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PubMedDate not supplied

HIV counseling and testing: women's experiences and the perceived role of testing as a prevention strategy.

CONTEXT: It is unclear why women decide to undergo testing for HIV, and how positive and negative testresults impact their sexual behavior. METHODS: A sample of 360 family planning clinic clients in New York City were randomly assigned to receive a four- or eight-week intervention aimed at reducing sexual risk or to serve as controls. Information on their HIV testing experiences was gathered through interviews at baseline and one month, six months and one year after the intervention. RESULTS: At baseline, 67% of women had been tested for HIV. The predominant reason for not being tested was anxiety about the result. Regardless of their testing status at baseline, more than 40% of the women believed that getting tested is a good way to prevent acquiring HIV. Women in the intervention who had been tested multiple times or had last been tested more than six months ago were more likely than women in the control group to initiate HIV testing by the one-month follow-up (relative risk, 2.9 and 6.1, respectively). Rates of mutual testing (being tested at the same time as one's partner) were significantly greater among women who participated in an intervention than among controls at the one-month and six-month interviews. CONCLUSIONS: HIV test counseling must emphasize that testing is not a prevention strategy in and of itself. Mutual testing, although not without risks, offers the safest possible alternative for monogamous couples who choose to forgo condoms.

AIDS Serodiagnosis↗

PubMedDate not supplied

School-based health clinics: a new approach to preventing adolescent pregnancy?

In an increasing number of U.S. communities, comprehensive health services--including family planning services--are being offered in clinics located in or near public high schools and junior high schools. Fourteen such programs operating in 32 schools are described here; they have caseloads ranging from about 500 to around 5,000 students per year and handle up to 20,000 patient visits annually. These clinics usually are staffed by teams consisting mainly of nurse practitioners, clinic aides and part-time physicians, as well as social workers, nutritionists and other professionals. Patients at school-based clinics generally are from low-income families, a reflection of the neighborhoods in which programs are located. Most school-based clinics serve only current students, but a few also serve former students. Most of these programs were originated by an individual from outside the school system. However, the cooperation and support of principals and teachers for student health services have been vital factors in gaining approval for in-school clinics. The programs also appear to enjoy the support of their local communities. However, their long-term funding remains uncertain. So far, private foundations have helped these programs become established, but they cannot be expected to provide continuing aid. Donations from schools, health providers and other groups have played an important part in keeping the cost of school-based programs low. Public funds, particularly from state departments of maternal and child health, social services and education, are being sought in order to expand existing programs to more schools and to start new clinics in other communities.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2006

Employment barriers for persons with psychiatric disabilities: update of a report for the President's Commission.

A major public policy problem is the extremely low labor force participation of people with severe mental illness coupled with their overrepresentation on the public disability rolls. This situation is especially troubling given the existence of evidence-based practices designed to return them to the labor force. This article reviews research from the fields of disability, economics, health care, and labor studies to describe the nature of barriers to paid work and economic security for people with disabling mental disorders. These barriers include low educational attainment, unfavorable labor market dynamics, low productivity, lack of appropriate vocational and clinical services, labor force discrimination, failure of protective legislation, work disincentives caused by state and federal policies, poverty-level income, linkage of health care access to disability beneficiary status, and ineffective work incentive programs. The article concludes with a discussion of current policy initiatives in health care, mental health, and disability. Recommendations for a comprehensive system of services and supports to address multiple barriers are presented. These include access to affordable health care, including mental health treatment and prescription drug coverage; integrated clinical and vocational services; safe and stable housing that is not threatened by changes in earned income; remedial and postsecondary education and vocational training; benefits counseling and financial literacy education; economic security through asset development; legal aid for dealing with employment discrimination; peer support and self-help to enhance vocational self-image and encourage labor force attachment; and active involvement of U.S. business and employer communities.

Achievement↗

PubMed1993

Investor-owned psychiatric hospitals and universities: can their marriage succeed?

