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At least 1,603 records · Page 89Linked to original sources
PubMed1988

Mothers' concepts of childhood diarrhea in rural Pakistan: what ORT program planners should know.

Diarrhea is the leading cause of infant and child death in Pakistan. Appropriately, the development of oral rehydration therapy (ORT) programs has become a major priority of the Pakistan Ministry of Health and of international funding agencies. Paradoxically, however, there is virtually no published anthropological literature on diarrhea-related traditional health beliefs and practices among the rural and illiterate people who make up 90% of the nation's population. The study reported on here focuses on these matters and suggests important implications for the multimillion-dollar ORT programs currently being launched. Mothers' ethnomedical models of diarrheal disease and concepts of appropriate treatment are discussed, as are practical problems relating to the effective implementation of ORT in such a setting. The results underline the need for anthropological studies as an adjunct to health interventions involving behavioral modification.

Adult↗
PubMed1998

Who checks the checkers? Four validation tools applied to eight atomic resolution structures. EU 3-D Validation Network.

Eight protein crystal structures, which have been refined against X-ray diffraction data extending to atomic resolution, 1.2 A or better, were inspected using four different validation tools, PROCHECK, PROVE, SQUID and WHATCHECK. Two general questions were addressed. (1) Do the structures imply changes in "expected" stereochemical properties and are the target values used for restraints in the validation programs and the refinement protocol appropriate? (2) Can errors in models be detected and how reliable are the coordinates after refinement? Preliminary analysis by members of the network led to modifications both to the validation programs and to the refinement protocols. The results of the final analyses are reported here. Apparent discrepancies in cell dimensions were identified. Most stereochemical properties are shown to be more tightly clustered than for lower resolution analyses. In contrast the omega angle has a wider distribution. The validation software is generally available and can be accessed at servers listed at the end of the paper.

Bacterial Proteins↗
PubMed2004

Tobacco cessation pharmacotherapy use among First Nations persons residing within British Columbia.

The rate of tobacco use is higher among First Nations (FN) peoples than among other Canadians. Cessation pharmacotherapy agents reduce tobacco use, but the appropriateness and effectiveness of these agents among FN smokers are not entirely clear. Rates of tobacco cessation pharmacotherapy use among FN smokers are unknown; such information would be useful for program planners and would indicate appropriateness of use. To examine cessation pharmacotherapy use, we extracted claims for nicotine gum, nicotine patch, and bupropion SR (Zyban) from the Non-Insured Health Benefits pharmacy database for FN persons living within British Columbia during 2001. A total of 3.8% (95% CI=3.6-4.0) of FN claimants filled a prescription for at least one tobacco cessation pharmacotherapy agent; 61.7% were female, and their mean age was 38.1 years. Most claims (60.5%) were for bupropion, followed by nicotine patch (40.7%) and nicotine gum (4.7%). A total of 4.6% of claimants used both nicotine patch and bupropion,.8% used nicotine gum and nicotine patch, and.5% used nicotine gum and bupropion. Pharmacotherapy agents appear to be used less often by FN smokers than by other Canadian smokers for several possible reasons. Additional research is needed related to FN populations and cessation pharmacotherapy use in terms of cultural appropriateness, barriers to use, and effectiveness.

Adult↗
PubMed2004

Looking for caries...? Teachers evaluate a program to improve caries diagnosis from radiographs.

We developed a computer-assisted learning (CAL) program to improve student caries diagnosis from bitewing radiographs. In order to decide on its appropriateness, dental teachers independently evaluated the program before it was introduced. Our objective was to describe an evaluation by the teachers of the CAL diagnostic module and to compare the diagnostic performance with the evaluation score of the program. Key dental teachers involved in teaching clinical caries diagnosis and epidemiology (n = 22) viewed the CAL program. They evaluated aspects of the program by scoring 10 criteria on a visual analogue scale. Measures of the teachers' initial diagnostic accuracy assessed during use of the program were: sensitivity and specificity for the presence of dentine caries. Using Pearson's correlation coefficients, these measures of the teachers' diagnostic accuracy were compared separately with their evaluation score of one aspect of the program: the overall functionality of the program for a 2nd-year dental student. The teachers' mean sensitivity for dentine caries diagnosis was 76.5% (median 77.8%; SD 15.4%) and the mean specificity was 93.7% (median 94.2%; SD 3.9%). The teachers gave the program a mean overall functionality score of 68% (median 75.1%; SD 21%). Dentists with a lower sensitivity (P = 0.065) for dentine caries tended to give the CAL program a higher overall functionality score than the other teachers. The CAL program was valued as generally useful. It tended to be more highly valued by the dentists with initially lower scores for diagnostic accuracy.

