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PubMed1986

Premarital counseling as perceived by newlywed couples: an exploratory study.

Ten couples from a marriage enrichment program for newlyweds and 68 female graduates from a high school course on family life were surveyed about their involvement in and their perceptions of the effectiveness of premarital counseling for preparing them for the realities of married life. Perceived effectiveness of premarital counseling was found to be related to duration of counseling in hours and to the degree to which the program was seen as voluntary. Perceived effectiveness was not consistently related to the duration of courtship. Suggestions for future research with larger samples are presented, along with recommendations for program design in premarital counseling programs.

Adolescent↗
PubMed2004

Voluntary HIV testing as part of routine medical care--Massachusetts, 2002.

In 2003, CDC released Advancing HIV Prevention: New Strategies for a Changing Epidemic. One of the four strategies of this initiative is to expand routine, voluntary human immunodeficiency virus (HIV) testing. This report describes the results of a state-funded program in Massachusetts that offered HIV counseling, testing, and referral (HIV CTR) to patients entering one of four hospital-associated urgent care centers. Among the 3,068 patients tested, the program identified an HIV seroprevalence of 2.0%. The findings underscore the effectiveness of routine HIV CTR in HIV case identification.

AIDS Serodiagnosis↗
PubMed1996

Testing for drugs of abuse in children and adolescents. American Academy of Pediatrics Committee on Substance Abuse.

The American Academy of Pediatrics (AAP) recognizes the abuse of psychoactive drugs as one of the greatest problems facing children and adolescents and condemns all such use. Diagnostic testing for drugs of abuse is frequently an integral part of the pediatrician's evaluation and management of those suspected of such use. "Voluntary screening" is the term applied to many mass non-suspicion-based screening programs, yet such programs may not be truly voluntary as there are often negative consequences for those who choose not to take part. Participation in such programs should not be a prerequisite to participation in school activities. Involuntary testing is not appropriate in adolescents with decisional capacity-even with parental consent-and should be performed only if there are strong medical or legal reasons to do so. The AAP reaffirms its position that the appropriate response to the suspicion of drug abuse in a young person is the referral to a qualified health care professional for comprehensive evaluation.

Adolescent↗
PubMed2002

Plantar flexor activation capacity and H reflex in older adults: adaptations to strength training.

The purpose of this study was to investigate whether the voluntary neural drive and the excitability of the reflex arc could be modulated by training, even in old age. To this aim, the effects of a 16-wk strengthening program on plantar flexor voluntary activation (VA) and on the maximum Hoffman reflex (H(max))-to-maximum M wave (M(max)) ratio were investigated in 14 elderly men (65-80 yr). After training, isometric maximum voluntary contraction (MVC) increased by 18% (P < 0.05) and weight-lifting ability by 24% (P < 0.001). Twitch contraction time decreased by 8% (P < 0.01), but no changes in half relaxation time and in peak twitch torque were observed. The VA, assessed by twitch interpolation, increased from 95 to 98% (P < 0.05). Pretraining VA, also evaluated from the expected MVC for total twitch occlusion, was 7% higher (P < 0.01) than MVC. This discrepancy persisted after training. The interpolated twitch torque-voluntary torque relationship was fitted by a nonlinear model and was found to deviate from linearity for torque levels >65% MVC. Compared with younger men (24-35 yr), the H(max)- to M(max) ratio and nerve conduction velocity (H index) of the older group were significantly lower (42%, P < 0.05; and 29%, P < 0.001, respectively) and were not modulated by training. In conclusion, older men seem to preserve a high VA of plantar flexors. However, the impaired functionality of the reflex pathway with aging and the lack of modulation with exercise suggest that the decrease in the H(max)- to M(max) ratio and H index may be related to degenerative phenomena.

Adaptation, Physiological↗
PubMed2003

Partnerships with health and private voluntary organizations: what are the issues for health authorities and boards?

