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PubMed1997

[Educational components of school health promotion programs].

To implement an education initiative on school health in the Region, PAHO and other agencies will disseminate knowledge and experiences to schools in various countries throughout the Americas, organize meetings and workshops for the purpose of strengthening institutional capacity to identify the needs of local health education systems, and put into practice strategies to promote health and strengthen schools' involvement in this area. To determine a country's ability to set up and evaluate school health programs, the rapid assessment and analysis methodology will be used. This methodology, which arose in response to the need of governments to make decisions, formulate policies, and design programs on the basis of knowledge of the individual and collective behavior of their beneficiaries, is a useful tool for decision making and facilitates coordination mechanisms between the health and education sectors. In addition, it contributes quantitative and qualitative information for program review and analysis in an average of two months. This information is obtained through the compilation of data from secondary sources, interviews with key informants, and discussions with focal groups made up of formal and informal community leaders.

Adolescent↗
PubMed1994

Outcome of psychoeducation for HIV risk reduction.

Our objectives were to assess the effects of a psychoeducational (PE) program designed to reduce HIV risk behaviors in recovering drug abusers and to evaluate mediating variables associated with risk reduction as described by the AIDS Risk Reduction Model (ARRM). Consecutive admissions to a Department of Veterans Affairs drug dependence inpatient treatment program (n = 152) were randomly assigned to PE or a standard information (INFO) condition. PE involved a 6-hour small group intervention designed to enhance knowledge and attitudes regarding HIV prevention, improve skills in condom use and needle sterilization, and modify high-risk sex- and drug-related behaviors. The INFO condition involved presentation of audiovisual and printed HIV prevention material with similar content. Following intervention, PE subjects showed significantly enhanced self-efficacy, condom use skills, and sexual communication skills relative to the INFO group. At 3-month follow-up, the PE group showed significantly greater reductions on some measures of sexual HIV risk behaviors relative to the INFO group. Hypotheses derived from the ARRM regarding presumed relationships between positive changes in mediating variables (e.g., self-efficacy and sexual communication) and ultimate outcome variables (e.g., condom use) were supported.

Adult↗
PubMed2001

Clinical nurse specialist as facilitator of interdisciplinary collaborative program for adult sickle cell population.

This article describes the evolution, implementation, and outcomes of a collaborative interdisciplinary inpatient program designed to improve the quality of healthcare provided to adult patients with sickle cell disease. Efforts by the clinical nurse specialist were directly responsible for improved patient education, more efficacious treatment of painful crises, and increased specialty consultation. Staff and patient satisfaction with the program have been very encouraging, and a city-wide initiative that embraces a comprehensive approach to the global care of this special needs population has been designed and is currently being implemented.

Adult↗
PubMed1995

Tobacco prevention education in a pediatric residency program.

OBJECTIVE: To report the impact of a tobacco intervention in a pediatric residency program. DESIGN: Residents and faculty took pretests and posttests and follow-up surveys 6 months later. SETTING: An urban, university-affiliated, county medical center. INTERVENTION: An educational program of three presentations, written materials, and a bulletin board. RESULTS: Significant improvement in counseling and confidence in counseling. Perceptions of barriers to counseling, specifically expertise, time limitation, and doubts regarding counseling effectiveness diminished. Residents changed less than faculty in particular areas. There were no differences between the posttests and the follow-up survey 6 months later. CONCLUSIONS: Pediatric health professionals in an academic setting, given an educational program, will change their behaviors and attitudes about their role in counseling patients about tobacco use.

Adult↗
PubMed1991

The Health Security Partnership. A federal-state universal insurance and cost-containment program.

The Health Security Partnership attempts to assure (1) that all Americans have insurance coverage for a set of comprehensive health care benefits, (2) that cost-containment issues are addressed in a manner that does not impinge negatively on the quality of care, and (3) that provider freedom to deliver appropriate clinical care is strengthened. It assigns important responsibilities to the federal government (eg, specification of benefits, review of proposed state health care budgets), while permitting states to select, develop, and administer specific program design features they deem appropriate (eg, states could build on and expand the existing health system infrastructure, including private insurance, and/or extend the role of tax-supported programs). It is estimated that in its first year the program would add about 5% to America's health expenditures, but within a few years, cost-containment efforts and administrative efficiencies would reduce overall expenditures below what they otherwise would be.

