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At least 1,405 records · Page 78Linked to original sources
PubMed2006

Differential use of adolescent reproductive health programs in Addis Ababa, Ethiopia.

PURPOSE: Adolescent reproductive health programs in Africa have largely remained as small-scale pilot programs, however, there is increasing interest in bringing programs to scale. Evaluations have focused on individual programs and few have gathered population-based information on the reach of program models and the profile of adolescents who utilize services, versus those who do not. This study examines the coverage and utilization of existing adolescent programs in Addis Ababa, Ethiopia. METHODS: Population-based surveys were undertaken among over 1000 adolescents aged 10 to 19 years in slum areas of Addis Ababa, Ethiopia. An inventory of youth programs including youth centers and peer education programs was compiled in the study area. RESULTS: Eight peer education programs and six youth centers were operating in the study area. Twenty percent of boys and only 7% of girls had visited a youth center in the last year; 27% of boys and 15% of girls had had contact with a peer educator. Older adolescents, especially boys, were more likely to utilize programs. Girls who work long hours and who are isolated are less likely to access and benefit from programs. CONCLUSIONS: Greater segmentation of the adolescent population is needed in the design and content of adolescent reproductive health programs. In addition, programmers should pay attention to the specific circumstances of young people in local settings, particularly vulnerable, hard-to-reach sub-groups of adolescents, including girls.

Adolescent↗
PubMed1991

Why do child mortality rates fall? An analysis of the Nicaraguan experience.

A comprehensive review of available sources of mortality data was undertaken to document the changes that have occurred in infant mortality in Nicaragua over the last three decades. It was found that a rapid fall in infant mortality commenced in the early 1970s and has continued steadily since. Trends in several different factors which might have led to this breakthrough were examined including: income, nutrition, breastfeeding practices, maternal education, immunizations, access to health services, provision of water supplies and sanitation, and anti-malarial programs. Of these, improved access to health services appears to have been the most important factor. At a time when the number of hospital beds per capita was dropping, increasing numbers of health care professionals, particularly nurses, were becoming available to staff primary health care facilities built in the 1960s. These were provided at least partly in response to the growing political turmoil enveloping the nation at that time. Certain Nicaraguan cultural attributes may have added to the impact of the reforms. Efforts in the field of public health made since the 1979 insurrection appear to have maintained the decline in child mortality.

Breast Feeding↗
PubMed2005

The University of Virginia Telemedicine Program: traversing barriers beyond geography.

Access to specialty healthcare remains inadequate for many of our rural citizens, a situation attributable to a host of factors ranging from geographic to economic barriers, worsened by the limited numbers of specialists who practice in rural communities. We wish to report our progress in the development of a robust 55-site telehealth network in the Commonwealth of Virginia, designed specifically to enhance access to specialty care not locally available in rural regions of the state. We will review the process by which we developed partnerships with otherwise unaffiliated healthcare facilities, the equipment and telecommunications services used, and the statutory, regulatory, and cultural impediments to the fullest deployment of telehealth facilitated healthcare and education. Through this network, early and timely intervention has saved lives, avoided unnecessary transfer and travel, and initiated previously unavailable screening and education programs in many rural communities.

Female↗
PubMed2004

Preventing cancer, cardiovascular disease, and diabetes: a common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association.

Collectively, cardiovascular disease (including stroke), cancer, and diabetes account for approximately two thirds of all deaths in the United States and about 700 billion dollars in direct and indirect economic costs each year. Current approaches to health promotion and prevention of cardiovascular disease, cancer, and diabetes do not approach the potential of the existing state of knowledge. A concerted effort to increase application of public health and clinical interventions of known efficacy to reduce prevalence of tobacco use, poor diet, and insufficient physical activity-the major risk factors for these diseases-and to increase utilization of screening tests for their early detection could substantially reduce the human and economic cost of these diseases. In this article, the ACS, ADA, and AHA review strategies for the prevention and early detection of cancer, cardiovascular disease, and diabetes, as the beginning of a new collaboration among the three organizations. The goal of this joint venture is to stimulate substantial improvements in primary prevention and early detection through collaboration between key organizations, greater public awareness about healthy lifestyles, legislative action that results in more funding for and access to primary prevention programs and research, and reconsideration of the concept of the periodic medical checkup as an effective platform for prevention, early detection, and treatment.

