Mental health has in recent years emerged as an issue of concern for university students globally, obstructing the completion of studies, according to delegates attending the 2016. Global Summit on Student Affairs and Services. “We are seeing increases in mental health challenges worldwide – more stress, more anxiety ...
Department of Veterans Affairs — Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a health care benefit program designed for the dependents of certain Veterans....
Tonmyr, Lil; Blackstock, Cindy
This commentary highlights indigenous public health research from a special issue of the International Journal of Mental Health and Addiction dealing with child maltreatment, mental health, substance abuse and gambling. We focus on the emerging and growing research movement in Indigenous research through three important themes: 1) worldview and…
was a significant relationship between extramarital affair and home instability in ... Department of Social Work, Faculty of Education, University of. Ibadan ..... devastating effects. It is said to be a major reason for relationship crisis around the world. Extramarital affair causes unbearable emotional pain and trauma, a blow to.
Wong, Edwin S; Maciejewski, Matthew L; Herbert, Paul L; Bryson, Christopher L; Liu, Chuan-Fen
Veterans Health Administration (VA) operates the largest integrated health system in the nation. The Affordable Care Act (ACA) does not require any changes to VA, but the individual mandate and expanded health insurance options may change veterans' preferences for coverage. We examined the impact of healthcare reform in Massachusetts, which also included these policy changes, on veterans' enrollment in VA, private insurance, and Medicaid. Massachusetts' healthcare reform in June 2006 served as a natural experiment. Using data from the 2004-2013 Current Population Surveys, we examined enrollment in VA, private insurance, and Medicaid, comparing veterans residing in Massachusetts with veterans residing in neighboring New England states that did not undergo health reform. We estimated the probability of being enrolled in VA, private insurance, and Medicaid before and after healthcare reform, using multivariate probit models while adjusting for individual characteristics. Using a difference-in-difference approach, we compared pre-post changes in enrollment probability among Massachusetts and non-Massachusetts veterans, respectively. Compared with other New England veterans, Massachusetts veterans decreased their enrollment in VA and private insurance by 0.2 (P = .857) and 0.9 (P = .666) percentage points, respectively, following health reform. In contrast, Medicaid enrollment increased by 2.5 percentage points (P = .038). Healthcare reform in Massachusetts was associated with greater Medicaid enrollment, but was not significantly associated with VA and private insurance enrollment. Our results are significant for informing VA fiscal planning in the post ACA era.
Moreau, Jessica L; Cordasco, Kristina M; Young, Alexander S; Oishi, Sabine M; Rose, Danielle E; Canelo, Ismelda; Yano, Elizabeth M; Haskell, Sally G; Hamilton, Alison B
Women veterans are a growing segment of Department of Veterans Affairs (VA) users with distinct mental health needs and well-documented barriers to care. Telemental health holds much promise for reducing barriers to mental health care. We assessed VA stakeholders' perceptions of telemental health's appropriateness and potential to address the mental health needs of women veteran VA users. We conducted semistructured qualitative interviews with 40 key leadership and clinical stakeholders at VA medical centers and associated outpatient clinics. Transcripts were summarized in a template of key domains developed based on the interview guide, and coded for topics relevant to women's mental health needs and telehealth services. Telemental health was perceived to increase access to mental health care, including same-gender care and access to providers with specialized training, especially for rural women and those with other limiting circumstances. Respondents saw women veterans as being particularly poised to benefit from telemental health, owing to responsibilities associated with childcare, spousal care, and elder caregiving. Interviewees expressed enthusiasm for telemental health's potential and were eager to expand services, including women-only mental health groups. Implementation challenges were also noted. Overall, our stakeholders saw telemental health as a good fit for helping to address the perceived needs of women veterans, especially in addressing the geographical barriers experienced by rural women and those with a limited ability to travel. These findings can help to inform gender-tailored expansion of telemental health within and outside of the VA. Published by Elsevier Inc.
Full Text Available At the present stage of social development takes on special urgency the problem of finding new means and methods of crime prevention among youth in the context of strengthening the nation's health. In our opinion, employees of the Ukrainian Interior Ministry must take a decisive role in solving these problems. One of the most effective ways to solve them is to organize youth sports schools and clubs to professionally-applied sports at the bases of relevant departments of higher educational institutions of Ministry of Internal Affairs of Ukraine, the involvement of the best specialists and trainers.
The report provides a review of the current state of affairs and development trends in the transport sector in Central and Eastern Europe including the associated environmental and health effects. Focus in the report is on the challenges and policy options for counteracting the negative effects from transport as well as integrating environmental and health aspects in transport policies. The report is undertaken as a desk study supplemented by two case studies in the Czech Republic and Bulgaria. (au)
Silva, Abigail; Tarlov, Elizabeth; French, Dustin D; Huo, Zhiping; Martinez, Rachael N; Stroupe, Kevin T
The Affordable Care Act (ACA) was signed into law in 2010 and its individual mandate and expanded health care coverage options were implemented in 2014. These provisions may affect Veterans Affairs (VA) enrollment and health care utilization. Using data from two VA regional networks, we examined recent patterns in the number of new VA enrollees and their primary care use. Trends were assessed by enrollment priority group (based on the veteran's severity of service-connected disabilities, exposures, and income level) and a state's Medicaid expansion status. Compared to the same time period in the previous year, the number of new enrollees from low-income priority groups was higher during the open enrollment period and the increase was sharper in Medicaid non-expansion states (25-42%) than in expansion states (20-32%). In addition, low-income patients with a copay requirement who enrolled in the VA during the ACA open enrollment had a lower average number of primary care visits than counterparts who had enrolled in prior time periods (1.73 versus 1.87, p < 0.0001). Although this study is an initial step, more research is required to better understand veterans' decision making and behavior in regard to health care coverage through the ACA and related impacts on VA and non-VA health care utilization and care coordination. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.
Hughes, Jaime M; Martin, Jennifer L
Addressing sleep disturbance can help to slow functional decline, delay nursing home admission, and improve overall health among older adults; however, sleep is not widely studied in high-risk older adults such as Adult Day Health Care (ADHC) participants. Sixty-eight ADHC participants were interviewed for sleep disturbance using a 28-item screening questionnaire. More than two thirds (n = 48, 70.6%) reported one or more characteristics of poor sleep, and 38% of participants met basic criteria for insomnia. Individuals with insomnia attended ADHC less frequently, reported worse sleep quality and shorter sleep duration, and were more likely to endorse trouble falling asleep, staying asleep, and waking up too early (ps < 0.001). Research is needed to better understand perceptions, predictors, and outcomes of sleep disturbance within ADHC participants.
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Massey, Jennifer; Brooks, Meghan; Burrow, Jeff
This study evaluates the effectiveness of providing the Mental Health First Aid training program to student affairs staff. The objective of the training was to increase knowledge of mental health, enhance sensitivity, and raise confidence to intervene and assist individuals experiencing a mental health issue. We found the training successfully met…
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Large numbers of homeless adolescents can be found in this country, with estimates of their numbers ranging from 500,000 to more than 2 million. Some are runaways while others are involuntarily without shelter, often having been forced out of their homes. Most receive no help from social service agencies and their lack of skills forces them into a marginal existence, leaving them vulnerable to abuse and victimization. Health problems are numerous and health care is generally inadequate for several reasons, including a lack of treatment facilities, the behavior of the adolescents themselves, the ability of providers to deal with such youths, and the questionable legal status of homeless adolescents. The Council on Scientific Affairs urges that reliable and up-to-date data on the extent of homelessness among adolescents and the nature of their needs be generated and that guidelines for the medical care of such youths be developed.
Altamimi, Samar; Alshoshan, Feda; Al Shaman, Ghada; Tawfeeq, Nasser; Alasmary, May; Ahmed, Anwar E
In recent years, several research studies have investigated health promotion practices in Saudi healthcare organizations, yet no published literature exists on health promotion practices of primary healthcare professionals working for the Ministry of National Guard Health Affairs (MNG-HA). A cross-sectional study was conducted in a convenience sample of 206 primary healthcare professionals at the MNG-HA. A self-reporting questionnaire was used to investigate the attitudes, awareness, satisfaction, and methods regarding health promotion practices of primary healthcare professionals. Of the 206 primary healthcare professionals surveyed, 58.1% reported awareness of health promotion programs conducted in the hospitals and 64.6% reported that the health promotion system in the hospitals needs to be improved. Language barriers and cultural beliefs were viewed as obstacles to carrying out effective health promotion by 65% and 64.6% of primary healthcare professionals, respectively. The majority (79.9%) of the primary healthcare professionals perceived themselves as having the necessary skills to promote health and 80.6% believed that printed educational materials are the most prevalent method of health promotion/education, whereas 55.8% reported that counseling was the most preferred method of health promotion. The awareness level of health promotion policies, strategies, and programs conducted in the hospitals was not found to be satisfactory. Therefore, widespread training programs are recommended to improve the health promotion system in the hospitals. These programs include facilitating behavioral change, introducing health promotion policies and strategies in hospitals, mandatory workshops, and systematic reminders.
Kilbourne, Amy M; Greenwald, Devra E; Hermann, Richard C; Charns, Martin P; McCarthy, John F; Yano, Elizabeth M
This study assessed the extent to which mental health leaders perceive their programs as being primarily accountable for monitoring general medical conditions among patients with serious mental illness, and it assessed associations with modifiable health system factors. As part of the Department of Veterans Affairs (VA) 2007 national Mental Health Program Survey, 108 mental health program directors were queried regarding program characteristics. Perceived accountability was defined as whether their providers, as opposed to external general medical providers, were primarily responsible for specific clinical tasks related to serious mental illness treatment or high-risk behaviors. Multivariable logistic regression was used to determine whether financial incentives or other system factors were associated with accountability. Thirty-six percent of programs reported primary accountability for monitoring diabetes and cardiovascular risk after prescription of second-generation antipsychotics, 10% for hepatitis C screening, and 17% for obesity screening and weight management. In addition, 18% and 27% of program leaders, respectively, received financial bonuses for high performance for screening for risk of diabetes and cardiovascular disease and for alcohol misuse. Financial bonuses for diabetes and cardiovascular screening were associated with primary accountability for such screening (odds ratio=5.01, pFinancial incentives to improve quality performance may promote accountability in monitoring diabetes and cardiovascular risk assessment within mental health programs. Integrated care strategies (co-location) might be needed to promote management of high-risk behaviors among patients with serious mental illness.
Department of Veterans Affairs — The VA's Veteran Health Administration, in support of the Open Data Initiative, is providing the Veterans Affairs Suicide Prevention Synthetic Dataset (VASPSD). The...
Crall, James J
The purpose of this paper was to highlight information and issues raised in a keynote address for the American Academy of Pediatric Dentistry's Symposium on Lifetime Oral Health Care for Patients with Special Needs held in November, 2006. Topics include: (1) relevant statistics and definitions; (2) the prevalence and impact of common oral diseases in individuals with special health care needs (ISHCN); (3) an overview of oral health care delivery for ISHCN; (4) key delivery system and policy issues; and (5) a synopsis of major contextual initiatives related to ISHCN. In light of the Academy's primary interest in infants, children, and adolescents--including children with special health care needs--the major focus is on children. Significant oral health and oral health care issues for adults with special needs, however, generally parallel those for children and are of interest to the Academy, particularly as they relate to the transition from pediatric care to adult care, a critical period for extending the level of oral health and health trajectory established during childhood.
Zullig, Leah L; Williams, Christina D; Fortune-Britt, Alice G
Lung cancer (LC) and colorectal cancer (CRC) are the second- and third-most commonly diagnosed cancers in the Veterans Affairs (VA) health care system. While many studies have evaluated the treatment quality and outcomes of various aspects of VA LC and CRC care, there are no known reviews synthesizing this information across studies. The purpose of this literature review was to describe LC and CRC treatment (ie, surgical and nonsurgical) and outcomes (eg, mortality, psychosocial, and other) in the VA health care system as reported in the existing peer-reviewed scientific literature. We identified potential articles through a search of published literature using the PubMed electronic database. Our search strategy identified articles containing Medical Subject Headings terms and keywords addressing veterans or veterans’ health and LC and/or CRC. We limited articles to those published in the previous 11 years (January 1, 2003 through December 31, 2013). A total of 230 articles were retrieved through the search. After applying the selection criteria, we included 74 studies (34 LC, 47 CRC, and seven both LC and CRC). VA provides a full array of treatments, often with better outcomes than other health care systems. More work is needed to assess patient-reported outcomes
Damron-Rodriguez, JoAnn; White-Kazemipour, Whitney; Washington, Donna; Villa, Valentine M; Dhanani, Shawkat; Harada, Nancy D
Diverse veteran's perspectives on the accessibility and acceptability of the Department of Veteran Affairs (VA) health services are presented. The qualitative methodology uses 16 focus groups (N = 178) stratified by war cohort (World War II and Korean Conflict versus Vietnam War and Persian Gulf War) and four ethnic/racial categories (African American, Asian American, European American, Hispanic American). Five themes emerged regarding veterans' health care expectations: (1) better information regarding available services, (2) sense of deserved benefits, (3) concern about welfare stigma, (4) importance of physician attentiveness, and (5) staff respect for patients as veterans. Although veterans' ethnic/racial backgrounds differentiated their military experiences, it was the informants' veteran identity that framed what they expected of VA health services. Accessibility and acceptability of VA health care is related to veterans' perspectives of the nature of their entitlement to service. Provider education and customer service strategies should consider the identified factors to increase access to VA as well as improve veterans' acceptance of the care.
... on Antimicrobial Resistance (TATFAR) AGENCY: Office of Global Health Affairs, HHS. ACTION: Notice of... Antimicrobial Resistance (TATFAR). DATES: A public meeting will be held in Bethesda, MD, on Friday, October 1...) agreed to establish a task force to focus ``on urgent antimicrobial resistance issues focused on...
Wong, Edwin S; Liu, Chuan-Fen
In the U.S., economic conditions are intertwined with labor market decisions, access to health care, health care utilization and health outcomes. The Veterans Affairs (VA) health care system has served as a safety net provider by supplying free or reduced cost care to qualifying veterans. This study examines whether local area labor market conditions, measured using county-level unemployment rates, influence whether veterans obtain health care from the VA. We used survey data from the Behavioral Risk Factor Surveillance System in years 2000, 2003 and 2004 to construct a random sample of 73,964 respondents self-identified as veterans. VA health service utilization was defined as whether veterans received all, some or no care from the VA. Hierarchical ordered logistic regression was used to address unobserved state and county random effects while adjusting for individual characteristics. Local area labor market conditions were defined as the average 12-month unemployment rate in veterans' county of residence. The mean unemployment rate for veterans receiving all, some and no care was 5.56%, 5.37% and 5.24%, respectively. After covariate adjustment, a one percentage point increase in the unemployment rate in a veteran's county of residence was associated with an increase in the probability of receiving all care (0.34%, p-value = 0.056) or some care (0.29%, p-value = 0.023) from the VA. Our findings suggest that the important role of the VA in providing health care services to veterans is magnified in locations with high unemployment.
Chang, Bei-Hung; Mueller, Lisa; Resnick, Sandra G; Osatuke, Katerine; Eisen, Susan V
Department of Veterans Affairs (VA) peer specialists and vocational rehabilitation specialists are Veterans employed in mental health services to help other Veterans with similar histories and experiences. Study objectives were to (a) examine job satisfaction among these employees, (b) compare them to other VA mental health workers, and (c) identify factors associated with job satisfaction across the 3 cohorts. The study sample included 152 VA-employed peer specialists and 222 vocational rehabilitation specialists. A comparison group included 460 VA employees from the same job categories. All participants completed the Job Satisfaction Index (11 aspects and overall satisfaction ratings). Linear regression was used to compare job satisfaction and identify its predictors among the 3 cohorts. Job satisfaction was fairly high, averaging "somewhat satisfied" to "very satisfied" in 6 (peer specialists) and 9 (vocational rehabilitation specialists) of the 11 aspects and overall job ratings. Adjusting for length of employment, age and gender resulted in no significant group differences with 2 exceptions: White peer specialists were less satisfied with pay and promotion opportunities than vocational rehabilitation specialists and comparison-group employees. Across all cohorts, shorter length of time employed in the job was associated with higher job satisfaction. The high job satisfaction levels among the 2 peer cohorts suggest support for the policy of hiring peer specialists in the VA. Furthermore, the results are consistent with those of the nonveteran samples, indicating that integrating peer providers into mental health care is possible in VA and non-VA settings. (c) 2016 APA, all rights reserved).
Public health officials, physicians, and politicians have long been aware of the squalid environmental conditions existing along the US-Mexico border. Some attempts have been made to improve the environmental pollution and causes of human disease, beginning as early as the 1930s with the IBWC, established in 1889. More recent agreements and legislation have called for US and Mexico cooperation by way of each nation's corresponding environmental agency (ie, the EPA and Mexico's SEDUE) and their agencies of foreign affairs (ie, the IBWC). Nevertheless, environmental monitoring and disease incidence data continue to point out that public and environmental health along the border--the result of uncontrolled air and water pollution and lack of disease vector control--is rapidly deteriorating and seriously affecting the health and future economic vitality on both sides of the border. Many prominent public health professionals and environmental organizations are concerned that the present working relationship between the United States and Mexico is not functioning well and cannot adequately cope with existing environmental conditions; for one thing, the efforts of the EPA and SEDUE are reviewed no more frequently than once a year by a staff quartered in Washington and Mexico City. Some projects to improve these conditions have been undertaken by the EPA and SEDUE and the IBWC; at present, the prospects for success do not appear promising. Consequently, these individuals and organizations have urged creation of a US-Mexico border environmental health commission. Congress did see fit last year to give responsibility for the environment to the IBWC in the form of Public Law 100-465. This law, however, does not address the full severity of environmental and public health degradation along the border; it does not address the pollution of the New River, Agua Prieta, the San Pedro River, or the Pacific Ocean, neither does it offer remedial control of hazardous waste sites
Yano, Elizabeth M; Goldzweig, Caroline; Canelo, Ismelda; Washington, Donna L
In response to concerns about the availability and quality of women's health services in Department of Veterans Affairs (VA) medical centers in the early 1990s, Congress approved landmark legislation earmarking funds to enhance women's health services. A portion of the appropriation was used to launch Comprehensive Women's Health Centers as exemplars for the development of VA women's health care throughout the system. We report on the diffusion and characteristics of VA women's health clinics (WHCs) 10 years later. In 2001, we surveyed the senior women's health clinician at each VA medical center serving > or =400 women veterans (83% response rate) regarding their internal organizational characteristics in relation to factors associated with organizational innovation (centralization, complexity, formalization, interconnectedness, organizational slack, size). We evaluated the comparability of WHCs (n = 66) with characteristics of the original comprehensive women's health centers (CWHCs; n = 8). Gender-specific service availability in WHCs was comparable to that of CWHCs with important exceptions in mental health, mammography and osteoporosis management. WHCs were less likely to have same-gender providers (p business case for managers faced with small female patient caseloads.
Atkinson, David M; Rodman, John L; Thuras, Paul D; Shiroma, Paulo R; Lim, Kelvin O
Burnout, a state of emotional exhaustion associated with negative personal and occupational outcomes, is prevalent among healthcare providers. A better understanding of the psychological factors that may be associated with resilience to burnout is essential to develop effective interventions. Self-compassion, which includes kindness toward oneself, recognition of suffering as part of shared human experience, mindfulness, and nonjudgment toward inadequacies and failures, may be one such factor. The purpose of this study was to examine the relationships between burnout, depression, and self-compassion in Veterans Affairs (VA) mental health staff. Cross-sectional study. VA medical center and affiliated community-based clinics. VA mental health staff. The 19-item Copenhagen Burnout Inventory, the 26-item Self-Compassion Scale, and the Patient Health Questionnaire 2-item depression screen. Demographic information included age, sex, years worked in current position, and number of staff supervised. One hundred and twenty-eight of a potential 379 individuals (33.8%) responded. Clerical support, nursing, social work, psychology, and psychiatry were the major professions represented. Self-compassion was inversely correlated with burnout (r = -0.41, p burnout remained significant even after accounting for depressive symptoms and demographic variables in a multiple linear regression model. Of all the variables examined, self-compassion was the strongest predictor of burnout. The results of this study support the hypothesis that self-compassion may be associated with resilience to burnout. Alternatively, decreased self-compassion may be a downstream effect of increased burnout. Prospective, longitudinal studies are needed to determine the directional relationship between these factors, and whether interventions that cultivate self-compassion may decrease burnout and/or protect against its negative personal and professional outcomes.
Swetter, Susan M; Chang, Julia; Shaub, Amanda R; Weinstock, Martin A; Lewis, Eleanor T; Asch, Steven M
Skin cancer screening may improve melanoma outcomes and keratinocyte carcinoma morbidity, but little is known about the feasibility of skin cancer training and clinical skin examination (CSE) by primary care practitioners (PCPs) in large health care systems. To assess the association of skin cancer training and screening by PCPs with dermatology referral patterns and rates of skin biopsies. In this pilot interventional study performed at the Veterans Affairs Palo Alto Health Care System, patients 35 years or older scheduled for an annual health habits screen in the PCP general medicine clinics were studied. Six PCPs underwent Internet Curriculum for Melanoma Early Detection (INFORMED) training in May 2015, and 5 screened patients during the following 14 months. Proportion of dermatology referrals, subsequent skin biopsies, and PCP diagnostic accuracy for skin cancer or precancer compared with dermatologist diagnosis were assessed in screened patients 14 months before the intervention (February 18, 2014, through April 30, 2015) and after the intervention (June 18, 2015, through August 30, 2016). Among 258 patients offered screening (median age, 70 years; age range, 35-94 years; 255 [98.8%] male), 189 (73.3%) received CSE and 69 (26.7%) declined. A total of 62 of 189 patients (32.8%) were referred to a dermatologist after intervention: 33 (53.2%) for presumptive skin cancers and 15 (24.2%) for precancers. Nine of 50 patients (18.0%) evaluated in dermatology clinic underwent biopsy to exclude skin cancer. Correct diagnoses were made by PCPs in 13 of 38 patients (34.2%; 4 of 27 patients [14.8%] diagnosed with skin cancers and 5 of 11 patients [45.5%] diagnosed with actinic keratoses). Comparison of all outpatient visits for the 5 main participating PCPs before vs after intervention revealed no significant differences in dermatology referrals overall and those for presumptive skin cancer or actinic keratoses, skin biopsies, or PCP diagnostic accuracy with the exception
Utah State Office of Education, Salt Lake City.
This document provides guidance to parents, educators, and health care providers in serving Utah students with special health care needs. An introduction defines special health care needs, outlines legal responsibilities, and notes the importance of transagency collaboration. Guidelines are then offered for the identification and placement…
Bloom, Sheila R; Kuhlthau, Karen; Van Cleave, Jeanne; Knapp, Alixandra A; Newacheck, Paul; Perrin, James M
Youth with special health care needs (YSHCN) increasingly live into adulthood, and approximately 500,000 U.S. youth transition from pediatric to adult health care systems annually. Through a systematic literature review, we sought to (1) determine adult outcomes for YSHCN who have no special transition interventions and (2) identify evidence for strategies that lead to better outcomes, in particular, access to adult health care. We searched the medical, nursing, psychology, and social science literature and reviewed selected articles' reference lists. Transition experts also recommended relevant articles. Search criteria included health conditions, transition-related activities, and health care and related outcomes. We selected English-language articles published from 1986 to 2010, with an abstract, description of transition-related interventions (objective 2), and posttransition outcomes. Investigators abstracted study design, population, sample size, description of intervention, data collection methods, and findings. The search yielded 3,370 articles, of which 15 met study criteria. Although many YSHCN appear to make the transition to adult health providers successfully, some experience serious gaps in outcomes; those with more complex conditions or with conditions affecting the nervous system appear to have less good transitions. Some evidence supports introducing YSHCN to adult providers before leaving the pediatric system; one study supports using care coordinators to improve outcomes. Evidence regarding programs to facilitate transition for YSHCN is inconclusive. Weak evidence suggests that meeting adult providers before transfer may facilitate posttransition access to care. We recommend additional studies with strong research designs to guide best practice in preparing YSHCN for adulthood. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
The Personal Health Record (PHR) is an electronic record that allows patients to maintain, manage and access their health information in one secure location. However, despite these potential capabilities, the adoption rate of the PHR has been slow due to various challenges. This study, being the first of its kind in Saudi Arabia, investigates the perceived barriers and /or challenges for PHR adoption in the Ministry of National Guard Health Affairs (MNGHA). The study explored perceived barriers and /or challenges from two different perspectives; a technical perspective and a social perspective. The study was conducted using a mixed methods approach. A cross-sectional study design using a questionnaire was used to measure patients' perceptions of the PHR and a qualitative approach through focus groups was used to capture comments and opinions from technical personnel for perceived technical barriers to PHR adoption. Results from 424 patients revealed a positive perception for PHR adoption with almost all of the participants (96.7%) indicating interest in using the PHR and the majority (73.3%) expressing no confidentiality concerns for the online accessibility of their health information. Patients with higher levels of education indicated higher interest in using the PHR and expressed more concern with confidentiality than patients with lower levels of education. However, the majority of patients (78.3%) expressed their lack of awareness of existing patient e-services on the MNGHA website. The themes that emerged from the focus groups reinforced lack of awareness of e-services as a potential barrier for PHR adoption as well as the role of policy in the regulation and business process for PHR adoption. This study has highlighted the perceived challenges and barriers for adoption of the PHR in MNGHA-Riyadh. In order to ensure an efficient PHR with a strong adoption rate, effective steps need to be undertaken by building PHR awareness as well as setting clear guidelines
Congress of the U.S., Washington, DC. Senate Select Committee on Indian Affairs.
In 1987, the United States Senate established the Special Committee to investigate American Indian affairs. Fraud, corruption, and mismanagement were found pervading the institutions serving American Indians. Corruption was also discovered in Indian tribal governments. The Committee faulted Congress for failing to adequately oversee and reform…
Misra-Hebert, Anita D; Santurri, Laura; DeChant, Richard; Watts, Brook; Sehgal, Ashwini R; Aron, David C
To assess health status among student veterans at a community college utilizing a partnership between a Veterans Affairs Medical Center and a community college. Student veterans at Cuyahoga Community College in Cleveland, Ohio, in January to April 2013. A health assessment survey was sent to 978 veteran students. Descriptive analyses to assess prevalence of clinical diagnoses and health behaviors were performed. Logistic regression analyses were performed to assess for independent predictors of functional limitations. 204 students participated in the survey (21% response rate). Self-reported depression and unhealthy behaviors were high. Physical and emotional limitations (45% and 35%, respectively), and pain interfering with work (42%) were reported. Logistic regression analyses confirmed the independent association of self-reported depression with functional limitation (odds ratio [OR] = 3.3, 95% confidence interval [CI] 1.4-7.8, p stress disorder with pain interfering with work (OR 3.9, CI 1.1-13.6, p student veterans at a community college. A partnership between a Veterans Affairs Medical Center and a community college can be utilized to help understand the health needs of veteran students. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.
Gupte, Gouri; Vimalananda, Varsha; Simon, Steven R; DeVito, Katerina; Clark, Justice; Orlander, Jay D
Electronic consultations (e-consults) offer rapid access to specialist input without the need for a patient visit. E-consult implementation began in 2011 at VA Boston Healthcare System (VABHS). By early 2013, e-consults were available for all clinical services. In this implementation, the requesting clinician selects the desired consultation within the electronic health record (EHR) ordering menu, which creates an electronic form that is pre-populated with patient demographic information and allows free-text entry of the reason for consult. This triggers a message to the requesting clinician and requested specialty, thereby enabling bidirectional clinician-clinician communication. The aim of this study is to examine the utilization of e-consults in a large Veterans Affairs (VA) health care system. Data from the electronic health record was used to measure frequency of e-consult use by provider type (physician or nurse practitioner (NP) and/or physician assistant), and by the requesting and responding specialty from January 2012 to December 2013. We conducted chart reviews for a purposive sample of e-consults and semi-structured interviews with a purposive sample of clinicians and hospital leaders to better characterize the process, challenges, and usability of e-consults. A total of 7097 e-consults were identified, 1998 from 2012 and 5099 from 2013. More than one quarter (27.56%, 1956/7097) of the e-consult requests originated from VA facilities in New England other than VABHS and were excluded from subsequent analysis. Within the VABHS e-consults (72.44%, 5141/7097), variability in frequency and use of e-consults across provider types and specialties was found. A total of 64 NPs requested 2407 e-consults (median 12.5, range 1-415). In contrast, 448 physicians (including residents and fellows) requested 2349 e-consults (median 2, range 1-116). More than one third (37.35%, 1920/5141) of e-consults were sent from primary care to specialists. While most e
Tsai, Jack; Doran, Kelly M; Rosenheck, Robert A
We examined the proportion of homeless veterans among users of Veterans Affairs (VA) emergency departments (EDs) and compared sociodemographic and clinical characteristics of homeless and nonhomeless VA emergency department users nationally. We used national VA administrative data from fiscal year 2010 for a cross-sectional study comparing homeless (n = 64,091) and nonhomeless (n = 866,621) ED users on sociodemographics, medical and psychiatric diagnoses, and other clinical characteristics. Homeless veterans had 4 times the odds of using EDs than nonhomeless veterans. Multivariate analyses found few differences between homeless and nonhomeless ED users on the medical conditions examined, but homeless ED users were more likely to have been diagnosed with a drug use disorder (odds ratio [OR] = 4.12; 95% confidence interval [CI] = 3.97, 4.27), alcohol use disorder (OR = 3.67; 95% CI = 3.55, 3.79), or schizophrenia (OR = 3.44; 95% CI = 3.25, 3.64) in the past year. In a national integrated health care system with no specific requirements for health insurance, the major differences found between homeless and nonhomeless ED users were high rates of psychiatric and substance abuse diagnoses. EDs may be an important location for specialized homeless outreach (or "in" reach) services to address mental health and addictive disorders.
...: (a) Guidance and training centers located at schools and colleges. (b) Space used for veterans hospitals, including outpatient and medical-related clinics, such as drug, mental health, and alcohol. Limitations on the Use of Delegated Authority ...
Aruda, Mary M.; Kelly, Mary; Newinsky, Karina
Children with Special Health Care Needs (CSHCN) represent a significant component of the pediatric population. They often present to schools with multiple and increasingly complex health issues, including medical technology dependency. Their daily variation in health status requires close monitoring and communication among caregivers. Limited…
Rehman, Shakaib U; Hutchison, Florence N; Hendrix, Katharine; Okonofua, Eni C; Egan, Brent M
Differential access to health care may contribute to lower blood pressure (BP) control rates to under 140/90 mm Hg in African American compared with white hypertensive patients, especially men (26.5% vs 36.5% of all hypertensive patients in the National Health and Nutrition Examination Survey 1999-2000). The Department of Veterans Affairs (VA) system, which provides access to health care and medications across ethnic and economic boundaries, may reduce disparities in BP control. To test this hypothesis, BP treatment and control groups were compared between African American (VA, n = 4379; non-VA, n = 2754) and white (VA, n = 7987; non-VA, n = 4980) hypertensive men. In both groups, whites were older than African Americans (Pcardiovascular risk.
Eibner, Christine; Krull, Heather; Brown, Kristine M.; Cefalu, Matthew; Mulcahy, Andrew W.; Pollard, Michael; Shetty, Kanaka; Adamson, David M.; Amaral, Ernesto F. L.; Armour, Philip; Beleche, Trinidad; Bogdan, Olena; Hastings, Jaime; Kapinos, Kandice; Kress, Amii; Mendelsohn, Joshua; Ross, Rachel; Rutter, Carolyn M.; Weinick, Robin M.; Woods, Dulani; Hosek, Susan D.; Farmer, Carrie M.
Abstract The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the current and projected demographics and health care needs of patients served by the Department of Veterans Affairs (VA). The number of U.S. veterans will continue to decline over the next decade, and the demographic mix and geographic locations of these veterans will change. While the number of veterans using VA health care has increased over time, demand will level off in the coming years. Veterans have more favorable economic circumstances than non-veterans, but they are also older and more likely to be diagnosed with many health conditions. Not all veterans are eligible for or use VA health care. Whether and to what extent an eligible veteran uses VA health care depends on a number of factors, including access to other sources of health care. Veterans who rely on VA health care are older and less healthy than veterans who do not, and the prevalence of costly conditions in this population is projected to increase. Potential changes to VA policy and the context for VA health care, including effects of the Affordable Care Act, could affect demand. Analysis of a range of data sources provided insight into how the veteran population is likely to change in the next decade. PMID:28083423
Evans, Martin E; Kralovic, Stephen M; Simbartl, Loretta A; Freyberg, Ron W; Obrosky, D Scott; Roselle, Gary A; Jain, Rajiv
Implementation of a methicillin-resistant Staphylococcus aureus (MRSA) Prevention Initiative was associated with significant declines in MRSA transmission and MRSA health care-associated infection rates in Veterans Affairs acute care facilities nationwide in the 33-month period from October 2007 through June 2010. Here, we show continuing declines in MRSA transmissions (P = .004 for trend, Poisson regression) and MRSA health care-associated infections (P < .001) from July 2010 through June 2012. The Veterans Affairs Initiative was associated with these effects, sustained over 57 months, in a large national health care system. Published by Mosby, Inc.
Forrest, Christopher B; Bevans, Katherine B; Riley, Anne W; Crespo, Richard; Louis, Thomas A
To examine the associations between having a special health care need and school outcomes measured as attendance, student engagement, behavioral threats to achievement, and academic achievement. A total of 1457 children in the fourth through sixth grades from 34 schools in 3 school districts and their parents provided survey data; parents completed the Children With Special Health Care Needs Screener. School records were abstracted for attendance, grades, and standardized achievement test scores. Across 34 schools, 33% of children screened positive for special health care needs. After adjusting for sociodemographic and school effects, children with special health care needs had lower motivation to do well in school, more disruptive behaviors, and more frequent experiences as a bully victim. They experienced significantly lower academic achievement, as measured by grades, standardized testing, and parental-assessed academic performance. These findings were observed for children who qualified as having a special health care need because they had functional limitations attributed to a chronic illness or a behavioral health problem but not for those who qualified only because they took prescription medications. Specific subgroups of children with special health care needs are at increased risk for poor school outcomes. Health and school professionals will need to collaborate to identify these children early, intervene with appropriate medical and educational services, and monitor long-term outcomes.
Frost, Robert A.; Strom, Stephen L.; Downey, JoAnna; Schultz, Deanna D.; Holland, Teresa A.
As the student affairs profession developed, expanded, and specialized over the last century, a disconnect occurred between student affairs professionals and academics. Despite that separation, the literature on student affairs in higher education supports the need for movement towards collaboration and integration of academic affairs and student…
Karlin, Bradley E.; Brown, Gregory K.; Trockel, Mickey; Cunning, Darby; Zeiss, Antonette M.; Taylor, C. Barr
Objective: The Department of Veterans Affairs (VA) health care system is nationally disseminating and implementing cognitive behavioral therapy for depression (CBT-D). The current article evaluates therapist and patient-level outcomes associated with national training in and implementation of CBT-D in the VA health care system. Method: Therapist…
Selker, Leopold; And Others
This article addresses the concept of "special needs" as it applies to health promotion and disease prevention. The three sections of this article deal with three special subgroups of the general population: the elderly, those with disabilities, and those with cultural heritages that are not the same as the majority population's. (Author/CT)
African Health Sciences Vol 9 Special Issue1 1 August 2009. S8. Non-adherence to anti-TB ... Objectives:To determine the prevalence and factors associated with non-adherence to anti-TB drugs among TB/HIV co-infected patients in Mbarara .... alcohol consumption, distance to the health facility, smoking, being on ART ...
June 2009. Number 43, Volume 2. GHANA MEDICAL JOURNAL. 82. SPECIAL ARTICLE. CHILD HEALTH: PAST, PRESENT AND FUTURE CHALLENGES i. YAW ASIRIFI. Aviation Road Clinic, Aviation Road, Accra, Ghana. Former Professor and Head, Department of Child Health, University of Ghana Medical School,.
Szymanski, Benjamin R.; Karlin, Bradley E.; Katz, Ira R.
Objectives. We assessed suicide rates up to 6 months following discharge from US Department of Veterans Affairs (VA) nursing homes. Methods. In VA Minimum Data Set (MDS) records, we identified 281 066 live discharges from the 137 VA nursing homes during fiscal years 2002 to 2008. We used MDS and administrative data to assess resident age, gender, behaviors, pain, and indications of psychoses, bipolar disorder, dementia, and depression. We identified vital status and suicide mortality within 6 months of discharge through National Death Index searches. Results. Suicide rates within 6 months of discharge were 88.0 per 100 000 person-years for men and 89.4 overall. Standardized mortality ratios relative to age- and gender-matched individuals in the VA patient population were 2.3 for men (95% confidence interval [CI] = 1.9, 2.8) and 2.4 overall (95% CI = 2.0, 2.9). In multivariable proportional hazards regression analyses, resident characteristics, diagnoses, behaviors, and pain were not significantly associated with suicide risk. Conclusions. Suicide risk was elevated following nursing home discharge. This underscores the importance of ongoing VA efforts to enhance discharge planning and timely postdischarge follow-up. PMID:24134359
Tsai, Jack; Rosenheck, Robert A
The Department of Veterans Affairs (VA) operates one of the largest nationwide healthcare systems and is increasing use of internet technology, including development of an online personal health record system called My HealtheVet. This study examined internet use among veterans in general and particularly use of online health information among VA patients and specifically mental health service users. A nationally representative sample of 7215 veterans from the 2010 National Survey of Veterans was used. Logistic regression was employed to examine background characteristics associated with internet use and My HealtheVet. 71% of veterans reported using the internet and about a fifth reported using My HealtheVet. Veterans who were younger, more educated, white, married, and had higher incomes were more likely to use the internet. There was no association between background characteristics and use of My HealtheVet. Mental health service users were no less likely to use the internet or My HealtheVet than other veterans. Most veterans are willing to access VA information online, although many VA service users do not use My HealtheVet, suggesting more education and research is needed to reduce barriers to its use. Although adoption of My HealtheVet has been slow, the majority of veterans, including mental health service users, use the internet and indicate a willingness to receive and interact with health information online.
Pini, Danielle de Moraes; Fröhlich, Paula Cristina Gil Ritter; Rigo, Lilian
To identify the prevalence of the main oral problems present in special needs children and to relate the underlying conditions with the clinical and demographic variables. The study was based on the physical examination of 47 students from the Associação de Pais e Amigos dos Excepcionais diagnosed as Down syndrome, cerebral palsy and intellectual deficit. For data collection, we used a self-administered questionnaire that included indices of dental caries and oral hygiene, Angle classification, malposition of dental groups and oral hygiene habits. The predominant age group was 12-25 years (46.8%) and most patients were male (55.3%). Regarding daily brushing, 63.8% reported brushing their teeth three times a day, and 85.1% did it by themselves. A total of 48.9% were rated as Angle class I, and 25.5% had no type of malocclusion. A high dental carries index (decayed, missing, filled >10) was observed in 44.7%, and 53.2% had inadequate oral hygiene (zero to 1.16). There was a statistically significant difference between cerebral palsy and the act of the participants brushing their teeth by themselves. There was a high decayed-missing-filled teeth index and malocclusion class I, as well as inadequate oral hygiene. The type of underlying condition of the participants influenced the act of brushing teeth by themselves. Conhecer a prevalência dos principais problemas bucais em crianças com necessidades especiais, e relacionar as doenças de base com variáveis clínicas e demográficas. O estudo foi realizado a partir de exame clínico em 47 alunos da Associação de Pais e Amigos dos Excepcionais com diagnóstico médico de síndrome de Down, paralisia cerebral e deficit intelectual. Para a coleta de dados, foi utilizado um questionário autoaplicativo com índices de cárie dentária e higiene oral, classificação de Angle, malposição de grupos dentários e hábitos de higiene oral. A faixa etária predominante foi de 12 a 25 anos (46,8%) e a maioria era do sexo
Carter, Andrea; Borrero, Sonya; Wessel, Charles; Washington, Donna L; Bean-Mayberry, Bevanne; Corbelli, Jennifer
Women are a rapidly growing segment of patients who seek care in the Veterans Affairs (VA) Healthcare System, yet many questions regarding their health care experiences and outcomes remain unanswered. Racial and ethnic disparities have been well-documented in the general population and among veterans; however, prior disparities research conducted in the VA focused primarily on male veterans. We sought to characterize the findings and gaps in the literature on racial and ethnic disparities among women using the VA. We systematically reviewed the literature on racial and ethnic health care disparities exclusively among women using the VA Healthcare System. We included studies that examined health care use, satisfaction, and/or quality, and stratified data by race or ethnicity. Nine studies of the 2,591 searched met our inclusion criteria. The included studies examined contraception provision/access (n = 3), treatment of low bone mass (n = 1), hormone therapy (n = 1), use of mental health or substance abuse-related services (n = 2), trauma exposure and use of various services (n = 1), and satisfaction with primary care (n = 1). Five of nine studies showed evidence of a significant racial or ethnic difference. In contrast with the wealth of literature examining disparities both among the male veterans and women in non-VA settings, only nine studies examine racial and ethnic disparities specifically among women in the VA Healthcare System. These results demonstrate that there is an unmet need to further assess health care disparities among female VA users. Published by Elsevier Inc.
Rosenberg, Angela; Zuver, Deborah; Kermon, McCafferty; Fernandez, Claudia; Margolis, Lewis H
To advance equity and to enhance leadership skills, self-advocates with intellectual/developmental disabilities are now part of the cohort of trainees in the University of North Carolina LEND, which means that they fully participate in the Interdisciplinary Leadership Development Program, a collaboration among programs in public health, social work, and LEND, which meets monthly. Given this important new participation by self-advocates, this study analyzes the reflections of graduate students on the contributions of self-advocates to their leadership training. At the conclusion of the program each year, graduate students respond to a questionnaire about how self-advocates influenced the content and interactions/discussions of the monthly workshops and are asked to provide specific examples to explain their perceptions. The 12 MCH leadership competencies were used to guide the coding of the comments for this qualitative, directed content analysis. Forty-six of 58 students (79.3%) from two consecutive cohorts responded for this cross-sectional study. Interactions with self-advocates prompted comments on 8 of the 12 leadership competencies, including interdisciplinary team building (29% of the comments); developing others through teaching and mentoring (22%); and self-reflection (18%). The inclusion of self-advocates throughout an interdisciplinary leadership development program for graduate students in health affairs can strengthen MCH leadership competencies for all participants as they enter an increasingly interdisciplinary workforce. Copyright © 2017 Elsevier Inc. All rights reserved.
Vieira de Campos, André Luiz
The Special Public Health Service (Servicio Especial de Salud Pública-SESP) was created in 1942 as a bilateral agency between Brazil and the United States, thanks to an agreement signed by the Brazilian Ministry of Education and Health and the Institute for Inter-American Affairs. Although it was originally conceived by the Americans as a temporary agency with the military purposes of "cleaning the Amazon" and stimulating rubber production, the SESP contributed from its beginningS to an expansion of the presence of the Brazilian state. In the context of the "Cold War" and the "discovery of underdevelopment", the SESP reoriented its goals towards the formation of a district model of healthcare, based on the construction of a horizontal and permanent network of sanitary units. Despite its international constitution and its inspiration on a American model, the health policies of the SESP in Brazil never resulted from a one-way process. On the contrary, they were the result of a process of conflict, negotiation, resistance and adaptation. The combination of American influences and local responses shaped the history of the SESP in Brazil.
Newacheck, Paul W; Houtrow, Amy J; Romm, Diane L; Kuhlthau, Karen A; Bloom, Sheila R; Van Cleave, Jeanne M; Perrin, James M
Because of their elevated need for services, health insurance is particularly important for children with special health care needs. In this article we assess how well the current system is meeting the insurance needs of children with special health care needs and how emerging trends in health insurance may affect their well-being. We begin with a review of the evidence on the impact of health insurance on the health care experiences of children with special health care needs based on the peer-reviewed literature. We then assess how well the current system meets the needs of these children by using data from 2 editions of the National Survey of Children With Special Health Care Needs. Finally, we present an analysis of recent developments and emerging trends in the health insurance marketplace that may affect this population. Although a high proportion of children with special health care needs have insurance at any point in time, nearly 40% are either uninsured at least part of the year or have coverage that is inadequate. Recent expansions in public coverage, although offset in part by a contraction in employer-based coverage, have led to modest but significant reductions in the number of uninsured children with special health care needs. Emerging insurance products, including consumer-directed health plans, may expose children with special health care needs and their families to greater financial risks. Health insurance coverage has the potential to secure access to needed care and improve the quality of life for these children while protecting their families from financially burdensome health care expenses. Continued vigilance and advocacy for children and youth with special health care needs are needed to ensure that these children have access to adequate coverage and that they fare well under health care reform.
Chavez, Margeaux; Nazi, Kim; Antinori, Nicole; Melillo, Christine; Cotner, Bridget A; Hathaway, Wendy; Cook, Ashley; Wilck, Nancy; Noonan, Abigail
Background The Department of Veterans Affairs (VA) has multiple health information technology (HIT) resources for veterans to support their health care management. These include a patient portal, VetLink Kiosks, mobile apps, and telehealth services. The veteran patient population has a variety of needs and preferences that can inform current VA HIT redesign efforts to meet consumer needs. Objective This study aimed to describe veterans’ experiences using the current VA HIT and identify their vision for the future of an integrated VA HIT system. Methods Two rounds of focus group interviews were conducted with a single cohort of 47 veterans and one female caregiver recruited from Bedford, Massachusetts, and Tampa, Florida. Focus group interviews included simulation modeling activities and a self-administered survey. This study also used an expert panel group to provide data and input throughout the study process. High-fidelity, interactive simulations were created and used to facilitate collection of qualitative data. The simulations were developed based on system requirements, data collected through operational efforts, and participants' reported preferences for using VA HIT. Pairwise comparison activities of HIT resources were conducted with both focus groups and the expert panel. Rapid iterative content analysis was used to analyze qualitative data. Descriptive statistics summarized quantitative data. Results Data themes included (1) current use of VA HIT, (2) non-VA HIT use, and (3) preferences for future use of VA HIT. Data indicated that, although the Secure Messaging feature was often preferred, a full range of HIT options are needed. These data were then used to develop veteran-driven simulations that illustrate user needs and expectations when using a HIT system and services to access VA health care services. Conclusions Patient participant redesign processes present critical opportunities for creating a human-centered design. Veterans value virtual health
Boyle, Melissa A; Lahey, Joanna N
Measuring the total impact of health insurance receipt on household labor supply is important in an era of increased access to publicly provided and subsidized insurance. Although government expansion of health insurance to older workers leads to direct labor supply reductions for recipients, there may be spillover effects on the labor supply of uncovered spouses. While the most basic model predicts a decrease in overall household work hours, financial incentives such as credit constraints, target income levels, and the need for own health insurance suggest that spousal labor supply might increase. In contrast, complementarities of spousal leisure would predict a decrease in labor supply for both spouses. Utilizing a mid-1990s expansion of health insurance for U.S. veterans, we provide evidence on the effects of public insurance availability on the labor supply of spouses. Using data from the Current Population Survey and Health and Retirement Study, we employ a difference-in-differences strategy to compare the labor market behavior of the wives of older male veterans and non-veterans before and after the VA health benefits expansion. Although husbands' labor supply decreases, wives' labor supply increases, suggesting that financial incentives dominate complementarities of spousal leisure. This effect is strongest for wives with lower education levels and lower levels of household wealth and those who were not previously employed full-time. These findings have implications for government programs such as Medicare and Social Security and the Affordable Care Act. Copyright © 2015 Elsevier B.V. All rights reserved.
Davis, Alaina M; Brown, Rebekah F; Taylor, Julie Lounds; Epstein, Richard A; McPheeters, Melissa L
Approximately 750,000 children in the United States with special health care needs will transition from pediatric to adult care annually. Fewer than half receive adequate transition care. We had conversations with key informants representing clinicians who provide transition care, pediatric and adult providers of services for individuals with special health care needs, policy experts, and researchers; searched online sources for information about currently available programs and resources; and conducted a literature search to identify research on the effectiveness of transition programs. We identified 25 studies evaluating transition care programs. Most (n = 8) were conducted in populations with diabetes, with a smaller literature (n = 5) on transplant patients. We identified an additional 12 studies on a range of conditions, with no more than 2 studies on the same condition. Common components of care included use of a transition coordinator, a special clinic for young adults in transition, and provision of educational materials. The issue of how to provide transition care for children with special health care needs warrants further attention. Research needs are wide ranging, including both substantive and methodologic concerns. Although there is widespread agreement on the need for adequate transition programs, there is no accepted way to measure transition success. It will be essential to establish consistent goals to build an adequate body of literature to affect practice. Copyright © 2014 by the American Academy of Pediatrics.
Glassman, Paul; Harrington, Maureen; Namakian, Maysa; Subar, Paul
People with complex medical, physical, and psychological conditions are among the most underserved groups in receiving dental care and consequently have the most significant oral health disparities of any group. The traditional dental care delivery system is not able to deliver adequate services to these people with "special needs" for a variety of reasons. New systems of care are evolving that better serve the needs of these groups by using interprofessional teams to reach these individuals and integrate oral health services into social, educational, and general health systems. Copyright © 2016 Elsevier Inc. All rights reserved.
.... This report contains articles from China dealing with Economic Affairs. The Topics include National Affairs and Policy, Foreign Trade and Investment, Economic Zones, Finance and Banking, and Agriculture.
Baker, Dian L.; Hebbeler, Kathleen; Davis-Alldritt, Linda; Anderson, Lori S.; Knauer, Heather
Children with special health care needs (CSHCN) are at risk for school failure when their health needs are not met. Current studies have identified a strong connection between school success and health. This study attempted to determine (a) how schools meet the direct service health needs of children and (b) who provides those services. The study…
Prince, Stephanie A; McDonnell, Lisa A; Turek, Michele A; Visintini, Sarah; Nahwegahbow, Amy; Kandasamy, Sujane; Sun, Louise Y; Coutinho, Thais
Cardiovascular disease (CVD) is the leading cause of death among Indigenous peoples in Canada. As rates of CVD rise, the impacts among the growing population of Indigenous women will emerge as an important health issue. The objective of this scoping review was to advance the state of knowledge about cardiovascular health research in Indigenous women in Canada. Five databases and grey literature (non-peer reviewed works) were searched to identify all studies that reported on the prevalence, pathophysiology, diagnosis, treatment, or interventions for CVD among adult Indigenous women in Canada, including First Nations, Métis, and Inuit. Searching identified 3194 potential articles; 61 of which were included. The most commonly researched topics were the prevalence of CVD, hypertension, and dyslipidemia. Rates of CVD and associated mortality among Indigenous women appear to have surpassed those of their nonindigenous counterparts. Very little research has examined the pathophysiology, diagnosis, and treatment of CVD. Gaps in the research identified the need for sex-based analyses, comparison with nonindigenous women, comprehensive longitudinal data, assessment of diagnosis criteria, development and evaluation of cardiovascular health interventions, and a better understanding of the role of culture and traditions in the prevention and treatment of CVD among Indigenous women. Although comprehensive CVD data are lacking, rates of CVD among Indigenous women in Canada are rising and are nearing or surpassing those of nonindigenous women. This review serves as a call to action to seek further research on the pathophysiology, diagnosis, and treatment of CVD among Indigenous women from across Canada. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.
Burgess, Diana J; van Ryn, Michelle; Noorbaloochi, Siamak; Clothier, Barbara; Taylor, Brent C; Sherman, Scott; Joseph, Anne M; Fu, Steven S
We examined whether a proactive care smoking cessation intervention designed to overcome barriers to treatment would be especially effective at increasing cessation among African Americans receiving care in the Veterans Health Administration. We analyzed data from a randomized controlled trial, the Veterans Victory over Tobacco study, involving a population-based electronic registry of current smokers (702 African Americans, 1569 whites) and assessed 6-month prolonged smoking abstinence at 1 year via a follow-up survey of all current smokers. We also examined candidate risk adjustors for the race effect on smoking abstinence. The interaction between patient race and intervention condition (proactive care vs. usual care) was not significant. Overall, African Americans had higher quit rates than Whites (13% vs. 9%; P Whites. These findings may be a result of the large number of veterans receiving smoking cessation services and the lack of racial differences in receipt of these services as well as racial differences in smoking history, self-efficacy, and motivation to quit that favor African Americans.
Haun, Jolie N; Chavez, Margeaux; Nazi, Kim; Antinori, Nicole; Melillo, Christine; Cotner, Bridget A; Hathaway, Wendy; Cook, Ashley; Wilck, Nancy; Noonan, Abigail
The Department of Veterans Affairs (VA) has multiple health information technology (HIT) resources for veterans to support their health care management. These include a patient portal, VetLink Kiosks, mobile apps, and telehealth services. The veteran patient population has a variety of needs and preferences that can inform current VA HIT redesign efforts to meet consumer needs. This study aimed to describe veterans' experiences using the current VA HIT and identify their vision for the future of an integrated VA HIT system. Two rounds of focus group interviews were conducted with a single cohort of 47 veterans and one female caregiver recruited from Bedford, Massachusetts, and Tampa, Florida. Focus group interviews included simulation modeling activities and a self-administered survey. This study also used an expert panel group to provide data and input throughout the study process. High-fidelity, interactive simulations were created and used to facilitate collection of qualitative data. The simulations were developed based on system requirements, data collected through operational efforts, and participants' reported preferences for using VA HIT. Pairwise comparison activities of HIT resources were conducted with both focus groups and the expert panel. Rapid iterative content analysis was used to analyze qualitative data. Descriptive statistics summarized quantitative data. Data themes included (1) current use of VA HIT, (2) non-VA HIT use, and (3) preferences for future use of VA HIT. Data indicated that, although the Secure Messaging feature was often preferred, a full range of HIT options are needed. These data were then used to develop veteran-driven simulations that illustrate user needs and expectations when using a HIT system and services to access VA health care services. Patient participant redesign processes present critical opportunities for creating a human-centered design. Veterans value virtual health care options and prefer standardized, integrated
problems. The medical profession should assume a more active role in teaching people how to achieve and maintain good health habits through behavioral modification.