Comprehensive Health Care↗
PubMed1976

Community assistance for rape victims.

This paper describes a program designed to use trained volunteer companions in crisis intervention with rape victims in a public hospital emergency room. The history of the extensive negotiations necessary to implement the program and detailed descriptions of volunteer training are included. Results are largely in the form of subjective experience.

Colorado↗
PubMed2000

Hitting a moving target: income-related health insurance subsidies for the uninsured.

New government health insurance programs are likely to emphasize voluntary purchases in a market setting, with subsidies targeted at low-income populations and stress on managed care. Such programs are best structured with a guaranteed enrollment period that is as long as six months to a year. However, given that incomes change over time, errors will be made in awarding income-related subsidies for that long. These errors are assessed in simulations undertaken with longitudinal data from the Survey of Income and Program Participation. Two allocations of the subsidies, based on current income at the beginning of the enrollment period and on actual income assessed at the end, are compared for a variety of program designs. Prospective determination of subsidies is somewhat biased toward overpayment. Net overpayments amount to 5-10 percent of subsidy costs. However, prospective payment encourages participation in the subsidy program. The simulated participation rate for true eligibles is as high as 73 percent with prospective subsidies, compared to 69 percent with retrospective reconciliation. Net overpayments are slightly reduced by testing income less frequently and over longer periods.

Child↗
PubMed2004

Effectiveness of the HomeSafe Pilot Program in reducing injury rates among residential construction workers, 1994-1998.

BACKGROUND: The construction industry typically has one of the highest fatal and non-fatal injury rates compared with other industries. Residential construction workers are at particular risk of injury (work is in remote sites with small crews, there are often many subcontractors, and they have limited access to safety programs). Difficulty accessing information specific to this group has made research more challenging, therefore, there are few studies. This study evaluated the effectiveness of the HomeSafe Pilot Program, a safety education and training program designed to reduce injuries among residential construction workers. METHODS: Researchers evaluated whether overall and severe injury incidence rates declined during the intervention period. Data were analyzed using incidence rates and Poisson regression to control for the effect of antecedent secular trend. RESULTS: Injury incidence rates declined significantly following HomeSafe; however, this effect was not statistically significant once temporal variation was controlled. CONCLUSIONS: The decline in injury rates following HomeSafe cannot be attributed solely to HomeSafe, however, programmatic and methodologic limitations contributed to the inconclusive results. Further research into the hazards faced by residential construction workers is needed. Am. J. Ind. Med. 45:210-217, 2004.

Accidents, Occupational↗
PubMed1984

Computer literacy in today's medical center environment.

The need for computer literacy is becoming increasingly important across the broad scope of the American work scene. At the Wilford Hall USAF Medical Center (WHMC) numerous computer systems have been introduced into the operational environment. Training for these systems has been restricted primarily to transaction processing and routine report generation for those actually involved as users of these systems. WHMC has developed and implemented a broad computer literacy program designed generally to raise the computer literacy of the overall staff, and specifically to inform executive and middle management of the general capabilities of the computer systems. The program consists of a brown-bag lunchtime videotape theater on a series of computer-related subjects as well as formal classes developed in a modular format. Each formal class is tailored to the specific needs of the target executive or middle-management group.

Administrative Personnel↗
PubMed2002

Admissions caused by adverse drug events to internal medicine and emergency departments in hospitals: a longitudinal population-based study.