Cardiovascular Diseases↗
PubMedDate not supplied

Self-efficacy theory as a framework for community pharmacy-based diabetes education programs.

Pharmacists are the most accessible healthcare professional to many chronically ill patients and see patients with diabetes up to five times more often than any other healthcare provider. Besides this high accessibility, pharmacists have a strong focus on counseling, health education, and interaction with patients, making them ideal providers of diabetes education and valuable members of a multidisciplinary diabetes care team. Health education programs in general often have been developed without a basic theoretical framework. These programs are more difficult to evaluate in terms of how behavioral change may be best accomplished. Self-efficacy theory has been used in the past to develop successful patient education programs for patients with diabetes. The purpose of this paper is to describe self-efficacy theory and its role in diabetes education, and to encourage its use as a framework for the development of community pharmacy-based diabetes education programs.

Community Pharmacy Services↗
PubMed2004

Influence of patient literacy on the effectiveness of a primary care-based diabetes disease management program.

CONTEXT: Low literacy is an important barrier for patients with diabetes, but interventions to address low literacy have not been well examined. OBJECTIVE: To examine the role of literacy on the effectiveness of a comprehensive disease management program for patients with diabetes. DESIGN, SETTING, AND PARTICIPANTS: Analysis of the influence of literacy on glycemic control and systolic blood pressure using data from a randomized controlled trial (conducted from February 2001 through April 2003) of a comprehensive diabetes management program. Participants were 217 patients aged 18 years or older with type 2 diabetes and poor glycemic control (glycosylated hemoglobin [HbA1c] levels > or =8.0%) and presenting to a US academic general internal medicine practice. INTERVENTIONS: All communication to patients was individualized and delivered to enhance comprehension among patients with low literacy. Intervention patients received intensive disease management from a multidisciplinary team. Control patients received an initial management session and continued with usual care. MAIN OUTCOME MEASURES: Achievement of goal HbA1c levels and systolic blood pressure at 12-month follow-up for control and intervention patients stratified by literacy status. RESULTS: Complete 12-month data were available for 193 patients (89%). Among patients with low literacy, intervention patients were more likely than control patients to achieve goal HbA1c levels (< or =7.0%) (42% vs 15%, respectively; adjusted odds ratio [OR], 4.6; 95% confidence interval [CI], 1.3 to 17.2; P = .02). Patients with higher literacy had similar odds of achieving goal HbA1c levels regardless of intervention status (24% vs 23%; adjusted OR, 1.0; 95% CI, 0.4 to 2.5; P = .98). Improvements in systolic blood pressure were similar by literacy status. CONCLUSIONS: Literacy may be an important factor for predicting who will benefit from an intervention for diabetes management. A diabetes disease management program that addresses literacy may be particularly beneficial for patients with low literacy, and increasing access to such a program could help reduce health disparities.

Academic Medical Centers↗
PubMedDate not supplied

Educational outcomes in teenage pregnancy and parenting programs: results from a demonstration.

A comparison of five in-school educational and service approaches offered at seven sites in Arizona to 789 pregnant and parenting teenagers shows that except for those who enroll in a program in their third trimester, pregnant and parenting teenagers who attend a comprehensive, school-based, community-linked program are significantly more likely to continue in school than are those who have no access to a special program. The comprehensive program's impact is greatest among Hispanic students, younger students, those in grades 9-10, those who are living with their partner and those who enter the program in the first trimester. Two of the program components--strong outreach efforts and case management-are believed to have an especially favorable impact on continuation in school.

Adolescent↗
PubMed1976

Child health in America: toward a rational public policy.