BACKGROUND: The number of voluntary organizations active in health care is considerable. There have been recent calls for a new closer working relationship between voluntary bodies and the National Health Service. The relationship between the two healthcare sectors needs to be efficient and harmonious in the interests of patient care; however, little is known about the nature and problems in the current relationship. The present study was undertaken to examine aspects of this relationship from the point of view of health board personnel. OBJECTIVE: To identify the practices and views of Scottish health board staff concerning the funding, role and responsibility of voluntary organizations in the health sector. METHODS: A qualitative study based on in-depth interviews with health board officials in all 15 Scottish health boards. RESULTS: Policies for financial and other relationships with the voluntary sector were often not explicit. The levels and method of funding voluntary health organizations varied across boards, as did the tenure of awards (from 1 to 3 years). Demand for funding far exceeded monies available. Some health boards ensured accountability through audited accounts, annual reports and site visits; however, others thought this inappropriate for small organizations. Health boards recognized the problems of the precariousness of funding and the administrative burden of the monitoring process and the ritual of applying for funding. CONCLUSION: The uncertainties of long-term funding may impede the contribution of voluntary organizations. There is a tension between the requirements of clinical governance and the ability of small voluntary organizations to provide the necessary documentation. One proposed solution, to reduce the number of organizations, might not appeal to the voluntary sector. Future initiatives could address the problem of tailoring funding and accounting to the resources of voluntary organizations.

Governing Board↗
PubMed2000

Failure to defend a successful state tobacco control program: policy lessons from Florida.

OBJECTIVES: This investigation sought to define policy and political factors related to the undermining of Florida's successful Tobacco Pilot Program in 1999. METHODS: Data were gathered from interviews with public health lobbyists, tobacco control advocates, and state officials; news reports; and public documents. RESULTS: As a result of a recent legal settlement with Florida, the tobacco industry agreed to fund a youth anti-smoking pilot program. The program combined community-based interventions and advertisements. In less than 1 year, the teen smoking prevalence rate dropped from 23.3% to 20.9%. The program also enjoyed high public visibility and strong public support. Nevertheless, in 1999, the state legislature cut the program's funding from $70.5 million to $38.7 million, and the Bush administration dismantled the program's administrative structure. Voluntary health agencies failed to publicly hold specific legislators and the governor responsible for the cuts. CONCLUSIONS: The legislature and administration succeeded in dismantling this highly visible and successful tobacco control program because pro-health forces limited their activities to behind-the-scenes lobbying and were unwilling to confront the politicians who made these decisions in a public forum.

Adolescent↗
PubMed1999

Psychological conditions diagnosed among veterans seeking Department of Defense Care for Gulf War-related health concerns.

The Comprehensive Clinical Evaluation Program is a US military program that provides a voluntary, clinically oriented evaluation for Gulf War health concerns. This article presents administrative data on psychological conditions (as coded using the International Classification of Diseases, 9th Revision) from the first year of the program. The most commonly diagnosed psychological conditions were medically unexplained physical-symptom syndromes; depression and anxiety, including post-traumatic stress disorder; and alcohol abuse or dependence. Psychological conditions were significantly related to a higher number of workdays lost, and the 19% of veterans with a primary diagnosis of a psychological condition reported 28% of the lost workdays among veteran who participated. Stressful Gulf War experiences were weakly but significantly related to psychological conditions. We conclude that among Gulf War veterans seeking evaluation for Gulf War-related health concerns, psychological conditions are common and are associated with important occupational morbidity.

Adult↗
PubMed2001

A pilot program of improved methods for community-based screening for dementia.

The authors examined the effectiveness of a voluntary memory impairment-screening program for community-dwelling older persons, assessing three factors: appropriateness of screening instrument, reliability of complaints of cognitive difficulties, and adherence to screening recommendations. Two cognitive screening instruments, the Mini-Mental State Exam (MMSE) and the Seven-Minute Screen (7MS) were compared in 59 participants. Twenty-nine percent showed signs of impairment on the 7MS. Results suggested that the 7MS and the MMSE may have different sensitivities and specificities for the detection of early dementia. Failure on the 7MS was not predicted by cognitive or functional complaints. The study identified and addressed factors affecting compliance with screening recommendations.

