health and home instability among couples in Ibadan, Nigeria. Descriptive survey ... importance of reproductive health education and home stability to health and general ..... extramarital affair in Nepal due to economic factors such as foreign ...
Global Summit on Student Affairs and Services. “We are seeing ... universities in China were offering courses, counselling and professional help. ... Botswana, said mental health issues varied, as students had different needs. ... in the job market, and to cope with academics and adjustment to universities and colleges.
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....
Kazak, A.E.; Bosch, J.; Klonoff, E.A.
With the initiation of this new ongoing special series in Health Psychology on health disparities, we will publish articles that highlight ways in which health psychology can contribute to understanding and ameliorating these disparities. We welcome articles for this new special series and
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.
In this booklet the author states that the health food industry has reached a stage where consumers must be wary of false advertising, misleading labelling devices, and other techniques used by manufacturers attempting to capitalize on the popularity of health foods. Included are nearly two dozen examples of health food products which are…
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)
Bureau of Indian Affairs (Dept. of Interior), Washington, DC.
The first annual report (1979) of the 15-member Bureau of Indian Affairs (BIA) Advisory Committee for Exceptional Children (ACEC) reflects activities, concerns, and recommendations to the Department of the Interior for providing appropriate specialized programs and services for education of the projected 4,506 American Indian and Alaska Native…
Varda, Danielle; Shoup, Jo Ann; Miller, Sara
We explored and analyzed how findings from public affairs research can inform public health research and practice, specifically in the area of interorganizational collaboration, one of the most promising practice-based approaches in the public health field. We conducted a systematic review of the public affairs literature by following a grounded theory approach. We coded 151 articles for demographics and empirical findings (n = 258). Three primary findings stand out in the public affairs literature: network structure affects governance, management strategies exist for administrators, and collaboration can be linked to outcomes. These findings are linked to priorities in public health practice. Overall, we found that public affairs has a long and rich history of research in collaborations that offers unique organizational theory and management tools to public health practitioners.
Dhanda Patil, Reena; Patil, Yash J
(1) To determine the presence of Veterans Affairs (VA) institutional guidelines for the perioperative management of obstructive sleep apnea (OSA); (2) to examine current use of preoperative screening tools for OSA in the VA; and (3) to understand current VA practice patterns regarding postoperative disposition of patients with OSA. Survey study. Veterans Affairs hospitals with surgical services; sample size 102 facilities. Veterans Affairs health care providers. The authors surveyed health care providers at VA hospitals using a survey tool developed by the authors. The response rate was 80%. A variety of preoperative screening tools for OSA were used by respondents, most commonly American Society of Anesthesiologists guidelines (53%). A policy for postoperative disposition of known and presumed OSA was present in 26% and 19% of responses, respectively. Of those respondents reporting a formal postoperative care policy, 48% and 30% admitted patients to a monitored ward bed and surgical intensive care unit, respectively. Of the 74% of respondents unaware of an institutional policy, Anesthesia and Surgery worked together to dictate postoperative disposition of patients with known OSA 73% of the time. The degree of OSA was ranked as the most important factor (58%) influencing postoperative disposition. Ten percent of respondents reported a major perioperative complication attributable to OSA in the past year. This survey study elucidates the heterogeneity of preoperative screening for and postoperative care of veterans with OSA. Future investigators may use these data to formalize institutional policies with regard to patients with OSA, with potentially significant impacts on patient care and usage of financial resources.
Nieuwsma, Jason A; Rhodes, Jeffrey E; Jackson, George L; Cantrell, William C; Lane, Marian E; Bates, Mark J; Dekraai, Mark B; Bulling, Denise J; Ethridge, Keith; Drescher, Kent D; Fitchett, George; Tenhula, Wendy N; Milstein, Glen; Bray, Robert M; Meador, Keith G
Chaplains play important roles in caring for Veterans and Service members with mental health problems. As part of the Department of Veterans Affairs (VA) and Department of Defense (DoD) Integrated Mental Health Strategy, we used a sequential approach to examining intersections between chaplaincy and mental health by gathering and building upon: 1) input from key subject matter experts; 2) quantitative data from the VA / DoD Chaplain Survey (N = 2,163; response rate of 75% in VA and 60% in DoD); and 3) qualitative data from site visits to 33 VA and DoD facilities. Findings indicate that chaplains are extensively involved in caring for individuals with mental health problems, yet integration between mental health and chaplaincy is frequently limited due to difficulties between the disciplines in establishing familiarity and trust. We present recommendations for improving integration of services, and we suggest key domains for future research.
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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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.
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...
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.
Nieuwsma, Jason A; Jackson, George L; DeKraai, Mark B; Bulling, Denise J; Cantrell, William C; Rhodes, Jeffrey E; Bates, Mark J; Ethridge, Keith; Lane, Marian E; Tenhula, Wendy N; Batten, Sonja V; Meador, Keith G
Recognizing that clergy and spiritual care providers are a key part of mental health care systems, the Department of Veterans Affairs (VA) and Department of Defense (DoD) jointly examined chaplains' current and potential roles in caring for veterans and service members with mental health needs. Our aim was to evaluate the intersection of chaplain and mental health care practices in VA and DoD in order to determine if improvement is needed, and if so, to develop actionable recommendations as indicated by evaluation findings. A 38-member multidisciplinary task group partnered with researchers in designing, implementing, and interpreting a mixed methods study that included: 1) a quantitative survey of VA and DoD chaplains; and 2) qualitative interviews with mental health providers and chaplains. Quantitative: the survey included all full-time VA chaplains and all active duty military chaplains (n = 2,163 completed of 3,464 invited; 62 % response rate). Qualitative: a total of 291 interviews were conducted with mental health providers and chaplains during site visits to 33 VA and DoD facilities. Quantitative: the online survey assessed intersections between chaplaincy and mental health care and took an average of 37 min to complete. Qualitative: the interviews assessed current integration of mental health and chaplain services and took an average of 1 h to complete. When included on interdisciplinary mental health care teams, chaplains feel understood and valued (82.8-100 % of chaplains indicated this, depending on the team). However, findings from the survey and site visits suggest that integration of services is often lacking and can be improved. Closely coordinating with a multidisciplinary task group in conducting a mixed method evaluation of chaplain-mental health integration in VA and DoD helped to ensure that researchers assessed relevant domains and that findings could be rapidly translated into actionable recommendations.
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
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...
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.
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
Bureau of Indian Affairs (Dept. of Interior), Washington, DC.
The report describes 1980-81 meetings and efforts of the Bureau of Indian Affairs (BIA) Advisory Committee for Exceptional Children. Proceedings of three meetings are summarized in Part I. Part II analyzes the Department of Interior/BIA state plans for fiscal years 1980-3. The section lists comments and recommendations for such aspects as the…
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).
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.
Byrne, Colene M; Mercincavage, Lauren M; Pan, Eric C; Vincent, Adam G; Johnston, Douglas S; Middleton, Blackford
We compare health information technology (IT) in the Department of Veterans Affairs (VA) to norms in the private sector, and we estimate the costs and benefits of selected VA health IT systems. The VA spent proportionately more on IT than the private health care sector spent, but it achieved higher levels of IT adoption and quality of care. The potential value of the VA's health IT investments is estimated at $3.09 billion in cumulative benefits net of investment costs. This study serves as a framework to inform efforts to measure and calculate the benefits of federal health IT stimulus programs.
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.
Cox, Robyn M; Alexander, Genevieve C; Gray, Ginger A
In hearing aid research, it is commonplace to combine data across subjects whose hearing aids were provided in different service delivery models. There is reason to question whether these types of patients are always similar enough to justify this practice. To explore this matter, this investigation evaluated similarities and differences in self-report data obtained from hearing aid patients derived from public health (Veterans Affairs, VA) and private practice (PP) settings. The study was a multisite, cross-sectional survey in which 230 hearing aid patients from VA and PP audiology clinic settings provided self-report data on a collection of questionnaires both before and after the hearing aid fitting. Subjects were all older adults with mild to moderately severe hearing loss. About half of them had previous experience wearing hearing aids. All subjects were fitted with wide-dynamic-range-compression instruments and received similar treatment protocols. Numerous statistically significant differences were observed between the VA and PP subject groups. Before the fitting, VA patients reported higher expectations from the hearing aids and more severe unaided problems compared with PP patients with similar audiograms. Three wks after the fitting, VA patients reported more satisfaction with their hearing aids. On some measures VA patients reported more benefit, but different measures of benefit did not give completely consistent results. Both groups reported using the hearing aids an average of approximately 8 hrs per day. VA patients reported age-normal physical and mental health, but PP patients tended to report better than typical health for their age group. These data indicate that hearing aid patients seen in the VA public health hearing services are systematically different in self-report domains from those seen in private practice services. It is therefore risky to casually combine data from these two types of subjects or to generalize research results from one
Landguth, David C
... of terrorism and natural disasters. Understanding the deficiencies that exist by public health specialization, and identifying the knowledge base required for each specialization will help the United States to meet its future...
Cruz, Jennifer L; Brown, Jamie N
Rigorous practices for safe dispensing of investigational drugs are not standardized. This investigation sought to identify error-prevention processes utilized in the provision of investigational drug services (IDS) and to characterize pharmacists' perceptions about safety risks posed by investigational drugs. An electronic questionnaire was distributed to an audience of IDS pharmacists within the Veteran Affairs Health System. Multiple facets were examined including demographics, perceptions of medication safety, and standard processes used to support investigational drug protocols. Twenty-one respondents (32.8% response rate) from the Northeast, Midwest, South, West, and Non-contiguous United States participated. The mean number of pharmacist full-time equivalents (FTEs) dedicated to the IDS was 0.77 per site with 0.2 technician FTEs. The mean number of active protocols was 22. Seventeen respondents (81%) indicated some level of concern for safety risks. Concerns related to the packaging of medications were expressed, most notably lack of product differentiation, expiration dating, barcodes, and choice of font size or color. Regarding medication safety practices, the majority of sites had specific procedures in place for storing and securing drug supply, temperature monitoring, and prescription labeling. Repackaging bulk items and proactive error-identification strategies were less common. Sixty-seven percent of respondents reported that an independent double check was not routinely performed. Medication safety concerns exist among pharmacists in an investigational drug service; however, a variety of measures have been employed to improve medication safety practices. Best practices for the safe dispensing of investigational medications should be developed in order to standardize these error-prevention strategies.
Harrod, Molly; Manojlovich, Milisa; Kowalski, Christine P; Saint, Sanjay; Krein, Sarah L
Health care-associated infection (HAI) is costly to hospitals and potentially life-threatening to patients. Numerous infection prevention programs have been implemented in hospitals across the United States. Yet, little is known about infection prevention practices and implementation in rural hospitals. The purpose of this study was to understand the infection prevention practices used by rural Veterans' Affairs (VA) hospitals and the unique factors they face in implementing these practices. This study used a sequential, mixed methods approach. Survey data to identify the HAI prevention practices used by rural VA hospitals were collected, analyzed, and used to inform the development of a semistructured interview guide. Phone interviews were conducted followed by site visits to rural VA hospitals. We found that most rural VA hospitals were using key recommended infection prevention practices. Nonetheless, a number of challenges with practice implementation were identified. The 3 most prominent themes were: (1) lack of human capital including staff with HAI expertise; (2) having to cultivate needed resources; and (3) operating as a system within a system. Rural VA hospitals are providing key infection prevention services to ensure a safe environment for the veterans they serve. However, certain factors, such as staff expertise, limited resources, and local context impacted how and when these practices were used. The creative use of more accessible alternative resources as well as greater flexibility in implementing HAI-related initiatives may be important strategies to further improve delivery of these important services by rural VA hospitals. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.
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 statistic 0.72) and of post-traumatic stress disorder with pain interfering with work (OR 3.9, CI 1.1-13.6, p statistic 0.75). A health assessment survey identified priority areas to inform targeted health promotion for 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.
Bogataj Ivančič, Petra
The purpose of the thesis was to investigate the health of special education teachers who teach in elementary special schools with lower educational standards in the Central Slovenia region. 89 special education teachers participated in the study, average age 37 years. Data were collected in 2013 through a questionnaire, which was summarized and organized according to the needs of the study from questionnaires Health-related behavioral style (CINDI Slovenia, 2008) and Stress profile questionn...
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
the career field and the tax: Student-Transient-Prisoner/Patient ( STP ), Special Duty, and Outside. o STP : The Army equivalent of this Air Force...patterns due to their highly marketable skills which can be transferred to another form of public service (e.g., inter-Service transfer) or are in high... STP , and developmental opportunities (primarily special duties). The inventory identifies categories indicating skill availability (“Not Fully
...: (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 ...
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
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.
Newins, Amie R; Wilson, Sarah M; Hopkins, Tiffany A; Straits-Troster, Kristy; Kudler, Harold; Calhoun, Patrick S
The study investigated barriers to the utilization of Veterans Affairs (VA) health care services among female veterans who served in served in Iraq and Afghanistan, including reasons for not choosing VA health care, reasons for not seeking mental health treatment, and types of desired VA services. Female respondents to a survey assessing Operation Enduring Freedom/Operation Iraqi Freedom veterans' needs and health (N = 186) completed measures of military history, posttraumatic stress disorder, depression, barriers to VA health care, and preferences for services. Barriers to use of VA health care endorsed by female veterans included receiving care elsewhere and logistical issues. Barriers to utilization of mental health services among female veterans who screened positive for depression or posttraumatic stress disorder included negative treatment biases and concerns about stigma, privacy, and cost. Female veterans endorsed preferences for services related to eligibility education, nonprimary care physical health services, vocational assistance, and a few behavioral/mental health services. Findings highlight the need for ongoing outreach and education regarding eligibility and types of resources for physical and mental health problems experienced by female veterans who served in Iraq and Afghanistan, as well as inform types of VA programming and services desired by female veterans. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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.
Bevans, Katherine B.; Riley, Anne W.; Crespo, Richard; Louis, Thomas A.
OBJECTIVE: 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. PARTICIPANTS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. PMID:21788226
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.
Wagner, Todd H; Sinnott, Patricia; Siroka, Andrew M
This study analyzed spending for treatment of mental health and substance use disorders in the Department of Veterans Affairs (VA) in fiscal years (FYs) 2000 through 2007. VA spending as reported in the VA Decision Support System was linked to patient utilization data as reported in the Patient Treatment Files, the National Patient Care Database, and the VA Fee Basis files. All care and costs from FY 2000 to FY 2007 were analyzed. Over the study period the number of veterans treated at the VA increased from 3.7 million to over 5.1 million (an average increase of 4.9% per year), and costs increased .7% per person per year. For mental health and substance use disorder treatment, the volume of inpatient care decreased markedly, residential care increased, and spending decreased on average 2% per year (from $668 in FY 2000 to $578 per person in FY 2007). FY 2007 saw large increases in mental health spending, bucking the trend from FY 2000 through FY 2006. VA's continued emphasis on outpatient and residential care was evident through 2007. This trend in spending might be unimpressive if VA were enrolling healthier Veterans, but the opposite seems to be true: over this time period the prevalence of most chronic conditions, including depression and posttraumatic stress disorder, increased. VA spending on mental health care grew rapidly in 2007, and given current military activities, this trend is likely to increase.
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
Wyne, Amjad; Hammad, Nouf; Splieth, Christian
Objective: To determine the oral health knowledge of health care workers in special children?s center. Methods: A self-administered questionnaire was used to collect following information: demographics, oral hygiene practices, importance of fluoride, dental visits, cause of tooth decay, gingival health, and sources of oral health information. The study was conducted at Riyadh Center for Special Children in Riyadh City from December 2013 to May 2014. Results: All 60 health care workers in the ...
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.
Brandt, Cynthia A.; Skanderson, Melissa; Justice, Amy C.; Shahrir, Shahida; Butt, Adeel A.; Brown, Sheldon T.; Freiberg, Matthew S.; Gibert, Cynthia L.; Goetz, Matthew Bidwell; Kim, Joon Woo; Pisani, Margaret A.; Rimland, David; Rodriguez-Barradas, Maria C.; Sico, Jason J.; Tindle, Hilary A.; Crothers, Kristina
Introduction: We assessed smoking data from the Veterans Health Administration (VHA) electronic medical record (EMR) Health Factors dataset. Methods: To assess the validity of the EMR Health Factors smoking data, we first created an algorithm to convert text entries into a 3-category smoking variable (never, former, and current). We compared this EMR smoking variable to 2 different sources of patient self-reported smoking survey data: (a) 6,816 HIV-infected and -uninfected participants in the 8-site Veterans Aging Cohort Study (VACS-8) and (b) a subset of 13,689 participants from the national VACS Virtual Cohort (VACS-VC), who also completed the 1999 Large Health Study (LHS) survey. Sensitivity, specificity, and kappa statistics were used to evaluate agreement of EMR Health Factors smoking data with self-report smoking data. Results: For the EMR Health Factors and VACS-8 comparison of current, former, and never smoking categories, the kappa statistic was .66. For EMR Health Factors and VACS-VC/LHS comparison of smoking, the kappa statistic was .61. Conclusions: Based on kappa statistics, agreement between the EMR Health Factors and survey sources is substantial. Identification of current smokers nationally within the VHA can be used in future studies to track smoking status over time, to evaluate smoking interventions, and to adjust for smoking status in research. Our methodology may provide insights for other organizations seeking to use EMR data for accurate determination of smoking status. PMID:21911825
Utz, Rebecca L; Berg, Cynthia A; Butner, Jonathan
One's health and aging cannot be uncoupled from the family system in which it occurs. Not only do families provide genetic material that determines major health risks and outcomes, families also share a culture, environment, and lifestyle that further influence health and aging trajectories. As well, family members are interconnected, so that an illness or a positive lifestyle change in one person can have reverberating effects on the health and well-being of others in the family system. This essay explores how families have the potential to both promote and threaten individual health and well-being, thereby influencing how an individual might age or experience later life. Weaving together personal biographies from three different authors, this essay provides specific examples of how the family affects the health and aging of individuals and how the health and aging of individuals affect the larger family unit. These dynamic processes have the potential to positively or negatively shape individual experiences of health and aging, even among those persons who are not yet in late life. This essay blends a developmental life course perspective with a dynamic family-systems approach to show how families engage in collaborative efforts throughout the life course, in which they both affect and are affected by the diagnosis and management of chronic diseases and the adoption of health promoting behaviors. Applying this perspective to the study of health and aging calls for interdisciplinary thinking, as well as novel methodological and quantitative solutions. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: email@example.com.
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.
Department of Veterans Affairs — Strategic Analytics for Improvement and Learning Value Model or SAIL, is a system for summarizing hospital system performance within Veterans Health Administration...
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.
Durieux-Paillard, S; Dao, M Dominicé; Perron, N Junod
When consulting with migrant patients, general practitioners should pay special attention to the quality of their communication, because language barriers and cultural differences may arise. They must also be aware that life events experienced in the home country, during transit and in the host country can impact negatively on their patients' health, and thus a detailed history must be carefully obtained. Finally, they must be conscious that the migratory policies of the host country can influence the delivery of health care to migrant patients as well as their health status.
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…
.... 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.
AGU public affairs will be cohosting two special events at Ocean Sciences 2012 that offer scientists opportunities to expand their communication, policy, and media experience. Join the conversations that highlight two important topics to connect science to society.
Hausmann, Leslie R M; Brandt, Cynthia A; Carroll, Constance M; Fenton, Brenda T; Ibrahim, Said A; Becker, William C; Burgess, Diana J; Wandner, Laura D; Bair, Matthew J; Goulet, Joseph L
To examine black-white and Hispanic-white differences in total knee arthroplasty from 2001 to 2013 in a large cohort of patients diagnosed with osteoarthritis (OA) in the Veterans Affairs (VA) health care system. Data were from the VA Musculoskeletal Disorders cohort, which includes data from electronic health records of more than 5.4 million veterans with musculoskeletal disorders diagnoses. We included white (non-Hispanic), black (non-Hispanic), and Hispanic (any race) veterans, age ≥50 years, with an OA diagnosis from 2001-2011 (n = 539,841). Veterans were followed from their first OA diagnosis until September 30, 2013. As a proxy for increased clinical severity, analyses were also conducted for a subsample restricted to those who saw an orthopedic or rheumatology specialist (n = 148,844). We used Cox proportional hazards regression to examine racial and ethnic differences in total knee arthroplasty by year of OA diagnosis, adjusting for age, sex, body mass index, physical and mental diagnoses, and pain intensity scores. We identified 12,087 total knee arthroplasty procedures in a sample of 473,170 white, 50,172 black, and 16,499 Hispanic veterans. In adjusted models examining black-white and Hispanic-white differences by year of OA diagnosis, total knee arthroplasty rates were lower for black than for white veterans diagnosed in all but 2 years. There were no Hispanic-white differences regardless of when diagnosis occurred. These patterns held in the specialty clinic subsample. Black-white differences in total knee arthroplasty appear to be persistent in the VA, even after controlling for potential clinical confounders. © 2016, American College of Rheumatology.
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.
Yu, Albert Cheung-Hoi; Vatcher, Greg; Yue, Xin; Dong, Yan; Li, Mao Hua; Tam, Patrick H K; Tsang, Parker Y L; Wong, April K Y; Hui, Michael H K; Yang, Bin; Tang, Hao; Lau, Lok-Ting
Infectious diseases, mostly caused by bacteria and viruses but also a result of fungal and parasitic infection, have been one of the most important public health concerns throughout human history. The first step in combating these pathogens is to get a timely and accurate diagnosis at an affordable cost. Many kinds of diagnostics have been developed, such as pathogen culture, biochemical tests and serological tests, to help detect and fight against the causative agents of diseases. However, these diagnostic tests are generally unsatisfactory because they are not particularly sensitive and specific and are unable to deliver speedy results. Nucleic acid-based diagnostics, detecting pathogens through the identification of their genomic sequences, have shown promise to overcome the above limitations and become more widely adopted in clinical tests. Here we review some of the most popular nucleic acid-based diagnostics and focus on their adaptability and applicability to routine clinical usage. We also compare and contrast the characteristics of different types of nucleic acid-based diagnostics.
