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At least 1,747 records · Page 97Linked to original sources
PubMed1996

Clients' evaluation of health care services in a battered women's shelter.

There is a dearth of evaluation research regarding shelter health care. Health needs outweigh health services which are rarities within shelter settings (Gross & Rosenberg, 1987). The purposes of this article are to review the need for shelter health care, describe how shelter-based advanced practice nurses (APNs) addressed health care needs and program goals in one shelter setting, and report findings from an impact evaluation study where APN services were rated by shelter clients (n = 69) for themselves and their children (n = 95). APNs have the ability to manage health care in shelter settings, but need to seek creative funding by documenting their worth. A 21-item evaluation survey was designed to measure components of health assessment and education provided to clients by APNs. Content and construct validity were addressed by a statistician and nursing experts, and the internal consistency reliability coefficient (Cronbach's alpha) was measured at .91. Results showed that clients (96.1%) identified strongly positive responses to health services provided with some weak areas detected. Implications include the need to continue programs that serve vulnerable populations in times of cutbacks. Measuring program effects via impact evaluation is recommended for services in process to monitor quality and to give impetus to funding opportunities.

Adolescent↗
PubMed1987

Pneumococcal bacteremia. Update from an adult hospital with a high rate of nosocomial cases.

Eighty-nine episodes of pneumococcal bacteremia were reviewed over a 66-month period at a Veterans Administration Medical Center. Forty-one percent of these episodes were nosocomial in origin, and 59% of the patients were elderly (60 years of age or older). Nosocomial infection occurred more often in the elderly (55%) compared to those less than 60 years of age (32%; P less than 0.05). Within the elderly group, those older than 75 years of age had a higher rate of nosocomial bacteremia than those 60 to 75 years of age (76 versus 44%; P less than 0.05). The clinical presentation of the elderly and younger groups was not significantly different. All but one patient had serious underlying diseases. Eighty-three percent of the episodes were due to pneumonia, and penicillin alone was prescribed for only 21% of all cases. The mortality rate directly due to the bacteremia was 22%, while the overall mortality during the hospitalization was 47%. In the elderly, the percentage of deaths due to infection was similar to the younger group, but overall mortality during the hospitalization was significantly higher in the elderly (74 versus 26%; P less than 0.01). Physicians showed poor recognition of the significance of pneumococcal disease, as demonstrated by inclusion of the diagnosis of pneumococcal infection or bacteremia in only 27% of the discharge summaries and by predischarge vaccination of only 7% (6 of 82) of those without previous pneumococcal vaccination. In conclusion, the rate of nosocomial pneumococcal bacteremia was high in a predominantly elderly male population; it may be appropriate to consider a hospital-based vaccine program in similar populations.

Age Factors↗
PubMed1993

Occlusal dental caries incidence and implications for sealant programs in a US college student population.

Given the decline in dental caries incidence in preteens and young teenagers in the United States, a study of the incidence of dental caries in young adults (17-23 years) was conducted to provide a descriptive epidemiologic picture of this "new" natural history of dental caries in the late and post-teenage years. A retrospective study was performed analyzing the detailed dental records of the four-year college experience in the class of 1989, US Coast Guard Academy. Occlusal caries incidence, in the absence of associated proximal caries, was shown to be moderately common in molars (11.9%) and rare in premolars (0.8%). In contrast to previous studies' findings, demographic indicators, socioeconomic status indicators, and prior caries experience were poor predictors of occlusal caries incidence; targeting a universal sealant policy in this population therefore would be done best by tooth type rather than patient type. A preliminary cost-comparison model, projected over a 40-month period, suggests that the cost of initiating a universal molar sealant policy in this population would be 92 cents per year per student greater than the cost of restoring occlusal caries in the presence of sound proximal surfaces. This cost comparison suggests that it would be advantageous to initiate such a policy.

Adolescent↗
PubMed1993

Influence of socioeconomic factors on attaining targets for reducing teenage pregnancies.

