WorldWideScience

Sample records for addressing complex health

  1. Nutritional metabolomics: progress in addressing complexity in diet and health.

    Jones, Dean P; Park, Youngja; Ziegler, Thomas R

    2012-08-21

    Nutritional metabolomics is rapidly maturing to use small-molecule chemical profiling to support integration of diet and nutrition in complex biosystems research. These developments are critical to facilitate transition of nutritional sciences from population-based to individual-based criteria for nutritional research, assessment, and management. This review addresses progress in making these approaches manageable for nutrition research. Important concept developments concerning the exposome, predictive health, and complex pathobiology serve to emphasize the central role of diet and nutrition in integrated biosystems models of health and disease. Improved analytic tools and databases for targeted and nontargeted metabolic profiling, along with bioinformatics, pathway mapping, and computational modeling, are now used for nutrition research on diet, metabolism, microbiome, and health associations. These new developments enable metabolome-wide association studies (MWAS) and provide a foundation for nutritional metabolomics, along with genomics, epigenomics, and health phenotyping, to support the integrated models required for personalized diet and nutrition forecasting.

  2. Evaluating complex community-based health promotion: addressing the challenges.

    Jolley, Gwyneth

    2014-08-01

    Community-based health promotion is poorly theorised and lacks an agreed evidence-base. This paper examines characteristics of community-based health promotion and the challenges they present to evaluation. A review of health promotion evaluation leads to an exploration of more recent approaches, drawing on ideas from complexity theory and developmental evaluation. A reflexive analysis of three program evaluations previously undertaken as an evaluation consultant is used to develop a conceptual model to help in the design and conduct of health promotion evaluation. The model is further explored by applying it retrospectively to one evaluation. Findings suggest that the context-contingent nature of health promotion programs; turbulence in the community context and players; multiple stakeholders, goals and strategies; and uncertainty of outcomes all contribute to the complexity of interventions. Bringing together insights from developmental evaluation and complexity theory can help to address some evaluation challenges. The proposed model emphasises recognising and responding to changing contexts and emerging outcomes, providing rapid feedback and facilitating reflexive practice. This will enable the evaluator to gain a better understanding of the influence of context and other implementation factors in a complex setting. Use of the model should contribute to building cumulative evidence and knowledge in order to identify the principles of health promotion effectiveness that may be transferable to new situations.

  3. On the road to a stronger public health workforce: visual tools to address complex challenges.

    Drehobl, Patricia; Stover, Beth H; Koo, Denise

    2014-11-01

    The public health workforce is vital to protecting the health and safety of the public, yet for years, state and local governmental public health agencies have reported substantial workforce losses and other challenges to the workforce that threaten the public's health. These challenges are complex, often involve multiple influencing or related causal factors, and demand comprehensive solutions. However, proposed solutions often focus on selected factors and might be fragmented rather than comprehensive. This paper describes approaches to characterizing the situation more comprehensively and includes two visual tools: (1) a fishbone, or Ishikawa, diagram that depicts multiple factors affecting the public health workforce; and (2) a roadmap that displays key elements-goals and strategies-to strengthen the public health workforce, thus moving from the problems depicted in the fishbone toward solutions. The visual tools aid thinking about ways to strengthen the public health workforce through collective solutions and to help leverage resources and build on each other's work. The strategic roadmap is intended to serve as a dynamic tool for partnership, prioritization, and gap assessment. These tools reflect and support CDC's commitment to working with partners on the highest priorities for strengthening the workforce to improve the public's health.

  4. Addressing Environmental Health Inequalities

    Gouveia, Nelson

    2016-01-01

    Environmental health inequalities refer to health hazards disproportionately or unfairly distributed among the most vulnerable social groups, which are generally the most discriminated, poor populations and minorities affected by environmental risks. Although it has been known for a long time that health and disease are socially determined, only recently has this idea been incorporated into the conceptual and practical framework for the formulation of policies and strategies regarding health. In this Special Issue of the International Journal of Environmental Research and Public Health (IJERPH), “Addressing Environmental Health Inequalities—Proceedings from the ISEE Conference 2015”, we incorporate nine papers that were presented at the 27th Conference of the International Society for Environmental Epidemiology (ISEE), held in Sao Paulo, Brazil, in 2015. This small collection of articles provides a brief overview of the different aspects of this topic. Addressing environmental health inequalities is important for the transformation of our reality and for changing the actual development model towards more just, democratic, and sustainable societies driven by another form of relationship between nature, economy, science, and politics. PMID:27618906

  5. Complex problems require complex solutions: the utility of social quality theory for addressing the Social Determinants of Health

    Ward Paul R

    2011-08-01

    Full Text Available Abstract Background In order to improve the health of the most vulnerable groups in society, the WHO Commission on Social Determinants of Health (CSDH called for multi-sectoral action, which requires research and policy on the multiple and inter-linking factors shaping health outcomes. Most conceptual tools available to researchers tend to focus on singular and specific social determinants of health (SDH (e.g. social capital, empowerment, social inclusion. However, a new and innovative conceptual framework, known as social quality theory, facilitates a more complex and complete understanding of the SDH, with its focus on four domains: social cohesion, social inclusion, social empowerment and socioeconomic security, all within the same conceptual framework. This paper provides both an overview of social quality theory in addition to findings from a national survey of social quality in Australia, as a means of demonstrating the operationalisation of the theory. Methods Data were collected using a national random postal survey of 1044 respondents in September, 2009. Multivariate logistic regression analysis was conducted. Results Statistical analysis revealed that people on lower incomes (less than $45000 experience worse social quality across all of the four domains: lower socio-economic security, lower levels of membership of organisations (lower social cohesion, higher levels of discrimination and less political action (lower social inclusion and lower social empowerment. The findings were mixed in terms of age, with people over 65 years experiencing lower socio-economic security, but having higher levels of social cohesion, experiencing lower levels of discrimination (higher social inclusion and engaging in more political action (higher social empowerment. In terms of gender, women had higher social cohesion than men, although also experienced more discrimination (lower social inclusion. Conclusions Applying social quality theory allows

  6. Atomic clusters with addressable complexity

    Wales, David J.

    2017-02-01

    A general formulation for constructing addressable atomic clusters is introduced, based on one or more reference structures. By modifying the well depths in a given interatomic potential in favour of nearest-neighbour interactions that are defined in the reference(s), the potential energy landscape can be biased to make a particular permutational isomer the global minimum. The magnitude of the bias changes the resulting potential energy landscape systematically, providing a framework to produce clusters that should self-organise efficiently into the target structure. These features are illustrated for small systems, where all the relevant local minima and transition states can be identified, and for the low-energy regions of the landscape for larger clusters. For a 55-particle cluster, it is possible to design a target structure from a transition state of the original potential and to retain this structure in a doubly addressable landscape. Disconnectivity graphs based on local minima that have no direct connections to a lower minimum provide a helpful way to visualise the larger databases. These minima correspond to the termini of monotonic sequences, which always proceed downhill in terms of potential energy, and we identify them as a class of biminimum. Multiple copies of the target cluster are treated by adding a repulsive term between particles with the same address to maintain distinguishable targets upon aggregation. By tuning the magnitude of this term, it is possible to create assemblies of the target cluster corresponding to a variety of structures, including rings and chains.

  7. Road Map to Address Cognitive Health

    2014-06-09

    In this podcast, CDC’s Dr. Lynda Anderson highlights the important roles that states and communities can play in addressing cognitive health as part of overall health.  Created: 6/9/2014 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 6/9/2014.

  8. Public health approach to address maternal mortality

    Sanjay K Rai

    2012-01-01

    Full Text Available Reducing maternal mortality is one of the major challenges to health systems worldwide, more so in developing countries that account for nearly 99% of these maternal deaths. Lack of a standard method for reporting of maternal death poses a major hurdle in making global comparisons. Currently much of the focus is on documenting the "number" of maternal deaths and delineating the "medical causes" behind these deaths. There is a need to acknowledge the social correlates of maternal deaths as well. Investigating and in-depth understanding of each maternal death can provide indications on practical ways of addressing the problem. Death of a mother has serious implications for the child as well as other family members and to prevent the same, a comprehensive approach is required. This could include providing essential maternal care, early management of complications and good quality intrapartum care through the involvement of skilled birth attendants. Ensuring the availability, affordability, and accessibility of quality maternal health services, including emergency obstetric care (EmOC would prove pivotal in reducing the maternal deaths. To increase perceived seriousness of the community regarding maternal health, a well-structured awareness campaign is needed with importance be given to avoid adolescent pregnancy as well. Initiatives like Janani Surakhsha Yojna (JSY that have the potential to improve maternal health needs to be strengthened. Quality assessments should form an essential part of all services that are directed toward improving maternal health. Further, emphasis needs to be given on research by involving multiple allied partners, with the aim to develop a prioritized, coordinated, and innovative research agenda for women′s health.

  9. Public health approach to address maternal mortality.

    Rai, Sanjay K; Anand, K; Misra, Puneet; Kant, Shashi; Upadhyay, Ravi Prakash

    2012-01-01

    Reducing maternal mortality is one of the major challenges to health systems worldwide, more so in developing countries that account for nearly 99% of these maternal deaths. Lack of a standard method for reporting of maternal death poses a major hurdle in making global comparisons. Currently much of the focus is on documenting the "number" of maternal deaths and delineating the "medical causes" behind these deaths. There is a need to acknowledge the social correlates of maternal deaths as well. Investigating and in-depth understanding of each maternal death can provide indications on practical ways of addressing the problem. Death of a mother has serious implications for the child as well as other family members and to prevent the same, a comprehensive approach is required. This could include providing essential maternal care, early management of complications and good quality intrapartum care through the involvement of skilled birth attendants. Ensuring the availability, affordability, and accessibility of quality maternal health services, including emergency obstetric care (EmOC) would prove pivotal in reducing the maternal deaths. To increase perceived seriousness of the community regarding maternal health, a well-structured awareness campaign is needed with importance be given to avoid adolescent pregnancy as well. Initiatives like Janani Surakhsha Yojna (JSY) that have the potential to improve maternal health needs to be strengthened. Quality assessments should form an essential part of all services that are directed toward improving maternal health. Further, emphasis needs to be given on research by involving multiple allied partners, with the aim to develop a prioritized, coordinated, and innovative research agenda for women's health.

  10. The role of health education in addressing the health divide

    Simovska, Venka

    2013-01-01

    The aim of this chapter is to argue that an approach to health education, consistent with critical education theory echoing Freire’s ideas, has the potential to play a significant role in addressing determinants of health by, first and foremost, providing children and young people...... with opportunities (as part of teaching and learning processes) to critically examine health issues, including social determinants of health, and to gain experience with initiating health-promoting changes within the everyday realms of their school or its adjacent community....

  11. EPIDEMIOLOGÍA Y ANTROPOLOGÍA: Una propuesta frente a problemas complejos en Salud Pública Epidemiology and Anthropology: a proposal to address complexity in public health

    Guillermo Sánchez Vanegas

    2012-09-01

    Full Text Available Los problemas de salud pública son objetos complejos, multifacéticos, concatenados y contradictorios. La epidemiología requiere de un complemento que le permita lidiar con esos objetos. El riesgo visto desde la perspectiva epidemiológica de los modelos multivariados, ofrece un alto potencial, pero es insuficiente para la comprensión integral de los fenómenos de estudio. La propuesta plantea una integración entre la epidemiología y la antropología, a partir del diálogo entre modelos de riesgo y narrativas provenientes de una etnografía abductiva, iterativa y recursiva.Public health problems are complex, multifaceted, concatenated and contradictory; epidemiology is in need of a complement allowing it to deal with such objects. Risk seen from the point of view of multivariate models' epidemiological perspective would seem to offer great potential in this respect but, nevertheless, this is inadequate for an integral understanding of study phenomena. The current proposal suggests integrating epidemiology and anthropology from dialogue between risk and narrative models arising from abductive, iterative and recursive ethnography.

  12. Community Changes Address Common Health Threat

    2013-09-30

    This podcast helps residents living in multiunit housing, like apartments and condos, understand the threat of secondhand smoke. It also helps residents understand what steps they can take to breathe a little easier if involuntarily exposed to secondhand smoke.  Created: 9/30/2013 by Division of Community Health, National Center for Chronic Disease Prevention and Health Promotion.   Date Released: 9/30/2013.

  13. Actions States and Communities Can Take to Address Cognitive Health

    2014-06-09

    In this podcast, CDC’s Dr. Lynda Anderson highlights the important roles that states and communities can play in addressing cognitive health as part of overall health.  Created: 6/9/2014 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 6/9/2014.

  14. Complexity and Health Coaching: Synergies in Nursing

    Gail J. Mitchell

    2013-01-01

    Full Text Available Health care professionals are increasingly aware that persons are complex and live in relation with other complex human communities and broader systems. Complex beings and systems are living and evolving in nonlinear ways through a process of mutual influence. Traditional standardized approaches in chronic disease management do not address these non-linear linkages and the meaning and changes that impact day-to-day life and caring for self and family. The RN health coach role described in this paper addresses the complexities and ambiguities for persons living with chronic illness in order to provide person-centered care and support that are unique and responsive to the context of persons’ lives. Informed by complexity thinking and relational inquiry, the RN health coach is an emergent innovation of creative action with community and groups that support persons as they shape their health and patterns of living.

  15. Complexity and health coaching: synergies in nursing.

    Mitchell, Gail J; Cross, Nadine; Wilson, Michelle; Biernacki, Shauna; Wong, Winnie; Adib, Behnam; Rush, Danica

    2013-01-01

    Health care professionals are increasingly aware that persons are complex and live in relation with other complex human communities and broader systems. Complex beings and systems are living and evolving in nonlinear ways through a process of mutual influence. Traditional standardized approaches in chronic disease management do not address these non-linear linkages and the meaning and changes that impact day-to-day life and caring for self and family. The RN health coach role described in this paper addresses the complexities and ambiguities for persons living with chronic illness in order to provide person-centered care and support that are unique and responsive to the context of persons' lives. Informed by complexity thinking and relational inquiry, the RN health coach is an emergent innovation of creative action with community and groups that support persons as they shape their health and patterns of living.

  16. Health and the environment : assessing the impacts, addressing the uncertainties

    Knol, A.B.

    2010-01-01

    Environmental health problems have become increasingly complex. Climate change, increased urbanization or exposure to electromagnetic fields are highly divergent examples of issues about which no scientific consensus exists, for which no straightforward solutions are available and which are embedded

  17. Increasing the capacity of health sciences to address health disparities.

    Daley, Sandra P; Broyles, Shelia L; Rivera, Lourdes M; Reznik, Vivian M

    2009-09-01

    In order to create a cohort of investigators who are engaged in health disparities research, scholarship, and practice, and to increase the amount of funding in the university that is invested in research focused on reducing health disparities, the San Diego EXPORT Center implemented 2 major initiatives: (1) the support of underrepresented minority (URM) junior faculty development and (2) the funding for pilot research grants in health disparities. This paper describes the activities employed by the center and summarizes the outcomes of these two initiatives. Ninety-five percent (18 of 19) URM junior faculty completed the faculty development program, and 83.3% (15 of 18) of the completers are advancing in their academic careers at University of California San Diego (UCSD) and are teaching, working with populations at risk and/or conducting research in health disparities. EXPORT awarded 7 investigators a total of $429186 to conduct pilot research, and 71.4% (5/7) have now obtained $4.7 million in independent extramural funding. The San Diego EXPORT Center has increased the research capacity, strengthened the infrastructure for health disparities research, and created a cohort of successful URM junior faculty who are advancing in their academic careers. These investigators are already changing the climate at UCSD by their leadership activities, research focus, peer-networking, and mentoring of students.

  18. Redesigning Health Care Practices to Address Childhood Poverty.

    Fierman, Arthur H; Beck, Andrew F; Chung, Esther K; Tschudy, Megan M; Coker, Tumaini R; Mistry, Kamila B; Siegel, Benjamin; Chamberlain, Lisa J; Conroy, Kathleen; Federico, Steven G; Flanagan, Patricia J; Garg, Arvin; Gitterman, Benjamin A; Grace, Aimee M; Gross, Rachel S; Hole, Michael K; Klass, Perri; Kraft, Colleen; Kuo, Alice; Lewis, Gena; Lobach, Katherine S; Long, Dayna; Ma, Christine T; Messito, Mary; Navsaria, Dipesh; Northrip, Kimberley R; Osman, Cynthia; Sadof, Matthew D; Schickedanz, Adam B; Cox, Joanne

    2016-04-01

    Child poverty in the United States is widespread and has serious negative effects on the health and well-being of children throughout their life course. Child health providers are considering ways to redesign their practices in order to mitigate the negative effects of poverty on children and support the efforts of families to lift themselves out of poverty. To do so, practices need to adopt effective methods to identify poverty-related social determinants of health and provide effective interventions to address them. Identification of needs can be accomplished with a variety of established screening tools. Interventions may include resource directories, best maintained in collaboration with local/regional public health, community, and/or professional organizations; programs embedded in the practice (eg, Reach Out and Read, Healthy Steps for Young Children, Medical-Legal Partnership, Health Leads); and collaboration with home visiting programs. Changes to health care financing are needed to support the delivery of these enhanced services, and active advocacy by child health providers continues to be important in effecting change. We highlight the ongoing work of the Health Care Delivery Subcommittee of the Academic Pediatric Association Task Force on Child Poverty in defining the ways in which child health care practice can be adapted to improve the approach to addressing child poverty.

  19. Addressing the health workforce crisis: towards a common approach

    McCaffery Jim

    2006-08-01

    Full Text Available Abstract The challenges in the health workforce are well known and clearly documented. What is not so clearly understood is how to address these issues in a comprehensive and integrated manner that will lead to solutions. This editorial presents – and invites comments on – a technical framework intended to raise awareness among donors and multisector organizations outside ministries of health and to guide planning and strategy development at the country level.

  20. Using Cost-Effectiveness Analysis to Address Health Equity Concerns.

    Cookson, Richard; Mirelman, Andrew J; Griffin, Susan; Asaria, Miqdad; Dawkins, Bryony; Norheim, Ole Frithjof; Verguet, Stéphane; J Culyer, Anthony

    2017-02-01

    This articles serves as a guide to using cost-effectiveness analysis (CEA) to address health equity concerns. We first introduce the "equity impact plane," a tool for considering trade-offs between improving total health-the objective underpinning conventional CEA-and equity objectives, such as reducing social inequality in health or prioritizing the severely ill. Improving total health may clash with reducing social inequality in health, for example, when effective delivery of services to disadvantaged communities requires additional costs. Who gains and who loses from a cost-increasing health program depends on differences among people in terms of health risks, uptake, quality, adherence, capacity to benefit, and-crucially-who bears the opportunity costs of diverting scarce resources from other uses. We describe two main ways of using CEA to address health equity concerns: 1) equity impact analysis, which quantifies the distribution of costs and effects by equity-relevant variables, such as socioeconomic status, location, ethnicity, sex, and severity of illness; and 2) equity trade-off analysis, which quantifies trade-offs between improving total health and other equity objectives. One way to analyze equity trade-offs is to count the cost of fairer but less cost-effective options in terms of health forgone. Another method is to explore how much concern for equity is required to choose fairer but less cost-effective options using equity weights or parameters. We hope this article will help the health technology assessment community navigate the practical options now available for conducting equity-informative CEA that gives policymakers a better understanding of equity impacts and trade-offs.

  1. Developing integrated methods to address complex resource and environmental issues

    Smith, Kathleen S.; Phillips, Jeffrey D.; McCafferty, Anne E.; Clark, Roger N.

    2016-02-08

    IntroductionThis circular provides an overview of selected activities that were conducted within the U.S. Geological Survey (USGS) Integrated Methods Development Project, an interdisciplinary project designed to develop new tools and conduct innovative research requiring integration of geologic, geophysical, geochemical, and remote-sensing expertise. The project was supported by the USGS Mineral Resources Program, and its products and acquired capabilities have broad applications to missions throughout the USGS and beyond.In addressing challenges associated with understanding the location, quantity, and quality of mineral resources, and in investigating the potential environmental consequences of resource development, a number of field and laboratory capabilities and interpretative methodologies evolved from the project that have applications to traditional resource studies as well as to studies related to ecosystem health, human health, disaster and hazard assessment, and planetary science. New or improved tools and research findings developed within the project have been applied to other projects and activities. Specifically, geophysical equipment and techniques have been applied to a variety of traditional and nontraditional mineral- and energy-resource studies, military applications, environmental investigations, and applied research activities that involve climate change, mapping techniques, and monitoring capabilities. Diverse applied geochemistry activities provide a process-level understanding of the mobility, chemical speciation, and bioavailability of elements, particularly metals and metalloids, in a variety of environmental settings. Imaging spectroscopy capabilities maintained and developed within the project have been applied to traditional resource studies as well as to studies related to ecosystem health, human health, disaster assessment, and planetary science. Brief descriptions of capabilities and laboratory facilities and summaries of some

  2. Developing integrated methods to address complex resource and environmental issues

    Smith, Kathleen S.; Phillips, Jeffrey D.; McCafferty, Anne E.; Clark, Roger N.

    2016-02-08

    IntroductionThis circular provides an overview of selected activities that were conducted within the U.S. Geological Survey (USGS) Integrated Methods Development Project, an interdisciplinary project designed to develop new tools and conduct innovative research requiring integration of geologic, geophysical, geochemical, and remote-sensing expertise. The project was supported by the USGS Mineral Resources Program, and its products and acquired capabilities have broad applications to missions throughout the USGS and beyond.In addressing challenges associated with understanding the location, quantity, and quality of mineral resources, and in investigating the potential environmental consequences of resource development, a number of field and laboratory capabilities and interpretative methodologies evolved from the project that have applications to traditional resource studies as well as to studies related to ecosystem health, human health, disaster and hazard assessment, and planetary science. New or improved tools and research findings developed within the project have been applied to other projects and activities. Specifically, geophysical equipment and techniques have been applied to a variety of traditional and nontraditional mineral- and energy-resource studies, military applications, environmental investigations, and applied research activities that involve climate change, mapping techniques, and monitoring capabilities. Diverse applied geochemistry activities provide a process-level understanding of the mobility, chemical speciation, and bioavailability of elements, particularly metals and metalloids, in a variety of environmental settings. Imaging spectroscopy capabilities maintained and developed within the project have been applied to traditional resource studies as well as to studies related to ecosystem health, human health, disaster assessment, and planetary science. Brief descriptions of capabilities and laboratory facilities and summaries of some

  3. Trends in public health policies addressing violence against women

    Kattia Rojas Loría

    2014-08-01

    Full Text Available OBJECTIVE To analyze the content of policies and action plans within the public healthcare system that addresses the issue of violence against women. METHODS A descriptive and comparative study was conducted on the health policies and plans in Catalonia and Costa Rica from 2005 to 2011. It uses a qualitative methodology with documentary analysis. It is classified by topics that describe and interpret the contents. We considered dimensions, such as principles, strategies, concepts concerning violence against women, health trends, and evaluations. RESULTS Thirteen public policy documents were analyzed. In both countries’ contexts, we have provided an overview of violence against women as a problem whose roots are in gender inequality. The strategies of gender policies that address violence against women are cultural exchange and institutional action within the public healthcare system. The actions of the healthcare sector are expanded into specific plans. The priorities and specificity of actions in healthcare plans were the distinguishing features between the two countries. CONCLUSIONS The common features of the healthcare plans in both the counties include violence against women, use of protocols, detection tasks, care and recovery for women, and professional self-care. Catalonia does not consider healthcare actions with aggressors. Costa Rica has a lower specificity in conceptualization and protocol patterns, as well as a lack of updates concerning health standards in Catalonia.

  4. Vaal Triangle air pollution health study. Addressing South African problems

    Terblanche, P.; Nel, R. [CSIR Environmental Services, Pretoria (South Africa); Surridge, T. [Dept. of Mineral and Energy Affairs (South Africa); Annegarn, H. [Annegarn Environmental Research, Johannesburg (South Africa); Tosen, G. [Eskom, Johannesburg (South Africa); Pols, A. [CSIR Informationtek, Pretoria (South Africa)

    1995-12-31

    Situated in the central region of South Africa, the Vaal Triangle is an area which plays a vital role in driving the economic dynamo of South Africa. Also, because of the concentration of heavy industry, it is an area which provides a challenge in effective air pollution control. The Vaal Triangle lies within the Vaal River Basin, at an altitude of 1 500 m above sea level. Meteorological conditions in the area are highly conducive to the formation of surface temperature inversions, resulting in a poor dispersion potential. Because of multiple sources of air pollution in the area, poor dispersion conditions increase the risk pollution build-up and subsequent adverse impacts. The situation is further exacerbated by the continued combustion of coal in households, even after the electrification of residences. This is particularly chronic in the developing communities and during winter. Vaal Triangle Air Pollution Health Study (VAPS) was initiated in 1990 by the Department of Health, the Medical Research Council and major industries in the area to determine effects of air pollution on the health of the community. The final results of that study summarised in this article, and options to ameliorate problems are addressed. (author)

  5. 75 FR 51831 - Request for Measures of Health Plan Efforts To Address Health Plan Members' Health Literacy Needs

    2010-08-23

    ... Quality Request for Measures of Health Plan Efforts To Address Health Plan Members' Health Literacy Needs...' health literacy needs and how well they communicate with health plan enrollees. This initiative is in response to the need identified by AHRQ to develop a new supplemental item set (the ``new instrument'')...

  6. Rebalancing brain drain: exploring resource reallocation to address health worker migration and promote global health.

    Mackey, Timothy Ken; Liang, Bryan Albert

    2012-09-01

    Global public health is threatened by an imbalance in health worker migration from resource-poor countries to developed countries. This "brain drain" results in health workforce shortages, health system weakening, and economic loss and waste, threatening the well-being of vulnerable populations and effectiveness of global health interventions. Current structural imbalances in resource allocation and global incentive structures have resulted in 57 countries identified by WHO as having a "critical shortage" of health workers. Yet current efforts to strengthen domestic health systems have fallen short in addressing this issue. Instead, global solutions should focus on sustainable forms of equitable resource sharing. This can be accomplished by adoption of mandatory global resource and staff-sharing programs in conjunction with implementation of state-based health services corps.

  7. Complex health care interventions: Characteristics relevant for ethical analysis in health technology assessment.

    Lysdahl, Kristin Bakke; Hofmann, Bjørn

    2016-01-01

    Complexity entails methodological challenges in assessing health care interventions. In order to address these challenges, a series of characteristics of complexity have been identified in the Health Technology Assessment (HTA) literature. These characteristics are primarily identified and developed to facilitate effectiveness, safety, and cost-effectiveness analysis. However, ethics is also a constitutive part of HTA, and it is not given that the conceptions of complexity that appears relevant for effectiveness, safety, and cost-effectiveness analysis are also relevant and directly applicable for ethical analysis in HTA. The objective of this article is therefore to identify and elaborate a set of key characteristics of complex health care interventions relevant for addressing ethical aspects in HTA. We start by investigating the relevance of the characteristics of complex interventions, as defined in the HTA literature. Most aspects of complexity found to be important when assessing effectiveness, safety, and efficiency turn out also to be relevant when assessing ethical issues of a given health technology. However, the importance and relevance of the complexity characteristics may differ when addressing ethical issues rather than effectiveness. Moreover, the moral challenges of a health care intervention may themselves contribute to the complexity. After identifying and analysing existing conceptions of complexity, we synthesise a set of five key characteristics of complexity for addressing ethical aspects in HTA: 1) multiple and changing perspectives, 2) indeterminate phenomena, 3) uncertain causality, 4) unpredictable outcome, and 5) ethical complexity. This may serve as an analytic tool in addressing ethical issues in HTA of complex interventions.

  8. Managing a scarce resource: addressing critical health workforce challenges.

    Giepmans. P.; Dussault, G.; Batenburg, R.; Frich, J.; Olivers, R.; Sermeus, W.

    2013-01-01

    With health care services significantly changing, the challenge is to initiate innovative, situational and integrated workforce forecasting and planning. Many health systems require a shift in mindset to move to the planning of skill mixes for health care professionals. This implies great challenges

  9. Cultural Diversity Among Older Adults: Addressing Health Education

    Haber, David

    2005-01-01

    The diversity of the older adult population is increasing, and health professionals need to learn new knowledge and skills to improve the adherence of older ethnic clients to their health recommendations. Much of the existing research literature on diversity in gerontology concludes that ethnic older adults are at a health disadvantage. Few if any…

  10. Developing Social Marketing Capacity to Address Health Issues

    Whitelaw, S.; Smart, E.; Kopela, J.; Gibson, T.; King, V.

    2011-01-01

    Purpose: Social marketing is increasingly being seen as a potentially effective means of pursuing health education practice generally and within various specific areas such as mental health and wellbeing and more broadly in tackling health inequalities. This paper aims to report and reflect on the authors' experiences of undertaking a health…

  11. Health Care Students’ Attitudes Towards Addressing Sexual Health in Their Future Professional Work

    Gerbild, Helle Nygaard; Larsen, Camilla Marie; Areskoug Josefsson, Kristina

    2016-01-01

    students’ attitudes towards working with and communicating about sexual health; thus, to be able to use the Students’ Attitudes Towards Addressing Sexual Health (SA-SH) questionnaire in a Danish context, it is necessary to translate and test the translated questionnaire psychometrically. The aim......Students’ attitudes and educational needs regarding sexual health are important, since their ability to promote sexual health in their future profession can be challenged by their attitudes and knowledge of sexuality and sexual health. There are no existing Danish instruments able to measure...... of the SA-SH (SA-SH-D) had a Cronbach’s alpha of 0.67. The content validity index showed high relevance (item context validity index 0.82–1.0), and item scale correlation was satisfactory. The SA-SH-D is a valid and reliable questionnaire, which can be used to measure health care professional students...

  12. Anthropologists address health equity: recognizing barriers to care

    2015-01-01

    Systems change is necessary for improving health care in the United States, especially for populations suffering from health disparities. Theoretical and methodological contributions of anthropology to health care design and delivery can inform systems change by providing a window into provider and patient perceptions and practices. Our community-engaged research teams conduct in-depth investigations of provider perceptions of patients, often uncovering gaps between patient and provider perceptions resulting in the degradation of health equity. We present examples of projects where collaborations between anthropologists and health professionals resulted in actionable data on functioning and malfunctioning systemic momentum toward efforts to eliminate disparities and support wellness. PMID:27158189

  13. Toward Culturally Centered Integrative Care for Addressing Mental Health Disparities among Ethnic Minorities

    Holden, Kisha; McGregor, Brian; Thandi, Poonam; Fresh, Edith; Sheats, Kameron; Belton, Allyson; Mattox, Gail; Satcher, David

    2014-01-01

    Despite decades of research, recognition and treatment of mental illness and its co-morbidities still remain a significant public health problem in the United States. Ethnic minorities are identified as a population that is vulnerable to mental health disparities and face unique challenges pertaining to mental health care. Psychiatric illness is associated with great physical, emotional, functional, and societal burden. The primary health care setting may be a promising venue for screening, assessment, and treatment of mental illnesses for ethnic minority populations. We propose a comprehensive, innovative, culturally centered integrated care model to address the complexities within the health care system, from the individual level, that includes provider and patient factors, to the system level, which include practice culture and system functionality issues. Our multi-disciplinary investigative team acknowledges the importance of providing culturally tailored integrative healthcare to holistically concentrate on physical, mental, emotional, and behavioral problems among ethnic minorities in a primary care setting. It is our intention that the proposed model will be useful for health practitioners, contribute to the reduction of mental health disparities, and promote better mental health and well-being for ethnic minority individuals, families, and communities. PMID:25383991

  14. Oral health in Libya: addressing the future challenges.

    Peeran, Syed Wali; Altaher, Omar Basheer; Peeran, Syed Ali; Alsaid, Fatma Mojtaba; Mugrabi, Marei Hamed; Ahmed, Aisha Mojtaba; Grain, Abdulgader

    2014-01-01

    Libya is a vast country situated in North Africa, having a relatively better functioning economy with a scanty population. This article is the first known attempt to review the current state of oral health care in Libya and to explore the present trends and future challenges. Libyan health system, oral health care, and human resources with the present status of dental education are reviewed comprehensively. A bibliographic study of oral health research and publications has been carried out. The results point toward a common indicator that oral health-related research is low. Strategies have to be developed to educate the medical and dental professionals, to update the current curriculum and enable the system to be competent in all aspects of oral health care management.

  15. Infusing Oral Health Care into Nursing Curriculum: Addressing Preventive Health in Aging and Disability

    Joan Earle Hahn

    2012-01-01

    Full Text Available Access to oral health care is essential for promoting and maintaining overall health and well-being, yet oral health disparities exist among vulnerable and underserved populations. While nurses make up the largest portion of the health care work force, educational preparation to address oral health needs of elders and persons with disabilities is limited across nursing curricula. This descriptive study reports on the interdisciplinary development, implementation, and testing of an oral health module that was included and infused into a graduate nursing curriculum in a three-phase plan. Phase 1 includes evaluation of a lecture presented to eight gerontological nurse practitioner (GNP students. Phase 2 includes evaluation of GNP students’ perceptions of learning, skills, and confidence following a one-time 8-hour practicum infused into 80 required practicum hours. The evaluation data show promise in preparing nurse practitioner students to assess and address preventive oral health needs of persons aging with disabilities such that further infusion and inclusion in a course for nurse practitioners across five specialties will implemented and tested in Phase 3.

  16. Ideological and organizational components of differing public health strategies for addressing the social determinants of health.

    Raphael, Dennis; Brassolotto, Julia; Baldeo, Navindra

    2015-12-01

    Despite a history of conceptual contributions to reducing health inequalities by addressing the social determinants of health (SDH), Canadian governmental authorities have struggled to put these concepts into action. Ontario's-Canada's most populous province-public health scene shows a similar pattern. In statements and reports, governmental ministries, professional associations and local public health units (PHUs) recognize the importance of these issues, yet there has been varying implementation of these concepts into public health activity. The purpose of this study was to gain insight into the key features responsible for differences in SDH-related activities among local PHUs. We interviewed Medical Officers of Health (MOH) and key staff members from nine local PHUs in Ontario varying in SDH activity as to their understandings of the SDH, public health's role in addressing the SDH, and their units' SDH-related activities. We also reviewed their unit's documents and their organizational structures in relation to acting on the SDH. Three clusters of PHUs are identified based on their SDH-related activities: service-delivery-oriented; intersectoral and community-based; and public policy/public education-focused. The two key factors that differentiate PHUs are specific ideological commitments held by MOHs and staff and the organizational structures established to carry out SDH-related activities. The ideological commitments and the organizational structures of the most active PHUs showed congruence with frameworks adopted by national jurisdictions known for addressing health inequalities. These include a structural analysis of the SDH and a centralized organizational structure that coordinates SDH-related activities.

  17. Megacities and Large Urban Complexes - WMO Role in Addressing Challenges and Opportunities

    Terblanche, Deon; Jalkanen, Liisa

    2013-04-01

    Megacities and Large Urban Complexes - WMO Role in Addressing Challenges and Opportunities Deon E. Terblanche and Liisa Jalkanen dterblanche@wmo.int ljalkanen@wmo.int World Meteorological Organization, Geneva, Switzerland The 21st Century could amongst others, become known as the century in which our species has evolved from Homo sapiens to Homo urbanus. By now the urban population has surpassed the rural population and the rate of urbanization will continue at such a pace that by 2050 urban dwellers could outnumber their rural counterpart by more than two to one. Most of this growth in urban population will occur in developing countries and along coastal areas. Urbanization is to a large extent the outcome of humans seeking a better life through improved opportunities presented by high-density communities. Megacities and large urban complexes provide more job opportunities and social structures, better transport and communication links and a relative abundance of physical goods and services when compared to most rural areas. Unfortunately these urban complexes also present numerous social and environmental challenges. Urban areas differ from their surroundings by morphology, population density, and with high concentration of industrial activities, energy consumption and transport. They also pose unique challenges to atmospheric modelling and monitoring and create a multi-disciplinary spectrum of potential threats, including air pollution, which need to be addressed in an integrated way. These areas are also vulnerable to the changing climate and its implications to sea-level and extreme events, air quality and related health impacts. Many urban activities are significantly impacted by weather events that would not be considered to be of high impact in less densely populated areas. For instance, moderate precipitation events can cause flooding and landslides as modified urban catchments generally have higher run-off to rainfall ratios than their more pristine rural

  18. Addressing the changing sources of health information in Iran

    Amir Alishahi Tabriz

    2013-01-01

    Conclusion : Although during 8 years of study radio and television remained as main source of health information but there is an increasing tendency to use internet especially in men. Policymakers should revise their broadcasting strategies based on people demand.

  19. The role of academic research and teaching in addressing health in situations of conflict and instability.

    Collinson, Lucie

    2014-01-01

    The key roles of academic research and teaching in addressing health in situations of conflict and instability are to better inform and better equip actors with the knowledge and skills to address health problems. The four key contributions of research are: quantifying the health problem, examining the contextual circumstances, investigating the epidemiology of health problems and evaluation of health care and humanitarian interventions. The role of teaching can complement research by distributing its' findings in addition to teaching skill sets to apply this knowledge and conduct further research. Academic research and teaching both play imperative roles in enabling more successful approaches in addressing health in situations of conflict and instability.

  20. Designing a Community-Based Lay Health Advisor Training Curriculum to Address Cancer Health Disparities

    Gwede, Clement K.; Ashley, Atalie A.; McGinnis, Kara; Montiel-Ishino, F. Alejandro; Standifer, Maisha; Baldwin, Julie; Williams, Coni; Sneed, Kevin B.; Wathington, Deanna; Dash-Pitts, Lolita; Green, B. Lee

    2012-01-01

    Introduction Racial and ethnic minorities have disproportionately higher cancer incidence and mortality than their White counterparts. In response to this inequity in cancer prevention and care, community-based lay health advisors (LHAs) may be suited to deliver effective, culturally relevant, quality cancer education, prevention/screening, and early detection services for underserved populations. Approach and Strategies Consistent with key tenets of community-based participatory research (CBPR), this project engaged community partners to develop and implement a unique LHA training curriculum to address cancer health disparities among medically underserved communities in a tricounty area. Seven phases of curriculum development went into designing a final seven-module LHA curriculum. In keeping with principles of CBPR and community engagement, academic–community partners and LHAs themselves were involved at all phases to ensure the needs of academic and community partners were mutually addressed in development and implementation of the LHA program. Discussion and Conclusions Community-based LHA programs for outreach, education, and promotion of cancer screening and early detection, are ideal for addressing cancer health disparities in access and quality care. When community-based LHAs are appropriately recruited, trained, and located in communities, they provide unique opportunities to link, bridge, and facilitate quality cancer education, services, and research. PMID:22982709

  1. Keeping Current. Library Media Specialists: Addressing the Student Health Epidemic

    Buddy, Juanita

    2005-01-01

    Health and educational leaders are sounding the alarm about the unhealthy condition of many students in America's K-12 schools. Each day, new scientific studies confirm that "The majority of American youth are sedentary and do not eat well. Sixteen percent of school-aged children and adolescents--or nine million--are overweight, a figure that has…

  2. Addressing health disparities in middle school students' nutrition and exercise.

    Frenn, Marilyn; Malin, Shelly; Bansal, Naveen; Delgado, Mary; Greer, Yvonne; Havice, Michael; Ho, Mary; Schweizer, Heidi

    2003-01-01

    Those with low income, especially women of African American and Hispanic heritage have the greatest risk of inactivity and obesity. A 4-session (Internet and video) intervention with healthy snack and gym labs was tested in 2 (gym lab in 1) urban low-middle-income middle schools to improve low fat diet and moderate and vigorous physical activity.1 The gym lab was particularly beneficial (p =.002). Fat in diet decreased with each Internet session in which students participated. Percentage of fat in food was reduced significantly p =.018 for Black, White, and Black/Native American girls in the intervention group. Interventions delivered through Internet and video may enable reduction of health disparities in students by encouraging those most at risk to consume 30% or less calories from fat and to engage in moderate and vigorous physical activity.

  3. NASA's Systems Engineering Approaches for Addressing Public Health Surveillance Requirements

    Vann, Timi

    2003-01-01

    NASA's systems engineering has its heritage in space mission analysis and design, including the end-to-end approach to managing every facet of the extreme engineering required for successful space missions. NASA sensor technology, understanding of remote sensing, and knowledge of Earth system science, can be powerful new tools for improved disease surveillance and environmental public health tracking. NASA's systems engineering framework facilitates the match between facilitates the match between partner needs and decision support requirements in the areas of 1) Science/Data; 2) Technology; 3) Integration. Partnerships between NASA and other Federal agencies are diagrammed in this viewgraph presentation. NASA's role in these partnerships is to provide systemic and sustainable solutions that contribute to the measurable enhancement of a partner agency's disease surveillance efforts.

  4. Understanding health from a complex systems perspective.

    Topolski, Stefan

    2009-08-01

    Doctors often use theory to inform medical practice. The current bio-psycho-social model of health may be advanced still further with theoretical rigour. Traditional fields of thermodynamics and newer fields of non-linear dynamics including chaos theory and complex systems science can inform our understanding of the complexity of human health, illness and disease. Commonly accepted aspects of human health may be projected as probabilities over time creating curves of human health potential. Maximum health may be represented by maximum functional complexity. Complexity's relationship to entropy and energy can produce a complex surface that better models the human experience of health and illness from birth to death. Such a potential health trajectory uniting complexity and entropy expands upon earlier theories of health while allowing for unusual predictions and the novel opportunity to test and validate this model of human health.

  5. School Nurses' Perceived Prevalence and Competence to Address Student Mental Health Problems

    Stephan, Sharon H.; Connors, Elizabeth H.

    2013-01-01

    Due to under-identification of student mental health problems and limited specialty mental health providers in schools, school nurses are often faced with identifying and addressing student mental health needs. This exploratory study assessed prevalence and types of student mental health problems encountered by school nurses, as well as their…

  6. New smart materials to address issues of structural health monitoring.

    Chaplya, Pavel Mikhail

    2004-12-01

    Nuclear weapons and their storage facilities may benefit from in-situ structural health monitoring systems. Appending health-monitoring functionality to conventional materials and structures has been only marginally successful. The purpose of this project was to evaluate feasibility of a new smart material that includes self-sensing health monitoring functions similar to that of a nervous system of a living organism. Reviews of current efforts in the fields of heath-monitoring, nanotechnology, micro-electromechanical systems (MEMS), and wireless sensor networks were conducted. Limitations of the current nanotechnology methods were identified and new approaches were proposed to accelerate the development of self-sensing materials. Wireless networks of MEMS sensors have been researched as possible prototypes of self-sensing materials. Sensor networks were also examined as enabling technologies for dense data collection techniques to be used for validation of numerical methods and material parameter identification. Each grain of the envisioned material contains sensors that are connected in a dendritic manner similar to networks of neurons in a nervous system. Each sensor/neuron can communicate with the neighboring grains. Both the state of the sensor (on/off) and the quality of communication signal (speed/amplitude) should indicate not only a presence of a structural defect but the nature of the defect as well. For example, a failed sensor may represent a through-grain crack, while a lost or degraded communication link may represent an inter-granular crack. A technology to create such material does not exist. While recent progress in the fields of MEMS and nanotechnology allows to envision these new smart materials, it is unrealistic to expect creation of self-sensing materials in the near future. The current state of MEMS, nanotechnology, communication, sensor networks, and data processing technologies indicates that it will take more than ten years for the

  7. Towards a feminist global bioethics: addressing women's health concerns worldwide.

    Tong, R

    2001-01-01

    In this paper I argue that a global bioethics is possible. Specifically, I present the view that there are within feminist approaches to bioethics some conceptual and methodological tools necessary to forge a bioethics that embraces the health-related concerns of both developing and developed nations equally. To support my argument I discuss some of the challenges that have historically confronted feminists. If feminists accept the idea that women are entirely the same, then feminists present as fact the fiction of the essential "Woman." Not only does "Woman" not exist, -she" obscures important racial, ethnic, cultural, and class differences among women. However, if feminists stress women's differences too much, feminists lose the power to speak coherently and cogently about gender justice, women's rights, and sexual equality in general. Analyzing the ways in which the idea of difference as well as the idea of sameness have led feminists astray, I ask whether it is possible to avoid the Scylla of absolutism (imperialism, colonialism, hegemony) on the one hand and the Charybdis of relativism (postmodernism, fragmentation, Balkanization) on the other. Finally, after reflecting upon the work of Uma Narayan, Susan Muller Okin, and Martha Nussbaum, I conclude that there is a way out of this ethical bind. By focusing on women's, children's, and men's common human needs, it is possible to lay the foundation for a just and caring global bioethics.

  8. Rewarding altruism: addressing the issue of payments for volunteers in public health initiatives.

    South, Jane; Purcell, Martin E; Branney, Peter; Gamsu, Mark; White, Judy

    2014-03-01

    Lay involvement in public health programmes occurs through formalised lay health worker (LHW) and other volunteer roles. Whether such participation should be supported, or indeed rewarded, by payment is a critical question. With reference to policy in England, UK, this paper argues how framing citizen involvement in health only as time freely given does not account for the complexities of practice, nor intrinsic motivations. The paper reports results on payment drawn from a study of approaches to support lay people in public health roles, conducted in England, 2007-9. The first phase of the study comprised a scoping review of 224 publications, three public hearings and a register of projects. Findings revealed the diversity of approaches to payment, but also the contested nature of the topic. The second phase investigated programme support matters in five case studies of public health projects, which were selected primarily to reflect role types. All five projects involved volunteers, with two utilising forms of payment to support engagement. Interviews were conducted with a sample of project staff, LHWs (paid and unpaid), external partners and service users. Drawing on both lay and professional perspectives, the paper explores how payment relates to social context as well as various motivations for giving, receiving or declining financial support. The findings show that personal costs are not always absorbed, and that there is a potential conflict between financial support, whether sessional payment or expenses, and welfare benefits. In identifying some of the advantages and disadvantages of payment, the paper highlights the complexity of an issue often addressed only superficially. It concludes that, in order to support citizen involvement, fairness and value should be considered alongside pragmatic matters of programme management; however policy conflicts need to be resolved to ensure that employment and welfare rights are maintained.

  9. New smart materials to address issues of structural health monitoring.

    Chaplya, Pavel Mikhail

    2004-12-01

    Nuclear weapons and their storage facilities may benefit from in-situ structural health monitoring systems. Appending health-monitoring functionality to conventional materials and structures has been only marginally successful. The purpose of this project was to evaluate feasibility of a new smart material that includes self-sensing health monitoring functions similar to that of a nervous system of a living organism. Reviews of current efforts in the fields of heath-monitoring, nanotechnology, micro-electromechanical systems (MEMS), and wireless sensor networks were conducted. Limitations of the current nanotechnology methods were identified and new approaches were proposed to accelerate the development of self-sensing materials. Wireless networks of MEMS sensors have been researched as possible prototypes of self-sensing materials. Sensor networks were also examined as enabling technologies for dense data collection techniques to be used for validation of numerical methods and material parameter identification. Each grain of the envisioned material contains sensors that are connected in a dendritic manner similar to networks of neurons in a nervous system. Each sensor/neuron can communicate with the neighboring grains. Both the state of the sensor (on/off) and the quality of communication signal (speed/amplitude) should indicate not only a presence of a structural defect but the nature of the defect as well. For example, a failed sensor may represent a through-grain crack, while a lost or degraded communication link may represent an inter-granular crack. A technology to create such material does not exist. While recent progress in the fields of MEMS and nanotechnology allows to envision these new smart materials, it is unrealistic to expect creation of self-sensing materials in the near future. The current state of MEMS, nanotechnology, communication, sensor networks, and data processing technologies indicates that it will take more than ten years for the

  10. Network-oriented modeling addressing complexity of cognitive, affective and social interactions

    Treur, Jan

    2016-01-01

    This book presents a new approach that can be applied to complex, integrated individual and social human processes. It provides an alternative means of addressing complexity, better suited for its purpose than and effectively complementing traditional strategies involving isolation and separation assumptions. Network-oriented modeling allows high-level cognitive, affective and social models in the form of (cyclic) graphs to be constructed, which can be automatically transformed into executable simulation models. The modeling format used makes it easy to take into account theories and findings about complex cognitive and social processes, which often involve dynamics based on interrelating cycles. Accordingly, it makes it possible to address complex phenomena such as the integration of emotions within cognitive processes of all kinds, of internal simulations of the mental processes of others, and of social phenomena such as shared understandings and collective actions. A variety of sample models – including ...

  11. Complex health care interventions: Characteristics relevant for ethical analysis in health technology assessment

    Lysdahl, Kristin Bakke

    2016-03-01

    Full Text Available Complexity entails methodological challenges in assessing health care interventions. In order to address these challenges, a series of characteristics of complexity have been identified in the Health Technology Assessment (HTA literature. These characteristics are primarily identified and developed to facilitate effectiveness, safety, and cost-effectiveness analysis. However, ethics is also a constitutive part of HTA, and it is not given that the conceptions of complexity that appears relevant for effectiveness, safety, and cost-effectiveness analysis are also relevant and directly applicable for ethical analysis in HTA. The objective of this article is therefore to identify and elaborate a set of key characteristics of complex health care interventions relevant for addressing ethical aspects in HTA. We start by investigating the relevance of the characteristics of complex interventions, as defined in the HTA literature. Most aspects of complexity found to be important when assessing effectiveness, safety, and efficiency turn out also to be relevant when assessing ethical issues of a given health technology. However, the importance and relevance of the complexity characteristics may differ when addressing ethical issues rather than effectiveness. Moreover, the moral challenges of a health care intervention may themselves contribute to the complexity. After identifying and analysing existing conceptions of complexity, we synthesise a set of five key characteristics of complexity for addressing ethical aspects in HTA: 1 multiple and changing perspectives, 2 indeterminate phenomena, 3 uncertain causality, 4 unpredictable outcome, and 5 ethical complexity. This may serve as an analytic tool in addressing ethical issues in HTA of complex interventions.

  12. The Role of Nutrition-Related Initiatives in Addressing Community Health Needs Assessments

    George, Daniel R.; Rovniak, Liza S.; Dillon, Judy; Snyder, Gail

    2017-01-01

    Academic Health Centers and nonprofit hospitals are exploring strategies to meet Affordable Care Act mandates requiring tax-exempt institutions to address community health needs, which commonly include major chronic illnesses. We explore the implications of this regulatory landscape, describing methods that nonprofit health care institutions are…

  13. Training Social Workers and Human Service Professionals to Address the Complex Financial Needs of Clients

    Frey, Jodi Jacobson; Hopkins, Karen; Osteen, Philip; Callahan, Christine; Hageman, Sally; Ko, Jungyai

    2017-01-01

    In social work and other community-based human services settings, clients often present with complex financial problems. As a need for more formal training is beginning to be addressed, evaluation of existing training is important, and this study evaluates outcomes from the Financial Stability Pathway (FSP) project. Designed to prepare…

  14. Strong Start Wraparound: Addressing the Complex Needs of Mothers in Early Recovery

    Teel, M. Kay

    2014-01-01

    The Strong Start Study tested an innovative, High-Fidelity Wraparound intervention with families in early recovery from substance use. The Strong Start Wraparound model addressed the complex needs of pregnant and parenting women who were in early recovery to increase the protective factors of parental resilience, social connections, concrete…

  15. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care.

    Betancourt, Joseph R.; Green, Alexander R.; Carrillo, J. Emilio; Ananeh-Firempong, Owusu

    2003-01-01

    OBJECTIVES: Racial/ethnic disparities in health in the U.S. have been well described. The field of "cultural competence" has emerged as one strategy to address these disparities. Based on a review of the relevant literature, the authors develop a definition of cultural competence, identify key components for intervention, and describe a practical framework for implementation of measures to address racial/ethnic disparities in health and health care. METHODS: The authors conducted a literature...

  16. Using Mixed Methods to Facilitate Complex, Multiphased Health Research

    Tina Strudsholm

    2016-02-01

    Full Text Available From conceptualization to application and evaluation, research is conducted in a context of increasing complexity of disciplines, goals, communities, and partnerships. Researchers often are challenged to demonstrate the rigor of their methods and results to audiences with diverse backgrounds and disciplinary expertise. This article illustrates the benefits of using mixed methods approaches in research designed to address issues in complex research projects. It outlines the implementation of a private, public, and academic partnership, where scientific merit of methods and results was a critical foundation to the development of public policy. The overall goal of the Public Health Leadership Competencies Project (the Project was to identify public health leadership competencies that could apply to public health practice across the country. This research demonstrates how mixed methods research in public health might be of perceived benefit to complex projects. The Project included challenges and opportunities through multiple phases of data collection and participation of members from each of the seven disciplines in public health (i.e., public health dentists, physicians, dietitians, and nurses, as well as epidemiologists, health promoters, and environmental health inspectors. The discussion addresses challenges of a national project, the complex organizational framework within which we were directed to work, and the lessons associated with using multiple sources of data.

  17. Leveraging Cloud Computing to Address Public Health Disparities: An Analysis of the SPHPS.

    Jalali, Arash; Olabode, Olusegun A; Bell, Christopher M

    2012-01-01

    As the use of certified electronic health record technology (CEHRT) has continued to gain prominence in hospitals and physician practices, public health agencies and health professionals have the ability to access health data through health information exchanges (HIE). With such knowledge health providers are well positioned to positively affect population health, and enhance health status or quality-of-life outcomes in at-risk populations. Through big data analytics, predictive analytics and cloud computing, public health agencies have the opportunity to observe emerging public health threats in real-time and provide more effective interventions addressing health disparities in our communities. The Smarter Public Health Prevention System (SPHPS) provides real-time reporting of potential public health threats to public health leaders through the use of a simple and efficient dashboard and links people with needed personal health services through mobile platforms for smartphones and tablets to promote and encourage healthy behaviors in our communities. The purpose of this working paper is to evaluate how a secure virtual private cloud (VPC) solution could facilitate the implementation of the SPHPS in order to address public health disparities.

  18. Addressing poverty, education, and gender equality to improve the health of women worldwide.

    Tyer-Viola, Lynda A; Cesario, Sandra K

    2010-01-01

    The Millennium Development Goals (MDG) that target alleviating poverty, improving primary education, and fostering gender equity are important as a foundation to promote world health. Achieving these goals will create an environment for healthy lives for women and children. Poverty, education, and gender equality, although undeniably linked, need to be addressed individually. Nurses have the capacity and political will to address MDGs and to contribute to the health and well-being of the world population.

  19. Implementing a Public Health Approach to Addressing Mental Health Needs in a University Setting: Lessons and Challenges

    Parcover, Jason; Mays, Sally; McCarthy, Amy

    2015-01-01

    The mental health needs of college students are placing increasing demands on counseling center resources, and traditional outreach efforts may be outdated or incomplete. The public health model provides an approach for reaching more students, decreasing stigma, and addressing mental health concerns before they reach crisis levels. Implementing a…

  20. Exploring the potential of Web 2.0 to address health disparities.

    Gibbons, M Chris; Fleisher, Linda; Slamon, Rachel E; Bass, Sarah; Kandadai, Venk; Beck, J Robert

    2011-01-01

    This article addresses use of the Internet and Web 2.0 technologies by racial and ethnic minorities and explores the potential opportunities and challenges in leveraging Web 2.0 approaches to impact health disparities. These opportunities and challenges include developing approaches and methods to (a) identify strategies for integrating social media into health promotion interventions focused on major health-related issues that affect members of medically underserved groups; (b) amalgamate techniques to leverage and connect social-media technologies to other evidence-informed online resources; (c) integrate health communication best practices, including addressing health literacy issues; (d) capitalize on social networking to enhance access and communication with health care providers; and (e) advance current efforts and ongoing expansion of research participation by individuals from underserved communities.

  1. Intervention Fidelity for a Complex Behaviour Change Intervention in Community Pharmacy Addressing Cardiovascular Disease Risk

    McNamara, K. P.; O'Reilly, S. L.; George, J.; Peterson, G. M.; Jackson, S. L.; Duncan, G.; Howarth, H.; Dunbar, J. A.

    2015-01-01

    Background: Delivery of cardiovascular disease (CVD) prevention programs by community pharmacists appears effective and enhances health service access. However, their capacity to implement complex behavioural change processes during patient counselling remains largely unexplored. This study aims to determine intervention fidelity by pharmacists…

  2. The case for the World Health Organization's Commission on the Social Determinants of Health to address sexual orientation.

    Logie, Carmen

    2012-07-01

    The World Health Organization's (WHO's) social determinants of health discussion underscores the need for health equity and social justice. Yet sexual orientation was not addressed within the WHO Commission on the Social Determinants of Health final report Closing the Gap in a Generation. This omission of sexual orientation as a social determinant of health stands in stark contrast with a body of evidence that demonstrates that sexual minorities are disproportionately affected by health problems associated with stigma and discrimination, such as mental health disorders. I propose strategies to integrate sexual orientation into the WHO's social determinants of health dialogue. Recognizing sexual orientation as a social determinant of health is an important first step toward health equity for sexual minorities.

  3. The politics of knowledge: implications for understanding and addressing mental health and illness.

    Jenkins, Emily K

    2014-03-01

    While knowledge represents a valuable commodity, not all forms of knowledge are afforded equal status. The politics of knowledge, which entails the privileging of particular ways of knowing through linkages between the producers of knowledge and other bearers of authority or influence, represents a powerful force driving knowledge development. Within the health research and practice community, biomedical knowledge (i.e. knowledge pertaining to the biological factors influencing health) has been afforded a privileged position, shaping the health research and practice community's view of health, illness and appropriate intervention. The aim of this study is to spark critical reflection and dialogue surrounding the ways in which the politics of knowledge have constrained progress in addressing mental health and illness, one of today's leading public health issues. I argue that the hegemony of biological knowledge represents an ethical issue as it limits the breadth of knowledge available to support practitioners to 'do good' in terms of addressing mental illness. Given the power and influence inherent within the nursing community, I propose that nurses ought to engage in critical reflection and action in an effort to better situate the health research and practice community to effectively address the mental health of populations.

  4. A Public Health Approach to Address the Mental Health Burden of Youth in Situations of Political Violence and Humanitarian Emergencies

    J.T.V.M. de Jong; L.H. Berckmoes; B.A. Kohrt; S.J. Song; W.A. Tol; R. Reis

    2015-01-01

    This paper describes how socio-ecological theory and a syndemic health systems and public health approach may help address the plight of youth in situations of political violence and humanitarian emergencies. We describe the treatment gap caused by discrepancies in epidemiological prevalence rates,

  5. CDC's Health Equity Resource Toolkit: disseminating guidance for state practitioners to address obesity disparities.

    Payne, Gayle Holmes; James, Stephen D; Hawley, Lisa; Corrigan, Bethany; Kramer, Rachel E; Overton, Samantha N; Farris, Rosanne P; Wasilewski, Yvonne

    2015-01-01

    Obesity has been on the rise in the United States over the past three decades, and is high. In addition to population-wide trends, it is clear that obesity affects some groups more than others and can be associated with age, income, education, gender, race and ethnicity, and geographic region. To reverse the obesity epidemic, the Centers for Disease Control and Prevention) promotes evidence-based and practice-informed strategies to address nutrition and physical activity environments and behaviors. These public health strategies require translation into actionable approaches that can be implemented by state and local entities to address disparities. The Centers for Disease Control and Prevention used findings from an expert panel meeting to guide the development and dissemination of the Health Equity Resource Toolkit for State Practitioners Addressing Obesity Disparities (available at http://www.cdc.gov/obesity/health_equity/toolkit.html). The Toolkit helps public health practitioners take a systematic approach to program planning using a health equity lens. The Toolkit provides a six-step process for planning, implementing, and evaluating strategies to address obesity disparities. Each section contains (a) a basic description of the steps of the process and suggested evidence-informed actions to help address obesity disparities, (b) practical tools for carrying out activities to help reduce obesity disparities, and (c) a "real-world" case study of a successful state-level effort to address obesity with a focus on health equity that is particularly relevant to the content in that section. Hyperlinks to additional resources are included throughout.

  6. CDC’s Health Equity Resource Toolkit: Disseminating Guidance for State Practitioners to Address Obesity Disparities

    Payne, Gayle Holmes; James, Stephen D.; Hawley, Lisa; Corrigan, Bethany; Kramer, Rachel E.; Overton, Samantha N.; Farris, Rosanne P.; Wasilewski, Yvonne

    2015-01-01

    Obesity has been on the rise in the United States over the past three decades, and is high. In addition to population-wide trends, it is clear that obesity affects some groups more than others and can be associated with age, income, education, gender, race and ethnicity, and geographic region. To reverse the obesity epidemic, the Centers for Disease Control and Prevention) promotes evidence-based and practice-informed strategies to address nutrition and physical activity environments and behaviors. These public health strategies require translation into actionable approaches that can be implemented by state and local entities to address disparities. The Centers for Disease Control and Prevention used findings from an expert panel meeting to guide the development and dissemination of the Health Equity Resource Toolkit for State Practitioners Addressing Obesity Disparities (available at http://www.cdc.gov/obesity/health_equity/toolkit.html). The Toolkit helps public health practitioners take a systematic approach to program planning using a health equity lens. The Toolkit provides a six-step process for planning, implementing, and evaluating strategies to address obesity disparities. Each section contains (a) a basic description of the steps of the process and suggested evidence-informed actions to help address obesity disparities, (b) practical tools for carrying out activities to help reduce obesity disparities, and (c) a “real-world” case study of a successful state-level effort to address obesity with a focus on health equity that is particularly relevant to the content in that section. Hyperlinks to additional resources are included throughout. PMID:24962967

  7. Addressing the Mental Health Problems of Chinese International College Students in the United States

    Meirong Liu

    2009-03-01

    Full Text Available This article identifies unique mental health problems experienced by Chinese international students in the United States. The uniqueness of these problems suggests the need to address them independently from other Chinese and international student communities. First, an overview of the common sources of mental health problems and specific stressors these students face is provided. This article then develops culturally sensitive programming recommendations to improve collaborative efforts between health providers, mental health social workers, faculty, and academic staff within universities to serve these students more effectively.

