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PubMed1977

Evaluation of a pilot school health education program for asthmatic children.

A pilot program was conducted and evaluated as a part of the development of a health education program designed to meet the needs of a specified target population. By focusing on a group of children with a common chronic health problem, it was possible to measure specific variables to evaluate the effectiveness of the program. Outcome evaluation together with subjective process information resulted in modification and changes in the program prior to implementation with a larger number of children and schools. The pilot phase conducted with a small number of children was demonstrated to be a critical part of the overall program development.

Asthma↗
PubMed1995

Use of a brief behavioral skills intervention to prevent HIV infection among chronic mentally ill adults.

OBJECTIVE: Research shows that many chronic psychiatric patients are at risk for infection by the human immunodeficiency virus (HIV). This study investigated the effects of a behavioral skills training program designed to prevent HIV infection among chronic mentally ill adults living in an inner-city area. METHODS: Twenty-seven men and 25 women were randomly assigned either to a four-session AIDS prevention program emphasizing risk education, sexual assertiveness, condom use, risk-related behavioral self-management, and problem-solving skills or to a waiting-list group, who later received the same intervention. RESULTS: Compared with the waiting-list control group, participants in the prevention program demonstrated significant gains in AIDS-related knowledge and intentions to change risk behaviors. The prevention program also significantly reduced rates of unprotected sexual intercourse and increased the use of condoms over a one-month follow-up period. A subset of participants who provided two-month follow-up data maintained some behavior changes. CONCLUSIONS: A relatively brief, skills-focused AIDS prevention program for chronic psychiatric patients produced reductions in HIV risk behaviors. Such HIV risk reduction intervention programs may be of use in inpatient, outpatient, and community-based settings.

Adult↗
PubMed2000

Later-life planning: promoting knowledge of options and choice-making.

The effectiveness of a person-centered later-life planning training program designed to teach older adults (N = 60) with mental retardation about later-life planning issues and increase their participation in choice-making was examined. Using quantitative data analyses, we assessed the impact of the program on intervention and control groups. Results indicated that the intervention group gained more knowledge of concepts in the curriculum and made more choices over time than did the control group. The wide variety of goals that participants set were examined through qualitative analyses; 87% of the participants met or partially met their goals. Information on the supports and barriers to meeting goals is provided.

Adult↗
PubMed2002

Practitioner acceptance of the dofetilide risk-management program.

STUDY OBJECTIVE: To assess the opinions and knowledge retention of practitioners after participation in the dofetilide risk-management program. DESIGN: A 21-item questionnaire. SETTING: A large academic medical center. PARTICIPANTS: One hundred forty-six practitioners were given the questionnaire; 91 (62%) completed it. MEASUREMENTS AND RESULTS: The questionnaire assessed practitioners' opinions of the program and guidelines, preparation time for implementing dofetilide treatment, and retention of facts from the program. Responses were graded on a 5-point Likert scale. Practitioners took a mean of 0.86 +/- 0.44 hours to complete the program; physicians took the least time, pharmacists the most. Practitioners agreed the program was necessary but were undecided about whether the guidelines were easily understood or implemented. Nurses answered one of the two knowledge-retention questions incorrectly significantly more often than physicians or pharmacists. Identification of seven drugs that should not be taken with dofetilide differed significantly (p < 0.0001) across groups (mean accuracy score was 41% for nurses, 80% for pharmacists, and 86% for physicians). CONCLUSION: This risk-management program has been well received by practitioners at our institution. We are gathering data to determine whether the program is effective in reducing inappropriate administration of dofetilide.

Drug Information Services↗
PubMed2002

Principles that underpin effective school-based drug education.

This study identifies the conceptual underpinnings of effective school-based drug education practice in light of contemporary research evidence and the practical experience of a broad range of drug education stakeholders. The research involved a review of the literature, a national survey of 210 Australian teachers and others involved in drug education, and structured interviews with 22 key Australian drug education policy stakeholders. The findings from this research have been distilled and presented as a list of 16 principles that underpin effective drug education. In broad terms, drug education should be evidence-based, developmentally appropriate, sequential, and contextual. Programs should be initiated before drug use commences. Strategies should be linked to goals and should incorporate harm minimization. Teaching should be interactive and use peer leaders. The role of the classroom teacher is central. Certain program content is important, as is social and resistance skills training. Community values, the social context of use, and the nature of drug harm have to be addressed. Coverage needs to be adequate and supported by follow-up. It is envisaged that these principles will provide all those involved in the drug education field with a set of up-to-date, research-based guidelines against which to reference decisions on program design, selection, implementation, and evaluation.

