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PubMed2002

Integrated Child Development Services (ICDS) scheme: a program for holistic development of children in India.

The Integrated Child Development Services (ICDS) scheme is the largest program for promotion of maternal and child health and nutrition not only in India but in the whole world. The scheme was launched in 1975 in pursuance of the National Policy for Children. The scheme has expanded in the last twenty-seven years form 33 projects to 5171 blocks. ICDS is a multi-sectoral program and involves several government departments. The program services are coordinated at the village, block, district, state and central government levels. The primary responsibility for the implementation of the program lies with the Department of Women & Child Development at the Centre and nodal department at the states, which may be Social Welfare, Rural Development, Tribal Welfare or Health Department or an independent Department. The beneficiaries are children below 6 years, pregnant and lactating women and women in the age group of 15 to 44 yrs. The beneficiaries of ICDS are to a large extent identical with those under the Maternal and Child Health Program. The program provides an integrated approach for converging all the basic services for improved childcare, early stimulation and learning, health and nutrition, water and environmental sanitation aimed at the young children, expectant and lactating mothers, other women and adolescent girls in a community. ICDS program is the reflection of the Government of India to effectively improve the nutrition and health status of underprivileged section of the population through direct intervention mechanism. The program covers 27.6 million beneficiaries with supplementary nutrition. The program services and beneficiaries has essentially remained the same since 1975. Recently a review of the scheme was held, sponsored by Government of India, which suggested modifications in the health and nutrition component of ICDS scheme to improve the program implementation and efficiency.

Adolescent↗
PubMedDate not supplied

Services for urban poor families in Kuala Lumpur, Malaysia: a case study.

With 25% of its population living in over 148 squatter settlements, with a high incidence of communicable diseases, teenage pregnancies, and psychological and familial stress, the city of Kuala Lumpur has sought ways to improve conditions. This article describes one particularly promising approach: community-based centers integrating three socioeconomic components--preschool education, maternal and child health clinics, and income-generating activities.

Child Welfare↗
PubMed2002

Integrating social model principles into broad-based treatment: results of a program evaluation.

Although traditional social model recovery programs appear to be decreasing, some aspects of social model recovery continue to exert a strong influence in broad-based, integrated programs. This article describes a four-week program that integrates licensed therapists, certified counselors, psychiatric consultation, and social model recovery principles into a broad-based treatment approach. The Social Model Philosophy Scale revealed a low overall rating on social model philosophy. However, social model principles that were heavily stressed included practicing 12-step recovery, the importance of getting a 12-step sponsor, staff-client interactions outside a formal office, employing staff who are in recovery, and emphasizing a goal of abstinence. Three- and six-month follow-up revealed significant improvement in alcohol and drug use, heavy alcohol use, satisfaction with family relationships, 12-step involvement, illegal behaviors, arrests, unsafe sex, self-esteem, use of medical resources, and health status. Findings provide a rationale for larger, multi-site studies that assess the effectiveness of social model characteristics using multivariate techniques.

Adolescent↗
PubMed2003

What are production diseases, and how do we manage them?

