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PubMed1997

Implementing family planning programs in developing countries: lessons and reflections from four decades of Population Council experience.

Over the last three decades, contraceptive prevalence has risen from about 10% to nearly 60% in developing countries, but still about 1 in 4 births in developing countries (outside China) is unwanted. More than 120 million women in these countries who do not want to become pregnant do not use contraceptives. Nearly 600,000 women die each year from pregnancy-related causes, between 67,000 and 204,000 of them from unsafe abortions. At the 1994 International Conference on Population and Development in Cairo, delegates endorsed the view long advocated by the Population Council: the primary purpose of family planning programs should be to help women avoid unwanted pregnancy and achieve their fertility goals safely. That means, at the very least, that programs should address those reproductive health issues that are directly related to fertility regulation. To meet the Cairo challenge, progress is needed simultaneously on several levels. We need more and better contraceptive technologies that meet the needs of different groups; higher-quality family planning services; more outreach to underserved groups (such as men and adolescents); programs tailored to local cultures; and measures to address all the factors that prevent women who do not want to become pregnant from using contraceptives. The call for a client-centered, reproductive health approach to family planning constitutes a critique of programs driven by demographic goals. The new family planning paradigm puts a premium on 'quality of care'. Unfortunately, many family planning programs still fall substantially short of offering clients reproductive choice and supporting their reproductive health. The Population Council takes the view that contraceptive research and development is an essential component of a multilevel strategy to reduce unwanted fertility safely. New products, used ethically and provided with quality, would be of tremendous benefit to women and men throughout the world. The Population Council has developed, registered, and licensed seven products, including some of the most widely used contraceptives in the world. The Council is also one of the world centers for research on male reproductive physiology and male contraception. New contraceptive methods are only as good as the context in which they are offered. To accelerate the pace of overall fertility decline, governments must adopt policies that reduce the economic and social risks associated with having smaller families, and policies that promote later and planned childbearing.

Contraception↗
PubMed2003

The Rapamune era of immunosuppression 2003: the journey from the laboratory to clinical transplantation.

The story of Rapamune (sirolimus, rapamycin) began with the isolation of an antibiotic from a soil sample sent to Ayerst Laboratories in Montreal. More than 25 years later, sirolimus was approved for use by transplant physicians in the United States. Development programs for new drugs for transplantation face significant challenges. Four key challenges were critical to the development of sirolimus as a drug for transplantation: First, sirolimus was not intended to be an antirejection agent. Second, sirolimus was not easy to make or purify into a palatable substance for human use and the development of a pharmaceutical form was an important and critical hurdle. Third, sirolimus showed potent antirejection activity when tested in de novo allograft recipients, but the development program required careful attention to its optimal use in multidrug transplant regimens. Fourth, the clinical program approved in the United States was rejected in Europe, and it was only with additional studies and a unique appeal process that sirolimus became available in Europe. Currently, sirolimus (Rapamune) is available throughout most of the world except in Japan, having achieved regulatory approvals in North America, Europe, the Middle East, Latin America, and Asia. Although sirolimus failed in its original role as an antifungal agent, it ultimately succeeded as an antirejection drug. Today, sirolimus holds additional promise both as a drug useful for the prevention of restenosis after coronary angioplasty and as an antitumor agent.

Humans↗
PubMedDate not supplied

Worker safety training in public hospitals in Costa Rica.

To develop a worker safety training program for its public hospital system, the Costa Rican Social Security System entered into a collaborative agreement with the University of Texas School of Public Health. A national survey to assess safety in the public hospitals revealed high rates of injury and under-reporting of injuries, as well a lack of worker safety training. A program developed based on the results of the survey was implemented using a training-of-trainers model. The program created opportunities for human resource development in occupational health in the hospital system, allowed for the sustainability of the training effort, and reduced dependency on external funding. Over 3700 workers were trained in its first three years, and 57 trainers were established in local hospitals and clinics.

Back Injuries↗
PubMed1992

Geriatric care approaches in health maintenance organizations.

