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PubMed2004

Access to dental care: the triad of essential factors in access-to-care programs.

BACKGROUND: Solutions to the problem of limited access to dental care for some segments of the population are being sought. Certain factors in access-to-dental-care program design are critical to the success of these programs. OVERVIEW: The author discusses the triad of factors that are essential in the successful design and operation of programs aimed at improving access to dental care for underserved populations. CONCLUSIONS: The author found that attention must be paid to creating an effective demand for dental care, an adequate dental work force to respond to that demand and an economic environment that enables patients and dentists to participate in any programs that are aimed at improving access to care. PRACTICE IMPLICATIONS: Failure to adequately address demand, work force and economic factors will condemn any program designed to increase access to dental care to failure at worst, or to limited success at best.

Cost-Benefit Analysis↗
PubMed1994

DESIGN: a guide to protein crystallization experiments.

Existing guidelines for crystallizing proteins generally require substantial amounts of protein and scarce laboratory resources. To address this problem we have developed the program DESIGN, which, suited to daily laboratory usage, utilizes statistics when screening variables of crystallization. The program DESIGN is described in considerable detail and examples of its outcome and capabilities are shown. In addition, a new scoring scale for crystallization trials is described. It is expected that the use of such an approach may provide additional constraints toward crystallizing the protein, even if the conditions applied are not successful.

Calmodulin↗
PubMed1996

A randomized study of the efficacy of the PROPATH Program for patients with Parkinson disease.

OBJECTIVES: To assess (1) the effects of the PROPATH Program, a health management program designed for patients with Parkinson disease, on perceived general health and psychological well-being and satisfaction with medical care, (2) utilization of health care resources by patients with Parkinson disease, and (3) physician impressions of the PROPATH Program. DESIGN: Patients were randomized to receive either the PROPATH Program in addition to usual care or usual medical care only. All patients and their physicians completed periodic questionnaires designed to assess the study variables. SETTING: Staff model health maintenance organization from June 1992 through June 1993. PATIENTS: Forty-six English-speaking patients diagnosed with Parkinson disease of Hoehn-Yahr stages I through IV. RESULTS: Enrollment in the PROPATH Program resulted in a statistically significant improvement in patient perception of general health and psychological well-being after 1 year. There was no significant difference in patient satisfaction with medical care or utilization of health care resources. The large majority of physicians did not find the PROPATH Program to be helpful for development of a treatment plan, management of the illness, identification of problems sooner than by usual treatment, or identification of drug side effects. CONCLUSIONS: The PROPATH Program may play a useful role in assisting patients to deal with the psychological aspect of Parkinson disease by improving perception of general health and psychological well-being. The program had no significant effect on patient satisfaction with medical care or medical resource utilization.

Aged↗
PubMed2001

Balancing Army and endangered species concerns: Green vs. Green.

A number of endangered, threatened, or at-risk species have been identified on US Army training bases. Before further training is restricted or curtailed under provisions of the US Endangered Species Act (ESA), the Army can explore available proactive options for providing habitat protection and mitigation. This paper investigates the possibility of an Army habitat acquisition program to acquire (by lease or purchase) buffer zones of at-risk species' habitat around its bases and away from training. To identify the most cost-effective manner for acquiring habitat, auction market experiments are utilized for analyzing program design. Laboratory auction experiments provide a powerful and low-cost vehicle for investigating ex ante program design issues. We find the discriminative, as opposed to a uniform price, auction with a minimum quantity requirement to be the least-cost mechanism.

Animals↗
PubMed2004

Auditing the accuracy of a volunteer-based surveillance program for an aquatic invader Bythotrephes.

We tested the sampling methods of a volunteer-based monitoring program designed to detect the non-indigenous spiny water flea, Bythotrephes longimanus, and found that the program could detect the majority of Bythotrephes invasions. Volunteers take two vertical hauls with a 30 cm diameter net at each of three pelagic stations. To determine if the volunteers were using a large enough net at their three stations, we performed a 17-lake comparison of the volunteer's net with a 75 cm diameter, research-grade net. We found no difference in the number of stations at which Bythotrephes was detected (paired t-test, p = 0.155) with the two nets, because Bythotrephes densities were above the detection limits for both nets. To determine if three stations were sufficient to detect the invader with the volunteer's net, we deployed it at 30 stations in two lakes with average (Harp Lake, 4.17 Bythotrephes m(-3)) vs. low Bythotrephes densities (Sugar Lake, 0.92 m(-3)). In Harp Lake, repeated randomized sampling of the 30 sets of data indicated that only three stations were needed for 100% capture success. In Sugar Lake, seven stations were needed for 100% capture success, but three stations, the current program design, failed to detect the invasion only 14% of the time.