The term "Production Diseases" referred traditionally to those diseases induced by management practices, metabolic diseases are typical examples. Recently, the term "Production related diseases" has been enhanced to include other traits, such as infertility, and diseases such as mastitis and lameness that might involve infectious agents but exacerbated by nutritional or managemental factors. The presentation deals with Production Diseases in the context of integrated herd health programs, using periparturient diseases and traits as an example. Studies, based on 9377 lactations of cows calving in the period 1995 through 1998 from the author's practice in 7 Israeli Holstein herds, show that most periparturient diseases and traits are followed by increased culling, lower production associated with late peaks and lower persistency, and impaired fertility. The effects are independent of other diseases, and at times are long lasting. Production Diseases are often multifactorial and appear at the same stage of lactation. Independent relationships among them must be established, so that common cause effects, direct and indirect causal associations, and incidental relationships can be differentiated. Control of Production Diseases often involves various disciplines and therefore calls for a "multivariate approach". Such an approach, centered on the herd, has led to the adaptation of integrated programs for herd health. The programs are characterized by the adaptation of multidisciplinary, multifactorial, and a population approach to clinical entities. Preventive measures and routine examinations are the hard core of programs, but deeper involvement in nutrition, production and economics is called for. A routine monitoring and causal analysis of periparturient traits and diseases, production, fertility and abortions are carried out, relevant data are processed, and monitoring reports are issued routinely. Five different linear regression models evaluate factors responsible for losses of a) peak milk yield; b) economy corrected (ECM) peak milk yield; c) extended 305-d milk yield; d) daily 3.5% FCM in the first 90 days in milk; and e) persistencies. Three different logistic and linear regression models evaluate factors that contribute to a) "non pregnancy to first service"; b) unobserved heat; and c) open days. Narrowing down the field of investigation is essential for an intervention to be efficient. Conclusions are drawn from the epidemiological study and the proposed recommendations are weighed with cost/benefit considerations. Possible losses are quantified and used with expected return value in decision analysis. Production Diseases are at times the outcome of managemental mistakes brought about by the drive for higher yields. Integrated herd health programs help to control the negative effects of management by enhancing production under optimal feeding and management regimens. The estimated contribution of improved management to the Israeli national herd phenotypic increase in yield, and the improved fertility that followed the increase in milk yield presented, show that the goal is within reach.

Animal Husbandry↗
PubMed2000

The integration of primary care and behavioral healthcare in northern California Kaiser-Permanente.

Integration of behavioral healthcare and primary care has a number of presumed benefits, including better communication between providers and systems, leading to improved patient care. There are studies showing medical cost offsets, although they tend to be in circumscribed research settings. Northern California Kaiser-Permanente has designed a new primary care system providing mental health clinicians on a primary care team. Those clinicians evaluate patients, create treatment plans, provide brief interventions, coordinate care with specialty behavioral healthcare, and consult with primary care physicians. Those physicians also have an increased role in the detection and treatment of behavioral health problems via guidelines developed with behavioral health. Structural changes within the overall system, including regional call centers and computerized clinical information systems, support the integration. Quality programs also support the ongoing improvement of the integration process. There are investment expenses in this type of re-design, but also expected cost savings. An infrastructure is now in place to measure both clinical outcomes, and cost effects of the new model.

Adult↗
PubMed1997

A view from the grass roots.

A 14-member study team learned firsthand about promotion of family planning and maternal and child health (FP/MCH) in China while in the country during August 17-30, 1997. The self-funded team was headed by JOICFP Chairman Masao Sawaki and included representatives of the public health and preventive health field as well as an official from a Japanese university. The team first traveled to Fangshan District of Beijing where implementation of JOICFP's Integrated Project (IP) began in 1996. A fifth-cycle project area, Fangshan is receiving assistance from IPPF through JOICFP for a period of 3 years. The team moved north to Inner Mongolia Autonomous Region to observe IP activities in Tumud Left Banner of Hohhot City, a second-cycle project area which received support between 1987 and 1989. The third area visited was Yunnan Province in the south, where they observed activities in Jiangchuan County, a third-cycle area which was supported between 1990 and 1992. The comparison between the pilot area and original project areas was rewarding for the team, which noted that activities had continued to expand with support from the people after the 3-year funding period had ceased. In Inner Mongolia, the team noted how parasite control has been effectively used to gain community participation in activities. The project has expanded from 2 towns with a population of 50,000 to cover 19 towns with 343,000 people. In Jiangchuan Country, the IP has expanded from 5 towns with 108,000 people to cover 12 towns with 240,000. Prior to the project launch in 1989, the infant mortality was 60/1000 live births and the hospital delivery rate was 45%. These had improved to reach 23.3/1000 and 87%, respectively, as of 1996.

Asia↗
PubMed2003

An integrated functional genomics screening program reveals a role for BMP-9 in glucose homeostasis.