Hanoch, Yaniv; Finkelstein, Eric Andrew
Introduces the special issue of Health Psychology, entitled Health Psychology Meets Behavioral Economics. Psychologists have long been interested in understanding the processes that underlie health behaviors and, based on health behavior models that they have developed, have devised a spectrum of effective prevention and treatment programs. More recently, behavioral economists have also provided evidence of effective behavior change strategies through nonprice mechanisms in a variety of contexts, including smoking cessation, weight loss, and illicit drug use. Yet, although all are addressing similar issues, surprisingly little cross-fertilization has taken place between traditional economists, behavioral economists, and psychologists. This special issue is rooted in the assumption that collaboration between economists and psychologists can promote the development of new methodologies and encourage exploration of novel solutions to enduring health problems. The hope is that readers will be intrigued and inspired by the methodologies used in the different articles and will explore whether they might be applicable to the problems they are addressing. Collaborative efforts, although challenging and at times risky, are a promising way to produce more innovative studies, results, and interventions. PsycINFO Database Record (c) 2013 APA, all rights reserved.
Full Text Available Nowadays there exist various kinds of special vehicles designed for some purposes, which are different from regular vehicles in overall dimension and design. In that case, accidents such as overturning will lead to large economical loss and casualties. There are still no technical specifications to follow to ensure the safe operation and driving of these special vehicles. Owing to the poor efficiency of regular maintenance, it is more feasible and effective to apply real-time monitoring during the operation and driving process. In this paper, the fiber Bragg grating (FBG sensors are used to monitor the safety of a z-type special vehicle. Based on the structural features and force distribution, a reasonable structural health monitoring (SHM scheme is presented. Comparing the monitoring results with the finite element simulation results guarantees the accuracy and reliability of the monitoring results. Large amounts of data are collected during the operation and driving progress to evaluate the structural safety condition and provide reference for SHM systems developed for other special vehicles.
Leung, Lucinda B; Yoon, Jean; Rubenstein, Lisa V; Post, Edward P; Metzger, Maureen E; Wells, Kenneth B; Sugar, Catherine A; Escarce, José J
Aiming to foster timely, high-quality mental health care for Veterans, VA's Primary Care-Mental Health Integration (PC-MHI) embeds mental health specialists in primary care and promotes care management for depression. PC-MHI and patient-centered medical home providers work together to provide the bulk of mental health care for primary care patients with low-to-moderate-complexity mental health conditions. This study examines whether increasing primary care clinic engagement in PC-MHI services is associated with changes in patient health care utilization and costs. We performed a retrospective longitudinal cohort study of primary care patients with identified mental health needs in 29 Southern California VA clinics from October 1, 2008 to September 30, 2013, using electronic administrative data (n = 66,638). We calculated clinic PC-MHI engagement as the proportion of patients receiving PC-MHI services among all primary care clinic patients in each year. Capitalizing on variation in PC-MHI engagement across clinics, our multivariable regression models predicted annual patient use of 1) non-primary care based mental health specialty (MHS) visits, 2) total mental health visits (ie, the sum of MHS and PC-MHI visits), and 3) health care utilization and costs. We controlled for year- and clinic-fixed effects, other clinic interventions, and patient characteristics. Median clinic PC-MHI engagement increased by 8.2 percentage points over 5 years. At any given year, patients treated at a clinic with 1 percentage-point higher PC-MHI engagement was associated with 0.5% more total mental health visits (CI, 0.18% to 0.90%; P = .003) and 1.0% fewer MHS visits (CI, -1.6% to -0.3%; P = .002); this is a substitution rate, at the mean, of 1.5 PC-MHI visits for each MHS visit. There was no PC-MHI effect on other health care utilization and costs. As intended, greater clinic engagement in PC-MHI services seems to increase realized accessibility to mental health care for primary care
Lucero, Cynthia A; Oda, Gina; Cox, Kenneth; Maldonado, Frank; Lombardo, Joseph; Wojcik, Richard; Holodniy, Mark
The establishment of robust biosurveillance capabilities is an important component of the U.S. strategy for identifying disease outbreaks, environmental exposures and bioterrorism events. Currently, U.S. Departments of Defense (DoD) and Veterans Affairs (VA) perform biosurveillance independently. This article describes a joint VA/DoD biosurveillance project at North Chicago-VA Medical Center (NC-VAMC). The Naval Health Clinics-Great Lakes facility physically merged with NC-VAMC beginning in 2006 with the full merger completed in October 2010 at which time all DoD care and medical personnel had relocated to the expanded and remodeled NC-VAMC campus and the combined facility was renamed the Lovell Federal Health Care Center (FHCC). The goal of this study was to evaluate disease surveillance using a biosurveillance application which combined data from both populations. A retrospective analysis of NC-VAMC/Lovell FHCC and other Chicago-area VAMC data was performed using the ESSENCE biosurveillance system, including one infectious disease outbreak (Salmonella/Taste of Chicago-July 2007) and one weather event (Heat Wave-July 2006). Influenza-like-illness (ILI) data from these same facilities was compared with CDC/Illinois Sentinel Provider and Cook County ESSENCE data for 2007-2008. Following consolidation of VA and DoD facilities in North Chicago, median number of visits more than doubled, median patient age dropped and proportion of females rose significantly in comparison with the pre-merger NC-VAMC facility. A high-level gastrointestinal alert was detected in July 2007, but only low-level alerts at other Chicago-area VAMCs. Heat-injury alerts were triggered for the merged facility in June 2006, but not at the other facilities. There was also limited evidence in these events that surveillance of the combined population provided utility above and beyond the VA-only and DoD-only components. Recorded ILI activity for NC-VAMC/Lovell FHCC was more pronounced in the Do
This study describes health, functioning, and health care service use by medically complex technology-dependent children according to condition severity (moderately disabled, severely disabled, and vegetative state). Data were collected monthly for 5 months using the Pediatric Quality of Life Generic Core Module 4.0 Parent-Proxy Report. Health care service use measured the number of routine and acute care office visits (including primary and specialty physicians), emergency department visits, hospitalizations, nursing health care services, special therapies, medications, medical technology devices (MTDs), and assistive devices. Child physical health was different across the condition severity groups. The average age of the children was 10.1 years (SD, 6.2); the average number of medications used was 5.5 (SD, 3.7); the average number of MTDs used was 4.2 (SD, 2.9); and the average number of assistive devices used was 4.3 (SD, 2.7). Severely disabled and vegetative children were similar in age (older) and had a similar number of medications, MTDs, and assistive devices (greater) than moderately disabled children. The advanced practice nurse care coordinator role is necessary for the health and functioning of medically complex, technology-dependent children. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
Oswald, Donald P.; Gilles, Donna L.; Cannady, Mariel S.; Wenzel, Donna B.; Willis, Janet H.; Bodurtha, Joann N.
Transition to adult services for children and youth with special health care needs (CYSHCN) has emerged as an important event in the life course of individuals with disabilities. Issues that interfere with efficient transition to adult health care include the perspectives of stakeholders, age limits on pediatric service, complexity of health conditions, a lack of experienced healthcare professionals in the adult arena, and health care financing for chronic and complex conditions. The purposes...
Quint, Elisabeth H
Adolescents with special needs have unique reproductive health care needs related to their physical and cognitive issues. This review discusses some of the most common concerns that are encountered in clinical practice, as the clinician will partner with the adolescent and her family to guide her through the pubertal transition and to help navigate the risks and rights of reproduction. Families often seek anticipatory guidance before menarche on menstrual hygiene, abuse risk and sexuality and can be reassured that most teens with special needs do very well with menstruation. The clinician needs to evaluate the teenager's reproductive knowledge as well her risk for abuse and coercion and her ability to consent to sexual activity, if she requests contraception. Menstrual management is mostly based on the impact of the menstrual cycles on the teenager's life and activities. The adolescents may have a decreased ability to tolerate menses or pain, or experience changes in seizure pattern or altered mood. Hormonal treatment is often used to assist with menstrual hygiene, cyclical mood changes or dysmenorrhea. The goal of treatment can be complete amenorrhea, alleviate pain or regulate and decrease menstrual flow. The unique risks and benefits of hormonal treatment for this special population are highlighted. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
de Campos, André Luiz Vieira
This paper analyzes the role of the Serviço Especial de Saúde Pública (Special Service of Public Health) in developing and expanding higher education in nursing and to train auxiliary health personnel in Brazil under bilateral agreements between the US and Brazil during the 1940s and 1950s. The Nursing Program of the Special Service is approached from the perspective of its participation in a broader international cooperation developed by the Pan American Health Organization, but also as part of the state and nation building effort of the first Vargas Regime.
Full Text Available Abstract Background The establishment of robust biosurveillance capabilities is an important component of the U.S. strategy for identifying disease outbreaks, environmental exposures and bioterrorism events. Currently, U.S. Departments of Defense (DoD and Veterans Affairs (VA perform biosurveillance independently. This article describes a joint VA/DoD biosurveillance project at North Chicago-VA Medical Center (NC-VAMC. The Naval Health Clinics-Great Lakes facility physically merged with NC-VAMC beginning in 2006 with the full merger completed in October 2010 at which time all DoD care and medical personnel had relocated to the expanded and remodeled NC-VAMC campus and the combined facility was renamed the Lovell Federal Health Care Center (FHCC. The goal of this study was to evaluate disease surveillance using a biosurveillance application which combined data from both populations. Methods A retrospective analysis of NC-VAMC/Lovell FHCC and other Chicago-area VAMC data was performed using the ESSENCE biosurveillance system, including one infectious disease outbreak (Salmonella/Taste of Chicago-July 2007 and one weather event (Heat Wave-July 2006. Influenza-like-illness (ILI data from these same facilities was compared with CDC/Illinois Sentinel Provider and Cook County ESSENCE data for 2007-2008. Results Following consolidation of VA and DoD facilities in North Chicago, median number of visits more than doubled, median patient age dropped and proportion of females rose significantly in comparison with the pre-merger NC-VAMC facility. A high-level gastrointestinal alert was detected in July 2007, but only low-level alerts at other Chicago-area VAMCs. Heat-injury alerts were triggered for the merged facility in June 2006, but not at the other facilities. There was also limited evidence in these events that surveillance of the combined population provided utility above and beyond the VA-only and DoD-only components. Recorded ILI activity for NC
Reuben, Cynthia A; Pastor, Patricia N
Past studies have shown that specific child conditions are associated with poor school outcomes. A national health survey with noncategorical measures of health and indicators of school functioning offers the opportunity to examine this association. To compare links between two health measures (children with special health care needs and general health status) and multiple school outcomes. The analysis was based on 59,440 children aged 6-17 years from the 2007 National Survey of Children's Health. Child health was assessed using the Children with Special Health Care Needs (CSHCN) screener and a question on general health status. CSHCN were classified by the complexity of their health care needs. Indicators of school functioning included special education use, many problem reports, repeated a grade, lack of school engagement, and many missed school days. Overall 22% of children were identified as CSHCN: 13% with more complex needs (C-CSHCN) and 9% with medication use only (CSHCN-RX). Approximately 17% of children were in less than optimal health. After controlling for a child's sociodemographic characteristics C-CSHCN had an increased risk of all of the negative school outcomes compared to children without SHCN, while CSHCN-RX had an increased risk of only one school outcome (many missed school days). Children in less than optimal health were at an increased risk of all negative school outcomes compared to children in optimal health. The CSHCN screener and health status question identify related, but distinct, groups of children with worse outcomes on the indicators of school functioning. Published by Elsevier Inc.
Full Text Available The chronic shortage of human transplants to treat tissue and organ failure has led to the development of xenotransplantation, the transplantation of cells, tissues and organs from another species to human recipients. For a number of reasons, pigs are best suited as donor animals. Successful, routine xenotransplantation would have an enormous impact on the health of the human population, including the young, who sometimes require a replacement organ or islet cells, but especially the elderly, who more often suffer the consequences of organ failure. The first form of xenotransplantation applied to humans is the use of pig islet cells to treat insulin-dependent diabetes, a procedure that will have a significant economic impact. However, although xenotransplantation using pig cells, tissues and organs may save and prolong the lives of patients, it may also be associated with the transmission of porcine microorganisms to the recipient, eventually resulting in emerging infectious diseases. For this reason, the health of both the donor animals and the human recipients represents a special and sensitive case of the One Health concept. Basic research leading to strategies how to prevent transmission of porcine microorganisms by selection of virus-free animals, treatment of donor pigs by antiviral drugs, vaccines, colostrum deprivation, early weaning, Caesarean delivery, embryo transfer and/or gene editing should be undertaken to supply an increasing number of potential recipients with urgently required transplants. The methods developed for the detection and elimination of porcine microorganisms in the context of xenotransplantation will also contribute to an improvement in the health of pig populations in general and an increase in the quality of meat products. At present, there is evidence for transmission of porcine viruses to humans eating pork and having contact with pigs, however the impact of these viruses on public health is still unknown.
Russ, Shirley A; Kenney, Mary K; Kogan, Michael D
To determine characteristics of children with special health care needs (CSHCN) with hearing difficulties including patterns of hearing aid use, comorbidity, and social and communication function. Bivariate and multivariable analysis of cross-sectional data on 40,723 children aged from birth to 17 years from the 2005-2006 National Survey of Children with Special Health Care Needs, including 1,982 (5%) with parent-reported hearing difficulties. Among CSHCN, 383 (1%) used hearing aids, representing 20% of those with reported hearing difficulties. Odds of hearing aid use increased with age, primary language other than English, and lower income. More than half (58%) of the aided children reported hearing difficulties even with their aid. Among CSHCN with cerebral palsy, 13% had reported hearing difficulties and 3% used hearing aids. Equivalent figures for children with Down syndrome were 24% and 4%, mental retardation/developmental delay 12% and 5%, and autism spectrum disorder 9% and 2%. Overall, two-thirds of CSHCN with hearing difficulties had one or more sensory/developmental comorbidities; CSHCN with both hearing difficulties and a sensory/developmental comorbidity had highest odds of learning difficulties, speaking/communication difficulties, feeling anxious/depressed, acting out/bullying, and difficulty making friends. CSHCN with hearing difficulties alone, or sensory/developmental conditions alone had intermediate odds, after socio-demographic adjustment. Sensory/developmental comorbidities are common among CSHCN with hearing difficulties, and they are associated with higher odds of poorer social, communication, and educational function. Services for CSHCN must be equipped to address a range of hearing difficulties as well as sensory/developmental comorbidities and to improve social/emotional functioning as well as learning and communication.
Murphy, James F; Ogloblin, Peter; Mirick, Steven C; Buxton, Richard; Sevier, David M; McKelvy, Marcia; Rubino, Frank
... within the military health care system: dentistry, veterinary medicine, optometry, pharmacy, clinical psychology, physical therapy, occupational therapy, audiology, speech pathology, podiatry, social work, dietetics, and physician assistant...
Blais, Pierre; Hirnschall, Gottfried; Mason, Elizabeth; Shaffer, Nathan; Lipa, Zuzanna; Baller, April; Rollins, Nigel
The government of Canada, through the Department of Foreign Affairs, Trade and Development (DFATD) has supported global efforts to reduce the impact of the HIV pandemic. In 2012, WHO and DFATD launched an implementation research initiative to increase access to interventions that were known to be effective in the prevention of mother-to-child transmission of HIV and to learn how these could be successfully integrated with other essential services for mothers and children. In addition to facilitating the implementation research projects, DFATD and WHO promoted four approaches: (1) Country-specific implementation research prioritization exercises, (2) Ministry of Health involvement, (3) Country-led, innovative, high-quality research, and (4) Leveraging regional networks and learning opportunities. While no single aspect of INSPIRE is unique, the process endeavors to promote and support high-quality, rigorous, locally-led implementation research that will have a substantial impact on the health and survival of HIV-infected women and their children.
Quach, Jon; Jansen, Pauline W; Mensah, Fiona K; Wake, Melissa
Outcomes for children with special health care needs (SHCN) can vary by their patterns and persistence over time. We aimed to empirically establish typical SHCN trajectories throughout childhood and their predictive relationships with child and parent outcomes. The 2 cohorts of the nationally representative Longitudinal Study of Australian Children were recruited in 2004 at ages 0 to 1 (n = 5107, B cohort) and 4 to 5 years (n = 4983, K cohort). The parent-reported Children With SHCN Screener (Short Form) was completed at each of 4 biennial waves. Wave 4 outcomes were parent-reported behavior and health-related quality of life, teacher-reported learning, and directly assessed cognition. Both parents self-reported mental distress. We derived intracohort trajectories by using latent class analysis in Mplus. We compared mean outcome scores across trajectories by using linear regression, adjusting for socioeconomic position. Four distinct SHCN trajectories were replicated in both cohorts: persistent (B 6.8%, K 8.7%), emerging (B 4.1%, K 11.5%), transient (B 7.9%, K 4.2%), and none (B 81.3%, K 75.6%). Every outcome was adversely affected except fathers' mental health. From infancy to age 6 to 7 years, the persistent and emerging groups had similarly poor outcomes. From age 4 and 5 to 10 and 11 years, outcomes were incrementally poorer on moving from none to transient to emerging and to persistent SHCN. Effect sizes were largest for behavior, learning, and psychosocial outcomes. Adverse outcomes are shaped more by cumulative burden than point prevalence of SHCNs. In addition to providing care according to a child's need at any given time, prioritizing care toward persistent SHCNs may have the biggest benefits for children and parents. Copyright © 2015 by the American Academy of Pediatrics.
Care of the child with special health care needs is gradually becoming a significant public health issue. To identify what these special health care needs are in our environment, 2 children presenting with clinical features of Duchenne Muscular Dystrophy were studied. This crippling neuromuscular disorder has no cure at ...
Paola Rucci; Jos Latour; Elisa Zanello; Simona Calugi; Silvia Vandini; Giacomo Faldella; Maria Pia Fantini
Introduction: Children with special health care needs are an exponentially growing population needing integrated health care programmes that involve primary, community, hospital and tertiary care services. The aims of the study are (1) to develop and validate the Special Needs Kids Questionnaire (SpeNK-Q) designed to measure parents’ perspective on continuity of care for children with special health care needs and (2) to evaluate the continuity of care based on parental experiences in this po...
Baker, Dian L; Hebbeler, Kathleen; Davis-Alldritt, Linda; Anderson, Lori S; Knauer, Heather
Children with special health care needs (CSHCN) are at risk for school failure when their health needs are not met. Current studies have identified a strong connection between school success and health. This study attempted to determine (a) how schools meet the direct service health needs of children and (b) who provides those services. The study used the following two methods: (a) analysis of administrative data from the California Basic Educational Data System and (b) a cross-sectional online survey of 446 practicing California school nurses. Only 43% of California's school districts employ school nurses. Unlicensed school personnel with a variety of unregulated training provide school health services. There is a lack of identification of CSHCN, and communication barriers impair the ability to deliver care. Study results indicate that California invests minimally in school health services. © The Author(s) 2015.
Higgins, Stephen T
This Special Issue of Preventive Medicine (PM) is the 4th in a series on behavior change, health, and health disparities, a topic of critical importance to improving U.S. population health. The U.S. ranks near the bottom on measures of population health relative to other industrialized countries despite spending orders of magnitude more on health care than any other nation. Population health experts agree that the area of personal behavior, or lifestyle, such as substance abuse, physical inactivity/obesity, and non-adherence with medical regimens is the single largest contributor to this situation. These unhealthy behavior patterns disproportionately impact economically disadvantaged populations and other vulnerable populations and represent a major contributor to health disparities. Thus, behavior change represents an essential step in improving population health generally and curtailing health disparities more specifically. While perhaps more severe in the U.S., other industrialized countries are facing similar challenges with personal behavior patterns, adverse health impacts, and health disparities. Thus the topics discussed in this series have implications well beyond the U.S. In this 4th Special Issue we address (a) the potential health impacts of liberalizing laws on recreational marijuana use; (b) the ongoing challenge of tobacco use in vulnerable populations; and (b) the importance of weight management and physical activity in caring for vulnerable medical populations. Across each of these topics we include contributions from accomplished policymakers and scientists to acquaint readers with recent accomplishments and remaining knowledge gaps and challenges in these important topic areas. Copyright © 2017. Published by Elsevier Inc.
Huebner, Colleen E; Chi, Donald L; Masterson, Erin; Milgrom, Peter
This study examined the preventive dental health care experiences of young children with special needs and determined the feasibility of conducting clinical dental examinations at a community-based early intervention services center. Study methods included 90 parent interviews and dental examinations of their preschool-age children. Thirteen percent of the children received optimal preventive care, defined as twice daily tooth brushing with fluoridated toothpaste and two preventive dental visits in the prior 12 months; 37% experienced care that fell short in both areas. Optimal care was more common among children of parents who reported tooth brushing was not a struggle and those with a personal dentist. Parents' opinion of the study experience was generally positive. Few children with special needs receive effective preventive care early, when primary prevention could be achieved. Barriers to optimal care could be readily addressed by the dental community in coordination with early intervention providers. © 2014 Special Care Dentistry Association and Wiley Periodicals, Inc.
The purpose of this plan is to identify how the construction and deployment activities of the National Ignition Facility (NIF) Special Equipment (SE) will be safely executed. This plan includes an identification of (1) the safety-related responsibilities of the SE people and their interaction with other organizations involved; (2) safety related requirements, policies, and documentation; (3) a list of the potential hazards unique to SE systems and the mechanisms that will be implemented to control them to acceptable levels; (4) a summary of Environmental Safety and Health (ES&H) training requirements; and (5) requirements of contractor safety plans that will be developed and used by all SE contractors participating in site activities. This plan is a subsidiary document to the NIF Construction Safety Program (CSP) and is intended to compliment the requirements stated therein with additional details specific to the safety needs of the SE construction-related activities. If a conflict arises between these two documents, the CSP will supersede. It is important to note that this plan does not list all of the potential hazards and their controls because the design and safety analysis process is still ongoing. Additional safety issues win be addressed in the Final Safety Analysis Report, Operational Safety Procedures (OSPs), and other plans and procedures as described in Section 3.0 of this plan.
The purpose of this plan is to identify how the construction and deployment activities of the National Ignition Facility (NIF) Special Equipment (SE) will be safely executed. This plan includes an identification of (1) the safety-related responsibilities of the SE people and their interaction with other organizations involved; (2) safety related requirements, policies, and documentation; (3) a list of the potential hazards unique to SE systems and the mechanisms that will be implemented to control them to acceptable levels; (4) a summary of Environmental Safety and Health (ES ampersand H) training requirements; and (5) requirements of contractor safety plans that will be developed and used by all SE contractors participating in site activities. This plan is a subsidiary document to the NIF Construction Safety Program (CSP) and is intended to compliment the requirements stated therein with additional details specific to the safety needs of the SE construction-related activities. If a conflict arises between these two documents, the CSP will supersede. It is important to note that this plan does not list all of the potential hazards and their controls because the design and safety analysis process is still ongoing. Additional safety issues win be addressed in the Final Safety Analysis Report, Operational Safety Procedures (OSPs), and other plans and procedures as described in Section 3.0 of this plan
Van Cleave, Jeanne; Davis, Matthew M
Dr Van Cleave's current address is Department of Pediatrics, Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, 50 Staniford St, Room 901, Boston, MA 02114. The association between bullying, being bullied, or being a bully/victim and having a special health care need has not been well described in a national sample of children with a broad variety of special needs. We aimed to determine the prevalence of bullying, being bullied, or being a bully/victim in children with special health care needs and associations of behaviors with particular types of special needs. We performed a secondary data analysis using the National Survey of Children's Health, a nationally representative telephone survey conducted by the National Center for Health Statistics of >102,000 US households. We measured associations between having a special health care need and being a victim of bullying, bullying other children, and being a bully/victim in children and adolescents aged 6 to 17 years. Multiple logistic-regression models were used to examine the association of children with special health care needs overall, and of particular special needs, with the bullying measures. Overall, children with special health care needs were 21% of the population. In multivariate models adjusting for sociodemographic factors, being a child with special health care needs was associated with being bullied but not with bullying or being a bully/victim. Having a chronic behavioral, emotional, or developmental problem was associated with bullying others and with being a bully/victim. Having a special health care need generally is associated with being bullied, and having a behavioral, emotional, or developmental problem is associated with bullying others and being a bully/victim. These findings may help pediatricians, mental health providers, and schools use targeted screening and interventions to address bullying for children with special health care needs.
Nageswaran, Savithri; Silver, Ellen Johnson; Stein, Ruth E K
The goal was to evaluate whether having a functional limitation was associated with health care needs and experiences of children with special health care needs. We used caregivers' responses in the National Survey of Children with Special Health Care Needs (2001). Functional limitation was categorized as severe, some, or no limitation. We performed analyses of the relationships of functional limitation to measures of health care needs and experiences. Children with special health care needs with severe functional limitation were more likely to have received specialized educational services, to have had physician visits, and to have needed health services, compared with those with no limitation. They had significantly greater odds of delayed care, unmet health care and care-coordination needs, referral problems, dissatisfaction, and difficulty using health services, compared with those without limitation. Caregivers of children with special health care needs with severe limitation were twice as likely as those with no limitation to report that providers did not spend enough time, listen carefully, provide needed information, and make family members partners in the child's care. Compared with children with special health care needs without limitation, those with severe limitation had worse health insurance experiences, in terms of insurance coverage, copayments, being able to see needed providers, and problems with health insurance. The impact on families (financial problems, need to provide home care, or need to stop or to cut work) of children with special health care needs with severe functional limitation was much greater than the impact on families of children with special health care needs without limitation. For most measures examined, results for some limitation were between those for severe limitation and no limitation. Functional limitation is significantly associated with the health care needs and experiences of children with special health care needs.
Scal, Peter; Ireland, Marjorie
To determine the factors associated with addressing the transition from pediatric to adult-oriented health care among US adolescents with special health care needs. Data for 4332 adolescents, 14 to 17 years of age, from the 2000-2001 National Survey of Children With Special Health Care Needs were used. The adequacy of transition services was determined by parent self-report. Explanatory variables, including parental education, family poverty status, race/ethnicity, measures of the severity and complexity of conditions, health insurance status, having a personal doctor, and the quality of the parent's relationship with the adolescent's doctor, were entered into a regression model. Overall, 50.2% of parents reported that they had discussed transition issues with their adolescent's doctor and 16.4% had discussed and developed a plan for addressing those needs. In a multivariate regression analysis, correlates of the adequacy of transition services included older age, female gender, complexity of health care needs, and higher quality of the parent-doctor relationship. Among adolescents with special health care needs, those who were older and those with more complicated needs were more likely to have addressed the transition from a pediatric to adult-oriented system of care. Furthermore, this analysis demonstrated a strong association between a high-quality parent-provider relationship and the extent to which transition issues were addressed. The importance of transition services for adolescents with less complex needs and the overall impact of health care transition services were not assessed in this study and remain important questions for future investigations.
Oswald, Donald P; Gilles, Donna L; Cannady, Mariel S; Wenzel, Donna B; Willis, Janet H; Bodurtha, Joann N
Transition to adult services for children and youth with special health care needs (CYSHCN) has emerged as an important event in the life course of individuals with disabilities. Issues that interfere with efficient transition to adult health care include the perspectives of stakeholders, age limits on pediatric service, complexity of health conditions, a lack of experienced healthcare professionals in the adult arena, and health care financing for chronic and complex conditions. The purposes of this study were to develop a definition of successful transition and to identify determinants that were associated with a successful transition. The 2007 Survey of Adult Transition and Health dataset was used to select variables to be considered for defining success and for identifying predictors of success. The results showed that a small percentage of young adults who participated in the 2007 survey had experienced a successful transition from their pediatric care.
Worsley, D J; Jones, K; Harris, J C; Charlesworth, J; Marshman, Z
A description of the process of a review of oral health improvement in special schools in Sheffield and the implementation of an action plan for these activities. Public health competencies encompassed: assessing the evidence on oral health and dental interventions, programmes and services; strategic leadership and collaborative working for health; oral health improvement. Copyright© 2018 Dennis Barber Ltd.
Nader, Philip R.; Rissel, Chris; Rowling, Louise; Marshall, Bernard J.; Sheehan, Margaret M.; Northfield, Jeff R.; Maher, Shelley; Carlisle, Rachel; St. Leger, Lawrence H.; Stewart, Donald E.; Parker, Elizabeth; Gillespie, Amaya; Stokes, Helen; Mukherjee, Dev; Nutbeam, Don; Mitchell, Anne; Ollis, Debbie; Watson, Jan
Eight papers on Australia's school health programs discuss: creating health promoting schools in the United States; intersectoral collaboration for developing a national framework for health promoting schools; school-based health promotion nationwide; auditing health promoting schools policy documentation; the nature of health service/school…
Full Text Available Public health was accepted as a specialty in the mid-19th century in United Kingdom and Germany and, the beginning of 20th century in USA and Russia. In Turkey, public health specialization training started at Refik Saydam Hifzissihha Institute in 1958, at Hacettepe University in 1965 and at Ataturk University in 1967. While sanitation, communicable diseases and immunization subjects had priority in public health specialization training programs in the 1800s, health care management and epidemiology were customary curriculum in the second half of the 1900s. International Health Organizations, health planning and health economics subjects were included in curriculum during European Public Health School Directors meeting in 1966. Later on, public health has become a multidisciplinary field and psychology, sociology, anthropology, health economics and surveillance techniques were added to training programs. There are 520 public health specialists and 286 public health specialization students in Turkey in 2013. Specialization training programmes are offered in 57 departments. Half of the public health specialists work for the Ministry of Health (51%, while 47% of public health specialists work for universities. While 17% of public health specialists in the Ministry of Health worked in managerial positions, this ratio is increased to 25% in 2010. The Ministry of Health does not require public health specialization when assigning health managers. Authors strongly recommend that only the public health specialists should be assigned in managerial positions in the Provincial Directorate of Public Health and Community Health Centers. In addition, number of public health specialists working in central organization of Turkish Public Health Institution should be increased. [TAF Prev Med Bull 2014; 13(6.000: 495-504
Full Text Available Purpose: to work out health related applied technology for special health girl students (with health problems and assess its influence on their physical condition. Material: 1st-3rd year girl students were the object of the research. All girl students were trained by discipline “Physical culture”. Somatic (body length and mass and physiometrical (vital capacity of lungs indicators were studied. Results: confident changes in morphological indicators (body mass and vital capacity of lungs were determined. We also noted demand in change of students’ approaches to assessment their physical condition. Principally new methods of students’ health protection and strengthening are offered. In its base there is methodology of human individual health, person’s deeply motivated social demands in being healthy. Conclusions: For strengthening girl students’ physical condition we recommend the following: prophylaxis health related physical culture measures; new approaches to assessment of own health; teachers’ pedagogic control; working out individual recommendations on correction of health related applied trainings.
Smith, Anna Jo; Chien, Alyna T
Children with special health care needs (CSHCN) face unique challenges in accessing affordable health care. Massachusetts implemented major health reform in 2006; little is known about the impact of this state's health reform on uninsurance, access to care, and financial protection for privately and publicly insured CSHCN. We used a difference-in-differences (DD) approach to compare uninsurance, access to primary and specialty care, and financial protection in Massachusetts versus other states and Washington, DC before and after Massachusetts health reform. Parent-reported data were used from the 2005-2006 and 2009-2010 National Survey of Children with Special Health Care Needs and adjusted for age, gender, race/ethnicity, non-English language at home, and functional difficulties. Postreform, living in Massachusetts was not associated with significant decreases in uninsurance or increases in access to primary care for CSHCN. For privately insured CSHCN, Massachusetts was associated with increased access to specialists (DD = 6.0%; P ≤ .001) postreform. For publicly insured CSHCN, however, there was a significant decrease in access to prescription medications (DD = -7.2%; P = .003) postreform. Living in Massachusetts postreform was not associated with significant changes in financial protection compared with privately or publicly insured CSHCN in other states. Massachusetts health reform likely improved access to specialists for privately insured CSHCN but did not decrease instances of uninsurance, increase access to primary care, or improve financial protection for CSHCN in general. Comparable provisions within the Affordable Care Act may produce similarly modest outcomes for CSHCN. Copyright © 2014 by the American Academy of Pediatrics.
Leiter, Valerie; Rieker, Patricia P
The gendered nature of special health care needs in childhood is an important yet understudied area. Although gendered differences in the prevalence of special health care needs have been documented, there is less knowledge about the factors which contribute to those differences. Two research questions guide this inquiry. First, is the gender gap consistent across child special health care need indicators? Second, to what extent is the gender gap in special health care needs driven by behavioral conditions? We use multiple indicators from the U.S. National Survey of Children's Health to expand our understanding about the dynamic relationship between gender and childhood health. There are clear gender differences in the prevalence of special health care needs. Boys are more likely than girls to have special health care needs overall and on the five separate components examined (medication, more care than typical, limitations, special therapies, and educational or behavioral problem). This gender gap is dynamic and varies by indicator; while behavioral conditions play a role, it remains even after controlling for behavioral conditions. The reasons for the gender differences appear to be both biological and social but much remains unknown about this pattern.
Houtrow, Amy J; Okumura, Megumi J; Hilton, Joan F; Rehm, Roberta S
The aims of this study were to profile and compare the health and health services characteristics for children with special health care needs (CSHCN), with and without disabilities, and to determine factors associated with unmet need. Secondary data analysis of the 2005-2006 National Survey of Children with Special Health Care Needs was conducted. The sociodemographics, health, and health services of CSHCN with and without disabilities were compared. Multivariable logistic regression was employed to examine factors associated with unmet need for health services. Children from minority racial and ethnic groups and children living in or near poverty were over-represented among CSHCN with disabilities, compared with other CSHCN. Statistically higher percentages of CSHCN with disabilities had behavioral problems (39.6% vs 25.2%), anxiety/depressed mood (46.1% vs 24.0%), and trouble making/keeping friends (38.1% vs 15.6%) compared with other CSHCN. Thirty-two percent of CSHCN with disabilities received care in a medical home compared with 51% of other CSHCN. CSHCN with disabilities had higher rates of need and unmet need than other CSHCN for specialty care, therapy services, mental health services, home health, assistive devices, medical supplies, and durable medical equipment. The adjusted odds of unmet need for CSHCN with disabilities were 71% higher than for other CSHCN. CSHCN with disabilities had more severe health conditions and more health services need, but they less commonly received care within a medical home and had more unmet need. These health care inequities should be amenable to policy and health service delivery interventions to improve outcomes for CSHCN with disabilities. Copyright Â© 2011 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Just health: meeting health needs fairly is an ambitious book, in which Norman Daniels attempts to bring together in a single framework all his work on health and justice from the past 25 years. One major aim is to reconcile his earlier work on the special moral importance of healthcare with his later work on the social determinants of health. In his earlier work, Daniels argued that healthcare is of special moral importance because it protects opportunity. In this later work, Daniels argues that the social determinants of health (which in fact tend to have a larger effect on health outcomes than healthcare does) should also be considered special. This paper argues that it is a mistake to base a theory of justice for health on the claim that health (or the social determinants of health) are "special", for three reasons. First, once we realise that health is to a large part socially determined by features such as distribution of income, which are also of independent importance for justice, we cannot talk about a theory of justice for health in isolation from an overall theory of justice. Second, when we are trying to work out the place of health in a general theory of justice, being told that health (or the social determinants of health) is special is unhelpful. The relevant starting point should rather be whether health matters in a fundamental way for justice, or whether it matters merely for the effects it has on those goods which are of fundamental importance for justice. Third, treating the social determinants of health as special would in fact be counterproductive in terms of the broad approach to justice Daniels favours.
.... This report from China contains the topics: NATIONAL POLICY AND ISSUES, PROVINCIAL AFFAIRS, ECONOMIC DEVELOPMENT ZONES, ECONOMIC PLANNING, ECONOMIC MANAGEMENT, FINANCE AND BANKING, INDUSTRY, SMALL- SCALE ENTERPRISES, CONSTRUCTION, DOMESTIC...
1Department of Psychiatry, Makerere University College of Health Sciences, Uganda , Department Research and Developmental ... Key Words: Multidimensional Scale of Perceived social support, (MSPSS), adaptation, social support, validity, reliability. African Health ... psychological concept, social support comprises of.
Electronic Health Information Technology, (EHIT) has become an integral part of the national health care delivery system. Reliance on EHIT seems poised to grow in the years to come due to the myriad of advantages derived from the capture, storage, retrieval and analysis of large volumes of protected health data, and from ...
active CWDs practice unsafe sex, some are exposed to sexual and substance abuse; putting them at risk of HIV ... health problems they encounter and associated factors; problems related to health care access including access to health-related information. Methods ... restriction or lack of ability to perform an activity in a.
Full Text Available INTRODCUTION: WHO’s definition of Physical, social and mental well - being is explained below. A positive mental health state indicates that the individual enjoys his routine; there are no undue conflicts. Health reiteration become s more imperative than health maintenanc e, where society’s responsibility is paramount. Health economics enables us to examine the burden caused by illness. In India, 620 million people live in rural area; only 9% of every one billion populatio n is covered under health schemes. Only 2% of GDP is spent on health, where the recommended percentage is 5%. In addition to this only 5% of annual family income is spent on curative health care. In the recent past rapid deterioration in the quality of environment has over - burdened the health problem. Occu pational Health is one of the environmental health sciences, concerned broadly with the health effects of work and of working conditions. Occupational illnesses and injuries have long been a preventable blight to health. A part from occupational diseases t here are some hazards which will impair health of employees in industries. Workers in every Occupation are faced with a multitude of hazards in the work place. Ronald Blake has classified occupational hazards into the following four categories. The most pr essing environmental health problems today, in terms of death and illness worldwide are those associated with poor households and communities in the development countries. According to WHO and the World Bank, environmental improvement at the household and community level would make the greatest difference for global health. This Article also focuses on the lung disease mainly occurring du e to hazards caused by the patient occupation. A good number of diseases like COAD, asthma and pneumoconiosis afflict the concerned population. Discussion has been made in threadbare about these problems in this article
The purpose of the Uranium Mill Tailings Remedial Action (UMTRA) Project Public Affairs Plan is to establish goals for the fiscal year (FY) 1996 UMTRA Project public affairs program and to identify specific activities to be conducted during the year. It describes the roles of various agencies involved in the public affairs program and defines the functions of the UMTRA Project Technical Assistance Contractor (TAC) Public Affairs Department. It replaces the FY 1995 Public Affairs Plan (DOE/AL/62350-154). The plan also describes the US Department of Energy's (DOE) plans to keep stakeholders and other members of the public informed about UMTRA Project policies, plans, and activities, and provide opportunities for stakeholders and interested segments of the public to participate in UMTRA Project decision-making processes. The plan applies to the UMTRA Project Team; the DOE Grand Junction Projects Office (GJPO); the DOE Albuquerque Operations Office, Office of Public Affairs (OPA); the TAC; the UMTRA Project Remedial Action Contractor (RAC); and other cooperating agencies
... History and Treatment of School-aged Children with Autism Spectrum Disorder and Special Health Care Needs Recommend on Facebook ... children with special health care needs (CSHCN) and autism spectrum disorder (ASD) were first identified as having ASD was ...
... cognitive impairment or a loss of functional capacity that is expected to be chronic. (v) Health flexible...) Medicare supplemental health insurance (as defined under section 1882(g)(1) of the Social Security Act... 26 Internal Revenue 17 2010-04-01 2010-04-01 false Special rules relating to group health plans...
....145 Section 146.145 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE GROUP HEALTH INSURANCE MARKET Preemption and Special Rules § 146... all of which are for treatment of the mouth (including any organ or structure within the mouth). (B...
and Chemical Terrorism ?” the authors believe that a serious flaw associated with our public health strategy for homeland security is a lack of...Davis and Janice C. Blanchard, Are Local Health Responders Ready for Biological and Chemical Terrorism ? (Arlington, VA: RAND), 1-7, RAND, IP-221-OSD...Ready for Biological and Chemical Terrorism ?” have recognized that a serious flaw associated with our public health strategy for homeland security is a
The District Health Team (DHT) thought this was due to poor attitude of health workers, lack of confidence and skills in its use. However, in order to improve on its use at least one midwife had been trained in each facility on the use of a partogram. It was expected that trained midwives would practice and subsequently build ...
Objectives: The National Health Insurance Scheme (NHIS), and the National Identification Authority (NIA), pose ethical challenges to the physician-patient relationship due to interoperability. This paper explores (1) the national legislation on Electronic Health Information Technology (EHIT), (2) the ethics of information ...
Background: Disability is often addressed exclusively as a medical concern. The greatest problems facing persons with disabilities (PWDs) are social inequity, poverty, and lack of human rights protection. Among others, these are reflected in their health status. Objective: To determine health problems encountered and ...
Bradley, Katharine A; Rubinsky, Anna D; Sun, Haili
Patients who screen positive for alcohol misuse on the Alcohol Use Disorder Identification Test Consumption Questionnaire (AUDIT-C ≥5 points) have significantly increased postoperative complications. Severe alcohol misuse (AUDIT-C ≥9 points) is associated with increased postoperative health care ...
Pineles, Lisa; Morgan, Daniel J; Lydecker, Alison; Johnson, J Kristie; Sorkin, John D; Langenberg, Patricia; Blanco, Natalia; Lesse, Alan; Sellick, John; Gupta, Kalpana; Leykum, Luci; Cadena, Jose; Lepcha, Nickie; Roghmann, Mary-Claire
This was an observational study designed to estimate the frequency of methicillin-resistant Staphylococcus aureus (MRSA) transmission to gowns and gloves worn by health care workers (HCWs) interacting with Veterans Affairs Community Living Center (VA nursing home) residents to inform MRSA prevention policies. Participants included residents and HCWs from 7 VA nursing homes in 4 states and Washington, DC. Residents were cultured for MRSA at the anterior nares, perianal skin, and wound (if present). HCWs wore gowns and gloves during usual care activities. After each activity, a research coordinator swabbed the HCW's gown and gloves. Swabs were cultured for MRSA. There were 200 residents enrolled; 94 (46%) were MRSA colonized. Glove contamination was higher than gown contamination (20% vs 11%, respectively; P care from 0%-19% for gowns and 7%-37% for gloves. High-risk care activities (odds ratio [OR] > 1.0, P hygiene (eg, brushing teeth), and bathing. Low-risk care activities (OR care, but all care had a risk of contamination, demonstrating the importance of hand hygiene after all care. Transmission to gowns was significantly higher with certain types of care. Optimizing gown and glove use by targeting high-risk care activities could improve resident-centered care for MRSA-colonized residents by promoting a home-like environment. Published by Elsevier Inc.
Evans, Martin E; Kralovic, Stephen M; Simbartl, Loretta A; Jain, Rajiv; Roselle, Gary A
Declines in methicillin-resistant Staphylococcus aureus (MRSA) health care associated infections (HAIs) were previously reported in Veterans Affairs acute care (2012), spinal cord injury (SCIU) (2011), and long-term-care facilities (LTCFs) (2012). Here we report continuing declines in infection rates in these settings through September 2015. Monthly data entered into a national database from 127 acute care facilities, 22 SCIUs, and 133 LTCFs were evaluated for trends using negative binomial regression. There were 23,153,240 intensive care unit (ICU) and non-ICU, and 1,794,234 SCIU patient-days from October 2007-September 2015, and 22,262,605 LTCF resident-days from July 2009-September 2015. Admission nasal swabbing remained >92% in all 3 venues. Admission prevalence changed from 13.2%-13.5% in acute care, from 35.1%-32.0% in SCIUs, and from 23.1%-25.0% in LTCFs during the analysis periods. Monthly HAI rates fell 87.0% in ICUs, 80.1% in non-ICUs, 80.9% in SCIUs, and 49.4% in LTCFs (all P values Prevention Initiative. Published by Elsevier Inc.
Santangelo, Peter; Procter, Nicholas; Fassett, Denise
How mental health nursing is differentiated from other disciplines and professions, and what special contribution mental health nurses make to health services, is a question at the heart of contemporary practice. One of the significant challenges for mental health nurses is identifying, developing and advancing those aspects of their practice that they consider differentiate them in the multi-disciplinary mental health care team and to articulate clearly what a mental health nurse is and does. This paper draws on data from interviews with 36 mental health nurses in Australia who identified their practice as autonomous. Participants were asked the question, "What's special about mental health nursing?" Constructivist grounded theory techniques were applied to the research process. Findings were formulated and expressed as the 'Ten P's of the professional profile that is mental health nursing', which are 'present', 'personal', 'participant partnering', 'professional', 'phenomenological', 'pragmatic', 'power-sharing', 'psycho-therapeutic', 'proud' and 'profound'. The combined elements of the findings present a theoretical construct of mental health nursing practice as something distinctive and special. It provides a model and exemplar for contemporary practice in mental health nursing, embracing the role of mental health nurses in the health care workforce as being well placed as providers of productive and effective care. © 2017 Australian College of Mental Health Nurses Inc.
Waldman, H Barry; Wong, Allen; Rojas, Jorge E; Perlman, Steven P
The results from latest study of children with special health care needs indicate at the national and state levels that (except for Asian children) the proportion of Hispanic children with special needs is less than for other child populations. A review of a series of associated factors raises questions of the validity of these general national and state findings. The significant projected increases in the Hispanic population during the next decades points to the necessity of reconsidering the recent survey findings in light of what could be continued increases in the numbers of youngsters with special health care needs and the evolving family cultural adaptation, education and employment opportunities.
Irish, D Elizabeth; Lyman, Deborah M; Squillace, Helen A; Geyer, Enid M; Cosgrove, Tammy D; Hagzan, Amanda; Leinung, Jill; Tosh, Traci
A successful partnership model between an academic health sciences library and a K-12 school district to provide librarians, nurses, and special education staff with access to health information to support special needs children and their parents is presented. Train-the-trainer staff sessions and a parent session were collaboratively developed. Funding support was used to purchase iPads for librarians and nurses to deliver mobile support. The results indicate the resources taught are being used to find health information and the school librarians and nurses are being sought after to assist in finding health information. Positive feedback from the school district indicates this model could be replicated in similar settings.
The application of behavioral economics to health and health care has captured the imagination of policymakers across the political spectrum. The idea is that many people are irrational in predictable ways, and that this both contributes to unhealthy behaviors like smoking and holds one of the keys to changing those behaviors. Because health care costs continue to increase, and a substantial portion of costs are incurred because of unhealthy behaviors, employers and insurers have great interest in using financial incentives to change behaviors. However, it is in the details that complexity and controversies emerge. Who should the targets be, and what outcomes should be rewarded? How should incentives be structured, to maximize their effectiveness and minimize unintended consequences? In what situations should we be intervening to affect decisions by people who may prefer to be obese or to smoke, and in what situations should we accept their preferences? To begin to answer these questions, the Penn-CMU Roybal P30 Center on Behavioral Economics and Health held its first annual Behavioral Economics and Health Symposium on March 24-25, 2011 with support from the Robert Wood Johnson Foundation. The symposium drew more than 50 researchers, scholars, and health professionals from a variety of disciplines, including medicine, public health, economics, law, management, marketing, and psychology. They heard perspectives on behavioral economics from public and private funders, the CEO of the University of Pennsylvania Health System, and the CEO of stickK.com, a start-up company that uses online, voluntary commitment contracts to help people achieve their goals. Participants formed eight working groups to review the current state-of-the-art in a variety of clinical contexts and to consider how behavioral economics could inform a research agenda to improve health. This Issue Brief summarizes the findings of these working groups and the symposium.
The purpose of the Uranium Mill Tailings Remedial Action (UMTRA) Project Public Affairs Plan is to establish goals for the Fiscal Year 1995 UMTRA public affairs program and identify specific activities to be conducted during the year. It also describes the roles of various agencies involved in the conduct of the public affairs program and defines the functions of the Technical Assistance Contractor (TAC) Public Affairs Department. It integrates and replaces the Public Participation Plan (DOE/AL/62350-47D) and Public Information Plan (DOE/AL/623590-71). The plan describes the US Department of Energy`s (DOE) plans to keep stakeholders and other members of the public informed about project policies, plans, and activities, and provide opportunities for stakeholders and interested segments of the public to participate in project decision-making processes. The plan applies to the UMTRA Project Office; the DOE Albuquerque Operations Office, Office of Intergovernmental and External Affairs (OIEA); the UMTRA TAC; the UMTRA Remedial Action Contractor (RAC); and other cooperating agencies.
The purpose of the Uranium Mill Tailings Remedial Action (UMTRA) Project Public Affairs Plan is to establish goals for the Fiscal Year 1995 UMTRA public affairs program and identify specific activities to be conducted during the year. It also describes the roles of various agencies involved in the conduct of the public affairs program and defines the functions of the Technical Assistance Contractor (TAC) Public Affairs Department. It integrates and replaces the Public Participation Plan (DOE/AL/62350-47D) and Public Information Plan (DOE/AL/623590-71). The plan describes the US Department of Energy's (DOE) plans to keep stakeholders and other members of the public informed about project policies, plans, and activities, and provide opportunities for stakeholders and interested segments of the public to participate in project decision-making processes. The plan applies to the UMTRA Project Office; the DOE Albuquerque Operations Office, Office of Intergovernmental and External Affairs (OIEA); the UMTRA TAC; the UMTRA Remedial Action Contractor (RAC); and other cooperating agencies
Landguth, David C
... requirements for homeland security. Since public health professional needs as viewed by the Federal Government may be different from those viewed from a state or local/rural perspective, three distinct groups/areas were sampled and analyzed...
Full Text Available The article highlights the new data on the prevalence and structure of the children's disablement in the Russian federation. Among the causes of the children's disablement, the authors mark dominance of the infectious and somatic diseases, neuropathies, mental diseases and congenital growth anomalies, in particular. They show the role of medical and biological, social and hygienic, medical and organizational and economical factors, defining the health formation and conducing to the children's incapacitation. The researchers characterize the health status of the disabled children in respect of the major indices: physical and neuropsychic growth, psychological personality peculiarities, sickness rate and quality of life. The article depicts many issues, arising within the family of an incapacitated child.Key words: disablement, children, prevalence, structure, causes, health indices.
Lotstein, Debra S; Ghandour, Reem; Cash, Amanda; McGuire, Elizabeth; Strickland, Bonnie; Newacheck, Paul
Many youth with special health care needs have difficulties transferring to adult medical care. To address this, the Maternal and Child Health Bureau has made receipt of transition services a core performance outcome for community-based systems of care for youth with special health care needs. In this article we describe the results for the transition core outcome from the 2005-2006 National Survey of Children With Special Health Care Needs. We also describe changes in the measurement strategy for this outcome since the first National Survey of Children With Special Health Care Needs in 2001. In the nationally representative, cross-sectional 2005-2006 National Survey of Children With Special Health Care Needs, parent or guardian respondents of 18198 youth with special health care needs (aged 12-17) were asked if they have had discussions with their child's health care providers about (1) future adult providers, (2) future adult health care needs, (3) changes in health insurance, and (4) encouraging their child to take responsibility for his or her care. All 4 components had to be met for the youth to meet the overall transition core outcome. Those who had not had transition discussions reported if such discussions would have been helpful. Overall, 41% of youth with special health care needs met the core performance outcome for transition. Forty-two percent had discussed shifting care to an adult provider, 62% discussed their child's adult health care needs, and 34% discussed upcoming changes in health insurance. Most (78%) respondents said that providers usually or always encourage their child to take responsibility for his or her health. Non-Hispanic black or Hispanic race/ethnicity, lower income level, not speaking English, and not having a medical home reduced the odds of meeting the transition core outcome. Current performance on the transition core outcome leaves much room for improvement. Many parents feel that having transition-related discussions with their
Access to healthcare is a determinant of the wellbeing of the people. Planning the location and distribution of health facilities to ensure efficiency and equity in the face of limited resources can be challenging, especially where the type of care requires expensive equipments and specialists. This study attempts to provide a ...
Ervasti, Jenni; Kivimäki, Mika; Pentti, Jaana; Salmi, Venla; Suominen, Sakari; Vahtera, Jussi; Virtanen, Marianna
Studies have reported higher levels of absenteeism due to illness among special education teachers compared to other teachers, but it is not known which factors might contribute to this difference. We examined whether health, health behaviors, and exposure to violence at work differed between special education and general education teachers in Finnish basic education. Survey data from 5760 general and special education teachers were analyzed with multilevel logistic models adjusted for individual- and school-level confounding factors. No difference was found between the health behaviors of general and special education teachers. The differences in physical and mental health between the two groups were also relatively small. With regard to work-related violence, however, male special education teachers were 3 times more likely to be exposed to mental abuse, and 5 times more likely to be exposed to physical violence when compared to their male colleagues in general education. Although female special educators were also at an increased risk of mental abuse and physical violence compared to their female general teacher colleagues, their odds ratios for such an encounter were smaller (2- and 3-fold, respectively) than those of male special education teachers. The school-level variance of physical violence toward teachers was large, which indicates that while most schools have little physical violence toward teachers, schools do exist in which teachers' exposure to violence is common. These findings suggest that special education teachers may benefit from training for handling violent situations and interventions to prevent violence at schools. © 2012, American School Health Association.
