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Sample records for health core set

  1. Patient Core Data Set. Standard for a longitudinal health/medical record.

    PubMed

    Renner, A L; Swart, J C

    1997-01-01

    Blue Chip Computers Company, in collaboration with Wright State University-Miami Valley College of Nursing and Health, with support from the Agency for Health Care Policy and Research, Public Health Service, completed Small Business innovative Research research to design a comprehensive integrated Patient information System. The Wright State University consultants undertook the development of a Patient Core Data Set (PCDS) in response to the lack of uniform standards of minimum data sets, and lack of standards in data transfer for continuity of care. The purpose of the Patient Core Data Set is to develop a longitudinal patient health record and medical history using a common set of standard data elements with uniform definitions and coding consistent with Health Level 7 (HL7) protocol and the American Society for Testing and Materials (ASTM) standards. The PCDS, intended for transfer across all patient-care settings, is essential information for clinicians, administrators, researchers, and health policy makers. PMID:9099030

  2. 77 FR 286 - Medicaid Program: Initial Core Set of Health Care Quality Measures for Medicaid-Eligible Adults

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-04

    ... HUMAN SERVICES Office of the Secretary Medicaid Program: Initial Core Set of Health Care Quality...: This final notice announces the initial core set of health care quality measures for Medicaid-eligible... administered under title XIX of the Social Security Act, health insurance issuers and managed care...

  3. Developing core sets for patients with obstetric brachial plexus injury based on the International Classification of Functioning, Disability and Health

    PubMed Central

    Duijnisveld, B. J.; Saraç, Ç.; Malessy, M. J. A.; Vliet Vlieland, T. P. M.; Nelissen, R. G. H. H.; Brachial Plexus Advisory Board, The ICF

    2013-01-01

    Background Symptoms of obstetric brachial plexus injury (OBPI) vary widely over the course of time and from individual to individual and can include various degrees of denervation, muscle weakness, contractures, bone deformities and functional limitations. To date, no universally accepted overall framework is available to assess the outcome of patients with OBPI. The objective of this paper is to outline the proposed process for the development of International Classification of Functioning, Disability and Health (ICF) Core Sets for patients with an OBPI. Methods The first step is to conduct four preparatory studies to identify ICF categories important for OBPI: a) a systematic literature review to identify outcome measures, b) a qualitative study using focus groups, c) an expert survey and d) a cross-sectional, multicentre study. A first version of ICF Core Sets will be defined at a consensus conference, which will integrate the evidence from the preparatory studies. In a second step, field-testing among patients will validate this first version of Core Sets for OBPI. Discussion The proposed method to develop ICF Core Sets for OBPI yields a practical tool for multiple purposes: for clinicians to systematically assess and evaluate the individual’s functioning, for researchers to design and compare studies, and for patients to get more insight into their health problems and their management. PMID:23836476

  4. Mapping of the Outcome Measures in Rheumatology Core Set for Antineutrophil Cytoplasmic Antibody–Associated Vasculitis to the International Classification of Function, Disability and Health

    PubMed Central

    MILMAN, NATALIYA; BOONEN, ANNELIES; MERKEL, PETER A.; TUGWELL, PETER

    2015-01-01

    Objective The International Classification of Functioning, Disability and Health (ICF) is a framework and classification of health that describes health along 4 components: body functions, body structures, activities and participation, and contextual factors. This study examined the content of instruments that constitute the Outcome Measures in Rheumatology (OMERACT) core set of outcome measures for antineutrophil cytoplasmic antibody–associated vasculitis (AAV) by “mapping” them to the ICF. Methods The content of the instruments included in the AAV core set were linked to the ICF by 2 independent investigators according to previously established ICF linkage rules. Results The AAV core set includes 3 measures of disease activity (3 versions of the Birmingham Vasculitis Activity Score), 1 damage measure (Vasculitis Damage Index), 1 patient-reported outcome (Short Form 36 health survey), and death. Linking these instruments to the ICF revealed comprehensive coverage of the ICF components body functions and body structures, limited coverage of the ICF component activities and participation, and complete absence of coverage of contextual factors. Conclusion ICF was found to be useful for thematic characterization of a heterogeneous group of outcome measures for AAV, i.e., a group of complex medical conditions. Linking of the instruments selected for the OMERACT AAV core set of outcome measures to the ICF classification revealed limitations in the representation of constructs related to life impact of AAV, represented by the ICF components activities and participation and contextual factors. Further research and methods development are needed to better incorporate important aspects of functioning and health relevant to patients into clinical trials of AAV. PMID:25048363

  5. Using core sets of the international classification of functioning, disability and health (ICF) to measure disability in vestibular disorders: study protocol.

    PubMed

    Grill, Eva; Furman, Joseph M; Alghwiri, Alia A; Müller, Martin; Whitney, Susan L

    2013-01-01

    Symptom frequency and severity in vestibular disorders often do not correlate well with patients' restrictions of activities of daily living and limitations of participation. Due to the lack of appropriate patient reported outcome measures (PRO), the extent of limitations and restrictions is mostly unknown. The International Classification of Functioning, Disability and Health (ICF) is a conceptual framework and classification to evaluate all aspects of health and disability. An ICF-based measure, the Vestibular and Participation Measure (VAP), was recently proposed. Also, an ICF Core Set for vertigo, dizziness and balance disorders was developed to describe what aspects of functioning should be measured. This study protocol describes the development and cross-cultural validation of a new measure, the VAP-extended (VAP-e), based on VAP and ICF Core Set on three continents. To determine objectivity and cross-cultural validity of the VAP and to find potentially redundant items, Rasch models will be used. The VAP-e will be created by modifying or adding items from the Activities and Participation and Environmental Factors component of the ICF Core Set. Reliability, objectivity and responsiveness of the VAP-e will be tested. PMID:24447970

  6. 75 FR 82397 - Medicaid Program: Initial Core Set of Health Quality Measures for Medicaid-Eligible Adults

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-30

    ... adults, as required by section 2701 of the Affordable Care Act, for voluntary use by State programs administered under title XIX of the Social Security Act (the Act), health insurance issuers and managed care... signed into law the Patient Protection and Affordable Care Act (Affordable Care Act) (Pub. L. 111-...

  7. Allied Health Core Curriculum: Its Time Has Come

    ERIC Educational Resources Information Center

    McPherson, M. LaCheeta

    2004-01-01

    There is lack of a clear definition regarding an allied health core curriculum. The Pew Health Professions Commission and the Bureau of Health Professions use the following to define a core curriculum: "A set of interdisciplinary courses, clinical training, and other educational exposures designed to provide allied health students at each level…

  8. Outbreaks in Health Care Settings.

    PubMed

    Sood, Geeta; Perl, Trish M

    2016-09-01

    Outbreaks and pseudo-outbreaks in health care settings can be complex and should be evaluated systematically using epidemiologic tools. Laboratory testing is an important part of an outbreak evaluation. Health care personnel, equipment, supplies, water, ventilation systems, and the hospital environment have been associated with health care outbreaks. Settings including the neonatal intensive care unit, endoscopy, oncology, and transplant units are areas that have specific issues which impact the approach to outbreak investigation and control. Certain organisms have a predilection for health care settings because of the illnesses of patients, the procedures performed, and the care provided. PMID:27515142

  9. Core Public Health Functions for New Zealand.

    PubMed

    Williams, Daniel; Garbutt, Barbara; Peters, Julia

    2015-07-24

    This special article defines the public health principles and core public health functions that are combined to produce the public health services essential for a highly-functioning New Zealand health system. The five core functions are: health assessment and surveillance; public health capacity development; health promotion; health protection; and preventive interventions. The core functions are interconnected and are rarely delivered individually. Public health services are not static, but evolve in response to changing needs, priorities, evidence and organisational structures. The core functions describe the different ways public health contributes to health outcomes in New Zealand and provide a framework for ensuring services are comprehensive and robust. PMID:26367356

  10. After Common Core, States Set Rigorous Standards

    ERIC Educational Resources Information Center

    Peterson, Paul E.; Barrows, Samuel; Gift, Thomas

    2016-01-01

    In spite of Tea Party criticism, union skepticism, and anti-testing outcries, the campaign to implement Common Core State Standards (otherwise known as Common Core) has achieved phenomenal success in statehouses across the country. Since 2011, 45 states have raised their standards for student proficiency in reading and math, with the greatest…

  11. Core-Generating Discretization for Rough Set Feature Selection

    NASA Astrophysics Data System (ADS)

    Tian, David; Zeng, Xiao-Jun; Keane, John

    Rough set feature selection (RSFS) can be used to improve classifier performance. RSFS removes redundant attributes whilst keeping important ones that preserve the classification power of the original dataset. The feature subsets selected by RSFS are called reducts. The intersection of all reducts is called core. However, RSFS handles discrete attributes only. To process datasets consisting of real attributes, they are discretized before applying RSFS. Discretization controls core of the discrete dataset. Moreover, core may critically affect the classification performance of reducts. This paper defines core-generating discretization, a type of discretization method; analyzes the properties of core-generating discretization; models core-generating discretization using constraint satisfaction; defines core-generating approximate minimum entropy (C-GAME) discretization; models C-GAME using constraint satisfaction and evaluates the performance of C-GAME as a pre-processor of RSFS using ten datasets from the UCI Machine Learning Repository.

  12. The Core Competencies for Adolescent Sexual and Reproductive Health

    ERIC Educational Resources Information Center

    Elfers, John; Carlton, Lidia; Gibson, Paul; Puffer, Maryjane; Smith, Sharla; Todd, Kay

    2014-01-01

    The Adolescent Sexual Health Work Group commissioned the development of core competencies that define the knowledge, skills, and attitudes necessary for all providers of adolescent sexual and reproductive health. This article describes the background and rationale for this set of competencies, the history and use of competencies, and the process…

  13. INTERIOR VIEW, SETTING LARGE CORE WITH ASSISTANCE FROM THE OVERHEAD ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    INTERIOR VIEW, SETTING LARGE CORE WITH ASSISTANCE FROM THE OVERHEAD RAIL CRANE IN BOX FLOOR MOLD AREA (WORKERS: DAN T. WELLS AND TRUMAN CARLISLE). - Stockham Pipe & Fittings Company, Ductile Iron Foundry, 4000 Tenth Avenue North, Birmingham, Jefferson County, AL

  14. INTERIOR VIEW WITH CORE SET IN MOLD HALF IN BOX ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    INTERIOR VIEW WITH CORE SET IN MOLD HALF IN BOX FLOOR AREA. AWAITING OTHER MOLD HALF TO BE PLACED ON TOP. - Stockham Pipe & Fittings Company, Ductile Iron Foundry, 4000 Tenth Avenue North, Birmingham, Jefferson County, AL

  15. Core competencies of the entrepreneurial leader in health care organizations.

    PubMed

    Guo, Kristina L

    2009-01-01

    The purpose of this article is to discuss core competencies that entrepreneurial health care leaders should acquire to ensure the survival and growth of US health care organizations. Three overlapping areas of core competencies are described: (1) health care system and environment competencies, (2) organization competencies, and (3) interpersonal competencies. This study offers insight into the relationship between leaders and entrepreneurship in health care organizations and establishes the foundation for more in-depth studies on leadership competencies in health care settings. The approach for identifying core competencies and designing a competency model is useful for practitioners in leadership positions in complex health care organizations, so that through the understanding and practice of these 3 areas of core competencies, they can enhance their entrepreneurial leadership skills to become more effective health care entrepreneurial leaders. This study can also be used as a tool by health care organizations to better understand leadership performance, and competencies can be used to further the organization's strategic vision and for individual improvement purposes. PMID:19225332

  16. Atomic orbital basis sets for use with effective core potentials

    SciTech Connect

    Blaudeau, J.P.; Brozell, S.R.; Matsika, S.; Zhang, Z.; Pitzer, R.M.

    2000-03-15

    Basis sets developed for use with effective core potentials describe pseudo-orbitals rather than orbitals. The primitive Gaussian functions and the contraction coefficients in the basis set must therefore both describe the valence region effectively and allow the pseudo-orbital to be small in the core region. The latter is particularly difficult using 1s primitive functions, which have their maxima at the nucleus. Several methods of choosing contraction coefficients are tried, and it is found that natural orbitals give the best results. The number and optimization of primitive functions are done following Dunning's correlation-consistent procedure. Optimization of orbital exponents for larger atoms frequently results in coalescence of adjacent exponents; use of orbitals with higher principal quantum number is one alternative. Actinide atoms or ions provide the most difficult cases in that basis sets must be optimized for valence shells of different radial size simultaneously considering correlation energy and spin-orbit energy.

  17. Health Care Assistant Core. Instructor Manual.

    ERIC Educational Resources Information Center

    Feilner, Veronica; Robling, Jeannine

    This document contains the core curriculum for a basic high school course for health care assistants. It is designed as a 1-semester course of study, after which students can take a course in an emphasis area, such as veterinary, nursing, pharmacology, or physical therapy, in which they learn skills for specific entry-level jobs. The curriculum…

  18. Prevention Opportunities in Health Care Settings.

    ERIC Educational Resources Information Center

    Johnson, Suzanne Bennett; Millstein, Susan G.

    2003-01-01

    Reviews changing patterns of health and illness that have led to increased interest in the role of patient and provider behaviors, discussing the advantages of using health care settings as prevention sites. Presents examples of successful behaviorally-based prevention programs, offering evidence supporting their cost-effectiveness. Describes…

  19. Validation of the Comprehensive ICF Core Set for rheumatoid arthritis: the perspective of psychologists.

    PubMed

    Kirchberger, Inge; Cieza, Alarcos; Stucki, Gerold

    2008-01-01

    The 'Comprehensive ICF Core Set for rheumatoid arthritis (RA)' is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of patients with RA. The objective of this study was to validate this ICF Core Set from the perspective of psychologists. Psychologists experienced in RA treatment were asked about the problems of RA patients, treated by psychologists, in a three-round survey using the Delphi technique. Responses were linked to the ICF. Twenty psychologists in five countries gave a total of 303 responses that were linked to 65 different ICF categories. Fifteen responses were linked to the not yet developed ICF component personal factors and nine were not covered by ICF. Overall, 66% of the ICF categories linked to the responses of the psychologists were represented by the Comprehensive ICF Core Set for RA. Several responses that were not covered need to be investigated further. PMID:25160808

  20. Technologies for retrieving sediment cores in Antarctic subglacial settings.

    PubMed

    Hodgson, Dominic A; Bentley, Michael J; Smith, James A; Klepacki, Julian; Makinson, Keith; Smith, Andrew M; Saw, Kevin; Scherer, Reed; Powell, Ross; Tulaczyk, Slawek; Rose, Mike; Pearce, David; Mowlem, Matt; Keen, Peter; Siegert, Martin J

    2016-01-28

    Accumulations of sediment beneath the Antarctic Ice Sheet contain a range of physical and chemical proxies with the potential to document changes in ice sheet history and to identify and characterize life in subglacial settings. Retrieving subglacial sediments and sediment cores presents several unique challenges to existing technologies. This paper briefly reviews the history of sediment sampling in subglacial environments. It then outlines some of the technological challenges and constraints in developing the corers being used in sub-ice shelf settings (e.g. George VI Ice Shelf and Larsen Ice Shelf), under ice streams (e.g. Rutford Ice Stream), at or close to the grounding line (e.g. Whillans Ice Stream) and in subglacial lakes deep under the ice sheet (e.g. Lake Ellsworth). The key features of the corers designed to operate in each of these subglacial settings are described and illustrated together with comments on their deployment procedures. PMID:26667918

  1. Worksite health promotion programs in college settings.

    PubMed

    Hill-Mey, Patricia E; Kumpfer, Karol L; Merrill, Ray M; Reel, Justine; Hyatt-Neville, Beverly; Richardson, Glenn E

    2015-01-01

    The purpose of this paper is to describe the multifaceted nature and benefits of worksite health promotion programs (WHPPs), with emphasis on the college setting. An assessment of the peer-reviewed literature was conducted of articles published since 2000. Several search engines were accessed and selected key words were used. Most studies examining WHPPs have focused on return on investment and productivity. Research that targets the softer side-benefits of health promotion programs in the workplace is less available. Although the college setting offers some advantages for implementing health promotion programs. They may also have unique challenges due to their large and diverse employee population. There is little research to show the effectiveness and unique challenges of college-based health promotion programs. PMID:25861657

  2. Worksite health promotion programs in college settings

    PubMed Central

    Hill-Mey, Patricia E.; Kumpfer, Karol L.; Merrill, Ray M.; Reel, Justine; Hyatt-Neville, Beverly; Richardson, Glenn E.

    2015-01-01

    The purpose of this paper is to describe the multifaceted nature and benefits of worksite health promotion programs (WHPPs), with emphasis on the college setting. An assessment of the peer-reviewed literature was conducted of articles published since 2000. Several search engines were accessed and selected key words were used. Most studies examining WHPPs have focused on return on investment and productivity. Research that targets the softer side-benefits of health promotion programs in the workplace is less available. Although the college setting offers some advantages for implementing health promotion programs. They may also have unique challenges due to their large and diverse employee population. There is little research to show the effectiveness and unique challenges of college-based health promotion programs. PMID:25861657

  3. Development of a provisional core set of response measures for clinical trials of systemic sclerosis

    PubMed Central

    Khanna, D; Lovell, D J; Giannini, E; Clements, P J; Merkel, P A; Seibold, J R; Matucci-Cerinic, M; Denton, C P; Mayes, M D; Steen, V D; Varga, J; Furst, D E

    2013-01-01

    Objective To develop a provisional core set of response measures for clinical trials of systemic sclerosis (SSc). Methods The Scleroderma Clinical Trials Consortium (SCTC) conducted a structured, 3-round Delphi exercise to reach consensus on a core set of measures for clinical trials of SSc. Round 1 asked the SCTC investigators to list items in 11 pre-defined domains (skin, musculoskeletal, cardiac, pulmonary, cardio-pulmonary, gastrointestinal, renal, Raynaud phenomenon and digital ulcers, health-related quality of life and function, global health, and biomarkers) for SSc clinical trials. Round 2 asked respondents to rate the importance of the chosen items and was followed by a meeting, during which the Steering Committee discussed the feasibility, reliability, redundancy and validity of the items. Round 3 sought to obtain broader consensus on the core set measures. Members also voted on items that had data on feasibility but lacked data on reliability and validity, but may still be useful research outcome measures for future trials. Results A total of 50 SCTC investigators participated in round 1, providing 212 unique items for the 11 domains. In all, 46 (92%) participants responded in round 2 and rated 177 items. The ratings of 177 items were reviewed by the Steering Committee and 31 items from the 11 domains were judged to be appropriate for inclusion in a 1-year multi-centre clinical trial. In total, 40 SCTC investigators completed round 3 and ranked 30 of 31 items as acceptable for inclusion in the core set. The Steering Committee also proposed 14 items for a research agenda. Conclusion Using a Delphi exercise, we have developed a provisional core set of measures for assessment of disease activity and severity in clinical trials of SSc. PMID:17893248

  4. The CORE study protocol: a stepped wedge cluster randomised controlled trial to test a co-design technique to optimise psychosocial recovery outcomes for people affected by mental illness in the community mental health setting

    PubMed Central

    Palmer, Victoria J; Chondros, Patty; Piper, Donella; Callander, Rosemary; Weavell, Wayne; Godbee, Kali; Potiriadis, Maria; Richard, Lauralie; Densely, Konstancja; Herrman, Helen; Furler, John; Pierce, David; Schuster, Tibor; Iedema, Rick; Gunn, Jane

    2015-01-01

    Introduction User engagement in mental health service design is heralded as integral to health systems quality and performance, but does engagement improve health outcomes? This article describes the CORE study protocol, a novel stepped wedge cluster randomised controlled trial (SWCRCT) to improve psychosocial recovery outcomes for people with severe mental illness. Methods An SWCRCT with a nested process evaluation will be conducted over nearly 4 years in Victoria, Australia. 11 teams from four mental health service providers will be randomly allocated to one of three dates 9 months apart to start the intervention. The intervention, a modified version of Mental Health Experience Co-Design (MH ECO), will be delivered to 30 service users, 30 carers and 10 staff in each cluster. Outcome data will be collected at baseline (6 months) and at completion of each intervention wave. The primary outcome is improvement in recovery score using the 24-item Revised Recovery Assessment Scale for service users. Secondary outcomes are improvements to user and carer mental health and well-being using the shortened 8-item version of the WHOQOL Quality of Life scale (EUROHIS), changes to staff attitudes using the 19-item Staff Attitudes to Recovery Scale and recovery orientation of services using the 36-item Recovery Self Assessment Scale (provider version). Intervention and usual care periods will be compared using a linear mixed effects model for continuous outcomes and a generalised linear mixed effects model for binary outcomes. Participants will be analysed in the group that the cluster was assigned to at each time point. Ethics and dissemination The University of Melbourne, Human Research Ethics Committee (1340299.3) and the Federal and State Departments of Health Committees (Project 20/2014) granted ethics approval. Baseline data results will be reported in 2015 and outcomes data in 2017. Trial registration number Australian and New Zealand Clinical Trials Registry ACTRN

  5. Priority setting for health in emerging markets.

    PubMed

    Glassman, Amanda; Giedion, Ursula; McQueston, Kate

    2013-05-01

    The use of health technology assessment research in emerging economies is becoming an increasingly important tool to determine the uses of health spending. As low- and middle-income countries' gross domestic product grows, the funding available for health has increased in tandem. There is growing evidence that comparative effectiveness research and cost-effectiveness can be used to improve health outcomes within a predefined financial space. The use of these evaluation tools, combined with a systematized process of priority setting, can help inform national and global health payers. This review of country institutions for health technology assessment illustrates two points: the efforts underway to use research to inform priorities are widespread and not confined to wealthier countries; and many countries' efforts to create evidence-based policy are incomplete and more country-specific research will be needed. Further evidence shows that there is scope to reduce these gaps and opportunity to support better incorporation of data through better-defined priority-setting processes. PMID:24236627

  6. [Community health worker: a core element of health actions].

    PubMed

    Costa, Simone de Melo; Araújo, Flávia Ferreira; Martins, Laiara Versiani; Nobre, Lívia Lícia Rafael; Araújo, Fabrícia Magalhães; Rodrigues, Carlos Alberto Quintão

    2013-07-01

    This research sought to identify the actions developed by the Community Health Worker (CHW) in the context of family health in Montes Claros, State of Minas Gerais, Brazil. The research was conducted under the Program of Education through Work for Health-PET-SAÚDE, and is a quantitative study and census together with 241 CHWs. Most of them make family registrations and home visits, identify families with health risks and inform the health team. They also instruct families about available health services, arrange referrals and schedule consultations/exams, perform health education and teamwork reflections. Some also assist in the clinical environment. The majority who provide health education and those who are responsible for the referrals feel that they are professionally qualified for such tasks. CHWs are a core element of health actions, but the scope of performance requires investment in professional training to maintain the quality of the work executed by them in surveillance activities and teamwork reflection. In this way, the CHW can be jointly responsible for primary care and integrate the system of health care administration. PMID:23827919

  7. Developing core outcomes sets: methods for identifying and including patient-reported outcomes (PROs)

    PubMed Central

    2014-01-01

    Background Synthesis of patient-reported outcome (PRO) data is hindered by the range of available PRO measures (PROMs) composed of multiple scales and single items with differing terminology and content. The use of core outcome sets, an agreed minimum set of outcomes to be measured and reported in all trials of a specific condition, may improve this issue but methods to select core PRO domains from the many available PROMs are lacking. This study examines existing PROMs and describes methods to identify health domains to inform the development of a core outcome set, illustrated with an example. Methods Systematic literature searches identified validated PROMs from studies evaluating radical treatment for oesophageal cancer. PROM scale/single item names were recorded verbatim and the frequency of similar names/scales documented. PROM contents (scale components/single items) were examined for conceptual meaning by an expert clinician and methodologist and categorised into health domains. A patient advocate independently checked this categorisation. Results Searches identified 21 generic and disease-specific PROMs containing 116 scales and 32 single items with 94 different verbatim names. Identical names for scales were repeatedly used (for example, ‘physical function’ in six different measures) and others were similar (overlapping face validity) although component items were not always comparable. Based on methodological, clinical and patient expertise, 606 individual items were categorised into 32 health domains. Conclusion This study outlines a methodology for identifying candidate PRO domains from existing PROMs to inform a core outcome set to use in clinical trials. PMID:24495582

  8. Setting mental health priorities: problems and possibilities.

    PubMed

    Callahan, D

    1994-01-01

    A recent project at the Hastings Center examined the question of priority setting in the provision of mental health services. A central issue was whether those services should be prioritized independently of other health services. The answer to that question was no: they should have full parity. Even so, priority setting can be a complex venture. At the heart of any such effort will be the relationship between empirical evidence on treatment outcomes and efficacy and the political and ethical interests that legitimately bear on interpreting and using that evidence. An argument is made that a priority should be given those whose suffering and inability to function in ordinary life is most pronounced, even if the available treatment for them is comparatively less efficacious than for other conditions. PMID:7935242

  9. Content Validity of the Comprehensive ICF Core Set for Multiple Sclerosis from the Perspective of Speech and Language Therapists

    ERIC Educational Resources Information Center

    Renom, Marta; Conrad, Andrea; Bascuñana, Helena; Cieza, Alarcos; Galán, Ingrid; Kesselring, Jürg; Coenen, Michaela

    2014-01-01

    Background: The Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Multiple Sclerosis (MS) is a comprehensive framework to structure the information obtained in multidisciplinary clinical settings according to the biopsychosocial perspective of the International Classification of Functioning,…

  10. Respiratory protection in the health care setting.

    PubMed

    Schaefer, J A

    1997-01-01

    Respiratory protection is of increased importance due to the resurgence of tuberculosis. This chapter examines protective devices and regulations and explains how a program can be designed to minimize workplace hazards. Of particular value is a table detailing 12 high-efficiency particulate air respirators that meet criteria set by the Centers for Disease Control and the National Institute of Occupational Safety and Health. PMID:9353814

  11. Children's environmental health in agricultural settings.

    PubMed

    Karr, Catherine

    2012-01-01

    Children residing in rural settings may encounter environmental hazards derived from agricultural production activities. Health consequences of organic dusts, farm chemicals including pesticides, machinery noise, excess sun exposure, and zoonotic infectious agents have been clearly described among farm-working adults. The author reviews the related evidence base on child health with a life-stage perspective on their differential exposure and vulnerabilities. Methemoglobinemia among infants consuming nitrate-contaminated well water, neurodevelopmental health impacts associated with early life exposure to organophosphate pesticides, and diarrheal disease due to zoonotic infectious agents are well-described pediatric concerns. There is suggestive but more limited evidence for respiratory health consequences from air contaminants associated with confined animal feeding operations and hearing deficits for children exposed to machinery-related noise. Many contaminants of concern for children in these environments remain largely understudied-diesel exhaust, biomass burning, solvents, veterinary antibiotics, and silica-containing particulate matter. Overall, the state of knowledge and programmatic activities on agriculturally derived environmental contaminants and child health is immature and much less complete than for working adults. This overview provides a context for research, policy, and programmatic needs. PMID:22490026

  12. Measles in health-care settings.

    PubMed

    Maltezou, Helena C; Wicker, Sabine

    2013-07-01

    Despite the availability of an effective and safe vaccine for almost half a century, measles is re-emerging in several developed countries because of the insufficient vaccination coverage among specific subpopulations, the emerging anti-vaccination movement, and the increasing movement of humans across borders. In this context, health-care settings play a critical role in the transmission of infection and generation of numerous cases. Health-care-associated outbreaks may be associated with severe morbidity and mortality among specific groups of patients, disruption of health-care services, and considerable costs. Misdiagnosis or delayed diagnosis of a measles case and inadequate implementation of infection control measures are common in almost all events of nosocomial spread. Measles vaccination of health-care workers is an effective means of prevention of nosocomial measles outbreaks. Eliminating measles by 2010 has not been accomplished. Stronger recommendations and higher vaccination coverage against measles in health-care workers could contribute to eliminate measles in the general population. PMID:23352075

  13. The expanded FindCore method for identification of a core atom set for assessment of protein structure prediction.

    PubMed

    Snyder, David A; Grullon, Jennifer; Huang, Yuanpeng J; Tejero, Roberto; Montelione, Gaetano T

    2014-02-01

    Maximizing the scientific impact of NMR-based structure determination requires robust and statistically sound methods for assessing the precision of NMR-derived structures. In particular, a method to define a core atom set for calculating superimpositions and validating structure predictions is critical to the use of NMR-derived structures as targets in the CASP competition. FindCore (Snyder and Montelione, Proteins 2005;59:673-686) is a superimposition independent method for identifying a core atom set and partitioning that set into domains. However, as FindCore optimizes superimposition by sensitively excluding not-well-defined atoms, the FindCore core may not comprise all atoms suitable for use in certain applications of NMR structures, including the CASP assessment process. Adapting the FindCore approach to assess predicted models against experimental NMR structures in CASP10 required modification of the FindCore method. This paper describes conventions and a standard protocol to calculate an "Expanded FindCore" atom set suitable for validation and application in biological and biophysical contexts. A key application of the Expanded FindCore method is to identify a core set of atoms in the experimental NMR structure for which it makes sense to validate predicted protein structure models. We demonstrate the application of this Expanded FindCore method in characterizing well-defined regions of 18 NMR-derived CASP10 target structures. The Expanded FindCore protocol defines "expanded core atom sets" that match an expert's intuition of which parts of the structure are sufficiently well defined to use in assessing CASP model predictions. We also illustrate the impact of this analysis on the CASP GDT assessment scores. PMID:24327305

  14. Selection of stratified core sets representing wild apple (Malus sieversii)

    Technology Transfer Automated Retrieval System (TEKTRAN)

    In this report, we estimate the minimum core size necessary to maximally represent of the USDA’s National Plant Germplasm System M. sieversii collection. We have identified a subset of M. sieversii individuals that complements the previously published core subsets for two collection sites within Ka...

  15. The Expanded FindCore Method for Identification of a Core Atom Set for Assessment of Protein Structure Prediction

    PubMed Central

    Snyder, David A.; Grullon, Jennifer; Huang, Yuanpeng J.; Tejero, Roberto; Montelione, Gaetano T.

    2014-01-01

    Maximizing the scientific impact of NMR-based structure determination requires robust and statistically sound methods for assessing the precision of NMR-derived structures. In particular, a method to define a core atom set for calculating superimpositions and validating structure predictions is critical to the use of NMR-derived structures as targets in the CASP competition. FindCore (D.A. Snyder and G.T. Montelione PROTEINS 2005;59:673–686) is a superimposition independent method for identifying a core atom set, and partitioning that set into domains. However, as FindCore optimizes superimposition by sensitively excluding not-well-defined atoms, the FindCore core may not comprise all atoms suitable for use in certain applications of NMR structures, including the CASP assessment process. Adapting the FindCore approach to assess predicted models against experimental NMR structures in CASP10 required modification of the FindCore method. This paper describes conventions and a standard protocol to calculate an “Expanded FindCore” atom set suitable for validation and application in biological and biophysical contexts. A key application of the Expanded FindCore method is to identify a core set of atoms in the experimental NMR structure for which it makes sense to validate predicted protein structure models. We demonstrate the application of this Expanded FindCore method in characterizing well-defined regions of 18 NMR-derived CASP10 target structures. The Expanded FindCore protocol defines “expanded core atom sets” that match an expert’s intuition of which parts of the structure are sufficiently well-defined to use in assessing CASP model predictions. We also illustrate the impact of this analysis on the CASP GDT assessment scores. PMID:24327305

  16. Situational awareness in public health preparedness settings

    NASA Astrophysics Data System (ADS)

    Mirhaji, Parsa; Michea, Yanko F.; Zhang, Jiajie; Casscells, Samuel W.

    2005-05-01

    September 11 2001 attacks and following Anthrax mailings introduced emergent need for developing technologies that can distinguish between man made and natural incidents in the public health level. With this objective in mind, government agencies started a funding effort to foster the design, development and implementation of such systems on a wide scale. But the outcomes have not met the expectations set by the resources invested. Multiple elements explain this phenomenon: As it has been frequent with technology, introduction of new surveillance systems to the workflow equation has occurred without taking into consideration the need for understanding and inclusion of deeper personal, psychosocial, organizational and methodological concepts. The environment, in which these systems are operating, is complex, highly dynamic, uncertain, risky, and subject to intense time pressures. Such 'difficult' environments are very challenging to the human as a decision maker. In this paper we will challenge these systems from the perspective of human factors design. We will propose employment of systematic situational awareness research for design and implementation of the next generation public health preparedness infrastructures. We believe that systems designed based on results of such analytical definition of the domain enable public health practitioners to effectively collect the most important cues from the environment, process, interpret and understand the information in the context of organizational objectives and immediate tasks at hand, and use that understanding to forecast the short term and long term impact of the events in the safety and well being of the community.

  17. Responsiveness of the core set, response criteria, and utilities in early rheumatoid arthritis

    PubMed Central

    Verhoeven, A; Boers, M; van der Linden, S

    2000-01-01

    OBJECTIVE—Validation of responsiveness and discriminative power of the World Health Organisation/International League of Associations for Rheumatology (WHO/ILAR) core set, the American College of Rheumatology (ACR), and European League for Rheumatology (EULAR) criteria for improvement/response, and other single and combined measures (indices) in a trial in patients with early rheumatoid arthritis (RA).
METHODS—Ranking of measures by response (standardised response means and effect sizes) and between-group discrimination (unpaired t test and χ2 values) at two time points in the COBRA study. This study included 155 patients with early RA randomly allocated to two treatment groups with distinct levels of expected response: combined treatment, high response; sulfasalazine treatment, moderate response.
RESULTS—At week 16, standardised response means of core set measures ranged between 0.8 and 3.5 for combined treatment and between 0.4 and 1.2 for sulfasalazine treatment (95% confidence interval ±0.25). Performance of patient oriented measures (for example, pain, global assessment) was best when the questions were focused on the disease. The most responsive single measure was the patient's assessment of change in disease activity, at 3.5. Patient utility, a generic health status measure, was moderately (rating scale) to poorly (standard gamble) responsive. Response means of most indices (combined measures) exceeded 2.0, the simple count of core set measures improved by 20% was most responsive at 4.1. Discrimination performance yielded similar but not identical results: best discrimination between treatment groups was achieved by the EULAR response and ACR improvement criteria (at 20% and other percentage levels), the pooled index, and the disease activity score (DAS), but also by the Health Assessment Questionnaire (HAQ) and grip strength.
CONCLUSIONS—Responsiveness and discrimination between levels of response are not identical concepts, and

  18. Low Back Pain in 17 Countries, a Rasch Analysis of the ICF Core Set for Low Back Pain

    ERIC Educational Resources Information Center

    Roe, Cecilie; Bautz-Holter, Erik; Cieza, Alarcos

    2013-01-01

    Previous studies indicate that a worldwide measurement tool may be developed based on the International Classification of Functioning Disability and Health (ICF) Core Sets for chronic conditions. The aim of the present study was to explore the possibility of constructing a cross-cultural measurement of functioning for patients with low back pain…

  19. ICF Core Set for Head and Neck Cancer: Do the Categories Discriminate Among Clinically Relevant Subgroups of Patients?

    ERIC Educational Resources Information Center

    Tschiesner, Uta; Oberhauser, Cornelia; Cieza, Alarcos

    2011-01-01

    The multidisciplinary assessment of functioning in patients with head and neck cancer (HNC) according to the "ICF Core Set for Head and Neck Cancer" (ICF-HNC) was developed in an international and multi-disciplinary approach. The ICF-HNC is an application of the ICF that was adopted by the World Health Organization. The objective of this study was…

  20. Text Sets, Deep Learning, and the Common Core

    ERIC Educational Resources Information Center

    Donham, Jean

    2013-01-01

    The Common Core Curriculum Standards point educators toward rigorous or deep learning so that students will become "college and career ready." College-ready students engage with text in thoughtful ways so that they arrive at insights through interpretation, discussion, and analysis. One reading anchor standard of relevance for school…

  1. Evaluating Community Health Advisor (CHA) Core Competencies: The CHA Core Competency Retrospective Pretest/Posttest (CCCRP).

    PubMed

    Story, Lachel; To, Yen M

    2016-05-01

    Health care and academic systems are increasingly collaborating with community health advisors (CHAs) to provide culturally relevant health interventions that promote sustained community transformation. Little attention has been placed on CHA training evaluation, including core competency attainment. This study identified common CHA core competencies, generated a theoretically based measure of those competencies, and explored psychometric properties of that measure. A concept synthesis revealed five CHA core competencies (leadership, translation, guidance, advocacy, and caring). The CHA Core Competency Retrospective Pretest/Posttest (CCCRP) resulted from that synthesis, which was administered using multiple approaches to individuals who previously received CHA training (N= 142). Exploratory factor analyses revealed a two-factor structure underlying the posttraining data, and Cronbach's alpha indicated high internal consistency. This study suggested some CHA core competencies might be more interrelated than previously thought, and two major competencies exist rather than five and supported the CCCRP's use to evaluate core competency attainment resulting from training. PMID:25416701

  2. Reliability, construct validity and measurement potential of the ICF comprehensive core set for osteoarthritis

    PubMed Central

    2011-01-01

    Background This study aimed to investigate the reliability and construct validity of the International Classification of Functioning, Disability and Health (ICF) Comprehensive Core Set for osteoarthritis (OA) in order to test its possible use as a measuring tool for functioning. Methods 100 patients with OA (84 F, 16 M; mean age 63 yr) completed forms including demographic and clinical information besides the Short Form (36) Health Survey (SF-36®) and the Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC). The ICF Comprehensive Core Set for OA was filled by health professionals. The internal construct validities of "Body Functions-Body structures" (BF-BS), "Activity" (A), "Participation" (P) and "Environmental Factors" (EF) domains were tested by Rasch analysis and reliability by internal consistency and person separation index (PSI). External construct validity was evaluated by correlating the Rasch transformed scores with SF-36 and WOMAC. Results In each scale, some items showing disordered thresholds were rescored, testlets were created to overcome the problem of local dependency and items that did not fit to the Rasch model were deleted. The internal construct validity of the four scales (BF-BS 16 items, A 8 items, P 7 items, EF 13 items) were good [mean item fit (SD) 0.138 (0.921), 0.216 (1.237), 0.759 (0.986) and -0.079 (2.200); person item fit (SD) -0.147 (0.652), -0.241 (0.894), -0.310 (1.187) and -0.491 (1.173) respectively], indicating a single underlying construct for each scale. The scales were free of differential item functioning (DIF) for age, gender, years of education and duration of disease. Reliabilities of the BF-BS, A, P, and EF scales were good with Cronbach's alphas of 0.79, 0.86, 0.88, and 0.83 and PSI's of 0.76, 0.86, 0.87, and 0.71, respectively. Rasch scores of BF-BS, A, and P showed moderate correlations with SF-36 and WOMAC scores where the EF had significant but weak correlations only with SF36-Social

  3. Setting standards for primary health services.

    PubMed

    Garner, P; Thomason, J

    1993-10-01

    Clear performance guidelines, appropriate resources, supportive supervision, and appropriate training are needed to help primary health workers to uphold high-quality care. The Ministry of Health in Papua New Guinea and authorities of provincial health divisions have developed minimum standards for all levels of the primary health service, which supervisors use to monitor the performance of workers. These levels are aidposts with 1 community health worker, aidposts with 2 community health workers, health subcenters, health centers, and urban clinics. The standards are part of the National Health Plan. They form the basis for developing a national quality assurance plan. These standards allow health workers to understand what they need to do and supervisors to know on what to focus. They also allow the monitoring of quality care and rational planning. They guard against inappropriate health infrastructure development in areas where local politicians are active in sectoral investments. Some examples of standards for the first level of primary health services are: An orderly or a community health worker at an aidpost provides basic care for a population of 500-1000 people. The community health worker provides outpatient care each working day from 8 to 1300 hours. He/she needs to be available to provide care of acute minor illnesses evenings from 18 to 2000 hours and on call for serious illness at all times. The community health worker follows up on mothers and children seen at the maternal and child health clinic. He/she promotes family planning and provides oral contraceptives an injections. Each aidpost must have an outpatient treatment area suitable for conducting child clinics and patient examinations: sink; water supply; pharmacy; and sterilizer. The community health worker's house must have a tin roof, an external tank, and a latrine. PMID:8273154

  4. Hazardous waste compliance in health care settings.

    PubMed

    Marcoux, Rita M; Vogenberg, F Randy

    2015-02-01

    Pharmaceutical waste has become an urgent public health and environmental protection issue in recent years, leading to a variety of sometimes-conflicting federal and state legislation and regulations that health care entities must take seriously. PMID:25673960

  5. Mental Health Promotion Education in Multicultural Settings.

    ERIC Educational Resources Information Center

    Khanlou, Nazilla

    2003-01-01

    A mental health promotion perspective provides a system-based understanding of relationships between culture and health. Educating nurses for multicultural practice should adopt an interdisciplinary approach that fosters critical awareness of diverse influences on mental health and their intersections. (Contains 38 references.) (SK)

  6. Language core values in a multicultural setting: An Australian experience

    NASA Astrophysics Data System (ADS)

    Smolicz, Jerzy J.

    1991-03-01

    While it has been agreed by the members of the European Community (except the UK) that all secondary students should study two EC languages in addition to their own, in Australia the recent emphasis has been on teaching languages for external trade, particularly in the Asian region. This policy over-looks the 13 per cent of the Australian population who already speak a language other than English at home (and a greater number who are second generation immigrants), and ignores the view that it is necessary to foster domestic multiculturalism in order to have fruitful links with other cultures abroad. During the 1980s there have been moves to reinforce the cultural identity of Australians of non-English speaking background, but these have sometimes been half-hearted and do not fully recognise that cultural core values, including language, have to achieve a certain critical mass in order to be sustainable. Without this recognition, semi-assimilation will continue to waste the potential cultural and economic contributions of many citizens, and to lead to frustration and eventual violence. The recent National Agenda for a Multicultural Australia addresses this concern.

  7. Towards an ICF core set for ADHD: a worldwide expert survey on ability and disability.

    PubMed

    de Schipper, Elles; Mahdi, Soheil; Coghill, David; de Vries, Petrus J; Gau, Susan Shur-Fen; Granlund, Mats; Holtmann, Martin; Karande, Sunil; Levy, Florence; Almodayfer, Omar; Rohde, Luis; Tannock, Rosemary; Bölte, Sven

    2015-12-01

    This is the second in a series of four empirical studies designed to develop International Classification of Functioning, Disability and Health (ICF and Children and Youth version, ICF-CY) core sets for attention deficit hyperactivity disorder (ADHD). The objective of this stage was to gather the opinions from international experts on which ability and disability concepts were considered relevant to functioning in ADHD. An email-based survey was carried out amongst international experts in ADHD. Relevant functional ability and disability concepts were extracted from their responses and linked to the ICF/-CY categories by two independent researchers using a standardised linking procedure. 174 experts from 11 different disciplines and 45 different countries completed the survey. Meaningful concepts identified in their responses were linked to 185 ICF/-CY categories. Of these, 83 categories were identified by at least 5 % of the experts and considered the most relevant to ADHD: 30 of these were related to Body functions (most identified: attention functions, 85 %), 30 to Activities and Participation (most identified: school education, 52 %), 20 to Environmental factors (most identified: support from immediate family, 61 %), and 3 to Body structures (most identified: structure of brain, 83 %). Experts also provided their views on particular abilities related to ADHD, naming characteristics such as high-energy levels, flexibility and resiliency. Gender differences in the expression of ADHD identified by experts pertained mainly to females showing more internalising (e.g. anxiety, low self-esteem) and less externalising behaviours (e.g. hyperactivity), leading to a risk of late- and under-diagnosis in females. Results indicate that the impact of ADHD extends beyond the core symptom domains, into all areas of life and across the lifespan. The current study in combination with three additional preparatory studies (comprehensive scoping review, focus groups, clinical study

  8. Mental Health in Long Term Care Settings.

    ERIC Educational Resources Information Center

    Shore, Herbert

    1978-01-01

    There are many ways in which long-term care facilities attempt to cope with the mental health problems of the elderly. The author reviews five factors crucial to effective care for the aged in these facilities. (Author/RK)

  9. U.S. National Institutes of Health core consolidation-investing in greater efficiency.

    PubMed

    Chang, Michael C; Birken, Steven; Grieder, Franziska; Anderson, James

    2015-04-01

    The U.S. National Institutes of Health (NIH) invests substantial resources in core research facilities (cores) that support research by providing advanced technologies and scientific and technical expertise as a shared resource. In 2010, the NIH issued an initiative to consolidate multiple core facilities into a single, more efficient core. Twenty-six institutions were awarded supplements to consolidate a number of similar core facilities. Although this approach may not work for all core settings, this effort resulted in consolidated cores that were more efficient and of greater benefit to investigators. The improvements in core operations resulted in both increased services and more core users through installation of advanced instrumentation, access to higher levels of management expertise; integration of information management and data systems; and consolidation of billing; purchasing, scheduling, and tracking services. Cost recovery to support core operations also benefitted from the consolidation effort, in some cases severalfold. In conclusion, this program of core consolidation resulted in improvements in the effective operation of core facilities, benefiting both investigators and their supporting institutions. PMID:25649473

  10. Infection Control in Alternative Health Care Settings: An Update.

    PubMed

    Flanagan, Elaine; Cassone, Marco; Montoya, Ana; Mody, Lona

    2016-09-01

    With changing health care delivery, patients receive care at various settings including acute care hospitals, nursing homes, outpatient primary care and specialty clinics, and at home, exposing them to pathogens in various settings. Various health care settings face unique challenges, requiring individualized infection control programs. Infection control programs in nursing homes should address surveillance for infections and antimicrobial resistance, outbreak investigation and control plan for epidemics, isolation precautions, hand hygiene, staff education, and employee and resident health programs. PMID:27515148

  11. The Harmonizing Outcome Measures for Eczema (HOME) roadmap: a methodological framework to develop core sets of outcome measurements in dermatology.

    PubMed

    Schmitt, Jochen; Apfelbacher, Christian; Spuls, Phyllis I; Thomas, Kim S; Simpson, Eric L; Furue, Masutaka; Chalmers, Joanne; Williams, Hywel C

    2015-01-01

    Core outcome sets (COSs) are consensus-derived minimum sets of outcomes to be assessed in a specific situation. COSs are being increasingly developed to limit outcome-reporting bias, allow comparisons across trials, and strengthen clinical decision making. Despite the increasing interest in outcomes research, methods to develop COSs have not yet been standardized. The aim of this paper is to present the Harmonizing Outcomes Measures for Eczema (HOME) roadmap for the development and implementation of COSs, which was developed on the basis of our experience in the standardization of outcome measurements for atopic eczema. Following the establishment of a panel representing all relevant stakeholders and a research team experienced in outcomes research, the scope and setting of the core set should be defined. The next steps are the definition of a core set of outcome domains such as symptoms or quality of life, followed by the identification or development and validation of appropriate outcome measurement instruments to measure these core domains. Finally, the consented COS needs to be disseminated, implemented, and reviewed. We believe that the HOME roadmap is a useful methodological framework to develop COSs in dermatology, with the ultimate goal of better decision making and promoting patient-centered health care. PMID:25186228

  12. Recommended Patient-Reported Core Set of Symptoms to Measure in Head and Neck Cancer Treatment Trials

    PubMed Central

    Eisbruch, Avraham; Murphy, Barbara A.; Ridge, John A.; Gavin, Patrick; Reeve, Bryce B.; Bruner, Deborah Watkins; Movsas, Benjamin

    2014-01-01

    We identified a standard core set of patient-reported symptoms and health-related quality-of-life (HRQOL) domains to be assessed in head and neck (H&N) cancer clinical trials. The core symptom and HRQOL domain scores were used to guide recommendations by a working group of experts as part of a National Cancer Institute Symptom Management and HRQOL Clinical Trials Planning Meeting. A PubMed search was conducted using the search terms of “health-related quality of life” and “head & neck cancer,” limited to publications from January 1, 2000, to December 31, 2010. Fifty-four articles were used to guide the choice of recommendations. Twenty-nine symptoms and nine domains were identified, from which 12 H&N-specific core symptoms and HRQOL domains were recommended: swallowing, oral pain, skin changes, dry mouth, dental health, opening mouth/trismus, taste, excess/thick mucous/saliva, shoulder disability/motion, voice/hoarseness, social domain, and functional domain. This core set of 12 H&N-specific, patient-reported symptoms and HRQOL domains should be assessed in future H&N cancer clinical trials. PMID:25006189

  13. Recommended patient-reported core set of symptoms to measure in head and neck cancer treatment trials.

    PubMed

    Chera, Bhishamjit S; Eisbruch, Avraham; Murphy, Barbara A; Ridge, John A; Gavin, Patrick; Reeve, Bryce B; Bruner, Deborah Watkins; Movsas, Benjamin

    2014-07-01

    We identified a standard core set of patient-reported symptoms and health-related quality-of-life (HRQOL) domains to be assessed in head and neck (H&N) cancer clinical trials. The core symptom and HRQOL domain scores were used to guide recommendations by a working group of experts as part of a National Cancer Institute Symptom Management and HRQOL Clinical Trials Planning Meeting. A PubMed search was conducted using the search terms of "health-related quality of life" and "head & neck cancer," limited to publications from January 1, 2000, to December 31, 2010. Fifty-four articles were used to guide the choice of recommendations. Twenty-nine symptoms and nine domains were identified, from which 12 H&N-specific core symptoms and HRQOL domains were recommended: swallowing, oral pain, skin changes, dry mouth, dental health, opening mouth/trismus, taste, excess/thick mucous/saliva, shoulder disability/motion, voice/hoarseness, social domain, and functional domain. This core set of 12 H&N-specific, patient-reported symptoms and HRQOL domains should be assessed in future H&N cancer clinical trials. PMID:25006189

  14. Motivational interviewing in the health care setting

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Alcohol use disorders are related to many negative health, emotional, societal, and economic consequences. These disorders are often difficult to treat because individuals suffering from them tend to be ambivalent about and resistant to change. Motivational interviewing (MI) provides healthcare prov...

  15. Child health in low-resource settings: pathways through UK paediatric training.

    PubMed

    Goenka, Anu; Magnus, Dan; Rehman, Tanya; Williams, Bhanu; Long, Andrew; Allen, Steve J

    2013-11-01

    UK doctors training in paediatrics benefit from experience of child health in low-resource settings. Institutions in low-resource settings reciprocally benefit from hosting UK trainees. A wide variety of opportunities exist for trainees working in low-resource settings including clinical work, research and the development of transferable skills in management, education and training. This article explores a range of pathways for UK trainees to develop experience in low-resource settings. It is important for trainees to start planning a robust rationale early for global child health activities via established pathways, in the interests of their own professional development as well as UK service provision. In the future, run-through paediatric training may include core elements of global child health, as well as designated 'tracks' for those wishing to develop their career in global child health further. Hands-on experience in low-resource settings is a critical component of these training initiatives. PMID:23899919

  16. Cataloging Internet Resources: The Evolution of the Dublin Core Metadata Set.

    ERIC Educational Resources Information Center

    Rogers, Diane

    1997-01-01

    One of the recent innovations attempting to catalog Internet resources is a standard for resource description called the Dublin Core metadata set. Discussion includes application of library standards; development of metadata elements; ongoing refinement of the elements; and applying the Dublin Core. (AEF)

  17. Generally Contracted Valence-Core/Valence Basis Sets for Use with Relativistic Effective Core Potentials and Spin-Orbit Coupling Operators

    SciTech Connect

    Ermler, Walter V.; Tilson, Jeffrey L.

    2012-12-15

    A procedure for structuring generally contracted valence-core/valence basis sets of Gaussian-type functions for use with relativistic effective core potentials (gcv-c/v-RECP basis sets) is presented. Large valence basis sets are enhanced using a compact basis set derived for outer core electrons in the presence of small-core RECPs. When core electrons are represented by relativistic effective core potentials (RECPs), and appropriate levels of theory, these basis sets are shown to provide accurate representations of atomic and molecular valence and outer-core electrons. Core/valence polarization and correlation effects can be calculated using these basis sets through standard methods for treating electron correlation. Calculations of energies and spectra for Ru, Os, Ir, In and Cs are reported. Spectroscopic constants for RuO2+, OsO2+, Cs2 and InH are calculated and compared with experiment.

  18. Test Result Management in Global Health Settings

    PubMed Central

    Palazuelos, Daniel; Payne, Jonathan D.

    2012-01-01

    OVERVIEW Across the globe, the ways in which patients' test results are managed are as varied as the many different types of healthcare systems that manage these data. The outcomes, however, are often not too dissimilar: too many clinically significant test results fall through the cracks. The consequences of not following up test results in a timely manner are serious and often devastating to patients: diagnoses are delayed, treatments are not initiated or altered in time, and diseases progress. In resource-poor settings, test results too commonly get filed away within the paper chart in ways that isolate them and prevent passage to future providers caring for a patient. To make matters worse, the onus to act upon these test results often rests on patients who need to return to the clinic within a specified timeframe in order to obtain their results but who may not have the means or are too ill to do so. Even in more developed healthcare settings that use electronic records, clinical data residing in the electronic medical record (EMR) are often stubbornly “static”—key pieces of clinical information are frequently not recognized, retrieved, or shared easily. In this way, EMRs are not unlike paper record systems, and therefore, EMRs alone will not solve this problem. To illustrate this problem, consider the case of a patient newly diagnosed with HIV in 3 different healthcare delivery settings. PMID:24278831

  19. Content Validity of the Comprehensive ICF Core Set for Chronic Obstructive Pulmonary Diseases: An International Delphi Survey

    PubMed Central

    Jobst, Andrea; Kirchberger, Inge; Cieza, Alarcos; Stucki, Gerold; Stucki, Armin

    2013-01-01

    Introduction: The “Comprehensive ICF Core Set for Chronic Obstructive Pulmonary Diseases (COPD)“ is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of patients with COPD. The objective of this study was to validate this ICF Core Set from the perspective of physicians. Materials and Methodology: Physicians experienced in COPD treatment were asked about the patients’ problems treated by physicians in patients with COPD in a three-round electronic mail survey using the Delphi technique. Responses were linked to the ICF. Results: Seventy-six physicians in 44 countries gave a total of 1330 responses that were linked to 148 different ICF categories. Nine ICF categories were not represented in the Comprehensive ICF Core Set for COPD although at least 75% of the participants have rated them as important. Nineteen concepts were linked to the not yet developed ICF component personal factors and seventeen concepts were not covered by the ICF. Conclusion: The high percentage of ICF categories represented in the ICF Core Set for COPD indicates satisfactory content validity from the perspective of the physicians. However, some issues were raised that were not covered and need to be investigated further. PMID:23730367

  20. Designing Groups to Meet Evolving Challenges in Health Care Settings

    ERIC Educational Resources Information Center

    McCarthy, Christopher J.; Hart, Sonia

    2011-01-01

    This article provides an overview of the special issue on groups in health care settings and describes how each contribution addresses challenges and opportunities in the health care field for group work. Fundamental criteria for evaluating groups in such settings are applied to each contribution. Finally, trends and opportunities about the future…

  1. Core attributes of stewardship; foundation of sound health system.

    PubMed

    Kapoor, Neelesh; Kumar, Dewesh; Thakur, Nivedita

    2014-06-01

    Stewardship is not a new concept for public policy, but has not been used to its optimum by the health policy-makers. Although it is being practiced in most successful models of health system, but the onus to this function is still due till date. Lately, few experts in World Health Organization (WHO) have realized its importance and have been raising the issue at different platforms to pursue the most important function of the health system i.e. stewardship. The core attributes of stewardship need to be understood in totality for better understanding of the concept. These core attributes, required for hassle free functioning of a health system, include responsible manager, political will, normative dimension, balanced interventionist and proponents of good governance. PMID:24987714

  2. Acknowledging How Older Australian Women Experience Life After Stroke: How Does the WHO 18-Item Brief ICF Core Set for Stroke Compare?

    PubMed

    Tavener, Meredith; Thijsen, Amanda; Hubbard, Isobel J; Francis, J Lynn; Grennall, Claire; Levi, Christopher; Byles, Julie

    2015-01-01

    We examined older women's qualitative experiences of stroke with the World Health Organization's 18-item Brief International Classification of Functioning, Disability and Health Core Set for Stroke. Women were participants of the Australian Longitudinal Study on Women's Health, born between 1921 and 1926, who had experienced a stroke in the previous 3 years. An inductive thematic analysis was conducted of women's qualitative experiences of stroke, which were then examined with the 18-item Brief Core Set for Stroke for congruency. Our analysis showed that for older Australian women, their concerns of poststroke living were not adequately classified, potentially impeding a full recovery. PMID:26042797

  3. Breastfeeding promotion and priority setting in health.

    PubMed

    Horton, S; Sanghvi, T; Phillips, M; Fiedler, J; Perez-Escamilla, R; Lutter, C; Rivera, A; Segall-Correa, A M

    1996-06-01

    An increase in exclusive breastfeeding prevalence can substantially reduce mortality and morbidity among infants. In this paper, estimates of the costs and impacts of three breastfeeding promotion programmes, implemented through maternity services in Brazil, Honduras and Mexico, are used to develop cost-effectiveness measures and these are compared with other health interventions. The results show that breastfeeding promotion can be one of the most cost-effective health interventions for preventing cases of diarrhoea, preventing deaths from diarrhoea, and gaining disability-adjusted life years (DALYs). The benefits are substantial over a broad range of programme types. Programmes starting with the removal of formula and medications during delivery are likely to derive a high level of impact per unit of net incremental cost. Cost-effectiveness is lower (but still attractive relative to other interventions) if hospitals already have rooming-in and no bottle-feeds; and the cost-effectiveness improves as programmes become well-established. At an annual cost of about 30 to 40 US cents per birth, programmes starting with formula feeding in nurseries and maternity wards can reduce diarrhoea cases for approximately $0.65 to $1.10 per case prevented, diarrhoea deaths for $100 to $200 per death averted, and reduce the burden of disease for approximately $2 to $4 per DALY. Maternity services that have already eliminated formula can, by investing from $2 to $3 per birth, prevent diarrhoea cases and deaths for $3.50 to $6.75 per case, and $550 to $800 per death respectively, with DALYs gained at $12 to $19 each. PMID:10158457

  4. Core state preconception health indicators: a voluntary, multi-state selection process.

    PubMed

    Broussard, Danielle L; Sappenfield, William B; Fussman, Chris; Kroelinger, Charlan D; Grigorescu, Violanda

    2011-02-01

    This report describes the consensus-based selection process undertaken by a voluntary committee of policy/program leaders and epidemiologists from seven states to identify core state indicators to monitor the health of reproductive age women (aged 18-44 years). Domains of preconception health were established based on priority areas within maternal and child health and women's health. Measures (i.e., potential indicators) addressing the domains were identified from population-based, state level data systems. Each indicator was evaluated on five criteria: public health importance, policy/program importance, data availability, data quality, and the complexity of calculating the indicator. Evaluations served as the basis for iterative voting, which was continued until unanimous consent or a super majority to retain or exclude each indicator was achieved. Eleven domains of preconception health were identified: general health status and life satisfaction; social determinants of health; health care; reproductive health and family planning; tobacco, alcohol and substance use; nutrition and physical activity; mental health; emotional and social support; chronic conditions; infections; and genetics/epigenetics. Ninety-six possible indicators were identified from which 45 core indicators were selected. The scope of preconception care and the public health components to address preconception health are still under development. Despite this challenge and other measurement limitations, preconception health and health care indicators are urgently needed. The proposed core indicators are a set of measures that all states can use to evaluate their preconception health efforts. Furthermore, the indicators serve as a basis for improving the surveillance of the health of reproductive age women. PMID:20225127

  5. Allied Health Occupations II (Health Careers--Core Curriculum).

    ERIC Educational Resources Information Center

    Middletown Public Schools, CT.

    This volume outlines the requirements and content of a second-year course in allied health occupations education that is designed to provide students with background informational material and practical skills used in various health fields. Addressed in the individual units of the course are the following topics: safety; ethical and legal…

  6. Priority-setting for achieving universal health coverage

    PubMed Central

    Chalkidou, Kalipso; Glassman, Amanda; Marten, Robert; Vega, Jeanette; Tritasavit, Nattha; Gyansa-Lutterodt, Martha; Seiter, Andreas; Kieny, Marie Paule; Hofman, Karen; Culyer, Anthony J

    2016-01-01

    Abstract Governments in low- and middle-income countries are legitimizing the implementation of universal health coverage (UHC), following a United Nation’s resolution on UHC in 2012 and its reinforcement in the sustainable development goals set in 2015. UHC will differ in each country depending on country contexts and needs, as well as demand and supply in health care. Therefore, fundamental issues such as objectives, users and cost–effectiveness of UHC have been raised by policy-makers and stakeholders. While priority-setting is done on a daily basis by health authorities – implicitly or explicitly – it has not been made clear how priority-setting for UHC should be conducted. We provide justification for explicit health priority-setting and guidance to countries on how to set priorities for UHC. PMID:27274598

  7. Priority-setting for achieving universal health coverage.

    PubMed

    Chalkidou, Kalipso; Glassman, Amanda; Marten, Robert; Vega, Jeanette; Teerawattananon, Yot; Tritasavit, Nattha; Gyansa-Lutterodt, Martha; Seiter, Andreas; Kieny, Marie Paule; Hofman, Karen; Culyer, Anthony J

    2016-06-01

    Governments in low- and middle-income countries are legitimizing the implementation of universal health coverage (UHC), following a United Nation's resolution on UHC in 2012 and its reinforcement in the sustainable development goals set in 2015. UHC will differ in each country depending on country contexts and needs, as well as demand and supply in health care. Therefore, fundamental issues such as objectives, users and cost-effectiveness of UHC have been raised by policy-makers and stakeholders. While priority-setting is done on a daily basis by health authorities - implicitly or explicitly - it has not been made clear how priority-setting for UHC should be conducted. We provide justification for explicit health priority-setting and guidance to countries on how to set priorities for UHC. PMID:27274598

  8. Taking mHealth Forward: Examining the Core Characteristics

    PubMed Central

    2016-01-01

    The emergence of mobile health (mHealth) offers unique and varied opportunities to address some of the most difficult problems of health. Some of the most promising and active efforts of mHealth involve the engagement of mobile phone technology. As this technology has spread and as this technology is still evolving, we begin a conversation about the core characteristics of mHealth relevant to any mobile phone platform. We assert that the relevance of these characteristics to mHealth will endure as the technology advances, so an understanding of these characteristics is essential to the design, implementation, and adoption of mHealth-based solutions. The core characteristics we discuss are (1) the penetration or adoption into populations, (2) the availability and form of apps, (3) the availability and form of wireless broadband access to the Internet, and (4) the tethering of the device to individuals. These collectively act to both enable and constrain the provision of population health in general, as well as personalized and precision individual health in particular. PMID:27511612

  9. Taking mHealth Forward: Examining the Core Characteristics.

    PubMed

    Davis, Teaniese Latham; DiClemente, Ralph; Prietula, Michael

    2016-01-01

    The emergence of mobile health (mHealth) offers unique and varied opportunities to address some of the most difficult problems of health. Some of the most promising and active efforts of mHealth involve the engagement of mobile phone technology. As this technology has spread and as this technology is still evolving, we begin a conversation about the core characteristics of mHealth relevant to any mobile phone platform. We assert that the relevance of these characteristics to mHealth will endure as the technology advances, so an understanding of these characteristics is essential to the design, implementation, and adoption of mHealth-based solutions. The core characteristics we discuss are (1) the penetration or adoption into populations, (2) the availability and form of apps, (3) the availability and form of wireless broadband access to the Internet, and (4) the tethering of the device to individuals. These collectively act to both enable and constrain the provision of population health in general, as well as personalized and precision individual health in particular. PMID:27511612

  10. Health Care. Georgia Core Standards for Occupational Clusters.

    ERIC Educational Resources Information Center

    Georgia Univ., Athens. Dept. of Occupational Studies.

    This document lists core standards and occupational knowledge and skills that have been identified/validated by industry as necessary to all Georgia students in secondary-level health care occupations programs. First, foundation skills are grouped as follows: basic skills (reading, writing, arithmetic/mathematics, listening, speaking); thinking…

  11. Teacher's Guide for Competency Based Core Curriculum for Health Occupations.

    ERIC Educational Resources Information Center

    Meckley, Richard; And Others

    This teacher's guide is intended to acompany the Competency Based Core Curriculum for Health Occupations student materials--see note. Contents include suggested tests and answer keys for student evaluation and a tool and equipment list. A comprehensive bibliography is organized into these topics: dental hygiene, medical laboratory technology,…

  12. Mental health-related stigma in health care and mental health-care settings.

    PubMed

    Henderson, Claire; Noblett, Jo; Parke, Hannah; Clement, Sarah; Caffrey, Alison; Gale-Grant, Oliver; Schulze, Beate; Druss, Benjamin; Thornicroft, Graham

    2014-11-01

    This Review considers the evidence for mental-health-related stigma in health-care and mental-health-care settings. Do mental-health-care and other health-care professionals stigmatise people using their services? If so, what are the effects on quality of mental and physical health care? How can stigma and discrimination in the context of health care be reduced? We show that the contact mental-health-care professionals have with people with mental illness is associated with positive attitudes about civil rights, but does not reduce stigma as does social contact such as with friends or family members with mental illness. Some evidence suggests educational interventions are effective in decreasing stigma especially for general health-care professionals with little or no formal mental health training. Intervention studies are needed to underpin policy; for instance, to decrease disparity in mortality associated with poor access to physical health care for people with mental illness compared with people without mental illness. PMID:26361202

  13. Exploring nurses' and patients' perspectives of limit setting in a forensic mental health setting.

    PubMed

    Maguire, Tessa; Daffern, Michael; Martin, Trish

    2014-04-01

    Limit setting is an intervention that is frequently used by mental health nurses. However, limit setting is poorly conceptualized, its purpose is unclear, and there are few evidence-based guidelines to assist nurses to set limits in a safe and effective manner. What is known is that the manner in which nurses set limits influences patients' perceptions of the interactions and their emotional and behavioural responses. In this qualitative study, 12 nurses and 12 patients participated in personal, semistructured interviews that aimed to explore limit setting and to propose principles to guide practice. The findings suggested that: (i) limit setting is important to safety in mental health hospitals; (ii) engaging patients in an empathic manner is necessary when setting limits (when nurses engage in an empathic manner, the therapeutic relationship is more likely to be preserved and the risk of aggressive responses is reduced); and (iii) an authoritative (fair, respectful, consistent, and knowledgeable), rather than authoritarian (controlling and indifferent), limit-setting style enhances positive outcomes with regards to adherence, reduced likelihood of aggression, and preservation of the therapeutic relationship. In conclusion, a limit-setting style characterized by empathic responding and an authoritative, rather than authoritarian interpersonal, style is recommended. Elucidating the components of this style is critical for effective training and best practice of mental health nurses, and to reduce aggressive responses from limit setting. PMID:23822138

  14. Social Antecedents of Learned Helplessness in the Health Care Setting.

    ERIC Educational Resources Information Center

    Solomon, Kenneth

    1982-01-01

    Examines social factors that lead to the development of learned helplessness in elderly persons in the health care setting, including stereotyping elderly by health care professionals, effects of unequal interpersonal exchange, and behaviors associated with sick and healer roles. Discusses programatic and educational prophylaxis and solutions to…

  15. Management of Teenage Pregnancies in Three Different Health Care Settings.

    ERIC Educational Resources Information Center

    Tatelbaum, Robert

    1978-01-01

    This paper reports a retrospective study undertaken to determine if differences existed in obstetric outcome, contraceptive usage, and repeat pregnancy rates of teenage patients cared for in three different health care settings: the Rochester Adolescent Maternity Project (RAMP), a traditional obstetric clinic, and a neighborhood health center.…

  16. Assessing Health Literacy in Diverse Primary Care Settings

    ERIC Educational Resources Information Center

    McCune, Renee L.

