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PubMed1999

Respite from stress and other service needs of homeless families.

This paper is a description of qualitative interviews with homeless mothers participating in an outdoor camp program designed as time out from the stressful conditions of shelter living. In addition to evaluation of family satisfaction with camp, the individual interviews and parental discussion groups offered at camp enabled the women to share stories about some of the obstacles they encounter in moving toward self-sufficiency and in parenting their children. Gaps in services to help overcome these obstacles ranged from learning to read to treatment of childhood sexual abuse and more comprehensive substance abuse treatment. Suggestions for expansion of the program to better meet needs of families included support groups and referrals to community mental health services.

Adaptation, Psychological↗
PubMedDate not supplied

The Parent-Baby Venture Program: prevention of child abuse.

TOPIC: The overwhelming obstacles adolescents face to successful achievement of the maternal role. PURPOSE: To describe an innovative, community-based program to support high risk adolescents during the early postpartum period. SOURCE: A review of the literature related to programs designed to promote maternal-role attainment and prevent child abuse/neglect. CONCLUSION: Interviews with participants indicate a positive response to the intervention but regression to maladaptive behavior in some following termination.

Adolescent↗
PubMed1995

"I have a future" comprehensive adolescent health promotion: cultural considerations in program implementation and design.

"I Have a Future" Adolescent Health Promotion Program is a life options program. The program uses the Nguzo Saba (seven principles) and African philosophy to systematically address violence and attitudes reinforcing the use of violence. The Nguzo Saba promotes self-respect, and commitment to and support for developing a positive community. Data was collected from four public housing developments--two served as match control sites. Adolescents residing in neighborhoods in which the program operated had greater acceptance of the Nguzo Saba than those in matched communities. Those who perceived themselves as having life options engaged in fewer delinquent/violent acts. There was a strong negative correlation between the acceptance of the Nguzo Saba and the number of reported delinquent/violent behaviors. There was a positive relationship between the acceptance of the Nguzo Saba and positive self-concept, psychosocial maturity, and clarity of goals.

Adolescent↗
PubMed1999

[The HIV/AIDS pandemic: African women at the heart of the control program or the difficulties with regard to gender].

The AIDS pandemia in developing countries forces forth the question of women's rights in Africa and underscores their extreme physical and sociocultural vulnerability. Experience gained during a program designed to reduce mother-to-child transmission of HIV in the Ivory Coast highlights the socially imposed and therefore intricate nature of differences between men and women and of the resulting relationships. Defending a woman's right to know her serologic status empowers her in the fight for emancipation but can also make her more fragile by undermining support from medical staff and family environment. To prevent the risk of outcasting, exclusion, and fragilization, gender must be given greater emphasis in planning future programs. Careful consideration must be devoted to the special sociocultural factors that affect women in Africa.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Patient perceptions about the influence of cholesterol on heart disease.

National surveys have shown that adults need to known more about their own blood cholesterol levels and about specific methods for lowering blood cholesterol. We examine patient perceptions of cholesterol and heart disease after their participation in a cholesterol management program designed for the primary care setting. We counseled 221 patients and successfully interviewed 179 by telephone four weeks after their initial dietary counseling visit. Nine of 10 patients could report their cholesterol level, and 98% of patients could appropriately label it as borderline-high or high-risk. Ninety-seven percent of the patients could give one valid reason why cholesterol was important to their health. Many patients knew specific dietary recommendations from counselors. Patients positively reviewed counseling and the cholesterol management program. A large percentage of patients had already made changes in diet and eating habits at the time of the interview. Total cholesterol measurements showed a mean reduction of 8.5% postcounseling.

Adult↗
PubMed2006

How Uganda reversed its HIV epidemic.

Uganda is one of only two countries in the world that has successfully reversed the course of its HIV epidemic. There remains much controversy about how Uganda's HIV prevalence declined in the 1990s. This article describes the prevention programs and activities that were implemented in Uganda during critical years in its HIV epidemic, 1987 to 1994. Multiple resources were aggregated to fuel HV prevention campaigns at multiple levels to a far greater degree than in neighboring countries. We conclude that the reversed direction of the HIV epidemic in Uganda was the direct result of these interventions and that other countries in the developing world could similarly prevent or reverse the escalation of HIV epidemics with greater availability of HIV prevention resources, and well designed programs that take efforts to a critical breadth and depth of effort.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Blended roles: preparing the advanced practice nurse educator/clinician with a Web-based nurse educator certificate program.

