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PubMedDate not supplied

A review of mammography test objects for the calibration of resolution, contrast, and exposure.

Mandated and voluntary accreditation and quality control programs for mammography require the use of standardized mammography test objects. We evaluated eleven commercially available test objects and three prototype test objects, comparing them with respect to their resolution targets, contrast targets, and the dose they required when imaged by the same automatic exposure meter. Ion chamber and/or thermoluminescent dosimeter measurements of exposure were made with each test object, while attenuation was measured for seven. Measurements of dosage using acrylic (5 test objects) and tissue equivalent epoxy (9 test objects) showed as much as a 400% variation in the radiation supplied by the same automatic exposure device when differences in thicknesses of test objects were normalized. Speck visibility was as dependent on the composition of the specks and of the surrounding material as on the size of the specks. Contrast targets were adequate in only three test objects. Optical density differences between images of a 4-cm-thick breast and of different test object materials, also 4 cm in thickness, exposed to the same radiation, imply that untested acrylic or epoxy resin materials should not used in the calibration of automatic exposure controls.

Evaluation Studies as Topic↗
PubMed1976

The role of the certified social worker in England's social services.

With the reorganization of England's social services into a single unified system, the professional called the certified qualified social worker is playing a key role in the administration and delivery of community services. The author describes some of the worker's activities and also presents an overview of hospital, day treatment, and outpatient services for adult psychiatric patients in the county of Warwickshire. One of the most effective programs is a system of voluntary group homes, operated by an area council of churches, for former psychiatric inpatients.

Aftercare↗
PubMed1984

Australia's mental health system.

Mental health programs in Australia are influenced greatly by the country's system of government and by its geography. In Australia, mental health is looked upon as part of the total health services of each state. This has forced the community-based mental health services to be more closely related to public health programs than is true in most of the United States. Australia's parliamentary civil service system provides greater stability to the planning and administration of health services, while her relatively homogeneous and less mobile urban populations have allowed state hospitals to move toward the functional division of patients. After providing a brief history and description of Australia's mental health system, the author discusses hospital programs for the chronic mentally ill; residential rehabilitation programs, which, like vocational rehabilitation programs, are provided through many voluntary organizations; the financial support provided to the mentally disabled by the Department of Social Security; and mental advocacy groups, which are noteworthy because they work more cooperatively together and with the professionaly community than do similar American groups.

Adolescent↗
PubMed1980

Working for women's health: The Women's Health Alliance of Long Island, Inc.

This article discusses the history of Long Island's feminist health organization, The Women's Health Alliance of Long Island, Inc. This community-based women's group was formed in 1975 by a group of educators, practitioners, students, and intersted laywomen who were concerned about health care for women in New York City and Long Island. Today, services include a major Women and Health conference held each spring, a feminist health education center, several smaller presentations for specific groups, and related projects. Through our history, we have faced difficult decisions regarding our functions, goals, and structure. This article addresses the means we have used to mediate these decisions in order to continue our programs and to open our voluntary agency, Healthouse, which functions as a resource and educational center for women.

Female↗
PubMed2005

Cost-effectiveness of free HIV voluntary counseling and testing through a community-based AIDS service organization in Northern Tanzania.

OBJECTIVES: We evaluated the cost-effectiveness of fee-based and free testing strategies at an HIV voluntary counseling and testing (VCT) program integrated into a community-based AIDS service organization in Moshi, Tanzania. METHODS: We waived the usual fee schedule during a 2-week free, advertised VCT campaign; analyzed the number of clients testing per day during prefree, free, and postfree testing periods; and estimated the cost-effectiveness of limited and sustained free testing strategies. RESULTS: The number of clients testing per day increased from 4.1 during the prefree testing interval to 15.0 during the free testing campaign (P<.0001) and remained significantly increased at 7.1 (P<.0001) after resumption of the standard fees. HIV seroprevalence (16.7%) and risk behaviors were unchanged over these intervals. Modeled over 1 year, the costs per infection averted with the standard fee schedule, with a 2-week free VCT campaign, and with sustained free VCT year-round were $170, $105, and $92, respectively, and the costs per disability-adjusted life year gained were $8.72, $5.40, and $4.72, respectively. CONCLUSIONS: The provision of free VCT enhances both the number of clients testing per day and its cost-effectiveness in resource-limited settings.