Animals↗
PubMed2002

MethPrimer: designing primers for methylation PCRs.

MOTIVATION: DNA methylation is an epigenetic mechanism of gene regulation. Bisulfite- conversion-based PCR methods, such as bisulfite sequencing PCR (BSP) and methylation specific PCR (MSP), remain the most commonly used techniques for methylation mapping. Existing primer design programs developed for standard PCR cannot handle primer design for bisulfite-conversion-based PCRs due to changes in DNA sequence context caused by bisulfite treatment and many special constraints both on the primers and the region to be amplified for such experiments. Therefore, the present study was designed to develop a program for such applications. RESULTS: MethPrimer, based on Primer 3, is a program for designing PCR primers for methylation mapping. It first takes a DNA sequence as its input and searches the sequence for potential CpG islands. Primers are then picked around the predicted CpG islands or around regions specified by users. MethPrimer can design primers for BSP and MSP. Results of primer selection are delivered through a web browser in text and in graphic view.

Base Sequence↗
PubMedDate not supplied

Managed dental care in the HMO setting.

DHMOs are gaining in popularity, and are the fastest-growing dental managed-care product, primarily because of their ability to reduce premium and patient costs. Dentistry, because of the strong correlation between prevention and disease control, is more suited to a managed-care system than medicine. However, there remains a wide gulf between theory and practice, as the DHMO industry continues to evolve. Poorly designed programs will save money but create problems with patient satisfaction and unmet treatment needs. Well-designed programs use the principles of population management to bring large numbers of patients to maintenance oral health levels. In any event, the continuing growth and development of DHMOs will benefit patients, group purchasers, and the dentists who can understand and embrace the concepts of dentistry in the HMO environment.

Capitation Fee↗
PubMed1983

Program development and maternal-child health consultation: a conceptual model for role enactment in developing countries.

Increasingly, nurses are serving as consultants in designing programs to improve the health of individuals in developing countries. In order to be effective, such programs must reflect the socio-cultural context in which identified health problems occur. This can become problematic when nurses work as consultants in cultures with which they are unfamiliar. This paper proposes the use of the World Health Organization's risk strategy approach as a conceptual framework for developing culture specific programs in maternal-infant health. Suggested consultant role behaviors are articulated with this approach and the various phases of program development using an ongoing project in Juarez, Mexico to which the author has provided nursing consultation as a concrete example.

Child Health Services↗
PubMed2004

Functional tasks exercise versus resistance exercise to improve daily function in older women: a feasibility study.

OBJECTIVE: To evaluate the feasibility of a new functional tasks exercise program, designed to improve functional performance of community-dwelling older women, by comparing it with a resistance exercise program. DESIGN: A 12-week, randomized, single-blind pilot study. SETTING: A community leisure center. PARTICIPANTS: Twenty-four community-dwelling, medically stable women (mean age, 74.6+/-4.8 y) were randomized to the functional tasks exercises (function group) or the resistance exercises (resistance group). Three participants withdrew from the study. INTERVENTIONS: Exercises were given 3 times weekly for 12 weeks. The functional tasks exercise program aimed to improve daily tasks in the domains first affected in older adults, whereas the resistance exercise program focused on strengthening the muscle groups that are important for functional performance. MAIN OUTCOME MEASURES: Participant satisfaction with the exercises, Assessment of Daily Activity Performance (ADAP), and, as a secondary outcome, muscle strength and power. RESULTS: Exercise adherence was 81% in the function group and 90% in the resistance group. Participants reported greater satisfaction with the resistance exercises than with the functional exercises. The ADAP total score improved with time (P =.001; mean change function group, 7.5 U; 95% confidence interval [CI], 2.1-12.8; resistance group, 2.8 U, 95% CI, -0.4 to 5.9), as did isometric knee extensor strength (P =.001; mean change function group, 6.4%; 95% CI, -1.6 to 14.5; resistance group, 14.4%; 95% CI, 6.4-22.2). Testing for differences in outcomes between the 2 groups showed no statistically significant differences. CONCLUSIONS: The functional tasks exercise program is feasible and shows promise of being more effective for functional performance than a resistance exercise program. A randomized controlled trial with a larger sample size is needed to test the difference between the 2 programs.

