An initial evaluation of a mindful parenting program

A growing number of children are experiencing marital transition. The effects of divorce on children have typically been considered deleterious, although factors can buffer the difficulty of postdivorce adjustment. One of these factors is a positive relationship with a parental figure. Unfortunately, divorce often overwhelms parents with a series of changes that compromise their parenting skills. One new approach to improving parenting after divorce is mindful parenting, which aims to enhance interpersonal and emotional connection in the parent-child relationship. This program is intended to facilitate parents' self-awareness, their mindfulness, and their intentionality in responding to their child's needs. The present study reports on the implementation of the Mindful Parenting Program, delivered in two groups to 12 recently divorced parents with preschool-aged children. Program effectiveness was conducted on two levels. First, mindfulness measured by the Toronto Mindfulness Scale revealed significant increases over the intervention and posttest period. Second, in-home behavioral observations conducted pre- and postintervention revealed no changes in parent-child relationships. These findings are discussed within the larger context of facilitating effective parenting postdivorce.     

An evaluation of a behavioral program for chronic pain

The current study evaluated a behavioral program for the management of chronic pain. One hundred twenty-one patients were treated. Primary pain complaints were predominantly in the low back or head/neck/face regions. Patients participated in a 4-week inpatient treatment package consisting of controlled medication reduction, physical therapy, behavioral group therapy, self-monitoring, contracting, and biofeedback/relaxation training. Several measures of verbal/nonverbal pain behavior and physical functioning were obtained over the baseline, treatment, and follow-up periods. Results showed significant reductions in analgesic medication use and verbal/nonverbal pain behavior and improvements in physical functioning, employment status, and pro-health behaviors which were maintained at 12-month follow-up.The authors wish to thank the following people for their assistance: D. Bugold, N. Flynn, A. Glavan, L. Graham, J. Henkel-Johnson, E. Martin, P. Panyan, B. Patric, K. Slack, J. Sommerfeld, K. Wahman, S. Wahman, B. Wilk, and M. Wipson. This research was supported in part by a grant from the Paul F. Dwan Foundation.     

An evaluation of a high school dropout prevention program

A primary preventive, community-based program designed to facilitate high school transition and reduce dropout and an evaluation of the program are described. Participants in the study were 154 ninth-grade, predominantly Hispanic, inner-city students. Students were assessed on midyear and end of 9th-grade academic achievement, grade averages, course failures, absences, class cutting, class rank, number of counseling referrals, and leave rate. Control group students were found to exhibit significantly higher Iowa Math Test Scores compared to experimental students. Significant time effects were found indicating experimental and control students' decreases in grades and overall class rank, and increases in course failures, absenteeism, and class cutting. Limitations of the study are discussed based on the program's comparison to the similar, yet effective, project conducted by Felner, Ginter, and Primavera (1982).     

AIDS education and a volunteer training program for medical students

The process of AIDS education poses exceptional challenges for teachers and students. Medical students are in a unique position in the health care system. They are young enough to be ideal role models for high school and college students. They are mature enough to be responsible educators. We describe a special program designed and implemented by a medical student to train other medical students to become AIDS educators. This student-run program provides education for student volunteers who are able to educate other students and members of the community. The program is designed to educate a generation of physicians who will be well-equipped to combat the HIV epidemic and who can serve the community as AIDS educators while still in medical school.     

A workshop program to train volunteer community preceptors

This paper describes a program initiated in 1984 by the University of Minnesota Department of Family Practice and Community Health to train volunteer community preceptors for their instructional role in the Ambulatory Care Rotation (ACR), a six-week outpatient medicine offering for third- and fourth-year medical students. The preceptor training program consists of a full-day faculty development workshop for prospective community preceptors and periodic follow-up activities designed to reinforce workshop goals. Five workshops have been held from 1984 to 1987 and have provided a group of trained faculty preceptors for the ACR. The authors reviewed the methods and results of the workshops; self-ratings by participants demonstrated a significant gain in teaching skills and knowledge. Students' ratings of both the ACR course and the teaching by preceptors have been high and compare favorably with ratings of other preceptors and clinical rotations. There has been a 97% retention rate of the workshop-trained preceptors as active teachers in the ACR course, which suggests that the preceptors are satisfied with their role.     