OBJECTIVE: To estimate incidence rates of drug-related hospitalizations (DRHs) in a longitudinal population-based study with prospective event assessment. DESIGN: Cohort study and time-trend analysis. SETTING: All departments of internal medicine and emergency departments in the urban regions of Jena and Rostock, Germany, serving about 520,000 residents. PARTICIPANTS: All patients admitted between October 1997 and March 2000. Patients with severe cutaneous reactions were excluded. MAIN OUTCOME MEASURES: Incidence of DRH was defined by symptoms or diagnoses at admission that were very likely, likely, or possibly caused by prescription medications, according to a standardized assessment. RESULTS: The incidence of DRH was 9.4 admissions per 10,000 treated patients [95% confidence interval (CI) 9.0-9.9]. Rates were highest for antithrombotics with 26.9 admissions per 10,000 treated patients (95% CI 23.6, 30.1). Most frequent events were gastroduodenal lesions and bleeding (45%). Digitalis preparations showed a linearly increasing trend from 2/10,000 to 14/10,000 during ten quarters ( P<0.0001), which was exclusively attributable to digitoxin, the major source of digitalis in the study area (93%). The incidence of DRH increased with age (4/10,000 to 20/10,000). The mean length of stays in patients with DRH was 13+/-10.6 days. Cumulative direct costs for hospitalization were Euro 4 million in the two urban study areas. The annual direct costs for Germany were estimated to be Euro 400 million. CONCLUSIONS: DRHs are a considerable public health and economic burden. A longitudinal design can observe changes in population-based incidence over time. This approach can be used for public-health planning or to evaluate outcomes of quality management programs designed to reduce drug-induced illness.

Adolescent↗
PubMed1995

Does intrauterine insemination offer an advantage to cervical cap insemination in a donor insemination program?

OBJECTIVE: To compare pregnancy outcome after IUI versus cervical cap insemination in a donor insemination program. DESIGN: A randomized prospective clinical trial in which patients were alternately inseminated with cryopreserved human semen using either IUI or cervical cap insemination methods. SETTING: The donor insemination program at Washington University School of Medicine. PATIENTS: Forty-two women with either isolated male factor or male factor plus corrected ovulatory dysfunction using clomiphene citrate underwent 141 cycles of donor insemination. MAIN OUTCOME MEASURES: Clinical pregnancy rates (PRs) defined as a viable intrauterine gestation > 12 weeks or delivered were compared between groups using the chi 2 test. RESULTS: Clinical PRs were significantly higher in the IUI group (16.4%) compared with the cervical cap insemination group (5.9%). The spontaneous abortion rates were similar between the IUI (1.4%) and cervical cap insemination groups (4.4%). CONCLUSIONS: These findings suggest an advantage to IUI over cervical cap insemination in a donor insemination program.

Abortion, Spontaneous↗
PubMed1998

The suitability and efficiency of human follicular fluid as a protein supplement in human in vitro fertilization programs.

OBJECTIVE: To evaluate the suitability and efficiency of human follicular fluid (HFF) as a protein supplement in human IVF programs. DESIGN: Comparative study of the effects of HFF and other protein supplements on the in vitro development of mouse oocytes and on the pregnancy rate in human IVF programs. SETTING: In Vitro Fertilization Center, Hanna Women's Clinic, Seoul, Korea. PATIENT(S): Three hundred twenty-seven patients (388 cycles) who were down-regulated with GnRH agonist and stimulated with hMG. INTERVENTION(S): The suitability was evaluated with the results of animal studies and the efficiency of HFF was investigated with the results of human IVF programs. MAIN OUTCOME MEASURE(S): Meiotic maturation of mouse oocytes, development of mouse embryos, morphological grades of human embryos, pregnancy rate in human IVF programs, and electrophoresis. RESULT(S): Human follicular fluid significantly stimulated meiotic resumption in mouse oocytes, even in the presence of meiotic inhibitors, and enhanced the developmental potential of mouse embryos in vitro. Compared with human fetal cord serum, human follicular fluid also improved the morphological grade of human embryos by reducing cytoplasmic fragmentation. In conventional IVF cycles of human IVF programs, use of HFF significantly increased the clinical PR (109/234 cycles, 46.5%; P < .05), compared with use of human fetal cord serum (14/52 cycles, 26.9%). However, in intracytoplasmic sperm injection cycles, there was no difference in PRs between use of HFF (38/85 cycles, 44.7%) and use of human fetal cord serum (7/17 cycles, 41.1%). When the protein compositions of human fetal cord serum and HFF were investigated by electrophoresis, a protein of 21 kD was detected specifically in HFF. CONCLUSION(S): Human follicular fluid is suitable for use as a protein supplement and is effective in increasing the pregnancy rate in human IVF programs.