Activities of Daily Living↗
PubMed2006

Faith-placed cardiovascular health promotion: a framework for contextual and organizational factors underlying program success.

The objective of this study was to assess the literature on faith-placed cardiovascular health promotion in order to construct a framework of factors meant to facilitate effective program design. Data source was empirical studies on the contextual and organizational factors underlying faith-placed cardiovascular program performance. Study inclusion criteria were papers reported from 1984 to 2003 that include contextual and organizational variables. Success factors identified in the literature fall under the following clusters: faith support, secular support, partnership (and obstacles to it), faith organization capabilities, secular organization capabilities and caring intervention. Each cluster consists of several factors, whose relative weights cannot be ascertained from the present state of the literature. These clusters of factors can be interrelated through a simple framework that is useful in program design.

Cardiovascular Diseases↗
PubMed1986

DIGICALC: a restriction fragment analysis program.

DIGICALC is a program designed to aid in the acquisition, storage, and analysis of nucleic acid restriction fragment data. The chief considerations during program design were (i) ease of use for people with varying degrees of computer experience, (ii) minimal hardware requirements (e.g. an IBM PC), (iii) portability and ease of modification, and (iv) improved functionality in sizing and comparing restriction fragments over manual methods. The program accepts manual or digitizer input of nucleic acid fragment mobility, calculates the fragments' sizes, and provides the means to search the fragment database and to produce charts of fragment sizes.

Base Sequence↗
PubMedDate not supplied

Low back pain: risk evaluation and preplacement screening.

As screening tests in a currently asymptomatic population, all of the available methods for predicting low back pain and disability have serious technical, ethical and legal limitations. From a technical point of view, none of the predictive tests appear to have sufficient sensitivity or specificity to justify routine usage. The most sensitive indicator (a past history of low back pain) lacks reliability and specificity. Muscle strength-testing may be predictive of future musculoskeletal injury as part of a well-designed program that considers specific job demands in relation to specific worker capabilities. Unfortunately, the conditions necessary for a well designed program--a large number of predictable high-risk jobs that have measurable specific demands that can be reproduced reliably in a testing situation--are rarely met. In the future, the use of computer-assisted multivariate models analogous to those used in the prediction of cardiovascular risk may be capable of integrating information about an individual's medical history, physical exam, physical capacity and other tests with specific job requirements to give us a more accurate prediction of the future risk of back pain and disability. If such predictive models are ever developed and verified, it would then be appropriate to examine various interventions and their effectiveness in modifying risks for the population and the individual worker. From a legal point of view, all of the techniques described hold potential for significant discrimination against legally protected groups. Making employment decisions with regard to a past history of low back pain or on the basis of an x-ray will lead to systematic age discrimination and discrimination against the handicapped. The use of muscle strength-testing will systematically discriminate against women and certain ethnic groups. The ethical implications of predictive screening for low back pain clearly depends on what is done with the information that is garnered from such tests. If the information is used only to make a safe job placement for an individual, and this placement does not affect the individual's salary or future job possibilities, then the testing program may have a net social value to the extent that it leads to true prevention of low back pain and disability. If the tests are used merely to reduce employer liability by refusing employment to those who are thought to be at "high risk," the technical, legal and ethical limitations will far outweigh any perceived benefits.

Back Pain↗
PubMed1990

Clinical pastoral education for laity.

Medical science, with its high technology, has had a major impact on today's hospitalized patient. Not only has the length of stay been shortened dramatically but the level of illness is much more intense. Both of these factors have influenced the role pastoral care plays as a member of the health care team if patients and families are to receive holistic care. Carefully selected and trained laity can help meet the expanding pastoral care needs of hospitalized patients. This article describes a program designed exclusively for laity, which equips these volunteers through a clinical process similar to that of Clinical Pastoral Education (CPE). The authors contend that any program designed to prepare laity for pastoral care must include the clinical component. Their experience with 38 laity who have completed the program described in this article has led them to the conclusion that such a process inspires a dynamic growth in faith as laity claim their rightful authority in pastoral care.