Project Medishare: a volunteer program in international health at the University of Miami.

Most U.S. medical schools have programs in international health, but there is a need to find ways to make students (particularly those with little clinical experience) more effective volunteers in international settings. The Department of Family Medicine at the University of Miami School of Medicine developed a program to help prepare students for international work and to ensure that the work they do makes a difference. Over the past four years, this program, Project Medishare, has sent groups of students to Haiti to conduct health fairs. Students prepare all year for their voluntary trips, which take place during the spring and summer breaks; they learn about Haiti's history, culture, language, and health problems. They also raise funds and donations of medicine and supplies. The health fairs, which are one-day events in orphanages and villages, emphasize patient education and preventive medicine. The success of the fairs is evaluated using testimonials from Haitian officials and patients, students' journals, and data collected by the students. Factors critical to Project Medishare's success include (1) having a "critical mass" of culturally and linguistically competent students and faculty; (2) collaboration with local authorities and providers; (3) advance preparation; and (4) using lessons learned from each event to improve the next.     

An experimental evaluation of a school-based program for children at risk: Wisconsin early intervention

This article describes the nature and effectiveness of Wisconsin Early Intervention (WEI), a social development program for rural elementary school children. Incorporating a social learning formulation of child and family dysfunction, program services included social skill groups and parent/teacher consultation for referred kindergarten through 4th-grade students at two schools. Services were evaluated experimentally with random assignment of 78 children from School A to Full Service (parent/teacher consultation, social skills groups) or Partial Service (parent/teacher consultation) and 49 children from School B to Partial Service or No Service conditions. Full services resulted in decreased depression relative to partial services, based on standardized interview data. However, multidimensional ratings obtained from parents, teachers, and WEI staff consistently indicated that children's competencies and behavior, regardless of service group, improved during the course of the program. Explanations for these results and the importance of experimentally evaluating community-level interventions are discussed.     

Concurrent validity of the MMPI-A in a counseling program for juvenile offenders

This study was conducted to examine the concurrent validity of the MMPI-A (Minnesota Multiphasic Personality Inventory-Adolescent) in an adolescent offender setting. From a sample of 50 court-adjudicated youths participating in an outpatient counseling program, 42 valid MMPI-A profiles were obtained, 33 of which were accompanied by counselor ratings of behavior problems. The highest mean elevations on the MMPI-A were on scales MAC-R (MacAndrew Alcoholism Scale-Revised), A-Con (Adolescent Conduct Problems), A-Sch (Adolescent School Problems), Pd (Psychopathic Deviate), and IMM (Adolescent Immaturity). Counselor ratings of behavior problems correlated highly with scales ACK (Alcohol and Drug Acknowledgment Scale), A-Sch, A-Ang (Adolescent Anger Problems), Ma (Hypomania), and PRO (Alcohol/Drug Problem Proneness). This pattern of results supports the concurrent validity of the MMPI-A for use in this setting. © 1998 John Wiley & Sons, Inc. J Clin Psychol 54: 395–399, 1998.     

Development and evaluation of a presurgical preparation program

Three presurgical preparation programs were developed and evaluated in an Australian hospital utilizing an additive component design. The component basic to all three preparation programs was modeling. This technique was compared with the additional components of teaching child coping skills and parent coping skills via videotape. Subjects were 28 children between the ages of 4 and 13 years who were scheduled for elective surgery. Anxiety of both the children and parents was assessed by self-report and behavior observation. Results indicated that there was no further anxiety reduction by the addition of child and parent coping skills. Results are discussed in terms of the viability of teaching coping skills via videotape particularly to parents. Methodological difficulties associated with research in this area are examined.     

An evaluation of a smoking cessation training program for medical residents in an inner-city hospital.

