Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Voluntary Programs”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,711 records · Page 95Linked to original sources
PubMed1998

Weight loss patterns and success rates in high school wrestlers.

PURPOSE: The purposes were to: 1) examine the weight loss patterns in a group of high school varsity wrestlers whose teams participated in a body composition measurement@nutrition education program, and 2) test the hypothesis that wrestling at a weight below recommended Minimum Wrestling Weight (MWW) results in decreased wrestling success. METHODS: We measured skinfold thickness in 465 wrestlers at 16 schools and, using the Lohman method, determined their percent body fat. An educational program presented at each school explained the results, provided nutritional information regarding proper diet and methods of weight loss, and suggested a voluntary MWW corresponding to 5% body fat. After excluding the heavyweight wrestlers, there were 159 varsity wrestlers. At the end of the season, we noted their weight class and whether they placed in post-season state championship qualifying tournaments. RESULTS: We found that 53 wrestlers (33%) wrestled below MWW. When analyzed by school, wrestlers' non-adherence to MWW ranged from 0% to 56% of all wrestlers. In the lightest four weight classes, 62% wrestled below MWW; in the middle four classes, 29%; and in the heaviest four classes, 6%. Of the 53 wrestlers below MWW, 57% placed and of the 106 above MWW, 33% placed (P < 0.01). CONCLUSIONS: These results show that a substantial number of wrestlers who participate in a voluntary body fat measurement and diet education program wrestle below recommended MWW. This is particularly true at lower weight classes. Further, wrestling below MWW was associated with greater wrestling success. The current concept of MWW should not be based on wrestling performance effects.

Adolescent↗
PubMed2001

An evaluation of Choose to Move 1999: an American Heart Association physical activity program for women.

BACKGROUND: Rates of physical inactivity and poor nutrition, which are 2 of the most important modifiable risk factors for cardiovascular disease in women, are substantial. Even so, studies of interventions designed to improve lifestyle behaviors in women have been limited and often confined to particular geographical areas. OBJECTIVE: To evaluate the effect of Choose to Move on increasing women's physical activity, improving their knowledge of heart disease and stroke, and improving their nutrition. PARTICIPANTS AND METHODS: A prospective, nonrandomized, 12-week educational intervention designed by the American Heart Association for women across the United States. Participants received a welcome kit and manual with weekly information about how to manage cardiovascular disease risk factors and how to build a support system for lifestyle change. Women (N = 23 171) aged 25 years or older were recruited by direct mail, the media, health care providers, and other means. Follow-up evaluations were returned from 6389 women at 2 weeks, 5338 at 4 weeks, 4209 at 8 weeks, 3916 at 10 weeks, and 3775 at 12 weeks. Participants self-reported their physical activity, diet, and knowledge about heart disease, stroke, and related symptoms. RESULTS: Ninety percent of the participants were white and 56% were aged between 35 and 54 years. Among the participants who completed the week 12 follow-up evaluation, the percentage who reported being active (at least moderate exercise > or =5 times per week or >2(1/2) hours per week for the past 1 to 6 months) increased from 32% at baseline to 67% at the program's end (P =.001). Participants currently limiting excess calories or fat increased from 72% to 91% at week 10 follow-up evaluation (P =.001). The proportion correctly identifying heart disease as the leading cause of death increased from 84% to 91% at week 10 follow-up evaluation (P<.001). CONCLUSIONS: Women who completed the Choose to Move program evaluation reported that they significantly increased their levels of physical activity, reduced their consumption of high-fat foods, and increased their knowledge and awareness of cardiovascular disease risk and its symptoms. This program provides an important model for public health, voluntary, and other health organizations of population-based, targeted low-cost self-help programs that support the Healthy People 2010 objectives for physical activity, nutrition, and cardiovascular health.

Adult↗
PubMed1994

The measurement of community benefit: issues, options, and questions for further research.

Community benefit from a conceptual perspective can be traced to the philanthropic and humanitarian spirit that dominated the earliest foundations of the hospital as a social institution. However, the measurement of community benefit is a recent development and one rarely addressed in the literature in any detail. This article outlines the various concepts integral to community benefit measurement that must be taken into account for a program to demonstrate community accountability in an era where hospitals and health care institutions are increasingly required to evaluate and document their value to society. The perspective taken is that of a practicing health care executive. The use of the discussed concepts will assist health care executives and their staff in designing and evaluating programs, and will also assist academics in preparing students for this important professional responsibility.

