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PubMed2002

Measuring integrated pest management programs for public buildings.

Integrated pest management (IPM) tends to be perceived by different stakeholder groups either as a methodology for effective pest control or as an ideology of responsible environmental stewardship. The IPM process has never been subjected to a rigorous empirical test as a control methodology in buildings; published studies have either tested isolated program components or have presented uncontrolled, sequential descriptions of IPM replacing traditional pest control service procedures. Because ideological measurement is simpler, cheaper, and more relevant than methodological testing to evaluate structural IPM performance in the public sector, data on pesticide use/risk and customer satisfaction, rather than control efficacy, are used by the General Services Administration (GSA) IPM program to demonstrate success compatible with Government Performance and Results Act (GPRA) guidelines. Implementation of IPM in 1989 resulted in significant decreases both in quantities of insecticide applied indoors and requests for pest control service by building occupants throughout the first decade of the program. Although these results do not provide an empirical test of structural IPM methodological superiority as a means of reducing pest populations, they indicate that replacing sprayed insecticide formulations with baits and using client reporting as the primary pest surveillance method can successfully achieve the policy goals of a large-scale IPM program for public buildings.

Animals↗
PubMed2005

Schoolteachers' awareness about scholastic performance and nutritional status of Egyptian schoolchildren.

Malnutrition disorders affect more than 30% of schoolchildren in Egypt. This problem appears to be largely attributable to poor dietary quality and micronutrient deficiencies, such as iron and vitamin A. Inadequate nutrition intake has important implications because malnutrition has been shown to negatively affect the cognitive development of primary schoolchildren. This study assesses the awareness of schoolteachers about the impact of malnutrition on the scholastic performance of primary schoolchildren living in Egypt. Two focus group discussions were conducted with Egyptian schoolteachers from the Quena and Kharbia Governorates. The study indicates that schoolteachers consider low body weight and thinness as the primary signs of malnutrition. They do not prioritize malnutrition as a factor for poor scholastic performance. They also suggest that unhealthful eating habits, especially a lack of breakfast, negatively affect children's interaction with schoolteachers and their ability to excel in their studies. Schoolteachers endorse a more reliable and nutritionally valuable school-feeding program as a way to increase the scholastic performance of their students. The teachers advocate developing integrated programs between the Ministry of Education, the Ministry of Health and Population, teachers, children, and parents that provide nutrition education. A lack of awareness among teachers about the relationship of nutrition and cognitive function can lead to the misdiagnosis or delayed management of malnourished and scholastically challenged schoolchildren. This paper suggests that proper school-feeding programs and nutrition education programs, which integrate government ministries, teachers, children and parents, should be developed to improve the physical and cognitive health status of Egyptian schoolchildren.

Absenteeism↗
PubMed2003

Integrated care in schizophrenia: a 2-year randomized controlled study of two community-based treatment programs.

OBJECTIVE: To evaluate the efficacy of two community-based programs that combined antipsychotic medication, family interventions and social skills training. METHOD: A randomized controlled trial with 2 years follow-up. The study included 84 patients with schizophrenic disorders, continuously managed in terms of care and treatment, and regularly assessed. Analysis was by intention-to-treat. RESULTS: Between-program comparisons showed significantly improved social function and consumer satisfaction in favour of the program 'Integrated Care' (IC) at the 2-year follow-up. The main clinically important differences between the two treatment programs studied were the procedures for shared decision making and patient empowerment in IC. CONCLUSION: The implementation of IC in clinical practice can improve social recovery and increase consumer satisfaction for patients with schizophrenic disorders. We identified specific procedures that might be added to improve the effectiveness of any program for severely mental ill people.

Adult↗
PubMed2001

Safety makes sense: a program to prevent unintentional injuries in New York City public schools.

Estimates suggesting that 10% to 25% of unintentional injuries to school-aged children occur in and around American schools are alarming. Information from the National Health Information Survey indicates as many as 3.7 million children are injured in schools annually. To address these concerns, The New York Academy of Medicine and the Board of Education of the City of New York in 1998 launched Safety Makes Sense, a multidimensional school-based, injury prevention initiative. The Safety Makes Sense program integrates unintentional injury prevention into comprehensive school health education in elementary and middle school classrooms and is implemented by interdisciplinary teams within a coordinated school health program. The multifaceted program also integrates safety and music education, and includes development of a handbook for teachers and staff, student booklets, staff development training workshops, and evaluation.

Accident Prevention↗
PubMed2006

Modeling the problem-based learning preferences of McMaster University undergraduate medical students using a discrete choice conjoint experiment.

