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PubMed2006

Evidence-based periodic health examination of adults. Memory aid for primary care physicians.

PROBLEM ADDRESSED: There is currently no peer-reviewed evidence-based memory aid that incorporates recommended prevention guidelines to direct family physicians during periodic health examination of adults. OBJECTIVE OF PROGRAM: To devise a memory aid to guide primary care physicians during periodic health examination of adults that incorporates the most current evidence-based recommendations of the Canadian Task Force on Preventive Health Care and of the United States Preventive Services Task Force. PROGRAM DESCRIPTION: This memory aid is a two-page easy-to-use form that lists evidence-based maneuvers for adults aged 21 to 64 that should be carried out during periodic health examinations. This article describes the form and discusses the evidence currently available for the maneuvers mentioned on the form. To validate the memory aid, results of qualitative assessment in one academic and 15 community settings are presented. CONCLUSION: This user-friendly memory aid was developed to provide primary care physicians with rigorously evaluated guidelines in an accessible format for use during periodic health examination of adults.

Adult↗

PubMedDate not supplied

Technology assessment in health care: group process and decision theory.

As biomedical technologies proliferate, it is incumbent upon the scientific community to monitor, validate, and encourage adoption of worthwhile procedures, drugs, and devices across the interface from research to practice. As the largest U.S. sponsor of biomedical research, the National Institutes of Health (NIH) formally established the Consensus Development Program and the Office of Medical Applications of Research (OMAR), in order to foster and improve the translation of biomedical research results into knowledge useful in the practice of medicine and public health. Individual technology assessments are conducted through a succession of consensus development conferences, which convene expert biomedical scientists, practicing clinicians, and public representatives in an effort to assess safety and efficacy, and to recommend clinical application of important medical technologies. The Consensus Development Program has evolved through three distinct stages. The "first generation," from 1977-82, initiated the experimental, untested concept of consensus development; the "second generation" (1982-84) stressed formulation of the code of standard operating principles enunciated above; and the ongoing "third generation" is testing the utility of formal data synthesis to augment assessments. OMAR is experimenting with an explicit, normative and analytic approach to aid technology assessments. Real-time microcomputer-based decision models are created to help the panel explore the implications of the data. This paper describes and discusses decision analysis and its potential applicability to medical technology assessment and consensus development. It explores OMAR's experience in testing the model during several consensus development conferences, as well as plans and projections for future investigation and implementation.

Decision Theory↗

PubMed1976

A statewide biomedical communications network for South Carolina.

In 1972, the Medical University of South Carolina was awarded a contract to establish 4 Area Health Education Centers in South Carolina. These centers, based in community hospitals, provide residency programs, clinical instruction for students, and continuing education programs for health professionals. In late 1974, contractual agreements between the Medical University of South Carolina's Library/Learning Resource Center and the Area Health Education Centers were negotiated to provide book and nonbook learning materials to all health practitioners in South Carolina. The history and the functions of the resulting network and evaluation of audiovisual and self-instructional learning materials procured and distributed by the network are described.

Area Health Education Centers↗

PubMedDate not supplied

Basic plan and assessment of an information system designed to aid patient transfer.

One of the important assignments in the planning of community medical care is to find an effective way of implementing the sharing of facilities together with their coordination. In particular, the establishment of a smooth and effective system co-ordinating facilities and functions of medical organizations, comprising clinics and hospitals of various levels, and the installation of an information system, designed to provide positive assistance in information control as well as in its operation, should be undertaken urgently. In this paper, we discuss the patient-transfer system, which is one of the facility-co-ordination-system for medical organizations, from the point of view of total community medical care. Specifically we describe the purpose, features and total structure of the patient-transfer system, and discuss the basic plan for an information system designed to aid patient transfer, from information control together with an advance assessment from the system-engineering point of view. This research has been promoted by the Aichi Medical Association committee for medical care system. The proposed system is planned to be operational in the near future.

Information Systems↗

PubMed1990

AIDS prevention for intravenous drug users in the community: street-based education and risk behavior.

