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A community program in primary care for control of cardiovascular risk factors: steps in program development.

A community program for the control of cardiovascular risk factors, the CHAD program, was integrated into the primary care system of a family practice in Jerusalem. The steps used in introducing a community orientation in primary health care are used as a basis for description of the program. In the preliminary steps cardiovascular diseases and their risk factors were defined as the priority for the adult population of the community. Community diagnosis was undertaken to serve as a baseline for program content and evaluation. Planning for intervention included setting up objectives and planning strategies using standardized guidelines, and preparation of the staff and the community. Methods of implementation and surveillance are described. Two examples of evaluation of the program are cited.

Adult↗

The Medical Library Association's professional development program: a look back at the way ahead.

OBJECTIVE: Reflecting patterns evident in past Janet Doe Lectures, the 2005 address reviews the Medical Library Association's (MLA's) professional development activities from their beginnings after World War II. A group of related but separate activities is traced through the establishment of an integrated professional development program. A further objective is to introduce newer members of MLA to their heritage and to remind others how the association has reached this point in its history. SETTING: The lecture provides an overview of the evolution of MLA's professional development program-with emphasis on certification and continuing education in the early years. It further reflects briefly on some of the more recent MLA activities that have greatly impacted professional development and underscores some new initiatives. ANALYSIS: The efforts of a virtual who's who of MLA's membership have been responsible for the convergence of the association's efforts over more than half a century to provide a comprehensive professional development program. As a participant in MLA's professional development activities for more than forty years, the 2005 lecturer provides a personal view of the growth and expansion of the program. CONCLUSIONS: Professional development has been a hallmark of MLA for many years. The association's challenge is to continue to develop creative and innovative programs, to continuously review and revise existing programs, and to have the vision and vitality to maintain a viable program that will provide the membership with the knowledge and skills needed to function effectively now and in the future.

Certification↗

Program development in military toxicology laboratories.

Military toxicology evolved from needs identified during the World Wars. The Army, Navy and Air Force developed toxicological capabilities in response to their respective operational needs. These 3 previously separate military toxicology efforts have been integrated into Tri-Service Toxicology in response to the continually changing and growing operational needs of the military. The continual process of program development must be initiated in order for Tri-Service Toxicology to improve, grow and better serve its customers. Program development entails developing and maintaining good customer relationships and cooperative relationships with other governmental agencies, industry and academia. The benefits of identifying and obtaining customers and collaborators will substantially outweigh the costs incurred by committing to the implementation of program development within Tri-Service Toxicology.

Humans↗

Assessment of faculty development program outcomes.

BACKGROUND AND OBJECTIVES: More and better research is needed about the effectiveness of faculty development programs. Increasingly, government leaders in Congress and the Administration expect comprehensive outcome and impact evaluation as justification for federal finding. This paper summarizes outcomes reported and methods used in published studies of faculty development programs since 1980.

Education↗

Preclinical efficacy evaluation of potential chemopreventive agents in animal carcinogenesis models: methods and results from the NCI Chemoprevention Drug Development Program.

In the NCI, Chemoprevention Branch drug development program, potential chemopreventive agents are evaluated for efficacy against chemical carcinogen-induced tumors in animal models. This paper summarizes the results of 144 agents in 352 tests using various animal efficacy models. Of these results, 146 were positive, representing 85 different agents. The target organs selected for the animals model are representative of high-incidence human cancers. The assays include inhibition of tumors induced by MNU in hamster trachea, DEN in hamster lung, AOM in rat colon (including inhibition of AOM-induced aberrant crypts), MAM in mouse colon, DMBA and MNU in rat mammary glands, DMBA promoted by TPA in mouse skin, and OH-BBN in mouse bladder. The agents tested may be classified into various pharmacological and chemical structural categories that are relevant to their chemopreventive potential. These categories include antiestrogens, antiinflammatories (e.g., NSAIDs), antioxidants, arachidonic acid metabolism inhibitors, GST and GSH enhancers, ODC inhibitors, protein kinase C inhibitors, retinoids and carotenoids, organosulfur compounds, calcium compounds, vitamin D3 and analogs, and phenolic compounds (e.g., flavonoids). The various categories of compounds have different spectra of efficacy in animal models. In hamster lung, GSH-enhancing agents and antioxidants appear to have high potential for inhibiting carcinogenesis. In the colon, NSAIDs and other antiinflammatory agents appear particularly promising. Likewise, NSAIDs are very active in mouse bladder. In rat mammary glands, retinoids and antiestrogens (as would be expected) are efficacious. Several of the chemicals evaluated also appear to be promising chemopreventive agents based on their activity in several of the animal models. Particularly, the ODC inhibitor DFMO was active in the colon, mammary glands, and bladder models, while the dithiolthione, oltipraz, was efficacious in all the models listed above (i.e., lung, colon, mammary glands, skin, and bladder).

