Forty private obstetrical patients cared for by a group practice employing a nurse-midwife were i... more Forty private obstetrical patients cared for by a group practice employing a nurse-midwife were interviewed. Half of the study group accepted the nurse-midwife for delivery. The other 20 were delivered by an obstetrician. Acceptance of prenatal care by the nurse-midwife was found to be favorable. Patients reported feeling more comfortable with the nurse-midwife and perceived her as more understanding, sympathetic and available to answer questions than the physicians. The initial encounter with the nurse-midwife differed significantly between those in the two delivery groups. Patients accepting the nurse-midwife for delivery were more likely to have first met her alone while those who chose to be delivered by an obstetrician-gynecologist were more likely to have been introduced to the nurse-midwife by the physician. The implications of this initial "imprinting experience" on the acceptance of the nurse-midwife for delivery are discussed.
Background: Even though strengthening primary health care (PHC) is now widely accepted as essenti... more Background: Even though strengthening primary health care (PHC) is now widely accepted as essential for achieving global health goals, evidence regarding the long-term effectiveness of comprehensive PHC programs remains limited. In contrast, the evidence for effectiveness of selected interventions assessed over shorter periods of time is abundant. Objectives: This report is the second in a series of two papers. The first paper describes the history and implementation features of the census-based, impact-oriented (CBIO) approach by the Consejo de Salud Rural Andino (CSRA)/Montero Comprehensive Primary Health Care Program that has been in operation for three decades, since 1988. This second paper in the series presents evidence of program effectiveness, including long-term trends in child and maternal mortality. Methods: We reviewed available documents, prior evaluations, and health information system data. We carried out interviews with 19 key informants. Finally, we reviewed data fr...
The Care Group approach, described in detail in a companion paper in this journal, uses volunteer... more The Care Group approach, described in detail in a companion paper in this journal, uses volunteers to convey health promotion messages to their neighbors. This article summarizes the available evidence on the effectiveness of the Care Group approach, drawing on articles published in the peer-reviewed literature as well as data from unpublished but publicly available project evaluations and summary analyses of these evaluations. When implemented by strong international NGOs with adequate funding, Care Groups have been remarkably effective in increasing population coverage of key child survival interventions. There is strong evidence that Care Groups can reduce childhood undernutrition and reduce the prevalence of diarrhea. Finally, evidence from multiple sources, comprising independent assessments of mortality impact, vital events collected by Care Group Volunteers themselves, and analyses using the Lives Saved Tool (LiST), that Care Groups are effective in reducing under-5 mortality...
A cohort of 724 physician assistants (PAs) was studied between 1974 and 1978. Cohort attrition (1... more A cohort of 724 physician assistants (PAs) was studied between 1974 and 1978. Cohort attrition (13% overall) was greater for younger PAs and those who had graduated in the top quarter of their high school class. A trend toward employment in institutional settings and toward employment in urban areas was observed. In a separate analysis of survey data from a national sample of 4,500 PAs, an attrition rate of 13% was observed. Men, former military medical corpsmen, and graduates of military PA programs exhibited the lowest attrition. The significance of these findings, especially for future manpower predictions, is discussed.
Journal of health & population in developing countries, 1999
Bangladesh has considerable national experience promoting and providing family planning services ... more Bangladesh has considerable national experience promoting and providing family planning services through home visits to reproductive-age married women by paid female community workers. Since 1978, the government has trained and employed 24,000 such workers, known as Family Welfare Assistants (FWA), while nongovernmental organizations (NGO) have trained and employed an additional 7000 field workers to carry out similar activities. NGO field workers are considered to be part of the national family planning program. Findings are presented from an assessment of the quality of family planning services provided by community-based field workers in zone 3 of Dhaka City, Bangladesh, and are based upon a large household survey of a representative sample of clients, direct field worker observation, and interviews with field workers and clients. Areas in greatest need of improvement include the frequency of contact with clients who are nonusers or who have special needs, client education about ...
