Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Program Appropriateness”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,063 records · Page 59Linked to original sources

Two NIOSH resources for implementing workplace safety and health surveillance.

To improve safety and health in the workplace, appropriate occupational health programs should be implemented utilizing expertise from multiple disciplines. In other words, the occupational health program should be a team effort. Expertise from all aspects of occupational health should be utilized, from the industrial hygienist, to the safety officer, to the occupational health nurse, and the practicing physician--all should be involved in the program to maintain a safe and healthy workplace. Two NIOSH resources have been described to assist the occupational health professional in the improvement of safety and health in the workplace. First, the SHEO approach, where a separate SHEO list is to be developed for each workplace. This may be a problem when the physician is an outside contractor, but with the help of the team approach, a list of SHEOs can be developed. Second, medical screening and biological monitoring is often required. While we realize that medical screening and biological monitoring is part of the complete occupational health program, the table of medical tests that we have prepared may give some leads into the type(s) of medical tests to be conducted on the individual worker at a particular worksite.

Communicable Diseases↗

Improved sensitivity of direct microscopy for acid-fast bacilli: sedimentation as an alternative to centrifugation for concentration of tubercle bacilli.

There is a great need for improved methods for the diagnosis of tuberculosis by techniques that are appropriate for control programs in low-income countries. Liquefaction of sputum with sodium hypochlorite followed by concentration of bacilli through overnight sedimentation significantly increases the sensitivity of direct microscopy, and this method could be an alternative for diagnostic centers not equipped with a centrifuge.

Bacteriological Techniques↗

Dual chamber pacing: how many patients remain in DDD mode over the long term?

OBJECTIVE: DDD pacing is better than VVI pacing in complete heart block and sick sinus syndrome but is more expensive and demanding. In addition, some patients have to be programmed out of DDD mode and this may have an important impact on the cost-effectiveness of DDD pacing. The purpose of this study was to determine how many patients remain in DDD mode over the long term (up to 10 years). DESIGN: A retrospective analysis of the outcome over 10 years of consecutive patients who had their pacemakers programmed initially in DDD mode. SETTING: A district general hospital. PATIENTS: 249 patients with DDD pacemakers. Sixty two patients (24.9%) had predominantly sick sinus syndrome and 180 (72.3%) had predominantly atrioventricular conduction disease. Mean (range) complete follow up for this group of patients was 32 months (1-10 years). RESULTS: Cumulative survival of DDD mode was 83.5% at 60 months. Atrial fibrillation was the commonest reason for abandonment of DDD pacing. Atrial fibrillation developed in 30 patients (12%), with atrial flutter in three (1.2%). Loss of atrial sensing or pacing, pacemaker mediated tachycardia, and various other reasons accounted for reprogramming out of DDD mode in eight patients (3.2%). Overall, an atrial pacing mode was maintained in 91% and VVI pacing was needed in only 9%. CONCLUSIONS: With careful use of programming facilities and appropriate secondary intervention, most patients with dual chamber pacemakers can be maintained successfully in DDD or an alternative atrial pacing mode until elective replacement, although atrial arrhythmia remains a significant problem. There are no good reasons, other than cost, for not using dual chamber pacing routinely as suggested by recent guidelines and this policy can be achieved successfully in a district general hospital pacing centre.

Aged↗

[Postnatal depression in a Colombian city. Risk factors].

OBJECTIVE: Depression is a major public health problem, which women present, as well as at other periods of their lives, at the puerperium. Postnatal depression is the most frequent complication at this period, with worldwide prevalence as high as 15%. In Colombia, its frequency and associated factors were not clearly defined. DESIGN: To establish the incidence and associated factors for postnatal depression in the Bucaramanga, Colombia, metropolitan area. METHODS: Between May 2003 and April 2004, a cohort was assembled of 286 puerperal women from 11 health centres at different levels, within the Bucaramanga metropolitan area. Women were monitored for 6 weeks. Information was obtained on social, demographic and obstetric variables, psychiatric history, variables concerning the newborn, satisfaction with delivery, and breast-feeding. Postnatal depression was established by a psychiatrist, in a semi-structured clinical interview, using DSM-IV criteria. Incidence rate and associated factors were calculated through a regression model. RESULTS: Incidence rate of postnatal depression was: 1 case per 1000 days/person monitored (95% CI, 0.5-1.7). After the data were then fitted, only these factors were associated with postnatal depression: depression background, HR 3.87 (95% CI, 1.02-14.7), absence of prenatal monitoring, HR 3.87 (95% CI, 1.1-13.2), and background of dysphoria, HR 15.13 (95% CI, 1.9-118.2). CONCLUSIONS: Postnatal depression is little recognized during the puerperium. It is a major public health problem in Bucaramanga, where an appropriate prenatal monitoring program could reduce it. A follow-up program for mother and child would help its early diagnosis and management.

