广西北部城乡孕妇微营养素调查及其干预的研究

目的 调查桂林市及周边县城孕妇膳食营养素水平,探讨微营养素与贫血和新生儿出生体重的关系,并且进行相关的营养素干预.方法 对桂林市及周边县城308例孕晚期孕妇并检测外周血红蛋白(Hb)、红细胞压积(HCT)、血清铁(SI)、血清铁蛋白(SF),对部分贫血孕妇进行维生素C、维生素A及铁剂干预.所有孕妇均进行个人问卷调查,应用营养计算软件评价膳食营养水平.结果 该地区孕妇植物性食品占总摄入量农村和城市组分别为73.0 %和65.6 %;动物性食品占总摄入量农村和城市组分别为22.2 %和28.6 %.孕晚期孕妇贫血患病率农村和城市组分别为46.2 %和28.9 %.孕妇贫血组与非贫血组的低体重儿的发病率比较,差异无统计学意义.微营养素干预后,孕晚期孕妇的贫血患病率干预组低于非干预组,差异有统计学意义.结论 城区孕妇膳食结构以植物性食品为主,农村孕晚期孕妇贫血的患病率高于城市.孕妇贫血对新生儿低出生体重的发病率影响不大.因此,应加强对农村孕晚期孕妇的膳食营养宣教及指导,并对贫血孕妇及时进行微营养素干预,可减少孕晚期孕妇贫血的发生.     

Optimizing the role of social workers in advance care planning within an academic hospital: an educational intervention program

Advance Care Planning (ACP) promotes communication to help patients express future health-care preferences and goals for their medical care. Social workers (SWs) are trained to facilitate complex conversations and assist in various ACP tasks across clinical settings. This three-part mixed-method interventional study implemented a comprehensive education and training program for SWs of a large academic hospital, which used pre- and post-training evaluations, chart review, and qualitative data from debrief sessions to examine ACP skills and confidence, and assess the number of ACP conversations initiated with patients. Self-reported level of preparation to facilitate ACP conversations improved significantly (n = 26; pre 36% versus post 82%; p < .05). A 4-month post-intervention chart audit showed an 8.69 fold increase in the number of initiated ACP conversations. Qualitative analysis identified key themes regarding barriers and enablers of initiating ACP conversations during standard care from the perspective of SWs.     

Nutrition and involuntary weight loss: a pilot study of an educational intervention for nursing home surveyors

OBJECTIVE: To describe the knowledge and attitudes of nursing home (NH) surveyors before and after a brief educational intervention related to nutrition and involuntary weight loss in nursing home residents. DESIGN: A questionnaire covering knowledge and attitudes about nutrition was given 1 month before and 6 months after a targeted educational intervention. PARTICIPANTS AND SETTING: State of Maryland nursing home surveyors. MEASUREMENTS: A 24-item questionnaire of NH surveyor knowledge (11 items) and attitudes (13 items) regarding issues related to nutrition and involuntary weight loss in NH residents. RESULTS: Overall surveyors' knowledge scores increased from 68% (SD, 17%) pre-intervention to 76% (SD, 18%) post-intervention (P = .11). Knowledge related to the lack of the effect of tube feeding on survival in NH residents with end-stage dementia was the only knowledge item that improved significantly with the intervention (39% correct pre-intervention and 68% correct post-intervention, P = .04). There were no changes in attitudes toward the diagnosis or treatment of nutrition after the intervention. CONCLUSION: Overall, NH surveyor knowledge related to nutrition and involuntary weight loss varied widely across topic areas. Neither knowledge nor attitudes were substantially affected by a brief educational intervention. Development of effective educational interventions for NH surveyors should be a priority for stakeholders in NH care.     

