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At least 541 records · Page 30Linked to original sources
PubMed2001

Intakes of most nutrients remain at acceptable levels during a weight management program using the food exchange system.

OBJECTIVE: The purpose of this study was to determine if the food exchange system allows subjects' nutrient intake to remain at recommended levels during a weight-loss program. DESIGN: Subjects in an intervention were prescribed an energy-restriction diet and exercise program lasting 32 weeks, and nutrient intake was measured prestudy and after 12, 16, and 32 weeks. SUBJECTS/SETTING: Healthy but overweight and obese premenopausal women (n = 219) were recruited at 6 university sites into community-based weight loss programs. One hundred fifteen women completed all aspects of the study. INTERVENTION: Energy intake was set at 0.8 x resting metabolic rate (RMR) for weeks 1 through 12, 1.0 x RMR for weeks 13 through 20, and 1.2 x RMR for weeks 21 through 32. Energy intake was based on food exchange tables, with the number of food exchanges adjusted to encourage a distribution of 55% carbohydrate, 30% fat, and 15% protein. Subjects increased their daily walking distance to 3.2 km above prestudy levels. MAIN OUTCOME MEASURES: Nutrient intake was measured from four 3-day food records. STATISTICAL ANALYSES PERFORMED: Repeated measures analysis of variance, with specific time point changes assessed from paired t tests adjusted for multiple comparisons. RESULTS: Body mass decreased by a mean +/- SD of 6.7 +/- 3.2 kg at week 12 and 7.8 +/- 6.2 kg by week 32. Walking distance increased by an average of 17.2 +/- 10.0 km/week during the first 12 weeks, and 12.4 +/- 12.4 km/week during the last 20 weeks. Despite a 23% to 36% reduction in energy intake during the study, intake of most nutrients was maintained. Intake of vitamin E, calcium, iron, and zinc decreased significantly from prestudy levels during the first 16 weeks of the intervention, but not at week 32. APPLICATIONS/CONCLUSIONS: Intake of most nutrients can remain at recommended levels when overweight and obese women follow the American Diabetes Association/American Dietetic Association food exchange system during a community-based weight-loss program.

Adult↗
PubMed2001

The use of a symptom "self-report" inventory to evaluate the acceptability and efficacy of a walking program for patients suffering with chronic fatigue syndrome.

OBJECTIVES: The purpose of this research was to evaluate the effectiveness of the modality of walking as a management strategy for patients suffering with chronic fatigue syndrome (CFS). METHODS: Six males and fourteen females with medically diagnosed CFS (CDC, 1994), completed a 12-week walking program. Prior to starting the program subjects underwent an incremental walking exercise test to predetermine their walking intensity. The SCL-90-R symptom "self-report" questionnaire was administered prior to, and at the completion of, the walking program. RESULTS: At the completion of the 12 weeks of walking, changes in four of the nine SCL-90-R dimensions were significant (somatisation, paranoid ideation, phobic anxiety, and psychoticism). Also significant were the changes in the combination indices, the Global Indices of Distress (GID) and the Positive Symptom Total (PST). CONCLUSION: This group of CFS subjects, by way of "self-report", indicated the possibility of an exercise-induced decrease in psychological stress. The walking intervention may have evoked positive changes in their well-being and, furthermore, provided no evidence of any exacerbation in their symptoms.

Adolescent↗
PubMed2005

Can a cancer program-sponsored spiritual event meet with acceptance from patients and other attendees?

BACKGROUND: While many cancer patients derive strength from spiritual or religious faith, concern often remains regarding how different patient subgroups and other community members might react to faith-based services when sponsored by a secular health care organization. METHODS: "A Sacred Gathering for Those Touched by Cancer" was presented in 2 Catholic and 2 Protestant churches. The service included key themes (surrendering fear, peace, hope, community support, and God's love) reinforced by Scripture, music, ritual, and prayer. Patients, clergy, and staff participated. Questionnaires evaluating attendee characteristics, emotional response to the service, and satisfaction with service components were distributed. RESULTS: Attendees (women: 80%; Catholic: 71%; half older than 50 years) returned 450 questionnaires. Most found the service very (83%) or somewhat (14%) helpful. Multivariate regression of perceptions indicated (1) the opinion that the service was helpful was associated with the perception that the service made the respondent feel hopeful (P < .0001), that respondents found inspirational messages important (P = .058), and that the respondent was a current patient (P = .018) and (2) an angry response reported by respondents was associated with current patient status (P = .0044). Men tended to feel less loved by God (P = .012) and people (P = .034) and less hopeful (P = .057) than women did. Men liked music less (P = .048), liked Scripture and prayers concerning community less (P = .040), and found prayer (P = .0035) less important. However, men felt the gatherings were as helpful as women did. Past patients felt less sadness than did others (P = .0084). Increased perceived helpfulness of the service was associated in a multivariate analysis with current patient status, feeling hopeful as a result of the service, increased appreciation of the service's inspirational message, and the perception that the service was not too long. CONCLUSIONS: While almost all attendees found the service somewhat or very helpful, distinct preferences and reactions to the service were noted for gender, patient status, and religious affiliation. This evaluation will help tailor future events to better meet the spiritual needs of cancer patients and their loved ones.