Changing demographics, a nursing shortage, and various societal changes underscore the need for nurse educators and new nurse educator programs. This article describes a Web-based nurse educator program designed to prepare advanced practice nurses for faculty roles while simultaneously preparing them as clinicians. Guided by adult education theory and self-directed learning theory, the Web-based Nurse Educator Certificate (four Web-based nurse educator courses including a teaching practicum) has been developed and offered to clinical master's and postmaster's students. This article also describes student work with mentors, interactive Web-based teaching strategies, portfolios, graduate competencies, and initial evaluative data. In the first two years of the program, 48 students have taken at least one course in the Nurse Educator Certificate program and eight students have completed it. A Web-based nurse educator certificate program, as part of a clinical master's or postmaster's program, has the potential to help meet the faculty shortage.

Attitude of Health Personnel↗
PubMed1988

Evaluation of Gannon-Hahnemann Program to provide family physicians for underserved area.

The Gannon-Hahnemann Family Medicine Program is a combined B.S.-M.D. program designed to provide family practitioners to northwest Pennsylvania, a medically underserved area. The first six graduating classes (1981 through 1986) of the combined six-year curriculum contained 81 students. These students completed two years of undergraduate education at Gannon University, Erie, Pennsylvania, and four years at Hahnemann University School of Medicine. The students were required to complete the clinical rotations of their final year of medical school in Erie, and one of the rotations had to be family practice. Of the 81 combined-program graduates, 24 (29.6 percent) initially selected family practice residencies, while only 5.2 percent of the regular admission Hahnemann students selected family practice. Of these 24 graduates, 13 completed family practice residencies, and six of those chose to practice in northwest Pennsylvania. Nine graduates remained in family practice training.

Curriculum↗
PubMed2000

Welfare reform consequences for children: the Wisconsin experience.

BACKGROUND: The Temporary Assistance to Needy Families, enacted under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, is a reality for many working families. As public policies are enacted, unintended consequences for infants/children must be minimized. Child advocates in Wisconsin, leading this nation in reforming Aid to Families with Dependent Children (AFDC), are concerned about supporting eligible infants/children as safety-net programs are unlinked. OBJECTIVE: This study reviews the enrollment status of 4 linked programs over time in Wisconsin, from January 1995 to August 1998. Eligible infants/children in programs, such as Medicaid/AFDC, Medicaid/Healthy Start, and Food Stamps, were analyzed and compared with enrollment in Special Supplemental Nutrition Program for Women, Infants/children (WIC), a nonlinked program. DESIGN: A cross-sectional analysis of monthly enrollment for infants/children was subdivided into 3 periods: prewelfare reform or AFDC (January 1, 1995 to December 31, 1995), the welfare reform pilot or Pay For Performance (January 1, 1996 to August 31, 1997), and welfare reform better known as Wisconsin Works (W-2), (September 1, 1998 to August 31, 1998), periods 1, 2, and 3, respectively. PARTICIPANTS: Infants/children in Wisconsin from birth to 18 years of age enrolled in W-2 and/or other safety-net programs were monitored: AFDC or W-2, WIC, Food Stamps, Medicaid/AFDC, and Medicaid/Healthy Start. RESULTS: The average number of infants/children removed from AFDC and Medicaid/AFDC during periods l and 2 were -1210 increasing to -3128 per month, respectively, almost tripling the rates of decline during the pilot period (see ). By the end of this study, >100 000 (111 198) infants/children were removed from AFDC/W-2 enrollment and 51 559 fewer infants/children benefited from Medicaid. This rate of decline slowed during period 3, averaging -687 per month, while W-2 enrollment continued to decline significantly at a rate of -2692 per month. In contrast, Medicaid/Healthy Start enrollment, targeted to infants/children <6 years of age, increased significantly over all periods by +332, +1327, and +266, respectively. Food Stamps enrollment also declined throughout all 3 consecutive periods, -603, -2462, and -1450, respectively. However, enrollment in the WIC program did not decline significantly to the same degree as other certification-linked programs with AFDC or W-2, as indicated by the consecutive slopes of -60, -111, and -183, respectively. CONCLUSION: Wisconsin infants/children were rapidly removed from welfare rolls in unprecedented numbers during the periods January 1995 and August 1998. Comparisons of periods before W-2 implementation and 1 year after implementation support the fact that certification-linked programs, such as Medicaid and Food Stamps, were sufficiently aligned to AFDC/W-2 to significantly impact infants/children enrollment. Historically, WIC certification in Wisconsin has not been linked to AFDC, and infants/children traditionally eligible for Medicaid and Food Stamps are also eligible for WIC. Yet, contrary to the AFDC-linked safety-net programs, declines in WIC enrollment were not statistically significant during all study periods. Statewide and local interventions within Wisconsin, such as outreach activities, targeted to Medicaid/Healthy Start and more recently Title XXI (State Children Health Insurance Program), slowed the reductions of Medicaid enrollment for Wisconsin infants/children. These findings support that altering safety-net programs can result in unintended consequences if not carefully transitioned as demonstrated in Wisconsin welfare reform.