Adolescent↗

[Mistletoe therapy from the pharmacologic perspective].

Because of their cytostatic/apoptotic and immunomodulatory effects mistletoe extracts are often applied in tumour patients. Recent experimental data suggest that the mistletoe lectins Viscum album agglutinin (VAA)-I and -II are play an important role in the efficacy of mistletoe therapy. VAA-I and -II are members of the type-II ribosome-inactivating proteins. VAA-I has been shown to induce cytostatic effects in cultures of various eukaryotic cells in vitro. In 24-hour cultures of human peripheral lymphocytes, flow-cytometric investigations with propidium iodide (PI) in hypotonic buffer and quantitative assessment of DNA breaks with terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-digoxigenin nick end-labeling (TUNEL) assay were carried out; they revealed a dose-dependent VAA-I-induced apoptosis (lectin concentrations between 10 ng/ml and 1 microg/ml). In 24-hour cultures of peripheral blood mononuclear cells (PBMC), VAA-I in non-cytotoxic concentrations (1+/-10 ng/ml) induced mRNA expression and enhanced the secretion of proinflammatory cytokines. The stimulation of NK cells by VAA-I in vitro was enhanced in additive manner by the combination of VAA-I with IL-2 and IL-12. In culture of PBMC and bone marrow CD34+ cells coincubation of VAA-I with other haematopoietic growth factors induced a dose-dependent increase in clonogenic growth. In cancer patients the mechanisms of natural immunity, believed to be essential for their survival, are often significantly decreased. VAA-I and standardized mistletoe extracts are able to stimulate the cellular parameters of natural immunity with a bell-shaped curve of efficacy. Studies in animal models suggest that application of 0.5-3 ng/kg VAA-I twice a week is effective in sustaining the elevation of the number and activity of peripheral blood NK cells. These parameters often exhibit high intrinsic fluctuations, in healthy persons, however, blind crossover studies reveal an optimal lectin dose of about 0.5 and 1 ng/kg bw, suggesting a potential use of mistletoe preparations as a modulator of the natural immune system. Selective apoptotic effects of VAA-I may represent a novel approach for pharmacological manipulation of the balance between cell growth and programmed cell death. Appropriate combination of immunomodulatory and cytotoxic doses may open new clinical perspectives in the mistletoe therapy.

Bone Marrow Cells↗

Dynamic subset selection based on a fitness case topology.

A large training set of fitness cases can critically slow down genetic programming, if no appropriate subset selection method is applied. Such a method allows an individual to be evaluated on a smaller subset of fitness cases. In this paper we suggest a new subset selection method that takes the problem structure into account, while being problem independent at the same time. In order to achieve this, information about the problem structure is acquired during evolutionary search by creating a topology (relationship) on the set of fitness cases. The topology is induced by individuals of the evolving population. This is done by increasing the strength of the relation between two fitness cases, if an individual of the population is able to solve both of them. Our new topology-based subset selection method chooses a subset, such that fitness cases in this subset are as distantly related as is possible with respect to the induced topology. We compare topology-based selection of fitness cases with dynamic subset selection and stochastic subset sampling on four different problems. On average, runs with topology-based selection show faster progress than the others.

Algorithms↗

Referral and housing processes in a long-term supported housing program for homeless veterans.

