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PubMed1982

Treatment of correctional center inmates at a public health department: a cooperative venture.

Minimum security correctional institutions in North Carolina are small units with no in-house dental facilities. Dental care for inmates of these institutions traditionally has been provided at larger correctional institutions each of which is responsible for the dental treatment of inmates of many smaller units. Services provided are therefore necessarily limited. This paper describes and evaluates an innovative program designed to provide high quality, cost-effective dental care for minimum security correctional center inmates at a nearby county health department clinic. The program is a cooperative effort sponsored by the North Carolina Department of Corrections, the University of North Carolina School of Dentistry, and the Orange County (N.C.) Health Department and is funded in part by a grant from the Robert Wood Johnson Foundation.

Adult↗
PubMed1984

The role of CPE in medical education.

Describes a program designed to aid medical students relate more empathically to patients and their families. Outlines the content of sessions, notes resistances and attitudes toward the program, and offers an anecdotal evaluation of the educational project.

Chaplaincy Service, Hospital↗
PubMedDate not supplied

Ambivalence and pregnancy: adolescents' attitudes, contraceptive use and pregnancy.

CONTEXT: It is often argued that adolescents who become pregnant do not sufficiently appreciate the negative consequences, and that prevention programs should target participants' attitudes toward pregnancy. METHODS: Data from the first two waves of the National Longitudinal Study of Adolescent Health were used to examine whether 15-19-year-old females' attitudes toward pregnancy influence their contraceptive consistency and their risk of pregnancy. Characteristics and attitudes associated with pregnancy and contraceptive use were assessed using bivariate and multivariate analysis. RESULTS: Twenty percent of female adolescents were defined as having antipregnancy attitudes, 8% as having propregnancy attitudes and 14% as being ambivalent toward pregnancy; the remainder were considered to have mainstream attitudes. Among sexually experienced adolescents, having an attitude toward pregnancy was not associated with risk of pregnancy. However, those who were ambivalent about pregnancy had reduced odds of using contraceptives consistently and inconsistently rather than not practicing contraception at all (odds ratios, 0.5 and 0.4, respectively). Antipregnancy respondents did not differ from proprepregancy respondents in terms of their contraceptive consistency. However, having a positive attitude toward contraception was associated with increased likelihood of inconsistent and consistent contraceptive use compared with nonuse (1.6 and 2.1, respectively). CONCLUSIONS: Programs designed to prevent pregnancy need to give young women information about pregnancy and opportunities to discuss the topic so that they form opinions. Furthermore, programs should emphasize positive attitudes toward contraception, because effective contraceptive use is shaped by such attitudes and is strongly associated with reduction of pregnancy risk.

Adolescent↗
PubMed2005

Comprehensive primary care for children with special health care needs in rural areas.

OBJECTIVE: Most research on comprehensive primary care interventions for children with chronic health conditions has been conducted in large urban areas, where child health and related services are readily available. The purpose of this study was to evaluate the feasibility and impact of a medical home demonstration project in a more rural part of the country. METHODS: Fifty-one parents of children with special health care needs participated in a pre-/posttreatment assessment of a program designed to enhance comprehensive and coordinated care. Participants were recruited from 3 primary care practices in a central Midwest state and remained in the program for approximately 12 months. RESULTS: Parents reported significant increases in satisfaction with care coordination and access to mental health services after the intervention. They also noted decreases in family needs, caregiver strain, parents' missed work days, children's school absences, and utilization of ambulatory services. Satisfaction with primary care declined slightly but remained in the "very good" range. Families of children with more complex conditions were more likely to report a decrease in needs after intervention, but other factors, such as geographic location or socioeconomic status, were not related to key outcome variables. CONCLUSIONS: Comprehensive care has a positive effect on children with chronic health conditions and their families, including those who live in more rural areas. Additional study is needed to learn more about rural service delivery strategies that promote implementation of this approach in general practice.

Adolescent↗
PubMed1974

Effects of contingency contracting on study rate and test performance.

