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PubMed2003

[Perceptions of obesity and management behaviors of obese adolescents and their families in Korea].

PURPOSE: The purpose of this study is to explore the perceptions of obesity and management behaviors of obese adolescents and their families in Korea. METHOD: Nine adolescents with moderate-degree obesity and of four their mothers of them were investigated using semi-structured interviews. RESULT: The perceptions of obesity was classified into four domains and obesity management behaviors was classified into three domains. The domains regarding the perceptions of obesity include definitions of obesity(a danger signal of health status, deviation status, symbols of growth), causes of obesity(out of balance), opinions about their obesity(contempt, negative preconception, superiority) and changes on thought and attitudes owing to obesity(shrinkage, repulsion, sustaining losses, decreased activity, decreased self-confidence, defensive behaviors). The domains regarding obesity management behaviors include attitude about the management of obesity(not having priority, optimistic view, ardent wish), management behaviors for correcting obesity(encouraging physical activity, control of diet, gathering information, trial of diet control), attitudes about performing the management behaviors for correcting obesity(inconsistency, non-autonomy, conflict). CONCLUSION: This study helps to enhance the understanding of the perception of obesity and management behaviors of obese adolescents and their families. Furthermore, based on this understanding, effective and appropriate heath management programs can be planned and conducted.

English Abstract↗
PubMed2004

[Developing and testing the effects of a psychosocial intervention on stress response and coping in Korean breast cancer survivors: a pilot study].

PURPOSE: The purpose of this study was to develop a socioculturally-appropriate psychosocial intervention program for Korean patients with breast cancer and test its effects on stress, anxiety, depression, and coping strategies. METHODS: One group pretest and posttest design was used to test the effects of the intervention. A post-intervention interview was conducted to refine the nature of the intervention. A convenience sample of 10 breast cancer survivors was recruited from the outpatients clinics. Psychosocial intervention was developed to provide the health education, stress management, coping skill training and support weekly (90 min) for 6 weeks. RESULTS: There was a significant decrease in stress scores following the intervention (Z= -2.388, p=0.017). However, no significant changes were noted in the use of problem-focused and emotion-focused coping strategies, nor in the changes of anxiety and depression levels. Content analysis of interview data revealed six clusters; changes in perception, changes in problem solving approaches, changes in anger management, changes in life pattern, social support and reduction of perceived stress. CONCLUSIONS: Based on quantitative and qualitative data, we recommend the refinements of the intervention in the following areas for future studies: 1) duration, activities, and progression of psychosocial intervention; 2) research design and sample size; and 3) measurements.

Adaptation, Psychological↗
PubMed2005

[The effects of fall prevention program on knowledge, self-efficacy, and preventive activity related to fall, and depression of low-income elderly women].

PURPOSE: This research was conducted to determine the effects of a fall prevention program on knowledge, self-efficacy, prevention activity, and depression in the low-income elderly women. METHOD: The design of this study was a nonequivalent control group pretest-posttest design. There were 22 subjects in the experimental group and 22 in the control group. A fall prevention program was performed for approximately 40 minutes, once a week for 6 weeks. RESULTS: The results of this study were as follows: There were statistically significant differences of knowledge, self-efficacy, and prevention activity related to falls and depression between the experimental group and control group. CONCLUSION: In conclusion, the fall prevention program used in this study is appropriate for the elderly, therefore this program is strongly recommended for community-based health and welfare centers.

Accidental Falls↗
PubMed2001

Exercise training in chronic heart failure: why, when and how.

The management of patients with chronic congestive heart failure has changed considerably during the last decade. Until recently, restriction of physical activity was recommended for patients with chronic heart failure. However, the knowledge that training influences largely the periphery rather than the heart itself has led to a dramatic change in the approach toward training in patients with chronic heart failure. Why to train patients with chronic heart failure: Training increases exercise tolerance by an average of 20% in chronic heart failure regardless of etiology (ischemic or non-ischemic cardiomyopathy) or severity of left ventricular dysfunction. Available data, while limited, demonstrate that increases in exercise capacity are paralleled by an improvement in quality of life. Studies have consistently demonstrated that training has no deleterious effect on central haemodynamics, left ventricular remodeling, systolic or diastolic function, or myocardial metabolism. At present, there are insufficient data to determine the effect of training on prognosis, but trials are currently underway to address this. When to train patients with chronic heart failure: Exercise training should be performed only with the patients that have been in a stable clinical condition for a period of at least 3-4 weeks. Clinical stability is defined as no change in symptoms, weight, drug regimen, or NYHA class over this period. How to train patients with chronic heart failure: Initially, the program should be supervised for a period of 2 to 4 weeks; home-based programs are usually appropriate thereafter. Activities that can be maintained for a lifetime should be encouraged, and the focus should be on aerobic-type activities. The intensity level should be targeted to about 50%-70% of peak VO2 and/or Borg ratings of 12-14 ("walk and talk").

