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PubMed2001

Cost-effectiveness of a school-based tobacco-use prevention program.

OBJECTIVE: To determine the cost-effectiveness of a school-based tobacco-use prevention program. DESIGN: Using data from the previously reported 2-year efficacy study of the Project Toward No Tobacco Use (TNT), we conducted a decision analysis to determine the cost-effectiveness of TNT. The benefits measured were life years (LYs) saved, quality-adjusted life years (QALYs) saved, and medical care costs saved, discounted at 3%. The costs measured were program costs. We quantified TNT's cost-effectiveness as cost per LY saved and cost per QALY saved. INTERVENTION: A 10-lesson curriculum designed to counteract social influences and misconceptions that lead to tobacco use was delivered by trained health educators to a cohort of 1234 seventh-grade students in 8 junior high schools. A 2-lesson booster session was delivered to the eighth-grade students in the second year. The efficacy evaluation was based on 770 ninth-grade students who participated in the program in the seventh and eighth grades and in both the baseline and the 2-year follow-up survey. RESULTS: Under base case assumptions, at an intervention cost of $16 403, TNT prevented an estimated 34.9 students from becoming established smokers. As a result, we could expect a saving of $13 316 per LY saved and a saving of $8482 per QALY saved. Results showed TNT to be cost saving over a reasonable range of model parameter estimates. CONCLUSIONS: The TNT is highly cost-effective compared with other widely accepted prevention interventions. School-based prevention programs of this type warrant careful consideration by policy makers and program planners.

Adolescent↗
PubMed1975

Ambulatory pediatric fellowship programs.

Pediatric ambulatory fellowships are post-residency training program designed to prepare pediatricians to deliver, organize, and evaluate primary pediatric care. A survey of the members of the ambulatory Pediatric Association details the funding, structure, content, and outcome of these training programs. The Ambulatory Pediatric Association has recently approved guidelines for the standards and content of these fellowship programs.

Ambulatory Care↗
PubMed1984

Cigarette smoking outcomes at four years of follow-up, psychosocial factors, and reactions to group intervention.

Carried out a study on a sample of male smokers (N = 182) who were at high risk of coronary heart disease (CHD) in order to determine the variables that discriminated between successful and nonsuccessful quitters in a group intervention program designed to lower CHD risk factors. The analysis revealed that baseline level of smoking, life events, personal security, and selected group process variables were predictive of success or failure in the intervention program. Recommendations for future study and clinical application were discussed.

Coronary Disease↗
PubMed1980

Storage and retrieval of bibliographic references using a microprocessor system.

A program is described for the storage and retrieval of bibliographic references. The program, designed for a dual floppy disk microcomputer system, allows fast access to references, which can be retrieved by keywords, by authors' names or by string matching. Provided a printer is available, the program prints reprint requests, while new references are being stored, and prints hard copies of the references. The program also includes the possibility of creating a new bibliographic file from one or more already existing files.

Bibliographies as Topic↗
PubMed1992

Relationship among age, serum cholesterol level and population percentile in adults.

The data of the National Health and Nutrition Examination Survey comprehensively have shown that distributions of serum cholesterol levels in the US adult population are age and sex dependent. General formulas were constructed and published by the author on the basis of the data of the National Health and Nutrition Examination Survey to predict the population percentile for serum cholesterol levels by age. A mathematical model and a computer program previously published by the author were employed in the study. Analysis of the computer-assisted predicted and the National Health and Nutrition Examination Survey-reported percentiles indicated that the designed program for calculating the formulas was accurate and reliable. The formula could determine the relationship among adult age, serum cholesterol level and population percentile. A comprehensive table and nomograms that show the relationship among age, serum cholesterol level and population percentile in men and women for each year group between 20 and 79 years of age are obtained in this study, using the previously published formulas. The population percentiles predicted by the formula may reflect the relative degrees of risk for coronary heart disease. The population percentile, simultaneously expressed as 'risk percentile', may be used as a parameter of risk assessment for coronary heart disease for all adult ages and sexes. Seventy-five population percentile of serum cholesterol level is suggested as a cutoff point of high 'risk percentile' for coronary heart disease. This information on the percentile may have a preventive diagnostic value for detection, evaluation and treatment of patients with high cholesterol levels. The comprehensive table and nomograms showing the relationship among age, serum cholesterol level and population percentile may be hopefully available to clinicians and useful in their medical practice and may also be helpful in future clinical investigation.

