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Health Clinics (health + clinic)
Kinds of Health Clinics Selected AbstractsFood consumption patterns, dietary quality and health status of expectant mothers: case studies in suburban and rural communities in GhanaINTERNATIONAL JOURNAL OF CONSUMER STUDIES, Issue 1 2002Christina A. Nti Abstract The study was conducted to determine the food consumption patterns, dietary quality and health status of expectant women and also to assess their level of awareness of nutritional requirements during pregnancy. Food beliefs, taboos and superstitions held by the women were also investigated. Using the purposive sampling technique, 30 pregnant women attending the Maternal and Child Health Clinic at Dodowa (rural) and University Hospital, Legon (suburban), were selected for the study. A structured questionnaire was used to collect information on the respondents' nutritional knowledge, beliefs, taboos and superstitions and health status. A food frequency questionnaire and the 24-h dietary recall method were used to obtain information on food consumption patterns and dietary quality. The study revealed that, although the majority of the respondents (83.3%) had some knowledge of nutrition, not all were applying it in their feeding practices because of financial constraints. With regard to consumption patterns, most of the women (83.3%) were having three meals a day, while the rest either ate twice a day or anytime they were hungry. Seventy-three per cent of the respondents also increased their food intake during pregnancy. Foods eaten were based mainly on starchy roots and tubers, cereals and vegetables. Legumes, oilseeds and fruits were often lacking in the main meals of respondents. Although animal products were consumed daily, the quantities taken were very small to provide for adequate protein, especially in the rural area. Various types of food were avoided by some of the expectant mothers for reasons such as nausea, loss of appetite, taboos and superstition. With regard to dietary quality, respondents from the rural area had diets of poorer quality in terms of nutrient intake compared with those from the suburban area. In both communities, iron contents of diets were quite low. Forty-seven per cent of the women interviewed were anaemic, with a higher prevalence of anaemia being observed in the rural community. Common ailments reported by the women were dizziness, headache, waist pains and malaria. Based on the results of the study, it was recommended that nutrition education for pregnant women should be stepped up at antenatal clinics especially in rural areas. [source] A Study of the Utilization Patterns of an Elementary School,Based Health Clinic Over a 5-Year PeriodJOURNAL OF SCHOOL HEALTH, Issue 7 2006Veda Johnson It involved a retrospective analysis of computer-based data for all patient visits during this study period. Results revealed high clinic utilization with an average of over 5 encounters for all users each year. The most frequent encounters by diagnostic category were respiratory followed by health supervision, skin disorders, and symptoms. There were no significant differences in most diagnostic categories in the number of patient encounters between the first and last year. There was a significant decrease in encounters for the categories of ear and injuries and poisonings and an increase in encounters for emotional conditions between the first and last year. A separate analysis of the encounter frequencies for users with chronic illnesses and emotional problems found the average number of encounters for users with chronic illnesses to be unpredictably less than for all users and for those with emotional or mental health diagnoses the encounters were considerably higher. Finally, an analysis of clinic users by insurance types revealed an unvarying distribution over of the study period. (J Sch Health. 2006;76(7):373-378) [source] Student-Run Health Clinic: Novel Arena to Educate Medical Students on Systems-Based PracticeMOUNT SINAI JOURNAL OF MEDICINE: A JOURNAL OF PERSONALIZED AND TRANSLATIONAL MEDICINE, Issue 4 2009Yasmin S. Meah MD Abstract In recent decades, the United States has experienced substantial growth in the number of student-run clinics for the indigent. Today, over 49 medical schools across the country operate over 110 student-run outreach clinics that provide primary care services to the poor and uninsured. Despite this development, little research has been published on the educational value of such student-led endeavors. Although much has been surmised, no general methodology for categorizing the learning experience in these clinics has been established. This article represents the first literature review of the novel method of educating students through the operation of a clinic for the underserved. It highlights the student-run clinic as a unique enhancement of medical education that may supplant current curricular arenas in teaching students about systems-based practice principles such as cost containment and financing, resource allocation, interdisciplinary collaboration, patient advocacy, and monitoring and delivery of quality care. The novelty of the student-run clinic is that students place themselves at the forefront of problem solving and system navigation to effectively care for severely disadvantaged populations. This article underscores the student-run clinic as a potentially ideal experiential learning method for preparing young physicians to confront a US healthcare system currently facing crises in cost, quality of care, and high rates of uninsurance. The article stresses the need for outcomes research on the long-term effectiveness of the student-run clinic experience in affecting medical student practice behaviors and attitudes in patient care settings that extend beyond the student-run clinic. Mt Sinai J Med 76:344,356, 2009. © 2008 Mount Sinai School of Medicine [source] A multidisciplinary primary healthcare clinic for newly arrived humanitarian entrants in regional NSW: model of service delivery and summary of preliminary findingsAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2010Gillian Gould Abstract Objective: To describe a multidisciplinary primary healthcare clinic for newly arrived humanitarian entrants in regional New South Wales and report health problems and issues encountered during the initial period of operation. Methods: A quality assurance study of the Coffs Harbour Refugee Health Clinic (a collaboration between the Area Health Service and general practitioners) was undertaken from February to December 2006. Results: Seventy-six patients received a comprehensive health assessment: 69 of these within 12 months of arrival. The median time from arrival in Australia to the first clinic visit was five days. Problems detected were categorised according to their management options. GP clinic providers expressed concern about referring patients