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Interaction effects of client and treatment program characteristics on retention: an exploratory analysis using hierarchical linear models.

This paper applied a hierarchical linear modeling approach to explore the interaction effects of treatment program and client characteristics on client retention in treatment for drug users. Program characteristics included services provision, funding sources, and staff-client gender congruence, and client characteristics included gender, age at admission, and drug use level prior to admission. The same model was applied separately to three modalities: residential, methadone maintenance, and outpatient drug-free programs. Data were obtained from 59 treatment programs and 3,764 of their clients who had discharge records. The most noteworthy significant interaction effect detected was program's funding source and client's gender on treatment retention in the outpatient drug-free modality. For example, female clients remained less time in the programs that accepted only public funding than in the programs that accepted both public and private funding. Male clients remained in the treatment an average of 25.3 fewer days than female clients in drug-free programs that only accepted public fund, but stayed about the same time as females if the programs received mixed funding.

Adult↗

Swine influenza vaccine program in the community: acceptability, reactions and responses.

The operation of the national swine influenza immunization program was observed in the community of Tecumseh, Michigan. The purpose was to determine acceptability of a parenteral vaccine intended for the general population. Participation of the residents was excellent. More than 64 per cent of eligibles were vaccinated; this figure resembled that of the rest of the local area, but not the national figures nor a suburban area of Michigan where a similar study was carried out. Sore arm after vaccination was reported most frequently in younger female participants; however, sore arm was accepted as part of the process of vaccination and not considered a reaction by most. Such perceived reactions were not as commonly reported as in the large suburban area. Antibody response to the vaccine was excellent, not only in terms of antibodies to the swine virus itself but also in terms of cross reactive antibodies to the emergent H1N1 (Russian) influenza strain. As a result of the program, many vaccine recipients in the 25 to 49 year age groups are protected against this new epidemic virus.

Adolescent↗

Health care provider and contraceptive care setting: the relationship to contraceptive behavior.

This study examines contraceptive delivery characteristics and their association with contraceptive behavior. Data were collected in telephone interviews from a national sample of 1057 women who were using female contraceptives. The overwhelming majority of the sample obtained contraceptive services from gynecologists and other physician specialists and were seen in private facilities. Whereas nearly half of the providers recommended use of specific methods, only one-fourth discouraged use of particular methods. The pill was both the most frequently recommended and most commonly discouraged method. With regards to the provision of contraceptive information, practitioners were most likely to discuss the effectiveness of a method. In three of the four categories examined, a higher percentage of non-MDs than MDs gave information to their patients. Although the majority of women reported they were satisfied with the quality of care, mean satisfaction ratings were higher for female providers compared to male providers.

Adolescent↗

Quality assurance in prevention.

The successful prevention of caries in Sweden, as in many other countries, is an example of what might he obtained when a systematic and complete program is adopted. Fluoride programs, mechanical cleaning of the teeth, and improved nutrition and eating habits have been the most important fundamentals for the positive results. A diminished use of tobacco, with a reduced frequency of periodontitis as one of the consequences, has been successful in some groups in the population but less so in others. There is, however, evidence now in Sweden of a less active preventive approach concerning caries prophylaxis among some parents today than a generation ago. Thus, there are obvious reasons to continue with oral preventive programs, preferably integrated with general health programs. For acceptable quality in preventive programs to be obtained, concrete goals must be formulated. These should be based upon scientific findings. Those in the society who should be given priority in the program must be identified by epidemiological studies. Systems for follow-up of the preventive measures should be integrated into the programs when they are initiated. Total quality assurance programs should include parameters which describe the resources and the process needed to obtain the formulated goals. The qualifications of those involved in the process are among the most important resources for success.

Dental Caries↗

Evolution of a processing system in a large biomedical library.

