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At least 1,603 records · Page 89Linked to original sources
PubMed1993

Economic and health needs of Wisconsin migrant farm workers.

Migrant farm workers play an essential role in the planting and harvesting of crops in our agricultural production system. In the United States today, about 6 percent of the paid farm labor force "follow the crops" across the nation. This article reports on the economic and health care needs of migrant farm workers who travel from the border areas of Texas to Wisconsin each year. Surveys conducted in 1978 and 1989 show that this population remains in serious need of health care and access to financial assistance programs. During the 11-year interval between surveys, little change occurred in the health care status or use patterns of Wisconsin migrant workers, although housing and sanitary conditions in the work environment improved somewhat due to the passage of new federal regulations. This article discusses the problems and barriers that migrants continue to face and offers recommendations for government action.

Adolescent↗
PubMedDate not supplied

Queensland public sector nurse executives: professional development needs.

In a time of health care reform and rapid change, nurse executives need effective leadership skills to be able to respond to a challenging environment, provide quality cost-effective care and promote the professional development of nursing. This research aimed to provide an understanding of nursing executives' roles and professional development needs and obtain concise information for the development of strategies and professional development programs to enhance the effectiveness of the present and future roles of nursing executives. A descriptive cross-sectional postal survey was sent to all public sector Level 4 and 5 nursing executives in Queensland (n = 281), with a response rate of 52.3% (n = 147). Financial management, human resource management and information technologies were identified as the areas where professional development was most needed. Structured educational activities such as short courses or seminars covering information technology, financial and budget management and general business management were identified as the type of activities best suited to nurse executives' needs. The most frequently reported barriers to professional development were difficulties obtaining relief staff, inadequate time, financial cost and inadequate district manager and regional support to enable access to professional development programs.

Attitude of Health Personnel↗
PubMed1995

Targeting adult smokers through a multi-ethnic public school system.

In a unique approach to utilizing an existing intervention, "opportunistic" and targeted school-based strategies were used to enroll 446 adults into a tailored preventive health program featuring a health screening and smoking-cessation intervention. Implemented through a public school district serving a multi-ethnic low-to-middle income urban community, subjects in this randomized trial were interviewed at enrollment and at three-, six-, and 12-month follow-up, and rescreened at 12 months, to assess changes in smoking-related knowledge, attitudes, and practices. Using conservative assumptions, self-reported ever-quit rates and continuous abstinence rates of 57.5% and 2.6%, respectively, were achieved across groups; point-prevalence abstinence rates were 13.2%, 12.9%, and 10.3% at three, six, and 12 months. The study examines issues relevant to smoking status and stages of change in this population. The role of the school in increasing access to needed health programming in underserved communities is explored.

Adult↗
PubMed1992

Images in Rheumatology: a multimedia program for medical education.

In recent years, undergraduate medical education has benefited from the use of computer-based instructional programs. However, in the case of clinical and postgraduate medical education there is a scarcity of such programs, particularly those with access to high-resolution images. Having a fundamental knowledge base of disease-associated images is crucial for the physicians during the diagnostic process. To fill this gap in clinical instruction in the rheumatic diseases, Images in Rheumatology was developed. By using a hypertext format, one may select representative color images of a clinical disease or view x-ray changes typical for one of the rheumatic disorders. In addition, for each displayed image there is an associated sound-bite which explains in detail what abnormalities are present and how the user may differentiate the disease being viewed from other illnesses. An extensive review element is also included so that one can assess their fundamental knowledge of rheumatologic images. The Images in Rheumatology program has been implemented in the DOS (IBM Microchannel). and Windows environments.

Computer Graphics↗
PubMedDate not supplied

Lifelong learning: skills and online resources.

