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PubMed2000

The COPE program: treatment efficacy and medical utilization outcome of a chronic pain management program at a major military hospital.

This study presents a treatment efficacy and medical utilization evaluation of a cognitive-behavioral, outpatient, chronic pain management program in a military hospital setting. A total of 61 nonmalignant chronic pain patients with heterogeneous pain syndromes who participated in sequential group programs were included in the study. Comprehensive and multi-dimensional outcome criteria were used, including pain ratings, relaxation skills, quality of life, satisfaction ratings, and medical utilization. The findings demonstrated improvements on all general indices. Military status had no effect on any of the outcome measures. Most significant was an 87% reduction in outpatient clinic visits in the first 3 months after treatment. This reduction amounts to a projected net annual saving of $78,960 in the first year after behavioral medicine intervention. In light of the increasing cost of health care for chronic pain patients, psychological approaches as an adjunct to traditional medical care seem to present a sound solution for cost savings. This study also supports the notion that a strategic biopsychosocial pain program, which targets the multiple dimensions of persistent pain, provides effective treatment and increases patient satisfaction.

Adaptation, Psychological↗

PubMedDate not supplied

A four-phase program to recruit African American women into breast cancer promotion programs.

The author discusses a successful, nurse-coordinated collaborative community-based breast health program that targeted older African American women from the state of South Carolina. Over 16 community organizations and health care partners supported the four-phase program that was funded by the South Carolina Breast and Cervical Risk Reduction Program and the South Carolina Chapter of the American Cancer Society.

Black or African American↗

PubMed2001

The Native Hawaiian Health Professions Scholarship program's impact on the community of Ko'olau Loa: a program report.

The Native Hawaiian Health Professions Scholarship was established as one component of the Native Hawaiian Health Care Act of 1988, which was later reauthorized as the Native Hawaiian Health Care Improvement Act of 1992. The Scholarship program was designed to develop Native Hawaiian primary health care professionals who would return to work in Native Hawaiian communities. To ensure this, scholarship recipients fulfill their scholarship agreement by working in medically unserved and underserved communities throughout Hawai'i. Since 1991, 121 scholarships have been awarded to Native Hawaiians training in different primary care professions including medicine, dentistry, nursing, midwifery, social work, and public health. Although the service obligation is attached to the scholarship as a means of "paying back," the intent is to provide an opportunity for graduates to establish a sense of social responsibility for the communities most in need. One of the communities benefiting from this program is Ko'olau Loa, a community that spans from Ka'a'awa to Pupukea on Windward O'ahu. Native Hawaiian Health Scholarship recipients, Kehau Santiago, Michele Shimizu, and Stephany Vaioleti live and continue to serve in the very community in which they fulfilled their service obligations. This article focuses on how the Native Hawaiian Health Scholarship Program--in particular, the three scholars--affected Ko'olau Loa.

Education, Professional↗

PubMedDate not supplied

[Curriculum design of the Master's in Public Health program via the inservice education system. The Working Group of the Innovation Program in Health Systems and Professional Training].

This article presents the curriculum design process experience of the School of Public Health of Mexico's In-Service Master of Public Health Program, offered through the distance education model. The Program was created as a response to the Mexican health system's human resources training needs, with the purpose of contributing to the health services decentralization process, the strengthening of managerial skills of local health district managers, and to the professionalization of public health. The Program's design and development are based on a distance education system as an alternative to the traditional training models. The distance education model offers the possibility to train human resources on their job, to link permanently theory and practice, and to improve, in the short-term, the professional performance of students. The curriculum design process included the analysis of the student's training needs based on their professional profile, the type of plan of study that could take into account those training needs, and of the advisers and tutor's required profile, educational background, and job experience. The different disciplines were grouped around the knowledge objects, and not around independent courses. The health planning process was taken as a central axis and conductive line for integrating the thematic contents. The Master's plan of study was conformed by four stages: health diagnosis, formulation of the organized social response, implementation, and evaluation.

Accreditation↗

PubMed1993

Sampling variance estimates for SSA program recipients from the 1990 Survey of Income and Program Participation.