Diastole↗
PubMed1993

Discriminative versus evaluative assessment: some observations on goal attainment scaling.

Goal attainment scaling has been described in the rehabilitation literature as a method of evaluation designed to monitor client progress, structure team conferences, and provide information on overall program evaluation. The appropriate use of goal attainment scaling in clinical environments depends on a clear understanding of its strengths and weaknesses. The primary strength of goal attainment scaling is the ability to evaluate individualized longitudinal change. Goal attainment scaling is not a methodology designed to assess functional status. Confusion occurs when evaluation tools designed to discriminate between persons (determine status) are used to assess change in individual patients over time. This paper describes the strengths and weaknesses of goal attainment scaling as a methodology for evaluating clinical change. The process of evaluative assessment with goal attainment scaling is compared to discriminative assessment where the purpose is to distinguish between persons or to classify persons into predefined categories.

Documentation↗
PubMed1994

Predicting outcome in high-risk newborns with a neonatal neurobehavioral assessment.

OBJECTIVES: Effective medical management and rehabilitation efforts in neonates at risk depend on early identification of underlying brain injury. The aim of this study was to determine the prognostic value of the Einstein Neonatal Neurobehavioral Assessment Scale (ENNAS) in high-risk neonates, and to compare its predictive validity at two stages in development (i.e., 1 and 3 years of age). METHOD: Twenty-three healthy neonates (control group) and 51 high-risk neonates (high-risk group) were assessed at term and were followed longitudinally. At 1 and 3 years, subjects in both groups were evaluated in a blind fashion by a psychologist and a pediatric neurologist. RESULTS: Developmental delays became more apparent as high-risk newborns matured; the percentage of subjects with an abnormal Griffiths general quotient increased from 1 year (13.7%) to 3 years (39%). Analysis revealed that a normal neonatal performance on the ENNAS in high-risk subjects accurately predicted a favorable outcome at 1 year and 3 years of age. Although an abnormal ENNAS was not consistently associated with a poor outcome, the positive predictive value improved markedly from 1 year to 3 years of age. CONCLUSION: The findings indicate that a normal neonatal neurobehavioral assessment is reassuring, as most of these children are free of neurodevelopmental sequelae at 3 years of age. For many persons, the ENNAS may provide early evidence of a pattern of brain injury that is manifested only as the child is challenged by more complex skill acquisition such as language, memory, and perceptual-motor tasks. The ability of this assessment to predict behavioral and academic skills at school age remains to be determined. Early identification of developmental deficits enables occupational therapists to direct infants to appropriate early intervention programs, thus optimizing their functional potential.

Brain Damage, Chronic↗
PubMedDate not supplied

A randomised controlled trial testing the impact of exercise on cognitive symptoms and disability of residents with dementia.

A randomized controlled trial was undertaken to measure effects of exercise on: 1) the progression of cognitive symptoms related to dementia using the Clock- Drawing test Shulman et al. 1993); and 2) disability using the Revised Elderly Persons Disabilities Scale (REPDS; Fleming and Bowles 1993). Data was analysed from 75 nursing home residents with dementia who were randomly assigned to one experimental group and two control groups. Group 1 (control) received no intervention, Group 2 (control) received a social visit equivalent in duration and frequency as those undertaking the exercise program in the experimental group, Group 3. A specifically designed, frail aged appropriate, twelve week exercise program was undertaken by the those in the experimental group three times per week, each session lasted for thirty minutes. The findings from: 1) the clock drawing test showed that exercise may slow the rate of progression of the cognitive symptoms related to dementia; and 2) the REPDS showed that exercise slowed and reversed disability in some of the activities of daily living.

Activities of Daily Living↗
PubMed2001

Differing influences on Aboriginal and non-Aboriginal neonatal phenotypes: a prospective study.