Crowley, Susan T; Chertow, Glenn M; Vitale, Joseph; O'Connor, Theresa; Zhang, Jane; Schein, Roland M H; Choudhury, Devasmita; Finkel, Kevin; Vijayan, Anitha; Paganini, Emil; Palevsky, Paul M
Design elements of clinical trials can introduce recruitment bias and reduce study efficiency. Trials involving the critically ill may be particularly prone to design-related inefficiencies. Enrollment into the Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network Study was systematically monitored. Reasons for nonenrollment into this study comparing strategies of renal replacement therapy in critically ill patients with acute kidney injury were categorized as modifiable or nonmodifiable. 4339 patients were screened; 2744 fulfilled inclusion criteria. Of these, 1034 were ineligible by exclusion criteria. Of the remaining 1710 patients, 1124 (65.7%) enrolled. Impediments to informed consent excluded 21.4% of potentially eligible patients. Delayed identification of potential patients, physician refusal, and involvement in competing trials accounted for 4.4, 2.7, and 2.3% of exclusions. Comfort measures only status, chronic illness, chronic kidney disease, and obesity excluded 11.8, 7.8, 7.6, and 5.9% of potential patients. Modification of an enrollment window reduced the loss of patients from 6.6 to 2.3%. The Acute Renal Failure Trial Network Study's enrollment efficiency compared favorably with previous intensive care unit intervention trials and supports the representativeness of its enrolled population. Impediments to informed consent highlight the need for nontraditional acquisition methods. Restrictive enrollment windows may hamper recruitment but can be effectively modified. The low rate of physician refusal acknowledges clinical equipoise in the study design. Underlying comorbidities are important design considerations for future trials that involve the critically ill with acute kidney injury.
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.
O'Neil, Joseph; Hoffman, Benjamin D
School systems are responsible for ensuring that children with special needs are safely transported on all forms of federally approved transportation provided by the school system. A plan to provide the most current and proper support to children with special transportation needs should be developed by the Individualized Education Program team, including the parent, school transportation director, and school nurse, in conjunction with physician orders and recommendations. With this statement, we provide current guidance for the protection of child passengers with specific health care needs. Guidance that applies to general school transportation should be followed, inclusive of staff training, provision of nurses or aides if needed, and establishment of a written emergency evacuation plan as well as a comprehensive infection control program. Researchers provide the basis for recommendations concerning occupant securement for children in wheelchairs and children with other special needs who are transported on a school bus. Pediatricians can help their patients by being aware of guidance for restraint systems for children with special needs and by remaining informed of new resources. Pediatricians can also play an important role at the state and local level in the development of school bus specifications. Copyright © 2018 by the American Academy of Pediatrics.
Castillo, Linda G; Schwartz, Seth J
This article provides an introduction to the special issue on college student mental health. It gives an overview of the establishment of the Multi-Site University Study of Identity and Culture (MUSIC) collaborative by a group of national experts on culture and identity. Information about the procedures used to collect a nationally represented sample of college students are provided. Data were collected from 30 university sites across the United States. The sample comprised 10,573 undergraduate college students, of which 73% were women, 63% White, 9% African American/Black, 14% Latino/Hispanic, 13% Asian American, and 1% Other. The special issue comprises a compilation of 8 studies that used the dataset specifically created to examine the issues of emerging adults, culture, and identity. Student mental health problems are a growing concern on college campuses. Studies covered in this special issue have implications for policy development regarding college alcohol use and traumatic victimization, include attention to underrepresented minority and immigrant groups on college campuses, and focus on positive as well as pathological aspects of the college experience. © 2013 Wiley Periodicals, Inc.
Horne, L Chad
While citizens in a liberal democracy are generally expected to see to their basic needs out of their own income shares, health care is treated differently. Most rich liberal democracies provide their citizens with health care or health care insurance in kind. Is this "special" treatment justified? The predominant liberal account of justice in health care holds that the moral importance of health justifies treating health care as special in this way. I reject this approach and offer an alternative account. Health needs are not more important than other basic needs, but they are more unpredictable. I argue that citizens are owed access to insurance against health risks to provide stability in their future expectations and thus to protect their capacities for self-determination.
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.
Samuel, Cleo A; Landrum, Mary Beth; McNeil, Barbara J; Bozeman, Samuel R; Williams, Christina D; Keating, Nancy L
We assessed cancer care disparities within the Veterans Affairs (VA) health care system and whether between-hospital differences explained disparities. We linked VA cancer registry data with VA and Medicare administrative data and examined 20 cancer-related quality measures among Black and White veterans diagnosed with colorectal (n = 12,897), lung (n = 25,608), or prostate (n = 38,202) cancer from 2001 to 2004. We used logistic regression to assess racial disparities for each measure and hospital fixed-effects models to determine whether disparities were attributable to between- or within-hospital differences. Compared with Whites, Blacks had lower rates of early-stage colon cancer diagnosis (adjusted odds ratio [AOR] = 0.80; 95% confidence interval [CI] = 0.72, 0.90), curative surgery for stage I, II, or III rectal cancer (AOR = 0.57; 95% CI = 0.41, 0.78), 3-year survival for colon cancer (AOR = 0.75; 95% CI = 0.62, 0.89) and rectal cancer (AOR = 0.61; 95% CI = 0.42, 0.87), curative surgery for early-stage lung cancer (AOR = 0.50; 95% CI = 0.41, 0.60), 3-dimensional conformal or intensity-modulated radiation (3-D CRT/IMRT; AOR = 0.53; 95% CI = 0.47, 0.59), and potent antiemetics for highly emetogenic chemotherapy (AOR = 0.87; 95% CI = 0.78, 0.98). Adjustment for hospital fixed-effects minimally influenced racial gaps except for 3-D CRT/IMRT (AOR = 0.75; 95% CI = 0.65, 0.87) and potent antiemetics (AOR = 0.95; 95% CI = 0.82, 1.10). Disparities in VA cancer care were observed for 7 of 20 measures and were primarily attributable to within-hospital differences.
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.
Koenig, Kristi L
The terrorist attacks of 11 September 2001 led to the largest US Government transformation since the formation of the Department of Defense following World War II. More than 22 different agencies, in whole or in part, and >170,000 employees were reorganized to form a new Cabinet-level Department of Homeland Security (DHS), with the primary mission to protect the American homeland. Legislation enacted in November 2002 transferred the entire Federal Emergency Management Agency and several Department of Health and Human Services (HHS) assets to DHS, including the Office of Emergency Response, and oversight for the National Disaster Medical System, Strategic National Stockpile, and Metropolitan Medical Response System. This created a potential separation of "health" and "medical" assets between the DHS and HHS. A subsequent presidential directive mandated the development of a National Incident Management System and an all-hazard National Response Plan. While no Department of Veterans Affairs (VA) assets were targeted for transfer, the VA remains the largest integrated healthcare system in the nation with important support roles in homeland security that complement its primary mission to provide care to veterans. The Emergency Management Strategic Healthcare Group (EMSHG) within the VA's medical component, the Veteran Health Administration (VHA), is the executive agent for the VA's Fourth Mission, emergency management. In addition to providing comprehensive emergency management services to the VA, the EMSHG coordinates medical back-up to the Department of Defense, and assists the public via the National Disaster Medical System and the National Response Plan. This article describes the VA's role in homeland security and disasters, and provides an overview of the ongoing organizational and operational changes introduced by the formation of the new DHS. Challenges and opportunities for public health are highlighted.
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.
Higgins, Stephen T
This Special Issue of Preventive Medicine (PM) is the 3rd that we have organized on behavior change, health, and health disparities. This is a topic of critical importance to improving U.S. population health. There is broad scientific consensus that personal behaviors such as cigarette smoking, other substance abuse, and physical inactivity/obesity are among the most important modifiable causes of chronic disease and its adverse impacts on population health. Hence, effectively promoting health-related behavior change needs to be a key component of health care research and policy. There is also broad recognition that while these problems extend throughout the population, they 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 curtailing health disparities, which receives special attention in this 3rd Special Issue. We also devote considerable space to the longstanding challenges of reducing cigarette smoking and use of other tobacco and nicotine delivery products in vulnerable populations, obesity, and for the first time food insecurity. Across each of these topics we include contributions from highly accomplished policymakers and scientists to acquaint readers with recent accomplishments as well as remaining knowledge gaps and challenges. Copyright © 2016 Elsevier Inc. All rights reserved.
Wyne, Amjad; Hammad, Nouf; Splieth, Christian
To determine the oral health knowledge of health care workers in special children's center. A self-administered questionnaire was used to collect following information: demographics, oral hygiene practices, importance of fluoride, dental visits, cause of tooth decay, gingival health, and sources of oral health information. The study was conducted at Riyadh Center for Special Children in Riyadh City from December 2013 to May 2014. All 60 health care workers in the center completed the questionnaire. A great majority (95%) of the workers brushed their teeth twice or more daily. More than two-third (71.7%) of the workers knew that fluoride helps in caries prevention. One in five (21.7%) workers thought that a dental visit only becomes necessary in case of a dental problem. Similarly, 13.3% of the workers thought to "wait till there is some pain in case of a dental cavity" before seeking dental treatment. The workers ranked soft drinks/soda (98.3%), flavored fizzy drinks (60%) and sweetened/flavored milks (43.3%) as top three cariogenic drinks. A great majority (95%) of the workers correctly responded that blood on toothbrush most probably is a sign of "gum disease". Dentists (50%) and media (45%) were the main source of their oral health information. There was no significant difference (p > 0.05) in workers' response in relation to their specific job. The special health care workers in the disabled children's center generally had satisfactory oral health knowledge and practices.
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.
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...
Organisation for Economic Cooperation and Development, Paris (France).
Conclusions are presented indicating the role which public bodies, employers, trade unions, and other private groups can play in improving the employment opportunities of special groups, such as older workers, workers with family responsibilities, and workers of rural origin engaged in non-agricultural employment. Because of the increasing number…
Seal, Karen H; Bertenthal, Daniel; Miner, Christian R; Sen, Saunak; Marmar, Charles
Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) have endured high combat stress and are eligible for 2 years of free military service-related health care through the Department of Veterans Affairs (VA) health care system, yet little is known about the burden and clinical circumstances of mental health diagnoses among OEF/OIF veterans seen at VA facilities. US veterans separated from OEF/OIF military service and first seen at VA health care facilities between September 30, 2001 (US invasion of Afghanistan), and September 30, 2005, were included. Mental health diagnoses and psychosocial problems were assessed using International Classification of Diseases, Ninth Revision, Clinical Modification codes. The prevalence and clinical circumstances of and subgroups at greatest risk for mental health disorders are described herein. Of 103 788 OEF/OIF veterans seen at VA health care facilities, 25 658 (25%) received mental health diagnosis(es); 56% of whom had 2 or more distinct mental health diagnoses. Overall, 32 010 (31%) received mental health and/or psychosocial diagnoses. Mental health diagnoses were detected soon after the first VA clinic visit (median of 13 days), and most initial mental health diagnoses (60%) were made in nonmental health clinics, mostly primary care settings. The youngest group of OEF/OIF veterans (age, 18-24 years) were at greatest risk for receiving mental health or posttraumatic stress disorder diagnoses compared with veterans 40 years or older. Co-occurring mental health diagnoses and psychosocial problems were detected early and in primary care medical settings in a substantial proportion of OEF/OIF veterans seen at VA facilities. Targeted early detection and intervention beginning in primary care settings are needed to prevent chronic mental illness and disability.
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 ...
Higgins, Stephen T
This Special Issue of Preventive Medicine (PM) is the 2nd that we have organized on behavior change, health, and health disparities. This is a topic of fundamental importance to improving population health in the U.S. and other industrialized countries that are trying to more effectively manage chronic health conditions. There is broad scientific consensus that personal behavior patterns such as cigarette smoking, other substance abuse, and physical inactivity/obesity are among the most important modifiable causes of chronic disease and its adverse impacts on population health. As such behavior change needs to be a key component of improving population health. There is also broad agreement that while these problems extend across socioeconomic strata, they are overrepresented among more economically disadvantaged populations and contribute directly to the growing problem of health disparities. Hence, behavior change represents an essential step in curtailing that unsettling problem as well. In this 2nd Special Issue, we devote considerable space to the current U.S. prescription opioid addiction epidemic, a crisis that was not addressed in the prior Special Issue. We also continue to devote attention to the two largest contributors to preventable disease and premature death, cigarette smoking and physical inactivity/obesity as well as risks of co-occurrence of these unhealthy behavior patterns. Across each of these topics we included contributions from highly accomplished policy makers and scientists to acquaint readers with recent accomplishments as well as remaining knowledge gaps and challenges to effectively managing these important chronic health problems. Copyright © 2015 Elsevier Inc. All rights reserved.
Wyne, Amjad; Hammad, Nouf; Splieth, Christian
Objective: To determine the oral health knowledge of health care workers in special children’s center. Methods: A self-administered questionnaire was used to collect following information: demographics, oral hygiene practices, importance of fluoride, dental visits, cause of tooth decay, gingival health, and sources of oral health information. The study was conducted at Riyadh Center for Special Children in Riyadh City from December 2013 to May 2014. Results: All 60 health care workers in the center completed the questionnaire. A great majority (95%) of the workers brushed their teeth twice or more daily. More than two-third (71.7%) of the workers knew that fluoride helps in caries prevention. One in five (21.7%) workers thought that a dental visit only becomes necessary in case of a dental problem. Similarly, 13.3% of the workers thought to “wait till there is some pain in case of a dental cavity” before seeking dental treatment. The workers ranked soft drinks/soda (98.3%), flavored fizzy drinks (60%) and sweetened/flavored milks (43.3%) as top three cariogenic drinks. A great majority (95%) of the workers correctly responded that blood on toothbrush most probably is a sign of “gum disease”. Dentists (50%) and media (45%) were the main source of their oral health information. There was no significant difference (p > 0.05) in workers’ response in relation to their specific job. Conclusion: The special health care workers in the disabled children’s center generally had satisfactory oral health knowledge and practices. PMID:25878636
Boyle, Melissa A; Lahey, Joanna N
This paper exploits a major mid-1990s expansion in the U.S. Department of Veterans Affairs health care system to provide evidence on the labor market effects of expanding health insurance availability. Using data from the Current Population Survey, we employ a difference-in-differences strategy to compare the labor market behavior of older veterans and non-veterans before and after the VA health benefits expansion to test the impact of public health insurance on labor supply. We find that older workers are significantly more likely to decrease work both on the extensive and intensive margins after receiving access to non-employer based insurance. Workers with some college education or a college degree are more likely to transition into self-employment, a result consistent with "job-lock" effects. However, less-educated workers are more likely to leave self-employment, a result suggesting that the positive income effect from receiving public insurance dominates the "job-lock" effect for these workers. Some relatively disadvantaged sub-populations may also increase their labor supply after gaining greater access to public insurance, consistent with complementary positive health effects of health care access or decreased work disincentives for these groups. We conclude that this reform has affected employment and retirement decisions, and suggest that future moves toward universal coverage or expansions of Medicare are likely to have significant labor market effects.
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
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.
Montgomery County of Maryland — This dataset contains allegations brought to the attention of the Internal Affairs Division either through external complaints or internal complaint or recognition....
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.
Logan, Robert A; Kreps, Gary L
This article introduces the Journal of Health Communication's special section, Evaluating Health Communication Programs. This special section is based on a public lecture series supported by the National Library of Medicine titled "Better Health: Evaluating Health Communication Programs" designed to share best practices for using evaluation research to develop, implement, refine, and institutionalize the best health communication programs for promoting public health. This introduction provides an overview to the series, summarizes the major presentations in the series, and describe implications from the series for translational health communication research, interventions, and programs that can enhance health outcomes.
guards, exhibit displays and speakers. Learn more about Community Relations Public Queries If you are Guard ARNG Media ARNG Public Affairs Family Services Youth Programs Survivor Services Military Funeral General Officer Management Public Affairs Executive Support Services Legislative Liaison Special Staff
: Public Affairs : Community Relations Community Relations The National Guard Bureau Civic Engagement Report National Commission of the Future of the Army White Papers I am the Guard ARNG Media ARNG Public Public Affairs Executive Support Services Legislative Liaison Special Staff Directorate of Management
Ervasti, Jenni; Kivimaki, Mika; Pentti, Jaana; Salmi, Venla; Suominen, Sakari; Vahtera, Jussi; Virtanen, Marianna
Background: 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…
Sierra, Isabel; Cabezas, Carmen; Brugulat, Pilar; Mompart, Anna
Through the Law 2/2004 on improving neighbourhoods, urban areas and towns requiring special attention, the Government of Catalonia set up a fund for financing projects prepared by town/city councils for the integral improvement of neighbourhoods. The Ministry of Health signed on to the strategy with The Neighbourhood Health Programme, which was a healthcare policy priority. Healthcare and municipal structures cooperate at neighbourhood level in all of the phases of the community intervention project (analysis and detection of needs, prioritisation of the problems detected, definition and distribution of actions). Techniques such as the nominal group are used. Four vulnerable groups have been identified with higher levels of illness, co-morbidity, situations of risk, etc. (the young, the elderly, women and recent immigrants). The actions of all the agents involved, among them those from the Ministry of Health itself, are then intensified and prioritised and a specific portfolio of public health services is prepared.
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
Diehl, Eliana Elisabeth; Langdon, Esther Jean; Dias-Scopel, Raquel Paiva
Indigenous community health workers are part of a strategy developed by Brazil in the last two decades to promote a special healthcare model for indigenous peoples. Their role is designed to deal with various aspects of the special health policy, including the link between the heath team and the community and mediation between scientific and indigenous medical knowledge. Despite a significant increase in the number of indigenous community health workers in recent years, an evaluation of their responsibilities and contributions to the success of special care had not been conducted previously. This article, based on a literature review and original research by the authors, analyzes the role of the indigenous community health workers vis-à-vis their training and participation in health teams in different contexts in Brazil. Considering the importance assigned to the role of indigenous community health workers, this analysis reveals various ambiguities and contradictions that hinder both their performance and their potential contribution to the special health services.
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.
Kiefer, H.; Koelzer, W.
In the Federal Republic of Germany knowledge in health physics is imparted mainly as a supplement training in courses of some days up to a few weeks duration. This may be adequate for strictly defined sectors, although it is not sufficient as to the education of a true health physicist. Already in the early sixties the necessity of such special training was recognized at the Karlsruhe Nuclear Research Center and training was started of 'health physics assistants' as this profession is called. Significant details are given about training, the contributions of the individual training institutions (Karlsruhe Nuclear Research Center, nuclear medical hospital, Euratom institute, S.C.P.R.I.) examinations and subjects examined, experience regarding future employments and activities
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.
Bhavsar, Tina R; Kim, Hye-Joo; Yu, Yon
To provide a general description of the roles and contributions of three pharmacists from the Regulatory Affairs program (RA) at the Centers for Disease Control and Prevention (CDC) who are involved in emergency preparedness and response activities, including the 2009 pandemic influenza A (H1N1) public health emergency. Atlanta, GA. RA consists of a staff of nine members, three of whom are pharmacists. The mission of RA is to support CDC's preparedness and emergency response activities and to ensure regulatory compliance for critical medical countermeasures against potential threats from natural, chemical, biological, radiological, or nuclear events. RA was well involved in the response to the H1N1 outbreak through numerous activities, such as submitting multiple Emergency Use Authorization (EUA) requests to the Food and Drug Administration, including those for medical countermeasures to be deployed from the Strategic National Stockpile, and developing the CDC EUA website (www.cdc.gov/h1n1flu/eua). RA will continue to support current and future preparedness and emergency response activities by ensuring that the appropriate regulatory mechanisms are in place for the deployment of critical medical countermeasures from the Strategic National Stockpile against threats to public health.
Department of Clinical Neuroscience, Section of Psychiatry,. SE-171 77 ... Uganda, both in communities and in health care facilities. Yet very .... mental disorders in the community. The SRQ- ..... of meeting mental health care needs in a timely,.
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 ...
.... 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...
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
Coons, Stephen Joel; Chongpison, Yuda; Wendel, Christopher S; Grant, Marcia; Krouse, Robert S
To explore whether there was a significant relationship between difficulty paying for ostomy supplies and overall quality of life among a sample of ostomates receiving care from the Veterans Health Administration (VHA). The data were collected as part of the Veterans Affairs (VA) Ostomy Health-Related Quality of Life Study, in which 511 respondents (239 cases, 272 controls) completed a survey instrument that included the modified City of Hope Quality of Life (mCOH-QOL) Ostomy questionnaire, SF-36V, and sociodemographic items. Responses from the 239 cases (ie, patients with intestinal stomas) were used in this analysis. The modified City of Hope Quality of Life Ostomy questionnaire item, "How good is your overall quality of life?," was the dependent variable for this analysis. The primary independent variable was the response (yes/no) to the item, "If you pay for any of the (ostomy) costs, is it difficult for you?" A hierarchical regression model was used to examine whether difficulty paying was significantly related to overall quality of life after adjusting for age, income, race/ethnicity, and physical health. After accounting for the proportion of variance explained by age, income, race/ethnicity, and physical health, the additional proportion of variance explained by difficulty paying was statistically significant. Individuals reporting difficulty paying had a roughly 1 point lower (ie, beta-coefficient = -1.052; SE = 0.481) overall quality of life score on the 11-point scale. We found a significant association between difficulty paying for ostomy supplies and overall quality of life. Although the cross-sectional study design does not allow causal inference, the results suggest a relationship that merits further examination.
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
... Component members not in a present duty status. This authority includes payment for health care services in... 0790-AI52] Health Care Eligibility Under the Secretarial Designee Program and Related Special... establish policies and assign responsibilities for health care eligibility under the Secretarial Designee...
... members not in a present duty status. This authority includes payment for health care services in private... 0790-AI52 Health Care Eligibility Under the Secretarial Designee Program and Related Special... assigns responsibilities for health care eligibility under the Secretarial Designee Program. It also...
For example, Vietnamese and Canadian research teams developed micronutrient-enriched instant flours and baby cereals using local crops and local processing facilities. Global Affairs Canada, IDRC, and the Canadian Institutes of Health Research are collaborating to improve health outcomes for African mothers and ...
American Alliance for Health, Physical Education, and Recreation, Washington, DC.