Animals↗
PubMed2001

An educational approach to improving physician breast cancer screening practices and counseling skills.

A multifaceted, individualized, physician education program designed to increase the breast cancer screening practices of community-based primary care physicians is described and the results are evaluated. Community-based surveys identified primary care providers with breast cancer screening educational needs who were assigned, using a factorial design, to an intervention or control condition. The sample included 154 control and 128 intervention physicians. The intervention consisted of a 1-2h in-office training program and/or self-study workbook. Self-reported overall breast cancer screening need scores improved for a greater proportion of intervention than control physicians, particularly those receiving the in-office intervention (P=0.03). Clinical breast examination (CBE) need declined (P=0.01); use of provider reminder systems increased (P=0.02); preparedness to counsel about CBE (P=0.04) and recognition that age is an important risk factor for breast cancer (P=0.02) improved in more intervention compared to control physicians.

Adult↗
PubMed1997

Laboratory diagnostic tests for retrovirus infections of small ruminants.

The most practical and reliable approach to confirming a diagnosis of OPPV or CAEV infection is a combination of serology and clinical evaluation. Although serology represents the most cost effective method of diagnosing persistently infected, clinically normal animals, testing errors occur; the frequency of error depends on the performance data of the particular serologic assay being used. When PCR detection of OPPV and CAEV becomes routinely available, this detection method can be used in rigorous eradication programs to determine the infection status of animals that cannot be definitively diagnosed by serology. The important aspects of OPPV and CAEV infection that must be considered in designing programs to prevent transmission are (1) OPPV and CAEV persist for life in the infected host, (2) a major route of transmission is to lambs and kids via colostrum and milk during nursing, (3) contact transmission among adults can occur, and (4) time variability can exist among individual sheep and goats from infection to the appearance of detectable antibodies.

Animals↗
PubMed2006

Validity of a new automated software program for visceral adipose tissue estimation.

INTRODUCTION: Given the considerable time and research cost of analyzing biomedical images to quantify adipose tissue volumes, automated image analysis methods are highly desirable. Hippo Fat is a new software program designed to automatically quantify adipose tissue areas from magnetic resonance images without user inputs. Hippo Fat has yet to be independently validated against commonly used image analysis software programs. OBJECTIVE: Our aim was to compare estimates of VAT (visceral adipose tissue) and SAT (subcutaneous adipose tissue) using the new Hippo Fat software against those from a widely used, validated, computer-assisted manual method (slice-O-matic version 4.2, Tomovision, Montreal, CA, USA) to assess its potential utility for large-scale studies. METHODS: A Siemens Magnetom Vision 1.5-T whole-body scanner and a T1-weighted fast-spin echo pulse sequence were used to collect multiple, contiguous axial images of the abdomen from a sample of 40 healthy adults (20 men) aged 18-77 years of age, with mean body mass index of 29 kg/m(2) (range=19-43 kg/m(2)). RESULTS: Hippo Fat provided estimates of VAT and SAT that were highly correlated with estimates using slice-O-matic (R (2)>0.9). Average VAT was 9.4% lower and average SAT was 3.7% higher using Hippo Fat compared to slice-O-matic; the overestimation of SAT tended to be greater among individuals with greater adiposity. Individual-level differences for VAT were also substantial; Hippo Fattrade mark gave estimates of VAT ranging from 1184 cm(3) less to 566 cm(3) more than estimates for the same person using slice-O-matic. CONCLUSION: Hippo Fat provides a rapid method of quantifying total VAT, although the method does not provide estimates that are interchangeable with slice-O-matic at either the group (mean) or individual level.

