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PubMed2006

Capturing complexity: integrating health and education research to inform health-promoting schools policy and practice.

Despite the intersectoral nature of health promotion practice many programs limit their evidence base to health sector research and do not draw on evidence from other sectors' research in program design. To help ensure programs are relevant and acceptable to intersectoral partners and intended outcomes are of value to all sectors involved, utilising evidence from more than one discipline is essential. This article identifies the narrow interpretation of existing evidence for health promoting schools and discusses the challenges faced by practitioners and policy makers when reviewing evidence. These issues include the various perspectives on what is 'quality' evidence and how to ensure multidisciplinary evidence is used to inform practice, particularly with the education sector that has a strong research base of its own. A data extraction tool was developed to help address these issues and assist the design of a health promoting schools program. A description of the tool's elements and two case studies provide examples of how research from two different disciplines can be integrated to inform planning and strengthen partnerships. The tool expands the evidence base for policy and practice decision-making for health promoting schools, acknowledging the practical realities of both sectors.

Evidence-Based Medicine↗
PubMedDate not supplied

Culture and the management of family planning programs.

Integrating family planning programs with local cultures can increase or undermine their effectiveness. Program design and organization will be influenced by kinship and reproductive decision-making, which varies across regions, racial and communal divisions, and religions. Program implementation depends on four aspects of culture: (1) the understanding, acceptance, and continued practice of family planning by clients; (2) the climate in the organizations responsible for fieldwork, which affects the disposition to work and the tasks to be done; (3) the ability and willingness of field implementers to do their work; and (4) the communities in which clients live, including collective attitudes toward family planning and local pressures put on clients to participate. The Indonesian family planning program is a case in which these elements of culture are often positive. Other programs, such as that in Kenya, have a more negative environment for action.

Cross-Cultural Comparison↗
PubMed2001

Outcomes monitoring in Minnesota: treatment implications, practical limitations.

Minnesota developed its treatment outcomes monitoring system to evaluate its service delivery system and to identify specific ways to enhance treatment outcomes. Standardized patient and treatment data were collected for all outpatient and inpatient admissions, and an assessment interview and weekly treatment services records were completed for 4953 adults and 387 adolescents who consented to participate in the outcomes study. Six-month follow-up interviews were completed for 64.4% of these adults and 83.5% of these adolescents. The study identified predictors of treatment completion and outcome for adults and adolescents, and predictors of outcome by setting for adults. The study also examined results for programs designed especially for adolescents, women, and culturally specific populations, as well as the relationships to outcomes of ancillary services and continuing care activities. Anticipated policy and program design changes resulting from the findings are discussed, along with the practical limitations of conducting a state outcomes monitoring system.

Adolescent↗
PubMed2000

Economics of using pharmacists as advisers to physicians in risk-sharing contracts.

An educational program designed to help physicians control the overall cost of drugs and total health care is described, along with its effectiveness at one managed health care plan. Prime Therapeutics, Inc., developed and manages an ongoing physician education program designed to help primary care physicians control drug and total health care costs. Physician education initiatives in the program are developed by using peer-reviewed literature; selections of preferred drugs are based on evidence of their safety, efficacy, uniqueness, and cost-effectiveness. For a typical educational initiative, a pharmacist meets with the physicians identified as being among the top 20% of prescribers of high-cost drugs addressed by the initiative and delivers a 20-minute presentation. One-on-one meetings with the physicians are then held quarterly to review their prescribing. Each physician is shown comparisons with the prescribing patterns of other physicians in the organization. The clinic chooses to present the clinicwide data as either blinded or nonblinded data. The program was evaluated by comparing per member per month (PMPM) total health care and drug costs for 1996 and 1997 at 12 general medicine clinics in a managed health care plan. Five clinics received no interventions, three clinics allowed the initial presentation and the quarterly face-to-face meetings, and four clinics allowed only the presentation and barred ongoing meetings. In general, the clinics with more interaction between pharmacists and physicians had lower PMPM costs for total health care and drugs than the clinics with less interaction. Pharmacists acting as advisers to primary care physicians in general medicine clinics helped lower PMPM costs for drugs and total health care.

Health Care Costs↗
PubMed1983

Survey-based indices for nursing home quality incentive reimbursement.

