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Vanguard family planning acceptors in Senegal.

This study examines contraceptive use among clients at the three clinics providing family planning services in Dakar, Senegal in early 1983. Most clients first became interested in family planning following the birth of a child, and most are interested in spacing future pregnancies, although one-third state that they want no more children. The clinic itself was found to be an important determinant of the type of contraceptive used, with only the government-operated clinic providing a balance between IUDs, oral contraceptives, and barrier methods. Nearly half of the clients interviewed said that a lack of knowledge about contraception is the reason for the low contraceptive prevalence rates among Senegalese women; another frequently cited reason was the opposition of the husband. Most clients reported the broadcast media to be the best means of providing family planning information to potential acceptors.

Contraceptive Devices, Male↗

The professional portfolio: documentation of prior learning.

Many questions about the use of the professional portfolio remain. Is the underlying assumption that registered nurses have prior learning that should be credited by baccalaureate programs acceptable to all faculty and all institutions of higher learning? Will the academic quality of the learning experiences of the registered nurse be enhanced or threatened by the portfolio process? Is the portfolio method appropriate for all nurse students or is it best suited to the experienced professional who is articulate and has clear educational and professional goals? How can questions of reliability and validity be addressed? Will faculty maintain the commitment to an individualized method of assessment in times of decreasing resources and expanding responsibilities?

Credentialing↗

Caries diagnosis and risk assessment. A review of preventive strategies and management.

The scientific basis for caries risk assessment, prevention and treatment on an individual patient basis requires further development, specification and continuing validation. Still, current technologies and techniques, taken together, can provide enhanced capabilities over those that have been employed traditionally. Undoubtedly, the clinical tools for carrying out these responsibilities will be refined and expanded in the future in response to the changing clinical profile of caries in the population. For example, bacteriologic testing methods have become easier and more reliable, and will become more widely used. Other effective methods to detect the early, pre-cavitation stage of caries also should become more available in the future. Practitioners will be continually challenged and responsible for evaluating the effectiveness and value of emerging technologies in their practices and in light of their patients' needs. But how can this be accomplished best? Effectiveness claims will be made for new drugs and devices that come onto the market. There are several sources of information to assist the practitioner in making such decisions. The American Dental Association acceptance programs (voluntary) and the U.S. Food and Drug Administration compliance programs (law) provide standards and guidance as to product safety and effectiveness. Without such determinations, the practitioner must judge independently product claims and clinical studies. Marketing materials by themselves (advertisements, videos, pamphlets) may not be sufficient evidence of effectiveness particularly when scientific references supporting claims either are not provided or are inadequate. Peer-reviewed scientific literature in publications of the major scientific and professional associations can be viewed as generally reliable. Changing the way dental caries is managed in clinical practice will require integrating new scientific information and technology into workable clinical procedures. Dental education and third-party reimbursement issues must be addressed also but are beyond the scope of this document. Given that disease patterns are always changing in the population, dentists need to modify practice decisions using risk assessment. Ultimately, the goal for dentistry is that adult patients also will enjoy the same low level of caries experience that many children enjoy today.

Adolescent↗

Estimating and minimizing effects of biologic sources of variation by relative range when measuring the mean of serum lipids and lipoproteins.

Biologic intraindividual variation (CVb) is a major source of inaccuracy in current lipid and lipoprotein measurements. Metaanalysis has been used to estimate the average CVb of serum total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), and triglyceride (TG). These CVb values are larger than the National Cholesterol Education Program-accepted and -proposed analytic (CVa) goals. Measuring serial specimens reduces the error in determination of the mean concentration used in classification of the patient by cutoff points. We show (a) a convenient technique, based on the relative range, to qualitatively estimate and interpret biologic variation of TC, HDLC, LDLC, and TG, and (b) the number of serial specimens required to meet a total variation goal for measurements of mean lipid and lipoprotein values. A total variation goal has been selected that can be met by two serial specimens for a majority of individuals.