Chaplaincy Service, Hospital↗
PubMed1990

Comparing nutrition programs conducted by public health and Cooperative Extension personnel.

We surveyed 218 county extension agents, 75 state extension specialists, 163 public health nutritionists, and 87 public health administrators in 16 states to compare the nutrition program characteristics of extension personnel with public health personnel. Public health personnel were most strongly influenced by funding regulations--more than 80% of public health nutritionists cited infant/preschool nutrition and nutrition for pregnant/lactating women as program topics. About half of the extension agents listed food preservation and preparation as the dominant topics provided. Public health personnel most frequently designed programs for pregnant and lactating women and low-income clientele; 91% of the nutritionists ranked one-to-one counseling as one of their three most important delivery methods. Extension personnel designed programs more often for homemakers/adults and youth and ranked a combination of group and media delivery methods as most important. Public health personnel use anthropometric measures and food intake records to evaluate their programs; extension personnel use written questionnaires and program records. More than 50% of the nutritionists ranked improving the health of their clients as one of the three most important impacts of their programs; more than 50% of the extension agents ranked increasing knowledge and improving skills as their most important impacts.

Dietary Services↗
PubMed2003

Strategies for integrating Medicare and Medicaid: design features and incentives.

In a typical third-party payer situation--representative of most U.S. health care delivery--the payer is likely to have interests that are at odds with the patient and provider. The separation and overlap between Medicare and Medicaid for individuals eligible for both programs introduces an additional level of complexity: multiple masters over plans, providers, and patients. This creates opportunities for shifting costs and administrative burdens between states and the federal government, providers and governments, and patients and everyone else. Program designers who wish to minimize unwanted consequences must find ways to structure their programs to produce financial incentives that encourage the pursuit of societal goals, including appropriately shared intergovernmental responsibilities and appropriate plan, provider, and patient behavior. Here the authors review nine federal and state initiatives that use varying strategies to integrate Medicare and Medicaid services for vulnerable populations. For each initiative, the authors examine and critique program design features in three areas: (1) eligibility determination, (2) finance and administration, and (3) service delivery. They find a few strengths and many weaknesses in design. Future efforts would be well served by carefully considering the incentive structures designed into these initiatives and working to improve them in the next generation of Medicare-Medicaid integration efforts.

Acute Disease↗
PubMed2003

Ridge filter design for proton therapy at Hyogo Ion Beam Medical Center.

At the Hyogo Ion Beam Medical Center (HIBMC) we have developed a new design method for the bar ridge filter used in proton therapy, taking into consideration the scattering and nuclear interaction effects within the filter itself, which are introduced in the design. In our beam delivery system, the bar ridge filter is employed as the range modulator. It is combined with the wobbler system, and produces a three-dimensionally uniform spread-out Bragg peak (SOBP). The design program predicts the three-dimensional dose distribution. Ridge filters of 3-12 cm SOBP in 1 cm increments were designed in the maximum radiation field for 150 MeV and 190 MeV proton beams so that a uniform physical dose area is obtained in the SOBP region three-dimensionally. Measurements were performed with the constructed ridge filters to verify the uniformity and these were compared with the predictions of the design program. The predictions and measurements were found to be in agreement except for the 12 cm SOBP. The uniformities were better than +/- 3.0% for all SOBPs produced. The ridge filters are now clinically in use.

Models, Theoretical↗
PubMed1993

Medicare program; revised designation of states in which Medicare SELECT insurance policies may be issued--HCFA. Notice.

Section 4358(c) of the Omnibus Budget Reconciliation Act of 1990, provides for the designation of 15 States in which Medicare supplemental insurance policies (commonly referred to as "Medigap" policies) may be approved for issuance as Medicare SELECT policies during the period January 1, 1992 through December 31, 1994. This notice announces two revisions in the list of States designated under this authority.

Centers for Medicare and Medicaid Services, U.S.↗