Analysis of currently available data on mortality and morbidity indicates that the major organic illnesses of childhood, and their developmental consequences, are susceptible in part to the technical interventions of American medical science. Environmental forces, however, exert a powerful impact on the health of children in the United states, manifested both in the disproportionate toll of most organic diseases on poor and nonwhite populations and in such increasingly important symptoms of familial, social, and behavioral distress as child abuse, accidents, and childhood suicide. Review of the nature, quality, and distribution of child health services demonstrates a systemic inability to reach and treat the children most in need of them. A rational basis for child health policy includes: appropriate concepts of health, disease, and preventive and therapeutic intervention; a capacity to acknowledge, to measure, and to act on the familial and environmental, as well as the medical, sources of illness; an orientation to the developmental and social implications of good and poor child health; and a commitment to enable all children to receive health services. The data and this policy framework lead to these program recommendations: the channeling of resources into a more rational system which guarantees equity and access; a planning and program implementation mechanism which addresses the health needs of diverse local populations and which makes real the advocacy concept; a screening, evaluation, and surveillance methodology; a delivery system which both applies preventive and curative health technology and addresses basic life needs of children; and a coherent program for the training, assignment, and supervision of the several kinds of manpower which such a system would require.

Adolescent↗
PubMed2000

Getting nutrition education into medical schools: a computer-based approach.

Despite awareness of the importance of nutrition as part of medical student's education, numerous barriers exist to incorporating nutrition education into the medical school curriculum. Chief among such barriers is that most medical schools do not have faculty trained specifically in nutrition. A curriculum is needed that can deliver comprehensive nutrition information that is consistent across medical schools. One way to deliver this information is to use computer-assisted instruction (CAI). To meet the different needs of medical schools and provide a consistent base of nutrition information, we developed a series of interactive, multimedia educational programs (Nutrition in Medicine) that teach the basic principles of nutritional science and apply those principles in a case-oriented approach. Curriculum content is derived from the American Society for Clinical Nutrition consensus guidelines. These modules offer the advantages of accessibility, self-paced study, interactivity, immediate feedback, and tracking of student performance. Modules are distributed free to all US medical schools. Preliminary data from surveys gathered by our team at the University of North Carolina at Chapel Hill indicate that 73 US medical schools use, or are planning to use, these modules; more schools are currently evaluating the programs. Successful implementation of CAI requires easy program access, faculty training, adequate technical support, and faculty commitment to the programs as a valuable resource. CAI fails when the program is just placed in the library and students are told to use it when they can find the time.

Computer-Assisted Instruction↗
PubMed2000

Information system powers innovative research project aimed at managing the care of senior citizens.

HealthAmerica Pennsylvania, Inc., in Pittsburgh, is aiming to increase access to health care for senior citizens in its Advantra health plan in Pittsburgh. Under its Senior Life Management program, Coventry Health Care, parent company of HealthAmerica, hired nine personal service representatives (PSRs) and is asking them to provide outreach to 5,000 senior citizens. The PSRs and other staff members will get to know each senior citizen in the program, evaluate and recognize their health needs, and develop methods to ensure that their needs are met before any patient's condition becomes unnecessarily costly. The goal of this innovative program is to improve access to health care for these 5,000 members and thus improve their satisfaction with care and help to reduce health care costs.

Aged↗
PubMedDate not supplied

Early detection and treatment of hemodialysis access dysfunction.

