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Results for “Program Appropriateness”

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PubMed1990

Rehabilitation of the pediatric patient with a neuromuscular disease.

A rehabilitation program for a patient with a neuromuscular disease can be developed only after an accurate diagnosis has been established. The diagnosis and its ramifications should suggest a natural course of disease which, it is hoped, can be improved upon with a rational and realistic program. The program is best developed by an interdisciplinary team, including a pediatric neurologist, who should have the greatest understanding of the patient's problem and should ultimately be responsible for the implementation and monitoring of the program. A child with cerebral palsy commonly requires the services of physical and occupational therapists as well as knowledgeable orthopedists. Is the program appropriate? Does it consider the child's potential as well as his limitations? A child with a traumatic brain injury requires, in addition to the above, psychological intervention and an intensive educational program. Will the child and family need help from mental health professionals? A child with a motor unit disease such as Duchenne's muscular dystrophy requires, in addition to the above services, a "philosophy" of care. Will the child ever ambulate independently? If so, at what cost? What will be necessary for the child to reach this potential, including items such as orthoses and adaptive equipment? Will respirator care become necessary? What issues must be addressed for this form of care to be established? There is no one program for all children. The programs must be individualized to meet the needs of the patient and the family. This point cannot be overemphasized.

Brain Damage, Chronic↗

PubMed1998

The Healthy for Life project: sexual risk behavior outcomes.

Sexual risk behavior outcome data from the Healthy for Life (HFL) project is presented. Using a social influences model, the intervention was designed to positively affect the health behaviors of middle school students in five related areas: alcohol use, tobacco use, marijuana use, nutrition, and sexuality. The in-school program was supplemented by parent, community and peer components. The research used self-report data on an initial sample of 2,483 middle school students followed from Grade 6 to Grade 10. Twenty-one schools were assigned to three conditions--age appropriate (program taught in Grades 6, 7, and 8), intensive (program taught in Grade 7) and control--using blocked randomization. Attrition was 20% (by Year 4) and 33% (by Year 5). By ninth grade the lifetime intercourse rate among both groups of HFL subjects was significantly higher than for controls (controlling for baseline substance use risk and involvement with the opposite sex), but reported past month intercourse rates and condom use did not differ. At the tenth grade follow-up, the age appropriate subjects reported higher adjusted rates of lifetime and past month intercourse than did the controls. Intensive subjects perceived significantly lower normative rates of intercourse than controls at ninth grade follow-up, but age appropriate subjects perceived significantly higher norms at tenth grade. Our expectation that this approach would be effective in reducing adolescent sexual risk behavior has not been supported. The influence of social and community norms and contextual factors has a far greater influence on the behavior of students (even 6 years later) than this school-based social influences program targeting only one grade cohort.

Adolescent↗

PubMed1998

The mean ventricular fibrillation cycle length: a potentially useful parameter for programming implantable cardioverter defibrillators.

In programming the implantable cardioverter defibrillator (ICD), the ventricular tachycardia (VT) detection cycle length (CL) is based on the CL of the documented tachycardia but the ventricular fibrillation (VF) detection CL is set arbitrarily. Appropriate programming of VF detection may not only reduce the incidence of inappropriate ICD shocks for non-VF rhythms but can also avoid the fatal underdetection of VF. The mean VFCL may provide a useful parameter for optimal ICD programming for VF detection if it is reproducible. This study examined the intrapatient reproducibility and interpatient variation of the mean VFCL in 30 ICD patients (25 men and 5 women, mean age 63 +/- 13 years). A total of 210 VF episodes (7 +/- 4 per patient, range 3-17) induced by T-wave shocks (166) or AC (44) at the ICD implant (30 patients) and the predischarge test (12 of 30 patients) were analyzed. The mean VFCL was calculated from the stored V-V intervals in the ICDs. Although the mean VFCL varied significantly from 171 +/- 6 to 263 +/- 11 ms (P < 0.01) among different patients, it was reproducible among different VF episodes in an individual patient (maximal variation 4-50 ms, P > 0.05). The mean VFCL was not significantly different between patients with and without antiarrhythmic drugs (210 +/- 32 vs 210 +/- 23 ms, P > 0.05) and was correlated with the ventricular effective refractory period (r = 0.5, P < 0.05). The mean VFCL varies greatly among different patients but remains reproducible in an individual patient, suggesting that the mean VFCL may serve as a reference for ICD programming of VF detection.