Community Health Services↗
PubMed1989

What do we really know about AIDS control?

For the near term, control of the AIDS epidemic depends entirely upon altering the human behavior which results in HIV transmission. How best to achieve the required changes has been controversial with approaches ranging from education/information only, to a vast array of largely unproven voluntary behavior modification techniques, to mandatory testing and restrictive measures. Given the complexity of human behavior and the reality of a still uncontrolled epidemic, at least among poor urban drug using minorities, there is a legitimate role for most approaches and any promising behavior modification strategy deserves evaluation. However, because voluntarism will not work for some individuals, society still must choose between effective public health law--including restrictive measures--now, and a much larger reservoir of HIV infection and more deaths from AIDS for many generations to come.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Partner notification in the control of human immunodeficiency virus infection.

Partner notification should be standard public health practice in the control of human immunodeficiency virus (HIV) infection. A universal partner notification program for the United States is affordable, operationally manageable, and can effectively reach high-risk persons. Such a focused approach personalizes the epidemic and probably enhances the efficacy of risk reduction messages. Confidentiality protections are attainable. Voluntary partner notification is acceptable to our constituents; while counseling is "mandatory," testing is optional. Evidence of partner notification's usefulness as a case prevention tool should be a by-product of program outcomes and not a prerequisite for its implementation.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Savings opportunities through Medicaid disease management.

In their attempts to control spending in Medicaid, a few states have looked beyond the obvious reductions in reimbursement, tightened eligibility requirements, and institution of copays to disease management outsourcing. While the traditional panoply of cutbacks will save money the year they are instituted, they tend to have trade-offs. Reducing reimbursement, for example, may encourage providers to leave the program. As a result, several states are implementing outsourced medical management programs, which together at maturity will, as shown below, noticeably reduce Medicaid spending by improving the way health care is delivered. These purely voluntary, quality-enhancing outsourced medical management programs are also fully guaranteed by a wide variety of vendors to save money starting in the first year they are implemented.

Child Health Services↗
PubMed1989

HIV antibody testing: who benefits and who loses?

From a public health perspective, a significant milestone in the AIDS crisis so far has been the development of serologic tests to detect exposure to the HIV. With AIDS now reported in more than 124 countries and in every state of the Union, with the possibility that in excess of two million Americans have been infected and in the absence of a cure or vaccine, the issue of testing cannot be ignored anymore. Unfortunately, the testing debate has generated more heat than light. This paper examines the proposed "benefit" to public health in testing certain target groups deemed "at risk", and also discusses socio-ethical implications of such testing. The whole question of HIV antibody testing essentially raises the need for a balance between voluntary and mandatory testing; and society's commitment to protect public health as well as safeguard individual civil rights.

AIDS Serodiagnosis↗
PubMed1982

Mandatory PKU screening: the other side of the looking glass.

The challenge that PKU screening programs face is to be effective without sacrificing individual liberty. Most states have assumed that this is impossible, and have enacted mandatory PKU screening tests. It now appears that in fact voluntary screening for PKU can be effective. Accordingly, it seems appropriate to reexamine existing mandatory screening statutes to determine if we can replace government coercion with voluntary informed consent. Focus should be placed on the proper role of the government in screening, and on improving the consent process, and not on those few couples who withhold consent.

Genetic Testing↗
PubMed2003

Multimodal intervention raises smoking cessation rate during pregnancy.

BACKGROUND: The aim was to study the effect of a multimodal smoking cessation intervention regimen on a number of pregnant smokers. METHODS: A prospective intervention study was designed where participants were allocated to intervention or control based on their birth date. The study included 647 pregnant smokers. The intervention group (n = 327) received initial individual smoking cessation counseling supplemented by an invitation to join, individually or in a group, a smoking cessation program with nicotine replacement therapy as a voluntary option. Intervention was designed as an integral part of the midwives' prenatal care. All pregnant smokers in the usual care group (n = 320) received standard counseling from a midwife. Outcome was self-reported smoking cessation in the 37th week of pregnancy and the reported cessation was validated by cotinine saliva concentration. RESULTS: Self-reported cessation rates during pregnancy were significantly higher in the intervention group (14%) than in the group receiving usual care (5.0%) (p < 0.0001) (Fisher's exact test). Cotinine-validated cessation rates during pregnancy were significantly higher among the former (7%) than the latter (2%) (p = 0.003). The adjusted odds ratio (OR) for smoking cessation was 4.20 (95% CI 2.13-8.03). Logistic regression analysis showed a significant positive association of smoking cessation with low caffeine consumption in pregnancy, many years in school, no exposure to passive smoking outside the home, and previous attempts to stop smoking. CONCLUSIONS: A multimodal intervention regimen with initial individual counseling supplemented by an invitation to join a smoking cessation program with nicotine replacement therapy as a voluntary option markedly increased cessation rates during pregnancy.

