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PubMed1998

A model for adolescent-targeted HIV/AIDS services: conclusions from 10 adolescent-targeted projects funded by the Special Projects of National Significance Program of the Health Resources and Services Administration.

This article describes a model of service for youth living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and youth at high risk for HIV, based on the lessons learned from a set of innovative service projects funded by the Health Resources and Services Administration Special Projects of National Significance (SPNS) Program. Although each project has a unique focus, all collectively seek to enroll youth with HIV into care through new or existing HIV service networks, and direct recruitment via street outreach and other similar methods. The use of various outreach methods tends to yield different patterns of engagement of youth in services. An ideal approach may use a combination of complementary outreach methods. Data at both the national and local levels point to five major elements that capture the innovations of the collective service model: (a) peer-youth information and dissemination; (b) peer-youth advisory groups; (c) peer-youth outreach and support; (d) professional, tightly linked medical social support networks; and (e) active case management and advocacy, for individual clients as well as the programs themselves, to link the various components together. One of the most important factors in the model's success is that youth and professionals share an equal partnership in all stages of program design, planning, and implementation. Youth and professionals each share their expertise in a dynamic process. In addition, active case management is crucial, not only to ensure that clients receive needed services, but also to ensure that the programs themselves run in a coordinated, tightly linked way. Given needs of adolescent clients and existing adult-oriented service networks, the use of active case management and the active participation of youth in the services system are critical.

Acquired Immunodeficiency Syndrome↗

PubMed2000

Results of a humanitarian otologic and audiologic project performed outside of the United States: lessons learned from the "Oye, Amigos!" project.

From 1989 to 1993, "Oye, Amigos!" a combined group of hearing health and other medical professionals performed 18 humanitarian medical and audiologic trips to Tepic, Nayarit, Mexico. The group saw 1500 patients, issued over 800 hearing aids, and performed 150 surgeries on 123 patients. Our tympanoplasty success rate, defined as an intact tympanic membrane, was 41% during the first 2 years of the project but increased to 74% during the last 3 years. Two hundred eighteen patients who were candidates for surgery did not return for care. We present the lessons learned from the surgical care and overall management of this project, and present suggestions to improve future projects.

Adolescent↗

PubMed1999

Serum cholesterol ester fatty acids in 7- and 13-month-old children in a prospective randomized trial of a low-saturated fat, low-cholesterol diet: the STRIP baby project. Special Turku coronary Risk factor Intervention Project for children.

To evaluate changes that occur in serum cholesterol ester fatty acid composition during the transition from typical infant feeding to a more adult type of nutrition, this study compared the effects on serum cholesterol ester fatty acids of breast milk or formula at the age of 7 mo with effects caused by 6-mo dietary intervention in 137 children. The intervention [Special Turku coronary Risk factor Intervention Project for children (STRIP baby project)] aimed at a reduction of saturated fat intake to 10% of energy after the age of 1 y without purposefully influencing total fat intake. Nutrient intakes were calculated from 3-d food records. At the age of 7 mo, i.e. before dietary education began, milk type markedly influenced dietary and serum cholesterol ester fatty acid composition (mean serum cholesterol ester 16:0 in breastfed vs formula-fed infants, 13.7% vs 12.0%, respectively, p < 0.001; serum cholesterol ester 18:2n-6 50.6% vs 57.6%, p < 0.001). At the age of 13 mo the calculated fat intake of the intervention and control children differed markedly but serum cholesterol ester fatty acid compositions in all children resembled closely those measured in 7-mo-old breastfed infants, e.g. at the age of 13 mo the relative proportions of 18:2n-6 were 49.9% and 51.1% in previously formula-fed intervention and control children, respectively, and 50.3% and 50.1% in previously breastfed intervention and control children, respectively. In conclusion, serum cholesterol ester fatty acid composition reflected differences in dietary fat quality (breast milk or formula) at the age of 7 mo, whereas dietary intervention as applied in the STRIP baby project had only a minimal effect.

Breast Feeding↗

PubMed1977

The effects of a finite number of projection angles and finite lateral sampling of projections on the propagation of statistical errors in transverse section reconstruction.

The dependence of noise amplification on the nuber of projection angles and on the lateral sampling interval of projections is presented. It is shown that about 1-5D/d angles and a sampling interval of about 0-5d are required in order that the data be efficiently utilized. D is the linear dimension of the reconstruction region and d is the linear dimension of the cells into which the reconstruction region is subdivided (resolution length). Values for noise amplification are given for various combinations of projection angles and lateral sampling intervals.

Information Theory↗

PubMed2004

The Balm of Gilead Project: a demonstration project on end-of-life care for safety-net populations.