Aged↗
PubMed2000

Using an anesthesia information management system to prove a deficit in voluntary reporting of adverse events in a quality assurance program.

OBJECTIVE: A deficit is suspected in the manual documentation of adverse events in quality assurance programs in anesthesiology. In order to verify and quantify this, we retrospectively compared the incidence of manually recorded perioperative adverse events with automatically detected events. METHODS: In 1998, data of all anesthetic procedures, including the data set for quality assurance of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI), was recorded online with the Anesthesia Information Management System (AIMS) NarkoData4 (Imeso GmbH). SQL (Structured Query Language) queries based on medical data were defined for the automatic detection of common adverse events. The definition of the SQL statements had to be in accordance with the definition of the DGAI for perioperative adverse events: A potentially harmful change of parameters led to therapeutic interventions by an anesthesiologist. RESULTS: During 16,019 surgical procedures, anesthesiologists recorded 911 (5.7%) adverse events manually, whereas 2966 (18.7%) events from the same database were detected automatically. With the exception of hypoxemia, the incidence of automatically detected events was considerably higher than that of manually recorded events. Fourteen and a half percent (435) of all automatically detected events were recorded manually. CONCLUSION: Using automatic detection, we were able to prove a considerable deficit in the documentation of adverse events according to the guidelines of the German quality assurance program in anesthesiology. Based on the data from manual recording, the results of the quality assurance of our department match those of other comparable German departments. Thus, we are of the opinion that manual incident reporting seriously underestimates the true occurrence rate of incidents. This brings into question the validity of quality assurance comparisons based on manually recorded data.

Anesthesia↗
PubMedDate not supplied

Efficiency, new equity capital enable systems to compete.

Because of limited cash, sponsors of some community and religious hospitals have sought to sell or lease their institutions to a not-for-profit (NFP) system or to a for-profit system. A number of national alliances address the capital formation problem of NFP institutions. Until now they have been almost exclusively concerned with acquiring less costly debt. Without new equity capital, market influence is difficult to obtain. Even well-managed voluntary systems face a serious threat from well-capitalized investor-owned systems. Increased competition among hospitals and physicians will force future advantages to those who have capital. It will also restrict funding of certain programs and services by voluntary enterprises. In anticipation of this, various forms of partnerships have developed with investor-owned systems. To regain the initiative as the premier sponsors of health care, religious and other voluntary systems must go beyond merely competing in their markets to acquiring weaker institutions. They also must revitalize private giving and excel in efficiency to offset threats from ambulatory, day-care operations and from high-technology hospitals. Structural changes in the industry can be predicted, including the following: The trend toward integration for production, financing, and marketing will continue. Public market equity capital will be increasingly used to finance medical practice. Hospitals that sell their equity values will establish service foundations. National alliances will continue, but strictly local systems will maintain operation. Investor-owned systems will move increasingly into high-technology tertiary care.

Capital Financing↗
PubMedDate not supplied

Using rate-based events to improve clinical practice.

This article describes the implementation and utilization of a continuous quality improvement (CQI) program in the identification, analysis, and correction of a rate-based event in anesthesia, in this case, intraoperative hypertension. A CQI program was implemented based on voluntary, handwritten, anonymous reports of intraoperative and postanesthesia care unit events. This CQI program detected a high incidence of intraoperative hypertension, indicated major causal factors, suggested a set of corrective measures, and allowed for measurement of their efficacy.

Anesthesiology↗
PubMed2002

Attrition rates of residents in postgraduate training programs.

