Paucity of family planning.
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Communication↗
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Results for “Program Accessibility”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
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Use of patient education and monitoring software in community pharmacies.
OBJECTIVE: To determine the level of use of health education and monitoring software programs in independent community pharmacies in rural locales. DESIGN: The use of seven software programs that deliver patient education and provide blood pressure monitoring was assessed at five sites of the Nebraska Drug Information Network (NDIN) for one month. Direct Access, a Windows-based software program, documented which programs were accessed and for what time period. RESULTS: During a one-month period, 326 accesses were logged representing 44 hours of computer time. Extrapolated to all 30 sites of NDIN, this represents 264 hours and 1,956 accesses monthly. On average, each pharmacy logged 8.8 hours within 65 accesses each month. Each access averaged 8 minutes. DynaPulse (167 accesses; 16.4 hours) was the most frequently used product, followed by Home Medical Advisor Pro (54 accesses; 8.9 hours) and Mayo Clinic The Family Pharmacist (35 accesses; 8.3 hours). The least amount of time was spent with BodyWorks (0.6 hours) but Wellness Checkpoint had fewest accesses (7 accesses). CONCLUSION: Applied medical informatics is assuming a larger role in daily clinical practice as pharmacy practitioners strive to better inform their patients. This is congruent with the finding that a better informed public can be a healthier public. This study demonstrates that computer systems are readily used by patients and pharmacists in rural communities.
Adult↗
Reach, efficacy, and cost-effectiveness of free nicotine medication giveaway programs.
In an effort to increase access to evidence-based smoking cessation therapies, regional tobacco control programs in New York State implemented different interventions to make free nicotine patches and gum available to smokers wishing to quit. In one region, eligible smokers were sent a voucher redeemable at a local pharmacy for a 2-week supply of either nicotine patches or gum. In other regions, smokers received either a 1-week supply or a 2-week supply of nicotine patches sent to their home. In New York City, eligible smokers received a 6-week supply of nicotine patches and a follow-up phone call. All of the programs utilized the state's Smokers' Quitline to screen and register eligible smokers for the free medication. The reach of the different programs was evaluated by computing the proportion of eligible smokers within a given area enrolled in the program and tracking call volume to the Quitline before, during, and after the free giveaway promotions. Efficacy was evaluated by a telephone follow-up survey of program participants conducted 4 months after enrollment to measure use of the medications and smoking behavior. The quit rate of program participants was contrasted with the quit rate computed from an earlier follow-up survey of Quitline callers who were not provided nicotine replacement therapy (NRT). Free nicotine patches or gum was sent to 40,090 smokers representing about 2.9 percent of eligible heavy smokers (10+ cigarettes per day) in the state. In each time period and location where free NRT was offered, call volume to the Quitline increased dramatically. Quit rates varied in relationship to the supply of NRT sent to participants, but in all cases was higher than the quit rate observed among smokers not sent NRT (21%-35% vs 12%). The offer of free NRT appears to be a cost-effective method to induce large numbers of smokers to make a quit attempt.
Adult↗
National Institutes of Health Consensus Development Conference Statement: phenylketonuria: screening and management, October 16-18, 2000.
OBJECTIVE: To provide health care providers, patients, and the general public with a responsible assessment of currently available data regarding screening for and management of phenylketonuria (PKU). PARTICIPANTS: A nonfederal, nonadvocate, 14-member panel representing the fields of pediatrics, genetics, human development, public policy, nursing, and molecular physiology and including patient representatives. In addition, 19 experts in pediatrics, medical genetics, psychology, pediatric neurology, biochemical and molecular genetics, and gene therapy presented data to the panel and to a conference audience of 312. EVIDENCE: The literature was searched using Medline for January 1980 through July 2000, and an extensive bibliography of 3394 references was provided to the panel. Experts prepared abstracts for their conference presentations with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. CONSENSUS PROCESS: The panel, answering predefined questions, developed its conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement, which was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately after its release at the conference and was updated with the panel's final revisions. The statement is available at http://consensus.nih.gov. CONCLUSIONS: Genetic testing for PKU has been in place for almost 40 years and has been very successful in preventing severe mental retardation in thousands of children and adults. Metabolic control is necessary across the lifespan of individuals with PKU. A comprehensive, multidisciplinary, integrated system is needed to delivery of care to individuals with PKU. Greatly needed are consistency and coordination between screening, treatment, data collection, and patient support programs. There should be equal access to culturally sensitive, age-appropriate treatment programs. Ethically sound, specific policies for storage, ownership, and use in future studies of archived samples remaining from PKU testing should be established. Research into the pathophysiology of PKU and relationship to genetic, neural, and behavioral variation is strongly encouraged. Uniform policies must be established to remove financial barriers to the acquisition of medical foods and modified low-protein foods and to provide access to support services needed to maintain metabolic control in individuals with PKU. Research on nondietary alternative treatments for PKU is strongly encouraged. To achieve optimal statistical power and cross-cultural applicability, it will be beneficial to use data acquired via national and international collaboration.phenylketonuria, hyperphenylalanimea, phenylketonuria screening, phenylalanine-restricted diet, maternal phenylketonuria, newborn screening, phenylalanine monitoring, phenylketonuria outcomes.
