Educational Inequalities in Exit from Paid Employment among Dutch Workers: The Influence of Health, Lifestyle and Work.

Science.gov (United States)

Robroek, Suzan J W; Rongen, Anne; Arts, Coos H; Otten, Ferdy W H; Burdorf, Alex; Schuring, Merel

2015-01-01

Individuals with lower socioeconomic status are at increased risk of involuntary exit from paid employment. To give sound advice for primary prevention in the workforce, insight is needed into the role of mediating factors between socioeconomic status and labour force participation. Therefore, it is aimed to investigate the influence of health status, lifestyle-related factors and work characteristics on educational differences in exit from paid employment. 14,708 Dutch employees participated in a ten-year follow-up study during 1999-2008. At baseline, education, self-perceived health, lifestyle (smoking, alcohol, sports, BMI) and psychosocial (demands, control, rewards) and physical work characteristics were measured by questionnaire. Employment status was ascertained monthly based on tax records. The relation between education, health, lifestyle, work-characteristics and exit from paid employment through disability benefits, unemployment, early retirement and economic inactivity was investigated by competing risks regression analyses. The mediating effects of these factors on educational differences in exit from paid employment were tested using a stepwise approach. Lower educated workers were more likely to exit paid employment through disability benefits (SHR:1.84), unemployment (SHR:1.74), and economic inactivity (SHR:1.53) but not due to early retirement (SHR:0.92). Poor or moderate health, an unhealthy lifestyle, and unfavourable work characteristics were associated with disability benefits and unemployment, and an unhealthy lifestyle with economic inactivity. Educational differences in disability benefits were explained for 40% by health, 31% by lifestyle, and 12% by work characteristics. For economic inactivity and unemployment, up to 14% and 21% of the educational differences could be explained, particularly by lifestyle-related factors. There are educational differences in exit from paid employment, which are partly mediated by health, lifestyle and work

The effects of ill health on entering and maintaining paid employment: evidence in European countries.

Science.gov (United States)

Schuring, Merel; Burdorf, Lex; Kunst, Anton; Mackenbach, Johan

2007-07-01

To examine the effects of ill health on selection into paid employment in European countries. Five annual waves (1994-8) of the European Community Household Panel were used to select two populations: (1) 4446 subjects unemployed for at least 2 years, of which 1590 (36%) subjects found employment in the next year, and (2) 57 436 subjects employed for at least 2 years, of which 6191 (11%) subjects left the workforce in the next year because of unemployment, (early) retirement or having to take care of household. The influence of a perceived poor health and a chronic health problem on employment transitions was studied using logistic regression analysis. An interaction between health and sex was observed, with women in poor health (odds ratio (OR) 0.4), men in poor health (OR 0.6) and women (OR 0.6) having less chance to enter paid employment than men in good health. Subjects with a poor health and low/intermediate education had the highest risks of unemployment or (early) retirement. Taking care of the household was only influenced by health among unmarried women. In most European countries, a poor health or a chronic health problem predicted staying or becoming unemployed and the effects of health were stronger with a lower national unemployment level. In most European countries, socioeconomic inequalities in ill health were an important determinant for entering and maintaining paid employment. In public health measures for health equity, it is of paramount importance to include people with poor health in the labour market.

Pre-fire planning for nuclear power plants

International Nuclear Information System (INIS)

Talbert, J.H.

1980-01-01

Regardless of the fire prevention measures which are taken, plant experience indicates that fires will occur in a nuclear power plant. When a fire occurs, the plant staff must handle the fire emergency. Pre-fire planning is a method of developing detailed fire attack plans and salvage operations to protect equipment from damage due to fire and fire fighting operations. This paper describes the purpose and use of a pre-fire plan to achieve these goals in nuclear power plants

Barriers to maternal workforce participation and relationship between paid work and health.

Science.gov (United States)

Bourke-Taylor, H; Howie, L; Law, M

2011-05-01

Families of children with disabilities experience extra financial strains, and mothers are frequently unable to participate in paid work because of caregiving obligations. A mailed survey and follow-up phone calls were used to gather data about mother's health, workforce participation and barriers to inclusion in the workplace (n = 152). Verbatim reports of issues that hindered workforce participation were analysed qualitatively to derive themes. Maternal health-related quality of life (HRQoL) was measured using the Short Form Health Survey Version 2 (SF-36v2). Norm-based conversions were used to compare HRQoL between working and non-working mothers and to compare to population norms. Eighty-two per cent of mothers in the sample wanted and needed to work for pay but indicated over 300 issues that prevent their work participation. Data analysis revealed 26 common issues which prevent work participation. These issues fit into three main categories: mother-related reasons (28%), child-related reasons (29%) and service limitations (43%). Mothers who worked (n = 83) reported significantly better HRQoL than mothers who did not work (n = 69) on five of the eight SF-36v2 dimensions and overall mental health. Compared to other working Australians, mothers in this study had higher education yet reported poorer health, lower family income and lower workforce participation. Respondents reported that service system limitations were the main barriers to participation in the paid workforce. Investigation of service changes such as increased respite care, availability of outside hours school care, improved professional competency and family-centred services is recommended in order to improve maternal participation in paid work. © 2011 The Authors. Journal of Intellectual Disability Research © 2011 Blackwell Publishing Ltd.

Determinants for employer-paid health insurance coverage: a population-based study of the Danish labour force

DEFF Research Database (Denmark)

Christensen, Ann Demant; Søgaard, Rikke

2013-01-01

AIM: In 2002, the Danish tax law was changed, giving employees a tax exemption on supplemental, employer-paid health insurance. This might have conflicted with one of the key foundations of the healthcare system, namely equal access for equal needs. The aim of this study was to investigate...... determinants for employer-paid health insurance coverage. Because the policy change affected only people who were part of the labour force and because the public sector at that time had no tradition of providing fringe benefits, the analysis was restricted to the private labour force. METHOD: The analysis...... employer-paid health insurance coverage. RESULTS: The individuals who were most likely to be insured were those employed in foreign companies as mid-level managers within the field of building and construction. Other important variables were the number of persons employed in a company, gender, ethnicity...

Housework, paid work and psychiatric symptoms

Directory of Open Access Journals (Sweden)

Vilma S Santana

2001-02-01

Full Text Available OBJECTIVE: To evaluate the hypothesis that work burden, the simultaneous engagement in paid work and unpaid family housework, is a potential risk factor for psychiatric symptoms among women. METHODS: A cross-sectional study was carried out with 460 women randomly selected from a poor area of the city of Salvador, Brazil. Women between 18 to 70 years old, who reported having a paid occupation or were involved in unpaid domestic activities for their families, were eligible. Work burden-related variables were defined as: a double work shift, i.e., simultaneous engagement in a paid job plus unpaid housework; and b daily working time. Psychiatric symptoms were collected through a validated questionnaire, the QMPA. RESULTS: Positive, statistically significant associations between high (>7 symptoms QMPA scores and either double work shift (prevalence ratio -- PR=2.04, 95% confidence interval -- CI: 1.16, 2.29 or more than 10 hours of daily work time (PR=2.29, 95% CI: 1.96, 3.43 were found after adjustment for age, marital status and number of pre-school children. CONCLUSIONS: Major correlates of high QMPA scores are work burden variables. Being married or having pre-school children are also associated with high QMPA scores only when associated with work burden.

Barriers to Maternal Workforce Participation and Relationship between Paid Work and Health

Science.gov (United States)

Bourke-Taylor, H.; Howie, L.; Law, M.

2011-01-01

Background: Families of children with disabilities experience extra financial strains, and mothers are frequently unable to participate in paid work because of caregiving obligations. Methods: A mailed survey and follow-up phone calls were used to gather data about mother's health, workforce participation and barriers to inclusion in the workplace…

Population Health and Paid Parental Leave: What the United States Can Learn from Two Decades of Research

Directory of Open Access Journals (Sweden)

Adam Burtle

2016-06-01

Full Text Available Over the last two decades, numerous studies have suggested that dedicated time for parents to be with their children in the earliest months of life offers significant benefits to child health. The United States (US is the only wealthy nation without a formalized policy guaranteeing workers paid time off when they become new parents. As individual US states consider enacting parental leave policies, there is a significant opportunity to decrease health inequities and build a healthier American population. This document is intended as a critical review of the present evidence for the association between paid parental leave and population health.

Population Health and Paid Parental Leave: What the United States Can Learn from Two Decades of Research.

Science.gov (United States)

Burtle, Adam; Bezruchka, Stephen

2016-06-01

Over the last two decades, numerous studies have suggested that dedicated time for parents to be with their children in the earliest months of life offers significant benefits to child health. The United States (US) is the only wealthy nation without a formalized policy guaranteeing workers paid time off when they become new parents. As individual US states consider enacting parental leave policies, there is a significant opportunity to decrease health inequities and build a healthier American population. This document is intended as a critical review of the present evidence for the association between paid parental leave and population health.

The benefits of paid employment among persons with common mental health problems: evidence for the selection and causation mechanism.

Science.gov (United States)

Schuring, Merel; Robroek, Suzan Jw; Burdorf, Alex

2017-11-01

Objectives The aims of this study were to (i) investigate the impact of paid employment on self-rated health, self-esteem, mastery, and happiness among previously unemployed persons with common mental health problems, and (ii) determine whether there are educational inequalities in these effects. Methods A quasi-experimental study was performed with a two-year follow-up period among unemployed persons with mental health problems. Eligible participants were identified at the social services departments of five cities in The Netherlands when being diagnosed with a common mental disorder, primarily depression and anxiety disorders, in the past 12 months by a physician (N=749). Employment status (defined as paid employment for ≥12 hours/week), mental health [Short Form 12 (SF-12)], physical health (SF-12), self-esteem, mastery, and happiness were measured at baseline, after 12 months and 24 months. The repeated-measurement longitudinal data were analyzed using a hybrid method, combining fixed and random effects. The regression coefficient was decomposed into between- and within-individual associations, respectively. Results The between-individuals associations showed that persons working ≥12 hours per week reported better mental health (b=26.7, SE 5.1), mastery (b=2.7, SE 0.6), self-esteem (b=5.7, SE 1.1), physical health (b=14.6, SE 5.6) and happiness (OR 7.7, 95% CI 2.3-26.4). The within-individual associations showed that entering paid employment for ≥12 hours per week resulted in better mental health (b=16.3, SE 3.4), mastery (b=1.7, SE 0.4), self-esteem (b=3.4, SE 0.7), physical health (b=9.8, SE 2.9), and happiness (OR 3.1, 95% CI 1.4-6.9). Among intermediate- and high-educated persons, entering paid employment had significantly larger effect on mental health than among low-educated persons. Conclusions This study provides evidence that entering paid employment has a positive impact on self-reported health; thus work should be considered as an important

The importance of pre-planning for large hydrostatic test programs

Energy Technology Data Exchange (ETDEWEB)

Bennett, Andrew Keith [WorleyParsons Calgary, Calgary, AB (Canada); Wong, Everett Clementi [Enbridge Pipelines Inc., Edmonton, AB (Canada)

2010-07-01

During the design phase of a pipeline project, large hydrostatic test programs are required to locate and secure water sources. Many companies complete hydrostatic test planning through high level desktop analysis, however this technique can result in important unplanned costs and schedule delays. The aim of this paper is to assess the cost benefits of pre-planning large hydrostatic test programs versus the costs of unplanned delays in the execution of hydrostatic testing. This comparison was based on the successful application of pre-planning of 57 mainline hydrostatic tests in the construction of the Line 4 Extension and Alberta Clipper Expansion oil pipelines by Enbridge Pipelines Inc. Results showed that costs of delays and uncertainty during construction far outweigh the costs of pre-planning. This study highlighted that pre-planning for large hydrostatic test programs should be carried out in the execution of large pipeline projects to ensure success.

Is being in paid work beyond state pension age beneficial for health? Evidence from England using a life-course approach

Science.gov (United States)

Corna, Laurie M; Worts, Diana; McDonough, Peggy; Sacker, Amanda; Price, Debora; Glaser, Karen

2017-01-01

Background Given the current policy emphasis in many Western societies on extending working lives, we investigated the health effects of being in paid work beyond state pension age (SPA). Until now, work has largely focused on the health of those who exit the labour force early. Methods Our data come from waves 2–4 of the English Longitudinal Study of Ageing, including the life history interview at wave 3. Using logistic and linear regression models, we assessed the longitudinal associations between being in paid work beyond SPA and 3 measures of health (depression, a latent measure of somatic health and sleep disturbance) among men aged 65–74 and women aged 60–69. Our analyses controlled for baseline health and socioeconomic characteristics, as well as for work histories and health in adulthood and childhood. Results Approximately a quarter of women and 15% of men were in paid work beyond SPA. Descriptive bivariate analyses suggested that men and women in paid work were more likely to report better health at follow-up. However, once baseline socioeconomic characteristics as well as adulthood and baseline health and labour market histories were accounted for, the health benefits of working beyond SPA were no longer significant. Conclusions Potential health benefits of working beyond SPA need to be considered in the light of the fact that those who report good health and are more socioeconomically advantaged are more likely to be working beyond SPA to begin with. PMID:27940656

Decentralized Planning for Pre-Conflict and Post-Conflict ...

African Journals Online (AJOL)

Decentralized Planning for Pre-Conflict and Post-Conflict Management in the Bawku Municipal ... institutional arrangements for conflict monitoring and evaluation. Such processes are 'sine qua non' to pre-conflict and post-conflict prevention.

[Socio-demographic and health conditions associated with paid work in adults (50-69 years) in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil].

Science.gov (United States)

Castro, Camila Menezes Sabino de; Mambrini, Juliana Vaz de Melo; Sampaio, Rosana Ferreira; Macinko, James; Lima-Costa, Maria Fernanda

2015-08-01

Factors associated with paid work were examined in a probabilistic sample of 3,320 adults (50-69 years) in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. Prevalence of paid work was 62.8% in men and 35.8% in women. For both men and women, paid work was positively associated with schooling and negatively associated with self-rated health. The probability of having paid work was higher for single women and those who knew someone that had suffered discrimination at the workplace. For men, prevalence of paid work varied from 67.2% in those with ≥ 8 years of schooling and better self-rated health, as compared to 37.8% in those with less schooling and poor self-rated health (PR = 0.56; 95%CI: 0.37-0.87). In women, the corresponding prevalence rates were 42.1% and 3.6% (PR = 0.09; 95%CI: 0.03-0.26). For women with little schooling and poor self-rated health, the likelihood of having paid work was ten times lower than for their male counterparts.

Evaluation of a comprehensive employee wellness program at an organization with a consumer-directed health plan.

Science.gov (United States)

Burton, Wayne N; Chen, Chin-Yu; Li, Xingquan; Schultz, Alyssa B; Kasiarz, David; Edington, Dee W

2014-04-01

Consumer-directed health plans (CDHPs) are popular among employers in the United States. This study examined an employee wellness program and its association with employee health in an organization that recently initiated a CDHP. This retrospective observational analysis compared the health risks, employer-paid health care costs, and short-term disability absences of employees of a large financial services corporation from 2009 to 2010. The two-time health risk appraisal participants had a significant improvement in the percentage of employees in the overall low-risk category. The average annual employer-paid medical and pharmacy costs did not significantly change. For employees who improved their health risk category, there was a commensurate change in costs and absences. In a difficult economic climate, this organization began a health promotion program for employees as well as a new CDHP benefit structure. No short-term reduction in health care usage or overall health status was observed.

Awakening consumer stewardship of health benefits: prevalence and differentiation of new health plan models.

Science.gov (United States)

Rosenthal, Meredith; Milstein, Arnold

2004-08-01

consumer-directed health plans are in tiered models (primarily point-of-care tiered networks) rather than HRAs. Tiers are predominantly determined based on both cost and quality criteria. Enrollment in HRAs has grown substantially, in part because of the entry of mainstream managed care plans into the consumer-directed market. Health reimbursement accounts, tiered networks, and traditional managed care plans vary in their capacity to support consumers in managing their health risks and selection of provider and treatment options, with HRAs providing the most and mainstream plans the least. While enrollment in consumer-directed health plans continues to grow steadily, it remains a tiny fraction of all employer-sponsored coverage. Decision support in these plans, a critical link to help consumers make more informed choices, is also still limited. This lack may be of concern in light of the fact that only a minority of such plans report that they monitor claims to protect against underuse. Tiered benefit models appear to be more readily accepted by the market than HRAs. If they are to succeed in optimizing consumers' utility from health benefit spending, careful attention needs to be paid to how well these models inform consumers about the consequences of their selections.

Educational differences in trajectories of self-rated health before, during, and after entering or leaving paid employment in the European workforce.

Science.gov (United States)

Schuring, Merel; Robroek, Suzan J W; Lingsma, Hester F; Burdorf, Alex

2015-09-01

This study aimed to investigate (i) the influence of entering or leaving paid employment on self-rated health trajectories before, during, and after this transition and (ii) educational differences in these health trajectories. In this prospective study, we used yearly measurements of self-rated health from the European Community Household Panel (ECHP) to establish how health is affected by employment transitions in or out of the workforce due to early retirement, unemployment or economic inactivity. Trajectories of self-rated health were analyzed among 136 556 persons with low, intermediate, or high educational level by repeated-measures logistic regression with generalized estimating equations. Among low-educated workers, ill-health partly prompted their voluntary labor force exit through early retirement and becoming economically inactive, but thereafter these exit routes seemed to prevent further deterioration of their health. In contrast, among higher educated workers, early retirement had an adverse effect on their self-rated health. Becoming unemployed had adverse effects on self-rated health among all educational levels. Entering paid employment was predetermined by self-rated health improvement in the preceding years among intermediate and high educated workers, whereas, among low-educated workers, self-rated health improved in the year of entering paid employed and continued to improve in the following years. Prolonging working life may have both adverse and beneficial effects on self-rated health. Health inequalities may increase when every person, independent of educational level, must perform paid employment until the same age before being able to retire.

Decentralized Planning for Pre-Conflict and Post-Conflict ...

African Journals Online (AJOL)

2012-10-02

Oct 2, 2012 ... Such processes are 'sine qua non' to pre-conflict and post-conflict prevention. .... A Basic Approach to Pre-Conflict Management Planning ... and also factor in an evaluation of perception variables that help us to understand ...

The lack of paid sick leave as a barrier to cancer screening and medical care-seeking: results from the National Health Interview Survey

Directory of Open Access Journals (Sweden)

Peipins Lucy A

2012-07-01

Full Text Available Abstract Background Preventive health care services, such as cancer screening can be particularly vulnerable to a lack of paid leave from work since care is not being sought for illness or symptoms. We first describe the prevalence of paid sick leave by broad occupational categories and then examine the association between access to paid sick leave and cancer testing and medical care-seeking in the U.S. workforce. Methods Data from the 2008 National Health Interview survey were analyzed by using paid sick leave status and other health-related factors to describe the proportion of U.S. workers undergoing mammography, Pap testing, endoscopy, fecal occult blood test (FOBT, and medical-care seeking. Results More than 48 million individuals (38% in an estimated U.S. working population of 127 million did not have paid sick leave in 2008. The percentage of workers who underwent mammography, Pap test, endoscopy at recommended intervals, had seen a doctor during the previous 12 months or had at least one visit to a health care provider during the previous 12 months was significantly higher among those with paid sick leave compared with those without sick leave after controlling for sociodemographic and health-care-related factors. Conclusions Lack of paid sick leave appears to be a potential barrier to obtaining preventive medical care and is a societal benefit that is potentially amenable to change.

Constructing health and sickness in the context of motherhood and paid work.

Science.gov (United States)

Cunningham-Burley, Sarah; Backett-Milburn, Kathryn; Kemmer, Debbie

2006-05-01

Changes in the labour market, especially the rise in the employment of women (lone or partnered) with children, alongside an increased policy emphasis on work as a component of active citizenship for men and women, have stimulated the development of research examining the balance between work and home. Although sociologists have long been interested in the interface between the spheres of paid work and domestic life, understandings of the subjective experience of health and illness have tended to keep the domains of family and work separate. This paper addresses the construction of health and illness as operating at the interface between the worlds of work and home. Interviews were conducted with 30 mothers in paid work and having primary school aged children; the study was located in Edinburgh, Scotland. Through an analysis of the interview accounts, this paper examines respondents' experiences and constructions of health, sickness and wellbeing in themselves and in their children. Four areas are discussed: respondents' accounts of the effects of caring and providing on their own health; respondents' accounts of the influence of workplace relationships in the construction of sickness; respondents' accounts of negotiating absence for their children's sickness and how they made sense of and defined child sickness. We argue that managing sickness, itself an anticipated but unpredictable event, gives analytical purchase to understanding the values and practices that characterise the interrelationship between work and family life. The intersections of home and work operate powerfully in respondents' constructions of health and sickness, and the analysis demonstrates how these are played out in everyday life, at home and at work.

20 CFR 341.2 - Sum or damages paid or payable.

Science.gov (United States)

2010-04-01

...-Fault” personal-injury protection benefits or any other benefits paid under a health, sickness, accident... INSURANCE ACT STATUTORY LIEN WHERE SICKNESS BENEFITS PAID § 341.2 Sum or damages paid or payable. (a) The...

Is being in paid work beyond state pension age beneficial for health? Evidence from England using a life-course approach.

Science.gov (United States)

Di Gessa, Giorgio; Corna, Laurie M; Platts, Loretta G; Worts, Diana; McDonough, Peggy; Sacker, Amanda; Price, Debora; Glaser, Karen

2017-05-01

Given the current policy emphasis in many Western societies on extending working lives, we investigated the health effects of being in paid work beyond state pension age (SPA). Until now, work has largely focused on the health of those who exit the labour force early. Our data come from waves 2-4 of the English Longitudinal Study of Ageing, including the life history interview at wave 3. Using logistic and linear regression models, we assessed the longitudinal associations between being in paid work beyond SPA and 3 measures of health (depression, a latent measure of somatic health and sleep disturbance) among men aged 65-74 and women aged 60-69. Our analyses controlled for baseline health and socioeconomic characteristics, as well as for work histories and health in adulthood and childhood. Approximately a quarter of women and 15% of men were in paid work beyond SPA. Descriptive bivariate analyses suggested that men and women in paid work were more likely to report better health at follow-up. However, once baseline socioeconomic characteristics as well as adulthood and baseline health and labour market histories were accounted for, the health benefits of working beyond SPA were no longer significant. Potential health benefits of working beyond SPA need to be considered in the light of the fact that those who report good health and are more socioeconomically advantaged are more likely to be working beyond SPA to begin with. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

An Analysis of Paid Family and Sick Leave Advocacy in Louisiana: Lessons Learned.

Science.gov (United States)

Raabe, Phyllis Hutton; Theall, Katherine P

2016-01-01

In contrast with other developed countries, the United States lacks national paid maternity/family and sick leave policies, negatively impacting the health and economic security of both female and male workers and their children. Employer paid family and sick leave policies cover only about half of workers, and those lacking paid leaves are more likely to be less educated and with lower incomes. Louisiana has high proportions of poor and low income workers who especially would benefit from national or state paid leave policies. In the absence of national paid leaves, several states and cities have implemented paid family and sick leaves. In this context and following the American Public Health Association's endorsement of paid family and sick leaves for health and wellbeing, the Tulane University Mary Amelia Women's Center decided to advocate for paid leave policies in Louisiana. Highlights of a Louisiana spring 2015 initiative were a talk by the President of the Institute for Women's Policy Research on the economic and health benefits of paid family and sick leaves and bills submitted by a State Senator. As has happened elsewhere, opposition from businesses and Republican legislators blocked passage. This outcome fit the Center's original expectations that communicating about the important health and other benefits of paid family and sick leaves, and developing support for state-wide policies, would be a long process-but one important to begin. The initiative in Louisiana may provide insights for paid leave advocacy elsewhere. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Paid parental leave and family wellbeing in the sustainable development era.

Science.gov (United States)

Heymann, Jody; Sprague, Aleta R; Nandi, Arijit; Earle, Alison; Batra, Priya; Schickedanz, Adam; Chung, Paul J; Raub, Amy

2017-01-01

The Sustainable development goals (SDGs) have the potential to have a significant impact on maternal and child health through their commitments both to directly addressing health services and to improving factors that form the foundation of social determinants of health. To achieve change at scale, national laws and policies have a critical role to play in implementing the SDGs' commitments. One particular policy that could advance a range of SDGs and importantly improve maternal and infant health is paid parental leave. This article analyzes literature on paid leave and related policies relevant to SDG 1 (poverty), SDG 3 (health), SDG 5 (gender equality), SDG 8 (decent work), and SDG 10 (inequality). In addition, this article presents global data on the prevalence of policies in all 193 UN Member States. A review of the literature finds that paid parental leave may support improvements across a range of SDG outcomes relevant to maternal and child health. Across national income levels, paid leave has been associated with lower infant mortality and higher rates of immunizations. In high-income countries, studies have found that paid leave increases exclusive breastfeeding and may improve women's economic outcomes. However, factors including the duration of leave, the wage replacement rate, and whether leave is made available to both parents importantly shape the impacts of paid leave policies. While most countries now offer at least some paid maternal leave, many provide less than the 6 months recommended for exclusive breastfeeding, and only around half as many provide paternal leave. To accelerate progress on the SDGs' commitments to maternal and child health, we should monitor countries' actions on enacting or strengthening paid leave policies. Further research is needed on the duration, wage replacement rate, and availability of leave before and after birth that would best support both child and parental health outcomes and social determinants of health more

Developing Health-Based Pre-Planning Clearance Goals for Airport Remediation Following Chemical Terrorist Attack: Introduction and Key Assessment Considerations

Science.gov (United States)

Watson, Annetta; Hall, Linda; Raber, Ellen; Hauschild, Veronique D.; Dolislager, Fredrick; Love, Adam H.; Hanna, M. Leslie

2011-01-01

In the event of a chemical terrorist attack on a transportation hub, post-event remediation and restoration activities necessary to attain unrestricted facility reuse and re-entry could require hours to multiple days. While restoration timeframes are dependent on numerous variables, a primary controlling factor is the level of pre-planning and decision-making completed prior to chemical terrorist release. What follows is the first of a two-part analysis identifying key considerations, critical information, and decision criteria to facilitate post-attack and post-decontamination consequence management activities. A conceptual site model and human health-based exposure guidelines are developed and reported as an aid to site-specific pre-planning in the current absence of U.S. state or Federal values designated as compound-specific remediation or re-entry concentrations, and to safely expedite facility recovery to full operational status. Chemicals of concern include chemical warfare nerve and vesicant agents and the toxic industrial compounds phosgene, hydrogen cyanide, and cyanogen chloride. This work has been performed as a national case study conducted in partnership with the Los Angeles International Airport and The Bradley International Terminal. All recommended guidelines have been selected for consistency with airport scenario release parameters of a one-time, short-duration, finite airborne release from a single source followed by compound-specific decontamination. PMID:21390292

Developing Health-Based Pre-Planning Clearance Goals for Airport Remediation Following Chemical Terrorist Attack: Introduction and Key Assessment Considerations.

Science.gov (United States)

Watson, Annetta; Hall, Linda; Raber, Ellen; Hauschild, Veronique D; Dolislager, Fredrick; Love, Adam H; Hanna, M Leslie

2011-02-13

In the event of a chemical terrorist attack on a transportation hub, post-event remediation and restoration activities necessary to attain unrestricted facility reuse and re-entry could require hours to multiple days. While restoration timeframes are dependent on numerous variables, a primary controlling factor is the level of pre-planning and decision-making completed prior to chemical terrorist release. What follows is the first of a two-part analysis identifying key considerations, critical information, and decision criteria to facilitate post-attack and post-decontamination consequence management activities. A conceptual site model and human health-based exposure guidelines are developed and reported as an aid to site-specific pre-planning in the current absence of U.S. state or Federal values designated as compound-specific remediation or re-entry concentrations, and to safely expedite facility recovery to full operational status. Chemicals of concern include chemical warfare nerve and vesicant agents and the toxic industrial compounds phosgene, hydrogen cyanide, and cyanogen chloride. This work has been performed as a national case study conducted in partnership with the Los Angeles International Airport and The Bradley International Terminal. All recommended guidelines have been selected for consistency with airport scenario release parameters of a one-time, short-duration, finite airborne release from a single source followed by compound-specific decontamination.

Learners’ processes during pre-task planning and Working Memory Capacity

Directory of Open Access Journals (Sweden)

Maria da Gloria Tavares

2016-01-01

Full Text Available http://dx.doi.org/10.5007/2175-8026.2016v69n1p79 The present study is part of a larger scale research (Guará-Tavares, 2011, 2013 that investigates the relationship among working memory capacity, pre-task planning, and L2 speech performance. The aim of the study was to analyze 1 what processes learners engage during pre-task planning, and 2 whether higher and lower working memory spans engage in different processes during pre-task planning. Learners’ processes were accessed by means of think aloud protocols and a retrospective interview. Working memory capacity was measured by the Speaking Span Test. Results show that learners engage mainly in organization of ideas, rehearsal, lexical searches, and monitoring.. Moreover, higher spans employ significantly more metacognitive strategies during planning when compared to lower spans.

Pre-Class Planning for Individualized Accounting

Science.gov (United States)

Clayton, Dean; Brooke, Joyce Ann

1974-01-01

Pre-class planning of individualized accounting is involved with goals, objectives, and activities developed and selected by the teacher in providing compatibility between accounting content and teaching strategy. A systematic arrangement of activities should be developed so that students can understand and apply accounting principles at their own…

The effects of ill health on entering and maintaining paid employment: Evidence in European countries

NARCIS (Netherlands)

M. Schuring (Merel); A. Burdorf (Alex); A.E. Kunst (Anton); J.P. Mackenbach (Johan)

2007-01-01

textabstractObjectives: To examine the effects of ill health on selection into paid employment in European countries. Methods: Five annual waves (1994-8) of the European Community Household Panel were used to select two populations: (1) 4446 subjects unemployed for at least 2 years, of which 1590

The effects of ill health on entering and maintaining paid employment: evidence in European countries

NARCIS (Netherlands)

Schuring, Merel; Burdorf, Lex; Kunst, Anton; Mackenbach, Johan

2007-01-01

OBJECTIVES: To examine the effects of ill health on selection into paid employment in European countries. METHODS: Five annual waves (1994-8) of the European Community Household Panel were used to select two populations: (1) 4446 subjects unemployed for at least 2 years, of which 1590 (36%) subjects

The potential and peril of health insurance tobacco surcharge programs: evidence from Georgia's State Employees' Health Benefit Plan.

Science.gov (United States)

Liber, Alex C; Hockenberry, Jason M; Gaydos, Laura M; Lipscomb, Joseph

2014-06-01

A rapidly growing number of U.S. employers are charging health insurance surcharges for tobacco use to their employees. Despite their potential to price-discriminate, little systematic empirical evidence of the impacts of these tobacco surcharges has been published. We attempted to assess the impact of a health insurance surcharge for tobacco use on cessation among enrollees in Georgia's State Health Benefit Plan (GSHBP). We identified a group of enrollees in GSHBP who began paying the tobacco surcharge at the program's inception in July 2005. We examined the proportion of these enrollees who certified themselves and their family members as tobacco-free and no longer paid the surcharge through April 2011, and we defined this as implied cessation. We compared this proportion to a national expected annual 2.6% cessation rate. We also compared our observation group to a comparison group to assess surcharge avoidance. By April 2011, 45% of enrollees who paid a tobacco surcharge starting in July 2005 had certified themselves as tobacco-free. This proportion exceeded the expected cessation based on 3 times the national rate (p health insurance surcharges in changing behavior, are tempered by the important limitation that enrollees' certification of quitting was self-reported and not subject to additional, clinical verification.

The Effects of Pre-Task Planning and On-line Planning on Fluency, Complexity, and Accuracy in L2 Monologic Oral Production.

Science.gov (United States)

Yuan, Fangyuan; Ellis, Rod

2003-01-01

Investigated the effects of both pre-task and on-line planning on second language (L2) oral production. Results show that pre-task planning enhances grammatical complexity while on-line planning positively influences accuracy and grammatical complexity. Pre-task planners also produced more fluent and lexically varied language than the on-line…

Who plans for health improvement? SEA, HIA and the separation of spatial planning and health planning

International Nuclear Information System (INIS)

Bond, Alan; Cave, Ben; Ballantyne, Rob

2013-01-01

This study examines whether there is active planning for health improvement in the English spatial planning system and how this varies across two regions using a combination of telephone surveys and focus group interviews in 2005 and 2010. The spatial planning profession was found to be ill-equipped to consider the health and well-being implications of its actions, whilst health professionals are rarely engaged and have limited understanding and aspirations when it comes to influencing spatial planning. Strategic Environmental Assessment was not considered to be successful in integrating health into spatial plans, given it was the responsibility of planners lacking the capacity to do so. For their part, health professionals have insufficient knowledge and understanding of planning and how to engage with it to be able to plan for health gains rather than simply respond to health impacts. HIA practice is patchy and generally undertaken by health professionals outside the statutory planning framework. Thus, whilst appropriate assessment tools exist, they currently lack a coherent context within which they can function effectively and the implementation of the Kiev protocol requiring the engagement of health professionals in SEA is not to likely improve the consideration of health in planning while there continues to be separation of functions between professions and lack of understanding of the other profession. -- Highlights: ► Health professionals have limited aspirations for health improvement through the planning system. ► Spatial planners are ill-equipped to understand the health and well-being implications of their activities. ► SEA and HIA currently do not embed health consideration in planning decisions. ► The separation of health and planning functions is problematic for the effective conduct of SEA and/or HIA

Who plans for health improvement? SEA, HIA and the separation of spatial planning and health planning

Energy Technology Data Exchange (ETDEWEB)

Bond, Alan, E-mail: alan.bond@uea.ac.uk [InteREAM (Interdisciplinary Research in Environmental Assessment and Management), School of Environmental Sciences, University of East Anglia, Norwich, NR4 7TJ (United Kingdom); Cave, Ben, E-mail: ben.cave@bcahealth.co.uk [Ben Cave Associates Ltd., Leeds (United Kingdom); Ballantyne, Rob, E-mail: robdballantyne@gmail.com [Planning and Health Consultant, Oxfordshire (United Kingdom)

2013-09-15

This study examines whether there is active planning for health improvement in the English spatial planning system and how this varies across two regions using a combination of telephone surveys and focus group interviews in 2005 and 2010. The spatial planning profession was found to be ill-equipped to consider the health and well-being implications of its actions, whilst health professionals are rarely engaged and have limited understanding and aspirations when it comes to influencing spatial planning. Strategic Environmental Assessment was not considered to be successful in integrating health into spatial plans, given it was the responsibility of planners lacking the capacity to do so. For their part, health professionals have insufficient knowledge and understanding of planning and how to engage with it to be able to plan for health gains rather than simply respond to health impacts. HIA practice is patchy and generally undertaken by health professionals outside the statutory planning framework. Thus, whilst appropriate assessment tools exist, they currently lack a coherent context within which they can function effectively and the implementation of the Kiev protocol requiring the engagement of health professionals in SEA is not to likely improve the consideration of health in planning while there continues to be separation of functions between professions and lack of understanding of the other profession. -- Highlights: ► Health professionals have limited aspirations for health improvement through the planning system. ► Spatial planners are ill-equipped to understand the health and well-being implications of their activities. ► SEA and HIA currently do not embed health consideration in planning decisions. ► The separation of health and planning functions is problematic for the effective conduct of SEA and/or HIA.

Paid care work and depression

DEFF Research Database (Denmark)

Madsen, Ida E H; Aust, Birgit; Burr, Hermann

2012-01-01

Previous studies have reported that employees in paid care work (e.g., child, health, and elderly care) have increased rates of hospitalization with depression and treatment with antidepressants. It is unclear, however, whether these findings reflect a causal effect of the work on employee mental...

The economic consequences of reproductive health and family planning.

Science.gov (United States)

Canning, David; Schultz, T Paul

2012-07-14

We consider the evidence for the effect of access to reproductive health services on the achievement of Millennium Development Goals 1, 2, and 3, which aim to eradicate extreme poverty and hunger, achieve universal primary education, and promote gender equality and empower women. At the household level, controlled trials in Matlab, Bangladesh, and Navrongo, Ghana, have shown that increasing access to family planning services reduces fertility and improves birth spacing. In the Matlab study, findings from long-term follow-up showed that women's earnings, assets, and body-mass indexes, and children's schooling and body-mass indexes, substantially improved in areas with improved access to family planning services compared with outcomes in control areas. At the macroeconomic level, reductions in fertility enhance economic growth as a result of reduced youth dependency and an increased number of women participating in paid labour. Copyright © 2012 Elsevier Ltd. All rights reserved.

Access to paid parental leave for academic surgeons.

Science.gov (United States)

Itum, Dina S; Oltmann, Sarah C; Choti, Michael A; Piper, Hannah G

2018-01-31

Parental leave is linked to health benefits for both child and parent. It is unclear whether surgeons at academic centers have access to paid parental leave. The aim of this study was to determine parental leave policies at the top academic medical centers in the United States to identify trends among institutions. The top academic medical centers were identified (US News & World Report 2016). Institutional websites were reviewed, or human resource departments were contacted to determine parental leave policies. "Paid leave" was defined as leave without the mandated use of personal time off. Institutions were categorized based on geographical region, funding, and ranking to determine trends regarding availability and duration of paid parental leave. Among the top 91 ranked medical schools, 48 (53%) offer paid parental leave. Availability of a paid leave policy differed based on private versus public institutions (70% versus 38%, P leaves (>6 wk) than public institutions (67% versus 33%; P = 0.02). No difference in paid leave duration was noted based on region (P = 0.60) or rank (P = 0.81). Approximately, 50% of top academic medical centers offer paid parental leave. Private institutions are more likely to offer paid leave and leave of longer duration. There is considerable variability in access to paid parenteral leave for academic surgeons. Copyright © 2018 Elsevier Inc. All rights reserved.

Socio-demographic and health conditions associated with paid work in adults (50-69 years) in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil

OpenAIRE

de Castro, CMS; Mambrini, JVDM; Sampaio, RF; Macinko, J; Lima-Costa, MF

2015-01-01

© 2015 Fundacao Oswaldo Cruz. All rights reserved. Factors associated with paid work were examined in a probabilistic sample of 3,320 adults (50-69 years) in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. Prevalence of paid work was 62.8% in men and 35.8% in women. For both men and women, paid work was positively associated with schooling and negatively associated with self-rated health. The probability of having paid work was higher for single women and those who knew someo...

Multi-centre audit of VMAT planning and pre-treatment verification.

Science.gov (United States)

Jurado-Bruggeman, Diego; Hernández, Victor; Sáez, Jordi; Navarro, David; Pino, Francisco; Martínez, Tatiana; Alayrach, Maria-Elena; Ailleres, Norbert; Melero, Alejandro; Jornet, Núria

2017-08-01

We performed a multi-centre intercomparison of VMAT dose planning and pre-treatment verification. The aims were to analyse the dose plans in terms of dosimetric quality and deliverability, and to validate whether in-house pre-treatment verification results agreed with those of an external audit. The nine participating centres encompassed different machines, equipment, and methodologies. Two mock cases (prostate and head and neck) were planned using one and two arcs. A plan quality index was defined to compare the plans and different complexity indices were calculated to check their deliverability. We compared gamma index pass rates using the centre's equipment and methodology to those of an external audit (global 3D gamma, absolute dose differences, 10% of maximum dose threshold). Log-file analysis was performed to look for delivery errors. All centres fulfilled the dosimetric goals but plan quality and delivery complexity were heterogeneous and uncorrelated, depending on the manufacturer and the planner's methodology. Pre-treatment verifications results were within tolerance in all cases for gamma 3%-3mm evaluation. Nevertheless, differences between the external audit and in-house measurements arose due to different equipment or methodology, especially for 2%-2mm criteria with differences up to 20%. No correlation was found between complexity indices and verification results amongst centres. All plans fulfilled dosimetric constraints, but plan quality and complexity did not correlate and were strongly dependent on the planner and the vendor. In-house measurements cannot completely replace external audits for credentialing. Copyright © 2017 Elsevier B.V. All rights reserved.

Introducing risk adjustment and free health plan choice in employer-based health insurance: Evidence from Germany.

Science.gov (United States)

Pilny, Adam; Wübker, Ansgar; Ziebarth, Nicolas R

2017-12-01

To equalize differences in health plan premiums due to differences in risk pools, the German legislature introduced a simple Risk Adjustment Scheme (RAS) based on age, gender and disability status in 1994. In addition, effective 1996, consumers gained the freedom to choose among hundreds of existing health plans, across employers and state-borders. This paper (a) estimates RAS pass-through rates on premiums, financial reserves, and expenditures and assesses the overall RAS impact on market price dispersion. Moreover, it (b) characterizes health plan switchers and investigates their annual and cumulative switching rates over time. Our main findings are based on representative enrollee panel data linked to administrative RAS and health plan data. We show that sickness funds with bad risk pools and high pre-RAS premiums lowered their total premiums by 42 cents per additional euro allocated by the RAS. Consequently, post-RAS, health plan prices converged but not fully. Because switchers are more likely to be white collar, young and healthy, the new consumer choice resulted in more risk segregation and the amount of money redistributed by the RAS increased over time. Copyright © 2017 Elsevier B.V. All rights reserved.

Developing Health-Based Pre-Planning Clearance Goals for Airport Remediation Following a Chemical Terrorist Attack: Decision Criteria for Multipathway Exposure Routes

Science.gov (United States)

Watson, Annetta; Dolislager, Fredrick; Hall, Linda; Raber, Ellen; Hauschild, Veronique D.; Love, Adam H.

2011-01-01

In the event of a chemical terrorist attack on a transportation hub, post-event remediation and restoration activities necessary to attain unrestricted facility re-use and re-entry could require hours to multiple days. While timeframes are dependent on numerous variables, a primary controlling factor is the level of pre-planning and decision-making completed prior to chemical release. What follows is the second of a two-part analysis identifying key considerations, critical information and decision criteria to facilitate post-attack and post-decontamination consequence management activities. Decision criteria analysis presented here provides first-time, open-literature documentation of multi-pathway, health-based remediation exposure guidelines for selected toxic industrial compounds, chemical warfare agents, and agent degradation products for pre-planning application in anticipation of a chemical terrorist attack. Guideline values are provided for inhalation and direct ocular vapor exposure routes as well as percutaneous vapor, surface contact, and ingestion. Target populations include various employees as well as transit passengers. This work has been performed as a national case study conducted in partnership with the Los Angeles International Airport and The Bradley International Terminal. All recommended guidelines have been selected for consistency with airport scenario release parameters of a one-time, short-duration, finite airborne release from a single source followed by compound-specific decontamination. PMID:21399674

The benefits of paid employment among persons with common mental health problems: Evidence for the selection and causation mechanism

NARCIS (Netherlands)

M. Schuring (Merel); S.J.W. Robroek (Suzan); A. Burdorf (Alex)

2017-01-01

textabstractObjectives The aims of this study were to (i) investigate the impact of paid employment on self-rated health, self-esteem, mastery, and happiness among previously unemployed persons with common mental health problems, and (ii) determine whether there are educational inequalities in these

Inconsistencies in the Roles of Family- and Paid- Carers in Monitoring Health Issues in People with Learning Disabilities: Some Implications for the Integration of Health and Social Care

Science.gov (United States)

Willis, Diane S.

2015-01-01

Changes in the living circumstances of people with learning disabilities have seen responsibility for their health become the provenance of paid-and family-carers. Thirteen semi-structured interviews were conducted with three family-carers and ten paid-carers. Findings revealed that the role of these carers was undefined, leading to difficulty in…

Community-level effect of the reproductive health vouchers program on out-of-pocket spending on family planning and safe motherhood services in Kenya.

