When South meets South. How Navrongo learnt from Matlab.
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Africa↗
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A majority remain untreated. Bangladesh.
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Abortion, Septic↗
Exploring new paths to service delivery in Palestine.
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Asia↗
Community, cooperation and sustainability in Ghana.
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Africa↗
Is Ministry of Health fully prepared to implement an effective DOTS program in Pakistan? An operations research on TB control program in the public health sector in Sindh.
PURPOSE OF THE STUDY: Pakistan is among the high-burden countries for tuberculosis. One of the fundamental problems in TB control is a high defaulter rate among the registered TB cases in the public sector. In 1999, a cross-sectional study was designed to identify the determinants of low compliance for the TB treatment in two rural districts in Sindh. METHODS: Before the actual data collection, a pilot testing was planned in a secondary level care hospital. Fourteen defaulters for TB treatment were identified but none could be contacted due to incomplete addresses. Other alternatives were explored with the health facility team to reach them including a field-based search through Lady Health Workers of the National Health Program but all endeavors went into vain. The pilot testing propelled us to postpone the cross-sectional study but we continued scrutinizing the follow up problem for TB patients in other health facilities. Not surprisingly, more or less a similar picture was found in those health facilities. PRINCIPAL CONCLUSIONS: The study concludes that the public health care system in Pakistan lacks even the basic requirements for an effective TB control program, that is, a viable information system and the functional integration of program with rest of the health care delivery system. A DOTS strategy to control TB was initiated in the public sector in Pakistan just one year prior to this study. The Ministry of Health requires re-visiting the program to ensure that the lacunae identified in this study are being taken care of in the current DOTS strategy.
Communicable Disease Control↗
Maintaining family planning acceptance levels through development incentives in Northeastern Thailand.
The results of a two-year longitudinal study of the effect that development program incentives have upon family planning in Northeastern Thailand are presented. These incentives, implemented by the Population and Community Development Association, Thailand, included animal raising and agricultural, home industry, and environmental activities. An experimental design including baseline and follow-up surveys supplemented by a continuous monitoring system was utilized to test hypotheses on the family planning impacts of the incentives. Findings indicate that the incentives contributed significantly to the maintenance of high levels of family planning practice through the program period 1982-1984.
Contraception Behavior↗
Approaches to the study of gender in marriage and family therapy curricula.
This study compares two accredited marriage and family therapy programs: One includes a separate course on gender, and the other integrates gender throughout the curriculum. Students from the two programs rated their own and their peers' experience of how gender education effects therapy, program culture, and personal life. Results indicate that students from the integrated program view their peers as incorporating gender ideas in therapy to a significantly greater extent (t = 2.83, p < .05) than do students in the gender course program. However, students from the program that has a gender course leaned more toward agreement with feminist concepts than did students from the integrated program. Overall, students appear to be learning about gender and integrating these concepts into their work as therapists. Discussion is included on how to choose a gender curriculum.
Adult↗
The ideal compliance world: integrating physicians into the compliance program.
Compliance officers are in a unique position to provide guidance to physicians and will succeed in gaining physician support and buy-in when appropriate steps are taken to integrate physicians into the compliance program. First and foremost, the compliance officer's primary responsibility is to apprise physicians of the seriousness nature of current compliance issues. When physicians are provided with clear information through a variety of media, they will understand that compliance program goals and objectives will resolve compliance-related issues dilemmas. Next, the compliance officer should expect no less than the ideal compliance world. Recruit physician champions who will actively participate in compliance program planning and development. Call upon medical staff members to get involved in implementation stages of compliance action plans and engage physician leaders to educate and train their physician peers on compliance-related issues. Most importantly, minimize individual physician liability by providing adequate education programs to physicians. Help them to master the art of coding and documentation and to mitigate any prospect of fraud and abuse or compliance-related concerns. Last, collaboration is the key--the compliance officer must provide guidance to the physician so that the physician may continue to fulfill the role of leader and healer. In turn, the physician must recognize that his or her actions and those of the hospital and system are inseparable and that they must actively participate in compliance program initiatives.
Cooperative Behavior↗
[Breastfeeding promotion and support services in local community health centers].
This study had a two-fold goal. First, to document services relating to breastfeeding promotion and support in CLSCs and, second, to examine the links between the delivery of such services and certain organizational and environmental factors. The data were collected in 1999 by means of a self-administered questionnaire sent to all CLSCs in Quebec. The responses indicated that breastfeeding is most often systematically addressed at prenatal meetings and through integrated perinatal programs. CLSCs belonging to a multipurpose establishment are more apt to integrate the issue of breastfeeding into perinatal activities; in addition, many of them offer breastfeeding activities considered innovative, although the average for this kind of activities is fairly low (33%). In addition, CLSCs that collaborate more closely with community organizations and those that spend more on perinatal programs are the ones that most often offer "innovative" breastfeeding activities.
