Family planning's benefits include improved child health and nutrition: new data from Bangladesh.
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Asia↗
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General theory of paradigms in health.
In Costa Rica, three sequential health paradigms have been identified over the last 50 years. The first began to develop during the 40's and has been called that of the deficiency diseases, since with a diachronic approach it placed excessive emphasis on malnutrition. The second began in 1970 and it is known as that of the infectious diseases, since through a holistic or synchronic approach, it underlined the importance of infections in high rates of morbidity and mortality. The third and last is the paradigm of the chronic diseases, it appeared in the 80's and is presently in process, doing battle with the chronic ailments, life styles, and environment, and it also utilizes a holistic approach. The recognition of these three paradigms has permitted Costa Rica a rapid advance in improving the health of its population, to the point that with a per capita outlay of $130 (US dollars), it has indices similar to those of the industrialized nations. This particular experience could be useful for other less-developed countries that are still applying the paradigm of the deficiency diseases.
Adult↗
Cost-effectiveness analysis of family planning programs in rural Bangladesh: evidence from Matlab.
The Family Planning Health Services Project in Matlab is often seen as more expensive than similar activities carried out by the government of Bangladesh. At the same time, it as been observed that the project is much more effective. The alleged high cost of the project is said to make it difficult to replicate throughout the nation. Previously, the true costs of the project had not been documented. This study systemically examines the cost of the project and assesses its cost-effectiveness. An experimental design framework is used as a basis for understanding the cost-effectiveness of the project, although a sensitivity analysis lends further support to the relative efficiency of the approach undertaken in Matlab. Although in the aggregate, the Matlab Project is more expensive than the government's family planning program, it is also more effective, generating enough output to offset the extra costs of the intensified delivery system.
Bangladesh↗
Nutrition interventions: problems associated with expanding pilot/demonstration projects into national-level programs.
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Adult↗
Post family planning acceptance experience in the Caribbean: St. Kitts-Nevis and St. Vincent.
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Adolescent↗
An attempt to reduce infant and child mortality in Bohol, Philippines.
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Abortion, Induced↗
Developing and maintaining the hemophilia program in Thailand.
Developing of the hemophilia program in Thailand during 1978-1990 has been achieved step by step as follow: 1. In 1978, organizing a series of scientific conferences to motivate and recruit expert teams and to have support from the health authority. 2. In 1978, a national survey of hemophilia which showed an incidence of 1:13,000 of population. 3. Training medical and paramedical personnel during 1973-1992. 4. In 1980, establishment of the National Hemophilia Society. 5. Improvement of blood bank and blood product supported by National Blood Center, Red Cross Society during 1960-1992. 6. In 1981, submitting hemophilia program to the 5th National Health Developmental Plan for 1982-1986. 7. Establishment of a nationwide hemophilia care program by integration with the national health care system. 8. In 1979, starting a home care program and initiation of comprehensive hemophilia care. 9. In 1982, promotion of comprehensive hemophilia care surgical orthopedic correction. 10. Promotion of local manufacture of equipment, reagents, therapeutic material and modification of technology. 11. In 1987, carrier detection. 12. In 1990, laboratory set up for prenatal diagnosis. The future plan is described for the years 1992-2000.
Blood Banks↗
Pension integration and Social Security reform.
Many employer-provided pensions plans explicitly account for Social Security in their benefit formulas-a practice known as integration. Because integrated pensions are directly linked to Social Security, both the incidence and design of explicitly integrated plans are likely to be affected by changes in the current Social Security program. While integration has been mentioned as an important issue in discussions of Social Security reform, researchers have largely ignored the concept of pension integration. This article provides basic information about pension integration and addresses, in general terms, the relationship between Social Security reform and pension integration.
Female↗
Personal empowerment program: addressing health concerns in people with schizophrenia.
Three staff nurses in the Outpatient Schizophrenia Service of the Foothills Medical Centre in Calgary, Alberta, Canada, became concerned about the weight gain of their patients. Patients and their family members were also concerned and asking for help. Before integrating a program to address these concerns, staff first had to demonstrate that a program of this nature would be beneficial for clinic patients. Of the 75 clients screened, many presented with problems in the areas of weight, blood pressure, and fasting blood sugar and lipid levels. Although not a research study, an 8-month pilot project was implemented to address these concerns. It was hypothesized that integrating all dimensions of wellness in patient programming would have a positive effect on various defined indicators (e.g., weight, body mass index, blood pressure, and fasting blood sugar and lipid levels). Screening tests before, during, and after the 8-month project provided the physical outcome measurements. Social and psychological outcomes were described through observation and group member feedback. The positive results are significant in terms of empowering patients in the long-term management of their health.
Adult↗
Development and evaluation of a vertebral fracture assessment program using IVA and its integration with mobile DXA.