    2010-01-01

    Patient health literacy skills are critical to effective healthcare communication and safe care delivery in primary care settings. Methods and strategies to identify patient health literacy (HL) capabilities and provider/staff knowledge, attitudes and beliefs (KAB) regarding HL must be known before addressing provider/staff communication skills.…

  17. Improving maternal, newborn and women's reproductive health in crisis settings

    PubMed Central

    Chi, Primus Che; Urdal, Henrik; Umeora, Odidika Uj; Sundby, Johanne; Spiegel, Paul; Devane, Declan

    2015-01-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: To identify, synthesise and evaluate the effects of health system and other interventions aimed at improving maternal, newborn and women's reproductive health in crisis settings.

  18. Approaches to Developing Health in Early Years Settings

    ERIC Educational Resources Information Center

    Mooney, Ann; Boddy, Janet; Statham, June; Warwick, Ian

    2008-01-01

    Purpose: The purpose of the paper is to consider the opportunities and difficulties in developing health-promotion work in early years settings in the UK. Design/methodology/approach: As the first study of its kind conducted in the UK, a multi-method approach was adopted involving: an overview of health-related guidance and of effective…

  19. Goal Setting: A Strategy for Reducing Health Disparities

    ERIC Educational Resources Information Center

    Young, Tara D.; Barrett, Gloria J.; Martin, Anna C.; Metz, Diane L.; Kaiser, Lucia L.; Steinberg, Francene M.

    2011-01-01

    The Healthy Rewards study tested the effectiveness of goal setting to encourage behavior change in Latino and African American adults in three northern California counties. Four groups of adults were alternately assigned to receive either 1) basic health promotion and nutrition education without goal setting (control) or 2) the same education with…

  20. Towards a minimal generic set of domains of functioning and health

    PubMed Central

    2014-01-01

    Background The World Health Organization (WHO) has argued that functioning, and, more concretely, functioning domains constitute the operationalization that best captures our intuitive notion of health. Functioning is, therefore, a major public-health goal. A great deal of data about functioning is already available. Nonetheless, it is not possible to compare and optimally utilize this information. One potential approach to address this challenge is to propose a generic and minimal set of functioning domains that captures the experience of individuals and populations with respect to functioning and health. The objective of this investigation was to identify a minimal generic set of ICF domains suitable for describing functioning in adults at both the individual and population levels. Methods We performed a psychometric study using data from: 1) the German National Health Interview and Examination Survey 1998, 2) the United States National Health and Nutrition Examination Survey 2007/2008, and 3) the ICF Core Set studies. Random Forests and Group Lasso regression were applied using one self-reported general-health question as a dependent variable. The domains selected were compared to those of the World Health Survey (WHS) developed by the WHO. Results Seven domains of the International Classification of Functioning, Disability and Health (ICF) are proposed as a minimal generic set of functioning and health: energy and drive functions, emotional functions, sensation of pain, carrying out daily routine, walking, moving around, and remunerative employment. The WHS domains of self-care, cognition, interpersonal activities, and vision were not included in our selection. Conclusions The minimal generic set proposed in this study is the starting point to address one of the most important challenges in health measurement – the comparability of data across studies and countries. It also represents the first step in developing a common metric of health to link information

  1. Genetic structure and a selected core set of Brazilian soybean cultivars

    PubMed Central

    Priolli, Regina Helena Geribello; Wysmierski, Philip Traldi; da Cunha, Camila Pinto; Pinheiro, José Baldin; Vello, Natal Antonio

    2013-01-01

    Soybean is one of the most valuable and profitable oil crop species and a thorough knowledge of the genetic structure of this crop is necessary for developing the best breeding strategies. In this study, a representative collection of soybean cultivars recommended for farming in all Brazilian regions was genotyped using 27 simple sequence repeat (SSR) loci. A total of 130 alleles were detected, with an average allelic number of 4.81 per locus. These alleles determined the core set that best represented this soybean germplasm. The Bayesian analysis revealed the presence of two clusters or subgroups within the whole collection (435 soybean cultivars) and the core set (31 entries). Cultivars of similar origin (ancestral) were clustered into the same groups in both analyses. The genetic diversity parameters, based on the SSR loci, revealed high similarity between the whole collection and core set. Differences between the two clusters detected in the core set were attributed more to the frequency of their ancestors than to their genetic base. In terms of ancestry, divergent groups were presented and a panel is shown which may foster efficient breeding programs and aid soybean breeders in planning reliable crossings in the development of new varieties. PMID:24130446

  2. Adopting a Core Set of Leadership Qualities in Support of Performance-Based Training.

    ERIC Educational Resources Information Center

    Fowler, William R.

    1994-01-01

    Identifies a core set of leadership qualities, and prescribes observable, measurable, and learnable behaviors for each. A review of the following major leadership themes is presented: power-influence research, trait research, behavior research, situation research, excellence, quality, empowerment, ethics, and vision. (Contains seven references.)…

  3. Setting Standards on the Core and Advanced iSkills[TM] Assessments. Research Memorandum

    ERIC Educational Resources Information Center

    Tannenbaum, Richard J.; Katz, Irvin R.

    2008-01-01

    This report documents a standard-setting study to determine recommended minimum scores (cut scores) needed on the Core and Advanced iSkills[TM] assessments for examinees to be considered at a foundational level of ICT literacy skill. Two foundational levels--one for each iSkills assessment--had been specified previously by the National ICT…

  4. A New Program for Detecting the Geometrical Core of a Set of Structures of Macromolecular Complexes.

    PubMed

    Vakulenko, Yu A; Nagaev, B E; Alexeevski, A V; Karyagina, A S; Spirin, S A

    2016-04-01

    Comparison of structures of homological proteins often helps to understand functionally significant features of these structures. This concerns not only structures of separate protein chains, but also structures of macromolecular complexes. In particular, a comparison of complexes of homologous proteins with DNA is significant for analysis of the recognition of DNA by proteins. We present program LCore for detecting geometrical cores of a family of structures; a geometrical core is a set of amino acid residues and nucleotides that disposed similarly in all structures of the family. We describe the algorithm of the program, its web interface, and an example of its application to analysis of complexes of homeodomains with DNA. PMID:27293101

  5. Contextualizing an Expanded Definition of Health Literacy among Adolescents in the Health Care Setting

    ERIC Educational Resources Information Center

    Massey, Philip M.; Prelip, Michael; Calimlim, Brian M.; Quiter, Elaine S.; Glik, Deborah C.

    2012-01-01

    The current emphasis on preventive health care and wellness services suggests that measures of skills and competencies needed to effectively navigate the health care system need to be better defined. We take an expanded perspective of health literacy and define it as a set of skills used to organize and apply health knowledge, attitudes and…

  6. Empowering nurses for work engagement and health in hospital settings.

    PubMed

    Laschinger, Heather K Spence; Finegan, Joan

    2005-10-01

    Employee empowerment has become an increasingly important factor in determining employee health and wellbeing in restructured healthcare settings. The authors tested a theoretical model which specified the relationships among structural empowerment, 6 areas of worklife that promote employee engagement, and staff nurses' physical and mental health. A predictive, non-experimental design was used to test the model in a random sample of staff nurses. The authors discuss their findings and the implication for nurse administrators. PMID:16220057

  7. Privacy Concerns and Disclosure Behavior in a Health Setting

    PubMed Central

    Caine, Kelly E.; Burnham, Kaylee E.; Fisk, Arthur D.; Rogers, Wendy A.

    2014-01-01

    Health care practitioners need complete and accurate information to provide quality care to their patients. However, health information is considered to be highly private. Patients may have concerns about disclosing such information, especially if asked to provide this information using technology. The goal of this study was to investigate how participants’ experience with a technology affect their level of disclosure in a health setting. Specifically, we were interested in understanding how the use of a health database system influences the disclosure of private health information. We asked 12 younger and 12 older adults to interact with a computerized health data entry system and then to rate the completeness and accuracy of their intended disclosures. Results indicate that, for the most part, participants would provide complete and accurate information using such a system. Younger adults were less likely than older adults to intend to disclose sensitive information, suggesting that additional information gathering may be appropriate for younger adults. The importance of providing a reason for the request of each piece of health information is discussed in relation to the setting where information is gathered. PMID:25349550

  8. Infant Mental Health Home Visitation: Setting and Maintaining Professional Boundaries

    ERIC Educational Resources Information Center

    Barron, Carla; Paradis, Nichole

    2010-01-01

    Relationship-based infant mental health home visiting services for infants, toddlers, and their families intensify the connection between the personal and professional. To promote the therapeutic relationship and maximize the effectiveness of the intervention, home visitors must exercise good judgment, in the field and in the moment, to set and…

  9. Settings for health promotion: an analytic framework to guide intervention design and implementation.

    PubMed

    Poland, Blake; Krupa, Gene; McCall, Douglas

    2009-10-01

    Taking a settings approach to health promotion means addressing the contexts within which people live, work, and play and making these the object of inquiry and intervention as well as the needs and capacities of people to be found in different settings. This approach can increase the likelihood of success because it offers opportunities to situate practice in its context. Members of the setting can optimize interventions for specific contextual contingencies, target crucial factors in the organizational context influencing behavior, and render settings themselves more health promoting. A number of attempts have been made to systematize evidence regarding the effectiveness of interventions in different types of settings (e.g., school-based health promotion, community development). Few, if any, attempts have been made to systematically develop a template or framework for analyzing those features of settings that should influence intervention design and delivery. This article lays out the core elements of such a framework in the form of a nested series of questions to guide analysis. Furthermore, it offers advice on additional considerations that should be taken into account when operationalizing a settings approach in the field. PMID:19809004

  10. Core set of recommendations for patients with ankylosing spondylitis concerning behaviour and environmental adaptations.

    PubMed

    Feldtkeller, Ernst; Lind-Albrecht, Gudrun; Rudwaleit, Martin

    2013-09-01

    Advice concerning behaviour and adaptations of living and working environment is considered an unmet need by patients with ankylosing spondylitis (AS). The aim of this study was to develop a core set of recommendations to be given to patients by their rheumatologists. A systematic literature research of scientific and patient-oriented literature revealed 70 raw recommendations. These recommendations were evaluated and ranked at a meeting of the Ankylosing Spondylitis International Federation (ASIF, 26 participants including 19 patients with AS, 5 rheumatologists and 2 physiotherapists from 13 countries) in November 2011. Thereafter, the 59 remaining recommendations were extensively discussed, supplemented, reworded, condensed and voted on during a meeting of local branch leaders of the AS patient organisation in Germany (Deutsche Vereinigung Morbus Bechterew, DVMB) with 80 participants (95 % of whom with AS), 2 rheumatologists and 1 occupational therapist in March 2012. The core set of final recommendations comprises (1) a general statement regarding living with AS which was considered highly important by patients and (2) the following domains: sitting position, walking, sleeping, at work, exercises, sports and recreational activities, diet and lifestyle, sexuality and pregnancy, fall prevention, car driving and advantages of membership in an AS-specific patient organisation. Most recommendations are relevant already in early disease, others concern advanced AS (e.g. fall prevention and car driving). The selected recommendations received high agreements (80-100 %). A first core set of recommendations for the behaviour and environmental adaptations of patients with AS was established under participation of many patients. PMID:23539272

  11. Segmented contracted basis sets for one- and two-component Dirac-Fock effective core potentials.

    PubMed

    Weigend, Florian; Baldes, Alexander

    2010-11-01

    Segmented contracted basis sets for 4d, 5d, 5s, and 6s elements of split (double zeta) valence to quadruple zeta valence quality optimized for Dirac-Fock effective core potentials (ECPs) are presented. They were obtained from previous bases optimized for Wood-Boring ECPs by comparably small modifications and reoptimizations. Additionally extensions for two-component self-consistent-field treatments accounting for spin-orbit (SO) coupling were designed and optimized. Reliability for chemical applications was assessed by comparing results to those obtained with a very large (19s16p17d7f6g) reference basis for a set of more than 80 representatively chosen 5s-5d compounds. Moreover, the effect of different types of ECPs and that of the SO-coupling at the basis set limit of density functional theory is documented for the above set of molecules extended by 40 5p-6p compounds. PMID:21054001

  12. Providing nursing leadership in a community residential mental health setting.

    PubMed

    Hughes, Frances A; Bamford, Anita

    2011-07-01

    The worldwide burden of mental illness is increasing. Strong leadership is increasingly emerging as a core component of good mental health nursing. The aim of this article is to demonstrate the ways in which nurses can provide strong and consistent leadership in a values-based practice environment that embodies respect for individuals' dignity and self-determination within a community residential mental health service, which provides a structural foundation for effective action. This is accomplished through the presentation of two vignettes, which highlight how the seemingly impossible becomes possible when an economic paradigm such as agency theory is exchanged for a sociological and psychological paradigm found in leadership as stewardship at the point of service. It is through stronger nursing leadership in mental health that stigma and discrimination can be reduced and better access to treatments and services can be gained by those with mental illness. Nurse leadership in mental health services is not new, but it is still relatively uncommon to see residential services for "high needs" individuals being led by nurses. How nurses meet the challenges faced by mental health services are often at the heart of effective leadership skills and strategies. PMID:21702426

  13. The Ice Core Data Gateway: A Multi-Agency Effort to Provide On-line Access to Ice Core Data Sets

    NASA Astrophysics Data System (ADS)

    Bauer, R.; Scharfen, G.; Scambos, T.; Eakin, M.; Anderson, D.

    2001-05-01

    The NSF-funded Antarctic Glaciological Data Center (AGDC) at the National Snow and Ice Data Center provides data management for the U.S. Antarctic Glaciological Program including ice core data from the Antarctic. The World Data Center for Paleoclimatology archives ice core data sets from many sites, globally. Recently, the AGDC, the WDC for Paleoclimatology and representatives from the International Ice Core Data Cooperative have developed a coordinated and cooperative approach to ice core data management. The Ice Core Data Gateway provides a single point of contact for access and submission for the research community to the breadth of ice core data sets. The need for a single point of contact for all ice core data was called for at the Spring 2000 Ice Core Working Group meeting in Denver. The design of the gateway allows for the continuation of valuable discipline-specific expertise and program-centric activities at the data centers, but utilizes web technology to provide a single point of entry for users. This poster describes existing and planned roles of the key ice core data management groups and technical issues such as common variable names, metadata, and quality control. We seek feedback from the ice core community regarding the Ice Core Data Gateway.

  14. Participation in health impact assessment: objectives, methods and core values.

    PubMed Central

    Wright, John; Parry, Jayne; Mathers, Jonathan

    2005-01-01

    Health impact assessment (HIA) is a multidisciplinary aid to decision-making that assesses the impact of policy on public health and on health inequalities. Its purpose is to assist decision-makers to maximize health gains and to reduce inequalities. The 1999 Gothenburg Consensus Paper (GCP) provides researchers with a rationale for establishing community participation as a core value of HIA. According to the GCP, participation in HIA empowers people within the decision-making process and redresses the democratic deficit between government and society. Participation in HIA generates a sense that health and decision-making is community-owned, and the personal experiences of citizens become integral to the formulation of policy. However, the participatory and empowering dimensions of HIA may prove difficult to operationalize. In this review of the participation strategies adopted in key applications of HIA in the United Kingdom, we found that HIA's aim of influencing decision-making creates tension between its participatory and knowledge-gathering dimensions. Accordingly, researchers have decreased the participatory dimension of HIA by reducing the importance attached to the community's experience of empowerment, ownership and democracy, while enlarging its knowledge-gathering dimension by giving pre-eminence to "expert" and "research-generated" evidence. Recent applications of HIA offer a serviceable rationale for participation as a means of information gathering and it is no longer tenable to uphold HIA as a means of empowering communities and advancing the aims of participatory democracy. PMID:15682250

  15. Decreasing nurse staffing costs in a hospital setting: development and support of core staff stability.

    PubMed

    Tuttas, Carol A

    2003-01-01

    The nursing shortage is a well-documented phenomenon that has impacted health care settings woldwide. A corresponding magnitudinal cost factor is linked directly to this dilemma, health care organizations struggle to meet professional nurse staffing, safety and quality requirements. The acute care hospital setting in South Florida is one of the hardest hit by the bedside nurse shortage. Nurse staffing presents as a cost accounting challenge that demands the application of management control systems by creative, energetic, and financially savvy nursing system administrators. Future-oriented planning is critical if repercussions of a foreseeable progressive worsening of this condition are to be avoided and control of future patient outcomes achieved. PMID:12856907

  16. Promoting health and preventing disease in health care settings: an analysis of barriers.

    PubMed

    Orlandi, M A

    1987-01-01

    Changes in lifestyle that promote health-enhancing behaviors and inhibit health-compromising behaviors have been recommended by the U.S. Surgeon General as an integral component of our general strategy for improving the health of the nation. A variety of innovations including new knowledge, new products, and new services have been developed with this recommendation in mind, and a major objective of these efforts is to identify settings for the effective diffusion and adoption of these new approaches into population groups that can make use of them. Health care settings such as hospitals, clinics, community health centers, health maintenance organizations, and private physicians' offices offer unique possibilities in this regard. Though opportunities exist for promoting health and preventing disease in other settings like schools and worksites, the primary objectives of such organizations are unrelated to health. Despite the obvious potential, however, our health care system has, in general, retained as its primary emphasis the treatment of disease rather than the enhancement of health. This article reviews the opportunities for health promotion and disease prevention in health care settings and identifies a range of barriers to such efforts. These barriers are discussed within a framework that focuses on dissemination and implementation as critical steps in the knowledge transfer process. Strategies for overcoming these barriers are described within the context of general linkage theory. PMID:3823010

  17. Qualitative methodologies in health-care priority setting research.

    PubMed

    Smith, Neale; Mitton, Craig; Peacock, Stuart

    2009-10-01

    Priority setting research in health economics has traditionally employed quantitative methodologies and been informed by post-positivist philosophical assumptions about the world and the nature of knowledge. These approaches have been rewarded with well-developed and validated tools. However, it is now commonly noted that there has been limited uptake of economic analysis into actual priority setting and resource allocation decisions made by health-care systems. There seem to be substantial organizational and political barriers. The authors argue in this paper that understanding and addressing these barriers will depend upon the application of qualitative research methodologies. Some efforts in this direction have been attempted; however these are theoretically under-developed and seldom rooted in any of the established qualitative research traditions. Two such approaches - narrative inquiry and discourse analysis - are highlighted here. These are illustrated with examples drawn from a real-world priority setting study. The examples demonstrate how such conceptually powerful qualitative traditions produce distinctive findings that offer unique insight into organizational contexts and decision-maker behavior. We argue that such investigations offer untapped benefits for the study of organizational priority setting and thus should be pursued more frequently by the health economics research community. PMID:18972324

  18. A strategy to improve priority setting in health care institutions.

    PubMed

    Martin, Doug; Singer, Peter

    2003-03-01

    Priority setting (also known as resource allocation or rationing) occurs at every level of every health system and is one of the most significant health care policy questions of the 21st century. Because it is so prevalent and context specific, improving priority setting in a health system entails improving it in the institutions that constitute the system. But, how should this be done? Normative approaches are necessary because they help identify key values that clarify policy choices, but insufficient because different approaches lead to different conclusions and there is no consensus about which ones are correct, and they are too abstract to be directly used in actual decision making. Empirical approaches are necessary because they help to identify what is being done and what can be done, but are insufficient because they cannot identify what should be done. Moreover, to be really helpful, an improvement strategy must utilize rigorous research methods that are able to analyze and capture experience so that past problems are corrected and lessons can be shared with others. Therefore, a constructive, practical and accessible improvement strategy must be research-based and combine both normative and empirical methods. In this paper we propose a research-based improvement strategy that involves combining three linked methods: case study research to describe priority setting; interdisciplinary research to evaluate the description using an ethical framework; and action research to improve priority setting. This describe-evaluate-improve strategy is a generalizable method that can be used in different health care institutions to improve priority setting in that context. PMID:14510309

  19. Setting a standard of affordability for health insurance coverage.

    PubMed

    Blumberg, Linda J; Holahan, John; Hadley, Jack; Nordahl, Katharine

    2007-01-01

    Recently, Massachusetts passed landmark legislation designed to expand health insurance coverage. This legislation includes a requirement that all adults enroll in a health insurance plan. This mandate takes effect only if an "affordable" plan is available. The definition of affordability for individuals and families of different incomes or circumstances is a critical decision in implementation and is relevant to any state or federal reform requiring individual premium or cost-sharing contributions, or both. This analysis was done to assist the policy design process in Massachusetts and delineates an empirically based approach to setting affordability standards. PMID:17548341

  20. Qualitative research: Observational methods in health care settings.

    PubMed Central

    Mays, N.; Pope, C.

    1995-01-01

    Clinicians used to observing individual patients, and epidemiologists trained to observe the course of disease, may be forgiven for misunderstanding the term observational method as used in qualitative research. In contrast to the clinician or epidemiologist, the qualitative researcher systematically watches people and events to find out about behaviours and interactions in natural settings. Observation, in this sense, epitomises the idea of the researcher as the research instrument. It involves "going into the field"--describing and analysing what has been seen. In health care settings this method has been insightful and illuminating, but it is not without pitfalls for the unprepared researcher. Images p183-a PMID:7613435

  1. Relevance or Excellence? Setting Research Priorities for Mental Health and Psychosocial Support in Humanitarian Settings

    PubMed Central

    Tol, Wietse A; Patel, Vikram; Tomlinson, Mark; Baingana, Florence; Galappatti, Ananda; Silove, Derrick; Sondorp, Egbert; van Ommeren, Mark; Wessells, Michael G; Catherine, Panter-Brick

    2012-01-01

    Background: Humanitarian crises are associated with an increase in mental disorders and psychological distress. Despite the emerging consensus on intervention strategies in humanitarian settings, the field of mental health and psychosocial support (MHPSS) in humanitarian settings lacks a consensus-based research agenda. Methods: From August 2009 to February 2010, we contacted policymakers, academic researchers, and humanitarian aid workers, and conducted nine semistructured focus group discussions with 114 participants in three locations (Peru, Uganda, and Nepal), in both the capitals and remote humanitarian settings. Local stakeholders representing a range of academic expertise (psychiatry, psychology, social work, child protection, and medical anthropology) and organizations (governments, universities, nongovernmental organizations, and UN agencies) were asked to identify priority questions for MHPSS research in humanitarian settings, and to discuss factors that hamper and facilitate research. Results: Thematic analyses of transcripts show that participants broadly agreed on prioritized research themes in the following order: (1) the prevalence and burden of mental health and psychosocial difficulties in humanitarian settings, (2) how MHPSS implementation can be improved, (3) evaluation of specific MHPSS interventions, (4) the determinants of mental health and psychological distress, and (5) improved research methods and processes. Rather than differences in research themes across countries, what emerged was a disconnect between different groups of stakeholders regarding research processes: the perceived lack of translation of research findings into actual policy and programs; misunderstanding of research methods by aid workers; different appreciation of the time needed to conduct research; and disputed universality of research constructs. Conclusions: To advance a collaborative research agenda, actors in this field need to bridge the perceived disconnect between

  2. Web-Based Triage in a College Health Setting

    ERIC Educational Resources Information Center

    Sole, Mary Lou; Stuart, Patricia L.; Deichen, Michael

    2006-01-01

    The authors describe the initiation and use of a Web-based triage system in a college health setting. During the first 4 months of implementation, the system recorded 1,290 encounters. More women accessed the system (70%); the average age was 21.8 years. The Web-based triage system advised the majority of students to seek care within 24 hours;…

  3. An algorithm for deriving core magnetic field models from the Swarm data set

    NASA Astrophysics Data System (ADS)

    Rother, Martin; Lesur, Vincent; Schachtschneider, Reyko

    2013-11-01

    In view of an optimal exploitation of the Swarm data set, we have prepared and tested software dedicated to the determination of accurate core magnetic field models and of the Euler angles between the magnetic sensors and the satellite reference frame. The dedicated core field model estimation is derived directly from the GFZ Reference Internal Magnetic Model (GRIMM) inversion and modeling family. The data selection techniques and the model parameterizations are similar to what were used for the derivation of the second (Lesur et al., 2010) and third versions of GRIMM, although the usage of observatory data is not planned in the framework of the application to Swarm. The regularization technique applied during the inversion process smoothes the magnetic field model in time. The algorithm to estimate the Euler angles is also derived from the CHAMP studies. The inversion scheme includes Euler angle determination with a quaternion representation for describing the rotations. It has been built to handle possible weak time variations of these angles. The modeling approach and software have been initially validated on a simple, noise-free, synthetic data set and on CHAMP vector magnetic field measurements. We present results of test runs applied to the synthetic Swarm test data set.

  4. Introducing herbal medicine into conventional health care settings.

    PubMed

    Lee, L

    1999-01-01

    Herbal therapy is one of several holistic therapies gaining recognition within the health care community in the United States. As a discipline, herbal medicine is in its infancy regarding educational standards for credentialling, standardization, and regulation of products and clinical applications within this health care system. This article discusses professional considerations for midwives who are interested in integrating herbal healing into their clinical practices, and offers examples of how to incorporate herbal medicine into midwifery care. Resources for practitioners including books, newsletters, journals, courses, computer sites, and databases are presented. The author offers guidance for creating an herbal practice manual for the midwifery office as well as the hospital setting and for documenting herbal healing in the medical record. Collegial support, barriers to practice, liability, and insurance issues are discussed. A clinical applications section includes specific herbal formulas for preconception health, pregnancy-induced hypertension, gestational diabetes, and postdates pregnancy. PMID:10380444

  5. Participatory health system priority setting: Evidence from a budget experiment.

    PubMed

    Costa-Font, Joan; Forns, Joan Rovira; Sato, Azusa

    2015-12-01

    Budget experiments can provide additional guidance to health system reform requiring the identification of a subset of programs and services that accrue the highest social value to 'communities'. Such experiments simulate a realistic budget resource allocation assessment among competitive programs, and position citizens as decision makers responsible for making 'collective sacrifices'. This paper explores the use of a participatory budget experiment (with 88 participants clustered in social groups) to model public health care reform, drawing from a set of realistic scenarios for potential health care users. We measure preferences by employing a contingent ranking alongside a budget allocation exercise (termed 'willingness to assign') before and after program cost information is revealed. Evidence suggests that the budget experiment method tested is cognitively feasible and incentive compatible. The main downside is the existence of ex-ante "cost estimation" bias. Additionally, we find that participants appeared to underestimate the net social gain of redistributive programs. Relative social value estimates can serve as a guide to aid priority setting at a health system level. PMID:26517295

  6. Unintended effects in settings-based health promotion.

    PubMed

    Mittelmark, Maurice B

    2014-11-01

    The settings-based approach to health promotion (HP) employs a social ecological (SE) framework to integrate HP into the usual activities of the setting and to increase the setting's support for healthy choices. The SE approach calls for systems thinking to account for the inextricable relationship between people, their behaviour and their environment. Knowledge about a setting can be used to mobilise people to participate in HP, to optimise success by taking into account the local context, and to anticipate and avoid barriers to success. In other words, the SE approach aims to help HP reach its goals for better health, established in concert with community needs and wishes. Yet, the focus on HP goals may detract attention from how intervention may have unanticipated, and even untoward effects on the setting. There is much evidence from classical ecological research that well-meaning interventions have unintended effects. Biology is so tuned to the possibility that the study of unintended effects is integral to the field. There is some evidence--but much less--that HP also has unexpected, deleterious effects. The evidence is limited because of neglect; the subject of unintended effects is only of peripheral interest in HP. This is a call for a more robust SE approach, in which frameworks used to guide settings-based HP are augmented so as to be concerned with planned effects, and also unplanned effects. What can be done to more responsibly monitor, document and report the full panoply of our effects, including detecting and preventing untoward effects? PMID:25416569

  7. Population Health Measurement: Applying Performance Measurement Concepts in Population Health Settings

    PubMed Central

    Stoto, Michael A.

    2014-01-01

    Introduction: Whether the focus of population-health improvement efforts, the measurement of health outcomes, risk factors, and interventions to improve them are central to achieving collective impact in the population health perspective. And because of the importance of a shared measurement system, appropriate measures can help to ensure the accountability of and ultimately integrate the efforts of public health, the health care delivery sector, and other public and private entities in the community to improve population health. Yet despite its importance, population health measurement efforts in the United States are poorly developed and uncoordinated. Collaborative Measurement Development: To achieve the potential of the population health perspective, public health officials, health system leaders, and others must work together to develop sets of population health measures that are suitable for different purposes yet are harmonized so that together they can help to improve a community’s health. This begins with clearly defining the purpose of a set of measures, distinguishing between outcomes for which all share responsibility and actions to improve health for which the health care sector, public health agencies, and others should be held accountable. Framework for Population Health Measurement: Depending on the purpose of the analysis, then, measurement systems should clearly specify what to measure—in particular the population served (the denominator), what the critical health dimensions are in a measurement framework, and how the measures can be used to ensure accountability. Building on a clear understanding of the purpose and dimensions of population health that must be measured, developers can then choose specific measures using existing data or developing new data sources if necessary, with established validity, reliability, and other scientific characteristics. Rather than indiscriminately choosing among the proliferating data streams, this

  8. [Priority setting for health interventions in Mexico's System of Social Protection in Health].

    PubMed

    González-Pier, Eduardo; Gutiérrez-Delgado, Cristina; Stevens, Gretchen; Barraza-Lloréns, Mariana; Porras-Condey, Raúl; Carvalho, Natalie; Loncich, Kristen; Dias, Rodrigo H; Kulkarni, Sandeep; Casey, Anna; Murakami, Yuki; Ezzati, Majid; Salomon, Joshua A

    2007-01-01

    Explicit priority setting presents Mexico with the opportunity to match the pressure and complexity of an advancing epidemiological transition with evidence-based policies driven by a fundamental concern for how to make the best use of scarce resources to improve population health. The Mexican priority-setting experience describes how standardised analytical approaches to decision making, mainly burden of disease and cost-effectiveness analyses, combine with other criteria -eg, being responsive to the legitimate non-health expectations of patients and ensuring fair financing across households- to design and implement a set of three differentiated health intervention packages. This process is a key element of a wider set of reform components aimed at extending health insurance, especially to the poor. The most relevant policy implications include lessons on the use of available and proven analytical tools to set national health priorities, the usefulness of priority-setting results to guide long-term capacity development, the importance of favouring an institutionalised approach to cost-effectiveness analysis, and the need for local technical capacity strengthening as an essential step to balance health-maximising arguments and other non-health criteria in a transparent and systematic process. PMID:17469398

  9. Using a profile of a modified Brief ICF Core Set for chronic widespread musculoskeletal pain with qualifiers for baseline assessment in interdisciplinary pain rehabilitation

    PubMed Central

    Löfgren, Monika; Ekholm, Jan; Broman, Lisbet; Njoo, Philipe; Schult, Marie-Louise

    2013-01-01

    Aim To describe the use of a “workable” visual profile of function and disability, based on a modified Brief International Classification of Functioning, Disability and Health (ICF) Core Set for chronic widespread pain, for initial assessments in a clinical setting of interdisciplinary pain rehabilitation teams. Method The Brief ICF Core Set was slightly adapted to meet the needs of an interdisciplinary rehabilitation medicine team working in a university outpatient clinic and admitting patients referred from primary care. The Core Set categories were made measurable by means of eg, assessment instruments and clinical investigations. The resulting profile was given a workable shape to facilitate rapid understanding of the initial assessment outcome. Results Individual patients showed different profiles of problems and resources, which facilitated individual rehabilitation planning. At the level of the study group, the profiles for the Core Set component Body Functions showed that most patients had severe impairment in the sensation of pain and exercise tolerance categories of function, but most had resources in the motivation and memory categories of function. Likewise, for the component Activities, most patients had limitations in lifting and carrying objects and remunerative employment, but most had resources in intimate relationships and family relationships. At first, the use of the modified Brief ICF Core Set in the team conference was rather time consuming, but after a couple of months of experience, the team assessment took approximately 30 minutes to complete per patient. Conclusion The profile of the modified Brief ICF Core Set for chronic widespread pain served as a common platform, facilitating cooperation between the rehabilitation team members and providing a uniform language, which helped in structuring the clinical work. The profile also provided an easily accessible, overall view of the patient’s problems and resources, which helped in

  10. Seismoelectric effect in a Laboratory setting for Characterizing Geological Cores saturated with either Water or Oil.

    NASA Astrophysics Data System (ADS)

    Dukhin, A.

    2014-12-01

    Seismoelectric effect belongs to a wide family of Electrokinetic phenomena that arises in heterogeneous systems due to electric charge separation at interfaces. Resulting structure is called an Electric Double Layer (EDL), which is characterized by electric potential drop - Zeta potential. This parameter serves as a major characteristic of liquid-solid interface in liquid dispersion and in porous materials, including geological ones. It varies roughly (in absolute value) from 0 to 100 mV and, therefore, play a major role in the seismoelectric effect, which is proportional to it. Siesmoelectric effect offers opportunity for measuring Zeta potential in geological cores. Phase of the seismoelectric current is pore size dependent, which can be used for characterizing this parameter as well. There are currently hundreds of instruments worldwide that are based on ultrasound for characterizing heterogeneous systems. There are even ISO standards providing guidelines for these characterization techniques, but mostly for concentrated dispersions and emulsions. We are attempting to extend application of these techniques for characterizing geological cores and other porous materials. This talk will present general features of the underlying theory, experimental setup and results for geological cores and several other porous materials. Studying seismoelectric effect in laboratory setting seems to be useful not for characterization purposes only but also for its better understanding on the large scale during seismological tests. This preliminary laboratory experiments reveal factors that affect seismoelectric signal and would allow more adequate interpretation of the seismoelectric signals.

  11. The Core Mouse Response to Infection by Neospora Caninum Defined by Gene Set Enrichment Analyses

    PubMed Central

    Ellis, John; Goodswen, Stephen; Kennedy, Paul J; Bush, Stephen

    2012-01-01

    In this study, the BALB/c and Qs mouse responses to infection by the parasite Neospora caninum were investigated in order to identify host response mechanisms. Investigation was done using gene set (enrichment) analyses of microarray data. GSEA, MANOVA, Romer, subGSE and SAM-GS were used to study the contrasts Neospora strain type, Mouse type (BALB/c and Qs) and time post infection (6 hours post infection and 10 days post infection). The analyses show that the major signal in the core mouse response to infection is from time post infection and can be defined by gene ontology terms Protein Kinase Activity, Cell Proliferation and Transcription Initiation. Several terms linked to signaling, morphogenesis, response and fat metabolism were also identified. At 10 days post infection, genes associated with fatty acid metabolism were identified as up regulated in expression. The value of gene set (enrichment) analyses in the analysis of microarray data is discussed. PMID:23012496

  12. Providing consumer health information in the rural setting: Planetree Health Resource Center's approach

    PubMed Central

    Spatz, Michele A.

    2000-01-01

    Both lifestyle and geography make the delivery of consumer health information in the rural setting unique. The Planetree Health Resource Center in The Dalles, Oregon, has served the public in a rural setting for the past eight years. It is a community-based consumer health library, affiliated with a small rural hospital, Mid-Columbia Medical Center. One task of providing consumer health information in rural environments is to be in relationship with individuals in the community. Integration into community life is very important for credibility and sustainability. The resource center takes a proactive approach and employs several different outreach efforts to deepen its relationship with community members. It also works hard to foster partnerships for improved health information delivery with other community organizations, including area schools. This paper describes Planetree Health Resource Center's approach to rural outreach. PMID:11055307

  13. Indicators of environmental health in the urban setting.

    PubMed

    Hancock, Trevor

    2002-01-01

    The North American population is approximately 80% urbanized and spends almost 90% of the time indoors. Accordingly, the built environment is the most important--one might almost say "natural"--human environment. Urban settlements incorporate within their boundaries natural ecosystems of plant and animal life (often highly adapted to the urban environment), and are in turn incorporated within wider bioregions and global ecosystems. But urban settlements are not just built and natural physical environments, they are social, economic, cultural and political environments; the whole constitutes an urban ecosystem. These ecosystems have profound implications for the physical, mental, social, emotional and spiritual well-being of their human inhabitants, as well as for human beings remote from these urban ecosystems. Therefore, this paper discusses urban ecosystems and human health and presents a framework for indicators of environmental health in the urban setting based on such an understanding. The concepts of environmental viability, ecological sustainability, urban livability, community conviviality, social equity, and economic adequacy are discussed in relation to human health and are used to organize proposed candidate indicators for urban ecosystems and public health. PMID:12425175

  14. Obtaining and Providing Health Information in the Community Pharmacy Setting

    PubMed Central

    Iwanowicz, Susan L.; Marciniak, Macary Weck; Zeolla, Mario M.

    2006-01-01

    Community pharmacists are a valuable information resource for patients and other healthcare providers. The advent of new information technology, most notably the Internet, coupled with the rapid availability of new healthcare information, has fueled this demand. Pharmacy students must receive training that enables them to meet this need. Community advanced pharmacy practice experiences (APPEs) provide an excellent opportunity for students to develop and master drug information skills in a real-world setting. Preceptors must ensure that students are familiar with drug information resources and can efficiently identify the most useful resource for a given topic. Students must also be trained to assess the quality of resources and use this information to effectively respond to drug or health information inquiries. This article will discuss key aspects of providing drug information in the community pharmacy setting and can serve as a guide and resource for APPE preceptors. PMID:17136178

  15. Ethical priority setting for universal health coverage: challenges in deciding upon fair distribution of health services.

    PubMed

    Norheim, Ole F

    2016-01-01

    Priority setting is inevitable on the path towards universal health coverage. All countries experience a gap between their population's health needs and what is economically feasible for governments to provide. Can priority setting ever be fair and ethically acceptable? Fairness requires that unmet health needs be addressed, but in a fair order. Three criteria for priority setting are widely accepted among ethicists: cost-effectiveness, priority to the worse-off, and financial risk protection. Thus, a fair health system will expand coverage for cost-effective services and give extra priority to those benefiting the worse-off, whilst at the same time providing high financial risk protection. It is considered unacceptable to treat people differently according to their gender, race, ethnicity, religion, sexual orientation, social status, or place of residence. Inequalities in health outcomes associated with such personal characteristics are therefore unfair and should be minimized. This commentary also discusses a third group of contested criteria, including rare diseases, small health benefits, age, and personal responsibility for health, subsequently rejecting them. In conclusion, countries need to agree on criteria and establish transparent and fair priority setting processes. PMID:27170046

  16. Assembly of large metagenome data sets using a Convey HC-1 hybrid core computer (7th Annual SFAF Meeting, 2012)

    ScienceCinema

    Copeland, Alex [DOE JGI

    2013-02-11

    Alex Copeland on "Assembly of large metagenome data sets using a Convey HC-1 hybrid core computer" at the 2012 Sequencing, Finishing, Analysis in the Future Meeting held June 5-7, 2012 in Santa Fe, New Mexico.

  17. HIV-Related discrimination in European health care settings.

    PubMed

    Nöstlinger, Christiana; Rojas Castro, Daniela; Platteau, Tom; Dias, Sonia; Le Gall, Jean

    2014-03-01

    This cross-sectional European study assessed self-reported HIV-related discrimination and its associated factors in health care settings. Socio-demographics, health status, support needs relating to sexual and reproductive health (SRH), and self-reported HIV-related discrimination were measured using an anonymous survey in a sample of 1549 people living with HIV from 14 countries. Thirty-two per cent of the participants had experienced HIV-related discrimination during the previous 3 years; almost half of them felt discriminated against by health care providers. For this type of discrimination, logistic regression analysis revealed significant associations with not being a migrant (OR: 2.0; IC 1.0-3.7; p<0.05), having been forced into sexual activities (OR: 1.6; IC 1.2-2.2; p<0.001), reporting lack of time to discuss SRH during service provision (OR: 1.7; IC 1.0-2.7; p<0.05), and insufficient openness among service providers to discuss SRH (OR: 2.0; IC 1.1-3.4; p<0.05). Other significant associations related to unmet support needs on safer sex practices (OR: 1.8; IC 1.0-3.2; p<0.05), partner communication about sexuality (OR: 2.0; IC 1.1-3.4; p<0.05), and prevention of sexually transmitted infections (OR: 1.7; IC 1.0-3.0; p<0.05). Female gender had a protective effect (OR: 0.2; IC 0.0-0.9; p<0.05). Being denied the opportunity to discuss SRH may translate in feelings of discrimination. Improving health care providers' communication skills, and fostering openness about SRH topics in HIV care could contribute to destigmatization of PLHIV. PMID:24568694

  18. Behavioral Health Order Sets in a Hybrid Information Environment

    PubMed Central

    Strauss, John; Olbrycht, Peggy; Woo, Vincent

    2013-01-01

    Introduction: The Centre for Addiction and Mental Health (CAMH) is a 500 bed freestanding psychiatric hospital in Canada. We are in the process of preparing for an integrated commercial clinical information system, which will have computerized physician order entry (CPOE) functionality. Methods: As a preparation for CPOE, we developed inpatient order sets (OSs). Development teams from individual clinical programs created and sent their OSs to an OS Working Group for initial endorsement, and then to Pharmacy & Therapeutics and Medical Advisory committees subsequent approvals. Results: In twelve months we created and introduced 22 behavioral health OSs across eight clinical programs in our hybrid information system with an excellent adoption rate (>97%) by clinicians. Discussion: The development and implementation temporarily contributed to a multifactorial flow problem in the emergency department (ED), which was addressed by substantially simplifying the General Admission via the ED OS. Also, as the OSs were developed and sent for approval the project identified areas where local clinical practice can improve. Our electronic-paper hybrid set of clinical systems was a major factor impacting the effort. PMID:24039642

  19. Clinical Research of Traditional Chinese Medicine Needs to Develop Its Own System of Core Outcome Sets

    PubMed Central

    Zhang, Li; Zhang, Junhua; Chen, Jing; Xing, Dongmei; Wang, Jiaying

    2013-01-01

    Currently, quality issues concerning clinical research of traditional Chinese medicine (TCM) have come into the spotlight. It has been recognized that poorly-devised research methodology largely restricted the development of clinical research in TCM. The choice of appropriate outcome measurements is key to the success of clinical research; however, the current procedure for outcomes selection in clinical research of TCM is problematic due to the underdevelopment of clinical methodology. Under this circumstance, we propose the introduction to the concept of Core Outcome Set (COS) and discuss the feasibility of developing a COS system that caters for clinical studies in TCM, in the hope that the outcome evaluation system could be up to international standards. PMID:24312133

  20. Genetic education and the challenge of genomic medicine: development of core competences to support preparation of health professionals in Europe

    PubMed Central

    Skirton, Heather; Lewis, Celine; Kent, Alastair; Coviello, Domenico A

    2010-01-01

    The use of genetics and genomics within a wide range of health-care settings requires health professionals to develop expertise to practise appropriately. There is a need for a common minimum standard of competence in genetics for health professionals in Europe but because of differences in professional education and regulation between European countries, setting curricula may not be practical. Core competences are used as a basis for health professional education in many fields and settings. An Expert Group working under the auspices of the EuroGentest project and European Society of Human Genetics Education Committee agreed that a pragmatic solution to the need to establish common standards for education and practice in genetic health care was to agree to a set of core competences that could apply across Europe. These were agreed through an exhaustive process of consultation with relevant health professionals and patient groups. Sets of competences for practitioners working in primary, secondary and tertiary care have been agreed and were approved by the European Society of Human Genetics. The competences provide an appropriate framework for genetics education of health professionals across national boundaries, and the suggested learning outcomes are available to guide development of curricula that are appropriate to the national context, educational system and health-care setting of the professional involved. Collaboration between individuals from many European countries and professions has resulted in an adaptable framework for both pre-registration and continuing professional education. This competence framework has the potential to improve the quality of genetic health care for patients globally. PMID:20442748

  1. Genetic education and the challenge of genomic medicine: development of core competences to support preparation of health professionals in Europe.

    PubMed

    Skirton, Heather; Lewis, Celine; Kent, Alastair; Coviello, Domenico A

    2010-09-01

    The use of genetics and genomics within a wide range of health-care settings requires health professionals to develop expertise to practise appropriately. There is a need for a common minimum standard of competence in genetics for health professionals in Europe but because of differences in professional education and regulation between European countries, setting curricula may not be practical. Core competences are used as a basis for health professional education in many fields and settings. An Expert Group working under the auspices of the EuroGentest project and European Society of Human Genetics Education Committee agreed that a pragmatic solution to the need to establish common standards for education and practice in genetic health care was to agree to a set of core competences that could apply across Europe. These were agreed through an exhaustive process of consultation with relevant health professionals and patient groups. Sets of competences for practitioners working in primary, secondary and tertiary care have been agreed and were approved by the European Society of Human Genetics. The competences provide an appropriate framework for genetics education of health professionals across national boundaries, and the suggested learning outcomes are available to guide development of curricula that are appropriate to the national context, educational system and health-care setting of the professional involved. Collaboration between individuals from many European countries and professions has resulted in an adaptable framework for both pre-registration and continuing professional education. This competence framework has the potential to improve the quality of genetic health care for patients globally. PMID:20442748

  2. Health Information Privacy and Health Information Technology in the US Correctional Setting

    PubMed Central

    Goldstein, Melissa M.

    2014-01-01

    Electronic health records and electronic health information exchange are essential to improving quality of care, reducing medical errors and health disparities, and advancing the delivery of patient-centered medical care. In the US correctional setting, these goals are critical because of the high numbers of Americans affected, yet the use of health information technology is quite limited. In this article, I describe the legal environment surrounding health information sharing in corrections by focusing on 2 key federal privacy laws: the Health Insurance Portability and Accountability Act of 1996 and the federal Confidentiality of Alcohol and Drug Abuse Patient Records laws. In addition, I review stakeholder concerns and describe possible ways forward that enable electronic exchange while ensuring protection of inmate information and legal compliance. PMID:24625160

  3. Management of Frontotemporal Dementia in Mental Health and Multidisciplinary Settings

    PubMed Central

    Wylie, Mary Anne; Shnall, Adriana; Onyike, Chiadi U.; Huey, Edward D.

    2014-01-01

    Diagnosis of frontotemporal dementia (FTD) in the mental health setting and issues pertaining to longitudinal care of this population in a specialty clinic are reviewed. FTD is often misdiagnosed as a psychiatric disorder, most commonly as a mood disorder. FTD has features that overlap with those of major depression, mania, obsessive-compulsive disorder and schizophrenia. We describe these features and how to differentiate FTD from these psychiatric disorders. This paper also describes practical issues in the management of FTD, specifically the issues that clinicians, patients and their families face in managing this disease. Areas of clinical care along the continuum are explored; FTD care involves collaborative management of symptoms and disability, and assisting patients and families in adapting to the disease. PMID:23611352

  4. MUTILS - a set of efficient modeling tools for multi-core CPUs implemented in MEX

    NASA Astrophysics Data System (ADS)

    Krotkiewski, Marcin; Dabrowski, Marcin

    2013-04-01

    The need for computational performance is common in scientific applications, and in particular in numerical simulations, where high resolution models require efficient processing of large amounts of data. Especially in the context of geological problems the need to increase the model resolution to resolve physical and geometrical complexities seems to have no limits. Alas, the performance of new generations of CPUs does not improve any longer by simply increasing clock speeds. Current industrial trends are to increase the number of computational cores. As a result, parallel implementations are required in order to fully utilize the potential of new processors, and to study more complex models. We target simulations on small to medium scale shared memory computers: laptops and desktop PCs with ~8 CPU cores and up to tens of GB of memory to high-end servers with ~50 CPU cores and hundereds of GB of memory. In this setting MATLAB is often the environment of choice for scientists that want to implement their own models with little effort. It is a useful general purpose mathematical software package, but due to its versatility some of its functionality is not as efficient as it could be. In particular, the challanges of modern multi-core architectures are not fully addressed. We have developed MILAMIN 2 - an efficient FEM modeling environment written in native MATLAB. Amongst others, MILAMIN provides functions to define model geometry, generate and convert structured and unstructured meshes (also through interfaces to external mesh generators), compute element and system matrices, apply boundary conditions, solve the system of linear equations, address non-linear and transient problems, and perform post-processing. MILAMIN strives to combine the ease of code development and the computational efficiency. Where possible, the code is optimized and/or parallelized within the MATLAB framework. Native MATLAB is augmented with the MUTILS library - a set of MEX functions that

  5. Initial condition for efficient mapping of level set algorithms on many-core architectures

    NASA Astrophysics Data System (ADS)

    Tornai, Gábor János; Cserey, György

    2014-12-01

    In this paper, we investigated the effect of adding more small curves to the initial condition which determines the required number of iterations of a fast level set (LS) evolution. As a result, we discovered two new theorems and developed a proof on the worst case of the required number of iterations. Furthermore, we found that these kinds of initial conditions fit well to many-core architectures. To show this, we have included two case studies which are presented on different platforms. One runs on a graphical processing unit (GPU) and the other is executed on a cellular nonlinear network universal machine (CNN-UM). With the new initial conditions, the steady-state solutions of the LS are reached in less than eight iterations depending on the granularity of the initial condition. These dense iterations can be calculated very quickly on many-core platforms according to the two case studies. In the case of the proposed dense initial condition on GPU, there is a significant speedup compared to the sparse initial condition in all cases since our dense initial condition together with the algorithm utilizes the properties of the underlying architecture. Therefore, greater performance gain can be achieved (up to 18 times speedup compared to the sparse initial condition on GPU). Additionally, we have validated our concept against numerically approximated LS evolution of standard flows (mean curvature, Chan-Vese, geodesic active regions). The dice indexes between the fast LS evolutions and the evolutions of the numerically approximated partial differential equations are in the range of 0.99±0.003.

  6. Relative Contributions of a Set of Health Factors to Selected Health Outcomes.

    PubMed

    Park, Hyojun; Roubal, Anne M; Jovaag, Amanda; Gennuso, Keith P; Catlin, Bridget B

    2015-12-01

    Although many researchers agree that multiple determinants impact health, there is no consensus regarding the magnitude of the relative contributions of individual health factors to health outcomes. This study presents a method to empirically estimate the relative contributions of health behaviors, clinical care, social and economic factors, and the physical environment to health outcomes using nationally representative county-level data and statistical approaches that account for potential sources of bias. The analyses for this study were conducted in 2014. Data were from the 2010-2013 County Health Rankings & Roadmaps. Data covered 2,996 of 3,141 U.S. counties. Ordinary least squares modeling was used as a baseline model. Multilevel latent growth curve modeling was used to estimate the relative contributions of health factors to health outcomes while accounting for measurement errors and state-specific characteristics. Almost half of the variance of health outcomes was due to state-level variation rather than county-level variation. When adjusted for measurement errors and state-level variation using multilevel latent growth curve modeling, the relative contribution of clinical care decreased and that of social and economic factors increased compared with the baseline model. This study presents how potential sources of bias affected the estimates of the relative contributions of a set of modifiable health factors to health outcomes at the county level. Further verification of these approaches with other data sources could lead to a better understanding of the impact of specific health determinants to health outcomes, and will provide useful information on policy interventions. PMID:26590942

  7. Water, ecology and health: ecosystems as settings for promoting health and sustainability.

    PubMed

    Parkes, Margot W; Horwitz, Pierre

    2009-03-01

    Despite the proposed ecological and systems-based perspectives of the settings-based approach to health promotion, most initiatives have tended to overlook the fundamental nature of ecosystems. This paper responds to this oversight by proposing an explicit re-integration of ecosystems within the healthy settings approach. We make this case by focusing on water as an integrating unit of analysis. Water, on which all life depends, is not only an integral consideration for the existing healthy settings (schools, hospitals, workplaces) but also highlights the ecosystem context of health and sustainability. A focus on catchments (also know as watersheds and river basins) exemplifies the scaled and upstream/downstream nature of ecosystems and draws into sharp focus the cross-sectoral and transdisciplinary context of the social and environmental determinants of health. We position this work in relation to the converging agendas of health promotion and ecosystem management at the local, regional and global scales--and draw on evidence from international initiatives as diverse as the WHO Commission on Social Determinants of Health, and the Millennium Ecosystem Assessment. Using water as a vehicle for understanding the systemic context for human wellbeing, health promotion and disease prevention draws inevitable attention to key challenges of scale, intersectoral governance and the complementary themes of promoting resilience and preventing vulnerability. We conclude by highlighting the importance of building individual and institutional capacity for this kind of integration--equipping a new generation of researchers, practitioners and decision-makers to be conversant with the language of ecosystems, capable of systemic thought and focused on settings that can promote both health and sustainability. PMID:19171669

  8. The CompHP Core Competencies Framework for Health Promotion in Europe

    ERIC Educational Resources Information Center

    Barry, Margaret M.; Battel-Kirk, Barbara; Dempsey, Colette

    2012-01-01

    Background: The CompHP Project on Developing Competencies and Professional Standards for Health Promotion in Europe was developed in response to the need for new and changing health promotion competencies to address health challenges. This article presents the process of developing the CompHP Core Competencies Framework for Health Promotion across…

  9. Pride and confidence at work: potential predictors of occupational health in a hospital setting

    PubMed Central

    Nilsson, Kerstin; Hertting, Anna; Petterson, Inga-Lill; Theorell, Töres

    2005-01-01

    of downsizing observed elsewhere in the hospital, and in the literature. Conclusion Research illuminating health-promoting aspects is rather unusual. This study could be seen as explorative. The themes and core dimensions we found could be used as a basis for further intervention studies in similar health-care settings. The result could also be used in future health promotion studies in larger populations. One of the first steps in such a strategy is to formulate relevant questions, and we consider that this study contributes to this. PMID:16137331

  10. To Your Health: NLM update transcript - Workplace violence increases in medical settings

    MedlinePlus

    ... transcript061316.html To Your Health: NLM update Transcript Workplace violence increases in medical settings : 06/13/2016 ... use MedlinePlus to follow up on weekly topics. Workplace violence in health care settings is increasingly common ...

  11. Practitioner perspectives from seven health professional groups on core competencies in the context of chronic care.

    PubMed

    Fouche, Christa; Kenealy, Timothy; Mace, Jennifer; Shaw, John

    2014-11-01

    The prevalence of chronic illness is growing worldwide and management is increasingly undertaken by interprofessional teams, yet education is still generally provided in separate professions. The aim of this study was to explore the perspectives of New Zealand healthcare practitioners from seven professional groups involved in chronic care (general practice medicine, nursing, occupational therapy, pharmacy, physiotherapy, social work, and speech language therapy) on the core competencies required of those working in this area. The study was set in the context of the chronic care and shared decision-making (SDM) models. The core competencies for chronic care practitioners proposed by the World Health Organisation were used to shape the research questions. Focus groups with expert clinicians (n = 20) and semi-structured interviews with practitioners (n = 32) were undertaken. Findings indicated a high level of agreement that the core competencies were appropriate and relevant for chronic care practitioners but that many educational and practice gaps existed and interprofessional education in New Zealand was not currently addressing these gaps. Among the key issues highlighted for attention by educators and policy-makers were the following: teams and teamwork, professional roles and responsibilities, interprofessional communication, cultural competence, better engagement with patients, families, and carers, and common systems, information sharing and confidentiality. PMID:24828623

  12. Manual development: A strategy for identifying core components of integrated health programs.

    PubMed

    Mooss, Angela; Hartman, Megan; Ibañez, Gladys

    2015-12-01

    Integrated care models are gaining popularity as a clinical strategy to reduce costs and improve client outcomes; however, implementation of such complex models requires an understanding of programmatic core components essential to producing positive outcomes. To promote this understanding, evaluators can work collaboratively with organization staff and leaderships to gather information on program implementation, adaptations, organizational buy-in, and project outcomes. In 2011, SAMHSA funded two Miami health clinics to implement integrated care models in co-located settings. Changes in the federal healthcare landscape, non-Medicaid expansion for Florida, and the complexity of projects goals led evaluators to facilitate a core component review as part of evaluation. A manual was developed throughout the project and captured a description, adaptations, inputs needed, lessons learned, and sustainability for each integrated care component. To increase chances for program success, evaluators should institute a method to better define core components of new programs and implementation adaptations, while keeping program replication in mind. Breaking down the program structurally gave the evaluation utility for stakeholders, and ultimately served as a resource for organizations to better understand their program model. The manual also continues to serve as a dissemination and replication source for other providers looking to implement integrated care. PMID:26298862

  13. Strengthening core public health capacity based on the implementation of the International Health Regulations (IHR) (2005): Chinese lessons.

    PubMed

    Liu, Bin; Sun, Yan; Dong, Qian; Zhang, Zongjiu; Zhang, Liang

    2015-06-01

    As an international legal instrument, the International Health Regulations (IHR) is internationally binding in 196 countries, especially in all the member states of the World Health Organization (WHO). The IHR aims to prevent, protect against, control, and respond to the international spread of disease and aims to cut out unnecessary interruptions to traffic and trade. To meet IHR requirements, countries need to improve capacity construction by developing, strengthening, and maintaining core response capacities for public health risk and Public Health Emergency of International Concern (PHEIC). In addition, all the related core capacity requirements should be met before June 15, 2012. If not, then the deadline can be extended until 2016 upon request by countries. China has promoted the implementation of the IHR comprehensively, continuingly strengthening the core public health capacity and advancing in core public health emergency capacity building, points of entry capacity building, as well as risk prevention and control of biological events (infectious diseases, zoonotic diseases, and food safety), radiological, nuclear, and chemical events, and other catastrophic events. With significant progress in core capacity building, China has dealt with many public health emergencies successfully, ensuring that its core public health capacity has met the IHR requirements, which was reported to WHO in June 2014. This article describes the steps, measures, and related experiences in the implementation of IHR in China. PMID:26029897

  14. Strengthening core public health capacity based on the implementation of the International Health Regulations (IHR) (2005): Chinese lessons

    PubMed Central

    Liu, Bin; Sun, Yan; Dong, Qian; Zhang, Zongjiu; Zhang, Liang

    2015-01-01

    As an international legal instrument, the International Health Regulations (IHR) is internationally binding in 196 countries, especially in all the member states of the World Health Organization (WHO). The IHR aims to prevent, protect against, control, and respond to the international spread of disease and aims to cut out unnecessary interruptions to traffic and trade. To meet IHR requirements, countries need to improve capacity construction by developing, strengthening, and maintaining core response capacities for public health risk and Public Health Emergency of International Concern (PHEIC). In addition, all the related core capacity requirements should be met before June 15, 2012. If not, then the deadline can be extended until 2016 upon request by countries. China has promoted the implementation of the IHR comprehensively, continuingly strengthening the core public health capacity and advancing in core public health emergency capacity building, points of entry capacity building, as well as risk prevention and control of biological events (infectious diseases, zoonotic diseases, and food safety), radiological, nuclear, and chemical events, and other catastrophic events. With significant progress in core capacity building, China has dealt with many public health emergencies successfully, ensuring that its core public health capacity has met the IHR requirements, which was reported to WHO in June 2014. This article describes the steps, measures, and related experiences in the implementation of IHR in China. PMID:26029897

  15. THE EFFECT OF SELF-SET GRADE GOALS AND CORE SELF-EVALUATIONS ON ACADEMIC PERFORMANCE: A DIARY STUDY.

    PubMed

    Bipp, Tanja; Kleingeld, Ad; Van Den Tooren, Marieke; Schinkel, Sonja

    2015-12-01

    The aim of this diary study was to examine the effect of self-set grade goals and core self-evaluations on academic performance. Data were collected among 59 university students (M age = 18.4 yr., SD = 0.8) in a 2-wk. exam period on up to five exam days. Multilevel analyses revealed that the individual grade goals students set for their exams were positively related to the grades they obtained for these exams. However, the goal-performance relationship only applied to students scoring high on core self-evaluations. The results of this study contribute to the understanding of the effect of self-set grade goals and core self-evaluations on academic performance and imply important practical applications to enhance academic performance. PMID:26595291

  16. An efficient out-of-core volume ray casting method for the visualization of large medical data sets

    NASA Astrophysics Data System (ADS)

    Xue, Jian; Tian, Jie; Chen, Jian; Dai, Yakang

    2007-03-01

    Volume ray casting algorithm is widely recognized for high quality volume visualization. However, when rendering very large volume data sets, the original ray casting algorithm will lead to very inefficient random accesses in disk and make it very slowly to render the whole volume data set. In order to solve this problem, an efficient out-of-core volume ray casting method with a new out-of-core framework for processing large volume data sets based on consumer PC hardware is proposed in this paper. The new framework gives a transparent and efficient access to the volume data set cached in disk, while the new volume ray casting method minimizes the data exchange between hard disk and physical memory and performs comparatively fast high quality volume rendering. The experimental results indicate that the new method and framework are effective and efficient for the visualization of very large medical data sets.

  17. The CROWN Initiative: journal editors invite researchers to develop core outcomes in women’s health

    PubMed Central

    2014-01-01

    Clinical trials, systematic reviews and guidelines compare beneficial and non-beneficial outcomes following interventions. Often, however, various studies on a particular topic do not address the same outcomes, making it difficult to draw clinically useful conclusions when a group of studies is looked at as a whole. This problem was recently thrown into sharp focus by a systematic review of interventions for preterm birth prevention, which found that among 103 randomised trials, no fewer than 72 different outcomes were reported. There is a growing recognition among clinical researchers that this variability undermines consistent synthesis of the evidence, and that what is needed is an agreed standardised collection of outcomes - a "core outcomes set" - for all trials in a specific clinical area. Recognising that the current inconsistency is a serious hindrance to progress in our specialty, the editors of over 50 journals related to women's health have come together to support The CROWN (CoRe Outcomes in WomeN's health) Initiative. PMID:25050130

  18. The CROWN initiative: journal editors invite researchers to develop core outcomes in women’s health

    PubMed Central

    2014-01-01

    Clinical trials, systematic reviews and guidelines compare beneficial and non-beneficial outcomes following interventions. Often, however, various studies on a particular topic do not address the same outcomes, making it difficult to draw clinically useful conclusions when a group of studies is looked at as a whole. This problem was recently thrown into sharp focus by a systematic review of interventions for preterm birth prevention, which found that among 103 randomised trials, no fewer than 72 different outcomes were reported. There is a growing recognition among clinical researchers that this variability undermines consistent synthesis of the evidence, and that what is needed is an agreed standardised collection of outcomes - a "core outcomes set" - for all trials in a specific clinical area. Recognising that the current inconsistency is a serious hindrance to progress in our specialty, the editors of over 50 journals related to women's health have come together to support The CROWN (CoRe Outcomes in WomeN's health) Initiative. PMID:25048583

  19. [Blood transfusion in emergency settings: French military health service experience].

    PubMed

    Sailliol, A; Ausset, S; Peytel, E

    2010-12-01

    Blood transfusion is required in a number of emergency settings and the French military health service (FMHS) has issued specific guidelines for the treatment of war casualties. These guidelines take into account European standards and laws, NATO standards, and also public sentiment regarding transfusion. These guidelines reflect a determination to control the process and to avoid the improvisation frequently associated with wartime transfusion. The evolution in warfare (terrorism and bombing more frequent than gunshot) and the wide use of body armor have deeply changed the clinical presentation of war injuries. These now involve the extremities in 80% of cases, with extensive tissue damage and heavy blood loss. The FMHS recommends that war casualties with hemorrhagic shock be brought quickly to a medical treatment facility (MTF) after first-line treatment applied through buddy aid or by medics. In the MTF, before an early Medevac, a damage control surgery will be performed, with resuscitation using freeze-dried plasma, red blood cells and fresh whole blood. The French military blood bank is responsible for blood product supply, training and medical advice regarding transfusion therapy during wartime, as well as hemovigilance. All transfusion therapy practices are periodically assessed but research on whole blood pathogen reduction is being conducted in order to reduce the residual infectious risk associated with this product. PMID:21051268

  20. Youth Sports Clubs' Potential as Health-Promoting Setting: Profiles, Motives and Barriers

    ERIC Educational Resources Information Center

    Meganck, Jeroen; Scheerder, Jeroen; Thibaut, Erik; Seghers, Jan

    2015-01-01

    Setting and Objective: For decades, the World Health Organisation has promoted settings-based health promotion, but its application to leisure settings is minimal. Focusing on organised sports as an important leisure activity, the present study had three goals: exploring the health promotion profile of youth sports clubs, identifying objective…

  1. Systematic literature review of domains assessed in psoriatic arthritis to inform the update of the psoriatic arthritis core domain set

    PubMed Central

    Kalyoncu, Umut; Ogdie, Alexis; Campbell, Willemina; Bingham, Clifton O; de Wit, Maarten; Gladman, Dafna D; Mease, Philip; Steinkoenig, Ingrid; Strand, Vibeke; Riese, Victoria G; Orbai, Ana-Maria

    2016-01-01

    The objectives of this systematic literature review (SLR) were to identify domains and outcome measures used in psoriatic arthritis (PsA) studies in the past 5 years, and to compare the measurement of the Outcome Measures in Rheumatology (OMERACT) 2006 PsA Core Domain Set in studies published in 2010–2015 vs those published in 2006–2010. We performed a systematic literature search in two databases, PubMed and Embase, to identify randomised controlled trials (RCTs) in PsA. We also identified PsA longitudinal observational studies (LOS). Three patient research partners provided input into study conception, and data collection and interpretation. We identified 41 studies representing 22 unique RCTs, 27 LOS and 12 registries. Across all studies, we identified 24 domains and 169 outcome measures. In addition to the PsA Core Domain Set (6 domains), the following domains were also assessed in more than 30% of RCTs: acute phase reactants, dactylitis, enthesitis, fatigue and work productivity. We identified a range of 1–15 outcome measures per domain with a mean (SD) of 7 (4.7) per domain. The complete PsA Core Domain Set was assessed in 59% of RCTs in 2010–2015 compared to 23.5% RCTs in 2006–2010. There has been increased measurement of the PsA Core Domain Set in RCTs and LOS in the past 5 years. Numerous additional outcomes were also measured. The PsA Core Domain Set needs an update to standardise PsA outcome assessments. This SLR will inform the development of an updated PsA Core Domain Set with patient research partner input. PMID:26966554

  2. Public-private partnerships with large corporations: setting the ground rules for better health.

    PubMed

    Galea, Gauden; McKee, Martin

    2014-04-01

    Public-private partnerships with large corporations offer potential benefits to the health sector but many concerns have been raised, highlighting the need for appropriate safeguards. In this paper we propose five tests that public policy makers may wish to apply when considering engaging in such a public-private partnership. First, are the core products and services provided by the corporation health enhancing or health damaging? In some cases, such as tobacco, the answer is obvious but others, such as food and alcohol, are contested. In such cases, the burden of proof is on the potential partners to show that their activities are health enhancing. Second, do potential partners put their policies into practice in the settings where they can do so, their own workplaces? Third, are the corporate social responsibility activities of potential partners independently audited? Fourth, do potential partners make contributions to the commons rather than to narrow programmes of their choosing? Fifth, is the role of the partner confined to policy implementation rather than policy development, which is ultimately the responsibility of government alone? PMID:24581699

  3. Synthetic enzyme mixtures for biomass deconstruction: production and optimization of a core set.

    PubMed

    Banerjee, Goutami; Car, Suzana; Scott-Craig, John S; Borrusch, Melissa S; Aslam, Nighat; Walton, Jonathan D

    2010-08-01

    The high cost of enzymes is a major bottleneck preventing the development of an economically viable lignocellulosic ethanol industry. Commercial enzyme cocktails for the conversion of plant biomass to fermentable sugars are complex mixtures containing more than 80 proteins of suboptimal activities and relative proportions. As a step toward the development of a more efficient enzyme cocktail for biomass conversion, we have developed a platform, called GENPLAT, that uses robotic liquid handling and statistically valid experimental design to analyze synthetic enzyme mixtures. Commercial enzymes (Accellerase 1000 +/- Multifect Xylanase, and Spezyme CP +/- Novozyme 188) were used to test the system and serve as comparative benchmarks. Using ammonia-fiber expansion (AFEX) pretreated corn stover ground to 0.5 mm and a glucan loading of 0.2%, an enzyme loading of 15 mg protein/g glucan, and 48 h digestion at 50 degrees C, commercial enzymes released 53% and 41% of the available glucose and xylose, respectively. Mixtures of three, five, and six pure enzymes of Trichoderma species, expressed in Pichia pastoris, were systematically optimized. Statistical models were developed for the optimization of glucose alone, xylose alone, and the average of glucose + xylose for two digestion durations, 24 and 48 h. The resulting models were statistically significant (P < 0.0001) and indicated an optimum composition for glucose release (values for optimized xylose release are in parentheses) of 29% (5%) cellobiohydrolase 1, 5% (14%) cellobiohydrolase 2, 25% (25%) endo-beta1,4-glucanase 1, 14% (5%) beta-glucosidase, 22% (34%) endo-beta1,4-xylanase 3, and 5% (17%) beta-xylosidase in 48 h at a protein loading of 15 mg/g glucan. Comparison of two AFEX-treated corn stover preparations ground to different particle sizes indicated that particle size (100 vs. 500 microm) makes a large difference in total digestibility. The assay platform and the optimized "core" set together provide a starting

  4. User Friendly Processing of Sediment CT Data: Software and Application in High Resolution Non-Destructive Sediment Core Data Sets

    NASA Astrophysics Data System (ADS)

    Reilly, B. T.; Stoner, J. S.; Wiest, J.; Abbott, M. B.; Francus, P.; Lapointe, F.

