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PubMed1999

Vaccine injury compensation programs worldwide.

Approximately a dozen countries provide some form of compensation for injuries (or deaths) following vaccination. More than anything else, they were instituted in the belief governments have a special responsibility to those injured by properly manufactured and administered vaccines used in public health programs. Administratively, most are managed through the national government, including decisions on eligibility for and amount of compensation. Eligibility may depend on the recipient's age, citizenship or residency status, category of vaccine (e.g., recommended, compulsory), the location it is administered (public vs private ambulatory setting), or satisfying certain time frames for filing a claim. Since few vaccine-related injuries have a clinical or laboratory marker, proving actual causation is difficult. Causation decisions are usually based on the balance of probabilities standard of more likely than not. All countries require that the effects be long lasting (e.g., greater than 6 months), and nearly all provide coverage for medical costs, disability pensions, and death benefits, while noneconomic damages (pain and suffering) are included much less frequently. Funding is generally from the national treasury, with some programs receiving support from lower governmental entities or vaccine manufacturers. After nearly 4 decades of operation, vaccine injury compensation program appears to be an increasingly accepted component of immunization programs today. While we have a much better understanding of their statutory purpose, frame work, process and outcome, there is much more to be learned. Future research should focus on vaccine compensation programs and (1) decision-making at the administrative level; (2) the utilization of outcome indicators in order to gauge effectiveness, including immunization acceptance; (3) the knowledge and attitudes of the public and medical community in host countries; and (4) the overall perspective of vaccine manufacturers. Insight into these and other areas will no doubt aid other countries as they consider implementing programs of their own.

Humans↗

PubMed1995

An individualized educational model for the remediation of physicians.

OBJECTIVE: To design and implement an individualized program of evaluation and education to provide remedial experiences to physicians. DESIGN AND SETTING: An evaluation and educational program for physicians practicing in New York State. PARTICIPANTS: Physicians referred for evaluation and possible remedial educational experiences from the New York State Office of Professional Medical Conduct, from the New York State Committee on Physicians' Health, or self-referred. MAIN OUTCOME MEASURES: Educational programs designed to meet the individually identified educational needs of physicians and placement of physicians in educational settings that facilitate their meeting the program goals and issues raised by the Office of Professional Medical Conduct. RESULTS: Of the 28 physicians who have undergone evaluation activities, at the time of this report, five (18%) had completed their educational programs, five (18%) were participating in directed educational programs, five (18%) had approved educational programs and were awaiting placement, and 10 (36%) were awaiting acceptance of their program by the Office of Professional Medical Conduct. CONCLUSIONS: A comprehensive evaluation program can identify areas amenable to education and target individualized remedial educational experiences that may enable physicians to become contributing members of the medical community.

Clinical Competence↗

PubMed2005

Psychological outcomes of an outpatient pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease.

STUDY/PRINCIPLES: The effects of an outpatient pulmonary rehabilitation program on psychological morbidity (anxiety and depressive symptoms) were examined in patients with chronic obstructive pulmonary disease (COPD). METHODS: The 26 rehabilitation patients with COPD were compared with 19 control patients with COPD similar in age, gender, COPD severity and other variables. Initial assessment included lung function testing, health status, exercise tolerance, dyspnea intensity and psychiatric interviews using Hamilton depression rating scale (HAM-D) and Hamilton anxiety rating scale (HAM-A). A pulmonary rehabilitation program was carried out during the following 2 months; psychiatric interviews and measurements of health status, exercise tolerance and dyspnea intensity were done again on completion of the study at 2 months. RESULTS: There was a decrease in HAM-A scores in the rehabilitation group and the decrease was statistically significant (P=0.010). On the contrary the HAM-A scores did not change in control group. The decrease in HAM-A scores in rehabilitation group was also statistically significant compared with the control group (P=0.042). There was no significant difference in HAM-D scores within the two groups and also there was no significant difference between the two groups in HAM-D scores. The health status, exercise tolerance and dyspnea intensity improved significantly in the rehabilitation group compared to the control group. CONCLUSION: This study shows that our outpatient rehabilitation program leads to a benefit in anxiety and depressive symptoms in COPD patients. The benefit was especially significant in anxiety symptoms. In addition to the improvement in psychological symptoms, the health status, exercise tolerance and dyspnea intensity were also significantly improved in COPD patients who underwent the rehabilitation program. This outpatient-based rehabilitation program was well accepted by the patients. The relatively simple design of the program makes it feasible independently of expensive equipment.

