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Education campaigns to reduce stormwater pollution in commercial areas: do they work?

A monitoring and evaluation program was undertaken, involving six different styles of evaluation to determine whether a low-cost, eight month education campaign that operated within a small commercial district was successful at changing people's behavior and reducing stormwater litter loads. This project also tested newly developed guidelines for monitoring and evaluating all types of non-structural stormwater quality best management practices (BMPs). The project evaluated: the extent and quality of the campaign's implementation; the degree to which it changed the awareness, attitudes, self-reported behavior and actual behavior of merchants and the public; and the nature of changes in stormwater litter loads. Overall, the education campaign produced mixed results, with the net result being modestly positive. Specifically, it was: unsuccessful at significantly influencing the knowledge or attitudes of merchants or the public; modestly successful at influencing the behavior of merchants and the public; and modestly successful at reducing litter loads in stormwater. At a theoretical level, the project highlights how using different 'styles' of BMP evaluation can help to build a more complete picture of a BMP's performance. At a practical level, the project helped to improve the monitoring and evaluation guidelines and produced evidence-based design guidelines for future campaigns that aim to reduce littering in commercial areas.

Awareness↗

Student nurses' knowledge, attitudes, and self-efficacy of children's pain management: evaluation of an education program in Taiwan.

The purpose of this study was to examine the effectiveness of a pediatric pain education program (PPEP) for student nurses. The sample consisted of 181 licensed student nurses who were enrolled in a nursing school in Taiwan. Student nurses attended a 4-hour PPEP that involved case scenario discussion, video, and lecture. Data were collected by an extensive questionnaire that assessed student nurses' knowledge of, attitudes toward, and self-efficacy in pediatric pain assessment and pharmacological and nonpharmacological pain management. The results demonstrated that student nurses gained significant knowledge of pediatric pain, expressed more appropriate attitudes, and reported greater self-efficacy in children's pain management after attending PPEP. Their knowledge of analgesic pharmacotherapy did not significantly improve. These results suggest that PPEP should be integrated into pediatric nursing curricula to enhance knowledge and skills regarding children's pain management during the early stage of a nursing career.

Attitude of Health Personnel↗

Evaluation of a training program for persons with SCI paraplegia using the Parastep 1 ambulation system: part 1. Ambulation performance and anthropometric measures.

OBJECTIVE: To describe performance parameters and effects on anthropometric measures in spinal cord injured subjects training with the Parastep 1 system. DESIGN: Before-after trial. SETTING: Human spinal cord injury applied research laboratory. PARTICIPANTS: Thirteen men and 3 women with thoracic (T4-T11) motor-complete spinal cord injury: mean age, 28.8yrs; mean duration postinjury, 3.8yrs. INTERVENTION: Thirty-two functional neuromuscular stimulation ambulation training sessions using a commercially available system (Parastep-1). The hybrid system consists of a microprocessor-controlled stimulator and a modified walking frame with finger-operated switches that permit the user to control the stimulation parameters and activate the stepping. OUTCOME MEASURES: Distance walked, time spent standing and walking, pace, circumferential (shoulders, chest, abdomen, waist, hips, upper arm, thigh, and calf) and skinfold (chest, triceps, axilla, subscapular, supraillium, abdomen, and thigh) measurements, body weight, thigh cross-sectional area, and calculated lean tissue. RESULTS: Statistically significant changes in distance, time standing and walking, and pace were found. Increases in thigh and calf girth, thigh cross-sectional area, and calculated lean tissue, as well as a decrease in thigh skinfold measure, were all statistically significant. CONCLUSIONS: The Parastep 1 system enables persons with thoracic-level spinal cord injuries to stand and ambulate short distances but with a high degree of performance variability across individuals. The factors that influence this variability have not been completely identified.

Adult↗

Evaluation of a training program for persons with SCI paraplegia using the Parastep 1 ambulation system: part 2. Effects on physiological responses to peak arm ergometry.

