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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↗

PubMed2003

Long-term effects of a maintenance program after supervised or self-monitored training programs in patients with COPD.

The evaluation of a 13-month maintenance program (MP) for 39 severe COPD patients with FEV(1)%pred 44(7)% who, as result of two different 8-week leg exercise training (LET) programs, one supervised at the hospital (group S; n = 20) and the other self-monitored (SM; n = 19), had achieved different levels of exercise tolerance. After LET, patients in group S had a higher maximal oxygen uptake and endurance time than patients in the SM group [ O(2)max 1.43(0.30) l. min(-1)] vs l.25(0.27) l. min(-1) and endurance-time 16(4) min vs 12 (5) min, respectively). During the MP patients were advised to walk vigorously at least 4 km/day, 4 times/wk. After the MP, while endurance time remained higher than at baseline, it had decreased ( p < 0.01) immediately after LET in both groups and no differences were evident between groups (11(4) min and 10(4), respectively). In contrast, Chronic Respiratory Diseases Questionnaire scores, which had improved significantly after LET in both groups, remained high. Long-term effects of MP were independent of the training strategy or whether physiological improvements had been obtained with the initial LET. SM exercise programs do not seem capable of maintaining physiological improvements in exercise tolerance, though "quality of life" can be maintained.

Exercise Therapy↗

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↗

PubMed1993

Nutrition knowledge and practices of physicians in a family-practice residency program: the effect of an education program provided by a physician nutrition specialist.

The purpose of this study was to determine the effects of a nutrition-education program provided by a physician nutrition specialist in a family-practice residency program on residents' and faculty members' nutrition knowledge and nutrition-related patient care, their patients' perceptions of the importance of nutrition, and the physicians' dietary patterns. The nutrition specialist provided recommendations for nutrition patient-care practices to the physicians for 6 mo. Pre- and post-intervention assessments included 1) nutrition exams for physicians and patients, 2) patient questionnaires concerning attitudes towards nutrition, 3) chart reviews, and 4) diet records for physicians. The educational intervention caused a small but statistically significant (P < 0.01) increase in physicians' nutrition-knowledge scores and a significantly higher (P < 0.05) frequency of physicians discussing nutrition and recommending diets for their patients. Effects were greater among residents than among faculty members. The results suggest that a physician nutrition specialist can provide effective nutrition education within a residency program.

Diet Records↗

PubMed1987

Epidemiologic programs for computers and calculators. Inferences on odds ratios, relative risks, and risk differences based on standard regression programs.

Statistical analyses of the joint effects of several factors (covariates) on the risk of disease, death, or other dichotomous outcomes, are frequently based on a model that relates the effect of the covariates to some function of the probability of the outcome. The odds ratio, relative risk, and the difference in risks are among the simplest candidates for the outcome function. Each can be specified as a special case of the generalized linear model, but their use has been limited to researchers with access to specialized computer programs that are not yet generally available in standard computer packages. The purpose of this communication is to describe how to implement the maximum likelihood estimation procedures and hypothesis testing associated with the generalized linear model using any computer program that can perform weighted least squares analyses. The procedure is applied specifically to models for relative risks, risk differences, and odds ratios. The techniques are illustrated with SAS and SPSSx programs for data sets previously presented.

Computers↗

PubMedDate not supplied

A school reentry program for burned children. Part I: Development and implementation of a school reentry program.

Sustaining a burn injury is a devastating and painful experience. After acute concerns have been dealt with, continued support of the child and family is important in achieving a smooth return to normal activities. Reports from burned patients for whom physical therapy was a concern identified a need for physical therapy involvement in school reentry to facilitate a resumption of normal school routine. Physical therapy involvement in school reentry has been successful and rewarding with a reasonable commitment of manpower. Utilization of personnel in the administrative structure of state and local school systems promoted the acceptance of the program by local school personnel. Although this program is designed to meet the needs of burned children, the goals of the school reentry program may meet similar needs of children with other chronic illnesses.

Adolescent↗

PubMedDate not supplied

The AHF SCENE II Preceptorship Program: rationale and design of an educational program to optimize management of advanced heart failure.

Advanced heart failure requires specialized treatment to improve symptoms, increase survival, and reverse or slow disease progression. The Advanced Heart Failure Shared Clinical Experiences Network, or AHF SCENE, was founded in 1995 to provide small groups of health care professionals with better advanced heart failure management strategies by sharing clinical experiences from centers treating large numbers of patients. The original AHF SCENE program has since been modified to provide health care professionals with more information on current strategies for advanced heart failure management and to better serve the educational needs of professionals who care for these patients. AHF SCENE II promotes new methods, programs, procedures, and pharmacologic interventions and also describes strategies for tracking and improving clinical and economic outcomes in the management of advanced heart failure. AHF SCENE II supports the understanding that rapid, aggressive medical management is essential and is more effective in the context of a well designed program that spans the continuum of care. (c)2000 by CHF, Inc.

Journal Article↗

PubMed1986

Dissemination of community health promotion programs: the Fargo-Moorhead Heart Health Program.

Dissemination often is the neglected phase of the development and distribution cycle. While attention has focused on developing and testing new health education and health promotion programs, relatively little effort has been placed on studying how the programs can be disseminated. This paper reviews the dissemination process, identifies factors critical to successful dissemination, uses examples from a community-based heart disease prevention study to illustrate how health promotion programs can be disseminated across a community, and suggests ways these methods might be applied to a community-based approach to adolescent drug use prevention.

Adolescent↗

PubMed1991

Who is served by programs for the homeless? Admission to a domiciliary care program for homeless veterans.

Demographic and clinical data are presented on 4,138 veterans assessed in the 20-site Department of Veterans Affairs (VA) Domiciliary Care for Homeless Veterans program during its first year of operation. More than two-thirds of the veterans who were screened had been hospitalized in VA medical centers during the year before assessment, and 34 percent were hospitalized at the time of assessment. Compared with veterans who were not admitted for residential treatment, veterans who were admitted were more likely to be previously involved in mental health treatment, literally homeless rather than at risk for homelessness, and without public financial support. Specialized service programs for the homeless such as the VA domiciliary care program may also be called on to play a broader role in the discharge and rehabilitative efforts of public mental health service systems.

Adult↗

PubMed1980

Effectiveness of a cephalosporin education program--a pharmacy education program.

In October, 1977, a cephalosporin drug-use review and an educational program were initiated to maximize savings in the pharmacy budget at UCSF and to revise the formulatory to include only one parenteral cephalosporin. The results of the drug-use review were presented to the Pharmacy and Therapeutics Committee where our proposal for an education campaign to encourage appropriate dosing of cefazolin was approved. An explanatory document comparing cephalosporin costs and equivalency was developed for hospital-wide distribution. Pharmacy staffs were informed of program objectives to coordinate education efforts. Physician education was undertaken via document and personal contact with pharmacy personnel. A drug-use review one month after institution of the cephalosporin education program showed marked changes in physician prescribing habits, with greater impact on services where pharmacists were members of the medical rounding team. A change to appropriate dosage prescribing of cefazolin resulted in significant cost savings to the pharmacy budget. These findings resulted in formulary revision to cefazolin as the single cephalosporin available at UCSF. Because cefazolin is available from more than one manufacturer, we were able to obtain a lower bid price the following year, thus realizing an additional cost savings.

California↗