Adult↗

PubMed1994

Interagency coordination: the key to mainstreaming children with special needs into day care.

While the need for mainstreamed day-care services continues to increase, many barriers remain that prevent or delay providers from enrolling children with special needs. The suggestions in this article to coordinate local resources will help programs begin to provide initial necessary services to children with special needs. The use of volunteers will help supplement the staffing needs of a day-care center and allow for more individualized care of the children. Unfortunately, the absence of public funds for child day care continues to be a major barrier to creating appropriate programs for children with special needs. State and federal policies need to be expanded to support day care in general and children with special needs specifically. Part H of PL 99-457 (now Part H of IDEA PL102-119) is a national impetus to promote interagency collaboration at state and local levels. This is a beginning, but more state and federal funding is needed. In addition, regulations need to be developed that will make it easier rather than more difficult for local agencies to participate. Day-care providers and professionals in every community must work together to provide appropriate services to children with special needs. The most effective services use interdisciplinary teams to work together to plan and implement the care. Let us pick up the challenge of this mandate and develop programs that will help future generations recognize and accept the differences between individuals as well as see the similarities.

Child↗

PubMed1999

The characteristics of asthma education programs within New South Wales.

The aim of the study was to examine the characteristics of asthma education programs within NSW. A cross-sectional questionnaire survey concerning the aims and characteristics of 42 asthma education programs was administered to members of the Asthma Educators Association (AEA) of NSW. While most programs sought to improve asthma knowledge (78%), only a small number sought to improve asthma management skills (38%), asthma control (33%) and attitudes (10%). Most programs performed one-to-one (69%) education. Medical intervention was under-utilized by most programs and only 4% gave feedback to the referring doctor. Program evaluation was incompletely linked to program aims. There was incomplete evaluation of knowledge gain as an outcome. The study reviewed the characteristics of education programs within NSW Existing programs appropriately employ a variety of educational methods and target a broad range of people with asthma. There remains a need to use a combined approach utilizing education and medical management, and to employ methods to evaluate programs.

Adolescent↗

PubMed2004

Developing and adapting a family-based diabetes program at the U.S.-Mexico border.

CONTEXT: The prevalence of diabetes among Hispanics is more than twice that of non-Hispanic whites in communities along the U.S.-Mexico border. The University of Arizona and two community health agencies on the Arizona border, Campesinos Sin Fronteras and Mariposa Community Health Center, collaborated to design, pilot and assess the feasibility of a lay health-outreach worker- (promotora-) delivered diabetes education program for families. La Diabetes y La Unión Familiar was developed to build family support for patients with diabetes and to teach primary prevention behaviors to family members. METHOD: Community and university partners designed a culturally appropriate program addressing family food choices and physical activity, behavior change, communication, and support behaviors. The program offers educational content and activities that can be presented in home visits or multifamily group sessions. Community partners led the implementation, and university partners guided the evaluation. CONSEQUENCES: Seventy-two families (249 total participants) including children and grandchildren participated. Preintervention and postintervention questionnaires completed by adults (n = 116) indicate a significant increase in knowledge of eight diabetes risk factors (P values for eight factors range from < 001 to .006) and a significant increase in family efficacy to change food (P < .001) and activity behaviors (P < .001). Interviews with participants highlight the program's positive psychosocial impact. INTERPRETATION: Community and university collaboration involved building upon the promotoras' expertise in engaging the community and the university's expertise in program design and evaluation. A promotora-delivered family-based diabetes prevention program that emphasizes family support, communication, and health behaviors is feasible and can yield change in family knowledge, attitude, and behavior relative to diabetes risk factors.

Adolescent↗

PubMed2000

Prevalence of suicide programs in schools and roadblocks to implementation.