  8. Addressing the Social Determinants of Suicidal Behaviors and Poor Mental Health in LGBTI Populations in Australia.

    Skerrett, Delaney Michael; Mars, Michelle

    2014-09-01

    The purpose of this article is to describe and assess-as well as identify and rectify gaps in-intervention and prevention initiatives that specifically address poor mental health outcomes and suicidal behaviors in lesbian, gay, bisexual, transgender, and intersex (LGBTI) populations in Australia. It begins with an overview of the evidence base for heightened vulnerability to suicidal behaviors among LGBTI people in Australia. It then provides a discussion on the public health implications for LGBTI-targeted mental health initiatives and the prevention of and timely intervention in LGBTI suicidal behaviors. We conclude that the literature supports an increased risk for poorer mental health outcomes and suicidal behaviors in LGBTI populations in the Australian context. Psychological distress and suicidal behaviors in LGBTI people in Australia have social determinants that can and have been addressed through the provision of interventions with a strong evidence base in reducing these outcomes, implemented at a nationwide level, including training of health professionals and gatekeepers to mental health services and the general public. We conclude that the current Australian focus appears to address many of the social determinants of suicidal behaviors and poor mental health in LGBTI people but requires sustained and uniform government support if it is to continue and to produce measurable results.

  9. Exploring health stakeholders' perceptions on moving towards comprehensive primary health care to address childhood malnutrition in Iran: a qualitative study

    Saikia Udoy

    2009-02-01

    Full Text Available Abstract Background Due to the multifaceted aspect of child malnutrition, a comprehensive approach, taking social factors into account, has been frequently recommended in health literature. The Alma-Ata declaration explicitly outlined comprehensive primary health care as an approach that addresses the social, economic and political causes of poor health and nutrition. Iran as a signatory country to the Alma Ata Declaration has established primary health care since 1979 with significant progress on many health indicators during the last three decades. However, the primary health care system is still challenged to reduce inequity in conditions such as child malnutrition which trace back to social factors. This study aimed to explore the perceptions of the Iranian health stakeholders with respect to the Iranian primary health care performance and actions to move towards a comprehensive approach in addressing childhood malnutrition. Health stakeholders are defined as those who affect or can be affected by health system, for example health policy-makers, health providers or health service recipients. Methods Stakeholder analysis approach was undertaken using a qualitative research method. Different levels of stakeholders, including health policy-makers, health providers and community members were interviewed as either individuals or focus groups. Qualitative content analysis was used to interpret and compare/contrast the viewpoints of the study participants. Results The results demonstrated that fundamental differences exist in the perceptions of different health stakeholders in the understanding of comprehensive notion and action. Health policy-makers mainly believed in the need for a secure health management environment and the necessity for a whole of the government approach to enhance collaborative action. Community health workers, on the other hand, indicated that staff motivation, advocacy and involvement are the main challenges need to be

  10. Oral health during pregnancy and early childhood: barriers to care and how to address them.

    Hughes, Dana

    2010-09-01

    This brief supplements recommendations developed by the California Dental Association Foundation and the American College of Obstetricians and Gynecologists that recommended practice guidelines during the perinatal period. This brief addresses the importance and safety of oral health care during pregnancy and outlines some of the multiple system-level barriers that make it difficult for many women to access oral health services, as well as offers specific strategies for mitigating these barriers.

  11. Are health-based payments a feasible tool for addressing risk segmentation?

    Rogal, D L; Gauthier, A K

    1998-01-01

    As they attempt to increase health insurance coverage and improve the efficiency of the market, researchers, policymakers, and health plan representatives have been addressing the issue of risk segmentation. Many risk assessment tools and risk-adjusted payment methodologies have been developed and demonstrated for a variety of populations and payers experiencing various market constraints. The evidence shows that risk-adjusted payments are feasible for most populations receiving acute care, while technical obstacles, political issues, and some research gaps remain.

  12. Corruption of pharmaceutical markets: addressing the misalignment of financial incentives and public health.

    Gagnon, Marc-André

    2013-01-01

    This paper explains how the current architecture of the pharmaceutical markets has created a misalignment of financial incentives and public health that is a central cause of harmful practices. It explores three possible solutions to address that misalignment: taxes, increased financial penalties, and drug pricing based on value. Each proposal could help to partly realign financial incentives and public health. However, because of the limits of each proposal, there is no easy solution to fixing the problem of financial incentives.

  13. Tailored Educational Approaches for Consumer Health (TEACH): a model system for addressing health communication.

    Cohn, Wendy F; Pannone, Aaron; Schubart, Jane; Lyman, Jason; Kinzie, Mable; Broshek, Donna K; Guterbock, Thomas M; Hartman, David; Mick, David; Bolmey, Armando; Garson, Arthur T

    2006-01-01

    The Consumer Health Education Institute (CHEDI) has developed a model system to improve the quality and effectiveness of patient education and health communication. Through assessment of characteristics and preferences, segmentation into groups and matching with the appropriate materials, we have demonstrated that patients and health consumers have different health information needs and preferences which show promise as a basis for selecting or designing the most appropriate materials or programs.

  14. Integrated approaches to address the social determinants of health for reducing health inequity.

    Barten, F.J.M.H.; Mitlin, D.; Mulholland, C.; Hardoy, A.; Stern, R.

    2007-01-01

    The social and physical environments have long since been recognized as important determinants of health. People in urban settings are exposed to a variety of health hazards that are interconnected with their health effects. The Millennium Development Goals (MDGs) have underlined the multidimensiona

  15. The health of women and girls: how can we address gender equality and gender equity?

    Payne, Sarah

    2015-01-01

    This article focuses on the health of women and girls, and the role of addressing gender inequalities experienced by women and girls. The health of both males and females is influenced by sex, or biological factors, and gender, or socially constructed influences, including gender differences in the distribution and impact of social determinants of health, access to health promoting resources, health behaviors and gender discourse, and the ways in which health systems are organized and financed, and how they deliver care. Various strategies to address the health of women and girls have been developed at intergovernmental, regional, and national level, and by international nongovernmental organizations. These include vertical programs which aim to target specific health risks and deliver services to meet women and girl's needs, and more cross-cutting approaches which aim at "gender" policy making. Much of this work has developed following the adoption of gender mainstreaming principles across different policy arenas and scales of policy making, and this article reviews some of these strategies and the evidence for their success, before concluding with a consideration of future directions in global policy.

  16. Addressing Agricultural Issues in Health Care Education: An Occupational Therapy Curriculum Program Description

    Smallfield, Stacy; Anderson, Angela J.

    2008-01-01

    Context: Medical and allied health professionals who work in agricultural states frequently address the needs of clients who live and work in rural and frontier environments. The primary occupations of those living in rural areas include farming, ranching, or other agriculture-related work. Farming is consistently ranked as one of the most…

  17. Faculty Attitudes toward Addressing Mental Health Conditions and Substance Abuse among College Students

    O'Connor-Merrigan, Mary L.

    2013-01-01

    The continued prevalence of mental health conditions and substance abuse among students enrolled in institutions of higher education is a significant and progressing concern, with marked impact on retention, academic success, graduation rate, and alarming personal consequences. Yet, many institutions struggle with successfully addressing these…

  18. A theoretical model to address organizational human conflict and disruptive behavior in health care organizations.

    Piper, Llewellyn E

    2006-01-01

    This article proposes a theoretical model for leaders to use to address organizational human conflict and disruptive behavior in health care organizations. Leadership is needed to improve interpersonal relationships within the workforce. A workforce with a culture of internal conflict will be unable to achieve its full potential to delivery quality patient care.

  19. Structural Vulnerability: Operationalizing the Concept to Address Health Disparities in Clinical Care.

    Bourgois, Philippe; Holmes, Seth M; Sue, Kim; Quesada, James

    2017-03-01

    The authors propose reinvigorating and extending the traditional social history beyond its narrow range of risk behaviors to enable clinicians to address negative health outcomes imposed by social determinants of health. In this Perspective, they outline a novel, practical medical vulnerability assessment questionnaire that operationalizes for clinical practice the social science concept of "structural vulnerability." A structural vulnerability assessment tool designed to highlight the pathways through which specific local hierarchies and broader sets of power relationships exacerbate individual patients' health problems is presented to help clinicians identify patients likely to benefit from additional multidisciplinary health and social services. To illustrate how the tool could be implemented in time- and resource-limited settings (e.g., emergency department), the authors contrast two cases of structurally vulnerable patients with differing outcomes. Operationalizing structural vulnerability in clinical practice and introducing it in medical education can help health care practitioners think more clearly, critically, and practically about the ways social structures make people sick. Use of the assessment tool could promote "structural competency," a potential new medical education priority, to improve understanding of how social conditions and practical logistics undermine the capacities of patients to access health care, adhere to treatment, and modify lifestyles successfully. Adoption of a structural vulnerability framework in health care could also justify the mobilization of resources inside and outside clinical settings to improve a patient's immediate access to care and long-term health outcomes. Ultimately, the concept may orient health care providers toward policy leadership to reduce health disparities and foster health equity.

  20. Disease patterns addressed by mobile health-enabling technologies--a literature review.

    Von Bargen, Tobias; Schwartze, Jonas; Haux, Reinhold

    2013-01-01

    Health-enabling technologies can contribute to a better living with diverse disease patterns, especially at home. Ambient Assisted Living (AAL) provides security and convenience at the main place of residence, but usually cannot be taken on the road. Mobile health-enabling technologies could overcome this barrier of immobility and enable its' users to take advantages of assistive technology with them. The presented literature review examines disease patterns, which can be addressed by mobile health-enabling technologies. Especially chronic diseases, like diabetes, are very responsive for continuous support by portable support technology.

  1. Health journalism internships: a social marketing strategy to address health disparities.

    Nguyen, Duy H; Shimasaki, Suzuho; Stafford, Helen Shi; Sadler, Georgia Robins

    2010-09-01

    The USA seeks to eliminate health disparities by stimulating the rapid uptake of health-promoting behaviors within disadvantaged communities. A health journalism internship incorporates social marketing strategies to increase communities' access to cancer information, while helping the interns who are recruited from underrepresented communities gain admission to top graduate schools. Interns are taught basic health journalism skills that enable them to create immediate streams of cancer-related press releases for submission to community newspapers. Interns are charged with the social responsibility of continuing this dissemination process throughout their careers. Intermediate outcomes are measured as mediators of distal behavioral change goals.

  2. Has the Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh Addressed the Educational Divide in Accessing Health Care?

    Mala Rao

    Full Text Available Equity of access to healthcare remains a major challenge with families continuing to face financial and non-financial barriers to services. Lack of education has been shown to be a key risk factor for 'catastrophic' health expenditure (CHE, in many countries including India. Consequently, ways to address the education divide need to be explored. We aimed to assess whether the innovative state-funded Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh state launched in 2007, has achieved equity of access to hospital inpatient care among households with varying levels of education.We used the National Sample Survey Organization 2004 survey as our baseline and the same survey design to collect post-intervention data from 8623 households in the state in 2012. Two outcomes, hospitalisation and CHE for inpatient care, were estimated using education as a measure of socio-economic status and transforming levels of education into ridit scores. We derived relative indices of inequality by regressing the outcome measures on education, transformed as a ridit score, using logistic regression models with appropriate weights and accounting for the complex survey design.Between 2004 and 2012, there was a 39% reduction in the likelihood of the most educated person being hospitalised compared to the least educated, with reductions observed in all households as well as those that had used the Aarogyasri. For CHE the inequality disappeared in 2012 in both groups. Sub-group analyses by economic status, social groups and rural-urban residence showed a decrease in relative indices of inequality in most groups. Nevertheless, inequalities in hospitalisation and CHE persisted across most groups.During the time of the Aarogyasri scheme implementation inequalities in access to hospital care were substantially reduced but not eliminated across the education divide. Universal access to education and schemes such as Aarogyasri have the synergistic potential

  3. Knowledge into action? understanding ideological barriers to addressing health inequalities at the local level.

    Collins, Patricia A; Abelson, Julia; Eyles, John D

    2007-01-01

    The objective of this study was to explore the presence of ideological barriers to addressing local health inequalities in Hamilton, Ontario, Canada. A survey of active citizens revealed low levels of awareness of the social determinants of health (SDOH) framework, and some incongruence between understanding and attitudes towards the SDOH. Support for addressing health inequalities was associated with awareness of the SDOH framework, liberal value-systems, and a cluster of socio-demographic characteristics. Liberal leaning participants were also more politically active than their conservative counterparts. Ideological barriers included lack of SDOH awareness, narrow understandings of the relative influences of the SDOH, resistance to de-prioritizing healthcare, and conservative values. Advancement of a SDOH policy agenda should incorporate wider dissemination efforts to citizens and local service providers to increase support for this framework, and utilization of existing support and political engagement from liberal-leaning demographics.

  4. Policy Options for Addressing Health System and Human Resources for Health Crisis in Liberia Post-Ebola Epidemic.

    Budy, Fidel C T

    2015-01-01

    Qualified healthcare workers within an effective health system are critical in promoting and achieving greater health outcomes such as those espoused in the Millennium Development Goals. Liberia is currently struggling with the effects of a brutal 14-year long civil war that devastated health infrastructures and caused most qualified health workers to flee and settle in foreign countries. The current output of locally trained health workers is not adequate for the tasks at hand. The recent Ebola Virus Disease (EVD) exposed the failings of the Liberian healthcare system. There is limited evidence of policies that could be replicated in Liberia to encourage qualified diaspora Liberian health workers to return and contribute to managing the phenomenon. This paper reviews the historical context for the human resources for health crisis in Liberia; it critically examines two context-specific health policy options to address the crisis, and recommends reverse brain drain as a policy option to address the immediate and critical crisis facing the health care sector in Liberia.

  5. Promoting Health by Addressing Basic Needs: Effect of Problem Resolution on Contacting Health Referrals

    Thompson, Tess; Kreuter, Matthew W.; Boyum, Sonia

    2016-01-01

    Members of vulnerable populations have heightened needs for health services. One advantage of integrating health risk assessment and referrals into social service assistance systems such as 2-1-1 is that such systems help callers resolve problems in other areas (e.g., housing). Callers to 2-1-1 in Missouri (N = 1,090) with at least one behavioral…

  6. Don't blame patients, engage them: transforming health systems to address health literacy

    Frosch, D.L.; Elwyn, G.

    2014-01-01

    The passage of the Patient Protection and Affordable Care Act is affirming a new era for health care delivery in the United States, with an increased focus on patient engagement. The field of health literacy has important contributions to make, and there are opportunities to achieve much more synerg

  7. New and improved proteomics technologies for understanding complex biological systems: addressing a grand challenge in the life sciences.

    Hood, Leroy E; Omenn, Gilbert S; Moritz, Robert L; Aebersold, Ruedi; Yamamoto, Keith R; Amos, Michael; Hunter-Cevera, Jennie; Locascio, Laurie

    2012-09-01

    This White Paper sets out a Life Sciences Grand Challenge for Proteomics Technologies to enhance our understanding of complex biological systems, link genomes with phenotypes, and bring broad benefits to the biosciences and the US economy. The paper is based on a workshop hosted by the National Institute of Standards and Technology (NIST) in Gaithersburg, MD, 14-15 February 2011, with participants from many federal R&D agencies and research communities, under the aegis of the US National Science and Technology Council (NSTC). Opportunities are identified for a coordinated R&D effort to achieve major technology-based goals and address societal challenges in health, agriculture, nutrition, energy, environment, national security, and economic development.

  8. Identifying and Addressing the Unmet Health Care Needs of Drug Court Clients.

    Dugosh, Karen L; Festinger, David S; Lipkin, Jessica L

    2016-12-01

    Drug courts address issues such as employment and housing but largely miss the opportunity to address important health care issues. The current study examined the prevalence and correlates of chronic medical conditions among a sample of drug court clients who were participating in a clinical trial of an intervention to reduce HIV risk. A total of 256 clients completed a health survey at entry into the drug court program and 9 months post-entry. The baseline health survey included a comprehensive list of chronic medical conditions, and participants were asked to indicate which, if any, they had ever been diagnosed as having. They were also asked to indicate whether or not they were currently receiving treatment for each chronic condition that they endorsed. The follow-up survey was identical to the baseline survey, with the exception that it contained items reflecting (1) whether or not any member of the drug court team engaged in discussion with the client about each of the chronic conditions reported and (2) whether the client received a referral to medical care for endorsed conditions while in the drug court program. Results indicated that over 50% of clients reported at least one chronic condition and 21% reported more than one condition. Among those with chronic conditions, 71% reported having chronic conditions for which they were not currently receiving treatment. Unfortunately, drug court clients reported that the drug court team did little to address these unmet health needs. Findings from this study suggest that clients could benefit if drug court programs began to widen their focus to include addressing health-related issues.

  9. Residential address errors in public health surveillance data: a description and analysis of the impact on geocoding.

    Zinszer, Kate; Jauvin, Christian; Verma, Aman; Bedard, Lucie; Allard, Robert; Schwartzman, Kevin; de Montigny, Luc; Charland, Katia; Buckeridge, David L

    2010-07-01

    The residential addresses of persons with reportable communicable diseases are used increasingly for spatial monitoring and cluster detection, and public health may direct interventions based upon the results of routine spatial surveillance. There has been little assessment, however, of the quality of address data in reportable disease notifications and of the corresponding impact of these errors on geocoding and routine public health practices. The objectives of this study were to examine address errors for a selected reportable disease in a large urban center in Canada and to assess the impact of identified errors on geocoding and the estimated spatial distribution of the disease. We extracted data for all notifications of campylobacteriosis from the Montreal public health department from 1995 to 2008 and used an address verification algorithm to determine the validity of the residential address for each case and to suggest corrections for invalid addresses. We assessed the types of address errors as well as the resulting positional errors, calculating the distance between the original address and the correct address as well as changes in disease density. Address errors and missing addresses were prevalent in the public health records (10% and 5%, respectively) and they influenced the observed distribution of campylobacteriosis in Montreal, with address correction changing case location by a median of 1.1 km. Further examination of the extent of address errors in public health data is essential, as is the investigation of how these errors impact routine public health functions.

  10. Addressing Geriatric Oral Health Concerns through National Oral Health Policy in India

    Abhinav Singh

    2015-01-01

    Full Text Available There is an escalating demand for geriatric oral healthcare in all developed and developing countries including India. Two-thirds of the world’s elderly live in developing countries. This is a huge population that must receive attention from policy-makers who will be challenged by the changing demands for social and health services including oral health services. Resources are limited thus rather than being aspirational in wanting to provide all treatment needed for everybody, this critique presents a road map of how we might answer the present and future geriatric oral health concerns in a most efficient manner in a developing country. Viewing the recent Indian demographic profile and the trends in oral health, pertinent policy subjects have been discussed concerning the oral health needs of the elderly and also the associated challenges which include strategies to improve quality of life, strategies to train and educate the dental workforce and above all the role of healthcare systems towards realization of better aged society in India and other developing countries

  11. Using community-based participatory research to address Chinese older women's health needs: Toward sustainability.

    Chang, E-Shien; Simon, Melissa A; Dong, XinQi

    2016-01-01

    Although community-based participatory research (CBPR) has been recognized as a useful approach for eliminating health disparities, less attention is given to how CBPR projects may address gender inequalities in health for immigrant older women. The goal of this article is to share culturally sensitive strategies and lessons learned from the PINE study-a population-based study of U.S. Chinese older adults that was strictly guided by the CBPR approach. Working with Chinese older women requires trust, respect, and understanding of their unique historical, social, and cultural positions. We also discuss implications for developing impact-driven research partnerships that meet the needs of this vulnerable population.

  12. Large system change challenges: addressing complex critical issues in linked physical and social domains

    Waddell, Steve; Cornell, Sarah; Hsueh, Joe; Ozer, Ceren; McLachlan, Milla; Birney, Anna

    2015-04-01

    Most action to address contemporary complex challenges, including the urgent issues of global sustainability, occurs piecemeal and without meaningful guidance from leading complex change knowledge and methods. The potential benefit of using such knowledge is greater efficacy of effort and investment. However, this knowledge and its associated tools and methods are under-utilized because understanding about them is low, fragmented between diverse knowledge traditions, and often requires shifts in mindsets and skills from expert-led to participant-based action. We have been engaged in diverse action-oriented research efforts in Large System Change for sustainability. For us, "large" systems can be characterized as large-scale systems - up to global - with many components, of many kinds (physical, biological, institutional, cultural/conceptual), operating at multiple levels, driven by multiple forces, and presenting major challenges for people involved. We see change of such systems as complex challenges, in contrast with simple or complicated problems, or chaotic situations. In other words, issues and sub-systems have unclear boundaries, interact with each other, and are often contradictory; dynamics are non-linear; issues are not "controllable", and "solutions" are "emergent" and often paradoxical. Since choices are opportunity-, power- and value-driven, these social, institutional and cultural factors need to be made explicit in any actionable theory of change. Our emerging network is sharing and building a knowledge base of experience, heuristics, and theories of change from multiple disciplines and practice domains. We will present our views on focal issues for the development of the field of large system change, which include processes of goal-setting and alignment; leverage of systemic transitions and transformation; and the role of choice in influencing critical change processes, when only some sub-systems or levels of the system behave in purposeful ways

  13. New dialogue for the way forward in maternal health: addressing market inefficiencies.

    McCarthy, Katharine; Ramarao, Saumya; Taboada, Hannah

    2015-06-01

    Despite notable progress in Millennium Development Goal (MDG) five, to reduce maternal deaths three-quarters by 2015, deaths due to treatable conditions during pregnancy and childbirth continue to concentrate in the developing world. Expanding access to three effective and low-cost maternal health drugs can reduce preventable maternal deaths, if available to all women. However, current failures in markets for maternal health drugs limit access to lifesaving medicines among those most in need. In effort to stimulate renewed action planning in the post-MDG era, we present three case examples from other global health initiatives to illustrate how market shaping strategies can scale-up access to essential maternal health drugs. Such strategies include: sharing intelligence among suppliers and users to better approximate and address unmet need for maternal health drugs, introducing innovative financial strategies to catalyze otherwise unattractive markets for drug manufacturers, and employing market segmentation to create a viable and sustainable market. By building on lessons learned from other market shaping interventions and capitalizing on opportunities for renewed action planning and partnership, the maternal health field can utilize market dynamics to better ensure sustainable and equitable distribution of essential maternal health drugs to all women, including the most marginalized.

  14. Education and Sexuality: Towards Addressing Adolescents’ Reproductive Health Needs in Nigeria

    James Godswill

    2012-07-01

    Full Text Available The aim of this study is to assess the crucial role of sexuality education in addressing adolescents’ reproductive health needs within the backdrops of immense challenges in Nigerian environment. Young people have been well documented as a special need group in the area of reproductive health. Adolescent sexuality and reproductive health are important contemporary concerns especially for reproductive health problems such as early marriage, unintended/unwanted pregnancy, maternal mortality and sexually transmitted diseases, including AIDS. A large number of adolescents in Nigeria decide to be more sexually active without access to preventive measure, such as condoms or family planning devices and thus face undesired consequences, including unwanted pregnancies, Sexually Transmitted Diseases (STDs, including the Acquired Immunodeficiency Syndrome (AIDS and the social consequences of both. In fact, adolescents have a higher prevalence of most reproductive health problems because of lack of information and poor access to service. However, one of the 2004 Nigerian National Population Policy objectives is increasing the integration of adolescents and young people into development efforts and effectively addressing their reproductive health and related needs. The study, which relies mainly on secondary data, examines the crucial role and benefits of sexuality education against the backdrops of the challenges including reaching the youths with sexuality and reproductive information and service, or motivating them to change behavior in the light of new information and awareness, more institutional support and creating the social and economic climate, which will make the desired changes possible and sustainable. The author contends that it is a violation of ones fundamental human rights and freedom guaranteed by numerous international, regional and national policies as well as legal instruments when attempts are made to control rather than educate

  15. Consumer-Involved Participatory Research to Address General Medical Health and Wellness in a Community Mental Health Setting.

    Iyer, Sharat P; Pancake, Laura S; Dandino, Elizabeth S; Wells, Kenneth B

    2015-12-01

    Barriers to sustainably implementing general medical interventions in community mental health (CMH) settings include role uncertainty, consumer engagement, workforce limitations, and sustainable reimbursement. To address these barriers, this project used a community-partnered participatory research framework to create a stakeholder-based general medical and wellness intervention in a large CMH organization, with consumers involved in all decision-making processes. Consumers faced practical barriers to participating in organizational decision making, but their narratives were critical in establishing priorities and ensuring sustainability. Addressing baseline knowledge and readiness of stakeholders and functional challenges to consumer involvement can aid stakeholder-based approaches to implementing general medical interventions in CMH settings.

  16. In the right words: addressing language and culture in providing health care.

    2003-08-01

    As part of its continuing mission to serve trustees, executives, and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) convened a group of experts from philanthropy, research, health care practice, and policy on April 4, 2003, to discuss the roles of language and culture in providing effective health care. During this Issue Dialogue, In the Right Words: Addressing Language and Culture in Providing Health Care, health grantmakers and experts from policy and practice participated in an open exchange of ideas and perspectives on language access and heard from fellow grantmakers who are funding innovative programs in this area. Together they explored ways to effectively support comprehensive language services, including the use of interpreters and translation of written materials. This Issue Brief synthesizes key points from the day's discussion with a background paper previously prepared for Issue Dialogue participants. It focuses on the challenges and opportunities involved with ensuring language access for the growing number of people who require it. Sections include: recent immigration trends and demographic changes; the effect of language barriers on health outcomes and health care processes; laws and policies regarding the provision of language services to patients, including an overview of public financing mechanisms; strategies for improving language access, including enhancing access in delivery settings, promoting advocacy and policy change, improving interpreter training, and advancing research; and roles for foundations in supporting improved language access, including examples of current activities. The Issue Dialogue focused mainly on activities and programs that ensure linguistic access to health care for all patients. Although language and culture are clearly inseparable, a full exploration of the field of cultural competence and initiatives that promote its application to the health care setting are beyond the scope

  17. Addressing complex healthcare problems in diverse settings: insights from activity theory.

    Greig, Gail; Entwistle, Vikki A; Beech, Nic

    2012-02-01

    In the U.K., approaches to policy implementation, service improvement and quality assurance treat policy, management and clinical care as separate, hierarchical domains. They are often based on the central knowledge transfer (KT) theory idea that best practice solutions to complex problems can be identified and 'rolled out' across organisations. When the designated 'best practice' is not implemented, this is interpreted as local--particularly management--failure. Remedial actions include reiterating policy aims and tightening performance management of solution implementation, frequently to no avail. We propose activity theory (AT) as an alternative approach to identifying and understanding the challenges of addressing complex healthcare problems across diverse settings. AT challenges the KT conceptual separations between levels of policy, management and clinical care. It does not regard knowledge and practice as separable, and does not understand them in the commodified way that has typified some versions of KT theory. Instead, AT focuses on "objects of activity" which can be contested. It sees new practice as emerging from contradiction and understands knowledge and practice as fundamentally entwined, not separate. From an AT perspective, there can be no single best practice. The contributions of AT are that it enables us to understand the dynamics of knowledge-practice in activities rather than between levels. It shows how efforts to reduce variation from best practice may paradoxically remove a key source of practice improvement. After explaining the principles of AT we illustrate its explanatory potential through an ethnographic study of primary healthcare teams responding to a policy aim of reducing inappropriate hospital admissions of older people by the 'best practice' of rapid response teams.

  18. Translating Life Course Theory to clinical practice to address health disparities.

    Cheng, Tina L; Solomon, Barry S

    2014-02-01

    Life Course Theory (LCT) is a framework that explains health and disease across populations and over time and in a powerful way, conceptualizes health and health disparities to guide improvements. It suggests a need to change priorities and paradigms in our healthcare delivery system. In "Rethinking Maternal and Child Health: The Life Course Model as an Organizing Framework," Fine and Kotelchuck identify three areas of rethinking that have relevance to clinical care: (1) recognition of context and the "whole-person, whole-family, whole-community systems approach;" (2) longitudinal approach with "greater emphasis on early ("upstream") determinants of health"; and (3) need for integration and "developing integrated, multi-sector service systems that become lifelong "pipelines" for healthy development". This paper discusses promising clinical practice innovations in these three areas: addressing social influences on health in clinical practice, longitudinal and vertical integration of clinical services and horizontal integration with community services and resources. In addition, barriers and facilitators to implementation are reviewed.

  19. Addressing antimicrobial resistance in China: policy implementation in a complex context.

    Wang, Li; Zhang, Xiulan; Liang, Xiaoyun; Bloom, Gerald

    2016-06-06

    The effectiveness of antibiotics in treating bacterial infections is decreasing in China because of the widespread development of resistant organisms. Although China has enacted a number of regulations to address this problem, but the impact is very limited. This paper investigates the implementation of these regulations through the lens of complex adaptive systems (CAS). It presents the findings from reviews of relevant policy documents and published papers. The paper identifies different types of agent and explores their interaction with regard to the use of antibiotics and their responses to changes of the regulations. It focuses particularly on the impact of perverse financial incentives on overall patterns of use of antibiotics. Implications for the possibilities of nonlinear results, interactive relationships, and new pathways of policy implementation are discussed. The paper concludes that policy-makers need to better understand the objectives, incentives and potential adaptive behaviors of the agents when they implement interventions to improve antibiotic use and reduce the risk of emergence of resistant organisms.

  20. Addressing gaps in abortion education: a sexual health elective created by medical students.

    Caro-Bruce, Emily; Schoenfeld, Elizabeth; Nothnagle, Melissa; Taylor, Julie

    2006-05-01

    Medical school curricula frequently contain gaps in the areas of abortion and sexual health. A group of first- and second-year medical students at the authors' institution organized a collaborative, multidisciplinary elective course to address such omissions in the preclinical curriculum. This paper describes the process of creating and implementing the elective. Medical students identified curricular gaps in the areas of abortion, sexual assault, lesbian/gay/bisexual/transgender health, and HIV counseling. Clinical faculty and community-based professionals were invited to address these topics in a weekly lecture series organized by students. The course also included a half-day experience shadowing at a local abortion clinic. Collaboration with several student groups helped broaden student interest in and increase financial support for the elective. Some 37% of all first- and second-year students enrolled in the elective and received institutional credit for the course. Written and verbal evaluations confirmed student satisfaction with the lectures and the clinical experience. Dynamic and well-prepared speakers who presented interesting medical content received the highest ratings from students. Student leaders identified several challenges in implementing the elective. Ultimately the elective proved to be a successful collaboration among students, faculty, and healthcare providers, and resulted in permanent changes in the standard medical school curriculum. Challenges for student-initiated electives include difficulty in finding administrative support, securing funding and ensuring sustainability. This paper aims to make this process accessible and applicable to other students and faculty interested in addressing curricular gaps at their respective medical schools.

  1. Strengthening national capacities for researching on Social Determinants of Health (SDH) towards informing and addressing health inequities in Tanzania

    Mtenga, Sally; Masanja, Irene M; Mamdani, Masuma

    2016-01-01

    Background Tanzania’s socio-economic development is challenged by sharp inequities between and within urban and rural areas, and among different socio-economic groups. This paper discusses the importance of strengthening SDH research, knowledge, relevant capacities and responsive systems towards addressing health inequities in Tanzania. Methods Based on a conceptual framework for building SDH research capacity, a mapping of existing research systems was undertaken between February and June 20...

  2. Addressing Hearing Health Care Disparities among Older Adults in a US-Mexico Border Community

    Ingram, Maia; Marrone, Nicole; Sanchez, Daisey Thalia; Sander, Alicia; Navarro, Cecilia; de Zapien, Jill Guernsey; Colina, Sonia; Harris, Frances

    2016-01-01

    Hearing loss is associated with cognitive decline and impairment in daily living activities. Access to hearing health care has broad implications for healthy aging of the U.S. population. This qualitative study investigated factors related to the socio-ecological domains of hearing health in a U.S.–Mexico border community experiencing disparities in access to care. A multidisciplinary research team partnered with community health workers (CHWs) from a Federally Qualified Health Center (FQHC) in designing the study. CHWs conducted interviews with people with hearing loss (n = 20) and focus groups with their family/friends (n = 27) and with members of the community-at-large (n = 47). The research team conducted interviews with FQHC providers and staff (n = 12). Individuals experienced depression, sadness, and social isolation, as well as frustration and even anger regarding communication. Family members experienced negative impacts of deteriorating communication, but expressed few coping strategies. There was general agreement across data sources that hearing loss was not routinely addressed within primary care and assistive hearing technology was generally unaffordable. Community members described stigma related to hearing loss and a need for greater access to hearing health care and broader community education. Findings confirm the causal sequence of hearing impairment on quality of life aggravated by socioeconomic conditions and lack of access to hearing health care. Hearing loss requires a comprehensive and innovative public health response across the socio-ecological framework that includes both individual communication intervention and greater access to hearing health resources. CHWs can be effective in tailoring intervention strategies to community characteristics. PMID:27574602

  3. Developing sustainable global health technologies: insight from an initiative to address neonatal hypothermia.

    Gupta, Rajesh; Patel, Rajan; Murty, Naganand; Panicker, Rahul; Chen, Jane

    2015-02-01

    Relative to drugs, diagnostics, and vaccines, efforts to develop other global health technologies, such as medical devices, are limited and often focus on the short-term goal of prototype development instead of the long-term goal of a sustainable business model. To develop a medical device to address neonatal hypothermia for use in resource-limited settings, we turned to principles of design theory: (1) define the problem with consideration of appropriate integration into relevant health policies, (2) identify the users of the technology and the scenarios in which the technology would be used, and (3) use a highly iterative product design and development process that incorporates the perspective of the user of the technology at the outset and addresses scalability. In contrast to our initial idea, to create a single device, the process guided us to create two separate devices, both strikingly different from current solutions. We offer insights from our initial experience that may be helpful to others engaging in global health technology development.

  4. Barriers to addressing the social determinants of health: insights from the Canadian experience.

    Raphael, Dennis; Curry-Stevens, Ann; Bryant, Toba

    2008-12-01

    Despite Canada's reputation as a leader in health promotion and population health, implementation of public policies in support of the social determinants of health has been woefully inadequate. The continuing presence of income, housing, and food insecurity has led to Canada being the subject of a series of rebukes from the United Nations for failing to address child and family poverty, discrimination against women and Aboriginal groups, and most recently the crisis of homelessness and housing insecurity. In this article we consider some of the reasons why this might be the case. These include the epistemological dominance of positivist approaches to the health sciences, the ideology of individualism prevalent in North America, and the increasing influence on public policy of the marketplace. Various models of public policy provide pathways by which these barriers can be surmounted. Considering that the International Commission on the Social Determinants of Health will soon be releasing its findings and recommendations, such an analysis seems especially timely for understanding both the Canadian scene and developments in other nations.

  5. Should Canadian health promoters support a food stamp-style program to address food insecurity?

    Power, Elaine M; Little, Margaret H; Collins, Patricia A

    2015-03-01

    Food insecurity is an urgent public health problem in Canada, affecting 4 million Canadians in 2012, including 1.15 million children, and associated with significant health concerns. With little political will to address this significant policy issue, it has been suggested that perhaps it is time for Canada to try a food stamp-style program. Such a program could reduce rates of food insecurity and improve the nutritional health of low-income Canadians. In this article, we explore the history of the US food stamp program; the key impetus of which was to support farmers and agricultural interests, not to look after the needs of people living in poverty. Though the US program has moved away from its roots, its history has had a lasting legacy, cementing an understanding of the problem as one of lack of food, not lack of income. While the contemporary food stamp program, now called Supplemental Nutrition Assistance Program (SNAP), reduces rates of poverty and food insecurity, food insecurity rates in the USA are significantly higher than those in Canada, suggesting a food stamp-style program per se will not eliminate the problem of food insecurity. Moreover, a food stamp-style program is inherently paternalistic and would create harm by reducing the autonomy of participants and generating stigma, which in itself has adverse health effects. Consequently, it is ethically problematic for health promoters to advocate for such a program, even if it could improve diet quality.

  6. The Mexican experience in monitoring and evaluation of public policies addressing social determinants of health

    Adolfo Martinez Valle

    2016-02-01

    Full Text Available Monitoring and evaluation (M&E have gradually become important and regular components of the policy-making process in Mexico since, and even before, the World Health Organization (WHO Commission on Social Determinants of Health (CSDH called for interventions and policies aimed at tackling the social determinants of health (SDH. This paper presents two case studies to show how public policies addressing the SDH have been monitored and evaluated in Mexico using reliable, valid, and complete information, which is not regularly available. Prospera, for example, evaluated programs seeking to improve the living conditions of families in extreme poverty in terms of direct effects on health, nutrition, education and income. Monitoring of Prospera's implementation has also helped policy-makers identify windows of opportunity to improve the design and operation of the program. Seguro Popular has monitored the reduction of health inequalities and inequities evaluated the positive effects of providing financial protection to its target population. Useful and sound evidence of the impact of programs such as Progresa and Seguro Popular plus legal mandates, and a regulatory evaluation agency, the National Council for Social Development Policy Evaluation, have been fundamental to institutionalizing M&E in Mexico. The Mexican experience may provide useful lessons for other countries facing the challenge of institutionalizing the M&E of public policy processes to assess the effects of SDH as recommended by the WHO CSDH.

  7. The Mexican experience in monitoring and evaluation of public policies addressing social determinants of health.

    Valle, Adolfo Martinez

    2016-01-01

    Monitoring and evaluation (M&E) have gradually become important and regular components of the policy-making process in Mexico since, and even before, the World Health Organization (WHO) Commission on Social Determinants of Health (CSDH) called for interventions and policies aimed at tackling the social determinants of health (SDH). This paper presents two case studies to show how public policies addressing the SDH have been monitored and evaluated in Mexico using reliable, valid, and complete information, which is not regularly available. Prospera, for example, evaluated programs seeking to improve the living conditions of families in extreme poverty in terms of direct effects on health, nutrition, education and income. Monitoring of Prospera's implementation has also helped policy-makers identify windows of opportunity to improve the design and operation of the program. Seguro Popular has monitored the reduction of health inequalities and inequities evaluated the positive effects of providing financial protection to its target population. Useful and sound evidence of the impact of programs such as Progresa and Seguro Popular plus legal mandates, and a regulatory evaluation agency, the National Council for Social Development Policy Evaluation, have been fundamental to institutionalizing M&E in Mexico. The Mexican experience may provide useful lessons for other countries facing the challenge of institutionalizing the M&E of public policy processes to assess the effects of SDH as recommended by the WHO CSDH.

  8. Emerging Developments in Pharmacists' Scope of Practice to Address Unmet Health Care Needs.

    Burns, Anne L

    2016-09-01

    Pharmacists' comprehensive training is being leveraged in emerging patient care service opportunities that include prescriptive authority under collaborative practice agreements (CPAs) with prescribers or through state-based protocols. CPAs and state-based protocols expand pharmacists' scope of practice to allow the pharmacist to perform designated functions under the terms of the agreement or protocol. For patient-specific CPAs, this often includes initiating, modifying, or discontinuing therapy and ordering laboratory tests. For population-based CPAs and state-based protocols, pharmacists are often authorized to initiate medications to address a public health need. CPAs and state-based protocols are mechanisms to optimally use pharmacists' education and training.

  9. Addressing Health Workforce Distribution Concerns: A Discrete Choice Experiment to Develop Rural Retention Strategies in Cameroon

    Paul Jacob Robyn

    2015-03-01

    the analysis of locally relevant, actionable incentives, generated through the involvement of policymakers at the design stage, this study provides an example of research directly linked to policy action to address a vitally important issue in global health.

  10. A public-policy practicum to address current issues in human, animal, and ecosystem health.

    Herrmann, John A; Johnson, Yvette J; Troutt, H Fred; Prudhomme, Thomas

    2009-01-01

    There are recognized needs for cross-training health professionals in human, animal, and ecosystem health and for public health policy to be informed by experts from medical, science, and social science disciplines. Faculty members of the Community Health and Preventive Medicine Section at the University of Illinois at Urbana-Champaign, College of Veterinary Medicine, and the Institute of Government and Public Affairs, University of Illinois at Urbana-Champaign, have offered a public-policy course designed to meet those needs. The course was designed as a practicum to teach students the policy-making process through the development of policy proposals and to instruct students on how to effectively present accurate scientific, demographic, and statistical information to policy makers and to the public. All students substantially met the learning objectives of the course. This course represents another model that can be implemented to help students learn about complex, multifactorial issues that affect the health of humans, animals, and ecosystems, while promoting participation in public health policy development.

  11. Comparing the health impacts of different sources of energy. Keynote address

    Hamilton, L.D.

    1981-01-01

    Assessing health impacts of different energy sources requires synthesis of research results from any different disciplines into a rational framework. Information is often scanty; qualitatively different risks, or energy systems with substantially different end uses, must be put on a common footing. Historically institutional constraints have inhibited agencies from making incisive comparisons necessary for formulating energy policy; this has exacerbated public controversy over appropriate energy sources. Risk assessment methods reviewed include examples drawn from work of the Biomedical and Environmental Assessment Division at Brookhaven National Laboratory and elsewhere. Uncertainty over the mechanism and size of air pollution health damage is addressed through a probabilistic health-damage function, using sulfate-particle exposure as an indicator. This facilitates intercomparison through analysis of each step in the whole fuel cycle between a typical coal and nuclear powerplant. Occupational health impacts, a significant fraction of overall damage, are illustrated by accident trends in coal mining. In broadening comparisons to include new technologies, one must include the impact of manufacturing the energy-producing device as part of an expanded fuel cycle, via input/output methods. Throughout the analysis, uncertainties must be made explicit in the results, including uncertainty of data and uncertainty in choice of appropriate models and methods. No single method of comparative risk assessment is fully satisfactory; each has its limitations. One needs to compare several methods if decision-making is to be realistic.

  12. The exocyst complex in health and disease

    Magdanela eMartin-Urdiroz

    2016-04-01

    Full Text Available Exocytosis involves the fusion of intracellular secretory vesicles with the PM, thereby delivering integral membrane proteins to the cell surface and releasing material into the extracellular space. Importantly, exocytosis also provides a source of lipid moieties for membrane extension. The tethering of the secretory vesicle before docking and fusion with the PM is mediated by the exocyst complex, an evolutionary conserved octameric complex of proteins. Recent findings indicate that the exocyst complex also takes part in other intra-cellular processes besides secretion. These various functions seem to converge towards defining a direction of membrane growth in a range of systems from fungi to plants and from neurons to cilia. In this review we summarise the current knowledge of exocyst function in cell polarity, signalling and cell-cell communication and discuss implications for plant and animal health and disease.

  13. A Road Map to Address the Social Determinants of Health Through Community Collaboration.

    Henize, Adrienne W; Beck, Andrew F; Klein, Melissa D; Adams, Monica; Kahn, Robert S

    2015-10-01

    Economic, environmental, and psychosocial needs are common and wide-ranging among families cared for in primary care settings. Still, pediatric care delivery models are not set up to systematically address these fundamental risks to health. We offer a roadmap to help structure primary care approaches to these needs through the development of comprehensive and effective collaborations between the primary care setting and community partners. We use Maslow's Hierarchy of Needs as a well-recognized conceptual model to organize, prioritize, and determine appropriate interventions that can be adapted to both small and large practices. Specifically, collaborations with community organizations expert in addressing issues commonly encountered in primary care centers can be designed and executed in a phased manner: (1) build the case for action through a family-centered risk assessment, (2) organize and prioritize risks and interventions, (3) develop and sustain interventions, and (4) operationalize interventions in the clinical setting. This phased approach to collaboration also includes shared vision, codeveloped plans for implementation and evaluation, resource alignment, joint reflection and adaptation, and shared decisions regarding next steps. Training, electronic health record integration, refinement by using quality improvement methods, and innovative use of clinical space are important components that may be useful in a variety of clinical settings. Successful examples highlight how clinical-community partnerships can help to systematically address a hierarchy of needs for children and families. Pediatricians and community partners can collaborate to improve the well-being of at-risk children by leveraging their respective strengths and shared vision for healthy families.

  14. Making sense in a complex landscape: how the Cynefin Framework from Complex Adaptive Systems Theory can inform health promotion practice.

    Van Beurden, Eric K; Kia, Annie M; Zask, Avigdor; Dietrich, Uta; Rose, Lauren

    2013-03-01

    Health promotion addresses issues from the simple (with well-known cause/effect links) to the highly complex (webs and loops of cause/effect with unpredictable, emergent properties). Yet there is no conceptual framework within its theory base to help identify approaches appropriate to the level of complexity. The default approach favours reductionism--the assumption that reducing a system to its parts will inform whole system behaviour. Such an approach can yield useful knowledge, yet is inadequate where issues have multiple interacting causes, such as social determinants of health. To address complex issues, there is a need for a conceptual framework that helps choose action that is appropriate to context. This paper presents the Cynefin Framework, informed by complexity science--the study of Complex Adaptive Systems (CAS). It introduces key CAS concepts and reviews the emergence and implications of 'complex' approaches within health promotion. It explains the framework and its use with examples from contemporary practice, and sets it within the context of related bodies of health promotion theory. The Cynefin Framework, especially when used as a sense-making tool, can help practitioners understand the complexity of issues, identify appropriate strategies and avoid the pitfalls of applying reductionist approaches to complex situations. The urgency to address critical issues such as climate change and the social determinants of health calls for us to engage with complexity science. The Cynefin Framework helps practitioners make the shift, and enables those already engaged in complex approaches to communicate the value and meaning of their work in a system that privileges reductionist approaches.

  15. Two-stage residual inclusion estimation: addressing endogeneity in health econometric modeling.

    Terza, Joseph V; Basu, Anirban; Rathouz, Paul J

    2008-05-01

    The paper focuses on two estimation methods that have been widely used to address endogeneity in empirical research in health economics and health services research-two-stage predictor substitution (2SPS) and two-stage residual inclusion (2SRI). 2SPS is the rote extension (to nonlinear models) of the popular linear two-stage least squares estimator. The 2SRI estimator is similar except that in the second-stage regression, the endogenous variables are not replaced by first-stage predictors. Instead, first-stage residuals are included as additional regressors. In a generic parametric framework, we show that 2SRI is consistent and 2SPS is not. Results from a simulation study and an illustrative example also recommend against 2SPS and favor 2SRI. Our findings are important given that there are many prominent examples of the application of inconsistent 2SPS in the recent literature. This study can be used as a guide by future researchers in health economics who are confronted with endogeneity in their empirical work.

  16. Medical mycology and fungal immunology: new research perspectives addressing a major world health challenge

    Gow, Neil A. R.; Netea, Mihai G.

    2016-01-01

    Fungi cause more than a billion skin infections, more than 100 million mucosal infections, 10 million serious allergies and more than a million deaths each year. Global mortality owing to fungal infections is greater than for malaria and breast cancer and is equivalent to that owing to tuberculosis (TB) and HIV. These statistics evidence fungal infections as a major threat to human health and a major burden to healthcare budgets worldwide. Those patients who are at greatest risk of life-threatening fungal infections include those who have weakened immunity or have suffered trauma or other predisposing infections such as HIV. To address these global threats to human health, more research is urgently needed to understand the immunopathology of fungal disease and human disease susceptibility in order to augment the advances being made in fungal diagnostics and drug development. Here, we highlight some recent advances in basic research in medical mycology and fungal immunology that are beginning to inform clinical decisions and options for personalized medicine, vaccine development and adjunct immunotherapies. This article is part of the themed issue ‘Tackling emerging fungal threats to animal health, food security and ecosystem resilience’. PMID:28080988

  17. Globalisation, complex humanitarian emergencies and health.

    O'Dempsey, T J D; Munslow, B

    2006-01-01

    A new political economy of conflict has emerged in the aftermath of colonialism and the Cold War. Complex political emergencies have been simmering in the post-colonial world for more than three decades. Intra-country armed conflict, often combined with natural disasters, at present contributes to the displacement of over 20 million people world-wide. The international community remains profoundly uncomfortable with the complex political emergencies of the new era, torn between the respect for national sovereignty upon which the international political system of the United Nations and other agencies is built, and the growth of concern with human rights and a burgeoning International Humanitarian Law. Globalisation may have brought many benefits to some but there are also many losers. The Word Bank and the International Monetary Fund imposed structural adjustment policies to ensure debt repayment and economic restructuring that have resulted in a net reduction in expenditure on health, education and development. A downward spiral has been created of debt, disease, malnutrition, missed education, economic entrapment, poverty, powerlessness, marginalization, migration and instability. Africa's complex political emergencies are particularly virulent and tenacious. Three examples that are among the most serious humanitarian emergencies to have faced the world in recent times--those in Angola, the Democratic Republic of Congo and Sudan--are reviewed here in detail. The political evolution of these emergencies and their impact on the health of the affected populations are also explored.

  18. Addressing Human Variability in Next-Generation Human Health Risk Assessments of Environmental Chemicals

    Bois, Frederic Y.; Chiu, Weihsueh A.; Hattis, Dale; Rusyn, Ivan; Guyton, Kathryn Z.

    2012-01-01

    Background: Characterizing variability in the extent and nature of responses to environmental exposures is a critical aspect of human health risk assessment. Objective: Our goal was to explore how next-generation human health risk assessments may better characterize variability in the context of the conceptual framework for the source-to-outcome continuum. Methods: This review was informed by a National Research Council workshop titled “Biological Factors that Underlie Individual Susceptibility to Environmental Stressors and Their Implications for Decision-Making.” We considered current experimental and in silico approaches, and emerging data streams (such as genetically defined human cells lines, genetically diverse rodent models, human omic profiling, and genome-wide association studies) that are providing new types of information and models relevant for assessing interindividual variability for application to human health risk assessments of environmental chemicals. Discussion: One challenge for characterizing variability is the wide range of sources of inherent biological variability (e.g., genetic and epigenetic variants) among individuals. A second challenge is that each particular pair of health outcomes and chemical exposures involves combinations of these sources, which may be further compounded by extrinsic factors (e.g., diet, psychosocial stressors, other exogenous chemical exposures). A third challenge is that different decision contexts present distinct needs regarding the identification—and extent of characterization—of interindividual variability in the human population. Conclusions: Despite these inherent challenges, opportunities exist to incorporate evidence from emerging data streams for addressing interindividual variability in a range of decision-making contexts. PMID:23086705

  19. Does problem complexity matter for environmental policy delivery? How public authorities address problems of water governance.

    Kirschke, Sabrina; Newig, Jens; Völker, Jeanette; Borchardt, Dietrich

    2017-03-08

    Problem complexity is often assumed to hamper effective environmental policy delivery. However, this claim is hardly substantiated, given the dominance of qualitative small-n designs in environmental governance research. We studied 37 types of contemporary problems defined by German water governance to assess the impact of problem complexity on policy delivery through public authorities. The analysis is based on a unique data set related to these problems, encompassing both in-depth interview-based data on complexities and independent official data on policy delivery. Our findings show that complexity in fact tends to delay implementation at the stage of planning. However, different dimensions of complexity (goals, variables, dynamics, interconnections, and uncertainty) impact on the different stages of policy delivery (goal formulation, stages and degrees of implementation) in various ways.

  20. Developing a Gap Taxonomy to Address Crew Health Risks in NASA's Human Research Program

    Kundrot, Craig E.; Edwards, J. Michelle

    2009-01-01

    The mission of NASA's Human Research Program (HRP) is to understand and reduce the risk to crew health and performance in exploration missions. The HRP addresses 27 specific risks by identifying and then filling gaps in understanding the risks and in the ability to disposition the risks. The primary bases for identifying gaps have been past experience and requirements definition. This approach has been very effective in identifying some important, relevant gaps, but may be inadequate for identifying gaps outside the past experience base. We are exploring the use of a gap taxonomy as a comprehensive, underlying conceptual framework that allows a more systematic identification of gaps. The taxonomy is based on these stages in medical care: prediction, prevention, detection/diagnosis, treatment, monitoring, rehabilitation, and lifetime surveillance. This gap taxonomy approach identifies new gaps in HRP health risks. Many of the new gaps suggest risk reduction approaches that are more cost effective than present approaches. A major benefit of the gap taxonomy approach is to identify new, economical approaches that reduce the likelihood and/or consequence of a risk.

  1. Systems approach to address incivility and disruptive behaviors in health-care organizations.

    Holloway, Elizabeth; Kusy, Mitchell

    2011-01-01

    In response to the growing evidence that disruptive behaviors within health-care teams constitute a major threat to the quality of care, the Joint Commission on Accreditation of Healthcare Organization (JCAHO; Joint Commission Resources, 2008) has a new leadership standard that addresses disruptive and inappropriate behaviors effective January 1, 2009. For professionals who work in human resources and organization development, these standards represent a clarion call to design and implement evidence-based interventions to create health-care communities of respectful engagement that have zero tolerance for disruptive, uncivil, and intimidating behaviors by any professional. In this chapter, we will build an evidence-based argument that sustainable change must include organizational, team, and individual strategies across all professionals in the organization. We will then describe an intervention model--Toxic Organization Change System--that has emerged from our own research on toxic behaviors in the workplace (Kusy & Holloway, 2009) and provide examples of specific strategies that we have used to prevent and ameliorate toxic cultures.

  2. Addressing the systems-based practice requirement with health policy content and educational technology.

    Nagler, Alisa; Andolsek, Kathryn; Dossary, Kristin; Schlueter, Joanne; Schulman, Kevin

    2010-01-01

    Duke University Hospital Office of Graduate Medical Education and Duke University's Fuqua School of Business collaborated to offer a Health Policy lecture series to residents and fellows across the institution, addressing the "Systems-based Practice" competency.During the first year, content was offered in two formats: live lecture and web/podcast. Participants could elect the modality which was most convenient for them. In Year Two, the format was changed so that all content was web/podcast and a quarterly live panel discussion was led by module presenters or content experts. Lecture evaluations, qualitative focus group feedback, and post-test data were analyzed.A total of 77 residents and fellows from 8 (of 12) Duke Graduate Medical Education departments participated. In the first year, post-test results were the same for those who attended the live lectures and those who participated via web/podcast. A greater number of individuals participated in Year Two. Participants from both years expressed the need for health policy content in their training programs. Participants in both years valued a hybrid format for content delivery, recognizing a desire for live interaction with the convenience of accessing web/podcasts at times and locations convenient for them. A positive unintended consequence of the project was participant networking with residents and fellows from other specialties.

  3. Using social marketing to address barriers and motivators to agricultural safety and health best practices.

    Yoder, Aaron M; Murphy, Dennis J

    2012-01-01

    Social marketing is an intervention development strategy that pays considerable attention to barriers to and motivators for behavioral change or adoption of recommended behaviors. Barriers are obstacles that prevent individuals from changing or adopting behaviors and are often referred to as the "cons" or "costs" of doing something. Motivators, on the other hand, are factors that encourage individuals to change or adopt behaviors and are often referred to as the "pros," "benefits," or "influencing factors" of doing something. Importantly, social marketing does not target education or knowledge change as an end point; rather, it targets behavior change. Studies across several types of desired behaviors (e.g., smoking cessation, weight control, more exercise, sunscreen use, radon testing) using the Stages of Change model have found systematic relationships between stages of change and pros and cons of changing behavior. A review of literature identifies numerous research and intervention studies that directly reference social marketing in agricultural safety and health, studies that identify reasons why parents allow their children to be exposed to hazardous situations on the farm, and reasons why youth engage in risky behaviors, but only two studies were found that show evidence of systematically researching specific behavioral change motivating factors. The authors offer several suggestions to help address issues relating to social marketing and agricultural safety and health.

  4. Makerere University College of Health Sciences’ role in addressing challenges in health service provision at Mulago National Referral Hospital

    Sekandi Juliet

    2011-03-01

    Full Text Available Abstract Background Mulago National Referral Hospital (MNRH, Uganda’s primary tertiary and teaching hospital, and Makerere University College of Health Sciences (MakCHS have a close collaborative relationship. MakCHS students complete clinical rotations at MNRH, and MakCHS faculty partner with Mulago staff in clinical care and research. In 2009, as part of a strategic planning process, MakCHS undertook a qualitative study to examine care and service provision at MNRH, identify challenges, gaps, and solutions, and explore how MakCHS could contribute to improving care and service delivery at MNRH. Methods Key informant interviews (n=23 and focus group discussions (n=7 were conducted with nurses, doctors, administrators, clinical officers and other key stakeholders. Interviews and focus groups were tape recorded and transcribed verbatim, and findings were analyzed through collaborative thematic analysis. Results Challenges to care and service delivery at MNRH included resource constraints (staff, space, equipment, and supplies, staff inadequacies (knowledge, motivation, and professionalism, overcrowding, a poorly functioning referral system, limited quality assurance, and a cumbersome procurement system. There were also insufficiencies in the teaching of professionalism and communication skills to students, and patient care challenges that included lack of access to specialized services, risk of infections, and inappropriate medications. Suggestions for how MakCHS could contribute to addressing these challenges included strengthening referral systems and peripheral health center capacity, and establishing quality assurance mechanisms. The College could also strengthen the teaching of professionalism, communication and leadership skills to students, and monitor student training and develop courses that contribute to continuous professional development. Additionally, the College could provide in-service education for providers on professionalism

  5. Looking beyond first-world problems: an emerging global workplace is encouraging more biomedical engineers to address the health issues of the developing world.

    Tucker, Lindsay

    2014-01-01

    Each year, the developed world is flooded with complex new medical technologies, from robotic prosthetics to remote-controlled aspirin implants. Meanwhile, only about 10% of health research funds are spent addressing the pressing problems of developing nations, although these countries make up 93% of the worldwide burden of disease. In short, while a small fraction of the world pops brand-name pharmaceuticals, the majority suffers from poor sanitation, contaminated drinking water, preventable disease, and child mortality.

  6. Addressing the social determinants of health through health system strengthening and inter-sectoral convergence: the case of the Indian National Rural Health Mission

    Amit Mohan Prasad

    2013-03-01

    Full Text Available Background: At the turn of the 21st century, India was plagued by significant rural–urban, inter-state and inter-district inequities in health. For example, in 2004, the infant mortality rate (IMR was 24 points higher in rural areas compared to urban areas. To address these inequities, to strengthen the rural health system (a major determinant of health in itself and to facilitate action on other determinants of health, India launched the National Rural Health Mission (NRHM in April 2005. Methods: Under the NRHM, Rs. 666 billion (US$12.1 billion was invested in rural areas from April 2005 to March 2012. There was also a substantially higher allocation for 18 high-focus states2 and 264 high-focus districts, identified on the basis of poor health and demographic indicators. Other determinants of health, especially nutrition and decentralized action, were addressed through mechanisms like State/District Health Missions, Village Health, Sanitation and Nutrition Committees, and Village Health and Nutrition Days. Results: Consequently, in bigger high-focus states, rural IMR fell by 15.6 points between 2004 and 2011, as compared to 9 points in urban areas. Similarly, the maternal mortality rate in high-focus states declined by 17.9% between 2004–2006 and 2007–2009 compared to 14.6% in other states. Conclusion: The article, on the basis of the above approaches employed under NRHM, proposes the NRHM model to ‘reduce health inequities and initiate action on SDH’.

  7. Addressing Student Mental Health Needs by Providing Direct and Indirect Services and Building Alliances in the Community

    Kaffenberger, Carol J.; O'Rorke-Trigiani, Judith

    2013-01-01

    Given that 20% of students experience mental health issues that interfere with school performance and most of these students will turn first to their school for help, school counselors need to consider how they can best serve this population. This article describes how school counselors can address the mental health needs of students by providing…

  8. Addressing the Complexity of Writing Development: Toward an Ecological Model of Assessment

    Wardle, Elizabeth; Roozen, Kevin

    2012-01-01

    This article offers one potential response to Yancey's (1999) call for a fourth wave of writing assessment able to capture writing development in all of its complexity. Based on an ecological perspective of literate development that situates students' growth as writers across multiple engagements with writing, including those outside of school,…

  9. Ecosystem services and cooperative fisheries research to address a complex fishery problem

    The St. Louis River represents a complex fishery management problem. Current fishery management goals have to be developed taking into account bi-state commercial, subsistence and recreational fisheries which are valued for different characteristics by a wide range of anglers, as...

  10. Strategies to increase demand for maternal health services in resource-limited settings: challenges to be addressed.

    Elmusharaf, Khalifa

    2015-09-01

    Universal health access will not be achieved unless women are cared for in their own communities and are empowered to take decisions about their own health in a supportive environment. This will only be achieved by community-based demand side interventions for maternal health access. In this review article, we highlight three common strategies to increase demand-side barriers to maternal healthcare access and identify the main challenges that still need to be addressed for these strategies to be effective.

  11. Priorities and realities: addressing the rich-poor gaps in health status and service access in Indonesia

    Utomo Budi

    2011-11-01

    Full Text Available Abstract Introduction Over the past four decades, the Indonesian health care system has greatly expanded and the health of Indonesian people has improved although the rich-poor gap in health status and service access remains an issue. The government has been trying to address these gaps and intensify efforts to improve the health of the poor following the economic crisis in 1998. Methods This paper examines trends and levels in socio-economic inequity of health and identifies critical factors constraining efforts to improve the health of the poor. Quantitative data were taken from the Indonesian Demographic Health Surveys and the National Socio-Economic Surveys, and qualitative data were obtained from interviews with individuals and groups representing relevant stakeholders. Results The health of the population has improved as indicated by child mortality decline and the increase in community access to health services. However, the continuing prevalence of malnourished children and the persisting socio-economic inequity of health suggest that efforts to improve the health of the poor have not yet been effective. Factors identified at institution and policy levels that have constrained improvements in health care access and outcomes for the poor include: the high cost of electing formal governance leaders; confused leadership roles in the health sector; lack of health inequity indicators; the generally weak capacity in the health care system, especially in planning and budgeting; and the leakage and limited coverage of programs for the poor. Conclusions Despite the government's efforts to improve the health of the poor, the rich-poor gap in health status and service access continues. Factors at institutional and policy levels are critical in contributing to the lack of efficiency and effectiveness for health programs that address the poor.

  12. Activating people to address their health care needs: learning from people with lived experience of chronic illnesses.