Conducted a study of behavior change associated with a street-based AIDS education project targeted to intravenous (IV) drug users in San Francisco. Two cross-sections were sampled from drug detoxification clinics and street locations in 1986 (n = 438) and 1987 (n = 623). Significant increases were reported in the percentage of IV drug users who used bleach to decontaminate syringes, who did not share needles in past year, and in condom use. A significant reduction in an index of the number of needle-sharing partners was reported. Respondents ranked treatment program as most important source of AIDS information prior to implementation of the program, and ranked outreach workers as most important after implementation. Findings suggest that this community-based outreach program had at least some impact on knowledge about AIDS and may have led to reductions in behaviors known to transmit HIV.

Acquired Immunodeficiency Syndrome↗

PubMed1985

Human artificial insemination by donor and the Australian community.

Findings from a national sample of 989 persons and an 'Opinion Leader' survey of 279 executive and ordinary members of 40 organizations identified as having an interest in AID showed that Australians overall approved of the procedure for helping infertile married couples, only 17% of the national sample unequivocally disapproving. Key variables in determining opinions on AID included age, education, country of origin, family status, religion and exposure to infertility. However only 15% of national respondents accepted that AID should be made available to any unmarried women on request although opinions were more evenly spread on its provision to unmarried women in a long-term relationship with a man. Over one-third of 'Opinion Leaders' believed that children should never be told of their AID conception, 13% that they should be given identifying and one third non-identifying information on the donor. A majority believed that AID should be directly carried out or supervised by doctors in hospital clinics. There was strong opposition to business or voluntary organization involvement. Suggestions for changes in the law, while emphasizing protection of donors, recipients, children, persons who ran AID programs and control over futuristic research activities, often showed a misunderstanding of the legal process. The major reasons for exclusion of donors were genetic defects and medical problems although many behavioural characteristics were mentioned. Views on recipients' rights to choose the sex of the AID child were marginally against the proposition.

Adolescent↗

PubMed2004

Scaling-up HIV treatment programmes in resource-limited settings: the rural Haiti experience.

OBJECTIVE: To scale-up a successful HIV/AIDS treatment project and provide comprehensive care to an entire Département du Centre (population 550 000) in rural Haiti, thereby demonstrating that community-based treatment of HIV is feasible and highly effective in resource-limited settings, and serving as a successful model for others to replicate. PARTICIPANTS: In the Département du Centre of rural Haiti comprehensive HIV and tuberculosis treatment is provided free of charge to anyone who presents for care. All those who meet clinical enrolment criteria are treated with highly active antiretroviral therapy (HAART). INTERVENTION: HAART was provided in the context of a comprehensive programme of HIV, tuberculosis (TB), sexually transmitted disease (STD) of the project, treatment and prevention, and women's health services at four sites in the first year. At each site, the medical facility was renovated, additional staff were hired as needed, and a network of accompagnateurs (community health workers) was established throughout the surrounding villages to serve as a link with the community, and to provide directly observed treatment (DOT). RESULTS: In the first year of programme scale-up, over 8000 patients were followed for HIV, and over 1050 were treated with DOT HAART. Adherence to HAART was very high, and clinical outcomes were excellent: all patients responded with weight gain and improved functional capacity, and fewer than 5% required medication changes due to side effects. Viral load was tested among a subset of patients showing that 86% had undetectable viral loads. CONCLUSION: Community-based care of AIDS has been highly effective in rural Haiti. With more international financial support for HIV/AIDS treatment in resource-limited settings, there should be no barriers to access to life-saving HAART for those who need it most.

Antiretroviral Therapy, Highly Active↗

PubMed1992

People's Community Clinic: collaboration in the Third World.

A West African government undertook to improve primary health care (PHC) training of mid-level health workers. In partnership with a neighboring squatter settlement, the premiere local training institution created a community-sponsored clinic, providing low-cost, PHC services, and a birthing center, as well as student experiences. Their collaboration in mobilization, research, planning and operations are described. Their success should encourage other educational and training institutions to consider a similar approach.

Africa, Western↗

PubMed1999

Vaccine injury compensation programs worldwide.

