three or more risk factors for morbidity and mortality received ribavirin before the program than afterward (97.8% versus 39.2%, respectively). A broad-spectrum i.v. antimicrobial was prescribed for 85.6% of patients before the program while 60.6% received one afterward (p < 0.001). The cost savings for ribavirin and antimicrobials during the three-year period after the program were $1,235,484 and $34,839, respectively. Hospital length of stay decreased from 5.6 to 5.1 days (p < 0.001). No readmissions occurred during the study period. A multifaceted educational intervention program may have been somewhat effective in modifying physician's prescribing habits for the treatment of RSV lower-respiratory-tract infection.

Antiviral Agents↗
PubMedDate not supplied

Implementation of a managed care model in an acute care setting.

The center of attention in recent nursing literature has been on the evolution of outcome-based care. This concept has emerged as an array of models that includes patient-focused care, case management, and managed care. All these approaches to redesigning patient care have a basic goal: to deliver quality care in a timely manner by using appropriate resources. The program at St. Margaret Mercy Healthcare Centers focused on the staff nurse as the multidisciplinary team member who would be responsible for coordinating patient care. This type of model, in which the pathway is initiated at the staff level, is called managed care. Managed care, as defined by Zander, is unit-based care that is organized to achieve specific patient outcomes within fiscally responsible time frames or lengths of stay (LOS) while using resources that are appropriate in amount and sequence to the specific case type and to the individual patient (1988a).

Clinical Protocols↗
PubMed1997

Guidelines for evaluating intervention programs for children with autism.

It is now well recognized that early diagnosis and intervention improves the prognosis for children with autism. It is crucial that professionals be aware and sensitive to the needs of autistic persons and their families. We must never lose sight of the long-term goal of treatment and must not become so infatuated with any one treatment that we fail to provide the education parents need. It is incumbent upon us, as professionals, to educate parents and help them evaluate the myriad of information with which they are bombarded. In this article a framework for thinking about autism and principles of evaluation are reviewed. Components of appropriate early intervention programs are then described and guidelines for evaluating alternative treatments are provided.

Autistic Disorder↗
PubMed2003

Occupational medicine programs for animal research facilities.

Occupational medicine is a key component of a comprehensive occupational health and safety program in support of laboratory animal research and production facilities. The mission of the department is to maximize employee health and productivity utilizing a population health management approach, which includes measurement and analysis of health benefits utilization. The department works in close cooperation with other institutional health and safety professionals to identify potential risks from exposure to physical, chemical, and biological hazards in the workplace. As soon as exposures are identified, the department is responsible for formulating and providing appropriate medical surveillance programs. Occupational medicine is also responsible for targeted delivery of preventive and wellness services; management of injury, disease, and disability; maintenance of medical information; and other clinic services required by the institution. Recommendations are provided for the organization and content of occupational medicine programs for animal research facilities.

Animal Experimentation↗
PubMedDate not supplied

Implementing an empowerment-based diabetes self-management education program.

Diabetes educators are challenged to develop culturally appropriate, integrated, behaviorally based, effective education programs. This article describes the intervention used in a problem-based educational program for urban African Americans with diabetes. The intervention consisted of six 2-hour, weekly group educational and data collection sessions. No lectures were used, and the content was determined by participants' questions and concerns. Culturally tailored written educational materials were also provided.

Diabetes Mellitus↗
PubMed1989

The systems approach: an innovative model for improving the delivery of inservice training.

A systems approach consisting of eight elements was used in the design, implementation, and evaluation of a module for physical therapy inservice training at McDonald Army Hospital, Fort Eustis, Virginia. Use of this approach was aimed at increasing the effectiveness of learning, improving participant attitudes toward inservice training, and developing a model which could be used for delivering inservice training throughout the helping professions. The design requires that the problem area be selected by staff consensus--in this case planning and administration of therapeutic exercise programs for patients with hip dysfunctions. Five sessions which centered around this patient oriented problem area were presented by the physical therapist to the three physical therapy technicians. Principles of instructional design and events of instruction were incorporated using the format of Gagne and Briggs (1979). The technicians' perception of physical therapy inservice training was rated before the implementation of the systems approach, after the second inservice session, and after the final inservice session. By the end of the five inservice sessions, all three technicians were able to accomplish the predetermined goal of planning and administering a safe therapeutic exercise program to patients with hip dysfunctions. Progress notes also indicated that patient programs were being appropriately upgraded based on the patient's condition. Technicians' ratings of inservice training also had increased after the final session. Further implementation and evaluation of this approach to training is recommended.

Attitude↗
PubMed1993

Contemporary issues in the treatment of alcohol dependence.

Alcoholism treatment has certainly come of age since its inception with the founding of Alcoholics Anonymous in 1935. Although AA is a "fellowship" and is not considered "treatment" per se, the growth and proliferation of professional treatment programs has spawned a significant new sector in the health care industry, with a corresponding rise in health care cost. Because the social cost due to the destructiveness of alcoholism is enormous, however, treatment appears to be a cost beneficial investment for society, both in terms of dollars expended and in terms of the lessening of human misery. Inpatient and outpatient programs appear to be effective, but simplistic comparisons are to be avoided because their populations are frequently much different, with patients with poor prognosis indicators showing up more frequently in inpatient settings. Although outpatient treatment is undeniably cheaper initially, appreciable long-term savings may not be realized because of the greater tendency for recidivism in outpatient-treated groups. Taken as a whole, studies of treatment outcome and cost effectiveness support the view that contemporary alcoholism treatment should provide multiple levels of care, with appropriate matching of patients, depending on severity and various demographic factors. This matching may be difficult to realize in actual practice because of the wide variability among alcoholic patients. Although some patient-treatment matching criteria are now in use by insurance carriers and treatment providers, the long-term efficacy of these criteria have not been tested adequately. In the end, it may evolve that the best determinant of assignment to a particular treatment level or modality might best be done by a responsible clinician exercising good judgment based on experience and training. Appropriate legal and financial accountability for this decision should be based on standards of reasonableness, consistent with criteria used in the treatment of other medical and surgical conditions. The alcoholism clinician is performing a valuable service to humanity and to society. Social policies should support this effort by making available appropriate facilities and programs for treatment, and by promoting access through destigmatization and favorable payment and reimbursement systems.

Aftercare↗
PubMed1998

A new school-based program to provide eyeglasses: childsight.

OBJECTIVE: To address the unmet need for glasses encountered in an urban school setting by developing and implementing a school-based, cost-effective program that provides appropriate spectacle correction to needy children. METHODS: A total of 5851 students 9 to 15 years of age in 4 middle schools in northern Manhattan were screened for vision. Those with vision worse than 20/40 were examined, given glasses if appropriate, or referred for additional evaluation. RESULTS: Of the 5851 children screened, 1614 (28%) had a failing result, with visual acuity less than 20/40 in the worse eye. Of this group, 1082 were given glasses that were assembled at the school within 1 hour of testing. Ten percent of the group that required glasses already had them, and the remaining were referred for a complete ophthalmic examination that was completed in 58 cases. Only 14 of these had vision loss unrelated to refractive error. CONCLUSIONS: The program successfully treated 88.3% of the children within the school who needed glasses. Given that only 10% of children who needed glasses had them, it indicates a huge need to provide glasses to at least a million children in this age group in the United States.

Adolescent↗