Full Text Available Objective: To characterize, through bibliometric approach, the scientific literature in this Special Education in the databases of the Virtual Health Library (VHL. The VHL is coordinated by BIREME - Specialized Center of the Pan American Health Organization whose objective is to promote the dissemination and use of scientific information in health. Method: The research methodology was performed by observing the following steps: a literature review on education special and bibliometrics, data collection from the site of BIREME about the presence of special education in the databases, organization, processing and bibliometric analysis of data collected using the software MS Excel and Vantage Point. Results: indicators produced allow signal that the predominant language of scientific production was the Portuguese and the majority of records were written individually, the themes addressed were psychology and developmental psychology. Conclusion: These bibliometric indicators characterizing the state of the art of scientific literature in Special Education at the various bases Data Bireme and also showed a field of interconnections between Health Sciences and Special Education.
Problem Statement: Previous studies showed that children with special health care needs are at increased risk for future linguistic problems and deficits in narrative abilities. Despite this evidence of increased risk, there has been limited research on the impact of young children's health problems on specific aspects of linguistic development.…
Johnson, Robert E.; Lavay, Barry
This manual was developed to address the need for health-related physical fitness testing of children with special needs. The first section defines the components of health-related physical fitness which consist of: (1)abdominal strength and endurance measured by a sit-up test; (2) flexibility, measured by a sit and reach test; (3) upper body…
Buhler, Amy G.; Ferree, Nita; Cataldo, Tara T.; Tennant, Michele R.
Very little literature exists on the nature of external reporting lines and funding structures of academic special libraries. This study focuses on academic health sciences libraries. The authors analyze information gathered from statistics published by the Association of Academic Health Sciences Libraries (AAHSL) from 1977 through 2007; an…
Guidetti, Laura; Franciosi, Emanuele; Gallotta, Maria Chiara; Emerenziani, Gian Pietro; Baldari, Carlo
Although several studies showed the positive effects of exercise and physical activity on health and well-being for individuals with ID, there is a lack of information about the influence of sport specialization on fitness and health components. Therefore, the aims of this study were to assess: (a) physical fitness of athletes with intellectual…
Alexandropoulou, Marianthi; Sourtzi, Panayota; Kalokerinou, Athena
Published research concerning health promotion in Greek schools is limited. The aim of the study was to evaluate special education school nurses' involvement in health promotion activities, examine their attitudes toward it, and to explore the factors influencing their practices. A cross-sectional survey was carried out in 2005 by mailed…
Full Text Available Background: In 2011, the Veterans Health Administration (VHA consulted with the Project ECHO (Extension for Community Healthcare Outcomes team at the University of New Mexico, Albuquerque, to reproduce their successful model within the VHA. Methods: The VHA launched SCAN-ECHO (Specialty Care Access Network-Extension for Community Healthcare Outcomes, a multisite videoconferencing system to conduct live clinical consultations between specialists at a VHA Medical Center (hospital and primary care providers stationed at satellite VHA CBOCs (Community-Based Outpatient Clinic. Results: Analysis of the first three years rendered a mean attendee satisfaction of 89.53% and a consultation satisfaction score of 88.10%. About half of the SCAN-ECHO consultations resulted in patients receiving their treatment from their local primary care providers; the remaining half were referred to the VHA Medical Center when the treatment involved equipment or services not available at the CBOCs (e.g., MRI, surgery. Conclusion: This paper details the setup, operation logistics and preliminary findings, suggesting that SCAN-ECHO is a viable model for providing quality specialty clinical consultation service, prompter access to care, reduced commutes and continuing education. Additionally, the use of a secured Internet-based videoconferencing system that supports connectivity to multiple (mobile devices could expand the utilization of this service.
Satyanarayana, K; Srivastava, S
This paper examines the nexus between poverty and global health with specific focus on IPR protection and attempts to highlight the current global endeavours to overcome barriers to access to medicines for diseases of the poor. The number of very poor people in the world has increased by 10.4 per cent between 1987 and 2001 to 2735 million. India is now home to the largest number of millionaires in the developing countries. But over 800 million Indians who still survive on Rs 20.0 (US$0.5) a day, and rural poverty is on the rise. The link between poverty and health is well established with the underprivileged are more vulnerable to major health risks due to poor nutrition, inadequate access to clean drinking water, sanitation, exposure to indoor smoke, etc. all of which contribute to the huge and growing burden of disease in the poor countries. The global disease burden is not just huge but growing: over 10 million children die of preventable conditions including vaccine-preventable diseases, about 14 million are killed by infectious diseases every year, 90-95 per cent in poor countries. An estimated third of global population has limited or no access to essential medicines. While the number of poor and unhealthy is growing, Government expenditure on health is dwindling. Many of the diseases of the poor require new medicines and none are forthcoming as there is little R&D for these infections. There are several barriers to access to existing and the newly discovered drugs. One major reason is the general lack of interest by the pharma industry to discover new medicines for diseases of the poor due to very limited market in developing countries. In addition, global intellectual property rights (IPR) protection regimes like the Trade Related Intellectual Property Rights (TRIPS) are considered a major obstacle for the poor access to medicines. There have been some global initiatives on the need to improve affordability and accessibility of medicines. Some strategies to
Jackson, Alun C; Liang, Rachel P-T; Frydenberg, Erica; Higgins, Rosemary O; Murphy, Barbara M
The aim of this review was to examine parent education programmes for families with children with special health care needs, to better design interventions focusing on the psychosocial aspects of living with a child's chronic condition. Studies of familial coping with children with special health care needs indicate high levels of parenting stress, with families with children with special health care needs at risk of major psychological and social disturbances and financial strain. Despite increased knowledge of the factors affecting children with special health care needs themselves, evidence for the effectiveness of preventative and treatment interventions in the form of parent education programmes remains limited. Systematic review using PRISMA guidelines. Multi database Boolean searches in EBSCO Discovery Services using the search terms 'complex/special health care needs children', 'child/pediatric/congenital heart disease', 'chronic illness (including diabetes, cancer and cystic fibrosis)', 'family coping', 'siblings' AND 'parenting/family support programs' were conducted. Analysis of 13 included studies showed evidence for the effectiveness of both mixed-health condition and condition-specific parenting programmes delivered in a variety of modes. Three common core intervention approaches were: use of narrative therapy enabling families to tell their own stories, thus facilitating emotional processing and (co-) construction of meaning; a focus on strengthening protective factors such as enhancing parents' skills in communication, and behavioural management and provision of psycho-education to deepen parents' understanding of their child's condition and associated developmental challenges. Irrespective of the type of outcome measures used in the studies, the review showed that there were positive gains and improvements across a range of areas of family functioning such as mental health, parenting, communication and problem-solving skills postprogramme
de Castro, Ricardo Dias; Rangel, Marianne de Lucena; da Silva, Marcos André Azevedo; de Lucena, Brunna Thaís Lucwu; Cavalcanti, Alessandro Leite; Bonan, Paulo Rogério Ferreti; Oliveira, Julyana de Araújo
The Specialized Dental Clinics (SDCs) represent the first government initiative in Latin America aimed at providing specialized oral health services. This study sought to evaluate the organizational accessibility to specialized oral health care services in Brazil and to understand the factors that may be associated with accessibility from the user’s perspective. This epidemiological, cross-sectional and quantitative study was conducted by means of interviews with individuals who sought specialized public oral health services in the city of João Pessoa, Paraíba, Brazil, and consisted of a sample of 590 individuals. Users expressed a favorable view of the classification and resolutive nature of specialized services offered by Brazilian public health. The binary logistic regression analysis revealed weak points highlighting the difficulty involved in obtaining such treatments leading to unfavorable evaluations. In the resolutive nature item, difficulty in accessing the location, queues and lack of materials and equipment were highlighted as statistically significant unfavorable aspects. While many of the users considered the service to be resolutive, weaknesses were mentioned that need to be detected to promote improvements and to prevent other health models adopted worldwide from reproducing the same flaws. PMID:27775584
Gage-Bouchard, Elizabeth A; LaValley, Susan; Mollica, Michelle; Beaupin, Lynda Kwon
Social support is an important factor that shapes how people cope with illness, and health-related communication among peers managing the same illness (network ties with experiential similarity) offers specialized information, resources, and emotional support. Facebook has become a ubiquitous part of many Americans' lives, and may offer a way for patients and caregivers experiencing a similar illness to exchange specialized health-related support. However, little is known about the content of communication among people who have coped with the same illness on personal Facebook pages. We conducted a content analysis of 12 months of data from 18 publicly available Facebook pages hosted by parents of children with acute lymphoblastic leukemia, focusing on communication between users who self-identified as parents of pediatric cancer patients. Support exchanges between users with experiential similarity contained highly specialized health-related information, including information about health services use, symptom recognition, compliance, medication use, treatment protocols, and medical procedures. Parents also exchanged tailored emotional support through comparison, empathy, encouragement, and hope. Building upon previous research documenting that social media use can widen and diversify support networks, our findings show that cancer caregivers access specialized health-related informational and emotional support through communication with others who have experienced the same illness on personal Facebook pages. These findings have implications for health communication practice and offer evidence to tailor M-Health interventions that leverage existing social media platforms to enhance peer support for patients and caregivers.
Okumura, Megumi J; Knauer, Heather A; Calvin, Kris E; Takayama, John I
Background and Objectives Pediatricians face numerous challenges in providing care for children with special health care needs (CSHCN). Few studies have described health care resources available to support pediatricians to care for CSHCN. This study investigated available resources to care for CSHCN and factors associated with having a greater proportion of CSHCN in practice. Methods We conducted a statewide survey of active members of the American Academy of Pediatrics in California to study pediatric subspecialty care access, community and office resources and practice barriers. We performed a logistic regression model on having an "above average proportion" of CSHCN in practice, adjusting for demographics, practice type (rural vs. suburban/urban) and medical resources, care satisfaction, and ease of subspecialty access. Results Our response rate was 50.2% (n = 1290); 75% of respondents reported providing some primary care services, with many primary care pediatricians caring for a high proportion of CSHCN. Pediatricians reported an average of 28% CSHCN in their practices. Rural pediatricians lacked subspecialty access (10-59% reporting no access to the various subspecialties). Factors relating to higher CSHCN in practice included being in academic medical centers and satisfaction in caring for CSHCN. Conclusions Pediatricians report lack of access to mental health services, care coordination and case management. Academic medical centers and higher physician satisfaction in care delivery for CSHCN are associated with more CSHCN in practice. Promoting ways to support pediatricians, such as practice collaboration with behavioral specialists, may be necessary to encourage primary care pediatricians to provide medical homes for CSHCN.
Earley, Elizabeth; Asti, Lindsey; Chisolm, Deena
The study assessed whether children with special health care needs (CSHCN) living in Appalachian Ohio have differential health care utilization, unmet needs, and health outcomes compared with CSHCN in Ohio's metropolitan counties using a statewide Ohio survey. Based on this survey, an estimated 28% of children in Appalachian Ohio counties have special health care needs compared with 25% of children in metropolitan counties. In Appalachia, CSHCN are poorer and more likely to have Medicaid than their metropolitan counterparts, but had no reported significant differences in health outcomes or unmet needs. Data suggested a trend toward higher use of emergency department care and inpatient services and lower use of well-child visits but these differences did not reach significance. We conclude that CSHCN in Appalachian and metropolitan areas face similar levels of health status and unmet needs but results suggest a need for additional research on access to primary care services.
McRee, Annie-Laurie; Maslow, Gary R; Reiter, Paul L
We examined vaccination coverage among youth with special health care needs (YSHCN) using data from parents of adolescents (11-17 years) who responded to a statewide survey in 2010-2012 (n = 2156). Using a validated screening tool, we identified 29% of adolescents as YSHCN. Weighted multivariable logistic regression assessed associations between special health care needs and receipt of tetanus booster, meningococcal, and human papillomavirus (HPV) vaccines. Only 12% of youth had received all 3 vaccines, with greater coverage for individual vaccines (tetanus booster, 91%; meningococcal, 32%; HPV, 26%). YSHCN had greater odds of HPV vaccination than other youth (33% vs 23%, OR = 1.70, 95% CI = 1.16-2.50) but vaccination coverage was similar ( P ≥ .05) for other outcomes. In subgroup analyses, HPV vaccination also differed depending on the number and type of special health care needs identified. Findings highlight low levels of vaccination overall and missed opportunities to administer recommended vaccines among all youth, including YSHCN.
Tesser, Charles Dalcanale; Poli, Paulo
The structuring of specialized outpatient care is a bottleneck in the operation of the Unified Health System. Based on a brief discussion about this void in an organizational model, we propose the federal induction of a format of specialized services from the experiences of Centers of Support for Family Health (NASF). They adapted matrix operations and constitute an excellent prototype for the organization of specialized outpatient care. It allows for equal access and maximum proximity to the specialized care of the reality of primary care users, the personal relationship and the close relationship between the family health teams and medical and non-medical specialists, enabling mutual lifelong learning, negotiated regulation and increased efficacy of primary care. Municipal experiences of Florianopolis and Curitiba are synthesized as partial examples of the proposal. the structure of care in mental health of Florianópolis, all organized as a matrix support is briefly described; and we focus on the change in the action of the support teams of Curitiba, which gradually began to engage, involve and mediate the relationship between basic and specialized care. This format can be expanded to most medical specialties.
Christensen, Alan J; Nezu, Arthur M
This issue represents the 4th Journal of Consulting and Clinical Psychology special issue on behavioral medicine and clinical health psychology over the past 4 decades. Recent developments in health care policy, as well as in the maturation of the science, make a special issue in this area particularly timely. This collection includes state of the clinical science reviews, reports of clinical trials, and articles addressing theory and methods in behavioral medicine and clinical health psychology. A multilevel, ecological perspective that considers multiple levels of influences (e.g., cultural influences on behavior-health linkages, individual differences) is salient throughout many of the articles. Our hope is that this sampling of this broad field, and coverage of some key issues and areas, will play a role in stimulating the next 10 years of research, practice, and policy implementation in behavioral medicine and clinical health psychology.
Sarah Moll León
Full Text Available The exploratory study aims to explore mental health representations in workers of two specialized institutions, through qualitative methodology. A total of ten members of two specialized institutions were selected, five from each, who comprise the interdisciplinary team in the area: A psychiatrist, a psychologist, a nurse, a nursing technician and a social worker. A semi-structured interview was developed to access the speech of the workers. Results show the representational world of the workers, their general conceptions about mental health, the factors that promote or interfere with it, as well as the reactions that a person that suffers mental illness generates, as well as expectations of improvement.
Systems of universal health coverage may aspire to provide care based on need and not ability to pay; the complexities of this aspiration (conceptual, practical, and ethical) call for normative analysis. This special issue arises in the wake of a judicial inquiry into preferential access in the Canadian province of Alberta, the Vertes Commission. I describe this inquiry and set out a taxonomy of forms of differential and preferential access. Papers in this special issue focus on the conceptual specification of health system boundaries (the concept of medical need) and on the normative questions raised by complex models of funding and delivery of care, where patients, providers, and services cross system boundaries.
... Home Adaptation AGENCY: Department of Veterans Affairs. ACTION: Final rule. SUMMARY: The Department of... specially adapted housing and special home adaptation grants. This final rule incorporates certain... regulations pertaining to eligibility for specially adapted housing (SAH) grants and special home adaptation...
Harper, Ruth; Wilson, Nona L.
Helping skills are an essential component of today's student affairs practice. On a day-to-day basis, it is student affairs professionals who often work directly with students in need of mental health support and monitoring. "More Than Listening: A Casebook for Using Counseling Skills in Student Affairs Work" is written for those student affairs…
Joosten, Koen; van der Velde, Kelly; Joosten, Pieter; Rutten, Hans; Hulst, Jessie; Dulfer, Karolijn
In hospitalized children with a chronic disease, malnutrition was associated with a lower subjective health status. In outpatient children with a chronic disease attending special schools, this association has never been studied. The aim of this study was to assess the association between nutritional status and subjective health status in chronically ill children attending special schools. Overall, 642 children, median age 9.8 years (IQR 7.7-11.5), 60 % male, 72 % Caucasian, were included in this prospective study in nine special schools for chronically ill children in the Netherlands. Overall malnutrition was assessed as: acute malnutrition (nutritional risk-screening tool STRONGkids. Subjective health status was assessed with EQ-5D. Overall, 16 % of the children had overall malnutrition: 3 % acute and 13 % chronic malnutrition. Nurses reported 'some/severe problems' on the health status dimensions mobility (15 %), self-care (17 %), usual activities (19 %), pain/discomfort (22 %), and anxiety/depression (22 %) in chronically ill children. Their mean visual analogue scale score (VAS) was 73.0 (SD 11.1). Malnutrition, medication usage, and younger age explained 38 % of the variance of the VAS score. The presence of overall malnutrition in chronically ill children attending special schools was associated with lower subjective health status, especially in younger children and in those with chronic medication usage. Therefore, it is important to develop and use profile-screening tools to identify these children.
Skinner, Asheley Cockrell; Slifkin, Rebecca T.; Mayer, Michelle L.
Background: Unmet need for dental care is the most prevalent unmet health care need among children with special health care needs (CSHCN), even though these children are at a greater risk for dental problems. The combination of rural residence and special health care needs may leave rural CSHCN particularly vulnerable to high levels of unmet…
to repeal the laws prohibiting interracial marriages and extramarital relations—the most odious laws in South Africa, as Minister of Home Affairs F...rapprochement of their economies and formation of the modern, highly effective economic structures being consciously regulated by the CMEA member...favourable condi- tions are created for the more effective use of the countries’ resources and wider application of the achievements of scientific and
Fernandez #, Carla; Kaschke, Imke; Perlman, Steven
Background Special Olympics athletes, as well as the general population of people with intellectual disabilities, are expected to have poorer gingival health. The aim of the study is to explore the prevalence of gingival signs of inflammation and its relationship to oral cleanliness and age among Special Olympics athletes from Europe and Eurasia. Material and Methods A retrospective longitudinal study was performed with data collected through standardized oral from 15.941 athletes from annual Special Olympics events held in 49 countries, from Europe and Eurasia between 2007 and 2012. The data was analysed descriptively, with One-Way ANOVA test and Chi-Square test. Results The level of significance was predetermined at a p value disability, Special Olympics. PMID:26241452
Full Text Available Whereas former research has studied the psychological health of parents raising a special needs child (a child with a disability or chronic disease, the present study focused on their perceived physical health in relation to meaning in life. Specifically, it was investigated whether physical health is positively related to the meaning in life dimensions self-actualization, self-acceptance and self-transcendence. Visitors of Dutch internet forums (N = 115 completed the Existential Fulfillment Scale and an inventory of subjective health, the VOEG-21. Parents of special needs children were found to suffer more health problems than the average population. In addition, self-actualization and self-acceptance were positively related to their perceived physical health. For self-transcendence, however, a negative relationship was established. The perceived poor health of these parents raising a special needs child implies a need for interventions for this group. The Existential Fulfillment Scale appears to be a useful instrument for identifying those parents in need of such interventions. Self-actualization and self-acceptance seem to be relevant subjects for therapeutic interventions and further research.
In 1990 the French Commissariat a l'energie atomique (CEA) had to deal with a series of issues concerning depositories of radioactive substances of very low activity, culminating, in October 1990, with the discovery of small amounts of plutonium in a depository. These were important issues for the following reasons: they highlighted the question o low activity wastes and their treatment, that is not yet resolved; they drew attention to the sensitivity of the concerned organisations, elected representatives and the public to the problems of radioactivity however low its level; they made the CEA aware of the gap that existed between the nuclear industry's practices, language and perception of risks and the perception of the French public. This paper outlines the different 'affairs', shows their common bases, and analyses the consequences for the CEA and the nuclear industry in general. These 'affairs' illustrate the absolute obligation for all producers of wastes to know, and to make known in the smallest detail, the way in which the wastes are treated and the places where they are stored and kept. Waste management has not always been as a noble task. These 'affairs' have shown that the reputation of the CEA was measured as much by the quality of its waste management as by the success of its research programme, with a budget that has doubled in the last few years. (author)
Santiago, Catherine DeCarlo; Kataoka, Sheryl H.; Forness, Steven R.; Miranda, Jeanne
This article presents a collaborative study conducted in a large urban school district, in which the authors surveyed 55 clinicians within the special education system, with a focus on the mental health services provided to students who were receiving related-services counseling as a mandated component of their individualized education plan.…
Markos-Capps, Gina; Godfrey, Athleen B.
Directors of 86 day care centers were surveyed to determine factors affecting the availability of day care services for preschool children with special health care needs. Barriers to admission included restrictive admittance requirements, lack of staff, fear of not meeting a child's needs, and lack of trained personnel. (Author/CR)
Lewis, Charlotte W
This paper grew out of a project reviewing progress in children's oral health after Oral Health in America: A Report of the Surgeon General was published in 2000. It includes a summary of advances in national surveillance of children with special health care needs (CSHCN), and presents more recent data on unmet dental care need among CSHCN. To that end, we used the 2006 National Survey of Children with Special Health Care Needs to determine the prevalence of unmet dental care need among CSHCN and to compare this within subgroups of CSHCN, as well as to children without special health care needs, and to results from the previous iteration of this survey. Dental care remains the most frequently cited unmet health need for CSHCN. More CSHCN had unmet needs for nonpreventive than preventive dental care. CSHCN who are teens, poorer, uninsured, had insurance lapses, or are more severely affected by their condition had higher adjusted odds of unmet dental care needs. CSHCN who were both low income and severely affected had 13.4 times the adjusted odds of unmet dental care need. In summary, CSHCN are more likely to be insured and to receive preventive dental care at equal or higher rates than children without special health care needs. Nevertheless, CSHCN, particularly lower income and severely affected, are more likely to report unmet dental care need compared with unaffected children. Despite advances in knowledge about dental care among CSHCN, unanswered questions remain. Recommendations are provided toward obtaining additional data and facilitating dental care access for this vulnerable population.
Zickafoose, Joseph S; Smith, Kimberly V; Dye, Claire
To assess how the Children's Health Insurance Program (CHIP) affects outcomes for children with special health care needs (CSHCN). We used data from a survey of parents of recent and established CHIP enrollees conducted from January 2012 through March 2013 as part of a congressionally mandated evaluation of CHIP. We identified CSHCN in the sample using the Child and Adolescent Health Measurement Initiative's CSHCN screener. We compared the health care experiences of established CHIP enrollees to the pre-enrollment experiences of previously uninsured and privately insured recent CHIP enrollees, controlling for observable characteristics. Parents of 4142 recent enrollees and 5518 established enrollees responded to the survey (response rates, 46% recent enrollees and 51% established enrollees). In the 10 survey states, about one-fourth of CHIP enrollees had a special health care need. Compared to being uninsured, parents of CSHCN who were established CHIP enrollees reported greater access to and use of medical and dental care, less difficulty meeting their child's health care needs, fewer unmet needs, and better dental health status for their child. Compared to having private insurance, parents of CSHCN who were established CHIP enrollees reported similar levels of access to and use of medical and dental care and unmet needs, and less difficulty meeting their child's health care needs. CHIP has significant benefits for eligible CSHCN and their families compared to being uninsured and appears to have some benefits compared to private insurance. Copyright © 2015 Academic Pediatric Association. All rights reserved.
Oftedahl, Elizabeth; Benedict, Ruth; Katcher, Murray L
The National Center for Health Statistics developed and conducted (2000-2002) the National Survey of Children with Special Health Care Needs (CSHCN), a module of the State and Local Area Integrated Telephone Survey (SLAITS). The purpose of this paper is to present the Wisconsin-specific data derived from analysis of the national survey and to make a comparison with the United States as a whole. In Wisconsin, approximately one fifth (21%) of households have CSHCN, and 13.4% of children have a special health care need; US comparison data are 20% and 12.8%, respectively. When examined by type of special need, Wisconsin shows slightly higher proportions of CSHCN in all categories, when compared with U.S. data, with the exception of limitation in activity. Families in Wisconsin with CSHCN are more likely to report being involved with medical decision making and satisfied with services they receive (67%); having a medical home (57%); having adequate insurance; easy use of community-based service systems (81%); and receiving services to make transition to adult life (7.5%). Though Wisconsin has a slightly higher proportion of CSHCN than the United States as a whole, a greater proportion of Wisconsin families receive important services. These measurements allow us to strive for further improvement through coordination of services in the private health care delivery sector with public health programs.
Lee, Katherine J; Ettinger, Ronald L; Cowen, Howard J; Caplan, Daniel J
To quantify differences and recent changes in health status among patients attending the Geriatric and Special Needs Dentistry (GSND) and Family Dentistry (FAMD) clinics at the University of Iowa College of Dentistry. A total of 388 randomly selected records from patients attending the GSND or FAMD clinics from 1996-2000 or from 2006-2010 were reviewed. Univariate and bivariate analyses were conducted, followed by multivariable logistic regression analyses to compare characteristics of patients across clinics. Between the two GSND cohorts, the mean number of medications reported increased from 4.0 to 6.5 (p Special Care Dentistry Association and Wiley Periodicals, Inc.
de Campos, André Luiz Vieira
This article analyzes the Special Public Health Service (SESP), a Brazilian-American agency created in 1942. Envisioned by the United States as a temporary wartime organization, SESP was transformed into an instrument of expansion of Brazilian state authority via the interactions around and Brazilian responses to these activities. After 1945, SESP reoriented its aims and became a structured organization consisting of a permanent horizontal network of health units linked to the Brazilian government's nation-building project. Notwithstanding their international origins, SESP's health policies involved not only the importation of a US model to Brazil but also projects marked by adaptation to the local reality.
The detection of nuclear or radioactive materials for homeland or national security purposes is inherently difficult. This is one reason detection efforts must be seen as just one part of an overall nuclear defense strategy which includes, inter alia, material security, detection, interdiction, consequence management and recovery. Nevertheless, one could argue that there has been a revolution in detection affairs in the past several decades as the innovative application of new technology has changed the character and conduct of detection operations. This revolution will likely be most effectively reinforced in the coming decades with the networking of detectors and innovative application of anomaly detection algorithms.
The AGU Public Affairs Committee will create an ad hoc committee to consider possible AGU position statements concerning the effects of nuclear war.The action was taken at the May 31, 1983, meeting of the Committee at the AGU Spring Meeting in Baltimore. Present were Carroll Ann Hodges, Chairman, and members Thomas J. Ahrens, David Cauffman, Jared Cohon, Stamatios Krimigis, Robert Murphy, Raymond Roble, and George Shaw. Also attending were the current Congressional Fellow Arthur Weissman and SPR—Cosmic Rays Section Secretary Miriam Forman.
Hanmer, Lyn A; Nicol, Edward
An analysis of roles and decision making structures to facilitate routine health information system (RHIS) implementation and use in public health facilities in South Africa identified a wide range of stakeholders in these processes. Two broad categories of RHIS 'special people' are analysed, i.e. leaders (administrative and/or clinical) and bridgers/support staff. In addition to health system personnel with specific responsibility for RHIS, users with an interest in effective use of RHIS and RHIS outputs, and staff of external system and/or service providers, can play significant roles in RHIS implementation and use.
Keim-Malpass, Jessica; Letzkus, Lisa C; Kennedy, Christine
Children with special health care needs (CSHCN) are children with medical or behavioral diagnoses that require services beyond those generally needed by pediatric populations. They account for a significant portion of pediatric health care expenditures and often have complicated treatment regiments. Health literacy has recently been recognized as a key indicator of quality chronic disease self-management and parental/caregiver health literacy of CSHCN is an understudied area. The purpose of this systematic review was to assess the available evidence of studies investigating parent/caregiver health literacy of CSHCN. Databases were searched to retrieve relevant articles for inclusion (dating from 1998 to 2014). Only studies that assessed the relationship between parent/caregiver health literacy on outcomes pertinent to CSHCN were included. Because of the limited number of studies, there were no restrictions placed on type of outcome. Thirteen studies were included in the final review with a range of health literacy assessments and outcome ascertainment. The majority of studies; (1) focused on the relationship between parental/caregiver health literacy and asthma outcomes, (2) were cross-sectional study designs, and (3) included samples recruited from pediatric clinics in academic medical settings. There were several gaps in the literature where future research is needed including; (1) direct assessment of child/adolescent health literacy, (2) inclusion of children with co-morbid conditions, (3) further assessment of the relationship between health literacy and health care utilization and cost, and (4) assessment of parental/caregiver health literacy in the inpatient care setting.
Eneriz-Wiemer, Monica; Sanders, Lee M; Barr, Donald A; Mendoza, Fernando S
One in 10 US adults of childbearing age has limited English proficiency (LEP). Parental LEP is associated with worse health outcomes among healthy children. The relationship of parental LEP to health outcomes for children with special health care needs (CSHCN) has not been systematically reviewed. To conduct a systematic review of peer-reviewed literature examining relationships between parental LEP and health outcomes for CSHCN. PubMed, Scopus, Cochrane Library, Social Science Abstracts, bibliographies of included studies. Key search term categories: language, child, special health care needs, and health outcomes. US studies published between 1964 and 2012 were included if: 1) subjects were CSHCN; 2) studies included some measure of parental LEP; 3) at least 1 outcome measure of child health status, access, utilization, costs, or quality; and 4) primary or secondary data analysis. Three trained reviewers independently screened studies and extracted data. Two separate reviewers appraised studies for methodological rigor and quality. From 2765 titles and abstracts, 31 studies met eligibility criteria. Five studies assessed child health status, 12 assessed access, 8 assessed utilization, 2 assessed costs, and 14 assessed quality. Nearly all (29 of 31) studies used only parent- or child-reported outcome measures, rather than objective measures. LEP parents were substantially more likely than English-proficient parents to report that their CSHCN were uninsured and had no usual source of care or medical home. LEP parents were also less likely to report family-centered care and satisfaction with care. Disparities persisted for children with LEP parents after adjustment for ethnicity and socioeconomic status. Parental LEP is independently associated with worse health care access and quality for CSHCN. Health care providers should recognize LEP as an independent risk factor for poor health outcomes among CSHCN. Emerging models of chronic disease care should integrate and
Kuo, Dennis Z; Bird, T Mac; Tilford, J Mick
The objective of this study is to examine the association of family-centered care (FCC) with specific health care service outcomes for children with special health care needs (CSHCN). The study is a secondary analysis of the 2005-2006 National Survey of Children with Special Health Care Needs. Receipt of FCC was determined by five questions regarding how well health care providers addressed family concerns in the prior 12 months. We measured family burden by reports of delayed health care, unmet need, financial costs, and time devoted to care; health status, by stability of health care needs; and emergency department and outpatient service use. All statistical analyses used propensity score-based matching models to address selection bias. FCC was reported by 65.6% of respondents (N = 38,915). FCC was associated with less delayed health care (AOR: 0.56; 95% CI: 0.48, 0.66), fewer unmet service needs (AOR: 0.53; 95% CI: 0.47, 0.60), reduced odds of ≥1 h/week coordinating care (AOR: 0.83; 95% CI: 0.74, 0.93) and reductions in out of pocket costs (AOR: 0.88; 95% CI: 0.80, 0.96). FCC was associated with more stable health care needs (AOR: 1.11; 95% CI: 1.01, 1.21), reduced odds of emergency room visits (AOR: 0.90; 95% CI: 0.82, 0.99) and increased odds of doctor visits (AOR: 1.25; 95% CI: 1.14, 1.37). Our study demonstrates associations of positive health and family outcomes with FCC. Realizing the health care delivery benefits of FCC may require additional encounters to build key elements of trust and partnership.
Lee, Jenny J.; Helm, Matthew
This study explores student affairs capitalism as the alteration of professional practice towards the financial interests of institutions. Student affairs capitalism has the potential to create dynamics in which the interests of students become secondary to the institution's economic needs. This study examined this phenomenon from the perspectives…
Sharma, Kanika; Popat, Paiyal; Lee, Diane; Hill, Caterina; Kaplan, Marc; Factor, Cae Ellen; Seibel, Kristine; Schiano, Frank; De Leon, Risha; Itty, Abraham; Nalliah, Romesh R
As part of the 2009-2010 Massachusetts Dental Society Leadership Institute, two oral health screening and prevention education programs were conducted at institutions in Massachusetts that serve individuals with special health care needs (ISHCN). Members of the Leadership Institute class of 2009-2010 built relationships with two institutions that served individuals with ISHCN-one that housed residents with special health care needs and another that served as a day-care facility. Oral health screenings were conducted at both institutions. Retrospective analysis of the data from the two screenings is presented in the current study. Forty-four oral health screenings were conducted at the organization that acted as a daycare/drop-in center for ISHCN who reside in a family home, and 21 screenings were conducted of ISHCN at a residential facility. Among those residing in family homes, 23 percent needed urgent care whereas only 5 percent who were living in an institution needed urgent care. Overall, a total of 40 percent had untreated caries and 48 percent were free of caries based on the oral health screenings. Sixteen percent of subjects were in pain from their mouth at the time of the screenings.
Butani, Yogita; Gansky, Stuart A; Weintraub, Jane A
The aim of this study was to compare parental perceptions of oral health status and access to dental services by children in 34 special education and 16 mainstream public elementary school classes in San Mateo County, California. A self-administered parental survey was utilized and included questions about demographics, oral health, and dental utilization. The overall response rate was 58.8%. After adjusting for age and gender of the child, compared to mainstream, parents of students in special education classes were significantly more likely to report their children to have worse oral health (OR = 2.4, 95% CI 1.54, 3.67), be lacking a past year dental visit (OR = 1.96, 95% CI 1.01, 3.84), and have missed school days due to dental reasons (OR = 2.5, 95% CI 1.55, 4.17). Both groups rated their children's oral health inferior to the overall health rating (p < .001). The authors concluded that disparities exist between the two groups in parental perceptions of their children's oral health status and dental service utilization.
Fulda, Kimberly G; Johnson, Katandria L; Hahn, Kristen; Lykens, Kristine
The purpose of this study was to identify geographic differences in health indicators for children with special health care needs (CSHCN). It was hypothesized that geographic differences in unmet health care needs exist among CSHCN by region in the United States. Data were obtained from the National Survey of Children with Special Health Care Needs, 2005-2006. Nine variables representing unmet needs were analyzed by geographic region. The region with the highest percent of unmet needs was identified for each service. Logistic regression was utilized to determine differences by region after controlling for age, gender, ethnicity, race, federal poverty level, relationship of responder to child, insurance status, severity of condition, and size of household. A total of 40,723 CSHCN were represented. Crude analysis demonstrated that the greatest unmet need for routine preventive care, specialist care, prescription medications, physical/occupational/speech therapy, mental health care, and genetic counseling occurred in the West. The greatest unmet need for preventive dental care, respite care, and vision care occurred in the South. Significant differences between regions remained for six of the nine services after controlling for potential confounders. Geographic differences in unmet health care needs exist for CSHCN. Further delving into these differences provides valuable information for program and policy planning and development. Meeting the needs of CSHCN is important to reduce cost burden and improve quality of life for the affected child and care providers.
Petitgout, Janine M; Pelzer, Daniel E; McConkey, Stacy A; Hanrahan, Kirsten
A hospital-based Continuity of Care program for children with special health care needs is described. A family-centered team approach provides care coordination and a medical home. The program has grown during the past 10 years to include inpatients and outpatients from multiple services and outreach clinics. Improved outcomes, including decreased length of stay, decreased cost, and high family satisfaction, are demonstrated by participants in the program. Pediatric nurse practitioners play an important role in the medical home, collaborating with primary care providers, hospital-based specialists, community services, and social workers to provide services to children with special health care needs. Copyright © 2013 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.
Fortune, B; Olszewski, J; Shaheen, P
The Children's Special Health Care Services Advisory Committee is an advisory group that includes stakeholders in the delivery of care for children with special health-care needs. An emphasis has purposely been placed on consumer participation to ensure adequate voice and balance with other provider, legislative, and bureaucratic interests. The Advisory Committee has assumed an aggressive and complete role in reviewing and recommending every aspect of the program. As a result of this active co-ownership, the program has repeatedly survived threats of serious budget cuts and reductions to its base. Agreement between providers and consumers on values, structure, and operational needs has been reached. A win-win approach has been possible, not only in the planning and growth of the program but also in the policy arena, legislatively, and with the administration.
Porterfield, Shirley L; McBride, Timothy D
We examined the association between several variables and the use of specialist physician services, developmental therapies, and prescription medications among children with special health care needs (N=38866). We used a bivariate probit model to estimate whether a given child needed specialized services and whether that child accessed those services; we controlled for activity limitations and severity of special needs. Variables included family income, mother's (or other caregiver's) educational level, health insurance coverage, and perceived need for specialized services. We used data from the 2001 National Survey of Children with Special Health Care Needs. Lower-income and less-educated parents were less likely than higher-income and more-educated parents to say their special needs children needed specialized health services. The probability of accessing specialized health services-when needed-increased with both higher family income and insurance coverage. Children with special health care needs have less access to health services because their parents do not recognize the need for those services. An intervention in the form of information at the family level may be an appropriate policy response.
Leung, Brenda; Lauche, Romy; Leach, Matthew; Zhang, Yan; Cramer, Holger; Sibbritt, David
Special diets are frequently used by the public but reasons for use and characteristics of users remain unclear. To determine prevalence of the use of special diets, the individual characteristics associated with their use and reasons for use. The secondary analysis used data from the 2012 National Health Interview Survey (NHIS), a cross-sectional household interview survey of a nationally representative sample of non-hospitalized US adult populations ( n = 34,525). The dependent variables in this secondary analysis were the use of a special diet (vegetarian, macrobiotic, Atkins, Pritikin, and Ornish) ever and during the past 12 months. Independent variables included sociodemographic, clinical and behavioral variables. Prevalence of special diet use and reasons for use were analyzed descriptively. Associations between independent and dependent variables were analyzed using Chi-square tests and logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Lifetime and 12-month prevalence of using special diets were 7.5% (weighted n = 17.7 million) and 2.9% (weighted n = 6.9 million), respectively. Individuals using special diets in the past 12 months were more likely female (OR = 1.45; 95% CI = 1.21-1.74), not married (OR = 0.76; 95% CI = 0.63-0.91), college-educated (OR = 1.98; 95% CI = 1.25-3.11) and depressed (OR = 1.50; 95% CI = 1.14-1.98). They more likely also used herbal products (OR = 2.35; 95%CI = 1.84-2.99), non-vitamin (OR = 1.82; 95% CI = 1.45-2.27) and vitamin supplements (OR = 1.57; 95% CI = 1.24-1.99). Diets were mainly used to improve overall health (76.7%) or for general wellness/prevention (70.4%). Special diets are mainly used for unspecific health reasons by those who are females, have a college degree or with depression, and commonly used in conjunction with herbs and dietary supplements.
The African Journal of International Affairs (AJIA) is a bi-annual publication of CODESRIA, Dakar, Senegal. It offers a platform for analyses on contemporary issues in African International Affairs in relation to global developments as they affect Africa. AJIA welcomes contributions in English and in French from both African ...
The 7th annual Health Information Technology (IT) issue provides a window into how health IT tools are working well, how they may not be working as intended, and what we can do to continue making progress toward optimal use of technology to accomplish our shared goals: better health, better care experience, and lower per capita cost.
Full Text Available Introduction: Children with special health care needs are an exponentially growing population needing integrated health care programmes that involve primary, community, hospital and tertiary care services. The aims of the study are (1 to develop and validate the Special Needs Kids Questionnaire (SpeNK-Q designed to measure parents’ perspective on continuity of care for children with special health care needs and (2 to evaluate the continuity of care based on parental experiences in this population.Methods: SpeNK-Q was derived from a previous qualitative study and was based on Haggerty’s constructs of informational, management and relational continuity. Parents of preterm birth children completed the 20-item SpeNK-Q at the second or subsequent planned follow-up visit after the child’s hospital discharge. Principal component analysis was used to examine the structure of the instrument.Results: Principal component analysis of 101 questionnaires administered allowed us to identify five factors explaining 60.2% of item variance: informational continuity; coordination of care; continuity of family–paediatrician relationship; family support; information on care plan.Conclusions and discussion: SpeNK-Q proved to be a psychometrically promising instrument. Its utilisation could improve the identification of areas for service development, the delivery of coordinated care and support policy makers in redesigning integrated services.
Rucci, Paola; Latour, Jos; Zanello, Elisa; Calugi, Simona; Vandini, Silvia; Faldella, Giacomo; Fantini, Maria Pia
Children with special health care needs are an exponentially growing population needing integrated health care programmes that involve primary, community, hospital and tertiary care services. The aims of the study are (1) to develop and validate the Special Needs Kids Questionnaire (SpeNK-Q) designed to measure parents' perspective on continuity of care for children with special health care needs and (2) to evaluate the continuity of care based on parental experiences in this population. SpeNK-Q was derived from a previous qualitative study and was based on Haggerty's constructs of informational, management and relational continuity. Parents of preterm birth children completed the 20-item SpeNK-Q at the second or subsequent planned follow-up visit after the child's hospital discharge. Principal component analysis was used to examine the structure of the instrument. Principal component analysis of 101 questionnaires administered allowed us to identify five factors explaining 60.2% of item variance: informational continuity; coordination of care; continuity of family-paediatrician relationship; family support; information on care plan. SpeNK-Q proved to be a psychometrically promising instrument. Its utilisation could improve the identification of areas for service development, the delivery of coordinated care and support policy makers in redesigning integrated services.
Full Text Available Introduction: Children with special health care needs are an exponentially growing population needing integrated health care programmes that involve primary, community, hospital and tertiary care services. The aims of the study are (1 to develop and validate the Special Needs Kids Questionnaire (SpeNK-Q designed to measure parents’ perspective on continuity of care for children with special health care needs and (2 to evaluate the continuity of care based on parental experiences in this population. Methods: SpeNK-Q was derived from a previous qualitative study and was based on Haggerty’s constructs of informational, management and relational continuity. Parents of preterm birth children completed the 20-item SpeNK-Q at the second or subsequent planned follow-up visit after the child’s hospital discharge. Principal component analysis was used to examine the structure of the instrument. Results: Principal component analysis of 101 questionnaires administered allowed us to identify five factors explaining 60.2% of item variance: informational continuity; coordination of care; continuity of family–paediatrician relationship; family support; information on care plan. Conclusions and discussion: SpeNK-Q proved to be a psychometrically promising instrument. Its utilisation could improve the identification of areas for service development, the delivery of coordinated care and support policy makers in redesigning integrated services.
Rucci, Paola; Latour, Jos; Zanello, Elisa; Calugi, Simona; Vandini, Silvia; Faldella, Giacomo
Introduction Children with special health care needs are an exponentially growing population needing integrated health care programmes that involve primary, community, hospital and tertiary care services. The aims of the study are (1) to develop and validate the Special Needs Kids Questionnaire (SpeNK-Q) designed to measure parents’ perspective on continuity of care for children with special health care needs and (2) to evaluate the continuity of care based on parental experiences in this population. Methods SpeNK-Q was derived from a previous qualitative study and was based on Haggerty’s constructs of informational, management and relational continuity. Parents of preterm birth children completed the 20-item SpeNK-Q at the second or subsequent planned follow-up visit after the child’s hospital discharge. Principal component analysis was used to examine the structure of the instrument. Results Principal component analysis of 101 questionnaires administered allowed us to identify five factors explaining 60.2% of item variance: informational continuity; coordination of care; continuity of family–paediatrician relationship; family support; information on care plan. Conclusions and discussion SpeNK-Q proved to be a psychometrically promising instrument. Its utilisation could improve the identification of areas for service development, the delivery of coordinated care and support policy makers in redesigning integrated services. PMID:27118963
Campanaro, Maria; Huebner, Colleen E; Davis, Beth Ellen
The oral hygiene routines of preschool-age children with special health care needs (CSHCN) were examined to identify caregiver behaviors and beliefs associated with twice daily tooth brushing. Ninety caregivers of CSHCN, ages 23 to 62 months, were interviewed to determine supports or barriers to tooth brushing. Ninety-eight percent of caregivers had begun brushing their child's teeth and half reported brushing twice daily. Caregivers' brushing skills and the availability of child-friendly supplies were associated with twice daily versus less frequent brushing (p = .02). This study adds insight into the challenges of establishing daily oral health care for children who must rely on others for their care. The facilitators and barriers to tooth brushing by caregivers of CSHCN are similar to those noted previously among parents of typically developing children. Efforts to improve all caregivers' oral hygiene skills are needed. For caregivers of CSHCN, oral health teaching opportunities may exist among professionals who provide ongoing medical care, special services and therapies. © 2014 Special Care Dentistry Association and Wiley Periodicals, Inc.
Conrey, Elizabeth J; Seidu, Dazar; Ryan, Norma J; Chapman, Dj Sam
Medical homes deliver primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate and culturally effective. Children with special health care needs (CSHCN) require a wide range of support to maintain health, making medical home access particularly important. We sought to understand independent risk factors for lacking access. We analyzed Ohio, USA data from the National Survey of Children with Special Health Care Needs (2005-2006). Among CSHCN, 55.6% had medical home access. The proportion achieving each medical home component was highest for having a personal doctor/nurse and lowest for receiving coordinated care, family-centered care and referrals. Specific subsets of CSHCN were significantly and independently more likely to lack medical home access: Hispanic (AOR=3.08), moderate/high severity of difficulty (AOR=2.84), and any public insurance (AOR=1.60). Efforts to advance medical home access must give special attention to these CSHCN populations and improvements must be made to referral access, family-centered care, and care coordination.
Oredugba, Folakemi A; Perlman, Steven P
Special Olympics (SO) athletes in many parts of the world were reported to have poor oral health and high unmet treatment needs. This study was carried out to determine the oral health condition and treatment needs of SO athletes in Nigeria and to suggest ways of improving access to oral healthcare. Consenting athletes who participated in SO events in Nigeria from 2007 to 2008 received oral examination and evaluation by trained volunteers, using standardized Special Smiles screening forms and procedures designed for the event. A total of 1,286 athletes aged 3 to 71 years, 480 (37.3%) females and 806 (62.7%) males, participated in the screening. The majority (86.1%) cleaned their mouths once daily, 12.2% complained of pain, 21.1% had untreated decay, 6.6% had dental injury, 48.1% had gingival signs suggestive of periodontal disease, 15.8% required urgent treatment, and 43.7% required non-urgent treatment. We found that the oral health of SO athletes in this study was poorer than that of the general population in Nigeria. ©2010 Special Care Dentistry Association and Wiley Periodicals, Inc.
education through conferences, organisations and publications, student affairs professionals ... assessment, student affairs, best practices, higher education. ..... on college campuses: Shifting the focus from teaching to learning. Boston, MA: Pearson. International Association of Student Affairs and Services (n.d.). History.
Okumura, Megumi J; Hersh, Aimee O; Hilton, Joan F; Lotstein, Debra S
Despite over 500,000 adolescents with special health care needs transitioning to adulthood each year, limited information is available on their health status or their access to care after transition. To describe the change in health status and access to care of a nationally sampled, longitudinal cohort of young adults with special health care needs (ASHCN). We analyzed follow-up data collected in the 2007 Survey of Adult Transition and Health on young adults who were 14-17 years of age when their parents participated in the 2001 National Survey of Children with Special Health Care Needs. We describe changes in access to care and health status over time, and used logistic regression to identify characteristics that were associated with declining health status in this cohort. 1,865 participants, aged 19-23 years, completed the Survey of Adult Transition and Health. Between 2001 and 2007, there was a 3.6 fold increase in the proportion experiencing delayed or forgone care; 10% reported a decline in health status. There was a 7.7-fold increase in the proportion reporting no insurance. In regression analysis, factors associated with declining health status between 2001 and 2007 included underlying disease severity and delayed or forgone care in young adulthood. We found significant deterioration in insurance coverage, usual source of care and receiving timely health care as ASHCN aged into adulthood, and that this was associated with decline in health status. Our findings suggest that further population-based analyses of health outcomes are needed to plan for interventions to assist this vulnerable population. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Moradi, Ghobad; Safari, Hossein; Piroozi, Bakhtiar; Qanbari, Laila; Farshadi, Salahadin; Qasri, Homan; Farhadifar, Fariba
Background: One of the main goals of health systems is to protect people against financial risks associated with diseases that can be catastrophic for patients. In 2014, Health Sector Evolution Plan (HSEP) was implemented in Iran; one of the objectives of HSEP was to reduce out-of-pocket payments and provide more financial protection for people. Therefore, the present study aimed at exploring the likelihood of facing catastrophic health expenditures (CHE) among households with members suffering from dialysis, kidney transplant, or multiple sclerosis (MS) after the implementation of HSEP. Methods: A total number of 385 households were selected using stratified random sampling and were asked to complete the World Health Survey questionnaire through telephone conversations. As outlined by the World Health Organization (WHO), when household out-of-pocket expense for health services is ≥40% of its capacity to pay, then that household is considered to be facing CHE. Furthermore, determinants of CHE were identified using logistic regression. Results: The percentage of facing catastrophic health care expenditures for households with a MS, dialysis, and kidney transplant patient was 20.6%, 18.7%, and 13.8%, respectively. Results of logistic regression analysis revealed that patient's economic status, level of education, supplementary insurance status, type of disease, multiple members with special diseases in the household, rural residence, use of inpatient, dental, and rehabilitation services were effective factors for determining the likelihood of facing CHE. Conclusion: Despite the implementation of HSEP, the percentage of CHE is still high for households that have members who suffer from special diseases. However, basic health insurance packages should be amended and more cost-sharing exemptions should be granted to provide more financial protection for the vulnerable households.
Knapp, Caprice; Madden, Vanessa; Wang, Hua; Sloyer, Phyllis; Shenkman, Elizabeth
The Internet has revolutionized the way in which many Americans search for health care information. Unfortunately, being able to use the Internet for this purpose is predicated on having access to the Internet and being able to understand and comprehend online health information. This is especially important for parents of children with special health care needs who are forced to make many medical decisions throughout the lives of their children. Yet, no information is available about this vulnerable group. For parents of children with special health care needs we sought to (1) describe their Internet access and use, (2) determine which child and household factors were associated with Internet use, (3) describe eHealth literacy of Internet users, and (4) determine which child and household factors were associated with greater eHealth literacy. This was a cross-sectional telephone survey of 2371 parents whose children with special health care needs were enrolled in Florida's Medicaid and State Children's Health Insurance Plan (SCHIP) programs (4072 parents were approached). To be enrolled in the program, families must have incomes that are less than or equal to 200% of the federal poverty level. The eHealth Literacy Scale (eHEALS) was used to measure eHealth literacy. Descriptive and multivariate analyses were conducted to address the study objectives. The survey response rate was 58.2%. Participating parents were mainly female (2154/2371, 91%), white non-Hispanic (915/2371, 39%), English speaking (1827/2371, 77%), high school graduates (721/2371, 30%), married (1252/2371, 53%), and living in a two-parent household (1212/2371, 51%). Additionally, 82% of parents (1945/2371) in the sample reported that they used the Internet, and 49% of those parents used it daily (1158/2371). Almost three-quarters of Internet users had access to the Internet at home while about one-half had access at work. Parents who were African American, non-English speaking, older, and not
Full Text Available Objectives. To investigate the health of young Sami in Sweden and the relationship between health and experience of negative societal treatment due to ethnicity, as well as socio-demographic background factors. Study design. Cross-sectional population-based questionnaire study. Methods. A total of 876 persons aged 18–28 and involved in Sami associated activities were addressed, and 516 (59% responded to a questionnaire investigating physical health, mental health, and stress. Data were analyzed with regard to gender, family situation, occupation, education, enculturation factors and experience of being badly treated because of ethnicity. Results. A majority of the young Sami reported feeling healthy, but close to half of the group reported often having worries, often forgetting things and often experiencing lack of time for doing needed things. Women and those living alone reported a more negative health. Furthermore, half of the group had perceived bad treatment because of Sami ethnicity, and this was negatively associated with some aspects of mental health. Conclusion. The young Sami had a rather good and possibly slightly better health than other young Swedes, except regarding worries and stress. A high degree of bad treatment due to Sami ethnicity and its negative association with health, may partly explain the high degree of some health problems.
Nelson, Linda P; Getzin, Anne; Graham, Dionne; Zhou, Jing; Wagle, Elke M; McQuiston, Jessie; McLaughlin, Suzanne; Govind, Akshay; Sadof, Matthew; Huntington, Noelle L
The purpose of this study was to conduct the first known large scale survey of parents of children with special health care needs (CSHCN) to determine their child's: oral health status; access to dental care; perceived barriers (environmental/system and nonenvironmental/family); and oral health quality of life, accounting for each child's medical diagnosis and severity of diagnosis. A 72-item survey was sent to 3760 families of CSHCN throughout urban and rural Massachusetts. The study yielded 1,128 completed surveys. More than 90% of the children had seen a dentist within the past year; 66% saw a pediatric dentist, and 21% needed intense behavioral interventions. Although most families had high education levels, private dental insurance, and above average incomes, 20% of CSHCN had an unmet dental need. Children with craniofacial anomalies had twice as many unmet needs and children with cystic fibrosis had fewer unmet needs. Children with cerebral palsy, autism, developmental delay, and Down syndrome had more aversions to dental treatment, more treatment complications posed by their medical conditions, and more difficulty finding a dentist willing to provide care. Children with cystic fibrosis, metabolic disorders, or hemophilia encountered fewer barriers to care. The data paint a picture of high unmet dental needs with subpopulations of children with special health care needs who are more at risk for system barriers and internal family barriers to care based on their medical diagnoses.