Thirty-four medical residents at a hospital serving a predominantly black inner-city area were trained to counsel their patients to quit smoking. They were tested before the training session and again 4 months later with questionnaires assessing smoking knowledge, attitude, and clinical practice. The training consisted of two 1-hour lectures, printed materials, and a 1.5-hour Objective Simulated Clinical Exam. Most of the residents were males (88.2%), in internal medicine (87.5%), under the age of 35 (79.4%), and foreign-born (76.5%). Asians (44.1%) comprised the largest racial group, followed by whites (29.4%) and blacks (20.6%). The impact of the training was assessed by comparing the pre- and posttests using paired Student''s t tests. Overall score increased from 69.3 to 89.1 (P = .0001) out of a maximum of 131. Scores increased significantly for attitudes and beliefs (38 to 52; P = .0001), knowledge (5.3 to 6.6; P = .0001), and usual practices with smoking patients (25 to 30; P = .002). These data provide evidence that training increased the confidence, motivation, and reported practice of these residents in intervening with their patients, the majority of whom are black. This has special significance because physicians are least likely to advise black patients and those in lower socioeconomic groups to quit smoking. The demographic profile of our residents is characteristic of many inner-city hospitals.     

Development and evaluation of a cognitive-behavioral intervention for juvenile fibromyalgia

OBJECTIVE: To describe the development and test the efficacy of a cognitive-behavioral intervention (CBT) for juvenile fibromyalgia. METHOD: Sixty-seven children with fibromyalgia and their parents were recruited to participate in an 8-week intervention that included modules of pain management, psychoeducation, sleep hygiene, and activities of daily living. Children were taught techniques of cognitive restructuring, thought stopping, distraction, relaxation, and self-reward. Additionally, they kept daily pain and sleep diaries. Children completed questionnaires of pre- and post-treatment measuring physical status and psychological functioning. RESULTS: Following CBT, children reported significant reductions (p < .006) in pain, somatic symptoms, anxiety, and fatigue, as well as improvements in sleep quality. Additionally, children reported improved functional ability and had fewer school absences. CONCLUSION: Children with fibromyalgia can be taught CBT strategies that help them effectively manage this chronic and disabling musculoskeletal pain disorder.     

An economic evaluation of a computer-tailored e-learning program to promote smoking cessation counseling guideline adherence among practice nurses

ObjectiveTo conduct an economic evaluation of a tailored e-learning program, which successfully improved practice nurses’ smoking cessation guideline adherence.MethodsThe economic evaluation was embedded in a randomized controlled trial, in which 269 practice nurses recruited 388 smoking patients. Cost-effectiveness was assessed using guideline adherence as effect measure on practice nurse level, and continued smoking abstinence on patient level. Cost-utility was assessed on patient level, using patients’ Quality Adjusted Life Years (QALYs) as effect measure.ResultsThe e-learning program was likely to be cost-effective on practice nurse level, as adherence to an additional guideline step cost €1,586. On patient level, cost-effectiveness was slightly likely after six months (cost per additional quitter: €7,126), but not after twelve months. The cost-utility analysis revealed slight cost-effectiveness (cost per QALY gained: €18,431) on patient level.ConclusionProviding practice nurses with a tailored e-learning program is cost-effective to improve their smoking cessation counseling. Though, cost-effectiveness on patient level was not found after twelve months, potentially resulting from smoking relapse.Practice implicationsWidespread implementation of the e-learning program can improve the quality of smoking cessation care in general practice. Strategies to prevent patients’ smoking relapse should be further explored to improve patients’ long-term abstinence.     

A qualitative evaluation of a citywide Community Health Partnership program

While there have been numerous community-based programs in Baltimore, Maryland, aimed at helping patients access medical treatments and services, they historically were underutilized and did not operate synergistically. For that reason, sanofi-aventis, along with key stakeholders in Baltimore, developed the Community Health Partnership (CHP) to educate, empower, and connect patients to community health resources to enable patients to be more proactive about their health. The CHP utilizes a community health liaison (CHL) and a community health action team (CHAT) consisting of community health leaders who are hands-on activists and health care workers who coordinate activities and provide guidance for the CHP. The goal of the program is to foster community collaboration to raise awareness of the need to improve health in the community and to identify and connect patients to existing resources and services that can help. A qualitative evaluation of the Baltimore CHP was conducted through focus group and key informant interviews with members of the CHAT and CHP. Results suggest that the CHP program has enhanced patient-provider relationships, brought together a wealth of resources, and made people more aware of health information. The CHP facilitated providers' ability to help patients find resources and empowered patients in the community to better manage their health conditions. In parallel, physicians requested additional culturally sensitive resources on medical conditions that addressed the health literacy of their diverse patients. Through stakeholder engagement, many more communities beyond Baltimore can become better networked to help patients navigate the health care system and improve their health.     