OBJECTIVE: The study examined client characteristics, case management variables, and housing features associated with referral, entry, and short-term success in a Department of Veterans Affairs (VA) national intensive case management and rental assistance program for homeless veterans. METHODS: Information collected from homeless veterans at the time of initial outreach contact and from case managers during the housing search was used to create logistic regression models of referral into the program and successful completion of several stages in the process of obtaining stable independent housing. RESULTS: Overall, only 8 percent of the more than 65,000 eligible veterans contacted by outreach workers were referred to the program. Those referred were more likely to be female, to have more sources of income, to have recently used VA services (including residential treatment), and to have serious mental health problems. Once in the program, 64 percent of veterans eventually moved into an apartment, and 84 percent of those who obtained an apartment were stably housed one year later. In general, activities of case managers, such as accompanying the veteran to the public housing authority and securing additional sources of income, were associated with success in the housing process. The therapeutic alliance, clients' housing preferences, and the quality of housing were unrelated to retention of housing. CONCLUSIONS: This supported housing program was judged appropriate for a small percentage of eligible veterans. However, a large proportion of clients were successful in attaining permanent housing, which lends support to the effectiveness of the supported housing approach.

Adult↗

Encouraging psychiatrists to work with chronic patients: opportunities and limitations of residency education.

In recent years, psychiatrists in both the public and private sectors have been insufficiently involved in the treatment of chronic psychiatric illness. Simultaneously, deinstitutionalization has made the treatment of chronic patients more complex. In this paper the authors discuss the use of medical education- specifically the psychiatric residency-to increase the number of psychiatrists involved in the treatment of chronic patients and to improve the quality of treatment. Optimally residency programs should provide intense, long-term contact with chronic patients, supervised by role models committed to the treatment of such patients. Programs should encourage appropriate attitudes, including realistic treatment expectations and understanding of the issues of patient passivity and dependence; convey specialized knowledge related to housing, ethnicity, occupational, social, and legal matters and train residents in treatment skills tailored to patient needs, including the ability to perform functional diagnostic assessments and to collaborate with other mental health professionals.

Chronic Disease↗

Moonlighting: why training programs should monitor residents' activities.

Moonlighting by psychiatric residents, or employment outside the residency program, is a longstanding and widespread practice. The author contends that moonlighting detracts from residents' ability to gain full benefit from their educational program, compromises the safety of patients treated by residents who moonlight in unsupervised settings, and exposes health care institutions to risk of costly legal actions. Although moonlighting should ideally be eliminated, a workable alternative to the current system would include oversight by residency program directors of residents' extracurricular employment to assure that the assignments complement the educational program. Institutions that employ moonlighting residents would also reimburse the residency program for selecting appropriate residents to fill the positions they offer.

Employment↗

Population-based assessment of diabetes care and self-management among Puerto Rican adults in New York City.

PURPOSE: The purpose of this study was to assess the status of diabetes medical care and self-management among adult Puerto Ricans in New York City. METHODS: A random-digit-dialing telephone survey with a dual-frame sampling design was employed to obtain a probability sample of adult Puerto Ricans with diagnosed diabetes (n = 606). Demographic characteristics, health status, and indicators of diabetes medical care and self-management were collected using the standard Behavioral Risk Factor Surveillance System (BRFSS) questionnaire. A statewide sample of adults with diagnosed diabetes (n = 232) was obtained from the BRFSS for comparison. RESULTS: Compared to New York State adults, Puerto Ricans were significantly less likely to receive annual A1C testing (72.7% vs 84.9%), cholesterol testing (67.5% vs 87.2%), blood-pressure-lowering medication (82.4% vs 91.9%), and pneumococcal vaccination (19.3% vs 28.5%, among those aged 18 to 64 years). Puerto Ricans were also less likely to take aspirin every day or every other day to prevent cardiovascular complications (30.6% vs 40.7%). Puerto Ricans were younger and more likely to have lower educational attainment and lower income than New York State adults, but they were not significantly disadvantaged in access to health care indicated by rates of health insurance coverage, having a particular place for medical care, and frequencies of seeing a provider for diabetes. CONCLUSIONS: These findings support the need to introduce culturally sensitive and linguistically appropriate diabetes education programs for Puerto Ricans and continue system-based diabetes care quality improvement efforts in the areas of prevention and control of cardiovascular complications, adult immunization, and A1C testing.

Adolescent↗

Using focus groups to characterize the health beliefs and practices of black women with non-insulin-dependent diabetes.