Animals↗

A faculty development program evaluation: from needs assessment to long-term effects, of the teaching skills improvement program.

BACKGROUND: We evaluated whether the faculty development program, the Teaching Skills Improvement Program, met medical educators' needs at Hacettepe University Faculty of Medicine, Turkey. In a 1997 needs assessment survey, large proportions of 178 medical educators assessed their knowledge of educational issues and teaching skills as good or excellent. Nonetheless, 86% of the respondents stated they would like to participate in a future training program focused on the content indicated in the survey. DESCRIPTION AND EVALUATION: In 1998, 83 faculty members took part in the program and expressed a high degree of satisfaction with its content and organization, as well as the course trainers' teaching. Most of the participants got high scores on a test of knowledge related to the course content and performed proficiently in a microteaching session. CONCLUSION: Six months to a year later, large proportions of the participants reported using many of the training techniques in their teaching program.

Clinical Competence↗

The OptiMARK clinical development program: summary of safety data.

PURPOSE: To describe and summarize the safety data from the OptiMARK clinical development program. MATERIALS AND METHODS: In the 18 clinical studies comprising the clinical program, doses ranging from 0.1 to 0.7 mmol/kg were administered to healthy adult volunteers, patients with hepatic or renal impairment, and patients with confirmed or highly suspected central nervous system (CNS), liver, breast, vascular, bone, or soft tissue pathologies. A total of 2038 injections of OptiMARK, Magnevist, or placebo were administered to 1684 subjects. Safety assessments were performed at appropriate intervals during all Phase 1, 2, and 3 studies. RESULTS: Of the 1684 subjects exposed to a study drug or placebo in the clinical development program, 646 subjects experienced 1293 adverse events. Thirty-one percent of the OptiMARK injections were associated with an adverse event. In comparison, 35% of Magnevist injections and 48% of placebo injections were associated with at least one adverse event. CONCLUSIONS: OptiMARK was safe and well-tolerated with a safety profile similar to that of Magnevist.

Adult↗

A development program: an alternative way of funding capital and program expenditures.

As medical groups look for new ways to acquire dollars to fund purchases of supplies, services, and capital equipment, the idea of a development program to raise funds from the private sector may become appealing. A development program can provide a mechanism for acquiring additional funds without charging patients more for medical services. The prerequisites of a successful program are: a group's commitment to the effort, establishment of proper tax-exempt status, and availability of competent legal counsel and a qualified person to lead the program. Also discussed here are the essential considerations of implementation approaches, the case statement, standard components of a program, and donor relations.

Capital Expenditures↗

The role of animation as a program development strategy.

As an approach to community organization, animation involves the activation of people to take responsibility for their own affairs, with the aim of achieving their own, self-defined ends. The authors analyze the use of animation as a strategy of social program development undertaken by a nonprofit organization to initiate a clubhouse serving people with serious mental illness. Six animation strategies and their impact on the local community, sponsoring organization, and subsequent clubhouse program development are examined. The authors recognize the intensive resource requirements of animation, but they conclude that successful animation results in a program that enjoys high levels of community support, understanding, and legitimacy.

Community Health Planning↗

Infant Health and Development Program for low birth weight, premature infants: program elements, family participation, and child intelligence.