Adult↗
PubMed1986

Transfer of numeric ASCII data files between Apple and IBM personal computers.

Listings for programs designed to transfer numeric ASCII data files between Apple and IBM personal computers are provided with accompanying descriptions of how the software operates. Details of the hardware used are also given. The programs may be easily adapted for transferring data between other microcomputers.

Computers↗
PubMed2000

Evaluation of the utility of NMR structures determined from minimal NOE-based restraints for structure-based drug design, using MMP-1 as an example.

The application of deuterium labeling and residual dipolar coupling constants in combination with other structural information has demonstrated the potential for significantly expanding the range of viable protein targets for structural analysis by NMR. A previous study by Clore et al. [(1999) J. Am. Chem. Soc. 121, 6513-6514] demonstrated that a significant improvement in the overall protein structure occurs with the combination of residual dipolar coupling constants and minimal tertiary long-range distance restraints. The analysis of NMR protein structures determined with minimal structural information is extended with a particular interest in the utility of these structures for a structure-based drug design program. As an example, the catalytic fragment of human fibroblast collagenase (MMP-1) was used to follow the effect of minimal restraint sets on the protein structure and its utility in drug design with a particular interest in the effect on the active site conformation. An MMP-1 structure that was calculated with the maximal number of restraints attainable with the constraint of a deuterated protein was shown to be very similar to a high-quality MMP-1 structure that was calculated from a complete set of restraints. The superposition of the active site backbone atoms for the high-quality and minimal restraint MMP-1 structures yielded an rmsd of 0.68 A where the size and shape of the S1' pocket are nearly identical. Additionally, an MMP-1-CGS-27023A complex based on a minimal set of NOE-based restraints reliably reproduced the structure of the complex, establishing the usefulness of the structures for drug design.

Binding Sites↗
PubMed2001

Cue exposure with coping skills training and communication skills training for alcohol dependence: 6- and 12-month outcomes.

AIMS: Cue exposure treatment (CET) has shown promise in preliminary studies with alcoholics, and Communication Skills Training (CST) has been found beneficial, especially in intensive treatment programs. The aim of the present study was to investigate the effects of CET and CST in a larger controlled study when both were added to intensive treatment programs. DESIGN AND INTERVENTIONS: A 2 x 2 design investigated the effects of CET with urge coping skills training compared to a meditation-relaxation control, and CST compared to an education control when all were added to intensive treatment programs for alcoholics. SETTING: The sites were the inpatient or partial hospital substance abuse treatment programs at a private psychiatric hospital, a state-funded residential facility and a VA medical center. PARTICIPANTS: Patients diagnosed with alcohol dependence without active psychosis were eligible. MEASUREMENTS: Participants were assessed for quantity and frequency of drinking, alcohol cue-reactivity, responses to high risk simulations and urge specific coping skills. FINDINGS: Of 100 treated patients, 86% provided 6-month and 84% provided 12-month follow-up data. Patients who received either CET or CST had fewer heavy drinking days in the first 6 months than control patients. In the second 6 months, CET continued to result in fewer heavy drinking days among lapsers and interacted with CST to decrease quantity of alcohol consumed. CST resulted in fewer alcohol-related problems reported at 12 months. CET resulted in greater reductions in urge to drink in a measure of simulated high-risk situations. CET also resulted in greater reports of use of coping strategies during the follow-up, and many of the urge-specific strategies taught in CET were associated with reduced drinking. CONCLUSIONS: Both CET and CST continue to show promise as elements of comprehensive alcohol treatment programs. Limitations and directions for future research are discussed.