Science.gov (United States)

Obare, Francis; Warren, Charlotte; Kanya, Lucy; Abuya, Timothy; Bellows, Ben

2015-08-25

Although vouchers can protect individuals in low-income countries from financial catastrophe and impoverishment arising from out-of-pocket expenditures on healthcare, their effectiveness in achieving this goal depends on whether both service and transport costs are subsidized as well as other factors such as service availability in a given locality and community perceptions about the quality of care. This paper examines the community-level effect of the reproductive health vouchers program on out-of-pocket expenditure on family planning, antenatal, delivery and postnatal care services in Kenya. Data are from two rounds of cross-sectional household surveys in voucher and non-voucher sites. The first survey was conducted between May 2010 and July 2011 among 2,933 women aged 15-49 years while the second survey took place between July and October 2012 among 3,094 women of similar age groups. The effect of the program on out-of-pocket expenditure is determined by difference-in-differences estimation. Analysis entails comparison of changes in proportions, means and medians as well as estimation of multivariate linear regression models with interaction terms between indicators for study site (voucher or non-voucher) and period of study (2010-2011 or 2012). There were significantly greater declines in the proportions of women from voucher sites that paid for antenatal, delivery and postnatal care services at health facilities compared to those from non-voucher sites. The changes were also consistent with increased uptake of the safe motherhood voucher in intervention sites over time. There was, however, no significant difference in changes in the proportions of women from voucher and non-voucher sites that paid for family planning services. The results further show that there were significant differences in changes in the amount paid for family planning and antenatal care services by women from voucher compared to those from non-voucher sites. Although there were greater

SU-F-T-617: Remotely Pre-Planned Stereotactic Ablative Radiation Therapy: Validation of Treatment Plan Quality

International Nuclear Information System (INIS)

Juang, T; Bush, K; Loo, B; Gensheimer, M

2016-01-01

Purpose: We propose a workflow to improve access to stereotactic ablative radiation therapy (SABR) for rural patients. When implemented, a separate trip to the central facility for simulation can be eliminated. Two elements are required: (1) Fabrication of custom immobilization devices to match positioning on prior diagnostic CT (dxCT). (2) Remote radiation pre-planning on dxCT, with transfer of contours/plan to simulation CT (simCT) and initiation of treatment same-day or next day. In this retrospective study, we validated part 2 of the workflow using patients already treated with SABR for upper lobe lung tumors. Methods: Target/normal structures were contoured on dxCT; a plan was created and approved by the physician. Structures were transferred to simCT using deformable image registration and the plan was re-optimized on simCT. Plan quality was evaluated through comparison to gold-standard structures contoured on simCT and a gold-standard plan based on these structures. Workflow-generated plan quality in this study represents a worst-case scenario as these patients were not treated using custom immobilization to match dxCT position as would be done when the workflow is implemented clinically. Results: 5/6 plans created through the pre-planning workflow were clinically acceptable. For all six plans, the gold-standard GTV received full prescription dose, along with median PTV V95%=95.2% and median PTV D95%=95.4%. Median GTV DSC=0.80, indicating high degree of similarity between the deformed and gold-standard GTV contours despite small GTV sizes (mean=3.0cc). One outlier (DSC=0.49) resulted in inadequate PTV coverage (V95%=62.9%) in the workflow plan; in clinical practice, this mismatch between deformed/gold-standard GTV would be revised by the physician after deformable registration. For all patients, normal tissue doses were comparable to the gold-standard plan and well within constraints. Conclusion: Pre-planning SABR cases on diagnostic imaging generated

Health Workforce Planning

Science.gov (United States)

Al-Sawai, Abdulaziz; Al-Shishtawy, Moeness M.

2015-01-01

In most countries, the lack of explicit health workforce planning has resulted in imbalances that threaten the capacity of healthcare systems to attain their objectives. This has directed attention towards the prospect of developing healthcare systems that are more responsive to the needs and expectations of the population by providing health planners with a systematic method to effectively manage human resources in this sector. This review analyses various approaches to health workforce planning and presents the Six-Step Methodology to Integrated Workforce Planning which highlights essential elements in workforce planning to ensure the quality of services. The purpose, scope and ownership of the approach is defined. Furthermore, developing an action plan for managing a health workforce is emphasised and a reviewing and monitoring process to guide corrective actions is suggested. PMID:25685381

Effects of Mental Health Parity on High Utilizers of Services: Pre-Post Evidence From a Large, Self-Insured Employer.

Science.gov (United States)

Grazier, Kyle L; Eisenberg, Daniel; Jedele, Jenefer M; Smiley, Mary L

2016-04-01

This study evaluated utilization of mental health and substance use services among enrollees at a large employee health plan following changes to benefit limits after passage in 2008 of federal mental health parity legislation. This study used a pre-post design. Benefits and claims data for 43,855 enrollees in the health plan in 2009 and 2010 were analyzed for utilization and costs after removal of a 30-visit cap on the number of covered mental health visits. There was a large increase in the proportion of health plan enrollees with more than 30 outpatient visits after the cap's removal, an increase of 255% among subscribers and 176% among dependents (pbenefit limit.

Paid maternity and paternity leave: rights and choices.

Science.gov (United States)

Jordan, Claire

2007-01-01

From April 2007 onwards, maternity leave will be raised to nine months Paid maternity leave is associated with significant health benefits for babies, including reduced infant mortality The Government proposes to increase paid maternity leave to one year and introduce additional paternity leave by around 2009 The U.K's provision for maternity leave and child care is more generous than the U.S.A. or Australia but less than in the Scandinavian countries

Understanding health insurance plans

Science.gov (United States)

... page: //medlineplus.gov/ency/patientinstructions/000879.htm Understanding health insurance plans To use the sharing features on this ... plan for you and your family. Types of Health Insurance Plans Depending on how you get your health ...

Light Duty Utility Arm system pre-operational (cold test) test plan

International Nuclear Information System (INIS)

Bennett, K.L.

1995-01-01

The Light Duty Utility (LDUA) Cold Test Facility, located in the Hanford 400 Area, will be used to support cold testing (pre- operational tests) of LDUA subsystems. Pre-operational testing is composed of subsystem development testing and rework activities, and integrated system qualification testing. Qualification testing will be conducted once development work is complete and documentation is under configuration control. Operational (hot) testing of the LDUA system will follow the testing covered in this plan and will be covered in a separate test plan

An analysis of pre-service family planning teaching in clinical and nursing education in Tanzania

OpenAIRE

Muganyizi, Projestine S; Ishengoma, Joyce; Kanama, Joseph; Kikumbih, Nassoro; Mwanga, Feddy; Killian, Richard; McGinn, Erin

2014-01-01

Background Promoting family planning (FP) is a key strategy for health, economic and population growth. Sub-Saharan Africa, with one of the lowest contraceptive prevalence and highest fertility rates globally, contributes half of the global maternal deaths. Improving the quality of FP services, including enhancing pre-service FP teaching, has the potential to improve contraceptive prevalence. In efforts to improve the quality of FP services in Tanzania, including provider skills, this study s...

Increased Duration of Paid Maternity Leave Lowers Infant Mortality in Low- and Middle-Income Countries: A Quasi-Experimental Study.

Science.gov (United States)

Nandi, Arijit; Hajizadeh, Mohammad; Harper, Sam; Koski, Alissa; Strumpf, Erin C; Heymann, Jody

2016-03-01

Maternity leave reduces neonatal and infant mortality rates in high-income countries. However, the impact of maternity leave on infant health has not been rigorously evaluated in low- and middle-income countries (LMICs). In this study, we utilized a difference-in-differences approach to evaluate whether paid maternity leave policies affect infant mortality in LMICs. We used birth history data collected via the Demographic and Health Surveys to assemble a panel of approximately 300,000 live births in 20 countries from 2000 to 2008; these observational data were merged with longitudinal information on the duration of paid maternity leave provided by each country. We estimated the effect of an increase in maternity leave in the prior year on the probability of infant (maternity was associated with 7.9 fewer infant deaths per 1,000 live births (95% CI 3.7, 12.0), reflecting a 13% relative reduction. Reductions in infant mortality associated with increases in the duration of paid maternity leave were concentrated in the post-neonatal period. Estimates were robust to adjustment for individual, household, and country-level characteristics, although there may be residual confounding by unmeasured time-varying confounders, such as coincident policy changes. More generous paid maternity leave policies represent a potential instrument for facilitating early-life interventions and reducing infant mortality in LMICs and warrant further discussion in the post-2015 sustainable development agenda. From a policy planning perspective, further work is needed to elucidate the mechanisms that explain the benefits of paid maternity leave for infant mortality.

Parenthood and Well-Being : The Moderating Role of Leisure and Paid Work

NARCIS (Netherlands)

Roeters, Anne; Mandemakers, Jornt; Voorpostel, Marieke

2016-01-01

This study contributes to our knowledge on the association between parenthood and psychological well-being by examining whether pre-parenthood lifestyles (leisure and paid work) moderate the transition to parenthood. We expected that people with less active lifestyles would find it easier to adapt

The Malaysian health care system: Ecology, plans, and reforms

Directory of Open Access Journals (Sweden)

Andrea Sebastian

2016-08-01

Full Text Available Malaysia is on its way to achieving developed nation status in the next 4 years. Currently, Malaysia is on track for three Millennium Development Goals (MDG1, MDG4, and MDG7. The maternal mortality rate, infant mortality rate, and mortality rate of children younger than 5 years improved from 25.6% (2012 to 6.6% (2013, and 7.7% (2012 per 100,000 live births, respectively whereas immunization coverage for infants increased to an average of 90%. As of 2013 the ratio of physicians to patients improved to 1:633 while the ratio of health facilities to the population was 1:10,272. The current government administration has proposed a reform in the form of the 10th Malaysian Plan coining the term “One Care for One Malaysia” as the newly improved and reorganized health care plan, where efficiency, effectiveness, and equity are the main focus. This review illustrates Malaysia’s transition from pre-independence to the current state, and its health and socioeconomic achievement as a country. It aims to contribute knowledge through identifying the plans and reforms by the Malaysian government while highlighting the challenges faced as a nation.

Paide raekoja renoveerimine = Renovation of the Paide Town Hall / Margit Mutso

Index Scriptorium Estoniae

Mutso, Margit, 1966-

2009-01-01

Paide raekoja muinsuskaitse eritingimused koostasid Epi Tohvri ja Pille Viirsalu. Arhitekt Merike Kordemets (Paide EKE Projekt), sisearhitektid Annes Arro ja Hanna Karits (Arro Projekt). Sisekujunduses lähtuti juugendstiilist. Žürii hinnang kultuurkapitali aastapreemiale esitatud hoonele

Organisational travel plans for improving health.

Science.gov (United States)

Hosking, Jamie; Macmillan, Alexandra; Connor, Jennie; Bullen, Chris; Ameratunga, Shanthi

2010-03-17

quality and extracted data. Seventeen studies were included. Ten were conducted in a school setting, two in universities, and five in workplaces. One study directly measured health outcomes, and all included studies measured travel outcomes. Two cluster randomised controlled trials in the school setting showed either no change in travel mode or mixed results. A randomised controlled trial in the workplace setting, conducted in a pre-selected group who were already contemplating or preparing for active travel, found improved health-related quality of life on some sub scales, and increased walking. Two controlled before-after studies found that school travel interventions increased walking. Other studies were judged to be at high risk of bias. No included studies were conducted in low- or middle-income countries, and no studies measured the social distribution of effects or adverse effects, such as injury. There is insufficient evidence to determine whether organisational travel plans are effective for improving health or changing travel mode. Organisational travel plans should be considered as complex health promotion interventions, with considerable potential to influence community health outcomes depending on the environmental context in which they are introduced. Given the current lack of evidence, organisational travel plans should be implemented in the context of robustly-designed research studies, such as well-designed cluster randomised trials.

"I'm so Much More Myself Now, Coming Back to Work"--Working Class Mothers, Paid Work and Childcare

Science.gov (United States)

Braun, Annette; Vincent, Carol; Ball, Stephen J.

2008-01-01

This paper explores the ways in which working class mothers negotiate mothering and paid work. Drawing on interviews with 70 families with pre-school children, we examine how caring and working responsibilities are conceptualised and presented in mothers' narratives. Mothers showed a high degree of commitment to paid work and, in contrast to…

Planning JWST NIRSpec MSA spectroscopy using NIRCam pre-images

Science.gov (United States)

Beck, Tracy L.; Ubeda, Leonardo; Kassin, Susan A.; Gilbert, Karoline; Karakla, Diane M.; Reid, I. N.; Blair, William P.; Keyes, Charles D.; Soderblom, D. R.; Peña-Guerrero, Maria A.

2016-07-01

The Near-Infrared Spectrograph (NIRSpec) is the work-horse spectrograph at 1-5microns for the James Webb Space Telescope (JWST). A showcase observing mode of NIRSpec is the multi-object spectroscopy with the Micro-Shutter Arrays (MSAs), which consist of a quarter million tiny configurable shutters that are 0. ''20×0. ''46 in size. The NIRSpec MSA shutters can be opened in adjacent rows to create flexible and positionable spectroscopy slits on prime science targets of interest. Because of the very small shutter width, the NIRSpec MSA spectral data quality will benefit significantly from accurate astrometric knowledge of the positions of planned science sources. Images acquired with the Hubble Space Telescope (HST) have the optimal relative astrometric accuracy for planning NIRSpec observations of 5-10 milli-arcseconds (mas). However, some science fields of interest might have no HST images, galactic fields can have moderate proper motions at the 5mas level or greater, and extragalactic images with HST may have inadequate source information at NIRSpec wavelengths beyond 2 microns. Thus, optimal NIRSpec spectroscopy planning may require pre-imaging observations with the Near-Infrared Camera (NIRCam) on JWST to accurately establish source positions for alignment with the NIRSpec MSAs. We describe operational philosophies and programmatic considerations for acquiring JWST NIRCam pre-image observations for NIRSpec MSA spectroscopic planning within the same JWST observing Cycle.

Pre-surgical planning and MR-tractography utility in brain tumour resection

Energy Technology Data Exchange (ETDEWEB)

Romano, A.; Fantozzi, L.M.; Bozzao, A. [University Sapienza, Department of Neuroradiology, S. Andrea Hospital, Rome (Italy); D' Andrea, G.; Mastronardi, L.; Ferrante, L. [University Sapienza, Department of Neurosurgery, S. Andrea Hospital, Rome (Italy); Minniti, G. [University Sapienza, Department of Radiotherapy, S. Andrea Hospital, Rome (Italy)

2009-12-15

The purposes of this study were (1) to evaluate the possible identification of trajectories of fibre tracts, (2) to examine the useful of a neuronavigation system for pre-surgical planning, (3) to assess pre- and post-surgery patients' clinical condition and (4) to evaluate the impact of this information on surgical planning and procedure. Twenty-eight right-handed patients were prospectively and consecutively studied. All the patients were clinically assessed by a neurologist in both pre- and post-surgical phases. Separately the pyramidal tract, optic radiation and arcuate fasciculus were reconstructed. The trajectories were considered suitable for surgical planning if there were no interruptions of any of the layers at the level of the lesion. Dedicated software 'merged' the acquired images with the tractographic processing, and the whole dataset was sent to the neuronavigation system. The assessment of the 37 visualised trajectories close to the tumour resulted in a modification of the surgical approach to corticotomy in six patients (21%); the impact on the definition of the resection margins during surgery was 64% (18 cases). The overall impact percentage on the surgical procedure was 82%. In 27 cases, the symptoms had not changed. MR-tractography provides the neurosurgeon with a new anatomical view that has an impact on the surgical resection planning for brain neoplasms. (orig.)

Pre-surgical planning and MR-tractography utility in brain tumour resection

International Nuclear Information System (INIS)

Romano, A.; Fantozzi, L.M.; Bozzao, A.; D'Andrea, G.; Mastronardi, L.; Ferrante, L.; Minniti, G.

2009-01-01

The purposes of this study were (1) to evaluate the possible identification of trajectories of fibre tracts, (2) to examine the useful of a neuronavigation system for pre-surgical planning, (3) to assess pre- and post-surgery patients' clinical condition and (4) to evaluate the impact of this information on surgical planning and procedure. Twenty-eight right-handed patients were prospectively and consecutively studied. All the patients were clinically assessed by a neurologist in both pre- and post-surgical phases. Separately the pyramidal tract, optic radiation and arcuate fasciculus were reconstructed. The trajectories were considered suitable for surgical planning if there were no interruptions of any of the layers at the level of the lesion. Dedicated software 'merged' the acquired images with the tractographic processing, and the whole dataset was sent to the neuronavigation system. The assessment of the 37 visualised trajectories close to the tumour resulted in a modification of the surgical approach to corticotomy in six patients (21%); the impact on the definition of the resection margins during surgery was 64% (18 cases). The overall impact percentage on the surgical procedure was 82%. In 27 cases, the symptoms had not changed. MR-tractography provides the neurosurgeon with a new anatomical view that has an impact on the surgical resection planning for brain neoplasms. (orig.)

Applicability of EPRI Decommissioning Pre-Planning Manual to International Decommissioning Projects

International Nuclear Information System (INIS)

Lessard, Leo; Kay, Jim; Lefrancois, Donald; Furr, Richard; Lucas, Matthieu; Schauer, Konrad

2016-01-01

Industry models for planning the efficient decommissioning of a nuclear power plant continue to evolve. Effective planning is a key to cost control, a critical aspect of decommissioning. In 2001, the Electric Power Research Institute (EPRI) published the 'Decommissioning Pre-Planning Manual', referred to as the 'Manual'. The goal of the Manual was to develop a framework for use in pre-planning the decommissioning of a nuclear power plant. The original research was based on information collected during the active decommissioning of power reactors in New England, and the ongoing decommissioning planning of another reactor still in operation. The research team identified thirty-two (32) major Decommissioning Tasks that support the strategic and tactical planning that can be conducted in advance of plant shutdown. The Decommissioning Tasks were organized in a logical sequence of execution, and sorted in common discipline groupings. Owners of U.S. nuclear plants that have shut down prematurely during the past 5 years have found the EPRI Decommissioning Pre-Planning Manual useful in developing their transition plans from an operating to shutdown facility. Concurrently, during the past 15 years, the IAEA has published numerous technical and safety reports on nuclear reactor decommissioning planning and execution. IAEA's goal is to provide its global members with useful and timely guidance for the planning and execution of nuclear decommissioning projects. This information has been used extensively by international nuclear plant operators. One of the key objectives will be to develop a road-map linking the 32 EPRI Decommissioning Tasks with the comparable (or equivalent) topics covered in the IAEA library of decommissioning knowledge. The logical and convenient structure of the Manual will be cross-referenced to the IAEA topics to aid in organizing the development of decommissioning plans. The road-map will serve to provide a basis for improved

Report on the Pre-existing Condition Insurance Plan Program

Data.gov (United States)

U.S. Department of Health & Human Services — Before the Affordable Care Act, Americans with pre-existing conditions who did not receive health coverage through their employers had few affordable options to get...

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

Science.gov (United States)

2010-08-23

... and health plans. The results of the planned survey may become an important source of information for... services and nurse advice lines, the quality and accessibility of health plan information on coverage...

The influence of chronic health problems and work-related factors on loss of paid employment among older workers.

Science.gov (United States)

Leijten, Fenna R M; de Wind, Astrid; van den Heuvel, Swenne G; Ybema, Jan Fekke; van der Beek, Allard J; Robroek, Suzan J W; Burdorf, Alex

2015-11-01

With an ageing society and increasing retirement ages, it is important to understand how employability can be promoted in older workers with health problems. The current study aimed to determine whether (1) different chronic health problems predict transitions from paid employment to disability benefits, unemployment and early retirement, and (2) how work-related factors modify these associations. Self-report questionnaire data was used from the Dutch longitudinal Study on Transitions in Employment, Ability and Motivation with 3 years of follow-up (2010-2013), among employees aged 45-64 years (N=8149). The influence of baseline chronic health problems and work-related factors on transitions from paid employment to disability benefits, unemployment and early retirement during follow-up was estimated in a competing risks proportional hazards model. Relative excess risk of transitions due to the interaction between chronic health problems and work-related factors was assessed. Severe headache, diabetes mellitus and musculoskeletal, respiratory, digestive and psychological health problems predicted an increased risk of disability benefits (HR range 1.78-2.79). Circulatory (HR=1.35) and psychological health problems (HR=2.58) predicted unemployment, and musculoskeletal (HR=1.23) and psychological health problems (HR=1.57) predicted early retirement. Work-related factors did not modify the influence of health problems on unemployment or early retirement. Psychosocial work-related factors, especially autonomy, modified the influence of health problems on disability benefits. Specifically, among workers with health problems, higher autonomy, higher support and lower psychological job demands reduced the risk of disability benefits by 82%, 49%, and 11%, respectively. All health problems affected disability benefits to a similar extent, but psychological health problems especially predicted unemployment and early retirement. For older workers with health problems

Paide Spordihall = Paide Sports Hall / Margit Mutso

Index Scriptorium Estoniae

Mutso, Margit, 1966-

2010-01-01

Paides Aiavilja 1 asuva spordihalli arhitektuursest lahendusest. Arhitektid: Maarja Kask, Karli Luik, Ralf Lõoke, kaasautor Jaan Port (Salto AB). Sisearhitekt Ville Lausmäe (VL Sisearhitektuur). Žürii liikme Kalle Komissarovi hinnang kultuurkapitali aastapreemiale esitatud hoonele

A relação entre o preço pago pelo consumidor de carne bovina em Santa Maria e o recebido pelo produtor de gado de corte no Rio Grande do Sul, Brasil Relationship between price paid by consumers in Santa Maria and prices paid to beef cattle farmers in Rio Grande do Sul, Brazil

Directory of Open Access Journals (Sweden)

João Garibaldi Almeida Viana

2007-08-01

Full Text Available Este estudo analisa em que medida os preços pagos pelos consumidores de carne bovina - ponto final da cadeia - são repassados ao produtor. Os preços dos diferentes cortes de carne foram coletados através de pesquisa mensal de preços, em quatro supermercados de Santa Maria, RS, Brasil. Depois de obtidos os valores percentuais dos diferentes cortes na composição da carcaça, estes valores foram multiplicados pelo preço pago pelo consumidor, obtendo-se assim os preços e as proporções dos cortes referentes ao valor ajustado de um quilo de carcaça pago pelo consumidor. Para a obtenção do preço médio do kg do boi vivo recebido pelos produtores, foram considerados os preços coletados pela EMATER-RS. Verificou-se uma baixa variação ao longo do ano das partes componentes da carcaça, na contribuição do preço total. Na média, o dianteiro contribui com 26,10%, o costilhar com 13,40% e o traseiro com 60,50% do preço total da carcaça. O setor a jusante na cadeia bovina tem função reguladora do preço final ao consumidor, com uma margem de operação de 7,61 pontos ao longo do ano. Nos três quadrimestres ao longo do ano, a associação entre o preço recebido pelo produtor (PRP e o pago pelo consumidor (PPC teve um comportamento diferenciado. As associações verificadas foram fraca, negativamente forte e positivamente muito forte para o primeiro, segundo e terceiro quadrimestres, respectivamente.This study analyses how much of prices paid by the consumers of beef meat are passed on to the farmer. The prices of different types of beef cuts were collected monthly in four supermarkets in Santa Maria-RS, Brazil. The percentage values of different cuts were obtained and multiplied by the price paid by consumers. Thus, it was calculated the adjusted price of kilogram of carcass commercialized at supermarket. The average price per kilogram of live steers received by the farmer was collected by EMATER-RS. There was a low price variation

Access to and use of paid sick leave among low-income families with children.

Science.gov (United States)

Clemans-Cope, Lisa; Perry, Cynthia D; Kenney, Genevieve M; Pelletier, Jennifer E; Pantell, Matthew S

2008-08-01

The ability of employed parents to meet the health needs of their children may depend on their access to sick leave, especially for low-income workers, who may be afforded less flexibility in their work schedules to accommodate these needs yet also more likely to have children in poor health. Our goal was to provide rates of access to paid sick leave and paid vacation leave among low-income families with children and to assess whether access to these benefits is associated with parents' leave taking to care for themselves or others. We used a sample of low-income families (paid leave and characteristics of children, families, and parents' employer. Access to paid leave was lower among children in low-income families than among those in families with higher income. Within low-income families, children without >or=1 full-time worker in the household were especially likely to lack access to this benefit, as were children whose parents work for small employers. Among children whose parents had access to paid sick leave, parents were more likely to take time away from work to care for themselves or others. This relationship is even more pronounced among families with the highest need, such as children in fair or poor health and children with all parents in full-time employment. Legislation mandating paid sick leave could dramatically increase access to this benefit among low-income families. It would likely diminish gaps in parents' leave taking to care for others between families with and without the benefit. However, until the health-related consequences are better understood, the full impact of such legislation remains unknown.

Association of rheumatic diseases with early exit from paid employment in Portugal.

Science.gov (United States)

Laires, Pedro A; Gouveia, Miguel

2014-04-01

To examine the association between rheumatic diseases (RD) and other chronic morbidity with early exit from paid employment in the Portuguese population. The study population consisted of all people between 50 and 64 years of age (3,762 men and 4,241 women) who participated in the Portuguese National Health Survey, conducted in 2005/2006. Data were collected on demographics, ill-health, lifestyle, and socioeconomic factors. Logistic regression was used to estimate the isolated effect of rheumatic diseases and other chronic diseases on the likelihood of exit from paid employment. At the time of the survey, 45.1 % of the Portuguese population with ages between 50 and 64 years old were not employed. In the nonemployed population, 31.6 % self-reported "poor" to "very poor" health, whereas 16.4 % did so in the employed population. A larger average number of major chronic diseases per capita were also found in those not employed (1.9 vs. 1.4, p paid employment. In particular, rheumatic diseases were more prevalent (43.4 vs. 32.1 %) and associated with early exit from work (OR 1.31; CI 1.12-1.52, p = 0.001). This study suggests an association between RD and other major chronic diseases with early exit from paid employment in Portugal. Thus, health and social protection policies should target these chronic disorders in order to better address sustainability issues and social protection effectiveness.

Increased Duration of Paid Maternity Leave Lowers Infant Mortality in Low- and Middle-Income Countries: A Quasi-Experimental Study.

Directory of Open Access Journals (Sweden)

Arijit Nandi

2016-03-01

Full Text Available Maternity leave reduces neonatal and infant mortality rates in high-income countries. However, the impact of maternity leave on infant health has not been rigorously evaluated in low- and middle-income countries (LMICs. In this study, we utilized a difference-in-differences approach to evaluate whether paid maternity leave policies affect infant mortality in LMICs.We used birth history data collected via the Demographic and Health Surveys to assemble a panel of approximately 300,000 live births in 20 countries from 2000 to 2008; these observational data were merged with longitudinal information on the duration of paid maternity leave provided by each country. We estimated the effect of an increase in maternity leave in the prior year on the probability of infant (<1 y, neonatal (<28 d, and post-neonatal (between 28 d and 1 y after birth mortality. Fixed effects for country and year were included to control for, respectively, unobserved time-invariant confounders that varied across countries and temporal trends in mortality that were shared across countries. Average rates of infant, neonatal, and post-neonatal mortality over the study period were 55.2, 30.7, and 23.0 per 1,000 live births, respectively. Each additional month of paid maternity was associated with 7.9 fewer infant deaths per 1,000 live births (95% CI 3.7, 12.0, reflecting a 13% relative reduction. Reductions in infant mortality associated with increases in the duration of paid maternity leave were concentrated in the post-neonatal period. Estimates were robust to adjustment for individual, household, and country-level characteristics, although there may be residual confounding by unmeasured time-varying confounders, such as coincident policy changes.More generous paid maternity leave policies represent a potential instrument for facilitating early-life interventions and reducing infant mortality in LMICs and warrant further discussion in the post-2015 sustainable development agenda

Simulation in Pre-departure Training for Residents Planning Clinical Work in a Low-Income Country

Directory of Open Access Journals (Sweden)

Kevin R. Schwartz

2015-12-01

Full Text Available Introduction: Increasingly, pediatric and emergency medicine (EM residents are pursuing clinical rotations in low-income countries. Optimal pre-departure preparation for such rotations has not yet been established. High-fidelity simulation represents a potentially effective modality for such preparation. This study was designed to assess whether a pre-departure high-fidelity medical simulation curriculum is effective in helping to prepare residents for clinical rotations in a low-income country. Methods: 43 pediatric and EM residents planning clinical rotations in Liberia, West Africa, participated in a simulation-based curriculum focused on severe pediatric malaria and malnutrition and were then assessed by survey at three time points: pre-simulation, post-simulation, and after returning from work abroad. Results: Prior to simulation, 1/43 (2% participants reported they were comfortable with the diagnosis and management of severe malnutrition; this increased to 30/42 (71% after simulation and 24/31 (77% after working abroad. Prior to simulation, 1/43 (2% of residents reported comfort with the diagnosis and management of severe malaria; this increased to 26/42 (62% after simulation and 28/31 (90% after working abroad; 36/42 (86% of residents agreed that a simulation-based global health curriculum is more useful than a didactic curriculum alone, and 41/42 (98% felt a simulator-based curriculum should be offered to all residents planning a clinical trip to a low-income country. Conclusion: High-fidelity simulation is effective in increasing residents’ self-rated comfort in management of pediatric malaria and malnutrition and a majority of participating residents feel it should be included as a component of pre-departure training for all residents rotating clinically to low-income countries.

Multistate Health Plans

Directory of Open Access Journals (Sweden)

Robert E. Moffit PhD

2015-09-01

Full Text Available We discuss and evaluate the Multi-State Plan (MSP Program, a provision of the Affordable Care Act that has not been the subject of much debate as yet. The MSP Program provides the Office of Personnel Management with new authority to negotiate and implement multistate insurance plans on all health insurance exchanges within the United States. We raise the concern that the MSP Program may lead to further consolidation of the health insurance industry despite the program’s stated goal of increasing competition by means of health insurance exchanges. The MSP Program arguably gives a competitive advantage to large insurers, which already dominate health insurance markets. We also contend that the MSP Program’s failure to produce increased competition may motivate a new effort for a public health insurance option.

Paid sick leave is associated with fewer ED visits among US private sector working adults.

Science.gov (United States)

Bhuyan, Soumitra S; Wang, Yang; Bhatt, Jay; Dismuke, S Edward; Carlton, Erik L; Gentry, Dan; LaGrange, Chad; Chang, Cyril F

2016-05-01

The United States (US) is the only developed country that does not guarantee short-term or longer-term paid sick leave. This study used a multiyear nationally representative database to examine the association between availability of paid sick leave and frequency of emergency department (ED) use among US private sector employees. We used the National Health Interview Survey data (2012-2014). The final study sample consists of 42,460 US adults between 18 and 64years of age and working in nongovernmental private sector. Our results suggest that availability of paid sick leave is significantly associated with lower likelihood of ED use, for both moderate (1-3 times/year) and repeated users (4 or more times/year). After controlling for confounding factors, respondents with paid sick leave are 14% less likely to be moderate ED users (adjusted odds ratio, 0.86; 95% CI, 0.79-0.93) and 32% less likely to be repeated ED users (adjusted odds ratio, 0.68; 95% CI, 0.50-0.91). Although expansion of health insurance coverage under the Affordable Care Act has not been shown to reduce utilization of high cost health care services such as the ED, our study suggests other factors such as the availability of paid sick leave may do so, by allowing patients to seek care through other more cost-effective mechanisms (eg, primary care providers). To reduce ED utilization, health policymakers should consider alternative reforms including paid sick leave. Copyright © 2016 Elsevier Inc. All rights reserved.

Undiagnosed Diabetes and Pre-Diabetes in Health Disparities.

Directory of Open Access Journals (Sweden)

Susan P Fisher-Hoch

Full Text Available Globally half of all diabetes mellitus is undiagnosed. We sought to determine the extent and characteristics of undiagnosed type 2 diabetes mellitus and pre-diabetes in Mexican Americans residing in the United States. This disadvantaged population with 50% lifetime risk of diabetes is a microcosm of the current pandemic. We accessed baseline data between 2004 and 2014 from 2,838 adults recruited to our Cameron County Hispanic Cohort (CCHC; a two-stage randomly selected 'Framingham-like' cohort of Mexican Americans on the US Mexico border with severe health disparities. We examined prevalence, risk factors and metabolic health in diagnosed and undiagnosed diabetes and pre-diabetes. Two thirds of this Mexican American population has diabetes or pre-diabetes. Diabetes prevalence was 28.0%, nearly half undiagnosed, and pre-diabetes 31.6%. Mean BMI among those with diabetes was 33.5 kg/m2 compared with 29.0 kg/m2 for those without diabetes. Significant risk factors were low income and educational levels. Most with diabetes had increased waist/hip ratio. Lack of insurance and access to health services played a decisive role in failure to have diabetes diagnosed. Participants with undiagnosed diabetes and pre-diabetes had similar measures of poor metabolic health similar but generally not as severe as those with diagnosed diabetes. More than 50% of a minority Mexican American population in South Texas has diabetes or pre-diabetes and is metabolically unhealthy. Only a third of diabetes cases were diagnosed. Sustained efforts are imperative to identify, diagnose and treat individuals in underserved communities.

[Occupational health protection in business economics--business plan for health intervention].

Science.gov (United States)

Rydlewska-Liszkowska, Izabela

2011-01-01

One of the company's actions for strengthening human capital is the protection of health and safety of its employees. Its implementation needs financial resources, therefore, employers expect tangible effectiveness in terms of health and economics. Business plan as an element of company planning can be a helpful tool for new health interventions management. The aim of this work was to elaborate a business plan framework for occupational health interventions at the company level, combining occupational health practices with company management and economics. The business plan of occupational health interventions was based on the literature review, the author's own research projects and meta-analysis of research reports on economic relations between occupational health status and company productivity. The study resulted in the development of the business plan for occupational health interventions at the company level. It consists of summary and several sections that address such issues as the key elements of the intervention discussed against a background of the company economics and management, occupational health and safety status of the staff, employees' health care organization, organizational plan of providing the employees with health protection, marketing plan, including specificity of health interventions in the company marketing plan and financial plan, reflecting the economic effects of health care interventions on the overall financial management of the company. Business plan defines occupational health and safety interventions as a part of the company activities as a whole. Planning health care interventions without relating them to the statutory goals of the company may have the adverse impact on the financial balance and profitability of the company. Therefore, business plan by providing the opportunity of comparing different options of occupational health interventions to be implemented by employers is a key element of the management of employees

谈项目施工的前期策划%Discussion on pre planning of project construction

Institute of Scientific and Technical Information of China (English)

谷来喜

2014-01-01

论述了项目前期策划的重要性，依据项目前期策划的基本原则，对项目策划的组织机构、施工部署、技术、质量、安全管理策划等项目施工前期策划编制的主要内容作了阐述，为项目管理提供参考依据。%This paper discussed the importance of project pre planning, based on the basic principles of project pre planning, elaborated the main contents of project planning organization, construction planning, technology, quality, safety management preparation and project construc-tion pre planning, provide reference basis for project management.

Pre-Project planning of Capital Facilities at NASA

OpenAIRE

Barrow, Benjamin John

1999-01-01

This thesis details the development of a NASA specific Project Definition Rating Index (PDRI) tool. This tool is to be used as a checklist for determining the necessary steps to follow in defining project scope and as a means to monitor progress and assess scope definition completeness at various stages during the NASA Pre-Project Planning process. This thesis also describes and identifies specific points in the NASA Capital Facility Programming Cycle for the performance of PDRI assessments ...

The Effects of Pre-Task, On-Line, and Both Pre-Task and On-Line Planning on Fluency, Complexity, and Accuracy--The Case of Iranian EFL Learners' Written Production

Science.gov (United States)

Piri, Faramarz; Barati, Hossein; Ketabi, Saeed

2012-01-01

Previous studies on the effect of planning on language production have revealed that planning does have a positive effect on language performance in terms of fluency, complexity, and accuracy. The present study was an attempt to investigate the effects of pre-task, on-line, and both pre-task and on-line planning on fluency, accuracy, and…

Qualified Health Plan (QHP) Landscape

Data.gov (United States)

U.S. Department of Health & Human Services — QHP Landscape Files present basic information about certified Qualified Health Plans and Stand-alone Dental Plans for individuals-families and small businesses...

Behavioral Health Services in the Changing Landscape of Private Health Plans.

Science.gov (United States)

Horgan, Constance M; Stewart, Maureen T; Reif, Sharon; Garnick, Deborah W; Hodgkin, Dominic; Merrick, Elizabeth L; Quinn, Amity E

2016-06-01

Health plans play a key role in facilitating improvements in population health and may engage in activities that have an impact on access, cost, and quality of behavioral health care. Although behavioral health care is becoming more integrated with general medical care, its delivery system has unique aspects. The study examined how health plans deliver and manage behavioral health care in the context of the Affordable Care Act (ACA) and the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA). This is a critical time to examine how health plans manage behavioral health care. A nationally representative survey of private health plans (weighted N=8,431 products; 89% response rate) was conducted in 2010 during the first year of MHPAEA, when plans were subject to the law but before final regulations, and just before the ACA went into effect. The survey addressed behavioral health coverage, cost-sharing, contracting arrangements, medical home innovations, support for technology, and financial incentives to improve behavioral health care. Coverage for inpatient and outpatient behavioral health services was stable between 2003 and 2010. In 2010, health plans were more likely than in 2003 to manage behavioral health care through internal arrangements and to contract for other services. Medical home initiatives were common and almost always included behavioral health, but financial incentives did not. Some plans facilitated providers' use of technology to improve care delivery, but this was not the norm. Health plans are key to mainstreaming and supporting delivery of high-quality behavioral health services. Since 2003, plans have made changes to support delivery of behavioral health services in the context of a rapidly changing environment.

75 FR 45013 - Pre-Existing Condition Insurance Plan Program

Science.gov (United States)

2010-07-30

... Department of Homeland Security's U.S. Citizenship and Immigration Services (USCIS) Systematic Alien... pre-existing condition based on evidence of the existence or history of certain medical or health...

Developing Health-Based Pre-Planning Clearance Goals for Airport Remediation Following Chemical Terrorist Attack: Introduction and Key Assessment Considerations

OpenAIRE

Watson, Annetta; Hall, Linda; Raber, Ellen; Hauschild, Veronique D.; Dolislager, Fredrick; Love, Adam H.; Hanna, M. Leslie

2011-01-01

In the event of a chemical terrorist attack on a transportation hub, post-event remediation and restoration activities necessary to attain unrestricted facility reuse and re-entry could require hours to multiple days. While restoration timeframes are dependent on numerous variables, a primary controlling factor is the level of pre-planning and decision-making completed prior to chemical terrorist release. What follows is the first of a two-part analysis identifying key considerations, critica...

Pre-movement planning processes in people with congenital mirror movements.

Science.gov (United States)

Franz, E A; Fu, Y

2017-10-01

Pre-movement processes were investigated in people with Congenital mirrormovement (CMM), a rare disorder in which bilateral movement (mirroring) occurs in the upper distal extremities (primarily the hands and fingers) during intended unilateral movements. Abnormal density of ipsilateral corticospinal projections is an established hallmark of CMM. This study tested whether the Lateralised Readiness Potential (LRP), which reflects movement planning and readiness, is also abnormal in people with CMM. Twenty-eight neurologically-normal controls and 8 people with CMM were tested on a unimanual Go/No-go task while electroencephalography (EEG) was recorded to assess the LRP. No significant group differences were found in reaction time (RT). However, significantly smaller LRP amplitudes were found, on average, in the CMM group compared to Controls at central-motor (C3,C4) sites in stimulus-locked and response-locked epochs; similar group differences were also found at further frontal sites (F3,F4) during response-locked epochs. Abnormal brain activity in pre-movement processes associated with response planning and preparation is present in people with CMM. Aberrant bilateral activity during pre-movement processes is clearly implicated; whether part of the etiology of CMM, or as a mechanism of neuro-compensation, is not yet known. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

Paid Maternity Leave and Breastfeeding Outcomes.

Science.gov (United States)

Mirkovic, Kelsey R; Perrine, Cria G; Scanlon, Kelley S

2016-09-01

Despite the benefits of breastfeeding, rates in the United States are low. Shorter maternity leave is associated with lower initiation and shorter durations of breastfeeding; however, little is known about how paid maternity leave may influence breastfeeding rates. We used data from the 2006-2010 U.S. National Survey of Family Growth on the most recent birth to employed women who delivered a child within the previous 5 years. Separate multivariable logistic regression models were used to describe the associations between paid leave duration (0, 1-5, 6-11, ≥ 12 weeks, maternity leave not taken) and three outcomes: 1) breastfeeding initiation, 2) 6-month duration, and 3) 6-month duration among initiators. Twenty-eight percent of prenatally employed women received no paid leave. Women who received 12 or more weeks of paid leave were more likely to initiate breastfeeding compared to women with no paid leave (87.3% vs 66.7%, adjusted odds ratio [aOR] 2.83 [95% confidence interval {CI} 1.23-6.48]). Similarly, women with 12 or more weeks of paid leave were more likely to breastfeed at 6 months, compared to women with no paid leave (24.9% vs 50.1%, aOR 2.26 [95% CI 1.20-4.26]). Among women who initiated breastfeeding, having received 12 or more weeks' paid leave increased the odds of breastfeeding for 6 or more months; however, the association was not statistically significant in the adjusted model (aOR 1.81 [95% CI 0.93-3.52]). Employed women who received 12 or more weeks of paid maternity leave were more likely to initiate breastfeeding and be breastfeeding their child at 6 months than those without paid leave. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

The proportion of work-related emergency department visits not expected to be paid by workers' compensation: implications for occupational health surveillance, research, policy, and health equity.

Science.gov (United States)

Groenewold, Matthew R; Baron, Sherry L

2013-12-01

To examine trends in the proportion of work-related emergency department visits not expected to be paid by workers' compensation during 2003-2006, and to identify demographic and clinical correlates of such visits. A total of 3,881 work-related emergency department visit records drawn from the 2003-2006 National Hospital Ambulatory Medical Care Surveys. Secondary, cross-sectional analyses of work-related emergency department visit data were performed. Odds ratios and 95 percent confidence intervals were modeled using logistic regression. A substantial and increasing proportion of work-related emergency department visits in the United States were not expected to be paid by workers' compensation. Private insurance, Medicaid, Medicare, and workers themselves were expected to pay for 40 percent of the work-related emergency department visits with this percentage increasing annually. Work-related visits by blacks, in the South, to for-profit hospitals and for work-related illnesses were all more likely not to be paid by workers' compensation. Emergency department-based surveillance and research that determine work-relatedness on the basis of expected payment by workers' compensation systematically underestimate the occurrence of occupational illness and injury. This has important methodological and policy implications. © Health Research and Educational Trust.

Maternal depression, pregnancy intention, and return to paid work after childbirth.

Science.gov (United States)

Dagher, Rada K; Hofferth, Sandra L; Lee, Yoonjoo

2014-01-01

Maternal depression is an important public health issue for women, their families, and their employers. Previous studies have examined the impact of leave duration on maternal depression, but none have studied the association between maternal depression and the pace of return to paid work. We examine herein the relationship between maternal depression and return to work, and the moderating effects of pregnancy intention. We utilized data from the Listening to Mothers II Survey collected from January 20 through February 21, 2006. The woman had to be 18 to 45 years old, speak English, and have given birth in 2005 to a live singleton baby in a U.S. hospital. Our analyses were limited to women who worked for an employer during pregnancy (n = 882). The primary outcome was return to paid work at the time of the interview and the analyses utilized Cox proportional hazard models. In combination, intending the baby and being depressed suppressed return to paid work. Nondepressed mothers with unintended pregnancies returned to work the soonest. Compared with mothers who were not depressed and with unintended pregnancy, the risk ratio of returning to paid work (0.70) was significantly lower for mothers who were depressed and had an intended pregnancy. Mothers who were not depressed and with intended pregnancy also had a significantly lower risk ratio (0.60) of returning to paid work than those who were not depressed and with unintended pregnancy. Primary care providers and policy makers can use these findings to support employed women in their childbearing years. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Technical aspects of the integration of three-dimensional treatment planning dose parameters (GEC-ESTRO Working Group) into pre-implant planning for LDR gynecological interstitial brachytherapy.

Science.gov (United States)

Chi, A; Gao, M; Nguyen, N P; Albuquerque, K

2009-06-01

This study investigates the technical feasibility of pre-implant image-based treatment planning for LDR GYN interstitial brachytherapy(IB) based on the GEC-ESTRO guidelines. Initially, a virtual plan is generated based on the prescription dose and GEC-ESTRO defined OAR dose constraints with a pre-implant CT. After the actual implant, a regular diagnostic CT was obtained and fused with our pre-implant scan/initial treatment plan in our planning software. The Flexi-needle position changes, and treatment plan modifications were made if needed. Dose values were normalized to equivalent doses in 2 Gy fractions (LQED 2 Gy) derived from the linear-quadratic model with alpha/beta of 3 for late responding tissues and alpha/beta of 10 for early responding tissues. D(90) to the CTV, which was gross tumor (GTV) at the time of brachytherapy with a margin to count for microscopic disease, was 84.7 +/- 4.9% of the prescribed dose. The OAR doses were evaluated by D(2cc) (EBRT+IB). Mean D(2cc) values (LQED(2Gy)) for the rectum, bladder, sigmoid, and small bowel were the following: 63.7 +/- 8.4 Gy, 61.2 +/- 6.9 Gy, 48.0 +/- 3.5 Gy, and 49.9 +/- 4.2 Gy. This study confirms the feasibility of applying the GEC-ESTRO recommended dose parameters in pre-implant CT-based treatment planning in GYN IB. In the process, this pre-implant technique also demonstrates a good approximation of the target volume dose coverage, and doses to the OARs.