OBJECTIVES: To use methods from the field of marketing research to involve students in the redesign of McMaster University's small group, problem-based undergraduate medical education program. METHODS: We used themes from a focus group conducted in an electronic decision support lab to compose 14 four-level educational attributes. Undergraduate medical students completed a discrete choice experiment composed of 15 web-administered, partial-profile, conjoint-choice tasks. RESULTS: Latent class analysis revealed two segments with different preferences. Segment 1, (86% of students), preferred a problem-based approach with more small group tutorial sessions led by expert tutors who facilitated the tutorial process without teaching didactically. Segment 2, (14% of students), preferred more large group lectures, explicit learning objectives, expert tutors who taught didactically, and streaming options based on learning preferences. Although Segment 1 preferred smaller tutorial groups, simulations predicted these students would trade increases in tutorial group size for a conceptually integrated program that included tutorial problems based on core curriculum concepts, greater integration of the content of clinical skills training sessions and the tutorial curriculum, and a link between clerkship patient selection and the program's curriculum. A majority of both segments would accept a more conceptually integrated program if the savings associated with increases in tutorial group size was reinvested in web-enhanced tutorial processes and computer-simulated health care problems. CONCLUSIONS: Most students preferred a small group, web-supported, problem-based learning approach led by content experts who facilitated group process. Students favored a program in which tutorial group problems, clinical skills training sessions and the patients selected for clerkship activities were more closely linked to core curriculum concepts.

Choice Behavior↗
PubMed1997

Research and practice in an academic community nursing center.

PURPOSE: To identify issues and describe strategies used in developing a successful program of clinical research focused on the vulnerable populations served by one urban academic nursing center. Academic community nursing centers provide ideal settings to implement programs of research. Understanding the challenges when integrating research into these practices and the strategies used is important. SETTING AND SCOPE: The University of Wisconsin-Milwaukee Silver Spring Community Nursing Center has provided primary health care services to a low-income urban population since 1987. A team of advanced practice nurse clinicians, community health nurses, and other health care professionals and community residents implemented a broad range of innovative, community-focused, clinical interventions that are routinely studied through an integrated program of nursing research. Their strategies for research implementation are analyzed. CONCLUSIONS AND IMPLICATIONS: Factors affecting the integration of research into the center include (a) community mistrust, (b) the need for participatory recruitment strategies, and (c) the need for multiple data collection methods. Meeting these challenges requires that research agendas and methods are consonant with community goals. The inclusion of clinicians, other providers, and community residents as active members of research teams is critical to success. Reframing research and practice role in terms of team effort that incorporates the community can strengthen research and practice-and benefit professionals and the populations they serve.

Academic Medical Centers↗
PubMed1996

[Evaluation of occupational programs in the city of Zurich].

Occupational and job integration programs are components of low threshold drug policies. Since the mid-eighties many such projects have been realized not least to counteract the increasing pauperization of drug addicts and the spreading of AIDS. Two of these occupational programs, the "job-Bus" and the "Förderband (Conveyor Belt)", were evaluated by the means of two quantitative cross-sectional studies and by a qualitative topic oriented interview in the second phase. The results presented refer to the second phase of the evaluation. The proportion of women in the programs is low with only 10%. The average age of 38.4 is higher than in other institutions for drug users. The work program is well accepted among the participants, and there is a high demand for such programs in the target group. Non-material aspects such as structuring of days, contact opportunities and fulfillment give the institution an additional significance. The author therefore recommends expansion of these programs under occupational and socio-pedagogical aspects in doing so, the underrepresented women and young adults ought to be reached. Furthermore it should be examined whether stable users can be employed permanently.

Adult↗
PubMed1995

Treatment of commercial broiler chickens with a characterized culture of cecal bacteria to reduce salmonellae colonization.

The effect of treatment with a newly developed characterized continuous-flow (CCF) culture composed of 29 strains of cecal bacteria on salmonellae colonization was evaluated in commercially reared broiler chickens. Newly hatched chicks in three flocks were sprayed with CCF culture as they were placed in rearing houses and compared with untreated flocks on the same farm. Hatchery transport tray liners and rearing house feed, water, and little samples were cultured for the presence of salmonellae. Cecal samples were cultured after 3- and 6-wk growout. Skin-feather samples were cultured at 6-wk growout. Fifty-five percent of the transport tray liners were contaminated with salmonellae on the day of chick placement. At 3 wk, salmonellae serotypes present on the tray liners were widely distributed in the litter of the rearing houses. The results indicated that exposure to salmonellae occurred before culture treatment and continued in the rearing houses during the 6-wk growout period. Salmonellae cecal colonization was decreased (P < .05) in two of the treated flocks at 3 wk and diminished (P < .07) in the third treated flock compared with control flocks. At 6 wk, skin-feather contamination and cecal colonization were decreased (P < .05) in one of the treated flocks whereas no treatment effect occurred in two of the treated flocks compared with controls. The results clearly indicate the necessity of implementing integrated programs to control salmonellae in both the hatchery and rearing house environments. The CCF culture served to enhance salmonellae colonization resistance and may serve as a useful component of an integrated control program.

