WorldWideScience

Sample records for federal health initiative

  1. Health Promotion and Aging: Educational and Clinical Initiatives by the Federal Government.

    Science.gov (United States)

    Haber, David

    2002-01-01

    Discusses positive and negative effects of five federal health promotion initiatives: Medicare Prevention Benefits, Surgeon General's Reports, Healthy People 2000 and 2001, Guide to Clinical Preventive Services, and Put Prevention into Practice Campaign. Recommends additional research and coordination with state and private sector agencies.…

  2. Federal government expands compliance initiatives.

    Science.gov (United States)

    Dugan, J K

    1997-09-01

    In 1995, the Federal government initiated Operation Restore Trust to increase enforcement of fraud and abuse regulations in Medicare and Medicaid programs. With the success of the original initiative, the government is expanding the project to additional states and program areas. The initial scrutiny of home health agencies, nursing homes, hospice care, and durable medical equipment is being expanded to managed care plans and acute care hospitals with an eye toward DRG creep. To manage this increased enforcement activity, healthcare organizations should institute comprehensive corporate compliance programs. Such programs should provide a framework that delineates responsibilities and provides a systematic means to resolve issues in a timely manner.

  3. Federalism and health policy.

    Science.gov (United States)

    Nathan, Richard P

    2005-01-01

    This paper presents a cyclical theory of U.S. federalism and social policy: Many social policy initiatives are tested and refined at the state level, especially during conservative periods, and later morph into national policies. The paper describes such federalism cycles and offers an interpretation of why and how they occur, focusing on Medicaid. State activism has preserved and expanded Medicaid through policy innovation and resistance to retrenchment, especially in conservative periods, by taking advantage of the flexibility the program provides. I conclude that Medicaid's incremental/partnership approach is appropriate and feasible to build on for a future expansion of health care coverage.

  4. Federalism and Health Care

    Directory of Open Access Journals (Sweden)

    G. Alan Tarr

    2011-10-01

    Full Text Available President Barack Obama proposed a major overhaul of the American healthsystem, and in 2010 the U.S. Congress enacted his proposal, the PatientProtection and Affordable Care Act. Opponents of the Act challenged itsconstitutionality in federal court, claiming that it exceeds the powers grantedto the federal government under the Commerce Clause and the NecessaryProper Clause of the federal Constitution. Some courts have upheldthe law, but others have agreed with the critics, in particular ruling thatthe provision requiring citizens to buy health insurance is unconstitutional.Eventually the U.S. Supreme Court will rule on the issue. This article tracesthe controversy, surveys the interpretation of pertinent constitutional provisionsin past cases, analyzes the constitutional arguments presented byproponents and opponents of the Act, and concludes that the Act is constitutional.

  5. Private sector joins Federal Building Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Endemann, C. [Public Works and Government Services Canada, Ottawa, ON (Canada)

    1998-09-01

    The Federal Buildings Initiative (FBI), aiming at making federally occupied buildings more energy efficient, was introduced in 1992. With the completion of the retrofit of the Place Vincent Massey Building in Hull, PQ, a new milestone has been achieved as retrofitting Place Vincent Massey was the first project in the FBI series involving a privately owned building. The mechanics of the process are simple. FBI encourages the owners of government-leased buildings to perform energy-wise upgrades and the work is financed through the savings achieved. By supporting innovative partnerships with the private sector, the government and Canadian taxpayers achieve significant savings and also help stimulate job creation in the area. At present, annual savings through the FBI program are estimated at about $20 million and more than 4,000 federal buildings have been retrofitted since 1992. When fully completed throughout all applicable federal buildings, FBI will have created a total of 20,000 person-years of employment, will have achieved $160 million in savings annually, and will have stimulated investment in the order of one billion dollars. The improvements in Place Vincent Massey encompass a new lighting system, and a new computerized control system to regulate the building`s ventilation system and peripheral air conditioning units. Flexibility of the systems will be enhanced by installing new variable speed motors. The results are reduced maintenance costs, a high standard of indoor air quality and improved comfort for building occupants.

  6. Home Health Quality Initiative

    Data.gov (United States)

    U.S. Department of Health & Human Services — The instrument-data collection tool used to collect and report performance data by home health agencies is called the Outcome and Assessment Information Set (OASIS)....

  7. 77 FR 11798 - Federal Housing Administration (FHA) Risk Management Initiatives: Revised Seller Concessions...

    Science.gov (United States)

    2012-02-28

    ... URBAN DEVELOPMENT 24 CFR Chapter II Federal Housing Administration (FHA) Risk Management Initiatives... title (Federal Housing Administration (FHA) Risk Management Initiatives: Revised Seller Concessions). 1... purchasing a home with financing insured by the Federal Housing Administration (FHA). The...

  8. How federalism shapes public health financing, policy, and program options.

    Science.gov (United States)

    Ogden, Lydia L

    2012-01-01

    In the United States, fiscal and functional federalism strongly shape public health policy and programs. Federalism has implications for public health practice: it molds financing and disbursement options, including funding formulas, which affect allocations and program goals, and shapes how funding decisions are operationalized in a political context. This article explores how American federalism, both fiscal and functional, structures public health funding, policy, and program options, investigating the effects of intergovernmental transfers on public health finance and programs.

  9. Nurse-midwives in federally funded health centers: understanding federal program requirements and benefits.

    Science.gov (United States)

    Carter, Martha

    2012-01-01

    Midwives are working in federally funded health centers in increasing numbers. Health centers provide primary and preventive health care to almost 20 million people and are located in every US state and territory. While health centers serve the entire community, they also serve as a safety net for low-income and uninsured individuals. In 2010, 93% of health center patients had incomes below 200% of the Federal Poverty Guidelines, and 38% were uninsured. Health centers, including community health centers, migrant health centers, health care for the homeless programs, and public housing primary care programs, receive grant funding and enjoy other benefits due to status as federal grantees and designation as federally qualified health centers. Clinicians working in health centers are also eligible for financial and professional benefits because of their willingness to serve vulnerable populations and work in underserved areas. Midwives, midwifery students, and faculty working in, or interacting with, health centers need to be aware of the regulations that health centers must comply with in order to qualify for and maintain federal funding. This article provides an overview of health center regulations and policies affecting midwives, including health center program requirements, scope of project policy, provider credentialing and privileging, Federal Tort Claims Act malpractice coverage, the 340B Drug Pricing Program, and National Health Service Corps scholarship and loan repayment programs.

  10. Federal funding of health policy in Brazil: trends and challenges

    Directory of Open Access Journals (Sweden)

    Cristiani Vieira Machado

    2014-01-01

    Full Text Available The article analyzes Federal funding of health policy in Brazil in the 2000s, focusing on the Ministry of Health’s budget implementation. Federal spending on health was less unstable between 2000 and 2002 and has expanded since 2006. However, it fluctuated as a share of both the Gross Domestic Product and Gross National Revenue. Federal intergovernmental transfers increased, exceeding 70% in 2007. Meanwhile, the proportion of Federal investments remained low, varying from 3.4% to 6.3%. The highest absolute amount of spending was on specialized outpatient and hospital care. The decade showed a proportionally greater increase in spending on pharmaceutical care. The growing allocation of Federal funds to States in the North and Northeast, especially for primary care and epidemiological surveillance, failed to offset the sharp regional inequalities in per capita Federal spending. The main characteristics of health funding limit Federal health policy governance and pose several challenges for the Brazilian Unified National Health System.

  11. Health Insurance Marketplace Quality Initiatives

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Affordable Care Act requires the U.S. Department of Health and Human Services (HHS) to develop quality data collection and reporting tools such as a Quality...

  12. The Thalassemia International Federation: a global public health paradigm

    Directory of Open Access Journals (Sweden)

    Elpidoforos S. Soteriades

    2014-09-01

    Full Text Available Many international organizations are struggling today to coordinate limited economic and human resources in support of governments’ efforts to advance public health around the world. The United Nations and the World Health Organization, along with others play a pivotal role in this global effort. Furthermore, during the past few decades an increasingly higher percentage of global efforts on public health are carried out by specific health initiatives, international projects and non-governmental patient-oriented organizations. The Thalassemia International Federation (TIF is one such organization focusing on the control of thalassemia around the world. The current paper aims at presenting a comprehensive overview of the mission, goals, objectives and activities of this organization. Our ultimate goal is to highlight TIF’s public health paradigm and diffuse its success at an international levels for others to follow. TIF is devoted to disseminating information, knowledge, experience and best practices around the world to empower patients with thalassemia and their relatives, support health professionals providing care to such patients and promote national and international policies, which secure equal access to quality care for all patients with thalassemia.

  13. A política federal de saneamento básico e as iniciativas de participação, mobilização, controle social, educação em saúde e ambiental nos programas governamentais de saneamento The federal politics of basic sanitation and the initiatives of participation, mobilization, social control, health and environmental education

    Directory of Open Access Journals (Sweden)

    Márcia Moisés

    2010-08-01

    , Social Control, Health Education and Environmental Education. They also made considerations about the difficulties, facilities, advances and challenges in the implantation and implementation of PESMS and PEAMSS in the fundament for the realization of the public services of basic sanitation. They conclude that the creation of conditions by means of initiatives of Participation, Mobilization, Social Control, Health Education and Environmental Education become necessary for the development of Federal Policies of Basic Sanitation.

  14. Harmonizing Access to Federal Data - Lessons Learned Through the Climate Data Initiative

    Science.gov (United States)

    Bugbee, K.; Pinheiro Privette, A. C.; Meyer, D. J.; Ramachandran, R.

    2016-12-01

    The Climate Data Initiative (CDI), launched by the Obama Administration in March of 2014, is an effort to leverage the extensive open Federal data to spur innovation and private-sector entrepreneurship in order to advance awareness of and preparedness for the impacts of climate change (see the White House fact sheet). The project includes an online catalog of climate-related datasets and data products in key areas of climate change risk and vulnerability from across the U.S. federal government through http://Climate.Data.gov. NASA was tasked with the implementation and management of the project and has been working closely with Subject Matter Experts (SMEs) and Data Curators (DCs) from across the Federal Government to identify and catalog federal datasets relevant for assessing climate risks and impacts. These datasets are organized around key themes and are framed by key climate questions. The current themes within CDI include: Arctic, Coastal Flooding, Ecosystem Vulnerability, Energy Infrastructure, Food Resilience, Human Health, Transportation, Tribal Nations and Water. This paper summarizes the main lessons learned from the last 2.5 years of CDI implementation.

  15. 77 FR 58412 - Meeting of the Global Justice Information Sharing Initiative Federal Advisory Committee

    Science.gov (United States)

    2012-09-20

    ... the meeting. Purpose The GAC will act as the focal point for justice information systems integration... of Justice Programs Meeting of the Global Justice Information Sharing Initiative Federal Advisory... announcement of a meeting of the Global Justice Information Sharing Initiative (Global) Federal...

  16. 77 FR 46425 - Federal Advisory Committee; Defense Health Board Meeting

    Science.gov (United States)

    2012-08-03

    ... of the Secretary Federal Advisory Committee; Defense Health Board Meeting AGENCY: Department of Defense (DoD). ACTION: Notice of meeting. SUMMARY: Pursuant to the Federal Advisory Committee Act of 1972... amended), and 41 CFR 102-3.150, and in accordance with section 10(a)(2) of Public Law, a meeting of...

  17. Federal Employees Health Benefits Program (FEHBP) Plan Information

    Data.gov (United States)

    Office of Personnel Management — A list of all Federal Employees Health Benefits Program (FEHBP) plans available in each state, as well as links to the plan brochures, changes for each plan from the...

  18. Standards for Teaching about the Federal Reserve System: An Initiative by Two Federal Reserve Banks

    Science.gov (United States)

    Bosshardt, William D.; Grimes, Paul W.; Suiter, Mary C.

    2011-01-01

    In the fall of 2008, the Federal Reserve Banks of Atlanta and St. Louis began a systematic evaluation of their economic and personal finance educational outreach programs. Both banks were interested in developing tools to assess the success of their existing economic and financial education programs. However, before any assessment could begin, a…

  19. Health information technology: strategic initiatives, real progress.

    Science.gov (United States)

    Kolodner, Robert M; Cohn, Simon P; Friedman, Charles P

    2008-01-01

    We fully agree with Carol Diamond and Clay Shirky that deployment of health information technology (IT) is necessary but not sufficient for transforming U.S. health care. However, the recent work to advance health IT is far from an exercise in "magical thinking." It has been strategic thinking. To illustrate this, we highlight recent initiatives and progress under four focus areas: adoption, governance, privacy and security, and interoperability. In addition, solutions exist for health IT to advance rapidly without adversely affecting future policy choices. A broad national consensus is emerging in support of advancing health IT to enable the transformation of health and care.

  20. LIFESTYLE, FITNESS AND HEALTH PROMOTION INITIATIVE OF ...

    African Journals Online (AJOL)

    Osondu

    NIGERIA: AN EDUCATIONAL MEDIA INTERVENTION. *SHEHU, R.A. ... This study examined the health promotion initiative introduced by the Management of the University of. Ilorin, Ngeria. .... comprehensive social, and public process, it not.

  1. 78 FR 68865 - Federal Advisory Council on Occupational Safety and Health (FACOSH)

    Science.gov (United States)

    2013-11-15

    ... Occupational Safety and Health Administration Federal Advisory Council on Occupational Safety and Health (FACOSH) AGENCY: Occupational Safety and Health Administration (OSHA), Labor. ACTION: Announcement of FACOSH meeting. SUMMARY: The Federal Advisory Council on Occupational Safety and Health (FACOSH)...

  2. 76 FR 39902 - Federal Advisory Council on Occupational Safety and Health (FACOSH)

    Science.gov (United States)

    2011-07-07

    ... Occupational Safety and Health Administration Federal Advisory Council on Occupational Safety and Health (FACOSH) AGENCY: Occupational Safety and Health Administration (OSHA), Labor. ACTION: Request for nominations to serve on the Federal Advisory Council on Occupational Safety and Health (FACOSH). SUMMARY:...

  3. 75 FR 10629 - Federal Advisory Council on Occupational Safety and Health

    Science.gov (United States)

    2010-03-08

    ... Labor Occupational Safety and Health Administration Federal Advisory Council on Occupational Safety and...; ] DEPARTMENT OF LABOR Occupational Safety and Health Administration Federal Advisory Council on Occupational Safety and Health AGENCY: Occupational Safety and Health Administration (OSHA), Labor. ACTION:...

  4. The invisibilization of health promotion in Australian public health initiatives.

    Science.gov (United States)

    O'Hara, Lily; Taylor, Jane; Barnes, Margaret

    2016-07-19

    The field of health promotion has arguably shifted over the past thirty years from being socially proactive to biomedically defensive. In many countries this has been accompanied by a gradual decline, or in some cases the almost complete removal of health promotion designated positions within Government health departments. The language or discourse used to describe the practice and discipline of health promotion is reflective of such changes. In this study, critical discourse analysis was used to determine the representation of health promotion as a practice and a discipline within 10 Australian Government weight-related public health initiatives. The analysis revealed the invisibilization of critical health promotion in favour of an agenda described as 'preventive health'. This was achieved primarily through the textual practices of overlexicalization and lexical suppression. Excluding document titles, there were 437 uses of the terms health promotion, illness prevention, disease prevention, preventive health, preventative health in the documents analysed. The term 'health promotion' was used sparingly (16% of total terms), and in many instances was coupled with the term 'illness prevention'. Conversely, the terms 'preventive health' and 'preventative health' were used extensively, and primarily used alone. The progressive invisibilization of critical health promotion has implications for the perceptions and practice of those identifying as health promotion professionals and for people with whom we work to address the social and structural determinants of health and wellbeing. Language matters, and the language and intent of critical health promotion will struggle to survive if its speakers are professionally unidentifiable or invisible.

  5. [Congressional amendments to the Brazilian Federal health budget].

    Science.gov (United States)

    Baptista, Tatiana Wargas de Faria; Machado, Cristiani Vieira; Lima, Luciana Dias de; Garcia, Marcia; Andrade, Carla Lourenço Tavares de; Gerassi, Camila Duarte

    2012-12-01

    The public budget in Brazil has undergone significant changes since enactment of the 1988 Federal Constitution. Mechanisms for integration of planning activities and budget execution have been created, and Legislative participation in budgeting has increased. Congressional amendments appeared in this context. The article discusses the participation of Congressional amendments in the Federal health budget from 1997 to 2006, combining elements for discussion of funding mechanisms and health planning. Such amendments played a significant role in the budget process, accounting for over half of health funds in some years. The North was the region of Brazil that received most resources resulting from Congressional amendments, suggesting the need for further studies on the relationship between the amendments' enforcement and political party coalitions. The article concludes that the amendments cannot be understood solely as a funding mechanism, but mainly as a political instrument, and that they are not necessarily subject to health planning logic.

  6. Federal disaster mental health response and compliance with best practices.

    Science.gov (United States)

    McIntyre, Jody; Nelson Goff, Briana S

    2012-12-01

    This study investigated the comprehensiveness of disaster mental health state plans and their adherence to published best practices in three states that experienced post-9/11 federally-declared disasters. There were 59 disaster mental health best practices used in this study to assess each state disaster mental plan's compliance with best practices; the states demonstrated a range of adherence to the best practices. This research may serve as a guide for those developing disaster mental health plans and encourage further considerations in disaster mental health response.

  7. 42 CFR 137.302 - Are Federal funds available to cover start-up costs associated with initial Tribal assumption of...

    Science.gov (United States)

    2010-10-01

    ... funds available to cover start-up costs associated with initial Tribal assumption of environmental... 42 Public Health 1 2010-10-01 2010-10-01 false Are Federal funds available to cover start-up costs associated with initial Tribal assumption of environmental responsibilities? 137.302 Section 137.302 Public...

  8. [Opinion of the National Federation of Education and Health Promotion on report "New approaches to public health prevention"].

    Science.gov (United States)

    Cambon, Linda; Ferron, Christine

    2011-01-01

    In 2009, the Center for Strategic Analysis initiated a study, entitled Neurosciences and Public Policies, to assess the use of neurosciences in prevention policy. Subsequently, a report highlighted the inefficiency of the "traditional" prevention programs and the potential contribution of neurosciences to defining a new prevention approach. For the French National Federation for Health Education and Promotion, health promotion cannot be limited to a "counter-manipulation" of consumers confronted with marketing strategies from the food and tobacco industries. Promoting health helps people increase control over the determinants of their health, by means of educational empowering strategies.

  9. 75 FR 62147 - Federal Advisory Council on Occupational Safety and Health (FACOSH)

    Science.gov (United States)

    2010-10-07

    ... Occupational Safety and Health Administration Federal Advisory Council on Occupational Safety and Health (FACOSH) AGENCY: Occupational Safety and Health Administration (OSHA), Labor. ACTION: Announcement of meeting and member appointments. SUMMARY: The Federal Advisory Council on Occupational Safety and...

  10. 76 FR 28816 - Federal Advisory Council on Occupational Safety and Health (FACOSH)

    Science.gov (United States)

    2011-05-18

    ... Occupational Safety and Health Administration Federal Advisory Council on Occupational Safety and Health (FACOSH) AGENCY: Occupational Safety and Health Administration (OSHA), Labor. ACTION: Announcement of meeting and member appointment. SUMMARY: The Federal Advisory Council on Occupational Safety and...

  11. 77 FR 22355 - Federal Advisory Council on Occupational Safety and Health (FACOSH)

    Science.gov (United States)

    2012-04-13

    ... Occupational Safety and Health Administration Federal Advisory Council on Occupational Safety and Health (FACOSH) AGENCY: Occupational Safety and Health Administration (OSHA), Labor. ACTION: Announcement of FACOSH meeting and member appointments. SUMMARY: The Federal Advisory Council on Occupational Safety...

  12. Federal mandatory spending caps vital for health care reform.

    Science.gov (United States)

    Domenici, P V

    1992-01-01

    Rising health spending creates an increasing burden on families, businesses, and government. Federal health spending--chiefly on Medicare and Medicaid--is a major contributor to a budget deficit that threatens to exceed $400 billion. In order to control that deficit, the President and the Congress must cap mandatory spending, excluding Social Security. In turn, policymakers should adopt health reforms to fit spending within the cap including enrolling more consumers in managed care plans, resolving medical liability disputes in arbitration instead of courts, and increasing assessment of research into cost-effective new technology.

  13. 77 FR 42417 - Federal Employees Health Benefits Program Coverage for Certain Firefighters

    Science.gov (United States)

    2012-07-19

    ... 3206-AM66 Federal Employees Health Benefits Program Coverage for Certain Firefighters AGENCY: Office of... (OPM) is issuing an interim final rule to amend the Federal Employees Health Benefits Program (FEHB... health insurance coverage under the Federal Employees Health Benefits (FEHB) program to...

  14. New York State Health Foundation grant helps health centers win federal expansion funds.

    Science.gov (United States)

    Sandman, David; Cozine, Maureen

    2012-11-01

    With approximately 1.2 million New Yorkers poised to gain health insurance coverage as a result of federal health reform, demand for primary care services is likely to increase greatly. The Affordable Care Act includes $11 billion in funding to enhance primary care access at community health centers. Recognizing a need and an opportunity, in August 2010 the New York State Health Foundation made a grant of nearly $400,000 to the Community Health Care Association of New York State to work with twelve health centers to develop successful proposals for obtaining and using these federal funds. Ultimately, eleven of the twelve sites are expected to receive $25.6 million in federal grants over a five-year period-a sixty-four-fold return on the foundation's investment. This article describes the strategy for investing in community health centers; identifies key project activities, challenges, and lessons; and highlights its next steps for strengthening primary care.

  15. Designing Work, Family & Health Organizational Change Initiatives.

    Science.gov (United States)

    Kossek, Ellen Ernst; Hammer, Leslie B; Kelly, Erin L; Moen, Phyllis

    2014-01-01

    For decades, leaders and scholars have been advocating change efforts to improve work-life relationships. Yet most initiatives have lacked rigor and not been developed using scientific principles. This has created an evidence gap for employer support of work and personal life as a win-win for productivity and employees' well-being. This paper examines the approach used by the U.S. Work Family Health Network (WFRN) to develop an innovative workplace intervention to improve employee and family health. The change initiative was designed to reduce organizationally based work-family conflict in two contrasting contexts representative of major segments of today's U.S. workforce: health care employees and informational technology professionals. The WFRN Intervention (called STAR) had three theoretically based change elements. They were: 1) increase job control over work time and schedule; 2) increase supervisor social support for family and job effectiveness; and 3) improve organizational culture and job design processes to foster results orientation. Seven practical lessons for developing work-life interventions emerged from this groundbreaking endeavor.

  16. Electronic Health Record Vendors Reported by Health Care Providers Participating in Federal EHR Incentive Programs

    Data.gov (United States)

    U.S. Department of Health & Human Services — This public use file combines registration data compiled from two federal programs that are on-going since February 2009 – the Centers for Medicare & Medicaid...

  17. 76 FR 38281 - Federal Employees Health Benefits Program: New Premium Rating Method for Most Community Rated...

    Science.gov (United States)

    2011-06-29

    .... Federal Employees Health Benefits Program: New Premium Rating Method for Most Community Rated Plans... 3206-AM39 Federal Employees Health Benefits Program: New Premium Rating Method for Most Community...

  18. Federalism and health policy: the intergovernmental committees in Brazil

    Directory of Open Access Journals (Sweden)

    Cristiani Vieira Machado

    2014-08-01

    Full Text Available OBJECTIVE To analyze the dynamics of operation of the Bipartite Committees in health care in the Brazilian states. METHODS The research included visits to 24 states, direct observation, document analysis, and performance of semi-structured interviews with state and local leaders. The characterization of each committee was performed between 2007 and 2010, and four dimensions were considered: (i level of institutionality, classified as advanced, intermediate, or incipient; (ii agenda of intergovernmental negotiations, classified as diversified/restricted, adapted/not adapted to the reality of each state, and shared/unshared between the state and municipalities; (iii political processes, considering the character and scope of intergovernmental relations; and (iv capacity of operation, assessed as high, moderate, or low. RESULTS Ten committees had advanced level of institutionality. The agenda of the negotiations was diversified in all states, and most of them were adapted to the state reality. However, one-third of the committees showed power inequalities between the government levels. Cooperative and interactive intergovernmental relations predominated in 54.0% of the states. The level of institutionality, scope of negotiations, and political processes influenced Bipartite Committees’ ability to formulate policies and coordinate health care at the federal level. Bipartite Committees with a high capacity of operation predominated in the South and Southeast regions, while those with a low capacity of operations predominated in the North and Northeast. CONCLUSIONS The regional differences in operation among Bipartite Interagency Committees suggest the influence of historical-structural variables (socioeconomic development, geographic barriers, characteristics of the health care system in their capacity of intergovernmental health care management. However, structural problems can be overcome in some states through institutional and political changes

  19. 76 FR 17419 - Federal Health IT Strategic Plan: 2011-2015 Open Comment Period

    Science.gov (United States)

    2011-03-29

    ... HUMAN SERVICES Federal Health IT Strategic Plan: 2011-2015 Open Comment Period AGENCY: Office of the... the Federal Health IT Strategic Plan (developed June 3, 2008) in consultation with other appropriate... the Federal Health IT Strategic Plan is open through Friday, April 22 at 11:59 p.m. (Eastern)....

  20. Repealing Federal Health Reform: Economic and Employment Consequences for States.

    Science.gov (United States)

    Ku, Leighton; Steinmetz, Erika; Brantley, Erin; Bruen, Brian

    2017-01-01

    Issue: The incoming Trump administration and Republicans in Congress are seeking to repeal the Affordable Care Act (ACA), likely beginning with the law’s insurance premium tax credits and expansion of Medicaid eligibility. Research shows that the loss of these two provisions would lead to a doubling of the number of uninsured, higher uncompensated care costs for providers, and higher taxes for low-income Americans. Goal: To determine the state-by-state effect of repeal on employment and economic activity. Methods: A multistate economic forecasting model (PI+ from Regional Economic Models, Inc.) was used to quantify for each state the effects of the federal spending cuts. Findings and Conclusions: Repeal results in a $140 billion loss in federal funding for health care in 2019, leading to the loss of 2.6 million jobs (mostly in the private sector) that year across all states. A third of lost jobs are in health care, with the majority in other industries. If replacement policies are not in place, there will be a cumulative $1.5 trillion loss in gross state products and a $2.6 trillion reduction in business output from 2019 to 2023. States and health care providers will be particularly hard hit by the funding cuts.

  1. Health effects of the Federal Bureau of Prisons tobacco ban

    Directory of Open Access Journals (Sweden)

    Martin Stephen A

    2012-10-01

    Full Text Available Abstract Background Tobacco smoking remains the leading cause of preventable death in America, claiming 450,000 lives annually. Chronic Obstructive Pulmonary Disease, caused by smoking in the vast majority of cases, became the third leading cause of death in the U.S. in 2008. The burden of asthma, often exacerbated by tobacco exposure, has widespread clinical and public health impact. Despite this considerable harm, we know relatively little about the natural history of lung disease and respiratory impairment in adults, especially after smoking cessation. Methods/Design Our paper describes the design and rationale for using the 2004 Federal Bureau of Prisons tobacco ban to obtain insights into the natural history of respiratory diseases in adult men and women of different races/ethnicities who are imprisoned in federal medical facilities. We have developed a longitudinal study of new prison arrivals, with data to be collected from each participant over the course of several years, through the use of standardized questionnaires, medical chart reviews, lung function tests, six-minute walk tests, and stored serum for the analysis of present and future biomarkers. Our endpoints include illness exacerbations, medication and health services utilization, lung function, serum biomarkers, and participants’ experience with their health and nicotine addiction. Discussion We believe the proposed longitudinal study will make a substantial contribution to the understanding and treatment of respiratory disease and tobacco addiction.

  2. Federal health policies in the United States: an alternative explanation.

    Science.gov (United States)

    Navarro, V

    1987-01-01

    Since 1980 there has been an unprecedented shift in federal expenditures away from health and social welfare; an "electoral mandate" to reduce government's role is widely cited as justification. Yet, a survey of all major opinion polls of the past decade shows that electoral behavior and popular opinion are not synonymous. In exploring the historical ideological roots of this disjunction, the post- New Deal rise of "interest group" over "class" behavior is noted; "depoliticization" of political issues and "abstentionism" in voting follow. Rather than a realignment, recent elections represent a dealignment from regressive choices.

  3. DOE-HUD Initiative on Energy Efficiency in Housing: A federal partnership. Program summary report

    Energy Technology Data Exchange (ETDEWEB)

    Brinch, J. [Energetics, Inc., Columbia, MD (United States)

    1996-06-01

    One of the primary goals of the US Department of Housing and urban Development (HUD) is the expansion of home ownership and affordable housing opportunities. Recognizing that energy efficiency is a key component in an affordable housing strategy, HUD and the US Department of Energy (DOE) created the DOE-HUD Initiative on Energy Efficiency in Housing. The DOE-HUD Initiative was designed to share the results of DOE research with housing providers throughout the nation, to reduce energy costs in federally-subsidized dwelling units and improve their affordability and comfort. This Program Summary Report provides an overview of the DOE-HUD Initiative and detailed project descriptions of the twenty-seven projects carried out with Initiative funding.

  4. Use of qualitative methods and user-centered design to develop customized health information technology tools within federally qualified health centers to keep children insured.

    Science.gov (United States)

    DeVoe, Jennifer; Angier, Heather; Likumahuwa, Sonja; Hall, Jennifer; Nelson, Christine; Dickerson, Kay; Keller, Sara; Burdick, Tim; Cohen, Deborah

    2014-01-01

    Lack of health insurance negatively impacts children's health. Despite federal initiatives to expand children's coverage and accelerate state outreach efforts, millions of US children remain uninsured or experience frequent gaps in coverage. Most current efforts to enroll and retain eligible children in public insurance programs take place outside of the health care system. This study is a partnership between patients' families, medical informaticists, federally qualified health center (FQHC) staff, and researchers to build and test information technology tools to help FQHCs reach uninsured children and those at risk for losing coverage.

  5. Federal health insurance reform and "exchanges": recent history.

    Science.gov (United States)

    Brandon, William P; Carnes, Keith

    2014-02-01

    The major national innovation of the Affordable Care Act (ACA) is the insurance exchange or health insurance marketplace (HIM). We begin by briefly reviewing the ACA's chief features and detailing its HIM provisions. Section two explores the policy history of exchanges, beginning with Clinton's proposals and Massachusetts' Connector and concluding by contrasting the House-passed bill with one national exchange and the Senate bill with state-based exchanges. The Senate bill became the ACA. The evolution of policy ideas about exchanges suggests three critical conditions for a successful exchange: commodification (of insurance products), competition (between insurers), and communication (to potential buyers and the public about insurance). The penultimate section compares the rollout of the state-run Kentucky exchange and the federally facilitated exchange in North Carolina in light of what we will call the 3 Cs. The conclusion reflects more widely upon the unique form that the pro-competition or deregulatory strategy has taken in health policy.

  6. DOE-HUD initiative on energy efficiency in housing: A federal partnership

    Energy Technology Data Exchange (ETDEWEB)

    Brinch, J. [Energetics, Inc., Columbia, MD (United States); Ternes, M. [Oak Ridge National Lab., TN (United States); Myers, M. [USDOE, Washington, DC (United States)

    1996-07-01

    A five-year initiative between the US Department of Energy (DOE) and the US Department of Housing and Urban Development (HUD) demonstrated the feasibility of improving the energy efficiency of publicly-assisted housing. Twenty-seven projects and activities undertaken during 1990--95 involved research and field demonstrations, institutional and administrative changes to HUD policies and procedures, innovative financing and leveraging of federal dollars with non-federal money, and education, training, and technical assistance. With most of the 27 projects and activities completed, the two departments have initiated a five-year deployment effort, the DOE-Energy Partnerships for Affordable Homes, to achieve energy and water savings in public and assisted housing on a large scale throughout the country. A Clearinghouse for Energy Efficiency in Public and Assisted Housing managed by the National Center for Appropriate Technology (NCAT), will offer hands-on energy assistance to housing providers to complement DOE`s assistance. This paper presents the findings of the DOE-HUD Initiative, with primary attention paid to those projects which successfully integrated energy efficiency into private and public single and multifamily housing. The paper includes examples of the publications, case-study reports, exhibits and videotapes developed during the course of the Initiative. Information on the new DOE Energy Partnerships and on the NCAT Clearinghouse is also presented. New Partnership projects with the Atlanta and Chicago Housing Authorities describe the technical assistance envisioned under the Partnership.

  7. Disaster prepared: How federal funding in the USA supports health system and public health readiness.

    Science.gov (United States)

    Schlegelmilch, Jeff; Petkova, Elisaveta; Redlener, Irwin

    Federal funding for health and medical preparedness in the USA has created an important foundation for preparing the health and medical systems to respond to a wide range of hazards. A declining trend in funding for these preparedness activities threatens to undo the progress that has been made over the last decade and reduce the state of readiness to respond to the health and medical impacts of disasters.

  8. Enabling Quality: Electronic Health Record Adoption and Meaningful Use Readiness in Federally Funded Health Centers.

    Science.gov (United States)

    Wittie, Michael; Ngo-Metzger, Quyen; Lebrun-Harris, Lydie; Shi, Leiyu; Nair, Suma

    2016-01-01

    The Health Resources and Services Administration has supported the adoption of electronic health records (EHRs) by federally funded health centers for over a decade; however, little is known about health centers' current EHR adoption rates, progress toward Meaningful Use, and factors related to adoption. We analyzed cross-sectional data from all 1,128 health centers in 2011, which served over 20 million patients during that year. As of 2011, 80% of health centers reported using an EHR, and high proportions reported using many advanced EHR functionalities. There were no indications of disparities in EHR adoption by census region, urban/rural location, patient sociodemographic composition, physician staffing, or health center funding; however, there were small variations in adoption by total patient cost and percent of revenue from grants. Findings revealed no evidence of a digital divide among health centers, indicating that health centers are implementing EHRs, in keeping with their mission to reduce health disparities.

  9. 78 FR 50119 - Federal Employees Health Benefits Program: Medically Underserved Areas for 2014

    Science.gov (United States)

    2013-08-16

    ... From the Federal Register Online via the Government Publishing Office OFFICE OF PERSONNEL MANAGEMENT Federal Employees Health Benefits Program: Medically Underserved Areas for 2014 AGENCY: U.S... Medically Underserved Areas under the Federal Employees Health Benefits (FEHB) Program for calendar...

  10. 77 FR 43127 - Federal Employees Health Benefits Program: Medically Underserved Areas for 2013

    Science.gov (United States)

    2012-07-23

    ... From the Federal Register Online via the Government Publishing Office OFFICE OF PERSONNEL MANAGEMENT Federal Employees Health Benefits Program: Medically Underserved Areas for 2013 AGENCY: U.S... Medically Underserved Areas under the Federal Employees Health Benefits (FEHB) Program for calendar...

  11. 78 FR 54923 - Federal Advisory Council on Occupational Safety and Health

    Science.gov (United States)

    2013-09-06

    ... Occupational Safety and Health Administration Federal Advisory Council on Occupational Safety and Health AGENCY: Occupational Safety and Health Administration (OSHA), Labor. ACTION: Request for nominations to serve on the Federal Advisory Council on Occupational Safety and Health (FACOSH). SUMMARY: The Assistant Secretary...

  12. 76 FR 71077 - Federal Advisory Council on Occupational Safety and Health (FACOSH)

    Science.gov (United States)

    2011-11-16

    ... Occupational Safety and Health Administration Federal Advisory Council on Occupational Safety and Health (FACOSH) AGENCY: Occupational Safety and Health Administration (OSHA), Labor. ACTION: Announcement of... advise the Secretary of Labor (Secretary) on all matters relating to the occupational safety and...

  13. 76 FR 60535 - Federal Advisory Council on Occupational Safety and Health

    Science.gov (United States)

    2011-09-29

    ... Occupational Safety and Health Administration Federal Advisory Council on Occupational Safety and Health AGENCY: Occupational Safety and Health Administration (OSHA), Labor. ACTION: Reopening of the record and extension of... submitting nominations for membership on the Federal Advisory Council on Occupational Safety and...

  14. The federal government commissioner for patient issues in Germany: initial analysis of the user inquiries

    Directory of Open Access Journals (Sweden)

    Seidel Gabriele

    2007-02-01

    Full Text Available Abstract Background The political objective in many countries worldwide is to give better consideration to the interests of patients within the health system. The establishment of a federal government commissioner for the issues of patients in the health system in Germany in 2004 is part of these endeavours. The structure and field of activities of this institution has been unique so far. This study investigates for the first time the inquiries the commissioner receives from the public. Methods A 33% sampling (n = 850 of the written inquiries (correspondence and e-mails addressed to the commissioner in the first six months of the year 2005 (n = 2580 was investigated. In a procedure comprising combined qualitative and quantitative levels, the material was thematically encoded and the inquiries allocated to the resulting categories (multiple nominations. The results are presented in descriptive form and investigated especially with respect to sex and age-specific differences. The interdependences between the categorized criteria are analysed. Results The inquirers are equally spread out amongst the sexes (49% women, 51% men. Older persons outweigh the younger (69% over 60 years. In most cases the issues take the form of claims (72%, n = 609. In every fifth inquiry (n = 168 the personal financial burden for health services is considered as being too high; about equally high (n = 159 is the proportion of persons who criticize the communication with health professionals, especially hospitals and doctors' surgeries. Every third who mentions a medical practice uses terms such as "uncertainty" and "anxiety". It is conspicuous that men more often than women write that they feel unfairly treated in the health system (62% vs. 38%, p Conclusion Predominantly older persons seek the assistance of the federal government commissioner for patient issues. Considerable uncertainty and anxiety with respect to services and charges within the system of the German

  15. Health Promoting Schools: Initiatives in Africa

    Science.gov (United States)

    Macnab, Andrew J.; Stewart, Donald; Gagnon, Faith A.

    2014-01-01

    Purpose: The purpose of this paper is to describe the rationale for and potential of World Health Organization (WHO) health promoting schools (HPS) in Africa. Design/Methodology/Approach: Overview of the related literature and presentations at the 2011 Stellenbosch international colloquium on HPS relating to sub-Saharan Africa. Findings: Schools…

  16. Health Promoting Schools: Initiatives in Africa

    Science.gov (United States)

    Macnab, Andrew J.; Stewart, Donald; Gagnon, Faith A.

    2014-01-01

    Purpose: The purpose of this paper is to describe the rationale for and potential of World Health Organization (WHO) health promoting schools (HPS) in Africa. Design/Methodology/Approach: Overview of the related literature and presentations at the 2011 Stellenbosch international colloquium on HPS relating to sub-Saharan Africa. Findings: Schools…

  17. [Art, health and prevention: initial collaborations].

    Science.gov (United States)

    Avila, Noemí; Orellana, Ana; Cano, Marta G; Antúnez, Noelia; Claver, Dolores

    2014-01-01

    This article presents a summary of the first 2 years of the collaboration between the Faculty of Fine Arts of the Universidad Complutense in Madrid and Madrid Health, an autonomous organism of Madrid Council. This collaboration has allowed the development of joint experiences and projects among distinct professionals with highly diverse profiles: health professionals (sexologists, psychiatrists, nurses, etc.), and teachers, researchers, artists and students in the Faculty of Fine Arts. As a result, these experiences could be the beginning of future collaborations between the arts, health and prevention. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

  18. Hospital federations and human resources for health: trends and proposals for improvement.

    Science.gov (United States)

    Vincent, Gérard; De Roodenbeke, Eric

    2007-01-01

    Health system performance depends on a performing health workforce. In many health care systems, hospital federations are key players as they represent actors, which are important in terms number of qualified health workers employed, and of the volume of services provided. In addressing the "crisis of human resources for health" (HRH) they are part of the problem as well as the solution.

  19. Physical Restraint Initiation in Nursing Homes and Subsequent Resident Health

    Science.gov (United States)

    Engberg, John; Castle, Nicholas G.; McCaffrey, Daniel

    2008-01-01

    Purpose: It is widely believed that physical restraint use causes mental and physical health decline in nursing home residents. Yet few studies exist showing an association between restraint initiation and health decline. In this research, we examined whether physical restraint initiation is associated with subsequent lower physical or mental…

  20. Initial Validation of the Mental Health Provider Stigma Inventory

    Science.gov (United States)

    Kennedy, Stephanie C.; Abell, Neil; Mennicke, Annelise

    2017-01-01

    Objective: To conduct an initial validation of the mental health provider stigma inventory (MHPSI). The MHPSI assesses stigma within the service provider--client relationship on three domains--namely, attitudes, behaviors, and coworker influence. Methods: Initial validation of the MHPSI was conducted with a sample of 212 mental health employees…

  1. Perspectives on the Federal Government and Health Information: Patterns, Impact, Expectations.

    Science.gov (United States)

    Lunin, Lois F.; And Others

    1987-01-01

    Nine articles examine patterns of federal health information services including: the current Administration's policy; the history of the National Library of Medicine; Federal Health Information Clearinghouses and other unique projects; the Center for the Utilization of Technology; marketing trends at the Government Printing Office; and…

  2. Women's Health Initiative (WHI) Background and Overview

    Science.gov (United States)

    ... chronic diseases are the major causes of death, disability and frailty in older women of all races and socioeconomic backgrounds. This multi- ... CDC), and the National Institutes of Health. Eight University-based Prevention ... encouraged women of all races and socioeconomic backgrounds to adopt ...

  3. Mobile phone health risk policy in Germany: the role of the federal government and the Federal Office for Radiation Protection.

    Science.gov (United States)

    Schweikardt, Christoph; Gross, Dominik

    2012-01-01

    In order to establish a regulatory framework for a given technology important to society, the government must make decisions in the face of existing unknowingness. In the last decade, health risks originating from electromagnetic fields of mobile telecommunication transmitting stations and devices have become a regulation policy issue in Germany. This article investigates the role of the government and the Federal Office for Radiation Protection in regard to policy-making by analysing publications and Federal Parliament reports, hearings and debates. The government and Federal Parliament perceived the research situation in 2001 as insufficient in the absence of hard evidence for health impairment. Against this background, the government struck a compromise with mobile telecommunication network operators, who did not want to integrate stricter limit values for transmission stations as precautionary measures. The network operators' voluntary self-commitment included financing half the budget of the German Mobile Telecommunication Research Programme (2002-2008) under the lead management of the Federal Office for Radiation Protection, which concluded that it was not required to change the position taken in 2001. The results of this programme provided the basis to continue the agreement of that year. With regard to health issues and all the other interests involved, this agreement was an acceptable and remarkably stable compromise.

  4. Federating clinical data from six pediatric hospitals: process and initial results for microbiology from the PHIS+ consortium.

    Science.gov (United States)

    Gouripeddi, Ramkiran; Warner, Phillip B; Mo, Peter; Levin, James E; Srivastava, Rajendu; Shah, Samir S; de Regt, David; Kirkendall, Eric; Bickel, Jonathan; Korgenski, E Kent; Precourt, Michelle; Stepanek, Richard L; Mitchell, Joyce A; Narus, Scott P; Keren, Ron

    2012-01-01

    Microbiology study results are necessary for conducting many comparative effectiveness research studies. Unlike core laboratory test results, microbiology results have a complex structure. Federating and integrating microbiology data from six disparate electronic medical record systems is challenging and requires a team of varied skills. The PHIS+ consortium which is partnership between members of the Pediatric Research in Inpatient Settings (PRIS) network, the Children's Hospital Association and the University of Utah, have used "FURTHeR' for federating laboratory data. We present our process and initial results for federating microbiology data from six pediatric hospitals.

  5. [Connections between fiscal federalism and the funding of the Brazilian health care policy].

    Science.gov (United States)

    de Lima, Luciana Dias

    2007-01-01

    In the Brazilian society's context of meager financial resources for health care, associated with structural features of fiscal federalism and with the current model of funding transfers for the Unified Health System's (SUS), important inequities directly impact political negotiations and the deployment of federal financing alternatives which are not directly linked to the supply and production of health care activities and services by states and municipalities. We observed that health policies, since the second half of the nineties, have developed their own mechanisms that, in the above mentioned context, tend to accommodate different interests and federative conflicts generated by structural factors and by institutional rules. However, the absence of an integrated planning program between the criteria to establish resource redistribution for financing the Unified Health System and the Brazilian Federation's fiscal sharing system, end up reinforcing certain asymmetric patterns and generating new imbalances, making the compensation of inequities difficult in public health spending at the sub-national domain.

  6. [The Federal Law "On the fundamentals of health protection of citizen in the Russian Federation" and the issues of management of medical care quality].

    Science.gov (United States)

    Lindenbraten, A P

    2012-01-01

    The article deals with the analysis of main statutory provisions of the Federal Law of the Russian Federation No 323-FZ of 21.11.2011 "On the fundamentals of health protection of citizen in the Russian Federation", concerning the issue of medical care quality.

  7. Bioterrorism and biological threats dominate federal health security research; other priorities get scant attention.

    Science.gov (United States)

    Shelton, Shoshana R; Connor, Kathryn; Uscher-Pines, Lori; Pillemer, Francesca Matthews; Mullikin, James M; Kellermann, Arthur L

    2012-12-01

    The federal government plays a critical role in achieving national health security by providing strategic guidance and funding research to help prevent, respond to, mitigate, and recover from disasters, epidemics, and acts of terrorism. In this article we describe the first-ever inventory of nonclassified national health security-related research funded by civilian agencies of the federal government. Our analysis revealed that the US government's portfolio of health security research is currently weighted toward bioterrorism and emerging biological threats, laboratory methods, and development of biological countermeasures. Eight of ten other priorities identified in the Department of Health and Human Services' National Health Security Strategy-such as developing and maintaining a national health security workforce or incorporating recovery into planning and response-receive scant attention. We offer recommendations to better align federal spending with health security research priorities, including the creation of an interagency working group charged with minimizing research redundancy and filling persistent gaps in knowledge.

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

    OpenAIRE

    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...

  9. Federal Program Encourages Health Service Innovations on Developmental Disabilities

    Science.gov (United States)

    Nix, Mary P.

    2009-01-01

    There is always room for improvement in the delivery of health services. This article discusses the U.S. Agency for Healthcare Research and Quality's (AHRQ) Health Care Innovations Exchange (www.innovations.ahrq.gov), a comprehensive program that aims to increase awareness of innovative strategies to meet health service delivery challenges and…

  10. Administrative Challenges to the Integration of Oral Health With Primary Care: A SWOT Analysis of Health Care Executives at Federally Qualified Health Centers.

    Science.gov (United States)

    Norwood, Connor W; Maxey, Hannah L; Randolph, Courtney; Gano, Laura; Kochhar, Komal

    Inadequate access to preventive oral health services contributes to oral health disparities and is a major public health concern in the United States. Federally Qualified Health Centers play a critical role in improving access to care for populations affected by oral health disparities but face a number of administrative challenges associated with implementation of oral health integration models. We conducted a SWOT (strengths, weaknesses, opportunities, and threats) analysis with health care executives to identify strengths, weaknesses, opportunities, and threats of successful oral health integration in Federally Qualified Health Centers. Four themes were identified: (1) culture of health care organizations; (2) operations and administration; (3) finance; and (4) workforce.

  11. 29 CFR 1960.19 - Other Federal agency standards affecting occupational safety and health.

    Science.gov (United States)

    2010-07-01

    ... safety and health. 1960.19 Section 1960.19 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL... EMPLOYEE OCCUPATIONAL SAFETY AND HEALTH PROGRAMS AND RELATED MATTERS Standards § 1960.19 Other Federal agency standards affecting occupational safety and health. (a) Where employees of different...

  12. 77 FR 39743 - Federal Advisory Council on Occupational Safety and Health (FACOSH)

    Science.gov (United States)

    2012-07-05

    ...] [FR Doc No: 2012-16468] DEPARTMENT OF LABOR Occupational Safety and Health Administration [Docket No. OSHA-2012-0022] Federal Advisory Council on Occupational Safety and Health (FACOSH) AGENCY: Occupational Safety and Health Administration (OSHA), Labor. ACTION: Request for nominations to serve on...

  13. Federal Civil Rights Policy and Mental Health Treatment Access for Persons with Limited English Proficiency

    Science.gov (United States)

    Snowden, Lonnie R.; Masland, Mary; Guerrero, Rachel

    2007-01-01

    As noted in the supplement to the U.S. Surgeon General's report on mental health (U.S. Department of Health and Human Services, 2001), overcoming language access barriers associated with limited English proficiency (LEP) should help to eliminate racial and ethnic disparities in mental health care access and quality. Federal policy requires…

  14. An Overview of Federal Concerns in Health Care and Preventive Medicine

    Science.gov (United States)

    Jordan, Barbara

    1978-01-01

    Improvement of federal effectiveness in the fields of health care and preventive medicine involves pressure by the public directed toward appropriation of monies, as well as their preliminary authorization. (MJB)

  15. 76 FR 22899 - Federal Health IT Strategic Plan: 2011-2015 Open Comment Period Extended Until Friday, May 6

    Science.gov (United States)

    2011-04-25

    ... HUMAN SERVICES Federal Health IT Strategic Plan: 2011-2015 Open Comment Period Extended Until Friday...: Notice. SUMMARY: The Federal Health IT Strategic Plan: 2011-2015 (``the Plan'') ] was posted on the ONC... considered, you must submit your comment via the Federal Health IT Buzz Blog:...

  16. 78 FR 64873 - Federal Employees Health Benefits Program and Federal Employees Dental and Vision Insurance...

    Science.gov (United States)

    2013-10-30

    ... legal union between one man and one woman as husband and wife, and that the term ``spouse'' referred only to a person of the opposite sex who is a husband or wife. Thus, the availability of same-sex... health insurance coverage for children under the Patient Protection and Affordable Care Act, Public...

  17. Does nativity matter?: Correlates of immigrant health by generation in the Russian Federation

    Directory of Open Access Journals (Sweden)

    Cynthia Buckley

    2011-06-01

    Full Text Available The Russian Federation has experienced simultaneous declines in health and rises in international migration. Guided by the "healthy migrant effect" found elsewhere, we examine two questions. First, do the foreign-born in the Russian Federation exhibit better overall health than the native-born? Second, to the extent positive health selectivity exists, is it transferred to the second generation? Using the first wave of the Russian Generations and Gender Survey, our findings support the idea of positive health selection among international migrants from non-Slavic regions. The effect of migrant status, regardless of origin, diminishes when age, sex, and native language are taken into account.

  18. 75 FR 76615 - Federal Employees Health Benefits Program Miscellaneous Changes

    Science.gov (United States)

    2010-12-09

    ... benefits. The authority to permit the Plan to offer more than two levels of benefits is a matter for... to subsidize health insurance premium payments for certain low-income children who have access to... child health assistance are eligible to receive State premium subsidy assistance payments to help...

  19. 75 FR 20314 - Federal Employees Health Benefits Program; Miscellaneous Changes

    Science.gov (United States)

    2010-04-19

    .... The law provides that a Senate Restaurants employee who was an employee of the Architect of the... deductible health plan. This will provide for more flexibility in contracting with health plans for modern... Restaurants employees. (a) A Senate Restaurants employee who was an employee of the Architect of the Capitol...

  20. Federally Sponsored Health Care Research Gulf War Illnesses and Beyond

    Science.gov (United States)

    2007-03-22

    amyotrophic lateral sclerosis or ALS).10 Many Gulf War veterans rejected the IOM study’s findings, as they did previous reports and studies that...assessment of the titles, abstracts and references found in the initial searches, the committee focused on 850 potentially relevant epidemiologic studies...and has ongoing initiatives to accomplish these goals which will be discussed later in this writing. In 1998, in response to growing concerns of

  1. Approaches to Reducing Federal Spending on Military Health Care

    Science.gov (United States)

    2014-01-01

    medical school, the Uniformed Services University of the Health Sciences (USUHS), while expanding the number of scholarships provided to students... actuaries esti- 8. Department of Defense, Evaluation of the TRICARE Program— Access, Cost and Quality: Fiscal Year 2013 Report to Congress (February...DoD’s Uniformed Services University of the Health Sciences —would be closed. 4. See Congressional Budget Office, Lessons from Medicare’s Demonstration

  2. A strategic approach of E-health initiatives.

    Science.gov (United States)

    Asoh, Derek A; Rivers, Patrick A; Shih, Stephen C; Tsai, Kai-Li

    2008-01-01

    The Internet is transforming the US economy. Though it continues to lag behind other industries, healthcare has begun to incorporate this technology on a wider scale to reduce costs and more effectively address quality and patient-choice issues. This article presents the background of the US healthcare system, examines the application of e-health, advocates for the integration of e-health components and discusses the roles of major stakeholders in e-health as the basis for the strategic planning, initiation and implementation of integrated e-health systems. Strategic planning provides the opportunity for an insightful view and consideration of the impacts, expectations and responses of e-health stakeholders while implementing integrated e-health solutions for access to more cost-effective and better patient care delivery.

  3. Federal investment in health information technology: how to motivate it?

    Science.gov (United States)

    Bower, Anthony G

    2005-01-01

    Health care market failures include inefficient standard making, problems with coordination among local providers to optimize care, and inability to measure quality accurately, inexpensively, or reliably. Study of other industries suggests policy directions for health information technology and the magnitude of gains from improving market functioning, which are very large. A perspective drawn from U.S. industrial history--in particular railroads and the interstate highway system--suggests an investment level roughly consistent with recent estimates drawn from the medical literature. The benefits of quick action probably outweigh the benefits of delaying and choosing the perfect funding mechanism.

  4. Health workforce responses to global health initiatives funding: a comparison of Malawi and Zambia

    NARCIS (Netherlands)

    R. Brugha; J. Kadzandira; J. Simbaya; P. Dicker; V. Mwapasa; A. Walsh

    2010-01-01

    Background Shortages of health workers are obstacles to utilising global health initiative (GHI) funds effectively in Africa. This paper reports and analyses two countries' health workforce responses during a period of large increases in GHI funds. Methods Health facility record reviews were conduct

  5. Student-Initiated Sexual Health Selective as a Curricular Tool

    Directory of Open Access Journals (Sweden)

    Katie Johnson, BS

    2015-06-01

    Conclusions: The 1-week SHS was successfully implemented through the teamwork of a medical student and faculty champion. It resulted in more accurate knowledge and more open attitudes toward sexual health among participating medical students. Potential benefits to undergraduate medical educators are reviewed. Johnson K, Rullo J, and Faubion S. Student-initiated sexual health selective as a curricular tool. Sex Med 2015;3:118–127.

  6. Federal spending on behavioral health accelerated during recession as individuals lost employer insurance.

    Science.gov (United States)

    Levit, Katharine R; Mark, Tami L; Coffey, Rosanna M; Frankel, Sasha; Santora, Patricia; Vandivort-Warren, Rita; Malone, Kevin

    2013-05-01

    The 2007-09 recession had a dramatic effect on behavioral health spending, with the effect most prominent for private, state, and local payers. During the recession behavioral health spending increased at a 4.6 percent average annual rate, down from 6.1 percent in 2004-07. Average annual growth in private behavioral health spending during the recession slowed to 2.7 percent from 7.2 percent in 2004-07. State and local behavioral health spending showed negative average annual growth, -1.2 percent, during the recession, compared with 3.7 percent increases in 2004-07. In contrast, federal behavioral health spending growth accelerated to 11.1 percent during the recession, up from 7.2 percent in 2004-07. These behavioral health spending trends were driven largely by increased federal spending in Medicaid, declining private insurance enrollment, and severe state budget constraints. An increased federal Medicaid match reduced the state share of Medicaid spending, which prevented more drastic cuts in state-funded behavioral health programs during the recession. Federal Medicaid served as a critical safety net for people with behavioral health treatment needs during the recession.

  7. 29 CFR 500.133 - Substantive Federal and State safety and health standards defined.

    Science.gov (United States)

    2010-07-01

    ..., DEPARTMENT OF LABOR REGULATIONS MIGRANT AND SEASONAL AGRICULTURAL WORKER PROTECTION Motor Vehicle Safety and Insurance for Transportation of Migrant and Seasonal Agricultural Workers, Housing Safety and Health for Migrant Workers Housing Safety and Health § 500.133 Substantive Federal and State safety and...

  8. Internal Variations in Health-care Federalism in Canada and the United States

    Directory of Open Access Journals (Sweden)

    Vandna Bhatia

    2014-12-01

    Full Text Available Federal systems are prone to dividing health benefits inconsistently across subnational jurisdictions. In this article, we examine how federalism intersects with economic and social factors, particularly gender and immigration status, to create structural barriers to accessing and receiving necessary healthcare. Drawing on insights from the historical institutionalist literature and the experiences of immigrant women in the Canadian and American health systems, we find significant subnational variations in access to health services and insurance coverage. Gaps in service – which are filled (if at all by costly, inaccessible private provision – are the product of piecemeal policymaking, as new programs and services are layered onto existing systems which are themselves outdated and anachronistic. Our analysis demonstrates the need to move beyond analyses of federal state architectures to an intersectional approach to better understand the differential negative impact of subnational variations on equity between social groups and their ability to access to basic health services.

  9. 75 FR 17700 - Energy Efficient Building Systems Regional Innovation Cluster Initiative-Joint Federal Funding...

    Science.gov (United States)

    2010-04-07

    ... organizations, and other interested parties to learn more about the Joint Federal Funding Opportunity... work to disseminate new technologies into the marketplace and share best practices with the public and... multidisciplinary team of researchers ideally working under one roof to conduct high-risk, high-reward research that...

  10. Federal Health Care Center: VA and DOD Need to Develop Better Information to Monitor Operations and Improve Efficiency

    Science.gov (United States)

    2017-01-01

    requirement to include two more reports, resulting in GAO reports in 2011, 2012, and 2016. 5GAO, VA and DOD Health Care: First Federal Health ...FEDERAL HEALTH CARE CENTER VA and DOD Need to Develop Better Information to Monitor Operations and Improve Efficiency...Government Accountability Office Highlights of GAO-17-197, a report to congressional committees January 2017 FEDERAL HEALTH CARE CENTER VA and DOD

  11. Administrative "health courts" for medical injury claims: the federal constitutional issues.

    Science.gov (United States)

    Elliott, E Donald; Narayan, Sanjay A; Nasmith, Moneen S

    2008-08-01

    Our article analyzes whether the federal government may constitutionally supplant a traditional system of common-law trials before state judges and juries with new federal institutions designed by statute for compensating victims of medical injuries. Specifically, this article examines the federal constitutional issues raised by various proposals to replace traditional medical malpractice litigation in state courts with a federal system of administrative "health courts." In doing so, we address the following constitutional issues: 1. Is there federal authority to preempt state law (the commerce clause and spending clause issues)? 2. May jurisdiction be created in non-article 3 tribunals, and may claims be decided without trial by jury (the separation of powers and Seventh Amendment issues)? 3. Would pilot programs that require some claims to be pursued in a federal administrative forum while other claimants are left to pursue traditional state tort law remedies be constitutional (the equal protection issue)? The article concludes that a federal compensation system through administrative health courts should be constitutional provided the statute is appropriately drafted and that appropriate factual findings are made concerning the benefits to patients and the public as well as to doctors and their insurers.

  12. Beacon Communities’ Public Health Initiatives: A Case Study Analysis

    Science.gov (United States)

    Massoudi, Barbara L.; Marcial, Laura H.; Haque, Saira; Bailey, Robert; Chester, Kelley; Cunningham, Shellery; Riley, Amanda; Soper, Paula

    2014-01-01

    Introduction: The Beacon Communities for Public Health (BCPH) project was launched in 2011 to gain a better understanding of the range of activities currently being conducted in population- and public health by the Beacon Communities. The project highlighted the successes and challenges of these efforts with the aim of sharing this information broadly among the public health community. Background: The Beacon Community Program, designed to showcase technology-enabled, community-based initiatives to improve outcomes, focused on: building and strengthening health information technology (IT) infrastructure and exchange capabilities; translating investments in health IT to measureable improvements in cost, quality, and population health; and, developing innovative approaches to performance measurement, technology, and care delivery. Methods: Four multimethod case studies were conducted based on a modified sociotechnical framework to learn more about public health initiative implementation and use in the Beacon Communities. Our methodological approach included using document review and semistructured key informant interviews. NACCHO Model Practice Program criteria were used to select the public health initiatives included in the case studies. Findings: Despite differences among the case studies, common barriers and facilitators were found to be present in all areas of the sociotechnical framework application including structure, people, technology, tasks, overarching considerations, and sustainability. Overall, there were many more facilitators (range = 7–14) present for each Beacon compared to barriers (range = 4–6). Discussion: Four influential promising practices were identified through the work: forging strong and sustainable partnerships; ensuring a good task-technology fit and a flexible and iterative design; fostering technology acceptance; and, providing education and demonstrating value. Conclusions: A common weakness was the lack of a framework or model for

  13. Beacon communities' public health initiatives: a case study analysis.

    Science.gov (United States)

    Massoudi, Barbara L; Marcial, Laura H; Haque, Saira; Bailey, Robert; Chester, Kelley; Cunningham, Shellery; Riley, Amanda; Soper, Paula

    2014-01-01

    The Beacon Communities for Public Health (BCPH) project was launched in 2011 to gain a better understanding of the range of activities currently being conducted in population- and public health by the Beacon Communities. The project highlighted the successes and challenges of these efforts with the aim of sharing this information broadly among the public health community. The Beacon Community Program, designed to showcase technology-enabled, community-based initiatives to improve outcomes, focused on: building and strengthening health information technology (IT) infrastructure and exchange capabilities; translating investments in health IT to measureable improvements in cost, quality, and population health; and, developing innovative approaches to performance measurement, technology, and care delivery. Four multimethod case studies were conducted based on a modified sociotechnical framework to learn more about public health initiative implementation and use in the Beacon Communities. Our methodological approach included using document review and semistructured key informant interviews. NACCHO Model Practice Program criteria were used to select the public health initiatives included in the case studies. Despite differences among the case studies, common barriers and facilitators were found to be present in all areas of the sociotechnical framework application including structure, people, technology, tasks, overarching considerations, and sustainability. Overall, there were many more facilitators (range = 7-14) present for each Beacon compared to barriers (range = 4-6). Four influential promising practices were identified through the work: forging strong and sustainable partnerships; ensuring a good task-technology fit and a flexible and iterative design; fostering technology acceptance; and, providing education and demonstrating value. A common weakness was the lack of a framework or model for the Beacon Communities evaluation work. Sharing a framework or approach

  14. The interplay of management accounting research and NPM health initiatives

    DEFF Research Database (Denmark)

    Malmmose, Margit

    This paper investigates the development of management accounting research in the context of New Public Management (NPM) initiatives in health care. Drawing on concepts from diffusion theory and earlier literature reviews, the paper examines the interplay between management accounting research...... and health care reforms in relation to country of origin, development, theoretical approach, research method and topic. The study thus establishes a different focus; namely the interrelationship between the development of management accounting research and practical socio-political NPM innovations. The study...... shows that management accounting techniques are increasingly adopted in governmental health reforms and diffused across nations, themes and initiatives through time with the result that wider social practices become more and more integrated in management accounting research themes...

