[National Health Service; the campaign against infectious diseases].
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Communicable Diseases↗
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Results for “Communication Programs”
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Innovative bridging program for overseas trained doctors.
Most overseas trained doctors wishing to practise in Australia are required to sit for examinations set by the Australian Medical Council (AMC) before they can seek registration through State medical boards. In 1989, the South Western Sydney Area Health Service, which is responsible for the delivery of health services to 650,000 people, initiated a bridging program with the joint aim of providing overseas trained doctors with the opportunity to undertake a comprehensive program of study and facilitating the recruitment of doctors into the area. The program comprises two integrated components, each extending over five months. Stage 1 relates to the AMC's multiple choice questionnaire (MCQ) examination; stage 2 prepares candidates for the clinical examination. In addition, provision is made for developing awareness of professional responsibility, standards and ethical bases for the practice of medicine in Australia. Participants are also required to study English and communication skills throughout the program. Acceptance into the program is based on a number of criteria including successful completion of a screening test and an interview. Progression to the Clinical Course requires that candidates pass the MCQ Course and undertake to work in the area. The program has been funded jointly by State and Commonwealth Government bodies. Results obtained by program participants in the MCQ and clinical examinations conducted by the AMC have been well ahead of the national average.
Australia↗
Organizing a hospitalist program: an overview of fundamental concepts.
This article has discussed several fundamental concepts in the development and implementation of a hospitalist program. Perhaps the two most important barriers to the success of hospitalist practices are lack of buy-in from PCPs and other physicians (which is becoming much less common) and the inability to gain durable financial support from the hospital or other sponsoring entity. These issues always should be addressed before starting a program. Systems for adequate communication between hospitalists and community physicians will ensure buy-in is maintained. Unique challenges for those administering a hospitalist group include physician scheduling that balances continuity with a sustainable career track. Finally, providing leadership with a medical director increases the likelihood that operational problems are quickly managed, and that strategic planning takes place to ensure the future success of the program.
Attitude of Health Personnel↗
The problem of futility: III. The importance of physician-patient communication and a suggested guide through the minefield.
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Attitude of Health Personnel↗
Apple II computer software for DNA and protein sequence data.
In our attempt to make the aid of a computer for the molecular biology laboratory available on a low-cost basis, we have improved the programs that we published recently. We have experienced in our laboratory, and have learned from others, that the average lab has an increasing demand to use a time-sharing-independent computer for the bulk of data handling. A microcomputer can give this independence. At the same time, a microcomputer can serve as a terminal for the few computer jobs, such as data communication or extensive search programs, which have to be conducted on a time-sharing basis. In this paper, we describe the programs which can be executed on a Apple II microcomputer using the Apple Language System. This system gives the researcher the opportunity to learn to handle sequence data, and it also includes a word processing system useful in writing letters and manuscripts and storing text.
Amino Acid Sequence↗
Exploratory space-time analysis of reported dengue cases during an outbreak in Florida, Puerto Rico, 1991-1992.
The spatial and temporal distributions of dengue cases reported during a 1991-1992 outbreak in Florida, Puerto Rico (population = 8,689), were studied by using a Geographic Information System. A total of 377 dengue cases were identified from a laboratory-based dengue surveillance system and georeferenced by their residential addresses on digital zoning and U.S. Geological Survey topographic maps. Weekly case maps were generated for the period between June and December 1991, when 94.2% of the dengue cases were reported. The temporal evolution of the epidemic was rapid, affecting a wide geographic area within seven weeks of the first reported cases of the season. Dengue cases were reported in 217 houses; of these 56 (25.8%) had between two and six reported cases. K-function analysis was used to characterize the spatial clustering patterns for all reported dengue cases (laboratory-positive and indeterminate) and laboratory-positive cases alone, while the Barton and David and Knox tests were used to characterize spatio-temporal attributes of dengue cases reported during the 1991-1992 outbreak. For both sets of data significant case clustering was identified within individual households over short periods of time (three days or less), but in general, the cases had spatial pattern characteristics much like the population pattern as a whole. The rapid temporal and spatial progress of the disease within the community suggests that control measures should be applied to the entire municipality, rather than to the areas immediately surrounding houses of reported cases. The potential for incorporating Geographic Information System technologies into a dengue surveillance system and the limitations of using surveillance data for spatial studies are discussed.
Adolescent↗
CINI's approaches to intervention: an innovative strategy to combat malnutrition in India.