Adult↗
Evaluation of a dental society-based ABCD program in Washington state.
BACKGROUND: The authors present a two-year evaluation of a dental society-managed dental care program in Washington state. A variation of the Access to Baby and Child Dentistry, or ABDC, program, the Mom & Me program was initiated to increase access to dental care for Medicaid-enrolled children younger than age 6 years in Yakima County. METHODS: This evaluation includes enrollment and visit data, first- and second-year cost data and results of a survey conducted with dental society members. RESULTS: The number of dentists treating Medicaid-enrolled children on a regular basis more than doubled, from 15 to 38 general dentists. In the first two years of the program, 4,705 children were enrolled and approximately 51 percent visited a dentist. CONCLUSIONS: The responses of dentists surveyed were positive, and the authors suggest that a dental society-managed program under the ABCD program -umbrella is a unique strategy for improving access to dental care for Medicaid clients. CLINICAL IMPLICATIONS: ABCD programs provide an avenue for dentists to treat children who otherwise would not receive care.
Adult↗
Phenylketonuria (PKU): screening and management.
OBJECTIVE: To provide health care providers, patients, and the general public with a responsible assessment of currently available data regarding screening for, and management of. phenylketonuria (PKU). PARTICIPANTS: A non-Federal, non-advocate, 14-member panel representing the fields of pediatrics, genetics, human development, public policy, nursing, molecular physiology, and including patient representatives. In addition, 19 experts in pediatrics, medical genetics, psychology, pediatric neurology, biochemical and molecular genetics, and gene therapy presented data to the panel and to a conference audience of more than 300. EVIDENCE: The literature was searched using MEDLINE and an extensive bibliography of references was provided to the panel. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. CONSENSUS PROCESS: The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately following its release at the conference and was updated with the panel's final revisions. CONCLUSIONS: Genetic testing for PKU has been in place for almost 40 years and has been very successful in the prevention of severe mental retardation in thousands of children and adults. Metabolic control is necessary across the lifespan of individuals with PKU. A comprehensive, multidisciplinary, integrated system is required for the delivery of care to individuals with PKU. Greatly needed are consistency and coordination among screening, treatment, data collection, and patient support programs. There should be equal access to culturally sensitive, age-appropriate treatment programs. Ethically sound, specific policies for storage, ownership, and use in future studies of archived samples remaining from PKU testing should be established. Research into the pathophysiology of PKU and relationship to genetic, neural, and behavioral variation is strongly encouraged. Uniform policies need to be established to remove from the individual and the family financial barriers to the acquisition of medical foods and modified low-protein foods, as well as to provide access to support services required to maintain metabolic control in individuals with PKU. Research on nondietary alternatives to treatment of PKU is strongly encouraged. To achieve optimal statistical power, as well as cross-cultural applicability, it will be beneficial to use data acquired via national and international collaboration.
Cost-Benefit Analysis↗
The effect of health programs on breastfeeding and child mortality in Peninsular Malaysia.
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Asia↗
Relational database model for DNA mutations and a software program for implementation of the model.
A relational database model for describing DNA mutations is presented. The model was developed in conjunction with the human hprt database and was successful in representing over 1800 hprt mutations. Mutants showing aberrant mRNA splicing can be adequately described using the model, as well as mutants showing more than one mutation. The basic aspects of the relational model should be applicable to mutations in a variety of genes. A data entry program developed using Microsoft Access 2.0 is also described that implements the relational model. The data entry program ensures that relational integrity is maintained between the tables and automatically generates key fields as needed. The program also has the ability to convert between the various numbering schemes that are used to describe base pair location in the hprt gene. The program and source code are placed in the public domain so that other experimenters can adapt the program for use with other genes.
Humans↗
Chronic kidney disease management--what can we learn from South African and Australian efforts?