Aged↗

PubMed2000

Changes in services and structure in community residential treatment facilities for substance abuse patients.

OBJECTIVE: This study examined the extent to which community residential facilities that contract with the Department of Veterans Affairs (VA) to treat substance abuse patients are providing more services and structure to meet the needs of a client population with increasingly severe problems. METHODS: A nationwide sample of 249 community residential facilities with VA contracts was surveyed in 1995 and again in 1998. RESULTS: In 1998 facilities were more likely than they were in 1995 to have psychiatrists and psychologists available to patients as well as specialized counseling and psychoeducational, rehabilitation, and medical services. Facilities also provided more social and recreational activities, and more structure was provided by discouraging patients' choice of individual daily living patterns. In 1998 the facilities were more likely to admit dual diagnosis patients, those with substance use disorders and psychiatric disorders. Programs that changed toward accepting dual diagnosis patients had more services and structure than programs that consistently accepted only substance abuse patients. CONCLUSIONS: Community residential facilities that contract with VA are responding appropriately to an increasingly ill patient population by providing more services and structure.

Adolescent↗

PubMed1994

[Exercise tests in spirometry].

Actual situation: There is a great variety of exercise programs (formerly called protocols) used in daily routine and general practice. Exercise programs vary with increments, step-duration, speed and grade, although standard recommendations have been published recently. In the USA, the Bruce program is widely accepted, although some criticism has been published. Comparing different exercise programs it is obvious, that maximal values (VO2, heart rate etc.) are only moderately affected by the program, but submaximal values are strongly influenced by the methodological procedure. Advantages and disadvantages of the different exercise testing procedures will be presented. As we need some standardized exercise programs to avoid "free-style ergometry", recommendations may be based on the following assumptions: Exercise testing should not be too short nor too long (10-12 min total test time), work rate increments should be intermediate (adapted to physical fitness), work rate steps should be about 2 min or an individualized ramp test should be used. Exercise test programs have to be selected according to the patient's fitness, to the disease or function to be studied, and to the laboratory setting. Standardization is strongly recommended.

Exercise Test↗

PubMed1996

Medicare HMOs: part of the solution or part of the problem in the struggle for cost containment?

The correct answer for salvage of the Medicare program while maintaining acceptable medical care is clearly not available today. Managed care programs for seniors have been an option in the last decade and plans are expanding rapidly into previously untapped areas. Some programs can indeed provide a multiplicity of services and thereby truly integrate and improve existing care plans. Others have less clear cut advantages. For any senior contemplating the options available for medical care under Medicare, HMOs and Medigap type instruments, the most salient advice is "buyer beware." A complete understanding of the options gained and lost by changing medical insurance coverage is essential.

Cost Control↗

PubMedDate not supplied

[Children's knowledge of sex behavior and contraception].

INTRODUCTION: Adolescent sexuality is not a new phenomenon, but it has been accepted differently at various times and societies. In modern times, adolescents start sexual life early, not well educated and not prepared for possible consequences. The period between the first sexual relationship, marriage and having children is prolonged with a greater possibility of having artificial abortions or sexually transmitted diseases (STD). It is of great importance to work on proper education of children and adolescents on sexual life and contraception. MATERIAL AND METHODS: An inquiry into the knowledge of sex and contraception was performed in an elementary school in Novi Sad, comprising 134 children from VII and VIII grade (aged 13-14, 77 girls and 57 boys) in order to prepare a lecture on these topics. RESULTS: Most of the knowledge on these topics children aged 13 and 14 got watching TV and reading magazines (44.15% girls and 70.17% boys) and from their friends (42.1%). Communication about sex and contraception exists mostly among friends (51.95% girls and 82.46% boys). One third of girls talk with parents and one quarter got knowledge from them. Only four boys (2.98%) had sexual intercourse without complications: artificial abortion or STD. Almost every child (96.95%) knows about AIDS and 89.25% children know about at least one method of contraception (mostly condom). Three quarters claim artificial abortion is harmful. 50% of children want more education about sex and contraception. DISCUSSION AND CONCLUSIONS: Most of the knowledge on sexual life and contraception children get from various forms of mass-media and from one another which is unreliable and incomplete. Unfortunately, parents and teachers play a minor role in sex education of children. In order to prevent spreading of sexually transmitted diseases and to decrease the percentage of adolescent pregnancy and artificial abortions, it is of great importance to investigate knowledge, attitudes and practice of children and adolescents in regard to sexual life and contraception and to prepare acceptable and efficient programs for education on these topics. However, not only education is important, but also acceptance and behavior of children and adolescents resulting from these programs.

