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PubMed1979

The need for integrated control programs for zoonoses affecting livestock.

Prior to recognition of etiologic agents of zoonoses (infections transmitted between animals and man), physicians encountered these illnesses in man and veterinarians observed them in animals. As the agents were identified, interspecies relationships (and spread) became evident and control programs evolved without consideration of cost-effectiveness. Today, the public demands efficient use of financial resources. Human health as well as economic losses are concerns of animal health agencies. Zoonoses affecting livestock, though not major priorities among public health agencies, cannot be ignored. It seems economical, therefore, to combine the efforts of these agencies in zoonoses control. This would benefit human health by reducing the animal reservoirs and the livestock industry will benefit by lowered production costs.

Animals↗
PubMed1980

The relationship between allied health practice and academic preparation programs: an integrating curriculum framework.

This article describes an integrating framework to provide guidance for curriculum evaluation and focus. The development of the framework was approached from a theoretical standpoint. A review of the work in allied health related to roles and functions is made. In the framework, society is placed in a central position and is equated with self, others, and institutions. Central to this thesis is the belief that higher education has an obligation to change society rather than to constantly respond to it.

Curriculum↗
PubMed1994

Assessing senior residents' knowledge and performance: an integrated evaluation program.

BACKGROUND: Surgical residents have traditionally been evaluated by ward evaluations and multiple-choice testing; overall resident performance has seldom been objectively evaluated. We developed a comprehensive evaluation program for senior residents. The purpose of this study was to determine whether the several different assessment methods included in this program provide similar information about senior residents' clinical knowledge and performance. METHODS: Sixteen senior general surgery residents were evaluated by subjective faculty ward evaluations, a structured oral examination, the American Board of Surgery In-Training Examination, and an objective structured clinical examination (OSCE). The OSCE was divided into two parts: part A required the resident to obtain a directed history or to perform a physical examination; part B required the resident to answer questions about the patient seen in part A. RESULTS: The various evaluation methods differed in their estimates of clinical competence (ward evaluations rated residents highest; the OSCE, lowest). The American Board of Surgery In-Training Examination correlated with both the structured oral examination and OSCE part B, indicating that all are adequate measures of knowledge. Neither the total OSCE score nor OSCE part A correlated with other measures, but the fact that both are highly reliable suggests that they evaluate different clinical skills. Faculty ward evaluations are inflated and do not correlate with other measures. CONCLUSIONS: We conclude that developing a comprehensive program for evaluating resident competence is desirable and feasible.

Employee Performance Appraisal↗
PubMed1996

Effect of integrated research programs on health care systems and costs.

We examined the effect of research program size on clinical costs (current dollars/work unit) and productivity (work units/ employee) in Department of Veterans Affairs (DVA) hospitals. Our data demonstrate that research programs have a small, almost negligible effect on clinical costs. The data also show that average acute medical service length-of-stay was inversely related to research program size. The indirect cost of research may have been almost entirely offset by an increased efficiency, as reflected in the shortened length of stay. This unexpected benefit of research may be due to the influence of research opportunities on the recruitment and retention of highly trained clinicians, including medical specialists. In the past, recruitment and retention was part of the justification for the DVA research program. Although this justification no longer appears to be considered politically acceptable, our data strongly support the notion that research programs can and do enhance the efficiency of medical care. Furthermore, research activities help professional staff maintain their critical thinking and analytic skills. We discuss the implications of these observations on cost containment in health care systems.

Cost Control↗
PubMed1993

PROBE: a computer program employing an integrated neural network approach to protein structure prediction.

A computer program, PROBE, has been designed for the prediction of protein structural features from amino acid sequence. This program integrates a variety of computer-simulated neural networks, each predicting an aspect of protein structure, into a single, easy-to-use package. The surface accessibility of each residue, the presence of disulfide bonds, the overall secondary structure composition and the residue secondary structures, including beta-turn type, are predicted. In addition, the overall amino acid composition and relative hydrophobicity are used to determine whether a protein belongs to one of four common folding motifs. PROBE is able to compare and synergistically improve the predictions by allowing communication between the different networks.

Amino Acid Sequence↗
PubMed2004

Integrating smoking cessation into worker training among Latino immigrant workers: development of a program.

The prevalence of smoking among Latino immigrant workers needs to be addressed with culturally and linguistically appropriate smoking cessation programs. One innovative approach to reaching these workers is through worker health and safety training programs. These programs offer multiple opportunities to provide smoking cessation messages, a "teachable moment" to focus on health issues, and the likelihood that peers and family members will share these messages. A collaborative effort between an occupational health and safety training facility and a university utilizing Latino and non-Latino personnel developed a smoking cessation program integrated with worker health and safety training. Preliminary results of an evaluation of the program indicate that the program was able to reach a wide range of immigrant workers and improve their knowledge of the risks of smoking and the effectiveness of different methods of quitting smoking.

Journal Article↗
PubMedDate not supplied

A review and analysis of the clinical- and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: 1998-2000 update.