Adolescent↗
PubMedDate not supplied

Fear of hypoglycemia: quantification, validation, and utilization.

Hypoglycemia can lead to various aversive symptomatic, affective, cognitive, physiological, and social consequences, which in turn can lead to the development of possible phobic avoidance behaviors associated with hypoglycemia. On the other hand, some patients may inappropriately deny or disregard warning signs of hypoglycemia. This study presents preliminary reliability and validity data on a psychometric instrument designed to quantify this fear: the hypoglycemic fear survey. The instrument was found to have internal consistency and test-retest stability, to covary with elevated glycosylated hemoglobin, and to be sensitive to a behavioral treatment program designed to increase awareness of hypoglycemia.

Adolescent↗
PubMed2002

MouseTrace: a better mousetrap for catching decision processes.

This paper describes MouseTrace, a computer program designed to monitor the process by which people make decisions by presenting complex choice information to subjects in the form of an alternative-by-attribute matrix. MouseTrace is a Windows-based extension of another program called MouseLab; however, MouseTrace accommodates significantly more information and allows for multiple responses, as well as multiple decision stages. It is also easier to use for both subjects and experimenters and more sophisticated in terms of its features and the data it records. These data include what information was examined, when, and in what order. This information can be used to derive a variety of cognitive process measures, including those related to search depth, sequence, and content, which in turn can be used to provide unique insights into decision-making theory, individual differences, and a variety of decision variables.

Decision Making↗
PubMed2005

Use of a television crime-drama series to promote legal understanding in mentally ill, incompetent defendants: a pilot study.

Videotaped material is used for educational purposes in many areas of medicine. In forensic facilities, programs designed to restore competency to stand trial (CST) in incompetent, mentally ill defendants have utilized videotaped courtroom proceedings as learning tools. This pilot study reviewed the progress of incompetent defendants (N = 15) who participated in a program that utilized videotaped segments of the television crime-drama "Law & Order", among other techniques, to promote CST in individuals deemed unfit to stand trial. The authors hypothesized that participation in at least one cycle of the Competency Restoration Group (CRG)'s curriculum would be associated with improvement in the areas of understanding, reasoning and appreciation. In order to assess whether the group was beneficial to the patient's treatment goal of competency restoration, patients were screened using the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA) prior to starting the group and after completing a cycle of the group's curriculum. The Wilcoxon signed ranks test was employed to analyze the results from the pre- and post-group MacCAT-CA testing. The tests yielded significant (p < 0.005) post-test differences in the hypothesized direction for each of the three subsections: Understanding, Reasoning, and Appreciation as well as a significant post test improvement in the total MacCAT-CA scores. These results suggest that a didactic program, using a popular crime drama series, can be effective in facilitating learning in competency restoration programs. Limitations of this study include its lack of a control group and small population.

Cognition↗
PubMed1998

Trends in cancer incidence and mortality in Missouri.

BACKGROUND: Cancer is the second leading cause of death in Missouri. Several factors influence public health planning and policy-making decisions, including assessment of the trends in disease and in related risk factors, of overall disease burden on the population, and of the effectiveness of intervention programs. To assess the influence of statewide cancer screening, education, and intervention programs on Missouri's cancer burden, recent trends in cancer incidence and mortality rates among Missourians were analyzed. METHODS: Age-standardized cancer incidence rates from 1985-1992 and cancer mortality rates from 1985-1994 and 1990-1996 were calculated by race, age group, and sex using data collected by the Missouri Cancer Registry and the Missouri Center for Health Statistics. Rates for each year examined were logged and regressed onto year. RESULTS: Between 1985 and 1992, the rate of cancer incidence increased by 16.1% (p < .05). From 1985-1994, cancer mortality rate increased by 3.5% (p < .05). Mortality among males, however, decreased between 1990 and 1996. This decrease was particularly pronounced among African-American males. Missouri males endured greater incidence of and mortality from cancer than Missouri females. Elderly males (both African American and white) exhibited the greatest increase in cancer incidence over the periods examined (+27.3% and +31.8% increase respectively, p < .05). Racial differences were nonexistent for cancer incidence rates, but the cancer mortality rate for African Americans was 45% greater than that for whites. CONCLUSIONS: Although Missouri cancer incidence and mortality rates are higher now compared to 16 years ago, data are presented that indicate a slight decline in mortality rates over the past six years. The recent decline (1990-96) in mortality was present only among men, particularly African-American men. The incidence increase was particularly important for women. Despite the implementation of some programs designed to target minorities and undeserved populations at greater risk, these data indicate that large demographic differences in cancer incidence and mortality still persist. A greater commitment to cancer screening, access to treatment, and cancer prevention programs are necessary to meet Missouri's year 2000 goals for cancer incidence and mortality.

