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12 children with handicapping problems were taught various strategies during a two-year period. These programs, designed to enrich their appreciation and awareness of the sounds of letters and how they are used, increased the children's attention span, parental participation with children and teacher, and promoted active involvement in reading.
Although there has been increasing attention to cancer prevention among low-income and minority populations, only a few nutrition interventions have addressed the special needs of people with low literacy skills. To determine the best provider and the most effective format for a nutrition intervention targeting patients with low literacy skills, we conducted interviews with literacy experts and health care providers and focus groups with members of adult basic education classes. Thirty-five literacy experts and health-center-based physicians, nurses, and nutritionists in Boston, Mass, were interviewed. In addition, 50 volunteer clients from 4 Boston-based adult basic education programs participated in 6 focus groups. Results suggested that health care providers consider nutrition to be a fundamental health education topic, but that its successful inculcation in patients with limited literacy skills is hindered mostly by insufficient provider time. Almost all providers agreed that patients need to be referred to nutritionists for nutrition education. Although most providers and patients acknowledged that patients perceive physicians to be the authorities on health, patients with low literacy skills turned first to family members and friends for health information. These results suggest that effective nutrition interventions must build on patients' social networks; appear in a visually based, interactive format; and be culturally appropriate.
STUDY DESIGN: This study investigated the interrelationship between total lumbosacral flexion and true lumbar flexion in a population of chronic low back pain sufferers, measured with a dual inclinometer technique. Correlations with self-reported disability also were assessed. Self-reported disability was measured with the Million Visual Analog Scale. OBJECTIVES: To assess whether total lumbosacral flexion could be substituted for true lumbar flexion in the clinical evaluation of trunk mobility. To determine which measure of flexion is a better predictor of self-reported disability after an intensive rehabilitation program for chronic spinal disorders. SUMMARY OF BACKGROUND DATA: Eighty-nine consecutive patients with chronic low back pain were evaluated. Fourteen subjects were excluded because of previous surgery. Seventy-five meet inclusion criteria and underwent quantification of lumbar mobility. Sixty-four met literacy criteria and were administered the Million Visual Analog Scale. Thirty-six patients completed rehabilitation and were re-evaluated at program completion for lumbar mobility. Thirty-three were re-evaluated with the Million Visual Analog Scale. RESULTS: Pearson's correlation coefficients for lumbar versus total flexion were r = 0.88 for initial evaluation and r = 0.84 after treatment. Correlation coefficients also were calculated for lumbar flexion and total flexion with disability scores. Before treatment, both measurements accounted for similar amounts of the variance in disability scores. However, after treatment, total flexion correlated higher with self-reported disability (r = -0.62 versus r = -0.43). CONCLUSIONS: Our results suggest that total lumbosacral flexion may be as equally relevant as true lumbar flexion in the measurement of trunk mobility in the clinical examination of patients with chronic low back pain. Regarding their relationship to self-reported disability, total flexion seems to be more relevant to outcome after intensive rehabilitation.
The internatal period, the time between births of successive children, has become a focal point for risk assessment and health promotion in women's healthcare. This period represents a time when women are at high risk for a depressive disorder. The pediatric venue offers a unique opportunity for the identification and management of depression in the internatal period, as mothers who do not attend their own medical appointments are likely to accompany their child to pediatric visits. This paper discusses the role pediatric providers can undertake to improve women's health in the internatal period through the detection and management of maternal depression at well-child visits. Successful models of the management of depression in other primary care settings are explored for their potential for implementation in the pediatric venue. A specific model developed and implemented as part of a 3-year project is presented to highlight the feasibility of an evidenced-based approach to the management of maternal depression in the pediatric setting. We present evidence demonstrating that pediatric providers can successfully identify postpartum women with depression, monitor symptoms and treatment adherence, and communicate results to a woman's healthcare provider. Yet more investigation is needed to create preventive interventions for maternal depression that integrate evidenced-based practice standards for the treatment of depression in primary care venues into pediatric settings. Future programs and policies targeting maternal depression in the pediatric environment should address patient mental health literacy and stigma, the training and education of pediatric providers, and issues of privacy and reimbursement.
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A study on the Immunization Coverage relating to the six vaccine preventable diseases was carried out in an urban, semi urban and rural area in Kerala and the results from the three areas were compared and discussed. The percentage of fully immunized children was similar in all the three areas and it was quite high. Coverage of measles vaccine was high in the Health Unit, Pangappara where health education activities were carried out by the interns. The awareness about vaccine preventable diseases was more in the urban and semiurban areas. The drop out rate for DPT and OPV was also less in urban and semiurban than in the rural areas. More than 50% of the households in urban, semiurban and rural areas were unaware of the diseases prevented by DPT vaccine. Intense Health Education Campaign can definitely improve the immunization coverage further in a state which has already attained total literacy.
PURPOSE: A comprehensive worksite health promotion program designed to reduce risk factors for cardiovascular disease among 4000 city of Birmingham employees was used to develop and implement a tailored antihypertensive educational intervention. The mean age of the underlying population was 36 years, 89% were blue-collar or unskilled workers, 50% were African Americans and 20% were female. METHODS: First, we identified barriers to hypertension control: low literacy, difficulty understanding the need for treatment of asymptomatic disease, and wide variability of health beliefs and priorities. We then tailored an educational program, which offered employees health education sessions on a variety of different topics, including heart disease, cancer, sleep disorders and back injury. All program materials focused on lifestyle changes and the need to seek medical care. This program was offered to all hypertensive workers; 130 chose to enroll, and 81 completed the program. These 81 participants were matched by age, sex, race and baseline BP with nonparticipating hypertensive workers (controls). Changes in SBP and DBP from before to after the educational program were used to evaluate the program. RESULTS: Overall, intervention participants had a decrease of 4.5 mm Hg in mean SBP (different from zero, [p = 0.03]). African American participants showed a significant decrease (7.4 mm Hg, [p = 0.004]), as did unskilled intervention participants (SBP changes = 7.7 mm Hg, [p = 0.004]). Although not statistically significant, controls showed decreases in BP in the same direction. CONCLUSION: An educational intervention tailored to the specific health perceptions and working conditions of a low literacy population is feasible, and may have a significant effect on hypertension control.