    Stanhope, Victoria; Henwood, Benjamin F

    2014-08-01

    One of the primary goals of health care reform is improving the quality and reducing the costs of care for people with co-morbid mental health and physical health conditions. One strategy is to integrate primary and behavioral health care through care coordination and patient activation. This qualitative study using community based participatory research methods informs the development of integrated care by presenting the perspectives of those with lived experience of chronic illnesses and homelessness. Themes presented include the internal and external barriers to addressing health needs and the key role of peer support in overcoming these barriers.

  13. The symptom matrix: Using a formalism-based approach to address complex syndromes systematically.

    Skillen, Jennifer D

    2016-12-01

    Complex rheumatological syndromes such as Systemic lupus erythematosus, Sjogren's Syndrome and many connective tissue disorders can be a challenge to classify and diagnose, due to their wide-ranging signs and symptoms, not all of which will necessarily be present in all patients. This can result in difficulties for the clinician, patient and researcher if signs and symptoms are either overlooked or are incorrectly included in the nosology or classification of diseases. This article presents a formalism-based approach to describing syndromes. This approach offers a more systematic way of representing signs and symptoms, to aid in diagnosis and classification of complex, heterogeneous and little understood syndromes. To illustrate this approach, Ehlers-Danlos Syndrome - Hypermobility Type is used as a worked example. This approach can also be applied to other syndromes in both clinical and educational settings, to assist with research, diagnosis, choice of treatment or intervention and nosology revision.

  14. Drug shortages: a complex health care crisis.

    Fox, Erin R; Sweet, Burgunda V; Jensen, Valerie

    2014-03-01

    National tracking of drug shortages began in 2001. However, a significant increase in the number of shortages began in late 2009, with numbers reaching what many have termed crisis level. The typical drug in short supply is a generic product administered by injection. Common classes of drugs affected by shortages include anesthesia medications, antibiotics, pain medications, nutrition and electrolyte products, and chemotherapy agents. The economic and clinical effects of drug shortages are significant. The financial effect of drug shortages is estimated to be hundreds of millions of dollars annually for health systems across the United States. Clinically, patients have been harmed by the lack of drugs or inferior alternatives, resulting in more than 15 documented deaths. Drug shortages occur for a variety of reasons. Generic injectable drugs are particularly susceptible to drug shortages because there are few manufacturers of these products and all manufacturers are running at full capacity. In addition, some manufacturers have had production problems, resulting in poor quality product. Although many suppliers are working to upgrade facilities and add additional manufacturing lines, these activities take time. A number of stakeholder organizations have been involved in meetings to further determine the causes and effects of drug shortages. A new law was enacted in July 2012 that granted the Food and Drug Administration additional tools to address the drug shortage crisis. The future of drug shortages is unknown, but there are hopeful indications that quality improvements and additional capacity may decrease the number of drug shortages in the years to come.

  15. Complexity and dynamism from an urban health perspective: a rationale for a system dynamics approach.

    Tozan, Yesim; Ompad, Danielle C

    2015-06-01

    In a variety of urban health frameworks, cities are conceptualized as complex and dynamic yet commonly used epidemiological methods have failed to address this complexity and dynamism head on due to their narrow problem definitions and linear analytical representations. Scholars from a variety of disciplines have also long conceptualized cities as systems, but few have modeled urban health issues as problems within a system. Systems thinking in general and system dynamics in particular are relatively new approaches in public health, but ones that hold immense promise as methodologies to model and analyze the complexity underlying urban processes to effectively inform policy actions in dynamic environments. This conceptual essay reviews the utility of applying the concepts, principles, and methods of systems thinking to the study of complex urban health phenomena as a complementary approach to standard epidemiological methods using specific examples and provides recommendations on how to better incorporate systems thinking methods in urban health research and practice.

  16. Addressing the Social Determinants of Health of Children and Youth: A Role for SOPHE Members

    Allensworth, Diane D.

    2011-01-01

    The determinants of youth health disparities include poverty, unequal access to health care, poor environmental conditions, and educational inequities. Poor and minority children have more health problems and less access to health care than their higher socioeconomic status cohorts. Having more health problems leads to more absenteeism in school,…

  17. Addressing complexity and uncertainty: conceptual models and expert judgments applied to migratory birds in the oil sands of Canada

    Marc A. Nelitz

    2015-12-01

    Full Text Available Complexity and uncertainty are inherent in social-ecological systems. Although they can create challenges for scientists and decision makers, they cannot be a reason for delaying decision making. Two strategies have matured in recent decades to address these challenges. Systems thinking, as embodied by conceptual modeling, is a holistic approach in which a system can be better understood by examining it as a whole. Expert elicitation represents a second strategy that enables a greater diversity of inputs to understand complex systems. We explored the use of conceptual models and expert judgments to inform expansion of monitoring around oil sands development in northern Alberta, Canada, particularly related to migratory forest birds. This study area is a complex social-ecological system for which there is an abundance of specific information, but a relatively weak understanding about system behavior. Multiple conceptual models were developed to represent complexity and provide a more fulsome view of influences across the landscape. A hierarchical approach proved useful, and a mechanistic structure of the models clarified the cumulative and interactive nature of factors within and outside the study area. To address gaps in understanding, expert judgments were integrated using a series of structured exercises to derive "weightings" of importance of different components in the conceptual models, specifically pairwise comparisons, Likert scaling, and a maximum difference conjoint approach. These exercises were helpful for discriminating the importance of different influences and illuminating the competing beliefs of experts. Various supporting tools helped us engage a group of experts from across North America, which included a virtual meeting, online polling, desktop sharing, web survey, and financial incentive. This combination of techniques was innovative and proved useful for addressing complexity and uncertainty in a specific natural resource

  18. Investigating hypoxia in aquatic environments: diverse approaches to addressing a complex phenomenon

    J. Friedrich

    2013-08-01

    Full Text Available In this paper we synthesize the new knowledge on oxygen and oxygen-related phenomena in aquatic systems, resulting from the EU-FP7 project HYPOX ("In situ monitoring of oxygen depletion in hypoxic ecosystems of coastal and open seas, and land-locked water bodies", www.hypox.net. In view of the anticipated oxygen loss in aquatic systems due to eutrophication and climate change, HYPOX was set up to improve capacities to monitor hypoxia as well as to understand its causes and consequences. Temporal dynamics and spatial patterns of hypoxia were analysed in field studies in various aquatic environments, including the Baltic Sea, the Black Sea, Scottish and Scandinavian fjords, Ionian Sea lagoons and embayments, and in Swiss lakes. Examples of episodic and rapid (hours occurrences of hypoxia as well as seasonal changes in bottom-water oxygenation in stratified systems are discussed. Geologically-driven hypoxia caused by gas seepage is demonstrated. Using novel technologies, temporal and spatial patterns of water-column oxygenation, from basin-scale seasonal patterns to meter-scale submicromolar oxygen distributions were resolved. Existing multi-decadal monitoring data were used to demonstrate the imprint of climate change and eutrophication on long-term oxygen distributions. Organic and inorganic proxies were used to extend investigations on past oxygen conditions to centennial and even longer timescales not resolved by monitoring. The effects of hypoxia on faunal communities and biogeochemical processes were also addressed in the project. An investigation of benthic fauna is presented as an example of hypoxia-devastated benthic communities that slowly recover upon a reduction in eutrophication in a system where natural and anthropogenic hypoxia overlap. Biogeochemical investigations reveal that oxygen intrusions have a strong effect on microbially-mediated redox cycling of elements. Observations and modeling studies of the sediments demonstrate the

  19. Addressing the Complexity of Tourette's Syndrome through the Use of Animal Models.

    Nespoli, Ester; Rizzo, Francesca; Boeckers, Tobias M; Hengerer, Bastian; Ludolph, Andrea G

    2016-01-01

    Tourette's syndrome (TS) is a neurodevelopmental disorder characterized by fluctuating motor and vocal tics, usually preceded by sensory premonitions, called premonitory urges. Besides tics, the vast majority-up to 90%-of TS patients suffer from psychiatric comorbidities, mainly attention deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). The etiology of TS remains elusive. Genetics is believed to play an important role, but it is clear that other factors contribute to TS, possibly altering brain functioning and architecture during a sensitive phase of neural development. Clinical brain imaging and genetic studies have contributed to elucidate TS pathophysiology and disease mechanisms; however, TS disease etiology still is poorly understood. Findings from genetic studies led to the development of genetic animal models, but they poorly reflect the pathophysiology of TS. Addressing the role of neurotransmission, brain regions, and brain circuits in TS disease pathomechanisms is another focus area for preclinical TS model development. We are now in an interesting moment in time when numerous innovative animal models are continuously brought to the attention of the public. Due to the diverse and largely unknown etiology of TS, there is no single preclinical model featuring all different aspects of TS symptomatology. TS has been dissected into its key symptomst hat have been investigated separately, in line with the Research Domain Criteria concept. The different rationales used to develop the respective animal models are critically reviewed, to discuss the potential of the contribution of animal models to elucidate TS disease mechanisms.

  20. Using a complex system approach to address world challenges in Food and Agriculture

    van Mil, H G J; Windhab, E J; Perrot, N; van der Linden, E

    2013-01-01

    World food supply is crucial to the well-being of every human on the planet in the basic sense that we need food to live. It also has a profound impact on the world economy, international trade and global political stability. Furthermore, consumption of certain types and amounts foods can affect health, and the choice of livestock and plants for food production can impact sustainable use of global resources. There are communities where insufficient food causes nutritional deficiencies, and at the same time other communities eating too much food leading to obesity and accompanying diseases. These aspects reflect the utmost importance of agricultural production and conversion of commodities to food products. Moreover, all factors contributing to the food supply are interdependent, and they are an integrative part of the continuously changing, adaptive and interdependent systems in the world around us. The properties of such interdependent systems usually cannot be inferred from the properties of its parts. In a...

  1. Policy Directions Addressing the Public Health Impact of Climate Change in South Korea: The Climate-change Health Adaptation and Mitigation Program

    Shin, Yong Seung; Ha, Jongsik

    2012-01-01

    Climate change, caused by global warming, is increasingly recognized as a major threat to mankind's survival. Climate change concurrently has both direct and modifying influences on environmental, social, and public health systems undermining human health as a whole. Environmental health policy-makers need to make use of political and technological alternatives to address these ramifying effects. The objective of this paper is to review public health policy in Korea, as well as internationall...

  2. To address surface reaction network complexity using scaling relations machine learning and DFT calculations

    Ulissi, Zachary W.; Medford, Andrew J.; Bligaard, Thomas; Nørskov, Jens K.

    2017-03-01

    Surface reaction networks involving hydrocarbons exhibit enormous complexity with thousands of species and reactions for all but the very simplest of chemistries. We present a framework for optimization under uncertainty for heterogeneous catalysis reaction networks using surrogate models that are trained on the fly. The surrogate model is constructed by teaching a Gaussian process adsorption energies based on group additivity fingerprints, combined with transition-state scaling relations and a simple classifier for determining the rate-limiting step. The surrogate model is iteratively used to predict the most important reaction step to be calculated explicitly with computationally demanding electronic structure theory. Applying these methods to the reaction of syngas on rhodium(111), we identify the most likely reaction mechanism. Propagating uncertainty throughout this process yields the likelihood that the final mechanism is complete given measurements on only a subset of the entire network and uncertainty in the underlying density functional theory calculations.

  3. Traceability and Risk Analysis Strategies for Addressing Counterfeit Electronics in Supply Chains for Complex Systems.

    DiMase, Daniel; Collier, Zachary A; Carlson, Jinae; Gray, Robin B; Linkov, Igor

    2016-10-01

    Within the microelectronics industry, there is a growing concern regarding the introduction of counterfeit electronic parts into the supply chain. Even though this problem is widespread, there have been limited attempts to implement risk-based approaches for testing and supply chain management. Supply chain risk management tends to focus on the highly visible disruptions of the supply chain instead of the covert entrance of counterfeits; thus counterfeit risk is difficult to mitigate. This article provides an overview of the complexities of the electronics supply chain, and highlights some gaps in risk assessment practices. In particular, this article calls for enhanced traceability capabilities to track and trace parts at risk through various stages of the supply chain. Placing the focus on risk-informed decision making through the following strategies is needed, including prioritization of high-risk parts, moving beyond certificates of conformance, incentivizing best supply chain management practices, adoption of industry standards, and design and management for supply chain resilience.

  4. To address surface reaction network complexity using scaling relations machine learning and DFT calculations

    Ulissi, Zachary W.; Medford, Andrew J.; Bligaard, Thomas; Nørskov, Jens K.

    2017-01-01

    Surface reaction networks involving hydrocarbons exhibit enormous complexity with thousands of species and reactions for all but the very simplest of chemistries. We present a framework for optimization under uncertainty for heterogeneous catalysis reaction networks using surrogate models that are trained on the fly. The surrogate model is constructed by teaching a Gaussian process adsorption energies based on group additivity fingerprints, combined with transition-state scaling relations and a simple classifier for determining the rate-limiting step. The surrogate model is iteratively used to predict the most important reaction step to be calculated explicitly with computationally demanding electronic structure theory. Applying these methods to the reaction of syngas on rhodium(111), we identify the most likely reaction mechanism. Propagating uncertainty throughout this process yields the likelihood that the final mechanism is complete given measurements on only a subset of the entire network and uncertainty in the underlying density functional theory calculations. PMID:28262694

  5. Exploring the Utilization of Complex Algal Communities to Address Algal Pond Crash and Increase Annual Biomass Production for Algal Biofuels

    Hamilton, Cyd E. [Dept. of Energy (DOE), Washington DC (United States).

    2014-03-25

    This white paper briefly reviews the research literature exploring complex algal communities as a means of increasing algal biomass production via increased tolerance, resilience, and resistance to a variety of abiotic and biotic perturbations occurring within harvesting timescales. This paper identifies what data are available and whether more research utilizing complex communities is needed to explore the potential of complex algal community stability (CACS) approach as a plausible means to increase biomass yields regardless of ecological context and resulting in decreased algal-based fuel prices by reducing operations costs. By reviewing the literature for what we do and do not know, in terms of CACS methodologies, this report will provide guidance for future research addressing pond crash phenomena.

  6. Addressing the complexity of water chemistry in environmental fate modeling for engineered nanoparticles.

    Sani-Kast, Nicole; Scheringer, Martin; Slomberg, Danielle; Labille, Jérôme; Praetorius, Antonia; Ollivier, Patrick; Hungerbühler, Konrad

    2015-12-01

    Engineered nanoparticle (ENP) fate models developed to date - aimed at predicting ENP concentration in the aqueous environment - have limited applicability because they employ constant environmental conditions along the modeled system or a highly specific environmental representation; both approaches do not show the effects of spatial and/or temporal variability. To address this conceptual gap, we developed a novel modeling strategy that: 1) incorporates spatial variability in environmental conditions in an existing ENP fate model; and 2) analyzes the effect of a wide range of randomly sampled environmental conditions (representing variations in water chemistry). This approach was employed to investigate the transport of nano-TiO2 in the Lower Rhône River (France) under numerous sets of environmental conditions. The predicted spatial concentration profiles of nano-TiO2 were then grouped according to their similarity by using cluster analysis. The analysis resulted in a small number of clusters representing groups of spatial concentration profiles. All clusters show nano-TiO2 accumulation in the sediment layer, supporting results from previous studies. Analysis of the characteristic features of each cluster demonstrated a strong association between the water conditions in regions close to the ENP emission source and the cluster membership of the corresponding spatial concentration profiles. In particular, water compositions favoring heteroaggregation between the ENPs and suspended particulate matter resulted in clusters of low variability. These conditions are, therefore, reliable predictors of the eventual fate of the modeled ENPs. The conclusions from this study are also valid for ENP fate in other large river systems. Our results, therefore, shift the focus of future modeling and experimental research of ENP environmental fate to the water characteristic in regions near the expected ENP emission sources. Under conditions favoring heteroaggregation in these

  7. Addressing the complexity of Tourette’s syndrome through the use of animal models.

    Ester eNespoli

    2016-04-01

    Full Text Available Tourette’s syndrome (TS is a neurodevelopmental disorder characterized by fluctuating motor and vocal tics, usually preceded by sensory premonitions, called premonitory urges. Besides tics, the vast majority – up to 90% - of TS patients suffer from psychiatric comorbidities, mainly attention deficit/hyperactivity disorder (ADHD and obsessive-compulsive disorder (OCD. The etiology of TS remains elusive. Genetics is believed to play an important role, but it is clear that other factors contribute to TS, possibly altering brain functioning and architecture during a sensitive phase of neural development. Clinical brain imaging and genetic studies have contributed in elucidating TS pathophysiology and disease mechanisms; however, TS disease etiology still is poorly understood. Findings from genetic studies led to the development of genetic animal models, but they poorly reflect the pathophysiology of TS. Addressing the role of neurotransmission, brain regions and brain circuits in TS disease pathomechanisms is another focus area for pre-clinical TS model development. We are now in an interesting moment in time when numerous innovative animal models are continuously brought to the attention of the public. Due to the diverse and largely unknown etiology of TS, there is no single pre-clinical model featuring all different aspects of TS symptomatology. TS has been dissected into its key symptoms that have been investigated separately, in line with the Research Domain Criteria concept. The different rationales used to develop the respective animal models are critically reviewed, to discuss the potential of the contribution of animal models to elucidate TS disease mechanisms.

  8. Technological challenges of addressing new and more complex migrating products from novel food packaging materials.

    Munro, Ian C; Haighton, Lois A; Lynch, Barry S; Tafazoli, Shahrzad

    2009-12-01

    The risk assessment of migration products resulting from packaging material has and continues to pose a difficult challenge. In most jurisdictions, there are regulatory requirements for the approval or notification of food contact substances that will be used in packaging. These processes generally require risk assessment to ensure safety concerns are addressed. The science of assessing food contact materials was instrumental in the development of the concept of Threshold of Regulation and the Threshold of Toxicological Concern procedures. While the risk assessment process is in place, the technology of food packaging continues to evolve to include new initiatives, such as the inclusion of antimicrobial substances or enzyme systems to prevent spoilage, use of plastic packaging intended to remain on foods as they are being cooked, to the introduction of more rigid, stable and reusable materials, and active packaging to extend the shelf-life of food. Each new technology brings with it the potential for exposure to new and possibly novel substances as a result of migration, interaction with other chemical packaging components, or, in the case of plastics now used in direct cooking of products, degradation products formed during heating. Furthermore, the presence of trace levels of certain chemicals from packaging that were once accepted as being of low risk based on traditional toxicology studies are being challenged on the basis of reports of adverse effects, particularly with respect to endocrine disruption, alleged to occur at very low doses. A recent example is the case of bisphenol A. The way forward to assess new packaging technologies and reports of very low dose effects in non-standard studies of food contact substances is likely to remain controversial. However, the risk assessment paradigm is sufficiently robust and flexible to be adapted to meet these challenges. The use of the Threshold of Regulation and the Threshold of Toxicological Concern concepts may

  9. Using Next Generation Science Standards (NGSS) Practices to Address Scientific Misunderstandings Around Complex Environmental Issues

    Turrin, M.; Kenna, T. C.

    2014-12-01

    The new NGSS provide an important opportunity for scientists to develop curriculum that links the practice of science to research-based data in order to improve understanding in areas of science that are both complex and confusing. Our curriculum focuses in particular on the fate and transport of anthropogenic radionuclides. Radioactivity, both naturally occurring and anthropogenic, is highly debated and largely misunderstood, and for large sections of the population is a source of scientific misunderstanding. Developed as part of the international GEOTRACES project which focuses on identifying ocean processes and quantifying fluxes that control the distributions of selected trace elements and isotopes in the ocean, and on establishing the sensitivity of these distributions to changing environmental conditions, the curriculum topic fits nicely into the applied focus of NGSS with both environmental and topical relevance. Our curriculum design focuses on small group discussion driven by questions, yet unlike more traditional curriculum pieces these are not questions posed to the students, rather they are questions posed by the students to facilitate their deeper understanding. Our curriculum design challenges the traditional question/answer memorization approach to instruction as we strive to develop an educational approach that supports the practice of science as well as the NGSS Cross Cutting Concepts and the Science & Engineering Practices. Our goal is for students to develop a methodology they can employ when faced with a complex scientific issue. Through background readings and team discussions they identify what type of information is important for them to know and where to find a reliable source for that information. Framing their discovery around key questions such as "What type of radioactive decay are we dealing with?", "What is the potential half-life of the isotope?", and "What are the pathways of transport of radioactivity?" allows students to evaluate a

  10. Addressing the cultural complexity of OHS in the Australian mining industry.

    Aickin, Christine; Shaw, Andrea; Blewett, Verna; Stiller, Laurie; Cox, Stephen

    2012-01-01

    This paper summarises the findings of the site assessments of ten pilot mine sites involved in a project entitled, Creating a world-leading OHS culture in the NSW Mining Industry which was undertaken for the New South Wales Mine Safety Advisory Council (NSW MSAC). NSW MSAC was established in 1998 in NSW Australia and aims to increase the emphasis on safety and health within the mining industry by reviewing and analyzing safety performance, setting strategic directions, providing advice and developing policy recommendations. The project itself aimed to deliver a self-sustaining method for achieving and monitoring continuous improvement in OHS culture and practice to the NSW mining industry. The pilot sites involved in the project tested a set of self-assessment tools to enable mines to assess and improve their own OHS culture and performance on key elements of an OHS management system. The tools allowed examination of the current OHS culture of the sites. Sites then used a participative planning process to develop an improvement plan. This paper provides summary data only, without identifying the individual sites that were the source of the data.

  11. Nanotechnology for sustainability: what does nanotechnology offer to address complex sustainability problems?

    Wiek, Arnim, E-mail: arnim.wiek@asu.edu; Foley, Rider W. [Arizona State University, School of Sustainability (United States); Guston, David H. [Arizona State University, Center for Nanotechnology in Society, Consortium for Science, Policy and Outcomes (United States)

    2012-09-15

    Nanotechnology is widely associated with the promise of positively contributing to sustainability. However, this view often focuses on end-of-pipe applications, for instance, for water purification or energy efficiency, and relies on a narrow concept of sustainability. Approaching sustainability problems and solution options from a comprehensive and systemic perspective instead may yield quite different conclusions about the contribution of nanotechnology to sustainability. This study conceptualizes sustainability problems as complex constellations with several potential intervention points and amenable to different solution options. The study presents results from interdisciplinary workshops and literature reviews that appraise the contribution of the selected nanotechnologies to mitigate such problems. The study focuses exemplarily on the urban context to make the appraisals tangible and relevant. The solution potential of nanotechnology is explored not only for well-known urban sustainability problems such as water contamination and energy use but also for less obvious ones such as childhood obesity. Results indicate not only potentials but also limitations of nanotechnology's contribution to sustainability and can inform anticipatory governance of nanotechnology in general, and in the urban context in particular.

  12. Addressing Health Inequities: Coronary Heart Disease Training within Learning Disabilities Services

    Holly, Deirdre; Sharp, John

    2014-01-01

    People with learning disabilities are at increased risk of coronary heart disease (CHD). Research suggests this may be due to inequalities in health status and inequities in the way health services respond to need. Little is known about the most effective way to improve health outcomes for people with learning disabilities. A previously developed…

  13. Learning from communities in the USA and England to promote equity and address the social determinants of health.

    Blanchard, Claire; Gibbs, Martin; Narle, Ginder; Brookes, Chris

    2013-12-01

    This commentary contextualises and documents the process of a twinning learning exchange between the US Racial and Ethnic Approaches to Community Health initiative and the Communities for Health initiative in England to enable the transfer and adaptation of ideas for similar community-focused initiatives in various contexts globally. The multi-partner twinning exchange built on and shared knowledge around community health promotion interventions, targeting 'marginalised' populations and focused on addressing the social determinants of health to effectively reduce health inequalities. This commentary presents the methodology of the exchange; provides key themes, outcomes and lessons learnt that arose from discussions and the experience; and provides insights, considerations and recommendations for adaptation. Finally, it highlights the importance of such exchanges in the current global context and the need for their replication and adaptation. These experiences contribute to building the evidence base on successful interventions and identifying strategies that work for improving health outcomes and reducing health inequalities. They strengthen the need for all governments to address the social determinants of health as a priority whilst providing insights to inform successful policy.

  14. Addressing health inequalities by using Structural Funds. A question of opportunities.

    Neagu, Oana Maria; Michelsen, Kai; Watson, Jonathan; Dowdeswell, Barrie; Brand, Helmut

    2017-03-01

    Making up a third of the EU budget, Structural and Investment Funds can provide important opportunities for investing in policies that tackle inequalities in health. This article looks back and forward at the 2007-2013 and 2014-2020 financial periods in an attempt to inform the development of health equity as a strand of policy intervention under regional development. It combines evidence from health projects funded through Structural Funds and a document analyses that locates interventions for health equity under the new regulations. The map of opportunities has changed considerably since the last programming period, creating more visibility for vulnerable groups, social determinants of health and health systems sustainability. As the current programming period is progressing, this paper contributes to maximizing this potential but also identifying challenges and implementation gaps for prospective health system engagement in pursuing health equity as part of Structural Funds projects. The austerity measures and their impact on public spending, building political support for investments as well as the difficulties around pursuing health gains as an objective of other policy areas are some of the challenges to overcome. European Structural and Investment Funds could be a window of opportunity that triggers engagement for health equity if sectors adopt a transformative approach and overcome barriers, cooperate for common goals and make better use of the availability of these resources.

  15. Addressing disparities in maternal health care in Pakistan: gender, class and exclusion

    Mumtaz Zubia

    2012-08-01

    Full Text Available Abstract Background After more than two decades of the Safe Motherhood Initiative and Millennium Development Goals aimed at reducing maternal mortality, women continue to die in childbirth at unacceptably high rates in Pakistan. While an extensive literature describes various programmatic strategies, it neglects the rigorous analysis of the reasons these strategies have been unsuccessful, especially for women living at the economic and social margins of society. A critical gap in current knowledge is a detailed understanding of the root causes of disparities in maternal health care, and in particular, how gender and class influence policy formulation and the design and delivery of maternal health care services. Taking Pakistan as a case study, this research builds upon two distinct yet interlinked conceptual approaches to understanding the phenomenon of inequity in access to maternal health care: social exclusion and health systems as social institutions. Methods/Design This four year project consists of two interrelated modules that focus on two distinct groups of participants: (1 poor, disadvantaged women and men and (2 policy makers, program managers and health service providers. Module one will employ critical ethnography to understand the key axes of social exclusion as related to gender, class and zaat and how they affect women’s experiences of using maternal health care. Through health care setting observations, interviews and document review, Module two will assess policy design and delivery of maternal health services. Discussion This research will provide theoretical advances to enhance understanding of the power dynamics of gender and class that may underlie poor women’s marginalization from health care systems in Pakistan. It will also provide empirical evidence to support formulation of maternal health care policies and health care system practices aimed at reducing disparities in maternal health care in Pakistan. Lastly, it

  16. Addressing inequities in access to primary health care: lessons for the training of health care professionals from a regional medical school.

    Larkins, Sarah; Sen Gupta, Tarun; Evans, Rebecca; Murray, Richard; Preston, Robyn

    2011-01-01

    Attention to the inequitable distribution and limited access to primary health care resources is key to addressing the priority health needs of underserved populations in rural, remote and outer metropolitan areas. There is little high-quality evidence about improving access to quality primary health care services for underserved groups, particularly in relation to geographic barriers, and limited discussion about the training implications of reforms to improve access. To progress equity in access to primary health care services, health professional education institutions need to work with both the health sector and policy makers to address issues of workforce mix, recruitment and retention, and new models of primary health care delivery. This requires a fundamental shift in focus from these institutions and the health sector, to each view themselves as partners in an integrated teaching, research and service-oriented health system. This paper discusses the challenges and opportunities for primary health care professionals, educators and the health sector in providing quality teaching and clinical experiences for increasing numbers of health professionals as a result of the reform agenda. It then outlines some practical strategies based on theory and evolving experience for dealing with some of these challenges and capitalising on opportunities.

  17. Complexity or Meaning in Health Professional Education and Practice?

    Lowe, Wendy Anne

    2014-01-01

    Objectives: Discourses of complexity have entered health professional education. This paper explores the meaning of complexity by asking how health professionals are educated and some of the consequences of that education. Design: A qualitative study was carried out drawing on reflexivity, discourse analysis and grounded methodology. Setting: Two…

  18. Developing a complex approach to health phenomena (step 1)

    Cifuentes, Myriam Patricia

    Health is a complex object for science and operative levels, partly because there are many approaches defining it but not scientifically sufficient or operatively accepted. This is relevant for health understanding but also for decision making on health related problems. "Determinants of Health" as a widely accepted theoretical proposal, identifies as problematic the reductionist view of health as the disease opposite, attempting to develop it positively according to WHO's definition, proposing a set of factors determining health outcomes. Though this allows a larger comprehension of health causes and effects, still has insufficiently defined theoretical statements and unproved assumptions which difficult understanding and effective actions orientation. Complexity deductive modeling since the insufficiently formalized frameworks, implies incorporating unmanageable object assumptions or reducing health broadness. Taking profit of Bogotá government adherence to DH proposal leading a health information system development, was possible inductive modeling since a systemic massive database (690.000 registries). In this way, DH theoretical statements about health components connectedness were explored by classic statistic approach, and by learning Bayesian networks from data (data mining). First approach showed understanding difficulties. Second was advantageous in approximating within and between determinants relationship structure. However, though DH introduces a systemic approach in considering diverse interacting elements is not empirically satisfactory to exhibit all the meaning of health complexity, because just matches analytic fashioned constructs depending on data expression. A strong networked model developing health complexity, needs the orientation by theoretical constructs as human agency and organization, to explore and understand emergent patterns of health.

  19. New approaches to addressing information needs in local public health agencies.

    Chambers, L W; Haynes, R B; Pickering, R; McKibbon, A; Walker-Dilks, C J; Panton, L; Goldblatt, E

    1991-01-01

    For local Public Health agencies to be fully responsive to community needs, staff must have ready access to up-to-date and accurate information. During the last several years, the Hamilton-Wentworth Department of Public Health Services (DPHS), a Teaching Health Unit affiliated with McMaster University, has been developing new information services including establishment of a specialized library on site; education sessions on the use of information stored in this library and in the Hamilton-Wentworth Health Library Network; innovative approaches to tailoring information services to staff needs including on-site access to on-line literature databases; and establishment of a group to retrieve and report community health data. In the initial three years of operation, surveys of Hamilton-Wentworth staff and a comparison health unit (Niagara) revealed that staff most frequently sought information from managers and support staff, as well as from personal books, articles and journals. Over half (57%) of the Hamilton-Wentworth staff reported use of the DPHS library, whereas 28% of Niagara Regional Health Unit staff reported use of their library. Other information services, for example, bibliographic indexes on population health, were less frequently used. Plans to increase their use are discussed.

  20. Addressing individual behaviours and living conditions: Four Nordic public health policies

    Vallgårda, Signild

    2011-01-01

    approach to public health exists. All programmes contain contradictory policies and ideological statements with differences regarding the emphasis on individual behaviour versus choice and living conditions and political responsibility. The policies are not entirely predictable from the political stance......: Analyses of recent public health programmes in Denmark, Finland, Norway, and Sweden. Results: Focus is on either, or both, individual behaviour and living conditions as causes of ill health; the remedies are classical liberal as well as social democratic policies. None of the programmes is consistent...... environment and the politicians’ responsibility to improve the population’s health. The Swedish and the Finnish programmes lie between those of Denmark and Norway. The Finnish and Norwegian governments stress their responsibility for the health of the population. Conclusions: No common Nordic political...

  1. The Role of Occupational Therapy in Community-Based Programming: Addressing Childhood Health Promotion

    Julie Kugel

    2017-01-01

    Full Text Available Background: Obesity and poor health habits impact youth’s health and occupational participation. Occupational therapy’s role in preventing and treating obesity continues to emerge in the research literature. This article explores the impact of a community-based program emphasizing health and wellness for female youth. Methods: Five girls 11 to 13 years of age participated in the healthy occupations program. Before and after the program, the participants engaged in an individual semi-structured interview and completed the Canadian Occupational Performance Measure and the CATCH Kids Club Questionnaire. The youth participated in a focus group midprogram. Results: The participants were receptive to information regarding healthy behaviors and initiated positive health behavior changes after implementation of a 7-week healthy lifestyle community- based program. Conclusion: Occupational therapy can collaborate with community partners to provide programming focused on health promotion and prevention as part of the interprofessional approach to preventing and treating childhood obesity and building healthier communities.

  2. Multi-sectoral action for addressing social determinants of noncommunicable diseases and mainstreaming health promotion in national health programmes in India.

    Arora, Monika; Chauhan, Kavita; John, Shoba; Mukhopadhyay, Alok

    2011-12-01

    Major noncommunicable diseases (NCDs) share common behavioral risk factors and deep-rooted social determinants. India needs to address its growing NCD burden through health promoting partnerships, policies, and programs. High-level political commitment, inter-sectoral coordination, and community mobilization are important in developing a successful, national, multi-sectoral program for the prevention and control of NCDs. The World Health Organization's "Action Plan for a Global Strategy for Prevention and Control of NCDs" calls for a comprehensive plan involving a whole-of-Government approach. Inter-sectoral coordination will need to start at the planning stage and continue to the implementation, evaluation of interventions, and enactment of public policies. An efficient multi-sectoral mechanism is also crucial at the stage of monitoring, evaluating enforcement of policies, and analyzing impact of multi-sectoral initiatives on reducing NCD burden in the country. This paper presents a critical appraisal of social determinants influencing NCDs, in the Indian context, and how multi-sectoral action can effectively address such challenges through mainstreaming health promotion into national health and development programs. India, with its wide socio-cultural, economic, and geographical diversities, poses several unique challenges in addressing NCDs. On the other hand, the jurisdiction States have over health, presents multiple opportunities to address health from the local perspective, while working on the national framework around multi-sectoral aspects of NCDs.

  3. Addressing Social Determinants of Health in a Clinic Setting: The WellRx Pilot in Albuquerque, New Mexico.

    Page-Reeves, Janet; Kaufman, Will; Bleecker, Molly; Norris, Jeffrey; McCalmont, Kate; Ianakieva, Veneta; Ianakieva, Dessislava; Kaufman, Arthur

    2016-01-01

    Although it is known that the social determinants of health have a larger influence on health outcomes than health care, there currently is no structured way for primary care providers to identify and address nonmedical social needs experienced by patients seen in a clinic setting. We developed and piloted WellRx, an 11-question instrument used to screen 3048 patients for social determinants in 3 family medicine clinics over a 90-day period. Results showed that 46% of patients screened positive for at least 1 area of social need, and 63% of those had multiple needs. Most of these needs were previously unknown to the clinicians. Medical assistants and community health workers then offered to connect patients with appropriate services and resources to address the identified needs. The WellRx pilot demonstrated that it is feasible for a clinic to implement such an assessment system, that the assessment can reveal important information, and that having information about patients' social needs improves provider ease of practice. Demonstrated feasibility and favorable outcomes led to institutionalization of the WellRx process at a university teaching hospital and influenced the state department of health to require managed care organizations to have community health workers available to care for Medicaid patients.

  4. Addressing health disparities through patient education: the development of culturally-tailored health education materials at Puentes de Salud.

    Harvey, Isobel; O'Brien, Matthew

    2011-10-01

    The availability of culturally appropriate written health information is essential for promoting health in diverse populations. Lack of English fluency has been shown to negatively impact health outcomes for Latinos in the United States. The authors conducted a needs assessment at a clinic serving Latino immigrants, focusing on patients' health and previous experiences with written health information. Based on these results and a literature review, we developed 10 Spanish language brochures to better serve the target population. This article outlines the process of developing and implementing this intervention, which can serve as a model for similar projects targeting diverse populations.

  5. Increasing the impact of health plan report cards by addressing consumers' concerns.

    Hibbard, J H; Harris-Kojetin, L; Mullin, P; Lubalin, J; Garfinkel, S

    2000-01-01

    Most plan report cards that compare the performance of health plans have framed the decision about plan choice as an opportunity to get better-quality care. This study uses a controlled experimental design to examine the effect of reframing the health plan choice decision to one that emphasizes protecting oneself from possible risk. The findings show that framing the health plan decision using a risk message has a consistent and significant positive impact on how consumers comprehend, value, and weight comparative performance information.

  6. 75 FR 20913 - Center for Devices and Radiological Health; New Address Information

    2010-04-22

    ... Electronic products, Labeling, Lasers, Medical devices, Radiation protection, Reporting and recordkeeping... and procedure, Medical devices. 21 CFR Part 900 Electronic products, Health facilities, Medical devices, Radiation protection, Reporting and recordkeeping requirements, X-rays. 21 CFR Part...

  7. Addressing the "Global Health Tax" and "Wild Cards": Practical Challenges to Building Academic Careers in Global Health.

    Palazuelos, Daniel; Dhillon, Ranu

    2016-01-01

    Among many possible benefits, global health efforts can expand the skills and experience of U.S. clinicians, improve health for communities in need, and generate innovations in care delivery with relevance everywhere. Yet, despite high rates of interest among students and medical trainees to include global health opportunities in their training, there is still no clear understanding of how this interest will translate into viable and sustained global health careers after graduation. Building on a growing conversation about how to support careers in academic global health, this Perspective describes the practical challenges faced by physicians pursuing these careers after they complete training. Writing from their perspective as junior faculty at one U.S. academic health center with a dedicated focus on global health training, the authors describe a number of practical issues they have found to be critical both for their own career development and for the advice they provide their mentees. With a particular emphasis on the financial, personal, professional, and logistical challenges that young "expat" global health physicians in academic institutions face, they underscore the importance of finding ways to support these career paths, and propose possible solutions. Such investments would not only respond to the rational and moral imperatives of global health work and advance the mission of improving human health but also help to fully leverage the potential of what is already an unprecedented movement within academic medicine.

  8. The effectiveness of health appraisal processes currently in addressing health and wellbeing during spatial plan appraisal: a systematic review

    Gray Selena

    2011-11-01

    Full Text Available Abstract Background Spatial planning affects the built environment, which in turn has the potential to have a significant impact on health, for good or ill. One way of ensuring that spatial plans take due account of health is through the inclusion of health considerations in the statutory and non statutory appraisal processes linked to plan-making processes. Methods A systematic review to identify evaluation studies of appraisals or assessments of plans where health issues were considered from 1987 to 2010. Results A total of 6161 citations were identified: 6069 from electronic databases, 57 fromwebsite searches, with a further 35 citations from grey literature, of which 20 met the inclusion criteria. These 20 citations reported on a total of 135 different case studies: 11 UK HIA; 11 non UK high income countries HIA, 5 UK SEA or other integrated appraisal; 108 non UK high income SEA or other integrated appraisal. All studies were in English. No relevant studies were identified reporting on low or middle income countries. The studies were limited by potential bias (no independent evaluation, with those undertaking the appraisal also responsible for reporting outcomes, lack of detail and a lack of triangulation of results. Health impact assessments generally covered the four specified health domains (physical activity, mental health and wellbeing, environmental health issues such as pollution and noise, injury more comprehensively than SEA or other integrated appraisals, although mental health and wellbeing was an underdeveloped area. There was no evidence available on the incorporation of health in Sustainability Appraisal, limited evidence that the recommendations from any type of appraisal were implemented, and almost no evidence that the recommendations had led to the anticipated outcomes or improvements in health postulated. Conclusion Research is needed to assess (i the degree to which statutory plan appraisal processes (SA in the UK

  9. Addressing the conundrum of multimorbidity in heart failure: Do we need a more strategic approach to improve health outcomes?

    Stewart, Simon; Riegel, Barbara; Thompson, David R

    2016-02-01

    There is clear evidence across the globe that the clinical complexity of patients presenting to hospital with the syndrome of heart failure is increasing - not only in terms of the presence of concurrent disease states, but with additional socio-demographic risk factors that complicate treatment. Management strategies that treat heart failure as the main determinant of health outcomes ignores the multiple and complex issues that will inevitably erode the efficacy and efficiency of current heart failure management programmes. This complex problem (or conundrum) requires a different way of thinking around the complex interactions that underpin poor outcomes in heart failure. In this context, we present the COordinated NUrse-led inteNsified Disease management for continuity of caRe for mUltiMorbidity in Heart Failure (CONUNDRUM-HF) matrix that may well inform future research and models of care to achieve better health outcomes in this rapidly increasing patient population.

  10. Public health agendas addressing violence against rural women - an analysis of local level health services in the State of Rio Grande do Sul, Brazil

    Marta Cocco da Costa

    2015-05-01

    Full Text Available This study analyses health managers' perceptions of local public health agendas addressing violence against rural women in municipalities in the southern part of the State Rio Grande do Sul in Brazil. It consists of an exploratory descriptive study utilizing a qualitative approach. Municipal health managers responsible for planning actions directed at women's health and primary health care were interviewed. The analysis sought to explore elements of programmatic vulnerability related to violence in the interviewees' narratives based on the following dimensions of programmatic vulnerability: expression of commitment, transformation of commitment into action, and planning and coordination. It was found that local health agendas directed at violence against rural women do not exist. Health managers are therefore faced with the challenge of defining lines of action in accordance with the guidelines and principles of the SUS. The repercussions of this situation are expressed in fragile comprehensive services for these women and programmatic vulnerability.

  11. A conceptual framework for addressing complexity and unfolding transition dynamics when developing sustainable adaptation strategies in urban water management

    Farné Fratini, Chiara; Elle, Morten; Jensen, Marina Bergen

    2012-01-01

    To achieve a successful and sustainable adaptation to climate change we need to transform the way we think about change. Much water management research has focused on technical innovation with a range of new solutions developed to achieve a “more sustainable and integrated urban water management...... addressing the complexity characterizing urban water management in the context of climate change. In this paper the framework is used to organize a research processes aiming at understanding and unfolding urban dynamics for sustainable transition. The final goal is to enable local authorities and utilities...... cycle”. But, Danish municipalities and utility companies are struggling to bring such solutions into practice. “Green infrastructure”, for example, requires the consideration of a larger range of aspects related to the urban context than the traditional urban water system optimization. There is the need...

  12. A conceptual framework for addressing complexity and unfolding transition dynamics when developing sustainable adaptation strategies in urban water management

    Fratini, Chiara; Elle, Morten; Jensen, M. B.

    2012-01-01

    To achieve a successful and sustainable adaptation to climate change we need to transform the way we think about change. Much water management research has focused on technical innovation with a range of new solutions developed to achieve a 'more sustainable and integrated urban water management...... addressing the complexity characterizing urban water management in the context of climate change. In this paper the framework is used to organize a research process aiming at understanding and unfolding urban dynamics for sustainable transition. The final goal is to enable local authorities and utilities...... cycle'. But Danish municipalities and utility companies are struggling to bring such solutions into practice. 'Green infrastructure', for example, requires the consideration of a larger range of aspects related to the urban context than the traditional urban water system optimization. There is the need...

  13. Complexity: a potential paradigm for a health promotion discipline.

    Tremblay, Marie-Claude; Richard, Lucie

    2014-06-01

    Health promotion underpins a distancing from narrow, simplifying health approaches associated with the biomedical model. However, it has not yet succeeded in formally establishing its theoretical, epistemological and methodological foundations on a single paradigm. The complexity paradigm, which it has yet to broach head-on, might provide it with a disciplinary matrix in line with its implicit stances and basic values. This article seeks to establish complexity's relevance as a paradigm that can contribute to the development of a health promotion discipline. The relevance of complexity is justified primarily by its matching with several implicit epistemological and methodological/theoretical stances found in the cardinal concepts and principles of health promotion. The transcendence of ontological realism and determinism as well as receptiveness in respect of the reflexivity that complexity encompasses are congruent with the values of social justice, participation, empowerment and the concept of positive health that the field promotes. Moreover, from a methodological and theoretical standpoint, complexity assumes a holistic, contextual and transdisciplinary approach, toward which health promotion is tending through its emphasis on ecology and interdisciplinary action. In a quest to illustrate our position, developmental evaluation is presented as an example of practice stemming from a complexity paradigm that can be useful in the evaluation of health promotion initiatives. In short, we argue that it would be advantageous for health promotion to integrate this paradigm, which would provide it with a formal framework appropriate to its purposes and concerns.

  14. Setting priorities to address cardiovascular diseases through universal health coverage in low- and middle-income countries

    Nugent, Rachel A

    2017-01-01

    Over the past decade, universal health coverage (UHC) has emerged as a major policy goal for many low- and middle-income country governments. Yet, despite the high burden of cardiovascular diseases (CVD), relatively little is known about how to address CVD through UHC. This review covers three major topics. First, we define UHC and provide some context for its importance, and then we illustrate its relevance to CVD prevention and treatment. Second, we discuss how countries might select high-priority CVD interventions for a UHC health benefits package drawing on economic evaluation methods. Third, we explore some implementation challenges and identify research gaps that, if addressed, could improve the inclusion of CVD into UHC. PMID:28321266

  15. Looking within and beyond the community: lessons learned by researching, theorising and acting to address urban poverty and health.

    Hodgetts, Darrin; Chamberlain, Kerry; Tankel, Yadena; Groot, Shiloh

    2014-01-01

    Urban poverty and health inequalities are inextricably intertwined. By working in partnership with service providers and communities to address urban poverty, we can enhance the wellness of people in need. This article reflects on lessons learned from the Family100 project that explores the everyday lives, frustrations and dilemmas faced by 100 families living in poverty in Auckland. Lessons learned support the need to bring the experiences and lived realities of families to the fore in public deliberations about community and societal responses to urban poverty and health inequality.

  16. A responsive evaluation of mental health treatment in Cambodia: Intentionally addressing poverty to increase cultural responsiveness in therapy.

    Seponski, Desiree M; Lewis, Denise C; Megginson, Maegan C

    2014-01-01

    Mental health issues are significant contributors to the global burden of disease with the highest incidence in resource poor countries; 90% of those in need of mental health treatment reside in low resource countries but receive only 10% of the world's resources. Cambodia, the eighth least developed country in the world, serves as one example of the need to address mental health concerns in low-income, resource poor countries. The current study utilises responsive evaluation methodology to explore how poverty-stricken Cambodian clients, therapists and supervisors experience Western models of therapy as culturally responsive to their unique needs. Quantitative and qualitative data were triangulated across multiple stakeholders using numerous methods including a focus group, interviews, surveys, case illustrations and live supervision observation and analysed using constant comparative analysis. Emerging findings suggest that poverty, material needs, therapy location and financial situations greatly impact the daily lives and mental health conditions of Cambodians and hinder clients' therapeutic progress. The local community needs and context of poverty greatly hinder clients' therapeutic progress in therapy treatment and when therapy does not directly address the culture of poverty, clients did not experience therapy as valuable despite some temporary decreases in mental health symptoms.

  17. Addressing inequity to achieve the maternal and child health millennium development goals: looking beyond averages

    Ruhago George M

    2012-12-01

    Full Text Available Abstract Background Inequity in access to and use of child and maternal health interventions is impeding progress towards the maternal and child health Millennium Development Goals. This study explores the potential health gains and equity impact if a set of priority interventions for mothers and under fives were scaled up to reach national universal coverage targets for MDGs in Tanzania. Methods We used the Lives Saved Tool (LiST to estimate potential reductions in maternal and child mortality and the number of lives saved across wealth quintiles and between rural and urban settings. High impact maternal and child health interventions were modelled for a five-year scale up, by linking intervention coverage, effectiveness and cause of mortality using data from Tanzania. Concentration curves were drawn and the concentration index estimated to measure the equity impact of the scale up. Results In the poorest population quintiles in Tanzania, the lives of more than twice as many mothers and under-fives were likely to be saved, compared to the richest quintile. Scaling up coverage to equal levels across quintiles would reduce inequality in maternal and child mortality from a pro rich concentration index of −0.11 (maternal and −0.12 (children to a more equitable concentration index of −0,03 and −0.03 respectively. In rural areas, there would likely be an eight times greater reduction in maternal deaths than in urban areas and a five times greater reduction in child deaths than in urban areas. Conclusions Scaling up priority maternal and child health interventions to equal levels would potentially save far more lives in the poorest populations, and would accelerate equitable progress towards maternal and child health MDGs.

  18. Complexity theory and geographies of health: a critical assessment.

    Gatrell, Anthony C

    2005-06-01

    The interest of social scientists in complexity theory has developed rapidly in recent years. Here, I consider briefly the primary characteristics of complexity theory, with particular emphasis given to relations and networks, non-linearity, emergence, and hybrids. I assess the 'added value' compared with other, existing perspectives that emphasise relationality and connectedness. I also consider the philosophical underpinnings of complexity theory and its reliance on metaphor. As a vehicle for moving away from reductionist accounts, complexity theory potentially has much to say to those interested in research on health inequalities, spatial diffusion, emerging and resurgent infections, and risk. These and other applications in health geography that have invoked complexity theory are examined in the paper. Finally, I consider some of the missing elements in complexity theory and argue that while it is refreshing to see a fruitful line of theoretical debate in health geography, we need good empirical work to illuminate it.

  19. The FDI African Strategy for Oral Health: addressing the specific needs of the continent.

    Hescot, Patrick; China, Emile; Bourgeois, Denis; Maina, Susan; Monteiro da Silva, Orlando; Luc Eiselé, Jean; Simpson, Christopher; Horn, Virginie

    2013-06-01

    The FDI World Dental Federation has defined a strategy for the development of oral health in Africa during the "African Summit" held in Cape Town, South Africa. The summit gathered presidents from 16 African National Dental Associations, FDI stakeholders, the World Health Organisation and government delegates. The outcomes of this summit were stated in a Declaration, defining the functional principles of the African strategy as three priorities: To establish and reinforce the credibility of NDAs To acquire and develop leadership and management skills Effective peer-to-peer exchange of information.

  20. The Role of School Health Services in Addressing the Needs of Students with Chronic Health Conditions: A Systematic Review

    Leroy, Zanie C.; Wallin, Robin; Lee, Sarah

    2017-01-01

    Children and adolescents in the United States spend many hours in school. Students with chronic health conditions (CHCs) may face lower academic achievement, increased disability, fewer job opportunities, and limited community interactions as they enter adulthood. School health services provide safe and effective management of CHCs, often for…

  1. Life Before Tests: A District's Coordinated Health Approach for Addressing Children's Full Range of Needs

    Cooper, Patrick

    2005-01-01

    Chronic illnesses, depression, abuse of drugs, alcohol and tobacco. Sugary snacks and drinks, vending machines, obesity and bullying. Guns, gang violence, school shootings and test scores. Teen-age birth rates, one-parent households, lack of health or dental care, and, dropouts. All of these issues are interconnected and intertwined with education…

  2. Perspectives on the strategic uses of concept mapping to address public health challenges.

    Anderson, Lynda A; Slonim, Amy

    2017-02-01

    We examine the adaptation of approaches used to plan and implement the steps of concept mapping to meet specialized needs and requirements in several public health projects. Seven published concept mapping projects are detailed to document how each of the phases were modified to meet the specific aims of each project. Concept mapping was found to be a useful tool to complement public health roles such as assessment, program development, and priority setting. The phases of concept mapping allow for a blending of diverse perspectives, which is critical to public health efforts. The adaptability of concept mapping permits the use of multiple modalities such as the addition of face-to-face brainstorming; use of qualitative methods, including structured interviews; and review and use of published literature and guidelines. Another positive aspect of concept mapping for public health practice is its ability to identify program elements, provide a visual map of generated ideas and their relationships to one another, and assist in identifying priorities. Our reflections on the adaptability should help inform another generation in designing concept mapping projects and related products that may benefit from unique adaptations and the rapidly expanding social media technology and platforms.

  3. Mobile farm clinic outreach to address health conditions among Latino migrant farmworkers in Georgia.

    Luque, John S; Reyes-Ortiz, Carlos; Marella, Prasen; Bowers, Angelica; Panchal, Viral; Anderson, Lisa; Charles, Simone

    2012-01-01

    Agricultural labor involves exposure to many occupational hazards, some of which can lead to chronic health conditions. The purpose of this study was to conduct an occupational health needs assessment of illnesses and work-related injuries among a Latino migrant farmworker population (recruited to harvest Vidalia onions) in South Georgia. Study data included survey responses from 100 farmworkers attending mobile farm clinics in 2010 at their worker housing residences, supplemented by medical diagnoses data from the same clinics collected over 3 years (2009-2011) for 1161 farmworkers at six different farms. From the survey, the main health problems reported were hypertension (25%), eye problems (12%), musculoskeletal problems (11%), diabetes (10%), and depression (7%). In multivariate analyses, depression scores were associated with having a history of musculoskeletal problems (p = .002). According to the mobile farm clinic data, the most common medical diagnoses included back pain (11.8%), hypertension (11.4%), musculoskeletal problems (11.3%), gastrointestinal disorders (8.6%), eye problems (7.2%), dermatitis or rash (7.0%), and tinea or fungal skin infections (5.6%). The study identified eye and musculoskeletal problems as the major occupational health conditions for this population of farmworkers.

  4. Conference Addresses Problems of Reproduction and Women’s Health Care

    JENNIFER LIM

    1994-01-01

    REPRODUCTION and health are important problems concerning women’s progress and development. Since the 1960s the subjects have attracted the attention of the world. Awareness of these problems has gradually increased to the extent that some concepts have generally been agreed upon. They are:

  5. Addressing Health Disparities in the Undergraduate Curriculum: An Approach to Develop a Knowledgeable Biomedical Workforce

    Benabentos, Rocio; Ray, Payal; Kumar, Deepak

    2014-01-01

    Disparities in health and healthcare are a major concern in the United States and worldwide. Approaches to alleviate these disparities must be multifaceted and should include initiatives that touch upon the diverse areas that influence the healthcare system. Developing a strong biomedical workforce with an awareness of the issues concerning health…

  6. Keep Calm and Contracept! Addressing Young Women's Pleasure in Sexual Health and Contraception Consultations

    Hanbury, Ali; Eastham, Rachael

    2016-01-01

    Clinical sexual health consultations with young women often focus on avoiding "risks;" namely pregnancy and sexually transmitted infection transmission. They also typically fail to explore how contraception use can impact on the capacity to enjoy sexual relationships. In contrast, this paper argues that sexual pleasure should be a…

  7. Addressing inequalities in oral health in India: need for skill mix in the dental workforce.

    Mathur, Manu Raj; Singh, Ankur; Watt, Richard

    2015-01-01

    Dentistry has always been an under-resourced profession. There are three main issues that dentistry is facing in the modern era. Firstly, how to rectify the widely acknowledged geographical imbalance in the demand and supply of dental personnel, secondly, how to provide access to primary dental care to maximum number of people, and thirdly, how to achieve both of these aims within the financial restraints imposed by the central and state governments. The trends of oral diseases have changed significantly in the last 20 years. The two of the most common oral diseases that affect a majority of the population worldwide, namely dental caries and periodontitis, have been proved to be entirely preventable. Even for life-threatening oral diseases like oral cancer, the best possible available treatment is prevention. There is a growing consensus that appropriate skill mix can prove very beneficial in providing these preventive dental care services to the public and aid in achieving the goal of universal oral health coverage. Professions complementary to dentistry (PCD) have been found to be effective in reducing inequalities in oral health, improving access and spreading the messages of health promotion across entire spectrum of socio-economic hierarchy in various studies conducted globally. This commentary provides a review of the effectiveness of skill mix in dentistry and a reflection on how this can be beneficial in achieving universal oral health care in India.

  8. Identifying and Addressing the Mental Health Needs of Online Students in Higher Education

    Barr, Bonny

    2014-01-01

    89% of colleges and universities in the United States offer online courses and of those institutions 58% offer degree programs that are completely online (Parker, Lenhart & Moore, 2011).Providing online student services is an important component of these distance programs and is often required by accrediting bodies. Health and wellness…

  9. Can TESOL Teachers Address the Mental Health Concerns of the Indochinese Refugees? Draft.

    Cohon, J. Donald, Jr.

    This paper examines research in the fields of psychology, anthropology, and the Teaching of English to Speakers of Other Languages (TESOL) as it relates to the mental health needs of the Indochinese refugees. It is argued that TESOL instructors are in a key position to influence the adaptation process of refugees in their classes. Cultural values…

  10. Addressing Diversity in Health Science Students by Enhancing Flexibility through e-Learning

    Penman, Joy; Thalluri, Jyothi

    2014-01-01

    The technological advancements for teaching and learning sciences for health science students are embedded in the Thalluri-Penman Good Practice Model, which aims to improve the learning experiences of science students and increase student retention and success rates. The model also links students from urban and rural areas, studying both on-and…

  11. The Health Sciences and Technology Academy: an educational pipeline to address health care disparities in West Virginia.

    McKendall, Sherron Benson; Kasten, Kasandra; Hanks, Sara; Chester, Ann

    2014-01-01

    Health and educational disparities are national issues in the United States. Research has shown that health care professionals from underserved backgrounds are more likely than others to work in underserved areas. The Association of American Medical Colleges' Project 3000 by 2000, to increase the number of underrepresented minorities in medical schools, spurred the West Virginia School of Medicine to start the Health Sciences and Technology Academy (HSTA) in 1994 with the goal of supporting interested underrepresented high school students in pursuing college and health professions careers. The program was based on three beliefs: (1) if underrepresented high school students have potential and the desire to pursue a health professions career and are given the support, they can reach their goals, including obtaining a health professions degree; (2) underserved high school students are able to predict their own success if given the right resources; and (3) community engagement would be key to the program's success.In this Perspective, the authors describe the HSTA and its framework and philosophy, including the underlying theories and pedagogy from research in the fields of education and the behavioral/social sciences. They then offer evidence of the program's success, specifically for African American students, including graduates' high college-going rate and overwhelming intention to choose a health professions major. Finally, the authors describe the benefits of the HSTA's community partnerships, including providing mentors to students, adding legislative language providing tuition waivers and a budgetary line item devoted to the program, and securing program funding from outside sources.

  12. Climate Change and Health on the U.S. Gulf Coast: Public Health Adaptation is Needed to Address Future Risks.

    Petkova, Elisaveta P; Ebi, Kristie L; Culp, Derrin; Redlener, Irwin

    2015-08-11

    The impacts of climate change on human health have been documented globally and in the United States. Numerous studies project greater morbidity and mortality as a result of extreme weather events and other climate-sensitive hazards. Public health impacts on the U.S. Gulf Coast may be severe as the region is expected to experience increases in extreme temperatures, sea level rise, and possibly fewer but more intense hurricanes. Through myriad pathways, climate change is likely to make the Gulf Coast less hospitable and more dangerous for its residents, and may prompt substantial migration from and into the region. Public health impacts may be further exacerbated by the concentration of people and infrastructure, as well as the region's coastal geography. Vulnerable populations, including the very young, elderly, and socioeconomically disadvantaged may face particularly high threats to their health and well-being. This paper provides an overview of potential public health impacts of climate variability and change on the Gulf Coast, with a focus on the region's unique vulnerabilities, and outlines recommendations for improving the region's ability to minimize the impacts of climate-sensitive hazards. Public health adaptation aimed at improving individual, public health system, and infrastructure resilience is urgently needed to meet the challenges climate change may pose to the Gulf Coast in the coming decades.

  13. Tools for address georeferencing - limitations and opportunities every public health professional should be aware of.

    Ana Isabel Ribeiro

    Full Text Available Various address georeferencing (AG tools are currently available. But little is known about the quality of each tool. Using data from the EPIPorto cohort we compared the most commonly used AG tools in terms of positional error (PE and subjects' misclassification according to census tract socioeconomic status (SES, a widely used variable in epidemiologic studies. Participants of the EPIPorto cohort (n = 2427 were georeferenced using Geographical Information Systems (GIS and Google Earth (GE. One hundred were randomly selected and georeferenced using three additional tools: 1 cadastral maps (gold-standard; 2 Global Positioning Systems (GPS and 3 Google Earth, single and in a batch. Mean PE and the proportion of misclassified individuals were compared. Google Earth showed lower PE than GIS, but 10% of the addresses were imprecisely positioned. Thirty-eight, 27, 16 and 14% of the participants were located in the wrong census tract by GIS, GPS, GE (batch and GE (single, respectively (p<0.001. Misclassification according to SES was less frequent but still non-negligible -14.4, 8.1, 4.2 and 2% (p<0.001. The quality of georeferencing differed substantially between AG tools. GE seems to be the best tool, but only if prudently used. Epidemiologic studies using spatial data should start including information on the quality and accuracy of their georeferencing tools and spatial datasets.

  14. Development of an interinstitutional collaboration to support community-partnered research addressing the health of emerging Latino populations.

    Corbie-Smith, Giselle; Yaggy, Susan D; Lyn, Michelle; Green, Melissa; Ornelas, India J; Simmons, Tia; Perez, Georgina; Blumenthal, Connie

    2010-04-01

    Collaborative and participatory research approaches have received considerable attention as means to understanding and addressing disparities in health and health care. In this article, the authors describe the process of building a three-way partnership among two academic health centers-Duke University and the University of North Carolina-and members of the Latino community in North Carolina to develop and pilot test a lay health advisor program to improve Latina immigrants' mental health and coping skills. The authors applied the principles of participatory research to engage community and academic partners, to select the health topic and population, and to develop program goals and objectives. Key challenges were negotiating administrative structures and learning institutional cultures, as well as dealing with contextual issues such as mental health reform and antiimmigrant sentiment in the state.Some important lessons learned are to seek opportunities for taking advantage of existing relationships and expertise at each academic institution, to be respectful of the burden of research on vulnerable communities, and to involve community partners at all stages of the process.

  15. Towards a Unified Theory of Health-Disease: I. Health as a complex model-object

    Naomar Almeida-Filho

    2013-06-01

    Full Text Available Theory building is one of the most crucial challenges faced by basic, clinical and population research, which form the scientific foundations of health practices in contemporary societies. The objective of the study is to propose a Unified Theory of Health-Disease as a conceptual tool for modeling health-disease-care in the light of complexity approaches. With this aim, the epistemological basis of theoretical work in the health field and concepts related to complexity theory as concerned to health problems are discussed. Secondly, the concepts of model-object, multi-planes of occurrence, modes of health and disease-illness-sickness complex are introduced and integrated into a unified theoretical framework. Finally, in the light of recent epistemological developments, the concept of Health-Disease-Care Integrals is updated as a complex reference object fit for modeling health-related processes and phenomena.