The processing system used in the UCLA Biomedical Library is modest in size and still under development. Its origins date back to a batch mode serials control system begun in the mid-1960s. This was converted to an on-line system which currently has modules for check-in, updating and retrieval, claims, bindery preparation, and invoice information. Titles can be retrieved at the terminal by search of any word in the title, by subject heading, language, country of publication, and type of publication. The system is adaptable to network use and at present is shared with one other library. To the serials system has been added a computer-assisted cataloging and card production system. The latter utilizes serials nucleus software as well as design for data input and data storage. In-house listings and coding procedures overlap in a general way. Work is under way on further integration of the two processing subsystems and a feasibility study has been completed for addition of a subsystem for acquisitions which will combine and adapt features of the other two; for example, information retrieval characteristics from both, catalog coding and programs for acceptance of data, serials programs for claims, and other output programs. Cost benefits of the subsystems are described and discussed.

Cataloging↗

Modern health services and health care behavior: a survey in Kathmandu, Nepal.

The most important problem regarding health service utilization in Third World countries is that established indigenous forms of health care are readily available and compete with modern health care. Thus, in addition to understanding the components of the decision to seek medical help, we must understand the conditions that affect the choice of a specific health care system. This study examines the impact of medical pluralism on the use of modern forms of health care in Nepal. The findings show that the presence of medical pluralism is a significant factor which delays use of modern health services. Policy implications are discussed, and the need for more research in this area is stressed.

Attitude to Health↗

Intuitive user interfaces (IUI): a CASE starting point for design and programming.

The acceptance of a software product depends to a considerable extent on the user interface. The class of graphic-oriented user interfaces that are called Intuitive User Interfaces (IUI) is described. These interfaces allow the user to learn to operate software programs quickly. In the following the graphical layout put to use in an IUI is elaborated. All images the layout consists of are created with the aid of a paint program. Using these images, a procedure for creating, programming and linking an IUI to software applications is discussed and recommendations are made concerning software and hardware demands for easily creating IUIs. Practical experience of the authors with this procedure, mainly in the medical area, is described.

Computer Graphics↗

Determinants of acceptance of a community-based program for the prevention of falls and fractures among the elderly.

BACKGROUND: Low-energy fractures among the elderly may be prevented by measures aimed at reducing the risk of falling or increasing the strength of the skeleton. Acceptance of these interventions in the target population is necessary for their success. METHODS: The total elderly population in a Danish municipality 7,543 community-dwelling persons aged 66+ years, were offered participation in one of three intervention programs: 2,550 persons were offered a home safety inspection, evaluation of prescribed medicine, and identification of possible health and food problems (Program I); 2,445 persons were offered 1000 mg of elemental calcium and 400 IU (10 microg) of vitamin D(3) per day in combination with evaluation of prescribed medicine (Program II); and 2,548 persons were offered a combination of the two programs (Program III). Acceptance was defined as willingness to receive an introductory visit by a nurse. RESULTS: Acceptance of Program I was 50%; of Program II, 56% (P < 0.00005 as contrasted with Program I); and of Program III, 46% (P < 0.005). Acceptance was associated with gender (females, 53%; males, 47%) and did not change from ages 66 to 84 but decreased significantly after the age of 85. Widows aged 66-84 had the highest acceptance (57%) and never married males aged 66-84 the lowest (30%). An important determinant, however, was the individual social service center that communicated the specific program. Acceptance varied from 39 to 66% between the social centers. CONCLUSIONS: Acceptance of a fall and fracture prevention program varies with intervention type; with gender, age, and social status of the target population; and with the motivation and attitude of the health workers involved in the implementation of the program.

Accidental Falls↗

An evaluation of a television-delivered behavioral weight loss program: are the ratings acceptable?

This experiment evaluated the efficacy of television delivery of a behavioral weight reduction program. Seventy-one overweight adults were randomly assigned to a live-contact weight loss group that was videotaped for viewing by other groups, a live-contact group that was not videotaped, a television-delivered group that observed the videotaped weight loss sessions, or a waiting-list control group. Participants in all 3 treatment groups lost significantly more weight during the 8-week treatment program than those in the waiting-list control group. There was no significant weight loss differences among the 3 treatment groups during the program. These weight changes were maintained at 3-month follow-up. At 15-month follow-up, the television-delivered group and the live-contact group maintained their weight losses, whereas the videotaped group did not. Cost-effectiveness analyses indicated that the television-delivered group received the most cost-effective treatment.

Adult↗