Since 1987 the Social Security Administration (SSA) has published a special set of tabulations on SSA program recipients in the Annual Statistical Supplement to the Social Security Bulletin using data derived from the Census Bureau's Survey of Income and Program Participation (SIPP). Estimates of sampling errors pertaining to these tabulations were derived from the 1984 SIPP panel. This article provides updated sampling error estimates for the 1990 SIPP panel to be used in conjunction with the SIPP-based tabulations provided in the Annual Statistical Supplement for 1992 and 1993. The computational approach is essentially the same as that used in the earlier analysis. Sampling variances are estimated by half-sample replication using the pseudo stratum and half-sample codes available on SIPP public use data files. Generalized tables of standard errors are provided for all SSA program participants. An appendix provides detailed specifications about the calculations. In order that it be self-contained, this article repeats much of the methodological exposition in the previous article that appeared in the October 1988 issue of the Social Security Bulletin.

Adolescent↗

PubMed1995

Developing patient education programs with multimedia technology incorporating patient feedback into program design.

The University of Texas Medical Branch in Galveston has been the site of a three year project to develop a unique set of computer-based health promotion programs for patients in community-based settings. The Healthy Touch Series is a collection of four interactive multimedia programs that were produced to provide health promotion information to underserved groups on topics related to maternal-infant health. The programs have bilingual audio tracks in English and Spanish and run on a CD-ROM platform with touch-screen control. Use of the technology with a large group of patients led to many modifications and alternations. Formative evaluation results review the key concepts we learned.

Audiovisual Aids↗

PubMed1984

Program maturity and cost analysis in the evaluation of primary prevention programs.

Primary prevention has been growing as a major initiative in mental health, and to avoid overpromising its benefits, primary prevention programs must be evaluated in a systematic and effective fashion. Information on the developmental maturity and the direct costs of a program is very useful in assessing its merit, even if definitive findings on incidence reduction are not available for many years. This paper outlines the steps by which information on a program's developmental maturity and direct costs can be obtained, and discusses the implications of these steps for primary prevention policy.

Cost-Benefit Analysis↗

PubMed1987

Do smoking prevention programs really work? Attrition and the internal and external validity of an evaluation of a refusal skills training program.

This study investigated the effects of a smoking prevention program that emphasized refusal skills training on 1730 adolescents in three high schools and six middle schools. Classes within these schools were randomly assigned to treatment or no-treatment conditions to avoid confounding schools with treatment condition. The effects of attrition on the internal and external validity of the study were examined. Although the results indicated an apparent effect of the program at the 1-year follow-up in deterring continued smoking among those who were smoking at pretest, this result may have been due to a higher rate of attrition among high-rate smokers in the treatment condition than in the control condition. Attrition also affected external validity. Across both conditions, subjects who were smoking at pretest and who were at risk to smoke were more likely to be missing at follow-up. The program did have an effect on the refusal skills of participants and the validity of this effect was not jeopardized by differential attrition.

Adolescent↗

PubMed1987

How generalizable are the effects of smoking prevention programs? Refusal skills training and parent messages in a teacher-administered program.

This study investigated both substantive and methodological issues associated with school-based smoking prevention programs. Substantive issues included the efficacy of a refusal skills training curriculum and of parent messages mailed to students' homes. Methodological issues included the effects of assigning classrooms versus entire schools to experimental conditions and determination of the effects of attrition on internal and external validity. Results revealed differential impact for different subgroups of adolescents. The refusal skills program produced lower rates of smoking than the control condition for students who were smokers at the pretreatment assessment but may have produced detrimental effects among males who were nonsmokers at pretest. The provision of parent messages did not affect outcome. Method of assignment (schools versus classrooms) failed to produce significant effects, and attrition did not affect internal validity. However, the above differential findings, as well as the impact of attrition on external validity, raise questions concerning the generalizability of smoking prevention programs.

Adolescent↗

PubMed1988

Programmed follicular stimulation reduces cycle cost and stress with no compromise in cycle quality: use of a modified programmed protocol.

To reduce cycle cost and patient/staff stress in an ongoing in vitro fertilization (IVF) program, we have utilized a modified "programmed" (PP) follicle stimulation protocol with limited monitoring. We have compared our PP results with those using a conventional, individualized, and fully monitored protocol (OP) in order to show that PP does not compromise the quality of care. Hormonal presuppression made possible an arbitrary starting day for the cycle. In 80% of the cycles, oocyte retrieval (OR) was performed on the planned day or 1 day later. There was no statistically significant difference between the two regimens in oocyte/embryo numbers, quality or pregnancy rates. The cycle cost was significantly reduced. In addition, patient stress was lessened because of the reasonable predictability of cycle timing. We conclude that PP has significant financial and emotional advantages for the patient over OP but does not appear to diminish the chance for pregnancy in an IVF cycle. PP also allows program staff to manage time more effectively, thereby reducing staff stress.

