Adolescent pregnancy: combating the problem from a multi-systemic health perspective.
Explore the source record for details and available documents.
Adolescent↗
SEARCH · Search PubMed
Results for “Integrated Programs”
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.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Integrated sexual health services: the views of medical professionals.
Explore the source record for details and available documents.
Behavior↗
The sorry state of F2 hybrids: consequences of rapid mitochondrial DNA evolution in allopatric populations.
Through the processes of natural selection and genetic drift, allopatric populations diverge genetically and may ultimately become reproductively incompatible. In cases of prezygotic reproductive isolation, candidate systems for speciation genes logically include genes involved in mate or gamete recognition. However, where only postzygotic isolation exists, candidate speciation genes could include any genes that affect hybrid performance. We hypothesize that because mitochondrial genes frequently evolve more rapidly than the nuclear genes with which they interact, interpopulation hybridization might be particularly disruptive to mitochondrial function. Understanding the potential impact of intergenomic (nuclear and mitochondrial) coadaptation on the evolution of allopatric populations of the intertidal copepod Tigriopus californicus has required a broadly integrative research program; here we present the results of experiments spanning the spectrum of biological organization in order to demonstrate the consequences of molecular evolution on physiological performance and organismal fitness. We suggest that disruption of mitochondrial function, known to result in a diverse set of human diseases, may frequently underlie reduced fitness in interpopulation and interspecies hybrids in animals.
Animals↗
Operationalizing the concept of the optimal healing environment in clinical settings: the importance of "readiness".
Creation of an optimal healing environment (OHE) in a clinical setting is a multifaceted undertaking and subject to a wide variety of developmental influences. While comprehensive definitions for OHE might provide sufficient guidance for communicating philosophy and values and developing patient-practitioner processes, direction for creating a supportive administrative structure or establishing an evaluation/research strategy is less defined. Operationalizing the concept of OHE by breaking it down into components such as values, structure, process, and measurement of outcomes, proved to be a useful framework for analyzing the evolution of our integrated care program. Future OHE initiatives may benefit from using this type of framework to assess readiness among cocreators prior to development and implementation, as a guide for ongoing evaluation of an OHE postimplementation and as a basis for comparing OHEs across a variety of clinical settings.
Attitude of Health Personnel↗
Biofield detection: role of bioenergy awareness training and individual differences in absorption.
OBJECTIVE: To measure health care providers' capacity to detect biofields before and after bioenergy awareness training in relation to individual differences in the personality trait of absorption. METHODS: Twenty-seven (27) physicians, psychologists, and nurses participated in a 5-day intensive bioenergy healing training course with Rev. Rosalyn Bruyere. The course was part of the Associate Fellows Program in the Program in Integrative Medicine at the University of Arizona. Blindfolded participants received a 24-trial hand biofield detection test (HBDT) pretraining and post-training. The experimenter placed his or her dominant hand a few inches above the participant's left or right hand for 30-second trials. After each trial, the participant guessed which hand was being tested. Blocks contained two right- and two left-hand trials in different orders. Participants filled out Tellegen's Absorption Scale, a measure of the capacity to focus attention in tasks. RESULTS: Percent HBDT accuracy for the entire sample was 50.8% (standard deviation [SD] = 12.24) at pretraining (50% is chance); accuracy increased to 55.5% (SD = 12.38) at post-training (t = p = 2.08, p < 0.05). Pretraining absorption (mean = 23.9; SD = 5.52) was significantly correlated with degree of detection accuracy increase (r = 0.42, n = 22, p < 0.05). High absorption (mean = 28.2 n = 11) participants increased to 58.3% compared to 52.7% for low absorption (mean = 19.2 n = 11) participants. CONCLUSION: The findings support claims of energy healers that (1) training can improve bioenergy awareness, and (2) there are substantial individual differences in response to training.
Adaptation, Physiological↗
Benefits and drawbacks of including consumer reviewers in the scientific merit review of breast cancer research.