Knipper, Michael; Baumann, Adrian; Hofstetter, Christine; Korte, Rolf; Krawinkel, Michael
Internationalizing higher education is considered to be a major goal for universities in Germany and many medical students aspire to include international experiences into their academic training. However, the exact meaning of "internationalizing" medical education is still poorly defined, just as is the possible pedagogic impact and effects. Against this background, this article presents the special track curriculum on global health (in German: Schwerpunktcurriculum Global Health, short: SPC) at Justus Liebig University Giessen, which was established in 2011 as a comprehensive teaching program to integrate international perspectives and activities systematically into the clinical years of the medical curriculum. The report of the structure, content, didactic principles and participants' evaluations of the SPC is embedded into a larger discussion of the pedagogic value of a broad and interdisciplinary perspective on "global health" in medical education, that explicitly includes attention for health inequities, social determinants of health and the cultural dimensions of medicine and health abroad and "at home" (e.g. in relation to migration). We conclude that if properly defined, the emerging field of "global health" represents a didactically meaningful approach for adding value to medical education through internationalizing the curriculum, especially in regard to themes that despite of their uncontested value are often rather weak within medical education. The concrete curricular structures, however, have always to be developed locally. The "SPC" at Giessen University Medical School is only one possible way of addressing these globally relevant issues in one particular local academic setting.
Petrova, Elena G; Hyman, Michael; Estrella, Maria Regina Padilla; Inglehart, Marita R
The purposes of this study were to increase dentists' understanding of how to best engage parents and their children with special health care needs (SHCN) in oral health promotion efforts and explore the relationships between these patients' level of functioning and oral health and their parents' comfort concerning oral health promotion. Survey data were collected from 154 caregivers of SHCN children. Children's oral health data were obtained from their clinical charts. The patients' level of functioning ranged from the lowest to the highest regarding their ability to listen/understand, talk, relate to others, care for themselves, play with others, and participate in physical activities. Children's gingival health was correlated with their ability to talk (r=-.12; Ppatient's level of functioning might predict the degree to which parents actually engage in oral health promotion efforts and are interested in oral health-related education.
Lima, Nísia Trindade; Maio, Marcos Chor
The article transcribes and comments on three papers published by sociologist José Arthur Rios in the Boletim do Serviço Especial de Saúde Pública in the early 1950s. These texts stand as valuable references in understanding a period in which projects for cultural change guided health programs and especially health education initiatives. The article begins by portraying the backdrop against which the Special Public Health Service conducted its activities following its 1942 creation as the result of a cooperation agreement between the Brazilian and U.S. governments. Aspects of José Arthur Rios' professional trajectory and intellectual influences are also examined, and the role of the social scientist in non-academic areas and in the shaping of public agencies and policies in Brazil is discussed.
Hartwig, Andreia Drawanz; Stüermer, Vanessa Müller; da Silva-Júnior, Ivam Freire; Schardosim, Lisandrea Rocha; Azevedo, Marina Sousa
To assess the effects of an oral health education strategy targeted at students with disabilities. This quasi-experimental study included students aged 7 to 24 years. The intervention was conducted for 5 weeks and divided into 2 phases: (1) comprising supervised toothbrushing and educational activities to students; (2) verbal oral health instructions and oral hygiene demonstration targeted at the caregivers. A clinical examination was conducted to evaluate the dental debris and gingival bleeding before the intervention, and the Wilcoxon test was performed after phase 1 and 2 for comparisons between paired samples. A significant decrease in dental debris and gingival indices compared with baseline occurred after phase 1 (p educational intervention to students with disabilities had a positive impact on their oral health. © 2017 Special Care Dentistry Association and Wiley Periodicals, Inc.
Pletneva, Natalia; Ruiz de Castaneda, Rafael; Baroz, Frederic; Boyer, Celia
This paper presents the results of a blind comparison of top ten search results retrieved by Google.ch (French) and Khresmoi for everyone, a health specialized search engine. Participants--students of the Faculty of Medicine of the University of Geneva had to complete three tasks and select their preferred results. The majority of the participants have largely preferred Google results while Khresmoi results showed potential to compete in specific topics. The coverage of the results seems to be one of the reasons. The second being that participants do not know how to select quality and transparent health web pages. More awareness, tools and education about the matter is required for the students of Medicine to be able to efficiently distinguish trustworthy online health information.
Hamidi, Yadollah; Hazavehei, Seyed Mohammad Mahdi; Karimi-Shahanjarini, Akram; SeifRabiei, Mohamad Ali; Farhadian, Maryam; Alimohamadi, Shohreh; Kharghani Moghadam, Seyedeh Melika
The prophecy of health promoting hospitals (HPH) is bringing about a change and transition from treatment-oriented to health-oriented attitudes. In Iran, hospitals usually play the traditional roles. The present study was aimed at the evaluation of the health promotion status in specialized hospitals associated with Hamadan University of Medical Sciences (HUMS). This applied study was conducted in two Hamadan specialized hospitals in the Hamadan city. The health promotion status was evaluated using a self-assessment checklist designed by the World Health Organization's HPH. The evaluation was done in five standards including management policy, patient assessment, patient information and intervention, promotion of a healthy workplace and continuity and cooperation. The results showed that both the hospitals studied had a poor status in terms of promoting a healthy workplace (average = 31.24%) and management policy standards (average = 35.29%) in comparison with the other relevant standards: patient assessment (53.12%), patient information and intervention (62.5%), continuity and cooperation (65.78%)). The results of the standards and sub-standards status displayed better performance in the cardiovascular hospital (53.67%) compared to the women and parturition hospital (42.64%). The findings indicated that HPH standards are very low in the studied hospitals. The reason behind this wide gap might be due to the fact that hospitals in Iran are more treatment-oriented and patient-oriented and they do not play an active part in health promoting. It was found that management policy and promoting healthy workplace standards had the worst status and must be improved.
There are 11.2 million children with special health care needs in the United States or one in five households caring for a special needs child. A small group of children who need continuous medical, nursing, therapeutic services that enable them to survive is growing in numbers. This study examined physical health (physical functioning), mental health (emotional, social, and cognitive functioning; communication; and worry), family functioning (daily activities, family relationships), and care burden (caregiver employment, caregiving time, travel time, health-related out-of-pocket expenditures) of parent caregivers for medically complex, medical technology-dependent children. Data were collected once a month for 5 months on 84 parents recruited in South Florida using the Pediatric Quality of Life Family Impact Module. Physically, parents were tired when they woke up: too tired to do the things they liked to do and with little energy for chores or social activities. Mentally, they were frustrated, anxious, and angry; felt helpless and hopeless; had cognitive problems remembering and focusing on tasks; were worried about the child's medications, treatments, side effects; and were anxious about child's future and effect of the child's condition on other family members. Socially, they felt isolated and that people did not understand their family situation; they found it hard to talk with others including physicians and nurses. Average weekly hours of direct care was 33.0 (SD = 30.4 hours); average monthly out-of-pocket expenditures was $348.78 (SD = $623.34). It is essential to assess parents' physical and mental health and functioning and to provide interventions to improve health and functioning for both the parents and the children for whom they are caring. © The Author(s) 2014.
... Government employees in the Public Health Service. 5501.107 Section 5501.107 Administrative Personnel... employees in the Public Health Service. (a) Applicability. This section applies to special Government employees in the Public Health Service who otherwise are prohibited from accepting compensation for teaching...
Tétreault, S; Freeman, A; Carrière, M; Beaupré, P; Gascon, H; Marier Deschênes, P
In 2003, Quebec's Ministry of Health and Social Services (MSSS) and the Ministry of Education, Recreation and Sports (MELS) concluded the Agreement for the complementarity of services between the health and social services network and the education network. The objectives of the current investigation were to evaluate the implementation of this Agreement and its impact upon renewal of practices and services, and to investigate the consequences for children with special needs and their families. The specific focus of this article is to describe parents' perspectives regarding the impact of this Agreement upon them and their children. Interviews were conducted with 56 parents of children with disabilities, social maladjustment or learning difficulties across the province of Quebec. Data were analysed using content analysis. Most parents were not directly aware of any contact between school staff and health or social professionals, although discussions might have been held without their knowledge. The intervention plans seemed to be the main vehicle through which some parents perceived collaboration to be occurring. For parents, the impact upon actual practices or collaborative work is either minimal or non-existent. School inclusion of children with special needs is a challenge for all societies. The Agreement illustrates the Quebec government's intent to promote an alliance between two complex networks and has the potential to greatly benefit children and their families. However, more concrete action is required in order to realize specific changes regarding work cohesion and service organization for these groups. © 2013 John Wiley & Sons Ltd.
Barón Cano, Natalia; Mosquera Gordillo, Miguel Armando; Ballester Añón, Rosa
Malaria was one of the most important public health problems of the Colonial Medicine and, for this reason, the subject was reflected in the Spanish medical journalism. The aim of the paper was to reconstruct the Spanish contributions to international health during the first half of the twentieth century. The primary sources of information on malaria were the medical journals Medicina de los Países Cálidos and Medicina Colonial, between 1929 and 1954. The documents were classified according to the sections of the magazine and its contents were studied, framing them in the history of international public health. In primary sources were found 466 documents. Malaria was one of the major diseases of the Spanish Protectorate in Morocco and Spanish Guinea, favoured by the occupation of the Spanish army. Antimalaria campaigns included strategies such as the use of Dichloro-diphenyl-trichloroethane, preventive education and massive quininización. Malariology in the specialized journalism, experienced a growing boom. The most outstanding authors in magazines analyzed were Gustavo Pittaluga, Sadí de Buen, Eliseo de Buen and Juan Gil-Collado. The Spanish specialized journalism provides the importance e interaction in antimalaria campaigns in Spain and Spanish African colonies of scientific, professional, political and military factors. The colonial situation was negative and marked differences between metropolis and colonies in terms of the effort, efficiency and the different temporal sequence of the measures undertaken.
Kan, Kristin; Choi, Hwajung; Davis, Matthew
Immigrant children in the United States historically experience lower-quality health care. Such disparities areconcerning for immigrant children with special health care needs (CSHCNs). Our study assesses the medical home presence for CSHCN by immigrant family type and evaluates which medical home components are associated with disparities. We used the 2011 National Survey of Children's Health, comparing the prevalence and odds of a parent-reported medical home and 5 specific medical home components by immigrant family types using bivariate and multivariate logistic regression. Foreign-born CSHCNs were less likely than CSHCNs with US-born parents to have a medical home (adjusted odds ratio = 0.40, 95% confidence interval 0.19-0.85). The adjusted prevalence of having a medical home was 28% among foreign-born CSHCNs (P special needs also had a lower odds of a medical home, compared with children with US-born parents (adjusted odds ratio = 0.62, 0.46-0.83). The medical home component most frequently absent for immigrant children without special needs and CSHCNs with a foreign-born parent was family-centered care. In contrast, foreign-born CSHCNs most often lacked care coordination (adjusted prevalence = 37% versus 56% for CSHCNs with US-born parents; P < .05). Disparities in medical home presence for CSHCNs appear to be exacerbated by immigrant family type. Efforts focused on improving family-centered care and care coordination may provide the greatest benefit for immigrant CSHCNs. Copyright © 2016 by the American Academy of Pediatrics.
Mcbean, Amanda L; Schlosnagle, Leo
Parents of children with special healthcare needs (CSHCNs) report poorer sleep than parents of typically developing (TD) children, which has been associated with poorer mental health. The relations between sleep disturbances and general health and memory among this population are unknown. The current study aimed to replicate the findings that parents of CSHCNs report poorer sleep quality than parents of TD children, and further examine how sleep is related to general health and memory. Participants (75 parents of TD children; 97 parents of CSHCNs) completed an online questionnaire consisting of: demographics, the Pittsburgh Sleep Quality Index (PSQI), the Prospective Retrospective Memory Questionnaire (PRMQ) and the Healthy Days Measure. Parents of CSHCNs reported worse global sleep than parents of TD children. Parents of CSHCNs took longer to fall asleep at night, had shorter sleep duration and worse subjective sleep quality than parents of TD children. Parents of CSHCNs also had worse prospective memory and were more likely to report poor general health than parents of TD children. Poorer sleep quality was associated with worse memory and health among both parents of TD children and parents of CSHCNs. Results from this study highlight the importance of addressing the sleep of parents of CSHCNs and support the need for more research in this area. By recognizing factors associated with parent's health and functioning, service providers may be better able to implement support programs for parents of CSHCNs. © 2015 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.
Mirza, M; Krischer, A; Stolley, M; Magaña, S; Martin, M
A large number of U.S. children are identified as having special health care needs (CSHCN). Despite parents' central role in managing their child's needs, many parents report difficulties in navigating service systems, finding information about their child's condition, and accessing health care and community resources. Therefore, there is a need for interventions that "activate" parents of children with special health care needs to increase their knowledge, skills, and confidence in managing, coordinating, and advocating for their child's needs. This study sought to review the existing literature and examine the effects of parent support interventions that focus on parental activation either in part or whole, on child, parent, or family outcomes. Specific aims included (a) summarizing the nature and content of interventions; (b) describing changes in relevant outcomes; (c) identifying limitations and making recommendations for future research. Following electronic databases were searched: MEDLINE, EMBASE, PsycINFO via ProQuest, PubMed, Cumulative Index to Nursing and Allied Health via EBSCO, Education Resources Information Center (ERIC) via ProQuest, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), and Google Scholar. Twenty-two studies were selected, data were extracted, and quality was assessed using standardized procedures. Five intervention categories were identified: parent-to-parent supports, psycho-educational groups, content-specific groups, community health worker model, and self-management-based interventions. Although most studies showed positive effects of the intervention, evidence was inconsistent for parental outcomes such as self-efficacy, confidence, strain, depression, and perceived social support. Evidence was more consistent in showing improvement in parent coping and in use of community-based services and resources. There is a need to boost active
AOB), eight Special Forces Operational Detachment-Alphas (SFODAs)2, and Civil Affairs and Psychological Operations teams working alongside two bat...Affairs, Psychological Operations, and Special Forces, the effort inte- grated the roles and missions of the Ranger Regiment, Special Mission Units, and...proper con- cept integration among all Army SOF, and what thinking and organizational gaps remain. ADP 3-05 clarified the conceptual framework for Army
Petcharat, Manika; Liehr, Patricia
Parents of children with special needs encounter specific challenges in carrying out their caregiving roles. They experience difficulty accepting their children due to unrealistically high expectations. Mindfulness training (MT) may increase parental psychological well-being and acceptance. The purpose of this article is to examine the evidence-base for the effectiveness of MT in enhancing psychological well-being for parents of children with special needs as a foundation for guidance for nurses in mental health practice. A literature review of relevant research studies was undertaken using specific inclusion criteria. The literature was derived from three databases that identified 56 articles narrowed to 5, which met inclusion criteria. The studies indicated that cultivating a more mindful way of parenting is associated with reduced stress, anxiety, and depression. Parents experienced increased mindful awareness and improved psychological well-being, and they were more accepting of their children. Their children also had fewer behavior problems and enhanced positive interaction with their parents. Because mindfulness interventions fall within the scope of independent nursing practice, nurses can play a significant role in applying mindfulness to promote psychological well-being in parents who have children with special needs. © 2017 Wiley Periodicals, Inc.
In September 2004, the Expert Group on Health of the Chernobyl Forum specifically focused on non-cancer diseases and mortality associated with the Chernobyl accident as well as on medical follow-up. The group considered the following topics: cataracts, cardiovascular disease, cytogenetic markers, immunological effects, reproductive effects and children's health, psychological and mental effects, mortality due to the accident, and medical programmes and medical monitoring. The issues of potential cataracts at low doses as well as follow-up of liquidators disease incidence and mortality should be continued. Cytogenetic effects may be used to assess doses above 0.2 Gy but are unlikely to be useful at lower doses. There is no clear evidence of radiation-related adverse clinical effects on the immune system of the general public or on hereditary or reproductive outcomes (particularly congenital malformations). Lifespan reduction and death rates of the general public are higher in both contaminated and clean areas than in other countries as is infant mortality, but these are not felt to be radiation related. Although the major potential radiation-related health effect is felt to be the cancer risk, screening programmes are not felt to be useful when absorbed doses are in the range of tens of mGy or lower. Psychological effects are real and represent the biggest public health impact of the accident. These will need continuing attention for the foreseeable future. While the paper is focused entirely on potential adverse effects of the accident, one should recognize the efforts of the Governments of Belarus, the Russian Federation and Ukraine to protect and take care of the affected populations. (author)
Djordjević, Dragan; Petrović, Dejan; Vuković, Dejana; Mihailović, Dobrivoje; Dimić, Aleksandar
Health care system is specific for each country, and therefore involves different motivation and job satisfaction factors. The aim of this study was to confirm the validity and applicability of the General Nordic Questionnaire translated into Serbian for analyzing motivation and job satisfaction, as well as to analyze the motivation factors and job satisfaction of health workers at the Institute for Treatment and Rehabilitation "Niska Banja". The General Nordic Questionnaire was translated into Serbian. It included 73 questions (5 answers by the Likert scale), which formed 24 scales. In May, 2012, 196 (82.3%) health workers filled in the questionnaire. A correlation of Ceronbach's alpha values between the Scandinavian study results and the results of Serbian study was statistically significant (r = 0.424; p motivation positively correlated with all the scales of organizational module, apart from inequality. Within this module, the degree of extrinsic motivation correlated with the support from the superior and coworkers, with fair leadership and human resources primacy. A negative correlation appeared with inequality. The general Nordic Questionnaire can be applied to a great extent to the conditions in our country. Our study shows a low consistency of the scales learning job demands, control of decision, control of work pacing, so the questions in them should be adjusted to the conditions in our country. Extrinsic motivation resulted in higher values than the values of intrinsic motivation in our workers, which is opposite to the results of the original questionnaire.
Alonso, Silvia; Dürr, Salome; Fahrion, Anna; Harisberger, Myriam; Papadopoulou, Christina; Zimmerli, Urs
Residents of the European College of Veterinary Public Health (ECVPH) carried out a survey to explore the expectations and needs of potential employers of ECVPH diplomates and to assess the extent to which the ECVPH post-graduate training program meets those requirements. An online questionnaire was sent to 707 individuals working for universities, government organizations, and private companies active in the field of public health in 16 countries. Details on the structure and activities of the participants' organizations, their current knowledge of the ECVPH, and potential interest in employing veterinary public health (VPH) experts or hosting internships were collected. Participants were requested to rate 22 relevant competencies according to their importance for VPH professionals exiting the ECVPH training. A total of 138 completed questionnaires were included in the analysis. While generic skills such as "problem solving" and "broad horizon and inter-/multidisciplinary thinking" were consistently given high grades by all participants, the importance ascribed to more specialized skills was less homogeneous. The current ECVPH training more closely complies with the profile sought in academia, which may partly explain the lower employment rate of residents and diplomates within government and industry sectors. The study revealed a lack of awareness of the ECVPH among public health institutions and demonstrated the need for greater promotion of this veterinary specialization within Europe, both in terms of its training capacity and the professional skill-set of its diplomates. This study provides input for a critical revision of the ECVPH curriculum and the design of post-graduate training programs in VPH.
Kerins, Carolyn; Casamassimo, Paul S; Ciesla, David; Lee, Yosuk; Seale, N Sue
The purpose of this study was to use existing data to determine capacity of the US dental care system to treat children with special health care needs (CSHCN). A deductive analysis using recent existing data was used to determine the: possible available appointments for CSHCN in hospitals and educational programs/institutions; and the ratio of CSHCN to potential available and able providers in the United States sorted by 6 American Academy of Pediatric Dentistry (AAPD) districts. Using existing data sets, this analysis found 57 dental schools, 61 advanced education in general dentistry programs, 174 general practice residencies, and 87 children's hospital dental clinics in the United States. Nationally, the number of CSHCN was determined to be 10,221,436. The distribution, on average, of CSHCN per care source/provider ranged from 1,327 to 2,357 in the 6 AAPD districts. Children's hospital dental clinics had fewer than 1 clinic appointment or 1 operating room appointment available per CSHCN. The mean number of CSHCN patients per provider, if distributed equally, was 1,792. The current US dental care system has extremely limited capacity to care for children with special health care needs.
Salles, Priscilla Soares; Tannure, Patricia Nivoloni; Oliveira, Cristiana Aroeira Gomes da Rosa; Souza, Ivete Pomarico Ribeiro de; Portela, Maristela Barbosa; Castro, Gloria Fernanda Barbosa de Araújo
The purpose of this study was to investigate the dental needs and management of special health care needs children in Rio de Janeiro, Brazil, according to the type of disability. Records of 428 0- to 19-year-old patients who received dental treatment at the Patients Special Care Needs Clinic (Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro) from 1996-2009 were analyzed. Information about the type of disability, use of medication, dental exam findings, management during treatment, dental treatment performed, and follow-up examinations were collected. Children were divided into 2 groups: those with medical conditions and those with intellectual disability. Patients with medical conditions used more medications and were older than those with intellectual disability. The most common dental treatments received were dental restorations (63%) and extractions (47%). There was no association between the type of disability and dental treatment needed. Children with intellectual disability were 3 times more likely to need general anesthesia and 7 times more likely to need physical restraint for dental care than the other group. Children with intellectual disability have a greater chance of requiring advanced management techniques during dental treatment. The development of effective oral health programs is recommended as well as a specific education program for their parents.
Mandell, David S; Machefsky, Aliza; Rubin, David; Feudtner, Chris; Pati, Susmita; Pita, Susmita; Rosenbaum, Sara
Recent changes to Medicaid policy may have unintended consequences in the education system. This study estimated the potential financial impact of the Deficit Reduction Act (DRA) on school districts by calculating Medicaid-reimbursed behavioral health care expenditures for school-aged children in general and children in special education in particular. Medicaid claims and special education records of youth ages 6 to 18 years in Philadelphia, PA, were merged for calendar year 2002. Behavioral health care volume, type, and expenditures were compared between Medicaid-enrolled children receiving and not receiving special education. Significant overlap existed among the 126,533 children who were either Medicaid enrolled (114,257) or received special education (27,620). Medicaid-reimbursed behavioral health care was used by 21% of children receiving special education (37% of those Medicaid enrolled) and 15% of other Medicaid-enrolled children. Total expenditures were $197.8 million, 40% of which was spent on the 5728 children in special education and 60% of which was spent on 15,092 other children. Medicaid-reimbursed behavioral health services disproportionately support special education students, with expenditures equivalent to 4% of Philadelphia's $2 billion education budget. The results suggest that special education programs depend on Medicaid-reimbursed services, the financing of which the DRA may jeopardize.
Goudie, Anthony; Carle, Adam C
Nearly 30 percent of young adults with special health care needs in Ohio lack health insurance, compared to 5 percent of the state's children with special health care needs. As children with such needs become too old for Medicaid or insurance through their parents' employer, they face great challenges in obtaining insurance. Lack of insurance is highly predictive of unmet needs, which in turn are predictive of costly hospital-based encounters. Young adults with special health care needs who are uninsured are more than twice as likely as their peers with insurance to forgo filling prescriptions and getting care and to have problems getting care. Even after insurance status is accounted for, young adults with special health care needs are more likely than children with such needs to not fill prescriptions because of cost and to delay or forgo needed care. This study demonstrates that continuous and adequate health insurance is vital to the continued well-being of children with special health care needs as they transition to young adulthood.
Van Riper, Cynthia L; Wallace, Lee Shelly
It is the position of the American Dietetic Association that nutrition services provided by registered dietitians (RDs) and dietetic technicians, registered (DTRs), are essential components of comprehensive care for all people with developmental disabilities and special health care needs. Nutrition services should be provided throughout life in a manner that is interdisciplinary, family-centered, community-based, and culturally competent. People with developmental disabilities and special health care needs frequently have nutrition concerns, including growth alterations (failure to thrive, obesity, or growth retardation), metabolic disorders, poor feeding skills, medication-nutrient interactions, and sometimes partial or total dependence on enteral or parenteral nutrition. Individuals with special needs are also more likely to develop comorbid conditions such as obesity or endocrine disorders that require nutrition interventions. Poor health habits, limited access to services, and long-term use of multiple medications are considered health risk factors. Health maintenance and avoidance of complications can be promoted by timely and cost-effective nutrition interventions. Public policy for individuals with special needs has evolved over time, resulting in a transition from institutional facilities and programs to community living. The expansion of public access to technology and health information on the Internet challenges RDs and DTRs to provide accurate scientific information for those with developmental disabilities and special health care needs. Nationally credentialed RDs and DTRs are best prepared to provide appropriate nutrition information for wellness and quality of life.
Full Text Available Background/Aim. Health care system is specific for each country, and therefore involves different motivation and job satisfaction factors. The aim of this study was to confirm the validity and applicability of the General Nordic Questionnaire translated into Serbian for analyzing motivation and job satisfaction, as well as to analyze the motivation factors and job satisfaction of health workers at the Institute for Treatment and Rehabilitation "Niška Banja". Methods. The General Nordic Questionnaire was translated into Serbian. It included 73 questions (5 answers by the Likert scale, which formed 24 scales. In May, 2012, 196 (82.3% health workers filled in the questionnaire. Results. A correlation of Ceronbach’s alpha values between the Scandinavian study results and the results of Serbian study was statistically significant (r = 0.424; p < 0.05. The lowest Cronbach’ alfa coefficient was for the scale “learning demand in job demands” (alpha 0.28. The other scale with no satisfactory reliability was “control of work pacing” (alpha 0.46. Intrinsic motivation positively correlated with all the scales of organizational module, apart from inequality. Within this module, the degree of extrinsic motivation correlated with the support from the superior and coworkers, with fair leadership and human resources primacy. A negative correlation appeared with inequality. Conclusion. The general Nordic Questionnaire can be applied to a great extent to the conditions in our country. Our study shows a low consistency of the scales learning job demands, control of decision, control of work pacing, so the questions in them should be adjusted to the conditions in our country. Extrinsic motivation resulted in higher values than the values of intrinsic motivation in our workers, which is opposite to the results of the original questionnaire.
annual expeditions to study the earth’s last terra incognita, we can speak of a special, Antarctic type of personality, brave, enterprising, efficient...Liechtenstein Turnover Export Import 25,8 1,0 24,8 7,9 0,8 7,1 Luxembourg Turnover Export Import 14,7 7,4 7,3 19,3 8,1 11,2 Malta
Miers, Margaret E; Rickaby, Caroline E; Pollard, Katherine C
As demand for nurses and other health professionals continues to outstrip supply it is important to understand what motivates individuals to join a non-medical health profession. The objectives of this study were to investigate students' reasons for choosing a particular nursing specialism, midwifery or other non-medical health profession, and to compare motivation factors across professions, gender, age, level of award, prior qualifications, prior experience and over time. A prospective follow-up study collected survey responses at the beginning and end of pre-qualifying professional programmes. The study took place in one large United Kingdom faculty. The study participants were 775 first-year students undertaking non-medical health professional programmes and 393 qualifying students. An open-ended question was included in a self-completed questionnaire administered at entry and at qualification. Content analysis identified themes. Altruism was the most frequently cited reason for wishing to join a non-medical health profession, followed by personal interest/abilities, professional values/rewards, and prior experience of the area. Students entering nursing were less likely to cite an altruistic motivation than those entering other non-medical health professions (chi(2)=21.61, df=1, pvalues/rewards (chi(2)=20.38, df=8, p=0.009). Students on degree level programmes were more likely to report altruism than those on diploma level courses (chi(2)=17.37, df=1, pvalues/rewards (chi(2)=6.67, p=0.010) decreased over time. Findings suggest that although a service orientation remains a key factor in choosing nursing, students also look for a career which matches their interests and attributes, as well as offering professional values and rewards. Nursing may be in danger of losing service orientated recruits to other non-medical health professions.
Ng, Stella; Stooke, Rosamund; Regan, Sandra; Hibbert, Kathryn; Schryer, Catherine; Phelan, Shanon; Lingard, Lorelei
Special education for children with chronic health conditions or disabilities requires the integration of health care work with education. This phenomenon occurs in an understudied and challenging context for integrated care despite policies and protocols that outline work processes in this context. We are interested in an approach to inquiry that will allow us to address gaps in current literature and practices in integrated care, and move towards informing policy. Institutional ethnography is an approach to inquiry that maps the actualities of what individuals do at an everyday local level, while examining this work activity in relation to the sociopolitical context. It has been used to change policy and local practice by highlighting disjunctures between policy and actuality. We are adopting institutional ethnography and its three common methods of data collection: document collection, interviews, and observation/shadowing. Informants to this inquiry are chosen from school-based teams, family-centred units and constellations of clinical professionals. We are following work processes, verbally and visually mapping what is done and by whom. It is important to note that work includes 'unofficial' work, including the work of families and others who may not be assigned an official work role in a policy or protocol. The mediating role of texts in work processes is also being mapped in order to link the local work to the high-level social coordinators. To begin, analysis focuses on local, or micro-level, work processes; next, analysis identifies and explains the macro-level coordination of the local work (i.e. social and political structures). A primary outcome of this study will be the creation of verbal and visual maps that demonstrate the social organisation of work processes occurring in the health care-special education interface. These maps will make invisible work visible, highlight disjunctures between policy and practice and identify opportunities for change
Iida, Hiroko; Lewis, Charlotte W
Our objective was to determine if a summative scale reflecting the number of positive criteria on the Children with Special Health Care Needs (CSHCN) Screener is useful in identifying subgroups of CSHCN at risk for poorer oral health and unmet dental care needs and who should be considered to have special dental care needs. Data were analyzed for a population-based sample of 91,642 US children needs in the past 12 months. Descriptive and multivariable logistic regression analyses were performed for each outcome using the survey command in Stata to account for the sampling design. A summative scale based on the number of positive CSHCN Screener criteria was independently associated with various parent-perceived poorer oral health outcomes in children. CSHCN who met 4 or 5 screener criteria had 4 and 4.5 times, respectively, the odds of having fair-poor condition of teeth and bleeding gums relative to non-CSHCN. They also had 87% higher odds for parent-perceived toothache and 2 and 2.5 times the odds of having recent broken teeth and unmet dental care needs relative to non-CSHCN, respectively. There was no dose-dependent association between summative number of positive CSHCN Screener criteria and reported cavities in children. Application of a summative score based on the CSHCN Screener has utility in identifying the CSHCN subgroup with special dental care needs.
Full Text Available Internationalizing higher education is considered to be a major goal for universities in Germany and many medical students aspire to include international experiences into their academic training. However, the exact meaning of “internationalizing” medical education is still poorly defined, just as is the possible pedagogic impact and effects. Against this background, this article presents the special track curriculum on global health (in German: , short: at Justus Liebig University Giessen, which was established in 2011 as a comprehensive teaching program to integrate international perspectives and activities systematically into the clinical years of the medical curriculum. The report of the structure, content, didactic principles and participants’ evaluations of the SPC is embedded into a larger discussion of the pedagogic value of a broad and interdisciplinary perspective on “global health” in medical education, that explicitly includes attention for health inequities, social determinants of health and the cultural dimensions of medicine and health abroad and “at home” (e.g. in relation to migration. We conclude that if properly defined, the emerging field of “global health” represents a didactically meaningful approach for adding value to medical education through internationalizing the curriculum, especially in regard to themes that despite of their uncontested value are often rather weak within medical education. The concrete curricular structures, however, have always to be developed locally. The “SPC” at Giessen University Medical School is only one possible way of addressing these globally relevant issues in one particular local academic setting.
Allman, Dan; Ditmore, Melissa Hope
This article provides an editorial introduction to a virtual special issue on sex work and prostitution. It offers a brief history of sex work studies as published in the journal Culture, Health & Sexuality; reflects on the breadth and scope of papers the journal has published; considers the contribution of the journal's papers to the wellbeing and sexuality of people who sell sex; and envisions future areas of inquiry for sex work studies. As authors, we identify major themes within the journal's archive, including activism, agency, context, discourse, hazard, health, legalisation, love, place, power, race, relationships, stigma and vulnerabilities. In particular, we reflect on how HIV has created an environment in which issues of culture, health and sexuality have come to be disentangled from the moral agendas of earlier years. As a venue for the dissemination of a reinvigorated scholarship, Culture, Health & Sexuality provides a platform for a community of often like-minded, rigorous thinkers, to provide new and established perspectives, methods and voices and to present important developments in studies of sex, sexuality and sex work.
Southwick, Steven M; Satodiya, Ritvij; Pietrzak, Robert H
The articles in this Special Issue are devoted to integrating the fields of disaster mental health and positive psychology. Their focus on resilience building, individual and community preparation, meaning making, and posttraumatic growth represents an important new development in disaster mental health. The overarching goal of this effort is to inform strategies to help both individuals-including children, adolescent, adult disaster survivors, and relief workers-and communities prepare for, respond to, recover from, and possibly even grow stronger in the face of adversity. To achieve this goal, this body of literature suggests that it is important for disaster mental health workers to partner with community leaders, organizations, and the population at large to understand community vulnerabilities, take advantage of existing strengths, and respect cultural factors implicated in disaster recovery. It further suggests that an effective community-based approach to disaster recovery will make psychosocial support and skill-building programs available to large numbers of survivors, which is critical for responding to future national and international disasters. Continued high-quality research that is comprehensive and considers not only relevant psychological, social, cultural, and biological factors but also interrelations between individuals, organizations and communities is needed to advance this relatively new and important direction of the disaster mental health field. © 2016 Wiley Periodicals, Inc.
Ghandour, Reem M; Comeau, Meg; Tobias, Carol; Dworetzky, Beth; Hamershock, Rose; Honberg, Lynda; Mann, Marie Y; Bachman, Sara S
To report on coverage and adequacy of health insurance for children with special health care needs (CSHCN) in 2009-2010 and assess changes since 2001. Data were from the National Survey of Children with Special Health Care Needs (NS-CSHCN), a random-digit telephone survey with 40,243 (2009-2010) and 38,866 (2001) completed interviews. Consistency and adequacy of insurance was measured by: 1) coverage status, 2) gaps in coverage, 3) coverage of needed services, 4) reasonableness of uncovered costs, and 5) ability to see needed providers, as reported by parents. Bivariate and multivariable analyses were conducted to assess factors associated with adequate insurance coverage in 2009-2010. Unadjusted and adjusted prevalence estimates were examined to identify changes in the type of insurance coverage and the proportion of CSHCN with adequate coverage by insurance type. The proportion of CSHCN with private coverage decreased from 64.7% to 50.7% between 2001 and 2009-2010, while public coverage increased from 21.7% to 34.7%; the proportion of CSHCN without any insurance declined from 5.2% to 3.5%. The proportion of CSHCN with adequate coverage varied over time and by insurance type: among privately covered CSHCN, the proportion with adequate coverage declined (62.6% to 59.6%), while among publicly covered CSHCN, the proportion with adequate insurance increased (63.0% to 70.7%). Publicly insured CSHCN experienced improvements in each of the 3 adequacy components. There has been a continued shift from private to public coverage, which is more affordable, offers benefits that are more likely to meet CSHCN needs, and allowed CSHCN to see necessary providers. Published by Elsevier Inc.
Nowak, Arthur J; Casamassimo, Paul S; Slayton, Rebecca L
Without guidelines or policies in dentistry for transitioning adolescents with special heath care needs from pediatric to adult oral health care, little is known about traditional support services. The authors surveyed pediatric dentists about their transition of adolescent patients with and without special health care needs (SHCNs) to adult care. In 2009, the authors e-mailed a pilot-tested survey modified from a survey used for U.S. pediatricians to 4,000 pediatric dentists. The survey included demographic questions and questions regarding services and barriers associated with the transition of patients to adult care. Responses were obtained from 1,686 (42.2 percent response) pediatric dentists who were mostly in group or solo private practices and were younger, in that most had completed their education in the preceding 15 years. More than one-half practiced in suburban settings, and most worked with both dental hygienists and dental assistants. Most assisted patients with SHCNs with their transitions to adult care, and the predominant barrier to transitioning to adult care was availability of general dentists and specialists who were willing to accept these new patients. Pediatric dentists' answers paralleled those of pediatricians for the most part in terms of services provided and barriers to transition. Most responding dentists helped adolescents with and without SHCNs make the transition into adult care, but the major barrier was the availability of general dentists and specialists. With an office protocol in place that includes trained staff members, transitioning patients (especially those with SHCNs) to adult care can be facilitated to provide the appropriate oral health and support services.
Aronson, Keith R; Kyler, Sandee J; Moeller, Jeremy D; Perkins, Daniel F
Little is known about military families who have a dependent with special health care and/or educational needs. The Exceptional Family Member Program (EFMP) is designed to link these families to military/community support services through family support provider (FS providers). The aim of this study was to understand FS providers' perspectives on the kinds of current challenges the families with whom they work face. This is the first study to ascertain the perspectives of professionals FS providers. FS providers (N = 160) completed a survey either on the phone or via the web. The survey consisted of four areas regarding EFMP: (1) background information; (2) caseload and work composition; (3) perceptions of Military Family needs; and (4) adequacy of community support services. The most commonly encountered diagnoses in military families were Autism (94%) and Attention-Deficit Hyperactivity Disorder (93%). Between 80% and 90% of FS providers reported working with families dealing with Emotional/Behavioral Disorders, Speech & Language Disorders, Asthma, Developmental Delays, and Mental Health Problems. FS providers noted that relocations are particularly challenging for military families in the EFMP. Training and programming of social service professionals working with military families who have a dependent with special health care and/or educational needs should focus on commonly occurring challenges seen in this population. As much as possible, FS providers should be familiar with evidence-based programs and practices designed to address these pressing problems. The process and execution of relocations should be streamlined so as to enhance continuity of care. Copyright © 2016 Elsevier Inc. All rights reserved.
Stella L. Ng
Full Text Available Background: Special education for children with chronic health conditions or disabilities requires the integration of health care work with education. This phenomenon is an under-studied and challenging context for integrated care despite policies and protocols that outline work processes in this context. We are interested in an approach to inquiry that will allow us to address gaps in current literature and practices in integrated care, and move toward policy change. Study design and data collection methods: Institutional ethnography is an approach to inquiry that maps the actualities of what individuals do at an everyday local level, while examining this work activity in relation to the socio-political context. It has been used to change policy and local practice by highlighting disjunctures between policy and actuality. We are adopting institutional ethnography and its three common methods of data collection: document collection, interviews, and observations/shadowing. Informants to this inquiry are chosen from school-based teams, family-centered units, and constellations of clinical professionals. Methods of analysis: We are following work processes, verbally and visually mapping what is done and by whom. The mediating role of texts in work processes is also being mapped. It is important to note that work includes “unofficial” work, including the work of families and others who may not be officially assigned a work role in a policy or protocol. Conclusion: A primary outcome of this study will be the creation of maps that demonstrate the social organization of work processes occurring in the health care-special education interface. These maps will make invisible work visible, highlight disjunctures between policy and practice, and identify opportunities for change. They may be useful for educational purposes, providing an orientation to the complex terrain of integrated care to professionals and families.
Stella L. Ng
Full Text Available Background: Special education for children with chronic health conditions or disabilities requires the integration of health care work with education. This phenomenon is an under-studied and challenging context for integrated care despite policies and protocols that outline work processes in this context. We are interested in an approach to inquiry that will allow us to address gaps in current literature and practices in integrated care, and move toward policy change.Study design and data collection methods: Institutional ethnography is an approach to inquiry that maps the actualities of what individuals do at an everyday local level, while examining this work activity in relation to the socio-political context. It has been used to change policy and local practice by highlighting disjunctures between policy and actuality. We are adopting institutional ethnography and its three common methods of data collection: document collection, interviews, and observations/shadowing. Informants to this inquiry are chosen from school-based teams, family-centered units, and constellations of clinical professionals.Methods of analysis: We are following work processes, verbally and visually mapping what is done and by whom. The mediating role of texts in work processes is also being mapped. It is important to note that work includes “unofficial” work, including the work of families and others who may not be officially assigned a work role in a policy or protocol.Conclusion: A primary outcome of this study will be the creation of maps that demonstrate the social organization of work processes occurring in the health care-special education interface. These maps will make invisible work visible, highlight disjunctures between policy and practice, and identify opportunities for change. They may be useful for educational purposes, providing an orientation to the complex terrain of integrated care to professionals and families.
Litt, Jonathan S; McCormick, Marie C
Preterm, low-birth-weight (LBW) children are at increased risk for poor academic achievement and special health care needs (SHCN) compared to term-born peers. It is not known how having SHCN during childhood modifies the relationship between LBW and achievement over time. We used data from the Infant Health and Development Program, a multisite randomized trial of an intervention for preterm, LBW infants with longitudinal follow-up. Primary outcome measures were Woodcock-Johnson Tests of Academic Achievement math and reading scores at age 8 and 18 years. Primary predictor was having a SHCN, defined by prescription medication and medical services use, receipt of special therapies, or any functional limitation. We used repeated measures multivariate analysis of covariance to test the effect of SHCN on achievement at 8 and 18 years and effect modification by IQ. The 576 participants had a mean body weight of 1798.1 ± 455.0 g and a median gestational age of 33 weeks (range, 26-37 weeks). Mean achievement scores were as follows: math (age 8) 97.5 ± 21.6, math (age 18) 90.1 ± 18.3, reading (age 8) 99.0 ± 20.1, and reading (age 18) 96.8 ± 23.5. Mean full scale IQ at age 8 was 92.3 ± 18.2. Eighty percent had a SHCN. Mean achievement scores were significantly different between those with and without SHCN in both math and reading. There was no evidence of effect modification by IQ. SHCNs are associated with poor academic achievement. Targeted interventions for improving performance outcomes by reducing the burden of chronic health problems may be accomplished through prevention strategies or efforts to limit the frequency and severity of symptoms. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
O'Connor, Meredith; Rosema, Stefanie; Quach, Jon; Kvalsvig, Amanda; Goldfeld, Sharon
A fifth of children enter school with special health care needs (SHCN), many of whom have difficulties that are milder or not yet formally diagnosed (emerging SHCN). This study aimed to investigate how differing perceptions of children's emerging SHCN across the family and school contexts relates to service utilization. Sample: The nationally representative birth cohort of the Longitudinal Study of Australian Children, which includes parent reports on the abbreviated Children with Special Health Care Needs Screener. For a subsample of 2459 children teachers also completed the Australian Early Development Census, a measure of early childhood development at school entry that includes SHCN. Logistic regression analyses were conducted adjusting for severity of condition, gender, language background, and disadvantage. Overall 24.1% of children were identified by their parent and/or teacher as experiencing emerging SHCN. Compared with those with consistent reports, children with parent-only identified needs had lower odds of accessing school services (odds ratio [OR], 0.29; 95% confidence interval [CI], 0.10-0.81). Similarly, children with parent-only (OR, 0.39; 95% CI, 0.20-0.75) and teacher-only (OR, 0.25; 95% CI, 0.14-0.46) identified needs had significantly lower odds of accessing services in the community. When parent and teacher perceptions of children's emerging SHCN were inconsistent, service use was lower at school and in the community. Further efforts are needed by health and education providers to ensure that common understandings about a child's needs at school are established early in children's educational careers. Copyright © 2017. Published by Elsevier Inc.
Goldfeld, Sharon; O'Connor, Meredith; Sayers, Mary; Moore, Tim; Oberklaid, Frank
Children with special health care needs are an important population for educational and health service providers. Accurate information about the prevalence and characteristics of these children and their families is needed to inform the planning and development of systems of care, yet data in Australia are currently lacking. This study utilizes population-level data from the Australian Early Development Index, a teacher-rated checklist, to provide estimates of the prevalence and developmental and demographic characteristics of Australian children with special health care needs on entrance to school. Four percent of children were reported with established special health care needs, and a further 18% were identified by teachers as "of concern." These children showed higher rates of vulnerability across all domains of development. Although children with established special health care needs were represented across demographic profiles, proportions were greater among boys, those from lower socioeconomic status communities, and Indigenous and older children. In contrast, those living in more remote settings were as likely to be identified as "of concern" as their peers but were less likely to have established special health care needs. These findings have important implications for service provision and policy development. There are substantial opportunities to reorient schooling and early childhood systems to better detect and accommodate the needs of these children.
Myklebust, Jon; Myklebust, Vidar
This article discusses how psychosocial health in adolescence influences adult mental health among former students with special educational needs in Norway. These individuals have been followed prospectively from their teens and into their mid-30s. The study is inspired by life course perspectives with an emphasis on cumulative processes. The…
Anderson, Lori S.
The numbers of children with special health care needs (CSHCN) have increased in schools. This study was conducted to document mothers' experiences of the care their CSHCN receive across health care and educational settings. Data were collected during standardized, open-ended, one-on-one interviews with 10 mothers of CSHCN in urban, suburban, and…
Full Text Available While the Western world – with Brexit, Trump, Festung Europa, and so forth – seems to be increasingly retreating into narrow nationalism, the Journal of Student Affairs in Africa is connecting African academics, executives and administrators and is becoming an evermore accessed international, African platform for publishing research on higher education and Student Affairs in Africa. In this issue, we do not only publish several commentaries on the recent Global Summit of Student Affairs and Services held in October 2016 at Stellenbosch University, South Africa. We also publish contributions from Ethiopia alongside articles from Australia, the USA, and universities in South Africa (University of the Free State, University of Johannesburg.
Lee, Hyo-Seol; Jung, Hoi In; Kim, Seon-Mi; Kim, Jiyoen; Doh, Re Mee; Lee, Jae-Ho
The purposes of this study were to ascertain the attitudes of dental students toward individuals with special health care needs (SHCNs) in Korea and to elucidate the characteristics associated with these attitudes. The authors recruited students from four of the 11 dental schools in Korea to participate in a survey; these schools were selected for regional balance. The Scale of Attitudes toward Disabled Persons (SADP) was used as the primary survey instrument, and ten independent variables were included. Of the 1,100 possible participants, 1,057 responded to the survey, for a response rate of 96.1%. The results showed that although the students' attitudes did not differ significantly by gender, their attitudes did show statistically significant differences on nine other variables: age, year, religion, self-esteem, friends with a disability, volunteering, admission course, concern for individuals with SHCNs, and intention to treat individuals with SHCNs (all pstudents toward individuals with SHCNs were relatively unfavorable, showing lower SADP scores than reported in Western countries and likely reflecting Eastern cultural values in general. Future efforts should place greater emphasis on special care dentistry education and encourage the development of more favorable attitudes regarding the treatment of individuals with SHCNs.
DeMattei, Ronda R; Allen, Jessica; Goss, Breanna
Children with special health care needs face many barriers to oral care and are at high risk for oral disease. School nurses are in a unique position to promote oral wellness in this vulnerable population. Collaboration between school nurses and dental hygiene faculty resulted in the formation of a partnership between a university-based dental hygiene program and two special education districts in rural southern Illinois. Senior dental hygiene students participated in a school-based service-learning project that provided dental examinations, preventive services, and education to children with special health care needs. Evidence-based behavioral interventions were used to teach children to comply with oral procedures. School nurses mentored dental hygiene students in behavior management of children. Dental exams were provided to 234 children from four special education schools with the majority receiving cleanings and fluoride.
Full Text Available Objectives. The purpose of this pilot study was to assess the knowledge and awareness of dental students with respect to oral health care of the person with special health care needs (SHCN and evaluate effectiveness of an education program on improving their knowledge. Method. An evaluation consisting of a questionnaire was answered before and immediately after a 30-minute educational presentation in the form of a DVD that includes a PowerPoint and a video of oral health care for individuals with SHCN. The questionnaire was based on the materials and information presented in the DVD and included 26 questions (true/false/I do not know. Results. The mean (±SD score on the pretest was 10.85 (±5.20, which increased to 16.85 (±5.47 on the posttest. This difference was statistically significant (P<0.001. Forty percent of the students surveyed reported that they were very satisfied with the educational part of the presentation, while 50% were somewhat satisfied. Thirty percent of students expressed that the educational intervention used is very effective. Conclusions. Viewing the educational intervention was effective in informing the sophomore students and providing them with instructive basic information on person with SHCN. Dental colleges should increase students’ knowledge, training, and exposure to individuals with SHCN.
Salama, Fouad; Al-Balkhi, Bader; Abdelmegid, Faika
The purpose of this pilot study was to assess the knowledge and awareness of dental students with respect to oral health care of the person with special health care needs (SHCN) and evaluate effectiveness of an education program on improving their knowledge. An evaluation consisting of a questionnaire was answered before and immediately after a 30-minute educational presentation in the form of a DVD that includes a PowerPoint and a video of oral health care for individuals with SHCN. The questionnaire was based on the materials and information presented in the DVD and included 26 questions (true/false/I do not know). The mean (± SD) score on the pretest was 10.85 (± 5.20), which increased to 16.85 (± 5.47) on the posttest. This difference was statistically significant (P educational part of the presentation, while 50% were somewhat satisfied. Thirty percent of students expressed that the educational intervention used is very effective. Viewing the educational intervention was effective in informing the sophomore students and providing them with instructive basic information on person with SHCN. Dental colleges should increase students' knowledge, training, and exposure to individuals with SHCN.
Parker, George F
This study determined the impact of a ten-hour mental health training program developed by the Indiana chapter of the National Alliance on Mental Illness (NAMI-Indiana) for correctional officers on a prison special housing ("supermax") unit. The training was delivered to all of the correctional officers on the unit in five weekly sessions and was repeated 15 months later for new unit staff. The number of incidents reported by unit staff in standard monthly reports, consisting of use of force by the officers and battery by bodily waste on the officers by the offenders, was compared for the nine months before and after both training sessions. Attendance at the initial training ranged from 48 to 57 officers per session, and on the basis of Likert ratings, training was well received by the officers. The total number of incidents, the use of force by the officers, and battery by bodily waste all declined significantly after the first mental health training, and the total number of incidents and battery by bodily waste declined significantly after the second training. The provision of ten hours of mental health training to correctional officers was associated with a significant decline in use of force and battery by bodily waste.
Barnard-Brak, Lucy; Stevens, Tara; Carpenter, Julianna
Objectives Family-centered care has been associated with positive outcomes for children with special health care needs. The purpose of the current study was to examine the relationship of family-centered care as associated with care coordination with schools and school absences (e.g., missed days) as reported by parents of children with special health care needs. Methods The current study utilized data from the National Survey of Children with Special Health Care Needs 2009-201 (N = 40,242) to achieve this purpose. The National Survey of Children with Special Health Care Needs may be considered a nationally-representative and community-based sample of parent responses for children with special health care needs across the United States. Results Results from the current study indicate that family-centered care is associated with fewer absences and improved care coordination with schools when applicable. The variables of functional difficulties, poverty level, and the number of conditions were statistically controlled. Conclusions We suggest that the positive influence of family-centered care when practiced extends beyond the family and interacts with educational outcomes. We also suggest that the role of schools appears to be under-studied given the role that schools can play in family-centered care.
Cabral, Ivone Evangelista; de Moraes, Juliana Rezende Montenegro Medeiros
In Brazil, studies rarely address the social network of a child with special health care needs (CSHCN). the study sought to characterize the social network of the child and analyze the role of the family in its creation. a qualitative approach was developed through five dynamics (Speaking Map) based on the creative sensitive method, with five groups of families (12 participants) in their homes. the critical discourse analysis of the caregivers (grandparents, siblings and neighbors) showed that the mother plays the main role in articulating the social network, with its points being linked by the hospital, primary and rehabilitation care, household, school, etc. Familial care becomes more visible at home and within the community. with the insufficient public policy that articulating healthcare facilities for CSHCN in the community, family members shape a social network characterized by a dense and fluid mesh.