This public affairs manual is designed for health, physical education, and recreation personnel. It begins with a position statement by the American Alliance for Health, Physical Education, and Recreation (AAHPER). In section two, resources and procedures for crises action at the local and state level are discussed. Several organizational models…
Conclusion: Majority of CWDs were not enjoying the health care provisions available in the study area because of the .... justice offices, the health office, the labor and social .... reasons (25.4 %), accidents (16.2%), hereditary (1.7%) and other ...
and suggest strategies in scaling up. Objectives: To establish extent of use of a partogram, health facility and health workers' factors that affected its use during ... line, denoting the timing of intervention for prolonged labor; .... (with probing for duration and nature) What is your ..... Using clinical audit to improve the quality.
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 ...
Haeok Lee, PhD, RN, FAAN who is a Korean-American nurse scientist, received her doctor al degree from the Nursing Physiology Department, College of Nursing, University of California, San Francisco (UCSF), in 1993, and her post doctor al training from College of Medicine, UCSF. Dr. Lee worked at Case Western Reserve University and University of Colorado Health Sciences Center. She has worked at the UMass Boston since 2008. Dr. Lee has established a long-term commitment to minority health, especially Asian American Pacific Islanders, as a community leader, community health educator, and community researcher, and all these services have become a foundation for her community-based participatory research. Dr. Lee's research addresses current health problems framed in the context of social, political, and economic settings, and her studies have improved racial and ethnic data and developed national health policies to address health disparities in hepatitis B virus (HBV) infections and liver cancer among minorities. Dr. Lee's research, which is noteworthy for its theoretical base, is clearly filling the gap. Especially, Dr. Lee's research is beginning to have a favorable impact on national and international health policies and continuing education programs directed toward the global elimination of cervical and liver cancer-related health disparities in underserved and understudied populations.
Weeks, William B; Wallace, Tanner A; Wallace, Amy E
To determine whether the Department of Veterans Affairs Health Care Personnel Enhancement Act (the Act), which was designed to achieve VA physician salary parity with American Academy of Medical Colleges (AAMC) Associate Professors and enacted in 2006, had achieved its goal. Using VA human resources datasets and data from the AAMC, we calculated mean VA physician salaries, with 95 percent confidence intervals, for 15 different medical specialties. For each specialty, we compared VA salaries to the median, 25th, and 75th percentile of AAMC Associate Professors' incomes. The Act's passage resulted in a $20,000 annual increase in VA physicians' salaries. VA primary care physicians, medical subspecialists, and psychiatrists had salaries that were comparable to their AAMC counterparts prior to and after enactment of the Act. However, VA surgical specialists', anesthesiologists', and radiologists' salaries lagged their AAMC counterparts both before and after the Act's enactment. Income increases were negatively correlated with full-time workforce changes. VA does not appear to provide comparable salaries for physicians necessary for surgical care. In certain cases, VA should consider outsourcing surgical services.
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.
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...
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.
Full Text Available Abstract In the rapidly changing context of research on animal health, INRA launched a collective discussion on the challenges facing the field, its distinguishing features, and synergies with biomedical research. As has been declared forcibly by the heads of WHO, FAO and OIE, the challenges facing animal health, beyond diseases transmissible to humans, are critically important and involve food security, agriculture economics, and the ensemble of economic activities associated with agriculture. There are in addition issues related to public health (zoonoses, xenobiotics, antimicrobial resistance, the environment, and animal welfare. Animal health research is distinguished by particular methodologies and scientific questions that stem from the specific biological features of domestic species and from animal husbandry practices. It generally does not explore the same scientific questions as research on human biology, even when the same pathogens are being studied, and the discipline is rooted in a very specific agricultural and economic context. Generic and methodological synergies nevertheless exist with biomedical research, particularly with regard to tools and biological models. Certain domestic species furthermore present more functional similarities with humans than laboratory rodents. The singularity of animal health research in relation to biomedical research should be taken into account in the organization, evaluation, and funding of the field through a policy that clearly recognizes the specific issues at stake. At the same time, the One Health approach should facilitate closer collaboration between biomedical and animal health research at the level of research teams and programmes.
Ducrot, Christian; Bed'hom, Bertrand; Béringue, Vincent; Coulon, Jean-Baptiste; Fourichon, Christine; Guérin, Jean-Luc; Krebs, Stéphane; Rainard, Pascal; Schwartz-Cornil, Isabelle; Torny, Didier; Vayssier-Taussat, Muriel; Zientara, Stephan; Zundel, Etienne; Pineau, Thierry
In the rapidly changing context of research on animal health, INRA launched a collective discussion on the challenges facing the field, its distinguishing features, and synergies with biomedical research. As has been declared forcibly by the heads of WHO, FAO and OIE, the challenges facing animal health, beyond diseases transmissible to humans, are critically important and involve food security, agriculture economics, and the ensemble of economic activities associated with agriculture. There are in addition issues related to public health (zoonoses, xenobiotics, antimicrobial resistance), the environment, and animal welfare.Animal health research is distinguished by particular methodologies and scientific questions that stem from the specific biological features of domestic species and from animal husbandry practices. It generally does not explore the same scientific questions as research on human biology, even when the same pathogens are being studied, and the discipline is rooted in a very specific agricultural and economic context.Generic and methodological synergies nevertheless exist with biomedical research, particularly with regard to tools and biological models. Certain domestic species furthermore present more functional similarities with humans than laboratory rodents.The singularity of animal health research in relation to biomedical research should be taken into account in the organization, evaluation, and funding of the field through a policy that clearly recognizes the specific issues at stake. At the same time, the One Health approach should facilitate closer collaboration between biomedical and animal health research at the level of research teams and programmes.
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.
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.
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
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
Among HIV positive individuals who were receiving additional treatment for a mental disorder, psychological distress was not significantly ... at least offer mental health screening with counseling geared at ... using HAART (less than or equal to 1year versus greater ..... Group Correlates and Predictors of Adherence to Highly.
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 ...
among other things at ... in the planning of the new extensions to Korle Bu ... one ward (ward M) housed all the paediatric pa- ... Health Care Delivery to children by the Women Medi- .... Street, London to try to learn some paediatrics. ... career. Times indeed have changed, but there will al- ways be personal challenges for ...
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…
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…
Full Text Available Introduction: Oral health is an essential component of overall health. Oral health maintenance is more complex for the physically challenged children; the essential problem is lack of cooperation and coordination because of their physical or mental inability. Thus, physically challenged children are considered as a high-risk group for having dental problems. Aim: The aim of this study is to assess dental caries experience, oral hygiene status, periodontal status, and prevalence of malocclusion among differently abled children attending special schools in Delhi. Materials and Methods: A total of 1060 (610 males and 450 females, differently abled children were included in the study. The children were grouped into visually impaired, hearing and speech impaired, and orthopedic physically challenged only. Clinical examination was recorded using Dentition Status and Treatment Need Index and periodontal status recommended by the World Health Organization (WHO, 2013 and examination for malocclusion was made according to the Dental Aesthetic Index as described by the WHO Oral Health Survey 1997. The Simplified Oral Hygiene Index introduced by John C Greene and Jack R Vermillion in 1964 was used to assess the oral hygiene status. Results: Out of 1060 physically challenged children, 56.4% (598 had dental caries with the mean index or decayed, missing, and filled teeth (DMFT being 1.10 (standard deviation ±1.26. It was observed that prevalence of dental caries was high in visually impaired group (63.2% and least in hearing and speech impaired group (51.7%. The overall oral hygiene status recorded was good in 58.5%, fair in 40.8%, and poor in 0.7% of the study population. Conclusion: The cumulative neglect of oral health was seen among the physically challenged children. Children with visual impairment had much more poorer oral health when compared to the hearing and speech impairment and orthopedically physically challenged group. An improved accessibility
A sound knowledge of the nature of qualitative research, along with an appreciation of some special ethical considerations, is needed for rigorous reviews to be conducted. The overall character of qualitative research is described with an emphasis on the tendency of qualitative researchers to explore sensitive topics using theoretically informed methods. A number of specific features of qualitative that require additional ethical attention and awareness are also examined including the following: 1) participants are frequently quite vulnerable and require protection because the data collection methods, such as in-depth interviews, can delve into personally and politically charged matters; 2) naturalistic observation can raise concerns regarding privacy and consent; 3) the potential for the identifiability of the results of this research may require extra efforts to maintain confidentiality. Ultimately, Reseach Ethics Committee members must be knowledgeable about qualitative approaches to be able to assess the potential harms and benefits in a protocol carefully. Without this knowledge gaining ethics approval can be overly difficult for researchers and the best practices for protecting human participants can be overlooked.
Full Text Available Abstract A sound knowledge of the nature of qualitative research, along with an appreciation of some special ethical considerations, is needed for rigorous reviews to be conducted. The overall character of qualitative research is described with an emphasis on the tendency of qualitative researchers to explore sensitive topics using theoretically informed methods. A number of specific features of qualitative that require additional ethical attention and awareness are also examined including the following: 1 participants are frequently quite vulnerable and require protection because the data collection methods, such as in-depth interviews, can delve into personally and politically charged matters; 2 naturalistic observation can raise concerns regarding privacy and consent; 3 the potential for the identifiability of the results of this research may require extra efforts to maintain confidentiality. Ultimately, Reseach Ethics Committee members must be knowledgeable about qualitative approaches to be able to assess the potential harms and benefits in a protocol carefully. Without this knowledge gaining ethics approval can be overly difficult for researchers and the best practices for protecting human participants can be overlooked.
Children with chronic medical conditions rely on complex management plans for problems that cause them to be at increased risk for suboptimal outcomes in emergency situations. The emergency information form (EIF) is a medical summary that describes medical condition(s), medications, and special health care needs to inform health care providers of a child's special health conditions and needs so that optimal emergency medical care can be provided. This statement describes updates to EIFs, including computerization of the EIF, expanding the potential benefits of the EIF, quality-improvement programs using the EIF, the EIF as a central repository, and facilitating emergency preparedness in disaster management and drills by using the EIF.
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.
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
...] Updated Special Advisory Bulletin on the Effect of Exclusion From Participation in Federal Health Care... release of an updated Special Advisory Bulletin on the effect of exclusion from participation in Federal health care programs by OIG. The updated Special Advisory Bulletin describes the scope and effect of the...
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
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.
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.
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.
Loprest, Pamela; Davidoff, Amy
To better understand the impact of having a child with special health care needs (CSHCN), on low-income parents' employment decisions. Using data from the 1999 and 2000 National Health Interview Survey (NHIS), we estimate multivariate statistical regressions (logit and tobit models) to estimate the relationship between having a CSHCN and the likelihood of employment and hours of employment for a sample-of low-income single parents. Controlling for differences in demographic and family characteristics, we find no significant association between having a CSHCN and the probability of work or the number of hours worked among low-income single-parent families. Separate analysis of different dimensions of special health care needs shows that parents of children with activity limitations are significantly less likely to work and work fewer hours. This result does not hold true for the group of children defined based on elevated or special service use, or for the group of children with specific chronic conditions. These results indicate that only a specific subset of children with special needs present difficulties for low-income parents' work. This suggests that policies to help low-income single parents of children with disabilities move into work should target this specific subset of children with special health care needs.
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.
La Torre, Giuseppe; Saulle, Rosella; Unim, Brigid; Angelillo, Italo Francesco; Baldo, Vincenzo; Bergomi, Margherita; Cacciari, Paolo; Castaldi, Silvana; Del Corno, Giuseppe; Di Stanislao, Francesco; Panà, Augusto; Gregorio, Pasquale; Grillo, Orazio Claudio; Grossi, Paolo; La Rosa, Francesco; Nante, Nicola; Pavia, Maria; Pelissero, Gabriele; Quarto, Michele; Ricciardi, Walter; Romano, Gabriele; Schioppa, Francesco Saverio; Fallico, Roberto; Siliquini, Roberta; Triassi, Maria; Vitale, Francesco; Boccia, Antonio
Healthcare professionals have an important role to play both as advisers-influencing smoking cessation-and as role models. However, many of them continue to smoke. The aims of this study were to examine smoking prevalence, knowledge, attitudes, and behaviours among four cohorts physicians specializing in public health, according to the Global Health Profession Students Survey (GHPSS) approach. A multicentre cross-sectional study was carried out in 24 Italian schools of public health. The survey was conducted between January and April 2012 and it was carried out a census of students in the selected schools for each years of course (from first to fourth year of attendance), therefore among four cohorts of physicians specializing in Public Health (for a total of n. 459 medical doctors). The GHPSS questionnaires were self-administered via a special website which is created ad hoc for the survey. Logistic regression model was used to identify possible associations with tobacco smoking status. Hosmer-Lemeshow test was performed. The level of significance was P ≤ 0.05. A total of 388 answered the questionnaire on the website (85%), of which 81 (20.9%) declared to be smokers, 309 (79.6%) considered health professionals as behavioural models for patients, and 375 (96.6%) affirmed that health professionals have a role in giving advice or information about smoking cessation. Although 388 (89.7%) heard about smoking related issues during undergraduate courses, only 17% received specific smoking cessation training during specialization. The present study highlights the importance of focusing attention on smoking cessation training, given the high prevalence of smokers among physicians specializing in public health, their key role both as advisers and behavioural models, and the limited tobacco training offered in public health schools.
Giuseppe La Torre
Full Text Available Background. Healthcare professionals have an important role to play both as advisers—influencing smoking cessation—and as role models. However, many of them continue to smoke. The aims of this study were to examine smoking prevalence, knowledge, attitudes, and behaviours among four cohorts physicians specializing in public health, according to the Global Health Profession Students Survey (GHPSS approach. Materials and Methods. A multicentre cross-sectional study was carried out in 24 Italian schools of public health. The survey was conducted between January and April 2012 and it was carried out a census of students in the selected schools for each years of course (from first to fourth year of attendance, therefore among four cohorts of physicians specializing in Public Health (for a total of n. 459 medical doctors. The GHPSS questionnaires were self-administered via a special website which is created ad hoc for the survey. Logistic regression model was used to identify possible associations with tobacco smoking status. Hosmer-Lemeshow test was performed. The level of significance was P≤0.05. Results. A total of 388 answered the questionnaire on the website (85%, of which 81 (20.9% declared to be smokers, 309 (79.6% considered health professionals as behavioural models for patients, and 375 (96.6% affirmed that health professionals have a role in giving advice or information about smoking cessation. Although 388 (89.7% heard about smoking related issues during undergraduate courses, only 17% received specific smoking cessation training during specialization. Conclusions. The present study highlights the importance of focusing attention on smoking cessation training, given the high prevalence of smokers among physicians specializing in public health, their key role both as advisers and behavioural models, and the limited tobacco training offered in public health schools.
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.
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.
... 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...
Cruz-Vega, Felipe; Loría-Castellanos, Jorge; Hernández-Olivas, Irma Patricia; Franco-Bey, Rubén; Ochoa-Avila, César; Sánchez-Badillo, Victoria
There has been interest in the Division of Special Projects in Health to offer the Instituto Mexicano del Seguro Social personnel resources for training and quality thereby respond to potential contingencies. Presented here is their experience in this field. To describe and analyse the productivity in different training programs in emergencies and disasters developed by the Division of Special Projects in Health, Mexican Social Security Institute (IMSS). Observational study in which different training activities conducted by the Division of Special Projects in Health between 1989 and 2014 are described. Descriptive statistics were used. In these 25 years have trained 20,674 participants; 19.451 IMSS and 1,223 other health institutions. The most productive courses were life support (BLS/ACLS) (47.17%), distance courses "Hospital medical evacuation plans and units" (14.17%), the workshop-run "Evacuation of hospital units with an emphasis on critical areas" (5.93%) and course "Programme Evaluators of Hospital Insurance" (8.43%). Although the Special Projects Division Health has primarily operational functions, it nevertheless has neglected its responsibility to maintain constantly trained and updated institute staff that every day is in a position to face any type of emergency and disaster. This increases the chance that the answer to any contingency is more organised and of higher quality, always to the benefit of the population. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.
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…
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.
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
Richey, Lisa Ann; Budabin, Alexandra Cosima
Celebrity engagement in global “helping” is not a simple matter of highly photogenic caring for needy others across borders; it is a complex relationship of power that often produces contradictory functions in relation to the goals of humanitarianism, development, and advocacy. This article argues...... that celebrities are acting as other elite actors in international affairs: investing considerable capital into processes that are highly political. It traces the emergence and practices of the elite politics of celebrities in North-South relations, an evolution made possible by recent changes in aid practices......, media, and NGOs, then considers exemplary cases of Angelina Jolie in Burma, Ben Affleck in the Democractic Republic of Congo, and Madonna in Malawi. These celebrity practices as diplomats, experts, and humanitarians in international affairs illustrate the diverse and contradictory forms of engagement...
AOB), eight Special Forces Operational Detachment-Alphas (SFODAs)2, and Civil Affairs and Psychological Operations teams working alongside two bat...Operations doctrine. Sixty years after the Army’s first special operations units were formed, the time had arrived for writing how Army special operations...Affairs, Psychological Operations, and Special Forces, the effort inte- grated the roles and missions of the Ranger Regiment, Special Mission Units, and
percent of members of leading groups of large and medium-sized back- bone enterprises have received education at and above college level. The average...enterprises, so that enterprises genuinely become lively "economic cells ," not simply subsidiaries of administrative organs. 4. In the sphere of...electric power stations, and breweries , resulting in great losses and waste. Such a state of affairs will certainly achieve no further development. 31
Edwin Ehi Eseigbe
Full Text Available To identify challenges encountered in the care of children with special health care needs in a resource limited environment a 10 year-old child with a diagnosis of Tuberous Sclerosis was studied. Challenges identified were in: making a definitive diagnosis, provision of adequate care, cost of care, meeting parental expectations and accessing community support for the child and family. Available specialist health care and related services, including community rehabilitation, were provided for the child and family. The study highlights the need for improved community awareness, development in the provision of specialist health care services and institution of governmental policies that identify, support and protect children with special health care needs.
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.…
K.F.M. Joosten (Koen); K. van der Velde (Kelly); P. Joosten (Pieter); H. Rutten (Hans); J.M. Hulst (Jessie); K. Dulfer (Karolijn)
textabstractPurpose: 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
Temple Univ., Philadelphia, PA. Div. of Vocational Education.
This module on medical terminology (using Latin words/abbreviations; special signs and symbols) is one of 17 modules designed for individualized instruction in health occupations education programs at both the secondary and postsecondary levels. This module consists of an introduction to the module topic, a list of resources needed, and three…
Papadopoulou, D.; Malliou, P.; Kofotolis, N.; Vlachopoulos, S. P.; Kellis, E.
The purpose of this study was to examine parental perceptions about Health Related Quality of Life (HRQoL) of typical education and special education students in Greece. The Pediatric Quality of Life Inventory (PedsQL) was administered to the parents of 251 children from typical schools, 46 students attending integration classes (IC) within a…
National Easter Seal Society for Crippled Children and Adults, Chicago, IL.
The directory of resident camps is designed for persons with special health needs (children and adults with physical, mental, social, or emotional handicaps). Published by the National Easter Seal Society for Crippled Children and Adults, the listing contains residential facilities only (day care camp program information is not included). Listed…
Dao, Amy; Mulligan, Jessica
This article introduces a special issue of Medical Anthropology Quarterly on health insurance and health reform. We begin by reviewing anthropological contributions to the study of financial models for health care and then discuss the unique contributions offered by the articles of this collection. The contributors demonstrate how insurance accentuates--but does not resolve tensions between granting universal access to care and rationing limited resources, between social solidarity and individual responsibility, and between private markets and public goods. Insurance does not have a single meaning, logic, or effect but needs to be viewed in practice, in context, and from multiple vantage points. As the field of insurance studies in the social sciences grows and as health reforms across the globe continue to use insurance to restructure the organization of health care, it is incumbent on medical anthropologists to undertake a renewed and concerted study of health insurance and health systems. © 2016 by the American Anthropological Association.
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.
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.
Leggat, Peter A; Zwar, Nicholas; Hudson, Bernie
The Travel Health Advisory Group (THAG), established in 1997, is a joint initiative between the travel industry and travel health professionals in Australia that aims to promote healthy travel. THAG seeks to promote cooperation in improving the health of travellers between the travel industry and travel medicine professionals and to raise public awareness of the importance of travel health. From 2011, THAG has been a Special Interest Group of The Australasian College of Tropical Medicine and its membership has been active in several areas, including web-based travel health information, travel health promotion, media releases, research and education in Australia. Information is given on the objectives, membership and an overview of the various activities of the group. Copyright © 2012 Elsevier Ltd. All rights reserved.
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.
... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Teaching, speaking and writing by special... DEPARTMENT OF HEALTH AND HUMAN SERVICES § 5501.107 Teaching, speaking and writing by special Government... employees in the Public Health Service who otherwise are prohibited from accepting compensation for teaching...
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.
Garbarino, Sergio; Cuomo, Giovanni; Chiorri, Carlo; Magnavita, Nicola
Law and order enforcement tasks may expose special force police officers to significant psychosocial risk factors. The aim of this work is to investigate the relationship between job stress and the presence of mental health symptoms while controlling sociodemographical, occupational and personality variables in special force police officers. At different time points, 292 of 294 members of the 'VI Reparto Mobile', a special police force engaged exclusively in the enforcement of law and order, responded to our invitation to complete questionnaires for the assessment of personality traits, work-related stress (using the Demand-Control-Support (DCS) and the Effort-Reward-Imbalance (ERI) models) and mental health problems such as depression, anxiety and burnout. Regression analyses showed that lower levels of support and reward and higher levels of effort and overcommitment were associated with higher levels of mental health symptoms. Psychological screening revealed 21 (7.3%) likely cases of mild depression (Beck Depression Inventory, BDI≥10). Officers who had experienced a discrepancy between work effort and rewards showed a marked increase in the risk of depression (OR 7.89, 95% CI 2.32 to 26.82) when compared with their counterparts who did not perceive themselves to be in a condition of distress. The findings of this study suggest that work-related stress may play a role in the development of mental health problems in police officers. The prevalence of mental health symptoms in the cohort investigated here was low, but not negligible in the case of depression. Since special forces police officers have to perform sensitive tasks for which a healthy psychological functioning is needed, the results of this study suggest that steps should be taken to prevent distress and improve the mental well-being of these workers.
