Cecilia Mosca | PubMed Health

PubMed2005

Implementation of youth development programs: promise and challenges.

PURPOSE: The Community Coalition Partnership Program for the Prevention of Teen Pregnancy provided a unique laboratory for observing how youth development projects were implemented in 13 community-based settings. This article focuses on the scope of these efforts, the content of the projects, and their expected outcomes. METHODS: The investigators inventoried all youth development activities created within the grantee communities between 1997 and 2000 and then surveyed 28 site representatives by telephone. The scope and content of the identified youth development programs were compared with national registries of other such programs. RESULTS: The youth development efforts implemented by the 13 grantees were diverse, multi-faceted, and broad in scope. Most were short-term, but reflected a broad base of support for youth development principles among various community partners. Of the array of youth development efforts developed, more than two-thirds targeted three program areas: community services/outreach, education/training programs, or mentoring programs-a pattern found among youth development programs throughout the country. CONCLUSIONS: Within this partnership, youth development was a better-received framework for mobilizing community partners than were more traditional pregnancy prevention approaches. Communities were successful in creating diverse programs that may have benefits for individual youth, service agencies, and the community at large.

Adolescent↗

PubMed2005

Determinants of long-term survival after major surgery and the adverse effect of postoperative complications.

OBJECTIVE: The objective of this study was to identify the determinants of 30-day postoperative mortality and long-term survival after major surgery as exemplified by 8 common operations. SUMMARY BACKGROUND DATA: The National Surgical Quality Improvement Program (NSQIP) database contains pre-, intra-, and 30-day postoperative data, prospectively collected in a standardized fashion by a dedicated nurse reviewer, on major surgery in the Veterans Administration (VA). The Beneficiary Identification and Records Locator Subsystem (BIRLS) is a VA file that depicts the vital status of U.S. veterans with 87% to 95% accuracy. METHODS: NSQIP data were merged with BIRLS to determine the vital status of 105,951 patients who underwent 8 types of operations performed between 1991 and 1999, providing an average follow up of 8 years. Logistic and Cox regression analyses were performed to identify the predictors of 30-day mortality and long-term survival, respectively. RESULTS: The most important determinant of decreased postoperative survival was the occurrence, within 30 days postoperatively, of any one of 22 types of complications collected in the NSQIP. Independent of preoperative patient risk, the occurrence of a 30-day complication in the total patient group reduced median patient survival by 69%. The adverse effect of a complication on patient survival was also influenced by the operation type and was sustained even when patients who did not survive for 30 days were excluded from the analyses. CONCLUSIONS: The occurrence of a 30-day postoperative complication is more important than preoperative patient risk and intraoperative factors in determining the survival after major surgery in the VA. Quality and process improvement in surgery should be directed toward the prevention of postoperative complications.

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