Incentive payments are a theoretically appealing complement to nursing home quality assurance systems that rely on regulatory enforcement. However, the practical aspects of incentive program design are not yet well understood. After reviewing the rationale for incentive approaches and recent State and Federal initiatives, the article considers a basic program design issue: creating an index of nursing home quality. It focuses on indices constructed from routine licensure and certification survey results because State initiatives have relied heavily on these readily accessible data. It also suggests a procedure for creating a survey-based index and discusses a sampling of implementation issues.

Abstracting and Indexing↗
PubMed2007

Batch RNAi selector: a standalone program to predict specific siRNA candidates in batches with enhanced sensitivity.

RNA interference (RNAi) is a popular and effective method for silencing gene expression. siRNAs should be gene-specific and effective to achieve specific and potent gene silencing. However, most currently available siRNA design programs are web-based programs that either require each sequence be submitted individually, making large-batch analyses difficult to conduct, or only provide limited options for searching off-target candidates (e.g. NCBI-BLAST). We have developed a stand-alone, enhanced RNAi design program that overcomes these shortcomings. We have implemented WU-BLAST, FASTA and SSEARCH homology searches for siRNA candidates to improve gene specific siRNA selection and to identity siRNA candidates that could lead to off-target gene silencing. We also included many new features such as siRNA score calculation and calculation of siRNA internal stability to help select highly potent siRNAs. This program is freely available for academic and commercial use (), and can be installed and run on any Linux machine. Our program automates the search for siRNAs and the resulting data files including a list of siRNA primers with scores and database search results for each siRNA candidate are stored locally for easy retrieval and inspection when needed.

Gene Expression↗
PubMed1985

Educational and exercise programs for asthmatic children.

We designed programs to teach appropriate exercises to asthmatic children and to educate their parents about their special needs. Each of 11 programs over a six-year period included a weekly two-hour session for four weeks. Lectures for parents dealt with the etiology and precipitating events of asthma, environmental control and drug therapy, family interaction with a psychiatrist, and hyposensitization therapy and food allergy. The 59 children, aged 4 to 13, played group games, learned breathing exercises, and were assisted by their parents in postural drainage. School absences decreased in 59%, emergency room visits decreased in 70%, medication usage decreased in 54%, and the number of attacks decreased in 70%. Greater understanding of asthma by both parents and children improved the quality of life and lessened the severity of the disease.

Asthma↗
PubMed1997

Self-directed patient education in soft-tissue rehabilitation: rationale and analysis of a pilot project.

OBJECTIVES: To determine the compliance level and topic choice selection frequency of rehabilitation patients in a self-directed education program offered in conjunction with a rehabilitation exercise program. DESIGN: Descriptive study. SETTING: Soft-tissue injury rehabilitation clinic located within a chiropractic college. SUBJECTS: Twenty-four rehabilitation patients with injured spines who were enrolled in a daily in-clinic program. OUTCOME MEASURES: Data was collected from patient log-book pages, which recorded frequency of use, topic, medium and personal satisfaction for each selected resource. Clinic attendance data was collected by the clinical staff. RESULTS: Eighty-one percent (81%) of the patient group voluntarily used the learning center. Average frequency of use was approximately one visit per patient per week. Of the 13 subject areas included in the resource center collection, back injury care (30), nutrition (22) and fitness/exercise (14) received the most use. Patient satisfaction with the resources' value/interest averaged 78.4%. CONCLUSIONS: Most (81%) patients in this group were willing to spend some of their own time learning information that they thought was important. The results may allow for patient education program designs that put more responsibility for learning with the patient and allow for more efficient clinician time allocation.

Adult↗
PubMed2002

Performance and physiologic adaptations to resistance training.

