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PubMedDate not supplied

The impact of development and population policies on fertility in India.

This article examines the impact of development and population policies on fertility decline and regional variations in India during the 1970s. Indicators of development at the household level include female literacy and education, infant mortality, and poverty; at the village level they include availability of such social services as schools, medical facilities, and transportation and communication facilities. Multiple regression analysis of data aggregated at the state level demonstrates that conditions conducive to fertility decline include high adult female literacy and low infant mortality as indicators of social development, and high contraceptive use and, to a lesser extent, high female age at marriage as proximate determinants of fertility. There are reasons to believe that India's national family planning program contributed to the decline in fertility observed since the 1960s. The pace of fertility decline in the future will depend upon the pace of infant mortality decline, enhancement in female education, and improvements in family planning programs.

Birth Rate↗
PubMedDate not supplied

From one generation to the next: changes in fertility, family size preferences, and family planning in an Indian state between 1951 and 1975.

Over the last 25 years modernization in Karnataka, India, resulted in a large reduction in infant and child mortality, substantial increases in literacy, and initiation of an intensive family planning program. The drop in the birth rate during this period, however, was much less than would be anticipated under such circumstances. Two surveys carried out in 1951--52 and 1975 provide data on current and cumulative fertility, family size preferences, and knowledge and use of family planning. A comparison of these data leads to the conclusion that the level of family planning activities was not high enough to counteract the increase in the fertility of married women that was a consequence of modernization.

Adolescent↗
PubMed1993

Acceptance of direct physician access to a computer-based patient record in a managed care setting.

Kaiser Permanente Mid-Atlantic States has developed a fully integrated outpatient information system which currently runs on an IBM ES9000 on a VM platform written in MUMPS. The applications include Lab, Radiology, Transcription, Appointments. Pharmacy, Encounter tracking, Hospitalizations, Referrals, Phone Advice, Pap tracking, Problem list, Immunization tracking, and Patient demographics. They are department specific and require input and output from a dumb terminal. We have developed a physician's work station to access this information using PC compatible computers running Microsoft Windows and a custom Microsoft Visual Basic 2.0 environment which draws from these 14 applications giving the physician a comprehensive view of all electronic medical records. Through rapid prototyping, voluntary participation, formal training and gradual implementation we have created an enthusiastic response. 95% of our physician PC users access the system each month. The use ranges from 0.2 to 3.0 screens of data viewed per patient visit. This response continues to drive the process toward still greater user acceptance and further practice enhancement.

Ambulatory Care Information Systems↗
PubMed1998

Health status and practices of urban Caribbean Latinos with diabetes mellitus.

Although Caribbean Latinos are more likely than non-Hispanic whites to develop diabetes, their health status has been poorly characterized. Information on diabetes management, metabolic control, dietary habits, and diabetes knowledge was gathered from a group of urban Caribbean Latinos with diabetes in order to characterize the nutritional behaviors, diabetes attitudes, health perceptions, and metabolic control of this high risk group. Interviews and medical record reviews were conducted among seventy low-income urban Caribbean Latinos with type 2 diabetes mellitus. Patients attending outpatient clinics were interviewed by bilingual interviewers. Medical records were reviewed to ascertain prevalence of diabetes-related complications, medications, and metabolic parameters. Participants were primarily Spanish-speaking and of Puerto Rican origin. Eighty-one percent were unemployed, and only 27% had completed high school or higher educational levels. Average hemoglobin A1c was 10.6%. Among those with hypertension and hyperlipidemia, many were not receiving treatment. Participants' estimation of their own degree of metabolic control was poor, as was their understanding of desirable blood glucose and weight goals. A second evening meal was common. Diets were higher in fat and sugar content than currently recommended. More effective treatment strategies for both patients and providers are needed to improve glycemic control and cardiovascular risk factors among indigent urban Caribbean Latinos. Essential features of such strategies for patient programs include culturally appropriate dietary counseling and low literacy materials to better communicate glycemic and weight goals and dietary guidelines. Provider education is needed regarding established guidelines and cultural influences on diabetes-related practices.

Attitude to Health↗
PubMed1996

The Washington Heights-Inwood Healthy Heart Program: a 6-year report from a disadvantaged urban setting.