Adolescent↗
PubMed2003

U.S. military officer participation in the Centers for Disease Control and Prevention's Epidemic Intelligence Service (1951-2001).

The Epidemic Intelligence Service (EIS) was created in 1951 to provide epidemiologists to investigate natural and intentional disease epidemics. From an initial class of 23 U.S. citizens, the program has evolved into a globally recognized, hands-on learning experience, accepting approximately 65 to 75 new officers each year. The first U.S. military epidemic intelligence service officer (EISO) was accepted into the program in 1994. Since that time, 12 such officers have completed, or have begun, EIS training. They have comprised 2.1% of all EISOs from 1994 to 2001 and 0.47% of all EISOs. This total has included nine Air Force veterinarians, one Army veterinarian, one Army physician, and one Navy physician. Each military EISO had the opportunity to lead investigations of significant public health events (e.g., Ebola, monkeypox, malaria, Nipah virus, West Nile fever, and anthrax outbreaks). All graduates from the military returned to active duty assignments in operational medical units, research institutes, or the intelligence community.

Adult↗
PubMed1991

[Care of tuberculosis patients at the community level in the state of Chiapas, Mexico].

From August 1989 to August 1990 in the municipio of Chicomuselo, State of Chiapas--an area with a high incidence of tuberculosis--health promoters were trained to carry out priority actions as part of the National Campaign Against Tuberculosis. A program to provide training, semi-monthly evaluation of the work carried out, detection of new cases, treatment supervision, and contact tracing was established utilizing the structure and resources of the Campaign. The health promoters were assigned the following functions: searching for patients with respiratory symptoms and conducting sputum smear examinations, examining postvaccination scars in persons under 15 years of age, and tracing tuberculosis patient contacts. In total, 1,778 doses of BCG vaccine were administered to individuals under 15 years of age in 35 communities; 144 patients with respiratory symptoms were studied; 257 sputum smear examinations were carried out; and 26 cases of tuberculosis were diagnosed. The most affected age group consisted of those 15 to 45 years old. Patients were monitored during treatment through sputum smear examinations. Twenty-nine persons started the treatment and 24 completed it; 24 were cured, five did not complete the treatment, two abandoned it, and three died. There were no treatment failures. The efficiency of the program was 82% and its effectiveness, 100%. The results show that it is possible to utilize the human resources in a community to carry out health programs. The community members' acceptance of and support for the program was due in part to that fact that their interests were taken into account in its implementation.

Adolescent↗
PubMed1991

OSHA's voluntary protection programs. The benefits to occupational health nurses and their companies.

The Voluntary Protection Programs (VPP) consist of three different programs: Star, Merit, and Demonstration. Each is designed with different criteria to allow the opportunity for a wide range of safety and health programs to be recognized. To be accepted into the Star program it is necessary to have statistics that indicate the program is effective and to have the following six elements incorporated into a comprehensive safety and health program: management commitment; established methods of worksite analysis; established methods of hazard prevention and control; quality safety and health training; employee participation; and annual self evaluation. Because occupational health nurses have daily experience and formal training in hazard prevention and control, safety and health training, and employee health, they are invaluable resources in the VPP application process and in the maintenance of Star level protection. Decreased workers' compensation costs, decreased injury rates, and development of a positive attitude toward OSHA are benefits of the VPP for management, employees, and OSHA.

Accidents, Occupational↗
PubMed2000

Research training in six selected internal medicine fellowship programs.