Cholesterol↗

In vitro and clinical evaluations of a dentin bonding system with a dentin primer.

The purpose of this study was to investigate the effect of a dentin primer in improving dentin-to-composite bond strengths mediated by a dentin adhesive. The investigation consisted of both an in vitro tensile bond test, in which fresh bovine dentin was used, and clinical evaluation. In the in vitro bond test, bovine dentin surfaces were treated with the primer (an aqueous solution of HEMA) for different durations (10, 20, 30, and 60 seconds) prior to bonding of the light-cured adhesive and placement of a light-cured composite material. For the clinical evaluation, a total of 33 cervical erosion lesions were restored with the combination of the primer, the adhesive, and the composite. To comply with ADA requirements for the acceptance program of dentin-bonding agents, no enamel etching nor any mechanical retentive locks were performed in those restorations. Significant increases in bond strength were obtained in specimens treated with the primer. Regarding the clinical evaluations in which 30 restorations were available for the 6-month recall and 15 restorations were also available for the 1-year recall, all samples demonstrated a retentive rate of 100%.

Adult↗

Participative style of management in a family planning program.

In 1973, a small-scale project to involve family planning staff in program management was introduced in the Sangam primary health center in Andhra Pradesh by the Adminstrative Staff College of India, Hyderabad. Through group meetings, involving all levels of health center personnel, problem areas were identified and analysed and solutions sought. On the basis of recommendations made by the groups, a work plan was drawn up. Monthly review meetings were held to discuss progress in implementing the plan. The project was found to have a positive effect on staff morale and commitment, and program acceptance levels increased. In light of the success of the project at Sangam, a proposal has been submitted to the government to expand the project to other primary health centers in the district.

Attitude of Health Personnel↗

Adolescent suicide prevention: acceptability of school-based programs among secondary school principals.

High school principals' acceptability ratings of three school-based programs for the prevention of adolescent suicide were examined. From a random sample of members from the 1994-1995 membership directory of the National Association of Secondary School Principals (NASSP), a total of 185 (40%) respondents completed the Suicide Prevention Program Rating Profile (SPPRP), a measure designed to evaluate the acceptability of suicide prevention programs, after reading a description of a particular prevention program. Programs evaluated for their acceptability included (1) curriculum-based programs presented to students, (2) in-service presentations to school staff, and (3) student self-report screening measures. The results indicated that the curriculum-based and staff in-service programs were significantly more acceptable to principals than was the schoolwide student screening program. No significant differences between the acceptability of curriculum-based and inservice programs were found. Limitations of the study and implications for practice and research are discussed.

Administrative Personnel↗

Drug usage guidelines, Part 3: assessment of acceptance of the program.

The Drug Usage Guidelines (DUG) program, as perceived by the members of the P & T Committee and by physicians who had prepared and submitted DUGs, was demonstrated to be an effective method for evaluating drugs for formulary inclusion. The majority of P & T members felt that the DUG program had strengthened the drug review process without being too tedious or preventing the addition of valuable drugs to the formulary. Sixty-eight percent of physicians who had submitted a DUG expressed the opinion that it served as a vehicle for providing educational information on rational therapeutics. A majority of respondents stated that they would recommend the DUG program to other hospitals.

Drug Utilization↗

Long-term care of obese individuals in a community-based primary health care program.

A four-year treatment program for severe obesity containing behavioural modification, exercise and nutrition advice was developed at the obesity unit at the Karolinska Hospital. The program made it possible to achieve a sustained weight loss. As far as we know such long-term treatment result has not been reported for this group of patients before. As a consequence of the positive outcome the hospital treatment program was transformed to an out-patient program that could be used in a primary health care setting. The transformation process is emphasized in this presentation but also preliminary results of the weight reduction and the attrition rate in the primary health care setting of the weight reduction program are presented. The evaluation indicates that instructors and participants in the program overall have accepted the program. The mean weight reduction after ten weeks was 6.3 kg. The attrition rate during that time was 2%.

Adult↗