The Balm of Gilead is a comprehensive program of end-of-life care for the populations served by the "safety net" public health system in Alabama's largest county. The Balm of Gilead serves terminally ill persons, predominantly of minority ethnic status who as a group are relatively younger than the national hospice population, and typically lacking in personal financial resources. Care provided by the Balm of Gilead addresses the holistic needs associated with terminal illness in each of its stages and each of its treatment settings. Balm of Gilead professionals and volunteers provide continuity of care across a continuum that includes inpatient palliative care, home hospice services, and specialized palliative care in nursing homes and other community residential settings. Cooper Green Hospital and the Jefferson County Department of Health are principal partners in the program. Community partnerships with local foundations, colleges and universities, faith communities, civic groups, and professional groups complete the collaborative network of the Balm of Gilead Project. This report discusses work to date toward fulfilling the project's two primary objectives: (1) to build the infrastructure necessary to support a comprehensive palliative care program that is available to county residents regardless of their ability to pay and (2) to develop systems and services to foster the institutional and community values that promote excellence in end-of-life care. The Project's current status and future challenges are reviewed.

Adult↗

PubMed2006

Projecting the demographic impact of AIDS and the number of people in need of treatment: updates to the Spectrum projection package.

BACKGROUND: In the Joint United Nations Programme on HIV/AIDS (UNAIDS) approach to HIV and AIDS estimates, estimates of adult prevalence produced by the Estimation and Projection Package (EPP) or the Workbook are transferred to Spectrum to estimate the consequences of the HIV/AIDS epidemic, including the number of people living with HIV by age and sex, new infections, AIDS deaths, AIDS orphans, treatment needs, and the impact of treatment on survival. METHODS: The UNAIDS Reference Group on Estimates, Models and Projections recommends updates to the methodology and assumptions based on the latest research findings and international policy and programme guidelines. The latest update to Spectrum has been used in the 2005 round of global estimates. RESULTS: Several new features have been added to Spectrum in the past two years. New patterns of the age distribution of prevalence over time are based on the latest survey data. A more detailed treatment of mother to child transmission of HIV is now based on information about current breastfeeding practices, treatment options offered to prevent mother to child transmission (PMTCT), infant feeding options, and the percentage or number of pregnant women accessing PMTCT services. A new section on child survival includes the effects of cotrimoxazole and ART on child survival. Projections can now be calibrated with national survey data. A new set of outputs is provided for all adults over the age of 15 in addition to the traditional 15-49 age group. New outputs are now available to show plausibility bounds and regional estimates for key indicators. CONCLUSIONS: The latest update to the Spectrum program is intended to incorporate the latest research findings and provide new outputs needed by national and international planners.

Adolescent↗

PubMed1994

[Afferent projections to the nodulus in the cat. I. Climbing fiber projections].

Olivocerebellar projections to the nodulus of the cat were studied by the horseradish peroxidase (HRP) method. The findings derived from the present study indicate that the nodulus can be divided into 5 longitudinal zones on the basis of differences in the afferent projection sites from the contralateral inferior olive. These zones are the medial-most zone projected from the caudal half of the nucleus beta, the lateral zone of the medial part from the rostral half of the nucleus beta, the medial zone of the intermediate part from the caudal part of the dorsal cap, the lateral zone of the intermediate part from the rostral part of the dorsal cap and the ventrolateral outgrowth, the lateral-most zone from the dorsomedial cell column. There is no difference between the ventral and dorsal nodulus.

Animals↗

PubMed1996

Podiatric educational enhancement project. A project overview.

Commitment to steady, adaptive improvement in podiatric medical professionals has taken shape in the Podiatric Educational Enhancement Project. This project involves wide representation from all interests, aspects, and constituencies in the profession to study opportunities and develop consensus on both small and large enhancements possible in the continuum of podiatric medical education. More than 1,300 podiatric physicians have contributed information and expertise, and more will be involved as the project develops during the next 18 months.

Curriculum↗

PubMed1999

Take it to heart: a national health screening and education project in African-American communities. A joint project of the NMA and Bayer Corporation.

"Take It to Heart" is a community health screening and education project jointly sponsored by the National Medical Association (NMA) and Bayer Corporation, Pharmaceutical Division. The project was designed to increase awareness of the prevalence of hypertension and the risks of coronary heart disease in the African-American community. Free health testing for hypertension and cholesterol was provided in six communities. Participants received an individualized coronary risk assessment outlining key risk areas, followed by consultation with an NMA physician. A total of 1651 individuals between the ages of 18 and 82 participated in the health screenings. Ninety-five percent of those tested were African American. In a preliminary health history, 76% reported insufficient exercise, 23% reported a history of high blood pressure, and 19% had a positive family history of early cardiovascular disease. Screening test results revealed 40% of participants had a blood pressure > 140/90 mmHg, 52% had a cholesterol level > 200 mg, and 42% had a body mass index > 27. Based on these results, more than 76% were calculated to have a moderate to high coronary risk profile. Hypertension and cardiovascular disease are major public health problems associated with an increased incidence of death in the African-American community. The Take It to Heart Project is an important mechanism of providing health information to the public and encouraging those at highest risk to take steps to improve their health status.