  16. Towards a unified theory of health-disease: I. Health as a complex model-object.

    Almeida-Filho, Naomar

    2013-06-01

    Theory building is one of the most crucial challenges faced by basic, clinical and population research, which form the scientific foundations of health practices in contemporary societies. The objective of the study is to propose a Unified Theory of Health-Disease as a conceptual tool for modeling health-disease-care in the light of complexity approaches. With this aim, the epistemological basis of theoretical work in the health field and concepts related to complexity theory as concerned to health problems are discussed. Secondly, the concepts of model-object, multi-planes of occurrence, modes of health and disease-illness-sickness complex are introduced and integrated into a unified theoretical framework. Finally, in the light of recent epistemological developments, the concept of Health-Disease-Care Integrals is updated as a complex reference object fit for modeling health-related processes and phenomena.

  17. Fort Collins Science Center Ecosystem Dynamics branch--interdisciplinary research for addressing complex natural resource issues across landscapes and time

    Bowen, Zachary H.; Melcher, Cynthia P.; Wilson, Juliette T.

    2013-01-01

    The Ecosystem Dynamics Branch of the Fort Collins Science Center offers an interdisciplinary team of talented and creative scientists with expertise in biology, botany, ecology, geology, biogeochemistry, physical sciences, geographic information systems, and remote-sensing, for tackling complex questions about natural resources. As demand for natural resources increases, the issues facing natural resource managers, planners, policy makers, industry, and private landowners are increasing in spatial and temporal scope, often involving entire regions, multiple jurisdictions, and long timeframes. Needs for addressing these issues include (1) a better understanding of biotic and abiotic ecosystem components and their complex interactions; (2) the ability to easily monitor, assess, and visualize the spatially complex movements of animals, plants, water, and elements across highly variable landscapes; and (3) the techniques for accurately predicting both immediate and long-term responses of system components to natural and human-caused change. The overall objectives of our research are to provide the knowledge, tools, and techniques needed by the U.S. Department of the Interior, state agencies, and other stakeholders in their endeavors to meet the demand for natural resources while conserving biodiversity and ecosystem services. Ecosystem Dynamics scientists use field and laboratory research, data assimilation, and ecological modeling to understand ecosystem patterns, trends, and mechanistic processes. This information is used to predict the outcomes of changes imposed on species, habitats, landscapes, and climate across spatiotemporal scales. The products we develop include conceptual models to illustrate system structure and processes; regional baseline and integrated assessments; predictive spatial and mathematical models; literature syntheses; and frameworks or protocols for improved ecosystem monitoring, adaptive management, and program evaluation. The descriptions

  18. [Proposal to address the mental health problems detected after the February 27, 2010 earthquake].

    Figueroa, Rodrigo A; Cortés, Paula F

    2016-02-01

    One of the most important topics mentioned by people from places affected by the February 27th, 2010 earthquake to the Presidential Delegation for the Reconstruction, was the urgent need of mental health care. Given the enormous individual and social burden of mental health sequelae after disasters, its treatment becomes a critical issue. In this article, we propose several actions to be implemented in Chile in the context of the process of recovery and reconstruction, including optimization of social communication and media response to disasters; designing and deployment of a national strategy for volunteer service; training of primary care staff in screening and initial management of post-traumatic stress reactions; and training, continuous education and clinical supervision of a critical number of therapists in evidence-based therapies for conditions specifically related to stress.

  19. Cystic fibrosis: addressing the transition from pediatric to adult-oriented health care

    Kreindler JL

    2013-12-01

    Full Text Available James L Kreindler,1,2 Victoria A Miller1,31The Children’s Hospital of Philadelphia, 2Department of Pediatrics, 3Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USAAbstract: Survival for patients with cystic fibrosis (CF increased to nearly 40 years in 2012 from the early childhood years in the 1940s. Therefore, patients are living long enough to require transition from pediatric CF centers to adult CF centers. The goal of transition is for the young adult to be engaged in the adult health care system in ways that optimize health, maximize potential, and increase quality of life. A successful transition promotes autonomy and responsibility with respect to one's own health. Currently, there is an information gap in the literature with respect to psychological models that can help guide informed transition processes. In this review, we establish the framework in which transition exists in CF; we review some of the published literature from the last 20 years of experience with transition in CF centers around the world; and we discuss psychological models of pediatric illness that can help to explain the current state of transition to adult-oriented care from pediatric-oriented care and help to formulate new models of ascertaining readiness for transition. Finally, we look at our current knowledge gaps and opportunities for future research endeavors.Keywords: cystic fibrosis, transition, adolescent, social-ecological model of AYA readiness for transition, SMART

  20. Addressing sexual health in congenital heart disease: when being the same isn't the same.

    Loomba, Rohit S; Aggarwal, Saurabh; Pelech, Andrew N

    2015-01-01

    A larger number of individuals born with congenital heart disease is living into adolescence and young adulthood. With this comes the responsibility to counsel these patients regarding their sexual and reproductive health. This study utilizes representative data from the National Health and Nutrition Examination Survey to compare sexual measures including percentage of that sexually active, age of first sexual activity, number of sexual partners, condom use, and history of sexually transmitted diseases in those with and without congenital heart disease. A total of 1086 patients (1057 without congenital heart disease and 29 with congenital heart disease) were included in this study. Likelihood of being sexually active, age of first sexual intercourse, and condom use did not differ significantly between the two groups after multivariate analysis. Incidence of sexually transmitted disease did not differ between the two groups after multivariate analysis except for genital warts. There are no major differences in sexual measures between those with and without congenital heart disease. The absence of significant differences in sexual measures in those with congenital heart disease compared with the general population places this group of individuals at increased health risk known to occur with pregnancy.

  1. Five Topics Health Care Simulation Can Address to Improve Patient Safety

    Sollid, Stephen J M; Dieckmann, Peter; Aase, Karina

    2016-01-01

    OBJECTIVES: There is little knowledge about which elements of health care simulation are most effective in improving patient safety. When empirical evidence is lacking, a consensus statement can help define priorities in, for example, education and research. A consensus process was therefore init......-day consensus meeting at the Utstein Abbey in Norway. The goals of stage 4 were to agree on the top 5 topics in health care simulation that contribute the most to patient safety, identify the patient safety problems they relate to, and suggest solutions with implementation strategies...... for these problems. RESULTS: The expert group agreed on the following topics: technical skills, nontechnical skills, system probing, assessment, and effectiveness. For each topic, 5 patient safety problems were suggested that each topic might contribute to solve. Solutions to these problems and implementation....... CONCLUSIONS: The expert group recommends that the 5 topics identified in this consensus process should be the main focus when health care simulation is implemented in patient safety curricula.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial...

  2. Addressing health system barriers to access to and use of skilled delivery services: perspectives from Ghana.

    Ganle, John Kuumuori; Fitzpatrick, Raymond; Otupiri, Easmon; Parker, Michael

    2016-10-01

    Poor access to and use of skilled delivery services have been identified as a major contributory factor to poor maternal and newborn health in sub-Saharan African countries, including Ghana. However, many previous studies that examine norms of childbirth and care-seeking behaviours have focused on identifying the norms of non-use of services, rather than factors, that can promote service use. Based on primary qualitative research with a total of 185 expectant and lactating mothers, and 20 healthcare providers in six communities in Ghana, this paper reports on strategies that can be used to overcome health system barriers to the use of skilled delivery services. The strategies identified include expansion and redistribution of existing maternal health resources and infrastructure, training of more skilled maternity caregivers, instituting special programmes to target women most in need, improving the quality of maternity care services provided, improving doctor-patient relationships in maternity wards, promotion of choice, protecting privacy and patient dignity in maternity wards and building partnerships with traditional birth attendants and other non-state actors. The findings suggest the need for structural changes to maternity clinics and routine nursing practices, including an emphasis on those doctor-patient relational practices that positively influence women's healthcare-seeking behaviours. Copyright © 2015 John Wiley & Sons, Ltd.

  3. Sports Complexes, Located during MicroData field address collection 2004-2006. Kept in Spillman database for retrieval., Published in 2004, Vilas County Land Information/Mapping.

    NSGIC GIS Inventory (aka Ramona) — This Sports Complexes dataset, was produced all or in part from Field Observation information as of 2004. It is described as 'Located during MicroData field address...

  4. The simplicity complex: exploring simplified health messages in a complex world.

    Zarcadoolas, Christina

    2011-09-01

    A challenge in individual and public health at the start of the 21st century is to effectively communicate health and science information about disease and complex emergencies. The low health literacy of millions of adults in the USA has been referred to as a 'silent killer'. A popular approach to improving health communication and health promotion to low health literate consumers has been to simplify the language of health information. The expected result has been that individuals and groups will better understand information and will then make informed decisions about their health and behaviors. This expectation has grown to include the belief that the public will be better prepared to take appropriate action in complex natural and man-made emergencies. Demonstrating the efficacy of this approach remains, in large part, uninvestigated. And it is becoming more evident that health literacy itself is complex and multifaceted. This article applies linguistic and sociolinguistic models in order to better articulate the role of simplification in health communication and health promotion. Focusing on two models from sociolinguistics-pragmatics and text theory-the article discusses their usefulness in rethinking message simplification. The discussion proposes that a richer, more theory-based understanding of text structures and functions, along with other powerful constructs, including cultural appropriateness, relevancy and context, are needed to close the gaps between health messages, health messengers and patients/the public. The article concludes by making recommendations for future study to empirically test the strengths and limitations of these models and constructs.

  5. A Socio-Ecological Approach in Addressing Hearing Loss and Disparities in Access to Hearing Health Care Among Older Adults

    Maia Ingram

    2016-08-01

    Full Text Available Hearing loss is associated with cognitive decline and impairment in daily living activities. Access to hearing health care has broad implications for healthy aging of the U.S. population. This qualitative study investigated factors related to the socio-ecological domains of hearing health in a US-Mexico border community experiencing disparities in access to care. A multidisciplinary research team partnered with Community Health Workers (CHWs from a Federally Qualified Health Center in designing the study. CHWs conducted interviews with people with hearing loss (n=20 and focus groups with their family/friends (n=27 and with members of the community-at-large (n=47. The research team conducted interviews with FQHC providers and staff (n=12. Individuals experienced depression, sadness and social isolation, as well as frustration and even anger regarding communication. Family members experienced negative impacts of deteriorating communication, but expressed few coping strategies. There was general agreement across data sources that hearing loss was not routinely addressed within primary care and assistive hearing technology was generally unaffordable. Community members described stigma related to hearing loss and a need for greater access to hearing health care and broader community education. Findings confirm the causal sequence of hearing impairment on quality of life aggravated by socio-economic conditions and lack of access to hearing health care. Hearing loss requires a comprehensive and innovative public health response across the socio-ecological framework that includes both individual communication intervention and greater access to hearing health resources. Community health workers can be effective in tailoring intervention strategies to community characteristics.

  6. A taxonomy characterizing complexity of consumer eHealth Literacy.

    Chan, Connie V; Matthews, Lisa A; Kaufman, David R

    2009-11-14

    There are a range of barriers precluding patients from fully engaging in and benefiting from the spectrum of eHealth interventions developed to support patient access to health information, disease self-management efforts, and patient-provider communication. Consumers with low eHealth literacy skills often stand to gain the greatest benefit from the use of eHealth tools. eHealth skills are comprised of reading/writing/numeracy skills, health literacy, computer literacy, information literacy, media literacy, and scientific literacy [1]. We aim to develop an approach to characterize dimensions of complexity and to reveal knowledge and skill-related barriers to eHealth engagement. We use Bloom's Taxonomy to guide development of an eHealth literacy taxonomy that categorizes and describes each type of literacy by complexity level. Illustrative examples demonstrate the utility of the taxonomy in characterizing dimensions of complexity of eHealth skills used and associated with each step in completing an eHealth task.

  7. Keynote address at the Fifth Congress of the International Association for Adolescent Health.

    Ransome-Kuti, O

    1992-07-01

    This Nigerian Ministry of Health speech reiterates the importance of focusing on the problems of youth and adolescents which was 1st identified in 1989 at a World Health Assembly. Every stage of the life cycle is important because mental, physical, psychological, and social scars are carried into the future. It is important to make the transition to adulthood as smooth as possible. Of the 30% (1.5 billion) of the World's population that are adolescents 10-24 years old, 80% live in developing countries. 50% of the world population is 25 years. In the preparation for adulthood, age-old customs, culture, and tradition have ensured the stability and survival of societies, but great changes have taken place due to colonialism, modern education, urban migration, rapid travel an communication, tourism, and trade. There is weakening of traditional marriage. Foreign cultural influence has armed youths to challenge community cultural norms and parental authority to direct their development. There is social tension, disruption, an instability. Adults as role models have sometimes failed to represent integrity and honesty. There is a need for sensitive support and guidance from adults. Peer pressure operates for both good or ill. Some will react to this stress to conform in unhealthy ways. The health care system may not fill adolescent needs because they are too old for the pediatrician and too young for the physician. Girls are particularly vulnerable to the problems of premarital pregnancy, induced abortion, out-of-wedlock births, and sexually transmitted diseases. The pressure is to grow up fast, particularly in polygamous societies where the woman has security only in her children. Opportunities for dialogue degenerate into sessions of being "talked at" and forced compliance. Unemployment is very high which can lead to loss of self-esteem, psychological stress, and hopelessness and sometimes street fighting, thuggery, drug pushing, and armed robbery. Attempts worldwide are

  8. Peer Navigators and Integrated Care to Address Ethnic Health Disparities of People with Serious Mental Illness

    Corrigan, Patrick W.; Pickett, Susan; Batia, Karen; Michaels, Patrick J.

    2017-01-01

    People of color with serious mental illnesses experience high rates of morbidity and mortality. Patient navigators, developed for cancer care, may help this group benefit from integrated care. This review examined patient navigators’ key ingredients for cancer care for relevance to patients of color for application of peer services to psychiatric goals. Among cancer patients, navigators lead to greater treatment engagement and improved health outcomes for ethnic minority groups. Research also suggests peers can improve integrated care by providing effective psychiatric services to individuals with mental illness. Ongoing research examines peer navigators’ impact on integrated care for patients of color. PMID:25144699

  9. Policy Directions Addressing the Public Health Impact of Climate Change in South Korea: The Climate-change Health Adaptation and Mitigation Program.

    Shin, Yong Seung; Ha, Jongsik

    2012-01-01

    Climate change, caused by global warming, is increasingly recognized as a major threat to mankind's survival. Climate change concurrently has both direct and modifying influences on environmental, social, and public health systems undermining human health as a whole. Environmental health policy-makers need to make use of political and technological alternatives to address these ramifying effects. The objective of this paper is to review public health policy in Korea, as well as internationally, particularly as it relates to climate change health adaptation and mitigation programs (such as C-CHAMP of Korea), in order to assess and elicit directions for a robust environmental health policy that is adaptive to the health impacts of climate change. In Korea, comprehensive measures to prevent or mitigate overall health effects are limited, and the diffusion of responsibility among various government departments makes consistency in policy execution very difficult. This paper proposes integration, synergy, and utilization as the three core principles of policy direction for the assessment and adaptation to the health impacts of climate change. For specific action plans, we suggest policy making based on scientifically integrated health impact assessments and the prioritization of environmental factors in climate change; the development of practical and technological tools that support policy decisions by making their political implementation more efficient; and customized policy development that deals with the vulnerability of local communities.

  10. Antecedents and Consequences of Consumer's Response to Health Information Complexity

    Hansen, Torben; Uth Thomsen, Thyra; Beckmann, Suzanne C.

    2013-01-01

    This study develops and empirically tests a model for understanding food consumers' health information seeking behaviour. Data were collected from 504 food consumers using a nationally representative consumer panel. The obtained Lisrel results suggest that consumers' product-specific health...... information seeking is positively affected by general food involvement and by usability of product-specific health information. Moreover, product-specific health information seeking and product-specific health information complexity are both positively related to post-purchase health-related dissonance....... This link between information complexity and post-purchase dissonance has implications for marketers of food products since our results suggest that consumers might avoid purchasing the same food item again if post-purchase dissonance is experienced....

  11. Using Mixed Methods to Facilitate Complex, Multiphased Health Research

    Tina Strudsholm; Lynn M. Meadows; Ardene Robinson Vollman; Thurston, Wilfreda E.; Rita Henderson

    2016-01-01

    From conceptualization to application and evaluation, research is conducted in a context of increasing complexity of disciplines, goals, communities, and partnerships. Researchers often are challenged to demonstrate the rigor of their methods and results to audiences with diverse backgrounds and disciplinary expertise. This article illustrates the benefits of using mixed methods approaches in research designed to address issues in complex research projects. It outlines the implementation of a...

  12. Addressing the socioeconomic determinants of adolescent health: experiences from the WHO/HBSC Forum 2007

    Koller, Theadora; Morgan, Antony; Guerreiro, Ana

    2009-01-01

    their health. Each Forum process consists of case studies produced by interdisciplinary teams in countries and regions, cross-country evidence reviews, a European consultation, an outcomes statement within a final publication, and a Web-based knowledge platform. In addition to emphasizing the translation...... process revealed that national-level impacts of involvement were: brokering new or strengthening existing working relationships among members of case study drafting teams and national delegations to events; feeding into the formulation of national policy or practice design; and enabling the comparison...... systematic, appropriate and meaningful youth involvement; maximization of the usefulness of the European consultation; and definition of a budget line and framework for evaluation of the process' impact at country level....

  13. Addressing health inequalities in the delivery of the human papillomavirus vaccination programme: examining the role of the school nurse.

    Tammy Boyce

    increase uptake and address health inequalities in childhood and adolescent vaccination programmes.

  14. Beyond inequality: Acknowledging the complexity of social determinants of health.

    Eckersley, Richard

    2015-12-01

    The impact of inequality on health is gaining more attention as public and political concern grows over increasing inequality. The income inequality hypothesis, which holds that inequality is detrimental to overall population health, is especially pertinent. However the emphasis on inequality can be challenged on both empirical and theoretical grounds. Empirically, the evidence is contradictory and contested; theoretically, it is inconsistent with our understanding of human societies as complex systems. Research and discussion, both scientific and political, need to reflect better this complexity, and give greater recognition to other social determinants of health.

  15. Toward core inter-professional health promotion competencies to address the non-communicable diseases and their risk factors through knowledge translation: Curriculum content assessment

    Dean, Elizabeth; Moffat, Marilyn; Skinner, Margot; Dornelas de Andrade, Armele; Myezwa, Hellen; Söderlund, Anne

    2014-01-01

    Background To increase the global impact of health promotion related to non-communicable diseases, health professionals need evidence-based core competencies in health assessment and lifestyle behavior change. Assessment of health promotion curricula by health professional programs is a first step. Such program assessment is a means of 1. demonstrating collective commitment across health professionals to prevent non-communicable diseases; 2. addressing the knowledge translation gap between wh...

  16. Understanding global health governance as a complex adaptive system.

    Hill, Peter S

    2011-01-01

    The transition from international to global health reflects the rapid growth in the numbers and nature of stakeholders in health, as well as the constant change embodied in the process of globalisation itself. This paper argues that global health governance shares the characteristics of complex adaptive systems, with its multiple and diverse players, and their polyvalent and constantly evolving relationships, and rich and dynamic interactions. The sheer quantum of initiatives, the multiple networks through which stakeholders (re)configure their influence, the range of contexts in which development for health is played out - all compound the complexity of this system. This paper maps out the characteristics of complex adaptive systems as they apply to global health governance, linking them to developments in the past two decades, and the multiple responses to these changes. Examining global health governance through the frame of complexity theory offers insight into the current dynamics of governance, and while providing a framework for making meaning of the whole, opens up ways of accessing this complexity through local points of engagement.

  17. The development and implementation of theory-driven programs capable of addressing poverty-impacted children's health, mental health, and prevention needs: CHAMP and CHAMP+, evidence-informed, family-based interventions to address HIV risk and care.

    McKernan McKay, Mary; Alicea, Stacey; Elwyn, Laura; McClain, Zachary R B; Parker, Gary; Small, Latoya A; Mellins, Claude Ann

    2014-01-01

    This article describes a program of prevention and intervention research conducted by the CHAMP (Collaborative HIV prevention and Adolescent Mental health Project; McKay & Paikoff, 2007 ) investigative team. CHAMP refers to a set of theory-driven, evidence-informed, collaboratively designed, family-based approaches meant to address the prevention, health, and mental health needs of poverty-impacted African American and Latino urban youth who are either at risk for HIV exposure or perinatally infected and at high risk for reinfection and possible transmission. CHAMP approaches are informed by theoretical frameworks that incorporate an understanding of the critical influences of multilevel contextual factors on youth risk taking and engagement in protective health behaviors. Highly influential theories include the triadic theory of influence, social action theory, and ecological developmental perspectives. CHAMP program delivery strategies were developed via a highly collaborative process drawing upon community-based participatory research methods in order to enhance cultural and contextual sensitivity of program content and format. The development and preliminary outcomes associated with a family-based intervention for a new population, perinatally HIV-infected youth and their adult caregivers, referred to as CHAMP+, is described to illustrate the integration of theory, existing evidence, and intensive input from consumers and healthcare providers.

  18. Health and environmental effects of complex chemical mixtures: proceedings

    1985-01-01

    The Office of Health and Environmental Research (OHER) of the Department of Energy supports a broad long-term research program on human health and environmental effects from potential exposure to energy-related complex chemical mixtures. The program seeks basic mechanistic data on the effects of complex mixtures at the cellular, molecular, and whole animal levels to aid in predicting human health effects and seeks ecological data on biological and physical transformations in the mixtures, concentrations of the mixtures in various compartments of the environment, and potential routes for human exposure to these mixtures (e.g., food chain). On June 17-18, 1985, OHER held its First Annual Technical Meeting on the Complex Chemical Mixtures Program in Chicago, IL. The primary purpose of the meeting was to enable principal investigators to report the research status and accomplishments of ongoing complex chemical mixture studies supported by OHER. To help focus future research directions round table discussions were conducted.

  19. Health benefits of primary care social work for adults with complex health and social needs: a systematic review.

    McGregor, Jules; Mercer, Stewart W; Harris, Fiona M

    2016-04-05

    The prevalence of complex health and social needs in primary care patients is growing. Furthermore, recent research suggests that the impact of psychosocial distress on the significantly poorer health outcomes in this population may have been underestimated. The potential of social work in primary care settings has been extensively discussed in both health and social work literature and there is evidence that social work interventions in other settings are particularly effective in addressing psychosocial needs. However, the evidence base for specific improved health outcomes related to primary care social work is minimal. This review aimed to identify and synthesise the available evidence on the health benefits of social work interventions in primary care settings. Nine electronic databases were searched from 1990 to 2015 and seven primary research studies were retrieved. Due to the heterogeneity of studies, a narrative synthesis was conducted. Although there is no definitive evidence for effectiveness, results suggest a promising role for primary care social work interventions in improving health outcomes. These include subjective health measures and self-management of long-term conditions, reducing psychosocial morbidity and barriers to treatment and health maintenance. Although few rigorous study designs were found, the contextual detail and clinical settings of studies provide evidence of the practice applicability of social work intervention. Emerging policy on the integration of health and social care may provide an opportunity to develop this model of care.

  20. A mismatch between population health literacy and the complexity of health information

    Rowlands, Gillian; Protheroe, Joanne; Winkley, John;

    2015-01-01

    BACKGROUND: Low health literacy is associated with poorer health and higher mortality. Complex health materials are a barrier to health. AIM: To assess the literacy and numeracy skills required to understand and use commonly used English health information materials, and to describe population...... skills in relation to these. DESIGN AND SETTING: An English observational study comparing health materials with national working-age population skills. METHOD: Health materials were sampled using a health literacy framework. Competency thresholds to understand and use the materials were identified...... of health materials and the skills of the English adult working-age population. Those most in need of health information have the least access to it. Efficacious strategies are building population skills, improving health professionals' communication, and improving written health information....

  1. Effectiveness of a parenting program in Bangladesh to address early childhood health, growth and development.

    Aboud, Frances E; Singla, Daisy R; Nahil, Md Imam; Borisova, Ivelina

    2013-11-01

    A stratified cluster design was used to evaluate a 10-month parenting program delivered to mothers of children in rural Bangladesh. Intervention mothers through a combination of group meetings and home visits received messages along with an illustrative card concerning hygiene, responsive feeding, play, communication, gentle discipline, and nutritious foods. Control mothers received the standard government care. Three months prior, 463 children between 4 and 14 months in a subdistrict of western Bangladesh were administered the cognitive, receptive language and expressive language Bayley III subtests, their length was taken and past week illness recorded. Gross motor milestones were reported by the mother and verified through observation. Mothers were interviewed concerning their practices: preventive health practices, dietary diversity, home stimulation, and knowledge about development milestones. Maternal depressive symptoms were assessed as a measure of emotional availability. Family sociodemographic variables included maternal education, family assets, decision-making and mobility autonomy. One month after the end of the program, mothers and their children were again assessed. Comparisons were made between intervention and control children who were under-12 months vs. 12 months and older at the start of the program. This may be a critical age, when children begin to be upright and mobile enough to explore on their own and be less dependent on parenting stimulation. Analyses yielded strong intervention effects on the three Bayley subtests and on parenting practices related to stimulation and knowledge of development milestones. Age effects were found only for dietary diversity in that younger children in the program benefited more than older ones. However, all children became more stunted. Findings are discussed in terms of theories of behaviour change and parenting, critical ages for parenting programs, and implications for program delivery.

  2. Challenges in researching violence affecting health service delivery in complex security environments.

    Foghammar, Ludvig; Jang, Suyoun; Kyzy, Gulzhan Asylbek; Weiss, Nerina; Sullivan, Katherine A; Gibson-Fall, Fawzia; Irwin, Rachel

    2016-08-01

    Complex security environments are characterized by violence (including, but not limited to "armed conflict" in the legal sense), poverty, environmental disasters and poor governance. Violence directly affecting health service delivery in complex security environments includes attacks on individuals (e.g. doctors, nurses, administrators, security guards, ambulance drivers and translators), obstructions (e.g. ambulances being stopped at checkpoints), discrimination (e.g. staff being pressured to treat one patient instead of another), attacks on and misappropriation of health facilities and property (e.g. vandalism, theft and ambulance theft by armed groups), and the criminalization of health workers. This paper examines the challenges associated with researching the context, scope and nature of violence directly affecting health service delivery in these environments. With a focus on data collection, it considers how these challenges affect researchers' ability to analyze the drivers of violence and impact of violence. This paper presents key findings from two research workshops organized in 2014 and 2015 which convened researchers and practitioners in the fields of health and humanitarian aid delivery and policy, and draws upon an analysis of organizational efforts to address violence affecting healthcare delivery and eleven in-depth interviews with representatives of organizations working in complex security environments. Despite the urgency and impact of violence affecting healthcare delivery, there is an overall lack of research that is of health-specific, publically accessible and comparable, as well as a lack of gender-disaggregated data, data on perpetrator motives and an assessment of the 'knock-on' effects of violence. These gaps limit analysis and, by extension, the ability of organizations operating in complex security environments to effectively manage the security of their staff and facilities and to deliver health services. Increased research

  3. Managing complex systems: performance management in public health.

    Landrum, Laura B; Baker, Stacy L

    2004-01-01

    The complexity of mobilizing and managing systems-wide public health responses has prompted Turning Point's Performance Management National Excellence Collaborative, funded by the Robert Wood Johnson Foundation, to develop a conceptual framework for performance management in public health. The framework has four integrated parts: (1) performance standards, (2) performance measures, (3) reporting of progress, and (4) a quality improvement process. The Collaborative based its framework on evidence gathered through a survey of current state performance management practices, a literature review, and its investigation of current practice models. This balanced and cohesive management model can be constructively used by public health programs, organizations, and community and state public health systems.

  4. What is the 'problem' that outreach work seeks to address and how might it be tackled? Seeking theory in a primary health prevention programme

    Mackenzie Mhairi

    2011-12-01

    Full Text Available Abstract Background Preventive approaches to health are disproportionately accessed by the more affluent and recent health improvement policy advocates the use of targeted preventive primary care to reduce risk factors in poorer individuals and communities. Outreach has become part of the health service response. Outreach has a long history of engaging those who do not otherwise access services. It has, however, been described as eclectic in its purpose, clientele and mode of practice; its effectiveness is unproven. Using a primary prevention programme in the UK as a case, this paper addresses two research questions: what are the perceived problems of non-engagement that outreach aims to address; and, what specific mechanisms of outreach are hypothesised to tackle these. Methods Drawing on a wider programme evaluation, the study undertook qualitative interviews with strategically selected health-care professionals. The analysis was thematically guided by the concept of 'candidacy' which theorises the dynamic process through which services and individuals negotiate appropriate service use. Results The study identified seven types of engagement 'problem' and corresponding solutions. These 'problems' lie on a continuum of complexity in terms of the challenges they present to primary care. Reasons for non-engagement are congruent with the concept of 'candidacy' but point to ways in which it can be expanded. Conclusions The paper draws conclusions about the role of outreach in contributing to the implementation of inequalities focused primary prevention and identifies further research needed in the theoretical development of both outreach as an approach and candidacy as a conceptual framework.

  5. [The cinema as a device for teaching complexity in mental health].

    Delego, Adriana; Carroll, Hugo

    2013-01-01

    This article proposes the use of Cinema as an instrument for a complex approach to Teaching in the field of Clinical Psychiatry and Psychopathology in Mental Health. With this aim, intends a different look that pretends the approach not only to the conceptual structures on Psychopathology, but also to the complexity involved, choosing Cinema as a powerful way of "empathic recreation". Based on previous work by several authors, the theoretical framework that supports this modality is presented in the philosophical, cognitive, pedagogical-didactic aspects and their consequences into teaching within Mental Health. This task also implies addressing the historical evolution of the representation of subjectivity in fiction. In this way, a new perspective to those working in the field of mental health, as subjects involved in continuous learning processes, is presented. This perspective emphasizes the interactions underlying psychic problematical.

  6. Facilitative governance: transforming global health through complexity theory.

    Haffeld, Just

    2012-01-01

    Any initiative to coordinate actions, plans, or initiatives to improve the interaction between global health stakeholders finds itself feeding into a vastly complex global system. By utilising complexity theory as part of a new scientific paradigm, complex adaptive behaviour can emerge to create coherence. A suggested global health convention facilitating incremental regime development could be a way to create good governance processes. Minimum specifications could provide wide space for innovation and encourage shared action. Such specifications would be both a product of, and a facilitator for, future generative relationships. The potential empowerment of individuals as a result of this has the potential to transform global health by creating an arena for continual cooperation, interaction and mutual dependence among global stakeholders.

  7. Health promotion interventions and policies addressing excessive alcohol use: A systematic review of national and global evidence as a guide to health-care reform in China

    Li, Qing; Babor, Thomas F.; Zeigler, Donald; Xuan, Ziming; Morisky, Donald; Hovell, Melbourne F.; Nelson, Toben F.; Shen, Weixing; Li, Bing

    2014-01-01

    Aims Steady increases in alcohol consumption and related problems are likely to accompany China's rapid epidemiologic transition and profit-based marketing activities. We reviewed research on health promotion interventions and policies to address excessive drinking and to guide health-care reform. Methods We searched in Chinese and English language databases and included 21 studies in China published between 1980 and 2013 that covered each policy area from the WHO Global Strategy to Reduce the Harmful Use of Alcohol. We evaluated and compared preventive interventions to the global alcohol literature for cross-national applicability. Results In contrast with hundreds of studies in the global literature, 11 of 12 studies from mainland China were published in Chinese; six of ten in English were on taxation from Taiwan or Hong Kong. Most studies demonstrated effectiveness in reducing excessive drinking, and some reported the reduction of health problems. Seven were randomized controlled trials. Studies targeted schools, drink-driving, workplaces, the health sector, and taxation. Conclusions China is the world's largest alcohol market, yet there has been little growth in alcohol policy research related to health promotion interventions over the past decade. Guided by a public health approach, the WHO Global Strategy, and health reform experience in Russia, Australia, Mexico, and the USA, China could improve its public health response through better coordination and implementation of surveillance and evidence-based research, and through programmatic and legal responses such as public health law research, screening and early intervention within health systems, and the implementation of effective alcohol control strategies. PMID:25533866

  8. Addressing gender inequalities to improve the sexual and reproductive health and wellbeing of women living with HIV

    Avni Amin

    2015-12-01

    Full Text Available Introduction: Globally, women constitute 50% of all persons living with HIV. Gender inequalities are a key driver of women's vulnerabilities to HIV. This paper looks at how these structural factors shape specific behaviours and outcomes related to the sexual and reproductive health of women living with HIV. Discussion: There are several pathways by which gender inequalities shape the sexual and reproductive health and wellbeing of women living with HIV. First, gender norms that privilege men's control over women and violence against women inhibit women's ability to practice safer sex, make reproductive decisions based on their own fertility preferences and disclose their HIV status. Second, women's lack of property and inheritance rights and limited access to formal employment makes them disproportionately vulnerable to food insecurity and its consequences. This includes compromising their adherence to antiretroviral therapy and increasing their vulnerability to transactional sex. Third, with respect to stigma and discrimination, women are more likely to be blamed for bringing HIV into the family, as they are often tested before men. In several settings, healthcare providers violate the reproductive rights of women living with HIV in relation to family planning and in denying them care. Lastly, a number of countries have laws that criminalize HIV transmission, which specifically impact women living with HIV who may be reluctant to disclose because of fears of violence and other negative consequences. Conclusions: Addressing gender inequalities is central to improving the sexual and reproductive health outcomes and more broadly the wellbeing of women living with HIV. Programmes that go beyond a narrow biomedical/clinical approach and address the social and structural context of women's lives can also maximize the benefits of HIV prevention, treatment, care and support.

  9. [Problems of formal organizational structure of industrial health care complexes].

    Włodarczyk, C

    1978-01-01

    The author formulates the thesis that the description of organizational structure of industrial health care complex calls for isolation of the following aspects:--structure of territorial links--systemof organizational units and divisions--organization of basic functions--structure of management--structure of supervision of middle and lowe-level personnel--composition of health care complex council--system of accessibility ranges. Each of the above aspects has been considered on the basis of operative rules of law, using organizational analysis methods.

  10. Association between School District Policies That Address Chronic Health Conditions of Students and Professional Development for School Nurses on Such Policies

    Jones, S. Everett; Brener, Nancy D.; Bergren, Martha Dewey

    2015-01-01

    Supportive school policies and well-prepared school nurses can best address the needs of students with chronic health conditions. We analyzed nationally representative data from the 2012 School Health Policies and Practices Study to examine whether districts with policies requiring that schools provide health services to students with chronic…

  11. Reducing refugee mental health disparities: a community-based intervention to address postmigration stressors with African adults.

    Goodkind, Jessica R; Hess, Julia M; Isakson, Brian; LaNoue, Marianna; Githinji, Ann; Roche, Natalie; Vadnais, Kathryn; Parker, Danielle P

    2014-08-01

    Refugees resettled in the United States have disproportionately high rates of psychological distress. Research has demonstrated the roles of postmigration stressors, including lack of meaningful social roles, poverty, unemployment, lack of environmental mastery, discrimination, limited English proficiency, and social isolation. We report a multimethod, within-group longitudinal pilot study involving the adaptation for African refugees of a community-based advocacy and learning intervention to address postmigration stressors. We found the intervention to be feasible, acceptable, and appropriate for African refugees. Growth trajectory analysis revealed significant decreases in participants' psychological distress and increases in quality of life, and also provided preliminary evidence of intervention mechanisms of change through the detection of mediating relationships whereby increased quality of life was mediated by increases in enculturation, English proficiency, and social support. Qualitative data helped to support and explain the quantitative data. Results demonstrate the importance of addressing the sociopolitical context of resettlement to promote the mental health of refugees and suggest a culturally appropriate, and replicable model for doing so.

  12. Using the World Health Organization's 4S-Framework to Strengthen National Strategies, Policies and Services to Address Mental Health Problems in Adolescents in Resource-Constrained Settings

    Cabral de Mello Meena

    2011-09-01

    Full Text Available Abstract Background Most adolescents live in resource-constrained countries and their mental health has been less well recognised than other aspects of their health. The World Health Organization's 4-S Framework provides a structure for national initiatives to improve adolescent health through: gathering and using strategic information; developing evidence-informed policies; scaling up provision and use of health services; and strengthening linkages with other government sectors. The aim of this paper is to discuss how the findings of a recent systematic review of mental health problems in adolescents in resource-constrained settings might be applied using the 4-S Framework. Method Analysis of the implications of the findings of a systematic search of the English-language literature for national strategies, policies, services and cross-sectoral linkages to improve the mental health of adolescents in resource-constrained settings. Results Data are available for only 33/112 [29%] resource-constrained countries, but in all where data are available, non-psychotic mental health problems in adolescents are identifiable, prevalent and associated with reduced quality of life, impaired participation and compromised development. In the absence of evidence about effective interventions in these settings expert opinion is that a broad public policy response which addresses direct strategies for prevention, early intervention and treatment; health service and health workforce requirements; social inclusion of marginalised groups of adolescents; and specific education is required. Specific endorsed strategies include public education, parent education, training for teachers and primary healthcare workers, psycho-educational curricula, identification through periodic screening of the most vulnerable and referral for care, and the availability of counsellors or other identified trained staff members in schools from whom adolescents can seek assistance for

  13. Computerization of Mental Health Integration complexity scores at Intermountain Healthcare.

    Oniki, Thomas A; Rodrigues, Drayton; Rahman, Noman; Patur, Saritha; Briot, Pascal; Taylor, David P; Wilcox, Adam B; Reiss-Brennan, Brenda; Cannon, Wayne H

    2014-01-01

    Intermountain Healthcare's Mental Health Integration (MHI) Care Process Model (CPM) contains formal scoring criteria for assessing a patient's mental health complexity as "mild," "medium," or "high" based on patient data. The complexity score attempts to assist Primary Care Physicians in assessing the mental health needs of their patients and what resources will need to be brought to bear. We describe an effort to computerize the scoring. Informatics and MHI personnel collaboratively and iteratively refined the criteria to make them adequately explicit and reflective of MHI objectives. When tested on retrospective data of 540 patients, the clinician agreed with the computer's conclusion in 52.8% of the cases (285/540). We considered the analysis sufficiently successful to begin piloting the computerized score in prospective clinical care. So far in the pilot, clinicians have agreed with the computer in 70.6% of the cases (24/34).

  14. Public Health Offices, Public Health Agencies - county, name, address, contact info, email, website, Published in 2007, Iowa Dept. of Public Health.

    NSGIC GIS Inventory (aka Ramona) — This Public Health Offices dataset, was produced all or in part from Published Reports/Deeds information as of 2007. It is described as 'Public Health Agencies -...

  15. Is food allergen analysis flawed? Health and supply chain risks and a proposed framework to address urgent analytical needs.

    Walker, M J; Burns, D T; Elliott, C T; Gowland, M H; Mills, E N Clare

    2016-01-07

    above recommendations from food authorities, business organisations and National Measurement Institutes is important; however transparent international coordination is essential. Thus our recommendations are primarily addressed to the European Commission, the Health and Food Safety Directorate, DG Santé. A global multidisciplinary consortium is required to provide a curated suite of data including genomic and proteomic data on key allergenic food sources, made publically available on line.

  16. Salud Para Su Corazon (health for your heart) community health worker model: community and clinical approaches for addressing cardiovascular disease risk reduction in Hispanics/Latinos.

    Balcazar, H; Alvarado, M; Ortiz, G

    2011-01-01

    This article describes 6 Salud Para Su Corazon (SPSC) family of programs that have addressed cardiovascular disease risk reduction in Hispanic communities facilitated by community health workers (CHWs) or Promotores de Salud (PS). A synopsis of the programs illustrates the designs and methodological approaches that combine community-based participatory research for 2 types of settings: community and clinical. Examples are provided as to how CHWs can serve as agents of change in these settings. A description is presented of a sustainability framework for the SPSC family of programs. Finally, implications are summarized for utilizing the SPSC CHW/PS model to inform ambulatory care management and policy.

  17. Strengthening the Paediatricians Project 2: The effectiveness of a workshop to address the Priority Mental Health Disorders of adolescence in low-health related human resource countries

    Russell Paul SS

    2010-02-01

    Full Text Available Abstract Background Paediatricians can be empowered to address the Priority Mental Health Disorders at primary care level. To evaluate the effectiveness of a collaborative workshop in enhancing the adolescent psychiatry knowledge among paediatricians. Methods A 3-day, 27-hours workshop was held for paediatricians from different regions of India under the auspices of the National Adolescent Paediatric Task Force of the Indian Academy of Paediatrics. A 5-item pretest-posttest questionnaire was developed and administered at the beginning and end of the workshop to evaluate the participants' knowledge acquisition in adolescent psychiatry. Bivariate and multivariate analyses were performed on an intention-to-participate basis. Results Forty-eight paediatricians completed the questionnaire. There was significant enhancement of the knowledge in understanding the phenomenology, identifying the psychopathology, diagnosing common mental disorder and selecting the psychotropic medication in the bivariate analysis. When the possible confounders of level of training in paediatrics and number of years spent as paediatrician were controlled, in addition to the above areas of adolescent psychiatry, the diagnostic ability involving multiple psychological concepts also gained significance. However, both in the bivariate and multivariate analyses, the ability to refer to appropriate psychotherapy remained unchanged after the workshop. Conclusions This workshop was effective in enhancing the adolescent psychiatry knowledge of paediatricians. Such workshops could strengthen paediatricians in addressing the priority mental health disorders at the primary-care level in countries with low-human resource for health as advocated by the World Health Organization. However, it remains to be seen if this acquisition of adolescent psychiatry knowledge results in enhancing their adolescent psychiatry practice.

  18. The potential role of health impact assessment in tackling the complexity of climate change adaptation for health.

    Brown, Helen L; Proust, Katrina; Spickett, Jeffery; Capon, Anthony

    2011-12-01

    Managing an issue of the magnitude, scope and complexity of climate change is a daunting prospect, yet one which nations around the world must face. Climate change is an issue without boundaries--impacts will cut across administrative and geographical borders and be felt by every sector of society. Responses to climate change will need to employ system approaches that take into account the relationships that cross organisational and sectoral boundaries. Solutions designed in isolation from these interdependencies will be unlikely to succeed, squandering opportunities for long-term effective adaptation. Health Impact Assessment (HIA) provides a structural approach to identify, evaluate and manage health impacts of climate change that is inclusive of a wide range of stakeholders. Climate change will affect decision-making across every government level and sector and the health implications of these decisions can also be addressed with HIA. Given the nature of the issue, HIA of climate change will identify a large number of variables that influence the type and extent of health impacts and the management of these impacts. In order to implement the most effective adaptation measures, it is critica that an understanding of the interactions between these variables is developed. The outcome of HIA of climate change can therefore be strengthened by the introduction of system dynamics tools, such as causal loop diagrams, that are designed to examine interactions between variables and the resulting behaviour of complex systems.

  19. The Carter Center Mental Health Program: Addressing the Public Health Crisis in the Field of Mental Health Through Policy Change and Stigma Reduction

    Rebecca G. Palpant, MS; Rachael Steimnitz; Thomas H. Bornemann, EdD; Katie Hawkins

    2006-01-01

    Some of the most pervasive and debilitating illnesses are mental illnesses, according to World Health Organization’s The World Health Report 2001 — Mental Health: New Understanding, New Hope. Neuropsychiatric conditions account for four of the top five leading causes of years of life lived with disability in people aged 15 to 44 in the Western world. Many barriers prevent people with mental illnesses from seeking care, such as prohibitive costs, lack of insurance, and the stigma and discrimin...

  20. Venturing into schools: Locating mental health initiatives in complex environments

    Helen Askell-Williams; Lawson, Michael J.; Phillip T. Slee

    2009-01-01

    Schools provide viable settings for mental health promotion initiatives, such as programs to develop students’ social and emotional capabilities (SEC). Complexity in the school environments into which initiatives are introduced, such as diverse student capabilities, school structures, and teachers’ knowledge and confidence, will play an integral role in the success of those initiatives. This paper investigates the environments of schools about to receive the KidsMatter mental heath prom...

  1. A Social Media mHealth Solution to Address the Needs of Dengue Prevention and Management in Sri Lanka

    Rathnayake, Vajira Sampath; Lim, Gentatsu; Panchapakesan, Chitra; Foo, Schubert; Wijayamuni, Ruwan; Wimalaratne, Prasad; Fernando, Owen Noel Newton

    2016-01-01

    Background Sri Lanka has witnessed a series of dengue epidemics over the past five years, with the western province, home to the political capital of Colombo, bearing more than half of the dengue burden. Existing dengue monitoring prevention programs are exhausted as public health inspectors (PHIs) cope with increasing workloads and paper-based modes of surveillance and education, characterizing a reactive system unable to cope with the enormity of the problem. On the other hand, the unprecedented proliferation and affordability of mobile phones since 2009 and a supportive political climate have thus far remained unexploited for the use of mobile-based interventions for dengue management. Objective To conduct a needs assessment of PHIs in Colombo with respect to their dengue-related tasks and develop a new mobile-based system to address these needs while strengthening existing systems. Methods One-on-one in-depth interviews were conducted with 29 PHIs to a) gain a nuanced, in-depth understanding of the current state of surveillance practices, b) understand the logistical, technological and social challenges they confront, and c) identify opportunities for mobile-based interventions. Quantitative analysis included simple descriptive statistics while qualitative analysis comprised textual analysis of 209 pages of transcripts (or nearly 600 minutes of conversations) using grounded theory approaches. Results Current paper-based data collection practices for dengue surveillance involved a circuitous, time consuming process that could take between 7-10 days to officially report and record a single case. PHIs confronted challenges in terms of unreliable, standalone GIS devices, delays in registering mosquito breeding sites and lack of engagement from communities while delivering dengue education. These findings, in concert with a high motivation to use mobile-based systems, informed the development of Mo-Buzz, a mobile-based system that integrates three components

  2. Social workers' roles in addressing the complex end-of-life care needs of elders with advanced chronic disease.

    Kramer, Betty J

    2013-01-01

    This study examined social workers' roles in caring for low-income elders with advanced chronic disease in an innovative, community-based managed care program, from the perspective of elders, family, team members, and social workers. The results are drawn from a larger longitudinal, multimethod case study. Sources of data include survey reports of needs addressed by social workers for 120 deceased elders, five focus groups with interdisciplinary team members, and in-depth interviews with 14 elders and 10 of their family caregivers. A thematic conceptual matrix was developed to detail 32 distinctive social work roles that address divergent needs of elders, family, and team members. Distinctive perceptions of social workers' roles were identified for the different stakeholder groups (i.e., elders, family caregivers, team members, and social workers). Findings from this study may inform supervisors and educators regarding training needs of those preparing to enter the rapidly growing workforce of gerontological social workers who may be called upon to care for elders at the end of life. Training is particularly warranted to help social workers gain the skills needed to more successfully treat symptom management, depression, anxiety, agitation, grief, funeral planning, and spiritual needs that are common to the end of life.

  3. Conceptualising population health: from mechanistic thinking to complexity science

    Jayasinghe Saroj

    2011-01-01

    Full Text Available Abstract The mechanistic interpretation of reality can be traced to the influential work by René Descartes and Sir Isaac Newton. Their theories were able to accurately predict most physical phenomena relating to motion, optics and gravity. This paradigm had at least three principles and approaches: reductionism, linearity and hierarchy. These ideas appear to have influenced social scientists and the discourse on population health. In contrast, Complexity Science takes a more holistic view of systems. It views natural systems as being 'open', with fuzzy borders, constantly adapting to cope with pressures from the environment. These are called Complex Adaptive Systems (CAS. The sub-systems within it lack stable hierarchies, and the roles of agency keep changing. The interactions with the environment and among sub-systems are non-linear interactions and lead to self-organisation and emergent properties. Theoretical frameworks such as epi+demos+cracy and the ecosocial approach to health have implicitly used some of these concepts of interacting dynamic sub-systems. Using Complexity Science we can view population health outcomes as an emergent property of CAS, which has numerous dynamic non-linear interactions among its interconnected sub-systems or agents. In order to appreciate these sub-systems and determinants, one should acquire a basic knowledge of diverse disciplines and interact with experts from different disciplines. Strategies to improve health should be multi-pronged, and take into account the diversity of actors, determinants and contexts. The dynamic nature of the system requires that the interventions are constantly monitored to provide early feedback to a flexible system that takes quick corrections.

  4. Health status transitions in community-living elderly with complex care needs: a latent class approach

    Béland François

    2009-02-01

    Full Text Available Abstract Background For older persons with complex care needs, accounting for the variability and interdependency in how health dimensions manifest themselves is necessary to understand the dynamic of health status. Our objective is to test the hypothesis that a latent classification can capture this heterogeneity in a population of frail elderly persons living in the community. Based on a person-centered approach, the classification corresponds to substantively meaningful groups of individuals who present with a comparable constellation of health problems. Methods Using data collected for the SIPA project, a system of integrated care for frail older people (n = 1164, we performed latent class analyses to identify homogenous categories of health status (i.e. health profiles based on 17 indicators of prevalent health problems (chronic conditions; depression; cognition; functional and sensory limitations; instrumental, mobility and personal care disability Then, we conducted latent transition analyses to study change in profile membership over 2 consecutive periods of 12 and 10 months, respectively. We modeled competing risks for mortality and lost to follow-up as absorbing states to avoid attrition biases. Results We identified four health profiles that distinguish the physical and cognitive dimensions of health and capture severity along the disability dimension. The profiles are stable over time and robust to mortality and lost to follow-up attrition. The differentiated and gender-specific patterns of transition probabilities demonstrate the profiles' sensitivity to change in health status and unmasked the differential relationship of physical and cognitive domains with progression in disability. Conclusion Our approach may prove useful at organization and policy levels where many issues call for classification of individuals into pragmatically meaningful groups. In dealing with attrition biases, our analytical strategy could provide critical

  5. Addressing the "other" health literacy competencies--knowledge, dispositions, and oral/aural communication: development of TALKDOC, an intervention assessment tool.

    Helitzer, Deborah; Hollis, Christine; Sanders, Margaret; Roybal, Suzanne

    2012-01-01

    Most health literacy assessments evaluate literacy skills including reading, writing; numeracy and interpretation of tables, graphs, diagrams and charts. Some assess understanding of health systems, and the ability to adequately apply one's skills to specific health-related tasks or demands in health situations. However, to achieve functional health literacy, the ability to "obtain, process, and understand basic health information and services needed to make appropriate health decisions," other health literacy dimensions should be assessed: a person's knowledge and attitudes about a health issue affects his or her ability to and interest in participating in his or her own care. In patient care settings, the abilities to listen, ask questions and check one's understanding are crucial to making appropriate decisions and carrying out instructions. Although literacy is a skill associated with educational attainment and therefore difficult to change in a short time, health education interventions can address health literacy domains such as knowledge, attitudes and oral communication skills. For this reason, an instrument that can assess these constructs is a valuable part of a health educator's toolbox. The authors describe the development and process and outcomes of testing a novel instrument targeted to assess HPV and cervical cancer health literacy competencies, TALKDOC, including its validation with the Health Activities Literacy Scale.

  6. Human Health and the Biological Effects of Tritium in Drinking Water: Prudent Policy Through Science - Addressing the ODWAC New Recommendation.

    Dingwall, S; Mills, C E; Phan, N; Taylor, K; Boreham, D R

    2011-02-22

    Tritium is a radioactive form of hydrogen and is a by-product of energy production in Canadian Deuterium Uranium (CANDU) reactors. The release of this radioisotope into the environment is carefully managed at CANDU facilities in order to minimize radiation exposure to the public. However, under some circumstances, small accidental releases to the environment can occur. The radiation doses to humans and non-human biota from these releases are low and orders of magnitude less than doses received from naturally occurring radioisotopes or from manmade activities, such as medical imaging and air travel. There is however a renewed interest in the biological consequences of low dose tritium exposures and a new limit for tritium levels in Ontario drinking water has been proposed. The Ontario Drinking Water Advisory Council (ODWAC) issued a formal report in May 2009 in response to a request by the Minister of the Environment, concluding that the Ontario Drinking Water Quality Standard for tritium should be revised from the current 7,000 Bq/L level to a new, lower 20 Bq/L level. In response to this recommendation, an international scientific symposium was held at McMaster University to address the issues surrounding this change in direction and the validity of a new policy. Scientists, regulators, government officials, and industrial stakeholders were present to discuss the potential health risks associated with low level radiation exposure from tritium. The regulatory, economic, and social implications of the new proposed limit were also considered.The new recommendation assumed a linear-no-threshold model to calculate carcinogenic risk associated with tritium exposure, and considered tritium as a non-threshold chemical carcinogen. Both of these assumptions are highly controversial given that recent research suggests that low dose exposures have thresholds below which there are no observable detrimental effects. Furthermore, mutagenic and carcinogenic risk calculated from

  7. Modelling the dynamics of the health-production complex in livestock herds

    Sørensen, J.T.; Enevoldsen, Carsten

    1992-01-01

    This paper reviews how the dynamics of the health-production complex in livestock herds is mimicked by livestock herd simulation models. Twelve models simulating the dynamics of dairy, beef, sheep and sow herds were examined. All models basically included options to alter input and output...... of reproductive animals in a manner which could be related to health problems. Direct effects of diseases on growth or milk production were, however, addressed in only a few models and were confined to a few basic relations if modelled. The lack of effects on individual animal production in the models may relate...... and their interactions could be studied by applying the same standards of analysis to simulated data as to real herd data. © 1992....

  8. Fire Stations, Fire Departments - name, address, # of fire fighters, Published in 2007, Iowa Dept. of Public Health.

    NSGIC GIS Inventory (aka Ramona) — This Fire Stations dataset, was produced all or in part from Published Reports/Deeds information as of 2007. It is described as 'Fire Departments - name, address, #...

  9. [International trade in health services and the medical industrial complex: implications for national health systems].

    Santos, Maria Angelica Borges dos; Passos, Sonia Regina Lambert

    2010-08-01

    Health services have increasingly proven to be an innovative sector, gaining prominence in the medical industrial complex through expansion to public and international markets. International trade can foster economic development and redirect the resources and infrastructure available for healthcare in different countries in favorable or unfavorable directions. Wherever private providers play a significant role in government-funded healthcare, GATS commitments may restrict health policy options in subscribing countries. Systematic information on the impacts of electronic health services, medical tourism, health workers' migration, and foreign direct investment is needed on a case-by-case basis to build evidence for informed decision-making, so as to maximize opportunities and minimize risks of GATS commitments.

  10. Comprehensive health workforce planning: re-consideration of the primary health care approach as a tool for addressing the human resource for health crisis in low and middle income countries.

    Munga, Michael A; Mwangu, Mughwira A

    2013-04-01

    Although the Human Resources for Health (HRH) crisis is apparently not new in the public health agenda of many countries, not many low and middle income countries are using Primary Health Care (PHC) as a tool for planning and addressing the crisis in a comprehensive manner. The aim of this paper is to appraise the inadequacies of the existing planning approaches in addressing the growing HRH crisis in resource limited settings. A descriptive literature review of selected case studies in middle and low income countries reinforced with the evidence from Tanzania was used. Consultations with experts in the field were also made. In this review, we propose a conceptual framework that describes planning may only be effective if it is structured to embrace the fundamental principles of PHC. We place the core principles of PHC at the centre of HRH planning as we acknowledge its major perspective that the effectiveness of any public health policy depends on the degree to which it envisages to address public health problems multi-dimensionally and comprehensively. The proponents of PHC approach in planning have identified inter-sectoral action and collaboration and comprehensive approach as the two basic principles that policies and plans should accentuate in order to make them effective in realizing their pre-determined goals. Two conclusions are made: Firstly, comprehensive health workforce planning is not widely known and thus not frequently used in HRH planning or analysis of health workforce issues; Secondly, comprehensiveness in HRH planning is important but not sufficient in ensuring that all the ingredients of HRH crisis are eliminated. In order to be effective and sustainable, the approach need to evoke three basic values namely effectiveness, efficiency and equity.

  11. Parents’ perspectives of the transition to home when a child has complex technological health care needs

    Maria Brenner

    2015-09-01

    Full Text Available Introduction: There is an increasing number of children with complex care needs, however, there is limited evidence of the experience of families during the process of transitioning to becoming their child's primary care giver. The aim of this study was to explore parents’ perspectives of the transition to home of a child with complex respiratory health care needs.Methods: Parents of children with a tracheostomy with or without other methods of respiratory assistance, who had transitioned to home from a large children's hospital in the last 5 years, were invited to participate in the interviews. Voice-centred relational method of qualitative analysis was used to analyse parent responses.Results: Four key themes emerged from the interviews including “stepping stones: negotiating the move to home”, “fighting and frustration”, “questioning competence” and “coping into the future”.Discussion: There is a need for clear and equitable assessments and shared policies and protocols for the discharge of children with complex care needs. Direction and support are required at the level of health service policy and planning to redress these problems. This study provides evidence that the transition of children with complex care needs from hospital to home is a challenging dynamic in need of further improvement and greater negotiation between the parent and health service provider. There are tangible issues that could be addressed including the introduction of a standardised approach to assessment of the needs of the child and family in preparation for discharge and for clear timelines and criteria for reassessment of needs once at home.

  12. Addressing the Common Pathway Underlying Hypertension and Diabetes in People Who Are Obese by Maximizing Health: The Ultimate Knowledge Translation Gap

    Elizabeth Dean

    2011-01-01

    Full Text Available In accordance with the WHO definition of health, this article examines the alarming discord between the epidemiology of hypertension, type 2 diabetes mellitus (T2DM, and obesity and the low profile of noninvasive (nondrug compared with invasive (drug interventions with respect to their prevention, reversal and management. Herein lies the ultimate knowledge translation gap and challenge in 21st century health care. Although lifestyle modification has long appeared in guidelines for medically managing these conditions, this evidence-based strategy is seldom implemented as rigorously as drug prescription. Biomedicine focuses largely on reducing signs and symptoms; the effects of the problem rather than the problem. This article highlights the evidence-based rationale supporting prioritizing the underlying causes and contributing factors for hypertension and T2DM, and, in turn, obesity. We argue that a primary focus on maximizing health could eliminate all three conditions, at best, or, at worst, minimize their severity, complications, and medication needs. To enable such knowledge translation and maximizing health outcome, the health care community needs to practice as an integrated team, and address barriers to effecting maximal health in all patients. Addressing the ultimate knowledge translation gap, by aligning the health care paradigm to 21st century needs, would constitute a major advance.

  13. What constitutes a health-enabling neighborhood? A grounded theory situational analysis addressing the significance of social capital and gender.

    Eriksson, Malin; Emmelin, Maria

    2013-11-01

    Variations in health between neighborhoods are well known and the conceptualization of social capital has contributed to an understanding of how contextual factors influence these differences. Studies show positive health-effects from living in high social capital areas, at least for some population sub-groups. The aim of this qualitative study was to understand what constitutes a 'health-enabling' neighborhood. It follows up results from a social capital survey in northern Sweden indicating that the health effects of living in a high social capital neighborhood is gendered in favor of women. A grounded theory situational analysis of eight focus group discussions--four with men and four with women--illustrated similar and different positions on how neighborhood characteristics influence health. A neighborhood, where people say hi to each other ("hi-factor") and where support between neighbors exist, were factors perceived as positive for health by all, as was a good location, neighborhood greenness and proximity to essential arenas. Women perceived freedom from demands, feeling safe and city life as additional health enabling factors. For men freedom to do what you want, a sense of belonging, and countryside life were important. To have burdensome neighbors, physical disturbances and a densely living environment were perceived as negative for health in both groups while demands for a well styled home and feeling unsafe were perceived as negative for health among women. Neighborhood social capital, together with other elements in the living environment, has fundamental influence on people's perceived health. Our findings do not confirm that social capital is more important for women than for men but that distinctive form of social capital differ in impact. Investing in physical interventions, such as planning for meeting places, constructing attractive green areas, and making neighborhoods walking-friendly, may increase human interactions that is instrumental for

  14. Programs Addressing Psychological Health and Traumatic Brain Injury Among U.S. Military Servicemembers and Their Families

    2011-01-01

    of the Health Sci- ences in conjunction with the Samueli Institute. Figure 2.3 Total Force Fitness Mission/performance Stress Well-being Prevention...Project  • Psychological Health/Traumatic Brain Injury Registry • Samueli Institute—The Family Needs Assessment at Fort Bliss The following entities

  15. VA and DOD Health Care: Department-Level Actions Needed to Assess Collaboration Performance, Address Barriers, and Identify Opportunities

    2012-09-01

    joint venture hired five full-time pharmacists specifically to conduct manual checks of patient records to reconcile allergy information and identify...Bidirectional Health Information Exchange was established in 2004 to allow clinicians in both departments to view limited health information on patients

  16. Complex interplay between health and successful aging: role of perceived stress, resilience, and social support.

    Moore, Raeanne C; Eyler, Lisa T; Mausbach, Brent T; Zlatar, Zvinka Z; Thompson, Wesley K; Peavy, Guerry; Fazeli, Pariya L; Jeste, Dilip V

    2015-06-01

    Psychological and psychosocial resources, including resilience and social support, have traditionally been studied in the context of the stress paradigm and, more recently, in the context of successful aging. This study used moderated mediation analyses to examine the role of perceived stress in the relationships between physical and mental health functioning and self-rated successful aging (SRSA) and whether differences between people in level of resilience and social support changes the role of perceived stress in these relationships. A cross-sectional study of 1,006 older adults (mean age: 77 years) completed scales addressing SRSA, physical and mental health functioning, perceived stress, resilience, and social support. Results indicated that the strength of relationships between both physical and mental health functioning and SRSA were reduced after accounting for variation in level of perceived stress. The role of perceived stress in the association between mental health functioning and SRSA was found to be stronger among participants with the highest levels of resilience, and the influence of perceived stress on the degree of relationship between physical health functioning and SRSA was stronger among those with greatest social support. These findings suggest that interventions to reduce perceived stress may help break the link between disability and poor well-being in older adults. The findings further suggest that the impact of such interventions might differ depending on psychological resources (i.e., resilience) for mental health disabilities and external resources (i.e., social support) for those with physical health problems. The complex interplay of these factors should be taken into account in clinical settings.

