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PubMed2004

An evaluation of a "best practices" musculoskeletal injury prevention program in nursing homes.

OBJECTIVE: To conduct an intervention trial of a "best practices" musculoskeletal injury prevention program designed to safely lift physically dependent nursing home residents. DESIGN: A pre-post intervention trial and cost benefit analysis at six nursing homes from January 1995 through December 2000. The intervention was established in January 1998 and injury rates, injury related costs and benefits, and severity are compared for 36 months pre-intervention and 36 months post-intervention. PARTICIPANTS: A dynamic cohort of all nursing staff (n = 1728) in six nursing homes during a six year study period. INTERVENTION: "Best practices" musculoskeletal injury prevention program consisting of mechanical lifts and repositioning aids, a zero lift policy, and employee training on lift usage. MAIN OUTCOME MEASURES: Injury incidence rates, workers' compensation costs, lost work day injury rates, restricted work day rates, and resident assaults on caregivers, annually from January 1995 through December 2000. RESULTS: There was a significant reduction in resident handling injury incidence, workers' compensation costs, and lost workday injuries after the intervention. Adjusted rate ratios were 0.39 (95% confidence interval (CI) 0.29 to 0.55) for workers' compensation claims, 0.54 (95% CI 0.40 to 0.73) for Occupational Safety and Health Administration (OSHA) 200 logs, and 0.65 (95% CI 0.50 to 0.86) for first reports of employee injury. The initial investment of $158 556 for lifting equipment and worker training was recovered in less than three years based on post-intervention savings of $55 000 annually in workers' compensation costs. The rate of post-intervention assaults on caregivers during resident transfers was down 72%, 50%, and 30% based on workers' compensation, OSHA, and first reports of injury data, respectively. CONCLUSIONS: The "best practices" prevention program significantly reduced injuries for full time and part time nurses in all age groups, all lengths of experience in all study sites.

Adult↗
PubMed1994

J.B. Wolffe Memorial Lecture. Health consequences of physical activity: understanding and challenges regarding dose-response.

The Guidelines for Exercise Training initially developed by the American College of Sports Medicine in 1978 and updated in 1990 have served as the foundation for most recommendations regarding physical activity program design for the general public. These guidelines have proven to be very useful by providing a specific regimen for enhancing aerobic capacity and body composition. As data supporting a causal link between increased activity or fitness and health status have evolved, questions have been raised about potential limitations of these guidelines for promoting physical activity to increase the health status of sedentary adults. The major issues have involved the necessity to achieve the values for each of the program parameters, especially the intensity, duration, and frequency of exercise, in order to improve health status. To address these issues, a paradigm shift from exercise training to promote physical fitness to physical activity to promote health has been introduced. This new paradigm is based on the results from numerous studies indicating that a generally active life style is associated with better health and performance and greater longevity and a certain set of assumptions, yet to be fully tested. The following article provides some background leading to the development of the ACSM guidelines and presents some of those issues we understand and some we do not regarding the characteristics of daily physical activity or exercise training that are likely to improve the physical health status of sedentary persons.

Chronic Disease↗
PubMed2006

Effects of a therapeutic riding program on at-risk and special education children.

OBJECTIVE: To determine the effects of a therapeutic riding program on psychosocial measurements among children considered at risk for poor performance or failure in school or life and among children in special education programs. DESIGN: Observational study. POPULATION: 17 at-risk children (6 boys and 11 girls) and 14 special education children (7 boys and 7 girls). PROCEDURE: For the at-risk children, anger, anxiety, perceived self-competence, and physical coordination were assessed. For the special education children, anger and cheerfulness were measured, and the children's and their mothers' perceptions of the children's behavior were assessed. Measurements were made before and after an 8-session therapeutic riding program. RESULTS: For boys enrolled in the special education program, anger was significantly decreased after completion of the riding program. The boys' mothers also perceived significant improvements in their children's behavior after completion of the program. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that an 8-session therapeutic riding program can significantly decrease anger in adolescent boys in a special education program and positively affect their mothers' perception of the boys' behavior.