to GPs in the community for ongoing care. Conclusions: The Coffs Harbour Refugee Health Clinic represents a successful collaboration between relevant stakeholders. It was well utilised by the target community. Implications: The service delivery model used in the clinic could be replicated in other areas in regional Australia, provided financial and human resources are available. [source] Atraumatic Restorative Treatment and Dental Anxiety in Outpatients Attending Public Oral Health Clinics in South AfricaJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 3 2007Steffen Mickenautsch BDS Abstract Objectives: This study was undertaken to test the hypotheses that using the atraumatic restorative treatment (ART) approach results in lower patient anxiety and that lower anxiety leads to higher restoration/extraction ratios. Methods: The test group of dental operators (n=9) was trained in ART. The control group (n=11) was not, and did not apply ART. The Short Form of the Dental Subscale of the Children's Fear Survey Schedule (CFSS-SF) and Corah's Dental Anxiety Scale (DAS) were used to assess patient anxiety after ART (test group) and after traditional restorations (control group). The restoration/extraction ratio calculated for primary (children) and permanent dentitions (adults) per operator was based on 12-month treatment statistics. Dental anxiety assessments were analysed using ANOVA. Differences were compared using the t -test and corrected for confounding factors (ANCOVA). The Pearson correlation coefficient was used to measure the correlation between dental anxiety levels and restoration/extraction ratios. Results: The mean CFSS-SF score for test-group children was statistically significantly lower than for the control-group children. The mean DAS score for test-group adults was statistically significant lower than the control. No significant correlation was observed between dental anxiety level and restoration/extraction ratio per operator for both dentitions in both groups. Conclusion: The first hypothesis was accepted; the second, rejected. Although dental anxiety scores were lower both in child and in adult patients treated by ART than in those who received traditional restorative treatments, this positive effect had not resulted in higher restoration/extraction ratios. [source] An open-label trial of enhanced brief interpersonal psychotherapy in depressed mothers whose children are receiving psychiatric treatment,,DEPRESSION AND ANXIETY, Issue 7 2006Holly A. Swartz M.D. Abstract Major depression affects one out of five women during her lifetime. Depressed mothers with psychiatrically ill children represent an especially vulnerable population. Challenged by the demands of caring for ill children, these mothers often put their own needs last; consequently, their depressions remain untreated. This population is especially difficult to engage in treatment. We have developed a nine-session intervention, an engagement session followed by eight sessions of brief interpersonal psychotherapy designed to increase maternal participation in their own psychotherapy, resolve symptoms of maternal depression, and enhance relationships (IPT-MOMS). This open-label trial assesses the feasibility and acceptability of providing this treatment to depressed mothers. Thirteen mothers meeting DSM-IV criteria for major depression were recruited from a pediatric mental health clinic where their school-age children were receiving psychiatric treatment. Subjects (mothers) were treated openly with IPT-MOMS. Eighty-five percent (11/13) completed the study. Subjects were evaluated with the Hamilton Rating Scale for Depression, and completed self-report measures of quality of life and functioning at three time points: baseline, after treatment completion, and 6-months posttreatment. A signed rank test was used to compare measurement changes between assessment time points. Subjects showed significant improvement from baseline to posttreatment on measures of maternal symptoms and functioning. These gains were maintained at 6-month follow-up. Therapy was well tolerated and accepted by depressed mothers, who are typically difficult to engage in treatment. A high proportion of subjects completed treatment and experienced improvements in functioning. Future randomized clinical trials are needed to establish the efficacy of this approach. Depression and Anxiety 23:398,404, 2006. Published 2006 Wiley-Liss, Inc. [source] Expectations of the child health nurse in Sweden: two perspectivesINTERNATIONAL NURSING REVIEW, Issue 2 2003A. Fägerskiöld MScN Abstract Background: the child health service exists to support and stimulate parents in order to reduce stress and to encourage an advantageous development of the preschool child. Aim: To explore and describe similarities and differences in expectations of the child health nurse, from the perspective of the recently delivered first-time mother, as compared to an expression of what the child health nurse believed mothers of infants expected of them. The data consisted of 15 interviews with child health nurses and 20 interviews with first-time mothers. Thematic content analysis resulted in seven categories of expectations. The child health nurse was expected to be someone to approach, who could assess the child's development and give immunizations and to be a supporter, counsellor, safety provider and a parent group organizer with knowledge. Similarities between the mothers' and the nurses' statements occurred more frequently than differences, which is suggested to depend on the Swedish tradition among new mothers of visiting the child health clinic. The mothers expected participation in parent groups to a higher degree than the nurses thought they did. Child health nurses who fulfil the mothers' expectations appear to require a good relationship with the mother in order to find out what she desires, which the allocation of sufficient time for regular meetings, will facilitate. Moreover, the nurse requires knowledge about children's requirements and the transition to motherhood as well as the father's important role. [source] Nurse practitioner,client interaction as resource exchange in a women's health clinic: an exploratory studyJOURNAL OF CLINICAL NURSING, Issue 5 2003Rebecca K. Donohue PhD Summary ,,Empirical research has thoroughly documented the success of nurse practitioners (NPs) in terms of patient satisfaction and cost-effectiveness. What is missing is the in-depth knowledge of the interactive process through which this is accomplished during a clinic visit. ,,The aim of this study was to understand the special nature and processes of NP and client encounters in the ambulatory primary care context using a resource exchange perspective. ,,An exploratory descriptive design was used to address the following research questions: (i) What do midlife female clients expect in terms of resources to be exchanged prior to a visit with