  15. The interplay of management accounting research and NPM health initiatives

    DEFF Research Database (Denmark)

    Malmmose, Margit

    This paper investigates the development of management accounting research in the context of New Public Management (NPM) initiatives in health care. Drawing on concepts from diffusion theory and earlier literature reviews, the paper examines the interplay between management accounting research...... and health care reforms in relation to country of origin, development, theoretical approach, research method and topic. The study thus establishes a different focus; namely the interrelationship between the development of management accounting research and practical socio-political NPM innovations. The study...... shows that management accounting techniques are increasingly adopted in governmental health reforms and diffused across nations, themes and initiatives through time with the result that wider social practices become more and more integrated in management accounting research themes...

  16. Global Climate Change: Federal Research on Possible Human Health Effects

    Science.gov (United States)

    2006-02-10

    conditioning systems.”20 A recent rise in one measure of poverty in the United States is argued by some to suggest that there may be more poor ...conclusions are common to several studies on possible health effects of climate change: the infirm, the elderly, and the poor may be disproportionately...Global Change Research Program, op. cit. 20 Ibid. 21 Madrick, Jeff. A Rise in Child Poverty Rates Is At Risk In U.S., the New York Times on the Web, June

  17. Electronic health record project initiation and early planning in a community health center.

    Science.gov (United States)

    Cortelyou-Ward, Kendall; Noblin, Alice; Martin, Jeremy

    2011-01-01

    Community health centers exist to help their constituents become proactive in addressing their own health care needs and to improve the overall well-being of the community. However, they pose a different set of challenges when implementing an electronic health record system. This article applies 2 project management principles, initiation and early planning, to the electronic health record implementation in a community health center. Issues such as planning, financial considerations, and quality improvement are discussed.

  18. E-Health Initiative and Customer's Expectation: Case Brunei

    CERN Document Server

    Almunawar, Mohammad Nabil; Low, Patrick Kim Cheng; Anshari, Muhammad

    2012-01-01

    This paper is to determine the dimension of e-health services in Brunei Darussalam (Brunei) from customers' perspective. It is to identify, understand, analyze and evaluate public's expectation on e-health in Brunei. A questionnaire was designed to gather quantitative and qualitative data to survey patients, patient's family, and health practitioners at hospitals, clinics, or home care centers in Brunei starting from February to March, 2011. A 25-item Likert-type survey instrument was specifically developed for this study and administered to a sample of 366 patients. The data were analyzed to provide initial ideas and recommendation to policy makers on how to move forward with the e-health initiative as a mean to improve healthcare services. The survey revealed that there exists a high demand and expectation from people in Brunei to have better healthcare services accessible through an e-health system in order to improve health literacy as well as quality and efficiency of healthcare. Regardless of the limita...

  19. Policy succession: the case for federal health planning in the 1990's.

    Science.gov (United States)

    Mueller, K J

    1993-01-01

    Direct federal involvement in local health planning ended in 1986 with the repeal of the Health Planning and Resources Development Act of 1974. This article argues that planning has remained an important element in state and local public health activities, and that it will re-emerge as a national effort. Theories of policy succession are used to derive conditions for policy renewal that are satisfied by the current policy environment for health planning. The need for planning is obvious when issues related to health care delivery in rural areas are considered, and there are strong advocates of the need for planning.

  20. Exploring Australian health promotion and environmental sustainability initiatives.

    Science.gov (United States)

    Patrick, Rebecca; Kingsley, Jonathan

    2016-04-01

    Issue addressed Health promotion practitioners have important roles in applying ecosystem approaches to health and actively promoting environmental sustainability within community-level practice. The present study identified the nature and scope of health promotion activities across Australia that tackle environmental sustainability. Methods A mixed-method approach was used, with 82 participants undertaking a quantitative survey and 11 undertaking a qualitative interview. Purposeful sampling strategies were used to recruit practitioners who were delivering community-level health promotion and sustainability programs in Australia. The data were analysed thematically and interpretation was guided by the principles of triangulation. Results Study participants were at various stages of linking health promotion and environmental sustainability. Initiatives focused on healthy and sustainable food, active transport, energy efficiency, contact with nature and capacity building. Conclusion Capacity building approaches were perceived as essential to strengthening this field of practice. Healthy and sustainable food and active transport were suitable platforms for simultaneously promoting community health and sustainability. There was potential for expansion of programs that emphasise contact with nature and energy issues, as well as interventions that emphasise systems thinking and interdisciplinary approaches. So what? It was promising that Australian health promotion programs have started to address complexity rather than single issues, as evidenced by explicit engagement with environmental sustainability. However, more effort is required to enable a shift towards ecosystem approaches to health.

  1. Effectiveness of health and wellness initiatives for seniors.

    Science.gov (United States)

    Coberley, Carter; Rula, Elizabeth Y; Pope, James E

    2011-02-01

    Given the increasing prevalence of obesity and lifestyle-related chronic diseases in the United States and abroad, senior wellness initiatives have emerged as a means to stem the troubling trends that threaten the well-being and the economy of many nations. Seniors are an important demographic for such programs because this age group is growing, both as a proportion of the overall population and as a contributor to health care cost escalation. The goal of senior wellness programs is to improve the overall health of seniors through a variety of approaches, including increased physical activity, better nutrition, smoking cessation, and support of other healthy behaviors. Outcome metrics of particular interest are the effects of participation in these programs on health care utilization and expenditures. This review describes several studies that demonstrate reduced inpatient admissions and health care costs, as well as improved health-related quality of life as a direct result of participation in large-scale senior wellness programs. Programs that effectively engage seniors in, and change behavior as a direct result of, participation provide strong evidence that health improvements and decreased health care expenditures can be achieved. However, solutions to the challenges of broader enrollment and sustained participation in these programs would increase the impact of their outcomes and health-related benefits.

  2. Bring Hidden Hazards to the Publics Attention, Understanding, and Informed Decision by Coordinating Federal Education Initiatives

    Science.gov (United States)

    Niepold, F.; Karsten, J. L.; Wei, M.; Jadin, J.

    2010-12-01

    In the 2010 National Research Council’s America’s Climate Choices’ report on Informing Effective Decisions and Actions Related to Climate Change concluded; “Education and communication are among the most powerful tools the nation has to bring hidden hazards to public attention, understanding, and action.” They conclude that the “current and future students, the broader public, and policymakers need to understand the causes, consequences, and potential solutions to climate change, develop scientific thinking and problem-solving skills, and improve their ability to make informed decisions.” The U.S. Global Change Research Program (USGCRP) works to integrate the climate related activities of these different agencies, with oversight from the Office of Science and Technology Policy and other White House offices. USGCRP’s focus is now on evaluating optimal strategies for addressing climate change risks, improving coordination among the Federal agencies, engaging stakeholders (including national policy leaders and local resource managers) on the research results to all and improving public understanding and decision-making related to global change. Implicit to these activities is the need to educate the public about the science of climate change and its consequences, as well as coordinate Federal investments related to climate change education. In a broader sense, the implementation of the proposed Interagency Taskforce on Climate Change Communication and Education will serve the evolving USGCRP mandates around cross-cutting, thematic elements, as recommended by the National Research Council (NRC, 2009) and the U.S. Climate Change Science Program Revised Research Plan: An update to the 2003 Strategic Plan (USGCRP, 2008), to help the Federal government “capitalize on its investments and aid in the development of increased climate literacy for the Nation.” This session will update the participants on the work to date and the near term coordinated plans

  3. 38 CFR 17.51 - Emergency use of Department of Defense, Public Health Service or other Federal hospitals.

    Science.gov (United States)

    2010-07-01

    ... Health Service Or Other Federal Hospitals § 17.51 Emergency use of Department of Defense, Public Health... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Emergency use of Department of Defense, Public Health Service or other Federal hospitals. 17.51 Section 17.51...

  4. Job Satisfaction and Expected Turnover Among Federal, State, and Local Public Health Practitioners

    Science.gov (United States)

    Harper, Elizabeth; Shon, Ji Won; Sellers, Katie; Castrucci, Brian C.

    2016-01-01

    Objectives. To use data on the governmental public health workforce to examine demographics and elucidate drivers of job satisfaction and intent to leave one’s organization. Methods. Using microdata from the 2014 Federal Employee Viewpoint Survey and 2014 Public Health Workforce Interests and Needs Survey, we drew comparisons between federal, state, and local public health staff. We fitted logistic regressions to examine correlates of both job satisfaction and intent to leave one’s organization within the coming year. Results. Correlates of job satisfaction included pay satisfaction, organizational support, and employee involvement. Approximately 40% of federal, state, and local staff said they were either considering leaving their organization in the next year or were planning to retire by 2020. Conclusions. Public health practitioners largely like their jobs, but many are dissatisfied with their pay and are considering working elsewhere. More should be done to understand the determinants of job satisfaction and how to successfully retain high-quality staff. Public Health Implications. Public health is at a crossroads. Significant turnover is expected in the coming years. Retention efforts should engage staff across all levels of public health. PMID:27552269

  5. Eastern Health Board Regional Orthodontic Service: an initial audit.

    LENUS (Irish Health Repository)

    Dowling, P A

    1997-01-01

    This initial audit of 600 recently assessed Eastern Health Board orthodontic patients suggests that a large number of them (47 per cent) requires referral for routine restorative and preventive dental care. Closer links are needed with general dental practitioners and community dental surgeons to resolve these needs. The trend for a high referral of females and Class 11 Division 1 malocclusion type correlated well with studies in other countries.

  6. 78 FR 60653 - Federal Employees Health Benefits Program: Members of Congress and Congressional Staff

    Science.gov (United States)

    2013-10-02

    ... care providers, Temporary continuation of coverage, Benefits for United States hostages in Iraq and Kuwait and United States hostages captured in Lebanon, Department of Defense Federal Employees Health... Abortion Services OPM received over 59,000 comments regarding coverage of abortion services for Members of...

  7. 78 FR 47180 - Basic Program Elements for Federal Employee Occupational Safety and Health Programs and Related...

    Science.gov (United States)

    2013-08-05

    ... rates for targeted inspection, and assist in determining the most effective safety and health training... establishments, and (2) OSHA to better track injury trends at Federal agencies, and to better target inspections... volunteers, the calculation of the total number of hours worked by uncompensated volunteers, and that OMB job...

  8. 75 FR 78755 - Notice of Initial Determination Revising the List of Products Requiring Federal Contractor...

    Science.gov (United States)

    2010-12-16

    ... products proposed in the initial determination except for carpets from India. (75 FR 42164). The current...-funded technical assistance and field research projects, academic research, independent research, media... important information by gathering data from contacts, conducting site visits, and reviewing local media...

  9. 75 FR 41217 - Federal Housing Administration Risk Management Initiatives: Reduction of Seller Concessions and...

    Science.gov (United States)

    2010-07-15

    ... broader purpose of the policy change, however, and of the capital reserve ratio requirement itself, is to... initiatives that will contribute to the restoration of the MMIF capital reserve account. The changes proposed... these costs proves excessive or if FHA implements policy changes that result in net income to the...

  10. Feminist initiatives on women's health in the Netherlands.

    Science.gov (United States)

    Schmitz, L

    1984-04-01

    In the 1960s the Dutch Women's Liberation organization "Dolle Mina" carried out a campaign in Holland to promote the use of oral contraceptives and tried to generate political support in the home and through street demonstrations. What was needed was an adequate abortion service with a corresponding abortion law, a free and adequate supply of contraceptives, and a non-sexist approach to and treatment of women in the field of sexuality, birth control, and medical servicces in general. About 15 years later, the Netherlands now has a flourishing women's health movement, including efforts in information provision, guidance, research, reference, schooling, and contact-building. The basic principles of the women's movement are; 1) the woman herself is the stardard; 2) problems women have with regard to their health are not to be observed in isolation from their social l ife and position; 3) women's acquaintance with feelings about the functioning of their own bodies form the basis of all therapies to improve women's health; 4) women must be offered the choice of existing methods of treatment and help procedures; 5) women should help each other with their common ailments, and heirarchical divisions such as helper-patient, and expert-nonexpert, should be removed; and 6) as often as possible help should be given to women in their own surroundings. Women's health centers have begun to take on a number of women's physical and psychosomatic complaints; 5 centers now operate in 5 different cities, and others are being developed. The Women's Health Center in Amsterdam was initiated in 1976 and caters to gynecological questions, breast examination problems, eating disorders, and drug addiction. Contracts between feminist health groups and the traditional health system are varied, and individuals involved in family planning groups are often also active in the feminist health acctiities. There is resistance to feminist initiatives, mainly from those working in traditional health

  11. The evolution of the federal funding policies for the public health surveillance component of Brazil's Unified Health System (SUS

    Directory of Open Access Journals (Sweden)

    Vitor Laerte Pinto Junior

    2014-12-01

    Full Text Available Health surveillance (HS is one of the key components of the Brazilian Unified Health System (SUS. This article describes recent changes in health surveillance funding models and the role these changes have had in the reorganization and decentralization of health actions. Federal law no. 8.080 of 1990 defined health surveillance as a fundamental pillar of the SUS, and an exclusive fund with equitable distribution criteria was created in the Basic Operational Norm of 1996 to pay for health surveillance actions. This step facilitated the decentralization of health care at the municipal level, giving local authorities autonomy to plan and provide services. The Health Pact of 2006 and its regulation under federal decree No. 3252 in 2009 bolstered the processes of decentralization, regionalization and integration of health care. Further changes in the basic concepts of health surveillance around the world and in the funding policies negotiated by different spheres of government in Brazil have been catalysts for the process of HS institutionalization in recent years.

  12. Firm's health going south. Federal authorities charge HealthSouth, leader Scrushy with 'massive accounting fraud,' systematic betrayal of investors.

    Science.gov (United States)

    Romano, Michael

    2003-03-24

    HealthSouth and its chief executive Richard Scrushy, left, find themselves coping with a public relations nightmare after federal officials last week charged the rehabilitation giant with "massive accounting fraud" and a systematic betrayal of tens of thousands of investors.

  13. eHealth and mHealth initiatives in Bangladesh: A scoping study

    Science.gov (United States)

    2014-01-01

    Background The health system of Bangladesh is haunted by challenges of accessibility and affordability. Despite impressive gains in many health indicators, recent evidence has raised concerns regarding the utilization, quality and equity of healthcare. In the context of new and unfamiliar public health challenges including high population density and rapid urbanization, eHealth and mHealth are being promoted as a route to cost-effective, equitable and quality healthcare in Bangladesh. The aim of this paper is to highlight such initiatives and understand their true potential. Methods This scoping study applies a combination of research tools to explore 26 eHealth and mHealth initiatives in Bangladesh. A screening matrix was developed by modifying the framework of Arksey & O’Malley, further complemented by case study and SWOT analysis to identify common traits among the selected interventions. The WHO health system building blocks approach was then used for thematic analysis of these traits. Results Findings suggest that most eHealth and mHealth initiatives have proliferated within the private sector, using mobile phones. The most common initiatives include tele-consultation, prescription and referral. While a minority of projects have a monitoring and evaluation framework, less than a quarter have undertaken evaluation. Most of the initiatives use a health management information system (HMIS) to monitor implementation. However, these do not provide for effective sharing of information and interconnectedness among the various actors. There are extremely few individuals with eHealth training in Bangladesh and there is a strong demand for capacity building and experience sharing, especially for implementation and policy making. There is also a lack of research evidence on how to design interventions to meet the needs of the population and on potential benefits. Conclusion This study concludes that Bangladesh needs considerable preparation and planning to sustain eHealth

  14. eHealth and mHealth initiatives in Bangladesh: a scoping study.

    Science.gov (United States)

    Ahmed, Tanvir; Lucas, Henry; Khan, Azfar Sadun; Islam, Rubana; Bhuiya, Abbas; Iqbal, Mohammad

    2014-06-16

    The health system of Bangladesh is haunted by challenges of accessibility and affordability. Despite impressive gains in many health indicators, recent evidence has raised concerns regarding the utilization, quality and equity of healthcare. In the context of new and unfamiliar public health challenges including high population density and rapid urbanization, eHealth and mHealth are being promoted as a route to cost-effective, equitable and quality healthcare in Bangladesh. The aim of this paper is to highlight such initiatives and understand their true potential. This scoping study applies a combination of research tools to explore 26 eHealth and mHealth initiatives in Bangladesh. A screening matrix was developed by modifying the framework of Arksey & O'Malley, further complemented by case study and SWOT analysis to identify common traits among the selected interventions. The WHO health system building blocks approach was then used for thematic analysis of these traits. Findings suggest that most eHealth and mHealth initiatives have proliferated within the private sector, using mobile phones. The most common initiatives include tele-consultation, prescription and referral. While a minority of projects have a monitoring and evaluation framework, less than a quarter have undertaken evaluation. Most of the initiatives use a health management information system (HMIS) to monitor implementation. However, these do not provide for effective sharing of information and interconnectedness among the various actors. There are extremely few individuals with eHealth training in Bangladesh and there is a strong demand for capacity building and experience sharing, especially for implementation and policy making. There is also a lack of research evidence on how to design interventions to meet the needs of the population and on potential benefits. This study concludes that Bangladesh needs considerable preparation and planning to sustain eHealth and mHealth initiatives successfully

  15. A political history of federal mental health and addiction insurance parity.

    Science.gov (United States)

    Barry, Colleen L; Huskamp, Haiden A; Goldman, Howard H

    2010-09-01

    This article chronicles the political history of efforts by the U.S. Congress to enact a law requiring "parity" for mental health and addiction benefits and medical/surgical benefits in private health insurance. The goal of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity (MHPAE) Act of 2008 is to eliminate differences in insurance coverage for behavioral health. Mental health and addiction treatment advocates have long viewed parity as a means of increasing fairness in the insurance market, whereas employers and insurers have opposed it because of concerns about its cost. The passage of this law is viewed as a legislative success by both consumer and provider advocates and the employer and insurance groups that fought against it for decades. Twenty-nine structured interviews were conducted with key informants in the federal parity debate, including members of Congress and their staff; lobbyists for consumer, provider, employer, and insurance groups; and other key contacts. Historical documentation, academic research on the effects of parity regulations, and public comment letters submitted to the U.S. Departments of Labor, Health and Human Services, and Treasury before the release of federal guidance also were examined. Three factors were instrumental to the passage of this law: the emergence of new evidence regarding the costs of parity, personal experience with mental illness and addiction, and the political strategies adopted by congressional champions in the Senate and House of Representatives. Challenges to implementing the federal parity policy warrant further consideration. This law raises new questions about the future direction of federal policymaking on behavioral health. © 2010 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

  16. Investigating the health implications of social policy initiatives at the local level: study design and methods

    Directory of Open Access Journals (Sweden)

    Carey Gemma E

    2010-12-01

    Full Text Available Abstract Background In this paper we present the research design and methods of a study that seeks to capture local level responses to an Australian national social policy initiative, aimed at reducing inequalities in the social determinants of health. Methods/Design The study takes a policy-to-practice approach and combines policy and stakeholder interviewing with a comparative case study analysis of two not-for-profit organisations involved in the delivery of federal government policy. Discussion Before the health impacts of broad-scale policies, such as the one described in this study, can be assessed at the population level, we need to understand the implementation process. This is consistent with current thinking in political science and social policy, which has emphasised the importance of investigating how, and if, policies are translated into operational realities.

  17. The Arctic Human Health Initiative: a legacy of the International Polar Year 2007–2009

    Directory of Open Access Journals (Sweden)

    Alan J. Parkinson

    2013-08-01

    strategies and health promotion; and promoting synergy and strategic direction of Arctic human health research and health promotion. Results . As of 31 March, 2009, the official end of the IPY, AHHI represented a total of 38 proposals, including 21 individual Expressions of Intent (EoI, and 9 full proposals (FP, submitted to the IPY Joint Committee for review and approval from lead investigators from the US, Canada, Greenland, Norway, Finland, Sweden and the Russian Federation. In addition, there were 10 National Initiatives (NI-projects undertaken during IPY beyond the IPY Joint Committee review process. Individual project details can be viewed at www.arctichealth.org. The AHHI currently monitors the progress of 28 individual active human health projects in the following thematic areas: health network expansion (5 projects, infectious disease research (7 projects, environmental health research (7 projects, behavioural and mental health research (4 projects, and outreach education and communication (5 projects. Conclusions . While some projects have been completed, others will continue well beyond the IPY. The IPY 2007–2008 represented a unique opportunity to further stimulate cooperation and coordination on Arctic health research and increase the awareness and visibility of Arctic regions.

  18. Federal state differentials in the efficiency of health production in Germany: an artifact of spatial dependence?

    Science.gov (United States)

    Felder, Stefan; Tauchmann, Harald

    2013-02-01

    Due to regional competition and patient migration, the efficiency of healthcare provision at the regional level is subject to spatial dependence. We address this issue by applying a spatial autoregressive model to longitudinal data from Germany at the district ('Kreis') level. The empirical model is specified to explain efficiency scores, which we derive through non-parametric order-m efficiency analysis of regional health production. The focus is on the role of health policy of federal states ('Bundesländer') for district efficiency. Regression results reveal significant spatial spillover effects. Notably, accounting for spatial dependence does not decrease but increases the estimated effect of federal states on district efficiency. It appears that genuinely more efficient states are less affected by positive efficiency spillovers, so that taking into account spatial dependence clarifies the importance of health policy at the state level.

  19. Measures to Improve Financial Indicators in Health Care System of the Federation of Bosnia and Herzegovina

    Directory of Open Access Journals (Sweden)

    Slavko Vukić

    2010-12-01

    Full Text Available The first part of the paper analyses the financial indicators in the health care system of the Federation of Bosnia and Herzegovina. The structure of total expenditure of compulsory health insurance in the period 2003-2008 was analysed by comparing the financial reports stipulated in the health care system of the Federation of Bosnia and Herzegovina with some foreign financial indicators. According to the existing situation, the objectives and measures required for their full implementation in the following medium-term period 2009-2013 have been determined. The movements of financial indicators following the implementation of certain institutional measures have been estimated according to the flow of some indicators from the previous period (time series and in accordance with the global trends of some macroeconomic indicators (employment, GDP, etc..

  20. Whose place is it anyway? Representational politics in a place-based health initiative.

    Science.gov (United States)

    Rushton, Carole

    2014-03-01

    The association between place and poor health, such as chronic disease, is well documented and in recent years has given rise to public health strategies such as place-based initiatives (PBIs). This article reports on the emergence of one such initiative in Australia, in regions identified as culturally diverse and socially disadvantaged. The study draws on the intellectual resources provided by governmentality and actor-network theory to provide insights into the reasons why community actors were excluded from a new governance body established to represent their interests. Risk-thinking and representational politics determined who represented whom in the PBI partnership. Paradoxically, actors representing 'community', identified as being 'at risk', were excluded from the partnership during its translation because they were also identified as being 'a risk'. As a consequence, contrary to federal government health and social policy in Australia, it was state government interests rather than the interests of community actors that influenced decisions made in relation to local health planning and the allocation of resources.

  1. What public health strategies are needed to reduce smoking initiation?

    Science.gov (United States)

    Pierce, John P; White, Victoria M; Emery, Sherry L

    2012-03-01

    Smoking initiation is a key behaviour that determines the future health consequences of smoking in a society. There is a marked difference in smoking patterns around the world, driven by initiation rates. While a number of high-income countries have seen smoking prevalence decline markedly from peak, many low-income and middle-income countries appear to still be on an upward trend. Unlike cessation where changes are limited by nicotine dependence, rates of smoking initiation can change rapidly over a short time span. Interventions that can be effective in achieving this include increases in the price of tobacco products, mass media anti-smoking advertising, smoke-free policies, smoking curricula in schools, restrictions on marketing opportunities for the tobacco industry as well as social norms that lead to restrictions on adolescents' ability to purchase cigarettes. Comprehensive tobacco control programmes that aim to denormalise smoking behaviour in the community contain all of these interventions. Rapid reductions in smoking initiation in adolescents have been documented in two case studies of comprehensive tobacco control programmes in California and Australia. Consistent and inescapable messages from multiple sources appear to be key to success. However, the California experience indicates that the rapid decline in adolescent smoking will not continue if tobacco control expenditures and the relative price of cigarettes are reduced. These case studies provide strong additional evidence of the importance of countries implementing the provisions of the Framework Treaty on Tobacco Control.

  2. [Memorandum on sustainable reinforcement of prevention and health promotion: challenges at the federal, state and local level].

    Science.gov (United States)

    Walter, U; Nöcker, G; Pawils, S; Robra, B-P; Trojan, A; Franz, M; Grossmann, B; Schmidt, T-A; Lehmann, H; Bauer, U; Göpel, E; Janz, A; Kuhn, J; Naegele, G; Müller-Kohlenberg, H; Plaumann, M; Stender, K-P; Stolzenberg, R; Süß, W; Trenker, M; Wanek, V; Wildner, M

    2015-05-01

    Research-based evidence and practice-based experience are core requirements for the effective implementation of preventive interventions. The knowledge gained in the Prevention Research Funding Initiative of the German Federal Ministry of Education and Research (2004-2013) was therefore amalgamated, reflected and consolidated in the Cooperation for Sustainable Prevention Research (KNP) meta-project. In annual strategy meetings, researchers and practitioners from the field and other experts developed 3 memoranda providing recommendations for the further development of research and practice in the field of prevention and health promotion. Memorandum III is primarily aimed at decision-makers in politics and administration at the federal, state and local level, in civil society and in the workplace. Its recommendations show that structuring efforts are urgently needed to achieve sustainable policy, particularly in the fields of health, education, employment and social affairs. Memorandum III brings together the knowledge extracted and problems identified in research projects. More so than its 2 predecessors, Memorandum III abstracts knowledge from the individual projects and attempts to derive guidance for action and decision-making, as shown by the 7 recommendations that appear to useful for consensus-building in practice and research. Value judgments are inevitable. Prevention and health promotion are an investment in the future: of social health, social capital and social peace. Improvement of the framework conditions is needed to achieve the harmonized awareness and the sustained effectiveness of these structure-building efforts in different policy areas, spheres of life, fields of action, and groups of actors. This includes the implementation of an overall national strategy as well as the expansion of sources of funding, extension of the legal framework, overarching coordination, and the establishment of a National Center of Excellence to develop and safeguard

  3. 78 FR 71676 - Submission for Review: 3206-0201, Federal Employees Health Benefits (FEHB) Open Season Express...

    Science.gov (United States)

    2013-11-29

    ... MANAGEMENT Submission for Review: 3206-0201, Federal Employees Health Benefits (FEHB) Open Season Express... information collection request (ICR) 3206-0201, Federal Employees Health Benefits (FEHB) Open Season Express... Publications Team, OPM, 1900 E Street NW., Room 3316-AC, Washington, DC 20415, Attention: Cyrus S. Benson;...

  4. 38 CFR 17.50 - Use of Department of Defense, Public Health Service or other Federal hospitals with beds...

    Science.gov (United States)

    2010-07-01

    ... Defense, Public Health Service or other Federal hospitals with beds allocated to the Department of... of Department of Defense, Public Health Service or other Federal hospitals with beds allocated to the... hospital covered by the agreement, care may be authorized within the bed allocation for any veteran...

  5. [Will health promotion remain a utopia in a fragmented political system? The case of the Wallonia-Brussels Federation].

    Science.gov (United States)

    Bantuelle, Martine

    2013-01-01

    In the French Community of Belgium (the Wallonia-Brussels Federation), the changing political landscape and the various laws relating to the roles of the federal state, communities and regions introduced since 1980 have had a significant impact on health policy. Since then, there have been significant developments in health education services and activities. In 1997, a government decree was issued to promote the concept of health promotion, to reform the existing system and to define policy priorities as part of a new five-year plan (1998-2003). Significant progress was made during this period as a result of the development of a global approach extending beyond the mere analysis of risk factors. The second five-year plan (2004-2008), aimed at combining preventive medicine and health promotion, resulted in the involvement of a wider range of actors and greater cross-sector collaboration. However, the sheer number of decision-making levels has been a major obstacle to popular participation and consultation. If the question of social and cultural accessibility is not seriously addressed, the focus on preventive medicine programs may prove to be detrimental to the development of an effective health promotion framework. The disconnect between the political vision and the reality of practice has had an adverse impact on health promotion. Health promotion professionals have repeatedly called for a third five-year plan involving all ministers and aimed at developing a cross-sector approach, at addressing the determinants of health, at promoting the active participation of local communities and at reducing social health inequalities. The concerns of health promotion practitioners were further exacerbated by the introduction of an external assessment process initiated by the Ministry of Health in 2010. The current concerns over the future of the Belgian state, the economic crisis and the impact of spending cuts have increased the sense of uncertainty. The upcoming elections

  6. Transdisciplinary Research and Evaluation for Community Health Initiatives

    Science.gov (United States)

    Harper, Gary W.; Neubauer, Leah C.; Bangi, Audrey K.; Francisco, Vincent T.

    2010-01-01

    Transdisciplinary research and evaluation projects provide valuable opportunities to collaborate on interventions to improve the health and well-being of individuals and communities. Given team members’ diverse backgrounds and roles or responsibilities in such projects, members’ perspectives are significant in strengthening a project’s infrastructure and improving its organizational functioning. This article presents an evaluation mechanism that allows team members to express the successes and challenges incurred throughout their involvement in a multisite transdisciplinary research project. Furthermore, their feedback is used to promote future sustainability and growth. Guided by a framework known as organizational development, the evaluative process was conducted by a neutral entity, the Quality Assurance Team. A mixed-methods approach was utilized to garner feedback and clarify how the research project goals could be achieved more effectively and efficiently. The multiple benefits gained by those involved in this evaluation and implications for utilizing transdisciplinary research and evaluation teams for health initiatives are detailed. PMID:18936267

  7. SMILE: Simple, Mental Health, Initiative in Learning and Education.

    Science.gov (United States)

    Ward, L J

    2011-12-01

    SMILE is a Simple, Mental health, Initiative in Learning and Education. SMILE was a pilot project introduced into an undergraduate clinical nursing program, Southern Cross University, Australia 2010. The program aimed to improve the knowledge and skills of third-year nursing students participating in their first clinical placement in mental healthcare. Complementary to the clinical nursing program and the university curriculum, SMILE provided further training and support for student learning in mental healthcare. The SMILE project was a structured 15-day education program that covered the following topics: suicide prevention; psychosis; drugs and alcohol education; mental state exam; families and carers in mental health; and the Mental Health Act. The education sessions were one hour in duration. The educational material and resources were created from current research, literature and health service policy. A problem-based learning approach was used to support this education project. The dynamic factor related to SMILE was that it was based in the field. SMILE enabled the students to bridge a theory-practice gap and expand upon their current knowledge base as well as participate in ward activity. Twenty students attending their first clinical placement in mental healthcare participated in SMILE and were asked to complete a pre- and post- evaluation questionnaire before starting and upon completion of the 15-day project. The students participating in SMILE reported a greater understanding of mental healthcare issues and expressed a developing knowledge base and improved practical skill level. SMILE was a positive initiative that provided valuable feedback and opportunity to improve on clinical education in mental healthcare.

  8. ONE Nano: NIEHS’s Strategic Initiative on the Health and Safety Effects of Engineered Nanomaterials

    Science.gov (United States)

    Johnson, Anne F.; Balshaw, David M.; Garantziotis, Stavros; Walker, Nigel J.; Weis, Christopher; Nadadur, Srikanth S.; Birnbaum, Linda S.

    2013-01-01

    Background: The past decade has seen tremendous expansion in the production and application of engineered nanomaterials (ENMs). The unique properties that make ENMs useful in the marketplace also make their interactions with biological systems difficult to anticipate and critically important to explore. Currently, little is known about the health effects of human exposure to these materials. Objectives: As part of its role in supporting the National Nanotechnology Initiative, the National Institute of Environmental Health Sciences (NIEHS) has developed an integrated, strategic research program—“ONE Nano”—to increase our fundamental understanding of how ENMs interact with living systems, to develop predictive models for quantifying ENM exposure and assessing ENM health impacts, and to guide the design of second-generation ENMs to minimize adverse health effects. Discussion: The NIEHS’s research investments in ENM health and safety include extramural grants and grantee consortia, intramural research activities, and toxicological studies being conducted by the National Toxicology Program (NTP). These efforts have enhanced collaboration within the nanotechnology research community and produced toxicological profiles for selected ENMs, as well as improved methods and protocols for conducting in vitro and in vivo studies to assess ENM health effects. Conclusion: By drawing upon the strengths of the NIEHS’s intramural, extramural, and NTP programs and establishing productive partnerships with other institutes and agencies across the federal government, the NIEHS’s strategic ONE Nano program is working toward new advances to improve our understanding of the health impacts of engineered nanomaterials and support the goals of the National Nanotechnology Initiative. PMID:23407114

  9. Canadian federalism and the Canadian health care program: a comparison of Ontario and Quebec.

    Science.gov (United States)

    Palley, H A

    1987-01-01

    The Quebec and Ontario health insurance and health service delivery systems, developed within the parameters of federal regulations and national financial subsidies, provide generally universal and comprehensive basic hospital and medical benefits and increasingly provide for the delivery of long-term care services. Within a framework of cooperative federalism, the health care systems of Ontario and Quebec have developed uniquely. In terms of vital statistics, the health of Ontario and Quebec residents generally is comparable. In viewing expenditures, Quebec has a more clearly articulated plan for providing accessible services to low-income persons and for integrating health and social services, although it has faced some difficulties in seeking to achieve the latter goal. Its plans for decentralized services are counter-balanced by a strong provincial role in health policy decision-making. Quebec's political culture also allows the province to play a stronger role in hospital planning and in the regulation of physician income than one finds in Ontario. These political dynamics allow Quebec an advantage in control of costs. In Ontario, in spite of some recent setbacks, physician interests and hospital sector interests play a more active role in health system bargaining and are usually able to influence remuneration and resource allocation decisions more than physician interests and hospital sector interests in Quebec.

  10. Recent federal initiatives to promote unconventional gas: High octane delivery of just hot air?

    Energy Technology Data Exchange (ETDEWEB)

    Griff, M.T.

    1995-10-01

    This paper provides an overview of recent initiatives of the United States which promote greater use of natural gas and unconventional gas as one part of this nations`s larger response to the global warming threat. Measurable increases in greenhouse gas concentrations since the beginning of the industrial revolution have led to the belief in the existence of a global warming problem. The international community has responded to the global warming threat with the United Nations Framework Convention on Climate Change which is directed toward the stabilization of greenhouse gases in the atmosphere. The Climate Change Action Plan is the Clinton Administration`s detailed response to the global warming threat. It is designed to return United States emissions of greenhouse gases to their 1990 levels by the year 2000. The Action Plan targets all greenhouse gases and emphasizes energy efficiency. Significant regulatory reformation designed to increase the efficiency of the natural gas industry has already occurred and will be continued. Recovery of methane emissions from landfills will be encouraged through indentification of suitable sites and use of existing technology and development of new technology. Recovery of methane from coal mining operations will be promoted by targeting 50 of the gassiest mines in the United States. Even if the Action Plan is fully implemented. legitimate questions arise as to whether its goals will be achieved as a result of funding shortfalls.

  11. The sustainability of public health expenditures: evidence from the Canadian federation.

    Science.gov (United States)

    Di Matteo, Livio

    2010-12-01

    The fiscal sustainability of government health expenditures is defined as the gap between growth rates of spending and measures of the resource base. The results show that over the period 1965-2008, real per capita Canadian provincial government health spending has grown at rates that exceed growth in basic measures of the resource base such as per capita gross domestic product (GDP), per capita federal transfers and per capita provincial government revenues. Forecasts of future spending to 2035 using determinant regression and growth rate extrapolation techniques show that Canadian provincial government health spending is projected to continue rising in the future and its share of provincial GDP will rise. While the amount spent on health is ultimately a public policy choice, provincial government health spending also cannot continue growing faster than the resource base indefinitely.

  12. STOPPING DECEPTIVE HEALTH CLAIMS: THE NEED FOR A PRIVATE RIGHT OF ACTION UNDER FEDERAL LAW.

    Science.gov (United States)

    Hoffmann, Diane; Schwartz, Jack

    2016-01-01

    This Article offers a thorough analysis of an important public health issue, namely how to confront the growing problem of deceptive claims regarding foods and dietary supplements, including increasingly prevalent but unverifiable claims. The authors call for the creation of a limited private right of action under the Federal Trade Commission (FTC) Act for deceptive health-related claims for these products. The proposal responds to the growing market for these products and the inadequacy of current laws and enforcement actions to prevent such claims. In crafting the limited private right of action, the authors attempt to enhance consumer protection without undermining federal agency primacy in enforcement. The Article ends with an appendix setting forth proposed language for a statutory amendment to the FTC Act incorporating the authors' proposal.

  13. Capital cost reimbursement to community hospitals under Federal health insurance programs.

    Science.gov (United States)

    Kinney, E D; Lefkowitz, B

    1982-01-01

    Issues in current capital cost reimbursement to community hospitals by Medicare and Medicaid are described, and options for change analyzed. Major reforms in the way the federal government pays for capital costs--in particular substitution of other methods of payment for existing depreciation reimbursement--could have significant impact on the structure of the health care system and on government expenditures. While such reforms are likely to engender substantial political opposition, they may be facilitated by broader changes in the reimbursement system.

  14. Courts and health care rationing: the case of the Brazilian Federal Supreme Court.

    Science.gov (United States)

    Wang, Daniel W L

    2013-01-01

    The recognition that access to health care is a constitutional right in Brazil has resulted in a situation in which citizens denied treatments by the public health care system have brought lawsuits against health authorities, claiming that their right to health was violated. This litigation forces the courts to decide between a patient-centred and a population-centred approach to public health - a choice that forces the courts to assess health care rationing decisions. This article analyses the judgments of the Brazilian Federal Supreme Court in right to health cases, arguing that the Court's recent decisions have been contrary to their long-standing stance against rationing. In 2009, the Court organized a public hearing to discuss this topic with civil society and established criteria to determine when rationing would be legal. However, I argue that these criteria for health care rationing do not adequately address the most difficult health care distribution dilemmas. They force the health care system to keep their rationing criteria implicit and make population-centred concerns secondary to individual-centred ones.

  15. Vital Directions for Health and Health Care: Priorities From a National Academy of Medicine Initiative.

    Science.gov (United States)

    Dzau, Victor J; McClellan, Mark B; McGinnis, J Michael; Burke, Sheila P; Coye, Molly J; Diaz, Angela; Daschle, Thomas A; Frist, William H; Gaines, Martha; Hamburg, Margaret A; Henney, Jane E; Kumanyika, Shiriki; Leavitt, Michael O; Parker, Ruth M; Sandy, Lewis G; Schaeffer, Leonard D; Steele, Glenn D; Thompson, Pamela; Zerhouni, Elias

    2017-04-11

    Recent discussion has focused on questions related to the repeal and replacement of portions of the Affordable Care Act (ACA). However, issues central to the future of health and health care in the United States transcend the ACA provisions receiving the greatest attention. Initiatives directed to certain strategic and infrastructure priorities are vital to achieve better health at lower cost. To review the most salient health challenges and opportunities facing the United States, to identify practical and achievable priorities essential to health progress, and to present policy initiatives critical to the nation's health and fiscal integrity. Qualitative synthesis of 19 National Academy of Medicine-commissioned white papers, with supplemental review and analysis of publicly available data and published research findings. The US health system faces major challenges. Health care costs remain high at $3.2 trillion spent annually, of which an estimated 30% is related to waste, inefficiencies, and excessive prices; health disparities are persistent and worsening; and the health and financial burdens of chronic illness and disability are straining families and communities. Concurrently, promising opportunities and knowledge to achieve change exist. Across the 19 discussion papers examined, 8 crosscutting policy directions were identified as vital to the nation's health and fiscal future, including 4 action priorities and 4 essential infrastructure needs. The action priorities-pay for value, empower people, activate communities, and connect care-recurred across the articles as direct and strategic opportunities to advance a more efficient, equitable, and patient- and community-focused health system. The essential infrastructure needs-measure what matters most, modernize skills, accelerate real-world evidence, and advance science-were the most commonly cited foundational elements to ensure progress. The action priorities and essential infrastructure needs represent major

  16. Access to health services in the southern outskirts of the Brazilian Federal District

    Directory of Open Access Journals (Sweden)

    Ana Cléia Margarida Tonhá

    2015-06-01

    Full Text Available The aim of this study was to analyze people's perception on the access to health services in the southern outskirts of the Integrated Region for the Development of the Federal District (RIDE/DF, as per its acronym in Portuguese. A descriptive, cross-sectional, epidemiological and population-based study with a household survey design was carried out in 2010 and 2011. A semi-structured questionnaire, previously validated, was applied. A total of 605 individuals who lived in the southern outskirts of the Federal District were interviewed, of which 311 (51.4% were female, 215 (35.8% had incomplete primary education, 163 (40.9% sought health services in Primary Care Units and 166 (45.5% sought health services in another municipality. Access to health services in the region is influenced by social and economic conditions and by the place of living. These findings allow managers to better study the setting, review care services provided and meet health needs of that population.

  17. Social media engagement analysis of U.S. Federal health agencies on Facebook.

    Science.gov (United States)

    Bhattacharya, Sanmitra; Srinivasan, Padmini; Polgreen, Philip

    2017-04-21

    It is becoming increasingly common for individuals and organizations to use social media platforms such as Facebook. These are being used for a wide variety of purposes including disseminating, discussing and seeking health related information. U.S. Federal health agencies are leveraging these platforms to 'engage' social media users to read, spread, promote and encourage health related discussions. However, different agencies and their communications get varying levels of engagement. In this study we use statistical models to identify factors that associate with engagement. We analyze over 45,000 Facebook posts from 72 Facebook accounts belonging to 24 health agencies. Account usage, user activity, sentiment and content of these posts are studied. We use the hurdle regression model to identify factors associated with the level of engagement and Cox proportional hazards model to identify factors associated with duration of engagement. In our analysis we find that agencies and accounts vary widely in their usage of social media and activity they generate. Statistical analysis shows, for instance, that Facebook posts with more visual cues such as photos or videos or those which express positive sentiment generate more engagement. We further find that posts on certain topics such as occupation or organizations negatively affect the duration of engagement. We present the first comprehensive analyses of engagement with U.S. Federal health agencies on Facebook. In addition, we briefly compare and contrast findings from this study to our earlier study with similar focus but on Twitter to show the robustness of our methods.

  18. [Problem mapping by state and federal actors for maternal health attention].

    Science.gov (United States)

    Rouvier, Mariel; González-Block, Miguel A; Becerril-Montekio, Víctor; Sesia, Paola; Duarte, María Beatriz; Flores-Collins, Estrella

    2011-01-01

    To analyze the characteristics of problems in the health system that present barriers to maternal care, according to their representation and rating by officials in different positions and social contexts. Workshops were held with state health system officials from Mexican states with high maternal mortality (Mexico, Guerrero, Oaxaca and Veracruz) as well as with federal officials. A total of 99 health system problems were identified. Using concept mapping, 94 officials rated problems according to importance and feasibility; they were grouped into issues. Data was analyzed according to state/federal levels and the responsibilities of participants. The association was measured between responsibility profile/social context and priority issues. The issues of highest priority for maternal health care are infrastructure, personnel hiring and financial resources. The importance of certain issues depends on context and, to an extent, on the actors' responsibilities. There is consensus among actors to address the principal maternal health problems in Mexico. Important differences correspond to context. The usefulness of concept mapping to analyze problems was demonstrated.

  19. Franco-German initiative for Chernobylsk health project; Initiative Franco-Allemande pour Tchernobyl projet sante

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2006-07-01

    The works led within the framework of the French-German initiative ( I.F.A.) on the health of the populations exposed to the ionizing radiations concentrated on the main useful indicators of health for the study of the excess incidence of cancers after a relatively long latency period. No net difference of the tendencies of leukaemia incidence was revealing between exposed regions and not exposed regions of Ukraine, Belarus and Russia. As regards solid tumors, the rates of incidence presented the same tendencies of increase in the course of time whatever are the studied regions. On the other hand, the works showed a net increase of the rate of incidence of the thyroid cancers in the exposed regions, notably at the aged persons of less than ten years at the time of the accident. In Belarus, the national register of cancers allowed to bring to light a very high number of thyroid cancers, from the beginning 1990 at the children of less than 15 years and net increase of these cancers, since 1998, in the slice of 15/29 the years. So for this exposed population, the risk of thyroid cancer continues to express itself 20 years after the accident. Besides, no tangible difference from the point of view of the tendencies between exposed and not exposed regions was revealing for the congenital malformations. (N.C.)

  20. Barriers to sustainable tuberculosis control in the Russian Federation health system.

    Science.gov (United States)

    Atun, R. A.; Samyshkin, Y. A.; Drobniewski, F.; Skuratova, N. M.; Gusarova, G.; Kuznetsov, S. I.; Fedorin, I. M.; Coker, R. J.

    2005-01-01

    The Russian Federation has the eleventh highest tuberculosis burden in the world in terms of the total estimated number of new cases that occur each year. In 2003, 26% of the population was covered by the internationally recommended control strategy known as directly observed treatment (DOT) compared to an overall average of 61% among the 22 countries with the highest burden of tuberculosis. The Director-General of WHO has identified two necessary starting points for the scaling-up of interventions to control emerging infectious diseases. These are a comprehensive engagement with the health system and a strengthening of the health system. The success of programmes aimed at controlling infectious diseases is often determined by constraints posed by the health system. We analyse and evaluate the impact of the arrangements for delivering tuberculosis services in the Russian Federation, drawing on detailed analyses of barriers and incentives created by the organizational structures, and financing and provider-payment systems. We demonstrate that the systems offer few incentives to improve the efficiency of services or the effectiveness of tuberculosis control. Instead, the system encourages prolonged supervision through specialized outpatient departments in hospitals (known as dispensaries), multiple admissions to hospital and lengthy hospitalization. The implementation, and expansion and sustainability of WHO-approved methods of tuberculosis control in the Russian Federation are unlikely to be realized under the prevailing system of service delivery. This is because implementation does not take into account the wider context of the health system. In order for the control programme to be sustainable, the health system will need to be changed to enable services to be reconfigured so that incentives are created to reward improvements in efficiency and outcomes. PMID:15798846

  1. Early Evaluation Findings From a Federally Funded Training Program: The Public Health Associate Program.

    Science.gov (United States)

    Sobelson, Robyn K; Young, Andrea C; Wigington, Corinne J; Duncan, Heather

    The Centers for Disease Control and Prevention (CDC) created the Public Health Associate Program (PHAP) to establish a continuous source of public health professionals who can deliver frontline services at the federal, state, tribal, local, and territorial levels. The article describes preliminary evaluation findings for PHAP. The evaluation's primary purposes are to assess the quality and effectiveness of PHAP, determine its value and impact, and provide information to continuously improve the program. Because the evaluation is both formative and summative and focuses on aggregate outputs and outcomes of PHAP, the methodology is complex and builds over time as different cohorts cycle into and out of the program. Results presented are outcomes of various Web-based surveys and reporting systems. Four PHAP cohorts, consisting of 579 individuals, participated in 1 or more of the evaluation activities described in this article. The majority of participants report satisfaction with their PHAP experiences, and 74% of recent graduates indicate they are continuing their careers or education in public health immediately after program completion. Seventy-eight percent of recent PHAP graduates who accept a job in public health are employed by the federal government. One year post-PHAP, 74% of alumni report that PHAP has been influential in their careers. CDC's investment in PHAP has increased the capacity and capabilities of the public health workforce. Results presented are early indicators of program quality, effectiveness, and impact. Today's public health workers are asked to do more with less, in the face of a dynamic array of complex public health challenges. PHAP offers public health agencies assistance in tackling these losses and challenges.

  2. Internal migration and health: premarital sexual initiation in Nigeria.

    Science.gov (United States)

    Mberu, Blessing Uchenna; White, Michael J

    2011-04-01

    The high rates of youth migration to urban and economic centers, in the context of persistent poverty and devastating HIV/AIDS burden, have raised intricate social policy challenges in developing countries. Using the 2008 Nigeria Demographic and Health Survey data, descriptive statistics, Kaplan-Meier survival curves and discrete-time hazard regression models, this study examines the patterns of internal migration and sexual initiation among never-married Nigerian youth aged 15-24. We find that migrants generally show stronger association than non-migrants, and urban-rural and rural-rural migrants particularly show the strongest independent association with premarital sexual initiation. Other significant covariates are age, religion, ethnic origin, educational attainment, independent living arrangement, formal employment and exposure to the mass media. The findings highlight the direct importance of youth migration in understanding and addressing the challenges of premarital sexual behavior and the need for behavior change policies and programs to be sensitive to the complex contextual nuances across youth groups in one country. Copyright © 2011 Elsevier Ltd. All rights reserved.

  3. Health initiatives for the prevention of skin cancer.

    Science.gov (United States)

    Greinert, Rüdiger; Breitbart, Eckhard W; Mohr, Peter; Volkmer, Beate

    2014-01-01

    Skin cancer is the most frequent type of cancer in white population worldwide. However, because the most prominent risk factor-solar UV-radiation and/or artificial UV from sunbeds-is known, skin cancer is highly preventable be primary prevention. This prevention needs, that the public is informed by simple and balanced messages about the possible harms and benefits of UV-exposure and how a person should behave under certain conditions of UV-exposure. For this purpose information and recommendations for the public must be age- and target-group specific to cover all periods of life and to reach all sub-groups of a population, continuously. There is a need that political institutions together with Health Institutions and Societies (e.g., European Commission, WHO, EUROSKIN, ICNIRP, etc.), which are responsible for primary prevention of skin cancer, find a common language to inform the public, in order not to confuse it. This is especially important in connection with the ongoing Vitamin D debate, where possible positive effects of UV have to be balanced with the well known skin cancer risk of UV. A continuously ongoing evaluation of interventions and programs in primary prevention is a pre-requisite to assess the effectiveness of strategies. There is surely no "no message fits all" approach, but balanced information in health initiatives for prevention of skin cancer, which use evidence-base strategies, will further be needed in the future to reduce the incidence, morbidity and mortality skin cancer.

  4. The Long Way From Government Open Data to Mobile Health Apps: Overcoming Institutional Barriers in the US Federal Government

    Science.gov (United States)

    2014-01-01

    Background Government agencies in the United States are creating mobile health (mHealth) apps as part of recent policy changes initiated by the White House’s Digital Government Strategy. Objective The objective of the study was to understand the institutional and managerial barriers for the implementation of mHealth, as well as the resulting adoption pathways of mHealth. Methods This article is based on insights derived from qualitative interview data with 35 public managers in charge of promoting the reuse of open data through Challenge.gov, the platform created to run prizes, challenges, and the vetting and implementation of the winning and vendor-created apps. Results The process of designing apps follows three different pathways: (1) entrepreneurs start to see opportunities for mobile apps, and develop either in-house or contract out to already vetted Web design vendors; (2) a top-down policy mandates agencies to adopt at least two customer-facing mobile apps; and (3) the federal government uses a policy instrument called “Prizes and Challenges”, encouraging civic hackers to design health-related mobile apps using open government data from HealthData.gov, in combination with citizen needs. All pathways of the development process incur a set of major obstacles that have to be actively managed before agencies can promote mobile apps on their websites and app stores. Conclusions Beyond the cultural paradigm shift to design interactive apps and to open health-related data to the public, the managerial challenges include accessibility, interoperability, security, privacy, and legal concerns using interactive apps tracking citizen. PMID:25537314

  5. A Preliminary Evaluation of Federal Dental Manpower Subsidy Program. Health Manpower Policy Discussion Paper Series, No. A5.

    Science.gov (United States)

    Feldstein, Paul J.

    This paper suggests an approach and an analysis of the impact that federal manpower programs have had on dentistry. The main beneficiaries under health manpower subsidy programs are indicated and some policy alternatives suggested. Emphasis is placed on federal subsidies for increasing the supply of dentists including students' financial…

  6. The Efficiency of Federal Subsidies to Medical Education. Health Manpower Policy Discussion Paper Series. No.: A8.

    Science.gov (United States)

    Wright, George E., Jr.

    This paper focuses on the efficiency of federal subsidies in meeting stated public goals and gives two reasons for doing so. First, specific data on subsidies for the education function of medical schools are available. Second, Congress is now considering the entire package of federal health manpower legislation. It is difficult to escape the…

  7. A comparative performance scorecard for federally funded community health centers in North Carolina.

    Science.gov (United States)

    Radford, Andrea; Pink, George; Ricketts, Thomas

    2007-01-01

    To make informed management decisions, healthcare executives must have timely and useful information about the performance of their organizations. A review of the methods used by the Health Resources and Services Administration's Bureau of Primary Health Care to evaluate the performance of community health centers (CHCs) revealed a lack of such information. This information gap motivated the development of a comparative performance scorecard for the federally funded CHCs in North Carolina. The scorecard includes 19 indicators in four performance dimensions (access to care, financial performance, human resources, and utilization and productivity). A survey of participating CHC executive directors showed that the comparative performance scorecard is a useful tool for managing and evaluating the performance of CHCs.

  8. Chronic health conditions related to quality of life for federal civil servants

    Directory of Open Access Journals (Sweden)

    Luciana Eduardo Fernandes Saraiva

    Full Text Available OBJECTIVE: The aim of this study is to correlate the QOL domains of the civil servants to the type and number of chronic health conditions. METHOD: A transversal, quantitative study, conducted at the Department of Civil Servant Assistance of the Federal University of Rio Grande do Norte with 215 civil servants, during the period from March to May 2011. RESULTS: Among the chronic health conditions studied, there was significant relationship between non-communicable chronic disease and QOL scores, correlating weakly (r <-376; p <0.008 in the other fields. It was found that the greater the number of chronic conditions, the lower the values on the QOL scale. CONCLUSION: The quality of life of civil servants is negatively influenced by chronic health conditions, compromising, in general, their daily work and life activities.

  9. The inequity of the Swiss health care system financing from a federal state perspective

    Science.gov (United States)

    2014-01-01

    Introduction Previous studies have shown that Swiss health-care financing is particularly regressive. However, as it has been emphasized in the 2011 OECD Review of the Swiss Health System, the inter cantonal variations of income-related inequities are still broadly unexplored. The present paper aims to fill this gap by analyzing the differences in the level of equity of health-care system financing across cantons and its evolution over time using household data. Methods Following the methodology proposed by Wagstaff et al. (JHE 11:361–387, 1992) we use the Kakwani index as a summary measure of regressivity and we compute it for each canton and for each of the sources that have a role in financing the health care system. We graphed concentration curves and performed relative dominance tests, which utilize the full distribution of expenditures. The microdata come from the Swiss Household Income and Expenditure Survey (SHIES) based on a sample of the Swiss population (about 3500 households per year), for the years 1998 - 2005. Results The empirical evidence confirms that the health-care financing in Switzerland has remained regressive since the major reform of 1996 and shows that the variations in equity across cantons are quite significant: the difference between the most and the least regressive canton is about the same as between two extremely different financing systems like the US and Sweden. There is no evidence, instead, of a clear evolution over time of regressivity. Conclusions The significant variation in equity across cantons can be explained by fiscal federalism and the related autonomy in the design of tax and social policies. In particular, the results highlight that earmarked subsidies, the policy adopted to smooth the regressivity of the premiums, appear to be not enough; in the practice of federal states the combination of allowances with mandatory community-rated health insurance premiums might lead to a modest outcome in terms of equity. PMID

  10. Osteoporosis in the Women's Health Initiative: Another Treatment Gap?

    Science.gov (United States)

    Sattari, Maryam; Cauley, Jane A; Garvan, Cynthia; Johnson, Karen C; LaMonte, Michael J; Li, Wenjun; Limacher, Marian; Manini, Todd; Sarto, Gloria E; Sullivan, Shannon D; Wactawski-Wende, Jean; Beyth, Rebecca J

    2017-08-01

    Osteoporotic fractures are associated with high morbidity, mortality, and cost. We performed a post hoc analysis of the Women's Health Initiative (WHI) clinical trials data to assess osteoporosis treatment and identify participant characteristics associated with utilization of osteoporosis medication(s) after new diagnoses of osteoporosis or fracture. Information from visits prior to and immediately subsequent to the first fracture event or osteoporosis diagnosis were evaluated for medication use. A full logistic regression model was used to identify factors predictive of osteoporosis medication use after a fracture or a diagnosis of osteoporosis. The median length of follow-up from enrollment to the last WHI clinic visit for the study cohort was 13.9 years. Among the 13,990 women who reported new diagnoses of osteoporosis or fracture between enrollment and their final WHI visit, and also had medication data available, 21.6% reported taking an osteoporosis medication other than estrogen. Higher daily calcium intake, diagnosis of osteoporosis alone or both osteoporosis and fracture (compared with diagnosis of fracture alone), Asian or Pacific Islander race/ethnicity (compared with White/Caucasian), higher income, and hormone therapy use (past or present) were associated with significantly higher likelihood of osteoporosis pharmacotherapy. Women with Black/African American race/ethnicity (compared with White/Caucasian), body mass index ≥30 (compared with body mass index of 18.5-24.9), current tobacco use (compared with past use or lifetime nonusers), and history of arthritis were less likely to use osteoporosis treatment. Despite well-established treatment guidelines in postmenopausal women with osteoporosis or history of fractures, pharmacotherapy use was suboptimal in this study. Initiation of osteoporosis treatment after fragility fracture may represent an opportunity to improve later outcomes in these high-risk women. Specific attention needs to be paid to

  11. Financing medical care for the underserved in an era of Federal retrenchment: the health service district.

    Science.gov (United States)

    Nichols, A W; Silverstein, G

    1987-01-01

    Federal funding programs have, since the 1960s, been available in a variety of forms to deal with problems of access to medical care for the medically underserved. Certain programs, such as the National Health Service Corps, have recently pulled back from their points of maximal impact in terms of numbers of obligated physicians in the field. This change leaves a need for greater contributions by State and local entities in the face of Federal retrenchment. The health service district (HSD) is one such mechanism for filling the gap. It has been available under this name in Arizona law since 1977, but the first such district in the State in only now under development in a small copper mining community. Similar to school districts in concept, the HSDs allow residents in their catchment areas to tax themselves for the purpose of delivering primary health care. Two successful HSDs--or similar entities--in other States are described. One program is in Stickney, IL, and other in Condon, OR. The political success and financial viability of the Condon program are documented.

  12. Current initiatives in One Health: consolidating the One Health Global Network.

    Science.gov (United States)

    Vandersmissen, A; Welburn, S C

    2014-08-01

    The Global Response to Avian Influenza has led to a longer-term One Health movement, which addresses risks, including zoonoses, at the human-animal- environment interface, and requires the development of innovative partnerships at the political, institutional and technical levels. One Health is a sustainable and rational option when the cumulative effects of health hazards on food and economic security are considered, but demands long-term financial investment. Projections of growth in the demand for livestock production and consumption in Asia and Africa also call for effective One Health responses. However, an effective response also requires validated evidence of the socio-economic value that the One Health approach can provide. Implementing the One Health approach depends on forging strong links between human and animal health services, the environment and public policy. The authors present a list of some of the national and transnational partnerships established since 2006. Political support, good governance and effective policies and networks are crucial building blocks for One Health sustainability. The Global Response to Avian Influenza was initially established under the joint leadership of the European Union, the United States and the United Nations System Influenza Coordination Office. Since then it has supported numerous initiatives, including the World Health Organization (WHO)/Food and Agriculture Organization of the United Nations (FAO)/World Organisation for Animal Health (OIE) Global Early Warning System (GLEWS). Indeed, the Global Response to Avian Influenza paved the way for an unprecedented WHO/FAO/OIE tripartite partnership, which promoted the integration of foodborne, neglected zoonotic and tropical diseases within the One Health movement and led to the tripartite High-Level Technical Meeting of 2011 in Mexico. The One Health Global Network, which began as a proposition at an Expert Consultation in Winnipeg, Canada, in 2009, is now a reality

  13. Federal Employees Health Benefits and Federal Employees Dental and Vision Insurance Programs' Coverage Exception for Children of Same-Sex Domestic Partners. Interim final rule.

    Science.gov (United States)

    2016-12-02

    This action amends the rule to create a regulatory exception that allows children of same-sex domestic partners living overseas to maintain their Federal Employees Health Benefits (FEHB) and Federal Employees Dental and Vision Program (FEDVIP) coverage until September 30, 2018. Due to a recent Supreme Court decision, as of January 1, 2016, coverage of children of same-sex domestic partners under the FEHB Program and FEDVIP will generally only be allowed if the couple is married, as discussed in Benefits Administration Letter (BAL) 15-207 dated October 5, 2015. OPM recognizes there are additional requirements placed on overseas federal employees that may not apply to other civilian employees with duty stations in the United States making it difficult to travel to the United States to marry same-sex partners.

  14. Partnership for implementation of evidence-based mental health practices in rural federally qualified health centers: theory and methods.

    Science.gov (United States)

    Hunt, Justin B; Curran, Geoffrey; Kramer, Teresa; Mouden, Sip; Ward-Jones, Susan; Owen, Richard; Fortney, John

    2012-01-01

    Mental health and substance abuse are among the most commonly reported reasons for visits to Federally Qualified Health Centers (CHCs), yet only 6.5% of encounters are with on-site behavioral health specialists. Rural CHCs are significantly less likely to have on-site behavioral specialists than urban CHCs. Because of this lack of mental health specialists in rural areas, the most promising approach to improving mental health outcomes is to help rural primary care (PC) providers deliver evidence-based practices (EBPs). Despite the scope of these problems, no research has developed an effective implementation strategy for facilitating the adoption of mental health EBPs for rural CHCs. We sought to describe the conceptual components of an implementation partnership that focuses on the adaption and adoption of mental health EBPs by rural CHCs in Arkansas. We present a conceptual model that integrates seven separate frameworks: (1) Jones and Wells' Evidence-Based Community Partnership Model, (2) Kitson's Promoting Action on Research Implementation in Health Services (PARiHS) implementation framework, (3) Sackett's definition of evidence-based medicine, (4) Glisson's organizational social context model, (5) Rubenstein's Evidence-Based Quality Improvement (EBQI) facilitation process, (6) Glasgow's RE-AIM evaluation approach, and (7) Naylor's concept of shared decision making. By integrating these frameworks into a meaningful conceptual model, we hope to develop a successful implementation partnership between an academic health center and small rural CHCs to improve mental health outcomes. Findings from this implementation partnership should have relevance to hundreds of clinics and millions of patients, and could help promote the sustained adoption of EBPs across rural America.

  15. eHealth in Belgium, a new "secure" federal network: role of patients, health professions and social security services.