OBJECTIVES: This report summarizes 6 years of experience in a large community-based cardiovascular disease prevention program in a predominately minority, urban setting. METHODS: The program seeks to reduce cardiovascular disease risk factors in an area of approximately 240,000 people in New York, NY; this population includes many Latino immigrants of low educational attainment and socioeconomic status. All program materials were in Spanish and English and at a low literacy level. RESULTS: Major elements that achieved high levels of reach and support were a marketing campaign promoting low-fat milk, exercise clubs, and a Spanish-language smoking cessation video. Program elements that did not meet expectations or were abandoned were school-based smoking prevention initiatives, cholesterol screening, and efforts to involve local physicians. At the end of 6 years, the program was transferred to a local community organization. CONCLUSIONS: Conclusions are that it is feasible to implement a complex cardiovascular disease prevention program in a socially disadvantaged urban community; that additional evaluation research is needed; that such programs can be transferred from an academic center to a community organization; and that such programs are unlikely to be sustained effectively without external resources.

Attitude of Health Personnel↗
PubMed1997

Conquering technophobia: preparing faculty for today.

The constantly changing world of technology creates excitement and an obligation for faculty of schools of nursing to address computer literacy in the curricula at all levels. The initial step in the process of meeting the goals was to assist the faculty in becoming computer literate so that they could foster and encourage the same in the students. The implementation of The Cure for Technophobia included basic and advanced computer skills designed to assist the faculty in becoming comfortable and competent computer users. The applications addressed included: introduction to windows, electronic mail, word processing, presentation and database applications, library on-line searches of literature databases, introduction to internet browsers and a computerized testing program. Efforts were made to overcome barriers to computer literacy and promote the learning process. Familiar, competent, computer literate individuals were used to conduct the classes to accomplish this goal.

Attitude to Computers↗
PubMed2001

Pictures to print: a software scaffold to written literacy.

BACKGROUND: Successful school placements require effective written literacy skills. When a student has traumatic brain injury (TBI), written literacy instruction may need to be individualized and intense to facilitate optimal reintegration into the school program. Software products can provide a method that assists in creating the needed individualized, intense experiences. Written literacy-learning experiences span a continuum from preconventional messages expressed through pictures, to conventional printed expressions designed to convey meaning, to the literate writing needed to create stories and reports. DESIGN: This article is designed to familiarize rehabilitation and research professionals in TBI with the range of written literacy software and to stimulate clinical applications and research related to their use with students who have sustained a TBI.

Adolescent↗
PubMed2005

Blood Pressure Sunday: introducing genomics to the community through family history.

BACKGROUND: Family history of a chronic disease, such as high blood pressure, is an important predictor of future disease. The integration of genomics information into public health activities offers the opportunity to help raise awareness among populations at high risk for high blood pressure. CONTEXT: The prevalence of high blood pressure in blacks at any age is about twice that of whites. Detroit is second among major U.S. cities in the percentage of residents who are black (81.6%). According to data from the Behavioral Risk Factor Surveillance System 1998-2002, the perceived health status of Detroit respondents was one of the worst in Michigan; 17.4% of Detroit respondents reported no health care coverage; 69.6% reported being obese or overweight; and 33.1% reported no physical activity. METHODS: The Michigan Department of Community Health and the University of Michigan's Center for Genomics and Public Health collaborated on a pilot program to develop a worksheet emphasizing the importance of personal family history of high blood pressure. The handout was distributed to individuals at primarily black, Detroit-area churches during an annual screening event for high blood pressure and stroke. CONSEQUENCES: Approximately 500 handouts were distributed; a collaborative effort was achieved; genomics information was integrated into an existing program; the ability to reach churches in a predominantly black community was demonstrated; consumers reported interest in the subject matter; and an appropriate literacy level for the handout was attained. INTERPRETATION: The strengths of this pilot program and suggested modifications may serve to guide others in genomics and/or chronic disease programs in future endeavors.

Black or African American↗
PubMed2001

[Analysis on the availability of programs and services for elderly people in Puerto Rico].

