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PubMed1991

Cardiovascular risk factor prevalence in African-American adult screenees for a church-based cholesterol education program: the Northeast Oklahoma City Cholesterol Education Program.

The status of selected cardiovascular risk factors was ascertained in a consecutive sample of 661 (222 men and 439 women) African-American adults who were screened for the Northeast Oklahoma City Cholesterol Education Program, a church-based cholesterol intervention program. Hypertension was present in 48.4% and 44.7% of men and women, respectively. Average systolic blood pressure levels were similar in men and women (132.0 vs 131.5 mm Hg, P = 0.40) although average diastolic blood pressure levels were higher in men (84.0 vs 81.1 mm Hg; P < .0001). A substantial proportion of the screenees were unaware of their hypertension, and blood pressure normalization (SBP < 140 and DBP < 90 mm Hg) was uncommon in drug-treated hypertensives. Average cholesterol levels were slightly higher in women compared to men (206.0 vs 199.6 mg/dL, P = 0.11). The majority of persons with elevated cholesterol levels (> or = 240 mg/dL) were unaware of their condition and were infrequently treated with cholesterol-lowering drugs. Overweight was highly prevalent, was more common with advancing age, and was related to the presence of hypertension in both men and women. In addition, a strong linear relation between overweight and blood pressure was present in both sexes. Overweight was more common in young men (< 35 years old) compared to age-matched women; however, women were increasingly more overweight than men after 35-44 years of age. In fact, by age 65, 90% of the women were overweight. These data indicate an excessive prevalence and high mean levels of modifiable cardiovascular risk factors in these church-attending African-American adults. Because churches are a central institution in most African-American communities, and their congregations appear to have an excessive cardiovascular disease risk factor burden, churches may be appropriate sites for the implementation of community-based risk factor control programs.

Adult↗

PubMed1991

Current and future perspectives regarding the framework for nurse anesthesia education: a freestanding academic program within a regionalized program framework.

In 1987, Pittsburgh's LaRoche College advanced its baccalaureate level nurse anesthesia program to the master's degree level. The coordinator of the didactic program collaborated with directors of two affiliated hospitals of nurse anesthesia to develop a program in which scientific concepts, theory and clinical applications have been well-integrated.

Curriculum↗

PubMedDate not supplied

Educational program evaluation: the University of Vermont family nurse practitioner program.

Graduates of the Family Nurse Practitioner (FNP) Program at the University of Vermont, Burlington, were surveyed to determine if the FNPs had enlarged their nursing roles following completion of the program. A sample of Vermont nurses served as a control group. Results of a questionnaire, used to obtain information about the nurses' training, functions, and attitudes, indicated that FNPs performed activities associated with an expanded nursing role more frequently than did their nonpractiioner counterparts. There was evidence that the two groups differed in their attitudes toward various aspects of their nursing roles. The evaluation is an ongoing study; as the number of program graduates increases, further characterization of their roles will be possible.

Attitude of Health Personnel↗

PubMed1989

Instructional computing in Alberta nursing programs as perceived by program leaders.

This paper summarized data from a survey which was conducted to establish the status of computing in Alberta's professional nursing programs. It describes the hardware and software applications in use and identifies barriers to the growth of instructional computing. The study reveals a range of activity in Alberta's nursing programs and definite progressive trends. Future directions as perceived by program leaders are reported.

Alberta↗

PubMedDate not supplied

The role of physicians in a community-wide program for prevention of cardiovascular disease: the Minnesota Heart Health Program.