  17. Statistical tools for prognostics and health management of complex systems

    Collins, David H [Los Alamos National Laboratory; Huzurbazar, Aparna V [Los Alamos National Laboratory; Anderson - Cook, Christine M [Los Alamos National Laboratory

    2010-01-01

    Prognostics and Health Management (PHM) is increasingly important for understanding and managing today's complex systems. These systems are typically mission- or safety-critical, expensive to replace, and operate in environments where reliability and cost-effectiveness are a priority. We present background on PHM and a suite of applicable statistical tools and methods. Our primary focus is on predicting future states of the system (e.g., the probability of being operational at a future time, or the expected remaining system life) using heterogeneous data from a variety of sources. We discuss component reliability models incorporating physical understanding, condition measurements from sensors, and environmental covariates; system reliability models that allow prediction of system failure time distributions from component failure models; and the use of Bayesian techniques to incorporate expert judgments into component and system models.

  18. Government leadership in addressing public health priorities: strides and delays in electronic laboratory reporting in the United States.

    Gluskin, Rebecca Tave; Mavinkurve, Maushumi; Varma, Jay K

    2014-03-01

    For nearly a decade, interest groups, from politicians to economists to physicians, have touted digitization of the nation's health information. One frequently mentioned benefit is the transmission of information electronically from laboratories to public health personnel, allowing them to rapidly analyze and act on these data. Switching from paper to electronic laboratory reports (ELRs) was thought to solve many public health surveillance issues, including workload, accuracy, and timeliness. However, barriers remain for both laboratories and public health agencies to realize the full benefits of ELRs. The New York City experience highlights several successes and challenges of electronic reporting and is supported by peer-reviewed literature. Lessons learned from ELR systems will benefit efforts to standardize electronic medical records reporting to health departments.

  19. Addressing the social and environmental determinants of urban health equity: evidence for action and a research agenda.

    Friel, Sharon; Akerman, Marco; Hancock, Trevor; Kumaresan, Jacob; Marmot, Michael; Melin, Thomas; Vlahov, David

    2011-10-01

    Urban living is the new reality for the majority of the world's population. Urban change is taking place in a context of other global challenges--economic globalization, climate change, financial crises, energy and food insecurity, old and emerging armed conflicts, as well as the changing patterns of communicable and noncommunicable diseases. These health and social problems, in countries with different levels of infrastructure and health system preparedness, pose significant development challenges in the 21st century. In all countries, rich and poor, the move to urban living has been both good and bad for population health, and has contributed to the unequal distribution of health both within countries (the urban-rural divide) and within cities (the rich-poor divide). In this series of papers, we demonstrate that urban planning and design and urban social conditions can be good or bad for human health and health equity depending on how they are set up. We argue that climate change mitigation and adaptation need to go hand-in-hand with efforts to achieve health equity through action in the social determinants. And we highlight how different forms of governance can shape agendas, policies, and programs in ways that are inclusive and health-promoting or perpetuate social exclusion, inequitable distribution of resources, and the inequities in health associated with that. While today we can describe many of the features of a healthy and sustainable city, and the governance and planning processes needed to achieve these ends, there is still much to learn, especially with respect to tailoring these concepts and applying them in the cities of lower- and middle-income countries. By outlining an integrated research agenda, we aim to assist researchers, policy makers, service providers, and funding bodies/donors to better support, coordinate, and undertake research that is organized around a conceptual framework that positions health, equity, and sustainability as central

  20. A Conceptual Framework to Address Stress-Associated Human Health Effects of Ecosystem Services Degraded by Disasters

    Chronic stress leads to a variety of mental and physiological disorders, and stress effects are the primary concern after traumatic injury and exposure to infectious diseases or toxic agents from disaster events. We developed a conceptual model to address the question of whether...

  1. Addressing Inequalities in Health: New Directions in Midwifery Education and Practice. Researching Professional Education Research Reports Series.

    Hart, Angie; Lockey, Rachael; Henwood, Flis; Pankhurst, Francesca; Hall, Valerie; Sommerville, Fiona

    This report addresses key questions concerning the effectiveness of midwifery education in preparing midwives to meet the needs of women from minority or disadvantaged groups in England. Chapter 1 sets out the methodological context within which the work was undertaken and provides an overview of data sources and sample sizes. Chapters 3 and 4…

  2. Addressing the Shortage of Health Professionals in Rural China: Issues and Progress; Comment on “Have Health Human Resources Become More Equal between Rural and Urban Areas after the New Reform?”

    Jianlin Hou

    2015-05-01

    Full Text Available Maldistribution of health professionals between urban and rural areas has been a serious problem in China. Urban hospitals attract most of the health professionals with serious shortages in rural areas. To address this issue, a number of policies have been implemented by the government, such as free medical education in exchange for obligatory rural service.

  3. Translating complex science into life-course health promoting strategies.

    Buttriss, Judith L

    2011-02-01

    These days, we are bombarded with nutrition information from diverse sources and of varying quality. There has been a dramatic increase in communication channels, including more television channels with airtime to fill, and the emergence of the Internet and 'new media' such as social networking sites. Part of this culture is to deliver ever changing and novel angles. The background 'noise' that this creates can make delivery of evidence-based advice about healthy eating that generally carries less novelty value, a huge challenge. This paper illustrates ways in which complex scientific information can be translated into meaningful health promoting strategies that can be applied across the life course. The examples used are nutrition in the context of healthy ageing, communicating the concept of energy density in the context of satiety, healthy hydration, health effects of probiotics and resources for use by teachers in the classroom. This selection of examples demonstrates the processes adopted at the British Nutrition Foundation to identify the evidence base for a particular topic and then to communicate this information to various target audiences. The British Nutrition Foundation's approach typically starts with preparation of a detailed review of the evidence, often with the involvement of external expertise, followed by peer review. For much of this work conventional science communication routes are used, but use is also made of the Internet and various forms of new media.

  4. The ethics of complex relationships in primary care behavioral health.

    Reiter, Jeff; Runyan, Christine

    2013-03-01

    Primary care settings are particularly prone to complex relationships that can be ethically challenging. This is due in part to three of the distinctive attributes of primary care: a whole family orientation; team-based care; and a longitudinal care delivery model. In addition, the high patient volume of primary care means that the likelihood of encountering ethically challenging relationships is probably greater than in a specialty setting. This article argues that one ethical standard of the American Psychological Association (APA, 2010, Ethical principles of psychologists and code of conduct, www.apa.org/ethics/code) (10.02, Therapy Involving Couples or Families) should be revised to better accommodate the work of psychologists in primary care. The corresponding Principles of Medical Ethics from the American Medical Association (AMA, 2012, Code of medical ethics: Current opinions with annotations, 2012-2013, Washington, DC: Author), most notably the principle regarding a physician's duty to "respect the rights of patients, colleagues, and other health professionals as well as safeguard privacy" are also noted. In addition, the article details how the three attributes of primary care often result in complex relationships, and provides suggestions for handling such relationships ethically.

  5. Addressing health care market reform through an insurance exchange: essential policy components, the public plan option, and other issues to consider.

    Fronstin, Paul; Ross, Murray N

    2009-06-01

    HEALTH INSURANCE EXCHANGE: This Issue Brief examines issues related to managed competition and the use of a health insurance exchange for the purpose of addressing cost, quality, and access to health care services. It discusses issues that must be addressed when designing an exchange in order to reform the health insurance market and also examines state efforts at health reform that use an exchange. RISK VS. PRICE COMPETITION: The basic component of managed competition is the creation an organized marketplace that brings together health insurers and consumers (either as individuals or through their employers). The sponsor of the exchange would set "rules of engagement" for participating insurers and offer consumers a menu of choices among different plans. Ultimately, the goal of a health insurance exchange is to shift the market from competition based on risk to competition based on price and quality. ADVERSE SELECTION AND AFFORDABILITY: Among the issues that need to be addressed if an exchange that uses managed competition has a realistic chance of reducing costs, improving quality, and expanding coverage: Everyone needs to be in the risk pool, with individuals required to purchase insurance or face significant financial consequences; effective risk adjustment is essential to eliminate risk selection as an insurance business model--forcing competition on costs and quality; the insurance benefit must be specific and clear--without standards governing cost sharing, covered services, and network coverage there is no way to assess whether a requirement to purchase or issue coverage has been met; and subsidies would be necessary for low-income individuals to purchase insurance. THE PUBLIC PLAN OPTION: The public plan option is shaping up to be one of the most contentious issues in the health reform debate. Proponents also believe of a public plan is necessary to drive private insurers toward true competition. Opponents view it as a step toward government-run health

  6. Health visiting and its role in addressing the nutritional needs of children in the first world war.

    Osborne, Wayne; Lawton, Sandra

    2014-10-01

    The first known UK health visitor post was established in 1862, in response to the living conditions of the poor. Before the first world war, local government boards advised district councils generally to employ health visitors: breastfeeding and child nutrition needed particular attention. In 1910, Hucknall District Council in Nottinghamshire, England, appointed nurse Ellen Woodcock to advise mothers and caregivers on looking after their children and themselves. Focusing on the welfare of women and children, health visitors could not fail to reach everyone in the community. This historical perspective shows that many of the initiatives and policies of today mirror those of a century ago.

  7. Politics and technology in health information systems development: a discourse analysis of conflicts addressed in a systems design group.

    Irestig, Magnus; Timpka, Toomas

    2008-02-01

    Different types of disagreements must be managed during the development of health information systems. This study examines the antagonisms discussed during the design of an information system for 175,000 users in a public health context. Discourse analysis methods were used for data collection and analysis. Three hundred and twenty-six conflict events were identified from four design meetings and divided into 16 categories. There were no differences regarding the types of conflicts that the different participants brought into the design discussions. Instead, conflict occurrence was primarily affected by the agendas that set the stage for examinations and debates. The results indicate that the selection of design method and the structure used for the meetings are important factors for the manner in which conflicts are brought into consideration during health information system design. Further studies comparing participatory and non-participatory information system design practices in health service settings are warranted.

  8. Clinical uncertainties, health service challenges, and ethical complexities of HIV "test-and-treat": a systematic review.

    Kulkarni, Sonali P; Shah, Kavita R; Sarma, Karthik V; Mahajan, Anish P

    2013-06-01

    Despite the HIV "test-and-treat" strategy's promise, questions about its clinical rationale, operational feasibility, and ethical appropriateness have led to vigorous debate in the global HIV community. We performed a systematic review of the literature published between January 2009 and May 2012 using PubMed, SCOPUS, Global Health, Web of Science, BIOSIS, Cochrane CENTRAL, EBSCO Africa-Wide Information, and EBSCO CINAHL Plus databases to summarize clinical uncertainties, health service challenges, and ethical complexities that may affect the test-and-treat strategy's success. A thoughtful approach to research and implementation to address clinical and health service questions and meaningful community engagement regarding ethical complexities may bring us closer to safe, feasible, and effective test-and-treat implementation.

  9. Addressing Global Health, Development, and Social Inequalities through Research and Policy Analyses: the International Journal of MCH and AIDS

    Romuladus E. Azuine, DrPH, RN

    2012-11-01

    Full Text Available One year after the birth of the International Journal of MCH and AIDS (IJMA, we continue to share the passion to document, and shine the light on the myriads of global health issues that debilitate developing countries.Although the focus of IJMA is on the social determinants of health and disease as well as on the disparities in the burden of communicable and non-communicable diseases affecting infants, children, women, adults, and families in developing countries, we would like to encourage our fellow researchers and policy makers in both the developing and developed countries to consider submitting work that examines cross-national variations in heath and social inequalities.Such a global focus allows us to identify and understand social, structural, developmental, and health policy determinants underlying health inequalities between nations.Global assessment of health and socioeconomic patterns reaffirms the role of broader societal-level factors such as human development, gender inequality, gross national product, income inequality, and healthcare infrastructure as the fundamental determinants of health inequalities between nations.This is also confirmed by our analysis of the WHO data that shows a strong negative association between levels of human development and infant and maternal mortality rates.Focusing on socioeconomic, demographic, and geographical inequalities within a developing country, on the other hand, should give us a sense of how big the problem of health inequity is within its own borders.Such an assessment, then, could lead to development of policy solutions to tackle health inequalities that are unique to that country.

  10. A snapshot review of culturally competent compassion as addressed in selected mental health textbooks for undergraduate nursing students

    Papadopoulos, Irena; Pezzella, Alfonso

    2015-01-01

    Background The recent scandals involving poor healthcare put nurses under the spotlight in an attempt to understand how compassionate they are towards their patients. The aim of this article is to investigate how compassion is embedded in the textbooks of the undergraduate mental health nursing degree. Methods A snapshot review of key textbooks used, was conducted through the distribution of a list of textbooks and search terms to a panel of mental health teachers in four United...

  11. Best Practices for Addressing Combat Operational Stress and Other Behavioral Health Conditions in Marine Corps Substance Abuse Counseling Centers

    2010-08-02

    Fairbank, 1991; Brady, Killeen, Saladin , Dansky, & Becker, 1994; Brown, Recupero, & Stout, 1995; Brown, Stout, & Mueller, 1999; Ruzek, Polusny, & Abueg...in addressing a client’s willingness to change ( Saladin , Brady, Dansky, & Kilpatrick, 1995). One study conducted by Brown, Stout, and Gannon-Rowley...4, 549-560. Brady, K., Killeen, T., Saladin , M., Dansky, B., & Becker, S. (1994). Comorbid substance abuse and posttraumatic stress disorder

  12. A pilot study of medical student attitudes to, and use of, commercial movies that address public health issues

    Cowie Rachael

    2011-04-01

    Full Text Available Abstract Background An innovative approach to learning public health by using feature-length commercial movies was piloted in the fourth year of a medical degree. We aimed to explore how students responded to this approach and the relative effectiveness of two promotional strategies. Firstly we placed DVDs of 15 movies (with public health-related content in the medical school library. Then alternating groups of students (total n = 82 students were exposed to either a brief promotional intervention or a more intensive intervention involving a class presentation. The response rates were 99% at baseline and 85% at follow-up. Findings The level and strength of support for using movies in public health training increased after exposure to the public health module with significantly more students "strongly agreeing". Student behaviour, in terms of movies viewed or accessed from the library, also suggested student interest. While there were no statistically significant differences in median viewing or library access rates between the two intervention groups, the distribution of viewing patterns was shifted favourably. Those exposed to the more intensive intervention (class presentation were significantly more likely to have reported watching at least one movie (97% vs. 81%; p = 0.033 or to having accessed at least one movie from the library (100% vs. 70%, p = 0.0001. Conclusions This pilot study found that the students had very positive attitudes towards viewing public health-related commercial movies. Movie access rates from the library were also favourable.

  13. Using Community-Based Participatory Research and Human-Centered Design to Address Violence-Related Health Disparities Among Latino/a Youth.

    Kia-Keating, Maryam; Santacrose, Diana E; Liu, Sabrina R; Adams, Jessica

    High rates of exposure to violence and other adversities among Latino/a youth contribute to health disparities. The current article addresses the ways in which community-based participatory research (CBPR) and human-centered design (HCD) can help engage communities in dialogue and action. We present a project exemplifying how community forums, with researchers, practitioners, and key stakeholders, including youths and parents, integrated HCD strategies with a CBPR approach. Given the potential for power inequities among these groups, CBPR + HCD acted as a catalyst for reciprocal dialogue and generated potential opportunity areas for health promotion and change. Future directions are described.

  14. Tenth Warren K. Sinclair keynote address-the Fukushima nuclear power plant accident and comprehensive health risk management.

    Yamashita, Shunichi

    2014-02-01

    Just two years have passed since the Tokyo Electric Power Company-Fukushima Daiichi Nuclear Power Plant (NPP) accident, a multidimensional disaster that combined to destroy the local infrastructure on which the safety system depended and gave a serious impact to the world. Countermeasures including evacuation, sheltering, and control of the food chain were implemented in a timely manner by the Japanese government. However, there is a clear need for improvement, especially in the areas of nuclear safety and protection and also in the management of the radiation health risk during and even after the accident. To date there have been no acute radiation injuries. The radiation-related physical health consequences to the general public, including evacuees, are likely to be much lower than those arising from the Chernobyl nuclear reactor accident, because the radiation fallout and the subsequent environmental contamination were much more limited. However, the social, psychological, and economic impacts of the Fukushima NPP accident are expected to be considerable. Currently, continued monitoring and characterization of the levels of radioactivity in the environment and foods in Fukushima are vital for obtaining informed consent to the decisions on living in the areas already radiocontaminated and returning back to the evacuated areas once re-entry is permitted; it is also important to perform a realistic assessment of the radiation doses on the basis of measurements. We are currently implementing the official plans of the Fukushima Health Management Survey, which includes a basic survey for the estimation of the external doses that were received during the first 4 mo after the accident and four more detailed surveys (thyroid ultrasound examination, comprehensive health check-up, mental health and life-style survey, and survey of pregnant women and nursing mothers), with the aim to take care of the health of all of the residents of the Fukushima Prefecture for a long time

  15. Investigating the role of state and local health departments in addressing public health concerns related to industrial food animal production sites.

    Jillian P Fry

    Full Text Available OBJECTIVES: Evidence of community health concerns stemming from industrial food animal production (IFAP facilities continues to accumulate. This study examined the role of local and state health departments in responding to and preventing community-driven concerns associated with IFAP. METHODS: We conducted semi-structured qualitative interviews with state and county health department staff and community members in eight states with high densities or rapid growth of IFAP operations. We investigated the extent to which health concerns associated with IFAP sites are reported to health departments, the nature of health departments' responses, and barriers to involvement. RESULTS: Health departments' roles in these matters are limited by political barriers, lack of jurisdiction, and finite resources, expertise, and staff. Community members reported difficulties in engaging health departments on these issues. CONCLUSIONS: Our investigation suggests that health departments frequently lack resources or jurisdiction to respond to health concerns related to IFAP sites, resulting in limited engagement. Since agencies with jurisdiction over IFAP frequently lack a health focus, increased health department engagement may better protect public health.

  16. [Complex expertise on the psychiatric health of a criminal].

    Gierowski, Józef Krzysztof

    2006-01-01

    The development of psychiatry and psychology has brought about a situation in need of newer evaluation of the surroundings in which the justice department tries to use specialist knowledge of the processes governing human psychic life and health. The lacking of clear criteria between the competencies of psychiatrists and psychologists is a certain standard in dealing with the disturbed or mentally ill persons. This is a result of the application of a multidisciplinary approach towards the patient in the area of diagnosis, therapy and rehabilitation. The advancing psychiatric and psychological knowledge has a difficulty in findings its way to forensic psychiatry and psychology. However, owing to the fact that current legal regulations require complex psychiatric-psychological opinions to be formulated, it is worthy to take a closer look at the issue. The fore-mentioned model has its benefits and its flaws. The compiling of the complex opinion may bring about the risk of "mixing up" of the contents as used by the various experts and cause certain methodological problems. From another perspective it would appear that it is impossible to refrain from applying the newly developing interdisciplinary links. Positive experiences with the DSM classification give a strong argument to the sensibility of this approach. The author analyses the bases for cooperation between the psychiatric-psychological expertise which arises from the rules and regulations of the penal law and the code of penal conduct. They pertain to the rules of being able in body and mind and the application of the so called security measures. The model of psychiatric-psychological cooperation taken up by the law-giver does not pertain fully to the essential competencies of psychiatry and psychology and is not a compact consequential solution.

  17. Human Capital: Additional Actions Needed to Enhance DOD’s Efforts to Address Mental Health Care Stigma

    2016-04-01

    post - traumatic stress disorder and other psychological health conditions to develop excellence in prevention, outreach, and care for those with... stress disorder or traumatic brain injury. Additionally, the Defense Suicide Prevention Office reports through the Executive Director of the Office of... post - traumatic stress disorder in particular on career. The Air Force Community Assessment Survey asks about the effects of counseling from

  18. Addressing Health Literacy Challenges With a Cutting-Edge Infectious Disease Curriculum for the High School Biology Classroom.

    Jacque, Berri; Koch-Weser, Susan; Faux, Russell; Meiri, Karina

    2016-02-01

    This study reports the secondary analysis of evaluation data from an innovative high school biology curriculum focused on infectious disease (ID) to examine the health literacy implications of teaching claims evaluation, data interpretation, and risk assessment skills in the context of 21st-Century health science. The curriculum was implemented between 2010 and 2013 in Biology II classes held in four public high schools (three in Massachusetts and one in Ohio), plus a private school in Virginia. A quasi-experimental design was used in which student participants (n = 273) were compared to an age-matched, nonparticipant, peer group (N = 125). Participants in each school setting demonstrated increases in conceptual content knowledge (Cohen's d > 1.89) as well as in understanding how to apply scientific principles to health claims evaluation and risk assessment (Cohen's d > 1.76) and in self-efficacy toward learning about ID (Cohen's d > 2.27). Participants also displayed enhanced communication about ID within their social networks relative to the comparison group (p biology classrooms is effective at fostering both the skills and self-efficacy pertinent to health literacy learning in diverse populations.

  19. Religious congregations' collaborations: with whom do they work and what resources do they share in addressing HIV and other health issues?

    Werber, Laura; Derose, Kathryn Pitkin; Domínguez, Blanca X; Mata, Michael A

    2012-12-01

    This study explores how religious congregations interact with other community organizations to address health and, in particular, HIV-related needs within their membership and/or local communities. Case study data from a diverse sample of 14 urban congregations (6 Black, 4 Latino, 2 White, and 2 mixed race-ethnicity) indicate that they engaged in three types of relationships to conduct HIV and other health-related activities: (a) resources flowed to congregations from external entities, (b) resources flowed from congregations to external entities, and (c) congregations interacted with external entities. These types of relationships were present in roughly equal proportions; thus, congregations were not primarily the recipients of resources from other organizations in these interactions. Financial, material, and human capital resources were shared across these three relationship types, and the most common organization types that congregations were involved with for health efforts were prevention and social service organizations, health care providers, and other congregations. In addition, congregations tended to have more collaborative relationships with other faith-based organizations (FBOs) and tended to engage with non-FBOs more to either receive or provide resources. Results suggest that congregations contribute to community health by not only sponsoring health activities for their own members but also by providing specific support or resources to enhance the programming of other community organizations and collaborating with external organizations to sponsor congregation-based and community-based health activities.

  20. Introducing a complex health innovation--primary health care reforms in Estonia (multimethods evaluation).

    Atun, Rifat Ali; Menabde, Nata; Saluvere, Katrin; Jesse, Maris; Habicht, Jarno

    2006-11-01

    All post-Soviet countries are trying to reform their primary health care (PHC) systems. The success to date has been uneven. We evaluated PHC reforms in Estonia, using multimethods evaluation: comprising retrospective analysis of routine health service data from Estonian Health Insurance Fund and health-related surveys; documentary analysis of policy reports, laws and regulations; key informant interviews. We analysed changes in organisational structure, regulations, financing and service provision in Estonian PHC system as well as key informant perceptions on factors influencing introduction of reforms. Estonia has successfully implemented and scaled-up multifaceted PHC reforms, including new organisational structures, user choice of family physicians (FPs), new payment methods, specialist training for family medicine, service contracts for FPs, broadened scope of services and evidence-based guidelines. These changes have been institutionalised. PHC effectiveness has been enhanced, as evidenced by improved management of key chronic conditions by FPs in PHC setting and reduced hospital admissions for these conditions. Introduction of PHC reforms - a complex innovation - was enhanced by strong leadership, good co-ordination between policy and operational level, practical approach to implementation emphasizing simplicity of interventions to be easily understood by potential adopters, an encircling strategy to roll-out which avoided direct confrontations with narrow specialists and opposing stakeholders in capital Tallinn, careful change-management strategy to avoid health reforms being politicized too early in the process, and early investment in training to establish a critical mass of health professionals to enable rapid operationalisation of policies. Most importantly, a multifaceted and coordinated approach to reform - with changes in laws; organisational restructuring; modifications to financing and provider payment systems; creation of incentives to enhance

  1. Does the development of new medicinal products in the European Union address global and regional health concerns?

    Álvarez-Martín Elena

    2010-12-01

    Full Text Available Abstract Background Since 1995, approval for many new medicinal products has been obtained through a centralized procedure in the European Union. In recent years, the use of summary measures of population health has become widespread. We investigated whether efforts to develop innovative medicines are focusing on the most relevant conditions from a global public health perspective. Methods We reviewed the information on new medicinal products approved by centralized procedure from 1995 to 2009, information that is available to the public in the European Commission Register of medicinal products and the European Public Assessment Reports from the European Medicines Agency. Morbidity and mortality data were included for each disease group, according to the Global Burden of Disease project. We evaluated the association between authorized medicinal products and burden of disease measures based on disability-adjusted life years (DALYs in the European Union and worldwide. Results We considered 520 marketing authorizations for medicinal products and 338 active ingredients. New authorizations were seen to increase over the period analyzed. There was a positive, high correlation between DALYs and new medicinal product development (ρ = 0.619, p = 0.005 in the European Union, and a moderate correlation for middle-low-income countries (ρ = 0.497, p = 0.030 and worldwide (ρ = 0.490, p = 0.033. The most neglected conditions at the European level (based on their attributable health losses were neuropsychiatric diseases, cardiovascular diseases, respiratory diseases, sense organ conditions, and digestive diseases, while globally, they were perinatal conditions, respiratory infections, sense organ conditions, respiratory diseases, and digestive diseases. Conclusions We find that the development of new medicinal products is higher for some diseases than others. Pharmaceutical industry leaders and policymakers are invited to consider the implications of this

  2. Complexity: A New Axiom for Structural Health Monitoring?

    2010-08-01

    done in a supervised learning mode. Axiom IVa : Sensors cannot measure damage. Feature extraction through signal processing and statistical...Engineering Institute, Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA. Keith Worden, Dynamics Research Group, University of...AND ADDRESS(ES) Gyuhae Park, The Engineering Institute, Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA. 8. PERFORMING ORGANIZATION

  3. Welcome Address

    2001-01-01

    @@  On behalf of the International Life Sciences Institute, I welcome you to Beijing and to the Third Asian Conference on Food Safety and Nutrition. Many of you will remember the first Asian conference on Food Safety held in Kuala Lumpur in 1990 and the second held in Bangkok in 1994. These meetings have been so successful that ILSI made the commitment to host such a conference periodically in order to provide a forum to share the latest information and to set new goals and priorities.   This year, we have broadened the scope of the agenda to include issues on nutrition. I want to thank all of our co-sponsors and members of the Planning Committee for preparing such a comprehensive and timely program. Some of the issues and challenges facing Asia that will be addressed at this meeting are:

  4. Seeing through the Smoke: A collaborative, multidisciplinary effort to address the interplay between wildfire, climate, air quality, and health

    Brey, S. J.; Fischer, E. V.; Pierce, J. R.; Ford, B.; Lassman, W.; Pfister, G.; Volckens, J.; Gan, R.; Magzamen, S.; Barnes, E. A.

    2015-12-01

    Exposure to wildfire smoke plumes represents an episodic, uncertain, and potentially growing threat to public health in the western United States. The area burned by wildfires in this region has increased over recent decades, and the future of fires within this region is largely unknown. Future fire emissions are intimately linked to future meteorological conditions, which are uncertain due to the variability of climate model outputs and differences between representative concentration pathways (RCP) scenarios. We know that exposure to wildfire smoke is harmful, particularly for vulnerable populations. However the literature on the heath effects of wildfire smoke exposure is thin, particularly when compared to the depth of information we have on the effects of exposure to smoke of anthropogenic origin. We are exploring the relationships between climate, fires, air quality and public health through multiple interdisciplinary collaborations. We will present several examples from these projects including 1) an analysis of the influence of fire on ozone abundances over the United States, and 2) efforts to use a high-resolution weather forecasting model to nail down exposure within specific smoke plumes. We will also highlight how our team works together. This discussion will include examples of the university structure that facilitates our current collaborations, and the lessons we have learned by seeking stakeholder input to make our science more useful.

  5. A Response to the Commentary Entitled: “Addressing the Shortage of Health Professionals in Rural China: Issues and Progress”

    Qian Yang

    2015-05-01

    Full Text Available The principal problems of healthcare services in China are “difficulty in seeing a doctor”and “high expense of getting medical service” (commonly known in Chinese as “kan bing nan, kan bing gui”. The central Chinese government has already launched the bottom-up cascading medical system and two-way referral system recently in order to solve these problems (1. Only when patients go to medical institutions in an orderly fashion, can we see the hope of breaking the kan bing nan, kan bing gui (2. However, we face a number of obstacles when implementing the referral policies. The biggest obstacle is the lack of Human Resource (HR for primary care both in capacity and volume (3. The central Chinese government has launched a series of policies to deal with the shortage of HRs in rural areas. Profound measurements involve postgraduate training for General Practitioner (GP (a three-year plan beginning in 2010 for producing health professionals for rural areas and improving rural retention, “3+2” medical education model (3-year diploma education and 2-year postgraduate GP training, and in-service training for physicians in rural areas (4. It is not the time to assess their effectiveness, however, these measurements are certain to improve the capacity of Community Health Service (CHS institutions.

  6. Staff perceptions of addressing lifestyle in primary health care: a qualitative evaluation 2 years after the introduction of a lifestyle intervention tool

    Carlfjord Siw

    2012-10-01

    Full Text Available Abstract Background Preventive services and health promotion in terms of lifestyle counselling provided through primary health care (PHC has the potential to reduce morbidity and mortality in the population. Health professionals in general are positive about and willing to develop a health-promoting and/or preventive role. A number of obstacles hindering PHC staff from addressing lifestyle issues have been identified, and one facilitator is the use of modern technology. When a computer-based tool for lifestyle intervention (CLT was introduced at a number of PHC units in Sweden, this provided an opportunity to study staff perspectives on the subject. The aim of this study was to explore PHC staff’s perceptions of handling lifestyle issues, including the consultation situation as well as the perceived usefulness of the CLT. Methods A qualitative study was conducted after the CLT had been in operation for 2 years. Six focus group interviews, one at each participating unit, including a total of 30 staff members with different professions participated. The interviews were designed to capture perceptions of addressing lifestyle issues, and of using the CLT. Interview data were analysed using manifest content analysis. Results Two main themes emerged from the interviews: a challenging task and confidence in handling lifestyle issues. The first theme covered the categories responsibilities and emotions, and the second theme covered the categories first contact, existing tools, and role of the CLT. Staff at the units showed commitment to health promotion/prevention, and saw that patients, caregivers, managers and politicians all have responsibilities regarding the issue. They expressed confidence in handling lifestyle-related conditions, but to a lesser extent had routines for general screening of lifestyle habits, and found addressing alcohol the most problematic issue. The CLT, intended to facilitate screening, was viewed as a complement, but was not

  7. Inaugural address

    Joshi, P. S.

    2014-03-01

    From jets to cosmos to cosmic censorship P S Joshi Tata Institute of Fundamental Research, Homi Bhabha Road, Colaba, Mumbai 400005, India E-mail: psj@tifr.res.in 1. Introduction At the outset, I should like to acknowledge that part of the title above, which tries to capture the main flavour of this meeting, and has been borrowed from one of the plenary talks at the conference. When we set out to make the programme for the conference, we thought of beginning with observations on the Universe, but then we certainly wanted to go further and address deeper questions, which were at the very foundations of our inquiry, and understanding on the nature and structure of the Universe. I believe, we succeeded to a good extent, and it is all here for you in the form of these Conference Proceedings, which have been aptly titled as 'Vishwa Mimansa', which could be possibly translated as 'Analysis of the Universe'! It is my great pleasure and privilege to welcome you all to the ICGC-2011 meeting at Goa. The International Conference on Gravitation and Cosmology (ICGC) series of meetings are being organized by the Indian Association for General Relativity and Gravitation (IAGRG), and the first such meeting was planned and conducted in Goa in 1987, with subsequent meetings taking place at a duration of about four years at various locations in India. So, it was thought appropriate to return to Goa to celebrate the 25 years of the ICGC meetings. The recollections from that first meeting have been recorded elsewhere here in these Proceedings. The research and teaching on gravitation and cosmology was initiated quite early in India, by V V Narlikar at the Banares Hindu University, and by N R Sen in Kolkata in the 1930s. In course of time, this activity grew and gained momentum, and in early 1969, at the felicitation held for the 60 years of V V Narlikar at a conference in Ahmedabad, P C Vaidya proposed the formation of the IAGRG society, with V V Narlikar being the first President. This

  8. Addressing preference heterogeneity in public health policy by combining Cluster Analysis and Multi-Criteria Decision Analysis

    Kaltoft, Mette Kjer; Turner, Robin; Cunich, Michelle;

    2015-01-01

    preferences as valid determinants of public policy, a transparent analytical procedure is needed. In this proof of method study we show how public preferences could be incorporated into policy decisions in a way that respects both the multi-criterial nature of those decisions, and the heterogeneity...... techniques of CA to demonstrate that not only do different techniques produce different clusters, but that choosing among techniques (as well as developing the MCDA structure) is an important task to be undertaken in implementing the approach outlined in any specific policy context. Data for the illustrative...... subgroups. Implementing CA and MCDA in combination to assist in the development of policies on important health and community issues such as drug coverage, reimbursement, and screening programs, poses major challenges - conceptual, methodological, ethical-political, and practical - but most are exposed...

  9. Is there scope for community health nurses to address lifestyle risk factors? the community nursing SNAP trial

    Chan Bibiana C

    2012-03-01

    Full Text Available Abstract Background This paper examines the opportunity and need for lifestyle interventions for patients attending generalist community nursing services in Australia. This will help determine the scope for risk factor management within community health care by generalist community nurses (GCNs. Methods This was a quasi-experimental study conducted in four generalist community nursing services in NSW, Australia. Prior to service contacts, clients were offered a computer-assisted telephone interview to collect baseline data on socio-demographics, health conditions, smoking status, physical activity levels, alcohol consumption, height and weight, fruit and vegetable intake and 'readiness-to-change' for lifestyle risk factors. Results 804 clients participated (a response rate of 34.1%. Participants had higher rates of obesity (40.5% vs 32.1% and higher prevalence of multiple risk factors (40.4% vs 29.5% than in the general population. Few with a SNAPW (Smoking-Nutrition-Alcohol-Physical-Activity-Weight risk factor had received advice or referral in the previous 3 months. The proportion of clients identified as at risk and who were open to change (i.e. contemplative, in preparation or in action phase were 65.0% for obese/overweight; 73.8% for smokers; 48.2% for individuals with high alcohol intake; 83.5% for the physically inactive and 59.0% for those with poor nutrition. Conclusions There was high prevalence of lifestyle risk factors. Although most were ready to change, few clients recalled having received any recent lifestyle advice. This suggests that there is considerable scope for intervention by GCNs. The results of this trial will shed light on how best to implement the lifestyle risk factor management in routine practice.

  10. Can Health 2.0 Address Critical Healthcare Challenges? Insights from the Case of How Online Social Networks Can Assist in Combatting the Obesity Epidemic

    Janine Hacker

    2017-03-01

    Full Text Available One of the serious concerns in healthcare in this 21st century is obesity. While the causes of obesity are multifaceted, social networks have been identified as one of the most important dimensions of people's social environment that may influence the adoption of many behaviours, including health-promoting behaviours. In this article, we examine the possibility of harnessing the appeal of online social networks to address the obesity epidemic currently plaguing society. Specifically, a design science research methodology is adopted to design, implement and test the Health 2.0 application called “Calorie Cruncher”. The application is designed specifically to explore the influence of online social networks on individual’s health-related behaviour. In this regard, pilot data collected based on qualitative interviews indicate that online social networks may influence health-related behaviours in several ways. Firstly, they can influence people’s norms and value system that have an impact on their health-related behaviours. Secondly, social control and pressure of social connections may also shape health-related behaviours, and operate implicitly when people make food selection decisions. Thirdly, social relationships may provide emotional support. Our study has implications for research and practice. From a theoretical perspective, the article inductively identifies three factors that influence specific types of health outcomes in the context of obesity. From a practical perspective, the study underscores the benefits of adopting a design science methodology to design and implement a technology solution for a healthcare issue as well as the key role for online social media to assist with health and wellness management and maintenance.

  11. The effects of training mental health practitioners in medication management to address nonadherence: a systematic review of clinician-related outcomes

    Bressington D

    2013-05-01

    Full Text Available Daniel Bressington,1 Esther Coren,1 Douglas MacInnes21Department of Health, Well-Being and Family, 2Centre for Health and Social Care Research, Canterbury Christ Church University, Canterbury, UKBackground: Nonadherence with medicine prescribed for mental health is a common problem that results in poor clinical outcomes for service users. Studies that provide medication management-related training for the mental health workforce have demonstrated that improvements in the knowledge, attitudes, and skills of staff can help to address nonadherence. This systematic review aims to establish the effectiveness of these training interventions in terms of clinician-related outcomes.Methods: Five electronic databases were systematically searched: PubMed, CINAHL, Medline, PsycInfo, and Google Scholar. Studies were included if they were qualitative or quantitative in nature and were primarily designed to provide mental health clinicians with knowledge and interventions in order to improve service users' experiences of taking psychotropic medications, and therefore potentially address nonadherence issues.Results: A total of five quantitative studies were included in the review. All studies reported improvements in clinicians' knowledge, attitudes, and skills immediately following training. The largest effect sizes related to improvements in clinicians' knowledge and attitudes towards nonadherence. Training interventions of longer duration resulted in the greatest knowledge- and skills-related effect sizes.Conclusion: The findings of this review indicate that training interventions are likely to improve clinician-related outcomes; however, due to the methodological limitations of the current evidence base, future research in this area should aim to conduct robust randomized controlled trials with follow-up and consider collecting qualitative data to explore clinicians' experiences of using the approaches in clinical practice.Keywords: staff training

  12. Addressing the human resources for health HRH crisis in countries: how far have we gone? What can we expect to achieve by 2015?

    Manuel M. Dayrit

    2011-06-01

    Full Text Available The World Health Report 2006 identified 57 countries world-wide whose health worker to population density fell below a critical threshold of 2.3 per 1,000 population. This meant that below this critical threshold, a country could not provide the basic health services to its population, defined here as 80% immunization coverage and 80% skilled birth attendance at delivery. Of the 57 countries, 36 are located in Africa.This article reviews the progress countries have made in addressing their health workforce crisis. It cites 3 of the most recent global studies and the indicators used to measure progress. It also features the experiences of 8 countries, namely Malawi, Peru, Ethiopia, Brazil, Thailand, Philippines, Zambia, Mali. Their situations provide a diverse picture of country efforts, challenges, and successes. The article asks the question of whether the target of 25% reduction in the number of crisis countries can be achieved by 2015. This was a goal set by the World Health Assembly in 2008. While the authors wish to remain optimistic about the striving towards this target, their optimism must be matched by an adequate level of investment in countries on HRH development. The next four years will show how much will really be achieved.

  13. Offshore finfish aquaculture in the United States: An examination of federal laws that could be used to address environmental and occupational public health risks.

    Fry, Jillian P; Love, David C; Shukla, Arunima; Lee, Ryan M

    2014-11-19

    Half of the world's edible seafood comes from aquaculture, and the United States (US) government is working to develop an offshore finfish aquaculture industry in federal waters. To date, US aquaculture has largely been regulated at the state level, and creating an offshore aquaculture industry will require the development of a new regulatory structure. Some aquaculture practices involve hazardous working conditions and the use of veterinary drugs, agrochemicals, and questionable farming methods, which could raise environmental and occupational public health concerns if these methods are employed in the offshore finfish industry in the US. This policy analysis aims to inform public health professionals and other stakeholders in the policy debate regarding how offshore finfish aquaculture should be regulated in the US to protect human health; previous policy analyses on this topic have focused on environmental impacts. We identified 20 federal laws related to offshore finfish aquaculture, including 11 that are relevant to preventing, controlling, or monitoring potential public health risks. Given the novelty of the industry in the US, myriad relevant laws, and jurisdictional issues in an offshore setting, federal agencies need to work collaboratively and transparently to ensure that a comprehensive and functional regulatory structure is established that addresses the potential public health risks associated with this type of food production.

  14. Offshore Finfish Aquaculture in the United States: An Examination of Federal Laws That Could be Used to Address Environmental and Occupational Public Health Risks

    Jillian P. Fry

    2014-11-01

    Full Text Available Half of the world’s edible seafood comes from aquaculture, and the United States (US government is working to develop an offshore finfish aquaculture industry in federal waters. To date, US aquaculture has largely been regulated at the state level, and creating an offshore aquaculture industry will require the development of a new regulatory structure. Some aquaculture practices involve hazardous working conditions and the use of veterinary drugs, agrochemicals, and questionable farming methods, which could raise environmental and occupational public health concerns if these methods are employed in the offshore finfish industry in the US. This policy analysis aims to inform public health professionals and other stakeholders in the policy debate regarding how offshore finfish aquaculture should be regulated in the US to protect human health; previous policy analyses on this topic have focused on environmental impacts. We identified 20 federal laws related to offshore finfish aquaculture, including 11 that are relevant to preventing, controlling, or monitoring potential public health risks. Given the novelty of the industry in the US, myriad relevant laws, and jurisdictional issues in an offshore setting, federal agencies need to work collaboratively and transparently to ensure that a comprehensive and functional regulatory structure is established that addresses the potential public health risks associated with this type of food production.

  15. Geoprocessamento dos dados da saúde: o tratamento dos endereços Geoprocessing of health data: treatment of information on addresses

    Daniel Albert Skaba

    2004-12-01

    Full Text Available Este trabalho faz uma análise da situação atual das informações de endereços nos Sistemas de Informações em Saúde (SIS em alguns municípios, visando a sua utilização em Sistemas de Informações Geográficas (SIG, para a análise e avaliação de riscos dos eventos de saúde pública em grandes cidades, com localização destes eventos em áreas intra-urbanas. Utiliza como base de dados uma amostra dos cadastros do Sistema de Informações de Agravos de Notificação (SINAN e tem como objetivo propor alternativas para aproveitamento de grandes volumes de dados já existentes. Nas amostras trabalhadas, cerca de metade dos endereços foi localizada automaticamente e aproximadamente 19%, em uma busca manual. As principais perdas ocorreram por falta de completitude ou de consistência nos dados de endereço.This paper analyzes the current status of address data in the Brazilian Health Information System (SIS, with a view towards mapping large-city health events in geographic information systems (GIS for risk analysis and evaluation. It is thus necessary to geocode these events to small geographic areas inside city limits. This study used a sample from the Reportable Health Events Information System (SINAN database and also proposes alternatives to work with this large amount of events. Approximately 50% of addresses were referenced automatically and another 19% through conventional search. Data losses occurred mainly due to incomplete or inconsistent address data.

  16. Stemming the Tide of Antibiotic Resistance (STAR: A protocol for a trial of a complex intervention addressing the 'why' and 'how' of appropriate antibiotic prescribing in general practice

    Hare Monika

    2009-03-01

    Full Text Available Abstract Background After some years of a downward trend, antibiotic prescribing rates in the community have tended to level out in many countries. There is also wide variation in antibiotic prescribing between general practices, and between countries. There are still considerable further gains that could be made in reducing inappropriate antibiotic prescribing, but complex interventions are required. Studies to date have generally evaluated the effect of interventions on antibiotic prescribing in a single consultation and pragmatic evaluations that assess maintenance of new skills are rare. This paper describes the protocol for a pragmatic, randomized evaluation of a complex intervention aimed at reducing antibiotic prescribing by primary care clinicians. Methods and design We developed a Social Learning Theory based, blended learning program (on-line learning, a practice based seminar, and context bound learning called the STAR Educational Program. The 'why of change' is addressed by providing clinicians in general practice with information on antibiotic resistance in urine samples submitted by their practice and their antibiotic prescribing data, and facilitating a practice-based seminar on the implications of this data. The 'how of change' is addressed through context-bound communication skills training and information on antibiotic indication and choice. This intervention will be evaluated in a trial involving 60 general practices, with general practice as the unit of randomization (clinicians from each practice to either receive the STAR Educational Program or not and analysis. The primary outcome will be the number of antibiotic items dispensed over one year. An economic and process evaluation will also be conducted. Discussion This trial will be the first to evaluate the effectiveness of this type of theory-based, blended learning intervention aimed at reducing antibiotic prescribing by primary care clinicians. Novel aspects include

  17. Addressing language barriers in client-centered health promotion: lessons learned and promising practices from Texas WIC.

    Seth, Jennifer Greenberg; Isbell, Matthew G; Atwood, Robin Dochen; Ray, Tara C

    2015-05-01

    The growing population of nonnative English speakers in the United States challenges program planners to offer services that will effectively reach limited English proficiency (LEP) audiences. This article presents findings from evaluation research conducted with the Special Supplemental Program for Women, Infants, and Children (WIC) to identify best practices and areas of concern for working with LEP clients. Data were collected through online surveys of 338 WIC teaching staff in 2010 and 65 WIC local agency directors in 2011 as part of an implementation evaluation of client-centered nutrition education. Data identified current practices, facilitating factors, and challenges in working with LEP clients. Facilitating factors included cultural competency, material and translation resources, linguistic competency, professional development opportunities, and rapport with clients. Challenges cited included linguistic challenges, lack of cultural competencies, issues related to the client-staff interaction, and insufficient time, materials, and staffing. Best practices inferred from the data relate to developing linguistic standards for bilingual staff, considerations for translating written materials, interpretation services, cultural competency, and staff training. Findings may help inform the development of this and other linguistically and culturally appropriate health promotion programs.

  18. Health-related problems and quality of life in patients with syndromic and complex craniosynostosis

    T. de Jong (Tim); M. Maliepaard (Marianne); N. Bannink (Natalja); H. Raat (Hein); I.M.J. Mathijssen (Irene)

    2012-01-01

    textabstractPurpose: We conducted this study to gauge the health-related problems, quality of life and the performance of the Health Utility Index Mark 3 (HUI-3) in patients with syndromic and complex craniosynostosis. Patients with syndromic and complex craniosynostosis have various physical and me

  19. Address by Joseph A. Califano, Jr., Secretary of Health, Education, and Welfare Before the National Interagency Council on Smokinq and Health.

    Califano, Joseph A.

    The Secretary of Health, Education, and Welfare outlines new government antismoking policies and programs, with emphasis on education and information dissemination, regulatory action, financial and other incentives, and research efforts. (MJB)

  20. Addressing preference heterogeneity in public health policy by combining Cluster Analysis and Multi-Criteria Decision Analysis: Proof of Method.

    Kaltoft, Mette Kjer; Turner, Robin; Cunich, Michelle; Salkeld, Glenn; Nielsen, Jesper Bo; Dowie, Jack

    2015-01-01

    The use of subgroups based on biological-clinical and socio-demographic variables to deal with population heterogeneity is well-established in public policy. The use of subgroups based on preferences is rare, except when religion based, and controversial. If it were decided to treat subgroup preferences as valid determinants of public policy, a transparent analytical procedure is needed. In this proof of method study we show how public preferences could be incorporated into policy decisions in a way that respects both the multi-criterial nature of those decisions, and the heterogeneity of the population in relation to the importance assigned to relevant criteria. It involves combining Cluster Analysis (CA), to generate the subgroup sets of preferences, with Multi-Criteria Decision Analysis (MCDA), to provide the policy framework into which the clustered preferences are entered. We employ three techniques of CA to demonstrate that not only do different techniques produce different clusters, but that choosing among techniques (as well as developing the MCDA structure) is an important task to be undertaken in implementing the approach outlined in any specific policy context. Data for the illustrative, not substantive, application are from a Randomized Controlled Trial of online decision aids for Australian men aged 40-69 years considering Prostate-specific Antigen testing for prostate cancer. We show that such analyses can provide policy-makers with insights into the criterion-specific needs of different subgroups. Implementing CA and MCDA in combination to assist in the development of policies on important health and community issues such as drug coverage, reimbursement, and screening programs, poses major challenges -conceptual, methodological, ethical-political, and practical - but most are exposed by the techniques, not created by them.

  1. Welcome Address

    Kiku, H.

    2014-12-01

    Ladies and Gentlemen, It is an honor for me to present my welcome address in the 3rd International Workshop on "State of the Art in Nuclear Cluster Physics"(SOTANCP3), as the president of Kanto Gakuin University. Particularly to those from abroad more than 17 countries, I am very grateful for your participation after long long trips from your home to Yokohama. On the behalf of the Kanto Gakuin University, we certainly welcome your visit to our university and stay in Yokohama. First I would like to introduce Kanto Gakuin University briefly. Kanto Gakuin University, which is called KGU, traces its roots back to the Yokohama Baptist Seminary founded in 1884 in Yamate, Yokohama. The seminary's founder was Albert Arnold Bennett, alumnus of Brown University, who came to Japan from the United States to establish a theological seminary for cultivating and training Japanese missionaries. Now KGU is a major member of the Kanto Gakuin School Corporation, which is composed of two kindergartens, two primary schools, two junior high schools, two senior high schools as well as KGU. In this university, we have eight faculties with graduate school including Humanities, Economics, Law, Sciences and Engineering, Architecture and Environmental Design, Human and Environmental Studies, Nursing, and Law School. Over eleven thousands students are currently learning in our university. By the way, my major is the geotechnical engineering, and I belong to the faculty of Sciences and Engineering in my university. Prof. T. Yamada, here, is my colleague in the same faculty. I know that the nuclear physics is one of the most active academic fields in the world. In fact, about half of the participants, namely, more than 50 scientists, come from abroad in this conference. Moreover, I know that the nuclear physics is related to not only the other fundamental physics such as the elementary particle physics and astrophysics but also chemistry, medical sciences, medical cares, and radiation metrology

  2. Addressing Inequities in Urban Health: Do Decision-Makers Have the Data They Need? Report from the Urban Health Data Special Session at International Conference on Urban Health Dhaka 2015.

    Elsey, H; Thomson, D R; Lin, R Y; Maharjan, U; Agarwal, S; Newell, J

    2016-06-01

    Rapid and uncontrolled urbanisation across low and middle-income countries is leading to ever expanding numbers of urban poor, defined here as slum dwellers and the homeless. It is estimated that 828 million people are currently living in slum conditions. If governments, donors and NGOs are to respond to these growing inequities they need data that adequately represents the needs of the urban poorest as well as others across the socio-economic spectrum.We report on the findings of a special session held at the International Conference on Urban Health, Dhaka 2015. We present an overview of the need for data on urban health for planning and allocating resources to address urban inequities. Such data needs to provide information on differences between urban and rural areas nationally, between and within urban communities. We discuss the limitations of data most commonly available to national and municipality level government, donor and NGO staff. In particular we assess, with reference to the WHO's Urban HEART tool, the challenges in the design of household surveys in understanding urban health inequities.We then present two novel approaches aimed at improving the information on the health of the urban poorest. The first uses gridded population sampling techniques within the design and implementation of household surveys and the second adapts Urban HEART into a participatory approach which enables slum residents to assess indicators whilst simultaneously planning the response. We argue that if progress is to be made towards inclusive, safe, resilient and sustainable cities, as articulated in Sustainable Development Goal 11, then understanding urban health inequities is a vital pre-requisite to an effective response by governments, donors, NGOs and communities.

  3. Addressing Inequality

    Raquel Sosa Elízaga

    2012-07-01

    Full Text Available The global sociology currently faces one of its greatest challenges: to contribute to the debate about the most serious problem which all societies have faced in recent years. The rising inequality has led to many initiatives for reflection, discussion and evaluation of public policies in order to combat poverty. Particularly, the fact that the Millennium Goals are supposed to accomplish their significance by 2015 provides the International Sociological Association (ISA the unique opportunity to contribute to those goals through their own analyses and proposals. Over many years, the ISA has promoted the integrated debate of its members on issues related to inequalities: from different perspectives such as education, health, social movements, public policies, gender problems and violence, among others. The overlapping and accumulation of inequalities has been, so to speak, the natural environment from which the ISA can take part in this international debate. This article identifies the work lines approved in the Association Program Committee Meeting held in Mexico in 2011, in the process of theAssociation’s Congress in Yokohama in 2014.

  4. Addressing intersections in HIV/AIDS and mental health: the role of organizations for d/Deaf and hard of hearing individuals in South Africa.

    Mall, Sumaya; Swartz, Leslie

    2012-01-01

    Like south africans generally, d/Deaf and hard of hearing South Africans are at risk of HIV/AIDS and mental disorders resulting from barriers to communication and care. In interviews and a focus group, members of South African organizations for d/Deaf and hard of hearing individuals all gave priority to HIV/AIDS education and prevention, citing risks resulting from language and communication barriers, inadequate schooling, and insufficient information in South African Sign Language. Participants gave varied descriptions of HIV/AIDS programs in schools for d/Deaf and hard of hearing students and described school initiatives they had directed. Some participants gave mental health problems lesser priority; others said susceptibility to mental disorders may result from communication difficulties and therefore warrants specialized services. Others, seeing a need to address mental health in HIV/AIDS prevention, had designed programs accordingly. Such prevention efforts merit support, as do activities to reduce communication barriers.

  5. A Model to Assemble: A Methodological Proposal to Address the Comparative Study of the History of Public Health, Health Professions and their Two-Way Relationships with Society

    Emilio Quevedo

    2013-09-01

    Full Text Available The article shows the theoretical and methodological proposal that, grounded in previous studies, was built during the first phase of a long-term project that seeks to develop a comparative history of medicine and public health in Latin America. For laying out purposes, this article initially develops a brief historiographical overview of the literature on the history of medicine and public health in Latin America. It then proposes a reconfiguration of the ‘health field’ concept, based on a critical analysis of the concept, that begins to appear as a framework for a long term program of Social Studies of Health Research in El Rosario University, in which this comparative proposal is articulated. In a third moment, the article presents the general outlines of the proposal. As a final result, it presents a matrix to be used in the second phase of the comparative project of the history of medicine and public health in Latin America. It was structured upon all the theoretical and methodological elements discussed in this historiography study. This matrix was composed by nine attributes and their corresponding categories, which will be used as a guide to gather the historical records and to do the respective analysis and comparison.

  6. Responding to health care complexity: suggestions for integrated and interprofessional workplace learning.

    Kuipers, Pim; Ehrlich, Carolyn; Brownie, Sharon

    2014-05-01

    This report highlights complexity in health care and the relevance of integrated and interprofessional care and learning. It is proposed that appropriate workforce training in response to complexity should be contextually relevant and workplace integrated, and should focus on building interprofessional capability for reflective practice and critical thinking. This training should be interprofessional and foster systems thinking. It is suggested that the World Health Organization's International Classification of Functioning, Disability and Health (ICF) is a useful integrating framework.

  7. Strategy to fight against malnutrition in chronic patients with complex health needs

    Burgos, Rosa; Joaquin, Clara; Blay, Carles; Ledesma, Albert; Figueiras, Guadalupe; Pérez-Portabella, Cleofe; Granados, Antonio; Gómez, Mª Dolores; González, Asunción; Sarquella, Esther; Amil, Paloma; Vaqué, Cristina

    2016-01-01

    Disease-related malnutrition (DRM) is a prevalent condition amongst older people as well as patients in all healthcare settings around the world. Chronic patients with complex health needs (CPCHN defined as those with complex chronic conditions that involve multiple health requirements, complex social support needs, or both) are especially vulnerable to malnutrition. Malnutrition is associated with increased morbidity, a higher hospital admission and readmission rate, increased needs for soci...

  8. Improving financial access to health care in the Kisantu district in the Democratic Republic of Congo: acting upon complexity

    Stéphanie Stasse

    2015-01-01

    Full Text Available Background: Comzmercialization of health care has contributed to widen inequities between the rich and the poor, especially in settings with suboptimal regulatory frameworks of the health sector. Poorly regulated fee-for-service payment systems generate inequity and initiate a vicious circle in which access to quality health care gradually deteriorates. Although the abolition of user fees is high on the international health policy agenda, the sudden removal of user fees may have disrupting effects on the health system and may not be affordable or sustainable in resource-constrained countries, such as the Democratic Republic of Congo. Methods and Results: Between 2008 and 2011, the Belgian development aid agency (BTC launched a set of reforms in the Kisantu district, in the province of Bas Congo, through an action-research process deemed appropriate for the implementation of change within open complex systems such as the Kisantu local health system. Moreover, the entire process contributed to strengthen the stewardship capacity of the Kisantu district management team. The reforms mainly comprised the rationalization of resources and the regulation of health services financing. Flat fees per episode of disease were introduced as an alternative to fee-for-service payments by patients. A financial subsidy from BTC allowed to reduce the height of the flat fees. The provision of the subsidy was made conditional upon a range of measures to rationalize the use of resources. Conclusions: The results in terms of enhancing people access to quality health care were immediate and substantial. The Kisantu experience demonstrates that a systems approach is essential in addressing complex problems. It provides useful lessons for other districts in the country.

  9. Approaches for synthesising complex mental health interventions in meta-analysis.

    Caldwell, Deborah M; Welton, Nicky J

    2016-02-01

    Clinical and statistical heterogeneity are commonplace in meta-analysis of mental health interventions. One possible source of this heterogeneity is the complexity of the intervention being evaluated. Complexity may relate to the intervention, or to the way in which it is implemented; however, the most common interpretation of a complex intervention is one which has multiple, potentially interacting components. In this article we outline different analytical strategies suggested for incorporating intervention complexity in a meta-analysis.

  10. Conceptualising health services in terms of level and location of care--a view from the academic health complex.

    Myers, J E; Pelteret, R

    1995-05-01

    The origin and characteristics of academic health complexes (AHCs) are briefly outlined, along with pressures for restructuring of health services towards primary levels of care within the primary health care (PHC) approach. Weaknesses and strengths of the AHCs together with imbalances in the overall health system of which they are part are discussed. The Cape Town AHC is used to exemplify a suggested framework for analysis and development of other AHCs in South Africa and their transformation in accordance with the PHC approach. A method of service mapping is employed to aid an appreciation of the complexity of AHC services. Planning for potential transformation may be facilitated by conceptualising services in two dimensions, viz. level and location of care. Two important additional dimensions of service component linkage are integration across levels of care along a vertical axis, and integration across different services at primary level along a horizontal axis (comprehensiveness). AHCs, however skewly developed in terms of level and location of care, are complex combinations of services. They encompass all levels of care provided both within and beyond the walls of multiple health care facilities which are located both centrally and peripherally. AHC services are managed by health professionals in specific academic disciplines. They include PHC functions at the interface between primary and specialist care provision, and community health functions which are principally located outside the health care facilities in the community.(ABSTRACT TRUNCATED AT 250 WORDS)

  11. [Complex chronic care situations and socio-health coordination].

    Morilla Herrera, Juan Carlos; Morales Asencio, José Miguel; Kaknani, Shakira; García Mayor, Silvia

    2016-01-01

    Patient-centered healthcare is currently one of the most pursued goals in health services. It is necessary to ensure a sufficient level of cooperative and coordinated work between different providers and settings, including family and social and community resources. Clinical integration occurs when the care provided by health professionals and providers is integrated into a single coherent process through different professions using shared guidelines and protocols. Such coordination can be developed at three levels: macro, which involves the integration of one or more of the three basic elements that support health care (the health plan, primary care and specialty care), with the aim of reducing fragmentation of care; meso, where health and social services are coordinated to provide comprehensive care to elderly and chronic patients; and micro, aimed to improve coordination in individual patients and caregivers. The implementation of new roles, such as Advanced Practice Nursing, along with improvements in family physicians' problem-solving capacity in certain processes, or modifying the place of provision of certain services are key to ensure services adapted to the requirements of chronic patients.

  12. Comfort Theory: Unraveling the Complexities of Veterans' Health Care Needs.

    Boudiab, Lina Daou; Kolcaba, Katharine

    2015-01-01

    The health care needs of veterans, especially those who have served in combat zones and their families are complicated, challenging, and interrelated. Physical limitations impact mental health, and mental health problems affect every aspect of adjustment to civilian life. Comfort theory offers a simple and holistic pattern for identifying needs, creating interventions to meet those needs, and evaluating the effects of those interventions. The aim of this article is to demonstrate how comfort theory has been applied throughout 1 Veterans Administration System to fulfill the goal of providing quality veteran-centric care. The application of comfort theory to daily patient and family care, discharge planning, and follow-up in various settings, as well as ways to enhance institutional integrity and branding are discussed.

  13. Complex leadership competency in health care: towards framing a theory of practice.

    Ford, Randal

    2009-08-01

    Many analysts characterize the health-care industry and health-care systems as complex adaptive organizations. New hybrid organizational forms are emerging that exhibit diverse relational-structural alliances between physicians, hospitals and/or insurers, over which administrators have limited control and restricted ability to predict or direct. Meeting the challenges in leading and managing health-care systems as complex adaptive organizations calls for additional competency in what theorists determine as 'complex leadership'. This research study presents findings on complex leadership principles that augment those competencies that health-care administration education scholars recognize and recommend as necessary for future leaders in health care to master. The findings from this study make two contributions: first, they ground complex leader theory, derived from complexity science, in empirical data; and second, the findings add to a growing body of literature investigating the underlying logics of the complex adaptive organization and the innovative ways complex leaders are developing practices and principles in leading and managing these new, emerging organizations.

  14. Procedures for addressing uncertainty and variability in exposure to characterize potential health risk from trichloroethylene contaminated groundwater at Beale Air Force Base in California

    Bogen, K T; Daniels, J I; Hall, L C

    1999-09-01

    This study was designed to accomplish two objectives. The first was to provide to the US Air Force and the regulatory community quantitative procedures that they might want to consider using for addressing uncertainty and variability in exposure to better characterize potential health risk. Such methods could be used at sites where populations may now or in the future be faced with using groundwater contaminated with low concentrations of the chemical trichloroethylene (TCE). The second was to illustrate and explain the application of these procedures with respect to available data for TCE in ground water beneath an inactive landfill site that is undergoing remediation at Beale Air Force Base in California. The results from this illustration provide more detail than the more traditional conservative deterministic, screening-level calculations of risk, also computed for purposes of comparison. Application of the procedures described in this report can lead to more reasonable and equitable risk-acceptability criteria for potentially exposed populations at specific sites.