Adolescent↗
PubMed1998

Methadone maintenance: results of treatment in heroin addict at Thanyarak Hospital (1990-1996).

Methadone maintenance is a treatment program designed for chronic heroin addicted patients. The purpose is to make them maintain their productive function and adaptive social behavior. The retrospective descriptive study was done from 1990 to 1996. 195 cases joined the Methadone Maintenance Program (MMP) during this period. 188 cases were men and 7 cases were women. The average age was 31.9 +/- 7.2 yr. (19-49 yr. old). 105 cases were single and 90 cases were married. 155 cases were labourers (79.2%). 159 cases (81.5%) used more than 500 mg of heroin a day, it may be assumed that they spent 327 +/- 159 baht a day ($13 +/- 5). The duration of heroin usage before MMP was 8.7 +/- 5.4 yr. (4-25 yr.) In and out of the detoxification treatment program was 12.7 +/- 10.1 times (4-44 times). We found that 11 cases successfully decreased and then stopped the methadone. 32 cases were in the program for more than 1 year and also joined the program until the end of this study. This meant that 43 cases (22%) were successful in stopping their heroin addicted behavior. The average dose of methadone administration was 61.5 mg (40-80 mg mostly). The average time for the patients attending the program was 8.2 months (2-80 months). 38 cases who attended the program for more than 1 1/2 years were in the older-aged and married group. We found no difference in the previous heroin usage or methadone dose in these patients before they attended the MMP. The 32 cases which remained on MMP used mostly less than 40 mg of methadone a day. Two-thirds of the cases discontinued the program due to their positive urine test findings for heroin up to 8 times. Although the MMP was a good way to decrease the heroin addicted behavior, it's not a promising way to stop this problem.

Adult↗
PubMed1997

New use of anticonvulsant medications among children enrolled in the Tennessee Medicaid Program.

OBJECTIVE: To describe the new use of anticonvulsant medications among children enrolled in the Tennessee Medicaid program. DESIGN: A retrospective cohort study. PATIENTS: New users of anticonvulsant medications in 1992 were identified from the 206,098 children (aged 0-18 years) enrolled continuously for 12 months in the Aid to Families With Dependent Children program or foster care program of Tennessee Medicaid. MAIN OUTCOME MEASURES: New users were categorized according to the diagnosis codes of health care encounters occurring 90 days before to 90 days after the first anticonvulsant prescription was filled as having diagnoses consistent with (1) epilepsy or convulsions, (2) neonatal seizures, (3) central nervous system disease, (4) no epilepsy diagnoses but diagnoses for which anticonvulsants might appropriately be used (jaundice, headaches, or psychiatric disorders), or (5) no diagnoses for which an anticonvulsant might appropriately be used. The children in each group were described according to sociodemographic variables, with logistic regression used to analyze variations in the subsequent filling of anticonvulsant prescriptions. RESULTS: Of 647 children continuously enrolled in the Tennessee Medicaid program who were new anticonvulsant users in 1992, 58% had at least 1 health care encounter coded as epilepsy or convulsions, 2% had a diagnosis of neonatal seizures, 8% had central nervous system diagnoses, 16% had specific nonepilepsy diagnoses (jaundice, headache, or psychiatric diagnoses), and 16% had no diagnoses for which anticonvulsants might appropriately be prescribed. For children with epilepsy diagnoses, white race (P = .002) and undergoing tests (P < .001) were independent predictors of a child filling 6 or more prescriptions in the year following the first prescription CONCLUSIONS: A large proportion of new users of anticonvulsants among children enrolled in the Tennessee Medicaid program received these medications for indications other than epilepsy. For children with epilepsy diagnoses, there was considerable variation in the subsequent filling of prescriptions. Further analysis of these variations in practice will allow for the development of policies that will maximize benefit for children who need anticonvulsant therapy, while diminishing unnecessary exposure to potentially toxic drugs for children who do not.