Weight lifting, or resistance training, is a potent stimulus to the neuromuscular system. Depending on the specific program design, resistance training can enhance strength, power, or local muscular endurance. These improvements in performance are directly related to the physiologic adaptations elicited through prolonged resistance training. Optimal resistance training programs are individualized to meet specific training goals. When trained properly (i.e., similar intensity and volume), these functional and physiologic adaptations are similarly impressive among women and the aged as they are among young men. Yet, in contrast to relative measurements, sex and age differences exist in the absolute magnitude of adaptation. Of equal importance, perhaps most notably among the elderly, are the important health benefits that may also be derived from resistance training. For example, bone density, insulin sensitivity, and co-morbidities associated with obesity can be effectively managed with resistance exercise when it is conducted on a regular basis. The extent of the functional and health benefits to be accrued from resistance training depend on factors such as initial performance and health status, along with the specification of program design variables such as frequency, duration, intensity, volume, and rest intervals.

Adaptation, Physiological↗
PubMedDate not supplied

Fostering psychosocial wellness in oncology nurses: addressing burnout and social support in the workplace.

PURPOSE/OBJECTIVES: To identify psychosocial wellness and the avoidance of burnout as key priorities for the retention of oncology nurses and to describe a program designed for a specific setting to enhance the psychosocial wellness and coping skills of oncology nurses. DATA SOURCES: Published research, books, and journal articles; theory; practice; and personal experience. DATA SYNTHESIS: Oncology nurses benefit from programs designed to bolster the development of coping skills to reduce stress, foster supportive relationships in the workplace, facilitate work-related grief and bereavement, and reduce burnout. CONCLUSIONS: Fostering psychosocial wellness in the workplace potentially can increase oncology nurse retention. IMPLICATIONS FOR NURSING: A renewed recognition of the stressful nature of oncology nursing should give rise to programs that address the psychological well-being of oncology nurses. Oncology nursing leadership, recognizing the potential for stress and burnout inherent in this profession, should research and develop programs to enhance staff coping skills and mutual support.

Attitude of Health Personnel↗
PubMed1989

Project SMART parent program: preliminary results of a chronic disease risk reduction trail.

Project SMART Parent Program is a school-based healthy lifestyle promotion program designed to reduce chronic disease risk in adults and to provide a health-conscious home environment for children through the adoption of healthy lifestyle by their parents. Parents in the high involvement condition received comprehensive health status appraisals, and a program designed to reduce dietary fat intake, and increase aerobic activity levels. Parents in the low involvement condition received only the comprehensive health status appraisals. ANCOVA, using treatment condition as the independent variable and change scores as the dependent variables, were used to assess program outcomes. At the first posttest measure, the intervention group compared to the control group had a significantly greater decrease in blood cholesterol, a greater gain in aerobic fitness, a greater weight loss, and a greater decrease in body fat. At the second posttest measure, the intervention group had significantly greater gain in aerobic fitness, a greater decrease in body fat, a greater decrease in systolic blood pressure, and a marginally significant decrease in weight. Preliminary results provide strong support for the effectiveness of the Parent Program in reducing chronic disease risks.

Adolescent↗
PubMed1997

[The Breast Program--25-year role of the health service].

In screening for breast cancer, the discovery of screening positive cases can be carried out either with screening mammographic examination, with breast physical examination, or with breast self-examination. The screening positive cases should be examined with diagnostic mammographic examination. In BSE-screening, one-way communication about BSE does not influence health behaviour like e.g. monthly BSE-performance, followed by self-referral to a physician if breasts change from normal. Aimed at behavioural change, two-way communication strategies are needed in comprehensive program designs. The finnish Mama Program Screening is based on delivery of the message with two-way communication and the use of specially designed Mama-calenders for follow-up of the health behaviour of the participants during the continuous program. In a cohort, exposed to the Mama Program, compliance with BSE increased from 2% to 55% monthly performance. Two percent self-referred to the diagnostic mammographic examinations arranged within public health care facilities. In a 14 years follow-up of the complying women, 20% more breast cancers were detected than expected and mortality from breast cancer was 29% less than expected in all age groups. The Mama Program Screening has been implemented in public health care in Finland on a voluntary basis as an easy and inexpensive basic screening for women in all ages. It can be implemented in different PHC and private health care systems.

Adult↗
PubMed2003

Strategy to assess the efficiency of U1 RNA-hammerhead ribozyme constructs using GFP-tagged targets.