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…
Zhang, Yongkang; Diana, Mark L
To examine the effects of the penetration of dual-eligible special needs plans (D-SNPs) on health care spending. Secondary state-level panel data from Medicare-Medicaid Linked Enrollee Analytic Data Source (MMLEADS) public use file and Special Needs Plan Comprehensive Reports, Area Health Resource Files, and Medicaid Managed Care Enrollment Report between 2007 and 2011. A difference-in-difference strategy that adjusts for dual-eligibles' demographic and socioeconomic characteristics, state health resources, beneficiaries' health risk factors, Medicare/Medicaid enrollment, and state- and year-fixed effects. Data from MMLEADS were summarized from Centers for Medicare and Medicaid Services (CMS)'s Chronic Conditions Data Warehouse, which contains 100 percent of Medicare enrollment data, claims for beneficiaries who are enrolled in the fee-for-service (FFS) program, and Medicaid Analytic Extract files. The MMLEADS public use file also includes payment information for managed care. Data in Special Needs Plan Comprehensive Reports were from CMS's Health Plan Management System. Results indicate that D-SNPs penetration was associated with reduced Medicare spending per dual-eligible beneficiary. Specifically, a 1 percent increase in D-SNPs penetration was associated with 0.2 percent reduction in Medicare spending per beneficiary. We found no association between D-SNPs penetration and Medicaid or total spending. Involving Medicaid services in D-SNPs may be crucial to improve coordination between Medicare and Medicaid programs and control Medicaid spending among dual-eligible beneficiaries. Starting from 2013, D-SNPs were mandated to have contracts with state Medicaid agencies. This change may introduce new effects of D-SNPs on health care spending. More research is needed to examine the impact of D-SNPs on dual-eligible spending. © Health Research and Educational Trust.
Zeisel, John; Silverstein, Nina M; Hyde, Joan; Levkoff, Sue; Lawton, M Powell; Holmes, William
We systematically measured the associations between environmental design features of nursing home special care units and the incidence of aggression, agitation, social withdrawal, depression, and psychotic problems among persons living there who have Alzheimer's disease or a related disorder. We developed and tested a model of critical health-related environmental design features in settings for people with Alzheimer's disease. We used hierarchical linear modeling statistical techniques to assess associations between seven environmental design features and behavioral health measures for 427 residents in 15 special care units. Behavioral health measures included the Cohen-Mansfield physical agitation, verbal agitation, and aggressive behavior scales, the Multidimensional Observation Scale for Elderly Subjects depression and social withdrawal scales, and BEHAVE-AD (psychotic symptom list) misidentification and paranoid delusions scales. Statistical controls were included for the influence of, among others, cognitive status, need for assistance with activities of daily living, prescription drug use, amount of Alzheimer's staff training, and staff-to-resident ratio. Although hierarchical linear modeling minimizes the risk of Type II-false positive-error, this exploratory study also pays special attention to avoiding Type I error-the failure to recognize possible relationships between behavioral health characteristics and independent variables. We found associations between each behavioral health measure and particular environmental design features, as well as between behavioral health measures and both resident and nonenvironmental facility variables. This research demonstrates the potential that environment has for contributing to the improvement of Alzheimer's symptoms. A balanced combination of pharmacologic, behavioral, and environmental approaches is likely to be most effective in improving the health, behavior, and quality of life of people with Alzheimer
Full Text Available Out of 121 million population, 2.86 crore accounts for disabled people which 1.21% of total population. It has been reported that oral health care status of disabled people are poor than normal population. The main reason for this situation is barrier to access health care centres. This article throws light on definition and types of disability listed by Indian government. It also highlights the prevalence of disability and their oral health status. Article focuses on barrier in accessing dental care and guidelines required to build a disable friendly dental health care deliver center to make the treatment acceptable for such pupils. It is utmost important to provide dental care to such patients by overcoming the barrier to accessibility. Before motivating the patients and caregivers, it is the dentist who has to be motivated first in fulfilling special health care needs of patients resulting in improvement of quality of life.
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.
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.
Davidson, Lynn F; Chhabra, Rosy; Cohen, Hillel W; Lechuga, Claudia; Diaz, Patricia; Racine, Andrew
To assess current practices of New York State pediatricians as they transition youth with special health care needs to adult-oriented medical care. A survey of New York State pediatricians included 6 critical steps from 2002 consensus statement, 11 essential steps adapted from recent literature, and questions targeting age of starting transition and availability of transition policy. Of 181 respondents, only 11% have a transition policy. Most assist patients in transition process; identify an adult provider (92%); and create portable medical summary (57%). Only 3% start planning process at recommended age. No respondents are compliant with all 6 critical steps; subspecialists were more likely to report compliance to more than 4 steps. Participating pediatricians are making gains, yet effort is needed, to incorporate the essential steps into practice for transitioning youth with special health care needs. Recognition of barriers, use of electronic tools, and clarifying subspecialist's approach, may improve compliance with transition recommendations. © The Author(s) 2015.
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.
Giallo, Rebecca; Roberts, Rachel; Emerson, Eric; Wood, Catherine; Gavidia-Payne, Susana
This study examined the emotional and behavioural functioning of siblings of children with special health care needs identified in the Longitudinal Study of Australian Children (LSAC). Of the 106 siblings identified, 15-52% had emotional and behavioural difficulties in the at-risk or clinical range on the parent-reported Strengths and Difficulties Questionnaire (SDQ) subscales when aged 4-5 (wave 1), 6-7 (wave 2), 8-9 (wave 3) and 10-11 years (wave 4). After controlling for differences in socio-economic position, siblings had significantly higher difficulties on all subscales than their peers without a brother or sister with a special health care need at most time points. Latent growth modelling revealed little change in emotional and behavioural symptoms for siblings across childhood, while behavioural symptoms decreased for their peers. These findings suggest that some siblings are at heightened risk of emotional and behavioural difficulties across childhood, underscoring the importance of assessing and promoting the wellbeing of all family members when providing services to children with special health care needs. Copyright © 2014 Elsevier Ltd. All rights reserved.
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 ...
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.
Nathawad, Rita; Hanks, Christopher
Youth with special health care needs (YSHCN) experience health care disparities and often need additional support to receive optimal medical care, particularly in adolescence as they prepare to transition to adult care. Many medical practices struggle to address their needs. Here, we discuss approaches to improve medical care in office-based settings for YSHCN. Office visits can be optimized by training staff in developmentally appropriate care and ensuring that the physical office space facilitates care. Participating in previsit preparation, including managing patient registries of YSHCN, engaging in regular team huddles, and incorporating previsit planning, can improve preparation and ensure that important needs are not overlooked. Additionally, approaches to improve patient and medical provider comfort with office visits with YSHCN, including approaches to measuring vital signs, examining patients, and communicating with patients with various disabilities, are reviewed. Finally, we discuss methods of supporting adolescents with special health care needs in developing self-management skills that will allow them to be better prepared to enter adult health care settings when appropriate. Although YSHCN can present challenges to medical teams, their care can be improved by developing office-based changes and processes to support improved care for these patients. This may help overcome the health care disparities they experience and increase comfort for all members of the medical team. Copyright © 2017. Published by Elsevier Inc.
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.
Davenport, E.; Eddy, P.; Gillman, P.
On 16 November 1968, 560 metal drums labelled 'Plumbat' were loaded on to a small ship, the Scheersberg A, in Antwerp. The drums contained uranium ore which was being shipped by a small German chemical company to an obscure Italian paint company for processing. At least, that was what the documents said, and the grounds upon which Euratom (the European Atomic Energy Commission) had licensed the sale and shipment of the ore. The Scheersberg A next appeared in a Turkish port, without her cargo. Potentially, the uranium in the drums could be formed into the raw material for a dozen nuclear bombs. As far as Euratom and the security forces of Germany and Itay were concerned, it had disappeared off the face of the earth. In fact, nothing more might ever have been heard about it were it not for a chance sentence uttered to the Norwegian police who were interrogating a suspect about the murder of an Arab waiter. Under questioning, the suspect revealed that he was one of Israel's secret 'hit teams', sent out to kill suspected Arab terrorists. He talked almost eagerly to the police, and divulged that he had once owned a ship called the Scheersberg A. Israel was a logical destination for the uranium, since it was one of the few countries which possessed a reactor capable of transmuting the uranium ore into plutonium, which could be used for bombs. Security officials and journalists followed up that chance remark and started to unravel the extraordinary history of the Scheersberg A, and its part in another mysterious affair, the hijacking by Israel of five gunboats from the port of Cherbourg late in 1969. The Plumbat Affair is a fascinating detective story; the alliances that were formed and the deals that were made at the highest levels of international politics and in the depths of the underworld make this a thriller beyond the imaginings of most novelists. (author)
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.
Marks, Luc; Fernandez, Carla; Kaschke, Imke; Perlman, Steven
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. 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. The level of significance was predetermined at a p value < 0.05. A total of 7,754 athletes presented with gingival signs (48.64%). There were no significant differences (p= 0,095) in mean gingival signs between age groups, however the association between mouth cleaning and age, was statistically significant. The data suggests that there is a high prevalence of gingival signs among individuals with special needs; over 50% in more than 20 countries. Therefore, there is a serious need for education and preventive programs for the patients, their parents and caregivers.
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
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.
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.
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.
Hauge, Lars Johan; Kornstad, Tom; Nes, Ragnhild Bang; Kristensen, Petter; Irgens, Lorentz M; Eskedal, Leif T; Landolt, Markus A; Vollrath, Margarete E
Many women temporarily reduce work hours or stop working when caring for small children. However, mothers of children with special health care needs may face particular challenges balancing childrearing responsibilities and employment demands. This study examines how the work participation among mothers of children with special health care needs compares with that of mothers in general during early motherhood, focusing in particular on the extent of the child's additional health care needs. By linkage of the population-based Norwegian Mother and Child Cohort Study with national registers on employment, child health care needs, and social background factors, 41,255 mothers employed prior to childbirth were followed until child age 3 years to investigate associations between the child's care needs and mother's dropping out of employment. In total, 16.3% of the formerly employed mothers were no longer employed at child age 3 years. Mothers of children with mild care needs did not differ from mothers in general, whereas mothers of children with moderate [Risk Ratio (RR) 1.45; 95% confidence interval (CI) 1.17, 1.80] and severe care needs [RR 2.19; 95% CI 1.67, 2.87] were at substantial risk of not being employed at follow-up. The impact of the child's health care needs remained strong also after adjusting for several factors associated with employment in general. Extensive childhood health care needs are associated with reduced short-term employment prospects and remain a substantial influence on mothers' work participation during early motherhood, irrespective of other important characteristics associated with maternal employment. © 2013 John Wiley & Sons Ltd.
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.
Rathmann, Katharina; Vockert, Theres; Bilz, Ludwig; Gebhardt, Markus; Hurrelmann, Klaus
Studies among students with special educational needs (SEN) in separate special schools (SSS) and mainstream schools (MS) are particularly applicable to educational attainment and social participation. However, indicators of health and wellbeing have rarely been considered. This study investigates two related topics: first, health and wellbeing differences between students with SEN in special schools (SSS) and students without SEN in regular schools, and second, the rarely considered question whether health and wellbeing among students with SEN differ between school settings (i.e. MS vs. SSS). Bivariate and multilevel analyses are applied with data from the German National Educational Panel Study (NEPS) with 5267 students (grade 7). After having controlled for background characteristics, students in SSS report higher likelihoods of poor self-rated health compared to students in higher track schools. Self-rated health of students with SEN does not significantly differ between MS vs. SSS. For life satisfaction, students with SEN show higher likelihoods of low life satisfaction when attending MS. Teachers in inclusive settings are encouraged to establish class work and teaching that support a real change from class placement to inclusive culture in order to suitably support students with SEN. Copyright © 2018 Elsevier Ltd. All rights reserved.
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.
Chung, Paul J; Garfield, Craig F; Elliott, Marc N; Carey, Colleen; Eriksson, Carl; Schuster, Mark A
Parents of children with special health care needs are especially vulnerable to work-family conflicts that family leave benefits might help resolve. We examined leave-taking among full-time-employed parents of children with special health care needs. We identified all children with special health care needs in 2 large inpatient/outpatient systems in Chicago, Illinois, and Los Angeles, California, and randomly selected 800 per site. From November 2003 to January 2004, we conducted telephone interviews with 1105 (87% of eligible and successfully contacted) parents. Among the sample's 574 full-time-employed parents, we examined whether leave benefits predicted missing any work for child illness, missing >4 weeks for child illness, and ability to miss work whenever their child needed them. Forty-eight percent of full-time-employed parents qualified for federal Family and Medical Leave Act benefits; 30% reported employer-provided leave benefits (not including sick leave/vacation). In the previous year, their children averaged 20 missed school/child care days, 12 doctor/emergency department visits, and 1.7 hospitalizations. Although 81% of parents missed work for child illness, 41% reported not always missing work when their child needed them, and 40% of leave-takers reported returning to work too soon. In multivariate regressions, parents who were eligible for Family and Medical Leave Act benefits and aware of their eligibility had 3.0 times greater odds of missing work for child illness than ineligible parents. Parents with >4 weeks of employer-provided leave benefits had 4.7 times greater odds of missing >4 weeks than parents without benefits. Parents with paid leave benefits had 2.8 times greater odds than other parents of missing work whenever their child needed them. Full-time-employed parents of children with special health care needs experience severe work-family conflicts. Although most have leave benefits, many report unmet need for leave. Access to Family and
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
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.
Full Text Available Objective: The lack of adequate recognition of health importance of non-HIV reproductive health infections (RHIs in Nigeria has led into this study, which was to determine clinical pathogens in non-HIV RHI in Nigeria using a tertiary health facility as case study.Materials and Methods: A nine-year investigation was carried out between 1997 and 2005 on 4047 (n = 1626 males; n = 2421 females patients presenting at Special Treatment Clinic (STC of University College Hospital (UCH Ibadan, Nigeria. Routine laboratory procedures using appropriate culture media, culture conditions, and current phenotypic taxonomic tools for classification of isolated pathogens were employed.Results: Age (p = 0.019 and gender (p<0.0001 were related to the recovery rates of pathogens Candida species (55.6 %, Neisseria gonorrhoae (11.1%, Gardenella vaginalis (10.3%, Escherichia coli (9.2 %, Klebsiella sp. (4.2%, streptococci (4.0%, Staphylococcus aureus (2.3%, Proteus sp., (1.8%, Haemophilus ducreyi (0.5%, Trichomonas vaginalis (0.44% and Pseudomonas aeruginosa (0.18%. Candida and Gardenella vaginalis species were mostly recovered from female patients, while N.gonorrhoeae were mostly isolated from male patients. Age brackets for the recovery of pathogens were Neisseria gonorrhoeae (16-30 years; Gardenella vaginalis (21-25 and 31-35 years and C.albicans (21-30 years.Conclusion: Candida, Neisseria gonorrhoea and Gadrenella vaginalis were the most recovered pathogens from patients presenting at Special Treatment Clinic of a tertiary health institution in Nigeria, and the relationship between age, gender and the aetiological agents was statistically significant.
www.va.gov/health/aboutVHA.asp. 24 Veterans Benefits Administration, “About VBA ,” last updated December 18, 2014, accessed May 10, 2015, http...Department of Veterans Affairs, 2014. Veterans Benefits Administration. “About VBA .” Last updated December 18, 2014. Accessed May 10, 2015. http...OIF Operation Iraqi Freedom VA Department of Veterans Affairs VA OIG Department of Veterans Affairs Office of Inspector General VBA Veterans Benefits
Mandell, David S.; Machefsky, Aliza; Rubin, David; Feudtner, Chris; Pita, Susmita; Rosenbaum, Sara
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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. PMID:18808472
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.
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.
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.
Ganz, Michael L; Tendulkar, Shalini A
To estimate the prevalence and correlates of unmet needs for mental health care services for children with special health care needs and their families. We use the National Survey of Children With Special Health Care Needs to estimate the prevalence of unmet mental health care needs among children with special health care needs (1-17 years old) and their families. Using logistic-regression models, we also assess the independent impact of child and family factors on unmet needs. Substantial numbers of children with special health care needs and members of their families have unmet needs for mental health care services. Children with special health care needs who were poor, uninsured, and were without a usual source of care were statistically significantly more likely to report that their mental health care needs were unmet. More severely affected children and those with emotional, developmental, or behavioral conditions were also statistically significantly more likely to report that their mental health care needs went unmet. Families of severely affected children or of children with emotional, developmental, or behavioral conditions were also statistically significantly more likely to report that their mental health care needs went unmet. Our results indicate that children with special health care needs and their families are at risk for not receiving needed mental health care services. Furthermore, we find that children in families of lower socioeconomic status are disproportionately reporting higher rates of unmet needs. These data suggest that broader policies to identify and connect families with needed services are warranted but that child- and family-centered approaches alone will not meet the needs of these children and their families. Other interventions such as anti-poverty and insurance expansion efforts may be needed as well.
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.
Nap, Annelies; van Loon, Annelies; Peen, Jaap; van Schaik, Digna Jf; Beekman, Aartjan Tf; Dekker, Jack Jm
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. The aim of this study is to explore the association between acculturation, mental health and treatment effect. In a longitudinal cohort study of patients treated in specialized mental health facilities, different dimensions of acculturation (skills, social integration, traditions, norms/values and feelings of loss) were explored for Moroccan, Turkish and Surinamese migrants in the Netherlands. Furthermore, the associations between acculturation status and symptom levels, quality of life, care needs and effects of mental health treatment were examined. Data were analyzed with analysis of covariance, correlation analysis and multiple regression analysis. Acculturation status differed among migrant groups. Turkish migrants showed most original culture maintenance (traditions, norms/values), Surinamese migrants showed most participation in Dutch society (skills, social integration), while Moroccan migrants were situated in between. Higher cultural adaptation was associated with less need for care, lower symptom levels and a higher quality of life. Participation significantly predicted lower symptom levels (p acculturation status is associated with symptom levels, quality of life and perceived need for care of migrants. Moreover, participation in Dutch society appears to be a favorable factor for treatment effect. It is of importance for professionals in clinical practice to be attentive to this. © The Author(s) 2014.
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.
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.
oldest of these is the Foreign Trade Arbitration Commission (FTAC) at the USSR Chamber of Commerce and Industry in Moscow, which was set up in 1932...commercial arbi- tration.2 The above-said disputes are subject to examination in the arbitration court set up at the chamber of commerce of the...at the chamber of commerce of a third country, signatory to the Convention, as well as (depending on the nature of the dispute) to the specialized
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.
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…
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...... with depressed patients (n = 9) in specialized mental health care. Patients' clinical profiles were established based on pre-treatment diagnostic information and patient self-reports on clinical measures. Patient treatment adherence rates were explored, together with patient ratings of credibility and expectancy...... 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. © 2016 The Authors....
Centeno, Carlos; Bolognesi, Deborah; Biasco, Guido
Palliative medicine (PM), still in the development phase, is a new, growing specialty aimed at caring for both oncology and non-oncology patients. There is still confusion about the training offered in the various European PM certification programs. To provide a detailed, comparative update and analysis of the PM certification process in Europe, including the different training approaches and their main features. Experts from each country completed an online survey addressing historical background, program name, training requirements, length of time in training, characteristic and content, official certifying institution, effectiveness of accreditation, and 2013 workforce capacity. We prepared a comparative analysis of the data provided. In 2014, 18 of 53 European countries had official programs on specialization in PM (POSPM): Czech Republic, Denmark, Finland, France, Georgia, Germany, Hungary, Ireland, Israel, Italy, Latvia, Malta, Norway, Poland, Portugal, Romania, Slovakia, and the U.K. Ten of these programs were begun in the last five years. The PM is recognized as a "specialty," "subspecialty," or "special area of competence," with no substantial differences between the last two designations. The certification contains the term "palliative medicine" in most countries. Clinical training varies, with one to two years being the most frequent duration. There is a clear trend toward establishing the POSPM as a mandatory condition for obtaining a clinical PM position in countries' respective health systems. PM is growing as a specialization field in Europe. Processes leading to certification are generally long and require substantial clinical training. The POSPM education plans are heterogeneous. The European Association for Palliative Care should commit to establishing common learning standards, leading to additional European-based recognition of expertise in PM. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All
NOTAS SOBRE LA ECONOMIA Y EL DESARROLLO. Santiago de Chile , 1985, No 424/425, p 10. 11. For more detail see: LATINSKAYA AMERIKA, No 5, 1984. 12...3.0 $billion. REVISTA DE LA CEPAL. Santiago de Chile , 1983, No 20, 21; INTERNATIONAL HERALD TRIBUNE. Paris, 25 June 1984. 7. EC0N0MIA DE AMERICA...34 The items in the anthology des - cribe in detail the means and methods of the special services—that secret legion of imperialism which makes active use
Fisher, Gwenith G; Ryan, Lindsay H
Twenty five years ago, the largest academic behavioral and social science project ever undertaken in the U.S. began: the Health and Retirement Study (HRS). The HRS is an invaluable publicly available dataset for investigating work, aging, and retirement and informing public policy on these issues. This biennial longitudinal study began in 1992 and has studied more than 43,000 individuals and produced almost 4000 journal articles, dissertations, books, book chapters, and reports to date. The purpose of this special issue of Work, Aging and Retirement is to describe the HRS and highlight relevant research that utilizes this rich and complex dataset. First, we briefly describe the background that led to the development of the HRS. Then we summarize key aspects of the study, including its development, sampling, and methodology. Our review of the content of the survey focuses on the aspects of the study most relevant to research on worker aging and retirement. Next, we identify key strengths and important limitations of the study and provide advice to current and future HRS data users. Finally, we summarize the articles in this Special Issue (all of which use data from the HRS) and how they advance our knowledge and understanding of worker aging and retirement.
Holsapple, Michael P.; Paustenbach, Dennis J.; Charnley, Gail; West, Lori J.; Luster, Michael I.; Dietert, Rodney R.; Burns-Naas, Leigh Ann
In recent years, there has been increasing regulatory pressure to protect the health of children, with the basic tenet being that children differ significantly from adults in their biological or physiological responses to chemical exposures. In a regulatory context, this has been translated to mean a requirement for an additional 10-fold safety factor for environmental contaminants, specialized tests, or both. Much of the initial focus has been on the developing endocrine and nervous systems; but increasingly, the developing immune system has been identified as a potential target organ for chemically mediated toxicity. More recently, the question has been raised regarding whether the current state of science supports the creation of developmental immunotoxicology (DIT) test guidelines. What is needed is a risk-based evaluation of the biology associated with the proposed differential sensitivity between children and adults and the impact of that assessment on additional regulatory measures to protect children in risk assessment analyses. Additionally, an understanding of whether the developing immune system shows greater susceptibility, either qualitatively or quantitatively, to chemical perturbation is critical. To address the question ''What's so special about the developing immune system?'' a symposium was organized for the 2003 Society of Toxicology annual meeting that brought together risk assessors, clinicians, immunologists, and toxicologists
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 p<0.05). The attitudes of these Korean dental students 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.