Adult↗
PubMedDate not supplied

Developing a community program on cancer pain and fatigue.

PURPOSE: The overall purpose of this project was to establish a community-based educational model on pain and fatigue management for individuals with cancer. The specific aims were: 1) to develop an appropriate educational program; 2) to pilot test this program in a community setting that supported a self-care approach; and 3) to evaluate the program process and outcomes. DESCRIPTION OF PROGRAM: The I Feel Better program was implemented through a two-session educational workshop taught by masters-prepared oncology nurses and was held at four Southern California sites of The Wellness Community. The focus of the sessions was to provide participants with general information about each symptom, assessment and management of those symptoms, and strategies for effectively communicating with their healthcare providers. Sessions of 2.5-hour duration were held on Saturday mornings and required preregistration. RESULTS: The participants were primarily female and White, with an average age of 58 years. Participants reported considerable pain and fatigue. They also lacked accurate information about pain management. Program evaluation revealed that the content and format were well received by the participants. They rated the program as extremely useful and reported positive outcomes after the first session. CLINICAL IMPLICATIONS: This pilot educational intervention program has strong implications for multidisciplinary educational approaches for patients with cancer. Limitations resulted from the setting selected and the possibility that participants were already active in their fight against cancer. Generalization to other community settings may not be as successful. Programs could be cosponsored by several collaborating institutions to share resources. Referral to community programs by physicians, nurses, and social workers can occur as needed when identified during patient interventions. The voluntary participation of health professionals in community education programs could provide a valuable service for patients and a rewarding experience for educators.

Adult↗
PubMedDate not supplied

The American College of Nurse-Midwives' dream becomes reality: The Division of Accreditation.

Recognized continuously by the US Department of Education since 1982 as a specialized accrediting agency, the American College of Nurse-Midwives' Division of Accreditation (DOA) accredits not only nurse-midwifery education programs at the postbaccalaureate or higher academic level as certificate and graduate programs for registered nurses (RNs), but also precertification programs for professional midwives from other countries who are licensed as RNs in the United States. The DOA also accredits midwifery education programs for non-nurses at the postbaccalaureate or higher academic level as certificate and graduate programs, and precertification programs for professional midwives from other countries. The accreditation process is a voluntary activity involving both nurse-midwifery and/or midwifery education programs and the DOA. Present plans include another expansion of recognition: to become an institutional accreditation agency for independent and proprietary schools and to continue as a programmatic accrediting agency. Since its inception, the accreditation process has been viewed as a positive development in nurse-midwifery education.

Accreditation↗
PubMed2001

Detection of acetylcodeine in urine as an indicator of illicit heroin use: method validation and results of a pilot study.

BACKGROUND: Acetylcodeine (AC), an impurity of illicit heroin synthesis, has been suggested as an interesting biomarker of illicit heroin use. METHODS: Procedures were developed for quantification of (a) morphine, 6-monoacetylmorphine (6-AM), and codeine in urine and (b) diacetylmorphine and AC in urine. Solid-phase extraction of the analytes was performed, and the extracted analytes were analyzed by selected-ion monitoring with gas chromatography-mass spectrometry. This procedure required prior derivatization with propionic anhydride. RESULTS: Different validation parameters were determined, such as linearity, reproducibility, extraction recoveries, and cutoffs. Seventy-one urine specimens of illicit heroin abusers and 44 urine specimens of subjects in a heroin maintenance program were analyzed. AC was detected in 85.9% of the samples of the first group but not in any of the samples from subjects taking medical heroin. In the two groups, there were 94.4% and 84.1% 6-AM positive urine specimens, respectively. Detection times were determined for AC and codeine by parallel administration of heroin containing various percentages of AC to four voluntary patients in a heroin maintenance program. The measured detection times were 8 and 23 h for AC and codeine, respectively. CONCLUSIONS: These results indicate that, together with detection of 6-AM in urine, AC is a suitable marker of illicit heroin use.