BACKGROUND: The prevalence of chronic kidney disease is on the rise. Our objective is to describe two programs to improve the awareness and management of hypertension, renal disease, and diabetes in remote Australian Aboriginal and urban and periurban South African communities. We focus on how the Australian Aboriginal and South African Chronic Disease Outreach Programs have worked together. METHODS: The establishment of prevention programs in developing countries is a challenge. The paper evaluates these challenges, including accessing international aid. The programs advocate that regular integrated checks for chronic disease and their risk factors are essential elements of regular adult health care. Programs should be run by primary health workers, following algorithms for testing and treatment, and a backup provided by nurse coordinators. Constant evaluation is essential to develop community health profiles and adapt program structure. RESULTS: Both programs are discussed, including how they are organized to deliver preventative and treatment strategies. The challenges and adaptations required are outlined. CONCLUSIONS: It is the aim of the international kidney community to prevent chronic kidney disease. The South African and Australian groups highlight the need for a systematic and sustained approach to the management of chronic diseases to achieve this goal.
Australia↗
Palliative care and hospice programs.
Palliative care and hospice programs are points on the continuum of comprehensive patient care. Unfortunately, provision of care for terminally ill patients is suboptimal. There are many new approaches to improving the skills of all physicians to fulfill the needs of patients, including better education for house staff, "train-the-trainers" programs for physicians in practice, research into methods of symptom control, and better access to established hospice programs. This review covers the history, current status, and practical suggestions for improving palliative care and hospice programs in primary care settings.
Advance Directives↗
The Reach to Recovery program.
The diagnosis of breast cancer brings with it significant psychosocial concerns and questions. Part of providing comprehensive care for a woman with breast cancer requires the physician to be aware of the Reach To Recovery Program, which is a peer modeling program provided by the American Cancer Society. The women who are part of the program have had treatment for breast cancer, either a lumpectomy or mastectomy, and are trained volunteers who provide support and information for the woman diagnosed with breast cancer. The Reach To Recovery Program is a tool that can benefit both the physician and the woman who is diagnosed with breast cancer, because the Reach To Recovery volunteer can respond to the unique concerns of the woman. The concerns can include the physical, emotional, and cosmetic needs related to the disease and/or its treatment. This paper will discuss the role of the Reach To Recovery volunteer, the features and benefits of the program, and ways in which the physician can access the Reach To Recovery Program. The Reach To Recovery Program is in the process of being revised to meet the changing needs that are the result of new treatments and shorter hospital stays. Alternative types of visit patterns will be presented.
American Cancer Society↗
A comparative analysis of computer-based grading programs.
There are several elements to nursing students' course grades: quizzes, examinations, and presentations. There are several weights for the elements, which adds to the complexity of calculating grades. The accuracy and efficiency of calculating grades can be increased with the help of an appropriate computer program. Nursing faculty may have access to a variety of these computer software programs to aid them in calculating and maintaining students' course grades. These programs include spreadsheets, specific grading programs, and grading features included in online course programs. This article reviews selected computer-based grading programs and reviewers' evaluation of each program, based on the major features.
Education, Nursing↗
Sonographic evaluation of normal and induced ovulation.
The adult premenopausal ovary exists in a dynamic state of flux, with ovarian position, size, activity, and structure constantly undergoing changes. Pelvic sonograms must be interpreted with knowledge of the stage of the menstrual cycle and the expected normal range of sonographic findings, because features that are normal in one phase may be abnormal in another. Only against this background knowledge can the challenging task of interpretation of pelvic sonograms be successfully performed. US also plays an increasingly important role in monitoring ovulation induction and alternative methods of fertilization and has improved pregnancy rates by distinguishing between the presence of one or more mature follicles as opposed to a cohort of immature follicles, suggesting the possibility of multiple ovulation with the risks of hyperstimulation or poor pregnancy outcome from multiple gestation, indicating optimum timing of human chorionic gonadotropin administration, allowing detection and confirmation of normal follicular rupture and ovulation, indicating optimum timing of oocyte retrieval in programs of in vitro fertilization with embryo transfer (IVF-ET) or insemination programs, and assessing pathologic pelvic conditions and ovarian accessibility in IVF-ET programs. Oocyte retrieval and embryo transfer are also being performed under US guidance.
Anovulation↗
Why women still die from cervical cancer.
Cervicovaginal cytology, known as Pap smear, is the most effective screening test in medical oncology. Introduced by Dr. George Papanicolaou in 1940, the Pap smear is now being recognized as a major contributor to the remarkable decrease in cervical cancer morbidity and mortality among women throughout the world. However, there are still significant numbers of women who lose their lives to cervical cancer every day. To overcome this major problem, first, we must search for the reasons for these lost lives and then take appropriate measures to resolve the existing issues. There is now substantial evidence that emphasizes the importance of an effective screening program. This program must integrate education and accessibility to health care for all women regardless of age, race, ethnic background and socioeconomic status. The public, the media, the government and health care providers must also become acutely aware of the inherent difficulties involved in providing a high-quality Pap smear. Compounded by medicolegal pressures and reimbursement issues, the Pap smear has become one of the more difficult tests to perform. Current reimbursement mechanisms are not appropriate for the cost of providing the service and cannot guarantee the resources necessary for a high-quality Pap smear. Congress should consider mandating direct billing to the patient for the service, so that cervicovaginal cytology could be reimbursed on a level commensurate with the requirements of providing quality service. A concerted effort should also be made to enhance the level of public knowledge about the issues surrounding Pap smear. This could be achieved by fostering the idea of designating a "Cervical Cancer Awareness Month," and by encouraging the spirit of community networking.