Clinical Protocols↗

PubMed1990

Moving child abuse and neglect prevention programs forward: improving program evaluations.

This paper focuses on evaluations of programs to prevent child abuse and neglect. It discusses the quality of the evaluations and offers suggestions for improvement to evaluators, program planners, and funders. Thirteen evaluations recommended by experts and published from 1978 through 1988 were reviewed. Using the true experiment as the standard of quality, we found evaluations frequently characterized by careful attention to methodologic detail. Evaluators describe eligibility criteria; half of the studies had control groups or followed progress. However, to learn more about prevention of abuse and neglect the caliber of evaluation research must improve. Evaluators do not define abuse or neglect; they accept reports of abuse. This has the effect of shifting the responsibility to others whose concerns and reporting standards differ. Lack of definition is reflected in a paucity of valid measurements; we could not assess the characteristics of families who benefit most from programs. Evaluators also omit important topics. Although seven evaluations studied health-related variables, no comprehensive analysis of the consequences and costs of medical neglect could be found; very little information on costs and benefits of any kind was available.

Child↗

PubMedDate not supplied

A day treatment program in a therapeutic community setting: six-month outcomes. The Walden House Day Treatment Program.

Although not well represented in the literature, day treatment programs targeting substance abuse problems have increased in both number and acceptability in recent years. This article reports on a day treatment program based on the Therapeutic Community (TC), and on outcomes for a sample of substance abuse clients (n = 66) entering the program. Participants were interviewed early in treatment and 6 months after admission using the Addiction Severity Index (ASI) and other measures. Clients entering day treatment were demographically diverse, with serious substance-abuse problems and psychiatric morbidity. Median retention in day treatment was about 5 weeks, but many clients received a contiguous episode of residential treatment, so that the median for total time in treatment was 18 weeks. Clients located and interviewed at 6-month follow-up (n = 38) showed significant improvement in alcohol and drug use, legal and social problems, and psychiatric symptoms. Findings suggest that day treatment can be used effectively as a precursor to residential treatment and that some clients applying for residential treatment can be treated effectively in day treatment alone.

Adult↗

PubMed2002

Different elution modes and field programming in gravitational field-flow fractionation. IV. Field programming achieved with channels of non-constant cross-sections.

Force field programming provided increased speed of separation with an improved resolution and detection capability in many field-flow fractionation (FFF) techniques. Gravitational field-flow fractionation (GFFF) uses the Earth's gravitational field to cause the settlement of particles towards the channel accumulation wall. Although this field is constant and relatively weak, there are different ways to implement force field programming in GFFF. Because hydrodynamic lift forces (HLF) participate in the separation process in focusing (hyperlayer) elution mode, they can control the resulting force field acting on particles via changes in flow-velocity. These changes can be accomplished by a programmable pump or with channels of non-constant cross-sections. This work is focused on flow-velocity programming accomplished with channels of non-constant cross-sections. Three trapezoidal channels of decreasing breadth and two channels of decreasing height (along the longitudinal axis) are tested as tools for optimization of the separation of a model silica gel particle mixture. The trapezoidal channels yielded reduced separation times. However, taking into account both speed of separation and resolution, the optimization effect was lower compared with the flow-rate gradients generated by a programmable pump. The channels of non-constant height did not yield advantageous separations.

Fractionation, Field Flow↗

PubMed2002

Characteristics of female smokers attending a lung cancer screening program: a pilot study with implications for program development.

Anticipating the development of lung cancer early detection programs, we examined the: (1) feasibility of a lung cancer early detection program; (2) characteristics of enrollees (e.g. motivation to quit smoking); (3) correlates of enrollee motivation to quit smoking; and (4) rates of smoking cessation following screening. Brief surveys were completed before and after screening, which involved sputum cytology, chest X-ray, bronchoscopy, spiral CT, and a meeting with an oncologist to discuss smoking cessation. Of the 168 eligible women who were heavy smokers recruited via newspaper and cancer center advertisements, 55 agreed to undergo screening. Enrollees showed low-to-moderate levels of quit motivation and high levels of nicotine addiction; enrollees were interested in a range of smoking cessation treatments; 20% of enrollees exhibited clinical-levels of emotional distress; 64% of enrollees reported low levels of self-efficacy (i.e. self-confidence) to quit; 24% of enrollees reported low levels of quitting pros and 25% reported high levels of quitting cons; 31% of enrollees showed high levels of fatalistic beliefs about cancer; and all enrollees recognized their elevated lung cancer risk. Greater motivation to quit smoking was related to: greater age, lower nicotine addiction, fewer health symptoms, and higher quitting self-efficacy and quitting pros. Finally, 16% of enrollees quit smoking after screening. Overall, many women eligible for screening refused to undergo comprehensive screening that included bronchoscopy and spiral CT. Screening may represent an opportunity for quitting smoking, although more intensive smoking cessation interventions that target nicotine addiction and self-efficacy may be needed to maximize the health benefits of an early detection program.