BACKGROUND: Effective July 1997, the American Board of Internal Medicine (ABIM) established a research pathway to certification to encourage research training of general internists and subspecialists. OBJECTIVE: To document the current status of research training in six selected subspecialty programs, to examine opportunities available for trainees to undertake formal course work, and to report the percentage of subspecialty programs that might accept research pathway fellows. DESIGN: National Study of Graduate Education in Internal Medicine questionnaires from 1996-1997 and 1997-1998. SETTING: Programs in internal medicine subspecialties accredited by the Accreditation Council for Graduate Medical Education. PARTICIPANTS: 1163 (84%) and 1094 (79%) directors of internal medicine subspecialty programs in 1996-1997 and 1997-1998, respectively. MEASUREMENTS: Survey questions on the amount of time fellows usually spend conducting research and available opportunities to pursue course work leading to an advanced degree. RESULTS: On average, during their last year of training, fellows enrolled in infectious disease, nephrology, endocrinology, and rheumatology programs spent 40% to 50% of their time conducting research, whereas fellows in gastroenterology and cardiology spent 25% to 30% of their time conducting research. Compared with programs sponsored by major teaching hospitals, a greater percentage of programs sponsored by academic medical center hospitals planned to accept persons interested in pursuing the new ABIM Research Pathway (28% vs. 8%) and to provide opportunities for fellows to obtain an advanced degree (60% vs. 14%). CONCLUSIONS: Few internal medicine subspecialty programs are currently designed to provide adequate research training as defined by the Institute of Medicine and the ABIM.

Academic Medical Centers↗
PubMed1978

Behavior therapy for autistic children: a study of acceptability and outcome.

An inpatient program for autistic children which used behavior modification methods is described, and a follow-up study of the first 15 children discharged from the program is reported. In general, the outcome results appear to be comparable to those of other treatment methods. A second main purpose of the study was to assess the acceptability of this program to parents and to document their impressions regarding their child's period of inpatient care. Overall, a high level of acceptability was found.

Autistic Disorder↗
PubMed2001

Evaluation of a regional pilot program to prevent mother-infant HIV transmission--Thailand, 1998-2000.

Worldwide, approximately 2.2 million women and 600,000 infants are infected with human immunodeficiency virus (HIV) each year. Extended zidovudine prophylaxis and other antiretroviral and obstetric interventions and the avoidance of breast-feeding have reduced dramatically mother-infant HIV transmission in countries with adequate health-care resources. However, in developing countries, where the impact of HIV is greatest, implementation has been limited by the complexity and expense of these interventions. In Thailand, where approximately 15,000 infants are born to HIV-infected women each year, the Ministry of Public Health (MOPH) has collaborated with other organizations to identify simpler and more cost-effective interventions to reduce mother-infant HIV transmission. In 1998, a placebo-controlled clinical trial in Thailand using a simplified zidovudine regimen from 36 weeks' gestation until delivery reduced the risk for mother-infant transmission by 50%. In 1998, MOPH initiated a pilot program to prevent mother-infant HIV transmission in region 7, a rural area in northeastern Thailand with an antenatal HIV prevalence of approximately 1%, to assess program feasibility, effectiveness, and acceptability. This report summarizes an evaluation of the 2-year pilot program, which indicated that acceptance of HIV testing and adherence to zidovudine were high and HIV transmission was reduced. The findings demonstrate the feasibility of implementing programs to prevent mother-infant HIV transmission on a large scale in a developing country.

Anti-HIV Agents↗
PubMed1978

Hospital counseling in Khartoum: a study of factors affecting contraceptive acceptance after abortion.

This study examines the impact of contraceptive counseling on 3 263 women hospitalized in Khartoum for treatment of incomplete abortion. The analysis which focused on education and parity/child desire, revealed that the counseling program produced contraceptive acceptance among 47.0% of those followed up. In spite of the counseling efforts, half of the women in this study did not accept contraception following the abortion-regardless of education or parity/child desire. It is difficult to determine why 50% of those who had recently undergone an incomplete abortion were willing to put themselves at risk again. Apparently, future efforts to increase the impact of counseling programs must also examine patients' motivation to accept (or not to accept) contraception.

Abortion, Incomplete↗
PubMed2003

The relationship of residency performance to match status and US versus international graduate status.