Adaptation, Psychological↗
PubMed2000

Milieu-based neurorehabilitation in patients with traumatic brain injury: outcome at up to 11 years postdischarge.

OBJECTIVE: To examine the rate of productivity and competitive activity in participants with traumatic brain injury (TBI) at a milieu-based day treatment neurorehabilitation program. DESIGN: Follow-up data in a cross-sectional design sought from all admissions from May 1986 to May 1998 at 3 months and at year 1, 3, 5, 7, 9, and 11. SETTING: Outpatient milieu-based interdisciplinary day treatment program. PATIENTS: One hundred twelve participants with TBI, representing 78.9% of TBI patients successfully discharged from the program. INTERVENTIONS: Milieu-based interdisciplinary neurorehabilitation (mean length of treatment, 6.2 mo). MAIN OUTCOME MEASURES: Productivity, defined as gainful employment, school, and/or volunteer work, and competitive activity, defined as work for pay or enrollment in school. RESULTS: 88.4% of patients were productive up to 11 years after discharge, with 76.8% engaged in competitive activity and with no decline in productivity seen over time from discharge. CONCLUSIONS: A large majority of patients suffering from TBI are able to return to work or a productive life situation after milieu-based neurorehabilitation. Level of outcome did not significantly decline over an 11-year follow-up interval.

Adolescent↗
PubMed1992

Combination of very-low-calorie diet and behavior modification in the treatment of obesity.

Very-low-calorie diets (VLCDs) cause rapid weight loss. However, weight regain is rapid upon discontinuing the VLCD unless lifestyle is altered. The addition of a behavioral-modification (BMOD) program improves the long-term outcome. The major components of a BMOD program to alter lifestyle are education about nutrition and eating habits with alteration of amount and patterns of eating, institution of an aerobic activity program designed to increase energy expenditure, training in self-awareness and assertiveness, and training in coping techniques for long-term alteration of lifestyle. By retrospective chart review, we evaluated two VLCD programs at the same institution. One program gave 12 wk of BMOD before a 12-wk course of VLCD (Program 1), then scheduled individual visits regularly thereafter. The other program used simultaneous VLCD and BMOD in a 26-wk treatment course (Program 2), consisting of 2 wk of stabilization on 5020 kJ/d (1200 kcal/d), 12 wk of VLCD, and 12 wk of transition to a low-calorie solid food diet. Follow-up was obtained at 1 y in both groups. Maximum weight loss was similar, but subjects in Program 2 regained about one-third of the lost weight versus approximately 10% in Program 2. A third program of preceding BMOD followed by a low-calorie diet (Program 3) gave similar weight maintenance at 1 y as Program 1. Prospective studies are needed to determine if BMOD simultaneously with or preceding VLCD promotes better long-term weight maintenance. These data confirm the benefits of long-term follow-up for maintaining weight loss.

Adult↗
PubMed1991

Intergenerational Partners Project: a model linking elementary students with senior center volunteers.

Age-integrated programming has become an effective way to bring the young and old closer together. This paper describes a 9-month intergenerational program designed to establish a more intimate involvement between a group of 4th graders and elderly volunteers from Senior Neighbors. The format used to organize the project is presented, and ongoing activities and program benefits are identified. The goals of this project have been richly met, reducing students' fears and misconceptions about aging and providing a satisfying experience for the seniors.

Aged↗
PubMedDate not supplied

Improving patient meal satisfaction with room service meal delivery.

Cancer and cancer therapies cause side effects that prevent patients from consuming adequate amounts of food. As evidenced by patient meal consumption studies conducted at patients' bedside, only 39 percent of patients surveyed consumed greater than 50 percent of their main entree. The Food and Nutrition Services Department at Memorial Sloan-Kettering Cancer Center used the organization's performance improvement process, STRAIGHT-A, to develop and execute a room service program designed to increase patient meal consumption and improve patient meal satisfaction A multidisciplinary task force developed policies and procedures and tested new menu items as part of the room service plan. After program implementation, 88 percent of patients surveyed consumed greater than 50 percent of their main entree.