The Graduate Medical Education National Advisory Committee's 1980 report on physician manpowe... more The Graduate Medical Education National Advisory Committee's 1980 report on physician manpower estimated that 23,500 general surgeons would be required in 1990 and that there would be a surplus of 11,800 trained general surgeons by then. Using the GMENAC estimates of need and our analysis of supply, we project a surplus of only about half that number. To balance the supply of general surgeons to anticipated needs by the year 2000, it is estimated that the number of physicians beginning their residency training in general surgery between 1984 and 1995 should be reduced by 20% in relation to the number of first-year general surgery residents in 1982-1983.
The actual use of surgical physician assistants in 1979 and the expected use of them in 1984 by 5... more The actual use of surgical physician assistants in 1979 and the expected use of them in 1984 by 552 general hospitals in the United States with 400 or more beds was assessed by means of a questionnaire mailed to the hospitals' surgical department chairmen. The influence of geographic and institutional variables upon this use was determined by multiple regression analysis. The most important determinants of actual use were the complexity of surgical care in the institution and its geographic location. Institutions with more complex surgical care and those located outside of the West were more likely to have used surgical physician assistants in 1979. Important determinants of the expected use of surgical physician assistants in 1984 appeared to be the complexity of surgical care and the degree of reliance upon foreign medical graduates (FMGs) in the surgical housestaff training program within the institution. Those surgical department chairmen in hospitals with a greater concentr...
The authors describe the major findings of a 1978 national survey of 4,500 physician's assist... more The authors describe the major findings of a 1978 national survey of 4,500 physician's assistants. Seventy-four percent of the respondents were working in primary care specialties, and two-thirds were located primarily in institutions rather than private practice settings. Almost half (47 percent) of the respondents were working in communities of fewer than 50,000 persons. Physician's assistants were more likely than physicians to be working in nonurban areas. The average income of a physician's assistant in 1978 was $17,611, and there was little variation by major specialty or practice-setting categories. Since 1974 there appeared to have been a shift within the profession toward employment in family practice, in institutional settings, and in urban areas. There also had been a notable increase in numbers of women, persons with more extensive educational backgrounds, and persons with civilian allied health backgrounds in the physician's assistant profession.
It is anticipated that there will be a major growth in the role of surgical physician assistants ... more It is anticipated that there will be a major growth in the role of surgical physician assistants in the immediate future. The authors believe that this trend will improve the quality of surgical care in the United States, reduce the number of surgeons being trained, and enable practicing surgeons to be more productive and hence more proficient.
Background: Strengthening primary health care (PHC) is now widely accepted as essential for achie... more Background: Strengthening primary health care (PHC) is now widely accepted as essential for achieving global health goals, including Universal Health Coverage. However, there are few examples of innovative approaches to the provision of comprehensive PHC services that have been implemented over more than a few years and that have evidence of long-term effectiveness. In contrast, the evidence for effectiveness of selected PHC interventions assessed over shorter periods of time is abundant. Objectives: This study describes the implementation of the census-based, impact-oriented (CBIO) approach for a program in Montero, Bolivia, managed by the Consejo de Salud Rural Andino (CSRA) that has been in operation for three decades, since 1988. A second paper in the series describes the effectiveness of the program, including population coverage of key interventions and changes in child and maternal mortality in the program area, over this period. Methods: We reviewed available documents, prio...
This paper describes the effectiveness for child health of a primary health care approach develop... more This paper describes the effectiveness for child health of a primary health care approach developed in Bolivia by Andean Rural Health Care and its colleagues, the census-based, impact-oriented (CBIO) approach. Here, we describe selected achievements, ...
Forty private obstetrical patients cared for by a group practice employing a nurse-midwife were i... more Forty private obstetrical patients cared for by a group practice employing a nurse-midwife were interviewed. Half of the study group accepted the nurse-midwife for delivery. The other 20 were delivered by an obstetrician. Acceptance of prenatal care by the nurse-midwife was found to be favorable. Patients reported feeling more comfortable with the nurse-midwife and perceived her as more understanding, sympathetic and available to answer questions than the physicians. The initial encounter with the nurse-midwife differed significantly between those in the two delivery groups. Patients accepting the nurse-midwife for delivery were more likely to have first met her alone while those who chose to be delivered by an obstetrician-gynecologist were more likely to have been introduced to the nurse-midwife by the physician. The implications of this initial "imprinting experience" on the acceptance of the nurse-midwife for delivery are discussed.