AIDS Serodiagnosis↗
PubMed2002

Comparison of two timed artificial insemination (TAI) protocols for management of first insemination postpartum.

Two estrus-synchronization programs were compared and factors influencing their success over a year were evaluated. All cows received a setup injection of PGF2alpha at 39 +/- 3 d postpartum. Fourteen days later they received GnRH, followed in 7 d by a second injection of PGF2alpha. Cows (n = 523) assigned to treatment 1 (modified targeted breeding) were inseminated based on visual signs of estrus at 24, 48, or 72 h after the second PGF2alpha injection. Any cow not observed in estrus was inseminated at 72 h. Cows (n = 440) assigned to treatment 2 received a second GnRH injection 48 h after the second PGF2alpha, and all were inseminated 24 h later. Treatment, season of calving, multiple birth, estrual status at insemination, number of occurrences of estrus before second PGF2alpha, prophylactic use of PGF2alpha, retained fetal membranes, and occurrence of estrus following the setup PGF2alpha influenced success. Conception rate was 31.2% (treatment 1) and 29.1% (treatment 2). A significant interaction occurred between protocol and estrual status at insemination. Cows in estrus at insemination had a 45.8% (treatment 1) or 35.4% (treatment 2) conception rate. The conception rate for cows not expressing estrus at insemination was 19.2% (treatment 1) and 27.7% (treatment 2). Provided good estrous detection exists, modified targeted breeding can be as successful as other timed artificial insemination programs. Nutritional, environmental, and management strategies to reduce postpartum disorders and to minimize the duration of postpartum anestrus are critical if synchronization schemes are used to program first insemination after the voluntary waiting period.

Animal Husbandry↗
PubMed1991

Budget deficits threaten to shut out Medicaid benefits.

Revenue shortfalls are prompting state officials to seek creative ways to keep their Medicaid programs afloat. Some tactics include voluntary provider contributions and provider taxes to increase federal matching funds and paring back on the number and kind of benefits that states offer. Hospital groups, meanwhile, are starting their own grass-roots campaigns to shield Medicaid from crippling budget cuts.

Budgets↗
PubMed2006

Risk assessment for children exposed to decabromodiphenyl (oxide) ether (Deca) in the United States.

Decabromodiphenyl (oxide) ether (Deca) is a widely used brominated flame retardant in the United States predominantly in the hard-plastic housings of consumer electronics and in flame-retarded backing on textiles used in furniture. A child-specific exposure assessment of Deca was performed for the US Environmental Protection Agency's Voluntary Children's Chemical Evaluation Program (VCCEP). The VCCEP guidance for a tier 1 exposure assessment requires that a screening-level assessment be conducted using currently available data and conservative assumptions. For Deca, relevant exposure pathways considered were general environmental exposures (e.g., exposures to contaminated soil, dust, air, and food), breast milk exposures, inhalation of Deca-containing particulates in air, and mouthing Deca-containing consumer products. For each of these scenarios, a mid-range and upper estimate of age-appropriate intakes were calculated. The calculated intakes indicate that, despite the uncertainties, children appear to be exposed to Deca at levels at least 1 order of magnitude, with most being several orders of magnitude, below the National Academy of Sciences reference dose for Deca of 4 mg/kg/d. This analysis indicates that, using the available data, current levels of Deca in the United States are unlikely to represent an adverse health risk for children.

Child↗
PubMedDate not supplied

Kaduna beggar children: a study of child abuse and neglect in northern Nigeria.

