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At least 1,513 records · Page 84Linked to original sources
PubMed1996

Sustainability of a successful malaria surveillance and treatment program in a Runggus community in Sabah, east Malaysia.

The district of Kudat has one of the highest and most persistent malaria transmission levels in Sabah, Malaysia, with annual parasite incidence of 102 per 1,000 inhabitants per year. Due to this situation and the failure of DDT spraying to control malaria, a community participation health program (Sukarelawan Penjagaan Kesihatan Primer or SPKP) was developed as an adjunct to current anti-malarial measures during 1987-1991. SPKP is made up of unpaid community workers known as village health volunteers (VHVs). VHVs are selected by a village development and security committees training and supervision a member of the Vector-Borne Diseases Control Program (VBDCP). The beneficiaries of SPKP consisted primarily of Runggus people and other remote, and mobile populations who visit the home of a VHV for diagnosis and treatment. This group of febrile patients and their children who attend a participating school submit finger prick blood and personal details to the VHV. and receive a presumptive treatment for malaria. Thick and thin blood smears are examined by a VBDCP microscopist who then prepare and forward a radical or curative treatment to the VHV so that it can be administered to the microscopically-positive patient free of charge. Between June 1987 to June 1991, VHVs from 32 kampungs (villages) and 22 schools collected 56,245 slides representing 24.7% of total slide collection compared to 74.9% collected by passive case detection (PCD) posts in health centers and district hospital. The average volunteer treated 11.8 (range 10.4-13.4) and 31.4 (range 26-49) patients per month in kampungs and schools respectively. In contrast, non-SPKP posts in a district hospital, health centers and flying doctor service treated an average of 616.3 patients per month (range 134.8-1032.8). The slide positivity rate of blood smears taken by VHVs was 8.43% compared with 7.37% for non-SPKP posts. Average slide collection and slide positivity rates varied considerably from one community to another, despite their close geographic proximity. The monthly number of VHV-diagnosed patients from the school and kampungs communities and the monthly number of true malaria patients in the two groups were significantly correlated. Sustainability of SPKP was linked to an ongoing process of social change which involved co-operative networking between the government health sector and the community. This in turn provided a stimulus for malaria abatement efforts. When Runggus people themselves control and maintain ownership of community-based malaria programs, the function of SPKP as a malaria surveillance system and an antimalarial drug distribution network is vastly improved.

Animals↗
PubMedDate not supplied

[The state and dynamics of disability in childhood in the Russian Federation].

Characterizes the state and time course of childhood disability in Russia as reflected in statistical files of the service of social protection of the population. Presents the invalidity level in childhood: 79.7 per 10,000 population aged under 16 in 1992. The level of childhood invalidity increased by 4.8 times over 13 years. An unfavorable prediction regarding invalidity in 2000 is given. Epidemiological assessment of childhood invalidity as a regional level and for some territories is presented. Territories with stable and unstable levels of childhood invalidity were detected. Classification of territories of the Russian Federation by levels and rates of growth of childhood invalidity was made. Recommendations to solve present day problems of childhood invalidity are offered.

Adolescent↗
PubMed1997

Challenges in measuring patient outcomes.

Reliable and valid measurement of outcomes is a key criterion for assessing the efficacy and effectiveness of nursing interventions. However, measurement in outcomes studies present a special challenge due to the longitudinal nature of such studies as well as the need to operationalize the intervention, specify and select the most relevant contextual and outcome variables, and delineate the influence of other providers on outcomes. This article specifies measurement-related issues and problems that threaten the credibility of outcome studies. Client-related and instrument-related measurement issues which could compromise outcomes measurement are also addressed.

Bias↗
PubMed1997

Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing. A randomized controlled trial.