Forty private obstetrical patients cared for by a group practice employing a nurse-midwife were i... more Forty private obstetrical patients cared for by a group practice employing a nurse-midwife were interviewed. Half of the study group accepted the nurse-midwife for delivery. The other 20 were delivered by an obstetrician. Acceptance of prenatal care by the nurse-midwife was found to be favorable. Patients reported feeling more comfortable with the nurse-midwife and perceived her as more understanding, sympathetic and available to answer questions than the physicians. The initial encounter with the nurse-midwife differed significantly between those in the two delivery groups. Patients accepting the nurse-midwife for delivery were more likely to have first met her alone while those who chose to be delivered by an obstetrician-gynecologist were more likely to have been introduced to the nurse-midwife by the physician. The implications of this initial "imprinting experience" on the acceptance of the nurse-midwife for delivery are discussed.
Background: Even though strengthening primary health care (PHC) is now widely accepted as essenti... more Background: Even though strengthening primary health care (PHC) is now widely accepted as essential for achieving global health goals, evidence regarding the long-term effectiveness of comprehensive PHC programs remains limited. In contrast, the evidence for effectiveness of selected interventions assessed over shorter periods of time is abundant. Objectives: This report is the second in a series of two papers. The first paper describes the history and implementation features of the census-based, impact-oriented (CBIO) approach by the Consejo de Salud Rural Andino (CSRA)/Montero Comprehensive Primary Health Care Program that has been in operation for three decades, since 1988. This second paper in the series presents evidence of program effectiveness, including long-term trends in child and maternal mortality. Methods: We reviewed available documents, prior evaluations, and health information system data. We carried out interviews with 19 key informants. Finally, we reviewed data fr...
The Care Group approach, described in detail in a companion paper in this journal, uses volunteer... more The Care Group approach, described in detail in a companion paper in this journal, uses volunteers to convey health promotion messages to their neighbors. This article summarizes the available evidence on the effectiveness of the Care Group approach, drawing on articles published in the peer-reviewed literature as well as data from unpublished but publicly available project evaluations and summary analyses of these evaluations. When implemented by strong international NGOs with adequate funding, Care Groups have been remarkably effective in increasing population coverage of key child survival interventions. There is strong evidence that Care Groups can reduce childhood undernutrition and reduce the prevalence of diarrhea. Finally, evidence from multiple sources, comprising independent assessments of mortality impact, vital events collected by Care Group Volunteers themselves, and analyses using the Lives Saved Tool (LiST), that Care Groups are effective in reducing under-5 mortality...
A cohort of 724 physician assistants (PAs) was studied between 1974 and 1978. Cohort attrition (1... more A cohort of 724 physician assistants (PAs) was studied between 1974 and 1978. Cohort attrition (13% overall) was greater for younger PAs and those who had graduated in the top quarter of their high school class. A trend toward employment in institutional settings and toward employment in urban areas was observed. In a separate analysis of survey data from a national sample of 4,500 PAs, an attrition rate of 13% was observed. Men, former military medical corpsmen, and graduates of military PA programs exhibited the lowest attrition. The significance of these findings, especially for future manpower predictions, is discussed.
Journal of health & population in developing countries, 1999
Bangladesh has considerable national experience promoting and providing family planning services ... more Bangladesh has considerable national experience promoting and providing family planning services through home visits to reproductive-age married women by paid female community workers. Since 1978, the government has trained and employed 24,000 such workers, known as Family Welfare Assistants (FWA), while nongovernmental organizations (NGO) have trained and employed an additional 7000 field workers to carry out similar activities. NGO field workers are considered to be part of the national family planning program. Findings are presented from an assessment of the quality of family planning services provided by community-based field workers in zone 3 of Dhaka City, Bangladesh, and are based upon a large household survey of a representative sample of clients, direct field worker observation, and interviews with field workers and clients. Areas in greatest need of improvement include the frequency of contact with clients who are nonusers or who have special needs, client education about ...