    2015-12-01

    Computed Tomography (CT) of sediment cores allow for high resolution images, three dimensional volumes, and down core profiles, generated through the attenuation of X-rays as a function of density and atomic number. When using a medical CT-Scanner, these quantitative data are stored in pixels using the Hounsfield scale, which are relative to the attenuation of X-rays in water and air at standard temperature and pressure. Here we present MATLAB based software specifically designed for sedimentary applications with a user friendly graphical interface to process DICOM files and stitch overlapping CT scans. For visualization, the software allows easy generation of core slice images with grayscale and false color relative to a user defined Hounsfield number range. For comparison to other high resolution non-destructive methods, down core Hounsfield number profiles are extracted using a method robust to coring imperfections, like deformation, bowing, gaps, and gas expansion. We demonstrate the usefulness of this technique with lacustrine sediment cores from the Western United States and Canadian High Arctic, including Fish Lake, Oregon, and Sawtooth Lake, Ellesmere Island. These sites represent two different depositional environments and provide examples for a variety of common coring defects and lithologies. The Hounsfield profiles and images can be used in combination with other high resolution data sets, including sediment magnetic parameters, XRF core scans and many other types of data, to provide unique insights into how lithology influences paleoenvironmental and paleomagnetic records and their interpretations.

  5. Comparison of the ICF Core Set for Cardiopulmonary Conditions in the Acute Hospital Setting among Different Types of Transplant Patients

    ERIC Educational Resources Information Center

    Ding, Xinhua

    2010-01-01

    To compare the functioning profiles of patients receiving different types of organ transplants using the International Classification of Functioning, Disability, and Health. The patients (n=102) were enrolled between days 5 and 10 after discharge following receipt of an organ transplant, and assessed for sociodemographic variables, the Functional…

  6. Young Starless Cores Embedded in the Magnetically Dominated Pipe Nebula. II. Extended Data Set

    NASA Astrophysics Data System (ADS)

    Frau, P.; Girart, J. M.; Beltrán, M. T.; Padovani, M.; Busquet, G.; Morata, O.; Masqué, J. M.; Alves, F. O.; Sánchez-Monge, Á.; Franco, G. A. P.; Estalella, R.

    2012-11-01

    The Pipe nebula is a massive, nearby, filamentary dark molecular cloud with a low star formation efficiency threaded by a uniform magnetic field perpendicular to its main axis. It harbors more than a hundred, mostly quiescent, very chemically young starless cores. The cloud is therefore a good laboratory to study the earliest stages of the star formation process. We aim to investigate the primordial conditions and the relation among physical, chemical, and magnetic properties in the evolution of low-mass starless cores. We used the IRAM 30 m telescope to map the 1.2 mm dust continuum emission of five new starless cores, which are in good agreement with previous visual extinction maps. For the sample of nine cores, which includes the four cores studied in a previous work, we derived an A V to N_H_2 factor of (1.27 ± 0.12) × 10-21 mag cm2 and a background visual extinction of ~6.7 mag possibly arising from the cloud material. We derived an average core diameter of ~0.08 pc, density of ~105 cm-3, and mass of ~1.7 M ⊙. Several trends seem to exist related to increasing core density: (1) the diameter seems to shrink, (2) the mass seems to increase, and (3) the chemistry tends to be richer. No correlation is found between the direction of the surrounding diffuse medium magnetic field and the projected orientation of the cores, suggesting that large-scale magnetic fields seem to play a secondary role in shaping the cores. We also used the IRAM 30 m telescope to extend the previous molecular survey at 1 and 3 mm of early- and late-time molecules toward the same five new Pipe nebula starless cores, and analyzed the normalized intensities of the detected molecular transitions. We confirmed the chemical differentiation toward the sample and increased the number of molecular transitions of the "diffuse" (e.g., the "ubiquitous" CO, C2H, and CS), "oxo-sulfurated" (e.g., SO and CH3OH), and "deuterated" (e.g., N2H+, CN, and HCN) starless core groups. The chemically defined

  7. YOUNG STARLESS CORES EMBEDDED IN THE MAGNETICALLY DOMINATED PIPE NEBULA. II. EXTENDED DATA SET

    SciTech Connect

    Frau, P.; Girart, J. M.; Padovani, M.; Beltran, M. T.; Sanchez-Monge, A.; Busquet, G.; Morata, O.; Masque, J. M.; Estalella, R.; Alves, F. O.; Franco, G. A. P.

    2012-11-01

    The Pipe nebula is a massive, nearby, filamentary dark molecular cloud with a low star formation efficiency threaded by a uniform magnetic field perpendicular to its main axis. It harbors more than a hundred, mostly quiescent, very chemically young starless cores. The cloud is therefore a good laboratory to study the earliest stages of the star formation process. We aim to investigate the primordial conditions and the relation among physical, chemical, and magnetic properties in the evolution of low-mass starless cores. We used the IRAM 30 m telescope to map the 1.2 mm dust continuum emission of five new starless cores, which are in good agreement with previous visual extinction maps. For the sample of nine cores, which includes the four cores studied in a previous work, we derived an A {sub V} to N{sub H{sub 2}} factor of (1.27 {+-} 0.12) Multiplication-Sign 10{sup -21} mag cm{sup 2} and a background visual extinction of {approx}6.7 mag possibly arising from the cloud material. We derived an average core diameter of {approx}0.08 pc, density of {approx}10{sup 5} cm{sup -3}, and mass of {approx}1.7 M {sub Sun }. Several trends seem to exist related to increasing core density: (1) the diameter seems to shrink, (2) the mass seems to increase, and (3) the chemistry tends to be richer. No correlation is found between the direction of the surrounding diffuse medium magnetic field and the projected orientation of the cores, suggesting that large-scale magnetic fields seem to play a secondary role in shaping the cores. We also used the IRAM 30 m telescope to extend the previous molecular survey at 1 and 3 mm of early- and late-time molecules toward the same five new Pipe nebula starless cores, and analyzed the normalized intensities of the detected molecular transitions. We confirmed the chemical differentiation toward the sample and increased the number of molecular transitions of the 'diffuse' (e.g., the 'ubiquitous' CO, C{sub 2}H, and CS), 'oxo-sulfurated' (e.g., SO and

  8. SIB health psychology in Brazil: The challenges for working in public health settings.

    PubMed

    Spink, Mary-Jane P; Brigagão, Jacqueline M; Menegon, Vera M; Vicentin, Maria-Cristina G

    2016-03-01

    Considering the diversity of theoretical approaches and settings for psychological practice, this editorial provides a background for the articles that have been included in this special issue concerning health psychology in the context of the Brazilian Unified Health System (Sistema Unico de Saude). We addressed issues concerning the national curricular outline for undergraduate training in psychology and historical data on the social movements that led to the creation of the Sistema Unico de Saude and the Psychiatric Reform which created an important area for psychological work absorbing a considerable number of psychologists. PMID:26987822

  9. Lining up: The Relationship between the Common Core State Standards and Five Sets of Comparison Standards

    ERIC Educational Resources Information Center

    Conley, David T.; Drummond, Kathryn V.; de Gonzalez, Alicia; Seburn, Mary; Stout, Odile; Rooseboom, Jennifer

    2011-01-01

    In June 2010, the National Governors Association Center for Best Practices (NGA Center) and the Council of Chief State School Offices (CCSSO) released the Common Core State Standards. The stated aim of the Common Core standards is to define the knowledge and skills students should achieve in order to graduate from high school ready to succeed in a…

  10. Establishing communication networks for health promotion in industrial settings.

    PubMed

    Heirich, M A; Cameron, V; Erfurt, J C; Foote, A; Gregg, W

    1989-11-01

    Abstract Health educators, medical personnel, and managers interested in worksite efforts to change health behaviors often face problems in communicating effectively with rank and file members of the workforce. This article describes an effective strategy for getting health information flowing among an industrial workforce and changing health behaviors. Identifying effective communication routes at a worksite and creating new ones, establishing relationships with key information carriers, and making health information salient to potential communicators are keys to successful information flow. Wellness Committees can provide access to formal communication routes, which may or may not work for health information. One-to-one counseling and development of buddy systems, however, create short-link, health-oriented communication networks. If people whom large numbers of employees contact for plant business get recruited into these health networks, information spreads rapidly. Poster posting can generate interaction with people so that they read and talk about health messages. Unusual motion, sound, and messages can call attention to special events. Using these methods has increased participation in specific health activities from a handful to between fifty and one hundred people at a time. PMID:22204404

  11. Health reform: setting the agenda for long term care.

    PubMed

    Hatch, O G; Wofford, H; Willging, P R; Pomeroy, E

    1993-06-01

    The White House Task Force on National Health Care Reform, headed by First Lady Hillary Rodham Clinton, is expected to release its prescription for health care reform this month. From the outset, Clinton's mandate was clear: to provide universal coverage while reining in costs for delivering quality health care. Before President Clinton was even sworn into office, he had outlined the major principles that would shape the health reform debate. Global budgeting would establish limits on all health care expenditures, thereby containing health costs. Under a system of managed competition, employers would form health alliances for consumers to negotiate for cost-effective health care at the community level. So far, a basic approach to health care reform has emerged. A key element is universal coverage--with an emphasis on acute, preventive, and mental health care. Other likely pieces are employer-employee contributions to health care plans, laws that guarantee continued coverage if an individual changes jobs or becomes ill, and health insurance alliances that would help assure individual access to low-cost health care. What still is not clear is the extent to which long term care will be included in the basic benefits package. A confidential report circulated by the task force last month includes four options for long term care: incremental Medicaid reform; a new federal/state program to replace Medicaid; a social insurance program for home and community-based services; or full social insurance for long term care. Some work group members have identified an additional option: prefunded long term care insurance.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:10126659

  12. The new role of patients in future health settings.

    PubMed

    Ruotsalainen, Pekka; Blobel, Bernd

    2015-01-01

    Health is wide concept covering a person's physical, mental and social well-being. Traditionally, regulated healthcare has been the main source for curative and preventive service offered to patients. Healthcare is in transition, however. Paradigms such as patient empowerment and patient in the centre as well as in-home care service are changing processes and locations healthcare services are offered. Parallel to healthcare, new service models such as pHealth, ubiquitous healthcare, and digital medicine are developing. In the near future, technology enables the creation of a personal digital health dossier (e.g. digital patient and virtual patient model) for any individual. This dossier is stored and used in the unsecure information space. This all means that the traditional paternalistic patient model where patient is a passive object for regulated healthcare services will not work in future pHealth and digital health anymore. Instead, the new patient role (e.g. pHealth user or health consumer role) is dynamic, context-aware and participatory. The pHealth user can also have many roles at the same time, such as the role of informed chooser, decision maker, and personal health coordinator. This requires that the pHealth user can make information-based meaningful decisions before starting to use health services, and that he or she can trust on service providers by having evidence-based and reliable information about the quality and health impact of the services offered. A big challenge is that pHealth and digital health take place in unsecure information space where current healthcare specific laws, regulations, and medical ethics are insufficient to guarantee users' autonomy and privacy as well as the application of fair information and ethical principles when processing personal health information. A new ethical, legal and technical framework is needed. One of the prerequisites successful pHealth and digital health has to meet is the possibility to create

  13. The Development of an Integrated Science Core Curriculum for Allied Health Students

    ERIC Educational Resources Information Center

    Sesney, John; And Others

    1977-01-01

    The article describes the development of BioMedical Sciences Core at Weber State College in Ogden, Utah for introductory level allied health students. The design of the "Core" curriculum is to integrate the disciplines of physics, chemistry, anatomy, physiology, and microbiology as they relate to the human body rather than teaching the traditional…

  14. Coded Statutory Data Sets for Evaluation of Public Health Law

    ERIC Educational Resources Information Center

    Costich, Julia Field

    2012-01-01

    Background and objectives: The evaluation of public health law requires reliable accounts of underlying statutes and regulations. States often enact public health-related statutes with nonuniform provisions, and variation in the structure of state legal codes can foster inaccuracy in evaluating the impact of specific categories of law. The optimal…

  15. Identification of Violence in Turkish Health Care Settings

    ERIC Educational Resources Information Center

    Ayranci, Unal; Yenilmez, Cinar; Balci, Yasemin; Kaptanoglu, Cem

    2006-01-01

    This study sought to investigate the contributing factors to and frequency of violence against health care workers (HCWs) working in western Turkey. The population is composed of a random sample of 1,209 HCWs from 34 health care workplaces. Written questionnaires were given to HCWs at all sites, where staff were instructed to register all types of…

  16. Medical Student Psychiatric Education in Neighborhood Health Settings.

    ERIC Educational Resources Information Center

    Morrison, Andrew P.

    1978-01-01

    Harvard medical students in a psychiatric rotation at the Massachusetts Mental Health Center may elect to do part of their work in a neighborhood comprehensive health center in which primary care services are offered. Students are exposed to a multiprofessional and mixed professional-paraprofessional staff, as well as to special patient problems.…

  17. Managing Evaluation in a Federal Public Health Setting

    ERIC Educational Resources Information Center

    Schooley, Michael W.

    2009-01-01

    The author, a federal manager who leads development and maintenance of evaluation for specific public health programs at the Centers for Disease Control and Prevention, tells the story of developing an evaluation unit in the Office on Smoking and Health. Lessons about managing evaluation, including his practices and related principles, are…

  18. A Guide to Health Education in Ambulatory Care Settings.

    ERIC Educational Resources Information Center

    Health Services Administration (DHEW/PHS), Rockville, MD. Bureau of Community Health Services.

    This report outlines ways in which health education strategies can be developed within an ambulatory care center and how they can be implemented to optimize their effectiveness and efficiency. Section 1 describes a program planning model for use in the development of health education programs. Sections 2 through 5 trace the consumer through four…

  19. Clinically Sensitive Peer-Assisted Mediation in Mental Health Settings.

    ERIC Educational Resources Information Center

    Kurtz, Susan; Stone, James L.; Holbrook, Terry

    2002-01-01

    Describes a pilot mediation program that offers an empowering alternative to problem resolution used by mental health consumers receiving treatment at an inpatient psychiatric center. The training program uses mental health clinicians and consumers (peer advocates) to act as assistants in mediating disputes between consumers and between consumers…

  20. Syllabi Set on Women, Health and Healing: Fourteen Courses.

    ERIC Educational Resources Information Center

    Ruzek, Sheryl, Comp.; And Others

    Compiled with the goal of developing social science perspectives on women's health and on topics at the intersection of social science and clinical issues, the syllabi included were developed by faculty teaching in the Women, Health and Healing Program at the University of California, San Francisco. The courses here are directed at upper division…

  1. Setting the rural health services research agenda: the congressional perspective.

    PubMed Central

    Patton, L

    1989-01-01

    This series of key research questions is based on the underlying congressional assumption that the rural health research agenda must be developed as an instrument equally relevant to policymakers, practitioners, and the public. PMID:2492981

  2. [Advances and challenges in setting priorities in health].

    PubMed

    Bobadilla, J L

    1992-01-01

    The advances and problems in the definition of explicit criteria to measure health needs are discussed. In part one the advantages and limitations of the retrospective and prospective approaches in the identification of health needs for a rational distribution of resources are described. In part two progress in the application of explicit criteria for the prioritization of diseases and interventions to control them are analyzed. Finally, the methodological, conceptual, and operative challenges confronted by this field are discussed. PMID:1411775

  3. Value and challenges of research on health professions' core subjects in education.

    PubMed

    Hooper, Barbara; Krishnagiri, Sheama; Pollie Price, M; Bilics, Andrea R; Taff, Steven D; Mitcham, Maralynne D

    2014-01-01

    Professions are organized around central concerns, or core subjects. Knowledge of a field's core subject is indispensable to effective practice, reasoning, and professional identity. In health professions education, however, core subjects are often obscured by the plethora of topics and skills that must be taught, rendering them largely implicit in the learning process. Core subjects and how they are addressed in curricula thus remain under-researched in health professions education. The scarcity of research can be attributed to the need for (1) explicating core subjects as the basis for learning, (2) language that describes professional education as connecting all learning to a field's core, and (3) research methods that go beyond early phases of research development, including a conceptual framework for understanding and studying core subjects. This paper presents strategies addressing each of these challenges that were developed through a pilot and a subsequent large national study of occupational therapy education. These strategies provide a foundation for dialogue and future research on the nature and function of core subjects in health professions education. PMID:25433182

  4. Development of core outcome sets in hidradenitis suppurativa: systematic review of outcome measure instruments to inform the process.

    PubMed

    Ingram, J R; Hadjieconomou, S; Piguet, V

    2016-08-01

    The recent hidradenitis suppurativa (HS) Cochrane review identified outcome measure heterogeneity as an important issue to address when designing future HS trials. Our objective was to follow the Harmonising Outcome Measures for Eczema (HOME) roadmap, by performing a systematic review of HS outcome measure instruments to inform the development of an HS core outcome set. We performed a systematic review to identify validation evidence for outcome measure instruments used in HS randomized controlled trials (RCTs), and assessed the methodological quality of all HS outcome measure validity studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. The 12 RCTs included in the Cochrane review utilized 30 outcome measure instruments, including 16 physician-reported instruments, 11 patient-reported instruments and three composite measures containing elements of both. Twenty-seven (90%) of the instruments lacked any validation data. Two further instruments have been developed and partially validated. Of the seven studies meeting our inclusion criteria, six were of 'fair' or 'poor' methodological quality, in part because most of the studies were not primarily designed for instrument validation. The HiSCR instrument is supported by good-quality validation data, but there are gaps, including assessment of internal consistency, inter-rater reliability and minimal clinically important difference, and convergent validity fell below the acceptable range for some comparisons. Multiple, usually unvalidated, outcome measure instruments have been used in HS RCTs. Where validation evidence is available there are issues of low methodological quality or incomplete validity assessment and so, currently, no instruments can be fully recommended. PMID:26873867

  5. Physical Interactions and Functional Coordination between the Core Subunits of Set1/Mll Complexes and the Reprogramming Factors

    PubMed Central

    Yang, Zhenhua; Augustin, Jonathan; Hu, Jing; Jiang, Hao

    2015-01-01

    Differentiated cells can be reprogrammed to the pluripotent state by overexpression of defined factors, and this process is profoundly influenced by epigenetic mechanisms including dynamic histone modifications. Changes in H3K4 methylation have been shown to be the predominant activating response in the early stage of cellular reprogramming. Mechanisms underlying such epigenetic priming, however, are not well understood. Here we show that the expression of the reprogramming factors (Yamanaka factors, Oct4, Sox2, Klf4 and Myc), especially Myc, directly promotes the expression of certain core subunits of the Set1/Mll family of H3K4 methyltransferase complexes. A dynamic recruitment of the Set1/Mll complexes largely, though not sufficiently in its own, explains the dynamics of the H3K4 methylation during cellular reprogramming. We then demonstrate that the core subunits of the Set1/Mll complexes physically interact with mainly Sox2 and Myc among the Yamanaka factors. We further show that Sox2 directly binds the Ash2l subunit in the Set1/Mll complexes and this binding is mediated by the HMG domain of Sox2. Functionally, we show that the Set1/Mll complex core subunits are required for efficient cellular reprogramming. We also show that Dpy30, one of the core subunits in the complexes, is required for the efficient target binding of the reprogramming factors. Interestingly, such requirement is not necessarily dependent on locus-specific H3K4 methylation. Our work provides a better understanding of how the reprogramming factors physically interact and functionally coordinate with a key group of epigenetic modulators to mediate transitions of the chromatin state involved in cellular reprogramming. PMID:26691508

  6. Physical Interactions and Functional Coordination between the Core Subunits of Set1/Mll Complexes and the Reprogramming Factors.

    PubMed

    Yang, Zhenhua; Augustin, Jonathan; Hu, Jing; Jiang, Hao

    2015-01-01

    Differentiated cells can be reprogrammed to the pluripotent state by overexpression of defined factors, and this process is profoundly influenced by epigenetic mechanisms including dynamic histone modifications. Changes in H3K4 methylation have been shown to be the predominant activating response in the early stage of cellular reprogramming. Mechanisms underlying such epigenetic priming, however, are not well understood. Here we show that the expression of the reprogramming factors (Yamanaka factors, Oct4, Sox2, Klf4 and Myc), especially Myc, directly promotes the expression of certain core subunits of the Set1/Mll family of H3K4 methyltransferase complexes. A dynamic recruitment of the Set1/Mll complexes largely, though not sufficiently in its own, explains the dynamics of the H3K4 methylation during cellular reprogramming. We then demonstrate that the core subunits of the Set1/Mll complexes physically interact with mainly Sox2 and Myc among the Yamanaka factors. We further show that Sox2 directly binds the Ash2l subunit in the Set1/Mll complexes and this binding is mediated by the HMG domain of Sox2. Functionally, we show that the Set1/Mll complex core subunits are required for efficient cellular reprogramming. We also show that Dpy30, one of the core subunits in the complexes, is required for the efficient target binding of the reprogramming factors. Interestingly, such requirement is not necessarily dependent on locus-specific H3K4 methylation. Our work provides a better understanding of how the reprogramming factors physically interact and functionally coordinate with a key group of epigenetic modulators to mediate transitions of the chromatin state involved in cellular reprogramming. PMID:26691508

  7. Three stage level set segmentation of mass core, periphery, and spiculations for automated image analysis of digital mammograms

    NASA Astrophysics Data System (ADS)

    Ball, John Eugene

    In this dissertation, level set methods are employed to segment masses in digital mammographic images and to classify land cover classes in hyperspectral data. For the mammography computer aided diagnosis (CAD) application, level set-based segmentation methods are designed and validated for mass-periphery segmentation, spiculation segmentation, and core segmentation. The proposed periphery segmentation uses the narrowband level set method in conjunction with an adaptive speed function based on a measure of the boundary complexity in the polar domain. The boundary complexity term is shown to be beneficial for delineating challenging masses with ill-defined and irregularly shaped borders. The proposed method is shown to outperform periphery segmentation methods currently reported in the literature. The proposed mass spiculation segmentation uses a generalized form of the Dixon and Taylor Line Operator along with narrowband level sets using a customized speed function. The resulting spiculation features are shown to be very beneficial for classifying the mass as benign or malignant. For example, when using patient age and texture features combined with a maximum likelihood (ML) classifier, the spiculation segmentation method increases the overall accuracy to 92% with 2 false negatives as compared to 87% with 4 false negatives when using periphery segmentation approaches. The proposed mass core segmentation uses the Chan-Vese level set method with a minimal variance criterion. The resulting core features are shown to be effective and comparable to periphery features, and are shown to reduce the number of false negatives in some cases. Most mammographic CAD systems use only a periphery segmentation, so those systems could potentially benefit from core features.

  8. Establishing a Core Domain Set to Measure Rheumatoid Arthritis Flares: Report of the OMERACT 11 RA Flare Workshop

    PubMed Central

    Bykerk, Vivian P.; Lie, Elisabeth; Bartlett, Susan J.; Alten, Rieke; Boonen, Annelies; Christensen, Robin; Furst, Daniel E.; Hewlett, Sarah; Leong, Amye L.; Lyddiatt, Anne; March, Lyn; May, James E.; Montie, Pam; Orbai, Ana-Maria; Pohl, Christoph; Voshaar, Marieke Scholte; Woodworth, Thasia; Bingham, Clifton O.; Choy, Ernest H.

    2015-01-01

    Objective The OMERACT Rheumatoid Arthritis (RA) Flare Group (FG) is developing a data-driven, patient-inclusive, consensus-based RA flare definition for use in clinical trials, longterm observational studies, and clinical practice. At OMERACT 11, we sought endorsement of a proposed core domain set to measure RA flare. Methods Patient and healthcare professional (HCP) qualitative studies, focus groups, and literature review, followed by patient and HCP Delphi exercises including combined Delphi consensus at Outcome Measures in Rheumatology 10 (OMERACT 10), identified potential domains to measure flare. At OMERACT 11, breakout groups discussed key domains and instruments to measure them, and proposed a research agenda. Patients were active research partners in all focus groups and domain identification activities. Processes for domain selection and patient partner involvement were case studies for OMERACT Filter 2.0 methodology. Results A pre-meeting combined Delphi exercise for defining flare identified 9 domains as important (> 70% consensus from patients or HCP). Four new patient-reported domains beyond those included in the RA disease activity core set were proposed for inclusion (fatigue, participation, stiffness, and self-management). The RA FG developed preliminary flare questions (PFQ) to measure domains. In combined plenary voting sessions, OMERACT 11 attendees endorsed the proposed RA core set to measure flare with ≥ 78% consensus and the addition of 3 additional domains to the research agenda for OMERACT 12. Conclusion At OMERACT 11, a core domain set to measure RA flare was ratified and endorsed by attendees. Domain validation aligning with Filter 2.0 is ongoing in new randomized controlled clinical trials and longitudinal observational studies using existing and new instruments including a set of PFQ. PMID:24584927

  9. Systematically convergent basis sets with relativistic pseudopotentials. II. Small-core pseudopotentials and correlation consistent basis sets for the post-d group 16-18 elements

    SciTech Connect

    Peterson, Kirk A.; Figgen, Detlev; Goll, Erich; Stoll, Hermann; Dolg, Michael F.

    2003-12-01

    Series of correlation consistent basis sets have been developed for the post-d group 16-18 elements in conjunction with small-core relativistic pseudopotentials (PPs) of the energy-consistent variety. The latter were adjusted to multiconfiguration Dirac-Hartree-Fock data based on the Dirac-Coulomb-Breit Hamiltonian. The outer-core (n-1)spd shells are explicitly treated together with the nsp valence shell with these PPs. The accompanying cc-pVnZ-PP and aug-cc-pVnZ-PP basis sets range in size from DZ to 5Z quality and yield systematic convergence of both Hartree-Fock and correlated total energies. In addition to the calculation of atomic electron affinities and dipole polarizabilities of the rare gas atoms, numerous molecular benchmark calculations (HBr, HI, HAt, Br2, I2, At2, SiSe, SiTe, SiPo, KrH+, XeH+, and RnH+) are also reported at the coupled cluster level of theory. For the purposes of comparison, all-electron calculations using the Douglas-Kroll-Hess Hamiltonian have also been carried out for the halogen-containing molecules using basis sets of 5Z quality.

  10. Can we teach core clinical obstetrics and gynaecology skills using low fidelity simulation in an interprofessional setting?

    PubMed

    Kumar, Arunaz; Gilmour, Carole; Nestel, Debra; Aldridge, Robyn; McLelland, Gayle; Wallace, Euan

    2014-12-01

    Core clinical skills acquisition is an essential component of undergraduate medical and midwifery education. Although interprofessional education is an increasingly common format for learning efficient teamwork in clinical medicine, its value in undergraduate education is less clear. We present a collaborative effort from the medical and midwifery schools of Monash University, Melbourne, towards the development of an educational package centred around a core skills-based workshop using low fidelity simulation models in an interprofessional setting. Detailed feedback on the package was positive with respect to the relevance of the teaching content, whether the topic was well taught by task trainers and simulation models used, pitch of level of teaching and perception of confidence gained in performing the skill on a real patient after attending the workshop. Overall, interprofessional core skills training using low fidelity simulation models introduced at an undergraduate level in medicine and midwifery had a good acceptance. PMID:25308468

  11. Needles and Other Sharps (Safe Disposal Outside of Health Care Settings)

    MedlinePlus

    ... are generally available through pharmacies, medical supply companies, health care providers and online. These containers are made of ... proper disposal methods for sharps used outside of health care settings visit this website or call (800) 643- ...

  12. Research priority setting for health policy and health systems strengthening in Nigeria: the policymakers and stakeholders perspective and involvement

    PubMed Central

    Uneke, Chigozie Jesse; Ezeoha, Abel Ebeh; Ndukwe, Chinwendu Daniel; Oyibo, Patrick Gold; Onwe, Friday; Aulakh, Bhupinder Kaur

    2013-01-01

    Introduction Nigeria is one of the low and middle income countries (LMICs) facing severe resource constraint, making it impossible for adequate resources to be allocated to the health sector. Priority setting becomes imperative because it guides investments in health care, health research and respects resource constraints. The objective of this study was to enhance the knowledge and understanding of policymakers on research priority setting and to conduct a research priority setting exercise. Methods A one-day evidence-to-policy research priority setting meeting was held. The meeting participants included senior and middle level policymakers and key decision makers/stakeholders in the health sector in Ebonyi State southeastern Nigeria. The priorities setting meeting involved a training session on priority setting process and conduction of priority setting exercise using the essential national health research (ENHR) approach. The focus was on the health systems building blocks (health workforce; health finance; leadership/governance; medical products/technology; service delivery; and health information/evidence). Results Of the total of 92 policymakers invited 90(97.8%) attended the meeting. It was the consensus of the policymakers that research should focus on the challenges of optimal access to health products and technology; effective health service delivery and disease control under a national emergency situation; the shortfalls in the supply of professional personnel; and the issues of governance in the health sector management. Conclusion Research priority setting exercise involving policymakers is an example of demand driven strategy in the health policymaking process capable of reversing inequities and strengthening the health systems in LMICs. PMID:24570781

  13. Mental health care utilization and costs in a corporate setting.

    PubMed

    Tsai, S P; Bernacki, E J; Reedy, S M

    1987-10-01

    This article presents the mental health care utilization and costs among 14,162 employees and their families, covered under a major medical policy of a large multinational corporation for the 1984 policy year. Mental health care costs comprise a substantial portion of the total health care dollars expended (8.1%) for a relatively small fraction of the total number of claims (2.8%). The average hospital stay for mental disorders (20 days for employees; 15 days for spouses; 43 days for dependents) was significantly longer than for other illnesses (6.1 days for employees; 6.2 days for spouses; 4.4 days for dependents). Although the average daily hospital cost for mental disorders was less than that for non-mental conditions, total expenditures per admission were approximately three times higher due to the long lengths of stay. Case management, peer utilization review, and day treatment are recommended to reduce these costs. PMID:3681492

  14. Addressing social determinants of health inequities through settings: a rapid review.

    PubMed

    Newman, Lareen; Baum, Fran; Javanparast, Sara; O'Rourke, Kerryn; Carlon, Leanne

    2015-09-01

    Changing settings to be more supportive of health and healthy choices is an optimum way to improve population health and health equity. This article uses the World Health Organisation's (1998) (WHO Health Promotion Glossary. WHO Collaborating Centre for Health Promotion, Department of Public Health and Community Medicine, University of Sydney, NSW) definition of settings approaches to health promotion as those focused on modifying settings' structure and nature. A rapid literature review was undertaken in the period June-August 2014, combining a systematically conducted search of two major databases with targeted searches. The review focused on identifying what works in settings approaches to address the social determinants of health inequities, using Fair Foundations: the VicHealth framework for health equity. This depicts the social determinants of health inequities as three layers of influence, and entry points for action to promote health equity. The evidence review identified work in 12 settings (cities; communities and neighbourhoods; educational; healthcare; online; faith-based; sports; workplaces; prisons; and nightlife, green and temporary settings), and work at the socioeconomic, political and cultural context layer of the Fair Foundations framework (governance, legislation, regulation and policy). It located a relatively small amount of evidence that settings themselves are being changed in ways which address the social determinants of health inequities. Rather, many initiatives focus on individual behaviour change within settings. There is considerable potential for health promotion professionals to focus settings work more upstream and so replace or integrate individual approaches with those addressing daily living conditions and higher level structures, and a significant need for programmes to be evaluated for differential equity impacts and published to provide a more solid evidence base. PMID:26420808

  15. The politics of women's health: setting a global agenda.

    PubMed

    Doyal, L

    1996-01-01

    The last decade has been marked by a rapid growth in the women's health movement around the world. There has been a marked shift in activities away from the developed countries, as campaigns increase in intensity in Africa, Asia, and Latin America. The practice of women's health politics has also become increasingly international with sustained and effective collaboration across the north-south divide. Both the goals of these campaigns and their methods vary with the circumstances of the women involved. But despite this diversity, common themes can be identified: reproductive self-determination; affordable, effective, and humane medical care; satisfaction of basic needs; a safe workplace; and freedom from violence. PMID:8932601

  16. Aboriginal and Torres Strait Islander Public Health: Online and Integrated into Core Master of Public Health Subjects

    PubMed Central

    Angus, Lynnell; Ewen, Shaun; Coombe, Leanne

    2016-01-01

    The Master of Public Health (MPH) is an internationally recognised post-graduate qualification for building the public health workforce. In Australia, MPH graduate attributes include six Indigenous public health (IPH) competencies. The University of Melbourne MPH program includes five core subjects and ten specialisation streams, of which one is Indigenous health. Unless students complete this specialisation or electives in Indigenous health, it is possible for students to graduate without attaining the IPH competencies. To address this issue in a crowded and competitive curriculum an innovative approach to integrating the IPH competencies in core MPH subjects was developed. Five online modules that corresponded with the learning outcomes of the core public health subjects were developed, implemented and evaluated in 2015. This brief report outlines the conceptualisation, development, and description of the curriculum content; it also provides preliminary student evaluation and staff feedback on the integration project. Significance for public health This approach to a comprehensive, online, integrated Indigenous public health (IPH) curriculum is significant, as it ensures that all University of Melbourne Master of Public Health (MPH) graduates will have the competencies to positively contribute to Indigenous health status. A workforce that is attuned not only to the challenges of IPH, but also to the principles of self-determination, Indigenous agency and collaboration is better equipped to be comprised of ethical and judgment-safe practitioners. Additionally, the outlined approach of utilizing IPH content and examples into core MPH subjects ensures both the Australian relevance for an Australian-based health professional course and international appeal through the modules inclusion of International Indigenous case-studies and content. Furthermore, approaches learned in a challenging Indigenous Australian context are transferable and applicable to other IPH

  17. Aboriginal and Torres Strait Islander Public Health: Online and Integrated into Core Master of Public Health Subjects.

    PubMed

    Angus, Lynnell; Ewen, Shaun; Coombe, Leanne

    2016-04-26

    The Master of Public Health (MPH) is an internationally recognised post-graduate qualification for building the public health workforce. In Australia, MPH graduate attributes include six Indigenous public health (IPH) competencies. The University of Melbourne MPH program includes five core subjects and ten specialisation streams, of which one is Indigenous health. Unless students complete this specialisation or electives in Indigenous health, it is possible for students to graduate without attaining the IPH competencies. To address this issue in a crowded and competitive curriculum an innovative approach to integrating the IPH competencies in core MPH subjects was developed. Five online modules that corresponded with the learning outcomes of the core public health subjects were developed, implemented and evaluated in 2015. This brief report outlines the conceptualisation, development, and description of the curriculum content; it also provides preliminary student evaluation and staff feedback on the integration project. Significance for public healthThis approach to a comprehensive, online, integrated Indigenous public health (IPH) curriculum is significant, as it ensures that all University of Melbourne Master of Public Health (MPH) graduates will have the competencies to positively contribute to Indigenous health status. A workforce that is attuned not only to the challenges of IPH, but also to the principles of self-determination, Indigenous agency and collaboration is better equipped to be comprised of ethical and judgment-safe practitioners. Additionally, the outlined approach of utilizing IPH content and examples into core MPH subjects ensures both the Australian relevance for an Australian-based health professional course and international appeal through the modules inclusion of International Indigenous case-studies and content. Furthermore, approaches learned in a challenging Indigenous Australian context are transferable and applicable to other IPH

  18. Distraction: an assessment of smartphone usage in health care work settings

    PubMed Central

    Gill, Preetinder S; Kamath, Ashwini; Gill, Tejkaran S

    2012-01-01

    Smartphone use in health care work settings presents both opportunities and challenges. The benefits could be severely undermined if abuse and overuse are not kept in check. This practice-focused research paper examines the current panorama of health software applications. Findings from existing research are consolidated to elucidate the level and effects of distraction in health care work settings due to smartphone use. A conceptual framework for crafting guidelines to regulate the use of smartphones in health care work settings is then presented. Finally, specific guidelines are delineated to assist in creating policies for the use of smartphones in a health care workplace. PMID:22969308

  19. Active Ways to Teach Health Concepts in the Elementary Setting

    ERIC Educational Resources Information Center

    Gregory, Julie

    2015-01-01

    This article provides three movement-based activities for teaching health concepts to elementary school students. Two activities focus on nutrition concepts and the other focuses on teaching body systems. Diagrams are provided to show the setup of activities, as well as links for accessing materials to help implement the activities.

  20. A Survey of Autism Knowledge in a Health Care Setting

    ERIC Educational Resources Information Center

    Heidgerken, Amanda, D.; Geffken, Gary; Modi, Avani; Frakey, Laura

    2005-01-01

    The current study extends research by Stone [Cross-disciplinary perspectives on autism? "Journal of Pediatric Psychology, 12", (1988) 615; A comparison of teacher and parent views of autism. "Journal of Autism and Development Disorders, 18", (1988) 403] exploring the knowledge and beliefs about autism across multiple health care professions. One…

  1. Fluoride Programs in the School Setting: Preventive Dental Health.

    ERIC Educational Resources Information Center

    Rebich, Theodore, Jr.; And Others

    1982-01-01

    Two types of school-based programs that increase students' use of fluoride for preventive dental health are described. In fluoride mouthrinse programs, teachers give their students a fluoride solution once a week in a paper cup. In areas where the level of fluoride in the water supply is insufficient, the flouride tablet program is used. (JN)

  2. Creating optimal healing environments in a health care setting.

    PubMed

    Zborowsky, Terri; Kreitzer, Mary Jo

    2008-03-01

    As evidence about the benefits of healing environments accumulates, health care organizations are starting to incorporate features into hospital design that reduce stress and promote healing. This article discusses some of the research supporting healing design and provides examples of how it is being used in new construction and renovations. PMID:18438085

  3. Predicting Physical Activity Promotion in Health Care Settings.

    ERIC Educational Resources Information Center

    Faulkner, Guy; Biddle, Stuart

    2001-01-01

    Tested the theory of planned behavior's (TPB) ability to predict stage of change for physical activity promotion among health professionals. Researchers measured attitudes, subjective norms, intentions, perceived behavioral control, and stage of change, then later reassessed stage of change. TPB variables of attitude, subjective norms, perceived…

  4. Men's Health Promotion by General Practitioners in a Workplace Setting.

    ERIC Educational Resources Information Center

    Aoun, Samar; Johnson, Lyn

    2002-01-01

    A project to promote rural men's health through diabetes education and screening in the workplace involved 446 men aged 40-65 in Western Australia. Of the 287 men identified at high risk of developing diabetes and referred to their general practitioner, 76 percent visited their physician. However, physician's advice on lifestyle changes was…

  5. Factor Structure of the WPPSI in Mental Health Clinic Settings.

    ERIC Educational Resources Information Center

    Haynes, Jack P.; Atkinson, David

    1984-01-01

    Factor-analyzed the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) scores of emotionally disturbed children (N=181). The results suggested that the structure of intelligence for emotionally disturbed children is similar to that for normal children. WPPSI profile analysis that uses subtest scores may be invalid in clinical settings.…

  6. Core Outcome Sets and Multidimensional Assessment Tools for Harmonizing Outcome Measure in Chronic Pain and Back Pain.

    PubMed

    Kaiser, Ulrike; Neustadt, Katrin; Kopkow, Christian; Schmitt, Jochen; Sabatowski, Rainer

    2016-01-01

    Core Outcome Sets (COSs) are a set of domains and measurement instruments recommended for application in any clinical trial to ensure comparable outcome assessment (both domains and instruments). COSs are not exclusively recommended for clinical trials, but also for daily record keeping in routine care. There are several COS recommendations considering clinical trials as well as multidimensional assessment tools to support daily record keeping in low back pain. In this article, relevant initiatives will be described, and implications for research in COS development in chronic pain and back pain will be discussed. PMID:27589816

  7. Computer networking in an ambulatory health care setting.

    PubMed

    Alger, R; Berkowitz, L L; Bergeron, B; Buskett, D

    1999-01-01

    Computers are a ubiquitous part of the ambulatory health care environment. Although stand-alone computers may be adequate for a small practice, networked computers can create much more powerful and cost-effective computerized systems. Local area networks allow groups of computers to share peripheral devices and computerized information within an office or cluster of offices. Wide area networks allow computers to securely share devices and information across a large geographical area. Either singly or in combination, these networks can be used to create robust systems to help physicians automate their practices and improve their access to important clinical information. In this article, we will examine common network configurations, explain how they function, and provide examples of real-world implementations of networking technology in health care. PMID:10662271

  8. Validation of the Patient Health Questionnaire-9 for Major Depressive Disorder in the Occupational Health Setting.

    PubMed

    Volker, D; Zijlstra-Vlasveld, M C; Brouwers, E P M; Homans, W A; Emons, W H M; van der Feltz-Cornelis, C M

    2016-06-01

    Purpose Because of the increased risk of long-term sickness leave for employees with a major depressive disorder (MDD), it is important for occupational health professionals to recognize depression in a timely manner. The Patient Health Questionnaire-9 (PHQ-9) has proven to be a reliable and valid instrument for screening MDD, but has not been validated in the occupational health setting. The aim of this study was to validate the PHQ-9 for MDD within a population of employees on sickness leave by using the MINI-International Neuropsychiatric Interview (MINI) as a gold standard. Methods Participants were recruited in collaboration with the occupational health service. The study sample consisted of 170 employees on sickness leave between 4 and 26 weeks who completed the PHQ-9 and were evaluated with the MINI by telephone. Sensitivity, specificity, positive and negative predictive value, efficiency and 95 % confidence intervals (95 % CIs) were calculated for all possible cut-off values. A receiver operator characteristics (ROC) analysis was computed for PHQ-9 score versus the MINI. Results The optimal cut-off value of the PHQ-9 was 10. This resulted in a sensitivity of 86.1 % [95 % CI (69.7-94.8)] and a specificity of 78.4 % [95 % CI (70.2-84.8)]. Based on the ROC analysis, the area under the curve for the PHQ-9 was 0.90 [SE = 0.02; 95 % CI (0.85-0.94)]. Conclusion The PHQ-9 shows good sensitivity and specificity as a screener for MDD within a population of employees on sickness leave. PMID:26377480

  9. Budget- and Priority-Setting Criteria at State Health Agencies in Times of Austerity: A Mixed-Methods Study

    PubMed Central

    Resnick, Beth; Kass, Nancy; Sellers, Katie; Young, Jessica; Bernet, Patrick; Jarris, Paul

    2014-01-01

    Objectives. We examined critical budget and priority criteria for state health agencies to identify likely decision-making factors, pressures, and opportunities in times of austerity. Methods. We have presented findings from a 2-stage, mixed-methods study with state public health leaders regarding public health budget- and priority-setting processes. In stage 1, we conducted hour-long interviews in 2011 with 45 health agency executive and division or bureau leaders from 6 states. Stage 2 was an online survey of 207 executive and division or bureau leaders from all state health agencies (66% response rate). Results. Respondents identified 5 key criteria: whether a program was viewed as “mission critical,” the seriousness of the consequences of not funding the program, financing considerations, external directives and mandates, and the magnitude of the problem the program addressed. Conclusions. We have presented empirical findings on criteria used in state health agency budgetary decision-making. These criteria suggested a focus and interest on core public health and the largest public health problems with the most serious ramifications. PMID:24825212

  10. Setting capitation payments in markets for health services

    PubMed Central

    Ellis, Randall P.; McGuire, Thomas G.

    1987-01-01

    Health maintenance organizations (HMO's) are paid a capitated amount for enrolled Medicare beneficiaries that is 95 percent of what these enrollees would be expected to cost in the fee-for-service sector. However, it appears that HMO enrollees are less costly than other Medicare beneficiaries. With a simulation model, we demonstrate that with a 95-percent pricing rule, any significant degree of biased selection leads to increased cost to the payer, even when HMO's are cost effective compared with the fee-for-service sector. Optimal pricing percentages from the point of view of cost minimization are considerably less than 95 percent. PMID:10312188

  11. Using electronic communication safely in health care settings.

    PubMed

    Broussard, Brenda S; Broussard, Anne B

    2013-01-01

    Nurses are increasingly using mobile and other devices, such as cell phones, smartphones, tablets, bar-coding scanners, monitoring equipment and bedside computers, to communicate with members of the health care team and with patients. Communication accomplished with such devices includes direct verbal communication, text-messaging, emailing, obtaining patient care information and accessing medical records for order entry and for documenting nursing care. Problems that could occur with such communication methods include distraction, errors, de-personalized care, violation of confidentiality and transmission of nosocomial pathogens. Policies are needed to prevent inappropriate use of technological devices in patient care and to promote patient safety and quality care with their use. PMID:23399014

  12. Dimensions and Determinants of Trust in Health Care in Resource Poor Settings – A Qualitative Exploration

    PubMed Central

    Gopichandran, Vijayaprasad; Chetlapalli, Satish Kumar

    2013-01-01

    Background Trust in health care has been intensely researched in resource rich settings. Some studies in resource poor settings suggest that the dimensions and determinants of trust are likely to be different. Objectives This study was done as a qualitative exploration of the dimensions and determinants of trust in health care in Tamil Nadu, a state in south India to assess the differences from dimensions and determinants in resource rich settings. Methodology The participants included people belonging to marginalized communities with poor access to health care services and living in conditions of resource deprivation. A total of thirty five in depth interviews were conducted. The interviews were summarized and transcribed and data were analyzed following thematic analysis and grounded theory approach. Results The key dimensions of trust in health care identified during the interviews were perceived competence, assurance of treatment irrespective of ability to pay or at any time of the day, patients’ willingness to accept drawbacks in health care, loyalty to the physician and respect for the physician. Comfort with the physician and health facility, personal involvement of the doctor with the patient, behavior and approach of doctor, economic factors, and health awareness were identified as factors determining the levels of trust in health care. Conclusions The dimensions and determinants of trust in health care in resource poor settings are different from that in resource rich settings. There is a need to develop scales to measure trust in health care in resource poor settings using these specific dimensions and determinants. PMID:23874904

  13. Learning and change in a community mental health setting.

    PubMed

    Mancini, Michael A; Miner, Craig S

    2013-10-01

    This article offers methodological reflections and lessons learned from a three-year university-community partnership that used participatory action research methods to develop and evaluate a model for learning and change. Communities of practice were used to facilitate the translation of recovery-oriented and evidence-based programs into everyday practice at a community mental health agency. Four lessons were drawn from this project. First, the processes of learning and organizational change are complex, slow, and multifaceted. Second, development of leaders and champions is vital to sustained implementation in an era of restricted resources. Third, it is important to have the agency's values, mission, policies, and procedures align with the principles and practices of recovery and integrated treatment. And fourth, effective learning of evidence-based practices is influenced by organizational culture and climate. These four lessons are expanded upon and situated within the broader literature and implications for future research are discussed. PMID:24066638

  14. Minimizing litigation risk. Documentation strategies in the occupational health setting.

    PubMed

    Baker, S K

    2000-02-01

    When advice is given by telephone, nurses are relying on employees' or clients' own assessments of situations. Nurses do not have the benefit of examination and objective findings. Therefore, every occupational health practice should have a system for keeping a record of telephone calls. Noncompliance should be documented so the nurse is reminded of the need to consider compliance when caring for the client in the future. Documentation of report tracking and follow up, consent, client education, and discharge information contributes to improved quality of care and reduced risk of litigation. Client records should never be altered (i.e., changed) so the original entry is no longer visible. The SLIDE (Single Line, Initials, Date, Explanation) rule should be used. PMID:10865552

  15. Power in global health agenda-setting: the role of private funding

    PubMed Central

    Levine, Ruth E.

    2015-01-01

    The editorial by Jeremy Shiffman, "Knowledge, moral claims and the exercise of power in global health", highlights the influence on global health priority-setting of individuals and organizations that do not have a formal political mandate. This sheds light on the way key functions in global health depend on private funding, particularly from the Bill & Melinda Gates Foundation. PMID:25905483

  16. Expanding the Application of Group Interventions: Emergence of Groups in Health Care Settings

    ERIC Educational Resources Information Center

    Drum, David; Becker, Martin Swanbrow; Hess, Elaine

    2011-01-01

    Changes in the health care arena and within the specialty of group work are contributing to the increased utilization of groups in health care settings. Psychoeducational, theme, and interpersonal therapy groups are highlighted for their contributions to treating challenging health conditions. An understanding of the evolution of these group…

  17. Developing a Set of Health Indicators for People with Intellectual Disabilities: "Pomona" Project

    ERIC Educational Resources Information Center

    Walsh, Patricia Noonan; Linehan, Christine; Kerr, M. P.; van Schrojenstein Lantman-de Valk, H. M. J.; Buono, Serafino; Azema, Bernard; Aussilloux, Charles; Maatta, Tuomo; Salvador-Carulla, Luis; Garrido-Cumbrera, Marco; van Hove, Geert; Bjorkman, Monica; Ceccotto, Raymond; Kamper, Marion; Weber, Germain; Heiss, Cecilia; Haveman, Meindert; Jorgensen, Frank Ulmer; O'Farrell, Lisa

    2005-01-01

    The European Commission's Health Monitoring Programme culminated in the development of a set of European Community Health Indicators (ECHI) for the general population. Despite evidence of marked disparities between the health of people with intellectual disabilities (ID) and their peers in the general population, the ECHI contain no significant…

  18. Brief Report: Applying an Indicator Set to Survey the Health of People with Intellectual Disabilities in Europe

    ERIC Educational Resources Information Center

    Walsh, Patricia Noonan

    2008-01-01

    This report gives an account of applying a health survey tool by the "Pomona" Group that earlier documented the process of developing a set of health indicators for people with intellectual disabilities in Europe. The "Pomona" health indicator set mirrors the much larger set of health indicators prepared by the European Community Health Indicators…

  19. A checklist for health research priority setting: nine common themes of good practice

    PubMed Central

    2010-01-01

    Health research priority setting processes assist researchers and policymakers in effectively targeting research that has the greatest potential public health benefit. Many different approaches to health research prioritization exist, but there is no agreement on what might constitute best practice. Moreover, because of the many different contexts for which priorities can be set, attempting to produce one best practice is in fact not appropriate, as the optimal approach varies per exercise. Therefore, following a literature review and an analysis of health research priority setting exercises that were organized or coordinated by the World Health Organization since 2005, we propose a checklist for health research priority setting that allows for informed choices on different approaches and outlines nine common themes of good practice. It is intended to provide generic assistance for planning health research prioritization processes. The checklist explains what needs to be clarified in order to establish the context for which priorities are set; it reviews available approaches to health research priority setting; it offers discussions on stakeholder participation and information gathering; it sets out options for use of criteria and different methods for deciding upon priorities; and it emphasizes the importance of well-planned implementation, evaluation and transparency. PMID:21159163

  20. Women's Health Care Minimum Data Set: pilot test and validation for use in clinical practice.

    PubMed

    Farley, Cindy L; Tharpe, Nell; Miller, Liane; Ruxer, Debbie Jenkins

    2006-01-01

    Basic elements of the structure, process, and outcomes of midwifery practice have not been fully determined, particularly in the areas of women's gynecologic and primary health care. The American College of Nurse-Midwives (ACNM) supported the development of clinical data sets to describe structure, process, and outcomes of midwifery practice for use by clinical practitioners. The Woman's Health Care Minimum Data Set was developed using a panel of expert midwives and other women's health care professionals, as well as literature resources. Students of the Graduate Midwifery Program at Philadelphia University performed pilot testing of the Woman's Health Care Minimum Data Set as a service to the profession of midwifery while applying concepts learned in their research methods courses. Each student (n = 19) recruited a midwifery practice in which she had a clinical affiliation, and gathered data sets on the previous 30 consecutive women's health care encounters by CNMs or CMs (n = 569). Item analysis and refinement were done. Criterion-related validity and construct-related validity of the Woman's Health Care Minimum Data Set were explored through comparison with the medical record and through the testing of plausible hypotheses. The Woman's Health Care Minimum Data Set has the potential to be an important instrument in documenting and understanding the evolving nature of the practice of primary women's health care by midwives and other women's health care providers. PMID:17081941

  1. Mental Health Service Delivery Systems and Perceived Qualifications of Mental Health Service Providers in School Settings

    ERIC Educational Resources Information Center

    Dixon, Decia Nicole

    2009-01-01

    Latest research on the mental health status of children indicates that schools are key providers of mental health services (U.S. Department of Health and Human Services, 2003). The push for school mental health services has only increased as stakeholders have begun to recognize the significance of sound mental health as an essential part of…

  2. Setting prudent public health policy for electromagnetic field exposures.

    PubMed

    Carpenter, David O; Sage, Cindy

    2008-01-01

    Electromagnetic fields (EMF) permeate our environment, coming both from such natural sources as the sun and from manmade sources like electricity, communication technologies and medical devices. Although life on earth would not be possible without sunlight, increasing evidence indicates that exposures to the magnetic fields associated with electricity and to communication frequencies associated with radio, television, WiFi technology, and mobile cellular phones pose significant hazards to human health. The evidence is strongest for leukemia from electricity-frequency fields and for brain tumors from communication-frequency fields, yet evidence is emerging for an association with other diseases as well, including neurodegenerative diseases. Some uncertainty remains as to the mechanism(s) responsible for these biological effects, and as to which components of the fields are of greatest importance. Nevertheless, regardless of whether the associations are causal, the strengths of the associations are sufficiently strong that in the opinion of the authors, taking action to reduce exposures is imperative, especially for the fetus and children. Inaction is not compatible with the Precautionary Principle, as enunciated by the Rio Declaration. Because of ubiquitous exposure, the rapidly expanding development of new EMF technologies and the long latency for the development of such serious diseases as brain cancers, the failure to take immediate action risks epidemics of potentially fatal diseases in the future. PMID:18763539

  3. Structural health monitoring algorithm comparisons using standard data sets

    SciTech Connect

    Figueiredo, Eloi; Park, Gyuhae; Figueiras, Joaquim; Farrar, Charles; Worden, Keith

    2009-03-01

    The real-world structures are subjected to operational and environmental condition changes that impose difficulties in detecting and identifying structural damage. The aim of this report is to detect damage with the presence of such operational and environmental condition changes through the application of the Los Alamos National Laboratory’s statistical pattern recognition paradigm for structural health monitoring (SHM). The test structure is a laboratory three-story building, and the damage is simulated through nonlinear effects introduced by a bumper mechanism that simulates a repetitive impact-type nonlinearity. The report reviews and illustrates various statistical principles that have had wide application in many engineering fields. The intent is to provide the reader with an introduction to feature extraction and statistical modelling for feature classification in the context of SHM. In this process, the strengths and limitations of some actual statistical techniques used to detect damage in the structures are discussed. In the hierarchical structure of damage detection, this report is only concerned with the first step of the damage detection strategy, which is the evaluation of the existence of damage in the structure. The data from this study and a detailed description of the test structure are available for download at: http://institute.lanl.gov/ei/software-and-data/.

  4. Proposing a Core Set of Instructional Practices and Tools for Teachers of Science

    ERIC Educational Resources Information Center

    Windschitl, Mark; Thompson, Jessica; Braaten, Melissa; Stroupe, David

    2012-01-01

    Recent calls for teacher preparation to become more grounded in practice prompt the questions: Which practices? and perhaps more fundamentally, what counts as a model of instruction worth learning for a new professional--i.e., the beginner's repertoire? In this report, we argue the following: If a defined set of subject-specific high-leverage…

  5. Development of a core set of SSR markers for the characterization of Gossypium germplasm

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Molecular markers such as simple sequence repeats (SSR) are a useful tool for characterizing genetic diversity of Gossypium germplasm collections. Genetic profiles by DNA fingerprinting of cotton accessions can only be compared among different collections if a common set of molecular markers are us...

  6. Pain in mental health setting and community: an exploration.

    PubMed

    Sharma, Manoj Kumar; Chaturvedi, Santosh K

    2014-01-01

    Pain is a commonly experienced complaint in the general population. It aims to determine the occurrence of pain complaints among the general population as well as the clinical group. The sample for the current study was drawn from the ongoing study on development of NIMHANS Screening tool for psychological problems. It includes males and females (119 males and 110 normal and 200 males and 100 clinical subjects) above age 18 years. Subjects were assessed on the question related to frequent experience of body ache and headache in the past one week in an individual setting. Data was analyzed using percentage scores. It indicate that 27% (16% in females and 11% in male) experience pain in the normal group, whereas in clinical categories, 14.5% of anxiety disorder (9.5% in females and 5% in males), 13.9% of depression (8.9% in females and 5% in males), 17.9% of obsessive compulsive disorder (OCD) (8.5% in females and 9.4% in males) and 13.9% of substance users reported pain in last seven days. It implies the need for sensitization among professionals and general population to identify pain complaints. PMID:24701023

  7. Report from the kick-off meeting of the Cochrane Skin Group Core Outcome Set Initiative (CSG-COUSIN).

    PubMed

    Schmitt, J; Deckert, S; Alam, M; Apfelbacher, C; Barbaric, J; Bauer, A; Chalmers, J; Chosidow, O; Delamere, F; Doney, E; Eleftheriadou, V; Grainge, M; Johannsen, L; Kottner, J; Le Cleach, L; Mayer, A; Pinart, M; Prescott, L; Prinsen, C A C; Ratib, S; Schlager, J G; Sharma, M; Thomas, K S; Weberschock, T; Weller, K; Werner, R N; Wild, T; Wilkes, S R; Williams, H C

    2016-02-01

    A major obstacle of evidence-based clinical decision making is the use of nonstandardized, partly untested outcome measurement instruments. Core Outcome Sets (COSs) are currently developed in different medical fields to standardize and improve the selection of outcomes and outcome measurement instruments in clinical trials, in order to pool results of trials or to allow indirect comparison between interventions. A COS is an agreed minimum set of outcomes that should be measured and reported in all clinical trials of a specific disease or trial population. The international, multidisciplinary Cochrane Skin Group Core Outcome Set Initiative (CSG-COUSIN) aims to develop and implement COSs in dermatology, thus making trial evidence comparable and, herewith, more useful for clinical decision making. The inaugural meeting of CSG-COUSIN was held on 17-18 March 2015 in Dresden, Germany, as the exclusive theme of the Annual Cochrane Skin Group Meeting. In total, 29 individuals representing a broad mix of different stakeholder groups, professions, skills and perspectives attended. This report provides a description of existing COS initiatives in dermatology, highlights current methodological challenges in COS development, and presents the concept, aims and structure of CSG-COUSIN. PMID:26779929

  8. Gender, traumatic events, and mental health disorders in a rural Asian setting.

    PubMed

    Axinn, William G; Ghimire, Dirgha J; Williams, Nathalie E; Scott, Kate M

    2013-01-01

    Research shows a strong association between traumatic life experience and mental health and important gender differences in that relationship in the western European Diaspora; but much less is known about these relationships in other settings. We investigate these relationships in a poor rural Asian setting that recently experienced a decade-long armed conflict. We use data from 400 adult interviews in rural Nepal. The measures come from World Mental Health survey instruments clinically validated for this study population to measure depression, posttraumatic stress disorder, and intermittent explosive disorder. Our results demonstrate that traumatic life experience significantly increases the likelihood of mental health disorders in this setting, and that these traumatic experiences have a larger effect on the mental health of women than men. These findings offer important clues regarding the potential mechanisms producing gender differences in mental health in many settings. PMID:24311755

  9. Gender, Traumatic Events, and Mental Health Disorders in a Rural Asian Setting*

    PubMed Central

    Axinn, William G.; Ghimire, Dirgha J.; Williams, Nathalie E.; Scott, Kate M.

    2014-01-01

    Research shows a strong association between traumatic life experience and mental health and important gender differences in that relationship in the Western European Diaspora, but much less is known about these relationships in other settings. We investigate these relationships in a poor rural Asian setting that recently experienced a decade-long armed conflict. We use data from 400 adult interviews in rural Nepal. The measures come from World Mental Health survey instruments clinically validated for this study population to measure Depression, Post Traumatic Stress Disorder (PTSD), and Intermittent Explosive Disorder (IED). Our results demonstrate that traumatic life experience significantly increases the likelihood of mental health disorders in this setting and that these traumatic experiences have a larger effect on the mental health of women than men. These findings offer important clues regarding the potential mechanisms producing gender differences in mental health in many settings. PMID:24311755

  10. Standardized Outcomes in Nephrology-Transplantation: A Global Initiative to Develop a Core Outcome Set for Trials in Kidney Transplantation

    PubMed Central

    Tong, Allison; Budde, Klemens; Gill, John; Josephson, Michelle A.; Marson, Lorna; Pruett, Timothy L.; Reese, Peter P.; Rosenbloom, David; Rostaing, Lionel; Warrens, Anthony N.; Wong, Germaine; Craig, Jonathan C.; Crowe, Sally; Harris, Tess; Hemmelgarn, Brenda; Manns, Braden; Tugwell, Peter; Van Biesen, Wim; Wheeler, David C.; Winkelmayer, Wolfgang C.; Evangelidis, Nicole; Sautenet, Benedicte; Howell, Martin; Chapman, Jeremy R.

    2016-01-01

    Background Although advances in treatment have dramatically improved short-term graft survival and acute rejection in kidney transplant recipients, long-term graft outcomes have not substantially improved. Transplant recipients also have a considerably increased risk of cancer, cardiovascular disease, diabetes, and infection, which all contribute to appreciable morbidity and premature mortality. Many trials in kidney transplantation are short-term, frequently use unvalidated surrogate endpoints, outcomes of uncertain relevance to patients and clinicians, and do not consistently measure and report key outcomes like death, graft loss, graft function, and adverse effects of therapy. This diminishes the value of trials in supporting treatment decisions that require individual-level multiple tradeoffs between graft survival and the risk of side effects, adverse events, and mortality. The Standardized Outcomes in Nephrology-Transplantation initiative aims to develop a core outcome set for trials in kidney transplantation that is based on the shared priorities of all stakeholders. Methods This will include a systematic review to identify outcomes reported in randomized trials, a Delphi survey with an international multistakeholder panel (patients, caregivers, clinicians, researchers, policy makers, members from industry) to develop a consensus-based prioritized list of outcome domains and a consensus workshop to review and finalize the core outcome set for trials in kidney transplantation. Conclusions Developing and implementing a core outcome set to be reported, at a minimum, in all kidney transplantation trials will improve the transparency, quality, and relevance of research; to enable kidney transplant recipients and their clinicians to make better-informed treatment decisions for improved patient outcomes. PMID:27500269

  11. Core Measures for Congestive Heart Failure in a Tertiary Care Setting in Pakistan

    PubMed Central

    Zafar, Rizwan; Haris, Muhammad; Shabbir, Muhammad Usman; Ghazanfar, Haider; Malik, Sarah A; Khalid, Tehreem; Abbas, Ali H; Saleem, Asad A

    2016-01-01

    Purpose: Heart failure presents a huge burden for individual patients and the healthcare system as a whole. This study aims to assess the adherence to these core measures as identified by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)/ American Heart Association (AHA) by physicians of Pakistan. Materials and Methodology: We conducted a cross-sectional study in Shifa International Hospital, Islamabad, Pakistan from the period of April 2013 to April 2016. Patients with a primary diagnosis of heart failure were drawn from a coding section of hospital’s record department. Data was evaluated to assess how strictly doctors were following core measures identified by JCAHO/AHA for the given diagnosis. Inclusion criteria for this study were patients ≥ 17 years of age and patients with a primary diagnosis of heart failure according to New York Heart Association (NYHA) classification. Patients with congenital anomalies and structural heart wall problems, like sarcoidosis, hemochromatosis, and amyloidosis, were excluded from the study. Results: Mean ejection fraction (EF) was found to be 27.23 ± 11.72 percent. Symptoms assessment of heart failure was done in 16/421 (3.8%) patients according to NYHA classification and in 405/421 (96.2%) patients according to outpatient-based heart failure assessment based on physician's experience other than NYHA classification. Left ventricle ejection fraction (LVEF) was assessed in 411/421 (97%) patients. Out of these, 336/411 (81.7%) patients had EF < 40%. Mean EF was found to be significantly higher in females as compared to males (p < 0.001). Three hundred and thirty-six out of 411 (81.7%) patients with EF < 40% needed angiotensin converting enzyme inhibitors (ACEi) and beta-blocker (BB) prescriptions. ACEi were prescribed only to 230/336 (68.7%) patients and 248/336 (73.8%) patients were given BB with documented contraindication to ACEi and BB in 7.36% and 17% patients, respectively. There was no

  12. Identification of a Core Curriculum in Gerontology for Allied Health Professionals. Final Report.

    ERIC Educational Resources Information Center

    Hedl, John J.; And Others

    The overall goal of this project was to identify a core curriculum in gerontology for seven allied health professions (radiologic technologist, radiation therapist, respiratory therapist, dental hygienist, dental assistant, physical therapy assistant, and occupational therapy assistant). The project also identified the current state of gerontology…

  13. Maximizing the benefit of health workforce secondment in Botswana: an approach for strengthening health systems in resource-limited settings.