BACKGROUND: This study assessed participant opinions about inclusion of breast cancer survivors as lay representatives in a scientific and technical merit review of proposals for the 1995 Department of Defense Breast Cancer Research Program (DOD BCRP). METHODS: The evaluation employed a prepanel and postpanel survey design, which was intended to elicit feedback about attitudes, perceptions, and beliefs toward collaborative consumer and scientist participation in scientific merit review. Qualitative methods were used to describe the consumers' and scientists' responses, to explore the significance of this interaction, and to gain an understanding of the benefits and disadvantages of bringing these participants together. RESULTS: Both groups were initially troubled about the consumers' lack of scientific background and questioned their qualifications and preparation for participation in a scientific panel. In particular, consumers were concerned that their judgments would not be taken seriously by scientists, a concern somewhat lessened by participation. After the meeting, scientists viewed the consumers as hard-working, dedicated survivors and advocates and endorsed the presence of carefully chosen lay panel members. Scientists were troubled that consumers potentially would have an impact on voting and on the subsequent scoring of proposals, a concern that was not validated by quantitative findings. CONCLUSIONS: As a result of these data, the DOD BCRP continues to embrace clarify the nature of collaborative participation in scientific merit review.
Adult↗
Qigong and hypertension: a critique of research.
Research studies have pointed to various health-related positive effects of qigong; however, problems in much of the current qigong research methodology have limited interpretation of the potential benefits of qigong. Examples of research on qigong and hypertension are used to bring to light some of these methodological issues. In a review of 30 representative studies, various areas of concern are addressed, including: the sources of studies, lack of random assignment, selection biases, treatment effects, placebo response issues, expectancy biases, blinded outcome assessment, adherence to treatment, reliability of blood pressure measurements, regression to the mean, publication biases, and lack of consistency of measurement. One of the longest term studies, conducted by Kuang et al. (1991) and updated by Wang et al. (1993) is examined in greater detail to illustrate these issues. This study took place over 20 years and reported significant differences between a group practicing qigong and a control group in a variety of measures including a reduction of total mortality rate. The weight of evidence suggests that practicing qigong may have a positive effect on hypertension. Whether qigong alone can affect hypertension is not necessarily the most important question. Further research will be required to better assess and understand the effect of adding qigong into an integrated, multifaceted program that selectively incorporates diet, moderate aerobic exercise, relaxation training, and social and psychological dimensions.
Breathing Exercises↗
Improving cancer pain management through a system wide commitment.
Despite the well documented need for better cancer pain management there is little evidence that conventional educational approaches have improved clinical practice. This article discusses strategies to improve cancer pain management, focusing particular attention to institutional approaches that contain quality assurance (QA) and quality improvement (QI) efforts. An innovative pain management project is described that includes an in-depth evaluation of system and provider strengths and weaknesses; a system-wide commitment to cancer pain management; patient/family, nurse, pharmacist, and physician collaborative teams; use of a Washington State law allowing pharmacist prescriptive authority of narcotics and other drugs within a prescribed treatment protocol; and QA and QI efforts to improve and document performance. The authors strongly believe that the development of collaborative programs that integrate the power of the institutional process with clinical care will produce the greatest improvement in patient care not only for cancer pain, but also for other difficult domains of end-of-life.
Journal Article↗
A WHO collaborative study on iron supplementation in Burma and in Thailand.
Studies on the treatment and prevention of iron deficiency anemia, in pregnant and nonpregnant women and in men, were conducted in Thailand and Burma. The effects of the dose of Fe, duration of Fe administration, additional supplementation with folate, mode of supplement delivery (either supervised or unsupervised), and the presence of Hb(AE) were studied. The frequency and severity of side effects were also recorded. Fe administration resulted in an increase in hemoglobin concentration in all anemic individuals but approximately 20% failed to reach normality. The length of administration and the dose influenced the results. Frequency and severity of side effects increased with the dose of Fe administered. Folate supplementation did not affect the results. It appears possible to integrate a program of prevention and treatment of Fe deficiency anemia in a primary health-care system but the constraints and limitations of achievable results should be recognized.
Adult↗
Gastrointestinal surgery for severe obesity. Proceedings of a National Institutes of Health Consensus Development Conference. March 25-27, 1991, Bethesda, MD.
Explore the source record for details and available documents.
Gastroplasty↗
A population-based study of the association between betel-quid chewing and the metabolic syndrome in men.