We surveyed all school districts in Washington State for information on the prevalence of suicide programs and on major roadblocks to implementing programs. With 163 districts responding (62%), we found that the majority did not have suicide programs or policies and procedures. The largest perceived roadblock was insufficient staff and the greatest perceived need was more information. Although establishing policies and procedures is considered by many as a necessary first step to establishing suicide programs, we did not find schools choosing this option as often as others. This raises questions as to what are effective ways to have schools start suicide programs. We analyzed the data by school district size and by the title of the staff member making the report. We discuss the implications of these findings as well as the need for further efforts to develop appropriate programs for schools.

Adolescent↗

PubMed1976

Summer day camp for multihandicapped children.

A six-week enriched sensorimotor, communication, and recreational summer day camp for twenty multihandicapped preschool children is described. The program, planned and supervised by therapists and mental retardation counselors, provided training for students who worked as camp counselors. Each counselor was assigned to work with one child and family and was responsible for assessing, establishing goals, designing appropriate programs, attending the child throughout the day, and relating to the family. The camp provided a trial for use of the Functional Skills Profile (FSP), an assessment battery designed by physical and occupational therapists to measure performance changes in low functioning, developmentally handicapped persons in order to determine the value of therapy programs. The camp is evaluated in terms of improvement in the children, the effectiveness of the student training, and parent satisfaction.

Aftercare↗

PubMed2003

Health education in an inner-city Catholic grade school.

The purpose of this article is to outline the process, content, and evaluation of a 14-week health education program for 6th, 7th, and 8th grade students in an inner city Catholic grade school who are at risk for multiple health problems. The process includes a needs assessment with findings, followed by construction of an age-appropriate program. A content outline displays the topics and information presented to the students. In conclusion, an evaluation presents the results and effectiveness of the program.

Catholicism↗

PubMed1990

Synergism of testosterone propionate with growth hormone in promoting growth of hypophysectomized rats: effect of sexual differentiation.

The effect of testosterone propionate (TP), alone and in combination with porcine GH, on the growth of hypophysectomized rats was investigated. An initial study determined doses of TP and GH which would result in a synergistic response. Hypophysectomized male rats, approximately 40 days of age, received GH at doses of 5, 25 and 62.5 micrograms/day administered in two injections/day at 08.00 and 16.00 h. At all doses of GH, administration of TP at 100 micrograms/day significantly enhanced the GH-stimulated rate of growth. This growth enhancement by TP was greatest in combination with GH at 25 micrograms/day. In a subsequent study, growth responses to 25 micrograms GH/day and 100 micrograms TP/day were examined in animals with differing degrees of sexual differentiation. Sex groups were: intact males, males castrated at 11 days of age and females administered 100 micrograms TP at 3 days of age (masculinized rats), and males castrated at 2 days of age and normal females (non-masculinized rats). In all sex groups, growth of hypophysectomized rats was stimulated by GH. Genetic sex and masculinization did not influence the response to GH. Masculinized hypophysectomized rats exhibited significantly greater rates of growth and final live, empty body, liver and kidney weights than non-masculinized hypophysectomized rats. All sex groups other than normal females responded synergistically to the combination treatment of GH plus TP. Rats that experienced neonatal exposure to testosterone became programmed to respond to testosterone and demonstrated greater rates of growth and body and organ weights when administered the combination of GH plus TP. These data indicate that TP synergizes with GH to promote growth of hypophysectomized rats appropriately programmed to respond.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMedDate not supplied

Formative research and stakeholder participation in intervention development.

OBJECTIVE: To present a model for using formative research and stakeholder participation to develop a community-based dietary intervention targeting American Indians. METHODS: Formative research included interviews, assessment of food- purchasing frequency and preparation methods, and dietary recalls. Stakeholders contributed to intervention development through formative research, a program planning workshop, group feedback, and implementation training. RESULTS: Foods high in fat and sugar are commonly consumed. Barriers to healthy eating include low availability, perceived high cost, and poor flavor. Stakeholder participation contributed to the development of a culturally appropriate intervention. CONCLUSIONS: This approach resulted in project acceptance, stakeholder collaboration, and a culturally appropriate program.