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.
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.
Koutkias, V; Thiessard, F
To select best papers published in 2013 in the field of big data and smart health strategies, and summarize outstanding research efforts. A systematic search was performed using two major bibliographic databases for relevant journal papers. The references obtained were reviewed in a two-stage process, starting with a blinded review performed by the two section editors, and followed by a peer review process operated by external reviewers recognized as experts in the field. The complete review process selected four best papers, illustrating various aspects of the special theme, among them: (a) using large volumes of unstructured data and, specifically, clinical notes from Electronic Health Records (EHRs) for pharmacovigilance; (b) knowledge discovery via querying large volumes of complex (both structured and unstructured) biological data using big data technologies and relevant tools; (c) methodologies for applying cloud computing and big data technologies in the field of genomics, and (d) system architectures enabling high-performance access to and processing of large datasets extracted from EHRs. The potential of big data in biomedicine has been pinpointed in various viewpoint papers and editorials. The review of current scientific literature illustrated a variety of interesting methods and applications in the field, but still the promises exceed the current outcomes. As we are getting closer towards a solid foundation with respect to common understanding of relevant concepts and technical aspects, and the use of standardized technologies and tools, we can anticipate to reach the potential that big data offer for personalized medicine and smart health strategies in the near future.
Parish, Susan L; Rose, Roderick A; Dababnah, Sarah; Yoo, Joan; Cassiman, Shawn A
Growing evidence supports the hypothesis that income inequality within a nation influences health outcomes net of the effect of any given household's absolute income. We tested the hypothesis that state-level income inequality in the United States is associated with increased family burden for care and health-related expenditures for low-income families of children with special health care needs. We analyzed the 2005-06 wave of the National Survey of Children with Special Health Care Needs, a probability sample of approximately 750 children with special health care needs in each state and the District of Columbia in the US Our measure of state-level income inequality was the Gini coefficient. Dependent measures of family caregiving burden included whether the parent received help arranging or coordinating the child's care and whether the parent stopped working due to the child's health. Dependent measures of family financial burden included absolute burden (spending in past 12 months for child's health care needs) and relative burden (spending as a proportion of total family income). After controlling for a host of child, family, and state factors, including family income and measures of the severity of a child's impairments, state-level income inequality has a significant and independent association with family burden related to the health care of their children with special health care needs. Families of children with special health care needs living in states with greater levels of income inequality report higher rates of absolute and relative financial burden. Copyright © 2011 Elsevier Ltd. All rights reserved.
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 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.
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.
Maddox, Thomas M; Plomondon, Mary E; Petrich, Megan; Tsai, Thomas T; Gethoffer, Hans; Noonan, Gregory; Gillespie, Brian; Box, Tamara; Fihn, Stephen D; Jesse, Robert L; Rumsfeld, John S
A "learning health care system", as outlined in a recent Institute of Medicine report, harnesses real-time clinical data to continuously measure and improve clinical care. However, most current efforts to understand and improve the quality of care rely on retrospective chart abstractions complied long after the provision of clinical care. To align more closely with the goals of a learning health care system, we present the novel design and initial results of the Veterans Affairs (VA) Clinical Assessment, Reporting, and Tracking (CART) program-a national clinical quality program for VA cardiac catheterization laboratories that harnesses real-time clinical data to support clinical care and quality-monitoring efforts. Integrated within the VA electronic health record, the CART program uses a specialized software platform to collect real-time patient and procedural data for all VA patients undergoing coronary procedures in VA catheterization laboratories. The program began in 2005 and currently contains data on 434,967 catheterization laboratory procedures, including 272,097 coronary angiograms and 86,481 percutaneous coronary interventions, performed by 801 clinicians on 246,967 patients. We present the initial data from the CART program and describe 3 quality-monitoring programs that use its unique characteristics-procedural and complications feedback to individual labs, coronary device surveillance, and major adverse event peer review. The VA CART program is a novel approach to electronic health record design that supports clinical care, quality, and safety in VA catheterization laboratories. Its approach holds promise in achieving the goals of a learning health care system. Published by Elsevier Inc.
Sakashita, Kazumi; Matthews, Wallace J; Yamamoto, Loren G
Children and youth with special health care needs (CYSHCN) are complex and often dependent on electrical devices (technoelectric dependent) for life support/maintenance. Because they are reliant on electricity and electricity failure is common, the purpose of this study was to survey their preparedness for electricity failure. Parents and caregivers of technoelectric CYSHCN were asked to complete a preparedness questionnaire. We collected a convenience sample of 50 patients. These 50 patients utilized a total of 166 electrical devices. A home ventilator, oxygen concentrator, and a feeding pump were identified as the most important device for the children in 35 of the 50 patients, yet only 19 of the 35 patients could confirm that this device had a battery backup. Also, 22 of the 50 patients had a prolonged power failure preparedness plan. Technoelectric-dependent CYSHCN are poorly prepared for electrical power failure.
The definition of the term radiation protection medicine is followed by a brief account of the pathophysiology of radiation effects. Developments in the special field of general and occupational health are also described together with relevant GDR regulations. Information is provided on what is done at present at various levels in the GDR, in the context of peaceful use of nuclear energy, to provide adequate services in radiation protection medicine for all radiation workers and the population, with reference to the scope of activities of the Institute of Medicine attached to the National Board for Atomic Safety and Radiation Protection, the network of works medical officers in charge of radiation protection and the system for clinical treatment of acute radiation damage. (author)
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 Children with 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.
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.
... Public Session Meeting AGENCY: International Labor Affairs Bureau (ILAB), U.S. Department of Labor.... Department of Labor gives notice of the public session of the meeting of the Labor Affairs Council (``Council... DEPARTMENT OF LABOR Office of the Secretary Bureau of International Labor Affairs; Office of Trade...
Strayhorn, Terrell L.
This chapter presents intersectionality as a useful heuristic for conducting research in higher education and student affairs contexts. Much more than just another theory, intersectionality can powerfully shape student affairs research in both obvious and tacit ways.
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...
This chapter illustrates how student affairs units participate in accreditation across regional agency expectations and program-level requirements. Strategies for student affairs units to engage in campus strategic planning processes to further highlight their contributions are also recommended.
Flynn, J M; Bravo, C J; Reyes, O
In 1994 the government of Puerto Rico adopted a capitated managed health care system for the medically indigent. The new law has been implemented in most municipalities. A survey of children with special health care needs treated at a tertiary pediatric center under the capitated managed care system and the prior non-capitated system was analyzed using the Consumer Assessments of Health Plan Survey (CHAPS) instrument. One third of the patients who were under the new capitated managed care system were not satisfied with the medial care they were receiving. The parents of children with multidisciplinary conditions found it much more difficult to access care at the tertiary center. It took parents two years to learn to navigate within the capitated managed care system. Studies to measure outcome and health quality of children with special health care needs in capitated managed health care programs must be developed to learn how the potential benefits of managed care can be maximized and the potential harms minimized. The purpose of this study was to analyze the accessibility and satisfaction of caretakers of children with special health care needs under a capitated managed health care system.
Dissatisfaction and frustration with political leaders have sent students ... In the Democratic Republic of Congo, the Minister of Higher Education has ordered a ... Student Affairs will need to anticipate and find innovative ways to adjust ... Razia Mayet's article focuses on the effectiveness of learning development interventions.
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…
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.
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.
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
Ansoborlo, Eric; Menager, Marie-Therese; Abergel, Rebecca J.
The 11. International Conference on Healths of Incorporated Radionuclides (HEIR 2013) took place in Berkeley (US) over four days in October 2013. It was co-organized by the Lawrence Berkeley National Laboratories (LBNL, US) and the Commissariat a l'Energie Atomique et aux Energies Alternatives (CEA, France). The HEIR 2013 was well attended and hosted about 90 scientists from 10 different countries. Forty oral presentations were given over the four days and 25 posters were discussed during two poster sessions. About a third of these contributions resulted in publications included in the present special issue, comprising most of the topics addressed at the meeting. Contributions and discussions spanned a variety of fields and were organized along the following four main scientific themes: 1) epidemiology, biological effects and dose assessment 2) bio-dosimetry, molecular biology and biochemistry 3) biokinetics 4) medical countermeasures and decorporation. Among the many important concepts and results treated during the conference, the following points can be highlighted: 1)the first reports on the effects of radiation and radionuclide contamination in Fukushima from the World Health Organization (WHO) and the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) allow assessing the current situation and health risks, three years after the power plant accident. Such events raise the significance of science-based findings to delineate the health risks for population exposed to radionuclides. 2)While most studies in the past decades have focused on the effects of acute or single exposure to radionuclides, few controlled studies have investigated the health impacts on chronic exposure to radioisotopes. Recent work on chronic cesium or uranium ingestion performed at the French Institute for Radioprotection and Nuclear Safety are reported. 3)The need for a good understanding of radionuclide speciation in biokinetic studies was emphasized and
... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Special acts. 3.801 Section 3.801 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUDICATION Pension, Compensation, and Dependency and Indemnity Compensation Special Benefits § 3.801 Special acts. (a) General. A...
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
Mustafa M Alquraini
Full Text Available Context: "Off-service" clinical rotations are part of the necessary requirements for many residency training programs. Because these rotations are off-service, little attention is given to their structure and quality of training. This often leads to suboptimal educational experience for the residents on these rotations. Aims: The aim of this study was to assess medical residents′ perceptions, opinions, and levels of satisfaction with their "off-service" rotations at a major residency training site in Saudi Arabia. It was also to evaluate the reliability and validity of a questionnaire used for quality assurance in these rotations. Improved reliability and validity of this questionnaire may help to improve the educational experience of residents in their "off-service" rotations. Materials and Methods: A close-ended questionnaire was developed, Pilot tested and distributed to 110 off-service residents in training programs of different specializations at King Fahad Naitonal Guard Hospital and King Abdulziz Medical City, Riyadh, Saudi Arabia, between September 2011 and December 2011. Results: A total of 80 out of 110 residents completed and returned the questionnaire. Only 33% of these residents had a clear set of goals and educational learning objectives before the beginning of their off-service rotations to direct their training. Surgical specializations had low satisfaction mean scores of 57.2 (11.9 compared to emergency medicine, which had 70.7 (16.2, P value (0.03. The reliability of the questionnaire was Cronbach′s alpha 0.57. The factor analysis yielded a 4-factor solution (educational environment, educational balance, educational goals and objectives, and learning ability; thus, accounting for 51% variance in the data. Conclusion: Our data suggest that there were significant weaknesses in the curriculum for off-service clinical rotations in KAMC and that residents were not completely satisfied with their training.
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.
McCown, Michael; Grzeszak, Benjamin
Although many public health articles have been published detailing foodborne illness outbreaks, a medical literature search revealed no articles that detail a case study or a specific response of a deployed U.S. military unit to a potential foodborne illness. This article describes a recent public health case study of a U.S. Special Operations Forces (SOF) team sickened while deployed to South America. It highlights public health factors which may affect U.S. personnel deployed or serving overseas and may serve as a guide for a deployed SOF medic to reference in response to a potential food- or waterborne illness outbreak. Eight food samples and five water samples were collected. The food samples were obtained from the host nation kitchen that provided food to the SOF team. The water samples were collected from the kitchen as well as from multiple sites on the host nation base. These samples were packaged in sterile containers, stored at appropriate temperatures, and submitted to a U.S. Army diagnostic laboratory for analysis. Laboratory results confirmed the presence of elevated aerobic plate counts (APCs) in the food prepared by the host nation and consumed by the SOF team. High APCs in food are the primary indicator of improper sanitation of food preparation surfaces and utensils. This case study concluded that poor kitchen sanitation, improper food storage, preparation, and/or holding were the probable conditions that led to the team?s symptoms. These results emphasize the importance of ensuring safe food and water for U.S. personnel serving overseas, especially in a deployment or combat setting. Contaminated food and/or water will negatively impact the health and availability of forces, which may lead to mission failure. The SOF medic must respond to potential outbreaks and be able to (1) critically inspect food preparation areas and accurately advise commanders in order to correct deficiencies and (2) perform food/water surveillance testing consistently
Nadpara, Pramit A; Joyce, Andrew R; Murrelle, E Lenn; Carroll, Nathan W; Carroll, Norman V; Barnard, Marie; Zedler, Barbara K
To characterize the risk factors associated with overdose or serious opioid-induced respiratory depression (OIRD) among medical users of prescription opioids in a commercially insured population (CIP) and to compare risk factor profiles between the CIP and Veterans Health Administration (VHA) population. Analysis of data from 18,365,497 patients in the IMS PharMetrics Plus health plan claims database (CIP) who were dispensed a prescription opioid in 2009 to 2013. Baseline factors associated with an event of serious OIRD among 7,234 cases and 28,932 controls were identified using multivariable logistic regression. The CIP risk factor profile was compared with that from a corresponding logistic regression among 817 VHA cases and 8,170 controls in 2010 to 2012. The strongest associations with serious OIRD in CIP were diagnosed substance use disorder (odds ratio [OR] = 10.20, 95% confidence interval [CI] = 9.06-11.40) and depression (OR = 3.12, 95% CI = 2.84-3.42). Other strongly associated factors included other mental health disorders; impaired liver, renal, vascular, and pulmonary function; prescribed fentanyl, methadone, and morphine; higher daily opioid doses; and concurrent psychoactive medications. These risk factors, except depression, vascular disease, and specific opioids, largely aligned with VHA despite CIP being substantially younger, including more females and less chronic disease, and having greater prescribing prevalence of higher daily opioid doses, specific opioids, and most selected nonopioids. Risk factor profiles for serious OIRD among US medical users of prescription opioids with private or public health insurance were largely concordant despite substantial differences between the populations in demographics, clinical conditions, health care delivery systems, and clinical practices. © 2017 American Academy of Pain Medicine.
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.
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.
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.
In this special expert opinion, the Environmental Council discusses the problem of how to assess the risk of environment-induced health hazards. In many cases, there is a discrepancy between scientific risk assessment and subjective risk perception of the exposed population in this context. The Environmental Council suggests that communication between all parties concerned should be improved by target-finding models and also proposes an integrative risk assessment procedure. It is particularly important to identify and characterize vulnerable groups by scientific methods. [German] In seinem Sondergutachten Umwelt und Gesundheit - Risiken richtig einschaetzen greift der Umweltrat die Problematik von Risikoabschaetzungen umweltbedingter Gesundheitsbeeintraechtigungen auf. In diesem Zusammenhang ist vielfach eine Diskrepanz zwischen wissenschaftlicher Risikoabschaetzung und der subjektiven Risikowahrnehmung seitens der Betroffenen festzustellen. Der Umweltrat verweist zur Verbesserung der Kommunikation zwischen den beteiligten Gruppen auf entsprechende Modelle zur Zielfindung und schlaegt einen integrativen Ansatz zur Risikobewertung vor. Von besonderer Bedeutung bei der Bewertung von umweltbedingten Gesundheitsbeeintraechtigungen ist die wissenschaftlich begruendete Identifizierung und Charakterisierung von empfindlichen Gruppen (vulnerablen Gruppen). (orig.)
Rizk, Sanaa A M; Sharaf, Nevin E; Mahdy-Abdallah, Heba; ElGelil, Khalid S Abd
Aircraft noise is an environmental stressor. A positive relationship exists between noise and high blood pressure. Shift work is an additional hazardous working condition with negative effect on the behavior attitude of workers. This study aimed at investigating some health hazards for shift work on workers at Cairo International Airport (CIA), Egypt, as a strategic work place, with more than one stressor. Assessment of noise effects were carried out in four working sites at the airport besides control sites. The average noise level in the exposure sites was 106.5 dB compared with 54 dB at the control sites. The study comprised a group of 200 male workers exposed to aircraft noise and 110 male workers not exposed to noise as control group. All workers had full general medical examination after filling specially formulated questionnaire. Hearing impairment, raised blood pressure, headaches, disturbed sleep, and symptoms of anxiety were more prominent among the exposed workers than the control. Symptoms of upper respiratory tract were reported among night shifters of both groups with high tendency for smoking. Thus, night-shift workers at CIA work under more than one stressor. Hypertension and smoking might act as intermediate factors on the causal pathway of complaints, making aircraft noise and night shift acting as two synergistic stressors. Airport workers are in need for aggressive hearing conservation programs. Organization of the working hours schedule is mandatory to avoid excessive noise exposure. © The Author(s) 2014.
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.
The testimony summarizes potential adverse health effects related to service in the Persian Gulf as presented by the Department of Health and Human Services. An estimated 9,000 workers from 43 different countries battled the burning oil wells in Kuwait from February 1991 through early November 1991 when the last was capped. Exposures and health effects in US military personnel, Kuwaiti citizens, and fire fighters were described. The hazards to the soldiers were largely dependent on the concentration of the pollutants in the air near the camps. Fortunately, the plume from the fires rose up to 10,000 and 12,000 feet, mixed with the air and then dispersed for several thousand miles downwind over a period of several weeks. The particles and gases contained in the plume were diluted as the plume travelled. Even so, some minor respiratory problems were present among the soldiers. Some of the hydrocarbons measured at low concentrations have been shown to produce cancer in laboratory animals only when present at higher levels of exposure. Based on the exposure information gathered, the author concludes that there will not likely be a detectable increase in lung cancer in Gulf War Veterans as a result of the oil well fires.
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.
Teacher stress has attracted considerable attention, yet few studies have focused on special education teachers. This article, by Lambros Lazuras of the South-East European Research Centre (SEERC) in Thessaloniki, reports research designed to explore differences in the stress levels of general and special educators in Greece and provides…
P. V. C. Santos
Full Text Available Chemical dependency is currently one of the most important public health problems in our country. The study deals with a quantitative and qualitative research, whose goal is to evaluate the perception and performance of the interdisciplinary team in serving drug dependents in specialized network of mental health Sinop, Mato Grosso. Applied a semi-structured questionnaire with objective and subjective questions with 11 professionals in health care at the Psychosocial Care Center (CAPS and Medical Specialties Center (EMC. The results reveal the importance of the preparation of these professionals to work in service to dependents and interdisciplinarity proved to be the best option to achieve a dignified and humane care
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.
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.
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.
Lal, Shalini; Dell'Elce, Jennifer; Tucci, Natasha; Fuhrer, Rebecca; Tamblyn, Robyn; Malla, Ashok
Despite the potential and interest of using technology for delivering specialized psychiatric services to young adults, surprisingly limited attention has been paid to systematically assess their perspectives in this regard. For example, limited knowledge exists on the extent to which young people receiving specialized services for a first-episode psychosis (FEP) are receptive to using new technologies as part of mental health care, and to which types of technology-enabled mental health interventions they are amenable to. The purpose of this study is to assess the interest of young adults with FEP in using technology to receive mental health information, services, and supports. This study uses a cross-sectional, descriptive survey design. A convenience sample of 67 participants between the ages of 18 and 35 were recruited from two specialized early intervention programs for psychosis. Interviewer-administered surveys were conducted between December 2013 and October 2014. Descriptive statistics are reported. Among the 67 respondents who completed the survey, the majority (85%, 57/67) agreed or strongly agreed with YouTube as a platform for mental health-related services and supports. The top five technology-enabled services that participants were amenable to were (1) information on medication (96%, 64/67); (2) information on education, career, and employment (93%, 62/67); (3) decision-making tools pertaining to treatment and recovery (93%, 62/67); (4) reminders for appointments via text messaging (93%, 62/67); and (5) information about mental health, psychosis, and recovery in general (91%, 61/67). The top self-reported barriers to seeking mental health information online were lack of knowledge on how to perform an Internet search (31%, 21/67) and the way information is presented online (27%, 18/67). Two thirds (67%; 45/67) reported being comfortable in online settings, and almost half (48%; 32/67) reported a preference for mixed formats when viewing mental health
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...
The relationship between exposure to extreme physical and mental activities and adverse environments to the susceptibility to injuries, disease, and death has not been examined for Special Operations Forces (SOF) personnel...
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.
The author draws upon over four decades of experience in student affairs administration to investigate how senior student affairs officers can incorporate intersectionality into comprehensive and targeted decision-making processes, strategic planning, and organizational considerations.
Stern, Warren M.
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
Vernaglia, Lawrence W; Herman, Dimitry S; Ziegler, Rachel Schneller
Lawyers and clients contemplating a health care transaction must have a strong working knowledge not only of the applicable law, but also of the provider's needs and culture. As illustrated by a recent Delaware court decision, Interim Healthcare, Inc. et al. v. Spherion Corporation, parties engaging in health care provider acquisitions are well advised to select a team of experienced business and legal advisors with specialized knowledge in health care practices that can find and address any suspicious activities before it is too late.
...; 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...
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.
Francis, Leslie J.
The purpose of this special section of Research in the Social Scientific Study of Religion is to provide a forum for examples of current scientific research examining work-related psychological health, stress, burnout and coping strategies among clergy. The collection, comprising three qualitative studies and seven quantitative studies, draws on the work of four established research groups which are making a scientific impact in that area (two in the USA, one in the UK, and one in Australia)....
Gursimer Jeet; Atul Sharma; Tulika Goswami Mohanta; Ajay Trakroo
Establishment of special care new-born units (SCNU) in hospitals not only serves to provide the intensive care to sick neonates, but presents with opportunities to enhance knowledge and modify attitude and practices of their parents through behavior change communication (BCC). A cross-sectional study was conducted in Dibrugarh District, Assam from January to June, 2011 to assess differences in health-care seeking behavior of these mothers from mothers of newborns who were born at home and mot...
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.
