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PubMed2005

Impact of a homestead gardening program on household food security and empowerment of women in Bangladesh.

This paper assesses the additional benefits of a homestead gardening program designed to control vitamin A deficiency in Bangladesh. In February and March 2002, data were collected on the food security and social status of women from 2,160 households of active and former participants in the gardening program and from control groups in order to assess the impact and sustainability of the program. The proportions of active and former-participant households that gardened year-round were fivefold and threefold, respectively, higher than that of the control group (78% and 50% vs. 15%). In a three-month period, the households of active participants produced a median of 135 kg and consumed a median of 85 kg of vegetables, while the control households produced a median of 46 kg and consumed a median of 38 kg (p <.001). About 64% of the active-participant households generated a median garden income of 347 taka (US$1 = 51 taka), which was spent mainly on food, and 25% of the control households generated 200 taka in the same period (p < .001). The garden production and income levels of formerly participating households three years after withdrawal of program support were much higher than those of the control households, illustrating the sustainability of the program and its ability to increase household food security. Significantly more women in active- and former-participant households than in control households perceived that they had increased their economic contribution to their households since the time the program was launched in their subdistricts (> 85% vs. 52%). Similar results were found for the level of influence gained by women on household decision-making. These results highlight the multiple benefits that homestead gardening programs can bring and demonstrate that these benefits should be considered when selecting nutritional and development approaches targeting poor households.

Adult↗
PubMed1984

Recreation therapy: reducing the effects of isolation for the patient in a protected environment.

The psychological effect of extended isolation in a protected environment is of concern to health care professionals on the Pediatric Oncology Unit at the National Institutes of Health. Problems such as increased anxiety, depression, boredom, passivity, and time-space disorientation have been noted in similarly isolated patients. The development of a comprehensive therapeutic recreation program designed to address these issues, as well as to meet the individual leisure needs of the isolated patient, is seen as an essential component of patient care. This article outlines the rationale and format of such a program.

Child↗
PubMed1994

Exercise and dietary modification with women of non-English speaking background: a pilot study with Polish-Australian women.

Health promotion programs aimed at the general community often fail to reach Australians of non-English speaking background (NESB) because of language and cultural barriers. A 12-week minimal-intervention heart health program, designed for women of European background, was piloted with 43 women from a Polish social group, with a further 30 women serving as a comparison group. Assessments of the intervention group before and after the 12-week program indicated significant decreases in exercising heart rate and in resting blood pressure, which were not evident in the comparison group. Twelve-week follow-up data indicated that these gains had been well maintained. When the comparison group was invited to participate in a similar program, there were also significant improvements on these variables. This pilot study suggests that health promotion programs aimed at NESB Australians can be effective in modifying risk factors for cardiovascular disease if an effort is made lo address language and cultural barriers.

Journal Article↗
PubMed1983

The control of smoking: smoking rate in designated smoking and no-smoking areas.

Unobtrusive measurements were taken over a 5-day period at three hospital areas designated as smoking permitted and three designated as no-smoking. A surprisingly high degree of compliance was observed in reported patient complaints or criticisms in regard to the controlled-smoking policy. The practical advantages of a comprehensive, hospital-wide sign program designating smoking and no-smoking areas are discussed.

Cooperative Behavior↗
PubMed2001

Impact of managed MediCal on California family practice programs.

BACKGROUND: An important source of patients for California's family practice program is MediCal. During the past 5 years, MediCal has established a variety of capitated managed care plans. OBJECTIVE: To assess the impact of California's managed MediCal program on the state's 38 family practice training programs. DESIGN: A cross-sectional, retrospective descriptive survey. METHODS: A 3-page, 11-question survey was developed by family practice residency directors and staff from the California Academy of Family Physicians, San Francisco. The 38 family practice programs in existence in California in September 1997 were stratified by type of managed MediCal in their county and by type of sponsoring institution--university, county, community based, staff-model health maintenance organization, or managed care system. RESULTS: Of the 38 family practice programs, 27 responded; 19 of 27 programs participated in managed MediCal. The total number of family health center patients, and the percentage of MediCal patients (48%-60%) at family practice programs was similar when stratified by programs with and without managed MediCal and by type of sponsorship. Most programs reported that they were able to compete effectively, although most also reported increased administrative, nursing, and front office costs. Managed MediCal patients were directly assigned to residents in only 3 of 19 programs. CONCLUSIONS: The introduction of managed MediCal has not adversely affected the number of patients cared for in California's family practice programs. Continued vigilance regarding California family practice programs' involvement in managed MediCal, including collection of accurate data on the number of MediCal patients and the financial and educational implications for California's family practice programs, is warranted.

California↗
PubMed1991

Program to improve nurses' knowledge of pediatric emergency medications.