The objective of this project was to describe geriatric care provided under Medicare-risk contracts in HMOs with established Medicare programs. These findings provided the basis for an invitational workshop, sponsored by the National Institute on Aging and the Robert Wood Johnson Foundation, to formulate a research agenda for geriatric care in HMOs. The case study method involved site visits to seven HMOs by a physician with expertise in geriatrics, a managed care specialist, and a program development specialist. Representatives from the HMOs included senior executive officials, physicians recognized for providing and promoting geriatric care, research and program development staff, and various clinical staff including pharmacists, geriatric nurse practitioners, nurses, and social workers. The most frequently encountered geriatric care programs were categorized by the following six objectives: (1) identifying high risk patients, (2) assessing multi-problem patients, (3) treating multi-problem patients, (4) rehabilitating patients following acute events, (5) reducing medication problems, and (6) providing long-term care and home health care. Unique programs identified from these site visits included screening methods for new enrollees, approaches to comprehensive geriatric assessment, use of skilled nursing facilities for intensive rehabilitation and postacute care, and drug profiling and review. Utilization of geriatric nurse specialists and programs aimed at coordination with social services were pervasive in many of these HMOs. Workshop participants proposed several research and demonstration projects in all six areas. Overall consensus emerged that HMOs with Medicare-risk contracts provide a valuable setting for experimentation in geriatric care. Given the current health policy emphasis on managed care and capitated payment methodologies, geriatric care research in HMOs should be a high priority.

Geriatric Assessment↗
PubMed2004

The cultural adaptation of prevention interventions: resolving tensions between fidelity and fit.

A dynamic tension has developed in prevention science regarding two imperatives: (a) fidelity of implementation-the delivery of a manualized prevention intervention program as prescribed by the program developer, and (b) program adaptation-the modification of program content to accommodate the needs of a specific consumer group. This paper examines this complex programmatic issue from a community-based participatory research approach for program adaptation that emphasizes motivating community participation to enhance program outcomes. Several issues, key concepts, and implementation strategies are presented under a strategic approach to address issues of fidelity and adaptation. Despite the noted tension between fidelity and adaptation, both are essential elements of prevention intervention program design and they are best addressed by a planned, organized, and systematic approach. Towards this aim, an innovative program design strategy is to develop hybrid prevention programs that "build in" adaptation to enhance program fit while also maximizing fidelity of implementation and program effectiveness.

Adolescent↗
PubMed1989

[The role of allied medical personnel in developing a program of primary medical and sanitary services in the Republic of Afghanistan].

When analyzing the role of paramedical and allied medical staff in the development of programmes of primary medical care in the DRA it is pointed out that not only the problems of disease prevention and treatment should be taken into account but also of the resources necessary for this personnel training. Since the DRA has a low literacy level, it is difficult to enroll students into secondary medical schools. As a result the number of medical school-leavers declines. The Ministry of Public Health of the DRA changed the level of general education sufficient for entering secondary medical schools and set up the programme for raising the rates of training of these specialists. At the modern stage of development the DRA should make a wider use of allied medical staff. Examples of such use are found in child and maternal health, control of communicable diseases, etc.

Afghanistan↗
PubMed2004

Cross-cultural faculty development: initial report of an American/Russian experience.

BACKGROUND: Faculty development programs can improve the teaching skills of medical teachers. We pilot-tested the transportability of an American-based faculty development seminar program to a Russian academic medical center. DESCRIPTION: Four seminars, based on the 7 categories of the Stanford Faculty Development Program model, were presented to 14 teachers at Kazan State Medical University. The seminars included minilectures and reviews of actual videotaped teaching scenario reenactments. Evaluation was performed through participants' self-reported ratings of teaching ability based on a validated pretest-posttest questionnaire. Measurements at both 1 month and 12 months postintervention were completed. EVALUATION: All 14 participants completed the evaluation. At both measured times, statistically significant improvements in the ratings of global teaching performance and specific teaching behaviors were reported. CONCLUSIONS: Our faculty development intervention was successfully transported across medical systems and demonstrated a positive, lasting affect on the teaching skills of a small number of Russian medical teachers.

Adult↗
PubMed2003

Integrating teaching skills and clinical content in a faculty development workshop.

Incorporating clinical content into medical education faculty development programs has been proposed as a strategy to consolidate faculty continuing medical education time and enhance learning. We developed a faculty development program for ambulatory internal medicine preceptors that integrated primary care genetics with ambulatory precepting. The instructional strategies addressed both areas simultaneously and included facilitated discussions, mini-lectures, trigger tapes, and role plays. To evaluate the program, we conducted a pre-post trial. Skills were measured by retrospective pre-post self-reported ratings and behaviors by self-reported implementation of commitment to change (CTC) statements. Participants' (N = 26) ambulatory precepting and primary care genetics skill ratings improved after the intervention. They listed an average of 2.4 clinical teaching CTC statements and 2.0 clinical practice CTC statements. By 3 months after the workshop, preceptors, as a group, fully implemented 32 (38%), partially implemented 35 (41%), and failed to implement 18 (21%) CTC statements. The most common barrier to clinical teaching change was insufficient skills (8 of 25; 32%) and to clinical practice change was lack of a suitable patient (15 of 25; 60%). Integrating clinical content with clinical teaching in a faculty development workshop is feasible, can improve clinical and teaching skills, and can facilitate behavior change.