a NP in an ambulatory clinic visit? (ii) What resources are actually exchanged during the clinic visit? (iii) To what extent is there congruence between a woman's expectations and what she is actually receiving from the clinic visit in terms of resources exchanged? ,,The participants included two women health NPs and eight midlife female clients. ,,Data for the study were comprised of audiotaped pre- and postencounter interviews with the clients, audiotapes of the entire clinic visits with the NP and field notes recorded by the researcher of the client visits. Content analysis was conducted using ETHNOGRAPH software. ,,Findings indicated that clients of both NPs had surprisingly similar expectations of receipt of services as well as actual receipt of services. Resources expected and received from the visits included some combination of services, health information, trust, self-disclosure, support, affirmation, time, acceptance and respect. ,,Results of this study suggest that resource exchange theoretical formulations can be applied to NP,client interactions to understand and explain the specific nature of resources the clients expect and receive from a NP during a woman's health clinic visit. [source] Role of gender in depressive disorder outcome for individual and group cognitive,behavioral treatment,JOURNAL OF CLINICAL PSYCHOLOGY, Issue 12 2008Hunna J. Watson Abstract Gender in cognitive,behavioral therapy (CBT) for outcome for depression has been inadequately examined in previous research. Thirty-five men and 55 women diagnosed with a depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994) completed individual CBT at an outpatient community mental health clinic and 56 men and 105 women completed group CBT. Depression severity was measured before treatment and at endpoint using the Beck Depression Inventory-II (Beck, Steer, & Brown, 1996) along with secondary outcomes of anxiety (Beck Anxiety Inventory; Beck, Epstein, Brown, & Steer, 1988) and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire; Endicott, Nee, Harrison, & Blumenthal, 1993). Men and women demonstrated equivalent pretreatment and posttreatment illness severity, a comparable gradient of improvement on outcomes, and attainment of clinically meaningful benchmarks. © 2008 Wiley Periodicals, Inc. J Clin Psychol 64:1,15, 2008. [source] Nurses , psychiatrists' main collaborators when treating women with postpartum psychosisJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 6 2010I. ENGQVIST rn ms Accessible summary ,The paper describes Swedish psychiatrists' experiences of collaboration with healthcare professionals when treating women with postpartum psychosis (PPP). ,,A qualitative design was used, and semi-structured interviews were performed with nine psychiatrists working in psychiatric hospitals in Sweden. ,,This result was identified: collaboration related to admission, collaboration during inpatient care and collaboration related to discharge. Collaboration with midwives and obstetricians was important in diagnosing the illness, as this often occurred on postnatal wards. Decisions about the form of care for the woman with PPP and for her baby demanded collaboration with various healthcare professionals. Collaboration with nurses was based on expectations and confidence in nurses' competence, and was very important during inpatient care. When the woman was to be discharged, collaboration with healthcare teams as outpatient clinic, child health clinic and community services, was required. ,,The conclusion was that psychiatrists collaborate with different professionals in the different parts of the caring process. When caring for women with PPP, they considered nurses to be their most important collaborators and relied on their competence. Abstract The focus was to describe Swedish psychiatrists' experiences of collaboration with healthcare professionals when treating women with postpartum psychosis (PPP). A qualitative design was used, and semi-structured interviews were performed with nine psychiatrists working in psychiatric hospitals in Sweden. Data were analysed using manifest and latent content analysis. The results of these experiences were categorized in this study as: collaboration related to admission, collaboration during inpatient care and collaboration related to discharge. Collaboration with midwives and obstetricians was important in diagnosing the illness, as this often occurred on postnatal wards; and decisions about the form of care for the woman with PPP and for her baby demanded collaboration with various healthcare professionals. Collaboration with nurses was based on expectations and confidence in nurses' competence, and was exceedingly important during inpatient care. When the woman was to be discharged, collaboration with healthcare teams, e.g. outpatient clinic, child health clinic and community services, was required. The conclusions were that psychiatrists collaborate with different professionals in the various phases of the caring process. They rely extensively on nurses' competence when caring for women with PPP, and consider nurses to be their most important collaborators. [source] Validity of the Alcohol Use Disorders Identification Test in College StudentsALCOHOLISM, Issue 6 2004Patricia K. Kokotailo Background: High-risk alcohol use among college students is associated with accidents, partner violence, unwanted sexual encounters, tobacco use, and performance issues. The identification and treatment of high-risk drinking students is a priority for many college campuses and college health centers. The goal of this study was to test the psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT) in college students. Methods: A convenience sample of students coming into a college health clinic was asked to complete the 10-question AUDIT and then participate in a research interview. The interview focused on assessing students for alcohol abuse and dependence by using the Composite International Diagnostic Interview Substance Abuse Module and timeline follow-back procedures to assess a 28-day drinking history. Results: A total of 302 students met the eligibility criteria and agreed to participate in the study. The sample consisted of 185 females (61%) and 117 males (39%), with a mean age of 20.3 years. Forty students were abstinent, 88 were high-risk drinkers, and 103 met criteria for a 12-month history of dependence. Receiver operator curves demonstrated that the AUDIT had the highest area under the cure for detecting high-risk alcohol use (0.872) and the lowest for identifying persons with a lifetime history of alcohol abuse or dependence (0.775). An AUDIT cutoff score of 6 or greater demonstrated a sensitivity of 91.0% and a specificity of 60.0% in the detection of high-risk drinkers. Conclusions: The AUDIT has reasonable psychometric properties in sample of college students using student health services. This study supports the use of the