Economic and competitive pressures have spurred a growing number of affiliations between university medical centers and for-profit health care corporations. University facilities can benefit from such partnerships through strengthened financial support, increased marketing and administrative expertise, and economies of scale. The university connection gives the investor-owned hospital enhanced status, sends a message of clinical excellence, and involves the hospital in educational and research programs that aid in physician recruitment and further enhance its reputation. However, the university's goals of education, research, and public service are not always compatible with the investor-owned hospital's goal of maximizing profits. The authors review the benefits and problems that result from affiliations between university medical centers and investor-owned corporations and discuss principles to be considered in structuring such partnerships.

Cost-Benefit Analysis↗

PubMed2001

The evolution of the Fenway Community Health model.

Fenway Community Health was founded by community activists in 1971 in the Fenway neighborhood of Boston, Mass, and within a decade had rapidly expanded its medical services for gay men in response to the AIDS epidemic. Increased expertise and cultural competence in lesbian, gay, bisexual, and transgender (LGBT) care led to expansion of medical services to address broader community concerns, ranging from substance use to parenting issues to domestic and homophobic violence, as well as specialized programs for lesbians, bisexuals, and transgendered individuals. Fenway began as a grassroots neighborhood clinic. In 1975, the center recorded 5000 patient care visits; in 2000, Fenway's clinical departments recorded 50,850 visits by 8361 individuals, including more than 1100 individuals receiving HIV-associated care. The center now has more than 170 staff people responsible for clinical programs, community education, research, administration, planning, and development. Over the past few years, Fenway's annual budget has exceeded $10 million. Fenway has established standards for improved cultural competence about LGBT health issues for other health providers and has developed programs to educate the general community about specific LGBT health concerns. This health center may provide a model of comprehensive LGBT health services that have a local impact.

Acquired Immunodeficiency Syndrome↗

PubMed1981

Development of the toxicological files in environmental chemicals data and information network (ECDIN).

A computer-based data network containing information on potentially toxic chemicals released into the environment is being developed by the Joint Research Centre of the Commission of the European Communities and by research institutions in the member states as part of a program for environmental research. The information requested daily by toxicologists involved in administration, scientific research, and clinical or forensic toxicology covers different fields or disciplines. The data base, which is still in a pilot phase, collects data on environmental chemicals (about 30,000) spread over more than 100 data fields. These include identification; physical and chemical properties; analytical methods; economic data; hazard classifications for transport, handling and storage; waste disposal; environmental dispersion and transformation; toxicology: acute and chronic effects, carcinogenicity, mutagenicity, behavioral effects; occupational air standards, first-aid treatments in case of poisoning or environmental disaster. Data stored in the data bank are original literature data which have been evaluated by specialists.

Data Collection↗

PubMedDate not supplied

Project BART: effectiveness of a behavioral intervention to reduce HIV risk in adolescents.

PURPOSE: To examine the effectiveness of Project BART (Becoming a Responsible Teen, [St. Lawrence, 1998]), a behavioral-based curriculum for adolescents at risk for developing HIV. The purpose of BART was to help adolescents acquire the skills needed to reduce risks, thus encouraging them to make safe, healthy choices concerning sexual behaviors. METHODS: This was a one-group, pre-and post-test intervention study with 105 adolescents (ages 12 to 18) of culturally diverse backgrounds. RESULTS: Results of the main effects varied. Significant differences were found between pre-and posttest means of the scores on the HIV Attitudes (P = 0.018) and between the means of the AIDS Risk Knowledge Test (P = 0.001), but no significant difference was found between the pre-and posttest means of two other questionnaires: the Condom Attitude Scale (CAS) and Risk Behavior Survey. Process evaluation of the program indicated positive reactions toward the content and presentation methods of the program. CLINICAL IMPLICATIONS: The need for programs to which adolescents' have positive reactions is vital to community-based participation by teens. Nurses can implement this comprehensive, theory-based program in community settings. Implementation should include a modification of the instruments for better clarity and more one-on-one instruction/attention during data collection. More research with clarified instruments and facilitated data collection is needed to further substantiate the effectiveness of Project BART with adolescents.