Using a new program evaluation model to chart the outcomes of an educational intervention in residency training

The purpose of this article is to introduce a new outcome-oriented, utilization-focused, and practical approach to program evaluation: Charting the Outcomes of Educational and Clinical Approaches (COECA) model. It provides a framework that encourages stakeholders to consider academic dissemination, product development, and implementation as three primary outcomes when evaluating educational and clinical approaches. The model then identifies measurements of the impact of each of these primary outcomes. Finally, it outlines three secondary outcomes that focus on education, clinical service, and administration. As an example, this article discusses the application of the model to an educational intervention in residency training. This intervention has been implemented at two sites. Secondary outcomes include increased competency of residents and a change in responsibilities among health care team members. The COECA model provides an easy-to-apply and efficient method for documenting actual progress and determining potential for further development.     

An educational program for psoriatics: an evaluation

Patients with psoriasis referred to the Dermatology Service at Women's College Hospital and satisfying certain criteria relating to percentage body involvement, age, and the absence of serious coincident conditions were assigned at random to three weeks of day care and education at the Psoriasis Education and Research Centre (PERC) or to the Dermatology Service at Women's College Hospital (WCH) for normal hospital care. On admission, all study patients received normal history and physical examinations and were photographed by a standardized procedure that provided an accurate estimate of type and extent of body involvement. A functional history was taken from PERC patients that provided information concerning their ability to cope at home, at work, and socially; the extent and appropriateness of their self-care practices; and their knowledge concerning the pathophysiology and etiology of psoriasis and the names and actions of the medications they were using. Individualized patient education programs were designed with reference to the medical and functional information and implemented in the three weeks of day care. Photographic assessment and the functional history were repeated at three weeks, six months and twelve months. Hospital patients were reassessed at six and twelve months and a functional history was taken at six months. The functional status of PERC and hospital patients was compared at six months. The results of this study reinforced the belief that in the case of psoriasis, education coupled with treatment is more effective than treatment alone.     

Capodanno Senza Danno: the effects of an intervention program on fireworks injuries in Naples.

To study the effects of a comprehensive, multifaceted intervention program to reduce fireworks-related injuries during the Italian New Year's holiday season, active surveillance was conducted in the 18 public emergency rooms of Naples, Italy, before and after implementation of the program. Preintervention data collected between December 24, 1992, and January 6, 1993, were compared with data collected during the same period in 1993-1994. The number of injuries decreased by 48% from 353 to 183, with the greatest declines seen among 10- to 12-year-olds. The broad-based intervention implemented during the 1993-1994 holiday season appears to have substantially reduced the number of injuries.     

Nutrition intervention in developmental disabilities: an interdisciplinary approach

The nutritional status of developmentally disabled persons is influenced by variables infrequently encountered in normal nutrition. The multitude of factors requires an approach to care that must incorporate information and assistance from a variety of disciplines. A model for viewing the network of variables is proposed as a tool for identifying voids in nutrition care and for developing appropriate plans that include interdisciplinary interactions for those persons with special needs.     

Intended and unintended effects of an eating disorder educational program: impact of presenter identity

OBJECTIVE: This study examines the impact of presenter identity on the intended and unintended effects of an eating disorder educational program. METHOD: High school students viewed one of two identical videotaped discussions about eating disorders. In one condition, the presenter was identified as an "eating disorder specialist"; in the other condition, she was identified as a "recovered patient." Before and after watching the video, participants reported on their awareness of various eating disorder symptoms, their beliefs about individuals with eating disorders, and their opinion of the presenter. RESULTS: At Time 2, both groups reported increased knowledge about eating disorders. There was also evidence of increased endorsement of a number of implicit messages, particularly among those in the "recovered patient" group (e.g., "Girls with eating disorders are very pretty"; "It would be nice to look like" the presenter). CONCLUSION: The unintended effects of eating disorder educational programs should be investigated before implementation because of their potential to undermine program efficacy.     

