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61.
Pappaioanou M Malison M Wilkins K Otto B Goodman RA Churchill RE White M Thacker SB 《Social science & medicine (1982)》2003,57(10):1925-1937
Public health officials and the communities they serve need to: identify priority health problems; formulate effective health policies; respond to public health emergencies; select, implement, and evaluate cost-effective interventions to prevent and control disease and injury; and allocate human and financial resources. Despite agreement that rational, data-based decisions will lead to improved health outcomes, many public health decisions appear to be made intuitively or politically. During 1991-1996, the US Centers for Disease Control and Prevention implemented the US Agency for International Development funded Data for Decision-Making (DDM) Project. DDM goals were to: (a) strengthen the capacity of decision makers to identify data needs for solving problems and to interpret and use data appropriately for public health decisions; (b) enhance the capacity of technical advisors to provide valid, essential, and timely data to decision makers clearly and effectively; and (c) strengthen health information systems (HISs) to facilitate the collection, analysis, reporting, presentation, and use of data at local, district, regional, and national levels. Assessments were conducted to identify important health problems, problem-driven implementation plans with data-based solutions as objectives were developed, interdisciplinary, in-service training programs for mid-level policy makers, program managers, and technical advisors in applied epidemiology, management and leadership, communications, economic evaluation, and HISs were designed and implemented, national staff were trained in the refinement of HISs to improve access to essential data from multiple sources, and the effectiveness of the strategy was evaluated. This strategy was tested in Bolivia, Cameroon, Mexico, and the Philippines, where decentralization of health services led to a need to strengthen the capacity of policy makers and health officers at sub-national levels to use information more effectively. Results showed that the DDM strategy improved evidence-based public health. Subsequently, DDM concepts and practices have been institutionalized in participating countries and at CDC. 相似文献
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Akif Serhat Gur Bulent Unal Gretchen Ahrendt Michael L. Gimbel Oguz Kayiran Ronald Johnson Marguerite Bonaventura Atilla Soran 《Central European Journal of Medicine》2009,4(1):65-70
Breast cancer related upper extremity lymphedema (BCRL) reduces the quality of life of those who have had surgery for breast
cancer. The aim of this study is to evaluate the risk factors for BCRL and determine whether immediate autologous tissue breast
reconstruction is one of them. A case control study was conducted comparing patients with BCRL (n=97) to surgically treated
breast cancer patients without BCRL (control, n=126). The groups were matched for age, type of breast surgery and radiation
therapy. Postoperative upper extremity infection, body mass index (BMI), occupation (level of hand-use), and immediate autologous
tissue breast reconstruction were investigated as a risk factor of BCRL. Mastectomy was performed on 47.6 % (n=60) and 37.2%
(n=36) of patients in the control and the BCRL groups, respectively. Eight patients (13.3%) had immediate autologous tissue
breast reconstruction in the control mastectomy group. Six of 36 BCRL patients (16.7%) underwent mastectomy with immediate
autologous tissue breast reconstruction. There was no significant difference between groups with respect to incidence or method
of immediate reconstruction (p=0.65). Patient occupation (level of hand use) was found to be positively correlated to development
of BCRL (p=0.0001). Upper extremity infection rate was 22.7% in the BCRL group and 4.0% in the controls (p=0.0001). The mean
BMI in the control and BCRL groups 26.8 kg/m2 and 29.1kg/m2, respectively (p=0.003). In conclusion, in this study characteristics positively associated with development of BCRL included
occupation, infection, and increased BMI. Immediate reconstruction of the breast was not found as a risk factor for BCRL.
However larger studies are needed, to further evaluate the effect of breast reconstruction on BCRL. 相似文献
67.
Adriana Aguilar-Mahecha Zuanel Diaz Marguerite Buchanan Cristiano Ferrario André Lisbona Errol Camlioglu Carole Séguin Mark Basik 《Journal of Medicine and the Person》2011,9(3):104-111
The success of personalized medicine in the oncology clinic is very dependent on the results from a translational research effort to identify individual and host molecular biomarkers to enable proper selection of anti-cancer therapy. For this to happen, it is necessary to obtain timely access to high-quality biological samples of both host and tumor tissues and biological fluids. At the Segal Cancer Center, we have initiated several prospective sample collections based on research-driven breast biopsies in different contexts, including primary and metastatic breast lesions in patients receiving specific treatments. We here describe some of the challenges involved in such a translational research program and our experience in setting up biopsy-driven research protocols, highlighting the human aspects of conducting these complex enterprises. 相似文献
68.