A contingency contracting program designed to increase study rate and subsequent test performance was implemented with a group of undergraduate psychology students. The function of the contingency contracting program in producing increased study rate was evaluated by individual experiments with each student in an experimental contracting group. The overall effect of the program on test performance was assessed by comparing the final scores for the course earned by the experimental group with those earned by two matched control groups. A reversal procedure established that contingency contracting did significantly increase the study rate of students of a wide range of ability. However, it was selectively effective in improving the test performance of below-average students only. Study rate gains in contracted courses did not generalize to noncontracted courses. Self-recording of study time in the absence of scheduled differential consequences did not improve test performance. Study rate under no-consequence conditions varied with test schedule. For both consequence and no-consequence groups, the correlation between study time and final score for the course was only moderate.

Achievement↗
PubMed1978

Smoking education programs 1960-1976.

This paper is a review of published reports, in English, of educational programs designed to change smoking behavior. Attempts to change the smoking behavior of young people have included anti-smoking campaigns, youth-to-youth programs, and a variety of message themes and teaching methods. Instruction has been presented both by teachers who were committed or persuasive and by teachers who were neutral or presented both sides of the issue. Didactic teaching, group discussion, individual study, peer instruction, and mass media have been employed. Health effects of smoking, both short- and long-term effects, have been emphasized. Most methods used with youth have shown little success. Studies of other methods have produced contradictory results. Educational programs for adults have included large scale anti-smoking campaigns, smoking cessation clinics, and a variety of more specific withdrawal methods. These methods have included individual counseling, emotional role playing, aversive conditioning, desensitization, and specific techniques to reduce the likelihood that smoking will occur in situations previously associated with smoking. Some of these techniques have produced poor results while studies of other methods have shown inconsistent results. The two methods showing the most promise are individual counseling and smoking withdrawal clinics.

Adolescent↗
PubMedDate not supplied

Social support in worksite smoking cessation: qualitative analysis of the EASE project.

PURPOSE: Mobilize and study social support in EASE, a worksite smoking cessation program. DESIGN: Qualitative study of social support in two pilot and two test worksites. SETTING: Collaboration with American Lung Association of eastern Missouri to implement program in 12 companies between 1982 and 1985. SUBJECTS: Ninety-eight participants in cessation clinics at pilot and test sites and 350 randomly sampled respondents from among all 877 employees at test sites. INTERVENTION: Steering committees included representatives of management and line employees and tailored the program from plans and materials for program promotion, self-help manuals, and a standard curriculum for a Group Comprehensive Clinic. MEASURES: Implementation and participation from project records. Outcomes and perceptions of social support from surveys of employees. RESULTS: Twelve to 24 months after program initiation, smoking cessation among active participants ranged from 21% to 41%. Consistent with emphasis on promoting support for quitting throughout the worksite, 10% to 25% of nonparticipants were abstinent at follow-ups, exceeding national base rates. Surveys indicated greater importance of social support than of program's procedures or materials and greater benefits of social ties to nonsmokers than to others attempting to quit. Differences among companies in both reported social support for nonsmoking and cessation rates paralleled differences in Steering Committees' activities and organizational support for the program. CONCLUSION: Though limited by lack of experimental controls, this qualitative study of active program participants as well as random samples of all employees indicates social support can be a strength of worksite smoking cessation programs.

Forecasting↗
PubMed2003

Utilisation of outpatient cardiac rehabilitation in Queensland.