Breast Feeding↗
Social science research in malaria prevention, management and control in the last two decades: an overview.
In the recent past, considerable progress has been made in understanding how human behavior and social organization, macro- and micro-level economic processes, and health and political systems affect responses to malaria at global, national, community, household, and individual levels. Advances in malaria-related social, behavioral, economic, evaluation, health systems, and policy (social science) research have resulted in improvements in the design and implementation of malaria prevention, management and control (PMC) strategies. Indeed, the past two decades chronicle dramatic advances in the implementation of evidence-based interventions, drawn not only from biomedical but also from social science research. Malaria awareness-raising, advocacy, case management, and prevention efforts have reaped the benefits of social science research and as a result, many programs are implemented and evaluated in a more effective manner than in the past. However, the pace at which findings from social science research are integrated into program and policy implementation is unsatisfactory. Additionally, examples remain of programs that fail to utilize findings from social science research and as a result, achieve minimal results. Furthermore, there is a sizeable body of knowledge that is underutilized and which, if assimilated into programs and policies, could accelerate progress in malaria PMC. Examples include information on meaningful community participation, gender, socio-economic status, and health systems. Regrettably, although social science input is necessary for almost all interventions for malaria management and control, the numbers of scientists working in this area are dismal in most of the key disciplines-medical anthropology; demography; geography and sociology; health economics and health policy; social psychology; social epidemiology; and behavior-change communication. Further, skills of program workers charged with implementation of interventions and strategies at country level are most often inadequate. The Special Program for Research and training in tropical diseases (TDR) and the multi-lateral initiative on malaria (MIM) have remained in the forefront of capacity building for this area of research, but additional efforts are needed to bring more applied social scientists into the fold. Their skills are necessary to ensure that social science findings get to program planners and implementers in a useful form that allows for more rapid and appropriate integration of the results into malaria PMC programs and policies. A re-thinking of the current focus within capacity building efforts is proposed.
Communication↗
Integrating nutrition services into primary care: Experience in Hamilton, Ont.
PROBLEM BEING ADDRESSED: Nutrition services can have an important role in prevention and management of many conditions seen by family physicians, but access to these services in primary care is limited. OBJECTIVE OF PROGRAM: To integrate specialized nutrition services into the offices of family physicians in Hamilton, Ont, in order to improve patient access to those services, to expand the range of problems seen in primary care, and to increase collaboration between family physicians and registered dietitians. PROGRAM DESCRIPTION: Registered dietitians were integrated into the offices of 80 family physicians. In collaboration with physicians, they assessed, treated, and consulted on a variety of nutrition-related problems. A central management team coordinated the dietitians' activities. CONCLUSION: Registered dietitians can augment and complement family physicians' activities in preventing, assessing, and treating nutrition-related problems. This model of shared care can be applied to integrating other specialized services into primary care practices.
Adolescent↗
Attaining superior outcomes with joint replacement patients.
Wanting to improve the quality outcomes of their joint care program, a team approach was used to implement a program with integrated care across the continuum. The authors describe the joint care program and its outcomes that included a decrease in length of stay, fewer complications, improved functional status, higher discharge disposition to home, and lower variable costs per case.
Advisory Committees↗
Graduate primary care training: a collaborative alternative for family practice, internal medicine, and pediatrics.
The Residency Program in Social Medicine at Montefiore Medical Center is a collaborative, integrated training program for primary care pediatricians, internists, and family physicians within one interdisciplinary organization. Since 1970 we have trained more than 200 physicians, prepared them for board certification in their specialty, emphasized the psychosocial aspects and social determinants of health and illness, and shared a faculty, curriculum, and commitment to provide medical care for inner-city, underserved populations. We discuss the program's history and curriculum, administrative and academic structure, shared "cross-track" faculty units (psychosocial; social medicine; and research, education, and evaluation), and graduates' practice outcomes. The interdisciplinary character of the Residency Program in Social Medicine helps physicians successfully serve the underserved and exemplifies that interdisciplinary medical education succeeds when interdisciplinary health care teams are organized for optimal patient care. Only the federal government has the perspective and power to foster more interdisciplinary collaboration and strengthen primary care education in a period of shrinking resources.
Curriculum↗
Seeking medical advice if HIV symptoms are suspected. Qualitative study of beliefs among HIV-negative gay men.