Attitude to Health↗

PubMed2006

Results of a proposed breath alcohol proficiency test program.

Although proficiency test programs have long been used in both clinical and forensic laboratories, they have not found uniform application in forensic breath alcohol programs. An initial effort to develop a proficiency test program appropriate to forensic breath alcohol analysis is described herein. A total of 11 jurisdictions participated in which 27 modern instruments were evaluated. Five wet bath simulator solutions with ethanol vapor concentrations ranging from 0.0254 to 0.2659 g/210 L were sent to participating programs, instructing them to perform n = 10 measurements on each solution using the same instrument. Four of the solutions contained ethanol only and one contained ethanol mixed with acetone. The systematic errors for all instruments ranged from -11.3% to +11.4% while the coefficient of variations ranged from zero to 6.1%. A components-of-variance analysis revealed at least 79% of the total variance as being due to the between-instrument component for all concentrations. Improving proficiency test program development should consider: (1) clear protocol instructions, (2) frequency of proficiency testing, (3) use lower concentrations for determining limits-of-detection and -quantitation, etc. Despite the lack of a biological component, proficiency test participation should enhance the credibility of forensic breath test programs.

Acetone↗

PubMed2003

Frequent ICD shocks due to double sensing in patients with bi-ventricular implantable cardioverter defibrillators.

Biventricular pacing has emerged as a modality for treatment of patients with heart failure. Combined biventricular pacers and implantable cardioverter defibrillators offer treatment of heart failure as well as protection from sudden cardiac death. However, inappropriate ICD shocks as a result of double sensing due to widely spaced ventricular bipoles may pose a significant problem in these patients. We examined the ICD records of twenty-three patients with biventricular ICDs, and evaluated all episodes of double sensing that resulted in aborted or delivered therapy. In follow-up of 3.7 +/- 2.6 months, thirty-three shocks in fifteen episodes occurred in five patients (21.7%) due to double sensing. Four patients (17.4%) had aborted shocks due to double sensing. All episodes resulting in shock occurred because of sinus tachycardia or supraventricular tachycardia above the upper programmed pacing rate of the device with resultant AV conduction and double sensing of the nonpaced ventricular depolarization. In conclusion, double sensing of the R-wave is a common and clinically important cause of inappropriate ICD detection and shock in patients with biventricular ICDs. Appropriate programming of the ICD can prevent episodes of inappropriate shocks.

Aged↗

PubMed1987

Report of the Commission on the Evaluation of Pain.

The following is a reprint of the report to Congress transmitted by the Department of Health and Human Services in response to a provision of the Social Security Disability Benefits Reform Acto of 1984 (Public Law 98-460). It also includes some of the report's appendix material. The congressional mandate called for a study, performed in consultation with the National Academy of Sciences, of how pain is evaluated in determining disability under titles II and XVI of the Social Security Act and for recommendations on how pain should be considered in evaluating disability under these programs. In addition to several recommendations for improvements in interviewing, applications, questionnaires, and development practices in "pain" cases by including pain specialists for consultative examinations, the Commission strongly advocated experiments to determine if individuals with impairment due primarily to pain can be reactivated and vocationally rehabilitated under appropriate programs or if such individuals should be allowed disability benefits.

Chronic Disease↗

PubMed1998

Peer helping/involvement: an efficacious way to meet the challenge of reducing alcohol, tobacco, and other drug use among youth?

Peer-led drug prevention programs for middle school youth are reviewed as to whether or not they are a vital resource in an overall effort to minimize the use of alcohol, tobacco, and other drugs (ATOD). The paper focuses on the following: a) results of a 120-study meta-analysis of school-based drug prevention programs and positive program features; b) considerations for falsely concluding that peer programs are ineffective; c) features of two model or stellar programs that compared interactive (peer leadership) to teacher/researcher-led (non-interactive) programs that followed National Peer Helpers Association (NPHA) Programmatic Standards; and d) suggestions for designing and implementing high-quality, peer-led programs. The authors conclude that interactive peer interventions for middle school students are statistically superior to non-interactive didactic, lecture programs led by teachers/researchers. Programs implemented according to NPHA Programmatic Standards may eliminate Type II (false negative) and III ("implementation failure" or ineffectively designed and implemented program) errors. Opportunities for prudent application of well-designed peer programs appropriately implemented and evaluated must remain a salient priority.

