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PubMed1999

Genotoxicity of the extracts from the compost of the organic and the total municipal garbage using three plant bioassays.

The production of compost is one of the alternatives for the disposal of non-hazardous solid wastes. Compost is used in agriculture and gardening as fertilizer. In the State of Queretaro, Mexico, there is a project to produce compost from the municipal garbage which could be used as a fertilizer. The presence of mutagenic compounds in the compost could be a major disadvantage for the selection of this alternative. For the above reason, this study was initiated as a pilot project to determine the potential mutagenic activity in the compost using three plant bioassays: Tradescantia-micronucleus (Trad-MCN), Tradescantia stamen hair mutations (Trad-SHM) and Allium root anaphase aberrations (AL-RAA). Compost was produced using both aerobic and anaerobic processes from either organic waste (from the residential area) or from the total components of the municipal garbage. Extractions from the compost were done using distilled water and organic solvents and shaking the sample for about 12 h under relatively low temperatures (15-20 degrees C). Plant cuttings of Tradescantia or the roots of Allium were treated by submerging them in the extracts. Three replicates of each sample were analyzed in each one of the three bioassays. As expected the samples of compost from the total garbage showed a higher genetoxicity than those from organic waste. In conclusion, there are some substances present in the compost capable of inducing genotoxicity in the plant assays and therefore there must be some restrictions for its use as a fertilizer.

Agriculture↗
PubMed2006

Childbirth policies and practices in Ireland and the journey towards midwifery-led care.

OBJECTIVE: To describe the dominant policies and practices that have governed childbirth in Ireland, and to outline the progress made towards the introduction of midwifery-led care in one health region. LITERATURE REVIEW: A review of maternity-care policies in Ireland was conducted using government and regional health-authority documents and two historical reviews of government policies. A search was also carried out in PubMed and cinahl databases, using the keywords 'maternity care', 'childbirth', 'policy', 'midwifery-led', 'Ireland/Irish', with relevant Boolean and string operands. Childbirth as a social process is influenced by the model of care, and affects the physical and psychological outcomes for the woman and her family. In Ireland, routine intervention in labour is common, but, since the early 1990s, some changes in the Irish maternity services have taken place. Pilot projects on community midwifery have been introduced in some areas. Challenges to the provision of maternity care in the Health Service Executive, North Eastern area (formerly the North-Eastern Health Board) led to the production of the Kinder report, which included a recommendation to introduce pilot midwifery-led units (MLUs). THE INTRODUCTION OF MIDWIFERY-LED CARE: A Maternity Services Taskforce was established in January 2002 with a wide remit, including facilitation of the establishment of MLUs in Cavan General Hospital, Cavan and Our Lady of Lourdes Hospital, Drogheda, Co. Louth. The MLUs are being evaluated within the context of a randomised trial known as 'the MidU study', which compares midwife-led care with the present system of medical-led care for women who are at low risk of complications during pregnancy and labour. CONCLUSION: The journey to midwifery-led care in Ireland has been a long one. The phased introduction of MLUs, which are subject to rigorous evaluation, will provide quality evidence upon which to base the future development of maternity care across Ireland.

Adult↗
PubMedDate not supplied

Mediated modeling of the impacts of enhanced UV-B radiation on ecosystem services.