Curriculum↗
PubMed1982

A systematic approach to faculty development for family practice faculty.

Although faculty developers often employ a systems approach to instruction when responding to individual faculty members' requests for assistance, they are seldom in a position to use this approach to conduct a unified faculty development program for an entire faculty with hundreds of members. This paper describes a two-year faculty development program in family medicine that used a systems approach to meet identified faculty needs through a series of integrated training efforts. Following this systematic framework involved several steps: using a needs assessment to identify faculty needs and preferred learning strategies, selecting instructors from local and national experts to conduct workshops and seminars, evaluating the program by examining participants' gains on the workshop/seminar objectives using a one-group repeated measures design employing self-assessments, and using evaluation results to revise faculty training programs to better meet their needs.

Education, Medical, Graduate↗
PubMedDate not supplied

The development of a patient safety program across the continuum of care.

In keeping with the national emphasis on patient safety, and in keeping with the concept that quality healthcare is not episodic but spans the entire continuum of care, with the patient's home being the "preferred site of care," the Home Operations Utilizing Safety Education Program was developed. This program uses patient assessment, education, and other interventions that adjust the home environment to complement the patient's needs. The assessment and education serve as a link between in-patient, ambulatory care, and the patient's home in a cost-effective and efficient manner for reducing preventable injuries in a predominantly rural setting. The unique aspects of this program include patient follow-up in the home after initial face-to-face interviews/assessments and interventions via a hand-held camera phone. This program was developed as part of our plan to further enhance safety as a cultural norm within our Medical Center.

Accidents, Home↗
PubMed2004

Impact of the Mexican program for education, health, and nutrition (Progresa) on rates of growth and anemia in infants and young children: a randomized effectiveness study.

CONTEXT: Malnutrition causes death and impaired health in millions of children. Existing interventions are effective under controlled conditions; however, little information is available on their effectiveness in large-scale programs. OBJECTIVE: To document the short-term nutritional impact of a large-scale, incentive-based development program in Mexico (Progresa), which included a nutritional component. DESIGN, SETTING, AND PARTICIPANTS: A randomized effectiveness study of 347 communities randomly assigned to immediate incorporation to the program in 1998 (intervention group; n = 205) or to incorporation in 1999 (crossover intervention group; n = 142). A random sample of children in those communities was surveyed at baseline and at 1 and 2 years afterward. Participants were from low-income households in poor rural communities in 6 central Mexican states. Children (N = 650) 12 months of age or younger (n = 373 intervention group; n = 277 crossover intervention group) were included in the analyses. INTERVENTION: Children and pregnant and lactating women in participating households received fortified nutrition supplements, and the families received nutrition education, health care, and cash transfers. MAIN OUTCOME MEASURES: Two-year height increments and anemia rates as measured by blood hemoglobin levels in participating children. RESULTS: Progresa was associated with better growth in height among the poorest and younger infants. Age- and length-adjusted height was greater by 1.1 cm (26.4 cm in the intervention group vs 25.3 cm in the crossover intervention group) among infants younger than 6 months at baseline and who lived in the poorest households. After 1 year, mean hemoglobin values were higher in the intervention group (11.12 g/dL; 95% confidence interval [CI], 10.9-11.3 g/dL) than in the crossover intervention group (10.75 g/dL; 95% CI, 10.5-11.0 g/dL) who had not yet received the benefits of the intervention (P =.01). There were no differences in hemoglobin levels between the 2 groups at year 2 after both groups were receiving the intervention. The age-adjusted rate of anemia (hemoglobin level <11 g/dL) in 1999 was higher in the crossover intervention group than in the intervention group (54.9% vs 44.3%; P =.03), whereas in 2000 the difference was not significant (23.0% vs 25.8%, respectively; P =.40). CONCLUSION: Progresa, a large-scale, incentive-based development program with a nutritional intervention, is associated with better growth and lower rates of anemia in low-income, rural infants and children in Mexico.

Anemia↗
PubMed2004

Educational needs of rural and remote Australian non-specialist medical practitioners for obstetric ultrasound.