Computer-Assisted Instruction↗
PubMedDate not supplied

Training lay health educators to conduct a church-based weight-loss program for African American women.

PURPOSE: Community-based lay health educators have been utilized in a range of settings and with a variety of health issues. However, little has been published about the specifics of training lay health educators to effectively deliver community-based programs. This paper describes the training used to prepare volunteer, church-based lay health educators to conduct a community-based weight-loss program, and the evaluation of that training. METHODS: After recruitment through their respective churches, volunteer lay health educators were given structured training in how to conduct the PATHWAYS weight-loss program. Program sessions were observed to monitor program delivery, and participation rates and weight loss were evaluated. RESULTS: The lay health educators were highly consistent in their delivery of the program content. Participant attendance was high and virtually all of the participants completed the program. Participant weight loss averaged 8.3 pounds, which correlated with session attendance. CONCLUSIONS: Given training appropriate to the structure of the program and specific to the targeted health behavior, lay health educators can reliably and effectively administer even rather complex programs.

Black or African American↗
PubMed1996

Image processing and computer-aided diagnosis.

The future of image processing and CAD in diagnostic radiology is more promising now than ever, with increasingly impressive results being reported from various observer performance studies in both mammography and chest radiography. Clinical trials in years to come will help optimize the accuracy of the programs and determine the actual contribution of CAD to the interpretation process. Radiologists using output from computer analyses of images, however, will still make the final decision regarding diagnosis and patient management. Nonetheless, studies have indicated that the computer output need not have greater overall accuracy than a given radiologist in order to improve his or her performance. A systematic and gradual introduction of CAD into radiology departments will be necessary so that radiologists can become familiar with the strengths and weaknesses of each CAD program, thereby avoiding either excessive reliance or a dismissive attitude toward the computer output. This should ensure the acceptance of CAD and optimal diagnostic performance by the radiologist. Thus, an appropriate role for each CAD program will be determined for each radiologist, according to his or her individual training and observational skills, reducing intraobserver variations and improving diagnostic performance.

Diagnosis, Computer-Assisted↗
PubMed2006

Theoretical, developmental & cultural orientations of school-based prevention programs for preschoolers.

Schools are the primary environment in which to conduct prevention programs for school-age children. Educators, policy makers, and psychologist argue that prevention efforts should begin as early as possible to maximize their effectiveness. Surprisingly, there are relatively few school-based prevention programs targeted for preschoolers. Given the evidence supporting earlier rather than later prevention efforts and the fact that many children in the United States attend preschool programs, more research on the feasibility and effectiveness of prevention programs administered in preschool environments is warranted. In this article, we review the existing literature on school-based prevention programs targeted for preschool children. We examine whether school-based prevention programs are theory driven, developmentally appropriate, culturally sensitive, and aimed specifically at symptom reduction or behavior promotion. Based on the findings of this review, our aim is to identify gaps in the prevention research literature regarding programs for preschoolers and propose research to address such gaps to create more effective school-based prevention programs for young children.

Child Behavior Disorders↗
PubMed1997

CHF disease management program slashes LOS, costs with innovative tracking, analysis.

Tracking care across the continuum for congestive heart failure patients: Evanston/Northwestern Healthcare's provider-driven disease management program for CHF patients crosses the boundaries of inpatient, outpatient, and home care. But that requires the savvy manipulation of data to ensure patients are tracked efficiently and resources are used appropriately. Here's how the program works.

Benchmarking↗
PubMed2000

The Marshall R. Urist Young Investigator Award. Orthopaedic applications of gene therapy. From concept to clinic.