The purpose of this focus group intervention was to characterize the health beliefs, self-care practices, diabetes education needs, weight-loss issues, and facilitators and barriers to diabetes health care in black women with non-insulin-dependent diabetes. Major themes that emerged from the focus group were motivation to prevent complications, unrealistic weight goals set by providers, multiple barriers to diet and exercise, and a dual role of family as supporter and deterrent to diabetes management, especially related to diet. These findings suggest that culturally sensitive and appropriate patient educational programs must be provided for minority groups such as black women who have higher rates of diabetes-related complications.

Adult↗

Impact studies in continuing education for health professionals. A critique of the research syntheses.

Documenting impact has been a continual pursuit in continuing education (CE) for health professionals. Hundreds of primary impact studies have been published, along with 16 impact study syntheses that have sought to generalize about the effectiveness of CE and sometimes how and why the effects occur. This article describes and critiques the methodology of the 16 syntheses and summarizes their findings. A first wave of syntheses established a general causal connection between CE and impacts, but explained impact variability only in the dependent variable-knowledge, competence, performance, or outcome. A second wave added a search for causal explanation through analysis of variables that moderate impact. This wave has begun to identify the most appropriate types of programs for promoting performance changes. The article concludes by suggesting questions and methods for future primary studies and meta-analyses, including improved experimental and meta-analytical methods, along with case and naturalistic studies and action research.

Clinical Competence↗

School nurses' experiences, concerns, and knowledge of growth disorders in children: development of a monograph.

Growth disorders may be associated with difficult psychosocial adjustment, learning problems, and specific health risks. Appropriate school health programming relies on school nurses who are skilled in growth assessment, management of psychosocial and behavioral problems, and effective communication with school personnel, children, families, and health care resources. A monograph and model individualized healthcare plans were developed for growth disorders in school-age children as an educational resource for school nurses. Knowledge of growth disorders among nurses receiving the monograph was evaluated in a random sample of 336 school nurses, members of the National Association of School Nurses. Knowledge of growth assessment and individualized health care plans for children with specific growth disorders was significantly higher in the group of school nurses who received the monograph. Specific obstacles to implementing school-based health care for children with growth disorders are discussed.

Adult↗

Fast-track cardiac anesthesia: choice of anesthetic agents and techniques.

Fast-track cardiac anesthesia (FTCA) incorporates early tracheal extubation, decreased length of intensive care unit (ICU) and hospital stay, and (ideally) should avoid or reduce complications to safely achieve cost-savings. A growing body of evidence from randomized trials has identified many anesthetic interventions that can improve outcome after cardiac surgery. These include new short-acting hypnotic, opioid, and neuromuscular blocking drugs. An effective FTCA program requires the appropriate selection of suitable patients, a low-dose opioid anesthetic technique, early tracheal extubation, a short stay in the ICU, and coordinated perioperative care. It is also dependent on the avoidance of postoperative complications such as excessive bleeding, myocardial ischemia, low cardiac output state, arrhythmias, sepsis, and renal failure. These complications will have a much greater adverse effect on hospital length of stay and healthcare costs. A number of clinical trials have identified interventions that can reduce some of these complications. The adoption of effective treatments into clinical practice should improve the effectiveness of FTCA.

Anesthesia↗

The effects of health information in a worksite hypertension screening program.

Two studies assessed the potential impact of health education messages at worksite blood pressure screenings. The messages sought to: motivate hypertensives to enter or return to treatment, motivate normotensives to improve health habits and discourage inappropriate use of blood pressure screening by normotensives. A total of 473 participants in the two studies viewed slide/tape shows about blood pressure and/or health promotion. Individuals with elevated readings at screening viewed either a show containing standard blood pressure information or an experimental show which emphasized the asymptomatic nature of high blood pressure and which described some concrete strategies for coping with high blood pressure. In both studies, individuals with normal readings at screening viewed a standard show or an experimental show which emphasized coping strategies for preventing high blood pressure. In addition, in Study 2, some normotensive individuals viewed one of several experimental shows which focused on health promotion. Results indicate that the experimental programs were significantly more effective than the standard programs in achieving appropriate followup of screening results for both normotensives and hypertensives. Implications for worksite blood pressure screenings are discussed.

Adult↗

Nutritional status of adult Santal men in Keonjhar District, Orissa, India.