Adolescent pregnancy program stresses family counseling, educational services

Pathways, and adolescent family life demostration program at St. Ann's Infant and Maternity Home in Hyattsville, Maryland, which initiated activities in March, 1983, served 268 clients in its 1st year. 59% were 17 years of age or under. A 5-year grant from the Department of Health and Human Services Office of Adolescent Pregnancy Programs provided for residential care for pregnant adolescents lacking family to assist them in the last phase of pregnancy; a day program offering accredited educational services and community vocational resources, training in parenting skills, individual and family counseling, and prenatal care for teenagers; an aftercare residence for adolescent mothers and their infants with an intensive program of vocational and parenting education; and a community outreach program offering health care, counseling, family life education, adoption, and other services. The program differs from previous programs at St. Ann's in 5 main ways: 1) substantial care is available to teenage mothers after delivery 2) educational services have been expanded for mothers living at home and attending during the day 3) a more comprehensive counseling program with more intensive family focus in included 4) the program is raching out into the community with a range of services to adolescents seeking assistance, regardless of race, religion, or financial status, and 5) an evluation program has been developed to monitor the operating program, the adolescents receiving services, and their children. The National Center for Family Studies at the Catholic University of America has assisted in staff training and service delivery design. Follow-up studies on clients who have left the program are only beginning. Counseling plans are formulated to fit individual needs, but all residents participate in group therapy sessions led by a psychiatrist and social worker. The infants' fathers and the adolescents' parents recieve services when possible. Although the grant finances the basic program, additional funds are contributed by foundations, United Way, program service fees, and public agencies. Client fees are based on a sliding scale which ranges from 30-100% of the acutal cost of care. Maximum enrollment in the program is 8 mothers and babies in the Aftercare Program, 25 adolescents in the residential program, 10-16 in the day programs, and 40-50 in the coumunity outreach program.     

Evaluation of an educational program in preventive cardiology

In 1979, an educational program in preventive cardiology (PC), supported by the National Heart, Lung, and Blood Institute (NHLBI) was introduced into the medical school at the University of Tennessee, Memphis (UTM). This report evaluates that program from 1979 to 1984 in terms of student health behaviors, student attitudes toward PC, student knowledge of PC, and the impact of the program on continuing development of educational programs in PC. In 1981, using a 30% random sample, freshmen students in medicine and dentistry at UTM and medical students at a nearby state medical school similar to UTM were surveyed concerning health behaviors, attitudes, and knowledge. The surveys were repeated three years later. Analysis of the data from these pre- and postsurveys showed that UTM medical students improved (P less than .05) their attitudes about the preventability of heart disease and that their PC knowledge scores increased (P less than .0001). Personal health habits and health parameters were generally good and remained so. Although control medical students improved their PC knowledge, this change was not as great as in UTM medical students (P less than .05). The improved attitude toward PC in UTM medical students was not statistically different from changes in control students. Unfortunately, the statistical power of this analysis was low (less than 20%), and important differences between UTM medical students and controls were likely to have been missed. In addition to changes in students, considerable institutional change occurred at UTM as a direct result of this project, leading to the expansion of emphasis on PC (and prevention in general) in the five years since the completion of this NHLBI-funded program.     

Laryngeal Mask Airway for neonatal resuscitation in a developing country: evaluation of an educational intervention. Neonatal LMA: an educational intervention in DRC

Background  

Studies carried out in developing countries have indicated that training courses in newborn resuscitation are efficacious in teaching local birth attendants how to properly utilize simple resuscitation devices. The aim of this study was to assess the knowledge and expertise gained by physicians and midwifes who participated in a Neonatal Resuscitation Course and workshop organized in a Third World Country on the use of Laryngeal Mask Airway (LMA).     

Attitudes toward care of the terminally ill: an educational intervention

This quasiexperimental study examined the effect of an educational program on attitudes toward caring for terminally ill persons and their families. Participants were 115 undergraduate students: intervention group, N = 49; control group, N = 66. Pre- and post-intervention measurements were done with the Frommelt Attitude Toward Care of the Dying Scale (FATCOD, Form B). Students in the intervention group participated in a semester-long (15-week, 45-hour) educational program. Demographic variables, including age, gender, religion, major area of study, influence of religious beliefs, profession, previous education, and past or present experience with loss were evaluated. Statistical analyses (t-test, ANOVA, ANCOVA, and APVs) indicated a significant positive change in the attitude scores of the intervention group and no significant change in the attitude scores of the control group.     