Eliciting consumer preferences for health plans.

Science.gov (United States)

Booske, B C; Sainfort, F; Hundt, A S

1999-10-01

To examine (1) what people say is important to them in choosing a health plan; (2) the effect, if any, that giving health plan information has on what people say is important to them; and (3) the effect of preference elicitation methods on what people say is important. A random sample of 201 Wisconsin state employees who participated in a health plan choice experiment during the 1995 open enrollment period. We designed a computer system to guide subjects through the review of information about health plan options. The system began by eliciting the stated preferences of the subjects before they viewed the information, at time 0. Subjects were given an opportunity to revise their preference structures first after viewing summary information about four health plans (time 1) and then after viewing more extensive, detailed information about the same options (time 2). At time 2, these individuals were also asked to rate the relative importance of a predefined list of health plan features presented to them. Data were collected on the number of attributes listed at each point in time and the importance weightings assigned to each attribute. In addition, each item on the attribute list was content analyzed. The provision of information changes the preference structures of individuals. Costs (price) and coverage dominated the attributes cited both before and after looking at health plan information. When presented with information on costs, quality, and how plans work, many of these relatively well educated consumers revised their preference structures; yet coverage and costs remained the primary cited attributes. Although efforts to provide health plan information should continue, decisions on the information to provide and on making it available are not enough. Individuals need help in understanding, processing, and using the information to construct their preferences and make better decisions.

Paid Family Leave, Fathers' Leave-Taking, and Leave-Sharing in Dual-Earner Households.

Science.gov (United States)

Bartel, Anne P; Rossin-Slater, Maya; Ruhm, Christopher J; Stearns, Jenna; Waldfogel, Jane

Using difference-in-difference and difference-in-difference-in-difference designs, we study California's Paid Family Leave (CA-PFL) program, the first source of government-provided paid parental leave available to fathers in the Unites States. Relative to the pre-treatment mean, fathers of infants in California are 46 percent more likely to be on leave when CA-PFL is available. In households where both parents work, we find suggestive evidence that CA-PFL increases both father-only leave-taking (i.e., father on leave while mother is at work) and joint leave-taking (i.e., both parents on leave at the same time). Effects are larger for fathers of first-born children than for fathers of later-born children.

Tradeoffs in the design of health plan payment systems: Fit, power and balance.

Science.gov (United States)

Geruso, Michael; McGuire, Thomas G

2016-05-01

In many markets, including the new U.S. Marketplaces, health insurance plans are paid by risk-adjusted capitation, sometimes combined with reinsurance and other payment mechanisms. This paper proposes a framework for evaluating the de facto insurer incentives embedded in these complex payment systems. We discuss fit, power and balance, each of which addresses a distinct market failure in health insurance. We implement empirical metrics of fit, power, and balance in a study of Marketplace payment systems. Using data similar to that used to develop the Marketplace risk adjustment scheme, we quantify tradeoffs among the three classes of incentives. We show that an essential tradeoff arises between the goals of limiting costs and limiting cream skimming because risk adjustment, which is aimed at discouraging cream-skimming, weakens cost control incentives in practice. A simple reinsurance system scores better on our measures of fit, power and balance than the risk adjustment scheme in use in the Marketplaces. Copyright © 2016 Elsevier B.V. All rights reserved.

ERISA and health plans.

Science.gov (United States)

Schmidt, P; Mazo, J; Ladenheim, K

1995-11-01

This Issue Brief is designed to provide a basic understanding of the relationship of the Employee Retirement Income Security Act of 1974 (ERISA) to health plans. It is based, in part, on an Employee Benefit Research Institute-Education and Research Fund (EBRI-ERF) educational briefing held in March 1995. This report includes a section by Peter Schmidt of Arnold & Porter, a section about multiemployer plans written by Judy Mazo of The Segal Company; and a section about ERISA and state health reform written by Kala Ladenheim of the Intergovernmental Health Policy Project. Starting in the late 1980s, three trends converged to make ERISA a critical factor in state health reforms: increasingly comprehensive state health policy experimentation; changes in the makeup of the insurance market (including the rise in self-insurance and the growth of managed care); and increasingly expansive interpretations of ERISA by federal courts. The changing interpretations of ERISA's relationship to three categories of state health initiatives--insurance mandates, medical high risk pools, and uncompensated care pools--illustrate how these forces are playing out today. ERISA does have a very broad preemptive effect. Federal statutes do not need to say anything about preemption in order to preempt state law. For example, if there is a direct conflict, it would be quite clear under the Supremacy Clause [of the U.S. Constitution] that ERISA, or any federal statue, would preempt a directly conflicting state statute. States can indirectly regulate health care plans that provide benefits through insurance contracts by establishing the terms of the contract. And they also raise money by imposing premium taxes. But they cannot do the same with respect to self-funded plans. That is one of the factors that has caused a great rise in the number of self-funded plans. State regulation [of employee benefits] can create three kinds of problems: cost of taxes, fees, or other charges; cost of dealing

An innovative approach for planning and execution of pre-experimental runs for Design of Experiments

Directory of Open Access Journals (Sweden)

Muhammad Arsalan Farooq

2016-09-01

Full Text Available This paper addresses the study of the pre-experimental planning phase of the Design of Experiments (DoE in order to improve the final product quality. The pre-experimental planning phase includes a clear identification of the problem statement, selection of control factors and their respective levels and ranges. To improve production quality based on the DoE a new approach for the pre-experimental planning phase, called Non-Conformity Matrix (NCM, is presented. This article also addresses the key steps of the pre-experimental runs considering a consumer goods manufacturing process. Results of the application for an industrial case show that this methodology can support a clear definition of the problem and also a correct identification of the factor ranges in particular situations. The proposed new approach allows modeling the entire manufacturing system holistically and correctly defining the factor ranges and respective levels for a more effective application of DoE. This new approach can be a useful resource for both research and industrial practitioners who are dedicated to large DoE projects with unknown factor interactions, when the operational levels and ranges are not completely defined.

Employee Responses to Health Insurance Premium Increases

OpenAIRE

Goldman, Dana; Leibowitz, Arleen; Robalino, David

2004-01-01

Objective: To determine the sensitivity of employees’ health insurance decisions—including the decision to not choose health maintenance organization or fee-for-service coverage—during periods of rapidly escalating healthcare costs. Study Design: A retrospective cohort study of employee plan choices at a single large firm with a “cafeteria-style” benefits plan wherein employees paid all the additional cost of purchasing more generous insurance. Methods: We modeled the probabil...

MARKETING RESEARCHES OF THE POPULATIONS HEALTH STATE AS A FACTOR OF DEMAND FORMATION IN THE MARKET OF PAID MEDICAL SERVICES

Directory of Open Access Journals (Sweden)

Nataliia Hrechanyk

2017-08-01

Full Text Available The state of health of the population is one of the most important indicators of the well-being of the nation. Important directions of health care reform are optimization of management, rational distribution of limited financial resources, efficient use of material resources, introduction of health insurance, restructuring of treatment and preventive care to the people. Marketing of medical services market is one of the most complex types of marketing. Because it is medical services that are connected with the protection and maintenance of the most important values ​​of a person - life and health. The market for medical services is a combination of socio-economic relations in the healthcare sector. The most important components of the analysis of any market, including the market of medical services, are marketing research, which is a systematic collection, processing, analysis of data and information in order to formulate proposals for effective activities on it. In the field of public health, marketing can be defined as a complex process of planning, economic substantiation and management of the process of provision of medical services, the formation of a pricing policy of the medical-preventive process, ensuring effective communication with patients. The purpose of the study is to identify the health of the population and determine the demand factors for paid health services and their demand. The main task set before market research on the health of the population is the formation and provision of benefits to consumers that meet their needs for qualified medical care and quality of life. The research methods used in the work are based on probabilistic, stratified, quota, representative samples for the entire population of Ivano-Frankivsk and Ivano-Frankivsk region. The obtained results allow us to give a realistic assessment of the main trends and allow us to assess the potential of socio-economic adaptation of the population in the

Implementing a Paid Leave Policy for Graduate Students at UW - Madison: The Student Perspective

Science.gov (United States)

Gosnell, Natalie M.

2013-01-01

In 2010 the University of Wisconsin - Madison Astronomy Department developed and implemented a departmental paid leave policy for our graduate students, even though the university lacks a campus-wide policy and cannot provide institutional funding for such programs. This policy includes 12 weeks of paid leave in event of a medical emergency or chronic medical condition, as well as paid parental leave for both male and female graduate research assistants. (The policy in its entirety can be found at http://www.astro.wisc.edu/grad-students/policies-procedures/medical-and-family-leave-policy.) This is the first of two presentations describing our policy implementation using a "bottom-up" approach, beginning with the graduate students. I will present the perspective of the graduate students who led the effort and will discuss the steps we took to put our policy in place, from the conception of the plan to the full implementation. These steps included identifying faculty allies, becoming knowledgeable about university policies and resources, involving department staff, and anticipating procedural and bureaucratic hurdles in order to come up with creative solutions in advance. Although each individual institution and department's path to implementing a similar plan will be unique, we hope the methods used to implement our policy at UW - Madison may serve as an example.

Experiences from a communication training programme of paid carers in a residential rehabilitation centre for people with traumatic brain injury.

Science.gov (United States)

Behn, Nicholas; Togher, Leanne; Power, Emma

2015-01-01

To determine the impact of a communication training programme by exploring the experiences of paid carers who attended the programme in a residential rehabilitation centre for people with traumatic brain injury (TBI). Five paid carers attended a communication training programme which comprised 17 hours (across 8 weeks). Semi-structured interviews were conducted pre- and post-training. Analysis used a generic procedure with constant comparative analysis to identify categories across and within interview transcripts. Paid carers described improved knowledge and use of strategies, improved communication, positive emotional experiences and barriers and facilitators to consider for future communication training programmes. Training communication skills of paid carers in a residential rehabilitation centre had a positive impact on their conversations with people with TBI. These positive changes support quantitative findings for the effectiveness of communication training.

Environmental health action plan for Europe

International Nuclear Information System (INIS)

1994-06-01

This Environmental Health Action Plan for Europe was endorsed by the second European Conference on Environment and Health, held in Helsinki, 20 to 22 June 1994. It sets out directions for the attainment of long term environment and health policy objectives define in the European Charter on Environment and Health. The Action Plan is primarily addressed at the public health and environmental protection sectors. 10 refs, 4 figs, 2 tabs

42 CFR 56.105 - Accord with health planning.

Science.gov (United States)

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Accord with health planning. 56.105 Section 56.105... HEALTH SERVICES General Provisions § 56.105 Accord with health planning. A grant may be made under this... appropriate health planning agencies have been met. ...

How to choose a health plan

Science.gov (United States)

... patientinstructions/000861.htm How to choose a health plan To use the sharing features on this page, ... paperwork for tax purposes. How to Compare Health Plans Employers and government sites, such as the Marketplace , ...

Female sex work and international sport events - no major changes in demand or supply of paid sex during the 2010 Soccer World Cup: a cross-sectional study

Science.gov (United States)

2012-01-01

Background Important unanswered questions remain on the impact of international sporting events on the sex industry. Speculation about increased demand and supply of sex work often generates significant attention, but also additional funding for HIV programmes. This study assessed whether changes occurred in the demand and supply of paid sex during the 2010 Soccer World Cup in South Africa. Methods Trained sex worker interviewers conducted face-to-face semi-structured interviews among consenting female sex workers during May-September 2010. Using bivariate analyses we compared supply, demand, sexual risk-taking, and police and health services contact pre-World Cup, to levels during the World Cup and after the event. Results No increases were detected in indicators of sex work supply, including the proportion of sex workers newly arrived in the city ( 92.4% in all phases). Health-care utilisation decreased non-significantly from the pre- to during World Cup period (62.4% to 57.0%; P = 0.075). Across all periods, about thirty percent of participants had interacted with police in the preceding month, two thirds of whom had negative interactions. Conclusions Contrary to public opinion, no major increases were detected in the demand or supply of paid sex during the World Cup. Although the study design employed was unable to select population-based samples, these findings do not support the public concern and media speculation prior to the event, but rather signal a missed opportunity for public health action. Given the media attention on sex work, future sporting events offer strategic opportunities to implement services for sex workers and their clients, especially as health service utilisation might decrease in this period. PMID:22967260

Public Health Agency Business plan 2010-2011

OpenAIRE

Public Health Agency

2010-01-01

This second corporate business plan explains the purpose of the PHA and focuses on health improvement, health protection and addressing health inequalities. The business plan is available to download below.

Family planning and health: the Narangwal experiment.

Science.gov (United States)

Faruqee, R

1983-06-01

The findings of a 7-year field experiment conducted in the Indian Punjab show that integrating family planning with health services is more effective and efficient than providing family planning separately. The field experiment was conducted between 1968 and 1974 at Narangwal in the Indian State of Punjab. It involved 26 villages, with a total population of 35,000 in 1971-72. The demographic characteristics of the villages were found to be typical of the area. 5 groups of villages were provided with different combinations of services for health, nutrition and family planning. A control group received no project services. A population study was made of the effects of integrating family planning with maternal and child health services. A nutritional study looked at the results of integrating nutritional care and health services. The effectiveness of integration was evaluated by identifying it both with increased use of family planning and improved health. Efficiency was judged by relating effectiveness to input costs. Distribution of the benefits was also examined. The effectiveness of these different combinations of services on the use of family planning was measured: 1) by all changes in the use of modern methods of family planning, 2) by the number of new acceptors, 3) by the changes in the proportion of eligible women using contraceptives, and 4) by how many people started to use the more effective methods. Results showed the use of family planning increased substantially in the experimental groups, whereas the control group remained constant. It was also found that, though the services combining family planning with maternal health care stimulated more use of family planning, they were more costly than the more integrated srevices. The Narangwal experiment provides significant evidence in favor of combining the provision of family planning and health services, but its potential for replication on a large scale needs to be studied.

Health care provider knowledge and routine management of pre-eclampsia in Pakistan.

Science.gov (United States)

Sheikh, Sana; Qureshi, Rahat Najam; Khowaja, Asif Raza; Salam, Rehana; Vidler, Marianne; Sawchuck, Diane; von Dadelszen, Peter; Zaidi, Shujat; Bhutta, Zulfiqar

2016-09-30

Maternal mortality ratio is 276 per 100,000 live births in Pakistan. Eclampsia is responsible for one in every ten maternal deaths despite the fact that management of this disease is inexpensive and has been available for decades. Many studies have shown that health care providers in low and middle-income countries have limited training to manage patients with eclampsia. Hence, we aimed to explore the knowledge of different cadres of health care providers regarding aetiology, diagnosis and treatment of pre-eclampsia and eclampsia and current management practices. We conducted a mixed method study in the districts of Hyderabad and Matiari in Sindh province, Pakistan. Focus group discussions and interviews were conducted with community health care providers, which included Lady Health Workers and their supervisors; traditional birth attendants and facility care providers. In total seven focus groups and 26 interviews were conducted. NVivo 10 was used for analysis and emerging themes and sub-themes were drawn. All participants were providing care for pregnant women for more than a decade except one traditional birth attendant and two doctors. The most common cause of pre-eclampsia mentioned by community health care providers was stress of daily life: the burden of care giving, physical workload, short birth spacing and financial constraints. All health care provider groups except traditional birth attendants correctly identified the signs, symptoms, and complications of pre-eclampsia and eclampsia and were referring such women to tertiary health facilities. Only doctors were aware that magnesium sulphate is recommended for eclampsia management and prevention; however, they expressed fears regarding its use at first and secondary level health facilities. This study found several gaps in knowledge regarding aetiology, diagnosis and treatment of pre-eclampsia among health care providers in Sindh. Findings suggest that lesser knowledge regarding management of pre

Functional MRI in pre-surgical planning: Case study and cautionary notes

Directory of Open Access Journals (Sweden)

Bruce S Spottiswoode

2012-09-01

Full Text Available Background. Since its inception almost 20 years ago, functional magnetic resonance imaging (fMRI has greatly advanced our knowledge of human brain function. Although the clinical applications of fMRI are still limited, there have recently been encouraging advances for its use in pre-operative functional cortical mapping to identify potentially eloquent areas prior to neurosurgery. Objectives. We explore the potential use of this emerging technique by presenting a neurosurgical case study, as performed at the Cape Universities Brain Imaging Centre (CUBIC, Tygerberg, Cape Town. We conclude with a brief summary of the potential pitfalls of this technique, as well as cautionary guidelines based on our experience. Methods and results. A 22-year-old male patient from Tygerberg Hospital underwent the successful resection of an anaplastic astrocytoma after fMRI presurgical planning at our facility. The subject was able to leave the ward unassisted. Conclusion. If consideration is given to the many limitations of this emerging technique, fMRI can be useful in aiding the neurosurgeon in pre-operative planning of his surgical approach.

[Consumer satisfaction study in philanthropic hospital health plans].

Science.gov (United States)

Gerschman, Silvia; Veiga, Luciana; Guimarães, César; Ugá, Maria Alicia Dominguez; Portela, Margareth Crisóstomo; Vasconcellos, Miguel Murat; Barbosa, Pedro Ribeiro; Lima, Sheyla Maria Lemos

2007-01-01

This paper presents the findings of research aimed at identifying and analyzing the argumentation and rationale that justify the satisfaction of consumers with their health plans. The qualitative method applied used the focus group technique, for which the following aspects were defined: the criteria for choosing the health plans which were considered, the composition of the group and its distribution, recruitment strategy, and infrastructure and dynamics of the meetings. The health plan beneficiaries were classified into groups according to their social class, the place where they lived, mainly, the relationship that they established with the health plan operators which enabled us to develop a typology for the plan beneficiaries. Initially, we indicated how the health plan beneficiaries assess and use the Brazilian Unified Health System (SUS), and, then, considering the types of plans defined, we evaluated their degree of satisfaction with the different aspects of health care, and identified which aspects mostly contributed explain their satisfaction.

42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

Science.gov (United States)

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Health information technology planning advance... STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.336 Health information technology planning advance planning document requirements...

Paid advertising for AIDS prevention--would the ends justify the means?

Science.gov (United States)

Donovan, R J; Jason, J; Gibbs, D A; Kroger, F

1991-01-01

An examination by the Centers for Disease Control and the Research Triangle Institute concluded that "hard-to-reach" populations could be reached with AIDS prevention messages through the broadcast and print media and that a study should be undertaken to assess whether paid placement of these messages could have an effect on HIV-related behaviors. The recommended target population for a study of paid advertising would be sexually active 18-24-year-old black urban dwellers. Its behavioral objectives would include abstinence and safer sex practices. For any evaluation of a paid advertising campaign to be valid, there would have to be extensive audience profiling, research into the development of the message, pretesting of the message, and involvement of the community. The proposed study would include measurement of various "dosage" levels of paid advertising, use of a no-intervention comparison group, and a novel data collection technique. Although a specific target group and specific messages would be involved, the evaluation would make a substantial contribution to resolving the broader issue of whether and how mass media should be used directly or indirectly to change or reinforce health-related behaviors. PMID:1659711

State of emergency preparedness for US health insurance plans.

Science.gov (United States)

Merchant, Raina M; Finne, Kristen; Lardy, Barbara; Veselovskiy, German; Korba, Caey; Margolis, Gregg S; Lurie, Nicole

2015-01-01

Health insurance plans serve a critical role in public health emergencies, yet little has been published about their collective emergency preparedness practices and policies. We evaluated, on a national scale, the state of health insurance plans' emergency preparedness and policies. A survey of health insurance plans. We queried members of America's Health Insurance Plans, the national trade association representing the health insurance industry, about issues related to emergency preparedness issues: infrastructure, adaptability, connectedness, and best practices. Of 137 health insurance plans queried, 63% responded, representing 190.6 million members and 81% of US plan enrollment. All respondents had emergency plans for business continuity, and most (85%) had infrastructure for emergency teams. Some health plans also have established benchmarks for preparedness (eg, response time). Regarding adaptability, 85% had protocols to extend claim filing time and 71% could temporarily suspend prior medical authorization rules. Regarding connectedness, many plans shared their contingency plans with health officials, but often cited challenges in identifying regulatory agency contacts. Some health insurance plans had specific policies for assisting individuals dependent on durable medical equipment or home healthcare. Many plans (60%) expressed interest in sharing best practices. Health insurance plans are prioritizing emergency preparedness. We identified 6 policy modifications that health insurance plans could undertake to potentially improve healthcare system preparedness: establishing metrics and benchmarks for emergency preparedness; identifying disaster-specific policy modifications, enhancing stakeholder connectedness, considering digital strategies to enhance communication, improving support and access for special-needs individuals, and developing regular forums for knowledge exchange about emergency preparedness.

The strategic planning of health management information systems.

Science.gov (United States)

Smith, J

1995-01-01

This paper discusses the roles and functions of strategic planning of information systems in health services. It selects four specialised methodologies of strategic planning for analysis with respect to their applicability in the health field. It then examines the utilisation of information planning in case studies of three health organisations (two State departments of health and community services and one acute care institution). Issues arising from the analysis concern the planning process, the use to which plans are put, and implications for management.

On the Need for Paid Maternity Leave in the U.S.

Science.gov (United States)

Archer, C. L.

2007-12-01

Maternity leave policies in the U.S. are among the worst in the world. The 12 weeks of un-paid family leave that the U.S. grants are only surpassed by South Korea's 8 un-paid weeks as the worst treatment to mothers and newborns in the developed world. California is the only state in the U.S. where two programs exist, the State Disability Insurance (SDI) and Paid Family Leave (PFL), which cover up to $840/week for up to 12 weeks (excluding a waiting period of 7 un-paid days combined for both SDI and PFL). Even with these State contributions, the average parent of a newborn in California receives less than the 100% paid 6 weeks of Portugal and the 100% paid 12 weeks of Mexico, with all other countries providing better treatment. For mothers and fathers, time at home during the first precious months after birth or adoption is critical to getting to know their babies. It can provide long-term benefits that improve a child's brain development, social development and overall well being. Parental leave results in better prenatal and postnatal care and more intense parental bonding over a child's life. It also improves the chance that a child will be immunized; as a result, it is associated with lower death rates for infants. But lawmakers and employers are denying those benefits to most families by refusing to provide paid parental leave. For some families, the economic burden of caring for a newborn alone results in financial hardship or ruin. Fortunately, about 12% of companies in the U.S. voluntarily choose to offer some sort of paid and/or longer maternity and family care leaves. Some companies offer on-site child care as a way to facilitate breastfeeding and bonding between new mothers and their babies. Other companies allow new parents to reduce their work schedule temporarily and to telecommute from their homes, both effective ways to guarantee work productivity without requiring the sacrifice of a newborn's right to better health through breastfeeding and bonding

77 FR 42914 - Federal Employees Health Benefits Program and Federal Employees Dental and Vision Insurance...

Science.gov (United States)

2012-07-20

... Federal Flexible Benefits Plan: Pre-Tax Payment of Health Benefits Premiums AGENCY: Office of Personnel... this proposed rule; and (4) update the Federal Flexible Benefits Plan: Pre-Tax Payment of Health...--FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENTS OF HEALTH BENEFITS PREMIUMS PROGRAM 8. The authority...

A decision support system for pre-earthquake planning of lifeline networks

Energy Technology Data Exchange (ETDEWEB)

Liang, J.W. [Tianjin Univ. (China). Dept. of Civil Engineering

1996-12-01

This paper describes the frame of a decision support system for pre-earthquake planning of gas and water networks. The system is mainly based on the earthquake experiences and lessons from the 1976 Tangshan earthquake. The objective of the system is to offer countermeasures and help make decisions for seismic strengthening, remaking, and upgrading of gas and water networks.

48 CFR 1602.170-9 - Health benefits plan.

Science.gov (United States)

2010-10-01

... EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION GENERAL DEFINITIONS OF WORDS AND TERMS Definitions of FEHBP Terms 1602.170-9 Health benefits plan. Health benefits plan means a group insurance policy, contract... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Health benefits plan. 1602...

Examining the Evolution of Paid Parental Leave.

Science.gov (United States)

Sladek, Carol

While the United States continues to be the only developed nation without mandated paid maternity leave, U.S. employers are blazing their own trail for new parents. This article defines parental leave, explains what's driving the increased interest in paid parental leave among employers offering it and discusses how paid parental leave can benefit employers and employees alike. Finally, the author discusses why not all employers are offering these benefits as well as considerations for employers contemplating whether paid parental leave is right for them.

Health care's new game changer. Thinking like a health plan.

Science.gov (United States)

Eggbeer, Bill; Bowers, Krista

2014-10-01

The transition for hospitals from having only a provider's perspective to thinking more like a health plan will require strategic alignment on four fronts: Health plan alignment. Hospital and physician alignment. Leadership alignment. Organizational alignment.

Pre-K Physical Education: Universal Initiatives and Teacher Preparation Recommendations

Science.gov (United States)

Ross, Susan M.

2013-01-01

The "National Physical Activity Plan", as well as professional and government agencies (NASPE, 2008a; US Department of Health and Human Services, 2000) acknowledge pre-kindergarten (pre-K) children should be part of comprehensive school physical activity initiatives anchored in quality physical education programming. These…

The Effect of Florida Medicaid's State-Mandated Formulary Provision on Prescription Drug Use and Health Plan Costs in a Medicaid Managed Care Plan.

Science.gov (United States)

Munshi, Kiraat D; Mager, Douglas; Ward, Krista M; Mischel, Brian; Henderson, Rochelle R

2018-02-01

Formulary or preferred drug list (PDL) management is an effective strategy to ensure clinically efficient prescription drug management by managed care organizations (MCOs). Medicaid MCOs participating in Florida's Medicaid program were required to use a state-mandated PDL between May and August 2014. To examine differences in prescription drug use and plan costs between a single Florida Medicaid managed care (MMC) health plan that implemented a state-mandated PDL policy on July 1, 2014, and a comparable MMC health plan in another state without a state-mandated PDL, controlling for sociodemographic confounders. A retrospective analysis with a pre-post design was conducted using deidentified administrative claims data from a large pharmacy benefit manager. The prepolicy evaluation period was January 1 through June 30, 2014, and the postpolicy period was January 1 through June 30, 2015. Continuously eligible Florida MMC plan members were matched on sociodemographic and health characteristics to their counterparts enrolled in a comparable MMC health plan in another state without a state-mandated formulary. Outcomes were drug use, measured as the number of 30-day adjusted nonspecialty drug prescriptions per member per period, and total drug plan costs per member per period for all drugs, with separate measures for generic and brand drugs. Bivariate comparisons were conducted using t-tests. Employing a difference-in-differences (DID) analytic approach, multivariate negative binomial regression and generalized estimating equation models were used to analyze prescription drug use and costs. The final analytical sample consisted of 18,372 enrollees, evenly divided between the 2 groups. In the postpolicy evaluation period, overall and generic use declined, while brand use increased for members in the Florida health plan. Drug costs, especially for brands, significantly increased for Florida health plan members. No significant changes were observed over the same time period

Paying to Get Paid.

Science.gov (United States)

Sorrel, Amy Lynn

2015-12-01

Some health plans and third-party vendors that process plan payments are moving to virtual credit cards, without warning and without much explanation of fees or opt-out procedures. Physician practices don't have to accept the financial and administrative costs associated with virtual cards. TMA officials say doctors have a choice and the right to demand that their payers issue payments via direct deposit.

Identifying beliefs underlying pre-drivers' intentions to take risks: An application of the Theory of Planned Behaviour.

Science.gov (United States)

Rowe, Richard; Andrews, Elizabeth; Harris, Peter R; Armitage, Christopher J; McKenna, Frank P; Norman, Paul

2016-04-01

Novice motorists are at high crash risk during the first few months of driving. Risky behaviours such as speeding and driving while distracted are well-documented contributors to crash risk during this period. To reduce this public health burden, effective road safety interventions need to target the pre-driving period. We use the Theory of Planned Behaviour (TPB) to identify the pre-driver beliefs underlying intentions to drive over the speed limit (N=77), and while over the legal alcohol limit (N=72), talking on a hand-held mobile phone (N=77) and feeling very tired (N=68). The TPB explained between 41% and 69% of the variance in intentions to perform these behaviours. Attitudes were strong predictors of intentions for all behaviours. Subjective norms and perceived behavioural control were significant, though weaker, independent predictors of speeding and mobile phone use. Behavioural beliefs underlying these attitudes could be separated into those reflecting perceived disadvantages (e.g., speeding increases my risk of crash) and advantages (e.g., speeding gives me a thrill). Interventions that can make these beliefs safer in pre-drivers may reduce crash risk once independent driving has begun. Copyright © 2015 Elsevier Ltd. All rights reserved.

The growth of medical groups paid through capitation in California.

Science.gov (United States)

Robinson, J C; Casalino, L P

1995-12-21

In California, it is common for health maintenance organizations (HMOs) to contract with large medical groups that are paid through capitation and are responsible for managing a full spectrum of medical services. We studied six large medical groups in California--Bristol Park Medical, Friendly Hills HealthCare Network, HealthCare Partners Medical Group, Mullikin Medical Centers, Palo Alto Medical Foundation, and San Jose Medical Group--that are paid through capitation and that are growing as a result of contracts with managed-care organizations. We conducted interviews and obtained data on factors such as patient enrollment, capitation and other revenue, numbers of days spent by enrollees in the hospital, and numbers of visits to physicians per enrollee. Between 1990 and 1994, the number of HMO enrollees whose care was paid for through capitation in the six medical groups increased by 91 percent, from 398,359 to 759,474. In 1994, the mean number of hospital days per 1000 HMO enrollees ranged from 120 to 149 for non-Medicare patients and from 643 to 936 days for Medicare patients. By comparison, in 1993 the mean numbers of hospital days per 1000 HMO enrollees not covered by Medicare were 232 for California and 297 for the United States; for HMO enrollees covered by Medicare, the numbers were 1337 for California and 1698 for the United States. In 1994, the average annual number of visits to physicians for HMO patients in the six groups not covered by Medicare ranged from 3.1 to 3.9; for Medicare patients, it ranged from 7.2 to 9.3; these rates were slightly lower than statewide and national rates. Four of the groups have sold their assets (such as facilities, supplies, equipment, and patients' charts) to outside investors; the physicians remain employed by physician-owned professional corporations. Medical groups paid through capitation offer a model for the status of physicians in managed-care systems that differs from the employee status offered by staff-model HMOs

Program Planning in Health Professions Education

Science.gov (United States)

Schmidt, Steven W.; Lawson, Luan

2018-01-01

In this chapter, the major concepts from program planning in adult education will be applied to health professions education (HPE). Curriculum planning and program planning will be differentiated, and program development and planning will be grounded in a systems thinking approach.

Patient-based cultural competency curriculum for pre-health professionals.

Science.gov (United States)

Melamed, Esther; Wyatt, Lacey E; Padilla, Tony; Ferry, Robert J

2008-01-01

The diverse US population requires medical cultural competency education for health providers throughout their pre-professional and professional years. We present a curriculum to train pre-health professional undergraduates by combining classroom education in the humanities and cross-cultural communication skills with volunteer clinical experiences at the University of California, Los Angeles (UCLA) hospital. The course was open to a maximum of 15 UCLA junior and senior undergraduate students with a pre-health or humanities major and was held in the spring quarters of 2002--2004. The change in students' knowledge of cultural competency was evaluated using the Provider's Guide to Quality and Culture Quiz (QCQ) and through students' written assignments and evaluations. Trainees displayed a statistically significant improvement in scores on the QCQ. Participants' written assignments and subjective evaluations confirmed an improvement in awareness and a high motivation to continue learning at the graduate level. This is the first evaluated undergraduate curriculum that integrates interdisciplinary cultural competency training with patient volunteering in the medical field. The didactic, volunteering, and writing components of the course comprise a broadly applicable tool for training future health care providers at other institutions.

Paid maternity leave and childhood vaccination uptake: Longitudinal evidence from 20 low-and-middle-income countries.

Science.gov (United States)

Hajizadeh, Mohammad; Heymann, Jody; Strumpf, Erin; Harper, Sam; Nandi, Arijit

2015-09-01

The availability of maternity leave might remove barriers to improved vaccination coverage by increasing the likelihood that parents are available to bring a child to the clinic for immunizations. Using information from 20 low-and-middle-income countries (LMICs) we estimated the effect of paid maternity leave policies on childhood vaccination uptake. We used birth history data collected via Demographic and Health Surveys (DHS) to assemble a multilevel panel of 258,769 live births in 20 countries from 2001 to 2008; these data were merged with longitudinal information on the number of full-time equivalent (FTE) weeks of paid maternity leave guaranteed by each country. We used Logistic regression models that included country and year fixed effects to estimate the impact of increases in FTE paid maternity leave policies in the prior year on the receipt of the following vaccines: Bacillus Calmette-Guérin (BCG) commonly given at birth, diphtheria, tetanus, and pertussis (DTP, 3 doses) commonly given in clinic visits and Polio (3 doses) given in clinic visits or as part of campaigns. We found that extending the duration of paid maternity leave had a positive effect on immunization rates for all three doses of the DTP vaccine; each additional FTE week of paid maternity leave increased DTP1, 2 and 3 coverage by 1.38 (95% CI = 1.18, 1.57), 1.62 (CI = 1.34, 1.91) and 2.17 (CI = 1.76, 2.58) percentage points, respectively. Estimates were robust to adjustment for birth characteristics, household-level covariates, attendance of skilled health personnel at birth and time-varying country-level covariates. We found no evidence for an effect of maternity leave on the probability of receiving vaccinations for BCG or Polio after adjustment for the above-mentioned covariates. Our findings were consistent with the hypothesis that more generous paid leave policies have the potential to improve DTP immunization coverage. Further work is needed to understand the health effects of

48 CFR 53.205-1 - Paid advertisements.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Paid advertisements. 53.205-1 Section 53.205-1 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION (CONTINUED) CLAUSES AND FORMS FORMS Prescription of Forms 53.205-1 Paid advertisements. SF 1449, prescribed in 53.212, shall be used to place orders for paid...

Health contribution to local government planning

International Nuclear Information System (INIS)

France, Cheryl

2004-01-01

When local government considers future land-use plans, the local health authorities are not always included as a key partner. In Cambridgeshire, England, the former Cambridgeshire Health Authority formed a partnership with local government to address this issue. The relationship that developed and the subsequent health impact review provided an opportunity to influence strategic policy and ensure that health objectives are taken into account. Through partnership working, lessons were learned about how to incorporate health issues into a strategic land-use planning document to the overall benefit of the community

Weight based stereotyping amongst pre-service health and physical educators

OpenAIRE

Werkhoven, Thea; Cotton, Wayne; Russell, Kate

2015-01-01

The purpose of this study was to examine the fat stereotyping attitudes of pre-service health and physical educators towards overweight and obese children and to determine if these attitudes were influenced by gender or degree progression. Pre-service health and physical educators (n=38) completed the Fat Stereotypes Questionnaire and endorsed fat stereotyping attitudes on characteristics and attributes including laziness, attractiveness and friendship. Males and females exhibited differing a...

Health Maintenance Organization (HMO) Plan

Science.gov (United States)

... Find & compare doctors, hospitals, & other providers Health Maintenance Organization (HMO) Plan In most HMO Plans, you generally ... certain service when needed. Related Resources Preferred Provider Organization (PPO) Private Fee-for-Service (PFFS) Special Needs ...

Health plans' disease management programs: extending across the medical and behavioral health spectrum?

Science.gov (United States)

Merrick, Elizabeth Levy; Horgan, Constance M; Garnick, Deborah W; Hodgkin, Dominic; Morley, Melissa

2008-01-01

Although the disease management industry has expanded rapidly, there is little nationally representative data regarding medical and behavioral health disease management programs at the health plan level. National estimates from a survey of private health plans indicate that 90% of health plan products offered disease management for general medical conditions such as diabetes but only 37% had depression programs. The frequency of specific depression disease management activities varied widely. Program adoption was significantly related to product type and behavioral health contracting. In health plans, disease management has penetrated more slowly into behavioral health and depression program characteristics are highly variable.

Balancing Unpaid Care Work and Paid Work in South Asia and sub ...

International Development Research Centre (IDRC) Digital Library (Canada)

In developing countries, women and girls regularly take on unpaid care work. ... We need a deeper understanding of the relationship between women's paid and unpaid care work, and how care is ... Maternal health research concerns men too.

Pre-Planning Civic Action: An Analysis of Civic Leaders' Problem Solving Strategies

Science.gov (United States)

Fitzgerald, Jason

2016-01-01

This study explores the civic thinking heuristics that civic leaders use when pre-planning action. Across eight think-aloud protocols, findings suggest that three heuristics are employed. "Frame alignment" refers to the process of harmonizing personal beliefs and interests with the particulars of a civic action issue to find personal…

Mental Health and Work: Issues and Perspectives.

Science.gov (United States)

Morrow, Lou, Ed.; Verins, Irene, Ed.; Willis, Eileen, Ed.

In Australia, there is increasing attention being paid to the promotion of mental health and the prevention of serious mental disorder by policymakers, funders, academics and service providers. This has required a shift in thinking to focus on health and well being, not just on illness and treatment. The National Action Plan for Promotion,…

26 CFR 31.3301-4 - When wages are paid.

Science.gov (United States)

2010-04-01

... 26 Internal Revenue 15 2010-04-01 2010-04-01 false When wages are paid. 31.3301-4 Section 31.3301... Unemployment Tax Act (Chapter 23, Internal Revenue Code of 1954) § 31.3301-4 When wages are paid. Wages are paid when actually or constructively paid. Wages are constructively paid when they are credited to the...

Examining pre-service science teachers' developing pedagogical design capacity for planning and supporting task-based classroom discussions

Science.gov (United States)

Ross, Danielle Kristina

Teachers face many challenges as we move forward into the age of the Next Generation Science Standards (NGSS) (Achieve, Inc., 2013). The NGSS aim to develop a population of scientifically literate and talented students who can participate in the "innovation-driven economy" (p. 1). In order to meet these goals, teachers must provide students with opportunities to engage in science and engineering practices (SEPs) and learn core ideas of these disciplines. This study followed pre-service secondary science teachers as they participated in a secondary science teacher preparation program intended to support the development of their pedagogical design capacity (Brown, 2009) related to planning and supporting whole-class taskbased discussions. Teacher educators in this program designed an intervention that aimed in supporting this development. This study examined a particular dimension of PDC -- specifically, PSTs effective use of resources to plan science lessons in which students engage in a high demand task, participate in SEPs, and discuss their work in a whole-class setting. In order to examine the effectiveness of the intervention, I had to define PDC a priori. I measured PDC by documenting how/whether PSTs engaged in the following instructional planning practices: developing Learning Goals, selecting and/or designing challenging tasks, anticipating student thinking, planning for monitoring student thinking, imagining the discussion storyline, planning questions, and planning marking strategies. Analyses showed a significant difference between baseline lesson plan scores and Instructional Performance scores. These findings suggest these patterns and changes were directly linked to the teacher preparation program. The mean increase in Instructional Performance scores during the course of the teacher preparation year further supports the effect of the teacher preparation coursework. Pre-service teachers with high pedagogical design capacity continually integrated the

Developing Health-Based Pre-Planning Clearance Goals for Airport Remediation Following a Chemical Terrorist Attack: Decision Criteria for Multipathway Exposure Routes

OpenAIRE

Watson, Annetta; Dolislager, Fredrick; Hall, Linda; Raber, Ellen; Hauschild, Veronique D.; Love, Adam H.

2011-01-01

In the event of a chemical terrorist attack on a transportation hub, post-event remediation and restoration activities necessary to attain unrestricted facility re-use and re-entry could require hours to multiple days. While timeframes are dependent on numerous variables, a primary controlling factor is the level of pre-planning and decision-making completed prior to chemical release. What follows is the second of a two-part analysis identifying key considerations, critical information and de...

UMTRA Project environmental, health, and safety plan

International Nuclear Information System (INIS)

1989-02-01

The basic health and safety requirements established in this plan are designed to provide guidelines to be applied at all Uranium Mill Tailings Remedial Action (UMTRA) Project sites. Specific restrictions are given where necessary. However, an attempt has been made to provide guidelines which are generic in nature, and will allow for evaluation of site-specific conditions. Health and safety personnel are expected to exercise professional judgment when interpreting these guidelines to ensure the health and safety of project personnel and the general population. This UMTRA Project Environmental, Health, and Safety (EH ampersand S) Plan specifies the basic Federal health and safety standards and special DOE requirements applicable to this program. In addition, responsibilities in carrying out this plan are delineated. Some guidance on program requirements and radiation control and monitoring is also included. An Environmental, Health, and Safety Plan shall be developed as part of the remedial action plan for each mill site and associated disposal site. Special conditions at the site which may present potential health hazards will be described, and special areas that should should be addressed by the Remedial Action Contractor (RAC) will be indicated. Site-specific EH ampersand S concerns will be addressed by special contract conditions in RAC subcontracts. 2 tabs

Common and Critical Components Among Community Health Assessment and Community Health Improvement Planning Models.

Science.gov (United States)

Pennel, Cara L; Burdine, James N; Prochaska, John D; McLeroy, Kenneth R

Community health assessment and community health improvement planning are continuous, systematic processes for assessing and addressing health needs in a community. Since there are different models to guide assessment and planning, as well as a variety of organizations and agencies that carry out these activities, there may be confusion in choosing among approaches. By examining the various components of the different assessment and planning models, we are able to identify areas for coordination, ways to maximize collaboration, and strategies to further improve community health. We identified 11 common assessment and planning components across 18 models and requirements, with a particular focus on health department, health system, and hospital models and requirements. These common components included preplanning; developing partnerships; developing vision and scope; collecting, analyzing, and interpreting data; identifying community assets; identifying priorities; developing and implementing an intervention plan; developing and implementing an evaluation plan; communicating and receiving feedback on the assessment findings and/or the plan; planning for sustainability; and celebrating success. Within several of these components, we discuss characteristics that are critical to improving community health. Practice implications include better understanding of different models and requirements by health departments, hospitals, and others involved in assessment and planning to improve cross-sector collaboration, collective impact, and community health. In addition, federal and state policy and accreditation requirements may be revised or implemented to better facilitate assessment and planning collaboration between health departments, hospitals, and others for the purpose of improving community health.

The Olympic and Paralympic Games 2012: literature review of the logistical planning and operational challenges for public health.

Science.gov (United States)

Enock, K E; Jacobs, J

2008-11-01

To undertake a review of the literature relating to public health planning and interventions at previous summer Olympic and Paralympic Games and other relevant major summer sporting events or mass gatherings, with a focus on official publications and peer-reviewed articles. Literature review. A literature review was undertaken using all biomedical databases and a freetext search using Google to widen the search beyond peer-reviewed publications. Search terms used were: Olympics; Paralympics; mass gatherings; mass gathering medicine; sporting events; weather; planning; and organisation. Citations within articles were searched to identify additional references that would inform this review. This literature review concentrates on the public health aspects of population care at mass gatherings, particularly the Olympic and Paralympic Games which are set over several weeks, focusing on surveillance, prevention and health service quality. The literature identified 10 areas of public health planning: public health command centre and communication; surveillance, assessment and control; environmental health and safety; infectious disease outbreaks; implications of weather conditions; health promotion; travel information; economic assessments; public transport and reduction of asthma events; and preparing athletes for potential allergies. The following themes emerged as crucial factors for the success of any public health interventions at Olympic and Paralympic Games: detailed planning of deliverables; pre-identification of critical success factors; management of risk; detailed contingency planning; and full testing of all plans prior to the event. The 2012 Olympic Games will provide an exciting challenge for public health providers and systems. Preparation requires early detailed planning of policies, procedures and on-site health promotion events, in addition to helping to set up the surveillance and monitoring systems that will capture public health activity alongside

42 CFR 51c.105 - Accord with health planning.

Science.gov (United States)

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Accord with health planning. 51c.105 Section 51c... COMMUNITY HEALTH SERVICES General Provisions § 51c.105 Accord with health planning. A grant may be made... approval by the appropriate health planning agencies have been met. ...