    Science.gov (United States)

    France, Francis Roger

    2011-02-01

    eHealth platform is the official federal network in Belgium (created by law on 21 August 2008) devoted to a secure exchange of health data in many types of applications, such as health care purposes, simplification of administrative procedures and contribution to health policy. It implies a controlled access to decentralized databases and uses encrypted personal data. The national identification number has been chosen in order to authenticate the requester, the patient, and the receiver of information exchange. Authorizations have to be respected in order to obtain personal health data. Several questions are raised about its security: the lack of mandatory request for systematic journaling on accesses to the electronic patient record as well as the absence of explicit procedures for sanctions in case of unauthorized access, the new role of social security administration in managing security where a eHealth manager can be both judge and party (in the function of trusted third party for health data encryption and of a required lawyer for texts proposed by physicians to the Commission for the protection of private life). Another critic concerns the number of physicians in minority and the absence of patients' delegates in the eHealth Board. At a time when the patient is becoming a partner in the care team, should not he be the gate-keeper for the access to his own health record? How could networks help him to get the appropriate knowledge to contribute to care and to write his testament of life? Recent laws (on private life, patient rights and euthanasia) have contributed to a behavioural change in citizens and physician attitudes. Recommendations are made in order to improve the acceptability of eHealth platform.

  16. Identifying emergent social networks at a federally qualified health center-based farmers' market.

    Science.gov (United States)

    Alia, Kassandra A; Freedman, Darcy A; Brandt, Heather M; Browne, Teri

    2014-06-01

    Identifying potential mechanisms connecting farmers' market interventions with health, economic, and community outcomes could inform strategies for addressing health disparities. The present study used social network theory to guide the in-depth examination of naturally occurring social interactions at a farmers' market located at a federally qualified health center located in a rural, low-income community. Trained observers recorded 61 observation logs at the market over 18 weeks. Thematic analysis revealed a range of actors and nonhuman facilitators instrumental to the farmers' market context. These actors connected with one another for communication and relationship development, economic and financial exchange, education, resource sharing, community ownership of the farmers' market, and conflict resolution. These interactions provided opportunities for social networks to develop among attendees, which may have facilitated the acquisition of social supports related to improved health, economic and community outcomes. Results provide insight into the role social networks may play in mediating the relationship between a farmers' market intervention and individual benefits. Findings also contribute to defining the typology of social networks, which may further disentangle the complex relationships between social networks and health outcomes. Future research should identify strategies for purposefully targeting social networks as a way to reduce diet-related health disparities.

  17. How Did Youth Mental Health Make It Onto Australia’s 2011 Federal Policy Agenda?

    Directory of Open Access Journals (Sweden)

    Harvey A. Whiteford

    2016-12-01

    Full Text Available The 2011 Australian federal budget included a large investment in youth mental health and early intervention services. In this article, we focus on the critical role of agenda setting in the preceding 4 years to examine how and why these services were given such a high priority at this time. We undertook a systematic review of relevant literature, including parliamentary Hansard transcripts from the House of Representatives and Senate, the final reports of all available parliamentary committees, government policy documents, other pertinent documents held by the Commonwealth Department of Health and Aging, and media reports from five widely circulated Australian publications/news outlets. We used Kingdon’s multiple streams framework to structure analysis. We highlight three factors that were influential in getting youth mental health issues onto the policy agenda: (a the strategic use of quantitative evidence to create a publicly visible “problem,” (b the marshalling of the “public” to create pressure on government, and (c the role of serendipity. Overall, we found the decision to prioritize youth mental health resulted from a combination of advocacy for a well-articulated policy solution by high-profile, influential policy entrepreneurs, and political pressure caused by an up swell of national support for mental health reform. Our findings highlight the socio-political factors that influence agenda setting and health policy formulation. They raise important ethical and strategic issues in utilizing research evidence to change policy.

  18. Federal Enactment of Healthy Homes Legislation in the United States to Improve Public Health

    Directory of Open Access Journals (Sweden)

    Alesia Coralie Ferguson

    2016-03-01

    Full Text Available Not all homes across America are ‘healthy’ homes. This contributes to the poor health of Americans and exacerbates existing health conditions costing millions each year in health care cost. Newer research is being conducted into strategies to alleviate biological, chemical and physical hazards in the home, and various programs exist to assist the homeowner in making improvements in the quality of their home. Not every homeowner or renter nationwide or within community localities has access to these strategies or programs that could potentially improve their home environment and therefore the health of their family. The objective of this article is to propose elements of a policy to address this inconsistency and variation. This proposal centers around the federal enactment of a national policy demanding that each state implements a healthy homes program tailored to fit their specific state housing and health needs. Members of Congress from States that have successfully implemented healthy home programs should champion this policy. Organizations that recognize the impact of housing on health should support the development of a national healthy homes strategy. This article will discuss the need, outcomes, stakeholders, and minimum requirements of such a policy.

  19. Incorporating Electronic Business Initiatives in Health Services and Health Tourism: A Case Study of Malaysia

    Directory of Open Access Journals (Sweden)

    Mohammad Talh

    2005-01-01

    Full Text Available Telecommunications, information communication technology, miniaturization, computers and Internet went through shorter product life styles and achieved widespread diffusion and reformed the nature of business operation and enhanced competitive business environment instantly. This technological advancement has resulted in evolution and innovation of many products, services and business processes. The Internet has resulted in the emergence of virtual markets with four primary distinctive characteristics, which are real time, shared, open and global. The greatest feature of the Internet is the absence of intermediaries; the manufacturers are able to sell their product relatively easier to buyers via Internet. E-business today is no longer technological issue, but is also a business issue. Incorporating E-business initiatives in health services aims to go beyond the traditional modes of healthcare delivery and instead, provide greater access to better and higher quality healthcare. It is achieved by grabbing opportunities of enhanced multimedia and information technologies and developing new technological solutions. In addition, E-business initiative is incorporated in enhancing health tourism sector through cost cutting strategies and improving quality of patients' care. Thus, this paper attempts to discuss the current states of health services and health tourism and how the emergence of E-business initiative can be capitalized to further boost the industry in Malaysia.

  20. An Investigation of the Awareness and Use of Open Access Initiative at the Federal Polytechnic, Offa, Kwara State, Nigeria

    Directory of Open Access Journals (Sweden)

    Issa, A.O.

    2014-09-01

    Full Text Available This study investigated the information environment of lecturers in Federal Polytechnic, Offa, Kwara State, Nigeria, in relation to their information seeking behavior, extent of use of the polytechnic library, perceptions of the resources and services of the library, level of awareness and extent of use of the open access model of scholarly communications, as well as the challenges of accessing and using information resources. It adopted the survey research method, using a questionnaire for data collection, while the descriptive statistics method was used to analyse the data, using tabular presentation and simple percentages. From a population of 280 lecturers for the study, a purposive sample of 164 was drawn. The findings showed that the lecturers' information needs are focused on online use; they hardly use the polytechnic library due to their perceptions of the resources and services of the library. They are, to a greater extent, aware of open access initiatives, but do not publish in open access outlets, while various challenges affect their access and use of information resources for teaching and research. A recommendation was made, among others, that the polytechnic management should pay more critical attention to the library especially in the areas of adequate, current and comprehensive collections on all the programmes of the institution, as well as the provision of wireless internet services on the campus through a public-private partnership arrangement.

  1. Informing the gestalt: an ethical framework for allocating scarce federal public health and medical resources to states during disasters.

    Science.gov (United States)

    Knebel, Ann R; Sharpe, Virginia A; Danis, Marion; Toomey, Lauren M; Knickerbocker, Deborah K

    2014-02-01

    During catastrophic disasters, government leaders must decide how to efficiently and effectively allocate scarce public health and medical resources. The literature about triage decision making at the individual patient level is substantial, and the National Response Framework provides guidance about the distribution of responsibilities between federal and state governments. However, little has been written about the decision-making process of federal leaders in disaster situations when resources are not sufficient to meet the needs of several states simultaneously. We offer an ethical framework and logic model for decision making in such circumstances. We adapted medical triage and the federalism principle to the decision-making process for allocating scarce federal public health and medical resources. We believe that the logic model provides a values-based framework that can inform the gestalt during the iterative decision process used by federal leaders as they allocate scarce resources to states during catastrophic disasters.

  2. Involving local health departments in community health partnerships: evaluation results from the partnership for the public's health initiative.

    Science.gov (United States)

    Cheadle, Allen; Hsu, Clarissa; Schwartz, Pamela M; Pearson, David; Greenwald, Howard P; Beery, William L; Flores, George; Casey, Maria Campbell

    2008-03-01

    Improving community health "from the ground up" entails a comprehensive ecological approach, deep involvement of community-based entities, and addressing social determinants of population health status. Although the Centers for Disease Control and Prevention, the Office of the Surgeon General, and other authorities have called for public health to be an "inter-sector" enterprise, few models have surfaced that feature local health departments as a key part of the collaborative model for effecting community-level change. This paper presents evaluation findings and lessons learned from the Partnership for the Public's Health (PPH), a comprehensive community initiative that featured a central role for local health departments with their community partners. Funded by The California Endowment, PPH provided technical and financial resources to 39 community partnerships in 14 local health department jurisdictions in California to promote community and health department capacity building and community-level policy and systems change designed to produce long-term improvements in population health. The evaluation used multiple data sources to create progress ratings for each partnership in five goal areas related to capacity building, community health improvement programs, and policy and systems change. Overall results were generally positive; in particular, of the 37 partnerships funded continuously throughout the 5 years of the initiative, between 25% and 40% were able to make a high level of progress in each of the Initiative's five goal areas. Factors associated with partnership success were also identified by local evaluators. These results showed that health departments able to work effectively with community groups had strong, committed leaders who used creative financing mechanisms, inclusive planning processes, organizational changes, and open communication to promote collaboration with the communities they served.

  3. Health workforce responses to global health initiatives funding: a comparison of Malawi and Zambia

    Directory of Open Access Journals (Sweden)

    Brugha Ruairí

    2010-08-01

    Full Text Available Abstract Background Shortages of health workers are obstacles to utilising global health initiative (GHI funds effectively in Africa. This paper reports and analyses two countries' health workforce responses during a period of large increases in GHI funds. Methods Health facility record reviews were conducted in 52 facilities in Malawi and 39 facilities in Zambia in 2006/07 and 2008; quarterly totals from the last quarter of 2005 to the first quarter of 2008 inclusive in Malawi; and annual totals for 2004 to 2007 inclusive in Zambia. Topic-guided interviews were conducted with facility and district managers in both countries, and with health workers in Malawi. Results Facility data confirm significant scale-up in HIV/AIDS service delivery in both countries. In Malawi, this was supported by a large increase in lower trained cadres and only a modest increase in clinical staff numbers. Routine outpatient workload fell in urban facilities, in rural health centres and in facilities not providing antiretroviral treatment (ART, while it increased at district hospitals and in facilities providing ART. In Zambia, total staff and clinical staff numbers stagnated between 2004 and 2007. In rural areas, outpatient workload, which was higher than at urban facilities, increased further. Key informants described the effects of increased workloads in both countries and attributed staff migration from public health facilities to non-government facilities in Zambia to PEPFAR. Conclusions Malawi, which received large levels of GHI funding from only the Global Fund, managed to increase facility staff across all levels of the health system: urban, district and rural health facilities, supported by task-shifting to lower trained staff. The more complex GHI arena in Zambia, where both Global Fund and PEPFAR provided large levels of support, may have undermined a coordinated national workforce response to addressing health worker shortages, leading to a less effective

  4. Reflections on health promotion in the Federal District ans its integration with the family health strategy

    Directory of Open Access Journals (Sweden)

    Sarah Guerra Gama TINOCO

    2009-04-01

    Full Text Available A Promoção à Saúde constitui hoje o eixo principal do projeto da Nova Saúde Pública. A Política Nacional de Promoção da Saúde foi criada com o objetivo geral de promover a qualidade de vida e reduzir vulnerabilidade e riscos à saúde relacionados a seus determinantes e condicionantes. A Secretaria de Estado de Saúde do Distrito Federal lançou em 2007 o Plano Distrital de Promoção da Saúde, tendo como meta geral a promoção da qualidade de vida da comunidade. Considerando a confluência de fatores conjunturais favoráveis, observa-se o potencial e ampliação da Estratégia Saúde da Família na implementação do Plano Distrital de Promoção da Saúde. Ressalta-se que para a efetiva concretização das diretrizes propostas tanto na política Nacional de Promoção da Saúde, na Política Nacional de Atenção Básica e no Plano Distrital de Promoção da Saúde, a Estratégia Saúde da Família caracteriza-se como pilar fundamental, não podendo estar dissociada de nenhum plano de ação. Nesse sentido, avaliasse que todas as ações específicas priorizadas no biênio 2006-2007, previstas para todos os entes federado, inclusive o Distrito Federal, podem ser melhor aplicadas, se o processo de educação e comunicação em saúde estiverem integrados, e com maior destaque, dentro das Equipes de Saúde da Família.

  5. Local food policies can help promote local foods and improve health: a case study from the Federated States of Micronesia.

    Science.gov (United States)

    Englberger, Lois; Lorens, Adelino; Pretrick, Moses; Tara, Mona J; Johnson, Emihner

    2011-11-01

    The Federated States of Micronesia (FSM) and other countries throughout the Pacific are facing an epidemic of non-communicable disease health problems. These are directly related to the increased consumption of unhealthy imported processed foods, the neglect of traditional food systems, and lifestyle changes, including decreased physical activity. The FSM faces the double burden of malnutrition with both non-communicable diseases and micronutrient deficiencies, including vitamin A deficiency and anemia. To help increase the use of traditional island foods and improve health, the Island Food Community of Pohnpei has initiated a program in the FSM to support and promote local food policies, along with its Go Local awareness campaign. Such local food policies are defined broadly and include individual and family commitments, community group local food policies and policies established by government, including presidential proclamations and increased taxation on soft drinks. The aim of this paper is to describe this work. An inter-agency, community- and research-based, participatory and media approach was used. Partners are both non-governmental and governmental. The use of continuing awareness work along with local food policy establishment and the acknowledgement of the individuals and groups involved are essential. The work is still in the preliminary stage but ad hoc examples show that this approach has had success in increased awareness on health issues and improving dietary intake on both an individual and group basis. This indicates that further use of local food policies could have an instrumental impact in FSM as well as other Pacific Island countries in promoting local foods and improving dietary intake and health, including the control of non-communicable diseases and other dietary-related health problems.

  6. The use of open source electronic health records within the federal safety net.

    Science.gov (United States)

    Goldwater, Jason C; Kwon, Nancy J; Nathanson, Ashley; Muckle, Alison E; Brown, Alexa; Cornejo, Kerri

    2014-01-01

    To conduct a federally funded study that examines the acquisition, implementation and operation of open source electronic health records (EHR) within safety net medical settings, such as federally qualified health centers (FQHC). The study was conducted by the National Opinion Research Center (NORC) at the University of Chicago from April to September 2010. The NORC team undertook a comprehensive environmental scan, including a literature review, a dozen key informant interviews using a semistructured protocol, and a series of site visits to West Virginia, California and Arizona FQHC that were currently using an open source EHR. Five of the six sites that were chosen as part of the study found a number of advantages in the use of their open source EHR system, such as utilizing a large community of users and developers to modify their EHR to fit the needs of their provider and patient communities, and lower acquisition and implementation costs as compared to a commercial system. Despite these advantages, many of the informants and site visit participants felt that widespread dissemination and use of open source was restrained due to a negative connotation regarding this type of software. In addition, a number of participants stated that there is a necessary level of technical acumen needed within the FQHC to make an open source EHR effective. An open source EHR provides advantages for FQHC that have limited resources to acquire and implement an EHR, but additional study is needed to evaluate its overall effectiveness.

  7. Luck Egalitarianism, Social Determinants and Public Health Initiatives

    DEFF Research Database (Denmark)

    Albertsen, Andreas

    2015-01-01

    People’s health is hugely affected by where they live, their occupational status and their socio-economic position. It has been widely argued that the presence of such social determinants in health provides good reasons to reject luck egalitarianism as a theory of distributive justice in health....... The literature provides different reasons why this responsibility-sensitive theory of distributive justice should not be applied to health. The critiques submit that (i) the social circumstances undermine or remove people’s responsibility for their health; (ii) responsibility sensitive health policies would...

  8. Luck Egalitarianism, Social Determinants and Public Health Initiatives

    DEFF Research Database (Denmark)

    Albertsen, Andreas

    2015-01-01

    People’s health is hugely affected by where they live, their occupational status and their socio-economic position. It has been widely argued that the presence of such social determinants in health provides good reasons to reject luck egalitarianism as a theory of distributive justice in health....... The literature provides different reasons why this responsibility-sensitive theory of distributive justice should not be applied to health. The critiques submit that (i) the social circumstances undermine or remove people’s responsibility for their health; (ii) responsibility sensitive health policies would...... adversely affect those who are worst off and; (iii) the luck egalitarian approach to health distracts from the important task of rectifying socio-economic influences on people's health and provides individualistic solutions to collective problems. But for each of these variants of the critique luck...

  9. Rural health care delivery amidst federal retrenchment: lessons from the Robert Wood Johnson Foundation's Rural Practice Project.

    Science.gov (United States)

    Moscovice, I S; Rosenblatt, R A

    1982-12-01

    This paper examines the experience of the Robert Wood Johnson Foundation's Rural Practice Project (RPP), a major non-governmental effort in the last decade concentrating on the direct delivery of rural health services. The nine RPP sites started prior to 1977 showed a slow but steady increase in their utilization levels and improvement in their financial status during their initial operational years. The tempo of their development was remarkably similar to that of federally sponsored practices in underserved rural areas. After four years of operation, all of the practices had completed their period of grant support; the practices survived in all cases, with almost all of the practices still retaining community sponsorship, salaried physicians, and a commitment to comprehensive care. Practices in sparsely populated rural areas and in areas with fewer hospital beds grew more slowly than those set in rural areas with higher population density and more ancillary resources. We conclude that the use of time-limited initial subsidies is an effective strategy in starting new rural practices in underserved areas and that those practices have a good chance of surviving their start-up phase.

  10. Impact of global health governance on country health systems: the case of HIV initiatives in Nigeria

    Directory of Open Access Journals (Sweden)

    Charles Chikodili Chima

    2015-06-01

    Full Text Available Background: Three global health initiatives (GHIs – the US President’s Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank Multi–Country HIV/AIDS Program – finance most HIV services in Nigeria. Critics assert that GHIs burden fragile health systems in resource–poor countries and that health system limitations in these countries constrain the achievement of the objectives of GHIs. This study analyzed interactions between HIV GHIs and the Nigerian Health System and explored how the impact of the GHIs could be optimized. Methods: A country case study was conducted using qualitative methods, including: semi–structured interviews, direct observation, and archival review. Semi–structured interviews were held with key informants selected to reach a broad range of stakeholders including policymakers, program managers, service providers, representatives of donor agencies and their implementing partners; the WHO country office in Nigeria; independent consultants; and civil society organizations involved in HIV work. The fieldwork was conducted between June and August 2013. Findings: HIV GHIs have had a mixed impact on the health system. They have enhanced availability of and access to HIV services, improved quality of services, and strengthened health information systems and the role of non–state actors in health care. On the negative end, HIV donor funding has increased dependency on foreign aid, widened disparities in access to HIV services, done little to address the sustainability of the services, crowded out non–HIV health services, and led to the development of a parallel supply management system. They have also not invested significantly in the production of new health workers and have not addressed maldistribution problems, but have rather contributed to internal brain drain by luring health workers from the public sector to non–governmental organizations and have

  11. The impact of global health initiatives on the health system in Angola.

    Science.gov (United States)

    Craveiro, Isabel; Dussault, Gilles

    2016-01-01

    We assessed the impact of global health initiatives (GHIs) on the health care system of Angola, as a contribution to documenting how GHIs, such as the Global Fund, GAVI and PEPFAR, influence the planning and delivery of health services in low-income countries and how national systems respond. We collected the views of national and sub-national key informants through 42 semi-structured interviews between April 2009 and May 2011 (12 at the national level and 30 at the sub-national level). We used a snowball technique to identify respondents from government, donors and non-governmental organisations. GHIs stimulated the formulation of a health policy and of plans and strategies, but the country has yet to decide on its priorities for health. At the regional level, managers lack knowledge of how GHIs' function, but they assess the effects of external funds as positive as they increased training opportunities, and augment the number of workers engaged in HIV or other specific disease programmes. However, GHIs did not address the challenge of attraction and retention of qualified personnel in provinces. Since Angola is not entirely dependent on external funding, national strategic programmes and the interventions of GHIs co-habit well, in contrast to countries such as Mozambique, which heavily depend on external aid.

  12. New federalism and intergovernmental fiscal relationships: the implications for health policy.

    Science.gov (United States)

    Anton, T J

    1997-06-01

    This paper explores a number of popular but largely inaccurate myths about American federalism in order to clarify the fundamental structures and processes that characterize American federal governance. Examination of financial and political trends over the past several decades reveals the development of a form of functional specialization among national, state, and local governments based on pragmatic responses to policy problems rather than decisions based on clearly articulated "principles." These responses have increasingly come from states in a wide variety of policy areas, including health care, where the energetic reform activity of the past decade provides a sharp contrast to the inability of the national government to enact reform. Recent pressure to devolve more authority to the states is thus much more than an ideological fad; it reflects widespread agreement among political elites that state and local governments have become capable governing partners. Nonetheless, there are limits to devolution which guarantee that close fiscal and political ties between the nation and the states will remain in place. Devolution does not, because it cannot, mean separation.

  13. Ensuring access to public information in Mexico: Proposal for treatment of the information portal of the Ministry of Federal Health

    Directory of Open Access Journals (Sweden)

    José Alfredo Hernández Landeros

    2011-03-01

    Full Text Available Reflect on the need to ensure access to information to everyone as the foundation of a information society. The case of Mexico and its public policy information from the Federal Institute of Access to Information. A proposal to adopt an information management system documentation for the Federal Ministry of Health of Mexico, based on international norms and standards in order to control, organize and retrieve information within your site.

  14. The first federal budget under Prime Minister Justin Trudeau: Addressing social determinants of health?

    Science.gov (United States)

    Ruckert, Arne; Labonté, Ronald

    2016-08-15

    A challenging budget environment during the Harper years has meant that crucial investments in the social determinants of health (SDHs) have increasingly been neglected. The tabling of what is widely considered a more progressive budget with expansionary fiscal elements under the new Prime Minister, Justin Trudeau, raises the question as to what extent this budget invests in policy areas that are crucial for achieving a more equitable distribution in the social determinants of health, as promised in the Liberal party platform. In this commentary, we argue that the first Liberal budget represents a step in the right direction, but that this first step needs to be followed up with a sustained commitment to address the pervasive (and unfair) social inequalities that are the root cause of persistent health inequities in Canada. We conclude that the first Trudeau budget, while moving in the right direction, does not fully embody the sustained policy changes needed to effectively address SDHs, including a more expansive role for the federal government in the redistribution of income and wealth.

  15. Federally Qualified Health Center Clinicians And Staff Increasingly Dissatisfied With Workplace Conditions.

    Science.gov (United States)

    Friedberg, Mark W; Reid, Rachel O; Timbie, Justin W; Setodji, Claude; Kofner, Aaron; Weidmer, Beverly; Kahn, Katherine

    2017-08-01

    Better working conditions for clinicians and staff could help primary care practices implement delivery system innovations and help sustain the US primary care workforce. Using longitudinal surveys, we assessed the experience of clinicians and staff in 296 clinical sites that participated in the Centers for Medicare and Medicaid Services (CMS) Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration. Participating FQHCs were expected to achieve, within three years, patient-centered medical home recognition at level 3-the highest level possible. During 2013-14, clinicians and staff in these FQHCs reported statistically significant declines in multiple measures of professional satisfaction, work environment, and practice culture. There were no significant improvements on any surveyed measure. These findings suggest that working conditions in FQHCs have deteriorated recently. Whether findings would be similar in other primary care practices is unknown. Although we did not identify the causes of these declines, possible stressors include the adoption of health information technology, practice transformation, and increased demand for services. Project HOPE—The People-to-People Health Foundation, Inc.

  16. Breastfeeding initiation at birth can help reduce health inequalities

    DEFF Research Database (Denmark)

    Robertson, Aileen

    2015-01-01

    The most socially isolated mothers may feel marginalised by our health services so that they feel excluded and not willing to seek support. They require different approaches to help them feel empowered and to increase their self-esteem. We have to learn how health services can better improve...

  17. "Razoo Health:" A Community-Based Nursing Education Initiative.

    Science.gov (United States)

    Kraus, Marjorie B.; Morgan, Connie M.; Matteson, Peggy S.

    2003-01-01

    In New Orleans, nursing faculty and students partnered with inner-city schools and churches to mobilize neighborhood assets and improve health care. Students learned community assessment skills and worked with empowered citizens who reclaimed their health resources. (Contains 28 references.) (SK)

  18. Federal administrative health courts are unconstitutional: a reply to Elliott, Narayan, and Nasmith.

    Science.gov (United States)

    Widman, Amy; Hochberg, Francine A

    2008-08-01

    This commentary responds to the essay by Elliott, Narayan, and Nasmith wherein they propose that the federal government may preclude plaintiffs with medically inflicted injuries from bringing state common-law tort claims against those whose negligence caused their injury. The administrative system championed by Elliott and other proponents is a radical departure from the current civil justice system. Specifically, we argue that the administrative health courts, as proposed, violate the commerce clause, the spending clause, the Seventh Amendment, and separation of powers principles. The commentary concludes that such a system is fatally flawed and cannot withstand constitutional scrutiny. Moreover, we are not persuaded that Congress will be able to ground such a radical constitutional restructuring in any sound public policy, as the majority of studies do not evidence Elliott, Narayan, and Nasmith's presumption that the civil justice system has failed in the medical malpractice context.

  19. Reconciliation of the cloud computing model with US federal electronic health record regulations.

    Science.gov (United States)

    Schweitzer, Eugene J

    2012-01-01

    Cloud computing refers to subscription-based, fee-for-service utilization of computer hardware and software over the Internet. The model is gaining acceptance for business information technology (IT) applications because it allows capacity and functionality to increase on the fly without major investment in infrastructure, personnel or licensing fees. Large IT investments can be converted to a series of smaller operating expenses. Cloud architectures could potentially be superior to traditional electronic health record (EHR) designs in terms of economy, efficiency and utility. A central issue for EHR developers in the US is that these systems are constrained by federal regulatory legislation and oversight. These laws focus on security and privacy, which are well-recognized challenges for cloud computing systems in general. EHRs built with the cloud computing model can achieve acceptable privacy and security through business associate contracts with cloud providers that specify compliance requirements, performance metrics and liability sharing.

  20. Research for improved health: variability and impact of structural characteristics in federally funded community engaged research.

    Science.gov (United States)

    Pearson, Cythina R; Duran, Bonnie; Oetzel, John; Margarati, Maya; Villegas, Malia; Lucero, Julie; Wallerstein, Nina

    2015-01-01

    Although there is strong scientific, policy, and community support for community-engaged research (CEnR)-including community-based participatory research (CBPR)-the science of CEnR is still developing. To describe structural differences in federally funded CEnR projects by type of research (i.e., descriptive, intervention, or dissemination/policy change) and race/ethnicity of the population served. We identified 333 federally funded projects in 2009 that potentially involved CEnR, 294 principal investigators/project directors (PI/PD) were eligible to participate in a key informant (KI) survey from late 2011 to early 2012 that asked about partnership structure (68% response rate). The National Institute on Minority Health & Health Disparities (19.1%), National Cancer Institute (NCI; 13.3%), and the Centers for Disease Control and Prevention (CDC; 12.6%) funded the most CEnR projects. Most were intervention projects (66.0%). Projects serving American Indian or Alaskan Native (AIAN) populations (compared with other community of color or multiple-race/unspecified) were likely to be descriptive projects (p<.01), receive less funding (p<.05), and have higher rates of written partnership agreements (p<.05), research integrity training (p<.05), approval of publications (p<.01), and data ownership (p<.01). AIAN-serving projects also reported similar rates of research productivity and greater levels of resource sharing compared with those serving multiple-race/unspecified groups. There is clear variability in the structure of CEnR projects with future research needed to determine the impact of this variability on partnering processes and outcomes. In addition, projects in AIAN communities receive lower levels of funding yet still have comparable research productivity to those projects in other racial/ethnic communities.

  1. Integration of structural health monitoring solutions onto commercial aircraft via the Federal Aviation Administration structural health monitoring research program

    Science.gov (United States)

    Swindell, Paul; Doyle, Jon; Roach, Dennis

    2017-02-01

    The Federal Aviation Administration (FAA) started a research program in structural health monitoring (SHM) in 2011. The program's goal was to understand the technical gaps of implementing SHM on commercial aircraft and the potential effects on FAA regulations and guidance. The program evolved into a demonstration program consisting of a team from Sandia National Labs Airworthiness Assurance NDI Center (AANC), the Boeing Corporation, Delta Air Lines, Structural Monitoring Systems (SMS), Anodyne Electronics Manufacturing Corp (AEM) and the FAA. This paper will discuss the program from the selection of the inspection problem, the SHM system (Comparative Vacuum Monitoring-CVM) that was selected as the inspection solution and the testing completed to provide sufficient data to gain the first approved use of an SHM system for routine maintenance on commercial US aircraft.

  2. Breckinridge Project, initial effort. Report VII, Volume 4. Safety and health plan

    Energy Technology Data Exchange (ETDEWEB)

    None

    1982-01-01

    The Safety and Health Plan recognizes the potential hazards associated with the Project and has been developed specifically to respond to these risks in a positive manner. Prevention, the primary objective of the Plan, starts with building safety controls into the process design and continues through engineering, construction, start-up, and operation of the Project facilities and equipment. Compliance with applicable federal, state, and local health and safety laws, regulations, and codes throughout all Project phases is required and assured. The Plan requires that each major Project phase be thoroughly reviewed and analyzed to determine that those provisions required to assure the safety and health of all employees and the public, and to prevent property and equipment losses, have been provided. The Plan requires followup on those items or situations where corrective action needs were identified to assure that the action was taken and is effective. Emphasis is placed on loss prevention. Exhibit 1 provides a breakdown of Ashland Synthetic Fuels, Inc.'s (ASFI's) Loss Prevention Program. The Plan recognizes that the varied nature of the work is such as to require the services of skilled, trained, and responsible personnel who are aware of the hazards and know that the work can be done safely, if done correctly. Good operating practice is likewise safe operating practice. Training is provided to familiarize personnel with good operational practice, the general sequence of activities, reporting requirements, and above all, the concept that each step in the operating procedures must be successfully concluded before the following step can be safely initiated. The Plan provides for periodic review and evaluation of all safety and loss prevention activities at the plant and departmental levels.

  3. Disease management strategy: initiative links pharmaceutical and mental health data.

    Science.gov (United States)

    Docherty, J P

    1996-02-01

    The emphasis in healthcare is shifting to practical applications of medical knowledge for the provision of more cost-effective care. This requires greater linkages among clinical information systems across multiple organizations. This article describes new initiatives in disease management to link the traditionally separate data systems fo pharmaceutical, behavioral and general medical care. The potential for improved patient care is highlighted. The author is an expert consultant for a large pharmaceutical manufacturer's disease state management initiative, and has an extensive leadership background in many segments of the behavioral healthcare industry.

  4. As emendas parlamentares no orçamento federal da saúde Congressional amendments to the Brazilian Federal health budget

    Directory of Open Access Journals (Sweden)

    Tatiana Wargas de Faria Baptista

    2012-12-01

    Full Text Available O orçamento público brasileiro passou por mudanças na Constituição Federal de 1988. Instituíram-se mecanismos para integração das atividades de planejamento e orçamento, e definiram-se formas de participação do Poder Legislativo no processo orçamentário. As emendas parlamentares surgem nesse contexto. O artigo discute a participação das emendas no orçamento federal da saúde no período de 1997 a 2006, reunindo elementos para a análise dos mecanismos de financiamento e planejamento setorial. Verificou-se uma participação significativa das emendas no período, reunindo mais da metade dos recursos de investimento em alguns anos. A Região Norte destaca-se pelo aporte de recursos, indicando a necessidade de estudos que aprofundem a relação entre destino de emendas e coalizões político-partidárias. Conclui-se que as emendas não podem ser compreendidas apenas como um mecanismo de financiamento, mas também como um mecanismo da política, não estando submetidas obrigatoriamente à lógica do planejamento, o que reforça a necessidade de maior transparência do poder público na execução orçamentária.The public budget in Brazil has undergone significant changes since enactment of the 1988 Federal Constitution. Mechanisms for integration of planning activities and budget execution have been created, and Legislative participation in budgeting has increased. Congressional amendments appeared in this context. The article discusses the participation of Congressional amendments in the Federal health budget from 1997 to 2006, combining elements for discussion of funding mechanisms and health planning. Such amendments played a significant role in the budget process, accounting for over half of health funds in some years. The North was the region of Brazil that received most resources resulting from Congressional amendments, suggesting the need for further studies on the relationship between the amendments' enforcement and

  5. Evaluation of a federally funded workforce development program: the Centers for Public Health Preparedness.

    Science.gov (United States)

    Sobelson, Robyn K; Young, Andrea C

    2013-04-01

    The Centers for Public Health Preparedness (CPHP) program was a five-year cooperative agreement funded by the Centers for Disease Control and Prevention (CDC). The program was initiated in 2004 to strengthen terrorism and emergency preparedness by linking academic expertise to state and local health agency needs. The purposes of the evaluation study were to identify the results achieved by the Centers and inform program planning for future programs. The evaluation was summative and retrospective in its design and focused on the aggregate outcomes of the CPHP program. The evaluation results indicated progress was achieved on program goals related to development of new training products, training members of the public health workforce, and expansion of partnerships between accredited schools of public health and state and local public health departments. Evaluation results, as well as methodological insights gleaned during the planning and conduct of the CPHP evaluation, were used to inform the design of the next iteration of the CPHP Program, the Preparedness and Emergency Response Learning Centers (PERLC).

  6. Analysis of Service-learning activities adopted in health courses of Federal University of Bahia.

    Science.gov (United States)

    Baldoino, Aline Silva; Veras, Renata Meira

    2016-06-01

    is study aimed to raise and discuss the data about the integration of health courses teaching and service activities o ered at the Federal University of Bahia (UFBA), pre- senting scenarios practices and major di culties existing in the relationship between the university and the services of health. is was a qualitative study of descriptive explo- ratory character, using a questionnaire as a research tool applied to the coordinators of selected health courses. e selection was by reading the political pedagogical project, the following courses were selected: nursing, physical therapy, speech therapy, medicine, nu- trition, dentistry and public health. e results indicated eight types of teaching-service integration activities, 57 scenarios of practice and the main di culties. It was concluded that these courses are sticking to changes in academic training in health, in view of the large number of basic health units in the teaching service process. us, it emphasizes that the UFBA includes activities in health care that enable the integration-education in the higher education process, although there are some di culties in this relationship indicated by the coordinators. Esse estudo teve como objetivo levantar e discutir os dados acerca das atividades de integração ensino-serviço de cursos de saúde oferecidos na Universidade Federal da Bahia (UFBA), apresentando os cenários de práticas e as principais di culdades existentes na relação entre a uni- versidadeeosserviçosdesaúde.Tratou-sedeumapesquisaqualitativa,decaráterdescritivoexploratório,utilizando-seumquestionáriocomo instrumento de investigação aplicado aos coordenadores dos cursos de saúde selecionados. A seleção foi mediante a leitura do projeto político pedagógico, sendo selecionados os seguintes cursos: enfermagem, sioterapia, fonoaudiologia, medicina, nutrição, odontologia e saúde coletiva. Os resultados indicaram 8 tipos de atividades de integração ensino-serviço, 57 cenários de pr

  7. Mindfulness based stress reduction adapted for depressed disadvantaged women in an urban Federally Qualified Health Center.

    Science.gov (United States)

    Burnett-Zeigler, Inger E; Satyshur, Maureen D; Hong, Sunghyun; Yang, Amy; T Moskowitz, Judith; Wisner, Katherine L

    2016-11-01

    In this study we examine the feasibility and preliminary effectiveness of mindfulness based stress reduction adapted for delivery in an urban Federally Qualified Health Center (FQHC). Thirty-one African- American adult women ages 18-65 with depressive symptoms enrolled to participate in an 8-week mindfulness group intervention. The primary outcome (depression) and secondary outcomes (stress, mindfulness, functioning, well-being, and depression stigma) were assessed at baseline, 8 and 16-weeks. Depressive symptoms significantly decreased from baseline to 16 weeks. A significant decrease in stress and significant increase in mindfulness was found from baseline to 8 weeks and baseline to 16 weeks. Additionally, aspects of well-being-self-acceptance and growth-significantly increased from baseline to 8-weeks. Stigma significantly increased from baseline to 8 weeks and significantly decreased from 8 to 16 weeks (all p's Mindfulness-based interventions implemented in FQHCs may increase access to effective treatments for mental health symptoms. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. The Shared Health Research Information Network (SHRINE): a prototype federated query tool for clinical data repositories.

    Science.gov (United States)

    Weber, Griffin M; Murphy, Shawn N; McMurry, Andrew J; Macfadden, Douglas; Nigrin, Daniel J; Churchill, Susanne; Kohane, Isaac S

    2009-01-01

    The authors developed a prototype Shared Health Research Information Network (SHRINE) to identify the technical, regulatory, and political challenges of creating a federated query tool for clinical data repositories. Separate Institutional Review Boards (IRBs) at Harvard's three largest affiliated health centers approved use of their data, and the Harvard Medical School IRB approved building a Query Aggregator Interface that can simultaneously send queries to each hospital and display aggregate counts of the number of matching patients. Our experience creating three local repositories using the open source Informatics for Integrating Biology and the Bedside (i2b2) platform can be used as a road map for other institutions. The authors are actively working with the IRBs and regulatory groups to develop procedures that will ultimately allow investigators to obtain identified patient data and biomaterials through SHRINE. This will guide us in creating a future technical architecture that is scalable to a national level, compliant with ethical guidelines, and protective of the interests of the participating hospitals.

  9. [The need of prenatal public health initiatives in Poland].

    Science.gov (United States)

    Jarosz, Mirosław J

    2012-11-01

    The author emphasizes the achievements of the Polish Gynecological Society in the field of improving the health indicators concerning perinatal mortality among infants during the last two decades in Poland. Attention is paid to the contribution of the members of the Society to organizational change in Polish health care after 1990, which resulted in the improvement of the care of mother and child. It is also underlined that the members of the Society contributed to the creation of early detection system of breast and cervical cancer in Poland. However it is noteworthy that in 'Polish Gynecology' - the publication of the Polish Gynecological Society - the number of reports devoted to risky health behaviors of women during periconceptional period and pregnancy is scarce. The author draws attention to the percentage of women who smoke cigarettes and consume alcohol before and during pregnancy Emphasis is also placed on the problem of nutritional disorders (mainly pathological methods of dieting) among Polish women during the reproductive period and in the first weeks of pregnancy (before the pregnancy is confirmed). These aspects may result in epigenetic changes shaping the phenotype of the offspring. The author refers to the Barker's theory of Developmental Origins of Adult Diseases and warns that the above-mentioned health behaviors of women may bring about negative effects for the offspring and future generations, namely susceptibility to chronic diseases: arterial hypertension, obesity type 2 diabetes and metabolic syndrome. Negative effects for the health of offspring may also result from low level of physical activity of women before and during pregnancy The author concludes that it is necessary to intensify the efforts of the Polish Gynecological Society in the area of prenatal public health.

  10. Health initiatives conducted outside hospitals and other medical settings

    DEFF Research Database (Denmark)

    Mik-Meyer, Nanna

    2016-01-01

    The aim of this essay is to critically reflect on the concept of health. ‘Health’ refers not only to the absence of biomedical diseases and bodily and mental dysfunctionalities; today, the concept is also synonymous with wellness, happiness, and a good life. However, this broad definition of what...... it means to be healthy nowadays produces a number of problems for citizens who struggle to meet the standards of this changed ideal of health. Consequently, unhealthy citizens, such as overweight individuals, possess not only a biomedically defined unhealthy body or mind; they are also, in a broader sense...

  11. Health initiatives conducted outside hospitals and other medical settings

    DEFF Research Database (Denmark)

    Mik-Meyer, Nanna

    2016-01-01

    The aim of this essay is to critically reflect on the concept of health. ‘Health’ refers not only to the absence of biomedical diseases and bodily and mental dysfunctionalities; today, the concept is also synonymous with wellness, happiness, and a good life. However, this broad definition of what...... it means to be healthy nowadays produces a number of problems for citizens who struggle to meet the standards of this changed ideal of health. Consequently, unhealthy citizens, such as overweight individuals, possess not only a biomedically defined unhealthy body or mind; they are also, in a broader sense...

  12. [The provision of population of the Russian Federation with basic personnel resource of public health care system].

    Science.gov (United States)

    Schepin, V O

    2013-01-01

    The article presents the results of complex scientific analysis of number and structure of physicians and paramedical personnel of public and municipal health care system of the Russian Federation. The provision of country population, its federal okrugs and federation subjects with physicians and paramedical personnel of various specialties are analyzed too, including ratio of physicians and paramedical personnel and territorial differentiation of provision of population with basic medical personnel. The study results demonstrate that in 2012 provision of population (per 10 000 of population) with physicians increased from 43.9 to 44.7. At the same time provision with paramedical personnel decreased from 92.3 to 90.8. in the Russian Federation are preserved significant territorial disproportions of provision of population with medical personnel resource. The provision of population with physicians and paramedical personnel is 4.3 times and 1.9 times higher in cities than in rural area. The differences between extreme indicators of provision of population of the Russian Federation with physicians and paramedical personnel are 2.9 and 2.4 times correspondingly. The differences between indicators of provision with physicians of clinical specialties are 2.6 times. The average ratio between physician and paramedical personnel is 1:2.03. The structure of medical manpower corresponds to the need of population in medical care in incomplete measure. The materials substantiate necessity to continue modernization, optimization and development of manpower support of public health care system in the Russian Federation.

  13. Impact of maternal and neonatal health initiatives on inequity in maternal health care utilization in Bangladesh.

    Science.gov (United States)

    Haider, Mohammad Rifat; Rahman, Mohammad Masudur; Moinuddin, Md; Rahman, Ahmed Ehsanur; Ahmed, Shakil; Khan, M Mahmud

    2017-01-01

    Despite remarkable progress in maternal and child health, inequity persists in maternal care utilization in Bangladesh. Government of Bangladesh (GOB) with technical assistance from United Nation Population Fund (UNFPA), United Nation Children's Fund (UNICEF) and World Health Organization (WHO) started implementing Maternal and Neonatal Health Initiatives in selected districts of Bangladesh (MNHIB) in 2007 with an aim to reduce inequity in healthcare utilization. This study examines the effect of MNHIB on inequity in maternal care utilization. Two surveys were carried out in four districts in Bangladesh- baseline in 2008 and end-line in 2013. The baseline survey collected data from 13,206 women giving birth in the preceding year and in end-line 7,177 women were interviewed. Inequity in maternal healthcare utilization was calculated pre and post-MNHIB using rich-to-poor ratio and concentration index. Mean age of respondents were 23.9 and 24.6 years in 2008 and 2013 respectively. Utilization of pregnancy-related care increased for all socioeconomic strata between these two surveys. The concentration indices (CI) for various maternal health service utilization in 2013 were found to be lower than the indices in 2008. However, in comparison to contemporary BDHS data in nearby districts, MNHIB was successful in reducing inequity in receiving ANC from a trained provider (CI: 0.337 and 0.272), institutional delivery (CI: 0.435 in 2008 to 0.362 in 2013), and delivery by skilled personnel (CI: 0.396 and 0.370). Overall use of maternal health care services increased in post-MNHIB year compared to pre-MNHIB year and inequity in maternal service utilization declined for three indicators out of six considered in the paper. The reductions in CI values for select maternal care indicators imply that the program has been successful not only in improving utilization of maternal health services but also in lowering inequality of service utilization across socioeconomic groups

  14. Amendments to the Center for Devices and Radiological Health federal performance standard for laser products.

    Science.gov (United States)

    Dennis, J E

    1997-12-01

    Federal law requires that all laser products that are imported into or introduced into commerce in the United States comply with the performance standard published in the Code of Federal Regulations (CRF), Title 21, Parts 1040.10 and 1040.11, administered by the Center for Devices and Radiological Health (CDRH), US Food and Drug Administration. Although it contains somewhat different requirements for hazard classification, engineering controls and labeling, the ANSI Z136.1 standard defers to the CDRH standard. The CDRH standard became effective in August, 1976 and was amended, in 1978 and also in 1985. In the early 1990s, US experts met to formulate an approach to bring the requirements of the CDRH standard and those of the International Electrotechnical Commission (IEC) standard, IEC 825, into closer agreement in order to lower barriers to international trade and to remove any excessive compliance burdens on manufacturers. In 1993, the CDRH published, formally in the Federal Register and informally, a Notice of Intent to amend the CDRH standard. Responses to those notices have now been analyzed and informal draft amendments were distributed in 1996. This draft is now being prepared for formal issuance as a Notice of Proposed Rulemaking. Meanwhile, the IEC standard was amended in 1993 and republished as IEC 825-1; these amendments created considerable controversy since they resulted in over classification of the hazard of many products, especially light emitting diodes (LEDs) that have a large divergence and increased source dimensions. Additional amendments are now being developed to correct this problem. The CDRH has carefully monitored developments in the IEC and actively participated in its proceedings as a guide in developing its own proposal. This paper describes the major changes that are being proposed for the CDRH standard and presents some rationale for the major changes. The more significant changes include expansion of applicability to include LEDs

  15. School-Based Health Promotion Initiative Increases Children's Physical Activity

    Science.gov (United States)

    Cluss, Patricia; Lorigan, Devin; Kinsky, Suzanne; Nikolajski, Cara; McDermott, Anne; Bhat, Kiran B.

    2016-01-01

    Background: Childhood obesity increases health risk, and modest physical activity can impact that risk. Schools have an opportunity to help children become more active. Purpose: This study implemented a program offering extra school-day activity opportunities in a rural school district where 37% of students were obese or overweight in 2005 and…

  16. Initiatives in the Romanian eHealth Landscape

    Directory of Open Access Journals (Sweden)

    Dan Andrei SITAR TAUT

    2011-01-01

    Full Text Available Even if the foundation in the field of eHealth was set almost half century ago, the current achievements’ status does not place Romania on a good position in a European ranking. The efforts made during the last years are promising, but they still cannot surpass the enormous gaps in many eHealth indicators. This is not a surprising fact because the eHealth level must be sustained by a healthy and stable sanitary system and infrastructure, which, in our country, is almost in collapse, especially now in the context of global economic and financial crisis. We consider being guilty for these circumstances the lack of a clear and solid mid-term strategy developed at the level of the Ministry of Health (MoH, harmonized in a global legal and regulatory framework as well, and also the non-correlated researcher groups interests. The good attitude of practitioners regarding the challenges of new technologies and the political will can still give a chance to the Romanian healthcare system and to its modern faces.

  17. ‘teen Mental Health First Aid’: a description of the program and an initial evaluation

    OpenAIRE

    Hart, Laura M; Mason, Robert J.; Kelly, Claire M; Cvetkovski, Stefan; Jorm, Anthony F

    2016-01-01

    Background Many adolescents have poor mental health literacy, stigmatising attitudes towards people with mental illness, and lack skills in providing optimal Mental Health First Aid to peers. These could be improved with training to facilitate better social support and increase appropriate help-seeking among adolescents with emerging mental health problems. teen Mental Health First Aid (teen MHFA), a new initiative of Mental Health First Aid International, is a 3 × 75 min classroom based trai...

  18. Governance and One Health: Exploring the Impact of Federalism and Bureaucracy on Zoonotic Disease Detection and Reporting

    Directory of Open Access Journals (Sweden)

    Heather A. Allen

    2015-05-01

    Full Text Available The merits of One Health have been thoroughly described in the literature, but how One Health operates in the United States federal system of government is rarely discussed or analyzed. Through a comparative case-study approach, this research explores how federalism, bureaucratic behavior, and institutional design in the United States may influence zoonotic disease outbreak detection and reporting, a key One Health activity. Using theoretical and empirical literature, as well as a survey/interview instrument for individuals directly involved in a past zoonotic disease outbreak, the impacts of governance are discussed. As predicted in the theoretical literature, empirical findings suggest that federalism, institutional design, and bureaucracy may play a role in facilitating or impeding zoonotic disease outbreak detection and reporting. Regulatory differences across states as well as compartmentalization of information within agencies may impede disease detection. However, the impact may not always be negative: bureaucracies can also be adaptive; federalism allows states important opportunities for innovation. While acknowledging there are many other factors that also matter in zoonotic disease detection and reporting, this research is one of the first attempts to raise awareness in the literature and stimulate discussion on the intersection of governance and One Health.

  19. An examination of the Total Quality Management (TQM) concept given current Federal/DoD competition initiatives

    Science.gov (United States)

    Stabile, Michael E.

    1992-06-01

    Quality is vital to our defense and quality improvement is key to increasing productivity. The Department of Defense (DoD) Total Quality Management (TQM) effort has been given top priority by the Secretary of Defense. Many questions exist concerning the problems encountered when implementing TQM throughout DoD. This thesis looks at the compatibility of the TQM philosophy with current Federal Acquisition Regulation competition requirements. The writer concludes that the TQM philosophy implementation is compatible with existing competition policy.

  20. Interactive Environments: Opportunities for Social Innovation and Public Health Initiatives

    Directory of Open Access Journals (Sweden)

    Predrag K. Nikolic

    2016-05-01

    Full Text Available How to keep people in a “good health”, longer and healthier life is more than just a phrase listed in a sustainable strategies it became crucial issue for any future social innovation initiative and community needs. New technologies and its application in everyday living surrounding are affecting a way we are interacting between each other and with services around us. As a result, we are facing huge psychological and cultural shift in human behavior and raising of new social practices. We are in need of using new approaches and models in order to provoke human behavior change which is more than ever depending on content and context users can reach in interactive environments they are approaching through their devices or in a physical space. New powerful playground for social innovations is born.

  1. [A framework for evaluating ethical issues of public health initiatives: practical aspects and theoretical implications].

    Science.gov (United States)

    Petrini, Carlo

    2015-01-01

    The "Framework for the Ethical Conduct of Public Health Initiatives", developed by Public Health Ontario, is a practical guide for assessing the ethical implications of evidence-generating public health initiatives, whether research or non-research activities, involving people, their biological materials or their personal information. The Framework is useful not only to those responsible for determining the ethical acceptability of an initiative, but also to investigators planning new public health initiatives. It is informed by a theoretical approach that draws on widely shared bioethical principles. Two considerations emerge from both the theoretical framework and its practical application: the line between practice and research is often blurred; public health ethics and biomedical research ethics are based on the same common heritage of values.

  2. Food security and nutrition in the Russian Federation – a health policy analysis

    Directory of Open Access Journals (Sweden)

    Karsten Lunze

    2015-06-01

    Full Text Available Background: In the Russian Federation (Russia, an elevated burden of premature mortality attributable to non-communicable diseases (NCDs has been observed since the country's economic transition. NCDs are largely related to preventable risk factors such as unhealthy diets. Objective: This health policy study's aim was to analyze past and current food production and nutritional trends in Russia and their policy implications for Russia's NCD burden. Design: We examined food security and nutrition in Russia using an analytical framework of food availability, access to food, and consumption. Results: Agricultural production declined during the period of economic transition, and nutritional habits changed from high-fat animal products to starches. However, per-capita energy consumption remained stable due to increased private expenditures on food and use of private land. Paradoxically, the prevalence of obesity still increased because of an excess consumption of unsaturated fat, sugar, and salt on one side, and insufficient intake of fruit and vegetables on the other. Conclusions: Policy and economic reforms in Russia were not accompanied by a food security crisis or macronutrient deprivation of the population. Yet, unhealthy diets in contemporary Russia contribute to the burden of NCDs and related avoidable mortality. Food and nutrition policies in Russia need to specifically address nutritional shortcomings and food-insecure vulnerable populations. Appropriate, evidence-informed food and nutrition policies might help address Russia's burden of NCDs on a population level.

  3. Evaluation of a "traditional food for health" intervention in Pohnpei, Federated States of Micronesia.

    Science.gov (United States)

    Kaufer, Laura; Englberger, Lois; Cue, Roger; Lorens, Adelino; Albert, Kiped; Pedrus, Podis; Kuhnlein, Harriet V

    2010-04-01

    Federated States of Micronesia (FSM) faces increasing rates of non-communicable diseases related to the neglect of the traditional food system and the shift to consumption of imported food and adoption of sedentary lifestyles. To reverse this trend, a two-year, food-based intervention in one Pohnpeian community in FSM promoted local food production and consumption using a variety of approaches including education, training, agriculture and social marketing following a "Go Local" message. Foods promoted were banana, giant swamp taro, breadfruit and pandanus varieties, green leafy vegetables and fruits for their provitamin A and total carotenoids, vitamins, minerals and fiber content. An evaluation was conducted in a random sample of households (n=47) to examine the extent of dietary changes following the intervention. Results indicated increased (110%) provitamin A carotenoid intake; increased frequency of consumption of local banana (53%), giant swamp taro (475%), and local vegetables (130%); and increased dietary diversity from local food. Exposure to intervention activities was high and there were positive changes in attitudes towards local food. The intervention approaches appear to have been successful in this short period. It is likely that similar approaches in additional communities in Pohnpei and other parts of the Pacific would also be successful in promoting local food. Evidence gathering should continue to document the long-term health outcomes of increased reliance on local food.

  4. STRATEGIC MANAGEMENT TOOLS, STAKEHOLDERS AND PERFORMANCE ORGANIZATIONS, PRIVATE HEALTH BRANCH OF THE FEDERAL DISTRICT

    Directory of Open Access Journals (Sweden)

    Bruno Vendruscolo

    2012-06-01

    Full Text Available This study aimed to identify the use of management tools and the influence of stakeholders on organizational performance of companies in the private health sector in the Federal District. We used the tools of strategic management, such as budgeting, strategic planning, balanced scorecard, benchmarking, and management software. Study participants consist of individuals involved in strategic processes. We analyzed the past 5 years in organizations to understand the performance. The data collection was face-to-face, the instruments consisted of qualitative interviews in person, and semi-structured content analysis. We also performed analysis of secondary data and documents. To measure the performance between the organizations we used the method of data envelopment analysis (DEA, using the CCR standard, and the mean change index as the number of employees, physicians, costs, number of appointments, and tests. In the analysis of tools and stakeholders we adapted values for the major and minor influences and the other results found framed. The results cite the presence of management tools in five of the six organizations. The comparison of performance between them presented as a result that organizations 2 and 4 were efficient and 3 was the least efficient. The study identified the need to understand the requirements of stakeholders and the indicators set out to understand organizational performance and its evolution, mainly determined by the management tools. Although not reaching proposed levels, this work creates hypotheses about the use of these tools and analysis of stakeholders in organizational performance.

  5. How federal health-care policies interface with urban and rural areas: a comparison of three systems.

    Science.gov (United States)

    Baracskay, Daniel

    2012-01-01

    Global public health policies span national borders and affect multitudes of people. The spread of infectious disease has neither political nor economic boundaries, and when elevated to a status of pandemic proportions, immediate action is required. In federal systems of government, the national level leads the policy formation and implementation process, but also collaborates with supranational organisations as part of the global health network. Likewise, the national level of government cooperates with sub-national governments located in both urban and rural areas. Rural areas, particularly in less developed countries, tend to have higher poverty rates and lack the benefits of proper medical facilities, communication modes and technology to prevent the spread of disease. From the perspective of epidemiological surveillance and intervention, this article will examine federal health policies in three federal systems: Australia, Malaysia and the USA. Using the theoretical foundations of collaborative federalism, this article specifically examines how collaborative arrangements and interactions among governmental and non-governmental actors help to address the inherent discrepancies that exist between policy implementation and reactions to outbreaks in urban and rural areas. This is considered in the context of the recent H1N1 influenza pandemic, which spread significantly across the globe in 2009 and is now in what has been termed the 'post-pandemic era'.

  6. [Public Health initiative for improved vaccination for asylum seekers].

    Science.gov (United States)

    Brockmann, Stefan O; Wjst, Stephanie; Zelmer, Ursula; Carollo, Stefanie; Schmid, Mirjam; Roller, Gottfried; Eichner, Martin

    2016-05-01

    The number of asylum seekers in Germany has increased dramatically in 2015. Their medical care includes the officially recommended vaccinations; yet, no detailed information on this is yet available in Germany. In light of the rising number of asylum seekers, we have developed a concept to facilitate their vaccination. This concept includes the coordination of different partners, the supply of vaccines and other materials through the local health office, and the cooperation with the local physicians' association. To evaluate and accelerate progress, we compared the number of vaccinations conducted by physicians independently of the vaccination concept with those conducted within the new concept. For the period of investigation, 2,256 new asylum seekers were temporarily accommodated in the facilities. The vaccination concept was applied in only some of the facilities. Twenty-eight percent of all asylum seekers (642) were vaccinated at least once; 89 % of the vaccinees (571) were vaccinated within the newly developed concept. In the facilities that were not included in this concept, only 6 % of the refugees were vaccinated, whereas in the facilities that were included up to 58 % were vaccinated. Even though the new concept has started successfully, further innovations are required to reach sufficient vaccination coverage among asylum seekers. In view of the large number of new asylum seekers expected, the adjustment and expansion of the new concept requires professional planning and coordination. Furthermore, additional resources are required.

  7. 76 FR 9968 - Regulation for the Enforcement of Federal Health Care Provider Conscience Protection Laws

    Science.gov (United States)

    2011-02-23

    ... performance of induced abortions, or make arrangements for the provision of such training. For the purposes of... the Federal Register on December 19, 2008. The Rule contained definitions of terms used in the federal...--from discriminating against any applicant or employee in hiring, discipline, promotion, termination, or...

  8. 78 FR 77399 - Basic Health Program: Proposed Federal Funding Methodology for Program Year 2015

    Science.gov (United States)

    2013-12-23

    ... interested in obtaining the applicable federal BHP payment rates for its state must submit such data.... By express or overnight mail. You may send written comments to the following address ONLY: Centers... Methodology and Calculation of the Federal Payment Amount 1. Equation 1: Estimated PTC by Rate Cell...

  9. United States Federal Health Care Websites: A Multimethod Evaluation of Website Accessibility for Individuals with Disabilities

    Science.gov (United States)

    Brobst, John L.

    2012-01-01

    The problem addressed by this study is the observed low levels of compliance with federal policy on website accessibility. The study examines the two key federal policies that promote website accessibility, using a side-by-side policy analysis technique. The analysis examines the Americans with Disabilities Act of 1990 and Section 508 of the…

  10. The effect of family policies and public health initiatives on breastfeeding initiation among 18 high-income countries: a qualitative comparative analysis research design

    National Research Council Canada - National Science Library

    Amanda Marie Lubold

    2017-01-01

    Background The objective of this study is to examine the effects of macro-level factors - welfare state policies and public health initiatives - on breastfeeding initiation among eighteen high-income countries...

  11. The “Picardie en Forme” Network: Federating Regional Health-enhancing Sports Resources

    Science.gov (United States)

    Weissland, Thierry; Passavant, Éric; Allal, Aziz; Amiard, Valérie; Antczak, Boris; Manzo, Julie

    2016-06-08

    Initiated by the Regional Olympic and Sports Committee and the Regional Directorate of Youth, Sports and Social Cohesion, the “Picardie en Forme” network has been working since 2011 in favour of adults of all ages, with chronic noncommunicable or similar diseases, to encourage a gradual return to reassuring and perennial regular physical activity,. A first step consisted of organizing a care pathway based on two principles: inform general practitioners so that they can encourage their patients to be physically active by referring them to the network, develop a range of local sports by accrediting certain clubs with sports instructors who have been trained in the management of this specific population. In 2013, 121 users entered the network at the request of 61 doctors. 48 sports instructors were trained and 20 associations obtained the Picardie en Forme label. Comparison of the results of tests performed on entry in the network and then eight months later shows a general physical reconditioning of users, increasing their motivation and perceived physical value. However, despite these encouraging results, the network has difficulty retaining users, and maintaining the involvement of general practitioners and certain local partners. This article discusses the relevance of initial approaches and describes the changes made to sustain this regional network, which, for the first time, links sport, health and users.

  12. What Factors are Associated with Consumer Initiation of Shared Decision Making in Mental Health Visits?

    OpenAIRE

    Matthias, Marianne S.; Fukui, Sadaaki; Salyers, Michelle P.

    2017-01-01

    Understanding consumer initiation of shared decision making (SDM) is critical to improving SDM in mental health consultations, particularly because providers do not always invite consumer participation in treatment decisions. This study examined the association between consumer initiation of nine elements of SDM as measured by the SDM scale, and measures of consumer illness self-management and the consumer-provider relationship. In 63 mental health visits, three SDM elements were associated w...

  13. Initiation of health-behaviour change among employees participating in a web-based health risk assessment with tailored feedback

    Directory of Open Access Journals (Sweden)

    Kraaijenhagen Roderik A

    2011-03-01

    Full Text Available Abstract Background Primary prevention programs at the worksite can improve employee health and reduce the burden of cardiovascular disease. Programs that include a web-based health risk assessment (HRA with tailored feedback hold the advantage of simultaneously increasing awareness of risk and enhancing initiation of health-behaviour change. In this study we evaluated initial health-behaviour change among employees who voluntarily participated in such a HRA program. Methods We conducted a questionnaire survey among 2289 employees who voluntarily participated in a HRA program at seven Dutch worksites between 2007 and 2009. The HRA included a web-based questionnaire, biometric measurements, laboratory evaluation, and tailored feedback. The survey questionnaire assessed initial self-reported health-behaviour change and satisfaction with the web-based HRA, and was e-mailed four weeks after employees completed the HRA. Results Response was received from 638 (28% employees. Of all, 86% rated the program as positive, 74% recommended it to others, and 58% reported to have initiated overall health-behaviour change. Compared with employees at low CVD risk, those at high risk more often reported to have increased physical activity (OR 3.36, 95% CI 1.52-7.45. Obese employees more frequently reported to have increased physical activity (OR 3.35, 95% CI 1.72-6.54 and improved diet (OR 3.38, 95% CI 1.50-7.60. Being satisfied with the HRA program in general was associated with more frequent self-reported initiation of overall health-behaviour change (OR 2.77, 95% CI 1.73-4.44, increased physical activity (OR 1.89, 95% CI 1.06-3.39, and improved diet (OR 2.89, 95% CI 1.61-5.17. Conclusions More than half of the employees who voluntarily participated in a web-based HRA with tailored feedback, reported to have initiated health-behaviour change. Self-reported initiation of health-behaviour change was more frequent among those at high CVD risk and BMI levels. In

  14. A new definition for oral health developed by the FDI World Dental Federation opens the door to a universal definition of oral health.

    Science.gov (United States)

    Glick, M; Williams, D M; Kleinman, D V; Vujicic, M; Watt, R G; Weyant, R J

    2016-12-16

    This article first published as an editorial in the Journal of the American Dental Association presents the FDI World Dental Federation's universal definition of oral health. This new definition was approved in September 2016 and developed as as part of the FDI's advocacy and strategic plan - Vision 2020.