OBJECTIVE: To understand the differences, if any, in major influences on birth phenotype between Aboriginal and non-Aboriginal neonates. DESIGN: Prospective study of a cohort of pregnant Aboriginal women presenting for antenatal care before 20 weeks' gestation (ultrasound proven), and a reference cohort of pregnant non-Aboriginal women. Comparison of the phenotypic and demographic characteristics of the women, their pregnancies and their babies. PARTICIPANTS: 96 Aboriginal and 96 non-Aboriginal women with no known medical factors affecting fetal growth or gestation. SETTING: Four remote far north Queensland communities served by the Far North Regional Obstetric and Gynaecological Service (FROGS) and the antenatal clinic at Cairns Base Hospital. MAIN OUTCOME MEASURES: Neonatal birth weight, length, head circumference, abdominal circumference, mid-arm circumference and triceps skinfold thickness, and derived ponderal index (weight/length3), head:abdomen circumference ratio and head:mid-arm circumference ratio. RESULTS: The Aboriginal neonates were on average almost 450 g lighter than their non-Aboriginal counterparts. They were also slightly shorter, with smaller head, abdomen and mid-arm circumferences and lower mean ponderal indices and triceps skinfold thickness. The gestational characteristics of the two groups were not significantly different. Neonatal phenotype was significantly associated with maternal body mass index and maternal age in both groups. Alcohol use in pregnancy was associated with a significant reduction in Aboriginal neonatal size, while tobacco use was significantly associated with size reductions in non-Aboriginal babies. CONCLUSIONS: Culturally appropriate antenatal care programs targeting the effects of poor nutrition and excessive alcohol use are needed if the excess incidence of low birthweight in Aboriginal people is to be reduced.

Adult↗
PubMed1993

Prostate cancer: screening, diagnosis, and management.

OBJECTIVE: To provide physicians with a review of diagnosis, screening, staging evaluation, treatment options, prognosis, psychosocial issues, economic considerations, and future research directions in the management of patients with all stages of prostate cancer. DATA SOURCES: A MEDLINE search of articles relating to the diagnosis, staging, screening, surgery, radiation therapy, medical management, and research in prostate cancer. Emphasis on information reported from government- and nongovernment-sponsored large cooperative trials, consensus development conferences, and proceedings of prostate cancer organ site workshops. STUDY SELECTION: Results of randomized treatment trials and consensus summary statements are reported where long-term results (> 5 years follow-up) are available for localized prostate cancer treatment and where survival outcomes are available for metastatic disease treatment. DATA SYNTHESIS: Both qualitative and quantitative data are reported. Information on staging, management, and prognosis of localized prostate cancer is based on studies that are predominantly nonrandomized, include heterogeneous patient groups, and often use differing outcome measures. Information on management of metastatic prostate cancer is more quantitative and includes side effects of treatment and survival results obtained from randomized, prospective, multi-institutional studies. CONCLUSIONS: Despite the increase in prostate cancer incidence and detection, substantial controversy still exists about the advisability and effectiveness of screening programs, the most appropriate staging evaluation, and the optimal management of patients with all stages of prostate cancer. Although randomized, prospective studies attempt to address some of these issues, physicians must appreciate inherent ambiguities involved in recommending staging and treatment choices.

Humans↗
PubMed1997

Government antifraud efforts intensify.

"Business as usual" is going by the wayside as new legislation strengthens penalties for fraud and abuse of federal healthcare contracts. Five experts warn of the consequences and emphasize the need for compliance programs to ensure appropriate billing decisions.

American Hospital Association↗
PubMed1987

Surgical manpower worldwide.

The essentials of manpower control are planning, production, and management. All countries need to control medical manpower in general and surgical manpower in particular, using both governmental and professional expertise and information. In many parts of the world, there is no health care whatever, in contrast to the abundance and often excess of health care personnel in western societies. This situation creates an unacceptable social imbalance. There is widespread imbalance of surgical manpower between urban and rural areas, and this imbalance is even more marked in developing countries. Manpower affects surgical training in many ways. The ideal is a well-structured program of training appropriate to the environment in which the surgeon will work. Finally, a considerable amount of surgery world-wide is still performed by unqualified surgeons, particularly in third world countries. The third world problem needs to be addressed by such health agencies as the World Health Organization.

Data Collection↗
PubMed1999

Treatment of shoulder deformity in acquired spasticity.

Cerebrovascular accidents and traumatic brain injury produce most of the deformities seen in patients with spastic imbalance of the shoulder. A general awareness of the global neurologic defect is required to understand appropriate treatment alternatives. Conservative treatment techniques include early initiation of therapy exercises. Muscle or nerve block treatments may prevent severe shoulder contractures. Diagnostic blocks may help differentiate between deformity caused by spasticity and that caused by fixed soft tissue contracture. Operative release procedures are described. These operations, when combined with appropriate postoperative therapy programs, permit correction of contractures caused by unbalanced muscle forces around the shoulder in patients with severe spasticity who do not respond to conservative care.

Contracture↗
PubMed1999

After-school programs for low-income children: promise and challenges.

Children's out-of-school time, long a low-level source of public concern, has recently emerged as a major social issue. This, in turn, has heightened interest in the heterogeneous field of after-school programs. This article provides a profile of after-school programs for low-income children, focusing on supply and demand, program emphases, and program sponsors and support organizations. It also discusses the major challenges facing the field in the areas of facilities, staffing, and financing. Details and examples are drawn from the ongoing evaluation of a specific after-school program initiative called MOST (Making the Most of Out-of-School Time), which seeks to strengthen after-school programs in Boston, Chicago, and Seattle. Looking ahead, the article highlights the pros and cons of options for increasing coverage to reach more low-income children, strengthening programs, expanding funding, and articulating an appropriate role for after-school programs to fill in the lives of low-income children.