Biomarkers↗
PubMed2004

HIV infection and zidovudine use in childbearing women.

OBJECTIVE: The risk of vertical HIV transmission from mother to child has been shown to be markedly decreased through HIV education, counseling, testing, and zidovudine (ZDV) use. The US Public Health Service published guidelines in 1994 for the use of ZDV on the basis of results of the AIDS Clinical Trials Group Protocol, a multicenter clinical trial of ZDV. The Public Health Service followed these guidelines with recommendations for routine HIV counseling and testing with informed consent for all pregnant women. New Jersey adopted these guidelines as the standard of care and created a program implementing the standard in all hospitals with maternity units. The purpose of this report was to study the trends in the rate of HIV infection in childbearing women over the past decade and to follow patterns of use of ZDV in the HIV-positive women, as a marker for the success of New Jersey's policy and program to reduce mother-to-child transmission. METHODS: Since 1988 in New Jersey, blood from heel-stick filter papers has been tested for the presence of HIV antibody through anonymous, unlinked surveys. Excess blood from screening for inborn errors of metabolism for all infants who were born in the state from July through September of each year was tested using a Food and Drug Administration-approved HIV-1 and Western blot test. Age, race, and ethnicity were recorded, as well as the results from the HIV-1 and Western blot tests. Since 1994, specimens confirmed to be HIV-1 positive by Western blot test were tested for the presence of ZDV, and the results were recorded. RESULTS: The number of New Jersey women included in the study for the period 1990 through 2002 numbered 372305. The percentage of childbearing women who tested positive for HIV declined by 55% during the period, although the declines were not uniform in all subgroups. In the early 1990s, women who were <30 years old had higher infection rates than older women, but this has not been a consistent pattern during the period. Younger women again had a higher rate in 2002. When HIV-positive rates are examined by 5-year age groups, the declines are dramatic for younger women. The rate per 100 women 20 through 24 years decreased from 0.46 per 100 tested women in 1990 to 0.29 in 2002 and for women 25 through 29 years from 0.51 per 100 in 1990 to 0.25 in 2002. The rate for women 30 through 34 years of age declined from 0.54 in 1990 to 0.13 in 2002. During the same time period, the rate per 100 tested women 35 though 39 years of age increased from 0.23 to 0.33. Black non-Hispanic women who give birth to live infants have the highest HIV-positive rates, followed by Hispanic women and white non-Hispanic women. In 2002, this rate was 0.74 per 100 in black non-Hispanic women, 0.22 per 100 in Hispanic women, and 0.08 in white non-Hispanic women. Although major disparities continue, the infection rate in black non-Hispanic women demonstrated the greatest decrease during the period, followed by the decline among Hispanic women. The use of ZDV in HIV-positive women increased dramatically during the period, from 13.3% in 1994, when it was first tested in New Jersey, to an all-time high of 88.5% in 2002. CONCLUSIONS: Reducing perinatal HIV transmission is a priority for the New Jersey Department of Health and Senior Services. Reducing perinatal transmission can be accomplished by reducing the number of infants who are exposed perinatally or decreasing the percentage of exposed infants for whom transmission occurs or both. The decrease in prevalence of HIV-positive status in childbearing women is in opposition to an overall increasing trend in prevalence rates. This decrease is thought to be attributable in part to the positive impact of numerous education and prevention programs but may also be the result of a voluntary decision on the part of HIV-infected women not to become pregnant or not to carry to term. In addition, the cohort of women who became infected in the early years of the epidemic may be aging out of their childbearing years, may have more advanced disease with a concomitant difficulty with fertility and carrying to term, or may have died. In New Jersey, a greater proportion of women with newly diagnosed HIV disease are past their childbearing years as compared with earlier years. Increased use of ZDV is thought to be attributable to several factors: dissemination of information to health care providers via continuing medical education activities; dissemination of information to the public, in particular to women; outreach via community-based organizations; and New Jersey Department of Health and Senior Service regulations and policies for mandatory counseling and voluntary testing of all pregnant women. A recent addition to New Jersey's comprehensive program to decrease perinatal transmission occurred in 2002 with dissemination to hospitals of the department's standard of care for women who present in labor with unknown HIV status. Physicians, nurses, and hospitals play vital roles in preventing vertical transmission of HIV by providing preconception and postconception counseling, testing with consent of pregnant women, and treatment for HIV-positive mothers, including administration of ZDV. This study not only provides an estimate of the prevalence of HIV infection in the population of childbearing women but also provides a means of examining the vertical transmission of HIV infection from mother to child. Continued research on this subpopulation as well as on other groups will provide additional knowledge to help in the overall goal of reducing HIV prevalence.