Adolescent↗
PubMed2004

Adults returning to school: the impact on family and work.

The authors examined the impact of attending a Weekend College (WEC) program on adult students' family, work, and social life. Student participants responded to a 26-item questionnaire and three open-ended questions. Regression analyses of the 566 completed surveys revealed that satisfaction with school and support from family and the work place were predictive of lower levels of stress. Content analyses of responses to open-ended questions showed that expected stress was the result of time constraints but also highlighted the positive aspects of continuing one's education. The study includes suggestions for designing programs to meet the needs of adult students.

Adult↗
PubMedDate not supplied

Putting medical practice guidelines into practice: the cholesterol model.

As more and more medical practice guidelines are developed in the United States, commensurate evaluation efforts should assess their impact on professional practice and patient outcomes. We describe an ongoing research program designed to develop and test practice models for applying the 1988 Adult Treatment Panel Guidelines for the clinical management of high blood cholesterol. Four studies are evaluating different models to assist nonacademic community practices in the detection, evaluation, and treatment of high blood cholesterol. We have designed randomized controlled trials set in solo and small-group primary care practices of family or general practitioners and internists situated in rural, suburban, and urban settings. Patients include adult men and women who represent diverse socioeconomic and ethnic backgrounds. We are measuring rates of cholesterol screening; dietary and drug treatment and follow-up; changes in dietary intake and compliance with drug therapy; changes in quality of life and cost of intervention; and reduction in cholesterol level. Scheduled for completion in 1994, this program will provide insights into practical and effective methods of lipid management. It serves as a model for studying the application of health guidelines in the context of nonacademic primary care practices serving diverse patient populations.

Cholesterol↗
PubMed1996

A computer program to assist in making breast cancer adjuvant therapy decisions.

This report describes a computer program designed to assist health care professionals in making projections of the average benefit of systemic adjuvant therapy for individual breast cancer patients. It requires as input patient age (used to make projections of natural mortality), an estimate of breast cancer-related mortality at 5 years (used to make projections of breast cancer-specific mortality), and the proportional risk reduction for breast cancer mortality expected for the adjuvant therapy (with included tables from the Early Breast Cancer Trialist's 1992 meta-analysis). The program uses life table analytical techniques to make projections of outcome in three scenarios: that the breast cancer never occurred, that the breast cancer patient received definitive local therapy but no adjuvant systemic therapy, and that the patient received adjuvant therapy. The outcome projections are given for total, natural (non-breast cancer-related), and breast cancer-related mortality at several time points and also of total remaining life expectancy. These estimates are currently widely made by clinicians by nonnumerical techniques. Computer-based tools can serve as valuable aids in physician and patient education and in the process of informed decision making.

Adult↗
PubMed2005

The U.S. experience in promoting sustainable chemistry.

BACKGROUND, AIM AND SCOPE: Recent developments in European chemicals policy, including the Registration, Evaluation and Authorization of Chemicals (REACH) proposal, provide a unique opportunity to examine the U.S. experience in promoting sustainable chemistry as well as the strengths and weaknesses of existing policies. Indeed, the problems of industrial chemicals and limitations in current regulatory approaches to address chemical risks are strikingly similar on both sides of the Atlantic. We provide an overview of the U.S. regulatory system for chemicals management and its relationship to efforts promoting sustainable chemistry. We examine federal and state initiatives and examine lessons learned from this system that can be applied to developing more integrated, sustainable approaches to chemicals management. MAIN FEATURES: There is truly no one U.S. chemicals policy, but rather a series of different un-integrated policies at the federal, regional, state and local levels. While centerpiece U.S. Chemicals Policy, the Toxic Substances Control Act of 1976, has resulted in the development of a comprehensive, efficient rapid screening process for new chemicals, agency action to manage existing chemicals has been very limited. The agency, however, has engaged in a number of successful, though highly underfunded, voluntary data collection, pollution prevention, and sustainable design programs that have been important motivators for sustainable chemistry. Policy innovation in the establishment of numerous state level initiatives on persistent and bioaccumulative toxics, chemical restrictions and toxics use reduction have resulted in pressure on the federal government to augment its efforts. RESULTS AND CONCLUSIONS: It is clear that data collection on chemical risks and phase-outs of the most egregious chemicals alone will not achieve the goals of sustainable chemistry. These alone will also not internalize the cultural and institutional changes needed to ensure that design and implementation of safer chemicals, processes, and products are the focus of the future. Thus, a more holistic approach of 'carrots and sticks'--that involves not just chemical producers but those who use and purchase chemicals is necessary. Some important lessons of the US experience in chemicals management include: (1) the need for good information on chemicals flows, toxic risks, and safer substances.; (2) the need for comprehensive planning processes for chemical substitution and reduction to avoid risk trade-offs and ensure product quality; (3) the need for technical and research support to firms for innovation in safer chemistry; and (4) the need for rapid screening processes and tools for comparison of alternative chemicals, materials, and products.

