A train-the-trainer education and promotion program: chronic fatigue syndrome – a diagnostic and management challenge

<p>Abstract</p> <p>Background</p> <p>Chronic fatigue syndrome (CFS) is a complicated illness for providers and patients. Fewer than 20% of persons with CFS have been diagnosed and treated. For providers, compounding the issue are the challenges in making a diagnosis due to the lack of a biomedical marker.</p> <p>Methods</p> <p>The objective of the CFS diagnosis and management curriculum was to instruct core trainers as to the evaluation, diagnosis, and management of CFS. Over a two year period, 79 primary care physicians, physician assistants, and nurse practitioners from diverse regions in the U.S. participated as core trainers in a two day Train-the-Trainer (TTT) workshop. As core trainers, the workshop participants were expected to show increases in knowledge, self-efficacy, and management skills with the primary goal of conducting secondary presentations.</p> <p>Results</p> <p>The optimal goal for each core trainer to present secondary training to 50 persons in the health care field was not reached. However, the combined core trainer group successfully reached 2064 primary care providers. Eighty-two percent of core trainers responded "Very good" or "Excellent" in a post-tessurvey of self-efficacy expectation and CFS diagnosis. Data from the Chicago workshops showed significant improvement on the Primary Care Opinion Survey (p < 0.01) and on the Relevance and Responsibility Factors of the CAT survey (p = 0.03 and p = 0.04, respectively). Dallas workshop data show a significant change from pre- to post-test scores on the CFS Knowledge test (p = 0.001). Qualitative and process evaluation data revealed that target audience and administrative barriers impacted secondary training feasibility.</p> <p>Conclusion</p> <p>Data show the workshop was successful in meeting the objectives of increasing CFS knowledge and raising perceived self-efficacy towards making a diagnosis. The CFS TTT program informed an educational provider project by shifting the format for physicians to grand rounds and continuing medical education design while retaining TTT aspects for nurse practitioners and physicians assistants. Evaluations also indicate that secondary trainings may be more readily employed and accepted if administrative barriers are addressed early in the planning phases.</p

The Effects of Governmental Protected Areas and Social Initiatives for Land Protection on the Conservation of Mexican Amphibians

Traditionally, biodiversity conservation gap analyses have been focused on governmental protected areas (PAs). However, an increasing number of social initiatives in conservation (SICs) are promoting a new perspective for analysis. SICs include all of the efforts that society implements to conserve biodiversity, such as land protection, from private reserves to community zoning plans some of which have generated community-protected areas. This is the first attempt to analyze the status of conservation in Latin America when some of these social initiatives are included. The analyses were focused on amphibians because they are one of the most threatened groups worldwide. Mexico is not an exception, where more than 60% of its amphibians are endemic. We used a niche model approach to map the potential and real geographical distribution (extracting the transformed areas) of the endemic amphibians. Based on remnant distribution, all the species have suffered some degree of loss, but 36 species have lost more than 50% of their potential distribution. For 50 micro-endemic species we could not model their potential distribution range due to the small number of records per species, therefore the analyses were performed using these records directly. We then evaluated the efficiency of the existing set of governmental protected areas and established the contribution of social initiatives (private and community) for land protection for amphibian conservation. We found that most of the species have some proportion of their potential ecological niche distribution protected, but 20% are not protected at all within governmental PAs. 73% of endemic and 26% of micro-endemic amphibians are represented within SICs. However, 30 micro-endemic species are not represented within either governmental PAs or SICs. This study shows how the role of land conservation through social initiatives is therefore becoming a crucial element for an important number of species not protected by governmental PAs

Fatores de risco para uso do tabaco em adolescentes de duas escolas do município de Santo André, São Paulo Risk factors for tobacco use in adolescent students of two high schools of Santo André city, São Paulo, Brazil

OBJETIVO: Avaliar fatores de risco para uso de tabaco em estudantes de duas escolas do ensino médio do município de Santo André (SP) em 2005, bem como traçar o perfil do adolescente experimentador do fumo. MÉTODOS: Estudo transversal, com questionário padronizado, autoaplicável e anônimo aplicado a adolescentes escolares de ambos os sexos, matriculados no primeiro ano do ensino médio de duas escolas de Santo André, uma particular e outra pública. Foram levantadas as seguintes variáveis: idade, sexo, raça, prática de esportes, religião e hábitos do adolescente e da família. Definiu-se como "experimentador do fumo" o adolescente que experimentou cigarro (tabaco) e não continuou o hábito tabagista. Foi feita a análise descritiva com o teste do qui-quadrado e os fatores de risco para "experimentar fumo" foram analisados por regressão logística. RESULTADOS: Dos 232 questionários aplicados, 226 (90%) foram respondidos, sendo 137 (61%) na escola particular e 89 (39%) na estadual. Dentre os entrevistados, 54 (24%) referiram já ter experimentado tabaco uma vez na vida (35 na escola privada e 19 na pública). Foram fatores de risco significativos para experimentar fumo na escola particular: mãe fumante (OR 12,4; IC95% 4,1-37,8) e amigos fumantes (OR 9,6; IC95% 3,1-29,9). Na escola pública, os fatores de risco para a mesma variável foram: consumo de bebida alcoólica (OR 8,8; IC95% 1,9-40,1), amigos fumantes, (OR 7,9; IC95% 1,9-31,3) e contato com fumaça do cigarro (OR 6,4; IC95% 1,6-26,2). CONCLUSÕES: Observou-se influência significativa do meio ambiente do adolescente, inclusive social e familiar, para a experimentação do tabaco.<br>OBJECTIVE: To evaluate risk factors for tobacco use in high school students of two schools of the city of Santo Andre (São Paulo, Brazil) in 2005, as well as to describe the profile of the adolescent who uses tobacco. METHODS: Cross sectional study that applied a standardized anonimous self-answered questionnaire in adolescents of both genders registered in the first year of a public and a private high school of the city of Santo André (Brazil). The following variables were collected: age, gender, race, practice of sports, religion and habits of the family/adolescent. "Tobacco trier" was defined as those who tried cigarette and did not continue with smoking habits, excluding those who inhaled illicit drugs. Statistical analysis applied chi-square test and logistic regression. RESULTS: A total of 226 (90%) questionnaires were answered: 137 (61%) in the private and 89 (39%) in the public school. Among the adolescents, 54 (24%) used tobacco (35 - private school and 19% - public school). Significant variables associated with tobacco use in the private school were: maternal smoking (OR 12.44; 95%CI 4.10-37.79) and friends who are smokers (OR 9.58; 95%CI 3.10-29.98). In the public school, the risk factors for smoking were: alcoholic beverage use (OR 8.78; 95%CI 1.92-40.06), smoking among friends (OR 7.90; CI95%: 1.99-31.29) and contact with cigarette smoke (OR 6.40; 95%CI 1.56-26.22). CONCLUSIONS: A significant influence of social and family environment was observed regarding the use of tobacco by adolescents