  15. Two heads are better than one: Australian tobacco control experts' and mental health change champions' consensus on addressing the problem of high smoking rates among people with mental illness.

    Rowley, Della; Lawn, Sharon; Coveney, John

    2016-04-01

    Objective The aims of the present study were to explore the beliefs of Australian experts in tobacco control and change champions working in mental health and tobacco cessation, and to identify measures for addressing the problem of high smoking rates for people with mental illness. Methods Qualitative interviews were undertaken to explore participants' views, and the Delphi technique was used to achieve consensus on ways in which the problem would be best addressed. Results This consensus centred on the need for leadership within the mental health system. The problem was reconceptualised from being solely the responsibility of the mental health sector into an issue that requires the combined resources of a partnership and shared leadership between government and non-government services, public health leaders, policy makers and people with mental illness and their families. Conclusions Collaboration would raise the priority of the issue, reduce the debilitating effect of stigma and discrimination within the mental health sector and would place smoking reduction firmly on the political and public agenda. A recovery-orientated focus would increase the skill base and be inclusive of workers, families and carers of people with mental illness who face smoking issues on a daily basis. Reconceptualising this as an issue that would benefit from cooperation and partnerships would disrupt the notion that the problem is solely the responsibility of the mental health sector. What is known about the topic? Rates of smoking have remained high for people with mental illness despite population-wide public health strategies successfully reducing smoking rates in the general population. For people with mental illness, the benefits of quitting smoking for both their mental and physical health are overshadowed by concerns about the complexity of their needs. There is a lack of knowledge about how smoking cessation support can be improved to increase success rates in smokers with

  16. Addressing the disconnect between public health science and personalised health care: the potential role of cluster analysis in combination with multi-criteria decision analysis

    Kaltoft, Mette Kjer; Dowie, Jack; Turner, Robin

    2013-01-01

    is to arrive at the necessary compromise between an individualised public policy (using each individual's preferences) and a deindividualised policy (using mean population preferences) in a more rigorous and transparent way. We show how cluster analysis can be combined with multi-criteria decision analysis...... rather than the entire population. The characteristics can be objective health indicators or, as in our case, individual's preferences, expressed as importance weights for criteria. The techniques vary in their assumptions and procedures, and typically produce different results, although their common aim...... their mean importance weights with the performance ratings in the evidence base showed that no PSA screening emerged as optimum for all subgroups (results shown only for the Ward's method). By following the link in the appendix, the reader can interact with the underlying online program and establish...

  17. Discovering complex interrelationships between socioeconomic status and health in Europe: A case study applying Bayesian Networks.

    Alvarez-Galvez, Javier

    2016-03-01

    Studies assume that socioeconomic status determines individuals' states of health, but how does health determine socioeconomic status? And how does this association vary depending on contextual differences? To answer this question, our study uses an additive Bayesian Networks model to explain the interrelationships between health and socioeconomic determinants using complex and messy data. This model has been used to find the most probable structure in a network to describe the interdependence of these factors in five European welfare state regimes. The advantage of this study is that it offers a specific picture to describe the complex interrelationship between socioeconomic determinants and health, producing a network that is controlled by socio-demographic factors such as gender and age. The present work provides a general framework to describe and understand the complex association between socioeconomic determinants and health.

  18. Complexity and indeterminism of evidence-based public health: an analytical framework.

    Attena, Francesco

    2014-08-01

    Improving the evidence in public health is an important goal for the health promotion community. With better evidence, health professionals can make better decisions to achieve effectiveness in their interventions. The relative failure of such evidence in public health is well-known, and it is due to several factors. Briefly, from an epistemological point of view, it is not easy to develop evidence-based public health because public health interventions are highly complex and indeterminate. This paper proposes an analytical explanation of the complexity and indeterminacy of public health interventions in terms of 12 points. Public health interventions are considered as a causal chain constituted by three elements (intervention, risk factor, and disease) and two levels of evaluation (risk factor and disease). Public health interventions thus differ from clinical interventions, which comprise two causal elements and one level of evaluation. From the two levels of evaluation, we suggest a classification of evidence into four typologies: evidence of both relations; evidence of the second (disease) but not of the first (risk factor) relation; evidence of the first but not of the second relation; and no evidence of either relation. In addition, a grading of indeterminacy of public health interventions is introduced. This theoretical point of view could be useful for public health professionals to better define and classify the public health interventions before acting.

  19. Procedures for addressing uncertainty and variability in exposure to characterize potential health risk from trichloroethylene contaminated ground water at Beale Air Force Base in California

    Daniels, J I; Bogen, K T; Hall, L C

    1999-10-05

    Conservative deterministic, screening-level calculations of exposure and risk commonly are used in quantitative assessments of potential human-health consequences from contaminants in environmental media. However, these calculations generally are based on multiple upper-bound point estimates of input parameters, particularly for exposure attributes, and can therefore produce results for decision makers that actually overstate the need for costly remediation. Alternatively, a more informative and quantitative characterization of health risk can be obtained by quantifying uncertainty and variability in exposure. This process is illustrated in this report for a hypothetical population at a specific site at Beale Air Force Base in California, where there is trichloroethylene (TCE) contaminated ground water and a potential for future residential use. When uncertainty and variability in exposure were addressed jointly for this case, the 95th-percentile upper-bound value of individual excess lifetime cancer risk was a factor approaching 10 lower than the most conservative deterministic estimate. Additionally, the probability of more than zero additional cases of cancer can be estimated, and in this case it is less than 0.5 for a hypothetical future residential population of up to 26,900 individuals present for any 7.6-y interval of a 70-y time period. Clearly, the results from application of this probabilistic approach can provide reasonable and equitable risk-acceptability criteria for a contaminated site.

  20. Governability Framework for the Evaluation and Implementation of Complex Public Health Functions

    Varghese, Joe; Kutty, V. Raman

    2012-01-01

    Background: The dominant theoretical basis of our public health practice originates from a positivist or reductionist paradigm. It fails to take into account the complexity emerging out of public health's multiple influences originating from biological and social worlds. A deeper understanding of the interaction of elements that characterize the…

  1. Parents' perspectives of the transition to home when a child has complex technological health care needs.

    Brenner, Maria

    2015-09-01

    There is an increasing number of children with complex care needs, however, there is limited evidence of the experience of families during the process of transitioning to becoming their child\\'s primary care giver. The aim of this study was to explore parents\\' perspectives of the transition to home of a child with complex respiratory health care needs.

  2. Applying a complex adaptive system's understanding of health to primary care

    Bircher, Johannes; Hahn, Eckhart G.

    2016-01-01

    This paper explores the diagnostic and therapeutic potential of a new concept of health. Investigations into the nature of health have led to a new definition that explains health as a complex adaptive system (CAS) and is based on five components (a-e). Humans like all biological creatures must satisfactorily respond to (a) the demands of life. For this purpose they need (b) a biologically given potential (BGP) and (c) a personally acquired potential (PAP). These properties of individuals are embedded within (d) social and (e) environmental determinants of health. Between these five components of health there are 10 complex interactions that justify viewing health as a CAS. In each patient, the current state of health as a CAS evolved from the past, will move forward to a new future, and has to be analyzed and treated as an autonomous whole. A diagnostic procedure is suggested as follows: together with the patient, the five components and 10 complex interactions are assessed. This may help patients to better understand their situations and to recognize possible next steps that may be useful in order to evolve toward better health by themselves. In this process mutual trust in the patient-physician interaction is critical. The described approach offers new possibilities for helping patients improve their health prospects. PMID:27746902

  3. A Novel Visual Method for Studying Complex Health Transitions for Older People Living With Dementia

    Belinda Parke

    2015-11-01

    Full Text Available Understanding the complexity of health services for older people living with dementia is a challenging research endeavor. We discuss a novel research approach that combines photographic methods with storyboarding techniques to understand the views of older people living with dementia who encounter the emergency department. A social ecological theoretical position was taken to study relationships between health care systems and processes and the social arrangements of those receiving care. The research approach uncovers complex contextual factors in health care systems that are amenable to change. The approach strengthens the contribution of older people living with dementia to have their voice included in research endeavors.

  4. Designing a 100-unit Residential Complex with Public and Mental Health Approach

    Mohsen Gholizadeh Maktoo

    2014-01-01

    Full Text Available The present study first discuses different climate conditions in Iran and traditional methods of architecture in these places as well as importance of identification and evaluation of these methods. Then, designing methods of residential complexes on the basis of components and conditions of the favorite climate will be closely taken into consideration. Finally, the impact of different methods and techniques of designing on society’s mental and public health will be examined. Accordingly, designing a 100-unit residential complex with open and local green spaces, dense neighborhoods with mixed land uses, physical and visual access to the nature, creation of cultural-social-business and entertainment opportunities adjacent to the residential complex, reducing car dependency in combination with walking, strategies of improving public health in designing residential complexes and architecture in Yazd city are used. Consequently, a few strategies are provided for enhancement of citizens’ health and development of this type of architecture.

  5. A history of the working group to address Los Alamos community health concerns - A case study of community involvement and risk communication

    Harry Otway; Jon Johnson

    2000-01-01

    In May 1991, at a Department of Energy (DOE) public hearing at Los Alamos, New Mexico, a local artist claimed there had been a recent brain tumor cluster in a small Los Alamos neighborhood. He suggested the cause was radiation from past operations of Los Alamos National Laboratory. Data from the Laboratory's extensive environmental monitoring program gave no reason to believe this charge to be true but also could not prove it false. These allegations, reported in the local and regional media, alarmed the community and revealed an unsuspected lack of trust in the Laboratory. Having no immediate and definitive response, the Laboratory offered to collaborate with the community to address this concern. The Los Alamos community accepted this offer and a joint Community-Laboratory Working Group met for the first time 29 days later. The working group set as its primary goal the search for possible carcinogens in the local environment. Meanwhile, the DOE announced its intention to fund the New Mexico Department of Health to perform a separate and independent epidemiological study of all Los Alamos cancer rates. In early 1994, after commissioning 17 environmental studies and meeting 34 times, the working group decided that the public health concerns had been resolved to the satisfaction of the community and voted to disband. This paper tells the story of the artist and the working group, and how the media covered their story. It summarizes the environmental studies directed by the working group and briefly reviews the main findings of the epidemiology study. An epilogue records the present-day recollections of some of the key players in this environmental drama.

  6. Addressing risk factors for child abuse among high risk pregnant women: design of a randomised controlled trial of the nurse family partnership in Dutch preventive health care

    Mejdoubi Jamila

    2011-10-01

    Full Text Available Abstract Background Low socio-economic status combined with other risk factors affects a person's physical and psychosocial health from childhood to adulthood. The societal impact of these problems is huge, and the consequences carry on into the next generation(s. Although several studies show these consequences, only a few actually intervene on these issues. In the United States, the Nurse Family Partnership focuses on high risk pregnant women and their children. The main goal of this program is primary prevention of child abuse. The Netherlands is the first country outside the United States allowed to translate and culturally adapt the Nurse Family Partnership into VoorZorg. The aim of the present study is to assess whether VoorZorg is as effective in the Netherland as in the United States. Methods The study consists of three partly overlapping phases. Phase 1 was the translation and cultural adaptation of Nurse Family Partnership and the design of a two-stage selection procedure. Phase 2 was a pilot study to examine the conditions for implementation. Phase 3 is the randomized controlled trial of VoorZorg compared to the care as usual. Primary outcome measures were smoking cessation during pregnancy and after birth, birth outcomes, child development, child abuse and domestic violence. The secondary outcome measure was the number of risk factors present. Discussion This study shows that the Nurse Family Partnership was successfully translated and culturally adapted into the Dutch health care system and that this program fulfills the needs of high-risk pregnant women. We hypothesize that this program will be effective in addressing risk factors that operate during pregnancy and childhood and compromise fetal and child development. Trial registration Current Controlled Trials ISRCTN16131117

  7. Strengthening the Paediatricians Project 1: The need, content and process of a workshop to address the Priority Mental Health Disorders of adolescence in countries with low human resource for health

    Russell Paul SS

    2010-02-01

    Full Text Available Abstract Objective World Health Organization has identified Priority Mental Health Disorders (PMHD of adolescence. To effectively address these disorders at the primary care level paediatricians have to be trained in the low-income countries, which often have paucity of mental health resources. We studied: (1 the need of psychiatric training required among paediatricians; (2 if the content and process of the model workshop suits them to identify and treat these disorders. Methods Forty-eight paediatricians completed evaluation questionnaire at the end of a 3-day workshop on adolescent psychiatry. They participated in a focused group discussion addressing the areas in psychiatry that needs to be strengthened in these workshops, the changes in the content and process of the workshop to bolster their learning. Qualitative and descriptive analyses were appropriately used. Results Training in adolescent psychiatry was considered necessary among the paediatricians at zonal level frequently to develop their private practice, treat psychiatric disorders confidently, make correct referrals, and learn about counselling. Prioritizing training from under and postgraduate training, integrate psychiatry training with conference, conducting special workshops or Continuing Medical Education were suggested as ways of inculcating adolescent psychiatry proficiency. Mental status examination, psychopathology and management of the PMHD were considered by the respondents as important content that need to be addressed in the program but aspects of behavioural problems and developmental disabilities were also identified as areas of focus to gain knowledge and skill. Appropriate group size, flexibility in management decisions to fit the diverse clinical practice- settings was appreciated. Lack of skills in giving clinical reasoning in relation to PMHD, time management and feedback to individuals were identified as required components in the collaborative effort of this

  8. Behavioral Health and Performance Operations at the NASA Johnson Space Center: A Comprehensive Program that Addresses Flight and Spaceflight Duty Adaptability

    Beven, G. E.

    2017-01-01

    NASA astronauts on active status require medical certification for aircraft flying duties as well as readiness for long duration spaceflight training, launch to the International Space Station (ISS), and mission continuation during spaceflight operations. Behavioral fitness and adaptability is an inherent component of medical certification at NASA and requires a unique approach that spans the professional life-span of all active astronauts. TOPIC: This presentation will address the Behavioral Health and Performance (BHP) operations program at the Johnson Space Center. Components of BHP operations include astronaut selection, as well as annual, elective, preflight, inflight, and postflight BHP assessments. Each aspect of the BHP operations program will be discussed, with a focus on behavioral fitness determination and resultant outcomes. Specifically, astronaut selection generates a rating of suitability for long duration spaceflight as well as psychiatric qualification; annual, preflight and postflight BHP assessments provoke a decision regarding the presence of any aeromedical concerns; and inflight assessment requires a conclusion pertaining to mission impact. The combination of these elements provide for a unique, comprehensive approach to flight and spaceflight adaptability. APPLICATIONS: Attendees will understand the differing facets of NASA's comprehensive BHP operations program that occurs over the course of an astronaut's career and be able to compare and contrast this to the Adaptability Rating for Military Aviation (ARMA) and proposed models presented by others on this panel.

  9. Creating a cadre of junior investigators to address the challenges of cancer-related health disparities: lessons learned from the community networks program.

    Felder, Tisha M; Brandt, Heather M; Armstead, Cheryl A; Cavicchia, Philip P; Braun, Kathryn L; Adams, Swann A; Friedman, Daniela B; Tanjasiri, Sora; Steck, Susan E; Smith, Emily R; Daguisé, Virginie G; Hébert, James R

    2012-06-01

    Community-based participatory research (CBPR) initiatives such as the National Cancer Institute's Community Networks Program (CNP) (2005-2010) often emphasize training of junior investigators from underrepresented backgrounds to address health disparities. From July to October 2010, a convenience sample of 80 participants from the 25 CNP national sites completed our 45-item, web-based survey on the training and mentoring of junior investigators. This study assessed the academic productivity and CBPR-related experiences of the CNP junior investigators (n=37). Those from underrepresented backgrounds reported giving more presentations in non-academic settings (nine vs. four in the last 5 years, p=0.01), having more co-authored publications (eight vs. three in the last 5 years, p=0.01), and spending more time on CBPR-related activities than their non-underrepresented counterparts. Regardless of background, junior investigators shared similar levels of satisfaction with their mentors and CBPR experiences. This study provides support for the success of the CNP's training program, especially effort directed at underrepresented investigators.

  10. Understanding the implementation of complex interventions in health care: the normalization process model

    Rogers Anne

    2007-09-01

    Full Text Available Abstract Background The Normalization Process Model is a theoretical model that assists in explaining the processes by which complex interventions become routinely embedded in health care practice. It offers a framework for process evaluation and also for comparative studies of complex interventions. It focuses on the factors that promote or inhibit the routine embedding of complex interventions in health care practice. Methods A formal theory structure is used to define the model, and its internal causal relations and mechanisms. The model is broken down to show that it is consistent and adequate in generating accurate description, systematic explanation, and the production of rational knowledge claims about the workability and integration of complex interventions. Results The model explains the normalization of complex interventions by reference to four factors demonstrated to promote or inhibit the operationalization and embedding of complex interventions (interactional workability, relational integration, skill-set workability, and contextual integration. Conclusion The model is consistent and adequate. Repeated calls for theoretically sound process evaluations in randomized controlled trials of complex interventions, and policy-makers who call for a proper understanding of implementation processes, emphasize the value of conceptual tools like the Normalization Process Model.

  11. Health-related fitness profiles in adolescents with complex congenital heart disease

    Klausen, Susanne Hwiid; Wetterslev, Jørn; Søndergaard, Lars

    2015-01-01

    PURPOSE: This study investigates whether subgroups of different health-related fitness (HrF) profiles exist among girls and boys with complex congenital heart disease (ConHD) and how these are associated with lifestyle behaviors. METHODS: We measured the cardiorespiratory fitness, muscle strength...

  12. Building Capacity of Occupational Therapy Practitioners to Address the Mental Health Needs of Children and Youth: A Mixed-Methods Study of Knowledge Translation

    Bazyk, Susan; Demirjian, Louise; LaGuardia, Teri; Thompson-Repas, Karen; Conway, Carol; Michaud, Paula

    2015-01-01

    A 6-mo building capacity process designed to promote knowledge translation of a public health approach to mental health among pediatric occupational therapy practitioners empowered change leaders to articulate, advocate for, and implement practice changes.

  13. Beyond information access: Support for complex cognitive activities in public health informatics tools.

    Sedig, Kamran; Parsons, Paul; Dittmer, Mark; Ola, Oluwakemi

    2012-01-01

    Public health professionals work with a variety of information sources to carry out their everyday activities. In recent years, interactive computational tools have become deeply embedded in such activities. Unlike the early days of computational tool use, the potential of tools nowadays is not limited to simply providing access to information; rather, they can act as powerful mediators of human-information discourse, enabling rich interaction with public health information. If public health informatics tools are designed and used properly, they can facilitate, enhance, and support the performance of complex cognitive activities that are essential to public health informatics, such as problem solving, forecasting, sense-making, and planning. However, the effective design and evaluation of public health informatics tools requires an understanding of the cognitive and perceptual issues pertaining to how humans work and think with information to perform such activities. This paper draws on research that has examined some of the relevant issues, including interaction design, complex cognition, and visual representations, to offer some human-centered design and evaluation considerations for public health informatics tools.

  14. Care coordination for patients with complex health profiles in inpatient and outpatient settings.

    Berry, Leonard L; Rock, Beth L; Smith Houskamp, Beth; Brueggeman, Joan; Tucker, Lois

    2013-02-01

    Patients with the most complex health profiles consume a disproportionate percentage of health care expenditures, yet often receive fragmented, suboptimal care. Since 2003, Wisconsin-based Gundersen Health has improved the quality of life and reduced the cost burden of patients with complex health profiles with an integrated care coordination program. Those results are consistent with data from the most successful care coordination demonstration projects funded by the Centers for Medicare and Medicaid Services. Specifically, Gundersen's program has been associated with reduced hospital stays, lower costs for inpatients, less use of inpatient services, and increased patient satisfaction. Gundersen's success is rooted in its team-based approach to coordinated care. Teams, led by a subspecialty-trained nurse, have regular, face-to-face contact with patients and their physicians in both inpatient and outpatient settings; involve patients deeply in care-related decisions; access a system-wide electronic medical record database that tracks patients' care; and take a macrolevel view of care-related factors and costs. Gundersen's model offers specific take-home lessons for institutions interested in coordinated care as they design programs aimed at improving quality and lowering costs. This institutional case study provides a window into well-executed care coordination at a large health care system in an era when major changes in health care provision and reimbursement mechanisms are on the horizon.

  15. Spatially addressable chemoselective C-terminal ligation of an intein fusion protein from a complex mixture to a hydrazine-terminated surface.

    Yang, Peng; Marinakos, Stella M; Chilkoti, Ashutosh

    2011-02-15

    Protein immobilization on surfaces is useful in many areas of research, including biological characterization, antibody purification, and clinical diagnostics. A critical limitation in the development of protein microarrays and heterogeneous protein-based assays is the enormous amount of work and associated costs in the purification of proteins prior to their immobilization onto a surface. Methods to address this problem would simplify the development of interfacial diagnostics that use a protein as the recognition element. Herein, we describe an approach for the facile, site-specific immobilization of proteins on a surface without any preprocessing or sample purification steps that ligates an intein fusion protein at its C-terminus by reaction with a hydrazine group presented by a surface. Furthermore, we demonstrate that this methodology can directly immobilize a protein directly from cell lysate onto a protein-resistant surface. This methodology is also compatible with soft lithography and inkjet printing so that one or more proteins can be patterned on a surface without the need for purification.

  16. Kinder- und jugendgesundheitsbezogene Unterrichtsinhalte im Querschnittsbereich Prävention und Gesundheitsförderung [Addressing child and youth health-related topics in the medical curriculum with the interdisciplinary subject “prevention and health promotion”

    Plaumann, Martina

    2009-11-01

    Full Text Available [english] Beyond the scope of their respective specialities, physicians are not sufficiently trained in preventive strategies in the area of child and adolescent health. To address this problem within medical education, clinical disciplines should be supplemented with public health-related disciplines such as the interdisciplinary subject “prevention and health promotion”. This paper takes a detailed look at prevention and health promotion seminars conducted at the Hanover Medical School in regard to child and youth health-related topics. These topics were compared with those listed in the sub-modules of the Catalogue of Subjects in the Socio-medical Sciences developed by the German Society for Social Medicine and Prevention (DGSMP. Five areas of behavioural and environmental prevention in childhood and adolescence were covered in the seminars. The seminars comprised all child and youth health-related topics listed in the sub-modules. Further topics of the Catalogue which are not intended explicitly for child and youth health were also included in the seminars in relation to child and youth health. Additionally, topics that are dealt with separately in the Catalogue of the DGSMP are combined with one another at the Hanover Medical School. Due to faculty-specific approaches to child and youth health-related topics in German medical education, standardization of topics and content can solve the problem of limited resources including time and staff. Therefore, prioritisation of such topics and agreement on the instruments to be used for the transfer of knowledge to students are needed. [german] Ärztinnen und Ärzte sind für bestimmte Bereiche der Prävention bei Kindern und Jugendlichen außerhalb ihrer konventionellen Tätigkeitsfelder unzureichend ausgebildet. Dem kann im humanmedizinischen Studium begegnet werden, indem medizinisch-klinische durch Public Health-nahe Disziplinen wie dem Querschnittsbereich Prävention und Gesundheitsf

  17. Allegheny County Address Points

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset contains address points which represent physical address locations assigned by the Allegheny County addressing authority. Data is updated by County...

  18. Triumph and adversity: Exploring the complexities of consumer storytelling in mental health nursing education.

    Happell, Brenda; Bennetts, Wanda

    2016-12-01

    Consumer participation in the education of health professionals is increasing, particularly in mental health nursing education and storytelling remains the most frequent approach to consumer involvement. The use of story has tended to be accepted as a legitimate educational tool with limited critique or consideration of its potential consequences presented within the academic literature. A qualitative exploratory research study was undertaken with mental health nurse academics (n = 34) and consumer educators and academics (n = 12), to investigate the perceptions and experiences of mental health nurses and consumers regarding the involvement of consumers in mental health nursing education. Data were analysed thematically. Story was a major theme to emerge from consumer participants and received some attention from nurse academics. Consumers and nurses both referred to the power of story to convey the human experience of mental illness diagnosis and service use; and the vulnerability that can result from storytelling. Consumers also described: story as expectation; preparation and support; and the politics of story. All participants supported the value of storytelling in mental health nursing education. Consumers had considered the complexities in far greater detail. The ongoing value of story as an educational technique requires further research. Equally important is considering a broader range of educational roles for mental health consumers.

  19. Evaluating complex health interventions: a critical analysis of the 'outcomes' concept

    Launsø Laila

    2009-06-01

    Full Text Available Abstract Background The extent to which a health care intervention causes or facilitates health-related change is a key question in research. The need to quantify such change has led to the development of an increasing number of change indicators, to measure what have come to be known as 'outcomes'. In the context of medical research into the efficacy or effectiveness of an intervention the term 'outcomes' has often been interpreted to mean single endpoints with a linear cause and effect link to an external intervention. Discussion In this paper we present a critical analysis of the nature and interpretation of the 'outcomes' concept and of the assumptions that underpin it. Drawing on our own work and that of others, we analyse the problems that arise when the concept is applied to complex interventions and discuss the use of other models, such as programme theory, as a basis for alternative conceptualisations for indicators of change. Our analysis demonstrates that the interpretation of 'outcomes' that may be appropriate for clinical trials of pharmaceutical products, is problematic when used in evaluations of complex interventions in areas such as complementary medicine, palliative care, rehabilitation, and health promotion. The 'outcomes' concept may impose inappropriate patterns of thought and meaning. We present alternative models, such as those based on programme theory, which conceptualise health-related change as resulting from the interaction between intervention, process and context over time. In this framework both the intervention and the patient are defined as causal factors, because the result of the treatment is dependent on the resources of the patient – such as the body's ability to heal itself – and the impact of the patient's situation. Summary Evaluations based on a model such as programme theory will encompass a wide range of health-related changes that include aspects of process, such as new meanings and understanding

  20. Why "What Data Are Necessary for This Project?" and Other Basic Questions are Important to Address in Public Health Informatics Practice and Research.

    Dixon, Brian E; Grannis, Shaun J

    2011-01-01

    Despite the likelihood of poor quality data flowing from clinical information systems to public health information systems, current policies and practices are pushing for the adoption and use of even greater numbers of electronic data feeds. However, using poor data can lead to poor decision-making outcomes in public health. Therefore public health informatics professionals need to assess, and periodically re-evaluate, the quality of electronic data and their sources. Unfortunately there is currently a paucity of tools and strategies in use across public health agencies. Our Center of Excellence in Public Health Informatics is working to develop and disseminate tools and strategies for supporting on-going assessment of data quality and solutions for overcoming data quality challenges. In this article, we outline the need for better data quality assessment and our approach to the development of new tools and strategies. In other words, public health informatics professionals need to ask questions about the electronic data received by public health agencies, and we hope to create tools and strategies to help informaticians ask questions that will lead to improved population health outcomes.

  1. Addressing governance challenges in the provision of animal health services: A review of the literature and empirical application transaction cost theory.

    Ilukor, John; Birner, Regina; Nielsen, Thea

    2015-11-01

    Providing adequate animal health services to smallholder farmers in developing countries has remained a challenge, in spite of various reform efforts during the past decades. The focuses of the past reforms were on market failures to decide what the public sector, the private sector, and the "third sector" (the community-based sector) should do with regard to providing animal health services. However, such frameworks have paid limited attention to the governance challenges inherent in the provision of animal health services. This paper presents a framework for analyzing institutional arrangements for providing animal health services that focus not only on market failures, but also on governance challenges, such as elite capture, and absenteeism of staff. As an analytical basis, Williamson's discriminating alignment hypothesis is applied to assess the cost-effectiveness of different institutional arrangements for animal health services in view of both market failures and governance challenges. This framework is used to generate testable hypotheses on the appropriateness of different institutional arrangements for providing animal health services, depending on context-specific circumstances. Data from Uganda and Kenya on clinical veterinary services is used to provide an empirical test of these hypotheses and to demonstrate application of Williamson's transaction cost theory to veterinary service delivery. The paper concludes that strong public sector involvement, especially in building and strengthening a synergistic relation-based referral arrangement between paraprofessionals and veterinarians is imperative in improving animal health service delivery in developing countries.

  2. Back to the basics: Identifying and addressing underlying challenges in achieving high quality and relevant health statistics for indigenous populations in Canada.

    Smylie, Janet; Firestone, Michelle

    Canada is known internationally for excellence in both the quality and public policy relevance of its health and social statistics. There is a double standard however with respect to the relevance and quality of statistics for Indigenous populations in Canada. Indigenous specific health and social statistics gathering is informed by unique ethical, rights-based, policy and practice imperatives regarding the need for Indigenous participation and leadership in Indigenous data processes throughout the spectrum of indicator development, data collection, management, analysis and use. We demonstrate how current Indigenous data quality challenges including misclassification errors and non-response bias systematically contribute to a significant underestimate of inequities in health determinants, health status, and health care access between Indigenous and non-Indigenous people in Canada. The major quality challenge underlying these errors and biases is the lack of Indigenous specific identifiers that are consistent and relevant in major health and social data sources. The recent removal of an Indigenous identity question from the Canadian census has resulted in further deterioration of an already suboptimal system. A revision of core health data sources to include relevant, consistent, and inclusive Indigenous self-identification is urgently required. These changes need to be carried out in partnership with Indigenous peoples and their representative and governing organizations.

  3. Organization Complexity and Primary Care Providers' Perceptions of Quality Improvement Culture Within the Veterans Health Administration.

    Korom-Djakovic, Danijela; Canamucio, Anne; Lempa, Michele; Yano, Elizabeth M; Long, Judith A

    2016-01-01

    This study examined how aspects of quality improvement (QI) culture changed during the introduction of the Veterans Health Administration (VHA) patient-centered medical home initiative and how they were influenced by existing organizational factors, including VHA facility complexity and practice location. A voluntary survey, measuring primary care providers' (PCPs') perspectives on QI culture at their primary care clinics, was administered in 2010 and 2012. Participants were 320 PCPs from hospital- and community-based primary care practices in Pennsylvania, West Virginia, Delaware, New Jersey, New York, and Ohio. PCPs in community-based outpatient clinics reported an improvement in established processes for QI, and communication and cooperation from 2010 to 2012. However, their peers in hospital-based clinics did not report any significant improvements in QI culture. In both years, compared with high-complexity facilities, medium- and low-complexity facilities had better scores on the scales assessing established processes for QI, and communication and cooperation.

  4. Patterns and Costs of Health Care Use of Children With Medical Complexity

    Cohen, Eyal; Berry, Jay G.; Camacho, Ximena; Anderson, Geoff; Wodchis, Walter

    2012-01-01

    BACKGROUND AND OBJECTIVE: Health care use of children with medical complexity (CMC), such as those with neurologic impairment or other complex chronic conditions (CCCs) and those with technology assistance (TA), is not well understood. The objective of the study was to evaluate health care utilization and costs in a population-based sample of CMC in Ontario, Canada. METHODS: Hospital discharge data from 2005 through 2007 identified CMC. Complete health system use and costs were analyzed over the subsequent 2-year period. RESULTS: The study identified 15 771 hospitalized CMC (0.67% of children in Ontario); 10 340 (65.6%) had single-organ CCC, 1063 (6.7%) multiorgan CCC, 4368 (27.6%) neurologic impairment, and 1863 (11.8%) had TA. CMC saw a median of 13 outpatient physicians and 6 distinct subspecialists. Thirty-six percent received home care services. Thirty-day readmission varied from 12.6% (single CCC without TA) to 23.7% (multiple CCC with TA). CMC accounted for almost one-third of child health spending. Rehospitalization accounted for the largest proportion of subsequent costs (27.2%), followed by home care (11.3%) and physician services (6.0%). Home care costs were a much larger proportion of costs in children with TA. Children with multiple CCC with TA had costs 3.5 times higher than children with a single CCC without TA. CONCLUSIONS: Although a small proportion of the population, CMC account for a substantial proportion of health care costs. CMC make multiple transitions across providers and care settings and CMC with TA have higher costs and home care use. Initiatives to improve their health outcomes and decrease costs need to focus on the entire continuum of care. PMID:23184117

  5. Lessons from the experience of U.N. Convention on the Rights of Persons With Disabilities: addressing the democratic deficit in global health governance.

    Lord, Janet E; Suozzi, David; Taylor, Allyn L

    2010-01-01

    This article reviews the contributions of the UN Convention on the Rights of Persons with Disabilities (CRPD) to the progressive development of both international human rights law and global health law and governance. It provides a summary of the global situation of persons with disabilities and outlines the progressive development of international disability standards, noting the salience of the shift from a medical model of disability to a rights-based social model reflected in the CRPD. Thereafter, the article considers the Convention's structure and substantive content, and then analyzes in specific detail the particular contributions of the Convention to health and human rights law and global health governance. It concludes with an exploration of the potential implications of the CRPD's innovations for some of the most pressing issues in global health governance, including the Convention's contributions to the principle of participation in decision-making.

  6. Taxing unhealthy choices: The complex idea of liberal egalitarianism in health.

    Albertsen, Andreas

    2016-05-01

    Under the heading of liberal egalitarianism, Cappelen and Norheim present a novel approach regarding how we are to assess health disadvantages reflecting people's choices. It seeks to uphold a commitment to principles of responsibility and egalitarianism, while avoiding objections that such theories fail for humanitarian, liberal or fairness reasons. The approach draws a line between those of such diseases which are life-threatening, costly to treat relative to income or undermining important political capabilities and those which are not. For the latter kind, their approach allows for co-payment, whereas the former requires a different measure. Here, the authors maintain that unhealthy choices should be taxed and treatment offered equally to everyone without further cost. While this is an interesting approach, it faces important difficulties. It consists of two elements, which can come into tension with each other when concerns for severity of disease and personal responsibility recommend the employment of different elements. Furthermore, as it stands, the approach is incomplete because it seems unable to address important non-monetary shortages, such as the organ shortage. Finally, it is not apparent how the approach is able to address the significant ways in which social circumstances influences people's choices in health and their ability to stay healthy.

  7. Alma-Ata: Rebirth and Revision 6 Interventions to address maternal, newborn, and child survival: what difference can integrated primary health care strategies make?

    Bhutta, Zulfiqar A; Ali, Samana; Cousens, Simon; Ali, Talaha M; Haider, Batool Azra; Rizvi, Arjumand; Okong, Pius; Bhutta, Shereen Z; Black, Robert E

    2008-09-13

    Several recent reviews of maternal, newborn, and child health (MNCH) and mortality have emphasised that a large range of interventions are available with the potential to reduce deaths and disability. The emphasis within MNCH varies, with skilled care at facility levels recommended for saving maternal lives and scale-up of community and household care for improving newborn and child survival. Systematic review of new evidence on potentially useful interventions and delivery strategies identifies 37 key promotional, preventive, and treatment interventions and strategies for delivery in primary health care. Some are especially suitable for delivery through community support groups and health workers, whereas others can only be delivered by linking community-based strategies with functional first-level referral facilities. Case studies of MNCH indicators in Pakistan and Uganda show how primary health-care interventions can be used effectively. Inclusion of evidence-based interventions in MNCH programmes in primary health care at pragmatic coverage in these two countries could prevent 20-30% of all maternal deaths (up to 32% with capability for caesarean section at first-level facilities), 20-21% of newborn deaths, and 29-40% of all postneonatal deaths in children aged less than 5 years. Strengthening MNCH at the primary health-care level should be a priority for countries to reach their Millennium Development Goal targets for reducing maternal and child mortality.

  8. ADDRESSING THE GAP:

    Bagger, Bettan; Taylor Kelly, Hélène

    2013-01-01

    for clinical practice. Moreover, posters help the students to put into perspective complex nursing practice, problems and dilemmas so they become understandable for themselves and their audiences. Students evaluate posters as a valuable and concrete and useable tool in the development of their roles......Abstract Content: Bologna recommendations shifting the focus of nurse education away from the acquirement of formal qualifications towards the development of nurse competencies calls for a change in pedagogical approach. Posterpresentations have been successfully used when developing nursing...... students’ intellectual, professional and academic competences as well as in the development of competencies relevant for nursing practice. Working with posters forces students to organize, evaluate and reflect upon information and develops their abilities to communicate health promotion knowledge...

  9. 77 FR 48429 - Commission Address Change

    2012-08-14

    ... HEALTH REVIEW COMMISSION 29 CFR Parts 2700, 2701, 2702, 2704, 2705, 2706 Commission Address Change AGENCY... to inform the public of the address change. DATES: This final rule will take effect on August 27... because the amendments are of a minor and administrative nature dealing with only a change in address....

  10. Reaching for Health Equity and Social Justice in Baltimore: The Evolution of an Academic-Community Partnership and Conceptual Framework to Address Hypertension Disparities.

    Cooper, Lisa A; Purnell, Tanjala S; Ibe, Chidinma A; Halbert, Jennifer P; Bone, Lee R; Carson, Kathryn A; Hickman, Debra; Simmons, Michelle; Vachon, Ann; Robb, Inez; Martin-Daniels, Michelle; Dietz, Katherine B; Golden, Sherita Hill; Crews, Deidra C; Hill-Briggs, Felicia; Marsteller, Jill A; Boulware, L Ebony; Miller, Edgar R Iii; Levine, David M

    2016-07-21

    Cardiovascular health disparities persist despite decades of recognition and the availability of evidence-based clinical and public health interventions. Racial and ethnic minorities and adults in urban and low-income communities are high-risk groups for uncontrolled hypertension (HTN), a major contributor to cardiovascular health disparities, in part due to inequitable social structures and economic systems that negatively impact daily environments and risk behaviors. This commentary presents the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities as a case study for highlighting the evolution of an academic-community partnership to overcome HTN disparities. Key elements of the iterative development process of a Community Advisory Board (CAB) are summarized, and major CAB activities and engagement with the Baltimore community are highlighted. Using a conceptual framework adapted from O'Mara-Eves and colleagues, the authors discuss how different population groups and needs, motivations, types and intensity of community participation, contextual factors, and actions have shaped the Center's approach to stakeholder engagement in research and community outreach efforts to achieve health equity.

  11. License Address List

    National Oceanic and Atmospheric Administration, Department of Commerce — Address list generated from National Saltwater Angler Registry. Used in conjunction with an address-based sample as per survey design.

  12. Reach Address Database (RAD)

    U.S. Environmental Protection Agency — The Reach Address Database (RAD) stores the reach address of each Water Program feature that has been linked to the underlying surface water features (streams,...

  13. Knowledge transfer on complex social interventions in public health: a scoping study.

    Christian Dagenais

    Full Text Available OBJECTIVES: Scientific knowledge can help develop interventions that improve public health. The objectives of this review are (1 to describe the status of research on knowledge transfer strategies in the field of complex social interventions in public health and (2 to identify priorities for future research in this field. METHOD: A scoping study is an exploratory study. After searching databases of bibliographic references and specialized periodicals, we summarized the relevant studies using a predetermined assessment framework. In-depth analysis focused on the following items: types of knowledge transfer strategies, fields of public health, types of publics, types of utilization, and types of research specifications. RESULTS: From the 1,374 references identified, we selected 26 studies. The strategies targeted mostly administrators of organizations and practitioners. The articles generally dealt with instrumental utilization and most often used qualitative methods. In general, the bias risk for the studies is high. CONCLUSION: Researchers need to consider the methodological challenges in this field of research in order to improve assessment of more complex knowledge transfer strategies (when they exist, not just diffusion/dissemination strategies and conceptual and persuasive utilization.

  14. Sustainable development goals for global health: facilitating good governance in a complex environment.

    Haffeld, Just

    2013-11-01

    Increasing complexity is following in the wake of rampant globalization. Thus, the discussion about Sustainable Development Goals (SDGs) requires new thinking that departs from a critique of current policy tools in exploration of a complexity-friendly approach. This article argues that potential SDGs should: treat stakeholders, like states, business and civil society actors, as agents on different aggregate levels of networks; incorporate good governance processes that facilitate early involvement of relevant resources, as well as equitable participation, consultative processes, and regular policy and programme implementation reviews; anchor adoption and enforcement of such rules to democratic processes in accountable organizations; and include comprehensive systems evaluations, including procedural indicators. A global framework convention for health could be a suitable instrument for handling some of the challenges related to the governance of a complex environment. It could structure and legitimize government involvement, engage stakeholders, arrange deliberation and decision-making processes with due participation and regular policy review, and define minimum standards for health services. A monitoring scheme could ensure that agents in networks comply according to whole-systems targets, locally defined outcome indicators, and process indicators, thus resolving the paradox of government control vs. local policy space. A convention could thus exploit the energy created in the encounter between civil society, international organizations and national authorities.

  15. Using the public health model to address unintentional injuries and TBI: A perspective from the Centers for Disease Control and Prevention (CDC).

    Baldwin, Grant; Breiding, Matt; Sleet, David

    2016-06-30

    Traumatic brain injury (TBI) can have long term effects on mental and physical health, and can disrupt vocational, educational, and social functioning. TBIs can range from mild to severe and their effects can last many years after the initial injury. CDC seeks to reduce the burden of TBI from unintentional injuries through a focus on primary prevention, improved recognition and management, and intervening to improve health outcomes after TBI. CDC uses a 4-stage public health model to guide TBI prevention, moving from 1) surveillance of TBI, 2) identification of risk and protective factors for TBI, 3) development and testing of evidence-based interventions, to 4) bringing effective intervention to scale through widespread adoption. CDC's unintentional injury prevention activities focus on the prevention of sports-related concussions, motor vehicle crashes, and older adult falls. For concussion prevention, CDC developed Heads Up - an awareness initiative focusing on ways to prevent a concussion in sports, and identifying how to recognize and manage potential concussions. In motor vehicle injury prevention, CDC has developed a tool (MV PICCS) to calculate the expected number of injuries prevented and lives saved using various evidence-based motor vehicle crash prevention strategies. To help prevent TBI related to older adult falls, CDC has developed STEADI, an initiative to help primary care providers identify their patients' falls risk and provide effective interventions. In the future, CDC is focused on advancing our understanding of the public health burden of TBI through improved surveillance in order to produce more comprehensive estimates of the public health burden of TBI.

  16. [Care as a cross-cutting element in the health care of complex chronic patients].

    Rico-Blázquez, Milagros; Sánchez Gómez, Sheila; Fuentelsaz Gallego, Carmen

    2014-01-01

    The care of people who live with chronic diseases is currently a priority on the roadmaps of all health care services. Within these strategies, there needs to be a specific approach required for a population group that is defined by having multiple diseases and the associated comorbidity. This group is especially vulnerable, fragile, and require very complex care, which uses up a high quantity of social health resources. The estimated prevalence in Spain is 1.4% in the general population, and approximately 5% in people over 64 years. The social and healthcare of this population requires a person-centered approach, as a paradigm of caring for the patients and not of the diseases. The models must leap from the segmented approach to diseases to a holistic and integrated vision, taking into account the social and psycho-affective situation, the experience of the patient, the family context, and the approach of human experience/response that these processes produce. The health professionals need support tools that can guide them and help in making clinical decisions in this population group. The clinical practice guidelines for the approach of patients with co-morbidity and multiple diseases have numerous limitations. Expert recommendations in this sense, lead us to a multidisciplinary approach, with self-care and self-health management as a cross-cutting element of healthcare.

  17. The use of race variables in genetic studies of complex traits and the goal of reducing health disparities: a transdisciplinary perspective.

    Shields, Alexandra E; Fortun, Michael; Hammonds, Evelynn M; King, Patricia A; Lerman, Caryn; Rapp, Rayna; Sullivan, Patrick F

    2005-01-01

    The use of racial variables in genetic studies has become a matter of intense public debate, with implications for research design and translation into practice. Using research on smoking as a springboard, the authors examine the history of racial categories, current research practices, and arguments for and against using race variables in genetic analyses. The authors argue that the sociopolitical constructs appropriate for monitoring health disparities are not appropriate for use in genetic studies investigating the etiology of complex diseases. More powerful methods for addressing population structure exist, and race variables are unacceptable as gross proxies for numerous social/environmental factors that disproportionately affect minority populations. The authors conclude with recommendations for genetic researchers and policymakers, aimed at facilitating better science and producing new knowledge useful for reducing health disparities.

  18. Waste Management: DOD Has Generally Addressed Legislative Requirements on the Use of Burn Pits but Needs to Fully Assess Health Effects

    2016-09-01

    Health Effects Report to Congressional Committees September 2016 GAO-16-781 United States Government Accountability Office...United States Government Accountability Office Highlights of GAO-16-781, a report to congressional committees September 2016 WASTE MANAGEMENT...on the results of its review in March 2016. Section 313 also includes a provision for GAO to assess DOD’s report and its compliance with

  19. Evidence-based recommendations for addressing malnutrition in health care: an updated strategy from the feedM.E. Global Study Group.

    Correia, M Isabel T D; Hegazi, Refaat A; Higashiguchi, Takashi; Michel, Jean-Pierre; Reddy, B Ravinder; Tappenden, Kelly A; Uyar, Mehmet; Muscaritoli, Maurizio

    2014-08-01

    The prevalence of malnutrition ranges up to 50% among patients in hospitals worldwide, and disease-related malnutrition is all too common in long-term and other health care settings as well. Regrettably, the numbers have not improved over the past decade. The consequences of malnutrition are serious, including increased complications (pressure ulcers, infections, falls), longer hospital stays, more frequent readmissions, increased costs of care, and higher risk of mortality. Yet disease-related malnutrition still goes unrecognized and undertreated. To help improve nutrition care around the world, the feedM.E. (Medical Education) Global Study Group, including members from Asia, Europe, the Middle East, and North and South America, defines a Nutrition Care Pathway that is simple and can be tailored for use in varied health care settings. The Pathway recommends screen, intervene, and supervene: screen patients' nutrition status on admission or initiation of care, intervene promptly when needed, and supervene or follow-up routinely with adjustment and reinforcement of nutrition care plans. This article is a call-to-action for health caregivers worldwide to increase attention to nutrition care.

  20. Complexity

    Gershenson, Carlos

    2011-01-01

    The term complexity derives etymologically from the Latin plexus, which means interwoven. Intuitively, this implies that something complex is composed by elements that are difficult to separate. This difficulty arises from the relevant interactions that take place between components. This lack of separability is at odds with the classical scientific method - which has been used since the times of Galileo, Newton, Descartes, and Laplace - and has also influenced philosophy and engineering. In recent decades, the scientific study of complexity and complex systems has proposed a paradigm shift in science and philosophy, proposing novel methods that take into account relevant interactions.

  1. Advancing efforts to address youth violence involvement.

    Weist, M D; Cooley-Quille, M

    2001-06-01

    Discusses the increased public attention on violence-related problems among youth and the concomitant increased diversity in research. Youth violence involvement is a complex construct that includes violence experienced in multiple settings (home, school, neighborhood) and in multiple forms (as victims, witnesses, perpetrators, and through family members, friends, and the media). Potential impacts of such violence involvement are considerable, including increased internalizing and externalizing behaviors among youth and future problems in school adjustment and life-course development. This introductory article reviews key dimensions of youth-related violence, describes an American Psychological Association Task Force (Division 12) developed to advance relevant research, and presents examples of national resources and efforts that attempt to address this critical public health issue.

  2. SUPPORT Tools for Evidence-informed policymaking in health 6: Using research evidence to address how an option will be implemented

    Lavis John N

    2009-12-01

    Full Text Available Abstract This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. After a policy decision has been made, the next key challenge is transforming this stated policy position into practical actions. What strategies, for instance, are available to facilitate effective implementation, and what is known about the effectiveness of such strategies? We suggest five questions that can be considered by policymakers when implementing a health policy or programme. These are: 1. What are the potential barriers to the successful implementation of a new policy? 2. What strategies should be considered in planning the implementation of a new policy in order to facilitate the necessary behavioural changes among healthcare recipients and citizens? 3. What strategies should be considered in planning the implementation of a new policy in order to facilitate the necessary behavioural changes in healthcare professionals? 4. What strategies should be considered in planning the implementation of a new policy in order to facilitate the necessary organisational changes? 5. What strategies should be considered in planning the implementation of a new policy in order to facilitate the necessary systems changes?

  3. Deciphering the complex intermediate role of health coverage through insurance in the context of well-being by network analysis

    Cifuentes, Myriam Patricia

    2016-01-01

    Recent initiatives that overstate health insurance coverage for well-being conflict with the recognized antagonistic facts identified by the determinants of health that identify health care as an intermediate factor. By using a network of controlled interdependences among multiple social resources including health insurance, which we reconstructed from survey data of the U.S. and Bayesian networks structure learning algorithms, we examined why health insurance through coverage, which in most countries is the access gate to health care, is just an intermediate factor of well-being. We used social network analysis methods to explore the complex relationships involved at general, specific and particular levels of the model. All levels provide evidence that the intermediate role of health insurance relies in a strong relationship to income and reproduces its unfair distribution. Some signals about the most efficient type of health coverage emerged in our analyses.

  4. Complex evaluation of health status and life quality of employees occupied in mining and processing of hydrocarbon raw materials

    G.G. Gimranova; A.B. Bakirov; L.K. Karimova; Z.F. Gimaeva; N.A. Beigul

    2016-01-01

    A complex social-hygienic investigation for the assessment of health-related life quality and living standards among 1200 male workers occupied in mining and primary processing of hydrocarbon raw materials has been performed. The study included the method of the anonymous survey for the employee with using a questionnaire developed by WHO experts for the realization of Health, environment and social capital management in enterprises (HESME). The health risk factors’ prevalence associated with...

  5. Development cooperation for health: reviewing a dynamic concept in a complex global aid environment

    Hill Peter S

    2012-03-01

    Full Text Available Abstract The 4th High Level Forum on Aid Effectiveness, held in Busan, South Korea in November 2011 again promised an opportunity for a "new consensus on development cooperation" to emerge. This paper reviews the recent evolution of the concept of coordination for development assistance in health as the basis from which to understand current discourses. The paper reviews peer-reviewed scientific literature and relevant 'grey' literature, revisiting landmark publications and influential authors, examining the transitions in the conceptualisation of coordination, and the related changes in development assistance. Four distinct transitions in the understanding, orientation and application of coordination have been identified: coordination within the sector, involving geographical zoning, sub-sector specialisation, donor consortia, project co-financing, sector aid, harmonisation of procedures, ear-marked budgetary support, donor agency reform and inter-agency intelligence gathering; sector-wide coordination, expressed particularly through the Sector-Wide Approach; coordination across sectors at national level, expressed in the evolution of Poverty Strategy Reduction Papers and the national monitoring of the Millennium Development Goals; and, most recently, global-level coordination, embodied in the Paris Principles, and the emergence of agencies such as the International Health Partnerships Plus. The transitions are largely but not strictly chronological, and each draws on earlier elements, in ways that are redefined in the new context. With the increasing complexity of both the territory of global health and its governance, and increasing stakeholders and networks, current imaginings of coordination are again being challenged. The High Level Forum in Busan may have been successful in recognising a much more complex landscape for development than previously conceived, but the challenges to coordination remain.

  6. Development cooperation for health: reviewing a dynamic concept in a complex global aid environment.

    Hill, Peter S; Dodd, Rebecca; Brown, Scott; Haffeld, Just

    2012-03-15

    The 4th High Level Forum on Aid Effectiveness, held in Busan, South Korea in November 2011 again promised an opportunity for a "new consensus on development cooperation" to emerge. This paper reviews the recent evolution of the concept of coordination for development assistance in health as the basis from which to understand current discourses. The paper reviews peer-reviewed scientific literature and relevant 'grey' literature, revisiting landmark publications and influential authors, examining the transitions in the conceptualisation of coordination, and the related changes in development assistance. Four distinct transitions in the understanding, orientation and application of coordination have been identified: coordination within the sector, involving geographical zoning, sub-sector specialisation, donor consortia, project co-financing, sector aid, harmonisation of procedures, ear-marked budgetary support, donor agency reform and inter-agency intelligence gathering; sector-wide coordination, expressed particularly through the Sector-Wide Approach; coordination across sectors at national level, expressed in the evolution of Poverty Strategy Reduction Papers and the national monitoring of the Millennium Development Goals; and, most recently, global-level coordination, embodied in the Paris Principles, and the emergence of agencies such as the International Health Partnerships Plus. The transitions are largely but not strictly chronological, and each draws on earlier elements, in ways that are redefined in the new context. With the increasing complexity of both the territory of global health and its governance, and increasing stakeholders and networks, current imaginings of coordination are again being challenged. The High Level Forum in Busan may have been successful in recognising a much more complex landscape for development than previously conceived, but the challenges to coordination remain.

  7. Balancing Control and Complexity in Field Studies of Neonicotinoids and Honey Bee Health

    Sainath Suryanarayanan

    2013-03-01

    Full Text Available Amidst ongoing declines in honey bee health, the contributory role of the newer systemic insecticides continues to be intensely debated. Scores of toxicological field experiments, which bee scientists and regulators in the United States have looked to for definitive causal evidence, indicate a lack of support. This paper analyzes the methodological norms that shape the design and interpretation of field toxicological studies. I argue that contemporary field studies of honey bees and pesticides are underpinned by a “control-oriented” approach, which precludes a serious investigation of the indirect and multifactorial ways in which pesticides could drive declines in honey bee health. I trace the historical rise to prominence of this approach in honey bee toxicology to the development of entomology as a science of insecticide development in the United States. Drawing on “complexity-oriented” knowledge practices in ecology, epidemiology, beekeeping and sociology, I suggest an alternative socio-ecological systems approach, which would entail in situ studies that are less concerned with isolating individual factors and more attentive to the interactive and place-based mix of factors affecting honey bee health.

  8. Simulation tools for developing policies for complex systems: modeling the health and safety of refugee communities.

    Anderson, James; Chaturvedi, Alok; Cibulskis, Mike

    2007-12-01

    The U.S. Committee for Refugees and Immigrants estimated that there were over 33 million refugees and internally displaced persons (IDPs) in the world at the beginning of 2005. IDP/Refugee communities behave in complex ways making it difficult to make policy decisions regarding the provision of humanitarian aid and health and safety. This paper reports the construction of an agent-based model that has been used to study humanitarian assistance policies executed by governments and NGOs that provide for the health and safety of refugee communities. Agent-based modeling (ABM) was chosen because the more widely used alternatives impose unrealistic restrictions and assumptions on the system being modeled and primarily apply to aggregate data. We created intelligent agents representing institutions, organizations, individuals, infrastructure, and governments and analyzed the resulting interactions and emergent behavior using a Central Composite Design of Experiments with five factors. The resulting model allows policy makers and analysts to create scenarios, to make rapid changes in parameters, and provides a test bed for concepts and strategies. Policies can be examined to see how refugee communities might respond to alternative courses of action and how these actions are likely to affect the health and well-being of the community.

  9. The entrepreneurship insurance of life: the tutelary complex in neoliberal market of health

    Flávia Cristina Silveira Lemos

    2016-07-01

    Full Text Available In this article, are presented and analyzed security practices of policies producing healthy bodies. Are problematized (scrutinized the effects of these interventions such as: save, morality, standardise and standardize populations in favor of entrepreneurship by itself and of the other, in neoliberal market of a new religion, which is the pastoral care of health, that is to say, the salvation of health care offered in a complex multiple of arts to lead the ducts of the flocks and the lost sheep. In this article, are presented and analyzed practices of security involves various mechanisms for social security, among whom are a corporal punishment, or lordships, disciplines, biopolíticas and ministries. In the name of the right to health, and biocidadanias medicalizações emerge and pass to cross our subjectivities almost as natural practices, gaining relevance to the extent that also become tools of investments, in calculations of cost and benefit in the relationship between freedom and security.

  10. The migrating motor complex: control mechanisms and its role in health and disease.

    Deloose, Eveline; Janssen, Pieter; Depoortere, Inge; Tack, Jan

    2012-03-27

    The migrating motor complex (MMC) is a cyclic, recurring motility pattern that occurs in the stomach and small bowel during fasting; it is interrupted by feeding. The MMC is present in the gastrointestinal tract of many species, including humans. The complex can be subdivided into four phases, of which phase III is the most active, with a burst of contractions originating from the antrum or duodenum and migrating distally. Control of the MMC is complex. Phase III of the MMC with an antral origin can be induced in humans through intravenous administration of motilin, erythromycin or ghrelin, whereas administration of serotonin or somatostatin induces phase III activity with duodenal origin. The role of the vagus nerve in control of the MMC seems to be restricted to the stomach, as vagotomy abolishes the motor activity in the stomach, but leaves the periodic activity in the small bowel intact. The physiological role of the MMC is incompletely understood, but its absence has been associated with gastroparesis, intestinal pseudo-obstruction and small intestinal bacterial overgrowth. Measuring the motility of the gastrointestinal tract can be important for the diagnosis of gastrointestinal disorders. In this Review we summarize current knowledge of the MMC, especially its role in health and disease.

  11. Building a platform for translational research in chronic noncommunicable diseases to address population health: lessons from NHLBI supported CRONICAS in Peru.

    Miranda, J Jaime; Bernabé-Ortiz, Antonio; Diez-Canseco, Francisco; Málaga, Germán; Cardenas, María K; Carrillo-Larco, Rodrigo M; Pesantes, M Amalia; Araya, Ricardo; Boggio, Oscar; Checkley, William; García, Patricia J; León-Velarde, Fabiola; Lescano, Andrés G; Montori, Victor; Pan, William; Rivera-Chira, Maria; Sacksteder, Katherine; Smeeth, Liam; García, Héctor H; Gilman, Robert H

    2015-03-01

    The CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Heredia, was created in 2009 with support from the U.S. National Heart, Lung, and Blood Institute (NHLBI). The vision of CRONICAS is to build a globally recognized center of excellence conducting quality and innovative research and generating high-impact evidence for health. The center's identity is embedded in its core values: generosity, innovation, integrity, and quality. This review has been structured to describe the development of the CRONICAS Centre, with a focus on highlighting the ongoing translational research projects and capacity-building strategies. The CRONICAS Centre of Excellence is not a risk-averse organization: it benefits from past experiences, including past mistakes, and improves upon them and thus challenges traditional research approaches. This ethos and environment are key to fostering innovation in research.

  12. Social cohesion through football: a quasi-experimental mixed methods design to evaluate a complex health promotion program

    Kemp Lynn

    2010-10-01

    Full Text Available Abstract Social isolation and disengagement fragments local communities. Evidence indicates that refugee families are highly vulnerable to social isolation in their countries of resettlement. Research to identify approaches to best address this is needed. Football United is a program that aims to foster social inclusion and cohesion in areas with high refugee settlement in New South Wales, Australia, through skills and leadership development, mentoring, and the creation of links with local community and corporate leaders and organisations. The Social Cohesion through Football study's broad goal is to examine the implementation of a complex health promotion program, and to analyse the processes involved in program implementation. The study will consider program impact on individual health and wellbeing, social inclusion and cohesion, as well as analyse how the program by necessity interacts and adapts to context during implementation, a concept we refer to as plasticity. The proposed study will be the first prospective cohort impact study to our knowledge to assess the impact of a comprehensive integrated program using football as a vehicle for fostering social inclusion and cohesion in communities with high refugee settlement. Methods/design A quasi-experimental cohort study design with treatment partitioning involving four study sites. The study employs a 'dose response' model, comparing those with no involvement in the Football United program with those with lower or higher levels of participation. A range of qualitative and quantitative measures will be used in the study. Study participants' emotional well being, resilience, ethnic identity and other group orientation, feelings of social inclusion and belonging will be measured using a survey instrument complemented by relevant data drawn from in-depth interviews, self reporting measures and participant observation. The views of key informants from the program and the wider community will

  13. Distinct and complex bacterial profiles in human periodontitis and health revealed by 16S pyrosequencing.

    Griffen, Ann L; Beall, Clifford J; Campbell, James H; Firestone, Noah D; Kumar, Purnima S; Yang, Zamin K; Podar, Mircea; Leys, Eugene J

    2012-06-01

    Periodontitis has a polymicrobial etiology within the framework of a complex microbial ecosystem. With advances in sequencing technologies, comprehensive studies to elucidate bacterial community differences have recently become possible. We used 454 sequencing of 16S rRNA genes to compare subgingival bacterial communities from 29 periodontally healthy controls and 29 subjects with chronic periodontitis. Amplicons from both the V1-2 and V4 regions of the 16S gene were sequenced, yielding 1,393,579 sequences. They were identified by BLAST against a curated oral 16S database, and mapped to 16 phyla, 106 genera, and 596 species. 81% of sequences could be mapped to cultivated species. Differences between health- and periodontitis-associated bacterial communities were observed at all phylogenetic levels, and UniFrac and principal coordinates analysis showed distinct community profiles in health and disease. Community diversity was higher in disease, and 123 species were identified that were significantly more abundant in disease, and 53 in health. Spirochaetes, Synergistetes and Bacteroidetes were more abundant in disease, whereas the Proteobacteria were found at higher levels in healthy controls. Within the phylum Firmicutes, the class Bacilli was health-associated, whereas the Clostridia, Negativicutes and Erysipelotrichia were associated with disease. These results implicate a number of taxa that will be targets for future research. Some, such as Filifactor alocis and many Spirochetes were represented by a large fraction of sequences as compared with previously identified targets. Elucidation of these differences in community composition provides a basis for further understanding the pathogenesis of periodontitis.

  14. Caring for Children With Tuberous Sclerosis Complex: What Is the Physical and Mental Health Impact on Caregivers?

    Rentz, Anne M; Skalicky, Anne M; Pashos, Chris L; Liu, Zhimei; Magestro, Matthew; Pelletier, Corey L; Prestifilippo, Judith A; Nakagawa, JoAnne; Frost, Michael D; Dunn, David W; Wheless, James W

    2015-10-01

    Disease burden associated with tuberous sclerosis complex, a genetic disorder characterized by benign tumor growth including lesions in multiple organs, puts tremendous demands on families. This analysis examines the physical and mental health burden of tuberous sclerosis complex caregivers in the United States. An institutional review board-approved web-based survey of tuberous sclerosis complex caregivers collected information; descriptive analyses were conducted on age-based subgroups. A total of 275 caregivers of tuberous sclerosis complex patients responded. Mean patient age ≤ 18 years was 6.9 (±4.4) and 42.3 (±18.2) for patients >18 years of age. Caregivers reported multiple tuberous sclerosis complex manifestations and high health care utilization for patients. Caregivers spending more time on doctor visits or researching tuberous sclerosis complex had lower physical and mental health-related quality of life scores and more depressive symptoms. Tuberous sclerosis complex caregivers had significantly lower physical and mental health-related quality of life scores and more depressive symptomatology compared to US healthy adult population norms.