This article describes the use of group model building to facilitate interaction with stakeholders, synthesize research results and assist in the development of hypotheses about climate change at the global level in relation to UV-B radiation and ecosystem service valuation. The objective was to provide a platform for integration of the various research components within a multidisciplinary research project as a basis for interaction with stakeholders with backgrounds in areas other than science. An integrated summary of the scientific findings, along with stakeholder input, was intended to produce a bridge between science and policymaking. We used a mediated modeling approach that was implemented as a pilot project in Ushuaia, Argentina. The investigation was divided into two participatory workshops: data gathering and model evaluation. Scientists and the local stakeholders supported the valuation of ecosystem services as a useful common denominator for integrating the various scientific results. The concept of economic impacts in aquatic and marsh systems was represented by values for ecosystem services altered by UV-B radiation. In addition, direct local socioeconomic impacts of enhanced UV-B radiation were modeled, using data from Ushuaia. We worked with 5 global latitudinal regions, focusing on net primary production and biomass for the marine system and on 3 plant species for the marsh system. Ecosystem service values were calculated for both sectors. The synthesis model reflects the conclusions from the literature and from experimental research at the global level. UV-B is not a significant stress for the marshes, relative to the potential impact of increases in the sea level. Enhanced UV-B favors microbial dynamics in marine systems that could cause a significant shift from primary producers to bacteria at the community level. In addition, synergetic effects of UV-B and certain pollutants potentiate the shift to heterotrophs. This may impact the oceanic carbon cycle by increasing the ratio of respiratory to photosynthetic organisms in surface waters and, thus, the role of the ocean as a carbon sink for atmospheric CO2. In summary, although changes in the marine sector due to anthropogenic influences may affect global climate change, marshes are expected to primarily be affected by climate change.

Animals↗
PubMed2005

Applying a basic development needs approach for sustainable and integrated community development in less-developed areas: report of ongoing Iranian experience.

INTRODUCTION: Despite considerable achievements in the provision of basic developmental facilities in terms of drinking water, access to primary healthcare services, high-quality and nutritious food, social services, and proper housing facilities, there are many rural and slum communities in Iran where these essential needs remain unfulfilled. Lack of equity is prominent, as large differences exist in underprivileged provinces. New policies developed in the past two decades have resulted in substantial achievements in meeting population needs and reducing the socio-economic gap; nevertheless, poverty levels, unemployment due to a large increase in the birth rate in the early 1980s, and lack of community participation are matters yet to be addressed. To overcome these deficiencies, a basic development needs approach was adopted to promote the concept of community self-help and self-reliance through intersectoral collaboration, creating an environment where people could take an active part in the development process, with the Iranian government providing the necessary support to achieve the desired level of development. DESCRIPTION OF THE PROJECT: Following firm commitment from the Iranian government and technical support from the World Health Organization Regional Office, basic development needs was assigned a high priority in health and health-related sectors, reflected in the third National Masterplan (2001-2005). A comprehensive intersectoral plan was designed, and pilot projects were commenced in three villages. Each village elected a representative, and committee clusters were formed to run and monitor projects identified by a process of local needs assessment and priority assignment. In each region, a variety of needs were elicited from these assessments, which were actively supported by local authorities. LESSON LEARNED: A basic development needs approach was found to be a reliable discipline to improve community participation, needs-led resource allocation and intersectoral co-operation in community development, particularly in underprivileged areas. Iran's initial experience of basic development needs has gained widespread public support but will require periodical evaluation as it is introduced into other rural and urban regions across the country.

Community Participation↗
PubMed1999

Moving healthcare reform forward: a complex and challenging transition.

As a long-time advocate of primary-care reform and a participant in the present implementation of the Ontario Primary Care Reform (PCR) pilot projects, I am sympathetic to the perspectives of Rosser and Kasperski. The model for reform that they propose has added fuel to the debate on PCR initiatives. However, the future strategic direction for primary care will be determined at the conclusion of the implementation and testing period for the pilot sites and after evaluating models in other provincial jurisdictions. Although the investment of resources over the past four years by government and the profession has clearly been significant, the methodical planning and breadth of consultation and review on many issues may not be apparent to observers.

Continuity of Patient Care↗
PubMed1999

Use of a mini-grant program to stimulate generalist training at the University of Massachusetts Medical Center.