This research was conducted with the purpose of analyzing the programs and services available to the aged population in the municipalities of Puerto Rico during 1999 and 2000. The analysis was performed using an evaluation instrument which collected data of the programs and services directed exclusively to the aged population, such as: senior centers, foster homes, institutions, independent living, employed and/or volunteer people, geriatric services, adult education (literacy), recreation, discounts, corporations and/or associations that benefit the aged population, aging offices, support groups, social services, home meal services, and financial aid. Data was also collected from programs and services that benefit diverse aged populations in areas such as: health, housing, employment and social welfare. The sources for the collection of data were directories available to government and private agencies, telephone directories, telephone interviews, and personal visits. The municipalities were divided into two zones, the Northern zone, constituted by 40 municipalities and the Southern zone, constituted by 38 municipalities, for a total of 78 evaluated municipalities. In the Northern region, which accounted to approximately 295,938 aged persons, 18 types of programs or services were found to serve the aged population directly and 50 types were aged-related programs or services. In the Southern region, which accounted for approximately 169,798 aged persons, 13 types of programs or services served the aged exclusively and 43 were aged-related services. The following were among the principal programs or services available: senior centers, foster homes and/or institutions, employment programs, home care services and hospices, independent living, and agricultural extension services. Among the least available programs or services were private home meal services, literacy and retraining, arts and travel services, corporations or associations for the benefit of the aged, geriatric evaluation programs, home repair services, home-assistance programs, support and respite programs, adequate or specialized transportation services, diverse housing models, different types of senior centers, and programs for psychological or psychiatric assistance. In conclusion, the availability of the programs and services in this study and the evaluation of the services needed for a community of aged persons indicate the need for increasing and developing services considered essential in accordance to the population demands.

Aged↗
PubMed2006

eHEALS: The eHealth Literacy Scale.

BACKGROUND: Electronic health resources are helpful only when people are able to use them, yet there remain few tools available to assess consumers' capacity for engaging in eHealth. Over 40% of US and Canadian adults have low basic literacy levels, suggesting that eHealth resources are likely to be inaccessible to large segments of the population. Using information technology for health requires eHealth literacy-the ability to read, use computers, search for information, understand health information, and put it into context. The eHealth Literacy Scale (eHEALS) was designed (1) to assess consumers' perceived skills at using information technology for health and (2) to aid in determining the fit between eHealth programs and consumers. OBJECTIVES: The eHEALS is an 8-item measure of eHealth literacy developed to measure consumers' combined knowledge, comfort, and perceived skills at finding, evaluating, and applying electronic health information to health problems. The objective of the study was to psychometrically evaluate the properties of the eHEALS within a population context. A youth population was chosen as the focus for the initial development primarily because they have high levels of eHealth use and familiarity with information technology tools. METHODS: Data were collected at baseline, post-intervention, and 3- and 6-month follow-up using control group data as part of a single session, randomized intervention trial evaluating Web-based eHealth programs. Scale reliability was tested using item analysis for internal consistency (coefficient alpha) and test-retest reliability estimates. Principal components factor analysis was used to determine the theoretical fit of the measures with the data. RESULTS: A total of 664 participants (370 boys; 294 girls) aged 13 to 21 (mean = 14.95; SD = 1.24) completed the eHEALS at four time points over 6 months. Item analysis was performed on the 8-item scale at baseline, producing a tight fitting scale with alpha = .88. Item-scale correlations ranged from r = .51 to .76. Test-retest reliability showed modest stability over time from baseline to 6-month follow-up (r = .68 to .40). Principal components analysis produced a single factor solution (56% of variance). Factor loadings ranged from .60 to .84 among the 8 items. CONCLUSIONS: The eHEALS reliably and consistently captures the eHealth literacy concept in repeated administrations, showing promise as tool for assessing consumer comfort and skill in using information technology for health. Within a clinical environment, the eHEALS has the potential to serve as a means of identifying those who may or may not benefit from referrals to an eHealth intervention or resource. Further research needs to examine the applicability of the eHEALS to other populations and settings while exploring the relationship between eHealth literacy and health care outcomes.

Adolescent↗
PubMed1984

The threshold hypothesis: evidence from less developed Latin American countries, 1950 to 1980.

Historical research among European countries finds large differences in the level of social, economic or demographic development among countries, or regions within countries at the time marital fertility rates began their decline from traditional high levels. This research tests a threshold hypothesis which holds that fertility will decline from traditional high levels if threshold levels of life expectancy and literacy are surpassed. Using a pooled regression analysis of 1950, 1960, 1970 and 1980 crude births rates (CBRs) in 20 less developed Latin American countries, in conjunction with 10-year lagged measures of social, economic and family planning program development, analyses reveal statistically significant effects of passing Beaver's (1975) threshold levels of 1950 literacy, or 1950 life expectancy, that are independent of levels of lagged literacy (or lagged life expectancy), economic and family planning program development, as well as measures that control period effects.

Birth Rate↗
PubMed2000

Library outreach: addressing Utah's "Digital Divide".