Kaduna State, Nigeria serves as an example of a third world state that in the wake of rapid change and the weakening of traditional forms of welfare has created an underclass of beggars, many of whom are children. Lack of a comprehensive welfare system in general, and more specifically, protective services for minors, has resulted in the neglect of some children who are exploited by poor families for street begging. Although laws exist to protect minors and prevent street begging by children, they are seldom enforced. Perhaps this is due to the absence of a governmental agency solely responsible for child welfare. In light of the need to assist beggar children, the following measures are recommended: Establish a Bureau for the Protection of Beggar Children. Establish a Division of Protective Services in the Ministry of Social Development. Establish advocacy programs for street children by voluntary agencies.

Adolescent↗
PubMed1987

Ability of the 1(2)s rule to detect substandard performance in interlaboratory proficiency testing.

The most common evaluation criterion used by regulatory and voluntary interlaboratory proficiency testing (PT) programs to judge the quality of chemistry results is based on the group mean +/- 2.0 standard deviations (SD), the 1(2)s rule. The mean and SD are those of the selected PT population. Through computer simulations we have quantified, for the first time, the ability of the 1(2)s criterion to detect "acceptable" as well as substandard ("unacceptable") intralaboratory performance by PT. We found that the 1(2)s rule correctly identifies "acceptable" performance--i.e., low intralaboratory coefficient of variation (CV) values and small bias values--greater than 90% of the time. However, this criterion fails to detect laboratories with "unacceptable" bias and (or) CV at least 23% of the time. The high failure rate of the 1(2)s rule raises serious questions about its appropriateness for use by PT programs.

Computer Simulation↗
PubMed1996

[5 years neuroblastoma screening in Austria: rate of participation, results and a comparison with other screening areas].

In late 1990 a screening program for the early detection of neuroblastoma in infants was introduced in Austria. The program is performed on a voluntary basis in collaboration with general pediatricians and practitioners. Filter strips for urine collection are distributed to parents of infants aged seven to nine months on the occasion of a routine check up. The samples are sent to the laboratory by parents and analysed for vanillylmandelic acid (VMA) and homovanillic acid (HVA). Between January 1991 and December 1995 125,201 infants were screened. The compliance rate was 26.8% for Austria, but great differences were seen for different regions (65% in Carinthia, 10% in Vorarlberg). 30 children were admitted to hospital for investigation of repeatedly elevated urine catecholamines. A neuroblastoma was identified in 16 cases. In 12 of these cases at least one unfavorable prognostic factor was present (stage > or = 3, elevated LDH, unfavorable histology, N-myc amplification, di- or tetraploidy). Neuroblastoma screening of infants aged more than six months seems to detect predominantly those tumors which are unlikely to regress spontaneously. The observation of one false negative case, however, demonstrates that neuroblastomas which become clinically manifest at a later date may remain undetected by early screening. Possible advantages of shifting screening to a later age and repeated screening are discussed.

Austria↗
PubMed1996

Gastroenterology workforce modeling.

OBJECTIVE: To examine the current supply and distribution of gastroenterologists and project future supply under various scenarios to provide a paradigm for workforce reform. DESIGN: An analysis of current practices and distribution of gastroenterologists and a demographic model, using the 1992 gastroenterology workforce as a baseline. MAIN OUTCOME MEASURE: Comparison of current supply, distribution, and practice profiles with past data and future projections, using analyses of data from the 1993 Area Resource File, 1992 Medicare Part B file, age- and sex-specific death and retirement rates from the Bureau of Health Professions, managed care staffing patterns, the National Survey of Internal Medicine Manpower, and the Bureau of the Census. RESULTS: Rapid growth in the number of US gastroenterologists has resulted in a gastroenterologist-to-population ratio double that used on average by health maintenance organizations. In addition, the work profile of gastroenterologists is shared significantly by primary care physicians and other specialists, with the exception of a few specific and uncommon procedures. CONCLUSIONS: Empirical evidence suggests that, even in the absence of detailed models to describe the desired supply/need balance for gastroenterology, the US health care system and clinicians may benefit from a reduction in gastroenterology training programs. The Gastroenterology Leadership Council endorsed a goal of 25% to 50% reduction in trainee numbers over 5 years, and recent National Resident Matching Program data indicate that a voluntary downsizing process is in full force. This study illustrates a paradigm for workforce planning that could be useful for other medical specialties.