Adolescent↗
PubMed2001

Deep water running: an effective non-weightbearing exercise for the maintenance of land-based running performance.

Deep water running (DWR) has become a well-recognized from of cardiovascular conditioning for injured athletes and has been used successfully to maintain running performance. DWR provides for decreased stress and weightbearing to injured tissue and joints, allows for maintenance of cardiovascular fitness and a training effect, and offers greater specificity of exercise in relation to running. During a 22-month period, 181 active duty Army soldiers, placed on temporary profiles for injuries that precluded them from their regular weightbearing physical fitness activities, participated in a DWR program. Injuries to the back, knee, and ankle were the most common reasons for referral to the program. This article reviews the physiological characteristics of DWR, specifics of DWR program design, DWR mechanics, and the advantages of DWR over other aerobic forms of exercise to maintain land running performance in military personnel on temporary non-weightbearing profiles.

Adolescent↗
PubMed2003

Developing rural information and assistance programs.

Older people living in rural areas face unique challenges, not only in accessing benefits and services, but also in gathering information about programs that can help them. In this brief, we tackle the issue of information and assistance (I&A) in rural areas by profiling an area agency on aging that has successfully established an I&A program designed to meet the needs of rural elders. We offer tips from the agency's experience and insight from experts in the field.

Aged↗
PubMed1999

The EARLY ALLIANCE prevention trial: an integrated set of interventions to promote competence and reduce risk for conduct disorder, substance abuse, and school failure.

Describes the EARLY ALLIANCE interventions, an integrated set of four programs designed to promote competence and reduce risk for early-onset conduct disorder, substance abuse, and school failure. These interventions are evaluated as part of a prevention trial that begins at school entry and targets child functioning and socializing practices across multiple contexts (school, peer group, family) and multiple domains (affective, social, and achievement coping-competence). The paper presents the conceptual foundation of the four interventions, including a synopsis of the risk and protective factors associated with conduct disorder and related outcomes, and of the coping-competence model driving EARLY ALLIANCE. The developmental rationale, intended impact, and procedures are described for each intervention: a universally administered classroom program and indicated, peer, reading-mentoring, and family programs. Interventions are currently being tested in a prevention trial, which is briefly summarized.

Adolescent↗
PubMed1997

Documenting the educational content of morning report.

OBJECTIVES: To document the educational content of a pediatric morning report and to determine if it represents a curriculum. SETTING: A midwestern, tertiary care, pediatric training program. DESIGN: A prospective, observational study was conducted of case presentations discussed during pediatric morning report from July 1995 through July 1996. Presented cases were analyzed for demographics, clinical venues where patients were encountered, case diagnoses, and ensuing discussion. RESULTS: Morning report by study criteria was considered a curriculum. A wide variety of patient ages (aged from birth to 41 years) and all clinical venues were represented. A broad spectrum of diagnoses covered 30 of 31 Pediatrics Review and Education Program (American Academy of Pediatrics, Elk Grove Village, Ill) Content Specification headings and most (72%) of the Educational Objectives listed (N = 977 [72%]). The most common topic areas were infectious diseases (n = 137 [18.2%]), disorders of the blood/neoplasms (n = 85 [11.2%]), neurological disorders (n = 57 [7.5%]), genetics or dysmorphology (n = 56 [7.4%]), and gastrointestinal tract disorders (n = 44 [5.8%]). Top discussion categories were patient clinical presentation (n = 399 [19.6%]), evaluation (n = 375 [18.4%]), and management (n = 377 [18.5%]). CONCLUSIONS: Morning report represents a curriculum in a pediatric residency training program. It can be used effectively to address nontraditional or rarely discussed topics that are important to the overall professional development of pediatric residents.

Adolescent↗
PubMed1982

The performance of three visual coding procedures and three computer programs in classification of electrocardiograms according to the Minnesota Code.