Adolescent↗

PubMed1990

A case for social marketing and education for acceptance and implementation of preventive health and occupational safety measure programs for rural communities.

The environment in which acceptance and implementation of preventive health and occupational safety occurs is not conducive to the message being heard, nor are people acting upon the message. Diffusion of innovation and community development models are explored for possible approaches to health education in the rural community. In particular, the community-oriented primary care approach to medical practice is discussed. In addition, the responsibility of the rural community is outlined.

Agriculture↗

PubMedDate not supplied

The role of epidemiology in chronic disease prevention and health promotion programs.

Although the role for epidemiology is widely accepted in public health programs in general, its role in chronic disease programs is not as widely recognized. One possible barrier to improving epidemiologic capacity in chronic disease prevention and health promotion programs is that chronic disease program managers and public health decision makers may have a limited understanding of basic chronic disease epidemiology functions. We describe the assessment process of data collection, analysis, interpretation, and dissemination, and, using examples from two states, illustrate how this approach can be used to support program and policy development in three areas: by defining the problem, finding programs that work, and evaluating the effects of the program over time. Given the significant burden of chronic diseases in the United States, the scientific guidance provided by epidemiology is essential to help public health leaders identify priorities and intervene with evidence-based and effective prevention and control programs.

Chronic Disease↗

PubMed2001

Pilot study of the practical relevance of a one-step test for prostate-specific antigen in capillary blood to improve the acceptance rate in the early detection program of prostate carcinoma.

OBJECTIVE: Current studies have proven that early, organ-confined stages of prostate cancer can be diagnosed through screening based on PSA levels, thus reducing cancer mortality. Here we report about our experience using an innovative one-step test for PSA in capillary blood. METHODS: The incubation time for a 50 microl blood sample with the indicator strip is 12 minutes until the qualitative visual results (<4.0 ng/ml or > or = 4 ng/ml) appear. In cooperation with urologists and accompanied by an extensive information campaign, the one-step test was made available free of charge to all men between the ages of 45 and 75 in all 28 pharmacies of our city (100,000 inhabitants). RESULTS: The test's acceptance rate among the 2,119 participants between the ages of 45 and 75 years amounted to 13.0%. Fifteen percent of all the tests conducted showed a positive PSA result (> or = 4 ng/ml). Prostate carcinoma was histologically confirmed in 14 (0.66%) of the men, nine times in the early stage (T2) and five times in the clinical stage (T3), corresponding to an incidence of circa 650 cases per 100,000 men in the target age group. CONCLUSIONS: This newly developed PSA test system can enhance the acceptance rate and effectiveness of medical check-ups for prostate cancer, because it is easy-to-use, cost-effective and accurate (specificity 81.3%, sensitivity 91.1%). The test should be always conducted by an experienced physician or pharmacist. It is not a substitute for a regular physical examination (DRE, TRUS, biopsy...).

Aged↗

PubMed2000

A pre-admission program for underrepresented minority and disadvantaged students: application, acceptance, graduation rates and timeliness of graduating from medical school.