OBJECTIVE: Advances in information technology enable the practicing psychiatrist's quest to keep up-to-date with new discoveries in psychiatry, as well as to meet recertification requirements. However, physicians' computer skills do not always keep up with technology, nor do they take advantage of online search and continuing education services. This article describes the rationale for using electronic databases and training, as well as basic computer skills, computer equipment, and important online resources for psychiatrists to meet their continuing education and recertification needs quickly, easily, and conveniently. METHOD: A literature review was performed using PUBMED and Google to find articles related to recertification, physician's technology adoption and computer skills, evidence-based medicine, and basic approaches to lifelong learning using computers and the Internet, and resources for lifelong learning. RESULTS: Psychiatrists are required to master a discrete set of information for board certification, and to maintain that knowledge for recertification. Surveys have shown that although most physicians use computers, the majority use them for personal or business purposes, and not for accessing Continuing Medical Education (CME) programs (1). The Council on Graduate Medical Education requires the acquisition of medical informatics skills for the Undergraduate Medical Education for the 21st Century (UME-21) curriculum project (2). There is a growing body of literature outlining basic computer skills and competencies for physicians to access online textbooks, databases, journals, and CME programs. CONCLUSIONS: Psychiatrists can benefit from learning how to use computers and the Internet to keep current with the advances in the field. Skills now being taught in medical school and residency are equally important for practicing psychiatrists to learn and master.

Clinical Competence↗
PubMed2004

The mental health of graduate students at the Federal University of São Paulo: a preliminary report.

We present data regarding the care provided to graduate level health professionals at the mental health center of the Federal University of São Paulo. From September 1996 to September 2003, 146 graduate students (99 in the Master's degree program and 47 in the Doctoral program) were attended. This population was predominantly female (68.5%), with a mean (+/- SD) age of 28.6 +/- 4.42 years, not married (71.9%). Most of the subjects were professionals who had not graduated from the Federal University (78.1%). The students who sought help for psychological and/or psychiatric problems were classified into two categories: situational-adaptive crises and psychopathological crises. The main diagnoses were depression and anxiety disorders (44%) causing 4.5% of the subjects to be temporarily suspended from their graduate studies; 19.2% reported that they had used psychotropic drugs within the previous month, and 47.9% referred to sleep disturbances. Suicidal tendencies were mentioned by 18% of those interviewed. Students with emotional disturbances and academic dysfunctions should be recognized at an early stage, and it is fundamental for them to have access to mental health programs that provide formal, structured and confidential care. Thus, it is important that professors and advisors in graduate programs build a warm and affective learning environment. If we consider the expressive growth in Brazilian scientific production resulting from the implementation of an extensive national system of graduate education, it is important to focus efforts on enhancing and upgrading the mental health care system.

Brazil↗
PubMed2004

Pegasys: software for executing and integrating analyses of biological sequences.

BACKGROUND: We present Pegasys--a flexible, modular and customizable software system that facilitates the execution and data integration from heterogeneous biological sequence analysis tools. RESULTS: The Pegasys system includes numerous tools for pair-wise and multiple sequence alignment, ab initio gene prediction, RNA gene detection, masking repetitive sequences in genomic DNA as well as filters for database formatting and processing raw output from various analysis tools. We introduce a novel data structure for creating workflows of sequence analyses and a unified data model to store its results. The software allows users to dynamically create analysis workflows at run-time by manipulating a graphical user interface. All non-serial dependent analyses are executed in parallel on a compute cluster for efficiency of data generation. The uniform data model and backend relational database management system of Pegasys allow for results of heterogeneous programs included in the workflow to be integrated and exported into General Feature Format for further analyses in GFF-dependent tools, or GAME XML for import into the Apollo genome editor. The modularity of the design allows for new tools to be added to the system with little programmer overhead. The database application programming interface allows programmatic access to the data stored in the backend through SQL queries. CONCLUSIONS: The Pegasys system enables biologists and bioinformaticians to create and manage sequence analysis workflows. The software is released under the Open Source GNU General Public License. All source code and documentation is available for download at http://bioinformatics.ubc.ca/pegasys/.

Computational Biology↗
PubMed2005

Context and healthcare access: looking beyond the individual.

