Evaluation of the foot and ankle outcome score in patients with osteoarthritis of the ankle.

The foot and ankle outcome score (FAOS) has been evaluated for many conditions of the foot and ankle. We evaluated its construct validity in 136 patients with osteoarthritis of the ankle, its content validity in 37 patients and its responsiveness in 39. Data were collected prospectively from the registry of patients at our institution. All FAOS subscales were rated relevant by patients. The Pain, Activities of Daily Living, and Quality of Life subscales showed good correlation with the Physical Component score of the Short-Form-12v2. All subscales except Symptoms were responsive to change after surgery. We concluded that the FAOS is a weak instrument for evaluating osteoarthritis of the ankle. However, some of the FAOS subscales have relative strengths that allow for its limited use while we continue to seek other satisfactory outcome instruments.

Utilizing grassroots workers in family planning programs in India: prospects and problems.

In order to rapidly expand the network of delivery systems and speed up the process of acceptance of family planning messages and methods, a shift took place in the Indian family planning program from the bureaucratic "clinical" approach to the people oriented "extension" approach. As a result, there is an increasing emphasis on moving the family planning efforts closer to the grassroots level. A key methodological issue centers on the proper selection, cultural acceptability, and the effectiveness of the grassroots workers who are to be trained and through whom family planning motivational messages and methods are to be introduced. The Indian government, from time to time, has trained and utilized different groups of grassroots workers in its family planning promotional efforts. Anthropological field studies were conducted in two different regions in India to examine the potential and actual roles of two groups of grassroots workers--opinion leaders and traditional birth attendants--in the delivery of family planning services in the rural areas. These studies revealed that while the traditional birth attendants can be trained and utilized to a limited extent in promoting family planning efforts, especially to the eligible female clients, the role of the opinion leaders in such efforts is at best questionable. Based on these field studies, cultural and technical (including bureaucratic) problems in training and utilizing opinion leaders and traditional birth attendants are explored in detail. Modifications in the training program strategies are suggested to improve and expand the family planning delivery system in rural India.

A review of midwife training programs in Tamil Nadu.

PIP: Beginning in 1969 the government of India intensified programs to train and actively involve traditional midwives in the integrated approach to maternal and child health and family planning. Information obtained through questionnaires from Primary Health Centers and secondary data on midwife training programs during 1954-76 for Tamil Nadu reveal that the training programs had a number of shortcomings, rendering the delivery of MCH/FP services problematical. Several improvements are recommended to make training programs more attractive and effective, among them micro level planning before, during, and after each training period; proper assessment of community needs; attention to sociocultural characteristics of the practicing midwives and their clients; and supervision and follow-up of trained midwives. Data reveal that, although it has not been well implemented, the training and utilization of indigenous midwives in the delivery of modern MCH/FP services and supplies in India is a well conceived and timely undertaking.^ieng