AUDIT in this population. [source] Mobile Crisis Team Intervention to Enhance Linkage of Discharged Suicidal Emergency Department Patients to Outpatient Psychiatric Services: A Randomized Controlled TrialACADEMIC EMERGENCY MEDICINE, Issue 1 2010Glenn W. Currier MD Abstract Objectives:, Many suicidal patients treated and released from emergency departments (ED) fail to follow through with subsequent outpatient psychiatric appointments, often presenting back for repeat ED services. Thus, the authors sought to determine whether a mobile crisis team (MCT) intervention would be more effective than standard referral to a hospital-based clinic as a means of establishing near-term clinical contact after ED discharge. This objective was based on the premise that increased attendance at the first outpatient mental health appointment would initiate an ongoing treatment course, with subsequent differential improvements in psychiatric symptoms and functioning for patients successfully linked to care. Methods:, In a rater-blinded, randomized controlled trial, 120 participants who were evaluated for suicidal thoughts, plans, or behaviors, and who were subsequently discharged from an urban ED, were randomized to follow-up either in the community via a MCT or at an outpatient mental health clinic (OPC). Both MCTs and OPCs offered the same structured array of clinical services and referral options. Results:, Successful first clinical contact after ED discharge (here described as "linkage" to care) occurred in 39 of 56 (69.6%) participants randomized to the MCT versus 19 of 64 (29.6%) to the OPC (relative risk = 2.35, 95% CI = 1.55,3.56, p < 0.001). However, we detected no significant differences between groups using intention-to-treat analyses in symptom or functional outcome measures, at either 2 weeks or 3 months after enrollment. We also found no significant differences in outcomes between participants who did attend their first prescribed appointment via MCT or OPC versus those who did not. However divided (MCT vs. OPC, present at first appointment vs. no show), groups showed significant improvements but maintained clinically significant levels of dysfunction and continued to rely on ED services at a similar rate in the 6 months after study enrollment. Conclusions:, Community-based mobile outreach was a highly effective method of contacting suicidal patients who were discharged from the ED. However, establishing initial postdischarge contact in the community versus the clinic did not prove more effective at enhancing symptomatic or functional outcomes, nor did successful linkage with outpatient psychiatric care. Overall, participants showed some improvement shortly after ED discharge regardless of outpatient clinical contact, but nonetheless remained significantly symptomatic and at risk for repeated ED presentations. ACADEMIC EMERGENCY MEDICINE 2010; 17:36,43 © 2009 by the Society for Academic Emergency Medicine [source] Rabies Antibody Seroprotection Rates Among Travelers in Nepal: "Rabies Seroprotection in Travelers"JOURNAL OF TRAVEL MEDICINE, Issue 6 2006Megan Ranney MD Background Rabies preexposure immunization is recommended for international travelers who are at risk for exposure to rabid animals, especially in areas where postexposure treatment may be limited. Rabies antibody seroprotection rates among international travelers has not been previously investigated. Objective To assess preexisting rabies seroprotection among travelers presenting to a health clinic in Nepal. Methods A prospective convenience sample of international travelers evaluated at a health center in Kathmandu, Nepal during a 2-month period. Subjects were eligible for inclusion if they had received rabies preexposure vaccination within the previous 5 years. Demographic information and vaccination records of rabies preexposure prophylaxis were obtained. Consenting subjects provided serum for rabies antibody measurement measured using the rapid fluorescent focus inhibition test. A dilution greater than or equal to 1:5 (0.5 IU/mL) was considered positive. Data were analyzed using chi-squares and two-sample t -tests with unequal variances. Results A total of 43 patients consented to enroll. Complete data were available for 38 patients. Subjects had received human diploid cell vaccine (HDCV) or purified Vero cell rabies vaccine (PVRV) vaccine, either via the intradermal or intramuscular route. All patients had adequate antibody titers except one, who had a titer below 0.5 IU/mL. There was no statistically significant relationship between antibody titer and type of vaccine, route of administration, time since vaccination, number of vaccinations, or patient age. Conclusions Among 38 travelers to Nepal who had received documented preexposure rabies HDCV or PVRV vaccination series, 37 demonstrated adequate titers of ,0.5 IU/mL and would be considered boostable if exposed to rabies virus. One traveler had a titer of <0.5 IU/mL. Type of vaccine, method of administration, number of vaccinations, and time since vaccination did not influence rabies antibody titer. Rabies vaccination with HDCV and PVRV vaccine was effective in stimulating adequate seroprotection in this sample of travelers. [source] Improvement of Chronic Pain by Treatment of Erectile DysfunctionTHE JOURNAL OF SEXUAL MEDICINE, Issue 12 2008Jalil Arabkheradmand MD ABSTRACT Introduction., Pain specialists, who do not routinely examine patients regarding their sexual medicine problems, need to be aware that sexual problems can and do aggravate the patient's pain. Patients may refuse to admit suffering from erectile dysfunction (ED) but complain about continuous or progressive severe pain. These patients may be best managed by the combined team effort of a sexual medicine specialist and pain specialist. Aim., This report documents the management of three cases with long-term intractable pain after severe trauma. Treatment of occult ED led to significant improvement of their pain. Main Outcome Measures., The association of the treatment of uncovered ED and improvement of chronic severe pain. Methods., Three case reports of patients with severe pain who attended a pain clinic in an academic medical center. Results., Three men suffering from chronic pain due to severe trauma were observed for several years by different physicians as well as pain specialists. In spite of different treatments, including administration of several analgesics, psychotherapy, and physical therapy, pain was not alleviated. After finding ED problems, patients were referred to the family health clinic. Using different therapies such as psychosexual therapy, correction of sexual misconceptions, relaxation training, treatment of interpersonal difficulties, and pharmacological intervention ED was cured. Treatment of ED was accompanied by a significant reduction of chronic pain in all three patients. Conclusion., The present report indicates that uncovered ED in