BACKGROUND: Although health is influenced by an individual's characteristics and choices, accumulating evidence suggests that contextual attributes may influence a variety of health outcomes. Whether these factors also represent "upstream" factors affecting one's ability to enter the healthcare system is less clear, however. OBJECTIVE: The objective of this study was to assess associations between contextual characteristics and an individual's report of having a usual source of health care. RESEARCH DESIGN: Cross-sectional, survey-weighted data assessing demographics, insurance status, needs, and healthcare access were obtained through telephone survey in 1998 and were linked with county-level data from the 1998 Area Resource File and the 1990 US Census. SUBJECTS: A state-representative sample of 16,261 adult residents, living in urban, suburban, and rural settings throughout Ohio comprised this study. MEASURES: Operational measures for social, economic, and health system characteristics were used in multilevel logistic regression models to test associations with an individual's report of a usual source of care. RESULTS: The weighted proportion of individuals reporting no usual source of care was 18.0%. Although individuals' current health, insurance status, income, demographics, educational attainment, and social support were closely associated with this outcome, significant associations remained for county-level characteristics representing the level of poverty and degree of urbanization. CONCLUSIONS: Persisting health status disparities increase the need for programs that promote equitable access to health care. Policy interventions may be more effective if they look beyond individual characteristics to incorporate strategies that address economic factors in areas where healthcare access is inequitable.

Adult↗
PubMedDate not supplied

Addressing issues for early detection and screening in ethnic populations.

PURPOSE/OBJECTIVES: To describe how multicultural knowledge and skills are applied in culturally competent practice to develop and deliver available, accessible, acceptable, and appropriate programs in early cancer detection and screening programs in ethnic communities. DATA SOURCES: Literature and clinical community practice reports. DATA SYNTHESIS: Successful community screening programs can be conducted within ethnic minority populations. Practitioners must tailor care based on salient cultural differences of the population of focus. Culturally based practice results in the (a) increased ability to think critically in community and individual assessments, (b) development of more accurate program plans and designs, and (c) increased likelihood that appropriate outcomes will be used in the evaluation of care. CONCLUSIONS: Greater cultural competence increases the accuracy of care and thereby its effectiveness, efficiency, and success in providing acceptable and optimal programs. IMPLICATIONS FOR NURSING PRACTICE: The first step in a cultural assessment is to know one's own beliefs and attitudes. The second step, conducted in parallel, requires knowledge about the groups that make up the patient and staff populations within the practice setting and then integrating those perspectives into practice. Practitioners then can begin the third step of negotiation of all stages of the project with members of the various communities on an equal basis that recognizes the expertise and integrity of all parties.

Culture↗
PubMed1996

Do school-based health centers improve adolescents' access to health care, health status, and risk-taking behavior?

PURPOSE: The purpose of this investigation was to assess the School-Based Adolescent Health Care Program, which provided comprehensive health-related services in 24 school-based health centers. METHODS: The outcomes evaluation compared a cohort of students attending 19 participating schools and a national sample of urban youths, using logit models to control for observed differences between the two groups of youths. Outcome measures included self-reports concerning health center utilization, use of other health care providers, knowledge of key health facts, substance use, sexual activity, contraceptive use, pregnancies and births, and health status. RESULTS: The health centers increased students' access to health care and improved their health knowledge. However, the estimated impacts on health status and risky behaviors were inconsistent, and most were small and not statistically significant. CONCLUSIONS: School-based health centers can increase students' health knowledge and access to health-related services, but more intensive or different services are needed if they are to significantly reduce risk-taking behaviors.

Adolescent↗
PubMed2005

The Prevention Research Centers Healthy Aging Research Network.