Correlates of paid sex among men who have sex with men in Chennai, India.

Science.gov (United States)

Newman, P A; Chakrapani, V; Cook, C; Shunmugam, M; Kakinami, L

2008-11-01

To assess correlates of paid sex among men who have sex with men (MSM) in Chennai, India. A randomised survey was conducted among 200 MSM recruited from public sex environments using time-space sampling. The association of predictors with paid sex was assessed with chi(2) tests and multiple logistic regression. Participants' mean age was 28.5 years (SD 8.7). Most (71.5%) were kothis; 60% had less than high school education and two-thirds had a monthly income less than 2000 Indian rupees. More than one-third (35.0%) reported daily/weekly harassment; 40.5% reported forced sex in the past year. The prevalence of paid sex was 59.5% (95% CI 52.7% to 66.3%). Univariate analyses indicated that paid sex was associated with kothi identity (chi(2) = 14.46; pharassment (chi(2) = 11.75; pharassment (AOR 2.34, 95% CI 1.16 to 4.72). MSM who engaged in paid sex (versus no paid sex) had a mean of 31 partners in the past month (versus 4, t = 6.17, pharassment and sexual violence against MSM who engage in paid sex, predominantly kothis, suggest that interventions should target structural factors placing these men at increased risk of HIV/sexually transmitted infections and other health-compromising conditions. The effectiveness of individual-level, knowledge-based and condom-focused preventive interventions may be constrained in the context of poverty, low education, harassment and sexual violence.

Case-mix adjustment of consumer reports about managed behavioral health care and health plans.

Science.gov (United States)

Eselius, Laura L; Cleary, Paul D; Zaslavsky, Alan M; Huskamp, Haiden A; Busch, Susan H

2008-12-01

To develop a model for adjusting patients' reports of behavioral health care experiences on the Experience of Care and Health Outcomes (ECHO) survey to allow for fair comparisons across health plans. Survey responses from 4,068 individuals enrolled in 21 managed behavioral health plans who received behavioral health care within the previous year (response rate = 48 percent). Potential case-mix adjustors were evaluated by combining information about their predictive power and the amount of within- and between-plan variability. Changes in plan scores and rankings due to case-mix adjustment were quantified. The final case-mix adjustment model included self-reported mental health status, self-reported general health status, alcohol/drug treatment, age, education, and race/ethnicity. The impact of adjustment on plan report scores was modest, but large enough to change some plan rankings. Adjusting plan report scores on the ECHO survey for differences in patient characteristics had modest effects, but still may be important to maintain the credibility of patient reports as a quality metric. Differences between those with self-reported fair/poor health compared with those in excellent/very good health varied by plan, suggesting quality differences associated with health status and underscoring the importance of collecting quality information.

Consumer-directed health plans: what happened?

Science.gov (United States)

Goldsmith, Jeff

2007-08-01

CDHPs can stabilize growth in health costs, but the health plan-subscriber relationship should be more transparent. CFOs should ensure that increased cost exposure in CDHPs is paired with broad, deep disease management and employee assistance support. Hospitals should plan for the likelihood that, one way or another, consumers will be paying more of their healthcare bill.

Iran's Health Reform Plan: Measuring Changes in Equity Indices.

Science.gov (United States)

Assari Arani, Abbas; Atashbar, Tohid; Antoun, Joseph; Bossert, Thomas

2018-03-01

Two years after the implementation of the Health Sector Evolution Plan (HSEP), this study evaluated the effects of the plan on health equity indices. The main indices assessed by the study were the Out-of-Pocket (OOP) health expenditures, the Fairness in Financial Contribution (FFC) to the health system index, the index of households' Catastrophic Health Expenditure (CHE) and the headcount ratio of Impoverishing Health Expenditure (IHE). The per capita share of costs for total health services has been decreased. The lowered costs have been more felt in rural areas, generally due to sharp decrease in inpatient costs. Per capita pay for outpatient services is almost constant or has slightly increased. The reform plan has managed to improve households' Catastrophic Health Expenditure (CHE) index from an average of 2.9% before the implementation of the plan to 2.3% after the plan. The Fairness in Financial Contribution (FFC) to the health system index has worsened from 0.79 to 0.76, and the headcount ratio of Impoverishing Health Expenditure (IHE) index deteriorated after the implementation of plan from 0.34 to 0.50. Considerable improvement, in decreasing the burden of catastrophic hospital costs in low income strata which is about 26% relative to the time before the implementation of the plan can be regarded as the main achievement of the plan, whereas the worsening in the headcount ratio of IHE and FFC are the equity bottlenecks of the plan.

Psychosocial factors and pre-abortion psychological health: The significance of stigma.

Science.gov (United States)

Steinberg, Julia R; Tschann, Jeanne M; Furgerson, Dorothy; Harper, Cynthia C

2016-02-01

Most research in mental health and abortion has examined factors associated with post-abortion psychological health. However, research that follows women from before to after their abortion consistently finds that depressive, anxiety, and stress symptoms are highest just before an abortion compared to any time afterwards. This finding suggests that studies investigating psychosocial factors related to pre-abortion mental health are warranted. The current study uses data from 353 women seeking abortions at three community reproductive health clinics to examine predictors of pre-abortion psychological health. Drawing from three perspectives in the abortion and mental health literature, common risks, stress and coping, and sociocultural context, we conducted multivariable analyses to examine the contribution of important factors on depressive, anxiety, and stress symptoms just before an abortion, including sociodemographics, abortion characteristics, childhood adversities, recent adversities with an intimate partner, relationship context, future pregnancy desires, and perceived abortion stigma. Childhood and partner adversities, including reproductive coercion, were associated with negative mental health symptoms, as was perceived abortion stigma. Before perceived abortion stigma was entered into the model, 18.6%, 20.7%, and 16.8% of the variance in depressive, anxiety, and stress symptoms respectively, was explained. Perceived abortion stigma explained an additional 13.2%, 9.7%, and 10.7% of the variance in depressive, anxiety, and stress symptoms pre-abortion. This study, one of the first to focus on pre-abortion mental health as an outcome, suggests that addressing stigma among women seeking abortions may significantly lower their psychological distress. Copyright © 2015 Elsevier Ltd. All rights reserved.

77 FR 38296 - Draft Public Health Action Plan-A National Public Health Action Plan for the Detection...

Science.gov (United States)

2012-06-27

... Prevention and Health Promotion, Division of Reproductive Health, Attn: National Public Health Action Plan... Disease Prevention and Health Promotion, Division of Reproductive Health, 4770 Buford Highway NE... topic's public health importance, existing challenges, and opportunities for action to decrease the...

Feasibility and outcomes of paid undergraduate student nurse positions.

Science.gov (United States)

Gamroth, Lucia; Budgen, Claire; Lougheed, Mary

2006-09-01

An Undergraduate Nurse Employment Demonstration Project (UNDP) was implemented in four Health Service Areas in British Columbia with a concurrent evaluation study. This demonstration project comprised the development and implementation of a new position in the BC healthcare system. The position enabled third- and fourth-year nursing students to be employed at their level of education. The purposes of the evaluation were to explore the feasibility and outcomes of this type of paid undergraduate student nurse employment. The three-year project and evaluation included both implementation and outcome analysis. The implementation evaluation design was descriptive and prospective, involving multiple data sources. The outcome evaluation design was quasi-experimental, with intervention and comparison groups. Learning outcomes for undergraduate nurses were increased confidence, organizational ability, competency and ability to work with a team. Workplace outcomes were increased unit morale, help with workload and improved patient care. New graduates with undergraduate nurse experience reported less time required for orientation and transition than other graduates who did not have this experience, and workplace nurses viewed these new graduates as more job-ready than other new graduates. After 21 months, new graduates with undergraduate nurse experience were less likely to move to other employment than other new graduates. Results from the four Health Service Areas indicated that the paid undergraduate nurse position was feasible and that outcomes benefited students, new graduates and workplaces. The undergraduate nurse position is now being implemented throughout all Health Service Areas in British Columbia.By 2000, concerns in British Columbia about the nursing workforce, workplace and patient safety had escalated to the point where diverse stakeholder groups were prepared to work together in new ways to prepare nursing graduates to be more job-ready, to recruit and retain

Health safety planning for possible accidental exposures of workers and population in Italy

International Nuclear Information System (INIS)

Strambi, E.; Trenta, G.; Muzzi, A.

1986-01-01

Unforeseen radiation exposures may be caused by technical or human faults in the utilization of radioactive devices, namely radionuclide sources, as well as from the peaceful uses of nuclear energy; the first instance is in general the more common one. The paper discusses the principal basis for health intervention planning in the case of possible accidental exposures of workers and/or the population to ionizing radiation, also with reference to hypothetical accidents at nuclear power stations. For this last purpose an important aspect is the definition of the 'source term' problem. The main differences existing between 'conventional' and radiation emergencies in the pre-planning of technical and health safety operations are discussed. Even if the general organizational planning is based on similar operating structures, radiation emergencies require a somewhat different approach. Besides the specialized aspects of prophylaxis and therapy which are needed in these cases, radiation emergencies call for a comparison of the social cost, the possible health detriment induced by health-related countermeasures and the specific radiation risk in a single case. In many instances, furthermore, a key role may also be played by psychological factors. Following this philosophy, a flexible organization plan has been drawn up, which consists of three-steps as follows: (1) local and/or regional level; (2) national level; (3) European or international level. For the first two levels, besides the possibility of utilizing health services, there is provision to arrange them into structures of increasing complexity, using modular, integrated and fixed operative units to adapt the intervention to specific aspects of each accident or emergency. The third level is represented by the WHO International Centre of Radiopathology (ICR) in Paris. An official agreement was recently signed by the ENEA and the Centre. (author)

A framework for health care planning and control

NARCIS (Netherlands)

Hans, Elias W.; van Houdenhoven, Mark; Hulshof, P.J.H.

Rising expenditures spur health care organizations to organize their processes more efficiently and effectively. Unfortunately, health care planning and control lags far behind manufacturing planning and control. Successful manufacturing planning and control concepts can not be directly copied,

Policies to support women’s paid work

OpenAIRE

Giannelli, Gianna Claudia

2015-01-01

Engaging in paid work is generally difficult for women in developing countries. Many women work unpaid in family businesses or on farms, are engaged in low-income self-employment activities, or work in low-paid wage employment. In some countries, vocational training or grants for starting a business have been effective policy tools for supporting women’s paid work. Mostly lacking, however, are job and business training programs that take into account how mothers’ employment affects child welf...

Preconception health: awareness, planning, and communication among a sample of US men and women.

Science.gov (United States)

Mitchell, Elizabeth W; Levis, Denise M; Prue, Christine E

2012-01-01

It is important to educate both men and women about preconception health (PCH), but limited research exists in this area. This paper examines men's and women's awareness of exposure to PCH information and of specific PCH behaviors, PCH planning, and PCH discussions with their partners. Data from Porter Novelli's 2007 Healthstyles survey were used. Women and men of reproductive age were included in the analysis (n = 2,736) to understand their awareness, planning, and conversations around PCH. Only 27.9% of women and men reported consistently using an effective birth control method. The majority of men (52%) and women (43%) were unaware of any exposure to PCH messages; few received information from their health care provider. Women were more aware than men of specific pre-pregnancy health behaviors. Women in the sample reported having more PCH conversations with their partners than did men. PCH education should focus on both women and men. Communication about PCH is lacking, both between couples and among men and women and their health care providers. PCH education might benefit from brand development so that consumers know what to ask for and providers know what to deliver.

Provider-Sponsored Health Plans: Lessons Learned over Three Decades.

Science.gov (United States)

Breon, Richard C

2016-01-01

Healthcare's movement to value-based care is causing health systems across the country to consider whether owning or partnering with a health plan could benefit their organizations. Although organizations have different reasons for wanting to enter the insurance business, potential benefits include improving care quality, lowering costs, managing population health, expanding geographic reach, and diversifying the organization's revenue stream. However, the challenges and risks of owning a health plan are formidable: Assuming 100 percent financial risk for a patient population requires considerable financial resources, as well as competencies that are wholly different from those needed to run a hospital or physician group. For Spectrum Health, an integrated, not-for-profit health system based in Grand Rapids, Michigan, owning a health plan has been vital to fulfilling its mission of improving the health of the communities it serves, as well as its value proposition of providing highquality care at lower costs. This article weighs the pros and cons of operating a health plan; explores key business factors and required competencies that organizations need to consider when deciding whether to buy, build, or partner; examines the current environment for provider-sponsored health plans; and shares some of the lessons Spectrum Health has learned over three decades of running its health plan, Priority Health.

The reliability of pre-travel history to decide on appropriate counseling and vaccinations: a prospective study.

Science.gov (United States)

Rossi, Isabelle A; Genton, Blaise

2012-01-01

Although medical and travel plans gathered from pre-travel interviews are used to decide the provision of specific pre-travel health advice and vaccinations, there has been no evaluation of the relevance of this strategy. In a prospective study, we assessed the agreement between pre-travel plans and post-travel history and the effect on advice regarding the administration of vaccines and recommendations for malaria prevention. We included prospectively all consenting adults who had not planned an organized tour. Pre- and post-travel information included questions on destination, itineraries, departure and return dates, access to bottled water, plan of bicycle ride, stays in a rural zone, and close contact with animals. The outcomes measured included: agreement between pre- and post-travel itineraries and activities; and the effect of these differences on pre-travel health recommendations, had the traveler gone to the actual versus intended destinations for actual versus intended duration and activities. Three hundred and sixty-five travelers were included in the survey, where 188 (52%) were males (median age 38 years). In 81(23%) travelers, there was no difference between pre- and post-travel history. Disagreement between pre- and post-travel history were the highest for stays in rural zones or with local people (66% of travelers), close contact with animals (33%), and bicycle riding (21%). According to post-travel history, 125 (35%) travelers would have needed rabies vaccine and 9 (3%) typhoid fever vaccine. Potential overprovision of vaccine was found in travelers. A change in the malaria prescription would have been recommended in 18 (5%) travelers. Pre-travel history does not adequately reflect what travelers do. However, difference between recommendations for the actual versus intended travel plans was only clinically significant for the need for rabies vaccine. Particular attention during pre-travel health counseling should focus on the risk of rabies, the

Joining up health and planning: how Joint Strategic Needs Assessment (JSNA) can inform health and wellbeing strategies and spatial planning.

Science.gov (United States)

Tomlinson, Paul; Hewitt, Stephen; Blackshaw, Neil

2013-09-01

There has been a welcome joining up of the rhetoric around health, the environment and land use or spatial planning in both the English public health white paper and the National Planning Policy Framework. However, this paper highlights a real concern that this is not being followed through into practical guidance needed by local authorities (LAs), health bodies and developers about how to deliver this at the local level. The role of Joint Strategic Needs Assessments (JSNAs) and Health and Wellbeing Strategies (HWSs) have the potential to provide a strong basis for integrated local policies for health improvement, to address the wider determinants of health and to reduce inequities. However, the draft JSNA guidance from the Department of Health falls short of providing a robust, comprehensive and practical guide to meeting these very significant challenges. The paper identifies some examples of good practice. It recommends that action should be taken to raise the standards of all JSNAs to meet the new challenges and that HWSs should be aligned spatially and temporally with local plans and other LA strategies. HWSs should also identify spatially targeted interventions that can be delivered through spatial planning or transport planning. Steps need to be taken to ensure that district councils are brought into the process.

Responsibility for health: personal, social, and environmental.

Science.gov (United States)

Resnik, D B

2007-08-01

Most of the discussion in bioethics and health policy concerning social responsibility for health has focused on society's obligation to provide access to healthcare. While ensuring access to healthcare is an important social responsibility, societies can promote health in many other ways, such as through sanitation, pollution control, food and drug safety, health education, disease surveillance, urban planning and occupational health. Greater attention should be paid to strategies for health promotion other than access to healthcare, such as environmental and public health and health research.

Evaluating Health Providers in Rural Zambia through Competency ...

International Development Research Centre (IDRC) Digital Library (Canada)

Addressing Africa's unmet need for family planning by intensifying sexual and reproductive and adolescent health research. ... Special journal issue highlights IDRC-supported findings on women's paid work. Policy in Focus publishes a special issue profiling evidence to empower women in the labour market.

The Experience of Paid Family-Care Workers of People with Dementia in South Korea

Directory of Open Access Journals (Sweden)

Jungmin Kim, RN, MN

2018-03-01

Full Text Available Purpose: The South Korean government introduced the universal long-term care insurance program in 2008 that created a new employment category of “paid family-care worker” to assist the elderly with chronic illnesses including dementia. The aim of this study was to understand the lived experience of paid family-care workers of people with dementia in South Korea. Methods: The study was a qualitative research design underpinned by interpretive description principles involving eight paid family-care workers. The participants were recruited by attaching the advertisement flyer in a notice board of an educational facility for paid family-care workers. Results: Paid family-care workers struggled to manage the behavioral and psychological symptoms of their care recipients. Their workloads created physical, emotional, social, and financial burdens. However, the care-giving activities were encouraged through their sense of responsibility, filial piety, and personal religious beliefs. Financial subsidies from the government and help received from others were also identified as encouragements. The education course provided to them assisted them to improve their dementia-care capabilities. Conclusion: Understanding paid family-care workers' lived experience in dementia care in South Korea assists with the identification of their educational needs and level of support they require to improve dementia care in the home care environment. A number of suggestions are made to increase paid family-care workers' knowledge, clinical skills, and job satisfaction to reduce their burdens and work-related incidents, such as challenging behaviors from those being cared for. Keywords: dementia, health personnel, long-term care, Republic of Korea

Sick of inequality: gender and support for paid sick days.

Science.gov (United States)

Lindemann, Danielle J; Houser, Linda; White, Karen

2015-01-01

The availability of paid sick days (PSD) is on the forefront of policy issues relating to women's health and well-being. Previous research regarding PSD and other forms of family-work balance legislation has linked access to paid time off from work for addressing one's own or another's health concerns to a range of health benefits for working women and their families. In general, public support for such policies is high, but little work has tested the extent to which support extends to PSD. Researchers have yet to engage in a rigorous statistical analysis of public opinion on PSD, including whether opinion varies by gender. Using data from a 2013 poll of adults in New Jersey (n = 925), we bridged this research gap by conducting the first multivariate analysis of public attitudes toward PSD. As expected, we found markedly high levels of support for PSD across all respondents, with a preponderance of most sociodemographic categories supporting proposed PSD legislation in New Jersey. We also found that gender was a strong predictor of support for PSD, with women significantly (odds ratio, 1.916; p ≤ .01) more likely than men to be in favor of such legislation. We discuss the implications of our findings for future work on PSD as well as for research concerning women, wellness, and work-life legislation more broadly. Published by Elsevier Inc.

An analysis of pre-service family planning teaching in clinical and nursing education in Tanzania.

Science.gov (United States)

Muganyizi, Projestine S; Ishengoma, Joyce; Kanama, Joseph; Kikumbih, Nassoro; Mwanga, Feddy; Killian, Richard; McGinn, Erin

2014-07-12

Promoting family planning (FP) is a key strategy for health, economic and population growth. Sub-Saharan Africa, with one of the lowest contraceptive prevalence and highest fertility rates globally, contributes half of the global maternal deaths. Improving the quality of FP services, including enhancing pre-service FP teaching, has the potential to improve contraceptive prevalence. In efforts to improve the quality of FP services in Tanzania, including provider skills, this study sought to identify gaps in pre-service FP teaching and suggest opportunities for strengthening the training. Data were collected from all medical schools and a representative sample of pre-service nursing, Assistant Medical Officer (AMO), Clinical Officer (CO) and assistant CO schools in mainland Tanzania. Teachers responsible for FP teaching at the schools were interviewed using a semi-structured questionnaire. Observations on availability of teaching resources and other evidence of FP teaching and evaluation were documented. Relevant approved teaching documents were assessed for their suitability as competency-based FP teaching tools against predefined criteria. Quantitative data were analyzed using EPI Info 6 and qualitative data were manually analyzed using content analysis. A total of 35 pre-service schools were evaluated for FP teaching including 30 technical education and five degree offering schools. Of the assessed 11 pre-service curricula, only one met the criteria for suitability of FP teaching. FP teaching was typically theoretical with only 22.9% of all the schools having systems in place to produce graduates who could skillfully provide FP methods. Across schools, the target skills were the same level of competence and skewed toward short acting methods of contraception. Only 23.3% (n = 7) of schools had skills laboratories, 76% (n = 22) were either physically connected or linked to FP clinics. None of the degree providing schools practiced FP at its own teaching hospital

24 CFR 245.416 - Initial submission of materials to HUD: Conversion from project-paid utilities to tenant-paid...

Science.gov (United States)

2010-04-01

... projects, and utility rate information, as obtained from the utility supplier; (iv) The estimated monthly... HUD: Conversion from project-paid utilities to tenant-paid utilities or a reduction in tenant utility... AUTHORITIES TENANT PARTICIPATION IN MULTIFAMILY HOUSING PROJECTS Procedures for Requesting Approval of a...

A cross-sectional study of pre-travel health-seeking practices among travelers departing Sydney and Bangkok airports.

Science.gov (United States)

Heywood, Anita E; Watkins, Rochelle E; Iamsirithaworn, Sopon; Nilvarangkul, Kessarawan; MacIntyre, C Raina

2012-05-02

Pre-travel health assessments aim to promote risk reduction through preventive measures and safe behavior, including ensuring travelers are up-to-date with their immunizations. However, studies assessing pre-travel health-seeking practices from a variety of medical and non-medical sources and vaccine uptake prior to travel to both developing and developed countries within the Asia-Pacific region are scarce. Cross-sectional surveys were conducted between July and December 2007 to assess pre-travel health seeking practices, including advice from health professionals, health information from other sources and vaccine uptake, in a sample of travelers departing Sydney and Bangkok airports. A two-stage cluster sampling technique was used to ensure representativeness of travelers and travel destinations. Pre-travel health seeking practices were assessed using a self-administered questionnaire distributed at the check-in queues of departing flights. Logistic regression models were used to identify significant factors associated with seeking pre-travel health advice from a health professional, reported separately for Australian residents, residents of other Western countries and residents of countries in Asia. A total of 843 surveys were included in the final sample (Sydney 729, response rate 56%; Bangkok 114, response rate 60%). Overall, pre-travel health information from any source was sought by 415 (49%) respondents with 298 (35%) seeking pre-travel advice from a health professional, the majority through general practice. Receipt of a pre-travel vaccine was reported by 100 (12%) respondents. Significant factors associated with seeking pre-travel health advice from a health professional differed by region of residence. Asian travelers were less likely to report seeking pre-travel health advice and uptake of pre-travel vaccines than Australian or other Western travelers. Migrant Australians were less likely to report seeking pre-travel health advice than Australian

A cross-sectional study of pre-travel health-seeking practices among travelers departing Sydney and Bangkok airports

Science.gov (United States)

2012-01-01

Background Pre-travel health assessments aim to promote risk reduction through preventive measures and safe behavior, including ensuring travelers are up-to-date with their immunizations. However, studies assessing pre-travel health-seeking practices from a variety of medical and non-medical sources and vaccine uptake prior to travel to both developing and developed countries within the Asia-Pacific region are scarce. Methods Cross-sectional surveys were conducted between July and December 2007 to assess pre-travel health seeking practices, including advice from health professionals, health information from other sources and vaccine uptake, in a sample of travelers departing Sydney and Bangkok airports. A two-stage cluster sampling technique was used to ensure representativeness of travelers and travel destinations. Pre-travel health seeking practices were assessed using a self-administered questionnaire distributed at the check-in queues of departing flights. Logistic regression models were used to identify significant factors associated with seeking pre-travel health advice from a health professional, reported separately for Australian residents, residents of other Western countries and residents of countries in Asia. Results A total of 843 surveys were included in the final sample (Sydney 729, response rate 56%; Bangkok 114, response rate 60%). Overall, pre-travel health information from any source was sought by 415 (49%) respondents with 298 (35%) seeking pre-travel advice from a health professional, the majority through general practice. Receipt of a pre-travel vaccine was reported by 100 (12%) respondents. Significant factors associated with seeking pre-travel health advice from a health professional differed by region of residence. Asian travelers were less likely to report seeking pre-travel health advice and uptake of pre-travel vaccines than Australian or other Western travelers. Migrant Australians were less likely to report seeking pre-travel health

Lifetime Paid Work and Mental Health Problems among Poor Urban 9-to-13-Year-Old Children in Brazil

Directory of Open Access Journals (Sweden)

Isabel A. Bordin

2013-01-01

Full Text Available Objective. To verify if emotional/behavioral problems are associated with lifetime paid work in poor urban children, when taking into account other potential correlates. Methods. Cross-sectional study focused on 9-to-13-year-old children (n=212. In a probabilistic sample of clusters of eligible households (women 15–49 years and son/daughter <18 years, one mother-child pair was randomly selected per household (n=813; response rate = 82.4%. CBCL/6-18 identified child emotional/behavioral problems. Potential correlates include child gender and age, socioeconomic status/SES, maternal education, parental working status, and family social isolation, among others. Multivariate analysis examined the relationship between emotional/behavioral problems and lifetime paid work in the presence of significant correlates. Findings. All work activities were non-harmful (e.g., selling fruits, helping parents at their small business, and baby sitting. Children with lower SES and socially isolated were more involved in paid work than less disadvantaged peers. Children ever exposed to paid work were four times more likely to present anxiety/depression symptoms at a clinical level compared to non-exposed children. Multivariate modeling identified three independent correlates: child pure internalizing problems, social isolation, and low SES. Conclusion. There is an association between lifetime exposure to exclusively non-harmful paid work activities and pure internalizing problems even when considering SES variability and family social isolation.

Paid Leave Benefits Among a National Sample of Working Mothers with Infants in the United States

Science.gov (United States)

Shepherd-Banigan, Megan; Bell, Janice F.

2013-01-01

To describe a range of employment benefits, including maternity and other paid leave, afforded to working women with infants; and to examine the geographic, socio-demographic correlates of such benefits to inform the workplace policy agenda in the US. Using data from the Listening to Mothers II Survey, a national sample of English-speaking women who gave birth in 2005, we conducted multivariable linear and logistic regression analyses to examine the associations between socio-demographic factors and employment leave variables (paid maternity, sick and personal leave). Forty-one percent of women received paid maternity leave for an average of 3.3 weeks with 31 % wage replacement. On average women took 10 weeks of maternity leave and received 10.4 days of paid sick leave and 11.6 days of paid personal time per year. Women who were non-Hispanic Black, privately insured, working full-time, and from higher income families were more likely to receive paid maternity leave, for more time, and at higher levels of wage replacement, when controlling for the other socio-demographic characteristics. Race/ethnicity, family income and employment status were associated with the number of paid personal days. Currently, the majority of female employees with young children in the US do not receive financial compensation for maternity leave and women receive limited paid leave every year to manage health-related family issues. Further, women from disadvantaged backgrounds generally receive less generous benefits. Federal policy that supports paid leave may be one avenue to address such disparities and should be modified to reflect accepted international standards. PMID:23584928

[The Health Plan for Catalonia: an instrument to transform the health system].

Science.gov (United States)

Constante i Beitia, Carles

2015-11-01

The Department of Health of the Generalitat in Catalonia periodically draws up the Health Plan, which is the strategic document that brings together the reference framework for initiatives concerning public health in terms of the Catalan health administration. The 2011-2015 version of the Health Plan incorporates key care and system governance-related elements, which, in conjunction with health goals, make up the complete picture of what the health system in Catalonia should look like until 2015. The Plan was drawn up at a time when the environmental conditions were extremely particular, given the major economic crisis that began in 2007. This has meant that the system has been forced to address public health problems using a significant reduction in the economic resources available, while aiming to maintain the level of care provided, both quantitatively and qualitatively, and preserve the sustainability of the system whose defining traits are its universality, equity and the wide range of services on offer. The Health Plan focuses on three areas of action, 9 major courses of action and 32 strategic projects designed to respond to new social needs: addressing the most common health issues, comprehensive care for chronic patients and organizational modernization. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Pre-travel health seeking practices of Umrah pilgrims departing from Assiut International Airport, Egypt.

Science.gov (United States)

Aziz, Mirette M; Abd El-Megeed, Hosnia S; Abd Ellatif, Mennat Allah M

2018-04-22

to assess the health seeking practices and their determinants among Umrah pilgrims departing from Assiut international Airport. We interviewed 300 pilgrims departing from Assiut International Airport while they were in the departure lounge, using a semi-structured questionnaire. Only 60%, 46.3% and 46.3% of Umrah pilgrims believed in importance of pre-travel vaccination, seeking health information, and health examination, respectively. The most frequently practiced pre-travel health related behaviour was getting vaccinated (56.3%), as compared to much lower frequencies of seeking health information (24%) or having a clinical health examination (26.7%). Private clinics, internet and the tourism companies were the main sources of health information of the pilgrims. Positive attitude of pilgrims about health seeking practices, the perception of health risk of travelling to Hajj/Umrah and having a chronic disease were the predictors of pre-travel health practices. Raising awareness among Hajj/Umrah pilgrims about the importance of seeking professional pre-travel health advice and communicating the risk of exposure to travel-related diseases to pilgrims could be important strategies to improve the uptake of preventive measures. Training of general practitioners in the public health sector about the travel health information would promote the travel health services. Copyright © 2018. Published by Elsevier Ltd.

EM Health and Safety Plan Guidelines

Energy Technology Data Exchange (ETDEWEB)

1994-12-01

This document contains information about the Health and Safety Plan Guidelines. Topics discussed include: Regulatory framework; key personnel; hazard assessment; training requirements; personal protective equipment; extreme temperature disorders or conditions; medical surveillance; exposure monitoring/air sampling; site control; decontamination; emergency response/contingency plan; emergency action plan; confined space entry; and spill containment.

Financial Performance of Health Plans in Medicaid Mana...

Data.gov (United States)

U.S. Department of Health & Human Services — This study assesses the financial performance of health plans that enroll Medicaid members across the key plan traits, specifically Medicaid dominant, publicly...

Decentralisation and health services delivery in Tanzania: Analysis of decision space in planning, allocation, and use of financial resources.

Science.gov (United States)

Kigume, Ramadhani; Maluka, Stephen; Kamuzora, Peter

2018-04-01

While decentralisation of health systems has been on the policy agenda in low-income and middle-income countries since the 1970s, many studies have focused on understanding who has more decision-making powers but less attention is paid to understand what those powers encompass. Using the decision space approach, this study aimed to understand the amount of decision-making space transferred from the central government to institutions at the periphery in the decentralised health system in Tanzania. The findings of this study indicated that the decentralisation process in Tanzania has provided authorities with a range of decision-making space. In the areas of priority setting and planning, district health authorities had moderate decision space. However, in the financial resource allocation and expenditure of funds from the central government, the districts had narrow decision-making space. The districts, nevertheless, had wider decision-making space in mobilising and using locally generated financial resources. However, the ability of the districts to allocate and use locally generated resources was constrained by bureaucratic procedures of the central government. The study concludes that decentralisation by devolution which is being promoted in the policy documents in Tanzania is yet to be realised at the district and local levels. The study recommends that the central government should provide more space to the decentralised district health systems to incorporate locally defined priorities in the district health plans. Copyright © 2018 John Wiley & Sons, Ltd.

Environmental health and health planning

International Nuclear Information System (INIS)

1975-07-01

Areas of environmental concern are identified and recommendations for improving environmental health are proposed by the Environmental Health Task Force of the Western Massachusetts Health Planning Council. Environmental health concerns in Western Massachusetts are in the areas of: air pollution; dental health and the specific problem of water flouridation; housing; injury control, including accidental death and disability; land use, and the specific problem of critical receptors; noise pollution; occupational hazards, specifically occupational accidents; pesticides; radiological exposure, particularly medical X-ray exposure and nuclear exposure; rural health care; sanitation; solid waste; and water quality including private and public water supplies, road salting, and rural sewerages. Each area of concern and specific problem are broken down into sections: background information; comments which incorporate recommendations for general problem-solving activities; and resources, including lists of key organization, individuals, laws and regulations, and publications relevant to the area of concern. Recommendations are presented based on long-term and short-term environmental goals. An inventory of environmental health organizations in Western Massachusetts is included. Appendices contain the charge to the Task Force, a definition of environmental health, sources of drinking water, the sanitation and sanitary codes, and housing and sanitation standards. Portions of this document are not fully legible

Housing, health and master planning: rules of engagement.

Science.gov (United States)

Harris, P; Haigh, F; Thornell, M; Molloy, L; Sainsbury, P

2014-04-01

Knowledge about health focussed policy collaboration to date has been either tactical or technical. This article focusses on both technical and tactical issues to describe the experience of cross-sectoral collaboration between health and housing stakeholders across the life of a housing master plan, including but not limited to a health impact assessment (HIA). A single explanatory case study of collaboration on a master plan to regenerate a deprived housing estate in Western Sydney was developed to explain why and how the collaboration worked or did not work. Data collection included stakeholder interviews, document review, and reflections by the health team. Following a realist approach, data was analysed against established public policy theory dimensions. Tactically we did not know what we were doing. Despite our technical knowledge and skills with health focussed processes, particularly HIA, we failed to appreciate complexities inherent in master planning. This limited our ability to provide information at the right points. Eventually however the HIA did provide substantive connections between the master plan and health. We use our analysis to develop technical and tactical rules of engagement for future cross-sectoral collaboration. This case study from the field provides insight for future health focussed policy collaboration. We demonstrate the technical and tactical requirements for future intersectoral policy and planning collaborations, including HIAs, with the housing sector on master planning. The experience also suggested how HIAs can be conducted flexibly alongside policy development rather than at a specific point after a policy is drafted. Copyright © 2014 The Royal Society for Public Health. All rights reserved.

Health impact assessment in planning: Development of the design for health HIA tools

International Nuclear Information System (INIS)

Forsyth, Ann; Slotterback, Carissa Schively; Krizek, Kevin J.

2010-01-01

How can planners more systematically incorporate health concerns into practical planning processes? This paper describes a suite of health impact assessment tools (HIAs) developed specifically for planning practice. Taking an evidence-based approach the tools are designed to fit into existing planning activities. The tools include: a short audit tool, the Preliminary Checklist; a structured participatory workshop, the Rapid HIA; an intermediate health impact assessment, the Threshold Analysis; and a set of Plan Review Checklists. This description provides a basis for future work including assessing tool validity, refining specific tools, and creating alternatives.

Interviews With Patients Who Traveled From Macedonia/Kosovo, The Netherlands, and Sweden for Paid Kidney Transplantations.

Science.gov (United States)

van Balen, L J; Ambagtsheer, Frederike; Ivanovski, N; Weimar, W

2016-12-01

Patients travel worldwide for paid kidney transplants. Although transplantations abroad are not always illegal, they are commonly perceived to be illegal and unethical involving risks. We aimed to describe the motivations and experiences of patients who traveled abroad for paid kidney transplantations and to examine how these transplantations were facilitated. We interviewed 22 patients who traveled from Macedonia/Kosovo, the Netherlands, and Sweden for paid kidney transplantations between years 2000 and 2009. Patients traveled because of inadequate transplant activity in their domestic countries and dialysis-related complaints. However, 6 patients underwent preemptive transplantations. Cultural factors such as patients' affinity with destination countries, feelings of being discriminated against by the health-care system, and family ties also help explain why patients travel abroad. Seven of the 22 patients went to their country of origin. They were able to organize their transplantations by arranging help from family and friends abroad who provided contacts of caregivers there and who helped cover the costs of their transplants. The costs varied from €5000 to €45 000 (US$6800-US$61 200). Seven patients paid the hospital, 5 paid their doctor, 4 paid a broker, and 6 paid their donors. Research should include interviews with brokers, transplant professionals, and other facilitators to achieve a full picture of illegally performed transplantations.

76 FR 46677 - Requirements for Group Health Plans and Health Insurance Issuers Relating to Coverage of...

Science.gov (United States)

2011-08-03

... Requirements for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services... regulations published July 19, 2010 with respect to group health plans and health insurance coverage offered... plans, and health insurance issuers providing group health insurance coverage. The text of those...

[Satisfaction according to health care insurance systems in an emergency department].

Science.gov (United States)

Dávila, F A; Herrera, J S; Yasnó, D A; Forero, L C; Alvarado, M V

Health satisfaction is a fundamental measure of the quality of health services. This study aims to validate and analyse the results of a quality of care questionnaire to assess the level of satisfaction of patients attended in the emergency department of a high complexity hospital. Observational, cross-sectional study, with a questionnaire designed to assess the quality of service and satisfaction at the end of care in the emergency department. Descriptive statistics of scale were established and presented, as well as determining the construct validity, overall reliability, internal and concurrent validity of an overall against a uni-dimensional scale. A total of 5,961 records were reviewed, most of them (77.3%) reported by patients in the Mandatory Health Plan. High levels of satisfaction overall and by subgroups were found. There were no significant differences between subgroups, with 86.8 for those with Pre-paid Medical Care Plan and 84.4 for mandatory health plan. Cronbach's alpha for the questionnaire was 0.90. The questionnaire proved to be reliable and valid in determining the quality and satisfaction with care. The results showed high levels of satisfaction overall and in the domains. A low consistency between the results of the multidimensional and unidimensional satisfaction scales suggests that there were aspects of satisfaction not investigated on the multidimensional scale. Ecologically-designed before and after studies are required to evaluate the effectiveness of interventions in satisfaction. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

How to inject consumerism into your existing health plans.

Science.gov (United States)

Havlin, Linda J; McAllister, Michael F; Slavney, David H

2003-09-01

Consumerism seeks to create a behavior change on the part of consumers so that they become accountable, knowledgeable and actively engaged in managing their health. It can be used in any existing health plan through targeted plan design changes and consumer education efforts. Employers have many options in addition to consumer-directed health plans (CDHPs).

Paying Medicare Advantage plans by competitive bidding: how much competition is there?

Science.gov (United States)

Biles, Brian; Pozen, Jonah; Guterman, Stuart

2009-08-01

Private health plans that enroll Medicare beneficiaries--known as Medicare Advantage (MA) plans--are being paid $11 billion more in 2009 than it would cost to cover these beneficiaries in regular fee-for-service Medicare. To generate Medicare savings for offsetting the costs of health reform, the Obama Administration has proposed eliminating these extra payments to private insurers and instituting a competitive bidding system that pays MA plans based on the bids they submit. This study examines the concentration of enrollment among MA plans and the degree to which firms offering MA plans actually face competition. The results show that in the large majority of U.S. counties, MA plan enrollment is highly concentrated in a small number of firms. Given the relative lack of competition in many markets as well as the potential impact on traditional Medicare, the authors call for careful consideration of a new system for setting MA plan payments.

Paid celebrity endorsement in health promotion: a case study from Australia.

Science.gov (United States)

Chapman, S; Leask, J A

2001-12-01

In late 1998, Australian cricketer Shane Warne was allegedly paid A$200 000 ( pound78 060, US$123 000) by a pharmaceutical company to publicize his attempt to stop smoking. Warne failed to stop, and his continuing smoking remained newsworthy more than a year later. The arrangement caused considerable media controversy about the ethics of payment for charitable or socially worthy actions. This paper explores the community's reaction to payment for modelling a healthy behaviour, discussing the values that Warne transgressed and whether these mattered, given that the campaign caused an unprecedented rise in the use of nicotine replacement therapy.

The Effect of Task Type and Pre-task Planning Condition on the Accuracy of Intermediate EFL Learners' Writing Performance

Directory of Open Access Journals (Sweden)

Seyeed Mohammad Alavi

2012-05-01

Full Text Available Task-based language teaching, which requires learners to transact tasks resembling their real life language needs, demands language learners to perform planning at different stages of their learning. Since various types of tasks can be used in task-based instruction, the present study examined the effect of task types and various participatory structures during pre-task planning on the quality of learners' writing performance, (i.e., accuracy. Towards this end, 120 intermediate EFL students were randomly assigned to 3 experimental groups and one control group. While the experimental groups were subjected to different pre-task planning conditions, (i.e., individual, pair, and group, the control group performed tasks without any planning. During the treatment, they experienced task modeling, presentation and completion. A factorial design was followed in the present study, and the collected data were analyzed through ANOVAs that revealed task type and pre-task planning condition influenced the writing accuracy of the participants in a way that resulted in greater accuracy in the decision-making task in the experimental groups, thereby ensuring the effectiveness of the treatment in mitigating the long-standing problem of EFL learners in achieving higher levels of accuracy when a specific task type is concerned.

Why Paid Family and Medical Leave Matters for the Future of America's Families, Businesses and Economy.

Science.gov (United States)

Rowe-Finkbeiner, Kristin; Martin, Ruth; Abrams, Brett; Zuccaro, Anna; Dardari, Yasmina

2016-11-01

Paid family and medical leave are vital public policies for promoting large-scale improvements in maternal and child health that can boost our national economy. That is why MomsRising-a national on-the-ground and online grassroots organization with over a million members across the United States-is thrilled by the growing momentum for paid family and medical leave. We are not the least bit surprised that support for this critical policy is growing. The United States is the only industrialized nation in the world without paid family and medical leave, and the fact that these basic workplace protections are missing hurts America's global competitiveness, businesses, economy, and, most importantly, infant and maternal mortality rates.

Paid leave benefits among a national sample of working mothers with infants in the United States.

Science.gov (United States)

Shepherd-Banigan, Megan; Bell, Janice F

2014-01-01

To describe a range of employment benefits, including maternity and other paid leave, afforded to working women with infants; and to examine the geographic, socio-demographic correlates of such benefits to inform the workplace policy agenda in the US. Using data from the Listening to Mothers II Survey, a national sample of English-speaking women who gave birth in 2005, we conducted multivariable linear and logistic regression analyses to examine the associations between socio-demographic factors and employment leave variables (paid maternity, sick and personal leave). Forty-one percent of women received paid maternity leave for an average of 3.3 weeks with 31 % wage replacement. On average women took 10 weeks of maternity leave and received 10.4 days of paid sick leave and 11.6 days of paid personal time per year. Women who were non-Hispanic Black, privately insured, working full-time, and from higher income families were more likely to receive paid maternity leave, for more time, and at higher levels of wage replacement, when controlling for the other socio-demographic characteristics. Race/ethnicity, family income and employment status were associated with the number of paid personal days. Currently, the majority of female employees with young children in the US do not receive financial compensation for maternity leave and women receive limited paid leave every year to manage health-related family issues. Further, women from disadvantaged backgrounds generally receive less generous benefits. Federal policy that supports paid leave may be one avenue to address such disparities and should be modified to reflect accepted international standards.

Emergency planning and long-term care: least paid, least powerful, most responsible.

Science.gov (United States)

Covan, Eleanor Krassen; Fugate-Whitlock, Elizabeth

2010-11-01

As disasters can occur anywhere, planning to avoid emergencies is an international concern. Our research specifically addresses planning for the needs and safety of a vulnerable population, long-term care residents. Our initial purposes in this evaluation research were to assess the utility of a template to gather emergency management information for individual long-term care communities, to report on how prepared they are to cope with emergencies that have occurred elsewhere in areas like ours, and to assess the effectiveness of employing gerontology students in the planning process. As we began analyzing our data, we realized that it is imperative to consider whether it is possible for long-term care communities to respond effectively to disasters. In our findings we focus on the impact of gender in the planning process, the importance of size with regard to template utility, the positive and negative consequences of student aid, and the fact that gathering plans for individual long-term care communities may have detracted from collaborative community planning.

Participatory quantitative health impact assessment of urban and transport planning in cities: A review and research needs.