Currently, it is unusual to combine evaluation for vertebral fracture with measurement of bone mineral density in clinical practice. Using Quantitative Morphometric Vertebral Analysis (Instant Vertebral Assessment [IVA]) in our existing Mobile Dual-Energy X-Ray Absorptiometry (DXA) Program, we implemented a testing procedure that examined 5 different IVA protocols focusing on clinical utility and cost. Using small-scale tests of change (PDSA cycles), data from the preceding cycle drives the development of the next cycle. In this article, we describe the process and rationale for selecting patients for the IVA study. In addition, we review the literature on vertebral fracture assessment using DXA and emphasize the clinical utility of point of service testing by providing the needed knowledge for best patient care by simultaneous DXA and IVA testing. The application of this new technology increased identification of the high-risk patient by 11%, with a nominal additional cost per DXA study of $14. This study provides a useful framework for the integration of IVA into a clinical DXA program.
Absorptiometry, Photon↗
SIVA: diagonal integration of spatial multi-omics data via spatially informed variational autoencoders and anchor guidance.
MOTIVATION: Understanding cellular states and regulatory programs requires integrative analysis of multiple omics layers. Although recent spatial sequencing technologies allow molecular profiling of cells within their tissue context, paired spatial multi-omics assays are still limited by technical complexity and cost. This creates a pressing need for diagonal integration methods that enable joint analysis of unpaired spatial omics datasets. RESULTS: We propose SIVA, a deep generative framework based on Spatially-Informed Variational Autoencoders with Anchor Guidance, for diagonal integration of spatial multi-modal data. SIVA employs modality-specific variational autoencoders (VAEs) with a hybrid latent embedding that integrates Gaussian process and standard Gaussian priors, enabling joint modeling of spatially structured variation and dominant underlying data distributions across modalities. To facilitate cross-modal alignment in the absence of one-to-one cell correspondence, SIVA adopts a dual integration strategy combining global distribution alignment via Maximum Mean Discrepancy and local correspondence guidance using mutual nearest neighbor anchors. Extensive experiments across multiple cross-slice integration scenarios demonstrate that SIVA achieves robust and accurate integration of unpaired spatial omics datasets, consistently outperforming existing methods. AVAILABILITY AND IMPLEMENTATION: The source codes are available at https://github.com/PelenJiang/SIVA.
Autoencoder↗
Nonlinear SPICE models for physiologic systems.
Most biological systems are nonlinear but investigators interested in modeling them often make linear approximations to avoid performing tedious manual calculations. SPICE (Simulation Program with Integrated Circuit Emphasis, developed at the University of California, Berkeley, CA), an electrical circuit simulation program, is frequently used for creating and analyzing linear network models of physiologic and pathophysiologic processes. However, few investigators use the full capabilities of the program by modeling nonlinear elements. We developed six nonlinear SPICE elements, allowing simplified modeling of most commonly encountered physiologic processes. These are provided as subcircuits that can be easily incorporated into existing SPICE models. Included are voltage and current controlled nonlinear resistors, capacitors and inductors. In addition, we describe adders, multipliers, powers, inverse, and derivative functions.
Computer Simulation↗
School-based mental health services: a research review.
This paper provides a synthetic review of research on school-based mental health services. Schools play an increasingly important role in providing mental health services to children, yet most school-based programs being provided have no evidence to support their impact. A computerized search of references published between 1985 and 1999 was used to identify studies of school-based mental health services for children. Study inclusion was determined by (i) use of randomized, quasi-experimental, or multiple baseline research design; (ii) inclusion of a control group; (iii) use of standardized outcome measures; and (iv) baseline and postintervention outcome assessment. The application of these criteria yielded a final sample of 47 studies on which this review is based. Results suggest that there are a strong group of school-based mental health programs that have evidence of impact across a range of emotional and behavioral problems. However, there were no programs that specifically targeted particular clinical syndromes. Important features of the implementation process that increase the probability of service sustainability and maintenance were identified. These include (i) consistent program implementation; (ii) inclusion of parents, teachers, or peers; (iii) use of multiple modalities; (iv) integration of program content into general classroom curriculum; and (v) developmentally appropriate program components. Implications of these findings and directions for future research are discussed.
Affective Symptoms↗
Adherence to a dietary fat intake reduction program in postmenopausal women receiving therapy for early breast cancer. The Women's Intervention Nutrition Study.
PURPOSE: To evaluate the feasibility of integrating a program based on dietary fat intake reduction into adjuvant treatment strategies for postmenopausal women receiving therapy for early breast cancer. PATIENTS AND METHODS: Two hundred ninety postmenopausal women with localized (stage I to IIIa) breast cancer receiving conventional systemic therapy provided informed consent and were randomized in a multicenter trial to either a dietary intervention group receiving a program of individualized instruction for reducing total fat intake or a dietary control group with minimal dietary counseling. RESULTS: Significantly reduced (P < .001) fat intake (in terms of percent calories derived from fat) was observed in the intervention group versus the control group at 3 months (20.3% +/- 2.4% v 31.5% +/- 2.6%, mean +/- SD, respectively) and maintained throughout 24 months of observation. The 50% reduction in daily fat-gram intake (from 66 +/- 23 to 33 +/- 14 g, P < .001) seen at 6 months was associated with reduced saturated fat, monounsaturated fat, polyunsaturated fat, and linoleic acid (P < .001). Significantly lower body weight was also seen in intervention compared with control patients at all observation periods, resulting in a 3.3-kg weight difference 18 months after randomization (P < .001). CONCLUSION: Substantial and sustained dietary fat reduction with associated weight change can be achieved at relatively low cost within the context of conventional multimodality clinical management of postmenopausal women with localized breast cancer. This result supports the feasibility of conducting a full-scale evaluation of the influence of dietary fat intake reduction on the clinical outcome of breast cancer patients.