A test library composed of the ECG's of 228 patients with clinically proven myocardial infarction and 294 subjects without clinical evidence of infarction was used to assess the performance of three visual coding procedures and three computer programs designed to classify ECGs according to the Minnesota Code. The results showed that visual coding performed by one experienced senior coder tended to be more consistent than visual coding relying on two less experienced coders and arbitration of disagreements by a supervisor. There was no significant difference in coding results when only one preprocessed complex was coded in comparison with the more elaborate coding of the whole source ECG using majority rule. The coding performance of the three computer programs was similar to that of the visual coding procedures. It is concluded that computer coding of ECGs according to the Minnesota Code is feasible. Combined optimal use of automated coding and visual verification of selected items may still further improve coding precision. However, when judged against an ECG independent standard, the accuracy of all coding procedures in discriminating infarcts from non-infarcts according to the Minnesota code criteria is rather limited. 'Soft' criteria give a reasonable sensitivity with low specificity whereas the use of 'hard' criteria with adequate specificity results in a substantial drop in sensitivity.

Computers↗
PubMed1998

European Organization for Research and Treatment of Cancer (EORTC) prostate cancer trials, 1976-1996.

The Genito-Urinary Tract Cancer Cooperative Group (GU Group) is one of the 18 European Organization for Research and Treatment of Cancer (EORTC) cooperative groups. It was established as a nonprofit organization in 1976 with the aim of conducting phase II and phase III clinical trials. Its membership includes urologists, oncologists, radiotherapists, and endocrinologists that work in close collaboration with its five data managers and one statistician in the EORTC Data Center. Eight subcommittees meet independently to plan and to monitor urological trials and to design programs on quality of life and quality control. In the past 20 years, 3,500 prostate cancer patients have been recruited in 16 phase III trials in untreated and advanced disease and in seven phase II trials in hormone-refractory, metastatic disease. This vast experience led the EORTC GU Group to be involved in the development of response and progression criteria, as well as the validation of prognostic factors, quality of life questionnaires, and basic expertise on the design and analysis of prostate cancer trials, including the meta-analysis of the trials with maximal androgen blockade. The conclusions drawn out of this large pool of experience show the complexity of the clinical research questions. Global collaboration and megatrials with the development of surrogate endpoints and the emphasis on quality of life may prove to be as important as the sacred overall survival endpoint.

Antibiotics, Antineoplastic↗
PubMed2001

A potential integrated water quality strategy for the Mississippi River Basin and the Gulf of Mexico.

Nutrient pollution, now the leading cause of water quality impairment in the U.S., has had significant impact on the nation"s waterways. Excessive nutrient pollution has been linked to habitat loss, fish kills, blooms of toxic algae, and hypoxia (oxygen-depleted water). The hypoxic "dead zone" in the Gulf of Mexico is one of the most striking illustrations of what can happen when too many nutrients from inland watersheds reach coastal areas. Despite programs to improve municipal wastewater treatment facilities, more stringent industrial wastewater requirements, and agricultural programs designed to reduce sediment loads in waterways, water quality and nutrient pollution continues to be a problem, and in many cases has worsened. We undertook a policy analysis to assess how the agricultural community could better reduce its contribution to the dead zone and also to evaluate the synergistic impacts of these policies on other environmental concerns such as climate change. Using a sectorial model of U.S. agriculture, we compared policies including untargeted conservation subsidies, nutrient trading, Conservation Reserve Program extension, agricultural sales of carbon and greenhouse gas credits, and fertilizer reduction. This economic and environmental analysis is watershed-based, primarily focusing on nitrogen in the Mississippi River basin, which allowed us to assess the distribution of nitrogen reduction in streams, environmental co-benefits, and impact on agricultural cash flows within the Mississippi River basin from various options. The model incorporates a number of environmental factors, making it possible to get a more a complete picture of the costs and co-benefits of nutrient reduction. These elements also help to identify the policy options that minimize the costs to farmers and maximize benefits to society.

Conservation of Natural Resources↗
PubMedDate not supplied

Profiles of self-reported HIV-risk behaviors among injection drug users in methadone maintenance treatment, detoxification, and needle exchange programs.