The authors describe and evaluate an annual competitive "mini-grant" program, funded by The Robert Wood Johnson Foundation's Generalist Physician Initiative established at the University of Massachusetts Medical School as a strategy to stimulate greater faculty involvement in the development of innovative, generalist-oriented projects. The mini-grant program stimulated proposals from across the academic community. The average award was small (mean = $7,039) but at times the awards led to results exceeding the scope of the original funding. In several cases, mini-grant support provided seed funding for faculty to undertake pilot projects to test new initiatives that would otherwise not have been developed. Some projects led to further ideas or to collaborations between generalists and basic scientists or specialists. More than half of funded projects were eventually institutionalized, and nearly 20% led to formal presentations at national meetings. Two problems are identified: (1) there were fewer proposals generated by specialist faculty and fewer collaborative proposals from generalists and specialists than anticipated, and (2) no funded proposals were generated by community-based faculty who were predominantly clinicians, such as preceptors. Despite these problems, and in light of available solutions, the authors conclude that an institutional mini-grant program can provide an ongoing, flexible mechanism to support a shift in institutional culture toward an enhanced status for generalism.

Curriculum↗
PubMed2001

Audit and summative assessment: a completed audit cycle.

OBJECTIVE: To develop and test a system for delivering a completed audit cycle for summative assessment of general practitioner registrars in the United Kingdom. DESIGN: A trainer-based questionnaire on criteria for a completed audit cycle, followed by two marking exercises of audit projects submitted by general practice registrars. SETTING: Training practices in the West of Scotland between 1997 and 1998. SUBJECTS: Trainers and registrars in the above practices. RESULTS: 116 (89%) agreed that two collections of data were an essential or desirable part of an audit project. All 57 registrars who started in August 1997 successfully completed an audit cycle, seven (12%) after resubmission. Using two rather than three independent assessors to screen the projects, the marking instrument was shown to have a sensitivity of 95% (95% confidence interval (CI) +/-3.9%) and a specificity of 77% (95% CI +/-7.5%). All assessors found the new system easier to mark and 47 registrars (87%) found completing an audit cycle as or easier than expected. CONCLUSION: Evidence from the pilot project has shown that a general practice registrar's ability to review and critically analyse a piece of his/her work, with appropriate management of any necessary change, can be tested feasibly by means of a completed audit cycle within the registrar year. The process retains adequate levels of sensitivity and specificity and requires fewer assessors for marking the projects.

Clinical Competence↗
PubMed1977

[Rural health center in Bali].

The rural Health Centre of Mengwi, on the island of Bali, was built and equipped for US $ 15,000 by Project Concern, a non-sectarian, medical relief organization. It has been run so successfully by them since it opened in 1974, that not only has the Centre gained the trust of the local community into which it is now fully integrated, but it is also regarded by the Indonesian Government as a pilot project. Amongst the factors leading to this success, the author underlines the following points: a suitable location for the Centre, easily accessible by the villagers; a local staff recruited from the villages of Mengwi District, well trained and sympathetic to the population; constant retraining of the staff leading to better medical care; the availability of a doctor and nurse around the clock; an adequate supply of drugs. Evaluation of the operation is best done by the acceptance of special programmes such as the Under-Five Clinic, the Family Planning Scheme, Ante-Natal Clinic and vaccinations. The mere success of the general clinic would not mean that the Centre had been integrated into the community and become a factor in rural development. The success of these special clinics, as well as the out-reach programmes, demonstrates that through adequate delivery of medical care, the Health Centre of Mengwi can now fulfil its role of being an important factor in the development of a rural community in the tropics.

Delivery of Health Care↗
PubMed2005

Crossing the divide: primary care and mental health integration.

This paper describes the views of primary care providers about treating depression among adult Medicaid patients and their experiences with managed behavioral health care. It also shows the outcomes of an intervention project that provides a care manager to facilitate connections among PCPs, patients, and behavioral health providers. Despite widespread initiatives to improve depression management in primary care and to manage behavioral health services, it appears that links between the two systems and the use of evidence-based approaches to managing patients are rare. A pilot project to initiate practice redesign, the use of a care manager to assist in patient support, and compliance with both medical and behavioral health treatment has been shown to improve communication and results in positive patient outcomes. Managed behavioral health care can result in incentive structures that create gaps between primary care and behavioral health systems. This project illustrates an initiative co-sponsored by the Massachusetts behavioral health program designed to strengthen links between behavioral health and primary care, and increase rates and effectiveness of depression treatment.

