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PubMed2002

Reducing conflict between child welfare communities.

Conflict is inherent in child welfare practice. This article describes a collaborative project between a public child welfare agency and a school of social work (the UFOCWL) to strengthen and improve the connections between the agency and the larger community. The collaboration focused on identifying and recognizing the diverse roles and responsibilities between the various players in the child welfare system. This paper discusses the areas in which the UFOCWL addressed the conflicts between the child welfare service delivery system and the legal, domestic violence, and substance abuse communities. By facilitating understanding of the unique concerns and contributions each child welfare player brings to the table, inherent conflicts can be reduced and managed, ultimately improving the results for vulnerable children.

Child↗
PubMed2006

Cheerleading-related injuries to children 5 to 18 years of age: United States, 1990-2002.

OBJECTIVE: To describe the epidemiology of cheerleading-related injuries among children in the United States. DESIGN: A retrospective analysis of data for children 5 to 18 years old from the National Electronic Injury Surveillance System (NEISS) of the US Consumer Product Safety Commission, 1990-2002. METHODS: Sample weights provided by the NEISS were used to make national estimates of cheerleading-related injuries. Injury rates were calculated for the most frequently occurring types of injury using cheerleading participation data. RESULTS: An estimated 208,800 children (95% confidence interval [CI]: 166,620-250,980) 5 to 18 years of age were treated in US hospital emergency departments for cheerleading-related injuries during the 13-year period of 1990-2002. The number of injuries increased by 110% from 10,900 in 1990 to 22,900 in 2002, with an average of 16,100 (95% CI: 12,848-19,352) injuries per year (P < .01). The average age of injured children was 14.4 years (median: 15.0 years); 97% were female; and 85% of injuries occurred to children 12 to 17 years old. The number of injuries per 1000 participants per year was greater for 12- to 17-year-olds (8.1) than for 6- to 11-year-olds (1.2) for all cheerleading-related injuries combined (P < .01; relative risk [RR]: 6.49; 95% CI: 6.40-6.58), as well as for injuries grouped by body part injured and type of injury. The body parts injured were lower extremity (37.2%), upper extremity (26.4%), head/neck (18.8%), trunk (16.8%), and other (0.8%). Injury diagnoses were strains/sprains (52.4%), soft tissue injuries (18.4%), fractures/dislocations (16.4%), lacerations/avulsions (3.8%), concussions/closed head injuries (3.5%), and other (5.5%). Children in the 12- to 18-year age group were more likely to sustain strains or sprains to the lower extremity than 5- to 11-year-olds (P < .01; RR: 1.62; 95% CI: 1.50-1.88). The majority of patients with cheerleading-related injuries was treated and released from the emergency department (98.7%). Patients sustaining fractures or dislocations were more likely to be admitted to the hospital than those sustaining other types of injury (P < .01; RR: 5.30; 95% CI: 3.29-6.43). CONCLUSIONS: To our knowledge, this study is the first to report numbers, rates, and trends of cheerleading-related injuries to children using a nationally representative sample. Cheerleading is an important source of injury to girls. The number of cheerleading-related injuries more than doubled during the 13-year study period. A set of uniform rules and regulations directed at increasing the safety of cheerleading, that are universally enforced, should be implemented. Mandatory completion of a safety training and certification program should be required of all cheerleading coaches. Establishment of a national database for cheerleading-related injuries would facilitate the development and evaluation of injury-prevention strategies based on epidemiologic evidence.

Adolescent↗
PubMedDate not supplied

A voluntary/mandatory cost containment program.

The first of only three U.S. coal companies to introduce health care cost containment measures to unionized employees, Westmoreland Coal offers the same program to salaried workers--except that participation is mandatory for the salaried group, voluntary for the union group. How the Company sold this dual approach to both groups, and the heartening results, are described by Westmoreland's Director of Human Resources.

Coal↗
PubMedDate not supplied

Clinical outcomes of educating nurses about pediatric pain management.

This pilot study examined the influence of a mandatory hospital in-service pediatric pain management program on nurses' administration of analgesics. Chart audits were conducted using a convenience sample of all children who had undergone tonsillectomies during a 2-week period before and after the in-service. In contrast to what was expected, after the educational program, there was an increased length of time before the first dose of analgesic was given and between doses of analgesics given to patients.

Adolescent↗
PubMed2002

Difficulties faced when conducting primary health care programs in rural areas.