OBJECTIVE: To determine the educational needs of rural and remote non-specialist Australian doctors for obstetric ultrasound. DESIGN: Survey design. SETTING: The study surveyed rural and remote doctors practising in a variety of settings including general practice, rural hospitals, Aboriginal communities and flying doctor organisations throughout Australia. SUBJECTS: Subjects included 314 solo and group practice rural general practitioners, rural hospital medical superintendents, senior medical officers, Aboriginal community controlled health service doctors, flying doctors, rural locums, registrars and two rural obstetricians. A total of 55% of the subjects were general practitioners in group practice. Respondents included 68 (22%) women and 246 (78%) men. RESULTS: The response rate was 32%. The highest priority areas of need for education included detecting foetal abnormalities and anomalies (19.1%), basic routine ultrasonography (17.17%), placental position (17.17%), dating (17.17%), foetal viability (12.88%) and morphology scan (12.26%). The main areas where doctors stated they lacked confidence included detecting foetal abnormalities (29.09%), basic routine ultrasonography (including machine use), such as, carrying out and interpreting obstetric ultrasound scans (27.27%), morphology scans (16.36%) and placental position (14.54%). CONCLUSION: The study showed there was a large unmet need for education in obstetric ultrasound among rural and remote non-specialist doctors. Information from the needs assessment was used to develop the Australian College of Rural and Remote Medicine national obstetric ultrasound professional development program. WHAT IS ALREADY KNOWN: The authors could not find any published work on the educational needs of Australian non-specialist rural and remote doctors for obstetric ultrasound. There is research about the outcome of obstetric ultrasound education for urban family physicians in the USA, but no information about rural doctors' educational needs or education outcomes. The study needed to be done so that obstetric ultrasound professional development program of the Australian College of Rural and Remote Medicine could be based on the real needs of the target group. WHAT THIS PAPER ADDS: As a result of this research, there is now information on the educational needs of rural and remote Australian non-specialist medical practitioners that can be used by education providers to develop quality education programs in obstetric ultrasound.

Adult↗
PubMed2002

Evaluation of practical sessions in clinical anatomy: a strategy for educational improvement.

We have evaluated the students' response to the practical teaching sessions in Clinical Anatomy in our Medical School using an action-research method. The aim was to identify problems and to introduce changes that might improve both the program and the performance of the teaching staff. At the end of each section of the program, each student completed a "target type" questionnaire with eight different components. As each one quarter of the whole class had its own teacher, we used an analysis of variance to evaluate the target questions in the various sections of the program, and the performance of the four teachers. This research method gave us feedback on the students' responses while the program was in progress. The results emphasize the importance of action-research in assessing and improving a developing program in a basic discipline of the medical curriculum.

Anatomy↗
PubMed1994

Women in academic dermatology. Results of survey from the professors of dermatology.

BACKGROUND: A survey of the professors of dermatology addressed questions of recruitment and retainment of women in academic dermatology. One hundred thirteen questionnaires were distributed and tabulated anonymously. RESULTS: Most programs selected residents independent of gender. No gender-specific residency problems were identified other than clinical coverage and completion of training related to pregnancy and maternity leave. Less than 50% of departments have faculty development programs in place, though there was considerable support for faculty development programs and modification of tenure track. The number of women faculty was determined for all departmental faculty. Of the total faculty members, 28.1% were women. Of the paid faculty members, 30.7% were women compared with 24.8% of unpaid faculty members. For paid faculty, 10.7% of full professors were women, compared with 34.1% of associate professors and 38.1% of assistant professors. Only two department chairs were identified as women, though five additional women headed divisions. CONCLUSIONS: With regard to residency training, any problems appear to be reflections of anecdotal experience. With regard to faculty, this datum argues for barriers to advancement to positions with administrative responsibility. Strategies for increasing the number of women in senior positions will depend on recognition and encouragement of current women faculty and require a concerted effort to further professional growth and development, to reward academic success, to provide role models and mentors, and to recognize inherent conflicts of professional women.

Dermatology↗
PubMed2002

Using culturally sensitive theories and research to meet the academic needs of low-income African American children.

The economic and social barriers to the academic and social success of many African American children remain in place as the new millennium begins. These realities provide impetus for developing community-based partnership education programs designed to self-empower African American children for academic and social success under any socioeconomic conditions that exist in their lives. Progress toward effective program development, however, has been hindered by a dearth of culturally sensitive theories and research. The Research-Based Model Partnership Education Program (Model Program) is an effective, community-based, university-school-community partnership education program for self-empowering African American children for success. The formative and summative research of the Model Program is described in hopes of advancing theory and research for meeting the academic and social needs of low-income African American children.

Achievement↗
PubMed1980

Method and design issues in evaluation of community health education programs: a case study in breast and cervical cancer.

Systemic evaluation efforts are often neglected in community health education programs due to lack of financial or technical resources. The utility of including program evaluation at an early state in program development and implementation is demonstrated in this case study of a community-wide breast and cervical cancer education program. A number of methodological issues that the health education practitioner should consider in evaluations of community health programs are identified and discussed including: 1) selection of design; 2) establishing controls; 3) determination of sample size; 4) standardization of instruments; 5) selection bias; and 6) participant attrition. Implications for program development are examined.

Adult↗