  15. The Ghana community-based health planning and services initiative for scaling up service delivery innovation.

    Science.gov (United States)

    Nyonator, Frank K; Awoonor-Williams, J Koku; Phillips, James F; Jones, Tanya C; Miller, Robert A

    2005-01-01

    Research projects demonstrating ways to improve health services often fail to have an impact on what national health programmes actually do. An approach to evidence-based policy development has been launched in Ghana which bridges the gap between research and programme implementation. After nearly two decades of national debate and investigation into appropriate strategies for service delivery at the periphery, the Community-based Health Planning and Services (CHPS) Initiative has employed strategies tested in the successful Navrongo experiment to guide national health reforms that mobilize volunteerism, resources and cultural institutions for supporting community-based primary health care. Over a 2-year period, 104 out of the 110 districts in Ghana started CHPS. This paper reviews the development of the CHPS initiative, describes the processes of implementation and relates the initiative to the principles of scaling up organizational change which it embraces. Evidence from the national monitoring and evaluation programme provides insights into CHPS' success and identifies constraints on future progress.

  16. Federal employees health program experiences lack of competition in some areas, raising cost concerns for exchange plans.

    Science.gov (United States)

    McBride, Timothy D; Barker, Abigail R; Pollack, Lisa M; Kemper, Leah M; Mueller, Keith J

    2012-06-01

    The Affordable Care Act calls for creation of health insurance exchanges designed to provide private health insurance plan choices. The Federal Employees Health Benefits Program is a national model that to some extent resembles the planned exchanges. Both offer plans at the state level but are also overseen by the federal government. We examined the availability of plans and enrollment levels in the Federal Employees Health Benefits Program throughout the United States in 2010. We found that although plans were widely available, enrollment was concentrated in plans owned by just a few organizations, typically Blue Cross/Blue Shield plans. Enrollment was more concentrated in rural areas, which may reflect historical patterns of enrollment or lack of provider networks. Average biweekly premiums for an individual were lowest ($58.48) in counties where competition was extremely high, rising to $65.13 where competition was extremely low. To make certain that coverage sold through exchanges is affordable, policy makers may need to pay attention to areas where there is little plan competition and take steps through risk-adjustment policies or other measures to narrow differences in premiums and out-of-pocket expenses for consumers.

  17. Social determinants of health in Canada: Are healthy living initiatives there yet? A policy analysis

    Directory of Open Access Journals (Sweden)

    Gore Dana

    2012-08-01

    Full Text Available Abstract Introduction Preventative strategies that focus on addressing the social determinants of health to improve healthy eating and physical activity have become an important strategy in British Columbia and Ontario for combating chronic diseases. What has not yet been examined is the extent to which healthy living initiatives implemented under these new policy frameworks successfully engage with and change the social determinants of health. Methods Initiatives active between January 1, 2006 and September 1, 2011 were found using provincial policy documents, web searches, health organization and government websites, and databases of initiatives that attempted to influence to nutrition and physical activity in order to prevent chronic diseases or improve overall health. Initiatives were reviewed, analyzed and grouped using the descriptive codes: lifestyle-based, environment-based or structure-based. Initiatives were also classified according to the mechanism by which they were administered: as direct programs (e.g. directly delivered, blueprints (or frameworks to tailor developed programs, and building blocks (resources to develop programs. Results 60 initiatives were identified in Ontario and 61 were identified in British Columbia. In British Columbia, 11.5% of initiatives were structure-based. In Ontario, of 60 provincial initiatives identified, 15% were structure-based. Ontario had a higher proportion of direct interventions than British Columbia for all intervention types. However, in both provinces, as the intervention became more upstream and attempted to target the social determinants of health more directly, the level of direct support for the intervention lessened. Conclusions The paucity of initiatives in British Columbia and Ontario that address healthy eating and active living through action on the social determinants of health is problematic. In the context of Canada's increasingly neoliberal political and economic policy, the

  18. The Delaware Geography-Health Initiative: Lessons Learned in Designing a GIS-Based Curriculum

    Science.gov (United States)

    Rees, Peter W.; Silberman, Jordan A.

    2010-01-01

    The Delaware Geography-Health Initiative is a Web- and GIS-based set of lesson units for teaching geographic concepts and research methods within the context of the state's high school geography standards. Each unit follows a research-based, inquiry-centered model addressing questions of health because of Delaware's high incidence of cancer,…

  19. The Delaware Geography-Health Initiative: Lessons Learned in Designing a GIS-Based Curriculum

    Science.gov (United States)

    Rees, Peter W.; Silberman, Jordan A.

    2010-01-01

    The Delaware Geography-Health Initiative is a Web- and GIS-based set of lesson units for teaching geographic concepts and research methods within the context of the state's high school geography standards. Each unit follows a research-based, inquiry-centered model addressing questions of health because of Delaware's high incidence of cancer,…

  20. Initial benzodiazepine use and improved health-related quality of life.

    NARCIS (Netherlands)

    van Hulten, Rolf; Teeuw, Bart; Bakker, Albert; Leufkens, Hubert G

    2005-01-01

    OBJECTIVE: The health-related quality of life (HRQOL) of initial benzodiazepine users was measured over time. Furthermore, benzodiazepine usage characteristics as determinants of change in mental and physical health status of the benzodiazepine users were examined. METHODS: In the only pharmacy of a

  1. 77 FR 67743 - Federal Employees Health Benefits Program Coverage for Certain Intermittent Employees

    Science.gov (United States)

    2012-11-14

    ... without power, gasoline has been scarce, and massive flooding and cold temperatures have increased the... Federal Regulations is sold by the Superintendent of Documents. #0;Prices of new books are listed in the...

  2. Early smoking initiation, sexual behavior and reproductive health - a large population-based study of Nordic women

    DEFF Research Database (Denmark)

    Hansen, Bo Terning; Kjaer, Susanne Krüger; Plum, Christian Edinger Munk;

    2010-01-01

    To investigate associations between early smoking initiation, risk-taking behavior and reproductive health.......To investigate associations between early smoking initiation, risk-taking behavior and reproductive health....

  3. Incorporating Preliminary Mental Health Assessment in the Initial Healthcare for Refugees in New Jersey.

    Science.gov (United States)

    Al-Obaidi, AbdulKareem; West, Bernadette; Fox, Anne; Savin, Daniel

    2015-07-01

    The study aims to assess the feasibility of introducing a mental health screening tool into the initial health care assessment for refugees in New Jersey, US. A semi-structured interview was conducted with a convenience sample of professionals providing refugee health care in New Jersey and in a number of other states. There is a widespread appreciation of the need to consider the mental and emotional issues of the refugees as a priority in healthcare services. A mental health screening tool is required for practice in NJ. Community resources should be coupled with early screening for better refugee mental health outcomes.

  4. Analysis of Developing Public Health Service Sector with Private Finance Initiative in Guangxi

    Institute of Scientific and Technical Information of China (English)

    王宇

    2006-01-01

    In Guangxi Public Health Service Sector (GPHSS), because lack of budget, it has caused a number of problems, such as weakened public health service in rural areas, poor professional quality of medical personnel in public health units at village and township levels, current urban public health service could not meet the health demand for urban residents. This paper is a secondary research. Through analysis of the financial problem and both of the advantages and disadvantages of using the Private Finance Initiative (PFI), it intend to demonstrate that using the PFI could be considered as a good way for the Guangxi government.

  5. 78 FR 9890 - DoD Medicare-Eligible Retiree Health Care Board of Actuaries; Notice of Federal Advisory...

    Science.gov (United States)

    2013-02-12

    ... of the Secretary DoD Medicare-Eligible Retiree Health Care Board of Actuaries; Notice of Federal... Board of Actuaries will take place. DATES: Friday, August 2, 2013, from 10:00 a.m. to 11:30 a.m..., DoD Office of the Actuary, 4800 Mark Center Drive, STE 06J25-01, Alexandria, VA 22350-4000....

  6. Provider beliefs associated with cervical cancer screening interval recommendations: A pilot study in Federally Qualified Health Centers

    Directory of Open Access Journals (Sweden)

    Katherine B. Roland

    2015-01-01

    Conclusion: Messages that promote the benefits of longer screening intervals after a normal co-test, the natural history of human papillomavirus and cervical cancer, and low risk of developing cancer with a longer interval may be useful to promote evidence-based screening in this population of Federally Qualified Health Center providers. Dissemination of targeted messages through professional journals and specialty organizations should be considered.

  7. The Genesis, Implementation and Impact of the Better Access Mental Health Initiative Introducing Medicare-Funded Psychology Services

    Science.gov (United States)

    Littlefield, Lyn; Giese, Jill

    2008-01-01

    The Australian Government's Better Access to Mental Health Care initiative introduced mental health reforms that included the availability of Medicare-funded psychology services. The mental health initiative has resulted in a huge uptake of these services, demonstrating the strong community demand for psychological treatment. The initiative has…

  8. International Society of Nephrology-Hydration and Kidney Health Initiative - Expanding Research and Knowledge.

    Science.gov (United States)

    Moist, Louise M; Clark, William F; Segantini, Luca; Damster, Sandrine; Le Bellego, Laurent; Wong, Germaine; Tonelli, Marcello

    2016-01-01

    The purpose of this manuscript is to describe a collaborative research initiative to explore the role of hydration in kidney health. Our understanding of the effects of hydration in health and disease is surprisingly limited, particularly when we consider the vital role of hydration in basic human physiology. Recent initiatives and research outcomes have challenged the global medical community to expand our knowledge about hydration, including the differences between water, sugared beverages and other consumables. Identification of the potential mechanisms contributing to the benefits of hydration has stimulated the global nephrology community to advance research regarding hydration for kidney health. Hydration and kidney health has been a focus of research for several research centers with a rapidly expanding world literature and knowledge. The International Society of Nephrology has collaborated with Danone Nutricia Research to promote development of kidney research initiatives, which focus on the role of hydration in kidney health and the global translation of this new information. This initiative supports the use of existing data in different regions and countries to expand dialogue among experts in the field of hydration and health, and to increase scientific interaction and productivity with the ultimate goal of improving kidney health. © 2016 The Author(s) Published by S. Karger AG, Basel.

  9. A survey of local health promotion initiatives for older people in Wales

    Directory of Open Access Journals (Sweden)

    Williams Nefyn H

    2008-06-01

    Full Text Available Abstract Background As the demographic profile of the UK changes, policy makers and practitioners have to respond to health challenges presented by a progressively ageing population. The health promotion plan for older people, aged over 50 years, in Wales included eight key areas: physical activity, healthy eating, home safety and warmth, emotional health, health protection, smoking, alcohol and sexual health. The aim of this study was to describe the extent, content and regional variation of existing health promotion initiatives for older people in Wales, provided by statutory, voluntary and private sector agencies. Method A questionnaire was sent to senior health promotion specialists employed in the 22 local authority areas in Wales to ascertain details of all projects promoting health and wellbeing in the eight key areas where the priority population was aged over 50, or the majority of users were older people. Additional information was sought from project leads and websites. Results Eighteen questionnaires were returned; not all were fully completed. Four areas did not return a questionnaire. Additional information was obtained from internet searches but this mainly concerned national initiatives rather than local projects. In all, 120 projects were included, 11 were throughout Wales. Best provision was for physical activity, with 3 national and 42 local initiatives, but local provision was patchy. Healthy eating, and home safety and warmth had far fewer initiatives, as did health protection, which comprised two national immunisation campaigns. Smoking and alcohol misuse were poorly provided for, and there was no provision for older people's sexual health. Evaluation arrangements were poorly described. Half of those who responded identified unmet training needs. Conclusion The reasons for patchy provision of services were not clear. Increased efforts to improve the coverage of interventions known to be effective should be made. Rigorous

  10. Interactions between Global Health Initiatives and country health systems: the case of a neglected tropical diseases control program in Mali.

    Science.gov (United States)

    Cavalli, Anna; Bamba, Sory I; Traore, Mamadou N; Boelaert, Marleen; Coulibaly, Youssouf; Polman, Katja; Pirard, Marjan; Van Dormael, Monique

    2010-08-17

    Recently, a number of Global Health Initiatives (GHI) have been created to address single disease issues in low-income countries, such as poliomyelitis, trachoma, neonatal tetanus, etc.. Empirical evidence on the effects of such GHIs on local health systems remains scarce. This paper explores positive and negative effects of the Integrated Neglected Tropical Disease (NTD) Control Initiative, consisting in mass preventive chemotherapy for five targeted NTDs, on Mali's health system where it was first implemented in 2007. Campaign processes and interactions with the health system were assessed through participant observation in two rural districts (8 health centres each). Information was complemented by interviews with key informants, website search and literature review. Preliminary results were validated during feedback sessions with Malian authorities from national, regional and district levels. We present positive and negative effects of the NTD campaign on the health system using the WHO framework of analysis based on six interrelated elements: health service delivery, health workforce, health information system, drug procurement system, financing and governance. At point of delivery, campaign-related workload severely interfered with routine care delivery which was cut down or totally interrupted during the campaign, as nurses were absent from their health centre for campaign-related activities. Only 2 of the 16 health centres, characterized by a qualified, stable and motivated workforce, were able to keep routine services running and to use the campaign as an opportunity for quality improvement. Increased workload was compensated by allowances, which significantly improved staff income, but also contributed to divert attention away from core routine activities. While the campaign increased the availability of NTD drugs at country level, parallel systems for drug supply and evaluation requested extra efforts burdening local health systems. The campaign budget

  11. Vegetarian diets in the Adventist Health Study 2: a review of initial published findings.

    Science.gov (United States)

    Orlich, Michael J; Fraser, Gary E

    2014-07-01

    The Adventist Health Study 2 is a large cohort that is well suited to the study of the relation of vegetarian dietary patterns to health and disease risk. Here we review initial published findings with regard to vegetarian diets and several health outcomes. Vegetarian dietary patterns were associated with lower body mass index, lower prevalence and incidence of diabetes mellitus, lower prevalence of the metabolic syndrome and its component factors, lower prevalence of hypertension, lower all-cause mortality, and in some instances, lower risk of cancer. Findings with regard to factors related to vegetarian diets and bone health are also reviewed. These initial results show important links between vegetarian dietary patterns and improved health. © 2014 American Society for Nutrition.

  12. Vegetarian diets in the Adventist Health Study 2: a review of initial published findings1234

    Science.gov (United States)

    Orlich, Michael J; Fraser, Gary E

    2014-01-01

    The Adventist Health Study 2 is a large cohort that is well suited to the study of the relation of vegetarian dietary patterns to health and disease risk. Here we review initial published findings with regard to vegetarian diets and several health outcomes. Vegetarian dietary patterns were associated with lower body mass index, lower prevalence and incidence of diabetes mellitus, lower prevalence of the metabolic syndrome and its component factors, lower prevalence of hypertension, lower all-cause mortality, and in some instances, lower risk of cancer. Findings with regard to factors related to vegetarian diets and bone health are also reviewed. These initial results show important links between vegetarian dietary patterns and improved health. PMID:24898223

  13. Mental health leadership and patient access to care: a public-private initiative in South Africa.

    Science.gov (United States)

    Szabo, Christopher Paul; Fine, Jennifer; Mayers, Pat; Naidoo, Shan; Zabow, Tuviah

    2017-01-01

    Mental health leadership is a critical component of patient access to care. More specifically, the ability of mental health professionals to articulate the needs of patients, formulate strategies and engage meaningfully at the appropriate level in pursuit of resources. This is not a skill set routinely taught to mental health professionals. A public-private mental health leadership initiative, emanating from a patient access to care programme, was developed with the aim of building leadership capacity within the South African public mental health sector. The express aim was to equip health care professionals with the requisite skills to more effectively advocate for their patients. The initiative involved participants from various sites within South Africa. Inclusion was based on the proposal of an ongoing "project", i.e. a clinician-initiated service development with a multidisciplinary focus. The projects were varied in nature but all involved identification of and a plan for addressing an aspect of the participants' daily professional work which negatively impacted on patient care due to unmet needs. Six such projects were included and involved 15 participants, comprising personnel from psychiatry, psychology, occupational therapy and nursing. Each project group was formally mentored as part of the initiative, with mentors being senior professionals with expertise in psychiatry, public health and nursing. The programme design thus provided a unique practical dimension in which skills and learnings were applied to the projects with numerous and diverse outcomes. Benefits were noted by participants but extended beyond the individuals to the health institutions in which they worked and the patients that they served. Participants acquired both the skills and the confidence which enabled them to sustain the changes that they themselves had initiated in their institutions. The initiative gave impetus to the inclusion of public mental health as part of the curriculum

  14. Where theory and practice of global health intersect: the developmental history of a Canadian global health initiative

    Directory of Open Access Journals (Sweden)

    Ibrahim Daibes

    2014-07-01

    Full Text Available Objective: This paper examines the scope of practice of global health, drawing on the practical experience of a global health initiative of the Government of Canada – the Teasdale-Corti Global Health Research Partnership Program. A number of challenges in the practical application of theoretical definitions and understandings of global health are addressed. These challenges are grouped under five areas that form essential characteristics of global health: equity and egalitarian North–South partnerships, interdisciplinary scope, focus on upstream determinants of health, global conceptualization, and global health as an area of both research and practice. Design: Information in this paper is based on the results of an external evaluation of the program, which involved analysis of project proposals and technical reports, surveys with grantees and interviews with grantees and program designers, as well as case studies of three projects and a review of relevant literature. Results: The philosophy and recent definitions of global health represent a significant and important departure from the international health paradigm. However, the practical applicability of this maturing area of research and practice still faces significant systemic and structural impediments that, if not acknowledged and addressed, will continue to undermine the development of global health as an effective means to addressing health inequities globally and to better understanding, and acting upon, upstream determinants of health toward health for all. Conclusions: While it strives to redress global inequities, global health continues to be a construct that is promoted, studied, and dictated mostly by Northern institutions and scholars. Until practical mechanisms are put in place for truly egalitarian partnerships between North and South for both the study and practice of global health, the emerging philosophy of global health cannot be effectively put into practice.

  15. The Smart Health Initiative in China: The Case of Wuhan, Hubei Province.

    Science.gov (United States)

    Fan, Meiyu; Sun, Jian; Zhou, Bin; Chen, Min

    2016-03-01

    To introduce smart health in Wuhan, and provide some references for other cities. As the largest mega-city in central China, Wuhan is investing large amounts of resources to push forward the development of Smart Wuhan and Health Wuhan, and it has unique features. It is one of the centerpieces of China's New Healthcare Reform, and great hope is put on it to help solve the conflict between limited healthcare resources and the large population of patients. How to plan and design smart health is important. The construction of Wuhan Smart Health includes some aspects as follows, like requirement analysis, the establishment of objectives and blueprint, the architecture design of regional health information platform, evaluation and implementation, problems and solutions, and so on. Wuhan Smart Health has obtained some achievements in health network, information systems, resident's health records, information standard, and the first phase of municipal health information platform. The focus of this article is the whole construction process of smart health in Wuhan. Although there are some difficulties during this period, some smart health services and management have been reflected. Compared with other cities or countries, Wuhan Smart Health has its own advantages and disadvantages. This study aims to provide a reference for other cities. Because smart health of Wuhan is characteristic in construction mode. Though still in the initial stage, it has great potentials in the future.

  16. Enacting sustainable school-based health initiatives: a communication-centered approach to policy and practice.

    Science.gov (United States)

    LeGreco, Marianne; Canary, Heather E

    2011-03-01

    Communication plays an important role in all aspects of the development and use of policy. We present a communication-centered perspective on the processes of enacting public health policies. Our proposed conceptual framework comprises 4 communication frames: orientation, amplification, implementation, and integration. Empirical examples from 2 longitudinal studies of school-based health policies show how each frame includes different communication processes that enable sustainable public health policy practices in school-based health initiatives. These 4 frames provide unique insight into the capacity of school-based public health policy to engage youths, parents, and a broader community of stakeholders. Communication is often included as an element of health policy; however, our framework demonstrates the importance of communication as a pivotal resource in sustaining changes in public health practices.

  17. [THE PERSPECTIVES OF DEVELOPMENT OF HEALTH CARE OF THE RUSSIAN FEDERATION].

    Science.gov (United States)

    Schepin, O P; Korotkikh, R V

    2015-01-01

    The article considers actual conditions and characteristics of reformation of health care of Russia. The comparison is applied to such sectoral aspects as decentralization, medical care accessibility, public sector of health care, health of healthy population, resources distribution, medical insurance, paid medical services, etc. The comprehensive approach is proposed to resolving problems of national health care and alternatives of main direction of sectoral development.

  18. Strengthening the Effectiveness of State-Level Community Health Worker Initiatives Through Ambulatory Care Partnerships

    Science.gov (United States)

    Allen, Caitlin; Nell Brownstein, J.; Jayapaul-Philip, Bina; Matos, Sergio; Mirambeau, Alberta

    2017-01-01

    The transformation of the US health care system and the recognition of the effectiveness of community health workers (CHWs) have accelerated national, state, and local efforts to engage CHWs in the support of vulnerable populations. Much can be learned about how to successfully integrate CHWs into health care teams, how to maximize their impact on chronic disease self-management, and how to strengthen their role as emissaries between clinical services and community resources; we share examples of effective strategies. Ambulatory care staff members are key partners in statewide initiatives to build and sustain the CHW workforce and reduce health disparities. PMID:26049655

  19. Under the (legal radar screen: global health initiatives and international human rights obligations

    Directory of Open Access Journals (Sweden)

    Hammonds Rachel

    2012-11-01

    Full Text Available Abstract Background Given that many low income countries are heavily reliant on external assistance to fund their health sectors the acceptance of obligations of international assistance and cooperation with regard to the right to health (global health obligations is insufficiently understood and studied by international health and human rights scholars. Over the past decade Global Health Initiatives, like the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund have adopted novel approaches to engaging with stakeholders in high and low income countries. This article explores how this experience impacted on acceptance of the international obligation to (help fulfil the right to health beyond borders. Methods The authors conducted an extensive review of international human rights law literature, transnational legal process literature, global public health literature and grey literature pertaining to Global Health Initiatives. To complement this desk work and deepen their understanding of how and why different legal norms evolve the authors conducted 19 in-depth key informant interviews with actors engaged with three stakeholders; the European Union, the United States and Belgium. The authors then analysed the interviews through a transnational legal process lens. Results Through according value to the process of examining how and why different legal norms evolve transnational legal process offers us a tool for engaging with the dynamism of developments in global health suggesting that operationalising global health obligations could advance the right to health for all. Conclusions In many low-income countries the health sector is heavily dependent on external assistance to fulfil the right to health of people thus it is vital that policies and tools for delivering reliable, long-term assistance are developed so that the right to health for all becomes more than a dream. Our research suggests that the Global Fund experience offers

  20. A Political History of Federal Mental Health and Addiction Insurance Parity

    OpenAIRE

    Barry, Colleen L.; Huskamp, Haiden A.; Goldman, Howard H

    2010-01-01

    Context: This article chronicles the political history of efforts by the U.S. Congress to enact a law requiring “parity” for mental health and addiction benefits and medical/surgical benefits in private health insurance. The goal of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity (MHPAE) Act of 2008 is to eliminate differences in insurance coverage for behavioral health. Mental health and addiction treatment advocates have long viewed parity as a means of increa...

  1. A política federal de atenção básica à saúde no Brasil nos anos 2000 The federal primary health care politics in Brazil in the 2000's

    Directory of Open Access Journals (Sweden)

    Ana Luisa Barros de Castro

    2012-06-01

    Full Text Available Este artigo analisa a condução federal da política de atenção básica à saúde no Brasil nos anos 2000, buscando identificar elementos de continuidade e mudança com relação ao período anterior. A pesquisa se baseou no marco teórico do institucionalismo histórico e no conceito de path-dependence. A metodologia compreendeu uma diversidade de estratégias: revisão bibliográfica; análise documental; análise de bases de dados secundários; análise orçamentária e realização de entrevistas com atores-chave da política. Foi possível identificar continuidades e mudanças na condução federal da política nacional de atenção básica no período estudado. A predominância de continuidades, ressaltando-se a persistência do Programa de Saúde da Família como estratégia hegemônica para a reorientação da atenção básica no país, configura uma situação de path-dependence. Observaram-se também mudanças incrementais, a exemplo de iniciativas de fortalecimento da articulação intersetorial e inovações importantes, com destaque para a criação dos Núcleos de Apoio à Saúde da Família. Persistem, no entanto, problemas estruturais no âmbito da atenção básica, cuja superação é importante para viabilizar a efetiva mudança do modelo de atenção à saúde no país.This paper analyzes the conduct of the federal primary health care politics in Brazil in the 2000's, seeking to identify elements of continuity and change in the previous period. The research was based on the theoretical framework of historical institutionalism and the concept of path dependence. The methodology included a variety of strategies: literature review, document analysis, analysis of secondary databases, budget analysis and interviews with key stakeholders of the policy. It was possible to identify continuities and changes in the conduct of national policy for federal primary care during the study period. The predominance of continuities

  2. Improving Strategic Planning for Federal Public Health Agencies Through Collaborative Strategic Management

    Science.gov (United States)

    2013-03-01

    preparedness have created an opportunity to rethink the collaborative approach to strategic planning . This thesis considers the role that collaborative...strategic management and collaborative frameworks may play in strengthening strategic planning at the federal level through a policy options analysis

  3. Can a regional government's social inclusion initiative contribute to the quest for health equity?

    Science.gov (United States)

    Baum, Fran; Newman, Lareen; Biedrzycki, Katherine; Patterson, Jan

    2010-12-01

    Despite decades of concern about reducing health inequity, the Commission on the Social Determinants of Health (CSDH) painted a picture of persistent and, in some cases, increasing health inequity. It also made a call for increased evaluation of interventions that might reduce inequities. This paper describes such an intervention-the Social Inclusion Initiative (SII) of the South Australian Government-that was documented for the Social Exclusion Knowledge Network of the CSDH. This initiative is designed to increase social inclusion by addressing key determinants of health inequity-in the study period these were education, homelessness and drug use. Our paper examines evidence from a rapid appraisal to determine whether a social inclusion initiative is a useful aspect of government action to reduce health inequity. It describes achievements in each specific area and the ways they can be expected to affect health equity. Our study highlighted four factors central to the successes achieved by the SII. These were the independent authority and influence of the leadership of the SII, the whole of government approach supported by an overarching strategic plan which sets clear goals for government and the clear and unambiguous support from the highest level of government. We conclude that a social inclusion approach can be valuable in the quest to reduce inequities and that further research on innovative social policy approaches is required to examine their likely impact on health equity.

  4. Basic Program Elements for Federal employee Occupational Safety and Health Programs and related matters; Subpart I for Recordkeeping and Reporting Requirements. Final rule.

    Science.gov (United States)

    2013-08-05

    OSHA is issuing a final rule amending the Basic Program Elements to require Federal agencies to submit their occupational injury and illness recordkeeping information to the Bureau of Labor Statistics (BLS) and OSHA on an annual basis. The information, which is already required to be created and maintained by Federal agencies, will be used by BLS to aggregate injury and illness information throughout the Federal government. OSHA will use the information to identify Federal establishments with high incidence rates for targeted inspection, and assist in determining the most effective safety and health training for Federal employees. The final rule also interprets several existing basic program elements in our regulations to clarify requirements applicable to Federal agencies, amends the date when Federal agencies must submit to the Secretary of Labor their annual report on occupational safety and health programs, amends the date when the Secretary of Labor must submit to the President the annual report on Federal agency safety and health, and clarifies that Federal agencies must include uncompensated volunteers when reporting and recording occupational injuries and illnesses.

  5. Racial bias in federal nutrition policy, Part I: The public health implications of variations in lactase persistence.

    Science.gov (United States)

    Bertron, P; Barnard, N D; Mills, M

    1999-03-01

    The Dietary Guidelines for Americans from the basis for all federal nutrition programs and incorporate the Food Guide Pyramid, a tool to educate consumers on putting the Guidelines into practice. The Pyramid recommends two to three daily servings of dairy products. However, research has shown that lactase nonpersistence, the loss of enzymes that digest the milk sugar lactose, occurs in a majority of African-, Asian-, Hispanic-, and Native-American individuals. Whites are less likely to develop lactase nonpersistence and less likely to have symptoms when it does occur. Calcium is available in other foods that do not contain lactose. Osteoporosis is less common among African Americans and Mexican Americans than among whites, and there is little evidence that dairy products have an effect on osteoporosis among racial minorities. Evidence suggests that a modification of federal nutrition policies, making dairy-product use optional in light of other calcium sources, may be a helpful public health measure.

  6. What Factors are Associated with Consumer Initiation of Shared Decision Making in Mental Health Visits?

    Science.gov (United States)

    Matthias, Marianne S; Fukui, Sadaaki; Salyers, Michelle P

    2017-01-01

    Understanding consumer initiation of shared decision making (SDM) is critical to improving SDM in mental health consultations, particularly because providers do not always invite consumer participation in treatment decisions. This study examined the association between consumer initiation of nine elements of SDM as measured by the SDM scale, and measures of consumer illness self-management and the consumer-provider relationship. In 63 mental health visits, three SDM elements were associated with self-management or relationship factors: discussion of consumer goals, treatment alternatives, and pros and cons of a decision. Limitations, implications, and future directions are discussed.

  7. Demographic and health attributes of the Nahua, initial contact population of the Peruvian Amazon

    Directory of Open Access Journals (Sweden)

    Dante R. Culqui

    2016-01-01

    Full Text Available Abstract We present the case of the Nahua population of Santa Rosa de Serjali, Peruvian Amazon's population, considered of initial contact. This population consists of human groups that for a long time decided to live in isolation, but lately have begun living a more sedentary lifestyle and in contact with Western populations. There are two fully identified initial contact groups in Peru: the Nahua and the Nanti. The health statistics of the Nahua are scarce. This study offers an interpretation of demographic and epidemiological indicators of the Nahua people, trying to identify if a certain degree of health vulnerability exists. We performed a cross sectional study, and after analyzing their health indicators, as well as the supplemental qualitative analysis of the population, brought us to conclude that in 2006, the Nahua, remained in a state of health vulnerability.

  8. Early Initiation of Antenatal Care and Factors Associated with Early Antenatal Care Initiation at Health Facilities in Southern Ethiopia

    Directory of Open Access Journals (Sweden)

    Mengesha Boko Geta

    2017-01-01

    Full Text Available Antenatal care (ANC is care given to pregnant mothers to timely identify and mitigate pregnancy related problems that can harm mother or fetus. Most of Ethiopian mothers present late for ANC. The aim of this paper was to assess determinants of early antenatal care initiation among pregnant women. Mothers attending Shebedino District Health Centers for ANC between January 12 and February 18, 2015, were invited to the study. Multistage sampling technique and structured questionnaire were used to collect data by trained data collectors. Univariate and bivariate analysis were conducted to study the association between explanatory and outcome variable. Out of 608 women, 132 [21.71%] had their first ANC within the recommended time [before or at 3 months]. Media access [AOR = 2.11 95% CI 1.00, 3.22], knowledge about the correct time of ANC booking [AOR = 4.49 95% CI 2.47, 6.16], and having been advised to book within 12 weeks [AOR = 4.14 95% CI 3.80, 5.21] were determinants of first-trimester booking. Health professionals and care providers should provide full information, advice, and appropriate care about early ANC for every eligible mother.

  9. 2 CFR 376.147 - Does an exclusion from participation in Federal health care programs under Title XI of the Social...

    Science.gov (United States)

    2010-01-01

    ... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false Does an exclusion from participation in Federal health care programs under Title XI of the Social Security Act affect a person's eligibility to... NONPROCUREMENT DEBARMENT AND SUSPENSION General § 376.147 Does an exclusion from participation in Federal...

  10. Considerations for community-based mHealth initiatives: insights from three Beacon Communities.

    Science.gov (United States)

    Abebe, Nebeyou A; Capozza, Korey L; Des Jardins, Terrisca R; Kulick, David A; Rein, Alison L; Schachter, Abigail A; Turske, Scott A

    2013-10-15

    Mobile health (mHealth) is gaining widespread attention for its potential to engage patients in their health and health care in their daily lives. Emerging evidence suggests that mHealth interventions can be used effectively to support behavior change, but numerous challenges remain when implementing these programs at the community level. This paper provides an overview of considerations when implementing community-based mHealth initiatives, based on the experiences of three Beacon Communities across the United States that have launched text messaging (short message service, SMS) pilot programs aimed at diabetes risk reduction and disease management. The paper addresses lessons learned and suggests strategies to overcome challenges related to developing text message content, conducting marketing and outreach, enrolling participants, engaging providers, evaluating program effectiveness, and sustaining and scaling the programs.

  11. Considerations for Community-Based mHealth Initiatives: Insights From Three Beacon Communities

    Science.gov (United States)

    2013-01-01

    Mobile health (mHealth) is gaining widespread attention for its potential to engage patients in their health and health care in their daily lives. Emerging evidence suggests that mHealth interventions can be used effectively to support behavior change, but numerous challenges remain when implementing these programs at the community level. This paper provides an overview of considerations when implementing community-based mHealth initiatives, based on the experiences of three Beacon Communities across the United States that have launched text messaging (short message service, SMS) pilot programs aimed at diabetes risk reduction and disease management. The paper addresses lessons learned and suggests strategies to overcome challenges related to developing text message content, conducting marketing and outreach, enrolling participants, engaging providers, evaluating program effectiveness, and sustaining and scaling the programs. PMID:24128406

  12. Advances in public health accreditation readiness and quality improvement: evaluation findings from the National Public Health Improvement Initiative.

    Science.gov (United States)

    McLees, Anita W; Thomas, Craig W; Nawaz, Saira; Young, Andrea C; Rider, Nikki; Davis, Mary

    2014-01-01

    Continuous quality improvement is a central tenet of the Public Health Accreditation Board's (PHAB) national voluntary public health accreditation program. Similarly, the Centers for Disease Control and Prevention launched the National Public Health Improvement Initiative (NPHII) in 2010 with the goal of advancing accreditation readiness, performance management, and quality improvement (QI). Evaluate the extent to which NPHII awardees have achieved program goals. NPHII awardees responded to an annual assessment and program monitoring data requests. Analysis included simple descriptive statistics. Seventy-four state, tribal, local, and territorial public health agencies receiving NPHII funds. NPHII performance improvement managers or principal investigators. Development of accreditation prerequisites, completion of an organizational self-assessment against the PHAB Standards and Measures, Version 1.0, establishment of a performance management system, and implementation of QI initiatives to increase efficiency and effectiveness. Of the 73 responding NPHII awardees, 42.5% had a current health assessment, 26% had a current health improvement plan, and 48% had a current strategic plan in place at the end of the second program year. Approximately 26% of awardees had completed an organizational PHAB self-assessment, 72% had established at least 1 of the 4 components of a performance management system, and 90% had conducted QI activities focused on increasing efficiencies and/or effectiveness. NPHII appears to be supporting awardees' initial achievement of program outcomes. As NPHII enters its third year, there will be additional opportunities to advance the work of NPHII, compile and disseminate results, and inform a vision of high-quality public health necessary to improve the health of the population.

  13. [Perspectives on veterinary public health, food security, and the "One Health" joint initiative].

    Science.gov (United States)

    Cartín-Rojas, Andrés

    2014-09-01

    Veterinarians play a key role in food security. The health of millions of people, stimulation of national economies, development of sustainable livestock production related to this food source, and the different agricultural production systems that compose value chains, and access to more profitable international markets all depend on their efficient and transparent work. Shifting nutritional patterns globally, along with expected population growth, and the increase in marketable food commodity routes and volumes, forecast that demand for animal source food will steadily intensify over the coming decades. To successfully address these challenges, the veterinary profession should establish more practical and up-to-date conceptual and methodological frameworks for academic and professional profiles, focusing the profession on the different public health subject areas, in undergraduate and graduate courses. Furthermore, interdisciplinary alliances should also be developed--such as the "One Health" approach proposed by the United Nations Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE), and the World Health Organization (WHO)--to establish frameworks for joint work and public policies more in line with the domestic conditions of Latin American countries, using a collaborative, sustainable, and comprehensive approach to animal health, food security, and public health policy.

  14. [Initiatives in urban health communities: Health promotion at work in deprived territories].

    Science.gov (United States)

    Motard, Clémentine; Tessier, Stéphane

    2016-12-19

    The “Urban Health Workshop” [“Atelier santé ville” (Asv)] approach, created in 2000 and interfacing between urban development policies and public health, is implemented in about 250 territories. After more than fifteen years of implementation and development, it appeared useful to review experiences and analyse their effects.Conducted in 2015, this research demonstrates the benefits of Asv, which created health territorial dynamics and local strategies to reduce social and territorial health inequalities. Fifty-one Asv coordinators participated in the study, 30 by answering a survey, 28 (7 of whom had already answered the survey) by a semi-structured interview. The high flexibility of the approach, essential to adapt to a complex reality, justifies a qualitative analysis.Capitalising on these experiences defined the main lessons from implementation of the Asv approach and identified the “good practices” of some of the projects, with the objective of promotion and dissemination of the knowledge acquired. The main consequences observed are territorial dynamics, mobilization of diverse actors and transfer of people’s needs to policy-makers and elected representatives. Health promotion was a central part of all experiences: Asvs implement an approach that is inspired and guided by the five action areas for health promotion identified in the Ottawa Charter.Moreover, the majority of Local Health Contracts (“Contrats locaux de santé”) are based on existing Asvs, indicating the effectiveness of the approach..

  15. Health sector initiatives for disaster risk management in ethiopia: a narrative review.

    Science.gov (United States)

    Tadesse, Luche; Ardalan, Ali

    2014-04-01

    Natural and man-made disasters are prevailing in Ethiopia mainly due to drought, floods, landslides, earthquake, volcanic eruptions, and disease epidemics. Few studies so far have critically reviewed about medical responses to disasters and little information exists pertaining to the initiatives being undertaken by health sector from the perspective of basic disaster management cycle. This article aimed to review emergency health responses to disasters and other related interventions which have been undertaken in the health sector. Relevant documents were identified by searches in the websites of different sectors in Ethiopian and international non-governmental organizations and United Nations agencies. Using selected keywords, articles were also searched in the data bases of Medline, CINAHL, Scopus, and Google Scholar. In addition, pertinent articles from non-indexed journals were referred to. Disaster management system in Ethiopia focused on response, recovery, and rehabilitation from 1974 to 1988; while the period between 1988 and 1993 marked the transition phase towards a more comprehensive approach. Theoretically, from 1993 onwards, the disaster management system has fully integrated the mitigation, prevention, and preparedness phases into already existing response and recovery approach, particularly for drought. This policy has changed the emergency response practices and the health sector has taken some initiatives in the area of emergency health care. Hence, drought early warning system, therapeutic feeding program in hospitals, health centers and posts in drought prone areas to manage promptly acute malnutrition cases have all been put in place. In addition, public health disease emergencies have been responded to at all levels of health care system. Emergency health responses to drought and its ramifications such as acute malnutrition and epidemics have become more comprehensive in the context of basic disaster management phases; and impacts of drought

  16. A review of health literacy: Definitions, interpretations, and implications for policy initiatives.

    Science.gov (United States)

    Malloy-Weir, Leslie J; Charles, Cathy; Gafni, Amiram; Entwistle, Vikki

    2016-05-19

    Definitions and interpretations of 'health literacy' have important implications for the delivery of health care and for health policy-related initiatives. We conducted a systematic review and critical analysis to determine the extent to which definitions of health literacy differ in the academic literature, the similarities and differences across definitions, and possible interpretations for the most commonly used definitions. We identified 250 different definitions of health literacy and grouped them into three categories: (i) most commonly used definitions (n=6), (ii) modified versions of these most commonly used definitions (n=133), and (iii) 'other' definitions (n=111). We found the most commonly used definitions to be open to multiple interpretations and to reflect underlying assumptions that are not always justifiable. Attention is needed to the ways in which differing definitions and interpretations of health literacy may affect patient care and the delivery of health literacy-related policy initiatives.Journal of Public Health Policy advance online publication, 19 May 2016; doi:10.1057/jphp.2016.18.

  17. Short-term functional health and well-being after marital separation: does initiator status make a difference?

    Science.gov (United States)

    Hewitt, Belinda; Turrell, Gavin

    2011-06-01

    The authors investigated the health consequences of marital separation and whether the partners who initiated the separation had better health than those who did not. The data came from the Households, Income and Labour Dynamics in Australia (HILDA) panel study (2001-2007), comprising an analytic sample of 1,786 men and 2,068 women who were in their first marriages in 2001. For participants who separated, the authors distinguished between self-initiated, partner-initiated, and jointly initiated separations. Using linear random-intercept models, they examined scores on the 8 physical and mental health dimensions of Short Form 36, with scale scores ranging from 0 to 100. The results indicated that in general, men who separated had a decline in health, although this was more pronounced for mental dimensions than for physical dimensions. Among separated men, those whose partner initiated the separation had poorer mental health than those for whom the separation was self-initiated or jointly initiated (-4.61). Women's physical health improved with separation, but their mental health declined. For separated women, those whose partner initiated the separation had lower scores on the general health (-5.39), role-emotional (-11.08), and mental health (-7.18) scales than women who self-initiated separation. The health consequences of separation were less severe for self- or jointly initiated separations, suggesting that not all marital dissolutions are equally bad for health.

  18. Management knowledge and skills required in the health care system of the Federation bosnia and herzegovina.

    Science.gov (United States)

    Slipicevic, Osman; Masic, Izet

    2012-01-01

    Extremely complex health care organizations, by their structure and organization, operate in a constantly changing business environment, and such situation implies and requires complex and demanding health management. Therefore, in order to manage health organizations in a competent manner, health managers must possess various managerial skills and be familiar with problems in health care. Research, identification, analysis, and assessment of health management education and training needs are basic preconditions for the development and implementation of adequate programs to meet those needs. Along with other specific activities, this research helped to determine the nature, profile, and level of top-priority needs for education. The need for knowledge of certain areas in health management, as well as the need for mastering concrete managerial competencies has been recognized as top-priorities requiring additional improvement and upgrading.

  19. Mapping of initiatives to increase membership in mutual health organizations in Benin

    Directory of Open Access Journals (Sweden)

    Turcotte-Tremblay Anne-Marie

    2012-12-01

    Full Text Available Abstract Introduction Mutual health organizations (MHO have been implemented across Africa to increase access to healthcare and improve financial protection. Despite efforts to develop MHOs, low levels of both initial enrolment and membership renewals continue to threaten their financial viability. The purpose of this study was to map initiatives implemented to increase the pool of MHO members in Benin. Methods A multiple case study was conducted to assess MHOs supported by five major promoters in Benin. Three months of fieldwork resulted in 23 semi-structured interviews and two focus groups with MHO promoters, technicians, elected members, and health professionals affiliated with the MHOs. Fifteen non-structured interviews provided additional information and a valuable source of triangulation. Results MHOs have adopted a wide range of initiatives targeting different entry points and involving a variety of stakeholders. Initiatives have included new types of collective health insurance packages and efforts to raise awareness by going door-to-door and organizing health education workshops. Different types of partnerships have been established to strengthen relationships with healthcare professionals and political leaders. However, the selection and implementation of these initiatives have been limited by insufficient financial and human resources. Conclusions The study highlights the importance of prioritizing sustainable strategies to increase MHO membership. No single MHO initiative has been able to resolve the issue of low membership on its own. If combined, existing initiatives could provide a comprehensive and inclusive approach that would target all entry points and include key stakeholders such as household decision-makers, MHO elected members, healthcare professionals, community leaders, governmental authorities, medical advisors, and promoters. There is a need to evaluate empirically the implementation of these interventions. Mechanisms

  20. Use of a Tablet-Based Risk Assessment Program to Improve Health Counseling and Patient-Provider Relationships in a Federally Qualified Health Center.

    Science.gov (United States)

    Diaz, Vanessa A; Mainous, Arch G; Gavin, Jennifer K; Player, Marty S; Wright, Robert U

    2016-09-01

    This study evaluates the impact of an interactive, tablet-based lifestyle behavior questionnaire prior to a patient's primary care visit on counseling for health behaviors and patient-provider relationships. Using a quasi-experimental design at 2 federally qualified health centers, adults aged 18 to 35 years were asked to complete a tablet-based assessment about nutrition, physical activity, weight, smoking status, and alcohol use to identify unhealthy behaviors and their desire to discuss them with their provider. In the intervention group, participants were more likely to trust their providers (83% vs 71%, P = .0427) and feel that their provider cared about their health (80% vs 68%, P = .0468). Overweight/obese individuals were more likely to discuss weight loss with their doctor (59% vs 33%, P = .0088). Integrating information technology into primary care to encourage providers to discuss lifestyle issues and promote a positive patient-provider relationship may help improve the health promotion in primary care practices.

  1. Enhancing the sustainability and climate resiliency of health care facilities: a comparison of initiatives and toolkits.

    Science.gov (United States)

    Balbus, John; Berry, Peter; Brettle, Meagan; Jagnarine-Azan, Shalini; Soares, Agnes; Ugarte, Ciro; Varangu, Linda; Prats, Elena Villalobos

    2016-09-01

    Extreme weather events have revealed the vulnerability of health care facilities and the extent of devastation to the community when they fail. With climate change anticipated to increase extreme weather and its impacts worldwide-severe droughts, floods, heat waves, and related vector-borne diseases-health care officials need to understand and address the vulnerabilities of their health care systems and take action to improve resiliency in ways that also meet sustainability goals. Generally, the health sector is among a country's largest consumers of energy and a significant source of greenhouse gas emissions. Now it has the opportunity lead climate mitigation, while reducing energy, water, and other costs. This Special Report summarizes several initiatives and compares three toolkits for implementing sustainability and resiliency measures for health care facilities: the Canadian Health Care Facility Climate Change Resiliency Toolkit, the U.S. Sustainable and Climate Resilient Health Care Facilities Toolkit, and the PAHO SMART Hospitals Toolkit of the World Health Organization/Pan American Health Organization. These tools and the lessons learned can provide a critical starting point for any health system in the Americas.

  2. Perfil da condição bucal de idosas do Distrito Federal Oral health status of elderly women from the Brazilian Federal District

    Directory of Open Access Journals (Sweden)

    Ana Maria Costa

    2010-07-01

    Full Text Available Os trabalhos realizados no Brasil a respeito das principais afecções bucais dos gerontes mostram situação preocupante. O objetivo deste estudo foi estimar a frequência de edentulismo, analisar o uso e a necessidade de prótese, calcular o índice CPOD e verificar a condição periodontal de idosas residentes no Distrito Federal. Cento e quarenta mulheres com idade igual ou superior a sessenta anos foram examinadas. A condição de cada prótese foi avaliada observando presença de prejuí­zo estético ou funcional. Em seguida, foi realizado exame clínico para detectar a presença de cárie, restaurações e dentes perdidos para cálculo do índice CPOD. O exame periodontal incluiu a verificação do índice de placa visível, índice de sangramento gengival, medidas de profundidade de sondagem clínica, perda de inserção clínica e mobilidade dental de todos os dentes presentes. Os resultados revelaram péssimas condições bucais dos pacientes examinados. A taxa de edentulismo mostrou-se elevada, o índice CPOD foi alto (29,8, com predomínio do componente extraído (87,1% e a condição periodontal foi considerada grave. A partir destes dados, pode-se concluir que o perfil da condição bucal das idosas representadas neste estudo é precário, o que reflete a necessidade de se elaborar programas de promoção de saúde e de reabilitação para este segmento da população.Data from Brazilian researches that evaluated oral health of elderly people show a worrisome situation. The purpose of this study was to estimate the frequency of edentulism, analyze both the use and need profiles of prosthesis, calculate the DMFT index and check the condition of periodontal elderly residents in the Federal District. One hundred and forty women aged 60 years or above were examined. The condition of each prosthesis was evaluated to detect the presence of functional or aesthetic damage. Then, clinical examination was carried out to detect the number of

  3. A Study of Failures of Follow-Through for Initial Mental Health Interviews.

    Science.gov (United States)

    Callister, Sheldon; Berger, Mike

    Mental health center administrators are concerned about persons who contact centers but fail to keep initial appointments. Factors within centers that discourage client follow-through must be identified and changed. Telephone surveys were attempted for 50 such individuals from the youth (N=23) and adult (N=27) team logs of the Weber Mental Health…

  4. Dietary patterns are associated with disease risk among participants in the women's health initiative observational study

    Science.gov (United States)

    Coronary heart disease (CHD) is the leading cause of death in women. A nested case-control study tested whether dietary patterns predicted CHD events among 1224 participants in the Women’s Health Initiative-Observational Study (WHI-OS) with centrally confirmed CHD, fatal or nonfatal myocardial infar...

  5. A Study of Failures of Follow-Through for Initial Mental Health Interviews.

    Science.gov (United States)

    Callister, Sheldon; Berger, Mike

    Mental health center administrators are concerned about persons who contact centers but fail to keep initial appointments. Factors within centers that discourage client follow-through must be identified and changed. Telephone surveys were attempted for 50 such individuals from the youth (N=23) and adult (N=27) team logs of the Weber Mental Health…

  6. Mental health promotion in the health care setting: collaboration and engagement in the development of a mental health promotion capacity-building initiative.

    Science.gov (United States)

    Horn, Michelle A; Rauscher, Alana B; Ardiles, Paola A; Griffin, Shannon L

    2014-01-01

    Health Compass is an innovative, multiphased project that aims to transform health care practice and shift organizational culture by building the capacity of Provincial Health Services Authority (PHSA) health care providers to further promote the mental health and well-being of patients and families accessing PHSA's health care services. Health Compass was developed within a health promotion framework, which involved collaboration and engagement with stakeholders across all partnering PHSA agencies. This approach led to the development of an educational and training resource that contributes to increased capacity for mental health promotion within the health care setting. Based on interviews with Health Compass' internal Project Team and findings from a Stakeholder Engagement Evaluation Report, this article outlines the participatory approach taken to develop the Health Compass Mental Health Promotion Resource and E-Learning Tool. A number of key facilitators for collaboration and engagement are discussed, which may be particularly applicable to the implementation of a mental health promotion program or initiative within a complex health care setting.

  7. A student-initiated and student-facilitated international health elective for preclinical medical students

    Directory of Open Access Journals (Sweden)

    Nirali Vora

    2010-02-01

    Full Text Available Introduction: Global health education is becoming more important for developing well-rounded physicians and may encourage students toward a career in primary care. Many medical schools, however, lack adequate and structured opportunities for students beginning the curriculum. Methods: Second-year medical students initiated, designed, and facilitated a pass–fail international health elective, providing a curricular framework for preclinical medical students wishing to gain exposure to the clinical and cultural practices of a developing country. Results: All course participants (N=30 completed a post-travel questionnaire within one week of sharing their experiences. Screening reflection essays for common themes that fulfill university core competencies yielded specific global health learning outcomes, including analysis of health care determinants. Conclusion: Medical students successfully implemented a sustainable global health curriculum for preclinical student peers. Financial constraints, language, and organizational burdens limit student participation. In future, long-term studies should analyze career impact and benefits to the host country.

  8. Real-world comparison of health care utilization between duloxetine and pregabalin initiators with fibromyalgia

    Directory of Open Access Journals (Sweden)

    Peng X

    2014-01-01

    Full Text Available X Peng,1 P Sun,2 D Novick,1 J Andrews,1 S Sun2 1Eli Lilly and Company, Indianapolis, IN, USA; 2Kailo Research Group, Indianapolis, IN, USA Objectives: To compare health care utilization of duloxetine initiators and pregabalin initiators among fibromyalgia patients in a real-world setting. Methods: A retrospective cohort study was conducted based on a US national commercial health claims database (2006–2009. Fibromyalgia patients who initiated duloxetine or pregabalin in 2008, aged 18–64 years, and who maintained continuous health insurance coverage 1 year before and 1 year after initiation were assigned to duloxetine or pregabalin cohorts on the basis of their initiated agent. Patients who had pill coverage of the agents over the course of 90 days preceding the initiation were excluded. The two comparative cohorts were constructed using propensity score greedy match methods. Descriptive analysis and paired t-test were performed to compare health care utilization rates in the postinitiation year and the changes of these rates from the preinitiation year to the postinitiation year. Results: Both matched cohorts (n=1,265 pairs had a similar mean initiation age (49–50 years, percentage of women (87%–88%, and prevalence of baseline comorbid conditions (neuropathic pain other than diabetic peripheral neuropathic pain, low back pain, cardiovascular disease, hypertension, headache or migraine, and osteoarthritis. In the preinitiation year, both cohorts had similar inpatient, outpatient, and medication utilization rates (inpatient, 15.7%–16.1%; outpatient, 100.0%; medication, 97.9%–98.7%. The utilization rates diverged in the postinitiation year, with the pregabalin cohort using more fibromyalgia-related inpatient care (3.2% versus 2.2%; P<0.05, any inpatient care (19.3% versus 16.8%; P<0.05, and fibromyalgia-related outpatient care (62.1% versus 51.8%; P<0.05. From the preinitiation period to the postinitiation period, the duloxetine cohort

  9. A comparative review of patient safety initiatives for national health information technology

    DEFF Research Database (Denmark)

    Magrabi, Farah; Aarts, Jos; Nøhr, Christian

    2013-01-01

    by searching the websites of regional and national agencies and programmes in a non-exhaustive set of exemplar countries including England, Denmark, the Netherlands, the USA, Canada and Australia. Initiatives were categorised by type and software systems covered. RESULTS: We found 27 patient safety initiatives...... regulations in some countries, the safety of the most common types of HIT systems such as EHRs and CPOE without decision support is not being explicitly addressed in most nations. Appropriate mechanisms for safety assurance are required for the full range of HIT systems for health professionals and consumers......OBJECTIVE: To collect and critically review patient safety initiatives for health information technology (HIT). METHOD: Publicly promulgated set of advisories, recommendations, guidelines, or standards potentially addressing safe system design, build, implementation or use were identified...

  10. Provider-Initiated Late Preterm Births in Brazil: Differences between Public and Private Health Services

    Science.gov (United States)

    Leal, Maria do Carmo; Esteves-Pereira, Ana Paula; Nakamura-Pereira, Marcos; Torres, Jacqueline Alves; Domingues, Rosa Maria Soares Madeira; Dias, Marcos Augusto Bastos; Moreira, Maria Elizabeth; Theme-Filha, Mariza; da Gama, Silvana Granado Nogueira

    2016-01-01

    Background A large proportion of the rise in prematurity worldwide is owing to late preterm births, which may be due to the expansion of obstetric interventions, especially pre-labour caesarean section. Late preterm births pose similar risks to overall prematurity, making this trend a concern. In this study, we describe factors associated with provider-initiated late preterm birth and verify differences in provider-initiated late preterm birth rates between public and private health services according to obstetric risk. Methods This is a sub-analysis of a national population-based survey of postpartum women entitled “Birth in Brazil”, performed between 2011 and 2012. We included 23,472 singleton live births. We performed non-conditional multiple logistic regressions assessing associated factors and analysing differences between public and private health services. Results Provider-initiated births accounted for 38% of late preterm births; 32% in public health services and 61% in private health services. They were associated with previous preterm birth(s) and maternal pathologies for women receiving both public and private services and with maternal age ≥35 years for women receiving public services. Women receiving private health services had higher rates of provider-initiated late preterm birth (rate of 4.8%) when compared to the ones receiving public services (rate of 2.4%), regardless of obstetric risk–adjusted OR of 2.3 (CI 1.5–3.6) for women of low obstetric risk and adjusted OR of 1.6 (CI 1.1–2.3) for women of high obstetric risk. Conclusion The high rates of provider-initiated late preterm birth suggests a considerable potential for reduction, as such prematurity can be avoided, especially in women of low obstetric risk. To promote healthy births, we advise introducing policies with incentives for the adoption of new models of birth care. PMID:27196102

  11. Provider-Initiated Late Preterm Births in Brazil: Differences between Public and Private Health Services.

    Science.gov (United States)

    Leal, Maria do Carmo; Esteves-Pereira, Ana Paula; Nakamura-Pereira, Marcos; Torres, Jacqueline Alves; Domingues, Rosa Maria Soares Madeira; Dias, Marcos Augusto Bastos; Moreira, Maria Elizabeth; Theme-Filha, Mariza; da Gama, Silvana Granado Nogueira

    2016-01-01

    A large proportion of the rise in prematurity worldwide is owing to late preterm births, which may be due to the expansion of obstetric interventions, especially pre-labour caesarean section. Late preterm births pose similar risks to overall prematurity, making this trend a concern. In this study, we describe factors associated with provider-initiated late preterm birth and verify differences in provider-initiated late preterm birth rates between public and private health services according to obstetric risk. This is a sub-analysis of a national population-based survey of postpartum women entitled "Birth in Brazil", performed between 2011 and 2012. We included 23,472 singleton live births. We performed non-conditional multiple logistic regressions assessing associated factors and analysing differences between public and private health services. Provider-initiated births accounted for 38% of late preterm births; 32% in public health services and 61% in private health services. They were associated with previous preterm birth(s) and maternal pathologies for women receiving both public and private services and with maternal age ≥35 years for women receiving public services. Women receiving private health services had higher rates of provider-initiated late preterm birth (rate of 4.8%) when compared to the ones receiving public services (rate of 2.4%), regardless of obstetric risk-adjusted OR of 2.3 (CI 1.5-3.6) for women of low obstetric risk and adjusted OR of 1.6 (CI 1.1-2.3) for women of high obstetric risk. The high rates of provider-initiated late preterm birth suggests a considerable potential for reduction, as such prematurity can be avoided, especially in women of low obstetric risk. To promote healthy births, we advise introducing policies with incentives for the adoption of new models of birth care.

  12. Provider-Initiated Late Preterm Births in Brazil: Differences between Public and Private Health Services.

    Directory of Open Access Journals (Sweden)

    Maria do Carmo Leal

    Full Text Available A large proportion of the rise in prematurity worldwide is owing to late preterm births, which may be due to the expansion of obstetric interventions, especially pre-labour caesarean section. Late preterm births pose similar risks to overall prematurity, making this trend a concern. In this study, we describe factors associated with provider-initiated late preterm birth and verify differences in provider-initiated late preterm birth rates between public and private health services according to obstetric risk.This is a sub-analysis of a national population-based survey of postpartum women entitled "Birth in Brazil", performed between 2011 and 2012. We included 23,472 singleton live births. We performed non-conditional multiple logistic regressions assessing associated factors and analysing differences between public and private health services.Provider-initiated births accounted for 38% of late preterm births; 32% in public health services and 61% in private health services. They were associated with previous preterm birth(s and maternal pathologies for women receiving both public and private services and with maternal age ≥35 years for women receiving public services. Women receiving private health services had higher rates of provider-initiated late preterm birth (rate of 4.8% when compared to the ones receiving public services (rate of 2.4%, regardless of obstetric risk-adjusted OR of 2.3 (CI 1.5-3.6 for women of low obstetric risk and adjusted OR of 1.6 (CI 1.1-2.3 for women of high obstetric risk.The high rates of provider-initiated late preterm birth suggests a considerable potential for reduction, as such prematurity can be avoided, especially in women of low obstetric risk. To promote healthy births, we advise introducing policies with incentives for the adoption of new models of birth care.

  13. [Adaptation to climate change-associated health risks as a task of environmental health protection. Analysis of a nationwide investigation by the Federal Environment Agency].

    Science.gov (United States)

    Kandarr, J; Reckert, H; Mücke, H-G

    2014-10-01

    The German Strategy for Adaptation to Climate Change (DAS, 2008) identified 'human health' as an important sector with a need for adaptation. In line with the DAS, the Federal Environment Agency (UBA) and the Robert Koch Institute jointly elaborated guidelines for decision makers and stakeholders. Building on these, in 2013/2014, UBA has conducted a nationwide survey, collecting data on completed, ongoing and planned adaptation measures. UBA also analysed 32 adaptation strategies of the Federal States. Selected best practice examples of potential health-related prevention and adaptation measures concerning heat stress, UV radiation exposure and the spread of Ambrosia artemisiifolia are presented in this article. The data collection with more than 330 activities can be found on the website of the German National Environment and Health Action Plan (APUG; www.apug.de , in German only). In the course of this project, the APUG website was also significantly extended with comprehensive information and overviews on health risks of climate change, hence creating a central platform for this particular topic.

  14. 76 FR 5340 - Federal Advisory Committee; Defense Health Board (DHB) Meeting

    Science.gov (United States)

    2011-01-31

    ... following Defense Health Board Subcommittees will present updates to the Board: Trauma and Injury... Psychological Health and Traumatic Brain Injury (DCoE). The Board will vote on a recommendation regarding the proposed research priorities of the Trauma and Injury Subcommittee. Pursuant to 5 U.S.C. 552b, as amended...

  15. 77 FR 65676 - Federal Advisory Committee; Defense Health Board (DHB) Meeting

    Science.gov (United States)

    2012-10-30

    ...) ADDRESSES: Renaissance Arlington Capital View Hotel, 2800 South Potomac Avenue, Arlington, Virginia 22202... of Excellence for Psychological Health and Traumatic Brain Injury; DoD Suicide Prevention Office; psychological health issues facing DoD; North Atlantic Treaty Organization Medical Systems Collaboration;...

  16. [Russian Federation implementation of WHO global efforts plan on workers health care].

    Science.gov (United States)

    Izmerov, N F; Bukhtiyarov, I V; Prokopenko, L V; Shigan, E E

    2015-01-01

    The article deals with problems of implementing global WHO efforts plan on workers health care, Target program of World Labor Organization on work and occupational environment safety "For safe labor", some WLO conventions. The authors justify priority directions of governmental policy on health care for working population in Russia.

  17. Universal health coverage in emerging economies: findings on health care utilization by older adults in China, Ghana, India, Mexico, the Russian Federation, and South Africa

    Directory of Open Access Journals (Sweden)

    Karl Peltzer

    2014-10-01

    Full Text Available Background and objective: The achievement of universal health coverage (UHC in emerging economies is a high priority within the global community. This timely study uses standardized national population data collected from adults aged 50 and older in China, Ghana, India, Mexico, the Russian Federation, and South Africa. The objective is to describe health care utilization and measure association between inpatient and outpatient service use and patient characteristics in these six low- and middle-income countries. Design: Secondary analysis of data from the World Health Organization's Study on global AGEing and adult health Wave 1 was undertaken. Country samples are compared by socio-demographic characteristics, type of health care, and reasons for use. Logistic regressions describe association between socio-demographic and health factors and inpatient and outpatient service use. Results: In the pooled multi-country sample of over 26,000 adults aged 50-plus, who reported getting health care the last time it was needed, almost 80% of men and women received inpatient or outpatient care, or both. Roughly 30% of men and women in the Russian Federation used inpatient services in the previous 3 years and 90% of men and women in India used outpatient services in the past year. In China, public hospitals were the most frequently used service type for 52% of men and 51% of women. Multivariable regression showed that, compared with men, women were less likely to use inpatient services and more likely to use outpatient services. Respondents with two or more chronic conditions were almost three times as likely to use inpatient services and twice as likely to use outpatient services compared with respondents with no reported chronic conditions. Conclusions: This study provides a basis for further investigation of country-specific responses to UHC.

