4 resultados para Pilot-scale

em DigitalCommons@The Texas Medical Center


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BACKGROUND: : Women at increased risk of breast cancer (BC) are not widely accepting of chemopreventive interventions, and ethnic minorities are underrepresented in related trials. Furthermore, there is no validated instrument to assess the health-seeking behavior of these women with respect to these interventions. METHODS: : By using constructs from the Health Belief Model, the authors developed and refined, based on pilot data, the Breast Cancer Risk Reduction Health Belief (BCRRHB) scale using a population of 265 women at increased risk of BC who were largely medically underserved, of low socioeconomic status (SES), and ethnic minorities. Construct validity was assessed using principal components analysis with oblique rotation to extract factors, and generate and interpret summary scales. Internal consistency was determined using Cronbach alpha coefficients. RESULTS: : Test-retest reliability for the pilot and final data was calculated to be r = 0.85. Principal components analysis yielded 16 components that explained 64% of the total variance, with communalities ranging from 0.50-0.75. Cronbach alpha coefficients for the extracted factors ranged from 0.45-0.77. CONCLUSIONS: : Evidence suggests that the BCRRHB yields reliable and valid data that allows for the identification of barriers and enhancing factors associated with use of breast cancer chemoprevention in the study population. These findings allow for tailoring treatment plans and intervention strategies to the individual. Future research is needed to validate the scale for use in other female populations. Cancer 2009. (c) 2009 American Cancer Society.

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Background. Consistent adherence to antiretroviral treatment is necessary for a treatment success. Improving and maintaining adherence rate >95% are challenging for health care professionals. This pilot randomized controlled study aimed to evaluate the impact of the interactive intervention on adherence to GPO-VIR, to describe the feasibility of the interactive intervention in Thailand, and to illustrate the adherence self-efficacy concept among HIV treatment-naïve patients in Thailand who were starting antiretroviral treatment. ^ Methods. The study took place at three HIV clinics located in Phayao, Thailand. Twenty-three patients were randomly assigned into the experimental (n=11) and the control groups (n=12). Each participant in the experimental group and a significant person to the patient received 5 educational sessions with a nurse at the clinics and at their homes. They also received 3 follow-up evaluations during the 6-month period of the study. The participants in the control group received the standard of care provided by HIV clinical personnel plus three follow-up evaluations at the clinic. ^ Results. Seventeen patients (7 in the experimental and 10 in the control group) completed the study. The 4-day recall on the Thai ACTG Adherence Scale demonstrated adherence rate >95% for most participants from both groups. After the first measurement, no experimental group patients reporting missing ART, while one control group participant continuously skipped ART. Participants from both groups had significantly increased CD4 cell counts after the study (F(1, 15) = 29.30, p = .000), but no differences were found between two groups (F(1, 15) = .001, p = .98). Examination of the intervention showed limitations and possibilities to implement it in Thailand. Qualitative data demonstrated self-efficacy expectations, resignation and acceptance as related concepts to improve adherence outcomes. ^ Conclusions. This interactive intervention, after appropriate modifications, is feasible to apply for Thai HIV-treatment naïve patients. Because of limitations the study could not demonstrate whether the interactive intervention improved adherence to ART among HIV-treatment naïve in Thailand. A longitudinal study in a larger sample would be required to test the impact of the intervention. ^ Keyword: antiretroviral treatment, adherence, treatment-naïve, Thailand, randomized controlled study ^

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Next to leisure, sport, and household activities, the most common activity resulting in medically consulted injuries and poisonings in the United States is work, with an estimated 4 million workplace related episodes reported in 2008 (U.S. Department of Health and Human Services, 2009). To address the risks inherent to various occupations, risk management programs are typically put in place that include worker training, engineering controls, and personal protective equipment. Recent studies have shown that such interventions alone are insufficient to adequately manage workplace risks, and that the climate in which the workers and safety program exist (known as the "safety climate") is an equally important consideration. The organizational safety climate is so important that many studies have focused on developing means of measuring it in various work settings. While safety climate studies have been reported for several industrial settings, published studies on assessing safety climate in the university work setting are largely absent. Universities are particularly unique workplaces because of the potential exposure to a diversity of agents representing both acute and chronic risks. Universities are also unique because readily detectable health and safety outcomes are relatively rare. The ability to measure safety climate in a work setting with rarely observed systemic outcome measures could serve as a powerful means of measure for the evaluation of safety risk management programs. ^ The goal of this research study was the development of a survey tool to measure safety climate specifically in the university work setting. The use of a standardized tool also allows for comparisons among universities throughout the United States. A specific study objective was accomplished to quantitatively assess safety climate at five universities across the United States. At five universities, 971 participants completed an online questionnaire to measure the safety climate. The average safety climate score across the five universities was 3.92 on a scale of 1 to 5, with 5 indicating very high perceptions of safety at these universities. The two lowest overall dimensions of university safety climate were "acknowledgement of safety performance" and "department and supervisor's safety commitment". The results underscore how the perception of safety climate is significantly influenced at the local level. A second study objective regarding evaluating the reliability and validity of the safety climate questionnaire was accomplished. A third objective fulfilled was to provide executive summaries resulting from the questionnaire to the participating universities' health & safety professionals and collect feedback on usefulness, relevance and perceived accuracy. Overall, the professionals found the survey and results to be very useful, relevant and accurate. Finally, the safety climate questionnaire will be offered to other universities for benchmarking purposes at the annual meeting of a nationally recognized university health and safety organization. The ultimate goal of the project was accomplished and was the creation of a standardized tool that can be used for measuring safety climate in the university work setting and can facilitate meaningful comparisons amongst institutions.^

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During the healthcare reform debate in the United States in 2009/2010, many health policy experts expressed a concern that expanding coverage would increase waiting times for patients to obtain care. Many complained that delays in obtaining care in turn would compromise the quality of healthcare in the United States. Using data from The Commonwealth Fund 2010 International Health Policy Survey in Eleven Countries, this study explored the relationship between wait times and quality of care, employing a wait time scale and several quality of care indicators present in the dataset. The impact of wait times on quality was assessed. Increased wait time was expected to reduce quality of care. However, this study found that wait times correlated with better health outcomes for some measures, and had no association with others. Since this is a pilot study and statistical significance was not achieved for any of the correlations, further research is needed to confirm and deepen the findings. However, if future studies confirm this finding, an emphasis on reducing wait times at the expense of other health system level performance variables may be inappropriate. ^