OBJECTIVE: The aim of this study is to explore the difficulties that face primary health care teams who work in rural areas in Aseer region, Kingdom of Saudi Arabia. METHODS: This study was carried out in 1999 by distributing a multi-purposes questionnaire to all members of health teams who work in the primary health care centers located in the rural areas of Aseer region, Kingdom of Saudi Arabia. This questionnaire consisted of 3 parts that were concerned with the characteristics of primary health care centers teams and difficulties faced by them while conducting primary health care programs during their daily activities at primary health care centers. Data was entered and analyzed by personal computer which was provided with statistical package for social sciences. RESULTS: A total of 68 primary health care centers were located in the rural areas of Aseer region, Kingdom of Saudi Arabia. Those primary health care centers serve 127,880 individuals who live in 657 villages. Three hundred and four members of the primary health care centers teams answered our questionnaire, 23% were physicians, 45% were nurses and 17% were Saudis. Thirty percent reported that they face some difficulties during conducting primary health care programs and 24% reported difficulties during dealing with clients. Most of the difficulties were the lack of medical facilities, rough roads and languages barriers. CONCLUSION: This study revealed that approximately one 3rd of primary health care teams who work in the rural areas of Aseer region, Kingdom of Saudi Arabia face significant difficulties that will affect the introducing of essential primary health care programs. A multi-sectoral integrated approach is mandatory to overcome these difficulties and introduce good quality care.

Community Health Centers↗
PubMed1991

[Cardiovascular risk factors in the working population of Alicante].

The aim of the present study was to evaluate the prevalence of certain cardiovascular risk factors in the population of Asepeyo-Elche. The study sample was a working population of 697 persons (71.8% males and 28.2% females) with ages ranging from 15 to 65 years (mean age 34.7 +/- 13.2 years), seen during the first 6 months of 1990 in the health care center of Asepeyo-Elche. The evaluated cardiovascular risk factors and their prevalence rates were: hypertension (14.2%), hypercholesterolemia (18.5%), smoking (52.5%), hyperglycemia (3.5%), obesity (28.2%) and sedentariness (80.3%). We conclude that in our working population the prevalence rates of some cardiovascular risk factors are high and that intervention programs to modify the diet and lifestyle are mandatory to prevent the pathogenetic consequences of these factors.

Age Factors↗
PubMedDate not supplied

Hib vaccine coverage in children attending day care/nursery school in East York.

This survey assessed Haemophilus influenzae b vaccine coverage and factors affecting compliance in children at increased risk. A telephone survey was conducted of a random sample of 75 children, aged 24-60 months, attending licensed day care/nursery schools in East York. 96% of the sample was surveyed; only 51% were vaccinated. Older children were less likely to be immunized and there were more single-parent families among the non-vaccinated. The age, educational level and country of birth of the parents and the number of siblings were not associated with vaccination status. In 20% of the non-vaccinated group, concern about side effects was the main reason for non-compliance. For 91%, a factor of "moderate/very much concern" was the perceived unimportance of preventing Haemophilus influenzae b illness. Education for parents and physicians, special programs aimed at risk groups, and consideration of mandatory immunization against Haemophilus influenzae b in children attending day care/nursery schools are needed.

Bacterial Vaccines↗
PubMed2003

Medical humanities: a new undergraduate teaching program at the University of Geneva School of Medicine, Switzerland.

In 2001, a new program of medical humanities was initiated at the University of Geneva School of Medicine in Switzerland. Four mandatory seminars and one optional 2-week internship are offered to second-through fifth-year medical students. The program has four interdependent goals: contextualizing, developing personal reflection and judgment, encouraging imagination, and offering specific ways to improve the quality of the therapeutic relationship. The program is based on an integrated vision of the humanities and stimulates the students' imagination and reflection in a way that medical students should find useful. Three steps help teachers to build an integrated vision: familiarization, confrontation, and adjustment to the medical culture. The mandatory seminars are taught by a team consisting of a physician and a humanities teacher. All the physicians, department heads, and clinicians involved in each seminar actively collaborated. The medical humanities program is in the Bioethics Unit, which is housed in the Department of Community Health and Medicine with medical history and legal medicine. This intellectual, institutional, and physical proximity encourages informal dialogue and ensures a more coherent and unified vision of the different disciplines. In their assessments of the program, students stated that the seminars gave them food for thought and met their expectations. However, it is premature to draw conclusions from these assessments because the program is still in its infancy. The program strives to provide students with tools specific to the humanities so that they can strengthen their own judgment, listening skills, open-mindedness, creativity, and curiosity, attributes that are needed to ensure that the therapeutic relationship will be satisfying for both physicians and patients.

Curriculum↗
PubMed1987

Computer-based instruction in clinical medical education: a pulmonary medicine self-assessment.

This computer assisted teaching program was designed to provide a comprehensive review of pulmonary medicine in the form of a self-assessment. The program consisted of 30 questions including multiple choice, true or false and matching questions. The questions were based on the respiratory chapter from a standard textbook of medicine. Forty students taking their mandatory medicine rotation at a major university teaching hospital used the program. Their scores ranged from 46.7% to 93.3% with a mean of 68.1%. The format enabled the student to answer the questions, to quickly determine which ones he got right and wrong and then he was provided with the correct answer and a reference in the respiratory chapter of the standard textbook of medicine on which the assessment was based. A score was given to each individual so that each student could be his own judge as to how well he did. After reading the references for the questions missed, the learner would decide for himself what area of pulmonary medicine deserved further study.

Computer-Assisted Instruction↗
PubMed1992

Resident training in breast imaging in Canada: current status.