patients suffering from chronic pain may trigger their somatic pain or reduce its threshold. Significant improvement in sexual functioning may improve the pain and reduce its complications. Arabkheradmand J, Foroutan SK, Ranjbar S, Abbasi T, Hessami S, and Gorji A. Improvement of chronic pain by treatment of erectile dysfunction. J Sex Med **;**:**,**. [source] Sexual behaviour and diagnosis of people over the age of 50 attending a sexual health clinicAUSTRALASIAN JOURNAL ON AGEING, Issue 1 2009Chris Bourne Objectives:,To investigate the sexual health and behaviour of older Australians attending a sexual health clinic. Methods:,A retrospective patient record of people aged 50 years and over attending the clinic. Results:,2438 people aged 50 years and over attending. The main reasons for attending were assessment of genital symptoms (40%), testing for sexually transmitted infections (STIs) (23%), and HIV testing/care (13%); more than 50% of the clients had a previous sexual health problem and more than 50% had not been tested for HIV. Men reported more lifetime sexual partners than women and were significantly more likely to report using condoms (P < 0.05), although condom use was variable. Genital herpes (10% women, 6% men) and non-gonococcal urethritis (9% men) were the most commonly diagnosed STIs. Conclusions:,High levels of unsafe sex and many important sexual health problems were identified which provide direction for public health interventions for older sexually active Australians. [source] 14 The Use of Medical Simulation to Enhance the Clinical Exposure to International Emergency MedicineACADEMIC EMERGENCY MEDICINE, Issue 2008David Bouslough Study Objectives:, Increasing numbers of immigrants and returned travelers use emergency departments for health care. Many physicians-in-training are interested in participating in health electives abroad, yet residency curricula generally address global health inadequately. Advanced medical simulation (SIM) is an educational modality used to artificially re-create clinical experiences. Authors explored the application of SIM and standardized patient encounters to teach emergency medicine residents select topics in tropical medicine, public health, and decision-making in varied-resource settings. Methods:, International Emergency Medicine (IEM) faculty created four case scenarios interspersed into the established residency simulation curriculum. Moulaged manikins and standardized patients in immersive IEM clinical settings provided history and physical exam cues to learners during the following clinical encounters: - "Tent-side" mobile clinic, East Africa: "Dizzy" pregnant patient (Hookworm). - Rural health clinic, Southeast Asia: Infant with "altered mental status" (Dengue). - Emergency department, North America: Central American immigrant with "dyspnea" (Chagas). - Emergency department, North America: Returned traveler from East Africa with "fever" (Typhoid). Post-scenario debriefings addressed unique elements of IEM including [source] Building our global family , achieving treatment for allHAEMOPHILIA, Issue 2010M. W. SKINNER Summary., Building our global family by reaching out to women, children and youth and those in sub-Saharan Africa to achieve Treatment for All. The World Federation of Hemophilia (WFH) has committed to recognizing and incorporating the critical and important challenges that are faced by women with bleeding disorders within our global family. The next crucial steps include the development of outreach and registry programmes which can be adapted globally to accelerate the identification of such women, and to educate and guide them to the appropriate clinical care setting. Equally important, awareness must be raised within the broader medical community where women would typically first present with clinical symptoms. Family practitioners, nurse-midwives, obstetricians, gynaecologists and community health clinics will increasingly be strategic and central to WFH outreach efforts, in addition to serving as new care partners essential to the multidisciplinary model of care. Adapting and implementing the WFH development model regionally within Africa is proving to be a successful approach both for the introduction as well as the development of sustainable national care programmes for patients with bleeding disorders. The targeted development of solid national programmes such as in South Africa, Senegal and Kenya has expanded the training capacity of the WFH, as well as providing key regional examples. Local medical professionals are now responsible for providing the training in many regional programmes. Children with bleeding disorders in low-income countries are at great risk of dying young. WFH data demonstrate that among such patients, as the economic capacity of a country decreases so does the ratio of adults to children. The organization of care, training of a multi-disciplinary healthcare team, and education of patients and their families lead to improved mortality independent of economic capacity or increased clotting factor concentrate availability. Additionally, through enhanced youth education, awareness and engagement, we will assure continuity within WFH national member organizations, build greater unity within our global family and capture the innovation and creativity of their ideas to improve Treatment for All. [source] Guided self-help supported by paraprofessional mental health workers: an uncontrolled before,after cohort studyHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2009Paul Farrand Senior Lecturer in Health Psychology Abstract There has been considerable development of guided self-help clinics within primary care. This uncontrolled before,after cohort study examines efficiency and effectiveness of these clinics when supported by paraprofessional mental health workers having little mental health training and experience. Data were collected by seven Graduate Mental Health Workers (GMHW) located in South-west England. Alongside an analysis of clinic attendance and dropout, efficiency was measured with respect to the number and length of sessions to support patients with the effectiveness of the interventions examined with respect to problem severity. Over a 15-month period, 1162 patients were referred to the GMHW clinics with 658 adopting guided self-help. Patients using guided self-help received an average input per patient, excluding assessment, of four sessions of 40 minutes. Dropout rate was comparable to other primary-care-based mental health clinics supported by experienced mental health professionals with 458 patients completing all support sessions. However, only 233 patients went on to attend the 3 months of follow-up session. Effectiveness of guided self-help clinics supported by paraprofessional mental health workers was comparable to that supported by an experienced mental health nurse. Improvements in problem severity were statistically