BACKGROUND: Betel-quid chewing, an established risk factor for oropharyngeal malignancy, is associated with hyperglycemia and obesity. Associations with other characteristics of the metabolic syndrome have not been reported. OBJECTIVE: This study examined associations between betel-quid chewing and the metabolic syndrome, allowing for recognized risk factors and exploring dose-response effects in a population-based study. DESIGN: Age-specific prevalence rates of the metabolic syndrome were examined in betel-quid chewing and nonchewing men (n = 19,839) recruited into the Keelung Community-based Integrated Screening program in 2001-2003. The independent effect of betel-quid chewing on metabolic syndrome risk was examined by using multiple logistic regression with control for well-recognized risk factors (eg, education, physical activity, and dietary factors) and dose-response effects were examined by using trend tests. RESULTS: The age-adjusted prevalence of the metabolic syndrome was highest in current chewers (25.13%), next highest in ex-chewers (22.04%), and lowest in nonchewers (15.73%) (P < 0.0001). Odds ratios (95% CIs) for the metabolic syndrome were 1.38 (1.19, 1.60) and 1.78 (1.53, 2.08) in ex-chewers and current chewers, respectively, adjusted for other significant correlates such as a family history of hypertension and diabetes mellitus. Meaningful odds ratios for the metabolic syndrome components ranged from 1.24 for hyperglycemia (95% CI: 1.09, 1.64) to 1.90 (95% CI: 1.66, 2.19) for hypertriacylglycerolemia. Increasing odds ratios for the metabolic syndrome with higher consumption of betel quid (whether by rate of use, duration of use, or cumulative exposure) suggest dose-response effects. CONCLUSIONS: After adjustment for well-established risk factors, our study showed independent predictive dose-response effects of betel-quid chewing for the metabolic syndrome and its components in a population-based study of men with a 15% prevalence of betel-nut chewing.
Adult↗
Blueprint for implementing USP chapter 797 for compounding sterile preparations.
PURPOSE: Guidelines for adopting and successfully implementing the requirements of the United States Pharmacopeia (USP) chapter 797 for compounding sterile preparations are presented. SUMMARY: The quality of a compounded sterile preparation (CSP) is directly related to the methods used to ensure that the CSP achieves the desired goal of purity, potency, and sterility. A properly designed, constructed, and maintained cleanroom contributes to the quality of CSPs. Design criteria of a sample clean-room are supplied, as are a summary and comparison of the liquid disinfectants that can be used to clean and sanitize the facility and maintain environmental controls. All activities associated with cleaning the cleanroom, including air and surface sampling, must be properly documented in logs, examples of which are provided. A robust employee-training program for properly teaching aseptic technique and a method to verify that personnel have successfully completed the program are integral to compliance with chapter 797 and thoroughly discussed herein. Emerging compounding and testing technology is also discussed. CONCLUSION: Although the task of compliance with the requirements of USP chapter 797 may appear overwhelming, complicated, expensive, and even unattainable, quality can be established via a methodical and organized approach. After the systems have been implemented, maintaining them requires vigilance and follow-up. Compliance with chapter 797 involves up-front and ongoing costs associated with establishing these systems, but the time, energy, and cost required to maintain them are far less than those of retrospective or manual systems of collecting, reviewing, and collating quality assurance data on a monthly basis.
Data Collection↗
Multifactor dimensionality reduction software for detecting gene-gene and gene-environment interactions.
MOTIVATION: Polymorphisms in human genes are being described in remarkable numbers. Determining which polymorphisms and which environmental factors are associated with common, complex diseases has become a daunting task. This is partly because the effect of any single genetic variation will likely be dependent on other genetic variations (gene-gene interaction or epistasis) and environmental factors (gene-environment interaction). Detecting and characterizing interactions among multiple factors is both a statistical and a computational challenge. To address this problem, we have developed a multifactor dimensionality reduction (MDR) method for collapsing high-dimensional genetic data into a single dimension thus permitting interactions to be detected in relatively small sample sizes. In this paper, we describe the MDR approach and an MDR software package. RESULTS: We developed a program that integrates MDR with a cross-validation strategy for estimating the classification and prediction error of multifactor models. The software can be used to analyze interactions among 2-15 genetic and/or environmental factors. The dataset may contain up to 500 total variables and a maximum of 4000 study subjects. AVAILABILITY: Information on obtaining the executable code, example data, example analysis, and documentation is available upon request. SUPPLEMENTARY INFORMATION: All supplementary information can be found at http://phg.mc.vanderbilt.edu/Software/MDR.
Algorithms↗
Teachers and health workers: partners in primary health care. Experiences from Papua New Guinea.
Explore the source record for details and available documents.
Adult↗
Child health promotion in developing countries: the case for integration of environmental and social interventions?
