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PubMed1989

AIDS. Implementation of universal blood and body fluid precautions.

The use of "universal blood and body-fluid precautions," or "universal precautions" to prevent the acquisition of blood-borne diseases in health care workers is now widely recommended. Such recommendations are soundly based on a number of biologic, psychologic, and administrative bases. Implementation of the program in an individual hospital is an imposing task, requiring administrative support and skill. A process for establishing initial definitions for the more ambiguous areas, and for administrative and educational support to all levels of care needs to be defined in advance, then put into effect. A wider definition of "universal precautions," which approaches the "Body Substance Isolation" system, is discussed. The use of a "task-classification" system, evaluating the risk inherent in specific tasks, may actually aid both the implementation and the acceptance of such a program.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Preparing medical students to care for older adults: the impact of a Senior Mentor Program.

PURPOSE: To provide alternative training experiences for medical students to improve the competencies needed to provide care for older adults. METHOD: Part of a comprehensive approach to integrating geriatric content at the University of South Carolina (USC) School of Medicine, the Senior Mentor Program (SMP) was launched in 2000. The SMP links pairs of students with older community volunteers in the spring of the first year. Students visit their mentors throughout medical school, and execute assignments that complement materials covered in the traditional curriculum. To evaluate the feasibility and efficacy of the SMP, the authors describe the program's operation and outputs, the extent to which undergraduate medical education at USC and the SMP meet the core competencies for care of older adults promulgated by the American Geriatrics Society (AGS), and analyze the coverage of geriatrics content from 2000 to 2005 at USC, as indicated by responses to the Medical School Graduation Questionnaire. RESULTS: From 2000 to 2005, 379 students enrolled in the SMP; 133 graduates of the classes of 2004 and 2005 have completed the SMP. Students and mentors indicated high acceptance and enthusiasm. The program has been maintained with minimal administrative burden. USC covered only half of AGS competencies before the SMP, but now covers 100%, with nearly a third met specifically through the SMP. USC graduates reporting inclusion of geriatrics throughout their four years of training rose from 66% in 2002 to 96% in 2004-05. CONCLUSIONS: The SMP has had a substantial impact on students' preparation for dealing with an aging patient population.

Adult↗
PubMed1997

Determinants of dental care utilization for diverse ethnic and age groups.

Dental services utilization in the past 12 months was compared across population-based samples of African-American, Navajo, Lakota, Hispanic, and White adults participating in the WHO International Collaborative Study of Oral Health Outcomes (ICS-II) at USA research locations. Bivariate results revealed that ethnic minority groups in both age cohorts reported significantly fewer dental visits in the past 12 months compared with White adults. When dentate status was controlled for, age cohort differences were not significant in Baltimore (African-American and White) and San Antonio (Hispanic and White) research locations. In contrast, older Native Americans (65-74 years) reported visiting the dentist significantly less often compared with their middle-aged (35-44 years) counterparts. Multivariate results indicated that generalizable variables were associated with dental contact in every ICS-II USA ethnic group (i.e., dentate, usual source of dental care, oral pain). Among the diverse ethnic groups, other determinants presented a varied pattern of risk factors for underutilizing dental care. Information on ethnic-specific risk factors can be used to design culturally appropriate and acceptable oral health promotion programs. Generalizable risk factors across ethnic groups inform oral health policy-makers about changing national priorities for promoting oral health.

Adult↗
PubMedDate not supplied

Occupational performance needs of adolescents in alternative education programs.

OBJECTIVE: Alternative education programs are schools that accept students who have not been successful in the general education setting. This study focuses on developing a better understanding of the needs of students in three area alternative education schools. METHODS: A needs assessment was created and distributed to the staff of each school regarding the problem areas of alternative education students. Data were analyzed descriptively. RESULTS: Thirty-nine of 47 surveys were returned resulting in an overall return rate of 83%. The staff identified several potential deficit areas faced by the students in these alternative education programs. The most frequently identified deficits included poor time management skills, decreased healthy participation in hobbies and leisure activities, and a lack of healthy lifestyle behaviors. In addition, the staff reported that many students had cognitive deficits including reduced ability to follow multistep directions, impaired higher-level thinking skills, reduced attention span, and limited memory. CONCLUSION: The results of this study are consistent with literature that suggests the students in alternative education settings may have underlying deficits that interfere with learning and produce misbehaviors. The alternative education programs should be further explored as a potential practice area for occupational therapists.

Data Collection↗
PubMed2006

Capturing complexity: integrating health and education research to inform health-promoting schools policy and practice.