The Minnesota Heart Health Program (MHHP) aims to reduce cardiovascular disease (CVD) morbidity and mortality by reducing risk factors among the mass of residents in three midwestern communities. A major aspect of the program is the involvement of community physicians because they have high credibility as citizen leaders, especially on health issues. In the MHHP, physicians contributed in a number of ways. The initial contacts with physicians resulted in their providing support and introductions to other community leaders, whose active support was also gained. Physicians sit as members of the central Community Advisory Borads of MHHP and serve on the executive committees of these boards. All MHHP issues related to medical practice are brought before Physicians' Advisory Groups in each community for resolution. Primary care physicians attend MHHP continuing education programs. In a survey of 109 physicians in one of the MHHP communities, 95 percent of respondents believed cigarette smoking to be an important risk factor for CVD, but only 15 percent judged themselves to be effective in dealing with patients who smoked. Forty-one percent of respondents said that elevated blood cholesterol is an important risk factor, but only 20 percent felt effective in treating the condition. Only 18 percent of the physicians in the sample believed that a poor eating pattern plays a substantial role in CVD, and 9 percent felt effective in counseling patients about eating habits. This pattern of results indicates the need not only for continuing education about risk factors for CVD, but also for training to improve patient counseling skills.

Attitude of Health Personnel↗

PubMed1966

Extramural programs of theNational Library of Medicine: program objectives and present status.

The National Library of Medicine Extramural Program, utilizing the authorities of the Medical Library Assistance Act of 1965 and the Public Health Service Act, includes support for library construction, improving and expanding basic library resources, research and development, man-power development, publications, and support for the operation of regional health sciences libraries. The program objectives relating to these various activities have been outlined. A $4,000,000 supplement has been appropriated by the Congress for fiscal year 1966 to implement the authorities of the Act. With the construction provision available in fiscal year 1967, over $13,000,000 has been requested for the second year of the program. The Medical Library Assistance Act is intended to catalyze and stimulate expanded support of medical libraries by their host institutions. Bold and imaginative plans by the medical library community are essential to the full success of the endeavor.

Legislation, Medical↗

PubMed1982

Teaching effectiveness in coordinated undergraduate program in dietetics. Assessments of students, graduates, and program directors.

The effect of practitioner experience on teaching effectiveness of faculty in coordinated undergraduate programs in dietetics (CUPs) was studied on the basis of ratings from program directors, students, and program graduates. Instruments to measure teaching effectiveness were developed that contained 36 items common to all teaching situations and 6 each related to teaching in clinical/community dietetics and to food service management. Four dimensions of effective teaching were identified using factor analysis: interpersonal skill, dietetic expertise, organizational focus, and clinical or practical orientation. Extensive practitioner experience did not contribute to teaching effectiveness.

Clinical Competence↗

PubMed1995

Petro-Canada Heart Health Program: successful program.

1. The economic impact of cardiovascular disease is significant, requiring 8.3 million annual inpatient days for treatment. Disability accounts for 25% of disability pensions paid by Canada Pension Plan to individuals less than 65 years of age. 2. Management of risk factors provides an opportunity to reduce the likelihood of coronary heart disease (CHD) and to mitigate the effects of non-modifiable risks. 3. There is an increased risk for CHD with elevated cholesterol. The best return on the value of a cholesterol program comes from testing work groups comprised mainly of males and older employees. 4. The goal of promoting and maintaining high levels of physical, mental, and social well being for workers can be achieved through programs such as the cholesterol screening and education programs.

Adolescent↗

PubMed1994

Therapeutic walking program: an alternative to a formal vascular rehabilitation program.

A formalized 3-day-a-week structured exercise program proved unsuccessful in a regional, inner-city referral center. However, a large number of patients who needed exercise training were seen. In response to this demand, a "Therapeutic Walking Program" was designed. This article describes the nurse's role, the exercise program, patient screening, and indications for future research.

Exercise Therapy↗

PubMed1994

Employee assistance programs: history and program description.

1. The history and development of Employee Assistance Programs (EAPs) can be traced back to the 1800s. There are currently over 10,000 EAPs in the United States. 2. Standards for program accreditation and counselor certification have been established for EAPs. The "core technology of Employee Assistance Programs" includes identification of behavioural problems based on job performance issues, expert consultation with supervisors, appropriate use of constructive confrontation, microlinkages with treatment providers and resources, macrolinkages between providers, resources, and work organizations, focus on substance abuse, and evaluation of employee success based on job performance. 3. Some EAPs take a broad brush approach, and incorporate health promotion and managed care functions.

