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[The concept of herd immunity applied to the evaluation of vaccination programs].

The article concerns the definition and ways of estimation of indicators of herd immunity as applied to the analysis of the efficiency of vaccination programmes. Some important factors are discussed which determine the proportion of vaccinated individuals in the population necessary for decrease of incidence and eventually for elimination of the disease from a population. The problems related to definition and calculation of herd immunity in populations non uniform in terms of individual risk of infection are discussed.

Communicable Disease Control↗

Medical surveillance in work-site safety and health programs.

Businesses frequently call on family physicians to provide employee health services at the work site or in the clinician's office. These services include medical screening (detection of dysfunction or disease before an employee would ordinarily seek medical care) and medical surveillance (analysis of health information to identify workplace problems that require targeted prevention). Such services can transform acute care and routine screening activities into opportunities for primary prevention when they are integrated into the broader framework of work-site safety and health programs. Components of these programs include management commitment, employee participation, hazard identification and control, employee training and program evaluation. For optimal program success, family physicians must communicate with frontline safety officers and have first-hand knowledge of the workplace and its hazards. Professional and technical resources are available to guide the family physician in the role of medical surveillance program coordinator.

Accidents, Occupational↗

[Preliminary evaluation of methadone program in Kraków].

Methadone maintenance programs have effectively reduced opiate dependency and are available in many countries, also in Poland. In Kraków 50 persons were qualified to methadone maintenance treatment. Their age varied from 21 to 46 years, mean 27.8 years. Participants of the programme were mainly educated on basic technical level, unemployed, after 3 to 30 attempts of detoxification treatment. After initial observation at the Detoxification Unit of the Department of Clinical Toxicology and establishing effective daily oral dose of methadone, all patients in Outpatient Clinic of Abuse receive daily adequate dose of methadone, where in parallel, individual and group psychotherapy is used. Methadone programme which was applied seems to prove the fact, that it can significantly improve life quality of addicted patients as well as increase the level of public safety.

Administration, Oral↗

Quality indicators for academic nursing primary care centers.

ANCs, by definition, deliver more than clinical services to patients and communities. The unique identifier that separates ANCs from other primary care/ambulatory care centers is the educational service they offer to students and other faculty in the school of nursing to which they belong. Therefore, measuring the quality of an ANC must include a measurement of the educational properties that it possesses in addition to the usual quality measurements by such organizations as AAAHC, JCAHO, CHAP, and AAACN. Unless these properties are included and measured by an ANC, it becomes difficult to justify the existence of such a clinic within a school of nursing. ANCs are encouraged to develop quality evaluation programs aimed at evaluating the educational aspects as well as the administrative and clinical aspects of their operations.

Academic Medical Centers↗

Evaluation of a program to motivate impaired driving offenders to install ignition interlocks.

Approximately 30,000 alcohol ignition interlocks, which prevent a drinking driver from operating a vehicle, are in use in the United States and Canada. Currently available studies indicate that interlocks reduce impaired driving recidivism while on the vehicle. However, in the United States, the practical effectiveness of these devices is limited because few offenders are willing to install them in order to drive legally. This paper reports on a study of a court policy that created a strong incentive for impaired driving offenders to install interlocks by making penalties (e.g., jail or electronically monitored house arrest) the alternative to the interlock. Comparison of the recidivism rates of offenders subject to this policy with offenders in similar, nearby courts not using interlocks indicated that the policy was producing substantial reductions in DUI recidivism.

Adult↗

Methodological approach to a multidimensional evaluation of food and nutrition policies.