Despite the intersectoral nature of health promotion practice many programs limit their evidence base to health sector research and do not draw on evidence from other sectors' research in program design. To help ensure programs are relevant and acceptable to intersectoral partners and intended outcomes are of value to all sectors involved, utilising evidence from more than one discipline is essential. This article identifies the narrow interpretation of existing evidence for health promoting schools and discusses the challenges faced by practitioners and policy makers when reviewing evidence. These issues include the various perspectives on what is 'quality' evidence and how to ensure multidisciplinary evidence is used to inform practice, particularly with the education sector that has a strong research base of its own. A data extraction tool was developed to help address these issues and assist the design of a health promoting schools program. A description of the tool's elements and two case studies provide examples of how research from two different disciplines can be integrated to inform planning and strengthen partnerships. The tool expands the evidence base for policy and practice decision-making for health promoting schools, acknowledging the practical realities of both sectors.

Evidence-Based Medicine↗
PubMed2000

Home visiting intervention for vulnerable families with newborns: follow-up results of a randomized controlled trial.

OBJECTIVE: This study aimed to: (1) Assess the community utility of a screening tool to identify families with child abuse or neglect risk factors in the immediate postnatal period (2) Determine the social validity and effectiveness of a home visiting program using community child health nurses and offering social work services for identified families, and (3) Identify factors in the immediate postnatal period associated with the child's environment that predict poor adjustment to the parenting role. METHOD: A randomized controlled trial using a cohort of 181 families was undertaken to evaluate the impact of a home visiting program. Mothers were recruited in the immediate postnatal period and allocated either into the home visiting program or into a comparison group. The research design required self-identification into the study by providing positive responses to a range of risk factors. A repeated measures design was used to test parenting stress and maternal depression from the immediate postnatal period to 12-month follow-up and physical child abuse potential to 18-month follow-up. To test whether measures taken in the immediate postnatal period were predictive for poor adjustment to the parenting role, a linear regression model was used. RESULTS: The screening procedure was shown to have utility in the context of recruitment to a research trial and mothers were willing to accept the home visiting program examined by this study from the immediate postnatal period. From as early as 6 weeks the program demonstrated ability to impact positively on maternal, infant, family, and home environment variables (testing 90 randomly allocated intervention vs. 91 comparison families). At follow-up, parental adjustment variables were not significantly different between groups (testing the remaining 68 (75.5%) intervention vs. 70 (76.9%) comparison families) and home environment assessment scores had converged. Predictive analysis of factors measured in the immediate postnatal period revealed an absence of any predictive value to demographic characteristics, which secondary prevention efforts typically target. CONCLUSIONS: Follow-up evaluation did not demonstrate a positive impact on parenting stress, parenting competence, or quality of the home environment confirming the need to test early program success on longer term outcomes. Further, thestudy not only demonstrated that there was a relationship between maternal, family and environmental factors identified in the immediate postnatal period. and adjustment to the parenting role, but also challenged demographic targeting for child abuse and neglect risk. At the same time, the immediate postnatal period presented an exciting window of opportunity to access high-risk families who may otherwise have become marginalized from traditional services.

Adaptation, Psychological↗
PubMed1980

Humanistic geriatric health care: an innovation in medical education.

A geriatric health maintenance program, started in 1976 as a community medicine elective, has developed into an innovative model in humanistic health care. Junior and senior medical students act as live-in facilitators of comprehensive health care for the elderly tenants in publicly subsidized housing units. Students rotate emergency night and weekend calls and hold weekly health clinics at the housing units. Weekly seminars are given by faculty members during which case presentations by students and topics related to the complex problems of the elderly are discussed. Important aspects of this elective are experiential learning in humanistic health care, exposure to ambulatory well or stable elderly people, development of communication/interpersonal skills, and acceptance of responsibility. The program has been received enthusiastically by tenants, community physicians, students, and an increasing number of faculty members at the University of Oregon Health Sciences Center School of Medicine.

Aged↗
PubMed2005

Cost-effectiveness of an intervention to prevent depression in at-risk teens.

CONTACT: Depression is common in adolescent offspring of depressed parents and can be prevented, but adoption of prevention programs is dependent on the balance of their incremental costs and benefits. OBJECTIVE: To examine the incremental cost-effectiveness of a group cognitive behavioral intervention to prevent depression in adolescent offspring of depressed parents. DESIGN: Cost-effectiveness analysis of a recent randomized controlled trial. SETTING: Kaiser Permanente Northwest, a large health maintenance organization. PARTICIPANTS: Teens 13 to 18 years old at risk for depression. INTERVENTIONS: Usual care (n = 49) or usual care plus a 15-session group cognitive therapy prevention program (n = 45). MAIN OUTCOME MEASURES: Clinical outcomes were converted to depression-free days and quality-adjusted life-years. Total health maintenance organization costs, costs of services received in other sectors, and family costs were combined with clinical outcomes in a cost-effectiveness analysis comparing the intervention with usual care for 1 year after the intervention. RESULTS: Average cost of the intervention was $1632, and total direct and indirect costs increased by $610 in the intervention group. However, the result was not statistically significant, suggesting a possible cost offset. Estimated incremental cost per depression-free day in the base-case analysis was $10 (95% confidence interval, -$13 to $52) or $9275 per quality-adjusted life-year (95% confidence interval, -$12 148 to $45 641). CONCLUSIONS: Societal cost-effectiveness of a brief prevention program to reduce the risk of depression in offspring of depressed parents is comparable to that of accepted depression treatments, and the program is cost-effective compared with other health interventions commonly covered in insurance contracts.