    PubMed

    Grignon, Jessica S; Ledikwe, Jenny H; Makati, Ditsapelo; Nyangah, Robert; Sento, Baraedi W; Semo, Bazghina-Werq

    2014-01-01

    To address health systems challenges in limited-resource settings, global health initiatives, particularly the President's Emergency Plan for AIDS Relief, have seconded health workers to the public sector. Implementation considerations for secondment as a health workforce development strategy are not well documented. The purpose of this article is to present outcomes, best practices, and lessons learned from a President's Emergency Plan for AIDS Relief-funded secondment program in Botswana. Outcomes are documented across four World Health Organization health systems' building blocks. Best practices include documentation of joint stakeholder expectations, collaborative recruitment, and early identification of counterparts. Lessons learned include inadequate ownership, a two-tier employment system, and ill-defined position duration. These findings can inform program and policy development to maximize the benefit of health workforce secondment. Secondment requires substantial investment, and emphasis should be placed on high-level technical positions responsible for building systems, developing health workers, and strengthening government to translate policy into programs. PMID:24876798

  14. Hyper Text Mark-up Language and Dublin Core metadata element set usage in websites of Iranian State Universities’ libraries

    PubMed Central

    Zare-Farashbandi, Firoozeh; Ramezan-Shirazi, Mahtab; Ashrafi-Rizi, Hasan; Nouri, Rasool

    2014-01-01

    Introduction: Recent progress in providing innovative solutions in the organization of electronic resources and research in this area shows a global trend in the use of new strategies such as metadata to facilitate description, place for, organization and retrieval of resources in the web environment. In this context, library metadata standards have a special place; therefore, the purpose of the present study has been a comparative study on the Central Libraries’ Websites of Iran State Universities for Hyper Text Mark-up Language (HTML) and Dublin Core metadata elements usage in 2011. Materials and Methods: The method of this study is applied-descriptive and data collection tool is the check lists created by the researchers. Statistical community includes 98 websites of the Iranian State Universities of the Ministry of Health and Medical Education and Ministry of Science, Research and Technology and method of sampling is the census. Information was collected through observation and direct visits to websites and data analysis was prepared by Microsoft Excel software, 2011. Results: The results of this study indicate that none of the websites use Dublin Core (DC) metadata and that only a few of them have used overlaps elements between HTML meta tags and Dublin Core (DC) elements. The percentage of overlaps of DC elements centralization in the Ministry of Health were 56% for both description and keywords and, in the Ministry of Science, were 45% for the keywords and 39% for the description. But, HTML meta tags have moderate presence in both Ministries, as the most-used elements were keywords and description (56%) and the least-used elements were date and formatter (0%). Conclusion: It was observed that the Ministry of Health and Ministry of Science follows the same path for using Dublin Core standard on their websites in the future. Because Central Library Websites are an example of scientific web pages, special attention in designing them can help the researchers

  15. The youth sports club as a health-promoting setting: An integrative review of research

    PubMed Central

    Quennerstedt, Mikael; Eriksson, Charli

    2013-01-01

    Aims: The aims of this review is to compile and identify key issues in international research about youth sports clubs as health-promoting settings, and then discuss the results of the review in terms of a framework for the youth sports club as a health-promoting setting. Methods: The framework guiding this review of research is the health-promoting settings approach introduced by the World Health Organization (WHO). The method used is the integrated review. Inclusion criteria were, first, that the studies concerned sports clubs for young people, not professional clubs; second, that it be a question of voluntary participation in some sort of ongoing organized athletics outside of the regular school curricula; third, that the studies consider issues about youth sports clubs in terms of health-promoting settings as described by WHO. The final sample for the review consists of 44 publications. Results: The review shows that youth sports clubs have plentiful opportunities to be or become health-promoting settings; however this is not something that happens automatically. To do so, the club needs to include an emphasis on certain important elements in its strategies and daily practices. The youth sports club needs to be a supportive and healthy environment with activities designed for and adapted to the specific age-group or stage of development of the youth. Conclusions: To become a health-promoting setting, a youth sports club needs to take a comprehensive approach to its activities, aims, and purposes. PMID:23349167

  16. Online social networking sites-a novel setting for health promotion?

    PubMed

    Loss, Julika; Lindacher, Verena; Curbach, Janina

    2014-03-01

    Among adolescents, online social networking sites (SNS) such as Facebook are popular platforms for social interaction and may therefore be considered as 'novel settings' that could be exploited for health promotion. In this article, we examine the relevant definitions in health promotion and literature in order to analyze whether key characteristics of 'settings for health promotion' and the socio-ecological settings approach can be transferred to SNS. As many of our daily activities have shifted to cyberspace, we argue that online social interaction may gain more importance than geographic closeness for defining a 'setting'. While exposition to positive references to risk behavior by peers may render the SNS environment detrimental to health, SNS may allow people to create their own content and therefore foster participation. However, those health promotion projects delivered on SNS up until today solely relied on health education directed at end users. It remains unclear how health promotion on SNS can meet other requirements of the settings approach (e.g. building partnerships, changing the environment). As yet, one should be cautious in terming SNS a 'setting'. PMID:24457613

  17. BLAST: at the core of a powerful and diverse set of sequence analysis tools.

    PubMed

    McGinnis, Scott; Madden, Thomas L

    2004-07-01

    Basic Local Alignment Search Tool (BLAST) is one of the most heavily used sequence analysis tools available in the public domain. There is now a wide choice of BLAST algorithms that can be used to search many different sequence databases via the BLAST web pages (http://www.ncbi.nlm.nih.gov/BLAST/). All the algorithm-database combinations can be executed with default parameters or with customized settings, and the results can be viewed in a variety of ways. A new online resource, the BLAST Program Selection Guide, has been created to assist in the definition of search strategies. This article discusses optimal search strategies and highlights some BLAST features that can make your searches more powerful. PMID:15215342

  18. Comparing simple root phenotyping methods on a core set of rice genotypes.

    PubMed

    Shrestha, R; Al-Shugeairy, Z; Al-Ogaidi, F; Munasinghe, M; Radermacher, M; Vandenhirtz, J; Price, A H

    2014-05-01

    Interest in belowground plant growth is increasing, especially in relation to arguments that shallow-rooted cultivars are efficient at exploiting soil phosphorus while deep-rooted ones will access water at depth. However, methods for assessing roots in large numbers of plants are diverse and direct comparisons of methods are rare. Three methods for measuring root growth traits were evaluated for utility in discriminating rice cultivars: soil-filled rhizotrons, hydroponics and soil-filled pots whose bottom was sealed with a non-woven fabric (a potential method for assessing root penetration ability). A set of 38 rice genotypes including the OryzaSNP set of 20 cultivars, additional parents of mapping populations and products of marker-assisted selection for root QTLs were assessed. A novel method of image analysis for assessing rooting angles from rhizotron photographs was employed. The non-woven fabric was the easiest yet least discriminatory method, while the rhizotron was highly discriminatory and allowed the most traits to be measured but required more than three times the labour of the other methods. The hydroponics was both easy and discriminatory, allowed temporal measurements, but is most likely to suffer from artefacts. Image analysis of rhizotrons compared favourably to manual methods for discriminating between cultivars. Previous observations that cultivars from the indica subpopulation have shallower rooting angles than aus or japonica cultivars were confirmed in the rhizotrons, and indica and temperate japonicas had lower maximum root lengths in rhizotrons and hydroponics. It is concluded that rhizotrons are the preferred method for root screening, particularly since root angles can be assessed. PMID:24015692

  19. Tackling health workforce challenges to universal health coverage: setting targets and measuring progress.

    PubMed

    Cometto, Giorgio; Witter, Sophie

    2013-11-01

    Human resources for health (HRH) will have to be strengthened if universal health coverage (UHC) is to be achieved. Existing health workforce benchmarks focus exclusively on the density of physicians, nurses and midwives and were developed with the objective of attaining relatively high coverage of skilled birth attendance and other essential health services of relevance to the health Millennium Development Goals (MDGs). However, the attainment of UHC will depend not only on the availability of adequate numbers of health workers, but also on the distribution, quality and performance of the available health workforce. In addition, as noncommunicable diseases grow in relative importance, the inputs required from health workers are changing. New, broader health-workforce benchmarks - and a corresponding monitoring framework - therefore need to be developed and included in the agenda for UHC to catalyse attention and investment in this critical area of health systems. The new benchmarks need to reflect the more diverse composition of the health workforce and the participation of community health workers and mid-level health workers, and they must capture the multifaceted nature and complexities of HRH development, including equity in accessibility, sex composition and quality. PMID:24347714

  20. Variations Among Medicare Beneficiaries Living in Different Settings: Demographics, Health Status, and Service Use.

    PubMed

    Degenholtz, Howard B; Park, Mijung; Kang, Yihuang; Nadash, Pamela

    2016-07-01

    Older people with complex health issues and needs for functional support are increasingly living in different types of residential care environments as alternatives to nursing homes. This study aims to compare the demographics and health-care expenditures of Medicare beneficiaries by the setting in which they live: nursing homes, residential care settings, and at home using data from the 2002 to 2010 Medicare Current Beneficiary Study (MCBS), a nationally representative survey of the Medicare population. All Medicare beneficiaries aged 65 years or older who participated in the fall MCBS interview (years 2002-2010) and were alive for the full year (N = 83,507) were included in the sample. We found that there is a gradient in health status, physical and cognitive functioning, and health-care use and spending across settings. Minority elderly are overrepresented in facilities and underrepresented in alternative living settings. PMID:26269562

  1. Core competencies for health professionals' training in pediatric behavioral sleep care: a Delphi study.

    PubMed

    Boerner, Katelynn E; Coulombe, J Aimée; Corkum, Penny

    2015-01-01

    The need to train non-sleep-specialist health professionals in evidence-based pediatric behavioral sleep care is well established. The objective of the present study was to develop a list of core competencies for training health professionals in assisting families of 1- to 10-year old children with behavioral insomnia of childhood. A modified Delphi methodology was employed, involving iterative rounds of surveys that were administered to 46 experts to obtain consensus on a core competency list. The final list captured areas relevant to the identification and treatment of pediatric behavioral sleep problems. This work has the potential to contribute to the development of training materials to prepare non-sleep-specialist health professionals to identify and treat pediatric behavioral sleep problems, ideally within stepped-care frameworks. PMID:24628091

  2. Clinical Practice Guidelines as Instruments for Sound Health Care Priority Setting.

    PubMed

    Lawler, Patrick R; Norheim, Ole F

    2015-11-01

    This editorial discusses the potential role that physician-authored clinical practice guidelines could play in health care priority setting decisions in the United States. We briefly review the challenges associated with increasingly obligate health care priority setting in the United States and discuss accountability for these decisions. We then propose a potential role for clinical practice guidelines in addressing these challenges, while considering the ethical foundations of such a proposal. PMID:26342516

  3. Strengthening fairness, transparency and accountability in health care priority setting at district level in Tanzania

    PubMed Central

    Maluka, Stephen Oswald

    2011-01-01

    Health care systems are faced with the challenge of resource scarcity and have insufficient resources to respond to all health problems and target groups simultaneously. Hence, priority setting is an inevitable aspect of every health system. However, priority setting is complex and difficult because the process is frequently influenced by political, institutional and managerial factors that are not considered by conventional priority-setting tools. In a five-year EU-supported project, which started in 2006, ways of strengthening fairness and accountability in priority setting in district health management were studied. This review is based on a PhD thesis that aimed to analyse health care organisation and management systems, and explore the potential and challenges of implementing Accountability for Reasonableness (A4R) approach to priority setting in Tanzania. A qualitative case study in Mbarali district formed the basis of exploring the sociopolitical and institutional contexts within which health care decision making takes place. The study also explores how the A4R intervention was shaped, enabled and constrained by the contexts. Key informant interviews were conducted. Relevant documents were also gathered and group priority-setting processes in the district were observed. The study revealed that, despite the obvious national rhetoric on decentralisation, actual practice in the district involved little community participation. The assumption that devolution to local government promotes transparency, accountability and community participation, is far from reality. The study also found that while the A4R approach was perceived to be helpful in strengthening transparency, accountability and stakeholder engagement, integrating the innovation into the district health system was challenging. This study underscores the idea that greater involvement and accountability among local actors may increase the legitimacy and fairness of priority-setting decisions. A broader

  4. Promoting community participation in priority setting in district health systems: experiences from Mbarali district, Tanzania

    PubMed Central

    Kamuzora, Peter; Maluka, Stephen; Ndawi, Benedict; Byskov, Jens; Hurtig, Anna-Karin

    2013-01-01

    Background Community participation in priority setting in health systems has gained importance all over the world, particularly in resource-poor settings where governments have often failed to provide adequate public-sector services for their citizens. Incorporation of public views into priority setting is perceived as a means to restore trust, improve accountability, and secure cost-effective priorities within healthcare. However, few studies have reported empirical experiences of involving communities in priority setting in developing countries. The aim of this article is to provide the experience of implementing community participation and the challenges of promoting it in the context of resource-poor settings, weak organizations, and fragile democratic institutions. Design Key informant interviews were conducted with the Council Health Management Team (CHMT), community representatives, namely women, youth, elderly, disabled, and people living with HIV/AIDS, and other stakeholders who participated in the preparation of the district annual budget and health plans. Additionally, minutes from the Action Research Team and planning and priority-setting meeting reports were analyzed. Results A number of benefits were reported: better identification of community needs and priorities, increased knowledge of the community representatives about priority setting, increased transparency and accountability, promoted trust among health systems and communities, and perceived improved quality and accessibility of health services. However, lack of funds to support the work of the selected community representatives, limited time for deliberations, short notice for the meetings, and lack of feedback on the approved priorities constrained the performance of the community representatives. Furthermore, the findings show the importance of external facilitation and support in enabling health professionals and community representatives to arrive at effective working arrangement

  5. Strengthening fairness, transparency and accountability in health care priority setting at district level in Tanzania.

    PubMed

    Maluka, Stephen Oswald

    2011-01-01

    Health care systems are faced with the challenge of resource scarcity and have insufficient resources to respond to all health problems and target groups simultaneously. Hence, priority setting is an inevitable aspect of every health system. However, priority setting is complex and difficult because the process is frequently influenced by political, institutional and managerial factors that are not considered by conventional priority-setting tools. In a five-year EU-supported project, which started in 2006, ways of strengthening fairness and accountability in priority setting in district health management were studied. This review is based on a PhD thesis that aimed to analyse health care organisation and management systems, and explore the potential and challenges of implementing Accountability for Reasonableness (A4R) approach to priority setting in Tanzania. A qualitative case study in Mbarali district formed the basis of exploring the sociopolitical and institutional contexts within which health care decision making takes place. The study also explores how the A4R intervention was shaped, enabled and constrained by the contexts. Key informant interviews were conducted. Relevant documents were also gathered and group priority-setting processes in the district were observed. The study revealed that, despite the obvious national rhetoric on decentralisation, actual practice in the district involved little community participation. The assumption that devolution to local government promotes transparency, accountability and community participation, is far from reality. The study also found that while the A4R approach was perceived to be helpful in strengthening transparency, accountability and stakeholder engagement, integrating the innovation into the district health system was challenging. This study underscores the idea that greater involvement and accountability among local actors may increase the legitimacy and fairness of priority-setting decisions. A broader

  6. The Role of eHealth in Optimizing Preventive Care in the Primary Care Setting.

    PubMed

    Carey, Mariko; Noble, Natasha; Mansfield, Elise; Waller, Amy; Henskens, Frans; Sanson-Fisher, Rob

    2015-01-01

    Modifiable health risk behaviors such as smoking, overweight and obesity, risky alcohol consumption, physical inactivity, and poor nutrition contribute to a substantial proportion of the world's morbidity and mortality burden. General practitioners (GPs) play a key role in identifying and managing modifiable health risk behaviors. However, these are often underdetected and undermanaged in the primary care setting. We describe the potential of eHealth to help patients and GPs to overcome some of the barriers to managing health risk behaviors. In particular, we discuss (1) the role of eHealth in facilitating routine collection of patient-reported data on lifestyle risk factors, and (2) the role of eHealth in improving clinical management of identified risk factors through provision of tailored feedback, point-of-care reminders, tailored educational materials, and referral to online self-management programs. Strategies to harness the capacity of the eHealth medium, including the use of dynamic features and tailoring to help end users engage with, understand, and apply information need to be considered and maximized. Finally, the potential challenges in implementing eHealth solutions in the primary care setting are discussed. In conclusion, there is significant potential for innovative eHealth solutions to make a contribution to improving preventive care in the primary care setting. However, attention to issues such as data security and designing eHealth interfaces that maximize engagement from end users will be important to moving this field forward. PMID:26001983

  7. Stereotype threat among black and white women in health care settings.

    PubMed

    Abdou, Cleopatra M; Fingerhut, Adam W

    2014-07-01

    The first of its kind, the present experiment applied stereotype threat-the threat of being judged by or confirming negative group-based stereotypes-to the health sciences. Black and White women (N = 162) engaged in a virtual health care situation. In the experimental condition, one's ethnic identity and negative stereotypes of Black women specifically were made salient. As predicted, Black women in the stereotype threat condition who were strongly identified as Black (in terms of having explored what their ethnic identity means to them and the role it plays in their lives) reported significantly greater anxiety while waiting to see the doctor in the virtual health care setting than all other women. It is hypothesized that stereotype threat experienced in health care settings is one overlooked social barrier contributing to disparities in health care utilization and broader health disparities among Black women. PMID:25045944

  8. Procedure Guidelines for Health Care of Special Needs Students in the School Setting.

    ERIC Educational Resources Information Center

    Viele, Elizabeth; Hertel, Victoria

    This manual presents detailed instructions for delivering health care services to students with special health needs within the school setting. Individual chapters address the following areas: dressing; vital signs; height and weight; fluids/nourishment; medications; oxygen and use of the respirator/ventilator; suctioning; respiratory therapy;…

  9. Clinical Instructor Characteristics, Behaviors and Skills in Allied Health Care Settings: A Literature Review

    ERIC Educational Resources Information Center

    Levy, Linda S.; Sexton, Patrick; Willeford, K. Sean; Barnum, Mary G.; Guyer, M. Susan; Gardner, Greg; Fincher, A. Louise

    2009-01-01

    The purpose of this literature review is to compare both clinical instructor and student perceptions of helpful and hindering clinical instructor characteristics, behaviors and skills in athletic training and allied health care settings. Clinical education in athletic training is similar to that of other allied health care professions. Clinical…

  10. Self-Rated Health and Mortality: Does the Relationship Extend to a Low Income Setting?

    ERIC Educational Resources Information Center

    Frankenberg, Elizabeth; Jones, Nathan R.

    2004-01-01

    Although a relationship between poor self-reported health status and excess mortality risk has been well-established for industrialized countries, almost no research considers developing countries. We use data from Indonesia to show that in a low-income setting, as in more advantaged parts of the world, individuals who perceive their health to be…

  11. A review of telemental health in international and post-disaster settings.

    PubMed

    Augusterfer, Eugene F; Mollica, Richard F; Lavelle, James

    2015-01-01

    Telemental health (TMH) is an important component in meeting critical mental health needs of the global population. Mental health is an issue of global importance; an estimated 450 million people worldwide have mental or behavioural disorders, accounting for 12% of the World Health Organization's (WHO) global burden of disease. However, it is reported that 75% of people suffering from mental disorders in the Developing World receive no treatment or care. In this paper, the authors review global mental health needs with a focus on the use of TMH to meet mental health needs in international and post-disaster settings. Telemedicine and TMH have the capacity to bring evidence-based best practices in medicine and mental health to the under-served and difficult to reach areas of the world, including post-disaster settings. The authors will also report on the mental health impact of the Haiti 2010 earthquake and on the limited use of telemedicine in post-disaster Haiti. The paper will underscore the point that published papers on the use of TMH in post-disaster settings are lacking. Finally, the paper will review considerations before working in TMH in international and post-disaster settings. PMID:26576720

  12. 75 FR 77642 - Priority Setting for the Children's Health Insurance Program Reauthorization Act (CHIPRA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-13

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Priority Setting for the Children's Health Insurance Program Reauthorization Act (CHIPRA) Pediatric Quality Measures Program--Notice of Correction...

  13. Towards deep inclusion for equity-oriented health research priority-setting: A working model.

    PubMed

    Pratt, Bridget; Merritt, Maria; Hyder, Adnan A

    2016-02-01

    Growing consensus that health research funders should align their investments with national research priorities presupposes that such national priorities exist and are just. Arguably, justice requires national health research priority-setting to promote health equity. Such a position is consistent with recommendations made by the World Health Organization and at global ministerial summits that health research should serve to reduce health inequalities between and within countries. Thus far, no specific requirements for equity-oriented research priority-setting have been described to guide policymakers. As a step towards the explication and defence of such requirements, we propose that deep inclusion is a key procedural component of equity-oriented research priority-setting. We offer a model of deep inclusion that was developed by applying concepts from work on deliberative democracy and development ethics. This model consists of three dimensions--breadth, qualitative equality, and high-quality non-elite participation. Deep inclusion is captured not only by who is invited to join a decision-making process but also by how they are involved and by when non-elite stakeholders are involved. To clarify and illustrate the proposed dimensions, we use the sustained example of health systems research. We conclude by reviewing practical challenges to achieving deep inclusion. Despite the existence of barriers to implementation, our model can help policymakers and other stakeholders design more inclusive national health research priority-setting processes and assess these processes' depth of inclusion. PMID:26812416

  14. Public Health Surveillance: At the Core of the Global Health Security Agenda.

    PubMed

    Wolicki, Sara Beth; Nuzzo, Jennifer B; Blazes, David L; Pitts, Dana L; Iskander, John K; Tappero, Jordan W

    2016-01-01

    Global health security involves developing the infrastructure and capacity to protect the health of people and societies worldwide. The acceleration of global travel and trade poses greater opportunities for infectious diseases to emerge and spread. The International Health Regulations (IHR) were adopted in 2005 with the intent of proactively developing public health systems that could react to the spread of infectious disease and provide better containment. Various challenges delayed adherence to the IHR. The Global Health Security Agenda came about as an international collaborative effort, working multilaterally among governments and across sectors, seeking to implement the IHR and develop the capacities to prevent, detect, and respond to public health emergencies of international concern. When examining the recent West African Ebola epidemic as a case study for global health security, both strengths and weaknesses in the public health response are evident. The central role of public health surveillance is a lesson reiterated by Ebola. Through further implementation of the Global Health Security Agenda, identified gaps in surveillance can be filled and global health security strengthened. PMID:27314658

  15. Characteristics of Effective Mental Health Consultation in Early Childhood Settings: Multilevel Analysis of a National Survey

    ERIC Educational Resources Information Center

    Green, Beth L.; Everhart, Maria; Gordon, Lyn; Gettman, Maria Garcia

    2006-01-01

    In response to (a) an increasing need to support children with emotional and behavioral challenges in childcare settings and (b) the high rates of expulsion among preschool children, mental health consultation in early childhood settings is becoming an increasingly popular intervention strategy. At the same time, there is little agreement or…

  16. Opening School-Based Health Centers in a Rural Setting: Effects on Emergency Department Use

    ERIC Educational Resources Information Center

    Schwartz, Katherine E.; Monie, Daphne; Scribani, Melissa B.; Krupa, Nicole L.; Jenkins, Paul; Leinhart, August; Kjolhede, Chris L.

    2016-01-01

    Background: Previous studies of urban school-based health centers (SBHCs) have shown that SBHCs decrease emergency department (ED) utilization. This study seeks to evaluate the effect of SBHCs on ED utilization in a rural setting. Methods: This retrospective, controlled, quasi-experimental study used an ED patient data set from the Bassett…

  17. An application for monitoring order set usage in a commercial electronic health record.

    PubMed

    Cowansage, Cadran B; Green, Robert A; Kratz, Alexander; Vawdrey, David K

    2012-01-01

    Organizations that use electronic health records (EHRs) often maintain a considerable amount of clinical content in the form of order sets, documentation templates, and decision support rules. EHR vendors seldom provide analytic tools for customers to maintain such content and monitor its usage. We developed an application for tracking order sets, documentation templates and clinical alerts in a commercial electronic health record. Using the application, we compared trends in order set creation and usage at two academic medical centers over a three-year period. In January 2012, one medical center had 873 order sets available to clinicians; the other had 787. Approximately 50-75 new order sets were added each year at each medical center. We found that 46% of order sets at the first medical center and 39% at the second medical center were unused over the three-year period. PMID:23304395

  18. An Application for Monitoring Order Set Usage in a Commercial Electronic Health Record

    PubMed Central

    Cowansage, Cadran B.; Green, Robert A.; Kratz, Alexander; Vawdrey, David K.

    2012-01-01

    Organizations that use electronic health records (EHRs) often maintain a considerable amount of clinical content in the form of order sets, documentation templates, and decision support rules. EHR vendors seldom provide analytic tools for customers to maintain such content and monitor its usage. We developed an application for tracking order sets, documentation templates and clinical alerts in a commercial electronic health record. Using the application, we compared trends in order set creation and usage at two academic medical centers over a three-year period. In January 2012, one medical center had 873 order sets available to clinicians; the other had 787. Approximately 50–75 new order sets were added each year at each medical center. We found that 46% of order sets at the first medical center and 39% at the second medical center were unused over the three-year period. PMID:23304395

  19. Consensus and contention in the priority setting process: examining the health sector in Uganda.

    PubMed

    Colenbrander, Sarah; Birungi, Charles; Mbonye, Anthony K

    2015-06-01

    Health priority setting is a critical and contentious issue in low-income countries because of the high burden of disease relative to the limited resource envelope. Many sophisticated quantitative tools and policy frameworks have been developed to promote transparent priority setting processes and allocative efficiency. However, low-income countries frequently lack effective governance systems or implementation capacity, so high-level priorities are not determined through evidence-based decision-making processes. This study uses qualitative research methods to explore how key actors' priorities differ in low-income countries, using Uganda as a case study. Human resources for health, disease prevention and family planning emerge as the common priorities among actors in the health sector (although the last of these is particularly emphasized by international agencies) because of their contribution to the long-term sustainability of health-care provision. Financing health-care services is the most disputed issue. Participants from the Ugandan Ministry of Health preferentially sought to increase net health expenditure and government ownership of the health sector, while non-state actors prioritized improving the efficiency of resource use. Ultimately it is apparent that the power to influence national health outcomes lies with only a handful of decision-makers within key institutions in the health sector, such as the Ministries of Health, the largest bilateral donors and the multilateral development agencies. These power relations reinforce the need for ongoing research into the paradigms and strategic interests of these actors. PMID:24846947

  20. Health care ethics consultation: an update on core competencies and emerging standards from the American Society For Bioethics and Humanities' core competencies update task force.

    PubMed

    Tarzian, Anita J

    2013-01-01

    Ethics consultation has become an integral part of the fabric of U.S. health care delivery. This article summarizes the second edition of the Core Competencies for Health Care Ethics Consultation report of the American Society for Bioethics and Humanities. The core knowledge and skills competencies identified in the first edition of Core Competencies have been adopted by various ethics consultation services and education programs, providing evidence of their endorsement as health care ethics consultation (HCEC) standards. This revised report was prompted by thinking in the field that has evolved since the original report. Patients, family members, and health care providers who encounter ethical questions or concerns that ethics consultants could help address deserve access to efficient, effective, and accountable HCEC services. All individuals providing such services should be held to the standards of competence and quality described in the revised report. PMID:23391049

  1. Core Courses in Public Health Laboratory Science and Practice: Findings from 2006 and 2011 Surveys

    PubMed Central

    Beck, Angela J.; Boulton, Matthew L.; Kim, Deborah H.; Wichman, Michael D.; Luedtke, Patrick F.

    2013-01-01

    Objectives We identified academic training courses or topics most important to the careers of U.S. public health, environmental, and agricultural laboratory (PHEAL) scientist-managers and directors, and determined what portions of the national PHEAL workforce completed these courses. Methods We conducted electronic national surveys in 2006 and 2011, and analyzed data using numerical ranking, Chi-square tests comparing rates, and Spearman's formula measuring rank correlation. Results In 2006, 40 of 50 PHEAL directors identified 56 course topics as either important, useful, or not needed for someone in their position. These course topics were then ranked to provide a list of 31 core courses. In 2011, 1,659 of approximately 5,555 PHEAL scientific and technical staff, using a subset of 25 core courses, evidenced higher core course completion rates associated with higher-level job classification, advanced academic degree, and age. The 2011 survey showed that 287 PHEAL scientist-managers and directors, on average, completed 37.7% (n=5/13) of leadership/managerial core courses and 51.7% (n=6/12) of scientific core courses. For 1,659 laboratorians in all scientific and technical classifications, core-subject completion rates were higher in local laboratories (42.8%, n=11/25) than in state (36.0%, n=9/25), federal (34.4%, n=9/25), and university (31.2%, n=8/25) laboratories. Conclusions There is a definable range of scientific, leadership, and managerial core courses needed by PHEAL scientist-managers and directors to function effectively in their positions. Potential PHEAL scientist-managers and directors need greater and continuing access to these courses, and academic and practice entities supporting development of this workforce should adopt curricula and core competencies aligned with these course topics. PMID:23997310

  2. Reorienting health services with capacity building: a case study of the Core Skills in Health Promotion Project.

    PubMed

    Yeatman, H R; Nove, T

    2002-12-01

    This paper presents a case study of the application of a framework for capacity building [Hawe, P., King, L., Noort, M., Jordens, C. and Lloyd, B. (2000) Indicators to Help with Capacity Building in Health Promotion. NSW Health, Sydney] to describe actions aimed at building organizational support for health promotion within an area health service in New South Wales, Australia. The Core Skills in Health Promotion Project (CSHPP) arose from an investigation which reported that participants of a health promotion training course had increased health promotion skills but that they lacked the support to apply their skills in the workplace. The project was action-research based. It investigated and facilitated the implementation of a range of initiatives to support community health staff to apply a more preventive approach in their practice and it contributed to the establishment of new organizational structures for health promotion. An evaluation was undertaken 4 years after the CSHPP was established, and 2 years after it had submitted its final report. Interviews with senior managers, document analysis of written reports, and focus groups with middle managers and service delivery staff were undertaken. Change was achieved in the three dimensions of health infrastructure, program maintenance and problem solving capacity of the organization. It was identified that the critically important elements in achieving the aims of the project-partnership, leadership and commitment-were also key elements of the capacity building framework. This case study provides a practical example of the usefulness of the capacity building framework in orienting health services to be supportive of health promotion. PMID:12406922

  3. Adapting Evidence-based Mental Health Treatments in Community Settings: Preliminary Results from a Partnership Approach

    PubMed Central

    Southam-Gerow, Michael A.; Hourigan, Shannon E.; Allin, Robert B.

    2009-01-01

    This paper describes the application of a university-community partnership model to the problem of adapting evidence-based treatment approaches in a community mental health setting. Background on partnership research is presented, with consideration of methodological and practical issues related to this kind of research. Then, a rationale for using partnerships as a basis for conducting mental health treatment research is presented. Finally, an ongoing partnership research project concerned with the adaptation of evidence-based mental health treatments for childhood internalizing problems in community settings is presented, with preliminary results of the ongoing effort discussed. PMID:18697917

  4. User charges and priority setting in health care: balancing equity and efficiency.

    PubMed

    Smith, Peter C

    2005-09-01

    User charges are the major source of finance for many health care systems. However, traditional approaches to health care priority setting, such as cost-effectiveness analysis, usually assume there are no user charges and therefore may ignore important implications for equity and efficiency. This paper therefore develops a rudimentary model of priority setting in which the fixed health care budget can be augmented by user charges. The paper uses methods analogous to models of optimal commodity taxation to develop a set of rules for the inclusion of a health technology in the subsidized health care package, and the calculation of its associated copayment rate. The results indicate that optimal levels of subsidy depend on the cost-effectiveness of the intervention, its price elasticity of demand, the epidemiology of the associated disease, and the policy maker's attitude towards equity. The model has important implications for policy making in three domains: health care priority setting, evaluation of health care technologies, and charging policy. PMID:16129131

  5. Fine-Needle Aspiration Followed by Core-Needle Biopsy in the Same Setting: Modifying Our Approach.

    PubMed

    Joudeh, Amani A; Shareef, Sameera Q; Al-Abbadi, Mousa A

    2016-01-01

    Fine-needle aspiration biopsy (FNAB) is a well-established initial diagnostic tool. However, in some instances limitations and shortcomings arise, making it insufficient for determining a specific diagnosis. Consequently, patients have to undergo another diagnostic procedure. The second procedure is either repeat FNAB, core-needle or open biopsy, and can be inconvenient and costly. In some centers, the FNAB is immediately followed by core-needle biopsy (CNB) in the same setting after assuring adequacy on the initial FNAB utilizing rapid on-site specimen evaluation (ROSE). It is argued that implementing such an approach will eventually have additional critical advantages that include the following: (a) it is more convenient to patients to have both procedures in one visit, (b) the tissue procured by both procedures will be more adequate, enabling cytopathologists to reach an accurate diagnosis, and (c) it is ultimately a cost-effective approach if we take into consideration the avoidance of a potential second more invasive diagnostic procedure. Since we are living in an era of patient-centered medicine coupled with cost-cutting strategies, we present here a brief review of the topic with analysis of this alternative approach, review of the pertinent literature and shed light on a few scenarios that justify this approach. PMID:26963594

  6. The health systems' priority setting criteria for selecting health technologies: A systematic review of the current evidence

    PubMed Central

    Mobinizadeh, Mohammadreza; Raeissi, Pouran; Nasiripour, Amir Ashkan; Olyaeemanesh, Alireza; Tabibi, Seyed Jamaleddin

    2016-01-01

    Background: In the recent years, using health technologies to diagnose and treat diseases has had a considerable and accelerated growth. The proper use of these technologies may considerably help in the diagnosis and treatment of different diseases. On the other hand, unlimited and unrestricted entry of these technologies may result in induced demand by service providers. The aim of this study was to determine the appropriate criteria used in health technologies priority-setting models in the world. Methods: Using MESH and free text, we sought and retrieved the relevant articles from the most appropriate medical databases (the Cochrane Library, PubMed and Scopus) through three separate search strategies up to March 2015. The inclusion criteria were as follows: 1) Studies with specific criteria; 2) Articles written in English; 3) Those articles conducted in compliance with priority setting of health technologies. Data were analyzed qualitatively using a thematic synthesis technique. Results: After screening the retrieved papers via PRISMA framework, from the 7,012 papers, 40 studies were included in the final phase. Criteria for selecting health technologies (in pre assessment and in the assessment phase) were categorized into six main themes: 1) Health outcomes; 2) Disease and target population; 3) Technology alternatives; 4) Economic aspects; 5) Evidence; 6) and other factors. "Health effects/benefits" had the maximum frequency in health outcomes (8 studies); "disease severity" had the maximum frequency in disease and target population (12 studies); "the number of alternatives" had the maximum frequency in alternatives (2 studies); "cost-effectiveness" had the maximum frequency in economic aspects (15 studies); "quality of evidence" had the maximum frequency in evidence (4 studies); and "issues concerning the health system" had the maximum frequency in other factors (10 studies). Conclusion: The results revealed an increase in the number of studies on health

  7. Identifying flares in rheumatoid arthritis: reliability and construct validation of the OMERACT RA Flare Core Domain Set

    PubMed Central

    Bykerk, Vivian P; Bingham, Clifton O; Choy, Ernest H; Lin, Daming; Alten, Rieke; Christensen, Robin; Furst, Daniel E; Hewlett, Sarah; Leong, Amye; March, Lyn; Woodworth, Thasia; Boire, Gilles; Haraoui, Boulos; Hitchon, Carol; Jamal, Shahin; Keystone, Edward C; Pope, Janet; Tin, Diane; Thorne, J Carter

    2016-01-01

    Objective To evaluate the reliability of concurrent flare identification using 3 methods (patient, rheumatologist and Disease Activity Score (DAS)28 criteria), and construct validity of candidate items representing the Outcome Measures in Rheumatology Clinical Trials (OMERACT) RA Flare Core Domain Set. Methods Candidate flare questions and legacy measures were administered at consecutive visits to Canadian Early Arthritis Cohort (CATCH) patients between November 2011 and November 2014. The American College of Rheumatology (ACR) core set indicators were recorded. Concordance to identify flares was assessed using the agreement coefficient. Construct validity of flare questions was examined: convergent (Spearman's r); discriminant (mean differences between flaring/non-flaring patients); and consequential (proportions with prior treatment reductions and intended therapeutic change postflare). Results The 849 patients were 75% female, 81% white, 42% were in remission/low disease activity (R/LDA), and 16–32% were flaring at the second visit. Agreement of flare status was low–strong (κ's 0.17–0.88) and inversely related to RA disease activity level. Flare domains correlated highly (r's≥0.70) with each other, patient global (r's≥0.66) and corresponding measures (r's 0.49–0.92); and moderately highly with MD and patient-reported joint counts (r's 0.29–0.62). When MD/patients agreed the patient was flaring, mean flare domain between-group differences were 2.1–3.0; 36% had treatment reductions prior to flare, with escalation planned in 61%. Conclusions Flares are common in rheumatoid arthritis (RA) and are often preceded by treatment reductions. Patient/MD/DAS agreement of flare status is highest in patients worsening from R/LDA. OMERACT RA flare questions can discriminate between patients with/without flare and have strong evidence of construct and consequential validity. Ongoing work will identify optimal scoring and cut points to identify RA flares. PMID

  8. Re-thinking HIV-Related Stigma in Health Care Settings: A Qualitative Study.

    PubMed

    Gagnon, Marilou

    2015-01-01

    People living with HIV (PLWH) continue to endure stigma and discrimination in the context of health care. This paper presents the findings of a qualitative study designed to (a) describe stigmatizing and discriminatory practices in health care settings, and (b) explore both symbolic and structural stigma from the perspectives of PLWH. For the purpose of this qualitative study, 21 semi-structured in-depth interviews were conducted in the province of Quebec, Canada. The data were analyzed following the principles of thematic analysis. During analysis, three themes were identified, and relations between these themes were delineated to reflect the experiences of participants. The findings suggest that HIV-related stigma in health care settings is episodic in nature. The findings also suggest that HIV-related stigma is experienced through interactions with health care providers (symbolic stigma) and, finally, that it is applied systematically to manage risk in the context of health care (structural stigma). PMID:26300466

  9. Priority setting in health authorities: a novel approach to a historical activity.

    PubMed

    Mitton, Craig; Patten, San; Waldner, Howard; Donaldson, Cam

    2003-11-01

    As resources in health care are scarce, health authorities and other health organizations are charged with determining how best to spend limited resources. While a number of formal approaches to priority setting within health authorities have been used internationally, there has been limited success with such activity, particularly across major service portfolios. This participatory action research project instituted a novel priority setting framework, coined macro-marginal analysis (MMA), in a fully integrated urban health region in Alberta, Canada. The focus of MMA is on identifying areas for service growth and areas for resource release, then determining, based on pre-defined, locally generated criteria, if actual shifts or re-allocation of resources should occur. For fiscal year 2002/03, the Calgary Health Region identified over 40 M dollars in resource releases (approximately 3% of the total budget), which were made available for servicing the deficit, and more importantly for our purposes, re-investing in service growth areas. The MMA framework is pragmatic in nature and has the ability to incorporate relevant evidence directly into the decision-making process. This work constitutes a significant advancement in health economics, and responds where previous priority setting approaches have failed in that it allows decision-makers to achieve genuine re-allocation of resources with the aim of improving population health or better meeting other important criteria. PMID:12948574

  10. The need for integration in health sciences sets the future direction for public health education.

    PubMed

    Li, L M; Tang, J L; Lv, J; Jiang, Y; Griffiths, S M

    2011-01-01

    Since the foundation of the People's Republic of China in 1949, there has been remarkable developments in public health in the country. These achievements are primarily attributed to the public health services and patriotic public health campaigns, although the contribution of high-technology medical applications is also recognized. However, along with the recent socio-economic developments and scientific and technological progress, medical disciplines have become more and more specialized, and clinical and preventive medicine have become further separated from each other. Conventional Chinese wisdom says 'when long divided they must unite, when long united they must divide'. At the onset of the new round of reforms of health care in China, it seems important to revisit the discussions on the urgency for integration of health sciences in medicine in China. Several issues and viewpoints on integrating medicine are discussed in this paper. The biopsychosocial model for health calls for broad integration. Primary care development in China requires integration in education and practice, and in treatment and prevention. Control of chronic diseases requires integrated and united action. Integration of traditional Chinese medicine with Western medicine requires creativity. The integration perspective should be instilled in the minds of medical students. Integration also entails integrated practice. After all, integration entails integrated education and practice in public health education. Changing the current public health education system still has a long way to go. True integration requires integration of concepts, policies, resources and measures, as well as changes in the organization of health care including public health, prevention and treatment. This needs to be a systematic process. Finally, success of integration relies on social mobilization, advocacy, promotion and attention of the entire society. PMID:21168177

  11. Health service availability and health seeking behaviour in resource poor settings: evidence from Mozambique.

    PubMed

    Anselmi, Laura; Lagarde, Mylène; Hanson, Kara

    2015-12-01

    Low-income countries are plagued by a high burden of preventable and curable disease as well as unmet need for healthcare, but detailed microeconomic evidence on the relationship between supply-side factors and service use is limited. Causality has rarely been assessed due to the challenges posed by the endogeneity of health service supply.In this study, using data from Mozambique, we investigate the effect of healthcare service availability, measured as the type of health facilities and their level of staffing and equipment, on the individual decision to seek care. We apply an instrumental variable approach to test for causality in the effect of staff and equipment availability on the decision to seek care and we explore heterogeneous effects based on the distance of households to the closest health facility.We find that living in the proximity of a health facility increases the probability of seeking care. A greater availability of referral health services in the locality has no significant effect on decision to seek care, while greater availability of staff and equipment increases the probability of seeking care when ill. Demand side barriers to health care use exist, but have a smaller impact when health care services are available within one hour walking distance. PMID:26329425

  12. Assessing health impacts in complex eco-epidemiological settings in the humid tropics: Modular baseline health surveys

    SciTech Connect

    Winkler, Mirko S.; Divall, Mark J.; Krieger, Gary R.; Schmidlin, Sandro; Magassouba, Mohamed L.; Knoblauch, Astrid M.; Singer, Burton H.; Utzinger, Juerg

    2012-02-15

    The quantitative assessment of health impacts has been identified as a crucial feature for realising the full potential of health impact assessment (HIA). In settings where demographic and health data are notoriously scarce, but there is a broad range of ascertainable ecological, environmental, epidemiological and socioeconomic information, a diverse toolkit of data collection strategies becomes relevant for the mainly small-area impacts of interest. We present a modular, cross-sectional baseline health survey study design, which has been developed for HIA of industrial development projects in the humid tropics. The modular nature of our toolkit allows our methodology to be readily adapted to the prevailing eco-epidemiological characteristics of a given project setting. Central to our design is a broad set of key performance indicators, covering a multiplicity of health outcomes and determinants at different levels and scales. We present experience and key findings from our modular baseline health survey methodology employed in 14 selected sentinel sites within an iron ore mining project in the Republic of Guinea. We argue that our methodology is a generic example of rapid evidence assembly in difficult-to-reach localities, where improvement of the predictive validity of the assessment and establishment of a benchmark for longitudinal monitoring of project impacts and mitigation efforts is needed.

  13. Decentralized health care priority-setting in Tanzania: evaluating against the accountability for reasonableness framework.

    PubMed

    Maluka, Stephen; Kamuzora, Peter; San Sebastiån, Miguel; Byskov, Jens; Olsen, Øystein E; Shayo, Elizabeth; Ndawi, Benedict; Hurtig, Anna-Karin

    2010-08-01

    Priority-setting has become one of the biggest challenges faced by health decision-makers worldwide. Fairness is a key goal of priority-setting and Accountability for Reasonableness has emerged as a guiding framework for fair priority-setting. This paper describes the processes of setting health care priorities in Mbarali district, Tanzania, and evaluates the descriptions against Accountability for Reasonableness. Key informant interviews were conducted with district health managers, local government officials and other stakeholders using a semi-structured interview guide. Relevant documents were also gathered and group priority-setting in the district was observed. The results indicate that, while Tanzania has a decentralized public health care system, the reality of the district level priority-setting process was that it was not nearly as participatory as the official guidelines suggest it should have been. Priority-setting usually occurred in the context of budget cycles and the process was driven by historical allocation. Stakeholders' involvement in the process was minimal. Decisions (but not the reasoning behind them) were publicized through circulars and notice boards, but there were no formal mechanisms in place to ensure that this information reached the public. There were neither formal mechanisms for challenging decisions nor an adequate enforcement mechanism to ensure that decisions were made in a fair and equitable manner. Therefore, priority-setting in Mbarali district did not satisfy all four conditions of Accountability for Reasonableness; namely relevance, publicity, appeals and revision, and enforcement. This paper aims to make two important contributions to this problematic situation. First, it provides empirical analysis of priority-setting at the district level in the contexts of low-income countries. Second, it provides guidance to decision-makers on how to improve fairness, legitimacy, and sustainability of the priority-setting process. PMID

  14. Identification of Pediatric Oral Health Core Competencies through Interprofessional Education and Practice.

    PubMed

    Hallas, D; Fernandez, J B; Herman, N G; Moursi, A

    2015-01-01

    Over the past seven years, the Department of Pediatric Dentistry at New York University College of Dentistry (NYUCD) and the Advanced Practice: Pediatrics and the Pediatric Nurse Practitioner (PNP) program at New York University College of Nursing (NYUCN) have engaged in a program of formal educational activities with the specific goals of advancing interprofessional education, evidence-based practice, and interprofessional strategies to improve the oral-systemic health of infants and young children. Mentoring interprofessional students in all health care professions to collaboratively assess, analyze, and care-manage patients demands that faculty reflect on current practices and determine ways to enhance the curriculum to include evidence-based scholarly activities, opportunities for interprofessional education and practice, and interprofessional socialization. Through the processes of interprofessional education and practice, the pediatric nursing and dental faculty identified interprofessional performance and affective oral health core competencies for all dental and pediatric primary care providers. Students demonstrated achievement of interprofessional core competencies, after completing the interprofessional educational clinical practice activities at Head Start programs that included interprofessional evidence-based collaborative practice, case analyses, and presentations with scholarly discussions that explored ways to improve the oral health of diverse pediatric populations. The goal of improving the oral health of all children begins with interprofessional education that lays the foundations for interprofessional practice. PMID:25653873

  15. The green choices project: integrating environmental health education into reproductive health care settings.

    PubMed

    Worthington, Sandra; Armstrong, Kay; Debevec, Elie

    2010-01-01

    A national reproductive health organization developed the Green Choices project to educate staff and clients about how to live in healthier environments by reducing potentially harmful environmental exposures to toxicants. An advisory group, comprised of experts in environmental and reproductive health and literacy, defined the project's scope and common environmental exposures to address. The following educational materials were developed: an online staff environmental health 101 curriculum, an environmental health assessment tool for clients to identify their potential risks, and information sheets for each environmental exposure that described potential risks and ways to reduce risks. Beta-testing methods included baseline and follow-up surveys, one-on-one interviews, focus groups, and recommendations from experts. Staff and client feedback on the educational materials resulted in increased clarity, sensitivity, relevancy, and appeal. Environmental health experts ensured accuracy of information, and reading experts lowered the reading level from 12th to 6th grade. A campaign to disseminate environmental health information and educational materials nationally is under way. PMID:20838173

  16. Connective tissue disease related interstitial lung diseases and idiopathic pulmonary fibrosis: provisional core sets of domains and instruments for use in clinical trials

    PubMed Central

    Saketkoo, Lesley Ann; Mittoo, Shikha; Huscher, Dörte; Khanna, Dinesh; Dellaripa, Paul F; Distler, Oliver; Flaherty, Kevin R; Frankel, Sid; Oddis, Chester V; Denton, Christopher P; Fischer, Aryeh; Kowal-Bielecka, Otylia M; LeSage, Daphne; Merkel, Peter A; Phillips, Kristine; Pittrow, David; Swigris, Jeffrey; Antoniou, Katerina; Baughman, Robert P; Castelino, Flavia V; Christmann, Romy B; Christopher-Stine, Lisa; Collard, Harold R; Cottin, Vincent; Danoff, Sonye; Highland, Kristin B; Hummers, Laura; Shah, Ami A; Kim, Dong Soon; Lynch, David A; Miller, Frederick W; Proudman, Susanna M; Richeldi, Luca; Ryu, Jay H; Sandorfi, Nora; Sarver, Catherine; Wells, Athol U; Strand, Vibeke; Matteson, Eric L; Brown, Kevin K; Seibold, James R

    2014-01-01

    Rationale Clinical trial design in interstitial lung diseases (ILDs) has been hampered by lack of consensus on appropriate outcome measures for reliably assessing treatment response. In the setting of connective tissue diseases (CTDs), some measures of ILD disease activity and severity may be confounded by non-pulmonary comorbidities. Methods The Connective Tissue Disease associated Interstitial Lung Disease (CTD-ILD) working group of Outcome Measures in Rheumatology—a non-profit international organisation dedicated to consensus methodology in identification of outcome measures—conducted a series of investigations which included a Delphi process including >248 ILD medical experts as well as patient focus groups culminating in a nominal group panel of ILD experts and patients. The goal was to define and develop a consensus on the status of outcome measure candidates for use in randomised controlled trials in CTD-ILD and idiopathic pulmonary fibrosis (IPF). Results A core set comprising specific measures in the domains of lung physiology, lung imaging, survival, dyspnoea, cough and health-related quality of life is proposed as appropriate for consideration for use in a hypothetical 1-year multicentre clinical trial for either CTD-ILD or IPF. As many widely used instruments were found to lack full validation, an agenda for future research is proposed. Conclusion Identification of consensus preliminary domains and instruments to measure them was attained and is a major advance anticipated to facilitate multicentre RCTs in the field. PMID:24368713

  17. Health information system reform in South Africa: developing an essential data set.

    PubMed Central

    Shaw, Vincent

    2005-01-01

    Health services are increasingly under pressure to develop information systems that are responsive to changing health needs and appropriate to service objectives. Developing an essential data set provides managers with a clearly defined set of indicators for monitoring and evaluating services. This article describes a process that resulted in the creation of an essential data set at district level. This had a significant impact on neighbouring districts and resulted in the development of a regional essential data set, which in turn helped to influence the creation of a provincial and then national essential data set. Four key lessons may be drawn from the process. The development of an essential data set both requires and can contribute to a process that allows the reporting requirements to be adjusted over time in response to changing circumstances. In addition, it contributes to (and requires) the integration of programme reporting requirements into a coherent information system. While the case study describes a bottom-up approach, a top-down consultative process is advocated because it establishes a framework within which information needs can be reviewed. Lastly, the use of surveys can aid efforts to keep the essential elements to a minimum. In conclusion, the development of an essential data set contributes to strengthening health services because it necessitates dialogue between programme managers and defines indicators to be monitored by them. PMID:16184283

  18. THE DEVELOPMENT AND USE OF A MODEL TO PREDICT SUSTAINABILITY OF CHANGE IN HEALTH CARE SETTINGS

    PubMed Central

    2011-01-01

    Innovations adopted through organizational change initiatives are often not sustained leading to diminished quality, productivity, and consumer satisfaction. Research explaining variance in the use of adopted innovations in health care settings is sparse, suggesting the need for a theoretical model to guide research and practice. In this article, we describe the development of a hybrid conjoint decision theoretic model designed to predict the sustainability of organizational change in health care settings. An initial test of the model’s predictive validity using expert scored hypothetic profiles resulted in an r-squared value of .77. The test of this model offers a theoretical base for future research on the sustainability of change in health care settings. PMID:22262947

  19. The Core Values that Support Health, Safety, and Well-being at Work

    PubMed Central

    Zwetsloot, Gerard I.J.M.; Scheppingen, Arjella R. van; Bos, Evelien H.; Dijkman, Anja; Starren, Annick

    2013-01-01

    Background Health, safety, and well-being (HSW) at work represent important values in themselves. It seems, however, that other values can contribute to HSW. This is to some extent reflected in the scientific literature in the attention paid to values like trust or justice. However, an overview of what values are important for HSW was not available. Our central research question was: what organizational values are supportive of health, safety, and well-being at work? Methods The literature was explored via the snowball approach to identify values and value-laden factors that support HSW. Twenty-nine factors were identified as relevant, including synonyms. In the next step, these were clustered around seven core values. Finally, these core values were structured into three main clusters. Results The first value cluster is characterized by a positive attitude toward people and their “being”; it comprises the core values of interconnectedness, participation, and trust. The second value cluster is relevant for the organizational and individual “doing”, for actions planned or undertaken, and comprises justice and responsibility. The third value cluster is relevant for “becoming” and is characterized by the alignment of personal and organizational development; it comprises the values of growth and resilience. Conclusion The three clusters of core values identified can be regarded as “basic value assumptions” that underlie both organizational culture and prevention culture. The core values identified form a natural and perhaps necessary aspect of a prevention culture, complementary to the focus on rational and informed behavior when dealing with HSW risks. PMID:24422174

  20. Duty to speak up in the health care setting a professionalism and ethics analysis.

    PubMed

    Topazian, Rachel J; Hook, C Christopher; Mueller, Paul S

    2013-11-01

    Staff and students working in health care settings are sometimes reluctant to speak up when they perceive patients to be at risk for harm. In this article, we describe four incidents that occurred at our institution (Mayo Clinic). In two of them, health care professionals failed to speak up, which resulted in harm; in the other two, they did speak up, which prevented harm and improved patient care. We analyzed each scenario using the Physician's Charter on Medical Professionalism and prima facie ethics principles to determine whether principles were violated or upheld. We conclude that anyone who works in a health care setting has a duty to speak up when a patient faces harm. We also provide guidance for health care institutions on promoting a culture in which speaking up is encouraged and integrated into routine practice. PMID:24428018

  1. Global health in the European Union – a review from an agenda-setting perspective

    PubMed Central

    Aluttis, Christoph; Krafft, Thomas; Brand, Helmut

    2014-01-01

    This review attempts to analyse the global health agenda-setting process in the European Union (EU). We give an overview of the European perspective on global health, making reference to the developments that led to the EU acknowledging its role as a global health actor. The article thereby focusses in particular on the European interpretation of its role in global health from 2010, which was formalised through, respectively, a European Commission Communication and European Council Conclusions. Departing from there, and based on Kingdon's multiple streams theory on agenda setting, we identify some barriers that seem to hinder the further establishment and promotion of a solid global health agenda in the EU. The main barriers for creating a strong European global health agenda are the fragmentation of the policy community and the lack of a common definition for global health in Europe. Forwarding the agenda in Europe for global health requires more clarification of the common goals and perspectives of the policy community and the use of arising windows of opportunity. PMID:24560264

  2. Using core competencies to build an evaluative framework: outcome assessment of the University of Guelph Master of Public Health program

    PubMed Central

    2014-01-01

    Background Master of Public Health programs have been developed across Canada in response to the need for graduate-level trained professionals to work in the public health sector. The University of Guelph recently conducted a five-year outcome assessment using the Core Competencies for Public Health in Canada as an evaluative framework to determine whether graduates are receiving adequate training, and identify areas for improvement. Methods A curriculum map of core courses and an online survey of University of Guelph Master of Public Health graduates comprised the outcome assessment. The curriculum map was constructed by evaluating course outlines, assignments, and content to determine the extent to which the Core Competencies were covered in each course. Quantitative survey results were characterized using descriptive statistics. Qualitative survey results were analyzed to identify common themes and patterns in open-ended responses. Results The University of Guelph Master of Public Health program provided a positive learning environment in which graduates gained proficiency across the Core Competencies through core and elective courses, meaningful practicums, and competent faculty. Practice-based learning environments, particularly in collaboration with public health organizations, were deemed to be beneficial to students’ learning experiences. Conclusions The Core Competencies and graduate surveys can be used to conduct a meaningful and informative outcome assessment. We encourage other Master of Public Health programs to conduct their own outcome assessments using a similar framework, and disseminate these results in order to identify best practices and strengthen the Canadian graduate public health education system. PMID:25078124

  3. The role of Health Impact Assessment in the setting of air quality standards: An Australian perspective

    SciTech Connect

    Spickett, Jeffery; Katscherian, Dianne; Harris, Patrick

    2013-11-15

    The approaches used for setting or reviewing air quality standards vary from country to country. The purpose of this research was to consider the potential to improve decision-making through integration of HIA into the processes to review and set air quality standards used in Australia. To assess the value of HIA in this policy process, its strengths and weaknesses were evaluated aligned with review of international processes for setting air quality standards. Air quality standard setting programmes elsewhere have either used HIA or have amalgamated and incorporated factors normally found within HIA frameworks. They clearly demonstrate the value of a formalised HIA process for setting air quality standards in Australia. The following elements should be taken into consideration when using HIA in standard setting. (a) The adequacy of a mainly technical approach in current standard setting procedures to consider social determinants of health. (b) The importance of risk assessment criteria and information within the HIA process. The assessment of risk should consider equity, the distribution of variations in air quality in different locations and the potential impacts on health. (c) The uncertainties in extrapolating evidence from one population to another or to subpopulations, especially the more vulnerable, due to differing environmental factors and population variables. (d) The significance of communication with all potential stakeholders on issues associated with the management of air quality. In Australia there is also an opportunity for HIA to be used in conjunction with the NEPM to develop local air quality standard measures. The outcomes of this research indicated that the use of HIA for air quality standard setting at the national and local levels would prove advantageous. -- Highlights: • Health Impact Assessment framework has been applied to a policy development process. • HIA process was evaluated for application in air quality standard setting.

  4. Learning and applying new quality improvement methods to the school health setting.

    PubMed

    Elik, Laurel L

    2013-11-01

    A school health registered nurse identified medication administration documentation errors by unlicensed assistive personnel (UAP) in a system of school health clinics in an urban setting. This nurse applied the Lean Six Sigma Define, Measure, Analyze, Improve, Control process of improvement methodology to effectively improve the process. The UAP of medication administration documentation error rate improved from 68% to 35%. This methodology may be used by school nurses to collaboratively look at ways to improve processes at the point of care. PMID:24386696

  5. The Potential Use of Health Care Financing Administration Data Sets for Health Care Services Research

    PubMed Central

    Lave, Judith; Dobson, Allen; Walton, Carol

    1983-01-01

    Administrative Record Systems may be an overlooked source of data for health services researchers. Through its administration of the Medicare and Medicaid Programs, the Health Care Financing Administration (HCFA) routinely receives data on items such as its beneficiary population, providers certified to deliver care to its beneficiary population, providers certified to deliver care to the beneficiaries, the use of services and reimbursements to providers. This article introduces the reader to the HCFA data, it describes the most important data bases that are useful for research, their relative strengths and weaknesses and the extent to which they are available to outside users. PMID:10310280

  6. Independent studies using deep sequencing resolve the same set of core bacterial species dominating gut communities of honey bees.

    PubMed

    Sabree, Zakee L; Hansen, Allison K; Moran, Nancy A

    2012-01-01

    Starting in 2003, numerous studies using culture-independent methodologies to characterize the gut microbiota of honey bees have retrieved a consistent and distinctive set of eight bacterial species, based on near identity of the 16S rRNA gene sequences. A recent study [Mattila HR, Rios D, Walker-Sperling VE, Roeselers G, Newton ILG (2012) Characterization of the active microbiotas associated with honey bees reveals healthier and broader communities when colonies are genetically diverse. PLoS ONE 7(3): e32962], using pyrosequencing of the V1-V2 hypervariable region of the 16S rRNA gene, reported finding entirely novel bacterial species in honey bee guts, and used taxonomic assignments from these reads to predict metabolic activities based on known metabolisms of cultivable species. To better understand this discrepancy, we analyzed the Mattila et al. pyrotag dataset. In contrast to the conclusions of Mattila et al., we found that the large majority of pyrotag sequences belonged to clusters for which representative sequences were identical to sequences from previously identified core species of the bee microbiota. On average, they represent 95% of the bacteria in each worker bee in the Mattila et al. dataset, a slightly lower value than that found in other studies. Some colonies contain small proportions of other bacteria, mostly species of Enterobacteriaceae. Reanalysis of the Mattila et al. dataset also did not support a relationship between abundances of Bifidobacterium and of putative pathogens or a significant difference in gut communities between colonies from queens that were singly or multiply mated. Additionally, consistent with previous studies, the dataset supports the occurrence of considerable strain variation within core species, even within single colonies. The roles of these bacteria within bees, or the implications of the strain variation, are not yet clear. PMID:22829932

  7. Independent Studies Using Deep Sequencing Resolve the Same Set of Core Bacterial Species Dominating Gut Communities of Honey Bees

    PubMed Central

    Sabree, Zakee L.; Hansen, Allison K.; Moran, Nancy A.

    2012-01-01

    Starting in 2003, numerous studies using culture-independent methodologies to characterize the gut microbiota of honey bees have retrieved a consistent and distinctive set of eight bacterial species, based on near identity of the 16S rRNA gene sequences. A recent study [Mattila HR, Rios D, Walker-Sperling VE, Roeselers G, Newton ILG (2012) Characterization of the active microbiotas associated with honey bees reveals healthier and broader communities when colonies are genetically diverse. PLoS ONE 7(3): e32962], using pyrosequencing of the V1–V2 hypervariable region of the 16S rRNA gene, reported finding entirely novel bacterial species in honey bee guts, and used taxonomic assignments from these reads to predict metabolic activities based on known metabolisms of cultivable species. To better understand this discrepancy, we analyzed the Mattila et al. pyrotag dataset. In contrast to the conclusions of Mattila et al., we found that the large majority of pyrotag sequences belonged to clusters for which representative sequences were identical to sequences from previously identified core species of the bee microbiota. On average, they represent 95% of the bacteria in each worker bee in the Mattila et al. dataset, a slightly lower value than that found in other studies. Some colonies contain small proportions of other bacteria, mostly species of Enterobacteriaceae. Reanalysis of the Mattila et al. dataset also did not support a relationship between abundances of Bifidobacterium and of putative pathogens or a significant difference in gut communities between colonies from queens that were singly or multiply mated. Additionally, consistent with previous studies, the dataset supports the occurrence of considerable strain variation within core species, even within single colonies. The roles of these bacteria within bees, or the implications of the strain variation, are not yet clear. PMID:22829932

  8. Best Practices for Ethical Sharing of Individual-Level Health Research Data From Low- and Middle-Income Settings

    PubMed Central

    Cheah, Phaik Yeong; Denny, Spencer; Jao, Irene; Marsh, Vicki; Merson, Laura; Shah More, Neena; Nhan, Le Nguyen Thanh; Osrin, David; Tangseefa, Decha; Wassenaar, Douglas; Parker, Michael

    2015-01-01

    Sharing individual-level data from clinical and public health research is increasingly being seen as a core requirement for effective and efficient biomedical research. This article discusses the results of a systematic review and multisite qualitative study of key stakeholders’ perspectives on best practices in ethical data sharing in low- and middle-income settings. Our research suggests that for data sharing to be effective and sustainable, multiple social and ethical requirements need to be met. An effective model of data sharing will be one in which considered judgments will need to be made about how best to achieve scientific progress, minimize risks of harm, promote fairness and reciprocity, and build and sustain trust. PMID:26297751

  9. Best Practices for Ethical Sharing of Individual-Level Health Research Data From Low- and Middle-Income Settings.

    PubMed

    Bull, Susan; Cheah, Phaik Yeong; Denny, Spencer; Jao, Irene; Marsh, Vicki; Merson, Laura; Shah More, Neena; Nhan, Le Nguyen Thanh; Osrin, David; Tangseefa, Decha; Wassenaar, Douglas; Parker, Michael

    2015-07-01

    Sharing individual-level data from clinical and public health research is increasingly being seen as a core requirement for effective and efficient biomedical research. This article discusses the results of a systematic review and multisite qualitative study of key stakeholders' perspectives on best practices in ethical data sharing in low- and middle-income settings. Our research suggests that for data sharing to be effective and sustainable, multiple social and ethical requirements need to be met. An effective model of data sharing will be one in which considered judgments will need to be made about how best to achieve scientific progress, minimize risks of harm, promote fairness and reciprocity, and build and sustain trust. PMID:26297751

  10. Centers Speak Up: The Clinical Context for Health Information Technology in the Ambulatory Care Setting

    PubMed Central

    Cheung, Ming; Webster, Tashonna R.; Curry, Leslie; Bradley, Elizabeth H.; Fifield, Judith; Burstin, Helen

    2008-01-01

    Background Clinicians in ambulatory care settings are increasingly called upon to use health information technology (health IT) to improve practice efficiency and performance. Successful adoption of health IT requires an understanding of how clinical tasks and workflows will be affected; yet this has not been well described. Objective To describe how health IT functions within a clinical context. Design Qualitative study, using in-depth, semi-structured interviews. Participants Executives and staff at 4 community health centers, 3 health center networks, and 1 large primary care organization. Approach Transcribed audio-recorded interviews, analyzed using the constant comparative method. Results Systematic characterization of clinical context identified 6 primary clinical domains. These included results management, intra-clinic communication, patient education and outreach, inter-clinic coordination, medication management, and provider education and feedback. We generated clinical process diagrams to characterize these domains. Participants suggested that underlying workflows for these domains must be fully operational to ensure successful deployment of health IT. Conclusions Understanding the clinical context is a necessary precursor to successful deployment of health IT. Process diagrams can serve as the basis for EHR certification, to identify challenges, to measure health IT adoption, or to develop curricular content regarding the role of health IT in clinical practice. PMID:18373132

  11. Job Satisfaction of Primary Health-Care Providers (Public Sector) in Urban Setting

    PubMed Central

    Kumar, Pawan; Khan, Abdul Majeed; Inder, Deep; Sharma, Nandini

    2013-01-01

    Introduction: Job satisfaction is determined by a discrepancy between what one wants in a job and what one has in a job. The core components of information necessary for what satisfies and motivates the health work force in our country are missing at policy level. Therefore present study will help us to know the factors for job satisfaction among primary health care providers in public sector. Materials and Methods: Present study is descriptive in nature conducted in public sector dispensaries/primary urban health centers in Delhi among health care providers. Pretested structured questionnaire was administered to 227 health care providers. Data was analyzed using SPSS and relevant statistical test were applied. Results: Analysis of study reveals that ANMs are more satisfied than MOs, Pharmacist and Lab assistants/Lab technicians; and the difference is significant (P < 0.01). Age and education level of health care providers don’t show any significant difference in job satisfaction. All the health care providers are dissatisfied from the training policies and practices, salaries and opportunities for career growth in the organization. Majority of variables studied for job satisfaction have low scores. Five factor were identified concerned with job satisfaction in factor analysis. Conclusion: Job satisfaction is poor for all the four groups of health care providers in dispensaries/primary urban health centers and it is not possible to assign a single factor as a sole determinant of dissatisfaction in the job. Therefore it is recommended that appropriate changes are required at the policy as well as at the dispensary/PUHC level to keep the health work force motivated under public sector in Delhi. PMID:24479088

  12. The Importance of Integration of Stakeholder Views in Core Outcome Set Development: Otitis Media with Effusion in Children with Cleft Palate

    PubMed Central

    Harman, Nicola L.; Bruce, Iain A.; Kirkham, Jamie J.; Tierney, Stephanie; Callery, Peter; O'Brien, Kevin; Williamson, Paula R.