Accreditation↗

PubMed1994

Programming for recognition and programming for response. Separate developmental subroutines in the murine thymus.

Pre-T cells become programmed with the capacity to make functional responses to activating stimuli in a process that occurs prior to, and independently of, T-cell receptor gene rearrangement and T-cell receptor-dependent positive selection. In spite of this early programming, as differentiation proceeds further the cells enter a stage in which they appear to be unable to make any functional responses. This 'eclipse' phase begins when the cells undergo successful T-cell receptor beta-chain rearrangement and ends, with the return of their functional competence, only when they successfully traverse positive selection. These results suggest that pre-T cells are subject to two distinct subroutines of differentiation, which cannot operate at the same time: one which confers function and one which confers and selects recognition specificity. To provide a possible molecular basis for the relationship between these two processes, we consider specific alterations in response-associated transcription factors that may cause the changes in responsiveness observed during programming for recognition. The interplay of the two differentiation subroutines is proposed to be a consequence of the use of common transcription factors in different combinatorial contexts for functional responses, assembly of T-cell receptor complexes, and selection.

Aging↗

PubMed1993

Work-site physical fitness programs. Comparing the impact of different program designs on cardiovascular risks.

The relative impact of three different approaches to physical fitness at the work site on cardiovascular risk reduction is examined, based on before/after health screening of employees, and employees' reports of participation in physical exercise activities. The three approaches tested were: 1) a staffed physical fitness facility, 2) one-to-one counseling with at-risk employees, and 3) a combination of one-to-one counseling with employees plus organization of the work site to encourage peer support and mutual exercise activity at work. A fourth site is used as a control site. The program that was centered around a physical fitness facility had little measurable impact on cardiovascular risks, and showed results similar to those at the control site. Both of the other programs were more effective, with the combination of counseling and plant organization providing the best health outcomes in terms of frequency of exercise, adequacy of blood pressure control (among hypertensives), weight loss (among the overweight), and smoking cessation. These results indicate that systematic, ongoing outreach to enlist employees in various types of exercise programs is more effective than the presence of fitness facilities without such outreach. Moreover, significant increases in frequency of exercise can be sustained without a substantial investment in facilities.

Cardiovascular Diseases↗

PubMed1983

A planning cycle in the development of a community health program. An intervention program in mother and child care.

The Or Yehuda Intervention Program was developed in accordance with a planning cycle that includes a situation analysis, formulation of objectives, selection of strategies, development of an operational plan, implementation and evaluation, which lead, in turn, to a new situation analysis. The primary aims of the program are to reduce the infant mortality rate in Or Yehuda to the level prevailing in the rest of the area and to promote continuity of care and proper medical management during pregnancy, delivery and the first year of life. Problems in implementation, especially those related to coordination and integration of the several medical facilities involved, the information tools developed, and preliminary results are presented.

Child Health Services↗

PubMedDate not supplied

Parent Partners: a parent-to-parent support program in the NICU. Part 1: Program development.

Neonatal intensive care units (NICU) face the challenge of developing family-centered systems of service delivery. An important component of family-centered care is parent-to-parent support. A parent-to-parent support program that meets the needs of both parents and staff can be successfully established in the NICU if the principles of planned change are used to guide the process of program development, implementation, and evaluation.

Health Services Needs and Demand↗

PubMed1989

Multiple program participation: comparison of nutrition and food assistance program benefits with food costs in Boston, Massachusetts.

The values of government cash and food assistance benefits are compared to estimated food costs in Boston for households whose sole source of income is Aid to Families with Dependent Children (AFDC) and who have housing in the private sector. Methods developed by the General Accounting Office (GAO) in 1978 are replicated. GAO found that the value of combined benefits can exceed the cost of the United States Department of Agriculture's Thrifty Food Plan. Key assumptions underlying GAO's methodology are challenged, and an alternate method is applied. The new results contradict GAO's conclusions and suggest that Boston food costs exceed the combined value of benefits that AFDC households may receive, although participation in multiple food assistance programs is more beneficial than receipt of benefits from single programs. The authors conclude that food stamps and AFDC benefits indexed to actual costs of living are needed to meet the food needs of low-income families in Boston.