Animals↗
PubMed2006

Integrated wilderness therapy for avoidant personality disorder.

Patients with avoidant personality disorder (APD) are difficult to treat because of their extensive social, emotional and cognitive avoidance. Few studies have addressed outcome in APD and there is no therapy of choice. In this quasi-experimental study, we integrated wilderness therapy in an inpatient group program (integrated wilderness therapy, IWT), in order to enhance outcome for patients with APD. We compared outcome of the IWT group with a similar inpatient group program without wilderness therapy: the comparison condition (CC). The subjects in the IWT-group (n=16) with DSM-IV APD were treated in 11.5 weeks. The subjects in the comparison group (n=37) were selected from our database with the same diagnostic criteria. The participants were examined at pre-care, admission, discharge and 1-year follow-up. Both groups were significantly improved, but there were no significant differences between them. There were some non-significant trends for males to gain most benefit from IWT, whereas females were more improved by the CC. The results indicate that by integrating wilderness therapy we were able to treat more impaired patients at shorter time with almost the same outcome.

Adult↗
PubMed1993

Community responses to violence.

Community level efforts are effective in the reduction of violence. Community-level interventions have three goals: to prevent the escalation of risk for violence among the families in the community, to assist families at risk of or using violence, and to protect victims of abuse. To prevent violence or reduce its prevalence, community groups need to collaborate to reduce the community-level risk factors. Assisting families and protecting victims of violence requires coordination of community services, including law enforcement, schools, therapists, courts, child care, and social services. All of these goals can best be achieved through the efforts of a community level, multidisciplinary council or board that directs the programs. A community process to establish an integrated program involves several steps. The leaders that are identified need to represent all the disciplines and the entire geographic area involved in the project. Once the leaders start meeting, the baseline information and plan can be developed. Then the project itself can be undertaken, with the support of the media and other appropriate organizations. Several examples of effective projects document this process and its success; the best efforts involve coalitions of private and governmental agencies working together. Physicians are integral to this process. The practice of medicine provides opportunities every day to prevent and intervene in potential cases of abuse and violence. Also, by participating actively in the community, physicians can be effective leaders to change attitudes and behaviors and institute programs toward reducing violence.

Adult↗
PubMed2004

An evaluation of an Internet-delivered eating disorder prevention program for adolescents and their parents.

PURPOSE: To evaluate the effectiveness of Student Bodies, an Internet-delivered eating disorder prevention program for adolescents, and a supplemental program for their parents. METHODS: One hundred fifty-two 10th grade females completing a health course at a private sectarian school, and 69 of their parents were assigned to either the Internet-delivered intervention group or to a comparison group (students) or wait-list control group (parents). Student participants completed subscales of the Eating Disorder Inventory, Eating Disorder Examination-Questionnaire, and a content knowledge test. Parents completed the Parental Attitudes and Criticism Scale. RESULTS: The main effects of the intervention were assessed pre- to post- and post- to follow-up using ANCOVA, with the baseline assessment of the independent variable as the covariate. Students using the program reported significantly reduced eating restraint and had significantly greater increases in knowledge than did students in the comparison group. However, there were no significant differences at follow-up. Parents significantly decreased their overall critical attitudes toward weight and shape. CONCLUSION: The program demonstrates the feasibility of providing an integrated program for students and their parents with short-term positive changes in parental attitudes toward weight and shape.

Adolescent↗
PubMed1994

The evolution of the end-stage renal disease program in Australia.

Australia was an early pioneer of national integrated programs for the management of end-stage renal disease (ESRD). From being a leader in numbers of patients per population treated, it is now in the top 15. The Australian program has a high proportion of living patients with functioning transplants and a high proportion of out-of-hospital dialysis. The proportion of elderly patients is increasing but lower than expected. A particular problem is the treatment of Aboriginal people. The ANZ Data surveys give accurate complete data for the national program. Unique features of the Australian patients are the high incidence of analgesic nephropathy and the low incidence of primary hypertension as a cause of renal failure. Surveys show that it is possible to improve transplantation rates 2 to 3 times. Analysis of Australian data raises the question of whether dialysis and transplantation should be offered to all potential patients regardless of comorbidity or quality of life when health resources are inevitably finite.