Adolescent↗
PubMed1998

A flexible triangulation method to describe the solvent-accessible surface of biopolymers.

A relatively simple protein solvent-accessible surface triangulation method for continuum electrostatics applications employing the boundary element method is presented. First, the protein is placed onto a three-dimensional lattice with a specified lattice spacing. To each lattice point, a box is assigned. Boxes located in the solvent region and in the interior of the protein are removed from the set. Improper connections between boxes and the possible existence of cavities in the interior of the protein which would destroy the proper connectivity of the triangulated surface are taken care of. The remaining set of boxes define the outer contour of the protein. Each free face exposed to the solvent of the remaining set of boxes is triangulated after the surface defined by the free faces has been smoothed to follow the shape of the macromolecule more accurately. The final step consists of a mapping of triangle vertices onto a set of surface points which define the solvent-accessible surface. Normal vectors at triangle vertices are obtained also from the free faces which define the orientation of the surface. The algorithm was tested for six molecules including four proteins; a dipeptide, a helical peptide consisting of 25 residues, calbindin, lysozyme, calmodulin and cutinase. For each molecule, total areas have been calculated and compared with the result computed from a dotted solvent-accessible surface. Since the boundary element method requires a low number of vertices and triangles to reduce the number of unknowns for reasons of efficiency, the number of triangles should not be too high. Nevertheless, credible results are obtained for the total area with relative errors not exceeding 12% for a large lattice spacing (0.30 nm) while close to zero for a smaller lattice spacing (down to 0.16 nm). The output of the triangulation computer program (written in C++) is rather simple so that it can be easily converted to any format acceptable for any molecular graphics programs.

Biopolymers↗
PubMed2006

Validity and reliability of the Community Integration Program Questionnaire.

The Community Integration Program Questionnaire was developed to measure various quantifiable characteristics of community integration programs for people with brain injury. There are three versions: one for outpatient facility-based, one for residential and one for home programs. In this study questionnaires were administered to directors and associate directors of seven programs. A research assistant then went on-site to collect corresponding data using patient records, planning books and schedules, annual and quarterly reports, employee lists, staff curricula vitae, census data, insurance payment data, team meeting notes, incident reports, and staff logs. Matching criteria between questionnaire and on-site data were established before either was collected. The survey data matched data acquired on-site in 42.2, 56.4, and 56.8% of questions in the three versions, respectively. Interviewers and a second listener recorded the same information 91.5% of the time across seven program interviews. For two programs, comparisons between a Program Director and Program Coordinator yielded matches on 42.8 and 40.6% of questions, respectively. In conclusion, the Community Integration Program Questionnaire does not have acceptable construct validity and inter-rater reliability. Researchers requiring information about quantifiable characteristics of community integration programs should go on-site to collect the data.

Brain Injuries↗
PubMed2006

Attitudes of new mothers towards genetics and newborn screening.

OBJECTIVE: To evaluate new mothers' opinions of genetics and newborn screening. SETTING: An Australian tertiary referral hospital. POPULATION: 232 women who delivered a liveborn infant and had received written and verbal information on newborn screening from midwifery staff during their antenatal care. METHODS: Participants were interviewed within 24 hours of blood being taken from their baby by heel prick for the newborn screen. Non-English speaking women were included using medical interpreters. The questionnaire evaluated opinions about newborn screening and parental consent. The opportunity was used to also question their views on the impact on lifestyle and discrimination of a theoretical diagnosis of genetic disease or carrier status in their baby. MAIN OUTCOME: Descriptive data on mother's attitudes. RESULTS: 200 women consented to participate in the study (86.2% response). New mothers supported newborn screening programs where outcomes could be used to prevent or reduce the severity of a disease (85-86% support), but were less supportive if screening had been used to assist with future family planning (65%). The majority of women (86%) felt that parental consent was mandatory before newborn screening tests were performed. A similar number felt that consent would be required before blood samples could be used if a National DNA library were to be created. The majority of women expressed concern that a child with a genetic illness would face discrimination and difficulty obtaining insurance or employment. A third of women felt that even a carrier of a genetic illness would face similar discrimination. CONCLUSION: Acceptance of newborn screening programs is high but mothers consider the need for consent to be mandatory. They have concerns about discrimination children with genetic illnesses may face.