The authors evaluated the current status of resident training in breast imaging in Canada to provide baseline data for guidelines on the amount and the nature of training necessary. Information was obtained, by means of a questionnaire or a telephone interview, from the directors of all 16 radiology residency programs and the 58 radiology residents in their final year at the time of the study. All programs offer training in breast imaging; the training is mandatory in 11 (69%) and elective in 5 (31%). Of the 58 residents, 52 had had some training in breast imaging at the time of the study. Of these, 24 (46%) had spent a period averaging 3.9 weeks exclusively on breast imaging. Forty-one percent of residents felt that the duration of their breast imaging training was too short, and 35% felt that they could not practise mammography independently after their rotation. The authors found that training in breast imaging across the country is highly variable. Although this training is being upgraded in many programs, deficiencies remain. Guidelines are needed to ensure a minimum standard for training in breast imaging.

Biopsy, Needle↗
PubMed1992

Lead intoxication in infancy.

Four years of experience in the evaluation and management of lead intoxication in the first year of life were reviewed. This study was conducted in a lead referral program within the state of Massachusetts, whose comprehensive lead laws include extensive (and now mandatory) lead screening of all children. Over the period of study, 50 (14%) of 370 new patients enrolled in the program were infants aged 12 months or younger. Median age of these infants was 11 months (range 1 through 12 months). Mean peak lead level was 39.0 micrograms/dL while the mean peak erythrocyte protoporphyrin concentration was 111.9 micrograms/dL of whole blood. Thirty-two percent of infants were ambulatory at the time lead intoxication was diagnosed; only 24% had a history of pica. Twenty-six percent of parents were welfare dependent. Apparent sources of plumbism included house-hold renovation (n = 20), direct ingestion of paint chips (n = 10), formula preparation with lead-contaminated water (n = 9), lead dust importation (n = 1), and congenital exposure to elevated maternal lead level (n = 1). In 9 cases the source was not found. When this profile was compared with that of a randomly selected group of 47 children aged 18 through 30 months, who were seen in the lead program during the same interval, apparent sources of intoxication in the older group were paint chip ingestion (n = 41), household renovation (n = 2), and unknown (n = 4) (P less than .0001). On the basis of these data, it is concluded that lead intoxication in infants is common and has significantly different origins from that in toddlers.(ABSTRACT TRUNCATED AT 250 WORDS)

Cooking and Eating Utensils↗
PubMed1997

Creating community agency placements for undergraduate medical education: a program description.

UNLABELLED: PROGRAM OBJECTIVE: To provide first- and second-year medical students with stimulating learning experiences in the community. SETTING: Three hundred placements representing a broad array of urban community agencies providing both general and specialized health care services. PARTICIPANTS: All first- and second-year medical students at the University of Toronto (n = 354). Other participants include staff of community agencies and tutors from the Faculty of Medicine and from the community. PROGRAM: The Health, illness and the Community course is mandatory and consists of 3 components. The first, in the first semester of first year, emphasizes the provision of health care in the community for individuals and populations. The second, in the second semester of first year, introduces a health promotion paradigm. The third component, throughout second year, allows students to engage in an in-depth study of the interconnection between a health problem and a social issue in a community agency setting. OUTCOMES: Students have expressed high levels of satisfaction with the community agency placements. The feedback from agencies has also been enthusiastic. Patients in the home care program have reported that visits by medical students are a positive experience. CONCLUSION: It is possible to recruit and maintain large numbers of urban community agencies as learning sites for medical students. It is hoped that this approach will help to produce socially responsive medical practitioners.

Canada↗
PubMed1999

Acceptable HLA mismatches for highly immunized patients.

Highly sensitized patients have developed antibodies against many different HLA antigens due to previous pregnancies, blood transfusions or failed transplants. These antibodies cause a positive crossmatch with almost all potential organ donors. As a positive crossmatch is a contra-indication for transplantation, highly sensitized patients have a low chance of transplantation unless special strategies are introduced. One such strategy is the acceptable mismatch program, which has led to transplantation of more than 300 of these highly sensitized patients within Eurotransplant. Centers are participating in the program on a voluntary basis. Before a patient can be included in this program, extensive antibody screening is necessary to define those HLA-A and -B antigens towards which the patient has never formed antibodies. Organ donor selection is based on complete compatibility with the patients own HLA antigens in combination with the acceptable mismatches. If such a combination is identified, mandatory exchange takes place. Despite the success of the acceptable mismatch program, about 25% of the patients will never receive a donor offer. These are patients with rare HLA antigens or rare combinations of HLA antigens. In the last few years, this group of patients has had the advantage of two additional programs running within Eurotransplant. In the HIT (highly immunized tray) program, sera of highly sensitized patients are sent to the different centers and crossmatched with all ABO compatible donors. In the case of a negative crossmatch, mandatory exchange takes place. Secondly, these patients can benefit from the extra points they receive for their waiting time, high antibody reactivity and rare HLA type in the standard Eurotransplant allocation system. We conclude that the application of these three strategies will lead to a significantly increased transplantation rate of highly sensitized patients.

Cross Reactions↗