BACKGROUND: The Prevention Research Centers Healthy Aging Research Network (PRC-HAN), funded by the Centers for Disease Control and Prevention's (CDC's) Healthy Aging program, was created in 2001 to help develop partnerships and create a research agenda that promotes healthy aging. The nine universities that participate in the network use their expertise in aging research to collaborate with their communities and other partners to develop and implement health promotion interventions for older adults at the individual, organizational, environmental, and policy levels. CONTEXT: The population of older adults in the United States is growing rapidly; approximately 20% of Americans will be aged 65 years or older by 2030. The health and economic impact of an aging society compel the CDC and the public health community to place increased emphasis on preventing unnecessary disease, disability, and injury among older Americans. METHODS: The PRC-HAN has a broad research agenda that addresses health-promoting skills and behaviors, disease and syndrome topics, and knowledge domains. The network chose physical activity for older adults as its initial focus for research and has initiated two networkwide projects: a comprehensive, multisite survey that collected information on the capacity, content, and accessibility of physical activity programs for older adults and a peer-reviewed publication that describes the role of public health in promoting physical activity among older adults. In addition to participating in the core research area, each network member works independently with its community committee on PRC-HAN activities. CONSEQUENCES: As a result, the network is 1) expanding prevention research for older adults and their communities; 2) promoting the translation and dissemination of findings to key stakeholders; 3) strengthening PRC-HAN capacity through partnerships and expanded funding; and 4) stimulating the adoption of policies and programs by engaging policymakers, planners, and practitioners. In 2003, the PRC-HAN initiated an internal evaluation to better define the network's contributions to healthy aging, formalize internal processes, and better equip itself to serve as a model for other PRC thematic networks. The PRC-HAN is conducting a pilot evaluation for eventual inclusion in the PRC national evaluation. INTERPRETATION: The PRC-HAN has established itself as an effective research network to promote healthy aging. It has developed trust and mutual respect among participants, forged strong ties to local communities, and shown the ability to combine its expertise in healthy aging with that of partners in national, state, and local organizations.

Aged↗
PubMed1992

[Can we improve primary adult medical care?].

In Chile, primary medical care of adult patients is delivered mostly by young physicians, who work with little or insufficient interaction with their referral centers and with the main teaching hospitals. These physicians have no defined expectancies of a professional career in the field of primary care and they generally recent the lack of a programmed post-graduate education. After 3 to 5 years as general practitioners, some of them may have access to a formal teaching program to become specialists in internal medicine but, as in many other countries, it usually becomes a transit stage leading them to a subspecialty. This position paper adopted most of the proposals raised in a recent meeting, with the participation of universities, scientific and medical organizations, and the Ministry of Health, and modifies some of them. Because financial limitations may hinder the possibility of residency training programs in primary care internal medicine (as established in the USA), primary care of adults is proposed to be organized as a basic medical specialty, with formal teaching activities designed, delivered or supervised by the universities and medical scientific societies, and given as "credits" to be taken along 3 to 5 years. Simultaneously, outpatient care facilities should be improved, in the hospitals and in community units, allowing them to be used in under-graduate and post-graduate teaching programs. General practitioners, focused in adult patients, would receive a new professional status with the stimulus of a specific program of continuing medical education.

Adult↗
PubMedDate not supplied

Overview of Nashville REACH 2010's approach to eliminating disparities in diabetes and cardiovascular disease.

Racial and Ethnic Approaches to Community Health (REACH 2010) is a federally sponsored initiative with the goal of reducing and eliminating disparities in health by 2010. The approach is community-driven, wherein community coalitions design, implement, and evaluate the strategies to eliminate health disparities. This article describes the history, development, and activities of Nashville, Tenn, REACH 2010's initiative that targets the reduction of cardiovascular disease and diabetes in African Americans. The team-based strategies, generated with considerable community input, focused on effecting changes in access to healthcare, health and wellness, screening, and tobacco use with the goal of making sustainable behavioral and environmental changes. Evaluation includes a Web-based system for collecting process data and random telephone surveys to monitor the program's impact on health disparities.

Black or African American↗
PubMed2002

[Results of a computerized vaccination database].

OBJECTIVE: To analyze vaccine coverage in children from Picassent in Valencia (Spain) and to evaluate the effectiveness of a new computerized vaccine registration program. MATERIAL AND METHODS: A computer equipped with our self-made Babyvac-2000 program, based on Microsoft Access was used. The 2,514 entries on children in our database were examined. The results were compared with those in other population groups. RESULTS: Uptake was high: 100 % in 12 of the 15 age groups (according to year of birth). Coverage was as follows: diptheria-tetanus-pertussis (DTP)-oral polio vaccine was 100 % for 9 groups; the first dose of the triple virus vaccine was 100 % in 7 groups; full vaccination was between 96.2 % and 100 % for all age groups; vaccination at 6 years was between 91.6 % and 98.7 %, the second dose of the triple virus vaccine was between 72.2 % and 96.3 %; vaccination at 14 years was between 82.9 % and 87.7 %; hepatitis B vaccination in young children (from 1994 to 2000) was 100 % in 5 groups and was between 90 % and 98 % in teenagers; the Haemophilus influenzae type b vaccination rate was 100 % for children born between 1998 and 2001 and was between 74.3 % and 93.5 % for those born between 1994 and 1997; meningococcal group C conjugated vaccination was between 86.8 % and 100 % for children born between 1994 and 2001. CONCLUSIONS: This computer program considerably increases uptake and vaccine coverage among children.

