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PubMed1997

SEALS: a system for easy analysis of lots of sequences.

We present a system of programs designed to facilitate sequence analysis projects involving large amounts of data. SEALS (System for Easy Analysis of Lots of Sequences) is a logically organized set of flexible, easily modifiable research tools, designed to run on open systems. Functionality is divided into approximately 50 commands which follow consistent syntax and semantics; wrappers are also provided for commonly used sequence analysis software to effect similar syntax for these programs. SEALS includes software for retrieving sequence information, scripting database search tools such as BLAST and MoST, viewing and analyzing search outputs, searching in and processing nucleotide and protein sequences using regular expressions, and constructing rational predictions of protein features. The system is designed to provide modular elements which can be combined, modified, and integrated with other methods in order to quickly design and execute computer experiments for sequence analysis projects at the scale of whole genomes.

Artificial Intelligence↗
PubMed2004

Implementing the new guidelines for hypertension: JNC 7, ADA, WHO-ISH.

BACKGROUND: The new guidelines issued by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) emphasize that aggressive blood pressure (BP) control is essential to reducing morbidity and mortality. Additionally, guidelines issued by the American Diabetes Association (ADA) and the World Health Organization-International Society of Hypertension (WHO-ISH) emphasize the critical need for lowering BP levels. Achieving BP goals is a challenge for patients and their physicians, and most patients are not at goal. Poor BP control is even more of a challenge for patients with diabetes and chronic kidney disease since their goals are even lower. The strategies for lowering BP levels include patient lifestyle changes, adherence to therapy, and regular monitoring of BP levels. OBJECTIVE: To summarize the antihypertension guidelines recommended by WHO-ISH, JNC 7, the ADA, and the Hypertension in African Americans Working Group (HAAW Group) of the International Society on Hypertension in Blacks and evaluate the pharmacist.s collaborative role in the management of hypertension by examining the results of programs designed to include pharmacist counseling. METHODS: The relevant literature was evaluated and reviewed. Emphasis was placed on literature that evaluated strategies to improve BP control. RESULTS: Results from several programs and studies showed positive effects of pharmacist collaboration. A program that provided pharmacist academic detailing to physicians at 5 Veterans Affairs facilities resulted in significant increases in patients receiving beta-blocker therapy or thiazide diuretics and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy. Another study in which hypertensive patients received clinical services from pharmacists showed significant improvement in patients. knowledge of hypertension and its management and in patient adherence, and also showed a significant increase in the number of patients whose BP stayed in the normal range. A 6-month, controlled, single-blind, parallel-group study of 51 hypertensive patients showed significant improvements in BP control, quality of life, and overall patient satisfaction in the study group that received treatment through a primary care team that included pharmacists. Among patients at a Veterans Administration medical center, results suggested that the intervention of a clinical pharmacist improved documentation of drug therapy and estimated patient compliance. A study of the effectiveness of comanagement in 197 hypertensive patients with physician-pharmacist collaboration using an evidence-based, systematic approach showed that a significantly larger number of patients in the study group achieved BP control than in the control group. CONCLUSIONS: The expanded role of clinical pharmacists in programs for evaluating, monitoring, and treating patients with hypertension can result in improved adherence to therapy and established guidelines. As members of interdisciplinary health care teams, pharmacists should utilize the JNC 7 guidelines and scientific evidence to consult with physicians about medications, design effective formularies, and collaborate with physicians in evaluating and comanaging patients with hypertension.

Black or African American↗
PubMed2006

The effect of an interventional program on adherence to the american academy of pediatrics guidelines for palivizumab prophylaxis.

OBJECTIVE: To determine the effect of an interventional program designed to improve adherence to American Academy of Pediatrics (AAP) guidelines for palivizumab prophylaxis. METHODS: The study was carried out at the Children's Hospital, University of California, Irvine Medical Center and its affiliated clinics. An interventional program focusing on education of health care workers on AAP guidelines, updating health care providers about respiratory syncytial virus (RSV) activity, as well as designating a single clinic with effective screening of referrals for administration of palivizumab, was implemented during the summer of 2004. The medical records of infants who had received at least 1 dose of palivizumab or were eligible to receive palivizumab during the 2003-2004 and the 2004-2005 RSV seasons at the University of California, Irvine Medical Center were reviewed. The proportion of patients who received injections according to AAP guidelines was compared. RESULTS: After the intervention, the proportion of patients who received palivizumab injections according to AAP recommendations increased from 39% to 61% (P < 0.0001). The program decreased the proportion of unnecessary injections significantly (140/525, or 27%, in 2003-2004 to 33/323, or 10%, in 2004-2005; P < 0.0001) but did not change the proportion of missing injections. The program resulted in a significant drop (14% to 2%; P < 0.0001) in proportion of palivizumab injections that were given too late, when RSV activity had subsided. RSV hospitalization rates did not change as a result of the intervention. CONCLUSIONS: Our interventional program improved adherence to AAP guidelines mainly by decreasing the unnecessary palivizumab injections.