  18. Infidelity, initiation, and the emotional climate of divorce: are there implications for mental health?

    Science.gov (United States)

    Sweeney, M M; Horwitz, A V

    2001-09-01

    A large literature has examined the role of "secondary" stressors, such as problems with finances, social support, residential mobility, and children, in producing the well-documented association between divorce and a variety of psychopathological conditions. Much less attention, however, has been paid to variation in the "primary" disruption experience. We address this omission using data from the National Survey of Families and Households to investigate the interrelationships among depression, initiator status, and spousal infidelity. While we find little evidence of direct effects of initiator status or spousal infidelity on post-divorce depression, the importance of these characteristics emerges when they are considered in an interactive context. Specifically, while divorce initiation is associated with reduced depression among individuals with unfaithful spouses, initiation is associated with increased depression in the absence of spousal infidelity. Taken together, our findings suggest that characteristics of the divorce experience may interact in complex ways to produce variation in mental health outcomes.

  19. Oral health workforce planning part 2: figures, determinants and trends in a sample of World Dental Federation member countries.

    Science.gov (United States)

    Yamalik, Nermin; Ensaldo-Carrasco, Eduardo; Cavalle, Edoardo; Kell, Kathyrn

    2014-06-01

    A range of factors needs to be taken into account for an ideal oral health workforce plan. The figures related to dentists, specialists, auxiliaries, practice patterns, undergraduate and continuing dental education, laws/regulations, the attitudes of oral health-care providers and the general trends affecting the practice patterns, work conditions and preferences of oral health-care providers are among such determinants. Thus, the aim of the present study was to gather such information from a sample of World Dental Federation (FDI) member countries with different characteristics. A cross-sectional survey study was carried out among a sample of FDI member countries between March 2, 2012 and March 27, 2012. A questionnaire was developed addressing some main determinants of oral health workforce, such as its structure, involvement of the public/private sector to provide oral health-care services, specialty services, dental schools, trends in workforce and compliance with oral health needs, and a descriptive analysis was performed. The countries were classified as developed and developing countries and Mann-Whitney U-tests and chi-square tests were used to identify potential significant differences (P > 0.05) between developed and developing countries. All data were processed in SPSS v.19. In the18 questionnaires processed, the median number of dentists (P = 0.005), dental practices (P = 0.002), hygienists (P = 0.005), technicians (P = 0.013) and graduates per year (P = 0.037) was higher in developed countries. Only 12.5% of developed and 22.2% of developing countries reported having optimal number of graduates per year. It was noted that 66.7% of developing countries had more regions lacking enough dentists to meet the demand (P = 0.050) and 77.8% lacked the necessary specialist care (P = 0.015). Although developing countries reported mostly an oversupply of dentists, regardless of the level of development most countries did not report an oversupply of specialists

  20. Legal rights during pandemics: federalism, rights and public health laws--a view from Australia.

    Science.gov (United States)

    Bennett, B

    2009-03-01

    Pandemic influenza will cause significant social and economic disruption. Legal frameworks can play an important role in clarifying the rights and duties of individuals, communities and governments for times of crisis. In addressing legal frameworks, there is a need for jurisdictional clarity between different levels of government in responding to public health emergencies. Public health laws are also informed by our understandings of rights and responsibilities for individuals and communities, and the balancing of public health and public freedoms. Consideration of these issues is an essential part of planning for pandemic influenza.

  1. The mental health of graduate students at the Federal University of São Paulo: a preliminary report

    Directory of Open Access Journals (Sweden)

    L.A. Nogueira-Martins

    2004-10-01

    Full Text Available We present data regarding the care provided to graduate level health professionals at the mental health center of the Federal University of São Paulo. From September 1996 to September 2003, 146 graduate students (99 in the Master's degree program and 47 in the Doctoral program were attended. This population was predominantly female (68.5%, with a mean (± SD age of 28.6 ± 4.42 years, not married (71.9%. Most of the subjects were professionals who had not graduated from the Federal University (78.1%. The students who sought help for psychological and/or psychiatric problems were classified into two categories: situational-adaptive crises and psychopathological crises. The main diagnoses were depression and anxiety disorders (44% causing 4.5% of the subjects to be temporarily suspended from their graduate studies; 19.2% reported that they had used psychotropic drugs within the previous month, and 47.9% referred to sleep disturbances. Suicidal tendencies were mentioned by 18% of those interviewed. Students with emotional disturbances and academic dysfunctions should be recognized at an early stage, and it is fundamental for them to have access to mental health programs that provide formal, structured and confidential care. Thus, it is important that professors and advisors in graduate programs build a warm and affective learning environment. If we consider the expressive growth in Brazilian scientific production resulting from the implementation of an extensive national system of graduate education, it is important to focus efforts on enhancing and upgrading the mental health care system.

  2. The Medical Reserve Corps as part of the federal medical and public health response in disaster settings.

    Science.gov (United States)

    Frasca, Dominic R

    2010-09-01

    The Secretary of the Department of Health and Human Services (HHS), through the Office of the Assistant Secretary for Preparedness and Response (ASPR), coordinates federal Emergency Support Function (ESF) #8 preparedness, response, and recovery actions. To address these needs, the ASPR can draw on trained personnel from a variety of sources, both from within and outside HHS. Among the resources under the domain of HHS is the Medical Reserve Corps (MRC), directed by the Office of the Civilian Volunteer Medical Reserve Corps (OCVMRC) in the Office of the Surgeon General. MRC units are community based and function as a way to locally organize and utilize medical and public health professionals, such as physicians, nurses, pharmacists, dentists, veterinarians, and epidemiologists. Nonclinical volunteers, such as interpreters, chaplains, office workers, legal advisors, and others, can fill logistical and support roles in MRC units. This article discusses locally controlled (Hurricanes Gustav and Ike) and federalized (Hurricanes Katrina and Rita) MRC activations, and it describes the advantages of using medical volunteers in a large-scale disaster response setting.

  3. 78 FR 34994 - Defense Health Board; Notice of Federal Advisory Committee Meeting

    Science.gov (United States)

    2013-06-11

    ... Traumatic Brain Injury, and an information briefing on the Defense Health Agency Transition. In addition... credentials, and the effort to capture lessons learned in trauma in theater for the Department. Pursuant to 5...

  4. From the Paralympics to public health: increasing physical activity through legislative and policy initiatives.

    Science.gov (United States)

    Blauwet, Cheri A; Iezzoni, Lisa I

    2014-08-01

    Individuals with disabilities experience a disproportionate rate of chronic disease and are more likely to lead sedentary lifestyles than the general population. Multiple complex factors likely contribute to these disparities, including structural, socioeconomic and attitudinal barriers that impede broad participation of individuals with disabilities in health and wellness promotion programs. Public health initiatives aimed at mitigating these health disparities emphasize improved access to physical activity and sports opportunities. Given its visibility, the Paralympic Movement provides an opportunity to transform how society conceptualizes the relationship of disability to physical fitness. The Paralympics also serve as a catalyst for public health education and program development. Already, public policies and governmental regulations are expanding grassroots sports opportunities for youth and adults with disabilities, thus promoting inclusive opportunities for participation in physical activity.

  5. Integration of Oral Health Into the Well-Child Visit at Federally Qualified Health Centers: Study of 6 Clinics, August 2014–March 2015

    Science.gov (United States)

    Gebel, Christina; Vargas, Clemencia; Geltman, Paul; Walter, Ashley; Garcia, Raul I.; Tinanoff, Norman

    2016-01-01

    Introduction Early childhood caries, the most common chronic childhood disease, affects primary dentition and can impair eating, sleeping, and school performance. The disease is most prevalent among vulnerable populations with limited access to pediatric dental services. These same children generally receive well-child care at federally qualified health centers. The objective of this study was to identify facilitators and barriers to the integration of oral health into pediatric primary care at health centers to improve problem recognition, delivery of preventive measures, and referral to a dentist. Methods We collected and analyzed background data and data from structured observations and 39 interviews with administrators and staff at 6 clinics in 2 states, Maryland and Massachusetts. Results Participants valued oral health across professional roles but cited limited time, lack of training and expertise, low caregiver literacy, and lack of shared medical and dental electronic records as barriers to cooperation. Facilitators included an upper-level administration with the vision to see the value of integration, designated team leaders, and champions. An administration’s vision, not structural determinants, patient characteristics, or geographic location, predicted the level of integration. Interviewees generated multilevel recommendations to promote delivery of oral health preventive measures and services during a well-child visit. Conclusion Poor oral health contributes to health care disparities. Barriers to integrating dental care into pediatric medical practice at health centers must be overcome to improve oral health for children living in poverty, with a disability, at a rural address, or any combination of these. Implementation will require adapting delivery systems to support multidisciplinary collaboration. Strategies suggested here may point the way to enhancing children’s oral health. PMID:27126556

  6. Building cooperation through health initiatives: an Arab and Israeli case study

    Directory of Open Access Journals (Sweden)

    Skinner Harvey A

    2007-07-01

    Full Text Available Abstract Background Ongoing conflict in the Middle East poses a major threat to health and security. A project screening Arab and Israeli newborns for hearing loss provided an opportunity to evaluate ways for building cooperation. The aims of this study were to: a examine what attracted Israeli, Jordanian and Palestinian participants to the project, b describe challenges they faced, and c draw lessons learned for guiding cross-border health initiatives. Methods A case study method was used involving 12 key informants stratified by country (3 Israeli, 3 Jordanian, 3 Palestinian, 3 Canadian. In-depth interviews were tape-recorded, transcribed and analyzed using an inductive qualitative approach to derive key themes. Results Major reasons for getting involved included: concern over an important health problem, curiosity about neighbors and opportunities for professional advancement. Participants were attracted to prospects for opening the dialogue, building relationships and facilitating cooperation in the region. The political situation was a major challenge that delayed implementation of the project and placed participants under social pressure. Among lessons learned, fostering personal relationships was viewed as critical for success of this initiative. Conclusion Arab and Israeli health professionals were prepared to get involved for two types of reasons: a Project Level: opportunity to address a significant health issue (e.g. congenital hearing loss while enhancing their professional careers, and b Meta Level: concern about taking positive steps for building cooperation in the region. We invite discussion about roles that health professionals can play in building "cooperation networks" for underpinning health security, conflict resolution and global health promotion.

  7. The Children's Oral Health Initiative: An intervention to address the challenges of dental caries in early childhood in Canada's First Nation and Inuit communities.

    Science.gov (United States)

    Mathu-Muju, Kavita R; McLeod, James; Walker, Mary Lou; Chartier, Martin; Harrison, Rosamund L

    2016-08-15

    The objective of the Children's Oral Health Initiative (COHI) is to increase access to preventive oral health services provided to First Nations and Inuit (FN/I) children living on federal reserves and in remote communities. COHI targets preschool children; 5-7-year-olds; pregnant women; and parents/caregivers in FN/I communities. The program was piloted in 2004 by Health Canada and is potentially available to all FN/I communities. However, the community must consent to the program's implementation and agree to support a community member to be trained as a COHI aide. Dental therapists and hygienists screen eligible children, apply fluoride varnish and sealants to children's teeth, and stabilize active dental caries with glass ionomer. An innovation was the development of a community oral health worker, the COHI Aide. The COHI Aide is a community member who serves as an advocate for preventive oral health in the community and provides instruction to children, parent/caregivers and expectant mothers in preventing dental caries. COHI was piloted in 41 communities in 2004. By 2014, the program had expanded to 320 FN/I communities, which represents 55% of all eligible FN/I communities. In 2012, 23,085 children had received COHI preventive oral health services. The results demonstrate COHI's success as a preventive oral health care delivery model in remote communities. Implementation and delivery of preventive oral health services has been enhanced by the sustained presence of a community-based COHI Aide.

  8. How to do better health reform: a snapshot of change and improvement initiatives in the health systems of 30 countries.

    Science.gov (United States)

    Braithwaite, Jeffrey; Matsuyama, Yukihiro; Mannion, Russell; Johnson, Julie; Bates, David W; Hughes, Cliff

    2016-09-21

    Health systems are continually being reformed. Why, and how? To answer these questions, we draw on a book we recently contributed, Healthcare Reform, Quality and Safety: Perspectives, Participants, Partnerships and Prospects in 30 Countries We analyse the impact that these health-reform initiatives have had on the quality and safety of care in an international context-that is, in low-, middle- and high-income countries-Argentina, Australia, Brazil, Chile, China, Denmark, England, Ghana, Germany, the Gulf states, Hong Kong, India, Indonesia, Israel, Italy, Japan, Mexico, Myanmar, New Zealand, Norway, Oman, Papua New Guinea (PNG), South Africa, the USA, Scotland and Sweden. Popular reforms in less well-off countries include boosting equity, providing infrastructure, and reducing mortality and morbidity in maternal and child health. In countries with higher GDP per capita, the focus is on new IT systems or trialling innovative funding models. Wealthy or less wealthy, countries are embracing ways to enhance quality of care and keep patients safe, via mechanisms such as accreditation, clinical guidelines and hand hygiene campaigns. Two timely reminders are that, first, a population's health is not determined solely by the acute system, but is a product of inter-sectoral effort-that is, measures to alleviate poverty and provide good housing, education, nutrition, running water and sanitation across the population. Second, all reformers and advocates of better-quality of care should include well-designed evaluation in their initiatives. Too often, improvement is assumed, not measured. That is perhaps the key message.

  9. Initiation of antiretroviral therapy at rural primary health care clinics in KwaZulu Natal

    Directory of Open Access Journals (Sweden)

    Hilda Ganesen-Moothusamy

    2013-05-01

    Full Text Available South Africa bears the greatest burden of HIV infection globally with the most infected people living in KwaZulu-Natal (KZN. Decentralised medical care for HIV positive patients and antiretroviral therapy (ART delivery to primary health care facilities were proposed nationally to achieve adequate ART coverage for patients in need of treatment. This study described the HIV positive patients who accessed medical care and were initiated on ART at two existing government Primary Health Care (PHC clinics with no added donor support, in Ilembe, KZN. This was an observational descriptive study of ART initiation from 01 April 2008 to 30 April 2009. Data were collected from clinical records kept on site. HIV Testing and the pre-ART programmes which consisted of medical care prior to ART initiation are briefly described. Socio-economic, demographic and clinical characteristics of patients who were initiated on ART were sampled and described. A minority (2.95% of the study population tested for HIV of which 36.0%tested positive. Majority (60.0% of patients who joined the pre-ART programme care did not return. The ART sample consisted of 375 patients of whom 65.0%were women, 85.9%were unmarried, 61.6%were unemployed and 50.4%had a secondary level of education. Tuberculosis (TB prevalence and incidence at ART initiation were 22.1%and 14.7%respectively. The prevalence of Syphilis and Hepatitis B co-infections were 13.1%and 8.6 %respectively. Two thirds of female patients (66.4% received a Pap smear result of which the majority (62.3% were abnormal. Uptake for HIV testing followed by relevant CD4 testing was poor. High TB, Hepatitis B and Syphilis co-infection was noted amongst patients initiated on ART. Cervical cancer screening must be intensified. Although ART initiation with no added external resources was successful, record keeping was suboptimal.

  10. OCCUPATIONAL THERAPY EXPERIENCES IN THE FAMILY HEALTH SUPPORT CENTERS (NASF IN THE DISTRITO FEDERAL

    Directory of Open Access Journals (Sweden)

    Kelly Ranyelle Alves Araujo

    2013-09-01

    Full Text Available To support and expand the care attention and the health management in primary care, in particular the Family Health Strategy, it was created the Family Health Support Centers (NASF. The NASF accounts with several professionals, including occupational therapists, who develop different activities, including health promotion, holistic care and psychosocial rehabilitation. The aim of this article is to discuss from practical experience in a NASF in the metropolitan region of Brasilia how students and practitioners of occupational therapy falls within that service, identifying the main limitations and the work that advances the health care setting. Results: The students and occupational therapist service sought to develop an integrated and intersectoral. Actions were part of the home visits, group approaches with different community groups, active search for users and partnerships in the community. Thus, the work is still very limited assistance and connected to the matricial point of view, as recommended. We conclude that, despite the NASF be a new field of labor for occupational therapists, the actions of social inclusion, empowerment and citizenship developed can encourage healthy habits, but practices need to be revised to follow the proposal of this device.

  11. From rhetoric to reality: barriers faced by Health For All initiatives.

    Science.gov (United States)

    Berkeley, Dina; Springett, Jane

    2006-07-01

    The last two decades have witnessed an upsurge in the development and implementation of 'Health For All-type' initiatives in many parts of the world. However, despite the popularity of the approach, barriers and constraints to the fulfillment of their remit still persist, making it difficult for them to achieve the potential originally envisaged. Drawing upon considerable empirical work while evaluating the European Healthy City projects and English Health Action Zones, this paper explores the differences between barriers and constraints and then focuses on barriers as they manifest themselves in England. It distinguishes between cultural barriers, stemming from different philosophical, organisational, and professional/experiential cultures, and political barriers, stemming from both party political and realpolitik concerns. It discusses how these barriers often operate together, compounding their individual impacts, with detrimental effects for Health For All initiatives. Consequently, while the prevailing rhetoric appears to promote an alternative, and more appropriate, vision of how health can be maintained and enhanced, these barriers effectively function to sustain the hegemony of the status quo which was, and is, based on a different and outdated vision. We argue that acknowledging the continuous persistence of these barriers is an essential first step towards turning the prevailing health-related rhetoric into reality.

  12. Political Action Day: A Student-Led Initiative to Increase Health Advocacy Training Among Medical Students

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    Harbir Gill

    2010-07-01

    Full Text Available Background: Health advocacy is a critical aspect of the competent physician's role. It is identified as a core competency by several national physician regulatory organizations, yet few formal training programs exist. We developed an initiative to teach medical students health advocacy skills. Methods: At Political Action Day, students from Alberta medical schools lobbied the provincial government. A day of training seminars preceded Political Action Day that focused on teaching health advocacy and communication strategies. The following day, medical students met with elected representatives at the Legislative Assembly. An entry and exit survey was administered to students. Results: On October 26-27th, 2008, 40 students met with 38/83 (46% elected representatives including the Minister of Health and Wellness. Feedback from students and politicians suggests the event was effective in teaching advocacy skills. This initiative inspired students to be politically active in the future. Conclusions: Political Action Day helps fulfill the health advocacy competency objectives, and requires minimal curriculum time and resources for integration. It is an effective tool to begin teaching advocacy, and should be further expanded and replicated at other Canadian medical schools.

  13. Geographically varying effects of weather on tobacco consumption: implications for health marketing initiatives.

    Science.gov (United States)

    Govind, Rahul; Garg, Nitika; Sun, Wenbin

    2014-01-01

    Weather and its fluctuations have been found to influence the consumption of negative hedonic goods. However, such findings are of limited use to health marketers who cannot control the weather, and hence, its effects. The current research utilizes data obtained at the zip-code level to study geographical variations in the effect of weather on tobacco consumption across the entire continental United States. The results allow health marketers to identify areas that will be most responsive to marketing efforts aimed at curtailing negative hedonic consumption and thus implement more effective, region-specific initiatives.

  14. Evaluation of extrapolation methods for actual state expenditures on health care in Russian Federation

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    S. A. Banin

    2016-01-01

    Full Text Available Forecasting methods, extrapolation ones in particular, are used in health care for medical, biological and clinical research. The author, using accessible internet space, has not met a single publication devoted to extrapolation of financial parameters of health care activities. This determined the relevance of the material presented in the article: based on health care financing dynamics in Russia in 2000–2010 the author examined possibility of application of basic perspective extrapolation methods - moving average, exponential smoothing and least squares. It is hypothesized that all three methods can equally forecast actual public expenditures on health care in medium term in Russia’s current financial and economic conditions. The study result was evaluated in two time periods: within the studied interval and a five-year period. It was found that within the study period all methods have an average relative extrapolation error of 3–5%, which means high precision of the forecast. The study shown a specific feature of the least squares method which were gradually accumulating results so their economic interpretation became possible only in the end of the studied period. That is why the extrapolating results obtained by least squares method are not applicable in an entire study period and rather have a theoretical value. Beyond the study period, however, this feature was found to be the most corresponding to the real situation. It was the least squares method that proved to be the most appropriate for economic interpretation of the forecast results of actual public expenditures on health care. The hypothesis was not confirmed, the author received three differently directed results, while each method had independent significance and its application depended on evaluation study objectives and real social, economic and financial situation in Russian health care system.

  15. The legacy of the Child Health and Nutrition Research Initiative (CHNRI

    Directory of Open Access Journals (Sweden)

    Robert E Black

    2016-06-01

    Full Text Available Under the Global Forum for Health Research, the Child Health and Nutrition Research Initiative (CHNRI began its operations in 1999 and became a Swiss foundation in 2006. The vision of CHNRI was to improve child health and nutrition of all children in low– and middle–income countries (LMIC through research that informs health policy and practice. Specific objectives included expanding global knowledge on childhood disease burden and cost-effectiveness of interventions, promoting priority setting in research, ensuring inclusion of institutions and scientists in LMIC in setting priorities, promoting capacity development in LMIC and stimulating donors and countries to increase resources for research. CHNRI created a knowledge network, funded research through multiple rounds of a global competitive process and published research papers and policy briefs. A signature effort was to develop a systematic methodology for prioritizing health and nutrition research investments. The “CHNRI method” has been extensively applied to global health problems and is now the most commonly used method for prioritizing health research questions.

  16. The legacy of the Child Health and Nutrition Research Initiative (CHNRI).

    Science.gov (United States)

    Black, Robert E

    2016-06-01

    Under the Global Forum for Health Research, the Child Health and Nutrition Research Initiative (CHNRI) began its operations in 1999 and became a Swiss foundation in 2006. The vision of CHNRI was to improve child health and nutrition of all children in low- and middle-income countries (LMIC) through research that informs health policy and practice. Specific objectives included expanding global knowledge on childhood disease burden and cost-effectiveness of interventions, promoting priority setting in research, ensuring inclusion of institutions and scientists in LMIC in setting priorities, promoting capacity development in LMIC and stimulating donors and countries to increase resources for research. CHNRI created a knowledge network, funded research through multiple rounds of a global competitive process and published research papers and policy briefs. A signature effort was to develop a systematic methodology for prioritizing health and nutrition research investments. The "CHNRI method" has been extensively applied to global health problems and is now the most commonly used method for prioritizing health research questions.

  17. Federal Health Coverage Mandates and Health Care Utilization: The Case of the Women's Health and Cancer Rights Act and Use of Breast Reconstruction Surgery.

    Science.gov (United States)

    Xie, Yang; Tang, Yuexin; Wehby, George L

    2015-08-01

    Utilization of breast reconstruction services remains low among women who underwent mastectomy despite the improvement in quality of life associated with this treatment. The objective of this study is to identify the effect of the Women's Health and Cancer Rights Act (WHCRA)-an understudied ongoing federal law that mandated insurance coverage of breast reconstruction following mastectomy beginning in 1999-on use of reconstructive surgery after mastectomy. We use a difference-in-differences (DD) approach to identify the change in breast reconstruction utilization induced by WHCRA by comparing the pre- and post-policy changes in utilization between states that did not have existing laws mandating coverage before the WHCRA (treatment group) and those that had such state laws (control group). The data are from the Surveillance, Epidemiology, and End Results program. The main sample includes 15,737 female patients who were under the age of 64 and underwent mastectomy within 4 months of diagnosis of early stage breast cancer during 1998 and 2000. Based on the DD model, the odds of using reconstruction services in the states without preexisting laws increased after the WHCRA by 31% in 1999 and 36% in 2000 (compared with 1998 before the WHCRA). These effects are masked in a simple pre/post model for change in reconstruction across all states. Additional analyses through 2007 indicate that the WHCRA had long-term effects on utilization. Furthermore, analyses by state indicate that most states in the treatment group experienced a significance increase in utilization. The use of breast reconstruction after mastectomy significantly increased after the WHCRA. At a minimum, our estimates may be considered the lower bound of the real policy effect.

  18. [Regionalization of federal health reporting using the example of diabetes surveillance : Aims and results of the discussion between the Robert Koch Institute and the federal states].

    Science.gov (United States)

    Gabrys, Lars; Heidemann, Christin; Teti, Andrea; Borrmann, Brigitte; Gawrich, Stefan; Maulbecker-Armstrong, Catharina; Fertmann, Regina; Schubert, Ulrike; Schmidt, Christian; Baumert, Jens; Paprott, Rebecca; Du, Yong; Scheidt-Nave, Christa; Ziese, Thomas

    2017-09-04

    Insufficiently treated diabetes mellitus can lead to severe comorbidities. National and international analyses show a continuous increase in diabetes prevalence over the last decades. Currently, an indicator-based national diabetes surveillance system is implemented at the Robert Koch Institute (RKI) to monitor and report on diabetes development on the basis of available primary and secondary data. The aim of the meeting was to go into deeper discussions and to integrate expectations and expertise of the federal states into the design of the national surveillance system. A close collaboration between the RKI and the federal states is intended.

  19. Why is it difficult to implement e-health initiatives? A qualitative study

    Directory of Open Access Journals (Sweden)

    Wallace Paul

    2011-01-01

    Full Text Available Abstract Background The use of information and communication technologies in healthcare is seen as essential for high quality and cost-effective healthcare. However, implementation of e-health initiatives has often been problematic, with many failing to demonstrate predicted benefits. This study aimed to explore and understand the experiences of implementers -- the senior managers and other staff charged with implementing e-health initiatives and their assessment of factors which promote or inhibit the successful implementation, embedding, and integration of e-health initiatives. Methods We used a case study methodology, using semi-structured interviews with implementers for data collection. Case studies were selected to provide a range of healthcare contexts (primary, secondary, community care, e-health initiatives, and degrees of normalization. The initiatives studied were Picture Archiving and Communication System (PACS in secondary care, a Community Nurse Information System (CNIS in community care, and Choose and Book (C&B across the primary-secondary care interface. Implementers were selected to provide a range of seniority, including chief executive officers, middle managers, and staff with 'on the ground' experience. Interview data were analyzed using a framework derived from Normalization Process Theory (NPT. Results Twenty-three interviews were completed across the three case studies. There were wide differences in experiences of implementation and embedding across these case studies; these differences were well explained by collective action components of NPT. New technology was most likely to 'normalize' where implementers perceived that it had a positive impact on interactions between professionals and patients and between different professional groups, and fit well with the organisational goals and skill sets of existing staff. However, where implementers perceived problems in one or more of these areas, they also perceived a lower

  20. Federal Employees Health Benefits (FEHB) program and Department of Defense (DoD) demonstration project; and other miscellaneous changes. Office of Personnel Management. Final rule.

    Science.gov (United States)

    2000-06-08

    OPM is issuing a final regulation to implement the portion of the Defense Authorization Act for 1999 that establishes authority for a demonstration project under which certain Medicare and other eligible DoD beneficiaries can enroll in health benefit plans in certain geographic areas under the Federal Employees Health Benefits (FEHB) Program. The demonstration project will run for a period of three years from January 1, 2000, through December 31, 2002. This regulation specifies only the requirements that differ from existing FEHB Program regulations because of unique aspects of the demonstration project. This regulation also makes other miscellaneous changes to the Federal Employees Health Benefits Acquisition Regulations.

  1. Pan-Canadian REspiratory STandards INitiative for Electronic Health Records (PRESTINE): 2011 national forum proceedings.

    Science.gov (United States)

    Lougheed, M Diane; Minard, Janice; Dworkin, Shari; Juurlink, Mary-Ann; Temple, Walley J; To, Teresa; Koehn, Marc; Van Dam, Anne; Boulet, Louis-Philippe

    2012-01-01

    In a novel knowledge translation initiative, the Government of Ontario's Asthma Plan of Action funded the development of an Asthma Care Map to enable adherence with the Canadian Asthma Consensus Guidelines developed under the auspices of the Canadian Thoracic Society (CTS). Following its successful evaluation within the Primary Care Asthma Pilot Project, respiratory clinicians from the Asthma Research Unit, Queen's University (Kingston, Ontario) are leading an initiative to incorporate standardized Asthma Care Map data elements into electronic health records in primary care in Ontario. Acknowledging that the issue of data standards affects all respiratory conditions, and all provinces and territories, the Government of Ontario approached the CTS Respiratory Guidelines Committee. At its meeting in September 2010, the CTS Respiratory Guidelines Committee agreed that developing and standardizing respiratory data elements for electronic health records are strategically important. In follow-up to that commitment, representatives from the CTS, the Lung Association, the Government of Ontario, the National Lung Health Framework and Canada Health Infoway came together to form a planning committee. The planning committee proposed a phased approach to inform stakeholders about the issue, and engage them in the development, implementation and evaluation of a standardized dataset. An environmental scan was completed in July 2011, which identified data definitions and standards currently available for clinical variables that are likely to be included in electronic medical records in primary care for diagnosis, management and patient education related to asthma and COPD. The scan, sponsored by the Government of Ontario, includes compliance with clinical nomenclatures such as SNOMED-CT® and LOINC®. To help launch and create momentum for this initiative, a national forum was convened on October 2 and 3, 2011, in Toronto, Ontario. The forum was designed to bring together key

  2. Pan-Canadian Respiratory Standards Initiative for Electronic Health Records (PRESTINE: 2011 National Forum Proceedings

    Directory of Open Access Journals (Sweden)

    M Diane Lougheed

    2012-01-01

    Full Text Available In a novel knowledge translation initiative, the Government of Ontario’s Asthma Plan of Action funded the development of an Asthma Care Map to enable adherence with the Canadian Asthma Consensus Guidelines developed under the auspices of the Canadian Thoracic Society (CTS. Following its successful evaluation within the Primary Care Asthma Pilot Project, respiratory clinicians from the Asthma Research Unit, Queen’s University (Kingston, Ontario are leading an initiative to incorporate standardized Asthma Care Map data elements into electronic health records in primary care in Ontario. Acknowledging that the issue of data standards affects all respiratory conditions, and all provinces and territories, the Government of Ontario approached the CTS Respiratory Guidelines Committee. At its meeting in September 2010, the CTS Respiratory Guidelines Committee agreed that developing and standardizing respiratory data elements for electronic health records are strategically important. In follow-up to that commitment, representatives from the CTS, the Lung Association, the Government of Ontario, the National Lung Health Framework and Canada Health Infoway came together to form a planning committee. The planning committee proposed a phased approach to inform stakeholders about the issue, and engage them in the development, implementation and evaluation of a standardized dataset. An environmental scan was completed in July 2011, which identified data definitions and standards currently available for clinical variables that are likely to be included in electronic medical records in primary care for diagnosis, management and patient education related to asthma and COPD. The scan, sponsored by the Government of Ontario, includes compliance with clinical nomenclatures such as SNOMED-CT® and LOINC®. To help launch and create momentum for this initiative, a national forum was convened on October 2 and 3, 2011, in Toronto, Ontario. The forum was designed to

  3. Pharmacokinetic Assessment in Patients Receiving Continuous RRT: Perspectives from the Kidney Health Initiative

    OpenAIRE

    Nolin, Thomas D.; Aronoff, George R.; Fissell, William H.; Jain, Lokesh; Madabushi, Rajnikanth; Reynolds, Kellie; Zhang, Lei; Huang, Shiew Mei; Mehrotra, Rajnish; Flessner, Michael F.; Leypoldt, John K.; Witcher, Jennifer W.; Zineh, Issam; Archdeacon, Patrick; Roy-Chaudhury, Prabir

    2014-01-01

    The effect of AKI and modern continuous RRT (CRRT) methods on drug disposition (pharmacokinetics) and response has been poorly studied. Pharmaceutical manufacturers have little incentive to perform pharmacokinetic studies in patients undergoing CRRT because such studies are neither recommended in existing US Food and Drug Administration (FDA) guidance documents nor required for new drug approval. Action is urgently needed to address the knowledge deficit. The Kidney Health Initiative has asse...

  4. Moving science into state child and adolescent mental health systems: Illinois' evidence-informed practice initiative.

    Science.gov (United States)

    Starin, Amy C; Atkins, Marc S; Wehrmann, Kathryn C; Mehta, Tara; Hesson-McInnis, Matthew S; Marinez-Lora, A; Mehlinger, Renee

    2014-01-01

    In 2005, the Illinois State Mental Health Authority embarked on an initiative to close the gap between research and practice in the children's mental health system. A stakeholder advisory council developed a plan to advance evidence informed practice through policy and program initiatives. A multilevel approach was developed to achieve this objective, which included policy change, stakeholder education, and clinician training. This article focuses on the evidence-informed training process designed following review of implementation research. The training involved in-person didactic sessions and twice-monthly telephone supervision across 6 cohorts of community based clinicians, each receiving 12 months of training. Training content initially included cognitive behavioral therapy and behavioral parent training and was adapted over the years to a practice model based on common element concepts. Evaluation based on provider and parent report indicated children treated by training clinicians generally showed superior outcomes versus both a treatment-as-usual comparison group for Cohorts 1 to 4 and the statewide child population as a whole after 90 days of care for Cohorts 5 to 6. The results indicated primarily moderate to strong effects for the evidence-based training groups. Moving a large public statewide child mental health system toward more effective services is a complex and lengthy process. These results indicate training of community mental health providers in Illinois in evidence-informed practice was moderately successful in positively impacting child-level functional outcomes. These findings also influenced state policy in committing resources to continuing the initiative, even in difficult economic times.

  5. Obesity and risk of pancreatic cancer among postmenopausal women: the Women's Health Initiative (United States)

    OpenAIRE

    Luo, J.; Margolis, K L.; Adami, H-O; LaCroix, A. (Andrea); Ye, W.

    2008-01-01

    A total of 138 503 women in the Women's Health Initiative in the United States were followed (for an average of 7.7 years) through 12 September 2005 to examine obesity, especially central obesity in relation to pancreatic cancer (n=251). Women in the highest quintile of waist-to-hip ratio had 70% (95% confidence interval 10–160%) excess risk of pancreatic cancer compared with women in the lowest quintile.

  6. First-line nurse leaders' health-care change management initiatives.

    Science.gov (United States)

    Macphee, Maura; Suryaprakash, Nitya

    2012-03-01

    To examine nurse leaders' change management projects within British Columbia, Canada. British Columbia Nursing Leadership Institute 2007-10 attendees worked on year-long change management initiatives/projects of importance to their respective health-care institutions. Most leaders were in first-line positions with Change management, a universal competency, must be included in leadership development programmes. © 2011 Blackwell Publishing Ltd.

  7. 76 FR 23999 - Federal Advisory Committee; Defense Health Board (DHB) Meeting

    Science.gov (United States)

    2011-04-29

    ...: Ms. Christine Bader, Director, Defense Health Board, Five Skyline Place, 5111 Leesburg Pike, Suite... the DoD Task Force on the Prevention of Suicide by Members of the Armed Forces, DoD Response to Evidence-Based Metrics, and a briefing from the Joint Task Force National Capital Region Medical...

  8. VA/DOD Federal Health Care Center: Costly Information Technology Delays Continue and Evaluation Plan Lacking

    Science.gov (United States)

    2012-06-01

    portability, which would allow VA and DOD clinicians to place, manage, and update clinical orders from either VA or DOD electronic health records systems...on, which includes five dedicated, full-time pharmacists to conduct manual checks of patient records to reconcile allergy information and identify

  9. 75 FR 69360 - Defense Federal Acquisition Regulation Supplement; Award-Fee Reductions for Health and Safety...

    Science.gov (United States)

    2010-11-12

    ... the evaluation of any award fee plan, a review of contractor actions that jeopardized the health and... liability that results in the payment of a monetary fine, penalty, reimbursement, restitution, or damage of... reimbursement, restitution, or damages in excess of $100,000. (iv) In a criminal, civil or administrative...

  10. A comparative review of patient safety initiatives for national health information technology

    DEFF Research Database (Denmark)

    Magrabi, Farah; Aarts, Jos; Nøhr, Christian

    2013-01-01

    OBJECTIVE: To collect and critically review patient safety initiatives for health information technology (HIT). METHOD: Publicly promulgated set of advisories, recommendations, guidelines, or standards potentially addressing safe system design, build, implementation or use were identified...... with blood bank and image management software which is regulated in the USA. Of the 16 initiatives directed at unregulated software, 11 were aimed at increasing standardisation using guidelines and standards for safe system design, build, implementation and use. Three initiatives for unregulated software...... were aimed at certification in the USA, Canada and Australia. Safety is addressed alongside interoperability in the Australian certification programme but it is not explicitly addressed in the US and Canadian programmes, though conformance with specific functionality, interoperability, security...

  11. Are current debt relief initiatives an option for scaling up health financing in beneficiary countries?

    Science.gov (United States)

    Kaddar, M; Furrer, E

    2008-11-01

    One central goal of the enhanced Heavily Indebted Poor Countries (HIPC) Initiative and the more recent Multilateral Debt Relief Initiative (MDRI) is to free up additional resources for public spending on poverty reduction. The health sector was expected to benefit from a considerable share of these funds. The volume of released resources is important enough in certain countries to make a difference for priority programmes that have been underfunded so far. However, the relevance of these initiatives in terms of boosting health expenditure depends essentially, at the global level, on the compliance of donors with their aid commitments and, at the domestic level, on the success of health officials in advocating for an adequate share of the additional fiscal space. Advocacy efforts are often limited by a state of asymmetric information whereby some ministries are not well aware of the economic consequences of debt relief on public finances and of the management systems in place to deal with savings from debt relief. A thorough comprehension of these issues seems essential for health advocates to increase their bargaining power and for a wider public to readjust expectations of what debt relief can realistically achieve and of what can be measured. This paper intends to narrow the information gap by classifying debt relief savings management systems observed in practice. We illustrate some of the major advantages and stated drawbacks and outline the policy implications for health officials operating in the countries concerned. There should be careful monitoring of fungibility (i.e. where untraceable funds risk substitution) and additionality (i.e. the extent to which new inputs add to existing inputs at national and international level).

  12. Predicting initial client engagement with community mental health services by routinely measured data.

    Science.gov (United States)

    Roeg, Diana; van de Goor, Ien; Garretsen, Henk

    2015-01-01

    Engagement is a determinant of how well a person will respond to professional input. This study investigates whether, in practice, routinely measured data predict initial client engagement with community mental health services. Engagement, problem severity, client characteristics, and duration before the first contact were measured at team entrance with clients (n = 529) of three community mental health teams. Regression analysis was used to predict engagement. Gender, age, referrer, having children, having a partner, and ethnicity showed a minor relationship with engagement. Higher problem severity measured by the team members with the Health of the Nation Outcome Scales, being referred for having psychiatric problems and/or causing severe and long-lasting trouble (as 'assessed' by the often non-professional referrer), and a longer duration between enrollment and the first conversation with a client, were indicative for a lower engagement. The final model explained 19.2 % of the variance in engagement. It can be concluded that initial client engagement with community mental health services can be predicted, in part, by routinely measured data. The findings can be used by community mental healthcare teams to create an awareness system.

  13. The role of the architectural environment in community health: an evidence-based initiative.

    Science.gov (United States)

    Verderber, Stephen; Kimbrell, Joseph

    2005-01-01

    This discussion reports the status of a 12-year program administered by a statewide health agency to strategically assess, redevelop, and monitor the architectural and facility management performance of its network of community-based public health care facilities. A protocol, the Strategic Facility Improvement initiative, has directly resulted in significant improvements to the major share of a network of over 100 community clinic and clinical support facilities in the State of Louisiana. The SFI initiative provides oversight with respect to the allocation of public health capital improvement infrastructural resources and has guided completion of 55 facility replacement or renovation projects to date. Its administrative mission, organizational structure, and field methodology is presented as a vehicle to significantly improve the architectural condition of clinical and clinical support environments for underrepresented patient populations. The SFI process is discussed as an evidence-based means to foster greater systemic success in capital improvement efforts within public sector health agencies in the United States and in international contexts.

  14. Pilot Variability Study for Federal Aviation Administration Health and Usage Monitoring Mock Certification

    Science.gov (United States)

    2015-09-01

    Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302 Respondents should be aware that notwithstanding any other provision of law, no person shall...health and usage monitoring systems and to reduce the effect of any bias that may result due to changes in pilots. The objective of the statistical...usage monitoring systems (HUMS) and to reduce the effect of any bias that may result due to changes in pilots. The objective of the DOE is to support

  15. Applying a global justice lens to health systems research ethics: an initial exploration.

    Science.gov (United States)

    Pratt, Bridget; Hyder, Adnan A

    2015-03-01

    Recent scholarship has considered what, if anything, rich people owe to poor people to achieve justice in global health and the implications of this for international research. Yet this work has primarily focused on international clinical research. Health systems research is increasingly being performed in low and middle income countries and is essential to reducing global health disparities. This paper provides an initial description of the ethical issues related to priority setting, capacity-building, and the provision of post-study benefits that arise during the conduct of such research. It presents a selection of issues discussed in the health systems research literature and argues that they constitute ethical concerns based on their being inconsistent with a particular theory of global justice (the health capability paradigm). Issues identified include the fact that priority setting for health systems research at the global level is often not driven by national priorities and that capacity-building efforts frequently utilize one-size-fits-all approaches.

  16. The initial evaluation in the working process of occupational therapists in the mental health system

    Directory of Open Access Journals (Sweden)

    Alana de Paiva Nogueira Fornereto Gozzi

    2013-12-01

    Full Text Available : In the field of mental health, Occupational Therapy uses different references in practice development. It is important to observe how occupational therapists in the mental health system assess users’ demands on their work scenarios. In this research, we aimed to study the assessment process of occupational therapists in different services of the mental health system. A descriptive cross-sectional case study was conducted using a qualitative approach. Data were obtained through interviews with occupational therapists integrated to the mental health services of a specific region. The region studied belongs to a Regional Health Department in the state of São Paulo. The thematic analysis method was applied to the data collected allowing the dentification of categories of analysis. The results obtained from one of these categories (the assessment process of occupational therapists showed that most of the professionals interviewed do perform the initial evaluation. This assessment was carried out informally in every case employing tools built by the professionals themselves during their own practices. In addition, patients with chronic mental illnesses are usually admitted in the Occupational Therapy services studied. These characteristics, obtained from active professionals, are useful in the creation of technical criteria for users’ admission in Occupational Therapy mental health treatment.

  17. The laboratory efficiencies initiative: partnership for building a sustainable national public health laboratory system.

    Science.gov (United States)

    Ridderhof, John C; Moulton, Anthony D; Ned, Renée M; Nicholson, Janet K A; Chu, May C; Becker, Scott J; Blank, Eric C; Breckenridge, Karen J; Waddell, Victor; Brokopp, Charles

    2013-01-01

    Beginning in early 2011, the Centers for Disease Control and Prevention and the Association of Public Health Laboratories launched the Laboratory Efficiencies Initiative (LEI) to help public health laboratories (PHLs) and the nation's entire PHL system achieve and maintain sustainability to continue to conduct vital services in the face of unprecedented financial and other pressures. The LEI focuses on stimulating substantial gains in laboratories' operating efficiency and cost efficiency through the adoption of proven and promising management practices. In its first year, the LEI generated a strategic plan and a number of resources that PHL directors can use toward achieving LEI goals. Additionally, the first year saw the formation of a dynamic community of practitioners committed to implementing the LEI strategic plan in coordination with state and local public health executives, program officials, foundations, and other key partners.

  18. Overview of the Veterans Health Administration (VHA) Quality Enhancement Research Initiative (QUERI)

    Science.gov (United States)

    McQueen, Lynn; Mittman, Brian S.; Demakis, John G.

    2004-01-01

    The U.S. Veterans Health Administration (VHA)'s Quality Enhancement Research Initiative (QUERI) is an innovative integration of health services research, policy, and clinical care delivery designed to improve the quality, outcomes, and efficiency of VHA health care through the identification and implementation of evidence-based practices in routine care settings. A total of eight condition-specific QUERI centers are currently in operation, each pursuing an integrated portfolio of activities designed to identify and correct gaps in clinical quality and performance and to derive generalizable scientific knowledge regarding quality improvement processes and methods and their effectiveness. This overview article describes QUERI's mission, history, structure, and activities and provides a brief summary of key findings and impacts. PMID:15187071

  19. [A history of primary health care policy in the Federal District, Brazil (1960-2007): an analysis based on the theoretical framework of historical neo-institutionalism].

    Science.gov (United States)

    Göttems, Leila Bernardo Donato; Evangelista, Maria do Socorro Nantua; Pires, Maria Raquel Gomes Maia; Silva, Aline Ferreira Melgaço da; Silva, Priscila Avelino da

    2009-06-01

    This article analyzes the history of primary health care policy in the Federal District, Brazil, based on the theoretical framework of historical neo-institutionalism, identifying the predominant configurations and trends in the various administrations of the State Health Secretariat (SES-DF) from 1960 to 2007. The study indicates that the characteristics of the Federal District's health policy are dependent on the history of the original health system plans for setting priorities and goals, as well as for the health system's implementation. This influence, in addition to the centralization of decision-making processes and limited political participation, can contribute to making primary care ancillary to hospital care, thus jeopardizing its potential to produce change in the health care model.

  20. Provider communication and role modeling related to patients' perceptions and use of a federally qualified health center-based farmers' market.

    Science.gov (United States)

    Friedman, Daniela B; Freedman, Darcy A; Choi, Seul Ki; Anadu, Edith C; Brandt, Heather M; Carvalho, Natalia; Hurley, Thomas G; Young, Vicki M; Hébert, James R

    2014-03-01

    Farmers' markets have the potential to improve the health of underserved communities, shape people's perceptions, values, and behaviors about healthy eating, and serve as a social space for both community members and vendors. This study explored the influence of health care provider communication and role modeling for diabetic patients within the context of a farmers' market located at a federally qualified health center. Although provider communication about diet decreased over time, communication strategies included: providing patients with "prescriptions" and vouchers for market purchases; educating patients about diet; and modeling healthy purchases. Data from patient interviews and provider surveys revealed that patients enjoyed social aspects of the market including interactions with their health care provider, and providers distributed prescriptions and vouchers to patients, shopped at the market, and believed that the market had potential to improve the health of staff and patients of the federally qualified health center. Provider modeling of healthy behaviors may influence patients' food-related perceptions and dietary behaviors.

  1. The Evolution of World Health Organization's Initiatives for the Strengthening of Nursing and Midwifery.

    Science.gov (United States)

    Ventura, Carla Aparecida Arena; Mendes, Isabel Amélia Costa; Fumincelli, Laís; Trevizan, Maria Auxiliadora

    2015-09-01

    To describe the evolution in the resolutions approved by World Health Organization (WHO)'s World Health Assembly (WHA) to strengthen nursing and midwifery. Qualitative and descriptive study, undertaken through a search of resolutions presented by WHA, on the WHO website, regarding the theme "strengthening of nursing and midwifery." The resolutions on the theme "nursing and midwifery" were included, whose titles were available and whose full texts were accessed, excluding those on general health themes. The key words used were resolutions, strengthening, and nursing and midwifery. Among the 20 resolutions found, 12 were selected, adopted between 1948 and 2013, in accordance with the study inclusion criteria. The data were interpreted using thematic qualitative analysis, identifying and grouping the data in categories related to the study theme. Based on the content analysis of the 12 resolutions studied, three thematic categories were defined: "nursing and midwifery in primary health"; "role of nursing and midwifery in health for all"; and "nurses and midwives' professional training." Based on the categories, the evolution in the strengthening of nursing and midwifery was demonstrated through the initiatives and resolutions approved by WHA, highlighting the importance of nurses and midwives as multiprofessional health team members and their fundamental role in the improvements of the health system. Therefore, in accordance with the needs of each country, the member states can implement strategies presented by the WHA resolutions to strengthen nursing and midwifery services. This study has relevance for the development of health policies considering the relevant contributions of nurses and midwives to healthcare systems and services, based on the analysis of WHO resolutions involving these professions. © 2015 Sigma Theta Tau International.

  2. Implementing health policy: lessons from the Scottish Well Mens policy initiative

    Directory of Open Access Journals (Sweden)

    Flora Douglas

    2015-12-01

    Full Text Available Background: Little is known about how health professionals translate national government health policy directives into action. This paper examines that process using the so-called Well Men's Services (WMS policy initiative as a ‘real world’ case study. The WMS were launched by the Scottish Government to address men's health inequalities. Our analysis aimed to develop a deeper understanding of policy implementation as it naturally occurred, used an analytical framework that was developed to reflect the ‘rational planning' principles health professionals are commonly encouraged to use for implementation purposes. Methods and materials: A mixed-methods qualitative enquiry using a data archive generated during the WMS policy evaluation was used to critically analyze (post hoc the perspectives of national policy makers, and local health and social care professionals about the: (a ‘policy problem’, (b interventions intended to address the problem, and (c anticipated policy outcomes. Results and conclusions: This analysis revealed four key themes: (1 ambiguity regarding the policy problem and means of intervention; (2 behavioral framing of the policy problem and intervention; (3 uncertainty about the policy evidence base and outcomes, and; (4 a focus on intervention as outcome. This study found that mechanistic planning heuristics (as a means of supporting implementation fails to grapple with the indeterminate nature of population health problems. A new approach to planning and implementing public health interventions is required that recognises the complex and political nature of health problems; the inevitability of imperfect and contested evidence regarding intervention, and, future associated uncertainties.

  3. AVTA Federal Fleet PEV Readiness Data Logging and Characterization Study for National Institute of Health

    Energy Technology Data Exchange (ETDEWEB)

    Schey, Stephen [Idaho National Lab. (INL), Idaho Falls, ID (United States); Francfort, Jim [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2014-11-01

    This report focuses on the National Institute of Health (NIH) fleet to identify daily operational characteristics of select vehicles and report findings on vehicle and mission characterizations to support the successful introduction of plug-in electric vehicles (PEVs) into the agencies’ fleets. Individual observations of these selected vehicles provide the basis for recommendations related to electric vehicle adoption and whether a battery electric vehicle (BEV) or plug-in hybrid electric vehicle (PHEV) (collectively plug-in electric vehicles, or PEVs) can fulfill the mission requirements.

  4. WIC mothers' social environment and postpartum health on breastfeeding initiation and duration.

    Science.gov (United States)

    Darfour-Oduro, Sandra Asantewaa; Kim, Juhee

    2014-12-01

    A low breastfeeding rate has been a consistent maternal and child health problem in the United States, especially for low-income families. Understanding mothers' social environment and overall well-being is important in determining how mothers will take care of themselves and their infants during the postnatal period in relation to the breastfeeding rate among low-income mothers. In this study, we examined the effects of the social environment of mothers enrolled in a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program in eastern Illinois and their postpartum health on breastfeeding initiation (n=103) and maintaining breastfeeding for at least 3 months (n=73). Using logistic regression models, a significant positive association (adjusted odds ratio [AOR]=3.47; 95% confidence interval [CI], 1.15-10.47; p=0.03) between marital status and breastfeeding initiation and a significant negative association (AOR=0.23; 95% CI, 0.06-0.88) between receiving food stamps and breastfeeding initiation were found. WIC mothers who were married were 4.1 times as likely to maintain any breastfeeding for at least 3 months than single mothers, and the association was significant (AOR=4.08; 95% CI, 1.36-12.27; p=0.01). The breastfeeding initiation rate was 77.7%, however, the mean±standard deviation age of the child when breastfeeding stopped was 2.2±1.4 months. There was a nonsignificant association between postpartum depression and breastfeeding initiation and maintaining any breastfeeding for 3 months. This study has shown that the familial environment of mothers plays a very important role in improving breastfeeding rates among WIC mothers. In addition, there is a negative relationship between using a food assistance program and breastfeeding among low-income women.

  5. Parents' Perspectives of School Mental Health Promotion Initiatives Are Related to Parents' Self-Assessed Parenting Capabilities

    Science.gov (United States)

    Askell-Williams, Helen

    2016-01-01

    Achieving broad-scale parent engagement with school initiatives has proven elusive. This article reports survey data from 287 Maltese parents about their perceptions of the quality of their child's school's initiatives for promoting students' wellbeing and mental health. Findings indicate that, on average, parents rated school initiatives highly.…

  6. Power rather than path dependency? The dynamics of institutional change under health care federalism.

    Science.gov (United States)

    Rico, Ana; Costa-Font, Joan

    2005-01-01

    Proposals for government decentralization rank high on the political reform agenda of health systems worldwide. Their impact on welfare state performance and change, however, is still under theoretical scrutiny. This article examines the impact of devolution on the construction of the Spanish National Health Service (NHS) in an attempt to shed some light on this debate. Against widespread claims of path dependency, we argue that the specific nature of the devolution model developed in Spain, given the more egalitarian sociopolitical structure that resulted from democratization, fostered policy innovation and institutional change. Consolidation of an NHS system was compatible with some regional diversity and apparently prevented the rise of significant territorial inequalities. The Spanish case also suggests that policy change depends more on the distribution of social power than on institutions. It underlines the key role of financial and knowledge transfers vis-à-vis institutional reforms in effecting social change as well as the potential for state intervention in supporting the development of collective action resources by social groups.

  7. An integrated approach to preventing cardiovascular disease: community-based approaches, health system initiatives, and public health policy

    Directory of Open Access Journals (Sweden)

    Tina Karwalajtys

    2010-09-01

    Full Text Available Tina Karwalajtys1, Janusz Kaczorowski2,31Department of Family Medicine, McMaster University, Hamilton, ON, Canada; 2Primary Care & Community Research, Child & Family Research Institute, Vancouver, BC, Canada; 3Department of Family Practice, University of British Columbia, Vancouver, BC, CanadaAbstract: Cardiovascular disease (CVD is largely the product of interactions among modifiable risk factors that are common in developed nations and increasingly of concern in developing countries. Hypertension is an important precursor to the development of CVD, and although detection and treatment rates have improved in recent years in some jurisdictions, effective strategies and policies supporting a shift in distribution of risk factors at the population level remain paramount. Challenges in managing cardiovascular health more effectively include factors at the patient, provider, and system level. Strategies to reduce hypertension and CVD should be population based, incorporate multilevel, multicomponent, and socioenvironmental approaches, and integrate community resources with public health and clinical care. There is an urgent need to improve monitoring and management of risk factors through community-wide, primary care-linked initiatives, increase the evidence base for community-based prevention strategies, further develop and evaluate promising program components, and develop new approaches to support healthy lifestyle behaviors in diverse age, socioeconomic, and ethnocultural groups. Policy and system changes are critical to reduce risk in populations, including legislation and public education to reduce dietary sodium and trans-fatty acids, food pricing policies, and changes to health care delivery systems to explicitly support prevention and management of CVD.Keywords: risk factors, blood pressure determination, community health services, community health planning, public health practice

  8. West African Youth Initiative: outcome of a reproductive health education program.

    Science.gov (United States)

    Brieger, W R; Delano, G E; Lane, C G; Oladepo, O; Oyediran, K A

    2001-12-01

    To describe the implementation and evaluation of an adolescent reproductive health peer education program in West Africa. The program, known as the West African Youth Initiative (WAYI), was developed to improve knowledge of sexuality and reproductive health, and promote safer sex behaviors and contraceptive use among sexually active adolescents in Nigeria and Ghana. Between November 1994 and April 1997, two organizations, the Association for Reproductive and Family Health (ARFH), based in Nigeria, and Advocates for Youth, based in Washington D.C., supported community-based youth-serving organizations in the two countries to implement peer education projects. Consultants from the African Regional Health Education Centre (ARHEC) in Nigeria provided technical assistance in designing and conducting a quasi-experimental process and outcome evaluation of the projects. There were significant differences over time and between intervention and control groups concerning reproductive health knowledge, use of contraceptives in the previous 3 months, willingness to buy contraceptives, and self-efficacy in contraceptive use. Overall, the project provides evidence that peer education is most effective at improving knowledge and promoting attitudinal and behavior change among young people in school settings.

  9. United States-Mexico cross-border health insurance initiatives: Salud Migrante and Medicare in Mexico.

    Science.gov (United States)

    Vargas Bustamante, Arturo; Laugesen, Miriam; Caban, Mabel; Rosenau, Pauline

    2012-01-01

    While U.S. health care reform will most likely reduce the overall number of uninsured Mexican-Americans, it does not address challenges related to health care coverage for undocumented Mexican immigrants, who will remain uninsured under the measures of the reform; documented low-income Mexican immigrants who have not met the five-year waiting period required for Medicaid benefits; or the growing number of retired U.S. citizens living in Mexico, who lack easy access to Medicare-supported services. This article reviews two promising binational initiatives that could help address these challenges-Salud Migrante and Medicare in Mexico; discusses their prospective applications within the context of U.S. health care reform; and identifies potential challenges to their implementation (legal, political, and regulatory), as well as the possible benefits, including coverage of uninsured Mexican immigrants, and their integration into the U.S. health care system (through Salud Migrante), and access to lower-cost Medicare-supported health care for U.S. retirees in Mexico (Medicare in Mexico).

  10. Influence of socio-economic changes on students' health of Siberian Federal University

    Directory of Open Access Journals (Sweden)

    Temnykh A.S.

    2012-11-01

    Full Text Available The results of statistical researches of morbidity of students of university are presented in times of socio-economic reforms from 1990 to 2011. 1775 students took part in an experiment. The tendency of decline of health of young people level is marked. It is set that principal reason of increase of morbidity is an unhealthy way of life of young people and low level of motive activity. The annual medical inspection of all of students, engaged in a physical culture and sport is recommended. The necessity of maintainance is marked for an educational process on a physical culture volume of employments in an amount 408 hours on 1, 2 and 3 courses. An increase of activity of students and efficiency of employments is possibly at the permanent improvement of financial base. It is recommended to organize in student dormitories sporting rooms with the proper equipment.

  11. Becoming a patient-centered medical home: a 9-year transition for a network of Federally Qualified Health Centers.

    Science.gov (United States)

    Calman, Neil S; Hauser, Diane; Weiss, Linda; Waltermaurer, Eve; Molina-Ortiz, Elizabeth; Chantarat, Tongtan; Bozack, Anne

    2013-01-01

    The patient-centered medical home (PCMH) model has great potential for optimizing the care of chronically ill patients, yet there is much to be learned about various implementations of this model and their impact on patient care processes and outcomes. We examined changes in patterns of health care use in a network of Federally Qualified Health Centers throughout a 9-year period of practice transformation that included recognition of all centers by the National Committee for Quality Assurance (NCQA) as Level 3 PCMH practices. We analyzed deidentified data from electronic health records for the period 2003 to 2011 to identify patterns of service use for all 4,595 patients with diabetes. We also examined a subsample of 545 patients who were in care throughout the study period to track improvement in glycated hemoglobin levels as a clinical measure over time. Through the transition to a PCMH, the mean number of encounters with outreach, diabetes educators, and psychosocial services increased for all diabetic patients; virtually all patients had visits with a primary care clinician, but the mean number of visits decreased slightly. Among patients in the subsample, mean annual levels of glycated hemoglobin decreased steadily during the 9-year study period, mainly driven by a reduction in patients having baseline levels exceeding 9%. This retrospective study conducted in a real-world setting using electronic health record data demonstrates a shift in resource use by diabetic patients from the primary care clinician to other members of the care team. The findings suggest that PCMH implementation has the potential to alter processes of care and improve outcomes of care, especially among those with higher disease burden.

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

    Science.gov (United States)

    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.

  13. The Border Environmental Health Initiative-investigating the transboundary Santa Cruz watershed

    Science.gov (United States)

    Norman, Laura M.; Callegary, James; van Riper, Charles; Gray, Floyd

    2010-01-01

    In 2004 the U.S. Geological Survey (USGS) launched the Border Environmental Health Initiative (BEHI), a major project encompassing the entire U.S.-Mexico border region. In 2009, a study of the Santa Cruz River Watershed (SCW), located in the border region of Arizona and Sonora, Mexico, was initiated as part of the BEHI. In this borderland region of the desert Southwest, human health and the ecosystems on which humans rely depend critically on limited water resources. Surface water is scarce during much of the year, and groundwater is the primary source for industrial, agricultural, and domestic use. In order to identify risks to water resources in the SCW, and the potential consequences to riparian ecosystems and ultimately human health, the USGS is using an interdisciplinary and integrative approach that incorporates the expertise of geographers, hydrologists, biologists, and geologists to track organic and inorganic contaminants and their effects from sources to sinks in sediment, water, plants, and animals. Existing groundwater and surface-water models are being used and modified to assess contaminant and sediment transport.

  14. Initiating a participatory action research process in the Agincourt health and socio-demographic surveillance site.

    Science.gov (United States)

    Wariri, Oghenebrume; D'Ambruoso, Lucia; Twine, Rhian; Ngobeni, Sizzy; van der Merwe, Maria; Spies, Barry; Kahn, Kathleen; Tollman, Stephen; Wagner, Ryan G; Byass, Peter

    2017-06-01

    Despite progressive health policy, disease burdens in South Africa remain patterned by deeply entrenched social inequalities. Accounting for the relationships between context, health and risk can provide important information for equitable service delivery. The aims of the research were to initiate a participatory research process with communities in a low income setting and produce evidence of practical relevance. We initiated a participatory action research (PAR) process in the Agincourt health and socio-demographic surveillance site (HDSS) in rural north-east South Africa. Three village-based discussion groups were convened and consulted about conditions to examine, one of which was under-5 mortality. A series of discussions followed in which routine HDSS data were presented and participants' subjective perspectives were elicited and systematized into collective forms of knowledge using ranking, diagramming and participatory photography. The process concluded with a priority setting exercise. Visual and narrative data were thematically analyzed to complement the participants' analysis. A range of social and structural root causes of under-5 mortality were identified: poverty, unemployment, inadequate housing, unsafe environments and shortages of clean water. Despite these constraints, single mothers were often viewed as negligent. A series of mid-level contributory factors in clinics were also identified: overcrowding, poor staffing, delays in treatment and shortages of medications. In a similar sense, pronounced blame and negativity were directed toward clinic nurses in spite of the systems constraints identified. Actions to address these issues were prioritized as: expanding clinics, improving accountability and responsiveness of health workers, improving employment, providing clean water, and expanding community engagement for health promotion. We initiated a PAR process to gain local knowledge and prioritize actions. The process was acceptable to those

  15. Exploring How Knowledge Translation Can Improve Sustainability of Community-Based Health Initiatives for People with Intellectual/Developmental Disabilities

    Science.gov (United States)

    Spassiani, Natasha A.; Parker Harris, Sarah; Hammel, Joy

    2016-01-01

    Community-based health initiatives (CBHI) play an important role in maintaining the health, function and participation of people with intellectual/developmental disabilities (I/DD) living in the community. However, implementation and long-term sustainability of CBHI is challenging. The Promoting Action on Research Implementation in Health Services…

  16. Initial experiences and innovations in supervising community health workers for maternal, newborn, and child health in Morogoro region, Tanzania.