PURPOSE: This article is the fifth in a series of critical reviews of the clinical effectiveness and cost-effectiveness studies of comprehensive, multifactorial health promotion and disease management programs conducted in worksites. As with the previous reviews, the purpose of this article is to review and assess the randomized control trials that have focused on both clinical and cost outcomes of worksite health promotion and disease management programs. For this current review, a new category of quasi-experimental studies has been added because this represents a major new trend in such interventions over the last 2 years. Comprehensive worksite programs are those that provide an ongoing, integrated program of health promotion and disease prevention that integrates specific components into a coherent, ongoing program that is consistent with corporate objectives and includes program evaluations of both clinical and cost outcomes. DATA SOURCES: A comprehensive search was conducted using a multistage process that included MEDLINE, ERIC, ADI, EDGAR, CARL, Inform, and Lexis-Nexis databases and direct inquiries to worksite researchers. INCLUSION AND EXCLUSION CRITERIA: The search identified 27 new studies to which the following inclusion criteria were applied: research conducted in the United States; results published in English; methodological quality of nonexperimental (pre- and postmeasures but no comparison group); quasi-experimental to randomized control trials; and both clinical and cost outcomes. Exclusion criteria were studies outside of the United States; non-English publications; and clinical or cost outcomes only. Fifteen studies remained for this review. FINDINGS EXTRACTION METHODS: Findings extraction and analysis of the 15 studies was done by extracting the relevant population, intervention design, clinical results, and cost outcomes from the published article. As in previous reviews, findings are summarized in a table format that extracts and describes each study by the following: (1) study author(s); (2) corporate site; (3) purpose of the evaluation; (4) employee population; (5) percentage of program participants; (6) number of employees included in the evaluation; (7) brief description of the intervention; (8) evaluation design; (9) evaluation period; (10) outcomes; (11) research rating; and (12) findings. FINDINGS SYNTHESIS: Based on these 15 studies, a methodological critique was conducted with brief reference to appropriate prior studies. Conclusions regarding study quality and new trends over the time period of 1998 to 2000 are discussed. MAJOR CONCLUSIONS: Results from randomized clinical trials and quasi-experimental designs suggest that providing individualized risk reduction for high risk employees within the context of comprehensive programming is the critical element of worksite interventions. Despite the many limitations of the current methodologies of the 15 new studies, the vast majority of the research to date indicates positive clinical and cost outcomes.

Cost-Benefit Analysis↗
PubMed2000

A model to simulate the effect of vaccination against Boophilus ticks on cattle.

This paper describes a vaccination model to simulate the effect of cattle vaccination with concealed antigens on Boophilus tick spp. The model considers the vaccination effect in three parts: antibody titer, accumulation of damaging vaccination effects by parasite stages, and the effect of accumulated damage on all tick life stages. Biological parameters for ticks and hosts, as well as parameters describing tick-host interaction, were included. The validity of this model, integrated with the TICKSIM simulation program, was demonstrated for the Bm86-containing vaccine Gavac by comparing simulated and real data for several geographic locations in the Americas. All model parameters were estimated using field data collected in the different geographic locations. The model sensitivity to changes in antibody titer level and titer half-life was studied, and the impact on tick population density of changes in these parameters was evaluated. Simulation results showed that to achieve a higher level of tick control, an increase in the maximum antibody titer levels was more important than extending titer half-life in geographical locations with short seasonal peaks of tick infestation. The TICKSIM program, integrated with the new vaccination model, proved to be a framework for designing and evaluating tick control strategies, including vaccination with GavacTM.

Animals↗
PubMed2002

Evaluation of a computer based interactive diabetes education program designed to train the estimation of the energy or carbohydrate contents of foods.

The objective of this study was to evaluate a computer based interactive diabetes education program designed to train patients with diabetes to correctly estimate the energy or carbohydrate contents of foods. The acceptance and the operator convenience of the program were evaluated with an integrated program and written questionnaires. The training success was calculated for each user from the data sets after multiple repetitions of the same exercise. Age, weight, type of diabetes, previous training and computer experience of 126 patients with type 1 or 2 diabetes from three different German diabetes centres were documented. The evaluation of the computer program indicated a good acceptance and operator convenience. Moreover, there was a significant training success in patients who have never used a structured diabetes education program before. Therefore, the potential impact of the program is to support but not to replace structured diabetes education programs and to further motivate and attract patients to diabetes education programs.

Computer-Assisted Instruction↗
PubMed2002

The impact of an integrated family planning program in Russia.

In 1995, the U.S. Agency for International Development implemented an integrated program of family planning education and services in six Russian cities to increase physicians' and women's contraceptive knowledge and change current contraceptive use. Large population-based surveys of women ages 15-44 were carried out at the beginning of project implementation (in 1996) and 3 years later in two project sites and a comparison site. Results from these surveys indicate that project activities affected women's knowledge of family planning methods, and caused women to have more favorable attitudes toward modern contraception. In addition, abortion rates decreased in project sites while remaining virtually unchanged in the comparison site. Because of uneven implementation of project interventions in the demonstration sites, however, the intervention's actual impact on abortion rates remains unclear.

Abortion, Legal↗
PubMedDate not supplied

International collaboration in health promotion and disease management: implications of U.S. health promotion efforts on Japan's health care system.

For more than 25 years, health promotion and disease management interventions have been conducted by large employers in the United States. Today there are more than 100 studies of such multifactorial, comprehensive interventions that all demonstrate positive clinical outcomes. For those interventions that have also been evaluated for return on investment, all but one have demonstrated cost-effectiveness. This article is an evidence-based overview of the clinical and cost outcomes research to elaborate on the insights gained from this research in the areas of implementation and evaluation of such programs; integration of health promotion and disease management programs into conventional, occupational medicine; accessing difficult to reach populations, such as mobile workers, retirees, and/or dependents; areas of potential conflict of interest and privacy/confidentiality issues; health consequences of downsizing and job strain; and, finally, recommendations for improved integration and evaluation of such programs for both clinical and cost outcomes. With medical costs rapidly escalating again on a global scale, these interventions with evidence of both clinical and cost outcomes can provide the foundation to improve the health, performance, and productivity of both individuals and their corporations.

Cost-Benefit Analysis↗