Adult↗

PubMed2001

Patients attachment patterns and response to a program for alleviating cardiovascular risk factors: a 1-year follow-up of patients in a patient education program.

This study was a 1-year follow-up of 295 consecutive patients at a patient education centre and assessed how attachment style influenced the outcome of the patient education program devised for individuals with multiple risk factors for cardiovascular disease. The program consisted of a 4-week residential program course, followed by a 4-day follow-up course a year later. In our cohort study, the 295 consecutive patients (mean age = 52years, S.D.=9.2) with multiple risk factors for cardiovascular disease, showed an initial overall reduction of 4.4 kg in weight (P=0.0001) and a reduction of 17/11 mm in systolic and diastolic blood pressure (P=0.0001 and 0.0001). The weight remained essentially the same at the follow-up 1 year later, whereas blood pressure tended to return to previous level. The attachment style was determined by means of a questionnaire: 87% were classified as 'secure', 9% 'avoidant' and 5% as 'ambivalent'. After 4 weeks, the ambivalent category had reduced weight (body mass index (BMI)) more than the secure group (P=0.04). At the 1-year follow-up, the avoidant category showed a more pronounced reduction in diastolic blood pressure than the other groups (P=0.001). Thus, it seems as if attachment style does have some influence on outcome. Patient education should take advantage of knowing patients' attachment style.

Cardiovascular Diseases↗

PubMed2001

[Research training in the programs of neurosurgery residency. Analysis of the situation in other developed countries and proposals to implementing the current program in Spain].

Research performed by neurosurgeons has been always linked to the progress of our specialty, and research training is included in the Neurosurgery Residency Programs in developed countries. Since the methodology of research related to the basic knowledge of the nervous system function is becoming increasingly complex, it could be proposed that neurosurgeons can not longer contribute to productive research in neurosciences, and this idea might be easily accepted in certain countries such as Spain, where research training is not contemplated in the Residency Program of Neurosurgery. However, all neurosurgeons academic or not, should exhibit a critical and inquiring mentality which enables them to evaluate scientific information and communicate their own clinical experience to the neurosurgical community. Such a critical capacity can not be acquired by a resident trained only in the art of clinical diagnosis and the surgical technique. The new medical practice is based on both basic and clinical-epidemiological research, and the new residents must be immersed into a motivating and inquisitive environment in which the scientific method is continuously applied to the clinical practice. In this paper I consider research training in Neurosurgery in developed countries with the aim of identifying a strategy for introducing a period devoted to research in the Spanish Residency Program. Thus, the methodologies, objectives, contents, duration and the moment for receiving research training in other countries are analysed and some alternatives for solving the problem in our country are pointed out.

Developed Countries↗

PubMed2002

Outcome measures across program sites for postsecondary supported education programs.

This article briefly describes three supported education programs and examines outcomes for each. The program settings were a mental health center, a clubhouse, and a community college. Students (n = 124) were followed for five semesters to assess program outcomes. Although this study did not statistically control for variations in services among sites, each site adhered to the principles and practice of supported education as a specialized intervention. Differences among sites in student demographics, education and employment outcomes, satisfaction with school, job/education fit, satisfaction with life, and self-esteem are reported. Although there were variations in outcomes among sites, few signifcant differences were found.

Adult↗

PubMed1984

The National Evaluation of School Nutrition Programs: program impact on family food expenditures.

Since the major goals of the school nutrition programs are to safeguard the health of children by providing nutritious meals and to promote consumption of domestic agricultural products, it is important to know the extent to which participation in the school nutrition programs increases the value of food obtained by participating families. The analysis of the factors that influence family food expenditures is described. No evidence is found that families reduce their other food expenditures in response to their children's participation in the school nutrition programs. The most important factors that influence family food expenditures are family size and income. The age of children in the family, location of the family, and educational attainment and employment status of heads of household also affect food expenditures.

Adolescent↗