Tamrat, Tigest; Kachnowski, Stan
Mobile health (mHealth) encompasses the use of mobile telecommunication and multimedia into increasingly mobile and wireless health care delivery systems and has the potential to improve tens of thousands of lives each year. The ubiquity and penetration of mobile phones presents the opportunity to leverage mHealth for maternal and newborn care, particularly in under-resourced health ecosystems. Moreover, the slow progress and funding constraints in attaining the Millennium Development Goals for child and maternal health encourage harnessing innovative measures, such as mHealth, to address these public health priorities. This literature review provides a schematic overview of the outcomes, barriers, and strategies of integrating mHealth to improve prenatal and neonatal health outcomes. Six electronic databases were methodically searched using predetermined search terms. Retrieved articles were then categorized according to themes identified in previous studies. A total of 34 articles and reports contributed to the findings with information about the use and limitations of mHealth for prenatal and neonatal healthcare access and delivery. Health systems have implemented mHealth programs to facilitate emergency medical responses, point-of-care support, health promotion and data collection. However, the policy infrastructure for funding, coordinating and guiding the sustainable adoption of prenatal and neonatal mHealth services remains under-developed. The integration of mobile health for prenatal and newborn health services has demonstrated positive outcomes, but the sustainability and scalability of operations requires further feedback from and evaluation of ongoing programs.
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.
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.…
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.
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
... Area Director, the Assistant Secretary may issue special instructions not inconsistent with the... 25 Indians 1 2010-04-01 2010-04-01 false Special instructions. 67.15 Section 67.15 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR TRIBAL GOVERNMENT PREPARATION OF A ROLL OF INDEPENDENT...
... Secretary may issue special instructions not inconsistent with the regulations in this part 61. ... 25 Indians 1 2010-04-01 2010-04-01 false Special instructions. 61.15 Section 61.15 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR TRIBAL GOVERNMENT PREPARATION OF ROLLS OF INDIANS § 61...
...This notice announces the online publication of the Interim Special Law Enforcement Commission Policy, Rules and Procedures, the Interim Special Law Enforcement Commission Protocols and the Interim Domestic Violence Waiver that will be used by the Office of Justice Services following passage of the Tribal Law and Order Act of 2010. The documents are published on the Indian Affairs Web site.
Singh, Jasvinder A.
Introduction Epidemiologic studies usually use database diagnoses or patient self-report to identify disease cohorts, but no previous research has examined the extent to which self-report of chronic disease agrees with database diagnoses in a Veterans Affairs (VA) health care setting. Methods All veterans who had a medical care visit from October 1, 1996, through May 31, 1998, at any of the Veterans Integrated Service Network 13 facilities were surveyed about physician diagnosis of chronic ob...
Ridho Azlam Ambo Asse
Full Text Available Management is the art of completing the work through others. In an organization there are various components that are structured and coordinated in the movement toward shared vision and mission. Management is looking for that component to move under coordination, pressure, and problems that hit. Editing management, especially for the current affair type program, has a special purpose. Not just the speed of productivity that is based on the ability of individual editors. This research is done to know the process of stage editor in work. The process of managing files, data management, human resources, tools, facilities, scheduling, until the pattern of editing stage in one of the national media industry. This study concludes that the current affair program management editing system based on the concept of planning, organizing, implementation, supervision, and productivity management is done by Top Down method from top to bottom in the management of currenf affair tvOne editing program. What gets from above during a pre-production meeting of a program. Then coordinate with the supervisor and then delegate down to be implemented according to the agreed plan and in accordance with the duties and functions of both the production team and the editor. Manajemen merupakan seni menyelesaikan pekerjaan melalui orang lain. Dalam sebuah organisasi terdapat berbagai macam komponen yang terstruktur dan terkordinasi dalam gerakan menuju visi dan misi bersama. Manajemen ialah mencari agar komponen tersebut dapat bergerak dibawah koordinasi, tekanan, dan masalah yang menerpa. Manajemen editing khususnya untuk program berjenis current affair, memiliki tujuan khusus. Tidak sekedar kecepatan produktifitas yang didasarkan pada kemampuan individu editor. Penelitian yang dilakukan ini untuk mengetahui proses tahapan editor dalam bekerja. Proses mengelola file, pengelolaan data, sumber daya manusia, alat, fasilitas, penjadwalan, hingga pola tahapan editing pada salah
... Advanced Search · Current Issue · Archives. Journal Homepage Image. 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.
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 ...
Deegan, William L.
Management processes and problems are examined in a variety of student affairs contexts. This book (1) proposes a theoretical framework for the analysis of management functions in colleges and universities, (2) studies the practice of management in several different student affairs contexts to uncover current practices, issues, problems, and…
Wald, Richard C.
Live programming, regular daily news programs, and documentary series, which are suggested as solutions to the limited scope of news and public affairs air time, would enable PBS to increase its coverage of news and public affairs. Some suggestions are also made for restructuring the functions of stations within the system to facilitate this…
Prisoners in correctional facilities constitute a unique population requiring specialized medical care. Drug withdrawal, self-destructive behavior, infectious diseases (including AIDS), and serious mental disorders are some of the challenges to the physician who provides medical services to these inmates.
Zeisel, John; Silverstein, Nina M.; Hyde, Joan; Levkoff, Sue; Lawton, M. Powell; Holmes, William
Purpose: We systematically measured the associations between environmental design features of nursing home special care units and the incidence of aggression, agitation, social withdrawal, depression, and psychotic problems among persons living there who have Alzheimer's disease or a related disorder. Design and Methods: We developed and tested a…
Forness, Steven R.
The emphasis or focus of a professional association often shifts imperceptibly over time in ways that neither its membership nor its leadership seems able to recognize until pivotal events compel it to do so. The historical shift from psychodynamic to behavioral approaches in special education for children with emotional or behavioral disorders…
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.
... this section. In addition, benefits provided under a health flexible spending arrangement are excepted... of a group health plan. For purposes of this paragraph (c)(3), benefits are not an integral part of a group health plan (whether the benefits are provided through the same plan or a separate plan) only if...
Rocha, Vania; Ximenes, Elisa Francioli; Carvalho, Mauren Lopes de; Alpino, Tais de Moura Ariza; Freitas, Carlos Machado de
In the specialized database of the Virtual Health Library (VHL), the DISASTER database highlights the importance of the theme for the health sector. The scope of this article is to identify the profiles of technical and scientific publications in the specialized database. Based on systematic searches and the analysis of results it is possible to determine: the type of publication; the main topics addressed; the most common type of disasters mentioned in published materials, countries and regions as subjects, historic periods with the most publications and the current trend of publications. When examining the specialized data in detail, it soon becomes clear that the number of major topics is very high, making a specific search process in this database a challenging exercise. On the other hand, it is encouraging that the disaster topic is discussed and assessed in a broad and diversified manner, associated with different aspects of the natural and social sciences. The disaster issue requires the production of interdisciplinary knowledge development to reduce the impacts of disasters and for risk management. In this way, since the health sector is a interdisciplinary area, it can contribute to knowledge production.
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...
88 APPENDIX E SPECIAL OPERATIONS FORCES CIVIL AFFAIRS INTERVIEW RESPONSES...cessation of combat operations. Major General Zachary Taylor’s occupation of northern Mexico, based in Vera Cruz, was...and C are examples of the questions asked of respondents, and Appendices D and E contain the interview responses themselves. The research employs
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.
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...
Pufpaff, Lisa A.; Mcintosh, Constance E.; Thomas, Cynthia; Elam, Megan; Irwin, Mary Kay
The number of students with special healthcare needs (SHCN) and severe disabilities in public schools in the United States has steadily increased in recent years, largely due to the changing landscape of public health relative to advances in medicine and medical technology. The specialized care required for these students often necessitates…
Farsi, Deema J; Farsi, Nada J; El-Housseiny, Azza A; Turkistani, Jihan M; Farsi, Najat M
Aim: The aim of this study is to compare the effect of dental rehabilitation on oral health-related quality-of-life (OHRQoL) in children with special health care needs (CSHCN) and healthy children. Materials and methods: The prospective study's sample consisted of 213 parents of caries-affected children, who were aged 6 years or younger and were scheduled for dental rehabilitation under general anesthesia (DRGA). The parent-child dyads were recruited from three public hospitals in Jeddah between October 2014 and May 2016. They comprised healthy children (n = 133) and CSHCN (n = 80). Parents self-completed the early childhood oral health impact scale (ECOHIS) before and 1 month after DRGA. The parents also rated the overall oral health status of their children by answering a global question before and after DRGA. Results: At baseline, the CSHCN had significantly worse OHRQoL in most of the scale domains at 25.9 [standard deviation (SD) 11.3] and 19.9 (SD 10.3) respectively. The OHRQoL significantly improved in both groups postoperatively (p = 0.005, Wilcoxon rank-sum test). The effect size of the improvement in the CSHCN group (+1.8) was greater than that in the healthy group (+1.5) in all domains, except for the family impact and parental distress sections. Conclusion: The DRGA markedly improves OHRQoL in children aged 6 years or younger, and the improvement is even greater in CSHCN. Clinical significance: The substantial improvement in OHRQoL after DRGA highlights the importance of oral health care in young children, which should receive higher priority than it has been done to date. Keywords: Children with special health care needs, Dental caries, Early childhood oral health impact scale, General anesthesia, Oral health-related quality-of-life.
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).
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
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.
Blaha, M.; Pidrman, V.; Vanasek, J.; Brandova, J.
Experience is presented with the training of nurses of the Centre of Specialized Health Care For Irradiated Persons of the Unit for Treatment of Hematological Diseases, which may serve as the model for the treatment of acute radiation syndrome. The concept of the training course is presented. The basic requirement is a nursing school diploma and a post-secondary training course (theoretical and practical, including the preparation of the work place, the treatment of patients, psychotherapy, microbial checks, etc.). Experience has shown that 2 to 3 years work in this field is needed to master the required theoretical knowledge and skills. (J.B.)
Blaha, M; Pidrman, V; Vanasek, J; Brandova, J [Vojensky Lekarsky Vyzkumny a Doskolovaci Ustav J.E. Purkyne, Hradec Kralove (Czechoslovakia)
Experience is presented with the training of nurses of the Centre of Specialized Health Care For Irradiated Persons of the Unit for Treatment of Hematological Diseases, which may serve as the model for the treatment of acute radiation syndrome. The concept of the training course is presented. The basic requirement is a nursing school diploma and a post-secondary training course (theoretical and practical, including the preparation of the work place, the treatment of patients, psychotherapy, microbial checks, etc.). Experience has shown that 2 to 3 years work in this field is needed to master the required theoretical knowledge and skills.
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...
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.
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.
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.
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,…
Del Vecchio, Mario; De Pietro, Carlo
The Italian National Health Service (INHS) has undergone profound changes over the past three decades. With establishment of the INHS in 1978--a tax-based public health care system with universal coverage--one of the underlying principles was integration. The recognition of health and health care as requiring integrated answers led to the creation of a single public organization, the Local Health Unit, responsible for the health status of the population of its catchment area. At the beginning of the 1990s, the scenario radically changed. The creation of hospital trusts, the development of quasi-market mechanisms and management control tools, the adoption of a prospective payment system for reimbursing health care providers--all were signs of deintegration and institutional unbundling. Two structural changes have deeply sustained this deintegration: patients' empowerment and the increased possibilities for outsourcing practices. In more recent years, a new reintegration effort has occurred, often led by regional governments and based on institutional cooperation and network relationships. However, the earlier structural changes require innovative approaches and solutions if public health care organizations want to retain their leading role.
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.
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
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.
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.
Gone, Joseph P
The calls for evidence-based practice (EBP) and cultural competence (CC) represent two increasingly influential mandates within the mental health professions. Advocates of EBP seek to standardize clinical practice by ensuring that only treatment techniques that have demonstrated therapeutic outcomes under scientifically controlled conditions would be adopted and promoted in mental health services. Advocates of CC seek to diversify clinical practice by ensuring that treatment approaches are designed and refined for a multicultural clientele that reflects a wide variety of psychological orientations and life experiences. As these two powerful mandates collide, the fundamental challenge becomes how to accommodate substantive cultural divergences in psychosocial experience using narrowly prescriptive clinical practices and approaches, without trivializing either professional knowledge or cultural difference. In this Introduction to a special issue of Transcultural Psychiatry, the virtue of an interdisciplinary conversation between and among anthropologists, psychologists, psychiatrists, and social work researchers in addressing these tensions is extolled. © The Author(s) 2015.
Abang, Theresa B.
This article discusses the special education system in Nigeria, focusing on integration; training of special educators; medical, health, and welfare services for children with disabilities; recreational facilities; employment opportunities; national planning; and problems and successes. (JDD)
Heinonen, Ilkka; Laukkanen, Jari A
Environmental stress such as extremely warm or cold temperature is often considered a challenge to human health and body homeostasis. However, the human body can adapt relatively well to heat and cold environments, and recent studies have also elucidated that particularly heat stress might be even highly beneficial for human health. Consequently, the aim of the present brief review is first to discuss general cardiovascular and other responses to acute heat stress, followed by a review of beneficial effects of Finnish sauna bathing on general and cardiovascular health and mortality as well as dementia and Alzheimer's disease risk. Plausible mechanisms included are improved endothelial and microvascular function, reduced blood pressure and arterial stiffness, and possibly increased angiogenesis in humans, which are likely to mediate the health benefits of sauna bathing. In addition to heat exposure with physiological adaptations, cold stress-induced physiological responses and brown fat activation on health are also discussed. This is important to take into consideration, as sauna bathing is frequently associated with cooling periods in cold(er) environments, but their combination remains poorly investigated. We finally propose, therefore, that possible additive effects of heat- and cold-stress-induced adaptations and effects on health would be worthy of further investigation.
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
Works with the Director Corporate Communications and the Manager, ... a comprehensive public affairs program for IDRC to foster awareness, understanding and support for IDRC's ... Management (including Financial and Human Resources).
POWERS AND DUTIES OF THE CORPORATE AFFAIRS. COMMISSION ... The Registrar-General is the Chief Executive of the Commission and is saddled .... Federal Board of Inland Revenue Department of the Ministry of Finance v). Register ...
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 .... students to act as partners and change agents in their educational experience.
African Journal of International Affairs and Development. ... Foreign Policy and Public Opinion: An Assessment of Ijebu Involvement in the Kiriji War ... Book Review: Critical Perspective's on Nigeria's International Economic Relations · EMAIL ...
Pujol, R; Conthe, P; Garcia Alegría, J
More than 30 years after the creation of postgraduate medical training program in Spain supported by the MIR system, a thorough review of it becomes essential. This was the goal of the LOPS law enacted in 2003. The development of the LOPS is being slow and difficult to enforce, because master lines have to be achieved in order to develop the training of specialists in accordance with internationals standards and, simultaneously, with the reform that is taking place in the undergraduate education. The start up of the medical core will be the cornerstone of this project. The principles of the LOPS provide an opportunity for the training of competent physician in basic general medical practice followed by a progressive specialization supported on a solid foundation. And these principles have to prevail over corporate interests. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.
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.
... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Office of Public Affairs... Central Offices § 105-53.142 Office of Public Affairs. The Office of Public Affairs, headed by the Associate Administrator for Public Affairs, is responsible for the planning, implementation, and...
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.
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
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.
Vernaglia, Lawrence W; Herman, Dimitry S; Ziegler, Rachel Schneller
A careful and comprehensive due diligence process is mission-critical to the success of any complex business acquisition. In heavily regulated industries such as health care, a buyer's greatest risks can arise from practices relating to Medicare, Medicaid, and other governmental payors. In particular, the rules of "successor liability" for the seller's sins are fundamentally different in a health care transaction than in other traditional corporate acquisitions. These liabilities may attach not only for expected business debts, but also for unexpected and draconian penalties available as remedies under the False Claims Act, Civil Money Penalties Law, and a number of other enforcement authorities. In addition, because critical cash flow depends on accepting certain liabilities of the seller, in the health care context these risks may be voluntarily assumed. Thus, here, due diligence is not just about finding "deal breakers," it is about helping the provider's management team understand the financial and risk-management components of the transaction at hand.
Black, Maureen M; Cutts, Diana B; Frank, Deborah A; Geppert, Joni; Skalicky, Anne; Levenson, Suzette; Casey, Patrick H; Berkowitz, Carol; Zaldivar, Nieves; Cook, John T; Meyers, Alan F; Herren, Tim
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is the largest food supplement program in the United States, serving almost 7 500 000 participants in 2002. Because the program is a grant program, rather than an entitlement program, Congress is not mandated to allocate funds to serve all eligible participants. Little is known about the effects of WIC on infant growth, health, and food security. To examine associations between WIC participation and indicators of underweight, overweight, length, caregiver-perceived health, and household food security among infants 95th percentile, varied from 7% to 9% and did not differ among the 3 groups but were higher than the 5% expected from national growth charts. Rates of food insecurity were consistent with national data for minority households with children. Families that did not receive WIC assistance because of access problems had higher rates of food insecurity (28%) than did WIC participants (23%), although differences were not significant after covariate control. Caregivers who did not perceive a need for WIC services had more economic and personal resources than did WIC participants and were less likely to be food-insecure, but there were no differences in infants' weight-for-age, perceived health, or overweight between families that did not perceive a need for WIC services and those that received WIC assistance. Infants participation. Health care providers should promote WIC utilization for eligible families and advocate that WIC receive support to reduce waiting lists and eliminate barriers that interfere with access.
National Inst. on Alcohol Abuse and Alcoholism (DHHS), Rockville, MD.
This report is divided into an overview of alcohol and health, and eight chapters which deal with various aspects of alcohol use and abuse. The epidemiology of alcohol abuse and alcoholism is discussed. Data are presented on self-reported consumption of alcohol among youths and adults; alcohol consumption during pregnancy; alcohol-related…
..., limited-scope vision benefits, or long-term care benefits are excepted if they are provided under a... the mouth). (B) Vision benefits. Limited scope vision benefits are benefits substantially all of which... impairment or a loss of functional capacity that is expected to be chronic. (v) Health flexible spending...
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.
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
genius of thought but also a true leader of the people. Alberto Beltran, chairman of the editorial council of the Mexican paper "El Dia," said...Guinea-Bissau and Cape Verde and minister of rural develop- ment, who had been on a visit to our country as a special envoy of Comrade Joao Bernardo
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
Yu, Hao; Dick, Andrew W; Szilagyi, Peter G
Health care costs grew rapidly since 2001, generating substantial economic pressures on families, especially those with children with special health care needs (CSHCN). To examine how the growth of health care costs affected financial burden for families of CSHCN between 2001 and 2004 and to determine the extent to which health insurance coverage protected families of CSHCN against financial burden. In 2001-2004, 5196 families of CSHCN were surveyed by the national Medical Expenditure Panel Survey (MEPS). The main outcome was financial burden, defined as the proportion of family income spent on out-of-pocket (OOP) health care expenditures for all family members, including OOP costs and premiums. Family insurance coverage was classified as: (1) all members publicly insured, (2) all members privately insured, (3) all members uninsured, (4) partial coverage, and (5) a mix of public and private with no uninsured periods. An upward trend in financial burden for families of CSHCN occurred and was associated with growth of economy-wide health care costs. A multivariate analysis indicated that, given the economy-wide increase in medical costs between 2001 and 2004, a family with CSHCN was at increased risk in 2004 for having financial burden exceeding 10% of family income [odds ratio (OR) = 1.39; P financial burden exceeding 20% of family income. Over 15% of families with public insurance had financial burden exceeding 10% of family income compared with 20% of families with private insurance (P financial burden of >10% or 20% of family income than privately-insured families. Rising health care costs increased financial burden on families of CSHCN in 2001-2004. Public insurance coverage provided better financial protection than private insurance against the rapidly rising health care costs for families of CSHCN.
Chun-Li, C; Le-Ping, S; Qing-Biao, H; Bian-Li, X U; Bo, Z; Jian-Bing, L; Dan-Dan, L; Shi-Zhu, L I; Oning, X; Xiao-Nong, Z
China's prevention and control of parasitic diseases has made remarkable achievements. However, the prevalence and transmission of parasitic diseases is impacted by the complicated natural and social factors of environment, natural disasters, population movements, and so on. Therefore, there are still the risks of the outbreak of emergency parasitic diseases affairs, which may affect the control effectiveness of parasitic diseases and endanger the social stability seriously. In this article, we aim at the analysis of typical cases of emergency parasitic disease affairs and their impacts on public health security in China in recently years, and we also elaborate the disposal characteristics of emergency parasitic disease affairs, and propose the establishment of response system to emergency parasitic disease affairs in China, including the organizational structure and response flow path, and in addition, point out that, in the future, we should strengthen the system construction and measures of the response system to emergency parasitic disease affairs, so as to control the risk and harm of parasitic disease spread as much as possible and to realize the early intervention and proper disposal of emergency parasitic disease affairs.
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.
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.
Diergaarde, Brenda; Bowen, Deborah J; Ludman, Evette J; Culver, Julie O; Press, Nancy; Burke, Wylie
Genetic information is used increasingly in health care. Some experts have argued that genetic information is qualitatively different from other medical information and, therefore, raises unique social issues. This view, called "genetic exceptionalism," has importantly influenced recent policy efforts. Others have argued that genetic information is like other medical information and that treating it differently may actually result in unintended disparities. Little is known about how the general public views genetic information. To identify opinions about implications of genetic and other medical information among the general population, we conducted a series of focus groups in Seattle, WA. Participants were women and men between ages 18 and 74, living within 30 miles of Seattle and members of the Group Health Cooperative. A structured discussion guide was used to ensure coverage of all predetermined topics. Sessions lasted approximately 2 hr; were audio taped and transcribed. The transcripts formed the basis of the current analysis. Key findings included the theme that genetic information was much like other medical information and that all sensitive medical information should be well protected. Personal choice (i.e., the right to choose whether to know health risk information and to control who else knows) was reported to be of crucial importance. Participants had an understanding of the tensions involved in protecting privacy versus sharing medical information to help another person. These data may guide future research and policy concerning the use and protection of medical information, including genetic information. (c) 2007 Wiley-Liss, Inc.
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.
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
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
Perrin, James M; Romm, Diane; Bloom, Sheila R; Homer, Charles J; Kuhlthau, Karen A; Cooley, Carl; Duncan, Paula; Roberts, Richard; Sloyer, Phyllis; Wells, Nora; Newacheck, Paul
To present a conceptual definition of a family-centered system of services for children and youth with special health care needs (CYSHCN). Previous work by the Maternal and Child Health Bureau to define CYSHCN has had widespread program effects. This article similarly seeks to provide a definition of a system of services. Comprehensive literature review of systems of services and consensus panel organized to review and refine the definition. Policy research group and advisors at multiple sites. Policy researchers, content experts on CYSHCN, family representatives, and state program directors. Definition of a system of services for CYSHCN. This article defines a system of services for CYSHCN as a family-centered network of community-based services designed to promote the healthy development and well-being of these children and their families. The definition can guide discussion among policy makers, practitioners, state programs, researchers, and families for implementing the "community-based systems of services" contained in Title V of the Social Security Act. Critical characteristics of a system include coordination of child and family services, effective communication among providers and the family, family partnership in care provision, and flexibility. This definition provides a conceptual model that can help measurement development and assessment of how well systems work and achieve their goals. Currently available performance objectives for the provision of care for CYSHCN and national surveys of child health could be modified to assess systems of services in general.