OBJECTIVES: To determine patient participation rates in outpatient cardiac rehabilitation (OCR) programs; ascertain the barriers to participation; and evaluate the quality of OCR programs. DESIGN AND SETTING: Retrospective cohort study of patient separations from selected public and private Queensland hospitals; questionnaire survey of hospitals and all registered OCR programs. PARTICIPANTS: Patients discharged with cardiac diagnoses between 1 July 1999 and 30 June 2000 from 31 hospitals (24 public; 7 private). MAIN OUTCOME MEASURES: Rates of referral of hospitalised patients to OCR programs; rates of program attendance and completion; barriers to OCR referral and attendance. RESULTS: 15 186 patients were discharged with cardiac diagnoses from participating hospitals, of whom 4346 (29%) were referred to an OCR program after discharge, compared with an estimated 59% (8895/15 186) of patients who were eligible for such a program. Proportionately more patients were referred from secondary (38% [1720/4500]) and private (52% [2116/4031]; P < 0.001) hospitals than from tertiary (25% [2626/10 686]) and public (20% [2230/11 155]) hospitals. Patients undergoing coronary revascularisation procedures comprised 35% of discharges, but accounted for 56% of all program attendances. Fewer than a third of all referred patients completed OCR programs, and only 39% of available OCR program places were fully utilised. Catchment populations of programs with unused places had excess coronary mortality. CONCLUSION: There is significant underutilisation of facility-based OCR programs in Queensland. Procedures are required for identifying and referring eligible patients to existing programs and improving program compliance. Alternative OCR models are also required.

Aged↗
PubMed2005

Sustaining remote-area programs: retinal camera use by Aboriginal health workers and nurses in a Kimberley partnership.

OBJECTIVE: To describe how a novel program of diabetic retinopathy screening was conceived, refined and sustained in a remote region over 10 years, and to evaluate its activities and outcomes. DESIGN: Program description; analysis of regional screening database; audit of electronic client registers of Aboriginal community controlled health services (ACCHSs). SETTING AND PARTICIPANTS: 1318 Aboriginal and 271 non-Aboriginal individuals who underwent retinal screening in the 5 years to September 2004 in the Kimberley region of north-west Australia; 11 758 regular local Aboriginal clients of Kimberley ACCHSs as at January 2005. MAIN OUTCOME MEASURES: Characteristics of clients and camera operators, prevalence of retinopathy, photograph quality, screening intervals and coverage. RESULTS: Among Aboriginal clients, 21% had diabetic retinopathy: 19% with non-proliferative retinopathy, 1.2% with proliferative retinopathy, and 2.8% with maculopathy. Corresponding figures for non-Aboriginal clients were 11%, 11%, 0 and 0.4%, respectively. Photograph quality was generally high, and better for non-Aboriginal clients, younger Aboriginal clients and from 2002 (when mydriatic use became universal). Quality was not related to operator qualifications, certification or experience. Of 718 regular Aboriginal clients with diabetes on local ACCHS databases, 48% had a record of retinal screening within the previous 18 months, and 65% within the previous 30 months. CONCLUSIONS: Screening for diabetic retinopathy performed locally by Aboriginal health workers and nurses with fundus cameras can be successfully sustained with regional support. Formal certification appears unnecessary. Data sharing across services, client recall and point-of-care prompts generated by electronic information systems, together with policies making primary care providers responsible for care coordination, support appropriate timely screening.

Aged↗
PubMed2001

One-year follow-up evaluation of the sexually transmitted diseases/human immunodeficiency virus intervention program in a marine corps sample.

Although a substantial number of studies have been conducted to evaluate the impact of various human immunodeficiency virus (HIV) prevention programs, most of them have focused on civilian populations. There is a clear need to develop and evaluate sexually transmitted diseases (STD)/HIV prevention programs designed specifically for U.S. military populations. The objective of the present study was to determine whether a behavioral intervention known as the STD/HIV Intervention Program (SHIP) would have a sustained positive impact on the behavior of a sample of Marines. A 1-year follow-up telephone interview was administered to (1) Marines who participated in the SHIP course (intervention group), and (2) a quasi-control group of Marines who were not exposed to the SHIP course. The intervention and control groups differed significantly in the percentage of the time they had used condoms during the past year. The intervention participants reported using condoms a greater percentage of the time than the nonparticipants.

Adult↗
PubMedDate not supplied

Outcomes of a genetics education program for nursing faculty.