Black or African American↗

PubMed1999

The new subnational population projections model: methodology and projection scenarios.

This article describes the most recent process of projecting population at the subnational level in England. It briefly explains the reasons why projecting population at the subnational level is important, describes the model and how it was used to produce the latest set of long-term subnational population projections in England published by the Office for National Statistics (ONS) in 1998. The article then discusses how the model may be applied to answer various 'what-if' questions about future population.

Adolescent↗

PubMed2000

Project LID (lower infant deaths). Lessons learned from a local infant mortality review project.

Project LID (Lower Infant Deaths) is an infant mortality review project conducted by the Minneapolis Department of Health and Family Support and the Saint Paul-Ramsey County Department of Public Health. Infant death occurs when a live-born infant dies before age 1. Multidisciplinary teams reviewed 112 infant-mother cases involving infant death using vital and medical records. Open-ended maternal interviews were conducted for approximately half of the cases. This combination of quantitative and qualitative data provided insights into the contributing social, medical, and environmental factors experienced by some families in Hennepin and Ramsey counties. Case review teams developed recommendations to address factors identified in each case. Recommendations are directed to health care providers, professional societies, health systems, government organizations, policymakers, and community- and school-based organizations. This article describes findings from the project and presents recommendations for Minnesota physicians with practices in obstetrics, family medicine, and pediatrics.

Adolescent↗

PubMed2001

[The LORAS Project and quality assurance. In four years from input- to outcome-oriented financing in public health. 1: The LORAS Project].

This series of three articles is a summary of the operations, findings and results of the hospital reform projects in the Canton of Zurich, termed LORAS. With the aid of the LORAS project within four years Zurich hospitals have been transformed. Whereas they used to adhere to input-oriented covering of deficits they now operate with outcome-oriented prospective financing of output. Part 1 describes the whole Project. Part 2 focuses on the development of outcome-measurement. Part 3 finally describes the implementation of the outcome-measurement in the canton of Zurich.

Economics, Hospital↗

PubMed2001

[The LORAS project and quality assurance. In four years from input- to outcome-oriented financing in public health. 2: LORAS project outcome parts 1 & 98].

This series of three articles is a summary of the operations, findings and results of the hospital reform projects in the Canton of Zurich, termed LORAS. With the aid of the LORAS project within four years Zurich hospitals have been transformed. Whereas they used to adhere to input-oriented covering of deficits they now operate with outcome-oriented prospective financing of output. Part 1 describes the whole project. Part 2 focuses on the development of outcome-measurement. Part 3 finally describes the implementation of the outcome-measurement in the canton of Zurich.

Hospitals↗

PubMed2003

Development of research capability in Ethiopia: the Ethio-Netherlands AIDS research project (ENARP): 1994-2002, achievements, scientific findings and project goals.

In 1992, HIV/AIDS researchers in Amsterdam, the Netherlands, were invited to work in partnership with researchers in Ethiopia to build an HIV/AIDS research infrastructure in Addis Ababa. This project, which began in 1994, was envisioned to contribute meaningfully to fighting the HIV pandemic in the decades to come. Its immediate objective was to establish an HIV research laboratory to serve international partnerships pursuing HIV vaccine research in Ethiopia and to support national health authorities fighting the HIV epidemic in Ethiopia. The overall goal was to develop research capacity at the Ethiopian Health and Nutrition Research Institute (EHNRI) by improving facilities, training technical and academic personnel (at PhD, MSc, and MPH level), establishing cohort studies to study HIV infection progression, and helping the government to implement a national HIV surveillance program. In the period 1994-2002, the projected HIV/AIDS research laboratory was built and several existing sections of EHNRI were renovated and upgraded. An active HIV-research program was established. Staff grew to more than 60, including three Ethiopian and three expatriate research/managers. Two PhD. students have graduated in immunology and virology (University of Amsterdam, 2000), and five are currently in training. Several technical persons were trained and over 19 MSc/MPH-programs were supported at Addis Ababa University (AAU). The first Ethiopian PhD graduate became the national program manager for ENARP. Two ENARP cohort studies and several HIV-prevalence studies have helped to document the severity of the HIV epidemic in Ethiopia, assisting national authorities in formulation of national and regional policies to prevent HIV transmission. Initial funding for ENARP from the Netherlands government was projected for eight years, to end by 2003. It was expected that management responsibilities would then be transferred from expatriate to Ethiopian staff and all ENARP activities integrated into EHNRI.