CONTEXT: Interest in home-visitation services as a way of improving maternal and child outcomes has grown out of the favorable results of a trial in semirural New York. The findings have not been replicated in other populations. OBJECTIVE: To test the effect of prenatal and infancy home visits by nurses on pregnancy-induced hypertension, preterm delivery, and low birth weight; on children's injuries, immunizations, mental development, and behavioral problems; and on maternal life course. DESIGN: Randomized controlled trial. SETTING: Public system of obstetric care in Memphis, Tenn. PARTICIPANTS: A total of 1139 primarily African-American women at less than 29 weeks' gestation, with no previous live births, and with at least 2 sociodemographic risk characteristics (unmarried, <12 years of education, unemployed). INTERVENTION: Nurses made an average of 7 (range, 0-18) home visits during pregnancy and 26 (range, 0-71) visits from birth to the children's second birthdays. MAIN OUTCOME MEASURES: Pregnancy-induced hypertension, preterm delivery, low birth weight, children's injuries, ingestions, and immunizations abstracted from medical records; mothers' reports of children's behavioral problems; tests of children's mental development; mothers' reports of subsequent pregnancy, educational achievement, and labor-force participation; and use of welfare derived from state records. MAIN RESULTS: In contrast to counterparts assigned to the comparison condition, fewer women visited by nurses during pregnancy had pregnancy-induced hypertension (13% vs 20%; P=.009). During the first 2 years after delivery, women visited by nurses during pregnancy and the first 2 years of the child's life had fewer health care encounters for children in which injuries or ingestions were detected (0.43 vs 0.55; P=.05); days that children were hospitalized with injuries or ingestions (0.03 vs 0.16; P<.001); and second pregnancies (36% vs 47%; P=.006). There were no program effects on preterm delivery or low birth weight; children's immunization rates, mental development, or behavioral problems; or mothers' education and employment. CONCLUSION: This program of home visitation by nurses can reduce pregnancy-induced hypertension, childhood injuries, and subsequent pregnancies among low-income women with no previous live births.

Child Development↗
PubMedDate not supplied

Bayesian communication of research results over the World Wide Web.

The World Wide Web provides a unique opportunity to reconsider how the results of scientific studies can best be presented to clinicians. For decades statisticians, philosophers, medical investigators, and others interested in data analysis have assumed that the Bayesian paradigm is the proper approach for reporting the findings of scientific analyses for use by client computers and readers. At the heart of that approach is the inclusion of the reader's preexisting knowledge and beliefs. Yet, to date, the methods for inclusion have been too complicated for non-statisticians to use. We believe that the World Wide Web provides an ideal environment for putting the Bayesian paradigm into practice: the author publishes the data from the server side, the reader uses the client to represent her or his prior belief, a downloaded program (a Java applet) combines the two. This article describes a prototype implementation for two-arm clinical trials with normally distributed outcomes.

Bayes Theorem↗
PubMed1997

[Treatment with human tetanus immunoglobulins in the Emergency Department. Effects of informed consent].

BACKGROUND: The impact of informed consent to tetanus prophylaxis with human immunoglobulins on patients treated in the Emergency Department has been evaluated. METHODS: Tetanus vaccination history was investigated in 1435 patients in 1995 and in 1300 patients in 1996 with post-traumatic skin lesions. RESULTS: The study has shown that in 1995, 55% and in 1996 49.5% of the total patients studied had not received vaccine for tetanus or boosters for over 10 years. These patients had been proposed the treatment with human tetanus immunoglobulins (TIG). The research was performed comparing the consent obtained before (from 17/5 to 15/7/1995) and after (from 17/5 to 15/7/1996) the introduction of the informed consent. The survey was divided into 15-day periods. In 1995 prophylaxis with human immunoglobulins was refused by 42 patients out of 831 (5%) while, in the following year, by 284 out of 641 (44.3%). Every period examined has shown highly significant differences (p < 0.000). CONCLUSIONS: Informing the patients that tetanus prophylaxis with human immunoglobulins can expose them to the risk, at present remote, of transmission of viral infections, has caused a heavy rise of denials to the suggestion of treatment with human immunoglobulins. The amount of the treated patients and the time that was devoted to informed consent would make Emergency Department one of the main places for effective and widespread tetanus prophylaxis. However a greater activity of outer structures would also be hoped for.

Adolescent↗
PubMedDate not supplied

[Bassini's technique versus Trabucco's technique in the treatment of inguinal hernia: randomized comparative study].

The authors have carried out a perspective randomized trial between two homogeneous groups, each one of 30 pts., consisting of 50 males and 10 females with an average age of 42 (18-65) affected by an uncomplicated inguinal hernia. Group A underwent a Bassini repair technique and group B underwent a Trabucco's operation. The early results in terms of clinical conditions and days of post-operative course and period of return to work were analysed with Shapiro-Wilk and t tests. The group B patients had a significant reduction of the post-operative period (2.3 days vs 3.46), a significant reduction of post-operative pain (present in all group A patients vs 6.6%) with rapid return to normal functions and to work. All these conditions reduce the costs of the operation for society and the health service. There were no statistically significant differences in terms of morbidity and long-term follow-up (about 9 months).