    2015-01-01

    Background Approximately 75% of children with cleft palate (CP) have Otitis Media with Effusion (OME) histories. Evidence for the effective management of OME in these children is lacking. The inconsistency in outcome measurement in previous studies has led to a call for the development of a Core Outcome Set (COS). Despite the increase in the number of published COS, involvement of patients in the COS development process, and methods to integrate the views of patients and health professionals, to date have been limited. Methods and Findings A list of outcomes measured in previous research was identified through reviewing the literature. Opinion on the importance of each of these outcomes was then sought from key stakeholders: Ear, Nose and Throat (ENT) surgeons, audiologists, cleft surgeons, speech and language therapists, specialist cleft nurses, psychologists, parents and children. The opinion of health professionals was sought in a three round Delphi survey where participants were asked to score each outcome using a bespoke online system. Parents and children were also asked to score outcomes in a survey and provided an in-depth insight into having OME through semi-structured interviews. The results of the Delphi survey, interviews and parent/patient survey were brought together in a final consensus meeting with representation from all stakeholders. A final set of eleven outcomes reached the definition of “consensus in” to form the recommended COS: hearing; chronic otitis media (COM); OME; receptive language skills; speech development; psycho social development; acute otitis media (AOM); cholesteatoma; side effects of treatment; listening skills; otalgia. Conclusions We have produced a recommendation about the outcomes that should be measured, as a minimum, in studies of the management of OME in children with CP. The development process included input from key stakeholders and used novel methodology to integrate the opinion of healthcare professionals

  13. Rethinking the Health Center: Assessing Your Health Center and Setting Goals.

    ERIC Educational Resources Information Center

    McMillan, Nancy S.

    2001-01-01

    Camp health center management begins with assessing the population served, camp areas impacted, and the contract of care with parents. That information is used to plan the size of the center; its location in the camp; the type of equipment; and considerations such as medication management, infectious disease control, size of in- and out-patient…

  14. Structuring a written examination to assess ASBH health care ethics consultation core knowledge competencies.

    PubMed

    White, Bruce D; Jankowski, Jane B; Shelton, Wayne N

    2014-01-01

    As clinical ethics consultants move toward professionalization, the process of certifying individual consultants or accrediting programs will be discussed and debated. With certification, some entity must be established or ordained to oversee the standards and procedures. If the process evolves like other professions, it seems plausible that it will eventually include a written examination to evaluate the core knowledge competencies that individual practitioners should possess to meet peer practice standards. The American Society for Bioethics and Humanities (ASBH) has published core knowledge competencies for many years that are accepted by experts as the prevailing standard. Probably any written examination will be based upon the ASBH core knowledge competencies. However, much remains to be done before any examination may be offered. In particular, it seems likely that a recognized examining board must create and validate examination questions and structure the examination so as to establish meaningful, defensible parameters after dealing with such challenging questions as: Should the certifying examination be multiple choice or short-answer essay? How should the test be graded? What should the pass rate be? How may the examination be best administered? To advance the field of health care ethics consultation, thought leaders should start to focus on the written examination possibilities, to date unaddressed carefully in the literature. Examination models-both objective and written-must be explored as a viable strategy about how the field of health care ethics consultations can grow toward professionalization. PMID:24422920

  15. Picture of the health status of Aboriginal children living in an urban setting of Sydney.

    PubMed

    Gardner, Suzie; Woolfenden, Susan; Callaghan, Lola; Allende, Trudy; Winters, Jennifer; Wong, Grace; Caplice, Shea; Zwi, Karen

    2016-06-01

    Objectives The aims of the present study were to: (1) describe the health status and health indicators for urban Aboriginal children (age 0-16 years) in south-east Sydney; and (2) evaluate the quality of routinely collected clinical data and its usefulness in monitoring local progress of health outcomes. Methods Aboriginal maternal and child health routine data, from multiple databases, for individuals accessing maternal and child health services between January 2007 and December 2012 were examined and compared with state and national health indicators. Results Reductions in maternal smoking, premature delivery and low birthweight delivery rates were achieved in some years, but no consistent trends emerged. Paediatric services had increased referrals each year. The most frequent diagnoses were nutritional problems, language delay or disorder and developmental delay or learning difficulties. Twenty per cent of children had a chronic medical condition requiring long-term follow-up. Aboriginal children were more likely to be discharged from hospital against medical advice than non-Aboriginal children. Routinely collected data did not include some information essential to monitor determinants of health and health outcomes. Conclusions Aboriginal children living in this urban setting had high levels of need. Routinely recorded data were suboptimal for monitoring local health status and needed to reflect national and state health indicators. Routinely collected data can identify service gaps and guide service development. What is known about this topic? Despite improvements in some areas, there continue to be significant gaps in maternal and child health outcomes between Aboriginal and non-Aboriginal Australians. These are poorly documented at a local service level. What does this paper add? Intensive, local services offered to Aboriginal women and children can result in rapid service engagement. Health service data routinely collected by local services can be used to

  16. Teaching Core Courses with a Focus on Rural Health. An Instructor Resource Guide. Appendix to a Final Report on the Paraprofessional Rurally Oriented Family Home Health Training Program.

    ERIC Educational Resources Information Center

    Myer, Donna Foster, Ed.

    This instructor's resource guide, one in a series of products from a project to develop an associate degree program for paraprofessional rural family health promoters, deals with teaching courses that focus on rural health. Discussed in the first section of the guide are the role of core courses in rural health promotional training and the…

  17. Operation Safe Haven: an evaluation of health surveillance and monitoring in an acute setting.

    PubMed

    Bennett, C; Mein, J; Beers, M; Harvey, B; Vemulpad, S; Chant, K; Dalton, C

    2000-02-17

    From May to June 1999, 3,920 ethnic Albanians from Kosovo arrived in Australia as part of Operation Safe Haven. These people were evacuated from refugee camps in the former Yugoslav Republic of Macedonia. Initial processing in Australia occurred at East Hills Reception Centre, and accommodation for the duration of stay was provided in eight Haven Centres in five States. The arrival of a large number of refugees in a short time frame is unprecedented in Australia. A health surveillance system was developed and critical health data were collected to assess health status and needs, plan care, monitor for potential outbreaks of communicable diseases, track service use, to meet international reporting requirements and document our response to this crisis. In this article the health surveillance system is evaluated and suggestions are offered for the formulation of specific guidelines necessary for health surveillance in acute settings. PMID:10758691

  18. [Latex exposure and gloves' use in health settings: old and new issues].

    PubMed

    Crippa, Michela

    2008-01-01

    The diffusion of the "universal precautions", promoted in 1987 by the Center for Disease Control and Prevention, dramatically increased the use of latex glove in health care settings for protection against the HIV and HBV. The increased demand caused an increased production of gloves, a reduction in processing time and a different chemical treatment of rubber trees which lowered the glove quality, that means high levels of antigens and high powder content. This situation caused an increase of frequency of allergic (type I and type IV) and irritant reactions to latex gloves in health care workers. Recommendations and guidelines for the prevention of latex allergy in health care settings were available from 1995 both in Italy and in other countries. When properly applied, the preventive effectiveness of these suggestions has been demonstrated, but unfortunately the guidelines are not widely adopted as we could think and the frequency of latex allergy and sensitization in health care workers is not as reduced as it could be expect. This could be due also to the fact that some practical issues are still open, for example: the possibility of assessing the real glove quality and the reliability of information provided by manufacturers that often are inaccurate and incomplete; the necessity to update the regulations in force to higher quality standards; the availability of procedures for the selection, purchase and use of gloves in relation to specific tasks within health care setting; the involvement of occupational physicians in the management of these procedures; clear indications of limit values for extractable latex allergens in medical and common latex devices; the assessment of the real protective efficacy against chemicals and biological agents of new synthetic rubber gloves. An Italian working group of occupational health professionals, involved for a long time in the management of glove and latex related problems in health care settings,finalized a consensus

  19. Identifying mental health symptoms in children and youth in residential and in-patient care settings.

    PubMed

    Stewart, Shannon L; Hirdes, John P

    2015-07-01

    This study demonstrates the use of the interRAI assessment instruments to examine mental health symptoms in children and adults within residential and in-patient care settings. Regardless of service setting, children exhibited more harm to self and others than adults. Children in adult in-patient beds were more likely to exhibit suicide and self-harm and less likely to exhibit harm to others compared to children in child-specific service settings. Implications related to service system improvements are discussed. PMID:26015486

  20. Patient and Provider Perspectives on HIV and HIV-Related Stigma in Dutch Health Care Settings

    PubMed Central

    Sicking, Lenneke; Brands, Ronald; Baas, Ineke; Roberts, Hilde; van Brakel, Wim H.; Lechner, Lilian; Kok, Gerjo; Bos, Arjan E. R.

    2014-01-01

    Abstract Ensuring that people living with HIV (PLWH) feel accepted in health care settings is imperative. This mixed methods study explored the perspectives of PLWH and health professionals on their interactions. A total of 262 predominantly gay men of Dutch origin participated in a survey study of possible negative interactions with health professionals, and semi-structured interviews were subsequently conducted with 22 PLWH and 14 health professionals. Again, most PLWH were gay men of Dutch origin. All health professionals were Dutch. PLWH reported negative experiences with health professionals including awkward interactions, irrelevant questions, rude treatment, blame, pity, excessive or differential precautions, care refusal, unnecessary referrals, delayed treatment, poor support, and confidentiality breaches. They also reported positive experiences including equal treatment, being valued as a partner in one's health, social support provision, and confidentiality assurances. Health professionals reported having little experience with PLWH and only basic knowledge of HIV. They contended that PLWH are treated equally and that HIV is no longer stigmatized, but also reported fear of occupational infection, resulting in differential precautions. Additionally, they conveyed labeling PLWH's files to warn others, and curiosity regarding how patients acquired HIV. The findings suggest that there is a gap in perception between PLWH and health professionals regarding the extent to which negative interactions occur, and that these interactions should be improved. Implications for stigma reduction and care optimization are discussed. PMID:25459231

  1. Setting priorities for the adoption of health technologies on a national level -- the Israeli experience.

    PubMed

    Shani, S; Siebzehner, M I; Luxenburg, O; Shemer, J

    2000-12-01

    The rapid development of new and expensive health technologies together with the limited resources available for the health care system, makes priority setting or rationing inevitable. The Israeli Health Insurance Law, enacted in 1995, determined a basic list of health services to be provided to all residents by public funding. Although the Israeli health care system has reached a high standard of medical care as expressed by parameters such as long life expectancy and low infant mortality, the social and professional demand for new and expensive health technologies is increasing. Towards the fiscal year of 1999, the Medical Technologies Administration of the Ministry of Health recommended a list of new technologies to be added to the list of health services. The Ministry of Finance allocated that year US dollars 35 million for this purpose, while a rough assessment found that there are new important technologies to be added at a cost of more than US dollars 350 million. The Medical Technologies Administration took a systematic approach of health technology assessment - ad-hoc teams were established for evaluating clinical safety, efficacy and effectiveness, conducting needs assessment and cost-effectiveness descriptions. Assessment of the data was based on evidence-based medicine. A set of criteria was determined in order to enable the prioritizing of the assessed new technologies. This procedure led to a list of technologies suggested for inclusion. The Minister of Health appointed a public committee whose purpose was to decide the technologies to be added to the list of health services. The committee, made up of representatives from the government, the sick-funds and the public, had to evaluate each technology, based on the analysis submitted to the committee, taking into consideration clinical, economic, social, ethical and legal aspects according to predefined criteria. The thorough work of the Medical Technologies Administration enabled the committee to adopt

  2. Health Care Aides' Struggle to Build and Maintain Relationships with Families in Complex Continuing Care Settings

    ERIC Educational Resources Information Center

    McGilton, Katherine S.; Guruge, Sepali; Librado, Ruby; Bloch, Lois; Boscart, Veronique

    2008-01-01

    Research on the relationships between health care aides (HCAs) and families of clients has been situated mainly in long-term care settings and includes scant findings about the perceptions of HCAs. Based on the findings of a larger qualitative study using a grounded theory approach, this paper addresses the topic of HCA-family relationships in…

  3. 75 FR 44589 - Health Information Technology: Initial Set of Standards, Implementation Specifications, and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-28

    ...The Department of Health and Human Services (HHS) is issuing this final rule to complete the adoption of an initial set of standards, implementation specifications, and certification criteria, and to more closely align such standards, implementation specifications, and certification criteria with final meaningful use Stage 1 objectives and measures. Adopted certification criteria establish the......

  4. Impact of Play Therapy on Parent-Child Relationship Stress at a Mental Health Training Setting

    ERIC Educational Resources Information Center

    Ray, Dee C.

    2008-01-01

    This study investigated the impact of Child-Centred Play Therapy (CCPT)/Non-Directive Play Therapy on parent-child relationship stress using archival data from 202 child clients divided into clinical behavioural groups over 3-74 sessions in a mental health training setting. Results demonstrated significant differences between pre and post testing…

  5. Analysis of the DNA Sequencing Quality and Efficiency of the Apollo100 Robotic Microcycler in a Core Facility Setting

    PubMed Central

    Logsdon, M. E.; Trounstine, M. C.; Zianni, M. R.

    2011-01-01

    Sanger, or dideoxynucleotide sequencing, is an important tool for biomolecular research. An important trend in DNA sequencing is to find new and innovative ways to provide high-quality, reliable sequences in a more efficient manner, using automated capillary electrophoresis. The Apollo100 combines Sanger cycle sequencing and solid-phase reversible immobilization for product purification in a single instrument with robotic liquid handling and microfluidic (Microscale On-chip Valve) chips that have onboard thermal cycling and pneumatic mixing. Experiments were performed to determine how the DNA sequencing results from the Apollo100 compared with conventional, manual methods used in a core facility setting. Through rigorous experimentation of multiple baseline runs and a dilution series of template concentration, the Apollo100 generated sequencing that exceeded 900 bases with a quality score of 20 or above. When comparing actual client samples of amplicons, plasmids, and cosmids, Apollo100 sequencing results did not differ significantly from those reactions prepared manually. In addition, bacterial genomic DNA was sequenced successfully, directly with the Apollo100, although results were of lower quality than the standard manual method. As a result of the microscale capabilities, the Apollo100 offers valuable savings with respect to the quantity of reagents consumed compared with current manual sequencing methods, thereby continuing the demand for smaller template and reagent requirements. In conclusion, the Apollo100 can generate high-quality DNA sequences for common templates equivalent to those produced using manual sequencing methods and increases efficiency through reduced labor and reagents. PMID:21738437

  6. A Core Gene Set Describes the Molecular Basis of Mutualism and Antagonism in Epichloë spp.

    PubMed

    Eaton, Carla J; Dupont, Pierre-Yves; Solomon, Peter; Clayton, William; Scott, Barry; Cox, Murray P

    2015-03-01

    Beneficial plant-fungal interactions play an important role in the ability of plants to survive changing environmental conditions. In contrast, phytopathogenic fungi fall at the opposite end of the symbiotic spectrum, causing reduced host growth or even death. In order to exploit beneficial interactions and prevent pathogenic ones, it is essential to understand the molecular differences underlying these alternative states. The association between the endophyte Epichloë festucae and Lolium perenne (perennial ryegrass) is an excellent system for studying these molecular patterns due to the existence of several fungal mutants that have an antagonistic rather than a mutualistic interaction with the host plant. By comparing gene expression in a wild-type beneficial association with three mutant antagonistic associations disrupted in key signaling genes, we identified a core set of 182 genes that show common differential expression patterns between these two states. These gene expression changes are indicative of a nutrient-starvation response, as supported by the upregulation of genes encoding degradative enzymes, transporters, and primary metabolism, and downregulation of genes encoding putative small-secreted proteins and secondary metabolism. These results suggest that disruption of a mutualistic symbiotic interaction may lead to an elevated uptake and degradation of host-derived nutrients and cell-wall components, reminiscent of phytopathogenic interactions. PMID:25496592

  7. Mental health/illness and prisons as place: frontline clinicians׳ perspectives of mental health work in a penal setting.

    PubMed

    Wright, Nicola; Jordan, Melanie; Kane, Eddie

    2014-09-01

    This article takes mental health and prisons as its two foci. It explores the links between social and structural aspects of the penal setting, the provision of mental healthcare in prisons, and mental health work in this environment. This analysis utilises qualitative interview data from prison-based fieldwork undertaken in Her Majesty׳s Prison Service, England. Two themes are discussed: (1) the desire and practicalities of doing mental health work and (2) prison staff as mental health work allies. Concepts covered include equivalence, training, ownership, informal communication, mental health knowledge, service gatekeepers, case identification, and unmet need. Implications for practice are (1) the mental health knowledge and understanding of prison wing staff could be appraised and developed to improve mental healthcare and address unmet need. Their role as observers and gatekeepers could be considered. (2) The realities of frontline mental health work for clinicians in the penal environment should be embraced and used to produce and implement improved policy and practice guidance, which is in better accord with the actuality of the context - both socially and structurally. PMID:25124166

  8. The impact of behavioral and mental health risk assessments on goal setting in primary care.

    PubMed

    Krist, Alex H; Glasgow, Russell E; Heurtin-Roberts, Suzanne; Sabo, Roy T; Roby, Dylan H; Gorin, Sherri N Sheinfeld; Balasubramanian, Bijal A; Estabrooks, Paul A; Ory, Marcia G; Glenn, Beth A; Phillips, Siobhan M; Kessler, Rodger; Johnson, Sallie Beth; Rohweder, Catherine L; Fernandez, Maria E

    2016-06-01

    Patient-centered health risk assessments (HRAs) that screen for unhealthy behaviors, prioritize concerns, and provide feedback may improve counseling, goal setting, and health. To evaluate the effectiveness of routinely administering a patient-centered HRA, My Own Health Report, for diet, exercise, smoking, alcohol, drug use, stress, depression, anxiety, and sleep, 18 primary care practices were randomized to ask patients to complete My Own Health Report (MOHR) before an office visit (intervention) or continue usual care (control). Intervention practice patients were more likely than control practice patients to be asked about each of eight risks (range of differences 5.3-15.8 %, p < 0.001), set goals for six risks (range of differences 3.8-16.6 %, p < 0.01), and improve five risks (range of differences 5.4-13.6 %, p < 0.01). Compared to controls, intervention patients felt clinicians cared more for them and showed more interest in their concerns. Patient-centered health risk assessments improve screening and goal setting.Trial RegistrationClinicaltrials.gov identifier: NCT01825746. PMID:27356991

  9. Integrating Science and Engineering to Implement Evidence-Based Practices in Health Care Settings.

    PubMed

    Wu, Shinyi; Duan, Naihua; Wisdom, Jennifer P; Kravitz, Richard L; Owen, Richard R; Sullivan, J Greer; Wu, Albert W; Di Capua, Paul; Hoagwood, Kimberly Eaton

    2015-09-01

    Integrating two distinct and complementary paradigms, science and engineering, may produce more effective outcomes for the implementation of evidence-based practices in health care settings. Science formalizes and tests innovations, whereas engineering customizes and optimizes how the innovation is applied tailoring to accommodate local conditions. Together they may accelerate the creation of an evidence-based healthcare system that works effectively in specific health care settings. We give examples of applying engineering methods for better quality, more efficient, and safer implementation of clinical practices, medical devices, and health services systems. A specific example was applying systems engineering design that orchestrated people, process, data, decision-making, and communication through a technology application to implement evidence-based depression care among low-income patients with diabetes. We recommend that leading journals recognize the fundamental role of engineering in implementation research, to improve understanding of design elements that create a better fit between program elements and local context. PMID:25217100

  10. Integrating Science and Engineering to Implement Evidence-Based Practices in Health Care Settings

    PubMed Central

    Wu, Shinyi; Duan, Naihua; Wisdom, Jennifer P.; Kravitz, Richard L.; Owen, Richard R.; Sullivan, Greer; Wu, Albert W.; Di Capua, Paul; Hoagwood, Kimberly Eaton

    2015-01-01

    Integrating two distinct and complementary paradigms, science and engineering, may produce more effective outcomes for the implementation of evidence-based practices in health care settings. Science formalizes and tests innovations, whereas engineering customizes and optimizes how the innovation is applied tailoring to accommodate local conditions. Together they may accelerate the creation of an evidence-based healthcare system that works effectively in specific health care settings. We give examples of applying engineering methods for better quality, more efficient, and safer implementation of clinical practices, medical devices, and health services systems. A specific example was applying systems engineering design that orchestrated people, process, data, decision-making, and communication through a technology application to implement evidence-based depression care among low-income patients with diabetes. We recommend that leading journals recognize the fundamental role of engineering in implementation research, to improve understanding of design elements that create a better fit between program elements and local context. PMID:25217100

  11. Value congruence in health care priority setting: social values, institutions and decisions in three countries.

    PubMed

    Landwehr, Claudia; Klinnert, Dorothea

    2015-04-01

    Most developed democracies have faced the challenge of priority setting in health care by setting up specialized agencies to take decisions on which medical services to include in public health baskets. Under the influence of Daniels and Sabin's seminal work on the topic, agencies increasingly aim to fulfil criteria of procedural justice, such as accountability and transparency. We assume, however, that the institutional design of agencies also and necessarily reflects substantial value judgments on the respective weight of distributive principles such as efficiency, need and equality. The public acceptance of prioritization decisions, and eventually of the health care system at large, will ultimately depend not only on considerations of procedural fairness, but also on the congruence between a society's values and its institutions. We study social values, institutions and decisions in three countries (France, Germany and the United Kingdom) in order to assess such congruence and formulate expectations on its effects. PMID:25434454

  12. Best practices of total quality management implementation in health care settings.

    PubMed

    Talib, Faisal; Rahman, Zillur; Azam, Mohammed

    2011-01-01

    Due to the growing prominence of total quality management (TQM) in health care, the present study was conducted to identify the set of TQM practices for its successful implementation in healthcare institutions through a systematic review of literature. A research strategy was performed on the selected papers published between 1995 and 2009. An appropriate database was chosen and 15 peer-reviewed research papers were identified through a screening process and were finally reviewed for this study. Eight supporting TQM practices, such as top-management commitment, teamwork and participation, process management, customer focus and satisfaction, resource management, organization behavior and culture, continuous improvement, and training and education were identified as best practices for TQM implementation in any health care setting. The article concludes with a set of recommendations for the future researchers to discuss, develop, and work upon in order to achieve better precision and generalizations. PMID:21815741

  13. A Multisite Study of the Prevalence of HIV With Rapid Testing in Mental Health Settings

    PubMed Central

    Blank, Michael B.; Himelhoch, Seth S.; Balaji, Alexandra B.; Metzger, David S.; Dixon, Lisa B.; Rose, Charles E.; Oraka, Emeka; Davis-Vogel, Annet; Thompson, William W.; Heffelfinger, James D.

    2014-01-01

    Objectives. We estimated HIV prevalence and risk factors among persons receiving mental health treatment in Philadelphia, Pennsylvania, and Baltimore, Maryland, January 2009 to August 2011. Methods. We used a multisite, cross-sectional design stratified by clinical setting. We tested 1061 individuals for HIV in university-based inpatient psychiatric units (n = 287), intensive case-management programs (n = 273), and community mental health centers (n = 501). Results. Fifty-one individuals (4.8%) were HIV-infected. Confirmed positive HIV tests were 5.9% (95% confidence interval [CI] = 3.7%, 9.4%) for inpatient units, 5.1% (95% CI = 3.1%, 8.5%) for intensive case-management programs, and 4.0% (95% CI = 2.6%, 6.1%) for community mental health centers. Characteristics associated with HIV included Black race, homosexual or bisexual identity, and HCV infection. Conclusions. HIV prevalence for individuals receiving mental health services was about 4 times as high as in the general population. We found a positive association between psychiatric symptom severity and HIV infection, indicating that engaging persons with mental illness in appropriate mental health treatment may be important to HIV prevention. These findings reinforce recommendations for routine HIV testing in all clinical settings to ensure that HIV-infected persons receiving mental health services are identified and referred to timely infectious disease care. PMID:24524493

  14. Proposal for a candidate core-set of fitness and strength tests for patients with childhood or adult idiopathic inflammatory myopathies

    PubMed Central

    van der Stap, Djamilla K.D.; Rider, Lisa G.; Alexanderson, Helene; Huber, Adam M.; Gualano, Bruno; Gordon, Patrick; van der Net, Janjaap; Mathiesen, Pernille; Johnson, Liam G.; Ernste, Floranne C.; Feldman, Brian M.; Houghton, Kristin M.; Singh-Grewal, Davinder; Kutzbach, Abraham Garcia; Munters, Li Alemo; Takken, Tim

    2015-01-01

    OBJECTIVES Currently there are no evidence-based recommendations regarding which fitness and strength tests to use for patients with childhood or adult idiopathic inflammatory myopathies (IIM). This hinders clinicians and researchers in choosing the appropriate fitness- or muscle strength-related outcome measures for these patients. Through a Delphi survey, we aimed to identify a candidate core-set of fitness and strength tests for children and adults with IIM. METHODS Fifteen experts participated in a Delphi survey that consisted of five stages to achieve a consensus. Using an extensive search of published literature and through the expertise of the experts, a candidate core-set based on expert opinion and clinimetric properties was developed. Members of the International Myositis Assessment and Clinical Studies Group (IMACS) were invited to review this candidate core-set during the final stage, which led to a final candidate core-set. RESULTS A core-set of fitness- and strength-related outcome measures was identified for children and adults with IIM. For both children and adults, different tests were identified and selected for maximal aerobic fitness, submaximal aerobic fitness, anaerobic fitness, muscle strength tests and muscle function tests. CONCLUSIONS The core-set of fitness and strength-related outcome measures provided by this expert consensus process will assist practitioners and researchers in deciding which tests to use in IIM patients. This will improve the uniformity of fitness and strength tests across studies, thereby facilitating the comparison of study results and therapeutic exercise program outcomes among patients with IIM. PMID:26568594

  15. Employee Choice of Consumer-Driven Health Insurance in a Multiplan, Multiproduct Setting

    PubMed Central

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

    2004-01-01

    Objective To determine who chooses a Consumer-Driven Health Plan (CDHP) in a multiplan, multiproduct setting, and, specifically, whether the CDHP attracts the sicker employees in a company's risk pool. Study Design We estimated a health plan choice equation for employees of the University of Minnesota, who had a choice in 2002 of a CDHP and three other health plans—a traditional health maintenance organization (HMO), a preferred provider organization (PPO), and a tiered network product based on care systems. Data from an employee survey were matched to information from the university's payroll system. Principal Findings Chronic illness of the employee or family members had no effect on choice of the CDHP, but such employees tended to choose the PPO. The employee's age was not related to CDHP choice. Higher-income employees chose the CDHP, as well as those who preferred health plans with a national provider panel that includes their physician in the panel. Employees tended to choose plans with lower out-of-pocket premiums, and surprisingly, employees with a chronic health condition themselves or in their family were more price-sensitive. Conclusions This study provides the first evidence on who chooses a CDHP in a multiplan, multiproduct setting. The CDHP was not chosen disproportionately by the young and healthy, but it did attract the wealthy and those who found the availability of providers more appealing. Low out-of-pocket premiums are important features of health plans and in this setting, low premiums appeal to those who are less healthy. PMID:15230913

  16. Comparison of Job Satisfaction among Eight Health Care Professions in Private (Non-Government) Settings

    PubMed Central

    Ai-Hong, Chen; Saidah Nafisah, Jaafar; Abdul Rahim, Md Noor

    2012-01-01

    Background: A comparison of the job satisfaction of health care professionals has not been well studied in Malaysia. This study aimed to compare the job satisfaction level among 8 groups of health care professionals in private settings, using the Job Satisfaction Survey (JSS). Methods: A total of 81 health care professionals, including nurses, physiotherapists, occupational therapists, medical laboratory technologists, dieticians, medical imaging practitioners, environmental health officers, and optometrists in private (non-government) settings in the Klang Valley, were interviewed using the Job Satisfaction Survey scale invented by Dr Paul E Spector. Their job satisfaction scores were calculated and determined. Results: In the demographic data, the majority of the subjects were 20–30 years old (81.5%), were female (72.8%), had a basic degree (98.8%), were single (64.2%), and had 1–5 years of working experience (83.9%). A Kruskal–Wallis analysis showed significant differences (P < 0.05) in promotion, supervision, operating conditions, co-workers, nature of the work, and communication, but there were no significant differences (P > 0.05) in pay, fringe benefits, and contingent rewards in JSS score among the 8 health care professions. The Friedman Test showed a significant difference of overall JSS scores (χ2 = 526.418, P < 0.001) among the 8 health care professions. Conclusion: The overall job satisfaction levels are different among health care professionals in private settings, especially regarding promotion, supervision, operating conditions, co-workers, the nature of the work, and communication. PMID:22973134

  17. [Core competencies in public health: a regional framework for the Americas].

    PubMed

    Conejero, Juana Suárez; Godue, Charles; Gutiérrez, José Francisco García; Valladares, Laura Magaña; Rabionet, Silvia; Concha, José; Valdés, Manuel Vázquez; Gómez, Rubén Darío; Mujica, Oscar J; Cabezas, César; Lucano, Lindaura Liendo; Castellanos, Jorge

    2013-07-01

    The response is described to the 2010 call from the Pan American Health Organization to develop a Regional Framework on Core Competencies in Public Health, with a view to supporting the efforts of the countries in the Americas to build public health systems capacity as a strategy for optimal performance of the Essential Public Health Functions. The methodological process for the response was divided into four phases. In the first, a team of experts was convened who defined the methodology to be used during a workshop at the National Institute of Public Health of Mexico in 2010. The second phase involved formation of the working groups, using two criteria: experience and multidisciplinary membership, which resulted in a regional team with 225 members from 12 countries. This team prepared an initial proposal with 88 competencies. In the third phase, the competencies were cross-validated and their number reduced to 64. During the fourth phase, which included two workshops, in March 2011 (Medellín, Colombia) and June 2011 (Lima, Peru), discussions centered on analyzing the association between the results and the methodology. PMID:24006020

  18. Infection Prevention and Control for Ebola in Health Care Settings - West Africa and United States.

    PubMed

    Hageman, Jeffrey C; Hazim, Carmen; Wilson, Katie; Malpiedi, Paul; Gupta, Neil; Bennett, Sarah; Kolwaite, Amy; Tumpey, Abbigail; Brinsley-Rainisch, Kristin; Christensen, Bryan; Gould, Carolyn; Fisher, Angela; Jhung, Michael; Hamilton, Douglas; Moran, Kerri; Delaney, Lisa; Dowell, Chad; Bell, Michael; Srinivasan, Arjun; Schaefer, Melissa; Fagan, Ryan; Adrien, Nedghie; Chea, Nora; Park, Benjamin J

    2016-01-01

    The 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa underscores the need for health care infection prevention and control (IPC) practices to be implemented properly and consistently to interrupt transmission of pathogens in health care settings to patients and health care workers. Training and assessing IPC practices in general health care facilities not designated as Ebola treatment units or centers became a priority for CDC as the number of Ebola virus transmissions among health care workers in West Africa began to affect the West African health care system and increasingly more persons became infected. CDC and partners developed policies, procedures, and training materials tailored to the affected countries. Safety training courses were also provided to U.S. health care workers intending to work with Ebola patients in West Africa. As the Ebola epidemic continued in West Africa, the possibility that patients with Ebola could be identified and treated in the United States became more realistic. In response, CDC, other federal components (e.g., Office of the Assistant Secretary for Preparedness and Response) and public health partners focused on health care worker training and preparedness for U.S. health care facilities. CDC used the input from these partners to develop guidelines on IPC for hospitalized patients with known or suspected Ebola, which was updated based on feedback from partners who provided care for Ebola patients in the United States. Strengthening and sustaining IPC helps health care systems be better prepared to prevent and respond to current and future infectious disease threats.The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html). PMID:27390018

  19. Quality of life among patients with bipolar disorder in primary care versus community mental health settings

    PubMed Central

    Miller, Christopher J.; Abraham, Kristen M.; Bajor, Laura A.; Lai, Zongshan; Kim, Hyungjin Myra; Nord, Kristina M.; Goodrich, David E.; Bauer, Mark S.; Kilbourne, Amy M.

    2012-01-01

    Introduction Bipolar disorder is associated with functional impairment across a number of domains, including health-related quality of life (HRQOL). Many patients are treated exclusively in primary care (PC) settings, yet little is known how HRQOL outcomes compare between PC and community mental health (CMH) settings. This study aimed to explore the correlates of HRQOL across treatment settings using baseline data from a multisite, randomized controlled trial for adults with bipolar disorder. Methods HRQOL was measured using the SF-12 physical (PCS) and mental (MCS) health scales. Independent sample t-tests were calculated to compare differences in HRQOL between settings. Multivariate regression models then examined the effect of treatment setting on HRQOL, adjusting for covariate demographic factors, mood symptoms (Internal State Scale), hazardous drinking (AUDIT-C), and substance abuse. Results A total of 384 enrolled participants completed baseline surveys. MCS and PCS scores reflected similar impairment in HRQOL across PC and CMH settings (p = .98 and p = .49, respectively). Depressive symptoms were associated with lower MCS scores (B = −.68, p < .001) while arthritis/chronic pain was strongly related to lower PCS scores (B = −5.23, p < .001). Limitations This study lacked a formal diagnostic interview, relied on cross-sectional self-report, and sampled from a small number of sites in two states. Discussion Participants reported similar impairments in both mental and physical HRQOL in PC and CMH treatment settings, emphasizing the need for integrated care for patients with bipolar disorder regardless of where they present for treatment. PMID:22981021

  20. Agenda Setting for Health Promotion: Exploring an Adapted Model for the Social Media Era

    PubMed Central

    2015-01-01

    Background The foundation of best practice in health promotion is a robust theoretical base that informs design, implementation, and evaluation of interventions that promote the public’s health. This study provides a novel contribution to health promotion through the adaptation of the agenda-setting approach in response to the contribution of social media. This exploration and proposed adaptation is derived from a study that examined the effectiveness of Twitter in influencing agenda setting among users in relation to road traffic accidents in Saudi Arabia. Objective The proposed adaptations to the agenda-setting model to be explored reflect two levels of engagement: agenda setting within the social media sphere and the position of social media within classic agenda setting. This exploratory research aims to assess the veracity of the proposed adaptations on the basis of the hypotheses developed to test these two levels of engagement. Methods To validate the hypotheses, we collected and analyzed data from two primary sources: Twitter activities and Saudi national newspapers. Keyword mentions served as indicators of agenda promotion; for Twitter, interactions were used to measure the process of agenda setting within the platform. The Twitter final dataset comprised 59,046 tweets and 38,066 users who contributed by tweeting, replying, or retweeting. Variables were collected for each tweet and user. In addition, 518 keyword mentions were recorded from six popular Saudi national newspapers. Results The results showed significant ratification of the study hypotheses at both levels of engagement that framed the proposed adaptions. The results indicate that social media facilitates the contribution of individuals in influencing agendas (individual users accounted for 76.29%, 67.79%, and 96.16% of retweet impressions, total impressions, and amplification multipliers, respectively), a component missing from traditional constructions of agenda-setting models. The influence

  1. Developing Staffing Models to Support Population Health Management And Quality Oucomes in Ambulatory Care Settings.

    PubMed

    Haas, Sheila A; Vlasses, Frances; Havey, Julia

    2016-01-01

    There are multiple demands and challenges inherent in establishing staffing models in ambulatory heath care settings today. If health care administrators establish a supportive physical and interpersonal health care environment, and develop high-performing interprofessional teams and staffing models and electronic documentation systems that track performance, patients will have more opportunities to receive safe, high-quality evidence-based care that encourages patient participation in decision making, as well as provision of their care. The health care organization must be aligned and responsive to the community within which it resides, fully invested in population health management, and continuously scanning the environment for competitive, regulatory, and external environmental risks. All of these challenges require highly competent providers willing to change attitudes and culture such as movement toward collaborative practice among the interprofessional team including the patient. PMID:27439249

  2. Medical Teaching in Sioux Lookout: Primary Health Care in a Cross-Cultural Setting

    PubMed Central

    Hagen, Catherine; Casson, Ian; Wilson, Ruth

    1989-01-01

    When participating in health care in northern Native communities, physician-teachers are challenged to understand community development, treat diverse manifestations of illness and socio-cultural strain, and provide opportunities for students and residents to learn the skills, knowledge, and attitudes that will promote the health of Native people and that will develop the students' own education. The University of Toronto Sioux Lookout Program includes a teaching practice with the goals of service, teaching, and research that provides care and promotes health for 13 000 Ojibway- or Cree-speaking aboriginal Canadians in northwestern Ontario. Knowledge gained in this setting about broad determinants of health, communication skills, and clinical decision making can be generalized to other practices. PMID:21249082

  3. Substance use disorder patient privacy and comprehensive care in integrated health care settings.

    PubMed

    Schaper, Elizabeth; Padwa, Howard; Urada, Darren; Shoptaw, Steven

    2016-02-01

    The Affordable Care Act (ACA) expands health insurance coverage for substance use disorder (SUD) treatment, underscoring the value of improving SUD service integration in primarily physical health care settings. It is not yet known to what degree specialized privacy regulations-Code of Federal Regulations Title 42, Part 2 (42 CFR Part 2), in particular-will affect access to or the utilization and delivery of SUD treatment in primary care. In addition to exploring the emerging benefits and barriers that specialized confidentiality regulations pose to treatment in early adopting integrated health care settings, this article introduces and explicates 42 CFR Part 2 to support provider and administrator implementation of SUD privacy regulations in integrated settings. The authors also argue that, although intended to protect patients with SUD, special SUD information protection may inadvertently reinforce stigma against patients by purporting the belief that SUD is different from other health problems and must be kept private. In turn, this stigma may inhibit the delivery of comprehensive integrated care. PMID:26845493

  4. From the trenches: views from decision-makers on health services priority setting.

    PubMed

    Patten, San; Mitton, Craig; Donaldson, Cam

    2005-05-01

    Due to resource scarcity, health organizations worldwide must decide what services to fund and, conversely, what services not to fund. One approach to priority setting, which has been widely used in Britain, Australia, New Zealand and Canada, is programme budgeting and marginal analysis (PBMA). To date, such activity has primarily been based at a micro level, within programmes of care. In order to institute and refine the PBMA framework at a macro level across major service areas within a single health authority, researchers and decision-makers in Alberta embarked on a participatory action research project together. This paper identifies key issues of importance to decision-makers in a real-world priority-setting context. Themes discussed include making comparisons across disparate patient groups, dealing with political factors, using relevant forms of evidence, recognizing innovations and involving the public. The in-depth insight gained through this qualitative analysis will enable future refinement of PBMA at a macro level in the health authority under study, and should also serve to inform priority-setting activity in regionalized contexts elsewhere. In identifying aspects of priority setting that are important to decision-makers, researchers can also be better informed with respect to real-world processes. PMID:15901420

  5. Strategies for Conducting Adolescent Health Research in the Clinical Setting: The Mount Sinai Adolescent Health Center HPV Experience

    PubMed Central

    Braun-Courville, Debra K.; Schlecht, Nicolas F.; Burk, Robert D.; Strickler, Howard D.; Rojas, Mary; Lorde-Rollins, Elizabeth; Nucci-Sack, Anne; Hollman, Dominic; Linares, L. Oriana; Diaz, Angela

    2013-01-01

    Background Clinical research with adolescents can be challenging due to issues of informed consent, parental involvement, institutional review board requirements, and adolescent psychosocial development. This presents a dilemma, particularly in the area of sexual health research, as adolescents are disproportionately affected by sexually transmitted infections such as human papillomavirus (HPV). To successfully conduct adolescent research in the clinical setting, one requires an awareness of state statutes regarding adolescent confidentiality and consent for medical care, and a close partnership with the IRB. Case Study In 2007, the Mount Sinai Adolescent Health Center (MSAHC) in collaboration with the Albert Einstein College of Medicine developed a longitudinal research study to examine the natural history of oral, cervical, and anal HPV in an adolescent female population engaged in high-risk sexual behaviors. We use this research project as a case study to explore the ethical, methodological, and clinical issues related to conducting adolescent health research. Summary and Conclusions Several strategies were identified to promote adolescent study participation, including: (1) building a research team that is motivated to work with adolescents; (2) combining research and patient care visits to avoid duplication of services; and (3) establishing a personalized communication network with participants. Using these methods, adolescent sexual health research can successfully be integrated into the clinical setting. While retaining a prospective cohort of adolescents has its challenges, a persistent and multi-disciplinary approach can help improve recruitment, sustain participation, and acquire critical data that will lead to improved healthcare knowledge applicable to understudied populations of adolescents. PMID:24332677

  6. Humpback whale populations share a core skin bacterial community: towards a health index for marine mammals?

    PubMed

    Apprill, Amy; Robbins, Jooke; Eren, A Murat; Pack, Adam A; Reveillaud, Julie; Mattila, David; Moore, Michael; Niemeyer, Misty; Moore, Kathleen M T; Mincer, Tracy J

    2014-01-01

    Microbes are now well regarded for their important role in mammalian health. The microbiology of skin--a unique interface between the host and environment--is a major research focus in human health and skin disorders, but is less explored in other mammals. Here, we report on a cross-population study of the skin-associated bacterial community of humpback whales (Megaptera novaeangliae), and examine the potential for a core bacterial community and its variability with host (endogenous) or geographic/environmental (exogenous) specific factors. Skin biopsies or freshly sloughed skin from 56 individuals were sampled from populations in the North Atlantic, North Pacific and South Pacific oceans and bacteria were characterized using 454 pyrosequencing of SSU rRNA genes. Phylogenetic and statistical analyses revealed the ubiquity and abundance of bacteria belonging to the Flavobacteria genus Tenacibaculum and the Gammaproteobacteria genus Psychrobacter across the whale populations. Scanning electron microscopy of skin indicated that microbial cells colonize the skin surface. Despite the ubiquity of Tenacibaculum and Psychrobater spp., the relative composition of the skin-bacterial community differed significantly by geographic area as well as metabolic state of the animals (feeding versus starving during migration and breeding), suggesting that both exogenous and endogenous factors may play a role in influencing the skin-bacteria. Further, characteristics of the skin bacterial community from these free-swimming individuals were assembled and compared to two entangled and three dead individuals, revealing a decrease in the central or core bacterial community members (Tenacibaculum and Psychrobater spp.), as well as the emergence of potential pathogens in the latter cases. This is the first discovery of a cross-population, shared skin bacterial community. This research suggests that the skin bacteria may be connected to humpback health and immunity and could possibly serve

  7. Humpback Whale Populations Share a Core Skin Bacterial Community: Towards a Health Index for Marine Mammals?

    PubMed Central

    Apprill, Amy; Robbins, Jooke; Eren, A. Murat; Pack, Adam A.; Reveillaud, Julie; Mattila, David; Moore, Michael; Niemeyer, Misty; Moore, Kathleen M. T.; Mincer, Tracy J.

    2014-01-01

    Microbes are now well regarded for their important role in mammalian health. The microbiology of skin – a unique interface between the host and environment - is a major research focus in human health and skin disorders, but is less explored in other mammals. Here, we report on a cross-population study of the skin-associated bacterial community of humpback whales (Megaptera novaeangliae), and examine the potential for a core bacterial community and its variability with host (endogenous) or geographic/environmental (exogenous) specific factors. Skin biopsies or freshly sloughed skin from 56 individuals were sampled from populations in the North Atlantic, North Pacific and South Pacific oceans and bacteria were characterized using 454 pyrosequencing of SSU rRNA genes. Phylogenetic and statistical analyses revealed the ubiquity and abundance of bacteria belonging to the Flavobacteria genus Tenacibaculum and the Gammaproteobacteria genus Psychrobacter across the whale populations. Scanning electron microscopy of skin indicated that microbial cells colonize the skin surface. Despite the ubiquity of Tenacibaculum and Psychrobater spp., the relative composition of the skin-bacterial community differed significantly by geographic area as well as metabolic state of the animals (feeding versus starving during migration and breeding), suggesting that both exogenous and endogenous factors may play a role in influencing the skin-bacteria. Further, characteristics of the skin bacterial community from these free-swimming individuals were assembled and compared to two entangled and three dead individuals, revealing a decrease in the central or core bacterial community members (Tenacibaculum and Psychrobater spp.), as well as the emergence of potential pathogens in the latter cases. This is the first discovery of a cross-population, shared skin bacterial community. This research suggests that the skin bacteria may be connected to humpback health and immunity and could possibly

  8. The Comparison of the Minimum Data Set for Elderly Health in Selected Countries

    PubMed Central

    Sadoughi, Farahnaz; Shahi, Mehraban; Ahmadi, Maryam; Davaridolatabadi, Nasrin

    2015-01-01

    Introduction: Ongoing increase in the elderly population in many developed countries has drawn attention to health of this age group. Recording adequate and relevant data for the elderly is considered as the basis for future planning for this segment of society. So this study was conducted to compare minimum data about elderly health in selected countries. Methods: This review study was conducted through Internet and library studies. Key words were extracted from search engines and data bases including Google, Yahoo, Google Scholar, PubMed, ProQuest and Iranian National Medical Digital Library. Inclusion criteria included English language with no time limits. All articles, research projects, theses, guidelines and progress reports were retrieved from the United States, Sweden, Japan and Iran and reviewed. Also, websites of organizations responsible for elderly health in selected countries were visited and their documents were reviewed. Results from this search were provided narratively and finally were presented within comparison tables. Findings: The findings of this study showed that elderly data in the selected countries are collected around four axis including minimum demographic data, medical histories, health assessment and financial data of elderly health. Discussion and Conclusion: Given the importance of the minimum data set of elderly health for future planning, the use of experiences of leading countries in elderly health seems necessary; however, localization of it according to the country’s needs is inevitable. PMID:26862252

  9. Tobacco Use and Its Treatment Among Young People in Mental Health Settings: A Qualitative Analysis

    PubMed Central

    2013-01-01

    Background: Youth with psychiatric disorders are at increased risk of tobacco use. Outpatient mental health settings have received little investigation for delivering tobacco treatment. This study obtained formative data to guide development of a tobacco cessation program for transitional age youth with co-occurring psychiatric disorders with a focus on outpatient mental health settings. Methods: Applying qualitative methods, we analyzed transcripts from interviews with 14 mental health clients (aged 16–23) and 8 mental health providers. Results: The youth identified internal (nicotine addiction and mood), social, parental, and media influences to their use of tobacco. Providers’ viewed youth tobacco use as a normative developmental process, closely tied to management of psychiatric symptoms, supported by parents, and of lower priority relative to youth alcohol and illicit drug use. Youth and providers believed that clinicians can do more to address tobacco use in practice and emphasized nonjudgmental support and nondirective approaches. Top recommended quitting strategies, however, differed notably for the youth (cold turkey, support from friends, physical activity, hobbies) and providers (cessation pharmacotherapy, cessation groups, treatment referrals). Conclusions: Mental health providers’ greater prioritization of other substances and view of youth smoking as developmentally normative and a coping strategy for psychopathology are likely contributing to the general lack of attention to tobacco use currently. Integrating care within mental health settings would serve to reach youth in an arena where clinical rapport is already established, and study findings suggest receptivity for system improvements. Of consideration, however, is the apparent disconnect between provider and youth recommended strategies for supporting cessation. PMID:23322765

  10. Setting priorities for mental health care in Nepal: a formative study

    PubMed Central

    2013-01-01

    Background There is an urgent need to address the massive treatment gap for mental health problems, especially in low income settings. Packages of care integrated in routine primary health care are posited as a strategy to scale-up mental health care, yet more needs to be known about the most feasible and effective way to go about this. Methods The study follows a combined methods design that includes engaging an expert panel in a priority setting exercise, running workshops to develop a Theory of Change and conducting in-depth qualitative interviews and focus group discussions with key stakeholders. The results of each research step were taken forward to inform the subsequent one. Results There was strong endorsement for a system of care that encompasses both the perspectives of health facility and the community. Issues related to increasing access and demand, guaranteeing a sustainable supply of psychotropic medicine, adequate human resourcing, and ensuring positive family involvement came up as priority areas of attention. Conclusion The study underlines many of the known barriers in developing mental health services. At the same time it provides a distinct pathway and concrete recommendations for overcoming these challenges in Nepal. PMID:24305432

  11. Challenges to HIV prevention in psychiatric settings: Perceptions of South African mental health care providers

    PubMed Central

    Collins, Pamela Y.

    2009-01-01

    Mental health services in South Africa increasingly feel the brunt of the AIDS epidemic. Despite the high prevalence of infection in the psychiatric setting, HIV risk reduction interventions targeting South Africans with psychiatric illness remain few and far between. The attitudes of mental health care providers about sexual relations and HIV among people with mental illness continue to influence the extent to which these issues are addressed in care settings. This study examines these attitudes through the use of a semi-structured interview administered to 46 mental health care providers in four provinces of South Africa. I found that personal, contextual and political factors in the clinic and the hospital create barriers to integrating prevention activities. In particular, providers face at least three challenges to intervening in the epidemic among their patients: their own views of psychiatric illness, the transitions occurring in the mental health care system, and shifting social attitudes toward sexuality. Barriers operate at the individual level, the institutional level, and the societal level. At the individual level providers’ perceptions of psychiatric symptoms shape their outlook on intervention with psychiatric patients. At the institutional level disruptive transitions in service delivery relegate HIV services to lesser importance. At the societal level, personal beliefs about sexuality and mental illness have remained slow to change despite major political changes. Minimizing barriers to implementing HIV prevention services requires institutional and health care policies that ensure adequate resources for treating people with mental illness and for staff development and support. PMID:16647793

  12. Recommendations for a Core Outcome Set for Measuring Standing Balance in Adult Populations: A Consensus-Based Approach

    PubMed Central

    Sibley, Kathryn M.; Howe, Tracey; Lamb, Sarah E.; Lord, Stephen R.; Maki, Brian E.; Rose, Debra J.; Scott, Vicky; Stathokostas, Liza; Straus, Sharon E.; Jaglal, Susan B.

    2015-01-01

    Background Standing balance is imperative for mobility and avoiding falls. Use of an excessive number of standing balance measures has limited the synthesis of balance intervention data and hampered consistent clinical practice. Objective To develop recommendations for a core outcome set (COS) of standing balance measures for research and practice among adults. Methodology A combination of scoping reviews, literature appraisal, anonymous voting and face-to-face meetings with fourteen invited experts from a range of disciplines with international recognition in balance measurement and falls prevention. Consensus was sought over three rounds using pre-established criteria. Data sources The scoping review identified 56 existing standing balance measures validated in adult populations with evidence of use in the past five years, and these were considered for inclusion in the COS. Results Fifteen measures were excluded after the first round of scoring and a further 36 after round two. Five measures were considered in round three. Two measures reached consensus for recommendation, and the expert panel recommended that at a minimum, either the Berg Balance Scale or Mini Balance Evaluation Systems Test be used when measuring standing balance in adult populations. Limitations Inclusion of two measures in the COS may increase the feasibility of potential uptake, but poses challenges for data synthesis. Adoption of the standing balance COS does not constitute a comprehensive balance assessment for any population, and users should include additional validated measures as appropriate. Conclusions The absence of a gold standard for measuring standing balance has contributed to the proliferation of outcome measures. These recommendations represent an important first step towards greater standardization in the assessment and measurement of this critical skill and will inform clinical research and practice internationally. PMID:25768435

  13. The CROWN Initiative: journal editors invite researchers to develop core outcomes in women’s health

    PubMed Central

    2014-01-01

    Clinical trials, systematic reviews and guidelines compare beneficial and non-beneficial outcomes following interventions. Often, however, various studies on a particular topic do not address the same outcomes, making it difficult to draw clinically useful conclusions when a group of studies is looked at as a whole. This problem was recently thrown into sharp focus by a systematic review of interventions for preterm birth prevention, which found that among 103 randomised trials, no fewer than 72 different outcomes were reported. There is a growing recognition among clinical researchers that this variability undermines consistent synthesis of the evidence, and that what is needed is an agreed standardised collection of outcomes - a “core outcomes set” - for all trials in a specific clinical area. Recognising that the current inconsistency is a serious hindrance to progress in our specialty, the editors of over 50 journals related to women’s health have come together to support The CROWN (CoRe Outcomes in WomeN’s health) Initiative. PMID:24993666

  14. The CROWN initiative: journal editors invite researchers to develop core outcomes in women’s health

    PubMed Central

    2014-01-01

    Clinical trials, systematic reviews and guidelines compare beneficial and non-beneficial outcomes following interventions. Often, however, various studies on a particular topic do not address the same outcomes, making it difficult to draw clinically useful conclusions when a group of studies is looked at as a whole. This problem was recently thrown into sharp focus by a systematic review of interventions for preterm birth prevention, which found that among 103 randomised trials, no fewer than 72 different outcomes were reported. There is a growing recognition among clinical researchers that this variability undermines consistent synthesis of the evidence, and that what is needed is an agreed standardised collection of outcomes - a “core outcomes set” - for all trials in a specific clinical area. Recognising that the current inconsistency is a serious hindrance to progress in our specialty, the editors of over 50 journals related to women’s health have come together to support The CROWN (CoRe Outcomes in WomeN’s health) Initiative. PMID:24957208

  15. Free, brief, and validated: Standardized instruments for low-resource mental health settings

    PubMed Central

    Beidas, Rinad S.; Stewart, Rebecca E.; Walsh, Lucia; Lucas, Steven; Downey, Margaret Mary; Jackson, Kamilah; Fernandez, Tara; Mandell, David S.

    2014-01-01

    Evidence-based assessment has received little attention despite its critical importance to the evidence-based practice movement. Given the limited resources in the public sector, it is necessary for evidence-based assessment to utilize tools with established reliability and validity metrics that are free, easily accessible, and brief. We review tools that meet these criteria for youth and adult mental health for the most prevalent mental health disorders to provide a clinical guide and reference for the selection of assessment tools for public sector settings. We also discuss recommendations for how to move forward the evidence-based assessment agenda. PMID:25642130

  16. Setting up a CLIA-certified laboratory in a student health services clinic.

    PubMed

    Nash, K A; Ross, A

    1999-11-01

    Performing some laboratory tests on site at a student health service clinic may increase efficiency and cut costs for patients. However, with the passage of the Clinical Laboratory Improvement Amendments (CLIA) of 1988, many laboratories in physician offices and clinics have shut down because of increased regulatory requirements. The personnel in one SHS laboratory found that the guidelines proposed by CLIA help assure quality care and are not prohibitive. In this article, the process of applying for and receiving a CLIA certificate in the student health clinic setting is explored. PMID:10584449

  17. Effectiveness of an educational video in improving oral health knowledge in a hospital setting

    PubMed Central

    Shah, Naseem; Mathur, Vijay Prakash; Kathuria, Vartika; Gupta, Tanupriya

    2016-01-01

    Introduction: Prevention of oral diseases can be achieved by preventive measures. There is an educational component associated to the preventive aspect. Health education is a cornerstone to the success of a preventive programme. Health education has always been regarded as a primary tool in imparting awareness, bringing changes in healthy behaviors and improved life. Aim: To assess the effectiveness of an Educational Video in improving oral health knowledge of subjects in a hospital setting. Methodology: The study was conducted in Outpatient Department, CDER, AIIMS. This was a cross sectional interventional study. In the present study a total of 109 subjects were considered those who completed pre and post intervention questionnaire. In order to assess baseline oral health knowledge, a-14 itemed questionnaire was specially designed, based on the contents of video and was pre-tested on 10 patients. Pre-intervention knowledge was assessed and then the 30-minute video was shown. Following this, post-exposure knowledge was assessed using the same questionnaire. Change in the knowledge score amongst the subjects was assessed pre and post-intervention (showing the video film). Results: Paired t- test was used to analyze the data. Pre-intervention mean knowledge score was 9.49±2.09 which increased to 11.55±1.60 post-intervention; the difference was statistically significant (P < 0.001). Conclusions: It was found that increase in knowledge score was statistically significant after exposure to an educational video film in a hospital setting. Incorporation of video in imparting oral health education can be an effective tool in improving oral health knowledge, which can impact the oral health behavior of people and community. PMID:27433049

  18. Agenda setting for maternal survival: the power of global health networks and norms.

    PubMed

    Smith, Stephanie L; Rodriguez, Mariela A

    2016-04-01

    Nearly 300 000 women-almost all poor women in low-income countries-died from pregnancy-related complications in 2010. This represents a decline since the 1980s, when an estimated half million women died each year, but is still far higher than the aims set in the United Nations Millennium Development Goals (MDGs) at the turn of the century. The 1970s, 1980s and 1990s witnessed a shift from near complete neglect of the issue to emergence of a network of individuals and organizations with a shared concern for reducing maternal deaths and growth in the number of organizations and governments with maternal health strategies and programmes. Maternal health experienced a marked change in agenda status in the 2000s, attracting significantly higher level attention (e.g. from world leaders) and greater resource commitments (e.g. as one issue addressed by US$40 billion in pledges to the 2010Global Strategy for Women's and Children's Health) than ever before. Several differences between network and actor features, issue characteristics and the policy environment pre- and post-2000 help to explain the change in agenda status for global maternal mortality reduction. Significantly, a strong poverty reduction norm emerged at the turn of the century; represented by the United Nations MDGs framework, the norm set unusually strong expectations for international development actors to advance included issues. As the norm grew, it drew policy attention to the maternal health goal (MDG 5). Seeking to advance the goals agenda, world leaders launched initiatives addressing maternal and child health. New network governance and framing strategies that closely linked maternal, newborn and child health shaped the initiatives. Diverse network composition-expanding beyond a relatively narrowly focused and technically oriented group to encompass allies and leaders that brought additional resources to bear on the problem-was crucial to maternal health's rise on the agenda in the 2000s. PMID

  19. Identification of a Core Set of Exercise Tests for Children and Adolescents with Cerebral Palsy: A Delphi Survey of Researchers and Clinicians

    ERIC Educational Resources Information Center

    Verschuren, Olaf; Ketelaar, Marjolijn; Keefer, Daniel; Wright, Virginia; Butler, Jane; Ada, Louise; Maher, Carol; Reid, Siobhan; Wright, Marilyn; Dalziel, Blythe; Wiart, Lesley; Fowler, Eileen; Unnithan, Viswanath; Maltais, Desiree B.; van den Berg-Emons, Rita; Takken, Tim

    2011-01-01

    Aim: Evidence-based recommendations regarding which exercise tests to use in children and adolescents with cerebral palsy (CP) are lacking. This makes it very difficult for therapists and researchers to choose the appropriate exercise-related outcome measures for this group. This study aimed to identify a core set of exercise tests for children…

  20. Conducting clinical research in community mental health settings: Opportunities and challenges

    PubMed Central

    Tcheremissine, Oleg V; Rossman, Whitney E; Castro, Manuel A; Gardner, Dineen R

    2014-01-01

    Tremendous progress has been made in the past decade surrounding the underlying mechanisms and treatment of neuropsychiatric disease. Technological advancements and a broadened research paradigm have contributed to the understanding of the neurochemistry, brain function and brain circuitry involved in neuropsychiatric disorders. The predominant area of unmet medical need in the United States is major psychiatric disorders, and major depressive disorder is the leading cause of disability for ages 15-44. Total spending on research and development by the pharmaceutical industry has grown exponentially during the past decade, but fewer new molecular entities (NME) for the treatment of major psychiatric disorders have received regulatory approvals compared to other therapeutic areas. Though significant expansion has occurred during the “decade of the brain”, the translation of clinical trials outcomes into the community mental health setting is deficient. Randomized controlled trials (RCTs) have been the standard approach to clinical evaluation of the safety and efficacy of NMEs for the past 60 years; however, there are significant barriers and skepticism in the implementation of evidence-based outcomes into clinical practice. Recruitment of patients, shortages of experienced clinical researchers, regulatory requirements and later translation of outcomes into clinical practice are ever growing problems faced by investigators. The community mental health setting presents particular barriers in the replication of therapeutic outcomes from RCTs. The diagnostic complexity of major psychiatric diseases and the highly selective patient populations involved in clinical trials lend to the gap in translation from the “bench to the bedside”. The community mental health setting lends to a diverse patient population with numerous co-morbidities and environmental factors that are unaccounted in the average RCT. While we acknowledge the enormous complexity in developing novel

  1. Opportunities to Strengthen Childhood Obesity Prevention in Two Mexican Health Care Settings

    PubMed Central

    Cespedes, Elizabeth; Andrade, Gloria Oliva Martínez; Rodríguez-Oliveros, Guadalupe; Perez-Cuevas, Ricardo; González-Unzaga, Marco A.; Trejo, Amalia Benitez; Haines, Jess; Gillman, Matthew W.; Taveras, Elsie M.

    2014-01-01

    Background The purpose of this study was to examine Mexican caregivers’ perceptions of the role of primary care in childhood obesity management, understand the barriers and facilitators of behavior change, and identify opportunities to strengthen obesity prevention and treatment in clinical settings. Methods We conducted 52 in-depth interviews with parents and caregivers of overweight and obese children age 2–5 years in 4 Ministry of Health (public, low SES) and 4 Social Security Institute (insured, higher SES) primary care clinics in Mexico City and did systematic thematic analysis. Results In both health systems, caregivers acknowledged childhood overweight but not its adverse health consequences. Although the majority of parents had not received nutrition or physical activity recommendations from health providers, many were open to clinician guidance. Despite knowledge of healthful nutrition and physical activity, parents identified several barriers to change including child feeding occurring in the context of competing priorities (work schedules, spouses’ food preferences), and cultural norms (heavy as healthy, food as nurturance) that take precedence over adherence to dietary guidelines. Physical activity, while viewed favorably, is not a structured part of most preschooler’s routines as reported by parents. Conclusions The likelihood of success for clinic-based obesity prevention among Mexican preschoolers will be higher by addressing contextual barriers such as cultural norms regarding children’s weight and support of family members for behavior change. Similarities in caregivers’ perceptions across 2 health systems highlight the possibility of developing comprehensive interventions for the population as a whole. PMID:25530836

  2. Using modular psychotherapy in school mental health: Provider perspectives on intervention-setting fit

    PubMed Central

    Lyon, Aaron R.; Ludwig, Kristy; Romano, Evalynn; Koltracht, Jane; Stoep, Ann Vander; McCauley, Elizabeth

    2013-01-01

    Objective The “fit” or appropriateness of well-researched interventions within usual care contexts is among the most commonly-cited, but infrequently researched, factors in the successful implementation of new practices. The current study was initiated to address two exploratory research questions: (1) How do clinicians describe their current school mental health service delivery context? and (2) How do clinicians describe the fit between modular psychotherapy and multiple levels of the school mental health service delivery context? Method Following a year-long training and consultation program in an evidence-based, modular approach to psychotherapy, semi-structured qualitative interviews were conducted with seventeen school-based mental health providers to evaluate their perspectives on the appropriateness of implementing the approach within a system of school-based health centers. Interviews were transcribed and coded for themes using conventional and directed content analysis. Results Findings identified key elements of the school mental health context including characteristics of the clinicians, their practices, the school context, and the service recipients. Specific evaluation of intervention-setting appropriateness elicited many comments about both practical and value-based (e.g., cultural considerations) aspects at the clinician and client levels, but fewer comments at the school or organizational levels. Conclusions Results suggest that a modular approach may fit well with the school mental health service context, especially along practical aspects of appropriateness. Future research focused on the development of methods for routinely assessing appropriateness at different stages of the implementation process is recommended. PMID:24134063

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

    PubMed

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

    2013-02-01

    Patients with the most complex health profiles consume a disproportionate percentage of health care expenditures, yet often receive fragmented, suboptimal care. Since 2003, Wisconsin-based Gundersen Health has improved the quality of life and reduced the cost burden of patients with complex health profiles with an integrated care coordination program. Those results are consistent with data from the most successful care coordination demonstration projects funded by the Centers for Medicare and Medicaid Services. Specifically, Gundersen's program has been associated with reduced hospital stays, lower costs for inpatients, less use of inpatient services, and increased patient satisfaction. Gundersen's success is rooted in its team-based approach to coordinated care. Teams, led by a subspecialty-trained nurse, have regular, face-to-face contact with patients and their physicians in both inpatient and outpatient settings; involve patients deeply in care-related decisions; access a system-wide electronic medical record database that tracks patients' care; and take a macrolevel view of care-related factors and costs. Gundersen's model offers specific take-home lessons for institutions interested in coordinated care as they design programs aimed at improving quality and lowering costs. This institutional case study provides a window into well-executed care coordination at a large health care system in an era when major changes in health care provision and reimbursement mechanisms are on the horizon. PMID:23290738

  4. Describing a residency program developed for newly graduated nurse practitioners employed in retail health settings.

    PubMed

    Thabault, Paulette; Mylott, Laura; Patterson, Angela

    2015-01-01

    Retail health clinics are an expanding health care delivery model and an emerging new practice site for nurse practitioners (NPs). Critical thinking skills, clinical competence, interprofessional collaboration, and business savvy are necessary for successful practice in this highly independent and autonomous setting. This article describes a pilot residency partnership program aimed at supporting new graduate NP transition to practice, reducing NP turnover, and promoting academic progression. Eight new graduate NPs were recruited to the pilot and paired with experienced clinical NP preceptors for a 12-month program that focused on increasing clinical and business competence in the retail health setting. The residency program utilized technology to facilitate case conferences and targeted Webinars to enhance learning and peer-to-peer sharing and support. An on-line doctoral-level academic course that focused on interprofessional collaboration in health care, population health, and business concepts was offered. Both NPs and preceptors were highly satisfied with the academic-service residency program between MinuteClinic and Northeastern University School of Nursing in Boston, MA. New NPs particularly valued the preceptor model, the clinical case conferences, and business Webinars. Because their priority was in gaining clinical experience and learning the business acumen relevant to managing the processes of care, they did not feel ready for the doctoral course and would have preferred to take later in their practice. The preceptors valued the academic course and felt that it enhanced their precepting and leadership skills. At the time of this article, 6 months post completion of the residency program, there has been no turnover. Our experience supports the benefits for residency programs for newly graduated NPs in retail settings. The model of partnering with academia by offering a course within a service organization's educational programs can enable academic

  5. Healthy universities: an example of a whole-system health-promoting setting.

    PubMed

    Newton, Joanne; Dooris, Mark; Wills, Jane

    2016-03-01

    The health-promoting settings approach is well established in health promotion, with organisational settings being understood as complex systems able to support human wellbeing and flourishing. Despite the reach and evident importance of higher education as a sector, 'healthy universities' has not received high-level international leadership comparable to many other settings programmes. This study explores how the concept of a healthy university is operationalised in two case study universities. Data collection methods included documentary analysis, observation field notes and semi-structured interviews with staff and students. Staff and students understood the characteristics of a healthy university to pertain to management processes relating to communication and to a respectful organisational ethos. Enhancers of health and wellbeing were feeling valued, being listened to, having skilled and supportive line managers and having a positive physical environment. Inhibitors of health and wellbeing were having a sense of powerlessness and a lack of care and concern. The concept of the healthy university has been slow to be adopted in contrast to initiatives such as healthy schools. In addition to challenges relating to lack of theorisation, paucity of evidence and difficulties in capturing the added value of whole-system working, this study suggests that this may be due to both their complex organisational structure and the diverse goals of higher education, which do not automatically privilege health and wellbeing. It also points to the need for a whole-university approach that pays attention to the complex interactions and interconnections between component parts and highlights how the organisation can function effectively as a social system. PMID:27199018

  6. District decision-making for health in low-income settings: a systematic literature review

    PubMed Central

    Avan, Bilal Iqbal

    2016-01-01

    Health management information systems (HMIS) produce large amounts of data about health service provision and population health, and provide opportunities for data-based decision-making in decentralized health systems. Yet the data are little-used locally. A well-defined approach to district-level decision-making using health data would help better meet the needs of the local population. In this second of four papers on district decision-making for health in low-income settings, our aim was to explore ways in which district administrators and health managers in low- and lower-middle-income countries use health data to make decisions, to describe the decision-making tools they used and identify challenges encountered when using these tools. A systematic literature review, following PRISMA guidelines, was undertaken. Experts were consulted about key sources of information. A search strategy was developed for 14 online databases of peer reviewed and grey literature. The resources were screened independently by two reviewers using pre-defined inclusion criteria. The 14 papers included were assessed for the quality of reported evidence and a descriptive evidence synthesis of the review findings was undertaken. We found 12 examples of tools to assist district-level decision-making, all of which included two key stages—identification of priorities, and development of an action plan to address them. Of those tools with more steps, four included steps to review or monitor the action plan agreed, suggesting the use of HMIS data. In eight papers HMIS data were used for prioritization. Challenges to decision-making processes fell into three main categories: the availability and quality of health and health facility data; human dynamics and financial constraints. Our findings suggest that evidence is available about a limited range of processes that include the use of data for decision-making at district level. Standardization and pre-testing in diverse settings would

  7. District decision-making for health in low-income settings: a systematic literature review.

    PubMed

    Wickremasinghe, Deepthi; Hashmi, Iram Ejaz; Schellenberg, Joanna; Avan, Bilal Iqbal

    2016-09-01

    Health management information systems (HMIS) produce large amounts of data about health service provision and population health, and provide opportunities for data-based decision-making in decentralized health systems. Yet the data are little-used locally. A well-defined approach to district-level decision-making using health data would help better meet the needs of the local population. In this second of four papers on district decision-making for health in low-income settings, our aim was to explore ways in which district administrators and health managers in low- and lower-middle-income countries use health data to make decisions, to describe the decision-making tools they used and identify challenges encountered when using these tools. A systematic literature review, following PRISMA guidelines, was undertaken. Experts were consulted about key sources of information. A search strategy was developed for 14 online databases of peer reviewed and grey literature. The resources were screened independently by two reviewers using pre-defined inclusion criteria. The 14 papers included were assessed for the quality of reported evidence and a descriptive evidence synthesis of the review findings was undertaken. We found 12 examples of tools to assist district-level decision-making, all of which included two key stages-identification of priorities, and development of an action plan to address them. Of those tools with more steps, four included steps to review or monitor the action plan agreed, suggesting the use of HMIS data. In eight papers HMIS data were used for prioritization. Challenges to decision-making processes fell into three main categories: the availability and quality of health and health facility data; human dynamics and financial constraints. Our findings suggest that evidence is available about a limited range of processes that include the use of data for decision-making at district level. Standardization and pre-testing in diverse settings would increase

  8. Public involvement in health priority setting: future challenges for policy, research and society.

    PubMed

    Hunter, David James; Kieslich, Katharina; Littlejohns, Peter; Staniszewska, Sophie; Tumilty, Emma; Weale, Albert; Williams, Iestyn

    2016-08-15

    Purpose - The purpose of this paper is to reflect on the findings of this special issue and discusses the future challenges for policy, research and society. The findings suggest that challenges emerge as a result of legitimacy deficits of both consensus and contestatory modes of public involvement in health priority setting. Design/methodology/approach - The paper draws on the discussions and findings presented in this special issue. It seeks to bring the country experiences and case studies together to draw conclusions for policy, research and society. Findings - At least two recurring themes emerge. An underlying theme is the importance, but also the challenge, of establishing legitimacy in health priority setting. The country experiences suggest that we understand very little about the conditions under which representative, or authentic, participation generates legitimacy and under which it will be regarded as insufficient. A second observation is that public participation takes a variety of forms that depend on the opportunity structures in a given national context. Given this variety the conceptualization of public participation needs to be expanded to account for the many forms of public participation. Originality/value - The paper concludes that the challenges of public involvement are closely linked to the question of how legitimate processes and decisions can be generated in priority setting. This suggests that future research must focus more narrowly on conditions under which legitimacy are generated in order to expand the understanding of public involvement in health prioritization. PMID:27468775

  9. Palliative care, public health and justice: setting priorities in resource poor countries.

    PubMed

    Blinderman, Craig

    2009-12-01

    Many countries have not considered palliative care a public health problem. With limited resources, disease-oriented therapies and prevention measures take priority. In this paper, I intend to describe the moral framework for considering palliative care as a public health priority in resource-poor countries. A distributive theory of justice for health care should consider integrative palliative care as morally required as it contributes to improving normal functioning and preserving opportunities for the individual. For patients requiring terminal care, we are guided less by principles of justice and more by the duty to relieve suffering and society's commitment to protecting the professional's obligation to uphold principles of beneficence, compassion and non-abandonment. A fair deliberation process is necessary to allow these strong moral commitments to serve as reasons when setting priorities in resource poor countries. PMID:19811525

  10. Assistants' in nursing perceptions of their social place within mental health-care settings.

    PubMed

    Cowan, Darrin; Frame, Nicholas; Brunero, Scott; Lamont, Scott; Joyce, Mark

    2015-10-01

    An international nurse shortage, tightening fiscal constraints, and increased service demands have seen health systems increasingly turn to employing assistants in nursing (AIN) as a cost-effective means to meet demand. This paper describes social positioning from the perspective of 11 AIN who were employed to work in specialist mental health settings in a metropolitan health service in Sydney. Data was collected by means of semistructured interviews. Interview questions encouraged AIN to explore their experience with reference to positioning within the service, role perception, role development, staff relationship, and role satisfaction. Thematic analysis was utilized to generate themes and explore meaning within the data. The following themes emerged: role definition and clarity; socialization and adaptation; and enhancing education. Analysis suggests that whilst AIN were integrated into mainstream service, the scope of activities or role remains geographically variable and inconsistent. Encouragingly, as AIN became familiar with their work environments and teams, they considered themselves to be of value and were able to play a meaningful role. A desire for learning and a need for continuing education also emerged as a primary theme. Findings from the data suggest that AIN in the mental health setting remain a novel and, to some extent, poorly utilized resource. PMID:26032120

  11. Patients' perceptions of need for primary health care services: useful for priority setting?

    PubMed Central

    Hopton, J. L.; Dlugolecka, M.

