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PubMed2006

WIC's promotion of infant formula in the United States.

BACKGROUND: The United States' Special Supplemental Nutrition Program for Women, Infants and Children (WIC) distributes about half the infant formula used in the United States at no cost to the families. This is a matter of concern because it is known that feeding with infant formula results in worse health outcomes for infants than breastfeeding. DISCUSSION: The evidence that is available indicates that the WIC program has the effect of promoting the use of infant formula, thus placing infants at higher risk. Moreover, the program violates the widely accepted principles that have been set out in the International Code of Marketing of Breast-milk Substitutes and in the human right to adequate food. SUMMARY: There is no good reason for an agency of government to distribute large quantities of free infant formula. It is recommended that the large-scale distribution of free infant formula by the WIC program should be phased out.

Journal Article↗
PubMed1999

Policy challenges for the Australian health care system.

In contrast to the regular media reports decrying the so-called crisis in the health system, a number of academic commentators have identified areas in which the Australian health care system could improve. George Palmer has been one of those, and over the years has published a body of work identifying areas for improvement. This paper reviews the performance of the Australian health care system against the criteria of equity, efficiency and acceptability, and explicates the contemporary problem areas associated with each criterion.

Australia↗
PubMed1987

Expanding the impact of behavioral staff management: a large-scale, long-term application in schools serving severely handicapped students.

Experimental evaluations of behavioral staff management procedures usually have been limited to relatively small-scale demonstration studies. We evaluated a large-scale, long-term application of a staff management program designed to improve the functional utility of educational services for severely handicapped persons. The intervention, involving a brief in-service program followed by supervisory prompts and feedback, was implemented by three principals in four schools involving 21 classrooms. Implementation of the management procedures was consistently accompanied by increases in student involvement in functional educational tasks in each classroom. Further, the improved services continued throughout a 2-year follow-up period. Staff responses to a questionnaire indicated a high degree of staff acceptance of the management program. Results are discussed in terms of expanding the use of behavioral supervisory procedures from experimental demonstrations to actual adoption by existing human service agencies.

Activities of Daily Living↗
PubMed1996

Identifying qualified underrepresented-minority students who otherwise appear to be at academic risk.

PURPOSE: To determine whether an academically intense program simulating six weeks of medical school could identify underrepresented-minority students at apparent academic risk who might actually have the time-management and other skills needed to succeed in medical school. METHOD: In the summer of 1995, 16 premedical students from minorities underrepresented in medicine participated in a six-course, six-week program at the Chicago College of Osteopathic Medicine. Academic credentials prior to participation in the program and performances in the program were compared for students subsequently offered or denied admission to the Chicago College of Osteopathic Medicine. Statistical methods included use of Student's t-test and Pearson correlation coefficients. RESULTS: Of the 16 participants, eight passed at least five courses and were accepted for early admission to the medical school; seven failed two or more courses and were denied admission; and one did not complete the program. The accepted and denied groups could be distinguished statistically by their overall performances in the program, and their performances in four of the six courses, but not by their performances prior to the program: the accepted students had a mean grade-point average of 2.68, SEM, 0.07, versus 2.66, SEM, 0.07, for the denied students, and a mean total Medical College Admission Test score of 16.2, SEM, 0.5, versus 17.0, SEM, 0.7. CONCLUSION: Programs such as the one at the Chicago College of Osteopathic Medicine might be relatively inexpensive ways for medical schools and underrepresented-minority students at apparent academic risk to learn whether the students are, nevertheless, prepared to succeed academically in medical school.

Chicago↗
PubMed2002

Post offer screening.

A well designed post offer screening program including PDA, clear acceptable criteria, physical screening, standardized objective tests, and occupational and job specific tests can substantially decrease the number of injuries and resulting costs. The results of a study suggest post offer screening makes a difference on post hire injury and resulting costs. These findings are consistent with the literature reviewed. Occupational health professionals are key to the development, implementation, and evaluation of such a program and can directly affect the company's bottom line when employees are accurately matched to their job requirements.

Cost Control↗
PubMed2005

Acceptance of nicotine dependence treatment among currently depressed smokers.