Okumura, Megumi J; Knauer, Heather A; Calvin, Kris E; Takayama, John I
Few studies have investigated pediatrician attitudes about providing primary medical care for children with special health care needs. The objective of this study was to determine pediatrician perspectives on their comfort level in providing care and on where the medical home should be for children with chronic medical and developmental conditions. Survey of pediatricians in California in 2014. Pediatricians were randomized to receive surveys featuring either a case of a child with a chronic medical (neurofibromatosis) or a developmental condition (autism). They were then asked about their comfort level in providing primary care for the child. We developed logistic regression models to adjust for practice and provider factors, and availability of family social resources. The survey response rate was 50.2%. Primary care pediatricians expressed more comfort than nonprimary care pediatricians in providing a medical home for a child with chronic medical or developmental condition (range, 84%-92% comfortable vs 58%-79% comfortable), respectively. All pediatricians expressed more comfort providing care for a child with autism than neurofibromatosis. Nearly all primary care pediatricians (90%) believed that the medical home should be in pediatric primary care practice. Pediatrician comfort in becoming a medical home was higher when the family had more social resources. Most pediatricians endorse that the medical home for children with special health care needs be in the primary care setting. Improving access to subspecialty care and providing resources, such as case management, to address family social complexity might raise pediatrician comfort in providing primary care to children with medical and developmental conditions. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Visser, Susanna N; Bitsko, Rebecca H; Danielson, Melissa L; Ghandour, Reem M; Blumberg, Stephen J; Schieve, Laura A; Holbrook, Joseph R; Wolraich, Mark L; Cuffe, Steven P
To describe the parent-reported prevalence of treatments for attention deficit/hyperactivity disorder (ADHD) among a national sample of children with special health care needs (CSHCN), and assess the alignment of ADHD treatment with current American Academy of Pediatrics guidelines. Parent-reported data from the 2009-2010 National Survey of Children with Special Health Care Needs allowed for weighted national and state-based prevalence estimates of medication, behavioral therapy, and dietary supplement use for ADHD treatment among CSHCN aged 4-17 years with current ADHD. National estimates were compared across demographic groups, ADHD severity, and comorbidities. Medication treatment by drug class was described. Of CSHCN with current ADHD, 74.0% had received medication treatment in the past week, 44.0% had received behavioral therapy in the past year, and 10.2% used dietary supplements for ADHD in the past year. Overall, 87.3% had received past week medication treatment or past year behavioral therapy (both, 30.7%; neither, 12.7%). Among preschool-aged CSHCN with ADHD, 25.4% received medication treatment alone, 31.9% received behavioral therapy alone, 21.2% received both treatments, and 21.4% received neither treatment. Central nervous system stimulants were the most common medication class (84.8%) among CSHCN with ADHD, followed by the selective norepinephrine reuptake inhibitor atomoxetine (8.4%). These estimates provide a benchmark of clinical practice for the period directly preceding issuance of the American Academy of Pediatrics' 2011 ADHD guidelines. Most children with ADHD received medication treatment or behavioral therapy; just under one-third received both. Multimodal treatment was most common for CSHCN with severe ADHD and those with comorbidities. Approximately one-half of preschoolers received behavioral therapy, the recommended first-line treatment for this age group. Published by Elsevier Inc.
Rose-Jacobs, Ruth; Fiore, Jennifer Goodhart; de Cuba, Stephanie Ettinger; Black, Maureen; Cutts, Diana B; Coleman, Sharon M; Heeren, Timothy; Chilton, Mariana; Casey, Patrick; Cook, John; Frank, Deborah A
To assess food insecurity in low-income households with young children with/without special health care needs (SHCN) and evaluate relationships between child Supplemental Security Income (SSI) receipt and food insecurity. A cross-sectional survey (2013-2015) of caregivers was conducted at 5 medical centers. Eligibility included index child age Special Health Care Needs Screener, 18-item US Food Security Survey Module, household public assistance program participation, and child SSI receipt. Household and child food insecurity, each, were evaluated using multivariable logistic regression models. Of 6724 index children, 81.5% screened negative for SHCN, 14.8% positive for SHCN (no SSI), and 3.7% had SHCN and received SSI. After covariate control, households, with versus without a child with SHCN, were more likely to experience household (Adjusted odds ratios [AOR] 1.24, 95% confidence intervals [CI], 1.03-1.48) and child (AOR 1.35, 95% CI, 1.11-1.63) food insecurity. Among households with children with SHCN, those with children receiving, versus not receiving SSI, were more likely to report household (AOR 1.42, 95% CI, 0.97-2.09) but not child food insecurity. Low-income households with young children having SHCN are at risk for food insecurity, regardless of child SSI receipt and household participation in other public assistance programs. Policy recommendations include reevaluation of assistance programs' income and medical deduction criteria for households with children with SHCN to decrease the food insecurity risk faced by these children and their families.
Van Cleave, Jeanne; Boudreau, Alexy Arauz; McAllister, Jeanne; Cooley, W Carl; Maxwell, Andrea; Kuhlthau, Karen
To explore how care coordination changes conceptually and practically in primary care practices when implementing the medical home and to identify reasons for different types of changes. Six years after a 2003-2004 national learning collaborative to implement the medical home model for children with special health care needs, we examined care coordination in 12 pediatric practices with the highest postintervention Medical Home Index scores, indicating high level of adoption of the model. Data included interviews of 48 clinicians, care coordinators, and parents and medical record reviews of 60 patients with special health care needs receiving care in these practices. Initially, care coordination activities were prompted by patients' acute problems, and over time activities, tools, and policies were implemented to avert many such problems and expand the scope of services offered to patients. Example activities were making previsit calls with families, writing care plans, developing relationships with community agencies, and tracking referrals. Although some activities were common across practices, the persons involved and efforts toward different activities varied with practice context. Drivers included motivation and creativity of medical home teams, organizational changes, funding to expand care coordinator positions, protected time for such activities, and adoption of electronic record systems. In high-performing medical homes, care coordination activities changed from being mostly reactive to patients' episodic needs to being more systematically proactive and comprehensive. This shift was promoted by factors external and internal to the practice. Ensuring these factors in medical home implementation may accelerate adoption of proactive care coordination activities. Copyright © 2015 by the American Academy of Pediatrics.
Thompson, Lindsay A; Ferdig, Rick; Black, Erik
In the United States, primary and secondary online schools are institutions that deliver online curricula for children enrolled in kindergarten through 12th grade (K-12). These institutions commonly provide opportunities for online instruction in conjunction with local schools for students who may need remediation, have advanced needs, encounter unqualified local instructors, or experience scheduling conflicts. Internet-based online schooling may potentially help children from populations known to have educational and health disadvantages, such as those from certain racial or ethnic backgrounds, those of low socioeconomic status, and children with special health care needs (CSHCN). To describe the basic and applied demographics of US online-school users and to compare student achievement in traditional versus online schooling environments. We performed a brief parental survey in three states examining basic demographics and educational history of the child and parents, the child's health status as measured by the CSHCN Screener, and their experiences and educational achievement with online schools and class(es). Results were compared with state public-school demographics and statistical analyses controlled for state-specific independence. We analyzed responses from 1971 parents with a response rate of 14.7% (1971/13,384). Parents of online-school participants were more likely to report having a bachelor's degree or higher than were parents of students statewide in traditional schools, and more of their children were white and female. Most notably, the prevalence of CSHCN was high (476/1971, 24.6%) in online schooling. Children who were male, black, or had special health care needs reported significantly lower grades in both traditional and online schools. However, when we controlled for age, gender, race, and parental education, parents of CSHCN or black children reported significantly lower grades in online than in traditional schooling (adjusted odds ratio [a
Garcia, Robin; Vonderheid, Susan; McFarlin, Barbara; Djonlich, Michelle; Jang, Catherine; Maghirang, Jeffrey
Methicillin-resistant Staphylococcus aureus (MRSA) rates continue to rise and pose a threat to patient health and limited hospital resources. In 2007, Illinois passed a legislative mandate requiring active surveillance cultures to screen for MRSA in all patients in hospital intensive care units. However, professional guidelines do not support mandated universal surveillance cultures, and funding to cover screening costs was not included. The purpose of the study was to examine the costs (personnel, screening test, and supply) associated with the mandated universal MRSA screening and to examine the infant health-related outcomes and costs associated with implementing MRSA screening in a special care nursery. Personnel-54 observations of staff members in a community-based hospital in a large midwestern city. Infants-445 infants admitted from January 2008 through January 2009. Time and motion (related to screening activities by registered nurses) based on observations of staff during MRSA screenings, and abstraction of health and cost data from the infant log, infant medical records, and financial reports. Costs (laboratory tests, personnel, and supplies) and infant health outcomes. A prospective descriptive study. Mandatory screening leads to increased costs, problems related to false-positives, and unintended consequences (eg, decision whether to treat non-MRSA organisms identified on screening cultures, possibility of legal implications, adverse family psychosocial affects, and questionable validity of the polymerase chain reaction test). The average total costs of laboratory, supply, and personnel were $15,270.12 ($34.31 per infant or $19.58 per screen). A screening test for MRSA with a high positive predictive value, low cost, and quick turnaround (providers require evidence when determining best practices, legislators should require adequate evidence before passing policy.
People with disability are subject to inequality in oral health both in terms of prevalence of disease and unmet healthcare needs. Over 18% of the global population is living with moderate to severe functional problems related to disability, and a large proportion of these persons will require Special Care Dentistry at some point in their lifetime. It is estimated that 90% of people requiring Special Care Dentistry should be able to access treatment in a local, primary care setting. Provision of such primary care is only possible through the education and training of dentists. The literature suggests that it is vital for the dental team to develop the necessary skills and gain experience treating people with special needs in order to ensure access to the provision of oral health care. Education in Special Care Dentistry worldwide might be improved by the development of a recognised academic and clinical discipline and by providing international curricula guidelines based on the International Classification of Functioning, Disability and Health (ICF, WHO). This article aims to discuss the role and value of promoting and harmonising education in Special Care Dentistry as a means of reducing inequalities in oral health.
Department of Veterans Affairs — The Veterans Affairs Central Cancer Registry (VACCR) receives and stores information on cancer diagnosis and treatment constraints compiled and sent in by the local...
Kerr, Kathleen G.; Hart-Steffes, Jeanne S.
Colleges and universities are developing both the next generation of leaders as well as state-of-the-art technology that allow climate reduction aspirations and triple bottom-line outcomes to become realities. Divisions of student affairs play a crucial role in the sustainability movement in colleges and universities. The technology-savvy,…
Johnson, Sharon L.; Hamrick, Florence A.
Offers recommendations to assist in introducing or expanding computer assistance in student affairs. Describes need for automation and considers areas of choosing hardware and software, funding and competitive bidding, installation and training, and system management. Cites greater efficiency in handling tasks and data and increased levels of…
Affairs Team CIM Civil Information Management CCDR Combatant Commander CF Conventional Forces CLT Civil Liaison Team CME Civil Military...this strategy from the 1930s to 1940s against the Japanese invaders in China in World War II and then against the Chinese ruling party, the
Ginn, Martha H.; Hammond, Augustine
This exploratory study provides an overview of the current landscape of online education in the fields of Master of Public Administration and Master of Public Policy (MPA/MPP) utilizing a dataset compiled from content analysis of MPA/MPP programs' websites and survey of 96 National Association of Schools of Public Affairs and Administration…
Campbell, Richard; Levenstein, Charles
One century ago, the landmark fire at the Triangle Shirtwaist Factory in New York City claimed the lives of 146 garment workers and helped spur the adoption of fire safety measures and laws targeting dangerous working conditions. Since that time, continuing advances have been made to address the threat of fire-in workplace fire safety practices and regulations, in training and safety requirements for firefighters and first responders, and in hazard communication laws that enhance disaster planning and response. Recent high profile events, including the West, Texas fertilizer plant explosion, derailments of fuel cargo trains, and garment factory fires in Bangladesh, have brought renewed attention to fire as a workplace health and safety issue and to the unevenness of safety standards and regulatory enforcement, in the United States as well as internationally. In this article, we provide an overview of fire as a workplace health and safety hazard and an introduction to the essays included in this special issue of New Solutions on fire and work. © 2015 SAGE Publications.
Somers, Logan J; Holtfreter, Kristy
The procedural justice framework has been applied in the criminal justice contexts of policing, corrections, and courts. According to this perspective, fair treatment, respectful dialogue and being given a proper voice will contribute to citizens' positive views of authority figures. While this literature has grown immensely, several questions remain unanswered. Do males and females perceive similar levels of procedural justice? Does mental health status influence perceptions of fair treatment? Whether procedural justice is a general perspective that can be applied across social groupings has important implications for correctional treatment in that programs that truly "work" for all are more cost-effective. Toward that end, the current study investigates the relationships among procedural justice perceptions, gender, and mental health status in specialized drug courts, a context that has received little empirical attention. We do so using secondary data originally collected between 2003 and 2009 for Rossman, Roman, Zweig, Rempel and Lindquist's Multisite Adult Drug Court Evaluation (MADCE). Results from a full-sample analysis reveal that women report higher levels of procedural justice; that drug court participation significantly influences procedural justice perceptions; and that depressive symptomology is a significant predictor of procedural justice perceptions. In male- and female-specific subsamples, drug court participation exerts similar effects for males and females, as does depressive symptomology. Implications for theory, research, and practice are discussed. Copyright © 2017 John Wiley & Sons, Ltd.
Wadia, Roxanne J; Yao, Xiaopan; Deng, Yanhong; Li, Jia; Maron, Steven; Connery, Donna; Gunduz-Bruce, Handan; Rose, Michal G
There are limited data on the impact of mental health comorbidities (MHC) on stage at diagnosis and timeliness of cancer care. Axis I MHC affect approximately 30% of Veterans receiving care within the Veterans Affairs (VA) system. The purpose of this study was to compare stage at diagnosis and timeliness of care of solid tumor malignancies among Veterans with and without MHC. We performed a retrospective analysis of 408 charts of Veterans with colorectal, urothelial, and head/neck cancer diagnosed and treated at VA Connecticut Health Care System (VACHS) between 2008 and 2011. We collected demographic data, stage at diagnosis, medical and mental health co-morbidities, treatments received, key time intervals, and number of appointments missed. The study was powered to assess for stage migration of 15–20% from Stage I/II to Stage III/IV. There was no significant change in stage distribution for patients with and without MHC in the entire study group (p = 0.9442) and in each individual tumor type. There were no significant differences in the time intervals from onset of symptoms to initiation of treatment between patients with and without MHC (p = 0.1135, 0.2042 and 0.2352, respectively). We conclude that at VACHS, stage at diagnosis for patients with colorectal, urothelial and head and neck cancers did not differ significantly between patients with and without MHC. Patients with MHC did not experience significant delays in care. Our study indicates that in a medical system in which mental health is integrated into routine care, patients with Axis I MHC do not experience delays in cancer care
Health service utilisation and investigations before diagnosis of cancer of unknown primary (CUP): A population-based nested case-control study in Australian Government Department of Veterans' Affairs clients.
Vajdic, Claire M; Schaffer, Andrea L; Dobbins, Timothy A; Ward, Robyn L; Er, Chuang C; Pearson, Sallie-Anne
Population-based data on the use of health services and diagnostic investigations for patients with cancer of unknown primary (CUP) is scarce. It is uncertain whether the pathways to diagnosis are different for CUP compared to other cancers. We performed a population-based nested matched case-control study using linked routinely collected records for Australian Government Department of Veterans' Affairs clients, 2004-2007. We compared health care consultations, hospitalisations, emergency department visits, and diagnostic procedures in the three months prior and the month of diagnosis for 281 clients registered with a diagnosis of CUP (C809) and 1102 controls randomly selected from clients registered with a first diagnosis of metastatic cancer of known primary. Overall, the median age at cancer diagnosis was 83 years. CUP patients were slightly older and had significantly more comorbidities prior to diagnosis than those with known primary. Compared to known primary, a diagnosis of CUP was significantly more likely after an emergency department visit, less specialist input, fewer invasive diagnostic procedures such as resection or endoscopy, and more non-invasive procedures such as magnetic resonance imaging. There were no differences in primary care or allied health consultations and hospitalisations. This health care pathway suggests delayed recognition of cancer and scope for improvement in the medical management of high-risk individuals presenting to primary care. The pattern of diagnostic investigations reveals under-investigation in some CUP patients but this is likely to reflect recognition of limited treatment options and poor prognosis and is consistent with clinical guidelines. Copyright © 2015 Commonwealth of Australia. Published by Elsevier Ltd.. All rights reserved.
Jauregi Unanue, Iñigo; Zare Borzeshi, Ehsan; Piccardi, Massimo
Previous state-of-the-art systems on Drug Name Recognition (DNR) and Clinical Concept Extraction (CCE) have focused on a combination of text "feature engineering" and conventional machine learning algorithms such as conditional random fields and support vector machines. However, developing good features is inherently heavily time-consuming. Conversely, more modern machine learning approaches such as recurrent neural networks (RNNs) have proved capable of automatically learning effective features from either random assignments or automated word "embeddings". (i) To create a highly accurate DNR and CCE system that avoids conventional, time-consuming feature engineering. (ii) To create richer, more specialized word embeddings by using health domain datasets such as MIMIC-III. (iii) To evaluate our systems over three contemporary datasets. Two deep learning methods, namely the Bidirectional LSTM and the Bidirectional LSTM-CRF, are evaluated. A CRF model is set as the baseline to compare the deep learning systems to a traditional machine learning approach. The same features are used for all the models. We have obtained the best results with the Bidirectional LSTM-CRF model, which has outperformed all previously proposed systems. The specialized embeddings have helped to cover unusual words in DrugBank and MedLine, but not in the i2b2/VA dataset. We present a state-of-the-art system for DNR and CCE. Automated word embeddings has allowed us to avoid costly feature engineering and achieve higher accuracy. Nevertheless, the embeddings need to be retrained over datasets that are adequate for the domain, in order to adequately cover the domain-specific vocabulary. Copyright © 2017 Elsevier Inc. All rights reserved.
ROGERS, WILLIAM C.
WRITTEN IN EVERYDAY ENGLISH, THIS READING BOOK PRESENTS MANY FACTS AND IDEAS ABOUT WORLD AFFAIRS. CHAPTERS COVER INTERNATIONAL LIFE, POWER IN WORLD AFFAIRS, WAR AS INTERNATIONAL CONFLICT, THE MEANS AND VARIETIES OF ARMED CONFLICT, INTERNATIONAL CONFLICT SHORT OF WAR, THE ACCOMMODATION OF CONFLICT IN WORLD AFFAIRS, AND PEACE--WHAT IT IS AND HOW TO…
Morgan, Myra F.; Policello, Sharon M.
Student affairs organizations must deal with the reality that if offering high-quality and innovative programs for students is a priority, then identifying and soliciting outside funding sources is essential. If the vice president for student affairs has decided to establish a development office in the division of student affairs in a large public…
This chapter highlights opportunities in the digital space for student affairs professionals. A blended approach, grounded in the new technology competency recently added in the ACPA and NASPA student affairs professional competencies, is proposed for student affairs professionals' digital identity development. It includes the awareness of one's…
Full Text Available Background Knowledge of the status of eye diseases among students’ enrolled in the special schools would assist in planning preventive and treatment strategies. Objectives To determine the types and causes of ocular morbidity leading to enrolment of students in special schools of Osun state. Methods We conducted a cross-sectional study by utilizing a total-sampling-technique on students attending all 8 special primary and integrated secondary schools to find out the common ophthalmic diseases between July and September 2013. Teachers’ registers, oral interview and clinical examination were used to obtain data. The data were analyzed by descriptive statistics through SPSS 17 software. Results Four hundred and seventy-two (472 students between the ages of 4 and 36 years with mean of 13.7 ± 4.7 were examined. Two hundred and seventy-six (58.5% were males and one hundred-ninety- six were females. Fathers’ occupation were mostly farmers 142 (30.1% and Artisans 133 (28.2%. Abnormal ocular findings were seen in 9.9% of students. The prevalence of blindness was 4.7% [95% Confidence Interval (CI 2.7 - 6.6]. Anatomical causes of blindness were corneal scarring (2.1% especially post measles keratopathy, whole globe disorders (1.1%, toxoplasma chorioretinal scars and maculopathies (0.6%, amblyopia/uncorrected refractive errors (0.4% and cortical visual impairment (0.2% . The prevalence of visual impairment was 1.4% [CI 0.0 -1.7], with cataracts and refractive error being the most common causes. Other findings included nystagmus (0.2%, vernal conjunctivitis (0.4%, and pigmentary retinopathy (4.2%. Ocular pathologies occurred most frequently among the lower socio-economic group (χ2 169.69, P < 0.001. Conclusions The common causes of ocular diseases leading to enrolment are avoidable. Mandatory eye examination at birth, preschool years and school age is needed for early detection and intervention. Health education, adequate nutrition, and immunization
Lakdawalla, Darius N; Doshi, Jalpa A; Garrison, Louis P; Phelps, Charles E; Basu, Anirban; Danzon, Patricia M
The third section of our Special Task Force report identifies and defines a series of elements that warrant consideration in value assessments of medical technologies. We aim to broaden the view of what constitutes value in health care and to spur new research on incorporating additional elements of value into cost-effectiveness analysis (CEA). Twelve potential elements of value are considered. Four of them-quality-adjusted life-years, net costs, productivity, and adherence-improving factors-are conventionally included or considered in value assessments. Eight others, which would be more novel in economic assessments, are defined and discussed: reduction in uncertainty, fear of contagion, insurance value, severity of disease, value of hope, real option value, equity, and scientific spillovers. Most of these are theoretically well understood and available for inclusion in value assessments. The two exceptions are equity and scientific spillover effects, which require more theoretical development and consensus. A number of regulatory authorities around the globe have shown interest in some of these novel elements. Augmenting CEA to consider these additional elements would result in a more comprehensive CEA in line with the "impact inventory" of the Second Panel on Cost-Effectiveness in Health and Medicine. Possible approaches for valuation and inclusion of these elements include integrating them as part of a net monetary benefit calculation, including elements as attributes in health state descriptions, or using them as criteria in a multicriteria decision analysis. Further research is needed on how best to measure and include them in decision making. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Zhang, Minghua; Xu, Jianming
The rapid economic and industrial growth of China, exemplified by a 10-fold increase in its gross domestic product in the past 15 years, has lifted millions of its citizens out of poverty but has simultaneously led to severe environmental problems. The World Health Organization estimates that approximately 2.4 million deaths in China per year could be attributed to degraded environmental quality. Much of China's soil, air, and water are polluted by xenobiotic contaminants, such as heavy metals and organic compounds. In addition, soil quality is degraded by erosion, desertification, and nutrient runoff. Air quality is further compromised by particulates, especially in heavily populated areas. Research shows that 80% of urban rivers in China are significantly polluted, and poor water quality is a key contributor to poverty in rural China. Economic and industrial growth has also greatly expanded the demand for water sources of appropriate quality; however, pollution has markedly diminished usable water resource quantity. Desertification and diminishing water resources threaten future food security. In recent years, China's government has increased efforts to reverse these trends and to improve ecosystem health. The Web of Science database showed that the percentage of articles on China devoting to environmental sciences increased dramatically in recent years. In addition, the top 25 institutes publishing the papers in environmental sciences were all in China. This special issue includes seven articles focusing on nonpoint source pollution, environmental quality, and ecosystem health in China. The major issues, and results of these studies, are discussed in this introduction. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.
Goldfeld, Sharon; O'Connor, Meredith; Quach, Jon; Tarasuik, Joanne; Kvalsvig, Amanda
A significant proportion of school-aged children experience special health care needs (SCHN) and seek care from pediatricians with a wide range of condition types and severity levels. This study examines the learning pathways of children with established (already diagnosed at school entry) and emerging (teacher identified) SHCN from school entry through the elementary school years. The Longitudinal Study of Australian Children (LSAC) is a nationally representative clustered cross-sequential sample of 2 cohorts of Australian children which commenced in May 2004. Data were analyzed from the LSAC kindergarten cohort (n = 4,983), as well as a subsample of 720 children for whom teachers also completed the Australian Early Development Index checklist, a measure of early childhood development at school entry that includes SHCN. Latent class analysis was utilized to establish 3 academic trajectories from 4-5 to 10-11 years: high (24.3%), average (49.8%), and low (23.6%). Descriptive statistics revealed a trend for both children with established and emerging SHCN to fall into weaker performing learning pathways. Multinomial logistic regression focusing on those children with emerging SHCN confirmed this pattern of results, even after adjustment for covariates (relative risk 3.06, 95% confidence interval 1.03-9.10). Children who additionally had low socioeconomic standing were particularly at risk. Even children with less complex SCHN are at risk for academic failure. Early identification, together with integrated health and educational support, may promote stronger pathways of educational attainment for these children. Achieving these better outcomes will require the involvement of both educational and health practitioners. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Bramlett, Matthew D; Blumberg, Stephen J; Ormson, A Elizabeth; George, Jacquelyn M; Williams, Kim L; Frasier, Alicia M; Skalland, Benjamin J; Santos, Kathleen B; Vsetecka, Danielle M; Morrison, Heather M; Pedlow, Steven; Wang, Fang
This report presents the development, plan, and operation of the 2009-2010 National Survey of Children with Special Health Care Needs, a module of the State and Local Area Integrated Telephone Survey. The survey is conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. This survey was designed to produce national and state-specific prevalence estimates of children with special health care needs (CSHCN), to describe the types of services that they need and use, and to assess aspects of the system of care for CSHCN. A random-digit-dial sample of households with children under age 18 years was constructed for each of the 50 states and the District of Columbia. The sampling frame consisted of landline phone numbers and cellular(cell) phone numbers of households that reported a cell-phone-only or cell-phone-mainly status. Children in identified households were screened for special health care needs. If CSHCN were identified in the household, a detailed interview was conducted for one randomly selected child with special health care needs. Respondents were parents or guardians who knew about the children's health and health care. A total of 196,159 household screening interviews were completed from July 2009 through March 2011, resulting in 40,242 completed special-needs interviews, including 2,991 from cell-phone interviews. The weighted overall response rate was 43.7% for the landline sample, 15.2% for the cell-phone sample, and 25.5% overall. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.
Bennett, B.; Repacholi, M.; Carr, Z.
Twenty years have passed since the worst nuclear reactor accident in the world occurred at the Chernobyl nuclear power plant in Ukraine. The radioactive contamination which resulted from the explosion and fire in the first few days spread over large areas of neighbouring Belarus and the Russian Federation, with most of the fallout in Belarus. While national and local authorities did not immediately disclose the scale of the accident, the mitigation measures, such as distribution of potassium iodine pills, food restriction, and mass evacuation from areas where the radioactive contamination was greatest, undoubtedly reduced the health impact of the radiation exposure and saved many lives. The accident caused severe social and economic disruption and had significant environmental and health impact. This was aggravated by the political and economical changes in the three affected states related to the break-down of the Soviet Union. In the aftermath of the accident the international scientific and medical community collaborated closely with national experts dealing with health effects of the accident in the affected countries. There is a substantial body of international collaborative projects on the situation, which should lead to advancement in radiation sciences. However, considerable speculation and disinformation remains about the possible health impact of the accident for the millions of affected people. To address the health, environmental and socioeconomic consequences of the Chernobyl accident, the United Nations in 2003 launched an Inter-Agency initiative, the Chernobyl Forum. The Forum's Secretariat, led by the International Atomic Energy Agency (IAEA), the World Health Organization (WHO), the United Nations Development Programme (UNDP), and several other international organizations collaborated with the governments of the affected countries. The purpose of the Chernobyl Forum was to review the consequences of the accident, issue technical reports and, based
Patient-Centered Pain Care Using Artificial Intelligence and Mobile Health Tools: Protocol for a Randomized Study Funded by the US Department of Veterans Affairs Health Services Research and Development Program.
Piette, John D; Krein, Sarah L; Striplin, Dana; Marinec, Nicolle; Kerns, Robert D; Farris, Karen B; Singh, Satinder; An, Lawrence; Heapy, Alicia A
Cognitive behavioral therapy (CBT) is one of the most effective treatments for chronic low back pain. However, only half of Department of Veterans Affairs (VA) patients have access to trained CBT therapists, and program expansion is costly. CBT typically consists of 10 weekly hour-long sessions. However, some patients improve after the first few sessions while others need more extensive contact. We are applying principles from "reinforcement learning" (a field of artificial intelligence or AI) to develop an evidence-based, personalized CBT pain management service that automatically adapts to each patient's unique and changing needs (AI-CBT). AI-CBT uses feedback from patients about their progress in pain-related functioning measured daily via pedometer step counts to automatically personalize the intensity and type of patient support. The specific aims of the study are to (1) demonstrate that AI-CBT has pain-related outcomes equivalent to standard telephone CBT, (2) document that AI-CBT achieves these outcomes with more efficient use of clinician resources, and (3) demonstrate the intervention's impact on proximal outcomes associated with treatment response, including program engagement, pain management skill acquisition, and patients' likelihood of dropout. In total, 320 patients with chronic low back pain will be recruited from 2 VA healthcare systems and randomized to a standard 10 sessions of telephone CBT versus AI-CBT. All patients will begin with weekly hour-long telephone counseling, but for patients in the AI-CBT group, those who demonstrate a significant treatment response will be stepped down through less resource-intensive alternatives including: (1) 15-minute contacts with a therapist, and (2) CBT clinician feedback provided via interactive voice response calls (IVR). The AI engine will learn what works best in terms of patients' personally tailored treatment plans based on daily feedback via IVR about their pedometer-measured step counts, CBT skill
..., National Veterans Sports Programs and Special Events, Event Registration Applications); Comment Request AGENCY: Office of National Veterans Sports Programs and Special Events, Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Office of National Veterans Sports Programs and Special Events (NVSP...
Bradley, Katharine A.; Williams, Emily C.; Achtmeyer, Carol E.; Hawkins, Eric J.; Harris, Alex H. S.; Frey, Madeleine S.; Craig, Thomas; Kivlahan, Daniel R.
Brief alcohol counseling is a top US prevention priority but has not been widely implemented. The lack of an easy performance measure for brief alcohol counseling is one important barrier to implementation. The purpose of this report is to outline important issues related to measuring performance of brief alcohol counseling in health care…
Vaz Junior, Carlos André; de Araujo Mendonça, Roberto; Vaz Morgado, Cláudia do Rosário
This paper focuses on the reality of very small and small enterprises (VSSEs) in Brazil, concerning health and safety management of their workers. These companies tend to operate in a few administrative levels. The owners' health and safety culture is fundamental for the implementation of preventive measures. The VSSEs end up adopting merely reactive and under-the-law actions. In order to understand such reality, a questionnaire was elaborated especially for the research made. Fifty-five very small and small enterprises of the industrial, commercial and service sectors were selected. The research confirmed the reactive attitude shown by the VSSEs, thus demonstrating that none of the companies involved presented policies of safety and health. Even though not holding policies, programs or scopes of their activities, 22% of them revealed to have a clear definition of the responsibilities of their high level administration. Nevertheless, 10% had financial resources allocated to this sector. Such companies do not count on a frequent safety and health support. The ignorance on it leads them to take a reactive action. This study reaches its objective on contributing to the debate, besides indicating that the way to improvement is on the strict cooperation between governments, companies, workers and society.
Perceptions of methicillin-resistant Staphylococcus aureus and hand hygiene provider training and patient education: results of a mixed method study of health care providers in Department of Veterans Affairs spinal cord injury and disorder units.
Hill, Jennifer N; Hogan, Timothy P; Cameron, Kenzie A; Guihan, Marylou; Goldstein, Barry; Evans, Martin E; Evans, Charlesnika T
The goal of this study was to assess current practices for training of spinal cord injury and disorder (SCI/D) health care workers and education of veterans with SCI/D in Department of Veterans Affairs (VA) spinal cord injury (SCI) centers on methicillin-resistant Staphylococcus aureus (MRSA) prevention. Mixed methods. A Web-based survey was distributed to 673 VA SCI/D providers across 24 SCI centers; 21 acute care and 1 long-term care facility participated. There were 295 that responded, 228 had complete data and were included in this analysis. Semistructured interviews were conducted with 30 SCI/D providers across 9 SCI centers. Nurses, physicians, and therapists represent most respondents (92.1%, n = 210); over half (56.6%, n = 129) were nurses. Of providers, 75.9% (n = 173) reported receiving excellent or good training on how to educate patients about MRSA. However, nurses were more likely to report having excellent or good training for how to educate patients about MRSA (P = .005). Despite this, only 63.6% (n = 82) of nurses perceived the education they provide patients on how MRSA is transmitted as excellent or good. Despite health care workers reporting receiving excellent or good training on MRSA-related topics, this did not translate to excellent or good education for patients, suggesting that health care workers need additional training for educating patients. Population-specific MRSA prevention educational materials may also assist providers in educating patients about MRSA prevention for individuals with SCI/D. Published by Mosby, Inc.
DeMattei, Ronda R.; Allen, Jessica; Goss, Breanna
Children with special health care needs face many barriers to oral care and are at high risk for oral disease. School nurses are in a unique position to promote oral wellness in this vulnerable population. Collaboration between school nurses and dental hygiene faculty resulted in the formation of a partnership between a university-based dental…
Dziwak, Marco; Heinrich-Weltzien, Roswitha; Limberger, Kathrin; Ifland, Susanne; Gottstein, Ilka; Lehmann, Thomas; Schüler, Ina M
This cross-sectional study aimed to assess dental health and odontogenic infections in students with special health care needs (SHCN) in the Free State of Thuringia, Germany. From 1283 students with SHCN aged 6-16 years, 66.0 % (n = 848 of whom are 35.7 % females and 64.3 % males) with intellectual/learning disabilities (ID/LD), physical disabilities (PD), and sensory disorders (SD) participated after informed consent in oral examinations according to WHO standards. Dental caries was assessed by dmft/DMFT, odontogenic infections by pufa/PUFA. Fissure sealants (FS) were scored in permanent molars. Data were compared to regional and national reference data and analysed by t test and age-adjusted logistic regression models. Students with SHCN revealed 41.2 % caries prevalence in permanent and 31.7 % in primary teeth. Highest prevalence/experience of caries and odontogenic infections in primary teeth was recorded in 6-11-year-olds with PD (65.1 %/2.3 dmft; 14.0 %/0.3 pufa). Most affected permanent teeth were observed in students with ID/LD (12-16-year-olds 59.6 %/2.4 DMFT; 6-11-year-olds 2.8 %/0.03 PUFA). All odontogenic infections in 12-16-year-olds occurred in males; n = 9 students revealed n = 9 teeth with pufa/PUFA. Students with ID/LD aged 6-11 years exhibited lowest prevalence of FS (29.0 %) and mean of 0.8 FS. Students with SHCN suffered more than twice as frequent from untreated dental caries and benefited up to 29.0 % less from FS than peers without disabilities. This first study investigating odontogenic infections of German students with SHCN revealed highest prevalence in primary teeth and in males. Oral health among students with SHCN is reduced, and FS are underutilized compared to German students without disabilities. Reinforcing the application of FS in students with SHCN might contribute to reducing disparities in oral health.
Full Text Available Bulimia nervosa is a serious and complex health problem encountered by many professionals, including general practitioners and dentists. The aim of the study was to describe the problem of bulimia (its prevalence, symptoms, special situations, treatment, with particular emphasis on the aspect of the oral health. The paper presents the causes and factors contributing to the disease, diagnostic criteria, the onset and the possible course of the disease, dental and oral mucosa pathologies due to bulimia as well as other comorbidities (including diabetes. The paper is of descriptive nature. The research method was based on the analysis of the available literature on bulimia nervosa supplemented by our own experience. It was concluded based on the analysed sources that appropriate diagnosis and treatment of bulimia nervosa is possible only with the cooperation of many specialists: psychiatrists or paediatric psychiatrists, dentists and general practitioners as well as other doctors if necessary. Psychotherapy is a necessary and integral aspect of treatment. Early treatment onset is essential for good treatment outcomes. Due to the low sense of illness, some patients would never meet a psychiatrist if not for the intervention of a family doctor or a dentist.
Preskitt, Julie K; McEldowney, Rene P; Mulvihill, Beverly A; Wingate, Martha S; Menachemi, Nir
To identify differences in groups of children with special healthcare needs (CSHCN) identified as underinsured by two alternate definitions and discuss implications for policy decisions based on using one definition over another. Secondary data from the National Survey of CSHCN 2005/2006 were analyzed. Only CSHCN who were continuously-insured for 12 months were included in analyses. We identified groups of underinsured CSHCN using two general definitions ("economic" and "attitudinal") and three mutually-exclusive groups (identified by both definitions, identified by attitudinal but not economic, and identified by economic but not attitudinal). Key variables included demographics and condition characteristics. Different underinsurance rates were identified [attitudinal = 30.9 % (n = 11,470); economic = 22.7 % (n = 8,447)] with fair agreement by kappa score (κ = 0.3194; Z = 65.91; p > 0.0001). Differences across mutually-exclusive groups included family income ≥400 % FPL (attitudinal only = 34.2 %, economic only = 16.3 %, both = 18.4 %; p needed equipment/supplies/home health (OR = 1.31, p needs.
Betz, Cecily L
The population of adolescents with special healthcare needs (ASHCN) surviving into adulthood has increased dramatically over the past two decades. Approximately, nine of every 10 children diagnosed with a chronic condition are expected to reach adulthood. Experts estimate nearly 750,000 ASHCN enter into adulthood each year. Advances in medical treatments, new technologies and scientific discoveries have all contributed to the increases in ASHCN life expectancies. As a result, new demands for services have emerged to address their clear needs for long-term services and supports. Foremost among the ASHCN service needs are healthcare transition services. Healthcare transition is recognized as a needed area of practice to facilitate ASHCN transfer of care from pediatric to adult healthcare and to support the acquisition of the developmental competencies needed to successfully transition to adulthood. Yet, few evidence-based and exemplary models of care exist. Healthcare transition research is in the early stages of development. The medical community has provided the leadership with the development of healthcare transition policy, practice, and research. As a result, policymaking, practice issues, and research have a prominent medically related focus. In contrast, the influence of nursing as it pertains to these areas of professional practice is limited. Opportunities exist for pediatric and child health nursing leaders to provide direction for greater involvement in this emerging and growing field of specialty practice. Copyright © 2013 Elsevier Inc. All rights reserved.
Full Text Available Hospital Pelopidas Silveira-IMIP/SES/SUS is a tertiary-unit, specialized in cardiology, neurology, neurosurgery and interventional radiology. It is the only hospital of Brazilian Public-Health-System (SUS with this profile and a 24h-acute-cardio/neurovascular facility. Challenges of Continuing-Education include a guaranteeing appropriate level of basic knowledge, b empowering clinical staff to remain up to date in current knowledge. HPS Continuing-Education Program is based on three branches: a Classroom-Tutorials (CT, b Online-Tutorials at "Pelopidas Digital" Virtual-Teaching-Platform (PD-VTP and c Daily-Practice Evaluation (DPE. This paper presents logistic details of HPS Continuing-Education Program. Training team coordinates tutorial meetings and performs continuous statistical analysis. Evaluation team visit hospital departments daily, observing in practice the incorporation of information provided, and retraining individuals in their work scenarios. Both teams perform curriculum development, meeting planning and creation of digital-training-modules. Tutorial meetings have pre/post-tests, allowing monitoring of attendance, topic significance and short-term retention. Tutorial groups are formed by 6-12 employees sharing similarities in training needs. CT is offered to 4 groups-of-interest: a nurses, b nursing assistants, c administrative staff, porters, drivers, d cleaning, laundry and security staff. Problematization and active strategies have resulted into an attractive, structured educational program customized to produce short-term results. The strategy is of interest to institutions sharing similar challenges.
Chen, Jessica A; Owens, Mandy D; Browne, Kendall C; Williams, Emily C
Unhealthy alcohol use and posttraumatic stress disorder (PTSD) frequently co-occur. Patients with both conditions have poorer functioning and worse treatment adherence compared to those with either condition alone. Therefore, it is possible that PTSD, when co-occurring with unhealthy alcohol use, may influence receipt of evidence-based alcohol-related care and mental health care. We evaluated receipt of interventions for unhealthy alcohol use and receipt of mental health follow-up care among patients screening positive for unhealthy alcohol use with and without PTSD in a national sample from the Veterans Health Administration (VA). National clinical and administrative data from VA's electronic medical record were used to identify all patients who screened positive for unhealthy alcohol use (AUDIT-C score≥5) between 10/1/09-5/30/13. Unadjusted and adjusted Poisson regression models were fit to estimate the relative rate and prevalence of receipt of: brief interventions (advice to reduce or abstain from drinking≤14days after positive screening), specialty addictions treatment for alcohol use disorder (AUD; documented visit≤365days after positive screening), pharmacotherapy for AUD (filled prescription≤365days after positive screening), and mental health care ≤14days after positive screening for patients with and without PTSD (documented with ICD-9 CM codes). In secondary analyses, we tested effect modification by both severity of unhealthy alcohol use and age. Among 830,825 patients who screened positive for unhealthy alcohol use, 140,388 (16.9%) had documented PTSD. Of the full sample, 71.6% received brief interventions, 10.3% received specialty AUD treatment, 3.1% received pharmacotherapy for AUD, and 24.0% received mental health care. PTSD was associated with increased likelihood of receiving all types of care. Adjusted relative rates were 1.04 (95% CI 1.03-1.05) for brief interventions, 1.06 (1.05-1.08) for specialty AUD treatment, 1.35 (1.31-1.39) for
Six Sigma and Lean Thinking are quality initiatives initially deployed in industry to improve operational efficiency leading to better quality and subsequent cost savings. The financial rationale for embarking on this quality journey is clear; applying it to today's health care remains challenging. The cost of medical care is increasing at an alarming rate; most of these cost increases are attributed to an aging population and technological advances; therefore, largely beyond control. Furthermore, health care cost increases are caused by unnecessary operational inefficiency associated with the direct medical service delivery process. This article describes the challenging journey of implementing Six Sigma methodology at a tertiary care medical center. Many lessons were learned; however, of utmost importance were team approach, "buy in" of the stakeholders, and the willingness of team members to change daily practice and to adapt new and innovative ways how health care can be delivered. Six Sigma incorporated as part of the "company's or hospital's culture" would be most desirable but the learning curve will be steep.
Dropouts Can Enter Underenrolled Departments Editorial on Education System Change. FOREIGN RELATIONS Daily Editorial on President Chon’s ’Vision...than 521,000 million won from "old politicians," "minister and vice-ministers of the government," "high-ranking officials" and big entrepreneurs to...revision of the controversial college gradua- tion system, while the Foreign Affairs and Defense Committees are for the recent defection of a Chinese
Evans, Mary E; Bruns, Eric J; Armstrong, Mary I; Hodges, Sharon; Hernandez, Mario
The passage of the Patient Protection and Affordable Care Act (ACA; 2010) has had tremendous influence on behavioral health in the United States (Alker & Chester, 2015). Shortly after its passage, the editors of this special section became interested in examining the provisions of the ACA related to care for mental, emotional, and behavioral disorders in children and youth and synthesizing their implications in the context of other contemporary trends in children's behavioral health promotion. We first developed a white paper with the goal of increasing our own understanding of these issues and their possible influence on the status quo of designing, implementing, financing, and evaluating behavioral health services for children and their families. From our discussions came the idea of developing a special section in the American Journal of Orthopsychiatry featuring input from researchers who have been exploring these issues and who have tangible and relevant examples of "new frontiers" in building mental, emotional, and behavioral health for children and youth. The result is the current special section, the purpose of which is to highlight the importance of prevention in behavioral health and to explore examples of efforts that have used a broad public health approach to prevention and early intervention in mental, emotional, and substance use disorders in children and youth. Before introducing the seven articles in this special section, we describe in detail our foundational thinking about building mental, emotional, and behavioral health for children and youth, as expressed in our initial white paper on this topic. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
Sanches-Ferreira, Manuela; Simeonsson, Rune J; Silveira-Maia, Mónica; Alves, Sílvia; Tavares, Ana; Pinheiro, Sara
The International Classification of Functioning, Disability and Health (ICF) was introduced in Portuguese education law as the compulsory system to guide eligibility policy and practice in special education. This paper describes the implementation of the ICF and its utility in the assessment process and eligibility determination of students for special education. A study to evaluate the utility of the ICF was commissioned by the Portuguese Ministry of Education and carried out by an external evaluation team. A document analysis was made of the assessment and eligibility processes of 237 students, selected from a nationally representative sample. The results provided support for the use of the ICF in student assessment and in the multidimensional approach of generating student functioning profiles as the basis for determining eligibility. The use of the ICF contributed to the differentiation of eligible and non eligible students based on their functioning profiles. The findings demonstrate the applicability of the ICF framework and classification system for determining eligibility for special education services on the basis of student functioning rather than medical or psychological diagnose. The use of the International Classification of Functioning, Disability and Health (ICF) framework in special education policy is as follows: • The functional perspective of the ICF offers a more comprehensive, holistic assessment of student needs than medical diagnoses. • ICF-based assessment of the nature and severity of functioning can serve as the basis for determining eligibility for special education and habilitation. • Profiles of functioning can support decision making in designing appropriate educational interventions for students.
Christiansen, Terkel; Erb, Karin; Rizvanovic, Amra
Objective. To examine the costs to the public health care system of couples in medically assisted reproduction. Design. Longitudinal cohort study of infertile couples initiating medically assisted reproduction treatment. Setting. Specialized public fertility clinics in Denmark. Sample. Seven...... hundred and thirty-nine couples having no child at study entry and with data on kind of treatment and live birth (yes/no) for each treatment attempt at the specialized public fertility clinic. Methods. Treatment data for medically assisted reproduction attempts conducted at the public fertility clinics...... or not – were estimated at 6607€. Costs per live birth of women relatively modest. The results can be generalized...
Warden, Clara; Yun, Katherine; Semere, Wagahta
Children in immigrant families are less likely to screen positive with the Children with Special Health Care Needs Screener (CSHCN-S). This may indicate that children in immigrant families are healthier or require fewer health services than non-immigrant peers. Alternatively, the screener may under-identify special healthcare needs in this population. Using the 2011-2012 National Survey of Children's Health, we examined the prevalence of a positive CSHCN-S among children from first, second, and third generation households with an equivalent number of currently diagnosed chronic conditions (0, 1, 2+). Multivariate analyses controlled for sociodemographic factors. Among children with an equivalent number of chronic conditions, fewer children from first and second generation households screened positive with the CSHCN-S relative to children from third generation households. This association remained after adjusting for covariates. The CSHCN Screener may under-identify children from immigrant households, allowing for missed opportunities to allocate health resources.
Boudreau, Alexy Arauz; Perrin, James M; Goodman, Elizabeth; Kurowski, Daniel; Cooley, W Carl; Kuhlthau, Karen
Care coordination and the medical home may ensure access to specialty care. Children with special health care needs (CSHCN) have higher rates of specialty care use and unmet need compared with the general pediatric population. We hypothesized that care coordination, regardless of whether it was provided in a medical home, would decrease unmet specialty care needs among CSHCN and that the effect of care coordination would be greater among low-income families. Secondary data analysis of participants in the 2009–2010 National Survey of CSHCN who reported unmet specialty care needs and for whom care coordination and medical home status could be determined (n = 18 905). Logistic regression models explored the association of unmet need with care coordination and medical home status adjusting for household income. Approximately 9% of CSHCN reported having unmet specialty care needs. Care coordination was associated with reduced odds of unmet specialty care need (without a medical home, odds ratio: 0.63, 95% confidence interval: 0.47–0.86; within a medical home, odds ratio: 0.22, 95% confidence interval: 0.16–0.29) with a greater reduction among those receiving care coordination within a medical home versus those receiving care coordination without a medical home. We did not find differences in the impact of care coordination by percentage of the federal poverty level. Care coordination is associated with family report of decreased unmet specialty care needs among CSHCN independent of household income. The effect of care coordination is greater when care is received in a medical home.
Vuori, Jari; Kylänen, Marika; Tritter, Jonathan
This paper highlights the importance of analysing patient transportation in Nordic circumpolar areas. The research questions we asked are as follows: How many Finnish patients have been transferred to special care intra-country and inter-country in 2009? Does it make any difference to health care policymakers if patients are transferred inter-country? We analysed the differences in distances from health care centres to special care services within Finland, Sweden and Norway and considered the health care policy implications. An analysis of the time required to drive between service providers using the "Google distance meter" (http://maps.google.com/); conducting interviews with key Finnish stakeholders; and undertaking a quantitative analyses of referral data from the Lapland Hospital District. Finnish patients are generally not transferred for health care services across national borders even if the distances are shorter. Finnish patients have limited access to health care services in circumpolar areas across the Nordic countries for 2 reasons. First, health professionals in Norway and Sweden do not speak Finnish, which presents a language problem. Second, the Social Insurance Institution of Finland does not cover the expenditures of travel or the costs of medicine. In addition, it seems that in circumpolar areas the density of Finnish service providers is greater than Swedish ones, causing many Swedish citizens to transfer to Finnish health care providers every year. However, future research is needed to determine the precise reasons for this.
Duke, Naomi N; Scal, Peter B
To examine the relationship between having a usual source of care, family centered care, and transition counseling for adolescents with special health care needs. Data are from 18,198 parents/guardians, of youth aged 12-17 years, who participated in the 2005-2006 National Survey of Children With Special Health Care Needs. Linear and logistic regression models were used to define relationships between parent report of identification of a usual place and provider of medical care for their child and counseling on four transition issues: transfer to adult providers, review of future health needs, maintaining health insurance in adulthood, and youth taking responsibility for care. The direct mediating effect of family centered care was evaluated. Youth having a usual source of care (vs. not) were more likely to receive counseling on future health needs (47.4 vs. 33.6%, P needs (56.3 vs. 39.6%, P needs and 94.9% of the effect of a usual source of care on encouragement to take responsibility for care. Study findings support the development of health care delivery models focusing on family centered care to the same degree as other health care access issues.
We would like to remind you that the Social Affairs Service is a centre offering advice and support that can provide the following: Information and documentation (education for your children, language courses, child-minding facilities, health-related matters etc.). Information on social protection (illness, disability, handicap, retirement, death, etc.) and integration. Assistance in dealings with the authorities/services concerned. Consultations with a view to resolving problems of a personal, family or professional nature, such as problems of dependency (alcohol, drugs, relationship) or behavioural problems (stress, depression, eating disorders)... Support in facing new situations (maternity, divorce, bereavement, change of post, geographical isolation). Assistance with decision making relating to family, personal or professional matters. The team is at the disposal of all members of personnel, whatever their status, as well as to members of their family. Interviews with this service are CONFIDENTI...
Hess, Janet S; Straub, Diane M
To assess acceptability and feasibility of a school-based health care transition education intervention designed to equip adolescents and young adults (A/YA) who have special health care needs with important health literacy, self-advocacy, and self-determination skills. A qualitative research approach was used to assess a 40-hr curriculum implemented with 137 A/YA in 13 high school special education classes. Three focus groups were conducted with 15 students and 7 educators. Participants were questioned about perceived relevance, readability, interest, ease of implementation and completeness of the curriculum. All focus group participants said the curriculum was highly relevant and valuable. Teachers reported little difficulty with ease of implementation, though the reading level appeared high for some students. This intervention model shows promise for empowering A/YA with special health care needs to become more independent in managing their health care, and warrants further development and evaluation. The curriculum is available at http://health.usf.edu/medicine/pediatrics/ad_med/resources.htm.
Bachman, Sara S; Comeau, Meg; Long, Thomas F
There is increasing interest in maximizing health care purchasing value by emphasizing strategies that promote cost-effectiveness while achieving optimal health outcomes. These value-based purchasing (VBP) strategies have largely focused on adult health, and little is known about the impact of VBP program development and implementation on children, especially children and youth with special health care needs (CYSHCN). With the increasing emphasis on VBP, policymakers must critically analyze the potential impact of VBP for CYSCHN, because this group of children, by definition, uses more health care services than other children and inevitably incurs higher per person costs. We provide a history and definition of VBP and insurance design, noting its origin in employer-sponsored health insurance, and discuss various financing and payment strategies that may be pursued under a VBP framework. The relevance of these approaches for CYSHCN is discussed, and recommendations for next steps are provided. There is considerable work to be done if VBP strategies are to be applied to CYSHCN. Issues include the low prevalence of specific special health care need conditions, how to factor in a life course perspective, in which investments in children's health pay off over a long period of time, the marginal savings that may or may not accrue, the increased risk of family financial hardship, and the potential to exacerbate existing inequities across race, class, ethnicity, functional status, and other social determinants of health. Copyright © 2017 by the American Academy of Pediatrics.
Spears, Amanda P
To assess the effectiveness of the Maternal and Child Health Bureau's (MCHB) Six Core Outcomes for children with special health care needs (CSHCN) as indicators in measuring the degree to which mental health care needs are met. This study analyzes data from the 2001 National Survey of Children with Special Health Care Needs for 9,748 CSHCN who needed mental health care. Bivariate and logistic analyses were employed to investigate the impact of the MCHB's Six Core Outcomes on the probability of having an unmet need for mental health services. Of the 2.3 million CSHCN in the U.S. who needed mental health care in 2001, almost one-fifth did not receive all of the mental health services that they needed. Ultimately, eight Outcomes and sub-categories of Outcomes were considered. Sixty-one percent of CSHCN with a need for mental health care had care that fulfills six of the eight considered Outcomes. Logistic analysis indicates that individual fulfillment of each of the Core Outcomes and fulfillment of additional Outcomes have a significant association with reducing the probability of having an unmet mental health care need for CSHCN. This study is the first attempt to apply the Six Core Outcomes to meeting the needs for mental health care among CSHCN. Estimates of unmet need for mental health care suggest that efforts can be made to improve access for CSHCN. The initial estimates generated by this study indicate that the MCHB Outcomes are important in meeting children's mental health needs and are important indicators for informing MCHB policy.
Minnesota State Dept. of Health, Minneapolis. Services for Children with Handicaps.
These guidelines were written to help families coordinate the health care that may be needed by a child with spina bifida. The booklet begins with general information about spina bifida. It then discusses the goals of health care, the health care team, the importance of periodic health care, and record keeping procedures. The child's health care…
...; REPUBLIC PARTY AND STATE AFFAIRS - Baltic Unity Efforts Assessed, Baltic Military District Loyal to USSR Law, Latvia Paramilitary Leader on Group's Role, Formation of Latvian Defense Units, Latvian...
Hirschy, Amy S.; Wilson, Maureen E.
Through professional associations and graduate preparation programs, members of the student affairs profession identify, communicate, and reinforce professional standards to promote the scholarship of practice.