Adolescent↗
PubMed1998

The effect of hospital volume on the in-hospital complication rate in knee replacement patients.

OBJECTIVE: To examine the effect of hospital volume on in-hospital surgical outcomes for knee replacement using six years of Medicare claims data. DATA SOURCES/STUDY SETTING: The data include inpatient claims for a 100 percent sample of Medicare patients who underwent primary knee replacement during 1985-1990. We supplemented these data with information from HCFA's denominator files, the Area Resource File, and the American Hospital Association survey files. STUDY DESIGN: We estimated the probability that a patient has an in-hospital complication in the initial hospitalization for the first primary knee replacement, using a Logit model, for three definitions of complication. The models controlled for hospital volume, other hospital characteristics, patient demographics, and patient health status. We tested for the endogeneity of hospital volume. DATA COLLECTION/EXTRACTION METHODS: A panel of two orthopaedic surgeons and two internists reviewed diagnosis codes to determine whether a complication was likely, possible, or due to anemia. After removing the few observations with bad or missing data, the final population has 295,473 observations. PRINCIPAL FINDINGS: The probability of a likely in-hospital complication declines rapidly from 53 through 107 operations per year, then levels off. Statistical tests imply that hospital volume is exogenous in this patient-level data. Complication rates increased steadily through the study period. Although obesity appeared to lower the probability of a complication, a counterintuitive result, further investigation revealed this to be an artifact of the claims data limit of listing no more than five diagnoses. Controlling for this restriction reversed the effect of obesity. CONCLUSIONS: Rather than uncontrolled expansion of knee surgery to small hospitals, decentralization to regional centers where at least about 50, and preferably about 100, operations per year are assured appears to be the optimal policy to reduce in-hospital complications.

Arthroplasty, Replacement, Knee↗
PubMed1996

Farm health and safety issues: do men and women differ in their perceptions?

This study identifies gender specific farm health and safety issues. Based on a sample from the 1988 New York Farm Family Survey, descriptive statistics and exploratory factor analysis were used to establish unique gender based profiles in terms of labor force participation, and prioritization of farm health and safety issues, concerns, and information sources. Based on the factor analysis, women's main farm health and safety issues included physical problems and occupational hazard screening needs, provider integrity, and economic incentives. Men's main issues consisted of accident related counseling needs, skin related hazards, and the farm related convenience of the services. Men and women had statistically significant differences in the types of information sources and reasons for using farm health and safety services. These differences imply that farm health and safety providers must consider both gender related information gathering and farm health and safety prioritizations to more efficiently allocate intervention resources, more effectively promote safety, and reduce the incidence of occupationally related morbidity and mortality in agriculture.

Agriculture↗
PubMed1983

Privacy Act of 1974; system of records--PHS.

In accordance with the Privacy Act, the Public Health Service (PHS) is publishing notice of a proposal to add a new routine use to system of records 00-37-0013. "Health Resources Utilization Statistics, HHS/OASH/NCHS." This system of records is maintained in the National Center for Health Statistics (NCHS) for the purposes of collecting statistics on the utilization of health services, processing and analyzing the data, and publication of the statistical findings. NCHS is proposing to add a new routine use to permit disclosure of information to a contractor. PHS invites interested persons to submit comments on or before January 11, 1984.

Civil Rights↗
PubMed1987

The impact of advanced prehospital emergency care on the mortality of severely brain-injured patients.

The mortality of 128 consecutive severely brain-injured patients (Glasgow Coma Score less than or equal to 8) treated by a land advanced life support system and transported to a trauma center was compared to the mortality of 104 consecutive severely brain-injured patients treated during the same time period by an advanced care rotorcraft aeromedical emergency service and transported to the same trauma center. The two patient groups had statistically similar distribution of CNS lesions and Glasgow Coma Scores. The mortality of the patients treated by the land ALS system was 40%. The mortality of the patients treated by the aeromedical service was 31%. The 9% reduction in mortality in the patients treated by the aeromedical service was statistically significant (p less than 0.001). There was also a statistically significant (p less than 0.05) reduction in the Glasgow Outcome Scores of the patients treated by the aeromedical service compared with patients treated by the land advanced life support system.

Adult↗