Adult↗
PubMed2003

Mass newborn screening in Singapore.

Births in Singapore are almost exclusively in hospitals and this is conducive to mass newborn screening. Mass newborn screeningbegan in 1965 for G6PD deficiency and has led to successful eradication of the complicating kernicterus. Screening has also identified the distinct ethnic and sex linked variations in incidence. The predominant molecular abnormality is the Canton variant. Congenital hypothyroidism screening was started as a pilot project in 1981, then became institution-based in 1985 and nationwide in 1990. The screening is carried out on the cord blood and is now a primary TSH screen. Anincidence of about 1 in 3000 is being obtained and treatment has been started within 2 weeks of birth in almost all babies. A pilot Newborn Screening for hearing impairment started in 1999. Ituses the measurement of Transient Evoked Oto-Acoustic Emissions, is hospital based andcovers about 10% of the newborn population. The program has identified hearing impairment requiring intervention at a rate of about 1:1000 births. A program covering about 50% of the national births has been commissioned by the Ministry of Health to establish epidemiologic data and to document the outcome of early intervention. Mass newborn screening for inborn errors of metabolism is being considered.

Congenital Hypothyroidism↗
PubMed1995

Volunteer low-risk outpatient surgery for uninsured patients in San Francisco. The Ambulatory Surgery Access Coalition.

OBJECTIVE: To provide uncompensated elective low-risk outpatient surgery for uninsured patients through a coalition of volunteer physicians, nurses, and hospitals. DESIGN: Description of the process of establishing the Ambulatory Surgery Access Coalition (ASAC), the political and administrative obstacles encountered, and the clinical results of treatment of the first 25 patients in the pilot project. SETTING: The ASAC includes the Kaiser Foundation Hospital, San Francisco, Calif, the University of California, San Francisco, the San Francisco General Hospital (SFGH), the San Francisco Department of Public Health, the San Francisco Consortium of Community Clinics, the Northern California Chapter of the American College of Surgeons, and the San Francisco Medical Society. A pilot program of uncompensated outpatient surgery was performed at the Kaiser Foundation Hospital. PATIENTS: Twenty-nine patients were referred to the ASAC between January 1 and November 1, 1994. Twenty-six patients were judged to be candidates for surgery, and 25 patients met the criteria for the ASAC program. One patient was referred to SFGH for treatment because of a perceived increased risk for hospitalization after surgery. RESULTS: Twenty-one patients underwent herniorrhaphy; three, excision of large inclusion cysts; and one, anal fistulotomy. Seventeen procedures were done under local anesthesia, seven under general anesthesia, and one under spinal anesthesia. None of the patients required hospital admission. No wound infections occurred. CONCLUSION: The ASAC successfully provided uncompensated low-risk outpatient surgery to 25 low-income uninsured patients in San Francisco. The coalition hopes, first, to include other San Francisco hospitals and surgical specialties, and second, to serve as a model for other communities throughout the country.

Ambulatory Surgical Procedures↗
PubMed2004

UK Quality Indicator Project (UK QIP) and the UK independent health care sector: a new development.

PURPOSE: To describe implementation of the UK Quality Indicator Project (UK QIP) in the independent health care sector, drawing upon 10 years experience in the UK and approaching 20 years experience in the USA. We describe the history of the project, with an emphasis on recent developments, reflecting upon the critical features of the project and its value for participants. BACKGROUND: The International Quality Indicator Project is the largest international data set of quality indicators. It provides participants with quarterly feedback of comparative indicator data and support for effective use of these data within the participants' own quality improvement programmes. The UK QIP now includes about two-thirds of UK private sector acute hospitals. The UK QIP began as a pilot project in the National Health Service (NHS) public sector in 1991. Implementation of the NHS performance assessment framework, and associated indicator programme, led to a reduction in public sector involvement. In contrast, the private sector, led by the Independent Healthcare Association, sought to identify a provider of key performance indicators to support both internal, within-sector drives for quality improvement and external demands produced by governmental review and the introduction of the National Care Standards Commission. The UK QIP was chosen since it provided a validated, epidemiologically sound system with capacity for support, education and flexibility to meet the changing demands of the sector. The future development of the QIP within the sector, including expansion from acute hospitals to mental health, is described. CONCLUSIONS: Reflection on the process of engagement of the UK independent sector with the QIP emphasizes the generic nature of the project and offers insights into the value of the project. Future challenges, including the issue of public accountability, are discussed in light of the project's underlying philosophy and purpose.