The Infant Health and Development Program was an eight-site randomized controlled trial testing the efficacy of early intervention to enhance the cognitive, behavioral, and health status of low birth weight, premature infants. The 377 intervention families received for the first 3 years of life: (1) pediatric follow-up, (2) home visits, (3) parent support groups, and (4) a systematic educational program provided in specialized child development centers. The control group (n = 608) received the same pediatric follow-up and referral services only. This paper describes the delivery of the intervention and its outcomes. A Family Participation Index that was the sum of participation frequencies in each of the program modalities unique to the intervention revealed that program implementation was not different across the eight sites. Index scores did not vary systematically with mother's ethnicity, age, or education or with child's birth weight, gender, or neonatal health status; but they were positively related to children's IQ scores at age 3. Only 1.9% of children of families in the highest tercile of participation scored in the mentally retarded range (IQ less than or equal to 70), whereas 3.5% and 13% of children in the middle and lowest participation terciles, respectively, scored in the retarded range. Similar findings were obtained for borderline intellectual functioning. These findings are consistent with previous research linking intensity of intervention services with degree of positive cognitive outcomes for high-risk infants. The determinants of variations in individual family participation remain unknown.

Child Day Care Centers↗

Zoledronic acid in the treatment of hypercalcemia of malignancy: results of the international clinical development program.

This report summarizes results of the clinical development program evaluating zoledronic acid (Zometa; Novartis Pharmaceuticals Corp, East Hanover, NJ) in the treatment of hypercalcemia of malignancy (HCM). In addition to a phase I dose escalation trial, two randomized, double-blind, double-dummy studies were conducted in parallel to investigate the clinical efficacy and safety of 4 mg and 8 mg zoledronic acid in patients with moderate to severe HCM. Patients were treated with a single dose of zoledronic acid (4 or 8 mg) via 5-minute infusion or a control treatment, 90 mg pamidronate via 2-hour infusion. Patients who relapsed or had refractory HCM after initial treatment could be re-treated with 8 mg zoledronic acid. End points included rate of complete response, defined as normalization of corrected serum calcium by day 10, change in corrected serum calcium, time to relapse, duration of response, and bone biochemical markers. Doses of > or =0.02 mg/kg were effective and nontoxic in the phase I study. In the controlled studies, 287 patients were randomized and evaluated for safety and 275 patients were evaluable for efficacy. The proportions of patients with a complete response by day 10 were 88.4% and 86.7% in the 4 mg and 8 mg zoledronic acid groups, respectively, compared with 69.7% in the 90 mg pamidronate group. Corrected serum calcium normalization occurred by day 4 in 45.3% of patients treated with 4 mg zoledronic acid, 55.6% of patients treated with 8 mg zoledronic acid, and 33.3% of patients treated with pamidronate. Mean change from baseline in corrected serum calcium also was greater with zoledronic acid than with pamidronate. Median times to relapse were significantly longer in both the zoledronic acid 4 mg and 8 mg groups compared with the pamidronate group. There were no significant differences in efficacy between the 4 mg and 8 mg zoledronic acid doses. Retreatment in 69 patients with relapsing or refractory hypercalcemia with 8 mg zoledronic acid resulted in a 52% complete response rate. Fever, hypophosphatemia, and asymptomatic hypocalcemia were the most common drug-related adverse events. These studies have shown that a short single intravenous dose of 4 mg or 8 mg zoledronic acid is effective in treating moderate to severe HCM. Zoledronic acid produced a higher rate of calcium normalization, faster onset of action, and longer time to relapse than pamidronate, while maintaining an excellent safety profile. The lower dose of 4 mg is recommended as initial therapy, with the 8 mg dose reserved for patients requiring retreatment.

Bone Neoplasms↗

Gender, mosquitos and malaria: implications for community development programs in Laputta, Myanmar.

This paper examines the gender roles linked to division of labor and potential exposure to mosquitos and malaria prevention activities. A "Human Development Initiative" (HDI) Project has been launched in Laputta, a mangrove delta region of Myanmar assisted by United Nations Development Program since 1994. The project aims to improve rural community access to primary health care and provide micro-credit programs, income generation schemes, and educational opportunities as a basis for community empowerment. Women and children of low-income households are the target beneficiaries. Prior to self-care training program and distribution of self-care manuals, altogether 20 focus group discussions (separately assigned to men and women) were conducted in eight study villages between January to February 2000. The primary vector for malaria in study area is Anopheles sundaicus. Rural women were prone to malaria due to exposure to mosquitos within the peak biting period at night because of their gender assigned roles. Both men and women perceived that mosquitos commonly bite before midnight, more at dusk. Lack of awareness of correlation between mosquitos and malaria together with lack of affordability enhance either non-use or shared use of bed-nets at home. Rural women did not consider destruction of breeding places of mosquitos as their major concern. Thus, it is essential for program planners to motivate local women for more active participation in vector control measures within and beyond their households in the context of community development programs.

