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PubMed2002

Charting a course for the future of women's health in the United States: concepts, findings and recommendations.

The JHU Women's and Children's Health Policy Center, with the federal Maternal and Child Health Bureau, undertook a review of the health of women in the United States and invited experts to develop recommendations on health policy, programs, practices and research. The review included published research, program reviews, and policy reports on women's physical health, mental health, and health behaviors, and on the effects of health services, systems and financing on their health. Based on trends in age, ethnic background, education, labor-force participation, marriage and childbearing among women, the results of the reviews, and the experts' consultation, several recommendations were made for a forward looking agenda. They included the need: (1) to focus broadly on women's health, not just during pregnancy; (2) for comprehensive, integrated programs and services addressing women's unique needs; (3) for integrated programs and services across the lifespan; (4) for better provider training about women's unique health needs, the differential effects of particular problems on them, and the consequences of chronic health problems heretofore considered primarily male problems; (5) to eliminate social policies that single out women, particularly pregnant women, for punitive actions; (6) to promote social policies that ensure economic security for women; and (7) for vigorous public health leadership to shape the women's health agenda, recognizing the social and economic context of their lives. The social and economic trends among women in the US and the recommendations for a women's health agenda have relevance to other developed countries as well.

Developed Countries↗
PubMed2001

Managing the Brisbane River and Moreton Bay: an integrated research/management program to reduce impacts on an Australian estuary.

The Brisbane River and Moreton Bay Study, an interdisciplinary study of Moreton Bay and its major tributaries, was initiated to address water quality issues which link sewage and diffuse loading with environmental degradation. Runoff and deposition of fine-grained sediments into Moreton Bay, followed by resuspension, have been linked with increased turbidity and significant loss of seagrass habitat. Sewage-derived nutrient enrichment, particularly nitrogen (N), has been linked to algal blooms by sewage plume maps. Blooms of a marine cyanobacterium, Lyngbya majuscula, in Moreton Bay have resulted in significant impacts on human health (e.g., contact dermatitis) and ecological health (e.g., seagrass loss), and the availability of dissolved iron from acid sulfate soil runoff has been hypothesised. The impacts of catchment activities resulting in runoff of sediments, nutrients and dissolved iron on the health of the Moreton Bay waterways are addressed. The Study, established by 6 local councils in association with two state departments in 1994, forms a regional component of a national and state program to achieve ecologically sustainable use of the waterways by protecting and enhancing their health, while maintaining economic and social development. The Study framework illustrates a unique integrated approach to water quality management whereby scientific research, community participation and the strategy development were done in parallel with each other. This collaborative effort resulted in a water quality management strategy which focuses on the integration of socioeconomic and ecological values of the waterways. This work has led to significant cost savings in infrastructure by providing a clear focus on initiatives towards achieving healthy waterways. The Study's Stage 2 initiatives form the basis for this paper.

Australia↗
PubMed1978

Integrated residency training in family medicine and general practice dentistry.

General practice dental training and family practice medical training can be combined into one effective integrated program. This combination benefits the patients in a family practice model unit, enhances family practice resident education, and will ultimately benefit patient care delivery. This paper describes the experience of such an integrated program which is now well established.

Education, Dental↗
PubMed1999

Monitoring of antimicrobial therapy by an integrated computer program.

OBJECTIVE: To assess the impact of the setting-up of a computer program designed by the Hospital Pharmacy Department as a tool that provides information for the antimicrobial therapy monitoring. To assess its influence on pharmaceutical costs. MATERIAL AND METHOD: The computer application for the follow-up of antimicrobial treatments integrates information from the Pharmacy Department and the Microbiology Laboratory and selects all patients to whom some controlled antibiotic has been prescribed. The pharmacist reviews all the controlled antibiotic treatments, suggests any change to the physician if needed and quantifies the economic impact of the accepted interventions. RESULTS: On average, 12.5% of controlled antibiotic treatments warranted a pharmaceutical intervention, and 92% of them were accepted. The most frequent interventions related to prescriptions were change of dosage and administration route and related to the disease were in respiratory and urinary tract infections. From the economic point of view, the accepted interventions represented a saving of 12,087,029 pesetas (83,359 $)/year, on average. CONCLUSION: The applied computer program resulted a useful tool for a clinical pharmacist to reach more correct antibiotical therapeutics and better cost-effectiveness relation. It also helped to achieve favorable clinical outcomes.

Anti-Bacterial Agents↗
PubMed2006

The patient experience with the mental health system: a focus on integrated care solutions.