Science.gov (United States)

Nieuwenhuijsen, Mark J; Khreis, Haneen; Verlinghieri, Ersilia; Mueller, Natalie; Rojas-Rueda, David

2017-06-01

Urban and transport planning have large impacts on public health, but these are generally not explicitly considered and/or quantified, partly because there are no comprehensive models, methods and tools readily available. Air pollution, noise, temperature, green space, motor vehicle crashes and physical activity are important pathways linking urban and transport planning and public health. For policy decision-making, it is important to understand and be able to quantify the full-chain from source through pathways to health effects and impacts to substantiate and effectively target actions. In this paper, we aim to provide an overview of recent studies on the health impacts related to urban and transport planning in cities, describe the need for novel participatory quantitative health impact assessments (HIA) and provide recommendations. To devise our searches and narrative, we were guided by a recent conceptual framework linking urban and transport planning, environmental exposures, behaviour and health. We searched PubMed, Web of Science, Science Direct, and references from relevant articles in English language from January 1, 1980, to November 1, 2016, using pre-defined search terms. The number of HIA studies is increasing rapidly, but there is lack of participatory integrated and full-chain HIA models, methods and tools. These should be based on the use of a systemic multidisciplinary/multisectorial approach and state-of-the-art methods to address questions such as what are the best, most feasible and needed urban and transport planning policy measures to improve public health in cities? Active citizen support and new forms of communication between experts and citizens and the involvement of all major stakeholders are crucial to find and successfully implement health promoting policy measures. We provided an overview of the current state-of-the art of HIA in cities and made recommendations for further work. The process on how to get there is as important and

Exploitation in International Paid Surrogacy Arrangements.

Science.gov (United States)

Wilkinson, Stephen

2016-05-01

Many critics have suggested that international paid surrogacy is exploitative. Taking such concerns as its starting point, this article asks: (1) how defensible is the claim that international paid surrogacy is exploitative and what could be done to make it less exploitative? (2) In the light of the answer to (1), how strong is the case for prohibiting it? Exploitation could in principle be dealt with by improving surrogates' pay and conditions. However, doing so may exacerbate problems with consent. Foremost amongst these is the argument that surrogates from economically disadvantaged countries cannot validly consent because their background circumstances are coercive. Several versions of this argument are examined and I conclude that at least one has some merit. The article's overall conclusion is that while ethically there is something to be concerned about, paid surrogacy is in no worse a position than many other exploitative commercial transactions which take place against a backdrop of global inequality and constrained options, such as poorly-paid and dangerous construction work. Hence, there is little reason to single surrogacy out for special condemnation. On a policy level, the case for prohibiting international commercial surrogacy is weak, despite legitimate concerns about consent and background poverty.

Exploitation in International Paid Surrogacy Arrangements

Science.gov (United States)

Wilkinson, Stephen

2015-01-01

Abstract Many critics have suggested that international paid surrogacy is exploitative. Taking such concerns as its starting point, this article asks: (1) how defensible is the claim that international paid surrogacy is exploitative and what could be done to make it less exploitative? (2) In the light of the answer to (1), how strong is the case for prohibiting it? Exploitation could in principle be dealt with by improving surrogates' pay and conditions. However, doing so may exacerbate problems with consent. Foremost amongst these is the argument that surrogates from economically disadvantaged countries cannot validly consent because their background circumstances are coercive. Several versions of this argument are examined and I conclude that at least one has some merit. The article's overall conclusion is that while ethically there is something to be concerned about, paid surrogacy is in no worse a position than many other exploitative commercial transactions which take place against a backdrop of global inequality and constrained options, such as poorly‐paid and dangerous construction work. Hence, there is little reason to single surrogacy out for special condemnation. On a policy level, the case for prohibiting international commercial surrogacy is weak, despite legitimate concerns about consent and background poverty. PMID:27471338

Computing Cumulative Interest and Principal Paid For a Calendar Year

OpenAIRE

John O. MASON

2011-01-01

This paper demonstrates how easy it is use Microsoft Excel’s CUMPRINC and CUMIPMT functions to compute principal and interest paid for an entire year, even though the payments were made monthly. The CUMPRINC function computes the principal paid by a series of loan payments; the CUMIPMT function computes the interest paid. These two functions provide an alternative to preparing a monthly loan amortization schedule and adding up the amounts of monthly interest paid and principal paid for the ye...

Are over-paid Chief Executive Officers better innovators?

OpenAIRE

Habib Jouber

2013-01-01

This paper focuses on the pay level of the highest paid executive directors, which we label as "Executive Director’s Organizational Level" (henceforth EDOL), to raise the question if highest paid CEOs invest heavily in innovative projects. Two-stage least squares (2SLS) regressions show that over-paid CEOs are more likely to invest in R & D projects. They highlight, moreover, both from a "statutory" and an "activist" perspective, that CEOs’ intends to invest in value-enhancing innovations are...

Empowering health personnel for decentralized health planning in India: The Public Health Resource Network

Directory of Open Access Journals (Sweden)

Prasad Vandana

2009-07-01

Full Text Available Abstract The Public Health Resource Network is an innovative distance-learning course in training, motivating, empowering and building a network of health personnel from government and civil society groups. Its aim is to build human resource capacity for strengthening decentralized health planning, especially at the district level, to improve accountability of health systems, elicit community participation for health, ensure equitable and accessible health facilities and to bring about convergence in programmes and services. The question confronting health systems in India is how best to reform, revitalize and resource primary health systems to deliver different levels of service aligned to local realities, ensuring universal coverage, equitable access, efficiency and effectiveness, through an empowered cadre of health personnel. To achieve these outcomes it is essential that health planning be decentralized. Districts vary widely according to the specific needs of their population, and even more so in terms of existing interventions and available resources. Strategies, therefore, have to be district-specific, not only because health needs vary, but also because people's perceptions and capacities to intervene and implement programmes vary. In centrally designed plans there is little scope for such adaptation and contextualization, and hence decentralized planning becomes crucial. To undertake these initiatives, there is a strong need for trained, motivated, empowered and networked health personnel. It is precisely at this level that a lack of technical knowledge and skills and the absence of a supportive network or adequate educational opportunities impede personnel from making improvements. The absence of in-service training and of training curricula that reflect field realities also adds to this, discouraging health workers from pursuing effective strategies. The Public Health Resource Network is thus an attempt to reach out to motivated

Empowering health personnel for decentralized health planning in India: The Public Health Resource Network.

Science.gov (United States)

Kalita, Anuska; Zaidi, Sarover; Prasad, Vandana; Raman, V R

2009-07-20

The Public Health Resource Network is an innovative distance-learning course in training, motivating, empowering and building a network of health personnel from government and civil society groups. Its aim is to build human resource capacity for strengthening decentralized health planning, especially at the district level, to improve accountability of health systems, elicit community participation for health, ensure equitable and accessible health facilities and to bring about convergence in programmes and services. The question confronting health systems in India is how best to reform, revitalize and resource primary health systems to deliver different levels of service aligned to local realities, ensuring universal coverage, equitable access, efficiency and effectiveness, through an empowered cadre of health personnel. To achieve these outcomes it is essential that health planning be decentralized. Districts vary widely according to the specific needs of their population, and even more so in terms of existing interventions and available resources. Strategies, therefore, have to be district-specific, not only because health needs vary, but also because people's perceptions and capacities to intervene and implement programmes vary. In centrally designed plans there is little scope for such adaptation and contextualization, and hence decentralized planning becomes crucial. To undertake these initiatives, there is a strong need for trained, motivated, empowered and networked health personnel. It is precisely at this level that a lack of technical knowledge and skills and the absence of a supportive network or adequate educational opportunities impede personnel from making improvements. The absence of in-service training and of training curricula that reflect field realities also adds to this, discouraging health workers from pursuing effective strategies. The Public Health Resource Network is thus an attempt to reach out to motivated though often isolated health

Pre-optimization of radiotherapy treatment planning: an artificial neural network classification aided technique

International Nuclear Information System (INIS)

Hosseini-Ashrafi, M.E.; Bagherebadian, H.; Yahaqi, E.

1999-01-01

A method has been developed which, by using the geometric information from treatment sample cases, selects from a given data set an initial treatment plan as a step for treatment plan optimization. The method uses an artificial neural network (ANN) classification technique to select a best matching plan from the 'optimized' ANN database. Separate back-propagation ANN classifiers were trained using 50, 60 and 77 examples for three groups of treatment case classes (up to 21 examples from each class were used). The performance of the classifiers in selecting the correct treatment class was tested using the leave-one-out method; the networks were optimized with respect their architecture. For the three groups used in this study, successful classification fractions of 0.83, 0.98 and 0.93 were achieved by the optimized ANN classifiers. The automated response of the ANN may be used to arrive at a pre-plan where many treatment parameters may be identified and therefore a significant reduction in the steps required to arrive at the optimum plan may be achieved. Treatment planning 'experience' and also results from lengthy calculations may be used for training the ANN. (author)

Reproductive health/family planning and the health of infants, girls and women.

Science.gov (United States)

Sadik, N

1997-01-01

The 1994 International Conference on Population and Development developed international consensus amongst health providers, policy makers, and group representing the whole of civil society regarding the concept of reproductive health and its definition. In line with this definition, reproductive health care is defined as the constellation of methods, techniques and services that contribute to reproductive health and well-being by preventing and solving reproductive health problems. Reproductive health care saves lives and prevents significant levels of morbidity through family planning programmes, antenatal, delivery and post-natal services, prevention and management programmes for reproductive tract infections (including sexually transmitted diseases and HIV/AIDS), prevention of abortion and management of its complications, cancers of the reproductive system, and harmful practices that impact on reproductive function. Reproductive health care needs are evident at all stages of the life cycle and account for a greater proportion of disability adjusted life years (DALYS) in girls and women than in boys and men. Reproductive health protects infant health by enabling birth spacing and birth limitation to be practiced through family planning. The prevention and early detection of reproductive tract infections, including sexually transmitted diseases and HIV, through the integration of preventive measures in family planning service delivery not only improves the quality of care provided but is also directly responsible for improvement in survival and health of infants. Addressing harmful practices such as son preference, sex selection, sexual violence and female genital mutilation complements the positive impact of planned and spaced children through family planning services on infant mortality and the reproductive health of young girls and women. They are also in addition to prenatal, delivery and postnatal services, positive determinants of low maternal mortality and

Consumer experiences in a consumer-driven health plan.

Science.gov (United States)

Christianson, Jon B; Parente, Stephen T; Feldman, Roger

2004-08-01

To assess the experience of enrollees in a consumer-driven health plan (CDHP). Survey of University of Minnesota employees regarding their 2002 health benefits. Comparison of regression-adjusted mean values for CDHP and other plan enrollees: customer service, plan paperwork, overall satisfaction, and plan switching. For CDHP enrollees only, use of plan features, willingness to recommend the plan to others, and reports of particularly negative or positive experiences. There were significant differences in experiences of CDHP enrollees versus enrollees in other plans with customer service and paperwork, but similar levels of satisfaction (on a 10-point scale) with health plans. Eight percent of CDHP enrollees left their plan after one year, compared to 5 percent of enrollees leaving other plans. A minority of CDHP enrollees used online plan features, but enrollees generally were satisfied with the amount and quality of the information provided by the CDHP. Almost half reported a particularly positive experience, compared to a quarter reporting a particularly negative experience. Thirty percent said they would recommend the plan to others, while an additional 57 percent said they would recommend it depending on the situation. Much more work is needed to determine how consumer experience varies with the number and type of plan options available, the design of the CDHP, and the length of time in the CDHP. Research also is needed on the factors that affect consumer decisions to leave CDHPs.

Risk sharing between competing health plans and sponsors

NARCIS (Netherlands)

E.M. van Barneveld (Erik); W.P.M.M. van de Ven (Wynand); R.C.J.A. van Vliet (René)

2001-01-01

textabstractIn many countries, competing health plans receive capitation payments from a sponsor, whether government or a private employer. All capitation payment methods are far from perfect and have raised concerns about risk selection. Paying health plans partly on the basis

The effectiveness of CCDSR learning model to improve skills of creating lesson plan and worksheet science process skill (SPS) for pre-service physics teacher

Science.gov (United States)

Limatahu, I.; Suyatno; Wasis; Prahani, B. K.

2018-03-01

In the previous research, CCDSR (Condition, Construction, Development, Simulation, and Reflection) learning model has been developed to improve science process skills for pre-service physics teacher. This research is aimed to analyze the effectiveness of CCDSR learning model towards the improvement skills of creating lesson plan and worksheet of Science Process Skill (SPS) for pre-service physics teacher in academic year 2016/2017. This research used one group pre-test and post-test design on 12 pre-service physics teacher at Physics Education, University of Khairun. Data collection was conducted through test and observation. Creating lesson plan and worksheet SPS skills of pre-service physics teacher measurement were conducted through Science Process Skill Evaluation Sheet (SPSES). The data analysis technique was done by Wilcoxon t-test and n-gain. The CCDSR learning model consists of 5 phases, including (1) Condition, (2) Construction, (3) Development, (4) Simulation, and (5) Reflection. The results showed that there was a significant increase in creating lesson plan and worksheet SPS skills of pre-service physics teacher at α = 5% and n-gain average of moderate category. Thus, the CCDSR learning model is effective for improving skills of creating lesson plan and worksheet SPS for pre-service physics teacher.

Exploitation in International Paid Surrogacy Arrangements

OpenAIRE

Wilkinson, Stephen

2015-01-01

Abstract Many critics have suggested that international paid surrogacy is exploitative. Taking such concerns as its starting point, this article asks: (1) how defensible is the claim that international paid surrogacy is exploitative and what could be done to make it less exploitative? (2) In the light of the answer to (1), how strong is the case for prohibiting it? Exploitation could in principle be dealt with by improving surrogates' pay and conditions. However, doing so may exacerbate probl...

Growth and variability in health plan premiums in the individual insurance market before the Affordable Care Act.

Science.gov (United States)

Gruber, Jonathan

2014-06-01

Before we can evaluate the impact of the Affordable Care Act on health insurance premiums in the individual market, it is critical to understand the pricing trends of these premiums before the implementation of the law. Using rates of increase in the individual insurance market collected from state regulators, this issue brief documents trends in premium growth in the pre-ACA period. From 2008 to 2010, premiums grew by 10 percent or more per year. This growth was also highly variable across states, and even more variable across insurance plans within states. The study suggests that evaluating trends in premiums requires looking across a broad array of states and plans, and that policymakers must examine how present and future changes in premium rates compare with the more than 10 percent per year premium increases in the years preceding health reform.

Specific occupational satisfaction and stresses that differentiate paid and volunteer EMTs.

Science.gov (United States)

Allison, E J; Whitley, T W; Revicki, D A; Landis, S S

1987-06-01

A survey completed by 265 emergency medical technicians (EMTs) who provide emergency prehospital care in a rural area included a stress inventory for health professionals and a job satisfaction scale. Logistic regression indicated that the 118 paid EMTs were more likely to be dissatisfied with the freedom they have on the job than were the 147 volunteer EMTs. Paid EMTs also are less likely to be satisfied with the recognition they receive and more likely to cite work interference with family life and perceptions that others are trying to take advantage of them as sources of stress. Volunteer EMTs are more likely to be dissatisfied with the way their days off work are scheduled and to report stress attributable to work responsibilities different from those they had anticipated. Additional information about the demographic characteristics of EMTs from a rural area is provided.

Planning for pre-exposure prophylaxis to prevent HIV transmission: challenges and opportunities

Science.gov (United States)

2010-01-01

There are currently several ongoing or planned trials evaluating the efficacy of pre-exposure prophylaxis (PrEP) as a preventative approach to reducing the transmission of HIV. PrEP may prove ineffective, demonstrate partial efficacy, or show high efficacy and have the potential to reduce HIV infection in a significant way. However, in addition to the trial results, it is important that issues related to delivery, implementation and further research are also discussed. As a part of the ongoing discussion, in June 2009, the Bill & Melinda Gates Foundation sponsored a Planning for PrEP conference with stakeholders to review expected trial results, outline responsible educational approaches, and develop potential delivery and implementation strategies. The conference reinforced the need for continued and sustained dialogue to identify where PrEP implementation may fit best within an integrated HIV prevention package. This paper identifies the key action points that emerged from the Planning for PrEP meeting. PMID:20624303

76 FR 37037 - Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and...

Science.gov (United States)

2011-06-24

... Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and... interim final regulations published July 23, 2010 with respect to group health plans and health insurance..., group health plans, and health insurance issuers providing group health insurance coverage. The text of...

Pre-Service Teacher Education for Mental Health and Inclusion in Schools

Science.gov (United States)

Atkins, Melanie-Anne; Rodger, Susan

2016-01-01

Pre-service teacher education in mental health and mental health literacy is essential to creating the conditions necessary to support the mental health and wellness of children and youth in schools. Many teachers report never having received any education about mental health, but recognize the importance of this knowledge in meeting the needs of…

Mental Health and Job Burnout Among Pre-Hospital Emergency Care Personnel

Directory of Open Access Journals (Sweden)

Mahsa Haji Mohammad Hoseini

2017-01-01

Full Text Available Background: Work environment dictates physical, social and mental tensions each of which affect the staff’s health. Likewise, pre-hospital emergency care staff, due to the special nature of their job, are exposed to the tensions of emergency situations which can affect their health. Therefore, this study was conducted to scrutinize the relationship between the job burnout and mental health in pre-hospital emergencies of Qom Province. Materials and Methods: In this descriptive sectional study, 150 employed personnel of Qom 115 Emergency Care entered the study using census method. Data were gathered using questionnaires of “Background and Clinical Information”, “Mental Health”, and “Job Burnout”, and then based on central indices, Pearson correlation test and multiple linear regression statistical tests were run through software SPSS13 and then analyzed. Results: The average age of the participants was 30.8±5.8. The averages of the values of burnout and mental health were 69.43±12.4 and 60±14.1, respectively. According to Pearson correlation test, the values of the burnout and mental health have a significant negative correlation (r=-0.8. The results of multiple linear regression test showed that the correlation of the burnout and mental health considering the confounding variables is significant. (P=0.05 Conclusion: Pre-hospital employed personnel have desirable mental health and [low] burnout. Furthermore, improved mental health results in decreasing job burnout. Therefore, it is advisable to consider necessary facilities for caring for oneself.

Impact of a Novel Cost-Saving Pharmacy Program on Pregabalin Use and Health Care Costs.

Science.gov (United States)

Martin, Carolyn; Odell, Kevin; Cappelleri, Joseph C; Bancroft, Tim; Halpern, Rachel; Sadosky, Alesia

2016-02-01

Pharmacy cost-saving programs often aim to reduce costs for members and payers by encouraging use of lower-tier or generic medications and lower-cost sales channels. In 2010, a national U.S. health plan began a novel pharmacy program directed at reducing pharmacy expenditures for targeted medications, including pregabalin. The program provided multiple options to avoid higher cost sharing: use mail order pharmacy or switch to a lower-cost alternative medication via mail order or retail. Members who did not choose any option eventually paid the full retail cost of pregabalin. To evaluate the impact of the pharmacy program on pregabalin and alternative medication use, health care costs, and health care utilization. This retrospective analysis of claims data included adult commercial health plan members with a retail claim for pregabalin in the first 13 months of the pharmacy program (identification [ID] period: February 1, 2010-February 28, 2011). Members whose benefit plan included the pharmacy program were assigned to the program cohort; all others were assigned to the nonprogram cohort. The program cohort index date was the first retail pregabalin claim during the ID period and after the program start; the nonprogram cohort index date was the first retail pregabalin claim during the ID period. All members were continuously enrolled for 12 months pre- and post-index and had at least 1 inpatient claim or ≥ 2 ambulatory visit claims for a pregabalin-indicated condition. Cohorts were propensity score matched (PSM) 1:1 with logistic regression on demographic and pre-index characteristics, including mail order and pregabalin use, comorbidity, health care costs, and health care utilization. Pregabalin, gabapentin and other alternative medication use, health care costs, and health care utilization were measured. The program cohort was also divided into 2 groups: members who changed to gabapentin post-index and those who did not. A difference-in-differences (Di

76 FR 44491 - Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals...

Science.gov (United States)

2011-07-26

... 37208) entitled, ``Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims..., ``Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals and... external review processes for group health plans and health insurance issuers offering coverage in the...

75 FR 70159 - Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered...

Science.gov (United States)

2010-11-17

... Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered Health Plan... contracts of insurance. The temporary regulations provide guidance to employers, group health plans, and health insurance issuers providing group health insurance coverage. The IRS is issuing the temporary...

The consideration of health in land use planning: Barriers and opportunities

International Nuclear Information System (INIS)

Burns, Jennifer; Bond, Alan

2008-01-01

This research investigates the consideration of human health effects within the plan-making process in the East of England. It is based primarily upon questionnaires and interviews with those involved in plan-making. The results indicate that, prior to the implementation of the Strategic Environmental Assessment (SEA) Directive, which established a statutory requirement for the consideration of significant effects on human health in European Union member states, very limited consideration has been given to human health in land use plans. The capacity of the planning system to affect human health is clearly understood by those responsible for their production, but they lack the expertise to consider the health implications of their plans. The SEA Directive, along with reforms to the planning system, does provide a framework for improving the consideration of health, but the capacity of the planning system to consider health must be improved as should dialogue with health practitioners, and the evidence base for health outcomes. Also, analytical and methodological complexity may hinder the ability of planners to consider health, indicating that greater application of the precautionary principle is required to deal with the present uncertainty over human health impacts resulting from the implementation of land use plans

NAGC Pre-K-Grade 12 Gifted Education Programming Standards: A Guide to Planning and Implementing High-Quality Services

Science.gov (United States)

Johnsen, Susan K., Ed.

2012-01-01

The new Pre-K-Grade 12 Gifted Education Programming Standards should be part of every school district's repertoire of standards to ensure that the learning needs of advanced students are being met. "NAGC Pre-K-Grade 12 Gifted Education Programming Standards: A Guide to Planning and Implementing High-Quality Services" details six standards that…

75 FR 34571 - Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered...

Science.gov (United States)

2010-06-17

... Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered Health Plan... of Consumer Information and Insurance Oversight of the U.S. Department of Health and Human Services... health insurance coverage offered in connection with a group health plan under the Employee Retirement...

Returning to paid employment after stroke: the Psychosocial Outcomes In StrokE (POISE cohort study.

Directory of Open Access Journals (Sweden)

Maree L Hackett

Full Text Available OBJECTIVES: To determine which early modifiable factors are associated with younger stroke survivors' ability to return to paid work in a cohort study with 12-months of follow-up conducted in 20 stroke units in the Stroke Services NSW clinical network. PARTICIPANTS: Were aged >17 and <65 years, recent (within 28 days stroke, able to speak English sufficiently to respond to study questions, and able to provide written informed consent. Participants with language or cognitive impairment were eligible to participate if their proxy provided consent and completed assessments on the participants' behalf. The main outcome measure was return to paid work during the 12 months following stroke. RESULTS: Of 441 consented participants (average age 52 years, 68% male, 83% with ischemic stroke, 218 were in paid full-time and 53 in paid part-time work immediately before their stroke, of whom 202 (75% returned to paid part- or full-time work within 12 months. Being male, female without a prior activity restricting illness, younger, independent in activities of daily living (ADL at 28 days after stroke, and having private health insurance was associated with return to paid work, following adjustment for other illnesses and a history of depression before stroke (C statistic 0·81. Work stress and post stroke depression showed no such independent association. CONCLUSIONS: Given that independence in ADL is the strongest predictor of return to paid work within 12 months of stroke, these data reinforce the importance of reducing stroke-related disability and increasing independence for younger stroke survivors. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ANZCTRN 12608000459325.

Perceived effects of leave from work and the role of paid leave among parents of children with special health care needs.

Science.gov (United States)

Schuster, Mark A; Chung, Paul J; Elliott, Marc N; Garfield, Craig F; Vestal, Katherine D; Klein, David J

2009-04-01

We examined the perceived effects of leave from work among employed parents of children with special health care needs. Telephone interviews were conducted from November 2003 to January 2004 with 585 parents who had missed 1 or more workdays for their child's illness in the previous year. Most parents reported positive effects of leave on their child's physical (81%) and emotional (85%) health; 57% reported a positive effect on their own emotional health, although 24% reported a negative effect. Most parents reported no effect (44%) or a negative effect (42%) on job performance; 73% reported leave-related financial problems. In multivariate analyses, parents receiving full pay during leave were more likely than were parents receiving no pay to report positive effects on child physical (odds ratio [OR] = 1.85) and emotional (OR = 1.68) health and parent emotional health (OR = 1.70), and were less likely to report financial problems (OR = 0.20). Employed parents believed that leave-taking benefited the health of their children with special health care needs and their own emotional health, but compromised their job performance and finances. Parents who received full pay reported better consequences across the board. Access to paid leave, particularly with full pay, may improve parent and child outcomes.

Pre-Test pan Work Plan sebagai Strategi Pembelajaran Efektif pada Praktikum Bahan Teknik Lanjut Jurusan Pendidikan Teknik Mesin FT UNY

Directory of Open Access Journals (Sweden)

Nurdjito Nurdjito

2013-09-01

Full Text Available To find the most effective learning strategy for the practicum in the laboratory of materials of the department of Mechanical Engineering Education, Faculty of Engineering, Yogyakarta State University (YSU, a study that aims to determine the effect of applying pre-test and work plan on the learning activities and the achievement of students in the laboratory was conducted. This action research used the purposive random sampling technique. Pre-test and work plan were conducted as the treatment. The data of study was collected through a test to analyse the students’ achievement scores, then they were analyzed using t-test with SPSS. The results of this study indicated that the application of pre-test and work plan in addition to the standard module was proven to be more effective than the  normative learning using the module with t = 3.055 p = 0.003 <0.05. The implementation of the pre-test and work plan in addition to the use of standard modules is able to  improve the students’ motivation, independence and readiness to learn as well as the cooperation among the students, therefore the achievement is also improved. The mastery of competencies increased significantly proved by the increasing values of mode 66 to 85 (the experiment, and mean 73.12 into 79.32 (experiment.

76 FR 37207 - Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals...

Science.gov (United States)

2011-06-24

... Department of Health and Human Services 45 CFR Part 147 Group Health Plans and Health Insurance Issuers... SERVICES [CMS-9993-IFC2] 45 CFR Part 147 RIN 0938-AQ66 Group Health Plans and Health Insurance Issuers... for group health plans and health insurance coverage in the group and individual markets under...

Public Health Climate Change Adaptation Planning Using Stakeholder Feedback.

Science.gov (United States)

Eidson, Millicent; Clancy, Kathleen A; Birkhead, Guthrie S

2016-01-01

Public health climate change adaptation planning is an urgent priority requiring stakeholder feedback. The 10 Essential Public Health Services can be applied to adaptation activities. To develop a state health department climate and health adaptation plan as informed by stakeholder feedback. With Centers for Disease Control and Prevention (CDC) funding, the New York State Department of Health (NYSDOH) implemented a 2010-2013 climate and health planning process, including 7 surveys on perceptions and adaptation priorities. New York State Department of Health program managers participated in initial (n = 41, denominator unknown) and follow-up (72.2%) needs assessments. Surveillance system information was collected from 98.1% of surveillance system managers. For adaptation prioritization surveys, participants included 75.4% of NYSDOH leaders; 60.3% of local health departments (LHDs); and 53.7% of other stakeholders representing environmental, governmental, health, community, policy, academic, and business organizations. Interviews were also completed with 38.9% of other stakeholders. In 2011 surveys, 34.1% of state health program directors believed that climate change would impact their program priorities. However, 84.6% of state health surveillance system managers provided ideas for using databases for climate and health monitoring/surveillance. In 2012 surveys, 46.5% of state health leaders agreed they had sufficient information about climate and health compared to 17.1% of LHDs (P = .0046) and 40.9% of other stakeholders (nonsignificant difference). Significantly fewer (P climate and health into planning compared to state health leaders (55.8%) and other stakeholders (68.2%). Stakeholder groups agreed on the 4 highest priority adaptation categories including core public health activities such as surveillance, coordination/collaboration, education, and policy development. Feedback from diverse stakeholders was utilized by NYSDOH to develop its Climate and Health

Building and measuring infrastructure and capacity for community health assessment and health improvement planning in Florida.

Science.gov (United States)

Abarca, Christine; Grigg, C Meade; Steele, Jo Ann; Osgood, Laurie; Keating, Heidi

2009-01-01

COMPASS (Comprehensive Assessment, Strategic Success) is the Florida Department of Health's community health assessment and health improvement planning initiative. Since 2002, COMPASS built state and county health department infrastructure to support a comprehensive, systematic, and integrated approach to community health assessment and planning. To assess the capacity of Florida's 67 county health departments (CHDs) to conduct community health assessment and planning and to identify training and technical assistance needs, COMPASS surveyed the CHDs using a Web-based instrument annually from 2004 through 2008. Response rate to the survey was 100 percent annually. In 2007, 96 percent of CHDs reported conducting assessment and planning within the past 3 years; 74 percent used the MAPP (Mobilizing for Action through Planning and Partnerships) framework. Progress was greater for the organizational and assessment phases of the MAPP-based work; only 10 CHDs had identified strategic priorities in 2007, and even fewer had implemented strategies for improving health. In 2007, the most frequently requested types of training were measuring success, developing goals and action plans, and using qualitative data; technical assistance was most frequently requested for program evaluation and writing community health status reports. Florida's CHDs have increased their capacity to conduct community health assessment and planning. Questions remain about sustaining these gains with limited resources.

Responsive consumerism: empowerment in markets for health plans.

Science.gov (United States)

Elbel, Brian; Schlesinger, Mark

2009-09-01

American health policy is increasingly relying on consumerism to improve its performance. This article examines a neglected aspect of medical consumerism: the extent to which consumers respond to problems with their health plans. Using a telephone survey of five thousand consumers conducted in 2002, this article assesses how frequently consumers voice formal grievances or exit from their health plan in response to problems of differing severity. This article also examines the potential impact of this responsiveness on both individuals and the market. In addition, using cross-group comparisons of means and regressions, it looks at how the responses of "empowered" consumers compared with those who are "less empowered." The vast majority of consumers do not formally voice their complaints or exit health plans, even in response to problems with significant consequences. "Empowered" consumers are only minimally more likely to formally voice and no more likely to leave their plan. Moreover, given the greater prevalence of trivial problems, consumers are much more likely to complain or leave their plans because of problems that are not severe. Greater empowerment does not alleviate this. While much of the attention on consumerism has focused on prospective choice, understanding how consumers respond to problems is equally, if not more, important. Relying on consumers' responses as a means to protect individual consumers or influence the market for health plans is unlikely to be successful in its current form.

Enhancing autonomy in paid surrogacy.

Science.gov (United States)

Damelio, Jennifer; Sorensen, Kelly

2008-06-01

The gestational surrogate--and her economic and educational vulnerability in particular--is the focus of many of the most persistent worries about paid surrogacy. Those who employ her, and those who broker and organize her services, usually have an advantage over her in resources and information. That asymmetry exposes her to the possibility of exploitation and abuse. Accordingly, some argue for banning paid surrogacy. Others defend legal permission on grounds of surrogate autonomy, but often retain concerns about the surrogate. In response to the dilemma of a ban versus bald permission, we propose a 'soft law' approach: states should require several hours of education of surrogates--education aimed at informing and enhancing surrogate autonomy.

Why good placements matter: Pre-placement and placement risk factors associated with mental health disorders in pre-school children in foster care.

Science.gov (United States)

Hillen, Thomas; Gafson, Leonie

2015-07-01

Pre-school children placed in local authority care show elevated rates of mental health disorders when compared to the general population. This study investigated risk factors for mental health disorders relating to the period prior to entering care and while in care. A representative sample of 43 children in care aged 0-72 months in an inner London borough underwent comprehensive multidimensional assessments. Presence of emotional, behavioural, attachment and adaptive disorders was ascertained. Exposure to two pre-placement risk factors and six placement risk factors was compared between children with and without a disorder. A total of 26 children (60.5%) had at least one mental health disorder. The two pre-placement risk factors, multiple types of maltreatment and entry into care after the age of 6 months, were both significantly associated with mental health disorders. The three placement risk factors of sudden placement moves, multiple placement moves and child-carer alienation showed a significant association with mental health disorders. There was a strong correlation between the number of risk factors and the number of co-morbid mental health disorders per child (r = .67, p school mental health. © The Author(s) 2014.

Planning a change project in mental health nursing.

Science.gov (United States)

Thorpe, Rebecca

2015-09-02

This article outlines a plan for a change project to improve the quality of physical health care on mental health wards. The plan was designed to improve the monitoring and recording of respiratory rates on mental health wards, through the implementation of a training programme for staff. A root cause analysis was used to explore the reasons for the low incidence of respiratory rate measurement on mental health wards, and the results of this establish the basis of the proposed change project and its aims and objectives. The article describes how the project could be implemented using a change management model, as well as how its effects could be measured and evaluated. Potential barriers to the planned change project are discussed, including the human dimensions of change. The article suggests methods to overcome such barriers, discusses the value of leadership as an important factor, and examines the principles of clinical governance in the context of the planned change project.

Family planning costs and benefits.

Science.gov (United States)

1989-01-01

Government sponsored family planning programs have had major success in declining birth rates in Barbados, China, Cuba, Hong Kong, Indonesia, Korea, Mexico, Singapore, Sri Lanka, Taiwan, and Thailand. Non- government programs have had similar success in Brazil and Colombia. These programs have been estimated as preventing over 100 million births in China and 80 million in India. Research indicates that family planning programs can produce a 30-50% drop in fertility. Family planning information and some contraceptives can be best distributed through community organizations. Research also indicates male opposition has been a major factor in wider acceptance of family planning. Surveys indicate that 50% of the woman who want no additional children are not using any birth control. Many governments do not have the resource and money to implement programs. In the developing countries if those who were able to prevent the unwanted births had birth control, the population increases in those countries would have been 1.3% versus 2.2%. In earlier family planning programs foreign assistance paid over 80% of the cost, and national governments 20%; today this is reversed. The World Bank estimates that for major improvements in population growth and women's health, $7 billion will be needed yearly by the year 2000. The countries that have had the similar goals in development of human resources, social services, health, and education. They have attended to the status of women, female employment, and maternal and child health. Estimates are that 1.3 billion couples and individuals will need family planning services by the year 2000, and this will be a formidable task. This key elements of successful family planning programs are community participation, decentralization, and training.

FAMILY HEALTH STRATEGY OF PARTICIPATION IN MUNICIPAL HEALTH PLAN CONSTRUCTION: AN EXPERIENCE REPOR

Directory of Open Access Journals (Sweden)

Adilson Ribeiro dos Santos

2015-08-01

Full Text Available The Municipal Health Plan is an important planning tool in the management at the Unified Health System and at the same time, a mechanism for popular participation. This study aims to report the experience of the Municipal Health Plan’s workshop conducted by a Family Health Program team in a municipality in the south of Bahia Construção do Plano Municipal de Saúde. in the year 2014. This is an experience report that consolidates itself as a descriptive research tool that presents a reflection about an action that addresses a situation experienced in the professional interest of the scientific community. The workshop included the team and community members’ participation. The population's health problems follow a national trend, highlighting problems like diabetes, hypertension, worms, abuse of alcohol and other drugs inaddition to viruses. The health system problems reveal the weaknesses in local management of the Unified Health System by the insufficiency and/or lack of resources such as drugs, tests, equipment maintenance and others. Therefore, we emphasize the importance of the Municipal Health Plan as a management tool of the Unified Health System that allows closeness between users, workers and managers, as well as being a space for policy vocalization, contributing to the real effectiveness of the Unified Health System, based on participatory planning in accordance with the needs of users.

75 FR 27121 - Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Dependent...

Science.gov (United States)

2010-05-13

... 45 CFR Parts 144, 146, and 147 Group Health Plans and Health Insurance Issuers Relating to Dependent... 144, 146, and 147 RIN 0991-AB66 Interim Final Rules for Group Health Plans and Health Insurance... requirements for group health plans and health insurance issuers in the group and individual markets under...

The double burden of and negative spillover between paid and domestic work: associations with health among men and women.

Science.gov (United States)

Väänänen, Ari; Kevin, May V; Ala-Mursula, Leena; Pentti, Jaana; Kivimäki, Mika; Vahtera, Jussi

2004-01-01

The objective of the study was to determine whether the double burden of and negative spillover between domestic and full-time paid work are associated with an increase in health problems. Survey responses were linked with sickness absence records in a cross-sectional study of 6442 full-time municipal employees. Women and men experiencing severe work-family spillover had a 1.5-1.6 (95% confidence intervals 1.1 to 2.0) times higher rate of sickness absence than those with no such experience. The corresponding odds ratios for psychological distress and suboptimal self-assessed health varied between 3.6 and 6.5 (2.3 to 11.0). Among the women, severe family-work spillover increased the risk of psychological distress and suboptimal health [odds ratios 2.0 (1.4 to 2.9) and 1.6 (1.1 to 2.3), respectively], and accumulated sole responsibilities were associated with a 1.5 (1.1 to 2.1) times higher odds ratio for psychological distress. Long domestic work hours (>50/week) were associated with a 1.5 (1.1 to 2.0) times higher rate of sickness absence among the men, but there was no such increase among the women. We conclude that negative work-family spillover especially is associated with health problems among both women and men, and negative family-work spillover is related to a poorer health status among women.

Physician Reimbursement in Medicare Advantage Compared With Traditional Medicare and Commercial Health Insurance.

Science.gov (United States)

Trish, Erin; Ginsburg, Paul; Gascue, Laura; Joyce, Geoffrey

2017-09-01

Nearly one-third of Medicare beneficiaries are enrolled in a Medicare Advantage (MA) plan, yet little is known about the prices that MA plans pay for physician services. Medicare Advantage insurers typically also sell commercial plans, and the extent to which MA physician reimbursement reflects traditional Medicare (TM) rates vs negotiated commercial prices is unclear. To compare prices paid for physician and other health care services in MA, traditional Medicare, and commercial plans. Retrospective analysis of claims data evaluating MA prices paid to physicians and for laboratory services and durable medical equipment between 2007 and 2012 in 348 US core-based statistical areas. The study population included all MA and commercial enrollees with a large national health insurer operating in both markets, as well as a 20% sample of TM beneficiaries. Enrollment in an MA plan. Mean reimbursement paid to physicians, laboratories, and durable medical equipment suppliers for MA and commercial enrollees relative to TM rates for 11 Healthcare Common Procedure Coding Systems (HCPCS) codes spanning 7 sites of care. The sample consisted of 144 million claims. Physician reimbursement in MA was more strongly tied to TM rates than commercial prices, although MA plans tended to pay physicians less than TM. For a mid-level office visit with an established patient (Current Procedural Terminology [CPT] code 99213), the mean MA price was 96.9% (95% CI, 96.7%-97.2%) of TM. Across the common physician services we evaluated, mean MA reimbursement ranged from 91.3% of TM for cataract removal in an ambulatory surgery center (CPT 66984; 95% CI, 90.7%-91.9%) to 102.3% of TM for complex evaluation and management of a patient in the emergency department (CPT 99285; 95% CI, 102.1%-102.6%). However, for laboratory services and durable medical equipment, where commercial prices are lower than TM rates, MA plans take advantage of these lower commercial prices, ranging from 67.4% for a walker

Strategic Planning in Population Health and Public Health Practice: A Call to Action for Higher Education.

Science.gov (United States)

Phelps, Charles; Madhavan, Guruprasad; Rappuoli, Rino; Levin, Scott; Shortliffe, Edward; Colwell, Rita

2016-03-01

Scarce resources, especially in population health and public health practice, underlie the importance of strategic planning. Public health agencies' current planning and priority setting efforts are often narrow, at times opaque, and focused on single metrics such as cost-effectiveness. As demonstrated by SMART Vaccines, a decision support software system developed by the Institute of Medicine and the National Academy of Engineering, new approaches to strategic planning allow the formal incorporation of multiple stakeholder views and multicriteria decision making that surpass even those sophisticated cost-effectiveness analyses widely recommended and used for public health planning. Institutions of higher education can and should respond by building on modern strategic planning tools as they teach their students how to improve population health and public health practice. Strategic planning in population health and public health practice often uses single indicators of success or, when using multiple indicators, provides no mechanism for coherently combining the assessments. Cost-effectiveness analysis, the most complex strategic planning tool commonly applied in public health, uses only a single metric to evaluate programmatic choices, even though other factors often influence actual decisions. Our work employed a multicriteria systems analysis approach--specifically, multiattribute utility theory--to assist in strategic planning and priority setting in a particular area of health care (vaccines), thereby moving beyond the traditional cost-effectiveness analysis approach. (1) Multicriteria systems analysis provides more flexibility, transparency, and clarity in decision support for public health issues compared with cost-effectiveness analysis. (2) More sophisticated systems-level analyses will become increasingly important to public health as disease burdens increase and the resources to deal with them become scarcer. The teaching of strategic planning in public

Parental knowledge of pre-school child oral health.

Science.gov (United States)

Prabhu, Anand; Rao, Arun Prasad; Reddy, Venugopal; Ahamed, Syed Shaheed; Muhammad, Shameer; Thayumanavan, Shanmugam

2013-10-01

The dental health of preschool children has extensive implications on the oral heath of the individual as he grows into an adult. Parents/guardians of preschool children play a central role in enforcing proper oral hygiene and preventive regime in these children. This study was conducted with the aim of describing the views of parents/guardians about the dental health of pre-school children. Response was obtained on a 21 point questionnaire from randomly visiting parents of the outpatient section of Rajah Muthiah dental college and Hospital, Annamalainagar, India. The findings of the present study point towards poor awareness among the parents/guardians of preschool children, pertaining to their childs' oral health and this could directly translate to poor oral health among the children in this area.

SU-F-T-44: A Comparison of the Pre-Plan, Intra-Operative Plan, and Post-Implant Dosimetry for a Prostate Implant Case Using Prefabricated Linear Polymer-Encapsulated Pd-103

International Nuclear Information System (INIS)

Sheu, R; Powers, A; McGee, H; Stock, R; Lo, Y

2016-01-01

Purpose: To investigate the reproducibility and limitations of Pd-103 prostate brachytherapy using fixed length linear sources (CivaString). Methods: An LDR prostate brachytherapy case which was preplanned on MR images with prefabricated linear polymer-encapsulated Pd-103 sources (CivaString) was studied and compared with ultrasound based intra-operative planning and CT based post-implant dosimetry. We evaluated the following parameters among the three studies: prostate geometry (volume and cross sectional area), needle position and alignment deviations, and dosimetry parameters (D90). Results: The prostate volumes and axial cross sectional areas at center of prostate were measured as 41.8, 39.3 and 36.8 cc, and 14.9, 14.3, and 11.3 respectively on pre-plan MR, inter-op US, and post-implant CT studies. The deviation of prostate volumes and axial cross sectional areas measured on pre-planning MR and intra-operative US were within 5%. 17 out of 19 pre-planned needles were positioned within 5mm (the template grid size). One needle location was adjusted intra-operatively and another needle was removed due to proximity to urethra. The needle pathways were not always parallel to the trans-rectal probe due to the flexibility of CivaString. The angle of deviation was up to 10 degrees. Two pairs of needles were exchanged to better fit the length of prostate at the time of implant. This resulted in a prostate D90 of 153.8 Gy (124%) and 131.4 Gy (106.7%) for intra-op and PID respectively. Conclusion: Preplanning is a necessary part of implants performed with prefabricated linear polymer sources. However, as is often the case, there were real-time deviations from the pre-plan. Intra-op planning provides the ability conform to anatomy at the time of implant. Therefore, we propose to develop a systematic way to order extra strings of different length to provide the flexibility to perform intra-operative planning with fixed length strands.

SU-F-T-44: A Comparison of the Pre-Plan, Intra-Operative Plan, and Post-Implant Dosimetry for a Prostate Implant Case Using Prefabricated Linear Polymer-Encapsulated Pd-103

Energy Technology Data Exchange (ETDEWEB)

Sheu, R; Powers, A; McGee, H; Stock, R; Lo, Y [Mount Sinai Medical Center, New York, NY (United States)

2016-06-15

Purpose: To investigate the reproducibility and limitations of Pd-103 prostate brachytherapy using fixed length linear sources (CivaString). Methods: An LDR prostate brachytherapy case which was preplanned on MR images with prefabricated linear polymer-encapsulated Pd-103 sources (CivaString) was studied and compared with ultrasound based intra-operative planning and CT based post-implant dosimetry. We evaluated the following parameters among the three studies: prostate geometry (volume and cross sectional area), needle position and alignment deviations, and dosimetry parameters (D90). Results: The prostate volumes and axial cross sectional areas at center of prostate were measured as 41.8, 39.3 and 36.8 cc, and 14.9, 14.3, and 11.3 respectively on pre-plan MR, inter-op US, and post-implant CT studies. The deviation of prostate volumes and axial cross sectional areas measured on pre-planning MR and intra-operative US were within 5%. 17 out of 19 pre-planned needles were positioned within 5mm (the template grid size). One needle location was adjusted intra-operatively and another needle was removed due to proximity to urethra. The needle pathways were not always parallel to the trans-rectal probe due to the flexibility of CivaString. The angle of deviation was up to 10 degrees. Two pairs of needles were exchanged to better fit the length of prostate at the time of implant. This resulted in a prostate D90 of 153.8 Gy (124%) and 131.4 Gy (106.7%) for intra-op and PID respectively. Conclusion: Preplanning is a necessary part of implants performed with prefabricated linear polymer sources. However, as is often the case, there were real-time deviations from the pre-plan. Intra-op planning provides the ability conform to anatomy at the time of implant. Therefore, we propose to develop a systematic way to order extra strings of different length to provide the flexibility to perform intra-operative planning with fixed length strands.