Gene therapy offers new possibilities for the clinical management of orthopaedic conditions that are difficult to treat by traditional surgical or medical means. To bring the potential of this novel technology into the clinic, a research program was initiated that aimed to identify orthopaedically useful genes and develop methods for delivering them to suitable sites under conditions in which gene expression remains at therapeutic levels for the appropriate periods of time; this program is now 10 years old. Rheumatoid arthritis was selected as the lead disease. Preclinical studies evaluating the local and systemic delivery of numerous different genes by in vivo and ex vivo methods in murine and lapin models led to the development of a human gene therapy protocol for arthritis. In this protocol, a gene encoding the human interleukin-1 receptor antagonist protein is transferred to the metacarpophalangeal joints of female patients with rheumatoid arthritis. The first patient was treated this way in July 1996. This is not only the first orthopaedic application of human gene therapy, but also the first use of gene therapy approved for a nonlethal disease. In addition to providing additional therapeutic options for the treatment of rheumatoid arthritis, the experimental data from this study suggest that gene transfer approaches may improve the treatment of osteoarthritis, the repair of cartilage, ligaments, tendons, menisci, intervertebral discs and bone, and the management of disorders such as osteoporosis and osteogenesis imperfecta. They also show promise as a means for developing novel and improved animal models of orthopaedic diseases. If the current rate of progress continues, wide clinical application of gene therapy in various orthopaedic indications should occur within the next 5 to 10 years.

Animals↗
PubMed2006

Pulmonary rehabilitation.

Pulmonary rehabilitation programs use multidisciplinary teams to optimize physical and social functioning of patients with chronic respiratory impairment. These programs provide rehabilitation in inpatient, outpatient, or home settings, using at least three sessions weekly (one may be unsupervised) for at least 6 wk. The programs usually consist of exercise training, education, and psychosocial/behavioral components. Upper extremity exercises and instruction on breathing technique are included in most rehabilitation programs and reduce dyspnea, but the contribution of these to improved functional capacity remains unproven. Decreases in the sensation of dyspnea, increased functional exercise capacity, and enhanced quality of life of patients with chronic obstructive pulmonary disease (COPD) are established benefits of pulmonary rehabilitation. Evidence is lacking for the efficacy of rehabilitation for patients with non-COPD causes of pulmonary impairment, but many of these patients probably benefit. Despite the availability of strong evidence to support the efficacy of pulmonary rehabilitation programs in patients with severe COPD, third-party reimbursement policies have been inconsistent. Nonetheless, enrollment in a pulmonary rehabilitation program is encouraged for all appropriate candidates with chronic respiratory impairment, particularly for those with severe COPD.

Exercise Therapy↗
PubMed2006

Impact of a national beta-thalassemia carrier screening program on the birth rate of thalassemia major.

BACKGROUND: In Taiwan, the prevalence of beta-thalassemia trait is at least 1.1%. The Taiwan government initiated a National Screening Program in 1993. Herein we examine the differences before and after the initiation of this program. PROCEDURE: Data consisting of the total number of patients and the birth prevalence beta-thalassemia major were collected. Ninety-one patients with transfusion-dependent thalassemia treated in our hospitals were included for analysis. DNA analysis was performed for 86 patients. RESULTS: In Taiwan 361 patients exist. The birth prevalence of per 100,000 births was 5.6% in 1994 and declined to 1.21 in 2002. Fourteen patients were born after the program's initiation. DNA analysis of them revealed a new mutation (IVS-1-5 (G-C)), which was introduced through an inter-racial marriage. Otherwise, the remainder was the common beta-thalassemia mutations found in Taiwan. CONCLUSIONS: Despite how successful the National Screening Program is, a few doctors still failed to detect parents at risk. In addition, we are concerned about the emerging problem of the increase of interracial marriages where parents may not have appropriate screening. Hence, postgraduate education programs for physicians, health education for the general population, and timely screening of inter-racial marriage should become a priority.

Child↗
PubMed1987

Pre-admission screening of nursing home applicants: implications for home care.

An increasing number of states are developing programs to evaluate nursing home applicants prior to admission. The purpose of these Pre-Admission Screening (PAS) programs is to assure that nursing home placement is needed and appropriate. Both the number and scope of these programs have grown considerably in the last decade as states attempt to reduce inappropriate placements and control nursing home costs and utilization. The increase in PAS can have a significant impact on community services as clients are diverted from nursing homes to home care. This article uses the results of a recently completed national survey of state-administered PAS programs to indicate the impact of PAS on community care. PAs was defined as an on-site assessment of the need or appropriateness of nursing home care conducted by a disinterested third party prior to nursing home admission. State administrators of Medicaid and/or PAS in all states and the District of Columbia were contacted by phone to determine whether or not their state conducted PAS. States with PAS were sent a comprehensive mail survey, and 25 of these (81%) returned a survey. Data is presented regarding the scope of PAS programs, the types of clients participating in PAS, the variety of services coordinated or funded in conjunction with PAS, the types of recommendations made by screening teams (institutional vs. home care), and how respondents felt that PAS was impacting community services. The article concluded with a discussion of these results.