Adolescent↗
PubMed1983

Evolution of a community program for the dying and their families.

A direct outcome of the death and dying movement has been the establishment of community programs designed to provide intervention services, support and education for the dying and their families and for the community at large. This paper discusses the evolution of such a program. Included in the discussion is a brief history, the nature of the program that evolved, problems related to community acceptance, and the current status and future of the program. Although the experiences of this program are to a degree unique, issues are raised that are likely to be common to many such community programs.

Awareness↗
PubMed2005

Teaching Filipino physiotherapists on-shore: an Australian-Filipino collaborative postgraduate health education initiative.

INTRODUCTION: This paper outlines a collaborative, cross-national educational initiative, commenced in 2001, in which an Australian university provided clinical and research education assistance to a Filipino University. The aim was to establish the first Filipino Master of Science in Physical Therapy program that would train physiotherapists in their home country using best available content and teaching expertise. PROCESS: Principles of quality transnational education underpinned the program design and contractual agreements. Australian educational input was tailored to local constraints to ensure efficient and effective delivery of high quality, relevant material. Approximately 60% of the inaugural program was delivered by Australian educators in one-week intensive courses on-shore in the Philippines, using local facilities and case-scenarios. Follow-up support and evaluation were provided by video, email, written workbooks and assignments once these educators returned to Australia. Filipino graduates, who were competent with course content, taught the remaining subjects. In line with an aim of empowering Filipino graduates to assume responsibility for teaching all aspects of the program by 2006, the Australian educators are now teaching less than 25% of the course content to subsequent student cohorts. After 2006, they will provide mentorship only to the program. RESULTS: In 2003, 12 students in the first cohort graduated with Master of Science in Physical Therapy from the University of Santo Tomas (UST). Twenty-four students subsequently enrolled in the second cohort (commenced 2003) and 21 students into the third cohort (commenced 2004). Six of the inaugural graduate cohort are currently acting as tutors for the Australian educators and will assume full teaching roles in 2006. Comparison of feedback from student evaluations at UST indicates significant improvements in teaching quality for the graduates from the inaugural program. Research activity and publications have also increased as a result of completion of the program. DISCUSSION: Such a cross-institutional, cross-national program has not been described previously for physiotherapy, and no other similar health program (for nursing) evaluated the educational processes in the manner used in this program. The program met its aims and has produced sustainable educational outcomes and outputs. CONCLUSION: Future scholarly activities between the two institutions include extension of postgraduate training to other health disciplines, cross-institutional PhD student enrollments and collaborative research.

Australia↗
PubMed2002

Beneficial effect on blood pressure and lipid profile by programmed exercise training in Taiwanese patients with mild hypertension.

Mild essential hypertensive patients comprise a large portion of the hypertensive population. Previous reports have shown that moderate-intensity regular exercise training in these patients usually reduces blood pressure. By designing programmed exercise to evaluate whether it is effective in reducing blood pressure in mild hypertensive patients and also has beneficial effects on other biochemical parameters. Twenty-three mild hypertensive Taiwanese patients (resting blood pressure 139.1 +/- 11.4/99.5 +/- 8.0 mmHg) were divided randomly into two groups: control (no exercise) and moderate-intensity exercise (average 6.4 +/- 0.7 METs). The training group exercised three times per week at the prescribed exercise intensity by using the Treadmill exercise test. Blood pressure, heart rate and other biochemical parameters were monitored regularly every 4 weeks for 12 weeks. After 12 weeks regular exercise training, the exercise group showed for significant resting blood pressure reduction. Mean maximal reduction of systolic pressure was 18 mmHg. Significant reduction of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglyceride were found; elevation of high-density lipoprotein cholesterol (HDL-C) was also noted. These data suggest that after 12 weeks of exercise training in mild hypertensive patients, successful reduction of blood pressure and favorable changes of lipid profile will be noted.

Adult↗