  15. Addressing Inequities in Access to Health Products through the Use of Social Marketing, Community Mobilization, and Local Entrepreneurs in Rural Western Kenya

    Julie R. Harris

    2012-01-01

    Full Text Available While social marketing can increase uptake of health products in developing countries, providing equitable access is challenging. We conducted a 2-year evaluation of uptake of WaterGuard, insecticide-treated bednets (ITNs, and micronutrient Sprinkles in Western Kenya. Sixty villages were randomly assigned to intervention and comparison groups. Following a baseline survey (BL, a multifaceted intervention comprising social marketing of these products, home visits by product vendors from a local women’s group (Safe Water and AIDS Project, or SWAP, product promotions, and modeling of water treatment and safe storage in was implemented in intervention villages. Comparison villages received only social marketing of WaterGuard and ITNs. We surveyed again at one year (FU1, implemented the intervention in comparison villages, and surveyed again at two years (FU2. At BL, 90% those reported ever purchasing a product from the vendor. WaterGuard (P=0.02 and ITNs (P=0.005 were purchased less frequently by lower-SES than higher-SES households; Sprinkles, the least expensive product, was purchased equally across all quintiles.

  16. Can pictorial warning labels on cigarette packages address smoking-related health disparities?: Field experiments in Mexico to assess warning label content

    Thrasher, James F.; Arillo-Santillán, Edna; Villalobos, Victor; Pérez-Hernández, Rosaura; Hammond, David; Carter, Jarvis; Sebrié, Ernesto; Sansores, Raul; Regalado-Piñeda, Justino

    2012-01-01

    Objective This study aimed to determine the most effective content of pictorial health warning labels (HWLs) and whether educational attainment moderates these effects. Methods Field experiments were conducted with 529 adult smokers and 530 young adults (258 nonsmokers; 271 smokers), wherein participants reported responses to different HWLs printed on cigarette packages. One experiment involved manipulating textual form (testimonial narrative vs didactic) and the other involved manipulating imagery type (diseased organs vs human suffering). Results Tests of mean ratings and rankings indicated that HWLs with didactic textual forms had equivalent or significantly higher credibility, relevance, and impact than HWLs with testimonial forms. Results from mixed-effects models confirmed these results. However, responses differed by participant educational attainment: didactic forms were consistently rated higher than testimonials among participants with higher education, whereas the difference between didactic and testimonial narrative forms was weaker or not statistically significant among participants with lower education. In the second experiment, with textual content held constant, greater credibility, relevance and impact was found for graphic imagery of diseased organs than imagery of human suffering. Conclusions Pictorial HWLs with didactic textual forms appear to work better than with testimonial narratives. Future research should determine which pictorial HWL content has the greatest real-world impact among consumers from disadvantaged groups, including assessment of how HWL content should change to maintain its impact as tobacco control environments strengthen and consumer awareness of smoking-related risks increases. PMID:22350859

  17. Design Criteria for Future Fuels and Related Power Systems Addressing the Impacts of Non-CO2 Pollutants on Human Health and Climate Change.

    Schauer, James Jay

    2015-01-01

    Concerns over the economics, supply chain, and emissions of greenhouse gases associated with the wide use of fossil fuels have led to increasing interest in developing alternative and renewable fuels for stationary power generation and transportation systems. Although there is considerable uncertainty regarding the economic and environmental impacts of alternative and renewable fuels, there is a great need for assessment of potential and emerging fuels to guide research priorities and infrastructure investment. Likewise, there is a great need to identify potential unintended adverse impacts of new fuels and related power systems before they are widely adopted. Historically, the environmental impacts of emerging fuels and power systems have largely focused on carbon dioxide emissions, often called the carbon footprint, which is used to assess impacts on climate change. Such assessments largely ignore the large impacts of emissions of other air pollutants. Given the potential changes in emissions of air pollutants associated with the large-scale use of new and emerging fuels and power systems, there is a great need to better guide efforts to develop new fuels and power systems that can avoid unexpected adverse impacts on the environment and human health. This review covers the nature of emissions, including the key components and impacts from the use of fuels, and the design criteria for future fuels and associated power systems to assure that the non-CO2 adverse impacts of stationary power generation and transportation are minimized.

  18. Addressing psychiatric comorbidity.

    Woody, G E; McLellan, A T; O'Brien, C P; Luborsky, L

    1991-01-01

    Research studies indicate that addressing psychiatric comorbidity can improve treatment for selected groups of substance-abusing patients. However, the chances for implementing the necessary techniques on a large scale are compromised by the absence of professional input and guidance within programs. This is especially true in public programs, which treat some of the most disadvantaged, disturbed, and socially destructive individuals in the entire mental health system. One starting point for upgrading the level of knowledge and training of staff members who work in this large treatment system could be to develop a better and more authoritative information dissemination network. Such a system exists in medicine; physicians are expected to read appropriate journals and to guide their treatment decisions using the data contained in the journals. Standards of practice and methods for modifying current practice are within the tradition of reading new facts, studying old ones, and comparing treatment outcome under different conditions with what is actually being done. No such general system of information-gathering or -sharing exists, particularly in public treatment programs. One of the most flagrant examples of this "educational shortfall" can be found among those methadone programs that adamantly insist on prescribing no more than 30 to 35 mg/day for all patients, in spite of the overwhelming evidence that these dose levels generally are inadequate. In some cases, program directors are unaware of studies that have shown the relationship between dose and outcome. In other cases, they are aware of the studies but do not modify their practices accordingly. This example of inadequate dosing is offered as an example of one situation that could be improved by adherence to a system of authoritative and systematic information dissemination. Many issues in substance abuse treatment do not lend themselves to information dissemination as readily as that of methadone dosing

  19. Occupational safety and health as an element of a complex compensation system evaluation within an organization.

    Beck-Krala, Ewa; Klimkiewicz, Katarzyna

    2016-12-01

    Occupational safety and health (OSH) plays a significant role in today's organizations, because it helps in attracting and retaining employees as well as molding their attitudes and behaviors at work. This is why the issue of OSH is stressed in a comprehensive approach to employee rewards: the total reward concept. This article explains how OSH may be included in a complex evaluation process of the compensation system. Although the literature on the effectiveness of employee compensation refers mainly to financial and non-financial components, there is a need for inclusion of working conditions in such analyses. An evaluation of the compensation system that incorporates OSH can drive many benefits for both the organization and employees. Obtaining such benefits, however, requires systematic evaluation of the reward system, including OSH. Incorporation of OSH issue within the comprehensive analysis of compensation systems promotes responsible behavior of all stakeholders.

  20. Complex PTSD: research directions for nosology/assessment, treatment, and public health

    Julian D. Ford

    2015-05-01

    Full Text Available Complex posttraumatic stress disorder (CPTSD in children and adolescents extends beyond the core PTSD symptoms to dysregulation in three psychobiological domains: (1 emotion processing, (2 self-organization (including bodily integrity, and (3 relational functioning. CPTSD research directions for the next decade and beyond are identified in three areas: (1 diagnostic classification (establishing the empirical integrity of CPTSD as a distinct form of psychopathology and psychometric assessment [validation and refinement of measures of childhood polyvictimization and developmental trauma disorder (DTD], (2 rigorous evaluation and refinement of interventions (and algorithms for their delivery developed or adapted for CPTSD and DTD, and (3 the epidemiology of CPTSD and DTD, and their public health and safety impact, across the lifespan and intergenerationally, for populations, nations, and cultures.

  1. Addressing Ozone Layer Depletion

    Access information on EPA's efforts to address ozone layer depletion through regulations, collaborations with stakeholders, international treaties, partnerships with the private sector, and enforcement actions under Title VI of the Clean Air Act.

  2. A stochastic model simulating the feeding-health-production complex in a dairy herd.

    Ostergaard, S; Sørensen, J T; Kristensen, A R

    2000-04-01

    A dynamic, stochastic, and mechanistic Monte Carlo model, simulating a dairy herd with focus on the feeding-health-production complex is presented. By specifying biological parameters at cow level and a management strategy at herd level, the model can simulate the technical and economic consequences of scenarios at herd level. The representation of the feeding-health-production complex is aimed to be sufficiently detailed, to include relationships likely to cause significant herd effects, and to be sufficiently simple to enable a feasible parameterization of the model and interpretation of the results from the model. Consequently, diseases are defined as four disease types: two metabolic disease types, an udder disease type, and a reproductive disease type. Risk factors for the diseases were defined as parity, yield capacity, disease recurrence, disease interrelationships, lactation stage, and season. Direct effects of the diseases were defined according to milk yield, feed intake, feed utilization, conception, culling, involuntary removal, and death. Scenarios differing in base risks of milk fever and ketosis, heat detection rate, and culling strategy were simulated for describing the model behavior. Annual milk yield per cow was decreased by increased risk of ketosis and by increased risk of milk fever, even though no direct effect of milk fever on milk yield was modeled at the cow level. The indirect effect from milk fever is a consequence of increased replacement rate (relatively lower milk yield from younger cows). By ignoring the history of milk fever in insemination and replacement decisions, a significantly reduced net income per cow was found in some herds. We concluded that important benefits from using such a herd model are the capability of accounting for herd management factors and the advantage of avoiding to double count the indirect effects from disease, such as increased risk of other diseases, poorer reproduction results, and increased risk of

  3. Addressivity in cogenerative dialogues

    Hsu, Pei-Ling

    2014-03-01

    Ashraf Shady's paper provides a first-hand reflection on how a foreign teacher used cogens as culturally adaptive pedagogy to address cultural misalignments with students. In this paper, Shady drew on several cogen sessions to showcase his journey of using different forms of cogens with his students. To improve the quality of cogens, one strategy he used was to adjust the number of participants in cogens. As a result, some cogens worked and others did not. During the course of reading his paper, I was impressed by his creative and flexible use of cogens and at the same time was intrigued by the question of why some cogens work and not others. In searching for an answer, I found that Mikhail Bakhtin's dialogism, especially the concept of addressivity, provides a comprehensive framework to address this question. In this commentary, I reanalyze the cogen episodes described in Shady's paper in the light of dialogism. My analysis suggests that addressivity plays an important role in mediating the success of cogens. Cogens with high addressivity function as internally persuasive discourse that allows diverse consciousnesses to coexist and so likely affords productive dialogues. The implications of addressivity in teaching and learning are further discussed.

  4. Continuity of care for children with complex chronic health conditions: parents' perspectives

    Shaw Nicola

    2009-12-01

    Full Text Available Abstract Background Continuity of care has been explored largely from academic and service provider perspectives, and in relation to adult patient/client groups. We interviewed parents of children with complex chronic health conditions to examine how their experiences and perceptions of continuity of care fit with these perspectives; and to identify the salient factors in the experience of, and factors contributing to, continuity in this population. Methods Parents of 47 elementary school-aged children with spina bifida, Down syndrome, attention-deficit/hyperactivity disorder, Duchenne muscular dystrophy or cystic fibrosis participated in semi-structured interviews. Parents described and mapped the pattern of their interactions with service providers over time in all domains relevant to their child's health, well-being, and development (medical, rehabilitational, educational, and social supportive services, with particular attention paid to their perceptions of connectedness or coherency in these interactions. Verbatim transcripts were analyzed thematically using a framework approach to impose structure regarding parents' perspectives on continuity of care. Results Existing academic concepts of relational, informational and management continuity were all discernable in parents' narratives. A thorough knowledge of the child on the part of service providers emerged as extremely important to parents; such knowledge was underpinned by continuity of personal relationships, principally, and also by written information. For this population, notions of continuity extend to the full range of service providers these children and families need to achieve optimal health status, and are not limited to physicians and nurses. Communication among providers was seen as integral to perceived continuity. Compartmentalization of services and information led to parents assuming a necessary, though at times, uncomfortable, coordinating role. Geographic factors

  5. Genetic Association Analysis under Complex Survey Sampling: The Hispanic Community Health Study/Study of Latinos

    Lin, Dan-Yu; Tao, Ran; Kalsbeek, William D.; Zeng, Donglin; Gonzalez, Franklyn; Fernández-Rhodes, Lindsay; Graff, Mariaelisa; Koch, Gary G.; North, Kari E.; Heiss, Gerardo

    2014-01-01

    The cohort design allows investigators to explore the genetic basis of a variety of diseases and traits in a single study while avoiding major weaknesses of the case-control design. Most cohort studies employ multistage cluster sampling with unequal probabilities to conveniently select participants with desired characteristics, and participants from different clusters might be genetically related. Analysis that ignores the complex sampling design can yield biased estimation of the genetic association and inflation of the type I error. Herein, we develop weighted estimators that reflect unequal selection probabilities and differential nonresponse rates, and we derive variance estimators that properly account for the sampling design and the potential relatedness of participants in different sampling units. We compare, both analytically and numerically, the performance of the proposed weighted estimators with unweighted estimators that disregard the sampling design. We demonstrate the usefulness of the proposed methods through analysis of MetaboChip data in the Hispanic Community Health Study/Study of Latinos, which is the largest health study of the Hispanic/Latino population in the United States aimed at identifying risk factors for various diseases and determining the role of genes and environment in the occurrence of diseases. We provide guidelines on the use of weighted and unweighted estimators, as well as the relevant software. PMID:25480034

  6. State of industry, environment, human resources addressed

    Yergin, D.; Brookes, W.; DeArment, R.

    1991-07-01

    The article is based on three addresses to the AMC Coal Convention '91. Yergin examines the impact of the Gulf crisis on the world energy market. Brookes is sceptical about the 'green industry' and calls for better scientific evidence. DeArment addresses the MSAA's Job Safety Analysis program and other health and safety matters.

  7. [Mental health in evacuees from the 3.11 complex disaster in Japan].

    Niwa, Shin-Ichi

    2014-01-01

    Two years after the "3.11" complex disaster--the Great East Japan Earthquake, the resulting tsunami, and the Fukushima nuclear power plant accident--that occurred on March 11, 2011, approximately 150,000 people were still living as evacuees, with approximately 50,000 evacuees living outside Fukushima Prefecture. In a survey conducted by the Asahi Shimbun newspaper in February 2012, the top three sources of anxiety among evacuees were radiation contamination (mentioned by 56% of respondents), income (48%), and school attendance of children (21%). In June 2012, results from the Mental Health Survey, which was conducted as part of the Fukushima Health Management Survey, indicated that 14.8% of adult evacuees had K6 scores equal to or greater than the standard cut-off of 13, a much higher proportion than the 3% found in previous studies. In the same survey, 21.5% of child evacuees had SDQ scores equal to or greater than the standard cut-off of 16, whereas previous studies suggest a typical ratio of around 9.5%. It is natural for people to experience anxiety when facing radiation exposure, even at low levels. Here the important thing is to be "accurately" afraid: people should pay attention to scientific facts, and avoid danger appropriately, but not be unduly frightened. However, some people remain anxious even when objective radiation levels are low enough to not result in harm. A number of parents with young children decided to relocate outside of Fukushima Prefecture. In consideration of the desires of these parents to have areas where their children could play without being concerned about radiation, some municipalities constructed spacious indoor play facilities where parents have increased opportunities to communicate with each other, which actually leads to effective risk communication. Compared to the trajectory of mental health recovery after the 1995 Hanshin-Awaji Earthquake, recovery after the present disaster is delayed, particularly in Fukushima. In

  8. Phases of school health promotion implementation through the lens of complexity theory: lessons learnt from an Austrian case study.

    Kremser, W

    2011-06-01

    The implementation of health promotion concepts in (school) settings is a complex undertaking on which little scientific knowledge exists. The purpose of this study was to better understand organizational influences on the implementation of school health promotion. An extended case study design that incorporated important insights from complexity science was used. This design influenced the focus of analysis and led to the use of multiple methods of data collection and analysis. A primary school in Vienna served as a case for observing and analysing the first year of implementing the health-promoting school concept. The study provided detailed insights into the implementation process. Results showed four chronologically overlapping implementation phases (starting health promotion, deciding what to do, planning health promotion projects, doing health promotion) on different system levels. In each phase, the original health-promoting school concept was adapted to the necessities and characteristics of each level and, therefore, changed considerably. Implications for possible adaptations of the health-promoting school concept to better fit the situation in schools are discussed.

  9. Addressing inequities in healthy eating.

    Friel, Sharon; Hattersley, Libby; Ford, Laura; O'Rourke, Kerryn

    2015-09-01

    What, when, where and how much people eat is influenced by a complex mix of factors at societal, community and individual levels. These influences operate both directly through the food system and indirectly through political, economic, social and cultural pathways that cause social stratification and influence the quality of conditions in which people live their lives. These factors are the social determinants of inequities in healthy eating. This paper provides an overview of the current evidence base for addressing these determinants and for the promotion of equity in healthy eating.

  10. How to Relate Complex DNA Repair Genotypes to Pathway Function and, Ultimately, Health Risk

    Jones, IM

    2002-01-09

    Exposure to ionizing radiation increases the incidence of cancer. However, predicting which individuals are at most risk from radiation exposure is a distant goal. Predictive ability is needed to guide policies that regulate radiation exposure and ensure that medical treatments have maximum benefit and minimum risk. Differences between people in susceptibility to radiation are largely based on their genotype, the genes inherited from their parents. Among the important genes are those that produce proteins that repair DNA damaged by radiation. Base Excision Repair (BER) proteins repair single strand breaks and oxidized bases in DNA. Double Strand Break Repair proteins repair broken chromosomes. Using technologies and information from the Human Genome Project, we have previously determined that the DNA sequence of DNA repair genes varies within the human population. An average of 3-4 different variants were found that affect the protein for each of 37 genes studied. The average frequency of these variants is 5%. Given the many genes in each DNA repair pathway and their many variants, technical ability to determine an individual's repair genotype greatly exceeds ability to interpret the information. A long-term goal is to relate DNA repair genotypes to health risk from radiation. This study focused on the BER pathway. The BER genes are known, variants of the genes have been identified at LLNL, and LLNL had recently developed an assay for BER function using white blood cells. The goal of this initial effort was to begin developing data that could be used to test the hypothesis that many different genotypes have similar DNA repair capacity phenotypes (function). Relationships between genotype and phenotype could then be used to group genotypes with similar function and ultimately test the association of groups of genotypes with health risk from radiation. Genotypes with reduced repair function are expected to increase risk of radiation-induced health effects. The

  11. Addressing mathematics & statistics anxiety

    Kotecha, Meena

    2015-01-01

    This paper should be of interest to mathematics and statistics educators ranging from pre-university to university education sectors. It will discuss some features of the author’s teaching model developed over her longitudinal study conducted to understand and address mathematics and statistics anxiety, which is one of the main barriers to engaging with these subjects especially in non-specialist undergraduates. It will demonstrate how a range of formative assessments are used to kindle, as w...

  12. Addressing spiritual leadership: an organizational model.

    Burkhart, Lisa; Solari-Twadell, P Ann; Haas, Sheila

    2008-01-01

    The Joint Commission requires health systems to address spiritual care. Research indicates that spirituality is associated with better physical, psychological, and social health and that culturally diverse populations and individuals at end-of-life often request spiritual care. The authors report the results of a consensus conference of 21 executives representing 10 large faith-based health systems who discussed the input, process, and outcomes of a corporate model for spiritual leadership. Specific initiatives are highlighted.

  13. Moving beyond "good fat, bad fat": the complex roles of dietary lipids in cellular function and health: session abstracts.

    Abumrad, Nada A; Piomelli, Daniele; Yurko-Mauro, Karin; Merrill, Alfred; Clandinin, M Tom; Serhan, Charles N

    2012-01-01

    The International Life Science Institute North America and the American Society for Nutrition annual Functional Foods for Health Symposium was held 9 April 2011. Evidence that foods and their components offer health benefits beyond basic nutrition continues to captivate the interest of the scientific community, government agencies, and the general public. This paper is comprised of extended abstracts from the session and addresses issues related to emerging lipid nutrition science, including active roles of lipids in modulating physiological pathways. Identified pathways underlie the development of obesity, cognitive development, and inflammation, the latter of which is thought to relate to multiple disease processes. These data point to a new way of thinking about the role of lipids in health and disease.

  14. Bioreactors addressing diabetes mellitus.

    Minteer, Danielle M; Gerlach, Jorg C; Marra, Kacey G

    2014-11-01

    The concept of bioreactors in biochemical engineering is a well-established process; however, the idea of applying bioreactor technology to biomedical and tissue engineering issues is relatively novel and has been rapidly accepted as a culture model. Tissue engineers have developed and adapted various types of bioreactors in which to culture many different cell types and therapies addressing several diseases, including diabetes mellitus types 1 and 2. With a rising world of bioreactor development and an ever increasing diagnosis rate of diabetes, this review aims to highlight bioreactor history and emerging bioreactor technologies used for diabetes-related cell culture and therapies.

  15. Unravelling of the health effects of polyphenols is a complex puzzle complicated by metabolism

    Hollman, P.C.H.

    2014-01-01

    Plant metabolism creates complex mixtures of polyphenols in plant foods. Epidemiology and human trials reduced this complexity, by studying specific foods; subclasses of polyphenols; individual polyphenols, or total antioxidant capacity (TAC). This implies the following assumptions: (1) a limited nu

  16. The 'sialo-microbial-dental complex' in oral health and disease.

    Kaidonis, John; Townsend, Grant

    2016-01-01

    Biofilms are naturally found in all wet environments including the oral structures of nearly all species. Human oral biofilms have existed since our earliest ancestors and have evolved symbiotically with the dentition over many millennia within a Palaeolithic, hunter-gatherer setting. Irrespective of the plant-animal ratio, it can be argued that the Palaeolithic diet was essentially acidic, and acted as a selective force for much of the evolution of the stomatognathic system. The relationship between saliva, biofilm and teeth, the 'sialo-microbial-dental complex', provides oral health benefits and offers a different perspective to the old dental paradigm that only associated oral biofilms (plaque) with disease (caries). This new paradigm emphasises that oral biofilms are essential for the 'mineral maintenance' of teeth. Oral biofilms provide physical protection from dietary acid and together with bacterial metabolic acids cause the resting pH of the biofilm to fall below neutral. This is then followed by the re-establishment of a neutral environment by chemical interactions mediated by the saliva within the biofilm. Such pH fluctuations are often responsible for the cyclic demineralisation, then remineralisation of teeth, a process necessary for tooth maturation. However, since the advent of farming and especially since the industrial revolution, the increase in consumption of carbohydrates, refined sugars and acidic drinks has changed the ecology of biofilms. Biofilm biodiversity is significantly reduced together with a proliferation of acidogenic and aciduric organisms, tipping the balance of the 'demin-remin' cycle towards net mineral loss and hence caries. In addition, the consumption of acidic drinks in today's societies has removed the protective nature of the biofilm, leading to erosion. Erosion and caries are 'modern-day' diseases and reflect an imbalance within the oral biofilm resulting in the demineralisation of teeth.

  17. Engaging with complexity to improve the health of indigenous people: a call for the use of systems thinking to tackle health inequity.

    Hernández, Alison; Ruano, Ana Lorena; Marchal, Bruno; San Sebastián, Miguel; Flores, Walter

    2017-02-21

    The 400 million indigenous people worldwide represent a wealth of linguistic and cultural diversity, as well as traditional knowledge and sustainable practices that are invaluable resources for human development. However, indigenous people remain on the margins of society in high, middle and low-income countries, and they bear a disproportionate burden of poverty, disease, and mortality compared to the general population. These inequalities have persisted, and in some countries have even worsened, despite the overall improvements in health indicators in relation to the 15-year push to meet the Millennium Development Goals. As we enter the Sustainable Development Goals (SDGs) era, there is growing consensus that efforts to achieve Universal Health Coverage (UHC) and promote sustainable development should be guided by the moral imperative to improve equity. To achieve this, we need to move beyond the reductionist tendency to frame indigenous health as a problem of poor health indicators to be solved through targeted service delivery tactics and move towards holistic, integrated approaches that address the causes of inequalities both inside and outside the health sector. To meet the challenge of engaging with the conditions underlying inequalities and promoting transformational change, equity-oriented research and practice in the field of indigenous health requires: engaging power, context-adapted strategies to improve service delivery, and mobilizing networks of collective action. The application of systems thinking approaches offers a pathway for the evolution of equity-oriented research and practice in collaborative, politically informed and mutually enhancing efforts to understand and transform the systems that generate and reproduce inequities in indigenous health. These approaches hold the potential to strengthen practice through the development of more nuanced, context-sensitive strategies for redressing power imbalances, reshaping the service delivery

  18. [Improvement of a complex of sanitary and health-promoting measures in enterobiasis for children of pediatric institutions and schools].

    Chernyshenko, A I; Pliushcheva, G L; Romanenko, N A; Rodilina, V D; Leksikova, L V

    2003-01-01

    The use of an improved complex of sanitary and health-promoting measures for children from 2 schools revealed that their infestation with pinworms among first-eleventh-form pupils from a boarding school was 42.6%, the above measures covering simultaneously them all with their subsequent repetition every 6 months allowed all the children to be free from pinworms. At school 8, the random use of these measures could reduce pinworm infestation to 4% of the children covered with health-promoting measures.

  19. Effects of eHealth physical activity encouragement in adolescents with complex congenital heart disease

    Klausen, Susanne Hwiid; Andersen, Lars L; Søndergaard, Lars;

    2016-01-01

    OBJECTIVE: To assess benefit and harms of adding an eHealth intervention to health education and individual counseling in adolescents with congenital heart disease. DESIGN: Randomized clinical trial. SETTING: Denmark. PATIENTS: A total of 158 adolescents aged 13-16years with no physical activity......%) fulfilled the compliance criteria of using the eHealth application for at least 2 consecutive weeks. In the control group, 61 patients (79%) completed both exercise tests. Adjusted for baseline values, the difference between the intervention group and the control group in mean VO2 peak at 1year was -0.65ml......·kg(-1)·min(-1) (95% CI -2.66 to 1.36). Between-group differences at 1year in physical activity, generic health-related quality of life, and disease-specific quality of life were not statistically significant. CONCLUSIONS: Adding a tailored eHealth intervention to health education and individual...

  20. Complex evaluation of health status and life quality of employees occupied in mining and processing of hydrocarbon raw materials

    G.G. Gimranova

    2016-06-01

    Full Text Available A complex social-hygienic investigation for the assessment of health-related life quality and living standards among 1200 male workers occupied in mining and primary processing of hydrocarbon raw materials has been performed. The study included the method of the anonymous survey for the employee with using a questionnaire developed by WHO experts for the realization of Health, environment and social capital management in enterprises (HESME. The health risk factors’ prevalence associated with alcohol, smoking, low physical activity, poor nutrition, stress in the workplace has been established. The feeling of stress and nervousness is generated by the fear of dismissal (18 % of employees, conflicts with administration (4% and by financial problems. About 47% of persons are anxious about social and economic instability. Not more than 4% of employees consider that the health deterioration is directly related to harmful working conditions. The survey has revealed an inflated self-esteem regarding the health. Thus 59.00 % of employee considers their health status to be excellent or normal, while an objective assessment revealed only 29.7 % of healthy employee. Due to the employee’s opinion, the saving of health is conditioned by healthy lifestyle, but the practice of self-preservation behavior is poorly spread. Not more than 37 % of respondents follow the doctors’ recommendations. Among the positive process there are changes in dietary habits in everyday life, namely 60 % of the respondents have chosen the balanced diet. The obtained data regarding the quality and way of life of the employee, occupied in mining and processing of hydrocarbon raw materials, should be taken into consideration when developing complex social development programs on an enterprise.

  1. Exploring the Institutional Logics and Complexity of Health Management Information System Implementation

    2014-01-01

    List of papers (paper 2 is removed awaiting publishing) Paper 1: Asangansi, I. (2012). Understanding HMIS Implementation in a Developing Country Ministry of Health Context - an Institutional Logics Perspective. Online Journal of Public Health Informatics, 4(3). DOI: 10.5210/ojphi.v4i3.4302 Paper 2: Asangansi I (forthcoming). Is mHealth Disrupting the Status Quo? Evidence from Implementations Highlighting Network vs. Hierarchical Institutional Logics. Submitted December 2013 to Elec...

  2. [Health and work: the case of the gas emissions at the Industrial Complex of Mayagüez].

    Cruz Chaulissant, M

    1990-04-01

    This article describes the effects of gas emissions on the health of the workers (mostly women) of garment Industry at the Guanajibo Industrial Complex in Mayagüez. The persons affected show the following diseases and conditions: peripherial neuropathy, alteration of time and space orientation, damage to the pulmonary system and the respiratory tract, allergies, degenerative diseases, and even death. The agencies concerned have been negligent alleging that the problem is caused by stress of mass hysteria, this without performing the necessary studies. Having evaluated the problem, the Committee concludes that its roots are in the establishment in Puerto Rico of industries without considering the negative effects over health due to the contamination they generate, and which they do not control properly, all to maintain jobs that in the long run will not solve our problems, but will surely affect the health of the people.

  3. Relationship between women's characteristics and continuum of care for maternal health in Kenya: Complex survey analysis using structural equation modeling.

    Owili, Patrick Opiyo; Muga, Miriam Adoyo; Chou, Yiing-Jenq; Hsu, Yi-Hsin Elsa; Huang, Nicole; Chien, Li-Yin

    2016-08-11

    The objective of this study was to understand and estimate the complex relationships in the continuum of care for maternal health to provide information to improve maternal and newborn health outcomes. Women (n = 4,082) aged 15-49 years in the 2008/2009 Kenya Demographic and Health Survey data were used to explore the complex relationships in the continuum of care for maternal health (i.e., before, during, and after delivery) using structural equation modeling. Results showed that the use of antenatal care was significantly positively related to the use of delivery care (β = 0.06; adjusted odds ratio [AOR] = 1.06; 95% confidence interval [CI]: 1.02-1.10) but not postnatal care, while delivery care was associated with postnatal care (β = 0.68; AOR = 1.97; 95% CI: 1.75-2.22). Socioeconomic status was significantly related to all elements in the continuum of care for maternal health; barriers to delivery of care and personal characteristics were only associated with the use of delivery care (β = 0.34; AOR = 1.40; 95% CI: 1.30-1.52) and postnatal care (β = 0.03; AOR = 1.03; 95% CI: 1.01-1.05), respectively. The three periods of maternal health care were related to each other. Developing a referral system of continuity of care is critical in the Sustainable Development Goals era.

  4. Find Shortage Areas: HPSA & MUA/P by Address

    U.S. Department of Health & Human Services — The Find Shortage Areas: Health Professional Shortage Area (HPSA) and Medically Underserved Area/Population (MUA/P) by Address tool helps you determine if a specific...

  5. Library outreach: addressing Utah's "Digital Divide".

    McCloskey, K M

    2000-10-01

    A "Digital Divide" in information and technological literacy exists in Utah between small hospitals and clinics in rural areas and the larger health care institutions in the major urban area of the state. The goals of the outreach program of the Spencer S. Eccles Health Sciences Library at the University of Utah address solutions to this disparity in partnership with the National Network of Libraries of Medicine-- Midcontinental Region, the Utah Department of Health, and the Utah Area Health Education Centers. In a circuit-rider approach, an outreach librarian offers classes and demonstrations throughout the state that teach information-access skills to health professionals. Provision of traditional library services to unaffiliated health professionals is integrated into the library's daily workload as a component of the outreach program. The paper describes the history, methodology, administration, funding, impact, and results of the program.

  6. Assessing health care needs and clinical outcome with Urological case complexity : A study using INTERMED

    Herms, AMRD; Pinggera, GM; De Jonge, P; Strasser, H; Sollner, W

    2003-01-01

    Urinary tract symptoms and, particularly, urinary incontinence are often chronic and complex conditions that cause diagnosis, treatment, and management problems. In many cases, psychosocial factors contribute to the development of a chronic condition. The authors investigated whether INTERMED, an in

  7. Address Points, Addressing, Published in 2008, Taylor County.

    NSGIC GIS Inventory (aka Ramona) — This Address Points dataset, was produced all or in part from Orthoimagery information as of 2008. It is described as 'Addressing'. Data by this publisher are often...

  8. Accessible Modelling of Complexity in Health (AMoCH and associated data flows: asthma as an exemplar

    Harshana Liyanage

    2016-04-01

    Full Text Available Background Modelling is an important part of information science. Models are abstractions of reality. We use models in the following contexts: (1 to describe the data and information flows in clinical practice to information scientists, (2 to compare health systems and care pathways, (3 to understand how clinical cases are recorded in record systems and (4 to model health care business models. Asthma is an important condition associated with a substantial mortality and morbidity. However, there are difficulties in determining who has the condition, making both its incidence and prevalence uncertain. Objective To demonstrate an approach for modelling complexity in health using asthma prevalence and incidence as an exemplar. Method The four steps in our process are: 1. Drawing a rich picture, following Checkland’s soft systems methodology; 2. Constructing data flow diagrams (DFDs; 3. Creating Unified Modelling Language (UML use case diagrams to describe the interaction of the key actors with the system; 4. Activity diagrams, either UML activity diagram or business process modelling notation diagram. Results Our rich picture flagged the complexity of factors that might impact on asthma diagnosis. There was consensus that the principle issue was that there were undiagnosed and misdiagnosed cases as well as correctly diagnosed. Genetic predisposition to atopy; exposure to environmental triggers; impact of respiratory health on earnings or ability to attend education or participate in sport, charities, pressure groups and the pharmaceutical industry all increased the likelihood of a diagnosis of asthma. Stigma and some factors within the health system diminished the likelihood of a diagnosis. The DFDs and other elements focused on better case finding. Conclusions This approach flagged the factors that might impact on the reported prevalence or incidence of asthma. The models suggested that applying selection criteria may improve the specificity of

  9. Accessible Modelling of Complexity in Health (AMoCH) and associated data flows: asthma as an exemplar.

    Liyanage, Harshana; Luzi, Daniela; De Lusignan, Simon; Pecoraro, Fabrizio; McNulty, Richard; Tamburis, Oscar; Krause, Paul; Rigby, Michael; Blair, Mitch

    2016-04-18

    Background Modelling is an important part of information science. Models are abstractions of reality. We use models in the following contexts: (1) to describe the data and information flows in clinical practice to information scientists, (2) to compare health systems and care pathways, (3) to understand how clinical cases are recorded in record systems and (4) to model health care business models.Asthma is an important condition associated with a substantial mortality and morbidity. However, there are difficulties in determining who has the condition, making both its incidence and prevalence uncertain.Objective To demonstrate an approach for modelling complexity in health using asthma prevalence and incidence as an exemplar.Method The four steps in our process are:1. Drawing a rich picture, following Checkland's soft systems methodology;2. Constructing data flow diagrams (DFDs);3. Creating Unified Modelling Language (UML) use case diagrams to describe the interaction of the key actors with the system;4. Activity diagrams, either UML activity diagram or business process modelling notation diagram.Results Our rich picture flagged the complexity of factors that might impact on asthma diagnosis. There was consensus that the principle issue was that there were undiagnosed and misdiagnosed cases as well as correctly diagnosed. Genetic predisposition to atopy; exposure to environmental triggers; impact of respiratory health on earnings or ability to attend education or participate in sport, charities, pressure groups and the pharmaceutical industry all increased the likelihood of a diagnosis of asthma. Stigma and some factors within the health system diminished the likelihood of a diagnosis. The DFDs and other elements focused on better case finding.Conclusions This approach flagged the factors that might impact on the reported prevalence or incidence of asthma. The models suggested that applying selection criteria may improve the specificity of new or confirmed diagnosis.

  10. Addressing language barriers to healthcare in India.

    Narayan, Lalit

    2013-01-01

    In spite of a growing recognition of the importance of doctor-patient communication, the issue of language barriers to healthcare has received very little attention in India. The Indian population speaks over 22 major languages with English used as the lingua franca for biomedicine. Large-scale internal migration has meant that health workers are encountering increasing instances of language discordance within clinical settings. Research done predominantly in the West has shown language discordance to significantly affect access to care, cause problems of comprehension and adherence, and decrease the satisfaction and quality of care. Addressing language barriers to healthcare in India requires a stronger political commitment to providing non-discriminatory health services, especially to vulnerable groups such as illiterate migrant workers. Research will have to address three broad areas: the ways in which language barriers affect health and healthcare, the efficacy of interventions to overcome language barriers, and the costs of language barriers and efforts to overcome them. There is a need to address such barriers in health worker education and clinical practice. Proven strategies such as hiring multilingual healthcare workers, providing language training to health providers, employing in situ translators or using telephone interpretation services will have to be evaluated for their appropriateness to the Indian context. Internet-based initiatives, the proliferation of mobile phones and recent advances in machine translation promise to contribute to the solution.

  11. Understanding the Role of GPCR Heteroreceptor Complexes in Modulating the Brain Networks in Health and Disease

    Borroto-Escuela, Dasiel O.; Carlsson, Jens; Ambrogini, Patricia; Narváez, Manuel; Wydra, Karolina; Tarakanov, Alexander O.; Li, Xiang; Millón, Carmelo; Ferraro, Luca; Cuppini, Riccardo; Tanganelli, Sergio; Liu, Fang; Filip, Malgorzata; Diaz-Cabiale, Zaida; Fuxe, Kjell

    2017-01-01

    The introduction of allosteric receptor–receptor interactions in G protein-coupled receptor (GPCR) heteroreceptor complexes of the central nervous system (CNS) gave a new dimension to brain integration and neuropsychopharmacology. The molecular basis of learning and memory was proposed to be based on the reorganization of the homo- and heteroreceptor complexes in the postjunctional membrane of synapses. Long-term memory may be created by the transformation of parts of the heteroreceptor complexes into unique transcription factors which can lead to the formation of specific adapter proteins. The observation of the GPCR heterodimer network (GPCR-HetNet) indicated that the allosteric receptor–receptor interactions dramatically increase GPCR diversity and biased recognition and signaling leading to enhanced specificity in signaling. Dysfunction of the GPCR heteroreceptor complexes can lead to brain disease. The findings of serotonin (5-HT) hetero and isoreceptor complexes in the brain over the last decade give new targets for drug development in major depression. Neuromodulation of neuronal networks in depression via 5-HT, galanin peptides and zinc involve a number of GPCR heteroreceptor complexes in the raphe-hippocampal system: GalR1-5-HT1A, GalR1-5-HT1A-GPR39, GalR1-GalR2, and putative GalR1-GalR2-5-HT1A heteroreceptor complexes. The 5-HT1A receptor protomer remains a receptor enhancing antidepressant actions through its participation in hetero- and homoreceptor complexes listed above in balance with each other. In depression, neuromodulation of neuronal networks in the raphe-hippocampal system and the cortical regions via 5-HT and fibroblast growth factor 2 involves either FGFR1-5-HT1A heteroreceptor complexes or the 5-HT isoreceptor complexes such as 5-HT1A-5-HT7 and 5-HT1A-5-HT2A. Neuromodulation of neuronal networks in cocaine use disorder via dopamine (DA) and adenosine signals involve A2AR-D2R and A2AR-D2R-Sigma1R heteroreceptor complexes in the dorsal and

  12. Methods for Addressing Uncertainty and Variability to Characterize Potential Health Risk from Trichloroethylene-Contaminated Ground Water at Beale Air Force Base in California:Integration of Uncertainty and Variability in Pharmacokinetics and Dose-Response

    Bogen, K T

    2001-05-24

    Traditional estimates of health risk are typically inflated, particularly if cancer is the dominant endpoint and there is fundamental uncertainty as to mechanism(s) of action. Risk is more realistically characterized if it accounts for joint uncertainty and interindividual variability within a systematic probabilistic framework to integrate the joint effects on risk of distributed parameters of all (linear as well as nonlinear) risk-extrapolation models involved. Such a framework was used to characterize risks to potential future residents posed by trichloroethylene (TCE) in ground water at an inactive landfill site on Beale Air Force Base in California. Variability and uncertainty were addressed in exposure-route-specific estimates of applied dose, in pharmacokinetically based estimates of route-specific metabolized fractions of absorbed TCE, and in corresponding biologically effective doses estimated under a genotoxic/linear (MA{sub G}) vs. a cytotoxic/nonlinear (MA{sub c}) mechanistic assumption for TCE-induced cancer. Increased risk conditional on effective dose was estimated under MA{sub G} based on seven rodent-bioassay data sets, and under MA{sub c} based on mouse hepatotoxicity data. Mean and upper-bound estimates of combined risk calculated by the unified approach were <10{sup -6} and 10{sup -4}, respectively, while corresponding estimates based on traditional deterministic methods were >10{sup -5} and 10{sup -4}, respectively. It was estimated that no TCE-related harm is likely to occur due to any plausible residential exposure scenario involving the site. The systematic probabilistic framework illustrated is particularly suited to characterizing risks that involve uncertain and/or diverse mechanisms of action.

  13. Methods for Addressing Uncertainty and Variability to Characterize Potential Health Risk From Trichloroethylene-Contaminated Ground Water Beale Air Force Base in California: Integration of Uncertainty and Variability in Pharmacokinetics and Dose-Response

    Bogen, K.T.

    1999-09-29

    Traditional estimates of health risk are typically inflated, particularly if cancer is the dominant endpoint and there is fundamental uncertainty as to mechanism(s) of action. Risk is more realistically characterized if it accounts for joint uncertainty and interindividual variability after applying a unified probabilistic approach to the distributed parameters of all (linear as well as nonlinear) risk-extrapolation models involved. Such an approach was applied to characterize risks to potential future residents posed by trichloroethylene (TCE) in ground water at an inactive landfill site on Beale Air Force Base in California. Variability and uncertainty were addressed in exposure-route-specific estimates of applied dose, in pharmacokinetically based estimates of route-specific metabolized fractions of absorbed TCE, and in corresponding biologically effective doses estimated under a genotoxic/linear (MA{sub g}) vs. a cytotoxic/nonlinear (MA{sub c}) mechanistic assumption for TCE-induced cancer. Increased risk conditional on effective dose was estimated under MA{sub G} based on seven rodent-bioassay data sets, and under MA, based on mouse hepatotoxicity data. Mean and upper-bound estimates of combined risk calculated by the unified approach were <10{sup -6} and <10{sup -4}, respectively, while corresponding estimates based on traditional deterministic methods were >10{sup -5} and >10{sup -4}, respectively. It was estimated that no TCE-related harm is likely occur due any plausible residential exposure scenario involving the site. The unified approach illustrated is particularly suited to characterizing risks that involve uncertain and/or diverse mechanisms of action.

  14. "It's not all in my head!" - The complex relationship between rare diseases and mental health problems.

    Nunn, Rebecca

    2017-02-27

    The incidence of mental health disorders is significantly higher in individuals with a rare disease, compared to the general population. This letter considers the possible reasons for this in terms of the many ways in which a rare disease impacts on an individual's life, and how these impacts can be strongly related to factors which predispose to mental health difficulties.Furthermore, issues surrounding mental health can also play a significant role in the process of diagnosing a rare disease. The unusual nature of such diseases intrinsically predisposes an individual to obtain an inaccurate diagnosis of a psychosomatic disorder, a diagnosis which can often be further complicated by the presence of genuine psychiatric symptoms.This letter argues that these common experiences of rare disease patients have impacts upon the way in which their psychiatric care should be offered and managed, and that sensitivity and understanding surrounding these issues should be considered a necessary part of effective care for rare disease patients.

  15. Framework for Smart Electronic Health Record- Linked Predictive Models to Optimize Care for Complex Digestive Diseases

    2015-03-01

    AD______________ AWARD NUMBER: W81XWH-11-2-0167 TITLE: Framework for Smart Electronic Health Record- Linked Predictive Models to Optimize Care...focuses on providing users with an intelligent workspace , by displaying annotation forms and de-identified reports with the same view, automatic report

  16. Alex in the Middle: Inclusion of a Child with Severe Disabilities and Complex Health Needs.

    Bruns, Deborah A.

    This case study describes the 2-year process of moving a young child with severe disabilities and complex medical needs from a special school setting to a special class in a regular education setting. The child had Marshall-Smith Syndrome, characterized by respiratory, pulmonary, and skeletal abnormalities, and developmental delays due to the…

  17. [Effect of auto-road complex in the city of Surgut on air pollution and population health].

    Vinokurova, M V; Vinokurov, M V; Voronin, S A

    2015-01-01

    Currently, due to the increase in motorization, the problem of environmental pollution by emissions of objects of auto-road complex is becoming more and more important not only for cities, butfor dynamically developing regional cities. The negative impact is characterized by the increase of the morbidity rate of environmentally-dependent diseases, primarily respiratory diseases, neoplasms. This exposure is most pronounced near the motorways, at the gas station, and also spreads to residential areas, which requires the optimization of protective and preventive measures. Presented article is devoted to the characterization of air pollution of various areas in the city of Surgut due to emission of sources of auto-road complex with the assessment of public health risks.

  18. Addressing techniques of liquid crystal displays

    Ruckmongathan, Temkar N

    2014-01-01

    Unique reference source that can be used from the beginning to end of a design project to aid choosing an appropriate LCD addressing technique for a given application This book will be aimed at design engineers who are likely to embed LCD drivers and controllers in many systems including systems on chip. Such designers face the challenge of making the right choice of an addressing technique that will serve them with best performance at minimal cost and complexity. Readers will be able to learn about various methods available for driving matrix LCDs and the comparisons at the end of each chap

  19. Influences on the implementation of TQM in health care organizations: professional bureaucracies, ownership and complexity.

    Badrick, T; Preston, A

    2001-01-01

    TQM is introduced into many organisations in an attempt to improve productivity and quality. There are a number of organisational variables that have been recognised as influencing the success of TQM implementation including leadership, teamwork, and suppliers. This paper presents findings of a study of the implementation of TQM in Australian health care organisations. Structural factors were observed to affect the progress of TQM. Professional bureaucracies were less successful than machine bureaucracies. Private organisations were more successful than their public counterparts.

  20. Risk managment of complex aquifers contaminated by chemical mixtures : numerical tools and human health risk assessment

    Henri, Christopher

    2015-01-01

    Human impact on groundwater resources has led to a rapid growth of social concerns worldwide owing to an increasing presence of toxic chemicals released in the subsurface. Risk assessment provides the scientific tool needed to quantify the actual thread that these potential hazards pose to human health. Specifically, risk analysis enables decision makers to answer: What can happen? How likely is it to happen? What can be the consequences? Risk assessment is in this context essential. However,...

  1. Three Essays on Modeling Complex Dynamic Problems in Health and Safety

    Hu, Kun

    2011-01-01

    Essay #1 â Factors influencing the risk of falls in the construction industry: a review of the evidence Falls are a significant public health risk and a leading cause of nonfatal and fatal injuries among construction workers worldwide. A more comprehensive understanding of casual factors leading to fall incidents is essential to prevent falls in the construction industry. However, an extensive overview of causal factors is missing from the literature. In this paper, 536 articles on fact...

  2. Multi-Agent-Based Simulation of a Complex Ecosystem of Mental Health Care.

    Kalton, Alan; Falconer, Erin; Docherty, John; Alevras, Dimitris; Brann, David; Johnson, Kyle

    2016-02-01

    This paper discusses the creation of an Agent-Based Simulation that modeled the introduction of care coordination capabilities into a complex system of care for patients with Serious and Persistent Mental Illness. The model describes the engagement between patients and the medical, social and criminal justice services they interact with in a complex ecosystem of care. We outline the challenges involved in developing the model, including process mapping and the collection and synthesis of data to support parametric estimates, and describe the controls built into the model to support analysis of potential changes to the system. We also describe the approach taken to calibrate the model to an observable level of system performance. Preliminary results from application of the simulation are provided to demonstrate how it can provide insights into potential improvements deriving from introduction of care coordination technology.

  3. Nomenclatural instability in the venomous snakes of the Bothrops complex: Implications in toxinology and public health.

    Carrasco, Paola Andrea; Venegas, Pablo Javier; Chaparro, Juan Carlos; Scrocchi, Gustavo José

    2016-09-01

    Since nomenclature is intended to reflect the evolutionary history of organisms, advances in our understanding of historical relationships may lead to changes in classification, and thus potentially in taxonomic instability. An unstable nomenclature for medically important animals like venomous snakes is of concern, and its implications in venom/antivenom research and snakebite treatment have been extensively discussed since the 90´s. The taxonomy of the pitvipers of the Bothrops complex has been historically problematic and different genus-level rearrangements were proposed to rectify the long-standing paraphyly of the group. Here we review the toxinological literature on the Bothrops complex to estimate the impact of recent proposals of classification in non-systematic research. This assessment revealed moderate levels of nomenclatural instability in the last five years, and the recurrence of some practices discussed in previous studies regarding the use of classifications and the information provided about the origin of venom samples. We briefly comment on a few examples and the implications of different proposals of classifications for the Bothrops complex. The aim of this review is to contribute to the reduction of adverse effects of current taxonomic instability in a group of medical importance in the Americas.

  4. Unravelling of the health effects of polyphenols is a complex puzzle complicated by metabolism.

    Hollman, Peter C H

    2014-10-01

    Plant metabolism creates complex mixtures of polyphenols in plant foods. Epidemiology and human trials reduced this complexity, by studying specific foods; subclasses of polyphenols; individual polyphenols, or total antioxidant capacity (TAC). This implies the following assumptions: (1) a limited number of potent polyphenols exists; (2) well-defined natural potent mixtures of polyphenols exist; (3) polyphenols share a common biological activity (e.g. antioxidant activity). To find potent polyphenols (1st assumption), in vitro screening has been widely applied, but most published results are of limited use because metabolism, changing biological activity profoundly, has frequently not been considered. The abundant anecdotal evidence for natural potent mixtures of polyphenols (2nd assumption) on the internet is very hard to verify. Additionally, cross-cultural studies have revealed the potency of e.g. cocoa. Polyphenols share the antioxidant phenolic group which inspired researchers to measure their antioxidant activity, thus greatly reducing complexity (3rd assumption). Unfortunately, the elegant antioxidant hypothesis has to be rejected, because poor absorption and extensive metabolism annihilate any contribution to the endogenous body antioxidants. In conclusion, the above assumptions are hard to verify, and no quick answers are to be expected. Future research should focus on structure-activity relations at nanomolar levels and explore metabolomics.

  5. Anonymous-address-resolution model

    Guang-jia SONG; Zhen-zhou JI

    2016-01-01

    Address-resolution protocol (ARP) is an important protocol of data link layers that aims to obtain the corresponding relationship between Internet Protocol (IP) and Media Access Control (MAC) addresses. Traditional ARPs (address-resolution and neighbor-discovery protocols) do not consider the existence of malicious nodes, which reveals destination addresses in the resolution process. Thus, these traditional protocols allow malicious nodes to easily carry out attacks, such as man-in-the-middle attack and denial-of-service attack. To overcome these weaknesses, we propose an anonymous-address-resolution (AS-AR) protocol. AS-AR does not publicize the destination address in the address-resolution process and hides the IP and MAC addresses of the source node. The malicious node cannot obtain the addresses of the destination and the node which initiates the address resolution; thus, it cannot attack. Analyses and experiments show that AS-AR has a higher security level than existing security methods, such as secure-neighbor discovery.

  6. Physical rehabilitation in complex therapy of the ureter stones patients in the Truskavets health resort area

    Shologon R.P.

    2010-05-01

    Full Text Available Efficiency of rehabilitation measures is considered in complex therapy with the use of differentiated methods of medical physical education for patients with stones of ureter. Under a supervision there was 143 patients. 93 patients were made basic group, 50 patients - control. From them 51 (56 % are men and 42 (54% are women. Age of patients made from 20 to 60 years. A sanatorium-resort rehabilitation is recommended with the use of the differentiated methods of medical gymnastics. Application of method improved the indexes of the functional state of buds and overhead urinary ways. Frequency of advancement and output of concrements is also megascopic.

  7. Preparing national health systems to cope with the impending tsunami of ageing and its associated complexities: Towards more sustainable health care.

    Amalberti, René; Nicklin, Wendy; Braithwaite, Jeffrey

    2016-06-01

    Healthcare systems across the world are experiencing increased financial, organizational and social pressures attributable to a range of critical issues including the challenge of ageing populations. Health systems need to adapt, in order to sustainably provide quality care to the widest range of patients, particularly those with chronic and complex diseases, and especially those in vulnerable and low-income groups. We report on a workshop designed to tackle such issues under the auspices of ISQua, with representatives from Argentina, Australia, Canada, Columbia, Denmark, Emirates, France, Ireland, Jordan, Qatar, Malaysia, Norway, Oman, UK, South Africa and Switzerland. We discuss some of the challenges facing healthcare systems in countries ageing rapidly, to those less so, and touch on current and future reform options.

  8. CONTENT-ADDRESSABLE MEMORY SYSTEMS,

    The utility of content -addressable memories (CAM’s) within a general purpose computing system is investigated. Word cells within CAM may be...addressed by the character of all or a part of cell contents . Multimembered sets of word cells may be addressed simultaneously. The distributed logical...capabilities of CAM are extended to allow simultaneous transformation of multimembered sets and to allow communication between neighboring word cells. A

  9. Speed kills: the complex links between transport, lack of time and urban health.

    Tranter, Paul Joseph

    2010-03-01

    Road safety experts understand the contribution of speed to the severity and frequency of road crashes. Yet, the impact of speed on health is far more subtle and pervasive than simply its effect on road safety. The emphasis in urban areas on increasing the speed and volume of car traffic contributes to ill-health through its impacts on local air pollution, greenhouse gas production, inactivity, obesity and social isolation. In addition to these impacts, a heavy reliance on cars as a supposedly 'fast' mode of transport consumes more time and money than a reliance on supposedly slower modes of transport (walking, cycling and public transport). Lack of time is a major reason why people do not engage in healthy behaviours. Using the concept of 'effective speed', this paper demonstrates that any attempt to 'save time' through increasing the speed of motorists is ultimately futile. Paradoxically, if planners wish to provide urban residents with more time for healthy behaviours (such as exercise and preparing healthy food), then, support for the 'slower' active modes of transport should be encouraged.

  10. A knowledge-based agent prototype for Chinese address geocoding

    Wei, Ran; Zhang, Xuehu; Ding, Linfang; Ma, Haoming; Li, Qi

    2009-10-01

    Chinese address geocoding is a difficult problem to deal with due to intrinsic complexities in Chinese address systems and a lack of standards in address assignments and usages. In order to improve existing address geocoding algorithm, a spatial knowledge-based agent prototype aimed at validating address geocoding results is built to determine the spatial accuracies as well as matching confidence. A portion of human's knowledge of judging the spatial closeness of two addresses is represented via first order logic and the corresponding algorithms are implemented with the Prolog language. Preliminary tests conducted using addresses matching result in Beijing area showed that the prototype can successfully assess the spatial closeness between the matching address and the query address with 97% accuracy.

  11. Reclaiming unused IPv4 addresses

    IT Department

    2016-01-01

    As many people might know, the number of IPv4 addresses is limited and almost all have been allocated (see here and here for more information).   Although CERN has been allocated some 340,000 addresses, the way these are allocated across the site is not as efficient as we would like. As we face an increasing demand for IPv4 addresses with the growth in virtual machines, the IT Department’s Communication Systems Group will be reorganising address allocation during 2016 to make more efficient use of the IPv4 address ranges that have been allocated to CERN. We aim, wherever possible, to avoid giving out fixed IP addresses, and have all devices connected to the campus network obtain an address dynamically each time they connect. As a first stage, starting in February, IP addresses that have not been used for more than 9 months will be reclaimed. No information about the devices concerned will be deleted from LANDB, but a new IP address will have to be requested if they are ever reconnected to t...

  12. 2015 ASHG Awards and Addresses

    2016-01-01

    Each year at the annual meeting of The American Society of Human Genetics (ASHG), addresses are given in honor of The Society and a number of award winners. A summary of each of these is given below. On the following pages, we have printed the presidential address and the addresses for the William Allan Award, the Curt Stern Award, and the Victor A. McKusick Leadership Award. Webcasts of these addresses, as well as those of many other presentations, can be found at http://www.ashg.org.

  13. Commentary on "Health care organizations as complex systems: new perspectives on design and management" by Reuben R. McDaniel, Dean J. Driebe, and Holly Jordan Lanham.

    Anderson, Ruth A

    2013-01-01

    In this commentary, I highlight a few of the assertions made by McDaniel et al. (2013) about the importance of complexity science guided management practices, and extend these ideas specifically to how we might think about reducing seemingly intractable problems in health care such as patient safety, patient falls, hospital acquired infection, and the rise of chronic illness and obesity. I suggest that such changes will require managers and providers to view health care organizations and patients as complex adaptive systems and include patients as full participants in co-producing their health care.

  14. Occupational risks for health of the workers of the chemical complex

    E.T. Valeyeva

    2016-09-01

    Full Text Available The article summarizes the materials of long-term studies to assess the working conditions, state of health in workers of the chemical industry - mainly manufacturers of ethylbenzene, styrene, olefin oxides, rocket fuel. It was found that the most adverse working conditions are typical for the production of heptyl, rubber and fiberglass. The causal relationships of working conditions in the form of an increased incidence of early (pre-clinical stages of occupational diseases, as well as major chronic non-communicable diseases, are identified. It is shown that depending on the tropism, mechanism of action and intensity of the chemical factor a clear staging of the development of pathological changes in the body is recorded. A very high degree of professional conditionality of early toxic hepatitis stages (biliary dyskinesia in a heptyl production operator was determined, as well as initial manifestations of autonomic-sensory polyneuropathy in hands of the workers splicing rubber products, specific changes of the hand skin in glass production operators. Production-related diseases with a high degree of conditionality in certain categories of workers include diseases of the musculoskeletal system; hypertension had an average degree of conditionality. During in-depth medical examination of 2411 workers it was found that the largest number of healthy individuals were identified in the bulk manufacture of ethylbenzene – styrene (54.7 %, and olefin oxide (35,0 % of the number of inspected workers, the least number (12 % – in the manufacture of rubber products. The remaining workers demonstrated the pathology of various organs and systems. Based on the results of risk assessment and professional damage to the workers’ health the chemical productions are ranked according to their degree of danger, a system of preventive measures and risk management principles has been developed. The programme implementation resulted in the positive effect of more

  15. Identifying and Promoting Best Practices in Residency Application and Selection in a Complex Academic Health Network.

    Bandiera, Glen; Abrahams, Caroline; Ruetalo, Mariela; Hanson, Mark D; Nickell, Leslie; Spadafora, Salvatore

    2015-12-01

    Medical education institutions have a social mandate to produce a diverse physician workforce that meets the public's needs. Recent reports have framed the admission process outcome of undergraduate and postgraduate medical education (UGME and PGME) programs as a key determinant of the collective contributions graduating cohorts will make to society, creating a sense of urgency around the issue of who gets accepted. The need for evidence-informed residency application and selection processes is growing because of the increasing size and diversity of the applicant pool and the need for equity, fairness, social accountability, and health human resource planning. The selection literature, however, is dominated by a UGME focus and emphasizes determination of desirable qualities of future physicians and selection instrument reliability and validity. Gaps remain regarding PGME selection, particularly the creation of specialty-specific selection criteria, suitable outcome measures, and reliable selection systems.In this Perspective, the authors describe the University of Toronto's centralized approach to defining system-level best practices for residency application and selection. Over the 2012-2013 academic year, the Best Practices in Application and Selection working group reviewed relevant literature and reports, consulted content experts, surveyed local practices, and conducted iterative stakeholder consultations on draft recommendations. Strong agreement arose around the resulting 13 principles and 24 best practices, which had either empirical support or face validity. These recommendations, which are shared in this article, have been adopted by the university's PGME advisory committee and will inform a national initiative to improve trainees' transition from UGME to PGME in Canada.

  16. Complexity index from a personalized wearable monitoring system for assessing remission in mental health.

    Lanata, Antonio; Valenza, Gaetano; Nardelli, Mimma; Gentili, Claudio; Scilingo, Enzo Pasquale

    2015-01-01

    This study discusses a personalized wearable monitoring system, which provides information and communication technologies to patients with mental disorders and physicians managing such diseases. The system, hereinafter called the PSYCHE system, is mainly comprised of a comfortable t-shirt with embedded sensors, such as textile electrodes, to monitor electrocardiogram-heart rate variability (HRV) series, piezoresistive sensors for respiration activity, and triaxial accelerometers for activity recognition. Moreover, on the patient-side, the PSYCHE system uses a smartphone-based interactive platform for electronic mood agenda and clinical scale administration, whereas on the physician-side provides data visualization and support to clinical decision. The smartphone collects the physiological and behavioral data and sends the information out to a centralized server for further processing. In this study, we present experimental results gathered from ten bipolar patients, wearing the PSYCHE system, with severe symptoms who exhibited mood states among depression (DP), hypomania(HM), mixed state (MX), and euthymia (EU), i.e., the good affective balance. In analyzing more than 400 h of cardiovascular dynamics, we found that patients experiencing mood transitions from a pathological mood state (HM, DP, or MX-where depressive and hypomanic symptoms are simultaneously present) to EU can be characterized through a commonly used measure of entropy. In particular, the SampEn estimated on long-term HRV series increases according to the patients' clinical improvement. These results are in agreement with the current literature reporting on the complexity dynamics of physiological systems and provides a promising and viable support to clinical decision in order to improve the diagnosis and management of psychiatric disorders.

  17. Partnership work between Public Health and Health Psychology: introduction to a novel training programme

    Robinson Clare

    2010-11-01

    Full Text Available Abstract Background Public health services implement individual, community and population level interventions to change health behaviours, improve healthy life expectancy and reduce health inequalities. Understanding and changing health behaviour is complex. Integrating behaviour change theory and evidence into interventions has the potential to improve services. Methods Health Psychologists apply evidence and theories aimed at understanding and changing health behaviour. A Scottish programme is piloting the training of Health Psychologists within NHS contexts to address prominent public health challenges. Results This article outlines the details of this novel programme. Two projects are examined to illustrate the potential of partnership working between public health and health psychology. Conclusion In order to develop and improve behaviour change interventions and services, public health planners may want to consider developing and using the knowledge and skills of Health Psychologists. Supporting such training within public health contexts is a promising avenue to build critical NHS internal mass to tackle the major public health challenges ahead.