OBJECTIVE: To discuss the benefits of working with a multidisciplinary team from the patient and family perspective. SUMMARY: According to patients and their families, stigma is the primary barrier hindering treatment for depression and is followed by a web of access to care, mental health parity, and medication issues. The Mental Health Integration program strives to eliminate these barriers by emphasizing consumer- or patient-driven treatment, family support, and community-based solutions. CONCLUSION: Working with a recovery model--"You are not alone, treatment works, recovery is possible, and there is hope"--the National Alliance on Mental Illness brings the family and consumer voice into the Mental Health Integration program, with the intention of effecting more widespread impact.

Adolescent↗
PubMed1978

25 years of an integrated vaccination program in Chile.

Various problems and subjects related to the long Chilean experience in vaccination programmes are reported. Emphasis is placed on proper administrative and planning steps in order to obtain the right epidemiological diagnosis, to develop the infrastructure of health, to support financially, to manage resources, to train personnel, to apply techniques and to evaluate periodically. The advantages of the integration of the programme in primary services are commented on. Epidemiological evaluation and surveillance are considered highly important in the successes obtained. The particular structure of health services in Chile has played a meaningful role in meeting public health requirements for the past 25 years, specifically with respect to vaccination programmes.

Chile↗
PubMed2004

Evaluation of perinatal care management programs: an integrated review.

Nursing care management has become a popular method to integrate health care systems with goals of decreasing costs and improving quality. As high-risk pregnancies and newborn intensive care unit (NBICU) costs generate some of the highest costs in health care, care management has been a strategy introduced in perinatal medicine to accomplish the same goals. Consistent with other areas of nursing, perinatal care management currently has no agreed upon model of practice or method of evaluating how and whether the goals have been achieved. The purpose of this project was to evaluate various perinatal care management programs found in the literature. Electronic and manual searches of current data were performed locating 31 relevant articles. From these articles, nine met the inclusion criteria and were reviewed. While some care management programs were able to decrease costs and improve outcomes, other programs did not. There are possibly two reasons for the varied results in the literature. The first is that there are differences in program designs, decreasing the likelihood of identifying specific interventions that can make a difference. Second, thus far researchers have used ineffective study designs in evaluating care management programs. More research needs to be completed before a conclusion can be drawn whether perinatal care management can decrease costs while improving quality.

Case Management↗
PubMedDate not supplied

[Development of an integrated software program to analyze statistically the results of complex investigations in space biology and medicine].

A concept of implementing the problem-oriented statistical software based on an application of expert systems is presented. The shortcomings of existing statistical software for personal computers and trends of their improvements are analyzed. Recommendations on designing of statistical expert systems can be used by the statisticians, mathematicians, programmers and users not being professionals in these fields. Integrated statistical software will make it possible to perform additional retrospective analysis and to check up the large arrays of previously gained data and to obtain supplementary scientific information and to find new regularities in the previous experimental findings.

Aerospace Medicine↗
PubMed2005

Learning opportunity and preparedness for practice: perceptions from dietetics programs in Canada.

PURPOSE: This study determined dietetics trainees' and program coordinators' perceptions about trainees' preparedness to practice, based on Dietitians of Canada's 145 competency statements. Depth and breadth of learning opportunity were also determined with definitions of these two concepts based on Elliott's view of professional education and practice. METHODS: Research questions were: 1. How prepared were trainees for practice? 2. What were the depth and breadth of learning opportunity in assessment, planning, implementation and evaluation? 3. How many learning opportunities were there in professional practice and communication? 4. Did responses vary between integrated programs and internships or between trainees and program coordinators? RESULTS: Of 313 trainees, 168 (54%) responded and 23 (72%) of 32 coordinators responded. Preparedness was rated as "well prepared" or better for 25 (56%) of the 45 main competencies. For every competency, preparedness ratings were higher in integrated programs than in internships. Learning opportunities were rated as sufficient in depth and breadth or number for 88 (61%) of the 145 competency statements. Low ratings for preparedness were accompanied by low ratings for depth and/or breadth or number of learning opportunities. CONCLUSIONS: The notion of depth and breadth is useful as a framework to assess learning opportunities for developing entry-level competence.

Canada↗
PubMed2002

New trend by states is to integrate HIV programs. Collaboration saves some resources.

Until recently, a typical model for providing HIV services has been to separate prevention and testing programs from treatment and care programs. While many states still adhere to this model, there's a new trend in which state health departments are encouraging the two groups to collaborate and even merge their boards. The goal is to increase efficiencies, save board members' time, and improve communication.

Cooperative Behavior↗
PubMedDate not supplied

[Program of integral general medicine].