OBJECTIVE: To determine the rate of pregnancy and outcome in teenagers in areas of different socioeconomic conditions, and to assess the implication for achievement of government and local targets in reducing unwanted pregnancies in teenagers. DESIGN: Records of pregnancies were obtained from hospital discharge files and rates of live and still births and abortions calculated for each postcode sector. Postcodes were grouped by categories of deprivation and by local government district. SETTING: Tayside, Scotland. SUBJECTS: Teenage girls admitted to National Health Service hospitals for delivery or abortion in 1980-90. MAIN OUTCOME MEASURES: Conception in girls aged under 16 by area of residence and relative proportion leading to live births or terminations. Rate of different outcomes in girls under the age of 20 by area of residence. RESULTS: The pregnancy rate in girls aged under 16 was three times as high, and in all girls under 20 six times as high in the most deprived areas as in the most affluent areas. The proportion of teenage pregnancies ending in abortions was higher in the affluent areas, where two out of three ended in abortion compared with one out of four in the deprived areas. CONCLUSIONS: Although there was a higher pregnancy rate in teenagers in more deprived areas, the proportion ending in abortion was greater in more affluent areas, possibly due to social and parental pressure. The wide geographical variation in patterns of teenage pregnancy indicates the need for a small area rather than a regional approach to setting targets and devising measures of achieving them.

Abortion, Legal↗
PubMed2005

HIV/AIDS prevention among the male population: results of a peer education program for taxicab and tricycle drivers in the Philippines.

This study assesses the results of a 2-year community-based peer education program aimed at increasing HIV/AIDS knowledge, attitudes toward condoms, and condom use behavior among taxicab and tricycle drivers in the Philippines. Pretest, posttest, and follow-up data were collected throughout the educational intervention program. The results of the repeated measures analysis of variance (ANOVA) indicate a significant change on knowledge about HIV/AIDS from baseline to posttest and from posttest to follow-up (F=449.27, df=2, p<.001). There was also a significant change on attitudes about condom use from baseline to posttest and from posttest to follow-up (F=425.19, df=2, p=0.001), and a significant effect on condom use behavior with commercial sex workers from baseline to posttest and follow-up (F=428.31, df=2, p=.001). The peer-mediated intervention was found to be an effective means of HIV/AIDS prevention among taxi and tricycle drivers in the Philippines.

Adult↗
PubMedDate not supplied

[Health education for triatomine control in an area under epidemiological surveillance in Paraná State, Brazil].

This paper describes a health education project targeting a rural community and health professionals from counties undergoing epidemiological surveillance for Chagas disease vectors in the State of Paraná, Brazil. A group of technicians from the Brazilian National Health Foundation (FUNASA) was trained, together with teachers, workers, and students from the State University of Maringá, who prepared an instructions manual and drew up guidelines for reporting presence of triatomines or suspected cases of Trypanosoma cruziinfection. From June 1996 through February 2000, the activities reached 742 families, 2,300 schoolchildren, and 27 teachers from 18 elementary schools, and included a meeting between FUNASA members and 40 participants, 21 meetings in health centers, and provision of a set of preserved triatomine specimens for use in vector surveillance and identification. After three years of health education activities and insecticide treatment (cipermetrina 125 mg i.a./m2), there was a reduction of 80.6% in households infested with triatomines and increased awareness among rural residents and health workers. The authors discuss the need to train professionals committed to changing Brazil's prevailing health model.

Animals↗
PubMed2006

[Prevalence of common mental disorders in a population covered by the Family Health Program (QUALIS) in São Paulo, Brazil].

The prevalence of common mental disorders has increased in many countries. Cases are often not identified and adequately treated because traditional health care services are rarely prepared to deal with this problem. The Family Health Program (FHP) has been implemented in Brazil since 1995-1996 and provides a new primary health care model with the potential for better care for these patients. This study investigates common mental disorders prevalence according to FHP coverage and associated socio-demographic factors. A large health and health care survey was conducted from January to March 2001 in areas partly covered by the FHP in a peripheral area of the city of Sao Paulo and included common mental disorders screening in 2,337 individuals > 15 years of age. There was no significant difference in common mental disorders prevalence according to FHP. Common mental disorders prevalence was significantly higher among females (PR = 1.34), elderly (PR = 1.56), and individuals with lower income (PR = 2.64) or less schooling (PR = 2.83). Common mental disorders was associated with indicators of social disadvantage, implying the need to focus on specific health problems and risk groups to improve the impact of care.

Adolescent↗
PubMed2005

[Breast feeding in a population attended by the family health program--FHP].