Approximately a dozen countries provide some form of compensation for injuries (or deaths) following vaccination. More than anything else, they were instituted in the belief governments have a special responsibility to those injured by properly manufactured and administered vaccines used in public health programs. Administratively, most are managed through the national government, including decisions on eligibility for and amount of compensation. Eligibility may depend on the recipient's age, citizenship or residency status, category of vaccine (e.g., recommended, compulsory), the location it is administered (public vs private ambulatory setting), or satisfying certain time frames for filing a claim. Since few vaccine-related injuries have a clinical or laboratory marker, proving actual causation is difficult. Causation decisions are usually based on the balance of probabilities standard of more likely than not. All countries require that the effects be long lasting (e.g., greater than 6 months), and nearly all provide coverage for medical costs, disability pensions, and death benefits, while noneconomic damages (pain and suffering) are included much less frequently. Funding is generally from the national treasury, with some programs receiving support from lower governmental entities or vaccine manufacturers. After nearly 4 decades of operation, vaccine injury compensation program appears to be an increasingly accepted component of immunization programs today. While we have a much better understanding of their statutory purpose, frame work, process and outcome, there is much more to be learned. Future research should focus on vaccine compensation programs and (1) decision-making at the administrative level; (2) the utilization of outcome indicators in order to gauge effectiveness, including immunization acceptance; (3) the knowledge and attitudes of the public and medical community in host countries; and (4) the overall perspective of vaccine manufacturers. Insight into these and other areas will no doubt aid other countries as they consider implementing programs of their own.

Humans↗

PubMed2004

Obstructed inguinal hernia: role of technical aid program.

AIM: The purpose of the study was to determine the influence of the presence of a surgeon on the outcome of obstructed inguinal hernia at Mongomo, in Equatorial Guinea. METHODOLOGY: A prospective study of patients with obstructed inguinal hernia seen between June 1997 and May 1999 was carried out. During the same period, all uncomplicated hernias seen at the surgical outpatient clinic were noted. RESULT: Fifteen patients presented with obstructed inguinal hernia, while 138 were uncomplicated. All the 15 patients were males, and one of them died. Death resulted from lack of treatment as he presented on our arrival on a technical aid program from Nigeria. The others (N = 14) were operated upon, and eight of them had resection of the intestine because of gangrene. The duration of obstruction was more than two days among those that had bowel resection. COMMENT: Inguinal hernia is a treatable surgical condition. When done electively, the cost and the risk of treatment are very low. Operative treatment can only be offered to patients with inguinal hernia by a surgeon in the community. CONCLUSION: The study has demonstrated that the presence of a surgeon in a community changes the outcome of obstructed inguinal hernia. Sponsorship of medical aid programs should be encouraged.

Equatorial Guinea↗

PubMed2002

Sexual health work in a playground: lessons learnt from the evaluation of a small-scale sexual health project.

OBJECTIVE: To evaluate a sexual health outreach programme in an adventure playground. DESIGN: A qualitative approach to evaluation is appropriate for a sexual health project where outcomes are unpredictable, difficult to define in numerical terms and the small scale of the intervention means that an impact on indices such as teenage pregnancy rates is unlikely. The data collection techniques used were the outreach worker's diary, questionnaires and interviews with youth workers, and a focus group with young people. RESULTS: Work in young people's leisure space requires flexible working in disrupted environments and a responsive approach to diverse individual needs. The outreach worker successfully engaged boys and girls in sexual health discussions. As a result of the project, youth workers' confidence in discussing sexual health issues and ability to refer to the clinic increased. CONCLUSION: Clinical staff providing a sexual health outreach service for young people offer a knowledge of sexual health and local clinical services and an opportunity to build positive relationships between clinics and local community organisations. The relationships help youth workers to raise sexual health issues with young people and to refer problems appropriately. Clinical staff doing outreach work may require additional skills to work in young people's leisure space, for example, the ability to negotiate the content of sessions and to tolerate disruption. A qualitative approach to evaluation effectively documents a range of project outcomes, including those which were unforeseen and which could not have been documented through the collection of numerical data. It also provides a detailed description of the process of project implementation, which aids replication.

Adolescent↗

PubMed1998

Long-term effects of HIV counseling and testing for women: behavioral and psychological consequences are limited at 18 months posttest.

Behavioral and psychological consequences of HIV counseling and testing (HIV C&T) for women were examined in a longitudinal, prospective study. Women who received HIV C&T at community health clinics (n = 106) and a comparison group of never-tested women (n = 54) were interviewed five times over 18 months. There was no change in risk behaviors as a consequence of testing: tested and untested women engaged in high-risk sexual behavior at baseline and 18 months later. Tested women reported more anxiety, depression, and intrusive thoughts about AIDS than did untested women. Although tested women were more concerned about AIDS, their potential risk factors over the study period generally were equivalent to those for untested women. HIV counseling and testing should be considered one aspect of a broader program of HIV prevention. Identification of alternative interventions must be a public health priority.