Adolescent↗

PubMed1997

Health promotion and injury prevention in a child development center.

The purpose of the study was to determine if a nurse-directed health promotion program in a day care center increased the health of the children in the center and decreased injury rates. The research used a quasi-experimental time series design to answer the research questions. The convenience sample consisted of 29 children between the ages of 6 weeks to 5 years who were enrolled in a university child care center in a metropolitan area. The subjects had their health evaluated by a registered nurse, using the Child Health Assessment Inventory, once per week for 4 consecutive weeks. The Child Health Assessment Inventory measures frequent childhood illnesses and injuries. At the end of this first stage of data collection the Health Promotion Program was given to the staff members in the center. The program consisted of primary care information, such as signs and symptoms of childhood illness, infection control, injury prevention, and first aid. At the conclusion of the program the children had their health evaluated again once per week for 4 weeks. Repeated measures ANOVA showed there was a significant decrease in upper respiratory illness and accidental injury rates. The clinical application of this research is that a nurse-directed health promotion program can have an impact on childhood injuries. Subsequent research can determine if similar health promotion classes to parents and children have a positive effect on health.

Analysis of Variance↗

PubMed2000

Behavioral prevention is today's AIDS vaccine!

INTRODUCTION: Behavioral prevention is currently the only effective way to stem the further spread of HIV. This article reviews the pro-active programmatic model of behavioral research that has led to the development and testing of successful HIV/STD preventive interventions in the last fifteen years. OBJECTIVE: To present (1) a model of behavioral prevention adapting phases of clinical trials research: Phase I: Discovery; Phase II: Exploratory; Phase III: Efficacy; and Phase IV: Effectiveness; and (2) a theoretical framework for behavioral prevention; and (3) A Lifespan Model of Health Promotion and Disease Prevention which can be used to design HIV/STD prevention programs across the lifespan, at different levels (e.g., individual, couple, family, community, societal) using different intervention modalities. CONCLUSIONS: Behavioral prevention is effective with different age groups and at different levels of intervention when the prevention program has a theoretical basis. Behavioral prevention works now and can be mobilized within a community to address all of the factors associated with the rapid development of an epidemic. Behavioral prevention is cost effective and can be delivered in communities that have limited resources.

Acquired Immunodeficiency Syndrome↗

PubMed1998

An intervention for changing high-risk HIV behaviors of African American drug-dependent women.

The purpose of this study was to test the effectiveness of an AIDS education intervention for methadone-dependent, African American women. The women were randomly assigned to experimental (n=107) or control (n=97) group. The experimental group participated in a peer counseling and leadership training program conducted by two experienced nurse counselors over an 8-week period, followed by 8 weeks of reinforcement. The program was designed to reduce AIDS high-risk sexual behavior, increase self-esteem, decrease depressive affect, and increase the women's community-based AIDS prevention communication activities. A total of 130 women completed all phases of the study, including longitudinal Posttests at 2, 4, and 7 months after enrollment. Compared to the control group, there were statistically significant differences in three of the outcomes for the experimental group: The experimental group reported an increased number of safer sexual behaviors (p=.029), showed decreases in depression (p=.001), and reported engaging in more AIDS-related, community-based communication activities regarding prevention (p=.005).

Adult↗

PubMed2006

Community senior first aid training in Western Australia: its extent and effect on knowledge and skills.