The effects of an educational program designed to improve nurses' knowledge of the use of emergency medications in the pediatric intensive-care unit (PICU) are reported. The clinical pharmacist for a six-bed PICU and a clinical nurse educator developed a program to assess and extend PICU nurses' knowledge of emergency medications with respect to calculations of bolus and continuous infusions, pharmacology, and proper dosage and administration route. The program consisted of a pretest, a pharmacology lecture, calculation problems, a hands-on practicum, and a posttest. Drugs covered were atropine sulfate, sodium bicarbonate, calcium gluconate, calcium chloride, dopamine hydrochloride, dobutamine hydrochloride, epinephrine hydrochloride, isoproterenol hydrochloride, lidocaine hydrochloride, sodium nitroprusside, and norepinephrine bitartrate. A retest was given 13 months after the pretest. The program was completed by 21 nurses over seven months. There was a significant difference between the mean pretest score, 69.5%, and the mean posttest score, 87.3%, due to improvements in scores for the calculation questions. There was no significant difference in the mean time required to complete the pretest and the posttest. A significant correlation was observed between pretest score and months spent practicing in the PICU. Time to take the retest was significantly shorter than the posttest time, and scores continued to improve. An educational program developed cooperatively by pharmacy and nursing improved specific measures of PICU nurses' knowledge of emergency drugs.

Chicago↗
PubMed1980

A new direction for public health care: changing cafeteria eating habits.

A "Food for Thought" game, an eight-week, media-based nutrition program designed to influence food choices in a cafeteria setting, was conducted in a National Institutes of Health employee cafeteria. Its purpose was to encourage customers to select lower-caloric food during lunch. The effects of the program on food choices and total calories of food purchased each day were measured by time series analyses. During the eight-week intervention period, skim milk purchases increased, and dessert and bread sales, as well as average number of calories purchased per day per person, declined significantly. Some evidence for a maintenance effect over a ten-week follow-up period was obtained. The "Food for Thought" game delivered nutrition education in an upbeat but unobtrusive way. Although people patronize cafeterias to eat, socialize, and relax and not to be educated, this program had only minimal requirements for participation. The result was a high level of interest and involvement. People can "learn while they eat," if careful attention is paid to customer needs and principles of effective communication.

Diet↗
PubMed1999

Genetics education for primary care providers in community health settings.

Patients who are in need of genetic services are often inappropriately managed, in part due to inadequate knowledge of genetic issues among primary health care providers. The purpose of this study was to determine the effect of a genetics education program on the knowledge and attitudes of primary care providers in community health settings. A total of one hundred twenty-one primary care providers who work in Texas Public Health Region VIII participated in an educational program designed to provide basic genetics information. A one-group pretest-posttest design was used to assess knowledge and attitudes of subjects, and comparisons were made pre and post intervention. Pretest assessment revealed less than adequate knowledge about basic genetic principles and relatively positive attitudes among the subjects. Following the program, there were statistically significant increases in both knowledge about genetic conditions (P = .001) and attitudes toward provision of genetic services (P = .001). These results indicate that primary health care providers, motivated to learn complex materials and new skills in order to assist their patients, can do so in a relatively short time period.

Attitude of Health Personnel↗
PubMed2002

Evaluating a 'non-diet' wellness intervention for improvement of metabolic fitness, psychological well-being and eating and activity behaviors.

CONTEXT: Current public health policy recommends weight loss for obese individuals, and encourages energy-restricted diets. Others advocate an alternative, 'non-diet' approach which emphasizes eating in response to physiological cues (eg hunger and satiety) and enhancing body acceptance. OBJECTIVE: To evaluate the effects of a 'health-centered' non-diet wellness program, and to compare this program to a traditional 'weight loss-centered' diet program. DESIGN: Six-month, randomized clinical trial. SETTING: Free-living, general community. PARTICIPANTS: Obese, Caucasian, female, chronic dieters, ages 30-45 y (n=78). INTERVENTIONS: Six months of weekly group intervention in a non-diet wellness program or a traditional diet program, followed by 6 months of monthly after-care group support. OUTCOME MEASURES: Anthropometry (weight, body mass index); metabolic fitness (blood pressure, blood lipids); energy expenditure; eating behavior (restraint, eating disorder pathology); psychology (self-esteem, depression, body image); attrition and attendance; and participant evaluations of treatment helpfulness. Measures obtained at baseline, 3 months, 6 months and 1 y. RESULTS: (1 y after program initiation): Cognitive restraint increased in the diet group and decreased in the non-diet group. Both groups demonstrated significant improvement in many metabolic fitness, psychological and eating behavior variables. There was high attrition in the diet group (41%), compared to 8% in the non-diet group. Weight significantly decreased in the diet group (5.9+/-6.3 kg) while there was no significant change in the non-diet group (-0.1+/-4.8 kg). CONCLUSIONS: Over a 1 y period, a diet approach results in weight loss for those who complete the intervention, while a non-diet approach does not. However, a non-diet approach can produce similar improvements in metabolic fitness, psychology and eating behavior, while at the same time effectively minimizing the attrition common in diet programs.