It is becoming increasingly apparent that medical schools must begin teaching the knowledge, skills and attitudes of information literacy and applied medical informatics as core competencies in undergraduate medical education. The University of Vermont College of Medicine recognized that these core competencies were lacking in its curriculum, and in 1992 it implemented a four year, integrated program to give students the information habits essential to twenty-first century practice. The first graduates of the program are now in residencies and feedback has enabled the College to refine the program to better meet the informatics education needs of the next generation of physicians. The result of these efforts is the Vertical Curriculum in Information Literacy and Applied Medical Informatics; its process of development, the product of the process, and its outcomes are discussed.
This poster describes a pilot study conducted to establish validity and reliability of an instrument that will be used in a nationwide needs assessment, implemented to identify gaps in Information Literacy skills, competencies, and knowledge among key nursing groups nationally. Data and information gathered using the tool will guide the profession in developing appropriate education and continuing education programs to close identified gaps and enhance nurses' readiness for Evidence-Based Practice (EBP).
The rapid expansion of computer use for various nursing activities has made computer technology an important part of the curriculum in many schools of nursing across the world. Computer technology has become an alternative tool for teaching practice skills to students in a variety of educational settings and disciplines. Information technology (IT) is not yet well recognized in the Lebanese nursing curricula. This article traces the events of planning, developing, integrating, and evaluating nursing informatics on the Bachelor of Science in Nursing (BSN) Program of the School of Nursing (SON), at The American University of Beirut (AUB), Lebanon.
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PURPOSE: One of the many challenges clinicians face is applying growing medical knowledge to specific patients; however, there is an information gap between information needs and delivery. Digital information resources could potentially bridge this gap. Because most medical students are exposed to personal computers throughout their education, this study postulated that students may be more comfortable using computer-based information resources within clinical interactions. METHOD: In 2001, the authors monitored second-year medical students' use of a unique digital textbook, UpToDate, as they transitioned from preclinical to clinical years at the University of Iowa Roy J. and Lucille A. Carver College of Medicine. In 2002, at the end of their third year, students were surveyed about their preferred clinical information resources. RESULTS: Medical students rapidly adopted UpToDate as a clinical resource during their clinical clerkship as evidenced by a rapid growth in the electronic textbook's use. One hundred sixteen of a possible 154 students (75%) responded to the survey. More than 85% of respondents identified electronic sources as their primary resource (UpToDate 53%, MDConsult 33%; p <.001 when compared to paper resources). They also reported using the information resources on a daily basis and requiring less than 15 minutes to answer most of their clinical questions. CONCLUSIONS: This study clearly demonstrates that medical students embrace and use electronic information resources much more than has been reported among practicing clinicians. The current generation of students may be the leaders in a medical culture shift from paper to electronic resources.
OBJECTIVE: To assess the immunization status of children in 90 districts of the country giving due representation to all States and UTs. METHODS: WHO 30 cluster survey methodology with certain modifications incorporating information on sex, literacy and distance of the village. RESULTS: Information was collected for about nineteen thousand children. Immunization program could touch about 90% of target children. About 63% of children received all the vaccines (BCG, DPT, OPV, Measles). In the states of Bihar, Rajasthan, UP, MP, and NE States (combined) coverage levels were relatively lower. The coverage levels were also lower for children of illiterate mothers and in small, inaccessible and tribal village. CONCLUSION: Immunization coverage of children has improved in recent years. Further improvement may be achieved by targeting illiterate mothers, inaccessible and tribal areas and low performing states.
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DataBook is a computer application developed to assist the nurse manager in collecting, assessing and monitoring unit data on a day-to-day and summary basis. Once captured, this information can then be presented to create "information snapshots" of unit characteristics. Utilizing a PC-based spreadsheet program, the application is designed to be used by individuals with a modest degree of computer literacy.
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OBJECTIVE: To review the effort of the University of Washington (UW) Department of Laboratory Medicine to develop and use personal computer programs to teach the interpretation of image-based clinical laboratory tests to medical technologists and other health care workers. DATA SOURCES: Professional journals and books; Software owned by and licensed by the University of Washington. STUDY SELECTION: Not applicable. DATA EXTRACTION: Not applicable. DATA SYNTHESIS: We have been developing interactive personal computer (PC) programs for teaching image-based laboratory tests to medical technologists and other health care workers. The programs, called "Laboratory Tutors," are useful for teaching microscope-based tests and tests based on electrophoresis. Our programs include ANA-Tutor, which teaches the immunofluorescence assay for anti-nuclear antibodies; Gram Stain-Tutor, which teaches the direct Gram stain; Electrophoresis-Tutor, which teaches the interpretation of agarose gel protein electrophoretic patterns; Urinalysis-Tutor, which teaches the microscopic examination of urine sediment; in addition to other programs. The tutorials are all based on high-quality digital images that were acquired and processed using digital imaging systems. They require minimal computer literacy and have a number of advantages over standard approaches to teaching image-based laboratory tests. The computer tutorials are used in UW's medical technology and medical school curriculum, where they are used as supplements to traditional instruction. CONCLUSION: Laboratory tutors are computer programs that use high resolution digital images to teach the interpretation of image-based laboratory tests. We plan to continue to develop these programs, study their educational effectiveness, and update them periodically.