Lisa Bardill Moscaritolo
Full Text Available In the most recent issue of the Journal of Student Affairs in Africa (JSAA, readers were introduced to the 3rd Global Summit on Student Affairs and Services that was hosted by Stellenbosch University (SU in Cape Town, South Africa, this past October 2016. This summary will provide a more detailed outline of the organisation of the summit, its processes, and the final written product for the 2016 summit, which was initiated by the International Association for Student Affairs and Services (IASAS and Student Affairs Administrators in Higher Education (NASPA.
Partial Contents: Party and State Affairs, History and Philosophy, Culture, Social Issues, Regional Issues, Narcotics Trafficking, Society, Teachers, Education, Students, Construction, Traditional Weddings, Economics...
Lisa C. Kooistra
Discussion: Although no conclusions can be drawn based on the current study, our observations suggest that a blended CBT approach might shorten treatment duration and has the potential to be a valuable treatment option for patients with severe depression in specialized mental health care settings. Further exploration of the effectiveness of our bCBT protocol by means of a randomized controlled trial is warranted.
Sandeep, V; Kumar, Manikya; Vinay, C; Chandrasekhar, R; Jyostna, P
Children with hearing impairment (CHI) have special accessibility issues to meet their health care needs. Their oral health status is deprived and has wide ranging treatment needs to attend. The aim of this study was to evaluate the oral health status and treatment needs of CHI attending a special school in Bhimavaram Town, India. The study design was a descriptive cross-sectional study. This study was conducted in November 2012 at SVS special school for deaf, Bhimavaram, India. This study involved 180 CHI of both genders, aged 6-16 years, divided into Group-I (6-8 years), Group-II (9-12 years), and Group-III (13-16 years). Oral health status and treatment needs were recorded using methods and standards recommended by the WHO for Oral Health Surveys, 1997. Dental caries prevalence (decayed, missing, and filled teeth [DMFT/dmft]), gingivitis levels (Lφe, Silness Gingival Index), plaque levels (Silness, Lφe Plaque index), and treatment needs were the parameters recorded and analyzed. Z-test for proportion, one-way analysis of variance, and Chi-square test were used to analyze the data. Prevalence of dental caries in the sample was found to be 65% with a mean level of caries prevalence (DMFT) of 1.6 ± 1.3 in Group-I, 1.9 ± 1.2 in Group-II, and 2.2 ± 1.2 in Group-III. About 91.7% of the total children examined needs treatment. The mean plaque and gingivitis scores of the sample were 1.70 ± 0.61 and 1.59 ± 0.58, respectively. These findings imply the overwhelming situation of CHI in oral health perspective. Hence, prevention-based educational and motivational programs should be targeted to this vital group to achieve adequate oral hygiene levels.
Bagattoni, S; Sadotti, A; D'Alessandro, G; Piana, G
Dental trauma is a frequent finding in people with special health care needs. The aim of this study was to determine the prevalence of dental trauma in a sample of Italian children and adolescents with special health care needs. 556 medical and dental records of children and adolescents visited from January 2010 to March 2015 were examined. Information about medical diagnosis, gender, site and type of dental trauma (DT) were collected. According to age and reflecting the dentition stage, the sample was divided into 3 groups: subjects aged 0-5 years (group A, primary dentition), 6-11 years (group B, mixed dentition), 12-18 years (group C, permanent dentition). 113 individuals experienced a DT (prevalence 20.3%), with no difference in relation to gender. Individuals with cerebral palsy and autism showed the highest frequency of DT: 39.6% and 30.4%, respectively. The highest frequency of DT occurred both in group A (21.8%) and B (21.5%), which differed significantly from group C (9%). Avulsion was the most frequent type of DT in the primary dentition (24%) and enamel-dentin fracture without pulp exposure in the permanent dentition (60%). Upper central incisors were the most affected teeth. The prevalence of DT in a sample of Italian children and adolescents with special health care needs is high, especially in young individuals with cerebral palsy and autism. Preventive strategies for those patients should be developed in order to reduce the risk of DT.
Smith, Anna Jo; Oswald, Donald; Bodurtha, Joann
Access to genetic counseling is increasingly important to guide families' and clinicians' decision making, yet there is limited research on accessibility and affordability of counseling for families with children with special health care needs (CSHCN). Our study's objectives were to measure changes in unmet need for genetic counseling for CSHCN from 2001 to 2010 and to characterize child, family, and health system factors associated with unmet need. We used parent-reported data from the 2001, 2005-2006, and 2009-2010 National Survey of Children With Special Health Care Needs. We used a logistic regression model to measure the impact of survey year, child (sex, age, severity of health condition), family (primary language, household income, insurance, financial problems related to cost of CSHCN's health care), and health system factors (region, genetic counselors per capita, having a usual source of care) on access to genetic counseling. Unmet need for genetic counseling increased significantly in 2009-2010 compared to 2001 (odds ratio 1.89; 95% confidence interval [CI] 1.44-2.47). Being older (adjusted odds ratio [aOR] 1.04; 95% CI 1.02-1.06), having severe health limitations (aOR 1.72; 95% CI 1.16-2.58), being uninsured (aOR 3.56; 95% CI 2.16-5.87), and having family financial problems due to health care costs (aOR 1.90; 95% CI 1.52-2.38) were significantly associated with greater unmet need for genetic counseling. Having a usual source of care was associated with decreased unmet need (aOR 0.55; 95% CI 0.37-0.83). Unmet need for genetic counseling has increased over the past 12 years. Uninsurance and financial problems related to health care costs were the largest drivers of unmet need over time. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Happell, Brenda; McAllister, Margaret
Preparation of nursing students for practice in mental health settings in Australia has been criticized since comprehensive education replaced preregistration specialist education. Current and projected workforce shortages have given rise to considering the reintroduction of specialization at preregistration level as a potential solution. Support of heads of schools of nursing would be essential for such an initiative to be considered. A qualitative exploratory study was undertaken involving in-depth telephone interviews with heads of schools of nursing in Queensland. Participants generally favoured the concept of specialization in mental health nursing at undergraduate level. Data analysis revealed the following themes: meeting workforce needs, improving quality of care, employability of graduates, an attractive option for students, and what would have to go. Participants identified many benefits to mental health service delivery and consumer outcomes. How the initiative could be developed within an already overcrowded curriculum was identified as the major barrier. This level of support is encouraging if necessary changes to the educational preparation for mental health nursing practice are to be considered. © 2014 Australian College of Mental Health Nurses Inc.
Gíslason, Davíð; Bjœrnsdóttir, Unnur Steina; Blœndal, Thornorsteinn; Gíslason, Thornórarinn
The European Community Respiratory Health Survey (ECRHS) was the first project embarked on extensive study of geographical difference between countries with regards to asthma and atopy incidence in a young adult population. The same methodology and definitions were used at all study sites. The purpose of this article is to review the published results of the ECRHS with a special emphasis on the findings from the Icelandic population, and compare these results with those from the participants from the other nations and study sites. Compiled results from all study sites participating in the ECHRS hereto published were reviewed. The compiled data are derived from approximately 140.000 individuals aged 20-44 (birth-years 1946-71) from 22 nations and 48 study sites. The Icelandic population was chosen from the greater Reykjavik metropolitan area. Subjects responded to seven questions on respiratory symptoms, diagnosis of asthma and use of asthma medications. In the latter part of the investigation, 800 individuals were randomly selected from each study site. They were asked to respond to a detailed questionnaire. Subsequently spirometry, methacholine challange and skin prick testing to 11-12 common aeroallergens was performed. Additionally, allergen specific IgE and total IgE was measured. Somewhat fewer sites participated in this latter part: 17 nations and 37 study sites. The findings are presented from two angles: the compiled data from all study sites and the results from the Icelandic population; specifically comparing the Icelandic data with the participants from the other nations. The study showed a geographical difference in the incidence of asthma, bronchial hyper- responsiveness and other respiratory symptoms. In the first part of the study, an eight-fold difference in wheezing, six-fold difference in asthma, ten-fold difference in physician- diagnosed asthma and a four-fold difference in the prevalence of allergic rhinitis was found between the study sites
Lopez, Ximena; Marinkovic, Maja; Eimicke, Toni; Rosenthal, Stephen M; Olshan, Jerrold S
The purpose of this Position Statement is to emphasize the importance of an affirmative approach to the health care of transgender individuals, as well as to improve the understanding of the rights of transgender youth. Transgender youth have optimal outcomes when affirmed in their gender identity, through support by their families and their environment, as well as appropriate mental health and medical care. The Pediatric Endocrine Society Special Interest Group on Transgender Health joins other academic societies involved in the care of children and adolescents in supporting policies that promote a safe and accepting environment for gender nonconforming/transgender youth, as well as adequate mental health and medical care. This document provides a summary of relevant definitions, information and current literature on which the medical management and affirmative approach to care of transgender youth are based.
Minnesota State Dept. of Health, Minneapolis. Services for Children with Handicaps.
These guidelines were written to help families coordinate the health care that may be needed by a child with congenital heart disease. The booklet begins with general information about congenital heart disease. It then discusses the goals of health care, the health care team, the importance of periodic health care, and record keeping procedures.…
Strickland, Bonnie B; Jones, Jessica R; Newacheck, Paul W; Bethell, Christina D; Blumberg, Stephen J; Kogan, Michael D
To provide a national, population-based assessment of the quality of the health care system for children and youth with special health care needs using a framework of six health care system quality indicators. 49,242 interviews with parents of children with special health care needs from the 2009-10 National Survey of Children with Special Health Care Needs (NS-CSHCN) were examined to determine the extent to which CSHCN had access to six quality indicators of a well-functioning system of services. Criteria for determining access to each indicator were established and applied to the survey data to estimate the proportion of CSHCN meeting each quality indicator by socio-demographic status and functional limitations. 17.6% of CSHCN received care consistent with all six quality indicators. Results for each component of the system quality framework ranged from a high of 70.3% of parents reporting that they shared decision-making with healthcare providers to a low of 40% of parents reporting receipt of services needed for transition to adult health care. Attainment rates were lower for CSHCN of minority racial and ethnic groups, those residing in households where English was not the primary language, those in lower income households, and those most impacted by their health condition. Only a small proportion of CSHCN receive all identified attributes of a high-quality system of services. Moreover, significant disparities exist whereby those most impacted by their conditions and those in traditionally disadvantaged groups are served least well by the current system. A small proportion of CSHCN appear to remain essentially outside of the system, having met few if any of the elements studied.
Jones, Jessica R.; Newacheck, Paul W.; Bethell, Christina D.; Blumberg, Stephen J.; Kogan, Michael D.
To provide a national, population-based assessment of the quality of the health care system for children and youth with special health care needs using a framework of six health care system quality indicators. 49,242 interviews with parents of children with special health care needs from the 2009–10 National Survey of Children with Special Health Care Needs (NS-CSHCN) were examined to determine the extent to which CSHCN had access to six quality indicators of a well-functioning system of services. Criteria for determining access to each indicator were established and applied to the survey data to estimate the proportion of CSHCN meeting each quality indicator by socio-demographic status and functional limitations. 17.6 % of CSHCN received care consistent with all six quality indicators. Results for each component of the system quality framework ranged from a high of 70.3 % of parents reporting that they shared decision-making with healthcare providers to a low of 40 % of parents reporting receipt of services needed for transition to adult health care. Attainment rates were lower for CSHCN of minority racial and ethnic groups, those residing in households where English was not the primary language, those in lower income households, and those most impacted by their health condition. Only a small proportion of CSHCN receive all identified attributes of a high-quality system of services. Moreover, significant disparities exist whereby those most impacted by their conditions and those in traditionally disadvantaged groups are served least well by the current system. A small proportion of CSHCN appear to remain essentially outside of the system, having met few if any of the elements studied. PMID:24912943
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The thought is that viewing assessment as an integral, rather than 'extra' aspect of student affairs and incorporating these activities within their work, student affairs professionals will not only improve the effectiveness of their work with students but also can help legitimise the field as a profession. Keywords: assessment ...
Barlow, Allen R.
An Australian student affairs leader summarizes issues discussed at recent international conferences. A significant number of commonalities appear in the information. These issues provide a global perspective on some of the problems and challenges facing student affairs. This international perspective has rarely been described in the literature…
The African Journal of International Affairs and Development (AJIAD) began in 1995 as a bi-annual devoted to the study of Africa in global affairs and development. Vol 17, No 2 (2014). DOWNLOAD FULL TEXT Open Access DOWNLOAD FULL TEXT Subscription or Fee Access. Table of Contents. Articles. The Global ...
Knapp, Caprice A; Madden, Vanessa L; Marcu, Mircea I
Partnering between families and their children's providers is a cornerstone of family-centered care. This study aimed to identify factors associated with family-provider partnership and determine the association between partnership and other outcome measures for children with special health care needs (CSHCN). Descriptive, bivariate, and multivariate analyses were conducted using data from the 2005-2006 National Survey of Children with Special Health Care Needs. Multivariate models showed that CSHCN who are White non-Hispanic, younger than 12, reside in households with incomes above 400% of the federal poverty level, and have a usual source of care were associated with family-provider partnership. Multivariate models showed that family-provider partnership was significantly associated with adequate insurance, early and continual screening, organized health care services, and transition preparedness. Family-provider partnership was associated with 20% fewer emergency department visits and 9% fewer school days missed. This study suggests that policies aimed at promoting family-provider partnership could increase health outcomes for CSHCN.
Background Alcohol use is an important factor in a population’s risk for disease and mortality. Alcohol has a long history of use in Africa, and changes in drinking behavior are underway in many African states. Women and older adults are two special populations that comprise sizable proportions of the general population and whose use of alcohol will have important consequences for public health in Africa. There is limited information about the drinking behavior of women and older adults, w...
Saragoça, M.; Candeias, A. A.; Rosário, A.
Since 2008, the International Classification of Functioning, Disability and Health - ICF (WHO, 2001) is the framework of reference in the assessment and intervention process with students with SEN, in the Portuguese educational system. As a consequence special education teachers’ training needs emerged from it. In this study, we characterize the received training and the special education teachers’ attitudes and training needs towards ICF. The sample consisted of 913 Portuguese special educat...
...—(1) Defined. A group health plan means an employee welfare benefit plan to the extent that the plan...) Excepted benefits—(1) In general. The requirements of this Part do not apply to any group health plan (or any group health insurance coverage) in relation to its provision of the benefits described in...
Langford, T L
Female college athletes constitute a population with potential health problems beyond those of their age-mates. The expectations of the elite college athlete for academic and athletic accomplishment and for exemplary personal behavior, in combination with the typical developmental crises of late adolescence, create health risks. This presents the opportunity for effective health promotion as a part of primary care for these young women. The HealthCoRE Program at Texas Tech University Health Sciences Center School of Nursing is an example of how a program approach using a community health perspective, in contrast to an episodic or an "array-of-available-services-cafeteria" approach, can affect the health of female college athletes. Program elements include identification of group and individual health risks and health information interests, individual physical examination including a gynecologic examination, individual client contracts for group and individual activities, and crisis intervention. Three years of experience with the program shows value both from the athletes' perspectives and from their coaches' perspectives. Nurse practitioners are the ideal providers for this type of service because of their knowledge of the community health approach, their skills in health promotion and disease prevention, and their use of health teaching as a therapeutic tool.
Christiansen, Terkel; Erb, Karin; Rizvanovic, Amra
Objective. To examine the costs to the public health care system of couples in medically assisted reproduction. Design. Longitudinal cohort study of infertile couples initiating medically assisted reproduction treatment. Setting. Specialized public fertility clinics in Denmark. Sample. Seven...... or not – were estimated at 6607€. Costs per live birth of women initiation were 9338€ and 15 040€ for women ≥35 years. Conclusion. The public costs for live births after conception with medically assisted reproduction treatment are relatively modest. The results can be generalized...... hundred and thirty-nine couples having no child at study entry and with data on kind of treatment and live birth (yes/no) for each treatment attempt at the specialized public fertility clinic. Methods. Treatment data for medically assisted reproduction attempts conducted at the public fertility clinics...
Kooistra, L. C.; Ruwaard, J.; Wiersma, J. E.
the costs of mental health care, by reducing treatment duration and/or therapist contact. However, knowledge on blended care for depression is still limited. Objectives: To develop a blended cognitive behavioural treatment (bCBT) for depressed patients in an outpatient specialized mental health care centre...... and to conduct a preliminary evaluation of this bCBT protocol. Method: A bCBT protocol was developed, taking recommendations into account from depressed patients (n = 3) and therapists and experts in the field of e-health (n = 18). Next, an initial evaluation of integrated high-intensive bCBT was conducted...... (CEQ) before treatment, and system usability (SUS) and treatment satisfaction after treatment (CSQ-8). During and after treatment, the blended treatment protocol was evaluated in supervision sessions with the participating therapists (n = 7). Results: Seven out of nine patients started bCBT, of whom...
McCarthy, Carla M
Public affairs has been identified as a key component of strategic communication, but incorporating public affairs within a strategic communication framework within the military, without compromising...
Knapp, Caprice; Huang, I-Chan; Hinojosa, Melanie; Baker, Kimberly; Sloyer, Phyllis
Several studies have investigated how prepared adolescents are to transition to adult health care and barriers to transition for adolescents with special health care needs. The majority of these studies, however, have only assessed these experiences from the parents' point of view. Our study aims to assess the congruence of adolescents and parents reported transition planning and the factors associated with planning. A secondary data analysis was conducted using telephone survey data. Data were collected from parents and adolescents with special health care needs who received health care through Florida's Title V public insurance program. The final sample included 376 matched pairs of adolescent-parent surveys. To assess health care transition planning, respondents were asked if discussions had occurred with the adolescents' doctor, nurse, or with each other. Parents reported higher levels of planning than adolescents. Results show the lowest level of agreement between the parent and adolescent reports (κ < 0.2) and the highest level of agreement when parents and adolescents were asked if they discussed transition with each other (κ = 0.19). Regression results suggest that older adolescents are more prepared (vs. younger) and that adolescents whose parents have lower educational attainment are less prepared for transition. Results from this study suggest that there may be miscommunication around discussions related to transition, although further research is warranted. It is important to ensure that adolescents, not just parents, have a thorough understanding of transition since they will ultimately be responsible for their own health care once they reach adulthood.
... AFFAIRS Advisory Committee on Prosthetics and Special-Disabilities Programs; Notice of Meeting The..., that a meeting of the Federal Advisory Committee on Prosthetics and Special-Disabilities Programs will... Veterans Affairs on VA's prosthetics programs designed to provide state-of-the- art prosthetics and the...
... AFFAIRS Advisory Committee on Prosthetics and Special-Disabilities Programs; Notice of Meeting The...) ] that a meeting of the Advisory Committee on Prosthetics and Special- Disabilities Programs will be held... advise the Secretary of Veterans Affairs on VA's prosthetics programs designed to provide state-of-the...
... AFFAIRS Advisory Committee on Prosthetics and Special-Disabilities Programs; Notice of Meeting The..., that a meeting of the Federal Advisory Committee on Prosthetics and Special-Disabilities Programs will... Veterans Affairs on VA's prosthetics programs designed to provide state-of-the- art prosthetics and the...
... AFFAIRS Advisory Committee on Prosthetics and Special-Disabilities Programs, Notice of Meeting The..., that a meeting of the Federal Advisory Committee on Prosthetics and Special-Disabilities Programs will... Veterans Affairs on VA's prosthetics programs designed to provide state-of-the- art prosthetics and the...
... AFFAIRS Advisory Committee on Prosthetics and Special Disabilities Programs; Notice of Meeting The...) that a meeting of the Advisory Committee on Prosthetics and Special Disabilities Programs (the... Secretary of Veterans Affairs on VA's prosthetic programs designed to provide state-of-the- art prosthetics...
... AFFAIRS Advisory Committee on Prosthetics and Special-Disabilities Programs; Notice of Meeting The...) that a meeting of the Advisory Committee on Prosthetics and Special-Disabilities Programs will be held... Veterans Affairs on VA's prosthetics programs designed to provide state-of-the art prosthetics and the...
Quach, Jon; Oberklaid, Frank; Gold, Lisa; Lucas, Nina; Mensah, Fiona K; Wake, Melissa
We studied infants and children with and without special health care needs (SHCN) during the first 8 years of life to compare the (i) types and costs to the government's Medicare system of non-hospital health-care services and prescription medication in each year and (ii) cumulative costs according to persistence of SHCN. Data from the first two biennial waves of the nationally representative Longitudinal Study of Australian Children, comprising two independent cohorts recruited in 2004, at ages 0-1 (n = 5107) and 4-5 (n = 4983) years. Exposure condition: parent-reported Children with Special Health Care Needs Screener at both waves, spanning ages 0-7 years. Federal Government Medicare expenditure, via data linkage to the Medicare database, on non-hospital health-care attendances and prescriptions from birth to 8 years. At both waves and in both cohorts, >92% of children had complete SHCN and Medicare data. The proportion of children with SHCN increased from 6.1% at age 0-1 years to 15.0% at age 6-7 years. Their additional Medicare costs ranged from $491 per child at 6-7 years to $1202 at 0-1 year. This equates to an additional $161.8 million annual cost or 0.8% of federal funding for non-hospital-based health care. In both cohorts, costs were highest for children with persistent SHCNs. SHCNs incur substantial non-hospital costs to Medicare, and no doubt other sources of care, from early childhood. This suggests that economic evaluations of early prevention and intervention services for SHCNs should consider impacts on not only the child and family but also the health-care system. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
Brook, U; Galili, A
One hundred seventy-one pupils of a high school in Holon (Israel) were questioned regarding their attitudes towards chronically disabled individuals who have special health-care needs. The level of pupils' knowledge concerning the etiology, symptoms and complications of these chronic conditions was approximately 72%; it did not increase in four years of study. Previous personal knowledge of a child or adolescent with a chronic disease or handicap influenced the understanding of that particular ailment. The pupils' attitude towards handicapped individuals become more positive and tolerant with increasing age (and class level). A correlation was found between the level of knowledge about special medical-health needs and tolerant attitudes toward chronic patients. Most of the pupils think that the following occupational and recreational interests for the disabled will help to increase their self-image and improve their feelings of acceptance: computers, music (playing and listening), sports and domestic pets. The pupils believe the topics of chronic diseases and patients should be studied as a regular part of the school curriculum and these subjects should be taught with the participation of both physicians and teachers. The pupils stressed the role of the teacher in handling children with the chronic disease. Only half of the pupils think that their class peers should also know about the chronic disease of this individual pupil. The information sources of pupils concerning chronic disease are mainly TV, newspapers, adolescent periodicals, books, physicians and nurses, and lastly, the school. Conclusions are presented concerning health promotion activities in the school.
Iida, Hiroko; Lewis, Charlotte; Zhou, Chuan; Novak, Louise; Grembowski, David
Controversy exists in the literature about whether dental care needs, use and expenditures differ between children with and without special health care needs (SHCN). The authors used data from the 2005 Medical Expenditure Panel Survey (MEPS) for children younger than 18 years. The MEPS questionnaire included the Children with Special Health Care Needs Screener, which defines a child as having SHCN if he or she meets at least one of five specific criteria. Using bivariate and multivariable regression analyses, the authors evaluated the effect of SHCN on unmet dental care needs, type of dental care received and average dental care expenditures. Children with special health care needs (CSHCN) had an adjusted odds ratio (AOR) of 1.49 (95 percent confidence interval [CI] = 1.09-2.05) of having unmet dental care needs compared with children without SHCN, and CSHCN who met four or five screener criteria had an AOR of 2.2 (95 percent CI = 1.16-4.20). CSHCN used more dental care services and were more likely to receive only nonpreventive care. Average dental care expenditures were not statistically different between CSHCN and children without SHCN, and there was variability among CSHCN in unmet dental care needs and use. Unmet dental care needs are associated independently with SHCN status and complexity (based on the number of screener criteria the child met). The CSHCN populations in MEPS varied in their ability to obtain and use needed dental care services. Practice Implications. It is important to consider the diversity of CSHCN when developing systems of dental care for this population.
Aydın P E K E L
Full Text Available I n this study it was aimed to investigate the relationship between life satisfaction and health promoting behaviour of teachers worked special education s chools in Kayseri city. Randomly selected, 102 teachers were participated to the st u dy volunteerly. Volunteers were performed demographic questionnaire, Healthy Lifestyle Behaviors Scale II (HLBS II and life satisfaction inventory. Data were analyzed by u sing IBM SPSS (version 20.0. Spearman Correlation parameter calculated in order to comment the relationship with data, Multiple regretion analysis was performed for the predictive power of life satisfaction for health promoting behaviour levels of participants. According to analysis, a positive relationship was found between life satisfaction and health promoting behaviours levels of teachers and it was found that life satisfaction levels predictived health promoting behaviour levels. As a result of this study, it was found that teachers had higher life satisfaction, were tend towards to higher health promoting behaviours. It was thought that increased life satisfaction of teachers could increase their health promoting behaviours, so that quality of education, they provided to handicapped students, would increase in the same parallels
Der-Martirosian, Claudia; Griffin, Anne R; Chu, Karen; Dobalian, Aram
Background Like other integrated health systems, the US Department of Veterans Affairs has widely implemented telehealth during the past decade to improve access to care for its patient population. During major crises, the US Department of Veterans Affairs has the potential to transition healthcare delivery from traditional care to telecare. This paper identifies the types of Veterans Affairs telehealth services used during Hurricane Sandy (2012), and examines the patient characteristics of those users. Methods This study conducted both quantitative and qualitative analyses. Veterans Affairs administrative and clinical data files were used to illustrate the use of telehealth services 12 months pre- and 12 months post- Hurricane Sandy. In-person interviews with 31 key informants at the Manhattan Veterans Affairs Medical Center three-months post- Hurricane Sandy were used to identify major themes related to telecare. Results During the seven-month period of hospital closure at the Manhattan Veterans Affairs Medical Center after Hurricane Sandy, in-person patient visits decreased dramatically while telehealth visits increased substantially, suggesting that telecare was used in lieu of in-person care for some vulnerable patients. The most commonly used types of Veterans Affairs telehealth services included primary care, triage, mental health, home health, and ancillary services. Using qualitative analyses, three themes emerged from the interviews regarding the use of Veterans Affairs telecare post- Hurricane Sandy: patient safety, provision of telecare, and patient outreach. Conclusion Telehealth offers the potential to improve post-disaster access to and coordination of care. More information is needed to better understand how telehealth can change the processes and outcomes during disasters. Future studies should also evaluate key elements, such as adequate resources, regulatory and technology issues, workflow integration, provider resistance, diagnostic fidelity and
Son, Esther; Moring, Nechama Sammet; Igdalsky, Leah; Parish, Susan L
Children with special health-care needs (CSHCNs) face notable barriers to health-care access and to receiving quality and family-centered care, despite higher health-care utilization rates. Within the population of CSHCNs, there are significant inequities in health-care quality impacting immigrants who have migrated to the United States. However, little is known about the experiences and needs of Asian immigrant families who have CSHCNs. This study aimed to explore how Asian immigrant parents of CSHCNs view their child's health-care access, quality, and utilization. We conducted semi-structured qualitative interviews with 22 Vietnamese- and Cantonese-speaking parents of CSHCNs. Participants were recruited through community partners. Interviews were transcribed, translated, and coded using content analysis. Participants were generally satisfied with their children's care and had strong relationships with their primary care doctors who were often culturally 'matched'. However, participants experienced several important and culturally specific barriers, including gaps in their understanding of the health-care system, language barriers, and a sense of alienation. Parents frequently turned to informal and community supports for assistance in navigating the US health-care system. Further research to understand the drivers of health disparities and policy level solutions is warranted.
The Social Affairs Service is pleased to announce that from now on it offers the services of a psychologist on Tuesday and Thursday mornings. The Social Affairs Service is a centre offering advice and support which can provide the following: Information and documentation (education for your children, language courses, child-minding facilities, health-related matters etc.). Information on social protection (illness, disability, handicap, retirement, death, etc.) and integration. Assistance in dealings with the authorities/services concerned. Consultations with a view to resolving problems of a personal, family or professional nature, such as problems of dependancy (alcohol, drugs, relationship) or behavioural problems (stress, depression, eating disorders). Support in facing new situations (maternity, divorce, bereavement, change of post, geographical isolation). Assistance with decision making relating to family, personal or professional matters. The team is at the disposition of all members of person...
Richmond, Nicole E; Tran, Tri; Berry, Susan
The Medical Home (MH) is shown to improve health outcomes for Youth with Special Health Care Needs (YSHCN). Some MH services involve Transition from pediatric to adult providers to ensure YSHCN have continuous care. Studies indicate racial/ethnic disparities for Transition, whereas the MH is shown to reduce health disparities. This study aims to (1) Determine the Transition rate for YSHCN with a MH (MH Transition) nationally, and by race/ethnicity (2) Identify which characteristics are associated with MH Transition (3) Determine if racial/ethnic disparities exist after controlling for associated characteristics, and (4) Identify which characteristics are uniquely associated with each race/ethnic group. National survey data were used. YSCHN with a MH were grouped as receiving Transition or not. Characteristics included race, ethnicity (Non-Hispanic (NH), Hispanic), sex, health condition effect, five special health care need categories, education, poverty, adequate insurance, and urban/rural residence. Frequencies, chi-square, and logistic regression were used to calculate rates and define associations. Alpha was set to 0.05. About 57.0% of YSHCN received MH Transition. Rates by race/ethnicity were 59.0, 45.5, 60.2, 41.9, and 44.6% for NH-White, NH-Black, NH-Multiple race, NH-Other, and Hispanic YSHCN, respectively. Disparities remained between NH-White and NH-Black YSHCN. All characteristics except urban/rural status were associated. Adequate insurance was associated for all race/ethnic groups, except NH-Black YSHCN. Almost 57.0% of YSHCN received MH Transition. Disparities remained. Rates and associated characteristics differed by race/ethnic group. Culturally tailored interventions incorporating universal factors to improve MH Transition outcomes are warranted.
Danzon, Patricia M; Drummond, Michael F; Towse, Adrian; Pauly, Mark V
The fourth section of our Special Task Force report focuses on a health plan or payer's technology adoption or reimbursement decision, given the array of technologies, on the basis of their different values and costs. We discuss the role of budgets, thresholds, opportunity costs, and affordability in making decisions. First, we discuss the use of budgets and thresholds in private and public health plans, their interdependence, and connection to opportunity cost. Essentially, each payer should adopt a decision rule about what is good value for money given their budget; consistent use of a cost-per-quality-adjusted life-year threshold will ensure the maximum health gain for the budget. In the United States, different public and private insurance programs could use different thresholds, reflecting the differing generosity of their budgets and implying different levels of access to technologies. In addition, different insurance plans could consider different additional elements to the quality-adjusted life-year metric discussed elsewhere in our Special Task Force report. We then define affordability and discuss approaches to deal with it, including consideration of disinvestment and related adjustment costs, the impact of delaying new technologies, and comparative cost effectiveness of technologies. Over time, the availability of new technologies may increase the amount that populations want to spend on health care. We then discuss potential modifiers to thresholds, including uncertainty about the evidence used in the decision-making process. This article concludes by discussing the application of these concepts in the context of the pluralistic US health care system, as well as the "excess burden" of tax-financed public programs versus private programs. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Klingenberg, Anja; Broge, Björn; Herholz, Harald; Szecsenyi, Joachim; Ose, Dominik
In 2004, German statutory health care funds were given the possibility to offer their insured a special general practitioner-( GP-)centered health care contract (HZV), since 2007 they are obliged to do so. The aim of these contracts is to strengthen the role of the GP as a coordinator in the health care system. Until now, the evidence regarding the GPs' view on these contracts is poor. A written survey was conducted in Hesse in order to learn how the participating GPs evaluate the regional HZV. In Apri 2008, a questionnaire was developed, tested and mailed to 2,815 GPs who were participating in the GP-centered health care contract at that time. All analyses where conducted with SPSS (version 15.0). A total of 686 questionnaires were returned (response rate 24.4%). Altogether, the GPs' feedback ranged from great approval to clear disapproval of the contract. However, 70.0% of the survey's participants evaluated the HZV in general to be positive, 60.1% felt it strengthens their role as a GP. Quality circles on good prescribing and GP-specific education, obligatory parts of the HZV, were evaluated to be especially positive (70.3% and 69.4%, respectively). Positive effects were also seen concerning coordination of care (53.3%) and cooperation with patients (36.3%). Improvements concerning cooperation with specialists and hospitals were reported less often (24.9% and 13.0%, respectively). Workload because of additional administration for the HZV was criticized. In future, special GP-centered health care contracts should focus on improvement of cooperation between GPs and other caregivers. Workload for additional administration should be reduced.
Shaw, W.S.; Tveito, T.H.; Boot, C.R.L.
Background The increasing prevalence of older workers and chronic health conditions represents a growing occupational health concern. More research is needed to understand risk factors, apply and adapt theories, and test workplace-focused interventions that might prevent work disability and
Shaw, W.S.; Tveito, T.H.; Boot, C.R.L.
Background The increasing prevalence of older workers and chronic health conditions represents a growing occupational health concern. More research is needed to understand risk factors, apply and adapt theories, and test workplace-focused interventions that might prevent work disability and
Every woman, man, youth and child has the human right to the highest attainable standard of physical and mental health, without discrimination of any kind. This is enshrined in the Indian Constitution and the Universal Declaration on Human Rights. Enjoyment of the human right to health is vital to all aspects of a person's life and well-being,…
Nap, A.W.; van Loon, A.; Peen, J.; van Schaik, D.J.F.; Beekman, A.T.F.; Dekker, J.J.M.
Background: The level of acculturation of migrants varies and is associated with variations in mental health. However, this association is complex and may differ among migrant groups. Aim: The aim of this study is to explore the association between acculturation, mental health and treatment effect.
centeredhealth care?A focus on cerebral palsy and spina bifida. Arch Phys Med Rehabil 2007;88:1064–73. g ance p-value % encouraged in self-responsibility...Health planning, Health services needs and demand 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: Unclassified 17. LIMITATION OF ABSTRACT
Scholz, Brett; Bocking, Julia; Happell, Brenda
Stigmatizing views towards consumers may be held even by those working within mental health organizations. Contemporary mental health policies require organizations to work collaboratively with consumers in producing and delivering services. Using social exchange theory, which emphasises mutual exchange to maximise benefits in partnership, the current study explores the perspectives of those working within organizations that have some level of consumer leadership. Interviews were conducted with 14 participants from a range of mental health organizations. Data were transcribed, and analyzed using thematic analytic and discursive psychological techniques. Findings suggest stigma is still prevalent even in organizations that have consumers in leadership positions, and consumers are often perceived as less able to work in mental health organizations than non-consumers. Several discourses challenged such a view - showing how consumers bring value to mental health organizations through their expertise in the mental health system, and their ability to provide safety and support to other consumers. Through a social exchange theory lens, the authors call for organizations to challenge stigma and promote the value that consumers can bring to maximize mutual benefits. © 2017 Australian College of Mental Health Nurses Inc.
Domingo, Christian; Rubio, Vicente Ortún
Health care demands have increased dramatically in recent decades. With the introduction of major changes in the management of health problems, health care costs have spiralled. Today, in the interests of cost control, medicine is geared towards outpatient care whenever possible. In this process, the medical community has been obliged to adapt its traditional criteria to the dictates of national economies. Today the criteria for the organization and evaluation of the health services are based on the concepts of efficacy, effectiveness and efficiency. This has led to the emergence of a new discipline for the design and evaluation of medical service production, known as servuction, an amalgam of “service” and “production”. The organigram of a new health product should include the problems the program faces and the steps proposed to overcome these problems. The concept of evaluation can be divided into two categories: administrative evaluation, and evaluative research. Avedis Donabedian was one of the founders of evaluative research, based on an easy-to-remember triad: structure-process-results. In the final evaluation of a new health care model, the innovations it provides must be considered. In this article we describe the stages involved in the design of a new health product and correlate them with the types of evaluation that should be applied at each point in the process. Our discussion addresses general aspects of servuction, but also focuses on the design of a particular service, created to care for patients with severe COPD. PMID:19340319
Schulenberg, Stefan E
This article serves as an introduction to the Journal of Clinical Psychology's special issue on disaster mental health and positive psychology. The special issue comprises two sections. The first section presents a series of data-driven articles and research-informed reviews examining meaning and resilience in the context of natural and technological disasters. The second section presents key topics in the area of disaster mental health, with particular relevance for positive psychology and related frameworks. The special issue is intended to bridge the gap between these two areas of applied science, with the audience being experienced clinicians or clinicians in training. © 2016 Wiley Periodicals, Inc.
Baker, Suher; Thomas, Marc
To describe pediatric dental residents education as it pertains to children with special healthcare needs (CSHCN). A web-based survey was administered to 80 program directors of pediatric dental residencies recognized by the American Academy of Pediatric Dentistry (AAPD). The survey identified demographic data and education and training methods pertaining to CSHCN. Forty surveys (50 percent) were received from programs in all six AAPD regions. Programs that treated 4,500 patients or less/year were statistically less likely to require a specific assessment and were less likely to use written tests to assess competency treating CSHCN. A specific special needs didactic course (88 percent) and journal articles (85 percent) were the most common didactic training methods. The majority of the programs (69 percent) offered more than 20 hours of didactic education. On average 36.3 percent of the patients treated in residencies reported to be CSHCN and each resident clinically treated and average of 13 CSHCN/week. One-third of the respondents planned to increase CSHCN education in the next three years. Almost 70 percent of respondents supported the standardization of a national curriculum regarding CSHCN. A wide disparity exists among residencies regarding education related to CSHCN. Most pediatric dental residency directors support the national standardization of CSHCN education.
van Orden, Mirjam; Leone, Stephanie; Haffmans, Judith; Spinhoven, Philip; Hoencamp, Erik
Referral to collaborative mental health care within the primary care setting is a service concept that has shown to be as effective as direct referral to specialized mental health care for patients with common mental disorders. Additionally it is more efficient in terms of lower mental health services use. This post-hoc analysis examines if treatment intensity during 1-year of follow-up can be predicted prospectively by baseline characteristics. With multilevel multivariate regression analyses baseline characteristics were examined as potential predictors of visit counts. Results showed that only the enabling factors service concept and referral delay for treatment had a significant association with mental health visit counts, when outcome was dichotomized in five or more visits. Inclusion of the outcome variable as a count variable confirmed the predictive value of service concept and referral delay, but added marital status as a significant predictor. Overall, enabling factors (service concept and referral delay) seem to be important and dominant predictors of mental health services use.
Huang, I-Chan; Anderson, Mary; Gandhi, Pranav; Tuli, Sanjeev; Krull, Kevin; Lai, Jin-Shei; Nackashi, John; Shenkman, Elizabeth
To examine the relationships among pediatric fatigue, health-related quality of life (HRQOL), and family impact among children with special health care needs (CSHCNs), specifically whether HRQOL mediates the influence of fatigue on family impact. 266 caregivers of CSHCNs were studied. The Pediatric Quality of Life Inventory Multidimensional Fatigue Scale, Pediatric Quality of Life Inventory Generic Scale, and Impact on Family Scale were used to measure fatigue, HRQOL, and family impact, respectively. Linear regressions were used to analyze the designated relationships; path analyses were performed to quantify the mediating effects of HRQOL on fatigue-family impact relationship. Although greater fatigue was associated with family impact (p family impact was not significant (p > .05), whereas physical and emotional functioning significantly mediated the fatigue-family impact relationship (p family impact among CSHCNs, acting through the impairment in HRQOL.
Serratia marcescens, a ubiquitous, essentially saprophytic bacterium with a predilection for starches, has played a significant role in human affairs. Its notoriety has been occasioned by a blood-red pigment liberated by the organism during its metabolic activities that has been mistaken for fresh blood. In early Greek and Roman history, such "bloody" episodes were viewed as manifestations of divine destiny; by the Middle Ages in Europe they coincided with the development of church doctrine regarding the holy sacraments and had a far more sinister effect. In numerous instances between 1300 and 1500 A.D. host wafers developed a "bloody" appearance and led to the mass slaughter of Jews, who were accused of destructive attempts against the Eucharist. In our time, Serratia marcescens has been shown to possess significant endotoxic activity and can no longer be regarded as a harmless nuisance. It has been implicated in a wide range of human infections, particularly hospital-associated infections, of varying degrees of severity and including fatal antibiotic-resistant septicemias.
Glassman, Paul; Folse, Gregory
Low-income people with disabilities or who are elderly have more dental disease, more missing teeth, and more difficulty obtaining dental care than other members of the general population. These realities lead to untreated infection, increased medical costs and needless suffering for the most vulnerable members of our society. It is critical we provide adequate reimbursement for oral health services in order to avoid the tragic and costly consequences of oral neglect. This article focuses on the financial implications of delivering oral health services to low-income individuals who are "aged, blind, and disabled" in the United States. The experience of providing oral health services in California for these populations is extrapolated to predict the cost implications of a national reimbursement system for ABD adults under Medicaid and reform Medicaid oral health programs for vulnerable children. The new federal dollars required to implement this legislation would be more than offset by a conservatively estimated 0.5 percent reduction in costly emergency room and hospital charges for the treatment of serious dental problems, as well as a reduction in the prevalence and severity of several general health conditions. Treating and/or preventing oral infection and disease for the ABD populations in our country will significantly reduce overall health care costs, improve quality of life, and end needless suffering for America's most vulnerable citizens. Treating and/or preventing oral infection and disease for this population simply is the right thing to do.
Hedley Brooke, John
Aspects of the Galileo affair are identified that can be of particular value in teaching AT 17. Some common myths are exposed as a corrective to popular images of intrinsic conflict between science and religion.
Dalton, Jon C.; Gardner, Diana Imanuel
Managing change is one of the most complex skills of leadership. This chapter examines some of the most difficult changes confronted by student affairs leaders and the practical wisdom they have gained from these encounters. (Author)
Björk Brämberg, Elisabeth; Torgerson, Jarl; Norman Kjellström, Anna; Welin, Peder; Rusner, Marie
Persons with severe mental illness (e.g. schizophrenia, bipolar disorder) have a high prevalence of somatic conditions compared to the general population. Mortality data in the Nordic countries reveal that these persons die 15-20 years earlier than the general population. Some factors explaining this high prevalence may be related to the individuals in question; others arise from the health care system's difficulty in offering somatic health care to these patient groups. The aim of the present study was therefore to explore the experiences and views of patients, relatives and clinicians regarding individual and organizational factors which facilitate or hinder access to somatic health care for persons with severe mental illness. Flexible qualitative design. Data was collected by means of semi-structured individual interviews with patients with severe mental illness, relatives and clinicians representing primary and specialized health care. In all, 50 participants participated. The main barrier to accessing somatic care is the gap between the organization of the health care system and the patients' individual health care needs. This is observed at both individual and organizational level. The health care system seems unable to support patients with severe mental illness and their psychiatric-somatic comorbidity. The main facilitators are the links between severe mental illness patients and medical departments. These links take the form of functions (i.e. systems which ensure that patients receive regular reminders), or persons (i.e. professional contacts who facilitate patients' access the health care). Health care services for patients with severe mental illness need reorganization. Organizational structures and systems that facilitate cooperation between different departments must be put in place, along with training for health care professionals about somatic disease among psychiatric patients. The links between individual and organizational levels could be
1947): 113-120. Borg, Lindsey. ―Communicating with Intent: DOD and Strategic Communication.‖ Air University, 2007. Chomsky , Noam and Barsamian, David...PUBLIC AFFAIRS: INFORM, EDUCATE , AND INFLUENCE A thesis presented to the Faculty of the U.S. Army Command and General Staff College...06-2009 2. REPORT TYPE Master‘s Thesis 3. DATES COVERED (From - To) AUG 2009 – JUN 2009 4. TITLE AND SUBTITLE Public Affairs: Inform, Educate
... Academic Affairs. 17.251 Section 17.251 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Grants for Exchange of Information § 17.251 The Subcommittee on Academic Affairs. There is... Subcommittee on Academic Affairs, and the Subcommittee shall advise the Secretary, through the Under Secretary...
Guo, Mary; Chock, Galen; Parlin, Leolinda; Yamashiroya, Vince; Rudoy, Raul
O'ahu's primary care physicians are in the process of implementing the Patient-Centered Medical Home (PCMH) model. The Medical Home Task Force recommends the implementation of the Children with Special Health Care Needs (CSHCN) Screener© as one of the two quality improvement programs that must be completed by each participating physician. This study sought to find how many pediatricians practice population health management and to determine barriers for incorporating population health management and care registries into practices. An online survey of 55 pediatricians in Hawai'i was conducted between January 10, 2012 and March 10, 2012. The survey contained questions regarding knowledge and use of population health management and investigated the utilization rate of the Screener©. This survey provides baseline data on the implementation of this recommended screener, and informs the process that will be necessary to ensure maximal adoption of recommendations. Sixty percent of the survey participants have not incorporated population health management into their routine practice. Twenty three percent did not have knowledge of population health management and 85% did not use a chronic disease registry. As of August 2011, 95% had not screened their patients with the Screener©. Reasons included not having heard of the Screener© and never having considered using a systematic process to ask patients to assess their health. Based on results, there are important educational goals that need to be accomplished in order for Hawai'i's physicians to transform their practices into effective PCMHs. Physicians will likely need instructional and monetary support to effectively change their practices into PCMHs.
Rajan R. Patil
Full Text Available Since occupation is a major determinant of health, traffic police personnel face multiple occupational hazards. They are continuously exposed to vehicular emissions and work in a noisy and polluted environment. The objective of the present review is to explore the impact of occupational health hazards on the health of traffic police personnel. Published research papers on traffic police reporting occupational health issues were accessed and reviewed. Attempts were made to access papers that reported negative associations in order to present a balanced review. The majority of the studies have reported a decrease in the lung function and increased respiratory morbidity. The research on the cytogenetic abnormalities or genotoxic effect of vehicular emissions arising due to long-term exposure to benzene and other polyaromatic hydrocarbons has provided conflicting results, since more or less equal numbers of studies have given evidence for and against the causal association. There is a vast accumulation of epidemiological evidence on the casual association between vehicular pollution and its carcinogenic effect. Multiple studies have concluded that traffic police are highly stressed. A number of occupational factors have been attributed to stress among traffic police. Occupational health studies help us to understand the effects of vehicular pollution and its adverse influence on workers. They also provide opportunity for defined exposures measurements and precise risk assessment. The findings from these studies are easily generalizable and can help us understand the impact of air pollution on the general population.
Güler, Sertaç Ata; Güllüoğlu, Bahadır M
Breast health is a subject of increasing importance. The statistical increase in the frequency of breast cancer and the consequent increase in death rate increase the importance of quality of services to be provided for breast health. For these reasons, the minimum standards and optimum quality metrics of breast care provided to the community are determined. The quality parameters for breast care service include the results, the structure and the operation of services. Within this group, the results of breast health services are determined according to clinical results, patient satisfaction and financial condition. The structure of quality services should include interdisciplinary meetings, written standards for specific procedures and the existence of standardized reporting systems. Establishing breast centers that adopt integrated multidisciplinary working principles and their cost-effective maintenance are important in terms of operation of breast health services. The importance of using a "reviewing/auditing" procedure that checks if all of these functions existing in the health system are carried out at the desired level and an "accreditation" system indicating that the working breast units/centers provide minimum quality adequacy in all aspects, is undeniable. Currently, the accreditation system for breast centers is being used in the European Union and the United States for the last 5-10 years. This system is thought to provide standardization in breast care services, and is accepted as one of the important factors that resulted in reduction in mortality associated with breast cancer.
Søvig, Karl Harald
All European countries are now facing a situation where a part of the population consists of migrants without a permit to stay or reside. These persons may have health problems, and the question then rises regarding health services to irregular migrants. Normally, welfare benefits are offered those with a relationship to the country concerned, as citizen, asylum seeker, tourist, etc. Irregular migrants are outside the society, and it could be suggested that they therefore should be denied health services. On the other hand, common European standards of humanity lay obligations on the States, for example, where situations are life-threatening. This contribution gives an overview of relevant legal instruments, both from the UN, Council of Europe and the European Union. Although there are many similarities, the instruments have their differences, and there may even be some tensions regarding the underlying values.
This report has been prepared by three WHO expert committees convened under auspices of the Chernobyl Forum's Expert Group 'Health' (EGH), and by WHO staff. It provides an updated assessment of the health consequences of the Chernobyl accident, and follows a detailed report on this topic published by the United Nations Scientific Committee on the Effects of Atomic Radiation in 2000 (UNSCEAR, 2000). The accident occurred at the Chernobyl nuclear power plant in northern Ukraine on April 26, 1986 and released large amounts of radioactivity, primarily radioactive isotopes of caesium and iodine. These releases contaminated large areas of Belarus, the Russian Federation and Ukraine and other countries to a lesser extent, These releases exposed sizable populations to internal and external radiation doses. The Chernobyl accident caused the deaths of 30 power plant employees and firemen within a few days or weeks (including 28 deaths that were due to radiation exposure). In addition, about 240,000 recovery operation workers (also called 'liquidators' or 'clean-up workers') were called upon in 1986 and 1987 to take part in major mitigation activities at the reactor and within the 30-km zone surrounding the reactor. Residual mitigation activities continued on a relatively large scale until 1990. All together, about 600,000 persons (civilian and military) have received special certificates confirming their status as liquidators, according to laws promulgated in Belarus, the Russian Federation, and Ukraine (UNSCEAR, 2000). In addition, massive releases of radioactive materials into the atmosphere brought about the evacuation of about 116,000 people from areas surrounding the reactor during 1986, and the relocation, after 1986, of about 220,000 people from what are at this time three independent republics of the former Soviet Union: Belarus, the Russian Federation, and Ukraine. Vast territories of those three republics were contaminated to a substantial level. The population of
Neumann, Peter J; Willke, Richard J; Garrison, Louis P
Concerns about rising spending on prescription drugs and other areas of health care have led to multiple initiatives in the United States designed to measure and communicate the value of pharmaceuticals and other technologies for decision making. In this section we introduce the work of the International Society for Pharmacoeconomics and Outcomes Research Special Task Force on US Value Assessment Frameworks formed to review relevant perspectives and appropriate approaches and methods to support the definition and use of high-quality value frameworks. The Special Task Force was part of the International Society for Pharmacoeconomics and Outcomes Research Initiative on US Value Assessment Frameworks, which enlisted the expertise of leading health economists, concentrating on what the field of health economics can provide to help inform the development and use of value assessment frameworks. We focus on five value framework initiatives: the American College of Cardiology/American Heart Association, the American Society of Clinical Oncology, the Institute for Clinical and Economic Review, the Memorial Sloan Kettering Cancer Center, and the National Comprehensive Cancer Network. These entities differ in their missions, scope of activities, and methodological approaches. Because they are gaining visibility and some traction in the United States, it is essential to scrutinize whether the frameworks use approaches that are transparent as well as conceptually and methodologically sound. Our objectives were to describe the conceptual bases for value and its use in decision making, critically examine existing value frameworks, discuss the importance of sound conceptual underpinning, identify key elements of value relevant to specific decision contexts, and recommend good practice in value definition and implementation as well as areas for further research. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc
Litt, Jonathan S; McCormick, Marie C
Children with special health care needs (CSHCN) are at increased risk for functional disabilities. Care coordination has been shown to decrease unmet health service use but has yet been shown to improve functional status. We hypothesize that care coordination services lower the odds of functional disability for CSHCN and that this effect is greater within the context of a family-centered medical home. A secondary objective was to test the mediating effect of unmet care needs on functional disability. Our sample included children ages 0 to 17 years participating the 2009-2010 National Survey of Children with Special Health Care Needs. Care coordination, unmet needs, and disability were measured by parent report. We used logistic regression models with covariate adjustment for confounding and a mediation analysis approach for binary outcomes to assess the effect of unmet needs. There were 34,459 children in our sample. Care coordination was associated with lower odds of having a functional disability (adjusted odds ratio 0.82, 95% confidence interval 0.77, 0.88). This effect was greater for care coordination in the context of a medical home (adjusted odds ratio 0.71, 95% confidence interval 0.66, 0.76). The relationship between care coordination and functional disability was mediated by reducing unmet services. Care coordination is associated with lower odds of functional disability among CSHCN, especially when delivered in the setting of a family-centered medical home. Reducing unmet service needs mediates this effect. Our findings support a central role for coordination services in improving outcomes for vulnerable children. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Vadivel, Vellingiri; Kunyanga, Catherine N; Biesalski, Hans K
Nuts are an integral part of the Mediterranean food patterns, and their incorporation into the regular diets of human beings is believed to provide many health benefits. The recent recognition of nuts as "heart-healthy" foods by the U.S. Food and Drug Administration has given a major boost to the positive image of nuts. Nut consumption has been associated with several health benefits, such as antioxidant, hypocholesterolemic, cardioprotective, anticancer, anti-inflammatory, and antidiabetic benefits, among other functional properties. However, although nuts possess these many health benefits, their consumption has been hampered by a lack of adequate information regarding those benefits. In addition, because nuts are energy-dense foods with high-fat content, there is a misconception among consumers that increased consumption may lead to unwanted gain in body weight with the risk of developing overweight/obesity. Nonetheless, available epidemiologic studies and short-term controlled feeding trials have supported the theory that the inclusion of nuts in the typical diet does not induce weight gain, despite an expected increase in total caloric intake. To address the misperception about nuts and body weight gain, the present review focuses mainly on the relation between nut consumption and body weight gain, in the context of the many health benefits of nuts. Copyright © 2012 Elsevier Inc. All rights reserved.
