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PubMed1992

Infant and child mortality in rural Egypt.

This research examines determinants of infant and child mortality in rural Egypt, primarily the effects of household economic status and the availability of health services. Certain features of the health service environment affect survival in the neonatal period. In early childhood, survival chances improve markedly as income increases and if the household depends almost exclusively on employment income. In infancy and in early childhood, mortality is strongly associated with region of residence and maternal demographic characteristics, and is weakly associated with parental schooling.

Child, Preschool↗
PubMed2004

Challenges in disseminating model programs: a qualitative analysis of the Strengthening Washington DC Families Program.

This article discusses the challenges faced when a popular model program, the Strengthening Families Program, which in the past has been implemented on a smaller scale in single organizations, moves to a larger, multiorganization endeavor. On the basis of 42 interviews conducted with program staff, the results highlight two main themes that address program and organizational characteristics. The themes relate to the cultural relevance of the program, the accessibility of program partners, the organization of program services, and the coordination of program activities. The article also offers a discussion of how to better prepare sites for program delivery. This discussion focuses explicitly on the need for good communication among program partners, extensive community outreach, and the ability to secure additional resources.

Diffusion of Innovation↗
PubMed2001

Types of patients in a psychiatric intensive care unit.

OBJECTIVE: This paper reports the findings of a descriptive study of a patient population over a three-month period on an eight bed psychiatric intensive care unit (PICU) in Western Australia. The report provides a quantitative insight into the profile of patients in PICUs. It provides information on patients' diagnoses, presenting signs, symptoms and/or behaviours, legal codes assigned to patients, treatment interventions and management. METHOD: Data were collected prospectively from August to October 1999. A total of 122 patients were admitted to the PICU during the review period. Data were entered into an Access program then exported to SPSS (Version 9 for Windows) for analysis and frequency distributions were obtained. RESULTS: The results confirmed that the majority of patients admitted to the PICU were assessed as a high level of risk or needed containment. This finding is in line with the admission criteria developed by staff working in the PICU. It also supports the view that staff working in these units require expertise and confidence to communicate with and manage potentially aggressive and highly aroused patients. CONCLUSION: This study demonstrates the importance of ongoing evaluations of patient populations in promoting best practice initiatives in psychiatric care.

Adult↗
PubMed2006

Early clinical experience with atazanavir in treatment-experienced patients.

BACKGROUND: Atazanavir (ATV) is a newly approved protease inhibitor following successful clinical trials in naive and treatment-experienced patients. We describe early experience with ATV in treatment-experienced patients attending a single ambulatory care clinic in Sydney. METHODS: Patients commencing ATV between February 2003 and May 2004 in an expanded access program were identified from the clinic pharmacy's database. Data were retrospectively collected from patients' medical records. RESULTS: Data from 30 patients were analysed. Reasons for commencing ATV were: virological failure in six patients (20%); toxicity to previous regimen in 13 patients (43%); simplification strategy in two patients (7%); and recommencing therapy in nine patients (30%) following treatment interruption. Six patients (20%) discontinued ATV. One patient discontinued ATV due to virological failure, two patients discontinued due to toxicity to concomitant antiretrovirals, two as a result of the patient's choice and one as a result of the physician's decision. Eighteen patients commenced ATV in combination therapy with a detectable viral load (VL). From a baseline VL of 4.3 +/- 1.1 log10 copies mL(-1), 15 (83%) had > 1.0 log decrease in VL with 11 (61%) achieving viral suppression (<50 copies mL(-1)). Three (16%) failures were recorded in this group. Twelve subjects commenced ATV with an undetectable VL. One failure was recorded in this group. Bilirubin increased by 22.7 micromol L(-1) (P < 0.001), with significant decreases in cholesterol (1.4 mmol L(-1), P = 0.01) and triglycerides (1.5 mmol L(-1), P = 0.01) in 12 patients on ritonavir-boosted ATV. CONCLUSION: This audit found ATV to be safe, well tolerated and had good potency in treatment-experienced patients. However caution should be exercised in switching to ATV in heavily pre-treated patients.

Adult↗
PubMed1987

Deaths in infancy and early childhood in a well-vaccinated, rural, West African population.

A survey of deaths in children under the age of 7 years was made over a 1-year period in a rural area of The Gambia with few facilities for curative medicine but with a good record of infant immunizations. One hundred and eighty-four deaths were investigated. Only 12% of deaths occurred in a hospital or health centre but an attempt was made to establish a cause of death by interviewing the family of each dead child and by examining any health records that were available. The infant mortality rate was 142 per 1000 live births and the child mortality rate (death in children aged 1-4 years) 43 per 1000 per year. Acute respiratory infections, malaria and chronic diarrhoea with marasmus were the most frequent causes of death after the 1st month of life. Few children died of diseases that could have been prevented by routine immunizations. An effective immunization programme has probably had some effect on deaths in infancy and early childhood but it will be necessary to find ways of preventing deaths from malaria, acute respiratory infections and chronic diarrhoea/marasmus at the primary health care level if infant and childhood mortality are to be reduced further in rural areas of The Gambia.