Private Sector↗
PubMed1981

Computer-assisted instruction in a health sciences library: an experimental project.

The Leon S. McGoogan Library of Medicine at the University of Nebraska received a grant from the University of Nebraska Computer Network to study management aspects of providing computer-assisted instruction (CAI) resources. The library wished to determine: (1) faculty and student receptiveness to CAI as a library resource and (2) user response to CAI library services. A user questionnaire was designed to ascertain the appropriateness of initial management decisions regarding CAI access. The methodology employed in implementing this pilot project, the results of the questionnaire, and the future of CAI at the University of Nebraska are addressed in this paper.

Computer-Assisted Instruction↗
PubMed1991

A foot in the door: art therapy in the nursing home.

Inclusion of art therapy in the residential nursing home and a day-care facility had positive effects on the elderly. Socialization, self-esteem, and memory retrieval were enhanced by the art experience. In addition, the staff and administrators of both the nursing home and day-care facility found art therapy to be valuable and arranged to continue the program. The funding agent for the pilot project was particularly interested in supporting a program that included an educational component, and the university recognized this program as an excellent training opportunity. The five art therapy interns gained experience in working with a population that will need increased professional services in the future, and the successful addition of part-time art therapists at the two pilot agencies will assure a continuation of intern training sites for art therapy students interested in gerontology. By developing sites for art therapy interns, we have opened the door to a method which will not only train professionals to work with older adults but will also offer job sharing between nursing homes. It has been suggested by the administrator of the nursing home in the program that we investigate the possibility of one art therapist serving two or three nursing homes on a part-time/full-time employment basis. Programs would then be affordable at most sites, and thus more people would be able to benefit from art therapy.

Aged↗
PubMed2001

Hospital and emergency ambulance link: using IT to enhance emergency pre-hospital care.

Emergency ambulances traditionally inform receiving hospitals of impending arrival of patients only in instances of load and go situations, which on average constitute less than 5% of ambulance runs. Information transmitted is usually sparse. For all other runs, information is made available only on arrival at the emergency department (ED). There have also been numerous limitations associated with voice transmissions.A comprehensive electronic ambulance case record was created as a pilot project in Singapore between three emergency ambulances and the busiest ED there. All information captured by the ambulance crew, including vital signs information and ECGs was entered or downloaded onto a ruggardised PC in the ambulance and this complete ambulance record was transmitted to the ED. Transmission was wireless via the public mobile data network. A 3-month analysis of this pilot run revealed the following. (1) It was possible to capture a complete ambulance case record electronically at a mean time of 94 s vs 7 min 7 s for the traditional written record. (2) Air transmission time for data was approximately 4 s unless ECG wave forms were also transmitted resulting in transmission times frequently exceeding 60 s. (3) At least 68% of data was transmissible in 75% of Hospital & Emergency Ambulance Link (HEAL) ambulances as opposed to only 25% in less than 5% of non-HEAL ambulances. (4) Paramedics' time in the ED decreased from 15 to 8 min as a result of HEAL. (5) The waiting time for critical care patients to be seen at the ED decreased from 35 to 17 min if brought by HEAL ambulances.(6) The HEAL system was able to effectively prompt paramedics in carrying out critical aspects of treatment in close to 100% of instances. (7) The pilot HEAL system was able to demonstrate a limited amount of automated audit of specific aspects of ambulance runs. Having demonstrated the feasibility of the HEAL system, it is a matter of time before enhanced features such as electronic data collection at patient site, voice activated data entry, transmission of data from site, automated ambulance audits and an enhanced level of professional care in the ambulances become common-place reality.