Phyllis W. Sharps Jacquelyn Campbell Marguerite L. Baty Keisha S. Walker Megan H. Bair-Merritt 《Journal of obstetric, gynecologic, and neonatal nursing : JOGNN / NAACOG》2008,37(4):480-491
Objective: To describe current evidence on home visiting interventions for pregnant or postpartum women with specific intimate partner violence assessment and content.
Data Sources: Online bibliographic databases including PubMed, CINAHL Plus, and Web of Science and a hand search of bibliographies of relevant articles.
Study Selection: Original research and intervention studies were included that contained (a) a well-described prenatal and/or postpartum home visitation; (b) an assessment of perinatal intimate partner violence; and (c) quantitative data describing health outcomes for the women and their infants.
Data Extraction: The search yielded 128 articles, and 8 relevant articles met all of the inclusion criteria. Nonresearch, nonintervention, and international articles were excluded.
Data Synthesis: No perinatal home visiting interventions were designed to address intimate partner violence. Programs that screened for intimate partner violence found high rates, and the presence of intimate partner violence limited the ability of the intervention to improve maternal and child outcomes.
Conclusions: Perinatal home visitation programs likely improve pregnancy and infant outcomes. Home visiting interventions addressing intimate partner violence in nonperinatal population groups have been effective in minimizing intimate partner violence and improving outcomes. This suggests that perinatal home visiting programs adding specific intimate partner violence interventions may reduce intimate partner violence and improve maternal and infant health. Continued rigorous research is needed. 相似文献
Data Sources: Online bibliographic databases including PubMed, CINAHL Plus, and Web of Science and a hand search of bibliographies of relevant articles.
Study Selection: Original research and intervention studies were included that contained (a) a well-described prenatal and/or postpartum home visitation; (b) an assessment of perinatal intimate partner violence; and (c) quantitative data describing health outcomes for the women and their infants.
Data Extraction: The search yielded 128 articles, and 8 relevant articles met all of the inclusion criteria. Nonresearch, nonintervention, and international articles were excluded.
Data Synthesis: No perinatal home visiting interventions were designed to address intimate partner violence. Programs that screened for intimate partner violence found high rates, and the presence of intimate partner violence limited the ability of the intervention to improve maternal and child outcomes.
Conclusions: Perinatal home visitation programs likely improve pregnancy and infant outcomes. Home visiting interventions addressing intimate partner violence in nonperinatal population groups have been effective in minimizing intimate partner violence and improving outcomes. This suggests that perinatal home visiting programs adding specific intimate partner violence interventions may reduce intimate partner violence and improve maternal and infant health. Continued rigorous research is needed. 相似文献
69.
Rheologic Behavior of Osteoarthritic Synovial Fluid after Addition of Hyaluronic Acid: A Pilot Study
Pierre Mathieu Thierry Conrozier Eric Vignon Yves Rozand Marguerite Rinaudo 《Clinical orthopaedics and related research》2009,467(11):3002-3009
Viscosupplementation is a symptomatic treatment of osteoarthritis (OA) intended to restore rheologic homeostasis of the synovial
fluid by injecting hyaluronic acid intraarticularly. Despite the long history of this therapy, little is known about its mechanisms
of action and differences between commercial preparations. We investigated the rheologic behavior of OA synovial fluid with
time, when stored at 4°C, before and after the addition of two hyaluronic acid commercial preparations (linear and cross-linked).
Thirteen OA synovial fluids were stored at 4°C and assayed using steric exclusion chromatography, which allows hyaluronic
acid to be separated from the remaining pool of proteins and its molecular weight and concentration to be determined without
any pretreatment and calibration. The synovial fluid rheology also was studied in vitro, before and after addition of two
viscosupplements, over 6 weeks. The non-Newtonian behavior of synovial fluid throughout followup appears to be the result
of loose interactions between proteins and hyaluronic acid. When mixed with the linear hyaluronic acid, synovial fluid becomes
less non-Newtonian whereas the non-Newtonian behavior was reinforced when mixed with the cross-linked hyaluronic acid. The
rheology was nearly unchanged for all synovial fluids over 6 weeks. Our preliminary trial shows it is possible to study synovial
fluid, stored at 4°C, over a long time and suggests the enzymatic degradation of hyaluronic acid is negligible under these
experimental conditions. 相似文献
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