    Science.gov (United States)

    Roberton, Timothy; Applegate, Jennifer; Lefevre, Amnesty E; Mosha, Idda; Cooper, Chelsea M; Silverman, Marissa; Feldhaus, Isabelle; Chebet, Joy J; Mpembeni, Rose; Semu, Helen; Killewo, Japhet; Winch, Peter; Baqui, Abdullah H; George, Asha S

    2015-04-09

    Supervision is meant to improve the performance and motivation of community health workers (CHWs). However, most evidence on supervision relates to facility health workers. The Integrated Maternal, Newborn, and Child Health (MNCH) Program in Morogoro region, Tanzania, implemented a CHW pilot with a cascade supervision model where facility health workers were trained in supportive supervision for volunteer CHWs, supported by regional and district staff, and with village leaders to further support CHWs. We examine the initial experiences of CHWs, their supervisors, and village leaders to understand the strengths and challenges of such a supervision model for CHWs. Quantitative and qualitative data were collected concurrently from CHWs, supervisors, and village leaders. A survey was administered to 228 (96%) of the CHWs in the Integrated MNCH Program and semi-structured interviews were conducted with 15 CHWs, 8 supervisors, and 15 village leaders purposefully sampled to represent different actor perspectives from health centre catchment villages in Morogoro region. Descriptive statistics analysed the frequency and content of CHW supervision, while thematic content analysis explored CHW, supervisor, and village leader experiences with CHW supervision. CHWs meet with their facility-based supervisors an average of 1.2 times per month. CHWs value supervision and appreciate the sense of legitimacy that arises when supervisors visit them in their village. Village leaders and district staff are engaged and committed to supporting CHWs. Despite these successes, facility-based supervisors visit CHWs in their village an average of only once every 2.8 months, CHWs and supervisors still see supervision primarily as an opportunity to check reports, and meetings with district staff are infrequent and not well scheduled. Supervision of CHWs could be strengthened by streamlining supervision protocols to focus less on report checking and more on problem solving and skills development

  17. Rethinking Evaluations of Health Equity Initiatives: an introduction to the special issue.

    Science.gov (United States)

    Sridharan, Sanjeev; Tannahill, Carol

    2013-02-01

    This paper is an introduction to a special issue on "Re-thinking Evaluations of Health Equity Initiatives." The papers in this volume aim to build understanding of how evaluations can contribute to addressing inequities and how evaluation design can develop a better understanding and also better respond to: (i) policy maker and practitioner needs; (ii) the systemic and complex nature of the interventions necessary to impact inequities; (iii) an understanding of the processes that generate inequities. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. Youth mental health first aid: a description of the program and an initial evaluation

    Directory of Open Access Journals (Sweden)

    Jorm Anthony F

    2011-01-01

    Full Text Available Abstract Background Adolescence is the peak age of onset for mental illness, with half of all people who will ever have a mental illness experiencing their first episode prior to 18 years of age. Early onset of mental illness is a significant predictor for future episodes. However, adolescents and young adults are less likely than the population as a whole to either seek or receive treatment for a mental illness. The knowledge and attitudes of the adults in an adolescent's life may affect whether or not help is sought, and how quickly. In 2007, the Youth Mental Health First Aid Program was launched in Australia with the aim to teach adults, who work with or care for adolescents, the skills needed to recognise the early signs of mental illness, identify potential mental health-related crises, and assist adolescents to get the help they need as early as possible. This paper provides a description of the program, some initial evaluation and an outline of future directions. Methods The program was evaluated in two ways. The first was an uncontrolled trial with 246 adult members of the Australian public, who completed questionnaires immediately before attending the 14 hour course, one month later and six months later. Outcome measures were: recognition of schizophrenia or depression; intention to offer and confidence in offering assistance; stigmatising attitudes; knowledge about adolescent mental health problems and also about the Mental Health First Aid action plan. The second method of evaluation was to track the uptake of the program, including the number of instructors trained across Australia to deliver the course, the number of courses they delivered, and the uptake of the YMHFA Program in other countries. Results The uncontrolled trial found improvements in: recognition of schizophrenia; confidence in offering help; stigmatising attitudes; knowledge about adolescent mental health problems and application of the Mental Health First Aid action

  19. 10 Jahre Women’s Health Initiative (WHI: Was haben wir gelernt?

    Directory of Open Access Journals (Sweden)

    Birkhäuser M

    2013-01-01

    Full Text Available Bis 2002 galten die Östrogen-Ersatztherapie (ERT und die kombinierte Östrogen-Gestagen-Ersatztherapie (oder Hormonersatztherapie [HRT] als sicher und zuverlässig. Nach allen damaligen Daten aus soliden Beobachtungsstudien wie der Nurses’ Health Study überwog der Nutzen einer ERT/HRT deren Risiken. Dann löste die Erstpublikation zur Women’s Health Initiative zu Unrecht eine panikartige Angst vor jeglicher Hormoneinnahme aus. Die vorliegende Stellungnahme fasst den heutigen evidenzbasierten Wissensstand zu Nutzen und Risken einer HRT (inklusive Tibolon und von SERMs 10 Jahre nach der ersten WHI-Publikation zusammen. Sie kommt zum Schluss, dass innerhalb des „günstigen Fensters“ der Nutzen signifikant über die Risiken überwiegt.

  20. Compliance with guidelines-recommended processes in pneumonia: impact of health status and initial signs.

    Directory of Open Access Journals (Sweden)

    Rosario Menéndez

    Full Text Available Initial care has been associated with improved survival of community-acquired pneumonia (CAP. We aimed to investigate patient comorbidities and health status measured by the Charlson index and clinical signs at diagnosis associated with adherence to recommended processes of care in CAP. We studied 3844 patients hospitalized with CAP. The evaluated recommendations were antibiotic adherence to Spanish guidelines, first antibiotic dose 65 (OR, 1.51 and COPD (OR, 1.80 were protective factors. The combination of antibiotic adherence and timing <6 hours was negatively associated with confusion (OR, 0.69 and a high Charlson score (OR, 0.92 adjusting for severity and hospital effect, whereas age was not an independent factor. Deficient health status and confusion, rather than age, are associated with lower compliance with antibiotic therapy recommendations and timing, thus identifying a subpopulation more prone to receiving lower quality care.

  1. Compliance with Guidelines-Recommended Processes in Pneumonia: Impact of Health Status and Initial Signs

    Science.gov (United States)

    Menéndez, Rosario; Torres, Antoni; Reyes, Soledad; Zalacain, Rafael; Capelastegui, Alberto; Rajas, Olga; Borderías, Luis; Martín-Villasclaras, Juan J.; Bello, Salvador; Alfageme, Inmaculada; de Castro, Felipe Rodríguez; Rello, Jordi; Molinos, Luis; Ruiz-Manzano, Juan

    2012-01-01

    Initial care has been associated with improved survival of community-acquired pneumonia (CAP). We aimed to investigate patient comorbidities and health status measured by the Charlson index and clinical signs at diagnosis associated with adherence to recommended processes of care in CAP. We studied 3844 patients hospitalized with CAP. The evaluated recommendations were antibiotic adherence to Spanish guidelines, first antibiotic dose 65 (OR, 1.51) and COPD (OR, 1.80) were protective factors. The combination of antibiotic adherence and timing <6 hours was negatively associated with confusion (OR, 0.69) and a high Charlson score (OR, 0.92) adjusting for severity and hospital effect, whereas age was not an independent factor. Deficient health status and confusion, rather than age, are associated with lower compliance with antibiotic therapy recommendations and timing, thus identifying a subpopulation more prone to receiving lower quality care. PMID:22629420

  2. Promoting policy and environmental change using photovoice in the Kaiser Permanente Community Health Initiative.

    Science.gov (United States)

    Kramer, Leila; Schwartz, Pamela; Cheadle, Allen; Borton, J Elaine; Wright, Merrick; Chase, Charlie; Lindley, Corina

    2010-05-01

    Creative ways must be found to engage both community residents and political leaders around policy and environmental solutions to public health issues. Photovoice is a community-based, participatory approach to documentary photography that provides people with training on photography, ethics, critical discussion, and policy advocacy. Photovoice projects have been implemented across the nation as part of Kaiser Permanente's Community Health Initiative-a community-based obesity prevention effort. This article focuses on the first Photovoice project implemented in three communities in Colorado. Photovoice themes related to healthy eating and active living include a lack of access to healthy food choices in stores and schools, unsafe street crossings and sidewalks, and the need to redevelop certain areas to encourage safe recreation. The involvement of policy leaders in the project combined with several dissemination activities has contributed to healthier food offerings in schools and neighborhoods and city planning efforts that emphasize walkability and access to healthy food, and park revitalization.

  3. A meta-ethnographic study of health care staff perceptions of the WHO/UNICEF Baby Friendly Health Initiative.

    Science.gov (United States)

    Schmied, Virginia; Thomson, Gillian; Byrom, Anna; Burns, Elaine; Sheehan, Athena; Dykes, Fiona

    2014-12-01

    Implementation of the Baby Friendly Health Initiative (BFHI) is associated with increases in breastfeeding initiation and duration of exclusive breastfeeding and 'any' breastfeeding. However, implementation of the BFHI is challenging. To identify and synthesise health care staff perceptions of the WHO/UNICEF BFHI and identify facilitators and barriers for implementation. Seven qualitative studies, published between 2003 and 2013 were analysed using meta-ethnographic synthesis. Three overarching themes were identified. First the BFHI was viewed variously as a 'desirable innovation or an unfriendly imposition'. Participants were passionate about supporting breastfeeding and improving consistency in the information provided. This view was juxtaposed against the belief that BFHI represents an imposition on women's choices, and is a costly exercise for little gain in breastfeeding rates. The second theme highlighted cultural and organisational constraints and obstacles to BFHI implementation including resource issues, entrenched staff practices and staff rationalisation of non-compliance. Theme three captured a level of optimism and enthusiasm amongst participants who could identify a dedicated and credible leader to lead the BFHI change process. Collaborative engagement with all key stakeholders was crucial. Health care staff hold variant beliefs and attitudes towards BFHI, which can help or hinder the implementation process. The introduction of the BFHI at a local level requires detailed planning, extensive collaboration, and an enthusiastic and committed leader to drive the change process. This synthesis has highlighted the importance of thinking more creatively about the translation of this global policy into effective change at the local level. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  4. The effects of global health initiatives on country health systems: a review of the evidence from HIV/AIDS control.

    Science.gov (United States)

    Biesma, Regien G; Brugha, Ruairí; Harmer, Andrew; Walsh, Aisling; Spicer, Neil; Walt, Gill

    2009-07-01

    This paper reviews country-level evidence about the impact of global health initiatives (GHIs), which have had profound effects on recipient country health systems in middle and low income countries. We have selected three initiatives that account for an estimated two-thirds of external funding earmarked for HIV/AIDS control in resource-poor countries: the Global Fund to Fight AIDS, TB and Malaria, the World Bank Multi-country AIDS Program (MAP) and the US President's Emergency Plan for AIDS Relief (PEPFAR). This paper draws on 31 original country-specific and cross-country articles and reports, based on country-level fieldwork conducted between 2002 and 2007. Positive effects have included a rapid scale-up in HIV/AIDS service delivery, greater stakeholder participation, and channelling of funds to non-governmental stakeholders, mainly NGOs and faith-based bodies. Negative effects include distortion of recipient countries' national policies, notably through distracting governments from coordinated efforts to strengthen health systems and re-verticalization of planning, management and monitoring and evaluation systems. Sub-national and district studies are needed to assess the degree to which GHIs are learning to align with and build the capacities of countries to respond to HIV/AIDS; whether marginalized populations access and benefit from GHI-funded programmes; and about the cost-effectiveness and long-term sustainability of the HIV and AIDS programmes funded by the GHIs. Three multi-country sets of evaluations, which will be reporting in 2009, will answer some of these questions.

  5. Evaluating the sub-national fidelity of national Initiatives in decentralized health systems: Integrated Primary Health Care Governance in Nigeria.

    Science.gov (United States)

    Eboreime, Ejemai Amaize; Abimbola, Seye; Obi, Felix Abrahams; Ebirim, Obinna; Olubajo, Olalekan; Eyles, John; Nxumalo, Nonhlanhla Lynette; Mambulu, Faith Nankasa

    2017-03-21

    Policy making, translation and implementation in politically and administratively decentralized systems can be challenging. Beyond the mere sub-national acceptance of national initiatives, adherence to policy implementation processes is often poor, particularly in low and middle-income countries. In this study, we explore the implementation fidelity of integrated PHC governance policy in Nigeria's decentralized governance system and its implications on closing implementation gaps with respect to other top-down health policies and initiatives. Having engaged policy makers, we identified 9 core components of the policy (Governance, Legislation, Minimum Service Package, Repositioning, Systems Development, Operational Guidelines, Human Resources, Funding Structure, and Office Establishment). We evaluated the level and pattern of implementation at state level as compared to the national guidelines using a scorecard approach. Contrary to national government's assessment of level of compliance, we found that sub-national governments exercised significant discretion with respect to the implementation of core components of the policy. Whereas 35 and 32% of states fully met national criteria for the structural domains of "Office Establishment" and Legislation" respectively, no state was fully compliant to "Human Resource Management" and "Funding" requirements, which are more indicative of functionality. The pattern of implementation suggests that, rather than implementing to improve outcomes, state governments may be more interested in executing low hanging fruits in order to access national incentives. Our study highlights the importance of evaluating implementation fidelity in providing evidence of implementation gaps towards improving policy execution, particularly in decentralized health systems. This approach will help national policy makers identify more effective ways of supporting lower tiers of governance towards improvement of health systems and outcomes.

  6. [Development and implementation of an outpatient clinic at an initial reception centre for asylum seekers in the German federal state of Baden-Wuerttemberg].

    Science.gov (United States)

    Nikendei, C; Huhn, D; Adler, G; von Rose, P Becker; Eckstein, T M; Fuchs, B; Gewalt, S C; Greiner, B; Günther, T; Herzog, W; Junghanss, T; Krczal, T; Lorenzen, D; Lutz, T; Manigault, M A; Reinhart, N; Rodenberg, M; Schelletter, I; Szecsenyi, J; Steen, R; Straßner, C; Thomsen, M; Wahedi, K; Bozorgmehr, K

    2017-09-19

    In 2015, more than 890,000 asylum seekers were registered in Germany. The provision of medical and psychosocial care for asylum seekers is facing numerous obstacles. Access to health care is mostly insufficient, particularly in initial reception centres. The present article describes the development and implementation of an interdisciplinary outpatient clinic for asylum seekers at the main registration authority in the state of Baden-Wuerttemberg operated by physicians of the University Hospital of Heidelberg and the local Medical Association in Heidelberg. A steering committee was appointed to plan and implement the interdisciplinary outpatient clinic. Semi-structured interviews with nine steering committee members were conducted to elucidate perceived barriers during the planning and implementation phase. The steering committee's strong personal commitment and the health authorities' impartial management were cited as the main contributing factors to the success of the implementation process. Significant barriers were seen in the funding of personnel, equipment, and language mediation as well as in legal liability and billing-related aspects. Results are discussed with a focus on financing, administrative and legal framework as well as language mediation, documentation and further matters that are essential to ensure high-quality care. Copyright © 2017. Published by Elsevier GmbH.

  7. Health care resource utilization before and after natalizumab initiation among patients with multiple sclerosis in Germany

    Directory of Open Access Journals (Sweden)

    Watson C

    2017-02-01

    Full Text Available Crystal Watson,1 Christine Prosser,2 Sebastian Braun,2 Pamela B Landsman-Blumberg,3 Erika Gleissner,4 Sarah Naoshy1 1Health Economics and Outcomes Research, Global Market Access, Biogen, Cambridge, MA, USA; 2Real World Evidence, Xcenda GmbH, Hanover, Germany; 3Applied Data Analytics, Xcenda LLC, Palm Harbor, FL, USA; 4Market Access, Biogen, Ismaning, Germany Background: Multiple sclerosis (MS, a progressive neurodegenerative disease, greatly impacts the quality of life and economic status of people affected by this disease. In Germany, the total annual cost of MS is estimated at €40,000 per person with MS. Natalizumab has shown to slow MS disease progression, reduce relapses, and improve the quality of life of people with MS.Objective: To evaluate MS-related and all-cause health care resource utilization and costs among German MS patients during the 12 months before and after initiation of natalizumab in a real-world setting.Methods: The current analysis was conducted using the Health Risk Institute research database. Identified patients were aged ≥18 years with ≥1 diagnosis of MS and had initiated natalizumab therapy (index, with 12-month pre– and post–index-period data. Patients were stratified by prior disease-modifying therapy (DMT usage or no DMT usage in the pre-index period. Outcome measures included corticosteroid use and number of sick/disability days, inpatient stays, and outpatient visits. Health care costs were calculated separately for pre- and post-index periods on a per-patient basis and adjusted for inflation.Results: In a final sample of 193 natalizumab-treated patients, per-patient MS-related corticosteroid use was reduced by 62.3%, MS-related sick days by 27.6%, and inpatient costs by 78.3% from the pre- to post-index period. Furthermore, the proportion of patients with MS-related hospitalizations decreased from 49.7% to 14.0% (P<0.001; this reduction was seen for patients with and without prior DMT use

  8. Community Asthma Initiative to Improve Health Outcomes and Reduce Disparities Among Children with Asthma.

    Science.gov (United States)

    Woods, Elizabeth R; Bhaumik, Urmi; Sommer, Susan J; Chan, Elaine; Tsopelas, Lindsay; Fleegler, Eric W; Lorenzi, Margarita; Klements, Elizabeth M; Dickerson, Deborah U; Nethersole, Shari; Dulin, Rick

    2016-02-12

    Black and Hispanic children are hospitalized with complications of asthma at much higher rates than white children. The Boston Children's Hospital Community Asthma Initiative (CAI) provides asthma case management and home visits for children from low-income neighborhoods in Boston, Massachusetts, to address racial/ethnic health disparities in pediatric asthma outcomes. CAI objectives were to evaluate 1) case management data by parent/guardian report for health outcomes and 2) hospital administrative data for comparison between intervention and comparison groups. Data from parent/guardian reports indicate that CAI decreased the number of children with any (one or more) asthma-related hospitalizations (decrease of 79% at 12 months) and any asthma-related emergency department visits (decrease of 56% at 12 months) among children served, most of whom were non-Hispanic black or Hispanic. Hospital administrative data also indicate that the number of asthma-related hospitalizations per child significantly decreased among CAI participants compared with a comparison group. The CAI model has been replicated in other cities and states with adaptations to local cultural and systems variations. Health outcome and cost data have been used to contribute to a business case to educate legislators and insurers about outcomes and costs for this enhanced approach to care. Strong partnerships with public health, community, and housing agencies have allowed CAI to leverage its outcomes to expand systemic changes locally and statewide to reduce asthma morbidity.

  9. A Pilot Physical Activity Initiative to Improve Mental Health Status amongst Iranian Institutionalized Older People

    Directory of Open Access Journals (Sweden)

    Hossein Matlabi

    2014-07-01

    Full Text Available Background: Sufficient level of physical activity may promote overall and mental health of old people. This study was carried out to investigate the practicability of a physical activity promotion initiative amongst institutionalized older people in Tabriz, Iran. Methods: Purposive sampling method was used in this semi-experimental study to recruit 31 older people living in a selected residential care in Tabriz. Moderate-intensity aerobic and muscle-strengthening activity was planned for those who had not severe baseline cognitive impairment or were not too frail to undertake the survey. The General Health Questionnaire (GHQ-28 was used to measure mental health status before and after intervention through a face-to-face interview. Descriptive statistics, Wilkcoxon rank-sum, Mann–Whitney U and Chi-Square tests were employed to analyses the data. Results: The applied intervention was significantly improved status of physical health, anxiety and insomnia, social dysfunction and severe depression. Conclusion: Incorporation of physical activity promotion programs into routines of older people residential care homes in Iran is feasible but may need training of physical activity specialists to work with older people based on their physical endurance and limitations.

  10. Participatory GIS in action, a public health initiative from Kerala, India

    Science.gov (United States)

    Soman, B.

    2014-11-01

    Community ownership is essential for sustainable public health initiatives. The advantages of getting active involvement of homebound village women in a public health campaign to establish community health surveillance are being reported in this paper. With the support of the local self government authorities, we had selected 120 village women, and they were given extensive training on various healthcare schemes, home based management of local ailments, leadership skills and survey techniques. Afterwards, they had been asked to share their knowledge with at least 10-15 women in their neighbourhood. This had improved their status in the neighbourhood, as more and more people started getting their advice on healthcare and social services related matters. Subsequently, they had collected the socio-demographic and morbidity details of the entire households, including the geometric coordinates (longitude and latitude) of the households and public offices. In this process, they began to use the geographic position system (GPS) machines, dismissing the myth that women are not that techno savvy, further improving their acceptability in the community. Many among them were seen proudly describing the implications of the thematic maps to the village people and line department staff in the monthly subcentre meetings. Many were offered seats in the local body elections by leading political parties, a few of them did stand in the elections and three of them had won the elections. This experience reinforces our belief that the empowerment of villagers with newer technology could be a public health tool with much wider positive implications.

  11. The Spatial Association Between Federally Qualified Health Centers and County-Level Reported Sexually Transmitted Infections: A Spatial Regression Approach.

    Science.gov (United States)

    Owusu-Edusei, Kwame; Gift, Thomas L; Leichliter, Jami S; Romaguera, Raul A

    2017-08-16

    The number of categorical sexually transmitted disease (STD) clinics is declining in the United States. Federally qualified health centers (FQHCs) have the potential to supplement the needed sexually transmitted infection (STI) services. In this study, we describe the spatial distribution of FQHC sites and determine if reported county-level nonviral STI morbidity were associated with having FQHC(s) using spatial regression techniques. We extracted map data from the Health Resources and Services Administration data warehouse on FQHCs (ie, geocoded health care service delivery [HCSD] sites) and extracted county-level data on the reported rates of chlamydia, gonorrhea and, primary and secondary (P&S) syphilis (2008-2012) from surveillance data. A 3-equation seemingly unrelated regression estimation procedure (with a spatial regression specification that controlled for county-level multiyear (2008-2012) demographic and socioeconomic factors) was used to determine the association between reported county-level STI morbidity and HCSD sites. Counties with HCSD sites had higher STI, poverty, unemployment, and violent crime rates than counties with no HCSD sites (P < 0.05). The number of HCSD sites was associated (P < 0.01) with increases in the temporally smoothed rates of chlamydia, gonorrhea, and P&S syphilis, but there was no significant association between the number of HCSD per 100,000 population and reported STI rates. There is a positive association between STI morbidity and the number of HCSD sites; however, this association does not exist when adjusting by population size. Further work may determine the extent to which HCSD sites can meet unmet needs for safety net STI services.

  12. Brazilian physical activity guidelines as a strategy for health promotion.

    Science.gov (United States)

    Sebastião, Emerson; Schwingel, Andiara; Chodzko-Zajko, Wojtek

    2014-08-01

    Public health actions endorsed by the federal government, for instance, health promotion initiatives, usually have greater impact at population level compared to other types of initiatives. This commentary aims to instigate debate on the importance and necessity of producing federally endorsed brazilian physical activity guidelines as a strategy for health promotion.

  13. Federal Holidays

    Data.gov (United States)

    Office of Personnel Management — Federal law (5 U.S.C. 6103) establishes the following public holidays for Federal employees. Please note that most Federal employees work on a Monday through Friday...

  14. World Health Organization guidelines should not change the CD4 count threshold for antiretroviral therapy initiation

    Directory of Open Access Journals (Sweden)

    Nathan Geffen

    2013-03-01

    Full Text Available The World Health Organization (WHO currently recommends that HIV-positive adults start antiretroviral therapy (ART at CD4 counts <350 cells/μl. Several countries have changed their guidelines to recommend ART irrespective of CD4 count or at a threshold of 500 CD4 cells/μl. Consequently, WHO is currently revising its treatment guidelines and considering recommending ART initiation at CD4 counts <500 cells/μl. Such decisions are critically important, as WHO guidelines inform healthcare policies in developing countries and are used by activists in their advocacy work. Changing the CD4 initiation point from 350 to 500 cells/μl would, however, be premature and have profound cost implications on Global Fund, President’s Emergency Plan for AIDS Relief (PEPFAR and developing country health budgets. We should be willing to campaign for such a change in guidelines despite cost implications, if supported by evidence. However, the evidence remains outstanding. S Afr J HIV Med 2013;14(1:6-7. DOI:10.7196/SAJHIVMED.906

  15. Establishing a health demographic surveillance site in Bhaktapur district, Nepal: initial experiences and findings

    Directory of Open Access Journals (Sweden)

    Aryal Umesh

    2012-09-01

    Full Text Available Abstract Background A health demographic surveillance system (HDSS provides longitudinal data regarding health and demography in countries with coverage error and poor quality data on vital registration systems due to lack of public awareness, inadequate legal basis and limited use of data in health planning. The health system in Nepal, a low-income country, does not focus primarily on health registration, and does not conduct regular health data collection. This study aimed to initiate and establish the first HDSS in Nepal. Results We conducted a baseline survey in Jhaukhel and Duwakot, two villages in Bhaktapur district. The study surveyed 2,712 households comprising a total population of 13,669. The sex ratio in the study area was 101 males per 100 females and the average household size was 5. The crude birth and death rates were 9.7 and 3.9/1,000 population/year, respectively. About 11% of births occurred at home, and we found no mortality in infants and children less than 5 years of age. Various health problems were found commonly and some of them include respiratory problems (41.9%; headache, vertigo and dizziness (16.7%; bone and joint pain (14.4%; gastrointestinal problems (13.9%; heart disease, including hypertension (8.8%; accidents and injuries (2.9%; and diabetes mellitus (2.6%. The prevalence of non-communicable disease (NCD was 4.3% (95% CI: 3.83; 4.86 among individuals older than 30 years. Age-adjusted odds ratios showed that risk factors, such as sex, ethnic group, occupation and education, associated with NCD. Conclusion Our baseline survey demonstrated that it is possible to collect accurate and reliable data in a village setting in Nepal, and this study successfully established an HDSS site. We determined that both maternal and child health are better in the surveillance site compared to the entire country. Risk factors associated with NCDs dominated morbidity and mortality patterns.

  16. Energy Transition Initiative: Island Energy Snapshot - Federated States of Micronesia; U.S. Department of Energy (DOE), NREL (National Renewable Energy Laboratory)

    Energy Technology Data Exchange (ETDEWEB)

    None

    2015-06-01

    This profile provides a snapshot of the energy landscape of the Federated States of Micronesia, a sovereign nation and U.S.-associated state in the western Pacific Ocean. The Federated States of Micronesia’s electricity rates for residential customers exceed $0.48 U.S. dollars (USD)/per kilowatt-hour (kWh), nearly four times the average U.S. residential rate of $0.13 USD/kWh.

  17. Bringing interdisciplinary and multicultural team building to health care education: the downstate team-building initiative.

    Science.gov (United States)

    Hope, Joanie Mayer; Lugassy, Daniel; Meyer, Rina; Jeanty, Freida; Myers, Stephanie; Jones, Sadie; Bradley, Joann; Mitchell, Rena; Cramer, Eva

    2005-01-01

    To evaluate the impact of the Downstate Team-Building Initiative (DTBI), a model multicultural and interdisciplinary health care team-building program for health professions students. A total of 65 students representing seven health disciplines participated in DTBI's first three years (one cohort per year since implementation). During the 18-session curriculum, students self-evaluated their group's progress through Tuckman's four team-development stages (FORMING, STORMING, NORMING, PERFORMING) on an 11-point scale. Students completed matched pre- and postintervention program evaluations assessing five variables: interdisciplinary understanding, interdisciplinary attitudes, teamwork skills, multicultural skills, and team atmosphere. After participation, students completed narrative follow-up questionnaires investigating impact one and two years after program completion. Each year's team development curve followed a similar logarithmic trajectory. Cohort 1 remained in team development stage 3 (NORMING) while Cohorts 2 and 3 advanced into the final stage-PERFORMING. A total of 34 matched pre- and postintervention evaluations showed significant change in all major variables: Team atmosphere and group teamwork skills improved most (48% and 44%, respectively). Interdisciplinary understanding improved 42%. Individual multicultural skills (defined by ability to address racism, homophobia, and sexism) started at the highest baseline and improved the least (13%). Group multicultural skills improved 36%. Of 23 responses to the follow-up surveys, 22 (96%) stated DTBI was a meaningful educational experience applicable to their current clinical surroundings. DTBI successfully united students across health discipline, ethnicity, socioeconomic class, gender, and sexual orientation into functioning teams. The model represents an effective approach to teaching health care team building and demonstrates benefits in both preclinical and clinical years of training.

  18. Scale refinement and initial evaluation of a behavioral health function measurement tool for work disability evaluation.

    Science.gov (United States)

    Marfeo, Elizabeth E; Ni, Pengsheng; Haley, Stephen M; Bogusz, Kara; Meterko, Mark; McDonough, Christine M; Chan, Leighton; Rasch, Elizabeth K; Brandt, Diane E; Jette, Alan M

    2013-09-01

    To use item response theory (IRT) data simulations to construct and perform initial psychometric testing of a newly developed instrument, the Social Security Administration Behavioral Health Function (SSA-BH) instrument, that aims to assess behavioral health functioning relevant to the context of work. Cross-sectional survey followed by IRT calibration data simulations. Community. Sample of individuals applying for Social Security Administration disability benefits: claimants (n=1015) and a normative comparative sample of U.S. adults (n=1000). None. SSA-BH measurement instrument. IRT analyses supported the unidimensionality of 4 SSA-BH scales: mood and emotions (35 items), self-efficacy (23 items), social interactions (6 items), and behavioral control (15 items). All SSA-BH scales demonstrated strong psychometric properties including reliability, accuracy, and breadth of coverage. High correlations of the simulated 5- or 10-item computer adaptive tests with the full item bank indicated robust ability of the computer adaptive testing approach to comprehensively characterize behavioral health function along 4 distinct dimensions. Initial testing and evaluation of the SSA-BH instrument demonstrated good accuracy, reliability, and content coverage along all 4 scales. Behavioral function profiles of Social Security Administration claimants were generated and compared with age- and sex-matched norms along 4 scales: mood and emotions, behavioral control, social interactions, and self-efficacy. Using the computer adaptive test-based approach offers the ability to collect standardized, comprehensive functional information about claimants in an efficient way, which may prove useful in the context of the Social Security Administration's work disability programs. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  19. Predictors on delay of initial health-seeking in new pulmonary tuberculosis cases among migrants population in East China.

    Directory of Open Access Journals (Sweden)

    Xinxu Li

    Full Text Available OBJECTIVES: To determine the length of delay in initial health-seeking in new pulmonary tuberculosis (PTB cases among migrant population in the eastern part of China, and factors associated with it. METHODS: A cross-sectional study was conducted using a structured questionnaire in six counties in Shanghai, Guangdong and Jiangsu from May to October, 2008, to estimate the extent and factors responsible for delayed initial health-seeking of the new PTB cases. The interval between self-reported onset of TB symptoms and date of first attendance at any medical institution was determined. More than the median duration was defined as delayed health-seeking. RESULTS: A total of 323 new migrant PTB patients participated in the study. Only 6.5% had medical insurance. The median and mean durations to initial health-seeking were respectively 10 and 31 days. There was no significant association between socio-demographic factors and delayed initial health-seeking. Average monthly working days >24 (AOR, 1.61; 95% CI, 1.03-2.51, and hemoptysis or bloody sputum (AOR, 0.48; 95% CI, 0.28-0.85 were significantly associated with delayed initial health-seeking. CONCLUSIONS: Interventions to improve health seeking behavior among the migrant population in China must focus on strengthening their labor, medical security and health education.

  20. An assessment of policymakers' engagement initiatives to promote evidence informed health policy making in Nigeria.

    Science.gov (United States)

    Uneke, Chigozie Jesse; Sombie, Issiaka; Keita, Namoudou; Lokossou, Virgil; Johnson, Ermel; Ongolo-Zogo, Pierre

    2017-01-01

    In most developing countries including Nigeria, one of the most challenging issues associated with evidence-to-policy link is the capacity constraints of policymakers to access, synthesize, adapt and utilize available research evidence. The purpose of this review is to assess the efforts and various initiatives that have been undertaken to deliberately engage policymakers and other stakeholders in the health sector in Nigeria for the promotion of evidence informed policymaking. A MEDLINE Entrez Pubmed search was performed and studies that investigated policy making process, evidence to policy link, research to policy mechanism, and researchers/policymakers interaction in Nigeria in relation to health policy were sought. Of the 132 publications found, 14(10.6%) fulfilled the study inclusion criteria and were selected and included in the review. Of the fourteen scientific publications identified, 11 of the studies targeted both researchers and policymakers and the principal tool of intervention was training workshops which focused on various aspects of evidence informed policymaking. All the studies indicated positive outcomes and impacts in relation to quantifiable improvement in policymakers' knowledge and competence in evidence to policy process. Capacity strengthening engagement mechanism is needed for both researchers to generate better evidence and for policymakers and health-care professionals to better use available evidence.

  1. Partnering with public schools: a resident-driven reproductive health education initiative.

    Science.gov (United States)

    Kuo, Kelly; Zhu, Tao Y; Raidoo, Shandhini; Zhao, Lulu X; Sammarco, Anne; Ashby, Karen

    2014-02-01

    To assess the impact of a resident-driven sexual health educational initiative in an inner-city Cleveland middle school. 10 resident physicians and 57 students in 7(th) and 8(th) grade participated in this prospective cohort study. Residents taught 3 sessions on the topics of basic anatomy and physiology, pregnancy, sexually transmitted infections (STI), contraception, and safe relationships. Outcome measures included the percentages of students able to name at least 3 different STIs and contraceptive methods; to name potential complications of STIs; and to correctly identify condoms and abstinence as the only contraceptive methods also protective against STI transmission. Significant improvements were noted in students' baseline knowledge of human anatomy, contraception, and safe sex practices after completion of the curriculum. The percentage of students able to name at least 3 forms of birth control increased from 1.7% to 70.7% (P reproductive health education in schools. The socioeconomic burden of teen pregnancy justifies comprehensive efforts to improve reproductive health education. Copyright © 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  2. Measuring sustainability within the Veterans Administration Mental Health System Redesign initiative.

    Science.gov (United States)

    Ford, James H; Krahn, Dean; Wise, Meg; Oliver, Karen Anderson

    2011-01-01

    To examine how attributes affecting sustainability differ across Veterans Health Administration organizational components and by staff characteristics. Surveys of 870 change team members and 50 staff interviews within the Veterans Affairs' Mental Health System Redesign initiative. A 1-way ANOVA with a Tukey post hoc test examined differences in sustainability by Veteran Integrated Service Networks, job classification, and tenure from staff survey data of the Sustainability Index. Qualitative interviews used an iterative process to identify "a priori" and "in vivo" themes. A simple stepwise linear regression explored predictors of sustainability. Sustainability differed across Veteran Integrated Service Networks and staff tenure. Job classification differences existed for the following: (1) benefits and credibility of the change and (2) staff involvement and attitudes toward change. Sustainability barriers were staff and institutional resistance and nonsupportive leadership. Facilitators were commitment to veterans, strong leadership, and use of quality improvement tools. Sustainability predictors were outcomes tracking, regular reporting, and use of Plan, Do, Study, Adjust cycles. Creating homogeneous implementation and sustainability processes across a national health system is difficult. Despite the Veterans Affairs' best evidence-based implementation efforts, there was significant variance. Locally tailored interventions might better support sustainability than "one-size-fits-all" approaches. Further research is needed to understand how participation in a quality improvement collaborative affects sustainability.

  3. [Mixed design for the evaluation of the Mesoamerica Health 2015 initiative].

    Science.gov (United States)

    Gutiérrez, Juan Pablo; Téllez-Rojo, Marta María; Torres, Pilar; Romero, Martín; Bertozzi, Stefano M

    2011-01-01

    Since the Salud Mesoamerica 2015 initiative (SM-2015) aim is to improve health and nutrition conditions of those most vulnerable in Mesoamerica, the goal of the evaluation is to generate evidence of the joint effectiveness of a package of interventions designed to improve the health conditions. We propose a mix design for the evaluation, which will allow to know the magnitude of changes attributable to the interventions, as well as the meanings of these changes for the target population, taking into account the specificities of each country. The main axis of this design is a locality panel where information about individuals, households, and health facilities (first and second level) will also be collected. The evaluation design described in this paper was developed between June and December, 2009, and it was integrated during workshops in Cuernavaca (Mexico), Managua (Nicaragua), and San Jose (Costa Rica). The proposed design will allow to generate evidence about the joint effectiveness of the package of interventions proposed for the SM-2015. The success of this design rests on the political commitment of countries and donors.

  4. Chapter 4: Assessing the Air Pollution, Greenhouse Gas, Air Quality, and Health Benefits of Clean Energy Initiatives

    Science.gov (United States)

    Chapter 4 of “Assessing the Multiple Benefits of Clean Energy” helps state energy, environmental, and economic policy makers assess the air quality, greenhouse gas, air pollution, and health benefits of clean energy initiatives.

  5. An evaluation of an initiative to improve Veterans Health Administration mental health services: broad impacts of the VHA's Mental Health Strategic Plan.

    Science.gov (United States)

    Greenberg, Greg A; Rosenheck, Robert A

    2009-12-01

    In federal fiscal year (FY) 2005 the Department of Veterans Affairs (VA) implemented the comprehensive Mental Health Strategic Plan (MHSP). This study used performance measures from six broad domains to examine changes in the overall delivery of mental health services in the VA since the implementation of the MHSP. Performance measures from fiscal year 2004, the year before implementation of the MHSP, were compared with measures from fiscal years 2005, 2006, and 2007, the first 3 years of MHSP implementation. We combined heterogeneous performance measures within domains through the use of standardized scores or "z-scores." An overall improvement of 0.32 standardized units was observed from FY 2004 to FY 2007, representing moderate to large changes by conventional standards. The domains with the greatest improvement (>1.0 standard deviation units) from FY 2004 to FY 2007 were population coverage/access, outpatient care quality, economic performance (primarily efficiency), and global functioning. There was a 0.3 standard deviation decline in inpatient satisfaction and a slight increase in reliance on inpatient care. Overall improvement in VA mental health care was thus substantial and continuing.

  6. Employees' perception of workplace health promotion initiatives in Taiwan: a cross-sectional survey of 30 worksites.

    Science.gov (United States)

    Hsu, Shang-Wei; Lin, Jin-Ding; Lee, Kuam-Tin; Loh, Ching-Hui; Yen, Chia-Feng; Lin, Lan-Ping; Chu, Cordia M; Chou, Yu-Ching

    2009-10-01

    The present study was to describe the input/process and evaluate the effectiveness of Taiwanese Workplace Health Promotion Initiatives based on employees' perspectives. This study employed a cross-sectional design by a structured questionnaire that was completed by 842 employees in 30 workplaces that participated in the Taiwan Workplace Health Promotion (WHP) Initiatives which supported by Ministry of Health from 2004 to 2006. The results found that the employees generally agreed that WHP improved their personal health skills. There was a lower level of agreement with respect to other input/process domains such as workplace healthy policy, workplace supportive health environments and WHP activities and services and the WHP effectiveness. With regard to the prediction of WHP effectiveness, the domain of workplace health activities/services could only predict 50.5% of the variation of the effectiveness in a regression model. Three domains of workplace - health activities/services, personal health skills and supportive health environments - were significantly correlated to the agree level of health promotion effectiveness. The results suggest that companies that intend initiating health promotion programs need to conduct a detailed assessment of the nature of the workplace settings and the perceptions of employees.

  7. Predictors of Colorectal Cancer Screening Prior to Implementation of a Large Pragmatic Trial in Federally Qualified Health Centers.

    Science.gov (United States)

    Petrik, Amanda F; Le, Thuy; Keast, Erin; Rivelli, Jennifer; Bigler, Keshia; Green, Beverly; Vollmer, William M; Coronado, Gloria

    2017-07-25

    Colorectal cancer screening can prevent cancer deaths. Federally qualified health centers serve a unique patient population that often is not screened. Knowing who in this environment is getting screened via fecal testing and via colonoscopy can assist in tailoring intervention to raise rates of colorectal cancer screening. We examined patient-level and neighborhood-level characteristics associated with being up to date with colorectal cancer screening guidelines. We also examined associations between these factors and being screened with a fecal test. We observed an increase in colorectal cancer screening rates from 2010 to 2015. Adjusted analyses revealed that the following factors were significantly associated with colorectal cancer screening: aged 65 or older, having any type of insurance, previous outpatient visits, and current or other preventive screenings. Among adults aged 50-75 who were up to date with colorectal cancer screening, factors associated with use of fecal testing, as opposed to colonoscopy, were: being younger, speaking a non-English language, being uninsured, having prior office visits, and having had a flu shot in past year. Our findings may inform clinic-based effort to raise rates of colorectal cancer screening, especially in the community clinic setting. ClinicalTrials.gov , NCT01742065.

  8. Insights into the epidemiology of postmenopausal osteoporosis: the Women's Health Initiative.

    Science.gov (United States)

    Jackson, Rebecca D; Mysiw, W Jerry

    2014-11-01

    Osteoporosis and its associated increased risk for fragility fracture is one of the most disabling consequences of aging in women. To successfully reduce the public health burden of this pervasive disease, it is necessary to develop strategies that permit the earlier identification of women at risk for fracture and ensure that preventive interventions to reduce the risk for fracture are both safe and effective. The Women's Health Initiative offers the unprecedented opportunity to systematically address both of these issues. Eleven clinically available risk factors (age, race/ethnicity, self-reported health, weight, height, physical activity, parental hip fracture, fracture history after age 54, current smoking, corticosteroid use, and history of treated diabetes), have been identified to predict 5-year hip fracture risk in white women. Two of these factors (age and fracture history) also predict risk for total fractures in women irrespective of race-ethnicity. Biomarkers including low vitamin D or bioavailable testosterone and/or high cystatin C, pro-inflammatory cytokines, osteoprotegerin and sex hormone-binding globulin also predict risk for hip fracture independent of clinical risk factors. Two cornerstones of therapy for postmenopausal osteoporosis-postmenopausal hormone therapy and calcium plus vitamin D supplementation- were rigorously studied. Estrogen with or without a progestin was effective at preventing bone loss and reducing risk for hip, clinical vertebral and total fractures but the balance of risks and benefits failed to show an overall benefit of taking estrogen-alone or estrogen plus progestin as a preventive strategy for skeletal health. Calcium plus vitamin D supplementation also demonstrated a small but significant favorable effect on hip bone density but in contrast, the modest effect did not translate into a significant reduction in the risk of fractures in intent-to-treat analyses. Data such as these have helped to lay a foundation for the

  9. Initiatives on early detection and intervention to proactively identify health and social problems in older people : Experiences from the Netherlands

    NARCIS (Netherlands)

    Lette, Manon; Baan, C.A.; van den Berg, Matthijs; de Bruin, Simone R.

    2015-01-01

    Background Over the last years, several initiatives on early detection and intervention have been put in place to proactively identify health and social problems in (frail) older people. An overview of the initiatives currently available in the Netherlands is lacking, and it is unknown whether they

  10. Getting Started: Initiating Critical Ethnography and Community-Based Action Research in a Program of Rural Health Studies

    Directory of Open Access Journals (Sweden)

    Jennifer B. Averill

    2006-06-01

    Full Text Available Rural populations experience higher rates of illness, less access to health care resources, and lower rates of health insurance coverage than do urban populations. A need exists to identify and address the health care needs of rural communities and other isolated populations and to contextualize the findings in the larger rural health environment. Critical ethnography combined with community-based action research is a constructive approach for improving the health status of rural elders as well as other members of isolated communities. Detailed guidelines on how to initiate an ethnographic community-based action study, as shown through a study that explores the definitions of health, health care perceptions, and health care issues for rural elders in the southwestern United States, highlight the value of this type of research for the study of the health care issues of rural populations.

  11. Development of a community health inclusion index: an evaluation tool for improving inclusion of people with disabilities in community health initiatives

    OpenAIRE

    Eisenberg, Yochai; Rimmer, James H.; Mehta, Tapan; Fox, Michael H.

    2015-01-01

    Background Community health initiatives often do not provide enough supports for people with disabilities to fully participate in healthy, active living opportunities. The purpose of this study was to design an instrument that focused on integrating disability-related items into a multi-level survey tool that assessed healthy, active living initiatives. Methods The development and testing of the Community Health Inclusion Index (CHII) involved four components: (a) literature review of studies...

  12. Continuation of care following an initial primary care visit with a mental health diagnosis: differences by receipt of VHA Primary Care-Mental Health Integration services.

    Science.gov (United States)

    Bohnert, Kipling M; Pfeiffer, Paul N; Szymanski, Benjamin R; McCarthy, John F

    2013-01-01

    For patients with an initial primary care (PC) encounter in the Veterans Health Administration (VHA) that included a mental health diagnosis, we evaluate whether same-day receipt of Primary Care-Mental Health Integration (PC-MHI) services is associated with the likelihood of receiving a subsequent mental-health-related encounter in the following 90 days. Using VHA administrative data, we identified 9046 patients who received VHA care for the first time in fiscal year 2009, received a PC encounter that included a mental health diagnosis on the first day of their VHA services and initiated care at a VHA facility that provided PC-MHI services. Using multivariable generalized estimating equations logistic regression, we examined whether receipt of same-day PC-MHI was associated with receipt of a subsequent encounter with a mental health diagnosis within 90 days. Analyses adjusted for Operation Enduring Freedom/Operation Iraqi Freedom Veteran status, demographic characteristics, service-connected disability, psychiatric and non-psychiatric diagnoses, and psychotropic medication initiation on the index day of service use. Receipt of same-day PC-MHI services was positively associated with having a mental-health-related encounter in the following 90 days (adjusted odds ratio=2.05; 95% confidence interval=1.66-2.54). PC-MHI services may enhance mental health continuation of care among PC patients with mental health conditions who initiate VHA services. Published by Elsevier Inc.

  13. How do experts define relevance criteria when initiating Health Impact Assessments of national policies?

    DEFF Research Database (Denmark)

    Kraemer, Stella Rj; Gulis, Gabriel

    2014-01-01

    The aim of this article is to present how the Danish Disease Prevention Committee (DDPC) members and HIA-experts understand when HIA is "relevant", which in this context means when there is "presumed to be a direct and documented effect on the health and morbidity of citizens". Method: DDPC members...... that the DDPC recommendation gives rise to a discussion on differing perceptions of relevance. The same definition can be used for both direct and indirect effects depending on interpretation. Documented evidence for an effect is desirable in the form provided by the traditional biomedical evidence hierarchy...... but HIA-experts emphasises use of local knowledge. The primary criteria for initiating a HIA, is whether the outcome of the HIA is expected to be taken into account in the decision-making process. The second criteria, is how do decision-makers perceive or interpret a decision to be relevant for HIA...

  14. Minimum Initial Service Package (MISP) for reproductive health during emergencies: time for a new paradigm?

    Science.gov (United States)

    Onyango, Monica Adhiambo; Hixson, Bretta Lynne; McNally, Siobhan

    2013-01-01

    Reproductive health (RH) has historically received low priority in the hierarchy of humanitarian response. Awareness of RH needs in emergencies began in the mid-1990s and led to the formation of the Inter-Agency Working Group (IAWG) for RH. Subsequently, the Minimum Initial Service Package (MISP), a set of guidelines for RH service delivery in crisis settings, was created. The objectives of the MISP are to facilitate the coordination of RH services, prevent and manage the consequences of sexual violence, reduce HIV transmission, minimize maternal and neonatal morbidity and mortality, and plan for comprehensive RH services in the post-crisis phase. Available documentation on MISP implementation is minimal, and reveals mixed success. Challenges include low MISP awareness, inadequate RH training among humanitarian actors, logistical difficulties and poor coordination. Continued emphasis on advocacy and capacity building, a stronger focus on logistics and coordination and a greater commitment to monitoring and evaluation are essential for improving the MISP's effectiveness in the field.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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.

  17. The Psychology School Mental Health Initiative: An Innovative Approach to the Delivery of School-Based Intervention Services

    Science.gov (United States)

    Millar, Golden M.; Lean, Debra; Sweet, Susan D.; Moraes, Sabrina C.; Nelson, Victoria

    2013-01-01

    Evidence suggests that schools have, by default, become the primary mental health system for students in Canada. The goal of the present study was to design, implement, and evaluate the Psychology School Mental Health Initiative (PSMHI). The PSMHI is an innovative attempt to increase the capacity of school-based psychology staff to deliver…

  18. The Refugee Health Nurse Liaison: a nurse led initiative to improve healthcare for asylum seekers and refugees.

    Science.gov (United States)

    McBride, Jacquie; Russo, Alana; Block, Andrew

    2016-12-01

    Asylum seekers and refugees experience a range of barriers to health service access and competent use. The Refugee Health Nurse Liaison initiative was piloted at a hospital in a high-settlement region of Victoria, Australia. This initiative aimed to build capacity within the health sector to more effectively respond to the needs of asylum seekers and refugees. A mixed-methods evaluation was undertaken to: describe issues encountered by asylum seekers and refugees within the hospital setting; capture the nature of the Refugee Health Nurse Liaison position; and document key outputs. Throughout the pilot period, 946 patients were referred to the role, of which 99% received an assessment of physical, mental, and social health. Refugee Health Nurse Liaisons effectively provided clinical support, advocacy, education, referrals, and both formal and informal capacity building. Learnings from this model are transferable to services in high-settlement regions, and could have application in improving patient care more broadly.

  19. Healthy People 2020: Leading Health Indicators

    Science.gov (United States)

    ... County Data Resources Federal Prevention Initiatives Healthy People eLearning Program Planning Content Syndication Public Health 3.0 ... of 10-year, national goals and objectives for improving the health of all Americans. Healthy People 2020 ...

  20. White Blood Cell Count and Total and Cause-Specific Mortality in the Women's Health Initiative.

    Science.gov (United States)

    Kabat, Geoffrey C; Kim, Mimi Y; Manson, JoAnn E; Lessin, Lawrence; Lin, Juan; Wassertheil-Smoller, Sylvia; Rohan, Thomas E

    2017-03-22

    White blood cell (WBC) count appears to predict total mortality and coronary heart disease (CHD) mortality, but it is unclear to what extent the association reflects confounding by smoking, underlying illness, or comorbid conditions. We used data from the Women's Health Initiative to examine the associations of WBC count with total mortality, CHD mortality, and cancer mortality. WBC count was measured at baseline in 160,117 postmenopausal women and again in year 3 in 74,375 participants. Participants were followed for a mean of 16 years. Cox proportional hazards models were used to estimate the relative mortality hazards associated with deciles of baseline WBC count and of the mean of baseline + year 3 WBC count. High deciles of both baseline and mean WBC count were positively associated with total mortality and CHD mortality, whereas the association with cancer mortality was weaker. The association of WBC count with mortality was independent of smoking and did not appear to be influenced by previous disease history. The potential clinical utility of this common laboratory test in predicting mortality risk warrants further study. © The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Collaboration and competition in a children's health initiative coalition: a network analysis.

    Science.gov (United States)

    Valente, Thomas W; Coronges, Kathryn A; Stevens, Gregory D; Cousineau, Michael R

    2008-11-01

    Activating communities to achieve public health change and initiate policy reform usually requires collective action from many entities. This case study analyzes inter-organizational networks among members of a coalition created to expand health insurance coverage to uninsured children in a large metropolitan area. Six networks were measured: collaboration, competition, formal agreements, receive funding from, send funding to, and greater communication. The response rate was 65.8% (50 of the 76 active members). Positive network questions such as "who do you collaborate with" elicited many network choices whereas negative ones such as "who do you compete with" elicited few. The collaboration network had a core-periphery structure and analysis showed that a large network can be reduced to a small set of core organizations one-sixth the size of the whole. Centrality (out- and in-degree) was associated with perceived organizational function and perceived barriers to success. For example, organizations that received many choices as collaboration partners were more likely to perceive the coalition functioned well than those who received few choices. The study suggests that perceptions of organizational performance are associated with position in the network, central members are more likely to perceive the organization performs well than those on the periphery.

  2. Electric Blanket Use and Risk of Thyroid Cancer in the Women's Health Initiative Observational Cohort.

    Science.gov (United States)

    Kato, Ikuko; Young, Alicia; Liu, Jingmin; Abrams, Judith; Bock, Cathryn; Simon, Michael

    2015-01-01

    Thyroid cancer disproportionally affects more women than men. The aim of this study was to assess whether exposure to extremely low frequency electric magnetic fields from electric blankets (EBs) was associated with the development of thyroid cancer. Data were analyzed from 89,527 women who participated in the Women's Health Initiative Observational Study and who responded to questions concerning prior use of EBs. During a mean follow-up of 12.2 years, 190 incident cases of thyroid cancer were identified. We estimated the hazard ratio (HR) and 95 percent confidence interval (CI) of incident thyroid cancer associated with EB use by Cox's proportional hazard model, adjusted for selected covariates. A majority, 57 percent, of the women in the cohort reported the use of EBs while sleeping and/or for warming the bed before sleep. No association was found between use of EBs and subsequent risk of thyroid cancer (HR = 0.98, 95 percent CI 0.72-1.32). Duration of EB use measured in years, months, or hours had no effect on risk. These results did not change when the cases were limited to papillary thyroid cancer, the most frequently occurring histologic type. The results of this study do not support possible health hazards of EBs in regards to thyroid cancer risk.

  3. Urinary cadmium and estimated dietary cadmium in the Women's Health Initiative.

    Science.gov (United States)

    Quraishi, Sabah M; Adams, Scott V; Shafer, Martin; Meliker, Jaymie R; Li, Wenjun; Luo, Juhua; Neuhouser, Marian L; Newcomb, Polly A

    2016-01-01

    Cadmium, a heavy metal dispersed in the environment as a result of industrial and agricultural applications, has been implicated in several human diseases including renal disease, cancers, and compromised bone health. In the general population, the predominant sources of cadmium exposure are tobacco and diet. Urinary cadmium (uCd) reflects long-term exposure and has been frequently used to assess cadmium exposure in epidemiological studies; estimated dietary intake of cadmium (dCd) has also been used in several studies. The validity of dCd in comparison with uCd is unclear. This study aimed to compare dCd, estimated from food frequency questionnaires, to uCd measured in spot urine samples from 1,002 participants of the Women's Health Initiative. Using linear regression, we found that dCd was not statistically significantly associated with uCd (β=0.006, P-value=0.14). When stratified by smoking status, dCd was not significantly associated with uCd both in never smokers (β=0.006, P-value=0.09) and in ever smokers (β=0.003, P-value=0.67). Our results suggest that because of the lack of association between estimated dCd and measured uCd, dietary estimation of cadmium exposure should be used with caution in epidemiologic studies.

  4. Can Using Rigorous Evidence to Guide Federal Education Funds Improve Student Achievement? Randomized Trials Show Encouraging Initial Results for DoED's Investing in Innovation Fund

    Science.gov (United States)

    Coalition for Evidence-Based Policy, 2014

    2014-01-01

    An important recent development in evidence-based policy is the federal government's use of a "tiered evidence" approach to allocating funding in grant programs such as the U.S. Department of Education's Investing in Innovation Fund (i3). A central feature of this approach is that the largest grants are awarded to fund large-scale…

  5. A University-Wide ePortfolio Initiative at Federation University Australia: Software Analysis, Test-to-Production, and Evaluation Phases

    Science.gov (United States)

    Hains-Wesson, Rachael; Wakeling, Lara; Aldred, Peter

    2014-01-01

    This paper describes an ePortfolio implementation strategy at Federation University Australia, Victoria (formerly the University of Ballarat). The authors combined a personal and practical viewpoint to elicit pitfalls, challenges, and recommendations for improvement. The paper is divided into three main areas in order to outline the experiments…

  6. Exploring Health Care Providers' Views About Initiating End-of-Life Care Communication.

    Science.gov (United States)

    Nedjat-Haiem, Frances R; Carrion, Iraida V; Gonzalez, Krystana; Ell, Kathleen; Thompson, Beti; Mishra, Shiraz I

    2017-05-01

    Numerous factors impede effective and timely end-of-life (EOL) care communication. These factors include delays in communication until patients are seriously ill and/or close to death. Gaps in patient-provider communication negatively affect advance care planning and limit referrals to palliative and hospice care. Confusion about the roles of various health care providers also limits communication, especially when providers do not coordinate care with other health care providers in various disciplines. Although providers receive education regarding EOL communication and care coordination, little is known about the roles of all health care providers, including nonphysician support staff working with physicians to discuss the possibility of dying and help patients prepare for death. This study explores the perspectives of physicians, nurses, social workers, and chaplains on engaging seriously ill patients and families in EOL care communication. Qualitative data were from 79 (medical and nonmedical) providers practicing at 2 medical centers in Central Los Angeles. Three themes that describe providers' perceptions of their roles and responsibility in talking with seriously ill patients emerged: (1) providers' roles for engaging in EOL discussions, (2) responsibility of physicians for initiating and leading discussions, and (3) need for team co-management patient care. Providers highlighted the importance of beginning discussions early by having physicians lead them, specifically due to their medical training and need to clarify medical information regarding patients' prognosis. Although physicians are a vital part of leading EOL communication, and are at the center of communication of medical information, an interdisciplinary approach that involves nurses, social workers, and chaplains could significantly improve patient care.

  7. Impact evaluation of the Urban Health Initiative in urban Uttar Pradesh, India

    Science.gov (United States)

    Achyut, Pranita; Benson, Aimee; Calhoun, Lisa M.; Corroon, Meghan; Guilkey, David K.; Kebede, Essete; Lance, Peter M.; Mishra, Anurag; Nanda, Priya; O'Hara, Rick; Sengupta, Ranajit; Speizer, Ilene S.; Stewart, John F.; Winston, Jennifer

    2016-01-01

    Objectives The Urban Health Initiative (UHI) was initiated in 2009 with the goal of increasing family planning (FP) use among the poor in urban areas of Uttar Pradesh, India. The Measurement, Learning & Evaluation project (MLE) was tasked with rigorous impact evaluation of the UHI. This paper presents the impact evaluation findings of the UHI program. Study design The MLE design includes a longitudinal sample of women and health facilities with baseline (2010) and endline (2014) data collection in six cities in Uttar Pradesh, India. At baseline, samples representative of women in each city were selected with oversampling of the poor. Eighty-four percent of women interviewed at baseline were reinterviewed 4 years later at endline. The longitudinal data support a within/fixed-effects approach to identification of program impact on changes in modern FP use. Results Impact evaluation results show significant effects of exposure to both demand and supply side program activities. In particular, women exposed to brochures (marginal effect: 6.96, p < .001), billboards/posters/wall hangings (marginal effect: 2.09, p < .05), and FP on the television (marginal effect: 2.46, p < .001) were significantly more likely to be using a modern method at endline. In addition, we found borderline significance for being exposed to a community health worker (marginal effect: 1.66, p < .10) and living close to an improved public and private supply environment where UHI undertook activities (marginal effects and p values: 2.48, p < .05 and 1.56, p < .10, respectively). Conclusions UHI program activities were designed to complement the Government of India's strategies aimed at ensuring access to and provision of FP to urban poor populations. The effective demand- and supply-side strategies of the UHI program are therefore likely to be sustainable and scalable to other urban areas in India. Implications statement Findings from this study are important for designing sustainable and

  8. ACA Federal Upper Limits

    Data.gov (United States)

    U.S. Department of Health & Human Services — Affordable Care Act Federal Upper Limits (FUL) based on the weighted average of the most recently reported monthly average manufacturer price (AMP) for...

  9. Time until first dental caries for young children first seen in Federally Qualified Health Centers: a retrospective cohort study

    Science.gov (United States)

    Kuthy, RA; Jones, M; Kavand, G; Momany, E; Askelson, N; Chi, D; Wehby, G; Damiano, P

    2014-01-01

    Objective The study assessed the time until first dental caries for young children seen at 5 Federally Qualified Health Centers (FQHC) in Iowa and the relationship with the frequency and gaps (in months) of dental episodes, the number of topical fluoride treatments, and the number of dentists caring for the subject. Methods Forty children were randomly selected at each FQHC (n=200). All children were continuously enrolled in the Medicaid program and had their first dental visit prior to age 6. Dental chart findings, claims data for the child and family, and birth certificate information were merged into one dataset. Dental visits were followed for a minimum of 36 months, including dental visits external to the FQHCs. Using time until first caries as the dependent variable, the data were subject to left, interval, and right censoring and were analyzed via Weibull regression. Results Slightly more than half of the 200 children experienced caries. Regression analysis indicated that the hazard rate of first dental caries increased by approximately 2% with each additional month that transpired between preventive recall examinations. In addition, children with older siblings who had a dental visit at the same center during the previous year prior to the subject’s first visit were more likely to have a longer time until first dental caries. Conclusions Timing of dental care episodes was associated with caries experience in young children from low income families. Dental professionals should focus on regularity of dental care in order to prevent or delay caries experience in young children. PMID:24483730

  10. Challenges conducting comparative effectiveness research: the Clinical and Health Outcomes Initiative in Comparative Effectiveness (CHOICE experience

    Directory of Open Access Journals (Sweden)

    Friedly JL

    2014-05-01

    Full Text Available Janna L Friedly,1,4 Zoya Bauer,2,4 Bryan A Comstock,3,4 Emily DiMango,5 Assiamira Ferrara,6 Susan S Huang,7 Elliot Israel,8 Jeffrey G Jarvik,2,4 Andrew A Nierenberg,9 Michael K Ong,10 David F Penson,11 Rebecca Smith-Bindman,12 Arthur E Stillman,13 William M Vollmer,6 Stephen M Warren,14 Chunliu Zhan,15 David Chu-Wen Hsia,15 Anne Trontell15 1Department of Rehabilitation Medicine, 2Department of Radiology, 3Department of Biostatistics, 4Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, WA, 5Columbia University Medical Center, New York, NY, 6Kaiser Foundation Research Institute, Oakland, 7Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA, 8Harvard Medical School, Pulmonary and Critical Care, Allergy and Immunology, Brigham and Women's Hospital, 9Massachusetts General Hospital, Boston, MA, 10Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 11Vanderbilt University and Tennessee Valley VAHCC, Nashville, TN, 12Departments of Radiology and Biomedical Imaging, Health Policy, Epidemiology and Biostatistics, University of California, San Francisco, SF, 13Emory University, Atlanta, GA, 14Department of Plastic Surgery, Division of Clinical and Translational Research, NYU Langone Medical Center, New York, NY, 15Agency for Healthcare Research and Quality, Rockville, MD, USA Abstract: The Clinical and Health Outcomes Initiative in Comparative Effectiveness (CHOICE program, which includes 12 ongoing comparative effectiveness research (CER trials funded by the Agency for Healthcare Research and Quality under the American Recovery and Reinvestment Act of 2009, has had firsthand experience in dealing with the unique challenges of conducting CER since the trials started in the fall of 2010. This paper will explore the collective experience

  11. The use of international service learning initiatives for global health education: case studies from Rwanda and Mexico.