This study aimed to identify the prevalence of different types of breastfeeding and how they relate to maternal variables in the municipality of Conchas, São Paulo, Brazil, which is fully covered by the family health program. We collected information about the current eating habits of children under one year old who were attended during the 2003 Multivaccination Campaign. Associations were submitted to the chi-square test, adopting p<0.05 as the critical level. The prevalence rates for exclusive breastfeeding (EB) and predominant breastfeeding (PB) in 4-month-olds and younger were 25.4% and 44.4%, respectively, and 66.7% of the children under one were still being breastfed. Prevalence for EB in 6-month-olds and younger was heterogeneous, ranging from 7.4 to 41.2% according to the children's region of origin in the FHP. Difficulties at the beginning of breastfeeding were associated with lower prevalence rates for EB and PB. These results show a situation far from WHO recommendations and from that situation in which there is evidence that children's health receives maximum protection, reiterate the need to support mothers in the early puerperal period and demonstrate the importance of diagnoses separated per regions for actions aimed at promoting breastfeeding.

Breast Feeding↗
PubMed1978

Quantitative care norms for a psychiatric ambulatory population in a county medical assistance program.

An approach for developing quantitative care norms for outpatient acute psychiatric patients is presented. Both the methodological concept of the norming procedure and its application to the needs of Medicaid in Rockland County, New York are given. The methodology is totally general in that it could be applied to concerns related to characterization of services rendered in a wide variety of applications ranging from planning to utilization review. The norms developed relate both to monthly quantity of services rendered and length of active treatment period. Further, the impact of a review rule is discussed in terms of its implication to number of cases reviewed.

Adolescent↗
PubMed1999

Immunisation coverage in Australian children: a systematic review 1990-1998.

The Australian Childhood Immunisation Register (ACIR) commenced operation in January 1996 and provides a comprehensive database of children's immunisations in Australia. The ACIR enables implementation of an immunisation recall and reminder system and improved surveillance and reporting of immunisation coverage. Before the introduction of the ACIR, the methods used in assessing coverage varied widely in design and quality, with few studies measuring coverage at national or statewide level. This is a systematic review of the scope and reliability of estimates of immunisation coverage available in Australia from 1990 to 1998. A total of 108 studies were identified of which 51 were classified as higher quality based on a range of criteria including whether they had a response rate of 50% or better.

Adolescent↗
PubMed1995

Patterns of Breast Cancer Treatment: A Comparison of a Rural Population With an Urban Population and a Community Clinical Oncology Program Sample.

This Illinois study shows that rural patients who were postmenopausal and node negative were more likely than urban patients to have a modified radical mastectomy (P=.03) and less likely to have had an oncology consultation (P=.01). Postmenopausal rural patients with positive nodes were more likely than comparable CCOP patients to receive radiation therapy (P=.0001), regardless of surgical choice, and were less likely to get hormone therapy than urban patients with an estrogen receptor-positive tumor (P=.007). After adjustment for confounders, rural patients were less likely than those in either comparison group to have limited surgery (odds ratio [OR] = 2.8, 95% confidence interval [CI] 1.4, 5.6 for urban patients, and OR = 2.9, 95% CI 1.5, 5.7 for CCOP patients) and more likely than CCOP patients to undergo radiation (OR = 0.2, 95% CI 0.1, 0.4). These data can be used to assess the impact that dissemination of state-of-the-art treatment strategies has on breast cancer mortality.

Journal Article↗
PubMed2001

[Where do we stand with BCG vaccination programme in Japan?].