AIDS Serodiagnosis↗

PubMed1992

[The long-term evaluation of a project for the primary prevention of coronary cardiopathy at 10 years from the stopping of treatment. The second phase of the Roman Project to Prevent Coronary Cardiopathy (PPCC II Phase)].

At the end of the Rome Project of Coronary Heart Disease (CHD) Prevention (PPCC) lasted 6 years and involving 3131 treated and 2896 control men aged 40-59 belonging to occupational groups, the mean values of some coronary risk factors (systolic blood pressure, serum cholesterol, smoking habits, body mass index) were favourably reduced in treated men as compared to controls. Incidence (-25.4%) and mortality (-26.8%) from CHD were also lower, in 6 years, in treated vs control groups. Ten years after the end of the project and of the treatment procedures in "treated men", a subgroup of 1013 former treated men and one of 843 former controls could be re-examined, whereas mortality data could be collected in those 3395 men who were examined at the end of the 6-year project. The 16 year examination showed that serum cholesterol, blood pressure, body mass index and cigarette consumption are now lower, on the average, in former control men, as compared to that of former treated ones. The finding is largely justified by different behaviours of eating, smoking and motion habits and by the motivation and behaviour toward health problems. Coronary mortality, during the last 10 years, was higher among the former treated men as compared to that of former control men (+50.0%; p less than 0.05%). The reverse trend observed in these 10 years is likely explained by a psychological "rebound" phenomenon occurred in the former treated men and to some beneficial effects, in the former control men, bound to the secular trend which presently characterizes some living habits of the Italian population.

Cause of Death↗

PubMed1991

Familial insulin-dependent diabetes mellitus (IDDM) epidemiology: standardization of data for the DIAMOND Project. The WHO Multinational Project for Childhood Diabetes Group.

The WHO Multinational Project for Childhood Diabetes, known as the DIAMOND Project, has been responsible for establishing insulin-dependent diabetes mellitus (IDDM) registries and for carrying out diabetes incidence studies, descriptive epidemiological research, and analytical investigations which are being used to test specific hypotheses regarding the etiology of the disease. Standardized epidemiological data are being collected from countries around the world, permitting international comparisons between registries. Multinational studies are also beginning to investigate the potential genetic determinants of the disease, and are contributing to the development of familial IDDM epidemiology worldwide. The development of standards for data collection of IDDM family histories is important for multinational studies of IDDM recurrence risks in families, descriptive analyses of patterns of familial aggregation, and comparative analytical investigations of specific etiological determinants of IDDM in relatives. These activities are being implemented through the DIAMOND Project.

Child↗

PubMed1998

Improving care for acute myocardial infarction: experience from the Cooperative Cardiovascular Project. The Cooperative Cardiovascular Project Best Practices Working Group.

BACKGROUND: The Cooperative Cardiovascular Project (CCP) was initiated by the Health Care Financing Administration to improve the quality of care for Medicare beneficiaries admitted to the hospital with acute myocardial infarction (AMI). Four peer review organizations formed the CCP Best Practices Working Group (Working Group) to identify effective intervention strategies that enable a hospital staff to improve AMI care. METHODS: The peer review organization in each state was asked to identify six hospitals with exemplary quality improvement (QI) plans for AMI care; 33 states responded. Data about the hospitals' baseline performance on the CCP quality indicators and components of the QI plans were collected from each hospital. Thirty-six of 40 randomly selected hospitals from this group were interviewed. RESULTS: The Working Group identified 191 hospitals in 33 states with exemplary QI plans. Administration of thrombolytic therapy and aspirin were the quality indicators most commonly addressed. Staff education, development or revision of clinical pathways and standing orders, and ongoing data collection were the most common QI plan components. The need to develop interdisciplinary teams and to identify a strong physician champion for the QI efforts were the most common recommendations for other hospitals considering implementation of the CCP. CONCLUSIONS: The CCP stimulated interest in QI activities for AMI care in the institutions identified for the Working Group. The characteristics of the hospitals' improvement plans were consistent with those identified by contemporary leaders of clinical QI as central to improving care. These plans focused on changes in clinical processes, deployment of interdisciplinary teams, identification of project champions, and ongoing data collection to assess and improve quality of care.

Alabama↗

PubMed1992

The Canadian Physiotherapy Quality of Care Project. Analysis of a derailed project.

The Physiotherapy Quality of Care Project was a project of the Canadian Physiotherapy Association, sponsored by the Canadian government to ensure the quality of physiotherapy. A consensus committee of physiotherapy educators and managers developed and tested an instrument to measure changes in patients' functional status during physiotherapy. Despite scientific development and wide distribution, this technology was not adopted. Alternative methods, which were heavily marketed, gained nationwide use instead.

Canada↗