OBJECTIVE: Injection drug use has accounted for more than one third of acquired immune deficiency syndrome cases in the United States. The purpose of this study was to compare the demographic characteristics, types, and frequency of human immunodeficiency virus (HIV)-risk behaviors among injection drug users (IDUs) recruited from a needle exchange program (NEP), methadone maintenance treatment (MMT), and detoxification (detox) program. DESIGN: A cross-sectional, correlational design was used to determine whether the selected HIV-risk behaviors and demographic characteristics of IDUs varied by site of recruitment. SAMPLE AND MEASUREMENTS: Confidential questionnaires were completed by 445 IDUs in Philadelphia, Pennsylvania. RESULTS: Data analysis revealed that HIV sexual and injection-risk behavior varied by recruitment site. Subjects recruited from the NEP were more likely to engage in HIV-risk behaviors than subjects recruited from the MMT or detox sites. CONCLUSIONS: Interventions occurring in program and treatment sites need to be sensitive to various demographic characteristics and behaviors if they are to reach those at highest risk of HIV infection. Targeting HIV prevention interventions based upon risk group membership alone (e.g. IDUs) fails to address the distinct risk behaviors and demographic characteristics of enrollees in different programs.

Adult↗
PubMed1996

A peer-led AIDS prevention program for students in an alternative school.

School-based programs designed to measure health risk behavior and reduce the risk of sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) infection have not addressed adequately the needs of adolescents outside of main-stream schools. In Florida, these youth represent a sizable proportion of the population and have been shown to be at increased risk for acquiring sexually transmitted diseases and human immunodeficiency virus. This article describes a peer-led STD/HIV intervention for students in a dropout prevention program in Dade Country, Florida. Trained peer counselor/educators (PCEs) led schoolwide activities and classroom sessions covering STD/HIV information, community health resources, communication and negotiation skills, and safer sex strategies. Teachers and students rated the PCEs effective in promoting discussion and serving as sources of information about AIDS and community health resources. Pre/post intervention questionaire results demonstrated an increase in AIDS awareness and discussion among students as well as an increase in condom use. Based on this social influences approach, peer education appears to be a promising health education strategy for students in dropout prevention programs.

Acquired Immunodeficiency Syndrome↗
PubMed1996

The use of theory based semistructured elicitation questionnaires: formative research for CDC's Prevention Marketing Initiative.

Through one of its many HIV prevention programs, the Prevention Marketing Initiative, the Centers for Disease Control and Prevention promotes a multifaceted strategy for preventing the sexual transmission of HIV/AIDS among people less than 25 years of age. The Prevention Marketing Initiative is an application of marketing and consumer-oriented technologies that rely heavily on behavioral research and behavior change theories to bring the behavioral and social sciences to bear on practical program planning decisions. One objective of the Prevention Marketing Initiative is to encourage consistent and correct condom use among sexually active young adults. Qualitative formative research is being conducted in several segments of the population of heterosexually active, unmarried young adults between 18 and 25 using a semistructured elicitation procedure to identify and understand underlying behavioral determinants of consistent condom use. The purpose of this paper is to illustrate the use of this type of qualitative research methodology in designing effective theory-based behavior change interventions. Issues of research design and data collection and analysis are discussed. To illustrate the methodology, results of content analyses of selected responses to open-ended questions on consistent condom use are presented by gender (male, female), ethnic group (white, African American), and consistency of condom use (always, sometimes). This type of formative research can be applied immediately to designing programs and is invaluable for valid and relevant larger-scale quantitative research.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Long-term impact of Johnson & Johnson's Health & Wellness Program on health care utilization and expenditures.

The long-term impact of corporate health and wellness programs is largely unknown, because most evaluations focus on impact in just 1 or 2 years after program initiation. This project estimated the longer-term impact of the Johnson & Johnson Health & Wellness Program on medical care utilization and expenditures. Employees were followed for up to 5 years before and 4 years after Program implementation. Fixed-effects regression models were used to control for measurable and unmeasurable factors that may influence utilization and expenditures. Results indicated a large reduction in medical care expenditures (approximately $224.66 per employee per year) over the 4-year Program period. These benefits came from reduced inpatient use, fewer mental health visits, and fewer outpatient visits compared with the baseline period. Most benefits occurred in years 3 and 4 after Program initiation. We conclude that programs designed to better integrate occupational health, disability, wellness, and medical benefits may have substantial health and economic benefits in later years.