BACKGROUND: Although tribal people constitute a sizable proportion of India's population, there is little information on their anthropometric and nutrition status. OBJECTIVE: The present study was undertaken to study the anthropometric characteristics of adult Santal males. It also attempted to evaluate their nutritional status based on body-mass index (BMI) and mid-upper-arm circumference (MUAC). METHODS: A cross-sectional study was conducted of adult (aged > 18 years) male Santals, a tribal population of Keonjhar District, Orissa, India. A total of 332 Santals from five villages (Gourshinga, Kashibera, Kumunia, Majhisahi, and Sonatangri) in the Anandapur Region of Keonjhar District were included in the study. These villages are located approximately 150 km from Bhubaneswar, the provincial capital of Orissa. Anthropometric measurements, including height, weight, and MUAC, were performed according to a standard protocol. Nutritional status was evaluated on the basis of internationally accepted cutoff points of BMI and MUAC. RESULTS: The mean height, weight, MUAC, and BMI of the men were 162.5 cm, 51.7 kg, 23.7 cm, and 19.6 kg/m2, respectively. The prevalence of undernutrition (chronic energy deficiency [CED]) based on BMI was 26.2%; 3.3%, 3.9%, and 19.0% had grades III, II, and I CED, respectively. According to MUAC cutoff points, the prevalence of undernutrition was 33.7%. CONCLUSIONS: The level of undernutrition among adult Santal males was high. Appropriate nutritional intervention programs should be implemented immediately.

Adult↗

Development of the Physical Activity Interactive Recall (PAIR) for Aboriginal children.

BACKGROUND: Aboriginal children in Canada are at increased risk for type 2 diabetes. Given that physical inactivity is an important modifiable risk factor for type 2 diabetes, prevention efforts targeting Aboriginal children include interventions to enhance physical activity involvement. These types of interventions require adequate assessment of physical activity patterns to identify determinants, detect trends, and evaluate progress towards intervention goals. The purpose of this study was to develop a culturally appropriate interactive computer program to self-report physical activity for Kanien'kehá:ka (Mohawk) children that could be administered in a group setting. This was an ancillary study of the ongoing Kahnawake Schools Diabetes Prevention Project (KSDPP). METHODS: During Phase I, focus groups were conducted to understand how children describe and graphically depict type, intensity and duration of physical activity. Sixty-six students (40 girls, 26 boys, mean age = 8.8 years, SD = 1.8) from four elementary schools in three eastern Canadian Kanien'kehá:ka communities participated in 15 focus groups. Children were asked to discuss and draw about physical activity. Content analysis of focus groups informed the development of a school-day and non-school-day version of the physical activity interactive recall (PAIR). In Phase II, pilot-tests were conducted in two waves with 17 and 28 children respectively to assess the content validity of PAIR. Observation, videotaping, and interviews were conducted to obtain children's feedback on PAIR content and format. RESULTS: Children's representations of activity type and activity intensity were used to compile a total of 30 different physical activity and 14 non-physical activity response choices with accompanying intensity options. Findings from the pilot tests revealed that Kanien'kehá:ka children between nine and 13 years old could answer PAIR without assistance. Content validity of PAIR was judged to be adequate. PAIR was judged to be comprehensive, acceptable, and enjoyable by the children. CONCLUSIONS: Results indicate that PAIR may be acceptable to children between nine and 13 years old, with most in this age range able to complete PAIR without assistance. The flexibility of its programming makes PAIR an easily adaptable tool to accommodate diverse populations, different seasons, and changing trends in physical activity involvement.

Journal Article↗

Family planning experiences of Vietnamese women.

The increasing Vietnamese population in the United States and the high fertility rate seen in this group warrant studies about Vietnamese cultural beliefs. The purpose of this qualitative study was to examine sociocultural factors that influence family planning practices of Vietnamese refugee women. Findings reveal that the stresses associated with starting over in a new land, such as concern about finances and learning English, influenced younger Vietnamese women in this study to use family planning methods that would limit the number of future pregnancies. The meaning of children and the importance of their educational future were also influential in determining the number of children desired and family planning practices. Cultural and religious beliefs also directed the women's choice of method. Results from this study can be used to educate health care professionals, increase appropriate educational material for Vietnamese women, and assist in the development of appropriate family planning programs.

Adult↗