OBJECTIVE: To define the extent of Senior First Aid training in a sample of the Western Australian community, and to evaluate the effect of previous training on first aid knowledge and skills. METHODS: A telephone survey of a random sample from suburban Perth and rural Western Australia; and practical assessment of first aid skills in a subsample of those surveyed. RESULTS: 30.4% of respondents had completed a Senior First Aid certificate. Trained individuals performed consistently better in theoretical tests (p=0.0001) and practical management of snakebite (p=0.021) than untrained. However, many volunteers, both trained and untrained, demonstrated poor skills in applying pressure immobilisation bandaging and splinting the limb adequately despite electing to do so in theory. CONCLUSIONS AND IMPLICATIONS: Overall knowledge and performance of first aid skills by the community are poor, but are improved by first aid training courses.

Age Factors↗

PubMedDate not supplied

Detection and treatment of childhood malnutrition in Papua New Guinea.

This paper reviews the importance of childhood malnutrition in Papua New Guinea and other developing countries. Emphasis is given to two important causes: chronic disease and limited food supply. Definitions and diagnostic criteria for malnutrition are discussed with particular focus on the mid-upper-arm circumference (MUAC). The design of a MUAC measuring tape with written treatment guidelines for use at the aid post level and a pilot project used to test the tape are described. The rationale for six treatment steps for malnutrition are described. The importance of community education, support through church groups and effective ongoing preventive health programs at the village level are stressed.

Child↗

PubMed2003

The National HIV Telephone Consultation Service (Warmline): a clinical resource for physicians caring for African-Americans.

The National HIV Telephone Consultion Service (Warmline) at San Francisco General Hospital is a free clinical consultation service that provides expert medical and clinical pharmacy guidance to clinicians caring for patients with HIV/AIDS. Consultation can be especially useful when making critically important decisions about antiretroviral therapy and opportunistic infections. The Warmline has served an essential role for the many clinicians who are not AIDS experts but play key roles In HIV care, but do not have ready access to expert consultation. In addition, the Warmline serves a a medical and clinical pharmacy resource to other AID experts. Because the AIDS epidemic in the US profoundly affects African-Americans, the Warmline can be a valuable resource for African-American physicans and clinicians caring for African-American patients.

Black or African American↗

PubMed1995

Shortened hospital stay for low-birth-weight infants: nuts and bolts of a nursing intervention project.

Prolonged hospitalization of low-birth-weight (LBW) newborns places them at increased risk for a number of medical and psychosocial complications. A randomized trial of earlier hospital discharge with community-based nursing follow-up and intervention was performed. Community-based, in-home, public-health nursing and homemaker services were provided on an individualized basis according to assessed need. A significantly higher number of nurse home visits and telephone contacts were made to the intervention families. One of the most identified needs of families of LBW infants was assistance with breastfeeding. More than half of the early discharge families needed and received homemaker assistance during the first 8 weeks after the newborn's discharge from hospital. Results showed that a community-based program that provided individualized support and education for families of LBW infants was safe, cost-effective, and had a positive influence on the home environment.

Community Health Nursing↗

PubMed2001

The cost and cost-effectiveness of an enhanced intervention for people with substance abuse problems at risk for HIV.

OBJECTIVE: To estimate the costs, effectiveness, and cost-effectiveness of prevention interventions for out-of-treatment substance abusers at risk for HIV. This is the first cost-effectiveness study of an AIDS intervention that focuses on drug use as an outcome. STUDY DESIGN: We examined data from the North Carolina Cooperative Agreement site (NC CoOp). All individuals in the study were given the revised NIDA standard intervention and randomly assigned to either a longer, more personalized enhanced intervention or no additional intervention. We estimated the cost of each intervention and, using simple means analysis and multiple regression models, estimated the incremental effectiveness of the enhanced intervention relative to the standard intervention. Finally, we computed cost-effectiveness ratios for several drug use outcomes and compared them to a "back-of-the-envelope" estimate of the benefit of reducing drug use. PRINCIPAL FINDINGS: The estimated cost of implementing the standard intervention is $187.52, and the additional cost of the enhanced intervention is $124.17. Cost-effectiveness ratios range from $35.68 to $139.52 per reduced day of drug use, which are less than an estimate of the benefit per reduced drug day. CONCLUSIONS: The additional cost of implementing the enhanced intervention is relatively small and compares favorably to a rough estimate of the benefits of reduced days of drug use. Thus, the enhanced intervention should be considered an important additional component of an AIDS prevention strategy for out-of-treatment substance abusers.