Demography↗
PubMed1997

Cost-effectiveness of chemoprophylaxis after occupational exposure to HIV.

OBJECTIVES: To assess the economic efficiency of recent US Public Health Service recommendations for chemoprophylaxis with a combination of antiretroviral drugs following high-risk occupational exposure to human immunodeficiency virus (HIV). To provide a framework for evaluating the relative effectiveness and costs associated with candidate postexposure prophylaxis (PEP) regimens. METHODS: Standard techniques of cost-effectiveness and cost-utility analysis were used. The analysis compares the costs and consequences of a hypothetical, voluntary combination-drug PEP program consisting of counseling for all HIV-exposed health care workers, followed by chemoprophylaxis for those who elect it vs an alternative in which PEP is not offered. A societal perspective was adopted and a 5% discount rate was used. Hospital costs of recommended treatment regimens (zidovudine alone or in combination with lamivudine and indinavir) were used, following the dosing schedules recommended by the US Public Health Service. Estimates of lifetime treatment costs for HIV and acquired immunodeficiency syndrome were obtained from the literature. Because the effectiveness of combination PEP has not been established, the effectiveness of zidovudine PEP was used in the base-case analyses. MAIN OUTCOME MEASURES: Net PEP program costs, number of HIV infections averted, cost per HIV infection averted, and cost-utility ratio (net cost per discounted quality-adjusted life-year saved) for zidovudine, lamivudine, and indinavir combination PEP. Lower bounds on the effectiveness required for combination regimens to be considered incrementally cost saving, relative to zidovudine PEP alone, were calculated. Multiple sensitivity and threshold analyses were performed to assess the impact of uncertainty in key parameters. RESULTS: Under base-case assumptions, the net cost of a combination PEP program for a hypothetical cohort of 10,000 HIV-exposed health care workers is about $4.8 million. Nearly 18 HIV infections are prevented. The net cost per averted infection is just less than $400,000, which exceeds estimated lifetime HIV and acquired immunodeficiency syndrome treatment costs. Although combination PEP is not cost saving, the cost-utility ratio (about $37,000 per quality-adjusted life-year in the base case) is within the range conventionally considered cost-effective, provided that chemoprophylaxis is delivered in accordance with Public Health Service guidelines. Small incremental improvements in the effectiveness of PEP are associated with large overall societal savings. CONCLUSIONS: Under most reasonable assumptions, chemoprophylaxis with zidovudine, lamivudine, and indinavir following moderate- to high-risk occupational exposures is cost-effective for society. If combination PEP is minimally more effective than zidovudine PEP, then the added expense of including lamivudine and indinavir in the drug regimen is clearly justified.

Adult↗
PubMedDate not supplied

[Attitudes and behavior of pregnant women towards HIV screening in Abidjan (Ivory Coast) in 1995 and 1996].