Comparison of a Restricted and Unrestricted Vegan Diet Plan with a Restricted Omnivorous Diet Plan on Health-Specific Measures.

Science.gov (United States)

Bloomer, Richard J; Gunnels, Trint A; Schriefer, JohnHenry M

2015-07-14

We have previously noted beneficial health outcomes when individuals follow a dietary restriction plan in accordance with the Daniel Fast (DF). This is true whether individuals eliminate all animal products or include small amounts of meat and dairy in their plan. The present study sought to compare anthropometric and biochemical measures of health in individuals following a traditional DF (i.e., restricted vegan) or modified DF (i.e., restricted omnivorous; inclusive of ad libitum meat and skim milk consumption), with those following an unrestricted vegan diet plan. 35 subjects (six men; 29 women; 33 ± 2 years; range: 18-67 years) completed a 21-day diet plan. Subjects reported to the lab for pre- (day 1) and post-intervention testing (day 22) in a 10 h fasted state. Blood samples were collected and assayed for complete blood count, metabolic panel, lipid panel, insulin, HOMA-IR, C-reactive protein, and oxidative stress biomarkers (malondialdehyde, advanced oxidation protein products, and nitrate/nitrite). Heart rate and blood pressure were measured and body composition was determined via dual energy X-ray absorptiometry. Subjects' self-reported compliance, mental and physical health, and satiety in relation to the dietary modification were recorded. No interaction effects were noted for our outcome measures (p > 0.05). However, subjects in the traditional DF group reported an approximate 10% increase in perceived mental and physical health, with a 25% reduction in malondialdehyde and a 33% reduction in blood insulin. Systolic BP was reduced approximately 7 mmHg in subjects assigned to the traditional DF, with an approximate 5 mmHg reduction in subjects assigned to the modified DF and the unrestricted vegan plan. A small (2 mmHg) reduction in diastolic BP was noted for subjects in both DF groups; a slight increase in diastolic BP was noted for subjects assigned to the unrestricted vegan group. An approximate 20% reduction was noted in total and LDL cholesterol

Comparison of a Restricted and Unrestricted Vegan Diet Plan with a Restricted Omnivorous Diet Plan on Health-Specific Measures

Science.gov (United States)

Bloomer, Richard J.; Gunnels, Trint A.; Schriefer, JohnHenry M.

2015-01-01

Background: We have previously noted beneficial health outcomes when individuals follow a dietary restriction plan in accordance with the Daniel Fast (DF). This is true whether individuals eliminate all animal products or include small amounts of meat and dairy in their plan. The present study sought to compare anthropometric and biochemical measures of health in individuals following a traditional DF (i.e., restricted vegan) or modified DF (i.e., restricted omnivorous; inclusive of ad libitum meat and skim milk consumption), with those following an unrestricted vegan diet plan. Methods: 35 subjects (six men; 29 women; 33 ± 2 years; range: 18–67 years) completed a 21-day diet plan. Subjects reported to the lab for pre- (day 1) and post-intervention testing (day 22) in a 10 h fasted state. Blood samples were collected and assayed for complete blood count, metabolic panel, lipid panel, insulin, HOMA-IR, C-reactive protein, and oxidative stress biomarkers (malondialdehyde, advanced oxidation protein products, and nitrate/nitrite). Heart rate and blood pressure were measured and body composition was determined via dual energy X-ray absorptiometry. Subjects’ self-reported compliance, mental and physical health, and satiety in relation to the dietary modification were recorded. Results: No interaction effects were noted for our outcome measures (p > 0.05). However, subjects in the traditional DF group reported an approximate 10% increase in perceived mental and physical health, with a 25% reduction in malondialdehyde and a 33% reduction in blood insulin. Systolic BP was reduced approximately 7 mmHg in subjects assigned to the traditional DF, with an approximate 5 mmHg reduction in subjects assigned to the modified DF and the unrestricted vegan plan. A small (2 mmHg) reduction in diastolic BP was noted for subjects in both DF groups; a slight increase in diastolic BP was noted for subjects assigned to the unrestricted vegan group. An approximate 20% reduction was

Comparison of a Restricted and Unrestricted Vegan Diet Plan with a Restricted Omnivorous Diet Plan on Health-Specific Measures

Directory of Open Access Journals (Sweden)

Richard J. Bloomer

2015-07-01

Full Text Available Background: We have previously noted beneficial health outcomes when individuals follow a dietary restriction plan in accordance with the Daniel Fast (DF. This is true whether individuals eliminate all animal products or include small amounts of meat and dairy in their plan. The present study sought to compare anthropometric and biochemical measures of health in individuals following a traditional DF (i.e., restricted vegan or modified DF (i.e., restricted omnivorous; inclusive of ad libitum meat and skim milk consumption, with those following an unrestricted vegan diet plan. Methods: 35 subjects (six men; 29 women; 33 ± 2 years; range: 18–67 years completed a 21-day diet plan. Subjects reported to the lab for pre- (day 1 and post-intervention testing (day 22 in a 10 h fasted state. Blood samples were collected and assayed for complete blood count, metabolic panel, lipid panel, insulin, HOMA-IR, C-reactive protein, and oxidative stress biomarkers (malondialdehyde, advanced oxidation protein products, and nitrate/nitrite. Heart rate and blood pressure were measured and body composition was determined via dual energy X-ray absorptiometry. Subjects’ self-reported compliance, mental and physical health, and satiety in relation to the dietary modification were recorded. Results: No interaction effects were noted for our outcome measures (p > 0.05. However, subjects in the traditional DF group reported an approximate 10% increase in perceived mental and physical health, with a 25% reduction in malondialdehyde and a 33% reduction in blood insulin. Systolic BP was reduced approximately 7 mmHg in subjects assigned to the traditional DF, with an approximate 5 mmHg reduction in subjects assigned to the modified DF and the unrestricted vegan plan. A small (2 mmHg reduction in diastolic BP was noted for subjects in both DF groups; a slight increase in diastolic BP was noted for subjects assigned to the unrestricted vegan group. An approximate 20

Essential pre-pregnancy and pregnancy interventions for improved maternal, newborn and child health

Science.gov (United States)

2014-01-01

The statistics related to pregnancy and its outcomes are staggering: annually, an estimated 250000-280000 women die during childbirth. Unfortunately, a large number of women receive little or no care during or before pregnancy. At a period of critical vulnerability, interventions can be effectively delivered to improve the health of women and their newborns and also to make their pregnancy safe. This paper reviews the interventions that are most effective during preconception and pregnancy period and synergistically improve maternal and neonatal outcomes. Among pre-pregnancy interventions, family planning and advocating pregnancies at appropriate intervals; prevention and management of sexually transmitted infections including HIV; and peri-conceptual folic-acid supplementation have shown significant impact on reducing maternal and neonatal morbidity and mortality. During pregnancy, interventions including antenatal care visit model; iron and folic acid supplementation; tetanus Immunisation; prevention and management of malaria; prevention and management of HIV and PMTCT; calcium for hypertension; anti-Platelet agents (low dose aspirin) for prevention of Pre-eclampsia; anti-hypertensives for treating severe hypertension; management of pregnancy-induced hypertension/eclampsia; external cephalic version for breech presentation at term (>36 weeks); management of preterm, premature rupture of membranes; management of unintended pregnancy; and home visits for women and children across the continuum of care have shown maximum impact on reducing the burden of maternal and newborn morbidity and mortality. All of the interventions summarized in this paper have the potential to improve maternal mortality rates and also contribute to better health care practices during preconception and periconception period. PMID:25178042

Patient-specific positioning guides for total knee arthroplasty: no significant difference between final component alignment and pre-operative digital plan except for tibial rotation.

Science.gov (United States)

Boonen, Bert; Schotanus, Martijn G M; Kerens, Bart; Hulsmans, Frans-Jan; Tuinebreijer, Wim E; Kort, Nanne P

2017-09-01

To assess whether there is a significant difference between the alignment of the individual femoral and tibial components (in the frontal, sagittal and horizontal planes) as calculated pre-operatively (digital plan) and the actually achieved alignment in vivo obtained with the use of patient-specific positioning guides (PSPGs) for TKA. It was hypothesised that there would be no difference between post-op implant position and pre-op digital plan. Twenty-six patients were included in this non-inferiority trial. Software permitted matching of the pre-operative MRI scan (and therefore calculated prosthesis position) to a pre-operative CT scan and then to a post-operative full-leg CT scan to determine deviations from pre-op planning in all three anatomical planes. For the femoral component, mean absolute deviations from planning were 1.8° (SD 1.3), 2.5° (SD 1.6) and 1.6° (SD 1.4) in the frontal, sagittal and transverse planes, respectively. For the tibial component, mean absolute deviations from planning were 1.7° (SD 1.2), 1.7° (SD 1.5) and 3.2° (SD 3.6) in the frontal, sagittal and transverse planes, respectively. Absolute mean deviation from planned mechanical axis was 1.9°. The a priori specified null hypothesis for equivalence testing: the difference from planning is >3 or plan in all planes, except for the tibial rotation in the transverse plane. Possible explanations for outliers are discussed and highlight the importance for adequate training surgeons before they start using PSPG in their day-by-day practise. Prospective cohort study, Level II.

The Hemophilia Games: An Experiment in Health Education Planning.

Science.gov (United States)

National Heart and Lung Inst. (DHEW/PHS), Bethesda, MD.

The Hemophilia Health Education Planning Project was designed to (1) create a set of tools useful in hemophilia planning and education, and (2) create a planning model for other diseases with similar factors. The project used the game-simulations technique which was felt to be particularly applicable to hemophilia health problems, since as a…

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...

SU-F-T-225: Is It Time to Have Pre-Configured Therapeutic Beams Available in Commercial Treatment Planning Systems?

International Nuclear Information System (INIS)

Ding, G

2016-01-01

Purpose: Commissioning radiation beams requires considerable effort to obtain the beam data for beam configuration in a commercial treatment planning system. With the advances in technology, the manufacturer of accelerators now has the ability to adjust radiation beam parameters to meet pre-determined specifications with high precision. This study aims to illustrate the feasibility of making pre-configured radiation beams available in commercial treatment planning systems. Methods: In recent years, Varian has made a set of measured beam data from the TrueBeam accelerator available to users. Although the beam data are provided as “suggestive data” without warranty, the commissioned data measured by users have been shown to be in excellent agreement with the data set provided when the beams from the installed Linacs were adjusted to meet the beam specifications. An unofficial survey among Varian Linac TrueBeam users shows that the suggestive data set has been used with validation by users in some clinics. This indicates that radiation beams from a specified Linac can be standardized and pre-configured in a treatment planning system. Results: Two newly installed Varian TrueBeam accelerators at two different centers were examined in which one set of commissioned beam data was obtained from measurements performed by an independent physics consulting company and the other was measured by local physicists in the department. All beams from both accelerators were tuned to meet the manufacturer’s specifications. Discrepancies of less than 1% were found between the commissioned beam data from both accelerators and the suggestive data set provided by Varian. Conclusion: It may be feasible that radiation beams can be pre-configured in commercial treatment planning systems. The radiation beam users will perform the beam validation and end-to-end tests instead of configuring beams. This framework can increase both the efficiency and the accuracy in commercial radiation

Pre-school manager training: a cost-effective tool to promote nutrition- and health-related practice improvements in the Irish full-day-care pre-school setting.

LENUS (Irish Health Repository)

Johnston Molloy, Charlotte

2013-10-18

To evaluate the impact on nutrition- and health-related practice of two methods of delivery of a nutrition and health intervention in Irish full-day-care pre-schools: training of pre-school managers only or training of managers and their staff.

Safety and health five-year plan, Fiscal years 1995--1999

International Nuclear Information System (INIS)

1994-10-01

This report describes efforts by the Department of Energy (DOE) to size and allocate funding to safety and health activities that protect workers and the public from harm. Although it is well recognized that virtually every aspect of an operation has health and safety implications, this effort is directed at identifying planned efforts specifically directed at health and safety. The initial effort, to compile information for the period covering FY 1994--1998, served two primary needs: (1) to document what was actually taking place in the DOE Complex, from a budget and resource utilization standpoint (how the complex was reacting to the calls for greater protection for workers and the public); and (2) to embark on an effort to utilize forward-looking management plans to allocate resources to meet safety and health needs (to begin to be proactive). It was recognized that it would take several years to achieve full acceptance and implementation of a single, DOE-wide approach toward planning for safety and health, and to develop plans that emphasized the benefits from both risk management and accident prevention strategies. This report, describing safety and health plans and budgets for FY 1995, reflects the increasing acceptance of risk-based strategies in the development of safety and health plans. More operations are using the prioritization methodology recommended for the safety and health planning process, and more operations have begun to review planned expenditures of resources to better assure that resources are allocated to the highest risk reduction activities

Carrots and sticks: impact of an incentive/disincentive employee flexible credit benefit plan on health status and medical costs.

Science.gov (United States)

Stein, A D; Karel, T; Zuidema, R

1999-01-01

Employee wellness programs aim to assist in controlling employer costs by improving the health status and fitness of employees, potentially increasing productivity, decreasing absenteeism, and reducing medical claims. Most such programs offer no disincentive for nonparticipation. We evaluated an incentive/disincentive program initiated by a large teaching hospital in western Michigan. The HealthPlus Health Quotient program is an incentive/disincentive approach to health promotion. The employer's contribution to the cafeteria plan benefit package is adjusted based on results of an annual appraisal of serum cholesterol, blood pressure, tobacco use, body fat, physical fitness, motor vehicle safety, nutrition, and alcohol consumption. The adjustment (health quotient [HQ]) can range from -$25 to +$25 per pay period. We examined whether appraised health improved between 1993 and 1996 and whether the HQ predicted medical claims. Mean HQ increased slightly (+$0.47 per pay period in 1993 to +$0.89 per pay period in 1996). Individuals with HQs of less than -$10 per pay period incurred approximately twice the medical claims of the other groups (test for linear trend, p = .003). After adjustment, medical claims of employees in the worst category (HQ benefits. Most employees are impacted minimally, but savings are accruing to the employer from reductions in medical claims paid and in days lost to illness and disability.

Predicting health-promoting self-care behaviors in people with pre-diabetes by applying Bandura social learning theory.

Science.gov (United States)

Chen, Mei-Fang; Wang, Ruey-Hsia; Hung, Shu-Ling

2015-11-01

The aim of this study was to apply Bandura social learning theory in a model for identifying personal and environmental factors that predict health-promoting self-care behaviors in people with pre-diabetes. The theoretical basis of health-promoting self-care behaviors must be examined to obtain evidence-based knowledge that can help improve the effectiveness of pre-diabetes care. However, such behaviors are rarely studied in people with pre-diabetes. This quantitative, cross-sectional survey study was performed in a convenience sample of two hospitals in southern Taiwan. Two hundred people diagnosed with pre-diabetes at a single health examination center were recruited. A questionnaire survey was performed to collect data regarding personal factors (i.e., participant characteristics, pre-diabetes knowledge, and self-efficacy) and data regarding environmental factors (i.e., social support and perceptions of empowerment process) that may have associations with health-promoting self-care behaviors in people with pre-diabetes. Multiple linear regression showed that the factors that had the largest influence on the practice of health-promoting self-care behaviors were self-efficacy, diabetes history, perceptions of empowerment process, and pre-diabetes knowledge. These factors explained 59.3% of the variance in health-promoting self-care behaviors. To prevent the development of diabetes in people with pre-diabetes, healthcare professionals should consider both the personal and the environmental factors identified in this study when assessing health promoting self-care behaviors in patients with pre-diabetes and when selecting the appropriate interventions. Copyright © 2015 Elsevier Inc. All rights reserved.

When Paid Work Matters for Fertility Intentions and Subsequent Behavior: Evidence from Two Waves of the Austrian Gender and Generation Survey

Directory of Open Access Journals (Sweden)

Doris Hanappi

2017-11-01

Full Text Available The anticipated risk of job loss and material insecurity are related to fertility postponement in the same way as unemployment is. Given the sequential nature of fertility and occupational decisions, unfavorable working conditions should be resolved before having children, and result in an increase in people’s assignment of importance to paid work when developing their childbearing plans. We aim to demonstrate this link, focusing on perceived employment and material insecurity, the importance assigned to paid work in forming fertility intentions, the construction of fertility intentions, and their realization. Using two waves of the Austrian Generations and Gender Survey, we apply probit regressions to analyze gender variations in the associations between uncertainty conditions, the importance of paid work, fertility intentions and behavior. Results reveal that work and related benefits become salient when they are insecure, and that material insecurity among men discourages childbearing. For women, we find support for the hypothesis that the anticipated risk of job loss inhibits the realization of fertility intentions – intentions which are less likely to be constructed under such conditions from the onset of family planning processes.

Quality improvement initiatives: the missed opportunity for health plans.

Science.gov (United States)

Fernandez-Lopez, Sara; Lennert, Barbara

2009-11-01

The increase in healthcare cost without direct improvements in health outcomes, coupled with a desire to expand access to the large uninsured population, has underscored the importance of quality initiatives and organizations that provide more affordable healthcare by maximizing value. To determine the knowledge of managed care organizations about quality organizations and initiatives and to identify potential opportunities in which pharmaceutical companies could collaborate with health plans in the development and implementation of quality initiatives. We conducted a survey of 36 pharmacy directors and 15 medical directors of different plans during a Managed Care Network meeting in 2008. The represented plans cover almost 74 million lives in commercial, Medicare, and Medicaid programs, or a combination of them. The responses show limited knowledge among pharmacy and medical directors about current quality organizations and initiatives, except for quality organizations that provide health plan quality accreditation. The results also reveal an opportunity for pharmaceutical companies to collaborate with private health plans in the development of quality initiatives, especially those related to drug utilization, such as patient adherence and education and correct drug utilization. Our survey shows clearly that today's focus for managed care organizations is mostly limited to the organizations that provide health plan quality accreditation, with less focus on other organizations.

Literature Review of Advantages and Disadvantages of Pre-planned Construction Projects 2013 PhD Conference

DEFF Research Database (Denmark)

Larsen, Jesper Kranker; Ussing, Lene Faber; Brunø, Thomas Ditlev

2013-01-01

The construction industry’s focus on pre-planning, with its advantages and disadvantages, has not been investigated in a literature review which gives a state of art understanding of the topic. The aim of the paper is to review related papers, to fulfill gaps in the literature which could...

Commitment with or without a stick of paid work: comparison of paid and unpaid workers in a non-profit organization

NARCIS (Netherlands)

van Vuuren, Hubrecht A.; de Jong, Menno D.T.; Seydel, E.R.

2008-01-01

The aim of this study is to investigate whether nonpaid volunteers have other reasons to be a member of an organization than paid workers. Volunteers are assumed to be hard to manage, because there is no “stick of a paid contract” to keep them in line. Therefore, we studied different dimensions

Federal, provincial and territorial public health response plan for biological events.

Science.gov (United States)

McNeill, R; Topping, J

2018-01-04

The Federal/Provincial/Territorial (FPT) Public Health Response Plan for Biological Events was developed for the Public Health Network Council (PHNC). This plan outlines how the national response to public health events caused by biological agents will be conducted and coordinated, with a focus on implementation of responses led by senior-level FPT public health decision-makers. The plan was developed by an expert task group and was approved by PHNC in October, 2017. The plan describes roles, responsibilities and authorities of FPT governments for public health and emergency management, a concept of operations outlining four scalable response levels and a governance structure that aims to facilitate an efficient, timely, evidence-informed and consistent approach across jurisdictions. Improving effective engagement amongst public health, health care delivery and health emergency management authorities is a key objective of the plan.

Combining pre-spill shoreline segmentation data and shoreline assessment tools to support early response management and planning

International Nuclear Information System (INIS)

Lamarche, A.; Owens, E.H.; Martin, V.; Laforest, S.

2003-01-01

Several organizations, such as Environment Canada and the Alyeska Pipeline Service Company, are developing or refining pre-spill databases containing information about physical shoreline characteristics. Automated links between these pre-spill shoreline characteristic databases and computerized shoreline assessment tools were recently created by Environment Canada (Quebec and Ontario regions). The tools, which use Geographical Information System (GIS) technology, can be used for planning and documenting support needed for shoreline cleanup operations. A training exercise, designed to evaluate a spill management system integrating the Quebec region pre-spill shoreline database and the ShoreAssess R shoreline assessment system, was conducted at Vercheres, Quebec in October 2002 by Eastern Canada Response Corporation. The testing took place during the planning stage of the early phases of a spill, namely after the first over-flight. The computerized shoreline assessment tools made it possible to evaluate the length and type of shoreline that would potentially be impacted by oil. The tools also made it possible to assess the shoreline treatment methods most likely to be used, and evaluate the probable duration of the cleanup operation. The information would have to be available in time to be considered during the planning activities. The training exercise demonstrated that the integration of the databases is a valuable tool during the early phases of an oil spill response. 9 refs., 2 tabs., 6 figs

The effectiveness of insurer-supported safety and health engineering controls in reducing workers' compensation claims and costs.

Science.gov (United States)

Wurzelbacher, Steven J; Bertke, Stephen J; Lampl, Michael P; Bushnell, P Timothy; Meyers, Alysha R; Robins, David C; Al-Tarawneh, Ibraheem S

2014-12-01

This study evaluated the effectiveness of a program in which a workers' compensation (WC) insurer provided matching funds to insured employers to implement safety/health engineering controls. Pre- and post-intervention WC metrics were compiled for the employees designated as affected by the interventions within 468 employers for interventions occurring from 2003 to 2009. Poisson, two-part, and linear regression models with repeated measures were used to evaluate differences in pre- and post-data, controlling for time trends independent of the interventions. For affected employees, total WC claim frequency rates (both medical-only and lost-time claims) decreased 66%, lost-time WC claim frequency rates decreased 78%, WC paid cost per employee decreased 81%, and WC geometric mean paid claim cost decreased 30% post-intervention. Reductions varied by employer size, specific industry, and intervention type. The insurer-supported safety/health engineering control program was effective in reducing WC claims and costs for affected employees. © 2014 Wiley Periodicals, Inc.

Patient Satisfaction with Physician Discussions of Treatment Impact on Fertility, Menopause and Sexual Health among Pre-menopausal Women with Cancer

Directory of Open Access Journals (Sweden)

Maura Scanlon, Anne Blaes, Melissa Geller, Navneet S Majhail, Bruce Lindgren, Tufia Haddad

2012-01-01

Full Text Available PURPOSE: Pre-menopausal women with cancer are at risk of therapy-associated infertility, premature menopause, and sexual dysfunction. However, it is unknown whether oncologists adequately address these risks during treatment planning. We conducted a study to evaluate physician-patient discussions addressing the impact of cancer treatment and actual treatment effects on fertility, menopause status, and general sexual health.METHODS: A questionnaire was administered in four oncology clinics specializing in breast, gynecologic, general hematology-oncology, and blood and marrow transplantation (BMT cancer care at a single institution. Eligible participants were pre-menopausal at the time of diagnosis and either actively receiving or within 24 months from completion of treatment. Participants completed the questionnaire at enrollment and at 1-year follow-up.RESULTS: Of the 104 eligible women, a majority were satisfied with the quality (68% and length (66% of reproductive health discussions, with the highest satisfaction levels in the gynecologic cancer clinic (85% and the lowest levels in the BMT clinic (53%. Fertility preservation was desired by 20% of women, including some >40 years old. Women were more interested in discussing treatment impact on menopause status and sexual health than fertility. Rates of discussions on treatment impact on sexual health were low despite 77% of women reporting severe sexual dysfunction at 1-year follow-up.CONCLUSIONS: One-third of women are dissatisfied with the quality and length of discussions regarding the impact of cancer treatment on reproductive health. There is notably inadequate counseling on the effect of treatment on fertility in women > 40 and on sexual function in all women. Oncologists must offer better resources and improve communication on the effect of treatment on reproductive health to pre-menopausal women with cancer.

Health and safety plan for operations performed for the Environmental Restoration Program

Energy Technology Data Exchange (ETDEWEB)

Trippet, W.A. II (IT Corp., (United States)); Reneau, M.; Morton, S.L. (EG and G Idaho, Inc., Idaho Falls, ID (United States))

1992-04-01

This document constitutes the generic health and safety plan for the Environmental Restoration Program (ERP). It addresses the health and safety requirements of the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA); Occupational Safety and Health Administration (OSHA) 29 CFR 1910.120 standard; and EG G Idaho, Inc. This plan is a guide to individuals who must complete a health and safety plan for a task performed for the EPR. It contains a task specific addendum that, when completed, specifically addresses task specific health and safety issues. This health and safety plan reduces the time it takes to write a task specific health and safety plan by providing discussions of requirements, guidance on where specific information is located, and specific topics in the Addendum that must be discussed at a task level. This format encourages a complete task specific health and safety plan and a standard for all health and safety plans written for ERP.

Health and safety plan for operations performed for the Environmental Restoration Program

International Nuclear Information System (INIS)

Trippet, W.A. II; Reneau, M.; Morton, S.L.

1992-04-01

This document constitutes the generic health and safety plan for the Environmental Restoration Program (ERP). It addresses the health and safety requirements of the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA); Occupational Safety and Health Administration (OSHA) 29 CFR 1910.120 standard; and EG ampersand G Idaho, Inc. This plan is a guide to individuals who must complete a health and safety plan for a task performed for the EPR. It contains a task specific addendum that, when completed, specifically addresses task specific health and safety issues. This health and safety plan reduces the time it takes to write a task specific health and safety plan by providing discussions of requirements, guidance on where specific information is located, and specific topics in the Addendum that must be discussed at a task level. This format encourages a complete task specific health and safety plan and a standard for all health and safety plans written for ERP

Comparative studies on permanent prostate brachytherapy: pre-plan and real-time transrectal ultrasound guided iodine-125 seed implants at Korle-Bu Teaching Hospital, Ghana

International Nuclear Information System (INIS)

Kalolo, L.T.

2013-06-01

This research was carried out to investigate and compare the real-time and pre-plan implant at the Radiotherapy Department of the Korle Bu Teaching Hospital, Ghana. Prowess Panther 4.5 treatment planning system and variseed 7.2 software were used for pre-plan and real-time implant respectively. The study was conducted for eighty three (83) patients treated for prostate cancer through real-time implant brachytherapy between september, 2008 to April, 2013. Thirty one patients (31) patients whose ultrasound images were available were selected for the pre-plan study. The slices of ultrasound images were re-drawn on transparent A-4 sheets and later on scanned, contoured and registered in the treatment planning system (prowess 4.5). After planning, the volume to be implanted, total number of needles, seeds and the total activity of the source were displayed. Comparison was done withe the pre-plan and real-time implant. In both cases the variation was below 5% as recommended in dosimetry. About 30% - 40% of the imported seeds were left un-used due to over-estimation of seeds ordered from the manufacturer (BARD Company-USA). Hence this work (pre-plan) aims to solve this problem. The comparison for dosimetric parameters was assessed for prostate, urethra and rectum as (V 95%, V 100%, V 150%, D90Gy, D90%), (D90Gy, D90%, D30Gy, D30% ) and (V 100%, D30Gy and D30%) respectively and the variation were within the limit of ± 5%. Comparison of dosimetric values for this work were done with other institutions, like Karolinska university hospital, Sweden, The institute of Curie/ hospital Cochin Group Paris-France and European recommendations. The values reported at Korle - Bu teaching hospital (this work) were in good agreement with the international guidelines. (au)

CT pre-operative planning of a new semi-implantable bone conduction hearing device

Energy Technology Data Exchange (ETDEWEB)

Law, Eric K.C.; Bhatia, Kunwar S.S. [Prince of Wales Hospital, The Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Hong Kong, SAR (China); Tsang, Willis S.S.; Tong, Michael C.F. [Prince of Wales Hospital, The Chinese University of Hong Kong, Department of Otorhinolaryngology, Head and Neck Surgery, Hong Kong, SAR (China); Shi, Lin [The Chinese University of Hong Kong, Department of Medicine and Therapeutics, Hong Kong, SAR (China); The Chinese University of Hong Kong, Chow Yuk Ho Technology Center for Innovative Medicine, Hong Kong, SAR (China)

2016-06-15

Accommodating a novel semi-implantable bone conduction hearing device within the temporal bone presents challenges for surgical planning. This study describes the utility of CT in pre-operative assessment of such an implant. Retrospective review of pre-operative CT, clinical and surgical records of 16 adults considered for device implantation. Radiological suitability was assessed on CT using 3D simulation software. Antero-posterior (AP) dimensions of the mastoid bone and minimum skull thickness were measured. CT planning results were correlated with operative records. Eight and five candidates were suitable for device placement in the transmastoid and retrosigmoid positions, respectively, and three were radiologically unsuitable. The mean AP diameter of the mastoid cavity was 14.6 mm for the transmastoid group and 4.6 mm for the retrosigmoid group (p < 0.05). Contracted mastoid and/or prior surgery were predisposing factors for unsuitability. Four transmastoid and five retrosigmoid positions required sigmoid sinus/dural depression and/or use of lifts due to insufficient bone capacity. A high proportion of patients being considered have contracted or operated mastoids, which reduces the feasibility of the transmastoid approach. This finding combined with the complex temporal bone geometry illustrates the importance of careful CT evaluation using 3D software for precise device simulation. (orig.)

Paide linna ja gümnaasiumi spordihall = Paide city and upper secondary school sports building

Index Scriptorium Estoniae

2010-01-01

Paides Aedvilja 1 asuva spordihalli sisekujundusest. Sisearhitektid Ville Lausmäe ja Kadi Karmann (VL Sisearhitektuur). Akustik Linda Madalik. Hoone arhitektid: Karli Luik, Ralf Lõoke, Maarja Kask, Jaan Port (Salto AB)

26 CFR 31.3121(a)-2 - Wages; when paid and received.

Science.gov (United States)

2010-04-01

... 26 Internal Revenue 15 2010-04-01 2010-04-01 false Wages; when paid and received. 31.3121(a)-2... § 31.3121(a)-2 Wages; when paid and received. (a) In general, wages are received by an employee at the time that they are paid by the employer to the employee. Wages are paid by an employer at the time that...

5 CFR 892.202 - Are retirees eligible for the premium conversion plan?

Science.gov (United States)

2010-01-01

... conversion plan? 892.202 Section 892.202 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.202 Are retirees eligible for the premium conversion plan? No...

5 CFR 892.201 - Who is covered by the premium conversion plan?

Science.gov (United States)

2010-01-01

... plan? 892.201 Section 892.201 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL FLEXIBLE BENEFITS PLAN: PRE-TAX PAYMENT OF HEALTH BENEFITS PREMIUMS Eligibility and Participation § 892.201 Who is covered by the premium conversion plan? (a) All...

Employment and paid work among participants in a randomized controlled trial comparing diacetylmorphine and hydromorphone.

Science.gov (United States)

Nikoo, Mohammadali; Vogel, Marc; Choi, Fiona; Song, Michael J; Burghardt, Jensen; Zafari, Zafar; Tabi, Katarina; Frank, Anastasia; Barbic, Skye; Schütz, Christian; Jang, Kerry; Krausz, Michael

2018-04-12

Employment is one of the less studied but a significant outcome of medication-assisted treatment. Thus, we aimed to explore employment outcomes of medication-assisted treatment with hydromorphone (HDM) or diacetylmorphine (DAM). The secondary aim was to estimate characteristics of this population as well as treatment-related factors associated with these outcomes. This was a secondary analysis of a randomized, double blind controlled trial. A total of 102 and 100 participants were randomized to receive injectable DAM or HDM for 6 months respectively. In stage 2, 144 participants were randomized again to receive either oral or injectable forms of the medication they received for another 6 months. Participants were interviewed at 5 timepoints: before and 3, 6, 9 and 12 months after treatment assignment. Generalized estimating equations (GEE) with a logit link was fitted to determine factors related to paid work in the past 30 days. Mean age of participants was 44.3 (SD = 9.6) and 59 (29.2%) participants were men. At each timepoint, 6-8 (3.6%-4.1%) participants reported employment in the past 30 days and 40 to 52 (19.7%-26.7%) reported minimum 1 day of paid work. University or college education [OR = 2.12: 95% CI = (1.25, 3.62), P = 0.01] was significantly associated with paid work after adjustment for age, gender, treatment arms, timepoints, days receiving study treatment, physical health, psychological health and crack cocaine use in the past 30 days. The rate of employment was lower among participants of this study compared to similar studies on heroin-assisted treatment. Higher education was associated with increased odds of paid work. A large gap exists between employment rate and the proportion of participants who reported paid work. Supported employment and occupational therapy could optimize the employment outcomes of this population. Copyright © 2018 Elsevier B.V. All rights reserved.

The Medical Humanities Effect: a Pilot Study of Pre-Health Professions Students at the University of Rochester.

Science.gov (United States)

Baker, Clayton J; Shaw, Margie Hodges; Mooney, Christopher J; Daiss, Susan Dodge-Peters; Clark, Stephanie Brown

2017-12-01

Qualitative and quantitative research on the impact of medical and health humanities teaching in baccalaureate education is sparse. This paper reviews recent studies of the impact of medical and health humanities coursework in pre-health professions education and describes a pilot study of baccalaureate students who completed semester-long medical humanities courses in the Division of Medical Humanities & Bioethics at the University of Rochester. The study format was an email survey. All participants were current or former baccalaureate students who had taken one or more courses in literature and narrative in medicine, bioethics, history of medicine, and/or visual arts and healthcare during the past four years. The survey gathered numerical data in several areas: demographic information, career plans, self-reported influence of coursework on educational and career plans, and self-reported influence of coursework on intellectual skills and abilities. It also gathered narrative commentary that elaborated on students' responses to the numerically-based questions. Notable findings from preliminary analysis of the data include higher scores of self-reported impact of the coursework on specific habits of mind and on preparedness for intended career rather than on gaining admission to future educational programs. Discussion of the results focuses on several potential future directions this type of study might take, including multi-center, longitudinal, and sequential approaches.

The Theory of Planned Behavior (TPB) and Pre-Service Teachers' Technology Acceptance: A Validation Study Using Structural Equation Modeling

Science.gov (United States)

Teo, Timothy; Tan, Lynde

2012-01-01

This study applies the theory of planned behavior (TPB), a theory that is commonly used in commercial settings, to the educational context to explain pre-service teachers' technology acceptance. It is also interested in examining its validity when used for this purpose. It has found evidence that the TPB is a valid model to explain pre-service…

The Theory of Planned Behaviour: Predicting Pre-Service Teachers' Teaching Behaviour towards a Constructivist Approach

Science.gov (United States)

Wang, Carrie Lijuan; Ha, Amy S.

2013-01-01

The two-pronged purpose of this study is to examine factors determining the teaching behaviour of pre-service physical education (PE) teachers towards a constructivist approach, likewise referred to as teaching games for understanding (TGfU). Theory of planned behaviour (TPB) was applied to guide the formulation of research purpose and design. Six…

Assessing environmental assets for health promotion program planning: a practical framework for health promotion practitioners.

Science.gov (United States)

Springer, Andrew E; Evans, Alexandra E

2016-01-01

Conducting a health needs assessment is an important if not essential first step for health promotion planning. This paper explores how health needs assessments may be further strengthened for health promotion planning via an assessment of environmental assets rooted in the multiple environments (policy, information, social and physical environments) that shape health and behavior. Guided by a behavioral-ecological perspective- one that seeks to identify environmental assets that can influence health behavior, and an implementation science perspective- one that seeks to interweave health promotion strategies into existing environmental assets, we present a basic framework for assessing environmental assets and review examples from the literature to illustrate the incorporation of environmental assets into health program design. Health promotion practitioners and researchers implicitly identify and apply environmental assets in the design and implementation of health promotion interventions;this paper provides foundation for greater intentionality in assessing environmental assets for health promotion planning.

Pre-planned versus unplanned decision making in the case of environmental decontamination

International Nuclear Information System (INIS)

Paschoa, A.S.; Tranjan Filho, A.

2000-01-01

Until a few years ago it was not usual to pre-plan realistic countermeasures directly related to a radiological emergency or a nuclear accident (RENA), mostly because the probability of occurrence of such events was considered to be too low for real concern. The Three Mile Island, Chernobyl and Goiania accidents, however, changed long accepted views of the decision making community throughout the world. Today, meetings are being held just to discuss how one can go about making decisions to face the problems that may occur in a number of RENAs. The present work will examine several well established scientifically based radiological criteria to be used in decision making processes concerning either radioactive decontamination following a severe RENA, or decommissioning procedures. Such criteria can certainly be used to select pre-planned countermeasures, but can also be helpful as guidance to decision makers when facing a choice of untested and unplanned options. Selected advantages and disadvantages of each criterion based option will be presented and briefly discussed, as, for example, the amount of radioactive waste produced vis-B-vis the risk (concentration or projected dose) level adopted in the decontamination procedures. In addition, non-scientific aspects will be brought into the discussion, because their social, economical, and political implications cannot be ignored by responsible decision makers. Uncertainties associated with both non-scientific aspects and scientifically based environmental and dosimetric models will also be examined for specific cases. (author)

Risk activities and pre-travel health seeking practices of notified cases of imported infectious diseases in Australia.

Science.gov (United States)

Paudel, Prakash; Raina, C; Zwar, Nicholas; Seale, Holly; Worth, Heather; Sheikh, Mohamud; Heywood, Anita E

2017-09-01

Travellers are at risk of acquiring infectious diseases during travel, with risks differing by destination, travel and traveller characteristics. A pre-travel health consultation may minimize this risk. However, uptake of pre-travel health advice remains low. We investigated pre-travel health preparations and disease-specific risk behaviours among notified cases of selected travel-associated infectious diseases imported into Australia. Prospective enhanced surveillance of notified cases of typhoid, paratyphoid, measles, hepatitis A, hepatitis E, malaria and chikungunya was conducted in two Australian states between February 2013 and January 2014. Details of pre-travel health preparation and disease-specific risk behaviours were collected. Among 180 cases associated with international travel, 28% were travellers and 22% were frequent travellers, having travelled ≥5 times in the past 5 years. 25% had sought pre-travel advice from a healthcare provider, and 16% reported a pre-travel vaccine. Seeking pre-travel health advice did not differ by immigrant status ( P  = 0.22) or by reason for travel ( P  = 0.13) but was more commonly sought by first time travellers ( P  = 0.03). Travellers visiting friends and relatives were more likely to report at-risk activities of brushing teeth with tap water ( P  food ( P  = 0.03) during travel compared to other travellers. Pre-travel health advice seeking practices and vaccine uptake was suboptimal among cases of notified disease. The results of this study highlight the need for a better understanding of barriers to pre-travel health seeking, particularly among high risk travellers, to reduce the importation of infectious diseases into Australia. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

Awareness and pattern of utilizing family planning services among women attending urban health care center Azizabad Sukkur

International Nuclear Information System (INIS)

Shah, N.A.; Nisar, N.

2008-01-01

To assess level of awareness and pattern of utilizing family planning services among women (15-49 years) of reproductive age at Urban Health Center, Azizabad Sukkur, Sindh. A cross-sectional study was conducted from April to June 2005 at Urban Health Care Center Azizabad Sukkur. Two hundred women of reproductive age group were interviewed by using a pre tested semi structured questionnaire visiting the health care center during the study period. Information was obtained after taking informed consent regarding socio demographic characteristics, knowledge, attitude and pattern of utilizing family planning services. The data was entered and analyzed by using statistical package SPSS version 13. About 75% of women and 42.5% husbands were found illiterate, 85% women were housewives, 69.5% were married before 18 years of age and 54% had nuclear family. Regarding desired number of children women responded one child (3%), 2-3 children (11%), 4-5 (37.5%), more than five children (36%), 5.5% said that children are God gifted and 7% did not answer. About 60% of women reported use of at least one contraceptive method and 40% had never used any contraceptive method. The women who received counseling from the health care provider were 48.5% and only 6% received information through media. Religious prohibition, shortage of female staff and cost of family planning contraceptive methods were the main reasons identified for not utilizing contraceptive methods. The unsatisfactory variables were long waiting hours at the center, non-availability of contraceptive, shortage of the female staff and cost. Limited number of women was aware and practice contraception in the area and utilization of family planning services were low. The efforts should be made for providing information to couple and improving quality of family planning services in the area. (author)

76 FR 13197 - National Institute of Environmental Health Sciences Strategic Planning

Science.gov (United States)

2011-03-10

... parties. The goal of this strategic planning process is to define an overarching Vision Statement... this planning process, visit the NIEHS Strategic Planning Web site at Request for Visionary Ideas The... Environmental Health Sciences Strategic Planning AGENCY: National Institutes of Health (NIH), National Institute...

Paid online advertising

OpenAIRE

Damjan, Jure

2016-01-01

In time when internet is becoming one of the major channels for sales and spreading information, organizations, companies and individuals face challenges on how to present their websites to wider audience as well as attract new visitors. In this thesis we have presented paid online advertising, which can be used by any website owner, even individual, to drive visitors to their websites in an easy and fast way. We have also presented main advertising channels, major global and local players, t...

Experience of Wellness Recovery Action Planning in Self-Help and Mutual Support Groups for People with Lived Experience of Mental Health Difficulties

Directory of Open Access Journals (Sweden)

Rebekah Pratt

2013-01-01

Full Text Available The main aim of this research was to assess the relevance and impact of wellness recovery action planning (WRAP as a tool for self-management and wellness planning by individuals with mental health problems from pre-existing and newly formed groups, where the possibilities for continued mutual support in the development of WRAPs could be explored. Interviews and focus groups were conducted and pre-post recovery outcome measures completed (Recovery Assessment Scale and Warwick Edinburgh Mental Well Being Scale. 21 WRAP group participants took part in the research. The WRAP approach, used in groups and delivered by trained facilitators who could also share their lived experience, was very relevant and appeared to have a positive impact on many of the participants. The impact on participants varied from learning more about recovery and developing improved self-awareness to integrating a WRAP approach into daily life. The apparent positive impact of WRAP delivered in the context of mutual support groups indicates that it should be given serious consideration as a unique and worthwhile option for improving mental health. WRAP groups could make a significant contribution to the range of self-management options that are available for improving mental health and well-being.

Effect of Planned Follow-up on Married Women's Health Beliefs and Behaviors Concerning Breast and Cervical Cancer Screenings.

Science.gov (United States)

Kolutek, Rahsan; Avci, Ilknur Aydin; Sevig, Umit

2018-04-01

The objective of this study was to identify the effect of planned follow-up visits on married women's health beliefs and behaviors concerning breast and cervical cancer screenings. The study was conducted using the single-group pre-test/post-test and quasi-experimental study designs. The sample of the study included 153 women. Data were collected using a Personal Information Form, the Health Belief Model (HBM) Scale for Breast Cancer Screening, the HBM Scale for Cervical Cancer Screening, and a Pap smear test. Data were collected using the aforementioned tools from September 2012 to March 2013. Four follow-up visits were conducted, nurses were educated, and telephone reminders were utilized. Friedman's test, McNemar's test, and descriptive statistics were used for data analyzing. The frequency of performing breast self-examination (BSE) at the last visit increased to 84.3 % compared to the pre-training. A statistically significant difference was observed between the pre- and post-training median values in four subscales except for the subscale of perceived seriousness of cervical cancer under "the Health Belief Model Scale for Cervical Cancer and the Pap Smear Test" (p < 0.001). The rate of performing BSE significantly increased after the training and follow-up visits. Also, the rate of having a Pap smear significantly increased after the follow-up visits.