OBJECTIVE: To examine the task-nonspecific effects of functional neuromuscular stimulation (FNS)-assisted ambulation training on the physiological responses of persons with paraplegia to upper extremity exercise challenge. DESIGN: Before-after trial. SETTING: Human spinal cord injury (SCI) applied research laboratory. PARTICIPANTS: Twelve men and three women with motor- and sensory-complete thoracic-level SCI (T4-T11), mean age 28.2 +/- 6.8yrs (range, 21.1 to 45.2yrs), mean injury duration 3.7 +/- 3.0yrs (range, 7 to 8.8yrs). INTERVENTION: Thirty-two sessions of FNS ambulation training using a commercial six-channel system (Parastep 1). This system is composed of a microprocessor-controlled electrical stimulation unit and a walking frame outfitted with finger switches that allow the user to independently control the system and stimulation parameters. OUTCOME MEASURES: Peak and subpeak physiological responses to arm ergometry testing and upper extremity strength measures, obtained before and after the FNS ambulation training. RESULTS: Statistically significant increases in peak values for time to fatigue, peak power output, and peak VO2 (all p < .001). Heart rate was significantly lower throughout subpeak levels of arm ergometry after the ambulation training (p < .05). Values of upper extremity strength were not significantly altered after training. CONCLUSIONS: FNS ambulation by persons with SCI paraplegia results in task-nonspecific training adaptations. Central cardiovascular adaptations were indicated as the primary source of these beneficial alterations in exercise responses.

Adult↗

Evaluation of a training program for persons with SCI paraplegia using the Parastep 1 ambulation system: part 3. Lack of effect on bone mineral density.

OBJECTIVE: To determine if the bone mineral density loss seen after spinal cord injury (SCI) is reversed by a walking program using the Parastep 1 system. DESIGN: Before-after trial. SETTING: Human SCI applied research laboratory. PARTICIPANTS: Thirteen men and 3 women with thoracic motor- and sensory-complete SCI, mean age 28.8yrs, mean duration postinjury 3.8yrs. INTERVENTION: Thirty-two functional neuromuscular stimulation (FNS) ambulation training sessions using a commercially available system (Parastep 1). This system consists of a microprocessor-controlled stimulator and a modified walking frame with finger-operated switches that permit the user to control the stimulation parameters and activate the stepping. OUTCOME MEASURE: Bone mineral density at the femoral head, neck, and Ward's triangle measured using a Lunar DP3 dual-photon densitometer. RESULTS: No significant change in bone mineral density was found using repeated measures analyses of variance. CONCLUSIONS: Axial loading combined with muscle stimulation and resistive exercise does not result in significant changes in bone mineral density in persons with complete paraplegia.

Absorptiometry, Photon↗

Evaluation of a training program for persons with SCI paraplegia using the Parastep 1 ambulation system: part 4. Effect on physical self-concept and depression.

OBJECTIVE: To determine whether persons with spinal cord injury (SCI) paraplegia who participated in an electrical stimulation walking program experienced changes in measures of physical self-concept and depression. DESIGN: Before-after trial. SETTING: Human SCI applied research laboratory. PARTICIPANTS: Volunteer sample of 12 men and 3 women with SCI paraplegia, mean age 28.75 +/- 6.6yrs and mean duration of injury 3.8 +/- 3.2yrs. INTERVENTION: Thirty-two FNS ambulation training sessions using a commercially available system (Parastep 1). The hybrid system consists of a microprocessor-controlled stimulator and a modified walking frame with finger-operated switches that permit the user to control the stimulation parameters and activate the stepping. OUTCOME MEASURES: The Tennessee Self-Concept Scale (TSCS) and the Beck Depression Inventory (BDI) were administered before and after training. Only the Physical Self subscale of the TSCS was analyzed. After training, individual interviews were performed to assess participants' subjective reactions to the training program. RESULTS: A repeated measures analysis of variance indicated that desired directional and statistically significant changes occurred on the Physical Self subscale of the TSCS (F(1,14) = 8.54, p < .011) and on the BDI (F(1,14) = 5.42, p < .035). CONCLUSIONS: Subsequent to the ambulation training program there were statistically significant increases in physical self-concept scores and decreases in depression scores.

Adult↗

Evaluation of a training program for persons with SCI paraplegia using the Parastep 1 ambulation system: part 5. Lower extremity blood flow and hyperemic responses to occlusion are augmented by ambulation training.