PURPOSE: To assess the usefulness of a program for the early detection of hemodialysis graft dysfunction and the impact on graft survival of percutaneous transluminal angioplasty (PTA) and stent implantation to correct venous stenosis. METHODS: A program for the early detection of hemodialysis access graft dysfunction was carried out in 110 patients over a period of 80 months. Detection was based on physical examination, flow rate measurements, venous pressure, and analytical determinations performed at dialysis. The stenoses detected were treated by PTA or PTA plus stent deployment. Survival curves compared primary and assisted patency rates for the different graft types. RESULTS: The most important indicators of dysfunction were increased venous pressure and difficulty in cannulation of the graft. Significant stenoses were revealed by 227 (92.2%) of the 246 fistulography procedures performed. PTA results were satisfactory in 100% of the Thomas grafts, 74% of the Brescia-Cimino (BC) grafts, and 53% of the polytetrafluoroethylene (PTFE) grafts. Technical success rates for stent deployment were 92% for BC grafts and 100% for PTFE grafts, while functional success rates were 96% and 97%, respectively. The difference in the primary patency (P1) and assisted patency (AP) values was statistically significant for all three graft types. There was no significant difference in the patency rates for grafts treated by PTA alone or by PTA and stent deployment. CONCLUSION: A surveillance program helped prevent graft thrombosis, and intervention as required achieved excellent primary and assisted patency rates. Stent deployment salvaged a considerable number of accesses but did not significantly extend access survival time.

Angioplasty, Balloon↗
PubMed1997

Pharmaceutical services in the United States Air Force.

The status of pharmaceutical services in the United States Air Force medical service is described. Air Force pharmacy is adopting new programs, staffing standards, inventory methods, and roles for pharmacists and technicians. One of the most visible changes is TRICARE, an interservice program that provides improved access to care. Many Air Force medical treatment facilities have been closed; prescription mail-out programs and networks of community pharmacies are filling the gap. The Air Force pharmacy team consists of more than 1300 pharmacists and technicians. Air Force pharmacists are military officers first. Great emphasis is placed on medical readiness training and continuing education. Some Air Force pharmacies are very small outpatient operations filling fewer than 300 prescriptions per day; others fill well over 4000. Many hospitals are being considered for more outpatient-focused operations. Because of anticipated minor reductions in pharmacist staffing, Air Force pharmacists will have to maximize efficiencies to maintain or improve current levels of service. More and better patient information will be provided and distributive processes streamlined. A greater role for technicians is anticipated. The future includes pharmacists serving in a wide variety of leadership and staff positions, improving the use of computers, and incorporating new technologies. Air Force pharmacy is changing to ensure uninterrupted fulfillment of its responsibilities.

Automation↗
PubMed1991

A menu-shell for the GCG programs.

We provide a menu-driven integration of the genetic programs of the Genetics Computer Group (GCG). This allows in-experienced users a very simple access to all GCG programs regardless of the system environment. No modifications to the GCG package are necessary.

Computer Simulation↗
PubMedDate not supplied

Hospice values, access to services, and the Medicare hospice benefit.

The Medicare benefit has been an important force in shaping the American hospice movement during the 1980's. Hospice reimbursement under Medicare added legitimacy to the movement, increased access to hospice care for some Medicare beneficiaries, and provided financial support to Medicare certified hospice programs. But the increased access for some may come at the cost of decreased access for others, and the price of reimbursement may be the erosion of hospice as a unique form of terminal care in this country. It is up to hospice professionals to balance the fiscal realities of providing hospice care without losing sight of the values and philosophies that have made hospice a "special kind of care."

Health Services Accessibility↗
PubMed1999

[Dr. Quiz: a program of medical question-data bank with access to Internet].

The authors' aim was to develop a programme of medical question-databank which could be used for self-assessment of knowledge. The programme incorporates computer-network technology utilising the Internet. The duration of Internet connection of users is merely limited to the time of selecting and downloading a group of questions. The series of multiple choice questions follows the decision making process of physicians from the description of the medical case to establishing the diagnosis and the therapy. The series of questions can be branched depending on the level of knowledge and the answers are evaluated with different number of scores emphasising the medical significance of the concrete question. Detailed explanations are attached to all possible responses and the general summary of the case can be read after completing the task. The addresses of the authors creating the different cases are also saved and in this way there is a chance of the direct communication between the authors and the users. Special feature of the programme is that when the users want to download a new group of questions, their previous answers are fed back to the server in order to get the possibility of improving the quality of the question-databank by means of an appropriate statistical analysis. At present, the programme is at the stage of checking and complementing.

Databases, Factual↗