AIDS Serodiagnosis↗

PubMed1998

The University of Alabama Teenage Access Project: a model for prevention, referrals, and linkages to testing for high-risk young women.

The Teenage Access Project (TAP) was supported by the Special Projects of National Significance Program to expand and ensure access to health and support services for disadvantaged, human immunodeficiency virus (HIV)-positive, and at-risk adolescent and young adult women aged 10-21 years by: (a) preventing further HIV transmission through empowerment and reduction of risk behavior, (b) providing HIV counseling and testing to increase screening of young women, and (c) facilitating referrals to medical and psychosocial services through the TAP activities. TAP served 403 young people (82% African-American and 83% young women). The basic elements of the TAP service model components were: (a) outreach to community agencies serving high-risk, disadvantaged young women; (b) My Individual Responsibility Reduces Our Risk (MIRROR), a six-module risk-reduction and empowerment activity specifically designed for young women in Jefferson County, using a small group format; and (c) the Adolescent Testing Center (ATC), a center for age and culturally appropriate HIV testing, pre- and posttest counseling, risk assessment, and referrals. HIV testing and pre- and posttest counseling were provided confidentially in both clinical and community settings. More than 200 participated in the MIRROR activity. A total of 101 young women received HIV counseling and testing services.

AIDS Serodiagnosis↗

PubMed2005

HIV risk perception and prevalence in a program for prevention of mother-to-child HIV transmission: comparison of women who accept voluntary counseling and testing and those tested anonymously.

OBJECTIVE: To determine whether data from voluntary counseling and testing (VCT)/prevention of mother-to-child transmission (PMTCT) programs can be used for HIV surveillance. METHODS: Women attending an antenatal clinic at the district hospital in Entebbe, Uganda, from May 2002 to April 2003 were offered counseling and HIV testing with same-day results (VCT) and nevirapine for PMTCT was provided for HIV-positive women and their babies. Those who declined VCT were tested for HIV anonymously. RESULTS: Overall, 2635 women accepted VCT; 883 were tested anonymously. HIV prevalence was higher in VCT than in anonymously tested women in the first month of the program (20% vs. 11%, P=0.05) and in months with <70% VCT uptake (17% vs. 8%, P<0.001) but was similar in months with high uptake. Uptake of VCT was higher in women who had risk factors for HIV, especially those who believed themselves to have been exposed (84% vs. 73%, P<0.001). CONCLUSION: There was a bias to accepting VCT in women with HIV, or risk factors for HIV infection, the former most apparent when there was low coverage. Data from VCT/PMTCT programs cannot replace anonymous surveillance for monitoring of HIV epidemic trends where coverage is incomplete within clinics or communities.

AIDS Serodiagnosis↗

PubMed1998

AIDS in Norway: a post hoc evaluation of an AIDS home care project.

Norway's National Health Care system guarantees all citizens a right to health care within a decentralized system based on values like solidarity and equality. Seventy-five per cent of people with HIV/AIDS live and are treated in Oslo, the capital. Local home care agencies have minimal, if any experience working with AIDS patients residing in the community. Therefore a home care team with two nurses employed by the hospital was established as a 2-year trial project to establish a home care system for AIDS patients. In March 1993 a post hoc evaluation of the project for AIDS patients was completed, based on descriptive data. Results seem to indicate that a prerequisite for patients to live at home is someone to do chores like cleaning, laundry and shopping. The home care nurses functioned as vital links between the hospital, the outpatient clinic and the local home agency.

Acquired Immunodeficiency Syndrome↗