Initial evaluation of a continuous speech recognition program for radiology

The aims of this work were to measure the accuracy of one continuous speech recognition product and dependence on the speaker's gender and status as a native or nonnative English speaker, and evaluate the product's potential for routine use in transcribing radiology reports. IBM MedSpeak/Radiology software, version 1.1 was evaluated by 6 speakers. Two were nonnative English speakers, and 3 were men. Each speaker dictated a set of 12 reports. The reports included neurologic and body imaging examinations performed with 6 different modalities. The dictated and original report texts were compared, and error rates for overall, significant, and subtle significant errors were computed. Error rate dependence on modality, native English speaker status, and gender were evaluated by performing ttests. The overall error rate was 10.3 +/- 3.3%. No difference in accuracy between men and women was found; however, significant differences were seen for overall and significant errors when comparing native and nonnative English speakers (P = .009 and P = .008, respectively). The speech recognition software is approximately 90% accurate, and while practical implementation issues (rather than accuracy) currently limit routine use of this product throughout a radiology practice, application in niche areas such as the emergency room currently is being pursued. This methodology provides a convenient way to compare the initial accuracy of different speech recognition products, and changes in accuracy over time, in a detailed and sensitive manner.     

Initial evaluation of a continuous speech recognition program for radiology

The aims of this work were to measure the accuracy of one continuous speech recognition product and dependence on the speaker's gender and status as a native or nonnative English speaker, and evaluate the product's potential for routine use in transcribing radiology reports. IBM MedSpeak/Radiology software, version 1.1 was evaluated by 6 speakers. Two were nonnative English speakers, and 3 were men. Each speaker dictated a set of 12 reports. The reports included neurologic and body imaging examinations performed with 6 different modalities. The dictated and original report texts were compared, and error rates for overall, significant, and subtle significant errors were computed. Error rate dependence on modality, native English speaker status, and gender were evaluated by performing ttests. The overall error rate was 10.3 +/- 3.3%. No difference in accuracy between men and women was found; however, significant differences were seen for overall and significant errors when comparing native and nonnative English speakers (P = .009 and P = .008, respectively). The speech recognition software is approximately 90% accurate, and while practical implementation issues (rather than accuracy) currently limit routine use of this product throughout a radiology practice, application in niche areas such as the emergency room currently is being pursued. This methodology provides a convenient way to compare the initial accuracy of different speech recognition products, and changes in accuracy over time, in a detailed and sensitive manner.     

Short term evaluation of a rural immunization program in Nigeria

BACKGROUND: Immunization remains the primary strategy in both the control and prevention of common childhood diseases, particularly in the developing world. Immunization and preprimary health care services were commenced in a rural community in Nigeria in 1998, when vaccine coverage for all Expanded Program on Immunization (EPI) diseases (tuberculosis, polio, diphtheria, pertussis, tetanus, measles, and hepatitis B) was considerably low with only 43% of children fully immunized. METHODS: Children aged 0-2 years and living in a rural community were recruited into the study. Data on vaccination history was collected by both vaccination card and maternal history. Three hundred and twenty-seven children were recruited into the study. Study participants were vaccinated for EPI diseases. Hepatitis-B vaccine was administered at birth, and a combined diphtheria and tetanus toxoids, and pertussis whole cell vaccine (DTP) plus hepatitis-B vaccine was administered in a single injection after six weeks. RESULTS AND CONCLUSIONS: Two years after the program was started, immunization coverage rates were 94% for BCG, 88% for DTP (third dose), and 82% for measles. All antigens showed significant improvements from baseline values (p < 0.0001). Eighty four percent of children were fully immunized against all six diseases, compared with 43% at the commencement (p < 0.0001). Hepatitis-B coverage (three doses) was 58%. The vaccination program has significantly improved vaccination coverage and could be a model for under served, non-industrialized communities.