The Child in Need Institute (CINI) has been working toward sustainable health and nutrition development for women and children for the last twenty-six years. During the initial stages, the Institute focused on treatment and prevention of malnutrition in children under five years of age. Over the years, the program strategies have shifted to a more holistic lifecycle approach. This approach targets individuals during crucial periods of their lives--pregnant women, children (0-2 years of age) and adolescents (10-19 years of age)--as well as other vulnerable segments of the population. To reach out to these target groups, the Institute uses a three-pronged strategy that includes case management, behavior change communication, and linkage formation. Programs are either community- or center-based depending upon the need of the populations. CINI's current strategy has shown positive trends in improving the health and nutrition status of women, children, and adolescents in the community. Results include reduction of low birth weight babies, increase in proper antenatal care, reduction of severely malnourished children, decrease in maternal and infant mortality and morbidity rates, and improvement in community involvement in all reproductive and child health programs. CINI is currently monitoring its performance and activities to carry out operations research for providing further evidence for the effectiveness of its interventions.
Adolescent↗
Reducing alcohol consumption among university students: recruitment and program design strategies based on Social Marketing Theory.
Recruitment of program participants and development of appealing comprehensive alcohol abuse prevention programs is an exigent priority for university campuses due to the serious physical and emotional consequences related to alcohol consumption. A sample of 67 students from a large midwestern university completed a survey based on Social Marketing Theory (SMT) which was developed to improve recruitment and enhance the design of comprehensive alcohol abuse prevention programs. The results indicate that recruitment may be optimized by providing a flexible, convenient, low-cost program that encourages friends' participation, communicates alcohol-related risks and offers university credit or refund as participation incentives. The design of alcohol abuse prevention programs may be enhanced by emphasizing the positive outcomes of reducing alcohol consumption, improving the quality and quantity of alternatives to the social atmosphere connected with drinking, and soliciting respected opinion leaders (physicians and parents) to communicate alcohol reduction messages. This project is a first initiative to 'fill the gap' in the social marketing research literature by providing formative information pertinent to recruitment and design of alcohol reduction programs specifically for college students.
Adolescent↗
Interactive DICOM image transmission and telediagnosis over the European ATM network.
The European High-Performance Information Infrastructure in Medicine, n(o)B3014 (HIM3) project of the Trans-European Network--Integrated Broadband Communications (TEN-IBC) program, started on March 1996 and finished on February 1997, aimed to test the medical usability of the European asynchronous transfer mode (ATM) network in medical image transmission. The Department of Radiology, University of Pisa, Pisa, Italy, and St-Luc University Hospital, Brussels, Belgium, involved in the project as healthcare partners in the radiological domain, established several connection sessions finalized to test the usability of Digital Imaging and Communication (DICOM) image transmission and interactive telediagnosis tools in the daily radiological practice. The Pisa site was connected to the Italian ATM pilot (Sirius Network) through the Tuscany metropolitan area network (MAN), while St-Luc University Hospital was connected to Belgium ATM network through the Brussels MAN. By means of international connections provided by the European JAMES project, a link between the two sites was established, connecting both national ATM networks. Due to the large variety of hardware present in the medical centers, multiplatform software tools were used and tested: central test node (CTN) release 2.8 [3], VAT [6], NV-3.3 [7], and IDI (UCL homemade multiplatform teleradiology tool for interactive visualization and processing of DICOM images). During the telediagnosis session, lead by radiologists in both hospitals, each site submitted neuroradiological clinical cases to the other for remote consultation. The connection, available for a period of two weeks, at 2-Mbit/s bandwidth, allowed the transmission of MR images (256 x 256 x 12 bit) and simultaneous multimedia interactive discussion of the cases. Both off-line transmission and review of the images, using the CTN DICOM transfer routines, and on-line interactive image discussion, using the IDI telediagnosis software, were tested successfully from the technical and medical point of view.
Computer Communication Networks↗
Effectiveness of computer ergonomics interventions for an engineering company: a program evaluation.
OBJECTIVE: Ergonomic principles at the computer workstation may reduce the occurrence of work related injuries commonly associated with intensive computer use. A program implemented in 2001 by an occupational therapist and a physical therapist utilized these preventative measures with education about ergonomics, individualized evaluations of computer workstations, and recommendations for ergonomic and environmental changes. METHOD: This study examined program outcomes and perceived effectiveness based on review of documents, interviews, and surveys of the employees and the plant manager. RESULTS: The program was deemed successful as shown by 59% of all therapist recommendations and 74% of ergonomic recommendations being implemented by the company, with an 85% satisfaction rate for the ergonomic interventions and an overall employee satisfaction rate of 70%. Eighty-one percent of the physical problems reported by employees were resolved to their satisfaction one year later. CONCLUSION: Successful implementation of ergonomics programs depend upon effective communication and education of the consumers, and the support, cooperation and collaboration of management and employees.