Ambulances↗
PubMed1999

[Prevention of alcohol-related problems. From therapy to primary health care: experience at the Udine "Healthy City"].

This paper is about a community action for the implementation of a WHO Collaborative Project on the reduction of hazardous drinking in Primary Health Care Settings called "Drink-less". The article stresses the need to shift the attention from alcoholic treatment towards the reduction of alcohol consumption. After the development of a valid screening instrument and counselling material ("Drink-less" Package), the strategies to involve General Practitioners in early intervention are studied. A Pilot Project was implemented in the City of Udine by the Municipality through its Healthy City Project Office. "Healthy City" is a WHO project that stimulates Local Administrations to implement health promotion and Community actions through an intersector work. Besides the undoubted validity of the overall "Drink-less Project", the study emphasizes the importance of GPs in secondary prevention of hazardous drinking and the necessity to re-orient programmed action in Public Health and health promotion. "Healthy City WHO Project" can be an important tool for the implementation of Community actions in Public Health.

Adolescent↗
PubMed1995

Médicarte software developed for the Quebec microprocessor health card project.

The Quebec Patient Smart Card Project is a Provincial Government initiative under the responsibility of the Rgie de l'assurance-maladie du Québec (Quebec Health Insurance Board). Development, implementation, and assessment duties were assigned to a team from Université Laval, which in turn joined a group from the Direction de la santé publique du Bas-St-Laurent in Rimouski, where the experiment is taking place. The pilot project seeks to evaluate the use and acceptance of a microprocessor card as a way to improve the exchange of clinical information between card users and various health professionals. The card can be best described as a résumé containing information pertinent to an individual's health history. It is not a complete medical file; rather, it is a summary to be used as a starting point for a discussion between health professionals and patients. The target population is composed of persons 60 years and over, pregnant women, infants under 18 months, and the residents of a small town located in the target area, St-Fabien, regardless of age. The health professionals involved are general practitioners, specialists, pharmacists, nurses, and ambulance personnel. Participation in the project is on a voluntary basis. Each health care provider participating in the project has a personal identification number (PIN) and must use both an access card and a user card to access information. This prevents unauthorized access to a patient's card and allows the staff to sign and date information entered onto the patient card. To test the microprocessor card, we developed software based on a problem-oriented approach integrating diagnosis, investigations, treatments, and referrals. This software is not an expert system that constrains the clinician to a particular decisional algorithm. Instead, the software supports the physician in decision making. The software was developed with a graphical interface (Windows 3.1) to maximize its user friendliness. A version of the software was developed for each of the four groups of health care providers involved. In addition we designed an application to interface with existing pharmaceutical software. For practical reasons and to make it possible to differentiate between the different access profiles, the information stored on the card is divided in several blocks: Identification, Emergency, History (personal and family), Screening Tests, Vaccinations, Drug Profile, General follow-up, and some Specific follow-ups (Pregnancy, Ophthalmology, Kidney failure, Cardiology, Pediatrics, Diabetes, Pneumology, Specific parameters). Over 14,000 diagnoses and symptoms are classified with four levels of precision, the codification being based on the ICPC (International Classification for Primary Care). The software contains different applications to assist the clinician in decision making. A "Drug Advisor" helps the prescriber by detecting possible interactions between drugs, giving indications (doses) and contraindications, cautions, potential side-effects and therapeutic alternatives. There is also a prevention module providing recommendations for vaccination and periodic examinations based on the patient's age and sex. The pharmaceutical, vaccination, and screening tests data banks are updated every six months. These sections of the software are accessible to access card holders at any times, even without a patient card, and constitute in themselves an interesting clinical tool. We developed a software server (SCAM) allowing the different applications to access the data in a memory card regardless of the type of memory card used. Using a single high level command language, this server provides a standardized utilization of memory cards from various manufacturers. It ensures the compatibility of the applications using the card as a storage medium. (abstract truncated)

Aged↗