Age Factors↗
PubMed1987

Oral rehydration salts and diarrhoeal diseases: effects of changing inpatient management in Tonga.

Methods of inpatient management of children with diarrhoeal diseases (DD) in 1978 and in 1980 were compared to assess the use of oral rehydration salts (ORS) and a national antidiarrhoeal programme (NAP). Inpatient notes of 369 children admitted with DD were reviewed. The management of DD differed significantly but the clinical outcome was similar, with the exception of the case-fatality rate. All deaths occurred within the first 24 h of admission, indicating that this difference was attributable to improved management of DD in the community rather than changes in the inpatient treatment regime.

Child↗
PubMedDate not supplied

Sociocultural factors in depression in Asian Indian women.

Depression is a pervasive illness with a wide distribution and is reported to be statistically more prevalent among women. The present study was undertaken to seek an understanding of depression in a sample of Asian Indian women. The research questions were (a) What sociocultural factors do adult depressed Indian women report as influences in the depression, and (b) how do these reported factors influence their treatment-seeking behavior? The setting was Madurai, India. The purposive, convenience sample comprised 30 Tamil-speaking married or widowed Hindu women ranging in age from 26 to 65 who had been diagnosed with depression. Tape-recorded interviews were conducted. Content analysis was completed on the data. Results indicate that cultural dictation of female role and lack of continued financial and emotional support, predominantly from spouses and other family members, were influential factors in depression. These along with religion and philosophy often influenced the decision to seek health care.

Adult↗
PubMed2004

Use of on-line evidence databases by Australian public health practitioners.

OBJECTIVE: To investigate use of a web-based portal, known as the Clinical Information Access Program (CIAP), and evidence databases in an Australian population health workforce. METHODS: Self-administered postal survey of 104 staff in a regional Division of Population Health in Sydney, Australia. The main outcome measures were CIAP use and organization support for CIAP use. Two thirds of the respondents agreed that using CIAP was a legitimate part of their practice. However, half agreed that staff were encouraged to use it. One in five respondents (21%) used CIAP weekly. CIAP use was significantly associated with medical qualification or, among non-medical staff, with having at least a Masters qualification. CIAP use was not associated with occupational category, gender, age, employment status nor years of experience. Use of specific evidence databases such as Cochrane also differed significantly by respondents' characteristics. CONCLUSIONS: There has been only partial uptake of on-line databases among this population health workforce, particularly according to attainment of relevant postgraduate qualifications. As CIAP is a resource for evidence-based practice, greater effort to increase its use is recommended to ensure population health does not fall behind hospital-based clinicians.

Adult↗
PubMed1984

Enhancing the usability of safety software for microcomputers.

With the proliferation of microcomputers, increasing effort is being made to write programs dealing with occupational safety and health. So as to assure the widespread use of this material, it is important that it be prepared in a manner easy to use. Ignoring this consideration may cause the potential users to be repelled by it from the start, or that its use will be difficult and error-prone. This article dwells on some of the points that need to be borne in mind when writing such software to make it easy and pleasant to use. Additionally, a project, carried out by the author, is described, which makes use of a free-form program access approach, as opposed to a purely menu-driven one. Two potential extensions of this approach are then described.

Computers↗
PubMed2005

Skin rash and good performance status predict improved survival with gefitinib in patients with advanced non-small cell lung cancer.

BACKGROUND: Gefitinib (Iressa) is active as a single agent in the treatment of select patients with recurrent non-small cell lung cancer (NSCLC). The clinical characteristics of patients treated with gefitinib on an Expanded Access Program (EAP) at our institution identified predictive variables associated with better outcome. PATIENTS AND METHODS: Patients (n=199) with advanced NSCLC were treated with gefitinib (250 mg) upon progression with chemotherapy. Baseline patient characteristics were: median age, 69 years; males, 57%; adenocarcinoma, 56%. RESULTS: Partial responses were noted in two patients (1%) and disease stabilization in 66 (35%) patients. The median survival (MS) was 5.9 months [95% confidence interval (CI) 4.1-7.1] and median time to progression was 3 months (95% CI 2.0-3.0). The predictive factors analyzed were gender, skin rash, diarrhea, tumor histology and performance status (PS). Patients who developed skin rash (any grade) had MS of 10.8 months versus 4.0 months for those without rash (P <0.0001, log rank test). Patients with PS 0, 1 and 2 had MS of 8.4, 6.2 and 2.8 months, respectively (P <0.0002). The other factors did not impact survival. CONCLUSIONS: Occurrence of skin rash and baseline PS of 0/1 were associated with improved survival with gefitinib for recurrent NSCLC patients at our institution.

Adult↗
PubMed1998

The Human PAX6 Mutation Database.