Adult↗
Autism: early identification and management in family practice.
Autism is a chronic, nonprogressive developmental disability with a unique triad of abnormalities in socialization, communication and behavior. Most, but not all, children with autism have some degree of mental retardation, and many develop epilepsy. No single biomedical etiology has been found, but a significant number of medical disorders occur in association with autism. The medical evaluation is directed toward finding underlying or associated neurologic, metabolic, genetic or infectious diseases. Psychoeducational and behavioral therapies are the most successful approaches to the treatment of autism. Community-based and structured programs that emphasize socialization, communication and family training are the most effective. Medical management focuses on treatment of underlying or associated diseases. Pharmacotherapy is sometimes beneficial, but no drug acts specifically on this complex of symptoms. Family physicians can provide early identification, continuing medical care and support to the child and the family.
Autistic Disorder↗
Efficacy of a home-based human immunodeficiency virus prevention video program for teens and parents.
Family-based communication about sexual behavior and sexuality is a predominate theme in the key risk reduction and service objectives for human immunodeficiency virus (HIV) prevention and related issues in Healthy People 2000. These recommendations are particularly poignant for younger adolescents who are not yet sexually active and whose social orientation is primarily to family and parents. A family-centered, home-based, video program to foster parent and teen knowledge and communication regarding issues related to HIV prevention and to increase family and teen communication skills was used in an intensive field test of program efficacy. Sixty-nine families with at least one adolescent age 12 to 14 years were recruited through their primary-care physicians and were randomly assigned to either experimental (video with information and skills training) or control (video with information only) conditions in a pre-posttest with a 4-month follow-up design. Both versions of the video program resulted in substantial increases in HIV-related knowledge for parents and teens, but only the skill-training (experimental) version produced increases in knowledge of communication skills and behavioral demonstrations of family problem solving. Approaches for a broader and more effective parent-training video program and for dissemination through primary-care physicians are discussed.
Adolescent↗
Tropical bont tick eradication campaign in the French Antilles. Current status.
The Amblyomma variegatum eradication campaign was officially started in April 1994 in Martinique and in Guadeloupe, including its dependencies of Marie Galante, Desirade and St Martin. A budget of $10.5 and $5.9 million for Guadeloupe and Martinique, respectively, was initially (1991) calculated and considered necessary to achieve the program. However, EEC, the most important donor, estimated that 75% only of this proposal was acceptable, on which it agrees to support a maximum of 50%. The balance had to be provided by French government, local political institutions, and animal owners. The current budget actualized in 1995 by veterinary authorities of Martinique and Guadeloupe is $7,200,000 and $9,900,000 respectively. The program will take 5 years: preparation (1 year), acaricide application (3 years), surveillance (1 year). During this first year, a pilot committee was established, and a project leader was designated for each island. Efforts were essentially oriented to organize the program in the field and to obtain funds from French and local counterparts. Funds allowed the recruitment and training of 19 new agents in Guadeloupe and 9 in Martinique, in addition to personnel already involved in the tick control program. Census of animal owners and identification of cattle started or were developed. Tenders were invited to provide vehicles and acaricides. For the latter, choices were made considering the prices and efficacy as well as funds available. Due to a limited budget and cost of pour-on formulations, pour-on acaricides will be used on a maximum of 30% of animals only. In order to investigate animal owners' reticences and the most appropriate media channels to establish a communication and a training program, a survey was conducted in Guadeloupe on a sample of 301 animal owners. The results are presented. In order to strengthen the chances of success of the campaign in the French islands, it is expected that a similar program will take place soon in infested neighboring islands.
Animals↗
Levels of evidence: universal newborn hearing screening (UNHS) and early hearing detection and intervention systems (EHDI).