Aged↗
DOC as an integral part of the community medicine curriculum.
Involving family practice residents in community medicine experiences can be a challenging task, and various programs have approached this curricular problem in different ways. The Cedar Rapids program has integrated the activities of the local Doctors Ought to Care (DOC) chapter into the residency with the goal of exposing residents to the concepts of community health education. DOC, a national organization interested in community health promotion and education, takes a lively approach to information sharing using image-based techniques.
Community Medicine↗
Implementing evidence-based practice: reducing risk for low birth weight through pregnancy smoking cessation.
In 1989, the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) developed a research utilization program to integrate evidence into practice areas where there were large discrepancies between research evidence and clinical practice. The current program, renamed Research-Based Practice (RBP), uses translational research methods to build from evidence such as that in the Cochrane database and to create protocols for integration of research directly into clinical practice. This article describes the development of the sixth project (RBP6), in which an evidence-based protocol to address smoking in pregnancy was integrated into clinical practice. The protocol includes screening women using descriptive statements and integrates the 5 As (ask, advise, assess, assist, arrange) into prenatal and postpartum care at every visit. By integrating smoking cessation counseling into care, nurses may reduce the risk of low birth weight among pregnant women in both the United States and Canada.
Female↗
Community integration and satisfaction with functioning after intensive cognitive rehabilitation for traumatic brain injury.
OBJECTIVE: To evaluate the effectiveness of an intensive cognitive rehabilitation program (ICRP) compared with standard neurorehabilitation (SRP) for persons with traumatic brain injury (TBI). DESIGN: Nonrandomized controlled intervention trial. SETTING: Community-based, postacute outpatient brain injury rehabilitation program. PARTICIPANTS: Fifty-six persons with TBI. INTERVENTIONS: Participants in ICRP (n=27) received an intensive, highly structured program of integrated cognitive and psychosocial interventions based on principles of holistic neuropsychologic rehabilitation. Participants in SRP (n=29) received comprehensive neurorehabilitation consisting primarily of physical therapy, occupational therapy, speech therapy, and neuropsychologic treatment. Duration of treatment was approximately 4 months for both interventions. MAIN OUTCOME MEASURES: Community Integration Questionnaire (CIQ); and Quality of Community Integration Questionnaire assessing satisfaction with community functioning and satisfaction with cognitive functioning. Neuropsychologic functioning was evaluated for the ICRP participants. RESULTS: Both groups showed significant improvement on the CIQ, with the ICRP group exhibiting a significant treatment effect compared with the SRP group. Analysis of clinically significant improvement indicated that ICRP participants were over twice as likely to show clinical benefit on the CIQ (odds ratio=2.41; 95% confidence interval, 0.8-7.2). ICRP participants showed significant improvement in overall neuropsychologic functioning; participants with clinically significant improvement on the CIQ also showed greater improvement of neuropsychologic functioning. Satisfaction with community functioning was not related to community integration after treatment. Satisfaction with cognitive functioning made a significant contribution to posttreatment community integration; this finding may reflect the mediating effects of perceived self-efficacy on functional outcome. CONCLUSIONS: Intensive, holistic, cognitive rehabilitation is an effective form of rehabilitation, particularly for persons with TBI who have previously been unable to resume community functioning. Perceived self-efficacy may have significant impact on functional outcomes after TBI rehabilitation. Measures of social participation and subjective well-being appear to represent distinct and separable rehabilitation outcomes after TBI.
Adult↗
Evaluation of an integrated workers' compensation/managed care pharmacy benefit program: employee satisfaction and health outcomes.
In response to rising costs, New York State developed an integrated workers' compensation/managed care pharmacy benefit program, ONECARD Rx. This study examined the effect of the program on employee satisfaction and health outcomes. The study design is cross-sectional; the two main study groups comprised users and nonusers of ONECARD Rx between January 1998 and March 2000. All 462 users and a sample of 880 nonusers were surveyed. More than 80% of ONECARD Rx users rated their prescription drug program as excellent, very good, or good compared with 47% of nonusers (P < .01). Of the least desirable features of ONECARD Rx were the time to get the prescription filled and the need to have a workers' compensation number to use the benefit, both of which may be a factor of the short period of exposure time to the benefit. No significant differences in health status were detected among users and nonusers. This study reveals that integration of workers' compensation and managed care pharmacy benefit programs is a promising innovative strategy to improve quality.
Canada↗