    Science.gov (United States)

    Plumb, Ellen; Roe, Kathleen; Plumb, James; Sepe, Priscilla; Soin, Komal; Ramirez, Aragon; Baganizi, Edmond; Simmons, Rob; Khubchandani, Jagdish

    2013-05-01

    Global health education and health promotion have the potential to engage students, scholars, and practitioners in ways that go beyond the classroom teaching routine. This engagement in global communities, can range from reflection on continuing deep-seated questions about human rights and civic responsibility to the use of health education and promotion-related theoretical, intellectual, and practical skills. In the arena of global health education and promotion, these skills also range from leadership and advocacy to decision making, critical and creative thinking, teamwork, and problem solving. In recent times, there has been a growing interest in cross-cultural collaborations and educational initiatives to improve stakeholder's understanding of global health principles and practices, to enrich the experiences of health professionals, and to improve the lives of those who are disenfranchised and live across borders. In this article of Health Promotion Practice, we highlight two unique cases of cross-national collaborations and provide a glimpse of the various shapes and forms taken by cross-cultural educational initiatives for global health education and promotion. We summarize the history, philosophy, and current working practices relevant to these collaborations, keeping in view the global health domains, competencies, and activities. In addition, we also compare the key components and activities of these two case studies from Rwanda and Mexico, wherein communities in these two countries collaborated with academic institutions and health professionals in the United States.

  12. The Initiative to extend Medicare into Mexico: a case study in changing U.S. Health Care Policy

    Directory of Open Access Journals (Sweden)

    Roberto A. Ibarra

    2011-10-01

    Full Text Available This study examines the geo-political activities of interest groups, governments and multinational corporations involved in an initiative to extend Medicare to U.S. retirees residing in Mexico.  If the initiative to change the current Medicare policy succeeds, the relocation of Medicare-eligible populations from the U.S. to Mexico is likely to increase; the U.S. is expected to gain cost-savings for taxpayers on Medicare; Mexico can develop senior-housing and options for long-term care it currently lacks; and foreign-led multinational corporations will increase their profits and dominance, fostering even more privatization in Mexico’s health care sector. By exploring new issues about retirement migration and health this study seeks to gain knowledge about the phenomena in a number of areas.  First, the retirement migration of North Americans to Latin America is an under-studied phenomenon in the fields of social gerontology, migration research, and health policy studies.  Second, the Medicare in Mexico initiative is even less well-known among health policy scholars than the retirement migration phenomenon into Mexico. Yet this initiative is inherently international in scope and involves a number of US-based institutions and interest groups actively promoting the project from within Mexico. Thus, the initiative has important geo-political and socio-economic implications for reforming health care systems in the U.S. and Mexico.

  13. Federalism Lives.

    Science.gov (United States)

    Howard, A. E. Dick

    1987-01-01

    Examines the concept of federalism in terms of its past history and its encouraging future. Calls for a revival of concern for federalism not simply as a convenient administrative arrangement but as a fundamental constitutional value. (BSR)

  14. A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa.

    Science.gov (United States)

    Barker, Pierre M; Reid, Amy; Schall, Marie W

    2016-01-29

    Scaling up complex health interventions to large populations is not a straightforward task. Without intentional, guided efforts to scale up, it can take many years for a new evidence-based intervention to be broadly implemented. For the past decade, researchers and implementers have developed models of scale-up that move beyond earlier paradigms that assumed ideas and practices would successfully spread through a combination of publication, policy, training, and example. Drawing from the previously reported frameworks for scaling up health interventions and our experience in the USA and abroad, we describe a framework for taking health interventions to full scale, and we use two large-scale improvement initiatives in Africa to illustrate the framework in action. We first identified other scale-up approaches for comparison and analysis of common constructs by searching for systematic reviews of scale-up in health care, reviewing those bibliographies, speaking with experts, and reviewing common research databases (PubMed, Google Scholar) for papers in English from peer-reviewed and "gray" sources that discussed models, frameworks, or theories for scale-up from 2000 to 2014. We then analyzed the results of this external review in the context of the models and frameworks developed over the past 20 years by Associates in Process Improvement (API) and the Institute for Healthcare improvement (IHI). Finally, we reflected on two national-scale improvement initiatives that IHI had undertaken in Ghana and South Africa that were testing grounds for early iterations of the framework presented in this paper. The framework describes three core components: a sequence of activities that are required to get a program of work to full scale, the mechanisms that are required to facilitate the adoption of interventions, and the underlying factors and support systems required for successful scale-up. The four steps in the sequence include (1) Set-up, which prepares the ground for

  15. News media coverage of smoking and health is associated with changes in population rates of smoking cessation but not initiation.

    Science.gov (United States)

    Pierce, J P; Gilpin, E A

    2001-06-01

    To determine whether changes in news media coverage of smoking and health issues are associated with changes in smoking behaviour in the USA. Issue importance in the US news media is assessed by the number of articles published annually in major magazines indexed in The Reader's Guide to Periodical Literature. Annual incidence rates for cessation and initiation in the USA were computed from the large, representative National Health Interview Surveys (1965-1992). Patterns in cessation incidence were considered for ages 20-34 years and 35-50 years. Initiation incidence was examined for adolescents (14-17 years) and young adults (18-21 years) of both sexes. From 1950 to the early 1980s, the annual incidence of cessation in the USA mirrored the pattern of news media coverage of smoking and health, particularly for middle aged smokers. Cessation rates in younger adults increased considerably when second hand smoke concerns started to increase in the US population. Incidence of initiation in young adults did not start to decline until the beginning of the public health campaign against smoking in the 1960s. Among adolescents, incidence rates did not start to decline until the 1970s, after the broadcast ban on cigarette advertising. The level of coverage of smoking and health in the news media may play an important role in determining the rate of population smoking cessation, but not initiation. In countries where cessation has lagged, advocates should work to increase the newsworthiness of smoking and health issues.

  16. The French-German initiative for Chernobyl. Programme 3 study of the health effects

    Energy Technology Data Exchange (ETDEWEB)

    Becker, S.; Kellerer, A.; Pott-Born, R. [Munich Univ., Radiobiological Institute (Germany); Gagniere, B. [CIRE Ouest, 35 - Rennes (France); Mansoux, H.; Rutschkowsky, N.; Valenty, M.; Calmont, I.; Brun-Yaba, Ch. [Institut de Radioprotection et de Surete Nucleaire, 92 - Fontenay-aux-Roses (France); Verger, P. [ORS PACA, 13 - Marseille (France); Franc, B. [Hopital Ambroise-Pare, 92 - Boulogne (France); Robert-Gnansia, E. [European Instituteof Genomutations, 69 - Lyon (France); Briend, A. [Scientific and Technical Institute of Nutrition and Alimentation/CNAM, 75 - Paris (France)

    2006-03-15

    The results of the French-German Initiative Health Effects project, conducted over a period of four years, were presented to the international authorities at a congress held in October 2004 in Kiev and are summarised below. Thyroid cancer increase in children and young adults seems clearly related to exposure at young ages in 1986. For the other cancers sites, the observed results do not add any decisive elements that would make it possible to quantify the impact of post-Chernobyl irradiation: the trend observed in time is similar in both exposed and non-exposed areas in most situations. These observations do not exclude the fact that an increase of leukaemia may exist for those exposed as children; it may be too low to be detectable in a statistically significant way. Similarly, the higher rate of congenital malformations observed during recent years cannot be attributed to radiation, because the same trend over time is observed both in contaminated and non-contaminated areas in Belarus. Reliable and up-to-date knowledge has been collected in a H.E.D.A.C. database, it should facilitate communication concerning the health impact of the Chernobyl accident. The main results published at national or international level, will be made available to the public and the international scientific community via modern distribution methods and will contribute to the development of a necessary cohesion between international research programmes and work carried out locally. Contact the web site: www.fgi.icc.gov.ua For detailed information, final reports are available: contact with mentioned investigators is proposed (see authors of final reports) or contact scientific coordinator M. Tirmarche at I.R.S.N. (France) D. Bazyka at R.C.R.M., Kiev in charge of the database and communication of scientific results at Chernobyl Center.

  17. Calcium, magnesium and potassium intake and mortality in women with heart failure: the Women's Health Initiative.

    Science.gov (United States)

    Levitan, Emily B; Shikany, James M; Ahmed, Ali; Snetselaar, Linda G; Martin, Lisa W; Curb, J David; Lewis, Cora E

    2013-07-14

    Although diet is thought to affect the natural history of heart failure (HF), nutrient intake in HF patients has not been well studied. Based on prior research linking high intake of Ca, Mg and K to improved cardiovascular health, we hypothesised that these nutrients would be inversely associated with mortality in people with HF. Of the 161 808 participants in the Women's Health Initiative (WHI), we studied 3340 who experienced a HF hospitalisation. These participants were followed for post-hospitalisation all-cause mortality. Intake was assessed using questionnaires on food and supplement intake. Hazard ratios (HR) and 95 % CI were calculated using Cox proportional hazards models adjusted for demographics, physical function, co-morbidities and dietary covariates. Over a median of 4·6 years of follow-up, 1433 (42·9 %) of the women died. HR across quartiles of dietary Ca intake were 1·00 (referent), 0·86 (95 % CI 0·73, 1·00), 0·88 (95 % CI 0·75, 1·04) and 0·92 (95 % CI 0·76, 1·11) (P for trend = 0·63). Corresponding HR were 1·00 (referent), 0·86 (95 % CI 0·71, 1·04), 0·88 (95 % CI 0·69, 1·11) and 0·84 (95 % CI 0·63, 1·12) (P for trend = 0·29), across quartiles of dietary Mg intake, and 1·00 (referent), 1·20 (95 % CI 1·01, 1·43), 1·06 (95 % CI 0·86, 1·32) and 1·16 (95 % CI 0·90, 1·51) (P for trend = 0·35), across quartiles of dietary K intake. Results were similar when total (dietary plus supplemental) nutrient intakes were examined. In summary, among WHI participants with incident HF hospitalisation, intakes of Ca, Mg and K were not significantly associated with subsequent mortality.

  18. The Impact of Federal Regulations on Research Management in Colleges and Universities: Overview and Summaries.

    Science.gov (United States)

    Perkins, John A.; And Others

    The University of California Research Management Improvement Project (RMIP) was initiated to point out federal requirements and their impacts on the educational institution. The findings are contained in nine separate reports covering case flow; environmental health and safety; federal procurement requirements; financial management: budgeting and…

  19. The NanoCare project: A German initiative on health aspects of synthetic nanoparticles

    Science.gov (United States)

    Nau, Katja; Krug, Harald F.

    2009-05-01

    Nanotechnology is increasingly considered to be the future technology. It will enable science and industry to provide new and better product solutions for the society. NanoCare is a German project, funded by the German Federal Ministry of Education and Research (BMBF), which aims to broaden knowledge about synthetic nanomaterials with regard to the potential impacts of nanomaterials on human health. 13 partners from industry, universities and research institutes are contributing their expertise to this partnership. The work plan of the NanoCare project is composed of three different parts: (1) the generation, (2) the management, and (3) the transfer of knowledge. The production of synthetic nanoparticles, the subsequent analysis of primary particles, aggregates and agglomerates, as well as the behaviour in biological media and effects on biological systems are focused in the generation of knowledge. In addition to the production and characterization of new synthetic nanoparticles (metal oxides like zirconium dioxide or zinc oxide), titanium dioxide and Carbon Black will be established as reference materials. This enables the comparison of the results of all partners of our project. Various analytical methods for characterization will be applied, for example: transmission and scanning electron microscopy, inductive coupled plasma mass spectroscopy (ICP-MS), atomic absorption spectroscopy (AAS) and the Brunner-Edward-Teller method (BET). In vitro studies will systematically investigate biological mechanisms of action of nanoparticles and the dependency on their size, shape, zeta potential and other important properties. In vitro data will be complemented by in vivo studies. Another work package deals with the measurement of working place exposure and agglomerate stabilities. Established measurement devices and methods will be developed further in order to determine aerosols and nanoparticles directly at the workplace during ongoing work processes. The stabilities of

  20. Intake of antioxidant nutrients and risk of non-Hodgkin's Lymphoma in the Women's Health Initiative.

    Science.gov (United States)

    Kabat, Geoffrey C; Kim, Mimi Y; Wactawski-Wende, Jean; Shikany, James M; Vitolins, Mara Z; Rohan, Thomas E

    2012-01-01

    Incidence rates of non-Hodgkin's lymphoma (NHL) increased substantially in the United States and worldwide during the latter part of the 20(th) century, but little is known about the etiology of this condition. Antioxidant nutrients may reduce the risk of NHL by quenching free radicals, which may contribute to carcinogenesis by damaging DNA and lipid membranes. We examined the association of intake of vitamin A and antioxidant nutrients with risk of NHL and its major subtypes in 1,104 cases of NHL identified among 154,363 postmenopausal women followed for an average of 11 yr in the Women's Health Initiative. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Of all nutrients examined, only total vitamin A intake (from diet and supplements combined) was inversely associated with risk of NHL overall (multivariate adjusted HR for highest vs. lowest quartile 0.83, 95% CI 0.69-0.99), whereas total vitamin C intake was inversely associated with risk of diffuse large B-cell lymphoma (HR for highest vs. lowest quartile 0.69, 95% CI 0.49-0.98). Overall, this study provides some evidence of inverse associations of intake of total vitamin A and total vitamin C with the risk of NHL and diffuse lymphoma, respectively.

  1. Platelet count and total and cause-specific mortality in the Women's Health Initiative.

    Science.gov (United States)

    Kabat, Geoffrey C; Kim, Mimi Y; Verma, Amit K; Manson, JoAnn E; Lin, Juan; Lessin, Lawrence; Wassertheil-Smoller, Sylvia; Rohan, Thomas E

    2017-04-01

    We used data from the Women's Health Initiative to examine the association of platelet count with total mortality, coronary heart disease (CHD) mortality, cancer mortality, and non-CHD/noncancer mortality. Platelet count was measured at baseline in 159,746 postmenopausal women and again in year 3 in 75,339 participants. Participants were followed for a median of 15.9 years. Cox proportional hazards models were used to estimate the relative mortality hazards associated with deciles of baseline platelet count and of the mean of baseline + year 3 platelet count. Low and high deciles of both baseline and mean platelet count were positively associated with total mortality, CHD mortality, cancer mortality, and non-CHD/noncancer mortality. The association was robust and was not affected by adjustment for a number of potential confounding factors, exclusion of women with comorbidity, or allowance for reverse causality. Low- and high-platelet counts were associated with all four outcomes in never smokers, former smokers, and current smokers. In this large study of postmenopausal women, both low- and high-platelet counts were associated with total and cause-specific mortality. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. New portable tool to screen vestibular and visual function--National Institutes of Health Toolbox initiative.

    Science.gov (United States)

    Rine, Rose Marie; Roberts, Dale; Corbin, Bree A; McKean-Cowdin, Roberta; Varma, Rohit; Beaumont, Jennifer; Slotkin, Jerry; Schubert, Michael C

    2012-01-01

    As part of the National Institutes of Health Toolbox initiative, we developed a low-cost, easy-to-administer, and time-efficient test of vestibular and visual function. A computerized test of dynamic visual acuity (cDVA) was used to measure the difference in visual acuity between head still and moving in yaw. Participants included 318 individuals, aged 3 to 85 years (301 without and 17 with vestibular pathology). Adults used Early Treatment of Diabetic Retinopathy Study (ETDRS) optotypes; children used ETDRS, Lea, and HOTV optotypes. Bithermal calorics, rotational chair, and light box testing were used to validate the cDVA. Analysis revealed that the cDVA test is reliable for static (intraclass correlation coefficient [ICC] >/= 0.64) and dynamic (ICC >/= 0.43-0.75) visual acuity. Children younger than 6 years old were more likely to complete cDVA with Lea optotypes, but reliability and correlation with ETDRS was better using HOTV optotypes. The high correlation between static acuity and light box test scores (r = 0.795), significant difference of cDVA scores between those with and without pathology (p visual acuity when the head is still and moving, as well as a good proxy of vestibular function to yaw rotation.

  3. Changes in physical activity, sedentary time, and risk of falling: The Women's Health Initiative Observational Study.

    Science.gov (United States)

    Bea, Jennifer W; Thomson, Cynthia A; Wallace, Robert B; Wu, Chunyuan; Seguin, Rebecca A; Going, Scott B; LaCroix, Andrea; Eaton, Charles; Ockene, Judith K; LaMonte, Michael J; Jackson, Rebecca; Jerry Mysiw, W; Wactawski-Wende, Jean

    2017-02-01

    Falling significantly affects quality of life, morbidity, and mortality among older adults. We sought to evaluate the prospective association between sedentary time, physical activity, and falling among post-menopausal women aged 50-79years recruited to the Women's Health Initiative Observational Study between 1993 and 1998 from 40 clinical centers across the United States. Baseline (B) and change in each of the following were evaluated at year 3 (Y3) and year 6 (Y6; baseline n=93,676; Y3 n=76,598; Y6 n=75,428): recreational physical activity (MET-h/wk), sitting, sleeping (min/day), and lean body mass by dual energy X-ray absorptiometry (subset N=6475). Falls per year (0, 1, 2, ≥3) were assessed annually by self-report questionnaire and then dichotomized as ≤1 and ≥2falls/year. Logistic regression models were adjusted for demographics, body mass index, fall history, tobacco and alcohol use, medical conditions, and medications. Higher baseline activity was associated with greater risk of falling at Y6 (18%; p for trend resistance training, should be evaluated to assist post-menopausal women in reaching or maintaining levels of aerobic activity known to prevent and manage several chronic diseases. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Urinary Cadmium and Risk of Invasive Breast Cancer in the Women's Health Initiative.

    Science.gov (United States)

    Adams, Scott V; Shafer, Martin M; Bonner, Matthew R; LaCroix, Andrea Z; Manson, JoAnn E; Meliker, Jaymie R; Neuhouser, Marian L; Newcomb, Polly A

    2016-05-01

    Cadmium is a widespread heavy metal pollutant that may act as an exogenous estrogenic hormone. Environmental cadmium exposure has been associated with risk of breast cancer in retrospective studies. We prospectively assessed the relationship between cadmium exposure, evaluated by creatinine-normalized urinary cadmium concentration, and invasive breast cancer among 12,701 postmenopausal women aged ≥50 years in a Women's Health Initiative study of bone mineral density. After a median of 13.2 years of follow-up (1993-2010), 508 cases of invasive breast cancer and 1,050 comparison women were identified for a case-cohort analysis. Multivariable Cox regression was used to calculate hazard ratios and 95% confidence intervals. Risk of breast cancer was not associated with urinary cadmium parameterized either in quartiles (comparing highest quartile with lowest, hazard ratio = 0.80, 95% confidence interval: 0.56, 1.14; P for trend = 0.20) or as a log-transformed continuous variable (per 2-fold higher urinary cadmium concentration, hazard ratio = 0.94, 95% confidence interval: 0.86, 1.03). We did not observe an association between urinary cadmium and breast cancer risk in any subgroup examined, including never smokers and women with body mass index (weight (kg)/height (m)(2)) less than 25. Results were consistent in both estrogen receptor-positive and estrogen receptor-negative tumors. Our results do not support the hypothesis that environmental cadmium exposure is associated with risk of postmenopausal breast cancer.

  5. Leveraging lean principles in creating a comprehensive quality program: The UCLA health readmission reduction initiative.

    Science.gov (United States)

    Afsar-Manesh, Nasim; Lonowski, Sarah; Namavar, Aram A

    2017-01-04

    UCLA Health embarked to transform care by integrating lean methodology in a key clinical project, Readmission Reduction Initiative (RRI). The first step focused on assembling a leadership team to articulate system-wide priorities for quality improvement. The lean principle of creating a culture of change and accountability was established by: 1) engaging stakeholders, 2) managing the process with performance accountability, and, 3) delivering patient-centered care. The RRI utilized three major lean principles: 1) A3, 2) root cause analyses, 3) value stream mapping. Baseline readmission rate at UCLA from 9/2010-12/2011 illustrated a mean of 12.1%. After the start of the RRI program, for the period of 1/2012-6/2013, the readmission rate decreased to 11.3% (pservice- and location-based interventions into strategies with broader approach. As elucidated, a systematic clinical approach grounded in lean methodologies is a viable solution to this complex problem. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Improving Initiation and Tracking of Research Projects at an Academic Health Center: A Case Study.

    Science.gov (United States)

    Schmidt, Susanne; Goros, Martin; Parsons, Helen M; Saygin, Can; Wan, Hung-Da; Shireman, Paula K; Gelfond, Jonathan A L

    2016-09-20

    Research service cores at academic health centers are important in driving translational advancements. Specifically, biostatistics and research design units provide services and training in data analytics, biostatistics, and study design. However, the increasing demand and complexity of assigning appropriate personnel to time-sensitive projects strains existing resources, potentially decreasing productivity and increasing costs. Improving processes for project initiation, assigning appropriate personnel, and tracking time-sensitive projects can eliminate bottlenecks and utilize resources more efficiently. In this case study, we describe our application of lean six sigma principles to our biostatistics unit to establish a systematic continual process improvement cycle for intake, allocation, and tracking of research design and data analysis projects. The define, measure, analyze, improve, and control methodology was used to guide the process improvement. Our goal was to assess and improve the efficiency and effectiveness of operations by objectively measuring outcomes, automating processes, and reducing bottlenecks. As a result, we developed a web-based dashboard application to capture, track, categorize, streamline, and automate project flow. Our workflow system resulted in improved transparency, efficiency, and workload allocation. Using the dashboard application, we reduced the average study intake time from 18 to 6 days, a 66.7% reduction over 12 months (January to December 2015).

  7. Pharmacokinetic assessment in patients receiving continuous RRT: perspectives from the Kidney Health Initiative.

    Science.gov (United States)

    Nolin, Thomas D; Aronoff, George R; Fissell, William H; Jain, Lokesh; Madabushi, Rajnikanth; Reynolds, Kellie; Zhang, Lei; Huang, Shiew Mei; Mehrotra, Rajnish; Flessner, Michael F; Leypoldt, John K; Witcher, Jennifer W; Zineh, Issam; Archdeacon, Patrick; Roy-Chaudhury, Prabir; Goldstein, Stuart L

    2015-01-07

    The effect of AKI and modern continuous RRT (CRRT) methods on drug disposition (pharmacokinetics) and response has been poorly studied. Pharmaceutical manufacturers have little incentive to perform pharmacokinetic studies in patients undergoing CRRT because such studies are neither recommended in existing US Food and Drug Administration (FDA) guidance documents nor required for new drug approval. Action is urgently needed to address the knowledge deficit. The Kidney Health Initiative has assembled a work group composed of clinicians and scientists representing academia, the FDA, and the pharmaceutical and dialysis industries with expertise related to pharmacokinetics, AKI, and/or CRRT. The work group critically evaluated key considerations in the assessment of pharmacokinetics and drug dosing in CRRT, practical constraints related to conducting pharmacokinetic studies in critically ill patients, and the generalizability of observations made in the context of specific CRRT prescriptions and specific patient populations in order to identify efficient study designs capable of addressing the knowledge deficit without impeding drug development. Considerations for the standardized assessment of pharmacokinetics and development of corresponding drug dosing recommendations in critically ill patients with AKI receiving CRRT are proposed. Copyright © 2015 by the American Society of Nephrology.

  8. Assessing the feasibility of eHealth and mHealth: a systematic review and analysis of initiatives implemented in Kenya.

    Science.gov (United States)

    Njoroge, Martin; Zurovac, Dejan; Ogara, Esther A A; Chuma, Jane; Kirigia, Doris

    2017-02-10

    The growth of Information and Communication Technology in Kenya has facilitated implementation of a large number of eHealth projects in a bid to cost-effectively address health and health system challenges. This systematic review aims to provide a situational analysis of eHealth initiatives being implemented in Kenya, including an assessment of the areas of focus and geographic distribution of the health projects. The search strategy involved peer and non-peer reviewed sources of relevant information relating to projects under implementation in Kenya. The projects were examined based on strategic area of implementation, health purpose and focus, geographic location, evaluation status and thematic area. A total of 114 citations comprising 69 eHealth projects fulfilled the inclusion criteria. The eHealth projects included 47 mHealth projects, 9 health information system projects, 8 eLearning projects and 5 telemedicine projects. In terms of projects geographical distribution, 24 were executed in Nairobi whilst 15 were designed to have a national coverage but only 3 were scaled up. In terms of health focus, 19 projects were mainly on primary care, 17 on HIV/AIDS and 11 on maternal and child health (MNCH). Only 8 projects were rigorously evaluated under randomized control trials. This review discovered that there is a myriad of eHealth projects being implemented in Kenya, mainly in the mHealth strategic area and focusing mostly on primary care and HIV/AIDs. Based on our analysis, most of the projects were rarely evaluated. In addition, few projects are implemented in marginalised areas and least urbanized counties with more health care needs, notwithstanding the fact that adoption of information and communication technology should aim to improve health equity (i.e. improve access to health care particularly in remote parts of the country in order to reduce geographical inequities) and contribute to overall health systems strengthening.

  9. Current and future initiatives for vascular health management in clinical practice

    Directory of Open Access Journals (Sweden)

    Cameron JD

    2013-05-01

    , or on drug combinations that target the various segments of the arterial system.3. Several blood pressure-independent mechanisms of large artery stiffness exist. Future considerations for clinical understanding of large artery stiffness should involve new drugs and new evaluation methods – with a focus on vascular health, for the initiation of cardiovascular prevention, for newly designed studies for treatment evaluation, and for new studies of drug combinations.4. Arterial stiffening is a sign of cardiovascular aging and is a major factor affecting the biomechanics of large arteries. Arterial stiffness is an attractive therapeutic target in terms of vascular aging. Healthy lifestyle, physical exercise, and smoking cessation are the most effective ways of preventing and treating early vascular aging. Long-term effects of cardiovascular drugs on arterial stiffness need to be further investigated.5. The emerging clinical data on the cardio ankle vascular index (CAVI technique of arterial health assessment is presented, showing that the CAVI is elevated in aging, coronary artery diseases, chronic kidney disease, hypertension, diabetes mellitus, smoking, and stress. The CAVI decreased with the administration of statins, angiotensin II receptor blocking agents, and calcium channel blockers. The CAVI is suggested as an important predictor of cardiovascular diseases.Future development of a clinical understanding of large artery stiffness is important and should include consideration of new drugs and new evaluation methods, with a focus on vascular health aimed at cardiovascular prevention.Keywords: arterial stiffness, cardiovascular protection, hypertension, arterial hemodynamic evaluation

  10. Federal Employees Health Benefits (FEHB) Program and Department of Defense (DoD) demonstration project. Office of Personnel Management. Final rule.

    Science.gov (United States)

    2000-06-02

    OPM is issuing a final regulation to implement the portion of the National Defense Authorization Act for 1999 that establishes authority for a demonstration project under which certain Medicare and other eligible DoD beneficiaries can enroll in health benefit plans in certain geographic areas under the Federal Employees Health Benefits (FEHB) Program. The demonstration project will run for a period of three years from January 1, 2000, through December 31, 2002. This regulation specifies only the requirements that differ from existing FEHB Program regulations because of unique aspects of the demonstration project.

  11. Deepening the impact of initiatives to promote teamwork and workplace health: a perspective from the NEKTA study.

    Science.gov (United States)

    Leiter, Michael P

    2007-01-01

    Evaluations of major policy initiatives on workplace health and teamwork have found significant progress on some issues and inertia on others. This article explores the applicability of a model describing employees' psychological relationships with work as a framework for considering workplace health initiatives. The Mediation Model contributes a way of focusing on experiences that are integral to staff nurses' day-to-day work life. As such, the model provides direction for developing and evaluating strategies for enhancing the quality of work life, especially pertaining to workplace health. The commentary considers a few key findings from the Nursing Environments: Knowledge to Action (NETKA) study that reviewed the applicability of national policy documents on the healthcare systems of Atlantic Canada. The discussion considers implications of staff nurses' participation in sharing and using new knowledge about workplace health.

  12. Initial experiences and innovations in supervising community health workers for maternal, newborn, and child health in Morogoro region, Tanzania

    OpenAIRE

    Roberton, Timothy; Applegate, Jennifer; LeFevre, Amnesty E.; Mosha, Idda; Cooper, Chelsea M; Silverman, Marissa; Feldhaus, Isabelle; Chebet, Joy J; Mpembeni, Rose; Semu, Helen; Killewo, Japhet; Winch, Peter; Baqui, Abdullah H.; George, Asha S.

    2015-01-01

    Abstract Background: Supervision is meant to improve the performance and motivation of community health workers (CHWs). However, most evidence on supervision relates to facility health workers. The Integrated Maternal, Newborn, and Child Health (MNCH) Program in Morogoro region, Tanzania, implemented a CHW pilot with a cascade supervision model where facility health workers were trained in supportive supervision for volunteer CHWs, supported by regional and district staff, and with village...

  13. Keeping health staff healthy: evaluation of a workplace initiative to reduce morbidity and mortality from HIV/AIDS in Malawi

    Directory of Open Access Journals (Sweden)

    Bemelmans Marielle

    2011-01-01

    Full Text Available Abstract Background In Malawi, the dramatic shortage of human resources for health is negatively impacted by HIV-related morbidity and mortality among health workers and their relatives. Many staff find it difficult to access HIV care through regular channels due to fear of stigma and discrimination. In 2006, two workplace initiatives were implemented in Thyolo District: a clinic at the district hospital dedicated to all district health staff and their first-degree relatives, providing medical services, including HIV care; and a support group for HIV-positive staff. Methods Using routine programme data, we evaluated the following outcomes up to the end of 2009: uptake and outcome of HIV testing and counselling among health staff and their dependents; uptake and outcomes of antiretroviral therapy (ART among health staff; and membership and activities of the support group. In addition, we included information from staff interviews and a job satisfaction survey to describe health workers' opinions of the initiatives. Results Almost two-thirds (91 of 144, 63% of health workers and their dependents undergoing HIV testing and counselling at the staff clinic tested HIV positive. Sixty-four health workers had accessed ART through the staff clinic, approximately the number of health workers estimated to be in need of ART. Of these, 60 had joined the support group. Cumulative ART outcomes were satisfactory, with more than 90% alive on treatment as of June 2009 (the end of the study observation period. The availability, confidentiality and quality of care in the staff clinic were considered adequate by beneficiaries. Conclusions Staff clinic and support group services successfully provided care and support to HIV-positive health workers. Similar initiatives should be considered in other settings with a high HIV prevalence.

  14. A National Initiative to Advance School Mental Health Performance Measurement in the US

    Science.gov (United States)

    Connors, Elizabeth Halsted; Stephan, Sharon Hoover; Lever, Nancy; Ereshefsky, Sabrina; Mosby, Amanda; Bohnenkamp, Jill

    2016-01-01

    Standardized health performance measurement has increasingly become an imperative for assuring quality standards in national health care systems. As compared to somatic health performance measures, behavioral health performance measures are less developed. There currently is no national standardized performance measurement system for monitoring…

  15. Mental health promotion initiatives for children and youth in contexts of poverty: the case of South Africa.

    Science.gov (United States)

    Petersen, Inge; Swartz, Leslie; Bhana, Arvin; Flisher, Alan J

    2010-09-01

    In order to achieve sustainable development and a consequent reduction in levels of poverty, a multisectoral response to development incorporating pro-poor economic policies in low- to middle-income countries (LMICs) is required. An important aspect is strengthening the human capital asset base of vulnerable populations. This should include the promotion of mental health, which can play an important role in breaking the intergenerational cycle of poverty and mental ill-health through promoting positive mental health outcomes within the context of risk. For each developmental phase of early childhood, middle childhood and adolescence, this article provides: (i) an overview of the critical risk influences and evidence of the role of mental health promotion initiatives in mediating these influences; (ii) a background to these risk influences in South Africa; and (iii) a review of mental health promotion initiatives addressing distal upstream influences at a macro-policy level in South Africa, as well as evidence-based micro- and community-level interventions that have the potential to be scaled up. From this review, strengths and gaps in existing micro- and community-level evidence-based mental health promotion interventions as well as macro-policy-level initiatives are identified, and recommendations made for South Africa that may also have applicability for other LMICs.

  16. Systemwide Initiative Documents Robust Health Screening for Adults With Intellectual Disability.

    Science.gov (United States)

    Brown, Marisa; Jacobstein, Diane; Yoon, Irene Seyoung; Anthony, Bruno; Bullock, Kim

    2016-10-01

    It is well documented that adults with intellectual disability (ID) experience higher rates of a series of health conditions compared to their peers without disability. These health conditions include cardiovascular disease, obesity, diabetes, gastrointestinal disorders, and psychiatric and behavioral disorders. With life expectancy approximating the general population, adults with ID are also now experiencing health conditions related to aging, further increasing their risk for diminished function and well-being. This increased morbidity poses new challenges in geriatric healthcare planning for this population. Relatively simple health prevention practices, such as the implementation of a health screening tool, can substantially increase disease detection and clinical activities directed toward improved health outcomes for people with ID. This study examines data collected from the District of Columbia Developmental Disabilities Administration's (DC DDA's) health screening component of its Health and Wellness Standards. Findings are presented, along with recommendations and implications for improving preventive health screening practices in the ID population.

  17. The social paediatrics initiative: a RICHER model of primary health care for at risk children and their families.

    Science.gov (United States)

    Wong, Sabrina T; Lynam, M Judith; Khan, Koushambhi B; Scott, Lorine; Loock, Christine

    2012-10-04

    The Responsive Interdisciplinary Child-Community Health Education and Research (RICHER) initiative is an intersectoral and interdisciplinary community outreach primary health care (PHC) model. It is being undertaken in partnership with community based organizations in order to address identified gaps in the continuum of health services delivery for 'at risk' children and their families. As part of a larger study, this paper reports on whether the RICHER initiative is associated with increased: 1) access to health care for children and families with multiple forms of disadvantage and 2) patient-reported empowerment. This study provides the first examination of a model of delivering PHC, using a Social Paediatrics approach. This was a mixed-methods study, using quantitative and qualitative approaches; it was undertaken in partnership with the community, both organizations and individual providers. Descriptive statistics, including logistic regression of patient survey data (n=86) and thematic analyses of patient interview data (n=7) were analyzed to examine the association between patient experiences with the RICHER initiative and parent-reported empowerment. Respondents found communication with the provider clear, that the provider explained any test results in a way they could understand, and that the provider was compassionate and respectful. Analysis of the survey and in-depth interview data provide evidence that interpersonal communication, particularly the provider's interpersonal style (e.g., being treated as an equal), was very important. Even after controlling for parents' education and ethnicity, the provider's interpersonal style remained positively associated with parent-reported empowerment (p<0.01). This model of PHC delivery is unique in its purposeful and required partnerships between health care providers and community members. This study provides beginning evidence that RICHER can better meet the health and health care needs of people, especially

  18. Statins and breast cancer stage and mortality in the Women’s Health Initiative

    Science.gov (United States)

    Desai, Pinkal; Lehman, Amy; Chlebowski, Rowan T.; Kwan, Marilyn L.; Arun, Monica; Manson, JoAnn E.; Lavasani, Sayeh; Wasswertheil-Smoller, Sylvia; Sarto, Gloria E.; LeBoff, Meryl; Cauley, Jane; Cote, Michele; Beebe-Dimmer, Jennifer; Jay, Allison

    2016-01-01

    Purpose To evaluate the association between statins and breast cancer stage and mortality in the Women’s Health Initiative. Methods The study population included 128,675 post-menopausal women aged 50–79 years, out of which there were 7,883 newly diagnosed cases of in situ (19 %), local (61 %)-, regional (19 %)- and distant (1 %)-stage breast cancer and 401 deaths due to breast cancer after an average of 11.5 (SD = 3.7) years of follow-up. Stage was coded using SEER criteria and was stratified into early (in situ and local)- versus late (regional and distant)-stage disease. Information on statins and other risk factors were collected by self- and interviewer-administered questionnaires. Cause of death was based on medical record review. Multivariable-adjusted hazards ratios (HR) and 95 % confidence intervals (CIs) evaluating the relationship between statin use (at baseline only and in a time-dependent manner) and diagnosis of late-stage breast cancer and breast cancer-specific mortality were computed from Cox proportional hazards analyses after adjusting for appropriate confounders. Results Statins were used by 10,474 women (8 %) at baseline. In the multivariable-adjusted time-dependent model, use of lipophilic statins was associated with a reduction in diagnosis of late-stage breast cancer (HR 0.80, 95 % CI 0.64–0.98, p = 0.035) which was also significant among women with estrogen receptor-positive disease (HR 0.72, 95 % CI 0.56–0.93, p = 0.012). Breast cancer mortality was marginally lower in statin users compared with nonusers (HR 0.59, 95 % CI 0.32–1.06, p = 0.075). Conclusions Prior statin use is associated with lower breast cancer stage at diagnosis. PMID:25736184

  19. Age at Time of Initial Sexual Intercourse and Health of Adolescent Girls.

    Science.gov (United States)

    Lara, Lúcia A S; Abdo, Carmita H N

    2016-10-01

    Adolescence is characterized by marked changes in the body, psychology, and sexual behavior due to increasing production of hormones. In this review we aimed to assess the effect of age at the time of first sexual intercourse (sexarche) on the health of adolescent girls, and identify factors that might protect against early initiation of sexual relations in girls. The PubMed, Lilacs, and Google Scholar databases were searched for clinical trials, comparative studies, case-control studies, cross-sectional studies, cohort studies, multicenter studies, observational studies, meta-analyses, and systematic reviews published up to December 2014 on this theme. The search terms were: "sexual debut," "coitarche," "sexarche," and "young people," "adolescent," "unplanned pregnancy," "adolescent contraception," and "STDs." Data were extracted from 28 studies and 41 references were used to introduce the theme and to support the discussion. Sexarche has been occurring in increasingly younger girls. A young age at sexarche can lead to subsequent risky sexual behavior. Girls who have sexarche when they are 14 years old or younger are less likely to use contraception on this occasion, take more time before they start using contraception in subsequent sexual relations, are more likely to have several sex partners, have a higher risk for depression, have lower self-esteem and more episodes of repentance, and have a higher risk for a sexually transmitted disease and cervical cancer. Girls with low educational, socioeconomic, and cultural status, little parental monitoring, parental separation, and absence of religiosity tend to experience sexarche at a younger age. Adolescent girls who postpone sexarche until they are 16 years old are physically and psychologically healthier than those who have sexarche at a younger age. This suggests that providing adolescent girls with appropriate education about sexual relations might reduce the negative effect of sexual relations at a young age.

  20. Association between Dietary Energy Density and Incident Type 2 Diabetes in the Women's Health Initiative.

    Science.gov (United States)

    Hingle, Melanie D; Wertheim, Betsy C; Neuhouser, Marian L; Tinker, Lesley F; Howard, Barbara V; Johnson, Karen; Liu, Simin; Phillips, Lawrence S; Qi, Lihong; Sarto, Gloria; Turner, Tami; Waring, Molly E; Thomson, Cynthia A

    2017-05-01

    Dietary energy density, or energy available in relation to gram intake, can inform disease risk. The objective of this study was to investigate the association between baseline dietary energy density and risk of incident type 2 diabetes in postmenopausal women. Dietary energy density, weight status, and type 2 diabetes incidence were prospectively characterized in a large cohort of postmenopausal women participating in one or more clinical trials or an observational study. The study involved 161,808 postmenopausal women recruited to the Women's Health Initiative observational study or clinical trials at 40 centers across the United States between 1993 and 1998. The primary outcome was incident type 2 diabetes. The association between dietary energy density quintiles and incident diabetes was tested using Cox proportional hazards regression. A total of 143,204 participants without self-reported diabetes at enrollment completed baseline dietary assessment and were followed for 12.7±4.6 years. Risk of diabetes developing was 24% greater for women in the highest dietary energy density quintile compared with the lowest after adjusting for confounders (95% CI 1.17 to 1.32). Body mass index (calculated as kg/m(2)) and waist circumference mediated the relationship between dietary energy density and diabetes. In waist circumference-stratified analysis, women in dietary energy density quintiles 2 to 5 with waist circumferences >88 cm were at 9% to 12% greater risk of diabetes developing compared with women with waist circumference ≤88 cm. In this prospective study, a higher baseline dietary energy density was associated with higher incidence of type 2 diabetes among postmenopausal women, both overall, and in women with elevated waist circumference. Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  1. Genome-wide association and admixture analysis of glaucoma in the Women's Health Initiative.

    Science.gov (United States)

    Hoffmann, Thomas J; Tang, Hua; Thornton, Timothy A; Caan, Bette; Haan, Mary; Millen, Amy E; Thomas, Fridtjof; Risch, Neil

    2014-12-15

    We report a genome-wide association study (GWAS) and admixture analysis of glaucoma in 12 008 African-American and Hispanic women (age 50-79 years) from the Women's Health Initiative (WHI). Although GWAS of glaucoma have been conducted on several populations, this is the first to look at glaucoma in individuals of African-American and Hispanic race/ethnicity. Prevalent and incident glaucoma was determined by self-report from study questionnaires administered at baseline (1993-1998) and annually through 2005. For African Americans, there was a total of 658 prevalent cases, 1062 incident cases and 6067 individuals who never progressed to glaucoma. For our replication cohort, we used the WHI Hispanics, including 153 prevalent cases, 336 incident cases and 2685 non-cases. We found an association of African ancestry with glaucoma incidence in African Americans (hazards ratio 1.62, 95% CI 1.023-2.56, P = 0.038) and in Hispanics (hazards ratio 3.21, 95% CI 1.32-7.80, P = 0.011). Although we found that no previously identified glaucoma SNPs replicated in either the WHI African Americans or Hispanics, a risk score combining all previously reported hits was significant in African-American prevalent cases (P = 0.0046), and was in the expected direction in the incident cases, as well as in the Hispanic incident cases. Additionally, after imputing to 1000 Genomes, two less common independent SNPs were suggestive in African Americans, but had too low of an allele frequency in Hispanics to test for replication. These results suggest the possibility of a distinct genetic architecture underlying glaucoma in individuals of African ancestry.

  2. No Increase in Fractures After Stopping Hormone Therapy: Results From the Women's Health Initiative.

    Science.gov (United States)

    Watts, Nelson B; Cauley, Jane A; Jackson, Rebecca D; LaCroix, Andrea Z; Lewis, Cora E; Manson, JoAnn E; Neuner, Joan M; Phillips, Lawrence S; Stefanick, Marcia L; Wactawski-Wende, Jean; Crandall, Carolyn

    2017-01-01

    The Women's Health Initiative (WHI) hormone therapy (HT) trials showed protection against hip and total fractures, but a later observational report suggested loss of benefit and a rebound increased risk after cessation of HT. The purpose of this study was to examine fractures after discontinuation of HT. Two placebo-controlled randomized trials served as the study setting. Study patients included WHI participants (N = 15,187) who continued active HT or placebo through the intervention period and who did not take HT in the postintervention period. Trial interventions included conjugated equine estrogen (CEE) plus medroxyprogesterone acetate (MPA) in naturally menopausal women and CEE alone in women with prior hysterectomy. Total fractures and hip fractures through 5 years after discontinuation of HT were recorded. Hip fractures were infrequent (∼2.5 per 1000 person-years); this finding was similar between trials and in former HT and placebo groups. There was no difference in total fractures in the CEE + MPA trial for former HT vs former placebo users (28.9 per 1000 person-years and 29.9 per 1000 person-years, respectively; hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.87 to 1.09; P = 0.63); however, in the CEE-alone trial, total fractures were higher in former placebo users (36.9 per 1000 person-years) compared with the former active group (31.1 per 1000 person-years), a finding that was suggestive of a residual benefit of CEE against total fractures (HR, 0.85; 95% CI, 0.73 to 0.98; P = 0.03). We found no evidence for increased fracture risk, either sustained or transient, for former HT users compared with former placebo users after stopping HT. There was residual benefit for total fractures in former HT users from the CEE-alone study.

  3. High glycemic index diet as a risk factor for depression: analyses from the Women's Health Initiative.

    Science.gov (United States)

    Gangwisch, James E; Hale, Lauren; Garcia, Lorena; Malaspina, Dolores; Opler, Mark G; Payne, Martha E; Rossom, Rebecca C; Lane, Dorothy

    2015-08-01

    The consumption of sweetened beverages, refined foods, and pastries has been shown to be associated with an increased risk of depression in longitudinal studies. However, any influence that refined carbohydrates has on mood could be commensurate with their proportion in the overall diet; studies are therefore needed that measure overall intakes of carbohydrate and sugar, glycemic index (GI), and glycemic load. We hypothesized that higher dietary GI and glycemic load would be associated with greater odds of the prevalence and incidence of depression. This was a prospective cohort study to investigate the relations between dietary GI, glycemic load, and other carbohydrate measures (added sugars, total sugars, glucose, sucrose, lactose, fructose, starch, carbohydrate) and depression in postmenopausal women who participated in the Women's Health Initiative Observational Study at baseline between 1994 and 1998 (n = 87,618) and at the 3-y follow-up (n = 69,954). We found a progressively higher dietary GI to be associated with increasing odds of incident depression in fully adjusted models (OR for the fifth compared with first quintile: 1.22; 95% CI: 1.09, 1.37), with the trend being statistically significant (P = 0.0032). Progressively higher consumption of dietary added sugars was also associated with increasing odds of incident depression (OR for the fifth compared with first quintile: 1.23; 95% CI: 1.07, 1.41; P-trend = 0.0029). Higher consumption of lactose, fiber, nonjuice fruit, and vegetables was significantly associated with lower odds of incident depression, and nonwhole/refined grain consumption was associated with increased odds of depression. The results from this study suggest that high-GI diets could be a risk factor for depression in postmenopausal women. Randomized trials should be undertaken to examine the question of whether diets rich in low-GI foods could serve as treatments and primary preventive measures for depression in postmenopausal women.

  4. Red Blood Cell Fatty Acids and Incident Diabetes Mellitus in the Women's Health Initiative Memory Study.

    Directory of Open Access Journals (Sweden)

    William S Harris

    Full Text Available The relations between dietary and/or circulating levels of fatty acids and the development of type 2 diabetes is unclear. Protective associations with the marine omega-3 fatty acids and linoleic acid, and with a marker of fatty acid desaturase activity delta-5 desaturase (D5D ratio have been reported, as have adverse relations with saturated fatty acids and D6D ratio.To determine the associations between red blood cell (RBC fatty acid distributions and incident type 2 diabetes.Prospective observational cohort study nested in the Women's Health Initiative Memory Study.General population.Postmenopausal women.Self-reported incident type 2 diabetes.There were 703 new cases of type 2 diabetes over 11 years of follow up among 6379 postmenopausal women. In the fully adjusted models, baseline RBC D5D ratio was inversely associated with incident type 2 diabetes [Hazard Ratio (HR 0.88, 95% confidence interval (CI 0.81-0.95 per 1 SD increase. Similarly, baseline RBC D6D ratio and palmitic acid were directly associated with incident type 2 diabetes (HR 1.14, 95% CI 1.04-1.25; and HR 1.24, 95% CI 1.14-1.35, respectively. None of these relations were materially altered by excluding incident cases in the first two years of follow-up. There were no significant relations with eicosapentaenoic, docosahexaenoic or linoleic acids.Whether altered fatty acid desaturase activities or palmitic acid levels are causally related to the development of type 2 diabetes cannot be determined from this study, but our findings suggest that proportions of certain fatty acids in RBC membranes are associated with risk for type 2 diabetes.

  5. Changing organizational culture: using the CEO cancer gold standard policy initiatives to promote health and wellness at a school of public health.

    Science.gov (United States)

    Towne, Samuel D; Anderson, Kelsey E; Smith, Matthew Lee; Dahlke, Deborah Vollmer; Kellstedt, Debra; Purcell, Ninfa Pena; Ory, Marcia G

    2015-09-03

    Worksite wellness initiatives for health promotion and health education have demonstrated effectiveness in improving employee health and wellness. We examined the effects of a multifaceted health promotion campaign on organizational capacity to meet requirements to become CEO Cancer Gold Standard Accredited. We conducted an online survey to assess perceived organizational values and support for the five CEO Cancer Gold Standard Pillars for cancer prevention: tobacco cessation; physical activity; nutrition; cancer screening and early detection; and accessing information on cancer clinical trials. Baseline and follow-up surveys were sent 6-months apart to faculty, staff, and students at a school of public health to test the impact of a multifaceted health promotion campaign on perceived organizational change. Descriptive analyses were used to characterize percent improvement. Multivariate logistic regression analyses were used to control for participants' university status. The current organizational culture highly supported tobacco cessation at both time points. Significant improvements (p < .05) from baseline to follow-up were observed for questions measuring organizational values for 'prevention, screening, and early detection of cancer' and 'accessing cancer treatment and clinical trials'. Health promotion and education efforts using multiple approaches were effective to improve perceived organizational values and support for cancer prevention and early detection, and increase access to information about cancer clinical trials. Future studies are needed to examine broader impacts of implementing worksite health promotion initiatives.

  6. Development and initial evaluation of blended cognitive behavioural treatment for major depression in routine specialized mental health care

    DEFF Research Database (Denmark)

    Kooistra, L. C.; Ruwaard, J.; Wiersma, J. E.

    2016-01-01

    the costs of mental health care, by reducing treatment duration and/or therapist contact. However, knowledge on blended care for depression is still limited. Objectives: To develop a blended cognitive behavioural treatment (bCBT) for depressed patients in an outpatient specialized mental health care centre...... and to conduct a preliminary evaluation of this bCBT protocol. Method: A bCBT protocol was developed, taking recommendations into account from depressed patients (n = 3) and therapists and experts in the field of e-health (n = 18). Next, an initial evaluation of integrated high-intensive bCBT was conducted...

  7. 76 FR 38282 - Federal Employees Health Benefits Program: New Premium Rating Method for Most Community Rated Plans

    Science.gov (United States)

    2011-06-29

    ... ensure the Government and Federal employees are receiving a fair market rate and a good value for their.... Instead of the SSSG comparison, there will be a separate settlement with OPM after the end of the plan... (b)(5) as follows: Sec. 1652.216-70 Accounting and price adjustment. * * * * * (b) * * * (2)...

  8. 75 FR 63159 - Federal Advisory Committee; Board of Regents of the Uniformed Services University of the Health...

    Science.gov (United States)

    2010-10-14

    ... CONTACT: Janet S. Taylor, Designated Federal Officer, 4301 Jones Bridge Road, Bethesda, Maryland 20814; telephone 301-295-3066. Ms. Taylor can also provide base access procedures. SUPPLEMENTARY INFORMATION: Purpose of the Meeting Meetings of the Board of Regents assure that USU operates in the best traditions of...

  9. 75 FR 18166 - Federal Advisory Committee; Board of Regents of the Uniformed Services University of the Health...

    Science.gov (United States)

    2010-04-09

    ... 20814. FOR FURTHER INFORMATION CONTACT: Janet S. Taylor, Designated Federal Official, 4301 Jones Bridge Road, Bethesda, Maryland 20814; telephone 301-295-3066. Ms. Taylor can also provide base access... USU operates in the best traditions of academia. An outside Board is necessary for institutional...

  10. Fasting plasma glucose as initial screening for diabetes and prediabetes in irish adults: The Diabetes Mellitus and Vascular health initiative (DMVhi.

    Directory of Open Access Journals (Sweden)

    Margaret Sinnott

    Full Text Available Type 2 diabetes has a long pre clinical asymptomatic phase. Early detection may delay or arrest disease progression. The Diabetes Mellitus and Vascular health initiative (DMVhi was initiated as a prospective longitudinal cohort study on the prevalence of undiagnosed Type 2 diabetes and prediabetes, diabetes risk and cardiovascular risk in a cohort of Irish adults aged 45-75 years.Members of the largest Irish private health insurance provider aged 45 to 75 years were invited to participate in the study.already diagnosed with diabetes or taking oral hypoglycaemic agents. Participants completed a detailed medical questionnaire, had weight, height, waist and hip circumference and blood pressure measured. Fasting blood samples were taken for fasting plasma glucose (FPG. Those with FPG in the impaired fasting glucose (IFG range had a 75gm oral glucose tolerance test performed.122,531 subjects were invited to participate. 29,144 (24% completed the study. The prevalence of undiagnosed diabetes was 1.8%, of impaired fasting glucose (IFG was 7.1% and of impaired glucose tolerance (IGT was 2.9%. Dysglycaemia increased among those aged 45-54, 55-64 and 65-75 years in both males (10.6%, 18.5%, 21.7% respectively and females (4.3%, 8.6%, 10.9% respectively. Undiagnosed T2D, IFG and IGT were all associated with gender, age, blood pressure, BMI, abdominal obesity, family history of diabetes and triglyceride levels. Using FPG as initial screening may underestimate the prevalence of T2D in the study population.This study is the largest screening study for diabetes and prediabetes in the Irish population. Follow up of this cohort will provide data on progression to diabetes and on cardiovascular outcomes.

  11. Fasting Plasma Glucose as Initial Screening for Diabetes and Prediabetes in Irish Adults: The Diabetes Mellitus and Vascular Health Initiative (DMVhi)

    Science.gov (United States)

    Sinnott, Margaret; Kinsley, Brendan T.; Jackson, Abaigeal D.; Walsh, Cathal; O’Grady, Tony; Nolan, John J.; Gaffney, Peter; Boran, Gerard; Kelleher, Cecily; Carr, Bernadette

    2015-01-01

    Objective Type 2 diabetes has a long pre clinical asymptomatic phase. Early detection may delay or arrest disease progression. The Diabetes Mellitus and Vascular health initiative (DMVhi) was initiated as a prospective longitudinal cohort study on the prevalence of undiagnosed Type 2 diabetes and prediabetes, diabetes risk and cardiovascular risk in a cohort of Irish adults aged 45-75 years. Research Design and Methods Members of the largest Irish private health insurance provider aged 45 to 75 years were invited to participate in the study. Exclusion criteria: already diagnosed with diabetes or taking oral hypoglycaemic agents. Participants completed a detailed medical questionnaire, had weight, height, waist and hip circumference and blood pressure measured. Fasting blood samples were taken for fasting plasma glucose (FPG). Those with FPG in the impaired fasting glucose (IFG) range had a 75gm oral glucose tolerance test performed. Results 122,531 subjects were invited to participate. 29,144 (24%) completed the study. The prevalence of undiagnosed diabetes was 1.8%, of impaired fasting glucose (IFG) was 7.1% and of impaired glucose tolerance (IGT) was 2.9%. Dysglycaemia increased among those aged 45-54, 55-64 and 65-75 years in both males (10.6%, 18.5%, 21.7% respectively) and females (4.3%, 8.6%, 10.9% respectively). Undiagnosed T2D, IFG and IGT were all associated with gender, age, blood pressure, BMI, abdominal obesity, family history of diabetes and triglyceride levels. Using FPG as initial screening may underestimate the prevalence of T2D in the study population. Conclusions This study is the largest screening study for diabetes and prediabetes in the Irish population. Follow up of this cohort will provide data on progression to diabetes and on cardiovascular outcomes. PMID:25874867

  12. 5 CFR 630.212 - Use of annual leave to establish initial eligibility for retirement or continuation of health...

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Use of annual leave to establish initial eligibility for retirement or continuation of health benefits. 630.212 Section 630.212 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS ABSENCE AND LEAVE Definitions and General...

  13. Self-Efficacy, Risk-Taking Behavior and Mental Health as Predictors of Personal Growth Initiative among University Undergraduates

    Science.gov (United States)

    Ogunyemi, Ajibola O.; Mabekoje, Sesan Ola

    2007-01-01

    Introduction: This study sought to determine the combined and relative efficacy of self-efficacy, risk-taking behaviour and mental health on personal growth initiative of university undergraduates. Method: The expo-facto research design was used to conduct the study. Stratified random sampling technique was used to select 425 participants from 6…

  14. Sustainable Professional Learning for Early Childhood Educators: Lessons from an Australia-Wide Mental Health Promotion Initiative

    Science.gov (United States)

    Askell-Williams, Helen; Murray-Harvey, Rosalind

    2016-01-01

    New policy initiatives, such as those concerned with promoting young children's positive mental health, highlight the need for good quality professional education in the early childhood education and care sector. However, although a wealth of literature exists from the school sector, little is known about professional education in early childhood…

  15. Dietary Patterns Predict Subsequent Coronary Heart Disease Risk In Postmenopausal Women : The Women’s Health Initiative Observational Cohort Study

    Science.gov (United States)

    Background: Evidence suggests that dietary patterns predispose to the development of coronary heart disease (CHD). The relationship between dietary patterns and CHD risk was assessed in postmenopausal women participating in the Women’s Health Initiative Observational Study (WHI-OS). Methods: Case-co...

  16. Governance of extended lifecycle in large-scale eHealth initiatives: analyzing variability of enterprise architecture elements.

    Science.gov (United States)

    Mykkänen, Juha; Virkanen, Hannu; Tuomainen, Mika

    2013-01-01

    The governance of large eHealth initiatives requires traceability of many requirements and design decisions. We provide a model which we use to conceptually analyze variability of several enterprise architecture (EA) elements throughout the extended lifecycle of development goals using interrelated projects related to the national ePrescription in Finland.

  17. Under the (legal) radar screen: global health initiatives and international human rights obligations

    National Research Council Canada - National Science Library

    Hammonds, Rachel; Ooms, Gorik; Vandenhole, Wouter

    2012-01-01

    Given that many low income countries are heavily reliant on external assistance to fund their health sectors the acceptance of obligations of international assistance and cooperation with regard to the right to health...

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

    Science.gov (United States)

    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…

  19. Interorganizational health care systems implementations: an exploratory study of early electronic commerce initiatives.

    Science.gov (United States)

    Payton, F C; Ginzberg, M J

    2001-01-01

    Changing business practices, customers needs, and market dynamics have driven many organizations to implement interorganizational systems (IOSs). IOSs have been successfully implemented in the banking, cotton, airline, and consumer-goods industries, and recently attention has turned to the health care industry. This article describes an exploratory study of health care IOS implementations based on the voluntary community health information network (CHIN) model.

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

    Science.gov (United States)

    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…

  1. China-Africa Health Development Initiatives: Benefits and Implications for Shaping Innovative and Evidence-informed National Health Policies and Programs in Sub-saharan African Countries

    Science.gov (United States)

    Tambo, Ernest; Ugwu, Chidiebere E.; Guan, Yayi; Wei, Ding; Xiao-Ning; Xiao-Nong, Zhou

    2016-01-01

    Background and Introduction: This review paper examines the growing implications of China’s engagement in shaping innovative national initiatives against infectious diseases and poverty control and elimination in African countries. It seeks to understand the factors and enhancers that can promote mutual and innovative health development initiatives, and those that are necessary in generating reliable and quality data for evidence-based contextual policy, priorities and programs. Methods: We examined the China-Africa health cooperation in supporting global health agenda on infectious diseases such as malaria, schistosomiasis, Ebola, TB, HIV/AIDS, neglected tropical diseases (NTDs) prevention, control and elimination spanning a period of 10 years. We reviewed referenced publications, global support data, and extensive sources related to and other emerging epidemics and infectious diseases of poverty, programs and interventions, health systems development issues, challenges, opportunities and investments. Published literature in PubMed, Scopus, Google Scholar, Books and web-based peer-reviewed journal articles, government annual reports were assessed from the first Forum on China-Africa Cooperation (FOCAC) in November 2006 to December 2015 Third Ministerial conferences. Results: Our findings highlight current shared public health challenges and emphasize the need to nurture, develop and establish effective, functional and sustainable health systems capacity to detect and respond to all public health threats and epidemic burdens, evidence-based programs and quality care outcomes. China’s significant health diplomacy emphasizes the importance of health financing in establishing health development commitment and investment in improving the gains and opportunities, importantly efficiency and value health priorities and planning. Conclusions and Global Health Implications: Strengthening China-Africa health development agenda towards collective commitment and investment

  2. Public health, medicine, and dentistry as partners in community health: a pioneering initiative in interprofessional, practice-based education.

    Science.gov (United States)

    McCloskey, Lois; Condon, Rebecca; Shanahan, Christopher W; Wolff, James; Culler, Corinna; Kalish, Richard

    2011-01-01

    As public health challenges grow more complex, the call for professional education to be interprofessional, collaborative, and grounded in real world practice has intensified. In this article, we describe the development, implementation, and results of one pioneering course at Boston University that aims to prepare public health, medical, and dental students for their combined roles in community health settings. The Schools of Public Health, Medicine, and Dental Medicine jointly offered the course in partnership with 3 community organizations. Participants include MPH, MD, and DMD candidates. The course design integrates the use of "The Challenge Model" (created by Management Sciences for Health) with training in public health consultation techniques (eg, community-based participatory research, logic models, monitoring and evaluation). Teams of 6 to 8 medical and public health students collaborate with managers and staff of a community health center to address 1 organizational challenge and recommend a sustainability plan. Postcourse evaluations revealed that a cross-disciplinary, practice-based education model is feasible and can meet students' learning objectives and exceed expectations of community partners. We overcame formidable obstacles related to the "silo'ed" nature of academic institutions and the competing priorities within overburdened community organizations. We found that sustained project implementation was attained at some but not all sites, yet all sites highly valued the perspective and contribution of student teams. Dynamic and replicable, this practice-based education model is adaptable to professional schools whose work intersects in the real world and calls for collaborative leadership.

  3. Initial results from the European Network of Health Promoting Schools program on development of health education in Finland.

    Science.gov (United States)

    Turunen, H; Tossavainen, K; Jakonen, S; Salomäki, U; Vertio, H

    1999-12-01

    The European Network of Health Promoting School (ENHPS) program aims to foster healthy lifestyles for school populations by developing supportive teaching and learning environments conducive to promotion of health. Most European countries have joined the network since its organization in 1993. This paper describes how the European, national, and local aims of the ENHPS program have been realized in Finnish schools during the first year of the second triennium (1997-1999). Substantial development related to health promotion has occurred in the Finnish ENHPS schools. A safe school environment was emphasized, and networking with other schools was encouraged at the international and national levels. Attitudes toward the ENHPS program generally were positive. However, Finnish schools have emphasized developing "structures" for health promotion. In the future, efforts should concentrate on students' active participation in the activities of health promotion in everyday teaching and learning situations.

  4. Health care provider attitudes and beliefs about people living with HIV: Initial validation of the Health Care Provider HIV/AIDS Stigma Scale (HPASS).

    Science.gov (United States)

    Wagner, Anne C; Hart, Trevor A; McShane, Kelly E; Margolese, Shari; Girard, Todd A

    2014-12-01

    HIV stigma is a pressing concern for people living with HIV, and particularly when it is perpetuated by health care providers, as it may affect quality of life and access to health care services. The current study describes the development and initial validation of a contextually appropriate HIV stigma scale for health care providers in North America. A ground-up qualitative approach was used to develop the scale, and it was assessed psychometrically with health care trainees across Canada. The measure demonstrates excellent internal consistency reliability and test-retest reliability, as well as convergent and divergent validity. The study supports a tripartite model of HIV stigma consisting of stereotyping, prejudice and discrimination. The scale provides a new tool to assess HIV stigma in health care providers and can be used to inform training, intervention and self-evaluation of stigmatizing attitudes, beliefs and behaviors among providers.