Teenage pregnancy prevention: an Atlanta program

this article describes the Fulton County (Georgia) Health Department Teen Clinical Services Program, which has 3 goals: 1) to reduce unplanned teenage pregnancies in 3 high risk health service areas in Atlanta by providing sex education and access to contraception, 2) to improve the health and well-being of teeangers by offering periodic disease screening, and 3) to educate adolescents on their total health needs. Clinics are held in inner city community health centers and all services are confidential. An introductory health questionnaire is used to assess the areas of counseling to be emphasized in the initial interview. 65% of teenagers initially attending the clinic are sexually active, but only 60-65% have ever used birth control. The reasons for sexual behavior are explored during the initial interview and contraception and sexually transmitted diseases are reviewed. Teenagers who are not sexually active are encouraged to postpone sexual activity. Community outreach and education is another component of the program. Rap sessions are held during each clinic session and peer counselors work as liaisons between the schools, community, and Teen Services Program. Peer counseling is believed to facilitate feelings of acceptance and support. In 1 of the high risk areas served by the program, the adolescent birth rate fell 17% in 1979-82. 94% of clients who accepted contraception returned and maintained contraception for 1 year. Approximately 20% of participants in the program are male. This experience suggests that this type of program is effective and should be expanded to other areas of the US.     

Early educational intervention in the maternal and child health services--long-term evaluation of program effectiveness

The program's effectiveness justifies the integration of early infant stimulation programs into the existing health services, by the existing health personnel, thus modifying the pediatric health care which mainly focuses on physical health, by adding to it the developmental promotive aspect of child care.

An early stimulation program aimed at promoting cognitive development of infants and young children was integrated into the routines of the Maternal and Child Health services. The program was implemented by nurses, at each visit of the mother with her infant at the centers, from birth to two years of age. The program focused on verbal and play interaction. At five years of age, three years after cessation of the intervention, evaluation was carried out on 59 pairs of exposed and control children matched for maternal ethnic group education and birth order and found to be similar on seven additional characteristics. A statistically significant difference in IQ score was found between the exposed and the control groups. The difference was more significant between exposed and controls whose mother belonged to the lower educational categories, and more so on the performance score than on the language score. In addition to the t test for matched pairs a modification of the Mantel Haenzel test for matched pairs was applied, in order to control for sib born after index case and exposure to additional intervention. Results were similar to the other methods of analysis used.     

Sustained effects of an educational program to reduce sales of cigarettes to minors.

We report 1-year follow-up data from a sample of stores participating in a 6-month community-wide educational effort to reduce cigarette sales to minors in Santa Clara County, California. The proportion of over-the-counter sales to minors at the 1-year follow-up illustrated that although statistically significant reductions were maintained 6 months after the intervention ended, recidivism occurred. Suggestions for achieving long-term reductions in sales to minors are offered.     

Evaluation of an educational program in health care teams

In July 1975, the Division of Ambulatory and Community Medicine at the University of California, San Francisco, initiated an interdisciplinary team education program as part of a required core medical clerkship in primary care. Significant emphasis was placed on evaluation of student and patient service outcomes. Overall, students rated the teaching in the program as moderately effective. The major measured gain for students was in their formal knowledge of the principles of teamwork, with secondary gains in patient problem-solving skills. The gains in knowledge were greatest for medicine and pharmacy students. During the team education program, the average number of patients seen by student providers was greater than it had been during previous clerkships. Similarly, the comprehensiveness of care provided was higher during the team education program. Although no significant differences were found between student teams and individual providers, those teams with consistent membership from all three participating disciplines (medicine, pharmacy, and nursing) delivered more comprehensive care.