Chemical Industry↗
PubMed1992

Drug use among university undergraduate students.

A sample of 457 undergraduate university students were surveyed to assess their current use of illicit drugs. Such information is to be used as a baseline to examine the effectiveness of drug prevention programs designed for this population. Marijuana was the most common illicit drug used among these students, and men were significantly more likely to report use. Age differences were noted; older students (age greater than or equal to 22 yr.) were more likely to report drug use than those students under 22 years of age. The age differences suggest that there may be a shift away from drug use among the younger students. The low over-all rate of drug use may make difficult the evaluation of prevention programs.

Adult↗
PubMed2003

[Quantitative assessment of right ventricular contractility by contrast angiography in healthy persons and patients with ischemic heart disease].

Absence of special programs for quantitative analysis of right ventricular volumes and function precludes precise evaluation of right ventriculography data. We used standard programs designed for analysis of left ventriculograms for evaluation of right ventricular volumes and function in 32 patients without and 20 patients with coronary artery disease. Left ventriculography and right angiography were carried out in 30- and 60-degree right and left anterior oblique projections, respectively. Average correction factors obtained by comparison of left and right ventricular stroke volumes were 0.9243+/-0.2887 and 0.8758+/-0.2232 for patients without and with coronary artery disease, respectively. Such conversion was considered to be simple and adequate method of adaptation of existing programs of quantitative analysis of angiograms for evaluation of right ventricular volumes and function.

Adult↗
PubMed2002

Evaluation of the North Country on the Job Network: a model of facilitated care for injured workers in rural upstate New York.

We describe the evaluation of a community-based program designed to facilitate access to care and return to work for injured workers in a rural, medically underserved area in upstate New York. Providers are recruited to provide easily accessible care and are oriented to concepts of transitional duty and rapid return to work as medically appropriate; companies are recruited with the agreement to provide transitional work for injured employees. Registered nurses, hired by the local hospital, serve as case coordinators to facilitate care and coordinate communications among all parties. Over 3000 injured workers received care through the program in the first 56 months, with a decline in the number of transitional days over time. The number of days that the cases remain open has steadily declined, and the number of return-to-work cases has increased. The success of this initiative provides an excellent background for continued improvement in delivery of care to injured workers and proactive efforts at improving workplace safety and health in a rural area.

Accidents, Occupational↗
PubMed1989

Prevention of childhood injuries: evaluation of the Statewide Childhood Injury Prevention Program (SCIPP).

We evaluated the effectiveness of a community-based injury prevention program designed to reduce the incidence of burns, falls in the home, motor vehicle occupant injuries, and poisonings and suffocations among children ages 0-5 years. Between September 1980 and June 1982, we implemented five injury prevention projects concurrently in nine Massachusetts cities and town; five sites, matched on selected demographic characteristics, were control communities. An estimated 42 percent of households with children ages 0-5 years were exposed to one or more of the interventions over the two-year period in the nine communities. Participation in safety programs increased three-fold in the intervention communities and two-fold in the control communities. Safety knowledge and practices increased in both intervention and control communities. Households that reported participatory exposure to the interventions had higher safety knowledge and behavior scores than those that received other community exposure or no exposure to intervention activities. We found a distinct reduction in motor vehicle occupant injuries among children ages 0-5 years in the intervention compared with control communities, associated with participatory exposure of about 55 percent of households with children ages 0-5 years. We have no evidence that the coordinated intervention programs reduced the other target injuries--although exposure to prevention messages was associated with safety behaviors for burns and poisonings.

Accident Prevention↗
PubMed2006

Workplace response to virtual caregiver support and remote home monitoring of elders: The WIN project.

Research has demonstrated the health and financial cost to working caregivers of older adults and the cost to business in lost productivity. This paper describes the implementation of the Worker Interactive Networking (WIN) project, a Web-based program designed to support employed caregivers at work. WIN innovatively linked working caregivers via the Internet to home to monitor elders' status using wireless sensor technology and included an online information and support group for a six-month period. Twenty-seven employees from thirteen business sites participated. Despite problems with wireless carrier service, feasibility outcomes were achieved. We were able to collect six months of continuous real time data wirelessly from multiple types of homes across 4 states. This model demonstrates that businesses can offer a similar program and not be overwhelmed by employee demand or abuse of technology access. Reluctance to consider home monitoring was apparent and was influenced by familial relationships and values of privacy and independence.

Aged↗