The current BCG vaccination program of Japan is critically discussed based on recent knowledge, especially with regard to its epidemiological aspects, in order to put the problem into perspective for Japan's future tuberculosis control program. 1. EFFICACY AND OVERALL EFFECTIVENESS: Various indicators of BCG efficacy have been proposed, and the meticulous analysis on the variability and the quality of these indicators seems to have formed a consensus on the efficacy, as seen in the recent meta-analysis studies. However, much has been left unanswered concerning the conditions under which the efficacy is guaranteed. The impact of the vaccination program on the population should also be considered in order to make decisions on the program. Comparing the age-specific tuberculosis notification rate between Japan and the USA, where there has been no BCG vaccination program, shows that the rate for 0 to 4 year olds is clearly lower in Japan than in the USA, while it is more than five times higher for all ages in Japan than in the USA. The statistics for Japanese children are superior to those of US children with respect to the speed of decline in notification rate as well. These observations support the overall effectiveness of BCG vaccination in Japan. 2. MECHANISMS OF BCG VACCINATION EFFICACY AND ITS DURATION: Two possible mechanisms of how BCG works to prevent tuberculosis were proposed. Epidemiological models based on each mechanism were subsequently tested by simulating 20 years' development of cases in the BCG vaccination trial by BMRC. In mechanism 1, the BCG-induced immunity is assumed to boost TB immunity in inhibiting the clinical breakdown of tuberculosis during the 10 to 15 years after the vaccination. In mechanism 2, the immunity makes the infection process abort (presumably, at 90%, during the seven years after infection, for example), leading to a smaller risk of future clinical development. So far, most epidemiological models implicitly assume mechanism 1 above. In animal experimental models, however, it has been difficult to simulate the mechanisms differentially, which has been one of the drawbacks to this argument. 3. EFFECTIVENESS OF REVACCINATION: Revaccination with BCG vaccine aims to restore or to endow immunological resistance through repeating vaccination to those who have partially or totally lost the immunity acquired from the primary vaccination. Although some animal experiments support the efficacy of revaccination with BCG, studies in humans have been rare and the results are variable. The observation of Polish infants and schoolchildren is suggestive of the efficacy, but it is not randomized and of questionable value. The recent study of Malawi is a randomized trial. It demonstrated that BCG revaccination protects against leprosy, but does not protect significantly against tuberculosis. It is possible, however, that it does protect against tuberculous lymphadenitis. The two above-mentioned possible mechanisms of BCG immunity were applied to a model analysis of BCG revaccination. It was known that revaccination effectiveness is very limited under any assumption, given the current Japanese epidemiological situation of tuberculosis, so that the demerits due to revaccination, such as strong local reactions, must not be neglected but should be carefully considered. At the same time, we should remember that this model analysis assumes that the primary vaccination is given to new borns with advanced and uniform techniques, which is not always true, and revaccination may supplement the technical failure of the primary vaccination. 4. DECIDING ON THE TOTAL DISCONTINUATION OF BCG VACCINATION PROGRAMME, JAPAN: The recommendations of WHO or IUATLD on the discontinuation of the BCG vaccination program are just conventional ones and the theoretical reasonings is difficult to accept. After all, the decision making should depend on the lay decision makers' subjective judgment balancing benefit and loss in terms of costs and health incurred by the policy, as shown by Waaler and Rouillon. The current Japanese BCG vaccination program is very expensive, but brings about some, though very small, benefit. This balance was compared with that of Sweden around 1975, when the program was discontinued. The comparison clearly showed that the cost-effectiveness of the program in Japan today in superior to that of Sweden in 1975.

BCG Vaccine↗
PubMed1975

Family planning services in the United States.

In recent years the United States has made considerable progress in providing family planning services for those in need. This does not mean, however, that the problems posed by unwanted pregnancies and unwanted births have been completely overcome. Estimates of the number of low-income women needing and receiving family planning services indicate that roughly 3.6 million women at risk of an unwanted pregnancy were receiving family planning services in 1973. This represented almost two-thirds of those in need at the time. Many programs are also seeking to meet the teenage need demonstrated by very high rates of out-of-wedlock births, premarital conceptions, obstetric problems, and legal abortion demands of women 15 to 19 years of age. As of 1973, it appeared that between 1.3 and 2.2 million never-married teenagers were in need of organized family planning services, and that of these, services were being received by between 25 and 42 per cent.

Abortion, Legal↗
PubMed1985

[Evaluation problems of anti-natalist policies].

"This study is a brief overview of the main problems hindering the measurement of the impact of family planning programmes on fertility. A brief description of several evaluation methods commonly resorted to is presented. A number of theoretical, conceptual and methodological difficulties pertaining to these methods are then scrutinized. Special attention is devoted to various concepts of potential fertility and...their effect on the measurement of the demographic impact of a programme. Likewise, problems encountered in attempts to disentangle the effect of programme factors from the effects of social change on fertility are also examined. The reliability of the results obtained with these methods is affected by these problems, but these results remain, despite some weaknesses, useful approximations of the demographic impact of anti-natalist population policies." The primary geographical focus is on developing countries. (SUMMARY IN ENG)

Demography↗