Antibodies, Monoclonal↗
PubMed2003

Dietary composition and weight change among low-income preschool children.

OBJECTIVE: To examine the relation between dietary composition and weight change among children. We tested several hypotheses considering intake of nutrients (total fat and fiber) and predefined food groups (breads and grains, "fat foods," fruits, and vegetables) used in the North Dakota Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program). DESIGN: Prospective study. Subjects We collected dietary, anthropometric, and sociodemographic data from 1379 children aged 2 to 5 years participating in the North Dakota WIC Program on 2 visits ranging from 6 to 12 months apart. Main Outcome Measure Annual change in weight. RESULTS: In multiple regression analyses, no significant relations were found between total intake of fat, fiber, fruits, or vegetables and weight change. There was a 0.16-kg lower weight change per year (95% confidence interval [CI], -0.20 to -0.12 kg; P<.01) with each additional daily serving of breads and grains, and a 0.05-kg greater weight change per year (95% CI, 0.1-0.09 kg; P<.05) for each additional serving of fat foods in a model adjusting for sex, age, baseline weight, change in height, and sociodemographic variables. CONCLUSIONS: Intake of North Dakota WIC Program-defined fat foods, but not dietary fat per se, significantly predicted weight gain, whereas intake of North Dakota WIC Program-defined breads and grains, but not fiber per se, significantly predicted weight loss in preschool children.

Body Weight↗
PubMed2000

[Smoking cessation from the community pharmacy].

OBJECTIVES: To evaluate the effectiveness of the intervention of the community pharmacist in a smoking-cessation program. DESIGN: A descriptive prospective study. SETTING: Two pharmacies of the Community of Madrid. PARTICIPANTS: 77 patients who wanted to participate in the smoking-cessation program. The middle age of the participants were 41.6 +/- 10.8; 51.9% were male and 42.8% female. MEASUREMENTS AND MAIN RESULTS: The quit rates of the smoking-cessation program were: 1st. month 80.5%; 3rd. month 54.5%; 6th month 45.5% and 1st. year 42.8%. The patient who use the nicotine treatment at least two months, have more probability to quit smoking successfully (p < 0.05). CONCLUSIONS: The community pharmacy could be a good place to help people to give up smoking. Results of this study show that pharmacists who counsel patients in an intensive smoking-cessation program can improve outcomes.

Adult↗
PubMed2002

A cognitive approach to child abuse prevention.

This investigation tested the incremental utility of cognitive retraining as a component within a program designed to prevent child maltreatment. High-risk families (N = 96) were randomly assigned to a control condition, home visitation modeled after the Healthy Start program (unenhanced home visitation), or home visitation that included a cognitive component (enhanced home visitation). Mothers were identified late during pregnancy or soon after birth, and their participation continued for 1 year. Lower levels of harsh parenting were found among mothers in the enhanced home visitation condition than among those in the unenhanced home visitation or control conditions. Prevalence of physical abuse (percentage of mothers who were abusive) during the first year was 26% in the control condition, 23% in the unenhanced home visitation condition, and 4% in the enhanced home visitation condition. Benefits were greatest in families that included a medically at-risk child. A linear pattern of benefits was found for child health; as program features were added, benefits for child health increased.

Child↗
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↗
PubMed1997

Pericranial muscle tenderness and exteroceptive suppression of temporalis muscle activity: a blind study of chronic tension-type headache.

The aim of the present study was to examine the ability of pericranial muscle tenderness and the second exteroceptive suppression period to distinguish chronic tension-type headache sufferers, migraine sufferers, and controls in a young adult population utilizing a blind design. The second exteroceptive suppression periods were assessed using the methodology recommended by the European Headache Federation and were scored with an automated computer software program designed in our laboratory to provide reliable, standardized, and precise quantification of exteroceptive suppression periods and eliminate any influence of experimenter bias that may occur with manual scoring. Our sample consisted of 45 subjects diagnosed according to IHS criteria: 25 with chronic tension-type headache and 20 with migraine without aura. Twenty-three headache-free controls were recruited. Consistent with our previous findings, abnormalities in pericranial muscle tenderness, but not in the second exteroceptive suppression period distinguished chronic tension-type headache sufferers from controls. The chronic tension headache sufferers exhibited the highest pericranial muscle tenderness and the control group exhibited the lowest tenderness (P < .001). Pericranial muscle tenderness was quite successful in distinguishing recurrent headache sufferers from controls, but failed to distinguish chronic tension-type headache sufferers from migraineurs. Our findings raise the possibility that pericranial muscle tenderness is present early in the development of chronic tension-type headache and migraine without aura, and thus might contribute to the etiology of headache disorders. Our findings also indicate that a shortened second exteroceptive suppression period is not a reliable marker for chronic tension-type headache in young adults.