This study reports on baseline characteristics associated with acceptance and refusal of available smoking treatment among currently depressed smokers in a psychiatric outpatient clinic who were enrolled in a larger clinical trial. The sample (N=154) was 68% female and 72% White, with a mean age of 41.4 years and average smoking rate of 17 cigarettes/day. All participants were assigned to a repeated contact experimental condition; received a stage-based expert system program to facilitate treatment acceptance; and were then offered smoking treatment, consisting of behavioral counseling, nicotine patch, and bupropion. Acceptors (n=53) were defined as those accepting behavioral counseling and pharmacological treatment at some point during the 18-month study, whereas refusers (n=101) received only the expert system. The number of days to treatment acceptance was significantly predicted by stage of change, with those in preparation entering treatment more quickly than contemplators or precontemplators. In a logistic regression, the variables most strongly associated with accepting treatment were current use of psychiatric medication and perceived success for quitting. Severity of depressive symptoms, duration of depression history, and history of recurrent depression were not related to treatment acceptance. Findings have implications for the psychiatric assessment and treatment of smokers in clinical settings. Psychiatric medication may play a significant role in smoking cessation treatment acceptance by currently depressed smokers.

Adult↗
PubMed1982

Screening for specific learning disabilities among dental students.

At a time when recognition of the needs of handicapped students is of great concern, many handicapped persons have not yet been identified. Even with the advent of legislation mandating educational equity for all handicapped students, those with specific learning disabilities (SLD) still remain unidentified or unserved by institutions of higher education. In 1979, New York University College of Dentistry instituted a classwide screening and testing program for SLD students. The program sought to identify accepted students "at risk" for SLD through the administration of a two-hour battery of tests designed by learning disabilities specialists. Follow-up in-depth evaluations yielded a 90 percent accuracy rate on correct identification of SLD students based on the screening results. This article presents specific test results, analyses of data, and comparison of self-report measures and suggests educational implications, including suggestions for program accommodations.

Adult↗
PubMed1996

Evaluating the potential of international medical graduates as physician assistants in primary care.

The need to increase the nation's primary care workforce, and the presence of large numbers of international medical graduates (IMGs) who encounter barriers to licensure as physicians, have led to consideration of ways that IMGs might practice as physician assistants (PAs). Several states have explored regulatory changes that would allow IMGs to obtain PA certification through equivalency mechanisms or accelerated educational programs. In California, surveys in 1980, 1993, and 1994 collected information about the interest and preparedness among IMGs seeking PA certification. These surveys revealed that few of the IMGs were interested in becoming PAs as a permanent career, and few could show a commitment to primary care of the underserved. Of the 50 IMGs accepted into California's PA programs in recent years, 62% had academic or personal difficulties. Only 34 IMGs became certified, and all accepted jobs in primary care specialties. Two preparatory programs in California have assessed the readiness of unlicensed IMGs to enter PA programs, and they have shown that the participants did not demonstrate knowledge or clinical skills equivalent to those expected of licensed PAs. Therefore, policymakers should not consider that IMGs are or can easily become the equivalent of PAs without additional professional training in accredited PA programs. Preparatory programs appear to lessen the barriers to PA training for a few IMGs. In times of scarce resources for training, however, these programs may not be the best use of public funds to increase the primary care workforce.

Certification↗
PubMedDate not supplied

A multisite field test of the acceptability of physical activity counseling in primary care: project PACE.

Primary health-care providers have been encouraged to counsel their patients about regular physical activity, but there are significant barriers to effective counseling. In this study a program of training and materials was tested for acceptability to providers, office staff, and patients. Primary care providers and office staff were trained to use the Physician-based Assessment and Counseling for Exercise (PACE) materials in four geographical sites in the United States. The program was tested in a variety of settings and with diverse patient populations. The acceptability of the program during a five-month study period was evaluated through structured interviews. The training was effective in preparing the providers to counsel, and the program was generally acceptable to providers, office staff, and patients. Counseling was provided in less than five minutes by 70% of providers, and most patients reported following the recommendations given. The PACE program assists providers in overcoming barriers to counseling patients about physical activity. The PACE program is potentially an important part of a national effort to enhance the adoption and maintenance of physical activity among adults.

Adult↗
PubMed2005

Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy.