Adult↗
PubMed1996

Survival of Medicare patients after enrollment in hospice programs.

BACKGROUND: Each year more than 220,000 Medicare beneficiaries receive care from hospice programs designed to enhance the quality of the end of life. Enrollment requires certification by a physician that the patient has a life expectancy of less than six months. We examined how long before death patients enrolled in hospice programs. METHODS: Using 1990 Medicare claim data, we analyzed the characteristics and survival of 6451 hospice patients followed for a minimum of 27 months with respect to mortality. RESULTS: The patients' mean age was 76.4 years; 92.4 percent were white. Half the patients were women, and 80.2 percent had cancer of some type. The most common diagnoses were lung cancer (21.4 percent), colorectal cancer (10.5 percent), and prostate cancer (7.4 percent). The median survival after enrollment was only 36 days, and 15.6 percent of the patients died within 7 days. At the other extreme, 14.9 percent of the patients lived longer than six months. Survival varied substantially according to diagnosis, even after adjustment for age and co-existing conditions. The unadjusted survival after enrollment was shortest for those with renal failure, those with leukemia or lymphoma, and those with liver or biliary cancer; it was longest for those with chronic lung disease, those with dementia, and those with breast cancer. Patients at for-profit, larger, outpatient, or newer hospices lived longer after enrollment than those in other types of hospice programs. CONCLUSIONS: Most patients who enter hospice care do so late in the course of their terminal illnesses. The timing of enrollment in hospice programs varies substantially with the characteristics of the patients and the hospices.

Aged↗
PubMed2006

Residential care provision in Medicaid home- and community-based waivers: a national study of program trends.

PURPOSE: While state policy and market factors are known to have contributed to the increased supply of residential care, little is known about efforts to accommodate demand from lower-income consumers. This study describes participation and expenditure trends for residential care services funded by Medicaid waivers and examines variation across programs. DESIGN AND METHODS: We collected annually reported Center for Medicare and Medicaid Services (CMS) Form 372 data from state officials for each waiver that provides residential care services for the period 1995 to 2002. Descriptive statistics examined waiver program participation and expenditures while adjusting for population changes and inflation. RESULTS: Between 1995 and 2002, national Medicaid waiver-funded residential care participants increased by almost threefold to 120,000 and expenditures more than quadrupled to 2.3 billion dollars. However, Medicaid waiver program participation and spending varied considerably by state, by target population, and by level of care. IMPLICATIONS: This study highlights three important policy concerns: (a) Medicaid-supported residents remain underrepresented in residential care, (b) large interstate variation persists in Medicaid residential care service provision, and (c) state policy choices favor Medicaid spending on residential care for persons with mental retardation or developmental disabilities.

Community Health Services↗
PubMed1994

Integrating developmentally supportive caregiving into practice through education.

Implementation of developmental caregiving is occurring in intensive care nurseries across the country. Sound theories of adult learning, program planning, and change principles must be utilized to guide this process and to provide a framework for program design. If leaders and change agents are aware of these concepts and use them to make the process easier, integration should be less painful and the concepts promptly instituted into routine practices. Neonatal Individualized Developmental Care and Assessment Program research has demonstrated positive outcomes. This research has provided us with a vision to guide our practice, but change theory and education of staff also need to be addressed in this process.

Education, Nursing, Continuing↗
PubMed1994

Ability of a computerized geriatric assessment to predict need for change in living status among elderly living at home.

The objective of this study was to determine the ability of a software program used in a primary care physician's office to predict the need for alternate living arrangement in a cohort of community-dwelling elderly. An analysis was conducted involving 124 consecutive patients between February 10, 1990, and December 20, 1991, in my private medical practice. These patients, all older than 65 years, underwent a computer-assisted geriatric assessment. Two scales--the Geriatric Functional Rating Scale (GFRS) and the Functional Assessment Screening Questionnaire (FASQ)--were compared for their accuracy at predicting change in living status during the 12- to 24-month period following the assessment. Similar analysis of the Tinetti gait and balance test was also performed. Ten and one-half percent of subjects (n = 13) required a change in living status during the study period. Ten went to nursing homes and three joined relatives' households. The GFRS was 62% accurate (8/13) and the FASQ was 54% (7/13) accurate in predicting this change. Abnormality in both gait and balance was predictive 77% (10/13) of the time. Combining all three parameters raised the successful prediction rate to 85% (11/13). Neither GFRS, FASQ, nor gait/balance testing was predictive of death. A computer software program designed to facilitate performance of geriatric assessments in primary care physicians' offices has a high rate of predictive capability relative to future need for change in living status among community-dwelling elderly. Further studies comparing this software program with traditional geriatric assessment protocols are suggested.