A research program into ways of reducing the maternal transmission of HIV (Project DITRAME, trial ANRS 049) was started in December 1994 in the maternity and child health clinics of the University Hospital and a community health center (Formation Sanitaire de Yopougon, FSU) in Abidjan. The first stage of this program was the introduction of voluntary HIV testing for pregnant women. During their first visit to the maternity clinic, all women were asked their age, how long they had been pregnant and where they were planning to give birth. Women over the age of 18, less than 32 weeks into gestation, who were planning to give birth in Abidjan were routinely offered an HIV test. Women who gave written consent to the test then gave a blood sample for HIV testing. Those testing positive for HIV were given posttest counseling and were invited to participate in a clinical trial of AZT. There were high rates of refusal to be tested and failure to return for posttest counseling during the first year of voluntary HIV testing. We therefore carried out a qualitative study of the reasons for refusal and failing to return. The study involved in-depth interviews with 50 pregnant women who refused to be tested and 50 others who missed the posttest appointment. Most of the women who refused to be tested thought they were probably HIV-positive. The main reason for refusing the test was the fear that the disease process would accelerate once they were informed of their HIV infection. Many women were also afraid of the reactions of their relatives, and particularly of their husband or partner, to a positive test result. There was also concern about possible breaches of confidentiality. Some women felt that pregnancy was not the best time to find out that they were HIV-positive. The reasons for not returning after testing were essentially the same, although some women were confused about the date of the appointment or did not understand the difference between standard prenatal blood test and HIV testing. Our study shows that even when most pregnant women accept the test, there are persistent problems. Some relate to the perception of HIV infection in Africa as "the disease" that cannot be cured, resulting in the view that there is no point in knowing that you are infected. Refusal to be tested is also associated with the socioeconomic vulnerability of women and their fear of exclusion. Means of reducing the maternal transmission of HIV will shortly become available in developing countries. Therefore, we need to address this problem and make voluntary HIV testing for pregnant women as widely available as possible.

Adult↗
PubMed1998

Effect of agonist load on fastest muscle contractions in human elbow flexors.

The purpose of this study was to investigate whether the central nervous system (CNS) motor program subserving most-rapid voluntary force pulse generation is modified according to the level of agonist muscle load maintained prior to the pulse. Five normal subjects produced most-rapid force pulses to a target of 20% maximum voluntary force (MVF) above different levels of steady tonic contraction. Time to reach peak force, the first agonist burst duration and area were relatively constant for loads up to approximately 40% of MVF and then increased substantially with larger loads. These results indicate that the CNS adjusts agonist burst amplitude and duration in order to accomplish the same rapid motor task depending on the load. It is argued that these adjustments are necessary to compensate for physiological limitations of motor unit behavior and non-linearity between EMG activity and phasic force output.

Adult↗
PubMed1995

Extramural fellowship program--the Oregon model.

Surveys of recent dental graduates indicated they were not ready for solo private practice immediately after completing their formal dental education. After assessment of the regional external and internal environment, the School of Dentistry, Oregon Health Sciences University established a voluntary one-year extramural fellowship program in a non-traditional setting. The program requires the fellow to spend 80% of his or her time in a general dentistry office and 20% in a public service setting. The preceptor dentists pay a stipend competitive with other residency programs. The advantages of this transition year are: 1) the fellow further develops technical and diagnostic skills and confidence in a general dentistry setting; 2) the fellow receives first-hand experience about the many business decisions made when running a successful dental office; and 3) the preceptor dentist has the opportunity to teach a fellow eager to learn, who could become an associate in the practice after completion of the program.

Clinical Competence↗
PubMed1990

Pharmacy-coordinated program that encourages physician reporting of adverse drug reactions.

A pharmacy-coordinated program for encouraging physician reporting of adverse drug reactions (ADRs) is described. The ADR surveillance program at the Medical Center Hospital of Vermont, a 500-bed tertiary-care hospital, is in its fifth year. Key elements are close interaction between physicians and pharmacists, feedback, program promotion, and financial incentive. The program is promoted chiefly to house staff physicians. A physician may identify a suspected ADR, or he or she may be alerted by a pharmacist. The physician completes the first part of a form, which requests information on the patient, the severity of the reaction, the actions taken, and any predisposing factors. A pharmacist reviews the incident independently and in consultation with the reporter and then completes the second part of the form, which asks the pharmacists to assess the probability that the drug caused the ADR and to classify the reaction. A summary is sent to the physician and may be reported to the FDA and the manufacturer. Each report earns the reporter a $5 stipend. Information from the ADR forms is entered into a dBASEIII PLUS computer program for later retrieval and analysis. During a 12-month period, 175 ADR reports (out of a total of 249 reports) were received from house staff members, compared with about 4 voluntary reports received annually before the program began. The ADR surveillance program has increased physician reporting of ADRs and produced a reliable database that can be used to influence hospital policy and promote education.

Drug-Related Side Effects and Adverse Reactions↗