PURPOSE: To determine whether students' performances in a pre-admission program predicted whether participants would (1) apply to medical school, (2) get accepted, and (3) graduate. METHOD: Using prospectively collected data from participants in the University of North Carolina at Chapel Hill's Medical Education Development Program (MEDP) and data from the Association of American Colleges Student and Applicant Information Management System, the author identified 371 underrepresented minority (URM) students who were full-time participants and completed the program between 1984 and 1989, prior to their acceptance into medical school. Logistic regression analysis was used to determine whether MEDP performance significantly predicted (after statistically controlling for traditional predictors of these outcomes) the proportions of URM participants who applied to medical school and were accepted, the timeliness of graduating, and the proportion graduating. Odds ratios with 95% confidence intervals were calculated to determine the associations between the independent and outcome variables. RESULTS: In separate logistic regression models, MEDP performance predicted the study's outcomes after statistically controlling for traditional predictors with 95% confidence intervals. CONCLUSIONS: Pre-admission programs with similar outcomes can improve the diversity of the physician workforce and the access to health care for underrepresented minority and economically disadvantaged populations.

Cultural Deprivation↗

PubMedDate not supplied

Maintaining acceptably low referral rates in TEOAE-based newborn hearing screening programs.

This article describes factors that can affect the refer rate for otoacoustic emission (OAE) based newborn hearing screening, including the population of infants being screened, the adequacy of probe fit, software options used, external ear conditions, screener training, and baby handling. The effect of the infant's age on screening outcomes is also discussed using results of screening for 1328 regular nursery newborns, ranging in age from 6 to 60 hours, who were screened with transient evoked otoaoustic emissions (TEOAE) prior to hospital discharge. The youngest infants (6-9 hours old) were as likely to pass (90% pass rate) as the infants who were 24-27 hours old (94% pass rate). The results of this study are consistent with reports from many TEOAE-based screening programs that have demonstrated that acceptably low refer rates (mean = 6.9%) can be obtained when appropriate screening procedures are followed.

Acoustic Stimulation↗

PubMed2005

A community-based sports massage course for Aboriginal health workers.

OBJECTIVE: To pilot a community-based and owned sports massage course for Aboriginal health workers (AHWs). DESIGN: Descriptive, pilot educational intervention study. SETTING: Rural, Indigenous Australian community. SUBJECTS: AHWs working in a rural community. MAIN OUTCOME MEASURES: Cultural and logistical acceptability of the program to AHWs. RESULTS: The course was delivered within a culturally acceptable framework with applicability for the evaluation of sports massage skills and knowledge changes in a larger sample. CONCLUSION: The sports massage course demonstrated its applicability in this rural Aboriginal community and it has the potential to be adapted and adopted in other similar settings.

Adult↗

PubMed2005

Measuring the significance of participant evaluation of acceptability of cases in the College of American Pathologists Interlaboratory Comparison Program in cervicovaginal cytology.

CONTEXT: The quality of gynecologic cytology slides within educational and proficiency testing programs may deteriorate during use. Participant evaluation of the acceptability of these slides subsequent to possible deterioration is not known. OBJECTIVE: To assess participants' evaluation of the acceptability of slides circulating within an educational gynecologic cytology glass slide program. DESIGN: The College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology is a peer comparison and educational program that evaluates the ability of the participants to correctly classify gynecologic cytology preparations. The program uses both expert review and field validation to select slides for the graded portion of the program. Participants were asked to assess the acceptability of slides within the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology, and their responses were assessed with respect to type of slide preparation, validation status, and reference diagnosis. In addition, we compared the cytodiagnostic discordancy rates of slides that were deemed acceptable by participants with those that were deemed unacceptable. SETTING: Participant assessments were derived from pathologists and cytotechnologists from cytology laboratories of all types. RESULTS: A total of 17,210 slide interpretations were reviewed, and 2.91% of the cases were labeled unacceptable by participants. For all slides, the percentage of cases called unacceptable varied from 1.65% for cases with a reference interpretation of herpes to 45% for cases with a reference interpretation of unsatisfactory. The percentage of slides deemed unacceptable was higher for validated slides than for educational slides (3.27% vs 2.55%, P = .006). The discordancy rate (to reference diagnosis series) for cases deemed unacceptable was significantly higher than the discordancy rate for cases deemed acceptable for both validated (10.39% vs 1.76%) and educational slides (21.72% vs 3.53%, P < .001). CONCLUSION: Greater than 97% of all slides in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology were judged acceptable by participants. Despite expert review and field validation, a small percentage of slides (almost 3%) in this program were deemed unacceptable by participants. These results support the use of participant evaluation of cases to continually improve the quality of cases in this program.