The Human PAX6 Mutation Database contains details of 94 mutations of the PAX6 gene. A Microsoft Access program is used by the Curator to store, update and search the database entries. Mutations can be entered directly by the Curator, or imported from submissions made via the World Wide Web. The PAX6 Mutation Database web page at URL http://www.hgu.mrc.ac.uk/Softdata/PAX6/ provides information about PAX6, as well as a fill-in form through which new mutations can be submitted to the Curator. A search facility allows remote users to query the database. A plain text format file of the data can be downloaded via the World Wide Web. The Curation program contains prior knowledge of the genetic code and of the PAX6 gene including cDNA sequence, location of intron/exon boundaries, and protein domains, so that the minimum of information need be provided by the submitter or Curator.

Computer Communication Networks↗
PubMed2005

The tRNAscan-SE, snoscan and snoGPS web servers for the detection of tRNAs and snoRNAs.

Transfer RNAs (tRNAs) and small nucleolar RNAs (snoRNAs) are two of the largest classes of non-protein-coding RNAs. Conventional gene finders that detect protein-coding genes do not find tRNA and snoRNA genes because they lack the codon structure and statistical signatures of protein-coding genes. Previously, we developed tRNAscan-SE, snoscan and snoGPS for the detection of tRNAs, methylation-guide snoRNAs and pseudouridylation-guide snoRNAs, respectively. tRNAscan-SE is routinely applied to completed genomes, resulting in the identification of thousands of tRNA genes. Snoscan has successfully detected methylation-guide snoRNAs in a variety of eukaryotes and archaea, and snoGPS has identified novel pseudouridylation-guide snoRNAs in yeast and mammals. Although these programs have been quite successful at RNA gene detection, their use has been limited by the need to install and configure the software packages on UNIX workstations. Here, we describe online implementations of these RNA detection tools that make these programs accessible to a wider range of research biologists. The tRNAscan-SE, snoscan and snoGPS servers are available at http://lowelab.ucsc.edu/tRNAscan-SE/, http://lowelab.ucsc.edu/snoscan/ and http://lowelab.ucsc.edu/snoGPS/, respectively.

Genomics↗
PubMed2006

Physician-directed primary care intervention to reduce risk factors for type 2 diabetes in high-risk youth.

BACKGROUND: The incidence of type 2 diabetes in youth is increasing at an alarming rate. The purpose of this pilot study was to determine whether a nutrition and physical activity intervention in an urban primary care office is feasible and effective in decreasing risk factors for type 2 diabetes in high-risk youth. METHODS: A one-group pretest/post-test design was used. Participants were recruited from existing patients in a primary care facility serving low-income children. Inclusion criteria included body mass index (BMI) over the 85th percentile for age and a fasting glucose-insulin ratio (FGIR) less than 6. Thirty-six African-American patients, 9 males, 27 females, average age 12.4 years (range, 8-18) participated in a 12-week nutrition and physical activity program. Measurements included fasting glucose, insulin, FGIR, lipid profile, blood pressure, and BMI. BMI and laboratory values were tested for significant differences before and after intervention using paired t-tests. A P-value of <.05 was considered statistically significant. RESULTS: On average, patients attended 8.3 of 24 physical activity sessions, 2 of 3 nutrition sessions and 1.5 of 3 planned clinical sessions. Twenty-six of 36 patients completed follow-up laboratory tests. Mean FGIR improved significantly from baseline (3.6 +/- 1.2 to 4.6 +/- 2.8; P = .043). CONCLUSIONS: A nutrition and physical activity intervention for overweight children can be conducted in an urban primary care setting and may decrease laboratory evidence of insulin resistance, a risk factor for type 2 diabetes. Making the program accessible by public transit and scheduling the sessions at convenient times were important factors.

Adolescent↗
PubMedDate not supplied

Building legitimacy and the early growth of health networks for the uninsured.

An integrated system of health care for serving the uninsured population of one community was followed from formation through early growth. Funding was provided through the Health Resources Services Administration's Community Access Program to bring together a diverse set of health care providers to form a collaborative network managed by a central administrative entity. Legitimacy building was critical for explaining how the network evolved and the effectiveness of the network in sustaining itself and building a patient base. Based on the study's results, conclusions are drawn that contribute to theory on network legitimacy in health care. In addition, lessons learned are offered that may help other communities address the health needs of the uninsured through collaborative health care networks.

Arizona↗
PubMedDate not supplied

Collaboration to improve services for the uninsured: exploring the concept of health navigators as interorganizational integrators.

This study examines one specific type of collaboration activity in a community health collaborative. The focus of the research is the operations level where services are coordinated, patients are referred, and access may be improved for vulnerable populations. Using a case study approach, we examine the creation of a new interorganizational role, the "health navigator" in the Miami-Dade Community Access Program. Drawing on traditional theoretical perspectives on coordination, we present the health navigator as an "integrator" among a complex set of safety net providers and public health insurance programs.

Community Networks↗