In spite of improving epidemiological knowledge in relation to child health, the challenge of promoting the survival and quality of life of infants and children in most parts of the developing world remains an abiding public health problem, for both the countries and the international agencies involved. Current infant and child health programmes largely reflect western style medical care, with emphasis placed on reducing mortality, and the preventive aspects confined mainly to immunisation, improved nutrition, provision of micronutrients, promotion of breast-feeding and birth spacing. In contrast, environmental and social factors which underpin the proliferation of disease agents are receiving minimal attention. This paper presents a critical review of current strategies for promoting child health in developing countries, and examines the environmental, social, and political factors that influence child health. Presenting a specific example of infant and childhood diarrhoea, the authors argue that in order for a real reduction in mortality, and improvements in quality of life to be sustained, attention needs to be focused equally on the environmental and social factors that underlie much of the childhood diseases in the developing world. This will involve the adoption of a broader strategy aimed at reducing childhood diarrhoea, using the hazard analysis critical control point (HACCP) system in combination with other methods.
Child↗
Controlling schistosomiasis: the cost-effectiveness of alternative delivery strategies.
Sustainable schistosomiasis control cannot be based on large-scale vertical treatment strategies in most endemic countries, yet little is known about the costs and effectiveness of more affordable options. This paper presents calculations of the cost-effectiveness of two forms of chemotherapy targeted at school-children and compares them with chemotherapy integrated into the routine activities of the primary health care system. The focus is on Schistosoma haematobium. Economic and epidemiological data are taken from the Kilombero District of Tanzania. The paper also develops a framework for possible use by programme managers to evaluate similar options in different epidemiological settings. The results suggest that all three options are more affordable and sustainable than the vertical strategies for which cost data are available in the literature. Passive testing and treatment through primary health facilities proved the most effective and cost-effective option given the screening and compliance rates observed in the Kilombero District.
Child↗
Effectiveness of selected granular acaricide formulations in suppressing populations of Ixodes dammini (Acari: Ixodidae): short-term control of nymphs and larvae.
Applications of selected granular acaricide formulations to the shrub layer of forested habitats during the peak activity periods of Ixodes dammini Spielman, Clifford, Piesman & Corwin nymphs and larvae significantly reduced the abundance of these stages on Peromyscus leucopus. The granules effectively penetrated growing vegetation and suppressed populations of subadult ticks questing in the leaf litter. The use of granular acaricide formulations provides the only documented method of control of free-living I. dammini nymphs and larvae in dense vegetation. As such, this technique will serve as a major component of any integrated control program against this vector tick species.
Animals↗
Psychosocial stimulation improves the development of undernourished children in rural Bangladesh.
Undernutrition in early childhood is associated with poor mental development and affects 45% of children in Bangladesh. Although limited evidence shows that psychosocial stimulation can reduce the deficits, no such interventions have been reported from Bangladesh. The Bangladesh Integrated Nutrition Program (BINP) has provided nutrition supplementation to undernourished children through community nutrition centers (CNCs). We added psychosocial stimulation to the treatment of undernourished children in a randomized controlled trial to assess the effects on children's development and growth and mothers' knowledge. Twenty CNCs were randomly assigned to intervention or control groups with 107 children in each group. We also studied 107 nonintervened better-nourished children from the same villages. Pre- and postintervention measurements included children's height, weight, development assessed on Bayley Scales, behavior ratings during the test, and a questionnaire on mothers' knowledge of childrearing. The intervention comprised home visits and group meetings with mothers and children for 12 mo. Intervention benefited children's mental development (4.6 +/- 2.0, P = 0.02), vocalization (0.48 +/- 0.23, P = 0.04), cooperation (0.45 +/- 0.16, P = 0.005), response-to-examiner (0.50 +/- 0.15, P = 0.001), emotional tone (0.33 +/- 0.15, P = 0.03), and mothers' knowledge (3.5 +/- 0.49, P < 0.001). At the end, undernourished controls had poorer mental (-4.6 +/- 2.0, P = 0.02) and motor (-6.6 +/- 2.2, P = 0.003) development, were more inhibited (-0.35 +/- 0.16, P = 0.03), fussier (-0.57 +/- 0.16, P < 0.001), less cooperative (-0.48 +/- 0.17, P = 0.005), and less vocal (-0.76 +/- 0.23, P = 0.001) than better-nourished children. Intervened children scored lower only in motor development (-4.4 +/- 2.3, P = 0.049). Neither group of undernourished children improved in nutritional status, indicating that treatment had no effect. In conclusion, adding child development activities to the BINP improved children's development and behavior and their mothers' knowledge; however, the lack of improvement in growth needs to be examined further.
Anthropometry↗