significant, with 55% and 58% (final support session) and 63% and 62% (3 months of follow-up) of patients experiencing clinically significant and reliable change for anxiety and depression, respectively. However, concerns exist over the efficiency of the GMHW clinic especially with respect to the use of longer support sessions and high dropout rate at the 3 months of follow-up session. The paper concludes by highlighting the effectiveness of guided self-help when supported by paraprofessional mental health workers, but questions the utility of the two-plus-one model of service delivery proposing a collaborative care approach as an alternative. [source] Exploring the implications for health professionals of men coming out as gay in healthcare settingsHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2006Bob Cant MA Abstract Coming out as gay is a social process which redefines the relationship between the persons who have decided to disclose their homosexuality and their listeners. This paper, drawing upon Bakhtin's (1984) theories of dialogue, the coming-out literature of gay men and lesbians and contemporary literature on doctor,patient communication, explores the coming-out experiences of gay men with their general practitioners and sexual health clinic staff. The findings are based upon a study of 38 gay men and 12 health service managers in London. The informants were recruited purposively to reflect some of the diversity of the London setting; recruitment was carried out through the channels of gay voluntary organisations and through snowballing. Semi-structured interviews were conducted and a grounded-theory approach was adopted. It was found that coming out in general practice was often/mostly followed by silence/noncommunication on the part of the practitioner; coming out could, however, result in an improvement in communication if the patients were well supported and assertive. If coming out in sexual health clinics did not result in improved communication, the informants in this study were likely to change clinics until they did find improved communication. This paper raises questions about the communication and training needs of general practitioners. It also raises questions about inequalities of access to ,respectful' sexual health clinics; while men who are articulate about the narratives of their lives as gay men are able to exercise informed choices, there were grounds for concern about the choice behaviours of men who are less articulate about their life narratives. [source] Comparison of haemoglobinometry by WHO Haemoglobin Colour Scale and copper sulphate against haemiglobincyanide reference methodINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 4 2004I. S. Timan Summary Although estimation of haemoglobin is essential for diagnosing anaemia and assessing its severity, many health centres in developing countries do not have the facilities for haemoglobinometry. The WHO Haemoglobin Colour Scale (HCS) method is a simple and inexpensive clinical device that was recently developed in order to diagnose anaemia in such centres. In Indonesia, the copper sulphate specific gravity method is used for blood donor screening and also in primary health clinics in the rural and remote areas. In this study, the HCS method is compared with the copper sulphate method and with an earlier paper scale, the Tallquist method, against the standard haemiglobincyanide spectrophotometric method. The HCS method showed an acceptable level of precision and accuracy for use as a reliable screening tool to diagnose anaemia in patients and also for blood donor screening. [source] Health providers' perceptions of adolescent sexual and reproductive health care in SwazilandINTERNATIONAL NURSING REVIEW, Issue 2 2008P.T. Mngadi srn/m, bed nursing, dipl. reproductive health Aim:, To explore health providers' perceptions of adolescent sexual and reproductive healthcare services in Swaziland. Methods:, Fifty-six healthcare providers, working in 11 health clinics in Swaziland in 2005, were surveyed using a semi-structured questionnaire. The data were analysed by descriptive statistics and content analysis to identify key themes. Findings:, Most participants were women with a mean age of 36 years and a mean number of 6 years in the profession. Services provided included STIs/HIV/AIDS advice, pre- and post-test counselling and testing on HIV, contraceptives and condom use. Half of the nurses/midwives had no continued education and lacked supervision on adolescent sexual and reproductive health care. The majority had unresolved moral doubts, negative attitudes, values and ethical dilemmas towards abortion care between the law, which is against abortion, and the reality of the adolescents' situation. Forty-four wanted to be trained on post-abortion care while eight on how to perform abortions. Twenty-six wanted the government to support adolescent-friendly services and to train heathcare providers in adolescent sexual and reproductive health services. Conclusion:, The curricula within nursing and midwifery preservice education need to be reviewed to incorporate comprehensive services for adolescents. There is need for provision of comprehensive services for adolescents in Swaziland and appropriate youth-friendly services at all levels. There is need for nurse/midwifery participation, advocacy and leadership in policy development. [source] The art of public health nursing: using confession technè in the sexual health domainJOURNAL OF ADVANCED NURSING, Issue 4 2006Dave Holmes PhD RN Aim., This paper explores the sexual health interview from a critical perspective, and to demonstrate how the confession ritual involved in this interview is implicated in the construction of subjectivities (meaning identities) as well as in fostering self-surveillance (self-regulation). Background., The concept of public health depends primarily on several surveillance tools that monitor both the incidence and prevalence rates of certain diseases. Within the subgroup of infectious diseases, sexually transmitted infections comprise a group that is closely monitored. As a result, surveillance techniques, including policing sexual practices, are part of the public health worker's mandate. Method., Using a Foucauldian perspective, we demonstrate that confession is a political technology in the sexual health domain. Findings., As one group of frontline workers in the field of sexual health, nurses are responsible for data collection through methods such as interviewing clients. Nurses play an integral role in the sexual health experience of clients as well as in the construction of the client's subjectivity. We strongly believe that a Foucauldian perspective could be useful in explaining certain current client behavioural trends (for example, an avoidance by at-risk groups of interactions with nurses in sexual health clinics) being observed in sexual health clinics across the Western