    1995-01-01

    OBJECTIVES--To assess the feasibility of using patients' perceptions of need for primary health care services to develop priorities. DESIGN--A postal survey of a random sample of 3478 patients registered with five general practices. SETTING--Lothian, Scotland. MAIN OUTCOME MEASURES--Comparison of rankings of 36 different kinds of help or advice according to (a) popularity in the sample size as a whole and in healthy and unhealthy subgroups and (b) health status (severity of need) of potential service users. RESULTS--Popularity rankings differed between the healthy and unhealthy subgroups and the whole sample. Popularity rankings were almost the inverse of rankings based on health status. The analysis identified two areas of substantial need both in terms of popularity and severity: pain management and advice about welfare benefits. CONCLUSIONS--Methodological efforts to ensure equal participation in the processes of assessing health needs and of priority setting do not in themselves promote equity. To promote equity some opinions may need to be given greater weight. PMID:7767195

  12. Criteria for priority-setting in health care in Uganda: exploration of stakeholders' values.

    PubMed Central

    Kapiriri, Lydia; Norheim, Ole Frithjof

    2004-01-01

    OBJECTIVE: To explore stakeholders' acceptance of criteria for setting priorities for the health care system in Uganda. METHODS: A self-administered questionnaire was used. It was distributed to health workers, planners and administrators working in all levels of the Ugandan health care system. It was also distributed to members of the public. Participants were asked how strongly they agreed or disagreed with 18 criteria that could be used to set priorities for allocating health care. A total of 408 people took part. Data were entered and analysed using SPSS statistical software. Predetermined cut-off points were used to rank the criteria into three different categories: high weight (>66% of respondents agreed), average weight (33-66% of respondents agreed) and low weight (<33% of respondents agreed). We also tested for associations between respondents' characteristics and their degree of agreement with the criteria. FINDINGS: High-weight criteria included severity of disease, benefit of the intervention, cost of the intervention, cost-effectiveness of the intervention, quality of the data on effectiveness, the patients age, place of residence, lifestyle, importance of providing equity of access to health care and the community's views. The average-weight criteria included the patient's social status, mental features, physical capabilities, political views, responsibilities for others and gender. Low-weight criteria included the patient's religion, and power and influence. There were few associations between respondents' characteristics and their preferences. CONCLUSION: There was a high degree of acceptance for commonly used disease-related and society-related criteria. There was less agreement about the patient-related criteria. We propose that average-weight criteria should be debated in Uganda and other countries facing the challenge of distributing scarce health care resources. PMID:15112005

  13. Setting the stage for circumstellar interaction in core-collapse supernovae. II. Wave-driven mass loss in supernova progenitors

    SciTech Connect

    Shiode, Joshua H.; Quataert, Eliot E-mail: eliot@berkeley.edu

    2014-01-01

    Supernovae (SNe) powered by interaction with circumstellar material provide evidence for intense stellar mass loss during the final years before core collapse. We have argued that during and after core neon burning, internal gravity waves excited by core convection can tap into the core fusion power and transport a super-Eddington energy flux out to the stellar envelope, potentially unbinding ∼1 solar mass of material. In this work, we explore the internal conditions of SN progenitors using the MESA one-dimensional stellar evolution code in search of those most susceptible to wave-driven mass loss. We focus on simple, order of magnitude considerations applicable to a wide range of progenitors. Wave-driven mass loss during core neon and oxygen fusion happens preferentially in either lower mass (∼20 solar mass zero-age main sequence) stars or massive, sub-solar metallicity stars. Roughly 20% of the SN progenitors we survey can excite 10{sup 46-48} erg of energy in waves that can potentially drive mass loss within a few months to a decade of core collapse. This energy can generate circumstellar environments with 10{sup –3}-1 solar masses reaching 100 AU before explosion. We predict a correlation between the energy associated with pre-SN mass ejection and the time to core collapse, with the most intense mass loss preferentially occurring closer to core collapse. During silicon burning, wave energy may inflate 10{sup –3}-1 solar masses of the envelope to 10-100 s of solar radii. This suggests that some nominally compact SN progenitors (Type Ibc progenitors) will have a significantly different SN shock breakout signature than traditionally assumed.

  14. Setting the Stage for Circumstellar Interaction in Core-Collapse Supernovae. II. Wave-driven Mass Loss in Supernova Progenitors

    NASA Astrophysics Data System (ADS)

    Shiode, Joshua H.; Quataert, Eliot

    2014-01-01

    Supernovae (SNe) powered by interaction with circumstellar material provide evidence for intense stellar mass loss during the final years before core collapse. We have argued that during and after core neon burning, internal gravity waves excited by core convection can tap into the core fusion power and transport a super-Eddington energy flux out to the stellar envelope, potentially unbinding ~1 solar mass of material. In this work, we explore the internal conditions of SN progenitors using the MESA one-dimensional stellar evolution code in search of those most susceptible to wave-driven mass loss. We focus on simple, order of magnitude considerations applicable to a wide range of progenitors. Wave-driven mass loss during core neon and oxygen fusion happens preferentially in either lower mass (~20 solar mass zero-age main sequence) stars or massive, sub-solar metallicity stars. Roughly 20% of the SN progenitors we survey can excite 1046-48 erg of energy in waves that can potentially drive mass loss within a few months to a decade of core collapse. This energy can generate circumstellar environments with 10-3-1 solar masses reaching 100 AU before explosion. We predict a correlation between the energy associated with pre-SN mass ejection and the time to core collapse, with the most intense mass loss preferentially occurring closer to core collapse. During silicon burning, wave energy may inflate 10-3-1 solar masses of the envelope to 10-100 s of solar radii. This suggests that some nominally compact SN progenitors (Type Ibc progenitors) will have a significantly different SN shock breakout signature than traditionally assumed.

  15. Institutional public private partnerships for core health services: evidence from Italy

    PubMed Central

    2011-01-01

    Background Public-private partnerships (PPPs) are potential instruments to enable private collaboration in the health sector. Despite theoretical debate, empirical analyses have thus far tended to focus on the contractual or project dimension, overlooking institutional PPPs, i.e., formal legal entities run by proper corporate-governance mechanisms and jointly owned by public and private parties for the provision of public-health goods. This work aims to fill this gap by carrying out a comparative analysis of the reasons for the adoption of institutional PPPs and the governance and managerial features necessary to establish them as appropriate arrangements for public-health services provisions. Methods A qualitative analysis is carried out on experiences of institutional PPPs within the Italian National Health Service (Sistema Sanitario Nazionale, SSN). The research question is addressed through a contextual and comparative embedded case study design, assuming the entire population of PPPs (4) currently in force in one Italian region as the unit of analysis: (i) a rehabilitation hospital, (ii), an orthopaedic-centre, (iii) a primary care and ambulatory services facility, and (iv) a health- and social-care facility. Internal validity is guaranteed by the triangulation of sources in the data collection phase, which included archival and interview data. Results Four governance and managerial issues were found to be critical in determining the positive performance of the case examined: (i) a strategic market orientation to a specialised service area with sufficient potential demand, (ii) the allocation of public capital assets and the consistent financial involvement of the private partner, (iii) the adoption of private administrative procedures in a regulated setting while guaranteeing the respect of public administration principles, and (iv) clear regulation of the workforce to align the contracts with the organisational culture. Conclusions Findings suggests that

  16. Effectiveness of Evidence-based Pneumonia CPOE Order Sets Measured by Health Outcomes

    PubMed Central

    Krive, Jacob; Shoolin, Joel S.; Zink, Steven D.

    2015-01-01

    Objective Evidence-based sets of medical orders for the treatment of patients with common conditions have the potential to induce greater efficiency and convenience across the system, along with more consistent health outcomes. Despite ongoing utilization of order sets, quantitative evidence of their effectiveness is lacking. In this study, conducted at Advocate Health Care in Illinois, we quantitatively analyzed the benefits of community acquired pneumonia order sets as measured by mortality, readmission, and length of stay (LOS) outcomes. Methods In this study, we examined five years (2007–2011) of computerized physician order entry (CPOE) data from two city and two suburban community care hospitals. Mortality and readmissions benefits were analyzed by comparing “order set” and “no order set” groups of adult patients using logistic regression, Pearson’s chi-squared, and Fisher’s exact methods. LOS was calculated by applying one-way ANOVA and the Mann-Whitney U test, supplemented by analysis of comorbidity via the Charlson Comorbidity Index. Results The results indicate that patient treatment orders placed via electronic sets were effective in reducing mortality [OR=1.787; 95% CF 1.170-2.730; P=.061], readmissions [OR=1.362; 95% CF 1.015-1.827; P=.039], and LOS [F (1,5087)=6.885, P=.009, 4.79 days (no order set group) vs. 4.32 days (order set group)]. Conclusion Evidence-based ordering practices have the potential to improve pneumonia outcomes through reduction of mortality, hospital readmissions, and cost of care. However, the practice must be part of a larger strategic effort to reduce variability in patient care processes. Further experimental and/or observational studies are required to reduce the barriers to retrospective patient care analyses. PMID:26392842

  17. Setting health research priorities using the CHNRI method: IV. Key conceptual advances

    PubMed Central

    Rudan, Igor

    2016-01-01

    Introduction Child Health and Nutrition Research Initiative (CHNRI) started as an initiative of the Global Forum for Health Research in Geneva, Switzerland. Its aim was to develop a method that could assist priority setting in health research investments. The first version of the CHNRI method was published in 2007–2008. The aim of this paper was to summarize the history of the development of the CHNRI method and its key conceptual advances. Methods The guiding principle of the CHNRI method is to expose the potential of many competing health research ideas to reduce disease burden and inequities that exist in the population in a feasible and cost–effective way. Results The CHNRI method introduced three key conceptual advances that led to its increased popularity in comparison to other priority–setting methods and processes. First, it proposed a systematic approach to listing a large number of possible research ideas, using the “4D” framework (description, delivery, development and discovery research) and a well–defined “depth” of proposed research ideas (research instruments, avenues, options and questions). Second, it proposed a systematic approach for discriminating between many proposed research ideas based on a well–defined context and criteria. The five “standard” components of the context are the population of interest, the disease burden of interest, geographic limits, time scale and the preferred style of investing with respect to risk. The five “standard” criteria proposed for prioritization between research ideas are answerability, effectiveness, deliverability, maximum potential for disease burden reduction and the effect on equity. However, both the context and the criteria can be flexibly changed to meet the specific needs of each priority–setting exercise. Third, it facilitated consensus development through measuring collective optimism on each component of each research idea among a larger group of experts using a simple

  18. Health Care–Associated Infection Outbreak Investigations in Outpatient Settings, Los Angeles County, California, USA, 2000−2012

    PubMed Central

    Coelho, Laura; Bancroft, Elizabeth; Terashita, Dawn

    2015-01-01

    Health care services are increasingly delivered in outpatient settings. However, infection control oversight in outpatient settings to ensure patient safety has not improved and literature quantifying reported health care–associated infection outbreaks in outpatient settings is scarce. The objective of this analysis was to characterize investigations of suspected and confirmed outbreaks in outpatient settings in Los Angeles County, California, USA, reported during 2000–2012, by using internal logs; publications; records; and correspondence of outbreak investigations by characteristics of the setting, number, and type of infection control breaches found during investigations, outcomes of cases, and public health responses. Twenty-eight investigations met the inclusion criteria. Investigations occurred frequently, in diverse settings, and required substantial public health resources. Most outpatient settings investigated had >1 infection control breach. Lapses in infection control were suspected to be the outbreak source for 16 of the reviewed investigations. PMID:26196293

  19. Setting goals and targets for performance standards within the Swedish health care system.

    PubMed

    Axelsson, L; Svensson, P G

    1994-01-01

    The development of any health care system towards setting goals and targets and intended outcomes--with national guidelines, a legislative framework, limited resources, consumer influence and competitive forces--makes great demands on the control mechanisms required. The Swedish health care system has no tradition of goal formulation of this type. Hence, the purpose of this article is to clarify the goal-setting process of performance standards, and to examine whether goal setting is a relevant method within the organization of a Swedish county council. Goal setting can be seen partly as a control method and partly as an administrative process. The approach used is a combination of qualitative and quantitative methods. Data have been collected from interviews, observations, notes taken in the field and available performance statistics. The analysis shows that working towards a goal is made easier through a common and simple concept. It 'stands and falls' with the management of the work and its manager. Good communications and information are important prerequisites if goal formulation, through dialogue, is to succeed. This process takes time and can be described as an iterative process, in which a common behaviour pattern develops a 'we-feeling' which spreads among the staff. It is important that the goal is relevant and directly related to the basic objects of the work. It is also crucial that the goal is realistic and reflects a priority. Goal formulation relating to performance standards can be a contributing factor to staff's experience of job satisfaction through increased engagement and motivation, and to the satisfaction of patients/relatives with the care given. It is difficult to formulate performance standards; there are many problems and obstacles. If goal formulation as a control method within the health care system in Sweden is to work, clearer manifestations of political will are necessary and also better measuring methods in order to guage

  20. Progress and gaps in reproductive health services in three humanitarian settings: mixed-methods case studies

    PubMed Central

    2015-01-01

    Background Reproductive health (RH) care is an essential component of humanitarian response. Women and girls living in humanitarian settings often face high maternal mortality and are vulnerable to unwanted pregnancy, unsafe abortion, and sexual violence. This study explored the availability and quality of, and access barriers to RH services in three humanitarian settings in Burkina Faso, Democratic Republic of the Congo (DRC), and South Sudan. Methods Data collection was conducted between July and October 2013. In total, 63 purposively selected health facilities were assessed: 28 in Burkina Faso, 25 in DRC, and nine in South Sudan, and 42 providers completed a questionnaire to assess RH knowledge and attitudes. Thirty-four focus group discussions were conducted with 29 members of the host communities and 273 displaced married and unmarried women and men to understand access barriers. Results All facilities reported providing some RH services in the prior three months. Five health facilities in Burkina Faso, six in DRC, and none in South Sudan met the criteria as a family planning service delivery point. Two health facilities in Burkina Faso, one in DRC, and two in South Sudan met the criteria as an emergency obstetric and newborn care service delivery point. Across settings, three facilities in DRC adequately provided selected elements of clinical management of rape. Safe abortion was unavailable. Many providers lacked essential knowledge and skills. Focus groups revealed limited knowledge of available RH services and socio-cultural barriers to accessing them, although participants reported a remarkable increase in use of facility-based delivery services. Conclusion Although RH services are being provided, the availability of good quality RH services was inconsistent across settings. Commodity management and security must be prioritized to ensure consistent availability of essential supplies. It is critical to improve the attitudes, managerial and technical

  1. Proceduralism and its role in economic evaluation and priority setting in health.

    PubMed

    Jan, Stephen

    2014-05-01

    This paper provides a critical overview of Gavin Mooney's proceduralist approach to economic evaluation and priority setting in health. Proceduralism is the notion that the social value attached to alternative courses of action should be determined not only by outcomes, but also processes. Mooney's brand of proceduralism was unique and couched within a broader critique of 'neo-liberal' economics. It operated on a number of levels. At the micro level of the individual program, he pioneered the notion that 'process utility' could be valued and measured within economic evaluation. At a macro level, he developed a framework in which the social objective of equity was defined by procedural justice in which communitarian values were used as the basis for judging how resources should be allocated across the health system. Finally, he applied the notion of procedural justice to further our understanding of the political economy of resource allocation; highlighting how fairness in decision making processes can overcome the sometimes intractable zero-sum resource allocation problem. In summary, his contributions to this field have set the stage for innovative programs of research to help in developing health policies and programs that are both in alignment with community values and implementable. PMID:24647102

  2. De-escalating aggression and violence in the mental health setting.

    PubMed

    Cowin, Leanne; Davies, Rhian; Estall, Graham; Berlin, Theresa; Fitzgerald, Maria; Hoot, Sandra

    2003-03-01

    Aggressive and violent incidents in the health-care setting are increasing phenomena around the world. The evidence from current literature suggests that changes in health-care access, nursing staff shortages and patient acuity are some of the possible causes. De-escalation is a valuable intervention that can be used by nurses to help counter the growing problems of aggression and violence. The de-escalation project, discussed in the present paper, aimed to explore de-escalation as an important therapeutic process and is an event of considerable potential in the management of aggression and violence. While de-escalation is not a new tool, particularly in the mental health-care setting, an educative programme aimed at renewing nurses' knowledge and skills in de-escalation is a timely project. The final de-escalation kit included a large glossy poster, a nursing staff survey, an in-service education session and a literature-based discussion paper. The de-escalation kit can be of considerable benefit to those nurses who are transient within the workplace, such as casual and agency nurses. PMID:14685961

  3. Reactions of nurses to the use of electronic health record alert features in an inpatient setting.

    PubMed

    Sidebottom, Abbey C; Collins, Beverly; Winden, Tamara J; Knutson, Asha; Britt, Heather R

    2012-04-01

    While studies have been conducted to assess nurse perception of electronic health records, once electronic health record systems are up and running, there is little to guide the use of features within the electronic health record for nursing practice. Alerts are a promising tool for implementing best practice for patient care in inpatient settings. Yet the use of alerts for inpatient nursing is understudied. This study examined nurse attitudes and reactions to alerts in the inpatient setting. Focus groups were conducted at three hospitals with 50 nurses. Nurses were asked about five different alert features. For each alert, participants were asked about their feelings and reactions to the alert, how alerts help or hinder work, and suggestions for improvements. Findings include clear preferences for alert types and content. Nurses preferred a dashboard style alert with functions included to accomplish tasks directly in the alert. While nurses reported positive reactions to certain alert pages, they also reported low use of those features and occasional distrust of the data included in alerts. Findings provide guidance for future use of alerts and design of new alerts. Findings also identify the important challenge of designing and implementing alerts for integration with nursing workflow. PMID:22045117

  4. Evidence-based cariology in clinical and public health practice as part of the European Core Curriculum in Cariology.

    PubMed

    Splieth, Ch H; Innes, N; Söhnel, A

    2011-11-01

    This paper is part of a series of papers contributing towards a European Core Curriculum in Cariology for undergraduate dental students. The European Core Curriculum in Cariology is the outcome of a process starting in 2006 and culminating in a joint workshop of the European Organization for Caries Research together with the Association for Dental Education in Europe, which was held in Berlin from 27 to 30 June 2010. The scope of this paper is to present the evidence-based cariology in clinical and public health section of the European Core Curriculum in Cariology. This section was developed on the basis of international consensus on the current and future educational needs in the fields of cariology and disorders of dental hard tissues. The paper will deal with the core skills of evidence-based dental practice within the undergraduate curriculum underpinning the dual facets of clinical cariology (relating particularly to individuals) and public health cariology (relating particularly to groups/societies). Core competencies in evidence-based dentistry, which are generic to the undergraduate curriculum as a whole and not only cariology, are integral to lifelong learning skills within dentistry. As the clinical cariology competencies in assessment and management of caries for the individual patient are dealt with within other sections of the European Core Curriculum in Cariology, only a few relevant examples will be presented here, but for Public Health Cariology, the competencies will be explored within this document and their relationship to the principles of evidence-based dentistry discussed. PMID:22023546

  5. Evaluations of reproductive health programs in humanitarian settings: a systematic review

    PubMed Central

    2015-01-01

    Provision of reproductive health (RH) services is a minimum standard of health care in humanitarian settings; however access to these services is often limited. This systematic review, one component of a global evaluation of RH in humanitarian settings, sought to explore the evidence regarding RH services provided in humanitarian settings and to determine if programs are being evaluated. In addition, the review explored which RH services receive more attention based on program evaluations and descriptive data. Peer-reviewed papers published between 2004 and 2013 were identified via the Ovid MEDLINE database, followed by a PubMed search. Papers on quantitative evaluations of RH programs, including experimental and non-experimental designs that reported outcome data, implemented in conflict and natural disaster settings, were included. Of 5,669 papers identified in the initial search, 36 papers describing 30 programs met inclusion criteria. Twenty-five papers described programs in sub-Saharan Africa, six in Asia, two in Haiti and three reported data from multiple countries. Some RH technical areas were better represented than others: seven papers reported on maternal and newborn health (including two that also covered family planning), six on family planning, three on sexual violence, 20 on HIV and other sexually transmitted infections and two on general RH topics. In comparison to the program evaluation papers identified, three times as many papers were found that reported RH descriptive or prevalence data in humanitarian settings. While data demonstrating the magnitude of the problem are crucial and were previously lacking, the need for RH services and for evaluations to measure their effectiveness is clear. Program evaluation and implementation science should be incorporated into more programs to determine the best ways to serve the RH needs of people affected by conflict or natural disaster. Standard program design should include rigorous program evaluation, and

  6. Generalized cost-effectiveness analysis for national-level priority-setting in the health sector

    PubMed Central

    Hutubessy, Raymond; Chisholm, Dan; Edejer, Tessa Tan-Torres

    2003-01-01

    Cost-effectiveness analysis (CEA) is potentially an important aid to public health decision-making but, with some notable exceptions, its use and impact at the level of individual countries is limited. A number of potential reasons may account for this, among them technical shortcomings associated with the generation of current economic evidence, political expediency, social preferences and systemic barriers to implementation. As a form of sectoral CEA, Generalized CEA sets out to overcome a number of these barriers to the appropriate use of cost-effectiveness information at the regional and country level. Its application via WHO-CHOICE provides a new economic evidence base, as well as underlying methodological developments, concerning the cost-effectiveness of a range of health interventions for leading causes of, and risk factors for, disease. The estimated sub-regional costs and effects of different interventions provided by WHO-CHOICE can readily be tailored to the specific context of individual countries, for example by adjustment to the quantity and unit prices of intervention inputs (costs) or the coverage, efficacy and adherence rates of interventions (effectiveness). The potential usefulness of this information for health policy and planning is in assessing if current intervention strategies represent an efficient use of scarce resources, and which of the potential additional interventions that are not yet implemented, or not implemented fully, should be given priority on the grounds of cost-effectiveness. Health policy-makers and programme managers can use results from WHO-CHOICE as a valuable input into the planning and prioritization of services at national level, as well as a starting point for additional analyses of the trade-off between the efficiency of interventions in producing health and their impact on other key outcomes such as reducing inequalities and improving the health of the poor. PMID:14687420

  7. Political Impetus: Towards a Successful Agenda-Setting for Inclusive Health Policies in Low- and Middle-Income Countries

    PubMed Central

    Yang, Xiaoguang; Qian, Xu

    2016-01-01

    Agenda-setting is a crucial step for inclusive health policies in the low- and middle-income countries (LMICs). Enlightened by Ha et al manuscript, this commentary paper argues that ‘political impetus’ is the key to the successful agenda-setting of health policies in LMICs, though other determinants may also play the role during the process. This Vietnamese case study presents a good example for policy-makers of other LMICs; it offers insights for contexts where there are limited health resources and poor health performance. Further research which compares various stages of the health policy process across countries, is much needed.

  8. Comprehensive Yet Scalable Health Information Systems for Low Resource Settings: A Collaborative Effort in Sierra Leone

    PubMed Central

    Braa, Jørn; Kanter, Andrew S.; Lesh, Neal; Crichton, Ryan; Jolliffe, Bob; Sæbø, Johan; Kossi, Edem; Seebregts, Christopher J.

    2010-01-01

    We address the problem of how to integrate health information systems in low-income African countries in which technical infrastructure and human resources vary wildly within countries. We describe a set of tools to meet the needs of different service areas including managing aggregate indicators, patient level record systems, and mobile tools for community outreach. We present the case of Sierra Leone and use this case to motivate and illustrate an architecture that allows us to provide services at each level of the health system (national, regional, facility and community) and provide different configurations of the tools as appropriate for the individual area. Finally, we present a, collaborative implementation of this approach in Sierra Leone. PMID:21347003

  9. Participatory health research within a prison setting: a qualitative analysis of 'Paragraphs of passion'.

    PubMed

    Ramsden, Vivian; Martin, Ruth; McMillan, Jennifer; Granger-Brown, Alison; Tole, Brenda

    2015-12-01

    The purpose of this research was to engage, empower and enhance the health and well-being of incarcerated women. The integration of primary health care, community-based participatory research, a settings approach to health promotion, and transformative action research guided the design of this study. A partnership between incarcerated women who became peer-researchers, correctional staff, and academic researchers facilitated the equitable contribution of expertise and decision-making by all partners. The study was conducted in a short sentence (two years or less), minimum/medium security Canadian women's correctional centre. Of the approximately 200 women that joined the research team, 115 participated in writing a 'paragraph of passion' while incarcerated between November, 2005 and August, 2007. Participatory, inductive qualitative, narrative and content analysis were used to illuminate four themes: expertise, transformation, building self-esteem, as well as access and support. The women organized monthly health forums in the prison to share their new knowledge and life experience with other incarcerated women, correctional staff, academics, and community members, and in doing so have built bridges and relationships, some of which have lasted to the present day. PMID:25312768

  10. Evaluation of mental health first aid training in a diverse community setting.

    PubMed

    Morawska, Alina; Fletcher, Renee; Pope, Susan; Heathwood, Ellen; Anderson, Emily; McAuliffe, Christine

    2013-02-01

    Mental health first aid (MHFA) training has been disseminated in the community and has yielded positive outcomes in terms of increasing help-seeking behaviour and mental health literacy. However, there has been limited research investigating the effectiveness of this programme in multicultural communities. Given the increasing levels of multiculturalism in many countries, as well as the large number of barriers presented to these groups when trying to seek help for mental illnesses, the present study aimed to investigate the effectiveness of MHFA in these settings. A total of 458 participants, who were recruited from multicultural organizations, participated in a series of MHFA training courses. Participants completed questionnaires pre and post the training course, and 6-month follow-up interviews were conducted with a subsample of participants. Findings suggested that MHFA training increased participant recognition of mental illnesses, concordance with primary care physicians about treatments, confidence in providing first aid, actual help provided to others, and a reduction in stigmatizing attitudes. A 6-month follow up also yielded positive long-term effects of MHFA. The results have implications for further dissemination and the use of MHFA in diverse communities. In addition, the results highlight the need for mental health training in health-care service providers. PMID:22783922

  11. Hearing loss and speech privacy in the health care setting: a case study.

    PubMed

    Zapala, David A; Hawkins, David B

    2008-03-01

    Ensuring speech privacy has become an important consideration in the design of health care environments. The Healthcare Insurance Portability and Accountability Act requirements include the establishment of reasonable technical and procedural methods to protect patient privacy. However, specific standards for meeting speech privacy requirements are not currently established. This article presents a case study of two clinical environments, one where speech privacy was judged by health care workers to be adequate and one where speech privacy was judged to be inadequate. Careful study of both environments revealed three factors that led to the perception of inadequate speech privacy. First, sound attenuation between adjacent rooms was slightly poorer by 5 dB in the inadequate environments. Second, ambient noise levels were lower by 9 dB in the inadequate environment. Finally, geriatric patients with hearing loss prompted health care workers to increase their speech intensity, decrease language complexity, and decrease the speed at which speech was articulated. These factors made it more probable that speech was overheard and understood. Existing methods to calculate speech privacy in health care settings need to consider the effect of hearing loss on the acoustics of the oral communication transaction. PMID:18672649

  12. "One people, one blood": public health, political violence, and HIV in an Ethiopian-Israeli setting.

    PubMed

    Seeman, D

    1999-06-01

    Between 1984 and 1996, public health authorities in Israel maintained a secret policy of discarding blood donations made by Ethiopian-Israeli citizens and immigrants. Officials later attempted to justify this policy on the grounds that immigrants from Ethiopia were subject to high rates of infectious disease (especially HIV). In 1996, this led to an explosive and violent confrontation between Ethiopian-Israeli protestors and agents of the state, including police and public health authorities. This essay explores the cultural and political context of that confrontation, including the discourse of political violence which it occasioned. The conflict between Ethiopian-Israelis and the state was located within a wider set of political contexts, including the Israeli-Palestinian conflict, which was linked to it through a shared trope of "spilled blood" common to both. Cultural analyses which ignore this dynamic political context are in danger of seriously misrepresenting the meaning of the "Blood Affair" to its participants. At the same time, this essay also engages a critical analysis of the public health policies which led to the crisis. Public health and nationalist discourse reinforced one another at the expense of Ethiopian immigrants in general, and so-called "Feres Mura" Ethiopians in particular. PMID:10451801

  13. Aboriginal Australians' experience of social capital and its relevance to health and wellbeing in urban settings.

    PubMed

    Browne-Yung, Kathryn; Ziersch, Anna; Baum, Fran; Gallaher, Gilbert

    2013-11-01

    Social capital has been linked to physical and mental health. While definitions of social capital vary, all include networks of social relationships and refer to the subsequent benefits and disadvantages accrued to members. Research on social capital for Aboriginal Australians has mainly focused on discrete rural and remote Aboriginal contexts with less known about the features and health and other benefits of social capital in urban settings. This paper presents findings from in-depth interviews with 153 Aboriginal people living in urban areas on their experiences of social capital. Of particular interest was how engagement in bonding and bridging networks influenced health and wellbeing. Employing Bourdieu's relational theory of capital where resources are unequally distributed and reproduced in society we found that patterns of social capital are strongly associated with economic, social and cultural position which in turn reflects the historical experiences of dispossession and disadvantage experienced by Aboriginal Australians. Social capital was also found to both reinforce and influence Aboriginal cultural identity, and had both positive and negative impacts on health and wellbeing. PMID:24161085

  14. Identifying research priorities for health care priority setting: a collaborative effort between managers and researchers

    PubMed Central

    Smith, Neale; Mitton, Craig; Peacock, Stuart; Cornelissen, Evelyn; MacLeod, Stuart

    2009-01-01

    Background To date there has been relatively little published about how research priorities are set, and even less about methods by which decision-makers can be engaged in defining a relevant and appropriate research agenda. We report on a recent effort in British Columbia to have researchers and decision-makers jointly establish an agenda for future research into questions of resource allocation. Methods The researchers enlisted decision-maker partners from each of British Columbia's six health authorities. Three forums were held, at which researchers and decision-makers from various levels in the health authorities considered possible research areas related to three key focus areas: (1) generation and use of decision criteria and measurement of 'benefit' against such criteria; (2) identification of so-called 'disinvestment' opportunities; and (3) evaluation of the effectiveness of priority setting procedures. Detailed notes were taken from each forum and synthesized into a set of qualitative themes. Results Forum participants suggested that future research into healthcare priority setting would benefit from studies that were longitudinal, comparative, and/or interdisciplinary. As well, participants identified two broad theme areas in which specific research projects were deemed desirable. First, future research might usefully consider how formal priority setting and resource allocation projects are situated within a larger organizational and political context. Second, additional research efforts should be devoted to better understanding and improving the actual implementation of priority setting frameworks, particularly with respect to issues of change management and the resolution of impediments to action on recommendations for resource allocation. Conclusion We were able to validate the importance of initial areas posed to the group and observed emergence of additional concerns and directions of critical importance to these decision-makers at this time. It is

  15. Cost accounting models used for price-setting of health services: an international review.

    PubMed

    Raulinajtys-Grzybek, Monika

    2014-12-01

    The aim of the article was to present and compare cost accounting models which are used in the area of healthcare for pricing purposes in different countries. Cost information generated by hospitals is further used by regulatory bodies for setting or updating prices of public health services. The article presents a set of examples from different countries of the European Union, Australia and the United States and concentrates on DRG-based payment systems as they primarily use cost information for pricing. Differences between countries concern the methodology used, as well as the data collection process and the scope of the regulations on cost accounting. The article indicates that the accuracy of the calculation is only one of the factors that determine the choice of the cost accounting methodology. Important aspects are also the selection of the reference hospitals, precise and detailed regulations and the existence of complex healthcare information systems in hospitals. PMID:25082465

  16. Assessment of health risks due to arsenic from iron ore lumps in a beach setting.

    PubMed

    Swartjes, Frank A; Janssen, Paul J C M

    2016-09-01

    In 2011, an artificial hook-shaped peninsula of 128ha beach area was created along the Dutch coast, containing thousands of iron ore lumps, which include arsenic from natural origin. Elemental arsenic and inorganic arsenic induce a range of toxicological effects and has been classified as proven human carcinogens. The combination of easy access to the beach and the presence of arsenic raised concern about possible human health effects by the local authorities. The objective of this study is therefore to investigate human health risks from the presence of arsenic-containing iron ore lumps in a beach setting. The exposure scenarios underlying the human health-based risk limits for contaminated land in The Netherlands, based on soil material ingestion and a residential setting, are not appropriate. Two specific exposure scenarios related to the playing with iron ore lumps on the beach ('sandcastle building') are developed on the basis of expert judgement, relating to children in the age of 2 to 12years, i.e., a worst case exposure scenario and a precautionary scenario. Subsequently, exposure is calculated by the quantification of the following factors: hand loading, soil-mouth transfer effectivity, hand-mouth contact frequency, contact surface, body weight and the relative oral bioavailability factor. By lack of consensus on a universal reference dose for arsenic for use in the stage of risk characterization, three different types of assessments have been evaluated: on the basis of the current Provisional Tolerable Daily Intake (PTWI), on the basis of the Benchmark Dose Lower limit (BMDL), and by a comparison of exposure from the iron ore lumps with background exposure. It is concluded, certainly from the perspective of the conservative exposure assessment, that unacceptable human health risks due to exposure to arsenic from the iron ore lumps are unlikely and there is no need for risk management actions. PMID:27145491

  17. Setting research priorities to improve global newborn health and prevent stillbirths by 2025

    PubMed Central

    Yoshida, Sachiyo; Martines, José; Lawn, Joy E; Wall, Stephen; Souza, Joăo Paulo; Rudan, Igor; Cousens, Simon; Aaby, Peter; Adam, Ishag; Adhikari, Ramesh Kant; Ambalavanan, Namasivayam; Arifeen, Shams EI; Aryal, Dhana Raj; Asiruddin, Sk; Baqui, Abdullah; Barros, Aluisio JD; Benn, Christine S; Bhandari, Vineet; Bhatnagar, Shinjini; Bhattacharya, Sohinee; Bhutta, Zulfiqar A; Black, Robert E; Blencowe, Hannah; Bose, Carl; Brown, Justin; Bührer, Christoph; Carlo, Wally; Cecatti, Jose Guilherme; Cheung, Po–Yin; Clark, Robert; Colbourn, Tim; Conde–Agudelo, Agustin; Corbett, Erica; Czeizel, Andrew E; Das, Abhik; Day, Louise Tina; Deal, Carolyn; Deorari, Ashok; Dilmen, Uğur; English, Mike; Engmann, Cyril; Esamai, Fabian; Fall, Caroline; Ferriero, Donna M; Gisore, Peter; Hazir, Tabish; Higgins, Rosemary D; Homer, Caroline SE; Hoque, DE; Irgens, Lorentz; Islam, MT; de Graft–Johnson, Joseph; Joshua, Martias Alice; Keenan, William; Khatoon, Soofia; Kieler, Helle; Kramer, Michael S; Lackritz, Eve M; Lavender, Tina; Lawintono, Laurensia; Luhanga, Richard; Marsh, David; McMillan, Douglas; McNamara, Patrick J; Mol, Ben Willem J; Molyneux, Elizabeth; Mukasa, G. K; Mutabazi, Miriam; Nacul, Luis Carlos; Nakakeeto, Margaret; Narayanan, Indira; Olusanya, Bolajoko; Osrin, David; Paul, Vinod; Poets, Christian; Reddy, Uma M; Santosham, Mathuram; Sayed, Rubayet; Schlabritz–Loutsevitch, Natalia E; Singhal, Nalini; Smith, Mary Alice; Smith, Peter G; Soofi, Sajid; Spong, Catherine Y; Sultana, Shahin; Tshefu, Antoinette; van Bel, Frank; Gray, Lauren Vestewig; Waiswa, Peter; Wang, Wei; Williams, Sarah LA; Wright, Linda; Zaidi, Anita; Zhang, Yanfeng; Zhong, Nanbert; Zuniga, Isabel; Bahl, Rajiv

    2016-01-01

    Background In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013–2025. Methods We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts. Results Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour. Conclusion These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to

  18. The Starting Early Starting Smart Integrated Services Model: Improving Access to Behavioral Health Services in the Pediatric Health Care Setting for At-Risk Families with Young Children

    ERIC Educational Resources Information Center

    Morrow, Connie E.; Mansoor, Elana; Hanson, K. Lori; Vogel, April L.; Rose-Jacobs, Ruth; Genatossio, Carolyn Seval; Windham, Amy; Bandstra, Emmalee S.

    2010-01-01

    We evaluated the Starting Early Starting Smart (SESS) national initiative to integrate behavioral health services (parenting, mental health, and drug treatment) into the pediatric health care setting for families with young children. Data are presented from five pediatric care (PC) sites, drawing from families at risk due to demographic and…

  19. Measuring health-related quality of life in adults with chronic conditions in primary care settings

    PubMed Central

    Hand, Carri

    2016-01-01

    Abstract Objective To describe health-related quality of life (HRQOL) conceptual frameworks, critically review 3 commonly used HRQOL scales relevant to adults with chronic conditions in primary care settings, and make recommendations for using HRQOL scales in primary care practice. Data sources Information was accessed regarding HRQOL conceptual and theoretical approaches. A comprehensive search strategy identified 3 commonly used scales that met the review criteria and evidence regarding use of the scales in adults with chronic conditions in community settings. Scale selection Scales were selected if they were designed for clinical use; were easy to administer; were generic and broad in content areas; and contained some individualized items. Scales were critiqued according to content development, theoretical basis, psychometric properties, scoring, feasibility, the concepts being measured, and the number of items that measured an individualized concept. Synthesis Early HRQOL approaches focused on health and functional status while recent approaches incorporate individualized concepts such as the person’s own values and the environment. The abbreviated World Health Organization Quality of Life Scale (WHOQOL-BREF), the 36-Item Short Form Health Survey (SF-36), and the Duke Health Profile were critiqued. All address physical, mental, and social domains, while the WHOQOL-BREF also addresses environment. Psychometric evidence supports use of the SF-36 and WHOQOL-BREF with this population. The SF-36 has the most evidence of responsiveness but has some floor and ceiling effects, while the WHOQOL-BREF does not appear to have floor or ceiling effects but has limited evidence of responsiveness. The WHOQOL-BREF has the highest proportion of individualized items. Conclusion Measurement of HRQOL in adults with chronic conditions can support patient management and contribute to primary care service evaluation. Scales that are based on a broad definition of health and that

  20. Do Subjective Measures Improve the Ability to Identify Limited Health Literacy in a Clinical Setting?

    PubMed Central

    Goodman, Melody S.; Griffey, Richard T.; Carpenter, Christopher R.; Blanchard, Melvin; Kaphingst, Kimberly A.

    2016-01-01

    Background Existing health literacy assessments developed for research purposes have constraints that limit their utility for clinical practice, including time requirements and administration protocols. The Brief Health Literacy Screen (BHLS) consists of 3 self-administered Single-Item Literacy Screener (SILS) questions and obviates these clinical barriers. We assessed whether the addition of SILS items or the BHLS to patient demographics readily available in ambulatory clinical settings reaching underserved patients improves the ability to identify limited health literacy. Methods We analyzed data from 2 cross-sectional convenience samples of patients from an urban academic emergency department (n = 425) and a primary care clinic (n = 486) in St. Louis, Missouri. Across samples, health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R), Newest Vital Sign (NVS), and the BHLS. Our analytic sample consisted of 911 adult patients, who were primarily female (62%), black (66%), and had at least a high school education (82%); 456 were randomly assigned to the estimation sample and 455 to the validation sample. Results The analysis showed that the best REALM-R estimation model contained age, sex, education, race, and 1 SILS item (difficulty understanding written information). In validation analysis this model had a sensitivity of 62%, specificity of 81%, a positive likelihood ratio (LR+) of 3.26, and a negative likelihood ratio (LR−) of 0.47; there was a 28% misclassification rate. The best NVS estimation model contained the BHLS, age, sex, education and race; this model had a sensitivity of 77%, specificity of 72%, LR+ of 2.75, LR− of 0.32, and a misclassification rate of 25%. Conclusions Findings suggest that the BHLS and SILS items improve the ability to identify patients with limited health literacy compared with demographic predictors alone. However, despite being easier to administer in clinical settings, subjective

  1. Integrated System Health Management (ISHM) for Test Stand and J-2X Engine: Core Implementation

    NASA Technical Reports Server (NTRS)

    Figueroa, Jorge F.; Schmalzel, John L.; Aguilar, Robert; Shwabacher, Mark; Morris, Jon

    2008-01-01

    ISHM capability enables a system to detect anomalies, determine causes and effects, predict future anomalies, and provides an integrated awareness of the health of the system to users (operators, customers, management, etc.). NASA Stennis Space Center, NASA Ames Research Center, and Pratt & Whitney Rocketdyne have implemented a core ISHM capability that encompasses the A1 Test Stand and the J-2X Engine. The implementation incorporates all aspects of ISHM; from anomaly detection (e.g. leaks) to root-cause-analysis based on failure mode and effects analysis (FMEA), to a user interface for an integrated visualization of the health of the system (Test Stand and Engine). The implementation provides a low functional capability level (FCL) in that it is populated with few algorithms and approaches for anomaly detection, and root-cause trees from a limited FMEA effort. However, it is a demonstration of a credible ISHM capability, and it is inherently designed for continuous and systematic augmentation of the capability. The ISHM capability is grounded on an integrating software environment used to create an ISHM model of the system. The ISHM model follows an object-oriented approach: includes all elements of the system (from schematics) and provides for compartmentalized storage of information associated with each element. For instance, a sensor object contains a transducer electronic data sheet (TEDS) with information that might be used by algorithms and approaches for anomaly detection, diagnostics, etc. Similarly, a component, such as a tank, contains a Component Electronic Data Sheet (CEDS). Each element also includes a Health Electronic Data Sheet (HEDS) that contains health-related information such as anomalies and health state. Some practical aspects of the implementation include: (1) near real-time data flow from the test stand data acquisition system through the ISHM model, for near real-time detection of anomalies and diagnostics, (2) insertion of the J-2X

  2. A qualitative study on hypertensive care behavior in primary health care settings in Malaysia

    PubMed Central

    Shima, Razatul; Farizah, Mohd Hairi; Majid, Hazreen Abdul

    2014-01-01

    Purpose The aim of this study was to explore patients’ experiences with their illnesses and the reasons which influenced them in not following hypertensive care recommendations (antihypertensive medication intake, physical activity, and diet changes) in primary health clinic settings. Patients and methods A qualitative methodology was applied. The data were gathered from in-depth interviews with 25 hypertensive patients attending follow-up in nine government primary health clinics in two districts (Hulu Langat and Klang) in the state of Selangor, Malaysia. The transcribed data were analyzed using thematic analysis. Results There was evidence of lack of patient self-empowerment and community support in Malaysian society. Most of the participants did not take their antihypertensive medication or change their physical activity and diet after diagnosis. There was an agreement between the patients and the health care professionals before starting the treatment recommendation, but there lacked further counseling and monitoring. Most of the reasons given for not taking antihypertensive medication, not doing physical activity and not following diet recommendations were due to side effects or fear of the side effects of antihypertensive medication, patients’ attitudes, lack of information from health care professionals and insufficient social support from their surrounding environment. We also observed the differences on these reasons for nonadherence among the three ethnic groups. Conclusion Health care professionals should move toward supporting adherence in the management of hypertensive patients by maintaining a dialogue. Patients need to be given time to enable them to overcome their inhibition of asking questions and to accept the recommendations. A self-management approach must be responsive to the needs of individuals, ethnicities, and communities. PMID:25484577

  3. Clowning in Health Care Settings: The Point of View of Adults

    PubMed Central

    Dionigi, Alberto; Canestrari, Carla

    2016-01-01

    Within the past decade, there has been a surge of interest in investigating the effects of clown intervention in a large variety of clinical settings. Many studies have focused on the effects of clown intervention on children. However, few studies have investigated clowning effects on adults. This paper presents an overview of the concept of medical clowning followed by a literature review conducted on the empirical studies drawn from three data bases (PubMed, PsycINFO, and Google Scholar), with the aim of mapping and discussing the evidence of clowning effects on non-children, namely adults. The following areas were investigated: Adult and elderly patients (mainly those with dementia), observers of clowning, namely non-hospitalized adults who are at the hospital as relatives of patients or health-care staff, and finally clowns themselves. The main results are that 1) clown intervention induces positive emotions, thereby enhancing the patient’s well-being, reduces psychological symptoms and emotional reactivity, and prompts a decrease in negative emotions, such as anxiety and stress; 2) clown doctors are also well-perceived by relatives and healthcare staff and their presence appears to be useful in creating a lighter atmosphere in the health setting; 3) few pilot studies have been conducted on clown doctors and this lacuna represents a subject for future research. PMID:27547261

  4. Non-culturable bioaerosols in indoor settings: Impact on health and molecular approaches for detection

    NASA Astrophysics Data System (ADS)

    Blais-Lecours, Pascale; Perrott, Phillipa; Duchaine, Caroline

    2015-06-01

    Despite their significant impact on respiratory health, bioaerosols in indoor settings remain understudied and misunderstood. Culture techniques, predominantly used for bioaerosol characterisation in the past, allow for the recovery of only a small fraction of the real airborne microbial burden in indoor settings, given the inability of several microorganisms to grow on agar plates. However, with the development of new tools to detect non-culturable environmental microorganisms, the study of bioaerosols has advanced significantly. Most importantly, these techniques have revealed a more complex bioaerosol burden that also includes non-culturable microorganisms, such as archaea and viruses. Nevertheless, air quality specialists and consultants remain reluctant to adopt these new research-developed techniques, given that there are relatively few studies found in the literature, making it difficult to find a point of comparison. Furthermore, it is unclear as to how this new non-culturable data can be used to assess the impact of bioaerosol exposure on human health. This article reviews the literature that describes the non-culturable fraction of bioaerosols, focussing on bacteria, archaea and viruses, and examines its impact on bioaerosol-related diseases. It also outlines available molecular tools for the detection and quantification of these microorganisms and states various research needs in this field.

  5. Introduction: priority setting, equitable access and public involvement in health care.

    PubMed

    Weale, Albert; Kieslich, Katharina; Littlejohns, Peter; Tugendhaft, Aviva; Tumilty, Emma; Weerasuriya, Krisantha; Whitty, Jennifer A

    2016-08-15

    Purpose - The purpose of this paper is to introduce the special issue on improving equitable access to health care through increased public and patient involvement (PPI) in prioritization decisions by discussing the conceptualization, scope and rationales of PPI in priority setting that inform the special issue. Design/methodology/approach - The paper employs a mixed-methods approach in that it provides a literature review and a conceptual discussion of the common themes emerging in the field of PPI and health priority setting. Findings - The special issue focuses on public participation that is collective in character, in the sense that the participation relates to a social, not personal, decision and is relevant to whole groups of people and not single individuals. It is aimed at influencing a decision on public policy or legal rules. The rationales for public participation can be found in democratic theory, especially as they relate to the social and political values of legitimacy and representation. Originality/value - The paper builds on previous definitions of public participation by underlining its collective character. In doing so, it develops the work by Parry, Moyser and Day by arguing that, in light of the empirical evidence presented in this issue, public participatory activities such as protests and demonstrations should no longer be labelled unconventional, but should instead be labelled as "contestatory participation". This is to better reflect a situation in which these modes of participation have become more conventional in many parts of the world. PMID:27468772

  6. Microbial contamination of mobile phones in a health care setting in Alexandria, Egypt

    PubMed Central

    Selim, Heba Sayed; Abaza, Amani Farouk

    2015-01-01

    Aim: This study aimed at investigating the microbial contamination of mobile phones in a hospital setting. Methods: Swab samples were collected from 40 mobile phones of patients and health care workers at the Alexandria University Students’ Hospital. They were tested for their bacterial contamination at the microbiology laboratory of the High Institute of Public Health. Quantification of bacteria was performed using both surface spread and pour plate methods. Isolated bacterial agents were identified using standard microbiological methods. Methicillin-resistant Staphylococcus aureus was identified by disk diffusion method described by Bauer and Kirby. Isolated Gram-negative bacilli were tested for being extended spectrum beta lactamase producers using the double disk diffusion method according to the Clinical and Laboratory Standards Institute recommendations. Results: All of the tested mobile phones (100%) were contaminated with either single or mixed bacterial agents. The most prevalent bacterial contaminants were methicillin-resistant S. aureus and coagulase-negative staphylococci representing 53% and 50%, respectively. The mean bacterial count was 357 CFU/ml, while the median was 13 CFU/ml using the pour plate method. The corresponding figures were 2,192 and 1,720 organisms/phone using the surface spread method. Conclusions: Mobile phones usage in hospital settings poses a risk of transmission of a variety of bacterial agents including multidrug-resistant pathogens as methicillin-resistant S. aureus. The surface spread method is an easy and useful tool for detection and estimation of bacterial contamination of mobile phones. PMID:25699226

  7. Clowning in Health Care Settings: The Point of View of Adults.

    PubMed

    Dionigi, Alberto; Canestrari, Carla

    2016-08-01

    Within the past decade, there has been a surge of interest in investigating the effects of clown intervention in a large variety of clinical settings. Many studies have focused on the effects of clown intervention on children. However, few studies have investigated clowning effects on adults. This paper presents an overview of the concept of medical clowning followed by a literature review conducted on the empirical studies drawn from three data bases (PubMed, PsycINFO, and Google Scholar), with the aim of mapping and discussing the evidence of clowning effects on non-children, namely adults. The following areas were investigated: Adult and elderly patients (mainly those with dementia), observers of clowning, namely non-hospitalized adults who are at the hospital as relatives of patients or health-care staff, and finally clowns themselves. The main results are that 1) clown intervention induces positive emotions, thereby enhancing the patient's well-being, reduces psychological symptoms and emotional reactivity, and prompts a decrease in negative emotions, such as anxiety and stress; 2) clown doctors are also well-perceived by relatives and healthcare staff and their presence appears to be useful in creating a lighter atmosphere in the health setting; 3) few pilot studies have been conducted on clown doctors and this lacuna represents a subject for future research. PMID:27547261

  8. Deconstructing myths, building alliances: a networking model to enhance tobacco control in hospital mental health settings.

    PubMed

    Ballbè, Montse; Gual, Antoni; Nieva, Gemma; Saltó, Esteve; Fernández, Esteve

    2016-01-01

    Life expectancy for people with severe mental disorders is up to 25 years less in comparison to the general population, mainly due to diseases caused or worsened by smoking. However, smoking is usually a neglected issue in mental healthcare settings. The aim of this article is to describe a strategy to improve tobacco control in the hospital mental healthcare services of Catalonia (Spain). To bridge this gap, the Catalan Network of Smoke-free Hospitals launched a nationwide bottom-up strategy in Catalonia in 2007. The strategy relied on the creation of a working group of key professionals from various hospitals -the early adopters- based on Rogers' theory of the Diffusion of Innovations. In 2016, the working group is composed of professionals from 17 hospitals (70.8% of all hospitals in the region with mental health inpatient units). Since 2007, tobacco control has improved in different areas such as increasing mental health professionals' awareness of smoking, training professionals on smoking cessation interventions and achieving good compliance with the national smoking ban. The working group has produced and disseminated various materials, including clinical practice and best practice guidelines, implemented smoking cessation programmes and organised seminars and training sessions on smoking cessation measures in patients with mental illnesses. The next challenge is to ensure effective follow-up for smoking cessation after discharge. While some areas of tobacco control within these services still require significant improvement, the aforementioned initiative promotes successful tobacco control in these settings. PMID:27325123

  9. Evaluation of a health setting-based stigma intervention in five African countries.

    PubMed

    Uys, Leana; Chirwa, Maureen; Kohi, Thecla; Greeff, Minrie; Naidoo, Joanne; Makoae, Lucia; Dlamini, Priscilla; Durrheim, Kevin; Cuca, Yvette; Holzemer, William L

    2009-12-01

    The study aim is to explore the results of an HIV stigma intervention in five African health care settings. A case study approach was used. The intervention consisted of bringing together a team of approximately 10 nurses and 10 people living with HIV or AIDS (PLHA) in each setting and facilitating a process in which they planned and implemented a stigma reduction intervention, involving both information giving and empowerment. Nurses (n = 134) completed a demographic questionnaire, the HIV/AIDS Stigma Instrument-Nurses (HASI-N), a self-efficacy scale, and a self-esteem scale, both before and after the intervention, and the team completed a similar set of instruments before and after the intervention, with the PLHA completing the HIV/AIDS Stigma Instrument for PLHA (HASI-P). The intervention as implemented in all five countries was inclusive, action-oriented, and well received. It led to understanding and mutual support between nurses and PLHA and created some momentum in all the settings for continued activity. PLHA involved in the intervention teams reported less stigma and increased self-esteem. Nurses in the intervention teams and those in the settings reported no reduction in stigma or increases in self- esteem and self-efficacy, but their HIV testing behavior increased significantly. This pilot study indicates that the stigma experience of PLHA can be decreased, but that the stigma experiences of nurses are less easy to change. Further evaluation research with control groups and larger samples and measuring change over longer periods of time is indicated. PMID:20025515

  10. Evaluation of a Health Setting-Based Stigma Intervention in Five African Countries

    PubMed Central

    Uys, Leana; Chirwa, Maureen; Kohi, Thecla; Greeff, Minrie; Makoae, Lucia; Dlamini, Priscilla; Durrheim, Kevin; Cuca, Yvette; Holzemer, William L.

    2009-01-01

    Abstract The study aim is to explore the results of an HIV stigma intervention in five African health care settings. A case study approach was used. The intervention consisted of bringing together a team of approximately 10 nurses and 10 people living with HIV or AIDS (PLHA) in each setting and facilitating a process in which they planned and implemented a stigma reduction intervention, involving both information giving and empowerment. Nurses (n = 134) completed a demographic questionnaire, the HIV/AIDS Stigma Instrument-Nurses (HASI-N), a self-efficacy scale, and a self-esteem scale, both before and after the intervention, and the team completed a similar set of instruments before and after the intervention, with the PLHA completing the HIV/AIDS Stigma Instrument for PLHA (HASI-P). The intervention as implemented in all five countries was inclusive, action-oriented, and well received. It led to understanding and mutual support between nurses and PLHA and created some momentum in all the settings for continued activity. PLHA involved in the intervention teams reported less stigma and increased self-esteem. Nurses in the intervention teams and those in the settings reported no reduction in stigma or increases in self- esteem and self-efficacy, but their HIV testing behavior increased significantly. This pilot study indicates that the stigma experience of PLHA can be decreased, but that the stigma experiences of nurses are less easy to change. Further evaluation research with control groups and larger samples and measuring change over longer periods of time is indicated. PMID:20025515

  11. The Costs of Delivering Integrated HIV and Sexual Reproductive Health Services in Limited Resource Settings

    PubMed Central

    Obure, Carol Dayo; Sweeney, Sedona; Darsamo, Vanessa; Michaels-Igbokwe, Christine; Guinness, Lorna; Terris-Prestholt, Fern; Muketo, Esther; Nhlabatsi, Zelda; Warren, Charlotte E.; Mayhew, Susannah; Watts, Charlotte; Vassall, Anna

    2015-01-01

    Objective To present evidence on the total costs and unit costs of delivering six integrated sexual reproductive health and HIV services in a high and medium HIV prevalence setting, in order to support policy makers and planners scaling up these essential services. Design A retrospective facility based costing study conducted in 40 non-government organization and public health facilities in Kenya and Swaziland. Methods Economic and financial costs were collected retrospectively for the year 2010/11, from each study site with an aim to estimate the cost per visit of six integrated HIV and SRH services. A full cost analysis using a combination of bottom-up and step-down costing methods was conducted from the health provider’s perspective. The main unit of analysis is the economic unit cost per visit for each service. Costs are converted to 2013 International dollars. Results The mean cost per visit for the HIV/SRH services ranged from $Int 14.23 (PNC visit) to $Int 74.21 (HIV treatment visit). We found considerable variation in the unit costs per visit across settings with family planning services exhibiting the least variation ($Int 6.71-52.24) and STI treatment and HIV treatment visits exhibiting the highest variation in unit cost ranging from ($Int 5.44-281.85) and ($Int 0.83-314.95), respectively. Unit costs of visits were driven by fixed costs while variability in visit costs across facilities was explained mainly by technology used and service maturity. Conclusion For all services, variability in unit costs and cost components suggest that potential exists to reduce costs through better use of both human and capital resources, despite the high proportion of expenditure on drugs and medical supplies. Further work is required to explore the key drivers of efficiency and interventions that may facilitate efficiency improvements. PMID:25933414

  12. Approaches, tools and methods used for setting priorities in health research in the 21st century

    PubMed Central

    Yoshida, Sachiyo

    2016-01-01

    Background Health research is difficult to prioritize, because the number of possible competing ideas for research is large, the outcome of research is inherently uncertain, and the impact of research is difficult to predict and measure. A systematic and transparent process to assist policy makers and research funding agencies in making investment decisions is a permanent need. Methods To obtain a better understanding of the landscape of approaches, tools and methods used to prioritize health research, I conducted a methodical review using the PubMed database for the period 2001–2014. Results A total of 165 relevant studies were identified, in which health research prioritization was conducted. They most frequently used the CHNRI method (26%), followed by the Delphi method (24%), James Lind Alliance method (8%), the Combined Approach Matrix (CAM) method (2%) and the Essential National Health Research method (<1%). About 3% of studies reported no clear process and provided very little information on how priorities were set. A further 19% used a combination of expert panel interview and focus group discussion (“consultation process”) but provided few details, while a further 2% used approaches that were clearly described, but not established as a replicable method. Online surveys that were not accompanied by face–to–face meetings were used in 8% of studies, while 9% used a combination of literature review and questionnaire to scrutinise the research options for prioritization among the participating experts. Conclusion The number of priority setting exercises in health research published in PubMed–indexed journals is increasing, especially since 2010. These exercises are being conducted at a variety of levels, ranging from the global level to the level of an individual hospital. With the development of new tools and methods which have a well–defined structure – such as the CHNRI method, James Lind Alliance Method and Combined Approach Matrix – it is

  13. [Consensus Document. Update on latex exposure and use of gloves in Italian health care settings].