OBJECTIVE: To test whether 12 weeks of exercise conditioning using functional neuromuscular stimulation (FNS) ambulation alters the resting lower extremity blood flow and hyperemic responses to vascular occlusion in subjects with paraplegia, and to determine whether an association exists between limb flow and lower extremity fat-free mass. DESIGN: Pretest, posttest. SETTING: Academic medical center. PARTICIPANTS: Subjects with chronic neurologically complete paraplegia. INTERVENTION: Thirty-two sessions of microprocessor-controlled ambulation using electrically stimulated contractions of lower extremity muscles and a rolling walker. OUTCOME MEASURES: Subjects underwent quantitative Doppler ultrasound examination of the common femoral artery (CFA) before and after training. End-diastolic arterial images and arterial flow-velocity profiles obtained at rest and after 5 minutes of suprasystolic thigh occlusion were computer-digitized for analysis of heart rate (HR), CFA peak systolic velocity (PSV), CFA cross-sectional area (CSA), flow velocity integral (FVI), pulse volume (PV), and CFA (arterial) inflow volume (AIV). RESULTS: Significant effects of training on CSA (p < .0001), FVI (p < .05), computed PV (p < .001), and computed AIV (p < .01) were observed. Resting HR was lower following training (p < .05). The change for resting PSV approached but did not reach significance (p = .083). Analysis of postocclusion PV and AIV showed significant effects for conditioning status (p values < .01), postcompression time (p values < .0001), and their interaction (p values < .01). At 1 minute after occlusion, the posttraining AIV response was 78.2% greater in absolute magnitude and 17.4% more robust when expressed as a percentage change from its resting value than before training. Significant correlations were found between thigh fat free mass and both AIV and PV (p values < .05). CONCLUSION: Exercise training using FNS ambulation increases the resting lower extremity AIV in individuals with paraplegia and augments the hyperemic response to vascular occlusion. Improved posttraining blood flow is attributable both to vascular structural changes and upregulation of vascular flow control mechanisms. Limb mass is associated with the volume of arterial blood flow.

Adult↗

Evaluation of an instructional program for improving medication compliance for chronically mentally ill outpatients.

Outpatient medication adherence is a major problem, especially for patients repeatedly hospitalized for psychiatric disorders. This study included 39 such patients who were receiving case management services from a community mental health center. Patients were matched and randomly assigned to receive in a single session either (1) information regarding medication and its benefits, (2) guidelines for assuring adherence which encompassed all phases related to pill-taking including filling prescriptions, use of a pill container, transportation, self-reminders, doctor's appointments and so forth, or (3) the same guidelines as (2) above but given in the presence of a family member who was enlisted in support. The results showed that adherence increased to about 94% after the guidelines were given for both the individual and family guideline procedure, whereas adherence remained unchanged at 73% after the medication information procedure. These results suggest a practical means for assuring a high level of medication adherence for patients with psychiatric disorders.

Adult↗

Reduction of noise levels in intensive care units for infants: evaluation of an intervention program.

OBJECTIVE: To investigate whether educational information for nurses concerning causes of noise would decrease noise levels in an intensive care unit for term newborns and infants. DESIGN: Pretest and posttest. SETTING: Children's surgical ward in a university hospital in southern Sweden. SUBJECTS: Fifty-two nurses in the surgical ward. OUTCOME MEASURES: Noise levels. INTERVENTION: An educational program consisting of a presentation of a videotape, presentation of the decibel values for various care activities, and a discussion of the problem. RESULTS: Statistical analysis with a paired two-tailed t test showed significant differences to exist between measurements in a cot and an incubator before the intervention (p = 0.0001), and between cot measurements before and after the intervention program (p = 0.0007). CONCLUSIONS: The results of this study show that through simple methods and without additional costs, and by making the staff aware of the problem, noise levels can be lowered considerably.

Adult↗

[Incidence of dental caries in a child population from Mostoles: evaluation of a preventive program after 2 years].

OBJECTIVE: To know the efficacy and effectivity od dental health program after 2 years. DESIGN: The study of prospective cohorts not aleatorized. POPULATION AND METHODS: The exposed cohort is composed of 583 school children, 296 girls and 287 boys, the non-exposed cohort is composed of 261 school children, 132 girls and 129 boys. We carried out and odontological exploration following the criteria of the WHO the preventive measures we carried out are health education, weekly mouthrinse of NaFl at 0.2%, occlusive sealant in the first permanent molar and external application fluorine gel. We measured and compared the different indexes of tooth decay and sociodemographic variables between both cohorts, the statistic meaning has been determined through the U est of Mann Whitney. RESULTS: We have found statistically significant differences between both cohorts in the indexes of decay in the exposed cohorts. The indexes of decay in the exposed cohort being DMFT: 0.31; DMFM (first permanent molar): 0.31; DMFS: 0.4. And in the non-exposed cohort DMFT: 0.81; DMFM: 0.81; DMFS; 1.09. Existing an epidemiological association between the preventive program and the prevention of dental decay with a relative risk of 0.24 (95% CI, 0.17-0.33) and the prevention fraction of 76.3% (95% CI, 67-83). CONCLUSIONS: The preventive program after two years elapsed is effective and has a clear protector effect.

Child↗

Evaluation of a pilot program in rural schools to increase bicycle and motor vehicle safety.