Cancer Care Facilities↗
PubMed1989

Effects of formal support on mothers' adaptation to the hospital-to-home transition of high-risk infants: the benefits and costs of helping.

94 mothers were randomly assigned to a control group or to a group who received a formal support program designed to aid their adaptation to the transition from hospital to home care of high-risk infants. Mothers' predischarge need for support and the severity of infants' predischarge medical problems moderated program effects assessed 6 months after NICU discharge. Positive effects of the program on mothers' sense of competence, perceived control, and responsiveness were evident for mothers who had needed the most support. But at low levels of need for support, participation in the program had negative effects on these outcomes. A similar pattern was found for the effects of the program on mothers' positive mood as a function of the severity of infants' medical problems. Secondary findings suggest why some mothers may benefit from formal support after NICU discharge and others may experience at least temporary disruptions in their adaptation from such support.

Cost-Benefit Analysis↗
PubMed1988

Impact of Medicare's prospective payment system and the farm crisis on the health care of the elderly: a case study.

The spectrum of health care for the rural elderly has been negatively affected by recent changes in Medicare reimbursement policies and by the farm crisis. This case study examined the effects of these changes on the ability of rural hospitals, the aging network, and care-givers to provide adequate and continuous care to the elderly. In this case study, three gaps in services were found: a lack of programs designed to meet the needs of terminally ill patients and their families; a lack of education during the crucial transitional period between hospital discharge and home; and a lack of services and programs for the chronically-ill older adult. More studies are needed to determine if similar service gaps will be found in other rural communities. If so, public attention should be focused on possible solutions.

Aged↗
PubMed2005

Worksite-based parenting programs to promote healthy adolescent sexual development: a qualitative study of feasibility and potential content.

CONTEXT: Parents can play a significant role in promoting healthy sexual development and risk reduction among adolescents, but many are uncertain about how to talk with their adolescents about sex. Worksites provide an untapped but promising setting in which to reach parents to help them develop parenting and communication skills. METHODS: Focus groups with 33 employed parents of adolescents and 41 high school students, and interviews with seven worksite executives, explored the desire for worksite-based parenting programs, how best to implement programs and recommendations for content. Standard qualitative analysis techniques were used to identify major themes in participants' comments. RESULTS: Parents and employers were enthusiastic about worksite-based parenting programs. Parents reported that adolescents are reluctant to talk with them, but acknowledged their own inexperience talking about sex. Their suggestions included that programs be held at lunchtime, give participants opportunities to interact with each other and with facilitators, and give participants exercises to practice at home. Employers described potential benefits (e.g., improved employee morale) and challenges (e.g., privacy concerns) of programs. Teenagers said that their parents made false assumptions about their sexual activity if they asked about sex. Participants suggested that parenting programs cover adolescent development, sex, abstinence and communication (e.g., how to start conversations). CONCLUSIONS: A worksite-based program designed to help parents of adolescents develop communication and parenting skills could provide a way to reach busy parents. Recommendations from parents, employers and teenagers can be used to make such a program appealing and effective.

Adolescent↗
PubMed2005

Understanding participation in an asthma self-management program.