Child↗
PubMed2000

Transmission of tuberculosis in an endemic urban setting in Brazil.

SETTING: Two out-patient facilities in São Paulo, Brazil. OBJECTIVE: To study the transmission pattern of tuberculosis (TB) among human immunodeficiency virus (HIV) infected and uninfected persons in a setting endemic for TB. DESIGN: A prospective study comparing HIV-seropositive and -seronegative TB patients identified consecutively between 1 March 1995 and 1 April 1997. The patients were stratified according to their Mycobacterium tuberculosis isolate IS6110 RFLP patterns. Risk factors were sought for infection with an RFLP cluster pattern strain, inferred to represent recent transmission. RESULTS: Fifty-eight (38%) of 151 HIV-seropositive patients and 36 (25%) of 142 HIV-seronegative patients were infected with M. tuberculosis isolates that belonged to cluster patterns (OR 1.84, 95% CI 1.08-3.13). Multidrug-resistant (MDR) strains were isolated from 19 patients, all of whom were HIV seropositive; 12 (63%) of these, and 46 (35%) of 132 drug-susceptible isolates had cluster patterns (OR 3.20, 95% CI 1.08-9.77). CONCLUSION: In a TB-endemic urban setting in Brazil, the proportion of cases resulting from recent transmission appears to be greater among HIV-seropositive than among HIV-seronegative patients. A large proportion of MDR-TB (63%) cases was caused by strains that had cluster RFLP patterns, suggesting recent transmission of already resistant organisms. This type of knowledge regarding TB transmission may help to improve locally appropriate TB control programs.

AIDS-Related Opportunistic Infections↗
PubMed2000

Health care professionals' attitudes toward licensure, national certification, and continuing education requirements: results of a Texas survey.

Health care professionals are challenged to not only maintain their skills but take them to new levels. Continuing education (CE), mandated by licensure and national certification, is one means of working toward this goal. This study examined the opinions and attitudes of professionals in regard to these issues. The majority of the survey respondents supported the need for licensure and certification and perceived that they benefited personally. A significant percentage indicated that existing CE systems might not meet their intended purposes and goals and might not be the best criteria for renewal. Many had difficulty finding appropriate and convenient programs, and some programs did not deliver as advertised. The results suggest an opportunity to improve both CE systems and CE programs offered to health care professionals.

Attitude of Health Personnel↗
PubMed2000

Ensuring that forensic psychiatry thrives as a medical specialty in the 21st century.

The author contends that forensic psychiatry will thrive as a legitimate medical specialty in the 21st century only if it helps to fulfill the crucial requirement of medical systems in the new health care era. The article presents six basic requirements of future medical systems: effective, efficient, and responsible organizations; quality educational programs of the appropriate type and size; linkage to health care networks; primary care capacity and services; restructured systems for research; and effective leadership. Specific opportunities for forensic psychiatry to help meet these requirements are outlined. The author presents major implications of these opportunities for forensic academicians and practitioners as well as for the American Academy of Psychiatry and the Law.

Forecasting↗
PubMed2000

The effect of continuous quality improvement on compliance with clinical practice guidelines in an optometric clinic: a retrospective review.

BACKGROUND: Quantitative documentation of quality is becoming increasingly more important. The SUNY State College of Optometry established clinical protocols outlining clinical standards for patient care. We compared documentation of actual clinical performance to these standards. METHODS: The Primary Care Service's Quality Management Team retrospectively reviews a random 10% sample of charts of patients seen in the teaching clinic of the SUNY State College of Optometry on an ongoing basis. They compare the care documented in the medical record to internally distributed clinical protocols. We reviewed the resultant data from January 1995 through June 1997 by analyzing the number of indicators that were out of compliance for each month. Then we graphed these data to ascertain trends and variability to determine what effect this continuous quality improvement process had on clinical care as measured by compliance with clinical protocols. RESULTS: A least-squares regression analysis demonstrated a correlation (0.717) between the decreasing number of items out of compliance and the time during which feedback was provided (r2 = 0.5143, p = 0.0001). These data show a distinct downward trend, indicating better compliance with the clinical protocols over time. We also found that the variability of the data decreased during the time period studied. CONCLUSIONS: A properly designed continuous quality improvement program that gives appropriate feedback to faculty optometrists and student interns measurably increased their compliance with--and decreased their variability from--this clinic's internally distributed clinical protocols over a 30-month time period.

Clinical Competence↗