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.
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…
Scialli, Anthony R
Compared to normal-weight women, obese women have an increased risk of infertility and pregnancy complications. The most consistently described pregnancy complications are hypertensive disorders, gestational diabetes mellitus, thromboembolic events, and cesarean section. Fetal and neonatal complications may include congenital malformations, macrosomia, and shoulder dystocia. The literature suggests that women with a body mass index (BMI) >or=30 have approximately double the risk of having a child with a neural tube defect (NTD) compared to normal-weight women, and the increased risk associated with higher maternal body weight does not appear to be modified by folic acid supplementation. The Public Affairs Committee of the Teratology Society supports the public health initiatives identified by the U.S. Food and Drug Administration in 2004 and the research initiatives identified by the National Institutes of Health in 2004. The Public Affairs Committee recommends that clinicians counsel women about appropriate caloric intake and exercise and that health-care providers educate parents about appropriate childhood nutrition. Breast-feeding should be encouraged based on evidence of a protective effect against childhood obesity, as well as other health advantages. Birth Defects Research (Part A), 2006. (c) 2006 Wiley-Liss, Inc.
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.
Khalsa, Hari-Mandir K; Denes, Attila C; M Pasini-Hill, Diane; Santelli, Jeffrey C; Baldessarini, Ross J
This study examined the implementation of crisis intervention teams by law enforcement agencies in Colorado. Rates of Special Weapons and Tactics (SWAT) use, arrests, use of force, and injuries were assessed during 6,353 incidents involving individuals experiencing a mental health crisis. Relationships among original complaint, psychiatric illness, substance abuse, violence risk, and disposition of crisis calls were analyzed. Rates of SWAT use (<1%), injuries (<1%), arrests (<5%), and use of force (<5%) were low. The relative risk of transfer to treatment (versus no transfer) was significantly higher for incidents involving psychiatric illness, suicide threat or attempt, weapons, substance abuse, and violence potential. Use of force or SWAT, arrests, and injuries were infrequent. Suicide risk, psychiatric illness and substance abuse, even in the presence of a weapon or violence threat, increased the odds of transfer to treatment, whereas suicide risk lowered the odds of transfer to jail.
Jeet, Gursimer; Sharma, Atul; Mohanta, Tulika Goswami; Trakroo, Ajay
Establishment of special care new-born units (SCNU) in hospitals not only serves to provide the intensive care to sick neonates, but presents with opportunities to enhance knowledge and modify attitude and practices of their parents through behavior change communication (BCC). A cross-sectional study was conducted in Dibrugarh District, Assam from January to June, 2011 to assess differences in health-care seeking behavior of these mothers from mothers of newborns who were born at home and mothers who had normal uneventful institutional deliveries. Mothers of 29 SCNU discharged, 34 institutions delivered and 26 home delivered children were interviewed using a semi-structured interview schedule and a knowledge, attitude and practice (KAP) survey tool. Mothers of children admitted to SCNU scored better in questions related to vaccination, contraception, protection of child from infections and cold and perceptions about traditional healers, but overall KAP scores in the three groups were not found significantly different.
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 ...
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.
Crystal, Yasmi O; Marghalani, Abdullah A; Ureles, Steven D; Wright, John Timothy; Sulyanto, Rosalyn; Divaris, Kimon; Fontana, Margherita; Graham, Laurel
This manuscript presents evidence-based guidance on the use of 38 percent silver diamine fluoride (SDF) for dental caries management in children and adolescents, including those with special health care needs. A guideline workgroup formed by the American Academy of Pediatric Dentistry developed guidance and an evidence-based recommendation regarding the application of 38 percent SDF to arrest cavitated caries lesions in primary teeth. The basis of the guideline's recommendation is evidence from an existing systematic review "Clinical trials of silver diamine fluoride in arresting caries among children: A systematic review." (JDR Clin Transl Res 2016;1:201-10). A systematic search was conducted in PubMed®/MEDLINE, Embase®, Cochrane Central Register of Controlled Trials, and gray literature databases to identify randomized controlled trials and systematic reviews reporting on the effect of silver diamine fluoride and address peripheral issues such as adverse effects and cost. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of the evidence and the evidence-to-decision framework was employed to formulate a recommendation. The panel made a conditional recommendation regarding the use of 38 percent SDF for the arrest of cavitated caries lesions in primary teeth as part of a comprehensive caries management program. After taking into consideration the low cost of the treatment and the disease burden of caries, panel members were confident that the benefits of SDF application in the target populations outweigh its possible undesirable effects. Per GRADE, this is a conditional recommendation based on low-quality evidence. Conclusions and practical implications: The guideline intends to inform the clinical practices involving the application of 38 percent SDF to enhance dental caries management outcomes in children and adolescents, including those with special health care needs. These recommended
Full Text Available Maintaining population health through exercise is a major responsibility of physical education teachers. Promoting regular exercising and transmitting basic sports culture elements are an important objective: they must be taught since early childhood and throughout the entire life– as lifelong education – for improving the quality of life. The purpose of this study is to contribute to changing people’s mindset and to raising awareness on the benefits brought by exercising; the ultimate goal is to make exercising a lifestyle. The issue of the study is that we can contribute to changing people’s attitude and mindset on exercising regularly, insofar as we present its benefits.The methods used for this study comprised meetings; more precisely, exchanges of educational experience between university teachers and weekend schools, where students took part. During these meetings, we discussed issues related to people’s perception of practicing sports activities for maintaining their health and we proposed new strategies to make people exercise.Findings. Following the meetings, we determined new research directions and methods for assessing people’s attitude toward practicing sports activities and methods to promote and raise awareness on the benefits of practicing sports activities.
Learning from developing countries in strengthening health systems: an evaluation of personal and professional impact among global health volunteers at Addis Ababa University's Tikur Anbessa Specialized Hospital (Ethiopia).
Busse, Heidi; Aboneh, Ephrem A; Tefera, Girma
The positive impact of global health activities by volunteers from the United States in low-and middle-income countries has been recognized. Most existing global health partnerships evaluate what knowledge, ideas, and activities the US institution transferred to the low- or middle-income country. However, what this fails to capture are what kinds of change happen to US-based partners due to engagement in global health partnerships, both at the individual and institutional levels. "Reverse innovation" is the term that is used in global health literature to describe this type of impact. The objectives of this study were to identify what kinds of impact global partnerships have on health volunteers from developed countries, advance this emerging body of knowledge, and improve understanding of methods and indicators for assessing reverse innovation. The study population consisted of 80 US, Canada, and South Africa-based health care professionals who volunteered at Tikur Anbessa Specialized Hospital in Ethiopia. Surveys were web-based and included multiple choice and open-ended questions to assess global health competencies. The data were analyzed using IBRM SPSS® version 21 for quantitative analysis; the open-ended responses were coded using constant comparative analysis to identify themes. Of the 80 volunteers, 63 responded (79 percent response rate). Fifty-two percent of the respondents were male, and over 60 percent were 40 years of age and older. Eighty-three percent reported they accomplished their trip objectives, 95 percent would participate in future activities and 96 percent would recommend participation to other colleagues. Eighty-nine percent reported personal impact and 73 percent reported change on their professional development. Previous global health experience, multiple prior trips, and the desire for career advancement were associated with positive impact on professional development. Professionally and personally meaningful learning happens often
Full Text Available ... Parents site Sitio para padres General Health Growth & Development Infections Diseases ... Special Needs: Planning for Adulthood (Video) KidsHealth / For Parents / Special Needs: ...
Christensen, Lisa Bøge; Hede, Borge; Nielsen, Ellen
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...... 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...
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.
Taruscio, Domenica; Baldi, Francesca; Carbone, Pietro; Neville, Amanda J; Rezza, Giovanni; Rizzo, Caterina; Mantovani, Alberto
Congenital anomalies (CA) represent an important fraction of rare diseases, due to the critical role of non-genetic factors in their pathogenesis. CA are the main group of rare diseases in which primary prevention measures will have a beneficial impact. Indeed, since 2013 the European Union has endorsed a body of evidence-based recommendations for CA primary prevention; the recommendations aim at facilitating the inclusion of primary prevention actions the National Rare Disease Plans of EU Member States and encompass different public health fields, from environment through to maternal diseases and lifestyles.The chapter overviews and discusses the assessment of main risk factors for CA, such as environmental toxicants, maternal health and lifestyles and infections, with a special attention to issues that are emerging or need more knowledge.Overall, the availability of CA registries is important for estimating the health burden of CA, identifying possible hotspots, assessing the impact of interventions and addressing further, fit-to-purpose research.The integration of relevant public health actions that are already in place (e.g., control of noxious chemicals, vaccination programmes, public health services addressing chronic maternal conditions) can increase the affordability and sustainability of CA primary prevention. In developing countries with less primary prevention in place and limited overall resources, a first recognition phase may be pivotal in order to identify priority targets. In the meanwhile, policy makers should be made aware that primary prevention of RD supports publicly endorsed societal values like the knowledge-based promotion of health, empowerment, equity and social inclusiveness.
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.
Chung, Paul J.; Garfield, Craig F.; Elliott, Marc N.; Vestal, Katherine D.; Klein, David J.; Schuster, Mark A.
Objective Family leave benefits are a critical tool allowing parents to miss work to care for their ill children. We examined whether access to benefits varies by level of childcare responsibilities among employed parents of children with special health care needs (CSHCN). Methods We conducted telephone interviews with three successive cohorts of employed parents of CSHCN, randomly sampled from a California children’s hospital. At Wave 1 (November 2003 to January 2004) we conducted 372 parent interviews. At Wave 2 (November 2005 to January 2006) we conducted 396 parent interviews. At Wave 3 (November 2007 to December 2008) we conducted 393 parent interviews. We pooled these samples for bivariate and multivariate regression analyses, using wave indicators and sample weights. Results Parents with more childcare responsibilities (primary caregivers) reported less access to sick leave/vacation (65% vs. 82%, Ppaid leave outside of sick leave/vacation (41% vs. 51%, Pleave benefits. Even in the context of part-time employment, however, primary caregivers were just as likely as secondary caregivers both to miss work due to their child’s illness and to report being unable to miss work when they needed to. Conclusions Due in part to employment and gender differences, leave benefits among parents of CSHCN are skewed away from primary caregivers and toward secondary caregivers. Thus, primary caregivers may face particularly difficult choices between employment and childcare responsibilities. Reducing this disparity in access to benefits may improve health for CSHCN and their families. PMID:23477748
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.
Liebelt, P; Sleyster, E; Leeferink-Smit, J
1. INTRODUCTION. In university hospitals, choices are made to which extend specialized health care will be supported. It is characteristic, for this type of care, that it takes place in a process of the continual advance of medical technology and the growing awareness by consumers and payors. Specialized healthcare contributes to the hospital qualifiers having a political and strategic impact. The hospital board needs information for planning and budgeting these new tasks. Much of the information will be based on data stored in the Hospital Information System (HIS). Due to load limitations, instant retrieval is not preferred. A separate executive information system, uploaded with HIS data, features statistics, on a corporate level, with the power to drill-down to detailed levels. However, the ability to supply information on new types of healthcare is limited since most of these topics require a flexible system for new dedicated cross-sections, like medical treatment from several specialisms and functional levels. 2. DATA RETRIEVAL AND DISTRIBUTION. During the information analysis, details were gathered on the necessary working procedures and the administrative organization, including the data registration in the HIS. In the next phase, all relevant data was organized in a relational datamodel. For each topic of care, dedicated views were developed at both low and high aggregation levels. It revealed that a matching change of the administrative organization was required, with an emphasis on financial registration aspects. For the selection of relevant data, a bottom-up approach was applied, which was based on the registrations starting from the patient administrative subsystem, through several transactional systems, ending at the general ledger in the HIS. Data on all levels was gathered, resulting in medical details presented in quantities, up to financial figures expressed in amounts of money. This procedure distinguishes from the predefined top-down techniques
our country, and for making a proud history. God bless you all. And God bless our wonderful country a special Veterans Day observance. Story * Command Sgt. Major Praises Women's Service Woman Vet Veterans Affairs * Center of Military History * White House: Honoring Our Veterans * Library of Congress
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.
Department of Veterans Affairs — At the Department of Veterans Affairs (VA), our most important mission is to provide the high quality health care and benefits Veterans have earned and deserve —...
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.
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
Lamore, Kristopher; Kaci, Sandra S; Czernichow, Sébastien; Bretault, Marion; Bouillot, Jean-Luc; Naudé, Anne-Jeanne; Gribe-Ouaknine, Sandra; Carette, Claire; Flahault, Cécile
Pre-operative psychological assessment is recommended by international guidelines for bariatric surgery candidates. Thereby, service teams caring for bariatric patients should include at least one mental health provider (e.g., a psychologist or psychiatrist). The objective of this study was to evaluate the psychology and psychiatry resources and practices in the 37 specialized obesity centers (CSOs) created by the French Ministry of Health. CSO coordinators were contacted by e-mail to collect general information on the centers (e.g., number of bariatric operations). Secondly, psychologists and psychiatrists of each center completed an anonymous questionnaire assessing their professional practices and their organization of care pathways. The vast majority of CSO coordinators (81%, n = 26/32) answered our survey. These results show significant differences and shortages in terms of the psychology/psychiatry resources available. Most of the psychologists (n = 26/31) and psychiatrists (n = 10/10) stated that they systematically meet new patients only before surgery (56%) or both before and after the operation (30%); however, some psychologists and psychiatrists (14%) do not systematically meet all the patients (before and/or after surgery). Nevertheless, all the professionals provide psychology assessments, and about 75% of them offer a psychological follow-up, indicating a similarity regarding the practices of psychologists and psychiatrists. Our results highlight the place of psychological/psychiatric evaluations in French CSOs and emphasize the absence of mental health providers in several of these services. Post-operative psychological follow-up is not usually provided. It would be appropriate to create clear recommendations for post-operative psychological or psychiatric long-term follow-up.
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.
Gordon, John B; Colby, Holly H; Bartelt, Tera; Jablonski, Debra; Krauthoefer, Mary L; Havens, Peter
To evaluate the impact of a tertiary care center special needs program that partners with families and primary care physicians to ensure seamless inpatient and outpatient care and assist in providing medical homes. Up to 3 years of preenrollment and postenrollment data were compared for patients in the special needs program from July 1, 2002, through June 30, 2005. A tertiary care center pediatric hospital and medical school serving urban and rural patients. A total of 227 of 230 medically complex and fragile children and youth with special needs who had a wide range of chronic disorders and were enrolled in the special needs program. Care coordination provided by a special needs program pediatric nurse case manager with or without a special needs program physician. Preenrollment and postenrollment tertiary care center resource utilization, charges, and payments. A statistically significant decrease was found in the number of hospitalizations, number of hospital days, and tertiary care center charges and payments, and an increase was found in the use of outpatient services. Aggregate data revealed a decrease in hospital days from 7926 to 3831, an increase in clinic visits from 3150 to 5420, and a decrease in tertiary care center payments of $10.7 million. The special needs program budget for fiscal year 2005 had a deficit of $400,000. This tertiary care-primary care partnership model improved health care and reduced costs with relatively modest institutional support.
Civil affairs CAPs combined action platoons CAS close-air support CBI China-Burma-India [theater] CDI Community Defense Initiative CENTCOM [U.S...special forces’ creed has changed over time, the sentiment has remained. The history of the basic unit of special forces—the SFODA—can be traced back to...reassigned CIDG forces no longer held the advantage of insight into local cultural norms and daily activities since they were no longer operating near
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...
TTI Phase 2 Institutional Support: The Institute of Economic Affairs, Ghana ... the Institute of Economic Affairs' (IEA-Ghana) role as a credible public policy ... public policy, facilitate private sector-led economic growth, and strengthen democracy.
Bureau of Indian Affairs (Dept. of Interior), Washington, DC. Div. of Exceptional Education.
The third annual report (1981-82) of the Bureau of Indian Affairs (BIA) Advisory Committee for Exceptional Children contains summaries of Committee meetings, results of a survey of BIA agency and area special education coordinators regarding Committee activities, recommendations, and five appendices. Results of the survey of coordinators indicate…
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.
Meetings of students and veterans, militarized physical culture celebrations , department and school activities which develop a sense of patriotism, formal...they capable of making military affairs interesting to a young men in Adidas jackets with dyed- hackle hairdos, of getting them to love military
cultivating the idea of forming a circle of domestic correspondents who would be fully immersed in studying parliamentary affairs, acquiring the neces...is to deal with ecological problems, and especially hydrobiologists in the field of ecotoxicology , to use as their tools the basic principles of
skillfully shift animal husbandry to the summer work regime, and to ensure the sheep are sheared. JPRS-UPA-89-046 27 JULY 1989 16 PARTY, STATE AFFAIRS... vineyards . Vegetable plantations must replant on an urgent basis, and also prepare right now for receiving, processing and storing fruit and
Naval Postgraduate School (U.S.); Center for Homeland Defense and Security
Homeland Security Affairs (HSA) is the peer-reviewed online journal of the Center for Homeland Defense and Security (CHDS). The journal provides a forum to propose and debate strategies, policies and organizational arrangements to strengthen U.S. homeland security.
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…
Landreman, Lisa M.; Williamsen, Kaaren M.
In this chapter, we outline the challenges campuses face in addressing sexual violence and Title IX compliance. We argue that there are critical roles for student affairs professionals in Title IX work in developing effective campus sexual violence prevention and response strategies.
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…
Faizi, Nafis; Khalique, Najam; Ahmad, Anees; Shah, Mohammad Salman
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.
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.
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... Accountability & Whistleblower Protection Transparency Media Room Inside 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 ...
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
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.
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.
... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Special and limited delegation. 801.670 Section 801.670 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS... Authority, and Responsibilities 801.670 Special and limited delegation. The authority vested in the...
... AFFAIRS, LOAN POLICIES AND OPERATIONS, AND FUNDING OPERATIONS Collateral § 615.5060 Special collateral... be withdrawn from collateral upon the expiration of 1 year from the date of the loan closing, unless... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Special collateral requirement. 615.5060...
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.
Kim, Juhee; Greaney, Mary L
Children with special health care needs (SHCN) may be at greater risk of obesity than children without SHCN. A new classification system categorizes SHCN among children by service type using the following categories: No-SHCN, medication use only, services use only, medication + service use, and functional limitations. Research is needed to examine obesity and obesity-related behaviors among children using the new classification system. To determine the prevalence of inadequate vigorous physical activity (VPA), high screen time and obesity by SHCN category using the new classification system. Multivariate regression models were fitted for inadequate VPA, high screen time, and obesity to determine if there were differences in these outcomes by SHCN category, adjusting for multistage-sampling and survey-design effects using a nationally representative sample of children in the National Survey of Children's Health 2007. 22.9% of the sample was classified as having SHCN: 9% medication use only, 5% medication + service use, 4% service use only, and 5% functional limitations. Children in the medication use only and medication + service use groups were not at increased risk for inadequate VPA, high screen time, or obesity. Children in the service use only and functional limitation groups had increased odds of high screen time and obesity, which disappeared after controlling for confounders. However, the higher odds of inadequate VPA remained significant in the service use only [OR (95% CI) = 2.00 (1.34-3.00)] and the functional limitations groups with 2.21 (1.55-3.15). Physical activity promotion programs are needed for children with SHCN, especially children with functional limitations and those who require service use only and do not use prescribed medication. Copyright © 2014 Elsevier Inc. All rights reserved.
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.
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,…
... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Public affairs. 952.204-75... SOLICITATION PROVISIONS AND CONTRACT CLAUSES Text of Provisions and Clauses 952.204-75 Public affairs. As prescribed in 904.7201, insert the following clause: Public Affairs (DEC 2000) (a) The Contractor must...
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.
Vos, J H; Deleu, S A; Heling, W; de Vries, A R; Zeeuwen, A A
The most relevant results of a written questionnaire among veterinarians in the Netherlands are presented and discussed. The inquiry was performed by MarketResponse Nederland BV. The objective was to get an overview of the current perception and the future view of the profession. The response was 37%. Most respondents (66%) were practitioners, 7% were active in research or teaching institutions, 5% were governmental employees, 5% were employed in industry, and 17% did not belong to any of these categories (retired, unemployed etc.). Forty-seven per cent of the veterinarians practised mainly small animal medicine, 24% large animal medicine (cattle 15%, swine 8%, and poultry 1%), and 4% equine medicine; 24% worked in mixed practices. This division reflects the real-life situation. The percentage of female respondents was considerably higher in the group of recent graduates than in the other groups of graduates (increasing from 27% in the graduation period 1980-1989 to 56% in the period 1990-1999). Sixty per cent of the veterinarians worked more than 40 hours a week. Veterinarians considered themselves reliable, honest, professional, client-minded, and animal-friendly. According to them, the public perceived veterinarians as being animal-friendly, professional, and reliable. Veterinarians were less satisfied in their current position than other professional groups, particularly with regard to their income. Their current market position was considered indifferent or good. This position was influenced negatively by the decrease in the number of animals and competition from non-veterinarians and others. The situation could be improved by collaboration and practice fusions, specialization, and differentiation. More demanding and price-conscious clients and governmental regulations were considered important trends. Social, management, and marketing skills, increased knowledge and cooperation, and a vision of future developments were considered essential in order to be able
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.