STUDY OBJECTIVE: Asthma education programs improve asthma treatment results significantly. Low participation rate is a recurrent problem that impedes the efficiency of those programs. The purpose of this study was to investigate social cognitive determinants of the intention to participate in an asthma self-management program. DESIGN: Structured interview. SETTING: Outpatient clinic, University Hospital Gasthuisberg, Leuven, Belgium. PATIENTS: One hundred seven asthmatic outpatients (mean age 42 years; 35% male). INTERVENTIONS: Patients received a standard explanation about the asthma program, were invited to participate, and were questioned about their beliefs about the program offered. MEASUREMENTS AND RESULTS: A social cognitive framework (attitude, social influence, and self-efficacy model) was used to compose a structured interview that was administered to assess the patients' attitude toward the program (perceived benefits), their social influence, and self-efficacy expectations to participate (perceived barriers). Asthma-related health behavior and clinical and demographic characteristics were evaluated by means of questionnaires. Fifty-nine percent of the patients expressed the intention to participate. Logistic regression analysis resulted in a model explaining 72% of the variance of intentions (Nagelkerke R(2) = 0.72). Having few structural barriers to participate was a significant predictor of participation (odds ratio [OR], 12.5; 95% confidence interval, 5.2 to 19.3), next to believing in the personal benefits of the program (OR, 7.6; 95% confidence interval, 2.4 to 12.5), social influence (OR, 3.3; 95% confidence interval, 1.3 to 8.4), and education level (OR, 2.7; 95% confidence interval, 1.3 to 5.6). CONCLUSIONS: Recruitment of patients with asthma for an educational program should emphasize personal benefits of the program, should include patients' social network, and should consider the impact of structural barriers on participation behavior.

Adult↗
PubMed1998

[Programs and politics on growth deficit (consequences of a line of research carried out in Chile)].

This communication offers suggestions for programs and policies in relation to stunting within the infant population. The proposal is based on current social strategies and the results of research carried out on Chilean school children. These results indicate that height deficit is concentrated in sectors of the population belonging to low socio-economic levels, and the risk factors are related to the small stature of their parents with a record of undernutrition, small size at birth and low per capita income. This deficit begins early, occurring mainly before the child's second birthday and as a consequence is reflected in below average performance at school of those children living in areas of social vulnerability. Suggestions offered take into account the orientation that should be considered for social policies, the selection of beneficiaries, program contents and management and problems that need to be overcome. Among these, the following issues are highlighted:--That the social welfare programs designed to combat stunting in the infant population should have, as a priority objective, the aim of benefiting sectors of the population most at need. It is vital to include in these programs: adequate pre-natal care of women with a high risk profile of giving birth to a child with intrauterine growth retardation; promotion of child growth; food supplementation and/or fortification, and improvement of physical fitness.--The government should play a leading role in the promotion and management of these programs, in the regulation of private sector involvement, as well as promoting local community participation.--Warnings are given about the inadequacies of present government social welfare policies related to infant nutrition, and the lack of research carried out into the effectiveness of current programs. In relation to future aims, we would like to see more emphasis put into the integration of international and regional intervention programs aimed at combating infant undernutrition. This would include sharing resources and collecting information related to the problem. Finally, all these actions should be aligned and focused on the principal aim; allowing children to reach their full growth potential.

Body Height↗
PubMed1990

Formulas predicting the percentile of serum cholesterol levels by age in adults.

The data of the National Health and Nutrition Examination Survey comprehensively have shown that distributions of serum cholesterol levels in the US adult population are age and sex dependent. General formulas have been constructed on the basis of the data of the National Health and Nutrition Examination Survey to predict the adult percentile in the population for serum cholesterol levels by age. A mathematical model and a computer program previously published by the author were employed in this study. Analysis of the computer-assisted predicted and the National Health and Nutrition Examination Survey-reported percentiles indicated that the designed program for calculating the formula was accurate and reliable. The formulas can determine the relationship among adult age, serum cholesterol level, and population percentile. It has been reported that adult individuals tend to have persistently the same percentiles of their serum cholesterol levels in the population with increasing ages in the absence of cholesterol-altering intervention. The percentiles predicted by the formula may reflect the relative degrees of risk for coronary heart disease. This information on the percentile may have a preventive diagnostic value for the detection, evaluation, and treatment of patients with high cholesterol levels. The percentile may be used as a parameter of risk assessment for coronary heart disease for all adult ages and sexes. However, clarification of a probable relationship between high percentiles (like high cholesterol levels) and coronary heart disease, and justification of the use of percentiles as a risk parameter, must await further clinical investigation.

Adult↗