  18. Mass Drug Administration and beyond: how can we strengthen health systems to deliver complex interventions to eliminate neglected tropical diseases?

    2015-01-01

    Achieving the 2020 goals for Neglected Tropical Diseases (NTDs) requires scale-up of Mass Drug Administration (MDA) which will require long-term commitment of national and global financing partners, strengthening national capacity and, at the community level, systems to monitor and evaluate activities and impact. For some settings and diseases, MDA is not appropriate and alternative interventions are required. Operational research is necessary to identify how existing MDA networks can deliver this more complex range of interventions equitably. The final stages of the different global programmes to eliminate NTDs require eliminating foci of transmission which are likely to persist in complex and remote rural settings. Operational research is required to identify how current tools and practices might be adapted to locate and eliminate these hard-to-reach foci. Chronic disabilities caused by NTDs will persist after transmission of pathogens ceases. Development and delivery of sustainable services to reduce the NTD-related disability is an urgent public health priority. LSTM and its partners are world leaders in developing and delivering interventions to control vector-borne NTDs and malaria, particularly in hard-to-reach settings in Africa. Our experience, partnerships and research capacity allows us to serve as a hub for developing, supporting, monitoring and evaluating global programmes to eliminate NTDs.

  19. "Fighting the system": Families caring for ventilator-dependent children and adults with complex health care needs at home

    Nielsen Erik W

    2011-07-01

    Full Text Available Abstract Background An increasing number of individuals with complex health care needs now receive life-long and life-prolonging ventilatory support at home. Family members often take on the role of primary caregivers. The aim of this study was to explore the experiences of families giving advanced care to family members dependent on home mechanical ventilation. Methods Using qualitative research methods, a Grounded Theory influenced approach was used to explore the families' experiences. A total of 15 family members with 11 ventilator-dependent individuals (three children and eight adults were recruited for 10 in-depth interviews. Results The core category, "fighting the system," became the central theme as family members were asked to describe their experiences. In addition, we identified three subcategories, "lack of competence and continuity", "being indispensable" and "worth fighting for". This study revealed no major differences in the families' experiences that were dependent on whether the ventilator-dependent individual was a child or an adult. Conclusions These findings show that there is a large gap between family members' expectations and what the community health care services are able to provide, even when almost unlimited resources are available. A number of measures are needed to reduce the burden on these family members and to make hospital care at home possible. In the future, the gap between what the health care can potentially provide and what they can provide in real life will rapidly increase. New proposals to limit the extremely costly provision of home mechanical ventilation in Norway will trigger new ethical dilemmas that should be studied further.

  20. Why performance-based contracting failed in Uganda--an "open-box" evaluation of a complex health system intervention.

    Ssengooba, Freddie; McPake, Barbara; Palmer, Natasha

    2012-07-01

    Performance-based contracting (PBC) is a tool that links rewards to attainment of measurable performance targets. Significant problems remain in the methods used to evaluate this tool. The primary focus of evaluations on the effects of PBC (black-box) and less attention to how these effects arise (open-box) generates suboptimal policy learning. A black-box impact evaluation of PBC pilot by the Development Research Group of the World Bank (DRG) and the Ministry of Health (MOH) concluded that PBC was ineffective. This paper reports a theory-based case study intended to clarify how and why PBC failed to achieve its objectives. To explain the observed PBC implementation and responses of participants, this case study employed two related theories i.e. complex adaptive system and expectancy theory respectively. A prospective study trailed the implementation of PBC (2003-2006) while collecting experiences of participants at district and hospital levels. Significant problems were encountered in the implementation of PBC that reflected its inadequate design. As problems were encountered, hasty adaptations resulted in a de facto intervention distinct from the one implied at the design stage. For example, inadequate time was allowed for the selection of service targets by the health centres yet they got 'locked-in' to these poor choices. The learning curve and workload among performance auditors weakened the validity of audit results. Above all, financial shortfalls led to delays, short-cuts and uncertainty about the size and payment of bonuses. The lesson for those intending to implement similar interventions is that PBC should not be attempted 'on the cheap'. It requires a plan to boost local institutional and technical capacities of implementers. It also requires careful consideration of the responses of multiple actors - both insiders and outsiders to the intended change process. Given the costs and complexity of PBC implementation, strengthening conventional approaches

  1. Processo saúde/doença e complexidade em epidemiologia Health/disease process and complexity in epidemiology

    Fermin R. Schramm

    1992-12-01

    Full Text Available O emprego da idéia de complexidade em epidemiologia serve para assinalar as crises, tanto no domínio interno da disciplina - resultante de uma cada vez mais evidente limitação de seus instrumentos conceituais (modelos e teorias para lidar com a realidade concreta da saúde - como no domínio do contexto cultural (paradigmas, quadro epistêmico, Zeitgeist, Weltanschauung no qual os problemas de saúde estão inscritos. Apesar de ambas as abordagens serem pertinentes, sob a ótica do sistema e do ambiente, sua separação leva a uma apreensão restrita dos atuais desafios no campo sanitário, e, portanto, insuficiente para promover a saúde e o bem-estar de indivíduos, populações e biosfera. A idéia de complexidade propõe-se a ultrapassar esta precariedade, apontando o reducionismo das dicotomias oriundas da era moderna, que tende a não estar equipado para perceber o universo composto por relações e emergências de novas propriedades ao se transitar por níveis diferenciados de organização. Além disso, discute modos de encarar os processos que ocorrem entre os seres vivos de maneira a incluir dimensões dinâmicas, evolutivas e históricas. Assim, há indícios de crise da Epidemiologia que apontam para a necessidade da complexificação de seus instrumentos prático-discursivos, de forma a viabilizar construções mais satisfatórias do processo saúde-doença.The use of the idea of Complexity in Epidemiology is an approach to point out either an internal disciplinary crisis, resulting from shortcomings in its conceptual instruments (theories, models regarding health's concrete reality, or a crisis in terms of the broader cultural context (paradigms, epistemic framework, Zeitgeist, Weltanschauung in which health issues are necessarily inserted. Although those two approaches are pertinent from a systemic and environmental standpoint, their disjunction is insufficient in dealing with the main contemporary health challenges that

  2. Identifiable Data Files - Name and Address File and Vital...

    U.S. Department of Health & Human Services — The Names and Addresses File and the Vital Status File are subsets of the data elements in the Enrollment Database (EDB). The particular information in each file is...

  3. Library outreach: addressing Utah's “Digital Divide”

    McCloskey, Kathleen M.

    2000-01-01

    A “Digital Divide” in information and technological literacy exists in Utah between small hospitals and clinics in rural areas and the larger health care institutions in the major urban area of the state. The goals of the outreach program of the Spencer S. Eccles Health Sciences Library at the University of Utah address solutions to this disparity in partnership with the National Network of Libraries of Medicine—Midcontinental Region, the Utah Department of Health, and the Utah Area Health Ed...

  4. World Federation of Vascular Societies: presidential address

    Sillesen, Henrik Hegaard

    2010-01-01

    The presidential address describes briefly the history of the World Federation for Vascular Societies (WFVS) and its objectives. Vascular Surgery today includes interventional procedures (open surgical and endovascular) in addition to risk factor reduction and medical treatment. It is equally imp...... throughout the world. In addition, for introduction of new treatments, training issues and dissemination of science a global organisation like the WFVS is needed.......The presidential address describes briefly the history of the World Federation for Vascular Societies (WFVS) and its objectives. Vascular Surgery today includes interventional procedures (open surgical and endovascular) in addition to risk factor reduction and medical treatment. It is equally....... Similar, in order to be able to train with relevant case mix and numbers, and in order always to have both complex open and endovascular skills on call 24 hours per day, 365 days a year, centralisation into larger units is necessary. The WFVS is important simply looking at the huge demographic differences...

  5. The Value of Addressing Patient Preferences.

    Allen, Jeff D; Stewart, Mark D; Roberts, Samantha A; Sigal, Ellen V

    2017-02-01

    Recent scientific progress is, in some cases, leading to transformative new medicines for diseases that previously had marginal or even no treatment options. This offers great promise for people affected by these diseases, but it has also placed stress on the health care system in terms of the growing cost associated with some new interventions. Effort has been taken to create tools to help patients and health care providers assess the value of new medical innovations. These tools may also provide the basis for assessing the price associated with new medical products. Given the growing expenditures in health care, value frameworks present an opportunity to evaluate new therapeutic options in the context of other treatments and potentially lead to a more economically sustainable health care system. In summary, the contribution to meaningful improvements in health outcomes is the primary focus of any assessment of the value of a new intervention. A component of such evaluations, however, should factor in timely access to new products that address an unmet medical need, as well as the magnitude of that beneficial impact. To achieve these goals, value assessment tools should allow for flexibility in clinical end points and trial designs, incorporate patient preferences, and continually evolve as new evidence, practice patterns, and medical progress advance.

  6. Public Library Training Program for Older Adults Addresses Their Computer and Health Literacy Needs. A Review of: Xie, B. (2011. Improving older adults’ e-health literacy through computer training using NIH online resources. Library & Information Science Research, 34, 63-71. doi: /10.1016/j.lisr.2011.07.006

    Cari Merkley

    2012-12-01

    – Participants showed significant decreases in their levels of computer anxiety, and significant increases in their interest in computers at the end of the program (p>0.01. Computer and web knowledge also increased among those completing the knowledge tests. Most participants (78% indicated that something they had learned in the program impacted their health decision making, and just over half of respondents (55% changed how they took medication as a result of the program. Participants were also very satisfied with the program’s delivery and format, with 97% indicating that they had learned a lot from the course. Most (68% participants said that they wished the class had been longer, and there was full support for similar programming to be offered at public libraries. Participants also reported that they found the NIHSeniorHealth website more useful, but not significantly more usable, than MedlinePlus.Conclusion – The intervention as designed successfully addressed issues of computer and health literacy with older adult participants. By using existing resources, such as public library computer facilities and curricula developed by the National Institutes of Health, the intervention also provides a model that could be easily replicated in other locations without the need for significant financial resources.

  7. Is It More Important to Address the Issue of Patient Mobility or to Guarantee Universal Health Coverage in Europe?; Comment on “Regional Incentives and Patient Cross-Border Mobility: Evidence From the Italian Experience”

    Helena Legido-Quigley

    2016-01-01

    Full Text Available This paper discusses whether European institutions should devote so much attention and funding to cross-border healthcare or they should instead prioritise guaranteeing universal health coverage (UHC, inequalities and tackling the effects of austerity measures. The paper argues through providing the evidence in both areas of research, that the priority at European level from a public health and social justice perspective should be to guarantee UHC for all the population living in Europe and prioritise protective action for those who are most in need.

  8. Indigenous Child Health in Brazil

    del Pino Marchito, Sandra; Vitoy, Bernardino

    2016-01-01

    Abstract Improving the health status of indigenous children is a long-standing challenge. Several United Nations committees have identified the health of indigenous peoples as a human rights concern. Addressing the health of indigenous children cannot be separated from their social, cultural, and historic contexts, and any related health program must offer culturally appropriate services and a community perspective broad enough to address the needs of children and the local worlds in which they live. Evaluations of programs must, therefore, address process as well as impacts. This paper assesses interventions addressing indigenous children’s health in Brazil, ranging from those explicitly targeting indigenous children’s health, such as the targeted immunization program for indigenous peoples, as well as more generalized programs, including a focus upon indigenous children, such as the Integrated Management of Childhood Illness. The paper discusses the tensions and complexities of ethnically targeted health interventions as well as the conceptual and methodological challenge of measuring the processes employed and their impact. The lessons learned, especially the need for countries to more systematically collect data and evaluate impacts using ethnicity as an analytical category, are drawn out with respect to ensuring human rights for all within health sector responses.

  9. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan.

    Teede, H; Deeks, A; Moran, L

    2010-06-30

    Polycystic ovary syndrome (PCOS) is of clinical and public health importance as it is very common, affecting up to one in five women of reproductive age. It has significant and diverse clinical implications including reproductive (infertility, hyperandrogenism, hirsutism), metabolic (insulin resistance, impaired glucose tolerance, type 2 diabetes mellitus, adverse cardiovascular risk profiles) and psychological features (increased anxiety, depression and worsened quality of life). Polycystic ovary syndrome is a heterogeneous condition and, as such, clinical and research agendas are broad and involve many disciplines. The phenotype varies widely depending on life stage, genotype, ethnicity and environmental factors including lifestyle and bodyweight. Importantly, PCOS has unique interactions with the ever increasing obesity prevalence worldwide as obesity-induced insulin resistance significantly exacerbates all the features of PCOS. Furthermore, it has clinical implications across the lifespan and is relevant to related family members with an increased risk for metabolic conditions reported in first-degree relatives. Therapy should focus on both the short and long-term reproductive, metabolic and psychological features. Given the aetiological role of insulin resistance and the impact of obesity on both hyperinsulinaemia and hyperandrogenism, multidisciplinary lifestyle improvement aimed at normalising insulin resistance, improving androgen status and aiding weight management is recognised as a crucial initial treatment strategy. Modest weight loss of 5% to 10% of initial body weight has been demonstrated to improve many of the features of PCOS. Management should focus on support, education, addressing psychological factors and strongly emphasising healthy lifestyle with targeted medical therapy as required. Monitoring and management of long-term metabolic complications is also an important part of routine clinical care. Comprehensive evidence-based guidelines are

  10. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan

    Deeks A

    2010-06-01

    Full Text Available Abstract Polycystic ovary syndrome (PCOS is of clinical and public health importance as it is very common, affecting up to one in five women of reproductive age. It has significant and diverse clinical implications including reproductive (infertility, hyperandrogenism, hirsutism, metabolic (insulin resistance, impaired glucose tolerance, type 2 diabetes mellitus, adverse cardiovascular risk profiles and psychological features (increased anxiety, depression and worsened quality of life. Polycystic ovary syndrome is a heterogeneous condition and, as such, clinical and research agendas are broad and involve many disciplines. The phenotype varies widely depending on life stage, genotype, ethnicity and environmental factors including lifestyle and bodyweight. Importantly, PCOS has unique interactions with the ever increasing obesity prevalence worldwide as obesity-induced insulin resistance significantly exacerbates all the features of PCOS. Furthermore, it has clinical implications across the lifespan and is relevant to related family members with an increased risk for metabolic conditions reported in first-degree relatives. Therapy should focus on both the short and long-term reproductive, metabolic and psychological features. Given the aetiological role of insulin resistance and the impact of obesity on both hyperinsulinaemia and hyperandrogenism, multidisciplinary lifestyle improvement aimed at normalising insulin resistance, improving androgen status and aiding weight management is recognised as a crucial initial treatment strategy. Modest weight loss of 5% to 10% of initial body weight has been demonstrated to improve many of the features of PCOS. Management should focus on support, education, addressing psychological factors and strongly emphasising healthy lifestyle with targeted medical therapy as required. Monitoring and management of long-term metabolic complications is also an important part of routine clinical care. Comprehensive

  11. Introduction to IP address management

    Rooney, Tim

    2010-01-01

    "The book begins with a basic overview of IP networking, followed by chapters describing each of the three core IPAM technologies: IPv4 and IPv6 addressing, DHCP, and DNS. The next three chapters describe IPAM management techniques and practice, followed by chapters on IPv4-IPv6 co-existence, security and the IPAM business case"--

  12. Religion and health: public health research and practice.

    Chatters, L M

    2000-01-01

    Research examining the relationships between religion and the health of individuals and populations has become increasingly visible in the social, behavioral, and health sciences. Systematic programs of research investigate religious phenomena within the context of coherent theoretical and conceptual frameworks that describe the causes and consequences of religious involvement for health outcomes. Recent research has validated the multidimensional aspects of religious involvement and investigated how religious factors operate through various biobehavioral and psychosocial constructs to affect health status through proposed mechanisms that link religion and health. Methodological and analytical advances in the field permit the development of more complex models of religion's effects, in keeping with proposed theoretical explanations. Investigations of religion and health have ethical and practical implications that should be addressed by the lay public, health professionals, the research community, and the clergy. Future research directions point to promising new areas of investigation that could bridge the constructs of religion and health.

  13. Theories of how the school environment impacts on student health: systematic review and synthesis.

    Bonell, C P; Fletcher, A; Jamal, F; Wells, H; Harden, A; Murphy, S; Thomas, J

    2013-11-01

    Public-health interventions informed by theory can be more effective but complex interventions often use insufficiently complex theories. We systematically reviewed theories of how school environments influence health. We included 37 reports drawing on 24 theories. Narrative synthesis summarised and categorised theories. We then produced an integrated theory of school environment influences on student health. This integrated theory could inform complex interventions such as health promoting schools programmes. Using systematic reviews to develop theories of change might be useful for other types of 'complex' public-health interventions addressing risks at the individual and community levels.

  14. An Integrated Assessment Approach to Address Artisanal and Small-Scale Gold Mining in Ghana

    Niladri Basu

    2015-09-01

    Full Text Available Artisanal and small-scale gold mining (ASGM is growing in many regions of the world including Ghana. The problems in these communities are complex and multi-faceted. To help increase understanding of such problems, and to enable consensus-building and effective translation of scientific findings to stakeholders, help inform policies, and ultimately improve decision making, we utilized an Integrated Assessment approach to study artisanal and small-scale gold mining activities in Ghana. Though Integrated Assessments have been used in the fields of environmental science and sustainable development, their use in addressing specific matter in public health, and in particular, environmental and occupational health is quite limited despite their many benefits. The aim of the current paper was to describe specific activities undertaken and how they were organized, and the outputs and outcomes of our activity. In brief, three disciplinary workgroups (Natural Sciences, Human Health, Social Sciences and Economics were formed, with 26 researchers from a range of Ghanaian institutions plus international experts. The workgroups conducted activities in order to address the following question: What are the causes, consequences and correctives of small-scale gold mining in Ghana? More specifically: What alternatives are available in resource-limited settings in Ghana that allow for gold-mining to occur in a manner that maintains ecological health and human health without hindering near- and long-term economic prosperity? Several response options were identified and evaluated, and are currently being disseminated to various stakeholders within Ghana and internationally.

  15. An Integrated Assessment Approach to Address Artisanal and Small-Scale Gold Mining in Ghana

    Basu, Niladri; Renne, Elisha P.; Long, Rachel N.

    2015-01-01

    Artisanal and small-scale gold mining (ASGM) is growing in many regions of the world including Ghana. The problems in these communities are complex and multi-faceted. To help increase understanding of such problems, and to enable consensus-building and effective translation of scientific findings to stakeholders, help inform policies, and ultimately improve decision making, we utilized an Integrated Assessment approach to study artisanal and small-scale gold mining activities in Ghana. Though Integrated Assessments have been used in the fields of environmental science and sustainable development, their use in addressing specific matter in public health, and in particular, environmental and occupational health is quite limited despite their many benefits. The aim of the current paper was to describe specific activities undertaken and how they were organized, and the outputs and outcomes of our activity. In brief, three disciplinary workgroups (Natural Sciences, Human Health, Social Sciences and Economics) were formed, with 26 researchers from a range of Ghanaian institutions plus international experts. The workgroups conducted activities in order to address the following question: What are the causes, consequences and correctives of small-scale gold mining in Ghana? More specifically: What alternatives are available in resource-limited settings in Ghana that allow for gold-mining to occur in a manner that maintains ecological health and human health without hindering near- and long-term economic prosperity? Several response options were identified and evaluated, and are currently being disseminated to various stakeholders within Ghana and internationally. PMID:26393627

  16. Towards anti-oppressive practice in mental health nursing.

    Hopton, J

    Working in Partnership, the Department of Health's report on the 1994 review of mental health nursing, implies that mental health nurses should develop anti-oppressive approaches to nursing practice. There is a notable absence of articles within the nursing literature which specifically address this issue. This is possibly because the historical and ideological issues which have informed the development of mental health nursing are complex and difficult to unravel. However, an integration of the theories of David Cooper and Frantz Fanon may provide an appropriate starting point for the development of a theory of anti-oppressive practice which addresses some of the issues specific to mental health nursing.

  17. Addressing Parental Vaccination Questions in the School Setting

    Luthy, Karlen E.; Burningham, Jana; Eden, Lacey M.; Macintosh, Janelle L. B.; Beckstrand, Renea L.

    2016-01-01

    School nurses work in a unique environment with key opportunities to address parental concerns and questions regarding their child's health. A common concern for parents during school enrollment is childhood vaccination safety and efficacy. As public health leaders, school nurses are well respected among parents, therefore school nurses are in a…

  18. A Breath of Fresh Air: Addressing Indoor Air Quality

    Palliser, Janna

    2011-01-01

    Indoor air pollution refers to "chemical, biological, and physical contamination of indoor air," which may result in adverse health effects (OECD 2003). The causes, sources, and types of indoor air pollutants will be addressed in this article, as well as health effects and how to reduce exposure. Learning more about potential pollutants in home…

  19. Addressing the Complexities of Evaluating Interdisciplinary Multimedia Learning Environments.

    McGee, Steven; Howard, Bruce C.; Dimitrov, Dimiter M.; Hong, Namsoo S.; Shia, Regina

    This study was a summative evaluation of Astronomy Village[R]: Investigating the Solar System[TM]. Funded by the National Science Foundation, Astronomy Village is designed to teach students fundamental concepts in life, earth, and physical science by having them investigate cutting-edge questions related to the solar system. In Astronomy Village…

  20. Addressing the Complex Needs of Students with Attachment Disorders

    Losinski, Mickey; Katsiyannis, Antonis; White, Sherry; Wiseman, Nicole

    2016-01-01

    Attachment disorders are a relatively rare condition affecting children. This is particularly true for those who are adopted or living in foster care, and are thought to be attributed to an interruption in the bonding between a child and his or her caregiver. Attachment disorders are divided into two distinct categories: a predominately withdrawn…

  1. [Features of the dynamics of the state of health of the population residing near fuel and energy complex of the Republic of Kazakhstan].

    Sraubaev, E N; Kulov, D B; Aĭtmagambetova, S S; Serik, B; Erdesov, N Zh

    2014-01-01

    There was performed the analysis of the state of health of the population residing near fuel and energy complex of the Republic of Kazakhstan in the vicinity of the fuel and energy complex of Kazakhstan, namely, of the Lebyazhinsky district of the Pavlodar region. The chemicals contained in the emissions of existing enterprises of the fuel and energy complex, have a direct impact on public health. There is noted an increase of some diseases such as respiratory diseases, complications of pregnancy, childbirths and the postpartum period, diseases of the nervous system, mental and behavioral disorders, neoplasms. The child population is particularly prone to the impact of air pollutants. In children from the studied area every year the incidence of asthma is increasing by 3 times, the incidence of neoplasms--by 2 times.

  2. Geocoding Patient Addresses for Biosurveillance

    Olson, Karen L; Kenneth D Mandl

    2002-01-01

    New biosurveillance information systems are being developed to detect clusters of disease using temporal and spatial characteristics. Geographical Information Systems (GIS) can use patient addresses stored in hospital information systems to assign latitude and longitude coordinates, enabling the detection of spatial clusters. However, inaccuracy can be introduced during the geocoding process and this could have a profound adverse effect on detection sensitivity. In an analysis of three years ...

  3. Addressing conflicts of interest in Public Private Partnerships

    Daar Abdallah S

    2010-07-01

    Full Text Available Abstract Background Many articles have been written on conflicts of interests (COIs in fields such as medicine, business, politics, public service and education. With the growing abundance of Public Private Partnerships (PPPs, often involving complex relationships among the partners, it is important to understand how COIs can be mitigated and managed in PPPs. Discussion We wanted to study PPPs, particularly in the areas of global health and agriculture, but discovered no single source of information available to identify and compare various approaches for avoiding and managing COIs in PPPs. This is a significant gap, especially for those wishing to study, compare and strengthen existing COI policies related to PPPs. In order to bridge this gap, we reviewed how PPPs currently address COIs and highlight what might be considered good practice in developing COI policies. We reviewed the online COI policies of 10 PPPs in global health and agriculture, and interviewed two global health PPP chief executives. Summary Based on our review of policies and interviews, we conclude that there exists a range of good practices including attention to accountability and governance, acknowledgement and disclosure, abstention and withdrawal, reporting and transparency, and independent monitoring. There appears to be a need for PPPs to interact closely and learn from each other on these parameters and to also place more emphasis on independent external monitoring of COIs as a means of strengthening their major social objectives on which their activities are largely predicated. We also recommend the establishment of a web based database, which would serve as a forum to discuss COI issues and how they can be resolved.

  4. A new method for QRS complex detection in multichannel ECG: Application to self-monitoring of fetal health.

    Varanini, Maurizio; Tartarisco, Gennaro; Balocchi, Rita; Macerata, Alberto; Pioggia, Giovanni; Billeci, Lucia

    2016-04-13

    This paper proposes a new approach for QRS complex detection in multichannel ECG and presents its application to fetal QRS (fQRS) detection in signals acquired from maternal abdominal leads. The method exploits the characteristics of pseudo-periodicity and time shape of QRS, it consists of devising a quality index (QI) which synthesizes these characteristics and of finding the linear combination of the acquired ECGs, which maximizes this QI. In the application for fQRS detection two QIs are devised, one QI (mQI) for maternal ECG (mECG) and one QI (fQI) for fetal ECG (fECG). The method is completely unsupervised and based on the following steps: signal pre-processing; maternal QRS-enhanced signal extraction by finding the linear combination that maximize the mQI; detection of maternal QRSs; mECG component approximation and canceling by weighted Singular Value Decomposition (SVD); fQRS-enhanced signal extraction by finding the linear combination that maximize the fQI and fQRS detection. The proposed method was compared with our previously developed Independent Component Analysis (ICA) based method as well as with simple mECG canceling and simple ICA methods. The comparison was carried out by evaluating the performances of the procedures in fQRS detection. The new method outperformed the results of the other approaches on the annotated open set of the Computing in Cardiology Challenge 2013 database. The proposed method seems to be promising for its implementation on portable device and for use in self-monitoring of fetal health in pregnant women.

  5. CONTROLLING AS ORGANIZATIONAL AND METHODICAL COMPLEX OF SUPPORT OF MODERNIZATION AND MANAGEMENT IN THE FIELD OF HEALTH CARE

    Miroshnichenko M. A.

    2015-03-01

    Full Text Available Justification of the need and the prospects of using controlling in the mechanism of management of a versatile medical center is an actual problem now. The concept of the introduction of controlling, as organizational and methodical complex of support of modernization and management in the field of health care is considered. The analysis of the essence, the tasks and the functions of controlling of medical institution, advantage and possibility of application of controlling in the treatment-and-prophylactic establishment (TAPE in system of administration is given. Controlling is capable to have an impact on adoption of administrative decisions at the different levels. Applications in a management system of LPT of controlling will allow carrying out the following kinds of activity: to study the parameters of administration and to define the quality of the purpose of medical activity and indicators estimating their result; to define the activity in specialty; to develop information support of the administration; to coordinate the process of planning at the level of intermedical and interdisciplinary interaction; to predict the work of LPU; to develop the structure of the accounting of activity which is rather detailed with the definition of the expenses of the work of LPU; to have an opportunity to estimate the work of LPU at the municipal level and at the level of the subject of the Russian Federation; to develop the unified assessment of the ways and the indicators allowing to compare the results of the administration at all stages of medical activity; to use offers on the basis of the analysis and the assessment of planned and registration data on medical activity and to be guided by them when making administrative decisions at various levels of management

  6. Supporting Goal-Oriented Primary Health Care for Seniors with Complex Care Needs Using Mobile Technology: Evaluation and Implementation of the Health System Performance Research Network, Bridgepoint Electronic Patient Reported Outcome Tool

    Wodchis, Walter P; Upshur, Ross; Cott, Cheryl; McKinstry, Brian; Mercer, Stewart; Palen, Ted E; Ramsay, Tim; Thavorn, Kednapa

    2016-01-01

    Background Older adults experiencing multiple chronic illnesses are at high risk of hospitalization and health decline if they are unable to manage the significant challenges posed by their health conditions. Goal-oriented care approaches can provide better care for these complex patients, but clinicians find the process of ascertaining goals “too complex and too-time consuming,” and goals are often not agreed upon between complex patients and their providers. The electronic patient reported outcomes (ePRO) mobile app and portal offers an innovative approach to creating and monitoring goal-oriented patient-care plans to improve patient self-management and shared decision-making between patients and health care providers. The ePRO tool also supports proactive patient monitoring by the patient, caregiver(s), and health care provider. It was developed with and for older adults with complex care needs as a means to improve their quality of life. Objective Our proposed project will evaluate the use, effectiveness, and value for money of the ePRO tool in a 12-month multicenter, randomized controlled trial in Ontario; targeting individuals 65 or over with two or more chronic conditions that require frequent health care visits to manage their health conditions. Methods Intervention groups using the ePRO tool will be compared with control groups on measures of quality of life, patient experience, and cost-effectiveness. We will also evaluate the implementation of the tool. Results The proposed project presented in this paper will be funded through the Canadian Institute for Health Research (CIHR) eHealth Innovation Partnerships Program (eHIPP) program (CIHR–143559). The expected completion date of the study is November, 2019. Conclusions We anticipate our program of work will support improved quality of life and patient self-management, improved patient-centered primary care delivery, and will encourage the adoption of goal-oriented care approaches across primary

  7. Addressing the workforce pipeline challenge

    Leonard Bond; Kevin Kostelnik; Richard Holman

    2006-11-01

    A secure and affordable energy supply is essential for achieving U.S. national security, in continuing U.S. prosperity and in laying the foundations to enable future economic growth. To meet this goal the next generation energy workforce in the U.S., in particular those needed to support instrumentation, controls and advanced operations and maintenance, is a critical element. The workforce is aging and a new workforce pipeline, to support both current generation and new build has yet to be established. The paper reviews the challenges and some actions being taken to address this need.

  8. Nanoscale content-addressable memory

    Davis, Bryan (Inventor); Principe, Jose C. (Inventor); Fortes, Jose (Inventor)

    2009-01-01

    A combined content addressable memory device and memory interface is provided. The combined device and interface includes one or more one molecular wire crossbar memories having spaced-apart key nanowires, spaced-apart value nanowires adjacent to the key nanowires, and configurable switches between the key nanowires and the value nanowires. The combination further includes a key microwire-nanowire grid (key MNG) electrically connected to the spaced-apart key nanowires, and a value microwire-nanowire grid (value MNG) electrically connected to the spaced-apart value nanowires. A key or value MNGs selects multiple nanowires for a given key or value.

  9. Identifying families with complex needs after an initial child abuse investigation: A comparison of demographics and needs related to domestic violence, mental health, and substance use.

    Simon, James David; Brooks, Devon

    2017-03-16

    Families with complex needs related to domestic violence, mental health, and substance use have some of the worst child protective services (CPS) outcomes. Although many of these families are identified during a CPS investigation and subsequently referred to home-based postinvestigation services (HBPS), many are re-reported to CPS, so it is important to understand the postinvestigation experiences of this vulnerable group. Therefore, this study compared families with and without complex needs to understand their uniquedemographics, needs, and postinvestigation outcomes. The sample consisted of 2008 caregivers who received HBPS following an initial CPS investigation. The Family Assessment Form (FAF) was used to measure family functioning in eight domains using a 1-5 scale with higher ratings representing worse functioning. Complex needs were indicated by a mean FAF score of 3 or higher for either domestic violence, mental health, or substance use. Using Pearson chi-square analyses and two-sample t-tests, comparisons were made between families with (n=836) and without (n=1172) complex needs. Half of caregivers with complex needs had a history of abuse, 25% had three to five needs, and nearly half had six to eight needs; 90% of caregivers without complex needs had zero to two needs. Furthermore, caregivers with complex needs had higher mean scores for concrete, educational, and clinical needs. These findings highlight the importance of recognizing variation among families referred to HBPS and accurate screening to ensure that families with complex needs are offered and receive services matched to their unique characteristics and needs.

  10. Addressing consumerization of IT risks with nudging

    Iryna Yevseyeva

    2015-01-01

    Full Text Available In this work we address the main issues of Information Technology (IT consumerization that are related to security risks, and vulnerabilities of devices used within Bring Your Own Device (BYOD strategy in particular. We propose a ‘soft’ mitigation strategy for user actions based on nudging, widely applied to health and social behavior influence. In particular, we propose a complementary, less strict, more flexible Information Security policies, based on risk assessment of device vulnerabilities and threats to corporate data and devices, combined with a strategy of influencing security behavior by nudging. We argue that nudging, by taking into account the context of the decision-making environment, and the fact that the employee may be in better position to make a more appropriate decision, may be more suitable than strict policies in situations of uncertainty of security-related decisions. Several examples of nudging are considered for different tested and potential scenarios in security context.

  11. Evaluating complex interventions and health technologies using normalization process theory: development of a simplified approach and web-enabled toolkit

    Murray Elizabeth

    2011-09-01

    Full Text Available Abstract Background Normalization Process Theory (NPT can be used to explain implementation processes in health care relating to new technologies and complex interventions. This paper describes the processes by which we developed a simplified version of NPT for use by clinicians, managers, and policy makers, and which could be embedded in a web-enabled toolkit and on-line users manual. Methods Between 2006 and 2010 we undertook four tasks. (i We presented NPT to potential and actual users in multiple workshops, seminars, and presentations. (ii Using what we discovered from these meetings, we decided to create a simplified set of statements and explanations expressing core constructs of the theory (iii We circulated these statements to a criterion sample of 60 researchers, clinicians and others, using SurveyMonkey to collect qualitative textual data about their criticisms of the statements. (iv We then reconstructed the statements and explanations to meet users' criticisms, embedded them in a web-enabled toolkit, and beta tested this 'in the wild'. Results On-line data collection was effective: over a four week period 50/60 participants responded using SurveyMonkey (40/60 or direct phone and email contact (10/60. An additional nine responses were received from people who had been sent the SurveyMonkey form by other respondents. Beta testing of the web enabled toolkit produced 13 responses, from 327 visits to http://www.normalizationprocess.org. Qualitative analysis of both sets of responses showed a high level of support for the statements but also showed that some statements poorly expressed their underlying constructs or overlapped with others. These were rewritten to take account of users' criticisms and then embedded in a web-enabled toolkit. As a result we were able translate the core constructs into a simplified set of statements that could be utilized by non-experts. Conclusion Normalization Process Theory has been developed through

  12. Evaluating Complex Interventions and Health Technologies Using Normalization Process Theory: Development of a Simplified Approach and Web-Enabled Toolkit

    May, Carl R

    2011-09-30

    Abstract Background Normalization Process Theory (NPT) can be used to explain implementation processes in health care relating to new technologies and complex interventions. This paper describes the processes by which we developed a simplified version of NPT for use by clinicians, managers, and policy makers, and which could be embedded in a web-enabled toolkit and on-line users manual. Methods Between 2006 and 2010 we undertook four tasks. (i) We presented NPT to potential and actual users in multiple workshops, seminars, and presentations. (ii) Using what we discovered from these meetings, we decided to create a simplified set of statements and explanations expressing core constructs of the theory (iii) We circulated these statements to a criterion sample of 60 researchers, clinicians and others, using SurveyMonkey to collect qualitative textual data about their criticisms of the statements. (iv) We then reconstructed the statements and explanations to meet users\\' criticisms, embedded them in a web-enabled toolkit, and beta tested this \\'in the wild\\'. Results On-line data collection was effective: over a four week period 50\\/60 participants responded using SurveyMonkey (40\\/60) or direct phone and email contact (10\\/60). An additional nine responses were received from people who had been sent the SurveyMonkey form by other respondents. Beta testing of the web enabled toolkit produced 13 responses, from 327 visits to http:\\/\\/www.normalizationprocess.org. Qualitative analysis of both sets of responses showed a high level of support for the statements but also showed that some statements poorly expressed their underlying constructs or overlapped with others. These were rewritten to take account of users\\' criticisms and then embedded in a web-enabled toolkit. As a result we were able translate the core constructs into a simplified set of statements that could be utilized by non-experts. Conclusion Normalization Process Theory has been developed through

  13. Building Footprints - Montana Structures/Addresses Framework

    NSGIC GIS Inventory (aka Ramona) — The Montana Structures/Addresses Framework is a statewide spatial database of structure and address points in the State of Montana. The Montana Structures/Addresses...

  14. Poverty, social stress & mental health.

    Kuruvilla, A; Jacob, K S

    2007-10-01

    While there is increasing evidence of an association between poor mental health and the experience of poverty and deprivation, the relationship is complex. We discuss the epidemiological data on mental illness among the different socio-economic groups, look at the cause -effect debate on poverty and mental illness and the nature of mental distress and disorders related to poverty. Issues related to individual versus area-based poverty, relative poverty and the impact of poverty on woman's and child mental health are presented. This review also addresses factors associated with poverty and the difficulties in the measurement of mental health and illness and levels/impact of poverty.

  15. [Early signs of the effect of complex occupational factors of plasma technology on the workers' health status].

    Sineva, E L; Il'nitskaia, A V; Marushkin, V E

    1991-01-01

    The article reports the results of health-related studies among workers engaged in plasma technology processes. It was found that the earliest indicators of health changes in the workers revealed themselves in the vegetative nervous system and vestibulocochlear function combined with subatrophic++ changes in the respiratory mucous membranes.

  16. Addressing neurological disorders with neuromodulation.

    Oluigbo, Chima O; Rezai, Ali R

    2011-07-01

    Neurological disorders are becoming increasingly common in developed countries as a result of the aging population. In spite of medications, these disorders can result in progressive loss of function as well as chronic physical, cognitive, and emotional disability that ultimately places enormous emotional and economic on the patient, caretakers, and the society in general. Neuromodulation is emerging as a therapeutic option in these patients. Neuromodulation is a field, which involves implantable devices that allow for the reversible adjustable application of electrical, chemical, or biological agents to the central or peripheral nervous system with the objective of altering its functioning with the objective of achieving a therapeutic or clinically beneficial effect. It is a rapidly evolving field that brings together many different specialties in the fields of medicine, materials science, computer science and technology, biomedical, and neural engineering as well as the surgical or interventional specialties. It has multiple current and emerging indications, and an enormous potential for growth. The main challenges before it are in the need for effective collaboration between engineers, basic scientists, and clinicians to develop innovations that address specific problems resulting in new devices and clinical applications.

  17. Nutritional issues for older adults: addressing degenerative ageing with long-term studies.

    de Groot, Lisette C P G M

    2016-05-01

    The ageing process is influenced by a variety of factors, including extrinsic, malleable lifestyle variables. The present paper deals with the epidemiological evidence for the role of dietary patterns and key nutritional concerns in relation to survival and ageing-related disorders that present themselves in later life. Healthful dietary patterns appear to be most relevant in old age. Specific nutritional concerns are related to vitamin D, vitamin B12 and protein malnutrition. An important challenge to further expand the knowledge base is currently addressed by the NuAge project, acknowledging the complexity of the ageing process and integrating different dimensions of research into human healthy ageing. In the meantime, reversing poor adherence to existing guidelines for a healthy diet remains a first challenge in public health nutritional practices.

  18. An address geocoding solution for Chinese cities

    Zhang, Xuehu; Ma, Haoming; Li, Qi

    2006-10-01

    We introduce the challenges of address geocoding for Chinese cities and present a potential solution along with a prototype system that deal with these challenges by combining and extending current geocoding solutions developed for United States and Japan. The proposed solution starts by separating city addresses into "standard" addresses which meet a predefined address model and non-standard ones. The standard addresses are stored in a structured relational database in their normalized forms, while a selected portion of the non-standard addresses are stored as aliases to the standard addresses. An in-memory address index is then constructed from the address database and serves as the basis for real-time address matching. Test results were obtained from two trials conducted in the city Beijing. On average 80% matching rate were achieved. Possible improvements to the current design are also discussed.

  19. My 'Fat Girl Complex': a preliminary investigation of sexual health and body image in women of size.

    Satinsky, Sonya; Dennis, Barbara; Reece, Michael; Sanders, Stephanie; Bardzell, Shaowen

    2013-01-01

    Women of size who inhabit non-normative bodies may have different experiences with body image and sexual health than women of average body size. In this exploratory study, we interviewed four women of size recruited from a larger mixed-methodological study of body image and sexuality. Each woman was interviewed twice on topics of body image, sexuality and sexual health. Reconstructive Horizon Analysis was used to analyse the content of the interviews. Women who expressed that their bodies had inherent personal and social value regardless of size did not articulate connections between body size and their sexual health. However, those women who looked externally for validation of their attractiveness struggled with acceptance of their sexuality and bodies and spoke of ways in which their body size and appearance hindered them from having the sexually healthy lives that they wanted. Findings highlight two important components of women's sexual health as participants related them to body image: the right to pleasure and the right to engage only in wanted sexual activity. Participants described how negative body attitudes affected both of these aspects of their sexual health. Interventions targeting weight-based stigma may offer a means of indirectly promoting sexual health and autonomy in women.

  20. Library outreach: addressing Utah's “Digital Divide”

    McCloskey, Kathleen M.

    2000-01-01

    A “Digital Divide” in information and technological literacy exists in Utah between small hospitals and clinics in rural areas and the larger health care institutions in the major urban area of the state. The goals of the outreach program of the Spencer S. Eccles Health Sciences Library at the University of Utah address solutions to this disparity in partnership with the National Network of Libraries of Medicine—Midcontinental Region, the Utah Department of Health, and the Utah Area Health Education Centers. In a circuit-rider approach, an outreach librarian offers classes and demonstrations throughout the state that teach information-access skills to health professionals. Provision of traditional library services to unaffiliated health professionals is integrated into the library's daily workload as a component of the outreach program. The paper describes the history, methodology, administration, funding, impact, and results of the program. PMID:11055305

  1. Addressing the sluggish progress in reducing maternal mortality in India.

    Rai, Rajesh Kumar; Tulchinsky, Theodore Herzl

    2015-03-01

    Although some progress has been made in India, achievement of the Fifth Millennium Development Goal (MDG5; ie, 75% reduction in maternal mortality ratio [MMR] from 1990 by 2015) target seems to be unattainable by 2015. Failure of the National Population Policy, 2000, and the National Health Policy, 2002, to reduce the MMR demanded a new direction, leading to the establishment of a National Rural Health Mission in 2005. This commentary addresses both the real achievements and the hurdles faced in India's stagnating progress in maternal health. Promotion of maternal nutrition and health education, with greater attention to emergency obstetrical care at the district subcenter and primary health care center levels, must be prioritized. These changes of focus are vital to make prenatal, delivery, and postnatal care safer with increased resources allotted to adolescents, the poor, and women living in rural areas in order to enhance maternal health and achieve the MDG target.

  2. Migration-related health inequalities: showing the complex interactions between gender, social class and place of origin.

    Malmusi, Davide; Borrell, Carme; Benach, Joan

    2010-11-01

    In this paper, we briefly review theories and findings on migration and health from the health equity perspective, and then analyse migration-related health inequalities taking into account gender, social class and migration characteristics in the adult population aged 25-64 living in Catalonia, Spain. On the basis of the characterisation of migration types derived from the review, we distinguished between immigrants from other regions of Spain and those from other countries, and within each group, those from richer or poorer areas; foreign immigrants from low-income countries were also distinguished according to duration of residence. Further stratification by sex and social class was applied. Groups were compared in relation to self-assessed health in two cross-sectional population-based surveys, and in relation to indicators of socio-economic conditions (individual income, an index of material and financial assets, and an index of employment precariousness) in one survey. Social class and gender inequalities were evident in both health and socio-economic conditions, and within both the native and immigrant subgroups. Migration-related health inequalities affected both internal and international immigrants, but were mainly limited to those from poor areas, were generally consistent with their socio-economic deprivation, and apparently more pronounced in manual social classes and especially for women. Foreign immigrants from poor countries had the poorest socio-economic situation but relatively better health (especially men with shorter length of residence). Our findings on immigrants from Spain highlight the transitory nature of the 'healthy immigrant effect', and that action on inequality in socio-economic determinants affecting migrant groups should not be deferred.

  3. Complex emergencies in Indonesia.

    Bradt, D A; Drummond, C M; Richman, M

    2001-01-01

    Recently, Indonesia has experienced six major provincial, civil, armed conflicts. Underlying causes include the transmigration policy, sectarian disputes, the Asian economic crisis, fall of authoritarian rule, and a backlash against civil and military abuses. The public health impact involves the displacement nationwide of > 1.2 million persons. Violence in the Malukus, Timor, and Kalimantan has sparked the greatest population movements such that five provinces in Indonesia each now harbor > 100,000 internally displaced persons. With a background of government instability, hyperinflation, macroeconomic collapse, and elusive political solutions, these civil armed conflicts are ripe for persistence as complex emergencies. Indonesia has made substantial progress in domestic disaster management with the establishment of central administrative authority, strategic planning, and training programs. Nevertheless, the Indonesian experience reveals recurrent issues in international humanitarian health assistance. Clinical care remains complicated by absences of treatment protocols, inappropriate drug use, high procedural complication rates, and variable referral practices. Epidemiological surveillance remains complicated by unsettled clinical case definitions, non-standardized case management of diseases with epidemic potential, variable outbreak management protocols, and inadequate epidemiological analytic capacity. International donor support has been semi-selective, insufficient, and late. The militia murders of three UN staff in West Timor prompted the withdrawal of UN international staff from West Timor for nearly a year to date. Re-establishing rules of engagement for humanitarian health workers must address security, public health, and clinical threats.

  4. Intercultural Identities: Addressing the Global Dimension through Art Education

    Bianchi, June

    2011-01-01

    Recent educational policy and practice have established an extended role for all subjects in addressing children and young peoples' academic and interpersonal development, with strategies facilitating key skills and wider learning across areas of Citizenship and Personal, Social and Health education providing an integrated approach to education…

  5. State Legislation to Address Childhood Obesity. Program Results Brief

    Fiester, Leila

    2012-01-01

    An estimated 12.5 million American children and teens are obese. Over time, the diseases and disabilities associated with obesity may undermine this population's health and result in substantial social and economic costs. Policies that address children's nutrition and physical activity are an important tool in reversing the obesity epidemic. More…

  6. Profissionais de saúde e violência intrafamiliar contra a criança e adolescente Profesionales de salud y violencia intrafamiliar contra el niño y el adolescente Health care professionals' approaches to address family violence against children and teenagers

    Cristina Brandt Nunes

    2009-01-01

    : Health care professionals were concerned with the lack of successful family problems resolution. Measures used by health care professionals emphasized punitive actions instead of caring behaviors. The characteristics of the job did not allow of the health care professionals to express their feelings and reactions and to know how to successfully address family violence. Health care professionals' approaches to address violence with families who already experienced violence may also become violent acts against those families. CONCLUSION: Approaches used to address family violence against children and teenagers reflect a lack of integration among the several categories of health care professionals and health care services.

  7. Age and gender diversity as determinants of performance and health in a public organization: the role of task complexity and group size.

    Wegge, Jürgen; Roth, Carla; Neubach, Barbara; Schmidt, Klaus-Helmut; Kanfer, Ruth

    2008-11-01

    The influence of age and gender composition on group performance and self-reported health disorders was examined with data from 4,538 federal tax employees working in 222 natural work unit groups. As hypothesized, age diversity correlated positively with performance only in groups solving complex decision-making tasks, and this finding was replicated when analyzing performance data collected 1 year later. Age diversity was also positively correlated with health disorders--but only in groups working on routine decision-making tasks. Gender composition also had a significant effect on group performance, such that groups with a high proportion of female employees performed worse and reported more health disorders than did gender-diverse teams. As expected, effects of gender composition were most pronounced in large groups. Effects of age diversity were found when controlling for gender diversity and vice versa. Thus, age and gender diversity seem to play a unique role in performance and well-being. The moderating role of task complexity for both effects of age diversity and the moderating role of group size for both effects of gender diversity further suggest that the impact of these 2 variables depends on different group processes (e.g., knowledge exchange, variation in gender salience).

  8. Clinical Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder (Bipolar CHOICE): A Pragmatic Trial of Complex Treatment for a Complex Disorder

    Nierenberg, Andrew A.; Sylvia, Louisa G.; Leon, Andrew C.; Reilly-Harrington, Noreen; Shesler, Leah W.; McElroy, Susan L.; Friedman, Edward S.; Thase, Michael E.; Shelton, Richard C.; Bowden, Charles; Tohen, Mauricio; Singh, Vivek; Deckersbach, Thilo; Ketter, Terence; Kocsis, James; McInnis, Melvin G.; Schoenfeld, David; Bobo, William V.; Calabrese, Joseph R.

    2015-01-01

    Background Classic and second generation antipsychotic mood stabilizers are recommended for treatment of bipolar disorder, yet there are no randomized comparative effectiveness studies that have examined the “real-world” advantages and disadvantages of these medications Purpose We describe the strategic decisions in the design of the Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder (Bipolar CHOICE). This paper outlines the key issues and solutions the investigators faced in designing a clinical trial that would maximize generalizability and inform real-world clinical treatment of bipolar disorder. Methods Bipolar CHOICE was a 6-month, multi-site, prospective, randomized clinical trial of outpatients with bipolar disorder. This study compares the effectiveness of quetiapine versus lithium, each with adjunctive personalized treatments. The co-primary outcomes selected are the overall benefits and harms of the study medications (as measured by the Clinical Global Impression-Efficacy Index) and the Necessary Clinical Adjustments (a measure of the number of medication changes). Secondary outcomes are continuous measures of mood, the Framingham General Cardiovascular Risk Score and the Longitudinal Interval Follow up Evaluation Range of Impaired Functioning Tool. Results The final study design consisted of a single-blind, randomized comparative effectiveness trial of quetiapine versus lithium, plus adjunctive personalized treatment (APT), across ten sites. Other important study considerations included limited exclusion criteria to maximize generalizability, flexible dosing of APT medications to mimic real-world treatment, and an intent-to-treat analysis plan. 482 participants were randomized to the study and 364 completed. Limitations The potential limitations of the study include the heterogeneity of APT, selection of study medications, lack of a placebo-control group, and participants’ ability to pay for study medications

  9. The Complexities of 'Consumerism': Choice, Collectivism and Participation within Britain's National Health Service, c.1961-c.1979.

    O'Hara, Glen

    2013-05-01

    This article explores the overlapping and conflicting points of contact between 'consumerism', collectivism and participation in Britain's National Health Service during a period of relatively well-funded expansion during the economic 'golden age' of the 1960s and 1970s. Despite recent neo-liberal attempts to define 'consumerism' around the wishes and choices of the individual, and to conceptualise areas such as individual hospital referrals as particularly 'consumerist', this article demonstrates that collective provision, the protection of disadvantaged groups and the concept of 'participatory' citizen involvement were all alternative meanings of the concept during this period, co-existing uneasily with the competitive concepts that have become more familiar since the late 1980s. This insight is then utilised to show how health care debates today might become better informed, ignoring extreme claims for all three concepts and focusing instead on a theoretically informed but ultimately empirical grasp of constant flux in any health care system.

  10. Addressing selection bias in dental health services research.

    Lee, J Y; Rozier, R G; Norton, E C; Vann, W F

    2005-10-01

    When randomization is not possible, researchers must control for non-random assignment to experimental groups. One technique for statistical adjustment for non-random assignment is through the use of a two-stage analytical technique. The purpose of this study was to demonstrate the use of this technique to control for selection bias in examining the effects of the The Supplemental Program for Women, Infants, and Children's (WIC) on dental visits. From 5 data sources, an analysis file was constructed for 49,512 children ages 1-5 years. The two-stage technique was used to control for selection bias in WIC participation, the potentially endogenous variable. Specification tests showed that WIC participation was not random and that selection bias was present. The effects of the WIC on dental use differed by 36% after adjustment for selection bias by means of the two-stage technique. This technique can be used to control for potential selection bias in dental research when randomization is not possible.

  11. Addressing the Health Concerns of VA Women with Sexual Trauma

    2015-10-01

    area code) 2 Table of Contents Page 1. Introduction………………………………………………………………….. 4 2. Keywords…………………………………………………………………….. 4 3. Accomplishments...Sheltered Women with Substance Use NICH R01 HD080780-01A1 (Rizzo) 4/01/2015-3/31/2020 0.6 calendar Dating Violence Prevention for Juvenile

  12. Innovations in public health education: promoting professional development and a culture of health.

    Levy, Marian; Gentry, Daniel; Klesges, Lisa M

    2015-03-01

    As the field of public health advances toward addressing complex, systemic problems, future public health professionals must be equipped with leadership and interprofessional skills that support collaboration and a culture of health. The University of Memphis School of Public Health has infused innovative strategies into graduate education via experiential learning opportunities to enhance leadership, collaboration, and professional development. Novel training programs such as Day One, Public Health Interdisciplinary Case Competition, and Memphis Healthy U support Association of Schools and Programs of Public Health cross-cutting competencies and prepare Master of Public Health and Master of Health Administration graduates to function effectively at the outset of their careers and become catalysts for creating a culture of health.

  13. Mental health learning needs assessment: competency-based instrument for best practice.

    McKnight, Sylvia E

    2013-06-01

    A learning needs assessment focused on psychiatric/mental health nursing competency development is a central component of nursing education in specialty mental health nursing practice. The provision of education for mental health nursing relies on the underlying assumption that the learning needs of experienced mental health nurses have been assessed and educational programs implemented to address educational needs for competency in professional practice. Few professional learning needs assessments have been developed to identify learning needs in mental health nursing practice. The majority of available professional learning needs assessments focus on medical nursing practice applications rather than the psychosocial aspects of a mental health assessment. The mental health field addresses very different assessment criteria such as knowledge of suicide assessment and therapeutic interventions. The purpose of this article is to present and describe the process of developing a learning needs assessment focused on competency development for the specialty practice of mental health nursing that addresses and resolves complex learning needs.

  14. OPENING ADDRESS: Heterostructures in Semiconductors

    Grimmeiss, Hermann G.

    1996-01-01

    Good morning, Gentlemen! On behalf of the Nobel Foundation, I should like to welcome you to the Nobel Symposium on "Heterostructures in Semiconductors". It gives me great pleasure to see so many colleagues and old friends from all over the world in the audience and, in particular, to bid welcome to our Nobel laureates, Prof. Esaki and Prof. von Klitzing. In front of a different audience I would now commend the scientific and technological importance of heterostructures in semiconductors and emphatically emphasise that heterostructures, as an important contribution to microelectronics and, hence, information technology, have changed societies all over the world. I would also mention that information technology is one of the most important global key industries which covers a wide field of important areas each of which bears its own character. Ever since the invention of the transistor, we have witnessed a fantastic growth in semiconductor technology, leading to more complex functions and higher densities of devices. This development would hardly be possible without an increasing understanding of semiconductor materials and new concepts in material growth techniques which allow the fabrication of previously unknown semiconductor structures. But here and today I will not do it because it would mean to carry coals to Newcastle. I will therefore not remind you that heterostructures were already suggested and discussed in detail a long time before proper technologies were available for the fabrication of such structures. Now, heterostructures are a foundation in science and part of our everyday life. Though this is certainly true, it is nevertheless fair to say that not all properties of heterostructures are yet understood and that further technologies have to be developed before a still better understanding is obtained. The organisers therefore hope that this symposium will contribute not only to improving our understanding of heterostructures but also to opening new

  15. Community embedded reproductive health interventions for adolescents in Latin America: development and evaluation of a complex multi-centre intervention

    Decat, P.; Nelson, E.; de Meyer, S.; Jaruseviciene, L.; Orozco, M.; Segura, Z.; Gorter, A.; Vega, B.; Cordova, K.; Maes, L.; Temmerman, M.; Leye, E.; Degomme, O.

    2013-01-01

    Background Adolescents in Latin America are at high risk for unwanted and unplanned pregnancies, which often result in unsafe abortions or poor maternal health outcomes. Both young men and women in the region face an increased risk of sexually transmitted infections due to inadequate sexual and repr

  16. Behind the scenes of the PRIME intervention: designing a complex intervention to improve malaria care at public health centres in Uganda

    Deborah D. DiLiberto

    2015-10-01

    Full Text Available Background: In Uganda, health system challenges limit access to good quality healthcare and contribute to slow progress on malaria control. We developed a complex intervention (PRIME, which was designed to improve quality of care for malaria at public health centres. Objective: Responding to calls for increased transparency, we describe the PRIME intervention's design process, rationale, and final content and reflect on the choices and challenges encountered during the design of this complex intervention. Design: To develop the intervention, we followed a multistep approach, including the following: 1 formative research to identify intervention target areas and objectives; 2 prioritization of intervention components; 3 review of relevant evidence; 4 development of intervention components; 5 piloting and refinement of workshop modules; and 6 consolidation of the PRIME intervention theories of change to articulate why and how the intervention was hypothesized to produce desired outcomes. We aimed to develop an intervention that was evidence-based, grounded in theory, and appropriate for the study context; could be evaluated within a randomized controlled trial; and had the potential to be scaled up sustainably. Results: The process of developing the PRIME intervention package was lengthy and dynamic. The final intervention package consisted of four components: 1 training in fever case management and use of rapid diagnostic tests for malaria (mRDTs; 2 workshops in health centre management; 3 workshops in patient-centred services; and 4 provision of mRDTs and antimalarials when stocks ran low. Conclusions: The slow and iterative process of intervention design contrasted with the continually shifting study context. We highlight the considerations and choices made at each design stage, discussing elements we included and why, as well as those that were ultimately excluded. Reflection on and reporting of ‘behind the scenes’ accounts of intervention

  17. Address burnout with a caring, nurturing environment.

    2014-06-01

    With their hectic schedules and demanding work responsibilities, emergency physicians are particularly vulnerable to symptoms of burnout. One study showed that more than half of emergency providers reported at least one symptom of burnout when they were asked to fill out a survey tool used to measure burnout--more than any other type of provider. It's a concern because physicians experiencing burnout may be less attentive to their patients, and some ultimately choose to leave medicine because they are no longer satisfied with their work. However, there are steps health systems and administrators can take to help physicians who are struggling, and prevent isolated problems from escalating into larger issues. When a national sample of more than 7,200 physicians agreed to take the Maslach Burnout Inventory, a survey tool used to measure burnout, nearly half (45.8%) reported at least one symptom of burnout, and 65% of the emergency providers reported symptoms of burnout. Burnout is not just fatigue. It involves disappointment in a relationship or relationships, and lack of satisfaction or fulfillment with work, according to experts. Symptoms may include moodiness, irritability, sarcasm, and may result in performance issues as well. Further, there may be physical changes such as weight loss or changes in appetite. To prevent or address burnout, experts advise health systems to nurture a caring, collaborative environment, and to make sure that providers have mentors or resources to reach out to if they are experiencing any work-related problems. They also advise administrators to make sure that burnout is a safe topic of conversation.

  18. Computational strategies to address chromatin structure problems

    Perišić, Ognjen; Schlick, Tamar

    2016-06-01

    While the genetic information is contained in double helical DNA, gene expression is a complex multilevel process that involves various functional units, from nucleosomes to fully formed chromatin fibers accompanied by a host of various chromatin binding enzymes. The chromatin fiber is a polymer composed of histone protein complexes upon which DNA wraps, like yarn upon many spools. The nature of chromatin structure has been an open question since the beginning of modern molecular biology. Many experiments have shown that the chromatin fiber is a highly dynamic entity with pronounced structural diversity that includes properties of idealized zig-zag and solenoid models, as well as other motifs. This diversity can produce a high packing ratio and thus inhibit access to a majority of the wound DNA. Despite much research, chromatin’s dynamic structure has not yet been fully described. Long stretches of chromatin fibers exhibit puzzling dynamic behavior that requires interpretation in the light of gene expression patterns in various tissue and organisms. The properties of chromatin fiber can be investigated with experimental techniques, like in vitro biochemistry, in vivo imagining, and high-throughput chromosome capture technology. Those techniques provide useful insights into the fiber’s structure and dynamics, but they are limited in resolution and scope, especially regarding compact fibers and chromosomes in the cellular milieu. Complementary but specialized modeling techniques are needed to handle large floppy polymers such as the chromatin fiber. In this review, we discuss current approaches in the chromatin structure field with an emphasis on modeling, such as molecular dynamics and coarse-grained computational approaches. Combinations of these computational techniques complement experiments and address many relevant biological problems, as we will illustrate with special focus on epigenetic modulation of chromatin structure.

  19. Inter-Professional Primary Care Practices Addressing Diabetes Prevention and Management

    Beagrie, Lesley

    2011-01-01

    Imagine a partnership of university and community which addresses the needs of the community to keep its citizens healthy as long as possible. Through a planning exercise to address the community's needs in primary health care and health promotion, the university has developed key strategic directions to help support the needs of the community it…

  20. Overview of the taxonomy and of the major secondary metabolites and their biological activities related to human health of the Laurencia complex (Ceramiales, Rhodophyta from Brazil

    Mutue T. Fujii

    2011-04-01

    Full Text Available In Brazil, the Laurencia complex is represented by twenty taxa: Laurencia s.s. with twelve species, Palisada with four species (including Chondrophycus furcatus now that the proposal of its transference to Palisada is in process, and Osmundea and Yuzurua with two species each. The majority of the Brazilian species of the Laurencia complex have been phylogenetically analyzed by 54 rbcL sequences, including five other Rhodomelacean species as outgroups. The analysis showed that the Laurencia complex is monophyletic with high posterior probability value. The complex was separated into five clades, corresponding to the genera: Chondrophycus, Laurencia, Osmundea, Palisada, and Yuzurua. A bibliographical survey of the terpenoids produced by Brazilian species showed that only six species of Laurencia and five of Palisada (including C. furcatcus have been submitted to chemical analysis with 48 terpenoids (47 sesquiterpenes and one triterpene isolated. No diterpenes were found. Of the total, 23 sesquiterpenes belong to the bisabolane class and eighteen to the chamigrene type, whose biochemical precursor is bisabolane, two are derived from lauranes and four are triquinols. Despite the considerable number of known terpenes and their ecological and pharmacological importance, few experimental biological studies have been performed. In this review, only bioactivities related to human health were considered.