    PubMed

    Crippa, Michela; Balbiani, Lara; Baruffini, Adriana; Belleri, L; Draicchio, F; Feltrin, G; Larese, Francesca; Maggio, G M; Marcer, G; Micheloni, G P; Montomoli, Loretta; Moscato, Gianna; Previdi, M; Sartorelli, P; Sossai, D; Spatari, Giovanna; Zanetti, Caterina

    2008-01-01

    This consensus document was prepared by an Italian working group including occupational health professionals involved for many years in the management of glove- and latex-related problems in health care settings. The aim of this document was to address the most significant technical, epidemiological, clinical, environmental and prevention problems related to the use of gloves and latex. The group's recommendations are based on scientific evidence and practical experience but they cannot be considered as final. These topics need to be periodically revised. The following points should be taken into account: glove quality seems to have improved considerably but the information on glove features provided by the manufacturers is often still inaccurate or incomplete; the regulations in force provide that the manufacturers perform tests to supply evidence for the quality of the products but they do not indicate which analytical method should be used and they do not require that the results be reported in the technical data sheets. Thus the manufacturers have only to declare that their products are "in accordance with the rules"; therefore, purchasers should require the manufacturing companies to supply detailed information and verify their reliability. Moreover, the rules should be adapted to higher quality standards; occupational physicians must be involved for the correct choice and purchase of protective gloves; the use of gloves (in particular latex gloves) and latex devices in health care settings should be based on specific criteria: procedures must be available stating which kind of gloves are suitable for specific tasks. When exposure to latex cannot be avoided it is necessary to choose products that have good biocompatibility (e.g., powder free-gloves with low allergen content); once and for all latex powdered gloves should no longer be commercially available! labels for latex devices (including gloves) should report the extractable latex allergen content. Limit

  14. Clinicians’ Perspectives on Cognitive Therapy in Community Mental Health Settings: Implications for Training and Implementation

    PubMed Central

    Gutiérrez-Colina, Ana; Toder, Katherine; Esposito, Gregory; Barg, Frances; Castro, Frank; Beck, Aaron T.; Crits-Christoph, Paul

    2012-01-01

    Policymakers are investing significant resources in large-scale training and implementation programs for evidence-based psychological treatments (EBPTs) in public mental health systems. However, relatively little research has been conducted to understand factors that may influence the success of efforts to implement EBPTs for adult consumers of mental health services. In a formative investigation during the development of a program to implement cognitive therapy (CT) in a community mental health system, we surveyed and interviewed clinicians and clinical administrators to identify potential influences on CT implementation within their agencies. Four primary themes were identified. Two related to attitudes towards CT: (1) ability to address client needs and issues that are perceived as most central to their presenting problems, and (2) reluctance to fully implement CT. Two themes were relevant to context: (1) agency-level barriers, specifically workload and productivity concerns and reactions to change, and (2) agency-level facilitators, specifically, treatment planning requirements and openness to training. These findings provide information that can be used to develop strategies to facilitate the implementation of CT interventions for clients being treated in public-sector settings. PMID:22426739

  15. Active Commuting Behaviors in a Nordic Metropolitan Setting in Relation to Modality, Gender, and Health Recommendations

    PubMed Central

    Stigell, Erik; Schantz, Peter

    2015-01-01

    Active commuting between home and place of work or study is often cited as an interesting source of physical activity in a public health perspective. However, knowledge about these behaviors is meager. This was therefore studied in adult active commuters (n = 1872) in Greater Stockholm, Sweden, a Nordic metropolitan setting. They received questionnaires and individually adjusted maps to draw their normal commuting route. Three different modality groups were identified in men and women: single-mode cyclists and pedestrians (those who only cycle or walk, respectively) and dual-mode commuters (those who alternately walk or cycle). Some gender differences were observed in trip distances, frequencies, and velocities. A large majority of the commuting trip durations met the minimum health recommendation of at least 10-minute-long activity bouts. The median single-mode pedestrians and dual-mode commuters met or were close to the recommended weekly physical activity levels of at least 150 minutes most of the year, whereas the single-mode cyclists did so only during spring–mid-fall. A high total number of trips per year (range of medians: 231–389) adds to the value in a health perspective. To fully grasp active commuting behaviors in future studies, both walking and cycling should be assessed over different seasons and ideally over the whole year. PMID:26690193

  16. The perceptions of nurses towards barriers to the safe administration of medicines in mental health settings.

    PubMed

    Hemingway, Steve; McCann, Terence; Baxter, Hazel; Smith, George; Burgess-Dawson, Rebecca; Dewhirst, Kate

    2015-12-01

    The purpose of this study was to investigate perceptions of barriers to safe administration of medicines in mental health settings. A cross-sectional survey was used, and 70 mental health nurses and 41 students were recruited from a mental health trust and a university in Yorkshire, UK. Respondents completed a questionnaire comprising closed- and open-response questions. One item, which contained seven sub-items, addressed barriers to safe administration of medication. Seven themes--five nurse- and prescriber-focused and two service user-focused--were abstracted from the data, depicting a range of barriers to safe administration of medicines. Nurse- and prescriber-focused themes included environmental distractions, insufficient pharmacological knowledge, poorly written and incomplete medication documentation, inability to calculate medication dosage correctly, and work-related pressure. Service user-focused themes comprised poor adherence to medication regimens, and cultural and linguistic communication barriers with service users. Tackling medication administration error is predominantly an organizational rather than individual practitioner responsibility. PMID:24666641

  17. Occupational exposure to antineoplastic drugs in four Italian health care settings.

    PubMed

    Sottani, Cristina; Porro, Benedetta; Imbriani, Marcello; Minoia, Claudio

    2012-08-13

    Exposure assessment of health care workers to antineoplastic drugs (ADs) is still an open issue since new, critical, and emerging factors may put pharmacists who prepare hazardous drugs or nurses who administer anti cancer agents to an increased risk of developing adverse health effects. Overall, eight pharmacies and nine patient areas have been surveyed in this study. Wipe and pad samples were experienced during the surveillance program in four Italian health care settings. Urine samples were collected from workers handling ADs. Cyclophosphamide (CP), ifosfamide (IF), and gemcitabine (GEM) were detected in all the work environments by using a LC-MS/MS method-based capable of analysing all the three drugs simultaneously. In total, 54% of wipe samples were positive for at least one drug and 19% of pad samples were shown to be contaminated by cyclophosphamide. Pharmacies were generally more contaminated than patient areas with the exception of one site where a nurse had an acute exposure during the cleaning-up of an hazardous drug solution spill. In total, 22 urine samples collected from pharmacists and 78 urine samples from nurses had no detectable concentrations of any antineoplastic drugs. Despite the adherence to the recommended safety practices residue contamination on surfaces and floors has continued to be assessed in all the investigated sites. PMID:21477641

  18. Using risk adjustment approaches in child welfare performance measurement: Applications and insights from health and mental health settings

    PubMed Central

    Raghavan, Ramesh

    2014-01-01

    Federal policymaking in the last decade has dramatically expanded performance measurement within child welfare systems, and states are currently being fiscally penalized for poor performance on defined outcomes. However, in contrast to performance measurement in health settings, current policy holds child welfare systems solely responsible for meeting outcomes, largely without taking into account the effects of factors at the level of the child, and his or her social ecology, that might undermine the performance of child welfare agencies. Appropriate measurement of performance is predicated upon the ability to disentangle individual, as opposed to organizational, determinants of outcomes, which is the goal of risk adjustment methodologies. This review briefly conceptualizes and examines risk adjustment approaches in health and child welfare, suggests approaches to expanding its use to appropriately measure the performance of child welfare agencies, and highlights research gaps that diminish the appropriate use of risk adjustment approaches – and which consequently suggest the need for caution – in policymaking around performance measurement of child welfare agencies. PMID:25253917

  19. Environmental Health Research Recommendations from the Inter-Environmental Health Sciences Core Center Working Group on Unconventional Natural Gas Drilling Operations

    PubMed Central

    Breysse, Patrick N.; Gray, Kathleen; Howarth, Marilyn; Yan, Beizhan

    2014-01-01

    Background: Unconventional natural gas drilling operations (UNGDO) (which include hydraulic fracturing and horizontal drilling) supply an energy source that is potentially cleaner than liquid or solid fossil fuels and may provide a route to energy independence. However, significant concerns have arisen due to the lack of research on the public health impact of UNGDO. Objectives: Environmental Health Sciences Core Centers (EHSCCs), funded by the National Institute of Environmental Health Sciences (NIEHS), formed a working group to review the literature on the potential public health impact of UNGDO and to make recommendations for needed research. Discussion: The Inter-EHSCC Working Group concluded that a potential for water and air pollution exists that might endanger public health, and that the social fabric of communities could be impacted by the rapid emergence of drilling operations. The working group recommends research to inform how potential risks could be mitigated. Conclusions: Research on exposure and health outcomes related to UNGDO is urgently needed, and community engagement is essential in the design of such studies. Citation: Penning TM, Breysse PN, Gray K, Howarth M, Yan B. 2014. Environmental health research recommendations from the Inter-Environmental Health Sciences Core Center Working Group on Unconventional Natural Gas Drilling Operations. Environ Health Perspect 122:1155–1159; http://dx.doi.org/10.1289/ehp.1408207 PMID:25036093

  20. Operationalizing public health skills to resource poor settings: is this the Achilles heel in the Ebola epidemic campaign?

    PubMed

    Burkle, Frederick M

    2015-02-01

    Sustainable approaches to crises, especially non-trauma-related public health emergencies, are severely lacking. At present, the Ebola crisis is defining the operational public health skill sets for infectious disease epidemics that are not widely known or appreciated. Indigenous and foreign medical teams will need to adapt to build competency-based curriculum and standards of care for the future that concentrate on public health emergencies. Only by adjusting and adapting specific operational public health skill sets to resource poor environments will it be possible to provide sustainable prevention and preparedness initiatives that work well across cultures and borders. PMID:25288216

  1. Identifying the factors influencing minority language use in health care education settings: a European perspective.

    PubMed

    Roberts, G W; Paden, L

    2000-07-01

    The recent enhanced status of many minority languages across the European Community has led to increasing demands for their use within the public sector. This is particularly evident in health care, where, in circumstances of stress and vulnerability, denying opportunities for clients to communicate in their preferred language may place them at a personal disadvantage and compromise their health chances. In view of the exclusion of many minority languages from the public domain over the years, their re-introduction demands adaptations to health care education programmes in order to promote language sensitivity in practice. Before embarking on developments which establish such languages within the professional sphere, valuable insight may be gained by examining their current use in practice education. Furthermore, comparing their use across language communities enables the sharing of common experiences and furthers opportunities for developing networks across Europe. This paper describes an ethnographic study of the use, within midwifery education, of the Welsh language in north Wales, the Catalan language in Barcelona and the Irish language in Western Ireland. Semi-structured interviews were conducted with key lecturers, clinical mentors and students across the three communities in order to determine patterns of language use within a range of learning environments. Focus groups were also held in order to confirm the findings. The data reveal many commonalities in terms of language use across the three settings and important factors are identified which support the use of minority languages in practice education. The findings are invaluable for guiding future bilingual initiatives across health care education programmes. PMID:10886437

  2. Corneal foreign bodies--first aid, treatment, and outcomes. Skills review for an occupational health setting.

    PubMed

    Owens, J K; Scibilia, J; Hezoucky, N

    2001-05-01

    Eye injuries from foreign body incidents remain prevalent in the workplace setting. Often the professional nurse provides the first line of treatment. The informal class presented at the authors' facility offered a comprehensive, organized presentation of a common injury encountered in the practice of occupational health nursing. Strenghts of the presentation included handouts demonstrating eye eversion technique and a flip chart summarizing the content to be placed in each medical station as quick reference. One challenge involved presenting the information to all nurses. The site encompasses four locations and some nurses function as the only staff in the plant for a given shift. With the support of administration and some creative scheduling, 10 of 17 nurses attended one of three classes offered in one morning, and the remaining 7 were able to view the class on videotape. Videotaping the presentation also provided material for future orientation, as well as an opportunity for review. Overall analysis found this a worthwhile offering relevant to practice. A brief formal written evaluation indicated the objectives for the class were achieved and elicited subjects for future topics. Informal chart reviews to check for documentation of visual acuity testing and eversion of the upper lid for foreign body injuries is another outcome measure currently in progress. In addition, a performance improvement project could be accomplished easily by retrospective chart review of assessment and treatment documentation, and tracking of revisits and referrals. Knowledge of current standards in the assessment, first aid, and treatment of eye injuries is every occupational health nurse's responsibility. However, prevention of foreign body injuries is far superior to any treatment modality available. As highly visible leaders within the occupational setting, nurses can be advocates and role models for safe work practices. Occupational health nurses may promote safe eye practices by

  3. Diffusion of e-health innovations in ‘post-conflict’ settings: a qualitative study on the personal experiences of health workers

    PubMed Central

    2014-01-01

    Background Technological innovations have the potential to strengthen human resources for health and improve access and quality of care in challenging ‘post-conflict’ contexts. However, analyses on the adoption of technology for health (that is, ‘e-health’) and whether and how e-health can strengthen a health workforce in these settings have been limited so far. This study explores the personal experiences of health workers using e-health innovations in selected post-conflict situations. Methods This study had a cross-sectional qualitative design. Telephone interviews were conducted with 12 health workers, from a variety of cadres and stages in their careers, from four post-conflict settings (Liberia, West Bank and Gaza, Sierra Leone and Somaliland) in 2012. Everett Roger’s diffusion of innovation-decision model (that is, knowledge, persuasion, decision, implementation, contemplation) guided the thematic analysis. Results All health workers interviewed held positive perceptions of e-health, related to their beliefs that e-health can help them to access information and communicate with other health workers. However, understanding of the scope of e-health was generally limited, and often based on innovations that health workers have been introduced through by their international partners. Health workers reported a range of engagement with e-health innovations, mostly for communication (for example, email) and educational purposes (for example, online learning platforms). Poor, unreliable and unaffordable Internet was a commonly mentioned barrier to e-health use. Scaling-up existing e-health partnerships and innovations were suggested starting points to increase e-health innovation dissemination. Conclusions Results from this study showed ICT based e-health innovations can relieve information and communication needs of health workers in post-conflict settings. However, more efforts and investments, preferably driven by healthcare workers within the post

  4. What could a strengthened right to health bring to the post-2015 health development agenda?: interrogating the role of the minimum core concept in advancing essential global health needs

    PubMed Central

    2013-01-01

    Background Global health institutions increasingly recognize that the right to health should guide the formulation of replacement goals for the Millennium Development Goals, which expire in 2015. However, the right to health’s contribution is undercut by the principle of progressive realization, which links provision of health services to available resources, permitting states to deny even basic levels of health coverage domestically and allowing international assistance for health to remain entirely discretionary. Discussion To prevent progressive realization from undermining both domestic and international responsibilities towards health, international human rights law institutions developed the idea of non-derogable “minimum core” obligations to provide essential health services. While minimum core obligations have enjoyed some uptake in human rights practice and scholarship, their definition in international law fails to specify which health services should fall within their scope, or to specify wealthy country obligations to assist poorer countries. These definitional gaps undercut the capacity of minimum core obligations to protect essential health needs against inaction, austerity and illegitimate trade-offs in both domestic and global action. If the right to health is to effectively advance essential global health needs in these contexts, weaknesses within the minimum core concept must be resolved through innovative research on social, political and legal conceptualizations of essential health needs. Summary We believe that if the minimum core concept is strengthened in these ways, it will produce a more feasible and grounded conception of legally prioritized health needs that could assist in advancing health equity, including by providing a framework rooted in legal obligations to guide the formulation of new health development goals, providing a baseline of essential health services to be protected as a matter of right against governmental claims of

  5. The accountability for reasonableness approach to guide priority setting in health systems within limited resources – findings from action research at district level in Kenya, Tanzania, and Zambia

    PubMed Central

    2014-01-01

    Background Priority-setting decisions are based on an important, but not sufficient set of values and thus lead to disagreement on priorities. Accountability for Reasonableness (AFR) is an ethics-based approach to a legitimate and fair priority-setting process that builds upon four conditions: relevance, publicity, appeals, and enforcement, which facilitate agreement on priority-setting decisions and gain support for their implementation. This paper focuses on the assessment of AFR within the project REsponse to ACcountable priority setting for Trust in health systems (REACT). Methods This intervention study applied an action research methodology to assess implementation of AFR in one district in Kenya, Tanzania, and Zambia, respectively. The assessments focused on selected disease, program, and managerial areas. An implementing action research team of core health team members and supporting researchers was formed to implement, and continually assess and improve the application of the four conditions. Researchers evaluated the intervention using qualitative and quantitative data collection and analysis methods. Results The values underlying the AFR approach were in all three districts well-aligned with general values expressed by both service providers and community representatives. There was some variation in the interpretations and actual use of the AFR in the decision-making processes in the three districts, and its effect ranged from an increase in awareness of the importance of fairness to a broadened engagement of health team members and other stakeholders in priority setting and other decision-making processes. Conclusions District stakeholders were able to take greater charge of closing the gap between nationally set planning and the local realities and demands of the served communities within the limited resources at hand. This study thus indicates that the operationalization of the four broadly defined and linked conditions is both possible and seems to

  6. Capturing Psychologists' Work in Academic Health Settings: The Role of the Educational Value Unit (EVU).

    PubMed

    D'Angelo, Eugene J; Gallagher, Katie

    2016-03-01

    This paper describes how psychology faculty positions in academic health centers (AHCs) have evolved to meet the changing needs in healthcare. In that context, the roles of psychologists have expanded significantly to include a wide array of clinical responsibilities, teaching and supervisory roles, administrative functions, research initiatives, and academic scholarship. Traditionally, faculty compensation plans have been calculated through the use of Relative Value Units which are primarily based on clinical service delivery, hence, incomplete when attempting to account for these growing academic responsibilities. This paper reviews the need to expand the ways in which the work provided by psychologists is appropriately identified and compensated for in AHCs. Drawing upon six models utilized in other areas of medical education, this paper describes the potential utility of incorporating Educational Value Units as a metric for capturing this expanding set of academic responsibilities and systematically incorporating them into a psychologist's job design. Recommendations for future considerations are provided. PMID:26894750

  7. Technical solutions for mitigating security threats caused by health professionals in clinical settings.

    PubMed

    Fernandez-Aleman, Jose Luis; Belen Sanchez Garcia, Ana; Garcia-Mateos, Gines; Toval, Ambrosio

    2015-08-01

    The objective of this paper is to present a brief description of technical solutions for health information system security threats caused by inadequate security and privacy practices in healthcare professionals. A literature search was carried out in ScienceDirect, ACM Digital Library and IEEE Digital Library to find papers reporting technical solutions for certain security problems in information systems used in clinical settings. A total of 17 technical solutions were identified: measures for password security, the secure use of e-mail, the Internet, portable storage devices, printers and screens. Although technical safeguards are essential to the security of healthcare organization's information systems, good training, awareness programs and adopting a proper information security policy are particularly important to prevent insiders from causing security incidents. PMID:26736528

  8. Managing disruptive behaviors in the health care setting: focus on obstetrics services.

    PubMed

    Rosenstein, Alan H

    2011-03-01

    Disruptive behaviors can have a significant negative impact on staff relationships, communication flow, task responsibility, and team collaboration, all of which can adversely impact patient outcomes of care. Addressing disruptive behaviors in a positive manner by emphasizing the benefits of mutual understanding, shared goals and priorities, and adherence to accepted standards of care will enhance communication flow and improve the process and outcomes of care. This is particularly relevant in the obstetrics setting, where care is delivered over a continuum of time, with multiple different members of the health care team playing a vital role as the patient progresses from labor to delivery. Critical strategies for success include having strong organizational commitment and leadership support, raising provider insight and awareness, implementing appropriate policies and procedures, providing appropriate educational and training programs, and facilitating action-oriented interventional support. PMID:21183152

  9. Patient satisfaction and service quality in the formation of customers' future purchase intentions in competitive health service settings.

    PubMed

    Baker, T L; Taylor, S A

    1997-01-01

    The following study provides evidence that the relationship between quality perceptions and satisfaction judgements in the formation of future purchase intentions may be very different in health service settings relative to other service settings. The study investigates Taylor and Baker's (1994) assertion that satisfaction judgements moderate the quality-->purchase intention relationship by testing the research model in both for-profit and not-for-profit hospital settings. The results of this study first support the growing view that satisfaction judgements are more closely related to outcome behaviors than quality perceptions in hospital settings. The results further support the assertion that the formation of important consumer outcomes, such as future purchase intentions, appears to be different for health services. Thus, health service managers are cautioned to empirically test models in the literature specific to their own competitive setting. The managerial and research implications of the reported study are presented and discussed. PMID:10179060

  10. [How should health and healthcare priorities be set and evaluated? Prioritization methods and regional disparities. 2008 SESPAS Report].

    PubMed

    Sánchez Martínez, Fernando I; Abellán Perpiñán, José María; Martínez Pérez, Jorge E

    2008-04-01

    The conflict between scarce resources and unlimited needs is perhaps more prominent in the healthcare sector than in any other areas. Thus, setting priorities in health care emerges as an unavoidable task. The laudable aim of adopting any health technology that improves the population's health is impossible when confronted by budgetary constraints. Therefore, the outstanding health problems of a society and the most efficient health technologies in terms of their cost-effectiveness must be identified and patients must be prioritized, bearing in mind aspects of equity and efficiency. The present article reviews the issue of setting health care priorities by examining the experiences that have been put into practice in Spain and abroad. The problem is analyzed at three levels: the "macro" level (strategic planning, identification of higher priority areas and the selection of health care interventions); the "meso" level (incorporation of cost-effectiveness analyses into clinical practice guidelines), and the "micro" level (how to design priority systems for patients on waiting lists based on clinical and social criteria). In all these levels, there is substantial heterogeneity between Spanish regional health services, the steps that need to be taken and the ground that needs to be covered. Thus, we suggest that the first steps that some regional health services have made, together with international initiatives, could serve as a reference for the definitive incorporation of new approaches in priority setting in the Spanish health system as a whole. PMID:18405562

  11. The treatment of depressed chinese americans using qigong in a health care setting: a pilot study.

    PubMed

    Yeung, Albert; Slipp, Lauren E; Jacquart, Jolene; Fava, Maurizio; Denninger, John W; Benson, Herbert; Fricchione, Gregory L

    2013-01-01

    Background. This pilot study examined the feasibility and efficacy of providing Qigong treatment in a health center to Chinese Americans with major depressive disorder (MDD). Methods. Fourteen Chinese Americans with MDD were enrolled, and they received a 12-week Qigong intervention. The key outcome measurement was the 17-item Hamilton Rating Scale for Depression (HAM-D17); the Clinical Global Impressions-Severity (CGI-S) and -Improvement (CGI-I), the Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form (Q-LES-Q-SF), and the Multidimensional Scale of Perceived Social Support (MSPSS) were also administered. Positive response was defined as a decrease of 50% or more on the HAM-D17, and remission was defined as HAM-D17 ≤ 7. Patients' outcome measurements were compared before and after the Qigong intervention. Results. Participants (N = 14) were 64% female, with a mean age of 53 (±14). A 71% of participants completed the intervention. The Qigong intervention resulted in a positive treatment-response rate of 60% and a remission rate of 40% and statistically significant improvement, as measured by the HAM-D17, CGI-S, CGI-I, Q-LES-Q-SF, and the family support subscale of the MSPSS. Conclusions. The Qigong intervention provided at a health care setting for the treatment of primary care patients with MDD is feasible. Further studies with larger sample sizes are warranted. PMID:23690836

  12. Setting the space for sex: architecture, desire and health issues in gay bathhouses.

    PubMed

    Holmes, Dave; O'Byrne, Patrick; Gastaldo, Denise

    2007-02-01

    This aim of this study was to describe and compare the physical design, as well as the atmosphere of urban gay bathhouses, and reflect on how desire operates within these premises when it intersects with the bathhouse environment and health imperatives. Three bathhouses were studied for a total of 147 h of observation. Men's desire for other men has created a landscape of spaces (real and virtual) where sex takes place in parks, alleys, restrooms, rest stops, adult theatres, video arcades, bookstores, bars, gay bathhouses and finally, the Internet. Although the Internet is perceived as an easy way for encountering sexual partners, gay bathhouses remain the most popular and convenient way, for men having sex with men to meet for regular or casual sex. This paper presents the descriptive results of an ethnographic nursing study that took place in three gay bathhouses located in two Canadian metropolitan areas. Gay bathhouses offer patrons a space within which a wide range of interactions, sensations and pleasure can be experienced. This paper highlights the specific features of three gay bathhouses, compares settings according to their specific architectural features and related sexual activities, and finally, proposes some changes in light of certain health issues. PMID:16426616

  13. Shared decision making in health care settings: a role for social work.

    PubMed

    Peterson, K Jean

    2012-01-01

    Shared decision making (SDM) is a process integral to social work practice, one where the provider/professional and the consumer/patient discuss treatment alternatives based on patient values and life circumstances and make a shared decision about whether and how to proceed with treatment. Evidence-based medicine suggests that for many health conditions, having the choice of several effective treatment options is not uncommon. In these cases treatment should be based on what is best for the individual, since many factors influence an individual's treatment preference, including the psychological, social, cultural, and spiritual history she/he brings to the medical encounter; a history that has long been ignored in somatic health care. This article develops the argument that medical social workers possess the professional knowledge and skill base to provide decisional coaching, and implementing SDM in primary care settings. Of particular importance are the values that guide professional social work practice, including client self-determination, which is the basis of SDM, and the ability to maintain neutrality. PMID:23151285

  14. Stratigraphy, correlation, depositional setting, and geophysical characteristics of the Oligocene Snowshoe Mountain Tuff and Creede Formation in two cored boreholes

    USGS Publications Warehouse

    Larsen, Daniel; Nelson, Philip H.

    2000-01-01

    Core descriptions and geophysical logs from two boreholes (CCM-1 and CCM-2) in the Oligocene Snowshoe Mountain Tuff and Creede Formation, south-central Colorado, are used to interpret sedimentary and volcanic facies associations and their physical properties. The seven facies association include a mixed sequence of intracaldera ash-flow tuffs and breccias, alluvial and lake margin deposits, and tuffaceous lake beds. These deposits represent volcanic units related to caldera collapse and emplacement of the Snowshoe Mountain Tuff, and sediments and pyroclastic material deposited in the newly formed caldera basin, Early sedimentation is interpreted to have been rapid, and to have occurred in volcaniclastic fan environments at CCM-1 and in a variery of volcaniclastic fan, braided stream shallow lacustrine, and mudflat environments at CCM-2. After an initial period of lake-level rise, suspension settling, turbidite, and debris-flow sedimentation occurred in lacustrine slope and basin environments below wave base. Carbonate sedimentation was initially sporadic, but more continuous in the latter part of the recorded lake history (after the H fallout tuff). Sublacustrine-fan deposition occurred at CCM-1 after a pronounced lake-level fall and subsequent rise that preceded the H tuff. Variations in density, neutron, gamma-ray, sonic, and electrical properties of deposits penetrated oin the two holes reflect variations in lithology, porosity, and alteration. Trends in the geophysical properties of the lacustrine strata are linked to downhole changes in authigenic mineralology and a decrease in porosity interpreted to have resulted primarily from diagenesis. Lithological and geophysical characteristics provide a basis for correlation of the cores; however, mineralogical methods of correlation are hampered by the degree of diagenesis and alteration.

  15. The WHO public-health approach to antiretroviral treatment against HIV in resource-limited settings.

    PubMed

    Gilks, Charles F; Crowley, Siobhan; Ekpini, René; Gove, Sandy; Perriens, Jos; Souteyrand, Yves; Sutherland, Don; Vitoria, Marco; Guerma, Teguest; De Cock, Kevin

    2006-08-01

    WHO has proposed a public-health approach to antiretroviral therapy (ART) to enable scaling-up access to treatment for HIV-positive people in developing countries, recognising that the western model of specialist physician management and advanced laboratory monitoring is not feasible in resource-poor settings. In this approach, standardised simplified treatment protocols and decentralised service delivery enable treatment to be delivered to large numbers of HIV-positive adults and children through the public and private sector. Simplified tools and approaches to clinical decision-making, centred on the "four Ss"--when to: start drug treatment; substitute for toxicity; switch after treatment failure; and stop--enable lower level health-care workers to deliver care. Simple limited formularies have driven large-scale production of fixed-dose combinations for first-line treatment for adults and lowered prices, but to ensure access to ART in the poorest countries, the care and drugs should be given free at point of service delivery. Population-based surveillance for acquired and transmitted resistance is needed to address concerns that switching regimens on the basis of clinical criteria for failure alone could lead to widespread emergence of drug-resistant virus strains. The integrated management of adult or childhood illness (IMAI/IMCI) facilitates decentralised implementation that is integrated within existing health systems. Simplified operational guidelines, tools, and training materials enable clinical teams in primary-care and second-level facilities to deliver HIV prevention, HIV care, and ART, and to use a standardised patient-tracking system. PMID:16890837

  16. Mental health and psychosocial support in humanitarian settings: linking practice and research

    PubMed Central

    Tol, Wietse A; Barbui, Corrado; Galappatti, Ananda; Silove, Derrick; Betancourt, Theresa S; Souza, Renato; Golaz, Anne; van Ommeren, Mark

    2014-01-01

    This review links practice, funding, and evidence for interventions for mental health and psychosocial wellbeing in humanitarian settings. We studied practice by reviewing reports of mental health and psychosocial support activities (2007–10); funding by analysis of the financial tracking service and the creditor reporting system (2007–09); and interventions by systematic review and meta-analysis. In 160 reports, the five most commonly reported activities were basic counselling for individuals (39%); facilitation of community support of vulnerable individuals (23%); provision of child-friendly spaces (21%); support of community-initiated social support (21%); and basic counselling for groups and families (20%). Most interventions took place and were funded outside national mental health and protection systems. 32 controlled studies of interventions were identified, 13 of which were randomised controlled trials (RCTs) that met the criteria for meta-analysis. Two studies showed promising effects for strengthening community and family supports. Psychosocial wellbeing was not included as an outcome in the meta-analysis, because its definition varied across studies. In adults with symptoms of post-traumatic stress disorder (PTSD), meta-analysis of seven RCTs showed beneficial effects for several interventions (psychotherapy and psychosocial supports) compared with usual care or waiting list (standardised mean difference [SMD] −0.38, 95% CI −0.55 to −0.20). In children, meta-analysis of four RCTs failed to show an effect for symptoms of PTSD (−0.36, −0.83 to 0.10), but showed a beneficial effect of interventions (group psychotherapy, school-based support, and other psychosocial support) for internalising symptoms (six RCTs; SMD −0.24, −0.40 to −0.09). Overall, research and evidence focuses on interventions that are infrequently implemented, whereas the most commonly used interventions have had little rigorous scrutiny. PMID:22008428

  17. Mental health and psychosocial support in humanitarian settings: linking practice and research.

    PubMed

    Tol, Wietse A; Barbui, Corrado; Galappatti, Ananda; Silove, Derrick; Betancourt, Theresa S; Souza, Renato; Golaz, Anne; van Ommeren, Mark

    2011-10-29

    This review links practice, funding, and evidence for interventions for mental health and psychosocial wellbeing in humanitarian settings. We studied practice by reviewing reports of mental health and psychosocial support activities (2007-10); funding by analysis of the financial tracking service and the creditor reporting system (2007-09); and interventions by systematic review and meta-analysis. In 160 reports, the five most commonly reported activities were basic counselling for individuals (39%); facilitation of community support of vulnerable individuals (23%); provision of child-friendly spaces (21%); support of community-initiated social support (21%); and basic counselling for groups and families (20%). Most interventions took place and were funded outside national mental health and protection systems. 32 controlled studies of interventions were identified, 13 of which were randomised controlled trials (RCTs) that met the criteria for meta-analysis. Two studies showed promising effects for strengthening community and family supports. Psychosocial wellbeing was not included as an outcome in the meta-analysis, because its definition varied across studies. In adults with symptoms of post-traumatic stress disorder (PTSD), meta-analysis of seven RCTs showed beneficial effects for several interventions (psychotherapy and psychosocial supports) compared with usual care or waiting list (standardised mean difference [SMD] -0·38, 95% CI -0·55 to -0·20). In children, meta-analysis of four RCTs failed to show an effect for symptoms of PTSD (-0·36, -0·83 to 0·10), but showed a beneficial effect of interventions (group psychotherapy, school-based support, and other psychosocial support) for internalising symptoms (six RCTs; SMD -0·24, -0·40 to -0·09). Overall, research and evidence focuses on interventions that are infrequently implemented, whereas the most commonly used interventions have had little rigorous scrutiny. PMID:22008428

  18. Breath tests sustainability in hospital settings: cost analysis and reimbursement in the Italian National Health System.

    PubMed

    Volpe, M; Scaldaferri, F; Ojetti, V; Poscia, A

    2013-01-01

    The high demand of Breath Tests (BT) in many gastroenterological conditions in time of limited resources for health care systems, generates increased interest in cost analysis from the point of view of the delivery of services to better understand how use the money to generate value. This study aims to measure the cost of C13 Urea and other most utilized breath tests in order to describe key aspects of costs and reimbursements looking at the economic sustainability for the hospital. A hospital based cost-analysis of the main breath tests commonly delivery in an ambulatory setting is performed. Mean salary for professional nurses and gastroenterologists, drugs/preparation used and disposable materials, purchase and depreciation of the instrument and the testing time was used to estimate the cost, while reimbursements are based on the 2013 Italian National Health System ambulatory pricelist. Variables that could influence the model are considered in the sensitivity analyses. The mean cost for C13--Urea, Lactulose and Lactose BT are, respectively, Euros 30,59; 45,20 and 30,29. National reimbursement often doesn't cover the cost of the analysis, especially considering the scenario with lower number of exam. On the contrary, in high performance scenario all the reimbursement could cover the cost, except for the C13 Urea BT that is high influenced by the drugs cost. However, consideration about the difference between Italian Regional Health System ambulatory pricelist are done. Our analysis shows that while national reimbursement rates cover the costs of H2 breath testing, they do not cover sufficiently C13 BT, particularly urea breath test. The real economic strength of these non invasive tests should be considered in the overall organization of inpatient and outpatient clinic, accounting for complete diagnostic pathway for each gastrointestinal disease. PMID:24443075

  19. Pharmacogenetic Smoking Cessation Intervention in a Health Care Setting: A Pilot Feasibility Study

    PubMed Central

    2013-01-01

    Introduction: There is increasing evidence that response to pharmacological treatment for nicotine dependence may be moderated by genetic polymorphisms. However, the feasibility, acceptability, and impact of genetically tailoring treatment in real-world clinical settings are unknown. Methods: We conducted a multiphased, mixed-methods feasibility study with current smokers to develop and evaluate a patient-centered, theoretically grounded personalized medicine treatment protocol. The initial research phase included formative work to develop intervention materials. The second phase included a randomized pilot trial to evaluate the intervention. Trial participants (n = 36) were genotyped for ANKK1 rs1800497 and were randomized to receive genetic feedback (GF) plus standard behavioral counseling (BC) for smoking cessation or BC without GF. All participants received genetically tailored pharmacotherapy (nicotine patch or bupropion). Results: The intervention was feasible to implement and was acceptable to participants based on satisfaction ratings and objective measures of participation. There was no evidence that the GF resulted in adverse psychological outcomes (e.g., depression, fatalism, reduced perceived control over quitting, differential motivation for quitting) based on quantitative or qualitative outcomes. Conclusions: Study results suggest that it is feasible to offer treatment within a health care setting that includes genetically tailored pharmacotherapy and doing so had no apparent adverse psychological impacts. Further evaluation of pharmacogenetically tailored smoking cessation interventions appears warranted. PMID:22949583

  20. Determinants of Children's Mental Health in War-Torn Settings: Translating Research Into Action.

    PubMed

    Miller, Kenneth E; Jordans, Mark J D

    2016-06-01

    Research on the mental health and psychosocial wellbeing of children in conflict-affected settings has undergone a significant paradigm shift in recent years. Earlier studies based on a war exposure model primarily emphasized the effects of direct exposure to armed conflict; this has gradually given way to a broader understanding of the diverse pathways by which organized violence affects children. A robustly supported comprehensive model includes risk factors at multiple points in time (prior war exposure, ongoing daily stressors) and at all levels of the social ecology. In particular, findings suggest that material deprivation and a set of family variables, including harsh parenting, parental distress, and witnessing intimate partner violence, are important mediators of the relationship between armed conflict and children's wellbeing. To date, however, interventions aimed at supporting war-affected children's wellbeing, both preventive and treatment-focused, have focused primarily on direct work with children, while paying only modest attention to ongoing risk factors in their families and broader environments. Possible reasons for the ongoing prioritization of child-focused interventions are considered, and examples are provided of recent evidence-based interventions that have reduced toxic stressors (harsh parenting and the use of violent discipline by teachers) in conflict-affected communities. PMID:27091645

  1. HIV Screening in the Health Care Setting: Status, Barriers, and Potential Solutions

    PubMed Central

    Rizza, Stacey A.; MacGowan, Robin J.; Purcell, David W.; Branson, Bernard M.; Temesgen, Zelalem

    2012-01-01

    Thirty years into the human immunodeficiency virus (HIV) epidemic in the United States, an estimated 50,000 persons become infected each year: highest rates are in black and Hispanic populations and in men who have sex with men. Testing for HIV has become more widespread over time, with the highest rates of HIV testing in populations most affected by HIV. However, approximately 55% of adults in the United States have never received an HIV test. Because of the individual and community benefits of treatment for HIV, in 2006 the Centers for Disease Control and Prevention recommended routine screening for HIV infection in clinical settings. The adoption of this recommendation has been gradual owing to a variety of issues: lack of awareness and misconceptions related to HIV screening by physicians and patients, barriers at the facility and legislative levels, costs associated with testing, and conflicting recommendations concerning the value of routine screening. Reducing or eliminating these barriers is needed to increase the implementation of routine screening in clinical settings so that more people with unrecognized infection can be identified, linked to care, and provided treatment to improve their health and prevent new cases of HIV infection in the United States. PMID:22958996

  2. CORE-OM Mental Health Norms of Students Attending University Counselling Services Benchmarked against an Age-Matched Primary Care Sample

    ERIC Educational Resources Information Center

    Connell, Janice; Barkham, Michael; Mellor-Clark, John

    2007-01-01

    Whilst concern has been expressed at the increasing severity of the mental health of students, there has been very little research on this growing population outside of small, single institution studies. The aims of this paper are to provide CORE Outcome Measure (CORE-OM) norms for the psychological health of students across multiple sites…

  3. Exploring the Relationships between the Electronic Health Record System Components and Patient Outcomes in an Acute Hospital Setting

    ERIC Educational Resources Information Center

    Wiggley, Shirley L.

    2011-01-01

    Purpose: The purpose of this study was to examine the relationship between the electronic health record system components and patient outcomes in an acute hospital setting, given that the current presidential administration has earmarked nearly $50 billion to the implementation of the electronic health record. The relationship between the…

  4. Guidelines for the Delineation of Roles and Responsibilities for the Safe Delivery of Specialized Health Care in the Educational Setting.

    ERIC Educational Resources Information Center

    Council for Exceptional Children, Reston, VA.

    These guidelines were developed by a joint task force of members and staff of four national associations, to be of assistance to persons concerned with the safe delivery of specialized health care in educational settings. The guidelines delineate the roles and responsibilities of personnel involved in the provision of specialized health care. They…

  5. Independent evolution of the core and accessory gene sets in the genus Neisseria: insights gained from the genome of Neisseria lactamica isolate 020-06

    PubMed Central

    2010-01-01

    Background The genus Neisseria contains two important yet very different pathogens, N. meningitidis and N. gonorrhoeae, in addition to non-pathogenic species, of which N. lactamica is the best characterized. Genomic comparisons of these three bacteria will provide insights into the mechanisms and evolution of pathogenesis in this group of organisms, which are applicable to understanding these processes more generally. Results Non-pathogenic N. lactamica exhibits very similar population structure and levels of diversity to the meningococcus, whilst gonococci are essentially recent descendents of a single clone. All three species share a common core gene set estimated to comprise around 1190 CDSs, corresponding to about 60% of the genome. However, some of the nucleotide sequence diversity within this core genome is particular to each group, indicating that cross-species recombination is rare in this shared core gene set. Other than the meningococcal cps region, which encodes the polysaccharide capsule, relatively few members of the large accessory gene pool are exclusive to one species group, and cross-species recombination within this accessory genome is frequent. Conclusion The three Neisseria species groups represent coherent biological and genetic groupings which appear to be maintained by low rates of inter-species horizontal genetic exchange within the core genome. There is extensive evidence for exchange among positively selected genes and the accessory genome and some evidence of hitch-hiking of housekeeping genes with other loci. It is not possible to define a 'pathogenome' for this group of organisms and the disease causing phenotypes are therefore likely to be complex, polygenic, and different among the various disease-associated phenotypes observed. PMID:21092259

  6. Validation and application of a core set of patient-relevant outcome domains to assess the effectiveness of multimodal pain therapy (VAPAIN): a study protocol

    PubMed Central

    Kaiser, Ulrike; Kopkow, Christian; Deckert, Stefanie; Sabatowski, Rainer; Schmitt, Jochen

    2015-01-01

    Introduction Multimodal pain therapy (MPT) has been established accounting for biopsychosocial consideration in diagnostic and therapy. MPT seems to be effective, but comparability of studies is limited due to diversity of study designs and outcome measurements. The presented study aims to develop a core outcome set consisting of a minimum of outcome measures deemed necessary for medical and therapeutic decision-making, which must be measured in all clinical trials and non-randomised intervention studies. Methods and analysis The study consists of several parts. First, the development and recommendation of preliminary core outcome domains will be based on results of a systematic review and structured online surveys. Participants of the expert panel are representatives of methodological, medical, physiotherapeutic, psychotherapeutic profession and patients suffering from chronic pain (n=25). Subsequently, candidate instruments to measure preliminary core outcome domains will be recommended by these experts. Therefore, systematic reviews on measurement properties of preliminary outcome measures will be conducted and finalised in a consensus meeting. Consented instruments and lacking psychometric properties of relevant instruments will be addressed and validated in the following part, a prospective multicentre study in multimodal pain centres on approximately 300 patients with chronic pain. Based on all previous results, a core outcome set for MPT measured in effectiveness studies and daily recordkeeping will be finalised by consensus. Statistical analyses will be performed according to methodological standards (COSMIN). Ethics and dissemination The methods and procedure of the study are developed in compliance with the ethical principles of the Helsinki Declaration and Good Epidemiologic Practice. Recruitment of study participants will require approval of the study by the responsible ethics committee and signed informed consent from each participant. Pseudonymised

  7. Power and Agenda-Setting in Tanzanian Health Policy: An Analysis of Stakeholder Perspectives

    PubMed Central

    Fischer, Sara Elisa; Strandberg-Larsen, Martin

    2016-01-01

    Background: Global health policy is created largely through a collaborative process between development agencies and aid-recipient governments, yet it remains unclear whether governments retain ownership over the creation of policy in their own countries. An assessment of the power structure in this relationship and its influence over agenda-setting is thus the first step towards understanding where progress is still needed in policy-making for development. Methods: This study employed qualitative policy analysis methodology to examine how health-related policy agendas are adopted in low-income countries, using Tanzania as a case study. Semi-structured, in-depth, key informant interviews with 11 policy-makers were conducted on perspectives of the agenda-setting process and its actors. Kingdon’s stream theory was chosen as the lens through which to interpret the data analysis. Results: This study demonstrates that while stakeholders each have ways of influencing the process, the power to do so can be assessed based on three major factors: financial incentives, technical expertise, and influential position. Since donors often have two or all of these elements simultaneously a natural power imbalance ensues, whereby donor interests tend to prevail over recipient government limitations in prioritization of agendas. One way to mediate these imbalances seems to be the initiation of meaningful policy dialogue. Conclusion: In Tanzania, the agenda-setting process operates within a complex network of factors that interact until a "policy window" opens and a decision is made. Power in this process often lies not with the Tanzanian government but with the donors, and the contrast between latent presence and deliberate use of this power seems to be based on the donor ideology behind giving aid (defined here by funding modality). Donors who used pooled funding (PF) modalities were less likely to exploit their inherent power, whereas those who preferred to maintain maximum

  8. Developing Institutional Capacity for Reproductive Health in Humanitarian Settings: A Descriptive Study

    PubMed Central

    Tran, Nguyen-Toan; Dawson, Angela; Meyers, Janet; Krause, Sandra; Hickling, Carina

    2015-01-01

    Introduction Institutions play a central role in advancing the field of reproductive health in humanitarian settings (RHHS), yet little is known about organizational capacity to deliver RHHS and how this has developed over the past decade. This study aimed to document the current institutional experiences and capacities related to RHHS. Materials and Methods Descriptive study using an online questionnaire tool. Results Respondents represented 82 institutions from 48 countries, of which two-thirds originated from low-and middle-income countries. RHHS work was found not to be restricted to humanitarian agencies (25%), but was also embraced by development organizations (25%) and institutions with dual humanitarian and development mandates (50%). Agencies reported working with refugees (81%), internally-displaced (87%) and stateless persons (20%), in camp-based settings (78%), and in urban (83%) and rural settings (78%). Sixty-eight percent of represented institutions indicated having an RHHS-related policy, 79% an accountability mechanism including humanitarian work, and 90% formal partnerships with other institutions. Seventy-three percent reported routinely appointing RH focal points to ensure coordination of RHHS implementation. There was reported progress in RHHS-related disaster risk reduction (DRR), emergency management and coordination, delivery of the Minimum Initial Services Package (MISP) for RH, comprehensive RH services in post-crisis/recovery situations, gender mainstreaming, and community-based programming. Other reported institutional areas of work included capacity development, program delivery, advocacy/policy work, followed by research and donor activities. Except for abortion-related services, respondents cited improved efforts in advocacy, capacity development and technical support in their institutions for RHHS to address clinical services, including maternal and newborn health, sexual violence prevention and response, HIV prevention, management

  9. Towards a spectroscopically accurate set of potentials for heavy hydride laser cooling candidates: Effective core potential calculations of BaH

    NASA Astrophysics Data System (ADS)

    Moore, Keith; McLaughlin, Brendan M.; Lane, Ian C.

    2016-04-01

    BaH (and its isotopomers) is an attractive molecular candidate for laser cooling to ultracold temperatures and a potential precursor for the production of ultracold gases of hydrogen and deuterium. The theoretical challenge is to simulate the laser cooling cycle as reliably as possible and this paper addresses the generation of a highly accurate ab initio 2Σ+ potential for such studies. The performance of various basis sets within the multi-reference configuration-interaction (MRCI) approximation with the Davidson correction is tested and taken to the Complete Basis Set (CBS) limit. It is shown that the calculated molecular constants using a 46 electron effective core-potential and even-tempered augmented polarized core-valence basis sets (aug-pCVnZ-PP, n = 4 and 5) but only including three active electrons in the MRCI calculation are in excellent agreement with the available experimental values. The predicted dissociation energy De for the X2Σ+ state (extrapolated to the CBS limit) is 16 895.12 cm-1 (2.094 eV), which agrees within 0.1% of a revised experimental value of <16 910.6 cm-1, while the calculated re is within 0.03 pm of the experimental result.

  10. Environmental Health in the School Setting: The Role of the School Nurse. Position Statement

    ERIC Educational Resources Information Center

    McDowell, Bernadette Moran; Bryner, Janet; Chau, Elizabeth A.

    2014-01-01

    Environmental health is a branch of public health that is concerned with all aspects of the natural and built environment. The World Health Organization (WHO) defines environmental health as those aspects of human health and diseases that are determined by factors in the environment. It also refers to the theory and practice of assessing and…

  11. Research for better health: the Panamanian priority-setting experience and the need for a new process

    PubMed Central

    2014-01-01

    Background Panama is, economically, the fastest growing country in Central America and is making efforts to improve management mechanisms for research and innovation. However, due to contextual factors, the Panamanian Health Research System is not well developed and is poorly coordinated with the Health System. Likewise, despite recent efforts to define a National Health Research Agenda, implementing this agenda and aligning it with Panamanians’ health needs remains difficult. This articles aims to review Panama’s experience in health research priority setting by analyzing the fairness of previous prioritization processes in order to promote an agreed-upon national agenda aligned with public health needs. Methods The three health research prioritization processes performed in Panama between 2006 and 2011 were analyzed based on the guidelines established by the four “Accountability for Reasonableness” principles, namely “relevance”, “publicity”, “revision”, and “enforcement”, which provide a framework for evaluating priority-setting fairness. Results The three health research priority-setting events performed in Panama during the reference period demonstrated a heterogeneous pattern of decision-making strategies, stakeholder group composition, and prioritization outcomes. None of the three analyzed events featured an open discussion process with the scientific community, health care providers, or civil society in order to reach consensus. Conclusions This investigation makes evident the lack of a strategy to encourage open discussion by the multiple stakeholders and interest groups that should be involved during the priority-setting process. The analysis reveals the need for a new priority-setting exercise that validates the National Agenda, promotes its implementation by the National Secretariat for Science, Technology and Innovation in conjunction with the Ministry of Health, and empowers multiple stakeholders; such an exercise would, in

  12. "The anticipation alone could kill you": past and potential clients' perspectives on HIV testing in non-health care settings.

    PubMed

    Joseph, Heather A; Fasula, Amy M; Morgan, Rebecca L; Stuckey, Amy; Alvarez, Maria E; Margolis, Andrew; Stratford, Dale; Dooley, Samuel W

    2011-12-01

    HIV testing in non-health care settings is an effective strategy for increasing the proportion of persons aware of their infection. We conducted 21 focus groups with 186 past and potential clients in five U.S. cities to explore attitudes and experiences related to HIV counseling and testing in non-health care settings. Qualitative analysis yielded several key themes. HIV-related stigma and fear emerged as a main theme throughout the discussions. Knowing one's HIV status quickly and accurately was of primary importance; HIV prevention counseling was secondary. Participants prioritized a supportive, nonjudgmental environment with adequate privacy and confidentiality. Provision of immediate emotional support, medical information, and linkage services to HIV-infected clients were considered essential. Staff with HIV-specific skills to address clients' emotional and informational needs was considered a strength of non-health care testing programs. Frequently, however, participants compared non-health care settings unfavorably to health care settings regarding privacy, competency, confidentiality, and test accuracy. Recommendations for enhancing counseling and testing services in non-health care settings are discussed. PMID:22201240

  13. Metabolic control in a nationally representative diabetic elderly sample in Costa Rica: patients at community health centers vs. patients at other health care settings

    PubMed Central

    Brenes-Camacho, Gilbert; Rosero-Bixby, Luis

    2008-01-01

    Background Costa Rica, like other developing countries, is experiencing an increasing burden of chronic conditions such as diabetes mellitus (DM), especially among its elderly population. This article has two goals: (1) to assess the level of metabolic control among the diabetic population age ≥ 60 years old in Costa Rica, and (2) to test whether diabetic elderly patients of community health centers differ from patients in other health care settings in terms of the level of metabolic control. Methods Data come from the project CRELES, a nationally representative study of people aged 60 and over in Costa Rica. This article analyzes a subsample of 542 participants in CRELES with self-reported diagnosis of diabetes mellitus. Odds ratios of poor levels of metabolic control at different health care settings are computed using logistic regressions. Results Lack of metabolic control among elderly diabetic population in Costa Rica is described as follows: 37% have glycated hemoglobin ≥ 7%; 78% have systolic blood pressure ≥ 130 mmHg; 66% have diastolic blood pressure ≥ 80 mmHg; 48% have triglycerides ≥ 150 mg/dl; 78% have LDL ≥ 100 mg/dl; 70% have HDL ≤ 40 mg/dl. Elevated levels of triglycerides and LDL were higher in patients of community health centers than in patients of other clinical settings. There were no statistical differences in the other metabolic control indicators across health care settings. Conclusion Levels of metabolic control among elderly population with DM in Costa Rica are not that different from those observed in industrialized countries. Elevated levels of triglycerides and LDL at community health centers may indicate problems of dyslipidemia treatment among diabetic patients; these problems are not observed in other health care settings. The Costa Rican health care system should address this problem, given that community health centers constitute a means of democratizing access to primary health care to underserved and poor areas. PMID

  14. Electronic health record training in undergraduate medical education: bridging theory to practice with curricula for empowering patient- and relationship-centered care in the computerized setting.

    PubMed

    Wald, Hedy S; George, Paul; Reis, Shmuel P; Taylor, Julie Scott

    2014-03-01

    While electronic health record (EHR) use is becoming state-of-the-art, deliberate teaching of health care information technology (HCIT) competencies is not keeping pace with burgeoning use. Medical students require training to become skilled users of HCIT, but formal pedagogy within undergraduate medical education (UME) is sparse. How can medical educators best meet the needs of learners while integrating EHRs into medical education and practice? How can they help learners preserve and foster effective communication skills within the computerized setting? In general, how can UME curricula be devised for skilled use of EHRs to enhance rather than hinder provision of effective, humanistic health care?Within this Perspective, the authors build on recent publications that "set the stage" for next steps: EHR curricula innovation and implementation as concrete embodiments of theoretical underpinnings. They elaborate on previous calls for maximizing benefits and minimizing risks of EHR use with sufficient focus on physician-patient communication skills and for developing core competencies within medical education. The authors describe bridging theory into practice with systematic longitudinal curriculum development for EHR training in UME at their institution, informed by Kern and colleagues' curriculum development framework, narrative medicine, and reflective practice. They consider this innovation within a broader perspective-the overarching goal of empowering undergraduate medical students' patient- and relationship-centered skills while effectively demonstrating HCIT-related skills. PMID:24448045

  15. Integration of non-communicable diseases in health care: tackling the double burden of disease in African settings

    PubMed Central

    Temu, Florence; Leonhardt, Marcus; Carter, Jane; Thiam, Sylla

    2014-01-01

    Sub-Saharan African countries now face the double burden of Non Communicable and Communicable Diseases. This situation represents a major threat to fragile health systems and emphasises the need for innovative integrative approaches to health care delivery. Health services need to be reorganised to address populations’ needs holistically and effectively leverage resources in already resource-limited settings. Access and delivery of quality health care should be reinforced and implemented at primary health care level within the framework of health system strengthening. Competencies need to be developed around services provided rather than specific diseases. New models of integration within the health sector and other sectors should be explored and further evidence generated to inform policy and practice to combat the double burden. PMID:25419329

  16. Agenda Setting and Evidence in Maternal Health: Connecting Research and Policy in Timor-Leste.

    PubMed

    Wild, Kayli; Kelly, Paul; Barclay, Lesley; Martins, Nelson

    2015-01-01

    The evidence-based policy (EBP) movement has received significant attention in the scientific literature; however, there is still very little empirical research to provide insight into how policy decisions are made and how evidence is used. The lack of research on this topic in low- and middle-income countries is of particular note. We examine the maternity waiting home policy in Timor-Leste to understand the role of context, policy characteristics, individual actors, and how evidence is used to influence the policy agenda. The research tracked the maternity waiting home policy from 2005 to 2009 and is based on in-depth interviews with 31 senior policy-makers, department managers, non-government organization representatives, and United Nations advisors. It is also informed by direct observation, attendance at meetings and workshops, and analysis of policy documents. The findings from this ethnographic case study demonstrate that although the post-conflict context opened up space for new policy ideas senior Ministry of Health officials rather than donors had the most power in setting the policy agenda. Maternity waiting homes were appealing because they were a visible, non-controversial, and logical solution to the problem of accessing maternal health services. Evidence was used in a variety of ways, from supporting pre-determined agendas to informing new policy directions. In the pursuit of EBP, we conclude that the power of research to inform policy lies in its timeliness and relevance, and is facilitated by the connection between researchers and policy-makers. PMID:26442239

  17. Infection in home health care: Results from national Outcome and Assessment Information Set data

    PubMed Central

    Shang, Jingjing; Larson, Elaine; Liu, Jianfang; Stone, Patricia

    2015-01-01

    Background Patients in home health care (HHC), the fastest growing health care sector, are at risk for infection. The existing research on infection in HHC is often limited by small sample sizes, local scope of inquiry, and a lack of current data. There is no national study examining agency-level infection rates. Methods This secondary data analysis used a 20% random sample of the 2010 national Outcome and Assessment Information Set (OASIS) data. An infection case was identified when the HHC patient was hospitalized or received emergency care for respiratory infection, urinary tract infection, intravenous catheter-related infection, wound infection, or deterioration. Proportions of infection cases out of the total number of patients were calculated for the whole sample and for each HHC agency. Results The final analysis included 199,462 patients from 8,255 HHC agencies. Approximately 3.5% of patients developed infections during their HHC stay, leading to emergency care treatment or hospitalization. Seventeen percent of unplanned hospitalizations among HHC patients were caused by infections. The agency-level infection rate ranged from 0%–34%, with an average of 3.5%. Conclusion To our knowledge, this is the first study to examine the proportion of hospitalizations or emergency care treatment caused by infection in HHC and the agency-level infection rate at a national level by using OASIS data. These data demonstrate that infection is a serious problem in HHC, and infection rates varied between agencies. The variance in agency level rates may be caused by differences in infection control policies and practices. Better infection surveillance system in HHC is needed to benchmark quality of care. PMID:25681302

  18. [Family planning and the health care team in the hospital setting].

    PubMed

    Nicole, N

    1982-12-01

    When family planning clinics opened in French-speaking Switzerland in the 1960s, their major function was provision of information on fertility regulation methods. Their functions have expanded over time to include a wider variety of counseling activities. 1 in-hospital family planning service operating in conjunction with the department of obstetrics and gynecology provides contraceptive information each week to 8-10 patients in group or individual settings with or without the partner. Discussions are held on demand about contraception, lactation, sterilization, sexuality, gynecological follow-up care, and sex education of children. The goal is to use the occasion of obstetrical or gynecological events affecting the identity of the woman or her partner for nondirected interviews based on listening and providing objective information. Women or couples are encouraged to express their fears and desires and to overcome taboos. In the gynecological service, individual interviews are held with women hospitalized for abortion, adnexitis or endometritis, miscarriage, intrauterine death, or hysterectomy. Collaboration between the family planning worker and other health workers is promoted through use of brief weekly reports and a monthly colloquium in which cases are presented and discussed. The public at large and other health workers still view family planning counselors solely as contraceptive technicians, but in fact these workers are obliged to take account of psychic, sexual, and relational issues that contraception invariably raises. To respond to these new demands, family counselors can provide information and education, or counseling and support, or they can refer clients to specialists such as sexologists, marriage counselors, or psychiatrists. A family planning service may, through its wide range of activities, prevent a useless psychiatrisation of problems. PMID:12281319

  19. Measuring Respiratory Pressures with Mercury Manometer in Low Economic Health Care Settings- An Analytical Study

    PubMed Central

    Hariharan, Vishnupriya; Manivel, Rajajeyakumar; Trakroo, Madanmohan

    2016-01-01

    Introduction Health care economics restricts many health centers from using hi-tech diagnostics equipment. Mercury manometers are used for calibration of pressure transducers. If standardized it would be a cost effective, simple alternative to transducers in low economic settings. Aim To analyse the feasibility of mercury manometer usage in respiratory pressure measurement. Materials and Methods The experimental study was conducted with 30 healthy volunteers of age group 17–19 yrs. They were recruited by using simple random sampling method. The volunteers were made familiarized to lab environment, instrument and techniques of maximum inspiratory (Pimax) and expiratory pressures (Pemax). Then parameters were recorded using mercury manometer connected to different syringes as mouth piece (2.5 ml, 10 ml, and 20 ml) and with sphygmomanometer. Statistical analysis was done by using IBM SPSS statistics version 21. Results The Pimax was 111.07 ± 6.53 with a 2.5 ml syringe as mouth piece. With 20 ml syringe it was 61.47 ± 9.98. PEmax with 2.5 ml syringe was 70.33 ± 8.19 with a confidence limit of 2.93 and with sphygmomanometer was 99.33 ± 8.16 with a confidence limit of 2.92. There was a change in recorded pressure and the correlation analysis result showed a significant difference from both above and below 10 ml mouth piece range. Conclusion Mercury manometers could be used for recording respiratory pressures in low economic facilities once standardized. Size of syringe to be used as mouth piece needs further more works although this study finds 10 ml syringe as suitable. PMID:26894061

  20. A clinical algorithm for triaging patients with significant lymphadenopathy in primary health care settings in Sudan

    PubMed Central

    El Hag, Imad A.; Elsiddig, Kamal E.; Elsafi, Mohamed E.M.O; Elfaki, Mona E.E.; Musa, Ahmed M.; Musa, Brima Y.; Elhassan, Ahmed M.

    2013-01-01

    Abstract Background Tuberculosis is a major health problem in developing countries. The distinction between tuberculous lymphadenitis, non-specific lymphadenitis and malignant lymph node enlargement has to be made at primary health care levels using easy, simple and cheap methods. Objective To develop a reliable clinical algorithm for primary care settings to triage cases of non-specific, tuberculous and malignant lymphadenopathies. Methods Calculation of the odd ratios (OR) of the chosen predictor variables was carried out using logistic regression. The numerical score values of the predictor variables were weighed against their respective OR. The performance of the score was evaluated by the ROC (Receiver Operator Characteristic) curve. Results Four predictor variables; Mantoux reading, erythrocytes sedimentation rate (ESR), nocturnal fever and discharging sinuses correlated significantly with TB diagnosis and were included in the reduced model to establish score A. For score B, the reduced model included Mantoux reading, ESR, lymph-node size and lymph-node number as predictor variables for malignant lymph nodes. Score A ranged 0 to 12 and a cut-off point of 6 gave a best sensitivity and specificity of 91% and 90% respectively, whilst score B ranged -3 to 8 and a cut-off point of 3 gave a best sensitivity and specificity of 83% and 76% respectively. The calculated area under the ROC curve was 0.964 (95% CI, 0.949 – 0.980) and -0.856 (95% CI, 0.787 - 0.925) for scores A and B respectively, indicating good performance. Conclusion The developed algorithm can efficiently triage cases with tuberculous and malignant lymphadenopathies for treatment or referral to specialised centres for further work-up.

  1. Agenda Setting and Evidence in Maternal Health: Connecting Research and Policy in Timor-Leste

    PubMed Central

    Wild, Kayli; Kelly, Paul; Barclay, Lesley; Martins, Nelson

    2015-01-01

    The evidence-based policy (EBP) movement has received significant attention in the scientific literature; however, there is still very little empirical research to provide insight into how policy decisions are made and how evidence is used. The lack of research on this topic in low- and middle-income countries is of particular note. We examine the maternity waiting home policy in Timor-Leste to understand the role of context, policy characteristics, individual actors, and how evidence is used to influence the policy agenda. The research tracked the maternity waiting home policy from 2005 to 2009 and is based on in-depth interviews with 31 senior policy-makers, department managers, non-government organization representatives, and United Nations advisors. It is also informed by direct observation, attendance at meetings and workshops, and analysis of policy documents. The findings from this ethnographic case study demonstrate that although the post-conflict context opened up space for new policy ideas senior Ministry of Health officials rather than donors had the most power in setting the policy agenda. Maternity waiting homes were appealing because they were a visible, non-controversial, and logical solution to the problem of accessing maternal health services. Evidence was used in a variety of ways, from supporting pre-determined agendas to informing new policy directions. In the pursuit of EBP, we conclude that the power of research to inform policy lies in its timeliness and relevance, and is facilitated by the connection between researchers and policy-makers. PMID:26442239

  2. Health protection of health care workers from the prospective of ethics, science and good medical practice. Opinions from stakeholders in health care settings.

    PubMed

    Porru, S; Cannatelli, P; Cerioli, Beloyanna; Flor, L; Gramegna, Maria; Polato, R; Rodriguez, D

    2012-01-01

    Fitness for work (FFW) in health care workers poses multidisciplinary challenges because of management problems scientific and ethical implications and the implementation of preventive interventions in health care settings. All the relevant stakeholders, including the General Manager, Medical Director, worker's representative, the person responsible for prevention and protection, forensic medicine expert, the person responsible for prevention and health safety at public administration level, commented on: danger to third parties; FFW formulation; human resource management; stress; professional independence; role of the person responsible for prevention and protection and of the person responsible for prevention at public administration level; professional responsibilities. Opinions are reported regarding the main problems related to the role of the Occupational Physician in FFW formulation, such as the difficult balance between autonomy and independence, limited turnover and aging of workforce, need of confidentiality and respect for professional status of the HCW prevalence of susceptibility conditions, rights and duties of stakeholders. The most significant result was the request by the Lombardy Region for more quality in risk assessment and health surveillance; to maintain uniform conduct over all the local health authorities, to allow the board in charge of examining appeals against FFW to fully cooperate with the occupational physician; due attention to the person/worker; the opportunity to convene referral boards for complex FFW management; the challenge of stress management and the need for an observatory for psychological discomforts; the importance of the ICOH Code of Ethics and avoidance of conflicts of interests; the need for individual risk assessment and risk management; the concept of sharing responsibilities and of a real multidisciplinary approach. PMID:22838299

  3. Setting research priorities to improve the health of children and young people with neurodisability: a British Academy of Childhood Disability-James Lind Alliance Research Priority Setting Partnership

    PubMed Central

    Morris, Christopher; Simkiss, Doug; Busk, Mary; Morris, Maureen; Allard, Amanda; Denness, Jacob; Janssens, Astrid; Stimson, Anna; Coghill, Joanna; Robinson, Kelly; Fenton, Mark; Cowan, Katherine

    2015-01-01

    Objectives To engage young people, parent carers and clinicians in a systematic process to identify and prioritise research questions regarding ways to improve the health and well-being of children and young people with neurodisability. Design British Academy of Childhood Disability (BACD)-James Lind Alliance research priority setting partnership bringing together patients, carers and clinicians as equal stakeholders. Setting UK health service and community. Methods The BACD Strategic Research Group formed the partnership. A Steering Group was established; charity and professional partner organisations were recruited. Suggestions were gathered in an open survey and from research recommendations for statutory guidance. Items were aggregated to formulate indicative research questions and verified as uncertainties from research evidence. An interim survey was used to rank the questions to shortlist topics. A mixed group of stakeholders discussed the top 25 questions at the final priority setting workshop agreeing a final rank order and the top 10 research priorities. Participants Partner organisations were 13 charities and 8 professional societies. 369 people submitted suggestions (40% non-clinicians). 76 people participated in the interim prioritisation (26 parents, 1 young person, 10 charity representatives, 39 clinicians); 22 took part in the final workshop (3 young people, 7 parents, 3 charity representatives, 9 professionals). Results The top three research priorities related to (1) establishing the optimal frequency and intensity (dose) for mainstream therapies, (2) means for selecting and encouraging use of communication strategies and (3) ways to improve children's attitudes towards disability. The top 10 included evaluating interventions to promote mobility, self-efficacy, mental health, continence, physical fitness, educational inclusion and reduce impacts of sleep disturbance. Conclusions The methodology provided a systematic and transparent process to

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

    ERIC Educational Resources Information Center

    Parcover, Jason; Mays, Sally; McCarthy, Amy

    2015-01-01

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

  5. Don't ask, they won't tell: the quality of adolescent health screening in five practice settings.

    PubMed Central

    Blum, R W; Beuhring, T; Wunderlich, M; Resnick, M D

    1996-01-01

    OBJECTIVES: This study examined the extent to which comprehensive, age-appropriate adolescent health screening is undertaken in the clinical setting and whether the extent of such screening varies by setting. METHODS: Charts of adolescents 13 to 17 years old (n = 788) were randomly selected from five practice settings in Minneapolis, Minn. Each was assessed for the number of biomedical and sociobehavioral health risks screened. RESULTS: In no practice setting was there screening to the level recommended. The two teen clinics screened more extensively for behavioral, psychosocial, substance use and sexual behavior risks than the community family practice setting, which, in turn, screened more extensively than either the private family practice or private pediatric practice settings, which did not differ from each other. Age differences and gender accounted for only small amounts of variance in total number of health risks screened, whereas differences among practice settings accounted for a larger amount. CONCLUSIONS: Results suggest substantive deficiencies in private practice settings' implementation of preventive care screening protocols for adolescents. PMID:9003135

  6. Setting health research priorities using the CHNRI method: VI. Quantitative properties of human collective opinion

    PubMed Central

    Yoshida, Sachiyo; Rudan, Igor; Cousens, Simon

    2016-01-01

    Introduction Crowdsourcing has become an increasingly important tool to address many problems – from government elections in democracies, stock market prices, to modern online tools such as TripAdvisor or Internet Movie Database (IMDB). The CHNRI method (the acronym for the Child Health and Nutrition Research Initiative) for setting health research priorities has crowdsourcing as the major component, which it uses to generate, assess and prioritize between many competing health research ideas. Methods We conducted a series of analyses using data from a group of 91 scorers to explore the quantitative properties of their collective opinion. We were interested in the stability of their collective opinion as the sample size increases from 15 to 90. From a pool of 91 scorers who took part in a previous CHNRI exercise, we used sampling with replacement to generate multiple random samples of different size. First, for each sample generated, we identified the top 20 ranked research ideas, among 205 that were proposed and scored, and calculated the concordance with the ranking generated by the 91 original scorers. Second, we used rank correlation coefficients to compare the ranks assigned to all 205 proposed research ideas when samples of different size are used. We also analysed the original pool of 91 scorers to to look for evidence of scoring variations based on scorers' characteristics. Results The sample sizes investigated ranged from 15 to 90. The concordance for the top 20 scored research ideas increased with sample sizes up to about 55 experts. At this point, the median level of concordance stabilized at 15/20 top ranked questions (75%), with the interquartile range also generally stable (14–16). There was little further increase in overlap when the sample size increased from 55 to 90. When analysing the ranking of all 205 ideas, the rank correlation coefficient increased as the sample size increased, with a median correlation of 0.95 reached at the sample size

  7. Setting the Stage: Coordinated Approaches to School Health and Physical Education

    ERIC Educational Resources Information Center

    Kelder, Steven H.; Karp, Grace Goc; Scruggs, Philip W.; Brown, Helen

    2014-01-01

    Is there anything more important than the health, well-being and education of a nation's children? This paper takes the position that school is the most important place to educate children about health and to develop lifelong health promoting skills. We believe that health promotion programs and activities are integral to the school's…

  8. Mental health treatment in the primary care setting: patterns and pathways.

    PubMed

    Petterson, Stephen; Miller, Benjamin F; Payne-Murphy, Jessica C; Phillips, Robert L

    2014-06-01

    The redesign of primary care through the patient-centered medical home offers an opportunity to assess the role of primary care in treating mental health relative to the rest of the health care system. Better understanding the patterns of care between primary care and mental health providers helps guide necessary policy changes. This article reports the findings from 109,593 respondents to the 2002-2009 Medical Expenditure Panel Surveys (MEPS). We examined the extent to which persons with poor mental health visited primary care providers, and distinguished among 4 patterns of care: (a) mental health only, (b) primary care only, (c) dual care (both mental health and primary care) and (d) other provider combinations. Our findings indicate that poor mental health and specific mental health conditions remain prevalent in primary care. An increased focus on patient-centered care requires greater integration of primary and mental health care to reduce fragmentation of care and disparities in health outcomes. PMID:24773273

  9. Creating a high-reliability health care system: improving performance on core processes of care at Johns Hopkins Medicine.