UNLABELLED: Levels of evidence differ according to the audience addressed. Implementation of universal newborn hearing screening requires responses to a complex myriad of diverse groups: the general public, families with children who are deaf or hard of hearing, the deaf and hard of hearing communities, hospital administrators, physicians (pediatricians, general practitioners, ear nose and throat physicians, geneticists), managed care, Medicaid, insurance agencies, and politicians. The level of evidence required by medical/health agencies and task forces may differ from the levels of evidence available in education and intervention. Issues related to the low incidence of the disability, the lack of a normal distribution within the disability study, the obstacles to random assignment to treatment, and designs that include a control group with "no treatment" have implications legally and ethically for the professional providing services to families and children who are deaf or hard of hearing. This session will discuss issues related to "convenience samples," number of subjects included in research studies, and the population required to obtain a large enough sample of children with low-incidence disabilities. The level of evidence required to demonstrate sensitive periods of development, which are a critical element for justification of implementing a universal newborn hearing screening includes both behavioral and neurological information. Sensitive periods may have different duration for different aspects of development, such as social-emotional development, auditory and speech development, or language development. Further complicating the question of sensitive periods of development are the distinct possibility that different sensitive periods exist for development of age-level vocabulary, for establishing English phonology, or for mastering English syntax. Research outcomes provide evidence that age of identification of hearing loss is reduced, that age of intervention initiation is lowered, and that the outcomes of intervention are better because of the establishment of a screening program. Most professionals in communication disorders believe that screening is not the actual cause of better developmental outcomes but that the age when children begin to have access to language and communication and the characteristics of the intervention are the primary cause of better outcomes. Screening is the avenue through which access to quality intervention is made available. The research still remains at an infant level of development such that there is very little evidence for the efficacy of specific characteristics of the intervention provided. LEARNING OUTCOMES: (1) The learner will be able to identify the obstacles in conducting research on the effectiveness of intervention of children identified through universal newborn hearing screening programs. (2) The learner will be able to identify the type of research on developmental outcomes of children with early-identified hearing loss.
Cost-Benefit Analysis↗
Art and community health: lessons from an urban health center.
Staff at a nurse-managed urban health center conducted a series of art sessions to benefit the community. The authors believe the program's success clearly communicated the relationship between art and community health. As a result of the success of the sessions, plans are in the works to make art a permanent part of the health center's services.
Art↗
Bringing the community in: partnerships for aging enrichment.
Aging enrichment of undergraduate social work curricula ensures that program graduates will be prepared to practice with older adults. This article reports the results of focus group research that was designed to engage social workers from community agencies serving older adults in preparing students to become "aging-savvy" social workers. The workers highlighted the importance of wide-ranging exposure to older adults, the changing needs of older adults, and the importance of increasing students' comfort with self-determination. These findings informed the program's ongoing curricular transformation process through the incorporation of new assignments that enabled increased contact with older adults in a variety of settings.
Aged↗
[Evaluation of epidemiologic surveillance practice in the public health service in Brazil].
The results of a process evaluation of the epidemiological surveillance activities in 948 health units, situated in 98 of the most populated cities of each State in the country are presented. The survey was conducted towards the end of 1985. The following aspects were analyzed: information system, data analysis, epidemiological investigation. Institutional insertion, vaccination activities, management aspects and capacitation of the health worker were considered as potential determinants of performance. Data were submitted to correspondence analysis and a process of ascendant hierarchical classification, using the statistical package "Systeme Portable Pour L' Analise de Données-SPAD". The performance pattern was not found to be homogeneous. Six different classes of epidemiological surveillance practice in the health units were observed. In 53.7% of the services visited, even the most elementary norms of activity were not complied with. The presence of vaccination activities in the health units was associated with better performance in epidemiological surveillance. The study points to the need to review the epidemiological surveillance model in use in Brazil. It is no longer acceptable to restrict the practice of epidemiology in health services to communicable diseases, now to manage programs and services without epidemiological information.
Brazil↗
Medical education and disability discrimination: the law and future implications.
Students with disabilities who are preparing for careers in health care have been in the forefront of those bringing suit under Section 504 of the Rehabilitation Act of 1973. Passage of the Americans with Disabilities Act in 1990 broadened discrimination statutes and renewed attention to students with disabilities in medical education. Based on an analysis of the statutes and case law, the courts in conjunction with medical educators may be expected to refine policies to identify (1) when physicians with disabilities are otherwise qualified; (2) what the essential tasks performed by physicians are; (3) what accommodations to disabled students are reasonable; and (4) how communications about disabilities between program administrators, faculty, and students should be carried out. To ensure that physicians with disabilities are welcome and productive members of the profession, policy must expand from the legal foundation by means of proactive planning and evaluation to minimize the risks of litigation and enhance the environment of medical education.
Civil Rights↗