hemisphere. Conclusion., Clinicians need to be aware of the confessional nature of their questions and provide requested services rather than impose services that they determine to be important and relevant. By appreciating that the sexual health interview is an invasive and embarrassing sexual confession, healthcare providers and policy-makers may be better able to design and implement more user-oriented, population-sensitive sexual health services. [source] Genetic Testing, Genetic Information, and the Role of Maternal-Child Health Nurses in IsraelJOURNAL OF NURSING SCHOLARSHIP, Issue 3 2006Sivia Barnoy Purpose: To examine the rate of genetic testing, the characteristics of those who had these tests, and to examine the public's openness to the possibility of expanding nurses' roles in maternal-child health (MCH) clinics to include providing genetic information. Design: The study was conducted in nine MCH clinics in the central district of Israel. All women attending the clinics during 1 week were requested to complete the questionnaire. The sample consisted of 361 participants. Findings: A high rate of genetic testing (80.4%) was shown. Higher education, being secular, and native-born Israeli predicted testing performance. Half of the tested participants reported that they did not understand the test results and were interested in receiving explanations regarding these results. Forty-four percent of respondents were interested in receiving genetic information from an MCH nurse. Conclusions: A high rate of genetic testing performance was reported. The public reported lack of information regarding genetic tests and their results. An appropriate setting for providing this information is the maternal-child health clinics. [source] Extreme College Drinking and Alcohol-Related Injury RiskALCOHOLISM, Issue 9 2009Marlon P. Mundt Background:, Despite the enormous burden of alcohol-related injuries, the direct connection between college drinking and physical injury has not been well understood. The goal of this study was to assess the connection between alcohol consumption levels and college alcohol-related injury risk. Methods:, A total of 12,900 college students seeking routine care in 5 college health clinics completed a general Health Screening Survey. Of these, 2,090 students exceeded at-risk alcohol use levels and participated in a face-to-face interview to determine eligibility for a brief alcohol intervention trial. The eligibility interview assessed past 28-day alcohol use and alcohol-related injuries in the past 6 months. Risk of alcohol-related injury was compared across daily drinking quantities and frequencies. Logistic regression analysis and the Bayesian Information Criterion were applied to compute the odds of alcohol-related injury based on daily drinking totals after adjusting for age, race, site, body weight, and sensation seeking. Results:, Male college students in the study were 19% more likely (95% CI: 1.12,1.26) to suffer an alcohol-related injury with each additional day of consuming 8 or more drinks. Injury risks among males increased marginally with each day of consuming 5 to 7 drinks (odds ratio = 1.03, 95% CI: 0.94,1.13). Female participants were 10% more likely (95% CI: 1.04,1.16) to suffer an alcohol-related injury with each additional day of drinking 5 or more drinks. Males (OR = 1.69, 95% CI: 1.14,2.50) and females (OR = 1.81, 95% CI: 1.27,2.57) with higher sensation-seeking scores were more likely to suffer alcohol-related injuries. Conclusions:, College health clinics may want to focus limited alcohol injury prevention resources on students who frequently engage in extreme drinking, defined in this study as 8+M/5+F drinks per day, and score high on sensation-seeking disposition. [source] Travel Agents and the Prevention of Health Problems among Travelers in QuébecJOURNAL OF TRAVEL MEDICINE, Issue 1 2002Sylvie Provost Background: Among the factors influencing travelers to seek preventive health advice before departure, the travel agent's recommendation plays an important role. The objective of our study was to document the practices and needs of travel agents in Québec (Canada) in relation to the prevention of health problems among travelers. Methods: In June 2000, a cross-sectional descriptive survey was carried out among travel agents from all travel agencies in Québec. One agent per agency was asked to answer our questions. Data were collected using a 32-item telephone questionnaire. Results: Altogether, 708 travel agents from the 948 agencies contacted answered our questionnaire (participation rate: 75%). Most respondents (81%) believed that the travel agent has a role to play in the prevention of health problems among travelers, especially to recommend that travelers consult a travel clinic before departure. Although over 80% of the agents interviewed mentioned recommending a visit to a travel clinic before an organized tour to Thailand or a backpacking trip in Mexico, less than half said they make the same recommendation for a stay in a seaside resort in Mexico. The majority of respondents were acquainted with the services offered in travel health clinics, and these clinics were the source of travel health information most often mentioned by travel agents. However, nearly 60% of the agents questioned had never personally consulted a travel clinic. When asked about the best way to receive information about travelers' health, more than 40% of respondents favoured receiving information newsletters from public health departments regularly whereas 28% preferred the Internet. Conclusion: Despite the limits of this study, our results should help the public health network better target its interventions aimed to inform travel agents on prevention of health problems among travelers. [source] The anatomy of a forbidden desire: men, penetration and semen exchangeNURSING INQUIRY, Issue 1 2005Dave Holmes The rising popularity of unprotected anal sex (bareback sex) among men who have sex with men (MSM) is perplexing healthcare providers working in sexual health clinics. Epidemiological research on the topic overlooks several socio-cultural and psychological dimensions. Our research attempts to construct an appropriate theoretical edifice by which we can understand this sexual practice. In order to achieve this objective, a qualitative design was selected and 18 semiconductive in-depth interviews were carried out with barebackers from five European and North American cities. We then analyzed the data using two theoretical approaches that were sensitive to the issues of desire, transgression and pleasure. These theories are those of the late French psychoanalyst, Jacques Lacan, and those of poststructural thinkers, Gilles Deleuze and Felix Guattari. These theoretical frameworks helped shed light on the significance of bareback sex, and can potentially influence healthcare providers in gaining a better understanding not only of their clients, but