BACKGROUND: The costs, benefits, and cost-effectiveness of screening for human immunodeficiency virus (HIV) in health care settings during the era of highly active antiretroviral therapy (HAART) have not been determined. METHODS: We developed a Markov model of costs, quality of life, and survival associated with an HIV-screening program as compared with current practice. In both strategies, symptomatic patients were identified through symptom-based case finding. Identified patients started treatment when their CD4 count dropped to 350 cells per cubic millimeter. Disease progression was defined on the basis of CD4 levels and viral load. The likelihood of sexual transmission was based on viral load, knowledge of HIV status, and efficacy of counseling. RESULTS: Given a 1 percent prevalence of unidentified HIV infection, screening increased life expectancy by 5.48 days, or 4.70 quality-adjusted days, at an estimated cost of 194 dollars per screened patient, for a cost-effectiveness ratio of 15,078 dollars per quality-adjusted life-year. Screening cost less than 50,000 dollars per quality-adjusted life-year if the prevalence of unidentified HIV infection exceeded 0.05 percent. Excluding HIV transmission, the cost-effectiveness of screening was 41,736 dollars per quality-adjusted life-year. Screening every five years, as compared with a one-time screening program, cost 57,138 dollars per quality-adjusted life-year, but was more attractive in settings with a high incidence of infection. Our results were sensitive to the efficacy of behavior modification, the benefit of early identification and therapy, and the prevalence and incidence of HIV infection. CONCLUSIONS: The cost-effectiveness of routine HIV screening in health care settings, even in relatively low-prevalence populations, is similar to that of commonly accepted interventions, and such programs should be expanded.

Adult↗
PubMed2002

Probability of receiving testing in a national lookback program: the English HCV experience.

BACKGROUND: The HCV lookback program was designed to trace and offer testing to recipients who received transfusion of blood components from donors subsequently found to be anti-HCV positive. Only approximately 20 percent of transfusable components entering lookback did result in a recipient obtaining testing through this program. STUDY DESIGN AND METHODS: Data from English blood centers were collated to describe the outcomes of the HCV lookback program. The data were used to assess factors affecting the likelihood that recipients of lookback components received testing by the program. RESULTS: In total, 4424 recipients of 6687 blood components that had been issued for transfusion were identified. The lookback resulted in a tested recipient for 1067 components. Factors positively associated with receiving testing in identified recipients were younger age at transfusion, more recent year of transfusion, certain component types, and transfusion under the care of certain medical specialties; these effects were largely explained by the association of these factors with survival after transfusion. CONCLUSIONS: Not accepting testing through this program was largely due to death before the lookback and partly due to inability to access information from records and to decisions that testing was not in recipients' best interests. The probability of obtaining testing through this lookback was associated with several factors that could be used to focus the efforts of similar lookbacks in the future.

Adult↗
PubMed1994

Filling in the primary care gaps.

More than 50,000 nurse practitioners and physician assistants now provide care in all 50 states. Through advancements in training programs, physician and consumer acceptance, and governmental legislation, managed care organizations benefit from the continued growth of utilization of these "mid-level" providers. The author provides some background on the certification of these professionals and offers reasons for their increasing popularity across the country.

Certification↗
PubMed2000

[Evaluation of a home care program for children with cancer].

The home care team dependent from the pediatric oncology unit in our institution started working in April, 1997. We evaluate in this paper the medical activities accomplished in seventeen month experience. The team is constituted by a pediatric oncologist, two pediatric nurses and a clinical assistant with experience in the specialty. The geographic area we cover is la Communidad Valenciana. We directly attend children living in Valencia city and its metropolitan area. For the rest of patients, we coordinate the interventions of the local primary care teams and local hospitals. 127 patients have been admitted in the home care unit in 433 occasions. The immediate reasons for the admission were: early discharge from the hospital (61%), followed by the administration of antibiotics (18%) and chemotherapy (12%) at home. We attended 17 children in the terminal phase of their diseases. Five of them required opioid treatment for pain control. Six out of eight patients living in the area of direct intervention of the home care team died at home. The most common cause of discharge (73%) was the achievement of the goals planned when the patient was included in the program. Only in two cases (0.5%) we did not found enough cooperation from the parents and the treatment was completed in the hospital. This program has been well accepted by our patients and their parents and permits to shorten the stay in the hospital.

Adolescent↗
PubMed2000

The primary care clinic as a setting for continuing medical education: program description.