OBJECTIVE: To identify beliefs associated with seeking medical advice promptly when symptoms of HIV infection are suspected among HIV-negative gay men. DESIGN: Qualitative study of beliefs among focus group participants. SETTING: Quebec city, Que, metropolitan area. PARTICIPANTS: Referred sample of 20 HIV-negative gay men 18 to 45 years old who attended bars, university, or gay associations in Quebec city. METHOD: Three focus groups of five to seven subjects were formed and each 2-hour session was tape-recorded. MAIN OUTCOME FINDINGS: Participants thought that seeking medical advice promptly when symptoms of HIV are suspected would help them be informed about their health status and would eliminate unnecessary anxiety and fear, but would force them to face reality and make major changes. Barriers were the quality of the relationship with their physicians and concern about discussing their sexual lives. Normative beliefs were sought from members of community groups, circles of close friends, health providers, and the media. CONCLUSIONS: Several beliefs could influence the motivation of seronegative gay men to seek medical advice promptly when symptoms of HIV infection are suspected. These beliefs should be integrated into programs promoting early consultation with physicians and into clinical counseling, as integration could facilitate early treatment and care. Physicians should give special attention to establishing relationships of trust with these patients.
Adolescent↗
Oral biology and the early introduction of clinical dentistry in the dental curriculum.
For the past nine years students entering the Dental School in the University of Western Australia have participated in an introductory clinical dentistry program closely integrated with oral biology. This paper outlines the content of the program and discusses its educational advantages. Changing attitudes in Australian universities toward the appointment of full professors in clinical disciplines also are discussed, and reference is made to the way in which these appointments are helping to achieve a closer correlation between basic science and clinical dentistry.
Anatomy↗
Impact evaluation of the "not me, not now" abstinence-oriented, adolescent pregnancy prevention communications program, Monroe County, New York.
"Not Me, Not Now" is an abstinence oriented, adolescent pregnancy prevention integrated communications program developed by Monroe County, NY. The evaluation utilized a cross-sectional time series approach in the analysis of items from several waves of youth surveys administered to two different age groups: (1) a survey of 7th and 8th graders on awareness, attitudes and intended behavior, and (2) the Youth Risk Behavior Survey administered to 9th through 12th graders. The trends found in the surveys demonstrated high levels of awareness of the program, changing attitudes and intended behaviors consistent with the program's messages. Analysis of pregnancy rates for 15-17 year-olds in the county were compared to reductions found in similar geographic areas. Pregnancy rates in Monroe County declined faster than in comparison areas. The authors conclude that there is a strong likelihood that the program had independent effect on the outcome of pregnancies in the population exposed to the program.
Adolescent↗
Preliminary assessment of a scientific curriculum in a surgical residency program.
A structured, basic science curriculum was instituted for surgical residents of the University of Connecticut (Farmington) Integrated Residency Program during the 1990-1991 academic year in concordance with American Board of Surgery guidelines. The impact of the new program was measured by comparing performance on monthly basic science examinations, the in-training examination, and "mock" oral examinations for the 1990-1991 academic year with that of the preceding academic year. While monthly examination scores improved for the entire group of residents (67.7 vs 64.6), in-training and oral examination scores did not change significantly. Categorical residents generally demonstrated superior performance and greater improvement than did preliminary residents. Data analysis suggested that the new curriculum was an effective educational device and that university-designed monthly examinations were valid testing instruments, but there was an apparent incongruity between the goals of the curriculum and the American Board of Surgery In-Training Examination.
Attitude↗
Assessment of a holistic wellness program for persons with spinal cord injury.
OBJECTIVE: To test the effectiveness of a holistic (comprehensive and integrated) wellness program for adults with spinal cord injury. DESIGN: A total of 43 adults with spinal cord injury were randomly assigned to intervention or control groups. The intervention group attended six half-day wellness workshops during 3 mos, covering physical activity, nutrition, lifestyle management, and prevention of secondary conditions. Outcome measures included several physical measures and standard psychosocial measures. Statistical analyses included paired t tests, used to determine within-group differences, and multiple regression conducted to assess between-group differences. RESULTS: When comparing within-group baseline and final results, the intervention group reported fewer and less severe secondary conditions by the end of the study. Similarly, significant improvements were found in health-related self-efficacy and health behaviors. No significant changes in physiologic variables were observed. Although no significant between-group differences were observed, regression analyses suggested participation in the wellness program may be associated with improved health behaviors. CONCLUSION: Within-group comparisons suggest improvements in several areas of the participants' overall health behaviors. These findings, although preliminary, emphasize the potential role of health behaviors in positively influencing long-term health outcomes and quality of life.
Adult↗