Multilevel Provider-Based Sampling for Recruitment of Pregnant Women and Mother-Newborn Dyads.

Objective: In 2010, the National Children's Study launched 3 alternative recruitment methods to test possible improvements in efficiency compared with traditional household-based recruitment and participant enrollment. In 2012, a fourth method, provider-based sampling (PBS), tested a probability-based sampling of prenatal provider locations supplemented by a second cohort of neonates born at a convenience sample of maternity hospitals.

Methods: From a sampling frame of 472 prenatal care provider locations and 59 maternity hospitals, 49 provider and 7 hospital locations within or just outside 3 counties participated in study recruitment.

A collaborative care model to improve access to pediatric mental health services.

To examine if an innovative collaborative care model known as Targeted Child Psychiatric Services designed for primary care pediatricians (PCPs) and child psychiatrists (1) was associated with improved access to child psychiatry services, (2) had the potential to identify optimal care settings for pediatric mental health care and (3) examined if pediatricians appeared as likely to accept children back into their practices at discharge from TCPS depending upon diagnostic category, controlling for severity of illness and function. The diagnostic classes examined were ADHD (39%), depression (31%) and anxiety (13%). This prospective cohort design study collected medical records of 329 children referred to TCPS by 139 PCPs.

Classes of depression, anxiety, and functioning in acute coronary syndrome patients.

Objectives: To describe change in subgroups characterized by patterns of depression, anxiety, and functional impairment; examine treatment effects on subgroup membership; examine effects of sex and age on subgroup membership.

Methods: Latent class models were used to meet the first 2 objectives using 79 patients with depression/anxiety. Generalized estimating equations were used to meet the third objective.

Identifying symptom profiles of depression and anxiety in patients with an acute coronary syndrome using latent class and latent transition analysis.

Objective: To identify symptom profiles of depression and anxiety in patients with an acute coronary syndrome (ACS), to examine changes in symptom profiles over time, and finally, to examine the effects of age and sex on patients' symptom profiles.

Methods: One hundred ACS patients with mild to severe symptoms of depression and/or anxiety at 1 month post-hospital discharge were enrolled in a randomized trial of cognitive behavioral therapy. Latent class and latent transition analyses were used to identify symptom profiles and describe change over the time in profile membership.

Vulnerability-based spatial sampling stratification for the National Children's Study, Worcester County, Massachusetts: capturing health-relevant environmental and sociodemographic variability.

Background: The National Children's Study is the most ambitious study ever attempted in the United States to assess how environmental factors impact child health and development. It aims to follow 100,000 children from gestation until 21 years of age. Success requires breaking new interdisciplinary ground, starting with how to select the sample of > 1,000 children in each of 105 study sites; no standardized protocol exists for stratification of the target population by factoring in the diverse environments it inhabits.

Existing capacity to manage pharmaceuticals and related commodities in East Africa: an assessment with specific reference to antiretroviral therapy.

Background: East African countries have in the recent past experienced a tremendous increase in the volume of antiretroviral drugs. Capacity to manage these medicines in the region remains limited. Makerere University, with technical assistance from the USAID supported Rational Pharmaceutical Management Plus (RPM Plus) Program of Management Sciences for Health (MSH) established a network of academic institutions to build capacity for pharmaceutical management in the East African region.

Improving psychologic adjustment to chronic illness in cardiac patients. The role of depression and anxiety.

Background: Poor mood adjustment to chronic medical illness is often accompanied by decrements in function.

Objective: To evaluate the effectiveness of a telephone-based intervention for psychologic distress and functional impairment in cardiac illness.

Design: Randomized, controlled trial.

The effect of a telephone counseling intervention on self-rated health of cardiac patients.

Objective: The objective of this study was to evaluate the effectiveness of a telephone-based intervention on psychological distress among patients with cardiac illness.

Methods: We recruited hospitalized patients surviving an acute coronary syndrome with scores on the Hospital and Anxiety Depression Scale (HADS) indicating mild to severe depression and/or anxiety at 1 month postdischarge. Recruited patients were randomized into either an intervention or control group.

Using the Hospital Anxiety and Depression Scale to screen for depression in cardiac patients.