The application of ribozymes for gene therapy of autosomal dominant diseases has become popularized in recent years. Further this technology has widespread utility in the treatment of any disease, acquired or inherited, by inhibition of gene expression. The design of ribozymes is usually accomplished using computer assisted design programs, however they are not very useful in predicting the behavior of the ribozyme in the in vivo setting. To overcome this technical challenge, we developed a simple in vivo strategy to accurately assess the efficiency of ribozyme cleavage that significantly enhances the computer based design programs.

Animals↗
PubMed2001

The efficacy of a universal school-based program to prevent adolescent depression.

Evaluated whether a universal school-based program, designed to prevent depression in adolescents, could be effectively implemented within the constraints of the school environment. Participants were 260 Year 9 secondary school students. Students completed measures of depressive symptoms and hopelessness and were then assigned to 1 of 3 groups: (a) Resourceful Adolescent Program-Adolescents (RAP-A), an 11-session school-based resilience building program, as part of the school curriculum; (b) Resourceful Adolescent Program-Family (RAP-F), the same program as in RAP-A, but in which each student's parents were also invited to participate in a 3-session parent program; and (c) Adolescent Watch, a comparison group in which adolescents simply completed the measures. The program was implemented with a high recruitment (88%), low attrition rate (5.8%), and satisfactory adherence to program protocol. Adolescents in either of the RAP programs reported significantly lower levels of depressive symptomatology and hopelessness at post-intervention and 10-month follow-up, compared with those in the comparison group. Adolescents also reported high satisfaction with the program. The study provides evidence for the efficacy of a school-based universal program designed to prevent depression in adolescence.

Adolescent↗
PubMed2004

Designer ribozymes: programming the tRNA specificity into flexizyme.

Fx3 is an artificial ribozyme with the ability to aminoacylate various tRNAs with phenylalanine and its nonnatural derivatives. Herein we report a simple strategy to build tRNA specificity into the generic Fx3, by appending to its 3'-end a tRNA-specific sequence (TSS), which is complementary to the acceptor stem of the cognate tRNA. This new designer ribozyme, referred to as Fx10, is able to recognize its cognate tRNA via a 10-base-pair interaction that is formed after the invasion of the tRNA acceptor stem by the TSS. We have demonstrated that Fx10 can aminoacylate its cognate tRNA with a high degree of specificity and also discriminate against the noncognate tRNAs. Because the tRNA specificity can be easily programmed into Fx10, it is a custom-made catalyst to generate nonnatural aminoacyl-tRNAs.

Acylation↗
PubMed1999

Home prophylactic warfarin anticoagulation program after hip and knee arthroplasty.

OBJECTIVE: To determine the efficiency of a program designed to maintain prophylactic oral anticoagulation within a target range for 6 weeks after hip and knee arthroplasty. DESIGN: A prospective continuous quality improvement indicator. SETTING: A tertiary care university hospital. PATIENTS: Patients who underwent hip and knee arthroplasty and had no indications for routine anticoagulation other than postoperative thromboembolism prophylaxis. INTERVENTION: An outpatient warfarin prophylaxis program, which included an information letter given to the patient. Home Care coordinated community laboratory services, communication with and anticoagulant dosage adjustment by the patient's personal family physician. OUTCOME MEASURES: The proportion of international normalized ratio (INR) values within, below and above the target range of 2.0 to 3.0. RESULTS: Sixty-two patients were enrolled over a 3-month period. On the day of hospital discharge, 64% of patients had INR values that were within the target range, 31% were below and 5% were above. After hospital discharge, 42% of the INR values were within the target range, 48% were below and 10% were above. CONCLUSION: Despite a program designed to address patient information, physician communication and laboratory testing, tight control of home INR values could not be achieved with the existing resources of Home Care and family physicians.

Ambulatory Care↗
PubMed1983

Integrating cognitive strategies into the physical therapy setting.

Effectively integrating cognitive management concepts into the physical therapy setting is dependent upon an adequate understanding of the cognitive and behavioral consequences of head injury and the appropriate use of diagnostic and prognostic cognitive data as a basis for program design. The intent of this article is to provide a framework for simultaneously addressing the physical and cognitive consequences of head injury. Behavioral manifestations of cognitive dysfunction and a means of clinically observing and assessing patient performance are provided as a basis for program design. Specific examples of treatment strategies applicable to various phases of cognitive recovery are described.

Behavior↗