Clinical Competence↗

PubMedDate not supplied

[Locus of control in alcoholics: comparative study of 64 alcoholics vs 50 hospitalized patients and 50 normal controls].

The locus of control is a construct that consists of factors that influence and contribute to a person's belief concerning the extent and degree to which he or others can influence life events. The study had four purposes. They were to examine differences between psychiatric inpatients alcoholics and non alcoholics on the internal, chance and powerful others subscales of the French version of Levenson's scale, to evaluate differences on these scores between the alcoholics who accepted the alcohol program treatment proposed at the admission (hospitalization of 15 days with a directive and structured context) and those who refused this treatment, to assess the impact of treatment on the Levenson scale scores of the alcoholics, and finally to determine whether the Levenson scale scores differentiate between treatment successes and failures (evaluated at three months). 171 subjects were divided into three groups: 64 patients hospitalized in psychiatry for chronic alcoholism (ICD-10 criteria for alcohol dependency), 50 patients hospitalized in psychiatry for an other pathology (control group) and 57 healthy subjects (normal group). These subjects filled out the IPC (Internal, Powerful others, Chance) scale of Levenson, different from the I-E (Internal-External) Rotter's scale because it distinguishes two types of externality: one imprevisible, the chance, and the other previsible, the powerful others. The results showed that the alcoholics as the controls are more external than the healthy subjects (Chance and Powerful others subscales). They also showed that the alcoholics who refused the alcohol treatment program proposed at the admission were more internal than those who accepted. We also found that, during the treatment, the alcoholics' scores of Internality increased while their scores of externality (Chance and Powerful others) decreased. This decreasing was also found with the check inpatients. So these changes would have connections with an "hospitalization factor" and wouldn't be due to the alcohol treatment. As for the last purpose, there were no significant differences between the initial locus of control scores of the successes and those of the failures.

Adult↗

PubMed1990

AIDS contact notification: initial program results in New Jersey.

As part of an 1988-89 evaluation of New Jersey's newly established HIV Notification Assistance Program (NAP), data were collected concerning number of HIV+ persons providing contact names; contact characteristics; reactions to NAP of HIV counselors, their clients, and of notified contacts; and program costs. There was initial resistance to the program both from HIV counselors and their clients. By mid-1989, acceptance of the program by referring HIV counselors had increased. The proportion of HIV+ clients who referred contacts was still low, but had increased to 10%. 160 contacts were notified: 72% sexual contacts and 28% needle sharing contacts, 59% male and 41% female, 58% black, 29% white, 13% Hispanic. 67% considered themselves at moderate or high risk for HIV; 31% stated that they had already been tested for HIV, with 7% having tested positive. Cost per notified contact was $2,260; cost per contact not previously tested HIV+ and unaware of risk was $3,014. Findings suggest that persuading counselors at HIV counseling and testing sites of the program's value is a key prerequisite for success, in situations where notification is carried out by a separate agency. Once the program has been in place for a time and has established credibility, the opportunity exists for initial resistance to be overcome.

AIDS Serodiagnosis↗

PubMed1995

A community-based cervical screening program in a remote Aboriginal community in the Northern Territory.

We established a culturally appropriate, community-based women's health service in Yuendumu, Northern Territory, to improve women's health and to remedy the low rate of cervical screening. During the 16 months of the program 419 cervical smears were taken, increasing coverage of the women eligible from 51 to 78 per cent. Acceptance of the program was excellent, with only 2 per cent of the women approached refusing to have a smear. Over 70 per cent of the Pap smears were done by the nursing staff in the clinic; quality control was good, with 9 per cent of smears reported as having no endocervical cells. Sixty-four per cent of screened women had normal smears and 0.9 per cent showed evidence of cervical intraepithelial neoplasia (CIN). Three women were referred for treatment of CIN, two for CIN I and one for CIN III. The program illustrates how a combination of community involvement, staff stability, teamwork, and cross cultural understanding can achieve a comprehensive and successful cervical screening service in a remote Aboriginal community.

Adolescent↗

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↗