Health Seeking Behavior and Family Planning Services Accessibility in Indonesia

Directory of Open Access Journals (Sweden)

Niniek Lely Pratiwi

2014-11-01

Full Text Available Background: The MDG target to increase maternal health will be achieved when 50% of maternal deaths can be prevented through improvment the coverage of K1, K4, to make sure that midwife stay in the village improve the delivery by health workers in health facilities, increase coverage long-term contraceptive methods participant as well as family and community empowerment in health. Methods: This study is a further analysis of Riskesdas in 2010 to assess how big the accessibility of services in family planning in Indonesia. Results: Women of 3–4 children in rural greater and prevalence (27.1% compared to women who live in urban areas (25.0%. The main reason of not using contraception mostly because they want to have children 27.0% in urban, 28.2% rural whereas, the second reason is the fear of side effects 23.1% in urban, 16.5% rural. There is 10% of respondent did not use contraceptives, because they did not need it. Health seeking behavior of pregnant women with family planning work status has a significant relationship (prevalence ratio 1.073. The jobless mothers has better access to family planning services compared to working mother. Conclusions: Accessibility of family planning services is inadequate, because not all rural ‘Poskesdes’ equipped with infrastructure and family planning devices, a lack of knowledge of family planning in rural areas. Health seeking behavior of family planning services is mostly to the midwives, the scond is to community health centers and than polindes, ‘poskesdes’ as the ranks third.

Teaching Health Education. A Thematic Analysis of Early Career Teachers' Experiences Following Pre-Service Health Training

Science.gov (United States)

Pickett, Karen; Rietdijk, Willeke; Byrne, Jenny; Shepherd, Jonathan; Roderick, Paul; Grace, Marcus

2017-01-01

Purpose: The purpose of this paper is to understand early career teachers' perceptions of the impact of a pre-service health education programme on their health promotion practice in schools and the contextual factors that influence this. Design/methodology/approach: Semi-structured interviews were conducted with 14 primary and secondary trainee…

Health Careers Planning Guide--Illinois. Second Edition.

Science.gov (United States)

Illinois Univ., Champaign.

This notebook of career counseling materials is a compilation of career information on nursing and the allied health fields. The first section provides general information useful in choosing a health career on such topics as career planning, career mobility, employment prospects, financial aid, terminology in health job titles, and an annotated…

Developing plan and pre-conceptual design of target system for JAERI`s high intensity neutron source

Energy Technology Data Exchange (ETDEWEB)

Hino, Ryutaro; Kaminaga, Masanori; Haga, Katsuhiro; Ishikura, Syuichi [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment; Nakamura, Fumito; Uchida, Shoji

1997-11-01

This paper presents an outline of developing plan of a target system and topics obtained by a pre-conceptual design, which aims to establish a technology base of the target system and to make clear a system concept. In the plan, two types of target - solid and mercury targets - are to be developed for a neutron scattering facility. Information obtained through the development shall be applied to designs of an irradiation and a transmutation facilities. Through the pre-conceptual design, system arrangement, scale etc. were made clear: total weight will be 12000 ton, and 26 beam lines with beam shutters will be equipped for 4 moderators. Engineering problems were also made clear through the design; high flux heat removal, dynamic stress caused by thermal shock and pressure wave, loop technology for the mercury target and a slurry moderator consisting of methane pellets and liquefied hydrogen. We are now constructing new test apparatuses and arranging computer codes for solving these problems. (author)

Mental Health Services Utilization and Expenditures Among Children Enrolled in Employer-Sponsored Health Plans.

Science.gov (United States)

Walter, Angela Wangari; Yuan, Yiyang; Cabral, Howard J

2017-05-01

Mental illness in children increases the risk of developing mental health disorders in adulthood, and reduces physical and emotional well-being across the life course. The Mental Health Parity and Addiction Equity Act (MHPAEA, 2008) aimed to improve access to mental health treatment by requiring employer-sponsored health plans to include insurance coverage for behavioral health services. Investigators used IBM Watson/Truven Analytics MarketScan claims data (2007-2013) to examine: (1) the distribution of mental illness; (2) trends in utilization and out-of-pocket expenditures; and (3) the overall effect of the MHPAEA on mental health services utilization and out-of-pocket expenditures among privately-insured children aged 3 to 17 with mental health disorders. Multivariate Poisson regression and linear regression modeling techniques were used. Mental health services use for outpatient behavioral health therapy (BHT) was higher in the years after the implementation of the MHPAEA (2010-2013). Specifically, before the MHPAEA implementation, the annual total visits for BHT provided by mental health physicians were 17.1% lower and 2.5% lower for BHT by mental health professionals, compared to years when MHPAEA was in effect. Children covered by consumer-driven and high-deductible plans had significantly higher out-of-pocket expenditures for BHT compared to those enrolled PPOs. Our findings demonstrate increased mental health services use and higher out-of-pocket costs per outpatient visit after implementation of the MHPAEA. As consumer-driven and high-deductible health plans continue to grow, enrollees need to be cognizant of the impact of health insurance benefit designs on health services offered in these plans. Copyright © 2017 by the American Academy of Pediatrics.

Health transformation plan: Goals achievement in Nemazee hospital

Directory of Open Access Journals (Sweden)

Ali Akbar Ahmadi

2016-01-01

Full Text Available Introduction: The main purpose of this study was to assess fulfillment of goals about “Health Transformation Plan (HTP of Ministry of Health, Treatment and Medical Education” from the perspective of managers, which is as one of the most important management challenges in the Health System Reform Plan. These goals included six packages determined by the Ministry of Health, Treatment and Medical Education, the fulfillment of each of which one was evaluated separately as sub-goals in the current study. Finally, the rank of each package in comparison to other packages was determined and presented, using means rank test (Friedman test. Method: This study was conducted using a questionnaire in which comments of the senior and middle managers of Nemazee hospital were collected as the research data. Due to the fact that about one year has passed since the beginning of implementation of HTP and since there were no documented methods or questionnaires, the researcher designed a self-made questionnaire. The basis of designing the questionnaire was the set of guidelines developed for Health System Reform Plan. These guidelines include goals that a hospital should achieve during implementation of Health System Reform Plan. After sharing these goals with senior and middle managers of Nemazee hospital (as the place of research, they were converted to a questionnaire including 20 questions. The questionnaire included the goals that must be achieved in Nemazee hospital of Shiraz during the implementation of the plan. After designing the questionnaire, a preliminary test was taken to assess the reliability. Results: Cronbach’s alpha coefficient (0.88 showed a high rate of reliability in the above questionnaire. After the final data collection, the questionnaire was tested in a sample of 100 senior and middle managers; the results showed that about six packages were specified by the Ministry of Health, Treatment and Medical Education. The majority of

Malpractice paid losses and financial performance of nursing homes.

Science.gov (United States)

Zhao, Mei; Haley, D Rob; Oetjen, Reid M; Carretta, Henry J

2011-01-01

Florida's nursing home industry has experienced significant financial pressure over the past decade. One of the primary reasons is the dramatic increase in litigation activity for nursing home providers claiming negligent care and abuse. Although anecdotal reports indicate a higher cost because of malpractice in nursing facilities, few studies have examined the extent of malpractice paid losses and their effect on the financial performance of nursing homes. The purpose of this study was to examine the impact of malpractice paid losses on the financial performance of nursing homes. Medicare Cost Report data and Online Survey, Certification, and Reporting data for Florida skilled nursing facilities over the 6-year period from 2001 to 2006 were used to calculate the malpractice paid losses and the financial performance indicators as well as the nursing home organizational and market factors. Descriptive analysis and multivariate regression analysis were used to examine the effect of paid loss on financial performance. The paid loss for malpractice claims was strongly associated with financial performance. Nursing facilities with malpractice paid losses had consistently lower total margins over the study period. The threat of nursing home litigation may create an incentive for nursing homes to improve quality of care; however, large paid claims can also force nursing homes into a financial situation where the organization no longer has the resources to improve quality. Nursing home managers must assess their malpractice litigation risk and identify tactics to mitigate these risks to better provide a safe and secure environment for the older persons. In addition, this research offers support for local, state, and federal policymakers to revisit the issue of malpractice litigation and the nursing home industry through its insight on the relationship of nursing home margins and litigation.

Higher fees paid to US physicians drive higher spending for physician services compared to other countries.

Science.gov (United States)

Laugesen, Miriam J; Glied, Sherry A

2011-09-01

Higher health care prices in the United States are a key reason that the nation's health spending is so much higher than that of other countries. Our study compared physicians' fees paid by public and private payers for primary care office visits and hip replacements in Australia, Canada, France, Germany, the United Kingdom, and the United States. We also compared physicians' incomes net of practice expenses, differences in financing the cost of medical education, and the relative contribution of payments per physician and of physician supply in the countries' national spending on physician services. Public and private payers paid somewhat higher fees to US primary care physicians for office visits (27 percent more for public, 70 percent more for private) and much higher fees to orthopedic physicians for hip replacements (70 percent more for public, 120 percent more for private) than public and private payers paid these physicians' counterparts in other countries. US primary care and orthopedic physicians also earned higher incomes ($186,582 and $442,450, respectively) than their foreign counterparts. We conclude that the higher fees, rather than factors such as higher practice costs, volume of services, or tuition expenses, were the main drivers of higher US spending, particularly in orthopedics.

75 FR 41726 - Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Coverage of...

Science.gov (United States)

2010-07-19

... Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient... and health insurance coverage in the group and individual markets under provisions of the Patient... plans and group health insurance issuers for plan years beginning on or after September 23, 2010. These...

75 FR 34537 - Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to Status as a...

Science.gov (United States)

2010-06-17

... 45 CFR Part 147 Group Health Plans and Health Insurance Coverage Relating to Status as a... for Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan... and Insurance Oversight, Department of Health and Human Services. ACTION: Interim final rules with...

Maternal Employment Effects of Paid Parental Leave

OpenAIRE

Bergemann, Annette; Riphahn, Regina T.

2015-01-01

We study the short, medium, and longer run employment effects of a substantial change in the parental leave benefit program in Germany. In 2007, a means-tested parental leave transfer program that had paid benefits for up to two years was replaced by an earnings related transfer which paid benefits for up to one year. The reform generated winners and losers with heterogeneous response incentives. We find that the reform speeds up the labor market return of both groups of mothers after benefit...

Strategic planning--a plan for excellence for South Haven Health System.

Science.gov (United States)

Urbanski, Joanne; Baskel, Maureen; Martelli, Mary

2011-01-01

South Haven Health System has developed an innovative approach to strategic planning. The key to success of this process has been the multidisciplinary involvement of all stakeholders from the first planning session through the final formation of a strategic plan with measurable objectives for each goal. The process utilizes a Conversation Café method for identifying opportunities and establishing goals, Strategic Oversight Teams to address each goal and a Champion for implementation of each objective. Progress is measured quarterly by Strategic Oversight Team report cards. Transparency of communication within the organization and the sharing of information move the plan forward. The feedback from participant evaluations has been overwhelmingly positive. They are involved and excited.

Portraits of Pre-Service Classroom Teachers: Exploring Intentions to Integrate Music through the Lens of the Theory of Planned Behavior

Science.gov (United States)

Harney, Kristin

2014-01-01

The primary purpose of this short-term study was to examine pre-service classroom teachers' intentions to integrate music in their future classrooms. Using the theory of planned behavior (Fishbein & Ajzen, 2010) as a framework, and embedded, multiple-case study design, I developed case studies of six pre-service classroom teachers enrolled in…

Health policies planning: methodological standards, boundaries and possibilities

Directory of Open Access Journals (Sweden)

Cassius Guimarães Chai

2016-12-01

Full Text Available Before the health right recognition and expansion brought about by the Federal Constitution of 1988,the impact on public accounts and the need to rationalize the system, now bound to the universalisation matrix, place “planning” as fundamental for the operationalization of actions and services of health accessing. The objective of this article is to carry out an integrative literature review in order to know the factors related to the methodological frameworks, challenges and possibilities for structuring a Municipal Health Plan (Administration. The following databases were searched: Lilacs, Library Digital Thesis and Dissertation (BDTD, in Google Scholar, the Coordination of Improvement of Higher Education Personnel (CAPES Thesis Bank. For the composition of the sample, the following descriptors were associated: Health Policy, Decentralization and Municipalization with Health Planning. In addition, papers were selected among dissertations, theses and scientific articles, as well as institutional handbooks of the Ministry of Health-MS Publics of PlanejaSUS, adopting scientific works published between 2005 and 2015 as a time cut. The results found synthesize the scenario of the intersectoral and tripartite arrangement of health management, contributing to a critical and evaluative exercise of experience, challenges and possibility Of advances in the understanding of the importance of SUS municipal planning.

75 FR 37242 - Requirements for Group Health Plans and Health Insurance Issuers Under the Patient Protection and...

Science.gov (United States)

2010-06-28

... Requirements for Group Health Plans and Health Insurance Issuers Under the Patient Protection and Affordable... Labor and the Office of Consumer Information and Insurance Oversight of the U.S. Department of Health... guidance to employers, group health plans, and health insurance issuers providing group health insurance...

26 CFR 54.9831-1 - Special rules relating to group health plans.

Science.gov (United States)

2010-04-01

... this section. In addition, benefits provided under a health flexible spending arrangement are excepted... of a group health plan. For purposes of this paragraph (c)(3), benefits are not an integral part of a group health plan (whether the benefits are provided through the same plan or a separate plan) only if...

A model of roles and responsibilities in oral health promotion based on perspectives of a community-based initiative for pre-school children in the U.K.

Science.gov (United States)

Henderson, E; Rubin, G

2014-03-01

(i) To explore dental, school and family perspectives of an oral health promotion (OHP) initiative to improve access for pre-school children in deprived communities; (ii) to develop a model of roles and responsibilities for OHP in community settings. Semi-structured focus groups (n = 6) with dental practice staff (n = 24), and semi-structured interviews with school staff (n = 9) and parents and children (n = 4) who were involved in an OHP initiative for pre-school children. Framework analysis was applied to identify themes. Themes were used to develop a model of roles and responsibilities for OHP, based on the WHO Planning and evaluating health promotion model. Respondents subscribed to a community-based approach to improving access to dental services for pre-school children in deprived areas, with an emphasis on shared responsibility and communication. In addition to macro-level actions in directing health policy and services, commissioners were held responsible for investing in micro-level actions, such as funding OHP training and involving parents, and meso-level actions such as reducing barriers to access. The model we have developed builds on WHO recommendations on health promotion to identify the key roles and responsibilities that should be incorporated into further initiatives in OHP.

A prison mental health in-reach model informed by assertive community treatment principles: evaluation of its impact on planning during the pre-release period, community mental health service engagement and reoffending.

Science.gov (United States)

McKenna, Brian; Skipworth, Jeremy; Tapsell, Rees; Madell, Dominic; Pillai, Krishna; Simpson, Alexander; Cavney, James; Rouse, Paul

2015-12-01

It is well recognised that prisoners with serious mental illness (SMI) are at high risk of poor outcomes on return to the community. Early engagement with mental health services and other community agencies could provide the substrate for reducing risk. To evaluate the impact of implementing an assertive community treatment informed prison in-reach model of care (PMOC) on post-release engagement with community mental health services and on reoffending rates. One hundred and eighty prisoners with SMI released from four prisons in the year before implementation of the PMOC were compared with 170 such prisoners released the year after its implementation. The assertive prison model of care was associated with more pre-release contacts with community mental health services and contacts with some social care agencies in some prisons. There were significantly more post-release community mental health service engagements after implementation of this model (Z = -2.388, p = 0.02). There was a trend towards reduction in reoffending rates after release from some of the prisons (Z =1.82, p = 0.07). Assertive community treatment applied to prisoners with mental health problems was superior to 'treatment as usual', but more work is needed to ensure that agencies will engage prisoners in pre-release care. The fact that the model showed some benefits in the absence of any increase in resources suggests that it may be the model per se that is effective. Copyright © 2014 John Wiley & Sons, Ltd.

45 CFR 162.925 - Additional requirements for health plans.

Science.gov (United States)

2010-10-01

... clearinghouse to receive, process, or transmit a standard transaction may not charge fees or costs in excess of... RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS General Provisions for Transactions § 162.925 Additional... transaction as a standard transaction, the health plan must do so. (2) A health plan may not delay or reject a...

Health-related quality of life before planned admission to intensive care: memory over three and six months

Directory of Open Access Journals (Sweden)

Tadini Laura

2010-09-01

Full Text Available Abstract Background The validity of Health-Related Quality of Life (HRQOL recalled by ICU admitted patients have not been published. The aim of this study was to compare the baseline HRQOL measured before surgery and ICU admission with that recalled at 3 and 6 months in a population of patients with planned ICU admission after surgery. Methods This prospective study was performed in three Italian centres on patients who had undergone General, Orthopaedic or Urologic surgery. All adult patients with planned ICU admission between October 2007 and July 2008 were considered for enrolment. At hospital admission, the Mini Mental Status Examination and EuroQoL (EQ questionnaire (referring to the last two weeks were administered to the patients who consented. Three and six months after ICU admission, the researchers administered by phone the EQ questionnaire and Post-Traumatic Stress Syndrome 14 questions Inventory, asking the patients to rate their HRQOL before surgery and ICU admission. Past medical history demographic and clinical ICU-related variables were collected. Statistical analysis Chi-square test and non parametric statistics were used to compare groups of patients. The EQ-5D was transformed in the time trade-off (TTO to obtain a continuous variable, subsequently analysed using the Intraclass Correlation Coefficient (ICC. Results Of the 104 patients assessed at baseline and discharged from the hospital, 93 had the EQ administered at 3 months, and 89 at 6 months. The ICC for TTO recalled at 3 months vs pre-ICU TTO was 0.851, and that for TTO recalled at 6 months vs pre-ICU TTO was 0.833. The ICC for the EQ-VAS recalled at 3 months vs pre-ICU EQ-VAS was 0.648, and that for the EQ-VAS recalled at 6 months vs pre-ICU EQ-VAS was 0.580. Forty-two (45% patients assessed at 3 months gave the same score in all EQ-5D items as at baseline. They underwent mainly orthopaedic surgery (p 0.011, and perceived the severity of their illness as lower (p 0

76 FR 1105 - Guidance on Reporting Interest Paid to Nonresident Aliens

Science.gov (United States)

2011-01-07

...-BJ01 Guidance on Reporting Interest Paid to Nonresident Aliens AGENCY: Internal Revenue Service (IRS... and paid to nonresident alien individuals. These proposed regulations affect persons making payments.... bank deposit interest paid to any nonresident alien individual must be reported annually to the IRS. On...

Integrating authorities and disciplines into the preparedness-planning process: a study of mental health, public health, and emergency management.

Science.gov (United States)

Robertson, Madeline; Pfefferbaum, Betty; Codispoti, Catherine R; Montgomery, Juliann M

2007-01-01

The process of integrating all necessary authorities and disciplines into an organized preparedness plan is complex, and the inclusion of disaster mental health poses specific challenges. The goals of this project were (1) to identify whether state mental health preparedness was included in state public health and emergency management preparedness plans, (2) to document barriers to entry and strategies reportedly used by state authorities in efforts to incorporate reasonable mental health preparedness into existing public health and emergency management preparedness planning, (3) to employ a theory for organizational change to organize and synthesize this information, and (4) to stimulate further discussion and research supporting coordinated preparedness efforts at the state level, particularly those inclusive of mental health. To accomplish these goals we (1) counted the number of state public health preparedness and emergency management plans that either included, mentioned, or omitted a mental health preparedness plan; (2) interviewed key officials from nine representative states for their reports on strategies used in seeking greater inclusion of mental health preparedness in public health and emergency management preparedness planning; and (3) synthesized these results to contribute to the national dialogue on coordinating disaster preparedness, particularly with respect to mental health preparedness. We found that 15 out of 29 publicly available public health preparedness plans (52 percent) included mental health preparedness, and eight of 43 publicly available emergency management plans (18 percent) incorporated mental health. Interviewees reported numerous barriers and strategies, which we cataloged according to a well-accepted eight-step plan for transforming organizations.

75 FR 43329 - Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Internal...

Science.gov (United States)

2010-07-23

... 45 CFR Part 147 Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to... Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and... of Labor; Office of Consumer Information and Insurance Oversight, Department of Health and Human...

75 FR 27141 - Group Health Plans and Health Insurance Issuers Providing Dependent Coverage of Children to Age...

Science.gov (United States)

2010-05-13

... Group Health Plans and Health Insurance Issuers Providing Dependent Coverage of Children to Age 26 Under... Information and Insurance Oversight of the U.S. Department of Health and Human Services are issuing substantially similar interim final regulations with respect to group health plans and health insurance coverage...

76 FR 46621 - Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under...

Science.gov (United States)

2011-08-03

... to the interim final regulations implementing the rules for group health plans and health insurance... dates. These interim final regulations generally apply to group health plans and group health insurance... from HHS on private health insurance for consumers can be found on the Centers for Medicare & Medicaid...

75 FR 41787 - Requirement for Group Health Plans and Health Insurance Issuers To Provide Coverage of Preventive...

Science.gov (United States)

2010-07-19

... Requirement for Group Health Plans and Health Insurance Issuers To Provide Coverage of Preventive Services... Insurance Oversight of the U.S. Department of Health and Human Services are issuing substantially similar interim final regulations with respect to group health plans and health insurance coverage offered in...

Poor Pre-Pregnancy and Antepartum Mental Health Predicts Postpartum Mental Health Problems among US Women: A Nationally Representative Population-Based Study

Science.gov (United States)

Witt, Whitney P.; Wisk, Lauren E.; Cheng, Erika R.; Hampton, John M.; Creswell, Paul; Hagen, Erika W.; Spear, Hilary A.; Maddox, Torsheika; DeLeire, Thomas

2011-01-01

Purpose Mental health problems disproportionately affect women, particularly during childbearing years. However, there is a paucity of research on the determinants of postpartum mental health problems using representative US populations. Taking a life course perspective, we determined the potential risk factors for postpartum mental health problems, with a particular focus on the role of mental health before and during pregnancy. Methods We examined data on 1,863 mothers from eleven panels of the 1996-2006 Medical Expenditure Panel Survey (MEPS). Poor postpartum mental health was defined using self-reports of mental health conditions, symptoms of mental health conditions, or global mental health ratings of “fair” or “poor.” Results 9.5% of women reported experiencing postpartum mental health problems, with over half of these women reporting a history of poor mental health. Poor pre-pregnancy mental health and poor antepartum mental health both independently increased the odds of having postpartum mental health problems. Staged multivariate analyses revealed that poor antepartum mental health attenuated the relationship between pre-pregnancy and postpartum mental health problems. Additionally, significant disparities exist in women's report of postpartum mental health status. Conclusions While poor antepartum mental health is the strongest predictor of postpartum mental health problems, pre-pregnancy mental health is also important. Accordingly, health care providers should identify, treat, and follow women with a history of poor mental health, as they are particularly susceptible to postpartum mental health problems. This will ensure that women and their children are in the best possible health and mental health during the postpartum period and beyond. PMID:21349740

'It is hard for mums to put themselves first': how mothers diagnosed with breast cancer manage the sociological boundaries between paid work, family and caring for the self.

Science.gov (United States)

Mackenzie, Catherine Ruth

2014-09-01

This paper aims to increase understanding of how mothers diagnosed with breast cancer while in the paid workforce experience and manage their multiple demands of taking care of themselves, their children and their paid work. In-depth, semi-structured interviews were conducted with 32 women who were mothers of dependent children and in the paid workforce at the time of their breast cancer diagnosis. The sample includes women living in urban and rural Australia. The study found that after a breast cancer diagnosis, participants tended to prioritise their health and wellbeing over paid work. Yet dominance of gendered identity meant that they tended to place the needs of family, especially children, above their own health and wellbeing. The key factors that influenced mothers' decisions to continue in, return to, or leave paid work after a breast cancer diagnosis included: a change in perspective regarding what was important in their lives; level of support from the workplace and home; the extent to which participating in paid work was a financial necessity; the extent to which their identity was connected to paid work, and; ongoing level of pain or fatigue. The paper concludes that using the sociological concepts of the fateful moment, boundary maintenance and a feminist ethic of care produces a more nuanced understanding of women's participation in paid work after breast cancer than examining paid workforce participation, or unpaid responsibilities and mothering, separately. The nature of the permeability or malleability of boundaries between work, family and taking care of the self affects women's participation in paid work during and/or after breast cancer treatment. Increased boundary permeability or malleability brought about more by cooperation than conflict facilitated positive experiences of re-negotiating boundaries, whereas increased permeability or malleability brought about more by conflict than cooperation created difficulties for women in finding an

RISK CORRIDORS AND REINSURANCE IN HEALTH INSURANCE MARKETPLACES: Insurance for Insurers

OpenAIRE

LAYTON, TIMOTHY J.; MCGUIRE, THOMAS G.; SINAIKO, ANNA D.

2016-01-01

In order to encourage entry and lower prices, most regulated markets for health insurance include policies that seek to reduce the uncertainty faced by insurers. In addition to risk adjustment of premiums paid to plans, the Health Insurance Marketplaces established by the Affordable Care Act implement reinsurance and risk corridors. Reinsurance limits insurer costs associated with specific individuals, while risk corridors protect against aggregate losses. Both tighten the insurer's distribut...

[World plan for reproductive autonomy and health].

Science.gov (United States)

Ospina, P

1994-06-01

The principal objective of the Third International Conference on Population and Development to be held in Cairo in 1994 is to achieve consensus on a Plan of Action to reinforce reproductive rights of individuals, who bear ultimate responsibility for slowing population growth. The Plan of Action should be adopted by all the peoples of the world in order to stabilize population growth during the next twenty years by means of programs to provide family planning and reproductive health services. The preliminary conference document incorporated recommendations and proposals of two preparatory committees, five regional conferences, six expert meetings, 109 countries, and over 400 nongovernmental organizations from around the world. At current rates of growth, the world's 5.7 billion inhabitants will increase to 9.1 billion by the year 2025, vastly increasing pressure on already limited resources and ecosystems. The central theme of the first World Population Conference in Bucharest in 1974 was the close relationship between population growth and socioeconomic development. The 1974 World Population Plan of Action stressed development of strategies to achieve a better quality of life and rapid socioeconomic development. Recommendations of the 1984 World Population Conference in Mexico remained centered on implementation of the Bucharest Plan of Action with a few additions. Although progress has been achieved in meeting the goals of the Bucharest Plan of Action, growth rates of some developing countries have actually increased. Poverty, unemployment, illiteracy, and discrimination against women are still obstacles to socioeconomic development, and contraceptive usage has not reached optimal levels. Urban migration remains excessive. Progress for many countries over the past decade has been directly related to increasing the access of women to health care and family planning. Themes related to women's status and rights will be incorporated in the 1994 Cairo Conference. The

75 FR 43109 - Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and...

Science.gov (United States)

2010-07-23

... Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and... the Office of Consumer Information and Insurance Oversight of the U.S. Department of Health and Human... health insurance coverage offered in connection with a group health plan under the Employee Retirement...

Policy Watch: The Federal Employees Health Benefits Plan

OpenAIRE

Roger Feldman; Kenneth E. Thorpe; Bradley Gray

2002-01-01

This short feature describes the Federal Employees Health Benefits Plan (FEHBP), which provides health insurance benefits to active and retired federal employees and their dependents. The article discusses the FEHBP as a touchstone for research on employment-based health insurance and as a touchstone for health policy reform.

[Philanthropic hospitals and the operation of provider-owned health plans in Brazil].

Science.gov (United States)

Lima, Sheyla Maria Lemos; Portela, Margareth C; Ugá, Maria Alicia Dominguez; Barbosa, Pedro Ribeiro; Gerschman, Silvia; Vasconcellos, Miguel Murat

2007-02-01

To describe the management performance of philanthropic hospitals that operate their own health plans, in comparison with philanthropic hospitals as a whole in Brazil. The managerial structures of philanthropic hospitals that operated their own health plans were compared with those seen in a representative group from the philanthropic hospital sector, in six dimensions: management and planning, economics and finance, human resources, technical services, logistics services and information technology. Data from a random sample of 69 hospitals within the philanthropic hospital sector and 94 philanthropic hospitals that operate their own health plans were evaluated. In both cases, only the hospitals with less than 599 beds were included. The results identified for the hospitals that operate their own health plans were more positive in all the managerial dimensions compared. In particular, the economics and finance and information technology dimensions were highlighted, for which more than 50% of the hospitals that operated their own health plans presented almost all the conditions considered. The philanthropic hospital sector is important in providing services to the Brazilian Health System (SUS). The challenges in maintaining and developing these hospitals impose the need to find alternatives. Stimulation of a public-private partnership in this segment, by means of operating provider-owned health plans or providing services to other health plans that work together with SUS, is a field that deserves more in-depth analysis.

Paid caregiver motivation, work conditions, and falls among senior clients.

Science.gov (United States)

Lindquist, Lee A; Tam, Karen; Friesema, Elisha; Martin, Gary J

2012-01-01

The purpose of this study was to determine the motivation of paid non-familial caregivers of seniors, understand more about their work conditions, and identify any links to negative outcomes among their senior clients. Ninety-eight paid caregivers (eighty-five female and thirteen male), recruited from multiple sites (i.e. senior centers, shopping malls, local parks, lobbies of senior apartments, caregiver agency meetings) completed face-to-face questionnaires and semi-structured interviews. We found that 60.7% of participants chose to become a caregiver because they enjoyed being with seniors while 31.7% were unable to obtain other work, and 8.2% stated it was a prerequisite to a different health related occupation. Caregivers stated that the most challenging conditions of their work were physical lifting (24.5%), behavioral and psychological symptoms of dementia (24.5%), senior depression/mood changes (18.4%), attachment with impending death (8.2%), missing injuries to client (5.1%), lack of sleep (4.1%), and lack of connection with outside world (3.1%). Caregivers who reported that the best part of their job was the salary, flexible hours, and ease of work were significantly more likely to have clients who fell and fractured a bone than those who enjoyed being with seniors (job characteristics, 62.5% vs. senior enjoyment, 25.6%; pmotivated commonly by their love of seniors and also by their lack of other job opportunities. Paid caregivers frequently face challenging work conditions. When seeking a caregiver for a senior, motivation of the caregiver should be considered when hiring. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Preventing intimate partner violence through paid parental leave policies.

Science.gov (United States)

D'Inverno, Ashley Schappell; Reidy, Dennis E; Kearns, Megan C

2018-05-30

Paid parental leave policies have the potential to strengthen economic supports, reduce family discord, and provide opportunities to empower women (Basile et al., 2016; Niolon et al., 2017). In this article, we present a theory of change and evidence to suggest how paid parental leave may impact intimate partner violence (IPV). In doing so, we present three mechanisms of change (i.e., reduction in financial stress, increase in egalitarian parenting practices, and promotion of child/parent bonding) through which paid parental leave could reduce rates of IPV. We also describe limitations of the current state of knowledge in this area, as well as opportunities for future research. Ultimately, our goal is to facilitate the identification and implementation of approaches that have the potential to reduce violence at the population level. Paid parental leave embodies the potential of policies to change societal-level factors and serve as an important prevention strategy for IPV. Copyright © 2018. Published by Elsevier Inc.

Health Plan Performance Measurement within Medicare Subvention.

Science.gov (United States)

1998-06-01

the causes of poor performance (Siren & Laffel, 1996). Although outcomes measures such as nosocomial infection rates, admission rates for select...defined. Traditional outcomes measures include infection rates, morbidity, and mortality. The problem with these traditional measures is... Maternal /Child Care Indicators Nursing Staffing Indicators Outcome Indicators Technical Outcomes Plan Performance Stability of Health Plan

77 FR 42462 - Hawaii State Plan for Occupational Safety and Health; Proposed Modification of 18(e) Plan Approval

Science.gov (United States)

2012-07-19

... DEPARTMENT OF LABOR Occupational Safety and Health Administration 29 CFR Part 1952 [Docket ID. OSHA 2012-0029] RIN 1218-AC78 Hawaii State Plan for Occupational Safety and Health; Proposed Modification of 18(e) Plan Approval AGENCY: Occupational Safety and Health Administration (OSHA), Department of...

Mental and somatic health and pre- and post-migration factors among older Somali refugees in Finland.

Science.gov (United States)

Mölsä, Mulki; Punamäki, Raija-Leena; Saarni, Samuli I; Tiilikainen, Marja; Kuittinen, Saija; Honkasalo, Marja-Liisa

2014-08-01

Mental and somatic health was compared between older Somali refugees and their pair-matched Finnish natives, and the role of pre-migration trauma and post-migration stressors among the refugees. One hundred and twenty-eight Somalis between 50-80 years of age were selected from the Somali older adult population living in the Helsinki area (N = 307). Participants were matched with native Finns by gender, age, education, and civic status. The BDI-21 was used for depressive symptoms, the GHQ-12 for psychological distress, and the HRQoL was used for health-related quality of life. Standard instruments were used for sleeping difficulties, somatic symptoms and somatization, hypochondria, and self-rated health. Clinically significant differences in psychological distress, depressive symptoms, sleeping difficulties, self-rated health status, subjective quality of life, and functional capacity were found between the Somali and Finnish groups. In each case, the Somalis fared worse than the Finns. No significant differences in somatization were found between the two groups. Exposure to traumatic events prior to immigrating to Finland was associated with higher levels of mental distress, as well as poorer health status, health-related quality of life, and subjective quality of life among Somalis. Refugee-related traumatic experiences may constitute a long lasting mental health burden among older adults. Health care professionals in host countries must take into account these realities while planning for the care of refugee populations. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

The effect of mergers and acquisitions on behavioral health care.

Science.gov (United States)

Lazarus, A

1995-01-01

The consolidation of America's managed health care industry rivals any corporate raider scenario. Unlike previous merger booms, however, health care unions in the 1990s have been strategically planned. Particular attention is paid to merger activity in the behavioral health care field. Ultimately, the author writes, mergers will bring greater efficiency and lower costs to health care but also less choice for patients. Unless providers and payers pay close attention to the human side of mergers and acquisitions, new alliances are likely to fall short of their goals.

Patient-specific instrumentation for total knee arthroplasty does not match the pre-operative plan as assessed by intra-operative computer-assisted navigation.

Science.gov (United States)

Scholes, Corey; Sahni, Varun; Lustig, Sebastien; Parker, David A; Coolican, Myles R J

2014-03-01

The introduction of patient-specific instruments (PSI) for guiding bone cuts could increase the incidence of malalignment in primary total knee arthroplasty. The purpose of this study was to assess the agreement between one type of patient-specific instrumentation (Zimmer PSI) and the pre-operative plan with respect to bone cuts and component alignment during TKR using imageless computer navigation. A consecutive series of 30 femoral and tibial guides were assessed in-theatre by the same surgeon using computer navigation. Following surgical exposure, the PSI cutting guides were placed on the joint surface and alignment assessed using the navigation tracker. The difference between in-theatre data and the pre-operative plan was recorded and analysed. The error between in-theatre measurements and pre-operative plan for the femoral and tibial components exceeded 3° for 3 and 17% of the sample, respectively, while the error for total coronal alignment exceeded 3° for 27% of the sample. The present results indicate that alignment with Zimmer PSI cutting blocks, assessed by imageless navigation, does not match the pre-operative plan in a proportion of cases. To prevent unnecessary increases in the incidence of malalignment in primary TKR, it is recommended that these devices should not be used without objective verification of alignment, either in real-time or with post-operative imaging. Further work is required to identify the source of discrepancies and validate these devices prior to routine use. II.

Indicators for planning of health services: assessing impacts of social and health care factors on population health.

Science.gov (United States)

Wan, T T; Broida, J H

1983-01-01

Community health planning requires identification of the level of access to care and factors which affect the differentials in use of health services. In formulating strategies or alternatives for planning, some assessment of the current level or patterns of health services must be made. It is this element of the planning process that is addressed in this paper. In this study sixty-five specifically designated areas (medical market areas) in the Province of Quebec, Canada were selected. The analysis was performed using data obtained from a large scale study of physicians' responses to the introduction of universal medical care insurance in Quebec. Our analysis offered an opportunity to observe the impact of Medicare on access to care for those thought to be underserved.

Nonprofit to for-profit conversions by hospitals, health insurers, and health plans.

Science.gov (United States)

Needleman, J

1999-01-01

Conversion of hospitals, health insurers, and health plans from nonprofit to for-profit ownership has become a focus of national debate. The author examines why nonprofit ownership has been dominant in the US health system and assesses the strength of the argument that nonprofits provide community benefits that would be threatened by for-profit conversion. The author concludes that many of the specific community benefits offered by nonprofits, such as care for the poor, could be maintained or replaced by adequate funding of public programs and that quality and fairness in treatment can be better assured through clear standards of care and adequate monitoring systems. As health care becomes increasingly commercialized, the most difficult parts of nonprofits' historic mission to preserve are the community orientation, leadership role, and innovation that nonprofit hospitals and health plans have provided out of their commitment to a community beyond those to whom they sell services.

Examining paid sickness absence by shift workers.

Science.gov (United States)

Catano, V M; Bissonnette, A B

2014-06-01

Shift workers are at greater risk than day workers with respect to psychological and physical health, yet little research has linked shift work to increased sickness absence. To investigate the relationship between shift work and sickness absence while controlling for organizational and individual characteristics and shift work attributes that have confounded previous research. The study used archive data collected from three national surveys in Canada, each involving over 20000 employees and 6000 private-sector firms in 14 different occupational groups. The employees reported the number of paid sickness absence days in the past 12 months. Data were analysed using both chi-squared statistics and hierarchical regressions. Contrary to previous research, shift workers took less paid sickness absence than day workers. There were no differences in the length of the sickness absence between both groups or in sickness absence taken by female and male workers whether working days or shifts. Only job tenure, the presence of a union in the workplace and working rotating shifts predicted sickness absence in shift workers. The results were consistent across all three samples. In general, shift work does not seem to be linked to increased sickness absence. However, such associations may be true for specific industries. Male and female workers did not differ in the amount of sickness absence taken. Rotating shifts, regardless of industry, predicted sickness absence among shift workers. Consideration should be given to implementing scheduled time off between shift changes. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Is health workforce planning recognising the dynamic interplay between health literacy at an individual, organisation and system level?

Science.gov (United States)

Naccarella, Lucio; Wraight, Brenda; Gorman, Des

2016-02-01

The growing demands on the health system to adapt to constant change has led to investment in health workforce planning agencies and approaches. Health workforce planning approaches focusing on identifying, predicting and modelling workforce supply and demand are criticised as being simplistic and not contributing to system-level resiliency. Alternative evidence- and needs-based health workforce planning approaches are being suggested. However, to contribute to system-level resiliency, workforce planning approaches need to also adopt system-based approaches. The increased complexity and fragmentation of the healthcare system, especially for patients with complex and chronic conditions, has also led to a focus on health literacy not simply as an individual trait, but also as a dynamic product of the interaction between individual (patients, workforce)-, organisational- and system-level health literacy. Although it is absolutely essential that patients have a level of health literacy that enables them to navigate and make decisions, so too the health workforce, organisations and indeed the system also needs to be health literate. Herein we explore whether health workforce planning is recognising the dynamic interplay between health literacy at an individual, organisation and system level, and the potential for strengthening resiliency across all those levels.

The effectiveness of Concept Mapping Content Representation Lesson Study (ComCoReLS) model to improve skills of Creating Physics Lesson Plan (CPLP) for pre-service physics teacher

Science.gov (United States)

Purwaningsih, E.; Suyatno; Wasis; Prahani, B. K.

2018-03-01

This research is aimed to analyse the effectiveness of ComCoReLS (Concept Mapping Content Representation Lesson Study) model towards the improvement skills of Creating Physics Lesson Plan (CPLP) for pre-service physics teacher. This research used one group pre-test and post-test design on 12 pre-service physics teacher at University of Malang State (Indonesia) in academic year 2016/2017. Data collection was conducted through test and interview. Skills of creating physics lesson plan for pre-service physics teacher measurement were conducted through Physics Lesson Plan Evaluation Sheet (PLPES). The data analysis technique was done by using paired t-test and n-gain. The CoMCoReLS model consists of 5 phases, including (1) Preparation, (2) Coaching, (3) Guided Practice, (4) Independent Practice, and (5) Evaluation. In the first, second, third and fifth phases are done at University of Malang State, while the fourth phase (Independent Practice) is done in SMAN 1 Singosari, SMAN 2 Malang, SMA Lab UM, MAN 3 Malang. The results showed that there was a significant increase in skills of creating physics lesson plan for pre-service physics teacher at α = 5% and n-gain average of high category. Thus, the ComCoReLS model is effective for improving skills of creating physics lesson plan for pre-service physics teacher.

77 FR 8725 - Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under...

Science.gov (United States)

2012-02-15

... regulations authorizing the exemption of group health plans and group health insurance coverage sponsored by... plans and group health insurance issuers on April 16, 2012. FOR FURTHER INFORMATION CONTACT: Amy Turner... addition, information from HHS on private health insurance for consumers can be found on the CMS Web site...

Animal Health and Welfare Planning in Organic Dairy Cattle Farms

DEFF Research Database (Denmark)

Vaarst, Mette; Winckler, Christoph; Roderick, Stephen

2011-01-01

Continuous development is needed within the farm to reach the goal of good animal health and welfare in organic livestock farming. The very different conditions between countries call for models that are relevant for different farming types and can be integrated into local practice and be relevant...... for each type of farming context. This article reviews frameworks, principles and practices for animal health and welfare planning which are relevant for organic livestock farming. This review is based on preliminary analyses carried out within a European project (acronym ANIPLAN) with participants from...... as well as animal health and welfare professionals (veterinarians and advisors) is paramount. This paper provides an overview of some current animal health and welfare planning initiatives and explains the principles of animal health and welfare planning which are being implemented in ANIPLAN partner...

The health-related quality of life among pre-diabetics and its association with body mass index and physical activity in a semi-urban community in Malaysia--a cross sectional study.

Science.gov (United States)

Ibrahim, Norliza; Moy, Foong Ming; Awalludin, Intan Attikah Nur; Ali, Zainudin; Ismail, Ikram Shah

2014-04-01

People with pre-diabetes are at high risk of developing type 2 diabetes and cardiovascular diseases. Measurements of health-related quality of life (HRQOL) among pre-diabetics enable the health care providers to understand their overall health status and planning of interventions to prevent type 2 diabetes. Therefore we aimed to determine the HRQOL and physical activity level; and its association with Body Mass Index (BMI) among pre-diabetics. This was a cross sectional study carried out in two primary care clinics in a semi-urban locality of Ampangan, Negeri Sembilan, Malaysia. Data was collected through self-administered questionnaires assessing the demographic characteristics, medical history, lifestyle and physical activity. The Short Form 36-items health survey was used to measure HRQOL among the pre-diabetics. Data entry and analysis were performed using the SPSS version 19. A total of 268 eligible pre-diabetics participated in this study. The prevalence of normal weight, overweight and obesity were 7.1%, 21.6% and 71.3% respectively. Their mean (SD) age was 52.5 (8.3) years and 64.2% were females. Among the obese pre-diabetics, 42.2% had both IFG and IGT, 47.0% had isolated IFG and 10.8% had isolated IGT, 36.2% had combination of hypertension, dyslipidemia and musculoskeletal diseases. More than 53.4% of the obese pre-diabetics had family history of diabetes, 15.7% were smokers and 60.8% were physically inactive with mean PA of obese; normal vs obese [Mdiff=9.84, p=0.006, 95% CIdiff=2.28, 17.40] and between overweight vs obese [Mdiff=8.14, pobese. These results suggest a potentially greater risk of poor HRQOL among pre-diabetics who were overweight and obese especially with regard to the physical health component. Promoting recommended amount of physical activity and weight control are particularly important interventions for pre-diabetics at the primary care level.

The health-related quality of life among pre-diabetics and its association with body mass index and physical activity in a semi-urban community in Malaysia- a cross sectional study

Science.gov (United States)

2014-01-01

Background People with pre-diabetes are at high risk of developing type 2 diabetes and cardiovascular diseases. Measurements of health-related quality of life (HRQOL) among pre-diabetics enable the health care providers to understand their overall health status and planning of interventions to prevent type 2 diabetes. Therefore we aimed to determine the HRQOL and physical activity level; and its association with Body Mass Index (BMI) among pre-diabetics. Methods This was a cross sectional study carried out in two primary care clinics in a semi-urban locality of Ampangan, Negeri Sembilan, Malaysia. Data was collected through self-administered questionnaires assessing the demographic characteristics, medical history, lifestyle and physical activity. The Short Form 36-items health survey was used to measure HRQOL among the pre-diabetics. Data entry and analysis were performed using the SPSS version 19. Results A total of 268 eligible pre-diabetics participated in this study. The prevalence of normal weight, overweight and obesity were 7.1%, 21.6% and 71.3% respectively. Their mean (SD) age was 52.5 (8.3) years and 64.2% were females. Among the obese pre-diabetics, 42.2% had both IFG and IGT, 47.0% had isolated IFG and 10.8% had isolated IGT, 36.2% had combination of hypertension, dyslipidemia and musculoskeletal diseases. More than 53.4% of the obese pre-diabetics had family history of diabetes, 15.7% were smokers and 60.8% were physically inactive with mean PA of obese; normal vs obese [Mdiff = 9.84, p = 0.006, 95% CIdiff = 2.28, 17.40] and between overweight vs obese [Mdiff = 8.14, p obese. These results suggest a potentially greater risk of poor HRQOL among pre-diabetics who were overweight and obese especially with regard to the physical health component. Promoting recommended amount of physical activity and weight control are particularly important interventions for pre-diabetics at the primary care level. PMID:24684809

Patient-specific surgical simulator for the pre-operative planning of single-incision laparoscopic surgery with bimanual robots.