Adolescent↗
PubMed2004

The status of empirical support for treatments of attention deficits.

Deficits in attention and self-regulation are common complaints associated with a number of disorders across the lifespan. The need to address attentional deficits is based on the premise that attention is a precursor and prerequisite to information processing and related cognitive tasks as well as a key factor in the success of other rehabilitation efforts. Many treatment programs have been developed with the intention of restoring or rehabilitating the impaired components of attention; the number and variety of attention programs is increasing rapidly. The purpose of this article is to evaluate available empirical support regarding the efficacy of treatments for remediation of attention deficits across disorders and age levels. The search of the major databases yielded 83 studies that included treatment of attentional deficits. Empirical studies were reviewed and categorized by the type of trial, whether or not the study included a control group, and the nature of the control group. The methodology and results of each study were then rated. For each treatment identified, the aggregated studies were then considered by the disorder of the samples included in the studies. Results indicated that, regardless of the treatment program or population, the existing research does not provide sufficient evidence to reach any conclusions about the efficacy of programs designed to address attention deficits. Before any conclusions, positive or negative, can be drawn, there is a need for more rigorous study of available treatment programs across age levels and disorders, with sufficient baseline and outcome data as well as control or alternative treatment conditions.

Attention Deficit Disorder with Hyperactivity↗
PubMed2006

An innovative program to augment community preceptors' practice and teaching skills.

Medical students currently interface more and more with community-based physicians, many of whom have little training or experience as educators. They also start their ambulatory experiences from the beginning of their medical school training, not just at the clerkship year. This has prompted substantial literature on the need for improved faculty development for community preceptors, which is widely believed to be inadequate at present. The authors describe a novel program, designed to augment community preceptor teaching skills and practice behaviors, focusing on topics relating to humanism, communication, and psychosocial issues common in primary care. The program was conducted for four years beginning in 1999 and organized around acknowledged attributes of successful adult learning, and used case-based, small-group sessions, where individual community preceptors were each asked to "teach" a series of standardized students, in front of the group, regarding issues raised by a number of hypothetical patient cases. The standardized students had in turn been trained by the authors to interact with the participating faculty in a defined manner. The small-group sessions were led by community "opinion leaders" who had been chosen for this role by the participants, and who themselves first underwent training by the authors to familiarize them with core concepts felt to be essential to the program. At the conclusion of the entire process, surveys of the opinion leaders, the other community preceptor participants, and the standardized students suggested that the program did stimulate significant changes in attitude and behavior, although further research is needed to confirm this.

Communication↗
PubMed1999

An open randomized controlled trial of infection prevention in child day-care centers.

OBJECTIVE: Child care outside the home increases children's infections substantially. We have to evaluate the possibilities for reducing the transmission of infections by an infection prevention program. DESIGN AND METHODS: A 15-month randomized controlled trial involving 20 day-care centers was conducted to evaluate the efficacy of an infection prevention program. The program was introduced in 10 centers and the other matched 10 centers served as controls. Records were made of the occurrence of infections and absences from care or work because of infections among the children, their parents and the personnel of the day-care centers. RESULTS: Both the children and the personnel in the program centers had significantly fewer infections than those in the control centers, the reduction being 9% [95% confidence interval (95% CI), 4 to 16%, P < 0.002] among 3-year-old children and 8% (95% CI 0 to 14%, P = 0.049) among the older children. The children at the program centers received 24% fewer prescriptions of antimicrobials (95% CI 22 to 27%, P < 0.001). Likewise there were 2.5 man-year fewer absences from work on the part of parents because of a child's illness during 1 year in the program centers, a 24% difference (95% CI 18 to 29%, P < 0.001). CONCLUSIONS: Effective prevention of infections is possible in child day-care centers, and this can benefit both the families and the personnel. Such a program is cost-effective even if a specialist nurse implements it.

Adult↗
PubMed2003

Keeping the focus on public health: the struggles of a tobacco prevention task force.

This case study examines a nonlegislative task force as it struggled to reach internal consensus despite external political constraints. The study highlights the convergence of politics and science, revealing complex issues likely to be confronted by advocates and public health officials. Three themes capture participants' experiences: context, sizing up the opportunities and constraints; task force process, tacit strategy to operate outside the political context and play the science card; and aftermath, a glass half full. The task force took advantage of ambiguous parameters, crafting a comprehensive statewide plan to reduce tobacco use and breaking out of the common public health paradigm of allowing budget considerations to drive program design. These internal victories could not sustain a policy success in the legislature. However, the group's product sets science-based standards for future program development, and the task force's process provides valuable insights into other states developing tobacco prevention and control policies.