Acquired Immunodeficiency Syndrome↗

PubMed1993

Educating school nurses to care for HIV-infected children in school.

Effects of an educational program on school nurses' knowledge and attitudes about human immunodeficiency virus (HIV) infection in children and changes in practice was investigated. Participants (N = 205) attended a one-day workshop held at 11 sites in New Jersey. Content was clinically focused and derived from a needs assessment of a sample of school nurses throughout New Jersey. An adult education format was used, with interactive and affective teaching strategies modeled on the AIDS Training Program of the California Nurses' Association. Subjects were pretested and posttested for knowledge and attitudes about HIV in children. An identical posttest mailed three months later included a self-report of change in practice since attending the workshop. Knowledge and attitude scores were significantly higher at program completion (p < .0001). Three months after the program, knowledge scores had fallen but not to pretest levels. No significant difference existed between attitude scores after the program and three months later. On self-report of change in practice, respondents indicated they institute or improved universal precautions, and were more comfortable in teaching children, staff, and their communities about HIV.

Adolescent↗

PubMed1991

Stories as a mnemonic aid for older learners.

The effectiveness of a story mnemonic for free-recall learning was assessed in 71 community-dwelling elderly adults. Participants received 1 of 3 memory-training programs: (a) narrative story, (b) method of loci, or (c) placebo training. The stimuli consisted of 26 nouns chosen for being highly imagible and concrete. Recall was examined immediately following study of the words, after 1 hr, and after 3 days. At each testing interval, both mnemonic condition groups outperformed the placebo group. The results suggest that a story mnemonic can enhance word retention on a free-recall task.

Aged↗

PubMed1986

Improvement in coverage of primary health care in a developing country through use of food incentives.

To improve attendance at mobile clinics for children food incentives were offered to attenders in a rural municipality in northern Nicaragua. Clinic attendance in villages where food incentives were offered was higher than that in control villages (96.5% vs 63.3% of child population, p less than 0.005). When food was later offered in control villages, attendance rose by 60.2% to full attendance (p less than 0.001). Some of the large amounts of non-emergency food aid available could be offered as incentives to increase the use of basic health services in developing countries.

Adult↗

PubMed1993

We have a prejudice against ourselves -- sentiment, ethics, and reason.

Briefly stated my point is that the well-being of each person in a community conceived abstractly may be all too easily sacrificed for the sake of the abstraction. Physicians may offer critically ill patients places in programs of experimental treatment, but there is commonly a catch to the offer. To take part in a program of clinical experiment a patient must not only risk a possible failure of a fresh drug and the chance of destructive side effects from the drug, but the patients must risk only getting the traditional treatment along with a placebo rather than the experimental drug. Placebo control, double blind critical protocols for testing effects of fresh drugs on critically ill patients are a commonplace. I question the scientific objectivity of the protocols and the underlying ethic, and suggest use of alternate protocols. Experimental tests in the treatment of gram-negative bacteria blood infections, muscular dystrophy, and AIDS and AIDS-related diseases are examples.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Patterns of use of a free nicotine patch program for Medicaid and uninsured patients.

This study assessed the use and effectiveness of a free nicotine patch program among Medicaid and uninsured smokers. Patterns of patch use, associated behaviors with quit attempt, side effects, and self-reported abstinence from smoking for 6 months were evaluated prospectively among patients from five urban family practice offices and a nicotine dependence clinic located in a comprehensive cancer center in Western New York. Results indicated that the majority of participants used the program as intended, and 90% of the participants found the patch useful in their quit attempt. Fourteen percent of participants were abstinent for 6 months or more. We found no support for inappropriate use of transdermal nicotine patches among patients with no health insurance or those on Medicaid. Transdermal nicotine patches are an effective cessation aid for smokers. Given the tall of the consequences of smoking on health costs, barriers to access to effective treatment for smoking cessation among individuals covered by Medicaid for health insurance need to be eliminated.

Administration, Cutaneous↗

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↗