Science.gov (United States)

Turini, Giuseppe; Moglia, Andrea; Ferrari, Vincenzo; Ferrari, Mauro; Mosca, Franco

2012-01-01

The trend of surgical robotics is to follow the evolution of laparoscopy, which is now moving towards single-incision laparoscopic surgery. The main drawback of this approach is the limited maneuverability of the surgical tools. Promising solutions to improve the surgeon's dexterity are based on bimanual robots. However, since both robot arms are completely inserted into the patient's body, issues related to possible unwanted collisions with structures adjacent to the target organ may arise. This paper presents a simulator based on patient-specific data for the positioning and workspace evaluation of bimanual surgical robots in the pre-operative planning of single-incision laparoscopic surgery. The simulator, designed for the pre-operative planning of robotic laparoscopic interventions, was tested by five expert surgeons who evaluated its main functionalities and provided an overall rating for the system. The proposed system demonstrated good performance and usability, and was designed to integrate both present and future bimanual surgical robots.

How institutional forces, ideas and actors shaped population health planning in Australian regional primary health care organisations.

Science.gov (United States)

Javanparast, Sara; Freeman, Toby; Baum, Fran; Labonté, Ronald; Ziersch, Anna; Mackean, Tamara; Reed, Richard; Sanders, David

2018-03-20

Worldwide, there are competing norms driving health system changes and reorganisation. One such norm is that of health systems' responsibilities for population health as distinct from a focus on clinical services. In this paper we report on a case study of population health planning in Australian primary health care (PHC) organisations (Medicare Locals, 2011-2015). Drawing on institutional theory, we describe how institutional forces, ideas and actors shaped such planning. We reviewed the planning documents of the 61 Medicare Locals and rated population health activities in each Medicare Local. We also conducted an online survey and 50 interviews with Medicare Local senior staff, and an interview and focus group with Federal Department of Health staff. Despite policy emphasis on population health, Medicare Locals reported higher levels of effort and capacity in providing clinical services. Health promotion and social determinants of health activities were undertaken on an ad hoc basis. Regulatory conditions imposed by the federal government including funding priorities and time schedules, were the predominant forces constraining population health planning. In some Medicare Locals, this was in conflict with the normative values and what Medicare Locals felt ought to be done. The alignment between the governmental and the cultural-cognitive forces of a narrow biomedical approach privileged clinical practice and ascribed less legitimacy to action on social determinants of health. Our study also shed light on the range of PHC actors and how their agency influenced Medicare Locals' performance in population health. The presence of senior staff or community boards with a strong commitment to population health were important in directing action towards population health and equity. There are numerous institutional, normative and cultural factors influencing population health planning. The experience of Australian Medicare Locals highlights the difficulties of planning in

20 CFR 404.1042 - Wages when paid and received.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Wages when paid and received. 404.1042... DISABILITY INSURANCE (1950- ) Employment, Wages, Self-Employment, and Self-Employment Income Wages § 404.1042 Wages when paid and received. (a) In general. Wages are received by an employee at the time they are...

Results from a national survey on chronic care management by health plans.

Science.gov (United States)

Mattke, Soeren; Higgins, Aparna; Brook, Robert

2015-05-01

The growing burden of chronic disease necessitates innovative approaches to help patients and to ensure the sustainability of our healthcare system. Health plans have introduced chronic care management models, but systematic data on the type and prevalence of different approaches are lacking. Our goal was to conduct a systematic examination of chronic care management programs offered by health plans in the commercial market (ie, in products sold to employers and individuals. We undertook a national survey of a representative sample of health plans (70 plans, 36% response rate) and 6 case studies on health plans' programs to improve chronic care in the commercial market. The data underwent descriptive and bivariate analyses. All plans, regardless of size, location, and ownership, offer chronic care management programs, which identify eligible members from claims data and match them to interventions based on overall risk and specific care gaps. Plans then report information on care gaps to providers and offer self-management support to their members. While internal evaluations suggest that the interventions improve care and reduce cost, plans report difficulties in engaging members and providers. To overcome those obstacles, plans are integrating their programs into provider work flow, collaborating with providers on care redesign and leveraging patient support technologies. Our study shows that chronic care management programs have become a standard component of the overall approach used by health plans to manage the health of their members.

Discharge Planning in Chronic Conditions

Science.gov (United States)

McMartin, K

2013-01-01

Background Chronically ill people experience frequent changes in health status accompanied by multiple transitions between care settings and care providers. Discharge planning provides support services, follow-up activities, and other interventions that span pre-hospital discharge to post-hospital settings. Objective To determine if discharge planning is effective at reducing health resource utilization and improving patient outcomes compared with standard care alone. Data Sources A standard systematic literature search was conducted for studies published from January 1, 2004, until December 13, 2011. Review Methods Reports, randomized controlled trials, systematic reviews, and meta-analyses with 1 month or more of follow-up and limited to specified chronic conditions were examined. Outcomes included mortality/survival, readmissions and emergency department (ED) visits, hospital length of stay (LOS), health-related quality of life (HRQOL), and patient satisfaction. Results One meta-analysis compared individualized discharge planning to usual care and found a significant reduction in readmissions favouring individualized discharge planning. A second meta-analysis compared comprehensive discharge planning with postdischarge support to usual care. There was a significant reduction in readmissions favouring discharge planning with postdischarge support. However, there was significant statistical heterogeneity. For both meta-analyses there was a nonsignificant reduction in mortality between the study arms. Limitations There was difficulty in distinguishing the relative contribution of each element within the terms “discharge planning” and “postdischarge support.” For most studies, “usual care” was not explicitly described. Conclusions Compared with usual care, there was moderate quality evidence that individualized discharge planning is more effective at reducing readmissions or hospital LOS but not mortality, and very low quality evidence that it is more

Health Care Waste Segregation Behavior among Health Workers in Uganda: An Application of the Theory of Planned Behavior.

Science.gov (United States)

Akulume, Martha; Kiwanuka, Suzanne N

2016-01-01

Objective . The goal of this study was to assess the appropriateness of the theory of planned behavior in predicting health care waste segregation behaviors and to examine the factors that influence waste segregation behaviors. Methodology . One hundred and sixty-three health workers completed a self-administered questionnaire in a cross-sectional survey that examined the theory of planned behavior constructs (attitudes, subjective norms, perceived behavioral control, and intention) and external variables (sociodemographic factors, personal characteristics, organizational characteristics, professional characteristics, and moral obligation). Results . For their most recent client 21.5% of the health workers reported that they most definitely segregated health care waste while 5.5% did not segregate. All the theory of planned behavior constructs were significant predictors of health workers' segregation behavior, but intention emerged as the strongest and most significant ( r = 0.524, P theory of planned behavior model explained 52.5% of the variance in health workers' segregation behavior. When external variables were added, the new model explained 66.7% of the variance in behavior. Conclusion . Generally, health workers' health care waste segregation behavior was high. The theory of planned behavior significantly predicted health workers' health care waste segregation behaviors.

Pre-operational Study on Impact of Temelin NPP on Hydrosphere

International Nuclear Information System (INIS)

Hanslik, E.J.

1999-01-01

Beginning of the construction of Temelin Nuclear Power Plant (NPP) in south Bohemia (CR) dates back to 1986. It is planned that the first water-cooled reactor could be put into operation in 2000. A research project, funded from the national budget and carried out under supervision of the Czech Ministry of Environment, has been aimed at examining pre-operational environmental conditions (a reference level) in terms of concentrations of radioactive and non-radioactive polluting substances in components of the environment, particularly in hydrosphere, and at predicting possible impacts of future operation of Temelin NPP. Special attention paid to the hydrosphere is associated with requirements for protection of water quality in the Vltava River, which serves as water resource for Prague capital. The paper summarises selected interim results of the project, particularly those concerning per-operational environmental conditions and impacts predicted for standard operation of the plant. More detailed description of the results including possible impacts of the so called maximum project accident is presented in (1)

Primary pre-service teachers' skills in planning a guided scientific inquiry

Science.gov (United States)

García-Carmona, Antonio; Criado, Ana M.; Cruz-Guzmán, Marta

2017-10-01

A study is presented of the skills that primary pre-service teachers (PPTs) have in completing the planning of a scientific inquiry on the basis of a guiding script. The sample comprised 66 PPTs who constituted a group-class of the subject Science Teaching, taught in the second year of an undergraduate degree in primary education at a Spanish university. The data was acquired from the responses of the PPTs (working in teams) to open-ended questions posed to them in the script concerning the various tasks involved in a scientific inquiry (formulation of hypotheses, design of the experiment, data collection, interpretation of results, drawing conclusions). Data were analyzed within the framework of a descriptive-interpretive qualitative research study with a combination of inter- and intra-rater methods, and the use of low-inference descriptors. The results showed that the PPTs have major shortcomings in planning the complete development of a guided scientific inquiry. The discussion of the results includes a number of implications for rethinking the Science Teaching course so that PPTs can attain a basic level of training in inquiry-based science education.

Curricula for Health Planning, Policy, and Marketing: Conference Papers 1981-82.

Science.gov (United States)

Bergwall, David F., Ed.

Papers from a 1981 conference on curriculum for health planning, policy, and marketing and from a 1982 conference on curriculum for strategic planning are presented. Responses to the papers and summaries of the proceedings are also presented. Titles and authors are as follows: "A Curriculum in Community Health Planning: An Approach for Today…

The use of mixed-integer programming for inverse treatment planning with pre-defined field segments

International Nuclear Information System (INIS)

Bednarz, Greg; Michalski, Darek; Houser, Chris; Huq, M. Saiful; Xiao Ying; Rani, Pramila Anne; Galvin, James M.

2002-01-01

Complex intensity patterns generated by traditional beamlet-based inverse treatment plans are often very difficult to deliver. In the approach presented in this work the intensity maps are controlled by pre-defining field segments to be used for dose optimization. A set of simple rules was used to define a pool of allowable delivery segments and the mixed-integer programming (MIP) method was used to optimize segment weights. The optimization problem was formulated by combining real variables describing segment weights with a set of binary variables, used to enumerate voxels in targets and critical structures. The MIP method was compared to the previously used Cimmino projection algorithm. The field segmentation approach was compared to an inverse planning system with a traditional beamlet-based beam intensity optimization. In four complex cases of oropharyngeal cancer the segmental inverse planning produced treatment plans, which competed with traditional beamlet-based IMRT plans. The mixed-integer programming provided mechanism for imposition of dose-volume constraints and allowed for identification of the optimal solution for feasible problems. Additional advantages of the segmental technique presented here are: simplified dosimetry, quality assurance and treatment delivery. (author)

A tool for enhancing strategic health planning: a modeled use of the International Classification of Functioning, Disability and Health.

Science.gov (United States)

Sinclair, Lisa Bundara; Fox, Michael H; Betts, Donald R

2013-01-01

This article describes use of the International Classification of Functioning, Disability and Health (ICF) as a tool for strategic planning. The ICF is the international classification system for factors that influence health, including Body Structures, Body Functions, Activities and Participation and Environmental Factors. An overview of strategic planning and the ICF are provided. Selected ICF concepts and nomenclature are used to demonstrate its utility in helping develop a classic planning framework, objectives, measures and actions. Some issues and resolutions for applying the ICF are described. Applying the ICF for strategic health planning is an innovative approach that fosters the inclusion of social ecological health determinants and broad populations. If employed from the onset of planning, the ICF can help public health organizations systematically conceptualize, organize and communicate a strategic health plan. Published 2012. This article is a US Government work and is in the public domain in the USA.

Risk-based flood protection planning under climate change and modeling uncertainty: a pre-alpine case study

Directory of Open Access Journals (Sweden)

B. Dittes

2018-05-01

Full Text Available Planning authorities are faced with a range of questions when planning flood protection measures: is the existing protection adequate for current and future demands or should it be extended? How will flood patterns change in the future? How should the uncertainty pertaining to this influence the planning decision, e.g., for delaying planning or including a safety margin? Is it sufficient to follow a protection criterion (e.g., to protect from the 100-year flood or should the planning be conducted in a risk-based way? How important is it for flood protection planning to accurately estimate flood frequency (changes, costs and damage? These are questions that we address for a medium-sized pre-alpine catchment in southern Germany, using a sequential Bayesian decision making framework that quantitatively addresses the full spectrum of uncertainty. We evaluate different flood protection systems considered by local agencies in a test study catchment. Despite large uncertainties in damage, cost and climate, the recommendation is robust for the most conservative approach. This demonstrates the feasibility of making robust decisions under large uncertainty. Furthermore, by comparison to a previous study, it highlights the benefits of risk-based planning over the planning of flood protection to a prescribed return period.

Risk-based flood protection planning under climate change and modeling uncertainty: a pre-alpine case study

Science.gov (United States)

Dittes, Beatrice; Kaiser, Maria; Špačková, Olga; Rieger, Wolfgang; Disse, Markus; Straub, Daniel

2018-05-01

Planning authorities are faced with a range of questions when planning flood protection measures: is the existing protection adequate for current and future demands or should it be extended? How will flood patterns change in the future? How should the uncertainty pertaining to this influence the planning decision, e.g., for delaying planning or including a safety margin? Is it sufficient to follow a protection criterion (e.g., to protect from the 100-year flood) or should the planning be conducted in a risk-based way? How important is it for flood protection planning to accurately estimate flood frequency (changes), costs and damage? These are questions that we address for a medium-sized pre-alpine catchment in southern Germany, using a sequential Bayesian decision making framework that quantitatively addresses the full spectrum of uncertainty. We evaluate different flood protection systems considered by local agencies in a test study catchment. Despite large uncertainties in damage, cost and climate, the recommendation is robust for the most conservative approach. This demonstrates the feasibility of making robust decisions under large uncertainty. Furthermore, by comparison to a previous study, it highlights the benefits of risk-based planning over the planning of flood protection to a prescribed return period.

The relationships of self-efficacy, physical activity, and paid work to health-related quality of life among patients with chronic obstructive pulmonary disease (COPD

Directory of Open Access Journals (Sweden)

Andenæs R

2014-06-01

predicting physical health and the other predicting mental health. The first analysis showed that better physical health was directly related to being in paid work (P-value <0.001, but was not significantly related to age, sex, marital status, education, work status, physical activity, or self-efficacy. In the second analysis, better mental health was directly related to living with a partner, being physically active, and having higher self-efficacy (P-value <0.001.Conclusion: The findings suggest that general self-efficacy has differential relationships to the two dimensions of HRQoL. Our results indicate that general self-efficacy, physical activity, and paid work might be important factors for improving HRQoL of persons with COPD, and should be taken into consideration in pulmonary rehabilitation.Keywords: chronic disease, employment, lung, rehabilitation, self-care

Predictors of health plan satisfaction among employees in an academic setting.

Science.gov (United States)

Dembe, Allard E; Lu, Bo; Sieck, Cynthia J

2010-01-01

This study's goal was to identify the strongest predictors of satisfaction with a health plan offered to employees at a large university in the Midwestern United States. Survey responses from 1533 employees were analyzed (response rate of 51.2%). Unadjusted odds ratios (ORs) were calculated to identify factors that were statistically associated with plan satisfaction. Multivariate logistic regression analyses followed by likelihood ratio testing were conducted to assess the predictive value of particular variables. The strongest predictors of satisfaction with the health plan were the perceived quality of the plan's wellness and prevention services (OR = 3.69), having a personal doctor or nurse (OR = 2.70), being satisfied with the cost of the health plan (OR = 2.18), and having claims handled correctly (OR = 1.90). The factors that have the greatest individual effect on these findings were the quality of the plan's prevention and wellness services and how effectively the plan communicated how much particular services or visits would cost.

Animal health and welfare planning improves udder health and cleanliness but not leg health in Austrian dairy herds.

Science.gov (United States)

Tremetsberger, Lukas; Leeb, Christine; Winckler, Christoph

2015-10-01

Animal health and welfare planning is considered an important tool for herd management; however, its effectiveness is less well known. The aim of this study was to conduct animal health and welfare planning on 34 Austrian dairy farms and to evaluate changes in health and welfare after 1 yr. After an initial assessment using the Welfare Quality protocol (Welfare Quality Consortium, Lelystad, the Netherlands), results were reported back to the farmers. Health and welfare area(s) in which both the farmer and the researcher regarded improvement as important were discussed. Management practices and husbandry measures were chosen according to the respective farm situation. One year after interventions had been initiated, farms were reassessed, and the degree of implementation of improvement measures was recorded. The average implementation rate was 57% and thus relatively high when compared with other studies. High degrees of implementation were achieved related to cleanliness and udder health, at 77 and 63%, respectively. Intervention measures addressing udder health were mostly easy to incorporate in the daily routine and led to a reduced somatic cell score, whereas this score increased in herds without implementation of measures. The decrease in cows with dirty teats was more pronounced when measures were implemented compared with control farms. The implementation rate regarding leg health (46%) was comparably low in the present study, and leg health did not improve even when measures were implemented. Lying comfort, social behavior, and human-animal relationship did not require interventions and were therefore seldom chosen by farmers as part of health and welfare plans. In conclusion, the structured, participatory process of animal health and welfare planning appears to be a promising way to improve at least some animal health and welfare issues. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Hawaii State Plan for Occupational Safety and Health. Final rule.

Science.gov (United States)

2012-09-21

This document announces the Occupational Safety and Health Administration's (OSHA) decision to modify the Hawaii State Plan's ``final approval'' determination under Section 18(e) of the Occupational Safety and Health Act (the Act) and to transition to ``initial approval'' status. OSHA is reinstating concurrent federal enforcement authority over occupational safety and health issues in the private sector, which have been solely covered by the Hawaii State Plan since 1984.

Comparing the Attitudes of Pre-Health Professional and Engineering Students in Introductory Physics Courses

Science.gov (United States)

McKinney, Meghan

2015-04-01

This talk will discuss using the Colorado Learning Attitudes about Science Survey (CLASS) to compare student attitudes towards the study of physics of two different groups. Northern Illinois University has two levels of introductory mechanics courses, one geared towards biology majors and pre-health professionals, and one for engineering and physics majors. The course for pre-health professionals is an algebra based course, while the course for engineering and physics majors is a calculus based course. We've adapted the CLASS into a twenty question survey that measures student attitudes towards the practice of and conceptions about physics. The survey is administered as a pre and post assessment to look at student attitudes before and after their first course in physics.

Impact of the World Health Organization's Decision-Making Tool for Family Planning Clients and Providers on the quality of family planning services in Iran.

Science.gov (United States)

Farrokh-Eslamlou, Hamidreza; Aghlmand, Siamak; Eslami, Mohammad; Homer, Caroline S E

2014-04-01

We investigated whether use of the World Health Organization's (WHO's) Decision-Making Tool (DMT) for Family Planning Clients and Providers would improve the process and outcome quality indicators of family planning (FP) services in Iran. The DMT was adapted for the Iranian setting. The study evaluated 24 FP quality key indicators grouped into two main areas, namely process and outcome. The tool was implemented in 52 urban and rural public health facilities in four selected and representative provinces of Iran. A pre-post methodology was undertaken to examine whether use of the tool improved the quality of FP services and client satisfaction with the services. Quantitative data were collected through observations of counselling and exit interviews with clients using structured questionnaires. Different numbers of FP clients were recruited during the baseline and the post-intervention rounds (n=448 vs 547, respectively). The DMT improved many client-provider interaction indicators, including verbal and non-verbal communication (p<0.05). The tool also impacted positively on the client's choice of contraceptive method, providers' technical competence, and quality of information provided to clients (p<0.05). Use of the tool improved the clients' satisfaction with FP services (from 72% to 99%; p<0.05). The adapted WHO's DMT has the potential to improve the quality of FP services.

Pre-fracture individual characteristics associated with high total health care costs after hip fracture.

Science.gov (United States)

Schousboe, J T; Paudel, M L; Taylor, B C; Kats, A M; Virnig, B A; Dowd, B E; Langsetmo, L; Ensrud, K E

2017-03-01

Older women with pre-fracture slow walk speed, high body mass index, and/or a high level of multimorbidity have significantly higher health care costs after hip fracture compared to those without those characteristics. Studies to investigate if targeted health care interventions for these individuals can reduce hip fracture costs are warranted. The aim of this study is to estimate the associations of individual pre-fracture characteristics with total health care costs after hip fracture, using Study of Osteoporotic Fractures (SOF) cohort data linked to Medicare claims. Our study population was 738 women age 70 and older enrolled in Medicare Fee for Service (FFS) who experienced an incident hip fracture between January 1, 1992 and December 31, 2009. We assessed pre-fracture individual characteristics at SOF study visits and estimated costs of hospitalizations, skilled nursing facility and inpatient rehabilitation stays, home health care visits, and outpatient utilization from Medicare FFS claims. We used generalized linear models to estimate the associations of predictor variables with total health care costs (2010 US dollars) after hip fracture. Median total health care costs for 1 year after hip fracture were $35,536 (inter-quartile range $24,830 to $50,903). Multivariable-adjusted total health care costs for 1 year after hip fracture were 14 % higher ($5256, 95 % CI $156 to $10,356) in those with walk speed total health care costs after hip fracture in older women. Studies to investigate if targeted health care interventions for these individuals can reduce the costs of hip fractures are warranted.

The North Carolina State Health Plan for Teachers and State Employees: Strategies in Creating Financial Stability While Improving Member Health.

Science.gov (United States)

Jones, Dee; Horner, Beth

2018-01-01

The North Carolina State Health Plan provides health care coverage to more than 700,000 members, including teachers, state employees, retirees, current and former lawmakers, state university and community college personnel, and their dependents. The State Health Plan is a division of the North Carolina Department of State Treasurer, self-insured, and exempt from the Employee Retirement Income Security Act as a government-sponsored plan. With health care costs rising at rates greater than funding, the Plan must take measures to stem cost growth while ensuring access to quality health care. The Plan anticipates focusing on strategic initiatives that drive results and cost savings while improving member health to protect the Plan's financial future. ©2018 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

[Planning a Health Residence for Prison Security Measures, Tuscany (Italy)].

Science.gov (United States)

Porfido, Eugenio; Colombai, Renato; Scarpa, Franco; Totaro, Michele; Tani, Luca; Baldini, Claudio; Baggiani, Angelo

2016-01-01

Health Residences for Prison Security Measures are facilities hosting psychotic persons who have committed crimes and providing them with personalized rehabilitation and treatment plans to promote their reinstatement in society. The aim of this study was to describe the criteria for planning and designing a prison health residence in the Tuscany region (Italy), to be managed by the regional healthcare service, in line with current regulations, with dedicated staff for providing specific treatment plans and programmes.

Action planning as predictor of health protective and health risk behavior: an investigation of fruit and snack consumption.

Science.gov (United States)

van Osch, Liesbeth; Beenackers, Mariëlle; Reubsaet, Astrid; Lechner, Lilian; Candel, Math; de Vries, Hein

2009-10-13

Large discrepancies between people's intention to eat a healthy diet and actual dietary behavior indicate that motivation is not a sufficient instigator for healthy behavior. Research efforts to decrease this 'intention - behavior gap' have centered on aspects of self-regulation, most importantly self-regulatory planning. Most studies on the impact of self-regulatory planning in health and dietary behavior focus on the promotion of health protective behaviors. This study investigates and compares the predictive value of action planning in health protective behavior and the restriction of health risk behavior. Two longitudinal observational studies were performed simultaneously, one focusing on fruit consumption (N = 572) and one on high-caloric snack consumption (N = 585) in Dutch adults. Structural equation modeling was used to investigate and compare the predictive value of action planning in both behaviors, correcting for demographics and the influence of motivational factors and past behavior. The nature of the influence of action planning was investigated by testing mediating and moderating effects. Action planning was a significant predictor of fruit consumption and restricted snack consumption beyond the influence of motivational factors and past behavior. The strength of the predictive value of action planning did not differ between the two behaviors. Evidence for mediation of the intention - behavior relationship was found for both behaviors. Positive moderating effects of action planning were demonstrated for fruit consumption, indicating that individuals who report high levels of action planning are significantly more likely to translate their intentions into actual behavior. The results indicate that the planning of specific preparatory actions predicts the performance of healthy dietary behavior and support the application of self-regulatory planning in both health protective and health risk behaviors. Future interventions in dietary modification may

Framing health for land-use planning legislation: A qualitative descriptive content analysis.

Science.gov (United States)

Harris, Patrick; Kent, Jennifer; Sainsbury, Peter; Thow, Anne Marie

2016-01-01

Framing health as a relevant policy issue for other sectors is not well understood. A recent review of the New South Wales (Australia) land-use planning system resulted in the drafting of legislation with an internationally unprecedented focus on human health. We apply a political science approach to investigate the question 'how and to what extent were health and wider issues framed in submissions to the review?' We investigated a range of stakeholder submissions including health focussed agencies (n = 31), purposively identified key stakeholders with influence on the review (n = 24), and a random sample of other agencies and individuals (n = 47). Using qualitative descriptive analysis we inductively coded for the term 'health' and sub-categories. We deductively coded for 'wider concerns' using a locally endorsed 'Healthy Urban Development Checklist'. Additional inductive analysis uncovered further 'wider concerns'. Health was explicitly identified as a relevant issue for planning policy only in submissions by health-focussed agencies. This framing concerned the new planning system promoting and protecting health as well as connecting health to wider planning concerns including economic issues, transport, public open space and, to a slightly lesser extent, environmental sustainability. Key stakeholder and other agency submissions focussed on these and other wider planning concerns but did not mention health in detail. Health agency submissions did not emphasise infrastructure, density or housing as explicitly as others. Framing health as a relevant policy issue has the potential to influence legislative change governing the business of other sectors. Without submissions from health agencies arguing the importance of having health as an objective in the proposed legislation it is unlikely health considerations would have gained prominence in the draft bill. The findings have implications for health agency engagement with legislative change processes and beyond in

Health Care Waste Segregation Behavior among Health Workers in Uganda: An Application of the Theory of Planned Behavior

Directory of Open Access Journals (Sweden)

Martha Akulume

2016-01-01

Full Text Available Objective. The goal of this study was to assess the appropriateness of the theory of planned behavior in predicting health care waste segregation behaviors and to examine the factors that influence waste segregation behaviors. Methodology. One hundred and sixty-three health workers completed a self-administered questionnaire in a cross-sectional survey that examined the theory of planned behavior constructs (attitudes, subjective norms, perceived behavioral control, and intention and external variables (sociodemographic factors, personal characteristics, organizational characteristics, professional characteristics, and moral obligation. Results. For their most recent client 21.5% of the health workers reported that they most definitely segregated health care waste while 5.5% did not segregate. All the theory of planned behavior constructs were significant predictors of health workers’ segregation behavior, but intention emerged as the strongest and most significant (r=0.524, P<0.001. The theory of planned behavior model explained 52.5% of the variance in health workers’ segregation behavior. When external variables were added, the new model explained 66.7% of the variance in behavior. Conclusion. Generally, health workers’ health care waste segregation behavior was high. The theory of planned behavior significantly predicted health workers’ health care waste segregation behaviors.

Educational inequalities in exit from paid employment among Dutch workers: The influence of health, lifestyle and work

NARCIS (Netherlands)

S.J.W. Robroek (Suzan); A. Rongen (Anne); C.H. Arts (Coos); Otten, F.W.H. (Ferdy W.H.); A. Burdorf (Alex); M. Schuring (Merel)

2015-01-01

textabstractBackground Individuals with lower socioeconomic status are at increased risk of involuntary exit from paid employment. To give sound advice for primary prevention in the workforce, insight is needed into the role of mediating factors between socioeconomic status and labour force

Can health feasibly be considered as part of the planning process in Scotland?

International Nuclear Information System (INIS)

Higgins, Martin; Douglas, Margaret; Muirie, Jill

2005-01-01

The planning system is significant because of its capacity to determine the quality of the built environment as well as the health, well-being and quality of life of the individuals and communities therein. Development planning is especially important because of the long-term impact of the decisions. This paper was developed in response to increasing recognition amongst HIA practitioners in Scotland of the importance of planning for health. It focuses on the relationship between the planning system in Scotland, specifically the Development Planning element of it, and population health and considers how the health impact assessment (HIA) approach can facilitate and support joint working with planners. In particular, consideration is given to the potential impact of the introduction of Strategic Environmental Assessment (SEA) on the linkages between health, HIA and planning

Paid employment and common mental disorders in 50-64-year olds: analysis of three cross-sectional nationally representative survey samples in 1993, 2000 and 2007.

Science.gov (United States)

Perera, G; Di Gessa, G; Corna, L M; Glaser, K; Stewart, R

2017-08-24

Associations between employment status and mental health are well recognised, but evidence is sparse on the relationship between paid employment and mental health in the years running up to statutory retirement ages using robust mental health measures. In addition, there has been no investigation into the stability over time in this relationship: an important consideration if survey findings are used to inform future policy. The aim of this study is to investigate the association between employment status and common mental disorder (CMD) in 50-64-year old residents in England and its stability over time, taking advantage of three national mental health surveys carried out over a 14-year period. Data were analysed from the British National Surveys of Psychiatric Morbidity of 1993, 2000 and 2007. Paid employment status was the primary exposure of interest and CMD the primary outcome - both ascertained identically in all three surveys (CMD from the revised Clinical Interview Schedule). Multivariable logistic regression models were used. The prevalence of CMD was higher in people not in paid employment across all survey years; however, this association was only present for non-employment related to poor health as an outcome and was not apparent in those citing other reasons for non-employment. Odds ratios for the association between non-employment due to ill health and CMD were 3.05 in 1993, 3.56 in 2000, and 2.80 in 2007, after adjustment for age, gender, marital status, education, social class, housing tenure, financial difficulties, smoking status, recent physical health consultation and activities of daily living impairment. The prevalence of CMD was higher in people not in paid employment for health reasons, but was not associated with non-employment for other reasons. Associations had been relatively stable in strength from 1993 to 2007 in those three cross-sectional nationally representative samples.

Health system barriers to access and use of magnesium sulfate for women with severe pre-eclampsia and eclampsia in Pakistan: evidence for policy and practice.

Directory of Open Access Journals (Sweden)

Maryam Bigdeli

Full Text Available Severe pre-eclampsia and eclampsia are rare but serious complications of pregnancy that threaten the lives of mothers during childbirth. Evidence supports the use of magnesium sulfate (MgSO4 as the first line treatment option for severe pre-eclampsia and eclampsia. Eclampsia is the third major cause of maternal mortality in Pakistan. As in many other Low- and Middle-Income Countries (LMIC, it is suspected that MgSO4 is critically under-utilized in the country. There is however a lack of information on context-specific health system barriers that prevent optimal use of this life-saving medicine in Pakistan. Combining quantitative and qualitative methods, namely policy document review, key informant interviews, focus group discussions and direct observation at health facility, we explored context-specific health system barriers and enablers that affect access and use of MgSO4 for severe pre-eclampsia and eclampsia in Pakistan. Our study finds that while international recommendations on MgSO4 have been adequately translated in national policies in Pakistan, the gap remains in implementation of national policies into practice. Barriers to access to and effective use of MgSO4 occur at health facility level where the medicine was not available and health staff was reluctant to use it. Low price of the medicine and the small market related to its narrow indications acted as disincentives for effective marketing. Results of our survey were further discussed in a multi-stakeholder round-table meeting and an action plan for increasing access to this life-saving medicine was identified.

Health system barriers to access and use of magnesium sulfate for women with severe pre-eclampsia and eclampsia in Pakistan: evidence for policy and practice.

Science.gov (United States)

Bigdeli, Maryam; Zafar, Shamsa; Assad, Hafeez; Ghaffar, Adbul

2013-01-01

Severe pre-eclampsia and eclampsia are rare but serious complications of pregnancy that threaten the lives of mothers during childbirth. Evidence supports the use of magnesium sulfate (MgSO4) as the first line treatment option for severe pre-eclampsia and eclampsia. Eclampsia is the third major cause of maternal mortality in Pakistan. As in many other Low- and Middle-Income Countries (LMIC), it is suspected that MgSO4 is critically under-utilized in the country. There is however a lack of information on context-specific health system barriers that prevent optimal use of this life-saving medicine in Pakistan. Combining quantitative and qualitative methods, namely policy document review, key informant interviews, focus group discussions and direct observation at health facility, we explored context-specific health system barriers and enablers that affect access and use of MgSO4 for severe pre-eclampsia and eclampsia in Pakistan. Our study finds that while international recommendations on MgSO4 have been adequately translated in national policies in Pakistan, the gap remains in implementation of national policies into practice. Barriers to access to and effective use of MgSO4 occur at health facility level where the medicine was not available and health staff was reluctant to use it. Low price of the medicine and the small market related to its narrow indications acted as disincentives for effective marketing. Results of our survey were further discussed in a multi-stakeholder round-table meeting and an action plan for increasing access to this life-saving medicine was identified.

Greater involvement of HIV-infected peer-mothers in provision of reproductive health services as "family planning champions" increases referrals and uptake of family planning among HIV-infected mothers.

Science.gov (United States)

Mudiope, Peter; Musingye, Ezra; Makumbi, Carolyne Onyango; Bagenda, Danstan; Homsy, Jaco; Nakitende, Mai; Mubiru, Mike; Mosha, Linda Barlow; Kagawa, Mike; Namukwaya, Zikulah; Fowler, Mary Glenn

2017-06-27

In 2012, Makerere University Johns - Hopkins University, and Mulago National Referral Hospital, with support from the National Institute of Health (under Grant number: NOT AI-01-023) undertook operational research at Mulago National Hospital PMTCT/PNC clinics. The study employed Peer Family Planning Champions to offer health education, counselling, and triage aimed at increasing the identification, referral and family planning (FP) uptake among HIV positive mothers attending the clinic. The Peer Champion Intervention to improve FP uptake was introduced into Mulago Hospital PMTCT/PNC clinic, Kampala Uganda. During the intervention period, peers provided additional FP counselling and education; assisted in identification and referral of HIV Positive mothers in need of FP services; and accompanied referred mothers to FP clinics. We compiled and compared the average proportions of mothers in need that were referred and took up FP in the pre-intervention (3 months), intervention (6 months), and post-intervention(3 months) periods using interrupted time series with segmented regression models with an autoregressive term of one. Overall, during the intervention, the proportion of referred mothers in need of FP increased by 30.4 percentage points (P family planning can be a valuable addition to clinic staff in limited-resource settings. The study provides additional evidence on the utilization of peer mothers in HIV care, improves health services uptake including family planning which is a common practice in many donor supported programs. It also provides evidence that may be used to advocate for policy revisions in low-income countries to include peers as support staff especially in busy clinic settings with poor services uptake.

Health Plans Can't Ignore The Customer Experience Any Longer.

Science.gov (United States)

Swanson, Erik

2017-10-01

With regulations limiting differentiation between products, health plans must rethink consumer experience to meet expectations of today's consumers, who seek convenience, quality, and speed from their health care organizations. Many plans understand they need to connect more effectively with their end customers, but technological, cultural, and other obstacles are in the way.

Core competency model for the family planning public health nurse.

Science.gov (United States)

Hewitt, Caroline M; Roye, Carol; Gebbie, Kristine M

2014-01-01

A core competency model for family planning public health nurses has been developed, using a three stage Delphi Method with an expert panel of 40 family planning senior administrators, community/public health nursing faculty and seasoned family planning public health nurses. The initial survey was developed from the 2011 Title X Family Planning program priorities. The 32-item survey was distributed electronically via SurveyMonkey(®). Panelist attrition was low, and participation robust resulting in the final 28-item model, suggesting that the Delphi Method was a successful technique through which to achieve consensus. Competencies with at least 75% consensus were included in the model and those competencies were primarily related to education/counseling and administration of medications and contraceptives. The competencies identified have implications for education/training, certification and workplace performance. © 2014 Wiley Periodicals, Inc.

Paid maternity leave and breastfeeding practice before and after California's implementation of the nation's first paid family leave program.

Science.gov (United States)

Huang, Rui; Yang, Muzhe

2015-01-01

California was the first state in the United States to implement a paid family leave (PFL) program in 2004. We use data from the Infant Feeding Practices Study to examine the changes in breastfeeding practices in California relative to other states before and after the implementation of PFL. We find an increase of 3-5 percentage points for exclusive breastfeeding and an increase of 10-20 percentage points for breastfeeding at several important markers of early infancy. Our study supports the recommendation of the Surgeon General to establish paid leave policies as a strategy for promoting breastfeeding. Copyright © 2014 Elsevier B.V. All rights reserved.

School-Sponsored Health Insurance: Planning for a New Reality

Science.gov (United States)

Liang, Bryan A.

2010-01-01

Health care reform efforts in both the Clinton and Obama administrations have attempted to address college and university health. Yet, although the world of health care delivery has almost universally evolved to managed care, school health programs have not. In general, school-sponsored health plans do little to improve access and have adopted…

Pre-segmented 2-Step IMRT with subsequent direct machine parameter optimisation – a planning study

International Nuclear Information System (INIS)

Bratengeier, Klaus; Meyer, Jürgen; Flentje, Michael

2008-01-01

Modern intensity modulated radiotherapy (IMRT) mostly uses iterative optimisation methods. The integration of machine parameters into the optimisation process of step and shoot leaf positions has been shown to be successful. For IMRT segmentation algorithms based on the analysis of the geometrical structure of the planning target volumes (PTV) and the organs at risk (OAR), the potential of such procedures has not yet been fully explored. In this work, 2-Step IMRT was combined with subsequent direct machine parameter optimisation (DMPO-Raysearch Laboratories, Sweden) to investigate this potential. In a planning study DMPO on a commercial planning system was compared with manual primary 2-Step IMRT segment generation followed by DMPO optimisation. 15 clinical cases and the ESTRO Quasimodo phantom were employed. Both the same number of optimisation steps and the same set of objective values were used. The plans were compared with a clinical DMPO reference plan and a traditional IMRT plan based on fluence optimisation and consequent segmentation. The composite objective value (the weighted sum of quadratic deviations of the objective values and the related points in the dose volume histogram) was used as a measure for the plan quality. Additionally, a more extended set of parameters was used for the breast cases to compare the plans. The plans with segments pre-defined with 2-Step IMRT were slightly superior to DMPO alone in the majority of cases. The composite objective value tended to be even lower for a smaller number of segments. The total number of monitor units was slightly higher than for the DMPO-plans. Traditional IMRT fluence optimisation with subsequent segmentation could not compete. 2-Step IMRT segmentation is suitable as starting point for further DMPO optimisation and, in general, results in less complex plans which are equal or superior to plans generated by DMPO alone

Developing a Spanish-language consumer report for CAHPS health plan surveys.

Science.gov (United States)

Derose, Kathryn Pitkin; Kanouse, David E; Weidmer, Beverly; Weech-Maldonado, Robert; García, Rosa Elena; Hays, Ron D

2007-11-01

A Spanish-language consumer report on health plan quality was developed for the Consumer Assessments of Healthcare Providers and Systems (CAHPS) project. Multiple translations, a committee review, and a readability assessment were performed to produce a draft Spanish report. The report was revised on the basis of a series of cognitive interviews with 24 Latinos. The median age of participants was 41 years, and the median number of years in the United States was 9; 67% were female, and 63% had less than a high school education. In general, participants understood the report and said they would use it to choose a health plan. Less-educated respondents had difficulty understanding the segmented bar graphs that showed the proportion of health plan members' responses. A summary chart comparing all health plans on all dimensions was easier to comprehend when differences were represented by word icons rather than by stars. Concepts and terms about health care quality translated well from English to Spanish. Simplifying graphical information involves losing some detail but makes information more usable. Summary charts facilitate comparisons across plans, but differences relative to a mean are difficult for both Spanish- and English-speaking consumers to understand.

Planning for Pre-Exascale Platform Environment (Fiscal Year 2015 Level 2 Milestone 5216)

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Springmeyer, R. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Lang, M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Noe, J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

2015-09-28

This Plan for ASC Pre-Exascale Platform Environments document constitutes the deliverable for the fiscal year 2015 (FY15) Advanced Simulation and Computing (ASC) Program Level 2 milestone Planning for Pre-Exascale Platform Environment. It acknowledges and quantifies challenges and recognized gaps for moving the ASC Program towards effective use of exascale platforms and recommends strategies to address these gaps. This document also presents an update to the concerns, strategies, and plans presented in the FY08 predecessor document that dealt with the upcoming (at the time) petascale high performance computing (HPC) platforms. With the looming push towards exascale systems, a review of the earlier document was appropriate in light of the myriad architectural choices currently under consideration. The ASC Program believes the platforms to be fielded in the 2020s will be fundamentally different systems that stress ASC’s ability to modify codes to take full advantage of new or unique features. In addition, the scale of components will increase the difficulty of maintaining an errorfree system, thus driving new approaches to resilience and error detection/correction. The code revamps of the past, from serial- to vector-centric code to distributed memory to threaded implementations, will be revisited as codes adapt to a new message passing interface (MPI) plus “x” or more advanced and dynamic programming models based on architectural specifics. Development efforts are already underway in some cases, and more difficult or uncertain aspects of the new architectures will require research and analysis that may inform future directions for program choices. In addition, the potential diversity of system architectures may require parallel if not duplicative efforts to analyze and modify environments, codes, subsystems, libraries, debugging tools, and performance analysis techniques as well as exploring new monitoring methodologies. It is difficult if not impossible to

Sustainable cities: challenges of an integrated planning approach

NARCIS (Netherlands)

Nijkamp, Peter; Geenhuizen, van Marina

1995-01-01

This paper will identify specific planning conditions that arise when planning aims at sustainable development. First, attention will be paid tosocio-ethical attitudes toward sustainability issues and to the reasons why much of the sustainability debate deserves an urban focus. Then,

Building the Capacity of Indonesian Education Universities for ICT in Pre-Service Teacher Education: A Case Study of a Strategic Planning Exercise

Science.gov (United States)

Lim, Cher Ping; Pannen, Paulina

2012-01-01

This paper documents how four Indonesian teacher education institutions (TEIs) engaged in strategic planning to build their capacity in developing pre-service teachers' ICT in education competencies. These TEIs adopted a holistic approach towards strategic planning by drawing upon the six dimensions of the "Capacity Building Toolkit" for…

18 CFR 382.106 - Accounting for annual charges paid under part 382.

Science.gov (United States)

2010-04-01

... subject to the provisions of this part must account for annual charges paid by charging the account to... public utility subject to the provisions of this part must account for annual charges paid by charging... charges paid by charging the amount to Account No. 510, Supplies and Expenses, of the Commission's Uniform...

Robustness in practice--the regional planning of health services.

Science.gov (United States)

Best, G; Parston, G; Rosenhead, J

1986-05-01

Earlier work has criticized the dominant tendencies in operational research contributions to health services planning as characterized by optimization, implausible demands for data, depoliticization, hierarchy and inflexibility. This paper describes an effort which avoids at least some of these pitfalls. The project was to construct a planning system for a regional health council in Ontario, Canada, which would take account of the possible alternative future states of the health-care system's environment and would aim to keep options for future development open. The planning system devised is described in the paper. It is based on robustness analysis, which evaluates alternative initial action sets in terms of the useful flexibility they preserve. Other features include the explicit incorporation of pressures for change generated outside the health-care system, and a satisficing approach to the identification of both initial action sets and alternative future configurations of the health-care system. It was found possible to borrow and radically 're-use' techniques or formulations from the mainstream of O.R. contributions. Thus the 'reference projection' method was used to identify inadequacies in performance which future health-care system configurations must repair. And Delphi analysis, normally a method for generating consensus, was used in conjunction with cluster analysis of responses to generate meaningfully different alternative futures.