Health Policy↗
PubMed2006

Learning from the best: the benefits of a structured health policy fellowship in developing nursing health policy leaders.

This article describes the experience of a nurse leader engaged in a state Health Policy Fellowship instituted in North Carolina by the North Carolina Center for Nursing (NCCN). This Health Policy Fellowship is designed to provide a focused practicum in major aspects of state-level health policy with emphasis on the role of the nurse leader. The program design includes exposure to experienced mentors with diverse areas of focus to learn from observation and interaction. This article describes the experience of a state Health Policy Fellow and includes discussion of understandings derived from interacting with key state stakeholders in the health policy arena and pearls of wisdom from the policy fellowship experience.

Attitude of Health Personnel↗
PubMed1989

The social costs of the International Monetary Fund's adjustment programs for poverty: the case of health care development in Ghana.

A primary health care (PHC) strategy was adopted in Ghana in 1978, but the civilian government at the time failed to implement the program designed to achieve health for all Ghanaians. In 1982, the revolutionary military government under Rawlings indicated its commitment to the full implementation of the PHC program. In this article, the author seeks to examine the extent to which the Economic Recovery Program initiated by the Rawlings' regime, its policy of decentralization and mobilization of the masses, and its promise to institute some fundamental organizational and structural changes in the health care delivery system, are contributing to the process of achieving "health for all" Ghanaians.

Community Participation↗
PubMed1980

Effects of modification of conceptual tempo on acquisition of work skills.

This study investigated the effects of modification of conceptual tempo on the skilled performance of a group of mildly intellectually handicapped adolescents receiving training in a work preparation centre (N, 41). On the basis of performance on Kagan's Matching Familiar Figures Test the group was divided into two subgroups, reflective, impulsive and then further divided through random allocation to control and experimental conditions. The two experimental groups received a training program designed to promote self-generation of strategies, using self-verbalization to induce a more reflective approach. The control groups received the normal training program of the centre. The criterion measure taken at pre- and posttest was a collation task standardized so as to provoke response uncertainty. Analysis of residual gain scores derived from the two testing occasions indicated that the experimental groups improved significantly more than the controls and that the improvement generalized to their performance on the Porteus Maze and Matching Familiar Figures Test. Contrary to expectation, however, the effect of training did not bring about significant differential improvement for impulsive as against reflective subjects. Both benefited from the training. On the basis of delayed posttests, no generalization was apparent.

Adolescent↗
PubMed2001

Effects of an early intervention group program for anxious and depressed adolescents: a pilot study.

The Resourceful Adolescent Program is an early intervention program designed to enhance psychological resilience in adolescents with emotional problems. Eight adolescents with high anxious and/or depressive symptoms were treated with this 11-session group program. Treatment effects were examined by means of self-report questionnaires of anxiety, depression, and self-efficacy. Pre- and postintervention data showed reductions in anxiety and depression scores and a concomitant increase in adolescents' self-efficacy.

Adolescent↗
PubMed2004

[Heart failure: preventing rehospitalizations by disease management programs].

Chronic heart failure is a growing public health problem for prevalence, morbidity and costs. The major proportion of costs is attributable to rehospitalizations and many of these readmissions may be preventable. Since 1990, some investigators have tested a variety of disease management programs designed to improve quality of life, functional status and decrease rehospitalizations rates. We identified these studies by a computerized search of the MEDLINE database. The programs described reflected a wide variety of methods and we categorized these programs recognizing the prevalent disease management approach. We reported the results of these trials about rehospitalizations and analysed a number of limitations that must be considered when determining their adoption into clinical practice.

Disease Management↗
PubMedDate not supplied

Characteristics of participants and nonparticipants in worksite health promotion.

PURPOSE: To identify demographic characteristics associated with worksite health promotion participation and to determine whether employees with high-risk health-related behaviors, as measured by a health risk appraisal, were participating in programs designed to address these behaviors. DESIGN: Descriptive. SETTING: A petrochemical research and development company where employees were offered a health risk appraisal questionnaire, a series of on-site wellness programs, and an on-site fitness center. SUBJECTS: All employees (n = 2290) working continuously from May 1, 1990, through February 28, 1992. MEASURES: Demographic and behavioral risk characteristics of participants and nonparticipants. RESULTS: Participation was 37% (health risk appraisal), 64% (all wellness programs), and 10% (fitness center), with women participating at higher rates than men in all programs. Most programs attracted 10% to 40% of the employees at risk for the particular behavior addressed by the program, although lower penetration (7% to 9%) was observed for the on-site fitness center and blood pressure education programs. With the exception of wellness programs for weight, smoking, and blood pressure, employees at lower behavioral risk tended to be more likely to participate than employees at high risk. CONCLUSIONS: Efforts to increase participation by all company employees, especially among those with high-risk behaviors, would benefit all health promotion programs, particularly the on-site fitness center.

Adult↗