Concerned with high bicycle-and motor vehicle-related mortality rates among children, Idaho's South Central District Health Department provided a competition to increase use of 1) seat belts, 2) motor vehicle rear seating, and 3) bicycle helmets among children attending elementary schools in the eight rural counties it serves. Nine of the 44 elementary schools in the health district chose to participate in the contest. Eight schools addressed increasing helmet use, four schools also addressed increasing seat belt use and rear seating, and one school addressed safety in general. A $1,000 prize was awarded to each of four schools judged to have the highest levels of student and community involvement, outreach, creativity, and changes in safety behavior (based on perceptions of outside judges). In 1997, baseline observations were collected for 1) seat belt use and rear seating for children in 28 schools, and for 2) bicycle helmet use among children in 25 schools. In 1998, follow up data were collected for 1) seat belt and rear seating in 42 schools, and 2) bicycle helmet use in 35 schools. Data were analyzed using SAS. Adjusting for differences in baseline rates, regression analysis was used to compare 1997 and 1998 rates for seat belt use, rear seating, and bicycle helmet use for those schools having baseline data. Results showed that although there was no significant difference between participating and non-participating schools in rear-seating behaviors, there was an increase in seat belt and bicycle helmet use for participating schools. Since schools self-selected participation, it is unknown whether those schools were fundamentally different from nonparticipating schools.

Automobile Driving↗

Evaluation of multimodal treatment program for fibromyalgia.

A quasi-experimental design was used to assess a multimodal pain treatment program for female patients with fibromyalgia to ascertain immediate and long-term effects. Laboratory and self-report pain measures together with psychological measures were obtained from patients who were tested up to 6 months after treatment. Comparison data were also obtained from fibromyalgia patients who failed to qualify for the treatment program because of insurance coverage. Immediate and long-term treatment effects were evident with the psychological measures and the subjective pain measures but not with the laboratory pain measures. Participants who attended the month-long multimodal program achieved significant and positive changes on most of the outcome measures. However, relapse prevention must be addressed.

Activities of Daily Living↗

A risk-adjusted measure of hospitalization rates for evaluating community mental health program performance.

The authors describe the use of risk-adjusted hospitalization rates to measure community mental health treatment outcomes. The risk adjustment involves comparing rates of hospitalization subsequent to treatment with rates of hospitalization prior to treatment. The research uses a probabilistic methodology that reliably estimates caseload overlap by comparing the distribution of the dates of birth observed in data sets to the distribution of dates of birth in the general population. Findings indicate that risk-adjusted hospitalization rates are substantially different than unadjusted rates. Half of the community programs in one state consistently achieved positive outcomes in four consecutive years; other programs had mixed results or no change.

Adult↗

Development of job-seeking ability in people with arthritis: evaluation of a pilot program.

Working Horizons is an intervention designed to prevent work disability by addressing the internal and external barriers faced by people with arthritis in their attempts to enter or maintain their positions in the employment arena. The aim of the pilot study was to determine whether Working Horizons influenced participants' self-efficacy and psychological well-being and to describe the experience of Working Horizons from the perspectives of participants and employment advisors (EAs). The study was a pre-test post-test design with an Intervention Group (n = 22) and Comparison Control Group (n = 22). Quantitative data were collected by self-completed questionnaires at baseline and at six-months follow-up. Qualitative data were collected via open questions on the questionnaires, interviews with a sub-sample of 10 participants, and a focus group with EAs at the end of the programme. Pilot data suggested that Working Horizons was effective in terms of increasing participants' job-seeking self-efficacy. In addition, the Intervention Group showed significant improvements on self-esteem and satisfaction with life. Qualitative findings confirmed that participants felt more 'confident' in relation to seeking employment, were more accepting of their condition, felt more positive and had greater awareness of the social model of disability. Participants valued the emotional and instrumental support provided by the EAs, who acted as successful 'work' role models. Interventions, such as Working Horizons, may be an effective means of addressing work disability, acting as a gateway to statutory services. The value of suitable role models in mentoring capacities was highlighted.

Adult↗

Guidelines for clinical engineering programs--Part I: guidelines for electrical isolation; Part II: performance evaluation of clinical engineering programs.

This series presents guidelines for: electrically isolated inputs and outputs; measuring the performance of hospital biomedical engineering programs; evaluating the risk of electric shock in hospitals; and for isolated power in anesthetizing locations. In Part I, specific recommendations are given for the use of insulated approach, battery-powered monitors in surgery, and for isolation requirements for devices connected to cardiac leads. In Part II, checklists are provided for the self-evaluation of an in-house, biomedical engineering staff. Parts III and IV, in future issues of this Journal, will include discussion of the theoretical electrical hazard potential in reference to the use of isolated power systems. The question of whether isolated power should be required in all anesthetizing locations will be discussed in Part IV.

Accident Prevention↗