Adolescent↗
PubMed2005

The insufficiency of evidence to establish the business case for quality.

PURPOSE: To determine whether a positive financial return on investment for quality-enhancing interventions is more likely for particular health conditions, in specific organizational settings, or with the use of particular interventions. DATA SOURCES: Electronic search of MEDLINE. DATA EXTRACTION: Search keywords included: business case, cost-effectiveness, cost-benefit, return on investment, costs, cost savings, quality, quality improvement, and program evaluation. RESULTS: Only 15 of 1968 articles identified contained sufficient information on both the costs of implementing quality-enhancing interventions and the resultant changes in costs of care or revenues to permit the calculation of a return on investment. CONCLUSIONS: Scant attention is currently paid in the quality-of-care literature to the cost of implementing quality-enhancing interventions. To understand which quality-enhancing interventions are likely to produce positive returns on investments, data collection and analysis must include tracking the investment and operating costs of implementing the intervention as well as the changes in revenues and costs that result from the intervention.

Cost-Benefit Analysis↗
PubMed1993

Quality, access, and clinical issues in a nurse practitioner colposcopy outreach program.

From 8/89 to 7/92 a NP-colposcopist performed 593 colposcopy examinations including cervical biopsies, endocervical curettages, and Pap smears. Procedures were performed in selected health departments in north-central Florida. This portable outreach program expanded services to a primarily rural, medically indigent population. Specimen results were 21.1% negative, 5.6% human papilloma virus (HPV) only, 37.3% CIN I, 17.4% CIN II, 11.9% CIN III, 2.4% CIS, 0.3% carcinoma, and 4% other. Many CIN lesions also included HPV, yielding an overall incidence of HPV at 62.7%. Using the Bethesda system, 42.8% were low grade lesions, 32.1% high grade. Fourteen cases of CIS and two of carcinoma (one invasive, one microinvasive) were found. An 87.7% colposcopic diagnostic acumen level is favorable compared with published physician studies. One third of undercalls were due to occult canal lesions. Significant risk factors were smoking (48.6%), first coitus at < 18 years old (74%), history of HPV (49.6%), and life-time sexual partners > 2 (61.3%). Holistic prevention enabled 209 non-colposcopy problems.

Adolescent↗
PubMed2003

Community based program to improve firearm storage practices in rural Alaska.

OBJECTIVE: To develop and evaluate a pilot program to reduce unauthorized access to firearms by youth by distributing gun safes and trigger locks to households. DESIGN: Pilot intervention with pre/post-evaluation design. SETTING: Two Alaska Native villages in the Bristol Bay Health Corporation region of southwest Alaska. SUBJECTS: Forty randomly selected households with two or more guns in the home. INTERVENTION: Initially, a focus group of community members who owned guns was convened to receive input regarding the acceptability of the distribution procedure for the gun storage devices. One gun safe and one trigger lock were distributed to each of the selected households during December 2000. Village public safety officers assisted with the distribution of the safes and provided gun storage education to participants. MAIN OUTCOME MEASURES: Baseline data were collected regarding household gun storage conditions at the time of device distribution. Three months after distribution, unannounced onsite home visits were conducted to identify if residents were using the gun safes and/or trigger locks. RESULTS: All selected households had at least two guns and 28 (70%) of the 40 households owned more than two guns. At baseline, 85% of homes were found to have unlocked guns in the home and were most often found in the breezeway, bedroom, storage room, or throughout the residence. During the follow up visits, 32 (86%) of the 37 gun safes were found locked with guns inside. In contrast, only 11 (30%) of the 37 trigger locks were found to be in use. CONCLUSIONS: This community based program demonstrated that Alaska Native gun owners accepted and used gun safes when they were installed in their homes, leading to substantial improvements in gun storage practices. Trigger locks were much less likely to be used.

Adolescent↗