A multifaceted educational program designed to teach nursing faculty about genetics was first offered in 1997 and subsequently repeated on an annual basis. The specific aims of the program were to: 1) increase nursing faculty knowledge about genetics and its clinical application, and 2) increase genetics content taught in entry-level nursing education programs. The major components of the program included an annual Genetics Summer Institute (GSI), pre-planned follow-up strategies, and continuing education offerings. Measured outcomes included significant improvement in nursing faculty genetics knowledge and increased amounts of genetics content in their curricula. The majority of surveyed faculty focused curriculum change efforts on lectures or courses for which they were personally responsible. Thirty-one percent were working on, or had developed, elective nursing genetics courses after attending a GSI. These findings indicate that this program provided the necessary foundational instruction and resources to enable nursing faculty participants to bring about change in their curricula.

Curriculum↗
PubMedDate not supplied

Teaching infant resuscitation skills to mothers.

This paper describes the evaluation of a program designed to teach basic infant resuscitation skills to mothers during the period of postnatal hospitalization. Data collected from participants before and immediately after the program, and at six months, follow-up indicated that knowledge of resuscitation techniques had moderately improved, however there was a substantial increase in participants' confidence and an associated reduction in anxiety. An additional aspect of the evaluation was to identify any logistical problems; data obtained from postnatal midwifery staff indicated none were evident. It was concluded that the Infant Resuscitation Education Program should be implemented for all mothers of newborn infants.

Female↗
PubMedDate not supplied

Child sexual abuse prevention: does it work?

Child sexual abuse prevention programs designed to teach children ways to recognize, resist, and report sexual abuse have proliferated in the past five years. The authors evaluate one such program to find out what children know before instruction, if they learn how to prevent sexual abuse, and how they and their parents and professionals who work with children react to such a program.

Child↗
PubMed1984

Effects of a weight-control promotion program on parents' responses to family eating situations.

The purpose of this research was to evaluate an education intervention program designed to prevent weight problems in children by encouraging family changes in food selection, eating habits, and activity levels. The Preschool Eating Patterns (PEP) Program worked with parents, teaching procedures of reinforcement and extinction to encourage or discourage various practices. Thirty-six families participating in the PEP program served as the experimental group and 11 families as a comparison group. The program was evaluated by assessing parents' verbalizations and behaviors relevant to their children's eating patterns. The results suggest that the PEP program is a promising education intervention leading to more constructive parental responses to family eating situations, but further investigations are necessary to determine whether the program is truly preventive of future overweight.

Adult↗
PubMed1980

Coronary heart disease: an expensive Air Force problem.

Death or disability from CHD is a major public health problem that costs the Air Force about $50 million annually. Statistically, 20% of 30,000 pilots in the Air Force could have a significant degree of coronary atherosclerosis. In-flight incapacitation due to "heart attack" is a real possibility. Fortunately, aircraft accidents related to coronary events have been very uncommon. The basic mechanisms leading to the development of CHD, a multifactorial condition, are not fully understood. The significance of various risk factors associated with an increased incidence of CHD are discussed. It is hoped that preventive programs designed to identify, educate, and treat those at high risk will reduce the incidence of premature death and disability due to CHD. Two such programs (HEW's MRFIT and USAF's HEART) are briefly described. The costs, benefits, risks, sensitivity, and predictive value of tests available to detect CHD in asymptomatic individuals are outlined.

Adult↗
PubMed1996

Measuring the effectiveness of a pilot continuing medical education program.

OBJECTIVE: To evaluate a learner-centred, small group CME program intended to improve the clinical performance of family physicians identified as having serious practice deficiencies by the University of Manitoba's Clinical Assessment and Enhancement Program. DESIGN: Nonrandomized control trial in which data were collected from patients' charts and physician performance was evaluated. Differences in subjects' scores were tested at program entry and at 6 months and 18 months later using a two-way analysis of variance. SETTING: Family medicine practices in Manitoba. PARTICIPANTS: Fifteen family physicians: five study subjects and 10 control subjects. The five study subjects were identified as needing CME to improve their clinical performance. The 10 control subjects were randomly selected. INTERVENTIONS: Participants attended a 10-session, learner-centred, small group CME program. MAIN OUTCOME MEASURES: Clinical care, preventive care, charting, and the use of drugs were the variables assessed. RESULTS: Study subjects' initial scores were much lower than those of controls, but improved significantly during the CME program. CONCLUSION: A learner-centred, small group CME program can improve clinical performance.