Animals↗

Porter Physiology Development Program 1967-2001: a retrospective study.

The Porter Physiology Development Program Fellowships have supported the predoctoral and postdoctoral studies of numerous minority students. All of the Fellows responding to the current survey continue to be involved in life sciences-related work, primarily as physiologists-in-training or as physiologists working in academia, government, or industry. Following receipt of their degree, the large majority of Fellows completed a single postdoctoral fellowship and entered their first professional position. Most employed past-Fellows spent at least part of their time engaged in research and were also involved in teaching, management, and administration. Respondents felt strongly that the Porter Fellowship had contributed to the quality of their pre/postdoctoral training. They felt it gave them intellectual freedom to select research advisors and topics or postdoctoral positions. They also felt the financial freedom provided by the Fellowship allowed them to concentrate on their research, contributing both to the quality of their work and to their overall career commitment. Fellows strongly recommended continuation of the program and offered suggestions for expansion and increased communication. Finally, one of the most powerful benefits of the program is in its longitudinal impact. Past Fellows now serve as role models for a new generation of minority students aspiring to careers in biomedical research. Some have their own graduate students who have received the Porter Fellowship. One such Fellow emphasized the importance of this aspect of the program: I was always told by my colleagues that I would be a good role model to minority students. Having Fellowships like the Porter Development Fellowship insures the training of minority professionals. Young minority students have hope of becoming scientists when they see those of us who have made it. I have graduate students who tell me that they want a laboratory and to do research like I am doing which makes me feel that I have accomplished something [important]. As stated earlier, the goal of the Porter Physiology Fellowship Program is to encourage diversity among students pursuing full-time studies toward the PhD (or DSc) in the physiological sciences, and to encourage their participation in the APS. The findings of this retrospective study suggest that the program has been highly successful in both of these aspects.

Fellowships and Scholarships↗

Evaluation of a community arthritis program in Australia: dissemination of a developed program.

OBJECTIVE: To evaluate the effectiveness of a community-based arthritis education program conducted in a number of locations throughout the Sydney, Australia, metropolitan area. METHODS: The program, based on earlier work, comprised 6 weekly sessions of 2.5 hours' duration. The study sample included 175 men and women with different types of arthritis, divided into intervention (n = 104) and control (n = 71) groups. Five outcome measures were selected to evaluate effectiveness of the program: pain perception, knowledge level, self-efficacy, disability index, and self-management behavior. RESULTS: The results indicated that the program was effective in increasing knowledge level (F[1,222] = 10.3, P = 0.001 at 6 weeks; F[1,108] = 7.8, P = 0.006 at 6 months), and a statistically significant difference was found in disability satisfaction 6 months after intervention (F[1,98] = 5.9, P = 0.01], but no statistically significant difference was found in pain perception, self-efficacy, and disability index. CONCLUSION: This research supports some of the successful outcomes which follow an arthritis education program: increased knowledge level and increased disability satisfaction.

Aged↗

Influence of birth weight on educational outcomes at age 9: the Miami site of the Infant Health and Development Program.

The Miami site of the Infant Health and Development Program, an early intervention for infants born low birth weight (LBW) and preterm, was investigated. Analyses unique to this sample were required because it was the only site that selected a normal birth weight (NBW) comparison group and had the lowest sociodemographic characteristics. Epidemiological methods determined the effects of LBW and early intervention on school outcomes. Children born LBW who did not receive intervention had an increased risk of scoring below the 10th percentile on achievement tests and were placed in special education three times more often than their peers born NBW. The school outcomes of children born LBW who received intervention were consistently better than those who did not, but were worse than children born NBW; however, differences did not reach statistical significance. Children born LBW who did not receive intervention are at significant risk for poor school outcomes compared with their peers born NBW.

Child↗