The Graduate Medical Education National Advisory Committee's 1980 report on physician manpowe... more The Graduate Medical Education National Advisory Committee's 1980 report on physician manpower estimated that 23,500 general surgeons would be required in 1990 and that there would be a surplus of 11,800 trained general surgeons by then. Using the GMENAC estimates of need and our analysis of supply, we project a surplus of only about half that number. To balance the supply of general surgeons to anticipated needs by the year 2000, it is estimated that the number of physicians beginning their residency training in general surgery between 1984 and 1995 should be reduced by 20% in relation to the number of first-year general surgery residents in 1982-1983.
The actual use of surgical physician assistants in 1979 and the expected use of them in 1984 by 5... more The actual use of surgical physician assistants in 1979 and the expected use of them in 1984 by 552 general hospitals in the United States with 400 or more beds was assessed by means of a questionnaire mailed to the hospitals' surgical department chairmen. The influence of geographic and institutional variables upon this use was determined by multiple regression analysis. The most important determinants of actual use were the complexity of surgical care in the institution and its geographic location. Institutions with more complex surgical care and those located outside of the West were more likely to have used surgical physician assistants in 1979. Important determinants of the expected use of surgical physician assistants in 1984 appeared to be the complexity of surgical care and the degree of reliance upon foreign medical graduates (FMGs) in the surgical housestaff training program within the institution. Those surgical department chairmen in hospitals with a greater concentr...
The authors describe the major findings of a 1978 national survey of 4,500 physician's assist... more The authors describe the major findings of a 1978 national survey of 4,500 physician's assistants. Seventy-four percent of the respondents were working in primary care specialties, and two-thirds were located primarily in institutions rather than private practice settings. Almost half (47 percent) of the respondents were working in communities of fewer than 50,000 persons. Physician's assistants were more likely than physicians to be working in nonurban areas. The average income of a physician's assistant in 1978 was $17,611, and there was little variation by major specialty or practice-setting categories. Since 1974 there appeared to have been a shift within the profession toward employment in family practice, in institutional settings, and in urban areas. There also had been a notable increase in numbers of women, persons with more extensive educational backgrounds, and persons with civilian allied health backgrounds in the physician's assistant profession.
It is anticipated that there will be a major growth in the role of surgical physician assistants ... more It is anticipated that there will be a major growth in the role of surgical physician assistants in the immediate future. The authors believe that this trend will improve the quality of surgical care in the United States, reduce the number of surgeons being trained, and enable practicing surgeons to be more productive and hence more proficient.
Background: Strengthening primary health care (PHC) is now widely accepted as essential for achie... more Background: Strengthening primary health care (PHC) is now widely accepted as essential for achieving global health goals, including Universal Health Coverage. However, there are few examples of innovative approaches to the provision of comprehensive PHC services that have been implemented over more than a few years and that have evidence of long-term effectiveness. In contrast, the evidence for effectiveness of selected PHC interventions assessed over shorter periods of time is abundant. Objectives: This study describes the implementation of the census-based, impact-oriented (CBIO) approach for a program in Montero, Bolivia, managed by the Consejo de Salud Rural Andino (CSRA) that has been in operation for three decades, since 1988. A second paper in the series describes the effectiveness of the program, including population coverage of key interventions and changes in child and maternal mortality in the program area, over this period. Methods: We reviewed available documents, prio...
This paper describes the effectiveness for child health of a primary health care approach develop... more This paper describes the effectiveness for child health of a primary health care approach developed in Bolivia by Andean Rural Health Care and its colleagues, the census-based, impact-oriented (CBIO) approach. Here, we describe selected achievements, ...
Forty private obstetrical patients cared for by a group practice employing a nurse-midwife were i... more Forty private obstetrical patients cared for by a group practice employing a nurse-midwife were interviewed. Half of the study group accepted the nurse-midwife for delivery. The other 20 were delivered by an obstetrician. Acceptance of prenatal care by the nurse-midwife was found to be favorable. Patients reported feeling more comfortable with the nurse-midwife and perceived her as more understanding, sympathetic and available to answer questions than the physicians. The initial encounter with the nurse-midwife differed significantly between those in the two delivery groups. Patients accepting the nurse-midwife for delivery were more likely to have first met her alone while those who chose to be delivered by an obstetrician-gynecologist were more likely to have been introduced to the nurse-midwife by the physician. The implications of this initial "imprinting experience" on the acceptance of the nurse-midwife for delivery are discussed.
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Papers by Henry B Perry