The Mexican Institute of Social Security (IMSS) is Mexico's Largest state-financed health care system, providing care to 50 million people. This system comprises 1450 family medicine clinics staffed by 14,000 family physicians, as well as 240 secondary care hospitals and 10 tertiary care medical centres. We developed a program of continuing medical education (CME) for IMSS family physicians. The program had 4 stages, which were completed over a 7-month period: development of clinical guidelines, training of clinical instructors, an educational intervention (consisting of interactive workshops, individual tutorials and peer group sessions), and evaluation of both physicians' performance and patients' health status. The pilot study was conducted in an IMSS family medicine clinic providing care to 45,000 people; 20 family physicians and 4 clinical instructors participated. The 2 main reasons for visits to IMSS family medicine clinics are acute respiratory infections and type 2 diabetes mellitus. Therefore, patients being treated at the clinic for either of these illnesses were included in the study. The sources of data were interviews with physicians and patients, clinical records and written prescriptions. A 1-group pretest-posttest design was used to compare physicians' performance in treating the 2 illnesses of interest. We found that the daily activities of the clinic could be reorganized to accommodate the CME program and that usual provision of health care services was maintained. Physicians accepted and participated actively in the program, and their performance improved over the course of the study. We conclude that this CME strategy is feasible, is acceptable to family physicians and may improve the quality of health care provided at IMSS primary care facilities. The effectiveness and sustainability of the strategy should be measured through an evaluative study.

Acute Disease↗
PubMed1998

Meeting the expectations of chronic tinnitus patients: comparison of a structured group therapy program for tinnitus management with a problem-solving group.

Two different group treatments were evaluated in 144 in-patients suffering from impairment due to chronic tinnitus. A tinnitus management therapy (TMT) was developed using principles of cognitive-behavioral therapy and compared with problem solving group therapy. Self-ratings were used to evaluate the help patients found in dealing with life problems and tinnitus as well as the degree to which they felt they were being properly treated and taken seriously. Patients showed significantly more satisfaction with the TMT group and evaluated the help they found in coping with tinnitus and life problems significantly higher. Thus, in the light of unsatisfactory medical solutions and the poor acceptance of some psychological treatments for tinnitus, TMT appears to be an acceptable and helpful treatment program.

Adaptation, Psychological↗
PubMed1994

Breast conservation therapy for invasive breast cancer: a review of prior trials and the Mayo Clinic experience.

OBJECTIVE: To assess the role of breast conservation therapy in the management of early-stage invasive breast cancer. DESIGN: We reviewed the results of previously published trials and summarized 165 cases of breast conservation surgical procedures and irradiation at the Mayo Clinic between January 1979 and September 1989. MATERIAL AND METHODS: From the prior clinical trials, the criteria for selection of patients, the surgical and radiation techniques used, the complications of treatment, the cosmetic results, and the follow-up assessment and survival were analyzed. The 165 Mayo patients were also characterized, and their results were described. RESULTS: Breast conservation therapy consists of excision of the primary tumor followed by irradiation. A coordinated multidisciplinary approach should be used for selection of patients. Several large-scale clinical trials have demonstrated that breast conservation therapy is an appropriate option for most women with early-stage breast cancer and provides tumor control and survival rates equivalent to mastectomy. With a collaborative treatment program and judicious application of contemporary standards of practice, a good-to-excellent cosmetic outcome can be achieved in most patients, and the risk of treatment-related sequelae is minimal. The Mayo Clinic experience with breast conservation therapy is consistent with these observations and compares favorably with other institutional and clinical trial results. CONCLUSION: Patients should be fully educated about the options for primary management of early-stage breast cancer because the selection of therapy may profoundly influence psychologic adjustment and acceptance of the treatment program.

Breast Neoplasms↗
PubMed2003

The dilemma of early intervention: some problems in mental health screening and labeling.

Motivated in part by a desire to identify and manage individuals considered to be at risk for serious mental disorders, early intervention programs are becoming increasingly accepted by the medical community, increasingly supported by the pharmaceutical industry, and increasingly unchallenged by the public. This article examines some of the conceptual and practical difficulties associated with early, or preventive, mental health care. Examples are drawn from contemporary research as well as historical commentaries in the fields of industrial psychology, sociology, and education. The tone of the discussion is cautionary, but the goal is to encourage mental health professionals and consumers to consider the potential harmfulness of early intervention strategies before these programs are uncritically copied, expanded, or renewed.

Effect Modifier, Epidemiologic↗