Recommendations arising from global conferences and summits, expressed the need to formulate and implement public policies to improve household food security. In the context of maximizing benefits given available resources, comprehensive evaluations of the nutrition policies and programs are needed. One obstacle to overcome was a clear definition of terminology; the words efficiency, effectiveness, efficacy and impact, widely used in the context of program evaluation, are sometimes interchanged and there is no consensus about their precise definition. Another approach to health evaluation is based in the paradigm structure-process-outcome. The level structure contemplated the installations, resources, instruments (physical and discursive), as well as the technical bureaucratic organizational structures. Process encompassed the whole set of intervention activities developed, whereas the dimension of outcome comprised the effects of interventions on the health and nutrition of beneficiaries. Each of the three dimensions constitutes a continuum in the evaluation procedure: the structure only fulfills its purposes if the processes are adequate and conversely, processes cannot alone supersede structural limitations. Moreover, all the three dimensions only reach their ultimate objectives through the completion of outcomes. The methodology proposed here has been tested in the case of Bahia, Northeast Brazil, and it was found to be adequate for this type of analysis. We hope this approach of a comprehensive multidimensional evaluation, constitutes an effective contribution for program planners and program managers, in particular with regard to the obstacles detected, some of which can surely be overcome.

Developing Countries↗

[Family planning: an evaluation of the program at a health center (1986-1990)].

OBJECTIVE: To gain dome idea of the characteristics of the population attended at a Family Planning Clinic (FPC) in a Health Centre, attempting to find the coverage and performance of the Clinic. DESIGN: Retrospective descriptive study, which analysed 403 cases between July 1986 and December 1990. SITE. Family Planning Clinic in the "Huerta de la Reina" Health Centre. PATIENTS AND OTHERS PARTICIPANTS: Women of child-bearing age who requested a consultation during the period of the study. MAIN MEASUREMENTS AND RESULTS: A uni/bivariate analysis of the studies was carried out. Coverage of 16.3% of the population of child-bearing age, with 69.5% of the women being under 29, was attained. The most frequent motive for a consultation was advice on methods of contraception. Oral contraception (65.0%) was the most common form prescribed. 27.1% of those attending consultation were referred to the second level. Attendance at periodic check-ups was very low.

Age Factors↗

[The participation of pharmacy services in evaluating parenteral nutrition programs].

The situation of parenteral nutrition practised in our hospital over one year was analyzed from the standpoint of Pharmacy Services, with a random sample of 26 patients with 322 days on parenteral nutrition. The most important results showed that the degree of compliance of the application sheets was 85.3%. The protocolized nutrient units were used in 80.1% of total days on parenteral nutrition, with an average of 0.97 +/- 0.60 modifications per day 855.0% electrolytes and 39.9% insulin). During the follow-up of parenteral nutrition, analytical determinations were performed every 2.3 +/- 1.8 and 4.2 +/- 2.6 days in blood and urine respectively. 30 biochemical alterations were observed, in particular hyperglycaemia (26.7%), hypoglycaemia (10%), hyperpotassemia (13.3%) and hyponatraemia (13.3%). In 70% of cases, corrective action was taken within 24 hours. The average number of multidisciplinary communications was 4.5 per patient. The initiative was taken by the pharmacist in 75.8% of cases, and the most frequent reason for communication was analysis of biochemical situation of patient and proposal for modification in daily intake.

Adult↗

[The role of epidemiologic research of the natural history of cancer for evaluating cancer screening programs--a prospective study of colorectal polyps on the occurrence of colorectal cancer].

In order to elucidate the natural history of colorectal polyps and to examine the effectiveness of endoscopic polypectomy in reducing the incidence of colorectal cancer, we conducted a retrospective cohort study of all patients who had undergone endoscopic examination at the Center for Adult Diseases, Osaka in 1970-82. The study subjects consist of 653 non-polyp cases and 431 colorectal polyp cases including 222 cases treated by endoscopic polypectomy. These were followed up until the end of 1985 by the method of a record linkage with the Osaka Cancer Registry's file. The colorectal polyp group and the endoscopic polypectomy group experienced 4.4 and 2.9 times, respectively, as much incidence of colorectal cancer as the non-polyp group. The magnitude of the prevented fraction by the use of endoscopic polypectomy was estimated at 31.3%. A large-scale and long-term study is necessary to elucidate the original study purpose.

Adult↗