This paper intends to present to all the medical profession, but more specifically to the Medican and Latin American medical workers and authorities, the main purposes that arm and give structure to a new concept of teaching and learning medicine called, "Integral General Medicine" (also known as "Plan A-36"). This plan in basically conceived for México and most of Latin American countries, but may be applied to any other. The main idea is to keep the students in close contact with the community in order to achieve the best of their knowledge, both theoretically and practically, since the very early stages of their entrance to the medical school. The whole scholarship curriculum is described with reference to every one of the four academic years that accomplish the program.

Community Medicine↗
PubMed1998

[The management of tuberculosis in the Republic of Cuba].

The essential aspects for the management of tuberculosis surveillance and control are described to propitiate their divulgation among to health professionals. Since 1970 there is an integrated program under way within the health services based on the localization of cases by the bacilloscopic examination and the sputum culture in symptomatic respiratory patients, the ambulatory controlled treatment, the investigation of the contacts of the notified cases, including the chemoprophylaxis with isoniacide, and the BCG vaccination to newborns. In 1995, the percentage of symptomatic patients detected at the general medicine offices was of 0.7%, whereas the percentage of the first bacilloscopy performed among the symptomatic individuals was of 78.6%, 99.5% of the detected contacts were investigated. 37.9% of the new cases were diagnosed at the primary health care level. After a decreasing trend maintained from 1979 to 1991, mortality has increased from 50 deaths (0.5 x 10(5)) in 1991 to 157 (1.4 x 10(5)) in 1995, and the incidence rose from 503 (4.7 x 10(5)) in 1991 to 1,574 (14.3 x 10(5)) in 1994, and to 1,553 (14.0 x 10(5)) in 1995, which suggests that the increase observed during the last 6 years begins to stop. The primary resistance to tuberculostatics was of 3.5% in 1992-1995, and of 11.5% in 1996. A priority integrated program of surveillance and control adjusted to the present socioeconomic conditions of the country is still going on.

Antitubercular Agents↗
PubMed2005

A comparison of sample weight and culture methods for the detection of Salmonella in pig feces.

Five protocols were compared to determine the combined effects of different sample weights and culture methods for the recovery of Salmonella from 310 pig cecal samples taken in abattoirs as part of the Canadian Integrated Program for Anti-microbial Resistance Surveillance. Sample weights evaluated were 1 and 10 g. Culture methods used with each sample weight were modified semisolid Rappaport-Vassiliadis agar (MSRV) and brilliant green agar with sulfa and novobiocin (BGSN) and xylose-lysine-tergitol-4 agar (XLT4). A preliminary sample preparation step in saline was also evaluated using a 10-g sample and MSRV. The Salmonella recovery rate varied from 20% for the saline MSRV 10-g protocol to 32% for the MSRV 10-g and the BGSN-XLT4 10-g protocols. A good agreement (K > 0.8) was observed between pairs of protocols except whenever the saline MSRV 10-g and the MSRV 1-g protocols were compared. Larger samples (10 g) yielded higher detection of Salmonella than 1-g samples for the MSRV protocol (32 versus 25%), whereas the differences were not statistically significant for the BGSN-XLT4 protocols. Protocols using the BGSN-XLT4 agar yielded higher detection rates of Salmonella compared with MSRV with 1-g samples (30 versus 25%), whereas it was equivalent with 10-g samples. Considering a greater recovery rate, the ease of use, and a better time and resource efficiency, the MSRV 10-g protocol was therefore adopted by the Canadian Integrated Program for Antimicrobial Resistance Surveillance.

Abattoirs↗
PubMed2005

Integrated Modeling Program, Applied Chemical Theory (IMPACT).

We provide an overview of the IMPACT molecular mechanics program with an emphasis on recent developments and a description of its current functionality. With respect to core molecular mechanics technologies we include a status report for the fixed charge and polarizable force fields that can be used with the program and illustrate how the force fields, when used together with new atom typing and parameter assignment modules, have greatly expanded the coverage of organic compounds and medicinally relevant ligands. As we discuss in this review, explicit solvent simulations have been used to guide our design of implicit solvent models based on the generalized Born framework and a novel nonpolar estimator that have recently been incorporated into the program. With IMPACT it is possible to use several different advanced conformational sampling algorithms based on combining features of molecular dynamics and Monte Carlo simulations. The program includes two specialized molecular mechanics modules: Glide, a high-throughput docking program, and QSite, a mixed quantum mechanics/molecular mechanics module. These modules employ the IMPACT infrastructure as a starting point for the construction of the protein model and assignment of molecular mechanics parameters, but have then been developed to meet specialized objectives with respect to sampling and the energy function.

Computer Simulation↗