Adolescent↗

PubMedDate not supplied

[Sports programs for the elderly in Germany in 1991].

The percentage of older people in the population will permanently increase. An attendant phenomenon is a rising demand for special exercise programs. In 1991, a survey of those programs was done in the unified FRG. The investigation was ordered by the Sportministerkonferenz der Länder to substantiate further promotion. Organizers and sponsors of exercise programs for older people originate from public and private non-profit institutions in the fields of sports (administration), social welfare, public health, and educational work. Concerning the structure and the extent of special exercise programs there exist large regional differences between the eastern vs. western part of the FRG and rural vs. urban areas. People of over 50 years of age have to be separated into different groups corresponding to their age, physical condition, experience, and needs; not all of them find appropriate programs. The Deutsche Turner-Bund, private charitable institutions, and a few private health-care organizations preferentially serve untrained and/or inexperienced women over 60-65 years of age with recreationally oriented exercise programs. The younger, more athletic find more competitively oriented programs within the scope of other sports federations. Recreational sports programs in age-independent groups are often attended by older physically fit people.

Adult↗

PubMed1992

First derivative of right ventricular pressure, dP/dt, as a sensor for a rate adaptive VVI pacemaker: initial experience.

Ten patients underwent implantation of a rate adaptive ventricular pacing system with a new pulse generator and lead. The unipolar lead has a steroid eluting tip and a pressure sensor. The first derivative of the signal from this sensor, dP/dt, is determined and the pacemaker rate is varied in response to changes in the right ventricular dP/dtMAX. During implantation, dP/dt values were in the range of 180-720 mm Hg/sec. The autothreshold for pacing at 2.5 V remained unchanged 1 month after implantation (0.065 +/- 0.045 msec, range 0.05-2.00 msec) and only slightly increased after 3 months (0.075 +/- 0.045 msec, range 0.05-2.00 msec). A significant correlation existed between the dP/dt measured during implantation and the right ventricular pressure measured by telemetry at follow-up visits (r = 0.93, P = 0.0001). Initial pacemaker programming was performed on the second day after implantation following a short walk and was adjusted subsequent to follow-up visits according to the patient's subjective assessment and in accordance with the results of exercise tests and Holter monitoring. Exercise and Holter tests did not significantly change initial programming. There was a significant correlation between right ventricular systolic pressure and the rate response setting (r = -0.66, P less than 0.05). During dP/dt pacing, all patients felt well, and eight of these reported an improvement compared to nonrate adaptive pacing. The heart rate response to effort and recovery was appropriate. It was concluded that: (1) right ventricular dP/dt is a suitable parameter for controlling the pacing rate; (2) appropriate programming of the dP/dt pacemaker results in a suitable heart rate response to exercise and recovery.

Aged↗

PubMed2003

Monitoring antimicrobial resistance for public health action.

Antibiotics are used both to treat infections in individual patients and in public health interventions to control disease outbreaks. In both circumstances the outcome, as measured by morbidity and mortality, is compromised by antimicrobial resistance (AMR) in the causative organism. Of necessity, antibiotics are frequently given empirically and their selection is based on presumptions of efficacy and the susceptibility of the infecting agent. AMR surveillance provides reassurance with regard to efficacy and guides the formulation of standard treatment regimens. However, AMR surveillance is not always appropriately performed nor are the data generated necessarily used to best advantage. Optimal use of AMR surveillance data requires for each disease of importance: an understanding of the applications of AMR surveillance and a clear definition of the type of data required: the 'triggers for surveillance'; construction of AMR surveillance programs appropriate to differing requirements; and better linkages between AMR surveillance data and disease control functions so that the thresholds for initiating public health action are clearly defined. Examples which illustrate the application of these principles are provided from experience with surveillance of AMR in the pathogenic Neisseria (N. gonorrhoeae and N. meningitidis).

Anti-Infective Agents↗