Age Factors↗
Mental health services under a U.S. national health insurance plan.
Sometime during the 1990s, the U.S. Congress could enact legislation that would establish universal access to basic hospital and physician services and, later, create a national health insurance plan. The author explores the potential effect of these programs on state psychiatric facilities; short-term acute psychiatric care facilities, including those under for-profit ownership; mental health professionals; and delivery of patient care. Each year about 63 million uninsured Americans would be eligible for basic health care under a universal access program, and mentally ill patients who are now unable to afford care would then be eligible for limited mental health services. National health insurance, enacted after the universal-access approach fails, is likely to support the current trend of proportionately more ambulatory and less inpatient mental health care. Wealthy Americans are likely to use the national health insurance system but may also use private mental health services, thereby perpetuating the current pluralistic health care delivery system.
Evaluation Studies as Topic↗
[Fertility trends in Indonesia: an analysis of preferences].
"This analysis begins with a presentation of a summary of levels and trends of fertility. Selected factors affecting fertility are also addressed. Then data from the National Indonesia Contraceptive Prevalence Survey (NICPS) carried out as part of the Demographic and Health Surveys program in 1987 are used to investigate the extent of fertility planning among Indonesian women, and the extent to which the plan is being implemented. Differentials in fertility intentions are also studied." (SUMMARY IN ENG)
Asia↗
[Introduction of human leukocytes in cold anabiosis (-20 degrees C) under an exponential program].
Investigation of effective and accessible method for administration of human blood leukocytes in the cold anabiosis condition at am oderately low temperature of minus 20 degrees C by the exponential program with cryopreservative which does not require washing from the bio-object after its thawing, has been proposed. Morphological and functional properties of the leukocytes after different periods of conservation in the state of cold anabiosis were studied. The data obtained suggest that optimal conservation of the morpho-functional properties of cells with the aid of this method equals 3 weeks.
Blood Preservation↗
Using Internet technology to deliver a behavioral weight loss program.
CONTEXT: Rapid increases in access to the Internet have made it a viable mode for public health intervention. No controlled studies have evaluated this resource for weight loss. OBJECTIVE: To determine whether a structured Internet behavioral weight loss program produces greater initial weight loss and changes in waist circumference than a weight loss education Web site. DESIGN: Randomized, controlled trial conducted from April to December 1999. SETTING AND PARTICIPANTS: Ninety-one healthy, overweight adult hospital employees aged 18 to 60 years with a body mass index of 25 to 36 kg/m(2). Analyses were performed for the 65 who had complete follow-up data. INTERVENTIONS: Participants were randomly assigned to a 6-month weight loss program of either Internet education (education; n = 32 with complete data) or Internet behavior therapy (behavior therapy; n = 33 with complete data). All participants were given 1 face-to-face group weight loss session and access to a Web site with organized links to Internet weight loss resources. Participants in the behavior therapy group received additional behavioral procedures, including a sequence of 24 weekly behavioral lessons via e-mail, weekly online submission of self-monitoring diaries with individualized therapist feedback via e-mail, and an online bulletin board. MAIN OUTCOME MEASURES: Body weight and waist circumference, measured at 0, 3, and 6 months, compared the 2 intervention groups. RESULTS: Repeated-measures analyses showed that the behavior therapy group lost more weight than the education group (P =.005). The behavior therapy group lost a mean (SD) of 4.0 (2.8) kg by 3 months and 4.1 (4.5) kg by 6 months. Weight loss in the education group was 1.7 (2.7) kg at 3 months and 1.6 (3.3) kg by 6 months. More participants in the behavior therapy than education group achieved the 5% weight loss goal (45% vs 22%; P =.05) by 6 months. Changes in waist circumference were also greater in the behavior therapy group than in the education group at both 3 months (P =.001) and 6 months (P =.005). CONCLUSIONS: Participants who were given a structured behavioral treatment program with weekly contact and individualized feedback had better weight loss compared with those given links to educational Web sites. Thus, the Internet and e-mail appear to be viable methods for delivery of structured behavioral weight loss programs.
Adult↗