Adolescent↗
PubMed1999

Assessment of asthma patients' willingness to pay for and give time to an asthma self-management program.

Despite the success of health education programs for patients with asthma, several researchers have found that patients are reluctant to enroll in and complete a program designed to help them manage their condition. The purpose of this study was to identify factors that influence asthma patients' willingness to pay (WTP) for and willingness to give time (WTGT) to an asthma self-management program. The patient sample consisted of 116 adult asthma patients (age range, 18 to 34 years) from 2 affiliated sites: a county teaching hospital with ambulatory clinics and a staff-model health maintenance organization. To determine WTP and WTGT, patients were presented with a scenario in which the components of an 8-week asthma management program were described. Patients were then asked how much they would be willing to pay for and how much time they would be willing to spend on the program. Regression analyses were used to determine what effect the following factors had on WTP and WTGT with respect to an asthma self-management program: sociodemographic factors; predisposing, enabling, and reinforcing factors; level of asthma self-management; and health care utilization. Mean patient WTP was $29.50 for an 8-week asthma education program. Several factors appeared to influence this amount. Patients who were willing to pay more for a program that would help them manage their asthma exhibited suboptimal behaviors during asthma attacks, had greater perceived access to health care resources, received less educational information from health care providers, had previously participated in a self-management program, and had indicated an interest in participating in a self-management program. This model was statistically significant (P < 0.0001), with 35% of the variation in WTP scores explained by the independent variables. Patients reported that they were willing to spend a mean of 5.8 hours per week on an 8-week asthma self-management program. Patients who were willing to spend more time on an asthma self-management program had indicated an interest in participating in such a program, had a higher number of comorbidities, or had more emergency department visits. This model was statistically significant (P = 0.0018), with 18% of the variance explained. This study identified several factors that may affect WTP and WTGT in relation to an asthma self-management program. This information may be helpful in identifying candidates for educational programs.

Adolescent↗
PubMed2000

Hippin: a semiautomatic computer program for selecting hip prosthesis femoral components.

This work illustrates a computer program designed to aid surgeons in selecting the hip prosthesis femoral component during the preoperation planning stage of hip replacement surgery. Starting from the processing of the patient's coxo-femoral region X-ray image, the program, called Hippin, interacts with the user to outline the femoral region, including the head and the inner contour of the proximal femur. It automatically examines all possible couplings with the patient's femur outlines from a database containing the outlines of the available prostheses created by digitizing the templates normally used in preoperation planning. The resulting images enable the surgeon to visually compare all the alternatives. In addition, the program provides numerical values for the distances between the physiological rotation and prosthesis centers, helping the surgeon in selecting from among the possibilities. The program has been validated by comparing the computer results with actual surgeon selections.

Automation↗
PubMed1998

A model for adolescent-targeted HIV/AIDS services: conclusions from 10 adolescent-targeted projects funded by the Special Projects of National Significance Program of the Health Resources and Services Administration.

This article describes a model of service for youth living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and youth at high risk for HIV, based on the lessons learned from a set of innovative service projects funded by the Health Resources and Services Administration Special Projects of National Significance (SPNS) Program. Although each project has a unique focus, all collectively seek to enroll youth with HIV into care through new or existing HIV service networks, and direct recruitment via street outreach and other similar methods. The use of various outreach methods tends to yield different patterns of engagement of youth in services. An ideal approach may use a combination of complementary outreach methods. Data at both the national and local levels point to five major elements that capture the innovations of the collective service model: (a) peer-youth information and dissemination; (b) peer-youth advisory groups; (c) peer-youth outreach and support; (d) professional, tightly linked medical social support networks; and (e) active case management and advocacy, for individual clients as well as the programs themselves, to link the various components together. One of the most important factors in the model's success is that youth and professionals share an equal partnership in all stages of program design, planning, and implementation. Youth and professionals each share their expertise in a dynamic process. In addition, active case management is crucial, not only to ensure that clients receive needed services, but also to ensure that the programs themselves run in a coordinated, tightly linked way. Given needs of adolescent clients and existing adult-oriented service networks, the use of active case management and the active participation of youth in the services system are critical.

