Family planning and human rights.
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People often think that "technology" means "machines". But according to WHO a technology is an association of methods, procedures, techniques, and equipment which, together with the people using them, can contribute to solving a health problem. An appropriate technology is one that is scientifically sound, adapted to local needs, acceptable to those who use it or for whom it is used, and that can be maintained and utilized with resources that the community can afford. Many different technologies have contributed enormously to reducing maternal and perinatal mortality and morbidity. Yet, very often, not enough attention is paid to the economic, human, and infrastructure implications of the technology or to the implications of introducing it into a new setting. This issue of Safe Motherhood looks at some of the technologies currently widely available in maternal and neonatal health care and asks two simple questions. Has this technology been evaluated in different settings? And at which level of the health care system can this technology be used appropriately?
BACKGROUND: Interactive health communication technologies have the potential to eliminate or greatly reduce many of the barriers to delivery of preventive services. This paper describes the process of developing and evaluating interactive health communication programs for primary care settings. We present as examples the Patient-centered Assessment and Counseling for Exercise plus Nutrition (PACE+) programs, designed to promote physical activity and healthy nutrition with adolescents and adults. METHODS: The PACE+ programs use interactive communication technology to screen multiple behaviors, prioritize areas for intervention, and initiate intervention. Patient information is synthesized for ease of use by clinicians. The patient completes the program on a computer in the clinic waiting room before the provider encounter. Acceptability of the program was evaluated with adolescents (n=252), adults (n=285), and their health care providers. RESULTS: The PACE+ programs were developed, evaluated, modified, and re-evaluated. Feasibility testing indicated that a diverse group of adolescents and adults found the PACE+ computer programs acceptable. Modifications to shorten and refine the programs were identified. CONCLUSIONS: Development of interactive health technologies is an iterative process dependent on feedback from intended users and systems of care. Interactive health communication technologies can be incorporated into clinical settings.
Conformal radiation therapy using dynamic beam delivery systems like scanned ion beams requires concise quality assurance procedures for the complete treatment planning process. For the heavy ion therapy facility at GSI, Darmstadt, a quality assurance program for the treatment planning system (TPS) has been developed. It covers the development and updating of software, data protection and safety, and the application of soft- and hardware. The tests also apply to the geometrical precision of imaging devices and the geometrical and dosimetrical verification of dose distributions in different phantoms. The quality assurance program addresses acceptance and constancy tests of the treatment planning program. Results of the acceptance tests served as a basis for its governmental approval. Two main results of the acceptance tests are representative for the overall performance of the system. (1) The geometrical uncertainty that could be achieved for the target point definition, setup accuracy, field contouring, and field alignment is typically 1.5 mm. The uncertainty for the setup verification using digitally reconstructed radiographs (DRR's) is limited to 2 mm. (2) The mean deviations between measured and planned dose values is 3% for standardized cases in a water phantom and up to 6% for more complicated treatment configurations.
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