Adult↗
PubMed1994

Warfarin 2.0--a computer program for warfarin management. Design and clinical use.

Warfarin 2.0 is a computer program that helps physicians optimize treatment of outpatients with warfarin. The main reason for its development was to achieve a good anticoagulation level, avoiding both undertreatment--which causes thromboembolic complications--and overtreatment--which causes hemorrhagic complications. The program was also designed to help educate the anticoagulated patient, standardize warfarin management and audit results of what had been done. The philosophy of continuous quality improvement was applied. Warfarin 2.0 is in clinical operation in the University Hospital, Montevideo, Uruguay, and it has also been used since the end of 1993 in the Favaloro Foundation, Dept. of Hematology, Buenos Aires, Argentina. The results from the first 15 months of use in Montevideo showed an increase in the number of patients being followed (from 91 to 132) and the average number of visits per patient (from one visit every 10.6 weeks to one every 6.5 weeks): The frequency of visits has been in the internationally accepted ranges since the program was implemented. Better anticoagulation levels were achieved after an adjusting period. Unfortunately, the number of undertreated patients is still large, and a thorough analysis of the data is going to be undertaken to continue improving warfarin management.

Drug Therapy, Computer-Assisted↗
PubMedDate not supplied

How to assess a patient's support system and personal abilities prior to liver transplantation.

Most liver transplant programs have come to accept the importance of evaluating the psychosocial status of potential liver transplant recipients prior to liver transplantation. The goal is to utilize a thorough assessment of the candidate's support system and personal abilities in order to predict post-transplantation compliance and overall medical-surgical outcome. To achieve this goal, it has been necessary to include a large number of multidisciplinary specialists including social workers, nurses, and psychologists as well as physicians in the evaluation process. Each disclipline contributes to the overall assessment and management of these candidates prior to and following liver transplantation. The purpose of this report is to describe how one spectrum of issues relating to a potential candidate's strengths and vulnerabilities are assessed in the liver transplant program at the University of Kentucky.

Adaptation, Psychological↗
PubMed2000

Health reform for children: the Egyptian experience with school health insurance.

In June 1992, the People's Assembly of Egypt passed Law 99 expanding health insurance to cover all school children. This was one of the most important initiatives undertaken in recent years by the Ministry of Health, and it effectively increased the number of beneficiaries covered by the Health Insurance Organization (HIO) from 3.75 million in 1988 to about 14 million in 1993. This paper first examines the policy processes for the introduction of this innovation in Egypt's health system. Next, the paper discusses the implementation and consequences of the new policy in terms of coverage, financing, benefits, and delivery of services, along with data on utilization and expenditures. Several important lessons derive from this analysis. First, major reform efforts are possible when there is a strong political commitment and the proposed program and solutions are acceptable to the key stakeholders. Second, compromises and trade-offs are essential to construct a politically feasible and ethically acceptable reform initiative. Third, while these trade-offs might yield short-term gains, the trade-offs in the long term may undermine the reform's capacity to achieve the anticipated equity enhancements and can potentially undermine the financial sustainability of the reform.

Adolescent↗
PubMed1976

Maximum exercise tests on "postcoronary" patients.

The maximum oxygen intake has been measured directly (uphill treadmill walking) in 36 patients following recovery from myocardial infarction. These were selected as follows: 15 consecutive new entrants to an exercise program that is currently accepting about one-sixth of the total reported myocardial infarction hospital admissions in metropolitan Toronto (group A), 12 patients not responding well to training (group B), and 9 patients now running substantial distances (group C). The only clinical complications were two episodes of ventricular tachycardia. Twenty patients reached an oxygen plateau, and in group C, the maximum heart rate (170/min) reached Scandinavian norms, with a maximum oxygen intake (2.63 +/- 0.35 1/min STPD, 36.9 +/- 4.8 ml/kg-min STPD) as in healthy men of the same age. The rate of adaptation to a progressive submaximum test was such that comparable Astrand nomogram predictions of VO2max were obtained from data in the 3rd and 5th min at the third load. Predictions generally agreed closely with directly measured values. It may be concluded that in patients who have recovered sufficiently to enter an exercise rehabilitation program 1) predictions of VO2max have about the same accuracy (+/-10) as in healthy subjects, and 2) direct measurements can often be pursued to an "oxygen plateau" without due risk.

Adult↗