Objective: There is an increasing interest in trying to identify patients with chronic physical illness who would benefit from interventions to decrease psychological distress. The Hospital Anxiety and Depression Scale (HADS) is one measure that can be effectively used to identify patients struggling with anxiety and/or depression in addition to comorbid medical illness such as cardiac disease. The aim of this study is to determine if the HADS correctly identified patients with depression according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [determined using the Primary Care Evaluation of Mental Disorders (PRIME-MD), a gold-standard diagnostic tool], as depressed and to determine which items on the HADS most strongly predicted the PRIME-MD major depression diagnosis among cardiac patients.

Management of acute respiratory infections in drug shops and private pharmacies in Uganda: a study of counter attendants' knowledge and reported behaviour.

Background: In Uganda, private pharmacies and drug shops are important sources of drugs for the majority of the population. In addition to selling drugs, these outlets often serve as primary sources of information about illness and drug therapy. However, the appropriateness of dispensing by staff in these drug outlets has been found to be suboptimal.

Impact of a face-to-face educational intervention on improving the management of acute respiratory infections in private pharmacies and drug shops in Uganda.

Background: In Uganda, although private retail pharmacies and drug shops are the most common sources of drugs for the majority of the population, the quality of care received from these outlets has been reported as suboptimal. It is believed that lack of adequate knowledge is an important underlying factor to such practices.

Objectives: In this study, we investigated the impact of a face-to-face educational intervention on counter attendants' dispensing behaviour for mild and severe acute respiratory infections (ARI) in children at private pharmacies and drug shops.

Impact of an educational intervention to improve prescribing by private physicians in Uganda.

Introduction: Private physicians in urban Uganda treat a large percentage of common adult illnesses. Improving their prescribing would not only encourage more rational drug use, but also reduce costs to patients. Interventions to improve drug use are generally more successful when face-to-face educational methods are included.

A comparison of prescribing practices between public and private sector physicians in Uganda.

Introduction: Previous studies in the public sector in Uganda have demonstrated major prescribing problems due to polypharmacy and irrational use of antibiotics and injections. Little is known about prescribing in the private sector although there is little government regulation influencing practice in this sector. The introduction of policies such as the Uganda National Standard Treatment Guidelines (UNSTG) was expected to improve prescribing practices in the public and private sectors.

Attitudes and perceptions of stakeholders on decentralization of health services in Uganda: the case of Lira and Apac districts.

Background: In Uganda, the decentralization of administrative functions, management, and responsibility for health care to districts, which began in 1994, resulted in fundamental changes in health care delivery. Since the introduction of the policy in Uganda, little information has been available on stakeholders' perceptions about the benefits of the policy and how decentralization affected health care delivery.

Objectives: To identify the perceptions and beliefs of key stakeholders on the impact and process of decentralization and on the operations of health services in two districts in Uganda, and to report their suggestions to improve future implementation of similar policies.

Impact of decentralization on health services in Uganda: a look at facility utilization, prescribing and availability of essential drugs.

Introduction: Uganda began implementation of a structural adjustment programme (SAP) in July 1994 in order to improve social services. The decentralization of health services administration to district level was intended to improve the quality of health services and pharmaceutical supplies in the hospitals, with resultant increase in the level of utilization of health facilities.

Objective: This study evaluated the impact of the decentralization policy on health facility utilization; availability of essential drugs, and prescribing patterns for acute respiratory infections (ARI), diarrhoea, and malaria in two district hospitals in Uganda.

The association between primary source of ambulatory care and access to and outcomes of treatment among AIDS patients.

Objectives: To examine the relationship between having a primary source of ambulatory care (PSAC), access to AIDS treatment and prophylaxis for opportunistic infection, and hospital and mortality outcomes among heterosexual men and women with AIDS.

Methods: Using a linked AIDS Registry-Medicaid database, 366 adults were identified (1989-1991) with at least 1 year of continuous Medicaid enrollment before AIDS diagnosis, who survived 2 weeks after diagnosis, and with no antiretroviral use or Pneumocystis carinii pneumonia (PCP) prophylaxis during the pre-diagnosis year. Outcomes included times to zidovudine treatment, PCP prophylaxis, hospitalization and death following diagnosis.