A coordinated functional genomics program was implemented to identify secreted polypeptides with therapeutic applications in the treatment of diabetes. Secreted factors were predicted from a diverse expressed-sequence tags (EST) database, representing >1,000 cDNA libraries, using a combination of bioinformatic algorithms. Subsequently, approximately 8,000 human proteins were screened in high-throughput cell-based assays designed to monitor key physiological transitions known to be centrally involved in the physiology of type 2 diabetes. Bone morphogenetic protein-9 (BMP-9) gave a positive response in two independent assays: reducing phosphoenolpyruvate carboxykinase (PEPCK) expression in hepatocytes and activating Akt kinase in differentiated myotubes. Purified recombinant BMP-9 potently inhibited hepatic glucose production and activated expression of key enzymes of lipid metabolism. In freely fed diabetic mice, a single subcutaneous injection of BMP-9 reduced glycemia to near-normal levels, with maximal reduction observed 30 hours after treatment. BMP-9 represents the first hepatic factor shown to regulate blood glucose concentration. Using a combination of bioinformatic and high-throughput functional analyses, we have identified a factor that may be exploited for the treatment of diabetes.

Animals↗
PubMed2000

Psychosocial approaches to dual diagnosis.

Recent research elucidates many aspects of the problem of co-occurring substance use disorder (SUD) in patients with severe mental illness, which is often termed dual diagnosis. This paper provides a brief overview of current research on the epidemiology, adverse consequences, and phenomenology of dual diagnosis, followed by a more extensive review of current approaches to services, assessment, and treatment. Accumulating evidence shows that comorbid SUD is quite common among individuals with severe mental illness and that these individuals suffer serious adverse consequences of SUD. The research further suggests that traditional, separate services for individuals with dual disorders are ineffective, and that integrated treatment programs, which combine mental health and substance abuse interventions, offer more promise. In addition to a comprehensive integration of services, successful programs include assessment, assertive case management, motivational interventions for patients who do not recognize the need for substance abuse treatment, behavioral interventions for those who are trying to attain or maintain abstinence, family interventions, housing, rehabilitation, and psychopharmacology. Further research is needed on the organization and financing of dual-diagnosis services and on specific components of the integrated treatment model, such as group treatments, family interventions, and housing approaches.

Behavior Therapy↗
PubMed1993

Clinical laboratory test reference (CLTR).

As the healthcare system undergoes a transformation in scope and funding, there remain many unfinished projects which will be essential for the next generation of automated medical support services. The most demanding and labor intensive tasks for this new frontier deal with the accumulation of knowledge which can be used as a clinical database to support supervisory functions in a physician operated interactive care delivery environment. These databases will contain the worlds accumulated knowledge in specialized areas. They will be organized by topic or clinical service, and have significant impact on the quality of care as well as medical malpractice exposure. This article will describe a clinical pathology database that has been adapted for medical practice. The database contains information about laboratory tests and their interpretation. The data is structured for rapid reading and has references where indicated. The database can be used in a stand alone program or integrated into an information system within an application program. The files are reviewed on a continuing basis and quarterly updates are made available to subscribers.

Clinical Laboratory Information Systems↗
PubMed2004

Integration of competing saccade programs.

Reflexive responses are often in direct competition with voluntary control. We test two opposing explanations for how this competition is resolved with respect to eye movements. One states that the quickest activation wins. The other states that the strongest activation wins. We show that an eye movement is executed according to the strongest activation, with the competition being staged at a common subcortical site.

Humans↗
PubMedDate not supplied

Reforms in nursing education across Western Europe: implementation processes and current status.

The aim of this review was to provide a comprehensive outlook on nursing education reforms enacted in Western Europe in the last three decades. Specifically, this analysis aimed to describe major trends in the implementation processes of nursing education reforms and the current academic status of nursing programs across Western Europe. A critical analysis of the scientific literature and policy documents was conducted. The results indicate that two major phases of reform were initiated in nursing education over the last three decades. The first phase was geared at creating a unified European platform of solid preregistration programs. The second phase was predominantly geared at integrating nursing programs into higher education institutions. In contrast to the first stage of reform, which yielded unity, the second phase resulted in a notable variation among existing structures, levels of education, duration of studies, and the titles (degrees) awarded. As a result, Western Europe today represents a myriad of arrangements for preregistration nursing programs. Nursing has viewed these reforms in the education system as vital in promoting the profession and crucial for responding to the reforming health care system. This research indicates that nursing goals have only been partially obtained.

Curriculum↗