Analysis of Variance↗
PubMed2004

An intervention to reduce television viewing by preschool children.

BACKGROUND: Television viewing has been associated with increased violence in play and higher rates of obesity. Although there are interventions to reduce television viewing by school-aged children, there are none for younger children. OBJECTIVE: To develop and evaluate an intervention to reduce television viewing by preschool children. DESIGN: Randomized controlled trial conducted in 16 preschool and/or day care centers in rural upstate New York. PATIENTS: Children aged 2.6 through 5.5 years. INTERVENTION: Children attending intervention centers received a 7-session program designed to reduce television viewing as part of a health promotion curriculum, whereas children attending the control centers received a safety and injury prevention program. OUTCOME MEASUREMENTS: Change in parent-reported child television/video viewing and measured growth variables. RESULTS: Before the intervention, the intervention and control groups viewed 11.9 and 14.0 h/wk of television/videos, respectively. Afterward, children in the intervention group decreased their television/video viewing 3.1 h/wk, whereas children in the control group increased their viewing by 1.6 h/wk, for an adjusted difference between the groups of -4.7 h/wk (95% confidence interval, -8.4 to -1.0 h/wk; P =.02). The percentage of children watching television/videos more than 2 h/d also decreased significantly from 33% to 18% among the intervention group, compared with an increase of 41% to 47% among the control group, for a difference of -21.5% (95% confidence interval, -42.5% to -0.5%; P =.046). There were no statistically significant differences in children's growth between groups. CONCLUSIONS: This study is the first to show that a preschool-based intervention can lead to reductions in young children's television/video viewing. Further research is needed to determine the long-term effects associated with reductions in young children's television viewing.

Analysis of Variance↗
PubMed2005

Effect of the self-monitoring approach on exercise maintenance during cardiac rehabilitation: a randomized, controlled trial.

OBJECTIVE: To evaluate the effect of the self-monitoring approach (SMA) on self-efficacy for physical activity (SEPA), exercise maintenance, and objective physical activity level over a 6-mo period after a supervised 6-mo cardiac rehabilitation (CR) program. DESIGN: We conducted a randomized, controlled trial with 45 myocardial infarction patients (38 men, seven women; mean age, 64.2 yrs) recruited after completion of an acute-phase, exercise-based CR program. Patients were randomly assigned to an SMA group (n = 24) or control group (n = 21). Along with CR, the subjects in the SMA group self-monitored their weight and physical activity for 6 mos. The SMA used in this study was based on Bandura's self-efficacy theory and was designed to enhance confidence for exercise maintenance. The control group participated in CR only. All patients were evaluated with the SEPA assessment tool. Exercise maintenance, SEPA scores, and objective physical activity (average steps per week) as a caloric expenditure were assessed at baseline and during a 6-mo period after the supervised CR program. RESULTS: Mean period from myocardial infarction onset did not differ significantly between the SMA and control groups (12.1 +/- 1.3 vs. 12.2 +/- 1.2 mos, P = 0.692). All patients maintained their exercise routine in the SMA group. Mean SEPA score (90.5 vs. 72.7 points, P < 0.001) and mean objective physical activity (10,458.7 vs. 6922.5 steps/wk, P < 0.001) at 12 mos after myocardial infarction onset were significantly higher in the SMA than control group. SEPA showed significant positive correlation with objective physical activity (r = 0.642, P < 0.001). CONCLUSIONS: SMA during supervised CR may effectively increase exercise maintenance, SEPA, and objective physical activity at 12 mos after myocardial infarction onset.

Analysis of Variance↗