Acquired Immunodeficiency Syndrome↗
PubMed2004

An evaluation of pupil size standards used by police officers for detecting drug impairment.

BACKGROUND: The Drug Evaluation and Classification (DEC) program was developed to detect, arrest, and convict drivers impaired by drugs other than alcohol. The DEC program is a training program designed to prepare police officers and other qualified persons to serve as Drug Recognition Experts (DREs). PURPOSE: The purposes of this study were: (1) to determine normative values and ranges for pupillary responses using the specific DEC program protocols for pupil testing in nonimpaired persons, and (2) to appraise the suitability of the 3.0- mm to 6.5-mm pupil range as a potential sign of impairment under three conditions. METHODS: Trained DRE officers measured pupi sizes using standardized DEC protocols. Pupil measurements were taken under three light levels: room light, near-total darkness, and direct light. The subjects were 250 volunteers, with an average age of 29.2 years (+/-6.1). All subjects were healthy, nonimpaired, and free of visual, and/or neurological problems. RESULTS: For each pupil measured (N= 500), the mean (SD) for each of the three test conditions were: room light 3.86 (0.93) mm; near-total darkness 6.41(1.55) mm; and direct light 3.35 (0.72) mm. CONCLUSIONS: This study determined normative values and potential ranges for pupillary responses using the specific DEC program protocols for pupil testing in non-impaired persons. When the presently approved DEC program pupil size range (3.0 to 6.5 mm) is compared with the results of this study, it appears that the DEC range for pupil size might be too sensitive. However, when determining impairment related to drug(s), the DRE reviews the results of all tests and draws a conclusion based on the totality of the evidence, not only on a variation in the pupil size.

Adult↗
PubMed1986

A comprehension monitoring program for language-impaired children.

Four language-impaired children (5:10-8:2) participated in an intervention program designed to improve their comprehension monitoring skills. A set of audiotaped adequate and inadequate messages was presented through the baseline and treatment phases of a multiple-baseline across subjects design, with the dependent variable being the percentage of inadequate messages that were verbally queried. Results revealed rapid increases in verbal queries of five types of inadequate messages in conjunction with progress through the comprehension monitoring treatment program. High levels of comprehension monitoring were maintained following a nontreatment interval of 3-6 weeks. Facilitation of comprehension monitoring skills appears to be a feasible and fruitful adjunct to traditional language intervention objectives.

Child↗
PubMed1977

The relationship of psychiatry to primary care.

Although it is not officially considered a primary care specialty, psychiatry is intimately related to training and practice in fields that are so designated. The primary care physician must have expertise in interviewing, counseling, psychophysiological disease, dependence syndromes, etc.--all areas in which psychiatry has a body of knowledge and intervention techniques. It is recommended that all primary care training programs develop behavioral objectives in the areas of mental illness and psychosocial aspects of disease; active liaison and consultation with departments of psychiatry should be an integral part of these programs. The author presents suggestions for possible program design and notes that the relationship between psychiatry and primary care specialties is a continuing challenge to the field.

Attitude of Health Personnel↗
PubMed1980

The state of school heart health education: a review of the literature.

The evidence and presence of modifiable risk factors associated with heart disease has heightened interest among health educators in developing prevention oriented programs. In an attempt to assist in planning future curriculum efforts and research in this area a literature review was conducted. It is presented and organized within the following three major categories: 1. incidence of cardiovascular risk factors (in the school age population); 2. need for health education (the status of adolescent health and problems of motivation); and 3. evaluations of current heart projects (knowledge, attitudes and behavioral outcomes). A few classic articles were included: the primary literature reviewed was that of the past 10 years. The following conclusions were drawn: 1. there is a need to be concerned about the cardiovascular health of young people; 2. the need for educational programs about proven methods of prevention is well documented; 3. studies have found that adolescents do not have sufficient knowledge upon which to make healthful decisions related to preventing cardiovascular disease; 4. research has demonstrated that well designed programs can be effective in increasing health knowledge and promoting positive attitudes; 5. some programs have encouraged behavioral change; 6. most programs have proven too expensive to become integral components of the curricula; and 7. further educational research must be conducted so that health education might by the end of this decade play a significant role in the reduction of the morbidity and mortality inflicted by cardiovascular disease.

Adolescent↗