A "Digital Divide" in information and technological literacy exists in Utah between small hospitals and clinics in rural areas and the larger health care institutions in the major urban area of the state. The goals of the outreach program of the Spencer S. Eccles Health Sciences Library at the University of Utah address solutions to this disparity in partnership with the National Network of Libraries of Medicine-- Midcontinental Region, the Utah Department of Health, and the Utah Area Health Education Centers. In a circuit-rider approach, an outreach librarian offers classes and demonstrations throughout the state that teach information-access skills to health professionals. Provision of traditional library services to unaffiliated health professionals is integrated into the library's daily workload as a component of the outreach program. The paper describes the history, methodology, administration, funding, impact, and results of the program.

Area Health Education Centers↗
PubMed1992

"Let's Talk Back": a program to empower laundry workers.

Laundry workers have traditionally been offered little input into the ergonomic and health and safety aspects of their jobs. The "Let's Talk Back" program was developed in response to worker demands, in order to empower them to effectively address some of these concerns. The program, endorsed by the union and administered by a hospital ergonomist, provided formal educational sessions, physical demand analyses, and a forum in which to communicate concerns and suggestions for improvements. Language and/or literacy barriers required innovative educational approaches. Management's reluctance to allow the program to interfere with production schedules hindered the efficiency of the program, but probably contributed to the sense of empowerment in the workforce. Through active participation in ergonomic assessments as well as the educational program, workers were able to demonstrate to management that changes were needed.

Community Participation↗
PubMed1992

Breaking the structuralist barrier. Literacy and numeracy with fluency.

Behavior analysis is an example of a selection science, and behavioral programs that follow the tenets of selectionism, long advocated by B. F. Skinner, can have a large impact on social problems. This article describes the characteristics of selection sciences and their application in the Morningside Model of Generative Instruction, which addresses both adult literacy and children's learning and attention problems. School curricula are analyzed for their key component elements and underlying tool skills. Teaching procedures then establish and build these key components to fluency. New and complex repertoires then emerge with little or no instruction, producing curriculum leaps that allow students to make rapid academic advancement. Children typically gain more than two grade levels per school year, and adults advance two grades per month.

Achievement↗
PubMed1999

Computer support for recording and interpreting family histories of breast and ovarian cancer in primary care (RAGs): qualitative evaluation with simulated patients.

OBJECTIVES: To explore general practitioners' attitudes towards and use of a computer program for assessing genetic risk of cancer in primary care. DESIGN: Qualitative analysis of semistructured interviews and video recordings of simulated consultations. PARTICIPANTS: Purposive sample of 15 general practitioners covering a range of computer literacy, interest in genetics, age, and sex. INTERVENTIONS: Each doctor used the program in two consultations in which an actor played a woman concerned about her family history of cancer. Consultations were videotaped and followed by interviews with the video as a prompt to questioning. MAIN OUTCOME MESURESs: Use of computer program in the Consultation. RESULTS: The program was viewed as an appropriate application of information technology because of the complexity of cancer genetics and a sense of "guideline chaos" in primary care. Doctors found the program easy to use, but it often affected their control of the consultation. They needed to balance their desire to share the computer screen with the patient, driven by their concerns about the effect of the computer on doctor-patient communication, against the risk of premature disclosure of bad news. CONCLUSIONS: This computer program could provide the necessary support to assist assessment of genetic risk of cancer in primary care. The potential impact of computer software on the consultation should not be underestimated. This study highlights the need for careful evaluation when developing medical information systems.

Adult↗
PubMed2003

Health literacy in low-income Latino men and women receiving antiretroviral therapy in community-based treatment centers.

Health literacy is an important and well known predictor of health-seeking behaviors and health status. Some populations of persons living with HIV/AIDS (PLHA) are reported to have low levels of health literacy. Factors contributing to low levels of health literacy in traditionally underserved ethnic minority groups seeking community-based treatment services are many and include individual level predisposing and enabling factors as well as system enabling factors. The purpose of this study was to describe deficits in health literacy in a sample of 90 low-income HIV-infected Latino men and women reported to have problems with treatment adherence. Additionally, correlates of health literacy were examined to identify the relative impact of these factors in predicting lower levels of health literacy in this at-risk population. Results of the study indicated that years of education was associated with understanding HIV terms and accurately reading and understanding instructions on prescription bottles. In a multivariate context, individual predisposing and system enabling factors accounted for 22% of the variance in patients' understanding HIV terms. Individual predisposing and individual enabling factors accounted for 17% of the variance in reading and understanding instructions on prescription bottles. Further research is needed to examine the role of treatment programs in mediating relationships between individual predisposing factors and health literacy and the linkages between health literacy, health promotion behaviors, and subsequent health status in at-risk populations.

Adult↗