Kolb, S; Hörmansdorfer, S; Ackermann, N; Höller, C; Brenner, B; Herr, C
Employees and volunteers often feel insecure about the potential transmission of infectious diseases when taking care of asylum seekers. It could be shown that overall only a minor risk of infection emanates from asylum seekers. However, aspects of occupational health and vaccination should be kept in mind.Besides the standard vaccination the Standing Committee on Vaccination (STIKO) recommends for occupational indication, which is given for employees and volunteers in asylum facilities, vaccination against hepatitis A, hepatitis B, polio (if the last vaccination was more than 10 years before) as well as influenza (seasonal).According to the German Occupational Safety and Health Act taking care of the employer has to determine which exposures might occur at the workplace (risk assessment) and define necessary protection measures. Depending on task and exposure when taking care of asylum seekers different acts (e. g. biological agents regulation) and technical guidelines for the handling biological agents (e. g. TRBA 250 or TRBA 500) have to be applied.The Bavarian Health and Food Safety Authority (LGL) has published several information sheets regarding "asylum seekers and health management" for employees and volunteers from the non-medical as well as the medical area (www.lgl.bayern.de search term "Asylbewerber"). With theses publications insecurities in taking care of asylum seekers should be prevented. Furthermore the employer gets support in the implementation of legal obligations to ensure occupational safety for the employees. © Georg Thieme Verlag KG Stuttgart · New York.
Ernst, M; Freed, M E; Zametkin, A J
This review provides information on health and biological effects of low-dose radiation to help institutional review boards and investigators make educated assessments of the risks of low-level radiation exposure involved in research, particularly in children. Studies of low-level radiation exposure with large sample sizes and long follow-up were reviewed. To help interpret the studies, we clarified the measures and measurement strategies of radiation exposure and of health risks. The few large studies of risks of low-level radiation in children have failed to detect an increased incidence of cancer. Most studies of low-level radiation involve adults. The risk of increased rates of cancer after low-level radiation exposure is not supported by population studies of health hazards from exposure to background radiation, radon in homes, radiation in the workplace or radiotherapy. Compared to the frequency of daily spontaneous genetic mutations, the biological effect of low-level radiation at the cellular level seems extremely low. Furthermore, the potentiation of cellular repair mechanisms by low-level radiation may result in a protective effect from subsequent high-level radiation. Studies approved by institutional review boards in the U.S. that involve the exposure of healthy normal children to ionizing radiation were reviewed. Health risks from low-level radiation could not be detected above the "noise" of adverse events of everyday life. In addition, no data were found that demonstrated higher risks with younger age at low-level radiation exposure.
Benagiano, Giuseppe; d'Arcangues, Catherine; Harris Requejo, Jennifer; Schafer, Alessandra; Say, Lale; Merialdi, Mario
The Special Programme of Research in Human Reproduction (HRP), co-sponsored by the UNDP, UNFPA, WHO, and the World Bank, is celebrating 40 years of activities with an expansion of its mandate and new co-sponsors. When it began, in 1972, the main focus was on evaluating the acceptability, effectiveness, and safety of existing fertility-regulating methods, as well as developing new, improved modalities for family planning. In 1994, HRP not only made major contributions to the Plan of Action of the International Conference on Population and Development (ICPD); it also broadened its scope of work to include other aspects of health dealing with sexuality and reproduction, adding a specific perspective on gender issues and human rights. In 2002, HRP's mandate was once again broadened to include sexually transmitted infections and HIV/AIDS and in 2003 it was further expanded to research activities on preventing violence against women and its many dire health consequences. Today, the work of the Programme includes research on: the sexual and reproductive health of adolescents, women, and men; maternal and perinatal health; reproductive tract and sexually transmitted infections (including HIV/AIDS); family planning; infertility; unsafe abortion; sexual health; screening for cancer of the cervix in developing countries, and gender and reproductive rights. Additional activities by the Programme have included: fostering international cooperation in the field of human reproduction; the elaboration of WHO's first Global Reproductive Health Strategy; work leading to the inclusion of ICPD's goal 'reproductive health for all by 2015' into the Millennium Development Goal framework; the promotion of critical interagency statements on the public health, legal, and human rights implications of female genital mutilation and gender-biased sex selection. Finally, HRP has been involved in the creation of guidelines and tools, such as the 'Medical eligibility criteria for contraceptive use
Full Text Available Purpose: substantiation of purposefulness of fitness yoga application for strengthening of special health groups’ girl students’ psycho-physical condition and psycho-social health at physical culture training and recreation classes. Material: trainings were practiced twice a week in 2 groups with 20 girl students in every group. Each training session lasted 60 minutes. The following indicators were registered: pressing ups in lying position; torso bending during 30 sec. from lying on back position; rising legs up to 90 degrees angle in hanging position; long jump from the spot; forward torso bending; test for coordination. Health condition was determined by express assessment of physical health. Results: in both groups girl students’ backbone mobility increased (р-0-05. First group’s girl students demonstrated higher results in pressing ups in lying position during 30 sec. (by 7.34+1.2 times and in long jump from the spot (14.2+0.4 cm. It was noticed that fitness yoga exercises render positive influence on girl students’ psycho-emotional state, general physical self-feeling and physical condition. Conclusions: targeted fitness yoga exercises’ influences on girl-students’ organism are recommended for support and correction of their health.
Rout Bikram Keshari; Rout Susanta Kumar; Kar Durga Madhab
Mental disorders are universal and very common. No country can postpone service development until the finalization of national level epidemiological surveys. It should be noted also that such surveys are very costly and the quality of mental health research is low in most developing countries. Anxiety is the result of stressful life, peer pressure, work pressure and family issues. Cognitive, somatic, emotional and behavioural components combine to form a psychological and physiological state ...
Reigstad, Bjørn Steinar
Traditionally, research on mental health problems among children and adolescents has focused mainly on prevalences and predictors of stability and changes in these disorders. Less is known about associated conditions as referral problems, and cooccurring conditions as pain and sleep disturbances, and psychosocial adversities like abuse and neglect. The purpose of this study is to focus on these less investigated problems and conditions which might be highly significant in day-to-day clinical ...
Seeberger, Jessica; Grandhi, Radhika; Kim, Stephani S; Mase, William A; Reponen, Tiina; Ho, Shuk-mei; Chen, Aimin
Electronic waste (e-waste) generation is increasing worldwide, and its management becomes a significant challenge because of the many toxicants present in electronic devices. The U.S. is a major producer of e-waste, although its management practice and policy regulation are not sufficient to meet the challenge. We reviewed e-waste generation, current management practices and trends, policy challenges, potential health impact, and toxicant exposure prevention in the U.S. A large amount of toxic metals, flame retardants, and other persistent organic pollutants exist in e-waste or can be released from the disposal of e-waste (e.g., landfill, incineration, recycling). Landfill is still a major method used to dispose of obsolete electronic devices, and only about half of the states have initiated a landfill ban for e-waste. Recycling of e-waste is an increasing trend in the past few years. There is potential, however, for workers to be exposed to a mixture of toxicants in e-waste and these exposures should be curtailed. Perspectives and recommendations are provided regarding managing e-waste in the U.S. to protect public health, including enacting federal legislation, discontinuing landfill disposal, protecting workers in recycling facilities from toxicant exposure, reducing toxicant release into the environment, and raising awareness of this growing environmental health issue among the public.
Full Text Available India faces problems with both communicable and non communicable diseases. The major non communicable diseases are cancer, cardiovascular disease and diabetes mellitus. This article focuses on communicable diseases (infectious diseases especially viral infections of public health importance. The infections include bacterial, parasitic and viruses. It could be said that fungal infections by the nature of the spread are not of public health concern. The viral infections are transmitted by the respiratory route, water and food borne route, vectors and blood and blood products, sexual route and are of major concern. Efforts are aimed at early detection, prevention by use of vaccines and sentinel surveillance. For the success of public health programmes sentinel surveillance of diseases is mandatory. India has got several programme initiatives addressing the problem. The programs include IDSP, VBDCP and NACO. The approximate cumulative annual prevalence of infectious disease in India ranges from 100 to 200 million individuals affected in one year. India should aim to improve case detection by strengthening laboratory services with manpower training and nationwide quality control scheme, sentinel surveillance activity and prevention by improving the efficiency and scope of UIP. Also, creation of a single portal of infectious disease data handling hub to collect information from different sources will help avoid overlap and duplication of reporting.
The prevalence and incidence of overweight or even obese children and adolescents is significantly on the increase worldwide. According to the German Children and Adolescent Health Survey (KIGGS) conducted in 2006, 15% of all children and adolescents in Germany aged 3 through 17 years are overweight, and 6.3% of these children and adolescents are obese. On account of the long-term consequences, such as the metabolic syndrome, it can be expected that this "crisis in public health" will lead to a significantly higher expenditure of economic resources in the health care sector. Therefore it is important that public health prevention strategies analyse the key causes of overweight and obesity, and that they not only incorporate individual behaviours regarding nutrition and physical activity, but also take environmental factors, such as the residential area and traffic situation, as well as political circumstances regarding the nutrition and social aspects, into account. Even though the definition of body-mass index (BMI) has been widely accepted, the epidemiological data and the drawn percentiles are in need of a solid interpretation. There are several causes for the rising prevalence in overweight and obesity which are currently being focused on and discussed. On the individual level, the focus is on the genetic disposition and the changes in the behaviour regarding nutrition and physical exercise. Additional key influential factors like the increase in urbanisation and motorisation, the respective changes in the living environment of children and their families, and migration with its specific biosocial and cultural implications are discussed from the environmental and sociomedical, as well as the public health perspective. The article concludes with a discussion on the consequences of effective prevention strategies with reference to the Cochrane analysis from 2005. In order to be effective and successful, interventions for the prevention of overweight and obesity
Differences in Health Care Needs, Health Care Utilization, and Health Care Outcomes Among Children With Special Health Care Needs in Ohio: A Comparative Analysis Between Medicaid and Private Insurance.
Sarkar, Madhurima; Earley, Elizabeth R; Asti, Lindsey; Chisolm, Deena J
This study explores comparative differentials in health care needs, health care utilization, and health status between Medicaid and private/employer-sponsored insurance (ESI) among a statewide population of children with special health care needs (CSHCN) in Ohio. We used data from the 2012 Ohio Medicaid Assessment Survey to examine CSHCN's health care needs, utilization, status, and health outcomes by insurance type. Adjusted multivariable logistic regression models were used to explore associations between public and private health insurance, as well as the utilization and health outcome variables. Bivariate analyses indicate that the Medicaid population had higher care coordination needs (odds ratio [OR] = 1.6; 95% confidence interval [CI], 1.1-2.2) as well as need for mental/educational health care services (OR = 1.5; 95% CI; 1.1-2.0). They also reported higher unmet dental care needs (OR = 2.2; 95% CI, 1.2-4.0), higher emergency department (ED) utilization (OR = 2.3; 95% CI, 1.7-3.2), and worse overall health (OR = 0.6; 95% CI, 0.4-0.7), oral health (OR = 0.4; 95% CI, 0.3-0.5), and vision health (OR = 0.4; 95% CI, 0.2-0.6). After controlling for demographic variables, CSHCN with Medicaid insurance coverage were more likely to need mental health and education services (adjusted odds ratio [AOR] = 1.8; 95% CI; 1.2-2.6), had significantly more ED visits (AOR = 2.3; 95% CI, 1.5-3.5), and were less likely to have excellent overall health (AOR = 0.64; 95% CI, 0.4-0.9), oral health (AOR = 0.43; 95% CI, 0.3-0.7), and vision health (AOR = 0.38; 95% CI, 0.2-0.6) than those with private insurance/ESI. The CSHCN population is a highly vulnerable population. While Ohio's Medicaid provides greater coverage to CSHCN, disparities continue to exist within access and services that Medicaid provides versus the ones provided by private insurance/ESI.
Bogetz, Jori F; Gabhart, Julia M; Rassbach, Caroline E; Sanders, Lee M; Mendoza, Fernando S; Bergman, David A; Blankenburg, Rebecca L
To evaluate an innovative curriculum meeting new pediatric residency education guidelines, Special Care Optimization for Patients and Education (SCOPE). Residents were randomized to intervention (n = 23) or control (n = 25) groups. Intervention residents participated in SCOPE, pairing them with a child with special health care needs (CSHCN) and faculty mentor to make a home visit, complete care coordination toolkits, and participate in case discussions. The primary outcome was resident self-efficacy in nine skills in caring for CSHCN. Secondary outcomes included curriculum feasibility/acceptance, resident attitudes, and family satisfaction. Response rates were ≥65%. Intervention residents improved in their self-efficacy for setting patient-centered goals compared with controls (mean change on 4-point Likert-type scale, 1.36 vs 0.56, P < .05). SCOPE was feasible/acceptable, residents had improved attitudes toward CSHCN, and families reported high satisfaction. SCOPE may serve as a model for efforts to increase residents' self-efficacy in their care of patients with chronic disease. © The Author(s) 2015.
Ashley, Evelyn LaVette
This study examined the gendered nature of the student affairs profession by investigating how three student affairs professional associations, the National Association of Student Personnel Administrators (NASPA), ACPA: College Student Educators International, and the Association of College and University Housing Officers International (ACUHO-I)…
Stewart, Stephanie C.; Williams, Terry E.
Success within today's challenging economic environment mandates that senior student affairs officers in higher education possess a sophisticated financial and budgetary skill set. Limited research addresses avenues through which professionals might best acquire the financial acumen needed. To address this gap, 19 senior student affairs officers…
Article challenges the division between student and academic affairs and encourages a view of learning and reason in a more holistic and integrated fashion. Outlines the historical factors for the separation of student and academic affairs and offers the programs instituted at Bellarmine College as examples of effective collaboration between…
Full Text Available Abstract Background The Netherlands, Belgium, and Luxembourg have adopted laws decriminalizing euthanasia under strict conditions of prudent practice. These laws stipulate, among other things, that the attending physician should consult an independent colleague to judge whether the substantive criteria of due care have been met. In this context initiatives were taken in the Netherlands and Belgium to establish specialized services providing such consultants: Support and Consultation for Euthanasia in the Netherlands (SCEN and Life End Information Forum (LEIF in Belgium. The aim of this study is to describe and compare these initiatives. Methods We studied and compared relevant documents concerning the Dutch and Belgian consultation service (e.g. articles of bye-laws, inventories of activities, training books, consultation protocols. Results In both countries, the consultation services are delivered by trained physicians who can be consulted in cases of a request for euthanasia and who offer support and information to attending physicians. The context in which the two organisations were founded, as well as the way they are organised and regulated, is different in each country. By providing information on all end-of-life care matters, the Belgian LEIF seems to have a broader consultation role than the Dutch SCEN. SCEN on the other hand has a longer history, is more regulated and organised on a larger scale and receives more government funding than LEIF. The number of training hours for physicians is equal. However, SCEN-training puts more emphasis on the consultation report, whereas LEIF-training primarily emphasizes the ethical framework of end-of-life decisions. Conclusion In case of a request for euthanasia, in the Netherlands as well as in Belgium similar consultation services by independent qualified physicians have been developed. In countries where legalising physician-assisted death is being contemplated, the development of such a
The French Ministry of Foreign Affairs (hereinafter referred to as "MAE") has sent a reminder of the following rules relating to legitimation documents (special cards, henceforth called "special residence permits" (titres de séjour spéciaux), and attestations de fonctions) that it issues. The Ministry has specified that compliance with these rules is essential to the proper functioning of any International Organization established in France. 1. Types of document and use a) Special CD, FI and AT residence permits They serve as residence permits for members of the personnel and the members of their families who are not of French nationality and who do not have the status of permanent resident (see N.B. below). Vis-à-vis the French authorities, they serve as proof that those holding these cards enjoy the privileges and immunities provided for by the Status Agreement between CERN and France (immunity from legal process in the discharge of their duties, entitlement to drive a vehicle registered in a special ...
Full Text Available which brings about a competitive environment for an increase of the quality of services offered. The aim of the study is making evident the recommendatory strategies of a health care institution for specialized pre-hospital medical aid in Sofia City for activity performed in the period from the year 2016 to 2018. The task assigned is an analysis of the opportunities for the widening of the activity, products, and markets of "DCC XXIVth-Sofia" EOOD. The chosen healthcare institution is active in a competitive environment in Sofia City, and in the district that it serves. Data from the health care institution, data from the institutions of National Statistics, and scientific literature on the topic were used in connection with the analysis. Some essential approaches of management were applied - analysis of the market share, and SWOT analysis, for determination of strategy. The conclusions of the analysis performed showed four possible strategies of advance in development and opportunities for activity in each of them. The administration of "DCC XXIVth-Sofia" EOOD had opportunities to all practical purposes for minimization of the negative effects, induced by the weaknesses and threats, and to successfully develop the activity - during the period from the year 2016 to 2018. Both the activity of the healthcare institution and the public health services of the population in the corresponding village/town/city depend on the choice of the administration and on its execution by the personnel.
Garrison, Louis P; Pauly, Mark V; Willke, Richard J; Neumann, Peter J
The second section of our Special Task Force builds on the discussion of value and perspective in the previous article of the report by 1) defining a health economics approach to the concept of value in health care systems; 2) discussing the relationship of value to perspective and decision context, that is, how recently proposed value frameworks vary by the types of decisions being made and by the stakeholders involved; 3) describing the patient perspective on value because the patient is a key stakeholder, but one also wearing the hat of a health insurance purchaser; and 4) discussing how value is relevant in the market-based US system of mixed private and public insurance, and differs from its use in single-payer systems. The five recent value frameworks that motivated this report vary in the types of decisions they intend to inform, ranging from coverage, access, and pricing decisions to those defining appropriate clinical pathways and to supporting provider-clinician shared decision making. Each of these value frameworks must be evaluated in its own decision context for its own objectives. Existing guidelines for cost-effectiveness analysis emphasize the importance of clearly specifying the perspective from which the analysis is undertaken. Relevant perspectives may include, among others, 1) the health plan enrollee, 2) the patient, 3) the health plan manager, 4) the provider, 5) the technology manufacturer, 6) the specialty society, 7) government regulators, or 8) society as a whole. A valid and informative cost-effectiveness analysis could be conducted from the perspective of any of these stakeholders, depending on the decision context. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Sola, Laura; Plata-Cornejo, Raúl; Fernández-Cean, Juan
Uruguay and Bolivia are two countries that show heterogenicity of the Latin American region, including the national income, the expenditure on health and the services for renal care. In Bolivia, there is manpower shortage for renal care with only 5 nephrologists per million people (pmp) and the prevalence of patients on dialysis is only 200 pmp. This is much lower than the mean prevalence rate of renal replacement therapy for Latin America as a whole. Uruguay on the other hand has more dedicated renal resources with 50 nephrologists pmp, and renal replacement therapy is provided to ~ 1,000 dialysis patients pmp. In November 2012, a collaborative project financed by the Uruguayan International Cooperation Agency was signed by both the Uruguay and Bolivia Ministries of Health, and the goal was to develop a comprehensive program for the prevention and management of all stages of chronic kidney disease (CKD) in Bolivia. The specific objectives were to: a) promote renal healthcare in the primary healthcare setting, b) identify kidney disease in populations at risk, and c) optimize patient care at all stages of CKD, including dialysis and transplantation supported with a national ESRD registry in Bolivia. As a first step, delegates from the Bolivian Health Ministry, visited Uruguay in April 2014, primarily to strengthen the development of tools required for developing and maintaining a national registry. In addition, during this visit, a meeting with the president of the Latin American Society of Nephrology and Hypertension (SLANH) culminated in designing a training program for peritoneal dialysis. This highly cooperative relationship is advancing the prevention and care of CKD in Bolivia and may serve as a model for international approaches to advance system level CKD care in countries with limited healthcare resources.
Pawar, A T; Kakrani, V A
A cross sectional study was conducted on health status of hotel workers of Pune city. Out of estimated 1000 hotel workers 516 were selected by stratified random sampling technique. The study revealed that 71.5% hotel workers were suffering from one or other type of morbid condition. Anemia was the commonest morbidity with prevalence of 40.3%. 187 (36.2%) of hotel workers had extramarital sexual relations. A total of 77 (14.9%) hotel workers were having STDs at the time of study.
Hexem, Kari R; Bosk, Abigail M; Feudtner, Chris
The work of care for parents of children with complex special health care needs may be increasing, while excessive work demands may erode the quality of care. We sought to summarize knowledge and develop a general conceptual model of the work of care. Systematic review of peer-reviewed journal articles that focused on parents of children with special health care needs and addressed factors related to the physical and emotional work of providing care for these children. From the large pool of eligible articles, we selected articles in a randomized sequence, using qualitative techniques to identify the conceptual components of the work of care and their relationship to the family system. The work of care for a child with special health care needs occurs within a dynamic system that comprises 5 core components: (1) performance of tasks such as monitoring symptoms or administering treatments, (2) the occurrence of various events and the pursuit of valued outcomes regarding the child's physical health, the parent's mental health, or other attributes of the child or family, (3) operating with available resources and within certain constraints (4) over the passage of time, (5) while mentally representing or depicting the ever-changing situation and detecting possible problems and opportunities. These components interact, some with simple cause-effect relationships and others with more complex interdependencies. The work of care affecting the health of children with special health care needs and their families can best be understood, studied, and managed as a multilevel complex system.
Martínez, Purificación; Galve, Elena; Arrazubi, Virginia; Sala, M Ángeles; Fernández, Seila; Pérez, Clara E; Arango, Juan F; Torre, Iñaki
Considering the increased fracture risk in early breast cancer patients treated with aromatase inhibitors (AI), we assessed the impact of a preventive intervention conducted by a specialized osteoporosis unit on bone health at AI treatment start. Retrospective cohort of postmenopausal women who started treatment with AI after breast cancer surgical/chemotherapy treatment and were referred to the osteoporosis unit for a comprehensive assessment of bone health. Bone densitometry and fracture screening by plain X-ray were performed at the baseline visit and once a year for 5 years. The final record included 130 patients. At AI treatment start, 49% had at least one high-risk factor for fractures, 55% had osteopenia, and 39% osteoporosis. Based on the baseline assessment, 79% of patients initiated treatment with bisphosphonates, 88% with calcium, and 79% with vitamin D. After a median of 65 (50-77) months, 4% developed osteopenia or osteoporosis, and 14% improved their densitometric diagnosis. Fifteen fractures were recorded in 11 (8.5%) patients, all of them receiving preventive treatment (10 with bisphosphonates). During the follow-up period, patients with one or more high-risk factors for fracture showed a greater frequency of fractures (15% vs. 3%) and experienced the first fracture earlier than those without high-risk factors (mean of 99 and 102 months, respectively; P=0.023). The preventive intervention of a specialized unit at the start of AI treatment in breast cancer survivors allows the identification of patients with high fracture risk and may contribute to preventing bone events in these patients. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.
Van Hooft, Gordon E.; And Others
This publication contains curriculum suggestions for teaching Environmental and Community Health-Consumer Health, for grades seven, eight, and nine. Outcomes desired at this level include: 1) being aware of the practice of health quackery and being able to recognize those traits that characterize the health fraud, his techniques, and his products;…
Hillard, James Randolph; Kashup, Suman
Helicobacter pylori infection is the major cause of dyspepsia, peptic ulcer disease, and gastric cancer. This paper will make specific recommendations for a diagnostic and treatment strategy tailored to the international student population. This paper is a case report and narrative review based on recent international epidemiologic studies and consensus conference recommendations identified in MEDLINE. In the nations (mostly Asian) that send the largest number of students to the United States, the prevalence of H. pylori is generally 60% to 80%, whereas the prevalence in the United States is about 25%. The patterns of antibiotic resistance in those countries are also different than that in the general US population. Health care providers should have a higher index of suspicion for Helicobacter infection among international students with dyspepsia and need to use a different treatment regimen than is standard for the general US population.
Thaís Araújo Barbosa
Full Text Available Objective: to understand and identify the support network and social support from the perspective of families of children with chronic conditions. Methods: a qualitative study, with content analysis of 134 records, followed by ten semi-structured interviews. Results: the analysis has revealed that the primary caregiver, the mother, participates in a network of limited support, only with the help of her husband, children, grandparents and the child´s godparents. They also have a social network through a multidisciplinary team, which in some cases is not effective. Conclusion: families have a deficient and limited support network and the demand for care rely only on the support of the husband, grandparents, children, and godparents. Social networking refers to the philanthropic institutions, while the aid of public service, basic health unit is basic.
Christensen, Lisa Bøge; Hede, Borge; Nielsen, Ellen
health-care programme. Clinical data and data from interviews comprising social factors, life-style, dental visit habits, oral hygiene practices and self-perceived oral health were collected. A modified index on perceived dysfunction, discomfort and disability due to oral disorders was used. Results......A cross-sectional study of oral health and oral health-related quality of life among frail elderly persons on admission to a special oral health care programme in Copenhagen City, Denmark Aim: To describe the oral health and the oral-health-related quality of life (OHRQoL) of citizens in Copenhagen...... City on admission to a specific oral health-care programme for disabled elderly persons. Further, to analyse how various factors influence the oral health and the OHRQoL among these patients. Methods: A cross-sectional study of 189 persons (average 85 years) consecutively admitted to a special oral...
Bethell, Christina; Forrest, Christopher B; Stumbo, Scott; Gombojav, Narangerel; Carle, Adam; Irwin, Charles E
School success predicts many pathways for health and well-being across the life span. Factors promoting or potentially impeding school success are critical to understand for all children and for children with special health care needs (CSHCN), whose life course trajectories are already impacted by their chronic health problems. The 2007 National Survey of Children's Health was used (1) to estimate national and state prevalence and within and across states disparities in factors promoting school success (engagement, participation, safety) or potentially impeding success (missing school, grade repetition, school identified problems) for all children and CSHCN and (2) to evaluate associations with CSHCN service need complexity and presence of emotional, behavioral or developmental problems (EBD) as well as with school case management policies in states. Among school age children, 60 % experienced all three factors promoting school success (49.3-73.8 % across states), dropping to 51.3 % for CSHCN (39.4-64.7 % across states) and to 36.2 % for the 40 % of all CSHCN who have both more complex service needs and EBD. CSHCN were more likely to experience factors potentially impeding school success. After accounting for child factors, CSHCN living in states requiring case management in schools for children with disabilities were less likely to experience grade repetition (OR 0.65). Within-state disparities between non-CSHCN and CSHCN varied across states. Threats to school success for US children are pervasive and are especially pronounced for CSHCN with more complex needs and EBD. Findings support broad, non-condition specific efforts to promote school success for CSHCN and consideration of state school policies, such as case management.
Quattrochi, Dale A.
At the 2011 Applied Science Public Health review held in Santa Fe, NM, it was announced that Dr. Dale Quattrochi from the NASA Marshall Space Flight Center, John Haynes, Program Manager for the Applied Sciences Public Health program at NASA Headquarters, and Sue Estes, Deputy Program Manager for the NASA Applied Sciences Public Health Program located at the Universities Space Research Association (USRA) at the National Space Science and Technology Center (NSSTC) in Huntsville, AL, would edit a special issue of the journal Geocarto International on "NASA Earth Science Satellite Data for Applications to Public Health". This issue would be focused on compiling research papers that use NASA Earth Science satellite data for applications to public health. NASA's Public Health Program concentrates on advancing the realization of societal and economic benefits from NASA Earth Science in the areas of infectious disease, emergency preparedness and response, and environmental health (e.g., air quality). This application area as a focus of the NASA Applied Sciences program, has engaged public health institutions and officials with research scientists in exploring new applications of Earth Science satellite data as an integral part of public health decision- and policy-making at the local, state and federal levels. Of interest to this special issue are papers submitted on are topics such as epidemiologic surveillance in the areas of infectious disease, environmental health, and emergency response and preparedness, national and international activities to improve skills, share data and applications, and broaden the range of users who apply Earth Science satellite data in public health decisions, or related focus areas.. This special issue has now been completed and will be published n early 2014. This talk will present an overview of the papers that will be published in this special Geocarto International issue.
Full Text Available Natural rubber latex allergy is a new illness whose prevalence has reached epidemic proportions in highly exposed populations such as health care workers and who has chronic illness. After anaphylactic type reactions due to latex has been shown as case reports. The major risk factors in latex are intense exposure to latex allergens (surgical gloves, catheters, etc, atopy, hand eczema, female gender, history of multiple operations and dental interventions. An association between latex allergy and allergy to various fruits (banana, kiwi, avocado, pineapple, etc has been reported. Latex allergy is responsible for a wide spectrum of clinical symptoms ranging from a mild dermatitis to severe anaphylaxis. In this report, we present that latex related systemic allergic reactions cases; the first one is 24 years old nurse woman who is working at the blood bank in our hospital and the other one is 32 years old woman patient who has repeatative medical examination, and in vitro fertilisation therapy plan and suffered for systemic allergic reaction due to latex gloves which was used in her last concha operations. [TAF Prev Med Bull 2008; 7(3.000: 265-268
Leon J S Brokken
Full Text Available Over the last few decades, there have been numerous reports of adverse effects on the reproductive health of wildlife and laboratory animals caused by exposure to endocrine disrupting chemicals (EDCs. The increasing trends in human male reproductive disorders and the mounting evidence for causative environmental factors have therefore sparked growing interest in the health threat posed to humans by EDCs, which are substances in our food, environment and consumer items that interfere with hormone action, biosynthesis or metabolism, resulting in disrupted tissue homeostasis or reproductive function. The mechanisms of EDCs involve a wide array of actions and pathways. Examples include the estrogenic, androgenic, thyroid and retinoid pathways, in which the EDCs may act directly as agonists or antagonists, or indirectly via other nuclear receptors. Dioxins and dioxin-like EDCs exert their biological and toxicological actions through activation of the aryl hydrocarbon-receptor, which besides inducing transcription of detoxifying enzymes also regulates transcriptional activity of other nuclear receptors. There is increasing evidence that genetic predispositions may modify the susceptibility to adverse effects of toxic chemicals. In this review, potential consequences of hereditary predisposition and EDCs are discussed, with a special focus on the currently available publications on interactions between dioxin and androgen signaling.
Hitchcock, Laurel Iverson; Mulvihill, Beverly A
This historical study examines the early years of the federal program of services for children with physical disabilities in the United States (US) during the 1930s, known today as services for Children with Special Health Care Needs (CSHCN). Established as part of the Social Security Act (SSA) of 1935, the Crippled Children Services (CCS) program was one of the first medical programs for children supported by the federal government. Under the SSA, states and territories quickly developed state-level CCS programs during the late 1930s. The US Children's Bureau administered the program for the federal government and helped states to incorporate preventive services and interdisciplinary approaches to service provision into state-level CCS programs. Factors that influenced the implementation of these programs included the availability of matching state funds, the establishment of state programs for crippled children prior to the SSA, and the accessibility of qualified health care professionals and facilities. The early efforts of this federal program on behalf of children with disabilities can be seen in services for CSHCN today.
McLaughlin, Suzanne; Bowering, Nancy; Crosby, Barbara; Neukirch, Jodie; Gollub, Eliza; Garneau, Deborah
A growing population of adolescents with special healthcare needs is aging into adulthood. These emerging adults face the transition challenges of their healthy peers but also potentially heightened risks and challenges related to their conditions. We describe the process of developing a pilot program to support healthcare services for emerging adults with chronic conditions and present preliminary data on utilization. An outpatient multidisciplinary consult model was developed based on patient, family and physician feedback. Patients with diverse conditions were equally referred from primary care, subspecialists and families and community agencies. Services provided included needs assessments (100%), referral to adult physicians (77%), care coordination (52%) and referrals to adult community services (10%). Clinical billing did not fully support the cost of providing services. The pilot program offered multidisciplinary transition services that were utilized by a diverse patient population. Local and national resources for health care transition are provided.
Study Design: The study design was a descriptive cross-sectional study. Materials and Methods: This study was conducted in November 2012 at SVS special school for deaf, Bhimavaram, India. This study involved 180 CHI of both genders, aged 6-16 years, divided into Group-I (6-8 years, Group-II (9-12 years, and Group-III (13-16 years. Oral health status and treatment needs were recorded using methods and standards recommended by the WHO for Oral Health Surveys, 1997. Dental caries prevalence (decayed, missing, and filled teeth [DMFT/dmft], gingivitis levels (Lφe, Silness Gingival Index, plaque levels (Silness, Lφe Plaque index, and treatment needs were the parameters recorded and analyzed. Statistical Analysis: Z-test for proportion, one-way analysis of variance, and Chi-square test were used to analyze the data. Results: Prevalence of dental caries in the sample was found to be 65% with a mean level of caries prevalence (DMFT of 1.6 ± 1.3 in Group-I, 1.9 ± 1.2 in Group-II, and 2.2 ± 1.2 in Group-III. About 91.7% of the total children examined needs treatment. The mean plaque and gingivitis scores of the sample were 1.70 ± 0.61 and 1.59 ± 0.58, respectively. Conclusion: These findings imply the overwhelming situation of CHI in oral health perspective. Hence, prevention-based educational and motivational programs should be targeted to this vital group to achieve adequate oral hygiene levels.
Aboneh, Ephrem A; Chui, Michelle A
Children with special health care needs (CSHCN) have multiple unmet health care needs including that of prescription medications. The objectives of this study were twofold: 1) to quantify and compare unmet needs for prescription medications for subgroups of CSHCN without and with medical complexity (CMC)-those who have multiple, chronic, and complex medical conditions associated with severe functional limitations and high utilization of health care resources, and 2) to describe its association with receipt of effective care coordination services and level of medical complexity. A secondary data analysis of the 2009/2010 National Survey of CSHCN, a nationally representative telephone survey of parents of CSHCN, was conducted. Logistic regression models were constructed to determine associations between unmet need for prescription medications and medical complexity and care coordination for families of CSHCN, while controlling for demographic variables such as race, insurance, education level, and household income. Analyses accounted for the complex survey design and sampling weights. CMC represented about 3% of CSHCN. CMC parents reported significantly more unmet need for prescription medications and care coordination (4%, 68%), compared to Non-CMC parents (2%, 40%). Greater unmet need for prescription medications was associated with unmet care coordination (adjusted OR 3.81; 95% CI: 2.70-5.40) and greater medical complexity (adjusted OR 2.01; 95% CI: 1.00-4.03). Traditional care coordination is primarily facilitated by nurses and nurse practitioners with little formal training in medication management. However, pharmacists are rarely part of the CSHCN care coordination model. As care delivery models for these children evolve, and given the complexity of and numerous transitions of care for these patients, pharmacists can play an integral role to improve unmet needs for prescription medications. Copyright © 2016 Elsevier Inc. All rights reserved.
Moen, Vegard Pihl; Drageset, Jorunn; Eide, Geir Egil; Klokkerud, Mari; Gjesdal, Sturla
The World Health Organization Disability Assessment Schedule (WHODAS) 2.0 is a generic instrument to assess disability covering six domains. The purpose of this study was to investigate the potential of the instrument for monitoring disability in specialized somatic rehabilitation by testing reliability, construct validity and responsiveness of WHODAS 2.0, Norwegian version, among patients with various health conditions. For taxonomy, terminology and definitions, the Consensus-based Standards for the Selection of Health Measurement Instruments were followed. Reproducibility was investigated by the intra-class correlation coefficient (ICC) in a randomly selected sample. Internal consistency was assessed by Cronbach's alpha. Construct validity was evaluated by correlations between WHODAS 2.0 and the Medical Outcomes Study 36-item Short Form, and fit of the hypothesized structure using confirmatory factor analysis (CFA). Responsiveness was evaluated in another randomly selected sample by testing a priori formulated hypotheses. Nine hundred seventy patients were included in the study. Reproducibility and responsiveness were evaluated in 53 and 104 patients, respectively. The ICC for the WHODAS 2.0 domains ranged from 0.63 to 0.84 and was 0.87 for total score. Cronbach's alpha for domains ranged from 0.75 to 0.94 and was 0.93 for total score. For construct validity, 6 of 12 expected correlations were confirmed and CFA did not achieve satisfactory fit indices. For responsiveness, 3 of 8 hypotheses were confirmed. The Norwegian version of WHODAS 2.0 showed moderate to satisfactory reliability and moderate validity in rehabilitation patients. However, the present study indicated possible limitations in terms of responsiveness.
Garfield, Susan; Polisena, Julie; S Spinner, Daryl; Postulka, Anne; Y Lu, Christine; Tiwana, Simrandeep K; Faulkner, Eric; Poulios, Nick; Zah, Vladimir; Longacre, Michael
Health technology assessments (HTAs) are increasingly used to inform coverage, access, and utilization of medical technologies including molecular diagnostics (MDx). Although MDx are used to screen patients and inform disease management and treatment decisions, there is no uniform approach to their evaluation by HTA organizations. The International Society for Pharmacoeconomics and Outcomes Research Devices and Diagnostics Special Interest Group reviewed diagnostic-specific HTA programs and identified elements representing common and best practices. MDx-specific HTA programs in Europe, Australia, and North America were characterized by methodology, evaluation framework, and impact. Published MDx HTAs were reviewed, and five representative case studies of test evaluations were developed: United Kingdom (National Institute for Health and Care Excellence's Diagnostics Assessment Programme, epidermal growth factor receptor tyrosine kinase mutation), United States (Palmetto's Molecular Diagnostic Services Program, OncotypeDx prostate cancer test), Germany (Institute for Quality and Efficiency in Healthcare, human papillomavirus testing), Australia (Medical Services Advisory Committee, anaplastic lymphoma kinase testing for non-small cell lung cancer), and Canada (Canadian Agency for Drugs and Technologies in Health, Rapid Response: Non-invasive Prenatal Testing). Overall, the few HTA programs that have MDx-specific methods do not provide clear parameters of acceptability related to clinical and analytic performance, clinical utility, and economic impact. The case studies highlight similarities and differences in evaluation approaches across HTAs in the performance metrics used (analytic and clinical validity, clinical utility), evidence requirements, and how value is measured. Not all HTAs are directly linked to reimbursement outcomes. To improve MDx HTAs, organizations should provide greater transparency, better communication and collaboration between industry and HTA
Verhagen, H.; Buijsse, B.; Jansen, E.; Bueno de Mesquita, B.
Oxidative stress is considered to be an adverse bodily event. Antioxidants are considered to be healthful because they may protect the body from oxidative damage. This simple paradigm is much more complicated in practice, however. Reactive oxygen species are a physiological necessity but too much of
English for Academic Purposes Professor at Algonquin. College, Ontario, Canada. .... of the Asia-Pacific Journal for Student Affairs: The Official Journal of the Philippine Association of Administrators of Student Affairs (PAASA). And finally, this ...
Salata, Jason P
.... This paper examines the soft power application of public affairs capacity building, and the resultant cultivation of a public affairs social network through the lens of social network theory (nodes and ties...
Cabellon, Edmund T.; Junco, Reynol
This chapter describes the student affairs profession in the digital age. The authors explore new challenges educators and professionals face as new areas are added and expanded, how social networks and digital technology tools continue to evolve, and what skills are needed to engage with students in person and online.
particularly aligned to the global aims of student affairs and services in higher education. These are: 1. Developing education systems to foster high-quality and inclusive lifelong learning for all;. 2. Empowering learners to be creative and responsible global citizens;. 3. Advancing Education for All (EFA) and shaping the ...
they capable of making military affairs interesting to a young men in Adidas jackets with dyed- hackle hairdos, of getting them to love military...of an emergency situation from its origins to the end result, hone the personnel’s interaction in the course of a specific modeled emergency, and
Morrison, Kathryn; Saboe-Wounded Head, Lorna; Cho, Soo Hyun
Forty-six Consumer Affairs (CA) internship supervisors were surveyed to identify critical knowledge and skills demonstrated by interns and to examine the importance of knowledge and skills needed in the workplace from the supervisors' perspectives.The knowledge and skills measured were identified through program goals. Results revealed that CA…
Public policy research (empirical and theoretical) on the democracy, security, and development nexus. Democracy & Development: Journal of West African Affairs is the only one of its kind entirely devoted to reporting and explaining democratic developments in the sub-region. It is read widely by researchers, journalists, ...
Student affairs professionals in the United States were surveyed to determine the predictive value of overall job satisfaction, organizational support, organizational politics, and work/nonwork interaction on affective organizational commitment. Results indicate that a supportive work environment leads to increased affective attachment to the…
53 2. Qualification Standards Versus Civil Affairs..................................55 3. Bill Payers...significant cost is associated with printed material for the students. The FLETC has piloted a program to implement the use of electronic tablets in...order to reduce the cost associated with traditional law enforcement textbooks (Federal Law Enforcement Training Center, 2012). In addition to
McManus, Beth M; Prosser, Laura A; Gannotti, Mary E
Pediatric rehabilitation therapy services and mobility aids have an important role in the health of children with special health care needs, and the Affordable Care Act (ACA) may increase coverage for these needs. Identifying the prevalence of and factors associated with therapy and mobility aid needs and unmet needs prior to the full implementation of the ACA will be useful for future evaluation of its impact. The purpose of this study was to identify the prevalence of and factors associated with caregiver perceived needs and unmet needs for therapy or mobility aids among children with special health care needs living in the United States. A cross-sectional, descriptive, multivariate analysis was conducted. The 2009-2010 National Survey of Children With Special Health Care Needs was used to identify a nationally representative sample of children with special health care needs with needs for therapy (weighted n=2,603,605) or mobility aids (weighted n=437,971). Odds of having unmet needs associated with child and family characteristics were estimated. Nearly 1 in 5 children with therapy needs had unmet needs, and nearly 1 in 10 children with mobility aid needs had unmet needs. Unmet needs were most strongly associated with how frequently the condition affected function and being uninsured in the previous year. Data were caregiver reported and not verified by clinical assessment. Survey data grouped physical therapy, occupational therapy, and speech therapy; analysis was not discipline specific. This evidence serves as a baseline about the future impact of the ACA. Pediatric rehabilitation professionals should be aware that children with special health care needs whose condition more frequently affects function and who have insurance discontinuity may need more support to meet therapy or mobility aid needs. © 2016 American Physical Therapy Association.
Full Text Available Primary health care is an evidence-based priority, but it is still inadequately supported in many countries. Ironically, on one hand, India is a popular destination for medical tourism due to the affordability of high quality of health care and, on the other hand, ill health and health care are the main reasons for becoming poor through medical poverty traps. Surprisingly, this is despite the fact that India was committed to 'Health for All by 2000' in the past, and is committed to 'Universal Health Coverage' by 2022! Clearly, these commitments are destined to fail unless something is done to improve the present state of affairs. This study argues for the need to develop primary care as a specialization in India as a remedial measure to reform its health care in order to truly commit to the commitments. Three critical issues for this specialization are discussed in this review: (1 The dynamic and distinct nature of primary care as opposed to other medical specializations, (2 the intersection of primary care and public health which can be facilitated by such a specialization, and (3 research in primary care including the development of screening and referral tools for early diagnosis of cancers, researches for evidence-based interventions via health programs, and primary care epidemiology. Despite the potential challenges and difficulties, India is a country in dire need for primary care specialization. India's experience in providing low-cost and high quality healthcare for medical tourism presages a more cost-effective and efficient primary care with due attention and specialization.
Anderson, Lori S.
The numbers of children with special health care needs (CSHCN) have increased in schools. This study was conducted to document mothers’ experiences of the care their CSHCN receive across health care and educational settings. Data were collected during standardized, open-ended, one-on-one interviews with 10 mothers of CSHCN in urban, suburban, and rural areas in a Midwestern state. Interviews were transcribed and content analysis revealed five themes: (a) communication, (b) educational system ...
Expanding the exposure of medical students and residents to persons with special health care needs has been a challenge. The purpose of this paper was to describe the development of the American Academy of Developmental Medicine and Dentistry, its principles, and its 5 essential concepts.
Full Text Available Abstract Background The oral health condition of individuals with special health care needs have been reported in literature to be influenced by various sociodemographic factors, including living conditions and severity of impairment. This study was carried out to determine the oral health status and treatment needs of children and young adults attending a day institution for those with special needs. Methods This study was carried out as part of an oral health screening program organized by the institution and consent was obtained from parents and guardians before the screening. All information was supplied by the parents during the screening using a questionnaire completed by the dentist. Oral examination was carried out on all consenting subjects in attendance on the days of screening in the school clinic with parents and teachers in attendance, using standard World Health Organisation oral health indices to assess dental caries, oral hygiene status, malocclusion and other oral health parameters. Results Fifty-four subjects aged 3–26 years (mean 12.28 ± 6.82 years and comprising 72.2% males and 27.8% females participated in the study. Over 90% were from parents of high and middle level educational background. Thirty-six (66.7% were caries free, with a mean dmft score of 0.7 ± 1.77 and mean DMFT score of 0.4 ± 1.44 with no significant difference across gender (p = 0.5 and parents' educational status (p = 0.43. The mean OHI-S of the total population in this study was 1.36 ± 0.16. Females had a mean score of 0.88 ± 1.10 while males had a mean score of 1.55 ± 1.24 with no significant difference (p = 0.6. Twenty-five (46.3% had good oral hygiene, 17 (31.5% had fair oral hygiene and 12 (22.2% had poor oral hygiene, with no significant difference across gender (p = 1.11 and age groups (p = 0.07. Fifteen (27.8% had gingivitis with no significant difference across age groups (p = 0.17. Forty-five (83.3% had Angle's class I malocclusion, 6
... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Special collateral requirement. 615.5060... AFFAIRS, LOAN POLICIES AND OPERATIONS, AND FUNDING OPERATIONS Collateral § 615.5060 Special collateral... collateral if the counsel for the bank or association has determined, in writing, that the bank or...
El-Meligy, Omar; Maashi, Manal; Al-Mushayt, Abdullah; Al-Nowaiser, Abeer; Al-Mubark, Sultan
Changes in oral health-related quality of life (OHRQoL) among 40 children with special health care needs (CSHCN) aged 5-14 years before and 12 months after full-mouth rehabilitation (FMR) under general anesthesia (GA) in two hospitals in Jeddah city were assessed. The questionnaire was delivered to the parents/caregivers at baseline (pre-operative) and at the 12-month post-operative follow-up visit. Medical and dental histories and clinical findings were correlated accordingly. The follow-up response rate was 87.5% with 35 children completing a 12-month follow-up visit. The age range was from 5 to 12 years with a mean of 7.3 ± 2.4 years. More than half of the study sample was boys (63%) in the 5-8 year age-group (69%). The impact on OHRQoL was reportedly negative before FMR under GA, with overall scores ranging from 12 to 68 and a mean of 43.34 ± 14.83. OHRQoL improved significantly in all aspects evaluated (P<0.05) following FMR under GA with overall scores ranging from 4 to 41 and a mean of 18.86 ± 8.54. Treating CSHCN under GA, with 3-month recall visits for the patients, had a significant long-term effect on their OHRQoL extending up to 12 months postoperatively.
This paper intends to address the essentiality of multicultural competence in student affairs administration in higher education. It discusses the meaning of multiculturalism; the role of the student affairs in the development of the students; and the importance of multicultural competence in student affairs administration.
TTI Phase 2 Institutional Support: The Institute of Economic Affairs, Ghana. This funding will help strengthen the Institute of Economic Affairs' (IEA-Ghana) role as a credible public policy institution by enhancing its ability to provide high-quality, influential, and policy-relevant research. About the Institute of Economic Affairs
The needs of human behavior are explored and correlated to the various departments within Student Affairs in an effort to show how Student Affairs can satisfy those needs. Maslow's Hierarchy of needs is briefly explained and related to the following Student Affairs departments: Financial Aid, Student Management, Career Development and Placement,…
Willke, Richard J; Neumann, Peter J; Garrison, Louis P; Ramsey, Scott D
The sixth section of our Special Task Force (STF) report reviews and comments on recent US-oriented value assessment frameworks, specifically those published by the American College of Cardiology/American Heart Association, the Institute for Clinical and Economic Research, the American Society of Clinical Oncology, the National Comprehensive Cancer Network, and the Memorial Sloan Kettering Cancer Center. We review published commentaries that address the validity, reliability, and conceptual underpinnings of these frameworks. We find common themes of critique regarding the strengths and limitations across frameworks. Particular shortcomings of some frameworks pose greater threats to their face validity and utility compared with others. The most significant limitations include lack of clear perspective (e.g., patient vs. health plan) and poor transparency in accounting for costs and benefits. We then review how each framework adheres to core STF recommendations, with particular emphasis on whether the framework can be used to support coverage decisions by health insurers, and whether it adheres to core principles of cost-effectiveness analysis. The Institute for Clinical and Economic Research framework most closely adheres to core STF recommendations. Others have significant limitations that vary widely from framework to framework. We also review how the frameworks follow STF recommendations for addressing potentially relevant issues beyond cost-effectiveness analysis - for example, equity in resource allocation and patient heterogeneity. Finally, we review whether and how each framework uses value thresholds and addresses affordability concerns. We conclude with suggestions for further research, particularly in the areas of testing the measurement and use of novel elements of value and deliberative processes. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Ballard, Billy R
The establishment of Minority Affairs Offices in dental schools following the American Association of Medical Colleges' model is discussed as one method of addressing the declining enrollment and compounding oral health disparities of underrepresented minorities African Americans, Hispanics, and Native Americans in U.S. dental schools. The pros and cons of the approach are discussed, with recommendations.
... the Media Room Public Affairs News Releases Speeches Videos Publications National Observances Veterans Day Memorial Day Celebrating America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival Golden Age Games Summer Sports Clinic Training - Exposure - Experience (TEE) Tournament ...
... the Media Room Public Affairs News Releases Speeches Videos Publications National Observances Veterans Day Memorial Day Celebrating America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival Golden Age Games Summer Sports Clinic Training - Exposure - Experience (TEE) Tournament ...
... the Media Room Public Affairs News Releases Speeches Videos Publications National Observances Veterans Day Memorial Day Celebrating America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival Golden Age Games Summer Sports Clinic Training - Exposure - Experience (TEE) Tournament ...
Flores Cano, Juan Carlos; Lizama Calvo, Macarena; Rodríguez Zamora, Natalie; Ávalos Anguita, María Eugenia; Galanti De La Paz, Mónica; Barja Yañez, Salesa; Becerra Flores, Carlos; Sanhueza Sepúlveda, Carolina; Cabezas Tamayo, Ana María; Orellana Welch, Jorge; Zillmann Geerdts, Gisela; Antilef, Rosa María; Cox Melane, Alfonso; Valle Maluenda, Marcelo; Vargas Catalán, Nelson
"Children with special health care needs" (CSHCN) is an emerging and heterogeneous group of paediatric patients, with a wide variety of medical conditions and with different uses of health care services. There is consensus on how to classify and assess these patients according to their needs, but not for their specific diagnosis. Needs are classified into 6 areas: a) specialised medical care; b) use or need of prescription medication; c) special nutrition; d) dependence on technology; e) rehabilitation therapy for functional limitation; and f) special education services. From the evaluation of each area, a classification for CSHCN is proposed according to low, medium, or high complexity health needs, to guide and distribute their care at an appropriate level of the health care system. Low complexity CSHCN should be incorporated into Primary Care services, to improve benefits for patients and families at this level. It is critical to train health care professionals in taking care of CSHCN, promoting a coordinated, dynamic and communicated work between different levels of the health care system. Compliance with these guidelines will achieve a high quality and integrated care for this vulnerable group of children. Copyright © 2016 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.
Katge, Farhin; Rusawat, Bhavesh; Shitoot, Abhinav; Poojari, Manohar; Pammi, Thejokrishna; Patil, Devendra
To assess the DMFT index of children with Special Health Care Needs (SHCN) in Navi Mumbai. To correlate the DMFT index with Streptococcus mutans count in the supragingival bacterial biofilm and with plaque pH. Dental examination of 158 patients aged 5-18 years was conducted to determine the DMFT/dmft index. Supragingival plaque samples were collected from the buccal surfaces of all teeth. The samples were inoculated in mitis salivarius bacitracin agar medium and incubated at 37°C for 48 h. Supragingival plaque was collected from interproximal sites of the molar area (preferably mandibular) for conducting plaque pH test. Chi-square test and Pearson's correlation were used to find the significance of the study parameters on categorical scale between the two groups. The mean DMFT recorded was 4.90 ± 4.63 and the mean dmft recorded was 1.77 ± 3.14. Mean number of S. mutans colony-forming units found was 2.961 × 10(4). Mean plaque pH recorded was 6.2. No statistically significant correlation was found between the DMFT index with the number of S. mutans and plaque pH.
Knapp, Caprice; Madden, Vanessa; Sloyer, Phyllis; Shenkman, Elizabeth
To assess the effects of an Integrated Care System (ICS) on parent-reported quality of care and satisfaction for Children with Special Health Care Needs (CSHCN). In 2006 Florida reformed its Medicaid program in Broward and Duval counties. Children's Medical Services Network (CMSN) chose to participate in the reform and developed an ICS for CSHCN. The ICS ushered in several changes such as more prior approval requirements and closing of the provider network. Telephone surveys were conducted with CMSN parents whose children reside in the reform counties and parents whose children reside outside of the reform counties in 2006 and 2007 (n = 1,727). Results from multivariate quasi-experimental models show that one component of parent-report quality of care, customer service, increased. Following implementation of the ICS, customer service increased by 0.22 points. After implementation of the ICS, parent-reported quality and satisfaction were generally unaffected. Although significant increases were not seen in the majority of the quality and satisfaction domains, it is nonetheless encouraging that parents did not report negative experiences with the ICS. It is important to present these interim findings so that progress can be monitored and decision-makers can begin to consider if the program should be expanded statewide.