  5. Making Sense of “Consumer Engagement” Initiatives to Improve Health and Health Care: A Conceptual Framework to Guide Policy and Practice

    Science.gov (United States)

    Mittler, Jessica N; Martsolf, Grant R; Telenko, Shannon J; Scanlon, Dennis P

    2013-01-01

    Context Policymakers and practitioners continue to pursue initiatives designed to engage individuals in their health and health care despite discordant views and mixed evidence regarding the ability to cultivate greater individual engagement that improves Americans’ health and well-being and helps manage health care costs. There is limited and mixed evidence regarding the value of different interventions. Methods Based on our involvement in evaluating various community-based consumer engagement initiatives and a targeted literature review of models of behavior change, we identified the need for a framework to classify the universe of consumer engagement initiatives toward advancing policymakers' and practitioners' knowledge of their value and fit in various contexts. We developed a framework that expanded our conceptualization of consumer engagement, building on elements of two common models, the individually focused transtheoretical model of behavior and the broader, multilevel social ecological model. Finally, we applied this framework to one community's existing consumer engagement program. Findings Consumer engagement in health and health care refers to the performance of specific behaviors (“engaged behaviors”) and/or an individual's capacity and motivation to perform these behaviors (“activation”). These two dimensions are related but distinct and thus should be differentiated. The framework creates four classification schemas, by (1) targeted behavior types (self-management, health care encounter, shopping, and health behaviors) and by (2) individual, (3) group, and (4) community dimensions. Our example illustrates that the framework can systematically classify a variety of consumer engagement programs, and that this exercise and resulting characterization can provide a structured way to consider the program and how its components fit program goals both individually and collectively. Conclusions Applying the framework could help advance the field

  6. Developing the protocol for the evaluation of the health foundation's 'engaging with quality initiative' - an emergent approach.

    Science.gov (United States)

    Soper, Bryony; Buxton, Martin; Hanney, Stephen; Oortwijn, Wija; Scoggins, Amanda; Steel, Nick; Ling, Tom

    2008-10-30

    In 2004 a UK charity, The Health Foundation, established the 'Engaging with Quality Initiative' to explore and evaluate the benefits of engaging clinicians in quality improvement in healthcare. Eight projects run by professional bodies or specialist societies were commissioned in various areas of acute care. A developmental approach to the initiative was adopted, accompanied by a two level evaluation: eight project self-evaluations and a related external evaluation. This paper describes how the protocol for the external evaluation was developed. The challenges faced included large variation between and within the projects (in approach, scope and context, and in understanding of quality improvement), the need to support the project teams in their self-evaluations while retaining a necessary objectivity, and the difficulty of evaluating the moving target created by the developmental approach adopted in the initiative. An initial period to develop the evaluation protocol proved invaluable in helping us to explore these issues.

  7. Developing the protocol for the evaluation of the health foundation's 'engaging with quality initiative' – an emergent approach

    Directory of Open Access Journals (Sweden)

    Scoggins Amanda

    2008-10-01

    Full Text Available Abstract In 2004 a UK charity, The Health Foundation, established the 'Engaging with Quality Initiative' to explore and evaluate the benefits of engaging clinicians in quality improvement in healthcare. Eight projects run by professional bodies or specialist societies were commissioned in various areas of acute care. A developmental approach to the initiative was adopted, accompanied by a two level evaluation: eight project self-evaluations and a related external evaluation. This paper describes how the protocol for the external evaluation was developed. The challenges faced included large variation between and within the projects (in approach, scope and context, and in understanding of quality improvement, the need to support the project teams in their self-evaluations while retaining a necessary objectivity, and the difficulty of evaluating the moving target created by the developmental approach adopted in the initiative. An initial period to develop the evaluation protocol proved invaluable in helping us to explore these issues.

  8. Initial community perspectives on the Health Service Extension Programme in Welkait, Ethiopia

    Directory of Open Access Journals (Sweden)

    McAuliffe Eilish

    2007-08-01

    Full Text Available Abstract Background The Health Service Extension Programme (HSEP is an innovative approach to addressing the shortfall in health human resources in Ethiopia. It has developed a new cadre of Health Extension Workers (HEWs, who are charged with providing the health and hygiene promotion and some treatment services, which together constitute the bedrock of Ethiopia's community health system. Methods This study seeks to explore the experience of the HSEP from the perspective of the community who received the service. A random sample of 60 female heads-of-household in a remote area of Tigray participated in a structured interview survey. Results Although Health Extension Workers (HEWs had visited them less frequently than planned, participants generally found the programme to be helpful. Despite this, their basic health knowledge was still quite poor regarding the major communicable diseases and their vectors. Participants felt the new HESP represented an improvement on previous health provision. HEWs were preferred over Traditional Birth Attendants for assistance with labour Conclusion While the introduction of HEWs has been a positive experience for women living at the study site, the frequency of visits, extent of effectively imparted health knowledge and affects of HEWs on other health providers needs to be further explored.

  9. Acceptability of Mental Health Stigma-Reduction Training and Initial Effects on Awareness Among Military Personnel

    Science.gov (United States)

    2015-10-13

    Hurtado et al. SpringerPlus (2015) 4:606 DOI 10.1186/s40064-015-1402-z RESEARCH Acceptability of  mental health stigma -reduction training and...purpose of this paper is to report on the development of a mental health stigma reduction toolkit and training, and the acceptability and level of stigma ...the usefulness and helpfulness of the training among other factors, and stigma awareness was measured with 10 items about mental health stigma . The

  10. 75 FR 3237 - Proposed Collection; Comment Request; Women's Health Initiative Observational Study

    Science.gov (United States)

    2010-01-20

    .... Dated: January 4, 2010. Michael S. Lauer, Director, Division of Cardiovascular Science, NHLBI, National Institutes of Health. Dated: January 6, 2010. Suzanne Freeman, Chief, FOIA, NHLBI, National Institutes...

  11. Labour market initiatives: potential settings for improving the health of people who are unemployed.

    Science.gov (United States)

    Harris, Elizabeth; Rose, Vanessa; Ritchie, Jan; Harris, Neil

    2009-12-01

    Unemployment is detrimental to health. The Unemployment and Health Project in South Western Sydney sought to work with labour market programs to improve the health, particularly, mental health, of unemployed people. This paper describes the experiences of the Project. Phase one commenced in 1995 and involved consultation with the majority of Skillshares (labour market programs under the Labor government) in south-western Sydney to identify potential areas of action. Phase two commenced in 1998 and involved the development of a brief cognitive behaviour therapy intervention that was delivered in Job Network Settings (the next generation of labour market programs under the Liberal government). The cognitive behaviour therapy intervention has been successful in improving mental health in five small scale trials but the intervention has proved difficult to scale up and evaluate comprehensively. Generating more general interest in improving the health of unemployed people through the Job Network has also been difficult. This is related to different understanding and valuing of evidence, a highly volatile context, lack of shared core business by the health and employment sectors, and the changing nature of work in Australia. There are theoretical and practical reasons why it is difficult for labour market programs to be a setting for improving the health of unemployed people. However, the reach of labour market programs into the high risk groups warrants more attention by mental health promotion programs.

  12. Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.

    Science.gov (United States)

    Chung, Sukyung; Zhao, Beinan; Lauderdale, Diane; Linde, Randolph; Stafford, Randall; Palaniappan, Latha

    2015-02-01

    We examined patterns and predictors of initiation of treatment for incident diabetes in an ambulatory care setting in the US. Data were extracted from electronic health records (EHR) for active patients ≥ 35 years in a multispecialty, multiclinic ambulatory care organization with 1000 providers. New onset type 2 diabetes and subsequent treatment were identified using lab, diagnosis, medication prescription, and service use data. Time from the first evidence of diabetes until initial treatment, either medication or education/counseling, was examined using a Kaplan-Meier hazards curve. Potential predictors of initial treatment were examined using multinomial logistic models accounting for physician random effects. Of 2258 patients with incident diabetes, 55% received either medication or education/counseling (20% received both) during the first year. Of the treated patients, 68% received a treatment within the first four weeks, and 13% after initial 16 weeks. Strong positive predictors (P health care system, incident diabetes is treated only half the time. Improved algorithms for identifying incident diabetes from the EHR and team approach for monitoring may help treatment initiation. Copyright © 2014 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  13. Integrating systematic screening for gender-based violence into sexual and reproductive health services: results of a baseline study by the International Planned Parenthood Federation, Western Hemisphere Region.

    Science.gov (United States)

    Guedes, A; Bott, S; Cuca, Y

    2002-09-01

    Three Latin American affiliates of the International Planned Parenthood Federation, Western Hemisphere Region, Inc. (IPPF/WHR) have begun to integrate gender-based violence screening and services into sexual and reproductive health programs. This paper presents results of a baseline study conducted in the affiliates. Although most staff support integration and many had already begun to address violence in their work, additional sensitization and training, as well as institution-wide changes are needed to provide services effectively and to address needs of women experiencing violence.

  14. Quality Improvement Initiative in School-Based Health Centers across New Mexico

    Science.gov (United States)

    Booker, John M.; Schluter, Janette A.; Carrillo, Kris; McGrath, Jane

    2011-01-01

    Background: Quality improvement principles have been applied extensively to health care organizations, but implementation of quality improvement methods in school-based health centers (SBHCs) remains in a developmental stage with demonstration projects under way in individual states and nationally. Rural areas, such as New Mexico, benefit from the…

  15. Lessons learned from a community-academic initiative: the development of a core competency-based training for community-academic initiative community health workers.

    Science.gov (United States)

    Ruiz, Yumary; Matos, Sergio; Kapadia, Smiti; Islam, Nadia; Cusack, Arthur; Kwong, Sylvia; Trinh-Shevrin, Chau

    2012-12-01

    Despite the importance of community health workers (CHWs) in strategies to reduce health disparities and the call to enhance their roles in research, little information exists on how to prepare CHWs involved in community-academic initiatives (CAIs). Therefore, the New York University Prevention Research Center piloted a CAI-CHW training program. We applied a core competency framework to an existing CHW curriculum and bolstered the curriculum to include research-specific sessions. We employed diverse training methods, guided by adult learning principles and popular education philosophy. Evaluation instruments assessed changes related to confidence, intention to use learned skills, usefulness of sessions, and satisfaction with the training. Results demonstrated that a core competency-based training can successfully affect CHWs' perceived confidence and intentions to apply learned content, and can provide a larger social justice context of their role and work. This program demonstrates that a core competency-based framework coupled with CAI-research-specific skill sessions (1) provides skills that CAI-CHWs intend to use, (2) builds confidence, and (3) provides participants with a more contextualized view of client needs and CHW roles.

  16. Lessons Learned From a Community–Academic Initiative: The Development of a Core Competency–Based Training for Community–Academic Initiative Community Health Workers

    Science.gov (United States)

    Matos, Sergio; Kapadia, Smiti; Islam, Nadia; Cusack, Arthur; Kwong, Sylvia; Trinh-Shevrin, Chau

    2012-01-01

    Objectives. Despite the importance of community health workers (CHWs) in strategies to reduce health disparities and the call to enhance their roles in research, little information exists on how to prepare CHWs involved in community–academic initiatives (CAIs). Therefore, the New York University Prevention Research Center piloted a CAI–CHW training program. Methods. We applied a core competency framework to an existing CHW curriculum and bolstered the curriculum to include research-specific sessions. We employed diverse training methods, guided by adult learning principles and popular education philosophy. Evaluation instruments assessed changes related to confidence, intention to use learned skills, usefulness of sessions, and satisfaction with the training. Results. Results demonstrated that a core competency–based training can successfully affect CHWs’ perceived confidence and intentions to apply learned content, and can provide a larger social justice context of their role and work. Conclusions. This program demonstrates that a core competency–based framework coupled with CAI-research–specific skill sessions (1) provides skills that CAI–CHWs intend to use, (2) builds confidence, and (3) provides participants with a more contextualized view of client needs and CHW roles. PMID:22594730

  17. Research workshop to research work: initial steps in establishing health research systems on Malaita, Solomon Islands

    Directory of Open Access Journals (Sweden)

    Kekuabata Esau

    2010-10-01

    Full Text Available Abstract Introduction Atoifi Adventist Hospital is a 90 bed general hospital in East Kwaio, Malaita, Solomon Islands providing services to the population of subsistence villagers of the region. Health professionals at the hospital and attached College of Nursing have considerable human capacity and willingness to undertake health research. However they are constrained by limited research experience, training opportunities, research systems, physical infrastructure and access to resources. This brief commentary describes an 'Introduction to Health Research' workshop delivered at Atoifi Adventist Hospital in September 2009 and efforts to move from 'research workshop' to 'research work'. The Approach Using a participatory-action research approach underpinned by decolonising methodologies, staff from Atoifi Adventist Hospital and James Cook University (Queensland, Australia collaboratively designed, implemented and evaluated a health research workshop. Basic health research principles and methods were presented using active learning methodologies. Following the workshop, Atoifi Adventist Hospital and Atoifi College of Nursing staff, other professionals and community members reported an increased awareness and understanding of health research. The formation of a local Research Committee, improved ethics review procedures and the identification of local research mentors followed the week long workshop. The workshop has acted as a catalyst for research activity, increasing structural and human resource capacity for local health professionals and community leaders to engage in research. Discussion and Conclusions Participants from a variety of educational backgrounds participated in, and received benefit from, a responsive, culturally and linguistically accessible health research workshop. Improving health research systems at a remote hospital and aligning these with local and national research agendas is establishing a base to strengthen public health

  18. Research workshop to research work: initial steps in establishing health research systems on Malaita, Solomon Islands.

    Science.gov (United States)

    Redman-Maclaren, Michelle L; Maclaren, David J; Solomon, Janella; Muse, Alwin; Asugeni, Rowena; Harrington, Humpress; Kekuabata, Esau; Speare, Richard; Clough, Alan R

    2010-10-31

    Atoifi Adventist Hospital is a 90 bed general hospital in East Kwaio, Malaita, Solomon Islands providing services to the population of subsistence villagers of the region. Health professionals at the hospital and attached College of Nursing have considerable human capacity and willingness to undertake health research. However they are constrained by limited research experience, training opportunities, research systems, physical infrastructure and access to resources. This brief commentary describes an 'Introduction to Health Research' workshop delivered at Atoifi Adventist Hospital in September 2009 and efforts to move from 'research workshop' to 'research work'. Using a participatory-action research approach underpinned by decolonising methodologies, staff from Atoifi Adventist Hospital and James Cook University (Queensland, Australia) collaboratively designed, implemented and evaluated a health research workshop. Basic health research principles and methods were presented using active learning methodologies. Following the workshop, Atoifi Adventist Hospital and Atoifi College of Nursing staff, other professionals and community members reported an increased awareness and understanding of health research. The formation of a local Research Committee, improved ethics review procedures and the identification of local research mentors followed the week long workshop. The workshop has acted as a catalyst for research activity, increasing structural and human resource capacity for local health professionals and community leaders to engage in research. Participants from a variety of educational backgrounds participated in, and received benefit from, a responsive, culturally and linguistically accessible health research workshop. Improving health research systems at a remote hospital and aligning these with local and national research agendas is establishing a base to strengthen public health research and practice on Malaita, Solomon Islands.

  19. After initial treatment for primary breast cancer: information needs, health literacy, and the role of health care workers.

    Science.gov (United States)

    Schmidt, Anna; Ernstmann, Nicole; Wesselmann, Simone; Pfaff, Holger; Wirtz, Markus; Kowalski, Christoph

    2016-02-01

    After a short hospital stay of just some days follows long-term outpatient care for breast cancer patients. The aim of the study is to describe the information needs of breast cancer outpatients and to get in touch with aspects of health literacy, as well as contact various health care workers. In a multicenter study, patients were asked about their information needs 10 weeks after surgery. The analysis on hand includes data about 1248 female patients. In addition to descriptive analyses identifying the most prevalent information needs, logistic regression analyses were calculated to identify factors associated with these. The results show that information needs of breast cancer outpatients are mainly in "follow-up after acute treatment", "coping with long-term side effects", and "heredity of breast cancer". In addition to sociodemographic patient characteristics, perceived helpful contacts with various health care workers as well as a satisfactory patient's level of health literacy reduced the probability of unmet information needs. Breast cancer outpatients have numerous information needs. In addition to provide information at the right time regarding a specific disease phase, it is important that health professionals' support affected breast cancer patients in coping with the new situation.

  20. Drop out from out-patient mental healthcare in the World Health Organization's World Mental Health Survey initiative.

    Science.gov (United States)

    Wells, J Elisabeth; Browne, Mark Oakley; Aguilar-Gaxiola, Sergio; Al-Hamzawi, Ali; Alonso, Jordi; Angermeyer, Matthias C; Bouzan, Colleen; Bruffaerts, Ronny; Bunting, Brendan; Caldas-de-Almeida, José Miguel; de Girolamo, Giovanni; de Graaf, Ron; Florescu, Silvia; Fukao, Akira; Gureje, Oye; Hinkov, Hristo Ruskov; Hu, Chiyi; Hwang, Irving; Karam, Elie G; Kostyuchenko, Stanislav; Kovess-Masfety, Viviane; Levinson, Daphna; Liu, Zhaorui; Medina-Mora, Maria Elena; Nizamie, S Haque; Posada-Villa, José; Sampson, Nancy A; Stein, Dan J; Viana, Maria Carmen; Kessler, Ronald C

    2013-01-01

    Previous community surveys of the drop out from mental health treatment have been carried out only in the USA and Canada. To explore mental health treatment drop out in the World Health Organization World Mental Health Surveys. Representative face-to-face household surveys were conducted among adults in 24 countries. People who reported mental health treatment in the 12 months before interview (n = 8482) were asked about drop out, defined as stopping treatment before the provider wanted. Overall, drop out was 31.7%: 26.3% in high-income countries, 45.1% in upper-middle-income countries, and 37.6% in low/lower-middle-income countries. Drop out from psychiatrists was 21.3% overall and similar across country income groups (high 20.3%, upper-middle 23.6%, low/lower-middle 23.8%) but the pattern of drop out across other sectors differed by country income group. Drop out was more likely early in treatment, particularly after the second visit. Drop out needs to be reduced to ensure effective treatment.

  1. The meta-leadership summit for preparedness initiative: an innovative model to advance public health preparedness and response.

    Science.gov (United States)

    Sobelson, Robyn K; Young, Andrea C; Marcus, Leonard J; Dorn, Barry C; Neslund, Verla S; McNulty, Eric J

    2013-12-01

    This article reports on the design, evaluation framework, and results from the Meta-Leadership Summit for Preparedness Initiative. The Meta-Leadership Summit for Preparedness was a 5-year initiative based on the premise that national preparedness and emergency response is not solely the responsibility of government. From 2006 to 2011, 36 Meta-Leadership Summits were delivered in communities across the country. Summits were customized, 10-hour leadership development, networking, and community action planning events. They included participation from targeted federal, state, local, nonprofit/philanthropic, and private sector leaders who are directly involved in decision making during a major community or state-wide emergency. A total of 4,971 government, nonprofit, and business leaders attended Meta-Leadership Summits; distribution of attendees by sector was balanced. Ninety-three percent of respondents reported the summit was a valuable use of time, 91% reported the overall quality as "good" or "outstanding," and 91% would recommend the summit to their colleagues. In addition, approximately 6 months after attending a summit, 80% of respondents reported that they had used meta-leadership concepts or principles. Of these, 93% reported that using meta-leadership concepts or principles had made a positive difference for them and their organizations. The Meta-Leadership Summit for Preparedness Initiative was a value-added opportunity for communities, providing the venue for learning the concepts and practice of meta-leadership, multisector collaboration, and resource sharing with the intent of substantively improving preparedness, response, and recovery efforts.

  2. Human influenza A H5N1 in Indonesia: health care service-associated delays in treatment initiation.

    Science.gov (United States)

    Adisasmito, Wiku; Aisyah, Dewi Nur; Aditama, Tjandra Yoga; Kusriastuti, Rita; Trihono; Suwandono, Agus; Sampurno, Ondri Dwi; Prasenohadi; Sapada, Nurshanty A; Mamahit, M J N; Swenson, Anna; Dreyer, Nancy A; Coker, Richard

    2013-06-11

    Indonesia has had more recorded human cases of influenza A H5N1 than any other country, with one of the world's highest case fatality rates. Understanding barriers to treatment may help ensure life-saving influenza-specific treatment is provided early enough to meaningfully improve clinical outcomes. Data for this observational study of humans infected with influenza A H5N1 were obtained primarily from Ministry of Health, Provincial and District Health Office clinical records. Data included time from symptom onset to presentation for medical care, source of medical care provided, influenza virology, time to initiation of influenza-specific treatment with antiviral drugs, and survival. Data on 124 human cases of virologically confirmed avian influenza were collected between September 2005 and December 2010, representing 73% of all reported Indonesia cases. The median time from health service presentation to antiviral drug initiation was 7.0 days. Time to viral testing was highly correlated with starting antiviral treatment (p influenza H5N1 in Indonesia appear related to delays in diagnosis rather than presentation to health care settings. Either cases are not suspected of being H5N1 cases until nearly one week after presenting for medical care, or viral testing and/or antiviral treatment is not available where patients are presenting for care. Health system delays have increased since 2007.

  3. Costs and financing of improvements in the quality of maternal health services through the Bamako Initiative in Nigeria.

    Science.gov (United States)

    Ogunbekun, I; Adeyi, O; Wouters, A; Morrow, R H

    1996-12-01

    This paper reports on a study to assess the quality of maternal health care in public health facilities in Nigeria and to identify the resource implications of making the necessary quality improvements. Drawing upon unifying themes from quality assurance, basic microeconomics and the Bamako Initiative, locally defined norms were used to estimate resource requirements for improving the quality of maternal health care. Wide gaps existed between what is required (the norm) and what was available in terms of fixed and variable resources required for the delivery of maternal health services in public facilities implementing the Bamako Initiative in the Local Government Areas studied. Given such constraints, it was highly unlikely that technically acceptable standards of care could be met without additional resource inputs to meet the norm. This is part of the cost of doing business and merits serious policy dialogue. Revenue generation from health services was poor and appeared to be more related to inadequate supply of essential drugs and consumables than to the use of uneconomic fee scales. It is likely that user fees will be necessary to supplement scarce government budgets, especially to fund the most critical variable inputs associated with quality improvements. However, any user fee system, especially one that raises fees to patients, will have to be accompanied by immediate and visible quality improvements. Without such quality improvements, cost recovery will result in even lower utilization and attempts to generate new revenues are unlikely to succeed.

  4. Bringing together values-based and evidence-based medicine: UK Department of Health Initiatives in the 'Personalization' of Care.

    Science.gov (United States)

    Fulford, K W M Bill

    2011-04-01

    Person-centred medicine depends on combining best research evidence with the unique values (including the preferences, concerns, needs and wishes) of individual patients and their families. The paper gives a brief introduction to values-based practice as a new approach to incorporating patients' values into clinical decision making alongside best research evidence as derived from evidence-based practice. The role of values-based practice as a partner to evidence-based practice is illustrated through a series of policy, training and service development initiatives in mental health from the UK Department of Health in London. These initiatives have supported person-centred developments in key areas of mental health practice including, (1) the use of involuntary treatment; and (2) a shared approach of assessment. Early moves are underway to extend values-based practice to other areas of health care beyond mental health. Values-based practice offers a new approach to incorporating patients' unique values into clinical decision making that is complementary to evidence-based practice as a resource for person-centred medicine. © 2010 Blackwell Publishing Ltd.

  5. [The Emerging Voices for Global Health Initiative: an intensive capacity-building effort for young researchers from the South].

    Science.gov (United States)

    Hercot, D; Keugoung, B; Zerbo, A; Appelmans, A; Van Damme, W

    2012-01-01

    Researchers from developing countries, French-speaking nations in particular, are underrepresented in the international biomedical and health literature. Various initiatives seek to address this problem. This article presents the experience of the Emerging Voices for Global Health (EV4GH) program. This initiative provided 52 young researchers from developing countries with intensive skills and content training, with an assortment of complementary components: training in scientific writing and presenting skills, immersion in global health and health systems research, an innovative presentation of their work at the 52nd colloquium of the Institute of Tropical Medicine in Antwerp, and an active role in the first Global Symposium on Health Systems Research, supervised by a team of experienced researchers/coaches who supported them in the publication of a scientific essay. This approach targeting researchers in developing countries and combining the development of skills and knowledge through the publication process, merits reproduction and encouragement. Young researchers from developing countries should not miss out on the second version of this program in October 2012 in Beijing, China.

  6. Telemonitoring increases patient awareness of health and prompts health-related action: initial evaluation of the TELE-ERA study.

    Science.gov (United States)

    Pecina, Jennifer L; Vickers, Kristin S; Finnie, Dawn M; Hathaway, Julie C; Hanson, Gregory J; Takahashi, Paul Y

    2011-01-01

    Telemonitoring is being increasingly used for chronic disease monitoring. Understanding elderly patients' feelings and perspectives toward telemonitoring is important to minimize any barriers to implementation in this population. Twenty Tele-Era Trial participants completed qualitative interviews assessing opinions about their telemonitoring experience. Participants also rated telemonitoring on burden, communication with clinicians, impact on medical condition knowledge, and confidence in using the monitor. On an average, participants rated telemonitoring as minimally burdensome, rated themselves confident in using the monitor, and positively rated telemonitoring for clinical communication. Qualitative analysis revealed a predominant theme that telemonitoring increases patient awareness of their health and also that telemonitoring prompts action. Elderly patients find home telemonitoring to be an acceptable and satisfying experience that can increase their awareness of their health and provide a sense of safety in their home. Home telemonitoring can lead to earlier evaluation of decline in health status.

  7. 77 FR 12577 - Department of Defense (DoD) Medicare-Eligible Retiree Health Care Board of Actuaries; Federal...

    Science.gov (United States)

    2012-03-01

    ... of the Secretary Department of Defense (DoD) Medicare-Eligible Retiree Health Care Board of Actuaries... Board of Actuaries will take place. DATES: Friday, August 3, 2012, from 1:30 p.m. to 3:30 p.m. ADDRESSES... Medicare- Eligible Retiree Health Care Board of Actuaries meeting or make an oral presentation or submit...

  8. Behavioral health in the gulf coast region following the Deepwater Horizon oil spill: findings from two federal surveys.

    Science.gov (United States)

    Gould, Deborah W; Teich, Judith L; Pemberton, Michael R; Pierannunzi, Carol; Larson, Sharon

    2015-01-01

    This article summarizes findings from two large-scale, population-based surveys conducted by Substance Abuse and Mental Health Services Administration (SAMHSA) and Centers for Disease Control and Prevention (CDC) in the Gulf Coast region following the 2010 Deepwater Horizon oil spill, to measure the prevalence of mental and substance use disorders, chronic health conditions, and utilization of behavioral health services. Although many area residents undoubtedly experienced increased levels of anxiety and stress following the spill, findings suggest only modest or minimal changes in behavioral health at the aggregate level before and after the spill. The studies do not address potential long-term effects of the spill on physical and behavioral health nor did they target subpopulations that might have been most affected by the spill. Resources mobilized to reduce the economic and behavioral health impacts of the spill on coastal residents-including compensation for lost income from BP and increases in available mental health services-may have resulted in a reduction in potential mental health problems.

  9. Digital chat reference in health science libraries: challenges in initiating a new service.

    Science.gov (United States)

    Dee, Cheryl R; Newhouse, Joshua D

    2005-01-01

    Digital reference service adds a valuable new dimension to health science reference services, but the road to implementation can present questions that require carefully considered decisions. This article incorporates suggestions from the published literature, provides tips from interviews with practicing academic health science librarians, and reports on data from students' exploration of academic health science library Web sites' digital reference services. The goal of this study is to provide guidelines to plan new services, assess user needs, and select software, and to showcase potential benefits of collaboration and proactive and user-friendly marketing. In addition, tips for successful operation and evaluation of services are discussed.

  10. The Environmental Health/Home Safety Education Project: a successful and practical U.S.-Mexico border initiative.

    Science.gov (United States)

    Forster-Cox, Susan C; Mangadu, Thenral; Jacquez, Benjamín; Fullerton, Lynne

    2010-05-01

    The Environmental Health/Home Safety Education Project (Proyecto de Salud Ambiental y Seguridad en el Hogar) has been developed in response to a wide array of severe and often preventable environmental health issues occurring in and around homes on the U.S.-Mexico border. Utilizing well-trained community members, called promotoras , homes are visited and assessed for potential environmental hazards, including home fire and food safety issues. Data analyzed from project years 2002 to 2005 shows a significant impact in knowledge levels and initial behavior change among targeted participants as it relates to fire and food safety issues. Since the initiation of the project in 1999, hundreds of participants have improved their quality of life by making their homes safer. The project has proven to be sustainable, replicable, flexible, and attractive to funders.

  11. Federal Lands

    Data.gov (United States)

    Department of Homeland Security — This map layer consists of federally owned or administered lands of theUnited States, Puerto Rico, and the U.S. Virgin Islands. Only areas of 640 acres or more are...

  12. Childhood Predictors of Adult Attention-Deficit/Hyperactivity Disorder : Results from the World Health Organization World Mental Health Survey Initiative

    NARCIS (Netherlands)

    Lara, Carmen; Fayyad, John; de Graaf, Ron; Kessler, Ronald C.; Aguilar-Gaxiola, Sergio; Angermeyer, Matthias; Demytteneare, Koen; de Girolamo, Giovanni; Haro, Josep Maria; Jin, Robert; Karam, Elie G.; Lepine, Jean-Pierre; Mora, Maria Elena Medina; Ormel, Johan; Posada-Villa, Jose; Sampson, Nancy

    2009-01-01

    Background: Although it is known that childhood attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood, childhood predictors of this persistence have not been widely studied. Methods: Childhood history of ADHD and adult ADHD were assessed in 10 countries in the World Health Or

  13. Childhood Predictors of Adult Attention-Deficit/Hyperactivity Disorder: Results from the World Health Organization World Mental Health Survey Initiative

    NARCIS (Netherlands)

    Lara, C.; Fayyad, J.; de Graaf, R.; Kessler, R.C.; Aguilar-Gaxiola, S.; Angermeyer, M.; Demytteneare, K.; De Girolamo, G.; Haro, J.M.; Jin, R.; Karam, E.G.; Lepine, J.P.; Mora, M.E.M.; Ormel, J.; Posada-Villa, J.; Sampson, N.

    2009-01-01

    Background: Although it is known that childhood attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood, childhood predictors of this persistence have not been widely studied. Methods: Childhood history of ADHD and adult ADHD were assessed in 10 countries in the World Health Or

  14. The social paediatrics initiative: a RICHER model of primary health care for at risk children and their families

    Directory of Open Access Journals (Sweden)

    Wong Sabrina T

    2012-10-01

    Full Text Available Abstract Background The Responsive Interdisciplinary Child-Community Health Education and Research (RICHER initiative is an intersectoral and interdisciplinary community outreach primary health care (PHC model. It is being undertaken in partnership with community based organizations in order to address identified gaps in the continuum of health services delivery for ‘at risk’ children and their families. As part of a larger study, this paper reports on whether the RICHER initiative is associated with increased: 1 access to health care for children and families with multiple forms of disadvantage and 2 patient-reported empowerment. This study provides the first examination of a model of delivering PHC, using a Social Paediatrics approach. Methods This was a mixed-methods study, using quantitative and qualitative approaches; it was undertaken in partnership with the community, both organizations and individual providers. Descriptive statistics, including logistic regression of patient survey data (n=86 and thematic analyses of patient interview data (n=7 were analyzed to examine the association between patient experiences with the RICHER initiative and parent-reported empowerment. Results Respondents found communication with the provider clear, that the provider explained any test results in a way they could understand, and that the provider was compassionate and respectful. Analysis of the survey and in-depth interview data provide evidence that interpersonal communication, particularly the provider’s interpersonal style (e.g., being treated as an equal, was very important. Even after controlling for parents’ education and ethnicity, the provider’s interpersonal style remained positively associated with parent-reported empowerment (p Conclusions This model of PHC delivery is unique in its purposeful and required partnerships between health care providers and community members. This study provides beginning evidence that RICHER can

  15. 75 FR 2013 - Health Information Technology: Initial Set of Standards, Implementation Specifications, and...

    Science.gov (United States)

    2010-01-13

    ... health record, including for the segmentation and protection from disclosure of specific and sensitive... patient demographic data, including, at a minimum, race, ethnicity, primary language, and gender... levels. For example, one organization may use an information model to describe patient...

  16. Acceptability of mental health stigma-reduction training and initial effects on awareness among military personnel

    National Research Council Canada - National Science Library

    Hurtado, Suzanne L; Simon-Arndt, Cynthia M; McAnany, Jennifer; Crain, Jenny A

    2015-01-01

    The purpose of this paper is to report on the development of a mental health stigma reduction toolkit and training, and the acceptability and level of stigma awareness following the stigma-reduction...

  17. Health Insurance Marketplace: Summary Enrollment Data for the Initial Annual Open Enrollment Period

    Data.gov (United States)

    U.S. Department of Health & Human Services — This file includes data for states that are implementing their own Marketplaces, also known as State-Based Marketplaces or SBMs, and states with Marketplaces that...

  18. Personal stories: voices of Latino youth health advocates in a diabetes prevention initiative.

    Science.gov (United States)

    Toussaint, Danielle W; Villagrana, Maria; Mora-Torres, Hugo; de Leon, Mario; Haughey, Mary Hoshiko

    2011-01-01

    The YMCA-Silicon Valley Racial and Ethnic Approaches to Community Health (REACH) U.S. Proyecto Movimiento (PM) Action Community project is a community-based partnership that aims to reduce the prevalence of diabetes among Latinos in the Greater Gilroy, California, area by delivering a prevention campaign across generations. A critical component of PM has been the creation of a Youth Health Advocate (YHA) afterschool club at three public high schools in Gilroy. The YHAs, who are trained on health, nutrition, diabetes, basic leadership skills, and digital storytelling, are at the forefront of the campaign targeting Gilroy youth. In their own words, the YHAs describe why they decided to become a YHA, the positive health impact of YHA activities on themselves and their family, and the positive impact on burgeoning leadership skills. The voices of YHAs in this prevention campaigns have brought value to the PM evaluation, and this qualitative element bears further examination in other community-based prevention campaigns.

  19. Integralidade do cuidado: representações sociais das equipes de Saúde da Família do Distrito Federal Comprehensive care: social representations of Family Health teams in Distrito Federal, Brazil

    Directory of Open Access Journals (Sweden)

    Vladimir Andrei Rodrigues Arce

    2013-03-01

    Full Text Available Trata-se de pesquisa qualitativa que analisou as representações sociais dos profissionais da Estratégia Saúde da Família (ESF do Distrito Federal-DF acerca da integralidade do cuidado. A ESF vem sendo implantada no Brasil desde 1994 como uma estratégia política para reordenar o modelo de atenção à saúde, estando atualmente em processo de ampliação no DF. Foram realizados entrevistas individuais semiestruturadas e grupo focal com gestores locais e profissionais das equipes de 11 das 15 regionais de saúde. Utilizou-se o Discurso de Sujeito Coletivo (DSC e a teoria das Representações Sociais para análise, com o objetivo de compreender a sociogênese da forma de pensar a partir de um olhar psicossocial sobre a realidade. Verificou-se que o cuidado é percebido como ato de solidariedade e atributo profissional, apoio às famílias em suas múltiplas necessidades e articulação de ações interdisciplinares de prevenção, promoção e tratamento, visando qualidade de vida. A integralidade do cuidado permeia a noção de autonomia profissional, requer a criação de vínculos de confiança e responsabilização entre profissionais e usuários, a contextualização da família sobre os determinantes e formas de enfrentamento dos problemas e demanda a integração com demais serviços. O estudo demonstrou que o cuidado relaciona-se com diferentes dimensões da integralidade, refletindo potencialidades e desafios do modelo da ESF para o desenvolvimento de práticas ampliadas de saúde. Faz-se necessário que a potencialidade das relações estabelecidas entre diferentes sujeitos no território permita a qualificação das ações de saúde, sobretudo aquelas voltadas para a promoção.This qualitative research analyzed the social representations about comprehensive care of the health professionals who work at the teams of the Family Health Strategy (ESF in Distrito Federal - DF, Brazil. The ESF is being implemented in Brazil since 1994

  20. Challenges and Opportunities for Urban Environmental Health and Sustainability: the HEALTHY-POLIS initiative.

    Science.gov (United States)

    Vardoulakis, Sotiris; Dear, Keith; Wilkinson, Paul

    2016-03-08

    Cities around the world face many environmental health challenges including contamination of air, water and soil, traffic congestion and noise, and poor housing conditions exacerbated by unsustainable urban development and climate change. Integrated assessment of these risks offers opportunities for holistic, low carbon solutions in the urban environment that can bring multiple benefits for public health. The Healthy-Polis consortium aims to protect and promote urban health through multi-disciplinary, policy-relevant research on urban environmental health and sustainability. We are doing this by promoting improved methods of health risk assessment, facilitating international collaboration, contributing to the training of research scientists and students, and engaging with key stakeholders in government, local authorities, international organisations, industry and academia. A major focus of the consortium is to promote and support international research projects coordinated between two or more countries. The disciplinary areas represented in the consortium are many and varied, including environmental epidemiology, modelling and exposure assessment, system dynamics, health impact assessment, multi-criteria decision analysis, and other quantitative and qualitative approaches. This Healthy-Polis special issue presents a range of case studies and reviews that illustrate the need for a systems-based understanding of the urban environment.

  1. A Conceptual Framework of Mapping Access to Health Care across EU Countries: The Patient Access Initiative.

    Science.gov (United States)

    Souliotis, Kyriakos; Hasardzhiev, Stanimir; Agapidaki, Eirini

    Research evidence suggests that access to health care is the key influential factor for improved population health outcomes and health care system sustainability. Although the importance of addressing barriers in access to health care across European countries is well documented, little has been done to improve the situation. This is due to different definitions, approaches and policies, and partly due to persisting disparities in access within and between European countries. To bridge this gap, the Patient Access Partnership (PACT) developed (a) the '5As' definition of access, which details the five critical elements (adequacy, accessibility, affordability, appropriateness, and availability) of access to health care, (b) a multi-stakeholders' approach for mapping access, and (c) a 13-item questionnaire based on the 5As definition in an effort to address these obstacles and to identify best practices. These tools are expected to contribute effectively to addressing access barriers in practice, by suggesting a common framework and facilitating the exchange of knowledge and expertise, in order to improve access to health care between and within European countries. © 2016 S. Karger AG, Basel.

  2. The 'Practice Entrepreneur' - An Australian case study of a systems thinking inspired health promotion initiative.

    Science.gov (United States)

    Joyce, A; Green, C; Carey, G; Malbon, E

    2017-01-23

    The potential of systems science concepts to inform approaches for addressing complex public health problems, such as obesity prevention, has been attracting significant attention over the last decade. Despite its recent popularity, there are very few studies examining the application of systems science concepts, termed systems thinking, in practice and whether (if at all) it influences the implementation of health promotion in real world settings and in what ways. Healthy Together Victoria (HTV) was based on a systems thinking approach to address obesity prevention alongside other chronic health problems and was implemented across 14 local government areas. This paper examines the experience of practitioners from one of those intervention sites. In-depth interviews with eight practitioners revealed that there was a rigidity with which they had experienced previous health promotion jobs relative to the flexibility and fluidity of HTV. While the health promotion literature does not indicate that health promotion should be overly prescriptive, the experience of these practitioners suggests it is being applied as such in real world settings. Within HTV, asking people to work with 'systems thinking', without giving a prescription about what systems thinking is, enabled practitioners to be 'practice entrepreneurs' by choosing from a variety of systems thinking methods (mapping, reflection) to engage actively in their positions. This highlights the importance of understanding how key concepts, both traditional planning approaches and systems science concepts, are interpreted and then implemented in real world settings.

  3. Promoting interprofessionalism: initial evaluation of a master of science in health professions education degree program

    Directory of Open Access Journals (Sweden)

    Lamba S

    2016-02-01

    Full Text Available Sangeeta Lamba,1 Aimee Strang,2 David Edelman,3 Deborah Navedo,4 Maria L Soto-Greene,1 Anthony J Guarino41Department of Emergency Medicine, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, 2Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY, 3Department of Surgery, Wayne State University School of Medicine, Detroit, MI, 4Health Professions Education Program, Massachusetts General Hospital Institute of Health Professions, Boston, MA, USAAbstract: This survey study assessed former students’ perceptions on the efficacy of how well a newly implemented master’s in health professions education degree program achieved its academic aims. These academic aims were operationalized by an author-developed scale to assess the following domains: a developing interprofessional skills and identity; b acquiring new academic skills; and c providing a student-centered environment. The respondents represented a broad range of health care providers, including physicians, nurses, and occupational and physical therapists. Generalizability-theory was applied to partition the variance of the scores. Student’s overwhelmingly responded that the program successfully achieved its academic aims.Keywords: health professions education, program evaluation, and survey, development, master’s degree, interprofessional education, G-theory, faculty development, teacher training

  4. Building the field of population health intervention research: The development and use of an initial set of competencies.

    Science.gov (United States)

    Riley, Barbara; Harvey, Jean; Di Ruggiero, Erica; Potvin, Louise

    2015-01-01

    Population health intervention research (PHIR) is a relatively new research field that studies interventions that can improve health and health equity at a population level. Competencies are one way to give legitimacy and definition to a field. An initial set of PHIR competencies was developed with leadership from a multi-sector group in Canada. This paper describes the development process for these competencies and their possible uses. Methods to develop the competencies included key informant interviews; a targeted review of scientific and gray literature; a 2-round, online adapted Delphi study with a 24-member panel; and a focus group with 9 international PHIR experts. The resulting competencies consist of 25 items grouped into 6 categories. They include principles of good science applicable though not exclusive to PHIR, and more suitable for PHIR teams rather than individuals. This initial set of competencies, released in 2013, may be used to develop graduate student curriculum, recruit trainees and faculty to academic institutions, plan non-degree professional development, and develop job descriptions for PHIR-related research and professional positions. The competencies provide some initial guideposts for the field and will need to be adapted as the PHIR field matures and to meet unique needs of different jurisdictions.

  5. Behavioral health referrals and treatment initiation rates in integrated primary care: a Collaborative Care Research Network study.

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    Auxier, Andrea; Runyan, Christine; Mullin, Daniel; Mendenhall, Tai; Young, Jessica; Kessler, Rodger

    2012-09-01

    Although the benefits of integrating behavioral health (BH) services into primary care are well established (World Health Organization and World Organization of Family Doctors, 2012; Chiles et al. in Clin Psychol-Sci Pr 6:204-220, 1999; Cummings 1997; O'Donohue et al. 2003; Olfson et al. in Health Aff 18:79-93, 1999; Katon et al. in Ann Intern Med 124:917-925, 2001; Simon et al. in Arch Gen Psychiatry 52:850-856, 1995; Anderson et al. in Diabetes Care 24:1069-1078, 2001; Ciechanowski et al. in Arch Intern Med 160:3278-3285, 2000; Egede et al. in Diabetes Care 25:464-470, 2002), research has focused primarily on describing the types of interventions behavioral health providers (BHPs) employ rather than on reasons for referral, treatment initiation rates, or the patient characteristics that may impact them. This study presents the results of a multisite card study organized by The Collaborative Care Research Network, a subnetwork of the American Academy of Family Physicians' National Research Network devoted to conducting practice-based research focused on the provision of BH and health behavior services within primary care practices. The goals of the study included: (1) identifying the characteristics of patients referred for BH services; (2) codifying reasons for referral and whether patients were treated for the referral; (3) exploring any differences between patients who initiated BH contact and those who did not; and (4) assessing the types and frequency of BH services provided to patients who attended at least one appointment. Of the 200 patients referred to a BHP, 81 % had an initial contact, 71 % of which occurred on the same day. Men and women were equally likely to engage with a BHP although the time between appointments varied by gender. Depression and anxiety were the primary reasons for referral. Practice-based research is a viable strategy for advancing the knowledge about integrated primary care.

  6. Securing health through food systems: an initiative of the nutrition consortium of the National Health Research Institutes in Taiwan and Asia Pacific regional partners as a network.

    Science.gov (United States)

    Wahlqvist, Mark L; Kuo, Ken N

    2009-01-01

    There are growing concerns about the health impacts of climate change with ecosystem degradation and global warming, finite reserves of non-renewable energy, water shortages in food-producing regions, limits to contemporary agriculture with its dependence on exhaustible petrochemical nitrogen and rock phosphate fertilizers, and failure of the global financial system. To date, health security has meant attention to safe environments especially water, sanitation and waste disposal; and access to health care and its affordability. Its dependency on food security (safety, sufficiency, sustainability, and satisfaction which requires diversity and quality) has been under-estimated because the current and imminent risks have increased and extended to more populations, because these may be less tractable and because the nature, extent and dynamics of nutritionally-related health are better appreciated. As a step towards more collaborative food and health systems, the National Health Research Institutes in Taiwan has created an interdisciplinary Nutrition Consortium (NC) with research and policy agendas. The NC held a food in Health Security (FIHS) in the Asia Pacific region roundtable in conjunction with the World Vegetable Center based in Tainan, supported by the National Science Council and Academia Sinica in Taiwan and the Australian Academies of Science and of Science Technology and Engineering, August 2-5th 2009 in Taiwan. A FIHS Network is being established to further the initiative. It should form part of the broader Human Security agenda.

  7. A política de atenção primária à saúde no Brasil: notas sobre a regulação e o financiamento federal Primary health care policy in Brazil: notes on Federal regulation and funding

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    Ana Luisa Barros de Castro

    2010-04-01

    Full Text Available O artigo analisa a condução federal da política de atenção primária à saúde no Brasil de 2003 a 2008, considerando as funções de Estado na saúde de planejamento, regulação, financiamento e execução direta de serviços. A pesquisa compreendeu revisão bibliográfica, realização de entrevistas semi-estruturadas com atores-chave da política, análise documental, orçamentária e de bases de dados secundários. Observou-se redução na execução federal direta das ações e fragilidades no que diz respeito ao planejamento. A atuação federal se caracterizou principalmente pela regulação, baseada na emissão de portarias atreladas a mecanismos financeiros. No que concerne ao financiamento, houve discreto aumento da participação da atenção básica no orçamento federal, reajustes e criação de novos incentivos, alguns visando à eqüidade. Embora tenham ocorrido avanços no período, permanece o desafio de reconuração do modelo regulatório federal e a garantia de um aporte maior de recursos para este nível de atenção, a fim de que ocorra o efetivo fortalecimento da atenção primária no país.This article analyzes the Federal implementation of primary health care policy in Brazil from 2003 to 2008, considering the government functions of health planning, regulation, financing, and health services delivery. The methodology included literature and document review, interviews with key policy actors, budget analysis, and health database analysis. The analysis showed a reduction in direct Federal health services delivery and weaknesses in Federal planning. Federal performance mainly involved regulation, based on norms linked to financial mechanisms. As for funding, the results showed a slight increase in the share for primary care in the Federal budget, adjustments, and creation of new incentives, some aimed at equity. Although some progress occurred, a remaining challenge is to reconure the Federal regulatory model and

  8. [Key measures for developing palliative care from a public health perspective. Initial results from a three-round Delphi study].

    Science.gov (United States)

    Behmann, M; Jünger, S; Radbruch, L; Schneider, N

    2011-05-01

    Recently, six key targets for public health initiatives to improve palliative care in Germany were defined. This article reports the initial results of a follow-up study aiming at developing concrete measures to achieve these targets. We carried out a three-round Delphi study with stakeholders acting on the meso- and macro-levels of the German healthcare system (e.g., representatives of patient organizations, health insurance funds, politics, medical and nursing associations). In the first Delphi round, participants proposed measures to achieve the six key targets using free-text answers. The answers were analyzed with a qualitative-descriptive approach. In total, 107 stakeholders responded to the first Delphi round. After data reduction, 37 measures were extracted and grouped into six major categories: family carers, qualification, quality, public relations, services, and coordination. The range of measures on the different levels of policy, health care, and education presents a substantiated basis for the elaboration of targeted public health action plans to improve palliative care. Prioritization of measures in the second and third Delphi rounds will provide empirical support for decision making.

  9. Population-based initiatives in college mental health: students helping students to overcome obstacles.

    Science.gov (United States)

    Kirsch, Daniel J; Pinder-Amaker, Stephanie L; Morse, Charles; Ellison, Marsha L; Doerfler, Leonard A; Riba, Michelle B

    2014-12-01

    College students' need for mental health care has increased dramatically, leaving campus counseling and mental health centers struggling to meet the demand. This has led to the investigation and development of extra-center, population-based interventions. Student-to-student support programs are but one example. Students themselves are a plentiful, often-untapped resource that extends the reach of mental health services on campus. Student-to-student programs capitalize on students' natural inclination to assist their peers. A brief review of the prevalence and effects of mental disorders in the college population is provided, followed by a broad overview of the range of peer-to-peer programs that can be available on college campuses. Two innovative programs are highlighted: (1) a hospital- and community-based program, the College Mental Health Program (CMHP) at McLean Hospital, and 2) the Student Support Network (SSN) at Worcester Polytechnic Institute. The subsequent section reviews the literature on peer-to-peer programs for students with serious and persistent mental illness for which there is a small but generally positive body of research. This lack of an empirical basis in college mental health leads the authors to argue for development of broad practice-research networks.

  10. Transferring Chemical Research to a Spin-Off Initiative in Health Care: The Lipidomic Approach

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    Ferreri, Carla; Chatgilialoglu, Chryssostomos; Ferreri, Rosaria

    2008-01-01

    Lipidomics is an emerging discipline in life sciences related to the lipid metabolism of living organisms. In the last decade chemical and biological research has attributed very important roles to membrane phospholipids in relationship to free radical stress and metabolic situations. An entrepreneurial initiative for diagnostic tools and health…

  11. Towards reframing health service delivery in Uganda: the Uganda Initiative for Integrated Management of Non-Communicable Diseases

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    Jeremy I. Schwartz

    2015-01-01

    Full Text Available Background: The burden of non-communicable diseases (NCDs in low- and middle-income countries (LMICs is accelerating. Given that the capacity of health systems in LMICs is already strained by the weight of communicable diseases, these countries find themselves facing a double burden of disease. NCDs contribute significantly to morbidity and mortality, thereby playing a major role in the cycle of poverty, and impeding development. Methods: Integrated approaches to health service delivery and healthcare worker (HCW training will be necessary in order to successfully combat the great challenge posed by NCDs. Results: In 2013, we formed the Uganda Initiative for Integrated Management of NCDs (UINCD, a multidisciplinary research collaboration that aims to present a systems approach to integrated management of chronic disease prevention, care, and the training of HCWs. Discussion: Through broad-based stakeholder engagement, catalytic partnerships, and a collective vision, UINCD is working to reframe integrated health service delivery in Uganda.

  12. Towards reframing health service delivery in Uganda: the Uganda Initiative for Integrated Management of Non-Communicable Diseases.

    Science.gov (United States)

    Schwartz, Jeremy I; Dunkle, Ashley; Akiteng, Ann R; Birabwa-Male, Doreen; Kagimu, Richard; Mondo, Charles K; Mutungi, Gerald; Rabin, Tracy L; Skonieczny, Michael; Sykes, Jamila; Mayanja-Kizza, Harriet

    2015-01-01

    The burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is accelerating. Given that the capacity of health systems in LMICs is already strained by the weight of communicable diseases, these countries find themselves facing a double burden of disease. NCDs contribute significantly to morbidity and mortality, thereby playing a major role in the cycle of poverty, and impeding development. Integrated approaches to health service delivery and healthcare worker (HCW) training will be necessary in order to successfully combat the great challenge posed by NCDs. In 2013, we formed the Uganda Initiative for Integrated Management of NCDs (UINCD), a multidisciplinary research collaboration that aims to present a systems approach to integrated management of chronic disease prevention, care, and the training of HCWs. Through broad-based stakeholder engagement, catalytic partnerships, and a collective vision, UINCD is working to reframe integrated health service delivery in Uganda.

  13. An evaluation of an Australian initiative designed to improve interdisciplinary collaboration in primary mental health care.

    Science.gov (United States)

    Fletcher, Justine; King, Kylie; Christo, Jo; Machlin, Anna; Bassilios, Bridget; Blashki, Grant; Gibbs, Chris; Nicholas, Angela; Pirkis, Jane

    2014-08-01

    This paper reports on a multi-component evaluation of Australia's Mental Health Professionals Network (MHPN). MHPN aims to improve consumer outcomes by fostering a collaborative clinical approach to primary mental health care. MHPN has promoted interdisciplinary communication and networking through activity in three inter-related areas: interdisciplinary workshops supported by education and training materials; fostering ongoing, self-sustained interdisciplinary clinical networks; and a website, web portal (MHPN Online) and a toll-free telephone information line. The evaluation showed that MHPN's workshops were highly successful; almost 1200 workshops were attended by 11,930 individuals from a range of mental health professions. Participants from 81% of these workshops have gone on to join ongoing, interdisciplinary networks of local providers, and MHPN is now supporting these networks in a range of innovative ways to encourage them to become self-sustaining and to improve collaborative care practices. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Priorities of legislatively active veteran services organizations: a content analysis and review for health promotion initiatives.

    Science.gov (United States)

    Jahnke, Sara A; Haddock, Christopher K; Carlos Poston, Walker S; Jitnarin, Nattinee

    2014-11-01

    Military and Veterans Service Organizations (MVSOs) have a unique opportunity to influence legislation and advocate for the interests of their members. However, little is known about what legislative priorities MVSOs see as important. Understanding the legislative priorities of MVSOs can inform efforts by health scientists to promote policy and laws designed to improve the health of our nation's veterans. Using a mixed methods approach, we conducted a thematic analysis of legislative priorities MVSOs promote with their legislative agendas. Most commonly, MVSOs addressed issues related to disability evaluations and ratings with the Veterans Administration and access to Veterans Administration services. Other common themes identified as priorities include benefits such as retirement, education, housing assistance for veterans, and TRICARE benefits. Findings highlight the broad range of topics MVSOs identify as legislative priorities as well as some health issues that receive relatively limited attention. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

  15. Scaling-up health information systems to improve HIV treatment: An assessment of initial patient monitoring systems in Mozambique.

    Science.gov (United States)

    Hochgesang, Mindy; Zamudio-Haas, Sophia; Moran, Lissa; Nhampossa, Leopoldo; Packel, Laura; Leslie, Hannah; Richards, Janise; Shade, Starley B

    2017-01-01

    The rapid scale-up of HIV care and treatment in resource-limited countries requires concurrent, rapid development of health information systems to support quality service delivery. Mozambique, a country with an 11.5% prevalence of HIV, has developed nation-wide patient monitoring systems (PMS) with standardized reporting tools, utilized by all HIV treatment providers in paper or electronic form. Evaluation of the initial implementation of PMS can inform and strengthen future development as the country moves towards a harmonized, sustainable health information system. This assessment was conducted in order to 1) characterize data collection and reporting processes and PMS resources available and 2) provide evidence-based recommendations for harmonization and sustainability of PMS. This baseline assessment of PMS was conducted with eight non-governmental organizations that supported the Ministry of Health to provide 90% of HIV care and treatment in Mozambique. The study team conducted structured and semi-structured surveys at 18 health facilities located in all 11 provinces. Seventy-nine staff were interviewed. Deductive a priori analytic categories guided analysis. Health facilities have implemented paper and electronic monitoring systems with varying success. Where in use, robust electronic PMS facilitate facility-level reporting of required indicators; improve ability to identify patients lost to follow-up; and support facility and patient management. Challenges to implementation of monitoring systems include a lack of national guidelines and norms for patient level HIS, variable system implementation and functionality, and limited human and infrastructure resources to maximize system functionality and information use. This initial assessment supports the need for national guidelines to harmonize, expand, and strengthen HIV-related health information systems. Recommendations may benefit other countries with similar epidemiologic and resource

  16. Promoting interprofessionalism: initial evaluation of a master of science in health professions education degree program.

    Science.gov (United States)

    Lamba, Sangeeta; Strang, Aimee; Edelman, David; Navedo, Deborah; Soto-Greene, Maria L; Guarino, Anthony J

    2016-01-01

    This survey study assessed former students' perceptions on the efficacy of how well a newly implemented master's in health professions education degree program achieved its academic aims. These academic aims were operationalized by an author-developed scale to assess the following domains: a) developing interprofessional skills and identity; b) acquiring new academic skills; and c) providing a student-centered environment. The respondents represented a broad range of health care providers, including physicians, nurses, and occupational and physical therapists. Generalizability-theory was applied to partition the variance of the scores. Student's overwhelmingly responded that the program successfully achieved its academic aims.

  17. Soil-restoration rate and initial soil formation trends on example of anthropogenically affected soils of opencast mine in Kursk region, Russian Federation

    Science.gov (United States)

    Pigareva, Tatiana

    2015-04-01

    The mining industry is one of the main factors which anthropogenically change the environment. Mining process results in removing of the rocks and mechanical changes of considerable amounts of ground. One of the main results of mining arising of antropic ecosystems as well as increasing of the new created soils total area is technosols. The main factor controlling the soil formation in postmining environment is the quality of spoiled materials. Initial soil formation has been investigated on spoils of the largest iron ore extraction complex in Russia - Mikhailovsky mining and concentration complex which is situated in Kursk region, Russia. Investigated soils are presented by monogenetic weak developed soils of different age (10-15-20 years). Young soils are formed on the loess parent materials (20 year-old soil), or on a mix of sand and clay overburdens (15 and 10-year-old soils). Anthropogenically affected soils are characterized by well-developed humus horizon which is gradually replaced by weakly changed soil-building rocks (profile type A-C for 10-, 15-years old soils, and A-AC-C for 20 years old soils). Gray-humus soils are characterized by presence of diagnostic humus horizon gradually replaced by soil-building rock. The maximum intensity of humus accumulation has been determined in a semi-hydromorphic 10-year-old soil developed on the mixed heaps which is connected with features of water-air conditions complicating mineralization of plant remnants. 20-year-old soil on loess is characterized by rather high rate of organic substances accumulation between all the automorphous soils. It was shown that one of the most effective restoration ways for anthropogenically affected soils is a biological reclamation. Since overburdens once appeared on a day surface are overgrown badly in the first years, they are subject to influence of water and wind erosion. Our researchers have found out that permanent grasses are able to grow quickly; they accumulate a considerable

  18. The implementation of health care aimed at the cessation of tobacco use, treatment of tobacco dependence and consequences of tobacco consumption in the Russian Federation

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    S. A. Boytsov

    2016-01-01

    Full Text Available The summarizing of the experience of medical care at the cessation of tobacco use and the treatment of tobacco addiction and consequences of tobacco consumption in the Russian Federation (RF as well as suggestions for their improvement are presented.For the effective implementation of health care, aimed at the cessation of tobacco use, treatment of tobacco addiction and consequences of tobacco consumption in the RF it is necessary to solve the following problems:to include doctors of all specialties in the process of medical care and treatment oftobacco addiction and consequences oftobacco consumption in the RF; to ensure effective implementation of the existing legal documents determining the procedure for providing medical aid, aimed at ending the use of tobacco, treatment of tobacco dependence and consequences of tobacco consumption, greater control over their performance and quality of their implementation; to expand of the network of medical offices for cessation of tobacco consumption on the basis of existing structures in primary health care settings (including women's and children’s outpatient clinics, as well as hospitals and health resorts, their provision of personnel and equipment, introduction of group forms of work; to ensure a permanent system of training on assistance at the cessation of tobacco consumption, the treatment of tobacco dependence and consequences of tobacco consumption, including the introduction of medical assistance cycle on cessation of tobacco consumption for student training in medical schools and programs for postgraduate education of health professionals

  19. [The 'Myozyme' decision of the Federal Supreme Court of Switzerland and German Law: a constitutional rights and health insurance law perspective].

    Science.gov (United States)

    Huster, Stefan; Bohmeier, André

    2012-01-01

    In November 2010, the Federal Supreme Court of Switzerland dismissed a plea seeking reimbursement for treatment of glycogen storage disease type II - a very rare genetic metabolic disease also referred to as acid maltase deficiency (AMD) or Pompe disease -with a drug called 'Myozyme'. The Court held that the medication was not sufficiently effective or, alternatively, there was insufficient evidence for its effectiveness. The Court argued that the cost was out of balance with respect to the effects of the drug and concluded that it would be against the principle of legal equality if taxpayers were required to defray excessive expenses benefiting only an extremely small fraction of the population. Cost-effectiveness, however, cannot be accepted as a standard criterion governing the allocation of health insurance benefits because diversity of individual health must be regarded as a risk which nature has distributed equally among the members of the population. Therefore, it is a manifestation, rather than a violation, of the principle of legal equality that a public health insurance provider should pay for medical treatment in a particular case even if such treatment could not necessarily be administered to all other insured parties as well. At the same time, if cost-effectiveness in public health care is taken into account carefully, the risk of irrational resource allocation may be minimised. (As supplied by publisher).

  20. Avaliação de iniciativas e programas intersetoriais em saúde: desafios e aprendizados Evaluation of initiatives and intersectorial programs in health: challenges and learning

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    Rosana Magalhães

    2009-06-01

    Full Text Available O objetivo deste artigo é contribuir para a avaliação das iniciativas voltadas para a construção de arranjos intersetoriais no âmbito das políticas públicas de saúde e de proteção social. São tomados como focos analíticos a iniciativa de Desenvolvimento Local Integrado e Sustentável de Manguinhos (DLIS-Manguinhos - uma proposta de base territorial e comunitária associada à estratégias de colaboração e negociação bottom up- e a experiência de implementação do programa federal de transferência condicionada de renda Bolsa Família (PBF. Nesta perspectiva, aspectos ligados às redes de mobilização social, perfil dos atores envolvidos, tipos de incentivos e níveis de integração institucional são tratados como elementos cruciais para a análise do alcance de programas e iniciativas que articulam propostas intersetoriais. Conclui-se que a interface e o diálogo entre pesquisa, avaliação e acompanhamento de processos decisórios constituem eixos centrais para o maior aprendizado social e institucional na área.The objective of his article is to contribute to the evaluation of the initiatives aimed at the creation of intersectorial arrangements in the scope of public health policies and social protection. The focus is on the Integrated and Sustainable Local Development of Manguinhos (DLIS-Manguinhos - a territory and community based proposal associated to bottom up cooperation and negotiation strategies - and the experience of establishing the conditioned cash transference federal program called Bolsa Família (Family Grant Program - PBF. In this perspective, the aspects related to social mobilization networks, profile of the players involved, types of incentive and levels of institutional integration are treated as crucial elements in the analysis of the programs and initiatives that articulate intersectorial proposals. It is concluded that the interface and dialog among research, evaluation and follow up of decision