also of their own role in the circuitry of desire at work within bareback. We found that while the exchange of semen constitutes a dangerous and irrational practice to healthcare professionals, it is nevertheless a significant variable in the sexual lives of barebackers that needs to be taken into consideration in the provision of healthcare services. [source] Social Optimal Location of Facilities with Fixed Servers, Stochastic Demand, and CongestionPRODUCTION AND OPERATIONS MANAGEMENT, Issue 6 2009Ignacio Castillo We consider two capacity choice scenarios for the optimal location of facilities with fixed servers, stochastic demand, and congestion. Motivating applications include virtual call centers, consisting of geographically dispersed centers, walk-in health clinics, motor vehicle inspection stations, automobile emissions testing stations, and internal service systems. The choice of locations for such facilities influences both the travel cost and waiting times of users. In contrast to most previous research, we explicitly embed both customer travel/connection and delay costs in the objective function and solve the location,allocation problem and choose facility capacities simultaneously. The choice of capacity for a facility that is viewed as a queueing system with Poisson arrivals and exponential service times could mean choosing a service rate for the servers (Scenario 1) or choosing the number of servers (Scenario 2). We express the optimal service rate in closed form in Scenario 1 and the (asymptotically) optimal number of servers in closed form in Scenario 2. This allows us to eliminate both the number of servers and the service rates from the optimization problems, leading to tractable mixed-integer nonlinear programs. Our computational results show that both problems can be solved efficiently using a Lagrangian relaxation optimization procedure. [source] Public Health Rural Health Priorities in America: Where You Stand Depends on Where You SitTHE JOURNAL OF RURAL HEALTH, Issue 3 2003Larry Gamm PhD Methods: Analysis of responses to a mail survey sent to 999 rural health leaders, with 501 responses. Respondents were asked to rank importance to rural health of focus areas named in Healthy People 2010 Findings: There was substantial agreement on top rural health priorities among state and local rural health leaders across the 50 states. "Access to quality health services" was the top priority among leaders of state-level rural agencies and health associations, local rural public health agencies, rural health clinics and community health centers, and rural hospitals. It was the top priority across all 4 major census regions of the nation as well. The next 4 top-ranking rural priorities,"heart disease and stroke,""diabetes,""mental health and mental disorders," and "oral health",were selected as 1 of the top 5 rural priorities by one third or more of respondents across most groups and regions. At the same time, some observed differences in rural health priorities suggest opportunities for community partnership strategies or for regional multistate policy initiatives by states sharing similar rural health priorities. [source] Comparison of a self-administered tampon ThinPrep test with conventional pap smears for cervical cytologyAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2005Mardi BUDGE Abstract Aim: To assess a self-administered tampon specimen as an alternative method of detecting cytological abnormalities and its acceptability in comparison with a conventional Papanicolou (pap) smear. Design: Comparative observational study. Setting/population: Two hundred and seventeen women were recruited from the colposcopy clinic of an outer urban public teaching hospital and from sexual health clinics at suburban and major metropolitan hospital clinics. Methods: Participants inserted and immediately withdrew a tampon, then placed it into a vial of ThinPrep PreservCyt fluid. This was analysed by a local private pathology laboratory. Results were compared to a pap smear performed the same day or within the previous 6 months. All women with an abnormal result (tampon or pap smear) underwent a colposcopy, with or without biopsy as necessary. Participants completed a questionnaire after performing the tampon test. Outcome measures: Probabilities of tampon test detecting (i) a high grade abnormality (pHG), (ii) any cervical intraepithelial neoplasia (CIN) changes (pCINany), and (iii) any abnormalities (pabn) compared to the conventional pap smear and, if abnormal, compared to the biopsy taken at colposcopy. Acceptability of the tampon test and conventional pap smear were also measured. Results: Probabilities of the tampon test compared to pap smear: pabn sensitivity 33%, specificity 89%, PPV 59%, NPV 73%; pCINany sensitivity 23%, specificity 97%, PPV 71%, NPV 79%; pHG sensitivity 19%, specificity 98%, PPV 63%, NPV 89%. Acceptability for tampon test was 91.21% and for pap smear, 45.85%. Conclusions: Although the self-administered tampon ThinPrep method is a poor detector of cervical abnormalities compared to pap smear, it is highly acceptable to women. It has a relatively good negative predictive value (NPV). Our study suggests that if a more acceptable, sensitive method of cervical screening was found, which removed some of the existing barriers to conventional pap testing, screening rates for cervical cancer may improve. [source] Household smoking behaviours and exposure to environmental tobacco smoke among infants: are current strategies effectively protecting our young?AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2010Justine B. Daly Abstract Objective: To determine the prevalence of infant exposure to environmental tobacco smoke (ETS) among infants attending child health clinics in regional NSW; the association between such exposure and household smoking behaviours; and the factors associated with smoking restrictions in households with infants. Methods: Parents completed a computer-based questionnaire and infant urine samples were collected. Information was obtained regarding the smoking behaviours of household members and samples were analysed for cotinine. Results: Twenty seven per cent of infants had detectable levels of cotinine. Infant ETS exposure was significantly associated with the smoking status of household members, absence of complete smoking bans in smoking households and having more than one smoker in the home. Smoking households were significantly less likely to have a complete smoking ban in place. Conclusions: This study suggests that a significant proportion of the population group most vulnerable to ETS were exposed. Implications: Future efforts to reduce children's exposure to ETS need to target cessation by smoking parents, and smoking bans in households of infants where parents are smokers if desired reductions in childhood ETS-related illness are to be realised. [source] | |||||||||||||||||||||||||||||||