Adolescent↗

PubMed1994

Laying hen production responses to least cost rations formulated with stochastic programming or linear programming with a margin of safety.

An experiment with 480 DeKalb DK laying hens was conducted to study the effect of rations formulated with stochastic programming (STCH) or linear programming with a margin of safety (LPMS) over 12, 28-d periods. Rations were formulated to guarantee the requirement of methionine and lysine > or = 69%, in all rations, and Ca and P > or = either 69 or 90%. The four rations were: LPMS69 with Ca and P > or = 69%, LPMS90 with Ca and P > or = 90%, STCH69 with Ca and P > or = 69%, and STCH90 with Ca and P > or = 90%. Rations formulated with STCH were lower in cost than LPMS rations for respective probability levels. Costs per metric ton for LPMS69, LPMS90, STCH69, and STCH90 were $155.70, $157.71, $155.00, and $156.30, respectively. Compared to STCH rations, LPMS rations were overformulated in nutrients. There was no difference (P > .05) in performance for hen-housed egg production, hen-day egg production, feed per dozen eggs, mortality, egg weight, or eggshell percentage.

Animals↗

PubMed1989

[The use of programmed consultation and compliance with the appointment in a teaching program of family medicine. Prospective study of 2,627 cases].

During the last years, systems of programmed consultation have been included in primary health care. These allow a better knowledge and improvement of the quality of care, and an evaluation of the satisfaction degree of the population. To evaluate the performance and acceptation of a model of programmed consultation in a teaching center of Family and Community Medicine, 2627 protocolized consultations were prospectively studied. The system was shown to be accessible, and was accepted by the population. The rate of lack of compliance with the appointment was 6.4%. The variables associated with compliance were the day of the week, the type of consultation (new patient, first visit or control visit) and the number of appointments per patient. Among the causes of lack of compliance, personal ones predominated over environmental and institutional. Further studies will be required to determine the mechanisms for the improvement of the compliance with the appointment.

Appointments and Schedules↗

PubMed1993

[Reference standards in the performance of a mammographic screening program. Results of the screening program in the province of Florence, 1992].

The authors report the results of the Florence District program for the year 1992. 11,033 subjects were examined. Attendance rate (64.4%) was significantly related to age (42-49 = 71.0%; 50-59 = 66.7%; 60-70 = 58.5%). Recall rate to diagnostic assessment was 2.09% (mammographic abnormalities = 199, subjective symptoms other than pain = 32) and was related to age (42-49 = 3.12%; 50-59 = 1.65%; 60-70 = 1.77%). According to the results of diagnostic assessment 53 surgical biopsies (0.48%) were recommended and performed. The biopsy rate was also related to age (42-49 = 0.2%; 50-59 = 0.4%; 60-70 = 0.7%). Forty-seven carcinomas were detected in 46 subjects (benign/malignant biopsy ratio = 0.13). Cancer detection rate was 0.42% and changed significantly with age (42-49 = 0.13; 50-59 = 0.36; 60-70 = 0.68%), as well as the observed/expected cancer ratio (42-49 = 0.89; 50-59 = 2.03; 60-70 = 2.98). Detected cancers were nonpalpable in 57% of cases. Pathologic staging was pTIS in 2 cases, pT1a in 5, pT1b in 17, pT1c in 17, pT2 in 5, and pT4b in one case. Six of 47 (12.8%) cancers involved axillary nodes. A preliminary estimate of screening cost yielded a total cost of Lit. 397,671,000 for the year 1992--i.e., Lit. 36,000 per examined subject and Lit. 8,461,000 per detected cancer. The results are compared with reference standards for the evaluation of screening performance provided by the national breast screening program in the United Kingdom.

Adult↗