Schuster, Mark A; Chung, Paul J; Elliott, Marc N; Garfield, Craig F; Vestal, Katherine D; Klein, David J
We examined the perceived effects of leave from work among employed parents of children with special health care needs. Telephone interviews were conducted from November 2003 to January 2004 with 585 parents who had missed 1 or more workdays for their child's illness in the previous year. Most parents reported positive effects of leave on their child's physical (81%) and emotional (85%) health; 57% reported a positive effect on their own emotional health, although 24% reported a negative effect. Most parents reported no effect (44%) or a negative effect (42%) on job performance; 73% reported leave-related financial problems. In multivariate analyses, parents receiving full pay during leave were more likely than were parents receiving no pay to report positive effects on child physical (odds ratio [OR] = 1.85) and emotional (OR = 1.68) health and parent emotional health (OR = 1.70), and were less likely to report financial problems (OR = 0.20). Employed parents believed that leave-taking benefited the health of their children with special health care needs and their own emotional health, but compromised their job performance and finances. Parents who received full pay reported better consequences across the board. Access to paid leave, particularly with full pay, may improve parent and child outcomes.
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.
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
Massuelle, M.H. [Inst. de Protection et de Surete Nucleaire, Fontenay aux Roses (France)
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 expertsand 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.
Chung, Paul J; Garfield, Craig F; Elliott, Marc N; Vestal, Katherine D; Klein, David J; Schuster, Mark A
Family leave benefits are a key tool that allow parents to miss work to care for their ill children. We examined whether access to benefits varies by level of childcare responsibilities among employed parents of children with special health care needs (CSHCN). We conducted telephone interviews with 3 successive cohorts of employed parents of CSHCN, randomly sampled from a California children's hospital. At Wave 1 (November 2003 to January 2004), we conducted 372 parent interviews. At Wave 2 (November 2005 to January 2006), we conducted 396 parent interviews. At Wave 3 (November 2007 to January 2008), we conducted 393 parent interviews. We pooled these samples for bivariate and multivariate regression analyses by using wave indicators and sample weights. Parents with more childcare responsibilities (primary caregivers) reported less access to sick leave/vacation (65% vs 82%, P paid leave outside of sick leave/vacation (41% vs 51%, P Leave Act benefits (28% vs 44%, P leave benefits. Even in the context of part-time employment, however, primary caregivers were just as likely as secondary caregivers both to miss work due to their child's illness and to report being unable to miss work when they needed to. Due in part to employment and gender differences, leave benefits among parents of CSHCN are skewed away from primary caregivers and toward secondary caregivers. Thus, primary caregivers may face particularly difficult choices between employment and childcare responsibilities. Reducing this disparity in access to benefits may improve the circumstances of CSHCN and their families. Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Marcos, Luis A; Maco, Vicente; Castillo, Maria; Terashima, Angélica; Zerpa, Rito; Gotuzzo, Eduardo
Human fascioliosis is one of the most important parasitic diseases in Peru, due to the high prevalence rates reported in the last few years, mainly in the Andean Trapeze. The most affected group is that of children and the clinical manifestations of the disease can be very varied. In this study we reported seven cases of human fascioliosis diagnosed in the Specialized Children's Health Institute (IESN) Lima, Peru, between 1988 and 2003. From 168 medical histories checked with the final diagnosis of parasitosis, 7 children (2 boys and 5 girls), between 2 and 14 years (average +/- DS: 8.52 +/- 1.43) were diagnosed with fascioliosis by a parasitic and/or serological examinations. Six of the seven cases came from cattle raising areas such as: Cajamarca, Ancash, Huancavelica and Junín. The most frequent clinical signs were prolonged fever (up to 42 days), hepatomegaly, moderate abdominal pain (right hypochondriac region and epigastrium), eosinophils count (between 132 and 8321/mm > or =), anemia (hematocrit up to 15%), jaundice and hypergammaglobulinemia. In some cases the diagnosis was difficult to reach with a delay between 1 and 24 weeks. It should be pointed out that one of these patients had hepatic cirrhosis diagnosed by anatomopathological investigations. Finally, we propose that in pediatric patients coming from endemic areas of animal fasciolosis who have prolonged fever, abdominal pain and hepatomegaly, should be considered suspicious and the infection of eliminated, to avoid hepatic damage caused by this parasite. We conclude that human fascioliosis must not be under-estimated as a secondary parasitic disease in patients coming from endemic areas in Peru.
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.
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.
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
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
Lăpăduşi Mihaela Loredana,; Căruntu Constantin
The risk is one of the most controversial issues for all persons involved both in domestic and international world economic affairs. The need to analyze, understand and effectively manage risk is growing, the ultimate aim being to obtain a higher degree of successThe risk means exposure to an uncertain future, the opportunity to face danger or suffering a loss ( "Risk - possibility of loss or injury", Webster's, 1995) or the chance that things go wrong ( "Risk is the change that something wil...
the popular "On-Duty Reporter" column , Yeliza- veta Bogoslovskaya, Sergey Chesnokov, and Galina Sapunova, literally have not gotten off the telephone...Affairs E . A. Didorenko. He has demonstrated the kind of admirable energy that he has failed to show in the fight against crime. Back on 23 February...Our editorial welcomed E . A. Didorenko’s and TASH- KENTSKAYA PRAVDA’s desire to shed light on many problems of interethnic relations and the
Read, Debra; Bethell, Christina; Blumberg, Stephen J; Abreu, Milagros; Molina, Clara
The 2001 National Survey of Children with Special Health Care Needs (CSHCN) used the CSHCN Screener, a 5-item survey based tool, to identify children with special health care needs. The prevalence of special health care needs for Hispanic children was lower than that reported for all other ethnic and racial groups, with the exception of Asian children. To better understand the reasons for the lower prevalence rate, this study examined variations in CSHCN prevalence for Hispanic children according to whether parents responded to the National Survey of CSHCN screening interview in Spanish or English. The Spanish translation of the CSHCN Screener was further evaluated through a series of face-to-face interviews with parents with limited English proficiency (LEP). The 2001 National Survey of CSHCN screened 372,174 children ages 0-17 years for special health care needs. Bivariate and multivariate analyses were conducted to examine the effects of interview language on the CSHCN prevalence rates for Hispanic children (n = 47,371). Using a standardized protocol, cognitive interviews were conducted in Spanish with 19 LEP parents to elicit their comprehension of and reactions to the screening questions. When parents were interviewed in English, 11.7% of Hispanic children were identified as CSHCN. When parents were interviewed in Spanish, 5.1% of Hispanic children were identified as CSHCN. Lower prevalence of the need for or use of prescription medications for chronic conditions made the largest contribution to the observed difference in CSHCN prevalence. Cognitive interviews with parents did not identify any linguistic or cultural deficiencies in the Spanish translation of the CSHCN Screener. Parents did express disinclination toward sharing details of their children's health in the context of a typical telephone survey.
Norris, Fran H; Rosen, Craig S
The severe consequences of Hurricane Katrina on mental health have sparked tremendous interest in improving the quality of mental health care for disaster victims. In this special issue, we seek to illustrate the breadth of work emerging in this area. The five empirical examples each reflect innovation, either in the nature of the services being provided or in the evaluation approach. Most importantly, they portray the variability of post-Katrina mental health programs, which ranged from national to state to local in scope and from educational to clinical in intensity. As a set, these papers address the fundamental question of whether it is useful and feasible to provide different intensities of mental health care to different populations according to presumed need. The issue concludes with recommendations for future disaster mental health service delivery and evaluation.
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
This expert report is a supplement to the report by L. von Klitzing (The actions and effects of electric, magnetic, and electro-magnetic fields in man with special reference to athermal effects) and concerns in particular the biological effects on cationic homeostasis and cell regulation with special reference to calcium and the effects on the pineal gland. The report concludes with statements on teratogenicity, concerogenicity, mutagenicity and a bibliography of literature. (VHE) [de
... 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...
Utilization of medical and health-related services among school-age children and adolescents with special health care needs (1994 National Health Interview Survey on Disability [NHIS-D] Baseline Data).
Weller, Wendy E; Minkovitz, Cynthia S; Anderson, Gerard F
To determine how sociodemographic factors and type of insurance influence use of medical and health-related services by children with special health care needs (CSHCN), after controlling for need. A cross-sectional analysis of 1994 National Health Interview Disability Survey was conducted. Children between 5 and 17 years were identified as chronically ill according to the Questionnaire for Identifying Children with Chronic Conditions (n = 3061). Independent variables included child and family characteristics categorized as predisposing, enabling, and need. Dependent variables included use of 4 medical or 7 health-related services. Most children (88.7%) had seen a physician; 23.9% had an emergency department visit, 11.4% had a mental health outpatient visit, and 6.4% were hospitalized. Health-related service use ranged from <5.0% (transportation and social work) to 65.1% (medical care coordination); 20% to 30% of children used the remaining services (therapeutic, assistive devices, nonmedical care coordination, housing modifications). In fully adjusted logistic models, children with public insurance were significantly more likely than privately insured children to use 2 of the 4 medical services and 5 of the 7 health-related services. Non-Hispanic black children and children from less educated families were significantly less likely to use many of the services examined. In 1994, factors in addition to need influenced medical and health-related service use by CSHCN. Differences in the scope of benefits covered by public insurance compared with private insurance may influence utilization of medical and especially health-related services. Attention is needed to ensure that CSHCN who are racial/ethnic minorities or are from less educated families have access to needed services. Future studies should determine whether these patterns have changed over time.
... 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...
... transport special education students? 39.705 Section 39.705 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF... Funds § 39.705 Are schools eligible for transportation funds to transport special education students? Yes. A school that transports a special education student from home to a treatment center and back to...
May 1, 2018 ... quantitative method used, data analysis and findings of Telehealth ... The users' acceptance of wireless sensor devise (Motes) for ..... access to specialized health care: the Telehealth Network of Minas Gerais, Brazil. Bulletin ...
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...
Health Insurance: Comparison of Coverage for Federal and Private Sector Employees. Briefing Report to the Chairman, Subcommittee on Civil Service, Post Office, and General Services, Committee on Governmental Affairs, U.S. Senate.
General Accounting Office, Washington, DC. Div. of Human Resources.
This briefing report was developed to provide a Senate subcommittee with information concerning certain benefit features of the Federal Employees Health Benefits Program (FEHBP). It compares coverage for selected health benefits in the federal and private sectors for a 6-year period (1980-1985). A description of methodology states that information…
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
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 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 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.
AGU's Public Affairs team presented two workshop luncheons and hosted 17 oral and poster sessions at the 2011 Fall Meeting. Topics ranged from defining the importance of the geosciences, to climate change science for communities and institutions. The workshop luncheon "How to Be a Congressional Science Fellow or Mass Media Fellow" was a well-attended event with more than 115 participants. The luncheon provided the opportunity for audience members to ask fellow scientists about their experiences working either in Congress or as a reporter for a news organization. For scientists looking to expand their expertise outside the academic environment, these AGU fellowships are fantastic opportunities.
resolutions on Namibia. However, the world has not failed to note that France and Britain have demonstrated some realism on that problem and have...Kagoshima, in a few days’ time. Seven ships of Japan’s navy and of the US 7th Fleet, two British patrol ships and a French destroyer will take...affairs in the Far East and in the history of war art. That event is well remembered in our country. Our poeple associate it with the stupid avarice of
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.
Partial Contents: International Affairs, Radio, Birthday Celebration, School Anniversary, Cultural Agreement, Presidents, Trade Union Bureau, Education, Olympic Committee, Ambassador, Conference, Exhibition, Campaign...
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…
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 ...
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....
Paucity of health workforce in rural India has always been a problem. Lack of interest of modern allopathic graduates in serving the rural poor has worsened the situation little more. The National Rural Health Mission brought an innovative concept of mainstreaming of AYUSH and revitalization of local health tradition by collocating AYUSH doctors at various rural health facilities such as community health centers and primary health centers. In this context a study was aimed, based on secondary...
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.
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
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...
Kuzmak, Peter M.; Dayhoff, Ruth E.
The U.S. Department of Veterans Affairs (VA) is using the Digital Imaging and Communications in Medicine (DICOM) standard to integrate image data objects from multiple systems for use across the healthcare enterprise. DICOM uses a structured representation of image data and a communication mechanism that allows the VA to easily acquire images from multiple sources and store them directly into the online patient record. The VA can obtain both radiology and non- radiology images using DICOM, and can display them on low-cost clinician's color workstations throughout the medical center. High-resolution gray-scale diagnostic quality multi-monitor workstations with specialized viewing software can be used for reading radiology images. The VA's DICOM capabilities can interface six different commercial Picture Archiving and Communication Systems (PACS) and over twenty different image acquisition modalities. The VA is advancing its use of DICOM beyond radiology. New color imaging applications for Gastrointestinal Endoscopy and Ophthalmology using DICOM are under development. These are the first DICOM offerings for the vendors, who are planning to support the recently passed DICOM Visible Light and Structured Reporting service classes. Implementing these in VistA is a challenge because of the different workflow and software support for these disciplines within the VA HIS environment.
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
individual tutoring programs . Additionally RAS personnel are offered regional enhancement studies opportunities at several facilities.48 RAS personnel...AU/ACSC/2015 AIR COMMAND AND STAFF COLLEGE AIR UNIVERSITY INTERNATIONAL AFFAIRS PROGRAMS : THE AIR FORCE VERSUS THE ARMY by Robin L...5 COMPARISON: INTERNATIONAL AFFAIRS PROGRAMS AIR FORCE VERSUS ARMY 8
... SMALL BUSINESS ADMINISTRATION Advisory Committee on Veterans Business Affairs AGENCY: U.S. Small Business Administration. ACTION: Notice of open Federal Advisory Committee meeting. SUMMARY: The SBA is... Committee on Veterans Business Affairs. The meeting will be open to the public. DATES: September 10, 2012...
... SMALL BUSINESS ADMINISTRATION Advisory Committee on Veterans Business Affairs AGENCY: U.S. Small Business Administration. ACTION: Notice of open Federal Advisory Committee meeting. SUMMARY: The SBA is... Committee on Veterans Business Affairs. The meeting will be open to the public. DATES: December 5, 2013 from...
... SMALL BUSINESS ADMINISTRATION Advisory Committee on Veterans Business Affairs AGENCY: U.S. Small Business Administration. ACTION: Notice of open Federal Advisory Committee Meeting. SUMMARY: The SBA is... Committee on Veterans Business Affairs. The meeting will be open to the public. DATES: Tuesday, May 25, 2010...
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 ...
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 ...
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…
Nov 1, 2016 ... He was a keynote speaker at the 2016 Global Summit on Student Affairs and Services held from 27–28 October ... and Services, with 50 student affairs leaders in attendance. To survive the 21st century, .... While Habib knew there was tax avoidance, if increased taxes resulted in a 20% contraction in gross ...
Shinn, Jeremiah B.
The purpose of this study was to understand the organizational functions of student-affairs at Indiana University and to understand the nature of the conflict between student-affairs and the larger organization. This study utilized the case-study research design. Much of the data collected and analyzed during this case study were of a historical…
... program direction and professional review of the performance of public affairs functions in the Regional... result in contracts in the area of public information and community relations. It develops proposals and... Administrator for External Affairs and supervises all the functions of the Office. The Director acts as national...
Reynolds, Amy L.
The purpose of this study was to gather student affairs professionals' perceptions of the knowledge and skills needed to effectively help students. Using the Delphi method, 159 entry-level and mid-level student affairs administrators from institutions across the United States were surveyed regarding their perceptions of the helping skills they use…
Reynolds, Amy L.
The purpose of this study was to increase awareness of the perceptions of student affairs professionals regarding the most frequent and challenging concerns facing college students today. Using the Delphi method, 159 entry-level and mid-level student affairs administrators from institutions across the country were surveyed about their perceptions…
... 10 Energy 1 2010-01-01 2010-01-01 false Office of Public Affairs. 1.28 Section 1.28 Energy NUCLEAR... Office of Public Affairs. The Office of Public Affairs— (a) Develops policies, programs, and procedures for the Chairman's approval for informing the public of NRC activities; (b) Prepares, clears, and...
Dean, Laura A.; Saunders, Sue A.; Thompson, George F.; Cooper, Dianne L.
New staff orientation is a strategy that can positively affect job satisfaction and productivity, especially for those beginning careers in student affairs. In this study, new student affairs professionals were surveyed to determine their perceptions about the content and efficacy of their orientation experiences. Despite literature encouraging…
Full Text Available Little research has empirically addressed the relationships among parental knowledge of child development, parental attunement, parental expectations, and child independence in predicting the social competence of infants and toddlers with special health care needs. We used baseline data from the Strengthening Families Project, a prevention intervention study that tested Bavolek’s Nurturing Program for Parents and Their Children with Health Challenges to explore the roles of these variables in predicting social competence in infants and toddlers with special health care needs. Bivariate relationships among the study variables were explored and used to develop and test a model for predicting social competence among these children. Study findings pointed to a combination of indirect and direct influences of parent variables in predicting social competence. Results indicated that parents who encouraged healthy behaviors for developing a sense of power/independence were more likely to have children with social competence developing on schedule. Elements related to parental expectations, however, did not have the hypothesized relationships to social competence. The present study provides preliminary data to support the development of knowledge based interventions. Within medical settings, such interventions may indeed maximize benefit while minimizing cost.
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
Schultz , Ulrik Pagh; Lawall , Julia ,; Consel , Charles
Design patterns offer numerous advantages for software development, but can introduce inefficiency into the finished program. Program specialization can eliminate such overheads, but is most effective when targeted by the user to specific bottlenecks. Consequently, we propose to consider program specialization and design patterns as complementary concepts. On the one hand, program specialization can optimize object-oriented programs written using design patterns. On the other hand, design pat...
Beštek, Mate; Stanimirović, Dalibor
The main aims of the paper comprise the characterization and examination of the potential approaches regarding interoperability. This includes openEHR, SNOMED, IHE, and Continua as combined interoperability approaches, possibilities for their incorporation into the eHealth environment, and identification of the main success factors in the field, which are necessary for achieving required interoperability, and consequently, for the successful implementation of eHealth projects in general. The paper represents an in-depth analysis regarding the potential application of openEHR, SNOMED, IHE and Continua approaches in the development and implementation process of eHealth in Slovenia. The research method used is both exploratory and deductive in nature. The methodological framework is grounded on information retrieval with a special focus on research and charting of existing experience in the field, and sources, both electronic and written, which include interoperability concepts and related implementation issues. The paper will try to answer the following inquiries that are complementing each other: 1. Scrutiny of the potential approaches, which could alleviate the pertinent interoperability issues in the Slovenian eHealth context. 2. Analyzing the possibilities (requirements) for their inclusion in the construction process for individual eHealth solutions. 3. Identification and charting the main success factors in the interoperability field that critically influence development and implementation of eHealth projects in an efficient manner. Provided insights and identified success factors could serve as a constituent of the strategic starting points for continuous integration of interoperability principles into the healthcare domain. Moreover, the general implementation of the identified success factors could facilitate better penetration of ICT into the healthcare environment and enable the eHealth-based transformation of the health system especially in the countries
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...
Federal Laboratory Consortium — Supporting Navy special weapons, the division provides an array of engineering services, technical publication support services, logistics support services, safety...
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 ...
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.
Cabellon, Edmund T.
The student affairs profession is at a crossroads (Torres & Walbert, 2010) given digital technology's growth and the academy's administrative expansion (Bowen, 2013). Student affairs administrators must simultaneously respond to digital technology's implications in students' lives (Kirschner & Karpinski, 2010) and to new state and federal…
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.
NGB Official March Today in Guard History Leadership CNGB VCNGB SEA DANG DARNG Joint Staff J-1 J-2 J-3 J-4 J-5 J-6 J-7 J-8 Personal Staff Inspector General Judge Advocate General Officer Management Public Affairs Executive Support Services Legislative Liaison Special Staff Directorate of Management
... 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...
Bethell, Christina D; Read, Debra; Brockwood, Krista
National health goals include ensuring that all children have a medical home. Historically, medical home has been determined by the presence of a usual or primary source of care, such as a pediatrician or a family physician. More recent definitions expand on this simplistic notion of medical home. A definition of medical home set forth by the American Academy of Pediatrics (AAP) includes 7 dimensions and 37 discrete concepts for determining the presence of a medical home for a child. Standardized methods to operationalize these definitions for purposes of national, state, health plan, or medical practice level reporting on the presence of medical homes for children are essential to assessing and improving health care system performance in this area. The objective of this study was to identify methods to measure the presence of medical homes for all children and for children with special health care needs (CSHCN) using existing population-based data sets. Methods were developed for using existing population-based data sets to assess the presence of medical homes, as defined by the AAP, for children with and without special health care needs. Data sets evaluated included the National Survey of Children With Special Health Care Needs, the National Medical Expenditures Panel Survey, the Consumer Assessment of Health Plans Study Child Survey (CAHPS), and the Consumer Assessment of Health Plans Study Child Survey--Children With Chronic Conditions (CAHPS-CCC2.0H). Alternative methods for constructing measures using existing data were compared and results used to inform the design of a new method for use in the upcoming National Survey of Children's Health. Data from CAHPS-CCC2.0H are used to illustrate measurement options and variations in the overall presence of medical homes for children across managed health care plans as well as to evaluate in which areas of the AAP definition of medical home improvements may be most needed for all CSHCN. Existing surveys vary in
Eickhoff-Shemek, J M; Ryan, K F
The purpose of this study was to compare the results from a survey of Omaha worksite health promotion activities with the results of a 1992 national survey. Comparisons were made on: (1) the kinds of health promotion activities offered, (2) progress toward the Healthy People 2000 worksite objectives, (3) types of program intervention offered, and (4) administrative factors. A one-time, written, mail-out/mail-back survey design was used. The study took place in Omaha, Nebraska. All area public and private worksites with 250 or more employees were sent surveys. Individuals who were preselected and identified as the best qualified within the company completed the survey instrument. Of the 176 worksites surveyed, 86 completed the survey (49%). Descriptive statistics (percentages) were used to compare the two surveys on kinds of programs offered, progress toward Healthy People 2000 related to worksite health promotion, the types of program intervention offered, and administrative factors. Generally, a greater percentage of respondent worksites from the national survey are offering more health promotion activities and have made more progress toward the Healthy People 2000 worksite objectives than the Omaha worksites. Results from both surveys showed that low levels of intervention are more prevalent than high levels of intervention, and that health promotion activities in most worksites are coordinated by human resources departments and not by someone professionally prepared in health education. Traditionally, major goals of worksite health promotion programs have focused on important organizational outcomes such as improved productivity/morale, reduction in absenteeism, and health care cost-containment. It is important to recognize, however, that low levels of intervention have less impact than more intensive programs on these desired outcomes. Future goals for local and national worksite health promotion programs may need to encourage implementation of more intensive
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.
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.