Adult↗
PubMed1995

Health care programs: fraud and abuse; technical revision to the scope and effect of the OIG exclusion regulations--HHS. Final rule.

This document sets forth a technical revision to OIG regulations on program integrity for Medicare and State Health Care programs, concerning the scope and effect of the OIG's program exclusion regulations. Prior to this revision, the regulations provided that a program exclusion imposed under title XI of the Social Security Act was to affect future participation in all Federal non-procurement programs. This revision specifically amends the language in the existing regulations to clarify that the scope of an exclusion is now applicable to all Executive Branch procurement and non-procurement programs and activities. This rule is consistent with the Federal Acquisition Streamlining Act, and the Department's Common Rule on debarment and suspension which is also being amended and published elsewhere in this issue of the Federal Register.

Fraud↗
PubMed2002

Integrated disease management pilot for diabetes.

A New Zealand diabetes program integrates management systems for hospitals and physician practices through a shared integrated care server (ICS), which supports collaborative patient management, virtual consults, and clinical feedback.

Diabetes Mellitus↗
PubMed2000

DNAssist, a C++ program for editing and analysis of nucleic acid and protein sequences on PC-compatible computers running Windows 95, 98, NT4.0 or 2000.

The size of sequence databases, the rapid rate of generating sequence data and the need to routinely construct recombinant DNA molecules in molecular biological research necessitate the frequent handling and analysis of nucleotide and protein sequences on a computer. Although several console or Web-based utility programs are available, the application of these programs generally requires reformatting the data when proceeding from one such program to the next. The acquisition of elaborate, integrated program suites is financially prohibitive to smaller laboratories. Here, we report the development of DNAssist, a shareware program for editing and analysis of nucleic acid and protein sequences. It was developed as a multiple-document interface program--similar to a word processor--where sequences are entered, edited and analyzed in a single integrated environment. DNAssist can calculate the physicochemical properties of a sequence, convert between nucleic acid and protein sequences, translate DNA in multiple frames, identify open reading frames and locate ambiguous sequence patterns allowing gaps and mismatches. DNAssist also performs restriction enzyme and transcription factor-binding site analyses of DNA sequences, the multiple alignment of nucleic acid and protein sequences and the analysis of DNA sequences for nucleosome positioning sites.

Amino Acid Sequence↗
PubMed2006

Community genetics and dignity in diversity in the Quebec Network of Genetic Medicine.

The Quebec Network of Genetic Medicine (QNGM), implemented in 1971, has been an integrated program of community genetics serving the population (approximately 7.5 million) of Quebec province in Canada. QNGM reported to the Minister of Social Affairs and operated under an umbrella of universal health insurance in the province. The Network's programs have been run by members of the four university medical schools of the province under the direction of a central committee. A global annual budget was awarded to QNGM from its inception. Among its many programs, QNGM supported: (1) two newborn screening programs (using blood and urine samples) for early diagnosis, treatment and research in phenylketonuria, hereditary tyrosinemia, congenital hypothyroidism, and in a large number of other hereditary metabolic diseases; (2) follow-up of confirmatory diagnostic tests at regional centers, followed by supervision of ambulatory treatment modalities; (3) carrier screening and reproductive counseling for Tay-Sachs and beta-thalassemia diseases; (4) a spectrum of feasibility (research) studies (e.g., screening for biotinidase deficiency, neuroblastoma, hemoglobinopathies, and cystic fibrosis) to inform policy decisions. QNGM performed economic analyses of its major programs and followed prevailing ethical guidelines. Its global budget and integrated structure terminated in 1994, although some of its programs continue independently.

Cystic Fibrosis↗
PubMed2003

Frail elderly patients. New model for integrated service delivery.

PROBLEM BEING ADDRESSED: Given the complex needs of frail older people and the multiplicity of care providers and services, care for this clientele lacks continuity. OBJECTIVE OF PROGRAM: Integrated service delivery (ISD) systems have been developed to improve continuity and increase the efficacy and efficiency of services. PROGRAM DESCRIPTION: The Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) is an innovative ISD model based on coordination. It includes coordination between decision makers and managers of different organizations and services; a single entry point; a case-management process; individualized service plans; a single assessment instrument based on clients' functional autonomy, coupled with a case-mix classification system; and a computerized clinical chart for communicating between institutions and professionals for client monitoring. CONCLUSION: Preliminary results on the efficacy of this model showed a decreased incidence of functional decline, a decreased burden for caregivers, and a smaller proportion of older people wishing to enter institutions.

Aged↗