    PubMed

    Pronovost, Peter J; Armstrong, C Michael; Demski, Renee; Callender, Tiffany; Winner, Laura; Miller, Marlene R; Austin, J Matthew; Berenholtz, Sean M; Yang, Ting; Peterson, Ronald R; Reitz, Judy A; Bennett, Richard G; Broccolino, Victor A; Davis, Richard O; Gragnolati, Brian A; Green, Gene E; Rothman, Paul B

    2015-02-01

    In this article, the authors describe an initiative that established an infrastructure to manage quality and safety efforts throughout a complex health care system and that improved performance on core measures for acute myocardial infarction, heart failure, pneumonia, surgical care, and children's asthma. The Johns Hopkins Medicine Board of Trustees created a governance structure to establish health care system-wide oversight and hospital accountability for quality and safety efforts throughout Johns Hopkins Medicine. The Armstrong Institute for Patient Safety and Quality was formed; institute leaders used a conceptual model nested in a fractal infrastructure to implement this initiative to improve performance at two academic medical centers and three community hospitals, starting in March 2012. The initiative aimed to achieve ≥ 96% compliance on seven inpatient process-of-care core measures and meet the requirements for the Delmarva Foundation and Joint Commission awards. The primary outcome measure was the percentage of patients at each hospital who received the recommended process of care. The authors compared health system and hospital performance before (2011) and after (2012, 2013) the initiative. The health system achieved ≥ 96% compliance on six of the seven targeted measures by 2013. Of the five hospitals, four received the Delmarva Foundation award and two received The Joint Commission award in 2013. The authors argue that, to improve quality and safety, health care systems should establish a system-wide governance structure and accountability process. They also should define and communicate goals and measures and build an infrastructure to support peer learning. PMID:25517699

  10. Life in acute mental health settings: experiences and perceptions of service users and nurses.

    PubMed

    Rose, D; Evans, J; Laker, C; Wykes, T

    2015-02-01

    Background. Acute psychiatric provision in the UK today as well as globally has many critics including service users and nurses. Method. Four focus groups, each meeting twice, were held separately for service users and nurses. The analysis was not purely inductive but driven by concerns with the social position of marginalised groups - both patients and staff. Results. The main themes were nurse/patient interaction and coercion. Service users and nurses conceptualised these differently. Service users found nurses inaccessible and uncaring, whereas nurses also felt powerless because their working life was dominated by administration. Nurses saw coercive situations as a reasonable response to factors 'internal' to the patient whereas for service users they were driven to extreme behaviour by the environment of the ward and coercive interventions were unnecessary and heavy handed. Conclusion. This study sheds new light on living and working in acute mental health settings today by comparing the perceptions of service users and nurses and deploying service user and nurse researchers. The intention is to promote better practice by providing a window on the perceptions of both groups. PMID:24330951

  11. Leadership support for ward managers in acute mental health inpatient settings.

    PubMed

    Bonner, Gwen; McLaughlin, Sue

    2014-05-01

    This article shares findings of work undertaken with a group of mental health ward managers to consider their roles through workshops using an action learning approach. The tensions between the need to balance the burden of administrative tasks and act as clinical role models, leaders and managers are considered in the context of providing recovery-focused services. The group reviewed their leadership styles, broke down the administrative elements of their roles using activity logs, reviewed their working environments and considered how recovery focused they believed their wards to be. Findings support the notion that the ward manager role in acute inpatient settings is at times unmanageable. Administration is one aspect of the role for which ward managers feel unprepared and the high number of administrative tasks take them away from front line clinical care, leading to frustration. Absence from clinical areas reduces opportunities for role modeling good clinical practice to other staff. Despite the frustrations of administrative tasks, overall the managers thought they were supportive to their staff and that their wards were recovery focused. PMID:24779763

  12. Treatment of Individuals with Borderline Personality Disorder Using Dialectical Behavior Therapy in a Community Mental Health Setting: Clinical Application and a Preliminary Investigation

    ERIC Educational Resources Information Center

    Ben-Porath, Denise D.; Peterson, Gregory A.; Smee, Jacqueline

    2004-01-01

    This article describes an effort to implement and examine dialectical behavior therapy's (DBT) effectiveness in a community mental health setting. Modifications made to address unique aspects of community mental health settings are described. Barriers encountered in implementation of DBT treatment in community mental health settings, such as staff…

  13. Public views on principles for health care priority setting: findings of a European cross-country study using Q methodology.

    PubMed

    van Exel, Job; Baker, Rachel; Mason, Helen; Donaldson, Cam; Brouwer, Werner

    2015-02-01

    Resources available to the health care sector are finite and typically insufficient to fulfil all the demands for health care in the population. Decisions must be made about which treatments to provide. Relatively little is known about the views of the general public regarding the principles that should guide such decisions. We present the findings of a Q methodology study designed to elicit the shared views in the general public across ten countries regarding the appropriate principles for prioritising health care resources. In 2010, 294 respondents rank ordered a set of cards and the results of these were subject to by-person factor analysis to identify common patterns in sorting. Five distinct viewpoints were identified, (I) "Egalitarianism, entitlement and equality of access"; (II) "Severity and the magnitude of health gains"; (III) "Fair innings, young people and maximising health benefits"; (IV) "The intrinsic value of life and healthy living"; (V) "Quality of life is more important than simply staying alive". Given the plurality of views on the principles for health care priority setting, no single equity principle can be used to underpin health care priority setting. Hence, the process of decision making becomes more important, in which, arguably, these multiple perspectives in society should be somehow reflected. PMID:25550076

  14. Striving to promote male involvement in maternal health care in rural and urban settings in Malawi - a qualitative study

    PubMed Central

    2011-01-01

    Background Understanding the strategies that health care providers employ in order to invite men to participate in maternal health care is very vital especially in today's dynamic cultural environment. Effective utilization of such strategies is dependent on uncovering the salient issues that facilitate male participation in maternal health care. This paper examines and describes the strategies that were used by different health care facilities to invite husbands to participate in maternal health care in rural and urban settings of southern Malawi. Methods The data was collected through in-depth interviews from sixteen of the twenty health care providers from five different health facilities in rural and urban settings of Malawi. The health facilities comprised two health centres, one district hospital, one mission hospital, one private hospital and one central hospital. A semi-structured interview guide was used to collect data from health care providers with the aim of understanding strategies they used to invite men to participate in maternal health care. Results Four main strategies were used to invite men to participate in maternal health care. The strategies were; health care provider initiative, partner notification, couple initiative and community mobilization. The health care provider initiative and partner notification were at health facility level, while the couple initiative was at family level and community mobilization was at village (community) level. The community mobilization had three sub-themes namely; male peer initiative, use of incentives and community sensitization. The sustainability of each strategy to significantly influence behaviour change for male participation in maternal health care is discussed. Conclusion Strategies to invite men to participate in maternal health care were at health facility, family and community levels. The couple strategy was most appropriate but was mostly used by educated and city residents. The male peer

  15. Short, Subjective Measures of Numeracy and General Health Literacy in an Adult Emergency Department Setting

    PubMed Central

    Wallston, Kenneth A.; Rothman, Russell L.; Marcovitz, David E.; Storrow, Alan B.

    2014-01-01

    Objectives To evaluate the reliability and validity of brief subjective measures of numeracy and general health literacy in the adult emergency department setting. Methods A convenience sample of adult emergency department patients completed subjective measures of general health literacy (Short Literacy Screening questions, SLS) and numeracy (Subjective Numeracy Scale, SNS). These patients also completed two objective tests of literacy (the Short Test of Functional Health Literacy in Adults, S-TOFHLA; and the Rapid Estimate of Adult Literacy in Medicine, REALM) and an objective test of numeracy (WRAT4). Internal reliability of the subjective measures was assessed using Cronbach’s alpha. Construct validity of the subjective measures was assessed by correlating them against the S-TOFHLA, REALM, and WRAT4, using Spearman’s rank correlation coefficients, receiver operating characteristics (ROC) curves, and hierarchical, multiple linear regression with adjustment for patient age, gender, race, and education. Results The median age of the 207 patients surveyed was 46 (interquartile range 32, 59); twenty-seven percent were African American. Sixty-one percent of patients reported their highest level of education was high school or below. As measured by the S-TOFHLA and REALM, most patients had adequate literacy levels (89% and 80%, respectively), while 44% of patients had below average numeracy skills on the WRAT4. Median SLS was 14 (IQR 12, 15) on a scale of 3 to 15; median SNS was 36 (IQR 30, 42) on a scale of 6 to 48. The SLS and SNS had good internal reliability, with Cronbach’s alphas of 0.74 and 0.82, respectively. The SLS Spearman’s rank order correlation coefficient was 0.33 (95% confidence interval 0.20, 0.45) for the S-TOFHLA, with a standardized beta coefficient of 0.36 (p<0.05) after adjustment for patient demographics. The SLS correlation coefficient was 0.26 (95% CI 0.13, 0.38) for the REALM, with a standardized beta coefficient of 0.38 (p<0.05) after

  16. Addressing the sexual problems of Iranian women in a primary health care setting: A quasi-experimental study

    PubMed Central

    Rostamkhani, Fatemeh; Jafari, Fatemeh; Ozgoli, Giti; Shakeri, Masomeh

    2015-01-01

    Background: The World Health Organization emphasizes on integration of sexual health into primary health care services, educating people and health care workers about sexuality, and promoting optimal sexual health. Despite the high prevalence of sexual problems, these problems are poorly managed in primary health care services. This study was conducted to evaluate the efficacy and feasibility of the first two steps of PLISSIT (Permission, Limited Information, Specific Suggestions, Intensive Treatment) model for handling of women sexual problems in a primary health care setting. Materials and Methods: This was a quasi-experimental study that was carried out in Zanjan, northwest of Iran. Eighty women who had got married in the past 5 years and had sexual problem were randomly assigned to control and intervention groups. The intervention group received consultation based on PLISSIT model by a trained midwife and the control group received routine services. Female Sexual Function Index (FSFI) questionnaire was used for assessing and tracking any changes in sexual function. Data were collected at three points: Before consultation and 2 and 4 weeks after consultation. Paired t-test and repeated measures analysis of variance (ANOVA) test were used for comparison of scores within groups. Results: Significant improvement was found in FSFI sub-domain scores, including sexual desire (P < 0.0001), arousal (P < 0.0001), lubrication (P < 0.0001), orgasm (P = 0.005), satisfaction (P = 0.005), pain (P < 0.0001), and FSFI total score (P < 0.0001) in the intervention group compared to the control group. Conclusions: This study showed that PLISSIT model can meet the sexual health needs of clients in a primary health care setting and it can be used easily by health workers in this setting for addressing sexual complaints and dysfunctions. PMID:25709703

  17. Guidance on priority setting in health care (GPS-Health): the inclusion of equity criteria not captured by cost-effectiveness analysis

    PubMed Central

    2014-01-01

    This Guidance for Priority Setting in Health Care (GPS-Health), initiated by the World Health Organization, offers a comprehensive map of equity criteria that are relevant to health care priority setting and should be considered in addition to cost-effectiveness analysis. The guidance, in the form of a checklist, is especially targeted at decision makers who set priorities at national and sub-national levels, and those who interpret findings from cost-effectiveness analysis. It is also targeted at researchers conducting cost-effectiveness analysis to improve reporting of their results in the light of these other criteria. The guidance was develop through a series of expert consultation meetings and involved three steps: i) methods and normative concepts were identified through a systematic review; ii) the review findings were critically assessed in the expert consultation meetings which resulted in a draft checklist of normative criteria; iii) the checklist was validated though an extensive hearing process with input from a range of relevant stakeholders. The GPS-Health incorporates criteria related to the disease an intervention targets (severity of disease, capacity to benefit, and past health loss); characteristics of social groups an intervention targets (socioeconomic status, area of living, gender; race, ethnicity, religion and sexual orientation); and non-health consequences of an intervention (financial protection, economic productivity, and care for others). PMID:25246855

  18. Managing Ethical Challenges to Mental Health Research in Post‐Conflict Settings

    PubMed Central

    Khan, Muhammad Naseem; Rahman, Atif; Frith, Lucy

    2015-01-01

    Abstract Recently the World Health Organization (WHO) has highlighted the need to strengthen mental health systems following emergencies, including natural and manmade disasters. Mental health services need to be informed by culturally attuned evidence that is developed through research. Therefore, there is an urgent need to establish rigorous ethical research practice to underpin the evidence‐base for mental health services delivered during and following emergencies. PMID:25580875

  19. Managing Ethical Challenges to Mental Health Research in Post-Conflict Settings.

    PubMed

    Chiumento, Anna; Khan, Muhammad Naseem; Rahman, Atif; Frith, Lucy

    2016-04-01

    Recently the World Health Organization (WHO) has highlighted the need to strengthen mental health systems following emergencies, including natural and manmade disasters. Mental health services need to be informed by culturally attuned evidence that is developed through research. Therefore, there is an urgent need to establish rigorous ethical research practice to underpin the evidence-base for mental health services delivered during and following emergencies. PMID:25580875

  20. Unmet Needs of Children with Special Health Care Needs in a Specialized Day School Setting

    ERIC Educational Resources Information Center

    Aruda, Mary M.; Kelly, Mary; Newinsky, Karina

    2011-01-01

    Children with Special Health Care Needs (CSHCN) represent a significant component of the pediatric population. They often present to schools with multiple and increasingly complex health issues, including medical technology dependency. Their daily variation in health status requires close monitoring and communication among caregivers. Limited…

  1. Ready, Set, Grow! Health Education for 3-5 Year Olds.

    ERIC Educational Resources Information Center

    Peterson, Paula J.

    Intended for use in family day care, preschool centers, professional preparation institutions, and in homes, this comprehensive health education curriculum for 3- through 5-year-old children contains units designed to sequentially teach concepts about physical health, mental health, family living, and safety. Contents include the following…

  2. Feasibility of Expanding Services for Very Young Children in the Public Mental Health Setting

    ERIC Educational Resources Information Center

    Knapp, Penelope K.; Ammen, Sue; Arstein-Kerslake, Cindy; Poulsen, Marie Kanne; Mastergeorge, Ann

    2007-01-01

    Objective: A quality-improvement study evaluated the feasibility of training mental health providers to provide mental health screening and relationship-based intervention to expand services for children 0 to 5 years of age in eight California county mental health systems from November 2002 to June 2003. State-level training was provided to more…

  3. 75 FR 75469 - Priority Setting for the Children's Health Insurance Program Reauthorization Act (CHIPRA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-03

    ... Children's Health Insurance Program Reauthorization Act of 2009 (Pub. L. 111-3) amended title Xl of the... enacted the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 (Pub. L. 111-3... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH...

  4. Education for Health in the School Community Setting. A Position Paper.

    ERIC Educational Resources Information Center

    American Public Health Association, Washington, DC.

    In this position paper of the American Public Health Association (APHA), emphasis is placed on the magnitude of the K-12 school community in both size and the duration of time individuals spend there and the subsequent need of good health education. The APHA states that it is concerned about the traditional crisis approach to health care, where…

  5. Health Researchers’ Ancillary Care Obligations in Low-Resource Settings How Can We Tell What Is Morally Required?

    PubMed Central

    Merritt, Maria W.

    2013-01-01

    Health researchers working in low-resource settings often encounter serious unmet health needs among participants. What is the nature and extent of researchers’ obligations to respond to such needs? Competing accounts have been proposed, but there is no independent standard by which to assess them or to guide future inquiry. I propose an independent standard and demonstrate its use. In conclusion I recommend two areas of focus for future inquiry: what makes an account of researchers’ obligations reasonable from the standpoint of both participants and researchers and how general duties of rescue apply to researchers’ resource-allocation decision making in low-resource settings. PMID:22187929

  6. DUBLIN CORE

    EPA Science Inventory

    The Dublin Core is a metadata element set intended to facilitate discovery of electronic resources. It was originally conceived for author-generated descriptions of Web resources, and the Dublin Core has attracted broad ranging international and interdisciplinary support. The cha...

  7. Identification of airborne microbiota in selected areas in a health-care setting in South Africa

    PubMed Central

    2014-01-01

    Background The role of bio-aerosols in the spread of disease and spoilage of food has been described in numerous studies; nevertheless this information at South African hospitals is limited. Attributable to their size, bio-aerosols may be suspended in the air for long periods placing patients at risk of infection and possibly settling on surfaces resulting in food contamination. The aim of the study is to assess the microbial composition of the air in the kitchen and selected wards at a typical district hospital in South Africa. Air samples were collected using the settle plates and an SAS Super 90 air sampler by impaction on agar. These microbial samples were quantified and identified using Matrix Assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) and Analytic Profile Index (API). Results Microbial counts were found to be higher in the fourth (≤6.0 × 101 cfu/m-3) sampling rounds when compared to the first (≥2 cfu/m-3), second (≤3.0 × 101 cfu/m-3) and third (≤1.5 × 101 cfu/m-3) sampling rounds. Genera identified included Bacillus, Kocuria, Staphylococcus, Arthrobacter, Candida, Aureobasidium, Penicillium and Phoma amongst others. The presence of these pathogens is of concern, attributable to their ability to cause diseases in humans especially in those with suppressed host immunity defenses. Furthermore, fungal genera identified (e.g. Candida) in this study are also known to cause food spoilage and fungal infections in patients. Conclusion Results from this study indicate the importance of air quality monitoring in health-care settings to prevent possible hospital-acquired infections and contamination of hospital surfaces including food contact surfaces by airborne contaminants. PMID:24750818

  8. Errorless Learning for Training Individuals With Schizophrenia at a Community Mental Health Setting Providing Work Experience

    PubMed Central

    Kern, Robert S.; Liberman, Robert P.; Becker, Deborah R.; Drake, Robert E.; Sugar, Catherine A.; Green, Michael F.

    2009-01-01

    The effects of errorless learning (EL) on work performance, tenure, and personal well-being were compared with conventional job training in a community mental health fellowship club offering 12-week time-limited work experience. Participants were 40 clinically stable schizophrenia and schizoaffective disorder outpatients randomly assigned to EL vs conventional instruction (CI) at a thrift-type clothing store. EL participants received training on how to perform their assigned job tasks based on principles of EL, such as error reduction and automation of task performance. CI participants received training common to other community-based entry-level jobs that included verbal instruction, a visual demonstration, independent practice, and corrective feedback. Participants were scheduled to work 2 hours per week for 12 weeks. For both groups, job training occurred during the first 2 weeks at the worksite. Work performance (assessed using the Work Behavior Inventory, WBI) and personal well-being (self-esteem, job satisfaction, and work stress) were assessed at weeks 2, 4, and 12. Job tenure was defined as the number of weeks on the job or total number of hours worked prior to quitting or study end. The EL group performed better than the CI group on the Work Quality Scale from the WBI, and the group differences were relatively consistent over time. Results from the survival analyses of job tenure revealed a non-significant trend favoring EL. There were no group differences on self-esteem, job satisfaction, or work stress. The findings provide modest support for the extensions of EL to community settings for enhancing work performance. PMID:18326529

  9. Mental health service utilization in sub-Saharan Africa: is public mental health literacy the problem? Setting the perspectives right.

    PubMed

    Atilola, Olayinka

    2016-06-01

    The severely constrained resources for mental health service in less-developed regions like sub-Saharan Africa underscore the need for good public mental health literacy as a potential additional mental health resource. Several studies examining the level of public knowledge about the nature and dynamics of mental illness in sub-Saharan Africa in the last decade had concluded that such knowledge was poor and had called for further public enlightenment. What was thought to be mental health 'ignorance' has also been blamed for poor mainstream service utilization. These views however assume that non-alignment of the views of community dwellers in sub-Saharan Africa with the biomedical understanding of mental illness connotes 'ignorance', and that correcting such 'ignorance' will translate to improvements in service utilization. Within the framework of contemporary thinking in mental health literacy, this paper argues that such assumptions are not culturally nuanced and may have overrated the usefulness of de-contextualized public engagement in enhancing mental health service utilization in the region. The paper concludes with a discourse on how to contextualize public mental health enlightenment in the region and the wider policy initiatives that can improve mental health service utilization. PMID:25749253

  10. Does cortisol influence core executive functions? A meta-analysis of acute cortisol administration effects on working memory, inhibition, and set-shifting.

    PubMed

    Shields, Grant S; Bonner, Joseph C; Moons, Wesley G

    2015-08-01

    The hormone cortisol is often believed to play a pivotal role in the effects of stress on human cognition. This meta-analysis is an attempt to determine the effects of acute cortisol administration on core executive functions. Drawing on both rodent and stress literatures, we hypothesized that acute cortisol administration would impair working memory and set-shifting but enhance inhibition. Additionally, because cortisol is thought to exert different nongenomic (rapid) and genomic (slow) effects, we further hypothesized that the effects of cortisol would differ as a function of the delay between cortisol administration and cognitive testing. Although the overall analyses were nonsignificant, after separating the rapid, nongenomic effects of cortisol from the slower, genomic effects of cortisol, the rapid effects of cortisol enhanced response inhibition, g+ = 0.113, p=.016, but impaired working memory, g+ = -0.315, p=.008, although these effects reversed over time. Contrary to our hypotheses, there was no effect of cortisol administration on set-shifting. Thus, although we did not find support for the idea that increases in cortisol influence set-shifting, we found that acute increases in cortisol exert differential effects on working memory and inhibition over time. PMID:25973565

  11. Health promotion in the Danish maritime setting: challenges and possibilities for changing lifestyle behavior and health among seafarers

    PubMed Central

    2013-01-01

    Background Seafaring is a risky occupation when compared to land-based industries as incidence rates of mortality and morbidity are higher. This trend is partly due to a higher number of accidents but also higher incidence of lifestyle-related diseases like cardiovascular disease and lung cancer. In Denmark, the proportion of smokers as well as of overweight and obese persons is higher among seafarers compared to the general population. This high burden of risk indicates that this occupational group might be a growing challenge at sea in regard to safety and health issues and there is a need to further our understanding of the health promotion approaches that work. Methods A single-group pre-post design was conducted in 2008–2009 in order to identify changes in lifestyle related behaviors and health risk factors among seafarers (N: 606) in two Danish shipping companies after implementing two structural health promotion interventions (healthy cooking courses for ship cooks and improvement of fitness facilities) as well as health education interventions (smoking cessation courses, individual exercise guidance and extra health check-ups) at the maritime workplace. Baseline and follow-up data were collected with a self-administrated standardized questionnaire and individual health profiling assessing parameters such as physical health and physical fitness. In addition, qualitative interviews with participants and non-participants were conducted in order to gain in-depth information on experiences with the intervention processes. Results Significant changes were identified for levels of fitness, daily sugar intake and metabolic syndrome. However, these results were not associated with participating in the health educational interventions. One possible explanation for the improved fitness rate could be the upgrading of fitness equipment onboard the ships provided by the management level. The decrease in daily sugar intake and prevalence of seafarers with metabolic

  12. Differences in HIV risk behavior of injection drug users in New York City by health care setting.

    PubMed

    Turner, A K; Harripersaud, K; Crawford, N D; Rivera, A V; Fuller, C M

    2013-01-01

    The purpose of this study is to examine the HIV risk behaviors and demographic characteristics of injection drug users (IDUs) by type of health care setting, which can inform development of tailored structural interventions to increase access to HIV prevention and medical treatment services. IDU syringe customers were recruited from pharmacies as part of the "Pharmacist As Resources Making Links to Community Services" (PHARM-Link) study, a randomized community-based intervention in New York City (NYC) aimed at connecting IDUs to HIV prevention, medical, and social services. An ACASI survey ascertained demographics, risk behavior, health-care utilization, and location where health care services were received in the past year. Data were analyzed using logistic regression. Of 602 participants, 34% reported receiving health care at a community clinic, 46% a private medical office, 15% a mobile medical unit, and 59% an emergency room (ER). After adjustment, participants who attended a community clinic were significantly more likely to have health insurance, report syringe sharing, and be HIV positive. Whites, nondaily injectors, insured, and higher income IDUs were more likely to attend a private medical office. Participants who recently used a case manager and had multiple sexual partners were more likely to use a mobile medical unit. ER attendees were more likely to be homeless and report recent drug treatment use. These findings show that IDU demographics and risk behaviors differ by health care setting, suggesting that risk reduction interventions should be tailored to health care settings. Specifically, these data suggest that community clinics and mobile medical units serve high-risk IDUs, highlighting the need for more research to develop and test innovative prevention and care programs within these settings. PMID:23451991

  13. Recovery-oriented care in older-adult acute inpatient mental health settings in Australia: an exploratory study.

    PubMed

    McKenna, Brian; Furness, Trentham; Dhital, Deepa; Ireland, Susan

    2014-10-01

    Recovery-oriented care acknowledges the unique journey that consumers lead with the aim of regaining control of their lives in order to live a good life. Recovery has become a dominant policy-directed model of many mental health care organizations, but in older-adult acute mental health inpatient settings, nurses do not have a clear description of how to be recovery-oriented. The aims of this study were to determine the extent to which elements of existing nursing practice resemble the domains of recovery-oriented care and provide a baseline understanding of practice in preparation for transformation to recovery-oriented mental health care provision. An exploratory, qualitative research design was used to meet the research aims. A purposive sample of mental health nurses (N = 12) participated in focus groups in three older-adult inpatient settings in Australia. A general inductive approach was used to analyze the qualitative data. The mental health nurses in this study readily discussed aspects of their current practice within the recovery domains. They described pragmatic ways to promote a culture of hope, collaborative partnerships, meaningful engagement, autonomy and self-determination, and community participation and citizenship. Nurses also discussed challenges and barriers to recovery-oriented care in older-adult acute mental health settings. This study identified a reasonable baseline understanding of practice in preparation for transformation to recovery-oriented older-adult mental healthcare provision. A concerted drive focused on recovery education is required to effectively embed a recovery-orientated paradigm into older-adult mental health settings. PMID:25263738

  14. Risk communication as a core public health competence in infectious disease management: Development of the ECDC training curriculum and programme.

    PubMed

    Dickmann, Petra; Abraham, Thomas; Sarkar, Satyajit; Wysocki, Piotr; Cecconi, Sabrina; Apfel, Franklin; Nurm, Ülla-Karin

    2016-01-01

    Risk communication has been identified as a core competence for guiding public health responses to infectious disease threats. The International Health Regulations (2005) call for all countries to build capacity and a comprehensive understanding of health risks before a public health emergency to allow systematic and coherent communication, response and management. Research studies indicate that while outbreak and crisis communication concepts and tools have long been on the agenda of public health officials, there is still a need to clarify and integrate risk communication concepts into more standardised practices and improve risk communication and health, particularly among disadvantaged populations. To address these challenges, the European Centre for Disease Prevention and Control (ECDC) convened a group of risk communication experts to review and integrate existing approaches and emerging concepts in the development of a training curriculum. This curriculum articulates a new approach in risk communication moving beyond information conveyance to knowledge- and relationship-building. In a pilot training this approach was reflected both in the topics addressed and in the methods applied. This article introduces the new conceptual approach to risk communication capacity building that emerged from this process, presents the pilot training approach developed, and shares the results of the course evaluation. PMID:27103616

  15. Health-risk based approach to setting drinking water standards for long-term space missions

    NASA Technical Reports Server (NTRS)

    Macler, Bruce A.; Dunsky, Elizabeth C.

    1992-01-01

    In order to develop plausible and appropriate drinking water contaminant standards for longer-term NASA space missions, such as those planned for the Space Exploration Initiative, a human health risk characterization was performed using toxicological and exposure values typical of space operations and crew. This risk characterization showed that the greatest acute waterborne health concern was from microbial infection leading to incapacitating gastrointestinal illness. Ingestion exposure pathways for toxic materials yielded de minimus acute health risks unlikely to affect SEI space missions. Risks of chronic health problems were within acceptable public health limits. Our analysis indicates that current Space Station Freedom maximum contamination levels may be unnecessarily strict. We propose alternative environmental contaminant values consistent with both acceptable short and long-term crew health safety.

  16. Training for an effective health and safety committee in a small business setting.

    PubMed

    Crollard, Allison; Neitzel, Richard L; Dominguez, Carlos F; Seixas, Noah S

    2013-01-01

    Health and safety committees are often heralded as a key element of successful health and safety programs, and are thought to represent a means of engaging workers in health and safety efforts. While the understanding of the factors that make these committees effective is growing, there are few resources for how to assist committees in developing these characteristics. This paper describes one approach to creating and implementing a training intervention aimed at improving health and safety committee function at one multilingual worksite. Short-term impacts were evaluated via questionnaire and qualitative observations of committee function. Results indicated high satisfaction with the training as well as modest increases in participation, cooperation, role clarity, and comfort with health and safety skills among committee members. The committee also made considerable achievements in establishing new processes for effective function. Similar interventions may be useful in other workplaces to increase health and safety committee success. PMID:24401485

  17. Some lessons in tackling social determinants of health in resource-poor settings: health promotion with young people in Vanuatu.

    PubMed

    Harris, Patrick; Ritchie, Jan; Tabi, Graham; Abel, Myriam; Lower, Tony

    2007-09-01

    Community based health promotion initiatives are recognised as important strategies to address the growing burden of non-communicable diseases in developing countries. However, limited knowledge exists on how such initiatives work in practice. One innovative health promotion program of work, the Pacific Action for Health Project, is working with young people and communities in the Pacific country of Vanuatu to offset the future effects of risk factors for these diseases, through optimising broad lifestyle and living conditions for the positive promotion of health. Recognising the established link between non-communicable diseases and their social determinants, the Pacific Action for Health Project works with young people to address these determinants at the community level including, but not limited to, unemployment. This paper appraises the program based on a constructivist approach to data gathering and analysis, with observations made in the field subsequently interpreted through the health promotion literature on community empowerment. From the data collected, six themes emerged as key attributes through which the program achieved its planned outcomes. Subsequent analysis through the community empowerment literature, specifically 'dynamic continuum' models of community development, provided deeper analysis of the program's strategies and offered insight into how the literature on community empowerment may work in practice in a resource poor context. In addition to the development of locally specific empowerment measures as indicators for future program evaluation, further ethnographic work and participatory-action research approaches are encouraged to assist the future development of the program. PMID:19588611

  18. Evaluation of behavior change goal-setting action plan on oral health activity and status.

    PubMed

    Lepore, Lindsay M; Yoon, Richard K; Chinn, Courtney H; Chussid, Steven

    2011-11-01

    This experimental study determined if a "report card-like" oral health action plan was effective in improving oral health behaviors in a sample of 69 patients, ages 1 to 6 years. Participants were divided randomly into control and intervention groups. Data collected included dmft, plaque score, Streptococcus mutans levels and oral health behaviors. Participants in the intervention group received an oral health action plan that included: 1. child's current caries-risk status; 2. identification issues of concern; and 3. one "goal" to improve on for the next visit. All participants returned after two months for follow-up examination and data collection. PMID:22338818

  19. Managing Hard-Core Smokers: Oral Health Team Challenges and Opportunities.

    ERIC Educational Resources Information Center

    Mecklenburg, Robert Ellis

    1994-01-01

    Focusing dental efforts on hard-core and high-risk smokers can decrease smoking prevalence. Challenges to the dental profession include professional legitimacy, dental professional education, defining special populations, and overcoming barriers to access. Opportunities include strategic placement, strategic relations with those serving high-risk…

  20. Partnership in Education: Preparation of the Family Nurse-Practitioner for Primary Care in Rural Health Settings.

    ERIC Educational Resources Information Center

    Fullerton, Judith T.

    A model program to educate primary care nurse-practitioners for rural areas illustrates successful collaboration between university and rural health settings. Part of the Intercampus Graduate Studies program of the University of California--San Francisco School of Nursing and the University of California--San Diego School of Medicine, the model…

  1. County-Level Poverty Is Equally Associated with Unmet Health Care Needs in Rural and Urban Settings

    ERIC Educational Resources Information Center

    Peterson, Lars E.; Litaker, David G.

    2010-01-01

    Context: Regional poverty is associated with reduced access to health care. Whether this relationship is equally strong in both rural and urban settings or is affected by the contextual and individual-level characteristics that distinguish these areas, is unclear. Purpose: Compare the association between regional poverty with self-reported unmet…

  2. Current Practices for Training Staff to Accommodate Youth with Special Health Care Needs in the 4-H Camp Setting

    ERIC Educational Resources Information Center

    Mouton, Lauren; Bruce, Jacklyn

    2013-01-01

    The theory of inclusion is the foundation for the study reported here; inclusion is a focus not only of formal education, but also of nonformal educational settings such as 4-H. Ideally, 4-H camps are designed to serve youth of all backgrounds and abilities. By accommodating youth with special health care needs, 4-H camps are effectively meeting…

  3. Training Health Service Technicians as Teacher Assistants in an Inpatient Residential Emotional/Behavior Disorder Classroom Setting

    ERIC Educational Resources Information Center

    Banks, Walter E.

    2012-01-01

    Schools have identified that the use of Teacher Assistants often provides needed additional support in the school setting. In a Health Care Facility that provides inpatient psychiatric services, children ages 5-14 are required to engage in school activities. Currently there are no Teacher Assistants trained in the facility. This study focuses on…

  4. Effective Practices in Providing Online, In-Service Training to Health Professionals in Low-Resource Settings

    ERIC Educational Resources Information Center

    Chio, Karen Sherk

    2012-01-01

    As doctors, nurses and public health professionals are promoted into management and leadership positions in resource-poor countries around the world, they are tasked with leading teams and managing drugs and financial and material resources. These responsibilities require a set of skills and knowledge different from that needed for their clinical…

  5. Implementation of Adolescent Family-Based Substance Use Prevention Programmes in Health Care Settings: Comparisons across Conditions and Programmes

    ERIC Educational Resources Information Center

    Aalborg, Annette E.; Miller, Brenda A.; Husson, Gail; Byrnes, Hilary F.; Bauman, Karl E.; Spoth, Richard L.

    2012-01-01

    Objective: To examine factors that influence the effectiveness and quality of implementation of evidence-based family-focused adolescent substance use prevention programmes delivered in health care settings and to assess the effects of programme choice versus programme assignment on programme delivery. Design: Strengthening Families Program: For…

  6. Walking the Labyrinth: Considering Mental Health Consumer Experience, Meaning Making, and the Illumination of the Sacred in a Forensic Mental Health Setting.

    PubMed

    Heard, Clark Patrick; Scott, Jared; Yeo, Stephen

    2015-12-01

    The purpose of this study is to explore the unique meaning and experience associated with walking a unicursal seven circuit outdoor Chartress Labyrinth and 11 circuit indoor Chartress Labyrinth for persons residing at a forensic mental health care facility. Over the past several decades labyrinths have enjoyed something of a renaissance and are often utilized by spiritual care practitioners and health care clinicians in order to support reflection, stress reduction, and the exploration of personal wellness in a sacred setting. Labyrinths are used in many settings including places of worship, hospitals, long-term care facilities, and parks. While labyrinths are becoming more prevalent, an understanding of their impact, particularly in the mental health context, is limited. This qualitative study supports a novel investigation of the meaning associated with participation in walking a labyrinth for persons residing at a forensic mental health care facility. The study design is a qualitative methodology involving transcribed interviews with 12 individuals resident at the Southwest Centre for Forensic Mental Health Care who participated in the 'Walking the Labyrinth' program as facilitated by spiritual care staff. A standardized interview protocol was utilized and the collected data was coded for themes. Several methods were employed to establish trustworthiness including triangulation by analyst and by theory/perspective. Member checking was also utilized in order to further validate the themes. Recommendations related to potential health care applications for labyrinths are identified. These include a focus upon the linkage between mental health care planning and labyrinth participation. PMID:26631524

  7. Comparison of primary health care services between urban and rural settings after the introduction of the first urban health centre in Vyronas, Greece

    PubMed Central

    Mariolis, Anargiros; Mihas, Constantinos; Alevizos, Alevizos; Mariolis-Sapsakos, Theodoros; Marayiannis, Konstantinos; Papathanasiou, Marek; Gizlis, Vassilios; Karanasios, Dimitris; Merkouris, Bodossakis

    2008-01-01

    Background Discrepancies in primary health care (PHC) services between urban and rural settings have already been studied in many countries; however, limited information exists regarding countries, such as Greece, where public Health Centres dedicated to primary care have not been in existence in major cities. The objective of this study was to evaluate points of divergence or convergence between an urban and a rural health centre, in an attempt to underline challenges faced by the introduction of urban health centres in Greece. Methods A cross-sectional analysis was conducted in the Health Centre of Vyronas, Athens, Greece and in the Health Centre of Nea (New) Madytos, Thessaloniki Prefecture, Greece between February 2004 and February 2006. The profile of the population seeking care, as well as data on the services provided were collected and compared. In addition, the reason for choosing each primary health care unit was also recorded. Results More patients visited the urban centre (145415 vs. 112513), while the pattern of services utilized by the citizens differed significantly (p < 0.001) between the two Health Centres. The frequency of diagnoses made according to ICPC-2 was not similar in the two Health Centres (p < 0.001). The three most frequent reasons for the adults choosing the Health Centre for their problem were low waiting time, proximity to residence and satisfaction with the services provided in previous visits in Vyronas. Conclusion The results of this study highlight the significant differences regarding PHC services utilization between an urban and a rural population. Urban citizens seem to have different health needs and reasons for choosing a PHC unit than residents of the Greek countryside. Proximity to health services and the public character of the urban health centre seem to be its main advantages. PMID:18541013

  8. Declining mortality among HIV-positive indigenous people at a Vancouver indigenous-focused urban-core health care centre

    PubMed Central

    Klakowicz, Piotr; Zhang, Wen; Colley, Guillaume; Moore, David; Tu, David

    2016-01-01

    Abstract Objective To examine mortality rates among HIV-positive indigenous people and others after initiation of HIV care improvements based on the chronic care model to address high HIV-related mortality. Design Retrospective cohort preintervention-to-postintervention evaluation study. Setting Urban-core primary health care centre focused on indigenous people in Vancouver, BC. Participants Individuals infected with HIV. Intervention Adoption of the chronic care model to improve HIV care over time. Main outcome measures All-cause mortality and HIV-related mortality rates, overall and from preintervention (2007 to 2009) to postintervention (2010 to 2012), by indigenous ethnicity, were calculated from clinical data linked with the provincial HIV treatment clinical registry. Results Of the 546 eligible study patients, 323 (59%) self-identified as indigenous. Indigenous persons had higher all-cause mortality compared with other patients (14% vs 8%, P = .035; 6.25 vs 4.02 per 100 person-years [PYRs], P = .113), with an adjusted hazard ratio of 1.77 (95% CI 0.95 to 3.30). Indigenous persons also had higher HIV-related mortality (6% vs 2%, P = .027; 2.50 vs 0.89 per 100 PYRs, P = .063), with an adjusted hazard ratio of 2.88 (95% CI 0.93 to 8.92). Between 2007 to 2009 and 2010 to 2012, a significant decline was observed in all-cause mortality for indigenous patients (10.00 to 5.00 per 100 PYRs, P = .023) and a non-significant decline was observed in other patients (7.21 to 2.97 per 100 PYRs, P = .061). A significant decline in HIV-related mortality was also seen for indigenous patients (5.56 to 1.80 per 100 PYRs, P = .005). Conclusion Despite the overall higher risk of death among indigenous patients compared with others, the decline in mortality in HIV-positive indigenous patients after the initiation of efforts to improve HIV care at the clinic further support HIV primary care informed by indigenous issues and the adoption of the chronic care model.

  9. Setting health research priorities using the CHNRI method: V. Quantitative properties of human collective knowledge

    PubMed Central

    Rudan, Igor; Yoshida, Sachiyo; Wazny, Kerri; Chan, Kit Yee; Cousens, Simon

    2016-01-01

    Introduction The CHNRI method for setting health research priorities has crowdsourcing as the major component. It uses the collective opinion of a group of experts to generate, assess and prioritize between many competing health research ideas. It is difficult to compare the accuracy of human individual and collective opinions in predicting uncertain future outcomes before the outcomes are known. However, this limitation does not apply to existing knowledge, which is an important component underlying opinion. In this paper, we report several experiments to explore the quantitative properties of human collective knowledge and discuss their relevance to the CHNRI method. Methods We conducted a series of experiments in groups of about 160 (range: 122–175) undergraduate Year 2 medical students to compare their collective knowledge to their individual knowledge. We asked them to answer 10 questions on each of the following: (i) an area in which they have a degree of expertise (undergraduate Year 1 medical curriculum); (ii) an area in which they likely have some knowledge (general knowledge); and (iii) an area in which they are not expected to have any knowledge (astronomy). We also presented them with 20 pairs of well–known celebrities and asked them to identify the older person of the pair. In all these experiments our goal was to examine how the collective answer compares to the distribution of students’ individual answers. Results When answering the questions in their own area of expertise, the collective answer (the median) was in the top 20.83% of the most accurate individual responses; in general knowledge, it was in the top 11.93%; and in an area with no expertise, the group answer was in the top 7.02%. However, the collective answer based on mean values fared much worse, ranging from top 75.60% to top 95.91%. Also, when confronted with guessing the older of the two celebrities, the collective response was correct in 18/20 cases (90%), while the 8 most

  10. Closing the mental health gap in low-income settings by building research capacity: Perspectives from Mozambique

    PubMed Central

    Sweetland, Annika C.; Oquendo, Maria A.; Sidat, Mohsin; Santos, Palmira F.; Vermund, Sten H.; Duarte, Cristiane S.; Arbuckle, Melissa; Wainberg, Milton L.

    2014-01-01

    Neuropsychiatric disorders are the leading cause of disability worldwide, accounting for 22.7% of all years lived with disability (YLDs). Despite this global burden, fewer than 25% of affected individuals ever access mental health treatment; in low-income settings, access is much lower, though non-allopathic interventions through traditional healers are common in many venues. Three main barriers to reducing the gap between individuals who need and those who have access to mental health treatment include stigma and lack of awareness, limited material and human resources, and insufficient research capacity. We argue that investment in dissemination and implementation research is critical to face these barriers. Dissemination and implementation research can improve mental health care in low-income settings by facilitating the adaptation of effective treatment interventions to new settings, particularly when adapting specialist-led interventions developed in high-resource countries to settings with few, if any, mental health professionals. In Mozambique, the World Health Organization estimates only 0.04 psychiatrists per 100,000 population, representing 30 times less than the global median, and more than 150 times lower than the median in high income countries. Emerging evidence from other low-income settings suggests that lay providers can be trained to detect mental disorders and deliver basic psychotherapeutic and psychopharmacological interventions when supervised by an expert. Mozambique has both the political commitment and available resources for mental health, but inadequate research capacity and workforce limits the country’s ability to assess local needs, adapt and test interventions, and identify implementation strategies that can be used to effectively bring evidence-based mental health interventions to scale within the public sector. Global training and research partnerships are critical to building capacity, promoting bilateral learning between and

  11. Mental Health Service Use for Patients with Co-occurring Mental and Physical Chronic Health Care Needs in Primary Care Settings

    PubMed Central

    Haynes-Maslow, Lindsey; Roberts, Megan C.; Dusetzina, Stacie B.

    2016-01-01

    Background Individuals with mental illness experience poor health and may die prematurely from chronic illness. Understanding whether the presence of co-occurring chronic physical health conditions complicates mental health treatment is important, particularly among patients seeking treatment in primary care settings. Objectives Examine (1) whether the presence of chronic physical conditions is associated with mental health service use for individuals with depression who visit a primary care physician, and (2) whether race modifies this relationship. Research Design Secondary analysis of the National Ambulatory Medical Care Survey, a survey of patient-visits collected annually from a random sample of 3,000 physicians in office-based settings. Subjects Office visits from 2007–2010 were pooled for adults ages 35–85 with a depression diagnosis at the time of visit (N=3,659 visits). Measures Mental health services were measured using a dichotomous variable indicating whether mental health services were provided during the office visit or a referral made for: (1) counseling, including psychotherapy and other mental health counseling and/or (2) prescribing of psychotropic medications. Results Most patient office visits (70%) where a depression diagnosis was recorded also had co-occurring chronic physical conditions recorded. The presence of at least one physical chronic condition was associated with a 6% decrease in the probability of receiving any mental health services (p<0.05). There were no differences in service use by race/ethnicity after controlling for other factors. Conclusions Additional research is needed on medical care delivery among patients with co-occurring health conditions, particularly as the health care system moves towards an integrated care model. PMID:26147863

  12. Sexual Orientation and Gender Identity Data Collection in Clinical Settings and in Electronic Health Records: A Key to Ending LGBT Health Disparities.

    PubMed

    Cahill, Sean; Makadon, Harvey

    2014-03-01

    The Institute of Medicine's (IOM's) 2011 report on the health of LGBT people pointed out that there are limited health data on these populations and that we need more research. It also described what we do know about LGBT health disparities, including lower rates of cervical cancer screening among lesbians, and mental health issues related to minority stress. Patient disclosure of LGBT identity enables provider-patient conversations about risk factors and can help us reduce and better understand disparities. It is essential to the success of Healthy People 2020's goal of eliminating LGBT health disparities. This is why the IOM's report recommended data collection in clinical settings and on electronic health records (EHRs). The Center for Medicare and Medicaid Services and the Office of the National Coordinator of Health Information Technology rejected including sexual orientation and gender identity (SOGI) questions in meaningful use guidelines for EHRs in 2012 but are considering this issue again in 2013. There is overwhelming community support for the routine collection of SOGI data in clinical settings, as evidenced by comments jointly submitted by 145 leading LGBT and HIV/AIDS organizations in January 2013. Gathering SOGI data in EHRs is supported by the 2011 IOM's report on LGBT health, Healthy People 2020, the Affordable Care Act, and the Joint Commission. Data collection has long been central to the quality assurance process. Preventive health care from providers knowledgeable of their patients' SOGI can lead to improved access, quality of care, and outcomes. Medical and nursing schools should expand their attention to LGBT health issues so that all clinicians can appropriately care for LGBT patients. PMID:26789508

  13. Integrating public health education in a public health practice setting: the experience of the School of Public Health, University at Albany and the New York State Department of Health.

    PubMed

    Birkhead, Guthrie S; Eidson, Millicent; Dewar, Diane; Nasca, Philip; Morse, Dale L; Shah, Nirav R

    2014-01-01

    The New York State Department of Health (DOH) has a long history of biomedical research, public health policy and program development, peer-reviewed scholarship, and teaching. Its evolution as an academic health department advanced significantly when the University at Albany and DOH formed the School of Public Health Sciences in 1985 to further develop these functions while formally training the next generation of public health workers. The School, renamed in 1990 as the School of Public Health (SPH), was initially located within the DOH with its staff as the founding faculty. The curriculum was heavily influenced by public health practice imperatives. The SPH has evolved to have an independent campus and full-time academic faculty, but the DOH remains closely linked. The relationship is governed by a memorandum of understanding that commits both partners to provide substantial and continuing resources to the SPH. The SPH brings value to the DOH's mission to improve the health of the state's citizens by providing an academic focus to problems faced in health department practice settings. The opportunity to teach and be involved in an academic environment increases the DOH's ability to recruit, retain, and improve the skill level of its professional and scientific staff and thereby improve its ability to assess health problems and to design and evaluate public health programs. The SPH also provides training and support to county health departments and nongovernment organizations, which further the DOH's mission, through continuing education programs and an online MPH degree program. International exchanges including those with China, Vietnam, and the Republic of Georgia have enriched the academic environment. Challenges include maintaining sufficient full-time faculty members, the need for the SPH to take on broader public health issues than those applicable to New York, and the shrinkage of the DOH's workforce and departure of many senior scientists who served as

  14. Mental health services in Cambodia, challenges and opportunities in a post-conflict setting.

    PubMed

    Jegannathan, Bhoomikumar; Kullgren, Gunnar; Deva, Parameshvara

    2015-02-01

    Cambodia had suffered enormously due to war and internecine conflict during the latter half of the twentieth century, more so during the Vietnam War. Total collapse of education and health systems during the Pol Pot era continues to be a challenge for developing the necessary infrastructure and human resources to provide basic minimum mental health care which is compounded by the prevailing cultural belief and stigma over mental, neurological and substance abuse disorders (MNSDs). The mental health research and services in Cambodia had been predominantly 'trauma focused', a legacy of war, and there is a need to move toward epidemiologically sound public health oriented mental health policy and service development. Integrating mental health program with primary health care services with specifically stated minimum package of activities at primary level and complementary package of activities at secondary level is an opportunity to meet the needs and rights of persons with mental, neurological and substance abuse disorders (PWMNSDs) in Cambodia, provided there is mental health leadership, government commitment and political will. PMID:25563073

  15. Collaborative Care: Infant Mental Health Consultation in a Child Welfare Setting

    ERIC Educational Resources Information Center

    Wotherspoon, Evelyn; O'Neill-Laberge, Marlene; Rafaat, Susan; Pirie, June; Hammel, David; MacDonald, Liane

    2008-01-01

    The Collaborative Mental Health Care program offers infant mental health consultations to case managers in child protection offices throughout the city of Calgary, Alberta, Canada. Through case examples, the authors demonstrate why clinicians working with maltreated infants should expand the scope of their practice to include multidisciplinary…

  16. Disclosure of domestic violence in mental health settings: A qualitative meta-synthesis

    PubMed Central

    Trevillion, Kylee; Hughes, Bryony; Feder, Gene; Borschmann, Rohan; Oram, Siân

    2014-01-01

    Little is known about how psychiatric services respond to service users’ experiences of domestic violence. This qualitative meta-synthesis examined the healthcare experiences and expectations of mental health service users experiencing domestic violence. Twenty-two biomedical, social science, grey literature databases and websites were searched, supplemented by citation tracking and expert recommendations. Qualitative studies which included mental health service users (aged ≥ 16 years) with experiences of domestic violence were eligible for inclusion. Two reviewers independently extracted data from included papers and assessed quality. Findings from primary studies were combined using meta-synthesis techniques. Twelve studies provided data on 140 female and four male mental health service users. Themes were generally consistent across studies. Overarching theoretical constructs included the role of professionals in identifying domestic violence and facilitating disclosures, implementing personalized care and referring appropriately. Mental health services often failed to identify and facilitate disclosures of domestic violence, and to develop responses that prioritized service users’ safety. Mental health services were reported to give little consideration to the role of domestic violence in precipitating or exacerbating mental illness and the dominance of the biomedical model and stigma of mental illness were found to inhibit effective responses. Mental health services often fail to adequately address the violence experienced by mental health service users. This meta-synthesis highlights the need for mental health services to establish appropriate strategies and responses to domestic violence to ensure optimal care of this vulnerable population. PMID:25137109

  17. Spiritual Needs in Health Care Settings: A Qualitative Meta-Synthesis of Clients' Perspectives

    ERIC Educational Resources Information Center

    Hodge, David R.; Horvath, Violet E.

    2011-01-01

    Spiritual needs often emerge in the context of receiving health or behavioral health services. Yet, despite the prevalence and salience of spiritual needs in service provision, clients often report their spiritual needs are inadequately addressed. In light of research suggesting that most social workers have received minimal training in…

  18. Is Higher Education Following the Path Set by Health Care in the U.S.?

    ERIC Educational Resources Information Center

    Castiglia, Beth

    2012-01-01

    The recent emergence of higher education into political and economic debate is reminiscent of the ongoing arguments about the appropriate provision of health care in the United States. Health care reform has been a political battle cry in the United States for years, and there are similar calls for reforms of higher education. These two industries…

  19. Differences in HIV risk behavior of injection drug users in New York City by health care setting

    PubMed Central

    Turner, AT; Harripersaud, K; Crawford, ND; Rivera, AV; Fuller, CM

    2013-01-01

    The purpose of this study is to examine the HIV risk behaviors and demographic characteristics of injection drug users (IDUs) by type of health care setting, which can inform development of tailored structural interventions to increase access to HIV prevention and medical treatment services. IDU syringe customers were recruited from pharmacies as part of the “Pharmacist As Resources Making Links to Community Services” (PHARM-Link) study, a randomized community-based intervention in New York City (NYC) aimed at connecting IDUs to HIV prevention, medical, and social services. An ACASI survey ascertained demographics, risk behavior, healthcare utilization, and location where health care services were received in the past year. Data were analyzed using logistic regression. Of 602 participants, 34% reported receiving health care at a community clinic, 46% a private medical office, 15% a mobile medical unit, and 59% an emergency room (ER). After adjustment, participants who attended a community clinic were significantly more likely to have health insurance, report syringe sharing, and be HIV positive. Whites, non-daily injectors, insured and higher income IDUs were more likely to attend a private medical office. Participants who recently used a case manager and had multiple sexual partners were more likely to use a mobile medical unit. ER attendees were more likely to be homeless and report recent drug treatment use. These findings show that IDU demographics and risk behaviors differ by health care setting suggesting that risk reduction interventions should be tailored to health care settings. Specifically, these data suggest that community clinics and mobile medical units serve high risk IDUs, highlighting the need for more research to develop and test innovative prevention and care programs within these settings. PMID:23451991

  20. Promoting health and advancing development through improved housing in low-income settings.

    PubMed

    Haines, Andy; Bruce, Nigel; Cairncross, Sandy; Davies, Michael; Greenland, Katie; Hiscox, Alexandra; Lindsay, Steve; Lindsay, Tom; Satterthwaite, David; Wilkinson, Paul

    2013-10-01

    There is major untapped potential to improve health in low-income communities through improved housing design, fittings, materials and construction. Adverse effects on health from inadequate housing can occur through a range of mechanisms, both direct and indirect, including as a result of extreme weather, household air pollution, injuries or burns, the ingress of disease vectors and lack of clean water and sanitation. Collaborative action between public health professionals and those involved in developing formal and informal housing could advance both health and development by addressing risk factors for a range of adverse health outcomes. Potential trade-offs between design features which may reduce the risk of some adverse outcomes whilst increasing the risk of others must be explicitly considered. PMID:23271143

  1. Setting health care capitations through diagnosis-based risk adjustment: a suitable model for the English NHS?

    PubMed

    Asthana, Sheena; Gibson, Alex

    2011-07-01

    The English system of health resource allocation has been described as the apotheosis of the area-level approach to setting health care capitations. However, recent policy developments have changed the scale at which commissioning decisions are made (and budgets allocated) with important implications for resource allocation. Doubts concerning the legitimacy of applying area-based formulae used to distribute resources between Primary Care Trusts (PCTs) to the much smaller scale required by Practice Based Commissioning (PBC) led the English Department of Health (DH) to introduce a new approach to setting health care budgets. To this end, practice-level allocations for acute services are now calculated using a diagnosis-based capitation model of the kind used in the United States and several other systems of competitive social health insurance. The new Coalition Government has proposed that these budgets are directly allocated to GP 'consortia', the new commissioning bodies in the NHS. This paper questions whether this is an appropriate development for a health system in which the major objective of resource allocation is to promote equal opportunity of access for equal needs. The chief reservation raised is that of circularity and the perpetuation of resource bias, the concern being that an existing social, demographic and geographical bias in the use of health care resources will be reinforced through the use of historic utilisation data. Demonstrating that there are legitimate reasons to suspect that this will be the case, the paper poses the question whether health systems internationally should more openly address the key limitations of empirical methods that select risk adjusters on the basis of existing patterns of health service utilisation. PMID:21093953

  2. A systematic review of the health, social and financial impacts of welfare rights advice delivered in healthcare settings

    PubMed Central

    Adams, Jean; White, Martin; Moffatt, Suzanne; Howel, Denise; Mackintosh, Joan

    2006-01-01

    Background Socio-economic variations in health, including variations in health according to wealth and income, have been widely reported. A potential method of improving the health of the most deprived groups is to increase their income. State funded welfare programmes of financial benefits and benefits in kind are common in developed countries. However, there is evidence of widespread under claiming of welfare benefits by those eligible for them. One method of exploring the health effects of income supplementation is, therefore, to measure the health effects of welfare benefit maximisation programmes. We conducted a systematic review of the health, social and financial impacts of welfare rights advice delivered in healthcare settings. Methods Published and unpublished literature was accessed through searches of electronic databases, websites and an internet search engine; hand searches of journals; suggestions from experts; and reference lists of relevant publications. Data on the intervention delivered, evaluation performed, and outcome data on health, social and economic measures were abstracted and assessed by pairs of independent reviewers. Results are reported in narrative form. Results 55 studies were included in the review. Only seven studies included a comparison or control group. There was evidence that welfare rights advice delivered in healthcare settings results in financial benefits. There was little evidence that the advice resulted in measurable health or social benefits. This is primarily due to lack of good quality evidence, rather than evidence of an absence of effect. Conclusion There are good theoretical reasons why income supplementation should improve health, but currently little evidence of adequate robustness and quality to indicate that the impact goes beyond increasing income. PMID:16571122

  3. Improving the Understanding of Progressing and Emerging Health Informatics Roles and Skill Sets among Health Information Management Professionals: An Action Research Study

    ERIC Educational Resources Information Center

    Palkie, Brooke N.

    2013-01-01

    The Health Information Management (HIM) profession is evolving to meet the technology demands of the current healthcare landscape. The 2009 enactment of the HITECH Act has placed unprecedented emphasis on utilizing technology to improve the quality of care and to decrease healthcare costs. Expectations of deep analytical skills have set the stage…

  4. Falls screening and assessment tools used in acute mental health settings: a review of policies in England and Wales

    PubMed Central

    Narayanan, V.; Dickinson, A.; Victor, C.; Griffiths, C.; Humphrey, D.

    2016-01-01

    Objectives There is an urgent need to improve the care of older people at risk of falls or who experience falls in mental health settings. The aims of this study were to evaluate the individual falls risk assessment tools adopted by National Health Service (NHS) mental health trusts in England and healthcare boards in Wales, to evaluate the comprehensiveness of these tools and to review their predictive validity. Methods All NHS mental health trusts in England (n = 56) and healthcare boards in Wales (n = 6) were invited to supply their falls policies and other relevant documentation (e.g. local falls audits). In order to check the comprehensiveness of tools listed in policy documents, the risk variables of the tools adopted by the mental health trusts’ policies were compared with the 2004 National Institute for Health and Care Excellence (NICE) falls prevention guidelines. A comprehensive analytical literature review was undertaken to evaluate the predictive validity of the tools used in these settings. Results Falls policies were obtained from 46 mental health trusts. Thirty-five policies met the study inclusion criteria and were included in the analysis. The main falls assessment tools used were the St. Thomas’ Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY), Falls Risk Assessment Scale for the Elderly, Morse Falls Scale (MFS) and Falls Risk Assessment Tool (FRAT). On detailed examination, a number of different versions of the FRAT were evident; validated tools had inconsistent predictive validity and none of them had been validated in mental health settings. Conclusions Falls risk assessment is the most commonly used component of risk prevention strategies, but most policies included unvalidated tools and even well validated tool such as the STRATIFY and the MFS that are reported to have inconsistent predictive accuracy. This raises questions about operational usefulness, as none of these tools have been tested in acute mental health

  5. Identifying Opportunities to Increase HIV Testing among Mexican Migrants: A Call to Step Up Efforts in Health Care and Detention Settings

    PubMed Central

    Martínez-Donate, Ana P.; Rangel, Maria Gudelia; Rhoads, Natalie; Zhang, Xiao; Hovell, Melbourne; Magis-Rodriguez, Carlos; González-Fagoaga, Eduardo

    2015-01-01

    HIV testing and counseling is a critical component of HIV prevention efforts and core element of current “treatment as prevention” strategies. Mobility, low education and income, and limited access to health care put Latino migrants at higher risk for HIV and represent barriers for adequate levels of HIV testing in this population. We examined correlates of, and missed opportunities to increase, HIV testing for circular Mexican migrants in the U.S. We used data from a probability-based survey of returning Mexican migrants (N=1161) conducted in the border city of Tijuana, Mexico. We estimated last 12-months rates of HIV testing and the percentage of migrants who received other health care services or were detained in an immigration center, jail, or prison for 30 or more days in the U.S., but were not tested for HIV. Twenty-two percent of migrants received HIV testing in the last 12 months. In general, utilization of other health care services or detention for 30 or more days in the U.S. was a significant predictor of last 12-months HIV testing. Despite this association, we found evidence of missed opportunities to promote testing in healthcare and/or correctional or immigration detention centers. About 27.6% of migrants received other health care and/or were detained at least 30 days but not tested for HIV. Health care systems, jails and detention centers play an important role in increasing access to HIV testing among circular migrants, but there is room for improvement. Policies to offer opt-out, confidential HIV testing and counseling to Mexican migrants in these settings on a routine and ethical manner need to be designed and pilot tested. These policies could increase knowledge of HIV status, facilitate engagement in HIV treatment among a highly mobile population, and contribute to decrease incidence of HIV in the host and receiving communities. PMID:25860261

  6. Identifying opportunities to increase HIV testing among mexican migrants: a call to step up efforts in health care and detention settings.

    PubMed

    Martínez-Donate, Ana P; Rangel, Maria Gudelia; Rhoads, Natalie; Zhang, Xiao; Hovell, Melbourne; Magis-Rodriguez, Carlos; González-Fagoaga, Eduardo

    2015-01-01

    HIV testing and counseling is a critical component of HIV prevention efforts and core element of current "treatment as prevention" strategies. Mobility, low education and income, and limited access to health care put Latino migrants at higher risk for HIV and represent barriers for adequate levels of HIV testing in this population. We examined correlates of, and missed opportunities to increase, HIV testing for circular Mexican migrants in the U.S. We used data from a probability-based survey of returning Mexican migrants (N=1161) conducted in the border city of Tijuana, Mexico. We estimated last 12-months rates of HIV testing and the percentage of migrants who received other health care services or were detained in an immigration center, jail, or prison for 30 or more days in the U.S., but were not tested for HIV. Twenty-two percent of migrants received HIV testing in the last 12 months. In general, utilization of other health care services or detention for 30 or more days in the U.S. was a significant predictor of last 12-months HIV testing. Despite this association, we found evidence of missed opportunities to promote testing in healthcare and/or correctional or immigration detention centers. About 27.6% of migrants received other health care and/or were detained at least 30 days but not tested for HIV. Health care systems, jails and detention centers play an important role in increasing access to HIV testing among circular migrants, but there is room for improvement. Policies to offer opt-out, confidential HIV testing and counseling to Mexican migrants in these settings on a routine and ethical manner need to be designed and pilot tested. These policies could increase knowledge of HIV status, facilitate engagement in HIV treatment among a highly mobile population, and contribute to decrease incidence of HIV in the host and receiving communities. PMID:25860261

  7. Trauma in conflict and postconflict settings: contributions to health systems strengthening.

    PubMed

    Lunze, F I; Offergeld, C; Eichhorn, T; Tsorieva, Z; Esenov, C; Lunze, K

    2013-06-01

    Violent trauma does not only affect conflict and post conflict regions, but increasingly industrialized nations afflicted by violence from terror attacks. We conducted a comparative health systems analysis, assuming that that health systems with various backgrounds might learn from each other's health systems challenges caused by violent trauma. During the tragedy of Beslan in the Russian North Caucasus in September of 2004, more than 1000 children with their families were taken hostage in a school. Over three days, 334 people were killed and many more injured. While immediate trauma care was offered to all victims, many suffered from more complex injuries or from blast injuries to the ear caused by indoor bomb explosions, which were left untreated due to the lack of regional capacity for the required specialized microsurgery. Most if not all victims suffered from mental trauma as a consequence of violence, which also impacted surgical care-seeking. In April of 2013, two improvised explosive devices detonated at the Boston Marathon, killed three victims and injured 264, more than 20 of them critically. As a consequence of previous terror acts with mass casualties, local hospitals were prepared with drilling and coordination among health facilities, responders and government agencies. Some injury patterns similar to those in the North Caucasus emerged in the aftermath of the event and need to be addressed by the health system. Trauma from violent conflict and terrorism creates similar challenges to health systems. Preparedness for mass casualties requires revision and coordination of available services, and may prompt the strengthening of existing health systems. Health professionals should encourage victims' representatives and citizen groups to assist with assessing the prevalence and burden of injuries, including mental trauma, and to facilitate connecting affected patients to health care. Awareness for late trauma sequelae, including mental health trauma, is

  8. Assessing health impacts in complex eco-epidemiological settings in the humid tropics: Advancing tools and methods

    SciTech Connect

    Winkler, Mirko S.; Divall, Mark J.; Krieger, Gary R.; Balge, Marci Z.; Singer, Burton H.; Utzinger, Juerg

    2010-01-15

    In the developing world, large-scale projects in the extractive industry and natural resources sectors are often controversial and associated with long-term adverse health consequences to local communities. In many industrialised countries, health impact assessment (HIA) has been institutionalized for the mitigation of anticipated negative health effects while enhancing the benefits of projects, programmes and policies. However, in developing country settings, relatively few HIAs have been performed. Hence, more HIAs with a focus on low- and middle-income countries are needed to advance and refine tools and methods for impact assessment and subsequent mitigation measures. We present a promising HIA approach, developed within the frame of a large gold-mining project in the Democratic Republic of the Congo. The articulation of environmental health areas, the spatial delineation of potentially affected communities and the use of a diversity of sources to obtain quality baseline health data are utilized for risk profiling. We demonstrate how these tools and data are fed into a risk analysis matrix, which facilitates ranking of potential health impacts for subsequent prioritization of mitigation strategies. The outcomes encapsulate a multitude of environmental and health determinants in a systematic manner, and will assist decision-makers in the development of mitigation measures that minimize potential adverse health effects and enhance positive ones.

  9. Predictors and a Framework for Fostering Community Advocacy as a Community Health Worker Core Function to Eliminate Health Disparities

    PubMed Central

    Ingram, Maia; Reinschmidt, Kerstin M.; Schachter, Kenneth; Jacobs, Laurel; Guernsey de Zapien, Jill; Robinson, Laurie; Carvajal, Scott

    2013-01-01

    Objectives. Using a mixed-method, participatory research approach, we investigated factors related to community health worker (CHW) community advocacy that affect social determinants of health. Methods. We used cross-sectional survey data for 371 CHWs to assess demographics, training, work environment, and leadership qualities on civic, political, and organizational advocacy. We present advocacy stories to further articulate CHW activities. The data reported are from the recently completed National Community Health Workers Advocacy Study. Results. CHWs are involved in advocacy that is community-focused, although advocacy differs by intrinsic leadership, experience, training, and work environment. We propose a framework to conceptualize, support, and evaluate CHW advocacy and the iterative processes they engage in. These processes create opportunities for community voice and action to affect social and structural conditions that are known to have wide-ranging health effects on communities. Conclusions. The framework presented may have utility for CHWs, their training programs, and their employers as well as funders and policymakers aiming to promote health equity. PMID:23678904

  10. The Group Setting: A Viable Mental Health Alternative for the Elderly.

    ERIC Educational Resources Information Center

    Klinger-Vartabedian, Laurel C.

    Group settings offer the elderly a unique outlet for interpersonal communication and can alleviate social isolation and aloneness. Group cohesiveness and instillation of hope are two curative factors in the group setting. Persons working with the elderly must be aware of their special problems and also be sensitive to their own age bias. Group…

  11. [The right to health: a model for determining the contents of the minimum core and the periphery].

    PubMed

    Ronconi, Liliana M

    2012-01-01

    The right to health has been widely recognized in the Argentine courts, however only those who have the ability to access the justice system are able to fully enjoy that right. Therefore traditionally excluded groups, who for different reasons have not been able to make their demands heard in a judicial court, do not benefit from the recognition gained up to this point in the different judicial resolutions. Taking into account these institutionalized unequal practices, this article suggests a model for understanding the right to health