Data Collection↗
PubMed1996

Barriers to lifestyle change, and the need to develop an integrated approach to prevention.

Many barriers exist to the delivery of preventive services by both cardiologists and other physicians. These barriers can be overcome by appropriate training and the development of supportive infrastructures. In addition, institutional priorities must change in a direction that encourages such efforts. Cardiologists must recognize the importance of risk-factor modification, and training programs in cardiology should teach appropriate counseling techniques, the use of risk factor-lowering pharmacologic agents, and the manner in which cardiologists should interface with dietitians and other ancillary personnel. In addition, we need to recognize and teach, both by didactics and by example, that counseling patients and carrying out long-term preventive interventions can be as gratifying and interesting as performing dramatic procedures that although valuable and rewarding take place at a very late point in the patient's clinical course and perhaps could have been averted by greater attention to risk-factor modification. Increasingly, the public and governmental agencies are becoming involved in encouraging these endeavors, and cardiologists should be in the vanguard of such efforts, not reluctantly bringing up the rear.

Coronary Disease↗
PubMed1999

Radiation protection and quality assurance in diagnostic radiology--an IAEA coordinated research project in Asia and eastern Europe.

The International Atomic Energy Agency currently has two parallel Coordinated Research Projects (CRP) running in Asia and Eastern Europe. The main objective of the CRPs is to raise the level of awareness in participating countries about the need for radiation protection for patients undergoing diagnostic radiology procedures. This is to be achieved by first assessing the status quo in a sample of hospitals and X-ray rooms in each participating country. A program of optimization of radiation protection for patients is then introduced by means of a comprehensive quality assurance program and the implementation of appropriate dose reduction methods, taking into account clinical requirements for diagnostically acceptable images. Patient dose assessment and image quality assessment are to be performed both before and after the introduction of the quality assurance program. The CRP is divided into two phases--the first is concerned with conventional radiography, while the second involves fluoroscopy and computed tomography. The CRP is still running, restricting the scope of this paper to a discussion of the approach being taken with the project. The project will be completed in 1998, with analysis to follow.

Asia↗
PubMed1996

The effects of a community-based literacy program on young children's language and conceptual development.

Effects of a community-based literacy program on 1-, 2-, and 3-year-old children's language and conceptual development were assessed. University students were trained to teach Head Start parents effective methods for reading to their children. Families were randomly assigned to receive 18, 3, or 0 instructional visits. Results indicated that parents in the 18-instructional-visit program increased their participation in appropriate literacy behaviors such as reading to their children, teaching concepts to their children, and using the library, more than parents in the 0-instructional-visit groups. Children in the 18-instructional-visit program showed greater gains in language and conceptual development than children in the 0-instructional-visit group. Few differences were found between children in the 3-visit and 0-instructional-visit groups. Thus, only a high-intensity community-based intervention designed to train parents was effective in increasing emergent literacy in low-income ethnic children.

Child, Preschool↗
PubMed2003

Evaluating disease management program effectiveness: an introduction to time-series analysis.

Currently, the most widely used method in the disease management (DM) industry for evaluating program effectiveness is referred to as the "total population approach." This model is a pretest-posttest design, with the most basic limitation being that without a control group, there may be sources of bias and/or competing extraneous confounding factors that offer a plausible rationale explaining the change from baseline. Furthermore, with the current inclination of DM programs to use financial indicators rather than program-specific utilization indicators as the principal measure of program success, additional biases are introduced that may cloud evaluation results. This paper presents a non-technical introduction to time-series analysis (using disease-specific utilization measures) as an alternative, and more appropriate, approach to evaluating DM program effectiveness than the current total population approach.

Disease Management↗
PubMed1988

Monitoring program implementation in community mental health settings.

Evaluations that monitor program implementation provide an empirical description of a program's services, the population served, and a method for assessing whether the program as delivered matches the conceptual model on which it is based. This article presents the Daily Contact Log (DCL), an instrument that has been used to monitor the longitudinal form and content of services delivered in several community mental health care programs for persons with chronic mental illness. The instrument is described and directions for its use are detailed. The psychometric properties of the instrument are discussed, as is its evolution in multisite applications in various mental health care settings. The usefulness of the DCL for programmatic and research purposes is outlined, as are some secondary benefits to staff who use the instrument. While the viability and versatility of the DCL as an instrument for measuring important aspects of program implementation are stressed, its appropriateness for quality assurance analyses is also suggested.

Community Mental Health Services↗