Health Expenditures↗
PubMed1999

Exercise--it's never too late: the strong-for-life program.

OBJECTIVES: This investigation determined whether an in-home resistance training program achieved health benefits in older adults with disabilities. METHODS: A randomized controlled trial compared the effects of assigning 215 older persons to either a home-based resistance exercise training group or a waiting list control group. Assessments were conducted at baseline and at 3 and 6 months following randomization. The program consisted of videotaped exercise routines performed with elastic bands of varying thickness. RESULTS: High rates of exercise adherence were achieved, with 89% of the recommended exercise sessions performed over 6 months. Relative to controls, subjects who participated in the program achieved statistically significant lower extremity strength improvements of 6% to 12%, a 20% improvement in tandem gait, and a 15% to 18% reduction in physical and overall disability at the 6-month follow-up. No adverse health effects were encountered. CONCLUSIONS: These findings provide important evidence that home-based resistance exercise programs designed for older persons with disabilities hold promise as an effective public health strategy.

Aged↗
PubMedDate not supplied

Determination of free calcium.

A computer program designed to be user friendly is described in this report. Two types of calculations are provided: a) determination of free calcium concentration based on known total salt concentration and b) those which calculate total salt concentration required to insure a desired free calcium concentration in the buffered system. The user can choose up to 10 different ligands, nine different cations (known total concentration) and 10 concentrations (either free or total) of the variable cation (e.g. calcium) per calculation. Thus, this program does not restrict its user to one or two parameters (e.g., buffer and/or ions). Data generated using this method are in excellent agreement with those derived using programs in current use.

Algorithms↗
PubMed1984

Self-preservation: treatment intervention for nurse impairment.

The nursing profession has initiated major intervention programs designed to address the issues and problems generated by impaired professional behavior. In Part I of this two-part series, the parameters of this key aspect of self-preservation were outlined. Part II will describe several existing and evolving intervention strategies tailored to the unique needs of the impaired nurse. Legal, social, and professional concerns are discussed as each relates to the challenges posed to peer and/or therapist efforts to treat the impaired nurse. A sampling of intervention programs is presented for both informational purposes as well as to serve as illustrations of methods that can be adapted by clinicians who have or can anticipate treating the impaired nurse.

Burnout, Professional↗
PubMed2004

Patterns of utilization for the Minnesota senior health options program.

OBJECTIVES: To compare the use of medical services provided under the Minnesota Senior Health Options (MSHO) (a special program designed to serve dually eligible older persons) with that provided to controls who received fee-for-service Medicare and Medicaid managed care. DESIGN: Quasi-experimental design using two control groups; separate matched cohort and rolling cross-sectional analyses; regression models used to adjust for case-mix differences. SETTING: Urban Minnesota community and nursing home long-term care. PARTICIPANTS: Dually eligible elderly MSHO enrollees in the community and in nursing homes were compared with two sets of controls; one was drawn from nonenrollees living in the same area (control-in) and another from comparable persons living in another urban area where the program was not available (control-out). Cohorts living in the community and in nursing homes were included. MEASUREMENTS: Use of hospitals and emergency rooms, physician visits. RESULTS: In the community cohort, there were no significant differences in hospital admission rates or in hospital days. MSHO enrollees had significantly fewer preventable hospital admissions and significantly fewer preventable emergency services than the control-in group. MSHO nursing home enrollees had significantly fewer hospital admissions than either control group with or without adjustment at 12 and 18 months. MSHO enrollees had significantly fewer hospital days and preventable hospitalizations than the control-in group. MSHO enrollees had significantly fewer emergency room visits and preventable emergency room visits than either control group. CONCLUSION: In general, the results of this evaluation are mixed but favor MSHO. The effect of MSHO was stronger for nursing home enrollees than community enrollees. The lower rate of preventable hospitalizations and emergency room visits of MSHO enrollees suggests that MSHO affected the process of care by providing more of some types of preventive and community-care services for community residents.

Aged↗