BACKGROUND: One goal of program directors is to attract and retain high-quality residents. It is therefore important to study attrition of residents to determine specific cohorts that may be less likely to complete residency training. PURPOSE: The purpose of this study was to investigate attrition rates in targeted programs. METHOD: Surveys were sent to 540 program directors whose programs contained at least 25% international medical graduates. The program directors reported both voluntary attrition and termination rates. RESULTS: Overall attrition rates for international medical graduates and U.S. medical graduates were similar, although U.S. medical graduates were terminated at a slightly lower rate than international medical graduates (2.5% vs. 3.6%) and were somewhat more likely to transfer to other programs (9.9% and 8.9%). CONCLUSIONS: Attrition from these programs remains a small but persistent issue. In addition, the differences in termination and transfer rates for the 2 years of the study were greater than the differences in rates between U.S. and international medical graduates.

Data Collection↗
PubMed2005

Involving the community in cervical cancer prevention programs.

Underutilization of cervical cancer prevention services by women in the high-risk age group of 30-60 years can be attributed to health service factors (such as poor availability, poor accessibility, and poor quality of care provided), to women's lack of information, and to cultural and behavioral barriers. The Alliance for Cervical Cancer Prevention (ACCP) partners have been working to identify effective ways to increase women's voluntary participation in prevention programs by testing strategies of community involvement in developing countries. The ACCP experiences include developing community partnerships to listen to and learn from the community, thereby enhancing appropriateness of services; developing culturally appropriate messages and educational materials; making access to high-quality screening services easier; and identifying effective ways to encourage women and their partners to complete diagnosis and treatment regimens. Cervical cancer prevention programs that use these strategies are more likely to increase demand, ensure follow-through for treatment, and ultimately reduce disease burden.

Ambulatory Care↗
PubMedDate not supplied

A study of closure of family practice residency programs.

BACKGROUND: Between July 1, 2000, and July 1, 2002, the Residency Review Committee for Family Practice had received requests for voluntary withdrawal from 27 residency programs. This number represents a significant increase in the rate of program closure over previous years. OBJECTIVES: We compared descriptive data on these closing programs and explored factors contributing to the closure. METHODS: Descriptive program data were collected from the Accreditation Council for Graduate Medical Education, National Resident Matching Program, the American Academy of Family Physicians, and the American Board of Family Practice. Program directors from closing programs were invited to participate in a semi-structured interview to discuss factors contributing to the closure of their program. RESULTS: Seventy-five percent of closing programs were community based, median program age was 11 years, board pass rate averaged 98%, and 69% cared for underserved communities. Financial, political, and institutional leadership changes were most frequently cited by program directors as primary reasons for program closure. CONCLUSIONS: The rate of program closure is increasing, affecting programs that meet most measures of high quality. Quality programs are being lost, and the ultimate impact is yet to be seen. Program directors offer warning signs and advice that is generally applicable to other family practice residency programs.

Family Practice↗
PubMed1996

Premotor interneurons in generation of adaptive leg reflexes and voluntary movements in stick insects.

We investigated the role of local nonspiking interneurons involved in motor control of legs in the stick insects, Carausius morosus. In a preparation that allowed the animals to perform active leg movements such as adaptive tactile reflexes, proprioceptive reflexes, and walking, we gathered the following results. Almost all tested nonspiking interneurons that provide synaptic drive onto moto-neurons of the proximal leg muscles contribute to all of the motor programs underlying tactile reflexes and voluntary leg movements such as walking, searching, and rocking. Most of them are also involved in the generation of proprioceptive reflexes. All motor programs for coactivation, avoidance reflexes, resistance reflexes, and voluntary leg movements result from parallel pathways including nonspiking interneurons that support and others that oppose the motoneuronal activity. The contribution of a single interneuron to the different motor program is specific: it can be supporting for one motor program but opposing for the other. Even for the same motor program, for example, coactivation, the contribution of an individual interneuron can depend on the stimulus site from where the response is elicited. Our results support the idea that the different motor patterns for adaptive tactile reflexes, resistance reflexes, and voluntary leg movements emerge from a multifunctional neuronal circuit that is reorganized corresponding to the motor behavior performed. The actual motor pattern is then shaped by distributed information processing in parallel supporting and opposing pathways.

Acclimatization↗