Huijts, Tim; Gkiouleka, Anna; Reibling, Nadine; Thomson, Katie H; Eikemo, Terje A; Bambra, Clare
It has been suggested that cross-national variation in educational inequalities in health outcomes (e.g. NCDs) is due to cross-national variation in risky health behaviour. In this paper we aim to use highly recent data (2014) to examine educational inequalities in risky health behaviour in 21 European countries from all regions of the continent to map cross-national variation in the extent to which educational level is associated with risky health behaviour. We focus on four dimensions of risky health behaviour: smoking, alcohol use, lack of physical activity and lack of fruit and vegetable consumption. We make use of recent data from the 7th wave of the European Social Survey (2014), which contains a special rotating module on the social determinants of health. We performed logistic regression analyses to examine the associations between educational level and the risky health behaviour indicators. Educational level was measured through a three-category version of the harmonized International Standard Classification of Education (ISCED). Our findings show substantial and mostly significant inequalities in risky health behaviour between educational groups in most of the 21 European countries examined in this paper. The risk of being a daily smoker is higher as respondents’ level of education is lower (Low education (L): OR = 4.24 (95% CI: 3.83–4.68); Middle education (M): OR = 2.91 (95% CI: 2.65–3.19)). Respondents have a lower risk of consuming alcohol frequently if they have a low level of education (L: OR = 0.59 (95% CI: 0.54–0.64); M: OR = 0.70 (95% CI: 0.65–0.76)), but a higher risk of binge drinking frequently (L: OR = 1.29 (95% CI: 1.16–1.44); M: OR = 1.15 (95% CI: 1.04–1.27)). People are more likely to be physically active at least 3 days in the past week when they have a higher level of education (M: OR = 1.42 (95% CI: 1.34–1.50); H: OR = 1.67 (95% CI: 1.55–1.80)). Finally, people are more likely to consume fruit and vegetables at least
Hexem Kari R
Full Text Available Abstract Background The work of care for parents of children with complex special health care needs may be increasing, while excessive work demands may erode the quality of care. We sought to summarize knowledge and develop a general conceptual model of the work of care. Methods Systematic review of peer-reviewed journal articles that focused on parents of children with special health care needs and addressed factors related to the physical and emotional work of providing care for these children. From the large pool of eligible articles, we selected articles in a randomized sequence, using qualitative techniques to identify the conceptual components of the work of care and their relationship to the family system. Results The work of care for a child with special health care needs occurs within a dynamic system that comprises 5 core components: (1 performance of tasks such as monitoring symptoms or administering treatments, (2 the occurrence of various events and the pursuit of valued outcomes regarding the child's physical health, the parent's mental health, or other attributes of the child or family, (3 operating with available resources and within certain constraints (4 over the passage of time, (5 while mentally representing or depicting the ever-changing situation and detecting possible problems and opportunities. These components interact, some with simple cause-effect relationships and others with more complex interdependencies. Conclusions The work of care affecting the health of children with special health care needs and their families can best be understood, studied, and managed as a multilevel complex system.
Grewal, Navneet; Sethi, Tanvi; Grewal, Sukrit
This study compared and evaluated the efficacy of conventional low-tech and improvised high-tech alternative and augmentative communication (AAC) software in behavior management in the dental environment and oral hygiene activities performance of children with special health care needs as well as improving their communication skills with the dentist and caretakers. A total of 60 institutionalized children with special health care needs were divided into two groups of 30 each to be exposed to low-tech AAC and high-tech AAC systems (special smiles for special children material). Assessment of knowledge as well as behavior modification achieved before and after training was carried out on the basis of pretested proformas formatted through various peer reviewed articles. Rapid and enhanced assimilation of knowledge was observed in group 2 exposed to high-tech AAC improvised software after intergroup comparison of total scores at baseline, first, second, third, sixth, and ninth month of training. Oral hygiene performance was compared using PHP (Patient Hygiene Performance) index and after training results revealed highly significant change in both groups. The subjects benefitted immensely from the programme as group 1 and group 2 children demonstrated good behavior after training compared to none at baseline. On the whole, this programme had a positive motivational impact. © 2014 Special Care Dentistry Association and Wiley Periodicals, Inc.
This book presents the principles and techniques of program specialization - a general method to make programs faster (and possibly smaller) when some inputs can be known in advance. As an illustration, it describes the architecture of Tempo, an offline program specializer for C that can also specialize code at runtime, and provides figures for concrete applications in various domains. Technical details address issues related to program analysis precision, value reification, incomplete program specialization, strategies to exploit specialized program, incremental specialization, and data speci
In France, it was only recently that cases related to high radon concentrations in dwellings received substantial publicity. This irruption of radon as a public health issue came with the general progress of scientific knowledge and the availability of a research capacity in France able to develop expertise. We are interested here in the legal implications of issues that arise from the lag between the activity of experts and the regulatory activity in the domain of radon. We use the term expertise very broadly, to cover the practical application of research findings, the relation of the researchers with the community, and finally the acts by which experts provide their knowledge to the community. We first examine the course by which science developed the radon issue and the way they organized to move from research to expertise; here we try to characterize the various needs for radon expertise. We then discuss the legal difficulties associated with radon expertise
Anderson, Betsy; Beckett, Julie; Wells, Nora; Comeau, Meg
There is broad agreement that increasing the cost-effectiveness and quality of health care services, thereby achieving greater value, is imperative given this country's current spiraling costs and poor health outcomes. However, how individuals or stakeholder groups define value may differ significantly. Discussion of value in the context of health care, in particular value-based purchasing and value-based insurance design, must acknowledge that there is no universal consensus definition as to what constitutes value. To date, the consumer perspective has been underrepresented in discussions of value-based strategies such as pay for performance, capitated and bundled payments, and high-deductible health plans, which have been driven primarily by payers and providers. This article will discuss 3 elements of value from the perspective of families of children and youth with special health care needs: the role of families in the delivery of care, consumer perspectives on what constitutes quality for children and youth with special health care needs, and health care and health care financing literacy, decision-making, and costs. The undervalued contributions made by family members in the delivery and oversight of pediatric care and the importance of partnering with them to achieve the goals of the Triple Aim are stressed. The article closes with a discussion of recommendations for a future policy and research agenda related to advancing the integration of the consumer perspective into value-based purchasing and value-based insurance design. Copyright © 2017 by the American Academy of Pediatrics.
The history, objectives and aims of this programme are described in detail. The principal goals achieved on anticonception, reproductive biology and abortion are analyzed, with special reference to the research done in Chile. The strengthening of research capabilities at national level was pointed out with special mention to the Chilean case.
The 'Bribe' and 'Drum' Affairs and suspected proliferation in connection with Transnuklear GmbH public around the turn of 1987/88. Many members of the press wished them to speed up the process of opting out of nuclear power. However, none of the accusations specifically related to nuclear power leveled at that time turned out to be tenable. Instead, all violations of the law which had been detected could have been punished in the same way as in any other branch of industry. As a consequence, the impacts arising to regulatory structures in the nuclear sector, especially the measures taken by the Federal Government, may be considered to have been unjustified in scope. The TN Affair and the associated litigation has caused a great deal of confidence in nuclear power to be lost, which now has to be reclaimed by purposeful public relations efforts. (orig.) [de
Litt, Jonathan S; Minich, Nori; Taylor, H Gerry; Hack, Maureen
Extremely low birth weight (ELBW; <1kg) adolescents are at risk for special health care needs (SHCN) and poor math achievement compared to normal birth weight (NBW) peers. SHCN are associated with poor academic achievement among NBW children. We hypothesize that SHCN explain the effect of ELBW on math achievement. We compared age 14 Woodcock-Johnson Calculation standard scores between 181 ELBW infants and 115 NBW controls. Persistent SHCN included: 1) prescription medication or equipment use, 2) subspecialty or therapeutic service use, or 3) hospitalization. We used nonlinear marginal effects models to decompose the total effect of ELBW on math into the following 4 components: the effect of ELBW controlling for SHCN, the effect of SHCN controlling for ELBW, effect modification by SHCN, and mediated interaction where SHCN is both causal mediator and effect modifier. Models were adjusted for sociodemographic factors. ELBW adolescents had lower mean math scores than NBW peers (81.3 vs. 96.4). SHCN were more common among ELBW adolescents (54.1% vs. 27%). The total effect of ELBW on math scores was -15.7 points (95% CI -21.0, -10.5). The effect of birth weight alone was -7.6 points (95% CI -13.7, -1.4); the effect of SHCN alone was negligible. SHCN interaction and mediated interaction effects each accounted for 25% of the total effect. Birth weight alone explains only half of the effect of ELBW on math achievement. We found evidence of effect modification and mediation by SHCN. Understanding these explanatory pathways may lead to targeted interventions for improved outcomes. Copyright © 2017. Published by Elsevier B.V.
Adepoju, Omolola E; Zhang, Yichen; Phillips, Charles D
The management of children with special needs can be very challenging and expensive. To examine direct and indirect cost drivers of home care expenditures for this vulnerable and expensive population. We retrospectively assessed secondary data on children, ages 4-20, receiving Medicaid Personal Care Services (PCS) (n = 2760). A structural equation model assessed direct and indirect effects of several child characteristics, clinical conditions and functional measures on Medicaid home care payments. The mean age of children was 12.1 years and approximately 60% were female. Almost half of all subjects reported mild, moderate or severe ID diagnosis. The mean ADL score was 5.27 and about 60% of subjects received some type of rehabilitation services. Caseworkers authorized an average of 25.5 h of PCS support per week. The SEM revealed three groups of costs drivers: indirect, direct and direct + indirect. Cognitive problems, health impairments, and age affect expenditures, but they operate completely through other variables. Other elements accumulate effects (externalizing behaviors, PCS hours, and rehabilitation) and send them on a single path to the dependent variable. A few elements exhibit a relatively complex position in the model by having both significant direct and indirect effects on home care expenditures - medical conditions, intellectual disability, region, and ADL function. The most important drivers of home care expenditures are variables that have both meaningful direct and indirect effects. The only one of these factors that may be within the sphere of policy change is the difference among costs in different regions. Copyright © 2014 Elsevier Inc. All rights reserved.
Phelps, Charles E; Lakdawalla, Darius N; Basu, Anirban; Drummond, Michael F; Towse, Adrian; Danzon, Patricia M
The fifth section of our Special Task Force report identifies and discusses two aggregation issues: 1) aggregation of cost and benefit information across individuals to a population level for benefit plan decision making and 2) combining multiple elements of value into a single value metric for individuals. First, we argue that additional elements could be included in measures of value, but such elements have not generally been included in measures of quality-adjusted life-years. For example, we describe a recently developed extended cost-effectiveness analysis (ECEA) that provides a good example of how to use a broader concept of utility. ECEA adds two features-measures of financial risk protection and income distributional consequences. We then discuss a further option for expanding this approach-augmented CEA, which can introduce many value measures. Neither of these approaches, however, provide a comprehensive measure of value. To resolve this issue, we review a technique called multicriteria decision analysis that can provide a comprehensive measure of value. We then discuss budget-setting and prioritization using multicriteria decision analysis, issues not yet fully resolved. Next, we discuss deliberative processes, which represent another important approach for population- or plan-level decisions used by many health technology assessment bodies. These use quantitative information on CEA and other elements, but the group decisions are reached by a deliberative voting process. Finally, we briefly discuss the use of stated preference methods for developing "hedonic" value frameworks, and conclude with some recommendations in this area. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
unmatched value of our statehood, which spans an entire millennium if one casts off ideo- logical and other stereotypes, consists in that not one of the...of the bolshevik party. However much bread, vegetables, meat, milk, sugar, clothing, footwear, heating fuel, energy, cast iron, iron and cement may...PARTY AND STATE AFFAIRS 41 each person of the means of existence with a ladle filled from the common pot, and this, selectively, depending on each
de estudios internationales (CEPEI), Lima, 1986, XXXVI+498 pp] [Text] The latest publication of the Peruvian Center for International Research is...United States on the Malvinas Islands and Easter Island (p 377). Mercado Harrin, former minister of foreign affairs and prime minister of Peru who...urgent tasks in the realm of foreign policy. E. Mercado Harrin, analyzing the geopolitical climate in Latin America after the Malvinas conflict of
Lee, Saerom; Myong, Jun-Pyo; Kim, Eun-A; Eom, Huisu; Choi, Bowha; Kang, Young Joong
We examined the current status of specialized agencies for occupational health management (SAs) and their workforce. Furthermore, we aimed to clarify the current practice status of SA healthcare professionals and factors that influence their performance. To examine the current SA workforce, we analyzed data from the 2014 Survey of Current Status of SA and their Workforce from the Ministry of Employment and Labor (MOEL). Furthermore, we mailed out an original questionnaire to SA professionals to determine their current health management status and factors that affect their performance. Data from the respondents ( N = 384) were analyzed. In 2014, the workforce performing health management in SAs comprised 232 physicians, 507 nurses, and 312 occupational hygienists, with no significant regional differences in the distribution of physicians and nurses. According to the findings of the questionnaire, the average daily number of worker consultations by physicians and nurses was 22.8, while the average time taken for health management ranged from 74.3 to 104.3 min, depending on the size of the firm. Most of the respondents (41.5%) answered that they were following-up on more than 80% of individuals with illnesses. Among health management tasks, performance scores of "consultations for general diseases" and "consultations for lifestyle habits" were relatively high, whereas health promotion activities at workplaces were relatively low. There was a significant correlation between the utilization of general and special health examination results and task performance. Among health management tasks, follow-up management of individuals with illnesses and consultations for disease/lifestyle habits were relatively well performed, whereas health promotion activities at workplaces were not performed well. Among factors that positively influenced SA performance at workplaces, only the utilization of health examination results had significant effects. Therefore, to accomplish
May 15, 2016 ... nature along one of the most polluted parts of the country is and the ability to become the center of a highly ... of intelligent health and with regard to the principles of sustainability in point of special importance to ... Keywords: Health; city health; smart; sustainability in architecture; architectural design.
... 25 Indians 1 2010-04-01 2010-04-01 false Who is eligible for special education funding? 39.106 Section 39.106 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION THE INDIAN SCHOOL... for special education funding? To receive ISEP special education funding, a student must be under 22...
Schultz, Ulrik Pagh; Lawall, Julia Laetitia; Consel, Charles
of design patterns. In this paper, we analyze the specialization opportunities provided by specific uses of design patterns. Based on the analysis of each design pattern, we define the associated specialization pattern. These specialization opportunities can be declared using the specialization classes......Design patterns offer many advantages for software development, but can introduce inefficiency into the final program. Program specialization can eliminate such overheads, but is most effective when targeted by the user to specific bottlenecks. Consequently, we propose that these concepts...... are complementary. Program specialization can optimize programs written using design patterns, and design patterns provide information about the program structure that can guide specialization. Concretely, we propose specialization patterns, which describe how to apply program specialization to optimize uses...
Schultz, Ulrik Pagh; Lawall, Julia Laetitia; Consel, Charles
Design patterns offer many advantages for software development, but can introduce inefficiency into the final program. Program specialization can eliminate such overheads, but is most effective when targeted by the user to specific bottlenecks. Consequently, we propose that these concepts...... are complementary. Program specialization can optimize programs written using design patterns, and design patterns provide information about the program structure that can guide specialization. Concretely, we propose specialization patterns, which describe how to apply program specialization to optimize uses...... of design patterns. In this paper, we analyze the specialization opportunities provided by specific uses of design patterns. Based on the analysis of each design pattern, we define the associated specialization pattern. These specialization opportunities can be declared using the specialization classes...
Moazzezi, Mousa; Ataie Moghanloo, Vahid; Ataie Moghanloo, Roghayeh; Pishvaei, Malihe
Diabetes Mellitus (DM) imposes restrictions on physical, emotional and social functioning of children and adolescents. The aim of this study was to determine the impact of acceptance and commitment therapy (ACT) on perceived stress and special health self-efficacy in seven to fifteen-year-old children with DM. The present study was a clinical trial with a pretest-posttest control group design. The study population included all seven to fifteen-year-old patients who had referred to the Diabetes Mellitus Association of Tabriz, Iran, of whom 40 participants were selected using convenient sampling. They were randomly allocated to two matched groups (experimental and control). The experimental group participated in therapy sessions, while the control group did not receive any interventions. The research instruments were perceived stress and special health self-efficacy scales. The multiple analysis of covariance (MANCOVA) results showed that the treatment was effective on variables of perceived stress and special health self-efficacy (P self-efficacy in children with DM.
Whisman, Mark A
Prior research has found that humiliating marital events are associated with depression. Building on this research, the current study investigated the association between one specific humiliating marital event-discovering that one's partner had an affair-and past-year major depressive episode (MDE) in a probability sample of married or cohabiting men and women who were at high risk for depression based on the criterion that they scored below the midpoint on a measure of marital satisfaction (N = 227). Results indicate that (i) women were more likely than men to report discovering their partner had an affair in the prior 12 months; (ii) discovering a partner affair was associated with a higher prevalence of past-year MDE and a lower level of marital adjustment; and (iii) the association between discovering a partner affair and MDE remained statistically significant when holding constant demographic variables and marital adjustment. These results support continued investigation into the impact that finding out about an affair has on the mental health of the person discovering a partner affair. © 2015 Family Process Institute.
Brogaard, Line Kai-Sørensen; Christensen, Thomas Højlund
In addition to the main types of special waste related to municipal solid waste (MSW) mentioned in the previous chapters (health care risk waste, WEEE, impregnated wood, hazardous waste) a range of other fractions of waste have in some countries been defined as special waste that must be handled...... separately from MSW. Some of these other special wastes are briefly described in this chapter with respect to their definition, quantity and composition, and management options. The special wastes mentioned here are batteries, tires, polyvinylchloride (PVC) and food waste....
Full Text Available The article deals with original methodology of health jogging and running. 175 students participated in experiment. Adaptive possibilities of cardiovascular system and changes in physical ability of students are assessed in the research. Index dynamics of physical state is determined in the paper. The research focuses on the fact that repetitive exercisers with aerobics alongside adjusted exercises caused the rise in health condition of students with vegetative-vascular dystonia. It is established that such use of running and jogging in the special sturdy department's program of physical exercisers can materially correct arterial pressure and improve students' feeling of feet.
... DEPARTMENT OF VETERANS AFFAIRS Health Services Research and Development Service Scientific Merit... nursing research. Applications are reviewed for scientific and technical merit, mission relevance, and the... Program Manager, Scientific Merit Review Board, Department of Veterans Affairs, Health Services Research...
Full Text Available Purpose: to study reliability of functioning and reserves of system, controlling movements with different coordination structure of special health group girl students (low health level in physical education process. Material: in the research special health group girl students (n=136, age 17-19 participated. They were divided into 2 groups - control and experimental. The program, directed to increase reliability and reserves of system controlling movements, was realized. It was based on physical exercises of complicated coordination with novelty elements, which were fulfilled under musical accompaniment. The research continued one academic year. Results: in girl students with health problems we registered higher differential thresholds, when reproducing local movements in complicated conditions. They used visual and hearing feedback channels for informing brain’s programming areas about made mistakes. They were worse teachable in training accurate movements. These girl students have less expressed compensation reserves under impact of hindering factors and interferences. It can be interpreted as non-specific crisscross negative response to motor functional system in case of health problems. All these determine reduction of reserve potentials of motor control system. Conclusions: The main reserve potentials’ criteria of control over different coordination structure movements are: quickness of passing to program mechanism of fine movements’ regulation in stable conditions of functioning; power and effectiveness of compensatory reactions, ensuring interference immunity of system, controlling movements under interfering factors; reliability of maintaining movements’ qualitative parameters in optimal range under interfering factors; reduction of sensor interconnections in stable functioning conditions.
McLeigh, Jill D; Kilmer, Ryan P
This editorial introduces this special section of the American Journal of Orthopsychiatry . The Global Alliance for Behavioral Health and Social Justice (formerly the American Orthopsychiatric Association) has developed the theme for its track at the 2016 Annual Research and Policy Conference on Child, Adolescent, and Young Adult Behavioral Health. The Global Alliance, the parent organization of the American Journal of Orthopsychiatry , has long sought to address prevailing social conditions by treating them as problems to be solved through multilevel, contextually grounded social interventions. Indeed, throughout the organization's history, it has advocated for focusing on the effects of social determinants of health (e.g., racism, violence, poverty, oppression, war) on behavioral health and for doing so across contexts, such as the family, community, and broader social environment. In keeping with the organization's history and the current social context, the theme for the Global Alliance's track was "Changing norms, strategies, and systems to support behavioral health and social justice." This special section includes articles that build on four of the presentations and two award addresses delivered as part of the Global Alliance's track. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Full Text Available Zeina N Chemali,1,2 Christina PC Borba,1,2 Tanya E Henderson,3 Markos Tesfaye41Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; 2Harvard Medical School, Boston, MA, USA; 3International and Human Rights Law Consultants, Cambridge, MA, USA; 4Department of Psychiatry, College of Public Health and Medical Sciences, Jimma University, Jimma, EthiopiaAbstract: This paper presents the delivery of mental health care to a sample of women living in Jimma, rural Ethiopia, and their access to mental health services. A total of 226 psychiatric charts were reviewed for women seen at Jimma University Specialized Hospital. The mental health charts included documentation ranging from one paragraph to a full note. No psychiatric chart recorded medication status, detailed substance abuse history, or a history of violence. Rendering appropriate mental health care for women requires concerted efforts by multiple stake holders. Using our results, we advance concrete and practical suggestions for improving women's mental health in rural Ethiopia. We point out that the health care system needs to be responsive, allowing for change starting with gender rights, so that rural women have access to basic mental health services.Keywords: global mental health, low income country, Africa, gender differences
Full Text Available This article focus on maybe the most striking judicial case in America during the early twenieth century. The Sacco and Vanzetti case. There is a widespead awareness about the crime they were accused for, the trial phases and their tragic end, but what about the defensive strategies adopted by their lawyers? The analisys of this theme and the involvement of the pubblic opinion demostrates how this jucidial case bacame an affaire, with a disrupting international eco, underestimated even by U.S. authorities. The pubblic opinion will elevate the two anarchists, crushed by injustice and the political trial, to icons of political struggle against the system.
Adams, Sharrika D.; Hazelwood, Sherry; Hayden, Bruce
Case management is a functional area in higher education and student affairs that emerged after the mass shootings at Virginia Tech in 2007. Although new to higher education, case management emerged from established social work practice. This article compares social work theory and case management standards with a new case management model for…
Partial Contents: International Affairs, Radio, Birthday Celebration, School Anniversary, Cultural Agreement, Presidents, Trade Union Bureau, Education, Olympic Committee, Ambassador, Conference, Exhibition, Campaign...
Full Text Available ... Search English Español Special Needs: Planning for Adulthood (Video) KidsHealth / For Parents / Special Needs: Planning for Adulthood (Video) Print Young adults with special needs have many ...
Full Text Available ... Videos for Educators Search English Español Special Needs: Planning for Adulthood (Video) KidsHealth / For Parents / Special Needs: Planning for Adulthood (Video) Print Young adults with special ...
Stock, Susan R.; Levine, Heidi
This chapter provides an overview of common student mental health issues and approaches for student affairs practitioners who are working with students with mental illness, and ways to support the overall mental health of students on campus.
Christiansen, Terkel; Erb, Karin; Rizvanovic, Amra
To examine the costs to the public health care system of couples in medically assisted reproduction.......To examine the costs to the public health care system of couples in medically assisted reproduction....
New rules and reminder The French Ministry of Foreign Affairs (hereinafter referred to as 'MAE') has informed CERN of the following solution to a problem that has existed for over 30 years: from now on, members of the personnel residing in France and holding a full-time contract of between three and six months will be entitled to a special EM-type residence permit that does not confer any privileges (see Paragraph 2 below). Furthermore, the MAE has stated that it is willing to request the competent authorities to look favourably on applications for work permits by a member of the personnel's family members who reside in France and wish to take up gainful employment, although it is unable to guarantee the outcome (see Paragraph 7 below). The MAE also wishes to draw attention to the following rules concerning the legitimation documents it issues and to point out that compliance with these rules is essential for the proper operation of all international organisations established in France. This communicatio...
Lazarchik, David A; Haywood, Van B
Plaque accumulation and resulting caries or periodontal disease is a frequent problem in patients with special-care needs. Tray-applied 10 percent carbamide peroxide (CP) is a tooth-bleaching agent that has positive effects on plaque, gingival health and caries. The authors review the antibacterial properties of CP and the effects of CP on saliva, plaque, caries and gingival health. They also review tray fabrication options and techniques, application methods, safety and side effects. Finally, they address the challenges involved in and research needed regarding use of tray-applied CP materials in special-care patients. In their literature review and clinical experience, the authors found 10 percent CP delivered in a custom-fitted tray to be an effective treatment for caries in patients with compromised oral hygiene. Plaque suppression and caries control result from a CP-induced increase in salivary and plaque pH caused by CP's urea component, and from possible antimicrobial action via physical debridement and the direct chemical effect of hydrogen peroxide. Tray-applied 10 percent CP may hold great promise for improving the oral health of many special-care patients, including elderly patients, patients with cancer and patients with dry mouth. Further research is needed to verify the potential benefits, specifics of treatment times and protocols and most cost-effective products for use in various patient groups. Application of 10 percent CP in a custom-fitted tray may reduce caries by elevating the pH above the level at which the caries process can occur, in addition to debriding the teeth and improving gingival health.
Since 1986, the Government of Navarra has taken over the functions of security and health as part of the health 'area', with a broad conception of health, avoiding separating the citizen from the worker. In 1993, the Instituto Navarro de Salud Laboral created, under the direction of the departments of Health and Labor, combined diverse functions and resources, integrating preexisting structures into a technical department to be responsible for the overall health care of workers. The structure is based on two coordinated pillars, security and hygiene at work and occupational health. As more specifically to do with health, we describe the systems of epidemiological information and vigilance and programs for occupational disabilities, health activities in industry and investigation of diseases. The Unidades de Salud Laboral link the workplace with the public health service. The occupational health plan of Navarra will set out future strategies. It is necessary to involve neurologists in occupational health. Occupational risks and injury are everyone's problem. The neurologist's role in accidents is usually of health care; detection of illness is more difficult when an occupational relationship is not considered. Data from work should be included in the clinical history. The official figures for occupational neurological diseases are ridiculous and more cases should be detected. There should be a fluid relationship between neurologists, occupational doctors and experts in prevention.
Strupp, Hans H.; Hadley, Suzanne W.
Society, the patient, and the mental health professional each define ideal mental health from a different vantage point. A truly adequate picture of an individual's mental health is possible only if these three facets of a tripartite model of functioning are evaluated and integrated. (Author/SJL)
Bakaeen, Faisal G; Stephens, Elizabeth H; Chu, Danny; Holman, William L; Vaporciyan, Ara A; Merrill, Walter H; Grover, Frederick L
With cardiothoracic education going through a critical phase of reevaluation and adaptation, we investigated perceptions of Veterans Affairs hospitals in cardiothoracic training. A content-validated survey was distributed electronically to 676 cardiothoracic surgery residents, recent cardiothoracic graduates (on or after June 2006), cardiothoracic surgery chairpersons, program directors, associate program directors, and section heads. The Cardiothoracic Surgery Network was used to identify target recipients and their e-mail addresses. Forty-three percent of the target recipients (292/676) completed the survey. Of those who were residents, 59% (65/111) rotated at a Veterans Affairs hospital during their cardiothoracic training; this rotation accounted for 25% or more of the total training period for 19% of them (21/111). A Veterans Affairs appointment was held by 42% of program directors/chairpersons (20/48) and 24% of graduates, associate program directors, and section heads (31/129). An affiliation with a Veterans Affairs hospital was rated as somewhat to very beneficial by 93% of the responders (273/292), and the cardiothoracic training received at Veterans Affairs facilities was rated as good to excellent by 73% of the responders (213/292). Sixty-nine percent of respondents (201/292) reported the operating room environment at Veterans Affairs hospitals to be at least as conducive to learning as that at the affiliate teaching hospital, and 76% (223/292) indicated that residents get more autonomy and hands-on experience at Veterans Affairs institutions. In addition, 64% of responders (188/292) reported that they would seek or recommend a Veterans Affairs job. Responses were positive toward the Veterans Affairs system regardless of whether the responder had any Veterans Affairs affiliation (ie, appointment as staff or rotation as resident); however, a Veterans Affairs affiliation was associated with a higher rate of positive responses regarding Veterans Affairs
Sanathanan, L.P.; Reilly, C.A.; Marshall, S.A.; Wilzbach, K.E.
This document contains annotated synopses of available information pertinent to health impacts of synthetic fuel technologies under development, and identifies needs for further information. The report focuses on carcinogenesis, which appears to be a special problem with coal conversion technologies. This review is intended to serve as a reference for the NEPA Affairs Division of DOE in its evaluation of the overall synthetic fuel program and specific projects in the program. Updated versions of this document are expected to be prepared annually or semiannually as new information becomes available.
Lichamelijke beperkingen en andere gezondheidsproblemen bij kinderen in het speciaal onderwijs in vergelijking met het regulier onderwijs [Physical limitation and other health problems in children who go to schools for special education compared with mainstream education
Reijneveld, S.A.; Spee-Van Der Wekke, J.; Verloove-Vanhorick, S.P.
Many children with developmental problems, especially with problems in cognition or in social and emotional functioning, go to schools for special education. Whether pupils in special education have more physical limitations, handicaps and other health problems than pupils in mainstream education
Stafford, John D.
The purpose of this study was to investigate entry-level student affairs practitioners' perceptions of professional development and their involvement in individualized professional development opportunities within the student affairs field. The literature review explored the founding of student affairs, a historical review of student affairs,…
Jan 15, 2018 ... to exposure of PM2.5, NO2 and O3 in 41 European countries in 2013 are 467 000, 71 000 and. 17 000 respectively. Risk of human health especially with special health conditions such as asthma patients can be reduce by providing useful information to the public through the early and precise prediction ...
Full Text Available Abstract Background Pregnancy is a time of significant physiological and physical change for women. In particular, it is a time at which many women are at risk of gaining excessive weight. We describe the rationale and methods of the Health in Pregnancy and Post-birth (HIPP Study, a study which aims primarily to determine the effectiveness of a specialized health coaching (HC intervention during pregnancy, compared to education alone, in preventing excessive gestational weight gain and postpartum weight retention 12 months post birth. A secondary aim of this study is to evaluate the mechanisms by which our HC intervention impacts on weight management both during pregnancy and post birth. Methods/Design The randomized controlled trial will be conducted with 220 women who have a BMI > 18.5 (American IOM cut-off for normal weight, are 18 years of age or older, English speaking, no history of disordered eating or diabetes and are less than 18 weeks gestation at recruitment. Women will be randomly allocated to either a specialized HC intervention group or an Education Alone group. Our specialized HC intervention has two components: (1 one-on-one sessions with a Health Coach, and (2 two by two hour educational group sessions led by a Health Coach. Women in the Education Alone group will receive two by two hour educational group sessions with no HC components. Body Mass Index, waist circumference, and psychological factors including motivation, readiness to change, symptoms of depression and anxiety, and body dissatisfaction will be assessed at baseline (14-16 weeks gestation, and again at follow-up: 32 weeks gestation, 6 weeks, 6 months and 12 months postpartum. Discussion Our study responds to the urgent need to design effective interventions in pregnancy to prevent excessive gestational weight gain and postpartum weight retention. Our pregnancy HC intervention is novel and innovative and has been designed to be easily adopted by health professionals
Nov 1, 2016 ... NASPA, and Stellenbosch University and the International Association of Student Affairs and Services, with 50 student affairs leaders in attendance. To survive the 21st century, it is essential to come together as global citizens and a global academy, said Habib, who is also chair of Universities South Africa, ...
This funding will enhance the Public Affairs Centre's (PAC) role as a credible public policy institution in India by strengthening its ability to provide high-quality, influential, and policy-relevant research. About the Public Affairs Centre PAC is a not-for-profit, non-partisan organization committed to improving the quality of ...
The International Association of Student Affairs and Services (IASAS) serves as a global network of student affairs and services workers that encourages sharing, cooperation, research, exchanges, and attendance at each other's conferences. The Vice President and. General Secretary of IASAS attended the 2016 Asia ...
The Corporate Affairs Commission was established by section 1 of the Companies and Allied Matters Act, Cap C.20, Laws of the Federation of Nigeria, 2004 (CAMA). The Corporate Affairs Commission is a regulatory body, established to regulate the incorporation, running and winding up of companies, business names and ...
Forney, Deanna S.
Provides background information about the Political Correctness debate, encourages student affairs administrators to reflect on their own perceptions and actions, offers ideas and suggestions about the debate, and explores the debate's implications for student affairs staff. Is intended to promote both individual reflection and group discussions…
Focus and Scope. The Journal of Student Affairs in Africa (JSAA) is an independent, peer-reviewed, multi-disciplinary, open-access academic journal that publishes scholarly research and reflective discussions about the theory and practice of student affairs in Africa. JSAA aims to contribute to the professionalization of ...
... 39 Postal Service 1 2010-07-01 2010-07-01 false Authority to administer postal affairs. 222.1 Section 222.1 Postal Service UNITED STATES POSTAL SERVICE ORGANIZATION AND ADMINISTRATION DELEGATIONS OF AUTHORITY § 222.1 Authority to administer postal affairs. (a) The Postmaster General. The postmaster general...
... to international securities markets. OIA facilitates the development of and, where appropriate... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Office of International... Organization § 200.15 Office of International Affairs. (a) The Office of International Affairs (“OIA”) is...
African Journal of International Affairs and Development. ... and military-security issues at the core of Africa's foreign relations and world affairs. It covers the environment, development issue, conflict, and cooperation among regional actors in a global context. Despite its African origin, AJIAD maintains a wide thematic variety ...
Woosley, Sherry A.; Hyman, Randy E.; Graunke, Steven S.
Although Q methodology has been especially well used by researchers in a variety of social and behavioral sciences, student affairs researchers have not been inclined to deploy this methodology. This article examines Q methodology and uses a case study to explore the potential for student affairs assessment and research. Overall, the authors…
Guido, Florence M.; Chavez, Alicia Fedelina; Lincoln, Yvonna S.
Student affairs professionals benefit from understanding paradigms, worldviews, and ways of being among diverse faculty, staff, and students. It is challenging to understand core differences of paradigms, design student affairs practice and research in congruence with or across specific philosophies, and work effectively with individuals operating…
Ranade-Kharkar, Pallavi; Weir, Charlene; Norlin, Chuck; Collins, Sarah A; Scarton, Lou Ann; Baker, Gina B; Borbolla, Damian; Taliercio, Vanina; Del Fiol, Guilherme
Identify and describe information needs and associated goals of physicians, care coordinators, and families related to coordinating care for medically complex children and youth with special health care needs (CYSHCN). We conducted 19 in-depth interviews with physicians, care coordinators, and parents of CYSHCN following the Critical Decision Method technique. We analyzed the interviews for information needs posed as questions using a systematic content analysis approach and categorized the questions into information need goal types and subtypes. The Critical Decision Method interviews resulted in an average of 80 information needs per interview. We categorized them into 6 information need goal types: (1) situation understanding, (2) care networking, (3) planning, (4) tracking/monitoring, (5) navigating the health care system, and (6) learning, and 32 subtypes. Caring for CYSHCN generates a large amount of information needs that require significant effort from physicians, care coordinators, parents, and various other individuals. CYSHCN are often chronically ill and face developmental challenges that translate into intense demands on time, effort, and resources. Care coordination for CYCHSN involves multiple information systems, specialized resources, and complex decision-making. Solutions currently offered by health information technology fall short in providing support to meet the information needs to perform the complex care coordination tasks. Our findings present significant opportunities to improve coordination of care through multifaceted and fully integrated informatics solutions. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: firstname.lastname@example.org
The Social Affairs team. Left to right: Emma Brown, Valérie Chaumeil and Pascale Leuzzi. The Social Affairs Office is expanding its services: the existing team of social affairs assistant Pascale Leuzzi and admininistrative assistant Emma Brown has now been joined by a psychologist, Valérie Chaumeil, who will be available for consultation on Tuesday and Thursday mornings to those seeking advice on personal, family or professional matters. Her role thus perfectly complements those of the social affairs assistant and the administrative assistant. Naturally, like any other consultation with a member of the Service, all consultations with the psychologist will remain confidential. For further details of the Social Affairs Service's remit, please consult the page 10 of the bulletin 20/2001.
Elsey, H; Thomson, D R; Lin, R Y; Maharjan, U; Agarwal, S; Newell, J
Rapid and uncontrolled urbanisation across low and middle-income countries is leading to ever expanding numbers of urban poor, defined here as slum dwellers and the homeless. It is estimated that 828 million people are currently living in slum conditions. If governments, donors and NGOs are to respond to these growing inequities they need data that adequately represents the needs of the urban poorest as well as others across the socio-economic spectrum.We report on the findings of a special session held at the International Conference on Urban Health, Dhaka 2015. We present an overview of the need for data on urban health for planning and allocating resources to address urban inequities. Such data needs to provide information on differences between urban and rural areas nationally, between and within urban communities. We discuss the limitations of data most commonly available to national and municipality level government, donor and NGO staff. In particular we assess, with reference to the WHO's Urban HEART tool, the challenges in the design of household surveys in understanding urban health inequities.We then present two novel approaches aimed at improving the information on the health of the urban poorest. The first uses gridded population sampling techniques within the design and implementation of household surveys and the second adapts Urban HEART into a participatory approach which enables slum residents to assess indicators whilst simultaneously planning the response. We argue that if progress is to be made towards inclusive, safe, resilient and sustainable cities, as articulated in Sustainable Development Goal 11, then understanding urban health inequities is a vital pre-requisite to an effective response by governments, donors, NGOs and communities.
Federal Laboratory Consortium — Supporting Navy special weapons, the division provides an array of engineering services, technical publication support services, logistics support services, safety...
Buskjær Christensen, Mette
European integration has been and still is a contested issue in Danish politics. Denmark is often thought of as a sceptical member of the European Union (EU), due in particular to the Danes’ rejection of two EU referendums (on the Maastricht Treaty and the euro) and Denmark’s opt-outs from...... political aspects of EU cooperation that have evolved since the 1970s. This became particularly clear with Danish voters’ rejection of the Maastricht Treaty in 1992, where the establishment of a more political union was on the agenda. The Danish rejection of the Treaty threw the EU into its first major......: (1) from the third phase of Economic and Monetary Union (EMU), that is, the euro; (2) from supranational cooperation on Justice and Home Affairs (JHA); (3) from defence cooperation within the Common Foreign and Security Policy (CFSP); and (4) from EU citizenship, which no longer has any practical...
Mogollón Tello, Luis Alberto; Huapaya Paricoto, Olinda; Dpto. Académico Médico Quirúrgico. Facultad Odontología. UNMSM. Lima, Perú.
The Prevalence and distribution of dental anomalies in patients with cleft lip alveolus and palate (CLAP) were studied using panoramic x-rays of 129 children (79 boys and 50 girls), 6 to 12 year old belonging the Institute specialized on Children’s Health, Lima - Perú, during 2005 to 2008. Hypodontia prevalence of 86.8% and supernumerary teeth prevalence in the 49.6% was found in the population. Both anomalies were simultaneously found in 43.4%. The studied population showed 78 patients with ...
Full Text Available ... Healthy Staying Safe Recipes & Cooking Health Problems Illnesses & Injuries Relax & Unwind People, Places & Things That Help Feelings ... for Health Insurance Finding Respite Care for Your Child With Special Needs Special Education: Getting Help for ...
Full Text Available ... Parents Parents site Sitio para padres General Health Growth & Development Infections Diseases & Conditions Pregnancy & Baby Nutrition & Fitness ... for Health Insurance Finding Respite Care for Your Child With Special Needs Special Education: Getting Help for ...
Full Text Available ... Parents site Sitio para padres General Health Growth & Development Infections Diseases & Conditions Pregnancy & Baby Nutrition & Fitness Emotions & ... for Health Insurance Finding Respite Care for Your Child With Special Needs Special Education: Getting Help for ...
despite the fact that this organizational handicap is clearly recog- nized by all echelons of CA forces. While not necessar- ily a result of the so... geography /GIS. He currently serves as the CIM NCO- IC for HHC, 415th CA BN, Kalamazoo, MI. 51 SSG Bjorn E. Hansen has served as a Civil Affairs...mission, country or sub-national CA area studies to establish baseline information relating to the geography , historical setting, and the social
Exploring factors related to the adoption and acceptance of an internet-based electronic personal health management tool (EPHMT) in a low income, special needs population of people living with HIV and AIDS in New York City.
Odlum, Michelle; Gordon, Peter; Camhi, Eli; Valdez, Esmerlin; Bakken, Suzanne
Access to personal health information assists efforts to improve health outcomes and creates a population of active and informed health consumers. Understanding this significance, Healthy People 2020 retained, as a Focus Area, the need for improved interactive Health Communication and HIT. Attainment of this goal includes increasing the use of Internet-based electronic personal health management tools (EPHMT). Health information management, essential for favorable health outcomes, can be problematic in low income, special needs populations with complex chronic illnesses such as HIV/AIDS. Furthermore, barriers to the adoption and acceptance of an EPHMT in such populations have not been well explored. The current study seeks to explore the usability of an EPHMT entitled MyHealthProfile and to identify perceived health information needs in a vulnerable population of people living with HIV and AIDS (PLWH) that have access to an EPHMT through their Medicaid Special Needs Plan.
Cruise, Keith R.; Evans, Lisa J.; Pickens, Isaiah B.
Previous research has established that justice-involved youth have higher rates of both learning disabilities and mental health disorders compared to youth in the community. Both need areas raise substantial intervention and rehabilitation concerns that must be addressed via educational and mental health service plans. The current study…
Pearce, Eiluned; Launay, Jacques; Machin, Anna; Dunbar, Robin I M
Evidence demonstrates that group singing improves health and well-being, but the precise mechanisms remain unknown. Given that cohesive social networks also positively influence health, we focus on the social aspects of singing, exploring whether improvements in health and well-being are mediated by stronger social bonds, both to the group as a whole (collective-bonding) and to individual classmates (relational-bonding). To do so, seven newly-formed community-based adult education classes (four singing, N =84, and three comparison classes studying creative writing or crafts, N =51) were followed over seven months. Self-report questionnaire data on mental and physical health, well-being, and social bonding were collected at Months 1, 3 and 7. We demonstrate that physical and mental health and satisfaction with life significantly improved over time in both conditions. Path analysis did not show any indirect effects via social bonding of Condition on health and well-being. However, higher collective-bonding at timepoint 3 significantly predicted increased flourishing, reduced anxiety and improved physical health independently of baseline levels. In contrast, relational-bonding showed no such effects, suggesting that it is feeling part of a group that particularly yields health and well-being benefits. Moreover, these results indicate that singing may not improve health and well-being more than other types of activities. Nonetheless, these findings encourage further work to refine our understanding of the social aspects of community-based adult education classes in promoting health, well-being and community cohesion.
Casadevall, Arturo; Fang, Ferric C
As the body of scientific knowledge in a discipline increases, there is pressure for specialization. Fields spawn subfields that then become entities in themselves that promote further specialization. The process by which scientists join specialized groups has remarkable similarities to the guild system of the middle ages. The advantages of specialization of science include efficiency, the establishment of normative standards, and the potential for greater rigor in experimental research. However, specialization also carries risks of monopoly, monotony, and isolation. The current tendency to judge scientific work by the impact factor of the journal in which it is published may have roots in overspecialization, as scientists are less able to critically evaluate work outside their field than before. Scientists in particular define themselves through group identity and adopt practices that conform to the expectations and dynamics of such groups. As part of our continuing analysis of issues confronting contemporary science, we analyze the emergence and consequences of specialization in science, with a particular emphasis on microbiology, a field highly vulnerable to balkanization along microbial phylogenetic boundaries, and suggest that specialization carries significant costs. We propose measures to mitigate the detrimental effects of scientific specialism.
... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Special award conditions. 49.14 Section 49.14 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED... applicant or recipient has a history of poor performance, is not financially stable, has a management system...
Hussey, Peter S.; Ringel, Jeanne S.; Ahluwalia, Sangeeta; Price, Rebecca Anhang; Buttorff, Christine; Concannon, Thomas W.; Lovejoy, Susan L.; Martsolf, Grant R.; Rudin, Robert S.; Schultz, Dana; Sloss, Elizabeth M.; Watkins, Katherine E.; Waxman, Daniel; Bauman, Melissa; Briscombe, Brian
The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the Department of Veterans Affairs (VA) current and projected health care capabilities and resources. An examination of data from a variety of sources, along with a survey of VA medical faci...
A special manifold is an allowed target manifold for the vector multiplets of D=4, N=2 supergravity. These manifolds are of interest for string theory because the moduli spaces of Calabi-Yau threefolds and c=9, (2,2) conformal field theories are special. Previous work has given a local, coordinate-dependent characterization of special geometry. A global description of special geometries is given herein, and their properties are studied. A special manifold M of complex dimension n is characterized by the existence of a holomorphic Sp(2n+2,R)xGL(1,C) vector bundle over M with a nowhere-vanishing holomorphic section Ω. The Kaehler potential on M is the logarithm of the Sp(2n+2,R) invariant norm of Ω. (orig.)
This article examines the disability compensation programs and health care system of the Department of Veterans Affairs (VA) from the perspective of therapeutic jurisprudence scholarship. VA psychiatric patients have unambiguous financial incentives to endlessly litigate disability claims, to seek lengthy hospitalization rather than outpatient treatment, and to be ill, disabled, and unemployed. These countertherapeutic incentives reward incapacitation, encourage perceiving one-self as sick, diminish personal responsibility, taint treatment relationships, and lead to disparaging perceptions of VA patients. In addition, such perceptions produce moral dilemmas that arise from mutual distrust and frustration when patients and caregivers have antagonistic goals for the clinical encounter. Changes in disability determination procedures, compensation levels, and patterns of payment for treatment could give VA patients and caregivers a "healthier" health care system that encourages personal responsibility and promotes respectful attitudes toward patients. In the absence of such changes, an awareness of countertherapeutic financial incentives can help clinicians distinguish between psychopathological behavior and the pursuit of a rational income strategy, and can help practitioners recognize that apparently deceitful or litigious behavior represents a reasonable response to the economic contingencies that VA patients face.
... MISCELLANEOUS CLAIMS Federal Tort Claims § 14.605 Suits against Department of Veterans Affairs employees arising... damage, personal injury, or death allegedly occurring as a result of malpractice or negligence committed... Health Administration. Accordingly, a malpractice or negligence suit for property damage, personal injury...
Department of Veterans Affairs — My HealtheVet (www.myhealth.va.gov) is a Personal Health Record portal designed to improve the delivery of health care services to Veterans, to promote health and...
It is important to understand and record the impact of therapy on severe mental health conditions through the use of clinical assessment measures. In this article, I propose to extend outcome evaluation by measuring service use and cost prior to and during the commencement of psychological therapy over a period of 4 years for 2 people diagnosed with dissociative identity disorder. The treatment was provided within an outpatient setting in a U.K. National Health Service hospital trust following therapeutic guidelines set out by the International Society for the Study of Trauma and Dissociation. Results show that service use in both inpatient and out-of-hours crisis services reduced as the 2 people received therapy over the 4-year time period. Based on these 2 cases, it appears to be cost effective to provide specialized therapy for dissociative identity disorder in outpatient settings.
Wood, David L; McCaskill, Quimby E; Winterbauer, Nancy; Jobli, Edessa; Hou, Tao; Wludyka, Peter S; Stowers, Kristi; Livingood, William
To assess satisfaction of parents of children with special health care needs with treatment by office staff, communication with the pediatrician, involvement in decision-making and coordination of services outside the practice. We used a mixed-method (qualitative and quantitative) approach to collect parental perceptions of the Medical Home services provided by their pediatricians. Six practices were selected to participate in the study based on geographic and patient demographic characteristics. In total, 262 (75% response rate) families completed surveys, and 28 families of these participated in focus groups. The Family Survey collected information (corroborated and enriched with focus group interviews) on parent and child demographics, severity of the child's condition and the burden on parents. We assessed parental satisfaction with treatment by office staff, communication with the pediatrician, involvement in decision-making, and connection to services outside the practice. Survey responses were analyzed using SAS with all associations considered significant at the P special health care needs. Overall, only a small percentage of families reported being dissatisfied with their treatment by office staff (13-14%), communication with the pediatrician (10%), and involvement in decision-making (15-16%). However, a majority of families (approximately 58%) were dissatisfied with the ability of the pediatrician and his/her office to connect the families with resources outside the pediatric office. Families whose children had more severe conditions, or whose conditions had more of an impact on the families, reported being less satisfied with all aspects of communication and care coordination Families of youth with special health care needs (>12 years of age) were less satisfied than families of younger children with the practice's ability to connect them to resources outside the practice. Both the focus groups and surveys demonstrated that families of children with
Full Text Available ... for Kids With Special Needs Giving Teens a Voice in Health Care Decisions How to Find Affordable Health Care How to Shop for Health Insurance Finding Respite Care for Your Child With Special Needs Special Education: Getting Help for Your Child Words to Know ( ...
Redwood-Campbell, Lynda J; Sekhar, Sharonya N; Persaud, Christine R
Violence against humanitarian health care workers and facilities in situations of armed conflict is a serious humanitarian problem. Targeting health care workers and destroying or looting medical facilities directly or indirectly impacts the delivery of emergency and life-saving medical assistance, often at a time when it is most needed. Attacks may be intentional or unintentional and can take a range of forms from road blockades and check points which delay or block transport, to the direct targeting of hospitals, attacks against medical personnel, suppliers, patients, and armed entry into health facilities. Lack of access to vital health care services weakens the entire health system and exacerbates existing vulnerabilities, particularly among communities of women, children, the elderly, and the disabled, or anyone else in need of urgent or chronic care. Health care workers, especially local workers, are often the target. This report reviews the work being spearheaded by the Red Cross and Red Crescent Movement on the Health Care in Danger initiative, which aims to strengthen the protections for health care workers and facilities in armed conflicts and ensure safe access for patients. This includes a review of internal reports generated from the expert workshops on a number of topics as well as a number of public sources documenting innovative coping mechanisms adopted by National Red Cross and Red Crescent Societies. The work of other organizations is also briefly examined. This is followed by a review of security mechanisms within the humanitarian sector to ensure the safety and security of health care personnel operating in armed conflicts. From the existing literature, a number of gaps have been identified with current security frameworks that need to be addressed to improve the safety of health care workers and ensure the protection and access of vulnerable populations requiring assistance. A way forward for policy, research, and practice is proposed for
Shivakumar, K M; Patil, Snehal; Kadashetti, Vidya; Raje, Vaishali
The individuals suffering from various disabilities form a considerable proportion of the community. The psychological reactions associated with a deformity can be devastating to the disabled, parents, caregivers, and family which often lead to attitudes of hopelessness in the lives of these disabled individuals. To assess the oral health status and treatment needs among 5-12-year-old children attending special school in Western Maharashtra, India. A descriptive cross-sectional study was conducted among 5-12-year-old children attending specials school in Western Maharashtra, India. The study group consisted of 100 children (62 males and 38 females). The oral health status was assessed by using decayed, missing, and filled teeth (DMFT) index, Community Periodontal Index, Dentition status and treatment needs. Information on disability status, intelligent quotient, and systemic diseases were recorded. The mean age of the study population was 9.35 ± 2.92 years. There were 62 (62%) males and 38 (38%) females in the study population. Among the total children examined, 50% of the children were suffering from mental retardation (MR), followed by MR with cerebral palsy (20%). The overall mean decayed and filled teeth and DMFT scores were 3.53 ± 1.02 and 3.89 ± 1.30, respectively, and decayed component had the highest score in both the groups. A statistically significant difference has been observed among the gender ( P < 0.001). There is a high proportion of dental treatment needs required for these children which reflect the barriers to access and utilize oral health care among these children. As dentist, we should emphasize on health education, periodic recall, and monitoring among these individuals.
Full Text Available Abstract Background Evaluating complex interventions in health services faces various difficulties, such as making practice changes and costs. Ways to increase research capacity and decrease costs include making research an integral part of health services and using routine data to judge outcomes. The purpose of this article is to report the feasibility of a pilot trial relying solely on routinely collected register data and being based on ordinary health services. Methods The example intervention was education to public health nurses (PHN (childbirth classes to reduce caesarean section rates via pre-delivery considerations of pregnant women. 20 maternity health centers (MHC were paired and of each 10 pairs, one MHC was randomly allocated to an intervention group and the other to a control; 8 pairs with successful intervention were used in the analyses (1601 mothers. The women visiting to the study maternity centers were identified from the Customer Register of Helsinki City. A list of the study women was made using the mother's personal identification number, visit date, the maternity center code, birth date and gestation length. The mode of delivery and health outcomes were retrieved from the Finnish Medical Birth Register (MBR. Process data of the intervention are based on observations, written feedback and questionnaires from PHNs, and project correspondence. Results It took almost two years to establish how to obtain permissions and to actually obtain it for the trial. Obtaining permissions for the customer and outcome data and register linkages was unproblematic and the cluster randomization provided comparable groups. The intervention did not succeed well. Had the main aim of the trial been to cause a change in PHNs behavior, we would have very likely intensified the intervention during the trial. Conclusion Our experiences encourage the use of trials that obtain their outcomes from registers. Changing the behavior of ordinary health