Adult↗
PubMed1965

Old age income security in Canada.

The position of older people in modern industrial society is markedly removed from the early industrial norm of continued participation in gainful employment until the end of life. Acceptance of a retirement age some 13 years before the end of average male life expectancy has brought with it serious social problems. At the same time, however, an increasingly productive economy has provided both the willingness and ability to complement the retirement provisions of individual initiative with public programs of old age income maintenance. This public support began in Canada with the voluntary approach embodied in the government annuities plan. A program of "public assistance" followed. These were succeeded, first, by the "universal payment" under the Old Age Security Act and, more recently, by the social insurance approach of the Canada Pension Plan. Along with improved public support, the role of occupational pension plans and of individually initiated retirement provisions continues to be substantial. Current interest in, and in some cases legislation on, such problems as vesting and solvency are leading to improvements in private pension programs.

Aged↗
PubMedDate not supplied

The argument for HIV-antibody testing in chemical dependence treatment programs.

Controversy surrounds the issue of human immunodeficiency virus (HIV) antibody testing in chemically dependent patients. However, HIV testing can be clinically and therapeutically useful in chemical dependence treatment programs. Prerequisites for HIV testing include: staff education, high-quality pre- and posttest counseling for patients, assurance of confidentiality of results, and the use of accurate screening and confirmatory tests. Reasons to offer voluntary HIV testing in chemical dependence treatment programs include: appropriate medical evaluation and treatment, prevention of the spread of HIV infection, and support for working through the crisis of a positive diagnosis. Voluntary informed consent should be obtained prior to HIV testing; involuntary testing and mass screening are not justified. Testing decisions should be individualized, with the focus on the patient's participation based on treatment- and health-related decisions.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Incidence and determinants of hepatitis C virus infection among individuals at risk of sexually transmitted diseases attending a human immunodeficiency virus type 1 testing program.

BACKGROUND: The role of sexual transmission of hepatitis C virus (HCV) infection is still not completely understood, partly because of the lack of longitudinal studies among cohorts of HCV-negative individuals who engage in at-risk sexual behavior. GOALS: To evaluate the incidence of HCV infection in a population at risk for human immunodeficiency virus type 1 (HIV-1) infection and other sexually transmitted diseases (STD) and to identify factors associated with HCV seroconversion. STUDY DESIGN: A retrospective longitudinal study was carried out on a cohort of consecutive attendees of a voluntary HIV-1 testing and counseling program in a large STD center in Rome. All individuals undergoing at least two consecutive tests for HCV antibodies were enrolled. Clinical data and information on individual behavior were collected for all study participants. RESULTS: Between June, 1992 and December, 1994, a total of 709 individuals (12 intravenous drug users [IDU], 244 homosexuals, and 453 heterosexual non-IDUs), initially negative for HCV antibody, were tested more than once. Among these individuals, 15 HCV seroconversions occurred. The average follow-up time was 1.25 person/years (p/y) for an incidence rate of 1.69 per 100 p/y. The incidence rates by exposure category were 39.30 per 100 p/y among IDUs, 1.37 per 100 p/y among homosexual men, and 0.97 per 100 p/y among heterosexual non-IDUs. Excluding IDUs, of the 697 STD clinic attendees engaging in at-risk sexual behavior, HIV-1-positive status tended to be associated with HCV seroconversion (relative hazard = 5.48; 95% confidence interval = 0.85-35.40). The HCV crude incidence rates among HIV-1-infected patients at enrollment was 11.5%, 4.2%, and 2.4% in those with severe, moderate, and mild levels of immunosuppression, respectively (chi-square for trend = 2.38, P = 0.1). CONCLUSIONS: In this cohort, HCV infection was confirmed to be strongly associated with intravenous drug use. Nonetheless, the occurrence of two thirds of the total HCV seroconversions in non-IDU individuals engaging in at-risk behavior suggests a role of sexual practices in the transmission of the infection. Among non-IDU individuals, the risk for development of HCV infection tended to increase in those who were HIV-1 infected.

Adolescent↗