Activities of Daily Living↗
PubMed1993

Attachment and conduct disorder: the Response Program.

An increasing number of youths are being identified as suffering from behavioural problems that cause difficulties in their family and peer relations which in turn reduces their chances of academic and vocational success. There is growing concern regarding their level of aggressiveness. The common diagnosis given to these disaffiliated youths is conduct disorder. To date, most treatment programs for conduct disorder have been unsuccessful. A review of recent studies indicates that the disruption of attachment may be an important feature that underlies the wide range of symptoms that are typically found in youths with conduct disorder. A community-oriented program designed to ensure long term care for these youths is described in this paper, and the findings of a six month follow-up evaluation are presented. Results indicated that communities, caregivers, and youths responded positively to the program; caregivers reported significant reductions in a broad range of psychiatric symptoms in youths, and youths reported a significant reduction in symptoms of conduct disorder.

Adolescent↗
PubMed1995

HIV infection and AIDS: attitudes and knowledge of Arizona pharmacists.

OBJECTIVE: To assess Arizona pharmacists' attitudes and knowledge regarding HIV infection and AIDS. METHODS: Mailing of a 7-page survey, which included demographic and attitudinal items, as well as preparedness, comfort, and knowledge scales. SETTING: Randomly selected pharmacists registered and residing in Arizona. PARTICIPANTS: Of the 479 pharmacists surveyed, 41 were removed from the sample because they had moved with no forwarding address, were retired or not practicing, or had died. The response rate was 46% for the remaining 438 pharmacists. A final sample size of 199 was obtained. RESULTS: The respondents had a high level of preparedness and comfort in addition to positive attitudes. Overall, their knowledge level was low. Inpatient pharmacists had a higher level of therapeutic knowledge (p < 0.0001) and were more willing to work with a person infected with HIV than were outpatient pharmacists (p = 0.05). Pharmacists who had attended at least 1 HIV/AIDS-related continuing education (CE) program had higher levels of preparedness (p < 0.0001), comfort (p = 0.01), and knowledge (p < 0.0001) than those who had not. The majority of respondents believed that an HIV/AIDS CE program should be mandatory. CONCLUSIONS: Although Arizona pharmacists feel prepared, are comfortable, and have positive attitudes regarding patients with HIV/AIDS, their level of knowledge is low. The results of this study may be used by CE providers to design programs to meet the educational needs of pharmacists.

Acquired Immunodeficiency Syndrome↗
PubMed1995

The effects of a life review program on disorientation, social interaction and self-esteem of nursing home residents.

This study examined the effects on veteran and novice participants of a life review program designed for nursing home residents with Alzheimer's disease or severe cognitive disfunction. Using a pre-post test experimental design, veterans, novices and the control group were tested for changes in disorientation, social interaction, and self-esteem. The results confirm the findings of an earlier study [1] that there is an impact of the Life Review Program on level of disorientation, social interaction and life review. There is some evidence to suggest that the improvements may be somehow stored in memory and triggered when the program is repeated.

Aged↗
PubMed2003

METASTATS: behavioral science statistics for Microsoft Windows and the HP49G programmable calculator.

METASTATS is an organized suite of approximately 150 programs designed for meta-analysis, power, effect sizes and their confidence intervals, significance test conversions, and other general statistics. This freeware works either on the HP49G calculator or preinstalled on a PC emulator under Windows. Many of the programs address gaps in commercially available software. The suite has a user-friendly interface: the screen prompts for input, and labels all output. Extensive documentation includes step-by-step examples, a fully annotated catalogue of the programs, and academic references for the formulas. Both versions of the programs (calculator and PC), documentation, and installation instructions are freely available from the author's Web site, http://www.netaxs.com/-efoster/.

Behavioral Sciences↗
PubMed2001

Injuries in women associated with a periodized strength training and running program.

Forty-five women participated in a 24-week physical training program designed to improve lifting, load carriage, and running performance. Activities included weightlifting, running, backpacking, lift and carry drills, and sprint running. Physicians documented by passive surveillance all training-related injuries. Thirty-two women successfully completed training program. Twenty-two women (48.9%) suffered least 1 injury during training, but only 2 women had to drop out of the study because of injuries. The rate of injury associated with lost training time was 2.8 injuries per 1,000 training hours of exposure. Total clinic visits and days lost from training were 89 and 69, respectively. Most injuries were the overuse type involving the lower back, knees, and feet. Weightlifting accounted for a majority of the lost training days. A combined strength training and running program resulted in significant performance gains in women. Only 2 out of 45 participants left the training program cause of injuries.

Adaptation, Physiological↗