BACKGROUND AND OBJECTIVES: This study compared the performance of family practice residents selected through the National Resident Matching Program (NRMP) with those selected outside the NRMP and that of US medical graduates (USMGs) versus international medical graduates (IMGs). METHODS: Surveys were mailed to all 470 US family practice residencies asking Match status and USMG versus IMG status of graduates accepted into their programs from 1994-1996. RESULTS: Of 3,222 residents, 2,815 (87.4%) were accepted through the Match, 159 (4.9%) before the Match, and 248 (7.7%) after the Match; 2,874 (89.2%) were USMGs, and 348 (10.8%) were IMGs. Residents accepted after the Match versus residents selected through the Match were more likely to leave their programs early (14.5% versus 4.8%), score in the lower 10% of their In-training Assessment Examination (ITE) (11.7% versus 2.2%), and require remedial programs (12.9% versus 2.6%). A lower proportion of residents accepted after the Match scored in the top 10% on the ITE examination (5.6% versus 15.2%). IMGs were more likely than USMGs to leave the program be fore graduating (8.0% versus 5.2%), to score within the lower 10% on the ITE examination (7.8% versus 2.5%), and to require remedial programs (7.8% versus 3.2%). CONCLUSIONS: Although a large majority of the residents studied here performed well, somewhat less-favorable performance was seen among residents accepted after the Match and among those with international medical degrees.

Chi-Square Distribution↗
PubMed2006

Cardiac event rate in a lifestyle modification program for patients with chronic coronary artery disease.

BACKGROUND: Several clinical trials have shown that intensive lifestyle modification programs have a significant impact on cardiovascular risk factors. HYPOTHESIS: This paper is a retrospective analysis to determine the effect of participation in a 2-year lifestyle management program on long-term clinical outcome in patients outside the setting of a clinical trial. METHODS: Patients with angiographically confirmed coronary artery disease (CAD) enrolled in a 2-year program of exercise training, dietary counseling, stress management, and therapeutic education. They were accepted into the program from 1991 through December 2002. Follow-up after completion of the program ranged from 10 to 2 years. RESULTS: In all, 134 patients enrolled in the program; of these, 77 completed the program and 57 failed to do so. Those who completed the program improved their effort tolerance and reached recommended goals for serum lipid and blood pressure levels. The cumulative event rate (cardiac death, myocardial infarction, and stroke) over 10 years in the patients who completed the program was 1.5%. The corresponding event rate in patients who dropped out was 18% (p < 0.02). CONCLUSIONS: It is suggested that patients who complete a 2-year lifestyle modification program appear to have a favorable prognosis over an extended period of time.

Aged↗
PubMed1998

A holistic approach to the economic evaluation of health programs using institutionalist methodology.

The paper examines possibilities for employing more holistic approaches to the evaluation of health care programs. It is argued that the reductionism of conventional forms of economic evaluation, where value (or benefit) is seen in terms of either health consequences or individuals' utility, can cause a number of aspects of such programs to be overlooked. As such, this imposes fairly strict limits on the capacity of economic evaluation to inform public policy. In contrast, institutionalist economic theory in common with the community development approach to health promotion is an area of research which acknowledges that change to the broader socio-political environment can be a source of value. It is suggested that this idea has, for instance, significance for the evaluation of indigenous health programs where notions of "cultural appropriateness" have strong influence over the effectiveness and acceptability of such programs. It is concluded that no one evaluative approach is appropriate in all situations and that a greater receptiveness to broader sources of social value can help to improve the way evaluations are conducted.

Evaluation Studies as Topic↗
PubMed2003

A framework for understanding "evidence" in prevention research and programs.

This report provides a multidimensional framework for understanding the meaning of evidence in prevention science. Six themes comprise the framework, each with impact on the meaning of evidence. (1) There are rigorous prevention scientific strategies now in use; each has shared but also unique requirements for the meaning of evidence. Some are directed at individuals, others at small social contexts, others at larger societal structures. (2) The phases of prevention research have shared but also unique requirements for evidence. These include efficacy, effectiveness, sustainability, going-to-scale, and sustaining programs systemwide. (3) Prevention programs address different segments of the population defined by levels of risk: the total population; a smaller subpopulation at increased risk; or a still smaller subpopulation at very high risk. The levels influence the meaning of evidence. (4) Economic analysis and economic evidence must become a central part of prevention research. These are needed for appropriate policy decision making and for assessing long-term benefits. (5) Collaboration is required for rigor in prevention research: including researchers, but also policy makers, program advocates and leaders, and community and institutional leaders. Broad ownership is critical for implementing rigorous research and for sustaining program fidelity. (6) Acceptance of a multidimensional framework for understanding "evidence" is essential across those agencies and institutions that carry out and/or use prevention science. The more widely the vision of the prevention field is shared, and the more the various qualities and rules of evidence are accepted and implemented, the better the quality will be of prevention research and programs.

Evidence-Based Medicine↗